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LONDON
JOURNAL OF MEDICINE
A MONTHLY
33etort of the ſºlebital étienttä.
VOLUME II.
B E IN G F O R T H E YEA R.
1850.
LONDON :
TAYLOR, WALTON, & MABERLY.
UPPER gow FR STREET, AND Ivy LANE, PATERNOSTER Row.
lºi).INBURGH : MACLACHLAN AND CO. DUBLIN : FAN NIN AND CO.
PARIS ... WICTOR MASSON.
I.O.N DON :
Ric HARDS, PRINTE. R, 101), st. MAR PIN's LAN F.
P. R. E. F. A. C. E.
THE LONDON Journal of MEDICINE was established for the
two-fold purpose of diffusing scientific and practical knowledge
among the profession, and of promoting true “medical reform”,
by striving to inculcate, by precept and example, feelings of
brotherhood, and generous principles of action. It has not been
part of our plan to write elaborate exposures of the practices of
quacks, or of the systems of quackery which are now most in
vogue: we have believed that we were best guarding the domains
of medicine from the farther intrusions of homoeopathy, globu-
lism, hydropathy, mesmerism, and other similar scandals, by
advocating the necessity of students having their minds trained
to think and reason, before they are launched upon their career
of medical study. A good preliminary education, combined with
integrity, are the only defences which any man can have against
lapsing into quackery, or indeed into any error or immorality.
Remembering the high ends for which the work was established,
we have diligently and impartially collected information from
every source, whence it could be obtained; carefully, and we
trust successfully, striving to keep ourselves free from party
influence, or personal bias.
In several respects, this volume surpasses its predecessor;
which, from the prevailing cholera epidemic, had less variety.
Greater attention and scope have been given to the Diseases of
Young Children; and in this, as well as in other respects, the
Digest of the Journals has been improved. The Reports of
Societies have been more condensed; and, in this way, space has
* &
11 PREFACE.
been gained for Dr. Henry's valuable Classified Catalogues of
the Papers in the British and Foreign Journals.
The experience of the last two years, and ampler resources,
enable us to announce that two very important improvements
are to be introduced into the new volume. The one is an ex-
tension of the range of the Bibliographical Record, so as to in-
clude notices of all the medical books, of any note, which appear
in France, Germany, and other Foreign countries. The other
is the introduction of a new department into the Journal, to
be entitled THE HospitaLs of LoNDoN; in which we propose
to give, to the best of our ability, the movement of epidemics;
the general news and statistics of Metropolitan Hospitals, Dis-
pensaries, and Asylums, so far as they can be obtained; com-
bined with the marrow of the clinical teaching of the physicians
and surgeons of these institutions. If we are enabled to carry
out our scheme with even one half of the completeness which
we ultimately hope to attain, we shall be able to excavate and
arrange such a mass of instructive clinical experience, as has
never yet been laid before the profession.
The following is a list of the authors of the Original Articles
which have appeared during the year now closed:—
ALISON, S. SCOTT, M.D. MADDEN, WILLIAM H., M.D.
BENNET, J. HENRY, M.D. MAYNE, R. G., M.D.
BIRD, JAMES, A.M., M.D. PEACock, THOMAS B., M.D.
CADGE, WILLIAM, Esq. PoySER, THOMAS, Esq.
CoopFR, WILLIAM WHITE, Esq. QUAIN, RICHARD, M.D.
CoRMACK, John Rose, M.D., F.R.S.E. RouTH, C. H. F., M.D.
CURLING, T. B., Esq., F.R.S. SEATON, EDWARD C., M.D.
HAAs, RUDOLF, M.D. SEMPLE, ROBERT HUNTER, M.D.
HALE, R. J., M.D. SMITH, HENRY L., Esq.
HARE, CHARLES J., M.D. SMITH, THOMAS, M.D.
HEWETT, PRESCOTT G., Esq. SMITH, TYLER, M.D.
KILGOUR, JAMES, M.D. TILT, EDWARD JoHN, M.D.
KNOx, ALEXANDER, M.D. TURNBULL, JAMES, M.D.
LEE, HENRY, Esq. WEBSTER, JoHN, M.D., F.R.S.
LEVER, J. C. W., M.D. WILLIAMS, CHARLEs J. B., M.D., F.R.S.
MACINTYRE, WILLIAM, M.D. WILSON, JAMES ARTHUR, M.D.
LONDON, December 1st, 1850.
L ON DON
JOURNAL OF MEDICINE,
A MONTHLY
38ttort of the ſºletícal Sºtienttg.
JANUARY 1850.-No. XIII.
O R. I. G. I. N A Is C O M M UN I CAT I O N S.
ON THE USE AND ADMINISTRATION OF TANNIC ACID
IN VARIOUS DISEASES.
By S. SCOTT ALISON, M.D., Licentiate of the Royal College of Physicians
of London.
DURING the last six years, I have been in the constant practice of
prescribing TANNIC ACID, usually termed Tannin, in various diseases.
I was led to its employment, by a knowledge of the potency of many
substances into whose composition it largely entered. It recommended
itself likewise by its bitter and intensely styptic taste. Its remarkable
chemical effect upon gelatine, and the alleged wholesomeness of the
tan-yard, in some measure also contributed to cause me to make trial
of this agent. In all the diseases, and, with two or three exceptions,
in all examples of the diseases in which I have employed it, marked
advantage has attended or followed its use. I can conscientiously say,
that, on the whole, the results have been such, in respect to promptitude,
certainty, convenience, and safety, as I have not procured from any
other remedial agent. This testimony in its favour is given only after
due analysis, and deliberation ; and I am so convinced of its correctness,
that I have decided upon continuing to consider and to use Tannic
Acid, as one of the most efficacious and valuable articles in the stores
of the pharmaceutist. It is to record the grounds of this decision,
and to point out the conditions and circumstances under which it is
useful, as well as to indicate the most advantageous mode of employing
it, that the present communication is designed. The facts to be related,
it is thought, possess Some value, and appear to justify a more exten-
sive and general employment of this remedy, than it has yet obtained.
The remarks are arranged under the following heads:
I. HISTORY AND PROPERTIES OF TANNIC ACID.
II. Its PHYstological AND THERAPEUTICAL EFFECTs.
III. MoDE OF ADMINISTRATION.
I. HISTORY AND PROPERTIES of TANNIC ACID. Tannic Acid has
been received into the human stomach since the first days of medical
WOL. II, I
2 THE USE AND ADMINISTRATION OF TANNIC ACID.
science, but only as an ingredient in numerous bitter, astringent, and
aromatic medicines, and in some vegetable articles of diet. Unknown as
a separate proximate principle, it doubtless contributed much to the
efficacy of the medicines, into the composition of which it entered. In
these substances, Tannic Acid is combined with other ingredients, some
inert, some possessing properties different from those of Tannic Acid,
and others closely resembling it in their effects. The first ingredients
must be useless, and would unnecessarily and inconveniently increase
bulk at least, in some forms for administration; the second would, in
most instances, injuriously modify or interfere with the action of the
Tannic Acid ; and the third, though auxiliary and useful, could seldom
be present in that proportion which would best suit the exigencies of
different diseases, ages, complications, and stages.
Since the discovery of Tannic Acid as a distinct vegetable proximate
principle, many years ago, according to Dr. Murray, by Seguin, and
particularly since the researches and experiments of Pelouze, this agent,
in its pure form, has been employed occasionally, to a limited extent, in
the practice of physic. Dr. Burns,” of Glasgow, mentions, in his work
on Midwifery, that it has been recommended in chlorosis in doses of one
hundred grains daily Dr. Pereira” says: “given to dogs to the ex-
tent of twelve grains, it caused constipation. In doses of two and a
half grains, it produced constipation in the human subject.” Dr. Todd.”
has recently recommended it as a powerful astringent; and Dr. Garrod.”
has lately given some account of its employment. I mentioned its
utility in goitre" connected with anaemia, in a paper on that subject.
I have reason to believe that it is employed by several practitioners in
London; and I have been informed by an eminent pharmaceutist, that
it is now more frequently prescribed than formerly. For years past,
I have recommended it to the notice of my professional friends. Never-
theless, there can be no doubt, that the use of Tannic Acid by the pro-
fession is not so general, as with advantage it might be. Even those
who employ it, do so, I believe, in only a very few diseases; and in
these, for the most part at least, merely as an astringent. Few prac-
tical hints are to be found in medical works, for the administration
or application of this potent medicine. While Dr. Pereira’ informs
us, that twelve grains produced dryness of the mucous membrane of
the bowels, and a collection of hard faces in the colon, and that it may
be given in doses of three grains, we learn from Dr. Burns (as already
stated), that some have recommended it in doses of a hundred grains
daily. It therefore appears, that a few practical suggestions on the
subject are yet a desideratum.
Tannic Acid exists in a great number of vegetable productions. It is
present in tea, and in many culinary vegetables. It is the combination
of the Tannic Acid in these articles of diet with the peroxyde of iron,
which causes the dark colour of the alvine evacuations of those taking
* MURRAY's System of Materia Medica. Fifth edition, p. 321.
* BURNs' Principles of Midwifery. Seventh edition, p. 147.
**PEREIRA's Elements of Materia Medica, p. 736.
4 MEDICAL GAZETTE, 1849. * LANCET, 1849.
* LoNDON Journ AL OF MEDICINE, June 1849.
7 PEREIRA, Op. cit. p. 786.
BY S. SCOTT ALISON, M.D. 3
the salts of that metal. And it is owing to the absence of this acid in
the aliment, that iron, when exhibited to children fed solely on milk
diet, fails to blacken their evacuations. The articles which contain
Tannic Acid in greatest abundance are certain medicinal substances,—
catechu, kino, galls, and oak-bark. Numerous barks likewise contain
Tannic Acid in large quantity; these are the chestnut, the willow, the
ash, the sycamore, the larch, the birch, the blackthorn, the hazel, and
many others, of all which it is the “true principle of astringency.” It is
chiefly prepared from gall-nuts, (which afford forty-five or fifty per cent.)
Tannic Acid is of a lively yellow, or canary-colour, inodorous, some-
what bitter, and intensely styptic to the taste. It is soluble to a very
considerable extent in water, and in alcohol, not highly rectified. Its
solution slightly reddens litmus. The alkaline carbonates it decom-
poses; and with most metallic solutions it throws down precipitates,
which are tannates of their respective bases. Dissolved in water, if not
exposed to the atmosphere, it may be long preserved without change;
but if otherwise, it soon decomposes, absorbing oxygen, becoming turbid,
and depositing gallic acid.” Tannic Acid is by no means expensive. It
may be had, in a pure form, for less than three shillings per ounce.
II. PHYSIOLOGICAL AND THERAPEUTICAL EFFECTs of TANNIC ACID.
1. As an ASTRINGENT, I have found Tannic Acid exceedingly efficacious,
certainly as much so as any other agent, vegetable or mineral, that I
have ever employed. It has equalled the salts of lead, copper, and
zinc, without producing any of those poisonous effects which are liable
to follow the free use of the salts of the first two metals.
Internal Use. In the chronic bronchial catarrh of weakly and elderly
persons, unconnected with disease of the heart or great blood-vessels,
and attended with copious and debilitating expectoration, the adminis-
tration of Tannic Acid by the mouth, in doses of one, two, and three
grains, two or three times daily, has greatly and gradually abated the
secretion, relieved the frequent cough, and improved the strength of
the patient. In the second stage of pulmonary consumption, viz., that
of softening, when bronchial catarrh has been present to a large extent,
weakening the patient, causing frequent cough, and disturbing sleep, the
same results have followed, and have greatly contributed to the com-
fort and welfare of the sufferer. But in pulmonary disease, the greatest
amount of benefit has obviously been derived when large cavities
have been present in the lungs, the walls of which have thrown out
large quantities of purulent matter, occasionally mixed with blood. In
such cases, the discharge has been effectually controlled, and the rate
of tear and wear of the system obviously restrained, without the induc-
tion of oppression or other evils. *
In chronic diarrhoea, which had resisted the ordinary treatment by
chalk, opium, and regulated diet, and was not dependent on obstructive
disease of the heart or liver, Tannic Acid, in a solid form, has proved
1 PARIs, J. A., M.D., Pharmacologia, p. 151.
* SIMPson, Professor J. Y., in 1843, recommended gallic acid in menorrhagia.
He suggested whether the antihaemorrhagic properties of some of our common
astringent drugs, do not depend upon their tannin becoming converted into gallic
acid within the body. Edinburgh Monthly Journal, July 1843, p. 661.
I 2
4 THE USE AND ADMINISTRATION OF TANNIC ACID.
of surprising efficacy. In cases of severe disease, depending on an irrit-
able weakly mucous membrane, I have not known of one failure; and
of those examples connected with chronic inflammation and disorganiza-
tion of the mucous membrane, only two proved beyond the influence of
this remedy. These two cases occurred during the last autumn, while
cholera was prevalent; and the disease of the mucous membrane was
extensive. The complaint in one of the examples was of long standing,
and the patient had been addicted to habits of intemperance. But it
was not Tannic Acid only that failed; the salts of copper, iron, lead,
and zinc, in large doses, proved to be of no more avail. In this form
of disease, Tannic Acid was administered in the form of pill, in com-
bination with opium.
In leucorrhaea, unconnected with inflammatory action, I have found
Tannic Acid efficacious in restraining the discharge, and in increasing
the strength of the patient. The aqueous solution, combined with a
small proportion of dilute nitric acid, was the form usually employed
in these examples of disease. In memorrhagia, not dependent on a
plethoric state of the system, or on local congestion, it was also ser-
viceable, administered in the same form.
The excessive sweating in phthisis, and in other diseases running on
to a fatal termination, has been usefully restrained by the use of Tannic
Acid, combined with dilute nitric acid; and the habitual cold damp upon
the skin of soft, weakly constitutions has been corrected by the same
means. I have had no opportunity of testing the virtues of this remedy
in the hamorrhagic diathesis; but I am strongly disposed to believe
they would be found very considerable, conjoined with other suitable
means. I believe it would prove serviceable in albuminuria, dependent
on chronic disorganization of the kidney, and not associated with obstruc-
tive disease. When the egress of albumen results, as I believe it often
does in no small degree, from reduced tone and elasticity in the organ,
and is not (as in a great majority of cases) a wholesome outlet necessary
for the relief of the circulation, Tannic Acid offers the promise of benefit.
Such a case, however, I have not lately met with, and consequently
have not had an opportunity of testing the treatment.
Local Application. In the form of aqueous solution, used as a gargle,
Tannic Acid has been most useful in correcting relaxation of the
throat. Sponginess and haemorrhage of the gums have been greatly
controlled by a lotion of Tannic Acid, and by the application of the dry
powder. By this means, loose teeth may be retained for a time, and
the impediment to articulation thereby prevented, which would result
from their removal.
In prolapsus ani I have prescribed Tannic Acid, dissolved in water,
as an injection. This remedy is particularly indicated, when the disease
is associated with great relaxation of the solids. Applied to homor-
rhoidal tumours, free from inflammation, in the form of a fine powder,
mixed with lard, it would doubtless prove more efficacious than galls,
the usual remedy. It is assuredly due to the Tannic Acid which it
contains, that uva ursi proves serviceable in catarrhus vesica.
In gomorrhaea, chronic or about to become such, Tannic Acid, applied
externally as a lotion, has proved serviceable. In the latter mode, it
bas induced no smarting, although the parts have been tender, and
BY S. SCOTT ALISON, M.D. 5
though it has been applied with little intermission for several days. It
is as a local astringent that Tannic Acid produces the most obvious
effects, as Dr. Garrod has remarked.
Of Tannic Acid as an astringent, I have merely further to say, that
it is of special excellence, as an external application to the skin, when
such a remedy is required. I have found it of extraordinary efficacy,
when reduced to a fine powder, mixed with lard, and applied to the
skin. The parts soon acquire a healthy aspect; very little of the
smarting or pungency is experienced, which so generally results from
the use of the salts of alumina, lead, zinc, or copper. I have found
it far superior to gallic acid. By way of testing their comparative
powers, I lately applied an ointment of gallic acid to one spot of psoriasis,
and one of Tannic Acid to another. The strength of both was the same.
The spots were of old date, and had resisted much treatment. In the
course of two days, the spot to which Tannic Acid had been applied, was
all but healthy; that for which gallic acid had been similarly employed,
was more inflamed than before. The gallic acid had caused smarting, and
brought away the protecting scales. This treatment was adopted merely
to test the comparative powers of the two acids, and not as curative
practice. Astringents, if they be applied in psoriasis, must be used only
as subsidiary to other treatment.
2. As a PEPTIC (Terro, coquo), Tannic Acid is very efficacious.
This I soon found, while employing it as a pure astringent. Symptoms
of dyspepsia disappeared under its use, the appetite increased, flatus
and sense of distension were abated at the same time; and, in several
instances, the bowels, far from becoming constipated, acquiring a more
healthy tone, actually became more free. A lady affected with phthisis,
who has been under my care for three years, during which time she has
taken Tannic Acid alternately with cod-liver oil, complained, very lately,
of loss of appetite while taking the oil. The morning dose of the
oil was replaced by Tannic Acid, combined with dilute nitric acid;
and the result was a very striking restoration of the appetite. With
such obvious improvement in the condition and action of the stomach,
it is reasonable to believe, that one of the results is the formation of a
more perfect chyle. The action, as a Peptic, is in accordance with the
statement of one of the best writers on Materia Medica. Dr. Pereira
says, “Administered in moderate doses, they (astringents) promote the
appetite, assist digestion,” etc.'
3. As a HISTOGENETIC, in promoting the genesis, and in improving the
quality of the blood, Tannic Acid, it may be inferred from what has been
stated above, would probably prove effective. But that it is really so, I
have the evidence of improved complexion, greater fulness of the blood-
vessels, increase of strength, buoyancy of spirits, and improved secre-
tions, in numerous examples of anaemic and other diseases, in which this
agent has been long employed.
The formation of structures in the young, I have reason to believe, is
subserved, to a valuable extent, by the long-continued administration of
Tannic Acid, in moderate doses. It is nearly six years since I began
to prescribe this remedy in cases of curvature of the bones in children,
* PEREIRA. Op. cit., vol. i., p. 80.
6 THE USE AND ADMINISTRATION OF TANNIC ACID.
with soft shafts and enlarged epiphyses. The number of cases placed
under this treatment, while I was Physician to the Northern Dispen-
sary, was considerable; and not a few occurring in private practice were
similarly treated. The general health was improved in all. The secre-
tions, in many cases exceedingly offensive, were greatly corrected. In
the course of a year or two, an obvious improvement in the shape and
form of the bones was manifest. The curve was reduced; and the
heads of the bones had lost no small amount of their disproportionate
prominence. I have lately seen two or three children, presenting no
appearance of having suffered from this affection of the bones, who,
some years ago, really were deformed, and who were put under the
influence of Tannic Acid, and also, it is true, of suitable regimen. In
most of these examples of disease, when they came under my care, the
urine contained an undue proportion of lime. This continued to be the
case, at least for some time, even under the use of Tannic Acid, though
perhaps not to the same extent. If Tannic Acid really possess the
power of correcting the tendency to rickets, or of staying the progress
of this affection, it cannot be through any astringent action on the kid-
ney arresting the exit of an undue quantity of lime, which is only a
sign or consequence of the disease, and not its cause. It must act by
invigorating the general health, and by imparting a more healthy cha-
racter to the formative processes, by virtue of which lime and other
mineral ingredients in the blood are more forcibly attracted to, and
fixed in, the osseous structure. Further evidence of the power of Tannic
Acid to improve the formation of tissues, has been afforded by the in-
crease in the volume and firmness of the soft parts of children placed
under its operation, which I have frequently observed.
4. In connexion with HETEROLOGOUS FORMATIONS, Tannic Acid has
been largely employed in my practice ; and as far as I can judge, and
with every wish to be impartial, I believe it has been operative, to a
great and valuable extent, in arresting or retarding their growth. Almost
every case of incipient tubercular deposit in the lungs, which came under
my care, either at the Northern Dispensary or in private practice, some
years ago, was treated, at least in part, with Tannic Acid; and I have
been agreeably surprised to find that not a few of these very patients
are now alive, some apparently not nearer the grave than at that time,
and some in really improved health. I was consulted in the case of a
young lady, five years ago. The apex of the right lung was solidified
with tubercle, and the patient had rapidly deteriorated. Sir James
Clarke saw her with me, and Dr. Watson, at a later period, also visited
her. Tannic Acid was employed, after the more ordinary practice had
been adopted; and though other means have been in use on different
occasions, I attribute much of her present health to the acid. That
lady's lung is still solidified, the respiration is bronchial, and percussion
is absolutely dull ; but the general health is equal to that of the other
members of the family, and permits of her going abroad.
A young lady from Bow consulted me. She was considerably ema-
ciated, had frequent cough, with much muco-purulent expectoration occa-
sionally mixed with blood; percussion at the left clavicle was dull; the
vocal resonance was augmented ; the pulse was rapid; there was much
sweating; and the patient, in short, was rapidly breaking up. With
BY S. SCOTT ALISON, M.D. 7
counter-irritation, opium, and Tannic Acid combined with dilute nitric
acid, very great improvement soon took place. The flesh increased in
volume, the cough and expectoration greatly abated, and the respiration
became easy. After this, Tannic Acid was made to alternate with cod-
liver oil. She mended so much that, without asking my advice on the
subject, she married soon after. I saw her subsequently, and found her
still improving. That lady is now in fair health, and, I understand,
was safely delivered of a fine child some weeks ago.
An elderly single lady lost her brother five years ago. She was
deeply afflicted, and became, immediately after this loss, the subject of
tubercular deposit in the apex of the right lung. Percussion was very
dull over the affected lung, and there was occasional cough; but the chief
symptoms were breathlessness, sweating, and rapid pulse. Dr. Watson
saw her, along with me, three or four years ago, and recommended
dilute nitric acid, etc. I subsequently gave her Tannic Acid, and, with
intermissions, she has taken it up to this time, generally in combination
with nitric acid. Cod-liver oil has likewise been employed sometimes
at one part of the day, while Tannic Acid has been given at another,
and sometimes for a week, alternating with the acid. That lady is still
under my care. She is very little worse than she was three years ago.
The tubercles have softened, but there is no cavity. The chief altera-
tion for the worse, has been a moderate increase of the emaciation, of
the cough, and of the expectoration. She is able to walk out, except in
bad weather; talks with energy, has a vigorous appetite, and sleeps well.
She takes, at present, Tannic Acid in small doses, (for she has a some-
what irritable stomach,) with dilute nitric acid; cod-liver oil is still occa-
sionally employed. She has no occasion for opiates or purgatives.
Mrs. W. had solidified lung, much tenacious muco-purulent expecto-
ration, occasional spitting of bloody fluid, and frequent cough. Small
portions of a dark brown substance, apparently separated lung-tissue, were
occasionally brought up. They had an extraordinary corrupted foetor,
with something of the odour of sulphuric ether or of naphtha. Counter-
irritation and opiates were employed. Tannic Acid, dissolved in infu-
sion of gentian, and combined with dilute nitric acid, was administered,
with the result of improving the general health, and of checking the
foetid expectoration.
The deposition of tubercular matter, it is reasonable to believe, may
be retarded by the use of a remedy which improves the health both of
the solids and fluids of the body. The surrounding lung-tissue may be so
beneficially acted on, as to reduce the tendency to inflammation and to
disorganization. With respect to malignant heterologous formations, I
have had no opportunity of seeing them under the influence of this
remedy, except as an external temporary application; but I think it is
consistent with what we see in other diseases, to believe that the cells of
cancer may be checked or retarded in their growth by its long-continued
administration. The normal formation of nutritive processes may receive
such an impulse, as effectually to interfere with the almost monopolizing
growth of malignant disease. With a more healthy condition of the
capillaries, and a more perfect quality of blood, may we not hope for
some benefit? It may be allowed, with this view, under such desperate
circumstances, to administer a remedy which, if not effectual against the

8 THE USF, AND ADMINISTRATION OF TANNIC ACID.
major evil, will at least improve the general health; and that without
the production of any ill consequence, worthy to be called by a higher
name than that of inconvenience.
5. As a NERVINE of a lasting character, I have found Tannic Acid
useful in several cases of nervous debility, languor, and excitability.
These distressing conditions have been relieved; and the benefit, in one
or two examples, has been permanent. Under the use of moderate
doses of this medicine, I have known even the symptoms of weakly
organization,--or, as I have thought, of impending softening of the
brain, such as flightiness of speech and manner, impatience of atten-
tion or of application, hasty judgments, weakness and unstable gait,
to lose not a little of their prominence. It has always, however, been
my object to guard against depending on this or any other such remedy,
where there has been good reason to suspect the presence of inflamma-
tory action, even in a subdued form. When thus used as a Nervine,
Tannic Acid should generally be combined with camphor, hops, or hyos-
cyamus. The shower-bath has been employed, and the secretions have
been attended to, at the same time. Thus exhibited, I believe that Tan-
nic Acid, by improving the natural galvanic battery, if our brain and
nerves may be so figuratively designated, will really, in many cases of
feeble volition and muscular action, produce not a little of that benefit
which has been sanguinely looked for from galvanism and electricity, and
which, when obtained, has been so fleeting, at least in my experience.
III. MoDE OF ADMINISTRATION OF TANNIC ACID. For administra-
tion, Tannic Acid is well suited. It possesses no great bitterness, is
free from odour, and does not induce nausea. A little sugar or syrup
will suffice to cover all unpleasantness. It is perfectly safe, and may
be continued for months without any evil effect. In moderate doses, it
does not reduce the secretions below the healthy standard. It may be
administered at all hours, before, or during, or after meals.
Tannic Acid may be employed alone in the treatment of disease; but
it is capable of exercising its virtues harmoniously with other remedies.
The use of this medicine does not preclude the employment of iron,
cod-liver oil, and other such means; but, on the contrary, I believe it
will make them more available to the patient. It may be given at one
time of the day, and the other remedies at another; or a week or a fort-
night may be given alternately to each medicine. Tannie Acid, more-
over, may be advantageously combined at the same moment with other
means. It may be prepared with bitters and aromatics, or conjoined
with astringent wines.
For diseases of the mouth, Tannic Acid may be dissolved in water:
three or four grains to the ounce of water make a strong styptic lotion.
It may be reduced to a fine powder, and dusted over the parts. Mr.
Morson has prepared a lozenge, which is well adapted for the mouth
and throat. Each lozenge contains about half a grain of Tannic Acid.
Some have had added to them essence of cayenne, the more to fit them
for relaxation of the fauces and glottis. For the stomach, the aqueous
solution is well adapted; and, when a pure bitter is required, some infu-
sion, such as that of gentian, may be used instead of water. When it
is intended to influence the bowels, Tannic Acid is suitably exhibited
BY S. SCOTT ALISON, M.D. 9
Af
in the form of pill; and as circumstances indicate, in combination with
opium or other remedies. If we desire it to enter the circulation, or to
act quickly, at a distance from the stomach, on some internal part, the
form of solution or powder should be employed. As a styptic for the
rectum, uterus, vagina, or urethra, the aqueous solution, used as an
injection, will generally prove most serviceable. For local skin diseases,
requiring an astringent, Tannic Acid may be advantageously used, either
as a lotion, or in the form of ointment. As, however, the application is
really effective, it will be well to attend, at the same time, to any re-
quirements that the general system may demand. Reduced to a very
fine powder, I have found that Tannic Acid may be inhaled into the
lungs and air-tubes. It has produced no irritation or cough, when
tolerably well managed. I have not had much experience of it in this
form ; but I believe that a cautious trial might be made of it in cases
of disease of the lungs and air-tubes, in which the local application of a
non-irritant styptic is indicated.
The dose of pure Tannic acid must vary according to the circumstances
under which it is employed. For urgent disease, such as hamorrhage
from the stomach, bowels, or lungs, five to ten grains should be used
every few hours. For chronic fluxes, wherever situated, two or three
grains, given twice a day, will generally suffice. When the general
improvement of the health is simply desiderated, one or two grains, two
or three times daily, are enough, but the remedy should be long conti-
nued. For children afflicted with rickets, half a grain to one grain
answers well, given night and morning. -
Tannic Acid is contra-indicated in haemorrhages and fluxes, wherever
situated, which are only the relieving of an obstructed circulation, or of
inflammatory or congestive action. It is, under such circumstances,
calculated to do mischief. In obstinate constipation of the bowels, when
circumstances render a lax state necessary, Tannic Acid is contra-indi-
cated in large doses, as a general rule. Irritability of stomach and
gastritis are liable to be aggravated by Tannic Acid.
Several preparations of Tannic Acid have been carefully prepared, at
my suggestion, by Mr. Morson, the eminent pharmaceutist, of South-
ampton-row. These preparations are the tannates of quinine, cinchonine,
alumina, bismuth, and lead. They are all coloured, possess more or
less the styptic taste of Tannic Acid, and are inodorous. I have not
yet had time to make sufficient trial of them, so as to be enabled to
report at present upon their virtues. I shall now only hazard an opinion
that they, as well as Tannic Acid itself, will be found, upon full trial,
to possess very considerable power, and to form valuable acquisitions to
the resources of the physician, wherewith he may render himself more
formidable to disease, and still more serviceable to the sick.
Park Street, Grosvenor Square, December 1849.
10
ILLUSTRATIONS OF DISEASES OF THE NERVOUS
SYSTEM.
By WILLIAM H. MADDEN, M.D., Physician to the Torbay Infirmary
and Dispensary, etc.
No. I. RAMoLLISSEMENT OF GREY MATTER of THE MEDULLA SPINALIs.
CASE. Mr. P., aet. 63, came under my care in August 1838. He was
a merchant, and had been constantly engaged in extensive speculations:
a man of acute intelligence, resolute will, and excitable passions. He
was rather above the average height, and strongly built; and had always
been of active habits, both of mind and body. About five years before
I first saw him, after dining with some hard drinkers, and fully parti-
cipating in the depth of their potations, he was attacked with burning
pain on the instep of the left foot, which mearly disabled him from walk-
ing, but was unaccompanied by any external appearance of inflamma-
tion. This feeling continued for some time, and gradually terminated
in diminished sensibility of that foot and leg, up to about the middle of
the calf. Shortly afterwards, the right foot and leg became similarly
affected; and this state continued persistent during the remainder of his
life. He always complained of heat in the parts, and stated that, in
walking, he felt as if he were treading upon heaps of warm bran.
About a twelvemonth after the above-mentioned occurrences, Mr. P.
first perceived that he passed an inordinate quantity of urine ; and, at
the same time, he was greatly tormented with thirst. He applied for
advice, and was informed that he laboured under diabetes. He accord-
ingly submitted to very rigorous discipline, one material item of which
was an almost total abstinence from fluids. His urine, carefully ex-
amined by several chemists, was found to contain no sugar. Having
persevered in this line of treatment for two years without any benefit,
he adopted, on the recommendation of Dr. Prout, an entirely different
course, living again in the way to which he had been formerly accus-
tomed, i. e., rather generously. Under this system, his general health
greatly improved, and the supposed diabetic symptoms gradually wore
away.
During the severe frost of January 1838, Mr. P. stood, on one occa-
sion, for some hours on the ice; and, on his return home, found that
both his great toes were frost-bitten. The ulcers resulting from this
accident healed but very slowly; and for seven weeks he was confined
entirely to his bed. I should mention that, for many years, he had been
troubled with varicose veins in the legs. Shortly after leaving his bed,
Mr. P. drove, on a very cold day, to Roslin, a distance of about six miles
from his residence, and sat for some time with the left side of his face
to an open window. During this ride, he felt an unusual degree of
stiffness of that side of the face; and, when he arrived at his friend's
house, found that he was unable to hold anything in his left hand.
This did not arise from loss of muscular power, but from the greatly
diminished sensibility of the cutaneous textures, which, he now perceived,
had extended over the whole of that side of the body, but was most com-
plete in the hand and fingers. There was no distortion of any portion
of the face. In this state he continued, notwithstanding the most active
D.R. W. H. MADDEN ON DISEASES OF THE NERVC US SYSTEMI. 11
treatment by bleeding, both local and general, blistering of the head and
spine, and severe purgation, until about the 11th or 12th of August,
when he suddenly perceived a dimness in the vision of both eyes. On
the 15th, the sight of the right eye was entirely lost for some hours,
but returned again. On the 16th, I saw him, with my friend Dr. J.
Renton, and found him in the following state: General health appa-
rently very good. Not the slightest distortion of any features. All
ordinary motions performed perfectly, but much feeling of stiffness, and
as of a weight in the hands, especially the left. Great, but not total,
loss of common sensation, over the whole of the left side of the body.
The muscular sense was entire. The eyes presented nothing remark-
able, the pupils contracting readily and freely. He could see distant
objects more clearly than near ones; and the indistinctness of vision
varied much at different times. Taste and smell were perfect. He had
no headache, and but little occasional giddiness. He complained much
of pain in the back, when driving over rough roads. Cutaneous tran-
spiration was entirely suspended. The appetite was good; the tongue
clean; and the bowels regular, and answering easily to medicine. Pulse
from 70 to 80, of good strength. A seton was inserted in the neck;
the diet was carefully regulated, and means were adopted to improve
the state of the capillary cutaneous circulation, which was very feeble.
We also made a few (about six) trials with galvanism; but our patient
would not persevere in the use of this agent. When first employed, it
excited no sensation at all; but subsequently its influence was felt, each
time more distinctly.
September 26th. Mr. P. was not so well. He complained much of
pain in the left hand and arm, with general uneasiness. Pulse 100,
and full. His face wore a contracted and unhealthy aspect He had
so strong a prejudice against bleeding, from the effects of former treat-
ment, that all that could be done was to prescribe a purgative and low
diet. These means, however, gave great relief, and he was much better
during the next two days; though his family observed that his temper,
always irritable, was now unusually so.
September 29th. He still complained much of pain, and of a feeling
of distension in the left hand. Pulse 90. Tongue clean, and bowels
open. During this day, he was much irritated and excited by an acci-
dent which happened to one of the members of the family. In the
afternoon he had rigors, and was unable to walk; and, when carried to
bed, could not turn himself. We were not summoned until the next
morning; but his friends administered two purgative pills. During the
night, he was very restless, and somewhat delirious.
September 30th. When I saw him, he was lying on his back, with his
eyes closed, and brows much contracted. The right hand and arm were
in incessant motion, and often carried to the head. Tongue very foul.
Pulse 120, full, hard, and bounding. Head hot. Pupils somewhat
dilated, but sensible to light. He was easily roused, but lay in a kind
of stupor, and did not seem willing to be disturbed. He was very rest-
less, but made no complaint of the head. He was bled largely, until an
impression was made upon the pulse; a purgative was administered, to
be repeated if the bowels did not act freely, An evaporating lotion was
directed to be applied to the head, and warmth to the feet.
-12 - DISEASEs of THE NERVoUs systEM.
October 1st. He was very restless and talkative during the night.
The bowels were once moved. He refused to take the second dose of
medicine, and would not allow the lotion to be applied to the head. The
blood drawn was strongly buffed and cupped. The pulse was softer.
There was erysipelatous redness of the right thumb and arm, extending
nearly to the elbow. Another purgative was ordered, and a lead lotion
to the inflamed part. In the evening, the pulse had become harder,
and he was again bled. The bowels had been freely opened; the stools
were copious, black, and offensive. He was more quiet, and perfectly
sensible, making no complaint of pain, except in the inflamed arm.
The sensibility of the feet was found to be greatly increased.
October 2nd. There was no improvement. The urine and faces
were passed involuntarily. He was perfectly sensible when roused;
slept much, and wandered occasionally. There was no intolerance of
light. The face was frequently flushed, and the temperature of the head
exalted; but at times there was great pallor and diminished heat. He
died during the night.
Sectio cadaveris, forty-two hours after death. There was little, if any,
appearance of decomposition. The scalp and cranium were very thick.
The dura mater was somewhat thicker than usual, and more adherent
to the subjacent parts. There was a considerable sub-arachnoid effu-
sion; also much bony deposit in the arteries of the brain, which also
contained a good deal of air. The base of the brain was extremely vas-
cular, especially about the optic commissure and the locus perforatus,
where it had a uniform pink colour. Ths ventricles were much dis-
tended with fluid, a considerable quantity of which flowed also from the
spinal canal. The fibres of the crura cerebri and pons were unusually
distinct. The medulla oblongata presented the same appearance : it
was hard, and apparently shrunk in size. The floor of the third ven-
tricle was very soft and pulpy. Both corpora striata were softer than
natural, but unaltered in colour. The membranes of the spinal cord
were unusually vascular. The cord itself, in the cervical and upper
dorsal regions, was of a natural consistence externally ; but the centre
was almost reduced to a state of fluidity, presenting the appearance of
thick cream. This was most particularly remarkable at the part where
the cervical plexus comes off. Below, it was harder; but we did not
examine the lumbar region. -
REMARKs. This case possesses many instructive features, and es-
pecially illustrates, in a very marked way, the difficulties which, in
the present state of our knowledge, beset a consistent interpretation of
the phenomena of Diseases of the Nervous System. It appears pretty
evident from the history, the course of the symptoms, and the lesion
found after death, that the spinal cord was, from the first, the organ at
fault. The marks of intra-cranial disease, with the exception of the
softening of the floor of the third ventricle, and perhaps the partial
ramollissement of the corpora striata, were, in all probability, of quite
recent origin, being merely the evidence of the last fatal inflammatory
attack. The persistent burning pain in the instep would seem to have
been the first indication of central mischief. It was clearly not depend-
ent upon any mere local affection; for, independently of the absence of
BY WILLIAM H. MADDEN, M.D. 13.
all proof of such by any external signs, the fact that this pain terminated
in numbness of the whole foot and a considerable part of the leg, and
was followed by a similar condition of the other extremity, is quite con-
clusive. The cause of both must have been identical, and should be
sought for in some pathological condition of that organ, from which all
the affected parts received their nervous supply. The exact nature of
that condition it is, of course, impossible to affirm; but seeing that the
exciting cause appears to have been the undue stimulus of excessive
drinking, we may not unreasonably conjecture that it was of an inflam-
matory character. But that it was not of any great extent appears also
evident, from the long period during which the paralytic symptoms
remained stationary. They did not increase in severity, nor were any
other portions of the body invaded; but, on the other hand, they did
not in the smallest degree diminish; consequently their cause, whatever
that might be, remained still in operation. And here we meet with
another proof that that cause was central, in the sudden and alarming
increase of anaesthesia, produced by the exposure to severe cold, which
constituted the next great step in the development of the nervous symp-
toms; for these, it will be observed, did not constitute a new set of phe-
nomena, but were merely an extension and exaltation of those which
had previously existed. The progress of the case henceforward was not
very different from what might have been predicated, on the supposi-
tion that the medulla spinalis was organically affected; and dissection
showed that such had been the case.
But, having arrived at this point, we meet here with much more formid-
able difficulties. The only pathological change at all sufficient to account
for the symptoms observed during life (I mean those which preceded
the fatal cerebral attack), was the ramollissement of the grey matter of
the cord. How does this comport with our knowledge of the functions
of that portion of the organ? - -
The opinion most commonly held at present by physiologists, is,
that the grey matter, wherever found, is the source of power, the me-
dullary fibres merély serving the purpose of conductors. Disease,
therefore, of this part should manifest itself either in perversion or in
destruction of power. In the case before us, it was the latter; and, so
far, all appears plain enough. But, though sensation was almost anni-
hilated, the power of motion remained but little impaired; and herein
lies our chief difficulty. That which would account for the loss of
sensation, should also, if the generally received hypothesis be correct,
have involved the loss of motion. But this was not observed. Nor
are the obscurities involving this subject at all diminished by references
to other recorded cases. Dr. Abercrombie quotes from Ollivier an in-
teresting case, in which a similar pathological condition existed, but
with symptoms very different. “The affection began with numbness
of the forefinger of the left hand, which gradually extended over the
hand and arm. After some time, the other hand and arm became
affected in the same manner; and, after a year, the lower extremities.
All the limbs then became paralytic, but without loss of feeling." The
legs were bent upon the thighs, and the thighs upon the abdomen, and
* There is here some little obscurity in the report. Did the numbness, spoken of
above, disappear, as the other symptoms were developed -
14 DISEASES OF THE NEIRVOUS SYSTEM.
the arms rigidly flexed across the thorax, with the points of the fingers
pressed against the palms of the hands. If attempts were made to
move the limbs from these positions, they were thrown into spasmodic
contractions with much pain. The patient died in this state at the
end of eight years from the commencement of the disease. Along
nearly the whole length of the cord, there was a central cavity full of
a soft grey mucus. It was considered as arising from ramollissement
of the grey central matter of the cord. The parietes of the cavity were
formed by the white matter in a healthy state.”
It is not easy to reconcile these discrepancies, nor indeed to account
satisfactorily for the phenomena of Ollivier's case standing by itself;
for the spasmodic contractions, into which the limbs were thrown, when
attempts were made to straighten them, were evidence that motor power
was not annihilated, though volition could not call it into action. And
the disorganization was too complete to allow us to fall back upon the
supposition, that there was a state of continued irritation in the nervous
centre, producing the permanent contraction when at rest, and the
spasms under fresh excitement. For a less extent of disease, this
might be a correct explanation; but it will not apply to such a degree
of structural mischief, as is involved in the conversion of the interior of
the cord into a canal filled with grey mucus.
But leaving this case, and turning our attention again to that one
which is the more immediate object before us, let us inquire if it be pos-
sible to offer any explanation of its symptoms and morbid appearances,
which shall preserve intact the foregoing hypothesis, “that the vesicular
is the truly dynamic nervous matter, the source of all nervous power.”
Todd and Bowman, in their very admirable work on Physiological
Anatomy, from which the above statement is quoted, contend that
the posterior horns of the grey matter of the cord, “as being the part
in which the sensitive roots are implanted, participate largely in the
mechanism of sensation; and that, by their union with the brain, they
become, pro tanto, a part of the centre of sensation, so long as that
union is unimpaired.” The impulse of volition, again, exerted prima-
rily in the grey matter of the brain, acts through the fibres of the
anterior pyramids (which they regard as merely commissural) on the
anterior horns of the grey matter of the cord, which in its turn stimu-
lates the motor roots of the implanted nerves, and produces muscular
contractions. Now, if it could be shown that, in the particular example
we are discussing, the posterior cornua of the grey matter were most
diseased, and had become, as a consequence, most profoundly degen-
erated, their analogues in front still retaining somewhat of more healthy
structure, we should be able to reconcile the difficulties of the case at
once. This it is not possible to do ; for the examination was not by
any means sufficiently minute ; and, therefore, any explanation thus
founded can merely rank as a supposition. This is but an unsatisfactory
position ; but it is the best, so far as I can see, which can be assumed.
On one occasion, during the last fatal attack, it was noticed that the
sensibility of the feet was greatly increased. Did this depend upon the
cerebral excitement? or might not the quickened circulation in which
* On Diseases of the Brain, etc. Third edition, p. 349.
* ToDD and Bowman. Physiological Anatomy, vol. i., p. 322. * Ibid. p. 331.
BY WILLIAM. H. MADDEN, M.D. 15
the cord, in common with other organs, must have shared, have stimu-
lated, for a time, its half-destroyed energies? -
It is greatly to be regretted, that no direct experiments were made
to ascertain the condition of the excito-motor functions. If the action
of the sphincter ani be reflex, as Dr. Marshall Hall supposes, then in
the perfect manner in which its office was performed, until within the
last few days of life, we have one proof that they were entire. But if
Todd and Bowman be correct in their opinion, that its active contrac-
tions are mainly excited by voluntary influence, then, of course, its
healthy condition will merely serve as an additional illustration of what
was manifested in the muscles of the limbs and trunk, viz., that the
stimulus of volition remained in great measure operative. And, pro-
bably, the circumstances under which it failed eventually, may be re-
garded as some evidence in favour of the last-mentioned view; for it
was when the brain itself was diseased, and when the power of volition
generally failed, the patient having become unable even to turn himself
in bed, that the urine and faeces were passed involuntarily. . .
There is one other point of interest in the case, to which I would refer
in conclusion, and that rather in the way of question than of affirmation.
May not the spurious diabetes, with which my patient was afflicted
about a twelvemonth after the commencement of his illness, have been
caused by the pathological condition of the spinal cord 2 We have
abundant evidence of the influence of the nervous system over the
secreting organs, especially the kidneys; witness the large discharges
of limpid urine, which so commonly accompany the hysterical seizure.
And this instance is one very much to the purpose ; for though it is pro-
bable, that, in many cases, the urinary apparatus is stimulated from
direct sympathy with the primarily affected uterine nerves; yet in
others, and more especially when the flow succeeds instead of preceding
the attack, it appears rather the indirect result of irritation propagated
to the spinal cord, and thence reflected on the kidneys. And if this be
the case, it is not difficult to understand how another, and more perma-
ment, state of excitement in the cord should originate and keep up an
undue action of these secreting organs. I do not know what was the
state of the skin, as regards its transpiration, at that time; but when
Mr. P. was under my care, the perfect absence of all perspiration was
most marked. This has often been observed in cases of paralysis; and
that it depends upon the same cause as that which produces the paralysis
itself, is proved by the fact that, in some cases, “while perspiration
is abundant on all other parts of the body, there is no perceptible
moisture on those which are paralysed.” In this, therefore, we have
the converse phenomenon to the first ; at least, if the hypothesis indi-
cated above be founded in truth. -
About the same time that Mr. P. was under my care, I attended a
case which, at the commencement, presented the ordinary symptoms of
continued fever. On the eighth day, the patient, a young man, became
suddenly comatose; and, at the same time, a most copious and wniversal
sweat broke out. His faces and urine were passed involuntarily, the
latter in inordinate quantity. On the night of the eleventh day, he
* Library of Medicine, vol. ii, p. 275.
16 CASE OF IDIOPATHIC TETANU.S.
suddenly recovered his consciousness, and was able to speak, though
very imperfectly; but the other symptoms remained unabated. He
gradually Sank, and died on the morning of the thirteenth day; the ex-
traordinary secretion of sweat and urine continuing to the last. There
was no dissection. Here, again, the symptoms of disturbance in the
nervous centres, and the abnormal excitement of the secreting organs,
were coincident.
Torquay, November 27, 1849.
CASE OF IDIOPATHIC TETANUS SUCCESSFULLY
r TREATED.
By THOMAS BEVILL PEACOCK, M.D., Assistant Physician to St. Thomas's
Hospital.
THOUGH cases of Idiopathic Tetanus, and those in which the symptoms
supervene gradually, are usually more tractable than the traumatic and
acute forms; yet, as the disease is, under all circumstances, so frequently
fatal in its result, it is conceived that the following may be worthy the
notice of the profession.
CASE. Samuel Sessions, a labourer, residing at East Acton, forty-
eight years of age, was admitted into the Royal Free Hospital, on the
2nd of November, 1847. He stated, at the time of his admission,
that he had taken cold on the 17th of October, while working in a potatoe
field and perspiring, and shortly after felt some stiffness, and difficulty
of moving the left leg; this was followed by similar stiffness of the
right leg, and cramp in the back; and subsequently the neck and muscles
of the jaws became affected. On the 21st, he was scarcely able to open
his mouth; and when he succeeded in separating his jaws, they sud-
denly snapped to, and bit his tongue. Since this time, he had been
quite incapable of taking any solid food. Soon after the locked jaw
came on, he began to suffer occasionally from severe spasms, more
especially when he made any exertion, as in the effort of getting out of
bed. In these attacks the body was drawn back, the legs extended,
and the stomach became hard and painful. He had several paroxysms
of this description during the last week; and the day before his
admission, he had one more severe than any of the former attacks. He
stated, that though formerly of intemperate habits, he had latterly
lived regularly, and had been but poorly off for some time.
When seen on the 3rd of November, he expressed a wish to be got
out of bed; but, immediately on placing his foot to the floor, he was
seized with one of the severe paroxysms. His body became arched
backwards, his limbs were rigidly extended, the abdomen was exces-
sively tense, and the muscles of the jaws contracted, and he cried
out from the severity of the pain in the epigastrium and back; the
pulse also became very hard and rapid. When the attack subsided,
the pulse became feeble and less frequent, the face was pale, and there
did not appear to be any tenderness of the spine; the jaw could with
difficulty be opened to a small extent, and the tongue was found dry
and furred; the bowels were confined, and had been so from the com-
BY THOMAS BEVILL PEACOCK, M.D. 17
mencement of his illness. He was directed to take a purgative draught
immediately, and afterwards to have two grains of calomel and one of
opium three times daily, and to be cupped to 8 oz. in the course of the
spine; to have port wine and beef-tea at intervals.
November 4. The medicines prescribed have been given to him, and
he has been cupped, and has passed a better night, having slept at in-
tervals. The bowels have been freely acted upon ; the pulse is 76 and
feeble, the skin cool ; the mouth admits of being somewhat more
opened, and he can protrude the tongue better,-it is less furred ; the
body is drawn somewhat back, and the abdomen is excessively tense;
he complains of the severe pain which he experiences at intervals in
the pit of the stomach. The pain, he says, is increased on pressure.
He has not had any of the more severe paroxysms during the night.
He was directed to continue to take the calomel and opium with the
wine and beef-tea; and, if the spasms should return, to inhale ether.
He had a severe spasmodic attack on the evening of the 4th, and the
ether was therefore administered. He inhaled it for three or four
minutes, and then became insensible, and the spasms relaxed, but
recurred almost immediately after he recovered his consciousness. The
inhalation was then repeated; and, this time, it was followed by more
decided and permanent relaxation of the cramps and relief from pain.
At 12 o'clock at night, however, the state of rigidity had returned,
and the cramps were becoming severe; the ether was therefore again
inhaled; and though there was entire relaxation after this for a short
time, in about twenty minutes he had a more severe spasmodic attack
than any which he had previously had since his admission. It was
evident, that the ether did not exercise any permanently favourable
influence; and he was therefore placed in a blanket wrung out of hot
water, and this again was wrapped in two or three other dry blankets;
he remained so “packed” from 10 P.M. on the 5th, to 6 A.M. on the 6th.
November 6. To-day there is an evident amendment in his symp-
toms. He states that he has passed a comfortable night, and has slept
at intervals. The permanent contraction still continues, so that his
body is arched backwards and the abdomen is tense; but he has been
entirely free from the severe spasms, and has less pain in the epigas-
trium. He can open the mouth a little more, and is able to protrude
the tongue better. The pulse is 100 and quiet; the tongue slightly
furred. He perspired profusely, but felt quite warm and easy during
the night, and says, that the bath has afforded him great relief. The
gums are affected by the calomel. The bowels have been freely acted
upon, and he makes water freely. He has taken his wine and beef.
tea well. .
To repeat the calomel and opium pills to-night, and afterwards omit
them. To take half-an-ounce of port wine, and one drachm of the com-
pound tincture of bark, every hour, and to have a turpentine enema at
night, and use the blanket bath, should the paroxysms recur.
November 8. On the evening of the 6th, he had a severe attack of
spasms, and was immediately put in the hot and damp blanket, and
packed as before. The paroxysm soon gave way, and he has had no attack
since; but, at his own wish, he was wrapped in the blankets again last
might. His body is now much less drawn backwards, the abdomen is less
WOL. II. 2
18 DR. T. B. PEACOCK ON IDIOPATHIC TETANUS.
tense, and he can open the mouth and protrude the tongue without much
difficulty. The pulse is 92 and quiet ; the skin cool and moist; the
bowels were three times relieved after the enema, and twice yesterday.
To take the wine and bark every two hours, and use the blanket if
necessary.
November 12. He has had no return of the severe spasms, and the
permanent cramp of the muscles of the back and abdomen has nearly
subsided. He has still some stiffness of the muscles of the jaws and
neck, and the face has not altogether lost its rigid appearance ; the
eyebrows and forehead being still corrugated and contracted. He can
now lie in any position; the pulse is of good volume, and quiet ; the
tongue is clean, and the bowels act naturally. Since the 10th he has
taken the bark and wine only every four hours, but, at his own request,
he has had the blanket bath for a short time each evening; and, when-
ever he feels the spasms, he immediately applies for it. -
November 16. He is now gaining strength, and for the last few
days has been able to take some solid food. The spasms have not
altogether left the muscles of the face and neck, but all remains of the
cramp of the abdominal and spinal muscles have entirely disappeared.
The blanket bath has been occasionally used. From this time he did not
again have recourse to it; and he was discharged, cured, on the 24th.
REMARKS. In reference to this case, I have few comments to offer.
The features which the disease presented, are sufficiently characteristic
of Tetanus; and the course of treatment pursued requires little ex-
planation. Few practitioners will probably be now found to contest
the conclusion of Mr. Curling, that Tetanus is a functional affection,
and not necessarily connected with inflammation of any portion of the
nervous system. Yet there can be little doubt, that the disease is occa-
sionally dependent on, or connected with, excited action of the spinal
cord or its membranes; and this would appear to be especially the case
when it arises after exposure to cold, etc. Taking this view of the
pathology of the disease, I thought it well to commence the treatment
of the case with mild antiphlogistic measures; a small quantity of
blood was abstracted, by cupping, from the neighbourhood of the spine;
the bowels were relieved by aperients, and calomel and opium were
prescribed ; and, though the febrile symptoms were at no time very
marked, this treatment was obviously productive of benefit. The
spasms, however, continued to recur; and, on the third day after his
admission, he was directed to inhale ether. This was repeated several
times; but, though in each instance temporary relaxation ensued, no
permanent relief was obtained, and the spasms became more frequent
and severe. On the evening of the fourth day, the packing in the
hot and moist blanket was therefore had recourse to ; and the bene-
ficial effect of this application was attested, not only by the obvious
relief which followed its first employment, but by the anxiety of the
patient to recur to its use, whenever there was the slightest return of
spasm, and to continue it till every symptom of the disease had sub-
sided. Throughout the course of the attack, the patient's strength
was supported by the free exhibition of animal food in a liquid form,
with stimulants and tonics. -
MR. COOPER'S CASE OF FATAL GASTRO-1NTESTINAL HAEMORRHAGE. 19
It is very generally admitted, that in Tetanus, few remedies afford
greater relief than the warm bath; but, as ordinarily employed, its use
can be continued for only a short time, and the frequent changes which
it necessitates, are often injurious to the patient, by exciting the
spasms or increasing their severity. To these objections the blanket-
bath is not exposed. If the wet blanket be not too much wrung out,
and the water be very hot, and if the patient be well packed in dry
blankets externally, the heat and moisture may be long retained, and
he may lie for many hours undisturbed, and during this time, food,
stimulants, and other remedies may be administered. The packing
may also be made the means of administering anodynes through the
medium of the skin.
During the period of nearly four years that I was connected with
the Royal Free Hospital, I had under my care another case of Idio-
pathic Tetanus, which occurred in a man, forty-seven years of age, a
labourer, who had taken cold while working in the fields. The attack
was more acute and severe than that which I have just detailed : he was
admitted on the third day of the disease, and died on the sixth. The
treatment pursued consisted in the exhibition of antimony, calomel,
and opium, with the warm bath. His death was probably accelerated
by an attempt to introduce a tube down the oesophagus, for the purpose
of administering food. While resident in the Royal Infirmary of
Edinburgh, I also witnessed a case of Idiopathic Tetanus, which proved
fatal. I mention these cases, as Mr. Curling has stated that Idio-
pathic Tetanus is, in this climate, rarely a fatal disease. On the con-
trary, however, it will be seen, that of the three cases which have fallen
under my personal observation, one only has terminated favourably.
20, Finsbury Circus, December 1849.
FATAL CASE OF GASTRO-INTESTINAL HAEMORRFIAGE
FROM CARDIAC DISEASE, WHILST UNDER
THE INFLUENCE OF MERCURY.
By W. WHITE COOPER, Esq., F.R.C.S., Senior Surgeon to the North London
Infirmary for Diseases of the Eye.
MR. W. S., a merchant from Havannah, consulted me on the 31st Oc-
tober 1848. His statement was, that he had suffered, on several occa-
sions, from severe febrile and liver attacks; and that, for some time
previously, he had been annoyed with fits of vomiting of bile, pain in the
right shoulder and side, etc. Whilst travelling on the continent, about
two months before I saw him, he remarked that the flames of candles,
when viewed with the left eye, appeared as blue as a Bengal light; he
was teased with frequent muscae and Scintillations, pain over the brow,
and headache; and objects appeared indistinct, as if seen through a film
or mist.
On examination of the eye, the pupil was found to be contracted and
nearly motionless, and the sclerotic had an unhealthy murky aspect;
the largest type was discerned with great difficulty, and he could merely
2 2
20 FATAL GASTRO-INTESTINAL HAEMORREIAGE.
see the outline of my features. His complexion was of a muddy yel-
low, tongue exceedingly loaded with thick yellow fur, and his breath
horribly offensive. The abdomen was tense, and there was considerable
tenderness and some fulness in the hepatic region; pulse 84, and irri-
table, and bowels confined. It was evident that there was active con-
gestion, and probably chronic inflammation of the choroid and retina,
and that the liver was also much congested: the first indication clearly
was, to unload that viscus and empty the alimentary canal. Con-
sidering that, as he had lived in the tropics, he would require a tolerably
active dose, I prescribed six grains of the chloride of mercury, to be
followed, after the lapse of four hours, by a brisk aperient draught, and
broth diet. A blister to be applied to the left temple. On the 2nd
November, I saw my patient again, and finding that the bowels had not
been acted on, I directed a draught of infusion of senna, with tincture
of jalap and sulphate of magnesia, to be taken immediately, and repeated
at the expiration of four hours, unless the bowels had been thoroughly
unloaded. This second dose brought away a panful of foul offensive
matter, and afforded much relief. On the 3rd inst. he was decidedly
better; the tension of the abdomen had diminished considerably, and
there was less tenderness in the right side and epigastrium. The gums,
however, showed evidence of mercurial action, and there was some sali-
vation. The usual washes of alum, etc., were prescribed, and a mild
aperient mixture also, in order that an action on the bowels should be
kept up. *.
November 4th. The general symptoms are greatly improved, and the
indistinctness of vision diminished, he being able to discern letters more
distinctly. The salivation, however, is profuse, and face much swelled.
To wash the mouth frequently with weak brandy and water, to omit the
aperient, which is no longer required, and to take a mixture of infusion
of cascarilla and orange peel, with dilute mineral acid, every six hours.
Diet, strong beef tea, isinglass jelly, etc.
November 5th. With the exception of the salivation, the improve-
ment still continues. There is much swelling of the gums; and an ulcer,
about the size of a split pea, has formed on the inside of the gum, on
each side, corresponding to the last upper molar teeth, and from one of
these ulcers there has been a trifling oozing of blood. I swept the
gums with a solution of nitrate of silver. The medicine to be continued.
November 6th. The salivation less, but in the night there had been
some bleeding from the mouth. Supposing it to have come from the
ulcers, I again touched them with caustic, and desired that the mouth
should be frequently rinsed with a gargle, containing tinct. matico, 3iii;
acidi gallici, 9j; aluminis, 9 iss; tinct. catechu, 5iij; aq. rosarum, 3vij.
The patient was, in all other respects, decidedly better. There was no
longer tenderness on pressure on the right side, the sight was improv-
ing, and he was cheerful. To take two grains of disulphate of quinine,
with five drops of dilute sulphuric acid, every six hours, and to continue
a bland nutritious diet. - - -
November 7th. The salivation was nearly gone, and the patient felt
so much better, that he went out for a drive for an hour. When I saw
him in the evening, he said that he had spat a little blood; but I could
not detect any bleeding spot, nor did it recur during an hour that I
BY W. WHITE COOPER, ESQ. 21
remained with him. He was desired to use the gargle frequently, and
to continue the quinine.
November 8th. The sight steadily improves, and the patient con-
siders himself convalescent. He has been out for another drive, and is
making preparations for his departure for Cuba. At my evening visit,
there had been no return of the bleeding; and I believed that it was at an
end, little anticipating the catastrophe which was so shortly to follow.
November 9th. On my arrival at 11 A.M., I was grieved at finding a
great change for the worse. Mr. W. S. had retired to bed on the pre-
vious evening in good spirits, and feeling very comfortable. About 1 I
P.M. he awoke with a sensation of suffocation; and, partly by coughing
and partly by vomiting, relieved himself of a quantity of blood. He
did not summon assistance; but continued at intervals, during the night, -
to hawk up blood mixed with viscid saliva, and was greatly tormented
with coagula in his throat, which he had difficulty in removing. I found
him reclining on a sofa, pale, and still expectorating blood. This did
not flow in gushes, nor pure, but was hawked up in the form of coagula,
mixed with much viscid saliva. His pulse was rapid and feeble, and he
was greatly depressed in spirits. I at once administered some hot
brandy and water; and, when he had rallied a little, washed out the
mouth with a sponge, and sought for the source of the haemorrhage.
With my fingers, I pulled out coagula from the fauces, but could not
discover whence the blood came. Under these circumstances, and not
desiring to take on myself the whole responsibility of the case, I sent
for Mr. Fergusson, requesting him to bring instruments, in case it
should be necessary to perform an operation. During the interval, I
caused the patient to hold ice in his mouth, to gargle his throat with a
strong styptic solution, and administered a dose of gallic acid. On Mr.
Fergusson's arrival, he made a most careful examination, but with no
better success than myself. In this state of absolute doubt as to the
seat of the hamorrhage, it was decided to give two grains of diacetate
of lead, with half a grain of opium, every two hours; to support the
strength by brandy in jelly; to cause the patient to swallow iced water
frequently; and to carefully watch the symptoms. I remained with him
several hours; and, at 11 P.M., had the satisfaction of finding that he had
ceased to expectorate blood, and had fallen into a tranquil sleep at 9
P.M., having taken three of the pills. His bowels had been acted on
thrice, and he had passed a considerable quantity of black grumous
blood. Pulse 100, of very fair strength, and extremities warm. He was
lying on a sofa on his right side; and, although he was still dressed, I
did not think it prudent to disturb him by removal to bed. I sat up with
him during the night, occasionally feeling his pulse and extremities.
The former continued good, and the latter retained their heat. He
continued to sleep in the same attitude until a little before 6 A.M., when,
whilst I was standing watching him, he raised himself up, turned round,
and laid down on his left side, with his head resting on his arm. Think-
ing that he was waking, I went up, and, placing my hand on his shoul-
der, inquired how he felt 2 Receiving no answer, I looked closely at
his face, and saw at once that he was dead | Nevertheless, I tried all
the means in my power to restore animation, but they were of no avail.
He had fainted, and the heart had ceased to pulsate.
22 FATAL GASTRO-INTESTINAL HAEMOHRHAGE.
A violent chill, from exposure to cold during my attendance on this
case, confined me to bed for the two following days, and prevented my
being present at the post-mortem examination, greatly to my disap-
pointment. It was, however, conducted in the most careful manner,
twenty-six hours after death, by Mr. Fergusson, to whom I am indebted
for the following particulars:
“On inspecting the body of the late Mr. W. S. this morning, I con-
cluded that the cause of death was bleeding from the bowels, compli-
cated with disease of the heart. The intestines generally were filled
with clotted blood, which had accumulated for many hours previous to
death. The stomach contained the same; and the appearance of the
mucous membrane of the canal indicated that it had been the seat of
the haemorrhage. The heart was at least one-third larger than natural,
- and its left ventricle was remarkably thickened. The liver was larger
than natural. One kidney was somewhat diseased, but all the other
viscera seemed tolerably healthy.
“There was no ulcer nor abrasion on the throat, ſauces, or tongue;
and the bleeding from the mouth must have resulted from some pecu-
liarity which had caused the escape of blood from the lining membrane
of the stomach and bowels.
“Mr. W. S. was, as you know, salivated by a very small quantity of
mercury. This condition is so common, while bleeding from the mu-
cous membranes at the same time is so rare, that I cannot suppose the
one to have been the result of the other.—W. F.”
REMARKs. “Haemorrhages”, says Dr. Watson,” “from various parts
of the mucous membranes, are, in truth, very common effects of cardiac
disease”; and to this fact must the fatal result of the case before us be
mainly ascribed. On review, it presents several points of considerable
interest. Had the disease of the heart existed without mischief in the
liver, or the liver been enlarged, the heart being sound, there would, in
either case, have been a predisposition to intestinal haemorrhage from the
congestion caused in the abdominal vessels. The hyperamia of the liver,
in the present instance, would be a natural consequence of the cardiac
disease; and thus there would result so great an obstruction in the
abdominal circulation, as to gorge the vessels of the whole intestinal
canal to the utmost, giving rise to hamorrhage by exhalation from the
mucous membrane. The spleen does not appear to have been enlarged
to any extent, though such a condition might have been expected. Con-
sidering that the patient had been long resident in the Havannah (the
climate of which is so pernicious to Europeans, that it is said that more
than one-half of those who arrive there are carried off in the course of
one year, principally by yellow fever), and that he had suffered from
fever, it is matter of surprise there was not more extensive mischief in
the liver and spleen.
The constitutional idiosyncracy, which led to the production of so
powerful an effect from a single dose of calomel, could not have been
foreseen, nor was the patient aware of such a peculiarity; but the mer-
curial action might have increased the haemorrhagic disposition, by dimi-
mishing the cohesion of the blood, and lessening its power of coagula-
* Lectures on the Practice of Physie, vol. i., 248.
BY W. WHITE COOPER, ESQ. 23
tion, Thus we find a series of conditions which, separately, might not
have caused death at that time, but in combination, led to the fatal
result. It is, however, clear that, with a heart so diseased, death must
have taken place at no distant period. -
A point which caused much embarrassment, and materially increased
the obscurity of the case, was the mode in which the blood was got rid
of Instead of being vomited up, as might have been expected, con-
sidering the source whence its originated, it was hawked up, as if it
came from some part of the fauces or throat. The swelling from the
mercurial action had not entirely subsided, rendering it difficult and
painful to open the mouth widely; thus it was no easy matter to obtain
a view of its interior: nevertheless, although neither Mr. Fergusson
nor I could detect the seat of the bleeding, we satisfied ourselves that
it was not in the mouth. It had occurred to me, that it might be a
case of haemorrhage by exhalation from the gums and fauces; but having
directed the patient to cleanse those parts thoroughly by washing and
gargling, I swept away the remaining coagula with a sponge, and care-
fully watched whether any blood exuded; nothing of the sort was
visible, but after the lapse of a minute, the patient began to hawk and
to endeavour to clear his throat of coagula. The distress occasioned by
these clots was painful to witness; a mass would be drawn out, afford-
ing momentary relief, only to be followed by the tickling and choking
sensation of another mass, and so firm were these, that it was necessary
to scoop them out of the fauces with the finger, or to sweep them away
with a sponge. During life, the impression on the minds of Mr. Fer-
gusson and myself was, that the blood came from the fauces or their
neighbourhood; but the most careful examination after death failed to
discover any ground for this opinion; on the other hand, ample evi-
dence appeared in the stomach and intestinal canal, especially the latter,
that the blood had been poured out from the mucous membrane lining
those parts. -
The death of this patient illustrated extremely well the effect pro-
duced on a weakened heart by the erect posture being suddenly assumed.
Well aware of the danger of throwing a burthen upon such a heart, I
had particularly cautioned him against sitting up. To this he had
attended whilst awake; but the stiffness, produced by lying the whole
night on one side, probably caused him to shift his position whilst more
than half asleep; he rose up with vigour, but the heart, unable to bear
the additional column of blood, stopped, and life became at once extinct.
The amount of blood lost was by no means such as to lead me to anti-
cipate death; so far as could be judged, it was between four and five
pounds—certainly not more; and so little did Mr. Fergusson expect a
fatal result so soon, that he had made an appointment for the morrow,
confidently believing that he should find an improvement in our patient,
but he, poor man, died some hours before the time named for the
consultation. - * -
Tenterden Street, December 1849.
24
BIBLIOGRAPHICAL RECORD.
MEDICo-CHIRURGICAL TRANSACTIONs. Published by the Royal Medical and
Chirurgical Society of London. Volume the Thirty-second. Pp. 192.
London : 1849. -
It has been often said, that all human institutions have their periods of
greatness and decay; and it would appear that the history of the Royal Me-
dical and Chirurgical Society of London forms no exception to this law. Here
we have a sparsely-printed 8vo, of 192 pages, published as the totality of the
papers of Session 1848-49, deemed worthy of appearing in the Transactions.
So startling a fact calls for investigation; and, as an important step in the
inquiry, we have, with the assistance of the copious reports of the Proceed-
ings which appeared in our volume for 1849, constructed the following tabu-
lar history of the session:—
- I. REJECTED PAPERS. SESSION 1848–9.


*- t
|- F. Or Londjour,
Subjects. Author. | Not F. When read. º
1. Protection from Conta-
gion of Animal Poisons William Acton, Esq. F. Nov. 14, 1848 p. 108
2. Creeping Bubo . . . . . Sam. Solly, Esq. F.R.S. F. Dec. 12 — 111& 437
3. Keloides . . . . . . . . Erasmus Wilson, Esq. F. Jan. 9, 1849 211
4. Case of Cheloidea. . . . W. O. Chalk, Esq. F. — * &b.
5. Aneurism of Axillary
Artery. . . . . . . . . Henry Hancock, Esq. F. — 23, - 296
6. Scarlatinal Albuminuria
$ (embracing 219 cases). James Miller, M.D. F. — tºº- 297
7. Cholera Statistics. . . . J. S. Streeter, Esq. F. Feb. 27, − 397
8. Cervical Paraplegia in
an infant . . . . . . . Henry Davies, M.D. F. Mar. 27, − 500
9. Diabetes . . . . . . . . Wm. Macintyre, M.D. F. — *s 501
10. Paracentesis Thoracis in
Pneumo-thorax . . . . Hamilton Roe, M.D. F. April 10, − 678
11. Foreign Body in Bronchi Sam. Solly, Esq., F.R.S. F. — 24, − 680
12. Secondary Syphilis . . . Henry Lee, Esq. Not F. May 22, — 1688& 797
13. Tumours of Mammary
Gland. . . . . . . . . J. Birkett, Esq. Not F. June 12, — 688
14. Variety of Closed Pupil P. C. Delagarde, Esq. Not F. — * 689
15. Wound of Radial Artery H. B. Norman, Esq. F. — 26, - 777
16. Case of Diseased Larynx. E. Humby, Esq. F. — * ib.
17. Anatomy of Sudorifer-
ous Organs . . . . . . G. Rainey, Esq. Not F.] — - 778
18. Treatment of Pericarditis John Taylor, M.D. F. — sº-º-º: 779
19. Calculi of Pancreas . . ." Oscar Clayton, Esq. F. : — * 781
II. PAPERS PUBLISHED IN TRANSACTIONS. SESSION 1848–9.
& F. or |Lond.Jour.
Subjects. Author. Notf When read. of Med.
* Vol. I.
1. Nitrate of Potash in -
Rheumatism . . . . . W. R. Basham, M.D. | F. Nov. 14, 1848 p. 106
2. Puerperal Fever of
Vienna. . . . . . . . . C. H. F. Routh, M.D. |Not F. — 28, - I08
3. Case of Cysticercus Cel-
lulosae in Anterior
chamber of Human Eye Wm. Mackenzie, M.D. F. — * III
4. Minute Anatomy of the
Lung of a Bird . . . . . G. Rainey, Esq. Not F.] — — . 110
5. Case of Lesion and Re-
paration before Birth | John D. Jones, Esq. |Not F. Dec. 12, — I 12

BIBLIOGRAPHICAL RECORD. 25
II. PAPERS PUBLISHED IN TRANSACTIONs (continued).

e g F. or Lond Jour.
Subject. Author. Not F. When read. º:
6. Appendix to a Case of
Successful Removal of - -
an Ovarian Tumour. . . H. E. Burd, Esq. Not F. Jan. 9, 1849 p. 213
7. Exfoliation of Anterior - -
Arch of Atlas. . . . . Robt. Wade, Esq. F. Feb. 13, − 395
8. Pathological Researches
into Diseases of the Earl J.Toynbee, Esq., F.R.S. F. — * 395
9. Case of Apoplexy of Ce-
rebellum . . . . . . . Robert Dunn, Esq. F. Mar. 13, − 498
10. Mental Diseases . . . . . J.Webster,M.D. F.R.S. F. May 8, - 686
11. Case of Dissecting Aneu-
rism. . . . . . . . . . J.Risdon Bennett, M.D. Not F. June 26, - 781
12. Case of Popliteal Aneu-
rism, in which Femo-
ral Artery wasted. . . . J. D. Wright, Esq. |Not F. — 12, — 689
13. Case of Chronic Hiccup
and Vomiting: oxalic
acid found in Blood. . . Alfred B. Garrod, M.D. Not F.] — 26, - 690
From the above tabular analysis, it appears, in the session 1848-49, that
nineteen papers were rejected, of which fifteen were by Fellows: and of the
thirteen allowed to appear in the Transactions, only six were by Fellows of
the Society! The six approved papers by Fellows may be thus classed:—
CASEs, BY PATHOLOGICAL AND THERAPEUTICAL
Dr. Mackenzie. INQUIRIES, By *
Mr. R. Dunn. Dr. Basham. -
Mr. Wade. Mr. Toynbee.
Dr. Webster.
The seven approved papers, not written by Fellows, may be thus analyzed:—
CASEs, BY - ANATOMICAL RESEARCHES, BY
Mr. Jones. - Mr. Rainey. -
Mr. H. E. Burd. PATHOLOGICAL AND THERAPEUTICAL
Mr. Wright. RESEARCHES, BY
Dr. Risdon Bennett. Dr. Routh.
Dr. Garrod.
We might pursue our analysis of the Transactions much further; but we
have said enough to show, that the Royal Medical and Chirurgical Society is
in a bad state;—and this, notwithstanding the number of its Fellows, and
the known talents and reputation of the majority. Among all the physicians
of the noble hospitals of London, and other Fellows equally competent, one
only—Dr. Basham—has exhibited an effort to benefit the neglected but
all-important science of Therapeutics. This fact, we think, marks the weak-
ness of the Society more than any other, while it points to an easy means
of invigoration :-to encourage the Fellows, who have the opportunities and
the talents fitted for the purpose, to make patient clinical researches into
the pathology of diseases, and uses of medicines, by giving their Essays an
honourable place in the Transactions. Our hospital surgeons have not con-
tributed one line to this tiny tome. Fellows are irritated by the present
regime; but we hope to see a more encouraging system introduced, and the
spectacle never again exhibited of papers of intrinsic value being rejected.
The whole machinery of the Society is rotten, and the institution, if not
renovated and kept in repair, will, in another year, dwindle into a mere book-
lending club. A select committee ought to be at once appointed, to inquire
into the present condition of the Society, not with the view of throwing
discredit on individuals, but of laying open to view the principles of govern-
ment, and the machinery by which the Volume of last session has been made
so paltry, and why the aspect of the present campaign is so dispiriting.
26 BIBLIOGRAPHICAL RECORD.
LETTER. To THE LORD ADvoCATE OF SCOTLAND ON MEDICAL REFORM. By
JAMEs SymF, Esq., F.R.S.E., Professor of Clinical Surgery in the Uni-
versity of Edinburgh, and President of the Royal College of Surgeons of
Edinburgh. Pp. 16. Edinburgh : 1849.
MR. SymF first points out that there is no deficiency in medical instruction
in Scotland, to warrant the exclusive privilege of the Apothecaries' Company
in England. We think this point is not likely to be disputed; but, unfortu-
nately, it has no practical bearing on medical legislation, which has, by almost
general consent, been handed over for settlement to Corporation committees
and intriguing coteries, for whom no common ground existed, but compro-
mise—that miserable refuge of selfishness and baffled ambition.
Mr. Syme avers that he has, for two reasons, constantly predicted the fail-
ure of the various schemes of Medical Reform hitherto brought forward :—
“In the first place, because they were all measures of detail—extremely com-
plex, and affecting a great variety of interests, so that any of the parties
concerned, wishing to impede their progress, could easily find means to do so;
like the London Apothecaries, who not being able to deny the justice of equal
privileges to practice being founded upon an equality of education, instead
of questioning this principle, or expressing any unwillingness to consider the
arrangements proposed for carrying it into effect, confided the safety of their
monopoly to the tactics of delay. Secondly, because none of these measures
were directed with a single straightforward view to general expediency and
public advantage, but were all founded on the principle of give and take, or
mutual concession and accommodation. Your lordship, and your lordship's
predecessors, in attempting to legislate for ‘Medical Reform', have said to
the various colleges and corporations, ‘Arrange the matter with each other,
and when you agree upon the details, I will embody them in a Bill.’ It may
be easily imagined what a tissue of absurd and mischievous regulations would
thus be woven, through the selfish eagerness of each body to gain some advan-
tage, blinding it to the tendency of proposals from others in the way of ex-
change or equivalent for what they surrendered.” (pp. 7-8.) In this passage,
we think, are most correctly stated the causes of the miscarriage of the Me-
dical Bills; and in it, also, we find much cause of thankfulness that they
have all proved abortive.
Mr. Syme laughs at the importance which some attach to the classification
of practitioners by Act of Parliament. In truth, it is an impracticable ab-
surdity. On this subject, we must again allow the author to speak for himself:
—“Another favourite scheme of medical legislation has been the classification
of practitioners into Physicians, Surgeons, and General Practitioners, in com-
plete disregard of many obvious objections; and especially the notorious fact,
that the two former classes exist only in metropolitan cities. The whole of
Scotland at present contains not more than three or four physicians, practis-
ing only as such, and but one surgeon [Mr. Syme QI who devotes his attention
exclusively to surgical cases. In all England there is not, so far as I know,
one pure surgeon out of London." How, then, could this arrangement have
been realized, with due regard to the real position of practitioners ? It is
true that the Medical Bills contained processes of education, which were to
confer the privilege of assuming these titles, which have hitherto been appro-
priated to men actually engaged in practice, immediately upon leaving the
schools. This was to be accomplished by lengthening the period of study,
and multiplying the examinations of candidates, so as to place the acquisi-
tion of such honours beyond the reach of any students, except those whose
pecuniary resources and endurance of irksome restraint—perhaps more indi-
cative of patience than of talent—might enable them to complete the pro-
tracted period of discipline. But is it possible to imagine anything more

* And very few in London. EDITOR.
BIBLIOGRAPHICAL RECORD, 27
absurd than such a system | Is it less absurd than would be the proposal of
a Theological Seminary or an Inn of Court, to determine by education and
examination the grade of eminence to be attained in the Church or Law 2 Is
it to be supposed that a physician or surgeon, having no claim to his title
except the possession of his parchment, could ever displace from public
confidence the practitioner who has gradually risen, in the estimation of his
professional brethren, through many long years of assiduous and successful
exertion; and who, although possessing no title different from those of his
neighbours, is resorted to by them in every case of difficulty . If, indeed,
gentlemen who elevate themselves to this position in practice could, without
any trouble to themselves, and especially without submitting to the annoy-
ance of an examination, be assumed as associates by a College of Physicians
or Surgeons, the arrangement would be no less reasonable than advantageous,
both publicly and privately. But any attempt to determine the estimation
in which medical men are to be held, by ushering them upon the stage
of practice in different ranks, is no less impracticable than irrational.”
(pp. 9-10.) This is true. -
We profess not to be able to follow medical reformers through all their
mysterious labyrinths of “give and take”, and therefore we decline giving
any opinion as to the origin and history of the project of establishing in Eng-
land a College of General Practitioners; but we agree with Mr. Syme in be-
lieving that, “ of all the contrivances which have resulted from the principle
of mutual accommodation, it is unquestionably the most pernicious, and the
most discreditable to its authors.” The dignity and usefulness of the medi-
cal profession cannot be maintained or augmented by vulgarizing the many,
and exalting a capriciously selected few to a theoretical altitude. It is the
first and most sacred duty of a Government, to elevate and improve the great
body of family or general practitioners, and especially those of the humbler
class, who, only by embracing all departments, are able to scrape together a
subsistence in districts too poor or too thinly-peopled to support the pure
physician, the pure surgeon, the pure obstetrician, and the pure pharma-
ceutist. The village surgeon, who “ condescends to men of low estate”, be-
longs to a class second to none in social importance; and his humanity is
not of an inferior stamp because he does not degrade to the rank of a pauper
those who are able and anxious to pay for his services, in such a way as they
can afford. It would be well for humanity, that Mr. Syme’s noble senti-
ments were to find a response in Parliament.
“It has hitherto been supposed”, says Mr. Syme, “that the great duty of
a Government or Legislature was, so far as possible, to elevate and improve
the department of medical practice which ministers to the poorer classes of
society. But the proposed College of General Practitioners would have sunk
beyond the power of recovery, all who were unwise enough to enrol them-
selves under its Charter of degradation.
“So long as the village surgeon is connected with a College, to which be-
long the great and good names of his profession, he is cheered in the dis-
charge of his laborious and ill-requited duties, by the light reflected from
the elevated station of his more eminent brethren ; and he may console him-
self with the reflection, that if circumstances had permitted his cultivation
of a wider field, he also might have proved an Abernethy or a Cooper: but
if you consign him to a fellowship of mere drudgery, without a single asso-
ciation of merit in teaching, writing, or hospital practice, what could be ex-
pected from him, except the feelings and conduct of a man bent upon gain
as the sole object of his exertions? If the new College were ever established,
its leading members could scarcely maintain a distinguished place in their
profession, and would probably not stand higher than the Apothecaries.”
(p. 13. -
tiºn of Medical Reform proposed by Mr. Syme is very simple, and
can therefore, unlike many other schemes which have been promulgated, be
28 BIBLIOGRAPHICAL RECORD.
discussed, by friends and foes, upon its real merits. We see no detail in it
to object to ; but, nevertheless, we pay our tribute of respect to the gene-
rous sentiments and right principles which pervade Mr. Syme’s pamphlet,
rather than to specific projects, which we shrink from entering upon, lest
their treatment should usurp the place of scientific discussions, which are
more suitable to our pages. It therefore now only remains for us to quote
the programme of
MR. ŠyME's PLAN of MEDICAL REFORM. “This plan is founded upon the
principle that an equal amount of qualification should entitle to an equal
right of practice, and upon the assumption that Scotland contains efficient
means of medical education. If these data be conceded, I would propose
that Government should constitute a Board, which, for the sake of distinc-
tion, might be named the Medical Council, and be charged with the follow-
ing duties:—
“I. To determine what amount of education and examination should be
held requisite for obtaining the license of general practice.
“2. To sanction or constitute Boards for bestowing the license of general
practice in London and Edinburgh, and also in Dublin, if the mea-
sure should be extended to Ireland.
“3. To publish annually a REGISTER OF QUALIFIED PRACTITIONERs, toge-
ther with the degrees, diplomas, or other honorary distinctions, which
they may have acquired.” (p. 15.)
Mr. Syme concludes by showing, that the honours at present conferred by
Universities, and by the Royal Colleges of Physicians and Surgeons, would
not be affected by this plan; but suggests, that if these honours were bestowed
in compliance with rules laid down in improved Charters, (in accordance
with the tone of public opinion,) “all the objects of Medical Reform being
thus accomplished, and peace taking the place of angry contention, profes-
sional talent would be allowed to pursue its proper course in the promotion
of Medical Science.” (p. 16.)
ANNUAL REPORT of THE PROGRESS OF CHEMISTRY AND THE ALLIED SCIENCEs.
By Justus LIEBIG and H. Kopp. Edited by A. W. HoFFMAN and W.
DELARUE. Parts I, II, III. 1847–48.
WE hail the appearance of this work with much satisfaction, believing it
likely to be of practical utility. Although the study of modern languages
is general at the present day, yet there are many chemists who, not possess-
ing the advantage of an acquaintance with French, German, and Italian,
are precluded from the study of the numerous valuable works and scientific
periodicals continually issuing from the foreign press. To them, as well as
to those to whom want of time or opportunity present an equal bar, this An-
nual Report will be of infinite service. The eminent names of LIEBIG, Kopp,
HoFFMAN, and DELARUE, are a guarantee for the fidelity of the execution;
and immense pains have clearly been bestowed on its compilation.
Part I treats of MoDECULAR ACTIONS and ATOMOLOGY ; and under the
head of THERMOLogy much valuable information is contained. That beau-
tiful experiment of Faraday's is now generally known, by which he ra-
pidly freezes mercury by a mixture of ether and condensed carbonic acid,
after it had assumed the spheroidal state in a red hot platinum crucible. The
mercury thus freezing in a red hot vessel, is one of the most striking pheno-
mena we know. Moritz states that, even on glass, water may easily be ob-
tained in the spheroidal state, when placed at the boiling temperature, upon
a heated glass surface; but this is less wonderful than the former. The sub-
ject of the formation of dew has undergone a re-examination by Melloni, and
the interesting results are carefully given. Melloni distinguishes three hori-
zontal strata in the air which surrounds thick vegetation. The highest
stratum is in contact with those parts of the plants, that are radiating most
strongly. This air falls down, and becomes still further cooled in the middle

BIBLIOGRAPHICAL RECORD. 29
region, where the vegetation is thicker, and still subject to radiation: it is
here that the dew point occurs. The air now falling quite down to the
ground, and between the lower parts of the plants, which are entirely pro-
tected by the upper, becomes warm again, and rises, loaded with the moisture
of the soil, again to commence the same route. This circulation is the special
condition of the formation of dew. Hence it is intelligible, why a draught of
air opposes its deposition; why, in very dry air, dew is met with only near
moist ground and stagnant water; and why the higher trees, exposed as they
are to air currents, and surrounded with a drier atmosphere, are so little
liable to be bedeved; and, on the same principles, why dew does not occur
on the little Polynesian islands, and on ships on the high seas. KINETICs (or
the science of motion), Acoustics, and OPTICs, complete the first part. The
nature of the candle flame has been recently investigated by Wolger, who
states that a globular blue flammule, or flame bud, is first produced at the
summit of the wick, and is surrounded by a reddish violet halo, the veil. The
increased heat now gives rise to the actual flame, which shoots forth from
the expanding bud. The interior consists of a dark gaseous cone, and is
surrounded by another dark hollow cone, the inner cap. The external cap
constitutes the most luminous portion of the flame, in which hydrogen is
consumed, and the carbon rendered incandescent.
Part II is devoted to MAGNETISM, ELECTRICITY, and INoRGANIC CHEMISTRY.
The last three years have been prolific in discoveries and observations on the
phenomena of Magnetism and dia-Magnetism, by Faraday, Oersted, and
other indefatigable labourers, at home and abroad. This portion of the work
is not less carefully done than the remainder; but the multiplicity of facts,
and the terse style in which they are recorded, obliges us to refer to the
work itself. -
ORGANIC CHEMISTRY forms the subject of Part III, and presents some valu-
able observations on Fermentation and Putrefaction, by Blondeau, Schmidt,
and Wagner. When speaking of Nicotine, we are informed that the pun-
gency of snuff is partly due thereto; and, as the question is not unfrequently
started, others besides snuff-takers may be glad to know that “in snuff nico-
tine is partly free, partly in the form of a neutral or basic salt, most proba-
bly an acetate. The ammonia therein is likewise present in form of salt,
and it is to these two salts that snuff owes its pungent effect on the mucous
membrane of the nose.” (p. 472.) *
In a Quina Bark, occurring in commerce in the same packages as quina
regia, but resembling externally quina Huamilies, Winckler has observed a
new organic base, which he calls quinºdine, and which, according to his ob-
servations, is frequently present in commercial sulphate of quinine. From a
large quantity of crude quinidine, Winckler separated quinine and a yellow
resinous substance. The insoluble residue, when dissolved in alcohol of 80
per cent, treated with animal charcoal, and slowly evaporated, yielded
coloured crystals of quinidine. These, when purified, formed large crystals,
possessing the lustre of glass, and having the form of a right angular four-
sided prism, either slightly truncated or pointed by one or two planes.
Winckler also strongly recommends cinchonine as possessing never-failing
febrifuge qualities.
The third Part not only concludes Wol. i., but contains the first sixty-four
pages of Wol. ii, a somewhat awkward arrangement, because they are almost
sure to be soiled or lost, if the first volume is bound up before the second
volume is completed,—leaving them as loose sheets. Alcohols, Wolatile Oils,
Colouring Matters, etc., form the subjects of these pages, and the mention of
colouring matters reminds us of a curious fact, which we give on undoubted
authority. One of the most eminent colour manufacturers, in London, was
unable, although repeated attempts were made, to strike a good scarlet, dur-
ing the whole time the cholera prevailed in the metropolis. Some atmo-
spheric influence was at work which bafflled the most carefully-conducted
30 IBIBLIOGRAPHICAT, RECORD.
experiments, and rendered the production of that brilliant colour impos-
sible. -
This work, being intended for practical men, is essentially practical; and
we believe it to be well calculated to assist the working chemist, and to for-
ward the progress of the science of Chemistry in this country and its depend-
encies.
Lectures on MEDICAL MISSIONS: delivered at the instance of the Edin-
burgh Medical Missionary Society. pp. 320. Edinburgh : 1849.
THIS is truly an important volume; and, apart from the particular object
for which the lectures were delivered, they contain such an exposition of
Medico-Christian Ethics as must produce a benign influence on every thought-
ful and conscientious physician, by whom they are perused.
The volume contains-six Lectures, and a Prefatory Essay by DR. WILLIAM
P. ALISON, the esteemed and able Professor of the Practice of Medicine in
the University of Edinburgh.
Lecture I is Introductory; and contains a very eloquent and stirring state-
ment by MR. MILLER (the Edinburgh Professor of Surgery), in which it is
proved, both by theoretical arguments and historical details, that the most
successful apostle of Christianity and civilization, is the man who combines
with the piety and devotion of the Christian, that aptitude in therapeu-
tics which is possessed by talented men, thoroughly educated in medico-
chirurgery. Mr. Miller advocates “no permanent or general conjunction of
Medicine and Divinity—as was attempted in the ancient period of conjunc-
tion and decline ; but only that occasionally Medicine shall become the
graceful handmaid of Religion, and assist in winning souls; that but a com-
paratively small number of devoted men shall go forth from the medical, to
the missionary, field, while the main body still continue, in their peculiar
vocation, to advance and elevate the healing art.” (p. 33.)
THE ACTUAL SUCCESS of MEDICAL MISSIONS is thus set forth : “It is not
the untried experiment of yesterday of which we speak. At this time, there
are about forty Medical Missionaries labouring in various fields. In Syria,
whence the system first sprung ; scattered through all Asia ; in Polynesia ;
in Africa ; among the Savage tribes of America. In God's providence, they
seem to have found wide doors specially opened for their entrance. As
Medical men, they have found ‘access to communities and families in heathem
lands, where the mere evangelist is not permitted to enter’. ‘He who is a
physician is pardoned for being a Christian ; religious and national preju-
dices disappear before him ; all hearts and harems are opened ; and he is
welcomed as if he were carrying to the dying the elixir of immortality. He,
more than any one else, possesses the mollia tempora fandi.” In the wilds of
the Assyrian mountains, Dr. Asahel Grant, ‘armed with his needle for the
removal of cataract, forced mountain passes’ which the sword could not com-
mand ; and ‘amidst ferocious warriors, won his way to their homes and their
hearts. On account of his professional skill, he was enabled to traverse, in
safety, regions heretofore untrodden by civilized man; where inevitable
death met the ordinary traveller, and in whose defiles an army would perish
in attempting to effect a forcible entrance.” In Damascus, “while all other
Franks were grossly insulted and pelted with stones, Dr. Thompson was
allowed to pass unmolested.’ A Missionary of thirty years’ standing in
India, has declared, that, “but for the attention he was at some pains to
render the sick, he knew not how he could have gained the confidence and
ultimately the affection of the natives'. Mr. Gerstmann, “by the exertion of
his medical skill amongst the people (at Jerusalem), was the means of
bringing large numbers of the Jews to listen again to Christianity, after they
had entirely withdrawn themselves, at the command of the Rabbis.” . In
$iam, Dr. Bradley introduced vaccination, and became something more than
BIBLIOGRAPHICAL RECORDI 3I
the Jenner of an empire of four millions. In Ceylon, Dr. Scudder, by his
wonderful healings, eclipsed the great idol Corduswammy ; and, as in Lystra
of old, they sought to worship him as a god. In China, progress has been
great, and promises almost unlimited increase. In 1820, Dr. Livingston
established a small hospital at Macao ; in 1827, he was followed by Mr.
Colledge; and to both of these British Medical Missionaries “the sick, the
maimed, and the blind, resorted in crowds.” In 1835, Dr. Parker, from
America, settled in Canton ; and to him ‘patients of all ranks flocked from
all quarters.” Other labourers have joined since. Now, the applicants for
relief are counted by thousands; and, true to the apostolic plan, while they
are ‘healed of all manner of disease, they have also ‘the Gospel preached
unto them.’ So bright is the prospect of success in that vast country, that we
find one of the Missionaries thus expressing himself: “I have no hesitation
in stating it as my solemn conviction, that, as yet, no medium of contact,
and of bringing the people under the sound of the gospel, and within the use
of other means of grace, can compare with the facilities afforded by Medical
Missionary operations.” Nearer home, the labours of Dr. Kalley, in Madeira,
have proved so signally triumphant as to awake the fiercest rage of the adver-
sary; and the very expulsion of the missionary and his converts from the island,
stands recorded as the measure of his faithfulness and success.” (pp. 35-8.)
Lecture II—on the IMPORTANCE OF MEDICAL MISSIONs is by the REv.
WILLIAM Swan, lately missionary in Siberia.
THE HEATHEN PRIEST-DoCTORs seem to understand and practise the same
tactics as our unlicensed counter-physicians, and other empirics, who, when
the case becomes alarming, or the patient’s money eachausted, retire in favour
of the legitimate practitioner “I have known,” says Mr. Swan, “repeated
instances of a heathen priest and doctor sending a patient to the Christian
missionary, after he found that, in his hands, the sufferer was sinking to the
grave. If the missionary's treatment be successful, the priest claims the
honour of the cure in virtue of some of his own medicines, which the patient
was ordered secretly to take 1 if the sufferer perish, after being prescribed
for by the Christian practitioner, his death is ascribed to his want of skill, or
even to his murderous intention. It is obviously necessary, that the medical
missionary ought never to take under his care a patient in the last stage of
disease, without very careful preparations, and a distinct prognosis to which
he can in due time appeal. Another rule is—never to undertake a case
while the native physician continues to tamper with it. . . . . I have spoken
of rich patients. The priests have taken care to give currency to a maxim,
which has a happy effect in securing the due payment of their fees. It is
this—that the medicine which is not paid for, will do the patient no good;
and that the skill of the physician will be exerted in vain, if his services are
not adequately rewarded. Perhaps the adoption of this maxim need not be
objected to nearer home.” (pp. 97-98.)
Lecture III contains a description, by Mr. WILLIAM BROWN, of the QUALI-
FICATIONs of THE MEDICAL MISSIONARY. We regret that we can only quote
one of the concluding paragraphs.
“Let me now gather together the leading thoughts that have been spread
over this address, and place them before you more briefly. The Medical
Missionary must know well his profession—he must have pursued steadfastly
a full course of professional discipline—he must have acquired the power of
distinguishing diseases, and of applying the suitable remedies—he must have
skill in operating, when he has ascertained that an operation is necessary—
he must exercise his profession with ardour and perseverance—he must have
* Patients coming to us from homoeopaths have several times secretly continued
to take their globules along with what we prescribed. The mixed faith of quack-
fanciers is a curious psychological study. EDITOR. -
32 Bj BLIOGRAPHICAI, HECORD.
a feeling heart for the sufferings of his fellow-creatures, and a conviction
that he is responsible to God for the use he makes of the remedies which are
placed at his disposal—he must be conciliatory and forbearing to his neigh-
bours and associates—he must be of a peaceable and peace-making spirit—
he must be a Christian ; convinced by reflection of the Divine authority of
the Scriptures ; feeling personally his need of that deliverance which the
Gospel reveals; grateful to that Saviour who has procured the blessing to
him ; and determined, by God's grace, to show his gratitude, by his obedi-
ence, and by the consistency of his conduct. Conscious of his own sins and
shortcomings, he has no desire to boast of his merits; and yet he thinks it
no boasting to tell others, that since he became a Christian, he has been
much happier than before, and that every effort he has made on the side of
truth and virtue, has ever advanced his own enjoyment. Knowing that the
efficiency of every remedy depends upon the blessing of God, he gladly asks,
—in prayer, for such a blessing; and he meekly feels that he is but an instru-
ment, in God’s hand, in all the success which attends his exertions. Being
himself a Christian, he desires that others shall become Christians also.
Being himself satisfied that sin is no trifle—that the displeasure of God, on
account of sin, is no idle imagination, but a stern reality—that there is only
one way to heaven hereafter, and one way to real, lasting happiness here, he
desires that all may find that blessed path, that all may listen to the Divine
Saviour when He says, “Come unto me, all ye that labour and are heavy
laden, and I will give you rest.’ (Matt. ix, 28.)
“He may possess the qualifications, physical, mental, moral, which fit him
for going to China, or some other far distant land. If so, he has a glorious
prospect before him ; because to do good to others ought to be, in subser-
vience to God’s will, a ruling motive in life, and to do the greatest amount
of good, must be the best sphere of duty. But he may lack some one of
these. His physical frame may be unfitted for a tropical climate ; or his
mental capacities may be unable to acquire an Oriental language, or to grapple
with the subtleties of Hindoo sophistry; or he may shrink from the supposed
dangers, privations, and toils of the professedly missionary work. In such
case, he cannot have the honourable place which belongs to those who press
into the van of the spiritual conflict. But he is not, therefore, excluded from
it altogether. He may still enjoy the blessed privilege of serving the Lord
Jesus nearer home. He is not relieved from the solemn responsibility laid
upon him, of consecrating himself, and all his powers to the Saviour. The
man who declines the missionary work at home, because he cannot prosecute
it abroad, has no missionary spirit at all.
“The minister may be a missionary to the poor and ignorant at home;
and the physician or surgeon may be a Medical Missionary to the same per-
sons. We know that it is possible to be a Medical Missionary in Ireland ;
and there are many districts in that “Emerald Isle' where there are darkened
minds and yet warm hearts, and where a Christian medical practioner will
do more for the moral and physical wants of the poor, than any other agent
of philanthropy. And are there not in Scotland and in England not a few
stations of which the same thing may be averred We need not travel out
of Edinburgh to find such stations. Many of you know the West Port, the
Grassmarket, the Cowgate, the Canongate, and know that a Medical Mis-
sionary is needed in each of these localities. It is cheering to know that not
a few of the practitioners in Edinburgh already fulfil that office, although no
society has appointed and sent them forth. There are students also in train-
ing for the same work. They are not the least promising alumni of the
University, and not the least exemplary in their deportment. The young
man who, in the surgery or shop, retains his integrity when others forget it;
who cultivates purity of life, when others wallow in vice ; who, consistent
himself, kindly, yet firmly, reproves the errors of others; who induces them
to frequent the public worship of God as sedulously as the lectures of their

BíBLIOGRAPHICAI, RECORD. 33
teachers ; who leads them to value the Scriptures, and to make them the
subject of their diligent perusal; who strives to raise the tone of moral con-
duct in all around him, and in himself also, up to the standard of God’s law,
and to the example of God our Saviour;-that is a Missionary, and will ob-
tain the Divine approbation, and the Divine reward.” (pp. 179-183.)
Lecture IV—on the DUTIES of A MEDICAL MISSIONARy—by the REv. J.
WATson, is highly practical, and well-suited to afford information to those
who contemplate entering upon the field of Medical Missions. We regret
that we are unable to afford space for extracts, as they would require to be
of considerable length to render them of any service to the reader.
LECTURE W. When all is excellent, it is difficult to praise with sufficient
discrimination ; but we can conceive of no discourse more calculated to do
good among the members of our profession, than that of DR. GEORGE WILson,
on THE SACREDNESS OF MEDIGINE. If printed off as a separate tract, and
freely circulated among medical men, it might, we believe, very eminently
subserve the cause of humanity and truth. It would indeed be a blessing to
society, if the majority of medical men were actuated by the principles therein
laid down : and to themselves the advantages would be as great. After all,
Christianity is the only safe foundation on which to rear a code of ethics
suited to bind together in one harmonious brotherhood our distracted ranks,
and to save them from being the prey of ill-regulated coteries, or individual
assaults. -
Dr. Wilson takes up high ground : but we do not think that he goes one
whit too far. If a physician be a Christian, he must act the part of a Chris-
tian in all circumstances, and not abstain in the chambers of sorrow, of sick-
ness, and of death. Rarely may it be proper for him, and still more rarely
may his special and often urgent avocations permit him, to administer reli-
gious consolation with fulness and formality, but he may often pave the
way for others, on whom this duty devolves. Life and health, be it remem-
bered, are the most likely seasons for the minister's usefulness. How often,
alas ! has it been our melancholy lot to witness the dying sinner seeking,
when it was too late, the advice of the minister; for, even when death is post-
poned, the pain, the delirium, the weakness, or the listlessness of disease,
too often renders useless the needed statements and appeals. In such cases,
the best spiritual friend in the sick-room is undoubtedly the pious physician.
He may be able gently to instil comfort and instruction, when more formal
inculcation would not be received. He may time and adapt his observations
to the varying bodily condition of his patient. Thus, truly and eloquently,
writes Dr. Wilson:—
“‘Not poppy, nor mandragora, nor all the drowsy syrups of the world”,
will overcome the wakefulness of despair; and a tortured conscience, even
without the help of insanity, can often resist all the calmatives, and ano-
dynes, and anaesthetics of the Pharmacopoeia. The ‘Materia Medica’ has,
of necessity, a moral as well as a physical department—a religious as well as
a chemical or botanical storehouse, from which to draw remedies. Layman
though the physician is, he is invested with some of the clerical functions;
and, though he does not share in clerical dignities or honours, he does in re-
sponsibility, and cannot throw it upon the clergyman's shoulders. He must
serve at some altar, though it be that of atheism, and be the minister of a
known, an unknown, or a no God.” (p. 225.)
These last words are terrible; but they are true.
We earnestly recommend these Lectures to the perusal and study of the
profession : and we hope that many may go forth from among us, under
the banner of the Medical Missionary Society, to bless a diseased and ruined
world. Here, we must pause, reserving the consideration of Dr. Coldstream's
lecture to another occasion. º:
(To be continued.) f
WOL. II. 3
34 BIBLIOGRAPHICAL RECORD.
SoMNoLISM AND PsychEIsM, or HERWISE WITAL MAGNETISM or MESMERISM.
With an Appendix. By JosRPH N. HADDock, Surgeon-Apothecary.
pp. 73. London: 1849.
In this dull weather, it is refreshing to meet with a really facetious book,
—a book which makes us laugh in spite of a fog without, and bile within.
We are not quite sure whether the author of the work before us is a wag who,
with a grave face, has put forth a satire upon the subjects of which he pro-
fesses to treat, under the sober garb of serious earnest,--a sort of Theodore
Hook in a Quaker's costume, mystifying the public, (as poor Theodore loved
to do in his best days,)—or, (which seems scarcely probable,) a visionary who
has faith in what he writes. We incline to the former belief, and thank him
for having helped us to pass, very pleasantly, what would otherwise have been
a dull evening. The book is, altogether, rather of an astonishing character,
like the Travels of Baron Munchausen; but the raciest parts are the expe-
riences of a certain Miss Emma, a damsel “five feet two in height, of rather
sallow complexion, and of a nervous bilious temperament”. This young lady
is supposed to be experimented on by the author, and we have met with
writers of fiction less successful than he. The following is by no means bad:
it indeed reminds us of our ancient friend, one Lemuel Gulliver, who visited
foreign parts, and saw rather strange things. The allusion to the necessity
for forbearance, lest harm should arise from over-excitement, is a masterly
touch.
“Having heard of clairvoyants visiting the planets, I determined to try
the experiment with Emma. I therefore proposed an eacursion to the moon,
and not then knowing how to direct her attention to such distant objects, and
she herself being, at the time alluded to, wholly ignorant of the mode by
which a knowledge of distant things is obtained, and fancying that she
actually travelled by some mode, I suggested the electric telegraph as an ex-
peditious mode of conveyance. The suggestion answered the purpose, and
she was, mentally, soon on our satellite. But on that and subsequent occa-
sions, the great excitement produced by the strangeness of what she saw,
and the distance travelled, caused such a palpitation of the heart, as to render
it necessary to shorten the visit by de-mesmerising her; being fearful that the
great physical excitement might produce some serious effect on her health,
if not immediate danger. Her description of what she saw was conveyed in
very ejaculatory language, from the surprise and pleasure she experienced.
Her statements were to the effect that the moon is inhabited; that the inha-
bitants she saw were very small—dwarfs—not larger than children on our
earth; their heads were large in proportion to their bodies, and the mouth
vertical rather than horizontal; their voices harsh, and rough, and resembling
the sound of distant thunder; and when they spoke, the speech seemed to
come up from the bowels. Their “insides’ were not quite like ours; the
lungs especially were different. She saw some food, something that looked
somewhat like bread, but they did not call it by that name. She saw only
one animal, something like a very small pig. There (sic) dwellings were
constructed of pieces of rocks, covered over with green stuff resembling
gorse; they were very low, for she could put her hand to the top. The
place did not look like what she conceived the moon to be, but a large place,
and very rocky, with immense precipices and lofty mountains. The ‘little
folk’, as she called the inhabitants, could clamber up these rocks with their
hands and feet, so fast that she could not catch them. Is there any water
there? Yes, “but it does not look like our water, but more like milk and water,
and yet it is clear (meaning probably that it is of greater density than our
water). It lies in the bottom of hollows, and down the steep precipices.
The ‘little folks’ can walk upon this water and not sink: they are very light.
They wear clothes, but they are very simple, and all alike. They seem a good
sort of people. They have a curious way of jumping on the backs of each
other. A very little baby was seen in a sort of cradle; it died; they said

BIBLIOGRAPHICAL RECORD. 35
what signified that it had gone to sleep; but they did not mean sleep, but
that it was dead.” (p. 59.)
This young lady would indeed be a formidable rival to Lord Rosse, and her
łong range would beat hollow that of Captain Warner
We have treated of this work as an amusing satire upon human credulity.
Could we have supposed it written with any other object, we should have
thrown it aside with indignation, as an outrage upon common sense, and an
exposition of false and impious philosophy.
STRICTURE OF THE URETHRA AND FISTULA IN PERINAEo. By JAMEs
SYME, F.R.S.E., Professor of Clinical Surgery in the University of Edin-
burgh. pp. 72. Edinburgh : 1849. -
The author, in his preface, states that he has been stimulated to the pub-
lication of this work by the circumstance of a plan of treatment made known
by him five years ago, having met with unmerited neglect by the profession ;
which would certainly appear to be the case, if “it has not yet been adopted
by others,” so far as he knows, “even in a single instance.” In this opinion,
however, he is mistaken, as may be seeing by referring to p. 1068 of
our volume for 1849, and p. 61 of the present number. Two objections,
probably, have weighed with practitioners generally, and with patients
also, against urethrotomy; namely, the repugnance entertained to so de-
cided an operation, except in very desperate cases, and the skill necessary
to enable a surgeon to perform it with that confidence which is no small
element in success. We entirely agree with the author that, in cases
where the life of the patient is rendered absolutely miserable by suffering
produced by hopeless STRICTURE, and a thoroughly diseased Urethra, the
operation described is the very best course that can be pursued; but we
doubt whether many patients or surgeons will assent to the proposition that
such a step is desirable “in cases of less obstinacy, but still requiring the
frequent use of bougies.” For so skilful an operator as Mr. SYME, it is, we
doubt not, an easy matter to cut down upon the urethra, and perform the
operation adroitly, and this must be taken as some explanation of his suc-
cess, which has been great ; but we think that the commonality of surgeons
ought to pause before they cut a patient, whose case appears to admit of a
fair amount of relief by ordinary treatment. The following is an account of
the operation recommended. The patient “should be brought to the edge
of his bed, and have his limbs supported by two assistants; one of them
standing on each side. A grooved director, slightly curved and small enough
to pass readily through the stricture, is next introduced, and confided to one
of the assistants. The surgeon sitting, or kneeling on one knee, now makes
an incision in the middle line of the perinaeum or penis, wherever the stric-
ture is situated. It should be about an inch, or an inch and a half, in
length, and extend through the integuments, together with the subjacent
textures exterior to the urethra. The operator then taking the handle of
the director in his left, and the knife, which should be a small straight bis-
toury, in his right hand, feels with his forefinger, guarding the blade for the
director, and pushes the point into the groove behind or on the bladder side
of the stricture, runs the knife forwards so as to divide the whole of the
thickened texture at the contracted part of the canal, and withdraws the
director. Finally, a No. 7 or 8 silver catheter is introduced into the bladder,
and retained by a suitable arrangement of tapes, with a plug to prevent
trouble from the discharge of urine.” p. 41.
The patient has merely to remain quietly in bed for forty-eight hours,
when the catheter should be withdrawn, and all restraint removed. The
urine sometimes maintains its proper course from the first, but more fre-
quently passes in part through the wound for some hours, or it may be a:
few days; at the end of eight or ten days, a moderate sized bougie should be
passed, and repeated once a week or fortnight, for two months. In most
3


36 BIBLIOGRAPHICAL RECORD,
cases, the cure may then be considered to be complete. Unquestionably,
such a proceeding, severe though it may seem, would be considered prefer-
able by many, whose occupations or positions in life are seriously interfered
with, by the torture of a diseased urethra and an irritable bladder. We are
therefore happy to assist Mr. Syme in making this operation more known,
hoping that when placed fairly on its trial, it may obtain a favourable verdict.
Sir B. Brodie, in his valuable Lectures on Diseases of the Urinary Organs,
describes FISTULA IN PERINEo as being the result of ulceration behind the
stricture, from the pressure of the urine ; and FISTULA IN ANo as being formed
in the same manner, by ulceration of the rectum allowing the escape of a
minute quantity of feculent matter into the neighbouring textures. From
this view of the case Mr. Syme entirely dissents, describing the process as
the formation of an abscess close to the external side of the mucous mem-
brane, whether of the rectum or urethra, and having no connexion whatever
with the interior of the canal, in the first instance, although a communication
is subsequently formed by ulceration. *
The treatment adopted by Mr. Syme, in cases of Perinaeal Fistula, is
simple dilatation of the urethra in the milder cases; in the more severe, he
practises the perinaeal incision already described.
We need hardly add, that this Essay, like every production of Mr. Syme,
deserves the earnest and careful consideration of surgeons.
Essays on SYPHILIs. Essay I. Syphilitic Sarcocele. By J. HAMILTON, Sur-
geon to the Richmond Hospital, Dublin. pp.40. Plates 11. Dublin: 1849.
The Author justly observes, that a hospital surgeon of moderate observa-
tion and diligence, cannot fail to discover, in the vast mass of disease submitted
to his care, something which may be considered as an addition to the know-
ledge already existing. Acting upon this principle, he proposes to publish
essays, containing the result of his experience ; and the first of the series of
these is before us.
MR. HAMILTON divides the Syphilitic Sarcocele into Simple and Tubercular,
the latter form being the most common. The Simple Syphilitic Sarcocele
is met with in persons of healthy constitution, and is generally accompanied
with secondary eruptions, occasionally by iritis, periostitis, and ulcers in the
throat. Its characteristics are, ovoid enlargement of the testis, which is
hard and heavy, but not painful, though large in size, and slow in progress;
one testicle only is usually affected, and he has never seen suppuration occur;
in this, and also in the tubercular form, there is almost always effusion of
fluid into the cavity of the tunica vaginalis. In the simple disease, the
treatment recommended is a steady and protracted course of mercury, which
is the only certain means of cure ; after the mercury has been discontinued,
the hydriodate of potash may be used with advantage for a fortnight. The
local treatment consists of leeches and lead lotion, if there be pain and ten-
derness; if not, mercurial unction to the scrotum, followed by the application
of dilute ointment of iodide of potassium. -
The characteristics of Tubercular Syphilitic Sarcocele are, increase of the
organ in size, with irregularity of shape, and both testes are usually affected,
one being worse than the other; there is much constitutional disturbance,
and aggravated secondary symptoms. In this form, slow suppuration occa-
sionally presents itself, leaving either a fistulous opening, or a protruding
fungus. A combination of mild mercurial treatment, with the administra-
tion of iodide of potassium, has been found most successful in subduing this
form. We are a little startled, however, at finding the mild mercurial recom-
mended, is ten grains of blue pill at bed-time for a week or ten days, and
subsequently, five grains. Such doses are not trifles. -
We trust that Mr. Hamilton will meet with sufficient encouragement to
carry out his intentions; and we hope that other hospital surgeons, with simi-
lar extensive opportunities for observation, will follow his laudable example.


IBIBLIOGRAPHICAL RECORD. - 37
THE FIRST ANNUAL REPORT of THE HospitaL FoR ConsumpTION AND
DISEASEs of THE CHEST. Presented to the Committee of Manage-
ment, by the Physicians of the Institution. London : 1849.
The valuable Report before us contains the conclusions drawn from a
statistical analysis of 4,358 cases of phthisis, treated at the Hospital for Con-
sumption, from its establishment in the year 1842, to the end of 1848.
It is arranged under the following heads:— -
I. The number of patients treated, and the facts in their history which
have reference to the origin and progress of Consumption.
II. Some of the principal signs and symptoms of the disease.
III. The duration of the disease and the result of treatment.
I. The entire number of phthisical patients admitted into the hospital was
888; and 3,470 were treated as out-patients. The total number of out-
patients was 10,051. - -
SEx-Of the cases of phthisis, sixty-one per cent, in both in and out-
patients, were males; and thirty-nine per cent. females. This preponderance
of males is at variance with the statement of Louis and other observers, and
with the Report of the Registrar-General for 1842, which states that, in the
provinces, 24,048 males, and 28,098 females, died of phthisis. It agrees
very closely, however, with the report made by Dr. Home, of the cases of
phthisis in the Royal Infirmary of Edinburgh, in the years 1833, 1834, and
1836, in which it is stated that of 297 such cases, 185, or 62.3 per cent.,
were males, and 112, or 37.7 per cent., females. -
AGE. The compilers of the Report find, that, taking the sexes collectively,
the period of life most liable to Consumption is, in both sexes, from twenty-
five to thirty-five years of age. The disease occurred in this period of life
in 953 males out of 2,679 cases, or nearly 36 per cent. ; and in 578
out of 1,679 females, or in a little more than 34 per cent. Under
this period, the liability is greater in females by nearly 10 per cent. ; above,
it is greater in males, by about 12 per cent. This difference perhaps depends,
in some measure, on early predisposition, which more readily affects females,
and on the occupations of males exposing them more to the exciting causes of
disease at a later period of life. - - - - - -
SocIAL CoNDITION. The following table exhibits the social condition of
4,056 of the patients treated. -
* . .


Per centage | Per centage | Total of | Per cent.
Males. of the total Females of total No. both of both
No. of Males. of Females. | Sexes. Sexes.
Singl Under 25, 633 || 25°2 540 35-0 | 1,173 || 28:9 |
*8* Over 25, 475 18-8 319 20.6 794 19:5
Married ºnder 23, 199 3-9 94 6-0 194 4-8 |
* † Over 251,240 49-3 489 31-7 1,729 42.6
Widowed—All ages 66 2.6 I00 6'4 166 4-3
Total . . . . . 2,514 | 1,542 4,056
TRADES AND OccupATIONs. The occupations of 4,358 patients are classified
under the heads of in-door, out-door, and mixed. Of those following in-
door occupations, 1,688 were males, and 1,679 (the total number) females.
Of those employed in out-door works, there were 798 males; and of carpen-
ters, painters, and glaziers, whose occupation is mixed, there were 193.
“The relative liability of persons following in-door and out-door occupations
to Consumption would seem, from the records of this hospital, to be as 63 per
cent. of in-door males to 30 per cent. of out-door; and all the consumptive
females followed in-door occupations. If it were possible to ascertain the
precise number of persons engaged in the various in and out-dyor occupations
38 BIBLIOGRAPHICAL RECORD,
in London, we might, by comparing them with the numbers just stated,
arrive at correct conclusions as to the effects which such occupations are cal-
culated to produce ; but in the absence of this information, we must confine
ourselves to a comparison of the apparent influence which in-door and out-
door occupations have in the production of Phthisis, with that which they
appear to have in inducing other diseases. At this hospital, the in-door occu-
pations of males and females form 77 per cent. of the whole; at a general
hospital, 85 per cent. Out-door occupations form 18 per cent. of the whole
at this hospital; at a general hospital, 9 per cent. The difference, therefore,
is not that which would warrant the inference, that in-door occupations in
themselves have a greater tendency to produce Consumption than any other
disease; on the contrary, the in-door occupations of the patients at this
hospital are 8 per cent. less than at a general hospital, whereas the out-door
are 9 per cent. more.” (p. 15.)
A much larger number of persons following certain employments seek
relief at this hospital, suffering from Phthisis, than of those following other
occupations. But we must bear in mind, that the numbers of persons pur-
suing different occupations vary very greatly ; and it would be desirable to
know the number of persons engaged in each occupation. “This not being
practicable, we avail ourselves of the means at our disposal, of comparing
the numbers which represent the occupations of the consumptive at this
Hospital, with those which represent similar occupations at one of the Lon-
don Hospitals for disease in general. This comparison will afford us the
means of judging how far such pursuits render those, who are engaged in them,
more liable to Consumption than to other diseases. Thus, if we compare the
18 per cent. of out-door labourers with the 10% per cent. of the same class who
attend a General Hospital, we can say that there are nine consumptive per-
soms of this class to five of the same class suffering from other diseases, re-
quiring Hospital assistance. Whilst, if we compare the 3.9 per cent. of
printers and compositors at this Hospital, with the 1 per cent. of the same
occupation at a General Hospital, we conclude that printers and composi-
tors are more liable to Consumption than to other diseases, in the proportion
of nearly 4 to 1, and, therefore, are sufferers to a much greater extent from
this disease than the class last named. Amongst clerks and shopmen, the
proportions are nearly the same as the last, viz. 4 to 1. Proceeding with the
comparison, we find two in-door male servants at this Hospital, for one at a
General Hospital. Tailors are in the proportion of 7 to 6, &c. &c. Amongst
females, the great variety and number of persons included under the de-
signation of domestic employments, forbid any attempt at drawing inference
as to the special influence of their occupations. The next class is that of
needlewomen and milliners, which, whilst it represents 18% per cent. of all
the females attending this Hospital, is found to constitute 13 per cent. of the
sick at a General Hospital; thus, while the persons following these occupa-
tions are shown to be very liable to Consumption, it will be noticed that they
constitute alsº a large proportion of those attending a general Hospital.
Tailors likewise are numerous at both institutions. Clerks and shopmen,
printers and compositors, as already mentioned, rank high amongst the pa.
tients at this institution. Hence the inference is a correct one, which
assigns to these different occupations the power of exerting a more or less
injurious influence on the health of those engaged in them ; for, whilst some
are rendered liable to both Consumption and disease in general, others, who
are less liable to disease in general, are particularly so to Consumption.
“In drawing these inferences, however, as to the effects of different em-
ployments, it cannot be denied that other influences are often conjoined
with those necessarily belonging to the occupation itself: for example, here-
ditary predisposition, intemperance, deficient food, want of cleanliness, etc.
These circumstances must all be kept in view, in forming any opinion as to
the injurious effects on health of any particular occupation. On the other

BIBLIOGRAPHICAL RECORD. 39
hand, there are certain pursuits which, it may be said, almost independently
of these conditions, exercise a directly injurious influence on the health of
those engaged in them—particularly those which compel persons to work in
close, ill-ventilated, and over-heated rooms, sitting for many hours each day in
a posture unfavourable to the free action of the muscles of respiration,
breathing an impure atmosphere, and restricted from taking exercise in the
open air. These are the circumstances which appear to render so painfully
prominent the class of clerks, milliners, printers, tailors, in-door servants,
&c. Persons thus occupied soon feel the effects of these injurious influences;
and if they have any tendency to tubercular disease, it rarely fails to de-
velope itself. Several striking instances presented themselves of young
men and women from the country, previously in good health, who soon fell
victims to Phthisis under these circumstances. It is greatly to be desired,
that the employers of such persons should endeavour to obviate these evils,
by not requiring too long service, by allowing time for exercise in the open
air, and by taking care that the offices, in which the employments are carried
on, be properly warmed and ventilated.” (pp. 16-18.)
HEREDITARY PREDISPOSITION. In investigating this subject, the authors of
the Report have carefully borne in mind the fact, that the hereditary trans-
mission of disease is not necessarily direct, but that a healthy, or apparently
healthy generation may intervene between two in which disease is exhibited.
In examining into the influence on the offspring of disease in the parent,
they have inquired into the state of health of the parents of 1,010 phthisical
patients. If the inquiry were extended to a preceding generation, and
to collateral relatives, the influence of predisposition would probably be
shewn to be still greater. The following table exhibits the result.


Cases of Predisposed by
Sex. Consumption. Disease in Parent. Per Cent.
Males. . . . . . . . . . 669 122 18-2
Females . . . . . . 341 124 36-3
Total . . . . 1,010 246 24'4
This table may be compared with the statistics of other diseases, as regards
hereditary predisposition. In insanity it is found that, “in males, insanity
is an hereditary disease in nearly 12 per cent. of the cases observed, while
Consumption is so in 18 per cent. In females, insanity is hereditary in
about 13.5 per cent., Consumption in 36 per cent. In both sexes, taken
together, the per centage of Insanity is 12.5, of Consumption 24.5. Thus the
probability of Consumption being transmitted to the offspring by a parent
affected with that disease, is as two to one when compared with the proba-
bility of the transmission of Insanity from an insane parent.” (p. 20.)
The table shows also, that daughters are more liable to inherit consumptive
disease from their parents, in the proportion of two to one. As to the rela-
tive influence of the father and mother, it has been found that the father
transmits consumptive disease to the sons in 59.4 per cent., to the daughters
in only 435 per cent. The mother to the sons in 40.6 per cent., but to the
daughters in 56.5 per cent. Remarkably similar results appear in the last
Report of the New York State Lunatic Asylum.
II. Under the head of SYMPTOMATOLOGY, the Report treats of SPIROMETER
OBSERVATIONs and HAEMOPTYSIS.
SPIRomETER OBSERVATIONs. Four hundred and fifteen phthisical patients
have had the capacity of their lungs for air tested by Dr. Hutchinson's Spi-
rometer. The results are exhibited in the following tables; in which, it
will be observed, the cases have been carefully compared with healthy
standards.
40 BIBLIOGRAPHICAL RECORD.
f
Comparison of Healthy and Diseased Cases in the First Stage of Phthisis, or
. . . before Softening. (All Males.)

N - f - Vital Capacity.
8: | Age. Height. - Difference. REMARKS.
~~~~ | Healthy. Diseased. &
. Ft. In. Cubic Inches.|Cubic Inches. Cubic In.
I 28 5 8 23 186 52
2 28 5 4% 206 140 66
3 37 6 2% 286 270 16
4 20 5 3} 198 120 78 d
Both sides, an
5 27 5 7 230 85 145 } emphysema.
6 || 45 6 0} 270 200 70
7 | 86 || 5 64 222 182 | 40
8 36 5 5% 214 170 44
9 || 35 5 7 230 160 70 Both sid d
. - oth sides, an
10 || 38 5 10} 254 140 114 } emphysema.
Much affected on
II 33 5 7 230 80 150 } both sides.
I2 28 5 7. 230 180 50
I3 27 6 1% 274 260 14
- Murmur heard
14 24 5 6} 222 I90 32 } over pulmonary
artery.
Comparison of Healthy and Diseased Cases in the Second Stage of Phthisis, or
after Softening. (All Males.) &

- Vital Capacity.
. Age. Height. pacity Difference.
Healthy. Diseased.
Ft. In. Cubic In. Cubic In. Cubic Im.
I 27 5 6 214 86 128
- 2 21 5 5% 214 60 154
3 45 5 9} 246 85 161
4 || 30. 5 6# 222 70 152
5 33 5 8% 238 70 168
6 26 5 6} 222 50 172
7 28 6 0 262 70 I92
8 38 5 8 238 60 178
9 41 5 9; 246 90 156
10 42 5 8 238 60 178
11 29 5 5% 214 50 164
12 32 5 7 230 70 160
I 3 42 6 0 270 140 130
14 29 6 2 286 150 136
The averagevital capacity of 415 phthisical patients, taken indiscriminately,
without reference to the stage of the disease, was 129 cubic inches, the average
capacity of the same number of healthy subjects being 222 inches. Of these,
241 were in the stage before softening, and had an average vital capacity of
149 cubic inches; 174 were in the stage after softening, and had a vital capa-
city of only 105 cubic inches, in contrast with 221, the healthy average.
The authors evidently—and probably justly—consider the Spirometer to
be an important aid in diagnosis. It “gives distinct indications at an early
period of the malady, and these indications become more obvious in propor-
tion to the progress of the disease. For instance, in the first stage, the dimi-
nution of vital capacity, in a range of 241 cases, is 74 cubic inches; but in
BIBLIOGRAPHICAL RECORD. 41
174 patients, after the stage of softening, the diminution is no less than
116.
“It is proper to mention that some patients, in their early trials with th
instrument, in consequence of nervousness or inexperience, do not expire an
amount of air equal to their vital capacity. In such cases, therefore, unfa-
vourable conclusions must not be too hastily drawn; but, on the other hand,
whenever an individual under six feet expires his average quantity, it may,
we think, be generally inferred that he is free from tubercular disease. In
various individuals, in whom there were circumstances calculated to excite
some suspicion of the existence of disease, the favourable indications fur-
nished by the Spirometer have enabled the medical officers to pronounce an
encouraging opinion, which, in the sequel, has been confirmed. It must be
added, that various other circumstances may prevent a patient from expiring
the average quantity of air indicated by his height, such as pneumonia, em-
physema, hernia, or abdominal tumours, diseased heart, etc. A deficiency of
vital capacity alone cannot, therefore, be considered a proof of the existence
of Phthisis; but these tables are given for the purpose of showing that, where
Consumption was present without any of these accidental circumstances, the
vital capacity, in all the cases, was more or less diminished.” (pp. 26–7.)
HAEMOPTYSIS. Considerable attention has been paid to the occurrence of
this phenomenon. In 910 males, it was present in 563 cases, or in 62 per
cent. ; in 471 females, it was observed in 307 cases, or in 65 per cent. The
cases of spitting of blood by non-phthisical females, arising from irregulari-
ties peculiar to the sex, have been carefully excluded from the list. Observa-
tions on the age at which Haemoptysis most frequently occurs, were made in
1084 cases—706 males and 308 females. The following table shows the ex-
istence or non-existence of Haemoptysis in these, the cases being arranged,
according to the sexes, in decennial periods; also the per-centage of the cases
in which Haemoptysis occurred.


Haemoptysis Haemoptysis did Total of Haemoptysis
Age. occurred. not occur. Cases observed. occurred per cent.
Males. | Females. || Males. | Females. || Males. | Females. || Males. | Females.
0 to 5 0 3 2 4 2 7 ... - || 42-9
5 to 10 7 32 14 9 21 41 33-3 78-0
15 to 25 124 I07 85 45 209 I52 59.3 70-4
25 to 35 175 59 71 42 246 I01 71-1 58-4
35 to 45 115 35 48 25 163 60 70-6 58-3
45 to 55 29 7 23 8 52 15 55.8 46-7
55 to 65 3 0 10 2 I3 2 23-1 tº e -
65 to 75 0 0 0 0 0 0 tº ſº º
Totals | 243 243 253 135 706 378 642 64-3
“Of the 706 males, 453 had Haemoptysis; and of the 378 females, 243
were similarly affected; being in each sex, on the whole number, in the ratio
of 64 per cent. Dividing the period of life during which Phthisis occurs,
according to our observations—that is, from birth to 70 years of age—into
two equal intervals, viz., from infancy to 35 years, and from 35 to 70, we find
in these periods respectively, that in males under 35 years, Haemoptysis
occurred in 306 out of 478 cases of the disease, being in a ratio of 64 per
cent.; whilst in 301 females, at the same period of life, it occurred in 201
cases, being in the ratio of nearly 67 per cent.: hence the inference may be
drawn, that Haemoptysis is slightly more frequent in the first of these periods
in females than in males. In the second period, that above 35, we find
Haemoptysis to have occurred in 147 males out of 228 cases, being again in
the ratio of about 64 per cent.—very nearly that of the antecedent period in
42 BIBLIOGRAPHICAL RECORD.
the same sex; whilst 42 instances of Haemoptysis were met with in 72 cases
in females above the age of 35, that is, in the ratio of 54.6 per cent.” (p. 29.)
The stage of the disease in which Haemoptysis occurred was noted in 696
cases; 453 males, and 243 females. In the stage previous to softening, it
occurred in 333 males, and in 176 females. In the stage subsequent to soft-
ening, or the formation of cavities, the Haemoptysis was found present in 120
males, and in 67 females. Haemoptysis is thus shown to be much more fre-
quent in the first period of the disease, and nearly equally so in both sexes.
III. The DURATION OF THE DISEASE has been observed in 215 cases, in
* it had been ascertained with tolerable accuracy. The following are the
results :
“Phthisis rarely proves fatal in less than three months, only one case being
recorded as having been fatal within that period. The disease existed in 22
of the 215 cases for a period of between three and six months; of these 22
cases, 11% per cent. were males, and a little more than 7+ per cent. were
females. In 36 cases, the disease lasted from six to nine months; of these,
19 per cent. were men, and 12 per cent. women. The disease existed for a
period of from nine to twelve months in 30 cases, of whom about 15 per cent.
were males, and nearly 12 per cent, females. The half-yearly periods, extend-
ing from twelve months to four years, contain, in each period, with one tri-
fling exception, a decreasing number of cases. For whilst we observe that
nearly 17 per cent. of the cases have a duration of from six to nine months,
not 2 per cent. are found in the period from three and a half years to four.
Fourteen persons, that is 6% per cent, lived for periods above four years.
We observe also, that considerably more than half the entire number of cases
were fatal within a period of eighteen months, the numbers being 123 to
78. In reference to the influence of sex, we observe a remarkable fact, viz.,
that the disease is more rapidly fatal amongst males than females: thus, of
the 123 cases which terminated within eighteen months, 89, or 60.5 per cent,
were males; whilst only 34, or 50 per cent, were females. After a period of
eighteen months, the duration is reversed,—of 78 cases, 47, or 31.9 per cent,
were males; whilst 31, or 45.5 per cent., were females.” (p. 33.)
RESULTS OF TREATMENT. These have been observed in 535 in-patients,
classified according to age, sex, and the stage of the disease. They are ex-
hibited in the accompanying table: -

First Stage. second stage | Third Stage.
§ +5 § *—s *; +
- ;: tº º: 42 *: Cº.
AGBs. Sexes. || || 3 |. #| . . . . . . . É - ... # |.. É º i
§ | 3 || 3 || 3 || 5 || 3 || 3 || 5 || 3 || 3 || 3 || 3 || 3 || 3 || 3 || 3 || 5 || 3 || 3
: $ § | 3 || 3 || 3 || 3 || 3 || 3 || 3 || 3 || 3 || 3 || 3 || 3 || 5 || 3 || 3 || H
& E | #: | 8 || 3 || 3 || 3 | E | }. 5 || 3 || 3 || 3 | E | * | 3 || 3 || 3 || o
à ||= |* |z|= | 5 || 3 |z| < |z|= |*||3|2|+|z a || 5 ||=
Males * * : * * : * s - a. º. - «» s g h a w sº e I º - - is e i e a se º e
0 to 5 #. l! . . . . . . . . 1 || . . . . . s & I e º - wº e - I - - tº e l
Males * - - - 2 . . 2 || 1 | . . . . . . . . 1 1| 1 | . . l I 4. 7
*** | *males || 3 || || || || 3 || i | | | | | | | . . . . i i || 4
15 to 25 | {Males 9| 11 || 2 | 1 23 || 6 || 3 || 1 || 3 | . . [13 || 9|12 || 2 |13 || 17 | 53 || 89
|Females || 23, 2}| 3| 2 | . . . 49 || 2 || 2 | ..] ...|| 1 || 5 || 6 5 || 1 || 9 || 9 || 30 || 84
25 to 35 {#. 11| 14|| 3 || | I 30 || 9 || 5 | . . . ] . . . ;5 || 18| 8 || 3 |13 20 | 62 ||107
* “” Females || 10| 10} 3| 2 | ..] 25 || 4 || 1 | . . . . . . | 5 || 14 6 || 1 || 7 | 16 || 44 || 74
35 to 45 {: 12| 6 | . . . 2 . . . . .22 || 5 | . . . . . . I |.. | 6 || 15| 8 || 1 || 9 || 18 || 51 || 79
Females || 4 3| . . . . . . . . || 7 || 1 || 1 || 1 | . . 3 || 4| 2 || 2 || 6 || 8 || 22 || 32
45 to 55 | {Males, 12 & 3. . . . . 23 || 2 | | | .. 3 || 6| 2 | . . | 2 || 4 || 14 || 40
* ..! 2: .. . || 2 || . . | 1 1 || 2 4 || 1 || 7 || 10
r €S * * | * * tº e e - - - - - - l & e 3 4. 4
55 to 65 * 1| “... . . . . . 1 * * • e s : * * * * * f
Viales e - 1 ..! I | -- 2 2|
ow is Females - . . . . . . . ] . . . . 1 || 1
All ages.|Both sexes. sº 75 is 8 || 1 ||87 ||31 ||4|| 2 || 5 || 1 |33 || 7744 10 66 98 |295 535
The per-centages of the preceding results are thus shown :
BIBLIOGRAPHICAL RECORD.
43

4s Much Disease Disease not g
Relieved º § * Died
Stages. * |##|º ºłº ºt
First Males ... 44-0 39:0 12:0 4'0 1-0
tº e ºs Females 47-1 41-3 6-8 4-5 0-0
Males ... 60°5 23-6 2’6 13-1 0-0
Second Females 53-3 33-3 6'6 * * * 6-6
Third Males ... 26-8 I6'3 3-1 20-5 33°l
Females 24-7 12-3 3-8 25-7 33-3
All ... ... Both 36.0 24'8 5-6 14-7 18°6
Among the out-patients, as far as could be observed, the symptoms in the
first stage were more or less relieved in about 35 per cent. ; in 33 per cent,
they are much relieved; in 18 per cent, the disease appears to have been
arrested; in 12 per cent., it passed into more advanced stages. In the second
and third stages together, there was relief in about 23 per cent. ; in 24 per
cent, the relief was material ; in 4% per cent, the disease was arrested ; in
48 per cent, it remained unchecked, or proceeded to a fatal termination.
TREATMENT. The remarks under this head appear to us so valuable, that
we extract them entire :
“In making some observations on the treatment of Consumption pursued
at this institution, the medical officers feel it a duty to bear testimony to the
judgment evinced in the selection of a site for the hospital, and to the excel-
lence of the arrangements for promoting the health and comfort of the pa-
tients. To those unacquainted with the locality, it will be necessary to say,
that the hospital is built on a dry gravelly soil, in a suburb of the metro-
polis long celebrated for its salubrity, sheltered on the north and east by the
whole of the metropolis, and open to the south and west; the wards are lofty,
and of moderate size ; the corridors light and capacious ; whilst the coldness
and dampness of our atmosphere, so highly injurious in diseases of the re-
spiratory organs, are corrected by the method of ventilation devised by Dr.
Arnott, and which is so arranged as to supply warm fresh air, in a continu-
ous stream, at the rate of 2,160 cubic feet per minute, thus allowing to each
patient, during that time, more than 23 cubic feet. This air reaches the
wards so modified, as to keep them at the uniform temperature of nearly 65°
in winter and summer. There is thus provided for the poor a climate, nearly
approaching that of the southern latitudes, the advantages of which can only
be enjoyed by the more favoured portion of the community. The beneficial
effects of these arrangements upon the patients are strikingly manifested in
the great improvement which generally takes place in their symptoms soon
after admission : the cough becomes less frequent, and the expectoration
diminishes; they lose the anxious expression of countenance frequently attend-
ing the disease; and strangers, who visit the hospital, often express their sur-
prise at the quiet and comfort of the patients, and their comparative freedom
from cough. It is proper to mention, that though a majority of the patients
are sensible of deriving benefit from the warmth of the atmosphere of the
hospital, certain individuals, owing to peculiarity of constitution or dis-
ease, find it oppressive. A similar statement applies to Madeira and like
climates.
“Of the strictly medical treatment of the disease, a detailed description
would be inappropriate in the pages of this Report; the medical officers limit
themselves, therefore, to a brief statement of the results of the use of a few
particular remedies which have attracted attention.
“Much has been accomplished, especially at the early period of the dis-
ease, by acting upon those general principles, which are familiar to every
medical practitioner, for strengthening the digestive powers, correcting pul-
monary congestion, improving the condition of the blood, and administering
those remedies which are considered suited to particular symptoms. -
44 BIBLIOGRAPHICAL RECORD.
“Naphtha. Amongst the medicines alleged to have curative powers, a fair
trial has been given to pyro-acetic spirit or naphtha. There are some com-
plications of Phthisis, such as bronchitis, attended with profuse secretion, in
which it has appeared occasionally to exert a favourable influence—moderat-
ing the secretion, improving the appetite, and increasing the strength; but
it was not observed to possess any specific power of suspending or amelior-
ating tubercular disease of the lungs; and, in many cases, it acted very injur-
iously. - -
£6 }on. The pale and anaemic condition of many consumptive patients, and
the deficiency of red globules in their blood, (as shown by the experiments of
Andral and Gavarret,) naturally suggested to us, in common with the pro-
fession, the use of iron ; especially as, when administered to the lower ami-
mals, this agent is stated to possess the power of arresting the formation of
tubercles. It has been used in different stages of the disease, and in various
forms, such as the iodide, phosphate, sulphate, sesquichloride, and citrate.
During the first stage of the disease, in the absence of pulmonary congestion
and haemoptysis, it has been found useful to the extent of arresting its pro-
gress; but the utmost benefit which persons in the later stages have derived
from this remedy is, an increase of strength, and a temporary improvement
of general health.
“Cod–Liver Oil. This substance is entitled to special notice, as having been
productive of more good in the treatment of Phthisis than any other agent
yet employed. The earliest trials of this remedy, made on a large scale,
were those instituted at the hospital ; and it has now been given in many
hundred cases.
“Of 542 cases, 293 were in the first stage of the disease, and 249 in the
second and third, or those stages subsequent to softening ; of those in the
first stage, 190 were males, and 103 were females. Applying to these cases
the terms already used, it will be observed that 72 per cent. of the males, and
62 per cent. of the females, had their symptoms materially improved ; in
nearly 18 per cent. of the males, and in 28 per cent. of the females, the dis-
ease was arrested ; in 10 per cent. of the males, and in nearly 10 per cent, of
the females, the disease progressed unchecked. Of the 249 patients in the
second stage of the disease, 139 were males, and 110 females. In 53 per
cent. of the males, the symptoms were materially improved, and in nearly 61
per cent. of the females. In a little more than 14 per cent. of the males,
and in nearly 14 per cent of the females, the disease was arrested. In a little
more than 32 per cent. of the males, and in 25% per cent. of the females, the
disease was not arrested. Viewing these results collectively, we find that in
about 63 per cent, the symptoms were improved ; in 18 per cent. the disease
was arrested ; and in 19 per cent. it went on unchecked. When it is recol-
lected that, of the whole number treated at this hospital, the disease was
arrested in only 5 per cent, the value of this remedy, under the use of
which the disease appears to have been arrested in 18 per cent. of the cases,
must be considered very great. -
“Different qualities of oil have been tried, without exhibiting any marked
difference in their remedial effects; but the offensiveness of some of the darker
kinds renders their general use impracticable. The oil now used is straw-
coloured, transparent, and free from offensive smell. Patients, in general,
take it without repugnance. The dose, at first, is 1 drachm three times a day
for an adult ; but it is gradually increased, in some few cases, to 1% oz. for a
dose. It is usually administered in camphor-water, any aromatic water, bit-
ter infusions, milk, or any other agreeable fluid. When there is great irrita-
bility of stomach, it has been given in mucilage of gum, with a few drops of
hydrocyanic acid. In cases where there existed great anaemia and debility,
and in those where the effect of the oil seemed slight, preparations of quinine
and iron, especially the iodide, have been conjoined with advantage. It has
appeared advantageous to intermit its use for a few days, when nausea and
BIBLIOGRAPHICAL RECORD. 45
feverishness, from whatever cause produced, are present. In certain cases,
the use of the oil has been continued during the existence of slight haemo-
ptysis, without producing any injurious results. -
“Other animal oils (not derived from the liver), and vegetable oils, have
been tried with a view of ascertaining how far their operation resembled-that
of cod-liver oil. The experiments hitherto made have not shown them to
possess the same powers ; but they have not been as yet sufficiently often
repeated to warrant decided conclusions. -
“One of the most striking effects of the use of cod-liver oil is an increase
in the patient's weight.
“It appears, that taking both stages of the disease and the sexes collec-
tively, a gain of weight occurred in 70 per cent, a loss of weight in only
21 per cent.; and in about 8% per cent. the weight remained stationary. The
amount of the increase varied, being in some patients little more than one
or two pounds during several months ; whilst, in many, the average increase
was from a pound to two pounds weekly during several weeks. Some very
remarkable instances of great increase of weight have presented themselves,
—thus, in one instance, 41 pounds were gained in 16 weeks; in another, 19%
pounds were gained in 28 days, and 10 pounds in the succeeding 10 days; in
another case, 29 pounds were added to the patient's weight in 31 days. It
must be observed, that an amelioration of the symptoms did not invariably
follow an increase of weight, though the exceptions were rare. An aggrava-
tion of the symptoms and a diminution of weight were almost invariable
coincidences. In a few cases the symptoms improved, though the weight re-
mained stationary, or even became slightly diminished. It is right to men-
tion that in some of the marked stationary in the Table, the first effects,
though encouraging, were not permanent. . In other cases, where the
amelioration was still more considerable, and the progress of the disease ap-
peared to have been stayed, relapse occurred, and was followed by a rapid
progress to a fatal issue. That such cases do occur requires to be remem-
bered, in order to restrain too sanguine expectations, and to prevent the
remedy from falling into the discredit which disappointment after an un-
limited confidence may induce. On the other hand, without entering into a
description of the successive steps of amelioration experienced by patients
(which have been already described under the head of Results of Treatment),
it will suffice to say, that many of the cases included in the 18 per cent, in
whom the disease is marked as arrested, felt themselves as well as they had
been before the attack of the disease. In some of these cases there was, as
already stated, a decided and progressive diminution in the local mischief.
Comparatively few of such cases having returned to the Hospital after a
lengthened interval, it is not too much to assume that the improvement is
permanent, it is so in some cases which are under observation. -
“From these facts and a more extended experience, since the period at
which this Report terminates, no other conclusion can be drawn, than that
Cod Liver Oil possesses the property of controlling the symptoms of Pul-
monary Consumption, if not of arresting the disease, to a greater extent than
any other agent hitherto tried.
* Inhalations have been tried under a variety of circumstances, and with
benefit to some of the distressing symptoms, such as cough and difficulty of
breathing. Experiments, with a view of ascertaining the simplest means of
using these agents, being now in course of trial, remarks on their use are re-
served for a subsequent Report. -
“Counter-irritation has been found useful in many cases in which local
congestion existed, or in which cough and abundant secretion were distress-
ing. In many of these cases, a solution of Iodine and Iodide of Potassium in
Alcohol sufficiently strong to produce vesication, applied with a camel's-hair
brush, was found remarkably beneficial. -
“Night Sweats have been relieved in very many cases, by the use of Gallic
46 BIBLIOGRAPHICAL RECORD.
Acid in doses of five or six grains, combined with Morphia. In the treat-
ment of diarrhoea, recent experience has shown that the Trisnitrate of Bis-
muth, when perseveringly administered, often proves a most safe and
effectual remedy.” .
We hail this Report with satisfaction, as the first instalment of a series of
valuable contributions to the Pathology and Treatment of Pulmonary Con-
sumption. The physicians of the hospital at Brompton have turned to good
account the means at their disposal. We hope that they will issue, from time
to time, as they have promised, “equally systematic and definite illustrations,
not only of subjects fully noticed here, but of others of equal interest ; and
thus, whilst rendering the institution useful in developing or confirming
scientific and practical knowledge, as well as in relieving the objects of the
charity, to demonstrate how happily the advancement of science may be
combined with the exercise of benevolence.”
REPORT on PULMonARY PHTHISIs As observKD AT THE HosfºrtAL FOR CON-
SUMPTION, BROMPTon. By WALTER HAYLE WALSHE, M.D., Physician
to the Hospital. In British and Foreign Medico-Chirurgical Review for
January, 1849.
This is a very able and valuable statistical document. Dr. WALSHE has
preferred publishing a Report of his own ; and his name does not appear in
the Hospital Report which we have just noticed, which is issued by and under
the sanction of Dr. Walshe's colleagues—viz., Drs. H. Roe, Theoph. Thomson,
G. Cursham, R. P. Cotton, R. Quain, and J. J. Bowie. In future, we would
recommend conjoint reports.
CLINICAL LECTUREs on THE PHYSICAL DIAGNoSIs of PHTHISIs: delivered at
the Hospital for Consumption and Diseases of the Chest. By RICHARD
PAYNE COTTON, M.D., Assistant-Physician to the Hospital. -
These Lectures recently appeared in the Medical Gazette. We have much
pleasure in strongly recommending them to the notice of our readers.
TIC-Dolor:EUx AND OTHER PAINFUL AFFECTIONs of THE NERVEs, witH Sug-
GESTIONS FOR THEIR TREATMENT, BY MEANS OF THE ANEURALGICON. By
C. Toogood DownING, M.D. Pp. 73. London: 1849.
Dr. Downing being of opinion, that local applications have been too much
slighted in the treatment of neuralgia, has directed his attention to the sub-
ject, and invented an apparatus with the above rather high-sounding name,
which merits attention. By its means, a mild or a powerful stream of warm
or hot vapour can be directed upon any part. The apparatus consists of a
cylinder, in which medicinal herbs can be burnt; bellows, for maintaining a
current of air through the heated mass; with tubes and cones for directing
the vapour. The chief effects observed have been of a sedative character ;
and we can well imagine that a regulated stream of heated and medicated
vapour, directed upon any spot in which the nerves are in a state of irrita-
tion, is likely to produce more powerful effects than could be caused by the
ordinary sedative endermic method. Dr. Downing cites several cases, in which
very remarkable benefit followed this treatment; but he has the good sense
to state that it cannot supersede general treatment, and does not always
succeed, but is a useful auxiliary to the common methods adopted in the
management of this distressing class of affections.
We have seen great benefit result in neuralgia, from the local application
of even unmedicated heat; and there is no better way of applying it, than
by passing and repassing an iron, such as is used by laundresses, over the
seat of pain. This is a much-esteemed, and, we believe, very useful domes-
tic remedy in many parts of the country. When it fails, and when constitu-
tional treatment is proving too slowly beneficial, we would certainly advise
a trial of Dr. Downing's Aneuralgicon.
47
CRITICAL DIGEST OF THE BRITISH AND FOREIGN MEDICAI,
JOURNALS.
ANATOMY AND PHYSIOLOGY.
*
RETZIUS ON THE STRUCTURE OF THE LIVER,
PROFESSOR RETZIUs has examined the liver in the human being, in the dog,
cat, rabbit, squirrel, pig, and ox; and his researches have been, on the whole,
confirmatory of the views of Mr. Kiernan. He has, some time since, stated
his opinion that the Liver is originally acinose or lobular, but that, by various
changes, the acini or lobules may become confused ; but they may regain
their distinctness, under favourable circumstances. A portion of the Liver
of a child six months old was examined. Before injection, the lobules were
distinct ; but in the injected preparation, where the capillaries were entirely
filled, there was no trace of interlobular partitions nor of cellular alveoli. The
lobular structure was only shown by the white injection (white-lead), which
was forced through the hepatic veins and their lobular branches into the
central capillaries of the acini. The acini were thickly surrounded by an
abundance of capillaries from the portal vein ; but even these did not in-
dicate any distinct limits to the acini. In many places, the lobular capillary
network was entirely filled by the injection thrown into it from the portal
vein. It was evident from this specimen, that already in the sixth month
after birth, the portal venous system, which has during intra-uterine life
formed a part of the umbilical venous system, possesses a development far
surpassing that of the hepatic vein. In large patches, especially in the right
lobe, the injection, which was thrown into the portal veins, occupied the
whole of the parenchyma, with the exception of the network of the hepatic
ducts, and the central vessel. In other places, the injection had not passed
into the finer portal twigs; while the twigs of the hepatic artery, and the
adjoining capillaries, were well filled. These arterial twigs gave a lobular or
acinose appearance to this portion of the organ. This was especially the
case at the surface, where the round ends of the intralobular vascular
plexus were raised in the form of small white knots. The circumference of
these lobules was partly uninjected, partly occupied by the network of the
hepatic ducts. In the parts which the perilobular injection had not reached,
there was an appearance of lobules with large interspaces; but where it had
perfectly penetrated, the smaller interlobular plexuses were entirely effaced.
Where a longitudinal section had been made through the lobules, they were
found, as Kiernan had represented, thickly set on the intralobular (sublo-
bular) twigs, like sessile leaves, surrounded by a portal and biliary capillary
network. -
Especially interesting, in a well injected preparation, are the ultimate
sheaths of Glisson's capsule, which follow the ramifications of the portal vein
through the entire organ, until it gives off its perilobular twigs. Professor
Retzius has been able to determine a remarkable fact, which Mr. Kiernan,
though he had systematically rendered it probable, had not so successfully
described,—that the biliary ducts form a network in the walls of this sheath,
continuous with that in the lobules. The vessels surrounded by this sheath
are, a pretty large portal twig, a somewhat smaller twig of the hepatic duct,
and a small twig of the hepatic artery. These Glissonian sheaths appear to
be situated where one would expect to find the perilobular septa. When
the hepatic ducts are well injected, the sheaths are seen like rings, having
the colour of the biliary ducts, with their walls covered or interwoven with
a capillary biliary network, of as fine meshes as the lobular network. Mr.
48 CRITICAL DIGEST OF THE JOURNALS.
Kiernan has without doubt seen this, and described it under the name of
“waginal branches” and “plexus”. From this vaginal plexus, a network
of biliary ducts proceeds in all directions, becoming interwoven throughout
with the capillary vascular network; it also penetrates into the lobules.
The only circumstance in which Professor Retzius differs from Mr. Kiernan,
is that the latter describes as twigs or branches the extension of the biliary
ducts, while it is in fact a network, in which neither stems nor branches can
be distinguished. *
The principal results at which Professor Retzius has arrived from the
above examination, and from similar examinations of the Liver in the lower
mammalia, are the following:—
1. That the Liver is originally lobular; but that the lobular structure
may undergo various changes, and present various appearances of develop-
ment. There may be confusion of the lobules, in conjunction with more or
less regular development of the ramifications of the hepatic vein. That
which is most in favour of the presence of the lobular type, is the constancy
of the alveolar biliary network.
2. That the perfect biliary ducts, with their peculiar walls (the basement
membrane of the English anatomists), without which they could not be per-
fectly injected, are regularly disposed tubes. Professor Retzius has also been
able to directly to determine the presence of this membrane ; and has found
it, as described by Schroeder van der Kolk, a simple membrane, surrounding
the angular as well as the round hepatic cells. This basement membrane
may be rendered apparent by macerating a Liver in ether, then drying it,
and cutting extremely thin slices. These become transparent when laid in
water, and exhibit the proper membrane of the finest biliary network in
single outline, surrounding the cells. º
3. That no arterial network has been found in Glisson’s capsule. The re-
gular distribution of twigs from the portal vein and hepatic artery was not
perceptible; but the perilobular vessels chiefly appeared as a network; and
there appeared no regular or perilobular type in the larger twigs. In two
other specimens from children of three years old, elegant hexagonal lobules
were seen. In one of these, the injection of the hepatic artery had succeeded
remarkably well. Besides the fine long twigs on the surface, each lobule
had its own perilobular capillary network, of extreme fineness; but in none
of these was the network of the portal vein so distinct, as the injection had
penetrated into the network of the lobules, so that the periphery became less
distinct. In one of these preparations, the perilobular part of the portal
vein was seen giving off triradiate angular branches (dreizweigige Ecken-
zweige), as well as the regular peripheral twigs. [Abridged from Müller's
Archiv. 1849. Heft. II.]
DF FROBERWILLE ON THE OSTRO-NEGROES OF EASTERN AFRICA.
THE following interesting paper on a peculiar race of men existing in
Africa, south of the Equator, was read to the Academy of Sciences of Paris,
on the 5th of March last, by M. DE FROBERVILLE:—
... “The figures which I have the honour to bring before the notice of the
Academy, have been moulded on the indigenous inhabitants of the eastern
region of Africa, situate between the Equator and the Bay of Lorenzo-
Marqués or Delagoa, and commonly denoted on maps by the name of Zan-
guebar, Maravi, and Monomotapa. During a residence of fourteen months
in the islands of Mauritius and Bourbon, I have collected these anthropo-
logical specimens, amounting altogether to sixty heads and masks, all moulded
on living subjects. . These morphological documents are accompanied by
thirty-one vocabularies of idioms spoken in the same region of Africa, by
notes on the creeds, traditions, manners and customs of the original inha-
bitants, as well as by itineraries and a geographical chart of this hitherto
little-known region.


CRITICAL DIGEST OF THE JOURNALS. 49
A rapid coup d'oeil is-sufficient to recognize that the type of this race, to
which I give the name of Ostro-negro, belongs to a negro origin. The general
characters, which are most striking, and which justify the classification of
these Africans among negroes, are the prognathous head, absence of mental
protuberance, flattened nose, thick lips, woolly hair, and a more or less dark
skin. To express myself with more precision, I would say, that these may
be considered as forming a branch of the great family of subequinoctial
negroes. This division is subdivided into four groups, as shewn by the casts.
The first group presents analogies with the Congo-Guinean races, bordering
on the west of the Ostro-negroes; the second approaches the type of the
Cafro-Bechuanians, their neighbours on the south; the third group has a
peculiar resemblance to the negroes of Oceania. The fourth group will pre-
sently occupy our attention. -
The analogies between the types of the first two groups, and their neigh-
bours on the west and south, are not easily explained by their vicinity. The
more the Congo-Guinean, Cafro-Bechuanian, and Ostro-negro races are studied
as a whole, under one point of view, the more is unity of origin determined.
Every where there is evidence of a common parentage, even in the most
minute details of social life; and when certain traits of custom do not ap-
pear to be alike in two neighbouring people, the similarity is invariably
found in a third, but more remote tribe. These intimate ethnological rela-
tions are bounded by the Equator. A community of manners with the
negroes now described, is well marked among the people of Northern
Guinea ; but this resemblance diminishes, as we advance north. The races
of the north-east, Gallas, Soumali, and other Ethiopians, have no resemblance
in manners or customs to the Ostro-negroes, and in their physical conforma-
tion only so far as they all belong to the immense negro family.
The resemblance between the third group of Ostro-negroes and the blacks
of Oceania, has given rise to much perplexity. How can a conformity of
type be explained in two peoples so distant from each other, and so little
accustomed to navigation, and living in such different countries? Such a
striking identity is not the result of chance ; there has been a common point
of departure. The problem, however, still remains unsolved ; the means
for its solution not having been yet matured. We possess a very imperfect
acquaintance with the savages of Australia and the neighbouring islands ;
nor have we discovered the link which connects them with the negro tribes
scattered throughout the Malay Archipelago, the south-west of Asia, and
even in the interior of the peninsula of India. All conclusions on this point
would be premature; but the fact is worthy of attention, being one of the
most curious results produced by a comparison of the negro races.
I now enter on a question which we have greater probability of explain-
ing. Besides the three groups already mentioned, there exists a fourth, ori-
ginally produced by a mixture of the negro element with an element foreign
to that race. Irefer to the Africans with curved noses, head scarcely or not at
all prognathous, and lips scarcely thick. The presence of physical characters
so dissimilar and superior to those of the mass of the population would be
easily explained, if it only occurred in one locality. But the hybrid type is
scattered more or less equally among all the peoples of Africa, south of
the Equator. It is found in the interior as well as in the maritime tribes ;
from the countries bordering on the Equator to the frontiers of the colony of .
the Cape of Good Hope ; and, in my experience at least, it is nowhere suf-
ficiently marked to constitute a distinct race. This geographical distribu-
tion, which makes the hybrid races on the banks of the lake Niassi (Maravi)
exhibit the same degree of mixture as thosé of Caffraria or Quiloa, prevents
us from determining, by a mere inspection of the physionomical charac-
teristics of the Ostro-negroes, from what direction their ancestors came, and
spread throughout Eastern Africa. But we see a proof, that the mixture of
races took place at a very early period, and that the focus from which
WOL. II. -- 4
50 CRITICAL DIGEST OF THE JOURNALS.
have radiated the ethnological elements which distinguish these from the
negro race, has long since become extinct. This conclusion is confirmed,
also, by the absence of any distinction of caste, idiom, belief, or customs be-
tween those individuals who present the character of hybrids, and those in
whom the negro form has been preserved in its primitive purity. The phy-
sical dissemblance, so striking to us, is entirely unnoticed by the natives.
The object of the present memoir is to inquire into the origin of the
foreign element, which has thus been grafted on the original type of the
Ostro-negroes. In examining into the traits of the hybrid race, we re-
cognize a defaced imprint of the Semitic type. This is the first and clearest
impression which we receive ; and it is not without some confirmation. In
the belief, manners, and customs of the Ostro-negroes, we find, in fact, the
most striking resemblance to the ideas proper to the Semitic races. The
traditions and religious rites of the Ostro-negroes have a Semitic tinge, which
cannot be mistaken. The tradition of the fault and punishment of the first
human pair, and of the drunkenness of Noah and his followers, the applica-
tion of the name Jowa to the sun, the appellation of “bow of the Good
God,” given to the rainbow, the idea that the meteor is a good sign, and that
it drinks up the water from the earth, the observation of circumcision, the
doctrine of legal impurity, and, finally, the pyrolatric worship of Moulouk,
whose name scarcely differs from that of Moloch, the great Canaanite divinity
in whose honour children were made to pass through the fire, all these
circumstances are so closely connected with the history of the Syro-Chaldean
religions, that there can be no doubt that the Ostro-negroes are of Canaanitish
origin. By inquiring more deeply into this hitherto unexplored subject, and
by combining a curious local tradition with the historical accounts of
Phenician navigators having sailed along the coast of Africa, we are led to
recognize the fact, that the type of the hybrid race which has engaged our
attention, artd most of the creeds, manners, and customs which we observe in
the Ostro-negroes, have been due to the residence of Phenicians among them
as merchants and navigators. [Gazette Médicale de Paris, 10 Mars, 1849.]
METHOD OF DETERMINING THE QUANTITY OF BLOOD IN THE BODY.
The following resumé of some experiments, made by DR. JAMES BLAKE,
Professor of Anatomy in St. Louis University, U.S., with the view of deter-
mining the quantity of blood in the body, is contained in the Philadelphia
Medical Earaminer for August 1849:
The experiments were performed by injecting a weighed quantity of sul-
phate of alumina into the veins, and analyzing a weighed portion of the
blood. As the salt had time to be well mixed with the blood before the ani-
mal died, such an analysis would enable us to determine the whole quantity
of blood, with which the salt had been mixed. The only error which might
arise, would be from a portion of the salt having combined with some of the
tissues, or having been rapidly excreted; and this would only affect the result
ºone direction, viz., in furnishing a greater quantity of blood than really
exists. -
The results of my experiments would lead to the conclusion, that no such
source of error exists; as I find, by this method, that the weight of blood, in
the body of a dog, does not amount to more than about one-eighth or one-
ninth part of the weight of the animal,—an estimate much lower than that
which is generally received as the quantity of blood in an animal. That this,
however, is nearer the truth, is probable, from a consideration of the velo-
city of the circulation and the capacity of the heart; as, on the generally
received opinion of the quantity of the blood, it is difficult to imagine how
it can circulate so rapidly.
CRITICAL DIGEST OF THE JOURNALS. 51
PRACTICE OF MEDICINE AND PATHOLOGY.
DR. FLIESS ON THE PARALYSIS WHICH ATTENDS DENTITION
DR.FLIESS, of Neusalz, has published, in the Journal fir Kinderkrankheiten,
for July and August 1849, the following memoir on the Paralysis which some-
times occurs in children during dentition.
The extraordinary progress which has been made in neuro-pathology, by
the labours of English, French, and German physiologists, has only ſately
caused especial attention to be directed to the paralytic affections, with which
young children are attacked. These affections are not unfrequent, but have
been long known. By some, they have been mistaken for rheumatism, even
though the child complained of no pain; while others have treated them as
the effects of a blow or contusion. And we meet with cases, in which sudden
paralysis of a limb has been even considered as a sign of rudeness or naughti-
ness, just as the nocturnal enuresis of children was until a short time ago;
for which children used almost always to be chastised with rods, or in some
other way, and of which we have only lately become convinced, that it de-
pends on a paralysis of the muscles which close the bladder, or rather on an
excessive excito-motor activity of those which expel the urine.
In using here the term Paralysis of Dentition (Dentalparalysen), we would
have no other paralysis to be understood, than that which arises from denti-
tion. . We intend first to describe the mode of attack of these paralytic
affections, and then to endeavour to point out their cause.
Paralysis is much less frequent during the first, than during the second
dentition; at least, we have not had an opportunity of observing its occur-
rence in the first dentition. It is possible that, as children at this time have
not yet the full use of their limbs, the affection may more readily escape no-
tice than during the second dentition, when the children can run about, and
employ their limbs in performing various actions. We believe it, however, to
be well established, that convulsions are much more frequent than Paralysis
during the first dentition ; and that, in the second, the ratio is changed, or,
a least, Paralysis is as frequent as convulsions. We take this opportunity -
of remarking, that the older the individual is, the less frequently do convul-
sions supervene on dentition ; while paralytic affections, and, at a later period,
especially during the development of the posterior molars, neuralgia, are
much more frequent. We shall hereafter have occasion to make use of these
facts. -
The attacks of Paralysis of Dentition are almost always sudden. A child
is cheerful, takes exercise, and plays as usual, has a good appetite, and goes
to bed in the evening apparently quite vigorous. At first, perhaps, it sleeps
very quietly; but it soon throws itself about in a restless manner, groans and
screams out in its sleep, grinds with its teeth, is thirsty, has some heat of
head, and is rather feverish towards morning. On the next day, when per-
fectly awake, it is unable to use one of its arms, or, in rare cases, an arm
and a leg. If the arm alone be paralysed, it hangs down ; it is indeed
warm, but, in consequence of the gravitation of the blood in the limbs, the
joints of the hand and the fingers are blue-red and swollen. The child can-
not move the arm; sensibility is either entirely lost, or is very obtuse; and
the excito-motory power can but little, if at all, be excited by strong stimu-
lation. If a medical man be summoned, who does not think of paralysis
from dentition, or knows nothing about it, he does not know how to recon-
cile the sudden attack of paralysis with the otherwise apparently healthy
state of the child, which, as has been said, has but little fever, and com-
plains of no pain whatever. He gives it as his opinion, that the child has
probably laid on the arm during the night, and pressed on the nerve ; and he
leads the parents to hope that, in a day or two, the effect will spontaneously
be removed, just as, in a limb benumbed or asleep through pressure, the
4 2
52 CRITICAL DIGEST OF THE JOURNALS.
removal of the pressure is followed by a return of its power. But when,
after some days, this result does not follow, but the limb remains paralysed,
and the parents become more anxious, the medical attendant is puzzled ; he
suspects that something of more importance is at the bottom, and he pre-
seribes accordingly. But what does he order ? Friction with opodel.doc,
camphorated spirit, etc.; and then, perhaps, imagining that there is some
deposit, he goes on to order friction with iodine ointment, mercurial oint-
ment, embrocations, etc. We have seen a case, in which the rotatory electro-
magnetic apparatus was diligently used; nevertheless, the arm remained
paralytic, and at last became atrophied. In another case, the medical attend-
ant could not be divested of the idea, that there was a subluxation: he pulled
the child's arm about, until, having had his attention called, by a colleague,
to the utter loss of power in the limb, and to the great impairment of sensa-
tion, he was convinced of the existence of Paralysis.
The paralysed arm usually hangs down as if dead; and if the child at last
complain of pain, it is from dragging of the muscles of the shoulder. The
Paralysis sometimes extends to the leg of the same side ; the child is then
unable to move it, and the sensation is lost, or at least impaired. More
rarely, one arm and both legs, or both arms, without the legs, are affected.
The duration of the Paralysis is very uncertain ; in many cases, it lasts
from a fortnight to three weeks, in others many months, and even, in some,
many years, and then becomes incurable. Convulsions not unfrequently
precede or occasionally accompany the Paralysis, without any cause, or from
a very slight one. If the child be in a passion or annoyed about any thing,
the paralysed limb sometimes become convulsed, and performs various move-
ments which the child has not power to restrain. These convulsive move-
ments are also produced by the use of electric shocks; or evident vibrations
of the muscles manifest themselves, on the application of a continued electric
current by means of the rotatory apparatus. The cases which we have ob-
served, were not preceded by convulsions; but several colleagues have observed
their occasional occurrence. The termination is not unfrequently favourable,
under judicious treatment; the Paralysis passes off gradually, and at last
entirely ceases, with a pricking or stinging sensation, or a feeling of formica-
tion. But not unfrequently the Paralysis is obstinate ; it resists the ordinary
remedies; and other symptoms, indicating an affection of the spinal cord and
brain, appear. The child is attacked with dyspnoea, palpitation, twitchings
of the muscles of the eyes; it begins to squint, becomes dull, falls into a
comatose state, and dies. The Paralysis may become chronic ; there are then
no obvious indications of affection of the spinal cord or brain, but the
affected limb remains paralysed, and ultimately becomes atrophied ; the indi-
vidual may be, in other respects, in the most flourishing health, even active
and strong. Cases have been sometimes met with, in which individuals, of
muscular and powerful build, have had an arm paralytic and arrested in de-
velopment ; and, when asked as to the origin of the Paralysis, they can give
no other answer, than that they have had it from childhood, and that a cold,
negligent treatment by a physician, a fall, a blow, or whatever they think
must be assigned, must have been the cause. - . .
There are, unfortunately, but few autopsies recorded, which can give an
explanation of this form of Paralysis. This perhaps depends on the circum-
stance that the affection is seldom fatal ; at most, the opportunity is
afforded in chronic affections of this kind, when death has resulted from the
supervention of some disease, or from an affection of the spinal cord or
brain. But then the appearances presented are rather to be considered as
results of the disease, which has more lately supervened ; at least, it is then
difficult to distinguish the primary from the secondary lesions in the brain or
spinal cord. - * - -
In one case only, we have had an opportunity of making a post-mortem
examination of a boy, who, while suffering from recent Paralysis of one arm,

CHITICAL DIGEST OF THE JOURNAI.S. 53
was killed by being thrown from a carriage. This is also the case which
first drew our attention to the form of Paralysis under consideration.
CASE. Rudolph Meyer, the son of a tobacconist of this place, was, at birth,
a strong well-made child. He was nursed by his mother, who was perfectly
healthy ; and, at the end of the tenth month, he was weaned. The first dem-
tition was easy, being attended only with slight indisposition, which made
him rather lean. He soon recovered, and was apparently healthy up to five
years of age. During this time, he had hooping-cough, which went through
its usual course and somewhat weakened him ; but when it was ended, his
health was perfectly re-established. At the end of his fifth year, he was
frequently troubled with loaded tongue, some fever, heat of head, and
flushed cheeks; these symptoms soon yielded to the employment of mild
purgatives. From time to time he had, for a week at a time, restless nights;
he cried out in his sleep, ground his teeth, got up as if to walk in his sleep,
and was, although apparently well, very tired in the morning. One morn-
ing, on awaking after such a restless night, he had complete Paralysis of the
left arm. This arm hung loosely by his side; the hand was very red, and
the joints somewhat swollen. The child could not perform any movement
with the limb ; if it were raised, it was as heavy as the arm of a dead per-
son, and fell again as soon as it was let alone. The warmth cf this arm did
not differ from that of the other. It felt a little colder; but the thermome-
ter indicated no difference of temperature. The pulse in the left arm was
somewhat weaker than in the right; but there was no difference in fre-
quency. The boy did not feel when the arm was pinched, or pricked with a
needle. This loss of sensation was more obvious on the extensor than on the
flexor surface of the arm ; it was least on the radial side. Here, as far as
could be gathered from his account, the boy had an obscure perception of
the above-named irritants; and, when he slept, the arm was slightly con-
vulsed, when irritated on the radial side. In other respects, the boy com-
plained of no pain ; he had some cough, was cheerful, played about, and
scarcely troubled himself about his arm. A great variety of remedies
were employed. At first, the cause of the Paralysis could not be understood ;
an examination of the arm, shoulder, and spinal column shewed nothing.
An examination of the mouth made it probable that the Paralysis was con-
nected with dentition : the anterior milk molars were found lying half de-
cayed in the gums, and near and between them were the edges of the per-
manent molars, in a row in the gums. We resolved to have all the remains
of the teeth extracted next day by a dentist, so as to make room for the new
teeth, But, on the same day, the boy met with an accident which deprived
him of life. Having been taken by his parents to see, a relation in the
country, he was thrown on his head from the carriage, and died towards the
evening. : . . . . . . . . . . . . .
A careful post-mortem examination was made. There was a considerable
fracture of the skull, and also injury of the brain, which was the immediate
cause of death. But the most interesting point, was the state of the upper
part of the spinal cord. This shewed, in the vicinity of the roots of the
brachial nerves, a very remarkable degree of vascularity: the membranes
were here reddened, and the whole circumference seemed congested; the
veins at least were here fuller, and more prominent, on the left side than on
the right. There was no true organic alteration to be observed, either in the
spinal cord, or in the roots of the nerves, or in the brachial nerves, so far
as they could be followed. On tracing the blood-vessels, it was found that
the turgescence of the veins on the left side extended on the shoulder and
neck, as far as the face, where all the veins were fuller and more prominent
than on the right side. The veins in the neck and submaxillary region were
remarkably prominent. There appeared to be no doubt, that dentition had
produced this state of the veins; and moreover, that this congestion, having
54 CRITICAL DIGEST OF THE JOURNALs.
extended to the spinal cord, had probably produced pressure on the roots of
the brachial nerves, and thus induced paralysis of the arm.
This autopsy fully confirms Dr. Marshall Hall’s views of the origin of Para-
lysis; and, although we have no other foundation than this single case, we
may here lay down certain rules for treatment, leaving it to subsequent re-
searches to determine whether they are perfectly correct. The rules, which
we deduce from our observations, are the following.
1. When a child, during the first or second dentition, is suddenly seized
with Paralysis of one arm, or of the whole side of the body, or is affected in
only a part of the same, without any obvious external cause, this is to be
considered as a Paralysis from Dentition.
2. An accurate examination of the mouth will confirm the diagnosis; for
the teeth will be found firmly compressed within the gums. Generally the
molar teeth are at fault; much more seldom the incisors; at least in those
cases, which we have found recorded by various writers, where the situation
of the teeth has been given, the molars have almost always been mentioned
as in progress of escaping from the gums.
3. The consequence of this dental irritation is obviously an increased san-
guineous congestion. In some children, this may extend to the brain, and
thus produce convulsions or some cerebral affection ; in others, however,
the congestion is limited, for some unknown reason, to the external veins,
and extends to those which are between the muscles, and even to the verte-
bral veins and their minutest branches, so that the roots of the brachial
nerves are compressed. Hence arises paralysis, which is generally confined
to that side where the dental irritation has given rise to congestion.
4. By obviating the venous plethora, the pressure on the roots of the
nerves, and consequently the paralysis, is prevented. But if the congestion
be intense and permanent, the pressure may produce partial atrophy of the
roots of the nerves, and consequent permanent and incurable paralysis.
5. The application of stimulants to the paralysed limbs, or even the use of
electricity, can produce no effect. Repeated cupping in the neighbourhood
of the origins of the nerves, scarification of the gums, wrapping the paralysed
limb in flannel, mild purgatives, can alone produce any result.
*
EPII, FPSY AND CHOREA TREATED BY PRUSSIATE OF IRON.
M. FAIVRE D’ESNANs, surgeon to the Hospital Baume-les-Dames, has
addressed the following communication to the Journal de Médecine et de
Chirurgie pratiques for November 1849. -
I have just read with much interest the article in this Journal, in which
M. Molas speaks of the treatment of Chorea by arseniate of soda. I do not
deny the efficacy of this medicine; but I may be permitted to offer some
remarks, which seem to prove, that another substance will produce the same
effect, if not so rapidly, at least as certainly.
CHOREA. CASE I. 1829. Mademoiselle Clotilda L., of Baume, aged 16,
presented all the symptoms of Chorea. The catamenia appeared a year before,
and had not been suppressed ; nevertheless, this young girl, of a nervous
temperament, was pale and lean ; and, for a week, she had distressed her
parents by her grimaces. The pupils were dilated. I at first thought she
was suffering from worms, and ordered an anthelmintic powder, with essen-
tial oil of tansy. Two or three lumbrici were evacuated, but the Chorea
continued. I then administered the following pills. Hydrocyanate of
iron (Prussian blue) gr. i. ; extract of valerian gr. xxxij. M. To be divided
into 24 pills, of which three were to be taken in the day, at intervals of six
hours, followed by a draught of infusion of valerian. After this treatment
had been continued some days, the Chorea entirely disappeared, without a
return. .
CASE II. 1832. Melania R., of Mamirolle, aged 9 years, was brought to me

CRITICAL DIGEST OF THE JOURNALS. 55

by her mother, who described her as labouring under symptoms which I re-
cognized as those of Chorea. I ordered a glass of infusion of fern every
morning, with two of the pills, as above prescribed, daily. In eight days, the
little patient was brought to me perfectly cured. -
CASE III. 1839. Mademoiselle Julia F., of Baume, aged 13 ; had not yet
menstruated. She had suddenly increased considerably in height, her stature
being four feet six inches. She was pale and weak, and presented the symp-
toms of Chorea. I placed her under similar treatment, and she completely
recovered in five days.
CASE IV. 1843. The same success attended in the case of a young girl of
the Haute Montagne, whose name I do not know. She had been ill for two
months at least, with an intense degree of Chorea. Her parents had con-
sulted all the good women of the neighbourhood and the Swiss sorcerers, who
regarded her as possessed by a devil. The prussiate of iron produced its
effect at the end of eight days.
EPILEPsy. CASE I. In despair of success, I administered the medicine to an
old epileptic patient, who had been a long time in the hospital at Baume.
All imaginable remedies had been tried; but they did not prevent the recur-
rence of epileptic attacks, four or five times in the day. The prussiate of
iron, given in doses of four grains daily, at first increased the intervals
between the attacks, and at last effected their entire removal. It is now five
years since this patient left the hospital; and he has had no subsequent attacks.
CASE II. 1845. Amedeus Laisné, of the hospital at Grosbois, aged 19 years,
of nervous temperament, tall, pale, was attacked with Epilepsy in 1845. The
prussiate of iron, in ten days, freed him from his frequent attacks. He had
a relapse at the end of six weeks, but a course of thirty pills completely
cured him.
CASE III. 1849. Eulalia B., daughter of a wood-cutter in the forest of
Voillans, in consequence of a severe fright last spring, was attacked with
Epilepsy. I visited her in her miserable hut, which was open to all the
winds, in the month of August. The patient was aged 22, large, strong, of a
sanguineous temperament. I commenced the treatment by ordering mild
infusion of balm, as a common drink. When the catamenia had ceased, I
gave Prussian blue and infusion of valerian ; the attacks ceased on the tenth
day. I have since had to treat a relapse of three attacks, which appeared at
the end of fifteen days; but I hope the disease will not return.
I have been led to employ Prussiate of Iron in Chorea and Epilepsy, by ob-
serving, in the military hospital at Strasbourg, that M. Fourdes used it in
intermittent fevers. Considering that Chorea and Epilepsy were diseases
connected with the spinal cord, I thought that the same medicine might be
beneficial in them.
RHEUMATIC DISEASE OF THE EAR.
MR. HARVEY read an interesting and highly practical paper on this sub-
ject, at the Medical Society of London, on the 24th September. The follow-
ing abstract we reprint from the Lancet of October 10, 1849 : ->
Mr. Harvey's attention was first directed to the subject, by observing the
effect of rheumatic inflammation on the tissue of the eye, and from noticing,
in many cases of ear-disease that came under his care, the presence of arti-
cular rheumatism, which influenced, either directly or indirectly, the ear-
disease, the relief of one, for instance, being followed immediately by aggra-
vation of the other, etc. Believing, from observation, that many such cases
were made worse, and even irremediable, by mistaking the cause of the dis-
ease, and by the application of stimulating remedies, he determined on in-
vestigating the subject. The result has been, that in a great number of cases
he has been able to trace the connexion of the ear affection, with rheumatism
of the system generally. In the eye, the secondary attack has been usually
found to come on, after the system has been well saturated by the poison of

§ {j CRITICAL DIGEST OF THE JOURNALS. *
the disease; but the ear may become affected early, the parts first implicated,
as in the eye, being the fibrous tissues, and, subsequently, the nervous ex-
pansions. The disease exhibited itself under two forms—the acute or destruc-
tive, and the chronic or insidious; both, when neglected, tended to impair
the sense of hearing; and the former, to the entire destruction of the organ.
The acute form generally attacked males, and was connected with articular
rheumatism ; the chronic was more frequent in females, and was associated
with rheumatism of the muscular system. . The symptoms of the acute form
of the disease, to which the paper was restricted, are, that the attacks are
paroxysmal, usually following a seizure of articular rheumatism, tinnitus
aurium, resembling the pumping of a steam-engine or forge-bellows, and
generally a benumbed sensation over the temporal and mastoid regions. This
was the part chiefly implicated in the disease, which, if not speedily relieved,
ended in the exfoliation of the bone. Some cases were detailed by Mr.
Harvey : in one, the patient—was a strong, robust man, in whom the attack
supervened on a severe rheumatic affection of the joints, which had been
treated actively. On the entire subsidence of the joint-affection, the left ear
became the subject of severe pain; there was a benumbed sensation over the
temporal and mastoid processes, accompanied with a heavy, deep tinnitus.
There was considerable tenderness over that portion of the head. The meatus
was much swollen, in consequence of the application of hot and stimulating
remedies. He had difficulty in swallowing; the left tonsil was much enlarged.
He was cupped and leeched over the mastoid process, and placed under the
influence of mercury with colchicum. This was pursued for ten days; the
tympanum could now be seen; it was of a brownish-red colour, and had lost
its transparency. The pain had diminished in intensity, but the tinnitus
continued; he had occasional flying pains about the joints. Pain and ten-
derness, continued over the mastoid process; and, though no fluctuation could
be detected, an incision was made over the part down to the bone. Relief
followed: he slept better. Colchicum, with quinine, was given, and the
patient recovered, though for twelve months his hearing was somewhat
affected. The second case was of a similar character; but owing to the obsti-
nacy of the patient, a female, who refused to allow of any incision being
made over the mastoid process, the structure of the ear was destroyed, and the
bone exfoliated, notwithstanding that active and judicious means were used
to prevent it. The third case was one associated with cardiac inflammation,
which ended fatally ; the ear-disease, under the treatment pursued in the
first case, was but little benefited. In concluding his paper, the author lays
great stress on the necessity of the incision over the seat of pain, and con-
siders that, in the second case, that proceeding, if adopted, would have been
as beneficial as in the first. In some remarks on colchicum, he says:– It
appears to me, that colchicum may act chemically, by producing some change
in the urinary and alvine secretions, both of which it tends to increase in
quantity and alter in quality; and secondly, it acts particularly upon the
nervous system. If given in large doses, it should be carefully watched as
to its effects. It should not be given, in a weakened constitution, without
either a tonic or an opiate, and it is better to have the bowels freely acted
upóñat first. I have found it extremely beneficial to continue its use inter-
nally for a lengthened period, in small and repeated doses, in chronic affec-
tiºns ºf the ear presumed to have arisen from rheumatism. I have found it
by figmeans beneficial when it produces nausea, vomiting, or purging, and
more pārticularly beneficial when the skin secretes freely. The preparations
I place most reliance upon, are the wine of the seeds internally, and the
acétous extract, combined with spermaceti, as an external application.” He
usually administered the colchicum wine in small doses, such as five or six
drops, at first, in chronic cases, continuing the remedy for a long period. He
conjoined it with a bitter infusion. In acute cases, he gave half a grain of
the acetous extract, with two grains of calomel, three times a day, till ptyal-
isin was produced. -


CRITICAL DIGEST OF THE JOURNALS. 57
SURGERY.
Local TREATMENT OF ERYSIPELAS BY NITRATE OF SILVER, AND BY
COMPOUND TINCTURE OF IODINE. " .
The following is interesting: “Some of our best authorities claim great
relief from the use of cold applications, while others favour the employment
of hot and emollient fomentations. Hog's lard, and simple molasses, have
their advocates; buckwheat and rye meal, mercurial ointment, oxide of zinc,
creasote, nitrate of silver, tincture of iodine, and other agents of different
names and properties, are pressed into service, with equal claims of restorative
power. So far as the experience and observation of your present reporters
will justify the expression of their opinion, there are no substances in the
whole range of the materia medica of equal value in this complaint, with the
nitrate of silver and the compound tincture of iodine. Probably the weight
of recorded testimony is on the side of the former agent ; although the latter
has been fairly tried, and proved, by ample experience, to be equally ser-
viceable. " . "
“Whether erysipelas requires any local treatment at all, is a question, in
the minds of many judicious and skilful practitioners, that is yet unsettled.
The disease is asserted to be dependent upon a morbid condition of the
blood ; and the constitutional injury arising from this change, it is said, can
only be repaired by means that are calculated to improve the vital fluid, or
to secure the abstraction of a portion of it from the body; but, whatever may
be the pathological condition of the blood, experience proves, most conclu-
sively, that sedative external remedies exercise a controlling power over the
cuticular inflammation, which cannot be exerted without them. - +
“The cutaneous disease is occasionally the only morbid change which is
exhibited by post-mortem examinations; and there is much reason to believe
that the property of contagion, which belongs to the malady, resides in the
inflamed and often abraded surface. When the inflammation is seen involving
the face and head, rapidly insinuating itself towards the inlets of the brain,
with sacs containing purulent matter presenting themselves upon the in-
flamed surface, and threatening to attack the sensorium, the question is one
of the most solemn import, whether we are justifiable in not employing some
direct means for its arrest. To cure disease, is our high calling. If we
cannot cure, we are bound to guard, as far as we can, those portions of the
citadel, that are not the seat of disorder, from being overtaken and destroyed.
The simultaneous occurrence of erysipelas and puerperal peritonitis, has
often been a subject of interesting and useful inquiry among physicians.
There has been no puerperal epidemic disease within the knowledge of your
committee; but, as evidence of there being great danger of communicating
to parturient females the contagious virus of erysipelas, it may be stated that
while recently visiting a patient with this disease, and engaged in making
applications to the inflamed part, the writer was called to wait upon a female
in labour. Under the apprehension that there might be some danger of
communicating the disease, the examinations per vaginam were as few and
as rapid as circumstances would justify; but the case being very tedious, and
requiring the employment of forceps, the hands were necessarily brought
into contact with the mucous coat of the vagina; and, though they had been
thoroughly washed, the patient barely escaped with her life, from an attack
of puerperal fever, attended with an offensive discharge from the uterus, and
an acrid secretion from the vaginal walls. The infant, at the age of about
two weeks, was seized with a severe attack of erysipelas, invading the head
and shoulders, and extending down the back. The integument became ex-
tremely indurated, the skin assumed a dark, livid hue, and the little sufferer
died on the third day, in a state of coma. A similar case occurred not long

58 CRITICAL DIGEST OF THE JOURNALS.
since, in the practice of another member of your committee, and the infant
died with erysipelas about the nates, between the third and fourth week.”
[Report of the Standing Committee for the Western District of the Wew Jersey
Medical Society, Dr. J. PARRISH, Chairman ; in the New Jersey Medical Re-
porter, for July, 1849.]

NITRATE OF SILVER AS A LOCAL APPLICATION IN ERYSIPELAS.
The efficacy of the application of the Nitrate of Silver in limiting the
spread of Erysipelas is undoubted. The very general voice of the profession
says so : and in our own experience the practice has rarely failed to produce
this result to a greater or less extent. Still, accidents may occur. DR. JoHN
C. HALL, of Sheffield, states, that “Sir Benjamin Brodie never uses the
Nitrate of Silver in Erysipelas, he considers it “dangerous’”; and “knows
of two cases in which there was reason to believe that the determination of
the inflammation to internal organs, and the death of the patient, was the
consequence of the application of the Nitrate of Silver to a local surface
affected with Erysipelas”. As the disease is constitutional, and not merely
local, the repression of the outward inflammation may often be most im-
proper. We refer to the Lancet of August 18th, and September 8th, 1849,
for a very full and instructive digest of the opinions of the most eminent
surgical authorities on this subject, by Dr. John C. Hall.
ExCISION OF THE HEAD OF THE FEMUR. D.R. GOTTON'S CASE.
At pages 195 and 774 of the volume of this Journal for 1849, we gave
some account of the controversy between Messrs. Syme, Fergusson, H. Smith,
and other surgeons, on the subject of Excision of the Head of the Femur.
The following case, which is recorded in the Provincial Medical and Surgical
Journal for December 12, as having occurred in the practice of Dr. C. Cotton,
Surgeon to the West Norfolk and Lynn Hospital, promises to be successful,
though the patient still remains under treatment. The reporter of the case
observes, that “although, in its present stage, no confident prediction of per-
manent benefit can be hazarded, nevertheless, an auspicious commencement,
and upwards of seven weeks progressive amelioration, create a hope that the
constitutionally-depraved condition of the system may in a degree expend
itself through the outlet still existing at the hip, and that the skin ulcerations,
resulting from long pressure, may be obviated, by the further favourable pro-
gress of the case allowing of a more frequent change of position. But what-
ever the termination—temporarily amended health only, protracted disease, or
death from phthisis—it must be conceded that the operation, severe and
formidable as it may appear, has, at least in this instance, given a chance of
life, and afforded marked comfort and relief to a hopelessly-deformed girl,
who, harassed by pain, and worn down by slow and wasting hectic, must, had
º, º have remained in a crippled and pitiable condition to the end
of her life.” -
CASE. Jessie Bullen, aged 12 years, was admitted into hospital September
16th, 1849, with hopeless disease of the right hip, said to have commenced
nine months ago. She is a pale, delicate child, of scrofulous habit. She lies
on her back, inclined to the left side; the limbs are drawn up and contracted ;
and there is observed a large open sore over the right hip, which discharges
thin, curdy, purulent matter. The least movement causes agonizing pain.
Both ankles are excoriated and ulcerated; and there is a painful bed-sore
over the ribs, near the spine, on the right side. The circulation is hurried,
the appetite capricious, and the stomach ticklish, but there is almost an entire
freedom from cough. Ordered to have cod-liver oil judiciously administered,
and any agreeable nutritious diet. Apply linseed poultice twice a-day to
the hip.
28th. Improved in appearance, and has gained flesh. The oil has been
CRITICAL DIGEST OF THE JOURNALS. 59
taken regularly, except an occasional discontinuance, owing to the stomach
being deranged. *
October 6th. Renewed hectic excitement, pain, and exhaustion ; loss of
appetite ; partial sweating, and restlessness. A large circular sore over the
right hip disclosed the great trochanter, covered with florid granulations,
prominently protruding ; and, on passing the finger through the posterior
part of the opening, the head of the femur was easily reached, and found dis-
located on the ilium, lying in the centre of a large abscess; the limb was
drawn up and shortened; the knee rigidly flexed and immoveable, and fixed
a little above and on the inner side of the opposite knee, which was also stiffly
contracted, and drawn upwards and inwards. As it was evident the patient
must sink, unless some operative proceeding was resorted to, and as chloro-
form inhalation promised to obviate the pain and tediousness of the operation,
it was determined, in consultation, to perform resection of the head of the
bone; there existing no positive indications of organic mischief, or of the
disease extending to the pelvis, or beyond the upper part of the femur.
12th. The patient having been rendered unconscious by the administration
of chloroform, Dr. Cotton proceeded to make an incision through the hyper-
trophied and ulcerated tissues, about five inches in length, commencing above
the head of the bone, and terminating below the protruding trochanter.
This was afterwards slightly prolonged, to facilitate the sawing of the bone.
The soft parts were then cautiously dissected away and separated, and the
head of the femur made to project through the wound, by forcibly twisting
the limb inwards. The portion of bone to be removed was then grasped
firmly in the operator's left hand, and a section made by a common saw, in
an oblique direction, through the great trochanter and neck of the femur.
The bevelled end of the bone being in a diseased condition, the saw was
again immediately applied, and a slice about a third of an inch in thickness
removed, the section apparently terminating just above the lesser trochanter.
The joint-cavity, on examination, was found filled up with a mass of soft
granulating deposit. An ineffectual attempt, owing to the friable state of
the tissues, was made to secure one vessel, which at first spouted out
rather freely ; but no haemorrhage of importance occurred. On the removal
of the patient to bed, the limb, now set free in the hip, was brought into
as good a position as the contracted knee would admit, and steadied by
means of a long splint, on the outside. Tenotomy of the hamstring ten-
dons was left for a future proceeding, should the case do well. The chloro-
form inhalation answered admirably ; some hysterical sobbings followed its
withdrawal, and the girl complained of much pain in the right knee. Ordered
Liq. Opii Sed. (Battlei). m. xv., ex Syrup. statim. Milk and toast-water
diet.
13th. Became quiet and composed towards the evening, but was restless
during the night, and a slight haemorrhage took place from the wound.
Has dozed much this morning, but still complains of pain at the knee,
and of being cramped at the ankle. This was relieved on loosening the
bandage. A slight sanguineous oozing continuing, the wound was dressed
with lint moistened with a solution of matico ; and the following draught
was prescribed to meet irritative feverishness: B. Liquoris Ammoniae Ace-
tatis 3.j; Tincturae Hyoscyami m.x.; Wini Ipecacuanhae m. v. ; Syrupi Pa-
paveris 3 SS. ; Aquae 3 x. Fiat. haustus tertià vel quartà quâque horã.
Sumendus.
18th. Though composed, and free from pain, there is slight fever, and a
disposition to diarrhoea. Has required a dose of astringent mixture. Bed
very foul and offensive. The thigh appears shortened, and the end of the
femur may be seen projecting within the wound, owing to the unavoidable
cocked-up and contracted condition of the knee. The complete influence of
chloroform having been induced, the patient was moved to an adjoining bed,
and placed upon a sheet of gutta percha web. Dr. Cotton then, grasping
60 CRITICAL DIGEST OF THE JOURNALS.

the thigh with the left hand, and the leg with the right, gradually but
forcibly straightened the limb. During the extension, the integuments of the
ham were torn across, and the lacerated edges drawn a finger's-breadth apart."
(Subcutaneous section of the tendons was dispensed with, as it was evident
that the whole of the tissues, from long faulty position, contributed to keep
up the contracted state of the knee.) A straight Liston's splint, reach-
ing from the axilla to beyond the foot, and previously shaped so as to
admit of easy access to the hip, was now applied, and secured by a bandage
to the limb, and further steadied by a wide web belt carried round the body.
All this was accomplished with but little apparent discomfort to the patient,
who only whiningly complained of the knee, on recovering from the effects
of the chloroform. Water dressing. A well was formed to receive the
discharge, by placing a heavy weight on the outside of the splint, near to the
wound.
19th. Easy and comfortable, and pleased with the straightness of the
limb. Hopes in time to overcome the contraction of the other knee herself.
The end of the femur is well imbedded in the soft parts, and cannot now
be seen in the wound.
The subsequent reports were altogether favourable ; she had tonic medi-
cine, nourishing diet, and cod-liver oil for a week.
Nov. 19th. The improvement in general health has continued ; she has no
sweats at night, nor cough ; less running of the pulse, and the cheeks flush
only when the hip is dressed ; the sore in the ham, from the integuments
yielding, is slowly healing. Fearing an operation upon the left knee, she,
º: by the nurse, has very much overcome the contracted condition of
the limb.
28th. Better; limb easy; very good appetite; thinks she will soon sit up
in bed; the wound, at the seat of the operation, does not now equal in size
that of the sore through which the trochanter originally protruded ; the
edges are rounded, and skinned over ; the base is hollowed, and coated
with dirty yellow shreddy lymph ; the discharge has much diminished.
Dress with resin ointment. *
A)cc. 3rd. Can move herself in bed, and admits of being raised for a short
period to a semi-upright posture with but little inconvenience ; hip-wound
stationary; the draining slightly increased from the ointment ; bed-sore and
other ulcerations healing; the limb lies extended upon a pillow, loosely sup-
ported by foot-splints; the left knee still remains much contracted. She
still remains under treatment. -
The portions of bone removed measured, (by a tape drawn from the point of
insertion of the round ligament to the upper edge of the section,) over the
head, curve of the neck, and the great trochanter, four inches and three-
quarters; and from similar points below, two inches and a half. The head
of the bone was denuded of cartilage ; and a carious cavity, admitting the
end of the finger, existed at its under surface ; the under part of the neck
was also softened and damaged by caries. The trochanter and remaining
shell of the bone retained a seemingly healthy firmness. The cancellous
structure was filled with pale yellow lardaceous pus.
VULCANISED INDIA-RUBBER IN SURGERY.
...Vulcanised Caoutchouc has now become very common in the arts, and is
likewise used in surgery. A systematic and extensive application of this
substancé has lately been made at Paris, for surgical purposes ; and DR,
GARIEL presented to the Surgical Society of that capital, on the 19th of
September last, a series of apparatuses, made of vulcanised caoutchouc, for
* Would not gradual and frequently-repeated extension, though the object were
longer in being accomplished, have been equally efficacious, and less productive of
suffering to the patient : &
CRITICAL DIGEST OF THE JOURNALS. 61
traction, compression, confinement, dilatation, suction, &c. Dr. Gariel pre-
pares the substance by dipping the caoutchoucinto a saline bath, and thereby
renders the India-rubber perfectly and regularly elastic, gives to it an im-
mense force of cohesion, prevents fatty bodies or the most energetic chemical
agents (nitrate of silver, nitric, sulphuric, and muriaric acids, &c.) from act-
ing upon it, and causes it to preserve its elasticity at extreme temperatures.
It should be remembered, that ordinary caoutchouc possesses none of the
above-named properties. One peculiarity pervades the numerous kinds of
apparatuses which Dr. Gariel laid before the Society ; and that is, a very in-
geniously-contrived mode of insufflating various tubes, when placed upon, or
introduced into, the body, thus giving them a greater diameter, and increasing
their power of pressure at will. We may mention a tube used for arresting
epistaxis, which will plug the posterior nares on being insufflated. Pessaries,
and a great number of variously-shaped cushions, intended for many different
surgical uses, are also made to change their sizes at will, by filling them
more or less with air. The Society expressed its highest approval of these
applications of Vulcanized Caoutchouc. [Lancet, lst Dec. 1849.]
URETHROTOMY FOR THE CURE OF STRICTURE.
In connexion with the extracts which we have given from MR. SYME's
work, at p. 35, the following passages, abridged from our weekly cotempo-
raries, will be read with interest.
MR. FERGUsson, on the 1st December 1849, operated upon a patient suf-
fering from a bad Stricture of the urethra, complicated with perinaeal and
scrotal fistulae. He had laboured under Stricture for many years; had ne-
glected himself; fistulae had formed, through which nearly all the urine came
away. He had not had a catheter passed for a long time previous to his
coming into the hospital, and, on admission, Mr. Fergusson discovered that
he had a cartilaginous Stricture at the bulb, through which it was impossi-
ble to pass any instrument. - -
The patient was placed fully under the influence of chloroform, and a
small catheter was attempted to be introduced, but it was found useless to
endeavour to pass it further than the obstruction. He was then tied up in
the position for lithotomy; and, the catheter being retained, a free incision
was made in the middle of the perinaeum, through the hardened tissues, until
the point of the knife impinged upon the catheter. The urethra was then
opened, and the Stricture was freely divided its whole length towards the
bladder. The catheter was then changed for a larger one, which, after an-
other incision or two, was carried along into the bladder, and there retained.
There was not so much difficulty as usual. This operation (in those cases
which really require it) is one of the most difficult in surgery; nevertheless,
there is very little hazard, when it is performed in the cautious and skilful
manner practised by Mr. Fergusson. This gentleman promised the pupils he
would make it the subject of a Clinical Lecture. [Medical Times, 8th De-
cember 1849.] - - - -
An operation of a somewhat similar character was also performed on the
8th December, by MR. FERGUsson.
The patient had suffered, in the most literal sense of the word, from a
bad Stricture of the urethra for about twelve years, and he had been under
the care of Mr. Fergusson at a previous period. The Stricture was, at that
time, exceedingly irritable and undilatable ; and, although a moderate-sized
catheter could be passed through it, so little relief was obtained, and there
was so great a tendency in the urethra to contract again, that it was de-
termined to cut him. He was actually brought into the theatre for the
purpose of being operated on, at the same time that an operation, of a simi-
lar character, was being performed on another patient; but Sir Philip Cramp-
62 CRITICAL DIGEST OF THE JOURNALs.
ton being present, recommended Mr. Fergusson to abstain from the proceed-
ing, and, instead, to put the patient under the influence of chloroform,
introduce as large a sized instrument as possible, and keep it in the bladder.
In deference to so high an authority, Mr. Fergusson pursued this course of
treatment; but, after remaining in the hospital some time, the patient left
much in the same state. In the course of six months, he was again admit-
ted; and Mr. Fergusson proposed the division of the Stricture, to which
proceeding the patient willingly consented to submit. The operation was
done in the following manner: A No. 6 staff, with a groove in its centre,
was passed through the Stricture; the knife was then carried through the
centre of the perinaeum down upon the groove, along which it was slid
against the Stricture, until the whole was divided; an elastic catheter was
then introduced, and retained. -
This operation is similar to one recommended by Professor Syme, only
there is this difference: the Edinburgh Professor divides the Stricture from
behind forwards, whilst Mr. Fergusson cuts from the urethra towards the
ladder. The great principle is the same—namely, the introduction of a
irector through the Stricture, upon which the division is made. The opera-
tion in this case was comparatively simple, far different from that performed
on the first, where no instrument could be passed, and where the structures
of the perinaeum were extensively diseased ; and Mr. Fergusson, in some
sound and practical remarks, forcibly contrasted the two proceedings, and
pointed out the cases in which each operation was applicable. [Medical
Times, 15th December 1849.] -

MR. QUAIN, of University College Hospital, has also been treating Stric-
ture upon the same principle. The following case we give from the Medical
Times, of December 15: -
STRICTURE OF URETHRA—FISTULA IN PERINAEo–OPERATION. James
Graby, aged 54, was admitted September 17, under Mr. Quain, with stricture of
urethra, traceable to repeated attacks of gonorrhoea during the last eight
years. Retention of urine occurred twice during that period. In 1848 an
abscess was formed in the perinaeum, after an attempt to pass an instrument
along the urethra. This patient is a spare, thin man, with an anxious, care-
worn countenance. At the junction of the scrotum and the perinaeum, and
in the median line, is a fistulous opening, with the tissues much thickened
and indurated around. The stream of urine is exceedingly small, and there
is frequent desire to pass it. With each effort, a few drops escape through
the fistula. The introduction of bougies was almost invariably followed by
rigors; and the Stricture was not improved by their use, for, though on
more than one occasion dilated to some extent, it again quickly returned to
the original very narrow state.
November 29. Chloroform having been administered, a full-sized wax
bougie was passed down to the Stricture, and marked with reference to the
meatus. The smallest lithotomy-staff being found too large to pass through
the narrowed part of the urethra, a very slender straight director, with the
extremity slightly bent, was introduced along the whole length of the canal
without any difficulty. [This instrument was constructed with reference to
the present case.] The patient being then put in the position for lithotomy,
incisions were made into the urethra through the fistula and the surround-
ing indurated substance. The depth was very considerable, the tissue cut-
ting like cartilage. After the urethra had been laid open for about half an
inch, the director was withdrawn, and a good-sized catheter.passed down; but
this instrument was arrested beyond the incision in the canal, the whole of
the Stricture not having been cut through. The director being now re-intro-
duced, the incision previously made in the urethra was continued backwards.
The catheter then slipped in easily.
Mr. Quain stated, that if the fistula and surrounding tumour had been
CRITICAL DIGEST OF THE JOURNALS, 63
at the side of the perinaeum, the operation would have been a more easy
one ; for, in that case, the incisions would have been made in the middle line,
without regard to the tumour. He added, that he had to perform the opera-
tion without a measure of the length of the Stricture. The position of the
anterior end of this was determined with a bougie, and that of its posterior
might have been sufficiently ascertained beforehand, if the fistula admitted a
probe to pass into the urethra. But as it was impossible to make a small
director penetrate any distance along the fistula, he had to divide the Stric-
ture by two separate incisions.
December 1. Catheter removed, having been retained since the operation
without any incovenience.
These reports abundantly testify to the importance of Mr. Syme’s opera-
tion, and likewise to the fact, that proceedings of a like nature are not
neglected by metropolitan surgeons. By referring to p. 1068 of our Number
for November, it will be seen that urethrotomy was advocated by Mr. H. Smith,
at the Westminster Medical Society, on the 5th of May 1849.
MATERIA MEDICA AND PHARMACY.
*=s=º
MR. NUNNELEY ON ANAESTHESIA AND ANAESTHETIC SUBSTANCES.
MR. NUNNELEY’s valuable paper, in the Transactions of the Provincial
Medical and Surgical Association, is of too great length to permit our giv-
ing more than an outline of its contents. He has been led to make the series
of investigations, whose results he has presented to us, by the consideration
that the information we possess respecting Anaesthetic agents, “is neither
sufficiently extensive, nor of that precise character which is absolutely neces-
sary to enable us to arrive at an accurate and certain conclusion as to their
practical value, and the circumstances in which, and under which, they, or
any of them, should be employed or not : in fact, hitherto their use has
been mainly, if not altogether, empirical,—not founded on any rational basis.
The intention of the present inquiry is to assist in affording that information,
and to furnish evidence from which such inferences and deductions may be
fairly drawn, as shall, if possible, render their practical application as safe
and certain as the nature of the case admits.” To the particular subjects of
inquiry, and the answers which have been furnished by experiment, we shall
presently recur.
CHEMICAL NATURE OF ANAESTHETIC SUBSTANCEs. These are nearly all com-
pounds of the hypothetical radical ethyle (CAHB)—the assumed base of ether;
combinations of hydrogen and carbon with oxygen, as an oxide of ethyle—
sulphuric ether (C4H5O); or combinations of this oxide with an acid, as
nitric ether (C4H5O, NOs); or of hydrogen and carbon with chlorine instead
of oxygen—chloroform (C2HCl3). These bodies are all hydro-carbons; one
substance, of somewhat analogous character, has been shown to possess, to
some extent, similar properties, in which the carbon is combined with sul-
phur—the bisulphuret of carbon (CS2). From reflecting on this circum-
stance, Mr. Nunneley was led to the supposition, that “where hydrogen and
carbon might be supposed to constitute an hypothetical radical or base,
whether as ethyle, acetyle, methyle, or some other modification, they might
be combined with another body ; which body might be replaced by an-
other element, the properties of the compound to a great extent remain-
ing.” Thus ether, as a base, might be combined with various acids, capable
of being substituted for each other, the general character of an ether fluid
remaining; and the chlorine of chloroform might be again replaced by iodine,
nitrogen, sulphur, or some other element, the new compound having similar
properties to the old. Hydrocyanic acid affords some confirmation of this
view. “This”, says Mr. Nunneley, “is in some degree an extension of the
beautiful theory of substitutions now so generally admitted among chemists,
64 CRITICAL DIGEST of THE JOURNALs.
applying the same doctrine to the therapeutic and physiological properties of
isomorphous bodies, as has long been known to prevail in their chemical qua-
lities.” - * . . . . . . . . . . . -
The substances tried, and of which the effects are recorded, are the fol-
lowing: . " . -
Chloroform | Olefiant gas
Alcohol . . . Light carburetted hydrogen
Spiritus vini of the Pharmacopoeia Coal gas
Sulphuric ether Benzole
Spiritus aetheris nitrici, Ph. L. Camphor * - -
Nitric ether Naphtha (three varieties of)
Acetic ether ... ' Oil of turpentine
Chloric ether - - Creasote
Chloroform and spirit of wine, mixed | Protoxide of nitrogen
Hydrochloric ether - Hydrocyanic acid - –
-- Hydriodic ether | Coneine
Hydrobromic ether Hydrogen
Dutch oil, or chloride of olefiant gas | Carbonic acid
Oleum aethereum, Ph. L. Carbonic oxide
Heavy oil of wine Bisulphuret of carbon
Aldehyde . Sulphuretted hydrogen
Two or more of these mixed together Bromoform
Iodoform
The mode of administration has been by-1. Inhalation, in various degrees
of concentration, for a limited period. 2. Inhalation for a prolonged period.
3. Internal administration, by the stomach and rectum. 4. Injection into
the veins. 5. Limited application to the skin—local action. . . " -
The post-mortem appearances are given in each experiment, when death
has been occasioned. - . . . .
ExPERIMENTs. The animals submitted to experiment were taken from the
four classes of the vertebrate division, and some of the invertebrata were
also used ; but, for several reasons, dogs and cats were principally employed.
The variety has been sufficient to shew, that the effect, throughout the
animal kingdom, is uniformly of the same kind, and therefore the same in .
man; and, hence, in applying the practical inferences to him, we are not
very liable to be wrong. w -- .
The details of 363 experimenis are given ; and, from the care which has
been taken in recording them, they must form a most valuable contribution
to our knowledge of the properties and effects of Anaesthetic agents. To
insure accuracy, Mr. Nunneley says, that “in no one case was the record left
to memory; in every case, as the experiment proceeded, were the effects
written down on the spot.” . . . . . . . . . . . . . . . . . . . . .
EFFECTs of THE SUBSTANGES INDIVIDUALLY. Having given his experi-
ments in detail, Mr. Nunneley makes some remarks on the effects produced
by each substance. From these we can only make a few extracts. . . . .
...CHLoRoFoRM. This is one of the most, if not the most, agreeable Anaes-
thetics with which we are acquainted, and, at the same time, possessed of very
considerable power. “It is, for the most part, pretty constant in its action ;
but I am also, bound to add, it is one of those which require more, care in
administration than most of the others, and, I would venture to say; much
more care than has always in practice been exhibited. It is true, that many
fatal cases, in which it has been given, are known; but, I am firmly convinced,
there are many more fatal cases which have not been reported... Even in
those cases which have come to light, all sorts of explanations, and attempts
to explain away, the true cause of death, have often been attempted, rather
than admit the fact of the person having been killed by the Chloroform.
This is, perhaps, scarcely to be wondered at ; the admission of the fact would
be almost like acknowledging being accessory to the death of the patient,
which most men naturally shrink from. A careful examination, however, of

CRITICAL DIGEST of Trie JourtsALs. 65
the preceding experiments, cannot, I think, but convince any impºrtial
person that, in reality, death in these cases was caused by the Öhloroform";
either from some abnormal condition or peculiar idiosyncrasy, by which the
person was rendered unusually susceptible to its influence; or, as I believe,
far more frequently from a want of that experience and care in its adminis:
tration, which the exhibitor should have possessed and attended to. When
I, see statements by medical men, that they have “boldly administered’
Chloroform, in quantities of from six drachms to an ounce-and-a-half at a
time, without any ill effects, I cannot but congratulate both the patient and
the doctor, that the rashness in employing such quantities has been equalled
by the carelessness in administering it, so that by far the greater portion of
the fluid has been wasted by escaping into the air of the room, rather than
passed into the lungs of the inhaler, and thus the carelessness of the admin-
istrator has, contrary to what generally occurs, and which he would do
. not to risk again, been the means of escaping from the effects of his
I’ā,SIll] eSS, - . . - - - - *
“Two very important practical points, in reference to the administration of
Chloroform, appear to be proved by these experiments. - Y -
“1st. That the effects produced upon similar animals by like quantities of
Chloroform, all circumstances, so far as can be ascertained, being precisely
similar, are not identical, the effects being far more considerable in one than in
another: even upon the same animal the effects are far more decided at one
time, than they are at another.” (p. 319.) This is demonstrated by a com-
parison of the following experiments, among others. - -- - -
“(Experiment 5.) I applied; by means of a damp, warm sponge, thirty
minims of Chloroform to the mouth of an active terrier dog. At first it
struggled hard, but in thirty seconds became quiet and breathed deeply, with
dilated pupils ; the saliva, freely dribbling from the mouth. The sponge
was retained over the mouth and nose during five minutes, when, the Chlo-
roform being exhausted, it was removed; the dog was not insensible, and
when let loose, immediately ran about and rubbed his neck and body
very violently. After seven minutes, a second dose of thirty minims was
administered, in a precisely similar manner to the first ; in two minutes
and a quarter, there was neither sensation nor reflex action, but an indication
of distress by the noise in breathing ; at six minutes, there was panting
respiration, with blowing motion of the cheeks; all the other muscles being
perfectly motionless and flaccid. The heart could just be perceived, with a
quick, fluttering, motion, until nine minutes, after which there was no indi-
cation of life.” (p. 177). , - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
“(Experiment 7.) A strong, but not very large, rough-haired water-
dog, inhaled from a sponge wrung out of water, temperature 120 degrees,
seventy minims of Chloroform. He inspired deeply and quickly, so as to in-
hale it rapidly; he struggled hard at first, but became affected in a minute;
never lost sensation nor sensibility. The sponge was removed at five'
minutes, before which time the whole of the Chloroform was exhausted. The
only effect was, that he appeared rather weak on the legs, and rubbed'his'
neck and breast with considerable force upon the floor. In a quarter of an hour,"
the experiment was repeated; temperature of water, 100 degrees. Did not
struggle so much as last time, and breathed steadily and deeply. The sponge'
was removed at five minutes, the Chloroform being completely exhausted. He
was unable to stand or move; no sensation, but reflex action remained; at nine
minutes, muscular power returning, as in sensibility; twelve minutes, can'
now see; eighteen minutes, able to run, but falls every now and then, the
muscles being tremulous and weak. ... In twenty-two minutes afterwards,
experiment repeated; struggled very little; not insensible until the expira-,
tion of five minutes, when he lay perfectly helpless without sensation, but
gradually recovered. In twenty-five minutes afterwards, experiment re-
peated ; in three minutes, respiration became quick and stertorous, then
WOL. II. .

66 CRITICAL DIGEST OF THE JOURNALS.
more feeble ; sponge removed in five minutes, as in the other experiments,
the Chloroform being exhausted ; dropped insensible and motionless, except
respiring quickly, but feebly, the heart, pulsating rapidly; in fourteen
minutes could see, and perceive the indications of a threatened blow, but
was unable to move ; at eighteen minutes began to move, and in twenty
minutes was able to stand, with the legs very straddling and wide apart.
The motions bore a strong resemblance to those of an animal recovering
from prussic acid. For twenty-four hours after, he appeared dull, and not
disposed to eat much ; on the following day he made his escape, being per-
fectly well and active again.” (pp. 177-8). -
The different effects on the same animal are most unequivocally shewn in
the following experiments.
“(Experiment 16.) A full-grown cat inhaled not quite one drachm and a
half of Chloroform from a sponge. She immediately struggled hard, and
passed urine in a stream of considerable force. In one minute and a half,
sensation and reflex action were quite lost ; she lay perfectly still without
respiring, but the heart beating rather rapidly, until five minutes, when there
was some little respiratory movement, which gradually became very rapid,
during which time the pulsations of the heart became excessively quick,
amounting to nearly three hundred per minute, as far as could be counted ;
at seven minutes, some sensation and reflex action had returned. The sponge
was removed from the mouth at ten minutes. She lay across the knee as
though asleep, but with motive power gradually returning, and gradually
awakening, when she slipped off the knee and sat crouched down, and for
awhile she was indisposed to move, but in a short time was quite well again.
“(Experiment 17.) To the same cat as last, two days afterwards, and being
perfectly recovered, I gave, by inhalation, in the same manner as before,
forty minims of Chloroform. In one minute and a quarter, sensation and
reflex action were lost; she continued to lie still and breathe quickly and
slowly until five minutes, when for a minute the respiration became rather
spasmodic, after which it ceased. The heart could just be felt moving until
eight minutes, after which there was no indication of life.” (p. 183.)
The intensity of the effect appears much rather to depend upon the
quantity of Chloroform inhaled in a given time—the concentration of the
vapour, than upon the absolute quantity inspired. A small quantity, Sud-
denly and quickly inhaled, will produce more rapid and decided—and at the
same time more dangerous—effects, than a much larger quantity taken more
slowly. The following experiments are illustrative of this,
“ (Experiment 13. Vapour not concentrated, but inhalation prolonged.)
A full-grown, but rather small, cat was put into a covered glass vessel,
holding three hundred and seventy-five cubic inches, with one drachm of
Chloroform. She immediatly became uneasy and tried to escape, the saliya
dribbling freely from her mouth. In half a minute, she became perfectly
still, supported against the side of the vessel. There was some convulsive
cough. At three minutes, the only motion was that of very feeble, rapid
respiration, sixty per minute; the pupils dilated. At three minutes and a
half, respiration had ceased, when the cover of the jar was removed, the cat
being apparently dead; but on being handled, she, for a few times, breathed
in a short.barking manner. At five minutes, there was neither sensation
nor reflex action, the muscles being perfectly flaccid; but by thrusting the
hand beneath the ribs, the heart could be felt very feebly beating at one
hundred and twenty per minute. At ten minutes, there was perceived a
very faint convulsion, which was immediately followed by rapid twitchings
over the whole body; at twelve minutes, on being taken from the vessel and
laid upon the floor, she immediately began to cough and respire, and reflex
action returned ; the urine and faeces were passed, and shortly afterwards
the convulsions were very strong. She now began to swear, and, though un-
able to crawl or stand, made most violent attempts to bite the floor, and every-



CRITICAL DIGEST OF THE JOURNAſ.S. 67
thing put near the mòuth, more viciously than I ever saw a cat bite. This
continued for ten minutes, during which time she improved so as to be able
to crawl about, attacking most furiously everything, so as to render it pru-
dent to get out of her way; even her own tail she apparently mistook for
something else, and bit most vigorously. By twenty-six minutes this
temper had subsided, and she then as earnestly sought to be caressed and
petted. At half an hour she eagerly eat meat, and though weak, could walk
about. The next morning she was quite well.” (pp. 18.1–2) .
“(Experiment 14. Vapour more concentrated, but inhalation less pro-
longed). Same cat as No. 13. Put one drachm of Chloroform upon a damp,
warm sponge, at 80 degrees Fahr., and held it over the mouth and nose.
For a minute she struggled hard, then became suddenly perfectly still. At
one minute and a half, there was neither sensation nor reflex action; at
three minutes, there was a little grunting noise, after which not any indica-
tion of life. The Chloroform was not nearly exhausted.”
“ (Experiment 15.) A very large powerful cat had one drachm of Chloro-
form given upon a warm damp sponge, at a temperature of 70 degrees Fahr.
She struggled very hard indeed against it for one minute and a half, when
she became still, and sensation appeared to be lost; but reflex action was not
completely so until ten minutes. She continued to breathe feebly until four
minutes, and the heart slightly to pulsate until five minutes; after which
there was no sign of life. The sponge was removed, still retaining a con-
siderable portion of the Chloroform.” (pp. 182-3.)
SULPHURIC ETHER. This Anaesthetic is considered by Mr. Nunneley
preferable to Chloroform, in cases where there is any reason to suspect any
peculiar susceptibility to the depressing influence of Anaesthetics, such as
asthenic heart disease ; also when an operation is likely to produce a con-
siderable shock of the system, or to be long and tedious. But where the
patient is plethoric, or very excitable, or where there is a tendency to fever,
—when there is any affection of the brain or its membranes, or any predis-
position to congestion,-any sthenic disorder of the heart, or disease of any
kind in the lungs;–then, if an Anaesthetic must be used, Ether is not the
one to be selected. f
CHLoRIC ETHER is “ composed of Chloroform and Alcohol, differing from
the former as nitric ether does from sweet spirits of nitre.”
From his experiments with this substance, Mr. Nunneley has concluded,
that it is a very safe and pleasant Anaesthetic ; and one which he would have
no hesitation in using, if neither Chloroform nor the Chloride of Olefiant gas
were at hand. A large quantity may be inhaled without destroying life.
CHLoRIDE of OLEF1ANT GAs—DUTCH LIQUID. Of this substance, as an
Anaesthetic, Mr. Nunneley thinks that it is in no one respect inferior to Chlo-
roform. In his experiments, the animals were rendered perfectly insensible
in as short a time, and shewed no uneasiness while passing into or emerging
from this condition. There does not seem also to be so much depression in-
duced as by chloroform ; and a larger quantity appears necessary to cause
death.
Besides numerous experiments on animals, Mr. Nunneley had several op-
portunities of trying the effect of this Anaesthetic on the human being.
* Having ascertained the quick and pleasant manner in which animals pass
into a complete state of Anaesthesia from a small quantity of the Dutch oil,
and that in no case was there any irritation, I inhaled a few minims myself—
not sufficient to lose all consciousness, but to enable me to judge of its effects.
These I found in every way agreeable. I now gave it seven times to some
medical students. One of them inhaled it three times, one twice, and two
once each. In no case were more than thirty minims given, at first, upon a
thin cloth ; and in-four, twenty minims more were given. Six out of the
seven times, perfect insensibility was produced ; the other gentleman was
5 2
68 CRITICAL, DIGEST OF THE JOURNALS.
made most happy, declaring the seventh heaven was nothing; he was in the
ninth—may, in the eleventh; hoped he might never come out, and so on.
“I now gave it to a parturient woman, in an extremely delicate and feeble
condition, with legs excessively Oedematous, and, I have no doubt, with diseased
lungs, who had been in strong labour three hours with hardly any progress,
from a rigid os uteri. Twenty minims were given ; and twice, ten. In a
quarter of an hour, the child, a small one, was born : the change in the os
uteri was marvellous. She was not altogether insensible.
“Thursday, March 8th. At three operations at the Leeds General Infirmary,
it was given to a man, aged fifty-five, who had had for some years con-
traction of the adductor muscles in both thighs ; the legs were forcibly
abducted while under the influence of this fluid. At first, forty minims
were given, and the effect kept up by twenty given twice afterwards;
in all, eighty minims. The muscles were fully relaxed, and the thighs were
much separated. A woman, aged forty-two, had forty minims at once ; a
small malignant tumour was removed from the side. A boy, aged fifteen,
had the outer hamstring muscles of both legs divided ; in all, he had eighty
minims, forty at first, and twice, twenty. The operation necessarily occupied
some time. He was unconscious, even after removal to bed. All did well.
“March 17th, Through the politeness of my friends, Messrs. Smith, Hey,
and Teale, the Dutch oil has again to-day been given in four operations (two
young women and two men), with success.” (p. 214.)
“I have since given it, in several other serious and important operations,
to two women in labour, and several times it has been inhaled for experi-
ment, so that no doubt can remain as to its value. When I used it, I was
not at all aware that it had been previously tried; both Drs. Simpson
and Snow had tried it, and were led to consider it a dangerous preparation
which could not be used. This error, I believe, arose from their using an
impure preparation; one which possibly contained free chlorine, which would
account for the irritation induced, and must always be avoided with the
utmost care ; a point, however, upon which there can be no great difficulty,
as I have used Chloride of Olefiant Gas perfectly pure, prepared by three
different chemists.” (p. 326.)
CoMMON CoAL GAs. This is not only a powerful, but a very safe and
manageable Anaesthetic. “The animal is quickly brought into a state of
unconsciousness and insensibility, and that without the least appearance of
suffering. It does not act as an irritant, it does not excite a cough, there is
no repugnance to the inhalation of it, and the condition of Anaesthesia may
be safely maintained, for a period sufficiently long to allow the performance
of most operations. It appears to deserve a full and fair trial ; and if in
practice it should be found, as I believe it will, to be successful, the cheap-
ness of it would be a recommendation not unworthy of attention, should its
gaseous form not prove too inconvenient.” (p. 332)
CHLORIDE OR PROTOCHLORIDE OF CARBON. This, in appearance and pro-
perties, has a close resemblance to Chloroform and Dutch Liquid. It is a
Safe and not unpleasant Anaesthetic, in action not dissimilar to Chloroform
and Chloride of Olefiant Gas, but apparently less powerful than either of
these. Mr. Nunneley, however, is uncertain as to the purity of the substance
employed, and consequently as to the accuracy of the results he obtained
in his experiments with this Anaesthetic, described in his paper.
Most of the other substances in the list are rejected by Mr. Nunneley
from among those which may be used as Anaesthetics. Some have no preten-
sions to this property ; others are too irritating; others, again, are dangerous
in their immediate action ; while two—the Bromide of Olefiant Gas and
Hydriodic Ether—have the remarkable property of producing death some
hours after the animal has perfectly recovered from their Anaesthetic effects.
This appears, according to Mr. Nunneley, due to a poisoming of the blood.

DIFFERENT MoDEs of ADMINISTRATION. Some experiments have been
CRITICAL DIGEST OF THE JOURNALS. 69
made by Mr. Nunneley, with the view of determining the effect of adminis-
tering the substances by Injection into the Weins, by the Alimentary Canal,
and by Prolonged Inhalation.
INJECTION INTO THE WEINs. The effect of Chloroform, and of Sulphuric
and Acetic Ether, when thrown into the veins, is not only very rapid, but a
very small quantity is sufficient to produce death. The symptoms preceding
death, and the appearances presented afterwards, do not differ materially
from those caused by inhalation. Of Chloroform, five minims were sufficient
to induce unconsciousness and insensibility, but not death ; ten minims de-
stroyed, with every symptom of poisoning by hydrocyanic acid, both before
and after death ; while twenty minims almost instantaneously destroyed a
large dog. Twenty minims of Sulphuric Ether in one dog did not entirely
destroy consciousness; but in another and larger dog, before the whole of
thirty minims could be got into the veins, it was very powerfully affected,
and shortly was dead. , Acetic ether is quite as destructive—apparently,
indeed, more so than sulphuric. 3.
ADMINISTRATION BY THE ALIMENTARY CANAL. Most of the substances,
administered in this way, produce scarcely any Anaesthetic effects, acting at
first as little more than local irritants, unless the dose be large ; and even
then producing less effect than an equal quantity of spirit of wine. “This is
an effect which, d. priori, hardly any one would have predicated, and which
may assist in throwing some light upon their action, and evidently depends
upon some property in the substance itself, inasmuch as we find a consider-
able difference in this respect amongst them. Some act very violently and
most speedily when applied upon the alimentary membrane, but with much
less effect when applied by inhalation upon the respiratory membrane, as
conia and spirit of wine. Hydrocyanic acid acts with great intensity,
administered by either method, while the ethers, chloroform, Dutch oil,
bisulphuret of carbon, (and especially sulphuretted hydrogen,) produce,
so to speak, hardly any effect when taken into the stomach, but very decided
when inhaled. A comparison of the experiments will show, that 'where
scarcely any effect has been produced when swallowed, a like quantity of the
same substance when inhaled, even in the same animal, induced, not merely
a complete state of Anaesthesia, but death. When given by means of a
sponge, a good portion is blown away by the expired air, so that a less portion,
actually reaching the lungs, produces a much greater effect than when
swallowed.” (pp. 344-5.) * : -
PROLONGED INHALATION. The following experiments illustrate the effects
of the administration of Anaesthetic agents by this method.
“ (Experiment 275.) A four-months'-old cat was put into a gallon jar,
with ten minims of Chloroform ; temperature 68 degrees. The jar was not
entirely covered over, a small portion being left open at each end (the jar
being oval), so that the animal should not suffer from the deterioration of the
air. The kitten was soon under the influence of the Chloroform ; and, as the
effect passed off, another portion was added, so as constantly to keep up the
effect. At each addition, there was some excitement, struggling, and some-
times convulsions, otherwise the cat lay perfectly still, as though asleep; the
heart beat rapidly; the breathing was at times very quiet and feeble, at others
more slow and deep. The faeces and urine were passed more than once. It was
taken out of the jar three times, wiped clean and dry, and allowed to remain
out four or five minutes, while the jar was washed out and dried. When least
under the influence, it was offered meat and milk, but during the whole
period it would not touch either. At the end of thirty-eight hours, it was
dead. It had gradually become weaker, and for several hours had scarcely
stirred in any way; indeed it was hard to say whether it was alive or not,
and for the last eight hours no fresh Chloroform had been put into the jar,
and the cover had in a great degree been removed, so that during this time
it could scarcely be said to have been subjected to the Chloroform.” (p. 276.)
70 CRITICAI, Di GTEST OF THE JOURNALS.
“ (Experiment 281.) On the 17th, at seven P.M., a seven-days'-old kitten
was placed in a two hundred and forty cubic inch jar (temperature 60
degrees), with four minims of chloride of olefiant gas. . It was soon asleep.
During the evening, at intervals of an hour, four minims were put in six
times (in all twenty-four minims), when it was left for the night. The next
morning (the 18th) it was lying still asleep, but was easily roused on being
touched, when it was taken out and put to the cat, which it sucked freely,
and was well cleansed. It was immediately returned to the jar, with four
minims of the liquid; this was repeated at intervals during the day nine
times (in all thirty-six minims), with the effect of keeping it quiet and
asleep. At three P.M., and again, at seven P.M., it was put to the cat, but
could not suck. The last dose, at eleven P.M., excited it at first when put in ;
before, this effect had not been observed. 19th, nine A.M., asleep, but soon
roused; taken out and put to the cat, which it sucked well. Returned after
an hour to the jar, with six minims, which, to half-past seven, were repeated
three times. During the day it lay perfectly still, except when touched, when
it roused up and crawled about ; during the day its eyes became opened. It
was taken out and put to the cat, which it well sucked, was made clean and
dry, and in half an hour returned to the jar, with six minims of the fluid.
This was twice repeated in the evening. At night it appeared exceedingly
dull, and likely to die. 20th, half-past eight A.M., after watching it for some
minutes, I thought it dead ; but on taking it up in the hand, there was the
faintest respiratory movement. All day it lay with the jar uncovered, never
stirring, and rarely breathing, excepting when touched; its temperature fell
to that of the room. A little faeces and urine escaped. Towards evening,
seventy-two hours after being placed in the jar, it had so far rallied as to be
able to stir the limbs, in the faintest manner, when touched. It was put with
the cat, who warmed and cleaned it. As it was found to have revived, but
not to have been able to suck, it was left with the mother during the night.
None of the fluid had been given to it during the day. 21st, nine A.M., being
quite active and well, it was returned to the jar with six minims of the fluid,
which was twice repeated during the day: in the evening it was just breathing.
On being put to the cat, cold and wet, it was cleansed, but being unable to
suck or move, the mother soon left it. In an hour again put in the jar, with
four minims of the fluid : this was repeated at half-past eleven P.M. 22nd,
nine A.M., it lay in exactly the same position as last night, and really appeared
to be dead, but on handling it, the faintest respiration was perceptible. It
was of the same temperature as the room, and contrasted strongly with the
kitten in the following experiment. It was put to the cat, who again cleaned
it, but it did not rouse nor suck. After two hours it was put into the jar,
with four minims more : it never stirred after. The respiration became
slower, but did not altogether cease until seven P.M., or one hundred and
twenty hours after being put into the jar.” (p. 281.)
The experiments show that Chloroform is one of the most speedily fatal
agents, but that life may be safely preserved, if the condition of insensibility
be not carried too far, for a much longer time than is required for any ordi-
nary purposes.
LoGAL ACTION. This, in all the agents tried, whether applied in the fluid
state or in vapour, induces redness, some tumefaction, and paralysis, with
loss of feeling, in the part which has been exposed to their influence.
Chloroform and Dutch Liquid possess this property in the most marked
degree. The limb may be cut, torn, or amputated, without any perception,
though sensation remain unimpaired in the other parts of the body. If the
hind leg of a frog be exposed to the vapour of Chloroform for a minute, red-
ness, Anaesthesia, and paralysis are produced in it; if the exposure be more
prolonged, the other hind limb loses its sensation and motion; and, in time,
the whole body participates in the condition. Besides performing experi-
ments on the lower animals, Mr. Nunneley subjected his own fingers to the


CRITICAL DIGEST OF THE JOURNALS. 71
influence of Sulphuric Ether, Chloroform, Oleum AEthereum, Acetic Ether,
and Dutch Liquid, with the effect of producing more or less sensation of heat,
stiffness, and numbness. He also applied Chloroform locally in some opera-
tions; it produced heat and Smarting at first, but the pain of the operation
was greatly diminished, and in some entirely destroyed. Whether in opera-
tive surgery the local action of Anaesthetics will be of much use, is, in Mr.
Nunneley’s opinion, doubtful. “In many cases, as, for instance, lithotomy
and deep-seated tumours, they could not be used; and in the larger amputa-
tions they would not penetrate to a sufficient depth to render the parts in-
sensible throughout, unless applied for a very long time; and it is not unlikely,
that during the long application, the system itself might be affected ;
besides which, there are many practical difficulties which would impede their
use, and which it would not be easy to overcome—as the confining the fluid,
without evaporation, to the part wished. In the smaller operations, they
certainly may be used so as to induce complete local Anaesthesia; and if there
be any constitutional impediment contra-indicating the internal exhibition,
as great susceptibility to their action (as in persons of a hysterical or cataleptic
diathesis), there the local action should be preferred ; but in other cases it is
doubtful if the longer time required for their application, and the smarting,
which, if there be any abrasion of the skin, is great, and, in a wound of any
extent, too great to inflict, which is occasioned, be worth undergoing for the
sake of avoiding the inhalation. There can, however, be no doubt, that the
local application of Chloroform and other similar agents, in cases of severe
pain, is often productive of the greatest comfort and relief. In painful and
irritable tumours, the pain may often be alleviated. Tic douloureux has dis-
appeared like magic, by rubbing the part with it, or saturating a piece of lint
and covering it over with oiled silk. Tooth-ache may often be charmed
away, by a drop put within the decayed tooth. Lumbago and sciatica may
be quieted by its use, and in many other cases, the local action of Chloroform
has been very successful in relieving pain; as, indeed, great numbers of
medical men, who have, since the announcement of its local action, tried it
with manifest advantage, can attest.” (pp. 350–1.)
At the commencement of his investigation, Mr. Nunneley proposed séveral
queries for investigation. We will give these, and the answers, in an abridged
form :
“Quest ION I. If the property of inducing Anaesthesia be confined to the
few substances which have hitherto been used, or if there be not a large class of
bodies which have in common the property of temporarily suspending conscious-
mess, or sensibility, or both, vitality remaining ; and if this be so, whether these
substances are characterized by any similar composition, or chemical alliance,
and have a common ‘modus operandi’ upon animal bodies 3"
To the first part of the question, an answer may be returned in the affirm-
ative; to the second, an answer has been given in the remarks on the various
substances. The following are the conclusions at which Mr. Nunneley has
arrived : “1. That no Anaesthetic substance has yet been discovered, which
does not contain carbon. 2. That the combination of carbon with hydrogen
or chlorine, constitutes the best binary agent; and that the greater the pro-
portion of the carbon to the hydrogen-being, at least equal to it, the more
powerful the agent is ; and if we could obtain a pure liquid of hydrocarbon,
containing these equal proportions, easy to be volatilized, and of constant
composition, it is highly probable that it would constitute a valuable and
safe Anaesthetic ; for if the carbon be too much in excess, as in benzole,
(where the proportions are as two of carbon to one of hydrogen,) although
the compound is a powerful and safe Anaesthetic, yet it is neither so manage-
able nor pleasant as where the proportions of carbon are not so great,
symptoms being developed, which may reasonably be supposed to arise from
the excess of carbon. 2. That hydrogen and carbon may unite, as a radical
base, with oxygen, chlorine, iodine, bromine, nitrogen, and, perhaps, some

72 CRITICAL DIGEST OF THE JOURNALS.
other substances, to constitute Anaesthetic agents; and that these compounds,
or at least some of them, may again unite with acids (consisting, perhaps, of
the same elements as the base itself), and yet retain, to a certain extent, the
same property as the oxide of ethyle: as nitric, chloric, acetic, and hydro-
chloric ethers do. 4. That of these ternary compounds, those act the best,-
all things taken into consideration,-in which the third element bears the
least proportion to the hydrocarbon, especially the carbon ; as, for instance,
ether and alcohol, perchloride of formyle (chloroform), and hydrochlorate of
the chloride of acetyle (Dutch liquid); and of the binary compounds, those
in which the atoms are in equal proportion to each other. 5. That substances
which are analogous in composition, and isomorphous in form, as well as in
physical and chemical character, are often similar in physiological action ;
but where they are not isomorphous, their action is not similar, as chloroform
and iodoform. 6. That substances which are isomeric, or nearly so, but very
dissimilar in physical and chemical properties, are also in physiological,— as
witness several of the pure hydrocarbons, which, though very similar in com-
position, are very different in properties. 7. That, should any other combi-
nation of elements be discovered, which shall possess more valuable and
important Anaesthetic power than those yet known, its composition will pro-
bably be found in accordance with the principles now announced. Lastly.
We may conclude that the action upon the animal economy of all true Anaes-
thetic agents, whether carbons or hydrocarbons, whether simple or combined,
is essentially the same in character.”
“QUESTION II. What is the ‘modus operandi’ of Anaesthetic substances 2
In other words,-upon what structures do they act 2 What changes do they
...;; What are their physiological effects 2 Is their primary effect local or
eneral Ž’’
9 Mr. Nunneley concludes: 1. That the action of Anaesthetic agents is imme-
diately and primarily upon the nerves; that the heart’s action, respiration, cir-
culation, the blood, and the muscles, are secondarily effected. 2. That, in the
first instance, all these substances act as stimulants, the action being more
or less prolonged, but, to some extent, perceptible in all. In hydrocyanic
acid, chloroform, and chloride of olefiant gas, the stage of stimulation (unless
the dose of the two latter be very small) is short and feeble; with ether, it is
considerable ; while with alcohol, the stimulant effect alone is produced.
3. That the action is, at first, local. 4. That the action is primarily and
directly, not upon the cerebral masses and sensorium, but upon the peri-
pheral expansions of the nerves ; that, catteris paribºts, the effect is in propor-
tion to the number of these which can be directly and simultaneously acted
on : hence the greater Anaesthetic effect produced by inhalation, than by inter-
nal administration.
“QUESTION III. Is there any one of these substances, which should be selected
&n preference to, or to the eaclusion of, all the others ? Is there any one, the
temporary effects of which are more complete and certain, the permanent more
harmless, and its administration more under our control than those of any of
the others, so that we should uniformly retain the employment of it, and reject
the use of them 2''
This question has been pretty fully answered in the remarks on the various
substances. Those substances which possess the greatest power, and the
effects of which are least objectionable, are sulphuric ether, the gaseous car-
buretted hydrogens (of which, common coal-gas is, perhaps, the best), chloric
ether, hydrobromic ether, chloroform, the chloride of olefiant gas, and the
chloride of carbon.
“QUESTION IV. Is there any essential difference in the action of these sub-
stances, according to the mode in which they are administered? Do they produce
the same effects in whatever way they are carried into the body; or does the
effect depend upon the nature of the tissue wpon which they are applied ? And
does the same dose, when applied to the same tissue, and in the same manner,
&nvariably produce the same uniform results 2"
CRITICAL DIGEST OF THE JOURNALS. 73
The first clause of this question has been already answered; as to the second,
Mr. Nunneley thinks that the effect depends more on the extent of surface
than upon the nature of the tissue. As to the uniformity of result, it may
be said, without hesitation, that the same dose not always produce the same
result. The very young (new-born) animal will bear a positively larger
quantity than the adult ; while an older, but not adult animal, will not bear
the same quantity as an old one of the same species will. Moreover, the
same animal is far more susceptible at one time than at another. “Hysterical
females, and lively, excitable animals also, are much more susceptible
to the action of Anaesthetic agents than the unexcitable and phlegmatic
are. In one instance, a lady called upon me, while suffering from a
paroxysm of tic-douloureux, anxious to have immediate relief. I rubbed,
upon the face, not more than twenty minims of chloroform, with success;
but while doing so, another lady, who had accompanied her, and stood near,
complained of feeling the effect of it. On leaving my house, instead of pro-
ceeding to some shops, as she intended, the head of the second lady became so
confused and giddy, that she was obliged to make the best of her way home
again ; indeed, she walked so unsteadily, that she afterwards told me she
was quite afraid of being supposed to be drunk. She laid down, and slept
for several hours afterwards. This lady is one of a family of the most highly
hysterical diathesis I ever met with. The quantity of any Anaesthetic which
is inhaled in a given time, is of the utmost importance,—catteris paribus, the
more concentrated the vapour, by far the greater is the danger. Given slowly,
the same animal will inhale at least twice the quantity, without dangerous
symptoms, that, if inhaled very rapidly, would be not unlikely to cause death,
as a reference to several of the preceding experiments will show.”
“QUESTION W. Are there any symptoms by which we may accurately judge
of their effects, and ascertain and control the point to which the system may,
with safety, be brought under their influence º’’
In answering this question, Mr. Nunneley remarks, that the vapour should
not be so concentrated as to produce a very sudden impression ; nor should
the Anaesthesia be carried so far as to render the patient altogether unable to
stir. This is especially important in the practice of midwifery. Mr. Nunneley is
convinced that the plunging a woman into a profound state of unconsciousness,
has been often productive of the worst and most fatal consequences. The
apparatus used should be simple,_a large, moderately–fine, linen handker-
chief is best.
“QUESTION WI. In case of an over-dose, are there any means which can be
employed to counteract the effects 2 Do we possess any antidotes, or are there
any remedies 2 If so, what are they £ In what manner do they act, and how
should they be employed ?”
“Of the remedies mentioned, no one appears to possess any great power, in
such a condition of things as would call for its employment. It is true, that
agitation, cold affusion, a cold stream of air, perhaps electricity or galvanism,
and some other stimulants, will expedite the process of rallying, where the
depression is not very profound ; so, also, it is possible that venesection, by
lessening the pressure of the column of blood upon the walls of the heart,
especially the right, may, when this organ is still acting, facilitate its con-
traction, and thus assist in restoring the circulation : at the same time it is
by no means certain that, with such a depression as exists in the nervous
energy, the abstraction of blood may not in itself tend to increase, or, at any
rate, to prolong this condition, precisely as it would do in syncope, to which
state it appears not improbable, that the condition induced by Anaesthetics
bears some considerable analogy.”
“But we have seen that, in the great majority of cases, so long as the heart
acts, and respiration at all goes on, the mere withdrawal of the Anaesthetic is
followed by the restoration of the functions; and therefore the question forces
itself upon us, as to the positive value or not of any of these means. If the


74 CRITICAL DIGEST OF THE JOURNALS.
heart has ceased to act, no blood will flow on a vein being opened. If respi-
ration has ceased, and the heart does not move, galvanism, though it may
make the voluntary muscles violently contract, only does this by the sooner
exhausting their power to do so, without, in any way, restoring the vital
functions. Oxygen, of course, if there be no respiration, cannot be taken into
the lungs; and the performance of artificial respiration with it, would be
both difficult and incomplete, even were it at hand, which it would not, in
the great majority of cases, be ; while, so far as experiment and chemical
action goes, it does not appear that, if it were ever so fully inhaled,—even in
combination with the Anaesthetic substance,—it would in any manner pre-
vent the development of full Anaesthesia; and therefore it cannot be for a
moment imagined it would, in any way, counteract the effects when they are
developed. Ammonia we have seen to be useless and inert, whether given
mixed with the substance, or after its effects were produced. The coldness
and depression which, in so marked a degree, are present, do not encourage
us in the supposition that either cold water or cold air, to any very great
extent, would be useful, a conclusion which the experience of their effects
confirms. We are, therefore, reduced to seek just that assistance from their
use, as shall suffice to produce such a moderate shock (if the nervous system
be capable of receiving any), as may cause a reaction and rousing of its
powers, by which the heart and respiration may again be set in motion, or
rendered more vigorous. This, as I have before said, appears far more likely
to be accomplished by the sudden dashing of a small quantity of cold water
upon the face and chest (possibly alternating with heat to the latter), or
such a moderate stream of air as may be produced by a fan, and a not too
violent agitation of the body, than by excessive violence, or by entire and
long-continued immersion. A moderate, interrupted compression of the chest,
and pressure upwards of the abdominal viscera, should not be neglected, as
tending to change the air in the lungs, and thus to get rid of the vapour
there remaining; or, with the same intention, a stream of air might be (not
too forcibly) blown through a small tube into the larynx for a minute or two.
These are remedial means, which some will, I doubt not, be disposed to
exclaim, are very paltry and meagre; and which, it must be allowed, are not
of a very energetic or hopeful character. But it is far better to employ
such as may do a little good, than to have recourse to those which not only
may, but probably will, do a great harm.” (pp. 379–380.)
CAUTERIZATION WITH SOLIDIFIED NITRIC ACID.
DR. RIVALLIER lately communicated to L'Union Médicale his mode of cau-
terizing cancerous tumours with Solidified Nitric Acid. He proceeds as
follows:–Some lint is placed in an earthen vessel, and a certain quantity of
Nitric Acid, in its highest degree of concentration, is gradually dropped upon
it. A gelatinous paste is the result, and to this a shape, in keeping with the
tissues to be cauterized, is to be given. The caustic mass is then seized with
long forceps, and placed upon the part. After a quarter of an hour, or
twenty minutes, it is carefully to be taken off, and an eschar, four or five lines
in thickness, is thus obtained. There are cases, however, where the caustic
may be left for twenty-four hours, as when the surgeon wishes to destroy
a large encephaloid cancer. The pain is trifling, except the skin intervene ;
and when the caustic is left a long time, there is no pain after the first three
or four hours . With large diseased masses, the cauterization should be
repeated every day, after the eschar has been carefully removed. When the
caustic is applied for a few minutes only, the part should, on its removal, be
dressed with lint dipped in a solution of alum, Dr. Rivallier gives a few
cases where this method of cauterization was used with success. [Lancet,
December 1, 1849.]
CRITICAL DIGEST OF TEIE JOURNALS. 75
OBSTETRICS.
THE UNIDER-SIZED WOMB.
The following, from the pen of DR. OLDHAM, of Guy’s Hospital, will be
read with interest, especially in connection with the paper of DR. WANONI,
on Atrophy of the Uterus, and persistence of its infantine condition, of which
we furnished an abstract at page 1116 of our number for December 1849.
“There is a variety of imperfect development of the female sexual organs
to be met with in adults, which consists in their retaining some marks of an
infantine character, being altogether small. This defect is not at first very
obvious; there is no striking error; but I believe it to be one which is, com-
paratively speaking, frequent in practice ; and, from not being properly
apprehended, has led to much mischievous meddling with instruments for
the cure of supposed contractions. I directed attention to this, originally,
in a paper on dysmenorrhoea, in the Medical Gazette (November 1846); and
since then I have seen many other examples, and feel it to be a matter of
practical interest.
“Physical Conditions. There is some variation in the state of the sexual
organs in different cases. The Uterus is generally under-sized ; and this is
to be detected by poising it on the finger, and moving it from the vaginal
cervix. It is then felt to be of light weight, and is moved as a lighter body
than usual. I have measured the length of the united cavities of the cervix
and body, in some cases, with the uterine sound, on the living subject, and
have found, in three or four instances, a reduction in length of from a half
to three-quarters of an inch ; but I have never met with so striking an in-
stance as that recorded in the paper referred to, where these cavities measured
only one inch and three-quarters. The light weight is, in a great measure,
produced by the thinness of the uterine walls; and hence the examination
by the finger, independently of other considerations, is the most satisfactory.
The cervix is altogether small, of little substance, and short, and the os uteri
is correspondingly narrow and small.
“Amongst my out-patients there is a female, nearly forty years of age,
who has been married many years, but is sterile, in whom the os uteri is so
small, that the aperture can only just be felt by the finger. I should say
that, in size, it was about equal to the aperture of a watch-key. The cervix
and body of the uterus are equally small.
“The only mark of arrest of development in this form of Uterus, which I
have noticed, has been the presence of the longitudinal striae in the cavity of
the body of the Uterus, which, in the healthy, full-sized virgin Uterus, are
confined to the cervix, and are effaced in the cavity. In March 1845, I ob-
tained the Uterus of a young woman, who died in the hospital, of Bright's
disease. She had been married six years, but had been sterile. I made the
following note of the appearance of the sexual organs at the time: ‘The
Uterus was smaller and thinner than usual; the ovaries regular in their form,
and not at all wrinkled. There were some distended vesicles, and the peri-
tonaeal covering was almost rent over one of them : indeed, it was slightly
torn. On opening the womb, it was seen injected, throughout the cavity of
the body, with a very beautiful capillary rete, which ended clearly at the os
internum, the canal of the cervix being white and well marked. The cavity
of the body had some raised ridges, beginning at the os internum, and branch-
ing, or rather bending, round to the two cornua, marking out a triangular
figure.’ I have taken this as the type of the Under-sized Womb, and it ex-
emplifies the amount of imperfect development which is present.
“The vagina, in these cases, varies a good deal. Sometimes it is well-
formed, and in full proportions; but I have noticed some peculiarities. I
should say that, generally, it is short and shallow, and rather contracted at its
76 CRITICAL DIGEST OF THE JOURNALS.
orifice. In one case, where the small state of the sexual organs was very
striking, the upper part of the vagina was contracted into a canal, just large
enough to admit the top of the index finger, and curved to the left side. At
the top, the small os uteri, with the merest trace of a vaginal cervix, could
be felt. This woman had been twice married ; she was flat-chested, with
small mammae, and a badly-developed pelvis.
“The general configuration of the body, in these cases, is sometimes with-
out any marked defect. For some years past I have, at intervals, seen a lady
who has been married for nine years, and is now nearly thirty years of age,
who has never menstruated. She has this low type of womb, and is sterile;
but the figure is well and symmetrically developed, and the mammary glands
are fully formed. She is of a strumous habit, subject to hysteria; but her
general health cannot be said to be bad. More commonly, however, there is
something wanting to the perfect evolution of the female form. A flat and
contracted chest, or a pelvis retaining the shallow front, cramped ilia, and
the forward-looking inlet of the infantine pelvis, and a diminutive stature,
are seen in different degrees in different cases.
“The two principal signs of this condition, and those for which medical
advice is sought, are scanty and generally painful menstruation, and, in the
married woman, sterility. In all the cases I have seen, the amount of the
menstrual flux has been less than usual. It may be entirely absent, as in
the case I have related ; or, as a habit, last an hour or two ; or, again, two
days or two days and a half, and then be often pale in its appearance, or
greenish like the lochia. Very commonly there is pain, more or less severe,
during the catamenial times, and then these patients are weak, fainty, and
hysterical. Amenorrhoea, for two or three months or longer, without any
known cause, and without chlorosis, generally forms a part of the history of
these cases.
“Sterility. There is nothing in the conformation or capacity of the exter-
nal organs in this state so to impede sexual intercourse as to require inter-
ference on this ground : at least I have never heard of this in a considerable
number of cases which I have noted. But, in connexion with the sterility,
there is usually sexual indifference, which is, in fact, pretty much the equi-
valent of impotence in the felmale. The general health of these females is
certainly below par; the forces of life are feeble; there is a want of energy
and tone about them ; they offer a comparatively feeble resistance to the in-
vasion of disease; and they are below the average of female life.
“Complications. I would remark on two complications which have occur-
red to me in the Undersized Womb: the first is a disease of its cavity, of which
#. seen a single case; and the other is a displacement of the body of the
terus.
“A married woman, an out-patient of mine at the hospital, who had the
characteristics and history of this organic defect of the sexual system, began,
three years after marriage, to have a thick white discharge, sometimes
streaked with blood. She came under my care after five weeks spotting of
the red discharge, having all the aspect and emaciation of phthisis. Her
lungs were carefully and frequently examined, but without detecting any
tubercular disease. On examination by the speculum, I found that the dis-
charge was not yielded from the vagina or cervix, which was healthy; but as
I pressed with the speculum, a small quantity oozed out from the os uteri.
This was not the mucus from the cervix, but presented the characters of
broken-up tubercle, imperfectly mixed with blood. 'I did this on several
occasions with the same result; and I have little doubt, that tubercular
matter had been deposited in the cavity of the body of the uterus, that it
was then breaking up, and was passed stained with blood. I watched this
case with much interest for some time: her general health improved; but
by and by I missed her, and I had no clue to her direction.
CRITICAL DIGEST OF THE JOURNALS. 77
“This disease, which is a true uterine phthisis,” is not by any means con-
fined to this type of womb; but I regarded it at the time with much interest,
as being a well-marked illustration of the disease, and also in its association
with the defect in question.” (Guy's Hospital Reports, October 1849.)
DR. CHARLES WALLER'S OPINIONS OF ETHER AND CHLoROFORM
IN MIDWIFERY.
The following are the CoNCLUSIONs with which DR. WALLER terminates
his interesting paper on this subject, in the Medical Times for 10th Novem-
ber, p. 375.
† That the inhalation of ETHER and CHLoRoFoRM has been followed
by injurions and fatal results.
2nd. That, in natural labours, no reason exists for the employment of a
i. the efficacy of which is at least doubtful, and its action often
urtful.
3rd. That the action of the uterus is sometimes suspended; but the pub-
lished accounts are so contradictory, that it is impossible to form an accurate
judgment on this point.
4th, That the production of anaesthesia in operative midwifery is likely
to be injurious rather than beneficial.
5th. The only circumstances which appear to justify inhalation are—
a. Where there is an unusual degree of nervous excitability and sensi-
tiveness. I should, however, not be inclined to produce perfect insensi-
bility, but should be satisfied with diminishing the powers of sensation.
b. Where there are severe muscular pains in the neighbourhood of the
uterus, interfering with its action. This state has been well described, by
Dr. Power, under the generic term “myopathia”, of which he describes seve-
ral varieties. In these cases, I should recommend moderate inhalation, and
not the production of perfect marcotism.
c. In very difficult cases of turning, some benefit might possibly be ob-
tained, although, in many instances, a dangerous amount of force might
(unless great care be taken) be employed in extracting the child when the
patient is in a state of insensibility.
* “I have examined very carefully four specimens of this disease, which has
been called strumous ulceration of the lining membrane of the uterus. Its morbid
anatomy I believe to be, that the glandular system of the cavity of the body of the
wterus becomes filled with scrofulous matter. This at first swells out the lining
membrane ; then it begins to break up, and, with the escape of the matter, the
inner surface becomes ragged and deeply furrowed, and the uterine walls consume ;
that is, become thinner and thinner. This goes on equally over the whole surface;
but in one specimen, the breaking-up process had gone on so deeply towards one
horn, as to form a cavity there; and had the patient lived, I think it would have
gone through the uterine peritonaeum, unless its progress had excited inflammatory
adhesion around it. This disease is strictly confined to the cavity of the body of the
womb : it does not touch the cervix ; but a clear line, separating the diseased from
the healthy structure, exists at the os internum. In one specimen in our museum,
the vagina is attacked, but the cervix is free.”
78
RE PORTS OF SO C I ETI E. S.
ROYAL MEDICAL AND CHIRURGICAL SOCIETY.
NovKMBER 27th, 1849.
DR. ADDISON, PRESIDENT, IN THE CHAIR.
ON SECTION' of THE TENDo ACHILLIS IN some, CASEs of FRACTURE OF
THE Bones of THE LEG. By CAMPBELI, DE MoRGAN, Esq. After referring
to the operation of tenotomy, as practised not unfrequently on the Continent
in cases of fracture, when unusual difficulty is experienced in reducing and
keeping quiescent the fractured ends of a bone, the author related the fol-
lowing eases illustrative of this practice, where the tibia and fibula were
the seat of injury, and the Tendo Achillis that of the operation. He believes
they are the only instances thus treated in this country. The first case is
furnished by Mr. Shaw, in whose practice it occurred :—W. S., aged 40, was
admitted into the Middlesex Hospital on Feb. 12, 1847, having fallen down
stairs in a state of intoxication. Both bones of the leg were broken, and the
fracture of the tibia extended through both malleoli, the foot being twisted
outwards. Violent spasms of the muscles frustrated all attempts to keep the
fractured extremities of the bones in apposition; the slightest movement
brought on this spasmodic contraction, which extended to all the muscles
of the limb, so as to cause great distortion of the foot, and render the skin
over the base of the tibia extremely tense. All the symptoms continuing
unabated on the following day, and the suffering of the patient being con-
siderable, Mr. Shaw determined on dividing, in the usual way, the Tendo-
Achillis, which was very tense. After this, all the difficulties entirely ceased,
and no further trouble was experienced in the treatment of the case. The
second case occurred in the author's own practice. The patient was a female,
aged sixty-six, of drunken habits, and was admitted into the Middlesex
Hospital in March, 1849. She had been knocked down by a cab, and both
bones of one leg were fractured a little above the ankle. The symptoms
and condition of this patient were very similar to those of the last, and every
mechanical and therapeutic measure which could be suggested to relieve the
spasms was tried in vain. The author divided the Tendo Achillis on the
ninth day, with instant relief to the suffering of the patient, and imme-
diate removal of all untoward symptoms. In less than a month, the chasm
left after division of the tendon, which was not very great, had disappeared;
and a fortnight subsequently, she was able to walk on crutches, and the foot
was free from deformity. After some general remarks on the value of the
operation in the foregoing cases in relieving suffering and spasm, the author
proceeded to remark, that he thought so simple and harmless a proceeding
as dividing the Tendo Achillis might be adopted with advantage in other
cases of more frequent occurrence, especially as the cure would not thereby
be retarded. He concluded with noticing a remark of M. Bonnet's, that he
has frequently divided the Tendo Achillis in cases of diseased ankle-joint,
where rest was imperative, and where the heel was drawn up by the muscles
inserted into it.
MR. CHARLES HAWKINS remarked, that as the occurrence of spasms
during the first few days aftera fracture greatly interfered with the well-doing
of the patient, the operation might be usefully performed ; as it might
also, in other cases, in which fracture had not taken place. He had no fear
of the elongation of the tendon, a result which he had never met with.
Cases of fracture of the patella were, perhaps, in their results, less creditable
to a surgeon than any other accident. The patient had rarely afterwards a
useful limb, owing in a great measure, as he thought, to the impossibility of
ROYAL MEDICAL AND CHIRURGICAL SOCIETY. 79
keeping the ends of the bone in apposition. In one case, and in one case
only, had he seen bony union occur, and in that the other patella was
shortly afterwards broken, and the patient was lamed for life. He had seen
a case lately in which, as he thought, this operation might be advantageously
performed. *
MR. ERICHSEN considered the operation justifiable in cases of fracture of
the leg low down, when muscular spasm prevented the keeping the foot in
position. This operation has been performed in dislocation of the astragalus
forwards. The difficulty, in such cases, arises from the upper surface of the
os calcis being jammed against the tibia, from which it cannot be replaced,
except after the section of the Tendo Achillis, when the foot can be drawn
downwards, and the astragalus reduced. This improvement we owed to the
modern school of Dublin surgery. Cases of this dislocation have been left
unreduced, because the strong spasms of the muscles of the calf could not be
OVer COIſle.
MR. SHAW mentioned a case of dislocation of the astragalus, which had
been under Mr. Arnott's care in the Middlesex Hospital. The division of
the Tendon was effected, but the fracture could not be reduced, and the bone
was ultimately excised. The patient did well.
CASE of Monstros1TY. By JAMEs BowFR HARRISON, M.R.C.S.E. (Com-
municated by DR. W. VESALIUS PETTIGREw.) The author was called on
the 10th of January, 1849, about seven o’clock in the evening, to attend a
poor woman who was in labour. On making a vaginal examination, he
found the membranes protruding in a pyriform tumour, but could not de-
tect through them any part of the child. After the membranes had burst,
he made a further examination, and felt a soft tumour presenting, which re-
sembled the bag of membranes before it had been ruptured. Passing his hand
around the tumour, he at length discovered a hard substance, partially con-
cealed between the tumour and the parietes of the uterus. This hard body
was a distorted leg and foot. A ligature was passed round the foot ; ergot
of rye was given ; the pains, before feeble, became stronger; and, with the
aid of slight traction, the foot was brought down, when a finger passed up
to the top of the thigh felt a substance which resembled the body of a
child having only one leg and no organs of generation; the soft mass being
still felt. After some time, the whole mass, with the distorted body of the
child, descended and came through the os externum. The foetus was a
monstrous growth. The soft mass was found to be a hermial protrusion
of the abdominal viscera, owing to the deficiency of the abdominal parietes
below the umbilicus. The navel string had become detached. The right
leg was directed transversely, and the foot curved inwards. The left leg was
pushed upwards, out of its proper position, by a second tumour, the sac of a
spina bifida, the left foot being curved like the other. The ossa pubis were
deficient, as well as the spinous and transverse processes of the lower ver-
tebrae, and the posterior walls of the sacrum. The genital organs were im-
perfect; the head, shoulders, arms, and chest were all natural. Some little
time having elapsed, the placenta was removed with the hand; the whole
being accomplished by about ten, or half-past ten o'clock; the mother did
well. This case possesses considerable interest in an obstetrical point of
view ; particularly as regards the presentation of a soft tumour in the
manner described.

DECEMBER 11, 1849.
DR. BURRows IN THE CHAIR.
IDENTITY OR NON-IDENTITY of THE SPECIFIC CAUSE of TYPHOID FEveR,
TYPHUs FEVER, AND RELAPSING FEVER. By DR. W.M. JENNER. (Communi-
cated by DR. SHARPE.Y.) This paper gave a general view of the elaborate and
truly valuable papers which the author has recently been publishing in the
Bdinburgh Monthly Journal, and Medical Times; from which sources we pro-
pose to give an analysis of Dr. JENNER's researches in our Digest of the
80 REPORTS OF SOCIETIES.
Journals. In the meantime, we may announce, that he thinks that he has
incontestably proved that the specific causes of Typhus and Typhoid Fevers
are absolutely different from each other; and, he conceives, that it is in the
highest degree probable, that the specific cause of relapsing fever is different
from that of either of the two former. º
DR. BARCLAY said, that in his ownexperience, fever without spots was very
common ; but with spots, uncommon. Out of 111 cases of fever admitted
into St. George's Hospital, fifty-nine only were spotted; and this number
included all kinds of spots. He had found great difficulty in distinguishing
the various spots mentioned in the paper as diagnostic of Typhus and
Typhoid Fever, as in some cases the rose-coloured spots changed to mul-
berry hue. The skin did not enable him to distinguish between Typhus
and Typhoid Fevers; his diagnosis was founded on the state of the tongue
and abdomen, the dejections, and other symptoms. If the eruption were of
a dark-hue, ulceration of the intestines was very uncommon; whilst it was
always present when the spots were rose-coloured.
MR. SANKEY supported the views of Dr. Jenner.
DR. BALY said that, as regarded the essential difference between Typhus
and Typhoid Fever, his experience in some measure corroborated that of Dr.
Jenner. In 1848 and 1849, 117 cases of fever occurred in the Millbank
Penitentiary, at the time that Typhus and Typhoid Fever were epidemic
without. Twenty were fatal; and, in all, the mesenteric and Peyer's glands
were affected; they were all cases of Typhoid Fever. His experience re-
garding the presence and nature of the eruptions in fever agreed, in the
main, with that of Dr. Barclay. Cases occurred without any eruption.
Dr. WEST believed, with Dr. Barthez of Paris, that the remittent fever of
children was of the same nature as the typhoid fever of Louis. The same
symptoms, allowance being made for age, were observed during life, and the
same appearances after death ; the characteristic eruption, however, was
often wanting. He recollected no case of remittent fever in a child, in which
typhus fever was present in the same house; and the converse of this also
obtained. These facts, so far as they went, bore on the difference between
typhus and typhoid fevers, and confirmed the view of Dr. Jenner.
DR. MERVyN CRAwford regarded the difference of opinion existing between
the physicians of St. George's and the Fever Hospital, as depending on the
different circumstances in which they saw cases of fever; in the latter,
crowded together, and the poison of the disease more condensed; whilst in
the former, the cases of fever were placed in various parts of a common ward,
and the poison was thus diluted. He had the same difficulty as Dr. Barclay in
recognizing the exanthem. He regarded the eruption as an accidental phe-
nomenon, modified and determined by the state of ventilation, and by locality.
DR. JENNER said, in reply, that, in typhoid fever, occasionally there was
no eruption. The mulberry spots in typhus, at first, in many cases, bore a
close resemblance to the rose-coloured spots of typhoid fever; so that, in a
few cases, they might be regarded as exactly similar. His experience, how-
ever, fortified by two thousand cases, enabled him to assert, that if by the
eighth day of the disease the eruption presented the true typhus character,
then, if death ensued, intestinal lesions would not be discovered. Dr. Baly’s
cases, to be of any service in determining the diagnostic value of the erup-
tion, must be confined to the fatal cases where the after-death appearances
were described; but these appearances had not been mentioned by him.
With regard to the opinions of Dr. Crawford, respecting the influence of im-
purity of the atmosphere and locality on the eruption, he might state, that
the Fever Hospital received patients from all parts of London and its neigh-
bourhood. Personal observation of houses, in these various localities, had
not enabled him to observe any difference in their hygienic conditions. It
must be self-evident, that no very great impurity of atmosphere existed in
the Fever Hospital, as no such change as that mentioned by Dr. Crawford
ever occurred. He agreed with Dr. West, that infantile remittent fever was
typhoid.
WESTMINSTER MEDICAL SOCIETY. 81
WESTMINSTER MEDICAL SOCIETY.
November 24, 1849.
FRANCIs HIRD, ESQ., PRESIDENT, IN THE CHAIR.
DR. DANIELL briefly related a case of ulceration of the tonsil, attended by
profuse haemorrhage, which placed the patient in great danger, in which Mr.
De Morgan had tied the common carotid with success.
THE DIAgNosis of OvariaN DROPSY. By Mr. I. B. B.Rown. Amongst the
general signs of Ov ARIAN DROPSY, we must place emaciation of the neck and
shoulders, an expression of the countenance peculiar, and indicating, in a
marked manner, the presence of this disease. The face is elongated, thin, and
partially shrivelled; anxiety and care are strongly depicted on it; the angles of
the nose are drawn downwards; the lips are thinned; the mouth loses its
curves, the angles being drawn downwards; the cheeks are furrowed; the
eyes are remarkably defined, owing often to the sunken space between the
eyelids and the bony margin of the orbit; the skin is thin and pale; in short,
the whole of the cellular tissue of the face is atrophied. The extremities
are seldom swollen, as in ascites; and, consequently, the patient can walk
about with comparative ease. There is generally little disturbance to diges–
tion and to the action of the liver. Respiration and the action of the heart
are less disturbed than in ascites; but the heart's action is feeble, owing to the
diminution in the whole mass of the blood.
The special signs are—First, we can generally trace the commencement of
this disease from one of the ovaries deep down into the iliac fossa ; a tumour
pressing between the rectum and the vagina may be felt, either through the
walls of the vagina or the rectum, not excessively painful, but elastic ; on
firmly pressing it, especially if at the commencement of the formation of the
tumour, you can get it between the thumb in the rectum and the middle
finger in the vagina ; but you can also frequently feel an egg-like enlarge-
ment around the ovary, through the abdominal parietes, especially if you flex
the thighs on the abdomen, so as to relax the muscles. This tumour gradu-
ally and definitely increases, still maintaining a rounded outline, and ascends
from the pelvic cavity to the abdominal, and rises in the front of the bowels,
distending the abdominal parietes, and sometimes reaches the ensiform car-
tilage, pressing up the liver, stomach, pancreas, and spleen, so as to elevate
the diaphragm, and thus contract very considerably the thoracic space. This
tumour, which, as it ascends, becomes more fluctuating, occupies the side
from which it originates; but whilst it throughout retains a preponderance
towards that side, it gradually extends to the opposite. The veins of the
abdomen are generally much increased in number and size. The sac con-
taining the fluid being circumscribed, the indications afforded by percussion
are also circumscribed, and the sounds on percussion are of course dull over
the sac, and resonant over the surrounding intestines, On examination per
vaginam, fluctuation can be generally felt through its walls, and the vagina
itself is elongated and drawn up, sometimes even under the arch of the
pubis; the uterus is also either drawn up or pressed back on the rectum.
The cyst is generally round and smooth on feeling it through the parietes of
the abdomen, and moveable from side to side, and is not materially altered by
change of position, either recumbent or upright. These special signs apply
more particularly to unilocular Ovarian Dropsy. In multilocular, we almost
invariably have an uneven and irregular surface of the cyst, and generally
one or more solid tumours, which appear inelastic and without fluid ; but in
very many cases, these tumours will be found to be additional cysts, contain-
ing fluid, and tense, owing to the pressure of the fluid in the larger one. Mr.
Brown had frequently found this to be the case; and this was proved by eva-
cuating the contents of the larger cyst, and again introducing the trocar
through the canula still in the opening, thrusting it into the apparently solid
WOI. II. 6
82 REPORTS OF SOCIETIES.
tumour, and finding immediately an escape of fluid. On examining a mul-
tilocular cyst, fluctuation is not very distinct, if you examine the entire
cyst ; but if you tap over any one of the sacs, fluctuation is apparent, but
only over that one, not being at all communicated to the adjoining cyst or
cysts; where, however, the fluid is gelatinous or albuminous, fluctuation can-
not be so readily felt. The same observation applies to those cases contain-
ing thick, cheesy matter, mixed with pus, and sometimes also with hair.
But we have also distinct solid tumours in connexion with these fluid ones;
and then there is no sense of fluetuation. This observation applies both be-
fore and after evacuating the contents of the fluid cysts. Having ascertained
the nature of the tumour, so far as to say whether it is unilocular or multilo-
cular, the next important subject is to ascertain the presence of adhesions. In
examining for adhesions, Mr. Brown directed that the patient should be laid
in the horizontal posture, and be made to flex the thighs on the abdomen so
as to relax the abdominal parietes; he then moved the cyst from side to side.
If this were readily done, he knew there were no adhesions. Again he placed
his hand firmly on the relaxed parietes, and moved them over the cyst. If
they moved readily, he knew there were no adhesions on the upper and late-
ral surfaces of the cyst. Again, as the parietes are thin in this disease, he
grasped and puckered them up, and then moved them over the cyst, and
also saw if they gathered up readily, without raising the cyst itself. If he
found these three indications, Mr. Brown determined that there were no ad-
hesions. Another plan, for which he was indebted to his friend, Dr. Sibson,
is based on the extent to which the contents of the abdomen are forced down-
wards during a deep inspiration, by the descent of the diaphragm. If there
be no adhesions in front, the upper boundary of the ovarian tumour descends,
to the extent &f an inch, during a deep inspiration, the place previously occu-
pied by the tumour being now taken up by the intestines; consequently, if
you percuss over the upper part of the tumour, a dull sound is elicited dur-
ing ordinary respiration; but when the patient takes a deep inspiration, an
intestinal resonance is there perceptible. Mr. Brown then alluded to those
diseases which may be mistaken for Ovarian Dropsy. They were-1st, retro-
flexion and retroversion of the uterus; 2ndly, tumours of the uterus; 3rdly,
cystic tumours of the abdomen; 4thly, ascites; 5thly, pregnancy; 6thly,
distended bladder; 7thly, distended bowels from flatus; 8thly, faeces in the
intestines; 9thly, diseased viscera of the abdomen.
MR. B. TRAVERs, jun., recollected a young girl, admitted into St. Thomas's
Hospital, some years ago, under the care of the late Dr. Williams. The
abdomen was much distended, and, on examination, the disease was supposed
to be ovarian. An examination, per vaginam, detected a fluctuating tumour,
which, on being punctured with a lancet, gave exit to a wash-hand-bason full
of menstrual fluid. This girl’s health was bad: she was anaemic, emaciated,
and did not sleep. There were other symptoms, also, to warrant the suspi-
cion that organic disease might be present; and he thought the cause, illus-
trated by this case, might be classed among those likely to be mistaken for
ovarian disease.
MR. DRUITT related a case, in which a young woman became enlarged in
the abdomen, after being violated; and pregnancy was supposed to exist. The
fetal heart was believed to be heard. Labour, however, did not come on at
thé ſinth month; and it was soon after discovered that the hymen was per-
feet, and the uterus healthy and empty. It turned out to be Ovarian Dropsy.
The fºliº of the heart was communicated to the swelling, and hence the
mistake. ,-- *
DR, MURPHY had met with cases of large cysts, or tumours, in the abdo-
men, resembling the º uterus, and accompanied by sounds imitating
those of the foetal heart. He believed that the pulsation was caused by the
beating of the patient's heart, and might be discovered to be so, by compar-
ing the pulse of the patient with the supposed foetal pulsations.


WESTMINSTER MEDIC_\L SOCIETY. S3
He wished to hear from Mr. Brown, how he ascertained the existence of
adhesions posteriorly; he thought they could not be recognized readily; he
had seen one case in which they existed. With reference to one of the cases
mentioned by Mr. Brown, in which Mr. Lane had been consulted, he could
not understand how, both having made a very careful examination, such a
mistake had been made, as to treat it as ovarian, when it was simply ascitic.
º ovarian tumours and ascites existed together, the diagnosis was dif-
eult.
DR. TILT said, that although the contents of ovarian cysts possessed very
different physical characters, they contain peculiar cells filled with minute
granules, and having the same appearance, however various may be their
shape and size. Mr. Quekett, whose authority is of much weight in similar
matters, had assured him, that, during the whole course of his microscopic
researches, he had never met with these particular cells in any other
cystic formation. The observations of Dr. Hughes Bennett, and others, con-
firm these facts. If future observation prove their truth, we shall have at
hand a pathognomonic sign of Ovarian Dropsy; for, by an innocuous explor-
atory puncture, it will be possible to inspect a portion of the fluid. In a
case wherein there was considerable difficulty of diagnosis, Dr. Hughes Ben-
nett did not hesitate to assert the existence of Ovarian Dropsy, after the exa-
mination of a portion of the fluid removed from the tumour: and his dia-
gnosis was confirmed.
DR. SIBSON said that Mr. Brown had supplied, in his paper, several very
valuable signs, indicating the freedom of an ovarian cyst from adhesions.
These were, the power of removing the cyst from side to side, of moving the
skin freely over the cyst, and of puckering up the parietes in a fold in front
of the tumour, and then moving them freely. Mr. Brown had referred to
an additional sign proposed by Dr. Sibson. He (Dr. S.) had been in the
habit, for some years, when in the Nottingham Hospital, of making dia-
grams of the relative position of the viscera in the living as well as in
the dead. He possessed several such diagrams taken from persons affected
with Ovarian Dropsy. He first mapped out the organs and the outlines of the
tumour, by means of percussion. He then desired the patient to take a deep
breath, and to hold it ; and he then mapped out the tumour and the organ
afresh. He found, in the cases referred to, in which the ovarian cyst was
free from adhesions, that when they took a deep inspiration, the upper boun-
dary of the tumour was an inch lower than it had been before, being re-
placed by the resonant intestines which the diaphragm in its descent had
pushed downwards before it, they, in turn, displacing the ovarian cyst. The
signs of the absence of adhesions brought forward by Mr. Brown were quite
conclusive and practicable, unless the abdomen were rendered tense by the
greatly increased size of the tumour:—then, the sign which he had pro-
posed would have its value, and would indicate, with precision, the absence
of adhesions over the upper and anterior part of the cyst.
DECEMBER 1, 1849.
FRANCIS HIRD, Esq., PRESIDENT, IN THE CHAIR.
FALLING-IN of THE CHEST DURING INSPIRATION, IN SOME DISEASEs of
THE CHEST. By DR. SIBSON. A young man, aged 34, was admitted into
the Nottingham Hospital, under the care of Dr. Hutchinson and Mr. White,
labouring under extreme difficulty of breathing. The fauces and glottis were
so much narrowed by disease, that only a very small portion of air could
enter at each inspiration. The countenance was pale and shrunk, and ex-
pressive of distress, anxiety, and starvation. He could only, with difficulty,
swallow liquids. The whole chest was narrow and flat, the abdomen pro-
minent. The lungs, though narrow, were much elongated, their inferior
* LoNDON Journal of MEDICINE for March 1849, p. 285.
i.
84. REPORTS OF SOCIETIES.
margin being an inch lower than usual. During each inspiration, all the
respiratory efforts were laborious and powerful ; but the whole of the sternum,
the costal cartilages, and ribs, instead of advancing, were actually forced
backwards, to the extent, at the lower end of the sternum, of half an inch.
At the same time, while the chest shrunk inwards, the abdomen protruded
considerably and forcibly. Mr. White performed laryngotomy. The air
entered freely, and the movements of inspiration, so singularly altered,
immediately resumed their healthy play. The walls of the chest, instead of
yielding inwards, advanced during inspiration; and the respiratory efforts,
instead of being ineffectual and laborious, became effectual and easy. At
the same time, the chest, formerly narrow and flat, became rounded and full;
the lower margins of the lungs, which had been dragged downwards, ascended
and resumed their normal position ; the countenance, once pallid, shrunk,
and anxious, was now ruddy, full, and placid ; and the pulse, formerly
almost imperceptible, became full and regular. The cause of the remarkable
deviation of the respiratory movements in this case was readily apparent.
Air could only enter the lungs scantily, and with difficulty ; the muscular
efforts at respiration were laborious ; the diaphragm, acting on the base of
each lung, descended forcibly, and lengthened the lungs from above down-
wards; the lengthened lungs, being inadequately supplied with air, became
narrower sideways, and the walls of the chest were forced inwards by
atmospheric pressure. If a bladder, two-thirds filled with air, be length-
ened, its side collapse, and a piece of wood, resting on the bladder,
will fall backwards ; if we shorten the bladder, its sides bulge out-
wards, and the piece of wood supported by them will be pushed forwards.
So with the lungs ; if they be lengthened when air can scarcely enter
them, during the efforts at inspiration their sides collapse, and the walls
of the chest in front of them must fall backwards; on the other hand,
if they be shortened during the attempts at expiration, their sides will
bulge outwards, and the walls of the chest will be forced forwards. Such
was the condition and such the chain of the phenomena in the case just
related, - a case which, in its respiratory conditions, may be readily
imitated by any one on his own person. Pass a tape round the chest, close
the glottis, and attempt to breathe by the diaphragm ; the abdomen will
protude, the circumference of the chest will be narrowed, and its walls will
be forced backwards. The action of the diaphragm overbalances the action
of the muscles acting on the ribs, not because of the superior strength of that
muscle; on the contrary, it is broad and sheet-like, while they are many of
them strong and fleshy; nor yet because it acts directly, while they act ob-
liquely; on the contrary, for the fibres of the diaphragm are bent upon them-
selves in an oblique convexity; their first action is to flatten the convexity,
and then, when the fibres are bent almost at a right angle, they draw down-
wards the floor of the muscle, and so lengthen the lungs. The diaphragm
overbalanced the costal muscles and ribs in the case in question, because of
the ease with which the lungs can be lengthened from above downwards,
gliding, as they each do, freely in an oval cylinder, composed of the costal
walls; and, because of the comparative difficulty, with which the whole of
the walls of the oval cylinder in question can be simultaneously expanded
sideways. The point is illustrated by the facility with which the piston of a
syringe is raised, even when the mouth of that syringe is closed, and by the
complete obstacle which is offered to the elastic expansion of a strong, empty,
and closed india-rubber bottle. Since Dr. Sibson observed the case just re-
lated, he had noticed the same phenomenon in many cases, in which there
was obstruction to the entrance of air into the lungs through the large air-
passages. He had observed it in cases of croup, of obstruction in the larynx,
fauces, and nostrils. The appearance was not alone observed in cases where
the obstruction was due to local disease ; it was also to be observed, and in
an extreme degree, in every case in which there was convulsive closure, or
WESTM INSTER MEDICAL SOCIETY. 85
great narrowing of the glottis during the struggling efforts at inspiration, as
in laryngismus stridulus, the first stage of hiccough, the whoop of whooping
cough, and the inspiratory convulsions of hysteria. Dr. Sibson had not ob-
served the walls of the chest to be forced backwards during inspiration,
under the influence of obstruction in the outer air passages, to so great an
extent in any other case as in that just related, and which he brought
forward as a type of the phenomenon in question. The extent to which the
respiratory movements of the walls of the chest are reversed in such cases,
is regulated by the amount of obstruction and by the flexibility of the costal
cartilages. If the obstruction be very great, the whole of the anterior thoracic
parietes may be forced backwards during inspiration, the reversed movement
being greater at the lower end of the sternum, and less at its upper end. If
the obstruction be comparatively slight, the lower end only of the sternum,
and the adjoining sixth costal cartilages, will yield during inspiration, while
the rest of the walls of the chest will, like those of the abdomen, move out-
wards. If the obstruction to inspiration increase in a case of croup, for
instance, the extent to which the respiratory movements are reversed will
proportionally increase; and, on the other hand, the extent will diminish as
the obstruction to respiration diminishes. An exact measure is thus afforded,
by close examination, from time to time, of the phenomenon in question, of
the increase or diminution of the obstruction to respiration. If the entrance
of air into one of the large bronchi be completely obstructed by the presence
of a foreign body, then the walls of the chest will fall in, during inspiration,
over that portion of lung supplied with air through the obstructed bronchus.
If there be great obstruction to respiration in the smaller bronchial tubes, as
in bronchitis, emphysema, and whooping cough, the same effect on the re-
spiratory organs is produced as in cases where the obstruction is in the larger
bronchial tube ; the walls of the chest fall, in, to a greater or less extent, in
proportion to the degree of obstruction, and the flexibility of the costal carti-
lages. The extent to which the respiratory movements are reversed, is in no
instance so great, in the cases where the small bronchi are obstructed, as it may
be in those where the obstruction is seated in the outer air passages. In
emphysema and bronchitis, while the abdomen protrudes, the upper part of
the chest invariably expands during inspiration; while the lower end of the
sternum, and the adjoining fourth, fifth, sixth, seventh, and eighth ribs may be
forced backwards. In cases in which the obstruction is great, all those cartilages,
as well as the lower end of the sternum, may fall in during inspiration ; but
in slighter cases, the yielding may be confined to the lower end of the sternum.
If bronchitis, or any disease in which there is obstruction to respiration in
the smaller bronchi, be confined to one lung, or portion of lung, the reversed
respiratory movements will be confined, to the region of the affected portion
of lung. Dr. Sibson had observed the walls of the chest to be forced backwards
during inspiration, in some cases of effusion into the pleura ; the inspiratory
descent of the diaphragm in such cases, may cause the lengthening, and con-
sequent collapse, of the sac containing the fluid. If, in such cases, the effu-
sion be so considerable as to displace the diaphragm to such an extent, that
it bulges downwards into the abdomen, then, should the diaphragm act, it
will be raised ; the pleural sac containing the fluid, instead of being length-
ened, will be shortened during inspiration ; and the walls of the chest, over
the seat of the effusion, instead of being forced inwards, will be forced out-
wards. When the whole, or a great part, of one lung is incapable of expansion,
owing to condensation, then the walls of the chest over the affected lung are
usually forced inwards during inspiration : in such cases, the respiratory
movements of the ribs of the opposite side are exaggerated, and the lower
end of the sternum is drawn over, at each inspiration, towards the unaffected
side; the ribs over the affected lung are in turn drawn over by the sternum,
and they consequently fall in during inspiration. In two cases of fracture of
the ribs with general emphysema, the side on which the ribs were fractured
S6 REPORTS OF SOCIETIES.
was indicated by the sinking in of the walls of the chest during each inspi-
ration. When there is extensive effusion into the perieardium, and when the
heart is enlarged and adherent, the lower end of the sternum and adjoining
left costal cartilages may, in some cases, beforced backwards during inspira-
tion. The yielding inwards of the sternum and ribs during inspiration, is
most marked in those whose cartilages are flexible; it therefore occurs most
frequently in children and young persons. Indeed, the inspiratory yielding
of the walls of the chest is usually present in healthy infants, especially when
they sob ; in these, the chest flattens during inspiration, the lower end of the
sternum receding ; but in rickety infants, the chest narrows and the sternum
protrudes, the parietes being forced inwards at the junction of the ribs to the
cartilages. The phenomenon is least marked, or is altogether absent, in those
whose costal cartilages have become firm or bony ; it is consequently seldom
observed in the aged. It is very seldom that the four superior or thoracic
ribs, or the four infelior or diaphragmatic ribs, fall inwards during inspiration,
under the influence of obstructed inspiration; the reversed respiratory move-
ment being usually confined to the lower end of the sternum, and to the fifth,
sixth, seventh, and eighth, or intermediate costal cartilages and ribs. When
the form of the chest is normal, the lower end of the sternum and the adjoin-
ing cartilages present the phenomenon in question ; but when the sternum is
unusually prominent, the ribs alone are forced inwards, and the sternum pro-
trudes. Dr. Sibson described a case, in which, owing to disease of the cervical
vertebrae, involving the phrenic nerves, the diaphragm was paralysed, and
in which, while the thoracic parietes advanced, the abdominal parietes shrunk
inwards during inspiration.
DECEMBER 8, 1848.
FRANCIs HIRD, Esq., PRESIDENT, IN THE CHAIR.
DIFFERENT ForMs of ULCER IN THE INTESTINAL MUCOUs MEMBRANE,
which Accompany VARIETIES of DYSENTERY AND DIARRHOEA IN INDIA.
DR. JAMES BIRD brought before the Society several coloured drawings of
ulcers in the mucous membrane of the intestines, as they occur in Dysentery
and Diarrhoea within the tropics, and gave an account of the cases from which
the illustrations had been taken. The plates represented dysenteric ulceration,
originating in simple inflammatory diffused action of the mucous follicles,
or in specific chronic inflammation of the same, following tubercular deposit
in the sub-mucous areolar tissue, in which latter, the transformation of the
mucous intestinal coat closely resembles the progress of tubercle in the
lungs. These two different forms of ulceration give rise to two distinct
varieties of Dysentery, which Dr. Bird characterized under the names of
phlogistic and cachectic, requiring very different systems of treatment—general
and local blood-letting being of great utility in the former, and very little re-
quisite for the latter, where sub-nitrate of bismuth, or sulphate of copper,
with opium, frequent emollient opiated enemata, blistering of the abdomen,
strict limitation to milk and farinaceous diet, with change of air, and other
adjuvants, are specially indicated.
, WAsqui,AR TUMoUR of THE URETHRA. By MR. HILLMAN. . A married
lady, aged twenty-six, had been suffering from pain in passing urine for about
eightéen months, and for a ratheries time also in matrimoniai intercourse—so
much so, indeed, that the latter had been necessarily discontinued for several
months. The pain...was aggravated during, the menstrual low. Befºre
coming under Mr. Hillman's care, she had been unsuccessfully treated for
gravel. On examining the parts, three or four small growths, of a dark-red
colour, were found round the urethral orifice and emerging from its interior.
Pressure on the urethra, by the finger, in the vagina, caused great pain.
Whilst the patient was under the influence of chloroform, the growths visible
... externally were removed by curved, blunt-pointed scissors; the urethra was

Wi...STYH.INSTER MEDICAL SOCIETY. 87
*
dilated, and another similar growth removed from the interior of the canal.
Not more than two ounces of blood was lost at the time; but on the day
following there was slight secondary hamorrhage. Some purulent dis-
charge followed the operation ; but in about three weeks the patient was
well, and in all respects quite comfortable.
EPILEPSY AND PUERPERAI, CoNvu LSIONs: some of THEIR RELATIONs
AND DIFFERENCEs. BY DR. TYLER SMITH. The author commenced by
observing, that there was a common opinion that epileptic persons were
more liable than others to Puerperal Convulsions. Reasoning a priori, it
was natural to conclude that such must be the case, the Convulsions being so
similar in the two classes of cases. Closer observations, however, showed
considerable differences between the two diseases, which he would briefly
enumerate. Epilepsy is generally a chronic, but Puerperal Convulsion is an
acute disease. Epilepsy commonly leads to idiocy; Puerperal Convulsions
to mania. Asphyxia is more nearly reached in Puerperal Convulsions than
in Epilepsy. Epilepsy is a disease of years; Puerperal Convulsion a disease
of hours or days. Epilepsy is connected with the ordinary functions of the
body; Puerperal attacks belong to an extraordinary function, of limited
duration. In the one, consciousness is generally recovered between the fits;
in the other, the continuance of coma from fit to fit is very common. The
treatment required in the two diseases is very dissimilar. In Epilepsy,
there is generally the characteristic aura ; in Puerperal Convulsions this is
wanting. In Puerperal Convulsions, oedema of the extremities is as common,
as it is rare in Epilepsy. These circumstances must induce us to inquire
whether Puerperal Convulsions ought not to be studied as a distinct and in-
dependent disease, as a variety of convulsions as far removed from Epilepsy,
as Epilepsy was removed from the convulsions of infancy. But the important
question, which could only be decided by experience, was—Were epileptics
predisposed to Puerperal Convulsions : The author related four cases of
epileptics becoming mothers, which had fallen under his own observation;
in one, the first pregnancy and labour had been completed without any con-
vulsion : in the second, two labours had been completed without Puerperal
Convulsions, and the fits were rare during pregnancy; in the two remaining
cases, the Epilepsy had been very much relieved during the whole of the
child-bearing epoch ; and in one, ten pregnancies and labours had passed,
without any convulsive seizure. These latter cases were now near the cata-
menial decline, and were affected with paroxysmal seizures of an epileptic
character. Dr. Smith related the particulars of eleven other cases, which
had been supplied to him by Dr. Fleetwood Churchill; Drs. Swayne and
Herapath, of Bristol; Dr. Robert Barnes; Mr. W. F. Barlow ; Mr. Higgin-
bottom ; and Mr R. U. West. The number of pregnancies, in the fifteen
cases, amounted to about fifty-one. Puerperal Convulsions of a decided
character only occurred in two labours. In one case, there were three
attacks of convulsions after the eleventh labour of an epileptic patient; and
in another case, there was a single seizure the day after one of five labours.
Generally, the epileptic attacks were fewer, and, in several cases, disappeared
altogether during gestation. Thus, the presence of Epilepsy by no means
appeared to be an active predisposing cause of Puerperal Convulsions; and,
so far as the author's inquiries had extended, there was no tendency in Puer-
peral Convulsions to be followed by Epilepsy, though it might be the case,
when organic disease of the nervous centres was induced by the Puerperal
attacks. Dr. Smith entered upon a consideration of the causes which lead to
the amelioration of Epilepsy during gestation, referring it principally to the
rest from the ovario-uterine excitement of menstruation in pregnancy. He
dwelt on the frequency with which Epilepsy was connected with the catame-
nial excitement, many cases only occurring at these periods, and others being
gravated at the monthly dates. He also pointed out the infrequency of
a£59
88 REPORTS OF SOCIETIES
Epilepsy, in purely amenorrhoeal or chlorotic subjects, and referred to the
fact, that other disorders dependent upon ovario-uterine excitement, as hys-
teria, and dysmemorrhoea, were relieved by pregnancy. As far as the cases
now detailed went, it appeared that marriage was not so much to be dreaded
in epileptic females as had been supposed, particularly where the fits were
connected with catamenial excitement. It was clearly indicated, that in
Epilepsy great attention should be given to soothe menstrual irritation, and
that Puerperal Convulsions should be studied and treated without any
special reference to Epilepsy. He had confined his attention chiefly to the
facts of the cases which he had observed, or which had been communicated
to him, and to the most simple and obvious deductions from them ; but if
these should be modified by future inquiries, he would take care hereafter to
inform the Society.
MR. DRUITT questioned the propriety of separating Puerperal Convulsions
from other forms of Epilepsy, and thought the distinction more in words than
in reality. The same conditions obtained more or less in both, and were
often influenced by the same conditions of the blood, and the same central
and peripheral sources of irritation. Puerperal Convulsions resembled more
nearly those cases of Epilepsy in which the convulsions occurred but once,
as for example, from irritation of the stomach, by indigestible food. He had
often known epileptic attacks to be caused by excessive beer-drinking. A
friend of his, in extensive midwifery practice, in a rural district, during the
failure of the potatoe crop, in 1847 and 1848, when the population was much
affected with scurvy, had, out of eighty cases, four of Puerperal Convulsions.
The poisoned condition of the blood would explain this unusual frequency.
DR. MURPHY had listened with much pleasure to Dr. Tyler Smith's paper,
having maintained the opinions expressed therein long ago. The distinc-
tion between the two diseases under consideration was more than one of
words: it was of essential service in practice. He could confirm the opinions
of Dr. Smith by cases. He thought it desirable not to confuse Epilepsy with
Puerperal Convulsion, as the two diseases might often require opposite plans
of treatment. He agreed with Dr. Smith as to the connexion between Epi-
lepsy and ovarian excitement.
DR. BARNES said, that, according to Dr. Smith, ovarian excitement was
the cause of labour, and also of Epilepsy. He would ask Dr. Smith, why it
was not also the cause of Puerperal Convulsions
DR. WEBSTER said, that matrimony had been recommended as a cure for
Epilepsy. . He mentioned a case, related by La Motte, of an epileptic woman
who had eight children—-five girls and three boys: with the girls she had no
Epilepsy during pregnancy, but with the boys she had. This case, though
anomalous, was, in some degree, confirmatory of the views of Dr. Tyler Smith.
DR, CAPE agreed in the distinction drawn by the author between Epilepsy
and Puerperal Convulsions ; for, however similar the symptoms of each, the
treatment was usually different. Besides, Epilepsy was more frequent in
children than adults, and men were subject to it. Women, moreover, were less
likely to be affected by it when not pregnant. Epileptic seizures occur more
frequently by night than by day. A young lady was seized with a violent and
protracted fit of Epilepsy on the first night of her marriage, during connexion.
Her husband imagined she must have been subject to these attacks previ-
ously; but her friends denied all knowledge of any such circumstance. She
had seizures in the night, without any one knowing it. This lady bore seven
children, and had no Epilepsy during gestation or delivery.
MR. W. F. BARLow had seen several cases of Epilepsy, of an unequivocal
character, during sleep. However much he admired Dr. Tyler Smith's paper,
he found a difficulty in separating Puerperal Convulsions from Epilepsy :
they differed more in degree than in nature, for all the symptoms were
similar. Practically, however, Puerperal Convulsions must be separated from
the other kinds of Epilepsy. But he agreed with Mr. Druitt, that the Puer-
WIESTMiNSTER MEDICAL SOC1ETY. 89
peral Convulsion was a form of Epilepsy, and that it should so be called.
Dr. Tyler Smith had spoken of the state of the puerperal patient between
the paroxysms. Epileptic patients often lay in profound coma in the inter-
vals of attack, in cases where one seizure follows another rapidly. He had
seen a case, in a young woman, which was fatal after numerous paroxysms,
each of which was preceded by a loud “crowing noise”; so that, had the affec-
tion happened in a child, it would have been called laryngismus stridulus.
DR. RoBERT LEE said that he had recently had under his care a lady, who
had been suffering from attacks of Epilepsy every fortnight during the last
eight or ten months, subsequent to the birth of her second child, when she
had Puerperal Convulsions, and he was called to see her. This lady had
never before been subject to Epilepsy. Not having succeeded in stopping the
fits, which at first occurred during the day, and latterly during the night, he
had requested her husband to consult, Dr. Marshall Hall, and to place her
under his care. The fits still continued every fortnight. This case, Dr. Lee
said, was the only one in which Puerperal Convulsions had terminated in
Epilepsy, which had come under his observation during twenty-two years.
Of the fifty-nine or sixty cases of Puerperal Convulsion which he had seen
during that period, there were three in which Epilepsy had previously ex-
isted in early life, and a considerably greater number where there had been
hysteria. Dr. Lee was of opinion that chorea, hysteria, Epilepsy, Puerperal
Convulsions, and puerperal mania, were all different diseases, though closely
allied to each other. He related a case of chorea in the sixth month of
pregnancy, which occurred in St. George's Hospital in 1842, in which, after
the expulsion of the contents of the uterus, the symptoms of chorea passed
into fatal Puerperal Convulsions. The brain and spinal cord were both care-
fully examined, but no morbid appearance was discovered, to account for the
phenomena. On what condition of the brain and nervous system these
diseases depended, he believed to be wholly unknown ; and he considered it
certain that they might all occur without any organic disease whatever.
Epilepsy and Puerperal Convulsions were not the same disease, though the
symptoms observed during the fits were similar. This was also the opinion
of Dr. Burns, who states, in page 483 of his Principles of Midwifery, that
“Puerperal Convulsions are quite different from Epilepsy.” Some of the
circumstances in which they differ have been pointed out by Burns, but in a
less distinct manner than had now been done by Dr. Tyler Smith.
DR. WILLSHIRE spoke at some length on the subjectſ of the causes and
symptoms of Puerperal Convulsions and Epilepsy. He thought we were not
warranted in considering them as two diseases.
DR. HENRY BENNET, although agreeing with Dr. Tyler Smith in all the
main features of his paper, was inclined to think that he attached more im-
portance to uterine irritation as a cause of Epilepsy in females than was war-
ranted by practical experience. Although seeing a great deal of uterine dis-
ease in every shape, he very seldom indeed met with the two diseases asso-
ciated. Thus, in the three hundred cases of uterine disease contained in the
appendix to his work on Inflammation of the Uterus, he believed there was
not a single instance of Epilepsy. He did not either recollect observing
uterineirritation or disease to be of frequent occurrence in the female epileptic
wards of La Salpêtrière, during the time he was connected with that hospital,
as resident medical officer. These wards contained five hundred incurable
epileptic females, and were for some time specially entrusted to his care. If,
as he was thus induced to believe, the connexion between uterine disease
and Epilepsy was rare, and not frequent, as supposed by Dr. Tyler Smith,
the non-appearance of epileptiform convulsions in the parturient state, in
epileptic females, was not so extraordinary a circumstance as it must other-
wise appear.
[On the motion of DR. CoRMACK, seconded by MR. STREETER, it was unani-
mously resolved to adjourn the discussion.]
90 REPORTS OF SOCIETIES.
DECEMBER 15, 1849,
FRANCIs HIRD, Esq. IN THE CHAIR.
IN3ANITY ASCRIBED To THE USE OF CHLoRoFoRM. To INDUCE ANAESTHESIA
IN PARTURITION. D.R. WEBSTER related the following case, which had been
communicated to him by a friend, on whose accuracy he could implicitly
rely. One drachm of Chloroform sprinkled on a handkerchief was used.
The effect of the inhalation was sudden, and violent: the patient remained
quite insensible ; along with the insensibility there was deadly pallor of the
countenance ; from this state she slowly emerged, but had a painful and ex-
hausting labour. For several days she was in a very nervous condition, but
not actually incoherent ; she soon, however, became furiously maniacal, and
required the restraint of the strait waistcoat. After continuing in a state of
insanity for many months, she gradually recovered her reason.
DR. CoRMACK was not an advocate of universal resort to Anaesthesia
in parturition-; but, nevertheless, he would remark, that eases such-as-Dr.
Webster had now related did not seem to him to tend, in any degree, to
prove that Anaesthesia was dangerous. Here, certainly, was a case of puer-
peral insanity: but who would venture to say, that the drachm of Chloroform
was alone, or even in part, the cause of the attack?
DR. S.Now could not, without further information, recognize the case as
one of insanity from the use of the Chloroform during labour. The most
necessary particulars had not been furnished.
DR. MURPHY was pleased to think that Dr. Webster was devoting his
attention to this inquiry, and he had no doubt, that results of great im-
portance would flow from it. But he would take the opportunity of re-
marking, that there existed a class of puerperal patients—commonly called
hysterical—in whom the most extraordinary and anomalous effects were
produced by the administration of any medicine, without reference to its
nature, and in whom the impression seemed to be mental. Any unusual
proceeding might in them originate such a train of symptoms.
DR. WEBSTER said that his object was to collect and analyse facts; and he
hoped to receive the assistance of the Society, and the profession, by the
contribution of cases.


THE ARCUs SENILIS. MR. CANTON displayed some sections of the cornea,
under the microscope, taken from a female, aged eighty-two years, with a
view of showing the Arcus Senilis to be a fatty degeneration of the cornea.
In the same subject, (a spare woman, who had died apparently of old age,)
the heart and arteries were affected with the like atrophy, with degenera-
tion, as it has been termed by Professor Paget. Several other specimens, made
from the corneae of persons who had passed the age of fifty, showed the de-
posit between the fibres of the part. Mr. Canton stated that he had not as
yet met with the appearance of a corresponding deposit in the edge of the
crystalline lens, as had been mentioned by Dr. Schön, of Hamburgh. A
clear internal layer of cornea is always to be seen between the edge of the
senile zone and the margin of the sclerotic.
Two HEN-Eggs UNITED AT THEIR ENDS BY A BAND, were exhibited by
DR. CoEMAGK. The eggs were rather less than the usual size, and some-
what elongated, apparently in consequence of their having been squeezed
together during their growth, when the shell was being formed. At their
points of apposition there existed a great roughness of the shell ; an effort
probably towards union of the eggs. Dr. C. stated that anomalous forma-
tions of the hen's egg were not by any means uncommon ; but, though he
was familiar with many of them, he had never met with one like the pre-
sent. Double yelks have been frequently observed, and Dr. C. had once
seen a triple yelk; but here were two perfect and distinct eggs, each with
its own shell, united by a neck or band, about a quarter of an inch in
diameter, also slightly covered with shell, and containing, apparently, a band
WESTMINSTER MEDICAT, SOCIETY. 9 |
of the white matter, and the medium of union between the eggs. Consider-
ing the great size of the conjoined eggs, and the parallel position in which
they had evidently been expelled, it was surprising that they had not been
fractured (except slightly at their neck), or that the hen had not been injured.
Hens frequently die from the egg assuming a transverse position in the
oviduct, unless some one in charge, suspecting the nature of the case, introduce
the finger and turn the egg. The hen which laid the united eggs was five-
toed, of the Dorking breed, and belonged to Dr. Cormack.
MR. WING had never before seen two eggs joined ; there were in the pos-
session of a friend of his, two chickens united by a band, just like the
Siamese twins. They died before they were hatched; and when he saw
them, they were preserved in spirits.
ADJournBD DISCUSSION on THE RELATIONS AND DIFFERENCES BETWEEN
EPILEPsy AND PUERPERAL Convulsions. DR. CoRMACK said that it was not
his intention to enter upon that department of Puerperal Convulsions, re-
garding which he had so recently had the honour of addressing the Society:
viz., those epileptic seizures which occur in pregnant women from toxaemia,
which he had described as being chiefly of renal or lochial origin. The renal
Puerperal Convulsions were not necessarily—nor indeed were they gene-
rally—connected with organic disease of the kidney; the pressure of the
uterine tumour upon the emulgent veins being sufficient to cause congestion
and functional disturbance of the organ, deficient blood-moulting, and con-
sequent toxaemia. The lochial Puerperal Convulsions depended on toxaemia
from suppression of the lochial discharge. Toxaemic convulsions—renal and
Jochial—were produced by direct impressions on the spinal centre; but the
cases which had been so instructively brought before the Society by Dr.
Tyler Smith were of reflex or excentric origin; though of course it must be
remembered, that cases of mixed origin occurred.
The main propositions which the author had sought to establish were
these—“That epileptics are not more liable than others to Puerperal Con-
vulsions; and that pregnancy has a tendency to ameliorate Epilepsy.” But
what is Epilepsy % What are Puerperal Convulsions 7 Epilepsy cannot be
considered as the name of a disease; and if it have any definite meaning at
all, it is when limited in its use to describe a particular form of convulsion.
Its causes are very various; and ovarian irritation is only one of them.
Again, Puerperal Convulsions do not by any means always depend upon the
same pathological causes; and each case must stand by itself, till investigated,
and placed in its own group. The term is mischievous, if employed with
reference to causes or treatment ; and ought to be restricted to its simple
meaning—viz. convulsions occurring in puerperal women. They may not be
epileptic ; but they are generally of this description. Dr. Cormack had seen,
in common, he ventured to say, with most of those whom he addressed, fits
of strictly epileptic character, characterized by coma, clenched teeth, and
bitten tongue, arising from the renal disorder of scarlatina; from toxaemia
dependent on organic or functional disease of the kidney, or of the liver; from
irritation of the peripheral extremities of the intra-cranial nerves by osteo-
phytic spicula, or by the presence of effused fluids within the cranium ; from
cerebral hypertrophy or tubercular deposit; from irritation of the fifth pair of
nerves in dentition; from irritation of the nerves of the stomach, bladder,
uterus, and ovaries—and, he said, if Epilepsy be more common in females, this
preponderance must depend upon the two latter causes. The greater frequency
of Epilepsy in women is not, however, established; for there is reason to sup-
pose, that the severer forms of certain other convulsions to which the sex are
liable, have been indiscriminately placed with it ; and possibly a rigid dia-
gnosis might nearly, if not entirely, equalize the number of epileptic seizures
in the two sexes. From these considerations, Dr. Cormack maintained, that
ovarian irritation was not so frequent a cause of Epilepsy as some supposed;

92 REPORTS OF SOCIETIES.
*.
and that it was only when the fits depended upon that cause, that the ovarian
repose of pregnancy could be ameliorative. Ovarian repose, however, was by
no means a constant condition in gravid women. If a young unmarried
woman had epileptic fits, only at her catamenial periods, marriage might be
allowed, because pregnancy would probably be curative ; but it was only when
thus stringently limited, that the sanitary influence of marriage in epileptics
could be admitted. And if Dr. Smith's proposition were intended to be a
general one, he (Dr. C.) must dissent from it. The ovarian repose of pre-
gnancy can only be curative, when the seizures depend on ovarian excitement.
Taking all cases indiscriminately, however, he believed it to be true, that
Epilepsy was rarer among pregnant, than other women. He had incidentally
stated this in a paper which he had read to the Society."
An interesting case, put on record by La Motte, had been mentioned
by Dr. Webster, as bearing on the question of pregnancy in epileptics. The
facts did not appear to be so anomalous, as Dr. Webster had said. An
epileptic woman married; and the history of eight successive pregnancies
was, that when five times gravid with girls, she escaped; but that on the
three other occasions, when the children were males, she had epileptic fits.
The explanation of the case is this: on each occasion, pregnancy proved pro-
phylactic against her old disorder—ovarian Epilepsy; but this benefit was only
manifest, when she was gravid of female children, because, in her other
pregnancies, the male foetus, from the greater bulk of the uterine tumour,
caused renal toxaemic convulsions. In illustration of this point, Dr. Cormack
referred to the statistics of Dr. Collins.
There exists an analogy between the intra-cranial osteophyte of many non-
puerperal epileptics of both sexes, and that remarkable condition of the cra-
nium which obtains during pregnancy, and which was discovered and described
about ten years ago by Rokitansky. The Wenzels and others observed long ago,
that in epileptics of both sexes, the calvarium was commonly thickened, and
had bony spicula projecting inwards from it, and that a bony deposit was to be
found in the dura mater and pituitary body. Modern physiology points to
these spicula as ‘the cause of convulsions, by their irritating the peripheral
extremities of the intra-cranial nerves. Now, if we have in pregnancy an
osseous deposit on the intra-cranial surface, as a normal condition, how very
probable is it, that when the deposit is either in excess, or, in place of being
smooth as it generally is, on its cerebral surface, is rough and jagged, we may
have thereby produced, epileptic seizures. If so, here we have an analogy be-
tween a group of cases of Puerperal and non-puerperal Convulsions, which has
not hitherto been suspected. Dr. Cormack thought that the whole subject of
osteophytes required elucidation, and was one which, if properly investigated,
might throw much light on those incipient derangements on which certain
cases of Epilepsy depended. He regarded the osteophyte as an inflammatory
product, or at least as one which required a highly fibrinous condition of the
blood ; and in proof of this referred to the condition of the blood in pregnancy,
and to a paper on osteophytes in pleurisy by M. Parise, in the Archives
Générales de Médecine for November of this year. He also read an account
of the discovery made by Rokitansky, from p. 16 of Dr. Fletcher's Elements
of General Pathology, and referred to the confirmation of this discovery by
Ducrest” and Moreau. The subject had hitherto been looked on as one
merely of curiosity, but he thought it might yet be found to have an
essential bearing on pathological doctrines.
The following are the observations of Professor Rokitansky, read to the
Society by Dr. Cormack:-* Professor Rokitansky, of Vienna, describes a cal-
* “From some convulsive attacks, e.g., Epilepsy, she seems very frequently to
be respited, in virtue of her pregnancy.” DR. CoRMACK, in LONDON JOURNAL OF
MEDICINE, June 1849, p. 535.
* Edinburgh Monthly Journal for 1844, p. 232, quoted from the Mem. de la Société
Médicale d’Observation de Paris, vol. ii, 1844.
WFSTMINSTER MEDICAI, SOCIETY. 93
careous deposit on the internal surface of the skull, as being almost con-
stantly present in the pregnant and puerperal states. This deposit varies
from one-sixth, one-third, to one-half of a line in thickness. It appears
principally on the frontal and parietal bones, especially in the course of the
arterial sulci. Sometimes, it is found on the base of the skull, and the frontal
bones. It does not extend uniformly over the surface of the skull, but is
scattered like little islands, leaving intervals quite unaffected. It may be
considered as an almost invariable appearance in pregnancy, and does not
at all indicate any abnormity of that condition. It seems to depend on the
state of the uterus during pregnancy, as it has not been observed either in
cases of extra-uterine conception, or in cases of polypi of the uterus. It has
been detected as early as the third month of pregnancy. This formation of
bone has been observed in three distinct stages of development. First, as a
yellowish red and gelatinous vascular condition, easily separated from the
tabula vitrea by the knife. Second, as a thin, weak, porous, calcareous layer,
attached by a gelatinous exudation to the skull ; this is likewise easily
separated by the knife. Third, as an osteo-cartilaginous plate, attached to
the skull by numerous fine vessels, which must be torn through before it
can be separated. These three stages of development are generally, observed
in the same skull. As far as observations hitherto made lead, it would seem,
that such a deposition takes place at each pregnancy, and that the substance
so deposited is not absorbed. Thus, Rokitansky is of opinion, as well from
these facts as from numerous observations, that the skull becomes perma-
nently thickened by frequent pregnancies. Regarding the connexion of this
osteophyte with the symptoms that appear in pregnancy, and its relation to
that condition of the system in general, we are as yet wholly unacquainted.”
(Fletcher's Pathology, edited by Drs. Drysdale and Russell. 1842, p. 16; from
OEsterreich. Medicin. Jahrbücher, Band. xv, s. 501.)
M. Moreau's observations were read from the Edinburgh Monthly Journal
for September 1846, as quoted from the Journal de %. for 1845.
Moreau states that the osteophyte can always be separated from the skull-
cap, and that it leaves its vitreous table uninjured, and healthy. In forty-
two cases, he found the first degree of thickness and solidity thirteen times,
the second, twenty-one times, and the third, eight times. A recent observer
had noticed osteophyte in the bones of the pelvis, as well as of the cranium, of
pregnant women.
In conclusion, Dr. Cormack reminded the Society, that the three points to
which he had attempted to direct attention were:—
1. That the term Epilepsy should be used only to designate a particular
form of Convulsions.
2. That pregnancy can only ameliorate the condition of epileptics, when
the Epilepsy is dependent on ovarian excitement.
3. That the abnormal development of the intra-cranial osteophytes of
pregnancy may be an occasional cause of Puerperal Convulsions.
MR. STREETER observed, that the valuable remarks which they had just
heard, showed that the Society had done right in continuing this discussion,
and that the subject had by no means been exhausted by the speakers at the
last meeting. He thought the inquiry, whether Epilepsy predisposed to, or
exempted from Puerperal Convulsions, novel, and important. In a disease
which was so comparatively rare, as to have occurred only thirty times
amongst sixteen thousand four hundred and fourteen women, during Dr.
Collins's Mastership at the Dublin Lying-in Hospital, or about once in 548
labours, the question could not be fairly answered by appeals to individual
testimony. Dr. Tyler Smith had, therefore, done good service in collecting
those units of personal experience, from the accumulation of which, the con-
nexion between the two diseases might be proved or disproved. As he (Mr.
Streeter) had never had a case of genuine Puerperal Convulsions in his own
practice, his experience had been limited to a very few cases which he had seen
94 REPORTS OF SOCl ETIES.
in that of others. In those, he was not aware of their having had any previous
Epilepsy, while he had certainly known Epilepsy occurring during gesta-
tion, and causing sanguineous infiltration of the labium, not followed by
Puerperal Convulsions during that or a succeeding labour. In another in-
stance, Epilepsy occurred after marriage, but neither the first nor succeeding
labours were attended with Convulsions.
In considering the next question proposed, viz. the influence of marriage,
he thought the scientific inquiry ought not to be limited to its influence over
the female, but extended to its effects on her own children, and those of their
offspring. For it most certainly happened, that family resemblances reap-
peared after one generation; and what was true of the face, most likely existed
with respect to internal predispositions and peculiarities. Much happiness
would arise, and much grief and disappointment be avoided, by a more strict
obedience to those laws of breeding which the Creator had appointed. They
were diligently studied and carefully enforced among hordes and the lower
animals, but he feared that during “negotiations for hymeneal alliances”,
medical opinion was rarely sought for any other purpose, than that of finding
reasons for justifying the inclinations of the contracting parties. One
general rule, however, might be safely applied to the case of Epilepsy, viz.
that of avoiding a similar defect or tendency in the parents.
While speaking of the similarity of Epilepsy and Puerperal Convulsions,
he observed that the term Epilepsy was applied far too loosely to every con-
vulsive movement attended with insensibility. He thought it should be re-
stricted to convulsive attacks implicating, not only the general muscles, but
those of the face, tongue, the larynx, and the respiratory organs. Puer-
peral Convulsions seemed to him most nearly allied to those fierce attacks of
acute Epilepsy which occurred but once or so during childhood. The fre-
quency with which vegetable poisons produced convulsions, led him to favour
the toxaemic or humoral theory of Puerperal Epilepsy, rather than the osteo-
phytic or solidist causation brought before their notice by Dr. Cormack, who
also regarded it as a much rarer cause of Puerperal Convulsions than
toxaemia. At the same time, he must say, that both the toxaemia and osteo-
phyte were to his mind only predisposing causes; the immediate cause was
the irritation of the nerves of the lower segment of the uterus—those supply-
ing the os and cervix, which are exposed to injurious pressure, and the
irritation of distention, at the commencement and during the progress of
labour. In practice, he had always endeavoured to relieve this, where the
dilating stage was attended with more than usual suffering, by gently press-
ing back the head at the termination of each pain. This freeing the parts
from continuous pressure between the pains often gave great relief, espe-
cially where the uterus was low down in the pelvis in the early stages. The
very great proportion of cases in which Puerperal Convulsions occurred in
first pregnancies and in unmarried women must not be overlooked, for it
showed that there was something more than physical irritation, whether
excentric, osteophytic, or toxaemic ;-that additional cause was the centric
one- of mental emotion. Mr. Streeter concluded, by dwelling on the im-
portance of keeping in view the centric and excentric causes of convulsive
diseases, and the mutual influence which these causes exert over each other.
He exhibited a tabular view of the data furnished by an analysis of 144 cases
of Puerperal Convulsions, which he published eight years ago.”
MR. Wrng, after acknowledging Dr. Tyler Smith's valuable paper, expressed
himself as having been deeply interested in Dr. Cormack's important obser-
vations upon a former occasion, as well as upon the present, respecting the
relation between the condition of the urinary organs, and their secretion, in
Epilepsy, and in connexion with Convulsions in first labours. Mr. Wing had
attended, some years since, two cases of Puerperal Convulsions, in which
1 Moreau's Icones Obstetricae. London : Baillière. 1842.
WESTMINSTER MEDICAL SOCIETY. 95
retention of urine was present. It was drawn off, the other symptoms
attended to, and both patients did well. In Dr Burrows' excellent work on
Insanity, it is said, that persons predisposed to Epilepsy have peculiarly pro-
minent eyes, arising from the great fulness of the blood-vessels supplying
those organs ; and that it is so marked a diagnostic, that it is designated the
“ epileptic eye.” It is accompanied with a peculiar glaze over it, as in mania,
and which it is necessary to observe, to prevent any confusion in distinguish-
ing it from the large convex eye of near-sighted persons. Dr. Smith's paper
had elicited from Dr Cape a most interesting case of epileptic fits, as having
occurred in the night only ; and which had involved parental honour, and a
child’s matrimonial prospects and happiness in life. A young lady, uncon-
scious of her nightly attacks, entered into the marriage state; and, on the
nuptial might, an epileptic fit took place, which gave rise to distressing ex-
planations,—the parents avowing their entire ignorance of the previous
existence of their child's affliction. Mr. Wing could readily feel disposed to
exonerate both the parents and their child, from the experience which he
had had in Epilepsy. In one confirmed case, of an adult, which he attended
during nine weeks, in a private asylum, though he was frequently seized
with paroxysms during the night, there was but one attack (to Mr. Wing's
knowledge) during the day, and it arose only from an accidental source
of irritation. In reply to interrogatories from time to time, the patient
denied being cognizant of his epileptic seizures.
MR. W. F. BARLow rose to remind the Society, that it was not the general
subject of Epilepsy that was before them, but certain definite propositions.
If Fellows did not confine themselves to the subject of Dr. Smith's paper,
the discussion would become desultory and endless.
DR. JAMES BIRD had listened with much interest to Dr. Cormack's observ-
ations, especially to those which referred to toxaemic Puerperal Convulsions.
He apprehended that toxaemia was the cause of those epileptic attacks which,
according to Mr. Druitt's experience, so frequently happened among those
who drunk beer to excess. As to the influence which habits of beer-drink-
ing might have in producing convulsions, he could not speak from his own
experience; though he possessed many facts to show that habits of spirit-
drinking were very influential in producing them in connexion with attacks
of delirium tremens. He thought that the pathological relation, character,
and origin, of the epileptiform varieties of this disease, were calculated to
throw some light both on the analogies and differences of Puerperal and
other Convulsions. Out of seventy cases of delirium tremens, which he had
seen from 1835 to 1840, six were attended by epileptic seizures, which in five
instances proved fatal. Of these five, three terminated in death by asphyxia,
and two by coma. Of the asphyxiated cases, two were accompanied, during
life, by almost complete suppression of urine, and were fatal from toxaemia;
the other was associated with endocarditis and fatty degeneration of the
heart, as revealed by the necroscopic examination of the body. The two
cases of coma terminated by the copious effusion of bloody serum into the
ventricles and substance of the brain; which effusion was accompanied, in
one of them, by great hypertrophy of the dura mater. Now, the eclampsia.
and state of coma in the latter were more nearly allied than in the other, to
apoplexy and Epilepsy proceeding from irritation and hyperaemia in the
nervous centres; whereas the cerebral congestion, which followed the cardiac
and pulmonary congestion, with attendant convulsions of the latter, were
results of peripheral irritation of the extremities of the sentient and motor
nerves, in connexion with the spinal marrow, as is usual in cases of Puerpe-
ral Convulsions. In such cases, the irritation is peripheral, and the convul-
sions reflex, giving them a characteristic difference from those of pure Epi-
lepsy, where the hyperaesthesia, or exalted seasibility, is centric in the brain
or medulla oblongata, and irradiates on the motor nerves so as to produce
convulsions. No essential distinction of the two diseases can be made out

96 REPORTS OF SOCIETIES.
from any difference of symptoms; but the marked pathological distinction
between Epilepsy generally and Puerperal Convulsions, is that the former
has its origin in irritation and exalted sensibility of the brain as a nervous
centre, the latter in a like state of the peripheries of the nerves and spinal
marrow. Epilepsy and epileptic delirium tremens are frequently the result
of toxaemia: but Puerperal Convulsions do not usually claim this origin. Epi-
lepsy and delirium tremens proceed generally from centric, but the latter
from peripheral nervous irritation. Epilepsy may be therefore regarded as
a state of psychical hyperaesthesia of the nervous centres; Puerperal Con-
vulsions as hyperaesthesia of the peripheries of the nerves ; and, as this ex-
alted sensibility, in either kind of convulsion, may be conjoined with a state
of hyperaemia or with an opposite state of anaemia, the treatment required
must necessarily be very different in those two opposite conditions.
Dr. SNow said, that the cases of Puerperal Convulsions which he had seen,
bore a much-closer resemblance to the convulsions which occurred in certain
cases of renal disease, than they did to ordinary Epilepsy; and he agreed
with the opinion expressed by Dr. Cormack, in his paper on this subject, last
session, that the greater number of cases of convulsion occurring in the
Puerperal state, were caused by congestion of the kidneys, and the conse-
quent detention of the urinary salts in the blood. He was ready to admit,
however, that a few cases might depend on peripheral irritation of the nerves,
as alleged.
DR. RouTH believed that the cause of most Puerperal Convulsions was
toxaemia from renal disease. Renal disease was very common in England,
and more particularly among the lower classes: in Vienna it was rare. He
had noted, during his residence at Vienna, that out of about 3,000 cases of
labour, there were only two cases of Convulsions. He also concurred with
Dr. Cormack in believing, that the greater frequency of Puerperal Convul-
sions in primiparae, was to be explained by the backward pressure of the
uterime tumour upon the kidneys, through the greater rigidity of the abdo-
minal parietes. A priori, we might expect a patient affected with Bright's
disease to have Puerperal Convulsions, even though the renal disease was
slight. He thought that the etiology of Puerperal Convulsions could only
be made out by an examination of the urine—not merely during labour,
when it was almost always albuminous, but likewise before, and after. If the
Epilepsy, under which a patient laboured before pregnancy, was due only to
º excitement, à priori, we ought not to expect Convulsions during
à,00lilº.
DR. Scott ALISON would like to know from Mr. Streeter, Dr. Routh, or
from any Fellow, whether there was evidence on record, which could be pro-
duced, to show that, in cases of what was commonly understood by the term
Epilepsy, the kidney was affected? Epilepsy was, in his opinion, generally
an hereditary disease.
DR. WEBSTER said that he was acquainted with the principal statistical
facts regarding about four thousand cases of Epilepsy and mania; and with
regard to hereditary transmission, there was this remarkable difference:—
that the male parent was more apt to transmit Epilepsy, and the female,
mania. As to the state of the kidney, he could say nothing, as many of the
patients referred to were still living.
DR. Scott ALISON. The point may be very often settled, even as regards
living patients. gº
DR. WEBSTER assented.
DR. TYLER SMITH could sincerely assure the Society, that the cases he had
related in his paper, were not selected with a view to support any par-
ticular opinion ; he had by no means sought for instances of ovarian
Epilepsy, followed by pregnancy, but had, with the strictest impartiality,
included all which had come within his knowledge. He had listened
with much interest to the observations of Dr. Cormack on the osteophytes
WESTMINSTER MEDICAL SOCIETY. 97
of Rokitansky; but he could not consider them to be very powerful as
a local cause of Puerperal Convulsions, because of their regular and uni-
form appearance during gestation and the Puerperal state. Their study
would, however, be most interesting in relation to the condition of the
blood during pregnancy; particularly when it was considered, that during
the two great convulsive epochs, those of dentition, and gestation,-the
economy was busily engaged in applying phosphatic salts to the formation of
teeth and the consolidation of the osseous tissues, in the one case, and to the
organization of the bones of the foetus, in the other. Future observation
might give to the state of the blood, which obtains during the progress of
ossification, a considerable share in producing that erethismus of the nervous
system, through which Convulsions were readily excited. Undoubtedly, as Dr.
Cormack had said, experiments proved that irritation of the intra-cranial
nerves might produce excentric Convulsions; and in some cases of Epilepsy,
this was evidently a cause of the Convulsions; but he regarded the thickening
of the calvarium and skull, so generally met with in the post-mortem examina-
tions of old epileptics and insane patients, as a consequence, rather than a
cause, of the paroxysmal disease; and as produced by the frequent congestions
of the cerebral and cranial vessels during the attacks, and even in the inter-
vals. He admitted the importance of the effects of the pressure of the gravid
womb upon the renal vessels, and the impediment to the full depuration of
the blood by the kidneys, which this occasioned; but he did not quite admit
it, to the extent contended for by Dr. Cormack. Something more was
required, some local irritation of a severe kind, otherwise Convulsions would
be as common during gestation, as at the time of parturition; and they would
rarely occur, as Puerperal Convulsions often did, after all abdominal pressure
had been removed by delivery. In the case of La Motte, he could scarcely
allow that the abdominal pressure was the cause of the Convulsions during the
pregnancies with male children: some other explanation must be looked for.
As regarded pressure upon the abdominal vessels, the difference between a
male and female child, during gestation, was almost infinitesimal ; but the
difference was greater, when the foetal head came to pass through the bony
pelvis and rigid parturient passages of a primiparous woman. Not only the
greater size, but the more perfect ossification of the head of the male foetus,
increased the irritation produced by its transit, to a very considerable degree.
To this increased irritation during delivery, in cases of male children in primi-
parae, he felt obliged to refer the greater frequency of Puerperal Convulsions in
such labours. He said this, with a full consciousness of the importance of the
state of the blood in causing the tendency to the disease. In reply to the ex-
cellent observations which had fallen from Mr. Streeter, respecting marriage in
Epilepsy, he would say, that he had merely mentioned the fact, that in
certain cases, Epilepsy was relieved, and in others suspended altogether, by
marriage and child-bearing ; and he had drawn the obvious inference, that
marriage was not so much to be dreaded as might be imagined. But he had
by no means intended to recommend marriage to female epileptics, fully
conscious as he was of the responsibility of an epileptic female, not only as
regards herself and her husband, but also her posterity. The facts relating
to the matter were, however, valuable, particularly as we were too seldom
consulted by persons in matters which concerned the passions and inclina-
tions, except to remedy mischiefs already committed. With this explana-
tion, he quite agreed with the views of Mr. Streeter on the moral point.
Dr. Snow had compared renal Epilepsy with Puerperal Convulsions, and the
same comparison had been made by Dr. Routh, in the inferences he had
drawn from the rarity of Puerperal Convulsions and of albuminuria in the great
hospitals of Vienna. He would admit, that the Puerperal Convulsion more
nearly resembled the Convulsion which occurred in the course of renal
disease, from the impure state of the blood, than any other form of Convul-
sion. But even here, there were important differences. In the cases he had
WOL. II. 7
98 REPORTS OF SOCIETIES.
seen, the convulsions were not so severe in the renal, as in the puerperal
váriety. In renal disease, the convulsion generally occurred in the latter
stages of the disease, when death was imminent, whereas the Puerperal Con-
vulsion was less frequently followed by death. In albuminuria, urea was
present in the blood, in large quantity; in Puerperal Convulsions, it was
not. A writer in the British and Foreign Medico-Chir. Review for October,
evidently speaking from experience, had stated, that cases of Bright's
disease, on becoming pregnant, had not been affected with Puerperal Con-
vulsions. This was highly important, as it appeared to indicate the distinct-
ness of the two diseases. Dr. Routh's observation of the infrequency of
Puerperal Convulsion in Vienna, was directly confirmatory of the facts he
had detailed in his paper; as no doubt Epilepsy was a frequent disease in
that city. Mr. Druitt had contributed an interesting fact to the pathology
of Puerperal Convulsions, one which was especially interesting, as convulsive
affections were sometimes present in cases of scurvy, apart from pregnancy.
Probably these cases formed a distinct variety of Puerperal Convulsions.
He agreed with his friend, Mr. Barlow, whose knowledge of the diseases of the
nervous system gave value to his criticism, that one could not say, that the
form of the convulsion, the spasmodic action, was different in the Puerperal
Convulsion, as compared with the Epileptic Convulsion. Still he thought
a distinction between the two should be preserved. As regards mere symp-
toms, we could not well separate the Convulsions of dentition, from the
Epilepsy of the adult ; yet every one recognized the distinctness of the two
diseases. So, with regard to the argument of Dr. Willshire, if we went to
the ultimate phenomena observed in Convulsions, and grouped together all
diseases in which the effects or essences were the same, however different
their causes, we must call by the same name, chorea, stammering, epilepsy,
tetanus, and hydrophobia: for in all, morbid contraction of the external
muscles was the essential phenomenon. This, as far as he understood
it, met the objection of Dr. Willshire. Such a plan would be obviously
inconvenient. For practical purposes, it was necessary to study dissim-
ilarities as well as similarities, diversities as well as analogies. If he
had referred to these points, he should have agreed with Dr. Webster
and Dr. Cape, respecting the times of the apoplectic seizures. Epilepsy,
when aggravated by the catamenial periods, generally appeared before the
actual setting in of the menstrual flow. The occurrence of Epilepsy during
sleep had been noticed from the earliest times; the act of falling into, and
waking out of, sleep, frequently induced a fit in persons liable to convulsions.
The relations between the congestion of sleep and the epileptic seizure had
been elucidated, in a clear manner, in the papers of Dr. Marshall Hall, in the
Lancet, which were certainly the most important contributions which had yet
been made to our knowledge of convulsive affections, particularly in relation
to the connexion between hidden paroxysmal seizures, and paralysis, and
mania. He had himself been recently asked his opinion, respecting a lady
who had been found in an epileptic fit, by her husband, while lying at his
side. In this lady, it was probable that many undetected seizures had pre-
viously occurred. He remembered once attending a child, in ailing health,
in whom nothing very remarkable had been observed, until one morning, on
entering the room where the child was in bed, he lifted the coverlet, and
found it in a strong convulsion, which would, however, have been over in a
few minutes unobserved, and have left no sign. He had no doubt whatever,
that in many cases of children found dead in bed with their nurses, where
the infant was thought to be overlain, death had been caused by a convulsion
unnoticed by the nurse or mother. Dr. Barnes’s question had not surprised
him; no doubt it was pertinent, and he should have referred to it in his
paper, but for the desire to avoid controversial points as much as possible.
In his work on Partwrition, he had given what he considered were the proofs
that the coming-on of labour was caused by ovarian excitement. To these
WESTMINSTER MEDICAL SOCIETY. 99
proofs he would refer those who were interested in the subject, and which,
he would say, were confirmed by subsequent observation and experience. In
the case of Epilepsy and pregnancy, with remission of the fits, he did not
think it extraordinary that the ovarian excitement at the time of parturi-
tion, should, in many cases, not reproduce the fits; for it was matter of ob-
servation that, after the respite of pregnancy, several catamenial periods
occurred before the Epilepsy was re-established; it was only gradually that
the erethismus of the nervous system, upon which Epilepsy depended, was
induced. He now came to the objections urged by Dr. Henry Bennet. In
saying that, in female epileptics, the fits were frequently aggravated by
the catamenial periods, and that, in some cases, they were limited to these
periods, appearing at no other times, he had merely repeated a remark which
had been made again and again by observers of Epilepsy, and for the cor-
rectness of which he was sure he could appeal to the experience of every
Fellow of the Society. But Dr. Bennet thought differently, because he had
not seen Epilepsy in cases of uterine disease. Neither had he (Dr. Tyler
Smith), nor had he spoken of uterine disease at all in the sense meant by
Dr. Bennet. It was well known to those conversant with the physiology
and pathology of the nervous system and the spinal cord, that apparently
slight irritations produced graver results than more serious lesions. For
instance, tickling the fauces produced vomiting, while this might not occur
in deep ulceration of the throat; an indigestible meal frequently produced
a fit of epilepsy, but this did not happen from cancer in the stomach; teta-
nus, too, arose from wounds of the thumb, but not from some of the most
grave injuries of more important parts; so also, in the case of the uterus
and ovaria, severe uterine disease, or malignant disease of the ovary, seldom,
if ever, caused Epilepsy, while slight ovario-uterine irritation, such as
could not be recognized either by touch or speculum, as, for instance, that
accompanying the catamenial periods, did most certainly excite epileptic
attacks. Thus the observations of Dr. Bennet did not in any way apply to the
facts of the paper which had been read. Nor was there more force in his refer-
ence to the epileptics of the Salpetrière, as these cases were incurables, proba-
bly with disease of the nervous centres: they were certainly not like the cases
commonly met within private practicein this country. One other point he would
refer to, namely, the question, whether or not Epilepsy succeeded Puerperal
Convulsions ! He had not himself seen or heard of any cases of this kind, but
Dr. Routh had named two, in which, he had little doubt, cerebral effusion had
occurred during the puerperal attacks, thus giving rise to centric Epi-
lepsy. Dr. Robert Lee, whose observations were most valuable, had men-
tioned another case which he had considered to be of this kind, but he (Dr.
Smith) had written to Dr. Marshall Hall, under whose care this patient had
been placed, and, in his reply, had been informed that Dr. Hall did not con-
sider that case as one of ordinary Puerperal Convulsion. “It occurred three
weeks after delivery, and was coincident (within four-and-twenty hours) with
paralysis of the left arm and leg, and ‘white swelling’ of the leg. I imagine
that connected with phlebitis and pure cerebral Epilepsy from the begin-
ning.” Dr. Tyler Smith, in conclusion, while thanking the Society for the
kind reception which had been given to his communication, and for the
valuable facts which had been elicited in the course of the discussion, was
gratified that the two most important points, namely, that, in the majority
of cases, epileptic seizures were more rare during gestation than at other
times; —and that epileptics were rarely affected with Puerperal Convulsions,
—had not been questioned, but, on the contrary, had received additional con-
firmation. The cases he had related, would probably be published hereafter
in detail, with others of great interest which he had since received, but
which at that late hour he would not read to the Society, though he should
have felt bound to do so, had they been at variance with those he had already
cited in his paper.
[00 REPORTS OF SOCIETIES.
DECEMBER 22, 1849.
FRANCIs HIRD, Esq., PRESIDENT, IN THE CHAIR.
A CALCAREous CoNCRETION, THE RESULT of TUBERCLE, in the apex of a
left lung, was exhibited by MR. HAYNEs WALToN. There was no other
appearance of tubercle in either lung.
CASEs of HERNIA : WITH REMARKs. By J. E. ERICHSEN, Esq. The
author related four cases of Hernia, which had come under his notice during
the past year. Each of them presented some peculiarities.
CASE I. W. J., aged 20, was admitted into University College Hospital, in
September last. He has always felt the scrotum to be larger on the left side ;
and nine months ago he perceived a tumour in the left groin, but had never
worm a truss. On the day before admission, he had pain in the abdomen,
and vomiting ; for which he was treated, by a surgeon, as for Cholera. He
was admitted on the 8th, when there was vomiting and abdominal tender-
ness. On examination, there was found to be a round, soft, fluctuating
tumour in the scrotum, extending into a neck in the inguinal canal. The
testis could be felt ; and pain was produced by pressure on the lower and
posterior part of the tumour. On his being placed in a warm bath, the swell-
ing was somewhat diminished in size by pressure, but soon returned. As
to the nature of the case, it might be acute hydrocele, or encysted hydrocele
of the cord, with effusion into the tunica vaginalis; or it might be Hernia,
with hydrocele in the tunica vaginalis. The last of these suppositions alone
seemed admissible. The operation was proceeded with in the usual way.
IIalf a pint of serum escaped from the tunica vaginalis, on being opened ;
and a knuckle of intestine was found, which, after the division of the stric-
ture, and of some dense adhesions, was reduced. The patient had a rather
severe attack of peritonitis, from which he recovered, but afterwards had to
be treated for an abscess in the prostate. The points worthy of remark in
this case, were : 1, the pyriform shape of the swelling; 2, its softness; 3, its
partial emptying, under pressure, in the warm bath ; and 4, that the testis
was felt unsurrounded by bowel, which was two inches from it.
CASE II. This was a case of strangulated oblique inguinal Hermia of the
right side, remarkable for the unusual situation of the stricture. The patient
was aged 20, and the Hernia was said to have been congenital ; the testis,
however, could be felt below it. He had not worn a truss. On admission,
he was labouring under symptoms of peritonitis. On operating, no fluid was
found in the sac ; but there was a large piece of red, congested omentum,
not thickened, nor unhealthy, with a coil of intestine at the inner side. The
stricture appeared to be situated at the external ring, and was divided. The
attempt, however, to return the intestine was unsuccessful; nor was there
any gurgling produced. On further search there was found, at a point cor-
responding with the internal abdominal ring, a narrow band of fibres, stretch-
ing from the omentum to the mesentery, not connected with the sac. The
intestine, above this point, was much congested ; below, it was natural. The
cause of the strangulation was now evident. When the band was removed,
the intestine passed up. The patient died of peritonitis on the following day.
Mr. Eiichsen remarked that, had the omentum not been held down during
the operation, while the intestine was being returned, the whole would have
gone back together, without relief to the patient. He considered this as a
case of internal strangulation in an incarcerated Hernia.
CASE III was one of strangulated femoral Hernia on the right side, in a
female, aged 45. The apparent stricture at Gimbernat's ligament was divided
without success. The sac, which had not been opened, was then pulled
down, and found to be constricted by a fibro-cellular band at the bottom of a
deep sulcus, giving an hour-glass form to the tumour. This was divided,
and the intestine readily slipped back. This was a case bearing on the ques-
Af
WESTMINSTER MEDICAL SOCIETY. 101
tion of the subcutaneous incision of Gimbernat's ligament. It was one of
those cases, where the stricture is formed by fibres on or within the sac.
, CASE IV was one of large hydrocele of the hermial sac. The patient had
had inguinal Hernia on the right side for twenty years, which some time ago
increased rapidly in size. The tumour was found elongated and pyriform ;
at the upper part of it, intestine and omentum were felt, of which the former
alone could be returned. Below, there was a large, soft, fluctuating tumour,
of the size of a cocoa-nut, thick, and not translucent. Its upper boundary
was not distinct ; posteriorly and inferiorly, the testes could be readily felt,
of the natural size. There was a central horizontal construction, with Hernia
above, and hydrocele below ; the latter becoming tense when the Hernia
was down. Mr. Erichsen considered this to be an accumulation of fluid in the
hernial Sac ; and in this diagnosis the late Mr. Morton agreed. The hernia
was reduced by taxis ; and, the tumour being made tense, a trocar was intro-
duced, when about three ounces of fluid escaped. Mr. Erichsen then intro-
duced a probe into the canula, and met with a dense membrane. This was
punctured, or rather bored through, when three pints of a dark fluid escaped.
The patient recovered. This was a case of very rare occurrence; and was
not to be confounded with accumulations of fluid in strangulated Herniae,
nor with cases in which there was still a connexion between the hermial sac
and the abdominal cavity. In this case, the irreducible omentum formed
the upper boundary of the hydrocele.
In conclusion, Mr. Erichsen remarked, that as yet, no general rule can be
laid down as to the performance or non-performance of Petit's operation, by
not opening the sac. The good and bad effects have to be balanced ; and,
till this is done, he did not think Petit's operation will be universally
adopted.
MR. GAY thought that Petit's operation was valuable in some cases.
We should operate according to the nature of the case ; and if we could do
this without opening the sac, we might. He related a case in which Hernia
and hydrocele co-existed : the hydrocele was tapped, and the Hernia, which
had produced symptoms of strangulation, became reducible with very little
trouble. The symptoms, however, continued as severe as ever, for three days,
notwithstanding the use of calomel, opium, etc. Mr. Gay then cut down
again, and found a dense contraction of the tunica vaginalis strangulating
the Hernia, which had been congenital. The patient recovered. He
thought that, in cases of Hernia which had been reducible, the operation
might be performed without opening the sac ; but that, in irreducible
Herniae, it should always be opened. He thought that the coincident occur-
rence of strangulation at the neck of, as well as within the sac, in one of Mr.
Erichsen’s cases, was curious. In a case of umbilical Hernia which he had
seen, it was apparently reduced, but without relief. On examination, it was
found that the intestine had passed through an aperture in a portion of
omentum, and had become strangulated. The patient died, being old and
unhealthy.
MR BoFLASE CHILDs thought Mr Erichsen’s second case interesting, as
it presented an irregularity in the seat of the stricture. He had met
with a case, in which no sign of Hernia could be discovered, except a slight
fulness of the inguinal canal. When this was divided, a large knuckle of
intestine was found to have been strangulated by it.
MR. HANcock did not think Mr. Gay's division of reducible and irredu-
cible, and the rule founded thereon, to be applicable He expressed himself
unfavourable to the performance of the operation without opening the sac ;
and could not see the utility of giving calomel immediately after the opera-
tion. Opium he thought valuable. He was doubtful whether Mr. Erichsen’s
last case was not one of simple hydrocele co-existing with Hernia.
MR. GAY remarked, with reference to the danger of opening the sac, that
102 MISCELLANEOUS INTELLIGENCE,
wounds of the peritoneum principally derived their danger, from the circum-
stance of the patient labouring under disease of some important organ.
MR. ERICHSEN, in reply, said he had given calomel and opium in one case
immediately after the operation, because peritonitis had already set in. He
thought opium most j. when given alone, in tranquillizing the patient.
The late Mr. Liston was for some time very unsuccessful in his cases of
Hernia, because he used to give a dose of sulphate of magnesia directly after
the operation. He agreed with Mr. Hancock in his criticism of Mr. Gay's
division of cases into reducible and irreducible; and he thought that he
would perhaps rather not open the sac in irreducible Herniae. As to the
incisions in the sac causing peritonitis, he thought this often present before
the operation. He thought that the rules laid down in books were rather
the exceptions ; and that surgeons would do well to contribute records of
those cases which appeared exceptional.
MISCELLANEOUS INT1:LLIGENCE.
THE MEDICAL SocIETIES of LoNDoN. The Westminster Society is at pre-
sent in greatest favour; as is indicated by the extraordinary increase in the
number of Fellows, the overflowing attendance at the meetings, the value of
the papers, and the vigour of the discussions. The number of Fellows ad-
mitted since January 1st, 1849, is about fifty, whereas the entries at the
Medico-Chirurgical are only about twenty-six during the same period. This
is much to be regretted, as it is only by an infusion of fresh blood that the
latter institution can be reanimated. Considering the value of the Library
and the Reading-room, no member of the profession can fail to be a great
gainer by becoming a Fellow of the Royal Medical and Chirurgical Society.
It is said that the question of amalgamation between the London Medical
Society and the Westminster Medical Society has been mooted. The incon-
venient situation of the former—in Bolt-court—is much complained of; but
there exist legal difficulties in the way of a removal, unless the Society en-
tirely relinquish the property. We really think that there is abundant scope
for the three public societies we have named ; and the sphere will be all the
wider, that they remain in their present localities. We can only see a dis-
advantage in having the leading medical societies crowded together at the
West-end, as some desire.
Therapeutics are at present a neglected branch of medicine; and were the
London Medical Society to cultivate with method and earnestness this depart-
ment of our science, the meetings in Bolt-court would soon be thronged, can-
didates for admission would abound, and a great advantage be conferred on the
profession. Besides the three societies whose names we have mentioned,
there exist in London many others of great importance, but of a more local
character. Pre-eminent among this class, may be mentioned the Western
Medical and Surgical Society, whose meetings are held in Sloane-street,
where also there is, belonging to the Society, a well-stocked reading-room
en daily, and an increasing library. The importance of establishing good
medical libraries and reading-rooms in the different quarters of our immense
capital, is so great and obvious, and some of the means by which it might be
aided are so easy and inexpensive, that we intend in a future number to
throw out a few hints on the subject.
EDINBURGH SCHool, of MEDICINE. The lecturers who do not belong to the
University have of late greatly diminished in numbers, but there is still a
complete school, and some of the teachers are eminent. The High School
Yard, Surgeon Square, Argyle Square, and Brown Square—replete with asso-
ciations of student-life to thousands of our profession—are fairly abandoned
by the votaries of Æsculapius, in consequence of the private lecturers having
collectively erected for their use, a commodious building behind the College
MISCELLANEOUS INTELLIGENCE. 103
\
of Surgeons in Nicholson Street. The precise constitution of the school is not
as yet announced, but there can be no doubt of its being under the wing of
the College of Surgeons. The University Medical School is not less active
than its unendowed rival, having demanded (and, we hear, with the probability
of obtaining) such an ascendancy in the management of the Infirmary, as will
give the professors a clinical hospital, complete for medicine, surgery, and
midwifery, with extra wards for such specialities as diseases of the skin,
syphilis, and affections of the eye. The benefits of this arrangement, so far as
medical teaching is concerned, are obvious ; and the shelving of that part of
the profession in Edinburgh, who do not aspire to chairs in the University,
but wish to be consulting physicians and operating surgeons, is dreaded by
some, but by many is not believed to be inevitable. The Monthly Journal
of Medical Science is in future to be more authoritatively devoted to “main-
tain and extend the influence which has been accorded to the Edinburgh
School of Medicine”; and it is officially announced, that the work will in
future be conducted by Professors Christison, Syme, Simpson, Goodsir, and
Bennett; Dr. Douglas Maclagan, lecturer (extra) on Materia Medica ; and
T}r. William Robertson, Physician to the Infirmary. These gentlemen have
already been among the leading contributors to this valuable work. A new
Quarterly Journal is announced by Messrs. Sutherland and Knox, under the
editorship of Professor Goodsir, entitled Annals of Anatomy and Physiology.
No. 1. is to appear on the first of February.
MonumENT To JENNER. Steps are being taken to bring this subject before
the profession ; and in addition to the Committee appointed by the Provincial
Medical and Surgical Association, mentioned at p. 890 of our number for
September 1849, a large and influential metropolitan committee has been
formed, with branches in various parts of the kingdom.
PROPOSED NEW CHARTER of THE Col.1.BGE of SURGEONs of ENGLAND. We
have been anxiously expecting some official explanation of the proposed
alteration in the constitution of the College of Surgeons. But, beyond the
general report, that members of twenty years' standing, in the possession of
testimonials, and on the payment of ten guineas, would be added to the list
of Fellows, no hint has reached us on this subject. It is clear, that nothing
can now undo the act of the Council in office in 1843, short of an entire
abandonment of the principles upon which the Charter was then granted.
We are sincerely of opinion, that the present Council are anxious to conci-
liate the members at large by every means in their power, and we do not well
see how they can do this more satisfactorily, than in the manner proposed.
In extending the Fellowship, there must be some line drawn; for, if all were
included, it would be only substituting one name for another. Now, we
think that age, coupled with respectability, as guaranteed by the signatures
of six Fellows, is the best criterion which can be at present selected. There
may be some hardship in requiring a fee of ten guineas; but it would be
still more hard to admit men of twenty years' standing now, without payment
of a fee, after receiving ten guineas from men of even thirty years’ standing
and upwards, together with an examination, as has been hitherto the case.
The proposed plan, if carried out, ought to be accepted as the amende honora-
ble ; and if, in addition, the College of Surgeons should come forward, and by
co-operating with the College of Physicians, should offer to the profession a
Board of Examiners, which might form a common portal to the different
departments of our art, we trust that all old grievances would be buried in
oblivion, and that we should all exert ourselves in carrying out this measure.
We trust that the College authorities will prevent the necessity for the
formation of the projected College of General Practitioners, which can only
act as a fresh element of discord in our already disorganized ranks. [Abridged
from Provincial Medical and Surgical Journal, Dec. 26, 1849.]
104
A PP O I N T M E N T S.
ALLAN, Dr. John, appointed Physician to the Islington Dispensary.
BRASSEUR, Professor, appointed Examiner in French to the Royal College of Sur-
geons of England.
CHAMBERS, Dr. A., elected Physician to the Dispensary for Consumption and Dis-
eases of the Chest, Margaret Street.
DAMPIER, N. J., Esq., F.R.C.S., elected Surgeon to the Islington Dispensary, in
the room of J. J. PARNELL, Esq., resigned.
HALE, Dr. R. J., appointed Physician to the Islington Dispensary.
HALL, C. Radclyffe, M.D., appointed Physician to the Bristol General Hospital, in
the room of DR. BEATTY, resigned.
HAWKINS, Caesar H., Esq., elected one of the Examiners at the Royal College of
Surgeons, in the room of the late J. G. ANDREWS, Esq.
HOOPER, R. L., Esq., appointed Surgeon to the Queen's Prison, in the room of the
late THOMAS MoRTON, Esq.
SMITH, Goldwin, Esq., M.A., appointed Examiner in Classics to the Royal College
of Surgeons of England.
STOKES, G. G., Esq., M.A., appointed Examiner in Mathematics to the Royal College
of Surgeons.
O BIT U A. R.Y.
BIRCH, John Spencer, Esq., Surgeon, at Blackburn, on 25th November 1849.
CARDEw, J., M.D., late Physician to the Bath General and United Hospitals, at
Weymouth, on 25th November.
CARRUTHERS, Robert, M.D., Royal Navy, at Longfleet, near Poole, Dorset, on
27th November.
CASE, Thomas, Esq., Surgeon, of Runcorn, Cheshire, lately.
CHEESBROUGH, John, Esq., at North Egremont, Cheshire, lately.
DEAS, Dr., Surgeon-Superintendent of the Neptune convict ship, at the Cape of
--- Good Hope, lately.
GAINE, E. L. J., Esq., Surgeon, H.E.I.C.S., at Waltair, East Indies, on 20th October.
GLENNIE, W. R., M.D., H.E.I.C.S., formerly of Maybank, Aberdeen, at Goruck-
pore, on 4th October.
GUNNING, Thomas, Esq., Inspector General, Army Medical Department, at Bromp-
ton Crescent, aged 74, on 30th November.
HEIR, Matthew, Esq., late Surgeon to the 66th Foot, at his residence, 16, Park
Walk, Chelsea, aged 73, lately.
MALING, C., Esq., Surgeon, at Abbey Holme, Cumberland, of Cholera, aged 34, on
24th November.
MITCHELL, John, M.D., at Hobshill, Cruden, after a short illness, aged 55, on 22nd
November.
MUNRo, Dr., Surgeon of H.M.S. Castor, lately.
ROBERTS, William, Esq., Surgeon, late of the 1st Royals, at Sydenham, Kent, aged
71, on 22nd November.
SHEFFIELD, Edmund, Esq., Surgeon, at 12, Grove, Hackney, aged 71, on 2nd
December.
TRUEFITT, Louis, Esq., Surgeon, at Burwood Place, Hyde Park, on 3rd December.
WHITELAW, Thomas, Esq., Surgeon, Royal Artillery, at Barbadoes.
WoRTHINGTON, Charles, Esq., Surgeon, at Llangollen, aged 73, on 1st December.
B O O K S R E G E IV E D.
Bacc. Med. Oxon. on Stammering and its Treatment. London: 1850. CHURCH-
HILL (Dr. F.) on Diseases of Children. Dublin: 1850. FLOOD on the Arteries.
Edited by DR. PoweR. Dublin; 1850. HAMILTON's Essays on Syphilis, Part I.
Dublin: 1849. HULL on Consumption. London: 1850. SNow on Pathology and
Communication of Cholera. London: 1849. STEwART (DR. A. P.), Sanitary Eco-
nomics. London: 1849. SYME on Medical Reform. Edinburgh: 1849. WARE
on the Duties and Qualifications of Physicians. Oxford: 1849. WINSLOw on Cho-
lera. Traduite en Français par E. ColMACHE. Paris: 1849.
I, ON DON
JOURNAL OF MEDICINE,
A MONTHLY
3Reſort of the ſºletícal Sºciemteg.
FEBRUARY 1850.-No. XIV.
O R. I. G. I. N. A. L. C. O M M UN I CAT I O N S.
AN INQUIRY INTO THE CURABILITY OF PULMONARY
CONSUMPTION:
WITH OBSERVATIONS ON ITS TREATMENT, AND CASES ILLUSTRATING
THE EFFICACY OF COD-LIVER, OIL.
By JAMES TURNBULL, M.D., Physician to the Liverpool Infirmary.
THE examination of the question, how far Consumption is a curable
disease, is a subject which has scarcely received from medical men the
attention it deserves, when we consider the very general prevalence of
this disease, and the amount of mortality it occasions. The profession,
as well as the public, have been so strongly impressed with the belief
that the disease is necessarily fatal, that any one who would have main-
tained the opposite opinion would, until very recently, have been looked
upon only in the light of a boasting pretender. Notwithstanding this,
pathological investigations have shown, in the clearest manner, that
recovery often does take place from this disease; and ever since the
able investigations of Laennec proved that this may occur from the
spontaneous efforts of nature, subsequent pathologists have been accu-
mulating facts, proving more fully the correctness of his views and
statements. Auscultation and percussion, by enabling us to separate
those diseases from Consumption which most nearly resemble it, and
to trace the successive steps of recovery on living individuals, have com-
pleted what was required, in order to establish the point. I believe
that medical men are not generally aware of the amount of strong evi-
dence that exists in reference to the curability of Phthisis; but I hope
to bring forward in this paper a sufficient amount of facts to prove, that
it admits of recovery in several ways, and that we should increase our
efforts to save consumptive patients, having now, in cod-liver oil, at
least one remedy which possesses an undoubted power over this destruc-
tive disease.
Let us, before entering upon this subject, inquire, as briefly as pos-
sible, what light has been thrown on the pathology of tubercle, and the
changes it undergoes during absorption and transformation, by recent
chemical and microscopical researches. As regards the blood itself,
WOL. II. 8
106 CURABILITY O'H' PULMONARY CONSUMPTION.
from which it is an exudation or secretion, the only change of any im-
portance which seems to have been yet discovered, is an increase in the
quantity of fibrin; but this does not seem due so much to the tuberculous
diathesis, as to the inflammation which accompanies the softening of
tubercle. The proportion of blood corpuscles is generally below the
standard of health ; but Becquerel and Rodieri have shown that this is
a change common to all chronic diseases, and much more marked in
chlorosis.
Analysis of tubercle itself has shown, that it consists chiefly of albu-
men, with a little casein and fibrin, a considerable quantity of fat, and
some extractive matters, probably the creatine and creatinine discovered
by Liebig” in the muscles and urine. Dr. Madden thinks that the
abundance of extractive matters shows, that there is either diminution
of healthy excretion, or undue activity of the decomposing forces. The
former he has taken as an indication for the use of means to promote the
function of the excreting organs—the skin, liver, and kidneys. Crude
yellow tubercle contains only about 2 per cent. of earthy salts, and 98
per cent. of animal matter; but, when it has undergone the cretaceous
transformation, the proportions are reversed, the quantity of animal
matter being about 3 per cent, and the remainder consisting of earthy
salts, carbonate and phosphate of lime, with a little muriate of Soda.
Tubercle being an exudation from the blood of a part of the liquor
Sanguinis, imperfectly vitalized, and therefore less highly organized than
the fibrinous exudations of healthy inflammation, we naturally expect to
find—what chemists have discovered in regard to its ultimate analysis—
that it differs very little in composition from the proteine compounds.”
These facts, it must be confessed, are almost negative, as regards any
practical value.
Microscopical researches have thrown more light on the pathology of
tubercle; and we have thus derived some information as to its primary
seat, its structure, its relations to surrounding parts, and to other depo-
sits of a healthy or morbid character. Dr. Carswell” thought that the
air-cells were the usual seat of tubercles in the lungs; and that, when-
ever mucous membrane formed a part of an organ, it was either the
exclusive seat, or more extensively affected than any of the other tissues.
There seems to be much reason to believe, that the air-cells are the
common, though not the exclusive, seat of tubercular deposit. I lately
examined a specimen of crude tubercle, where it was beautifully seen
filling the cells. Mr. Rainey” has described its appearance in the air-
cells, and says, that it may sometimes be seen filling only one part of
a single cell. He has endeavoured to show that the cells are not lined
with mucous membrane, but the fact observed by Hassall, of the epithe-
lium extending into them, appears to show that they are lined by this
membrane. Different microscopical observers have shown that it may
also be deposited in the intercellular tissue between the air-vesicles; in
fact, anywhere external to the vessels; and Dr. C.J. B.Williams thinks it
probable, that it may even form within the blood-vessels themselves.
* Recherches sur la Composition du Sang. * On the Chemistry of Food.
8 BENNETT, Northern Journal, 1846.
* Illustrations of the Elementary Forms of Disease.
* Medico-Chirurg. Trans. 1845.
BY JAMES TURNBULL, M.D. 107
Microscopical examination of tubercular matter has shown that it con-
sists of corpuscles, which are characteristic of tubercle, and of granules
and minute molecules. The corpuscles have no nuclei, and are con-
sidered to be undeveloped cells, which approach more or less nearly to
the exudation or plastic cells of healthy inflammatory deposits. The
miliary tubercle has some appearance of cells and fibres, but the crude
yellow tubercle has no appearance of organization, and, during soften-
ing, the corpuscles swell, burst, and discharge granules. Dr.Williams's
view—that lymph, tubercle, and pus, are only modifications of each
other—shows how nearly tubercular deposition and inflammation must
approach each other; and pathologists seem now agreed that they are
closely allied processes, both being modified states of nutrition. Growth,
nutrition, inflammation, and scrofulous diseases, are, observes Dr. Addi-
son, analogous phenomena.
Besides the objects already described, there are also seen in tubercles
the filamentous remains of the air-cells, fat globules, which increase in
quantity as the softening takes place, pus, and other exudation products
of inflammation, epithelium cells; and in cretaceous tubercles, large
dark particles, and crystals of cholesterine.
Of these facts, furnished by microscopical examination, perhaps the
most important, in reference to our present inquiry, is that of the
tubercular corpuscles being most nearly allied to the fully developed
cells of healthy inflammatory products, from which they appear to re-
cede, and assume more of a granular aspect, in proportion as they
become yellow and cheesy, or soften. “The miliary tubercle”, Dr. C.J. B.
Williams observes,” “differs from fibrin, not in kind, but in degree, of
vitality and capacity of organization"; and this proves to us what ex-
perience had previously taught—the importance of removing the com-
plication of inflammation or congestion of the lungs, in the prevention,
as well as treatment, of phthisis.
In examining the pathological facts bearing upon the question of
curability, I will first call attention to the circumstance, that many medi-
cal men, seeing their patients frequently die of phthisis, have become
so incredulous of the possibility of recovery, that when they have seen
a patient recover after having presented the usual symptoms, they have
distrusted their diagnosis, and have taken the fact of recovery as a suf-
ficient proof that the disease could not have been tubercular Consump-
tion. Pathological investigations show that such is a most erroneous
mode of forming an opinion, and prove also, that many persons, who
have never had more than a moderate amount of pectoral symptoms,
must have recovered from this disease. Laennec, in a chapter in his
work, entitled, Earamen de cette question : la guérison de la phthisie est-
elle possible % had the merit of first proving that phthisical persons may
recover, by the cretaceous transformation of tubercular matter, as well
as by the cicatrization of cavities. He investigated the subject very
fully, and detailed ten cases, in three of which the healing of cavities
was traced by the stethoscope, and recovery took place after all the
worst symptoms had supervened. In seven other cases, where the
* WILLIAMs, C. J. B., M.D. Principles of Medicine, p. 386.
8 2
108 CURABILITY OF PULMONARY CONSUMIPTION.
patients were phthisical, but died of other diseases, he ascertained how
recovery might take place by absorption of crude tubercles, and trans-
formation into cretaceous or calcareous concretions; or by the softening
and evacuation of tubercular matter, and the lining of the cavity so
formed by a false membrane of cellular fibrous or cartilaginous texture,
and also the complete disappearance of the cavity by the formation of a
cicatrix. These facts were confirmed by Andral; and even Louis, who
does not take by any means a favourable view of the curability of phthisis,
and is more sceptical than most men as to any good effect from medical
treatment, relates three cases of recovery; one in a man, 45 years of
age, who, after presenting all the usual symptoms, as well as the phy-
sical signs, and keeping his bed for six months, recovered, and returned
to his occupation; the second, in a man, 50 years of age, who had
cavernous respiration and pectoriloquy ; and the third, in a gentleman
of rank, who consulted him several times, during a period of eight years,
for trifling attacks of acute pulmonary catarrh, and afterwards died of
a painful affection of the urinary passages. It was then discovered that
he had a cavity at the summit of the right lung, and near to it two
tubercles. This patient enjoyed robust health, with the exception of
being subject to attacks of cold, and would probably have continued to
do so, but for the other disease of which he died.
M. Rogée, in an able paper on the Curability of Phthisis, in the
Archives Générales de Médecine for 1839, has proved in the clearest man-
ner, that the chalky, as well as the calcareous concretions, resembling
small stones, which are so often found in the lungs, are the result of the
transformation of tubercle. There are many facts which prove this;
the situation of these concretions, generally at the summit of the lung,
sometimes in the midst of a group of tubercles, and often in a cavity
from which the greater part of the tubercular matter has been evacuated.
Tubercles are also sometimes found evidently undergoing this trans-
formation, presenting the appearance of having become smaller, and
being more opaque and whiter than other deposits in the same, or in
the other lung. If further proof were wanted, it might be found in the
fact, that crude tubercle, when dried, assumes a chalky appearance,
similar to that of these concretions. I had last summer an opportunity
of seeing tubercular matter in great quantity in every stage of trans-
formation, in a woman who died in the Liverpool Infirmary of tubercular
peritonitis. The abdominal cavity contained a very large quantity of a
matter like mortar, and the mosenteric glands exhibited almost every
form of tubercular disease, some being in the state of crude, cheesy
tubercle, and others undergoing transformation. The liver was also
fatty in this case; a fact tending to show that the fatty degeneration of
the liver, which so often occurs in Pulmonary Consumption, cannot be
ascribed to the function of respiration being interfered with, but that it
bears a relation to tubercular disease generally, and is most frequently
found in Pulmonary Consumption, only because the lungs are the organs
in which tubercles are oftenest deposited in abundance.
It was at one time regarded as doubtful, whether tubercles could be
absorbed; and Andral' noticed the wrinkled appearance which they some-
times assume, as showing the possibility of their being thus removed.
1 Précis d’Anatomie Pathologique, tom. iii, p. 545.
BY JAMES TURNBULL, M.D. I09
On this point there cannot now be any doubt, but the conditions which
favour absorption require further investigation. The miliary granula-
tions, which Laennec considered the first stage of tubercle, and in which
opinion he has been confirmed by Louis, are believed by Rokitansky to
be, in many cases, merely a kind of fibrin. He considers that this form
or stage of tubercle may undergo a kind of metamorphosis, which he
calls obsolescence. “After the tubercle has passed through its condition
of crudity, it loses its shining appearance and increases in density, be-
comes converted into a small hard lump, and then shrinks into a tough
amorphous or slightly horny mass-cornification. It forms the basis of
a complete destruction or death of the tubercle, and no further meta-
morphosis can take place.”
The softening of tubercle, Dr. Williams thinks, is promoted either by
a deficient supply of blood, which does not maintain its imperfect
vitality, or by an undue flow or accumulation of it exalting chemical
affinities in a material which has no vital power of resistance.
When crude tubercle undergoes the cretaceous transformation, the
animal matter must be removed by the vessels absorbing it; but the
quantity of earthy matter is so much greater than what is contained in
crude tubercle, that there must be a secretion of earthy salts at the same
time, and this sometimes appears to take place into empty cavities also.
Dr. Hughes Bennett considers the tendency of tubercular matter to dis-
integrate as highly favourable to absorption, if fresh deposits could be
prevented; and Rokitansky observes, in reference to cretifaction, that it
occurs as a secondary change, never attacking tubercle in its original form,
but confining itself to the dissolving and dissolved blastema. It is easy
to conceive that, when the corpuscles of tubercle have broken down into
the granular state, they must be more within the absorbent power of
the vessels; but the fact of the yellow crude tubercle being sometimes
observed undergoing cretaceous change without softening, would seem
to show, that it is at least not necessary that it should undergo such a
degree of disintegration as that which immediately precedes the evacua-
tion of tubercular matter. It is worthy, however, of remark, that trans-
formation commences, as softening has usually been observed to do, at
the centre of tubercles; and Dr. Valleix” has observed, that we some-
times find a tubercle having a hard calcareous concretion at the centre,
round this cretaceous matter, and at the circumference a layer of tuber-
cular matter, Boudet affirms, that transformation may take place in
all the phases of their evolution.”
Such are some of the chief facts relating to the curability of Consump-
tion by absorption and transformation of tubercle; but pathological
researches furnish us with further evidence of the possibility of recovery
in a more advanced stage, in the discovery of cicatrices produced by the
healing of cavities at the summit of the lungs. Rogée has described
four kinds,-those with persistence of the cavity; those in which the
cavity contains some chalky or calcareous matter; those cicatrices which
are fibro-cartilaginous; and those of cellular structure. There is usually
some depression, or puckering, of the summit of the lung, where these

* British and Foreign Medico-Chirurgical Review, vol. i., 1848.
* De la Curabilité de la Phthisie pulmonaire, Archives Générales de Médecine, 1841.
* Recherches sur les transformations des tubercles: Comptes Rendus, 1843.
110 CURABILITY OF PULATONARY CONSUMPTION.
cicatrices are discovered, and the surrounding pulmonary tissue is often
of a dark colour and indurated. These appearances may be regarded as
some evidence of the former extent of the disease. Dr. Carswell has
observed, that there may remain only a small globular oval or even
linear portion of fibrous or fibro-cartilaginous tissue in a portion of the
lung, where, from the extensive puckering around it, there must
formerly have existed an evacuation of considerable extent. The heal-
ing of cavities has been observed in every stage; and it would seem,
that the disease may be arrested, or at least become quiescent, even
after it has produced great disorganization of the lungs, of which we
have a remarkable example in a case related by Dr. Kingston."
There are few medical men, who are in the habit of observing the
post-mortem appearances in the lungs, who have not had opportunities
of seeing cretaceous tubercles, and even the less frequent appearance of
cicatrices and puckerings at the summit of these organs. The facts,
indeed, are so palpable, that they have never been disputed; but they
have been looked upon rather as rare and curious examples of what
nature can do where art has failed, than as important practical facts,
which should lead us to observe carefully the favourable circumstances
under which the changes are brought about, with the view of arriving at
a more successful method of treatment.
These appearances are not, however, by any means rare, indeed they
are very common. Rogée found that of one hundred aged persons, who
died at the Salpêtrière, there were fifty-one of this number who had
concretions and other traces of tubercular disease of the lungs. In five
of the cases he also found the cicatrices of the cavities which had healed;
and he states, that in the course of a single year, he had been able
to collect ten or twelve incontrovertible examples of the same kind.
“J'insiste sur ce fait de fréquence, car c'est là que git, à mes yeux, le
point capital, le cété nouveau de la question. Les médecins instruits
d’aujourd’hui ne nient guère qu'on ait vu quelquefois la phthisie guérir;
mais poureux cela tient du miracle tant c'est rare : ils n'osent jamais
l'espèrer. Puisse-je avoir réussi à convaincre que la guérison est assez
commune quand la maladie n'est pas fort avancée, et qu'on a droit de la
chercher avec espoir.” In 197 subjects, Boudet found ten with cavities
completely healed; and within one year, he also collected fourteen
cases of recovery from phthisis.
Dr. Hughes Bennett” also found in seventy-three bodies which
he examined, that there were concretions and puckerings in twenty-
eight. He also ascertained that these traces of the removal of tubercles
are most common in elderly persons; for, in the twenty-eight cases, he
found puckerings and concretions in only three individuals of the age
of eighteen, in six between that age and forty, and in nineteen after that
epoch of life. Dr. Stokes, when he published his work, was strongly
in favour of the view, that patients sometimes recovered from phthisis;
and he laid down the favourable indications, which he considered to
justify the medical man in attempting what he called the curative treat-
* Medico-Chirurg. Trans., vol. xx, 1837.
* Essai sur la Curabilité de la Phthisie pulmonaire, etc. Archives Générales de
Médecime, 1839,
8 BENNETT (J. Hughes, M.D.), Frequent and Spontaneous Cure of Pulmonary
Consumption. Edinburgh Med. and Surg. Journal, 1845.
BY JAMES TURNBULL, M.D. Ill
ment. Dr. Williams has also argued in support of the curability of
phthisis, and has stated that he found phthisical lesions in the lungs of
half the adults beyond the age of forty that he had examined, and that
nature resists the progress, and limits and circumscribes the extent of
the disease. I shall also have occasion to allude to the valuable facts
of a much stronger nature, which he has since published, in reference
to the efficacy of cod-liver oil.
These pathological observations are, as Louis has remarked, “as-
suredly of immense importance”, and they form a body of facts which
do not admit of being controverted. But it may be said, that the dis-
ease had in such cases been of only limited extent, and had not pre-
sented the ordinary symptoms, but been latent. A sufficient number
of cases have, however, now been accurately observed during their course,
and up to complete recovery, to disprove such a statement. Consump-
tion is a disease, the diagnosis of which is more difficult than that of
most others; and, though stethoscopic examination has assisted patholo-
gical investigations, more especially in demonstrating the occurrence of
recovery by the healing of cavities, yet we know that in the earliest stage,
when we have reason to suppose that tubercles admit most readily of being
removed, neither the symptoms nor the stethoscopic signs furnish us
always with undoubted evidence of their existence; and hence some
doubt must often hang over the precise nature of such cases. There
is reason therefore to believe, that much evidence of the curability of
Consumption, which we would possess, were it not for the difficulty of
diagnosis in the earliest period, is in this way entirely lost. The num-
ber of cases in which the cretaceous transformation of tubercles has been
found, so far exceeds those in which cicatrices have been discovered,
that this is proved not to be a mere speculative assumption; and we
can scarcely therefore avoid the conclusion, that many, who have suf-
fered to a moderate extent from cough and other pulmonary symptoms,
have really recovered from the early symptoms of consumption.
The limits of this paper prevent me from entering into an examina-
tion of the symptoms and physical signs of the early stage, for the purpose
of proving this more fully, and of showing what diseases we are apt to
confound with it. There are, however, one or two important points
which I shall briefly notice. The symptoms furnished directly by the
condition of the lungs themselves in phthisis, are, cough, expectoration
of different kinds of sputa, shortness of breath, pain, and hamoptysis,
Now all of these symptoms, with the exception of the last, derive their
value and signification entirely from their combination with other
symptoms, and with physical signs. It is otherwise, however, with
haemoptysis, which is alone the most certain of all the symptoms of
tubercle in the lungs, provided the patient has not received any injury
of the chest, is free from disease of the heart, and, if a female, is not
suffering from sudden suppression of menstruation. Yet it very often
happens that we see patients recover, and enjoy a fair share of health,
after having had cough and haemoptysis." Of the symptoms arising
from disorder of other functions than that of the lungs, the most
important are hectic fever, perspirations, emaciation, and diarrhoea.
* Louis, (P. C. A., M.D.) Researches on Phthisis, p. 169.
I 1.2 CURABILITY OF PULMONARY CONSUMPTION.
These also derive much of their value and signification from being com-
bined with some of the preceding. Perspirations are very rarely absent
during the course of this disease; and I believe that loss of flesh
always occurs, to a greater or less extent, when tubercles are in an
active state. We may observe, then, that cough of some standing,
night-sweats, and loss of flesh, constitute a group of symptoms which,
in the majority of cases, indicate the presence of tubercular disease; and,
if to these we can add haemoptysis, we combine those symptoms which
afford the most certain evidence of the presence of tubercular disease of
the lungs. -
Examination of the chest with the stethoscope has furnished the
counterpart of some of the proofs of the curability of Consumption,
which have been derived from pathology, more especially in reference
to the healing of cavities; and it often enables us to discover the disease,
long before it can be detected by symptoms alone. It is, however, a
well-ascertained fact, that tubercle must be deposited to a considerable
extent, before it can be discovered by the signs which it occasions
directly by its own presence, such as dulness; and it often happens that,
before it gives any decided evidence of its presence by producing con-
solidation, the local irritation it has excited may occasion crepitation, or
sibilant, or other rhonchi. Now it has been shown by Louis (see his ob-
servations on case 56), and others, that when these signs of bronchitis
or pneumonia are confined to the apex of one lung, they indicate, with
great certainty, the presence of tubercles. I have seen several cases, in
which the signs of bronchitis (sibilant and mucous rhonchi, with a scarcely
appreciable amount of dulness), were thus confined to the summit of one
lung, and where recovery took place. Such cases, I think, I have been
justified in regarding as recoveries from the early stage of phthisis.
If the facts and arguments which I have now advanced to prove the
curability of Consumption, have appeared wanting in sufficient founda-
tion, I would now refer, in confirmation of these views, to the valuable
statistical proofs furnished by the able Report of the Hospital for Con-
sumption.” The Report shows, as we might expect, that the most
favourable results have been obtained in the first stage; and of 187
cases in this stage, it appears that seventy-five, or nearly one half, were
much relieved. In eighteen cases, or more than ten per cent, the
disease was arrested; and the term arrest is defined as implying that
all, or nearly all, the symptoms of the disease had disappeared, the
patients feeling themselves well, and being able to pursue their ordi-
nary occupations. The report also states, that in some of these, the
evidence of local mischief had greatly diminished, and in a few had dis-
appeared; such patients being, in fact, scarcely in a worse position than
they were before the attack. Of fifty-three cases in the second stage,
the disease was arrested in two. Of 295 cases in the third stage, it
was arrested in ten cases. The Report observes: “Viewing these re-
sults collectively, without reference to age or sex, we find that benefit
is conferred in 36 per cent. of the cases, material relief in nearly 25 per
cent.; in nearly 6 per cent, the disease is arrested; and here it should be
borne in mind, that the delay which occurs in the admission of patients,
* First Medical Report of the Hospital for Consumption, 1849. An analysis of
this Report was given at page 37 of our last number. .
BY.JAMES TURNBULL, M.D. 113.
in consequence of the want of accommodation for the numbers who
apply, allows the disease to advance, and thus renders the treatment.
more difficult and less successful than it would otherwise have been.
Still, under such unfavourable circumstances, it is satisfactory to find,
that in nearly 6 per cent. of the cases of this disease, considered by
many to be beyond the reach of treatment, a result has been obtained,
which a desire not to speak too confidently alone forbids to designate
as cure.” When I speak of treatment, I shall have occasion to show
that still more favourable results were obtained in those cases where
cod-liver oil was used; but the facts advanced in the preceding inquiry,
and the statistical proofs now adduced, justify me in stating, that a close
examination of this disease proves that it is not, as has been generally
believed, utterly hopeless and incurable—a view which would paralyse
all our efforts at treatment. Whilst, therefore, “we must pause, ere we
in future pass the terrible sentence of no hope on the consumptive in-
valid”,” it becomes also our duty to redouble our efforts to save such
patients.
- ANTAGONISTIC DISEASES.
The investigation of the favourable circumstances under which spon-
taneous recovery takes place, has scarcely received the attention it
deserves.” There are, however, a few facts in reference to antagonistic
diseases, which bear upon this point, and to which I must allude before
entering upon the treatment. r
Emphysema of the lungs is a disease which undoubtedly tends to
prevent the development of tubercles, and a moderate degree of it must
therefore favour recovery from Consumption. I have seen some cases
which have convinced me of this; and the researches of Rokitansky and
Hasse confirm what I have observed. • .
A gentleman, aged 38, who was of rather weak constitution, and had
suffered slightly for a considerable time from cough and shortness of
breath, became much worse in the end of September 1847, and soon
after consulted me, with the usual symptoms of Consumption. He had
very troublesome cough, with muco-purulent expectoration. He had
become very thin and weak, and had also profuse perspirations at night;
and to these symptoms was afterwards added haemoptysis. There was
increased clearness of sound on percussion; but this affecting the summit
of the lungs chiefly, rendered it difficult to ascertain, by physical exa-
mination, to what extent tubercles might be deposited, though the
symptoms left no doubt as to their presence. He had persistent pain
in the left side of the chest, rather low down, and just below the level of
the left nipple; where there were, while the spitting of blood lasted, a few
bubbles of mucous rhonchus, indicating that this was the seat of the dis-
ease. Having observed the antagonistic effect of emphysema in other
cases, I ventured, notwithstanding the apparently hopeless character of
the symptoms to hold out some prospect of recovery. The spitting of
blood was stopped by means of turpentine ; and counter-irritation, by
croton-oil limiment, and the use of sedatives, with expectorants, relieved
* WILLIAMS (C. J., B., M.D.) Cod-liver Oil in Consumption. LONDON JOURNAL
OF MEDICINE, January 1849. - - .
* BACON. “Homo naturae minister et interpres tantum facit et intelligit quan-
tum de naturae ordine revel mente observaverit, nec amplius scit-aut potest.”
114 CURABILITY OF PULMONARY CONSUMPTION.
the cough and difficulty of breathing, so that he was enabled to go to the
country for change of air, and to take tonics. He returned in Decem-
ber, much improved; and though he has seldom been long free from
cough altogether, yet he has enjoyed a fair share of health, considering
that he has emphysema of the lungs, along with tubercles. He had
some return of haemoptysis at the beginning of this winter, after which
he took cod-liver oil with much benefit.
In this case, I have no doubt that emphysema was a chief cause of
preventing, and still continues to repress, the progress of the tuber-
cular disease. I had also in the two following cases, where the patients
died of another disease—inflammation of the lungs—an opportunity of
observing the power of the same cause in retarding the advance of
tubercular disease.
A seaman, ag
into the Northern Hospital, in a very advanced stage of inflammation
of the lungs. It was ascertained that the acute attack was of recent
occurrence, but that he had suffered from cough, more or less, for two
years. He died the same evening; and, on examination, it was found
that both lungs were emphysematous. The upper part of the left lung
was highly so, and it was also very much puckered from an old cicatrix.
Within this part a cavity was found, which was completely lined with a
false membrane, and in progress of healing. Around this, and in other
parts of the lung, there were tubercles, which seemed to have been
deposited at different times, as some of them were small miliary tuber-
cles, and others larger and hard, as if undergoing cretaceous transform-
ation. The right lung was inflamed throughout; and, at the lower part,
it was in a state of purulent infiltration, and at the summit, in a state
of red hepatization. There were some tubercles in this lung also, and
at the apex, a cavity lined with false membrane. The disease was
evidently not in a progressive state in this case ; this being proved by
the dryness and hardness of the tubercles, one of which was as large as
a nut, and by the lining of the cavities by a well-organized membrane.
Nature was therefore evidently making an effort to repair the ravages
of the disease; and we have seen that this coincided with a great amount
of emphysema. -
A man, aged 26, was admitted into the Infirmary last September, in
a similarly advanced stage of pneumonia. On examination, it was found
that there was intense bronchitis and lobular pneumonia affecting both
lungs. There were tubercles in both lungs, and much emphysema. At
the apex of the left, a cavity of considerable size was found, lined by a
fine membrane, like that of the bronchial tubes, and there were two
others, lined with a thick white membrane of a soft texture. The
tubercular disease was evidently making but slow progress in this case
also. (See also Laennec, Emphysema, Obs. VIII.)
Hasse observes, that “those much in the habit of examining the dead
body, cannot but be struck with two circumstances: first, the almost
invariable existence of emphysema in lungs which bear the character-
istic marks of recovery from phthisis; and, secondly, the proportional
rareness of tubercular deposits in emphysematous lungs. This would
seem to show, that dilatation of the air-cells constitutes one of the con-
ditions, under which the cure of phthisis is possible; and, again, that
ged 40, of muscular frame, was admitted under my care
BY JAMES TURNBULL, M.D. 115
it forms an obstacle to the development and progress of tubercle.”
Rokitansky thinks that emphysema hinders the formation of tubercle,
by inducing a state of venosity of the blood, in which it is imperfectly
arterialized, and wanting in fibrin. To the same cause he attributes
the rare occurrence of tubercle in those cases of disease of the heart
and arteries which prevent the proper arterialization of the blood. His
observations on the connexion of tubercle with other morbid states are
of the deepest interest; and, if his explanation of the effect of emphy-
sema and disease of the heart, in repressing the deposition of tubercle,
were correct, we should see an object which we might seek directly to
attain in treating tubercular diseases. I am, however, disposed to
think that emphysema may have merely a local effect in preventing the
formation of tubercle; for the quantity of blood circulating in the capil-
laries of an emphysematous portion of lung is much diminished, and
hence we find that pneumonia is less apt to attack such parts. We have
already alluded to Dr. C.J. B.Williams's opinion, that an undue flow or
accumulation of blood, from congestion or inflammation, will hasten the
maturation of tubercles, by exalting chemical affinities; while, on the
other hand, they manifest little disposition to change, so long as they
are kept free from superfluous moisture. In this way, emphysema may
prevent their progress, by lessening the quantity of blood in the capil-
laries ; and it is also worthy of observation, as supporting this view,
that in some cases of phthisis, where the function of one lung has been
arrested by perforation, the progress of the disease has (where the patient
has recovered from the immediate effects of the accident) been for a
considerable time arrested. Of this, some examples have been given by
Dr. Stokes. If Rokitansky's view of the venosity of the blood retarding
the advance of tubercles were correct, we should find the progress of
the disease equally repressed in both lungs; but I believe that this
occurs chiefly in that lung, the function of which is arrested; and indeed,
if this were the true explanation, then tubercular deposition in the lungs,
by impeding respiration, and thus causing a more venous state of the
blood, should tend to arrest its own development.
The arrest of the development of tubercular disease of the lungs
during pregnancy, is an important fact, and there are few medical men
who have not had opportunities of observing it. About two years ago,
I had under my care a young female, advanced towards the fourth
month of pregnancy, in whom one lung was destroyed to nearly half its
extent by cavities. She had obstinate diarrhoea, and was reduced to
the last stage of emaciation and debility. Yet, as soon as she was made
aware of being pregnant, it had such a cheering effect upon her, that
she speedily began to recover, believing that all her illness arose from
that cause ; and thus the disease was arrested for a time. Rokitansky's
mode of accounting for the antagonistic effect of pregnancy in Consump-
tion, by referring it to the venosity of the blood, induced by the enlarge-
ment of the abdomen interfering with respiration, is too mechanical an
explanation, and not at all satisfactory, as it is by no means proved that
the blood is imperfectly arterialized during pregnancy. The demand
for an increased supply of blood for the uterus and its contents, is a
*HASSE (C. E., M.D.) Anatomical Description of the Diseases of the Organs of
Circulation and Respiration. Translated by W. E. Swaine, M.D. Sydenham So-
ciety. 1846. p. 313.
T 16. CURABILITY OF PULMONARY CONSUMPTION.
much more important change, through which we may endeavour to ex-
plain the arrest of the tubercular disease. It is a fact, that the blood,
instead of becoming more venous, contains an augmented proportion of
fibrin; and the growth of the foetus seems not only to require this, but,
by attracting it to itself from the lungs, to arrest the morbid process of
nutrition in these organs.
There are some other diseases which are believed to be antagonistic
to phthisis. Thus, Consumption is not common in situations where
ague prevails. Rokitansky also thinks that bronchocele and rachitis
prevent tubercular disease of the lungs.
TREATMENT OF CONSUMIPTION.
The limits of this paper prevent me from entering into any extended
observations on the treatment of this disease; and, as my chief object
has been to prove that persons more frequently recover from Consump-
tion than has been generally supposed, I shall confine my remarks, as
much as possible, to an examination of those means which have been
thought to have some power in promoting the absorption of tubercle,
and I shall speak more particularly of the efficacy of cod-liver oil.
There are, however, a few important indications which I shall first
notice as briefly as possible.
Whatever may be the condition of the blood and of the capillary
vessels, which determines the exudation or secretion of tubercular mat-
ter, there cannot be any doubt that debilitating causes, such as innutri-
tious food, deficient exercise, and impure air, have a powerful influence
in producing this disease. The researches which have been made in
the present day in chemistry and physiology, have tended more and
more to prove the connexion between deranged assimilation and many
diseases; and in struma, Dr. Prout has observed that all the assimilating
processes are at fault, but chiefly those which take place between the duo-
denum and the circulating system, and by which the chyle is converted
into blood. It is also well worthy of notice, that tubercles may be pro-
duced in some of the lower animals by confining them in damp places,
and feeding them on unwholesome food. This was done with rabbits by
Drs. Baron and Jemmer," and by Dr. Carswell; and it is a fact of some
importance, as well in reference to the curability of tubercular diseases
by absorption, as in showing the power of good alimentation, that the
tubercular disease has been removed by feeding them afterwards on more
nutritious food. In some kinds of insects, too, it has been found that a
tubercular deposit may be produced by feeding them on bad food, and re-
peatedly plunging them in cold water. The same influences operate on
man; for Dr. Baly” has shown, that mental depression and confinement
cause a remarkable increase in the mortality among the inmates of pri-
sons, and that this is chiefly produced by Consumption and scrofula.
Such facts show us the importance of hygienic means of treatment; and,
viewed in connexion with the power of cod-liver oil in promoting the
assimilation of the food, they prove to us forcibly the necessity of
bringing the digestive organs into as healthy a state as possible, in
order to effect the most perfect assimilation of light nutritious articles
of diet.
* BARON on Tubercular Diseases. * Medico-Chirurg. Trans. vol. xxviii, 1845.
BY JAMES TURNBULL, M.D. 117
We have already shown, that inflammation and tubercular deposition
are allied processes; and the effect of local irritation, in producing Pul-
monary Consumption, is exemplified in the frequency of the disease in
persons whose occupations cause them to inhale silicious or metallic
particles; and I have no doubt that the fact, noticed by Phillips, of
Consumption being most prevalent in towns, and scrofula less so, while
the reverse occurs in the country, arises, not, as he supposes, from any
difference between these diseases, but, in a great measure, from the inha-
lation of particles of dust and smoke determining the deposition of tuber-
cular matter in the lungs instead of the external parts. In all our efforts to
cause the absorption of tubercles, it must, therefore, be amatter of primary
importance to prevent irritation, and to remove inflammation or conges.
tion of the lungs by the usual means—local depletion, and counter-irri-
tation more especially. The action of all the depurating organs which
purify the blood by removing from it the products of the worn-out
tissues, should be promoted by the appropriate means; and, with the
view of preventing catarrhal irritation at the earliest period, I believe
that there is no means so effectual as washing the whole surface with
tepid or cold salt and water, followed by friction, which excites the de-
purating function of the skin, fortifies it against the impression of cold,
and acts as a general tonic.
The condition of the blood, as ascertained by Andral, and subse-
quently by Becquerel and Rodier, furnishes another important indication
in the treatment of phthisis, and one which has been found practically
useful. In the earliest stage, and perhaps in some cases also before
the formation of tubercles, the proportion of globules is below the
healthy standard: as the disease progresses the quantity falls; and in
one case, Andral found the proportion as low as 72 parts in 1000 of
blood. In this respect, Consumption bears a resemblance to chlorosis,
and in the diminution of the red globules, we have, in the one disease
as well as the other, an indication for the employment of chalybeate
tonics. I may here observe that, though we have this diminution of
the red globules, we are seldom able to discover a loud continuous mur-
mur in the veins of the neck, which is so common a sign in chlorosis;
This difference I account for, from there being in chlorosis not simply
a diminution of the red globules, but also an increase of the aqueous
part of the blood. The veins are thus kept in a state of tension, which
is favourable to the production of the venous murmur. In Consump-
tion, on the other hand, especially when the disease is in an active
state, there is a diminution not merely of the globules, but of the
whole quantity of blood in the system, which, with the relaxed state of
the tissues arising from loss of flesh, prevent the degree of venous
tension necessary for the full development of this murmur. When,
however, the tubercular disease has become quiescent or has receded, I
have sometimes observed the occurrence of a continuous murmur in cases
where it had at first been absent; and this I have considered a favour-
able sign.
In the preceding part of the paper, we have endeavoured to show
that there are three ways in which recovery from Consumption may
take place; first, by the shrivelling of miliary tubercles; secondly, by
the transformation of crude yellow tubercles into cretaceous or cal-
118 CURABILITY OF PULMONARY consumpTION.
careous concretions; thirdly, by the healing of cavities. We have now,
fourthly, to show that the results of treatment seem to prove that
tubercles may be removed by absorption. We cannot, however, have
ocular proof of this, and hence there has been doubt as to the possibi-
lity of the removal of tubercles in this way; but the facts I have still to
adduce will tend still further to remove any doubt on this point.
The remedies which, I think, have most claim to our attention as
agents capable of promoting changes in tubercular matter, are mercury,
iodine, the alkalis, and cod liver oil.
As mercury is unquestionably the most powerful remedy we possess,
for promoting absorption of the serous and fibrinous exudations of
acute inflammation, we would naturally expect that it should have some
power in causing absorption of tuberculous deposits; but it would seem
that in proportion as they recede from and lose the characters of plastic
organizable fibrin, they are less under the sorbefacient influence of this
remedy; and in ordinary cases of Consumption, not distinctly produced
by acute inflammation, mercury, though occasionally useful as an altera-
tive, to promote the biliary and other secretions, is injurious when given
so as to act upon the constitution—producing a debilitating effect, and
hastening the softening of tubercles. In cases of chronic pneumonia,
which hold an intermediate place between pneumonia and phthisis, I
have employed the remedy in the latter way; and, if we had reason to be-
lieve that miliary tubercles existed in an early stage, Ithink we might be
justified in using this remedy, with the view of promoting the mode of
transformation described by Rokitansky. The local application of mer-
cury is a powerful means of causing the absorption of indurated swellings,
as, for example, of the joints; and, as we are now able in many cases to
arrest the constitutionaldisease in Consumption, it becomes us to use every
means likely to assist in the removal of the local disease also; and none
appears likely to be of more service than mercurial inunction. Dr. C. J.B.
Williams says, that he has successfully treated several cases, in which
the signs and symptoms left him in no doubt as to the existence of
tuberculous peritonitis, by ointment of iodide of mercury to the abdo-
men, together with iodide of potassium internally. -
The preparations of iodine have some resemblance to mercury in their
effects, but, unlike this remedy, they are not of any service in acute dis-
ease, but are more useful in causing the absorption of tubercular deposits,
especially in glandular structures. The syrup of the iodide of iron is
the preparation I have most frequently used, as it combines the absorb-
ent properties of iodine with the tonic power of iron, and thus fulfils
the indication in reference to the diminution of the globules of the
blood. I regard it as one of the best tonics we can use in the early stage
of the disease, and I think that I have seen the early symptoms of
phthisis arrested by it in a few cases. It was, during last summer, the
chief means of restoring to health a young gentleman, who, in addition
to cough, and loss of flesh and strength, presented the signs of incipient
tubercular deposit at the summit of the left lung—very slight dulness
with some sibilant rhonchus. I prescribed it with very good effect in the
case of a lady about thirty years of age, who came from Some distance
in the country to consult me, in July 1847. She had become thin and
very liable to colds, and had some mucous expectoration. She had also
BY JAMES TURNBULL, M.D. 119
had an attack of spitting of blood three years previous. Some consolid-
ation at the upper part of the right lung was indicated by slight but dis-
tinct dulness on percussion close to the sternum, and increased loudness
of the cough and voice in the same spot; but there were no mucous or
other rhonchi. She wished to remove to the South of England; but as
the disease did not seem in an active state, I recommended hygienic
means of treatment, to improve the general health. I also ordered
syrup of the iodide of iron, with tincture of hyoscyamus in infusion of
calumba, and inunction of iodide of lead ointment below the right
clavicle. When I again saw her, five or six weeks after, I found her
improved in health; and the signs of consolidation appeared, both to her
ordinary medical man and myself, to have diminished considerably.
She has since then enjoyed pretty good health, and has had two chil-
dren, but during last pregnancy there was some return of haemoptysis.
After this, she took cod-liver oil for a considerable time, with benefit.
The iodide of lead ointment I have used in other cases besides this,
with the view of causing absorption of tubercular deposits in the lungs,
on the same principle on which we use it in scrofulous glandular swell-
ings. I think it better suited to produce such an effect than the appli-
eation of a concentrated tincture of iodine, which is a powerful counter-
irritant, and, as such, has been found “remarkably beneficial” at the
Hospital for Consumption.
Before the introduction of iodine, the alkalis were regarded as reme.
dies of considerable absorbent power. Liquor potassae is a powerful
alterative medicine, and it has sometimes been found to cause absorp-
tion of an enlarged gland even after iodine has failed. Dr. Campbell
recommended it very strongly in phthisis; and Sir J. Clarke has ob-
served, that the alkalis increase the urinary, and appear to promote the
bilious secretion, and to render that of the mucous membranes more
fluid : in whatever way they operate, they are certainly beneficial in
many tuberculous affections." Their power of promoting absorption of
the lymph and other exudation products of inflammation of the lungs
or pleura, especially when combined with iodine, is a fact of acknow-
ledged practical value. Dr. Golding Bird” has communicated some
most interesting and useful information as to the action of alkaline
remedies; he calls them depurating or chemical diuretics, and has
shown that, unlike most diuretics, they increase not only the fluid, but
also the solid parts of the urine. This they do by a chemical action on
the exhausted and worn-out tissues; and he thinks that parts of low
vitality, such as tubercle, will be most readily acted on by these che-
mical agents. It is also worthy of notice, that the caustic alkalis are the
most powerful solvents of tubercle ; and it is therefore reasonable to
suppose that they will retain a portion of that power, when circulating
with the blood in the capillaries.
Cod-liver oil has been known as a remedy for Consumption and
scrofula in Germany and the north of Europe for a considerable period,
and Dr. Hughes Bennett has the merit of having brought it into notice in
this country. Of the three kinds of oil, the pale, the light brown, and the
* Treatise on Pulmonary Consumption.
* Lectures on the Influence of Researches in Organic Chemistry on Therapeutics.
* Treatise on the Oleum Jecoris Aselli. 1841.
120 CURABILITY OF PULMONARY CONSUM PTION.
brown, it has been thought in Germany that the darkest coloured is the
most useful; and this opinion was supported by Dr. Bennett, and is
still maintained by Dr. De Jongh. It seems, however, to be now suffi-
ciently well ascertained, that the brown has no superiority over the pale
oil. I have seen the best effects speedily produced by the purest spe-
cimens of pale oil. Dr. Williams used the pale oil prepared according
to Donovan's method; and in the report of the Hospital for Consump-
tion, it is stated that “ different qualities of oil, have been tried without
exhibiting any marked difference in the remedial effects; but the
offensiveness of some of the darker kinds renders their general use
impracticable.”
The power of this remedy in controlling the progress of phthisis in
a large proportion of cases, and even of arresting its progress in not a
few, has now been completely established; and the Hospital for Con-
sumption has even furnished us with statistical facts as to the results of
treatment in each stage of the disease.
In Dr. Bennett's work, we are furnished with three cases, fully
detailed, of decided Consumption, where recovery took place under the
use of this remedy. In the appendix to the last edition, he says: “I
have succeeded, in several cases, in ascertaining that the caverns have
completely healed up, every symptom and physical sign indicating their
presence has disappeared, and there has remained only slight dulness
on percussion, and increased vocal resonance, as a proof of the puckering
and induration of the pulmonary parenchyma attendant on the cicatrix.”
In proof of this statement, he relates two other cases. The most favour-
able account that has yet been given of the efficacy of cod-liver oil, is that
published in this Journal by Dr. C.J. B.Williams, who states that of 234
cases of which he kept a record, there were no fewer than 206 in which
its use was followed by marked and unequivocal improvement. The most
numerous examples of decided and lasting improvement occurred in
those cases in the second stage, where the tubercular matter was begin-
ning to soften. He has given a full account of eleven cases in the
third stage, the results of which may be stated as follows. In one case,
a cavity seemed to have healed completely; in five, all the symptoms
were removed and recovery took place, but dry cavities remained in the
lungs; in one, it seemed probable that the restoration was even more
complete; in one case, that of a child, recovery took place, but the
existence of phthisis was somewhat doubtful; in one, the advance of the
disease was stayed; in one, the patient recovered so far as to marry,
but relapsed; and in one, after temporary recovery, the patient died.
From the report of the Hospital for Consumption, it appears, that
this remedy has been productive of more good in the treatment of
phthisis than any agent yet employed; and the results furnished by a
table of 542 cases in which it was given, are highly interesting. The
collective results in all the stages show, that in 63 percent. the symptoms
improved; in 18 per cent, the disease was arrested; and in 19 per
cent, only, it went on unchecked. The report observes, that when it is
recollected that of the whole number treated at the Hospital, the
disease was arrested in only 5 per cent., the value of this remedy,
under which the disease was arrested in 18 per cent, must be consi-
dered very great. Dr. Williams speaks most favourably of the oil in
BY JAMES TURNBULL, M.D. 121
the second and third stages, observing that, though not less satisfactory
in the first than in these, it is slower in its action. This report, how-
ever, establishes the fact which we might naturally expect—that the
greatest number of cases are arrested in the first stage. In nearly 18 per
cent. of the males, and in 28 of the females, in the first stage, the
disease was arrested; that is, in 293 cases of both sexes, it was arrested
in 23 per cent. It was arrested in 14 per cent. of the cases of both
sexes in the second and third stages.
What I have seen in my own practice fully confirms these state-
ments; and in two of the cases which follow, II and III, the symptoms
and physical signs showed as hopeless a condition as in any cases of
Consumption I have ever seen, and indicated a speedily fatal termina-
tion, which, I am persuaded, nothing that we are yet acquainted with,
except this remedy, could have averted.
Cod-liver oil has been called a tonic remedy, which it undoubtedly is;
but it differs from other tonics, and indeed from most other remedies
we are in the habit of giving in this disease, in one important respect,
—that we may use it with advantage in every stage, and that there is
scarcely any symptom which contra-indicates its employment. In
general. the appetite speedily improves, the cough abates, the hectic
fever diminishes, and the perspirations are arrested. The patient at the
same time improves in colour, and gains strength and flesh. There are
very few cases in which the pale oil cannot be taken ; and if we begin
with a tea or dessert spoonful, and gradually increase it to an ounce
thrice a day, on the surface of peppermint water or milk, there are few
persons who do not take it with facility, and become reconciled to it.
When it causes nausea, naphtha or hydrocyanic acid will usually remove
this symptom. We must not, however, trust exclusively to this remedy,
but must give due attention to those general indications for treatment
which have been pointed out. We should also remove any urgent
symptoms, such as cough, by a sedative; and morphia is one of the best,
given either in simple oxymel, or oxymel Scillae, where an expectorant
is required. Local inflammatory action must also be removed by the
usual means. Unless we are thus careful in removing prominent symp-
toms, and in bringing the digestive organs into a healthy state, so that
the oil may be assimilated, we may fail in deriving from the remedy
the benefit which it is capable of producing underjudicious management.
The following cases will illustrate these and some other points bearing
upon the treatment.
CASE I. First Stage. Removal of the Tubercular Deposit by Absorption.
Thomas Daly, aged 18, a sailor, was admitted into the Infirmary under
my care, on the 1st of October 1849. He had suffered from cough
three months previous, but recovered until seventeen days before admis-
sion, when he was seized with cough and pain in the left side of the
chest. He was pale, emaciated, and weak. His breath was very short,
and he had sometrifling expectoration, but never had haemoptysis. The
sound, on percussion of both clavicles, was less clear than natural, and
below the left clavicle it was decidedly dull. Close to the sternum, and
an inch and a half below the clavicle, it had somewhat of the sound eli-
cited from the trachea. In the same spot the respiration was blowing,
WOL. II.
122 CURABILITY OF PULMONARY CONSUMPTION.
and I was at first disposed to think that there might be a cavity; but
the absence of gurgling and of purulent expectoration, showed that it
was caused by tubercular deposit near the bronchus. There were no
rhonchi on either side of the chest; but below the left clavicle the respir-
ation was harsh or bronchial, and the resonance of the voice and cough
very loud. Blisters were applied to remove the pain in the left side ;
and he took an ounce of cod liver oil thrice a day. He improved
rapidly; and on the 22nd, he had got fatter and stronger, though he was
pale and still had cough. Some dry crackling was now heard below
the left clavicle. On the 29th, this could no longer be heard, but respi-
ration was interrupted in the same situation. It was observed, however,
that the dulness and bronchial character of the respiration had some-
what lessened. He was now ordered to rub in the iodide of lead oint-
ment upon the upper part of the chest. On the 8th November, he had
become quite fat and much stronger, but was still pale. A continuous
murmur was audible in the veins of the neck. He still had shortness
of breath on ascending the stairs; but the dulness and bronchial respi-
ration had very decidedly diminished, and, in fact, were scarcely per-
ceptible. With the view of increasing the red globules of the blood,
the want of which seemed now to be as much the cause of the shortness
of breath as the affection of the lungs, he was ordered to take twenty
minims of the syrup of the iodide of iron, thrice a day, in place of the
oil. On the 20th, he had not only grown fat, but had also acquired so
healthy an appearance, that he would scarcely have been taken for an
invalid. He still, however, had some pain below the cartilages of the
false ribs on the left side, for which he was blistered. He remained in
the hospital, and continued the syrup of iodide of iron, till the 14th
December, when the presence of tubercular disease of the lungs could
Scarcely have been pronounced, with certainty, by any one who had not
previously seen him.
REMARKs. The crackling heard in this case would seem to show that
softening was just begining to take place. The removal of the consoli-
dation was chiefly due to the oil; but there can be no doubt that it was
also promoted by the inunction with iodide of lead, and by the iodide
of iron. I have at present, under my care, a young man in whom the
deposit is undergoing equally rapid absorption under the use of the oil,
assisted by inunction with iodide of mercury ointment.
CASE II.” Third stage, far advanced ; abscess of lung pointing ea:-
ternally. A ship carpenter, aged 36, was admitted under my care in
the Northern Hospital, on December 6th, 1848. More than twelve
months previous, he had been attacked with spitting of blood, and other
pulmonary symptoms which had never entirely left him. He was much
emaciated, and had profuse perspirations; he expectorated large quanti-
ties of puriform secretion of an offensive odour; and, when he coughed,
his breath was insupportably offensive, scarcely less so than in cases of
gangrene. . The left lung was extensively diseased. There was a great
amount of dulness, extending from the clavicle into the mammary region.
There was the gurgling of a large cavity below the left nipple. Below
the clavicle, there was the gurgling of smaller cavities, as well as the
* Condensed from notes, for which I am indebted to Mr. Wall, the House-surgeon.
BY JAMES TURNBULL, M.D. 123
subcrepitant rhonchus, indicating extensive softening of tubercular mat-
ter. There were no decided indications of disease in the other lung. He
was treated with mild mercurial aperients, and a sedative mixture
for the cough; and as he had much pain in his left side, a blister was
applied. On the 11th, cod liver oil was prescribed. Below the left
nipple, where the large cavity was found, a fluctuating tumour formed,
and was opened on the 14th. When he coughed, air was expelled along
with matter, showing that the abscess communicated with the lung.
He continued taking the oil till the 23rd, when he was somewhat better;
but as it caused nausea it was omitted, and he took a mixture composed
of creasote, oxymel of squills, and compound tincture of camphor, with
great benefit; the abundant purulent expectoration being much lessened
by it. On the 1st January, the cod liver oil was resumed, in two drachm
doses; and in a fortnight from that time, he had improved in a remark-
able manner, he had gained flesh, and considered himself half-a-stone
heavier. His countenance had assumed a cheerful and more healthy
appearance, and his skin had become soft and smooth. Though he had
Some return of the pain, in the side, and the abscess was opened more
than once, he continued to improve steadily after recommencing the oil.
On the 4th of February, he had every appearance of health; the abscess
had all but healed, his appetite was good, and the expectoration had
almost ceased. There was considerable contraction of the left side of
the chest, and a great amount of dulness. The lung had been exten-
sively excavated; but the progress of the disease was now arrested, and
instead of the gurgling and rhonchiindicating the passing of air through
muco-purulent fluid, there was heard the dry blowing of air passing into
empty cavities. On the 16th February, he considered himself capable
of following his employment, and left the hospital to go to New York.
CASE III. Third stage, far advanced. Mr. W., aged 35, was seen by
me, on the 2nd of February 1849, in consultation with Mr. Atcherley.
The patient had been intemperate in his habits, and dated his illness
from about the preceding Christmas. He was much emaciated, and had
violent hectic fever. The pulse was above 120, and the perspirations
were unusually profuse, continuing during the day as well as the night.
He had no appetite, and the tongue was much loaded, but there was no
diarrhoea. He was confined to bed, and had considerable oedematous
swelling of the ankles—a symptom indicating great debility and an ad-
vanced stage of the disease. The cough was unusually violent and
troublesome, and the expectoration was brought up with difficulty, and
was of a tenacious muco-purulent character. The physical signs showed
that the right lung was sound, but the left was extensively diseased.
There was a great degree of dulness at the upper part, before and be-
hind, and the gurgling and other signs of a cavity were heard in both
situations. Over every other part of the lung, mucous and subcrepitant
rhonchi, mixed with sibilant, indicated that extensive softening of tuber-
cular matter was going forward. We resolved to make trial of cod liver
oil, though we had little expectation of benefit in a case apparently so
hopeless. Counter-irritation, with croton oil, was adopted, the diet was
regulated, small doses of mercury with chalk and rhubarb were given,
and an attempt was made to stop the perspirations with sulphuric acid.
Sedative expectorants were at the same time given, to relieve hº cough.
* 9
124 CURATBILITY OF PUI MONARY CONSUMPTION.
These means were, however, of but little service beyond preparing him
for the use of cod liver oil, which he began to take on the 9th February.
In a short time he began to recover; and some months after, Mr.
Atcherley informed me that he had got stout and well. About the
beginning of July, I had again an opportunity of examining him. He
had then, for a long time, ceased taking any oil, but was still so stout
that I could not have known him. He had at that time a slight return
of cough, but had been nearly free from cough or expectoration, until a
few days previous. The upper part of the left side of the chest was
still dull on percussion, though less so than when I first saw him. Respi-
ration was harsh and blowing, with some sibilant rhonchus, but there was
none of the gurgling cavernous rhonchus; and towards the lower part of
the lung, the breath sound was natural. The habits of this patient
---- have been so intemperate, that he has not given himself a fair chance of
recovery; and when I lately saw him, I did not find that any farther
progress towards reparation of the local disease had been made.
CASE IV. Third Stage. Thomas Alpen, aged 40, was admitted into
the Infirmary, on the 21st of June 1849. He had been a soldier more
than twenty years, during which he had been ten years in the Mediter-
ranean, three in the West, and four in the East Indies. Three months
previous he had been much exposed to wet and cold, in enforcing the
collection of rates in Ireland; and this brought on cough and other symp-
toms of Consumption, on account of which he was discharged from the
service as incurable. He was much emaciated, and his whole appear-
ance indicated phthisis. He had hot skin, profuse night perspirations,
and abundant purulent expectoration. He had diarrhoea, the tongue
was red at the tip and centre, and he had lost his appetite and strength.
The physical signs were equally well marked. On percussion, the
sound was very dull below the right clavicle. In this situation, there
was cavernous respiration, mixed with loud gurgling, arising either from
a large cavity, or from several communicating. He took cod-liver oil,
in addition to some mixture, to relieve the cough, and improved very
speedily under this treatment. On the 9th July, he had gained flesh,
and improved in appearance. He had no night sweats, and very little
cough or expectoration. The bowels continued rather loose, and the
tongue reddish at the centre, but in all other respects he was better.
There was loud blowing cavernous respiration, but no movement of
fluid in the cavity could now be heard, except when he coughed vio-
lently. On the 17th, some astringent mixture was given to check the
diarrhoea, and after its removal he improved most rapidly. On the 5th
August he looked so stout and healthy, that no one, from his appear-
ance, could have supposed that he had a cavity in the lung, or that he
was ill at all. His appetite was good, his tongue clean, his pulse 88,
his skin cool, his complexion healthy, respiration easy, no night sweats,
scarcely any cough, expectoration scanty and no longer purulent, but
consisting of only a greenish-yellow mucus. There was still dulness
below the right clavicle, and considerable depression, with dry blowing
respiration, and other signs of an empty cavity tending to collapse.
The patient felt so well, that he did not wish to remain longer in the
Infirmary.
I am prevented, by the length to which this paper has extended beyond
BY JAMIS TURNBULL, M.D. 125
what I had anticipated, from relating other cases, in which equally good
effects followed the employment of cod-liver oil. I have also at present
under my care several very interesting cases, to one of which I may briefly
allude, as I have satisfied myself of the healing of a cavity. The
patient has been several months under my care, and has been ill nearly a
year, with frequent attacks of spitting of blood. He has had dulness
and signs of consolidation of the middle and lower part of the right
lung, and those of a cavity towards the lower part laterally. The ex-
pectoration has been abundant, purulent, and fetid. The situation
might cause some doubt of the cavity being tubercular; but the symp-
toms and progress of the case cause me to regard it as such. He has
been treated according to the varying symptoms; the chief means used
being counter-irritation, iodide of iron, and cod-liver oil. The latter dis-
agreed at first ; but after several trials it was borne by the stomach, and
seemed to be digested, the patient observing, that it no longer “rose on
his stomach.” Since then, the dulness has diminished, the cough has
nearly ceased, the expectoration has stopped, and the signs of a cavity,
and of mucous or purulent secretion in its vicinity, have disappeared;
while the patient has at the same time become stronger and stouter.
It will naturally be inquired, how far recovery is permanent, in cases
where cod liver oil has been used with benefit. The question admits
of being answered now; but it will be more fully and satisfactorily re-
plied to, when we have had further experience of the remedy. We
have shown that, before its introduction, pathological researches and
stethoscopic examination had united in proving that recovery not un-
frequently occurred in cases of tubercular disease of the lungs, and was so
permanent that the patients afterwards died of other diseases. And I
see no reason why it should be otherwise, in cases where the disease is
arrested by treatment, than in those where it is arrested spontaneously,
except that in the former it may often be more extensive. I have, there-
fore, no doubt that when the disease is arrested at an early period, the
cure may often be rendered permanent; and it has been ascertained by
different observers, that it is often so, and even in a few of the more ad-
vanced cases. The report of the Hospital for Consumption assumes very
properly that, as in some cases under observation the improvement is
permanent, it must also be so in many that have not returned.
Consumption will, however, necessarily continue a more or less fatal
disease; but the treatment is open to much improvement, and I believe
that the close attention which is now being devoted to it, will enable
medical men to accumulate proofs of its permanent curability in an en-
couraging number of cases.
4, Mornington Terrace, Liverpool,
January 1850.
126
CASE OF ANEURISMAL VARIX IN A STUMP, AFTER
AMPUTATION AT THE ANKLE JOINT
By WILLIAM CADGE, Esq., F.R.C.S.Eng., Demonstrator of Anatomy in
University College, London.
THE following case is worthy of record, less as a pathological rarity,
than on account of the clinical instruction it affords.
The patient was afflicted with several complaints besides that which
I wish now to describe; but to carry the history of the case through
the whole of these, would be not only tedious and unnecessary, but
would occupy too much time and space. I shall, therefore, simply
- select such passages from my case-book, as will complete the history of
the disease I desire to illustrate: viz., Aneurismal Varix occurring in a
stump, after amputation at the ankle joint.
CASE. G. K., a young man between thirty and thirty-five years of age,
consulted the late Mr. Liston, in the spring of 1847, on account of stru-
mous disease of the tarsal joints of the right lower extremity, resulting
from a neglected sprain of the foot. There was pain, lameness, and
chronic thickening of the synovial membrane. Lateral leather splints
were applied; a strong solution of iodine was painted on the part; fer-
ruginous tomics were prescribed; and he was sent to the sea-side.
These measures failed to improve his health; on the contrary, abscesses
formed and opened, and sinuses were established. The health be-
ginning to give way, he returned to London. The question of ampu-
tation was raised; but the previous history of the patient gave rise to
some difference of opinion.
A few years before, the patient, then a lieutenant in the navy, had
suffered from an attack of pleuro-pneumonia, which ended in phthisis,
and threatened to prove speedily fatal. By great skill and care, how-
ever, the disease was arrested after it had reached its third stage; and
he recovered so far as a patient, having large cavities at the apices of
both lungs, can ever be said to recover. At the time when the question
of amputation was raised, he was in apparent health; the phthisical
symptoms were latent; he had scarcely any cough or expectoration, and
was but little emaciated. Under these circumstances, Mr. Liston re-
commended the operation, as the only means of saving him from a
lingering illness and certain death; while the late Mr. Key rather dis-
suaded him from any operation, on account of the condition of the lungs.
The former opinion was acted on, and then another question arose.
Was the disease so located as to admit of the performance of Chopart's
operation, or was it necessary to go higher and remove the whole foot?
This point was settled at the time of operating.
The patient having been rendered insensible with chloroform, admin-
istered by Dr. Snow, Mr. Liston, assisted by Mr. Field and myself, first
made a transverse incision over and into the astragalo-scaphoid articula-
tion, which was examined by the finger, and found to be rough and
scabrous. Chopart's operation was, therefore, relinquished; and it was
determined to remove the foot at the ankle joint. With this view, the
incision already made was continued upwards, on both sides, to the tip
of the malleolus, so as to form a slightly convex anterior flap; the
MR. W. CADGE's CASE OF ANEURISMAL VARIX IN A STUMP. 127
knife (a strong bistoury) was next drawn across the sole of the foot, from
one malleolus to the other. The anterior flap having been raised, and
the joint opened and separated, it only remained to divide the tendo
Achillis, and dissect out the os calcis from the posterior flap—rather a
tedious and troublesome proceeding. The tips of the malleoli were
clipped off on a level with the lower end of the tibia, by means of strong
bone pliers; two or three small arteries were secured, and, in the even-
ing, I brought the flaps together, with a few sutures and strips of isin-
glass plaister. Union by the first intention occurred, save where the
ligatures escaped; and the stump required no second dressing.
About ten days or a fortnight after the operation, I visited the patient
with Mr. Field, during Mr. Liston's illness; and my attention was at
once drawn to a swelling over the inner side of the stump, apart from
the wound, about the size of a large walnut, red, tender, and fluctuating;
in appearance it was an abscess, and I was about to open it; but hesi-
tated, on finding that it pulsated violently at every part. There was
also a loud whirring murmur, audible with each beat of the pulse. At
first, I doubted whether I had not a false aneurism to deal with ; but a
more careful examination led to the conclusion, that it was simply an
abscess seated over or under the posterior tibial artery; accordingly, I
opened it on one side where the pulsation was least violent, and evacu-
ated a quantity of well formed pus; poultices were applied, and in a
few days the discharge and swelling disappeared, and the wound healed.
The remarkable pulsation and bruit continued as strongly as before.
The patient himself was quite aware of the pulsation, but, as it caused
no pain or inconvenience, it attracted no further notice. A small sinus
formed at the back of the stump, which allowed a probe to enter and
pass upwards about an inch. As there was no pain nor tenderness, and
scarcely any discharge from it, firm pressure was made over the whole
stump, and I put an issue in the arm. The sinus quickly healed, and
the whole part became sound and consolidated, and the chest symptoms
also were better than they had been for many months. An artificial
foot of admirable construction was made by Mr. Gray of Cork Street,
and the patient was able to walk several miles daily, with scarcely any
lameness; and to use his own expression, he could “go through a
quadrille very creditably.” The whole weight of the body could be
borne without uneasiness by the naked stump; indeed, the case proved,
in an eminent degree, the superior advantage of this operation. In
January 1849, about fifteen months after the amputation, he fancied
that the pulsation was stronger than usual, and that, in addition, there
was some swelling of the inner side of the stump. He consulted Mr.
Key, who regarded the case as one of false aneurism, and, without giving
a positive opinion, hinted at the necessity of some operation : either a
fresh amputation, or ligature of the vessel above. This advice caused
a good deal of alarm; and, on the following day, I was requested to visit
the patient. There were the same pulsation and bruit, both somewhat
increased in intensity, as had existed a year ago; but there was also—
what had not been before noticed—a pretty distinct elastic swelling,
about two inches long and of two fingers breadth, over the inner side of
the stump. Every part of this swelling pulsated forcibly, and the loud
whirring murmur could be heard at some little distance. When the
128 CASE OF ANEURISMAL VARIX IN A STUMP.
posterior tibial artery was compressed above, the pulsation ceased, and
the tumour became flaccid; and both returned when the finger was re-
moved. What was the nature of this swelling? That it was aneuris-
mal, there could not be a doubt: if it was a common false aneurism, then
it had existed at the time of the operation, or very shortly after ; but
the progress, during the interval, had been very unlike that which usually
obtains in false aneurisms.
I advised him not to submit to any operation for the present, both
because of the long duration and uncertainty of the nature of the disease,
and because he was doubtful whether the swelling was undergoing any
increase in size. I proposed that he should refrain from using the stump
for a time, and permit me to attempt a cure by means of pressure, both
on the swelling and on the artery above, by two of Signorini's tourni-
quets. Should this plan fail, and the swelling increase, it would then be
time enough to decide what operation to perform; but if no increase
in size occurred, firm pressure should be made on the whole stump with
an elastic bandage, and he should continue to use it.
On the following day, Mr. Fergusson met Mr. Field and myself in
consultation, and fully concurred in the plan of treatment by compres-
sion; and it was, accordingly, commenced at once. While we were
applying the tourniquets, the patient complained to me of constipated
bowels. The usual purgative medicines were prescribed, but without
the usual effect; stronger medicines and injections were ordered, but
no evacuation could be procured. Pain, flatulence, and distension of
the abdomen ensued; and, in a day or two, it became evident, that there
existed some internal mechanical obstruction, but at what particular
part, there were no signs to indicate. I need not describe in detail the
progress of this unfortunate case; suffice it to say, that all our remedies
were unavailing. The abdomen grew immensely distended, and the
patient died, eight days from the commencement of the attack.
An anatomical examination was made thirty-six hours after death :
and the abdomen was first examined. The obstruction was seated in the
sigmoid flexure of the colon, close to the rectum, where it was so twisted
as completely to close the canal. This part of the large intestine was
of greater length than usual; and, instead of making its ordinary curve
in the iliac fossa, it reached upwards as high as the xiphoid cartilage,
where it doubled on itself, and returned to end in the rectum at the
margin of the pelvis; this coil was of amazing size, resembling the
stomach when distended. The mucous membrane, for some distance
above the obstructed part, was of a purple colour, very soft, and easily
raised; the caecum and colon were much distended; the small intestines
were empty; the diaphragm was pushed up to a level with the upper border
of the third rib on the left side, and fifth on the right. I have, in one
instance before, discovered the sigmoid flexure of the colon to be of in-
ordinate length, reaching nearly to the rightiliac fossa; and Dr. Yelloly
has given numerous instances of the same kind. He regarded it as a
natural conformation, and not, as Dr. Wells thought, the result of dis-
ease ; in the present case it seems most probable that it was the cause,
and not the consequence, of the obstruction. The lungs were adherent
* Edinburgh Medical and Surgical Journal, No. 64, p. 476.
BY WILLIAM CADGE, ESQ., F.R.C.S.ENG. 129
to the parietes of the chest at every part, the connecting false mem-
brane being at some places fully a quarter of an inch in thickness and as
tough as fibro-cartilage. There were large dry cavities in the upper
lobes of both lungs, surrounded by dense non-crepitous lung, which
sank in water; the lower lobes were healthy, and contained not a trace
of tubercle in any stage. I was permitted to remove the stump about
six inches above the extremity; and, some injection having been thrown
into the arteries, a careful dissection was made. - * *
The first thing which attracted notice was, that the two companions
veins of the posterior tibial artery were filled with injection. On tracing
the artery downwards, a large branch, probably the internal plantar,
was found to arise from it at the inner side of the stump; this branch,
about the size of a crow-quill, ended, within a quarter of an inch from
its origin, in a bulbous enlargement, about the size of a horse-beam,
which communicated, by means of a large short branch, with the poste-
rior tibial vein, and thus formed an Aneurismal Varix. The tibial artery
and veins were continued onwards to about the centre of the lower end
of the stump, where they ended abruptly, being of full calibre to their
termination; there was no distinct tumour of any kind. In the leg,
the vessels were bound down deeply by the strong fascia which passes
between the tibia and fibula; close to the ankle, this fascia had been
interfered with by the operation, and the vessels escaped from beneath
its lower border and mounted over the root of the inner malleolus,
separated from the bone by the bulbous extremity of the tibial nerve;
and thus at this point, where the Varix existed, they were close beneath
the skin, and both artery and veins beating strongly, gave the elastic
feel and appearance of defined swelling, which had been mistaken during
life for the sac of a circumscribed false aneurism.
The dissection of the stump showed how well adapted it was to bear
pressure. The plantar fascia, where it had been cut from the os calcis,
had become attached to the tendo Achillis behind, and in front, to the
cut ends of the extensor tendons; between it and the lower end of the
tibia there was merely some reddish loose cellular tissue; but, between
the fascia and the skin, there was a great thickness of dense granular
fat, much more than is usually found over the heel, and this not only
served as a most efficient pad, but also reduced the difference in the
length of the two limbs to less than two inches.
REMARKs. The diagnosis of Aneurismal Varix from circumscribed false
aneurism, is generally clear and plain; and it may be thought that in this
case the true condition of the parts ought to have been appreciated. But a
little consideration will show, that the differential signs were few and im-
perfectly marked, while all the symptoms of false aneurism were present,
viz., a pulsating tumour, situated in the course of an artery, apparently
slowly increasing in size, and attended by a marked bruit as the blood
flowed into the supposed sac,+the pulsation, swelling, and bruit, all dis-
appearing when pressure was made on the vessel above, and returning
when the finger was removed. That which tended most to throw a
doubt on this view of the case was, that whatever the true nature of the
disease might have been, it had existed upwards of a year, and the in-
crease in size of the tumour, if indeed it enlarged at all, was very slow,
130 MR. W. CADGE's CASE OF ANEURISMAL VARIx IN A STUMP.
and wholly unlike the usual behaviour of an aneurism. This slow pro-
gress and long duration led me to recommend the patient to pause
before submitting to any operation; and I need scarcely say, that the
dissection has shown that, in all probability, no surgical interference
would have been necessary, had he continued to live.
The unprecedented occurrence of Varix in a stump contributed not
a little to mislead the diagnosis. Since the first discovery of the disease
by Dr. W. Hunter, in 1757, the records of surgery contain numerous
cases, showing that it may occur in various parts of the body besides at
the bend of the elbow; thus, the carotid, subclavian, temporal, radial,
femoral, and popliteal arteries, have all been the seat of Varix; and Mr.
Syme” has met with a case of varicose aneurism of the aorta and vena
cava, which occurred spontaneously. Next to the bend of the elbow,
the most frequent situation of Varix is the thigh, between the femoral
artery and vein, and it is generally produced by the sudden closure of
the thighs to catch a falling sharp instrument, the point of which passes
between the artery and vein, wounding both. Mr. Liston” has described
a case of this kind, which I had an opportunity of examining; there were
varicose veins and ulcers of the leg, and a tumour on the front of the
thigh, caused by venous dilatation, thrilling pulsation, and loud systolic
murmur, together with weakness and numbness of the whole limb. Firm
pressure from the toes upwards diminished the pulsation and reduced
the swelling, and no operation was required.
I have, however, met with no instance of its having occurred in any
part of the body as a consequence of amputation, and it is not easy to
understand how it was brought about in this particular case. Most pro-
bably, the point of the bistoury passed between the artery and vein,
wounding both at the point where they lay in apposition. The com-
munication thus established at the time of the operation, would require
but very little pressure to prevent all outward haemorrhage, and this
was afforded by dressing the stump.
It was remarked by Dr. Hunter,” that in Aneurismal Varix at the
bend of the elbow, while the pulse at the wrist was weakened, the bra-
chial artery was enlarged and dilated; this he attributed to the dimin-
ished resistance to the circulation from the aperture in the artery, which
had almost the same effect as if a branch as large as the opening had
been added. Mr. Hodgson explained it by saying, that as part of the
blood was diverted from its usual course, it was necessary for the artery
above to enlarge and carry more blood, in order to keep up the nourish-
ment of the lower part of the limb ; the former is the law, and the
latter its application. The case I have described affords a negative
proof of the correctness of these explanations, as there was no limb
below the point at which the Varix existed, so there was no necessity
that the vessel above should dilate; accordingly it was found, on dissec-
tion, to be of ordinary calibre.
University College, January 1850.
—º-
1 SYME. Edinburgh Medical and Surgical Journal, No. cviii, p. 104.
* LISTON. Elements of Surgery, p. 676.
3 HUNTER, Dr. Wm. Medical Observations and Inquiries, vol. ii, p. 390.
131
CASE OF LACERATION OF THE WAGINA AND UTERUS,
REPORTED BY MIR. THOMAS MORLEY ROOKE :
WITH REMARKS AND THE SUBSTANCE OF A CLINICAL LECTURE;
By JOHN C. W. LEVER, M.D., Physician-Accoucheur to Guy's Hospital.
CASE. S. B., actat. 28, is a married woman, and has been so for six years.
She has had three children; she was confined of the first, ten months
after marriage; it was still born ; the labour was lingering, but she
recovered well. The second child was born at the end of about another
year, and lived fourteen months; and the third, a boy, after about the
same period. He is still living, and is a healthy child, about two years
and eight months old. She has not since given birth to any child up
to the present time, and has never had any abortion. Her last con-
finement was more lingering than the previous one, where the child
was a girl. She is a woman of rather short stature, fair, and of tolerably
florid complexion. Her husband is a labourer, and she follows the
occupation of a sempstress; but for the last few months she has had little
to do, and in consequence of her husband being frequently out of em-
ployment, she has not lived well, eating chiefly fish in the way of animal
food. She has never had any serious illness, but is now pregnant with
her fourth child; and, for the last ten months, has complained of a severe
dragging pain in the abdomen and back, to which, however, she has not
attached the slightest importance, and, when requested to have advice,
she has been averse to it.
At a quarter before three, A.M., on the 16th, I arrived at her house,
having been summoned to attend her in labour, and seeing her then for
the first time. I found her laid on the bed, with severe expulsive
labour-pains. On inquiry, I understood that the membranes had rup-
tured half an hour previously, that she had had vigorous bearing-
down pains since one o'clock A.M., and that the first stage of labour had
been going on all the previous day. On examination, per vaginam, I
found the os uteri fully dilated, and the head presenting at the upper part
of the vagina, and looking backwards towards the Sacrum. Under the
pains it rapidly made the turn of the axis, and appeared in about half
an hour in the cavity of the pelvis, in the first position. A short time
before my arrival, she had both defaecated and passed urine. The pains
continued at intervals of every two or three minutes, and there seemed,
at first, every probability of a speedy termination of the labour; the pains
were now not only strong and straining, but seemed almost of an ago-
nizing and torturing character—at least I thought more so than I had
hitherto witnessed in my limited experience. The head advanced some-
what further during the next half-hour, so that the scalpy tumour which
had formed on the head of the child could be felt little more than half
an inch within the labia, and the soft parts became all freely dilated.
The pulse was now full and quick; a small quantity of faeces was
squeezed out of the rectum during the advance of the head; but from this
time, the head seemed to make no progress, though the pains continued
in nearly full force. On several times examining, during the next two
or three hours, I could detect no advance of the head during the acces-
sion of a pain, or recession of the head during the decline and intervals
132 LACERATION OF THE WAGINA AND UTERUS.
of pain; it seemed very firmly fixed between the bones of the pelvis.
About seven o'clock, A.M., the woman rather suddenly complained of
a peculiar pain, unlike anything which, she said, she had ever felt
before; she described it as a severe scalding or burning pain in her
belly, extending up to her chest. This (by no means unimportant,
when taken in conjunction with the after symptoms) considerably im-
pressed me at the time, though not in the greatest degree, as we fre-
quently hear women complain during labour of sudden peculiar pains,
which, they say, they have never before experienced, but which do not
prove to have any serious connexion. The pains, however, continued;
but from this time, or a little before, they began to occur less frequently,
though still of considerable force; they perhaps now occurred (i. e.,
during the first half-hour of the decline) every five or six minutes, in-
stead of every three. At the same time, the pulse, I thought, began to
get smaller and quicker; and, on making a vaginal examination, the finger
was smeared with blood, not, however, more than was to be accounted
for. I now became more impressed than ever, that this was no common
case ; and at half-past seven, sent a note to Mr. Assaid requesting
his attendance, briefly stating the character of the labour, viz., the
time it had lasted, the great severity of the pains, followed by their
decline, and, from some cause, the appearance of exhaustion commencing
in the patient; and that I considered the chief peculiarity consisted in
the immobility of the head during the pains. Mr. Assaid arrived about
a quarter past eight, when I detailed to him the particulars; he insti-
tuted an examination, and considered the pelvis of tolerable dimensions,
and the head of the child of normal size. For the last half-hour before
he arrived, the pains had rapidly subsided, and were now all but gone,
and the patient remained much more quiet; she had vomited five
or six ounces of a dark greenish liquid. Mr. Assaid considered that,
after all, nature would be found equal to the expulsion; that the present
condition was one of uterine inertia, and that, if temporarily stimu-
lated by the administration of secale cornutum, nature might resume her
powers, and labour be completed. At any rate, it was better to make
the trial before having recourse to instrumental aid, especially as she
had not been long in labour, and had already become the mother of
three full-grown children, born by natural efforts; at the same time, he
was of opinion, that if symptoms of exhaustion continued, brandy should
be judiciously administered. Accordingly, thirty minims of the ethereal
tincture of ergot were given; this produced a few sharp pains, but
they did not continue ; a second dose was administered at the end of
half an hour, but this produced no effect, and she immediately vomited
a.large quantity (perhaps a pint) of dark grumous fluid; she complained
of thirst, and was supplied with tea, and brandy with it. In another
half-hour, she again vomited the same quantity, and was given some more
brandy; this was about ten o'clock; exhaustion, however, was not then
very great. At her request, she was allowed to get up, and, with assist-
ance, took a turn or two in the room ; she laid down again, and now
exhaustion rapidly increased. She began to complain of dimness of
sight, and of seeing objects double.
In the interval, Mr. Pettigrew had been applied to by Mr. Assaid, and
he soon arrived. He considered it a case of laceration of the womb, or
BY JOHN C. W. LEVER, M.D. 133
of the parts adjoining, and immediately proceeded to the further admin-
istration of brandy, to cover her with warm clothing, and to endeavour
by some means to rouse the vital powers before applying the foreeps, so
as to have a greater chance of securing contraction of the uterus and the
prevention of subsequent hamorrhage. The catheter was also passed,
but no urine escaped. Towards twelve o'clock, she was rather revived,
and professed to feel better, although complaining at intervals of the
sharp pain in the belly, and saying if it were not for that, she could go
to sleep. A drachm of laudanum was then administered; she was gently
moved to the edge of the bed, and the proper preliminaries having been
arranged, and an attendant being stationed to apply pressure to the
uterus, and follow it down during the gradual withdrawal of its contents,
the forceps were then applied by Mr. Assaid, and the head slowly
extracted. The whole delivery was performed slowly, partly with the hope
of more surely ensuring contraction, by the gradual emptying of the
uterus, and partly, to give as little fatigue as possible to the patient,
The child was dead—it appeared as a large male, with a full-sized head;
the uterus was felt contracting under the hand during the delivery, and
it remained so afterwards. The placenta easily came away, by slight
traction on the cord; delivery was completed at half-past twelve. The
child had a livid hue, and the placenta contained venous-looking blood;
very slight haemorrhage followed the birth. A broad bandage with a
firm and thick pad over the uterus was immediately applied round the
abdomen, and half a drachm of aromatic spirits of ammonia, with twenty
minims of tincture of opium, were administered, but the patient was evi-
dently sinking. The abdomen now, as it did, though in a less marked
degree, before delivery, gave evidence of its containing fluid of some sort;
the pulse was no longer perceptible at the wrist. The patient complained
of greater dimness of sight, of ringing in her ears, and that her breath
was getting shorter, which indeed it was ; her countenance wore a
shrunken and anxious expression, her extremities were getting cold, she
once or twice raised herself up on the bed, gave a vacant and rather
wild stare around, and as suddenly dropped again. She refused every-
thing offered her to swallow, but she replied coherently and intelligibly
when spoken to, and offered some voluntary remarks. She once more
complained of a racking pain in her stomach, and now being soon after-
wards asked (as she had previously wished it) if she would like to see
her little boy, she rather feebly and dreamily answered, that she
should. When he was brought, in two or three minutes, to her, her
eyes were feebly opened, but the film of death was on them; a slight
expression of recognition played for an instant over her features, and
as quickly passed, but she did not speak; and now, evidently, uncon-
sciousness supervened, the intervals of respiration became longer and
longer, and in five minutes life was extinct. She died at 1 P.M., half-
an-hour after the completion of delivery.
Post-mortem ea:amination, twenty-four hours after death. The whole
surface of the body was very pale and wax-like; the mammae were
well developed and enlarged; the abdomen much distended (more so
than immediately after death); the pelvis externally seemed of normal
size. Over the front of the legs, a few dark purpurous spots were per-
ceived, which could scarcely have been produced after death, as they
134 LACERATION OF THE WAGINA AND UTERUS.
were uppermost as the body was laid. On incising the abdomen, a layer
of fat, half an inch thick, was found beneath the integuments, but the
muscular parietes were thin. On opening the peritoneum, we found the
cavity almost filled with blood and clots, of which it must have contained
half a gallon. The uterus appeared well contracted at its fundus; but
lower down was discovered a rent, commencing towards the left side of
the posterior wall of the vagina, immediately below the os uteri. It
at first ran almost transversely across the vagina, separating it from the
uterus, then obliquely upwards to the right side, through the muscular
and serous parietes of the uterus for two or three inches, and continued
on to the right broad ligament, through the serous coat only; the
whole rent was nearly seven inches in extent. The right ovary con-
tained a well-formed corpus luteum; the left was very small, and appa-
rently atrophied. As regards the bones of the pelvis, the promontory
of the Sacrum was sharp and prominent, and the tuberosities of the
ischia rather near together; but the pelvis was by no means too small
for the safe expulsion of the child by natural efforts, had everything
else been favourable. There was no appearance of inflammation hav-
ing existed in the uterus. Different parts of its serous surface had, cer-
tainly, a bright rose-coloured tint, as had other parts of the peritoneal
sac, but not more, it was supposed, than was explicable from post-mortem
changes. The spleen was small, the bladder was empty and somewhat
mottled. The kidneys were rather large; and on stripping off their
investing tunic, a number of small white spots were perceived, which
were imbedded in the secreting structure; this seemed like the lymphic
deposits of inflammation at some former period. Owing to the presence
of friends, the remaining viscera of the abdomen, and those of the chest,
were not examined. T. M. R.
REMARKS. The previous history of this patient demands some notice.
She had given birth to three children; her first labour was difficult, and
the child still-born; her second child was born alive, and lived fourteen
months; the third, a boy, is still living, and was expelled after a lin-
gering labour. Multipara are more liable to suffer from laceration of
the uterus and vagina, than are primipara, this accords with the expe-
rience of all writers on the subject; thus Dr. Churchill, at p. 357 of
his work On the Diseases of Pregnancy and Childbed, gives the result of
Seventy-five cases quoted from different authorities, and, of this number,
but nine occurred in the first pregnancy; of the nine cases recorded by
Drs. Hardy and M'Clintoch, all were multiparae. I have myself seen
but two instances in which this serious lesion occurred in primiparae ;
in one, there was intense agonizing and irregular uterine contraction,
unrelieved by bleeding or opium; in the other, there was disease of the
uterus itself, This woman's constitutional powers were also very feeble;
the husband had but occasional employment; and, to increase their means
of subsistence, she had recourse to the badly-paid occupation of a semp-
stress; but, notwithstanding she had fared so badly, the child was of full
size—in fact large and well developed. It has been recommended by
Some of the older writers on midwifery, where there exists but a slight
diminution of the natural size of the pelvis, to keep the mother on a
small allowance of food during the last weeks or months of gestation,
BY JOHN C. W. LEVER, M.D. 135
in order that the child may not be so well nourished, and, therefore,
unable to attain a size which might render the labour tedious or diffi-
cult. In several instances this has been experimentally tested; but,
although the mother has suffered and become attenuated under the di-
minished diet, the development and nourishment of the child has not
been interfered with. For two months prior to her labour, this patient
had been complaining of dragging pain in the abdomen and back, but
which could not have been very distressing, as although she might, with
but little trouble, have had advice when recommended to do so, she
refused. In my opinion, these pains were due to the dragging and
weight of the gravid uterus, and altogether distinct from those pains
which sometimes are found in pregnant women, and which depend upon
a diseased state of the uterus itself, resulting in alteration of the
tissues, and frequently terminating in ramollissement; or from those
which usually attend the various forms of placentitis, and which are
followed, more or less, by adhesion of the placenta to the walls of the
womb. Labour appears to have been established at one o'clock, A.M.,
on the 16th ; in one hour and a quarter, the membranes ruptured; and
at a quarter to three, when Mr. Rooke saw her, he found the os uteri
fully dilated, and the pains vigorous and bearing down; the head, which
presented quickly, passed into the cavity, and the attendant was led to
hope a speedy termination to the labour; but the pains assumed a
new character, they became “agonising and torturing”, and yet
they served to advance the head, so that the scalpy tumour was not more
than half an inch within the labia. From this period the head seemed
to make no advance, neither advancing during pain, or receding during
its remission. Matters continued much in the same state until 7 A. M.,
when the patient expressed herself as feeling a pain, which on previous
similar occasions she had never experienced; she described it as
“severe, scalding, burning”, extending from the abdomen to the chest.
This symptom deserves some notice, for I have rarely seen laceration of
the uterus occur without a cramping or burning pain, with a degree of
local tenderness in the abdomen, having preceded the lesion. Dr.
Douglas is emphatic in his injunction for us to be on our guard for rup-
ture, when such pain is suddenly complained of. From this time, the
pains declined, not suddenly, as in many cases of rupture, but gradu-
ally; at first five or six minutes' interval took place between them
instead of three. If the whole of the uterime tissues had been at first
involved, if the rupture had implicated all the parts of the cervix or
body, then, according to my experience, there is in the majority of cases
a sudden cessation of uterine contraction; but this symptom does not
hold good in all cases; for I have seen the child expelled by natural
efforts, even when it was known by examination, and by other symptoms,
that rupture had occurred. The alteration in the state of the pulse must
also be noticed: at first, it was full and quick; when the lesion occurred,
it became small, rapid, and thread-like; and just before dissolution, or
rather soon after her delivery, it was imperceptible at the wrist. This
alteration in the state of the pulse is usually found in cases of ruptured
uterus and vagina, but it is also present where there exists laceration
of any important internal organ. I have known it present, where
a large ovarian abscess burst, and emptied its contents into the peri-
136 LACERATION OF THE WAGINA AND UTERUS.
toneal cavity, during the progress of the expulsion of a premature child.
When Mr. Rooke passed his finger to ascertain the progress of the
labour, he found it stained with blood, but to not such an extent as to
surprise him; and yet the quantity of blood poured out from the lacera-
tion, as gathered from the results of the post-mortem examination, was
very great. Where lacerations of the vagina or uterus take place, one
very frequent symptom is the discharge of fluid blood; but as in this
case the head was fixed in the pelvic cavity, the blood found more ready
ingress into the peritoneal cavity than egress through the vagina. That
fluid was collecting within, was ascertained before delivery, and was
rendered much more evident after the uterus was emptied; and this is
not surprising, as the quantity of fluid and coagulated blood was esti-
mated at half a gallon. Recession of the head, is generally another
diagnostic symptom of rupture; here it was not, as the head was seated
low down in the cavity of the pelvis. Vomiting is also a distressing but
marked symptom ; and here the fluid rejected was of a dark grumous cha-
racter like coffee grounds. The vomiting of fluid of this character during
the advanced stage of labour, is always to be reckoned as a grave symptom,
especially if attended with symptoms of exhaustion. I have never seen a
case of rupture of the vagina or uterus without it, but I have known it
occur in labours which have terminated happily; but then it has not been
accompanied by other symptoms, which usually attend this serious
lesion.
Mr. Rooke, seriously impressed with the gravity of his case, requested
the advice and assistance of his colleague, Mr. Assaid. This gentleman,
taking into consideration that the patient had given birth to three full-
grown children, and that the pelvis was not seriously abbreviated, was
disposed to regard the case as one of uterine inertia, and was of opinion
that, if by means of general and specific stimuli the system could be
roused and the uterus excited to contract, the case might be terminated
by matural efforts. To effect these purposes brandy was given, and the
ethereal tincture of ergot was administered; the exhibition of the latter
was followed hy the production of three or four sharp pains, but their
continuance was brief; a second dose was administered—no pain resulted,
but vomiting occurred Even at this time, the symptoms betokening
exhaustion were not very great; yet the gentleman in attendance, doubt-
ing the issue of the case, sought the advice of the surgeon-accoucheur.
Before the arrival of this gentleman, at the earnest entreaty of the
patient, she was permitted to rise from her bed, and supported to walk
up and down the room; this was quickly followed by aggravation of all
the symptoms. It is at all times most difficult and painful to with-
stand the entreaties of the patient and her friends; the sense of con-
striction of the chest, the desire to breathe more freely, the feeling of
oppression, the sensation of sinking, lead the patient to implore change
of posture, to sit up, to stand, to walk; anxious relatives and watching
friends join most emergetically in the appeal; but such must not be
conceded, for exhaustion will be developed more speedily, and death take
place more quickly. It was so in this case; the alteration of position was
speedily followed by dimness of sight and double vision; and when Mr.
Pettigrew arrived, he readily suspected and diagnosed the character of
the lesion. He wisely resolved to endeavour to rouse the vital powers
BY JOHN C. W. LEVER, M.D. 137
before attempting to deliver, by the administration of brandy, the appli-
cation of warmth, and other similar means. About twelve o'clock,
she had revived to a certain extent; opium was administered, the
alteration to the proper position was slowly and cautiously accomplished.
This is of great importance; we should, especially, be careful to keep
the head of the patient lower down even than the shoulders. Due pre-
caution was taken to secure the contraction of the uterus according
to its diminishing contents, the forceps were carefully applied, traction
was cautiously made, and the child slowly withdrawn. In rupture
of the uterus, there are three modes in which delivery may be com-
pleted: firstly, by turning; secondly, by the employment of the forceps;
and thirdly, by the use of the perforator. The first is only applicable
to those cases where the head does not occupy the pelvis, or where it
has receded; the forceps may be applied in cases where the head
has not receded, and where there is no material abbreviation of the
pelvic dimensions; yet, in the application of the blades of this instru-
ment, great care must be had lest the child be forced to recede; thirdly
and lastly, if the perforator be employed, the opening into the skull
must be made gently, and not with so much force as in cases of locked
or impacted head, lest it should also recede. In this case, the forceps
were applied with tolerable facility; and the wisdom of the selection of
this mode of delivery is shown by the sequel. But little difficulty was
experienced in the extraction of the placenta; and in but one case that
has fallen under my notice, have I had any trouble in the extraction of
the secundines. In this solitary case, the placenta and its membranes
escaped into the peritoneal cavity; and the difficulties in its delivery,
with the feelings attendant thereupon, may be more easily imagined
than described. There is one symptom which I have already alluded
to, but which deserves a further remark, viz., the sensation of fluctuation
in the abdomen, coming on and gradually increasing during labour.
This could not have been ascitic fluid, for there was no evidence of its
existence at the commencement of labour; if it were the contents of
a cyst or abscess, its quantity after evacuation would not have been in-
creased. Taking into consideration the time when it first evidenced
itself, its gradually increasing quantity and its attendant constitutional
symptoms, the gentlemen in attendance very rightly supposed it to be
due to the effusion of blood. Large as the quantity'was, it was not
larger than might be expected from an examination of the parts after
death. The symptoms following delivery were those to be expected;
exhaustion became greater, dimness of sight and ringing in the ears
supervened, her countenance became pallid and anxious, the extremi-
ties became cold, but coherence remained; she could answer questions
as well as make voluntary remarks, and her last but momentary act of
recognition, was bestowed on her only child. I have often observed that
in the majority of these cases, where death takes place quickly after the
lesion, consciousness persists to the last. It is unnecessary to recapi-
tulate the necroscopic appearances, except as far as relate to the pelvis,
vagina, and uterus. The promontory of the sacrum was sharp and
prominent, the tuberosities were slightly approximated, but the pelvis
was by no means too small for the safe expulsion of the child by natural
efforts, although it must be remarked that the child was a male and its
VOL. II. 10
138 DR. LEVER ON LACERATION OF THE WAGINA AND UTERUS.
head of full size. The laceration separated the posterior wall of the
vagina from the uterus; then, running obliquely upwards to the right
side, it divided the muscular and serous coat of the uterus for two or
three inches, continuing to the right broad ligament, implicating only
the serous coat; in its course it laid open several large sinuses, and
hence the quantity of blood effused, which so speedily terminated this
poor woman's life. On careful examination, there seemed to be no pre-
viously existing morbid lesion, produced by inflammation, or other cause,
such as is found in the majority of cases of this fearful complication.
I am inclined to suppose, that from the pressure of the tightly fitting
head on the soft parts, the structures of which they are composed
became infiltrated with serum prior to the laceration; that the lesion
at first was small, but gradually increased until it assumed the fearful
size that post-mortem investigation revealed.

Wellington Street, Southwark,
January 1850.
139
BIBLIOGRAPHICAI, RECORD.
A FEW SUGGESTIONs on CoNSUMPTION. By RoRERT HULL, M.D.; Extra-
Licentiate of the Royal College of Physicians; Physician to the Norfolk
and Norwich Hospital. Pp. 138. London : 1849.
DR. HULL informs us that his object in publishing this little book, is to
“deprecate and supersede mischievous agents” in the treatment of Consump-
tion : a very laudable intention, in the following out of which, a good work
might have, we wish we could say has, been written. A careful investigation
of the physiological and therapeutic actions of the various remedies which
are ordinarily employed, or have from time to time been recommended as our
weapons against this insidious, and too often death-dealing foe, would be a
boon of great value ; and had Dr. Hull even made an attempt, however im-
perfect, to furnish us with such a gift, we should have thanked him for it,
and cheerfully awarded the praise due to all who labour heartily with right
efforts to advance our real knowledge. But he has done nothing of the kind.
We meet with strong words and dogmatic assertions in abundance; but
proofs, such as we might expcct, based upon anything like substantial found-
ations, exist not in his pages. For instance, opiates are Dr. Hull's favourite
aversion—ea optatis, tanguam a peste, fugiendum est, is a quotation more than
once repeated. “Opiates, I cannot repeat too often, are lethal,” he says,
near the close of the book, and the same dogma is asserted and re-asserted
continually throughout it, but there is no attempt to demonstrate its truth;
and, with amusing inconsistency, he recommends morphia when haemoptysis
occurs! Let any of our readers consult the recent report of the Hospital for
Consumption at Brompton, as to the relative frequency of this symptom, and
then say how many patients would escape the administration of this lethal
remedy ? “In haemoptysis,” he says, p. 61, “according to the degree of cough,
opiates must be given, lest the succussions of cough should burst afresh the
vessels, or open fresh vessels not already burst.” But at p. 66, in comment-
ing upon a case we are told that—“Thaulius displayed this peculiarity in the
treatment of himself, that he rode on horseback more often and more violently
during his protracted and copious bleedings. In fact, he despaired of his
life, and he rode with desperation. Whether this horse-exercise, or Dr.
Elliotson's turpentine, saved him—who shall decide 7 He thinks the turpen-
tine ; I am disposed to believe in the horse.” How shall we reconcile these
discrepancies of the author :
Dr. Hull's treatment of phthisis is simple enough;-avoid physic, especially
what he is pleased to denominate bee-hive medicines, “ride, eat, and drink,
like bagmen º’-do this, and, upon Sydenham's authority, salvation is pro-
mised to our invalids (p. 16). Here is a case in point.—“Uranius, a young
gentleman, aged fifteen, consulted me in the autumn of 1845. He displayed
all the external signs of the phthisical frame. And he gave proofs of an
ample cavity in the apex of the left lung, and of a smaller excavation in the
summit of the right; the pulse ranged to 120. The liver was very torpid,
and the alvine excreta drab-coloured. The father of this patient, a gentle-
man of masculine sense, was quite ready to send his son, on medical autho-
rity, to the South of France, or to Spain, to Italy, or Malta, to Madeira, or
anywhere. I told him of the uselessness of such inconvenient expeditions;
and he chose that his son should not be banished. I directed attention to
the liver, prescribing dandelion internally, and baths impregnated with nitro-
muriatic acid. That the diet should be generous, of milk and solid animal
food, of malt liquor. That no pectoral drugs, nor opiates, should be given.
That, if the cough disturbed by night, free potation of porter, which is som-
niferous, should be preferred, medical sedatives excluded. That the patient
should expose his lungs, his body being warmly clad, to the air. He resided
in the northern part of Norfolk, and he rode daily on horseback to the sea-

10 2
140 BIBLIOGRAPHICAL RECORD.
shore, distant seven miles. At Christmas, his pulse being quick as ever, the
sputa were puriform, very offensive, and copious; the gurgling in the cavi-
ties was remarkable as ever, and emaciation was extreme. Profuse perspiration
at night. It seemed that death could not be very distant, but he persevered
in his course. In the month of May, he presented himself to me, fleshy as
he had ever been, in buoyant spirits, in juvenile strength. On stethoscopic
examination, all cavernous symptoms were gone.” (p. I5).
Truly, this is a marvellous case, large cavities at Christmas, all physical
signs of their existence banished by May ! Well may Dr. Hull say, that na-
ture “healed all breaches with triumphant energy”!
But the worst feature in the book is the spirit in which Dr. Hull reviles
all treatment but his own, and the accusation he brings against his profes-
sional brethren, of systematically destroying their phthisical patients. The
following quotations will illustrate this point: “There is a complication in
the menacing, incipient stage of phthisis in young women, which very often
occurs; amenorrhaea. And this is occasionally a lucky symptom for them.
Their own minds are ever impressed with a conviction, that this irregularity
is the sole cause of all their ailments, debility, dry cough, shrinking. And,
if their family surgeon takes the same view, they have a good chance of re-
covery. If this uterine torpor did not co-exist, then phthisis would be
diagnized [sic], and the usual routine of blistering plasters, leeches for pains,
merely muscular, of foxglove for quickness of pulse, would be instituted,
and the usual result would occur. But, fortunately, the surgeon himself does
now and then look on this functional effect as the efficient cause. And, as
this disorder is notoriously cured by tonic medicines, good diet, pure air, and
horse-exercise, so these are hopefully prescribed ; and cough, rapidity of
pulsation, thinness, all vanish. The young lady is cured of commencing
phthisis when she was occupied with a different idea. She has had a narrow
escape.” (p. 46).
This is bad enough, but our author speaks even more plainly elsewhere.
“Is it so clear that the cold and cough, which end in phthisis and the early
grave, are so abstractedly fatal As I live, I believe that numberless cases
are lethal, through medical meddling.” (p. 40).
“Let people themselves see the simple logic of the question. If mankind
are not one whit the better for being physicked and narcotized year after
year, century after century, is it not high time to suspect that the very physic
hath caused this wretched stationary state of things' Almost every other
malady hath confessed the power of medicine; is it not time to believe that
phthisis is not to be healed by medical art; that art has paralysed nature ;
that the purveyor of animal food, the brewer, the wine merchant, are most
probably the best physicians; that the non-naturals are after all the natural
means of prevention, of cure ? That if nature were incompetent, which the
meddlers assert or imply, which is by no means whatever proved, art is not
less feeble ; that art is even pernicious, shortening days which might have
been prolonged; exasperating existence, which nature would have soothed;
may, often curtailing life, which might have reached the allotted span. Most
implicitly do I believe that, while some few cases of decline may have been
cured, under the routine treatment, not by it, the huge mass of phthisicals
is prematurely despatched. That if, from the first consumptive down to the
last victim, art had abstained with respectful diffidence, the human race
would have been less decimated, by millions.”
We are no drug-fanciers, nor is it to our interest to make our patients swallow
unnecessary physic; and therefore we do not belong to the category of those
“chatterboxes” with “long tongues unscrupulously used,” from whom Dr. Hull
anticipates opposition to his views; but we do most strongly protest against
such wholesale condemnation of all medication; and we can assure the author
that, if he had written in a different spirit, and with more cautious language,_
if he had given others credit for honesty of purpose and soundness of

BIBLIOGRAPHICAL RECORD. 141
judgment; and had not misrepresented the generally received practice, en-
deavouring to make the public believe that it is essentially lowering in its
character, when as he must, or ought to know, the highest and most gene-
rally followed authorities insist strongly on the necessity of supporting the
patient's strength; he would both have written a better book, and have
secured a more attentive consideration for the sound advice which he does
sometimes give.
ON THE OPERATION FoR STRANGULATED HERNIA. By H. HAncock, F.R.C.S.
Eng. pp. 94. London, 1850.
The subject of Hernia is a battle-ground, on which many knights are ever
ready to break a lance in defence of the most opposite and conflicting opi-
nions. The champions for the various modes of practice are pretty equally
divided in number, and very fairly matched. If a Petit, an Aston Key, and
a Bell, opposed the opening of the sac, the opposite proceeding has been
advocated by a Dupuytren, an Astley Cooper, and a Lawrence. Mr. Gay
has, in a recent work, enlisted himself under the banners of the three eminent
surgeons first mentioned; and in the work before us, MR. HANGock has come
forward to do battle with Mr. Gay and all other comers, not only on the point
mentioned, but on others scarcely less important.
The first question, then, on which Mr. Hancock joins issue, is that of the
propriety of laying open the hernial sac ; and if ever the oft-quoted remark
of the squire of the knight of La Mancha was applicable, it is so to the case
in point. Much may, indeed, be said on both sides; and, though with such
conflicting evidence as can be adduced, we must decline attempting to adjust
the balance, we shall not shrink from expressing our opinion.
There can be no question, that the opening of the sac enables the operator
to obtain much important information which could not be gained in any
other way. It is no small matter to be in the dark as to whether the intes-
tine be healthy, ulcerated, inflamed, or gangrenous ; whether adhesions
confine it to any part of the sac; whether the omentum be healthy, or other-
wise ; what is the condition of the sac, the number of protrusions, and, above
all, the precise seat of stricture. To learn all this with certainty, we must
open the sac; and when we consider the knowledge derived from that pro-
ceeding, we certainly think the advantages more than counterbalance the
objections. We do not pretend to say, that an incision into the peritonaeum
is a trifling affair; but we certainly think, with Mr. Hancock, that its danger
has been exaggerated. We have strongly impressed on our minds certain
cases we have witnessed, in which the most unexpected complications were dis-
covered on the sac being laid open;–complications which were not suspected,
and which would have killed the patient had they not been brought to light.
A remarkable illustration of this is afforded in a case communicated to Mr.
H. Hancock by Sir J. Fife. He operated for Femoral Hernia on a woman.
The operation was, apparently, completed in a few minutes; but on Sir J. F.
passing his finger into the abdomen, to make sure that all was clear, he found
the intestine bound to the iliac artery by an adhesion so strong, that a knife
was required to divide it. The intestine was freed ; but the gush of blood
which took place showed what had happened. With equal promptitude and
skill Sir John extended the wound, passed a ligature round the iliac, and the
patient recovered without a bad symptom. Certain tables have been pub-
lished, from which it would appear, that the mortality has been far greater
in instances in which the sac has been opened, than where the contrary prac-
tice has been pursued ; but Mr. Hancock has analyzed these tables, and
satisfactorily shown that the impression intended to be conveyed by them, is
not by any means borne out on an investigation into the actual causes of
death; as, in a considerable number, the fatal result was not attributable to
the nature of the operation, but arose from causes quite independent of it.
Mr. Hancock is strongly adverse to the employment of the taxis beyond
142 BIBLIOGRAPHICAL RECORD.
certain limits. In this we entirely agree with him, feeling satisfied that the
risk of a fatal result is infinitely increased by the irritation and violence too
often connected with long-continued and ill-directed efforts at reduction.
Our own impression is, that if, after a fair trial of the taxis, skilfully applied,
the Hernia is not reduced, further manipulation ought not to be attempted.
Mr. Hancock recommends the use of chloroform, as superseding the necessity
for the warm bath, bleeding, and tobacco. It is likely to prove a valuable auxi-
liary; and as to the employment of tobacco, if we were so unfortunate as to
be the subject of Strangulated Hernia, we would rather submit at once to
the operation, than trust to the slender chance of success afforded by the use
of that potent, but dangerous and capricious, drug.
Another point on which much stress is laid by Mr. Hancock, is the avoid-
ance of purgatives after the operation. A little reflection would show that,
in the inflamed, irritable, and unnatural condition in which the bowel must
be after incarceration, soothing measures are more rational than those which
would tend to excite irritation. If, therefore, it be necessary to open the
bowels, mild enemata afford the least objectionable mode of proceeding. We
should never forget that our business is simply to assist nature ; and it is
both dangerous and unnecessary to be over-officious. To tranquillize the sys-
tem, Mr. Hancock employs opium freely. On this point we would remark, that,
with some persons opium disagrees so much, that, in our opinion, it is always
prudent, before prescribing it in any case where vomiting is likely to be
injurious, to ascertain, if possible, whether it does agree; if not, hyoscyamus
would be preferable.
In conclusion, we recommend this work to our readers, as a sensible and
practical exposition of the subject. That it may not meet the views of every
one, is very possible; but the facts are so clearly put, and so ably argued, that
it must leave a favourable impression on the minds of all, even of those whom
it fails to convince.1
SURGICAL ANATOMy of THE ARTERIES, AND DESCRIPTIVE ANATOMY of THE
HEART. By the late W. FLooD, M.D. New Edition, by J. H. Power,
M.D. pp. 189 Dublin, 1850.
The preface to this edition bears date November 1849, from which circum-
stance, as also from the statement of the editor, we were led to expect that
such a revision had been made, as would have brought the information con-
veyed, up to the standard of the present day. In this, however, our expecta-
tions have been disappointed; and we shall point out instances in which, for
the sake of correctness, a little more attention in the editor would not have
been misplaced. We are told that the operation of tying the right sub-
clavian artery in the first part of its course was first performed by Professor
Colles, of Dublin ; then by Mr. Hayden, and afterwards by Mr. O'Reilly,
both of the same city. Particulars of these cases are given; and as no
allusion is made to any other example of this operation, it might naturally
be inferred, that the three mentioned were the only instances in which it had
been undertaken. We learn, however, from Dr. Hargreave, that there are
ten cases on record, in which this operation has been performed; although, in
every one, death from haemorrhage was the discouraging result.
Whilst on the subject of subclavian operations, we may mention, that in
the American Journal of Medical Sciences for January 1849, a very remarkable
deviation of the left subclavian artery is described, combined with a singular
and embarrassing condition of the neighbouring parts. The patient, who was
considerably deformed from spinal curvature, was the subject of subclavian
aneurism, and the artery was found to pass obliquely upwards, parallel to,
and about an inch from, the external border of the trapezius. The first rib,

1 Our readers will find some important discussions on Hernia, by Mr. Hancock
and others, in the reports of the Westminster Society, given in our volume for
1849; and also at page 100 of last number.
BIBLIOGRAPHICAL RECORD. 143
and part of the second, passed obliquely across the neck above the clavicle,
and the tubercle of the first rib was not sufficiently developed to be manifest
to the touch ; notwithstanding all these difficulties, Dr. Mason Warren suc-
cessfully ligatured the artery. The particulars are given at p. 381 of our
volume for 1849.
To return from this digression. It is stated in the work before us, that
“both common carotids were tied successively by Dr. Mussey, of New Hamp-
shire, in America, for aneurism by anastomosis on the crown of the head;
between the two operations there were only twelve days interval; the tumour
was subsequently removed, and the patient recovered”. (p. 34.) This being
the solitary instance mentioned, some of our readers may be surprised to
learn, that in ten published instances, ligatures have been applied to both
carotids, for various diseases.
A tendency to temerity is a very common failing with surgeons in the
early part of their career, and it is therefore desirable not to stimulate such
a tendency by under-stating the danger of the more serious operations. We
find it remarked, at page 34, that “the possibility of tying the carotid without
impairing the functions of the brain, has been abundantly proved by dissec-
tion”. It would perhaps have been well to have added a caution against the
rash or hasty performance of the operation. In twelve, out of thirty-eight
cases in which the carotid was tied for aneurism, serious symptoms were
manifested, in the brain, after the application of the ligature; and in vol.
xxix of the Medico-Chirurgical Transactions, there are two strikingly in-
structive fatal cases recorded by Mr. Vincent.
A little investigation into the statistics of surgery would have corrected
the statement which we presume was made in the first edition of Dr. Flood's
book (which we do not happen to have at hand), to the effect, that the arteria
innominata has been tied “about six times on the human subject”. Wine
instances are recorded, in which ligatures have been placed on that vessel;
and in three others, the operation was commenced, but abandoned without
the object being attained.
The description of the branches of the internal maxillary artery is con-
cluded by the remark, that in cases of haemorrhage after the extraction of
teeth, “we may plug up the socket, or apply the actual cautery, or, if prac-
ticable, the tooth may be replaced”. The student should, however, know,
that there are yet two other modes, preferable (in our opinion) to either of
the above. The first is the application of turpentine, which seldom fails,
more especially if administered internally, as well as applied locally: the
second is to place a small piece of matico leaf on the end of a piece of cork
cut to the size of the tooth which has been extracted, introduce that into the
socket, and let the patient bite upon it; this will answer far better than the
clumsy replacement of the tooth.
Dr. Power speaks of the treatment of aneurism by compression, as one of
the greatest achievements in modern surgery; and states, that in Dublin, it
has almost entirely superseded the use of the ligature in cases of popliteal
aneurism. In the hands of Dr. Bellingham, Mr. Greatrex, Mr. Newcombe,
and more recently Mr. Tuffnell, the treatment by compression has been at-
tended with great success. Some distinguished surgeons, however, are
strongly in favour of the ligature ; and no one more so than Mr. Syme, whose
strictures on the treatment by compression are well deserving of perusal.
They are not, however, alluded to by Dr. Power; and we may mention, en
passant, that a little national prejudice seems to have reigned during the
composition of the work before us; for the frequency with which the names
of Irish surgeons occur, as compared with others, is quite remarkable.
At the present day, the illustrations to anatomical and surgical works are
usually as remarkable for artistic excellence as for correctness of design. We
need only refer to Dr. Carpenter's Manual of Physiology, Mr. E. Wilson's
Anatomist's Wade Mecum, and Mr. Fergusson's admirable work on surgery. In

144 BIBLIOGRAPHICAL HECORD.
this respect, the volume before us falls far short of its competitors, for there
is no disguising the fact, that the wood-cuts are, to use the mildest term,
exceedingly inferior.
We have felt it our duty to offer these remarks, not in any carping or un-
friendly spirit, but because we think that the execution of a book should
bear out its pretensions. We readily admit that Dr. Flood's work was origin-
ally one of the best of its day; but should a third edition be required, the
editor would do well to bestow more pains upon his charge, in order that it
may be more fully brought up, in letter as well as in spirit, to the superior
information and extended knowledge of the present age.
LECTURE INTRODUCTORY. To A Course of CLINICAL MEDIGINE, delivered in the
Glasgow Royal Infirmary, on the 13th November, 1849. By J. A. EASToN,
M.D. pp. 20. Glasgow: 1849.
This is a very sensible Introductory Lecture, and indicates that the Clinical
Department of the Glasgow School of Medicine is in a sound state. This we
rejoice to know; for, from the large population of that city, from the cele-
brity of its ancient University, and from the influence which attaches to the
School of Medicine connected with the Andersonian College, a large number
of the medical practitioners of Scotland must continue to be educated there.
It is, therefore, matter of congratulation, that the museums, hospitals, and
medical professors of Glasgow, are fully competent to supply such an educa-
tion, as is commensurate with the present advanced state of medical science.
In a foot-note, Dr. Easton gives the following interesting particulars:
“THE ADVANTAGES of THE GLAsgow Roy AL INFIRMARY as a School of
Practical Medicine and Surgery, have been so well set forth by my esteemed
colleague Dr. M. S. Buchanan, in a Clinical Lecture, delivered under circum-
stances nearly similar to the present, that to insist any farther on such a topic
is almost superfluous.” Yet, I may be permitted to remark, that in that Insti-
tution there are four hundred and sixty beds, that three thousand patients
are admitted annually, and that the average number of surgical operations
in a year, is one hundred and twenty. Attached to the Hospital, there is
also a Dispensary, at which are treated annually six thousand out-door
patients. Students have the opportunity of seeing the practice of the
Hospital for Two YEARs, and of hearing the Clinical Lectures on Medicine
and Surgery, which are delivered four times weekly, and all this for the sum
of £7.7s. To constitute a good Medical School, whatever else may be re-
quired, two things at least are essential, not only to its success, but to its
very existence—abundance of subjects for anatomical purposes, and an exten-
sive hospital. Now, neither of these essentials can be obtained excepting in
localities where the population is not only large, but comprehensive of all
grades of society, and where public works are numerous, varied, and exten-
sive. Can the same facilities, then, for studying medicine be found in places
in which the inhabitants are few comparatively in number, and nearly similar
in grade and vocation? For example, can Galway, with its thirty-three
thousand fishermen, kelp-manufacturers, exporters of pigs, flour, meal, and
bacon, (vide M’Culloch's Geographieal Dictionary, article ‘ Galway',) be
expected to furnish the essentials alluded to above, as constituting the
foundation of a Medical School, in the same degree or extent, that the
flourishing and public-spirited town of Belfast can, with its busy population
engaged in the diversified arts which spring from talent, enterprise, and
industry? Or can Belfast, even with its daily increasing population, be sup-
posed to furnish the essential pre-requisites for the study of medicine, that
are afforded in a place like Glasgow, the second city in Great Britain—and
in which the population is increasing in the ratio of nearly ten thousand
annually,–an increase not equalled, certainly not surpassed, by any other
place in the United Kingdom?”


" An analysis of the Lecture will be found in the Edinburgh Monthly Journal for
1844, p. 590.
BIBLIOGRAPHICAL RECORD. 145
Our limits prevent us from giving extensive extracts from Dr. Easton's
excellent and well-written exposition of the way in which disease ought to
be observed and studied ; but we must say that it is fully equal to any thing
of the kind which could have been brought forward on such an occasion.
The following sentences, specially applicable to Glasgow, situated, as it is,
in the midst of a mining population, and with its own dissipated and impro-
vident artisans crowding the hospitals, may probably be taken as an indica-
tion of Dr. Easton's method of instruction :-
“If the patient have been addicted to intemperate habits (as is the case, I
am sorry to say, with too many of our patients), then you may have to deal
with a prostrated nervous system, possibly with a softened brain, a cirrhose
or tuberculated liver, a granular kidney, and almost invariably with a thick-
ened gastric mucous membrane. Not that I mean to affirm that, in such
persons, all these abnormal deviations, or even any one of them, must of
necessity be present; but the very knowledge that they occasionally occur,
ought to ensure a minute examination as to their presence or absence. Again,
a knowledge of the occupation of the patient frequently furnishes a clue to
the disease under which he labours. Thus, it is well known, that masons and
knife-grinders, partly in consequence of pursuing their calling in the open
air, during all vicissitudes of weather, and partly also from the introduction
into their lungs of irritating particles from the materials on which they
manipulate, are prone to pulmonary diseases; and to the same diseases, like-
wise, are book-printers liable, in consequence of the constrained position into
which the chest is forced during their laudable exertions to promote the dif-
fusion of knowledge. Again, the melanotic sputa, the rounded thorax, and
the dingy complexion, proclaim that the unhappy possessor of them has
habitually inhaled a carbonaceous atmosphere, in
‘Subterranean caverns shunning the light.”
Having noted these, and many other circumstances, which your time will
not permit me even to name, regarding what is called the previous history of
the patient, you then proceed to ascertain his present condition. And here
the examination consists of two parts, the subjective and the objective. In
pursuing the former, we listen to the patient's own statements; or we give a
direction to these by putting a few leading questions, and thus obtain a
knowledge of his own view of his case, so to speak, and become acquainted
with his sensations, normal as well as abnormal, commencing our examina-
tion possibly at the head, and, if necessary, extending our inquiries down-
wards, through every part of the body.”
We believe that so early as the year 1827, Clinical Instruction was estab-
lished in Glasgow, upon a creditable basis; and, perhaps, had the Glasgow
Medical Journal then established, continued to publish its valuable additions
to practical medicine and surgery, the reputation of the school might have
been higher, and its advantages better known. Since 1841, the Edinburgh
Monthly Journal has published some good original memoirs by the physicians
and surgeons of Glasgow.
The remuneration of the medical profession in Glasgow—to the disgrace
of her merchant princes, be it said—is miserable in the extreme ; and it is
notorious, that the most eminent men in the profession, from the smallness
of the fees, are obliged to undertake such an amount of general practice as
necessitates greater fatigue and physical exertion than are compatible with
sustained scientific research and literary occupation. To those who enjoy
University endowments we do not allude; but to others of equal repute, who,
we have good reason to believe, are more worn out by the toils of ill-paid
daily practice than is proper or reasonable. The teachers of an efficient
medical school must either be adequately paid for their services, or the re-
cipients of the large fees of a metropolitan practice. Leisure, reading, and
reflection, are almost as necessary to the clinical professor as opportunities
of observing disease.

146 BIBLIOGRAPHICAL RECORD.
PRACTICAL TREATISF on INFLAMMATION OF THE UTERUS AND ITS APPENDAGES.
ByJAMES HENRY BENNET, M.D. Second edition. pp. 527. London: 1849.
(Concluded from p. 1038 of the volume for 1849.)
In November last, we pointed out the importance, in practice, of recognizing
the two facts, that inflammation of the cervix is a very common disease, and
that inflammation of the body of the womb is a very rare affection ; and by
extracts from Dr. BENNET's work, we laid before our readers the anatomical
conditions which explain this difference. We now proceed with our analysis;
refraining from saying more at present upon these points. The very in-
teresting discussions in connexion therewith, which have recently engaged
the French Academy of Medicine, we shall lay before our readers upon an
early occasion.
INFLAMMATION of THE BoDY of THE UTERUs, apart from that which is
connected with the puerperal state, occupies the third chapter. It is con-
sidered with reference to degree, as to whether it be acute or chronic ; and
with reference to its seat, as to whether it attack the entire body of the
uterus, the peritoneum, or the internal mucous lining. Dr. Bennet believes
that inflammation of the lateral ligaments is often mistaken, even by ex-
perienced practitioners, for inflammation of the body of the uterus. “The
chief causes that tend immediately to induce acute metritis are, arrested
menstruation, sexual excesses, and the extension of chronic inflammation
from the neck of the organ. To these I would also add, as occasionally acute
inflammation, all kind of surgical interference with the uterine organs, such
as cauterization of ulcerations of the cervix, the use of vaginal injections, of
pessaries, etc. Any influence that suddenly arrests menstruation, such as
exposure to cold or damp, wet feet, or mental emotions, especially in its in-
cipient stage, may give rise to acute metritis. These latter causes are gene-
rally considered to be capable of occasioning acute inflammation, even in the
interval of menstruation. I have very seldom, however, observed it in the
unimpregnated uterus apart from the menstrual period, except as the result
of some physical injury—of a blow, of a severe fall, or of cauterization of the
cervix. This latter cause of inflammation acts, it must be remembered, on
an organ, the vitality of which has been raised by the existence in its imme-
diate vicinity of inflammatory disease, generally of a chronic mature. Although
of rare occurrence, acute metritis having this origin is occasionally met with
by those who have great opportunities of observation.” (p. 26.)
ACUTE METRITIS. The Symptoms are local, and general or sympathetic.
“The inflamed uterus is so exquisitely painful, that the slightest pressure
exercised directly upon it, through the vagina, occasions severe pain, often
giving rise instantaneously to a sensation of nausea. Notwithstanding this
excessive sensitiveness of the uterus, it is possible in every case to ascertain,
without putting the patient to any great amount of pain, that it is the uterus
itself which is the seat of inflammation, and not the adjoining tissues. The
sensitive tumour is the immediate continuation of the cervix, occupying the
median line, and is equally painful and evident on the right and on the left
of that line ; unless, however, the uterus be naturally lying transversely from
right to left, as is sometimes the case, when the inflamed organ will extend
more to the right than to the left side. This is a very important practical
point to determine, as in inflammation of the lateral ligaments, the tumour
formed by the inflamed tissues is generally applied, annexed, as it were, to
the side of the uterus, so as only to form one mass. Owing to the great
sensitiveness of the uterus if touched or moved, directly or indirectly, the
patient is unable to walk, or even to stand ; and when sitting up in bed (a
very painful position), the body is generally so inclined as to take off all
strain from the abdominal region. When lying down, the patient always
remains on the back, that being the position in which the uterus presses
BIBLIOGRAPHICAL RECORD. 147
least on the surrounding organs. The passage of the faeces through the
rectum is often attended with very great pain, owing principally to its posi-
tion immediately behind the uterus. This is more especially the case when
the motions are constipated. They are then sometimes coated with mucus,
showing an irritable state of the rectal mucous membrane. There is also,
frequently, considerable irritation and pain about the bladder, accompanied
by more or less marked dysuria. The vascular and nervous connexion be-
tween the uterus, the rectum, and the bladder, is too intimate, for these organs
not all to suffer when one of them is severely inflamed.” (p. 28.) There is
generally considerable febrile reaction : and the breasts—one or both—are
often sympathetically affected. Acute metritis generally terminates in reso-
lution within from five to ten days, suppuration being extremely rare, in
consequence of the absence of cellular tissue in the structure of the body of
the uterus. The affection may become chronic, or it may extend to the
lateral ligaments. Dr. Bennet has never seen acute metritis terminate
fatally in the unimpregnated condition, and there are very few such cases on
record. The author remarks that this is “owing to the inflammation so
seldom extending to the peritoneum, and to the uterus not being an organ
having functions to perform necessary to the preservation of the individual.
A vast amount of uterine disease may consequently exist, without life being
directly endangered.” (p. 30.) But, although not a disease dangerous to life,
it is one which, if neglected or mismanaged, by becoming chronic, may occa-
sion serious and prolonged suffering. Perhaps inflammation of the womb
is very often not suspected by the practitioner; in many instances, the case
being subjected to no rigorous diagnosis, and regarded vaguely as inflamma-
tion of the bowels. With Dr. Bennet, we say that—“Treatment based on
such obscure notions of the real state of the patient, is apt to fall short of
the necessities of the case, to partially subdue the morbid symptoms only, and
to leave behind the seeds of future and more intractable disease.”
CHRONIC METRITIS is very well described: and it is instructive to observe,
that the general symptoms are really those which are popularly, and even in
the profession, too little recognized as being associated with a morbid and re-
mediable state of the womb. We are very far from wishing to detract from
the paramount importance and necessity of much that is embraced in the
common treatment of hysteria, but we believe that a better direction would
often be given to our curative efforts, if it were more generally understood that
the condition of the womb was often the essential cause of the derangement
of the nervous system. Over and over again have we seen a wretched state
of general health, and nervous symptoms the most anomalous, subside under
the active and successful treatment of a leucorrhoea, which had been long
...” as an evil only to be got rid of when the general health was
restored.
INTERNAL METRITIS OR. UTERINE CATARRH–as defined by Dr. Bennet—is
a rare disease : *
“It has only been considered common because it has been confounded with
inflammation of the cavity of the cervia, a disease which, on the contrary, is
very often met with. The mucous membrane that lines the cavity of the
cervix, as we have seen, instead of being rudimentary, like that which lines
the uterine cavity, presents a certain thickness, is plaited in folds, is abund-
antly studded with mucous follicles, and presents a more extensive surface
than the uterine mucous membrane. It is not generally known, that the
uterine cavity, in the unimpregnated state, is exceedingly limited in extent ;
so much so indeed, that, according to M. Vidal de Cassis, who made, some
years ago, many careful experiments, in order to ascertain its capacity with
reference to the use of injections in the disease we are studying, the uterus
of a full-grown woman does not contain more than from nine to eleven
minims of fluid. The cavity of the healthy cervix, if distended, contains
º
148 BIBLIOGRAPHICAL RECORD.
about as much. The two cavities are distinctly separated one from the other,
as I have explained, by a constriction, or natural sphincter, which has not
been described by anatomists, but which is sufficiently powerful to offer a
decided obstacle to the introduction of the uterine sound into the cavity of
the uterus, in the healthy state. The existence of this constriction was first
pointed out to me, some years ago, by Dr. Simpson of Edinburgh, as an indi-
cation of a morbid condition; but my subsequent researches have led me to
believe that it exists in the healthy state, and that it is not necessarily mor-
bid, even when carried to such an extent as to render the introduction of the
uterine sound impossible. The cavity of the cervix is also deeper by half an
inch than that of the uterus itself. The uterine sound, when passed into the
uterus, is concealed to the extent of two inches and a half; of which, one
inch and a half occupies the cavity of the cervix, whilst one inch only is in
the uterus.
“The above anatomical facts will at once explain the cause of the error
into which even the latest continental writers on uterine catarrh have fallen.
Whenever, on examining the cervix with the speculum, muco-pus is observed
issuing from the os uteri, they conclude, without further examination, that
it proceeds from the cavity of the uterus, and that the latter is the seat of
inflammation. They do not reflect that the muco-pus may proceed, as it
really does in nineteen cases out of twenty, from the cavity of the cervia. The
result of a careful examination of all the cases of inflammation of the cervix
uteri that I have seen during the last three years, amounting to between five
and six hundred, with reference to this point, has shown me that, in the im-
mense majority, the inflammation does not extend into the cavity of the
uterus. I have been led to this conclusion by the observation of the follow-
ing facts: Firstly. The dilatation which invariably accompanies inflammation
of the cavity of the cervix, does not, generally speaking, extend to the
internal constricted point, or ‘os internum’; the latter remaining contracted,
so as not to allow the free admission of the sound into the uterine cavity.
Secondly. Therapeutical means, carried so far only as the morbid dilatation
exists, or to the os internum, effectually cure the inflammation, and put a
stop to the discharge.
“In some few cases, on the contrary, the os internum participates in the
relaxation of the cervical cavity, so that the sound passes freely into the
uterus, the two cavities communicating. When this is noticed, the cavity
of the uterus may or may not be inflamed ; if it is, the discharge from the
os uteri is more abundant, and presents peculiar characters; the local and
general symptoms are rather different; and, what is conclusive, therapeutical
agents carried into the cavity of the cervix alone, may not be sufficient to
effect a cure. These latter cases are really cases of Internal Metritis, or
uterine catarrh. The former (by far the more numerous) I look upon as
cases of inflammation of the mucous membrane lining the cavity of the cervia,
only, or of cervical catarrh.
“Causes. All the causes which give rise to acute or chronic Metritis, may
also occasion Internal Metritis. It appears, however, to be generally met
with in practice, as the result of the lengthened existence of inflammatory
disease of the cervix and of its cavity. The inflammation gradually pro-
gresses along the cavity of the cervix until it reaches the os internum, and
passes into the uterus. Indeed, considering the extreme frequency of in-
flammation of the entire cavity of the cervix, it is only surprising that the
disease should so generally stop at the internal sphincter of that organ. The
cause, however, of this clinical fact is, no doubt, the change in the structure
of the mucous membrane, which commences at this point.
“Among the causes most likely to give rise to Internal Metritis, a promi-
nent position must be given to the inflammations that occur after parturition
and abortion. When inflammation of the uterus follows the expulsion of
the ovum, the surface on which the placenta was implanted, is peculiarly
BIBLIOGRAPHICAL RECORD. 149
liable to be attacked, and the seeds of chronic inflammation of the uterine
lining membrane may thus be sown. In some exceptional cases, blennorrha-
gic inflammation may be a cause of Internal Metritis; the inflammation
gradually extending from the vagina to the cervix, to its cavity, and to that
of the uterus. This, however, I believe to be much less frequently the case
than has been asserted.
“Symptoms. Internal Metritis being nearly always complicated by in-
flammation of the cervix, of its cavity, or of the substance of the womb,
its symptoms are rather difficult to unravel; so difficult, indeed, that I do
not believe the task has yet been accomplished satisfactorily by any writer.
Internal Metritis may be said to exist to a certainty, if the os internum of
the cervix is so completely open as to allow the uterine sound to pass
freely into the uterine cavity; if that cavity is increased in size, and more
sensitive, and if, likewise, there is a more or less abundant sero-sanguinolent
discharge, accompanied by dull, deep-seated pain in the region of the uterus
itself,-that is, behind and slightly above the pubis, and by a certain
amount of general febrile reaction.
“The sero-sanguinolent discharge is the most important of these symptoms;
indeed, it may be said to be as characteristic of Internal Metritis as the
rust-coloured expectoration is of pneumonia. The presence of blood in the
secretion from the inflamed mucous surfaces is, in both cases, owing to the
same cause—viz., the absence of an epithelial covering. The epithelium
ceases to exist in the cavity of the uterus as in the cells of the lungs; and,
when this is the case, the blood corpuscules exude in inflammation, and
blood is expelled mingled with the secretion of the inflamed surface. This
sanguinolent discharge, however, is not always present when there is inflam-
mation of the interior of the uterus. It is only when the inflammation is
severe, or in its period of greatest intensity, that it is observed. At the on-
set, in the period of decrease, and sometimes throughout the entire duration
of the disease, the secretion may be merely muciform or puriform. When
congestion alone remains, it may consist only of transparent mucus. If
this is the case, it becomes more difficult to distinguish Internal Metritis
from inflammation of the cavity of the cervix, in which the same discharges
are present ; in both, they may be seen issuing in a thick stream from the
os uteri, when the cervix is brought into view with the speculum. We can
then only be guided by the amount of the discharge, by the morbid dilatation
of the os internum, and by the other symptoms which I have enumerated.
“In the healthy unimpregnated uterus, as I have stated, the cavity of the
uterus is only one inch in depth, and so extremely small as merely to contain
a few drops of fluid ; consequently, the uterine sound, once introduced, has
but an exceedingly limited range of motion. In Internal Metritis, the
cavity of the uterus is dilated, increased in size, and the uterine sound moves
with more freedom ; the presence of the sound in the uterus, and its contact
with the walls of its cavity, seem also to be attended with more pain than
usual. This symptom, however, cannot be much depended upon, as the
introduction of the sound generally occasions pain even in the healthy
uterus; not unfrequently giving rise to nausea and faintness. Indeed, the
cavity of the uterus appears to be naturally as sensitive as that of the cervix,
and its os is little so.
“Internal Metritis is nearly always accompanied by a dull, aching pain in
the back or ovarian regions, similar to that experienced in inflammation of
the cervix, and by deep-seated pain in the region of the uterus. The uterus
is generally rather swollen, enlarged and sensitive to the touch, the entire
organ being in a congested, irritable state. Internal Metritis is also often
accompanied by a slight amount of febrile reaction, occurring at intervals,
after exertion, instrumental interference, or at the monthly periods. The
catamenia are often disordered, generally manifesting themselves more
frequently and more abundantly, lasting longer, and being attended with
150 BIBLIOGRAPHICAL RECORD.
more pain than usual. Sometimes the flow of blood is so great and so
lengthened as to constitute flooding; and this is more especially observed, as
might be anticipated, when the sero-sanguinolent discharge is present. With
some patients, however, on the contrary, the menstrual secretion appears to
be diminished ; but in either case it may be laid down as a rule, that the
disease is aggravated by the appearance of menstruation. In addition to
these symptoms, all the general sympathetic reactions which are observed in
chronic metritis, and in chronic inflammation of the cervix, may be present.
As Internal Metritis is generally complicated by these diseases, we may also
have the peculiar symptoms which they present.
“In some rare instances, inflammation of the lining membrane of the
uterine cavity is followed by ulceration. When this is the case, the cavity
of the uterus becomes considerably enlarged, and large quantities of pus,
blood, and mucus, collect within it, and are expelled through the os uteri.
Dr. Hall Davis exhibited, a short time ago, to the Pathological Society, the
uterus of a woman thus affected, who died under his care ; there were several
large ulcerations on the internal surface of the organ. There are other
cases on record; but this termination of Internal Metritis is undoubtedly
very rare. The rudimentary mucous membrane of the uterus does not seem
very liable to the ulcerative stage of inflammation.
“From what precedes, it will be evident that, although a careful digital
examination, combined with the use of the uterine sound, enables us to ap-
preciate many of the symptoms of Internal Metritis, yet we can only obtain
all the information we require to form a diagnosis, by carefully examining
with the speculum the condition of the uterine organs. The cervix should
be brought completely into view, in a good light, so as to enable the
medical attendant, not only to ascertain its precise condition, and that of the
inferior and external portion of the cavity of the cervix, but likewise to
appreciate the amount and precise nature of the discharge that issues from
the os uteri.
“Progress, Termination, Prognosis. Internal Metritis, when acute, and a
mere complication of inflammation of the body of the uterus, as is often
the case when the immediate result of parturition or abortion,-not unfre-
quently terminates by resolution. Sometimes, even in these cases, it passes
into the chronic form. Apart from the puerperal condition, it is generally
observed in the chronic stage. Once it has become chronic, it may per-
petuate its existence indefinitely, if unmodified by treatment. Like all other
uterine inflammations, it is often kept alive, even in the best constitutions,
by the periodical exacerbations occasioned by the monthly molimen hemor-
rhagicum. Indeed, owing in a great measure to this cause, it is very rarely
that we see Internal Metritis, once it has attained the chronic stage, sponta-
neously terminating by resolution, at least during the persistence of the
menses. When the latter have definitely ceased, this form of uterine inflam-
mation, like those which we have studied or shall study, may gradually yield,
and eventually disappear under the mere influence of the modified functional
and structural vitality of the uterine organs. Confirmed Internal Metritis may
exercise a sufficiently severe sympathetic influence over the constitution to
debilitate the patient thoroughly, and to occasion death indirectly, by ex-
posing her, thus weakened and reduced, to the development of cachectic and
accidental affections.
“Pathological Anatomy. I have repeatedly seen the surface of the uterine
cavity presenting the anatomical evidences of inflammation, in patients who
have died of puerperal inflammation at various periods after their confine-
ment. The internal surface of the uterus was then red, swollen, congested,
and covered with a thin coat of muco-pus; but I have only once seen a
uterus presenting evidence of this form of disease in the non-puerperal state;
it was in the case of internal uterine ulceration, observed by Dr. Hall Davis,
to which I have alluded. The mucous membrane presented several large in-

BIBLIOGRAPHICAL RECORD. 151
flammatory ulcerations, situated on the internal surface of the uterine walls,
and quite distinct from the cavity of the cervix, which appeared free from
inflammation. There was, however, considerable disease of the uterus pre-
sent, besides the inflammation of its cavity. The organ was much enlarged,
its walls thickened, and its cavity greatly dilated.
“Diagnosis. The elements of a correct diagnosis of this disease are to be
found in the account which I have given of its symptoms. Internal Metritis
presents so many points of contact of inflammation of the cervix or of the
body of the uterus, that the diagnosis can only be satisfactorily established
by a rigorous analysis of the symptoms of all these diseases; with which,
moreover, it is generally complicated. I may, however, remind the reader,
that Internal Metritis is generally confounded with acute or chronic metri-
tis, but more especially with inflammation of the lining membrane of the
cavity of the cervic. In acute metritis, there is much more febrile reaction,
greater local pain, and more sensibility of the uterus. In chronic metritis,
there is a marked partial sensibility of the uterus, accompanied by local
changes in its volume. In inflammation confined to the cavity of the cervix,
muco-pus oozes out of the os uteri, and the cavity of the cervix is dilated,
but the os internum remains closed. Moreover, although the mucoso-puri-
form secretion may be streaked with blood, it is not mingled with it, as in
the acute stage of Internal Metritis. There is not that sero-sanguinolent,
sanious discharge which characterizes this latter disease, nor the often severe
reactional symptoms to which it appears to give rise.
“As I have already stated, it is to inflammation of the cavity of the cervix
that we must refer nearly all that has been written of late years by conti-
mental writers respecting Internal Metritis. They are evidently quite igno-
rant of the normal existence of the internal sphincter on which I have found
it necessary to lay such stress, and do not appear to have any clear view of
the comparative length of the two cavities of the cervix and of the body of the
uterus. Consequently,they have concluded that the injections, which they used
therapeutically, penetrated into the interior of the uterus, and cured the in-
ternal uterine inflammation which they supposed to exist; whereas, in reality,
the disease must have been nearly always confined to the cavity of the cervix,
and the remedies used cannot have penetrated beyond the os internum, that
is, beyond the sphincter, which separates the two cavities.”
It will be observed that, in the above extract, Dr. Bennet makes a state-
ment regarding the stricture between the cavities of the cervix and body of
the womb, which runs counter to much that has lately been written by Dr.
Simpson of Edinburgh, and his followers, as to the uterine sound. Dr. Ben-
net's assertion, that the arctation may be such as to prevent the entrance of
the uterine sound, and yet be not a morbid condition, if correct, would go far
to displace from practice the Edinburgh dilatation method of treating certain
cases of dysmemorrhoea and sterility; and it would likewise point out a diffi-
culty in the way of catheterism of the Fallopian tubes, which has not yet
been weighed. Having already given the anatomical statements which
bear on this stricture being normal or morbid (unless when temporarily
absent during menstruation), we can only call attention to the important
practical questions, which depend upon the point being correctly settled, and
not left, as at present, with authorities of high repute, and most ample expe-
rience, making opposing statements.
INFLAMMATION AND ABSGESS OF THE UTERINE APPENDAGES: OvaBIES,
FALLOPIAN TUBES, AND CELLULAR TISSUE. This is an important chapter,
upon a subject which, although exidently not unknown to the ancients,
receives but little satisfactory consideration, even in the best modern works.
This is the more remarkable, as abscesses in the lateral ligaments were well
described by Puzos. We consider this chapter very valuable, especially
that part of it devoted to Inflammation and Abscesses of the Uterine Append-
*.
152 BIBLIOGRAPHICAL RECORD.
ages in the non-puerperal state. In non-puerperal women, inflammation of
the lateral ligaments is most commonly confined to the “cellular tissue, and
to the organs contained between them, and does not extend to the free cellu-
lar tissue of the pelvic cavity”; and Dr. Bennet supposes that, in the puer-
peral form, the disease is, at least at first, similarly limited. These abscesses
generally open into the rectum or vagina; and the escape of the pus is often
the first notice which the patient, or the medical attendant, receives as to the
exact nature of the affection. The two diseases with which inflammation of
the lateral ligaments is most likely to be confounded, are acute metritis and
abscess of the iliac fossa. In the puerperal state, abscess of the lateral liga-
ments is generally associated with extensive abdominal and pelvic inflamma-
tion ; and it is not easy to determine in what structure the inflammation has
commenced.
INFLAMMATION, ULGERATION, AND HYPERTROPHY OF THE NEGK-of-THE
UTERUs. This subject is treated by Dr. Bennet under the following heads:
1. In the virgin female.
2. In the pregnant female.
3. During and after abortion and parturition.
4. In advanced life, after the cessation of menstruation.
5. As a concomitant of polypi and of fibrous tumours of the uterus.
This portion of Dr. Bennet's work occupies 160 pages, and contains a very
luminous account of the whole subject. At the same time, we cannot help
saying, that the same ideas are frequently repeated ; and that, by abridgment,
the value of the matter would not be diminished. There is also another
point, which deserves notice; and that is, the complete hold which the author's
favourite subject has acquired over his mind. We see, as it were, an ina-
bility on his part to recognize any other cause of deranged female health,
than Inflammation of the Uterus and its Appendages; and, in particular, of
the cervix. At the same time, it must be admitted that Dr. Bennet has
rendered essential service to obstetric medicine, by proclaiming the true
pathology of many cases, hitherto regarded incurable, of leucorrhoea, dysme-
norrhoea, menorrhagia, amenorrhoea, irregular menstruation, and partial pro-
lapsus. He has also pointed out the causes and treatment of abortion and
sterility in women who, some years ago, and even yet, we fear, might in many
instances be subjected to treatment, the very opposite of what is requisite or
proper. We would particularly draw attention to the general derangement
of health, which exists in connexion with Inflammation of the Neck of the
Uterus. We quite agree with Dr. Bennet, in thinking that digital or instru-
mental examination of the uterus, in unmarried women, ought very rarely
to be resorted to ; and perhaps we would have recourse to it even less fre-
quently than he would approve of, though nothing could be more satisfactory
than the following sentences, in which the subject is adverted to. “It is of
the utmost importance that no physical examination should even be thought
of in an unmarried female, unless there be next to a moral certainty that
inflammation and ulceration of the uterine neck actually exist. Fortunately,
a practitioner, familiarized with the disease, may generally acquire this con-
viction by oral examination of the patient, and by a careful and judicious
appreciation of all the elements of the case.” (p. 163.) And again, at p. 170,
we find the following passage : “Experience having thus taught me, that
severe ulcerative inflammation of the cervix uteri is occasionally met with in
unmarried females; that it is then the cause of great functional uterine disor-
der, and of extreme general debility; and that by physical examination only
can the disease be fully recognized and treated; I have no hesitation in stating,
that such an examination, in these earceptional cases, becomes imperative. As,
however, an investigation of this nature is a serious matter, and must be
equally repugnant to the feelings of the medical attendant and of his patient,
it should only be resorted to as an extreme measure—as a last resource. No
wi-
B} HL.IOGRAPHICAL RECORD. 153
practitioner, who has not acquired an accurate knowledge of these forms of
uterine disease in married females, ought, in my opinion, to resort to it on
his own responsibility, as he may, by so doing, unnecessarily expose his pa-
tient and her friends to great mental distress, through his ignorance of the
real meaning of the symptoms which she presents. It is only by educating
the finger by the eye, that it acquires that delicacy of tact which enables the
medical attendant to discover ulceration of the cervix by digital examination.
Indeed, I cannot too strongly insist on the practical importance of the fact,
hitherto overlooked in this country, that the information afforded by digital
examination is alike obscure and useless, until the finger has been educated,
and its errors corrected by the eye.”
INFLAMMATION AND ULCERATION OF THE NECK, of THE UTERUs, DURING
PREGNANCY. The remarks on this subject are full of practical interest; and
we feel assured, that their general truthfulness will be assented to, by every
one engaged in this department of practice. Cases of haemorrhage during
the early months of pregnancy, simulating menorrhagia, and casting a doubt
on the existence of pregnancy from their almost periodical recurrence, are
sufficiently common, though their true nature is but little understood.
This affection appears to have escaped the notice of all writers, British or
foreign, on uterime pathology. The history of its first observation is thus
given by Dr. Bennet.
“My attention was first drawn to inflammatory ulceration of the cervix
uteri in pregnant females, by M. Boys de Loury, one of the physicians of
Saint Lazare, an hospital-prison in Paris, where women of the town labour-
ing under syphilis are confined and treated. The speculum being used with
all the patients, as a means of exploration, (with those who are pregnant as
well as with those who are not), M. Boys de Loury thus discovered that
ulcerative inflammation of the cervix is not uncommon in pregnant women,
and that when left to itself, it frequently occasions abortion. I believe that
I am authorized to attribute to M. Boys de Loury this great discovery, as I
certainly never heard any other practitioner allude in the most cursory
manner to the subject, and I am not acquainted even with a hint respecting
it in the entire range of medical literature. M. Boys de Loury's discovery
was briefly noticed, in 1843, by one of his house-physicians, M. H. Costilhes,
in a thesis sustained before the Paris Faculty of Medicine. M. Costilhes'
cursory notice was the only one that had appeared of this pathological fact in
any language, when the first edition of the present work was published.
Since that time, I have devoted great attention to the elucidation of inflam-
matory ulceration of the cervix during pregnancy, and have ascertained that
it is of frequent occurrence, that it is the key-stone to the diseases of the
pregnant state, and the most general cause of laborious pregnancy, obstinate
sickness, moles, abortions, miscarriages, and haemorrhage. The results of my
researches on these points, as contained in the present chapter, were read be-
fore the physiological section of the British Association at Southampton, on
September 11th, 1846.
“Waluable corroborative evidence has since been brought forward by Mr.
Whitehead, of Manchester, whose laborious and interesting investigations on
this subject are contained in the Treatise on Abortion, which he published the
following year, in 1847.” (pp. 191-2.)
The disease will, on inquiry, be generally found to have existed previous
to conception; and this has led Dr. Bennet to modify his opinion with re-
spect to the production of sterility by inflammatory ulceration of the uterine
neck. It produces this effect chiefly in young married females, who have not
yet become pregnant.
The local symptoms are mostly the same as those which exist in the non-
pregnant state, but modified or obscured by the changed state of the uterus,
The diagnosis by the touch is rendered difficult by the fact, that both preg-
WOL, Il. * 11

154 B}BI, I OGItAPHICAL RECORD.
nancy and inflammation of the neck of the virgin uterus, are alike accom-
panied by increased volume in the cervix, an open state of the os, and
retroversion, coupled with a velvety surface. The affection may, however,
be diagnosed even in the early stage of pregnancy, by the following data.
“When inflamed and ulcerated, the non-pregnant cervix is usually more or
less indurated, whereas in the first months of pregnancy, even when inflamed
and ulcerated, it is generally, but not always, soft : the ulcerated os is much
more open than is consistent with the period of the pregnancy; and instead
of presenting a smooth surface, it has a very peculiar feel, of which the word
velvety scarcely conveys an idea. Its surface appears fungous to the touch,
and in a more advanced period of pregnancy, of a quaggy, pultaceous con-
sistency. In the midst of this fungous surface may sometimes be felt small,
moveable indurations, of the size of a large pin's head, constituted by indu-
rated and hypertrophied mucous crypts. On withdrawing the finger, it will
generally be found covered with muco-pus, and sometimestinged with blood;
indeed, the vagina generally contains a great quantity of muco-pus, espe-
cially in its upper region.” (p. 194.)
Examination with the speculum is somewhat difficult, on account of the
retroversion of the cervix ; hence Dr. Bennet recommends here the use of a
conical bivalve or large conical speculum. The cervix “will be found tumid,
congested, of a livid hue, voluminous, soft, or only partially indurated ; and
on one or both lips, generally penetrating into the cavity of the os, is seen a
more or less extensive ulceration, sometimes covered with large fungous
granulations.” Dr. Bennet considers the luxuriant fungosity to be exclu-
sively connected with the gravid state.
A previously hypertrophied and indurated cervix begins to soften at about
the third month of pregnancy; and this, no doubt, accounts for induration of
the os at the time of labour being comparatively rare.
The patient complains of pains in the lumbar, hypogastric, and ovarian
regions ; there is generally a profuse purulent secretion, often mixed with a
white flux from the congested cervix and vagina, which may obscure the na-
ture of the affection. There is often haemorrhage from the ulcerated surface.
This may be periodical, and simulate menstruation; but, though Dr. Bennet
denies that the haemorrhage can be assimilated to menstruation, he admits
that its periodicity is connected with the periodical molimen homorrhagicum
which accompanies this process.
In speaking of the general symptoms of this affection, which consist
in a derangement of the general health, Dr. Bennet offers some valuable re-
marks on its tendency to produce abortion. The symptoms are those which
are known to precede abortion ; and Dr. Bennet believes, that when mis-
carriage occurs, the symptoms preceding it are connected, much oftener than
is suspected, with inflammation of the neck of the uterus. “It stands to
reason, that the existence of ulcerative inflammation of the uterine neck
must often occasion such an amount of inflammatory congestion of the entire
uterine system, as to be incompatible with the development of the foetus,
even during the first months of pregnancy. Thence the death of the foetus,
repeated haemorrhage, diseased placenta, the formation of moles, and finally,
abortion. If the patient escapes during the first months of pregnancy, the
gradual dilatation of the inflamed tissues of the cervix which takes place in
the latter months, causes irritation, and exciting the uterus to contract by
reflex spinal action, may occasion abortion or premature labour. In a case
which I lately attended, the patient, a young married woman of four-and
twenty, labouring under severe inflammatory ulceration of the cervix, mis-
carried five times successively within the first four years of her marriage, at
the end of the sixth or at the beginning of the seventh month.
“In some instances, notwithstanding the existence of severe inflammatory
ulceration of the cervix, the patient goes to her full time, and is safely deli-
vered. But the fact of extensive ulceration existing at the uterine neck is a


Bf BLIOGRAPHICAI, RECORD. l 55
most unfavourable complication to labour, rendering the patient much more
liable to metro-peritonitis, and to the accidents which occasionally follow
parturition. r
“When once under the influence of appropriate treatment, the ulceration,
generally speaking, soon assumes a healthier, less luxuriant appearance, then
begins to cicatrize, and finally heals. When the progress of cicatrization has
fairly set in, and the irritability of the ulcer and of the surrounding tissues
has been subdued, there is but little fear of abortion taking place. But until
this is the case, abortion is imminent, and may, indeed, be feared daily. In
some instances, the morbid change which the disease has occasioned in the
uterus and its contents, has progressed too far before the treatment is com-
menced, and in spite of all our efforts, and even of progressive amelioration,
abortion takes place from some of the causes enumerated above. It is neces-
sary, therefore, to apprize the patient, under all circumstances, of the danger
she encounters, as she would otherwise be certain to attribute the miscarriage
to the instrumental examination.” (pp. 198-99.) With regard to the careful
use of the speculum during pregnancy, Dr. Bennet states it to be perfectly
harmless, and even imperative, from the great probability of the production
of abortion by the local affection.
Several interesting cases of inflammation of the neck of the uterus, during
pregnancy, are detailed; of these we will select a few, as illustrative of this
evidently important, but obscurely-known, affection.
CASE. Abortion prevented. Cure. Death from Metro-Peritomitis, after a
favourable confinement. “June 26, 1846. I was consulted at the Western
Dispensary by Eliza T , a pale, sickly-looking, young married woman,
aged twenty-three. Her uterine and general antecedents were as follow :—
Menstruated at sixteen ; she continued to be so regularly every three weeks,
until she married, four months ago, at the end of last February, just after
menstruation. The menses were, usually, abundant, lasting four days,
during the first of which she was generally in an agony of pain ; and were
followed by a white leucorrhoeal discharge for some days. Her health, how-
ever, was very good, until about a twelmonth ago, when the whites increased
in intensity, lasting during the entire menstrual interval, and she became
weak and poorly. She also experienced severe pain in the back, and occa-
sionally in her side. After her marriage, the first attempts at intercourse
were followed by such severe uterine pains, that she was obliged to return
home to her family, and was confined to her bed for above a week. The same
symptoms afterwards occurred on every similar occasion; and were always
accompanied, as at first, by the loss of more or less blood. The leucorrhoeal
discharge, which she recollects to have been then of a decidedly yellow cha-
racter, was occasionally streaked with blood, even in the absence of the cause
mentioned. There was never any flow of blood, however, which could be
considered menstrual. Her general health gradually became more and more
affected. When I saw her, she was pale and sallow, although rather stout,
and felt very weak and ill. Tongue white, no appetite, bowels constipated,
cephalalgia, cardialgia, rest bad, disturbed by dreams, frequent hysterical and
fainting fits. g
“On examination, I found the uterus enlarged, rising in the abdomen
several inches above the pubis, as in the fourth or fifth month of pregnancy.
The cervix, although voluminous, was not much indurated: the os was very
open, and around and within it, the spongy sensation of an ulcerated surface
was evident. On withdrawing the finger, it was found covered with pus
tinged with blood. On using the speculum, the vagina appeared much more
florid than is generally the case in the first months of pregnancy; it was lax,
and contained a considerable quantity of pus. The cervix was voluminous,
congested, of a florid-red hue, and presented an extensive fungous bleeding
ulceration, existing on both lips of the cervix around the os, and extending
into the cervical cavity. The ulceration was freely cauterized with the
11
156 I31 [3]_IOG RAI’HICAL I&ECQ RID.
nitrate of silver; alum injections were prescribed, perfect rest, an occasional
saline aperient mixture, and very light diet.
‘ “July 3rd. The application of the caustic was followed, for several days,
by an abundant sanguineo-purulent secretion. On the disappearance of the
blood, the discharge diminished in quantity. The patient feels easier; the
uterine and lumbar pains are less intense ; the ulceration has a less fungous
and more healthy appearance. Treatment the same as before.
“10th. The ulceration is diminished to half its original size, and is
healthy-looking ; vagina less injected ; pains in uterus and back very much
º: ; leucorrhoea less ; alum injections, cauterization with the nitrate of
SI IV el'.
“ 17th. Ulceration healed, except in the cavity of the open cervix, and
immediately around it. Leucorrhoeal discharge, white, no longer purulent ;
the fainting fits are less frequent, and the general health is much improved.
Same treatment. - - *
“August 10th. On examining the cervix, I found the ulceration com-
pletely healed ; the redness of the vagina and uterine neck was merely what
it usually is at this period of pregnancy; the pains in the back and uterus
had almost entirely disappeared, as also the leucorrhoeal discharge. The
general health had rallied in a very marked manner. She had not felt so
well, she said, for months before her marriage.
“On the 1st of September, I again ascertained, instrumentally, the perfect
integrity of the cervix. I continued, however, to see her at intervals. She
remained quite free from her former uterine symptoms, gradually recovering
health and strength, although rather weak. When I last saw her, in the
eighth month of her pregnancy, she did not present an unfavourable symp-
tom, and appeared in good spirits. She had latterly had a severe attack of
acute bronchitis, from which she had quite recovered. I then lost sight of
her, and only heard, some months afterwards, that she had entered Queen
Charlotte's Lying-in Hospital, for her confinement, which took place favour-
ably, but that she was attacked with metro-peritonitis, and died a few days
afterwards.” (pp. 208-10.) i;
“CASE. Ulcerative Inflammation of the Uterine Weck recognized in the
sixth month of Pregnancy; Abortion; Four previous Abortions at the same
period of Pregnancy; ultimate Recovery. April the 12th, 1846, I was re-
quested, at the Western Dispensary, to sign a midwifery letter, by Elizabeth
G., a married woman, aged 28, six months gone in her fifth pregnancy. On
inquiring as to the present and past state of her health, a precaution which
I generally take under similar circumstances, I was told that she felt very
unwell; that she had miscarried four times since her marriage, within the
last four years; that the last three miscarriages had occurred at six or seven
months, the period of pregnancy at which she had then arrived ; and that
she then experienced all the symptoms which had preceded the former mis-
carriages. This statement induced me to examine more minutely into her
history, when I ascertained the following details. Tall, and rather thin, her
health had been always delicate ; she was born, and brought up, in town.
Menstruated at seventeen, she was irregularly unwell, but without pain, for
a year ; the menses then disappeared for two years, during which time she
was very poorly. At twenty they returned, and continued to appear regu-
larly until she married, at the age of twenty-four. She became at once
pregnant, and aborted at three months; cause unknown. Her second abor-
tion, which occurred at six months, as likewise the subsequent ones, was pre-
ceded by a week's flooding, and she was confined to her bed for a fortnight.
Since that, epoch she has always had a yellow leucorrhoeal discharge. As a
girl, she often had ‘the whites,’ but the discharge was never yellow. IIer
abortions, were never preceded by any circumstances to which she could
ascribe them. Uterine pains, sometimes accompanied by flooding, came on
a few hours or days previous, gradually increased, and terminated in the ex-


BIBLIog RAPHICAL RECoRD. 157
pulsion of the foetus. During the present pregnancy, she had been much
weaker, and more generally indisposed, than before ; so much so, that she
had not been able to work at all, which was not the case in her former preg-
nancies. She had had, throughout, severe pain in the lumbar region, and
occasionally slight pains in the ovarian and hypogastric regions. The leu-
corrheal discharge has been, for some months, more abundant, and thicker.
For the last two months she had experienced severe cephalalgia, accompanied
by extreme heaviness. The appetite, however, was tolerably good; bowels
costive; rest indifferent. . She had been much troubled latterly by nausea
and acidity. Pulse very full. … " . . . ~ ;
“On examining digitally, I found the abdomen developed, the uterus
rising above the umbilicus, as in the beginning of the seventh month of preg-
nancy. The vagina was moistened by an abundant secretion, The cervix,
in its usual position, more voluminous, and softer, than it is normally at this
period of pregnancy, formed a quaggy mass; its surface, of a fungous soft-
mess, presented, more especially round the os, which was very open, numerous
small indurations, about the size of large pin-heads. On withdrawing the
finger it was covered with thick whitish pus. This pulpy, fungous state of
the cervix, along with the partial indurations, the purulent discharge, the
general symptoms, and the previous history of the case, all indicating the
existence of extensive Ulcerative Inflammation of the Cervix, I proposed an
instrumental examination. This, however, the patient would not consent to;
I therefore ordered her to be bled to twelve ounces, and gave her a mild
purgative. - - . . . . . . . . . . . . "
“On the 21st I saw her again. The bleeding had slightly relieved the
cephalalgia, and softened the pulse; but all the other symptoms were present,
and had more attracted her attention since I had so minutely questioned
her. On my again pointing out the necessity of instrumental examination,
she no longer offered any objection. The vulva was congested and swollen;
the vagina red, tender, and bathed with pus. On getting the cervix between
the expanded blades of the conical bivalve speculum, I found that it pre-
sented a large fungous ulceration, covered with pus, and bleeding easily on
being touched. The entire cervix was covered with luxuriant granulations,
and presented a very different appearance to that which ulceration offers in
the unimpregnated state. It was a fungous ulceration, softened and broken
up as it were. From the regularity of the surface, however, from the absence
of uneven, deep-seated induration, and the frankly purulent nature of the
secretion, the ulceration was evidently of an inflammatory nature. I there-
fore touched the entire diseased surface with the nitrate of silver, and ordered
astringent vaginal injections, with the sulphate of zinc, night and morning;
mild aperients, and a tonic antacid mixture (infusion of gentian and carbon-
ate of magnesia); light diet; complete rest. -
“28th. The application of the nitrate of silver was followed by a slight
oozing of blood for three days, but by no increase in the local pains. The
latter are still severe in the lower segment of the developed abdomen, and in
the loins. The yellow discharge is very abundant. She has the same bear-
ing-down pains which preceded her other miscarriages. Same treatment.
“May 4th. I was summoned to Mrs. G.'s residence, and found that she
had miscarried, during the previous night, of a seven months' child, which
lived a few hours only. The bearing-down uterine pains had never left her
from the time I last saw her. The previous afternoon they had been suc-
ceeded by regular labour-pâins; and the confinement was completed in the
course of eight hours, without anything unusual having occurred. I con-
tinued to see her for the first two weeks after delivery, during which period
mo unusual symptom appeared. She suffered, however, more tha" is gene-
rally the case from uterine pain; and the lochial discharge was" ºre than
usually abundant. - . . . . . .
“June 3rd. She was examined with the speculum. The vagina was very
| 58 BIBLIOGRAPHICAL RECORD.
red and congested, and contained pus. The cervix was voluminous, not very
hard, and presented an ulceration as large as a half-crown. The ulceration
had a florid fungous surface, but did not offer the pulpy appearance which
characterized it during pregnancy. She had still the old pains in the back,
and in the hypogastric and ovarian regions, and an abundant yellow dis-
charge ; appetite bad; tongue white ; feels very weak. The ulceration was
touched with the nitrate of silver; injections, with a solution of alum, pre-
scribed, and a saline mixture; light diet; rest, in the recumbent position.
“This, the usual treatment which I pursue in such cases, was persevered
in during the month, the ulcerated surface being regularly cauterized once
a week with nitrate of silver, or the acid nitrate of mercury. The menses
returned at the beginning of the month, and lasted four days. Their mani-
festation was attended with considerable pain. Towards the latter part of June
she had an attack of diarrhoea, then very prevalent, which proved obstinate.
“July 31st. The ulceration was healed ; the cervix was still more volu-
minous than natural, but soft throughout. On opening the lips of the os,
and examining its cavity in a good light, there was still seen, however, vivid
redness of the internal mucous membrane lining it; which was touched, for
the last time, with the nitrate of silver. Slight white leucorrhoea only. The
vaginal mucous membrane was of a deep red colour, the body of the uterus
rather voluminous, the breasts large, the areola prominent. She had not
menstruated since the beginning of June, and was probably pregnant. She
stated that she had never been so well since her marriage ; she ate and slept
well; had no headache, and felt strong. Six weeks later I again examined
this patient instrumentally, and found the cervix and its cavity perfectly
sound and healthy. There were no morbid phenomena, local or general. The
pregnancy was then manifest. It continued to progress favourably ; she had
no aches nor pains, no vaginal discharge, and continued well throughout its
course; very different to what she had been in any of her previous preg-
nancies. At the full period, she was safely confined of a healthy child, and
has since done very well, remaining perfectly free from uterine symptoms.”
(pp. 212–217.)
For the excellent remarks on these and similar cases, made by Dr. Bennet,
we must refer our readers to his work. We will only further observe, that
he “firmly believes that most of the abortions which occur in the early months
of pregnancy, from diseased ova and placenta, as well as those which are pre-
ceded by flooding and the death of the foetus, are, in reality, the result of
inflammatory disease of the neck of the uterus.”


The next chapter treats of INFLAMMATION, ULCERATION, AND INDURATION, of
THE NECK of THE UTERUs, DURING AND AFTER ABORTION AND PARTURITION.
The subjects brought under notice are, its connexion with rigidity of the os
during labour; with laceration and abrasion of the cervix ; with flooding;
and with the morbid symptoms that follow natural and difficult labour. We
must, however, pass over this chapter, as well as the one on Inflammation
and Ulceration of the Neck of the Uterus in advanced life, after the cessation
of menstruation. - -
... INFLAMMATION AND ULCERATION of the Neck of the Uterus Accompany ING
UTERINE POLYP1, is a frequent circumstance, the practical importance of which
is well pointed out by Dr. Bennet. He says that the contact of the pedicle
and of the narrow extremity of a fibrous polypus on the expanded lips of the
os uteri, appears often to produce irritation, and, eventually, inflammation
and ulceration. His reasons for this belief are, “the probability that the
contact of a morbid growth with so susceptible a mucous membrane would
produce inflammation ; and that the mere existence of a tumour developed
in the substance of the uterus, without any local cause of irritation, is fre-
quently attended with ulceration of the cervix.” The presence of ulceration
of the cervix, in cases where the interior of the uterus is the seat of a fibrous
BiB L1 OGRAPHICAL RECORD. 159
tumour, would, we think, very much interfere with the safe dilatation of the
os uteri by sponge-tents for the purpose of being able to reach the tumour
within, as recommended by Dr. Simpson in the Edinburgh Monthly Journal
of Medical Science, for January 1850.1 Dr. Bennet considers the inflamma-
tion and ulceration accompanying fibrous polypi to be the principal cause of
the local pains, discharges, and constitutional symptoms which attend this
affection ; and points out that such a state may keep up a congestion of the
uterine system highly favourable to the development of the polypus. He
has found great benefit to arise from the removal of the inflammatory affec-
tion of the cervix. Similar remarks are applied by Dr. Bennet to vascular
polypi growing from the cervix. Of these he observes, that the patient is by
no means cured when these are removed. “The presence of the polypus is
merely an element in the case ; of importance, inasmuch as it is probably, in
most instances, the cause of the irritation and ulceration of the mucous sur-
face, but having in itself little evil reaction over the system. The distressing
uterine and general symptoms which usually exist, and direct the attention
of the medical attendant and of the patient to the uterus, are the result of
the local inflammatory disease secondarily produced, and can only be removed
by its removal.” (p. 251.)
While we express our opinion of the importance of the views which Dr.
Bennet has promulgated in the chapter before us, we would caution our
readers against being so far led away by them, as to be content with pallia-
tive means, to the neglect of operative interference, when at all possible. The
author himself we cannot accuse of this fault; he appears to judiciously limit
the application of his views. “In the cases in which the tumour can be re-
moved, the patient is only half cured if extensive inflammatory lesions are
allowed to remain ; whilst in those in which the tumour is beyond the reach
of instrumental means, the only chance we have of arresting its increase, and
of restoring the patient to tolerable health, is our being able entirely to
subdue all inflammatory action in the uterine system, thus bringing it to a
state of quiescence.” (p. 251.) The latter clause of this sentence will be
somewhat modified, in the minds of many, by a perusal of Dr. Simpson's
paper, to our abstract of which we refer them. Though the introduction of
Dr. Simpson's sponge-tents into the os uteri, may be greatly interfered with
by the presence of inflammation and ulceration, yet, by attending to Dr.
Bennet's suggestions to moderate uterine inflammatory action, the operation
proposed by Dr. Simpson may, we think, be sometimes advantageously per-
formed : at any rate, it is worthy of attention, originating from so distin-
guished an authority. Dr. Bennet relates several illustrative cases; one in
which there was a fibrous polypus lying in the vagina, attached by its pedicle
to the cervix uteri, and accompanied with extensive inflammatory ulceration
of that region, and severe constitutional disturbance. The polypus was re-
moved : and the ulceration healed by cauterization with nitrate of silver.
The second case we transcribe. .
“CASE. Fibrous Polypus of the Uterus, complicated by Inflammatory
Ulceration of the Cervic. On the 1st of May, 1845, Mrs. D , aged fifty,
came to town, from Somersetshire, by the advice of her medical attendant,
to place herself under my care. During eight years she had suffered from
uterine haemorrhage, the intensity of which had gradually increased. She
had had several children, the last at the age of forty-two. The two following
years she miscarried at three months. After the last miscarriage she was
seized with flooding, which returned at each menstrual period to such an
extent as greatly to debilitate her; sometimes even producing syncope. At
the age of forty-five she ceased to lose blood at periodical periods, but since
that time the haemorrhage has been nearly continual ; seldom sºlº passing
; : ** { } jº

{{ {}}
* For the substance of Dr. Simpson's paper, see our Reports of #Edinburgh
Medico-Chirurgical Society. $
160 BIBLIOGRAPHICAL RECORD.
without more or less blood being lost. She has presented for some time all
the symptoms of extreme anemia; the skin is sallow, the body emaciated ;
she suffers from palpitations, headach, want of sleep, and extreme debility;
and a bellows-murmur is heard over the heart and along the arteries. The
digestive functions do not, however, appear much disordered ; the appetite
is good, and she takes a great quantity of meat, wine, and porter, in order
to keep up her strength. Complains of lumbar and hypogastric pains, and
of a bearing-down sensation when walking. On examination per vaginam,
a pedunculated tumour, as large as a goose's egg, was found situated in the
vagina, issuing from the orifice of the os uteri. The examination occasioned
a copious flow of blood. Ligature of the tumour was proposed, and gladly
accepted, as she had been told that no operation was possible. -
“On the 3rd, the bowels having been previously well relieved, I passed a
whipcord ligature round the neck of the tumour with great ease. The
haemorrhage during the process was, however, considerable ; the blood
evidently exuded from the entire surface of the tumour, which was exposed
by the mere separation of the labia, and which was of a florid red colour.
“ 11th. The tumour escaped from the vagina whilst she was making
water ; the canula and ligature remaining. On exercising traction, I brought
down the uterus, but did not bring away the ligature and canula. I was,
therefore, obliged to untie the whipcord, and pull it through one of the
branches of the latter.
“ 17th. Examined the os uteri with the speculum, and found a large
ulcerated surface on the anterior and posterior lips. The anterior was much
more voluminous than the inferior, and was the principal seat of the ulcera-
tion. There was no trace whatever of the pedicle of the tumour. Cau-
terized the ulceration with the nitrate of silver ; ordered injections with
sulphate of zinc ; sesquioxide of iron half a drachm a day, and a nourish-
ing diet. -
“On the 25th, she was absolutely obliged to leave town for family reasons,
although the ulceration was not healed. I ordered her to use the sulphate
of zinc injections carefully for some weeks. The sallowness of complexion
was already much modified, and she felt stronger than she had done for
some time.
“I subsequently learnt that her general health had very much improved.
She still felt pain in the back, which might probably be owing to the ulcera-
tion not having quite healed. As, however, I have not again heard from
her, it is probable that these symptoms gradually subsided, and that the
cervix is restored to a state of integrity”. (pp. 254-55.)
The third case is an interesting one of vascular polypus, in which the
patient had been long and unsuccessfully treated for inflammation of the
womb, without having been examined by the speculum. A vascular
polypus was discovered by Dr. Bennet, conjoined with extensive inflamma-
tion and ulceration of the uterine neck. We can only quote the conclusion
of the case:–
“By means of a pair of speculum forceps, with a small serrated ex-
tremity, I broke down, and brought away, by torsion, the small tumour,
and the greater part of its pedicle. A few drops only of blood were lost. I
subsequently cauterized the ulcerated surface, which appeared to extend
to the entire depth and circumference of the cavity of the uterine neck.
“From this time the case resolved itself into one of simple inflammation
and hypertrophy of the cervix, along with deep-seated ulceration; and was
treated by the means which I usually employ—cauterization at variable
intervals, emollient or astringent vaginal injections, hip-baths, leeches to the
inflamed cervix, and rest in the recumbent position. Both the inflammation
and ulceration, however, proved very rebellious to treatment. It was only
by very slow degrees that the inflammatory hypertrophy of the lips of the
cervix subsided. As this change occurred, the cervix, which, as we have

BIBLIOGRAPHICAL BECOR}). 161
seen, was very low and retroverted, gradually rose in the pelvis, and partly
assumed a more normal direction, the ulceration likewise cicatrizing.
“The ulceration external to the cavity of the os healed in the course of a
few weeks, but the internal ulceration proved very obstinate, and the more
so the deeper it was situated. It was only after an almost uninterrupted
treatment of five months that the cavity of the cervix was completely
healed. As it cicatrized it closed, until, from being long sufficiently open
for an inch in depth to admit a large-sized drawing-pencil, it became so
contracted as merely to admit the uterine sound. For the last six weeks of
the treatment, the ulceration appeared limited to a small deep seated surface,
probably that from which the polypus sprung, near the inner orifice of the
cavity of the uterine neck. At the time the local treatment was brought to
a close, the cervix was at least two inches higher in the pelvis than when I
extirpated the polypus. It was also very much smaller, very much less retro-
verted, and presented no evidence of inflammatory induration, although still
rather larger and harder than natural. The vagina was quite healthy. All
the uterine organs were, however, still very sensible to the touch ; but in this
respect they merely participated in the exaggerated State of nervous sensi-
bility of the entire economy. Ever since the evulsion of the polypus, there
had been no continued sanguineous discharge after the monthly periods,
although the purulent discharge was often streaked with blood, especially
after cauterization. The menses flowed rather abundantly for five or six
days, and were then replaced by the purulent or sanguineo-purulent discharge
from the ulcer.
“The slowness of the process of cicatrization in this case may be accounted
for by two circumstances, first, by the very lengthened existence which I
feel warranted in ascribing to the local disease ; and secondly, to the very
debilitated state of the general health, depraved by fifteen years of flooding and
suffering. Not only was the patient so reduced by the continued loss of
blood, morbid and artificial, that loud anaemic murmurs were heard in the
heart, and in the large bloodvessels, but the digestive and nervous system had
received a severe shock. The stomach could scarcely bear even the lightest
food, and that only in very small quantities; the action of the bowels was
irregular, they were often relaxed and irritable; and no stimulant, or dietetic
or medicinal tonic, could be borne. She had been salivated more than once,
and attributed the extreme susceptibility of the digestive system partly to
this cause. Iron, quinine, iodine, etc., were all tried at various periods, but
as often suspended from the disturbance they created in the economy. The
intercostal, the sciatic, the crural, the dorsal and other nerves, were all at
different times the seat of severe neuralgic pains, which generally proved
rebellious to local therapeutic agents. They seemed to change their seat, or
disappear, under the influence of atmospheric variations, or of mental or
bodily conditions of a still less tangible nature, and were evidently the result
of the general anaemic state of the economy.” (pp. 260-3.) -
We must pass over the chapters on INFLAMMATION OF THE WAGINA AND
WULVA and on the CoNNExIon BETWEEN INFLAMMATION of THE UTERUs or
ITs NECK, AND FUNCTIONAL DERANGEMENTS AND DISPLACEMENTs of THE
UTERUS, with merely recommending them, though there is, in the latter
chapter, much repetition of what has been already said, • .
SYPHILITIC ULCERATIONs of the Neck of the Uterus have, according to Dr.
Bennet, escaped the notice of most writers on uterine diseases. He divides
them into two classes: 1. The true Hunterian chancre, which, he believes, to
be very rare : and 2. Non-chancrous ulcerations, which frequently compli-
cate blennorrhagia and the secondary forms of syphilis. ºf . , , , -
The complication of secondary syphilitic symptoms, with ulceration of the
cervix uteri, was observed by Dr. Bennet in 1843, while in charge of a female
skin-ward of seventy-five beds, in which there were always a great number of
syphilitic skin diseases. He examined them with the speculum, and was led

162 BIBLIOGRAPHICAI, RECORD.
to adopt this course “by finding, on inquiry, that several of those patients
who presented no syphilitic disease of the external genital organs, except
trifling leucorrhoea, were labouring under the symptoms which I have enume-
rated as indicating slight inflammation and ulceration of the cervix uteri.
On examining these latter patients, I found the cervix ulcerated and slightly
indurated, and it then occurred to me that the others might be similarly dis-
eased, although they had not directed my attention to any symptoms of
uterine disease. To my great surprise, I found that three out of four—per-
haps more—also presented ulcerations of the cervix. Most of these patients
were young women who had either never borne children, or had been confined
several years previously, and were under treatment for syphilitic psoriasis,
lichen, rupia, etc. When questioned narrowly, they all admitted that they
experienced slight hypogastric pain; that congress had been rather painful
for some time; some, that they had likewise a slight leucorrhoeal discharge.
They had not, however, paid any attention to these symptoms. - - - - -
“What was the nature of these ulcerations ! Were they syphilitic, modi-
fied chancres, or secondary ulcerations; or were they merely inflammatory
sores'. In their appearance, I myself could discover little or no difference
from the ulcerations observed in non-syphilitic patients, and was therefore
inclined to deny their general syphilitic nature. Some were large, some
small : some had a well-defined margin, others not ; some were covered with
large unhealthy granulations; others with small, florid, healthy granulations;
whilst some, again, presented a kind of pseudo-membranous film.” (p. 324.)
Dr. Bennet differs from M. Gibert, who thinks that these are modified
chancres. As to their being secondary, he does not think they are so in a
large number of cases. Their nature he then considers to be inflammatory.
He concludes this chapter by the following propositions:
“First. The real classical chancre, presenting its ordinary physical cha-
racters, is eaccessively rare on the cervix uteri.
“Secondly. Ulcerations presenting the characters of the inflammatory
ulceration are, on the contrary, excessively common in patients labouring
under blennorrhagia, or primary, secondary, and tertiary syphilis.
“Thirdly. Some few of these ulcerations may be primary or secondary,
but the very great majority are merely inflammatory.” (p. 329.)
CANGER of THE UTERUs. The diagnosis has not, according to Dr. Bennet,
arrived at a very high degree of perfection. Those who have written on the
disease, would appear to have described hypertrophied induration of the neck
as the incipient stage of cancer; while Dr. Bennet thinks this stage remark-
able for its quiescence, and that patients seldom apply for relief until a cancer
has far advanced. He gives copious extracts from the works of Sir Charles
Clarke, Dr. Ashwell, and Dr. Montgomery, showing the prevalence of the
opinion, that cancer may be arrested in its early stage; and he subsequently
quotes several of their cases, making remarks on them.
His critical examination of the physical data on which the views of most
other writers are founded, we quote entire :—
“The principal anatomical changes stated to characterize Cancer in its
incipient, non-ulcerated stage, by the three authors I have quoted, are as
follow : A firm tumour, of a rounded form, springing from the surface of the
cervix, or embedded in it, or general enlargement and hardness of the cervix ;
an open, gaping os, which admits the extremity of the finger; perfect free-
dom of the vagina from thickening or disease.—(SIR CHARLES CLARK.) Hard
tumour of the entire cervix ; puckering and hardening of the edges of the
os, and hard tumours deposited in any portion of the cervix ; a dull white,
or slightly grey, colour of the mucous membrane covering the cervix,−(DR.
AsHwBI.L.) Margin of the os hard, slightly fissured, projecting into the
vagina, and irregular; in the situation of the muciparous glands are felt
several small, hard, and distinctly-defined projections, like grains of shot,
painful on pressure; cervix slightly enlarged, and harder than natural; cir-

BIBL106 RAPHICAL RECORſ). 168
cumference of the os turgid, of a deep crimson colour, the projecting points
being bluish ; no thickening or disease of vagina, or consolidation of the
uterus to the pelvic contents.-(DR. MonTGOMERY.)
“All these are anatomical conditions which may be produced in the neck
of the uterus, and are daily produced, by inflammation and puerperal lacera-
tion of its orifice.
“The enlargement of the cervix described by Sir Charles Clarke is evi-
dently that produced by inflammatory hypertrophy; and the two chapters
which he devotes to ‘Carcinoma of the uterus, and its treatment’, in the non-
ulcerated stage, are clearly descriptive, in almost their entire extent, of in-
flammatory hypertrophy alone. The ‘form’ in which a firm tumour springs
from the surface of the cervix, is probably hypertrophy limited to one lip;
whilst the form in which there is enlargement and general hardness of the
cervix, is general hypertrophy. If any evidence, beyond the mere descrip-
tion of the state of the neck of the uterus, were wanted to indicate the in-
flammatory nature of these changes, it would be found in the open, gaping
state of the os, admitting the end of the finger. This is the characteristic
condition of the os uteri in inflammatory hypertrophy.
“Dr. Ashwell, falling into the same error, admits the malignant nature of
simple “hard tumour of the cervix’, as he designates the condition described
by Sir Charles Clarke. He considers also puckering and hardening of the
edges of the os, with the presence of hard tumours in any region of the cer-
vix, as characteristic of cancerous disease. Dr. Montgomery's description of
incipient Cancer seems limited to the latter changes.
“Puckering of the edges of the os has always appeared to me merely the
result of laceration of the os and cervix during labour, and of subsequent
inflammation of the lobules into which the margin of the os and cervix is
thus accidentally divided, as I have elsewhere explained (p. 225).
“The cervix is, in reality, frequently lacerated; and if Dr. Ashwell has
not observed this to be the case (see page 433 of his work), it must be that,
on the one hand, he has not analyzed with sufficient care the results fur-
nished by digital and instrumental examination ; and that, on the other,
he has mistaken for incipient Cancer the cases in which the lacerations, not
having healed, have led to a puckered, indurated state of the edges of the os.
When laceration occurs in abortion or labour, if the parts involved do not
return to a healthy state, but remain ulcerated and inflamed, lobes are formed
around the os, separated from one another by fissures more or less deep.
These lobes, although merely inflamed, may become of a stony hardness; and
when this occurs, the hardness is very erroneously supposed to characterize
schirrus, and is cited as an evidence of the malignant nature of the disease.
If the lobes thus formed around the os, and thus indurated, be considerably
hypertrophied, they present exactly the sensation to the touch which Dr.
Montgomery compares to the ends of the fingers brought closely together,
and which he considers to characterize the second stage of Cancer.
“The isolated nodosities described by Dr. Montgomery may certainly be
cancerous nodules; but they may also be merely muciparous glands inflamed
and indurated. In fact, their being of a crimson hue would seem to show
that such is really the case, inasmuch as cancerous growths in mucous mem-
branes are rather characterized by a bleaching or whitening of the tissues
which they attack.
“Thus, a critical analysis of the anatomical changes ascribed to incipient
Cancer, shows that, on the one hand, these changes present nothing special,
nothing that can be said to characterize, as malignant, the case in which
they are found; whilst, on the other, it shows that they are constantly met
with as the result of inflammation.” (pp. 350–354.)
The progress of the so-called incipient cancer, its quiescence for years, its
yielding to treatment, afford Dr. Bennet additional confirmation of his
views. He concludes that cancer is as untractable in the womb, as in other
164 BIBLIOGRAPHICAL RECOHD.
organs, and much more prompt, according to Dr. Hughes Bennett, to enlarge,
soften, and ulcerate.
The symptoms which really characterize incipient cancer, Dr. Bennet is
unable to describe, as he has never seen a case of the kind ; but he would
“expect to find shot-like, pale, indolent indurations, all but insensible to
pressure, strewn irregularly over the cervix ; or an irregular hard tumour,
similarly characterized, developed on its surface. This description of what
I should expect to find is drawn from the state of the non-ulcerated parts of
* uteri when examined in its more advanced or ulcerated stage.”
. 368.
*T. * concludes with some remarks on ulcerated cancer of the
cervix uteri, and on cancroid growths. Dr. Bennet's observations lead us to
hope that the non-cancerous nature of certain diseased conditions of the
uterus may be so far established by him, as to afford encouragement to the
practitioner, and to relieve many patients from the groundless apprehension
that they are labouring under malignant disease. Dr. Bennet's partiality for
inflammation of the uterus, perhaps leads him sometimes a little too far, and
may, if his views be carried out by others, tend occasionally to an error of
diagnosis in the opposite direction. What he has written on the diagnosis
of Cancer of the Uterus, should be compared with the opinions of other
authors, and brought to the test of experience. In this way, either his
opinions may be confirmed, or we may arrive at a more precise knowledge of
the incipient stages of the affection. It is certainly very questionable, whether
true incipient cancer be really so curable, as is asserted by many writers.
TREATMENT OF INFLAMMATION of THE NECK OF THE UTERUs. The local
remedial measures principally consist of vaginal injections, hip-baths, local
depletion, and the use of caustics. Ulceration or hypertrophy do not prevent
them from being used.
Vaginal injections, properly used, are very valuable: and cold water alone
is often very beneficial, not only in washing away the mucus which tends
to stagnate, but as a powerful tonic and astringent. To produce an anodyne
effect, a few drops of laudanum, or a drachm or two of tincture of hyoscy-
amus, may be added to the water; but Dr. Bennet remarks, that a more
powerful sedative effect may be obtained by the injection of anodynes into
the rectum, which is in accordance with our experience. As an astringent
injection, he prefers alum, generally in the proportion of a drachm to a pint
of water.
However useful injections are in cleansing the vagina from all morbid
secretions, in diminishing uterine irritation, and in removing vaginal and
vulvar irritation, they are generally powerless to subdue confirmed inflam-
mation of the cavity of the cervix : mainly because the region affected is not
reached. Dr. Bennet admits that some of the milder cases of ulceration, or
non-ulcerative inflammation may be treated, when recent, by emollient and
astringent injections, and attention to the general health ; but in these
cases, he says, the treatment cannot be depended on, and is more tedious
than that by caustics.
In order that the full benefit should be derived from vaginal injections,
Dr. Bennet recommends, that the patient should be placed in the horizontal
position, with the pelvis slightly elevated. The instrument he recommends
is a pump syringe, with which any quantity of fluid can be thrown in. To
the inefficiency of small syringes, which have to be frequently introduced, in
order to produce any effect, he attributes the discredit into which the use of
vaginal injections has fallen. For the poorer classes, he recommends a large
metal syringe with a long curved extremity. In all cases, we prefer a nicely-
rounded glass syringe, about half an inch or more in diameter. To ascer-
tain whether the injection reaches the entire extent of the vaginal cavity,
Dr. Bennet recommends that the patient should use an aluminous injection,
BITELIOGRAPHICAH, RFCORD. 1.65
an hour or two before being examined. “Unless the vaginal secretion be very
profuse, all that part of the vaginal cavity, which the injection has reached,
will be contracted, so as to admit with difficulty the introduction of the
finger. If, however, it has only washed the lower part of the vagina, the
finger, after passing the contracted region, finds the upper part moist and
uncontracted.” (p. 282-3.)
Leeches are a valuable means, both of moderating intense inflammatory
action, and also of diminishing or removing the congestion which frequently
attends menstruation, when the cervix or body of the uterus is the seat of
inflammation. Dr. Bennet thinks them more certain than scarification ; and
the flow of blood may be arrested easily by an alum injection. We generally
prefer depletion by the scarificator, by which, when properly used, a suffi-
cient quantity of blood can always be obtained. Nurses rarely apply
leeches properly, and the medical attendant has seldom leisure to superin-
tend their application.
Dr. Bennet has been able to test the efficacy of local depletion, on a large
scale, in the Western Dispensary ; and has arrived at the conclusion, “that
local depletion, although a great adjuvant, is by no means indispensable to
the successful treatment of inflammation of the uterus and of its cervix.
My dispensary patients, treated without leeches, get well, as do those whom
I attend in private life, and with whom I employ depletion. Merely the
latter get well sooner, and with less suffering; because, by the local abstrac-
tion of blood, the inflammation is sooner favourably modified, and the morbid
congestions connected with menstruation, which so much aggravate the
sufferings of patients, and so greatly retard their recovery, are prevented or
removed.
“At the same time, I have become convinced, through the experience
thus acquired, that if, by frequent leeching, or by a too copious abstraction
of blood from the occasional application of leeches, the general strength of
the patient is permanently reduced ; she is placed even in a more un-
favourable condition than the one in whom depletion is never employed.”
(pp. 386-7.)
To derive benefit from leeches, they should be employed once or twice at
the commencement of the treatment, while the inflammation is acute : they
, are also indicated in the exacerbations before, during, and after menstrua-
tion. The uterus seems sometimes incapable of expelling the blood, which
has accumulated in it at the catamenial period; and in this case leeches
should be employed, so that the bleeding may form a part, as it were, of the
monthly exudation.
While entertaining a high opinion of the benefits which may be produced
by a judicious application of leeches, Dr. Bennet thinks their use may be
often omitted; and this he is compelled to do in dispensary practice. He
fears that local depletion will be rather abused than neglected, and gives
some excellent cautionary remarks on this subject :—
“I am continually seeing cases in which, in my opinion, it is, or has been,
carried very much too far, and in which the constitution of the patient has
been greatly weakened by the repeated abstraction of blood. This is an error
the more to be guarded against, as the frequent repetition of local depletion
does not remove nutritive hypertrophy of the neck of the uterus, or cure
ulceration. I have a case now under my care, in which the patient, a lady,
aged thirty-nine, had leeches applied to the cervix twice a week for five years,
without the ulceration or hypertrophy being removed, at least, I found both
these morbid conditions existing, to a very decided extent, when I examined
her ; and by the symptoms which had been present from the first, their ori-
gin could clearly be traced back many years, probably fifteen or twenty. She
was reduced, by this treatment, to a very low state of anaemia, the blood being
in a perfectly serous condition. I have repeatedly seen the same state of
the general system induced by the repeated internal application of leeches,
166 BIBLIOGRAPHICAL RECORD.
blindly followed up, for eight or ten weeks, on theoretical grounds only, and
irrespective of the effects produced, the local disease remaining unmodified.
“The application of leeches every week, or twice a week, for a lengthened
period, appears to me sometimes to keep up local congestion, thus tending
rather to increase than to diminish the nutritive hypertrophy of the cervix
and uterus, to which chronic inflammation gives rise. Leeches, when applied
to the neck of the uterus, not only remove the blood which it contains, but
appear to establish a flow to that organ from the abdominal organs, as seems
indicated by the patient generally feeling a dragging sensation all over the
lower abdominal region, when the leeches begin to fill. This drawing of
blood from the pelvic viscera, is in no degree prejudicial, when there is sub-
acute inflammation, or even congestion of the uterine system ; because the
surrounding organs are also more or less congested, as we have seen, and the
subtraction of blood from them, as well as from the uterus, relieves the entire
abdominal circulation. But this is no longer the case, when all acute inflam-
mation has been subdued, and chronic inflammatory hypertrophy and indu-
ration, with atonic ulceration, remain. These are conditions which must be
remedied by other means of treatment, repeated local bleeding, irrespective
of menstrual congestion, merely keeping up a flow of blood to the uterus, and
debilitating the system, not only without benefit, but with positive injury to
the patient.
“The tendency to abuse the use of leeches, shown by some practitioners,
who have adopted it as an ordinary means of treatment, is promoted by their
generally entrusting the application of the leeches to midwives, as they are
unable to judge of the effect produced. It is too much the custom with such
practitioners to prescribe a ‘course of leeching', as they would a ‘course of
medicine', giving directions for leeches to be applied once or twice a week,
for one, two, or more months, without ascertaining whether the continuance
of depletion is necessary or not.” (pp. 389-390.)
The leeches should be applied by the practitioner himself, both with the
view of forming an opinion as to the propriety of their repetition, and also
to avoid the pain which is often produced, when they are applied by a mid-
wife. The proper mode of application is thus described:
“Leeches may be applied to the cervix uteri by means of open tubes, or of
tubes closed at their extremity so as to prevent the possibility of their escape.
In the latter case, the closed end has several small holes, of sufficient size to
allow the leeches fixing on the part with which the tube is placed in con-
tact. In the former, the ordinary conical or cylindrical speculum is the best
instrument that can be used. The application of leeches by means of the
closed leech-tube is generally very tedious, and the leeches do not fill by any
means so promptly as when an open tube is used ; moreover, it does not
always prevent their fixing in the cavity of the cervix, if the tube is in
contact with the open os uteri. An open tube is certainly much preferable.
“When the cervix has been brought within the field of the instrument, and
the os, if open, has been closed as above directed, the leeches should be put
into the speculum and pushed close up to the cervix by a plug of sponge or
cotton; they are thus imprisoned in the instrument between the cervix and
the plug. All that are inclined to bite do so immediately, whilst those that
are not, generally work their way out in the course of two or three minutes,
between the vagina and the speculum. When leeches have thus come away,
it is of very little use to re-introduce them, as they seldom take. The plug
may be left in about fifteen minutes, and on being withdrawn it will gene-
rally be found that the leeches have filled, and that some have already come
away. If the plug is allowed to remain longer, the leeches that have filled,
generally work their way out by the side of the instrument. If they have
got between the vagina and the speculum, and have not appeared externally,
they fall into the speculum as it is slowly withdrawn. The entire operation
need not last more than half-an-hour, from first to last.” (pp. 392–393.)


BIBLIOGRAPHICAL RECORD. 167
Cauterization. This seems the only remedy on which Dr. Bennet would
depend for the cure of inflammation of the cervix uteri, especially when ac-
companied with ulceration and hypertrophy. We would be inclined to think,
however, that vaginal injections, rest, and attention to the general health,
may prove of sufficient efficacy in a greater number of cases than he
supposes. When the disease obstinately resists these measures, then cau-
terization is doubtless necessary. But there is one circumstance in particular
pointed out by Dr. Bennet, which gives a high value to cauterization; we
refer to the frequent existence of ulceration within the cavity of the cervix,
and the impossibility of reaching this by injections. On this point we will
quote the author's remarks, “The last part to heal in an ulceration of the
neck of the uterus, is that which dips into the cervical cavity, inside the os.
Thence the absolute necessity of separating the lips of the os with a bivalve
speculum in a good light, and of thus carefully exploring the state of the
cavity of the cervix before the disease is pronounced cured. Unless this pre-
caution be adopted, in a very considerable proportion of the cases treated,
the ulceration will be only partially cured, and what is erroneously considered
a relapse will occur in the course of a few months. In reality, the relapse
in such cases is nothing more than the disease creeping out of the cavity of
the cervix, where it had been lurking from the first.
“A few years ago, in this country, ulcerative disease of the uterine neck
was seldom detected, even by the most eminent uterine practitioners of the
day. In a large proportion of the chronic cases of this description, for
which I was then consulted in private practice, the very existence of the in-
flammatory ulceration, from which the patient had been suffering for many
years, had not been even suspected, notwithstanding many valued opinions
had been taken. Since the attention of the profession was directed, in the
first edition of this work, to the frequency of this form of disease, and since
the doctrines therein promulgated have been adopted and acted upon by
many leading practitioners, I begin to see fewer instances of non-detection of
ulcerative disease. I am still, however, continually witnessing cases in which
ulceration has thus been imperfectly recognized and treated, the external or
cervical ulceration only having been attended to, and the internal ulcerative
element remaining unperceived. This error is committed in Paris as well as
in this country. I never recollect seeing the cervical cavity examined, as I
now examine it, when I held office in the Paris hospitals; and in what has
been written by French pathologists on uterine diseases, there is no evidence
of their being acquainted with the fact of ulceration so frequently penetrat-
ing and lurking into the cavity of the cervix. On the contrary, they mistake
for indications of internal metritis the discharges which exist when the cer-
vical cavity is inflamed or ulcerated.” (398-9.)
The principal cauterizing agents—viz: the nitrate of silver, the mineral
acids, and more especially the acid nitrate of mercury, potassa fusa, and
potassa cum calce, and the actual cautery, are passed in review by Dr. Bennet.
Nitrate of silver has very limited powers as a cauterizing agent; but it is
often an useful application in bringing on healthy action in ulcers. It more-
over acts as an astringent on the surrounding tissues : and, “even when re-
course is had to other caustics, the nitrate of silver, solid or in solution, is a
most useful agent as a topical application in the interval of their application.
The more powerful caustics should be used only at lengthened intervals, to
rouse or modify energetically the vitality of the diseased surface; and it is
by the nitrate of silver that the new action thus created should be moderated
and guided. Its occasional employment serves as a dressing to the ulcerated
surface, prevents its becoming irritable and unhealthy, keeps down the
granulations, and thus powerfully assists in bringing about cicatrization.”
(pp. 403-404.)
The acid nitrate of mercury is rather more efficacious in its action than
other mineral acids, and is much used by-French practitioners. It is pre-
I (38 BIBLIOGRAPHICAL RECORD,
pared by adding to 100 parts of mercury, 200 parts of nitric acid ; dissolving
the mercury by the aid of heat, and evaporating to 225 parts. This prepa-
ration is a dense solution of deuto-nitrate of mercury, in an excess of acid,
and contains 71 per cent. of the deuto-nitrate. It is much more powerful
than nitrate of silver. “It gives rise to a white eschar, which falls piece-
meal about the sixth day, and sometimes not until later. I generally use it
pure, but sometimes diluted with a little water. In the former case, the
beneficial effect is only obtained by the seventh or eighth day, and it should
not, consequently, be reapplied sooner. It is seldom however advisable to
reapply the acid nitrate several weeks in succession. Generally speaking, ten
days or a fortnight should be allowed to elapse between two cauterizations,
the nitrate of silver, solid or in solution, being used in the interim. When
the ulceration is large, and the granulations are redundant and unhealthy,
this caustic exercises a very prompt and beneficial influence, often cleansing
and modifying the sore in one application, even when the nitrate of silver
has failed. In slight ulcerations, however, it is too powerful a remedy, and
may aggravate the inflammation if injudiciously employed.” (p. 405.)
The mineral acids require care in their application; as the caustic, if allowed
to run on the cervix and vagina, may produce very painful inflammation and
ulceration. The acid should be applied by means of a dossil of cotton, at
the end of a small and narrow platinum fork, or of a wire; and any super-
fluity of acid should be pressed out from the cotton, before it is used.
The caustics above enumerated will often serve, with judicious general
treatment, injections, and local depletion, to bring on a healthy state of the
parts; but in some instances, especially in ulceration of the cavity of the os
uteri, the disease proves rebellious. The more powerful agents, to be em-
ployed in such cases, are potassa fusa and the actual cautery.
Potassa fusa was introduced into practice for the treatment of intractable
ulcerations, and of chronic inflammatory hypertrophy of the cervix, by M.
Gendrin of Paris. Its use is, however, confined to a very few practitioners ;
and Dr. Simpson of Edinburgh appears to be the only one, in this country,
who has given it a trial, and reported its efficacy. Dr. Simpson’s testimony
tends to show the utility of the remedy. In order to obviate the difficulties
and dangers, which, unless great care be taken, result from the use of so
powerful and fusible a caustic as the hydrate of potassa, Dr. Bennet has been
endeavouring, for some years, to render its application more safe ; and he
thinks he has succeeded.
Dr. Bennet gives a clear account of the method followed by M. Gendrin,
and of the modification introduced by himself. M. Gendrin preferred potassa
cum calce, made into a paste, with a few drops of alcohol, and applied it in
the following manner:—
“A large conical speculum being first introduced, the uterine neck is made
to enter its orifice; or should the cervix be too voluminous, the speculum is
firmly pressed on the part which it is intended to cauterize, great care being
taken not to enclose a fold of the vagina between the rim of the speculum
and the cervix. About as much of the paste as would cover a fourpenny-
piece, a line in thickness, is placed on a triangular piece of diachylon plaster,
one end of which is inserted in the cleft extremity of a common bougie,
The caustic paste is then carried, by means of the bougie, to the cervix, and
applied to the centre of the part comprised within the speculum. With the
long forceps, cotton is placed carefully all round the spot on which the
caustic paste is applied, so as to completely protect the neighbouring parts;
and the bougie having been withdrawn, the speculum is two-thirds filled with
cotton or lint, which is firmly pressed against the uterine neck. The specu-
lum is then slowly extracted, the cotton which fills it being at the same time
forcibly pushed back in the vagina with the forceps, as the speculum is with-
drawn, so that the vagina, remains thoroughly plugged. If this is carefully
done, the caustic cannot fuse, and injure the parietes of the vagina. In about
BIBLIOGRAPHICAL RECORD. 169
fifteen or twenty minutes, the cotton or lint must be gradually withdrawn, by
means of a bivalve speculum gradually introduced, and an eschar, of the size
of a shilling, or rather larger, will be found where the caustic was applied.
The vagina should then be washed out with a little tepid water, complete
rest in bed enjoined, and emollient injections employed until the separation
of the eschar, which takes place from the sixth to the eighth or tenth day.
“Enlightened by subsequent experience, I should now reject entirely this
mode of applying the Vienna paste, even did I employ the preparation, which
. I have long ceased to do, having discovered a more safe and efficacious way
of applying the potassa cum calce. Although I have for years seen M.
Gendrin follow this mode of operation, and have myself often adopted it,
without once witnessing the extension of the eschar to the vagina, still I
think it demands too much caution and instrumental experience to be re-
tained; especially as it is possible to apply potassa fusa, either combined
with lime or alone, with equal efficacy and greater safety, in a more simple
IYlä.E.The]".
“The extraction of the speculum, after the application of the caustic paste,
evidently depriving the vagina of the protection which the instrument affords
it, I first determined to leave the speculum in situ until the process of caute-
rization was entirely accomplished. With this view, after getting the cervix
well into the field of the large conical speculum, I introduced pledgets of
cotton, steeped in acetic acid and water, between the speculum and the cer-
vix in its entire circumference, so as to completely isolate the organ. I then,
as before, applied the paste to the surface to be cauterized; and, when the
desired effect was obtained, carefully wiped it away, washed the eschar with
the diluted acetic acid, and, placing on the latter, as a dressing to prevent its
coming in contact with the surrounding parts, a large pledget of cotton
soaked in the vinegar-and-water, and tied to a piece of strong silk, withdrew
the speculum.
“This plan succeeded so well, and appeared so thoroughly to isolate the
cervix, and to prevent the possibility of the surrounding parts being compro-
mised, that I determined to use the pure potassa fusa instead of the potassa
cum calce, on account of the greater facility of applying it to any given part,
and of graduating the intensity of its action. As an additional precaution,
however, I first applied the nitrate of silver freely to the lower lip of the cer-
vix, in order more effectually to guarantee it from the liquefied potassa,
which invariably runs on the most depending part when the pure hydrate is
used. The eschar formed by the nitrate of silver, superficial as it is, prevents
the part which it covers from being acted upon. The lower lip of the neck
of the uterus being protected by the nitrate of silver eschar, and the vagina
by the pledgets of lint soaked in dilute acetic acid and pushed carefully in
between the lower valve or circumference of the speculum and the cervix,
there can be no risk of the potassa, although so very fusible, extending to
parts which it is not intended to cauterize. I long used it exclusively, and
in a great number of cases, in this manner, without its action once extend-
ing to the vagina. When thus applied, however, it is always advisable to
leave for a few hours a pledget of lint soaked in dilute acetic acid in con-
tact with the eschar, as uncombined particles of caustic lying on it might
otherwise slightly cauterize the vagina. This has happened to me in one or
two instances, in which I had omitted to take the precaution in question.
The pledget or dressing may be withdrawn in the course of a few hours, and
a pint or two of tepid water injected,
“In giving the above directions, I have supposed the patient to be lying on
her back when examined, and the pelvis to be elevated so as to admit of easy
and thorough inspection. In this case the cervix is, necessarily, the most
depending part of the canal represented by the speculum and the vagina;
and, consequently, any fluid which runs off from the cervix has a tendency to
gravitate on to the vaginal cul-de-sac. Hence the necessity of taking the
WOL. II. 12
170 BIBLTOGRAPHICAT, RECORD,
above precautions. The pelvis might, it is true, be elevated to such an extent
as to render the vaginal canal dependent, especially if the patient were lying
on the side ; and this position would diminish the danger of the potassa
running on the vaginal cul-de-sac ; but as it renders the inspection of the
cervix uteri and all surgical manipulations difficult, I reject it without hesi-
tation. When about to use so powerful an agent as potassa fusa, we cannot
see too clearly and satisfactorily the state of the parts on which we have to
operate. Otherwise, all is doubt and danger.” (pp. 409–12.)
Dr. Bennet has subsequently found it more advantageous to use potassa
cum calce, which, with the assistance of Mr. Squire of Oxford-street, he has
had fused into cylinders like those of nitrate of silver. Their action is ener-
getic, and as prompt and deep as potassa fusa ; and they require less precau-
tion : “All that is necessary, is to see the cervix well isolated in the speculum,
to wipe off the sanies that oozes from the surface cauterized, and then to
apply a cotton pledget, moistened with vinegar and water, which is to remain
as a dressing on the withdrawal of the speculum. These precautions are
necessary, as, for two or three minutes after the application of the caustic, a
straw-coloured fluid exudes, especially if it has been carried into the cervical
cavity, which may slightly cauterize the parts with which it comes in con-
tact.” (p. 413.)
The effects produced by the use of potassa fusa, or potassa cum calce, are, “a
profound modification of the vitality of the diseased tissues, and the substitu-
tion of a healthy ulceration for a morbid one, with a tendency to indefinitely
perpetuate its existence.” The ulceration, thus modified by the cautery, may
heal without the employment of any further means; but Dr. Bennet thinks
it injudicious to depend on this so as to forego the subsequent dressing of the
sore. He says: “I have, in many cases, tried to ensure the continued im-
provement of patients who could not remain long with me, by resorting to
severe cauterization, and then allowing them to suspend local treatment for
a few weeks, so soon as they had recovered from its immediate effects ; but
have generally failed, the diseased condition evidently not improving, or only
slightly improving, for want of subsequent treatment.” (p. 416.)
Dr. Bennet generally applies a small cylinder to the cavity of the neck of
the uterus, much less in size than the common nitrate of silver cylinders;
and he only leaves it a few seconds in contact with the diseased surface, as
its object is not to create a slough, but profoundly to modify its vitality.
The application may sometimes produce a greater narrowing of the os uteri
than exists in the healthy state ; but this does not seem permanent.
The actual cautery was recommended by Celsus, in the treatment of ulcers
of the prolapsed uterus ; and the same means of treatment has been advo-
cated by several modern surgeons. M. Jobert de Lamballe appears to
have been the first to adopt these suggestions, and to have employed the
actual cautery for many years, with great success, in simple ulceration, as
well as in severe inflammatory hypertrophy of the neck of the uterus. The
action of the actual cautery appears identical with that of the potassa fusa,
although M. Jobert thinks that the former possesses some peculiar advantages.
Dr. Bennet has found both remedies free from risk or danger in his hands :
and, in an experience of twelve years, he has only once seen serious inflam-
mation occurring as a sequela ; and even here, the results can scarcely be
fairly attributed to the means employed. This was a case, in which inflam-
mation and abscess arose in the lateral ligaments, twelve days after the
application of the caustic, and at the time of the appearance of the menses.
But it is by no means certain that it was not merely a coincidence—perhaps
an usual aggravation of the disease at the menstrual period, but located in
the lateral ligaments instead of in the uterus. Dr. Bennet does not pretend to
claim, for the operation of cauterization, absolute immunity from danger.
“Cauterization of the cervix, and especially deep cauterization, is an opera-
tion, and, like all operations, surrounded with danger. It must not, there-




BIBLIOGRAPHICAL RECORD. 171
fore, be either injudiciously resorted to, or carelessly carried out. Although
my own practice has hitherto been free, or all but free, from serious accidents,
the same immunity cannot always be expected. Indeed, I learnt recently
from M. Gendrin, that within the last few years he has had several cases of
acute metritis, and of abscess in the lateral ligaments, the evident and imme-
diate result of deep cauterization. But he also tells me that he had seen the
same results follow the use of the nitrate of silver, and of injections; and I
may mention that the two most severe instances of acute metritis that I have
myself witnessed for some time, in the unimpregnated womb, occurred after
the use of weak astringent vaginal injections.
“It is clear, from what precedes, that no surgical interference with the
womb, however simple, is absolutely free from some slight risk. No such
means of treatment, therefore, should be resorted to unless rendered neces-
sary by the state of the patient ; but, at the same time, we should not shrink
from resorting to those remedial agencies which experience teaches us to be
the most efficacious. We must bear in mind that, in order to restore to
health a person suffering from severe disease, which can only be removed by
surgical treatment, generally speaking, there is considerable risk and danger
to be encountered ; whereas, in the surgical treatment of uterine disease, the
risk is so slight that it scarcely deserves to be taken into consideration.”
(pp. 425-6.)
The possibility of danger resulting from the use of the potent means so
ably advocated by Dr. Bennet will, we think, tend to make many pause be-
fore applying these remedies. Milder measures should first have a fair trial,
and if these fail, then the more severe means may be resorted to.
Hypertrophy and induration may sometimes be removed by the subdual of
both deep-seated and superficial inflammation : but sometimes they prove
obstinate, and then it is necessary to try other remedies. Dr. Bennet has
found but little benefit from the use of iodine or mercurials, external or in-
ternal ; and depends most on the use of potassa fusa for the purpose of
making a deep eschar on the hypertrophied cervix. The object in view is
thus explained : “I must, however, most emphatically guard practitioners
against an error into which there would appear to be some danger of their
falling, from misinterpretation of my views. I wish it to be most distinctly
understood that I do not propose to destroy the hypertrophied cervix by cau-
terization, but merely to set up an artificial eliminatory inflammation, by
means of an eschar or issue, of limited eartent, established in the centre of the
hypertrophied region. I do not calculate, in the remotest degree, on the de-
struction of tissue to which the caustic or cautery gives rise, for diminishing
the size of the hypertrophied cervix; but solely and entirely on the inflam-
mation subsequently set up. Any attempt to actually destroy the hypertrophy,
by direct cauterization, appears to me both dangerous and unnecessary —
dangerous, because I should be afraid that the intensity of the reactional in-
flammation would be so great, as often to extend to the uterus or to the
lateral ligaments, and because I consider it next to impossible always to limit
the action of the caustic when applied with such profusion;–unnecessary,
because a mere eschar, of the size of a shilling, will equally well answer the
purpose of reducing the hypertrophy. It may perhaps be necessary to apply
it several times; but of what consequence is prolonging for a few weeks the
treatment of a disease which must have existed for years to require treating
at all by such agents, compared with the danger of perforating the vagina
and causing peritonitis, or of giving rise to intense metritis.” (pp. 430–1.)


The extent to which we have carried our analysis of Dr. Bennet's work,
prevents us from doing more than refer our readers to his remaining observa-
tions on the local and general treatment of the various forms of uterine in-
flammation.
12 2
172 BIBLIOGIRAIPHH [C_\T, RECORD.
Before concluding, however, we must quote a paragraph from his APPENDIX
on the PHYSICAL ExAMINATION OF THE UTERUS AND ITS APPENDAGES. We
allude to the ForM of THE SPEGULUM, which is a very important considera-
tion. Dr. Bennet generally employs the bivalve speculum, as ingeniously
modified by Mr. Coxeter.
“The bulging of the vagina between the open valves of the bivalve specu-
lum renders it of no use in the cases in which this occurs. Mr. Coxeter has
met the difficulty, by very ingeniously combining the conical and bivalve
specula. He has made an instrument which, when closed, represents the No. 3
conical speculum, slightly flattened transversely. The come, however, is
composed of two valves, which can be separated to any extent by means of a
hinge. We thus get the side protection of the conical, and the expansive
power of the bivalve speculum. This is, indeed, a most valuable instrument,
and has enabled me to discard, nearly entirely, the largest conical size. It
is more especially applicable, in the same class of cases:—during pregnancy,
when the vagina is more than usually relaxed, and when it is desirable
effectually to protect the sides of the vagina, as in the application of the
potassa cum calce or potassa fusa.” (p. 501.)

Our readers may already have observed that we adopt, pretty nearly to
their full extent, the pathological and therapeutical views of the author;
and, therefore, any formal additional recognition of them in this place is
hardly called for. The point on which we feel greatest difficulty in going
cordially along with Dr. Bennet, is his limited appreciation of general
medical treatment. He certainly recommends it as an adjuvant to local
means; but he does not concede to it that amount of efficacy, which from our
own experience, as well as from the testimony of the best authorities, it seems
fairly to merit. We think, with Dr. Oldham, that in hypertrophy and indu-
ration of the cervix, much local treatment may be dispensed with, if the
bichloride of mercury be skilfully administered internally. Dr. Bennet seems
to consider, that to employ surgical, or, to use his expression, local treatment, as
an adjuvant to medical treatment, when there is absolute uterine disease of a
chronic nature existing, would be like putting the cart before the horse ; but,
that, on the other hand, it is reasonable to admit the value of medicine as an
aid to local treatment. Our difference, therefore, though of importance in its
bearing upon the management of particular cases, is not one of principle, but
of degree.
We have already stated, at p. 1029 of the volume for 1849, that Dr. Bennet
has furnished “an amount of solid information regarding uterine diseases
not to be met with in any other treatise”; and we would now add, that to
Dr. Bennet is fairly due the great improvement, we might say the revolution,
which has taken place in the management of these affections, since his views
first began to be diffused by means of his original contributions to the Lancet,
and subsequently by their republication, in the first edition of the work now
under review. While we declare our belief that Dr. Bennet rides his
hobby a little too hard, we willingly admit, that enthusiasm and earnestness
are almost essentially requisite (even beyond all common limits), when old pre-
judices have to be unsparingly swept away, from ruling over a great domain
of medical practice. It is no small merit, to have been chiefly instrumental in
rescuing a very numerous class of patients from the inefficacious, trifling, and
empirical routine till recently in the ascendant : and to be niggardly in re-
cognizing the merits of such an author, because he has pushed some of his
ideas too far, would be ungenerous and unjustifiable.
BIBLIOGRAPHICAL RECORD. 173
SANITARY ECONOMICS ; OR, OUR MEDICAL CHARITIES AS THEY ARE, AND
As THEY oughT To BE. By ALEXANDER P. STEwART, M.D., Physician
to the St. Pancras Royal General Dispensary. Pp. 30. London : 1849.
DR. STEwART has not converted us to his opinions, simply because we
held the same years before we perused his pamphlet. He has, however,
established our previous convictions, and greatly illuminated some parts of
the subject. We wish the public and the profession were more alive to the
momentous facts, that some of our most ostentatious Medical Charities are
unblushingly, and on a large scale, made use of by the rich for their servants;
and that the majority of the hospitals and dispensaries of England are
actually operating as the forcing beds of pauperism, the very schools in
which are taught to all comers the first lessons of improvidence. Chalmers
long ago admirably embodied the truth which Dr. Stewart so well illus-
trates, and which Mr. H. L. Smith, of Southam, twenty years ago, successfully
applied. It was thus that Chalmers wrote in 1814: “The remedy against
the extension of pauperism does not lie in the liberalities of the rich—it lies
in the hearts and habits of the poor. Plant in their bosoms a principle of
independence—give a high tone of delicacy to their characters, and teach
them to recoil from pauperism as a degradation. Could we reform the im-
provident habits of the people, and pour the healthful infusion of Scripture
principles into their hearts, it would reduce the existing poverty of the land
to a very humble fraction of its present extent. We make bold to say, that,
in ordinary times, there is not one-tenth of the pauperism of England due to
unavoidable misfortune.”l
It is not our intention on the present occasion to enter upon the general
subject of a reform in our Medical Charities, as we intend, from time to
time, to introduce to the notice of our readers the reports of different dis-
pensaries, hospitals, and clubs; and also, because in our next number we
propose to give the substance of a recent lecture, by Mr. H. L. Smith, on
Provident Dispensaries. In the meantime, we content ourselves by select-
ing a few passages from Dr. Stewart's important and admirably written
pamphlet, in the hope that it may aid him in securing the co-operation of
the profession in introducing a better order of things.
GRATUITOUS ADVICE AND MEDICINE, DRAW To THE DISPENSARY MANY
who ARE MERE CANDIDATES FoR PUBLIC or PRIVATE CHARITY. “I have
been led to this conclusion from having been often asked, in a way that
plainly showed it was the main errand, for a certificate of ill health, either
couched in general terms or addressed to some benevolent individual ; at
other times, for a few lines to the Board of Guardians; but oftener far, for a
recommendation to the District Visiting Society. The mere fact of being
under treatment at a dispensary may prompt many charitable persons to
extend a helping hand to the patient, and to this there could, in many
instances, be no reasonable objection, if the applicant were a patient in the
sense of being a sufferer. Where, again, the dispensary letters and
charitable relief are distributed by the same hands, the application for the
wished-for dole is a natural, as the granting of it is a frequent, result of the
physician's prescription, which is looked upon as a certificate of genuine
sickness. And if it is not so, asks some smart objector, must not the
physician be held as particeps criminis, the wilful abettor of fraudulent
beggary 7 Nay, not so fast, sweet master. The physician, unpaid as he is
for all his exertions, knows too well the consequence of turning adrift, with
the assurance that they have nothing the matter with them, applicants for
* HANNA (Rev. William, LL.D.), Life and Writings of Thomas Chalmers, D.D.,
LL.D. Vol. i., p. 384. Edinburgh : 1849. We are not acquainted with any bio-
graphy in the English language more instructive or more interesting.
174 BIBLIOGRAPHICAL RECORD.
advice, armed with that formidable instrument—a Governor's recommenda-
tion. He knows very well that such a course exposes him to the risk of a
correspondence with the incensed Governor, of which he must keep dupli-
cates, in case of his being summoned to answer for his audacity before the
Committee. I frankly confess, that if I had discharged all whom, during
my incumbency in the St. Pancras Royal General Dispensary, I have sus-
pected of having no disease specified in the nosology, or of being themselves
the authors of their ailments, I should have involved myself in an endless
succession of broils. And who does not know, that the time and thought
required for sifting and exposing most cases of feigned disease, would amply
suffice for the investigation of half a dozen cases of serious illness? So much
for this feature of dispensary practice.”
GRATUITOUs ADVICE AND MEDICINE MAKE PAUPERS OF MANY :—for if once
a family accept one form of alms, they soon become greedy of eleemosynary
aid in every form in which they can grasp it. “Hitherto, in England,
benevolence seems rather to have aimed at paralyzing, than at stimulating,
the self-supporting energies of the working classes; but a healthy reaction
is now taking place, and is assigning a remarkable and cheering prominence
to all sorts of provident institutions ; and that is a very false philanthropy,
which would deter us, by the ready and popular cry of hard-heartedness,
from seeking to develop these energies to the uttermost. A procedure this,
which is in the highest degree compatible with a liberal and generous treat-
ment of the deserving poor. But what shall we say of the second class :
Why, that many of them—I can depone to the fact—have long withstood
the temptation held out to them by the dispensary, have availed themselves
of it only after a painful struggle with their own inclinations, and would
never have done so had there been any via media between private attendance
and the receipt of alms. Often have I been spontaneously told, ‘Indeed,
sir, we have always paid for attendance till now, and we didn’t like to send
to the dispensary ; but we’ve been forced to it, for we couldn't pay any
longer.' . But this is the first step of the ‘facilis descensus ; they have no
scruple in returning to the dispensary, though a recurrence of sickness
should find them improved in circumstances. This, however, it must be
confessed, is seldom the case; for, once fairly reconciled to the idea of
receiving public charity, the benevolent society or the parish is thence-
forwärd too often looked upon as superseding the necessity of economy and
forethought, and as the appropriate refuge in any season of temporary
pressure. As regards this and the third class of cases, I am persuaded, from
instances that have come under my own observation, that thoughtless bene-
volence does much harm by actually pressing dispensary letters on the
acceptance of those who were paying for attendance. The result of one
such victory may be most disastrous. The neighbours all around begin to
say, ‘Why, if so-and-so goes to the dispensary, why should not we, who are
no better, or, it may be, much worse off " ' And so the infection spreads,
till one such case may have pauperized a whole neighbourhood. Here is a
case in point :—Coming down stairs one day from visiting a lady, who occu-
pied the second floor of a very nice lodging-house in a highly-respectable
quarter, I was thus accosted by the landlady:-‘Well, Sir, if Mrs. is a
fit patient for the dispensary, I shall know where to go when I’m ill next.”
Th: lodger was, I believe, better off than the landlady; and what could
say ?”
How Gover Norts DERIVE PEGUNIARY ASSISTANCE FROM DISPENSARIES.
“I have always considered the system of allowing Governors to have their
servants supplied with advice and medicines utterly indefensible. Yet such
is far from being the opinion of all. Rumour, for instance, asserts very
positively, that some years ago a Noble Marquis, who has repeatedly held a
high place in the councils of the realm, offered a donation of £50 to a well-
BIBILIOGRAPHICAL RECORD. 175
known dispensary, on condition of his being allowed, during the term of his
natural life, to send the servants of his princely establishment for advice and
medicine whenever any of them should require it. The reader naturally
wishes to know what reception the Committee is said to have given to this
tempting bargain ; but let him first bestow a few moments’ thought on the
important question it opens up. I confess that early associations, certain
primitive ideas instilled into my mind from very childhood, and the customs
of those among whom I was reared, all combined to impress me with very
old-fashioned views of the sacredness of the relation between master and
servant. It was my delight to hear of servants growing up almost from
childhood in the bosom of families, of which they reckoned themselves, and
were reckoned, members, and in which they remained till their heads were
‘silvered over with the frost of age.’ And if the great destroyer suddenly
broke up, or by slow decay extinguished, the households of which they were
component parts, it was pleasant to see them taken into the employ of other
members of the same family, and cared for when bowed down with the
weight of years, by those around whom their life-long associations were
entwined. Now I do not assert that either the feeling or the practice to
which I allude is wholly extinct—for I know that in many quarters they
both exist, and are in full operation. But no one, I apprehend, will deny
that they are yearly becoming more and more rare, and that in very many
quarters the relation between master and servant has become one of mutual
convenience. Each seeks to serve himself of the other, for his own, and not for
the other's benefit. The very idea of an established relation is lost sight of,
where, on either side, a freak, a whim, an explosion of temper, or fancied
self-interest, may terminate it at any moment. The servant is in a twofold
sense a tenant-at-will—at his employer's will, and at his own ; and as his
place is thus doubly insecure, he seeks (like all of that class of º to
obtain from it the largest possible return for the smallest possible outlay.
The only relation that can be said to subsist between those heads of families,
who think it beneath them to occupy their thoughts about what is going on
below stairs, and their servants, is that of so much menial labour exacted,
and grudgingly given, for a stipulated equivalent, which is relinquished so
soon as a larger one can be had for still lighter service. In such a state of
things, of course, moral obligation ceases to be thought of, and legal obli-
gation becomes, on either side, the standard of right and wrong. Now, the
verdict found upon the alleged offer of the Noble Marquis will vary greatly,
according as the jury is composed of those who take the moral, or of those
who take the legal view of the question. If of the former, they will
denounce it as mean ; if of the latter, they will praise it as generous. What
said the Committee of the dispensary They are said to have rejected the
proposal, on the ground that the institution, of which they were the
guardians, was not intended for the relief of noblemen's servants.
“I might adduce various considerations in vindication of this decision. I
might show that the moral obligation lying on masters, to promote the phy-
sical, as well as the moral health of their immediate dependants, is one of
which, however they may neglect it, they cannot shake themselves free; and
that, sanctioned alike by the principles, the precepts, and the recorded
examples of Holy Writ, it is still largely recognized in all professedly
Christian communities. Or I might show, that the servants in large es-
tablishments should either have such wages as will enable them to pay for
advice themselves, or be provided with such advice by their employers, who,
if they excuse themselves from adopting either alternative, by referring to
the size of their establishments, ought rather to abate somewhat of their
pomp and circumstance, than to set at nought the maxim, “Owe no man
anything.” Or, yet, again, I might point out how cheap is that generosity
towards a sick servant, which would supply him with attendance and medi-
cines at the nominal rate of two shillings a-month ; and how peculiar that
I 76 BIBLIOGRAPHICAL RECORD.
sympathy for the sick poor, which cannot find relief to its yearnings, with-
out exacting the aforesaid equivalent
“But I greatly prefer exhibiting by contrast the nature of the alleged
proposal, on which I dwell thus at length, because it brings out in a clear
and striking light several of the worst features of the present system of dis-
pensary management. Many, we suspect, would be j to think the
offer of 50%, even with the condition attached to it, an extremely liberal one,
and would, in return for a donation half as large, reckon themselves fairly
entitled to summon to their servants' sickroom, at any hour of the day or night,
the unpaid physician or surgeon of the dispensary, which they are said, by a
figure of speech, to “patronize”. Has it, we ask, ever occurred to those,
who, Qut of yearly incomes of thousands sterling, bestow one annual guinea
on a dispensary, to estimate the contributions of the medical officers, whom
they look upon as their servants’ servants To begin with the annual guinea,
let them bear in mind that the medical officer is generally a Governor liké
themselves; that he has exerted himself, more or less successfully, to obtain
additional subscribers among his friends; and, that, besides the carriage-
hires entailed upon him by his dispensary duties, but for which he is allowed
no equivalent), and the shillings and half-crowns extorted by pity for his
starving patients from his already over-taxed pocket—he makes in time and
toil a WEEKLY contribution of certainly not less than a couple of guineas to
the public health. In other words, each medical officer contributes annually
to the funds of his dispensary a sum at least twice as large as the proffered
donation—which many will call munificent—of the Noble Marquis. But
this estimate does not include those items of which money value is no ade-
quate exponent, the frequent exhaustion of the body, depression of spirits,
and utter unfitness for intellectual exertion after the day’s work is done; the
weeks, and sometimes months, of broken health and dyspeptic languor; the
continual risk of life in his attempts to combat the great enemy in his
dreariest fastnesses and most malignant aspects; the sudden summons which,
in these haunts of death, he may receive at any moment, from a career of
promise scarce begun, to the bar of the Eternal Judge. Surely, if any man
can be said to have made good his title to a standing supply of medicines for
his household, it is the dispensary medical officer. Yet he would scorn to
avail himself, for such a purpose, of the public charity to which he contri-
butes so largely. If, then, his wealthy and titled neighbours, who have all
their lives been dandled in the lap of luxury, or those on whose honest exer-
tions a kind and liberal Providence has smiled so sweetly, that in present
affluence they have almost forgotten former want and toil, do, from motives
of economy, stoop to, and resolutely insist on that, in consenting to which
he would feel himself to have lost caste, why should not they be reckoned the
pariahs of the philanthropic commonwealth 2" (pp. 15-17.)
“Many, I doubt not, would be startled, and blush crimson at seeing their
deeds of charity translated into such plain and unseemly English as this.
And I purposely ‘use plainness of speech’, that I may stir up thoughtful and
earnest minds to inquire whether we are not unconsciously accustoming our-
Selves to confound domestic duty with public charity, and deluding ourselves
with the idea that we are satisfying the claims of both, while our so-called
alms-deeds only serve to conceal from ourselves the havoc that the canker
selfishness is silently working on our kindlier and more Christ-like sympathies.
I especially desire to concentrate attention on the practice of systematically
holding out a bribe (for such it is, disguise it by what other name we may), to
draw forth the subscriptions of the wealthy—a practice, the very existence
of which proves, that love for the sick poor is not of itself strong enough to
secure an adequate support to our medical charities. It is one of those shifts,
now-a-days so common, for beguiling or enticing, or, may we not say, cheat-
ing people into the commission of charitable acts, from which, if presented
in their naked unattractiveness, they would be apt instinctively to recoil. It
BIBLIOGRAPHICAL RECORD. 177
must take its place in the weary round of dinners, balls, and fancy-fairs,
miscalled charitable, and so well-fitted, if the task were not so hopeless, to
bring down the high looks of our boastful but hollow-hearted philanthropy.
If this charge be deemed offensive, there is a simple, and, if our love for the
poor be so disinterested, a natural way of escaping from it. Let the privi-
lege be put an end to forall future subscribers; and if any of the life-governors
say with Shylock,-
“I’ll have my bond; I will not hear thee speak;
I’ll have my bond ; and therefore speak no more,'—
the most unfriendly wish I could allow myself to breathe for him would be,
that he may exact the uttermost farthing. By such a measure some annual
guineas might be lost, but it is more than likely, that the adoption of a bold
and comprehensive plan of medical relief for the labouring classes would in-
duce many others to double or treble their subscriptions, instead of with-
drawing them.” (pp. 18–20.)
The eager canvassing for the unsalaried appointments to Dispensaries and
Infirmaries, the pretext which this gives for newspaper advertisements from
medical aspirants, the profusion of medical charities in the neighbourhoods
where they are least wanted, are subjects which provoke inquiry; and they
shall have it. But, for the reasons already explained, we in the mean time
refrain from entering upon their consideration.
1. CIIARTER AND BYE-LAws of THE ROYAL MEDICAL AND CHIRURGICAL
SocIETY OF LONDON. pp. 32. London : 1846.
2. CATALOGUE OF TIIE LIBRARY OF THE ROYAL MEDICAL AND CHIRURGICAL
SocIETY OF LONDON. Supplement for 1844-49. pp. 47. London: 1849.
In our last number, we had occasion to complain of the badness of the
machinery of the Royal Medical and Chirurgical Society, as exposed by the
dispiriting aspect of the present session, the attenuated volume of Trans-
actions last issued, and the inexplicable want of discrimination or justice
displayed in the selection and rejection of papers. We are glad to learn,
that our remarks have not passed unheeded; and that it is admitted on all
hands, that some modifications of present usages are urgently demanded.
Though we are not hostile to the project, at present so popular, of amalga-
mating the London Medical, the Westminster, and other Societies, and es-
tablishing the new institute in a commodious and elegant mansion at the
West End, with a library, a reading, and a refreshment room, we strongly feel
that the first care of the medical profession in London ought to be, to re-
animate the Royal Medical and Chirurgical Society. It contains, though
little visible at present, all the elements of greatness and prosperity; its
Fellows are the élite of the profession ; it has, besides, a noble library and
a respectable treasury, which the United Societies could not, under the most
favourable circumstances, cope with for many years to come. We would there-
fore advise a general rallying round the standard of reform in the Royal
Medical and Chirurgical Society, and would strongly deprecate the threatened
secession of members. No violent changes are required; it is only necessary To
ABOLISH A BYE-LAW OF DOUBTFUL LEGALITY, AND CONFORM TO THE CHARTER.
Nearly the whole power of the Fellows of the Royal Medical and Chirurgical
Society is vested in the Council; and this body, through the disastrous
working of the Bye-law to which we have referred, has become independent,
and irresponsible, devoid of sympathy with those by whom it is nominally,
* “The above remarks are not applicable, without important modifications,
to the in-door department of hospitals, which must often be the refuge of servants
laid aside by tedious and contagious diseases, but are largely so to the out-door
department, which is, in fact, a dispensary.”
178 BIB [..IOGRAPHICAL RECORD.
but not in reality, chosen. In the Charter granted to the Society by his late
Majesty William IV, we find the following provision:-" Our further will
and pleasure is, that the Fellows of the said Society shall and may, on the
first day of March, one thousand, eight hundred and thirty-five, and also
shall and may, on the first day of March in every succeeding year, or as near
the same as conveniently may be, assemble together at the then last or other
usual place of meeting of the said Society, and proceed, by method of ballot,
to nominate and appoint a President of the said Society, and such Officers and
other Members of the Council, as may, with the President, form the number
of twenty-one, of whom we have willed that the Council shall consist.” It
is very clear, from this passage, that the election of the Council ought to be
made by an unfettered general assembly of the Fellows ; and that the
annual meeting in March should be something more than a farce—something
better than a cold and compulsory recognition of what is called the “House
List”. We use the term “compulsory”, advisedly, because it has been found
experimentally, that positively obnoxious names on the house-list are of
necessity chosen, simply from there being no organization among the disap-
proving majority. The mischievous Bye-law to which we refer is as follows:
* Balloting lists, recommended by the Council, and having blank spaces for
such alterations as any Fellow may wish to make in them, shall be laid on the
Society's table, for the use of the Fellows, and sent to each resident Fellow, with
the circular summons.” The needed reform, therefore, is simply to repeal
this Bye-law, and to introduce a practice consistent with the charter, and in
accordance with what is due to the feelings of every individual gentleman
who has been duly admitted as a Fellow. Previous to the day of election,
let the President call upon any of the assembled Fellows to nominate suit-
able individuals to fill the offices: and then let the names of all Fellows so
nominated be inscribed on the balloting lists. Should the number of names
proposed be exactly equal to the offices to be filled up, the ballot would be little
more than a formal operation; but if, on the other hand, as would generally
be the case, the candidates should exceed the number of vacancies, then the
ballot would elicit the true feeling of the Society, as those least acceptable to
the majority would be struck out. Were the office-bearers to be thus chosen
by the whole body of the Society, an immense stimulus would be given to
individual exertions; and we would never again see dormant Fellows pro-
moted to the chief offices. It is not safe, it is not reasonable, that the
Council,-the supreme executive, who, by the constitution of the Society,
have almost unlimited power, should not be the free choice of the Fellows.
(To be continued.)


THE DISEASEs of CHILDREN. By FLEETwooD CHURCHILL, M.D., M.R.I.A.
pp. 656. Dublin : 1850.
DR. F. CHURCHILL's name is so favourably known to the profession, that
we had high anticipations as to the excellence of the work now before us:
but though it be undoubtedly possessed of much merit, we find that it falls
short of what we had expected. The performance is most unequal ; some
subjects are amply and ably discussed, others are treated very superficially,
and not a few, of great importance, are not even referred to... Dr. Churchill
does not seem to be fully acquainted with the recent English literature of the
Diseases of Children; though we are glad to observe that this remark does
not apply to his knowledge of the LoNDON Journal of MEDIGINE, which,
however, unfortunately, when his work was printed, only embraced the very
limited period of less than one year. .
The work consists of two parts: the First being devoted to the Management
of Infants and Children: and the Second to the Diseases of Infants and
Children.
The first part we have perused with much pleasure. It is sound, clear,
BIBLIOGRAPHICAL RECORD. 179
and practical. The second part consists of seven sections, viz.: 1. Diseases
of the Nervous System. 2. Of the Respiratory System. 3. Of the Heart.
4. Of the Digestive System. 5. Of the Skin. 6. Eruptive Fevers; and,
7. Infantile Remittent Fever. The first four sections each contain a chapter
on Intra-uterine Diseases, but they are very far from being complete; and
in the fifth section no notice is taken of congenital affections of the skin.
Intra-uterine diseases of the kidney—a most interesting and important sub-
ject—is not noticed ; and, except under Scarlet fever, there is no notice of renal
disease in any part of the work. The all-important subject of encephalitis is
discussed in ten pages ; whereas pertussis occupies three times that space.
The paralysis of dentition is not mentioned. The same may be said of syphilis,
phthisis, tabes mesenterica, all the forms of scrofula, influenza, various fevers,
the diseases of the urinary and genital organs, malignant diseases, atelectasis
pulmonum, etc. It does seem extraordinary to neglect such subjects in a
systematic Treatise on the Diseases of Children.

Notwithstanding, the deficiencies which we have pointed out (and which
must be remedied in a subsequent edition), we can truly say, that this volume
will form a most valuable addition to the library of the medical practitioner.
LoNDON AND PROVINCIAL MEDICAL DIRECTORY FOR 1850. pp. 576. London:
1850.
We regard the Medical Directory, as a work, of great value to the pro-
fession ; and we therefore hail with satisfaction the strong desire evidently
manifested by the proprietors to insure greater accuracy for the future.
Though, upon the whole, the errors of omission and of commission are fewer
in number than in the Directory for 1849, we have yet to complain of such
errors as could not have occurred, had the proof-sheets been looked at by a
member of the medical profession, ordinarily well informed as to the occur-
rences of the last twelve months. It reveals incompetency on the part of
the editor, to describe Dr. Day, Chandos Professor of Medicine at St. Andrews,
as residing at 27 Upper Seymour Street, Portman Square, and to insert Dr.
Peacock as holding the office of Physician to the Royal Free Hospital,—he
having resigned that post on his appointment as Assistant Physician to St.
Thomas’s Hospital.
The number of double entries is hardly excusable. We mention a few
which we have observed in the course of a very cursory examination. Dr.
Edward Ballard is entered in the London Directory as residing at 64, Gower
Street, and in the Provincial Directory, at East Retford : the latter being
correct. Mr. Joseph Henry Green, of Hadley, President of the Royal Col-
lege of Surgeons, is to be found in both departments of the Directory. Mr.
J. T. R. Burroughs, of Lee, Kent, is similarly honoured: as is also Mr. F. C.
Dodsworth, of Turnham Green. Dr. Jephson Potter, of Manchester, is styled
in one page “Potter, Jephson”, and in another, “Jephson, Potter.”
Some of the suburbs of London are also given in the Provincial list, most
frequently with separate lists of practitioners. We refer to Tottenham,
Turnham Green, Streatham, Stratford, and Lee. In Putney, Dr. Ridge and
Mr. Whiteman have been selected for location in “High Street”, in the
general Street list, while the other gentlemen are entered under “Putney”.
There are a few more miscellaneous errors, the occurrence of which should
certainly have been avoided. Mr. Rymer Jones is styled “Examiner in
Physiology at the University of London”, though he resigned that office two
or three years ago. Dr. Carpenter is deprived of his title as Professor of
Medical Jurisprudence in University College. Mr. J. F. South is still de-
scribed as “Professor of Surgery to the Royal College of Surgeons.” Dr.
Turnbull, of Liverpool, in the list of the provincial hospitals and dispensaries,
is not stated to be one of the physicians to the Liverpool Infirmary: and Dr.

180 BIBLIOGRAPHICAL BECORD.
Freckleton is retained, in the same place, as physician to that Institution,
although he has resigned. We were rather surprised to find retained in the
Street list, Mr. Samuel Cooper and Dr. Clendinning;-gentlemen whose loss
has been long mourned by the profession. Some gentlemen, we observe, have
“Phys.” appended to their names; though the designation is not so much
employed as in last year's Directory. If it were uniformly used to denote
those who belong to the London College of Physicians, but had no claim to
the academical degree, it would be reasonable ; but no such rule is observed.
Dr. Tyler Smith, of 7 Bolton Street, is entitled Phys. in lieu of M.D., and we
might multiply illustrations of the same confusion.
We may, perhaps, appear hypercritical ; but when such errors as we have
noticed strike us in a slight and cursory examination of a book, of whose
utility and general excellence we have a high opinion, and whose success we
heartily desire, we should be failing in our duty, if we did not point them out.
There is one other subject to which we beg particularly to direct attention,
and that is the absurd selection which is frequently made of an author's pro-
ductions. The best are often passed over in silence, and the least important
paraded at full length. In this way a positive injustice has been done to
many. Why were gentlemen troubled with an inquiry as to what papers
they had published, “to ensure accuracy”, if their returns were to be treated
as waste-paper ?
Under competent editorial supervision, we have little doubt that the
Directory might be made immaculate as compared to its present state. Being
from this time under the controul of Mr. Churchill, we confidently expect to
find the volume for 1851 free from all such unpardonable blemishes as those
we have now mentioned. The work is a very useful one ; and has our hearty
good wishes.
UNDERWooD's MEDICAL APPoſNTMENT Book, MIDWIFERY REGISTER, DIARY,
AND ALMANAGK: for 1850.
Every physician, surgeon, and general practitioner, ought to use Under-
wood's Appointment Book and Diary. It is very portable, and adapted for
every department of practice. The form we recommend is that done up with
pocket, pencil, and test papers. We find that this wade-mecum greatly assists
us in arranging and performing the duties of the day; and that it likewise
enables us, by making a few brief jottings in the diary, to write up our case-
book reports with much greater confidence and precision, should the hurry or
pressure of practice prevent the progress of a case from being daily extended
in detail.
LoCKE AND SyDENHAM, pp. 36. Edinburgh : 1849.
This is a wholesome and racy pamphlet, giving us some admirable lessons
from the olden time. It appeared originally in a brilliant cotemporary—
the North British Review. Rumour assigns its authorship to an accomplished
young physician of Edinburgh ; but to whomsoever the honour of its pater-
nity may belong, we should be glad to see the essay reprinted, with the au-
thor's name on the title-page, and in such a form as to command a wide cir-
culation, particularly among medical students and junior practitioners. They
may imbibe from it more benefit than from all the disputatious leaders that
were ever written on Medical Education and Medical Reform.

I Sl
crrºrical, DIGEST or THE BRITIs H AND Foreign MEDICAI,
l JOURNALS.
ANATOMY AND PHYSIOLOGY.
LONGET ON THE FUNCTIONS OF THE PNEUMOGASTRIC NERVES.
M. LoNGET has published, in the Archives Générales de Médecine for Novem-
ber 1849, a memoir entitled Sur la véritable Mature des Merſs Pneumogas-
triques, et les Usages de leurs Anastomoses. His principal object appears to
be, to prove that the Pneumogastric Merve, at its origin, is evclusively a nerve
of sensation; and to this he devotes the first part of his memoir.
The idea that the Par Wagum, at its origin, is purely sensitive, has been
maintained by Scarpa, Arnold, Bischoff, Walentin, and Morgani. The con-
trary opinion—that it contains motor filaments—has been maintained by
several physiologists of repute, viz. Wan Kempen, Hein, Wolkmann, Bernard,
Hyrtl, and Stilling. To these we would add Bischoff, who, not long after the
publication of his remarks on the accessory nerve (to which M. Longet alludes),
stated that he observed movements of the velum pendulum palati, in which
contractions of the levator palati muscles were very decided, on irritating
either the roots of the vagus, or the nervus accessorius. [Dr. John Reid, also,
of whose researches on the Eighth Pair of Nerves M. Longet appears to have
been ignorant, mentions that, in some of his experiments, “a distinct move-
ment of the pharynx and arytenoid cartilages followed the pinching of the
insulated par vagum, within the cranium, with the forceps.”] M. Longet con-
siders his view supported by the fact, that the roots of the Pneumogastric
Nerve are implanted in the same tract as the posterior roots of the spinal
nerves; by its being provided with a ganglion; and by his having failed to
observe any movement in the muscles of the larynx or pharynx, after care-
fully isolating the roots of the par vagum, and applying electricity to them.
He attaches much importance to these negative experiments; and hence
concludes that the nerve is exclusively sensitive, from its origin to the gan-
glion which is formed on it in the foramen lacerum. The filaments proceed-
ing from this part of the nerve, he says, impart its peculiar sensibility to
each organ to which they are distributed, and give rise to various forms of
reaction, dependent on the organ and on the nature of the stimulus applied.
M. Longet states that, having excised the free part of the epiglottis in
dogs, he opened the trachea immediately below the larynx, and introduced
some small morsels of food into the glosso-epiglottic folds, where only the
lingual filaments of the superior laryngeal are found: the action of degluti-
tion was always easily excited. He considers, however, that the glosso-
pharyngeal nerves, the pharyngeal branches of the pneumogastric, and some
filaments of the trifacial nerve, are also excitor nerves of deglutition. The
Pneumogastric Nerve is also the excitor nerve of the besoin de respirer; of
the action of the stomach in chymification, and in vomiting; and, by its
filaments, distributed to the inner surface of the heart, of the continual
reflex movements of that organ. -
But a grave error would be committed, if we supposed that the reflex
movements of deglutition, chymification, respiration, and circulation, were
all suspended on section of the par vagum. 1. Besides the lingual, pha-
ryngeal, and oesophageal branches of the Pneumogastrics, the glosso-pharyn-
geal, and some divisions of the trifacial nerves, also act as excitor nerves of
deglutition. 2. The presence of other nerves, besides the Pneumogastric, as


* Bericht tiber die Fortschritte der Physiologie im Jahre 1842; in Müller's Archiv.
Jahrgang 1843, s. 155-6. --
182 CRITICAL DIGEST OF THE JOURNALS.
excitors of respiration, is shown by the effect produced in syncope, by dashing
cold water on the face, or applying strong and penetrating odours to the
nostrils. 3. The movements of the heart, though altered in rhythm and
energy by section of the Pneumogastrics, are not thereby destroyed. 4. The
movements of the stomach are not entirely suspended after section of the
Pneumogastric Nerves in the neck.

Trunk of the Pneumogastric, considered as a Moto-sensitive Merve. It is
difficult to imagine how so small a number of fibres as the par vagum has at
its origin, can impart sensation to so large an extent of mucous surface as
they seem to do. The motor power also which it imparts, is not less aston-
ishing at first ; for if the whole of the spinal accessory nerve were added
(which is contrary to what is known), this would still be insufficient, so in-
numerable are the ramifications of the mixed trunk of the par vagum.
Of the sources from which it derives its motor power—voluntary over some
organs, involuntary over most, some are direct, and proceed,—-1. From the
internal branch of the spinal accessory: 2. From the facial nerve: 3. From
the vertical portion of the hypoglossal: 4. From the anterior branches of
the first and second cervical nerves. The others, which proceed from the
anterior branches of the cervical and the first five or six dorsal nerves, are
called indirect, because they pass through the ganglia of the sympathetic
before arriving at their destination. The direct filaments all contribute to
form the trunk of the nerve ; while the indirect only communicate with its
branches. No physiologist seems to have given to these anastomoses all the
importance they deserve. To explain this multiplicity of sources, from which
the Pneumogastric nerve derives its motor power, we must bear in mind the
high physiological mission which is confided to the mixed trunk of the nerve.
It presides, in fact, over the chief organs, whose action is indispensable to
life. In order, then, that its functional integrity may be better preserved,
and that any sudden interruption of its influence may be less easy, it derives
its motor power from a large extent of the spinal chord. If it derived its
power, like other nerves, from a limited portion of the central mass, a lesion
at this point would instantly suspend its functions.
M. Longet next enters on the consideration of the question,-Is it possible
to determine from what particular source the motor fibres, distributed to each
organ, are derived This can, he thinks, be answered in the affirmative,
1. The influence which the Pneumogastric nerve exerts over the movements
of the lungs, heart, oesophagus, and stomach, is due to the filaments which it
receives from the anterior branches of the cervical and upper dorsal nerves,
which pass through the sympathetic ganglia. Irritation of the par vagum at
its origin, or of the spinal accessory, hypoglossal, or facial, which are con-
nected with it, does not produce any movement in these organs. Those parts
which are supplied through the medium of the sympathetic, have this pecu-
liarity, that the contractions produced by irritation of the nerves are not im-
mediate, and continue, even increasing in intensity, after the stimulant has
been removed. It would be an error to conclude that, because the pheno-
mena of respiration, circulation and digestion, continue after the spinal acces-
sory nerve has been divided, the pneumogastric is a mixed nerve at its origin:
for the internal branch of the spinal accessory is only one of the motor nerves
connected with the par vagum, and, moreover, presides over the functions of
other organs.
2. The direct motor filaments, supplied to the Pneumogastric, are derived
from the spinal accessory, the facial, the hypoglossal, and the anterior
branches of the first and second cervical nerves.
The internal branch of the spinal accessory, which arises from the bulb,
passes into the foramen lacerum between the external branch and the Pneu-
mogastric. It gives some filaments to the latter nerve and then divides; one
part forms a large portion of the pharyngeal nerve, and the other is united


CRITICAL DIGEST OF THE JOURNALS. 183
with the Pneumogastric, just above the origin of the superior laryngeal. Its
connection with the nerve cannot be demonstrated anatomically ; but the ex-
periments of Bischoff and Longet tend to show that the voice is destroyed
on division of the internal branch of the spinal accessory.
Has the internal branch of the spinal accessory any influence over the
respiratory movements of the glottis ' It indeed transmits to the laryngeal
muscles the motor power, on which depend the tension and approximation of
the vocal chords; and it must be admitted, that the whole laryngeal mus-
cular apparatus is called into action in the production of sounds. But in
normal respiration, we only see a permanent separation of the glottis or of
the nostrils; when respiration is impeded, these orifices at first become di-
lated, but soon return to their original dimensions, without having any
necessity for the action of constrictor muscles. For the nasal orifice, this
intervention is indispensable, as in the act of smelling; for the orifice of the
glottis, it only acts in producing Sonorous expiration, as in coughing and
sneezing—that is to say, when the larynx acts both as an organ of voice and
of respiration. The narrowing of the glottis, which occurs in certain deter-
minate acts, is independent of the constrictor muscles of the larynx. It hence
follows, that all the muscles of the larynx, with the exception of the arico-
arytenoidei postici, are engaged in the production of the voice ; and that,
if section of the spinal accessory nerves produce aphonia, it is because
they supply these muscles.
The crico-arytenoidei postici, which dilate the glottis in respiration, are
under the influence of a greater number of nerves. Before giving off the
recurrent nerves, which supply these muscles, the Pneumogastrics have ex-
tended to such a distance as to be able to receive motor fibres from the spinal
nerves. These accessory fibres of the Pneumogastric supply also the con-
strictor muscles of the pharynx, which are in no way affected by irritation
or injury of the spinal accessory nerve within the skull. In an animal, how-
ever, deprived of its spinal accessory nerves, there is some disorder of deglu-
tition; and M. Bernard has observed some difficulty, which he refers to the
non-closure of the larynx. When one wishes to compel the animal to eat
quickly, when it is frightened during its meal, or when it is pinched, there
is a kind of hoarse cough produced by the introduction of morsels of the food
into the air passages. But when it is let alone, deglutition goes on without
accident, but slowly ; it sometimes recovers, however, its normal rapidity in
a few days. The introduction of the food into the air passages is explained
by the slowness of its progress through the pharynx. As to the latter phe-
momenon, it depends on a diminution of the power of the pharyngeal mus-
cles; and its restoration tends to show, that these muscles derive their motor
power from other nerves than the spinal accessory. The non-closure of the
larynx cannot be adduced as a reason for the entrance of food into the
trachea ; for the closure of the glottis is effected by the action of the lower
constrictor muscles of the pharynx during deglutition. From experiments
performed by M. Longet, it appears that deglutition proceeds normally, even
if the trachea be opened, and the glottis prevented from being closed. M.
Louis, also, has observed deglutition performed with perfect regularity in
phthisical patients, whose glottides had been destroyed by ulceration.
The principal causes which prevent the introduction of food into the air-
passages are, the ascent of the larynx forward, with the movement of the
tongue backward, and the momentary arrest of respiration which precedes
these movements. M. Longet states that the arrest of the respiration can-
not be attributed to the closure of the air passages at the level of the larynx :
for the same phenomenon has taken place in dogs, whose trachea has been
cut across; and in rabbits, whose spinal accessory nerves have been divided,
and in whom the aperture of the glottis has been kept open. In deglutition,
then, the pharynx ceases its respiratory function, to appropriate itself exclu-
sively to deglutition. The acts of respiration and deglutition thus alternate

184 CRITICAL DIGEST OF THE JOURNALS.
and never come into opposition. M. Longet concludes, that the temporary
arrest of respiration is not dependent on the internal branches of the spinal
accessory nerves ; and that the slight impediment to deglutition which fol-
lows section of these nerves, is not to be attributed to the persistence of re-
spiration. That the pharynx should continue to act, after division of the
spinal accessory nerves, is not surprising, when we reflect on the number of
nerves which it receives from other sources. The filaments from the facial,
which anastomose with the glosso-pharyngeal, are distributed to the stylo-
pharyngei and palato-pharyngei muscles, as well as to the superior and middle
constrictors ; the latter also receive nerves from the three or four upper
cervical, which have passed through the superior cervical ganglia of the
sympathetic ; and the superior constrictor also divides some nerves from the
non-ganglionic portion of the trifacial. The inferior constrictor is supplied
indirectly both by the upper and lower cervical nerves ; the filaments from
the latter pass through the inferior cervical ganglia, and enter largely into
the formation of those portions of the recurrent nerve which end in the in-
ferior constrictor.
The motor power of the pharynx is thus dependent on the inferior maxil-
lary, the facial, spinal accessory, and hypoglossal nerves, and on direct or
indirect motor fibres from the cervical nerves; while its property of sensa-
tion is presided over by the ganglionic portions of the par vagum, glosso-
pharyngeal, trifacial, and sensory fibres from the anterior branches of the
cervical nerves. The importance and diversity of the uses of this organ
afford a just explanation of the numerous sources from which it derives its
In€TVeS.
The pharynx, by varying in dimensions, produces differences in the timbre
of the voice; but this function is of course useless, when the movements of
the larynx in phonation have been arrested by section of the internal
branches of the spinal accessory nerves.
M. Longet has always seen contractions produced in the upper part of the
oesophagus by applying electricity to the internal branch of the spinal acces-
sory. The muscular fibres, at this part, are mostly striated. The influence of
the spinal accessory nerve seems to be exerted on the oesophagus during pho-
nation ; for M. Longet has several times seen very obvious contractions of
the upper part of the tube, at the same time that the animal was uttering
violent cries.
It will perhaps be interesting to inquire, how far the ganglionic portion of
the pneumogastric, and the numerous motor-filaments which join it, can
represent the two elements of a rachidian nerve.
The mixed trunk of the pneumogastric consists, as before seen, of sensory
and direct (voluntary or semi-voluntary), and indirect or reflex motor fibres.
But if all these motor nerves were so grouped as to arise from a limited part
of the cerebro-spinal axis, we would naturally be led to consider the pneu-
mogastric as composed of elements analogous to the motor and sensory roots
of spinal nerves. But the motor fibres of the pneumogastric arise from a
large extent of the cerebro-spinal axis; hence the impossibility of their
uniting with the sensory portion of the nerve at the level of the jugular
ganglion, as the motor and sensory portions of the spinal nerves unite at the
level of the intervertebral ganglion. There is also another essential difference,
in the presence of the indirect motor fibres, which do not exist in a mixed
spinal nerve.
It would be easy to shew, that the muscular division of the inferior
maxillary nerve is not the only motor root of the trifacial; but that the
oculo-motor, the facial, and the hypoglossal, form anastomoses with it, below
the Gasserian ganglion, and thus represent complementary motor roots. We
could certainly imagine, in place of all these nerves, a single large motor
root; but then the interruption of the motor function, by injury, would be
CRITICAL DIGEST OF THE JOURNALS. 185
much more easy. However this may be, we should be greatly mistaken in
imagining that a nerve, reputed motor in relation to another which is sensory,
must necessarily accompany all the divisions of the latter. No one denies,
that the masticatory nerve is the motor portion of the trifacial, nor that the
anterior root of the second cervical nerve is motor : yet the posterior root,
which gives sensation to the skin of the back of the head, and the trifacial,
which performs the same function anteriorly, are far from being accompanied,
in their whole extent, by their corresponding motor filaments. An incom-
plete state of fusion between the motor and sensory fibres of the different
nerves, would not authorize us to deny all analogy between them and the
spinal nerves : in fact, we admit this analogy between the masticatory and
the sensory portion of the inferior dental nerve, although their filaments are
very easily separable, and accompany each other for only a very short
distance.
The internal or anastomotic branch of the spinal accessory only represents
an incomplete motor root. It is, at first, pretty distant from the pneumo-
gastric, only giving some filaments to it; but the two nerves are soon closely
united, so that, in the laryngeal nerves, it is absolutely impossible to
separate the filaments of the pneumogastric from those of the spinal
accessory. The apparent origin of the internal branch of the spinal acces-
sory in the vicinity of the posterior roots, cannot be alleged as a reason for
its not being motor; for the whole extent of the antero-lateral portions of
the cord is devoted to motion. The masticatory and sixth nerves do not
apparently arise from the prolongations of the anterior columns of the cord ;
but they are not the less nerves of motion.
M. Longet thinks he has shewn, that it is absurd to suppose, because the
movements of the lungs, heart, liver, and stomach, continue after destruction
of the spinal accessory nerve (one only of the motor sources) that the par-
vagum, at its origin, has any proper motor power. The same law which
regulates the spinal nerves must be applied to the cerebral: and consequently,
there can be no nerves mixed from their origin. - - - -
The following is M. Longet's SUMMARY :— - -
1. From its origin, as far as the superior jugular ganglion, the Pneumogas-
tric is exclusively a nerve of sensation. , ,
2. The stimulation of its proper fibres, at their extremities, has especially
the effect of inducing the reflex movements of deglutition, chymification,
circulation, and respiration. At the same time, it would be a serious error
to suppose that, if the excitor influence of these fibres were cut off, the reflex
motor actions would necessarily be abolished. r
3. Below the Superior jugular ganglion, the trunk of the Pneumogastric
represents a mixed nerve, exercising a motor influence, voluntary on some
organs, involuntary on others. The voluntary power it owes to its direct
motor fibres ; the involuntary, to the indirect before enumerated.
4. The sources of innervation required to maintain the function of an
organ, are multiplied in proportion to its physiological importance. Thus
the organic movements of the lungs; heart, and stomach, are influenced by
motor fibres coming from numerous points of the nervous system. It is the
same with the movements of deglutition, and with the respiratory dilatation
of the glottis. * *
5. The anastomotic branch of the spinal accessory, which, to the exclusion
of every other nerve, presides over the vocal movements of the larynx, only
represents a partial motor root of the Pneumogastric.
6. It is neither correct nor rational to conclude that, because, in the absence
of this amastomotic branch, the phenomena of respiration, circulation, and
digestion, continue in animals, the Pneumogastric Nerve must be mixed at
its origin. The internal branch of the spinal accessory is only one of the
sources through which the trunk of the Pneumogastric receives motor fila-
ments from the cerebro-spinal centre.
vol. II. 13
186 CRITICAL DIGEST OF THE JOURNALS.
John REID's RESEARCHES. Any contribution to physiology by M. Lon-
get, is deserving of careful attention: and it is from our high opinion of
his scientific merits, that we have devoted so much of our space to his memoir
on the Functions of the Pneumogastric Nerves. But we regret to have to
notice a serious fault, which is common to not a few of his countrymen, and
which he commits in no moderate degree. We allude to disregard or ignorance
of what has been done by British physiologists. In a careful perusal of his
memoir, we have not once met with any allusion to the elaborate and valuable
Essays of Dr. John Reid, on the Eighth Pair of Nerves: and we have been
more struck with this omission, both because M. Longet has noticed the
opinions of German physiologists, and because there are several points in his
memoir, whereon the opinions of Dr. Reid might have been adduced, as
either confirmatory or opposing. We are utterly at a loss to imagine a valid
excuse for M. Longet. We have some idea, that he cannot be ignorant of at
least the existence of the first memoir of Dr. Reid, published in 1838. Even
supposing him to be ignorant of the English language, he might surely have
become acquainted with what Dr. Reid had done, through the medium of
some friend who understood English ; and he must know, that the reputation
of Dr. Reid entitles his writings to a careful and respectful examination.
We regret having to make these remarks; but we have felt it our impera-
tive duty to offer them, as an act of simple justice to British physiologists, and
in particular to our lamented countryman, whose sense of honour was so
nice, that he never published the results of his own researches, without giving
full credit to every fellow-labourer in the same field.

PRACTICE OF MEDICINE AND PATHOLOGY.
COINCIDENCE OF ALBUMINURIA AND AMAUROSIS.
DR. LANDouzy has contributed an article on this subject to the Gazette
Médicale of Oct. 20, 1849. His speculations are misty ; but his paper is in-
teresting, as establishing the fact, that impaired vision is an almost constant
symptom of that form of renal toxaemia, which is indicated by an albuminous
condition of the urine. We have often seen amaurosis and albuminuria co-
incident : but we cannot speak to this being so very frequent as Dr. Lan-
douzy states, though we can, from what we have seen, give full credit to the
accuracy of his observations. The conclusions at which he has arrived are
thus stated :—
1. Enfeebled vision is a symptom almost constantly present in albuminous
nephritis.
2. It is the earliest symptom of albuminous nephritis.
3. It disappears and returns simultaneously with the albuminous condition
of the urine.
4. Albuminous nephritis ought to be considered as dependent upon an
alteration in the gangliomic system of nerves.
TREATMENT OF CROUP BY GALOMEL AND ALUM.
In a letter addressed to the Medical Society of Inde-et-Loire, M. MigurL,
of Torres, has given some important details of the result of the method of
treatment which he employs in diphtheritis.
He relates that, about twelve years ago, a little girl, seven years old, having
been simultaneously seized with angina and croup, he proposed to perform
the operation of tracheotomy, which was objected to by the parents.
Being thus deprived of the last resource of art, he alternately administered
to the child, every hour, two grains of Calomel and three grains of Alum.
This treatment was continued a week, and produced no purgation nor saliva-
CRITICAL DIGEST OF THE JOURNAL8. 1S 7
tion. Since this case, M. Miguel has treated twenty-six cases of croup, only
three or four of which were doubtful; and only five cases have been fatal. He
attributes the efficacy of his method to the mercury; but as it is liable to
produce salivation and other disastrous consequences, these must be pre-
vented; and M. Miguel thinks he has attained this object by combining alum
with calomel. He thinks that when the Calomel and Alum are alternated,
the latter serves to circumscribe the mercurial action, which should also be
well watched, so that the administration of Calomel may be suspended on the
least appearance of mercurial intoxication.
REMARKS: The treatment of M. Miguel is founded on the property which
is attributed to mercury, of diminishing the plasticity of the blood, and op-
posing the formation of false membranes. The important point is, that this
treatment has proved successful in a certain number of cases. It should be
known, also, that such treatment will not supersede the necessity of emetics
and of energetic cauterization, when the disease has commenced in the pha-
rynx. In such cases, mercury alone is useless : it may be prescribed, but the
local treatment is that which must be chiefly depended on, to arrest the pro-
gress of the disease. Of this we saw a remarkable instance, a short time ago,
in the practice of M. Trousseau.
In this case, the diphtheritis had commenced in the tonsils, and had ex-
tended towards the larynx. On the first day of its appearance, an emetic of
sulphate of copper was administered, and the back of the throat was well
cauterized with fuming hydrochloric acid. This cauterization was repeated
once on the next day, twice on the day following, and once on the subse-
quent day. At the same time, the patient took, in small quantities every
quarter or half hour, a mixture of ten grammes of alum with the same quan-
tity of honey. This is preferable to alum in powder, because the medicine
comes into permanent contact with the throat and the arytaeno-epiglottic
cartilages.
In prescribing Alum, M. Trousseau used it as an auxiliary to cauterization,
not as a corrective to mercury, which he did not give during the whole pro-
gress of the case. From the third day, there was a steady improvement;
and, on the sixth, the cough had lost its croupy character. The voice con-
tinued rather weak, which showed the existence of false membranes on some
points. Cauterization was continued once a day, for two days, together with
the Alum and honey: and the child recovered. This method of treatment is
considered, by M. Trousseau, to be the most certain which can be employed in
cases of croup. [Journal de Médecine et de Chirurgie Pratiques, 1849. p. 533.]
THE WARIOUS FORMS OF DIARRHOEA IN CHILDREN ; AND ESPECIALLY
CHOLERIFORM DIARRHOEA, OR INFANTILE CHOLERA.
Besides lientery, there are several forms of Diarrhoea which affect infants,
and with the nature of which it is important to become acquainted. Bilious
diarrhoea is characterized by bilious mossy stools of the colour of oil. There
is also a modified form of bilious diarrhoea, in which the stools resemble
chopped vegetables. There is the appearance of the débris of spinage in the
stools, which are also spotted with a liquid of the colour of sulphate of copper.
This modification of bilious diarrhoea is very common in new-born children,
but becomes more rare as age advances. Mucous or glairy diarrhoea is cha-
racterized by the resemblance of the stools to slightly boiled white of egg.
This is sometimes combined with ordinary bilious matter, and more rarely
with food: sometimes also blood is present. This form is commonly attended
with pain, but is fortunately more amenable to treatment than the others.
It appears to be confined to the large intestines. In pseudo-membranous
diarrhoea, the stools are imperfectly moulded, and covered with a pseudo-
membranous concretion of thickened mucus or fibrin. The most severe form
of all, exclusive even of epidemic conditions, is the purely serous, watery O?"
13
188 CRITICAL DIGEST OF THE JOURNALS.
choleriform diarrhoea, or infantile cholera, which is very common in infants
at the breast.
The following is an abstract of the opinions of M. TroussBAU on the symp-
toms of each of these forms of Diarrhoea.
In bilious diarrhaea, the stools are yellow and abundant, and almost always
accompanied with bilious vomiting, with more or less intense fever, and in-
crease of the biliary and pancreatic secretion. It is more manageable than
lientery, and yields to remedies in children as well as in adults. It is a re-
markable fact, that if the diarrhoea be very abundant, the vomiting ceases;
but if, on the other hand, the diarrhoea is abruptly suspended, the vomiting
immediately returns. This is especially remarkable in children, and is con-
sidered by M. Trousseau to have an important bearing on the treatment.
When the stools are yellow, the patient is not severely ill; but when they
are copious and green, and there is fever, the prognosis is more unfavourable.
The glairy diarrhoea commonly depends on inflammation of the large or
small intestines. There are colic and fever, but rarely vomiting. The func-
tions of digestion and assimilation still go on to some extent. The pseudo-
membranous secretions are extremely rare as a result of inflammation of the
large intestines, but are most commonly observed after enteritis. In choleroid
diarrhoea, which is the most severe form, after one, two, or three days of
bilious diarrhoea, the children are suddenly seized, more frequently in sum-
mer than in winter, with irrestrainable vomiting, and with serous dejections,
which scarcely colour the linen cloths green. At the same time, the child
utters constant cries; the eyes are hollow, the respiration impeded, the abdo-
men is drawn in, and the skin assumes a blue tint ; and the patient dies.
M. Trousseau does not hesitate to affirm, that this disease kills more than
one half of the children at the breast, for it is at this age that it is principally
observed. It rages independently of an epidemic of cholera, from the age of
one to two years, that is to say, during the first dentition, and attacks few
children who have been weaned for some time.
TREATMENT. In bilious diarrhoea, the first remedy to be given is ipecacu-
anha, in emetic doses, of fifty centigrammes to a child at the breast, a gramme
to older children, and two grammes to adults. It is given three days in suc-
cession, and commonly modifies the vomiting, diarrhoea, and fever. If it
fails, ten centigrammes of sulphate of copper may be given, in four doses, at
intervals of ten minutes, dissolved in water. This has produced astonishing
results in three children. In one child, who had been labouring under vomit-
ing and copious diarrhoea for three days, the number of stools was reduced
from ten to three by the administration of sulphate of copper. In a second,
it succeeded, after the failure of bismuth and saline purgatives. In a third
child, who was labouring under morbillar pneumonia, which was treated by
antimonials and digitalis, diarrhoea was arrested by sulphate of copper.
Rochelle Salt, sulphate of magnesia, or magnesia alone, or combined with
calomel, are useful in such cases. It is good practice, for instance, to give
five centigrammes of calomel in the evening, and twenty-five or thirty centi-
grammes of magnesia the next morning.
The green form of diarrhoea is equally well combated by the preceding
means, but especially by saline purgatives, as the potassio-tartrate of soda.
If, however, the stools remain green at the end of two or three days, it will
be found advantageous to administer twenty-five or thirty centigrammes of
magnesia, with an equal quantity of sugar, at the same time applying cata-
plasms to the abdomen, and administering enemata. In case of failure of
these means, emetics may be employed.
In glairy diarrhoea, if there be no vomiting nor flatulent distension, the
treatment may consist of injections. If the pain be severe, an injection, con-
sisting of from five to ten centigrammes of nitrate of silver in two or three
hundred grammes of distilled water, should be administered. When returned,
it is immediately followed by a similar one, containing a drop of laudanum.

CRITICAL DIGEST OF THE JOURNALS. I 89
This is repeated once a-day for three or four days, according to the amount of
glairy mucus and blood in the stools. When there are flatulent distension
and fever, it is well to commence the treatment with ipecacuanha, then to
give Rochelle salts, and afterwards to employ lavements, and not to give opium
till there be no more vomiting. The injections may contain sulphate of cop-
per or of zinc, the quantities being double that of nitrate of silver. It is rare,
says M. Trousseau, that acute colitis will not yield to this treatment: sul-
phate of copper is almost as active, and quite as excellent, as nitrate of silver.
Pseudo-membranous diarrhoea is rare in children, but common in adults,
especially in constipated females. It yields readily to enemata of nitrate of
silver, or sulphate of zinc or copper, and to belladonna given internally. Chil-
dren affected with this disease appear to void boiled rice, the stools contain-
ing the fibrinous productions developed on the surface of the intestinal
excoriations, which are seated either in the rectum or the colon. It is treated
as in adults: calomel may also be administered in the form of enema, by tri-
turating one or two grammes with a thick solution of gum, and injecting it
every one or two days.
The most severeform is infantile cholera. A child, after it has been weaned,
or while it is suckling, or during dentition, has diarrhoea: this is considered
salutary by the nurses, and by medical men, who misinterpret the saying of
Sydendam, that a child's bowels should be open during dentition. This is a
grave error, which should be guarded against. If the diarrhoea last one or
two days, it may be let alone ; but if it continue beyond that time, it must
be moderated and arrested. If this be not done, a child may have diarrhoea
for ten days, a fortnight, or a month, without any apparent constitutional
disturbance ; on a sudden, it is seized with violent vomiting and abundant
serous diarrhoea ; the eyes became hollow, the skin blue, the tongue cold, the
pulse small, and the muscles frequently soft and flaccid like rags. The vomited
matters are greenish, generally with a copper colour; the diarrhoea is so
completely watery in most cases, that the linens seem wetted with urine ; in
other cases, they seem as if dipped in a solution of copper. The child utters
continual cries, and is restless and sleepless. Sometimes the diarrhoea stops,
and the vomiting becomes violent; at others, the diarrhoea and vomiting are
partially suspended, but not entirely arrested ; the child soon loses strength,
and dies. This disease lasts from twelve hours to five or six days, but the
most common duration is from twenty-four to forty-eight hours.
The first remedy which presents itself is opium. In this, M. Trousseau
has very little confidence. It may arrest diarrhoea, but the vomiting con-
tinues; and if the opium be given by mouth, it is more likely to aggravate
the vomiting and kill the patient, than to cure him. Astringents, such as
monesia, rhatany, bistort, tormentilla, cinchona in draught and in injection,
etc., are of no use in this form of diarrhoea. The only treatment on which
M. Trousseau depends, is based on emetics and purgatives. As an emetic,
powdered ipecacuanha is the best ; among purgatives, the potassio-tartrate
of soda, in doses of four, five, or ten grammes, is to be preferred. But in the
proper choleraic form, we must at once use mustard baths. The child must
be kept in the bath until the hands of the person holding it are attacked
with an unsupportable Smarting ; it is then wrapped in woollen cloths, and
at the same time has administered to it a little syrup of ether, with mint and
Seltzer water. When moderate reaction has set in, we may advantageously
give ipecacuanha and Rochelle salts, to modify the condition of the alimentary
canal. If at the end of forty-eight hours, there be heat, slight stupor, and
other typhoid symptoms, and the diarrhoea continue at the same time, M.
Trousseau gives a mixture, containing one centigramme of nitrate of silver,
with thirty grammes of distilled water and twenty grammes of syrup; and
injects twice or thrice daily, an enema containing from five to ten centi-
grammes of nitrate of silver in two hundred grammes of distilled water.
The mustard bath is continued, if required. When the nervous or typhoid
190 CRITICAI, DIGEST OF THE JOURNALS.
symptoms are inclined to be obstinate, the infant might be plunged in a cold
bath for one or two minutes, or have a slight cold affusion. These means,
aided by refreshing drinks of milk or beef tea, often put an end to the disease.
We see then, that in indigenous cholera, the indications are almost the same
as in epidemic cholera. Nevertheless, whatever is done, the greater number
of children die, even after they are thought to be recovering. Two or three
drops of laudanum may arrest the vomiting and diarrhoea; but let no one
trust to this. As long as the pulse is small, and there are slight fever, rest-
lessness, cries, etc., the condition of the child is precarious, even though the
vomiting and diarrhoea have been arrested. The most favourable signs are the
return of a gentle heat to the skin, and the diminution of restlessness; be-
cause these symptoms indicate, even though the diarrhoea persist, that there
is nothing left but ordinary-enteritis. [Journal de Médecine et de Chirurgie
Pratiques. 1849. p. 535.]
SURGERY.
g==
MIR. LLOYD ON THE RADICAL CURE OF HYDROCELE.
The following is the substance of some interesting clinical remarks lately
made by MR LLoyd at St. Bartholomew's Hospital, and reported in the
Medical Times for January 5th.
1. ForcIBLE INJECTION of THE SAC of THE TUNICA WAGINALIS. He em-
ployed this plan some years ago in several cases among the out-patients of the
hospital; at first he thought with success, but, with the exception of one case,
the disease recurred in all; and what was the permanent result in that one,
he had no opportunity of ascertaining.
2. ACUPUNCTURE. He had also given acupuncture a fair trial, but found it
a very uncertain remedy; but oftener successful in children than in adults.
3. INTRODUCTION of Powder of HYDRARGYRI NITR. OxIDUM INTO THE SAG.
This is the plan of treatment most relied on by Mr. Lloyd, and he has adopted
it almost exclusively at the hospital for several years. It consists of the intro-
duction into the sac, after it has been emptied of its contents, through the
canula, of the substance finely levigated. This plan has been employed in
a large number of cases, and hitherto without a failure, as well as without
any untoward consequence whatever. It excites the necessary degree of in-
flammation, with as great, if not greater, certainty than the injection of wine,
of solutions of sulphate of zinc, iodine, etc. It is, moreover, a much more con-
venient mode of treatment, as well as a saving of much time. The mercury is
fººd, the patient is left to himself, and the surgeon is at once at
iberty.
4, PRESSURE. Mr. Lloyd lately cured a case of Hydrocele by pressure—
tightly strapping up the testicle directly after evacuating the fluid. The
pressure was kept up for three days, by which time hernia humoralis was
established; since which the patient has gone on precisely in the same course
as is usual after vinous injection.
5. WINous INJECTION. This method was adopted in the case which elicited
the preceding remarks. After puncturing the sac, and drawing off about
thirty ounces of greenish yellow fluid, Mr. Lloyd injected a pint of undiluted
port-wine, which was allowed to remain for fourteen minutes.

TOPICAT, USE OF POWDERED AGETATE OF LEAD IN GRANULAR OPHTELAIMIA.
Since 1834, M. BUYs has employed powdered Acetate of Lead in the treat-
ment of palpebral granulations. His success, especially in cases reputed
incurable by other methods, has drawn attention to the practice of the
Military Hospital of Bruges . The plan seems to be free from several objec-
tions to which cauterization with nitrate of silver is liable ; and it is particu-
CRITICAL DIGEST OF THE JOURNALS. 191
larly to be recommended, as curing granulations without destroying the
palpebral conjunctiva, or causing the formation of bands of cicatrix tissue,
the frequent sources of secondary evils. --
The author thus describes his method of applying the Acetate of Lead:—
“I first select”, says he, “perfectly neutral Acetate of Lead: that which is
sold in common shops is not always of this description, and gives rise to
acute pains. ... A pencil, similar to those commonly used for applying a solu-
tion of the nitrate of silver, is slightly moistened in water, dipped in powdered
acetate of lead, and then applied to the everted eyelid, where the granula-
tions are situated. The eyelid is held down sufficiently long to allow the
tears to moisten the salt of lead and wash off the excess. The chemical
action of the tears on the powder must take place, before the eyelid be
restored to its natural contact with the globe. This is one of the most im-
portant particulars to be attended to. . If the tears be scanty, the pencil may
be moistened by those flowing down the cheek, and then applied to the eye-
lid where the Acetate of Lead may still be undissolved. Whilst the eyelid is
still exposed to the action of the tears, and of the air, the granulations may
be seen to.”
DR. JOHN CHARLES HALL, ON THE NITRATE OF SILVER AS A
LOCAL APPLICATION IN EFYSIPELAS.
Dr. J.C. HALL has sent to us the following note:–“I am made (p. 58) to ex-
press the opinion, “that, as the disease is constitutional, and not local, the re-
pression, by Nitrate of Silver, of the outward inflammation, may often be most
improper.” What I stated 1 most distinctly, was, that the application of the
Nitrate of Silver did not repel erysipelas; but, that it limited the inflamma-
tion, and, when applied sufficiently early, prevented that fatal destruction of
parts, which, before the discovery of this remedy, by Mr. Higginbottom, was,
too often, a result of erysipelas. Of course no experienced practitioner
would fail, at the same time the Nitrate of Silver was used locally, to exhibit
such constitutional remedies as were indicated; but I think no one will deny,
that the checking the local disease in the bud will have no trifling effect in
mitigating the constitutional symptoms.” C. H.”
TOXICOLOGY.
ARSENIC IN UNFERMENTED BREAD.
The Medical Gazette has the following:-A few years since a pamphlet was
published by “A London Physician,” strongly recommending the employ-
ment of unfermented in preference to baker's bread. The unfermented bread
is made by mixing bicarbonate of soda with the flour, and subsequently knead-
ing it with diluted muriatic acid . . . . We predicted some time since, that
accidents would arise from the use of common muriatic acid in making un-
fermented bread. The following extract is quoted from a letter by Mr. DAVIs,
in the Provincial Medical Journal of December 26th. It comes in the
shape of a communication from Dr. HENRY, who says– *.
My attention was forcibly called to the question of impurities present in
the common muriatic acid, by the injurious effects of bread made on the non-
fermented principle, upon my own family and myself. In all, nausea and
severe pains in the stomach followed its use (continued for three weeks be-
fore discovery); in some, instant vomiting and irregularity of bowels, though
not actual diarrhoea; and in one case (my footman), the outbreak of the
arsenical eczema. I lost no time in testing the acid for metallic impurities,
but, not happening to have any sulphuretted hydrogen, could at first detect
nothing. When I procured some, I was astonished by its throwing down a
* Lancet, August 18th, and September 8th, 1849.
| 92 CRITICAL DIGEST OF THE JOURNALS.
dense yellow precipitate, which I at first suspected to be tin (from knowing
that the manufacturers also made muriate of tin), but soon discovered it to
be Arsenic.”
It has been long known to English chemists, that much of the sulphuric
acid sold is largely contaminated with Arsenic. It is manufactured from
pyrites, which generally contains arseniuret of iron. Arsenic, therefore, may
be thus transferred to nitric acid, muriatic acid, and numerous salts in the
preparation of which sulphuric acid is largely employed. It may even find
its way into the diluted sulphuric acid used medicinally. Under a proper
system of medical police, the sale of this poisoned acid would be strictly pro-
hibited. [Medical Gazette, Jan. 11, 1850.]
POISONOUS EFFECTS OF THE BRASSICA NAPUS, OR WILD CORN KALE.
DR. JoHN PopBAM, of Cork, has lately recorded the following remarkable
phenomenon : In the months of June and July of the present year, when
very great destitution prevailed in the southern and western parts of Ireland,
I was surprised to find a large number of persons from some of the famine-
stricken districts of the Cork union, applying for admission into the work-
house hospital, with very peculiar and alarming symptoms. They were chiefly
the families of country labourers out of employment, emigrating from place
to place in search of work, and totally deficient of the means to procure the
merest necessaries of life. They all exhibited indications of deteriorated
health, the hue of the skin being uniformly sallow and muddy-looking, totally
different from the brown discoloration caused by exposure to the sun; the
surface was also covered with that colourless downy hair, so characteristic of
what the country people here call “impoverished blood.” There was gene-
rally an oedematous state of the whole body, but always of the face and lower
extremities, the former being sometimes swollen to an enormous extent, the
distended state of the eyelids and upper lip especially producing remarkable
deformity. The abdomen was tympanitic; the bowels torpid : the mucous
membrane of the mouth and pharynx was inflamed, and in some parts ulcer-
ated, and the gums spongy; the appetite was usually greater than natural,
in some cases voracious; the urinary secretion was deficient and irritating,
and that of the skin suspended; very distressing frontal headache and ten-
sion was also complained of; but the most curious symptoms, next to the
oedematous appearance of the patient, was the state of the hands and feet,
which were dry and shrunken, with blotches of a deep-red, resembling burns,
on the backs of the hands and dorsum of the feet, the fingers and toes being
frequently cold and livid. Similar blotches existed on the nose and fore-
head, and these varied in their consequences from simple discoloration to
ulceration of a most troublesome description, terminating in loss of the cuticle
and dropping off of the nails, with a marked disposition, in the aggravated
cases, to gangrene. The oedematous appearance of these patients was so like
that of persons suffering from extreme cardiac or renal disease, that I formed
at first a very unfavourable prognosis; but, on a closer inquiry, I discovered
that all the persons thus affected had made use of the field species of brassica
as food. Some of the worst cases had used it almost as the sole means of Sup-
port; others again had partaken of it at longer intervals, and with the addi-
tion of Indian meal or other farinaceous food. From the similarity of Some
of the symptoms to those produced in the human body by the acrid pro-
perties of the ranunculaceae, I thought it possible that some plants of this
family might by mistake have been gathered with the Kale, but the identity
of the symptoms in all the persons, who were from very different parts of the
country, led me to abandon the idea. This was further confirmed by show-
ing the patients the respective plants, when, in all instances, they at once
distinguished the yellow racemes and cordate leaves of the Praiseach buidhe,
or yellow Kale, from any other. They stated that their mode of cooking the
CRITICAL DIGEST OF THE JOURNALS. 193
herb for food, was to strip the leaves, rejecting the stalk, root, and flower, and
to boil them with common salt or soda. Most of them had used the Corn Kale
for a period extending from one week to six, before the unfavourable effects
became manifest, and these were more rapidly produced in persons previously
suffering from gastric or intestinal disturbance.
I am not aware of the effects above described have been heretofore ob-
served. The family of plants to which it belongs—the cruciferae—has always
been considered salutary; but in many of its genera there exists a volatile
oily principle, peculiarly irritating to the skin and digestive organs. This
volatile oil, which in some genera, as the mustard tribe, resides more particu-
larly in the seeds, and in others in the root, exists, in the wild varieties of
the colewort tribe, also in the leaves, which give to the tongue a disagreeable
biting taste. By cultivation, this acrid property becomes more diffused and
diluted. The quantity of nitrogen, also, which the cruciferae contain, affords
great facility for the formation of ammoniacal products; and the tympanitic
condition of the abdomen is most likely due to this cause. The analogy
which exists between the enfeebled capillary circulation and ulcerative ten-
dency in the extremities arising from the use of the Corn Kale, and the more
marked gangrenous effects produced by the ergot of rye, is apparent; but
whether it would have proceeded to sphacelus, I am not able to say, as, for-
tunately, the unsightly appearance presented by the patients led them to
apply early for relief. The treatment consisted of such medicines as were
best adapted to restore the action of the skin and kidneys, together with mild
purgatives, warm baths, rest in the horizontal position, and wholesome food.
The state of the extremities required careful stimulation until the circulation
was restored, when the tepid water-dressing was the best application. It was
some time before many of these patients regained their former health; and
in ſº the blotches have left a permanent mark.-[Lancet, December 15,
1849.
OBSTETRICS.
DIAGNOSIS BETWEEN REAL AND APPARENT DEATH IN NEWIY-BORN
CHILDREN.
It is well known how difficult it is, to determine whether a child born in a
state of asphyxia be really dead. If the pulse be not perceptible, if respira-
tion be absent, and if the beating of the heart be not heard, it is sufficient to
lead most accoucheurs to decide that the child is born dead, and to decline
making any attempt at artificial respiration—too probably fruitless. It would
be important to possess a certain sign that life still existed, even though all
its functions had apparently ceased. M. WAN HENGEL thinks he has disco-
vered such a sign.
In May 1848, he administered ergot of rye to a patient labouring under
haemorrhage. The haemorrhage was arrested ; but the infant was born appa-
rently dead. There was no respiration; the hot bath was first tried, then
alternate immersion in hot and in cold water. Tickling of the nostrils also
produced no result. M. Van Hengel thought of stimulating the sacral nerves
by means of a stimulant enema. Having no syringe at hand, he took in his
mouth a mixture of brandy and cold water, and blew it into the anus through
a pipe. He then removed the pipe, and retained the liquid in the rectum for
a few seconds by means of his finger. Three or four seconds after he removed
it, the liquid was forcibly ejected, mixed with mecomium. This experiment
made such an impression on the parents, that though they had previously
thought it unnecessary to have the child baptized, they now had that cere-
mony performed without delay. It was not possible to further reanimate the
child ; and a mixture of brandy and water, injected half an hour after, flowe
out immediately.
194 CRITICAL DIGEST OF THE JOURNALS.
In subsequent experiments on the dead body, the liquid either returned
immediately, or remained in the interior. M. Wan Hengel hence thought
himself authorized to suppose, that by the use of the stimulant injection, the
nerves of the rectum had been acted on so as to produce expulsive action;
and that this denoted that life still remained.
It might, however, be objected that the expulsion of the enema was due to
the contractile power of the intestines remaining some time after death; and
that, to give any importance to the sign adduced by the author, it would be
necessary to perfectly resuscitate a child, in which this sign alone denoted
the existence of life. M. Van Hengel has had the good fortune to do this ;
and the following case will be read with interest.
CASE. Madame B. was delivered of a female child, by the natural efforts,
after a labour of two hours, during which, symptoms produced by shortness
of the umbilical chord were perceived. This was twisted round the neck of
the child, and pulsated very feebly; the infant did not cry; the skin was
bluish, and the limbs tolerably firm. The cord was immediately cut, and
about a tea-spoonful of blood expressed from it ; the child was placed in a
warm bath, after which, a little more blood flowed. M. Wan Hengel then
injected an enema of brandy and water; this was ejected in three minutes,
in an arched form, with meconium. The infant was baptized ; and air was
blown into the mouth, the nostrils remaining open. This was done very
cautiously at first, but soon with more force, and with the mouth of the ope-
rator applied to that of the infant. After a little time, the thorax dilated ;
pressure was now made on the ribs, and it was thought that the infant per-
formed a share of the movements thereby produced. This operation was
continued for three quarters of an hour. Alternate hot and cold baths were
again tried ; a spasmodic respiration seemed to set in, but at long intervals.
As this diminished in intensity, an attempt was made to produce vomiting,
so as to cause a deep inspiration, by tickling the palate and tonsils with a
feather. The desired result was obtained ; the infant made a deep inspira-
tion, but without crying ; and it was necessary to press the abdomen and
thorax to produce expiration. On endeavouring to repeat the experiment,
the mouth was found spasmodically closed, and it was necessary to introduce
the feather into the nostrils. This induced a tendency to sneezing; and a
strong expiration took place. This circumstance suggested a means of pro-
ducing, at pleasure, inspiration and expiration.
The barbs of a feather were cut, so as to leave them about three centi-
mêtres long at the end; the stem was then stript of them for four or five
centimétres, and beyond this they were left. On introducing the feather
into the nose, the tickling of the nostril produced an effort at sneezing, and
consequently an expiration ; when the feather was carried as far as the velum
palati, there was an attempt at vomiting, and consequently an inspiration;
when it was carried still further inwards, the last barbs of the feather tickled
the nostril, while the others only provoked an effort at deglutition. By
alternately introducing and withdrawing the feather, efforts of inspiration and
expiration were produced in succession. This process was continued for half
an hour.
At the end of this time, the operation was suspended, because the infant
lost some blood by the nose. The object, however, had been gained; the
child was alive, and cried. The next day, a tea-spoonful of syrup of marsh-
mallows was administered to it. Everything went on well; and the child
continues to enjoy health.
Such a fact as this is sufficiently important to call for a series of analogous
experiments on a large scale. Practitioners should especially not lose sight
of the ingenious means employed by M. Wan Hengel to promote a kind of
respiration at once natural and artificial, which may be substituted, at least
at first, for the always difficult process of insufflation.
195
IRIE PORT'S OF SOC I ETI E. S.
ROYAL MEDICAL AND CHIRURGICAL SOCIETY.
TUESDAY, JANUARY 8, 1850.
DR. ADDISON, PRESIDENT, IN THE CHAIR.
Two CASES OF COMPLETE INTESTINAL OBSTRUCTION, ARISING FROM DISEASE
of THE SIGMOID FLEXURE OF THE COLON AND THE RECTUM, IN which THE
DESCENDING COLON WAS SUCCESSFULLY OPENED IN THE LOIN. By FREDERICK
FIELD and JosIAH CLARKSON, Esqs., Members of the Royal College of Sur-
geons of England. Communicated by JosłPH HopesoN, Esq., F.R.S.
I. M.R. FIELD's CASE. On May 3rd, 1846, the author was requested to see
J. R.—, a coach-axle forger, aged thirty-three, corpulent and muscular, and
a great beer-drinker. He enjoyed good health until a year back, when he
began to suffer from pain in the bowels, constipation, and tenesmus, his
stools becoming scanty, and being voided with difficulty. There was also some
derangement of the functions of the stomach. Three months since, all these
symptoms became aggravated, and were relieved only temporarily by purga-
tives. He often vomited after his food ; his stools were voided with more
difficulty, being of a more fluid consistence, though he had not noticed any
diminution in their diameter. Four days before the author's visit, the bowels
had ceased to act, and all the symptoms became greatly aggravated. When
seen, the abdomen was greatly distended and tympanitic ; there were pain,
tenderness, and some bulging over the transverse colon; the pain was parox-
ysmal, and accompanied by strong tenesmus; vomiting was almost incessant.
Five grains of calomel and two grains of opium were ordered ; to be followed
by a black draught every four hours. On the following day (May 4th), the
symptoms continued unabated; the urine was scanty and high-coloured.
Prussic acid and castor oil were administered at distinct intervals, and the
calomel and opium continued. Some relief to the pain and vomiting was
thus procured. In the evening, a purgative enema and a warm bath were
ordered ; the injection was immediately returned, and not more than a pint
could be thrown up. On the 5th of May, the colon tube was passed up, but
could not be introduced more than eight inches. Twelve ounces of blood
were taken from the arm ; larger doses of calomel and opium, croton oil, the
cold douche, were successively tried, but without any relief from the bowels,
or other than a temporary relief to the more urgent symptoms; galvanism
was equally ineffective. Still the patient's strength and spirits were sustained
until the 15th, when they began to fail, and his countenance, tongue, and
pulse, betrayed a marked change for the worse ; the matter ejected by vomit-
ing had assumed a faeculent colour and smell. It was then determined that
an operation was the only resource left, and this was accordingly performed.
As the patient lay on his back or belly, no indication was observable of the
seat of obstruction, for the abdomen was equally swollen on both sides, and
no bulging was perceptible in either lumbar region, though percussion elicited
a duller sound on the left than the right side. The patient was extended
on a bed with his face downwards, and a transverse incision was made in the
left loin, commencing about two inches from the spine, and carried directly
outwards for five inches and a half, about one finger's breadth above the crest
of the ilium. The skin, fat, latissimus dorsimuscle and quadratus lumborum
were successively divided, and a shining membrane exposed. This last, which
was mistaken for intestine, proved to be fascia; and when it was divided, a large
quantity of fat was brought into view, which was carefully cleared away, and
the intestine at length exposed, at a considerable depth. Sutures were passed
through it, to retain it in its position, and subsequently to affix it to the edges
196 REPORTS OF SOCIETIES.
of the wound, and an incision was then made into it to the extent of half-
an-inch, which immediately, gave exit to an immense quantity of light-
coloured fluid faeces. Womiting entirely ceased, and the patient was relieved
of all his urgent symptoms. The opening in the bowel being fixed by sutures
to the skin, a large bread poultice was placed over the wound, and the patient
was enjoined to lie on his left side. Through thefollowing night, the evacuations
continued abundant ; the belly became soft and free from tenderness, and the
general symptoms were still further relieved. On May 17th, the sutures had
ulcerated from the intestine, which was adherent all around to the circum-
ference of the wound. On the 18th, the wound was rather inactive ; it was
syringed with yeast mixed with warm water, and dressed with lint dipped in
oil, the surrounding skin being smeared with cerate. Granulations subse-
quently sprang up, and with occasional variations and trifling drawbacks, he
proceeded favourably, and his health became ultimately re-established, and
he was able to follow his former calling, which required great physical exer-
tion. The only interruption to perfect health resulted from occasional con-
stipation, caused, apparently, in a measure, by tendency to contraction of
the artificial anus, which was remedied by the introduction of a bone glyster-
pipe, and the injection of warm water; thus the passage was dilated, and the
faeces were, at the same time, softened. This state of things continued until
the latter part of 1847, when the patient was attacked with symptoms of
hepatic disease; he lost his appetite, and became emaciated and ascitic, and
ultimately died in February 1848, one year and nine months from the time
of the operation.
Examination of the body. The peritonaeum was found covered with lymph,
the liver granular and thickened, and the kidneys congested. The stricture
of the intestine was found to be in the sigmoid flexure of the colon, and was
about four inches in length, this portion being filled by a plug of coagulated
lymph, which became broken up and detached by maceration in spirit,
leaving the intestinal tube continuous, though contracted and slightly
thickened. The plug resembled the deposit which takes places in the larynx
in acute laryngitis. The artificial opening was funnel-shaped, with its apex
externally; the outer orifice was contracted to the size of a small goose-quill;
it appeared to be lined by mucous membrane. The lower portion of the
intestine was much contracted.
II. Mr. CLARKSON's CASE. B. F , aged twenty-one, a robust and
healthy-looking woman, applied to the author, in July 1846, with symptoms
of dyspepsia, the bowels not having been relieved during the preceding five
days. She was ordered an aperient pill and draught. Two days afterwards
she returned, the symptoms being still unrelieved, and bowels still consti-
pated. A stronger aperient was administered, but still without relief. On
the 22nd (the bowels not having acted since the 14th), she complained of
pain in the umbilical and left hypochondriac regions; the abdomen was
slightly distended and tympanitic, and pressure upon its parietes increased
the pain. Constant nausea, but no vomiting ; pulse 110; urine copious. To
take croton oil, half a drop, every second hour. On passing the colon tube,
it could not be introduced further than six inches. Two pints of fluid were
injected, and returned untinged by faecal matter. The abdomen became
more distended and tender; flatus moved about the bowels, and appeared to
be arrested in the left iliac fossa. Leeches were twice applied, and some of
Battley's solution of opium given; vomiting had commenced. Subsequently,
the following expedients were tried, but in vain, to induce the bowels to act:
large doses of opium, the cold douche, free injection of water into the rectum,
and its retention by pressure, galvanism ; and on the 26th, the symptoms
becoming more urgent, an operation was undertaken, Mr. Hodgson concur-
ring in the propriety of the step, and urging its immediate performance. The
patient was laid on her belly, a pillow being placed under the abdomen, so as

ROYAL MEDICAL AND CHIRURGICAL SOCIETY, 197
to raise it. An incision, five inches in length, was carried outwards from the
edge of the erector spinae muscle, about two fingers’ breadth above the crest
of the ilium; the quadratus lumborum and fascia were exposed and divided,
and after some loose fat was removed, the intestine was reached: four liga-
tures were passed through it, and fastened, two to the upper, and two to the
lower edge of the wound, and the bowel then divided longitudinally between
them. A large quantity of fluid faeces at once escaped. The patient, who
expressed herself relieved, was placed on her left side, in bed. The discharge
continued very profuse, and a poultice was shortly after applied. On the
following day, the symptoms were further relieved, and the distension of the
belly had subsided, the escape of faeculent matter being abundant. From
this time she steadily improved, and was able, after a time, to return to her
usual household duties. Whenever the bowels became confined, aperient
medicine, and an injection, relieved her; but a tendency to contraction of
the bowels gradually exhibited itself, which was for a time relieved by the
use of bougies. This annoyance increased, and her health began to suffer
seriously. After the expiration of ten months, the patient's appetite failed,
digestion was impaired, and she suffered from more constant and severe pain.
The artificial anus was further dilated with sponge tents, and subsequently
with the scalpel; but the constipation and other symptoms were not relieved,
and she vomited nearly all she took into the stomach. She died in September
1847, having survived the operation nearly fourteen months. On examina-
tion of the body, the parietal peritonaeum was found mottled, tubercular, and
thickened; the opposed surfaces of the intestine were glued together, and to
the liver, spleen, and stomach ; these adhesions were very firm, and sufficient
to have greatly interfered with the peristaltic action of the bowels. The
small intestines were distended with faeces, but the transverse and descending
colon were empty. The mucous membrane was ulcerated at several points:
the obstruction was found to be about six inches from the anus, and on a
level with the fundus of the uterus. It consisted of a dense, cartilaginous sub-
stance, surrounding the intestine and completely obliterating the canal; it
appeared to have originated externally, and pushed forward the fundus of
the uterus, to which it adhered firmly. On section, the canal was found to
be completely obliterated to the extent of half an inch. The edges of the
artificial opening were rounded and smooth, and the neighbouring mucous
membrane was healthy.
MR. HILTON had seen five cases of operation for artificial anus, either
performed or thought of. He alluded to a case in which he had performed
the operation, the patient living for seventeen days; the case he should bring
before the Society. As regards the best position to make the external in-
cision in adults, for the purpose of entering the colon in the lumbar region,
without opening the peritonaeum, he had found that a vertical incision, three
inches or less in length (terminating below, at half an inch above the crest
of the ilium), made parallel with, and one inch and a quarter distant from,
the outer edge of the erector spinae, enabled him to bring into view the ex-
ternal border of the quadratus lumborum muscle, and then to expose and
open the colon which is placed in front of the muscle. He could not speak
to the relative merits of the vertical incision, as compared with that selected
by the operators in the cases before the Society; but he had found this ver-
tical incision available in one case of obstructed colon operated on by himself
during life, and in four other like cases in which he had opened the colon
satisfactorily a few hours after death ; and, he added, that he had repeatedly,
on the dead body, demonstrated to his class, at Guy’s Hospital, that a colon,
although nearly empty, may be reached and opened with safety at the lower
part of such an incision, without wounding the peritonaeum. He had seen no
danger or inconvenience from this operation. The pain and spasm round the
margin of the wound, in one of the cases before the Society, in which Amus-
Sat's operation was performed, might depend on one of the lumbar nerves

198 REPORTS OF SOCIETIES.
being involved in the wound. Division of the nerve nearer to its origin,
might relieve the pain and spasm. -
MR. Coulson said that he could not refrain from expressing his obligation
to the authors of the communication which had just been read, for calling
the attention of the profession to an operation, for the want of which he felt
convinced many persons had died, whose lives might have been saved or pro-
longed if this operation had been performed. In cases where the obstruction
depends on malignant disease, confined, as far as can be ascertained, to the
bowel itself, and not of great extent, it may, or may not, be advisable to have
recourse to the operation recommended to-night, according to a variety of
circumstances, which can only be judged of in each case, as the amount
of distress, the state of the system, the feelings of the patient, etc.; but
where the local mischief is complicated with disease in any other organ, then
the operation ought not to be entertained. But in the cases brought before
the Society, the recent occurrence of the constipation showed that there was
no malignant disease; and examination with the rectum-tube indicated where
the obstruction was situated; so that no doubt could exist as to the pro-
priety of the operation in these cases.
MR. Hodgson had known two instances in which the operation was not suc-
cessful, in consequence, as he believed, of the delay which had taken place in
operating. It is, however, a most difficult point to determine when to desist
from other remedies, and resort to an operation. Some cases of long-con-
tinued and obstimate constipation were ultimately relieved by taking, not-
withstanding the vomiting, during several days, at short intervals, repeated
doses of castor oil, sometimes with a little laudanum, after more active ape-
rients had failed. Amussat’s operation was easy of performance; indeed, it
involved far less difficulty and danger than a common operation for strangu-
lated hernia. If we reflected upon the parts to be divided, we should find
that none of importance required to interfered with. First came the integu-
ments, then the muscles, and then the fascia, which at first sight had been
thought to be the bowel. In one of the cases before the Society, when ex-
posed, the fascia appeared of a dark colour, and was supposed to be the gut.
It was present in all cases, and when divided, a large quantity of loose fat,
very like omentum, or mesentery, was exposed. Even in these persons this was,
as generally, the case; and until this loose fat has been met with and divided,
the operator may be satisfied that he has not yet reached the intestine. The
operation is rendered more easy in cases of obstruction by the distended state
of the bowel, so that in such instances it is next to impossible that any error
or difficulty can arise in its performance. With respect to the precise spot
at which this portion of the colon is situated, if two perpendicular lines be
carried upwards from the anterior and posterior superior spines of the ilium,
and a horizontal line be drawn from one to the other of the former lines, one
inch above the highest part of the crest of the ilium, in an adult the centre
of the horizontal line will be immediately over the descending colon, which
will be penetrated by an instrument passed in that situation. In the cases
read that evening, the greatest difficulties that had to be encountered oc-
curred in the after-treatment, in consequence of the tendency of the artificial
opening into the bowel to contract. In the case of the young woman, tents,
bougies, etc., were of but little service in keeping the orifice open, and he
thought that a canula, or tube of gutta percha, secured by a shield, might be
advantageously employed when the wound began to cicatrize and contract.
Looking at the result of some of the late formidable operations for remov-
ing diseased ovaria, he thought that the fears generally entertained of opening
the peritonaeal cavity were over-rated.

WESTMINSTER MEDICAL SOCIETY. 199
WESTMINSTER MEDICAL SOCIETY.
SATURDAY, JANUARY 5, 1850.
FRANCIS HIRD, ESQ., PRESIDENT, IN THE CHAIR.
LENGTH of THE UMBILICAL CORD. DR. TYLER SMITH exhibited a Funis,
fifty-nine inches and a half in length. The average length is about eighteen
inches; the longest of which he could find an account was detailed by Bau-
delocque, where the cord measured fifty-seven inches. In Dr. Tyler Smith's
case, the cord presented, with the head. Such an extraordinary length was
one of the causes of funis presentations; and also illustrated the power of the
foetal circulation. In this case, including the placenta, the length of the
blood-channels beyond the umbilicus was upwards of ten feet, and still
longer, if allowance be made for the spiral arrangement of the umbilical arteries.
HySTERICAL PTOSIS.—Mr. CANTON related the following case, which came
under his care at the Royal Wesminster Ophthalmic Hospital. Emily T 2
aged seventeen years, had menstruated at the age of thirteen years; the
flow continued profuse for a week, when it suddenly ceased, in consequence
of her being much frightened, and had not re-appeared until three
weeks ago. She remained very sickly for a year after menstruating, when
her eyes became inflamed, in consequence of some matter getting to them
from the face of a child she was nursing. For this complaint, she was under
treatment two months; and since that time has complained of dimness of
vision in both eyes. She suffers pain occasionally in the head, but not of a
severe kind. Light is stated to increase the impairment of sight; and when
attempting to read for any time, “the letters run into one another ”; or if
working, she “misses seeing her needle" after a while. The pupils are
dilated, but the irides are active in their movements. The patient is very
hysterical, and suffers from globus, palpitation, waywardness of appetite,
constipation, etc. The treatment adopted by Mr. Canton had been with a
view to the establishment of the menstrual flow, by the exhibition of aloes,
steel, lytta, and similar remedies, without, however, any resulting benefit.
In October last, the patient found, suddenly, that she was unable to open
the right eye, except by raising the upper lid with her finger, which, being
removed, the lid again fell, and remained drooping. Pricking pain was now
complained of in the eye, and in the corresponding temple; and she
suffered still further diminution of vision. The iris, nevertheless, moved
with its former activity, and the ptosis was unaccompanied by external stra-
bismus, or a pupil larger than the one of the opposite eye. The fellow-organ
continued, in all respects, the same as previously. Symptoms of an hys-
terical character being again present, in a marked degree, the plan of treat-
ment was again resorted to by Mr. Canton which he had previously employed,
and which for two months had been suspended. Mercury, strychnine,
blisters, and such remedies as are ordinarily employed in the usual ex-
amples of ptosis were avoided, from the peculiarities presented by the case,
which Mr. Canton considered might be fairly regarded as one having for its
origin uterine derangement. The sequel proved this view to be based on
fact; for, at the expiration of a month, (during which time the remedies
were persevered in,) the ptosis disappeared as suddenly as it had occurred ;
and in a fortnight afterwards, the menses appeared, and continued to flow for
ten days. Since that time, the vision of both eyes has been improving.


STRICTURE-ExTRAVASATION OF URINE, Mr. HANcocK was called, during
last July to a gentleman suffering from Extravasation of Urine. He had
suffered from Stricture for nineteen years, and had had the Stricture divided
through the perinaeum, and also the bladder punctured through the rectum,
but without relief; as, in the first instance, the wound in perinaeo was allowed
to heal up without attention being paid to the urethra, Mr. HANGoCK treated
200 REPORTS OF SOCIETIES.
the extravasation in the usual way ; and in the course of a few days, with
the patient's consent, again divided the Stricture through the perinaeum. He
kept the wound open by passing a No. 10 gum catheter into the bladder by
that passage until a No. 11 silver catheter could be readily passed along the
urethra into the bladder, when he allowed the perinaeal wound to close, and
the patient has now recovered. . He considers the case of interest, as bearing
upon the questions, mooted during last session, with reference to the treat-
ment of abscess of perinaeum connected with obstinate Strictureof the Urethra,
and also with reference to the operation for opening the urethra from the
perinaeum, and its after treatment, especially in relation to the employment
of the catheter. When the abscess is unconnected with an opening into the
urethra, it is better to abstain from the employment of the catheter, notwith-
standing the patient may experience difficulty in urinating, but Mr. H. thinks
that where such complication exists (which is most frequently the case), the
employment of the catheter should be carefully attended to, particularly when
it has been found necessary to open the urethra through the perinaeum : in
such a case the instrument ought never to be entirely discontinued. To this
cause Mr. H. attributed the failure of the first operation in the case just related
as well as in others to which he alluded; the catheter had been neglected,
the parts allowed to heal and contract, and thus the patient relapsed.
In conclusion, Mr. Hancock spoke of the common perinaeal operation
for opening the urethra. He considered that the difficulties of its perform-
ance were greatly enhanced by the situation at which the urethra was usually
opened, the opening being made towards the anterior part of the membranous
portion of the urethra, which is sometimes completely cut across, so that when
the catheter is introduced and passed along the anterior part of the urethra,
it comes out through the wound, but the posterior part having nothing to
support it, the sides of the canal fall together, close up, and great difficulty
is experienced in hitting it with the point of the catheter; this difficulty may
be obviated by making the opening in the urethra further back, close to the
front of the prostrate gland. In performing the operation, the surgeon will
be greatly assisted by recollecting that the urethra, passing through Cowper's
ligament, corresponds exactly to the points in the raphé of the perinaeum,
midway between the posterior root of the scrotum and the anterior margin of
the anus ; and that a knife plunged straight in at this point will reach the
membranous portion. After describing the various steps of the operation, he
concluded his paper by observing, that the catheter employed should be suffi-
ciently large to fill the canal of the urethra, otherwise the portion of the
urethra behind the Stricture when divided will fall together, and the point of
the instrument catch, and thus be prevented entering the bladder.
JANUARY 12, 1850.
FRANCIS HIRD, ESQ., PRESIDENT, IN THE CHAIR.
ON PRIMARY WENEREALULCERs, NOT CURABLE BY THE ACTION OF MERCURY.
By BENJAMIN TRAVERs, Jun., Esq., F.R.S. The author observed, that it is
admitted the Hunterian definition no longer applies in a great majority of
cases; and it is not at present safe to assert, or fair to presume, that all forms
of Primary Wenereal Sore require mercurial treatment. It is true that this
remedy is generally employed, from a fear of incurring the risk of secondary
symptoms, which always, more or less, follow the non-mercurial plan. Much
patient inquiry, however, has shown that many primary sores do not require
mercury, and that, in some, the healing process is even retarded by its use ;
and there are other instances, which do not require, or will not bear, the local
use of mercury, but require, for the subsequent well-being of the patient, that
the system should be subjected to its action. The object which Mr. TRAVERs
had in view, was to elicit the experience of his professional brethren, with the
view of forming a more precise diagnosis of those conditions which do or do
not require mercury. He did not believe that there was more than one type
WESTMI1NSTER MEDICAL SOCIETY. 201
of lues; but its forms he had found, in conformity with the observations of
others, infinitely varied. From the same source of contamination, one person
may contract a gonorrhoea, another primary sores, while a third may escape
altogether. Mr. Travers related a case, in which gonorrhoea, and sores
requiring mercury for their cure, were contracted by intercourse with a
woman who exhibited no symptom of disease. He also referred to the fact,
that foreign Seamen inoculate females in London with venereal phagedaena.
in its worst form, and to the communication of frightful venereal sores to our
men and officers during the Peninsular war, by the native women. Yet those
who imparted the disease had not been prevented from labouring at their
ordinary avocations, and were cured by means which many would consider
worse than trivial. These facts were mentioned, as illustrating the share
which the constitutional susceptibility of the individual had in producing
the particular form of syphilitic ulceration. An over-exclusive attention to
these constitutional tendencies has, however, not unfrequently tended to
mislead the practitioner. Mercury has been abruptly stopped, or given in
insufficient quantity, so as only to exasperate and promote that, which it was
intended to annihilate.
In the many cases, in which mercury does no good, or actually does harm,
it remains to be determined whether the peculiarity is due to idiosyncracy
alone, or whether the perverted action belongs in part to individual temper-
ament, and in part to the remedial agent operating upon a poisoned system.
Is there any rule, by which we may be emboldened to say, that, under certain
circumstances, this remedy may and ought to be withheld | The class of
cases brought under consideration were exceptions, but by no means unfre-
quent ; and hence arose the value of the inquiry. Mr. Travers related the
following case, which had forcibly suggested the question to him.
CASE. A young man, a shopman, had been under treatment since May
1849, for a superficial spreading ulcer of the glans penis, covering its sides
and apex, and nearly surrounding the orifice of the urethra. Mr. Travers
first saw the case on the 8th of November. At this time, the edges of the
sore were raised and irregular; its surface was smeared with a greasy secre-
tion; it was deeper in some parts than in others ; there was no promise of
cicatrization; but, at the same time, it was not disposed to spread rapidly.
The patient was sallow, of small stature; the pulse was irritable, the tongue
clean, the bowels acted regularly, the appetite was unimpaired, and rest at
night uncertain. He was rather anxious about the disease, but was not con-
stitutionally ill. Mercury had been administered, both internally and locally:
hydriodate of potash had also been perseveringly given. No local improve-
ment was produced, nor had his mouth been affected in the slightest degree.
Mr. Travers believed, that the case required mercury for its cure, and suc-
ceeded in getting the gums affected, in about three weeks, by the diligent
use of Plummer's pill. Black wash, with a little mucilage, and a scruple of
powdered alum, in a six ounce mixture, were at first applied: but the surface
of the sore only became cleaner and more level. Mercurial action was kept
up by the use of Plummer's pill at night, and the ulcer was dressed with
cold water. A draught, containing one drop of nitric and two drops of
muriatic acid, with some liquorice and poppy syrup, in water, was also admi-
nistered twice daily. There was now an appearance of healing on one side
of the sore, but it was less clean and wider in an opposite direction. The
mercury was entirely discontinued: and ten drops of the tincture of muriate
of iron were given twice a day, the cold water dressing being continued.
The sore was twice touched with nitrate of mercury. The ulcer rapidly im-
proved, and the patient regained his health and spirits. No secondary
symptoms have yet appeared, and Mr. Travers did not anticipate their occur-
rence. In another case, in which mercury had proved inefficacious, the sore had
been healed under the use of full doses of disulphate of quinine, with cold
water dressing, and a trip to the sea-coast. Secondary symptoms had not super-
VOL. II. I
202 REPORTS OF SOCIETIES.
vened. In a third case, of a similar character, the individual remained well
for some years, but had recently been compelled to quit business, in consequence
of impaired health, and of penetrating local ulcers and glandular swellings.
In this patient, there was some reason to suspect the presence of struma. Not-
withstanding these and other similar cases, Mr. Travers was still an advocate
for the use of mercury as the general rule ; but in certain cases its exhibition
is, to say the least of it, useless.
Mr. Travers observed, that the sores contracted by impure intercourse are
typical of one and the same poison, but people are not alike as regards the
pemedy. In this anomalous case, he thought that the explanation turned
largely on a latent peculiarity of constitution, the nature of which we must
be content to arrive at chiefly through the teaching of the medicinal agent.
He looked, however, for an earlier, if not a better guide, in some indication
to be drawn at first sight from the aspect of the local disorder, and an esti-
mate of the powers of the patient —a result which would require lengthened
and careful observation. It is not enough to say, that struma is present in
the exceptional cases: for many scrofulous subjects bear the action of mer-
cury well. When the system is inaccessible to the action of mercury, the
sooner this is known the better. It is satisfactory to know that such cases
may be cured by other means, and that they do not then suffer from second-
ary symptoms.
In conclusion, Mr. Travers deprecated the system of giving mercury in
inadequate doses, which, together with the uncontrolled disease, engenders the
multifarious and hybrid disorders which seem to bear out the non-mercurial-
ists in all their objections, if not to render their triumph complete. The
mercury should be either given effectually, or wholly omitted. No one who
has watched the effect of mercury, in summarily retarding the progress of
some phagedaemic ulcers of the genitals, can doubt its efficacy ; especially
when it is considered that the patient will, after the usual interwal, suffer
from secondary symptoms, unless they are averted by a mercurial course.
The discussion, which was interesting but discursive, was adjourned.

- JANUARY 19, 1850.
FRANCIs HIRD, Esq., PRESIDENT, IN THE CHAIR.
NEw OPERATION For OVARIAN DRoPsy, By MR. I. B. BRown. Mr. BRowN
was anxious to be understood as never having condemned operative surgery
for the relief or cure of this disease. Pressure should be first tried ; and
after that and other remedies had been unsuccessful, it was not only justi-
fiable, but advisable, to have recourse to operation. He believed that the
plan he was now about to submit to the Society, coupled with another which
he would also mention, would be found of practical utility, and be of less
danger to the patient than ovariotomy. He would not enter into the very
interesting case in which this operation was performed ; he would do so fully
hereafter, in the series of his cases which he from time to time should place
before the profession, whether successful...or unsuccessful: he would merely
remark, that the patient was considered by herself, and also by Mr. Fergusson,
as having only a few days of life remaining. The operation was successful
in prolonging her life for some weeks. This operation differed materially
from Mr. Bainbridge's ; that required the patient to be in the prone posture
for many months; this enabled her to be on her back, on water cushions,
which added very greatly to her comfort, and also permitted the nurse to dress
and clean the wounds without fatigue or annoyance to the patient; the sur-
geon could also apply pressure over the cyst, by placing strips of plaster on
the opposite side of the abdomen, and bringing them firmly over beyond the
incision and open wound. . . . . . . . --
He placed the patient on the edge of the bed, in the horizontal posture; and
then, drawing an imaginary line from the umbilicus to the superior spinous
WESTMINSTER MEDICAL SOCIETY. 203
process of the ilium, and dividing it into thirds, he made an oblique incision
from above downwards, and from within outwards, through part of the middle
third and into the outer third. The -
oblique incision was about threeinchesin \
length. He dissected carefully through * ~~
the muscles and fascia down to the \
peritonaeum ; through this could be b.
seen the whitish shining coat of the º
cyst. He then made another smaller W
incision at right angles to the first,
and dissected down to the peritonaeum;
this incision was about an inch and a
half in length. At the point of the
angle, E, a large-sized trocar was in-
troduced, and the fluid drawn off. The
canula being kept in, the peritonaeum
was divided from E to C, and reflected
back ; then the cyst was stitched by
sutures to the aponeurotic tendon of
the external abdominal oblique muscle,
carefully avoiding the other structures.
These sutures were nine in number, and * * * * º
were so arranged as to secure com- *.*.*.*.*.*.*
pletely the cyst OIl all sides to the incision; º: of puncture. *
tendon of the muscle, and prevent any . .
escape of the fluid from the cyst into the peritonaeal cavity. The canula was
now withdrawn, and, by means of a pair of scissors, the cyst was divided from
E to C, between the sutures ; a pledget of lint, soaked in oil, was then intro-
duced into the wound, and changed occasionally, and some adhesive straps
were placed across the abdomen, to keep up gentle pressure. Not a single bad
symptom, referrible to the operation, followed. The second operation was
performed in a similar manner, and in the same position ; but a piece of the
cyst was cut out, the fluid being first evacuated, and then the remaining
portion of the cyst was allowed to return to the peritonaeal cavity, the ex-
ternal wound being closed. Pressure was applied over the whole abdomen by
means of adhesive strapping and flannel bandage. This operation was in-
tended to imitate spontaneous rupture, and was only to be recommended
where the fluid was of an unirritating character. -
PREMATURE LABour, AND SyMPToMS SIMILAR. To THOSE of IRRITANT
PoisonING, INDUCED BY EXCESSIVE INDULGENCE IN ARDENT SPIRITs. By Dr.
CoRMACK. After briefly referring to cases of poisoning by alcohol, detailed in
“Taylor's Medical Jurisprudence,” and to a paper by the late Dr. Nicol, of
Inverness, in the Edinburgh Monthly Journal for June 1844, in which are
given the post-mortem appearances in a fatal case of rapid poisoning by
whisky, Dr. CoRMACK gave an account of a case which had recently occurred
to him. The leading particulars are embraced in the following abstract.
Dr. Cormack was sent for in urgent haste during the night, to a lady in pre-
mature labour, and affected with violent vomiting and extreme depression.
Upon examination, a long loop of the funis was found protruding from the
vagina and lying under the nates. The os uteri was so slightly dilated, as not
to admit the finger without some degree of difficulty ; but a head-presentation
was readily recognized. The patient was a stranger to Dr. Cormack; but he
has been able to obtain a complete account of her medical history. Previous
to marriage (six years ago) she was subject to the globus hystericus, with
associated sensations of agony and impending Suffocation. For these attacks,
stimulants were freely prescribed by a physician, till at last she only found
relief by taking a glass of brandy. Under this system, she acquired a craving


14 2
204 REPORTS OF SOCIETIES.
for stimulants, which has on several occasions been irrepressible, even though,
since marriage, there has not been the slightest return of the hysterical
seizures. On four occasions, the excessive use of stimulants has brought on
dangerous illnesses, in two of which the predominating symptoms were those
of delirium tremens; and on the two other occasions, they séem to have been
such as characterize gastro-enteritis. Several times she has had epileptiform
seizures, immediately after taking a large quantity of ardent spirits. When
abstinent, her health is excellent ; and the potation impulse is often in abey-
ance for a very long period. She has had three abortions at very early
periods, and one miscarriage about the seventh month, three years ago. At
that time, she seems to have been in great jeopardy from haemorrhage, as it
appears that she was in labour for twenty-four hours, and the gentleman in
attendance deemed it necessary to call in Dr. F. Ramsbotham.
The most urgent symptom which Dr. Cormack found on his arrival, was
extreme depression. There was some transient mental obscuration, charac-
terized by delirious and incoherent talking about her ordinary affairs; and
she several times addressed herself to persons who were not present. The
pulse was rapid, very compressible, and for minutes at a time imperceptible
at the wrist. She had been taking regularly, every three hours during the
day, a saline effervescing draught, prescribed by her medical attendant;
but the sickness and gastric pain had gone on increasing. Dr. Cormack ap-
plied sinapisms to the pit of the stomach, and administered strong coffee with
brandy; and some of the doses, which were small in bulk, remained down for
nearly ten minutes, and produced a slight reaction. With this improvement,
considerable oozing of blood came on from the uterus; and as the haemorrhage
increased, and the vomiting and depression became really alarming, Dr. Cor-
mack resolved to hasten delivery by such means as the circumstances might
require ; and, as a first measure, he had a turpentine enema administered.
Very soon, the heart's action, the respiration, and the skin, gave evidence of
the improved condition of the patient; and the expulsive efforts of the uterus
became regular and energetic. The vomitive straining, however, continued
with great severity. In about an hour and a half from the administration of
the turpentine enema, there was born a dead foetus, of about the sixth month.
During and after the birth, there was scarcely, if at all, an unusual amount of
haemorrhage; but nevertheless it seriously affected the circulation, and occa-
sioned some anxiety from impending syncope. Dr. Cormack removed the pla-
centa with the hand, and, through the abdominal parietes, firmly grasped the
uterine tumour, till it had become so regular and reduced in size, as to prevent
the risk of farther haemorrhage. A well-padded and carefully adjusted abdo-
minal bandage was then applied. After about twenty minutes respite, the sick-
ness and depression returned ; and, having no creasote with him, Dr. Cormack
administered a pill of one grain of solid opium. It soon afterwards came up.
One drachm of the Edinburgh solution of the muriate of morphia was then
given, and with better effect. About seven A.M., Dr. Cormack left her calmer,
of natural warmth, and altogether in a more satisfactory state, though con-
stantly roused from broken and delirious slumbers by violent attacks of
retching. At ten o’clock, the sickness was less harassing. At this time, she
took a pill containing two drops of creasote, made up with crumb of bread ;
after which she had no vomiting for two hours, when it was re-excited by
attempting to take a little cold beef-tea. Upon examining the interior of
the mouth, there were found intense general stomatitis, considerable glossitis,
(as evinced by the swollen and painful condition of the tongue,) and a red
and turgid state of the pharynx as far down as the eye could reach. It was
now ascertained that in the ejecta there had been a good deal of that sort of
matter usually compared to coffee-grounds, which is often thrown up in
the congestive forms of tropical fevers, and which is blood exuded into, and
altered by, the stomach. During six days, she went on improving very slowly,
but without any back-going, and on the seventh she could retain tepid food
WESTMINSTER MEDICAL sociFTY. 205
in the liquid form, without pain or nausea being excited. During these six
days the quantity of aliment taken was infinitesimally small, not exceeding,
Dr. Cormack would venture to affirm, what an infant of a year old would
take at a single meal; it consisted of a few spoonfuls of tepid beef-tea, with
a solution of isinglass and gum arabic. It was only at first, immediately
after taking a dose of creasote mixture, that any ingesta could be retained.
This mixture, in which the creasote was largely diluted, was regularly taken
after the first morning, and was the only medicament prescribed. On the
third and fifth days, the bowels were moved by tepid water enemata. It was
impossible to ascertain the exact quantity of stimulants which had been
taken ; but it was established, that during the four or five days before Dr.
Cormack first saw her, she had taken no food, but had consumed clandestinely
about twenty shillings' worth of various stimulant drinks, principally gin,
brandy, and wine, but including some ale. - -
Dr. Cormack thought that the principal points of interest in this case
were the three following:—
1. The extreme nervous depression caused by the alcoholic stimulants be-
ing nearly converted into irrecoverable prostration, by an inconsider-
able amount of haemorrhage. *
2. The satisfactory result of the simple and easy means used for inducing
uterine contraction :-viz., in the first instance, the turpentine enema
causing quick expulsion of the foetus; and subsequently the grasping
of the uterine tumour, arresting and preventing the haemorrhage.
3. The satisfactory recovery under the combined influence of abstinence,
and of the creasote, which allayed the vomiting, and acted as a spe-
cific sedative upon the inflamed and morbidly-excited mucous mem-
branëand nerves of the alimentary canal; and thus, beneficially upon
the system generally.
DR. DANIELL doubted very much the propriety of giving creasote in such
a case. It was generally used only in cases of vomiting from passive disease,
From its acrid properties, it would increase inflammation. -
DR. S.Now said, that though creasote was a local stimulant, it possessed de-
cided narcotic properties. In the Provincial Medical Journal a case was
recently related, in which a patient became insensible from inhaling the
vapour of this medicine too freely applied in tooth-ache—in which affection,
Dr. Snow believed, the benefit was to be attributed to the narcotic properties
of the creasote. Experience alone could decide, whether it could be advan-
tageously given to allay morbid irritability of the stomach, when inflamma-
tion was present.
DR. SIBSON remarked, that there was nothing irrational—but the contrary,
in treating the injurious effects of one stimulant and narcotic, such as alcohol,
by the administration of another stimulant and narcotic, such as creasote.
Michaelis and Humboldt found, that when the excitability of a muscle was first
stimulated, and then exhausted by an acid, its excitability could be again im-
mediately stimulated, and subsequently exhausted, by means of opium. The
excitability of the muscle thus a second time exhausted, and now by means
of opium, could be again roused and again exhausted by an acid, the effects
of which could again, in like manner, be removed by the opium. In a similar
manner, the injurious effects of the alcohol in Dr. Cormack's case was ration-
ally met, by the counteracting effect of creasote; and it had likewise also
been successfully met by the administration of opium—another stimulant
and marcotic. -
Dr. CoRMACK had given creasote for a great number of years, in cases of
vomiting depending on different causes ; and although it possessed acrid
properties when undiluted, and was properly classed among the narcotico-acrid
poisons, yet, when judiciously administered in medicinal doses, it was a seda-
tive very similar in its behaviour to prussic acid. So far from there being
any objection to the application of creasote to inflamed surfaces, it possessed
206 REPORTS OF SOCIETIES.
an almost specific effect in controlling inflammation, being in that respect
similar in its operation to nitrate of silver. The solid nitrate of silver and
pure creasote were often almost magical in their beneficial effects, when ap-
plied to an inflamed surface;—and in such cases dilute solutions were often
much less safe, being actually more apt to produce a violent increase of the
local action.
ADJourne D DISGUSSION ON MR. TRAVERs, JUN.'s, CoMMUNICATION ON THE
ForMs of WENEREAL, ULCER. WARIOUS FELLows addressed the Society ;
but we find it impossible to appropriate space to their speeches, as the facts
and opinions stated, though interesting, were not novel ; and in some in-
stances did not specially bear upon the points suggested by the author for
discussion. -
Mr. ACTON would confine himself to two or three questions. 1. What
is a venereal sore ? Previously to discussing syphilis, this preliminary
inquiry must be settled and agreed upon. That sores, venereal and of
other kinds, are met with on the organs of generation, no one would
doubt;-but what was the meaning of a venereal sore ? Different prac-
titioners entertained opposite opinions on this preliminary inquiry, as might
be observed by the speeches delivered on this occasion. He (Mr. Acton) was
in the habit, when attached to the Continental hospitals, of inoculating
sores. When the characteristic pustule appeared, no doubt could exist
that he had to treat a venereal sore. By watching a large number of such
chancres, and treating them without mercury, proof positive was afforded
that they were curable without mercury, and, in the large majority of cases,
secondary symptoms did not follow. Such was the result in simple uncom-
plicated chancres or venereal sores. But if the venereal sore were compli-
cated, that is to say, if it were aggravated by irritability of constitution, bad
diet, by phagedaena, induration, etc., and mercury were indiscriminately given,
the consequences were of the most serious kind. These experiments clearly
showed why the great differences existed as to the proper treatment of vene-
real sores. Mercury was required for some forms of indurated sores, iron
for the phagedaenic and irritable, opium for the inflammatory, as he had else-
where shown. Syphilis no longer bore any specific treatment ; the day was
past in which to say that, if a sore did not get well of itself, mercury must be
used; this was a fatal error, attended with the worst consequences both to sur-
geon and patient, and yet it was still followed. In the short time given to the
discussion of such an important subject, all the material points could not be
touched upon, but simply some of the leading facts. Mr. Acton attempted
in every possible way to lay aside the use of mercury, even in the indurated
forms ; he tried to omit it particularly when the sore occurred in delicate
constitutions, and substituted iodide of potassium with excellent effects. In
private practice, however, another question of no less importance arose: was
it expedient to omit the employment of the mineral This would be
answered in a different manner, according to the experience of surgeons.
He might relate a case, which put the question not in a scientific view, but
bore on the point of expediency, as interesting to the junior members of the
profession. +
. A gentleman consulted him with an indurated sore. It was thought that
mercury might possibly be avoided, and the iodide of potassium was tried.
The treatment succeeded in removing the induration, but secondary symptoms
followed; the patient consulted an eminent surgeon, Mr. Acton believed
the father of the author of the paper, and mercury was at once prescribed ;
the patient naturally recovered, but he, Mr. Acton, lost his patient, and was
told by some over-indulgent friends of the gentleman, that he, the patient,
would probably have lost his nose had the potash been persisted in. These
cases were not frequent ; but those who attempted to treat patients without
mercury were exposed to such consequences; results like these, however,
WESTMIINSTER MEDICAL SOCIETY. 207
would never deter him from attempting to cure patients without mercury,
particularly in delicate constitutions; and he should shortly, in a new edition
of his work, show what could be done with iodide of potash, even under the
most unfavourable circumstances.
Now, although not an advocate for the indiscriminate use of mercury, he
was convinced that when given, it should be administered in sufficient doses
and continued for a sufficient length of time; half the relapses depended on
this omission. . As to this or that preparation being preferable, he was at
issue with much that had been said on the subject ; he believed that there
was more in the mode of administering than in the preparation itself. But
the discussion of these matters would occupy too much time, on an occasion
like the present, when he had come rather to learn the opinion of others than
to communicate his own.
Mr. J. F. CLARKE, with reference the remarks of various speakers who had
advocated the use of mercury, mentioned, that in some countries, where the
mercurial treatment of the venereal disease had never been adopted, secondary
symptoms were unknown. -
MR. TRAVERs, in reply, would reiterate his inquiry, as to whether our col-
lective experience could supply a general rule, whereby we might at once
recognize and distinguish certain primary sores, contracted under circum-
stances which would admit of no doubt as to their origin, but which could
not be mercurialized either with safety or success ; and further, what were
the conditions which should lead one to decide against the internal use of
mercury. The discussion on his paper, though often irrelevant, had been
illustrative of the fact, that the venereal disease has gradually become milder
in its character, although there are many cases in which the Hunterian defi-
nition still holds good, and for the cure of which mercury is indisputably
necessary. In the occasional appearance of such cases, he was a firm believer.
He had been led to reconsider the subject by observing cases, of the origin
of which there could be no doubt, but which would not yield to the ordinary
modes of treatment. He did not refer to chaps or excoriated surfaces,
which only require to be let alone ; nor did he speak of the pseudo-
syphilitic or gonorrhoeal modifications of the disease. But he referred to
certain ulcers, of indubitable syphilitic origin, which appear from seven to
ten days after connection, varying much in their subsequent history and
complexion, but which do not only not yield to mercury, but are actually
retarded, if not actually hindered from healing, by it ; a form of the disease
which, in fact, will not bear to be mercurialized any longer. Of these sores,
some are flat, others excavated: in some the surface is moist, in others dry
or clean ; in one instance, the edges are raised and irregular ; in another,
level or excavated. Still, they have this character in common, that they are
indolent—whether spreading or contracting, the work is slow and uncertain.
His remarks were intended as indicative of the kind of observation, which
should enable a surgeon to decide positively whether mercury should be em-
ployed or not, instead of waiting for the empirical teaching of the remedy.
In addition to the local appearances, we have as guides the temperament or
constitution of the individual. The explanation of the virulence of syphilis
in the French army before Naples, and in the British army in the Peninsula,
seemed to be, that it underwent amelioration at certain epochs or in certain
climates, while at other places or times it has broken out, as it were, afresh.
The law of which he was in search must be founded on such considerations,
and on the right appreciation of such circumstances as poverty and intem-
perance, and the general aspect of epidemic diseases at the time.
Mr. Travers replied to a remark, that the matter of gonorrhoea will not
produce a sore, to be followed by secondary symptoms; and referred to the
experiments of Mr. Hunter, and to the common opinion held among surgeons
of the present day, that gonorrhoeal matter, applied to a broken surface, may
produce all the secondary symptoms which arise from genuine syphilitic
208 REPORTS OF SOCIETIES.
poison. In conclusion, Mr. Travers remarked, that if the assertion of several
army authorities be correct, that mercury may be dispensed with, it is a proof
that the power and resources of the human constitution are eventually supe-
rior to the influence of the poison; but he thought that some of the cases would
have done better if mercury had been used for their cure. In private prac-
tice, he dared not withhold mercury when the local symptoms were well
marked. But as it was well-known that many ulcers could be, and were
healed without it, he asked for greater refinement of observation, and an ac-
curate discrimination of cases, in the further progress of this inquiry.
Dr. HENRY BENNET would like to ask Mr. Travers, before the society ad-
journed, whether he did not think that the observations of Ricord, as to
urethral discharges only producing chancres, in those cases in which there
was actually a chancre within the urethra, explained the statements of Mr.
Hunter, without proving the identity of gonorrhoea and syphilis.
Mr. TRAVERS said he had quoted the experiments of Hunter as he had
found them, and he had no reason to distrust their accuracy.
S U R G I C A L S O C.I.E. T. Y O F I R. E. L. A. N. D.
DECEMBER 15, 1849.
ANDREW ELLIS, ESQ.. IN THE CHAIR.
CASE of CAULIFLOWER ExcKESCENCE of THE UTERUS. By MR. TUFNELL.
The author trusted that the history of this case might cause the ligature to
be more employed; for in no instance could appearances be more unpromising,
and yet, comparative health was for a time restored, and life considerably
prolonged. -
Susan N , aged forty-two, of small stature, sharp features, and with
dark brown hair, the only child of parents who both reached an advanced
period of life, was married at twenty years of age. Her first child was born
within the year, and lived till it was six years old. At her second confine-
ment, she had still-born twins; her third, fourth, fifth, and sixth children,
were also still-born, delivery occurring in each case between the seventh and
eighth month. The seventh child was born alive, and is healthy and strong.
The eighth and last child, she also carried to the full time : the labour was
protracted, and finally terminated by cephalotomy, and the removal of the
body of the child. This occurred five years since. She never entirely re-
covered; she suffered at first from dyspepsia, then from flatulence and loss of
appetite, and finally her spirits gave way. Three years ago, she suffered
from menorrhagia ; it, however, spontaneously ceased, and did not recur
until the early part of the year 1848. Her menstruation was always regular
as to time, but generally in excess. In February 1848, it became violent,
and till she came under Mr. Tufnell's care in June, haemorrhage had never
ceased, and was increased at the monthly period. Upon making an examina-
tion, for the purpose of ascertaining the cause, he found the upper half of the
vagina to be filled with cauliflower growth. Its surface was of a mottled gray
appearance, exuding florid blood, its interstices filled with coagula, the whole
forming a tuberculated mass with a sickening foetor. The complexion was
pale and wan, and the skin was of a tallowy shade. She could scarcely
drag herself along.
Satisfied that nothing but removal of this fungoid growth could check the
bleeding, and thereby offer a chance of prolonging life, Mr.Tufnell obtained the
valuable opinions of Drs. Montgomery and Beatty. The latter kindly offered
her a bed in the City of Dublin Hospital. A salmon-line ligature was placed
by Dr. Beatty (with the aid of Gooche’s canula) round the base of the growth,
cutting through a considerable portion of it at the time; the remainder came
away upon the seventh day. Little pain was experienced ; that felt being
rather a dragging sensation than actual pain, -
SURGICAL SOCIETY OF I RELAND. 209
She was progressing favourably, and indeed might have been regarded as
convalescent, when, from incautious exposure to cold, she was attacked by
inflammation of the lung. Her life was in danger; but she left the hospital
late in autumn, with her general health good, and her person inclined even
to be fat. She did work as a domestic servant, and continued actively em-
ployed in this capacity for nearly six months.
During this period, she was again under the author's care. The functions of
the uterus were healthy, the catamenia appearing at the ordinary time. The
surface from whence the malignant growth had been removed, had healed into
the dimensions of a shilling, leaving a healthy-looking raspberry ulcer sur-
rounding the orifice of the womb, with an elastic cartilaginous base, of the
size of a half-crown. To this ulcer escharotics were constantly applied, and
the disposition to fungous growth thereby kept in check. The ulcer, how-
ever, obstinately refused to cicatrize beyond the point to which it had at first
healed. The tendency of this ulcer to reproduce fungous growth was most
unequal. Sometimes it would remain indolent for a considerable time, then
suddenly, as it were, spring into life. After each menstrual period, the surface
became more spongy, and the granules of a deeper red. During the whole
of this time, the patient made no complaint of pain, but had occasional
stitches running, or rather shooting, from the pubes to the lumbar glands.
All tendency to haemorrhage was controlled, and the local affection restrained
to a small ulcerated spot, insensible to any escharotic that was applied. In-
ternally she took either a cold infusion of bark with sulphuric acid,or mineral
acid alone. This, and an occasional purgative of colocynth, with hyoscyamus
at night, constituted the medical treatment. Nothing could be more satis-
factory than her condition at this time. In June, however, whilst using
exertion during her menstrual course, violent haemorrhage came on, from the
cavity of the uterus—not from the surface of the ulcer. Gallic acid, in five-
grain doses, repeated every third hour, tincture of Indian hemp, muriated
tincture of iron, infusion of matico, and ergot of rye, were all in turns em-
ployed to suppress the discharge of blood; but, as might have been expected,
failed to do so whilst she continued to move about. Being much weakened
by the haemorrhage, and incapable of following her employment, Dr. Beatty
kindly re-admitted her into the City of Dublin Hospital, when, under constant
rest, the bleeding again ceased, and she returned to her home once more.
Shortly afterwards, in the early part of August, she was attacked by diarrhoea,
the discharges being frequent and large, consisting of watery faecal fluid.
Opiate enemata and astringents produced only temporary effect, the purging
constantly recurring up to the 27th of September, on which day it finally
ceased, shortly however to be followed by sickness and vomiting, rejection of
the contents of the stomach, and lastly of the bowels as well. Tenderness
of the abdomen supervened, and symptoms of strangulated intestine ensued:
no hernial tumour could, however, be found. She gradually sunk: and died
upon the 4th of October 1849, one year and five months after the removal
of the growth.
For the six weeks preceding death, no treatment was adopted to check the
fungoid growth ; and an inspection of the preparation will show, that the
moment escharotics were laid aside, it again sprung into being, a small tumour
having sprouted from the anterior lip of the womb, where it may now be
seen to exist.
Dissection twenty-four hours after Death. On opening the cavity of the
abdomen, the uterus was seen prominent, of a greyish hue, mottled with
purple spots, smooth upon its surface, of the dimensions of a large pear, its
fundus being upon a level with the pelvic brim, wedged in between the
bladder in front, which bore a healthy appearance, and the rectum behind,
which was of a deep purple hue, convoluted and nodulated as if filled with solid
faecal matter, but which subsequently proved to be masses of scirrhous deposit.
The peritonaeum covering the intestines, as well as that lining the abdomen,

2 10 REPORTS OF SOCIETIES.
was subacutely inflamed, more particularly towards the right iliac fossa. In
many places, the peritonaeum was studded with small tubercles, varying in
size from a millet seed to that of a pea. The liver was firmly adherent to
the diaphragm : its substance was soft, of a pale nutmeg colour, and slightly
greasy. The spleen was healthy. The right kidney was preternaturally soft,
but bore no other signs of disease. The left was of natural size, and exter-
mally bore a healthy appearance; but when cut into, the pelvis was found
filled with clotted blood, and a small fungoid growth, apparently of the same
character as that sprouting from the womb, was seen occupying the upper
portion of the tubular structure in the substance of the organ, between two
of the mamillary processes. The pancreas was slightly enlarged, but of
normal consistence. The stomach and duodenum were healthy, as also the
small intestine, down to the right iliac fossa. Here a knuckle of this gut was
impacted between the right border of the fundus of the uterus, the ilio-pelvic
brim, and the edge of the rectum. In this position it had become fixed by
adhesions of old standing, and in addition was acutely inflamed, the perito-
nitis radiating from this spot over the whole abdomen. The colon was unal-
tered till, approaching the sigmoid flexure, it became thickened; and below this
point, it was so condensed by scirrhous deposit, and its cavity so constricted,
as barely to allow an urethra bougie to pass. The upper portion of the rectum
was similarly condensed, the lower portion being still free. The aorta and vena
cava were surrounded by the lumbar glands in an hypertrophied condition.
Upon removing the pelvic viscera, and making a longitudinal incision through
the whole, the following was the appearance of the parts. The upper por-
tion of the bladder was healthy, but its base, anterior and posterior walls,
were much thickened, and studded with cancerous masses developed in the
submucous tissue; one of these, a pisiform body, occupyied the entrance of
the urethra. The mucous surface was highly vascular, but not abraded in
any part. The opening of the ureter was patulous on both sides, its valvular
condition being lost. The vagina was healthy as far as the cervix uteri.
Here, between the anterior lip and orifice of the womb, a small cauliflower
growth had sprung up, from the submucous tissue, during the few weeks that
the escharotics had been laid aside. The walls of the vagina were thickened,
the anterior with the base of the bladder, together forming a scirrhous mass
more than half-an-inch in depth. The cavity of the uterus remained ; the
walls of this organ were hard, thickened, and condensed. The ovary upon
the right side was glued to the fundus of the womb. Upon the left side it
was altogether lost in the cancerous mass. The rectum, taken from below,
retained almost a natural cavity up to the point of the coccyx. Its mucous
surface was much congested from the constriction above, of a deep purple
colour, hypertrophied, and hanging in folds. Beyond the coccyx, the cavity
of the intestine had nearly disappeared; the bowel having been converted
into a solid mass, permeated by an irregular sinuous way, pervious to fluids,
but not permitting any solid matter to pass. It was this irregular constric-
tion, this binding in of the gut, that, viewed in situ, established the idea of
Scybala being lodged in the parts. I succeeded in removing the whole of the
parts engaged.
Microscopic Examination. The fungoid mass under the microscope, at a
power of 250, showed the presence of nucleated cells and other phenomena,
now commonly supposed to be peculiar to malignant growth. Of the can-
cerous character of this case there could be no doubt, springing as it did
directly from a scirrhous womb ; the finding, therefore, of these bodies, sup-
posed to be characteristic of cancer, in this specimen, was confirmatory of
the truth of the views of Müller. A drawing of the ultimate structures, as
yiewed under the microscope at this power, taken by the aid of the camera,
by Dr. Carte, closely resembled the figure (No. 2) delineated as the micro-
scopic appearance of cauliflower growth, depicted in the October number of
the Edinburgh Monthly Journal for 1842, in connexion with a paper on this
SURGICAL SOCIETY OF IRELAND. 2 11
subject, by Dr. Anderson of Glasgow. The white substance which constitutes
the bulk of the structure, Dr. Anderson considers to be formed by a mem-
brane of extreme tenuity as a matrix, which, amply supplied with blood,
creates, by a change in the corpuscules, this whitish substance, a lardaceous
or cauliflower structure, having all the characters of soft cancer: being, in
fact, a growth by imbibition from the blood, but beyond the capillaries.
REMARKs. A difference in the two cases (and one of importance), is, as
regards the formation of the central or fibrous portion of the tumour. Dr.
Anderson considers it to have been an hypertrophied condition of the neck
of the womb. In the case before us, however, this central, hardened struc-
ture, which resisted the action of the ligature at the time of being applied,
when the circumference, or softer portion, was cut through, must have been
a portion of malignant growth ; as inspection of the preparation shews the
neck of the uterus to be perfect, the cauliflower excrescence having sprung
from the sub-mucous tissue covering its anterior lip.
The immediate occasion of death, there can be little doubt, was peritoneal
inflammation, consequent upon the implication of a portion of the small in-
testine in this disease.
By reference to the preparation shewn, the intestine was seen pinched in, and
adhering to the structures between the rectum and the womb : its being so,
Mr. Tufnell considered as consequent upon an effort of nature to establish a pas-
sage for the contents of the bowel into one of the natural outlets of the body,
when its further progress was arrested by the schirrous deposit, and obliteration
of the cavity of the gut. In similarcases, the desired communication has been
established. A case in point is reported by the late Dr. Beatty, in the Trans-
actions of the College of Physicians for the year 1830 : “The principal com-
plaint of the patient was incessant vomiting and inability to pass her stools,
from what she termed a lump in the passage. A few days subsequently the
nurse informed me that the stools came from the vagina when the patient
endeavoured to pass water : the truth of this statement was doubted, from
the absence of feculent smell. Subsequent dissection, however, proved the
fact : a convolution of the ileum near its termination dipped down into the
pelvis, and passed in a curved line from left to right, between the back part
of the vagina and rectum. On endeavouring to draw up this fold of intes-
tine, it was found to adhere to the organs between which it passed. The
anterior surface of the rectum was perforated by an ulcerated opening, com-
municating direct with the vagina, the ileum also opening into it at this
spot. This communication contributed largely to the comfort of the patient,
by affording a ready outlet for the contents of the bowel; thus preventing
any accumulation in the large intestine, whilst the faeces at the same time
passed off in a comparatively inoffensive state, not having acquired that
peculiar odour which they gain on entering the caecum.” The case before
us greatly accords with the one related by Dr. Beatty, but differs in one im-
portant point. “I do not remember,” says Dr. B., “to have met with an
instance of this disease (scirrhous uterus with cauliflower growth) in which
an early interruption of connubial intercourse had not taken place.” Susan
N. had never been separated from her husband for any length of time, and
had borne eight children, dispersed over eighteen years.
As to the propriety of interfering with a disease which we know must
eventually terminate life, Mr. Tufnell observed, that it is by many considered
impolitic to undertake an operation which must have an unsuccessful result;
but this feeling should never prevent a man from doing that which experience
tells him will tend even to the prolongation of life, more particularly when
acute suffering does not accompany the operation. He might safely say, that
Susan N. could not have survived two months in the condition she was in,
when the fungoid mass was removed. Yet, what was the actual result
Despite of additional illness from inflammation of the lung, she was restored
to temporary health ; and even enabled to earn her bread by active employ-
212 REPORTS OF SOCIETIES.
ment. Could she have enjoyed those advantages which fortune bestows, the
progress of the disease might have been longer stayed. The very employment
she followed—viz, going constantly up and down stairs, was the opposite to
what we should enjoin upon a person in her situation; nay, the very walking
a distance so frequently, to have the ulcer touched, must have had an in-
jurious effect. Neither haemorrhage from the base of the tumour, nor con-
stitutional irritation from the constriction of the ligature, occurred.
Mere removal of the fungous growth is likely only to afford temporary re-
lief, so great is the tendency to reproduction. Once removed, and its base
laid bare, we must assiduously apply escharotics to the ulcerated spot, in
order to check reproduction. In the case now under consideration, a variety
of caustics and astringents were employed–nitrate of silver, nitric acid, acid
nitrate of mercury, and sulphate of copper, together with undiluted goulard,
the latter being chiefly resorted to at the termination of the menstrual flux,
More benefit, the author said, accrues from the frequent changing of these ap-
plications than from the continuance of any particular one. Much stress has
been justly laid upon the lasting effect produced by the application of the
actual cautery to the spot: but this imposes the necessity for a second person
to assist in its use. Were he to give preference to any one in particular, it
would be the nitric acid, used pure or diluted, according to the effect to be
produced.
In the application of this or any other fluid caustic, I use a very simple
and efficient contrivance—viz, a stout glass rod, with an eye at One ex-
tremity, through which the end of a piece of lint is placed. This, twisted
firmly round between the fingers and thumb, forms a spongy bulb, which,
dipped into the fluid, will retain whatever quantity it may be requisite to
apply, without any disposition to drip.
Remedies calculated to check the formation of fungus, and thereby pre-
vent haemorrhage from the spongy growth, are useful. During the attacks
of menorrhagia, he had full opportunities of testing the relative value of tur-
pentine, mineral acids, muriated tincture of iron, gallic acid, alum, lead,
matico, ergot of rye, and the tincture of Indian hemp. Of all these, the
most decided benefit followed the use of the ergot of rye, given in ten-grain
doses, at intervals of four hours, repeated up to the fourth or fifth time.
DR. JoHNs, thinking the society would like to see the morbid parts of
the case treated by Mr. Anderson of Glasgow, had brought them with
him to the meeting. The ligature had been passed round the tumour ; but
he was inclined to think that the whole of the diseased mass had not been
removed, as the disease had returned. After the operation, the woman went
away, and subsequently came under the observation of Dr. Montgomery, who
removed a similar tumour by means of a ligature. Dr. Johns exhibited the
morbid specimens removed from the patient referred to, and at the same
time showed a drawing illustrative of a similar disease, which had been
removed by himself from another female by incision. In this instance, he
laid aside the ligature, and removed the diseased mass by incision, after the
method recommended by Lisfranc. The disease was of very long standing ;
and the patient, who was greatly debilitated at the period of the operation,
sank from haemorrhage at the end of a week. The disease was almost sure
to return, unless the morbid mass were completely taken away. Dr. Simpson
had published several cases, in which he had successfully employed the liga-
ture ; and the reason that the disease had not returned in these cases was,
because the entire of the diseased structure had been removed. In Mr.
Tufnell’s case, however, it was evident that the ligature had passed through
the diseased mass. He thought that in every instance in which the disease
had returned, this was caused by the ligature not being placed sufficiently
high to reach the healthy portion of the uterus. Notwithstanding the
result of the case upon which he had himself operated, he was of opinion,
that in most instances, the cure by incision was preferable to the ligature; for
SURGICAL SOCIETY OF IRELAND. 213
he had no doubt, that the woman to whom he had alluded would have survived
the operation, if she had not been in the debilitated condition he had described.
He would strongly recommend, that in every case in which incision was to
be employed, a ligature should be applied, and left on for at least twenty-
four hours previous to the operation.
DR. MoWTGOMERY begged to offer one or two remarks in reference to the
allusions which had been made to him, in connexion with a case upon which
Dr. A. Anderson, of Glasgow, had operated once; and in which the disease
had subsequently returned. It was stated that he (Dr. M.) had operated
upon this patient a second time, and had removed another portion of the tu-
ºnour. The course he took was not to remove any portion of the tumour.
He passed a ligature as high as he could reach upon the surface of the
uterus, and removed a portion of the healthy structure, together with the whole
of the diseased mass.” The woman was at present quite well, although six
years had intervened since the operation.
DR. JoHNs thought the remarks made by Dr. Montgomery tended to
fortify the position he had taken, which was, that if the healthy portion of
the uterus be included in the incision, the disease would not return.
MR. TUFNELL said, that a case like the present precluded the possibility of
ligature being so applied. The whole uterus was in a scirrhous state, and
the fungoid growth was but an offshoot from it.
DR. BANoN hoped that Dr. Montgomery would state his experience, as to
the ºve advantages of incision and ligature in the removal of these
growths.
DR. MonTGOMERY said, that if he had acquired much experience as to the
relative value of the two operations, he would gladly state his views; but he
had but little experience in operating with the knife upon these tumours.
He had almost invariably employed the ligature, and, upon the whole, the
result of his practice was such as to induce him not to alter this course. He
was fully aware that other practitioners had excised these growths with re-
markable success. But he also knew that some of the cases so treated had ter-
minated in a truly lamentable manner, from profuse haemorrhage resulting
from the operation. Perhaps excision might be employed with advantage
in a few cases ; but, as far as the removal of polypi and scirrhous growths
was concerned, his opinion was altogether in favour of the ligature. With
respect to the glass rod, he was unable to perceive any valid objection to its
employment ; it was used through a speculum, and if it were managed by a
steady hand, he did not think that a jerk on the part of the patient would be
likely to fracture it ; but even if it did, there was, after all, no danger to be
apprehended. He had himself been in the habit of employing for this
purpose, in the application of escharotics, a material of a very unpretending
character, but which he had nevertheless found exceedingly useful—mamely,
a piece of deal Stick. These sticks might be formed of the requisite length and
thickness by means of a penknife, and soaked to such a degree of Saturation in
the acid as would ensure the application of a sufficient quantity of the liquid
without the possibility of any portion of it dripping back into the vagina, a
very unpleasant accident in such cases. He concurred as to the general in-
sensibility of the surface of the uterus in these cases ; but it was impossible
to determine beforehand, that the application of escharotics would not cause
pain; and even sometimes, after they had been, to all appearance, applied
with impunity, at the end of two or three hours the most agonizing pain
would come on.
DR. STAPLETON had found a stick of “prepared vine root” a very useful
instrument for the application of escharotics. Nothing further was neces-
sary, than to dip it into the acid before using it. He had always been able to
apply acids and other escharotics with these sticks, without the slightest
danger of dripping.

214
MISCEI. IsāNEOUS INTELLIGENCE.
THE PROPOSED JUNCTION OF THE MEDICAL SoCIETY of LonDoN WITH THE
WESTMINSTER MEDICAL SoCIETY. We understand that the deputations
elected by the respective Councils of the above Societies have met in con-
ference, with a view to carry out the proposed amalgamation, and we believe
it is the wish of the active movers in the change, that the principles of the
United Society shall be both comprehensive and liberal. The great boon to
the members of our profession of a society, in which every department is
represented on conditions of perfect equality, cannot be overlooked, and that
the “Medical Society of London” will take a high position among our metro-
politan institutions, we cannot entertain a doubt. The antiquity of the
parent Medical Society of the metropolis, its valuable ancient library, con-
sisting of upwards of fifteen thousand volumes; its Fothergillian fund, and
freehold house, together with a list of about one hundred Fellows, in which
are numbered some of the most distinguished members of our profession, con-
stituting what we may term its contribution to the amalgamated Society. On
the part of the Westminster Society, about two hundred and fifty subscribing
Fellows, and a long list of honorary Fellows (in both of which lists we find
most active and distinguished men), in addition to a well filled exchequer,
will form their share in the new Society. The locality is to be in the vicinity
of Saville-row; and in addition to the advantages of a good circulating library,
areading-room, and capacious accommodation for the discussions, a proposition
has been made of combining the advantages of a Club, for the especial
accommodation of the suburban members of the Society. This department, if
carried out, will be somewhat analogous to the arrangement which formerly
existed between the Royal Institution in Albemarle-street, and the Alfred
Club contiguous to it, in which the literary Fellows, who felt disposed, en-
joyed the privileges of the social Club, and the members of the latter were
eligible to the advantages of the former.
DINNER AT EDINBURGH To DR. GEORGE PATERSON. On Friday, 4th January,
Dr. Paterson, Secretary to the Royal College of Physicians, was entertained
at dinner in the Archers' Hall by a large party of his professional and personal
friends, on the occasion of his leaving Edinburgh to settle at Tiverton, in
Devonshire. Dr. Seller, President of the Royal College of Physicians of
Edinburgh, occupied the chair. Professor Syme, President of the Royal
College of Surgeons, officiated as croupier. Dr. Charles Ransford, who pre-
ceded Dr. Paterson as Secretary to the College of Physicians of Edinburgh,
received a dinner about twelvemonths ago, in similar circumstances, viz.:
preparatory to his settling in Alnwick, Northumberland.
Roy AL INFIRMARY of EDINBURGH REPORT For 1849. It appears that the
number of patients admitted during the year, from the 1st October 1848 to
1st October 1849, with 320 remaining over the previous year, amounted to
4006 ; of whom there were dismissed, cured 2466, 391 relieved, 179 with
advice, or at their own desire, 86 as irregular or improper, and 84 as having
received no benefit ; the number of deaths were 518; amounting in all to
3724; thus leaving in the hospital on 1st October last 282. In these num-
bers were included 726 cases of fever, and 132 cases of cholera, 88 of the
former, and the same number of the latter having proved fatal. The daily
average of patients was 322, the greatest number 350, and the lowest 280.
The greatest number in 1846-47 were 7705, and in 1847-48, 7766; thus show-
ing a diminution this year of about 3709. For the first time for many years
the ordinary expenditure has been brought within the ordinary income to the
extent of 614. The remaining properties in Surgeons' Square, with the ex-
MISCELLANEOUS INTELLIGENCE, 215
ception of a house belonging to the Medical Society, have been purchased.
The managers are now able to proceed with the proposed additional buildings
without interfering with the existing capital stock of the corporation, through
legacies and other bequests added to the surplus of the present year. The
Royal Infirmary is the only hospital in Edinburgh.
MEDICAL MEN AND NEW MEDICAL Books IN EUROPE.-‘‘We are informed
that Copland's Medical Dictionary is in a fair way of completion, there being
but two more numbers to come besides the ‘Index’, and one of these is now
in press. Dr. Copland has promised that the whole shall be completed within
a year from this. He is in good health, and looks as if he might write another
dictionary as large as the present, if necessary.—Dr. Marshall Hall intends
soon to visit the U.S.—Dr. Forbes is preparing a work on ‘Young Physic’,
which he says will close his professional career. Ricord and Civiale take the
lead in their respective specialities, and are overwhelmed with business. In
Edinburgh, Prof. Simpson takes the lead ; especially in diseases of females,
having patients from every part of the globe.”— Boston Medical and Surgical
Journal.
PROFESSIONAL NATIONALITY: “In illustration of the Clannish rule by
which the Directors-General of the Medical Departments of the Army and
Navy are governed, the following tabular analysis has been prepared. It is
a really curious document, and shows respectively, the comparative number
of natives of England, Scotland, and Ireland, with their rank in the service
—WIZ.

Inspectors- Dep. Inspectors- | Staff. Surgeons Staff Surgeons Assistant Staff.
General. General. 1st class. 2nd class. Surgeons.
Scotch ...... 3 Scotch ......7 | Scotch ...21 | Scotch ...26 Scotch ...61
Irish .........2 Irish ......... 3 Irish ......10 | Irish ...... 14 Irish ... ... IO
English...... 0 | English...... 2 English ...4 English ...10 | English...... 6
West Indianl Colonists ...2
In addition to the above, we notice that the ‘Blane Medal,’ founded by
the late Sir Gilbert Blane, which is awarded by the Council of the College of
Surgeons on the recommendation of the Director-General of the Medical
Department of the Royal Navy, Sir William Burnett (another Scotchman),
that eight out of ten are Archy McSycophants, Campbells, and Macduffs.”—
Lancet, 26th Jan., 1850.
Have Sir James M*Grigor and Sir Wm. Burnet planted and made to prosper
Scotch physicians in nearly every town of England 7 or, how is the prepond-
erance of Scotchmen in the H.E.I.C. service to be explained 7 We believe
that medicine is as much a pet profession with the Scotch, as cookery is
with our French neighbours: and that the army being chiefly supplied with
Scotch surgeons and French cooks arises truly from “professional nation-
ality”, and not from the prostitution of patronage. The educated youth of
Scotland have an extraordinary and foolish repugnance to the trades which,
in England, men of good position are willing to enter. The cheap, good,
and universal education of Scotland spoils too many for trade, and forces an
undue numerical proportion of the aspiring youth to seek their fortunes in
foreign parts, or to enter the learned professions. The same causes are some-
what operative in Ireland, as is illustrated by the above table copied from
the Lancet.
PoRTRAIT OF J. RANALD MARTIN, ESQ. An admirable likeness of this
distinguished surgeon has been added to the series of medical portraits, pub-
lished by Mr. T. Stone, of the Royal College of Surgeons. It has the merit
of being a beautiful work of art, as well as a faithful portrait.
DR. CHARLEs D. MEIGs, the eminent author of the Treatises on Females
and their Diseases, and on Obstetrics, has resigned the post of Physician to
the Lying-in department in the Pennsylvania Hospital. Dr. Joseph Carson
has been elected in his stead.
Q 16
A PPO IN T M. E. N. T. S.
BANKS, Dr. John, Physician to the Whitworth Hospital, and to the Lord-Lieutenant,
elected King's Professor of the Practice of Medicine in Dublin University.
BRICHETEAU, M., appointed President of the Academy of Medicine of Paris for the
ensuing year, on the 17th December.
CANTON, Edwin, Esq., appointed Assistant-Surgeon to the Royal Westminster Oph-
thalmic Hospital.
GARROD, Dr. A. B., appointed Physician to University College Hospital, in the
room of the late Dr. A. T. THOMSON. D.R. GARROD had been already ap-
pointed to the chair of Materia Medica.
LANSDOWN, J. G., Esq., re-elected Surgeon to the Bristol General Hospital.
MARKHAM, Dr. W. A., elected Physician to the Western General Dispensary, in the
** place of DR. DAY, appointed to the Chandos Professorship at St. Andrew's.
MAULEY, Dr. John, elected Physician to the City Dispensary, in the room of DR.
BENTLEY, resigned.
ORFILA, M., appointed Vice-President of the Academy of Medicine of Paris.
SKEY, F. C., Esq., appointed to deliver the Hunterian Oration, on the 14th Feb-
ruary, at the Royal College of Surgeons.
TOPHAM, Dr. John, Physician to the South Staffordshire General Hospital, elected
Consulting Physician to the Infirmary at Bridgnorth, Salop.
O BIT U A. R.Y.
ABERCROMBIE, John B. Esq., Surgeon, after a few days illness, lately.
ACHESON, Guy, Esq., late Surgeon R.N., at Dublin, lately.
BAIN, Dr., suddenly, at Nairn, N.B., lately.
CLANNY, Dr. W. Reid, at Bishopwearmouth, on 10th January. He was Physician
Extraordinary to H.R.H., the late Duke of Sussex, and upwards of fifty-five
years Physician to the Bishopwearmouth Infirmary, and an eminent con-
tributor, in various branches of knowledge, to most of the leading publica-
tions of the day.
DAWSON, Charles, M.D., Surgeon to the 54th regiment, at Antigua, of yellow fever.
on 13th December.
DICKSON, Sir David J. H., M.D., Inspector of Hospitals and Fleets, at his residence,
Lower Durnford Street, Stonehouse, Devon, aged 69, on 2nd January.
ELLIOTT, Dr. T. C., 6th Bengal Light Cavalry, at Meerut, E.I., aged 54, on 14th
November. .
Foot, Jesse, Esq., late of Jamaica, at Ilfracombe, Devon, aged 70, on 5th January.
GLACOMINI, Professor, of Padua, lately.
GILLARD, Richard, Esq., Surgeon, at Salcombe, near Kingsbridge, Devon, lately.
HARBORD, H. G. Esq., Surgeon, at Liverpool, lately. -
HUNT, Francis, Esq., Surgeon, at his residence, Bath, aged 51, on 27th December.
KIDD, Dr., Inspector of Military Hospitals, of bronchitis, on 24th December.
LEWIS, John, Esq., Surgeon, formerly of Mark Lane, on 25th December.
STEVENSON, Dr. John, of Craigmore, Bute, at Hamilton, N.B., on 9th January.
PRUS, Dr., late Sanitary Physician in Alexandria to the Academy of Medicine, at
Paris, aged 56, lately. §
ROUSE, Robert, Esq., Surgeon, at his residence, Wallham Green, Fulham, on 25th
January. He was found dead in his bed.

Books RE c B 1 v Eil. -
BRINTON, Contributions to the Physiology of the Alimentary Canal. London: 1849.
DAVEY, Contributions to Medical Pathology. London: 1850. EASTON, Intro-
ductory Lecture at Andersonian University in Glasgow. Glasgow : 1849. HAN-
COCK on the Operation for Strangulated Hernia. London: 1850. JACOB on In-
flammation of the Eye. Dublin. : 1850. LocKE and SYDENHAM : a Review. Edin-
burgh: 1849. MEDICAL DIRECTORY for 1850: London : 1850. MURPHY on Chlo-
roform in Midwifery. London: 1850. REES on Diseases of the Kidney. London:
1850. REPORT of Pathological Society for 1848-9. London: 1849. WooD (Dr.
A.), Rational Medicine. Edinburgh: 1849.


L ON DON
JOURNAL OF MEDICINE,
A MONTHLY
3Reſort of the ſºletical Sºttenteg.
MARCH 1850.-No. XV.
O R. I. G. I. N.A. E. C. O M M UN I CATION S.
ON THE CAUSES, CONSEQUENCES, AND TREATMENT
OF INFLAMHMATION OF THE WEINS :
WITH EXPERIMENTS ILLUSTRATING THE EFFECTS OF THE MIXTURE
OF FOREIGN MATTER WITH THE BLOOD.
By HENRY LEE, Esq., F.R.C.S.Eng., Assistant-Surgeon to King's College
Hospital, etc.
PART I.
I. JoHN HUNTER expressed his belief that the blood has “the power
of action within itself”,” and that when it coagulates, it does so in con-
sequence of an “impression” which it receives. Such an impression
may be communicated by separation from the living vessels, or from
“cessation of natural action” in them. In certain circumstances also
the living vessels themselves may be the means of exciting coagulation.”
In others, the admixture of extraneous substances may either retard or
hasten this operation.* The experiments made to determine the last
point, Mr. Hunter informs us, “were rather imagined than fully car-
ried out; and the subject rather broached and touched upon, than pro-
secuted”.” In these experiments, different articles used in medicine
were mixed with portions of blood taken from the body; and it was
found that, in some cases, they altered both “the time,” and “the firm-
mess of the coagulation”.” The circumstance of medicines being used
in such experiments, conveys the idea, that, in instituting these re-
searches, Hunter conceived that substances which would tend to pro-
duce such actions out of the body, might likewise produce some effect
upon the blood in living animals. In endeavouring to prosecute the
idea thus thrown out, I have been led to try the effect of different sub-
stances upon the blood, and to consider the changes which may be
produced in that fluid, by the admixture of animal secretions. The
experiments which will be hereafter detailed, not only confirm Mr.
Hunter's notion, that foreign substances may induce actions in the blood
* HUNTER on the Blood. Ed. 1794, p. 21.
3 P. 25. 3 P. 24, 4 P. 97. 5 P. 94. 6 P. 98.
WOL. II. . 15
218 INFLAMMATION OF THE WEINS.
when withdrawn from the body, but also show that some of these effects
may be produced still more rapidly in the living vessels.
In these experiments, pus was used in preference to any other fluid;
first, because the power of coagulating the blood which it was found
to possess, enables its influence to be traced within the body; and
secondly, because, being an animal secretion, the results obtained are
likely to be analogous to those produced by the admixture of other se-
cretions with the blood. -
When pus is mixed with blood, fresh-drawn from a healthy animal, it
is found in a marked manner to favour coagulation. This effect does not
take place immediately, as in the case of the mixture of an acid with the
blood; and I have reason to believe, that where the blood has lost its
natural power of coagulation, no visible change is produced in it by the
addition of pus. It appears, therefore, that this effect depends rather
upon a vital than a chemical influence. In some cases, the coagulation
takes place in less than two minutes; in others, after a longer period;
but in all the experiments made, the influence of pus, when added to
blood, in promoting its coagulation, was sufficiently evident. Putrid
pus was found to act more rapidly than healthy pus (Exp. I, b), but
the admixture of water was found to retard the operation; the result,
in this respect, differing in some degree from the conclusion drawn from
a similar experiment performed by Hunter." The causes which usually
favour coagulation out of the body, are rest, and separation of the blood
into small quantities. These conditions are, in some degree, brought
into play during the circulation of the blood through the capillaries;
and when the influence of the admixture of pus with the blood is not
sufficient to produce coagulation at once, we should naturally expect the
effect to be more readily induced, where these two additional causes
concur in favouring such an action. When the pus introduced is in
any quantity, the coagulation of the blood is at once determined, and
the entrance of pus into the circulation thereby prevented. The ex-
periments VI, VII, and VIII, appear to furnish evidence of the correct-
ness of this opinion, and to show that the result may be produced more
quickly in the vessels than elsewhere. In these cases, so sudden was
the effect, that the mixture of blood and pus coagulated before it could
traverse the jugular vein, as indicated by the induration and cord-like
feeling of the vessel.
In Experiment VIII, the obstruction formed was sufficient to resist
even firm pressure, and in a great measure, if not altogether, to prevent
the pus injected from finding its way along the vein. The coagulum
was felt in the vessel during the operation, and was there found after
death. One effect of the coagulation of the blood thus immediately
produced, is necessarily to retaia the witiated blood in the part, and to
prevent its being carried in the course of the circulation. This inten-
tion may be interfered with, either by accident or design. The coagu-
lum, as in Experiment VI, may be broken up during the process of
its formation, or after it has formed, and, the parts of which it was
composed carried forward with the circulating blood. In such a case,
the vein in which the coagulum first formed, is found in its natural con-
dition (except at the part where it may have been mechanically injured),
z—=t-r-z-z
£r
& 1 Op. cit. p. 98.
BY HENRY LEE, Esq., F.R.C.S.ESQ. 219
and dark patches of congestion may be found in distant systems of
capillaries. If the coagulum be allowed to remain, the vein in which
it is formed soon becomes thickened; but, as the experiments cited
prove, this thickening is the effect and not the cause of the coagulum of
blood lodged in the vessel.
II. When blood coagulates in a serous cavity, a thin pellicle forms
upon its surface, and, becoming thickened by deposition from the fibrin
of the blood, forms a cyst, which completely circumscribes the effusion.
This point has not probably received the attention which it deserves;
and as it is believed to be of primary importance in the investigation of
the present subject, a short space will be devoted to the purpose of fully
establishing it, and tracing its connexion with other and subsequent
changes. Every layer of lymph observed upon dissection, has perhaps
too generally been considered as the result of inflammation; and hence
there has arisen a confusion in the terms employed. That lymph may
be derived from the blood directly, and deposited in the form of a mem-
brane, without being secreted by any vessel, has been fully shown by a
paper in the Medico-Chirurgical Transactions." Such layers of lymph
assume so much the appearance of others, derived by secretion from in-
flamed capillaries, that they have been described as identical. But the
mode of their formation in the two instances is altogether different. In
the one case, the process is a local one, confined to the blood itself, and
subsequently to the membrane with which it happens to be in contact. In
the other case, it is an effort of the constitution, accompanied by consti.
tutional symptoms. The former of these processes was clearly described
by Hunter. In describing the process of union by the first intention,
“Coagulation”, he says, “I imagine to proceed upon exactly the same
principle as the union by the first intention. It is particle uniting
with particle by the attraction of cohesion, which, in the blood, forms a
solid; and it is this coagulum uniting to the surrounding parts which
forms the union by the first intention : for union by the first intention
is no more than the living parts when separated, whether naturally, or
by art, forming a reciprocal attraction of cohesion with the intermediate
coagulum, which immediately admits of mutual intercourse, and, as it
were, one interest.” “When the blood has coagulated, so as to adhere
to both surfaces and to keep them together, it may be said that union
has begun.” “The uniting medium becomes immediately a part of
ourselves, and the parts not being offended at it, no irritation is pro-
duced.” “If the quantity of blood extravasated be large, the whole will
not become vascular, but the surface only, which is in contact with the
surrounding parts.” The process thus described in general terms may
take place in serous cavities. In the third plate at the end of Mr.
Hunter's work, is represented a coagulum of blood adhering to the
tunica vaginalis. “The adhesion was firm, though it admitted of a
separation at one end; when separated, fibres were seen running be-
tween it and the testis.”
It might seem unnecessary to dwell upon this process further, had
not some of the highest authorities in surgery, both here and on the
continent, described it as identical with adhesive inflammation. Thus
* Vol. x, p. 45-82. * Op. cit. p. 26. 3 P. 200. 4 P. 205.
15 2
220 INFLAMMATION OF THE WEINS.
Bichati says, “The cicatrization of wounds in veins after bleeding is a
result of inflammation.” Now, it is submitted, that when the blood
coagulates, either in serous cavities or in veins, the process of union is
not usually one of inflammation, or one in which the powers of the con-
stitution are called into increased activity. It is true, that in both cases,
inflammation may take place, and lymph, as the result of such inflam-
mation, may be secreted; but this is only when, to use Mr. Hunter's
language, the “primary intention” has not been fulfilled.2
When a membranous layer of lymph is deposited from effused blood,
it adheres with some firmness to the surface with which it is in contact;
but, as there is at first no vascular connexion established between them,
it may be separated, leaving the part to which it adhered in its natural
condition. Lymph derived from adhesive inflammation, on the other
hand, when separated, leaves the surface upon which it was formed
rough and uneven. Coagulated fibrin, when recently deposited, may
thus be distinguished from effused lymph. The changes which blood
undergoes when effused in serous cavities, may likewise take place when
it is detained in injured or exposed veins. The coagulation of the blood
in such cases (Experiments VII and VIII) serves as a bond of union
between the sides of the veins (which may be either temporary or per-
mament), so as to prevent the entrance of any foreign matter into the
circulation. When the blood thus coagulates in veins, changes may be
produced analogous to those mentioned as occurring in serous cavities.
If the quantity of blood be large, a thin pellicle is at first formed upon
its surface (see Preparations 1523-25 and 1525-64, in the Museum of
Guy's Hospital). This membrane becomes thickened and adheres to
the internal surface of the vein (see plate No. 13, Cooper and Travers'
Surgical Essays, Part I, and Prep. No. 1736, in the Pathological Mu-
seum of the College of Surgeons). It then becomes vascular, and finally
so firmly united to a part of the circumference of the vessel as to be
inseparable from it, without lacerating its lining membrane.
If the wounded vessel be small, or if the animal be strong and robust,
the whole of the blood in the vein may at once coagulate and become
united to its sides. The usual economy of nature, however, is here
exercised, with a precision proportionate to the strength of the patient.
A simple wound in a vein, in healing by the first intention, will not
obstruct the circulation through the vessel under ordinary circumstances.
A coagulum will form, sufficient to unite together the divided edges,
and the circulation of blood through the vessel will be uninterrupted;
but if the wound does not readily heal, coagula may form, which en-
croach more or less upon the cavity of the vein. There are then three
ways in which a coagulum may obstruct the circulation through a vein.
1. By the outer layer of the coagulum forming a membrane, which con-
tains the more fluid parts of the blood. 2. By the whole of the blood
contained in the vessel forming a solid coagulum. 3. By a coagulum
adhering to the injured side only of the vessel. ; : *
In whichever of these ways the process of repair is commenced, it
1 Anatomie Générale, vol.ii, p. 423. -- * s
* In speaking of the two principles, I shall use the term by “first intention”, to
designate that the fibrin is derived from coagulated blood; and restrict the term
“adhesive inflammation” to indicate the effusion of lymph from inflamed vessels.
BY HENRY LEE, ESQ., F.R.C.S.ENG. 221
may be interfered with, and the union dissolved. This is practically
known to farriers; who, when they want to bleed a second time from
the same orifice, break down the “union by the first intention” by a
blow upon the vein. During the time that the parts are united only
by the fibrin from the blood, any violence must tend to produce the
same effect. If the constitution is good, and the coagulating power of
the blood unimpaired, the union may be frequently interrupted, and yet
be as frequently re-established in the same way. When from any local
cause, or from any constitutional peculiarity, the union by the first in-
tention fails at the seat of the injury, it may yet be attempted at some
distance up the vein; and then we have coagula formed at different
distances along the vessel. If these coagula fill the vein, are firm, and
remain undisturbed by violence, the union may be complete, and the
vessel sealed at those parts, even although the original wound should
suppurate. But it sometimes happens, that the same peculiarity of
constitution, or the same local cause, which prevented the union at the
original wound, may prevent complete union by the first intention at
any other point of the vein; and then its canal is open to any secretion
that may be introduced into it. Foreign matter may thus find its way
along a vein; but still there is a provision against its being carried the
round of the circulation. It has been already shown that the blood,
when in a natural condition, has a tendency to coagulate around pus,
and, probably, many other fluids, even out of the body (Experiments I, v),
and that this property is exercised in a still more remarkable manner
in the living vessels (see Experiments VII, VIII). Foreign matter, even
after it has got into the veins, may then, by the same means, be pre-
vented from proceeding farther towards the centre of circulation. The
process that takes place under such circumstances, is strictly analogous
to union by the first intention. The blood may coagulate and adhere to
the sides of any part of the vascular system. The union thus formed
may be permanent, or the coagulum may be again broken up and car-
ried with the blood in the course of the circulation, as shown in Experi-
ment VI. When this occurs, as is shown in the same experiment, other
changes supervene in remote parts of the body. This tendency to coa-
gulate around the foreign matter once impressed upon the blood, cannot
be destroyed by the coagulum being mechanically broken up, as indeed
is proved by the fact already mentioned, that after one attempt at union
in a vein (in consequence of the introduction of foreign matter) has
failed, another attempt is made immediately farther up the vessel. Under
these last circumstances, we may find a vein partially obliterated at dif-
ferent points, leaving intervals where lymph or pus are secreted. If
the purulent matter introduced is allowed to remain a short time only
in the vein, no inflammation is produced (Experiment VI). But when
any irritating fluid is detained there in consequence of the blood coagu-
lating around it, adhesive ulcerative, or suppurative inflammation, will
be excited (Experiments VII and VIII).
The slowness with which veins inflame when cut, tied, or bruised, has
been made a subject of comment by different authors; and Mr. Travers,
in particular, has endeavoured to reconcile “the infrequency of its oc-
currence” with the rapid and violent character of the inflammation in
certain cases. Although, under ordinary circumstances, a wounded vein

222 IN FLAMMATION OF THE WEINS.
does not inflame, yet the annexed experiments show, that pus intro-
duced into its cavity will produce inflammation, in which the system
will sympathize. Other fluids besides pus will no doubt produce similar
effects; but those of pus are here particularly noticed, as affording a
good illustration of the series of changes produced by the introduction
of foreign matter into the blood.
What the symptoms are which characterize the presence of pus, as
distinguished from other secretions in the blood, it would probably be
difficult to determine in cases as they occur in practice. The examina-
tion of the blood in these instances affords no very satisfactory inform-
ation ; for the characters of pus, when the blood has once coagulated
round it, are so altered, that I know of no means by which a small
quantity can be recognized, when it has once entered the circulation.
The conclusions drawn from the different facts now stated are, first,
that inflammation of a vein, or phlebitis, is no essential part of the pri-
mary affection which precedes constitutional symptoms, even when
morbid matter has found its way into the circulation through a vein.
Secondly, that when inflammation of a vein does occur, in some instances
at least, it is not the cause, but the consequence of the introduction of
diseased or foreign matter into the blood. Thirdly, that although veins
are with difficulty inflamed by any mechanical injury, they are suscep-
tible of rapid inflammation, accompanied with constitutional disorder,
whenever any irritating fluids are introduced into their cavities.
III. When the principal veins in a part become obstructed, it is
natural to suppose that changes should be produced in the smaller veins
which supply them. These changes may be expected in a more marked
degree, when the obstruction depends upon coagulation of the blood,
than when it arises from other causes, inasmuch as the coagulum usually
extends to several veins at the same time. *
In the experiments that have been made upon animals, it has been a
matter of surprise that, while extreme pain was evinced upon the injec-
tion of irritating fluids into the veins, comparatively little or no suffering
was produced, when similar experiments were performed upon the arte-
ries. The foreign matter introduced in these cases would probably
have the effect of coagulating the blood, as in the instances already
mentioned. If this occurred in an artery, the supply of blood below
the obstruction would be diminished; but if in a vein, the return of
blood would be prevented: in the latter case, the continued influx of
blood to the part would necessarily distend the capillaries.
In M. Cruveilhier's 1 experiment, of injecting ink into the veins of
dogs, he found, that in thirty-six hours the legs swelled, and a number
of bloody patches (foyers apoplectiques) were found in the substance of
the muscles and the cellular tissues of the limb. The large veins were
distended with adherent coagula of blood, and the smaller veins around
the livid patches were also filled with coagulated blood. If the animal
were allowed to live, the congested spots suppurated. The appearances
thus produced in the muscles and cellular tissue of the limb were evi-
dently not those of inflammatory action propagated along the coats of
the veins, for the affection in the capillaries was circumscribed, and ter-
* CRUVEILHIER's Path. Liv. xl.
$
BY HENRY LEE, ESQ., F.R.C.S.ENG. 223
minated in many places abruptly, leaving the veins in the immediate
neighbourhood perfectly healthy; still less could the appearance pro-
duced depend upon the injected fluid finding its way through the veins
(contrary to the course of the circulation) to the capillary system; nor,
lastly, could it depend upon the ink finding its way into the general
circulation, and producing its effects in its course a second time through
the limb; for, not to mention that the capillaries of the lungs and other
parts would be equally liable to be affected, one essential condition of the
success of the experiment is mentioned to have been, that the fluid
injected should not find its way along the vein in the usual course of
the blood. We therefore conclude, that it was the coagulation of
the blood in the large veins which caused the congestion of the capil-
laries, those veins remaining unaffected which could discharge their con-
tents by Some collateral channel. . In cases of phlegmasia dolens after
child-birth, the same principle can in some instances be clearly traced;
thus, in a dissection performed by Mr. Lawrence” it is mentioned, that
the external and common iliac veins were filled with a substance like
the laminated coagulum of an aneurism. “The tube was completely
obstructed by this matter, adhering as firmly as the coagulum does in
any part of an old aneurismal sac. In its centre was a cavity contain-
ing about a teaspoonful of thick fluid of the consistence of pus, of a light
brownish red tint, and pultaceous appearance.” The femoral vein was
in this case also filled with a coagulum; but, as is observed in the
account of the dissection, the red colour of that vein might have been
caused by the clot everywhere in contact with it, and therefore cannot
be deemed a proof of inflammation.
Mr. Guthrie” has published a case of inflammation of the veins after
amputation, resembling phlegmasia dolens, in which the veins of the
opposite limb, even down to the foot, had become affected. In this case,
on the fourteenth and fifteenth days after amputation of the right thigh,
the left leg began to swell, and became intolerably painful. “The
swelling was elastic, yielding to the pressure of the finger, but not in
any manner like an Oedematous limb. Upon a careful ea:amination, no
pain was felt in the course of the iliac vessels upon that side; the stump
looked well, Save at one small point, corresponding to the termination.
of the femoral vein.” On examination after death, the termination of
the vein on the surface of the stump was open, and in a sloughy condi-
tion. At the left groin, the iliac vein was greatly distended with pus.
Sir Henry Halford” has also mentioned three cases of what he has
termed phlegmasia dolens, occurring in the male, in one of which the
iliac vein was found obliterated after death. In this case, the patient
had suffered, for several years before his death, from swelling of the left
leg and thigh. In the interior of the obliterated vessel there is a coagu-
lum, which has lost its colour, and become firm and completely adherent
to the inner surface of the vein. (See Prep. No. 1732, Path. Mus. Coll.
of Surgeons.) The rapid swelling and general pain of the limb in
such cases; indicate a sudden obstruction to the circulation, while the
absence of tenderness in the course of the vessels during the first stages
- * Medico-Chirurgical Transactions, vol. xii.
* Medical and Physical Journal, vol. lvi. * London Medical Gazette.
224 IN FLAMIMIATION OF THE WEINS.
of the disease, tends to show that the contents of the vessels, and not
the vessels themselves, are primarily interested in its production.
The foregoing remarks have appeared necessary, in order to explain a
circumstance mentioned by Hunter, upon which considerable stress has
been laid by subsequent writers. Mr. Hunter observed that the whole
side of the head in horses that had been bled would frequently become
swollen and inflamed. The explanation of this fact appears very simple,
when viewed in relation to the general principle illustrated by the above
cases. The horse has only one jugular vein upon each side; and, although
in the usual operation of bleeding, its channel is not obstructed, yet if
the wound do not readily heal, it contents will coagulate. The circulation
will then be obstructed in all the distant branches, and the blood, if long re-
tained, will coagulate in them also. It will then part with its serum, and
give rise to all the symptoms of inflammation in the distant vessels; a
pulpy elastic swelling, accompanied with great pain, will then be the princi-
pal symptom, while the turgescence on the surface will be less than where
the superficial veins have been mechanically compressed. It will, how-
ever, very frequently happen, that a vein in a part may be felt distended
without any symptom of inflammation being present; and, in other cases,
the pain and swelling will appear and disappear too rapidly to allow the
idea that they depend upon inflammation of the coats of the vein. It
has occurred to the author, to feel a vein in the arm and hand distended
during life, and after death, to find it empty, and its coats of their
natural colour and thickness; in such a case, the coagulum gives way,
becomes broken up, and mixed with the circulating blood.
IV. When pus, or other diseased fluid, is confined to the cavity of a
vein, the constitutional symptoms produced are comparatively mild, as
long as it remains limited and circumscribed by adherent coagula; that
is to say, so as to be excluded from the rest of the circulating system.
(Compare the frequency of the respiration in Experiments VI and VII.)
But the tendency of a clot of blood is to contract; and a time comes
when the coagulum is either broken up, or shrinks, so that if no further
changes are produced, the current of blood through the vein is re-estab-
lished.1 Meanwhile, however, the coats of the veins have undergone
changes corresponding to the degree of irritation produced by the con-
tained fluids, and the intention or result to which the inflammation
tends. If the coagula have long remained, the coats of the veins are
always found thickened, sometimes to three or four times their natural
thickness, and sometimes so as to completely obliterate the vessels.
The contents of the veins are occasionally found to consist, as far as can
be seen, simply of coagulated blood; at other times, they are found
filled with soft yellowish coagula, deprived, more or less perfectly, of
their colouring matter; more rarely, the cavity of a vein will be found
filled with dark-coloured membranous layers, leaving still a channel
through the vessel; and occasionally it will be found completely, ob-
x
structed by “dense, dark-coloured, bluish membranes.”
1 This remark I have had opportunities of verifying in cases, where needles have
been introduced under varicose veins in the lower extremities, and allowed to re-
main, with a ligature around them, for ten days or a fortnight. The circulation
through the vein will in such cases be obstructed; but, in a year or two, will be
found to have become completely re-established.
BY HENRY LEE, Esq., F.R.C.S.ENG. 225
As the coagulum contracts in a vein, if the intention is to obliterate
the vessel, its sides are gradually approximated. In the smaller veins,
and in the divided extremities of large veins, the sides are soon com-
pletely drawn together. But the latter, if not wounded, may for a long
time (see Prep. 1732, Path. Mus., Coll. of Surg) retain coagulated blood
in their contracted, but not completely closed, cavities. In both cases, the
coagula which close the veins are liable to be displaced by accident, or
to have their adhesions loosened by the changes which they undergo.
The position of a vein, and the structure of the organ through which it
passes, may be unfavourable to its healthy reparation. The process of
repair goes on frequently during a continued flow of blood over the part,
and sometimes during the constant action of the muscles in the neigh-
bourhood: at other times, an injured vein will be situated immediately
in the bend of a joint, and will be subject to be continually bent and ex-
tended with the motions of the limb. In the structure of the bones,
the veins lie in unyielding channels, and are consequently deprived of
the assistance derived from the approximation of their sides, as in soft
parts, during the process of reparation. As the coagula contract in such
a case, there is danger lest the union by the first intention should be
disturbed, and that the cavities of the injured veins should be left ex-
posed. Again, in the uncontracted uterus after child-birth, the veins
which open upon the placental surface, pass through the firm texture of
the organ, and are incapable of contraction independently of the mus-
cular structure which surrounds them. The coagula which close their
extremities secure them against the entrance of any foreign matter; but
should these coagula be removed before the vessels are otherwise pro-
tected, their open mouths are exposed to any secretions that the uterus
may happen to contain. In these cases, if a coagulum is not firmly
formed, or if it is displaced by violence, it may be broken up, and por-
tions of it mixed with the fluid blood. Subsequent coagula may form
in the veins and offer fresh obstructions to the admission of any foreign
matter, but these may, as in the first instance, be disturbed, and carried,
together with any admixture of the secretions of the part, in the course
of the circulation. The period at which the union of a coagulum in a
vein is dissolved, is sometimes marked with great precision. In a case
recorded by Dr. Davis,' a patient was convalescent from an attack of
phlegmasia dolens, when death took place instantaneously, while the
patient was in the act of changing the sitting for the recumbent posture;
the left external iliac vein was thickened, and its internal tunic was
studded in several places with deposits of adherent lymph. The por-
tion most remarkable for this incrustation, as well as for other disease,
was immediately beneath Poupart's ligament; the vein, although con-
tracted, was manifestly pervious. -
V. It has been shown in the previous sections, that secretions mixed
with the blood will alter its properties, and influence the period of its
coagulation: that when the blood is thus altered, it may pass through
a vessel without leaving any trace of its passage; but that if it coagu-
lates and remains in a vein, the coats of the vessel will then take on
increased action. The exciting cause of the inflammation in such cases
appears to be conveyed by means of the contents of the vessels to the
* Medico-Chirurgical Transactions, vol. xii.
226 INFLAMMATION OF THE WEINS.
vessels themselves. But, as in post-mortem examinations, the changes
produced in the vessels are much more easily recognized than the alter-
ations in their contents, the former have of late years almost exclusively
occupied the attention of pathologists. The cases in which constitutional
symptoms follow inflammation of the veins, will be found to divide them-
selves principally into three large classes. 1. Those in which one of the
larger veins has been opened. 2. Those in which some portion of bone
has been involved in the original lesion. 3. Those that occur after
child-birth.
In each of these three classes of cases, a free communication will be
found to exist between the injured part and the general circulation.
The natural mode of sealing this communication, when it is no longer
proper, is the coagulation of the blood in the veins of the injured part.
When, from some constitutional affection, or from some local peculiarity
of structure, this intention is not fulfilled, a ready passage remains open,
through which the blood may become infected. In injecting fluids into
the veins, it has frequently happened, that no great constitutional dis-
turbance, and no signs of secondary inflammation, have been produced ;
but this is believed to have depended upon the coagula in the veins
having prevented (as probably occurred in Experiments VII and VIII) the
foreign matter from finding its way along the vessels. But if this ob-
struction be not offered, or be overcome, then the appearance of secondary
inflammation, accompanied by corresponding constitutional symptoms,
will be produced. If water be injected into the cancellous structure of
bone, it will find its way out in drops through the apertures of the
nutritious vessels. The ready communication which is thus shown to
exist between the interior of bones and the veins, has been but too often
exemplified by M. Cruveilhier's experiments of introducing mercury
into their cancellous structure, and finding it subsequently in the vas-
cular system. This fact assumes peculiar significance, when taken in
conjunction with the very large proportion of cases, in which some por-
tions of bone will be found to have been involved in the primary lesion,
in those who have died of secondary inflammations. Of fifty-two con-
secutive cases, occurring in surgical hospital practice, of which I have
preserved notes, in no less than forty-one was some portion of the
osseous system implicated. . Again, in the third class of cases, if the
vena cava be injected after parturition, the injection will very speedily
find its way into the uterus." The ready communication which is thus
shown to exist between the vascular system and the local affection, in
each of the three large classes of cases which usually give rise to subse-
quent disease, would of itself afford at least a very remarkable coinci-
dence. But more direct evidence presents itself of the way in which
the system becomes contaminated in these affections: thus, after an
operation for hamorrhoidal tumours, an effusion of lymph and pus has
been found in the haemorrhoidal veins,” from thence the same appear-
* DANCE. Archives Générales de Méd. vol. xviii, p. 480, Dec. 1828.
* In cases where pus has been found in veins surrounded by coagula, its presence
and detention there have been differently accounted for. M. Gruveilhier appears
to have imagined that the loose coagula act as filters, through which the blood
passes, while the pus is retained. (Dict. de Med. et de Chir. t. xii, p. 641.) The
true explanation of the way in which coagula form round pus in the veins has
already been given. • **
BY HENRY LEE, ESQ , F.R.C.S.ENG. 227
ances have been traced to the inferior mesenteric vein, and the severity
of the secondary affection, indicated both by the symptoms and the
post-mortem appearances, has fallen upon the liver. These circum-
stances all tend to point to the venous system as the means by which
morbid matter in such instances is introduced: and the still more con-
clusive facts afforded in the production of secondary disease, by injecting
fluids into the veins," allow scarcely a doubt to remain upon the mind,
that the unprotected veins are the channels, in a very large proportion
of cases, through which the blood becomes infected.
VI. The cancellous structure of bone may be compared to the cel-
lular tissue in soft parts. When inflamed, its intervals become filled
up by effusion from the vessels, and an abscess may be as accurately
circumscribed in the hard as in the soft structures of the body. In a
healthy constitution, the adhesive inflammation will always precede the
suppurative; but where the inflammation is not circumscribed by adhe-
sion, the secretions may permeate from cell to cell in unadhering parts.
In soft structures, a remedy is at hand for allowing the escape of the
secreted fluid, by a free division of the parts; but in bone, where the
same thing takes place, the hard unyielding sides offer an effectual
obstruction to the escape of any effused fluid. The cells of the bone
then become infiltrated, and the same want of power which is manifested
in the deficient adhesion in the bone, will probably be indicated by want
of union in the veins. There is nothing, then, to prevent any secretion
permeating the cancellous structure from finding its way into the cir-
culation.
M. Cruveilhier assures us, that a single drop of mercury introduced
into the cancellous structure of living bone, may subsequently be detected
in the capillaries of the lung, where it becomes the centre of one or
more patches of livid congestion. This experiment appears to afford a
perfect illustration of the way in which diseased secretion may be con-
veyed into the circulation, when the natural processes of repair in bone
are abortive. These processes, as we have seen, are, first, union by
the first intention; secondly, adhesive inflammation. In Soft parts, as
the fibrin, which forms the bond of union in the first of these, is ab-
sorbed, the divided veins collapse, and thus continue closed; but in
bony structures, where the injured vessels are held open, as the fibrin
which at first closed their extremities becomes removed, their channels
may be left as much open to the diseased secretions of the part, as to
the globule of mercury in M. Cruveilhier's experiment.
The low degree of organization in bone, and the comparative slowness
with which actions are there carried on, render it, in a peculiar degree,
liable to interruptions in the process of repair; especially when, as not
unfrequently happens, there is reason to believe that the vitality of
some portion of the bone has been threatened. The offensive smell of
the bone, as well, as the appearance of its cancellous structure infiltrated
with puriform matter, will frequently show in such cases, that the pro-
cesses above-named have not followed their natural course.
VII. As a necessary deduction from the accompanying experiments,
and those of M. Cruveilhier, alluded to in the previous section, we
* See M. Gaspard's experiments.
228 INFLAMMATION OF THE WEINS,
arrive at the conclusion, that a vitiated condition of the blood may give
rise to inflammation of the veins in different parts of the body. The
circumstances which occasionally attend reparation of the uterine veins
after child-birth, will be found to lead to the same inference; and the
same general proposition will derive fresh support from the considera-
tion of this class of cases.
The veins which terminate upon the placental surface of the uterus
are necessarily open when this organ is distended, and become more or
less perfectly closed when it contracts. In cases when the contraction
is incomplete, innumerable open-mouthed orifices are left bathed in
secretions, which are often offensive and undergoing decomposition; the
natural protection to the vessels then, is the coagulation of the blood in
them. If examined, the uterine veins will be found filled with coagula
for some distance. But in cases where this power is impaired, all the
uterine veins and arteries recently separated from the placenta may be
found bathed in the secretions of the part, under circumstances most
favourable for their absorption. The passage of diseased secretions
through the vessels cannot always be traced in this, any more than in
the other forms of the disease. Many of the substances introduced
artificially into the circulation by M. Gaspard, produced no action upon
the coats of the veins through which they passed, and yet the general
symptoms were precisely similar to those originating from genuine phle-
bitis. In accordance with this, it may be observed that the uterine veins
are often found perfectly healthy when the spermatic, or renal, or still
more distant veins are thoroughly disorganized. In either case, the
healthy condition of the veins near the original lesion forbids the idea
of inflammation having been propagated along the coats of the vessels,
while all analogy appears in favour of the disease being transmitted
through their contents.
In a certain number of cases no lesion will be found in any of the
veins of the body, but the uterine veins will be found to contain some
unnatural fluid; at other times coagula of blood, which have lost their
elasticity, gritty to the feel, and greyish or light brown in appearance,
will be found filling the veins or leaving intervals in them, where lymph
or pus may be recognized. It matters little whether the unnatural
fluids, thus found in the uterine vessels, have been absorbed from the
cavity of the uterus, or are the product of venous inflammation. The
effect upon the blood in either case would be the same.
When obstructions form in the spermatic veins, they are not indi-
cated by any external symptoms; but when the veins opening into the
internal iliac are similarly affected, the coagula are liable to extend into
its cavity, and even beyond it to the external and common iliac vessels.
The free return of the blood from the inferior extremity, will then be
prevented. The effects of this have already been described (sec. III.)
The connection of this form of disease with affections in distant parts
of the body, has been noticed by several eminent writers. Legallois
has expressed his conviction, that phlegmasia dolens, puerperal fever,
and many other puerperal ailments, are solely dependent upon the ab-
sorption of pus from the uterine surface." This opinion appears to have
been formed upon too hasty a generalization, inasmuch as other fluids
besides pus, as evinced by some of the annexed experiments, may pro-
BY HENRY LEE, ESQ., F.R.C.S.ENG. 229
duce similar effects upon the blood. But that pus, when absorbed, will
determine the coagulation of the blood in the iliac as well as in other
veins, must be allowed; and that the symptoms of obstructed venous
circulation arising from this cause, will exactly resemble those of
phlegmasia dolens, will scarcely be denied. -
“Besides depositions of pus in certain portions of the frame,” ob-
serves Dr. Ferguson, “I have seen two other states of the limb, which
are connected with and traceable to the cause originating puerperal
fever. In one of these the malady looks like erysipelas . . . .; in the
other, the leg is attacked with a disease so exactly resembling phleg-
masia dolens, as to leave no doubt in my mind that they are one and the
same malady. In this, as in other forms of the disease, there may be
a tendency to gangrene of the skin.”
The period of the occurrence of what has been described under the
name of uterine phlebitis is marked with much precision, and the affec-
tion of the system is often general and sudden. It may be stated as
the result of all the observations hitherto made, that it occurs most
frequently from the 10th to the 20th day after parturition. If the in-
flammation in such cases were propagated along the vessel only, it would
be difficult to account for such an apparently capricious selection of time
for its development. This difficulty, however, disappears when the
period is observed to be so strictly in accordance with the time at which
the same symptoms occur after other local complaints, and to be, more-
over, the time at which the coagula formed in the veins, may naturally
be expected to shrink. . . . .
It has been observed, that inflammation after child-birth usually
attacks the spermatic veins alone, and for the most part the one only on
that side of the uterus to which the placenta has been attached. The
hypogastric veins are comparatively rarely affected. The appearances
observed upon dissection in the spermatic vein, usually terminate
abruptly at its opening into the vena cava on the right side, or into the
renal on the left. This fact is in perfect accordance with that observed
by Mr. Arnott, that the coagulum in veins extends usually, only to the
nearest collateral branch ; the explanation appears to be the same in
both cases, as illustrated by Experiment VI. If the coagulating blood
be left undisturbed, it will form adhesions to the sides of the vessel and
produce increased action in its coats; but if mechanically disturbed, it
will be carried forward before the process of coagulation is completed,
and leave the vein in its natural condition. When any portion of a
vein is obstructed, the blood is kept at rest between the obstruction and
the next collateral branch; and, if disposed to coagulate, there is nothing
to interfere with such an action. But the case is different, as soon as
one vein opens into another. A fresh current of blood is then con-
tinually sweeping the orifice of the obstructed vessel; and, even although
the blood at this point should have a tendency to coagulate, it is carried
on in the course of the circulation, before it can adhere to the sides of
the unobstructed vein. The sudden termination of the diseased appear-
ances in these cases, affords an additional proof that the blood is the
medium by means of which this affection is transmitted. It is true, in
—r
* DB. LEE. Medico-Chirurgieal Transactions,
230 INFLAMMATION OF THE WEINS.
such instances the diseased fluid cannot be always, or even generally,
traced in the veins, and very many cases occur where a retained and
putrid placenta, or decomposing coagula, remain in contact with the
mouths of the uterine veins, without any of the symptoms of local phle-
bitis being produced; but this is only in accordance with what is ob-.
served in cases where purulent or other fluids have been directly injected
into the blood. The examination of the blood, or of the vessels, in such
cases, will by no means invariably indicate the presence of foreign
matter after it has once become thoroughly mixed with the blood, nor
will inflammation of the vein through which the fluid passes, be by any
means invariably produced.
When a foreign substance is introduced into an artery, any immediate
effects upon the blood may naturally be looked for in the system of
capillaries which it supplies. If the blood then coagulates, local symp-
toms alone, will, in the first instance, be produced, and the constitution
will remain unaffected. M. Magendie," indeed, asserts that fluids in-
jected into the arteries of animals, return quickly through the corre-
sponding veins, and that this takes place even more rapidly in the
living than in the dead body. If this were universally true, it would
matter little whether foreign matter were introduced into the arterial
or venous system. The effect upon the constitution would be the same
in either case. But if, as is now maintained, extraneous matter intro-
duced into the blood may, under certain circumstances, produce its co-
agulation, then the effects will be confined, more or less completely, to
the first system of capillaries which the blood meets with in the natural
course of its circulation, and the constitution will be affected only in
consequence of the changes which then take place. M. Gaspard has
shown that greasy fluids, and such as contain sediments, do not find
their way readily from the small arteries into the veins. They become
entangled in the intermediate capillaries, and there produce, first patches
of local congestion, and subsequently serous effusion and abscesses.
Some clear fluids, on the other hand, such as solutions of tartar emetic,
of opium, and of nux vomica, when introduced into an artery, pass
readily in the course of the circulation, and produce their full effect
upon the constitution; and in such cases no irritation is manifested in
the capillaries through which they pass. The first of these poisons
produces vomiting and purging, the second stupor, and the third tetanic
rigidity, exactly in the same manner as if they had been introduced
into the stomach, or injected into a vein.
There are yet another class of substances differing in their effects
from both of the former; and under this head are classed infusion of to-
bacco, solution of acetate of lead, putrid fluids, etc. These are dis-
tinguished from the first class above mentioned, as not offering in them-
selves any mechanical impediment to the circulation of the blood, and
from the second, as not producing the same constitutional symptoms
when injected into an artery as when thrown into a vein. M. Gaspard
found that, when introduced into an artery, the infusion of tobacco neither
produced vomiting nor stupor, the solution of acetate of lead did not act
upon the intestines, and the putrid fluids did not produce the evacua-
1 Précis Elémentaire de Physiologie, t. ii, p. 389.
BY HENRY LEE, ESQ., F.R.C.S.ENG. 231
tions usually observed after their introduction into the system by other
means. All these substances, however, were found to produce violent
local irritation in the parts to which the branches of the injected artery
were distributed, and the constitutional symptoms were those produced
in consequence of the local irritation, and not those which would arise
directly from the action of those poisons upon the system.
In Experiment xx, seven or eight cubic inches of common air were
gradually injected into the carotid artery of a dog, and half an hour
afterwards an ounce of water, to which seventy drops of medicinal
prussic acid had been added, was thrown into the same vessel; none of
the peculiar effects of the poison followed this operation. At the ex-
piration of another quarter of an hour, an ounce of a saturated solution
of nux vomica was likewise injected, still without producing any con-
stitutional symptoms. It is very remarkable in this experiment, that
M. Gaspardi should have considered that the elasticity of the air con-
tained in the vessels was sufficient to counteract the impetus of the
blood, and thus to prevent the progress of the poison along the vessels,
especially when we find him stating that, on a post-mortem examination,
the smaller vessels appeared to have been obstructed by very hard clots
of blood.
EXPERIMENTS.
I (a). On the 25th of September, 1848, having procured four small
vessels of equal sizes, I placed in the first some dilute sulphuric acid,
in the second some offensive pus, and in the third some water. The
fourth vessel was left empty. They were then all equally warmed, and
some blood from the jugular vein of a healthy horse was received into
each of them so as to fill them to the same level. They were now
stirred with separate pieces of wood. At the expiration of two minutes
(noted by a watch), the contents of the second vessel had become coagu-
lated into one uniform mass. The contents of the first vessel (contain-
ing the acid) were thickened and of a dark brown colour; in the third
and fourth cups the blood was of its natural fluidity, but darker coloured
in the cup containing water than in the other. At the expiration of ten
minutes, the blood contained in the fourth cup had begun to coagulate;
the blood and water still remained fluid. At the expiration of a quarter
of an hour, the blood had completely coagulated in the fourth cup, con-
taining blood alone ; and had very partially coagulated in the third cup
containing the blood and water.
(b). Four vessels were taken, each capable of holding three fluid
ounces. In the first was placed half an ounce of cold water, in the
second half an ounce of dilute sulphuric acid, and in the third half a
drachm of pus, which was quite fresh and sweet. All the vessels were
then quickly filled with blood, from the jugular vein of a horse. The
contents of each vessel were stirred. The blood and dilute sulphuric
acid became thick, and changed in colour almost immediately, as in the
first experiment, but did not coagulate. The pus and blood coagulated
in six minutes, and the mass was firm in seven. The pure blood coagu-
lated in twelve minutes and was firm in sixteen. The blood and water
* Journal de Physiologie, t.v, p. 328 and 336.
232 IN FLAMMIATION OF THE WEINS.
jºined in about the same time, but took nineteen minutes to become
Trn.
The above and the following experiments were made at the suggestion
of the author, in conjunction with Mr. T. W. Mayer, veterinary surgeon.
II. An abscess was opened in the groin and a quantity of pus re-
ceived into a gallipot; Some blood from the divided vessels was also
received into the same vessel; they were then stirred together, and in
two minutes the mass coagulated. Some blood taken from the same
patient in the same manner, but not mixed with pus, coagulated in
eleven and a half minutes. tº
III. On the 20th of January, 1849, an inflamed and suppurating
abscess was opened, and the blood and pus which flowed from it were
mixed together. They coagulated in two minutes and twenty seconds.
This experiment was repeated several times, with nearly similar results.
IV. In June 1849, a tense inflamed swelling was opened in the
perinaeum of a patient, who had for years laboured under a very obsti-
nate stricture. A quantity of matter first escaped, and subsequently
serum, mixed with shreds of lymph and small quantities of pus and
blood, continued to flow for some time. Portions of this mixed fluid
were received into separate vessels; they coagulated on an average in
about two minutes.
W. Two ounces and six drachms of blood were taken from a healthy
horse, and two drachms of pus were mixed with it. The mass coagu-
lated in three minutes and three-quarters.
VI. A healthy male ass, three years old, was procured, and, with
the assistance of Mr. Mayer, was made the subject of the following
experiment, on the 23rd of September, 1848. Three drachms of pus
were collected from an issue in the chest of a horse, which laboured
under inflammation of the lungs. The pus thus obtained was quite
pure and sweet, and having been warmed, was injected, by means of a
syringe, into the left brachial vein of the ass. The animal lay quiet,
till nearly the whole of the pus was injected; it then struggled, and a
small quantity of the pus may have been lost. When the operation
was completed, the sides of the vein were brought together with a pin,
and the animal was allowed to get up. The vein above the opening
could now be felt as a hard, unyielding cord, as high as it could be
traced with the hand; but upon gentle pressure being made, so as to
propel the blood in the course of the circulation, the hardness com-
pletely disappeared. The vein which, immediately after the operation,
was hard and prominent, no longer presented anything remarkable to
the touch. The animal now moved from side to side, as #f-imelined to
lie down. # ' ' , , ; ; ; ; ; ; ;
Two hours and a half after the operation, the pulse, which naturally
was 36, had risen to 60; and the respiration from 12 per minuté had in-
creased to 26. --- is ſt";
September 24th. Pulse #2; respiration 20; mouth hot; ears cold.
In the evening the pulse bêcame 48 and the respiration 16; he coughed
occasionally. f : ...? , , , , , ; ; F
25th. Pulse 48; respiration 12; some dulness of eountenance, but
| A ' ' ' ' ' . . . . . . ; *-tt-Hill—ulu-------—- ———º

i * The present mayor of Newcastle-under-Lyme. §
BY HENRY LEE, Esq., F.R.C.S.ENG. 233
he is lively and occasionally playful. The left fore-leg is swollen ; the
ears are very cold. In the afternoon he was killed, and the blood was
allowed to flow from the body.
Post-mortem appearances. The wound in the left leg opened directly
into the brachial vein, which was filled with lymph and a thin pus for
a very short distance, both above and below the external opening; imme-
diately above this, the vein was healthy, nor was there any appearance
of disease in any of the other veins of the limb, nor in the veins leading
to the heart. The glands in the axilla were swollen. The lungs were
found studded irregularly in different parts, with circumscribed spots of
livid congestion: these existed both upon the surface and in the sub-
stance of the lungs; they were generally about the size of a filbert,
but in some places they occupied a single lobule, and were accurately
circumscribed by its outline.
VII. On the 23rd of November, 1848, about an ounce of perfectly
pure pus (previously warmed) was injected into the right jugular vein of
an aged ass; the vein immediately became “corded”, and the blood
appeared to have coagulated in the vessel. The operation did not much
excite the breathing; but the pulse, which naturally was 35 in the
minute, rose to 60, and subsequently fell to 55.
24th. The animal dejected; appetite indifferent. The vein can be
traced as a thickened cord as far as the sternum. Respiration 12 (the
natural standard); pulse 50.
25th. The parts around the vein much infiltrated with serum : pulse
55; respiration 12. **
26th. The wound in the neck began to suppurate, and an abscess Sub-
sequently formed in the course of the vein, about midway between the
opening and the sternum. The general symptoms continued, with very
slight variation, until the 4th of December, when the animal was de-
stroyed.
Post-mortem appearances. The jugular vein was found to have become
inflamed only in the course of the circulation, and to be obliterated a
short distance below the external opening. The surrounding parts
were greatly infiltrated with serum and lymph, and several abscesses
had formed in the immediate neighbourhood. The lungs did not present
any well-defined patches of congestion, as in the last mentioned experi-
ment.
VIII. A healthy ass, six years old, was operated on upon the 16th of
November, 1848. The respiration was naturally 14 in the minute, and
the pulse 38. About two ounces of highly offensive pus, obtained from
the frontal sinus of a horse, were injected into the left jugular vein; the
pus had unintentionally been mixed with water previous to its being in-
jected., The vein became full during the operation, as though the blood
in it were in a semi-coagulated state. The pulse now became 60, and
the respiration 20 in a minute; slight rigors occurred in two hours.
November 17th. The animal is tranquil; appetite good; pulse 48, small
and wiry; respiration 16. In the evening he was rather more excited.;
the vein was becoming inflamed downwards towards the heart; pulse
60; respiration. 20. º - 4 t , a
November 18th. The vein was more inflamed, and slight suppuration
was visible at the orifice of the wound. Respiration 16; pulse 55. From
WOL. II. 16
234 INFLAMMIATION OF THE WEINS.
this period to the 23rd, the pulse continued from 55 to 60, and the re-
spiration varied from 12 to 18. -
November 26th. The swelling in the situation of the vein is rapidly
subsiding; pulse 55 ; respiration 12.
The animal gradually recovered, and on the 26th of February, 1849,
was made the subject of another experiment. The right jugular vein
having been opened, two fluid ounces of pure healthy pus were injected,
and propelled in the course of the circulation, by pressure upon the vein
externally. The vein became tense during the operation, and sensibly
resisted the attempts that were made to propel its contents towards the
heart. Even forcible pressure was not sufficient to overcome the resistance
offered to the return of blood. Soon after the operation, the animal had
a rigor; the breathing became laborious, but not accelerated; pulse 57.
After the lapse of seven hours, the animal appeared dejected; he re-
fused to eat or drink; the extremities were cold; breathing 16 in the
minute ; pulse 60, Small and irregular.
February 27th. The vein can be felt thickened as far as the sternum.
The general symptoms are the same as on the previous evening.
28th. There appears less constitutional irritation; pulse 60 ; respi-
ration 14.
March 2nd. Appetite still indifferent; pulse 60; respiration 16.
From this date to the 7th, when the animal was destroyed, the general
symptoms continued much the same, but the induration and swelling
around the jugular vein, from the opening to the sternum, became
greater.
Post-mortem appearances. The left jugular vein was found com-
pletely obliterated. The remains of a firm coagulum obstructed its
canal for some distancé below the opening which had been made into it,
and terminated, below, in an elongated conical portion, which adhered
to one side only of the vessel. On the right side, an abscess had
formed in the course of the vein; and for two inches, thew hole of the
parts were imbedded in a confused mass of pus and lymph, in which it
was impossible to distinguish the structure of the vein. Both above
and below this, for several inches, the vein was filled with coagula,
which effectually obliterated it. These coagula extended for several
inches in the course of the circulation ; but beyond them, in both direc-
tions, the vessel was pervious. The hungs presented some slight spots
of congestion, but not of the same characteristic kind observed in Expe-
riment VI. The other organs were healthy.
IX." Two drachms of pus, somewhat fetid, derived from a large com-
mon ulcer, and diluted with a little water, were injected into the jugular
vein of a middling-sized dog. The animal immediately made several
convulsive efforts to swallow, and soon became faint. It showed indi-
cations of pain, and vomited more than six times in the course of the
day. At the expiration of an hour, it appeared slightly relieved by an
evacuation, and by passing turbid urine. In the evening, it was very ill;
it lay upon its side with its legs extended; had a very feeble pulse and
scarcely perceptible respiration. Ten hours after the experiment, it
1 This, and the following experiments, are among those recorded by M. Gaspard,
referred to in the foregoing dissertation.
BY HENRY LEE, ESQ., F.R.C.S.ENG. 235
passed black, liquid, and extremely offensive motions; these were accom-
panied by immediate relief. The animal regained its appetite, eat
and drank freely, and went to sleep. The day following, it appeared
nearly well. On the third day, three drachms of the same pus were
injected into the opposite vein; after the lapse of a certain time, there
occurred, as in the first instance, faintness, vomiting, and frequent desire
to pass urine; twelve hours after the injection, frequent liquid, white,
and very fetid motions were passed, and it died at the expiration of
twenty-four hours. On opening the body, no alteration was found either
in the intestines or other organs.
X. The last experiment was repeated on a greyhound with the same
results: faintness, fever, vomiting, and repeated evacuations succeeded
each other, with recovery after the first experiment, but not after the
second. On opening the body, no lesion was observed, except that the
inferior lobes of the lungs were gorged and almost hepatized.
XI. Three drachms of recent pus, derived from the same patient as
in the last experiments, were injected into the jugular vein of a small
emaciated unhealthy dog. After the expiration of three minutes, there
was an abundant evacuation of urine, followed by repeated vomiting,
and repeated ineffectual efforts to pass faeces. For nearly a quarter
of an hour, there was a kind of emprosthotonos, rigidity of the limbs,
and a death-like condition. . Subsequently, fresh vomiting ensued, with
very fetid liquid evacuations, which were followed by apparent relief;
soon after, however, long continued tenesmus made its appearance,
and terminated in death, five hours after the injection of the pus. On
opening the body, the mucous membrane of the intestines was found
red, swollen, and inflamed, especially in the colon and rectum.
XII. Half an ounce of pus, similar to that used in the preceding in-
stances, but more putrid, in consequence of having been longer kept,
was introduced into the veins of a middling sized dog. The animal, as
in the other cases, was seized with vomiting, accompanied by violent
straining. Subsequently, strongly marked nervous symptoms made
their appearance. The eyes wandered; there was extreme sensibility,
and involuntary convulsive twitching over the whole body, accompanied
by faintness, hiccough, and short piteous cries. The walk was unsteady,
staggering, and without apparent object. There was furious delirium,
ardent thirst, dyspnoea, palpitation of the heart, etc. This state lasted
for nearly two hours, and the animal died in frightful convulsions, with-
out having experienced any critical evacuations, as in the former cases.
Post-mortem appearances. On opening the body, while still warm,
the venous blood was found very firmly coagulated, not parting with any
of its serum when left at rest ; the left ventricle of the heart showed,
on its external surface, some stains of the colour of lees of wine, formed
by a kind of concrete pellicle, which disappeared only after long rubbing
and maceration. The other organs appeared healthy.
XIII. Some beef was allowed to decompose in some dog's blood; half
an ounce of the fluid resulting from the decomposition, was injected into
the jugular vein of a little bitch. Immediately, the animal made several
convulsive efforts to swallow, and soon became oppressed, uneasy, and
faint. At the expiration of an hour, there was great prostration, accom-
panied by repeated gelatinous and bloody evacuations, and vomiting of

16 2
236 INFLAMMATION OF THE WEINS.
bilious matter. The strength became gradually less, and the animal
died three hours after the injection. $
Post-mortem appearances. The lungs were found inflamed in a very
peculiar manner. They were gorged with blood, of a violet or black
colour, and presented many petechial spots, like small ecchymoses.
These spots existed also on the left ventricle of the heart, in the spleen,
in the mesenteric glands, in the gall-bladder, and even in the subcuta-
neous cellular tissue. The peritoneum contained some spoonsful of a
reddish serum ; but the mucous membrane of the digestive organs was
found to have been principally affected. In the stomach it was slightly
inflamed; in the intestines, but especially in the duodenum and rectum,
it was of a livid colour, presenting many black spots, and covered by a
gelatinous and bloody secretion, resembling lees of wine. The tissues
in these parts were slightly thickened.
XIV. The preceding experiment was repeated, by injecting into the
jugular vein of a moderately large dog, an ounce of fluid, derived from
the maceration of putrid beef in water. The animal very soon passed
extremely offensive, liquid evacuations, with much urine. The breathing
became quick and deep, the pulse small and quick. Repeated efforts
were made to empty the bowels. There was great depression and want
of strength. At the expiration of an hour, a kind of diarrhoea or dysen-
'tery made its appearance. Liquid, bloody, and fetid evacuations, con-
tinued for an hour and a half, when the animal died.
Post-mortem appearances. Livid, brown, and black patches were
found, scattered, over the lungs. The intestinal canal was filled with a
bloody mucous secretion, resembling the matter that had been voided;
its mucous membrane was of a livid colour, as in the preceding case.
XV. Two ounces and a half of thick fetid fluid, derived from the
maceration of cabbage leaves in an equal quantity of water, for two days,
at a temperature of 77 Fah., were injected into the right jugular vein
of a moderate sized dog. During the operation, the animal made several
efforts to swallow, and soon became faint, and vomited several times.
Some hours afterwards, there was great uneasiness and oppression, with
recurrence of the vomiting, and continued faintness during the day.
After nine hours, a most copious and very fetid evacuation took place.
The discharge was as black as soot, and composed of mucus, with a little
faecal matter, and a large quantity of what appeared to be corrupted
blood. Some time afterwards, there was a second evacuation of bloody
mucus, exactly resembling the first. On the following day, there was much
loss of strength: the animal lay upon its side, or staggered as it walked.
There was great and insatiable thirst, with a small feverish pulse. But
the most remarkable symptom was the occurrence, at intervals, of pal-
pitation of the heart, accompanied by extraordinary force and Sound,
resembling that produced by long continued hypertrophy of that organ,
in consequence of aneurism” of one of the large arteries. On the third and
* I once observed a similar condition in a young woman in St. George's Hospital.
Each pulsation of the heart could be heard with great distinctness at a distance of
two or three yards from the patient; during the paroxysms, there was the greatest
difficulty of breathing; the countenance became anxious and livid, and a distinct
thrill was communicated to all the arteries. After death, the countenance, and
upper part of the body were found livid from venous congestion. The lungs did not
BY HENRY LEE, Esq., F.R.C.S.ENG. 237
fourth days, the animal was better, but there were still great thirst, fever,
and occasional rejection of fluids from the stomach. On the fifth day,
the symptoms became aggravated; there was extreme weakness, a totter-
ing gait, excessive thirst, the eyes red and filled with gum; the nostrils
were stuffed, swollen, and obstructed with mucus; and the lining mem-
brane of the mouth was tumid, and of a violet red colour. In the
middle of the day, there was a liquid greyish white evacuation, re-
sembling pus in its odour, consistence, and appearance, mixed with some
clots of putrified blood. Death occurred during the following night.
Post-mortem appearances. The mucous membrane of the eyes, nose,
and mouth, was red or violet, and covered by a very abundant thick mucus.
The lungs were of a dark colour, with some black patches, but still cre-
pitant. The left ventricle of the heart presented several brown stains,
resembling ecchymoses, which penetrated into its tissue. Its internal
surface was of the colour of lees of wine, offering a singular contrast
to that of the right side, which, however, contained a hard fibrinous
concretion, two drachms and a half in weight, of a light yellow colour,
resembling grease. This was of the same consistence throughout,
everywhere free, with the exception of a portion of the size of a finger mail,
which adhered to an irregular and apparently inflamed spot on the inner
surface of the ventricle ; no appearance of the injected fluid could be
recognized in this clot, which was continued of the same colour and con-
sistence into the pulmonary artery, and into the vena cava, the azygos,
the axillary, and even the right jugular vein. . .
The intestinal mucous membrane, especially in the rectum, the
duodenum, and a small portion of the small intestines, was of a violet
red colour, inflamed principally in longitudinal stripes and in patches,
which gave a mottled appearance, even to the outer surface of the intes-
times, before they were opened. This discolouration was not accom-
panied by any thickening of the tissues, nor by ulceration, and appeared
rather the result of ecchymosis or haemorrhage. The lining membrane
of the rectum was principally affected, and its mucous glands were
swollen and very prominent. This intestine contained puriform fluid,
resembling the matter evacuated before death. The other intestines
contained a very thick greyish white mucus. The mesenteric glands
were inflamed, and appeared as if infiltrated with blood. The gall
bladder was mottled on its surface by brown and violet patches, and
contained black, thick, ropy bile, resembling melted tar.
XVI. Effects of the introduction of Mercury into an artery. An
ounce and a half of mercury, mixed with water, was injected into the
left carotid artery of a sheep. The animal immediately evinced pain,
and stood immoveable upon its feet. The head was held down, there
was stupor and heaviness, and the eyes were protruded and widely open.
The fore legs subsequently became bent, and the head inclined over
the right shoulder with a kind of convulsive rigidity, which continued
readily collapse when the chest was opened. The auricles of the heart were greatly
distended with black blood; the inner surface of the left ventricle presented a white
patch, of about two square inches in extent; the lining membrane of the aorta, for
several inches, was of a bright red colour; this extended round one-third only of
the circumference of the vessel. No other structural change could be found in the
heart or vessels, which would aceount for the symptoms observed during life. “
238 INFLAMMATION OF THE WEINS.
till death. Two hours afterwards, the animal became comatose, with
some convulsive motions of the limbs, and the left eye became red and
inflamed. Death took place fifty hours after the operation.
Post-mortem appearances. The left eye was found in a state of suppura-
tion, and contained mercury. Many of the branches of the left carotid
also contained some mercury, which had not penetrated to the capillary
system. All the organs supplied with these vessels were red, swollen,
and inflamed, in consequence of the presence of the foreign matter.
The thyroid gland, the tongue, the cheeks, and the lips, were, however,
only affected as far as the median line, leaving the opposite halves pale
and in their natural condition.
XVII. A drachm and a half of mercury, mixed with some warm
water, was injected into the crural artery of a large dog. The animal
evinced no pain, and walked resting slightly on the affected limb, which
became sensibly colder. After the expiration of an hour, the animal
refused its food, became restless, and indicated severe pain in the limb,
which was now very hot. On the following day, the leg was swollen and
oadematous. On the third day, there was extreme thirst, increased oedema,
and greatsuffering. The animal was killed sixty hours after the operation.
Post-mortem appearances. No disease was found in any organ, ex-
cepting the affected limb. This was swollen and oedematous in every
part; abscesses of different sizes had formed, which contained sanious
fluid, mercury, and pus; some parts were in an incipient state of mor-
tification, and gave out a considerable quantity of air. Globules of
mercury were found in different parts, occupying usually the centre of
the abscesses, and ran out upon the scalpel when incisions were made
into the limb.
XVIII. Effect of the injection of Oil into an artery. Three drachms
of olive oil were thrown into the crural artery of a large dog. Slight
pain was experienced, and the limb became evidently cold, and the
pulse under the tendo-Achillis could no longer be felt. Two hours
afterwards, a like quantity of oil was again injected. The leg now began
to inflame, and became tender. The following day, the whole limb was
oedematous, much swollen, and very painful. Twenty-nine hours after
the first experiment, the muscles of the thigh and leg, as well as the
cellular tissue, were found in some places gorged with blood, and in-
flamed in lived patches; in others, infiltrated with yellow serum and
gelatinous exudations. No oil could be detected in the affected parts.
XIX. An ounce of putrid water, in which some beef had been mace-
rated, was injected into the crural artery of a middling-sized dog. The
artery having been tied, the pulse ceased below the tendo-Achillis; the
limb, however, preserved its usual degree of heat, offering a contrast in
this respect to the last experiment. A considerable degree of fever and
restlessness followed the operation; this continued the whole day and
the following night, without any vomiting or evacuations, which so con-
stantly followed similar operations upon the veins. The next day the
limb was very painful, but not swollen; there was thirst, with the ordi-
nary secretion of faeces and urine. On the third day, the animal was
evidently better; the appetite had become almost natural, and he could
walk more easily, although the limb was still very painful. In the night,
there were some soft, almost liquid, evacuations. The fourth day, the
BY HENRY LEE, ESQ., F.R.C.S.ENG. 239
animal was evidently recovering, when an ounce and a half of very fetid
and very concentrated fluid (derived from the maceration of beef), was
injected into the crural artery of the opposite limb. The animal imme-
diately evinced pain, accompanied by very violent and remarkable palpi-
tation of the heart. It walked lame, keeping the leg raised, and soon
became feverish and uneasy. The symptoms were exactly the same as
after the first experiment. The leg became gradually more and more
painful, extremely sensitive, but not infiltrated with serum. During
the night, there was much expression of pain; the animal was in con-
tinual motion. , Death occurred nineteen hours after the second injec-
tion. The limb had become swollen only within five or six hours previous
to death. - , , . . . .
Post-mortem appearances. The limb presented a very large quantity of
bloody fluid infiltrated in all the tissues. The superficial muscles were
black, and presented more or less the appearances of gangrene. The deep
muscles existed as such no longer, but were entirely disorganized, and
converted into a putrid pulp, resembling masses of the red lees of wine,
extremely fetid, and disengaging a quantity of gas. The limb first in-
jected, was still swollen, and presented, in the interior of the adductor
muscles, two or three cavities filled with a putrid bloody serum. In
the chest, the lungs were healthy, as were also the right cavities of the
heart; but the left cavities presented several reddish-black spots, scat-
tered over the external surface. In the left auricle was a firm yellowish-
white coagulum, adhering to an inflamed spot on its inner surface.
The intestinal canal was filled with a brownish red fluid, resembling
altered blood, which, in the stomach and duodenum, was of the colour
of Soot. The mucous membrane of these organs, as well as of the jeju-
num and rectum, were gorged with blood, of the colour of the lees of
red wine, but without any inflammatory thickening of their coats.
XX. Effect of the introduction of Air into an artery. Seven or
eight cubic inches of common air were injected gradually into the
crural artery of a large dog. A peculiar rustling noise, depending upon
the admixture of the air with the blood, accompanied the operation. No
particular symptoms followed; but after some minutes the corresponding
vein became distended with frothy blood, which moved with difficulty,
and became stagnant in the vessel. The whole limb crepitated upon
pressure, but no untoward symptom presented itself for more than half
an hour. An ounce of water, to which seventy drops of medicinal
prussic acid had been added, was now injected into the same artery.
This produced no apparent effect upon the constitution.
A quarter of an hour after, an ounce of Saturated solution of nux
vomica was injected into the same vessel. This also was followed by
no particular symptoms. An hour after the first injection, half an
ounce of a weak infusion of tobacco was introduced into the same
artery. Excessive pain immediately followed, accompanied by great
rapidity of breathing. The animal now appeared as if he were going
to die; however, he slowly recovered, appeared giddy and inclined to
vomit, and kept himself in a continual state of restlessness. This
condition was succeeded by fever, accompanied by extreme sensibility
of the limb, and irregularity of the pulse. At the expiration of some
hours, he appeared better; the pulse became more regular and less
feverish, but the leg continued swollen, and extremely painful upon
240 ON PROGREATIVE POWER.
pressure. During the night, the pain returned, indicated by howling
and restlessness. There were several evacuations of faeces, and urine.
The following morning, there was great prostration with much fever, and
continued howling. The limb was slightly emphysematous, greatly
Swollen, inflamed, and infiltrated with serum.
On the following day, two ounces and a half of water, in which some
nux vomica had been boiled, were injected into the crural artery of the
opposite limb. The dog expressed no pain; but, at the expiration of ten
or twelve minutes, slight convulsive motions became evident, which were
gradually converted into violent tetanic spasms. The animal threw
himself backwards with his limbs extended, and died, after, repeated
convulsive attacks, an hour and a half after the last injection.
Post-mortem appearances. On opening the body, no unusual appear-
ances were observed in the limb upon which the last experiment had been
tried, but the opposite one was tumid and emphysematous, infiltrated
with a greyish red frothy serum of a fetid odour. The small vessels were
obstructed by firm clots of blood. The gall-bladder was greatly distended;
and the intestinal canal contained a quantity of yellowish mucus.
(To be continued.)
- ON PROGREATIVE POWER.
By C. H. F. RouTH, M.D.Lond. , Physician to the St. Pancras Royal General
Dispensary.
THE physiological and mathematical determination of the Procreative
Power of Man is a portion of vital statistics, which, I believe, has not
hitherto been properly investigated. When we contemplate the very
interesting nature of the inquiry, and its importance as applied to
individuals and national exigencies, and to emigration Societies in parti-
cular, the cause of this omission is not very clear. Probably this
neglect has, in a great measure, arisen from a natural disinclination in
most persons to contend with controverted facts and dismembered
statistics, and to perform the heavy arithmetical calculations required.
There is, it is true, always more or less difficulty in investigating any
new subject; and more especially in applying statistical data, originally
drawn out for a totally different object. Moreover, many of the inves-
tigations are often, after all, founded on insufficient data; and what is
still more embarrassing, frequently this disadvantage is not discovered
till a series of heavy calculations, founded upon them, has been made,
and a palpably absurd result has been brought out. Herein, therefore,
is a source of great delay and annoyance. Further, when a question
like the present involves a point in the physiology of man, he who
would investigate its real nature, must consult statistical data, not only
founded upon the experience of one, but of several nations. In making,
however, this comparison, he is met at once by a most embarrassing
difficulty. The statistics of no two nations involving questions of popu-
lation are founded upon the same general plan; and it thus often
happens, that a point elicited by the examinations of the vital statistics

BY C. H. F. ROUTH, M.D. 24I'
of our own country, cannot be confirmed by those of another. Even
among ourselves, the plan adopted by the Census of Ireland Commis-
sioners is totally different from that adopted by the Census Commis-
sioners of Great Britain. The arrangement of years is different; and
several most important omissions are made. Thus, in the returns of
Great Britain, no table of the number of married, unmarried, and
widowed persons is given, in which the ages are at the same time dis-
tinguished; nor is there any table of fecundity; perhaps, also, conclu-
sions are sometimes made, the truth of which may be questioned. In
the following pages, we shall often have to recur to these difficulties, by
which, unfortunately, our conclusions are in some degree vitiated.
Indeed, so frequently have I been embarrassed in the course of this
inquiry, by such obstacles, that I have been more than once induced to
abandon it altogether. Assisted, however, by an excellent mathemati-
cian, and by the prospect of probably calling attention to a subject of
general utility, of disproving, perhaps, a few of the dogmas of the
present day on the exigencies of an overcrowded population, and point-
ing out some foundation upon which something like a scientific super-
structure might be raised, I have persevered in my endeavour to
accomplish my object. Imperfect, nay, very imperfect, as the attempt
must necesarily be in many of its details, it may, nevertheless, not be
altogether presumptuous to hope, that the perusal of the succeeding
pages may, by calling the attention of the learned to this portion of
vital statistics, lead to the collection of such data as may hereafter place
this branch of science upon something like a correct foundation.
WARIETIES OF PROCREATIVE POWER.
Procreative Power is that power inherent in every animal, which, when
brought into practical operation by the union of the sexes, assures the
continuance of the species. Man, in his animal relations, possesses this
power in common with all created beings; yet, by the very fact of his
being an intelligent creature, his procreative power must be regulated
by, and depend upon, several auxiliary influences, all of which must
modify or bear upon its general action and exercise in the inhabited
globe. Of these, three only will be considered; the others may be
incidentally alluded to as we proceed, but they affect the question so little,
that they need not be particularly enumerated.
I. A person must have obtained that physical constitution of body
which enables him to procreate; in other words, he must have reached the
age of puberty. Thus, children generally cannot have this power.
Having once obtained the age of puberty, a person will continue to have
this powerfor a number of years; at the end of which time, a new change
will come upon the animal organism, and the power of procreation
will be lost; in other words, the procreative power has its limit as wełł
as beginning. But between the period of its commencement and
termination it is not equally powerful; there is a particular age in
which it is most powerful, most effective; in other words, a maximum
age of procreative power. For instance,—it is not sufficient to know
that a man is within the limits of procreative ages, but the actual age
must be known also, as according to that age he will have more or less
* {
4-
242 ON, PROCREATIVE POWER,
procreative power. This procreative power we have denominated as the
Physiological Procreative Power. Furthermore, it may be convenient to
distinguish it as of two kinds. (a) A man of a certain age will have a
certain average amount of physiological power when brought in union
with women of all ages. It will be greatest, it is true, when the wife
is at her maximum age of procreative power, and least when she is
reaching the limits of its disappearance: but, nevertheless, taking
women of all ages, the average physiological procreative power will be
expressed by a fixed number. (b) For every different age of the female,
with the same age as the male, it will be different, and expressed by a
different number. Hence the necessary division into two kinds,-1st.,
the average physiological power, and 2nd, the united physiological power.
Both of these will necessarily have a certain and fixed relation one to
another. . -
II. It will be likewise affected by the social condition of the person,
especially if he be married or not married. The procreative agents of a
mation are, if not exclusively, at least eminently, the married persons.
Taking our population of this year (1850) as calculated by the Registrar
General, it amounts to 29,679,000, with an annual increase of 305,000;
of these, 285,000 are exclusively produced by married persons, and yet
the difference in numbers between the married and unmarried popula-
tion is expressed by the numbers, 100 and 293, or nearly 1 to 3. If
out of this number we separate the active procreative agents, or at least
persons possessing physiological procreative power, from children and
old persons who are incapable of procreation, the numbers will be in the
proportion of about 260 unmarried or widowed to 100 married. It
follows, that about 9,000,000 persons only, or about 4,500,000 of
couples out of the 29,000,000, produce, annually, this increase. We
have said that the increase is not exclusively produced by married
couples; because, although with most unmarried persons the procreative
power is dormant, still with some it is active, as in the production of
illegitimate children. Thus the increase to the population from this
source, will be 20,000 out of the 305,000. This kind of power,
dependent upon the social condition of a person, we have contra-distin-
guished as Practical Procreative Power, which may be further subdivided,
according as the person is married or unmarried, into connubial or ea:-
connubial practical procreative power. + -
III. Procreative power will also be modified in the unmarried by two
other contingent circumstances;–1st, the chance he has of getting
married, or becoming possessed of connubial procreative power;-2nd.
it depends also on his expectancy of life. Thus, supposing two persons
marry at the same time, it is clear that the one who runs the risk of
dying soonest, cateris paribus, cannot have the prospect of having as
many children as the other. This kind of procreative power we have
termed the Eaſpectant Procreative Power. Children, in the two last cases,
may have their power represented by a certain number, just according
as a child has a chance of reaching a marriageable or procreative age;
and thus of becoming a practical procreative agent. In this manner,
they may be looked upon as having a nominal or prospective amount of
procreative power. - . . . . . . . . . . . . . .
BY C. H. F. ROUTH, M.D. 243
To recapitulate: every person's procreative power is made up of
1st, his physiological, 2nd, his practical, and 3rd, his expectant pro-
creative power. This totality may be expressed by the term Absolute
Procreative Power, which may again be subdivided into two kinds,
according as the individual is unmarried or married,—the Ea-connubial
and Connubial Absolute Procreative Powers.
PHYSIOLOGICAL PROCREATIVE POWER.
In fixing the limits of Procreative Power, it should be remembered,
(more especially for the practical bearing of the question), that it is
not so much the early limit we should insist upon and endeavour
to fix accurately, as the late. And this is manifest, because most
persons at these later ages are married, and therefore in the position of
being active procreative agents. In fixing the limit of the disappear-
ance of procreative power too low, we are therefore materially vitiating
the result. In the earlier ages it is not so important, as whatever be the
exact age at which the power begins, it is seldom active before sixteen,
and the proportion of increase of population by persons of this age is
comparatively unimportant. *
The first thing to be remarked in reference to these limits, is that
procreative power will differ according to the sex. Its limits have not
been hitherto very distinctly made; and yet there appear to be four
ways in which it may be estimated in the female, and three in the male.
In the former only, by the first appearance and cessation of the cata-
menia; and in both sexes, 1st, by the ages at which crimes arising
from sexual desires are committed; 2nd, by the fecundity tables, where
the age of the parents is given at the birth of their children; and 3rd,
though here less decidedly, because fallacious influences more readily
vitiate the result, by the ages at which persons marry. *
I. (a) In the female, the catamenia are usually said, in this country, to
begin at fifteen, and to disappear at forty-five. In warm countries,
however, they are believed to begin and end earlier. Upon the latter
point, however, and in the absence of any statistical data upon which
alone any dependence can be laid, I am inclined to be very sceptical.
Looking to the limited opportunities for observation of travellers, upon
whose statement this opinion is founded, and other causes of error, as
noticed by Dr. Churchill, I am inclined to believe that the instances
recorded by them are exceptions, precisely similar to those cases re-
curring amongst ourselves; and that there is, probably, no such great
difference in the age of uterine activity in different countries. The
annexed table, collected from various sources, will shew how little the
opinion before given, touching the earlier appearance of the catamenia
in warm countries, is to be depended on, as there appears to be, in
reality, very little difference between its commencement in Marseilles,
England, and Germany. In the following table, consisting of 4438
cases, in which the first appearance of the catamenia was noted, 4 cases
of M. Brierre de Boismont, occurring, respectively, one at 5 years old,
one at 7, and two at 8 years old, have been omitted, as they appear to
have been rather cases of lusus natura, and as their insertion would only
affect the result in the second place of decimals.
[TABLE,
244
ON PROCREATIVE POWER.
Table, showing the Age at which the Catamenia occurred in 4,433
Females for the first time.

gi o, # º, ; : -: d
##|ail is lift|† : | ##|##| ##| is gi
Age. # É É # # # ă # # #: tº a # 93 || Total.
T. ##|5 ##|##| 3 || : | 3 (5 | * * | * *
>} : = §§ # ſº ſº § | * : ſº ſº
9 || 0 || 1 || 0 || 0 | 10 || 3 || 0 | 11 || 0 || 0 || 25
10 || 0 || 0 || 0 || 5 || 29 || 0 || 0 || 55 || 5 || 0 || 94
11 || 6 || 3 || 0 || 14 93 15 10 || 52 | 16 || 2 || 211
12 || 10 || 14 || 3 || 26 || 105 i 37 19 || 86 28 || 8 || 336
13 | 13 || 6 || 8 || 47 132 57 53 | 153 || 35 | 1Q 514 g;
14 || 9 || 18 21 50 | 194 | 107 || 85 204 || 42 19 749 .
15 | 16 || 14 || 32 || 76 | 190 || 119 97 | 201 || 42 | 16 || 803 | "
16 || 8 || 7 || 24 || 79 141 110 || 76 154 26 15 640 g.
17 || 4 || 6 || 11 58 127 57 || 57 | 101 || 20 18 459 | <
18 || 2 || 5 | 18 38 90 | 84 26 || 78 || 23 || 2 || 316 a
19 || 0 || 8 || 10 || 21 35 | 9 || 23 33 10 || 1 || 150 , §
20 | 0 || 0 || 0 || || 9 || 30 || 6 || 4 || 23 || 6 || 2 | 80 | *
21 || 0 || 3 || 8 || 5 || 8 || 3 || 0 || 6 || 0 || 0 || 33
22 || 0 || 0 || 0 || 0 || 8 || 2 || 0 || 2 || 0 || 0 | 12
23 || 0 || 0 || 2 || 1 || 4 || 0 || 0 || 1 || 0 || 0 8
24 || 0 || 0 || 0 || 3 || 0 || 0 || 0 || 0 || 0 || 0 3
Totall 68 || 85 | 137 || 432 (1196 || 559 || 450 1160 || 253 || 93 || 4433
Touching the disappearance of this function, we have but few statistical
data, for which reason, much reliance cannot be placed in the result
obtained. There is also in the following tables a great source of fallacy,
especially applicable to those cases where the catamenia did not disap-
pear till a very late age; viz., the possibility of uterine diseases existing,
It is, therefore, here
subjoined, more for reference than as any actual ground of conclusion.
an affection by no means rare in old females.
Table, showing the Age at Cessation of the Catamenia.

Mr. Dr. - ſº
Age. Rºon. Routh. Total. Age. Roºn. Rºſſ. Total.
35 I 0 1 50 26 1 27
38 0 2 2 51 2 l 3 CS
40 4 I 5 52 7 3 10 3.
42 2 0 2 53 2 0 2 3
43 I 0 1 54 2 0. 2 d5°
44 3 3 6 55 0. 1 1. 80
45 4 5 9 || 57 I 6 i i <
46 0 1 1 60 2 0 |'' 2 | :
47 3 ig 6 70 I O , - 1 >
48 10 3 13 * t
49 7 0 7 Total 78 24 102
*::::: . i. º
..º.º.º.º. §prº
dréâtive power), %titiënëtuñ&#hoºfemalesto €ºmé prágnant,

in whom no menstrual period has occurred between the présent and a
By c. H. F. RouTH, M.D. 2 : 5
former pregnancy. This, I believe, is a point admitted by all accou-
cheurs. Indeed I have known a few cases, in which this absence of
menstruation has persisted through several consecutive pregnancies;
and, lastly, although we cannot reduce this statement to numbers, I
believe that these examples most frequently occur at the later ages of
procreation. In such cases, therefore, the cessation of the catamenia is
no index of the cessation of procreative power.
(b) From the Fecundity Tables a more certain result is to be obtained,
more especially with reference to the cessation of this physiological
power. First, from the Irish Fecundity Table, where the ages of the
parents on the wedding-day, as well as the number of children born
during a period varying from 1 to 11 years, are given.
Table of the Number of Marriages, and the Issue from such marriages
occurring in the Eleven Years ending 1841, for women of the ages
wnder 17, 46-55, and above 55.

ºr Prop. Of Prop. of Prop.
Age of * ºf ğ. * *:::: ği. * §§ to %
Husband, wife. riages. mº *. Wife. riages. *. Wife.]riages. #:
|Under 17 661 256 I 0 I O
17–25 tº 9,847 232 || 3 35 | 51 || 3 3 || 0
26–35 | . 4,066 252 || | | 145 || 51 .., | 12 0
36—45 || 3 313 248 || | | 227 | 39 § | 15 20
46—55 5 36 205 || Sº 428 22 || 3 || 2 | 1Q
Above 55 18 128 295 || 10 || > | 186, 12
Total... 14,947 257 1,131 26 219 12
In the two following tables, we have the proportion of pregnancies
of 2509 females, admitted as lying-in patients in the Westminster
General Dispensary, under Dr. Bland. There were 36, or 1 in 58,
admitted pregnant between the ages of 15 and 19. Thus:
1 between 15 and 16
1
- - - e º - 16 e tº º 17
2 • * * * s • 17 a s tº 18
10 - - - ºr º sº. 18 e - - 19
21 - - - g º - 19 e - - 20
36
In all there were—
85 between 15 and 20 Or 1 in 25
578 ... ... 21 ... 25 5 19
699 ... ... 26 ... 30 tº gº tº 1 ... 3
407 ... ... 31 ... 35 e - - 1 ... 5
291 ... ... 36 ... 40 tº ſe - 3 ... 22
336 ... ... 41 ... 45 I 58
6 ... ... 46 ... 49 I 350
2509
The following is a list of 1,527 cases admitted in the St. Pancras
Royal Général Dispensary, in the practice of Mr. Smith, Dr. Cox, and
Mr. Greenhalgh. - . . . . . º J
* * : *;
246
ON PROCREATIVE POWER.

Age. Number of || Age. Number of || Age. Number of || Age. Number of
Conceptions. Deliveries. Deliveries, Deliveries.
I6 1 26 83 36 62 46 2 GN
17 0 27 80 37 47 47 2 r:
18 5 28 85 38 48 48 2 §
I9 I6 29 96 39 31 50 2 q}^
20 33 30 139 40 50 52 I #
21 56 31 61 41 7 55 2 g
22 56 32 88 42 17 57 I §
23 67 33 59 43 15 >
24 77 34 71 44 9
25 83 35 69 45 4 Total 1,527
The Fecundity Table for Sweden and Finland, gives about the same
limits.

A Annual Average Proportion to 100 Females
ge. Number of Deliveries. living.
15 to 20 3,298 2°48
20 — 25 16,507 12:56
25 – 30 26,329 21:64
30 — 35 25,618 22.82
35 — 40 18,093 18.32
40 — 45 8,518 9'54
45 – 50 1,694 2:28
50 — 55 39 •05
Thus, as far as we can judge from these fecundity tables, it does not
appear that women younger than fifteen have borne children. In the
St. Pancras Dispenary table, there are three cases only, where females
fifty-five and above fifty years old were delivered. In the Irish table,
however, a greater number of such cases occur. Thus far it is proved,
that it is inaccurate to say too generally, that women cease to procreate
at forty-five. It appears that, in ten years in Ireland, out of 427,977
marriages of women of all ages, there were 1,350 marriages of females
between forty-six and fifty-five, and above fifty-five, with a mean of
fourteen children to 100 marriages.
(c) As I have before stated, the marriage tables afford some degree of
information, with regard to the first appearance of procreative power.
It is natural to suppose, that in an enlightened age, like the present,
parents would prevent marriages of their children if the signs of puberty
were absent; and upon this presumption, we might infer the existence
of procreative powerin all couples marrying early. The marriage tables,
however, being for the most part arranged by ternal, quinquennial,
and decennial, and not by annual periods, the precise age at which
marriage occurred is not given. In the Irish tables, all early marriages
are included in the term under seventeen, which may, and most likely
does, only include two years: fifteen and sixteen. With females in
Ireland, the number of such marriages is stated to have been, in the
eleven years preceding 1841, 14,947. The English marriage table in-
cludes the marriages under the general terms, between fifteen and under
twenty; but, excepting that the mention of the former age justifies the
belief that some marriages do take place at fifteen, the division is too

BY C. H. F. ROUTH, M.D. 247
ambiguous to enable us to say distinctly, what is the earliest age at which
they occur.
(b) The Criminal Tables give no very good index as to the early period
for females. In the three following, that for England and Wales is
defective, as it unites the sexes.
Table of Seasual Offences for the United Kingdom.

ºnlyales. Hº!& | #. Ireland and Scotland
"...º. To 100,000 population.
Persons. Males. | Females. Males. | Females. Males. | Females.
Under 12 *- -- -*. *-** * -- *-
12 — 16 3.4 1.46 - 4°14 *- § 60 *º-
16 — 20 18:0 17-73 3.81 | 16-19 4-62 || 33-92 8’43
21 — 30 32.8 31-24 7-02 || 17-80 7'94 || 49-04 || 14-96
31 — 40 22°4 16:04 3-26 || 13-19 4.70 || 29-23 7.96
41 — 50 12.8 7-16 •29 5.97 “28 13-13 •57
51 – 60 6-9 4:18 •76 4-40 .02 8°58 ‘78
Above 60 3-7 3.03 -º 4'54 *mºm, 7-57 tº-
In the above tables, in the statistics for Ireland and Scotland, the
offences only, which may be said to arise from sexual desire, are included.
These, in addition to two of an unnatural kind, which need not be speci-
fied, are rape and carnal abuses of girls; and, in addition, bigamy, con-
cealment of the birth of infants, and child-dropping. Bigamy, because
the motives that induce a man to commit it, are the same as those
which induce him to marry; and the two latter, because they invariably
occur among persons giving rise to illegitimate children, whose sexual
passion may be, therefore, said to have led them into error. It is true,
that other motives may sometimes have their influence, but these cannot
be now considered. The same objection to defining the age of the first
commencement of the sexual desire, offers in this as in the case of
marriages. Concerning the limit, however, in females, sexual desire
does not appear to exist above sixty. Duly weighing, therefore, all these
results, it appears most correct to limit the existence of procreative
power in females, between the ages of fifteen and fifty-five.
II. (a) In the case of males, our evidence is of a different kind. In
one respect, it cannot be so precise. We labour under the disadvantage of
not having a function like that of the catamenia, upon which to found
our conclusions, It is usually said, that the approach of puberty in
males is marked by “the change of voice, growth of hair on the pubes,
and the occurrence and discharge of semen.” We are not, however,
acquainted with any statistical data in which the age of the first appear-
ance of these signs, either single or conjointly, has been noted. The
only tables which appear to give some positive information on this sub-
ject, are the Irish Fecundity Tables. Here again, however, we have
the two undefined terms of “under seventeen and above fifty-five”
occurring, the former of which may include two or three, the latter
several years. It is useful, however, as pointing out, approximately, the
periods at which procreative power is effective.
248 ON PROCREATIVE POWER.
Table of the number of marriages, and the issue from such marriages
occurring in the eleven years, ending January 1841, for the
ages of husbands under 17, 46 to §5, and above 55.

→
As of No oil if Age of No. of § §§
O. O. - Jºl,0s - ºw RJs º
*::::::: #. Mar- to 100 #. *::: to ; Age of $ºf º;
€. band. ||riages. |Marrgs, band. ||riages. Marrgs. |*|riages. Marººs.
Under 17 | . 661 || 256 || | 36, 205 || || '18 128
17–25 | is 757 256 || 46 |1,516 210 || 240 | 169
26–35 | E. 92 || 203 2,469 167 || Above 461 119
36—45 | # 4 || – || to 1,335 70 429 43
46—55 5 1 — 428 22 || 55, , ; 295 || 10
Above 55 1 | 200 || 55 §2 I0 137 12
It will be seen by this table, that the number of marriages of males
at the earlier ages is less than that of females, still they do occur. In
Ireland for instance, out of 428,802 marriages, there were 1516 where
the age of the husband was under seventeen.
(b) The English Table for Marriages is still less precise. The early
marriages of males are included under the given nominal period from
fifteen to twenty, and only seem to justify the inference, that, while at
this early period a few take place, their number is small, as compared
with females; since, out of 20,437 marriages given, only 587 among
the males, and 2711 among the females, occurred, where the parties
were respectively between fifteen and twenty years old. As a rule,
however, it is believed, that in England, men seldom become active
procreative agents before sixteen; and this number appears to receive
some confirmation from the marriage tables. }_ " " : , , , ~ 2.
(c) The Criminal Tables before given, give the cypher 5-60, as the
amount of sexual offences committed by males between the ages twelve
and sixteen, to 100,000 of the population of every age. This number,
however, compared with the next period, sixteen and twenty-one, is
very insignificant; but in either case, the terms are too vague, and the
period too lengthened, to enable us to infer, very accurately, the early
age. Moreover, the offences that do occur at these ages, twelve and
sixteen, are precisely those where other motives than sexual desires may
influence the perpetrators. Duly weighing all these results, it seems,
therefore, more correct to fix the age of sixteen as the early limit. But
if puberty appears later in males than in females, the physiological pro-
creative power certainly persists longer. Thus, in the marriage ages from
forty-six to fifty-five, their power, in 1 to 11 years after, is represented
by the number 144, while that of females, for the same period, is only
26; and for the ages above fifty-five, it is represented by the number
77, that for females for the same period, being only 12, Indeed, a
male, from forty-six to fifty-five years old, has almost as much procrea-
tive power as a female from thirty-six to forty-five, whose power is
répresented by the numbers, 1 to 99. It is cléar, however, from the
table given above; that it persists above fifty-five, but it does not shew
how long it continues after this periºd. . .

The Čriminal Tableświll, iº ju
- { * * t
-*.
* -1 | * *; , ;", ; , , º stify 8, further inference. The
sexual offences committed in Scotland, and in Ireland, for the period
, , ,' - ' '
BY C. H. F. ROUTH, M.D. 249
above sixty, (i.e., from sixty to sixty-six) are represented by the cypher,
7-57, a number almost equal to that of females for the ages thirty-one
to forty, and exceeding that for males for the ages sixteen to twenty-one.
So far, then, as these tables go, they seem to justify the conclusion, that
men have procreative power above sixty.
M. Bernard Hebellen, in a paper published in the London Statistical
Society's Reports, speaks of sixty as the age in males, from the probable
marriage of whom, no issue could be expected. Our own experience,
we must say, is not confirmatory of this opinion, as we have known
several instances where, with a young wife, men, as late as sixty-eight,
have had several children. Here, however, we speak with great diffi-
dence, from the absence of statistical data by which to support our own
opinion. The Marriage Tables will, in some measure, however, assist
us in fixing this limit. Thus, if we take the number of marriages
occurring to 100 of the unmarried population, living between the ages
of fifty-five and eighty-five, as given, for instance, in the Irish tables,
and take the mean age, we obtain sixty-six as the average age. But
here, another objection presents itself, as regards this limit deduced
from the Marriage Tables. When persons marry late, they do so,
frequently, from motives of convenience, apart from any sexual desire.
According to the number of these marriages of convenience, there
will necessarily be a tendency to diminish the value of marriages, as a
test of sexual desire. In this calculation we labour, therefore, under
the disadvantage of including all these exceptions. Yet it is convenient
(as it is the end of a quinquennial period), to fix, for practical purposes,
the age sixty-six or sixty-five, the former of which is the mean of all
marriages occurring after fifty-five, as the limit of the duration of phy-
siological power. It is true, we may thus give rise to more or less error
for the last three or four years; but this is inconsiderable, as it affects
only the results for the period above fifty-five, and these only in the
second place of decimals.
AVERAGE PHYSIOLOGICAL PROCREATIVE POWER.
In fixing the limits of Procreative Power, it also appears, ā priori,
that the maximum age of fecundity will be that at which most marriages
occur, and in which those offences, arising from the desire to gratify
sexual passion, are most numerous. How far these suppositions are
correct, the following inquiry will, in a great measure, shew.
In relation to the first of these points, it is laid down by Captain
T. A. Larcom (Journal of Statistical Society, vol. viii, p. 212), that the
most marrying race shew the lowest cypher of fecundity; and the
authority of 'Mr. Gregg, in his work on the Social Statistics of the
Netherlands, is adduced as evidence of this fact. It is not purposed to
enter upon this controversy at present. It is presumed, however, that
it will not be denied to be rational, a priori, to suppose, that with any
person whose moral and better feelings are not entirely extinct, the
marriage tendency will be greatest when his sexual passions are
strongest. The number of marriages, at all ages, may not bear a
direct proportion to sexual passion, for the reasons before given; but
the maximä in both cases will agree.
If, now, sexual passion be looked upon as an index of fecundity, or, in
VOL. II. 17

250 ON PROCREATIVE POWER.
other words, the most impassioned be allowed to have most procreative
strength, then marriage tables, tables of sexual offences, and of fecun-
dity will, in so far as the maxima are concerned, pretty nearly agree.
Now, so far as analogy among the brute creation goes, it is favourable
to the supposition. An animal, when in heat, is in the condition most
favourable to procreation. Indeed, in most, if not in all cases, this
preliminary excitement is a sine quá non to conception. Woman, it is
true, differs, in this respect, from other animals, in being always capable
of procreation, so long as the catamenial function persists; but we are
not aware of any data that shew, that when, within procreative ages,
the sexual passion is strongest, she is not then most liable to concep-
tion. We have already spoken of morbid feelings which may exist
without procreative power; but, in default of statistical data to prove
this assertion, it behoves us to inquire how far these opinions are
carried out by the indirect statistical documents at our command.
(a) At what age do most people marry? Tables are given for several
countries, in which the number of marriages that take }. annually, at
different ages, is set forth. It is right, however, in deducing our conclu-
sions, also to take their ratio to the population of unmarried persons
living at every age. Thus, there may be more persons living at one age
than at another. In the former age, therefore, more marriages may
positively take place, though relatively fewer than in the latter age.
Moreover, in making this comparison, the married should be excluded
from the population, as these can give no index as to the desire of
marriage among the unmarried."
* This disadvantage exists in a marked manner in our English tables. We have
no table of the unmarried population for corresponding periods to make the
comparison; therefore, by including the married, our conclusions are necessarily
vitiated. The calculation has, however, been made, and the table is given here
for ºne, to make this source of fallacy more evident by comparison with other
tables.
age, however, obtained, differébut.httlé from that
;
MALES. FEMALES.
No. of Weddings | Reduced No. of Weddings | Reduced |\o lo
Age. Weddings. to 10000 to a maxi-] Age. Weddings. to 10000 to a maxi-ſ: H
population.jmum of 100 |population.jmum of 100 3 le
r—ſ rºl
15–20 537 5.94% 3.70 || 15–20 2,711 27-40° 23'79 ||g ºf
20–25] 10,383 12:58 7-78 || 20–25] 10,424 107-06 92.97 ||: #
25–30) 5,103 74°35 | 46.42 || 25–30 3,951 b{):03 43.44 ||: ā
30–35 1,900 29.35 | 1832 || 30–35 1,498 || 21:15 18:36 || > *
35–40 944 | 18-97 || 11.84 || 35–40 739 || 13.95 || 12:11 ||8
40—45 603 12:00 7-78 || 40–45 532 9.94 8-63 #
45—50 371 10-59 6-61 || 45–50 273 7.18 6-23 | #
50–55 271 || 7-68 || 4-79 || 50–55 161 || 4-17 | 3.62.É
55-60 Al 671 || 4:19 || 55–69 69 || 2:04, l'77, #2
60—65 112 4-60. 2.87 || 60—65 55 1:99 || 1:72, f
65–70 41 2.96 1.84 || 65–70 17 1-05' '91"|
70–75 15 I'24 •76 || 70–75 5 •35 *30 ||
# 75–80ſ 3 || •91. *56; "| 75–80 2 “26 : *21 ||:
, 80—85| 4 1.19 “67 || 804-85 g tº a * - - - •,• * ||#
From these results, it appears, that most women marry at the lº of 22:80, and
most men at that of 27:80, or persons in general, at 24:94. In the American table
the same error exists, and males'and'femalês aréhot distinguished." The maximum


of the English table, namely, 25-84.
BY C. H. F. ROUTH, M.D. 25 l
In the Irish table, in which the number of married and unmarried
persons, for corresponding periods, are given for comparison, the result
obtained is much higher; the maximum age being; for males, 31-84,
and for females, 26.84, or for persons, 28-61. The total number of
marriages that took place in the 11 years, from 1830 to 1840, inclusive,
are given in the following table; the calculation is made upon the
population of 1841. It would have been more correct to use the mean
population for all these 11 years; but in the numbers now obtained,
positive accuracy is not so much sought after, as results for practical
application.
Marriage Table for Ireland, 11 years ending 1841.

MALES. FEMALES.
A. No. of | To 10000 To a maxi- “H No. of . To 10000 To a maxi- “H
ge. Weddings. population. mum 100. g Weddings. population mum 100. §
* wrº. r Qº) GN
Under 17 | 1,516 80-81 '92 || 5 || 14,941 831-11 || 13-3 | dº
17–25 191,677 |3021:23 || 34°4 39 || 305,312 |4977-90 79.26 §
26–35 | 193,639 |8335.63 || 94.8 || 3 || 98,195 |4981-20 | 79-32
33–45 || 33380 |ſiº || 484 || 5 || sº |ºisi iii |{
46—55 5,836 |1128-82 | 12:7 || 3 || 1,131 || 101.61 | 1.5 3
Above 55 | iſ㺠ſigiº | 1.6 |* | *310|| ióð3 | "is |A
Other marriage tables were obtained; but as a comparison could not be
made with the unmarried population only, and as, moreover, the popu-
lation was frequently grouped in periods different from those in which
the marriages were arranged, the deductions made were considered
insufficient, and accordingly rejected.
(b) The Criminal Tables before given, bring out maxima, which, after
all, are not very different from the above. That for England and Wales
gives 28:50 as the maximum age for persons; the Irish marriage tables,
taken also for persons, give 29.09: two results which come very near
one to another.
The United Table of Sexual Offences committed in Ireland and
Scotland, gives—
Maximum age for Males 28-00
Ditto for Females 26-66
For Ireland alone—for Males 27-01
Ditto for Females 26-55
ForScotlandalone—for Males on tº ºr 28-09
Ditto for Females 26-77
These results, for females, may be said almost entirely to agree with
those obtained from the Marriage Tables, though there is some slight
difference as regards males. The reality is, perhaps, that for the ages
between twenty-seven and thirty-one in males,there is very little differ-
ence in the amount of procreative power. The mean of the Marriage
and Criminal Tables is 29. * –
There is another way, in which this apparent discrepancy may
be explained. The calculations of the criminal tables are made upon
the whole population, married and unmarried. This was purposely
done, because bigamy is an offence belonging only to married persons, and
to which, therefore, a comparison with the unmarried, exclusively, could
not apply; but, it has the disadvantage of affecting, perhaps the propor-
17

252 ON PROCREATIVE POWER,
tion, in relation to the other sexual offences. These, (though, perhaps,
occasionally, a married man may be implicated) are chiefly committed
by unmarried persons. On the other hand, however, the amount of
this error could not be shewn, as there is no table of the unmarried and
married persons, for the periods of age here given; and the comparison
was, therefore, impossible. Having thus to choose between two evils,
we selected the least, though a simple consideration of the above facts
would explain, why the criminal tables might give a lower maximum.
The nature of the sexual offences committed by women, explains why
their maximum cypher is not equally vitiated.
(c) We would naturally expect, however, that the accuracy would be
much greater, if we deduced this maximum from Fecundity Tables. Un-
doubtedly, this would be the case, if these were constructed with more
care; and the calculations would be as brief as correct. It would suffice
to know the age of the parents at the birth of every child; and that age
in which, relatively to the population of active procreative agents, most
children were born, would be the age of greatest fecundity. Unfortu-
nately, no such tables are given; and we are, therefore, compelled to
make use of tables comparatively defective.
The Swedish table, before given, would be one of the most valuable
in determining this age for females, if the number of active procreative
agents were known, relatively to every age. In the absence of these
data, it must be rejected. As, also, Dr. Metcalf's Table for Fecundity,
in New York, is arranged in periods of years, for which no corres-
ponding table of the active procreative agents (for similar periods), is
given, it must be also set aside. Thus are we reduced, for females, to
the Westminster and St. Pancras General Dispensary tables, and to
the Irish tables. For the males, the Irish table is the only one upon
which we can depend.
It may be well to mention here, in speaking of the Irish tables, one
capital defect in them, which, if not insuperable, is at least calculated
to give rise to very erroneous results. This table, given at page 487
of the Report of the Census Commissioners for Ireland, includes, in
the total, not only the children born of parents, while only they con-
tinued within the ages in which they married, but also for a period,
varying from 1 to 11 years after, when their fecundity would be the
same as that of persons who married at a later period. To make our
meaning more plain by an example: 437 females married while under
seventeen, in the year 1830, and in 11 years they had 883 children.
This number is retained, as measuring the fecundity of the age under
seventeen; whereas, in reality, these females, in these eleven years,
had passed through the phases and procreative power of the next period,
i.e., from seventeen to twenty-five, and necessarily enjoyed the procrea-
tive power of that period. The number, therefore, as measuring the
fecundity to 100 marriages, for this period, should be divided, at
least by 11. If the number of those who married in 1831, be taken, the
measure of fecundity is at least 10 times too great for this period, and so
on. The effect of this is to raise, unduly, the fecundity of the earlier age,
up to the maximum, and to lower that of those below this maximum.
In order to obviate this difficulty, we have been satisfied to deduce our
table of Average Physiological Power from the two years, 1889 and 1840,

BY C. H. F. ROUTH, M.D. 253
dividing by 2 the number of births in the former years. This, it is true,
introduces a small amount of error; but it is very inconsiderable. The
advantage thereby obtained, quite makes up for this trifling error, by
enabling us to correct the inaccurate numbers obtained from the consi-
deration of a smaller number of marriages and births (especially during
the earliest and latest periods), occurring in the single year. We begin
first with males.l
Table of Fecundity for Males for the years 1839 and 1840.

No. of Children to 600 Marriages. To 100 To a ©
Age. married maximum go
1840. 1839. Total. population. of 100. Fº
~35
Under 17 60 117 177 16-42* 31:59 || 3
17 — 25 197 154 351 29:25 56.46 || 3
26 – 35 157 160 317 26-42 51*00 3
36 – 45 158 161 319 26-58 51*00 :
46 – 55 92 T10 202 16-83 32.49 || 3
Above 55 60 94 159 13:25 25-57 | *
The maximum for each of these years separately, differing only by
78. That for 1840 being 25-40; that for 1839, 26:22; mean, 25.81.
There can be no doubt, that this maximum is too low; and the reason
is obvious. Both the years 1839 and 1840 are defective for husbands
under seventeen, as it happened that no marriages took place of males
of this age with females from thirty-six and upwards, and only thirty-
mine altogether with females under thirty-five. The cypher of fecundity
obtained for this age of males is, therefore, much too high; and as it
* As before said, we have three tables from which we may deduce the average
Procreative Power for females: the Westminster Dispensary, the St. Pancras Dis-
pensary, and the Irish Fecundity Tables. To deduce from the two former the
maximum of fecundity, it is necessary that we should have a table of the number
of active procreative agents, i. e., the married, as these form so much the greater
part among these. There is no such table for England. If to remedy, however,
this error, we assume that the proportion in England and Ireland is about the same,
which, after all, may not be very far from the truth, we have the following results.

Number of Deliveries.
Age e * # mºn
ge. St. PancrasſWestminst Irish Fecundity Tbls. Total. population.] of 100
Dispens. | Dispens. 1840. 1839.
Under 17 1 2 86 175 264 24-78 8-8
17—25 393 661 11,190 12,319 || 23,563 228:50 82-0
26–35 831 1,106 3,980 4,898 || 10,815 45-98 52-4
36–45 290 698 160 245 1,396 64-66 23-2
46—55 11 42 5 5 63 2-91 1-04
Above 55 I 0 0 2 3 •21 *14
But in the above table, the number for the period between 26 and 35 is evidently
incorrect. This arises from the accidental circumstance, that the number of delive-
ries in the Westminster Dispensary for this period is so great. The mean of 64-66
and 228.5 is about 146. If this number be substituted, we have for maximum age,
24-01, and maximum ordinate, 278-60. The two Dispensary Tables, worked sepa-
. , give results not very different from that above obtained, where the two are
combined. *
In applying, however, the proportionate numbers for married persons of all ages
to the Dispensary Tables, as the usual number of children born to one marriage is
254 ON PROCREATIVE POWER.
necessarily enters into the calculation for the maximum, the maximum
age comes to be too low.
Such as it stands, however, the analysis of the above table brings
out the following fact. The procreative power increases exceedingly
uick at first, till it reaches its maximum in about eleven years. For
; next ten years it diminishes gradually. For the next twenty it re-
mains in statu quo, till in ten years more it comes to equal what it
was at the age under seventeen, and then gradually, but slowly, dis-
8.0068. T8.
P. estimating the average physiological power for females, we have
also made use only of the Irish tables. The two dispensary tables have
been rejected, as the correct proportion to the married population of the
respective periods could not be made out. An attempt, however, has
been made to rectify this disadvantage; and the results are appended
for reference in a note.
The Irish Fecundity Tables, worked for two years only with the same
precaution observed as in the case of males, fix the age somewhat
higher.
Table of Fecundity for Females, for the years 1839 and 1840.

No. of deliveries to 600 married, To 100 To a
Age. population. maximum
1840. 1839. Total. of 100.
| Under 17, 104. 114 218 36°33 44.96,
17–25 230 240 470 78-33 96-94
, 26–35 | 185 265 450 75.00 90%281, if
86–45 129 II8 247 41-17 50-95
46—55 81 33 114 19-00 23:51
Above 55 0 37 37 6-16 '7-06
giving as a maximum age 26-66, and maximum ordinate 80-80. The
maximum age for 1840 alone, is 25:13.
This result would seem to fix the maximum of male and female about
the same for average physiological power, and, if anything, rather higher

estimated in England at three, the total number of deliveries should be trebled,
to give the number of marriages.
Number of Deliveries.
Age. West. St.
West- St. Westmins. to a St. Pancras to a minster. Pancras.
minster. | Pancras, maximum of 100maximum of 100
Under 17 2 1 65°32 53-76 Max. age.|Max. age,
17—25 661 393 72°22 70-55 22:29 23-67
26–35 | 1,106 831 55.93 52-92 i ' ' ' ||
36 45 | "698 290 B2°12 24°10 |Max. Ord. Max, ord.
46—55 42 11 *34 0-15 73:60 || 75-48
; : Above 55 0. 1 : ] •0 *019 , * tº i ! .
• rº" tilt,
It may be here remarked, that the mean maximum age of the two Dispensary
Tables is 22-98, a result very near that of the maximum age of marriage among
English females. It should, however; be borne in mind, that apart from the error
of the English Marriage:Table before mentioned, the results are not of equal weight
with those of the Irish Tables. The English Marriage Table is calculated upon
40,000 marriages, and the fecundity only from 4,196 deliveries. The Irish are
made from upwards of 400,000 marriages, and 17,000 deliveries.
BY C. H. F. ROUTH, M.D. 255
for females than males. The single year 1840 alone makes it higher
for males. This is manifestly an error, owing to the accident before
noticed. Yet, as the deduction of average procreative power from
fecundity tables may be useful for reference, it is perhaps convenient to
consider the maxima in both males and females to be 26, at the same
time, as by reducing to the same unit, the numbers deduced from the
marriage tables, other numbers for the ages 21%, 31, and 41, may be
annexed in another column for comparison, and this is what has been
done in the annexed table for physiological procreative power.
That there is a curve representing the exact inclination of procreative
power, cannot be doubted. Its exact determination, however, is impos.
sible, when such distant intervals as ten years are given as ordinates
between the ages. The circle would perhaps be the nearest curve that
could be selected, but it very much increases the amount of arithmetical
labour necessary. Fortunately, for practical purposes, such accuracy,
however desirable, is not absolutely needed. If we suppose these
several ordinates joined by a straight line, the procreative power of every
age may in this manner be calculated, which, if not exactly correct, may
yet be very useful in its application. Accordingly, in the following table,
the procreative power for every age has been so calculated.
Table of Average Physiological Power, calculated from the Irish Tables.

Males. Fem. Males. IFem Males. |Fem.
* Age. & t— * Male. Fem.
Age Marr. Fee. Fec. ge Marr.) Fec, ; Fec. Age Marr. Fee. Fec. Age Fec. Tab.
15 ... . ... 22 || 28 || 82 | 80 || 96 || 41 || 60 || 51 || 51 || 54 30 5
16 ... 31 || 44 || 29 || 87 || 70 94 || 42 | ... 49 || 48 || 55 29 ...
17 | ... 36 || 54 || 30 || 93 60 | 92 || 43 | ... 47 || 45 || 56 || 28 ...
18 ... | 40 || 63 || 31 100 || 51 90 || 44 ... 45 || 42 || 57 || 28 ...
19 ... 45 | 73 || 32 95 51 86 || 45 ... 43 || 39 || 58 || 27 ...
20 ... 49 || 82 || 33 91 51 82 || 46 ... 41 || 37 || 59 26
21 ... 54 92 || 34 || 87 || 51 78 || 47 ... 39 || 34 || 60 || 26
22 || 47 61 || 97 || 35 | 84 || 51 || 74 || 48 ... 37 || 31 || 61 25
23 53 || 70 97 || 36 || 80 || 51 || 70 || 49 ... 35 | 28 || 62 | 19
24 59 80 98 || 37 || 76 || 51 | 66 || 50 | ... 33 26 || 63 | 12
25 || 65 90 99 || 38 || 72 51 62 || 51 | ... 32 || 23 || 64 6
26 70 100 ||100 || 39 || 68 || 51 || 58 || 52 ... 31 17 || 65 ...
27 76 90 98 || 40 || 64 || 51 || 54 || 53 30 11
ABSOLUTE CONNUBIAL PROGREATIVE PoweR.
The above table will not enable us to decide the procreative power of
any one couple coming together, whose fixed ages are given; in other
words, the United Procreative Power. Herein we are met with one
great difficulty. The procreative power, which we have termed the
united procreative power, is only to be deduced from the Irish Fecundity
Tables. It bears a relation to the last table; but, with the data at our
command, to determine this relation is impossible. The table for the
year 1840, gives the number of children born for one year; and hence,
& priori, we might hope that the result obtained would be conclusive;
such, however, is not the case.
[Table
256 ON PROGREATIVE POWER.
Table of United Procreative Power (Ireland) for 1840.

Age of Husband.
Age of Wife. Remarks.
Und. 17|17–25 | 26–35 | 36–45 '46—55 |Abov. 55
Under 17 | 20 15 19* 50* | ... tº we tº
17–25 | 40 44 47 44 35 20 * These numbers re-
26–35 | ... 45 48 42 28 22 present the number of
36–45 ... 43 23 22 26 I5 children born to 100
46—55 ! ... 50 20 gº tº ſº 3 8 marriages of each age.
Above 55 ... gº tº º tº ſº º tº º ſº. * * * tº º sº.
But very little consideration of the above table will show, that to de-
duce from it the procreative power of other than the middle ages,
would be impossible; because, there being but very few and sometimes
no marriages in the extreme periods, for obvious reasons, the cypher
of fecundity for these periods cannot be depended upon. It is either
much too high, or absent altogether, nor does any method for taking
a mean in such cases, promise any very correct result.
On analysing, for instance, more closely, the above table for 1840,
the power is found, by calculation, to be greatest at the ages of twenty-
nine for males, and twenty-six for females. It would be reasonable to
suppose, that the maximum age of united power would be the same as
that for average physiological power. This is the truth in the case of
females, the age being in both cases twenty-six; but it is not true for
males. The reason has already been stated. The Irish Fecundity
Table for 1840, is defective for the period under seventeen for makes;
and the cypher of a man's fecundity for the age under seventeen, enters
into the calculation necessary to bring out the average maximum age of
procreative power for males; while it is excluded in the calculation re-
quired for the maximum age of the united power. This accounts for the
remarkably low maximum, obtained in the former case. Again, for the
ages between thirty-six and forty-five, there is another defect, as it would
appear that a man of that age has more procreative power than one of
between twenty-six and thirty-five. This may arise from the table giving
too small a number, for the fecundity of husbands of the former period.
It is in reality, highly probable, as the subsequent reasoning will show,
that the fecundity of these two periods is very nearly the same in both
cases. If we attempt to raise the cypher of fecundity for the period
between twenty-six and thirty-five, supposing that between thirty-six and
forty-five to be correct, it must be raised to more than twice its present
value, to make the maximum age of procreative power for males twenty-
seven. These sources of fallacy, therefore, so entirely vitiate the result,
that it was found impossible to make use of the fecundity table for 1840
singly, and the following plan was therefore adopted,
In the Census Tables of Ireland for 1841, the table given at page 487,
was selected. The number of marriages, and children born to such mar-
riages, were here given for the eleven years, from 1830 to 1840 inclusive.
The number of children born to each couple was divided by the num-
ber of years they had been married; and the quotient in each case was
supposed to indicate the number of children born to each couple per
BY C. H. F. ROUTH, M.D. 257
annum. In this way, a series of additional numbers were obtained, for
comparison with the numbers for 1840.
Had we been satisfied with taking the mean of the numbers so ob-
tained, this proceeding would have been open to the objection, that
fecundity is greater in the middle, than in the earlier or the later
ages. The cypher of fecundity for the earlier ages would be too high, as
the couples would, in these eleven years, be passing through the phases
of greater fecundity pertaining to the middle ages, while that for the
later ages would be too low, for precisely the converse reason. To take
such a mean would, therefore, have been wrong.
Now it is a mathematical theorem that, in any curve, the mean of any
number of ordinates, between two fixed points, is nearly equal to the
middle ordinate; and differs from it less and less as the two points
approach one another. This is most true, when the curve increases very
rapidly, and is accurately true for the straight line. Applying this law to
the present case, the mean number of children obtained between any
two fixed ages by a large number of persons, will be nearly equal to the
number of children obtained by that same number of persons in the
middle age between the two. This will become more evident by an
example. Supposing 27 be the average number of children born to
100 couples, both under seventeen, in eleven years; 27 may be taken
as the measure of the fecundity of a couple aged twenty-one, nearly.
As each male and female grow older each year, these results come to be
arranged in diagonals in the table.
For the sake of greater accuracy, we have reduced this table to one
for every two years, by taking means. Moreover, by comparison, the
extraordinary and accidental numbers have been corrected; in an arbi-
trary manner, it is true, yet yielding necessarily results more to be
depended upon, and probably sufficiently correct for all practical pur-
poses. The intermediate years have either been filled up in a similar
manner, or proportional parts taken.
There are yet two other sources of error, which, in strict honesty,
should be here mentioned. 1. The three last years, 1838-39-40, are un-
fortunate years; as, whatever may have been the cause, there were
proportionally fewer marriages in those years than in the preceding.
This accident diminishes the value of our table, for the reasoning would
be most correct for the later and least so for the earlier; and, 2. the
results from the preceding years are formed from better data. These
two errors mutually aid one another in vitiating the results.
No method, however, to obviate this inconvenience could be found;
and hence, the results must be considered as unfavourably influenced,
though probably not sufficiently to affect their practical utility. (See
Table, p. 258.)
It is clear, however, that although the table (p. 259) may be looked
upon as expressing the relative fecundity of different ages, among
united or married persons of both sexes, abstractedly considered, still,
it does not express the totality of procreative power, which we have
termed the Connubial Absolute Power. This must depend on two other
circumstances, first, the chance a person has of living through the
succeeding ages; and secondly, of enjoying, in addition to his actual
present fecundity, the fecundity appertaining to these succeeding ages.

258 ON PROCREATIVE POWER.
Cyphers of Fecundity for 11 years, ending 1840.

‘s tº Age of Husbands. *:S g; Age of Husbands.
$ º, ſ
#|Und. Z | * | * | * |Abov.] § |Und, 17 | 36|| 36|| 46 Abov, *.
17 | . . . . . . . [ 55 # 3 |-}} | . . . . ;
20 || 50 | 19 || 50 ... . ... ... 43 -23 # 22 + 26 15 1840
33 || 30 || 34 | 16 . . . . . ... ... 22 || 29 || 28 || 23 || 14 | 1839
18 || 32 28 23 18 || 23 – 23 21 || 9 || 1838
§ 36 || 35 | 35 | 37 37 \º 22 || 23 || 21 I5 | 10 | 1837
# 37 || 36 |34 ||34 || 30 || 5 || Sº 18 || 17 | 13 | 12 || 4 || 1836
# 37 ||37 || 36|| 36||13 22 || 8 18 17 17 | 13 II | 1835
5 |33 || 36||38|| 39 35 || 7 || 3 17 | 15 12 10 | 11 1834
33 36 || 36||32 || 26 18 16 || I5 10 || 2 | 1833
30 || 35 | 36 34 || 26 || 44 ... 16 || 17 | 15 10 || 4 || 1832
29 || 36 37 || 37 || 30- 30 ... 17 | 14 || 14 || 8 || 4 || 1831
27 || 25 || 34 || 34 || 24 || 22 ... 13 | 12 || 13 || 9 || 5 | 1830
40 || 44 || 47 44 || 35 | 20 50 | 20 ! ... 3 || 8 || 1840
21 43 || 45 || 46 || 43 || 42 16 || 6 || 4 || 6 1839
35 | 42 || 44 || 43 | 40 || 25 17 | 8 || 8 || 4 || 1 | 1838
37 || 41 || 43 || 42 || 37 41 ... || 5 || 7 || 4 | ... 1837
§ 37 || 41 || 42 || 41 || 34 || 30 || 3 ... 15 || 3 || 4 | ... 1836
g 43 | 40 || 41 || 39 36 22 || 8 ... 13 || 1 || 6 || 2 | 1835
t- i 35 | 39 || 40 || 38 || 35 | 26 || sc 58 || 6 || 8 || 4 || 2 | 1834
" || 32 || 39 40 || 37 27 22 || * 4 || 5 || 5 || 2 | ... 1833
33 38 || 39 37 || 35 | 11 18 || 9 || 5 || 3 || 4 || 1832
31 || 38 || 39 || 39 || 30 || 24 4 || 8 || 8 || 2 || 2 | 1831
28 37 | 38 35 | 29 || 27 ... || 4 || 6 || 9 || 4 || 1 | 1830
: |45 || 48 || 42 [28 22 ... I ... . ... I ... . ... . ... I 1840
62 41 || 45 || 47 || 36 32 ... . . . . . ... 25 || 1 || 6 || 1839
22 | 89 || 43 | 40 || 38 || 25 | 8 || 3 | 1838
35 | 38 || 43 || 39 || 33 28 || > ... 1837
§ 40 || 36 42 34 || 31 || 26 || 5 ... 1836
3 22 || 36 49 |34 || 26 22 || # 2 1835
sc 27 || 35 | 40 || 32 27 | 19 || 5 7 | 1834
* 27 | 84 || 40 || 33 26 || 19 || “. 8 2 | 1833
23 33 || 39 || 30 26 || 7 4 | 1832
23 || 32 || 39 || 34 24 || 14 ... . . . . . . . . . ... | 3 || 9 || 1831
29 || 30 38 27 23 13 ... . . . . . . . . . ... . ... . ... I 1830
Both these conditions are regulated by his expectancy of life. The
chance of living, should, therefore, also be taken in consideration, which
will have the effect of raising, considerably, the numbers expressing
physiological procreative power. The difference of this increase, is
what we have before termed Eaſpectant Power, and must be added to the
connubial physiological, to give the connubial absolute power.
. In drawing out this table, we have made use of the Carlisle Life
Table, both because it is universally known, and because, even in these
controversial times, it is very generally admitted to be good. . It has
the inconvenience of uniting the sexes; but, on the other hand, any
inaccuracy hereby introduced, can scarcely much affect the result, and
certainly not interfere with its practical utility.
It was necessary, however, to assume, in the calculations involved,
first, that for so few a number of succeeding ages as ten, the procreative
power increases or decreases, uniformly with the average rate between
these limits; and secondly, that the same proposition was true, with
regard to expectancy of life.

By C H. F. RouTH, M.D.
259

TABLE OF UNITED, OR CONNUBIAL PHYSIOLOGICAL PROCREATIVE POWER.’
Maximum, Age, Males 33，94; Females 26，07; Maximum Ordinate 50.
Age «.Age of Husbands.
wſ.16 | 17 - || B3-19ļ20–ł|22–32-slºe-ke-sko-1s-3|bſ-3|bs-1|bs-340–1ø-ska-ske-7as-de-152–3a-dº-ºse-sko-|w-364-5 | 66
1640 | 44 | 48 | 52 | 56 | 57 | 57 | 58 | 59 | 56 | 54 | 51 | 48 | 46 | 40 | 34 | 28 | 22 | 16 | 18 | l1 | 9 || 7 | 4 || 2 | 0 | 0
1742 | 52 | 54 | 54 | 59 | 64 | 65 | 66 | 67 | 68 | 66 | 63 | 59 | 56 | 54 | 49 | 46 | 42 | 88 || 84 | 24 | 14 | 12 | 8 | 4 || 0 || 0
13 - 19 | 45 | 58 | 55 | 56 | 62 | 67 | 72 || 78 | 74 | 75 | 74 | 71 | 66 | 65 || 64 | 62 || 57 | 58 | 48 || 44 | 40 | 28 | 17 | 12. || -7 || 0 | 0
55 51 | 50 | 56 | 57 | 58 | 66 | 70 | 75 || 80 | 94 || 95 | 94 | 90 || 89 | 88 | 84 | 73 | 72 | 71 || 70 || 68 | 56 | 50 || 85 || 20 | 9 | 0 | 0
99_93 || 52 | 62 | 64 | 66 | 68 | 74 | 80 || 86 | 95 | 96 || 95 | 93 || 90 | 88 || 86 | 76 | 76 | 76 | 76 | 76 | 72 | 59 | 46 | 83 | 10 | 0 | 0
| 34 35 | 54 | 63 | 74 | 75 | 76 | 78 | 88 | 88 | 96 | 97 || 98 | 97 | 98 || 89 || 84 | 76 | 75 | 72 | 70 | 68 | 66 | 61 || 52 | 44 | 28 || 0 | 0
23_97 | 56 || 64 | 71 | 77 | 80 | 82 || 84 || 89 | 97 [100 | 97 | 96 | 92 | 87 | 83 || 78 | 74 | 70 | -69 | 66 | 68 | 58 | 51 | 43 || 22 | 0 | 0
| 55 5ğ | 58 | 66 | 72 | 79 || 84 || 86 | 88 | 90 || 97 || 97 | 95 | 92 || 90 || 86 | 82 | 76 | 72 | 68 | 62 || 59 | 56 | 58 | 50 | 42 || 21 | 0 | 0
| 30 31 | 60 | 66 | 72 | 77 | 82 || 85 | 87 | 91 || 96 | 92 || 90 | 88 || 86 || 84 || 81 | 74 | 68 | 60 | 54 | 52 | 49 | 46 | 43 | 40 | 20 | 0 | 0
º 55 53 | 55 | 62 | 65 || 69 | 73 | 72 | 75 || 79 | 82 || 86 | 86 | 85 || 83 || 81 || 80 | 70 | 63 | 56 | 49 | 42 | 40 | 85 || 80 || 25 | 20 | 0 | 0
·| 34 35 | 50 | 52 | 56 | 61 | 65 | 70 | 66 | 69 | 72 | 76 || 80 | 77 | 73 | 70 | 67 || 64 | 62 || 54 | 46 | 40 | 88 || 38 | 28 | 23 | 12 | 0 | 0
šș_ğ7 | 45 | 46 | 48 | 50 | 56 | 61 | 67 | 64 | 67 | 70 | 73 | 76 | 72 || 69 | 66 | 63 | 69 | 52 | 44 | 38 | 82 | 26 | 24 | 22 | 11 || 0 | 0
§§ 53 | 40 | 41 | 42 | 45 | 49 | 58 | 58 | 63 | 62 | 68 | 64 | 66 | 68 | 64 | 60 | 57 | 54 | 50 | 42 | 87 | 29 | 25 | 22 | 21 | 1:0 || 0 | 0
4õ_4:1 || 35 | 36 | 37 | 38 | 42 | 46 | 51 | 55 | 60 || 60 || 59 | 58 | 57 | 56 | 58 | 50 | 46 | 43 | 40 | 36 | 26 || 24 | 21 | 20 | 9 || 0 | 0
43_4.3 || 30 || 31 | 32 | 83 | 34 | 36 | 38 | 41 | 43 | 46 | 46 | 45 | 44 | 48 | 42 | 40 || 39 | 38 | 86 | 34 | 28 | 21 | 18 | 14 | 10 | 0 || 0
44 45 | 24 | 25 || 26 | 28 | 30 | 82 | 33 | 34 | 35 | 36 | 37 | 86 || 34 | 33 || 32 | 30 | 28 | 26 | 24 | 22 || 20 | 17 | l5 | 8 | 4 || 0 | 0
43 47 | 19 | 20 | 21 | 28 | 25 || 27 | 29 | 30 | 30 || 31 | 32 | 28 | 28 | 27 | 27 | 26 || 26 | 24 | 22 | 20 | 18 | 16 | l4 | 8 | 4 || 0 | 0
45 4ğ | 14 | 15 | 16 | 17 | 19 | 22 | 25 | 27 | 28 | 29 | 28 | 26 | 24 | 24 | 28 | 22 | 21 | 20 | l9 | 18 | 17 | 15 | 14 | 7 | 8 || 0 | 0
șğ și | 73 || 9 | 10 | 11 | 13 | 16 || 19 || 21 | 24 | 25 || 26 | 24 || 21 | 18 | 18 | 17 | 16 | 15 | 14 | 12 | 12 | 10 || 8 || 6 || 2 | 0 | 0
šğ ș3 || 3 || 5 | 6 | 7 | 8 | 8 || 10 | 12 | 14 | 16 | 17 | 17 | 16 | 15 | 14 | 14 | 13 | 12 | 11 | 10 || 9 | 8 | 4 || 2 | 0 || 0 | 0
54 55 | 1 || 2 || 2 | 8 || 3 | 4 | 4 || 6 || 8 | 10 | 12 | 11 | 10 | 9 || 8 || 7 || 7 | 7 | 6 | 6 | 6 || 4 || 2 || 1 || 0 || 0 | 0
5600 | 000 | 0000 | 0000000 | 00 | - 000000 | 000
1 The numbers represent twice the average number of children born to 100 couples, taking 100 as the maximum.
260 ON PROCREATIVE POWER.
As regards the first supposition, it is, strictly speaking, not quite
correct; but as the data, from which we have deduced the table of commu-
bial or united power, are also imperfect, it is needless to make a more
strict supposition in this case, lest we might lay ourselves open to the
charge of pretending to accuracy which does not exist: because, as
before remarked, two sources of fallacy cooperate to vitiate the result.
Secondly, upon looking at the Carlisle table, it is found that the
method of the straight line does not differ very much from the truth,
for small periods, as exhibited in that table. If the straight line were
accurately true, for any period of years, the same number of persons
would die in that period every year. On looking at the table, this is
found to be pretty nearly the case for periods of 10 years. Indeed, in
the Northampton tables, of Mr. Price, this was so remarkably true,
that (in 26 Geo. III., chap. 52) they were selected by Act of Parlia-
ment for estimating the legacy duty; and these tables were, and are
now, almost universally used by the Life Assurance Offices.
In this manner, it was thought, an approximation, sufficiently near
the truth, for all practical purposes, would be obtained. Indeed, on
examining our data, it is doubtful if any other plan could have been
adopted.

ABSOLUTE EXCONNUBIAL PROCREATIVE POWER.
The Absolute Exconnubial Procreative Power of any person, is his
chance of bringing his dormant power into action. This may be realized
in two ways; first, by the criminal connexion of the sexes, as in the
production of illegitimate children; secondly, by the chance of a given
person living long enough to marry, and thus begetting children.
The first of these, is the practical power of any unmarried person.
To include, however, in the absolute power, this practical power, requires
data which we do not possess. Tables should be given of the number of
illegitimate children born during each period, as we have in the case of
married persons, with the ages of both parents; and then, by drawing
the proportion between these number of children, and the number of
unmarried and widowed persons within procreative ages, we should
obtain a cypher for this fecundity, which, though small as compared
with that of married persons (since, for parents of all ages, the legiti-
mate are to the illegitimate, as 16 to 1), might yet be appreciated, and
by addition to this expectant exconnubial power, at once give the
absolute exconnubial power.
In the absence of the data required, this practical power must be
completely overlooked. While, therefore, we retain the term absolute
exconnubial power, for convenience, it should be borne in mind, that this
expression is incorrect, and that, in the totality given, the practical
power having been omitted, the results are smaller than they should be
in reality. - - * .
The second way in which a person may realize his dormant power, is
by marrying in any one of the subsequent years of his life, and thus
becoming possessed of connubial absolute power. The chance, there-
fore, of his obtaining this power, must be the measure of his fecundity.
Take the case of a male. As his chance will be different for every
year, so we must consider each year separately. In any one of these,
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$262 ON PRO CREATIVE POWER.
a male may marry a female of any age; his power, then, depending
upon this, may be found by taking the chance of his marrying a wife of
any age in a given year, and multiplying by his absolute connubial power,
if he did so marry. The sum of these results gives his procreative
power, depending on the chance of his marrying that year. Repeating
this process for every succeeding year (or period of years) of his life, and
taking into account his chance of life, the sum of these results will be
his absolute exconnubial power for that year or period of years.
By the Irish Marriage Tables, these may be found for the years 16,
21, 31, 41, 61 ; and by taking proportional parts for the intervals, the
tables may be calculated.
It should be, moreover, borne in mind, that as children have, neces-
sarily, the chance of attaining procreative and marriageable ages, so
have they also an amount of exconnubial absolute power. It is small,
it is true, but still not to be neglected.
Taking these several circumstances into consideration, the following
table was calculated.

Table of Eaconnubial Absolute Procreative Power.

Age. Males. Females. Age. Males. | Females. Age. Males. | Females.
0— 1 || 498 366 || 22—23 664 451 44–45 || 41
2— 3 || 611 445 || 24–25 | 557 | 394 || 46–47 37
4— 5 | 660 480 || 26–27 450 337 || 48–49 33
6— 7 || 700 510 || 28–29 || 343 279 || 50–5] 30
8— 9 || 710 || 520 || 30–31 236 222 || 52–53 26 •01
10–11 || 728 530 || 32—33 || 129 165 || 54–55 24 .005
12–13 | 733 534 || 34–35 | 112 134 || 56–57 22 | ...
14–15 742 540 36–37 96 102 || 58–59 || 21
I6–17 741 538 || 38–39 79 71 60–61 19
18–19, 713 505 || 40–41 62. 39 62–63 | 18
20–21 | 688 478 || 42–43 45 8 64–65 9
66 ge tº s
:
The preceding investigation would enable us to give an opinion on
several most important probabilities connected with our social relations
in life. Two only, however, will here be noted. If a party presented
himself before us, as being very desirous of offspring, we would be
enabled to tell him, in relation to his own age, what ought to be the
age of the partner to be selected, which would promise best for the
gratification of this wish. In like manner, many other prudential con-
siderations in social life might hereby be more certainly assured. It is
to emigration societies, and governments, however, that tables, setting
forth the procreative power for the various ages, prove most valuable. To
the former, if the benefit and increase of the population in the colony
be the chief desire, these tables at once explain at what ages persons
should be sent out. To the latter, they designate those agents, who, as
most active in the increase of an over-crowded population, should be
removed. ! , i ;
If we are not misinformed, the principle adopted by emigration Socie-
ties, is to send out no parties free of expense above twenty-five years
old; and generally, they encourage persons of or about this age to
1 The numbers here given, divided by 200, will give the number of children each
person on the average may be expected to have. *
BY C. H. F. ROUTH, M.D. 263
.#
emigrate. This plan may be correct, if the parties be already active
procreative agents, or married persons; because they are very near the
maximum age of fecundity, and, besides their bodily strength being
greatest in and about these ages, these persons are more likely to be
useful members in the colony: but if they be unmarried, and due regard
be also paid to the future prospects of these persons, and to the increase
of population in the colony, the value of such persons is not so great
as that of children between two and three years old. This assertion
may appear a startling one ; yet it is borne out fully by the table of
exconnubial absolute power before given. &
These tables would, indeed, seem to point out the advantages to be
derived in sending out persons upon the principle of a sliding scale;
parties between twelve and seventeen being sent out free, and those
either below or above these ages being charged at a rate proportional to
their procreating value. In like manner, it explains the advantage there
would be in sending out married persons at a cheaper rate than the un-
married, etc. The government, in seconding such a movement, would
contribute powerfully towards ameliorating the condition of thousands,
whose distressed social condition calls for such heavy taxation on the
middling and wealthier classes of the community, and who, as the most
active procreative agents (for who are more so than the poor?) promise
tens of thousands more in equal misery, which the coming generations
will have hereafter to support. All these persons, if removed and
transferred to the colony, would not only benefit themselves, and assist
towards the development of its resources, but likewise do great good
to our own country, by consuming many of our useless manufactures,
and checking, by their absence, the impetus of population at home.
The discussion, however, of this question, does not immediately con-
cern us at present; though, as illustrative of the importance of the pre-
sent inquiry, the digression may be excused.
The preceding investigation has necessarily occupied much labour and
time. As it will be evident, our chief difficulty has been the imperfect
nature of our data; yet is it a question that could, with proper data,
be made most easy of solution.
First, as regards public or state documents.
1. If, in the population returns, there were tables, in which the exact
age of parties marrying were separately given for every year, these re-
sults, when equated, would at once enable us to form another table for
the expectancy of marriage for both sexes.
2. If in the registry of births, due note were made of the exact age
of the parents, the legitimate being distinguished from the illegitimate
children, a table of exconnubial and connubial practical power could be
easily made out, and the maximum age of fecundity for both sexes at
once determined.
3. The number of married, unmarried, and widowed, for every sepa-
rate year, should be given.
4. In the Criminal Tables, the offences arising from sexual desire,
throughout the country, should be given also for every year. This would
also lead to the determination of the age of greatest procreative power.
Secondly, as to the collection of tables from private sources. There
264 DR. C. H. F. ROUTH ON PROCREATIVE POWER.
are many of the greatest value, which medical men alone would be com-
petent to provide.
1. The age at which puberty appears in a male. Hitherto no tables
showing this have been made. f
2. More extended tables of the date of the disappearance of the cata-
menial function in the female; distinguishing, in those cases where it has
persisted late through life, whether the discharge per vaginam be or be
not connected with uterine disease. *-x
3. In the records of obstetric practice, more especially in hospitals
and dispensaries, where patients present themselves for lying-in letters,
and births or miscarriages occur, to note not only the age of the mother,
as is almost invariably done, but also the age of the father.
These data given, the limits of the procreative ages, and the ages of
greatest fecundity, could be very easily deduced. ſ
In the absence of these data, our conclusions are less certain; yet,
so far as the results above given go, the following GENERAL CoNCLUSIONS
may be drawn.
1. The age of greatest fecundity in males is from thirty-one to thirty-
three, in females twenty-six.
2. But the procreative value of a person between fifteen and sixteen,
is greater than at any preceding or succeeding age.
3. The ages at which most marriages occur, are about the same as the
ages of greatest fecundity. Thus in the Irish marriage tables, in which
only the proportion to unmarried and widowed could be drawn, the ages
were, thirty-two for males, twenty-six for females.
4. There is, very probably, a relation between procreative power, and
marriages taking place, at all ages.
5. Sexual desire and fecundity, appear to have also about the same
maximum age, and bear a relation generally one to another. The English
table gives a mean of twenty-eight for persons. The Irish twenty eight;
the Scotch twenty-nine for males—both twenty-six for females. Th
fecundity for persons, according to the Irish, is also twenty-nine
6. And lastly. The earliest and latest limits of procreative power are
sixteen and sixty-six for males, fifteen and fifty-five for females.
Such are the results which the preceding inquiry has brought out. It
should be borne in mind, that perfect accuracy with our data was impos-
sible. We have, therefore, endeavoured only to treat the question in
its practical bearings; and in this view we venture to offer it to the
profession. Hereafter, if better data be afforded, we may be more
fortunate, or others may bring out more correct results. For the pre-
sent, however, if we have contributed in the least towards the elucidation
of this question, we must be satisfied.


19, Dorset Square, January 1850.
265.
ON THE ADMINISTRATION OF CHLOROFORM IN
MIDWIFERY, AND ASA SEDATIVE of UTERINE
. - PAIN GENERALLY.
By J. HENRY BENNET, M.D., Physician. Accoucheur to the western General
. . . . . . . . . . . . . . . . . Dispensary, etc. * * *
... IN February 1848, I published, in the Lancet, the result of my ex-
perience, respecting the administration of Chloroform in irregular
and operative labour, in dysmemorrhoea, and in uterine pain generally;
and on that occasion I stated that it had proved, in my hands, almost valu-
able therapeutic agent. During the two years which have since elapsed,
I have been constantly in the habit of administering Chloroform in
these varied conditions, and am able to confirm, in every respect, the
statements which I then made ; no single event having occurred in my
practice, calculated to modify the opinion which I then expressed, re-
specting its great practical value to the accoucheur and to the uterine
pathologist. * . . . . . . . . . . . . . .
Various fatal cases, however, have been since published, in which
death was so evidently the result of the employment of Chloroform,
that we cannot but admit its inhalation to be attended with a certain
amount of risk. ...That this risk is very slight indeed, is proved by
the very small number of fatal cases recorded, as compared with the
innumerable instances in which it has been administered for surgical
purposes; and by the fact that, in many large hospitals in London
and Paris, it has been given, ever since its first introduction, in all
cases of operation, to the full anaesthetic extent, without any unto-
ward event having been observed. Such being the case, I do not think
that the fatal instances that have occurred, imply such an amount
of danger as to induce us to forego the benefit of Chloroform, when it
is likely to be therapeutically useful, or when its inhalation will save a
patient from the pain of an operation; or even to refuse our sanction to
its inhalation in a slight operation, if the patient shrink from any pain,
and is willing to incur the very trifling risk attached to its administration.
The very greatest, care, however, ought clearly to be shown, and I
cannot too decidedly urge the precaution on which I laid so much stress
two years ago, viz., that of seeing . that the Chloroform vapour is
mixed with a sufficient quantity of atmospheric air for the purposes of
respiration; so that, on the one hand, asphyxia may not be produced;
and that, on the other, the sedative effect of the Chloroform on the
nervous centres may take place gradually, so that the latter may not be
instantaneously paralysed by the sudden presence of a large quantity of
Chloroform in the system. It is for this reason that, like Dr. Simpson,
I generally prefer, for inhaling, a thin cambric handkerchief, to the
various inhalers now in use. The former appears to me to admit more
easily of gradual, progressive chloroformization. Extreme caution in the
first stage of inhalation is the more necessary, as, in most of the cases
of death from Chloroform that have been recorded, it seems to have
taken place after a few inhalations only, and from a quantity of Chloro-
form, which appears incredibly small (half a drichm, or a drachm) to
VOI. II. 18
266 CHIOROFORM IN MIDWIFERy, ETC.
those who are in the habit of using it, who continually find it neces-
sary to give four or five times that amount, in order to produce complete
anaesthesia.
Within the last eighteen months, I have myself taken Chloroform to
the full surgical extent, on three occasions, with perfect success; twice
for dental operations, and once for the extirpation, by Mr. Fergusson, of
a fatty tumour from the shoulder. On each of these occasions, but
especially on the two first, when a less perfect inhaler was used, I
distinctly and painfully felt the sense of suffocation occasioned by the
absence of a due supply of atmospheric air. This error is the more
dangerous, as all sense of the wants of the economy is lost as soon as
anaesthésia commences, and the patient may then be asphyxiated by the
absence of oxygen, without any sense of suffocation being experienced
or manifested.
I still administer Chloroform in four classes of cases. 1. In Irregular
but Natural Labour. II. In Operative Labour. III. To facilitate Opera-
tions on the Uterus. Iv. To subdue Uterine Pain in dysmenorrhoea, etc.
I. In NATURAL LABOUR, I seldom resort to the inhalation of Chloro-
form, unless it be occasionally to facilitate its last stage, or to allay some
morbid conditions of the nervous and circulatory systems, which may
be interfering with the progress of parturition. The pains of labour are
sometimes partially arrested, diminished, or rendered irregular and
inefficient, by fear, impatience, want of self-control, or by long-con-
tinued suffering. When this is the case, Chloroform generally exercises
an all-but-magical effect. Under its influence, all nervous excitement
is soothed, the pains gradually become more regular, powerful, and
efficient, and the labour once more progresses normally. This return
of the labour pains, and their regularization under the calming in-
fluence exercised by Chloroform on the brain, probably explains the
increase in their intensity, noticed by some writers, on its first adminis-
tration; and thus is explained the apparent discrepancy of different
observers, on which so much stress is laid by the opponents to Chloro-
form. If the pains are arrested or modified by nervous reaction, they
return; if, on the contrary, they are too violent and prolonged, as is
sometimes the case in the latter stages of parturition, when the soft
parts are rigid and irritable, the intensity of the pains diminishes on
the withdrawal of the excess of stimulation.
The disordered state of the circulation, and the congested condition
of the capillaries, which are often observed in the cases to which I have
alluded, also give way, in a most remarkable manner, to the calm pro-
duced by the inhalation of Chloroform. This is so much the case, that
since I have had recourse to it, I have never found"it necessary to
bleed from the arm during labour; the inhalation of Chloroform having
always been indirectly efficacious; even in some cases in which the
cephalic congestion was so great as to make me fear convulsions.
"Although I never hestitate, as will be perceived by the above re-
marks, to give’ Chloroform in natural labour, whenever"I think it may
be of use, I do not urge my patients to take it, merely as a remedy for
pain. If they wish to avoid the pangs of parturitiºn, and are anxious to
inhale Chloroform (asſ most certainly should, in their cofidition), I
do not object to its administration. Firmly believing its careful inha.

BY J. HENRY BENNET, M.D. 267
lation to be innocuous in parturient women, I do not see how I can
object; but I never press them to resort to it, not feeling called upon
to interfere with a natural function, even to allay pain, if my patient be
willing and able to bear it.
II. In OPERATIVE MIDWIFERY, I continue to derive valuable assist-
ance from Chloroform. The cases in which I have resorted to its use,
have been, exclusively, turning and retained placenta. In consultation and
dispensary practice, the accoucheur occasionally meets with instances, in
which the placenta has been retained for some hours, before he sees the
patient. In these, and in the more difficult forms of turning, Chloro-
form very much simplifies the operation, by rendering the patient
unconscious of pain, and perhaps by slightly relaxing the rigidly-con-
tracted uterus. In craniotomy, the pain inflicted on the mother is
generally so slight, and the duration of the operation is often so pro-
longed, that the inhalation of Chloroform is scarcely, if at all, indicated.
As I am also one of those accoucheurs who very seldom find the appli-
cation of the forceps necessary, or even warranted, I have scarcely had
an opportunity of judging as to the advisability of placing the patient
under the influence of Chloroform, prior to their use. I should, how-
ever, feel inclined to give a negative opinion, as either the maternal
parts are sufficiently roomy to admit of their application without pain,
or they are not; and, in the latter case, the danger of injury to the
mother would only be increased by her unconsciousness.
I have only once had to contend with post-partum hamorrhage, after
the administration of Chloroform, during or after labour; and in the
case in question, the patient, the wife of a medical practitioner, was
labouring under disease of the heart, unknown either to her husband
or to myself. Her history is interesting in a scientific point of view,
but very melancholy. She was a young, delicate, lymphatic female,
twenty-three years of age ; and I was called to her by her husband
(August 1848), in the early stage of her first labour, owing to severe
haemorrhage having occurred. I detected a partial placenta presenta-
tion, and arrested the hamorrhage by rupturing the membranes. The
labour progressed favourably, but was rather tedious and painful during
its latter stage, owing to the resistance and narrowness of the soft parts.
Under these circumstances, and with the entire approbation of the
husband, she inhaled Chloroform, at intervals, for about an hour. Par-
turition was thus easily accomplished; and the placenta was expelled
within a few minutes. The uterus contracted, the uterine bandage was
properly applied, and all seemed to be going on normally, when, about
ten minutes later, as I was washing my hands at the bed-side, I per-
ceived, on looking at the patient, from the paleness of the lips and
face, that haemorrhage was probably taking place. I immediately un-
fastened the bandage, and, finding the uterus redilated, at once intro-
duced the hand into its cavity, and found it filling with blood. With
the left hand placed externally on the abdomen, I manipulated the
uterus, to arouse its contractions; and, having passed the tube of
an enema syringe, which was fortunately at hand, into the uterine
cavity, freely injected cold water for some minutes. Under the influ-
ence of these means, the uterus contracted firmly on my hand, which I
withdrew gradually, and no further haemorrhage took place. I subse-
IS 2
268 CHLOROFORM IN MIDWIFERY, ETC.
quently paid more than usual attention to this lady, as puerperal
fever was then reigning epidemically ; and I was fearful, lest the knead-
ing of the uterus, to which I had been obliged to resort, might be fol-
lowed by inflammatory reaction. Nothing of the sort, however, occurred;
and all continued to progress favourably until the twelfth day, when
she had an attack of indigestion, followed by fever, after taking a small
quantity of animal food for the first time. She soon recovered, and
appeared to be progressing so favourably, that, a few days later, I left
her entirely to her husband's care. On the twenty-first day after her
confinement, she again tried, in the afternoon, for the second time,
animal food—a mutton chop ; and, although she subsequently com-
plained of considerable pain in the region of the stomach, she was
cheerful and talkative during the evening. At eleven, her husband
went into an adjoining room for a few minutes, but hearing a noise of
choking, rushed to his wife's bed, and found her sitting up and gasping
for breath. In less than a minute, she died in his arms, without
having been able to utter a word. A careful post-mortem examination
was made by my friend Mr. Avery and myself; but no morbid condition
of any description was found in any region of the body, with the ex-
ception of the heart. This organ was enlarged, its cavities were
dilated, and its walls softened. The uterus was perfectly healthy, and
of a natural size.
In this case, death appears to have been the result of syncope occur-
ring, under the immediate influence of laborious digestion, in a natu-
rally delicate female, weakened by loss of blood, and labouring under
dilatation of the cavities of the heart. It is well known to pathologists,
that syncope is often attended with a fatal result, in softening and
morbid dilatation of the heart. Indeed, in such cases, it is dangerous
to bleed from the arm, to any great extent, lest fatal syncope should
ensue, from the inability of the diseased and weakened heart to con-
tract on the mass of blood which chokes its cavities.
The haemorrhage which occurred after delivery, although not very
considerable (for it was at once arrested), no doubt contributed to the sub-
sequent fatal result, by increasing the debility of the patient; but that
haemorrhage can in no way be attributed to the use of the Chloroform.
Post-partum haemorrhage is one of the common accidents of midwifery,
which every practical accoucheur meets with in women who have never
taken Chloroform, and there is no evidence to prove that it is more
frequent in those who have inhaled it. My own experience goes
directly to negative such a proposition. This case is the only Chloro-
form one in which I have seen it, during the three years that I have
administered, the agent; whereas I have, during that time, been
repeatedly called to cases in which it has occurred in patients, who
had never inhaled Chloroform.
Moreover, females who labour under disease of the heart, are pecu-
liarly liable to hamorrhage after delivery. I recollect a remarkable
illustration of this fact, which occurred in my-wards, whilst I was In-
terne at the hospital of La Pitié, Paris. A woman, aged 34, multiparous,
who was under treatment for heart disease (mitral insufficiency, hyper-
trophy, and dilatation), was found to be pregnant, and was consequently
retained in the hospital for her confinement. One morning I left her
BY J. HENRY BENNET, M.D. 269
in perfect health, at ten o'clock A.M., and found her dead on my return,
at four P.M. Labour had come on, and the child and placenta were
expelled in a few hours; but, immediately after the expulsion of the
placenta, irrestrainable hamorrhage followed, and she died in a few
minutes. The congested state of the venous system, and especially of
the portal veins, explains this tendency to uterine haemorrhage, in
females in whom the circulation is impeded by insufficient heart-action.
I would here remark, that there is a very unphilosophical tendency in
the opponents of Chloroform, to attribute any accident that may occur
to parturient females, to whom it is administered, to the action of Chlo.
roform, as if a certain proportion of accidents did not occur in midwifery
practice, whether Chloroform be used or not. Thus I have heard it
argued, that Chloroform may lead to puerperal mania, because Dr.
Webster stated, at the Westminster Society, when Dr. Murphy's valuable
paper on Chloroform was read," that he had seen three cases of puer-
peral mania, at Bethlem Hospital, in which Chloroform had been ad-
ministered. The question is, whether these females would not have
been equally seized with puerperal mania had they not taken Chloro-
form 2 If it could be shewn, that since the use of Chloroform in mid-
wifery had become more frequent, the annual number of cases of puer-
peral mania received at this hospital had very greatly increased, the
argument would then be valid: but in the form in which Dr. Webster
notices the fact, it is altogether valueless.
When administering Chloroform in simple midwifery, I never give
it to such an extent as to annihilate pain, but merely so as to allay or
deaden it ; in a word, I do not attempt to render the patient totally un-
conscious of her sufferings, but merely to render them bearable. In
operative midwifery, the anaesthesia must necessarily be pushed further,
that is, to the surgical extent, as the intention is then both to render
the patient unconscious of what is done, and to obtain the muscular re-
laxation to which this stage of anaesthesia gives rise.
III. In UTERINE ExAMINATIONs and OPERATIONs, Chloroform is occa-
sionally very useful to me; though, as a rule, no instrumental examina-
tion of the uterus need be painful, if an instrument proportioned to the
degree of dilatability of the vaginal orifice be used, and proper gentle-
ness be observed. There are cases, however, in which the fears of the
patient are so great, that the use of Chloroform may be desirable; there
also cases in which the uterus, its neck, and even the vagina, are the seat
of such intense neuralgic sensibility, that interference of any kind is all
but impossible, unless the patient be under the influence of Chloroform.
I have now under my care a case of this kind, a married lady, aged 26,
who for the last four years has been a martyr to neuralgia of the most
intense and agonising description. The neuralgic affection has occu-
pied principally the branches of the fifth pair, the nerves of the uterus,
and occasionally those of other parts of the body, and has evidently
been connected all along with extensive ulcerative disease of the cervix
uteri. The uterine disease appears to have followed an abortion some
years ago, and had been totally overlooked until she consulted me. The
r
Tº Tº
* See LoNDON Journal, of MEDIGINE, vol. for 1849, p. 1084, 1170, for the discus.
sion on, and an abstract of, Dr. Murphy's essay : vide also vol. for 1850, p. 90.
270 CHLOROFORM IN MIDWIFERY, ETC.
entire pharmacopoeia had been ransacked, and the most powerful seda-
tives had been administered for years, without any favourable result. A
careful digital examination of the uterus having brought on a frightful
neuralgic attack which lasted a fortnight, I determined to put her under
the influence of Chloroform, and thus was able to bring to light a very
extensive ulceration of the cervix. This organ was lacerated, and the
seat of great inflammatory enlargement. I have now given this lady
Chloroform to the full surgical extent for fourteen consecutive weeks,
that is fourteen times, and she has seldom taken less than half an ounce
on a handkerchief, and sometimes more. I was very unwilling thus to
continue its administration; but, until within the last week or two, she
has never been able to bear the slightest interference whilst conscious,
not even an injection of warm water. The disease, however, is now all
but cured, and the morbid sensitiveness is fast disappearing. She has
had no regular neuralgic attack for the last two months, and will evi-
dently get quite well, both of the local disease and of the neuralgia
which it occasioned. I have not been able to discover, in this patient's
mental or general state, any detrimental effect whatever from this length-
ened administration of Chloroform. It occasionally gives rise to sick-
ness, but that is all: nor does there appear to be any difference in her
subsequent condition, whether she have taken much or little; the quantity
inhaled in order to produce the same anaesthetic effect varies, without
our being able to discover the cause. Sometimes she becomes insensible
after a couple of minutes’ inhalation; sometimes after eight or ten only.
This case appears to me to prove the general innocuity of Chloroform,
even when taken in large doses and for a continuance. The last time it
was administered, it was for the application of leeches to bring on men-
struation, or to supply its deficiency, the menses being delayed to her
great distress; and although she was kept under its influence for half-an-
hour, there was even less subsequent distress from sickness than usual.
IV. In UTERINE PAIN from dysmemorrhoea, cauterisation, or from any
other cause, Chloroform continues to prove, in my hands, a valuable me-
dicinal agent, either when given by inhalation, or internally as a medicine.
It is, however, capricious in its action, and not to be depended upon in
every case, especially when administered internally; its virtues as a seda-
tive of pain are also much more decided when inhaled than when taken.
The most propitious moment for inhalation with this view, but the most
inconvenient to the medical practitioner, is at bed-time; it will often
insure freedom from pain, and a night's rest, when every thing else fails.
For this effect to be obtained, however, the patient must remain per-
fectly quiet on recovering consciousness; and this is the reason that night
is so much preferable to day for inhalation. If the patient who has in-
haled Chloroform be once thoroughly roused, the sedative effect fre-
quently passes away.
When given internally, twenty, thirty, or forty minims of Chloroform
should be mixed with mucilage, or with the yolk of an egg, previous to
water being added, so as to be held in suspension. If a little camphor
be added to the Chloroform, which soon dissolves it, the solution will also
mingle with water.
Chloroform may be injected into the rectum in any of these shapes,
and if it be retained, its sedative effect is effectually produced ; the rectal
BY J. HENRY BENNET, M.D. 27, 1
mucous membrane, however, is so extremely sensitive, that it generally
contracts, and expels the fluid containing the Chloroform.
In conclusion, I consider that my experience of Chloroform during
the last two years, as likewise the published experience of others on the
subject during that time, fully corroborates the opinions I formerly ad-
vanced respecting its great value, not merely as a means of lessening
pain, but as a therapeutic remedy in connexion with its anaesthetic
powers. I must also remark, that all that has been written against its
cautious and exceptional use in midwifery, has been written by persons
who had not used it, or at least not sufficiently to entitle them to give
an opinion on the subject. Indeed, they appear merely to sustain a
“ thesis” founded on prejudice, and not to reason from their own expe-
I'léIłC€.
At the same time, although thus supporting the use of Chloroform, I
feel bound to repeat, that the fatal cases which have been published prove
that its inhalation is not altogether free from danger to life. Neither
does it appear that this danger can be avoided by the greatest caution;
death having followed, as I have already stated, the administration of an
insignificant dose in the hands of experienced practitioners. It would
indeed seem as if, in the cases to which I allude, Chloroform had acted
as a deadly poison from the first moment of inhalation. These cases
must, therefore, teach us not to resort to it without a good and sufficient
reason, and not to urge it on unwilling patients. For my own part, I
am perfectly prepared in my own person, again to run the risk, such as
it is, should I be again called upon to suffer a painful operation; and,
consequently, I feel no hesitation in giving it to any one else who, like
myself, may wish to avoid pain at a very trifling risk.
We must not forget, however, that the dangers of Chloroform inhal-
ation have only been exemplified in surgical cases, and that no partu-
rient woman has died during, or from its administration. They are, in
reality, less exposed than surgical patients, as anaesthesia need not be
carried so far; moreover, the entire economy is during labour in such
an increased state of stimulation, that the vitality of the patient would,
I think, be much less easily subdued, than in one who is depressed by
the dread of a surgical operation.
9, Cambridge Square, Hyde Park,
January 1850.
272
BIBLIOGRAPHICAL RECORD.
RATIONAL MEDICINE : A WINDICATION. The Address delivered at the opening
of the New School of Medicine, Surgeons' Hall, Edinburgh, November
6, 1849. By ALEXANDER WooD, M.D., Fellow and Member of Council of
the Royal College of Physicians of Edinburgh. pp.88. Edinburgh: 1849.
We very cordially recommend this address to the notice of our readers. It
is alike admirable in design and in execution, and we do not know any
similar production which we could, with more satisfaction, place in the hands
of the student. It has become the fashion with many, to speak in slighting
terms of the appliances of our art; to represent cures as mere accidents,
rather than the consequents of treatment; and, thus to encourage a spirit of
sneering incredulity, which is, of all states of mind, the most unlikely to
conduce to steady perseverance, and hopeful study. The little work before
us will serve as an admirable antidote to such paralysing poison.
“Medicine,” says Dr. Wood, “is at once a science and an art. But, as a
living philosopher observes, ‘Art is the application of knowledge to a prac-
tical end. If the knowledge be merely accumulated experience, the art is
empirical ; but if it be experience reasoned upon, and brought under general
principles, it assumes a higher character, and becomes a scientific art.’
(HERSCHEL.) This, then, is the great question we have to solve. Is our
art really, as our enemies would fain represent it, a chaotic mass, without
form and void, where there is no general principle to guide, and no scientific
rule to follow or can we, on taking an impartial survey, really conclude,
that, notwithstanding the numerous errors that have marred it, and the
numerous imperfections that yet cling to it, there is still in it so much of
truth as to bid us strive, amidst our imperfect knowledge, after that which
is more full 7”
Dr. Wood's object is to prove that the latter question must be answered in
the affirmative : and this he does, not by slurring over the difficulties which
beset the truthful inquirer, nor by denying the existence of many a broken
link in the chain of our system ; but by showing, that in the treatment of
disease, there are certain fixed principles which serve as trustworthy guides—
by demonstrating that, in the scientific choice of remedies, the philosophical
practitioner is really influenced by the known conditions and necessities of
the disordered economy. “It is in this,” he observes, “that the true philosophy
of the healing art consists. We must know that power which has become
perverted; ascertain in what the perversion consists; endeavour to discover
and remove the causes which have produced it ; and, if the removal of these
do not issue in the return of natural action, have recourse to means which
may assist it so to do.”
As an example, we quote his analysis of the treatment of inflammation.
“If agreement among physicians, as to the plan of treatment to be pursued,
were the test of the propriety of the practice adopted, assuredly we should
not appeal to inflammation. One applies cold, another heat, to the part in
which the disease is seated. One seeks to soothe it by emollient sedatives;
another, to combat it by astringent stimulants. What a field for exultation
to those, who delight to proclaim the uncertainty of medicine ! How can
practice so different be successful ? If one is right, the other must assuredly
be wrong. Such assertions, however, go no farther than to proclaim the
ignorance of those who make them. In our management of disease, we
possess few, if any specifics, which can directly destroy the morbid influence.
We can only operate on it by modifying the vital force; and there are many
agents, acting apparently in opposite ways, by which this purpose can be

A
BIBILIOGRAPHICAL RECORD. 273
effected. Thus, taking a very general view of the subject, we find that
nervous irritation is usually the first step in the train of morbid phenomena
exhibited by inflammation ; and that it is followed by dilatation of the capil-
lary vessels, with retarded motion of blood through them, and consequent
increase in the quantity of the blood which they receive. Sooner or later,
excitement of the heart Supervenes, causing acceleration of the circulation
throughout the body, and accompanied with changes in the character of the
blood. Later still, we may have certain of the elements of the blood, or new
products formed from.it, deposited by those vessels in which the inflamma-
tion is seated. In endeavouring, then, so to regulate the vital force by
which these derangements have been caused, as to lead the capillary vessels
back to their normal state, it is evident, that respect must be had both to
the stage at which the disease presents itself, and to the importance in the
economy of the organ in which it is seated.
“If, for example, the morbid process have scarcely advanced further than
the dilatation of the capillary vessels, then means may be employed to restore
them to their normal state of tonicity. This may be done in two ways,
first, by allaying that nervous irritation from which the loss of tone first
resulted, which may be effected by warmth, emollients, and other sedatives;
or by exciting them to contract, by the use of astringents, or even of local
stimulants. In the first case, the cause being removed, the effect spon-
taneously disappears. In the second case, means are employed to check the
progress of the effect, irrespective altogether of the cause by which it was
produced. The two classes of remedies which are thus employed, although
apparently opposed in the way in which they act, may yet produce the same
ultimate effect—operating, however, through different channels. The heat of
the fire, which at first stimulated the nerves, and through them, produced
inflammation of the tissue, may, if steadily applied, and longer continued,
cure that inflammation which itself excited, by causing the disturbed capil-
laries to contract ; or the apparently opposite remedy, plunging the part in
cold water, will equally alleviate the disease. Seeming contradictions,
certainly ; but real contradictions only to those who refuse to study the
vital laws.
“But, though one great object is to produce contraction of the capillary
vessels, mere local treatment applied to them will not, in every case, suffice.
The energetic action of the heart, forcibly propelling the blood into these
vessels, acts by keeping them in a state of forced distension. By reducing
the quantity of the circulating fluid, we remedy this in various ways; and
hence the utility of bleeding in cases of acute inflammation. For, first, by
removing some of the circulating fluid, we relieve the over distension at the
affected part. Second, we diminish the blood, which is the normal stimulus
of the heart, and thus weaken the force of the heart's action. Third, by
withdrawing part of the blood from the brain, its susceptibility is diminished;
and thus irritation is allayed, because the brain then less readily sympathises
with the affected part, and also less powerfully stimulates the heart to
increased action. Fourth, we cause an afflux of blood to the opening in the
vein, and thus mechanically diminish the congestion at the seat of the
disease. Fifth, we effect an alteration in the character of the circulating
fluid, as is proved by the disappearance of the buffy coat of the blood after free
bleeding in inflammation. There are certain medicinal agents also, although
not so potent in their action, which produce similar effects. Tartar emetic,
for example, at once diminishes the action of the heart, and causes contrac-
tion of the capillaries; and thus is entitled, perhaps, to rank next to blood-
letting, in the treatment of inflammation. Saline substances, again, taken
into the intestinal canal, withdraw water from the blood circulating in the
adjacent vessels; and thus the quantity of that fluid is decreased, and its
quality altered ; hence they are largely used in the treatment of inflamma-.
tion. Opium, again, diminishes the nervous sensibility, and thus removes
274 BIBLIOGRAPHICAL RECORD.
one element of the disease. There is no blind play in all this. The agents
we have recourse to, have a determinate action ; and the determinate action
of each is precisely suited to combat some one of the elements, of which this
complex disease is formed.”
In an appendix, Dr. Wood republishes, from the Worthern Journal of
Medicine, a review of Dr. Hastings' work on Naphtha, and a critique on the
alleged mesmeric cure of Miss Martineau, both of which will repay perusal.
1. PATHoLogy OF THE HUMAN EYE. By J. DALRYMPLE, F.R.C.S. Fasciculi
III and IV. London : 1849.
2. A TREATISE ON THE INFLAMMATIONS of THE EYE-BALL. By ARTHUR
JACOB, M.D., F.R.C.S. pp. 344. Dublin : 1849.
The promise of the early numbers of MR. DALRYMPLE's work continues to
be amply fulfilled." The fidelity of the delineations of disease is only equalled
by the exquisite beauty of the execution,
Part II presents us with excellent representations of the various Ulcera-
tions, Tumours, and Warts, which have their seats in the eyelids, with diseases
of the Lachrymal Apparatus, Ecchymosis of the Eye, and Scrofulous Oph-
thalmia. The figure 1, in plate VII, representing Ecchymosis, or a literally
“blood-shot” eye, is admirable ; and the delicacy of execution of figures 5
and 6, in the same plate, is greatly to be commended.
Part III is devoted to Purulent Ophthalmia, as it appears in the infant
and in the adult; and that formidable malady is most truthfully depicted
from its commencement, through its various stages, to the sad and hopeless
conditions which but too often result, even when treatment has been judi-
ciously applied. There are also two clever and striking representations of a
very peculiar and very terrible disease—apparently of carbuncular character
—which occurred in the practice of that very eminent ophthalmic surgeon,
Mr. Wilde, of Dublin. It has never fallen to our lot to meet with such a case.
Part IV cannot be sufficiently commended. It renders us familiar with In-
flammation of the Conjunctiva, Ulcers, and Inflammation of the Cornea, with
their sequelae, and Sclerotitis. We would especially point out fig. 1, in
plate xv, as a masterpiece of pictorial skill.
The value of the plates is greatly enhanced by the excellent instructions
for treatment, which are laid down with simplicity and clearness; and the
work, when completed, will, in our judgment, be the noblest contribution to
ophthalmic science, which this country has ever produced.

DR. JAcoB's remarkable work originally appeared in the form of detached
essays, in the Dublin Medical Press, and is, therefore, we presume, generally
known by the profession. For this reason, we leave our readers to judge for
themselves as to the correctness of the views entertained by the learned author.
tººk
CoNTRIBUTIONs To MENTAL PATHoLogy. WITH INTRODUCTORY OBSERVA-
TIONs, CONTAINING THE PAST AND PRESENT STATE of THE INSANE
fy CEYLON, ETG. By JAMEs GEORGE DAVEY, Licentiate of the Royal
College of Physicians, London, etc. 8vo., pp. 276. London: 1850.
The title of this work scarcely gives a correct idea of its contents. The
“Contributions to Mental Pathology” form by far the smallest portion, the
great bulk of the volume being occupied with an exposure of the unplea-
Santness of the author's position, as superintendent of the Lunatic Asylum at
Ceylon—a vindication of his own conduct there, and loud complaints of the
treatment he received at the hands of the medical authorities of the colony.
We think DR. DAVEY was ill-advised, in putting forth his statement in its
present shape. A pamphlet, containing the essential facts, would have an-
i. | k
* London Journal of MEDICINE for 1849, p. 356.
BIBLMOGRAPHICAL RECORD. 275
swered the purpose quite as well as this volume—may, much better; for any
one who may buy the book, trusting to its title, will rather feel himself
aggrieved, by finding he must wade through page after page of irrelevant
matter, and vex his brain with the quarrels of Dr. Davey and the “P.C.M.O.”
The state of mind thus induced will scarcely be favourable to the reception
of that impression, which the author has laboured to produce.
Dr. Davey is a keen supporter of the phrenological views, and a mesmerist
to boot, as the following quotation will show —“We feel we should be
guilty of great and unpardonable neglect, and moreover incur, and de-
servedly too, the censure of the man of science and the philanthropist, if we
were to allow this opportunity to pass without insisting on the remedial
efficacy of animal magnetism, or mesmerism, in cases of epilepsy, combined
with mental disease. Since our connexion with Hendelle, we have succeeded.
in restoring one poor native lad to perfect health, who, for a period of,
we learn, seven years, was afflicted with epilepsy of the most distressing
character. He used to have from two to five fits every day, and each one
was commonly so severe as to leave him for some time more or less insensible.
His appearance, when first mesmerised, was exactly that which belongs to the
last stage of phthisis, so emaciated was he. Three months after we had
commenced our operations, not only had the fits entirely left him, but he
then presented the appearance of robust health, and had become stout, and
really muscular. The case created a great sensation among the servants,
whose remarks upon it were not a little curious. When on the eve of ob-
taining his discharge, he was attacked with apoplexy, and died about thirty
hours after. A very similar case has occurred in our private practice ; and
it affords us much pleasure and happiness, to learn of our patient's continued
good health.”
We do not stop to comment upon this extract, but leave each reader to
judge of its value, in accordance with his state of knowledge, and his capacity
for disentangling the opinions from the facts of an author.

A TREATISE on THE PRACTICE or MEDICINE. By GEORGE B. Wood, M.D.,
Professor of Materia Medica and Pharmacy in the University of Penn-
sylvania, President of the College of Physicians of Philadelphia, etc.
Second Edition. Two Wols. pp. 1622. Philadelphia: 1849.
The work before us, though not possessing much originality, gives evidence
of great industry on the part of the author. He has made himself acquainted
with almost all, if not all, the contributions which have been made to pa-
thology and practical medicine, by the labours of American, British, and
continental observers; and has, with considerable ability, digested these,
along with his own remarks, into a very creditable treatise. The first part
of the work, amounting to 215 pages, is judiciously devoted to General
Pathology and Therapeutics; and here we find abundant evidence of his
having drawn largely from the stores of pathological knowledge collected
by the labours of Drs. C. J. B. Williams, A. B. Garrod, Hughes Bennett,
Andral, Rokitansky, and others.
While we thus express our sense of the merits of Dr. Wood's work, the
frequent references to the American editions of Dr. Williams's Principles of
Medicine and other British works, lead us to express our opinion of the trade
of re-printing, which is carried on so actively by our transatlantic brethren.
In almost every American journal which we receive, we'rmeet with advertise-
ments of re-productions, often with astonishing rapidity, by American editors,
not only of the standard works, which, from time to time, appear in this
country, but even of many of small value. In the year preceding May 1849,
it appears that twenty-five native medical works, including second editions,
were published in America; while thirty-six, principally English, were re-
276 BIBLIOJ RAPHICAL RECORD.
produced.” Süch proceedings both indicate and tend to perpetuate a low
and spiritless condition of native American literature. That American
physicians are/capable of producing original:Works; of the highest class, is
undoubted; and of this proof has been given in our pages by our repro-
duction of the anatomical and physiological researches on cartilage of Dr.
Joseph Leidy. Every day adds to the treasures of native American litera-
ture and science. We hope that our medical brethren of the great common-
wealth beyond the Atlantic may soon cease to be contented to reprint Eng-
lish books, and that Americans may become as emulous to equal the mother
country in literature, as they have shown themselves to be in arms and com-
merce. We are all children of the same family; and whatever greatness
may be achieved by American citizens, will be a source of pleasure and pecu-
liar pride to British subjects, their elder brethren.
PATHoLOGY OF THE KIDNEY IN SCARLATINA. Illustrated by Cases. By JAMES
MILLER, M.D., Physician to the Western General Dispensary. pp. 177.
London : 1850.
This is a valuable addition to the literature of Scarlatina; and deserves to
be classed with the best monographs which have appeared on this disease.
The cases are full of interest, and will, doubtless, be read with great profit by
all who have the time and taste for such studies, and who do not rest satisfied
with what is conveyed by a paragraph in reviews or retrospects. Dr. Miller
corroborates the opinions of the best and most accepted authorities ; and we
think that those who have given adequate attention to Scarlatina will concur
with most of his opinions. The subject has recently been discussed at such
length by various authors in this Journal, that we cannot upon this occasion
afford space to re-enter upon its consideration, nor to give any extracts.
Dr. Miller entertains the same views regarding albuminuria as have been
expressed in this Journal, viz., that it is not pathognomonic of special renal
disease, but has been long since proved to be only the depletion of a congested
kidney—a serous haematuria. The engorgement may depend, primarily, on
granular disease of the organ, on an aneurism or other tumour pressing upon
the emulgent vein, on the pressure of the gravid uterus, etc.; but in all these
cases albuminuria is simply the sign of congestion—the spontaneous deple-
tion of a congested organ.
Though Dr. Miller does not pretend to give a complete bibliography, yet,
from the aspect of that which he has produced, we think it was due to Dr.
Snow, Dr. Behrend, of Erlangen, and others, to have noticed their essays.
Dr. Snow's papers appeared in the Lancet for 1839 and 1843; and a full ac-
count of Dr. Behrend’s paper was given in this Journal, for 1849, p. 765,
The author of such a monograph as that now under review, ought to show
that he is conversant with the labours of his predecessors and contemporaries,
and likewise that he is willing to give them as much credit as they deserve.


-x
* Transactions of American Medical Association, vol. ii, pp. 407; et seq.
i |
277
f
CRITICAL DIGEST OF THE BRITISH AND FOREIGN MEDICAL,
JOURNAIAS.
PRACTICE OF MEDIGINE AND PATHOLOGY.
*
ON THE SITE OF MORBID Action IN DISEASEs of BoSE.' '
By MR. JoHN GooDSIR, of Edinburgh.
I HAVE, in another place, directed the attention of the physiologist to the
important distinction which exists between the essential and accessory ele-
ments of a texture. “A texture may be considered either by itself, or in
connexion with the parts which usually accompany it. These subsidiary
parts may be entirely removed, without interfering with the anatomical con-
stitution of the texture. It is essentially non-vascular, neither vessels nor
nerves entering into its intimate structure. It possesses in itself those powers
by which it is nourished, produces its kind, and performs the actions for
which it is destined; the subsidiary or superadded parts supplying it with
materials, which it appropriates by its own inherent powers, or connecting it
in sympathetic and harmonious action with the other parts of the organism
to which it belongs.”
The neglect of this distinction by the pathologist has been the cause of
much misconception regarding morbid action in textures, and has introduced
many errors into the general theory of disease. Disease may have its site
either in the essential or accessory elements of a texture. Our knowledge
of the diseases which have their site in the essential elements of the textures
is still in its infancy; but I am inclined to believe, that they consist prin-
cipally of alterations in the nutritive and reproductive functions, in the
chemical or physical constitution of the textures. The fatty degeneration of
the muscular texture is a familiar example of a morbid change of this kind.
The great majority of the recognized morbid changes have their site in the
accessory elements of textures. They are situated in the midst of the areolar
texture, and among the vascular and nervous networks which separate as well
as connect all the essential textural elements of the frame. They consist
generally of bloody or other infiltrations ; of lymph, in various stages of
development ; of pus; of the various forms of new formation, such as cancer,
tubercle, etc. It will thus be perceived, that the majority of diseases are
situated, not in the essential textures of a part, but around or amongst them;
that the majority of these are new formations, parasitic in their nature,
making their appearance, undergoing development, and occupying a position
in the areolae of that general connecting texture, which, either in the form
of the nucleated cellule, or of the filamentous fibre, is the first to appear, as
well as the most lasting and abundant of all the textures.
The more distinct the conception, therefore, which an observer may pos-
sess of the relative position of the essential and accessory elements of any
given texture, the better prepared will he be to investigate and understand
the phenomena of diseased action in that texture.
The successful investigation of the site and phenomena of diseases in one
texture, will render the investigation in all the others comparatively easy.
I have been accustomed to consider the osseous texture as best adapted for
this purpose, from its stability, and the comparative ease with which its essen-
tial and accessory parts may be separated from one another, distinguished,
and examined. “A well-macerated bone is one of the most easily-made, and,
at the same time, one of the most curious anatomical preparations: it is a
perfect example of a texture completely isolated; the vessels, nerves, mem-
* Anatomical and Pathological Observations, p. 64.
278 CRITICAL DIGEST OF THE JOURNALS.
branes, and fat, are all separated, and nothing is left but the non-vascular
osseous substance.”
The essential elements of the osseous texture consists of all that part which
resists maceration, along with the contents of the corpuscles. The accessory
elements are the periosteum, with the vessels and nerves which ramify in it;
the cells, areolar texture, fat vessels, and nerves, which occupy the continuous
network of the Haversian canals and cancelli, which are hollowed out in the
hard substance.
MoRBID CHANGES IN THE ESSENTIAL ELEMENT of Bon E. In the course of
lectures which I delivered in the theatre of the College of Surgeons, in the
winter of 1842-3, I announced the existence, and hazarded a hypothesis as to
the functions, of minute masses of nucleated particles, occupying the corpus-
cles of bone, which are generally believed to be empty spaces. I, at the same
time, stated, that I had been led by my observations to consider it as highly
probable that caries, or intractable ulceration of cancellated bony texture,
consisted essentially in more or less complete obliteration of the corpuscles
and their contents, as well as of the connecting canaliculi, and the neighbour-
ing Haversian canals.
I have lately repeated some of my observations on these bodies, and have
been confirmed in my belief of their importance in the economy of bone, and
more especially of their obliteration in caries. Caries never attacks compact
bone. It is met with only in shafts, when expanded by previous disease, in
the epiphyses or extremities of the long bones, and in the short bones. It
occupies surfaces somewhat limited in extent, irregularly hollow, with a sur-
face hard and spicular, encroached upon, but not generally covered by, un-
healthy granulations; the pus, discharged from which has, very generally,
mixed with it, minute portions of bone, apparently thrown off from the carious
surface. Caries is to be distinguished from the mere absorption of the sur-
face of a bone, as well as from that open condition of the cancellated texture
which is the result of the removal of the cartilaginous and osseous articular
surface. These two latter conditions of bone are capable of cure, although
slowly and with difficulty, partly in consequence of the disease which accom-
panies or precedes them, but principally because the cancellated texture con-
tains few Haversian canals, the abundance of which, in the shafts of bones,
explains the vigorous actions which they exhibit.
In true caries, it may be observed, that for a certain depth below the sur-
face of the affected part, the corpuscles and canaliculi have more or less
completely disappeared, so that the subjacent unaltered osseous texture is
covered in by a layer of apparently homogeneous solid bone resembling marble.
It is analogous, in some respects, to the enamel of the teeth—1, in not being
covered by soft parts; 2, in being a portion of the exterior surface of the
body; 3, in containing no corpuscles or canaliculi ; 4, in being incapable
# ºption. and requiring, therefore, to exfoliate, or to be removed arti-
claily.
I am not prepared at present to enter upon the consideration of the changes
which the essential element of bone undergoes in rickets, malacosteon, etc.,
but shall refer, in the meantime, as confirmatory of my own views and ob-
servations regarding the condition of the corpuscles and canaliculiin disease,
to the recent work of Won Bibra and Geist.” In this work, which is princi-
pally devoted to the consideration of that peculiar necrosis, which attacks the
jaws of the workmen engaged in making phosphoric matches, the authors
have allotted a section to the microscopic structure of various forms of dis-
eased bone. They have described and figured the empty condition and the
altered form of the corpuscles, as well as the obliterated canaliculi in certain


* Anatomical and Pathological Observations, p. 64.
* Die Krankheiten der Arbeiter in den Phosphorzündholzfabriken, insbesondere
das Leiden der Kieferknochen durch Phosphordämpfe, p. 77-86.
CRITICAL DIGEST OF THE JOURNALS. 279
forms of exostosis and caries, without attaching apparently much importance
to the observation.
II. MoRBID CHANGES IN THE ACCESSORY PARTs of Bon E., The greater num-
ber of the morbid changes in the accessory parts of bone occur during that
condition usually called inflammatory.
As the accessory parts are situated on the external and internal surfaces,
and in the Haversian canals of bone, the changes which occur during inflam-
matory action make their appearance only in these situations.
The increased vascularity which the texture presents when inflamed, de-
pends in the first place on the engorgement, and in the second, on the in-
crease in number of the vessels which are situated in the periosteum, the
medullary membrane, and the Haversian canals.
After the accession of inflammatory action, the surface of compact bone
assumes a porous condition, and its substance becomes more or less cancellated.
This change is induced by an action similar to that by which the cancelli of
healthy bone are formed. The Haversian canals assume an increased calibre
so that their orifices on the exterior surface of the bone become larger, an
their cavities ultimately open into one another laterally, and assume the
appearance of cancelli.
As the Haversian canals increase in size, their cavities are filled, in the first
place, by enlarged and new blood vessels; and in the second, and principally,
by a substance having a gelatinous appearance, similar to the lymph effused
in other inflamed textures.
When the inflammation extends to, or occurs at, the external surface of a
bone, the periosteum is raised by the effusion, dragging out or extending the
processes, which stretch from its external surface into the superficial Haver-
sian canals : and as the texture which occupies the canals is the formative
organ of bone, these retracted processes are the centres from which new de-
posits of bone proceed.
When the action is acute, and occurs in certain constitutions, death of the
inflamed bone may take place, before any very decided change has appeared
in the Haversian canals.
But if the inflammation is more chronic, new bone is formed soon after, or
along with the enlargement of the Haversian canals. This new bone is situ-
ated around the orifices of the canals, enclosing the processes which have been
drawn out by the sub-periosteal effusion, so that the surface of an inflamed
bone presents numerous orifices of enlarged and open Haversian canals, with
their lips more or less thickened or everted ; the internal half of the convex
edge, which bounds an orifice belonging to its own lip, the other half to those
of the neighbouring canals. The inflamed surface is now slightly elevated
by this new deposit of bone, the degree of elevation, and the size of the canals,
being greatest at the centre of the inflamed spot, or where the action was
most acute. This process of deposition continues for some time, and exhibits,
on section, a structure similar to that of the subjacent inflamed old bone, the
Haversian canals being large, and assuming more of a direction rectangular
to the surface.
An enlargement by absorption now occurs in certain Haversian canals, in
the new and old bone.
If the inflammation be periosteal,—that is, if it be confined to the super-
ficial part of the bone, this secondary absorption takes place in the first
formed canals of the new bone, those on its deep surface, and in those of
the external aspect of the old. There now appears, in consequence of this
absorption, a line of cancellated texture between the new and old bone. If
the action have involved more or less of the entire thickness of the compact
wall of the shaft, the secondary absorption invades, from the surface.inwards,
* See Howship's Observations on Healthy and Diseased Bone, in vols. vi., vii, viii,
and x, of the Med.-Chir. Transactions, London.
280 CRITICAL DIGEST OF THE JOURNALS.
a greater or less extent of the old bone, and less of the new. While the
inflammatory action and the process of absorption continues, new deposit of
bone still appears towards the surface, increasing the swelling, and preserv-
ing the more compact structure of the periosteal aspect. * * *
By modifications of this general mode of action, all the varieties of inflamed
bone are induced. - r
A node is produced by an action such as has been now described, occurring
over a limited portion of the periosteal surface, the inflammation and
secondary absorption not extending, in general, deeply into the surface of
the old bone, but confining themselves to the newly formed texture.
A section of a common osseous node, therefore, presents, from the external
surface inwards, first its periosteal compact surface, the Haversian orifices of
which, are larger than those of the healthy bone, and largest at the most
prominent part of the node ; secondly, its cancellated texture, consisting of
enlarged amastomosing irregular Haversian canals; third, a layer of the ex-
ternal surface of the original bone cancellated,—that is, with its Haversian
canals enlarged over an extent equal to the base of the mode, and to a depth
corresponding to the progress of the inflammatory action inwards.
In some nodes, the section exhibits the secondary absorption entirely con-
fined to the new bone, so that the latter appears as if it had been entirely
developed in the periosteum, and had not become intimately united to the
surface of the old bone.
The uniform, or more or less irregular, thickening of the shafts of bones
which have suffered from chronic inflammation of a specific character, is
produced by modifications of the same process of deposition and absorption
as occurs in the formation of nodes. The orifices of the Haversian canals on
the surface of the expanded shafts are all more or less enlarged, especially
where the action has been greatest, and the bone most prominent. They
exhibit various modifications of the ring-shaped, or tubular osseous deposit
which has been formed around, and encircles each of them ; and, according
as these happen to be arranged or combined, we may observe the surface
covered by tuberous, spicular, stalactitic, or obliquely-lamellar processes, the
osseous edges and extremities of which represent the Haversian orifices with
corresponding peculiarities of character and combination.
Sections of enlarged shafts exhibit, on a more extensive scale, the results
of secondary absorption, similar to those which occur in nodes. When this
absorption has been more or less completely confined to the new bone, the
original wall of the shaft may be traced through the section, with more or
less of its original thickness. When the entire thickness of the shaft has
been affected, then the absorption will have extended over a greater or less
extent of the compact texture of the original wall, and the entire bone will
be light and cancellated.
In nodes and enlarged shafts, we occasionally observe alternate layers of
compact and cancellated bone, more or less regularly disposed. This is one
of those appearances, which have given rise to the expansion theory of en-
rged bone. But as bone enlarges in disease, as in health, by reciprocal
depositions and absorptions, this laminated arrangement cannot be explained
by the hypothesis.
It would appear to be the result of renewed inflammation, nearly in the
planes of the compact laminae of the originally cancellated node or shaft,
and a consequent deposit of new bone narrowing the canals, and rendering
compact a plane of bone immediately exterior. -
The spicular, nodular, or lamellar processes which are developed around
ulcerated or carious surfaces, and at the margins of exfoliations, are produced
in the same manner, by modifications of the Haversian canals of the part.
The extreme modification of this kind of enlarged bone, is exhibited by the
more or less complete osseous shells which envelope dead shafts, and the

t CRITICAL DIGEST OF THE JOURNALS. 281
origin, or source of which, have given rise to so much controversy in the
pathology of necrosis.
The areolar and vascular texture contained in the Haversian canals of bone,
is also the site of all cancerous, medullary, sarcomatous, fibrous, and scrofu.
lous deposits, and tumours in bone. The essential element of the texture is
in no way affected by these new formations. The cells, granules, and plasma
of which they consist, become developed, and propagate themselves in the
areolar and vascular net-works within the canals, like the sporules, thallus,
and phycomater of fungi : the walls of the osseous canals giving way by
absorption before the increasing mass of new organisation.
But here also, as in the inflammatory affection of bone, the absorption of
one part is accompanied by deposition in another. ;
It is highly interesting to observe how the spicular and laminated masses
which lie imbedded in cancerous and medullary tumours of bone, if traced
back to the old bone from which they arise, will be found to spring from
between the more enlarged Haversian orifices, out of which the parasitic
masses have protruded; and how these spicular lamellated processes derive
their characteristic forms and directions from this anatomical arrangement.
Ulceration of bone consists in the entire removal of the osseous texture of
a part, by the continued and complete absorption of the walls of the Haversian
canals of the part affected. It is important to observe, that this absorption
or ulceration of bone never takes place, without a corresponding deposition of
bone in the neighbourhood.
CoNCLUSIONS. 1. That in the osseous, as well as in the other textures, we
must distinguish between those morbid conditions which have their site in
the essential, from those which are situated in the accessory, parts of the
texture.
That, in reference to the changes in the essential parts of bone;
2. Caries, one of the most obstinate and painful affections of the texture,
depends on the more or less complete obliteration of the corpuscles and
canaliculi, and the conversion of the carious surface, for a certain depth, into
a substance resembling the enamel of the teeth.
3. That all the inflammatory changes in bone have their site in, and
depend on, an increase or diminution in the number and size of the Haver-
sian canals.
4. That all the malignant and non-malignant growths in bone have their
site in the Haversian canals.
5. That the various forms of spicular and laminated exostosis, which are
found co-existing with malignant or non-malignant growths, are necessary
results of the dilatation and extension of the affected Haversian canals.
[Edinburgh Monthly Journal, February 1850.]
INDURATION OF THE CEREBRUM.
M. DUPLAY, physician to the Hospice des Incurables in Paris, related the
following interesting case at a meeting of the Société de Biologie, in No-
vember 1849: .
CASE. W., aged 41, was admitted into the hospice for males, on the 22d of
June, 1849. He had complete paralysis of the lower extremities, and moved
the upper limbs with difficulty, so as not to be able to feed himself. His in-
tellect appeared intact, for he understood all that was said to him; but he
had extreme difficulty in articulating. His sister gave me the following ac-
count of the progress of his disorder:-. . .
He had enjoyed good health up to 1839. He was strong, and well able to
follow his occupation as a Sawyer; he was not addicted to drinking, but ap-
peared to have indulged in an abuse of venereal pleasures. In the course of
the year 1839, he felt numbness in the lower limbs, which gradually became
weak; walking was at first unsteady, and soon became so diº that he
WOL. II. I

282 CRITICAL DIGEST OF THE JOURNALS,
was obliged to use a stick, and subsequently crutches. The usual remedies
were employed : the spine was covered with cauteries and moxas; he was
admitted into the hospital St. Louis to have sulphur baths; but no remedies
had any effect. At the end of three years, his speech became difficult, and
soon almost unintelligible. He preserved his intellect entire. The rectum
and bladder were paralysed ; he had no stools without the aid of enemata or
purgatives. About the time when the difficulty of speech appeared, the
movements of the upper limbs began to be unsteady. Having exhausted all
his resources, and obtaining no amelioration of his condition, he was admitted
into the hospice.
On the 29th November, 1849, W. was admitted into the infirmary of the
hospice with symptoms of pericarditis, and pleurisy of the left side. By
energetic treatment, these affections were removed in a fortnight ; but his
health had been much shattered by them. In the sacral and trochanteric
regions, there were large sloughs; he was in a state of extreme emaciation,
and it seemed improbable that he would be able to bear up with the abun-
dant suppuration. During his stay in the infirmary, I was able to observe
the Mºtion. of the nervous system, which continued the same up to his
death.
There was complete paralysis of the lower extremities ; the legs were semi-
flexed on the thighs, and the thighs on the pelvis; and they returned to
this position immediately on the cessation of any attempt to straighten them.
Sensation was preserved; the slightest irritation of the skin was felt by the
patient. The upper limbs were not in a state of semi-flexion; the patient
could move them, but was unable to regulate the movements, and easily let
fall whatever he took in his hand ; sensation was perfect here also. His speech
was unintelligible ; he could only with very great difficulty articulate a few
words at intervals. The intellect appeared intact, and he understood the
questions which were addressed to him. The functions of sight, hearing,
smelling, and taste, were normal. The rectum was paralysed ; and there was
incontinence of urine. I was several times obliged to administer croton oil,
in order to obtain alvine evacuations. The patient became gradually weaker,
being reduced by the extensive suppuration, and died in an extreme stage of
marasmus, on the 23d of November, 1849.
Post-mortem easamination. The appearances found, were such as the pro-
gress of the disease had not led us to expect. The bones of the skull seemed
natural ; the dura mater was not adherent to the cranium, and the arachnoid
cavity did not contain more serum than usual; the cerebral arachnoid pre-
sented, on the convex surface of the hemispheres, a slightly opaline tint ;
the sub-arachnoid cellular tissue was slightly infiltrated with a transparent
serosity; the membranes were not at any point adherent to the cerebral con-
volutions, but were easily detached. The grey matter of the brain was normal;
no change in consistence or in colour could be perceived. The outer third of
the white matter on each side, except slightly presenting vascular points,
was of normal consistence. But the two other thirds presented a remarkable
increase of consistence, which gradually became greater towards the ventri-
cles. The cerebral substance here was divided with difficulty; the slices re-
sisted traction, and required considerable force to be used before the finger
could divide and crush them. The change was symmetrical on the two sides,
and occupied an extent of six centimétres (2.358 inches) from before back-
wards, by four (1:572 in.) in a transverse direction. The white substance had
lost its brilliancy; it was dull, and of a slightly pale red tint. The thalamus
opticus and corpus striatum on each side were also somewhat hardened, but
less so than the white matter. The ventricles contained only a small quantity
of limpid serosity. The cerebral protuberance appeared to have undergone
a slight increase in consistence, but this was not very apparent. The spinal
chord was small and slender, as if atrophied. The membranes were healthy;
and the vertebral canal presented no trace of tumour or other appreciable


CRITICAI, DIGEST OF THE JOURNALS. 2S3
lesion. The medulla, on being examined very carefully throughout its whole
extent, was found to possess everywhere its natural colour and consistence;
no trace of ramollissement or of haemorrhage could be discovered. The other
organs presented no remarkable appearance. [Gazette Médicale de Paris, 9
February, 1850.]
CRYPTOGAMIC VIEGETATIONS IN THE INTERIOR OF THE HAIR IN FAVU S.
DR. C. WEDL has published an account of his having discovered Crypto-
gamic Wegetations in the interior of the hair in Favus. After briefly referring
to the observations of Gruby, Günsburg, Malmsten, and Lebert, he says:–
I directed my attention to the interior of the hair, making use of a con-
centrated alkaline solution to render it more transparent. This solution acts
on some parts of the hair in a very remarkable manner ; in different strata
of it, there appear small elongated gas-bubbles, with a sharp dark outline,
giving the appearance of an interrupted canal ; sometimes also larger gas-
bubbles are seen lying at the outside of the hair. The latter gradually be-
comes more transparent ; and, in the situation of the dark broken canals,
there appear filaments formed of elongated quadrangular or roundish mole-
cules ; these extend through a certain portion of the hair, here and there
giving off branches, and are to be found in all layers of the hair. These fila-
ments consist of granules arranged like beads. Their transverse diameter
varies; their length is also very variable; here and there, only a few granules
are linked together, while in other parts there are several dozens of them.
The branches which spring from them are sparse, generally very short, and
always single ; the direction of these filaments is in the longitudinal axis of
the hair. I have never seen them hanging from the outside, unless I had
torn the sheath of hair, or the whole hair, by rubbing it to and fro on the
glass, after it had been acted on for an hour by strong liquor potassae. On
the surface, one often indeed sometimes sees regularly arranged filaments
surrounding the hair; but the most beautiful and conspicuous are these trans-
verse granular filaments, at the place of exit of the hair from the epidermis.
In the latter, which often remains hanging when the hair is torn out, are
usually some pretty numerous groups of granules (sporidia), and here and
there a granular filament comes into view, which passes transversely across
the hair, or even seems to end in it.
I could not ascertain with precision the entrance of the filaments of the
dependent epidermis into the hair; but I have no doubt that such is the
case, because these granular filaments are most abundant at the above-men-
tioned point of exit ; moreover, they decrease as they proceed upwards, and
disappear at the end of two or three lines; they extend some way down, but
not in such numbers, and do not seem to reach the bulb. The point of con-
centration of these filaments is, then, the place where the hair emerges from
the epidermis; it is here surrounded with the vegetations of favus. In order
to establish the fact, that the filaments in the hair are really fungous growths,
it is necessary to examine fungi, but especially those of favus, under the ac-
tion of strong liquor potassae. There also is an extrication of gas under the
microscope; the sporidia and thallus fibres are not dissolved, but are rendered
more conspicuous, while the epidermis cells become faint. Dr. Hebra per-
ceived the development of a foetid gas in his researches, when fungi were
exposed longer than usual to the action of liquor potassae.
With regard to the frequency of this appearance, it is to be observed, that
in most cases of favus, it is possible to find these fungi in the hair, especially
when light. When it is dark-coloured, it requires to be macerated about
half an hour in strong liquor potassae ; but, in light hairs, the sporidia can be
seen in from five to ten minutes.
This remarkable circumstance—the growth of fungi in the interior of the
hair in favus—gives an explanation of its well-known dryness and brittle-

19 2
284 CRITICAL DIGEST OF THE JOURNALs.
ness, for the nutrition of the hair must be interfered with by the parasitic
structures. Moreover, these observations throw light on the long known
rule in dermatology, that, in order to cure favus effectually, the hair must
be removed. [Zeitschrift der K. K. Gesellschaft der Aerzte zu Wien. Fünfter
Jahrjang 1849, p. 643.
MUcous PNEUMONIA, OR SUFFOCATIVE CATARRH, of VERY YoUNG CHILDREN.
Every one who has been in the habit of carefully observing and reflecting
upon the phenomena of disease in early infancy, must have been struck with
this remarkable fact—that extensive pneumonia is, comparatively speak-
ing, often, not only easily, but speedily cured ; while that which is circum-
scribed and apparently less formidable, has, more commonly, a fatal issue.
We think the following remarks, by M. DUCLos, are interesting, and im-
portant in their bearings upon this subject. We concur generally in his
treatment, though we consider it defective, in not pointing out the danger of
fatal depression, if the emetics be pushed too far, especially when they do
not cause vomiting: in the omission of an account of the precautions required
in such cases; and in the absence of rules for the management of the skin.
Our abstract is chiefly taken from the Revue Médico-Chirurgicale de Paris,
for January 1850, p. 38. -
MEMOIR of M. DUCLos. M. Duclos has seen, at the Hospital for Children,
cases of double pneumonia, in which the whole pulmonary parenchyma was
involved, and in some spots presenting hepatization, yield after from nine
to twelve days—the mean duration of pneumonia in early infancy: whereas,
others in which the affection was more limited, without reaching the stage of
hepatization, have, after four or five days, terminated in death. He has found
that these two classes of cases differ essentially : -
Ist. In the mode of production. 2nd. In the symptoms. 3rd. In the
anatomical characters.
M. Duclos designates the rapidly fatal form of the disease MUGous PNEU-
MonTA; being what others have described under the names of Suffocative
Catarrh and Capillary Bronchitis.
1. Mode of Production. Vigorous, strong children with fat chests, are
those liable to Mucous Prieumonia. Most commonly, it begins as a simple
bronchitic attack. The chest, as ought to be the case, is probably auscultated
at brief intervals during the day, without any other symptom being indicated;
when at last, upon some one occasion, signs of inflammation of the substance
of the lungs are discovered. Mucous Pneumonia may be considered as the
sequel or extension of a catarrhal phlegmasia. It is important to bear in
mind, that it occurs most frequently during the first dentition. The ordinary
pneumonia is more generally a distinct disease, -
2. The Symptoms also present essential differences. In the ordinary pneu-
monia of very young children, a subcrepitant rāle is heard when lobular in-
flammation exists, and a Souffle is also heard in like circumstances. There
exist likewise oppression, agitation of the alae nasi, and a sulcus at the base
of the chest corresponding to the insertion of the diaphragm; a sulcus so
very characteristic as a symptom, that M. Trousseau has called it the sillon
peri-pneumonique. Fever attends the above-named symptoms. The latter
symptoms are to be met with in Mucous Pneumonia, but those furnished by
auscultation are different ; there is no souffle to be heard, because the pneu-
monia is not lobular. In Mucous Prieumonia, the bronchial secretion is ex-
tremely abundant ; the mucous rāle masks the sub-crepitant rāle ; and the
mucous ràle is so loud that it may be heard by approximating the ear to the
chest, without actually applying it. • -
3. The Anatomical Characters of bronchitis and lobular pneumonia are both
found in the Mucous Pheumonia ; and it is on this account that M. Duclos
CRITICAL DIGEST OF THE JOURNALS. 285
has adopted that name for the disease. On slicing the lung with the scalpel, a
marbled aspect is presented; some lobules are decolorized, or of their natural
hue, while others appear as if deeply stained with the lees of wine, and which
have evidently been the seat of inflammation. If the last-mentioned lobules
be carefully isolated and placed in water, they sink to the bottom ; but the
others, which have not been the seat of inflammation, float on the surface
when similarly treated, and even after an attempt has been made to press out
the air with the fingers. The bronchial ramifications are choked with mucus.
Prognosis and Treatment. Physicians form very often a favourable pro-
gnosis in Mucous Pheumonia, which, to their dismay, is abruptly disproved
by the death of the patient. It ought always to be looked upon as a most
formidable complication of pulmonary disease. With regard to treatment,
M. Duclos shows that it must be different from that of ordinary pneumonia ;
first, on account of the rapid progress of the malady, from the onset of the in-
flammatory symptoms; second, from the mechanical obstacle to respiration,
caused by the choking of the air-passages by mucus. Emetics are essential; and
a syrup of tartar emetic and ipecacuanha is to be given every ten minutes, till
the infant have vomited four or five times. The medicine is then suspended,
and it is again exhibited in the same way, morning and evening, till the same
effect be obtained. It is not so easy to produce vomiting after the first time,
so that larger doses, and the drinking of tepid water as an adjuvant, are re-
quired. During the intervals between the excitement of vomiting, an anti-
monial mixture, with a small quantity of opiate syrup, is given; but this is
a secondary and not an essential part of the treatment. In the same category
he places counter-irritation of the skin, whether by embrocations of croton
oil, etc., or by blisters, which, when he does employ, he puts on the legs, in
preference to the anterior or posterior part of the chest. Blisters early ap-
plied to the legs, and made to discharge freely, M. Duclos considers very useful.
His treatment may be thus summed up :
1. Emetic treatment as described—Essential.
2. Use of antimonials in the intervals. Useful
3. Counter-irritants, especially blisters to the legs, } SëIlll.
CHLOROFORM ADMINISTERED WITH ADVANTAGE IN LEAD COLIC :
ANODYNES IN LEAD COLIC.
DR. BLANCHET, in the Journal de Chimie Médicale, recommends this prac-
tice. He details two successful cases. Believing that the best method of
treatment is, in the first instance, to give emergetic anodynes and antispas-
modics, we are prepared, d priori, to approve of this recommendation of
Chloroform in Lead Colic ; but the form of administration, which we would
decidedly prefer, is Smith's mixture (with camphor), both from its convenience,
and from the therapeutic utility, in such cases, of both ingredients. We
have not had an opportunity of giving this mixture in lead colic, but we
have largely used it in analogous cases; and when an anodyne and antispas-
modic is required, we know of no better prescription. Notices on this subject
will be found in our volume for 1849, pp. 102 and 842. Belladonna, applied
externally, we have several times used with success in cases of Lead Colic.
The patient obtains speedy relief; and the cure is completed by one or two
doses of castor oil, or a mercurial purge, with or without camphor and hen-
bane, as the case may require. Opium may, in some subjects, be found more
useful than any other medicine. The important principle to bear in mind is
this—that the spasm of the intestines must be first subdued; and that till
this be accomplished, purgatives only aggravate the severity of the symptoms.

286 CI&ITICAL DIGEST OF THE JOURNALS.
SURGERY.
ON LITHOTOMY AND LITHOTRITY : BEING AN ACCOUNT OF THE EXPERIENCE
of MM. PAMARD, SENIOR AND JUNIOB, FROM 1792 To 1849,
EMERACING SEVENTY-TWO CASES.
The following is the substance of a paper (Revue Médico-Chirurgicale, May
1849), by M. PAMARD, Surgeon to the Hospitals of Avignon, in which he
describes all the cases of Lithotomy and Lithotrity which had come under
himself and his father. Documents of this description are as valuable as
they are rare.
I am one of those who attach great value to authentic and well-compiled
medical and surgical statistics. In furnishing such contributions to science,
country practitioners possess an advantage. Their practice is daily open to
the observation of their brethren, who live, like themselves, in the midst of
the patients, and exercise such a check, as to render it very difficult for
errors, either voluntary or involuntary, to occur. I proceed to give the opera-
tions of my father; giving first the cases upon whom Lithotomy was per-
formed more than once; and then those who died within two months after
the operation. The other cases are arranged according to their date. From
the 5th May 1792, to the 19th May 1818, my father performed Lithotomy
in sixty cases, of which he lost five : but the sixty operations only represent
fifty-five patients, because one was cut thrice, and two were cut twice.
CASE 1. W. Duclos, of Pont-Saint-Esprit (Gard), aged 68, was cut in the
year v1.1 (A.D. 1797), by an operator of Grenoble. On the 30 fruct. year VIII
(1798), my father operated for the first time. A stone again formed ; and
was removed on the 5 vend. of the year x (1800), and a third stone was
removed on the 1st vend. of the year XII (1802). The patient survived a
long time after the third operation, without another stone forming.
CASE 2. A. J. Jouve, aged 48, of Gordes (Vaucluse), was cut for stone, on
the 13 floréal, year v1 (1796). A fistula formed, which probably was the
cause of the production of a new calculus; for which a second successful
operation was performed on the 15 frimaire, year VII (1797).
CASE 3. J. Ricard, of Cavaillon (Vaucluse), aged 15, was cut the first time
on the 8 frimaire, year VIII (1798); and the second operation, which was
successful, was not performed till the 27th September 1811.
CASE 4. J. Lombard, of Avignon, was cut for stone on the 23 brumaire,
year VII (1797), having had the same operation performed when 4 years old
by my grandfather. The stone never formed after the second operation.
CASE 5. J. Weyren, aged 19, of Willeneuve (Gard), had Lithotomy per-
formed on the 4 floréal, year v1.11 (1798). My father conjectured that the
first operator had left fragments of the calculus in the bladder. The operation
was repeated on the 3 frimaire, year Ix (1799); and the patient recovered.
CASE 6. T. Morgan, of Caumont (Vaucluse), a female, aged 8 years, had
suffered from her birth. Lithotomy was performed on the 30 vendémiaire,
year III (1793). The operation was difficult, and the bladder was torn at its
fundus. The stone was very large, considering the age of the patient, weigh-
ing 105 grammes (about 27 drachms apoth. weight). The child died on the
fifth day after the operation.
CASE 7. N., a man, aged 72, of Avignon, was cut on the 20th August 1792.
He had suffered for 20 years, and was only driven by pain to submit to the
operation. The pubic artery was probably involved : the stone was very
large and jagged. After a succession of haemorrhagic attacks, the patient
died on the 26th September.
CASE 8. J. O., a boy, aged 10, of Crillon (Vaucluse), was cut for stone on
the 8 floréal, year-vi (1796). Owing to the size of the stone, the operation
was long and painful. It broke under the pressure of the forceps, which

CRITICAL DIGEST OF THE JOURNALS. 287
necessitated their repeated introduction. Death, from inflammation of the
bladder, ensued three days after the operation.
CASE 9., F. C., a lad, aged 19, of Malaucene (Vaucluse), was cut on the
23 brumaire, year VII (1797). The operation was easily and rapidly per-
formed ; but the patient died from phlebitis on the eighth day.
CASE 10. M. W., a man, aged 25, was cut on the 16 floréal, year v1.11; and
though there was no complication in the operation, it was followed by death
from phlebitis on the 27th of the same month.
CASE ll. P., a boy, had a small stone removed by Lithotomy, on the 5th
May 1792. Rapid recovery.
CASE 12. V., male, aged 17; cut 19th April 1797. Rapid recovery.
CASE 13. M., aged 47, a man, was cut 18th May 1793. Rapid recovery.
CASE 14. Fabre, aged 8 years, cut 9th May 1793. Recovery.
CASE 15. F., a boy, aged 4 years, cut 27th September 1793. Rapid re-
COWery.
§ 16. R., a boy, aged 7 years, cut 21st September 1793. Recovery.
CASE 17. M., a boy, aged 10 years, cut 7th October 1793. Haemorrhage
occurred, requiring a canula, armed with agaric, to be introduced ; but,
nevertheless, a rapid recovery ensued.
CASE 18. P., a boy, aged 3 years and 8 months, cut 9th October 1793:
stone Small ; recovery rapid.
CASE 19. T., a boy, aged 17, was cut 4th January 1794, Recovery.
CASE 20. T., a boy, aged 12, cut 2nd May 1795, Rapid recovery.
CASE 21. F., a young lad, cut 2nd May 1795. Rapid recovery.
CASE 22. R., a boy, aged 7, cut 2nd June 1795. The stone was fractured;
the operation was protracted, and recovery took two months.
CASE 23., R., a man aged 80, cut 27th May 1796. He had haemorrhage,
requiring the introduction of a canula. Recovery.
CASE 24. G., a man, aged 24, cut on the 3 brumaire, year VII (1797).
Recovery.
CASE 25. R., a boy, aged 5, cut 16 frimaire, year VII (1797). The stone
was large; and the seizing and extracting of it were difficult. Recovery.
CASE 26. A., a boy, aged 53 years, cut 16 floréal, year v1.1 (1797). Re-
covery.
CASE 27. R., a man, aged 75; enormous stone extracted by Lithotomy on
10 floréal, year v1.II (1798). Recovery.
CASE 28. L., a man, aged 47, cut 3 fructidor, year VIII ; the stone was
enormous. Recovery took place, but with a recto-vesical fistula, evidently
originating in a wound of the rectum.
CASE 29. A., a boy, aged 9 years, cut 5 floréal, year v1II (1798). Speedy
recovery.
CASE 30. R., a boy, aged 9 years, cut 6 frimaire, year x (1800); two small
calculi. Speedy recovery.
CASE 31. G., a boy, aged 5 years, cut 20 floréal, year x (1800). Recovery.
CASE 32, B., a boy, aged 4 years, cut 24 floréal, year XI (1801); mulberry
calculus. Rapid recovery.
CASE 33. B., a boy, aged 8, cut 9 thermidor, year XII (1802). Recovery.
CASE 34. D., a young lad, cut 2 messidor, year XII (1802). Recovery.
CASE 35. G., a boy, aged 4%, cut 27 brumaire, year XII (1802). Recovery.
CASE 36. C., aged 27: cut 3 floréal, year XIII (1803) The calculus was
large and friable; the operation was prolonged. Recovery.
CASE 37. D., a boy aged 13: cut 21 floréal, year XIII (1803). Recovery.
CASE 38. D., a doctor in surgery, aged 65; he had suffered for twenty
years, but had never allowed himself to be sounded. Pain, at last, overcame
his reluctance: and he was cut for stone on 15th March 1806. The stone
was very large ; but nothing untoward occurred, and recovery was rapid.
CASE 39. S., a man aged 22 : cut 3rd June 1806. Recovery.
CASE 40. C., a boy aged 11: cut 13th September 1806. Speedy recovery.

288 CRITICAL DIGEST OF THE JOURNALS.
CASE 41, R., a man, aged 31 : cut 6th December 1806. From the large
size of the stone, force had to be used in the extraction; nothing untoward
occurred. Recovery.
CASE 42. T., a boy, aged 8: cut 24th October 1806. The stone was large
and friable ; the child had suffered from his birth ; the operation was pro-
longed : recovery took place, but there was a urinary fistula.
CASE 43. Servant, the curate of Tulette (Drôme), aged 68 years, was cut
on the 9th May 1808; he was a lusty subject, and the operation was labo-
rious ; but the success of the operation was complete—a fact worth notice,
as Roux, the famous operator of the Hôtel Dieu, states that every ecclesiastic
whom he has cut for stone, has died.
CASE 44. S., aged 56 years: cut, 2nd of September 1810: large stone.
Recovery.
CASE 45. T., a managed 74: cut 3rd of October 1810. The stone was very
large, and weighed 110 grammes (about 28} drachms apoth. weight). In
spite of the age of the patient, and the force required in extraction, recovery
was quick and complete.
CASE 46. F., a man aged 50: cut 15th October, 1810. Recovery.
CASE 47. C., a man aged 22; cut 4th October, 1810. Stone large. Re-
covery.
CASE 48. Madame Walentin, of Avignon, aged 25 : cut 7th October,
1811. The stone was very large, and its extraction was difficult. The in-
cision, which was low, and on the left, involved the vagina. Recovery took
place, but she had incontinence of urine.
CASE 49. Madame Cambon, aged 21 : operated on in the same way as
Madame W., on 10th November, 1812. She recovered, and had no remaining
inconvenience.
CASE 50. P., a boy aged 12: cut 24th September, 1812. Recovery.
CASE 51. Melin, aged 3} : Lithotomy 17th May, 1814: small calculus.
Speedy recovery.
CASE 52. Reynaud, aged 64 : large calculus extracted l?th May, 1817:
considerable haemorrhage. Recovery.
CASE 53. Joussaud : cut 16th June, 1817. Recovery.
CASE 54. Jeaume ; suffered from birth: cut 14th June, 1817. From the
number of calculi, the operation was laborious. Recovery in ten weeks.
CASE 55. M., a woman aged 58 : cut 10th June, 1817. Very large stone.
Complete recovery.
CASE 56. R., a man aged 17: cut 19th May, 1818. Success complete.

I now proceed to detail my own experience ; first, in Lithotomy; second,
in Lithotomy preceded by attempts at Lithotrity ; and, lastly, in cases in
which Lithotrity alone was performed.
I. LITHoToMY. CASE 1. M. Baldy, of Nîmes, aged 15, had, when six years
old, been cut for stone, by M. Pleindoux. Till within two years, he had re-
tained a fistula in perinaeo: operated on, 2nd March 1832. Dismissed cured
on the 8th April. *
CASE 2. M. Martin, of Avignon, aged 20, had suffered from infancy; but
neither her pain, nor the entreaties of her relatives, could induce her to sub-
mit to an operation. The operation was ultimately performed on the 18th
of January 1837, under the disadvantageous circumstances of a presenti-
ment on the part of the patient that she would not recover, Lithotrity ap-
pearing inadmissible from the large size of the stone, and the very irritable
state of the urethra. The stone weighed 77 grammes. . For the first days,
the patient appeared to be doing well; but, on the fourth, rigors and fever
set in, and she died upon the 24th of January. On dissection, I found the
mucous tunic of the bladder red and soft ; there was pus in the iliac veins.
The abdomen was distended with gas, and the peritonaeum dotted with red
spots.
CRITICAL DIGEST OF THE JOURNALS. 289

CASE 3. B., of Monteux (Vaucluse), aged 9 years, was operated upon, at
his father's house, on the 21st of September 1836. The stone weighed ten
grammes. Recovery was complete fourteen days after the operation ; and
the patient, who is now a military officer, has never had any return of the
affection. - - -
CASE 4. M. C., aged 72, of Entrechaux (Vaucluse), a healthy old man,
after suffering for four years, was operated upon on the llth May 1840. I
removed three calculi, smooth and presenting facets formed by friction against
each other, and weighing, collectively, 80 grammes. The cure was complete
on the 28th June. -
CASE 5. L., aged 21, of Fresney (Mayenne), who had suffered from his
earliest years, was operated upon in hospital on the 10th of January 1841.
The stone was bulky and indented, and weighed 45 grammes; it broke under
the forceps, but was all removed : and the patient was dismissed cured on
the 5th of February.
CASE 6. M., a soldier, aged 27, of Bourret (Tarn-et-Garonne), was operated
upon on the 18th of January 1842, in hospital. The stone was hard, volu-
minous, and brown in colour; weighed 60 grammes, and was extracted entire.
The wound shewed an indisposition to heal, which rendered it necessary to
introduce deeply the solid nitrate of silver. On the 17th of May, being four
months after the operation, he went out completely cured.
CASE 7. M., aged 15, of Willeneuve (Gard), a thin and irritable youth, had
suffered from his earliest recollection ; but his parents could never persuade
him to allow himself to be sounded, till I was permitted to do this, and dis-
covered a hard calculus with unequal surface. The extremely sensitive.
condition of the urethra rendered Lithotrity inadmissible ; and I performed
Lithotomy on the 20th of February 1844. The stone was very large, and
very light, not weighing more than 8 grammes. On the 22nd of March the
patient left the hospital, perfectly cured. .
CASE 8. N., a man aged 27, of Labastal (Hautes-Pyrénées), had endured
a miserable existence for a long time previous to his entering the hospital, on
the 28th of February, 1845. I cut him on the 2nd of March. The case
presented a circumstance worthy of being mentioned. There was contraction
of the bladder to such an extent, as to impede the separation of the blades
of the forceps. The stone, however, was seized and extracted; it weighed
32 grammes. Its appearance might have suggested the idea, that it was a
substance moulded in the bladder of a child. On its upper part there was
a plane surface ; but, upon digital exploration, I satisfied myself that there
was not a second stone. The patient left the hospital cured, on the 11th
of April. -
ğ. 9. G., aged 4% years, of Gravéson (Bouches-du-Rhône), had suffered
from the time of his lactation. . I performed Lithotomy on the 22nd of July,
1847, as, in young children, I infinitely prefer this operation to Lithotrity.
He was placed under the full anaesthetic influence of ether. I used polypi
forceps, being an instrument which I prefer in children. I removed an oval
calculus, of the size of a large bean ; after which, I introduced my finger (as
I always do in children), and discovered a second calculus, of the size of a
pea, which was easily extracted by means of the index finger, without the
aid of any instrument. The two stones, collectively, weighed 3 grammes.
On examining the second calculus with care, it was found to be covered with
facets, which led me to conclude that there were a group of small calculi ;
but, on again introducing the index finger, I found the bladder completely
unembarrassed. The only explanation which can be given of these facets, isº
to suppose that friction took place between the two calculi. The issue of
this case was fortunate. At the end of a month, the child was well ; and,
though thin, he was in good health. I have seen him this winter, and can
testify that he is a superb child, and in the enjoyment of perfect health.
LITHOTOMY PRECEDED BY ATTEMPTS AT LITHOTRITY. CASE 10. A. B., of
Avignon, aged 8 years, was brought into hospital on the 27th March,
290 CRITICAL DIGEST OF THE JOURNALS.
1845. I detected a small calculus in the bladder; and, yielding to the
wishes of the parents, though in opposition to my own opinion, consented to
perform Lithotrity. Having dilated the urethra, I introduced Charrière's
modification of Heurteloup's lithotrite. I seized the calculus, and broke off
a pretty large fragment, which was voided into the bath in which I placed
the patient immediately after operating. The operation was quickly per-
formed ; but the restlessness of the patient induced such severe pain, that I
thought it my duty at once to propose lithotomy, as offering less incon-
venience than Lithotrity. . . I performed the operation on the 18th of April,
and it was followed by quick recovery.
If we may judge from the complaints of the patient, he would seem to
have suffered less from the operation of Lithotomy than from Lithotrity,
although the calculus had been readily seized and broken. The calculus
extracted from the bladder, weighed 5 grammes; and the piece broken off by
the lithotrite, one gramme and 50 centigrammes.
CASE 11. Mademoiselle P. M., aged 17 years, of Angles (Gard), had been
the subject of calculus for some years, the existence of which she concealed
for a considerable time. Her family attendant having discovered its presence,
advised Lithotrity; and she was placed under my care. On the 10th of May
1847, I operated on her at Angles, in the presence of Drs. Salomon, senior
and junior, Dr. Touzet, and others. The patient having been placed under the
influence of ether, I easily introduced a No. 3 Lithotrite, and immediately
found a large calculus. The instrument was opened in the bladder with
some difficulty; the calculus was broken at three attempts. The patient ex-
perienced no pain whatever; and, when she awoke, said she thought she was
at church with her father. She was placed in a bath immediately after
the operation, where she voided some fragments of the calculus: she also
voided some fragments, and a large quantity of detritus, during the night.
The operation was twice repeated, at intervals of a few days ; but we
found that the calculus still remained large. The patient experienced pretty
severe pain in passing the larger fragments; and on the last two occasions
of operating, she suffered severe pain, and was very restless: she refused to
be etherized. Considering it imprudent to continue Lithotrity, we proposed
that Lithotomy should be performed. This was accordingly done on the
25th of June, 1847. We adopted the method improperly attributed to
Dubois, but which, according to Paré, belongs to Laurent Collot, a surgeon of
the sixteenth century. The incision was made directly upwards, with the
lithotome of Friar Côme. As the calculus had been broken in several
pieces, we had to introduce the forceps several times. The largest fragment
measured 4 centimétres in its greatest diameter. The fragments which had
been passed before this operation, weighed 7 grammes; and those which we
extracted, amounted to 26 grammes. The result of the operation was most
fortunate : on the twentieth day, the patient was completely cured, and was
able to visit me at Avignon.
This result must be allowed to be infinitely preferable to that which must
have been produced by Lithotrity. This proceeding would have required,
perhaps, fifteen or twenty sittings, each nearly as painful as Lithotomy, and
have exposed the patient to the risk of fatal cystitis,
We now come to a case in which Lithotrity was impossible, and Lithotomy
was the only resource. - : -
CASE 12. Mademoiselle M. M., aged 30 years, of Malaucène (Vaucluse),
had, a month previously, introduced a pen-case into the urethra, which
escaped, and fell into the bladder. She came to me, and, with much hesita-
tion, confessed what she had done. I detected the presence of the foreign
body by means of a catheter, and endeavoured, but in vain, to extract it with
Heurteloup's lithotrite. It was easily seized ; but, on attempting to extract
it, resistance was encountered, and the patient was put to great pain. It
was evident that the foreign body lay transversely, and that it was probably
impossible to make it change its direction. We proposed Lithotomy, which


CRITICAL DIGEST OF THE JOURNALS. 29 |
was immediately accepted. On the 19th June 1847, having perfectly ether-
ized the patient, I operated with a lithotome, making the incision directly
upwards. I introduced the index finger of my left hand, and discovered that
the body was actually placed transversely: I caused it to assume a longitu-
dinal direction, and introduced a pair of polypus forceps along the finger, by
the aid of which I extracted the substance without difficulty. It was almost
entirely covered with an incrustation of phosphate of lime; there was a de-
pression at the point where it had been seized by the lithotrite: it was eight
centimètres in length, and weighed three grammes.
The rapid success of this operation could not have been surpassed. Eight
days after the operation, the patient was able to return home, perfectly cured.
It is somewhat remarkable, that, a few days after, I read in the Bulletin de
l'Académie (15 July, 1847), an account of a perfectly similar case to that
which I have just related, occurring in a male. As in my patient, Lithotrity
was impracticable, and Lithotomy was followed by cure.
LITHOTRITY. CASE 13, M. P., of Avignon, aged 68 years, had long suf-
fered from calculus; but he would not consent to Lithotomy. The pain, how-
ever, becoming more severe, the general health being impaired, and the urine
depositing a glairy foetid matter, he was compelled to decide on an operation,
and chose Lithotrity. On the 25th January 1832, after having previously
caimed the patient with baths and refreshing drinks, we proceeded to the
operation, using M. Civiale's instruments, which were then generally em-
ployed. Although I had several times performed Lithotrity on the dead
body, and had demonstrated it to the pupils at the hospital, this was the first
occasion of my operating on the living subject.
The instruments were introduced easily enough; but there was difficulty in
seizing the stone, from its large size, and from the contracted state and ex-
cessive sensibility of the bladder. At last, however, the stone was seized, and
perforated in several points, by slightly relaxing the hold and rotating it.
This sitting lasted eight minutes. A pretty large quantity of detritus was
passed on the same day : on the next, the patient felt tolerably well; but,
two days after, there was tenderness and tension in the hypogastrium, with
difficult passage of urine. This was ascertained, by means of a sound, not to
arise from the retention of a fragment of the calculus in the urethra. A large
number of leeches were applied ; and baths, lavements, with calmative
draughts and applications, were prescribed; but nothing could arrest the pro-
gress of the inflammation of the bladder. The patient went on getting worse,
and died on the 26th February, a month after the operation. Although the
cystitis only appeared on the third day, and death did not take place for a
month, we think that no one can doubt that the Lithotrity was the cause of
death. At the autopsy, we found the calculus broken into numerous frag-
ments. It weighed altogether 52 grammes, and the nucleus bore the mark
of the perforator. The mucous membrane of the bladder was red, softened,
and covered with a layer of purulent mucus, having the appearance of a false
membrane. The peritoneum presented some red points of inflammation.
The abdomen was distended with gas : this had distressed the patient during
the whole course of his illness.
CASE I4. M. R., of Orange (Vaucluse), had Lithotrity performed by M. A.
Jourkoski, on the 3rd of October 1841. I was not present at the opera-
tion, but only know that percussion instruments were used, and that there is
no reason to doubt that it was performed skilfully. On the 5th of October,
two days after the operation, I was called to the patient, who was in a state
of ardent fever, with burning skin, tension, and pain in the abdomen, and
difficulty in micturition. By aid of the catheter, I recognized the presence
of a calculus, and drew off a large quantity of urine. The patient felt great
pain in the bladder, and earnestly requested me to relieve him by an opera-
tion. ... I confined my treatment, however, to calmatives and antiphlogistics,
but without any hope of a favourable result. In this I was not mistaken, for
the patient died on the following day. An autopsy was not made. In this


292 CRITICAL DIGEST OF THE JOURNALS.
case, death was so evidently and rapidly the result of a single sitting of
Lithotrity, that we do not think that the most ardent admirers of this opera-
tion can mistake it. We will now relate some successful cases.
CASE 15. E. B., aged 16, of Tarascon (Bouches-du-Rhône), had been suffer-
ing for about a year, and was supposed to have a calculus. He came to
Avignon to consult me ; I recognized the presence of a small stone, and pro-
posed Lithotrity, to which he consented. On the 5th of March 1832, we
operated with Civiale's instrument. The instrument was easily introduced,
and the calculus was readily seized and broken up, being small and friable.
The patient experienced severe pain during the search for the calculus, but
afterwards did not complain. A pretty large quantity of detritus was passed
in the warm bath, and a larger quantity during the night ; some of the frag-
ments were rather large, and gave some pain. The whole of the detritus
weighed three grammes. The next morning, the patient had no pain; and,
though we sounded him on several occasions, we could discover nothing in
the bladder. He was evidently perfectly cured. If Lithotrity were always
attended with such results, it would be one of the most splendid operations.
CASE 16. M. J. A., aged 82, of Avignon, presents us with an interesting
case. He was a timid man, who had suffered for a number of years, but
had never been able to determine to be operated on, not even to be sounded.
At last he consented ; and I recognized the presence of several apparently
hard and resistant calculi, which gave a very distinct sound on being struck.
Lithotrity seemed the only practicable operation ; it was accordingly per-
formed for the first time on the 25th of February 1833, with M. Heurteloup's
instruments. The canal was very large ; the instrument was easily intro-
duced, and I soon seized a large calculus, about the size of an egg, which
offered some resistance to the action of the lithotrite, but which I succeeded
in breaking down. The patient groaned a good deal, but did not seem to
suffer much ; he appeared to have more fear than pain. He immediately
voided a considerable quantity of detritus. Four days after, the operation
was repeated with the same results; and we were obliged to have recourse to
it fourteen times. He was under treatment up to the end of October; and
there were several circumstances which gave me anxiety. On several occa-
sions, the operation was followed by an attack of violent fever ; and the
patient each time became more impatient of the operation, and appeared to
suffer more. At last I had the happiness of telling him, that I could find
nothing in his bladder. The disappearance of pain confirmed my diagnosis;
and, in spite of his advanced age, M.A. was restored to health.
It cannot be denied, that, in spite of the pain and of the difficulties at-
tending the operation, the success was due to Lithotrity. The detritus, as far
as they could be collected, weighed 20 grammes ; but it is probable that the
patient lost a considerable quantity.
CASE 17. M. B., aged 22, of Bollènes (Vaucluse), had suffered for several
years from a single and rather small calculus; his general health was good.
On the 9th of May 1840, we performed Lithotrity with M. Heurteloup's in-
strument, and repeated the operation thrice subsequently. . The patient
returned home, perfectly cured, on the 9th of June. The detritus of the
calculus weighed 6 grammes. O
CASE 18. M. A. A., aged 22, of Cébagola, (Corsica) presents us with an
analogous case. First sitting, 21st of March 1842. Calculus of moderate
size, but hard: operation performed with percussion instruments; cured on
the 19th of April, after five sittings. . We collected 15 grammes of detritus.
CASE 19. M. P. R., aged 17, of Avignon, was as fortunate as the two pre-
ceding patients. On the 15th February 1843, we operated for the first time;
but the narrowness of the canal caused considerable resistance and pain.
The calculus was small and friable; in fact, the smallest I ever met with:
The collected fragments weighed 10 grammes. . The operation was repeated
four times, at intervals of a few days: on each occasion, fever supervened.
The patient was cured in the space of a month.

CRITICAL DIGEST OF THE JOURNALS. 293
CASE 20. M. M., aged 25, of Borey (Haute-Saône), had suffered several
years from stone. He told me that M. Pétrequin had discovered the exist-
ence of one, at Lyons; but he had not been able to determine to submit to an
operation. Having, however, seen a patient at Avignon, on whom I had
operated, he requested me to perform Lithotrity. . To this I consented; and,
on the 14th January 1844, operated for the first time. The stone was large ;
the graduated scale on the instrument indicated 35 millimetres: it was easily
broken down, but offered some resistance, which increased towards the centre.
The patient experienced some pain, from the retention of one of the fragments
in his urethra; and I was obliged to remove it with a three-branched forceps.
The operation was repeated six days after, and in all, nine times. The patient
was under treatment during two months, and was found to be cured on the
11th March. The calculus weighed 30 grammes: it was formed of two
layers; the external soft, friable, consisting of phosphate of lime ; the in-
ternal hard, brittle, composed of uric acid.
REMARKs. When we take into consideration the duration of the treatment,
the number of sittings which were necessary, the necessity of using Hunter's
forceps to search for fragments—we may ask, whether Lithotrity possesses
any marked advantages over Lithotomy. It will be seen that, out of sixty
patients operated on by my father, there were only five deaths, or one in
twelve. I have arrived at exactly the same result: of nine patients on
whom Lithotomy was primarily performed, one died ; and of three, in whom
Lithotomy was preceded by attempts at Lithotrity, none died; which gives
one death in twelve cases of Lithotomy.
In Lithotrity, I have been less fortunate; for in eight operations, seven
by myself, and one by another operator, two patients died. This gives a
proportion of one in four. I have three times found Lithotrity useless, or
attended with such inconvenience that I was obliged to have recourse to
Lithotomy. I know that it will be said, that I do not praise Lithotrity,
because I do not know how to perform it. This reproach, however, has been
addressed to my illustrious masters, MM. Roux and Welpeau.
My father had five relapses among fifty-six cases; and in the case of M.
Baldy, of Nîmes, I found a calculus in the tissue of the perineum. In
72 operations, then, there were six cases of relapse. I would desire much to
know, whether, in an equal number of cases of Lithotrity, there would not
be a greater proportion of relapses.
opBRATION FOR THE EXTRACTION OF A WOMAN's DoublE HAIR-PIN FROM
THE MALE U RETHRA.
DR. SouLÉ, Surgeon to St. Andrew's Hospital, in Bourdeaux, has published
the following case in the Journal de Médicine of that city. A man, aged 23,
came to Dr. Soulé, stating that his mistress had, while he slept, introduced
into his urethra, one of those black forceps-shaped pins which women use for
arranging their hair; but he afterwards owned that he had himself com-
mitted the folly. The blunt curve had been pushed inwards ; and the two
sharp points were scarcely two centimétres from the orifice. Attempts at
extraction by the natural passage having failed, the penis was strongly bent,
so as to cause the points of the pin to traverse the inferior wall of the urethra.
The curved portion uniting the two stems was then straightened, and one of
the stems was cut off close to the penis, when the extraction was completed
with much difficulty. The penis was enveloped in compresses wetted
with cold water; and in two days the patient left the hospital, presenting no
trace of what had happened, except two ecchymotic spots, corresponding to
the two punctures made by the points of the pin. The procedure of Dr.
Soulé is similar to that recommended in 1847, by Dr. Boinet, in the Journal
des Connaissances Medico-Chirurgicales, to which work we must refer for
farther details.
294
IRE POR T S OF SOC I E' "I E. S.
ROYAL MEDICAL AND CHIRURGICAL SOCIETY,
TUESDAY, JANUARY 22, 1850.
DR. ADDISON, PRESIDENT, IN THE CHAIR.
CHEMICAL RESEARCHES ON THE NATURE AND CAUSE of CHOLERA. By
RoBERT DUNDAS THOMSON, M.D., GLAsgow. CoMMUNICATED BY SIR. B. C.
BRODIE, BART. In the first part of the paper, the author detailed the results
of chemical analyses of the blood, urine, and intestinal discharges, in the
cold, or “lymphatic,” stage of cholera ; and in the “biliary,” or febrile
stage. The main results arrived at were—1. That in the cold stage of the
disease, the specific gravity of the blood, and of the serum separated from the
clot, is increased ; that the proportion of water is less than in health, by at
least nine per cent., and in some cases by as much as seventeen per cent. ; that
both the organic and the inorganic components of the blood are proportion-
ally increased in amount ; but that the increase of the insoluble salts is much
greater than that of the soluble. 2. That the intestinal discharges, in the
cold stage, when of the true “rice-water” character, resemble closely, in
their chemical composition, the fluids of hydrocele and hydrocephalus; that
their flocculi are formed of epithelial scales, and the watery part of water,
containing a small portion of organic matter (albumen) and salts (chloride
of sodium, carbonate of soda, earthy phosphate, alkaline sulphate, and some
lime). 3. That the small quantity of urine sometimes found in the bladder,
in this stage, presented no apparent aberration from an ordinary standard.
4. That in the biliary, or febrile stage of cholera, the blood soon regains its
normal proportion of water, or even an excess of it ; and that the other con-
stituents resume their natural relation to each other. 5. That the urine, in
the biliary stage, in several cases contained albumen, but presented scarcely
any other deviation from the urine of health, except in the amount of urea,
which at first was deficient.
In the second part of the paper, the author described some experiments,
instituted by him, with the view of determining whether any poison could
be detected in the atmosphere. In one series of experiments, it was ascer-
tained that no solid matter existed in the air; but ammonia was obtained
from it in the proportion of 0.319 grains of caustic ammonia, or 0.731 grains
of carbonate of ammonia to 1,000 pounds of air. By another series of ex-
periments, it was determined that no carbon or hydrogen existed in the at-
mosphere, except in the states of carbonic acid and water ; while carbonic
acid was obtained in the proportion of one volume to 6,650 volumes of air.
The author inferred, that the cause of cholera is not a specific tangible poison,
introduced into the body from without, but rather a vicarious transference of
the cutaneous excretion to the intestinal mucous membrane, dependent partly
on atmospheric influence, and partly on a predisposing state of the system in
those who are affected with the disease.
DR. S.Now addressed the society upon the peculiar views which he holds
regarding the communication of cholera, and which have already been laid
before our readers. [Wide LoNDON Journal of MEDIGINE for 1849, pp.
1077, 1083, and 1123.
DR. CoPLAND thought the experiments were too few in number to justify
any definite conclusions. He feared that the emissaries of the Board of
Health had been employed to support preconceived opinions, and not to
elicit truth. Many misstatements had been made on the subject of conta-
gion; but he believed that even the Board of Health had modified its views,
and now admitted that cholera was, at least in certain circumstances, con-
glous.

ROYAL MEDICAL AND CHIRURGICAL SOCIETY. 295

DR. BALY said, that the author's hypothesis of the cause of cholera was
not supported by the phenomena of the disease ; for not only would the sup-
pression of the cutaneous and pulmonary exhalations, and the transference
of the fluids normally excreted by the lungs and skin to the intestimal mu-
cous membrane, be inadequate to produce the enormous discharges which
drain the system of its fluids ; but it is a fact that the cutaneous exudation
is, in many of the worst cases of cholera, greatly increased, a watery fluid
being in these cases poured out by the whole surface of the skin, as well as
by the mucous membrane of the intestines. The draining away of the watery
part of the blood was certainly the main phenomenon of the disease, all, or
nearly all, the others being secondary to and dependent on it. It undoubt-
edly was the cause of the coldness of the body; but it prevented the deve-
lopment of animal heat ; not, he thought, by rendering the blood thick, and
thus incapable of circulating quickly, as suggested by Dr. Snow, but by
rendering impossible those chemical changes which normally go on in all
parts of the capillary system, and which are the source of the animal heat,
The circulation in cholera is undoubtedly much retarded ; but the rapidity
with which the nervous system of the patients is affected by chloroform,
inhaled into the lungs, shows us that the motion of the blood would still be
sufficient to allow of some evolution of caloric, if other necessary conditions
were present ; but an essential condition for the normal processes of nutri-
tion, and for the chemical processes on which the temperature of the body is
dependent, seems to be the presence of a certain proportion of water in the
blood; and it is most probably because this is wanting, that the body becomes
cold. To the same causes are obviously to be ascribed the arrest of the
natural secretions of the liver and kidneys, and the depressed state of other
organic functions of the body; and even the remarkable condition of the
mind, and of the sensitive and motor functions—their state of comparative
integrity—not only affords evidence that the nervous and muscular systems
are, in a great measure, independent of the watery part of the blood, so
essential to the organic functions, but is itself a result of the loss of that
part of the circulating fluid. Under ordinary circumstances, if the respira-
tion continued so imperfect, and the secretion of urine were suspended for a
long period, as they are in the cold stage of cholera, the blood would become
charged with carbonic acid and urea, and coma would result. In the cold
stage of cholera, the natural chemical processes of the body are brought
nearly to a stand-still, by the loss of the water of the blood, and neither urea
nor carbonic acid is formed in large quantity; the powers of the mind and
of voluntary motion are therefore left comparatively unimpaired.
Mr. W. F. BARLow could not discover how failures to demonstrate any
poison in the atmosphere could lead to inferences of its non-existence. Pro-
bably it was so subtle, as to defy all scrutiny, Could the poison of small-pox
or scarlatina be demonstrated in the atmosphere " Yet, was there any doubt
that the air could be made infectious by, and could communicate, those dis-
eases 2 He had paid some attention to the state of the muscles in cases of
cholera. Nothing was more marked than the extreme excitability of the
muscles during life, and their extraordinary manifestation of irritability after
death. The facts which related to these points were most obvious; but as to
the causes of them, there were so many difficulties in the way of satisfactorily
accounting for them, that he begged the few words which he had to offer
might be viewed as suggestive, and not positive. The condition of the blood
must be considered, if we would even approach a rational conjecture on the
state of the muscles. It seemed pretty clear, that there was a great defect in
the formation of carbonic acid, in cases of cholera, and therefore in the produc-
tion of animal heat. He had listened with interest to what had fallen from
Dr. Baly, respecting the failure of chemical changes in the blood, and their
consequences. There appeared a broad difference between death in the col-
lapse of cholera and death by asphyxia, as ordinarily considered ; in the
296 REPORTS OF SOCIETIES.
latter, noxious blood circulated, and impaired the irritability; but in the
former, carbonic acid could not be carried freely through the system ; if it
were, coma would follow, and the heart's action would cease, even more quickly
than it was observed to do. The elevation of temperature after death is very
difficult to explain. It does not depend on the post-mortem muscular con-
tractions, because extreme elevation of temperature has occurred when the
contractions have not been met with. A formation of heat takes place some-
times after death ; and in cases where the body was actually cold at the time
of decease, the temperature has risen to 1090 Fah. As a suggestion, Mr.
Barlow threw out the idea, that this was caused by chemical changes going on
in the blood after death, such as occur during life.
DR. BASHAM did not collect from the paper, that the different salts were
specified, and their proportions given ; but the author inferred that the total
saline ingredients was greater than in health. 8:56 parts in 1000 were given
as the mean of several analyses; and this proportion was compared with
Lecanu's standard of six parts in 1000, as the mean of healthy blood. It was
generally admitted that Lecanu's standard was below the mean ; Simon had
placed it as high as about eleven ; and if the mean of many analyses of
healthy blood by various chemists—Enderling, Marchand, Becquerel, Simon,
and our own English chemists—was taken, the average proportion of salines
in 1000 parts would not be below 11-5 to 12. He had never found the saline
matters of healthy blood, on an average, lower than 10 to 10:50. Individual
cases would occasionally present a lower proportion. In two cases of cholera
blood, examined last August, the saline matters were considerably below the
mean ; this was also the case with regard to the fibrin, and these results
agreed with Simon's analysis. Dr. Thomson estimated this element above
the average, but did not state whether this increase was absolute, or only
relative. The deficiency of water in 1000 parts would cause an apparent
increase in the whole solid contents ; but was the fibrin augmented in rela-
tion to the amount of albumen and blood-corpuscles' He (Dr. Basham) was
surprised that no reference was made to the presence or absence of urea in
the serum of the blood ; he had obtained it, in several instances, during the
late epidemic, from the blood, both during life and after death. The state-
ment, that there was no departure from the natural standard of the urine in
a small quantity taken from the bladder, was very contrary to the results of
numerous examinations of the urine, made during the prevalence of the dis-
ease. In every case, the fluid found in the bladder was more like an alkaline
solution of albumen than urine ; it contained no urea, no phosphatic salts,
traces only of chlorides; and these qualities were observed even in the urine
of those who, for many days after the collapsed stage, passed scanty urine,
but who ultimately recovered.
DR. CoPLAND regarded the heat of the body after death as the result of
incipient decomposition. In all cases of death from cholera, the stomach and
intestines were easily torm. This was also observed in yellow fever, and in
malignant puerperal fever. In these diseases, there was a great increase of
temperature after death.
WESTMINSTER MEDICAL SOCIETY.
* SATURDAY, JANUARY 26, 1850.
FRANCIS HIRD, Esq., PRESIDENT, IN THE CHAIR.
CARIES of THE HEAD of THE FEMUR. M.R. HENRY SMITH exhibited
two specimens, both of which had been excised during life. The first had
been removed by Mr. Morris, of Spalding, from a youth, eighteen years of
age. This instance was eminently successful. The other specimen was
1 This case has been published by Mr. Morris in the Provincial Medical and Sur-
gical Journal for February 6, p. 57, as well as in other periodicals.
WESTMINSTER MEDICAL SOCIETY. 297
obtained by him (Mr. S.) from an adult, between thirty and forty years of
age, formerly in the Grenadier Guards. He had removed the diseased bone
two years ago. The patient survived the operation six months. This last-
named specimen, which had been macerated in warm water for three months,
exhibited the early stage of caries; the disease had only existed eighteen
months; the globular shape of the head was unchanged, but it was carious
(honey-combed) all over. . The neck of the bone was altogether unaffected;
it remained of the usual length, and at the ordinary oblique angle with the
head. In the other case, the diseasehad been in existence six years, and the head
of the bone was completely flattened out, the neck being almost destroyed.
Instead of an oblique arch, it presented a right angle with the head. In his
own case, all the symptoms of dislocation of the head of the femur existed,
and the operation proved his diagnosis to be correct. In Mr. Morris’ case,
it was supposed that dislocation had taken place, but this was proved not to
be the case, when the operation was performed. A difficulty was experienced
in dislocating the head, owing to a small piece of bone, which had separated
from it, and lay in one of the sinuses. It was this which caused the symptoms
simulating dislocation. There was very great shortening of the limb, in con-
sequence of the destruction of the neck of the bones. He had often been
asked, as to the manner in which locomotion could be performed without a
hip-joint: but when the head of the femur was excised, a new joint might
soon be formed. After the removal of the diseased bone, inflammation set
in, lymph was thrown out in the acetabulum, (if healthy) the head of the
femur became rounded off, and fibrous tissue was formed, from which resulted
an entirely new capsule. Mr. Morris' patient was able to flex the mutilated
thigh on the pelvis, as readily as the other, seven weeks after the operation.
He had seen, a few days since, a woman who had been operated on by Mr.
Fergusson, a year ago; she was able to walk, with the aid of a high-heeled
shoe, without a crutch.
MALIGNANT DISEASE of Both OVARIES, THE RECTUM, ETC. MR. NUNN
exhibited the morbid parts. The patient was aged sixty-two. She died in
St. Giles's Infirmary, after several copious discharges of blood from the
rectum. The right ovary presented the greatest evidences of malignancy,
The left contained within it several cysts, the fluid in each of which
differed in its appearance from that in the others. The gorged cells, which
are said to be proper to ovarian fluid, were found in all, in greater or less
abundance. The right ovary was highest in the pelvis, and was most plenti-
fully supplied with blood. The spermatic artery entering its upper part, was
excessively tortuous. In addition to this, branches from the right colic,
superior and middle haemorrhoidal, epigastric, internal iliac, and uterine
arteries, also assisted to feed the tumour; the ureter was involved in the
pedicle of this ovary. The uterus was draggèd from the centre to the side
of the pelvis, and was so placed, that its long axis was directed transversely,
instead of being in its normal relations. The organ presented, on being laid
open, no marks of disease, although malformed, by being divided into an
upper and lower compartment. The os uteri was perfectly healthy, and had
the appearance of belonging to a virgin uterus. The vagina and bladder
were quite sound; the rectum, about an inch and a half from its lower termin-
ation, was perforated by a circular opening, large enough to admit three
fingers, otherwise this viscus was healthy. The aperture formed the means
of communication between the rectum and a highly vascular cancerous mass,
situated in front of the rectum, and behind the vagina and uterus. This
mass, if it originated in either of the organs referred to, must have occurred
in the outer covering, since the mucous lining of all was, with the excep-
tion of the aperture mentioned, as sound as it is ever found in persons of an
advanced age. The caecum was thrown from its seat in the right iliac fossa,
into the middle of the belly,–not by being displaced by the enlarged ovary,
WOL. II. 20
298 REPORTS OF SOCIETIES.
but by means of the tension of the peritonaeum. Cancerous deposit was
found in the mammae, and in several other organs.
DETACHED OstEoPHYTES IN THE LONGITUDINAL SINUs, AND ON THE SUR-
FACE of THE BRAIN, of A SUPPOSED EPILEPTIC. Dr. WooDFALL exhibited
two Osteophytes, taken from the longitudinal sinus of a woman aged sixty.
They were of irregular shape, and each about an inch in length, and one-
sixth of an inch in thickness at the thickest part. The larger weighed
above two grains, and the smaller rather less than two grains. Dr. Woodfall
only once saw the deceased in life, when she was in a state of stupor. He
had ascertained from her sister, that she had, since her 14th year, been sub-
ject to fits, rather resembling syncope than epilepsy, but also somewhat
epileptiform.
At eight o'clock on the morning of Oct. 20th, 1849, she was found on the
floor of her bed-room, where she had fallen while in the act of washing her-
self, unable to rise, but perfectly sensible. Her speech was observed to be
altered. She continued sensible until about eleven o’clock, A.M., when she
gradually became unconscious; and when seen by Dr. Woodfall, at four
o'clock, P.M., was in a state of profound coma. She died at three o'clock the
following morning, nineteen hours from the commencement of the attack.
The head was examined thirty-six hours after death. The substance of the
brain was wounded in removing the calvarium, and a considerable quantity
of blood flowed out. On the surface of the left hemisphere two thin plates
of bone were found, of small size; and in the superior longitudinal sinus
were exhibited the two others. The substance of the brain was generally
soft. The floors of the lateral ventricles were stained with blood, which had
filled them, but which had mostly escaped in opening the cranium. The
softening was most marked in the posterior corner of the right ventricle,
which, in parts, presented almost the appearance of pus.
MALIGNANT DISEASE of THE BLADDER. By DR. LANKESTER. In 1845, Dr.
Lankester was consulted by a gentleman, sixty-two years of age, a small
man, of active habits, and temperate all his life. He had, nevertheless, suffered
much from dyspepsia, and had frequently had medical advice for his dyspeptic
attacks. About twelve months before Dr. L. saw him, when working in his
garden, he was attacked suddenly with pain in his back, followed by a desire
to make water, which he found coloured with blood. He immediately sought
medical advice, but the pain in the back continued, with a fresh appearance
of blood in the urine. He wasted, lost his appetite, became sleepless, the
frequent desire to pass his water increased, and the pain in the back con-
tinued, with great pain in the inside of the thighs. Under these circum-
stances, it occurred to his medical attendants that stone in the bladder was
the cause of his symptoms; he was accordingly sounded more than once, but
no stone could be found.
When first seen by Dr. Lankester, he was very thin, with an anxious counte-
nance, and a peculiar stoop in his gait. He suffered much from dyspeptic
symptoms, and after taking food he frequently had severe gastrodynia. The
bowels were habitually constipated, and never relieved without medicine. He
suffered great pain in the back; but referred the seat of it to the region of
the bladder in front, above the pubes. Pressure in this region evidently gave
him pain. The urine, which he passed every hour or hour and a half, was
sometimes more coloured than at others. It gave an acid re-action to test
paper; and, after standing a considerable time, threw down a deposit which,
under the microscope, presented lithate of ammonia and organic shreds, appa-
rently of mucus and fibrine. Blood and pus-globules could also be plainly
distinguished. On applying heat and nitric acid, albumen was precipitated.
With these symptoms, it was somewhat difficult to come to a conclusion with
regard to the disease. Dr. L. was inclined to regard the case as one of chronic
inflammation of the bladder, with ulceration. With the view of alleviating
WESTMINSTER MEDICAL SOCIETY. 299
the pain, opium and henbane were given, and mustard cataplasms applied
over the region of the pubes. He seemed to get a little better under this
treatment. He subsequently took copaiba. In the summer, he went into the
country; and Dr. L. lost sight of him for a few months, till sent for to see him
on the 21st of December. In the mean time, he had consulted an eminent
surgeon, who had passed a catheter, and endeavoured to inject the bladder.
This operation had been attended with great pain, and an increased amount
of blood in the urine. In a note from the surgeon, who was then consulted,
he says, “I could not, when I once tried to inject the bladder with warm
water, get the fluid to pass, although the catheter was fairly beyond all possi-
bility of prostatic obstruction.” The patient was now in a much worse con-
dition than when Dr. L. last saw him. He was exceedingly emaciated ; the
pain in the back and region of the bladder was constant and intense. He
passed his urine more frequently than ever. It was occasionally bloody, but
sometimes clear. On standing for a short time, it deposited a thick sediment,
which consisted of lithates, mixed with amorphous organic matter. Nitric
acid and heat showed a large quantity of albumen. His bowels were very
much relaxed, and he was troubled with vomiting. The purging was arrested
in the course of a few days, but the sickness continued. He took quarter-
grain doses of morphia thrice a-day, which in some measure subdued the pain;
but he gradually got weaker, and sank on the 2nd of January following.
Post-mortem. Eacamination. The lungs and liver were healthy. The heart
was of natural size ; slight deposits were observed upon the mitral and semi-
lunar valves. Both kidneys were enlarged, but the left much more than the
right. The capsule was easily separable from the mass of the kidney. The
tissue of the whole kidney was soft and easily broken down, but there was no
conversion of tissue. The pelvis contained some puriform fluid, which was
traceable down the ureter. Parts of the kidney presented granular degene-
ration. The coats of the bladder were firm, when grasped from the outside.
It contained no urine. On opening it through the urethra, a loose organized
mass of a yellowish colour was found free. Attached to a point near the neck
of the bladder, was a granulated mass, highly injected, presenting portions
of a red colour passing off into white. It was easily broken down with the
knife, and yielded to slight pressure. , Higher up the bladder, on one side of
the fundus, another tumour presented itself, of larger size, but having the same
character. The loose mass had evidently been separated from one of the por-
tions still in connexion with the bladder. Dr. Lankester had not had the oppor-
tunity of examining these growths by the microscope; but no doubt could exist
of their belonging to that variety of carcinomatous growths which have been
designated medullary sarcoma, fungushaematodes,etc. Thecoats of the bladder
were very much thickened. The prostate was considerably enlarged ; and,
on its being sliced, several points presented matter precisely similar to the
growths in the bladder. The glands of the abdomen, the spleen, pancreas,
stomach, etc., presented no trace of malignant disease.
REMARKS. In cases of this kind, the general symptoms are often insuffi-
cient to afford a clear diagnosis. There are, however, some points with regard
to the blood and other products in the urine, which may serve to assist our
diagnosis. When blood flows after the introduction of the sound, or passes
in small quantity from the urethra after the flow of urine has terminated, we
may conclude that the haemorrhage is not from the kidneys, but from the
bladder. Sir Benjamin Brodie states, that it is not uncommon for small por-
tions of the fungoid growth to be passed with the urine, which will discover
the disease. This, however, does not always occur; and it was not observed
in the case now related. It thus appears, that thus far we are without any
absolute diagnostic of the presence of this disease. There is still, however,
one mode of inquiry, the microscope. At the time this case occurred to Dr.
Lankester, we were not so well acquainted with the microscopical appearances
of carcinoma as at present ; and it appeared to him that the use of his instru-
20

300 REPORTS OF SOCIETIES.
ment afforded the most available means for diagnosis in this disease. Carci-
noma in the bladder is generally of the softer kind, and as this organ is seldom
affected by analogous formations, which occur on the external parts of the body,
the diagnosis of malignant disease of the bladder is more difficult. Injections of
warm water gave no relief in this case. Opium, as in so many other forms of
malignant disease, seems to be the medicine which best alleviates the suffer-
ings of the patient. Gallic acid, acetate of lead, etc., which act favourably
in haemorrhage generally, would probably be of service where the haemorrhage
was alarming in fungoid disease of the bladder.
MR. CouTSON agreed with Dr. Lankester, as to the difficulty of distinguish-
ing morbid growths in the bladder. There was first the simple polypus, which
might be of small size, or might occupy the entire cavity. There was, also,
fungus haematodes, a very rare disease, and generally complicated with calcu-
lus. A man who had been well known about town, suffered from this disease,
and had also numerous calculi. He sank at last from exhaustion. There was
also the disease which was met with in Dr. Lankester's case, which he be-
lieved was medullary sarcoma. Mr. Coulson also mentioned the case of a gouty
subject, who was suddenly seized with haemorrhage from the bladder, com-
plaining also of a wearing, aching pain in the loins. There was afterwards,
almost invariably, blood in the urine, at first diffused through the fluid, and
passed without pain, and subsequently in the form of coagula, with great
pain. The discharge of blood suddenly ceased ; and he was then affected with
the symptoms of chronic inflammation of the bladder, with indications of
calculus. No stone could be discovered. There was great difficulty in passing
the catheter, and moving it round the bladder; while doing this, a portion of
morbid growth came away, which proved to be malignant. He was not
sounded afterwards. The use of the catheter was attended with exquisite
pain. The patient died in twelve months, worn out by intense suffering.
For ten or twelve days before death, the urine escaped involuntarily and with-
out pain. The abdomen only was examined. The bladder and surrounding
parts filled up the entire pelvis. The former was so soft, that it gave way in
taking it out; it was filled with a mass resembling cauliflower excrescence of
the uterus. It appeared to have arisen from the mucous and sub-mucous
tissue of the organ.
Malignant disease of the bladder is only relievable by opiates; and the less
done, the better for the patient. The diagnosis in this case was only obtained
by bringing away a portion of the diseased growth. The microscope might
certainly be of use by detecting the existence of nucleated cells; otherwise
there are no positive signs by which a malignant disease affecting the bladder
can be detected before death, except from a fortuitous occurrence, such as was
met with in his case.
THE PRESIDENT directed attention to the means of arresting haemorrhage
from the bladder. A patient, under M. Dupasquier's care, an old man of
seventy, passed daily a pint of blood for a long while, and used many medi-
cines, including gallic acid in large doses, and the muriated tincture of iron,
but without benefit. No disease of the bladder could be detected. Whether
it were the effect of the drug, or of accident, no one could tell; but the
haemorrhage ceased while he was taking the oxide of silver.
MR. NUNN stated, that in a case of Mr. Simon's, of superficial carcinoma
of the prostate, the microscope was employed, the malignant character of
the disease discovered, and the catheter, in consequence, was not again passed.
Sir B. Brodie had seen the case, and remarked that it was the first in which
malignant disease of the urinary organs had been detected during life.
MR. KESTEvKN mentioned a case of haemorrhage from the bladder, which
he published some time since in the Medical Gazette. The diagnosis of malig-
nant disease was not clearly made out ; and some thought there was gouty
disease, others stone. The tincture of the sesqui-chloride of iron was of most
service. It was looked upon as malignant, because the haemorrhage con-
tinued while the patient was at rest.

WIS TMINSTER MEDICAL SOCIETY. 301
MR. HANGoCK could only see a very great impropriety in sounding the
bladder in a case of haemorrhage from that organ, unless there were symp-
toms of stone, which in malignant disease of the bladder was not usual.
DR. SIBSON thought the microscope of more use in discovering the source
of the haemorrhage, than the presence of malignant cells. If it came from
the coats of the bladder, it would not present the tubular casts from the
kidneys. The source being discovered, would serve as a guide to the treat-
ment. To relieve pain, he advised belladonna, or stramonium. Belladonna
completely controlled pain; it was not necessary to give it as often as opium,
as its action was more permanent ; it required, however, to be carefully
watched. It would be useful to give opium with it, as the combination of
marcotics is more powerful than a large dose of any one singly.
DR. DANIELL, after making some remarks on the diagnosis, said that tur-
pentine in small doses will often arrest renal and vesical haemorrhage
MR. Gower said, that he had considerably relieved pain in two cases, very
similar to those described by Dr. Lankester, by giving gum-arabic. The
patients had consumed about a quarter of a pound weekly.
DR. LANKESTER thought that medullary sarcoma and fungus haematodes
were transition diseases, and still considered his case one of fungus. The
principal malignant diseases of the bladder are of a soft kind, in which the
cells easily break down, and are found in the urine. The finding of nucleated
cells is, however, not a diagnostic sign, as they are met with in fibrous and
other tumours, interspersed among other cells; when, however, these cells
are very numerous, then we may conclude that malignant disease exists. We
cannot, however, affirm that their absence is a proof of the non-existence of
malignant disease; because the diseased growth may not have become broken
down.
SATURDAY, FFBRUARY 2, 1850.
FRANCIS HIRD, Esq., PRESIDENT, IN THE CHAIR.
CARIES of THE HEAD of THE FEMUR. M.R. HAYNES WALTon exhibited
three specimens of Caries of the head of the Femur, removed during life, to
show the alteration in form and structure, effected by morbus coxarius. The
first was taken from a girl nine years old. In place of the head and neck,
there was a rounded and spongy portion of bone, projecting little more than
half an inch from the femur. She made a good recovery. The second was
from a lad twenty years old. The head was nearly gone ; the neck was of
the natural size, but so soft that it broke in two during the operation. The
third was from a boy eleven years old. Part of the head was lost, and the
neck was shortened and reduced in size. Mr. Walton was anxious to discover
some diagnostic signs by which dislocation could be ascertained. The change
in the form of the bones he had shown, would cause all the symptoms of dis-
location. The limb would be shortened and the trochanter elevated, and
brought nearer the pelvis. From the position of the limb, nothing could be
learned ; it may be turned inwards or outwards; and the thigh may be
flexed on the pelvis or extended.
PASSAGE OF A PLUM-STONE, SEVERAL MonTHS AFTER IT HAD BEEN swal-
Low ED, THROUGH A FISTULA AT THE UMBILICUs. Mr. G. B. CHILDs exhibited
a plum-stone, which had escaped from a fistulous opening at the Umbilicus,
after having been lodged in the intestines for five or six months.” The patient,
a boy four years old, had suffered from hooping-cough, measles, and scarlet-
fever. The latter had been followed by dropsy, from which he recovered, and
seemed to enjoy good health afterwards. Some months.since, the umbilicus
became swollen and red, and an abscess formed, which burst, and continued
to discharge for several months. He was admitted into a hospital, where the
opening was enlarged, and another made about two inches below it. He re-
mained there a fortnight; and while in the hospital, feculent discharge oc-
302 REPORTS OF SOCIETIES.
curred from the lower aperture. When he came under Mr. C.’s care, there
were two sinuses—one in the centre of the umbilicus, the other a little lower
down : the latter yielded the faecal discharge. On the 16th of last month
(January), the plum-stone was discharged from the wound, after great suffer-
ing. After this, the fºcal discharge was greater ; and, on probing the wound,
the instrument passed at least two inches backwards into the abdomen. The
bowels acted freely, and the general health was pretty good. Did the abscess
and fecal fistula in this case arise from the presence of the foreign body in
the intestine, or from the previous ill-health of the patient 7
ON INFLAMMATION of THE MAMMA. By MR. T. W. NUNN. After a few re-
marks on the common modes of treatment of Inflammation of the Mammary
Gland, and their inadequacy to prevent suppuration, the author stated that
he proposed the following plan. 1. To confine the patient to the horizontal
position. 2. To prevent any extraneous irritation of the inflamed organ. 3.
To envelope the breast with mercurial ointment spread on thin linen, and to
cover this with a tepid poultice. 4. To support the gland by a suitable
bandage, when the horizontal position cannot be maintained. 5. After the
constitutional irritation has been allayed by a brisk purgative, effervescing
salines, and proper regimen, to carefully watch the state of the pulse, and
look for the proper moment for the administration of tonic medicines. 6.
Wine and stimulating articles of diet should be allowed only with great cau-
tion. In the majority of cases, Mr. Nunn was of opinion that, after the first
day or two, the patient needs bark and ammonia, quinine and iron, rather
than depletive drugs. The strength of the mercurial application should be
adapted to the condition and natural texture of the skin covering the gland.
In some instances, the unguentum hydrargyri fortius will not be found too
powerful; in others, it will be necessary to dilute it with an equal proportion
of ceratum resinae. A combination of the extract of belladonna, hyoscyamus,
or opium, in the proportion of 3i. to the 3i. of ointment, will be most effectual
in allaying the intense agony frequently complained of. The leading idea in
treating mammary inflammation, should be the prevention of suppuration :
when that cannot be avoided, the attempt should be made to render it as cir-
cumscribed as possible. Mr. Nunn opposed large incisions of mammary
abscesses, and thought the practice of laying open extensive sinuses of the
breast uncalled for. The tissue of the gland, he averred, should not be cut ;
and he quoted Dr. Gibson of Philadelphia, to show that sinuses may be oblite-
rated by pressure. The importance of preserving the integrity of the gland,
he (Mr. Nunn) observed, cannot be overrated. He related several cases in
illustration of his position.
CASE I. A young woman, aged twenty-two, who had been confined with her
second child about a month, applied to Mr. Nunn, with her breast in a state
of intense inflammation. She had been applying poultices and hot fomenta-
tions for two or three days, without any relief. Her tongue was white; bowels
confined; much thirst ; pulse rapid, but weak; skin moist. She was ordered
a saline aperient of magnesia, and a drachm of decoction of cinchona twice
a day; also to have mercurial ointment, diluted with resin cerate, applied to
the breast. In ten days, the redness, heat, and swelling, had much diminished;
and the constitutional symptoms were improved. The ointment gave great
ease, and had enabled her to sleep; it had not produced any unpleasant effects.
She was ordered to apply the ointment more sparingly, and to take quinine
and porter. In a few weeks, the disappearance of some hardening which had
remained, indicated a satisfactory termination of the case. &
CASE II. M. R., aged thirty-nine, had chronic inflammation of the right
breast, for which she had been subjected to a variety of treatment. The swell-
ing was principally confined to the lower half of the organ; there was little
redness, but much tenderness. Mr. Nunn ordered mercurial ointment, with
a drachm of opium to the ounce, to be rubbed in ; and the patient to take

WESTMINSTER MEDICAL SOCIETY. 303
ammonia, with cinchona and conium. The ointment gave rapid relief, and
the patient soon recovered. .
CASE III. M. M., aged twenty-one, applied to Mr. Nunn, about six weeks
after delivery, with an acutely inflamed breast. The mercurial application
was ordered. She neglected to report herself at the time appointed, but
applied the ointment for a week. The system became affected: but no actual
mischief appeared to have been done. This was the only case in which the
mercurial application had effected more than was desirable ; and though
suggesting caution in its employment, Mr. Nunn did not consider that it
formed an objection.
CASE IV. M. A., aged forty, had mammary abscess, which had been treated.
by poultices, etc. It had burst, and left a circular ulceration of the size of
half-a-crown. The granulations on the surface of the gland were weak and
flabby, and covered with a copious secretion of pale pus. Mr. Nunn dis-
covered a large flat sinus, extending a considerable distance beyond the
margin of the ulcer; the discharge from it was very abundant, and depress-
ing to the patient. The poultices were discontinued ; bark and ammonia
were administered, with a more generous diet. The sinus healed without the
necessity of laying it open, and the patient was restored to health.
The author pointed out the importance of attending to the peculiar relation
in which the mammary gland stands to the economy, and to the effects pro-
duced by inflammation of the trabecular and of the secreting structures. It is
important to the mother, as well as to the child, that the integrity of the organ
should be maintained. Mercury, in virtue of its efficacy in checking the
tendency of blood to deposit fibrin, and of its property of causing the re-
absorption of effused lymph, seems to be strongly indicated in the disease
under consideration. Its benefit is obvious, when we reflect that by the for-
mation of an abscess in the substance of the gland, the ducts are destroyed,
and the portion of the gland becomes isolated. For a time, it may give no
inconvenience ; but, under the excitement of lactation, it may become the
seat of a fresh attack of inflammation. This, Mr. Nunn observed, must have
been met with by every practitioner of experience. In conclusion, Mr. Nunn
said that he would not be understood to advocate the use of mercury in all
cases of mammary irritation ; but he believed the plan he had recommended
likely to prove of great service.
MR. I. B. B.RowN said, that one great cause of inflammation of the breast
was, the not applying the child to the breast early enough. This cannot be
done too soon after delivery. Stagnation of the milk in the breast acts as an
irritant, and causes inflammation. It can be overcome by general remedies,
—the horizontal position, keeping the breast supported, causing the skin to
act, and by warm-water dressing. He objected to drastic purges. Parturient
women cannot bear to be lowered, and ought not to be subjected to the de-
pressing action of mercury. . Mammary inflammation was often caused by
keeping the patients on gruel, when they required an improved diet. The
excess of fluid was bad. Most patients subject to inflammation of the breast
were of the strumous diathesis, and could not bear mercury, which would
deteriorate their milk, and injure their offspring. Mercurial ointment might
be useful in chronic mammary inflammation; but it could not be used with
safety, he thought, in an acute attack.
Mr. GAY did not think the lacteal vessels were implicated in the disease;
the abscess was situated in the cellular tissue; for, after recovery, the breast
generally resumed its proper action. He was in favour of the early use of the
lancet in opening the abscess, to prevent the burrowing of the matter, and
the formation of sinuses, which are difficult to treat. The fascia, in some
cases, becomes more dense, from the inflammatory action, and thus prevents
the abscess from bursting through it.
DR, KING would be inclined, to give Mr. Nunn's treatment a trial.
MR. GREENHALGH had tried the plan, and found it successful.
304 4. REPORTS OF SOCIETIES.

MR. HANgock thought that mercury would be useful in cases of occlusion of
the lacteal duct, as it would be probably caused by effusion of lymph, and
mercury is the best absorbent. His practice was, to keep the child to the
breast as long as possible; and when that could not be continued, to draw off
the milk artificially. Mr. Nunn's plan was not original; for he (Mr. H.) had
used mercurial plaster to the breast for the last five or six years, with an
opening in it for the discharge to pass away. He did not consider these cases
as instances of phlegmonous, but of irritative inflammation. Hyoscyamus
was of great service. He objected to the early opening of an abscess, unless
there be great constitutional disturbance: when he did use the lancet, he
avoided incising transversely to the ducts, so as not to wound them.
* DR. MURPHY said, that no one plan of treatment could be followed as the
best, in all cases of inflammation of the mammae. Mammary abscess might
be sthenic or asthenic. In strong, healthy young women, where the milk, from
some cause, was not withdrawn, he was satisfied, that if proper antiphlogistic
measures were adopted, there would be no reason to fear abscesses forming.
He advised the combination of târtar emetic with the neutral Salimes. The
feelings of the patient should be consulted, as to the use of warm or cold
applications. In weak and irritable women, if purgatives and tartar emetic
were used, the irritation would be increased, and abscess after abscess would
form. Such patients require tonics and support. If, on the other hand, a
robust, plethoric woman, be placed on full diet, after parturition, mammary
abscess will be very apt to occur.
DR. MANSON stated, that at the General Lying-in-Hospital, it had been the
custom for the last twenty years, when the breast became hard and knotty
after parturition, to rub in freely the linimentum ammoniae, as a preventive
of suppuration; and so successful had this practice been, that they had
scarcely ever had a case of mammary abscess.' The liniment is rubbed in for
ten minutes or a quarter of an hour, until the breast becomes soft and
supple. He thought it acted as an emollient and evaporating lotion, while
the stimulant quality of the ammonia was evidenced in the reduction of the
quantity of the milk. When the inflammation is so severe, that friction with
the limiment cannot be used, he thought the mercurial ointment might be
tried, with a poultice over it. In a very severe case, chloroform was given
before friction was used, and successfully ; the patient recovered without
suppuration.
MR. Coulson recommended the treatment of mammary inflammation by
pressure; strips of soap plaster, encircling the breast, being applied on the
same principle as in orchitis. He considered it eminently serviceable in the
incipient stage, perhaps not so much so when the disease is more advanced,
but again advised it after the abscesses have burst, and sinuses have formed.
The advantage attending this plan is, that the patient can go about her
avocations while under treatment. .
SATURDAY, FEBRUARY 9, 1850.
. FRANCIs HIRD, Esq., PRESIDENT, IN THE CHAIR.
MALIGNANT DISEASE of THE OVARIES, MR. GREENHALGH exhibited a very
interesting specimen; and stated, that the history of the case would be given
to the Society on some early occasion.
TREATMENT or STRICTURE OF THE URETHRA BY PERINEAL INCISION. MR
HENRY SMITH read a paper upon this subject. The principles of practice
which he wished to establish, were three in number, viz.:- -
1. Strictures so obstinate as not to allow the passage of any instrument,
and so complicated as to resist the ordinary modes of treatment, should
be treated by free Perineal Incision. - .
1 A more common, and, so far as our experience goes, an equally successful method,
is frequent gentle friction with warm olive or other bland oil. EDITOR.
WESTM INSTER MEDICAL SOCIETY. º 305
2. Strictures which permit the passage of the smallest instrument, ought
not to be cut, because it has been found that this operation is not
unfrequently followed by fatal results.
3. Strictures of a bad kind, which do not admit of cure by simple dilata-
tion, may often be treated successfully by the potassa fusa, which,
being safer than incision, ought to be tried before that operation is
resorted to.
The author dissented from, and strongly condemned the practice advocated
by Mr. Syme, of freely dividing with the knife strictures which, though
obstinate, permitted a bougie to enter.
The discussion on Mr. H. Smith's paper was deferred.
AUDITORS’ REPORT. From this document, it appeared that the balance in
hand was 731. 18s. 3d., after an expenditure of 921. 15s. 2d. The total
receipts during the year were 1667. 13s. 5d. The item 231. 19s. 11d., for
printing the Abstract of the Proceedings, seemed almost an unnecessary
waste of money, considering that the journals give much better accounts of
memoirs and discussions.
NoMINATION OF CANDIDATES FOR OFFICE. In accordance with the laws of
the Society, the PRESIDENT intimated that any Fellow might propose those
whom he thought most eligible. The offices to become vacant, were those of
a President, two Vice-Presidents, and five Members of Council. Dr. Murphy
was nominated as President, and Dr. A. B. Garrod and Mr. James F. Clark,
as Vice-Presidents. For the five vacancies in the Council, numerous Fellows
were proposed; but several having withdrawn, they were ultimately reduced
to nine, viz.:-Dr. Sibson, Dr. Cormack, Dr. Tilt, Dr. Tyler Smith, Mr. Hird,
(retiring President) Mr. B. Travers, jun., Mr. Greenhalgh, Dr. Lightfoot, and
Mr. H. Walton.
UNION of THE SocIETY witH THE LONDON MEDICAL SocIETY. . The PRESI-
DENT gave a detailed account of the negociations now taking place between
the Councils of the two bodies. The proposed amalgamation has already
been noticed by us (p. 214); but this was the first occasion on which it was
formally announced to the Fellows.
SATURDAY, FEBRUARY 16, 1850.
FRANCIS HIRD, ESQ., PRESIDENT, IN THE CHAIR.
CHLoROFORM IN ABORTION. MR. I. B. BROWN mentioned a case of abortion
at the sixth week, in which, by subjecting the patient to the influence of
Chloroform, he was enabled to remove the ovum, previously grasped by the
os uteri ; the haemorrhage ceased. Mr. Brown thought that the treatment
which he had adopted in this case, would be found generally applicable to
others of like nature.
DR. TYLER SMITH had never seen a case of abortion in the early months,
in which he could not get away the ovum by means of an enema, containing
some stimulating ingredient, such as turpentine. He had seen some re-
markable cases in which this treatment had been most successful. In one
case which he had attended, with Dr. Cormack, a lady's life had been saved,
when at the last extremity, by this proceeding. A stimulating enema inva-
riably produced reflex dilatation of the os uteri, and contraction of the uterus
itself.
Dr. CoRMACK, in reference to the case mentioned by Dr. Tyler Smith, said,
that he was quite satisfied that the turpentine enema had saved the patient
from impending death. He greatly approved of the practice advocated by
Dr. Tyler Smith ; and another illustration of its value was afforded by the
case which he had detailed to the Society on the 19th January. [Wide LoNDoN
JoukNAL of MEDIGINE for February, p. 203.]
06 - REPORTS OF SOCIETIES.
ADJourned DISCUSSION ON MR. H. SMITH's PAPER on STRICTURE. The
discussion was animated and interesting ; but as all the points adverted to
have, in one form or another, been recently laid before the profession, it is
not necessary to give a detailed report of the speeches.
DR. KNox, (late teacher of anatomy in Edinburgh,) in a lively address,
severely criticised Mr. Syme’s recent work on Stricture. He thought that a
verdict on his practice could not yet be given, as time might yet show that
the cases boasted of as cures, were, after all, not cures ; it was not tempo-
rary amendment, but permanent relief, which was entitled to the name of a
cure. . Some surgeons were too quick—too quick—in publishing their suc-
cessful cases.
MR. WADE gave an exposition of his views regarding the use of potassa
fusa, and replied to certain passages in Mr. Syme’s recent work.
MR. H.W.ALTON, MR.G.B.CHILDs, and Mr. AcToN also addressed the Society.
ELECTION OF OFFICE-BEARERs To FILL THE PLACES of THOSE RETIRING IN
RoTATION. At 10 o'clock the ballot closed, and the following was announced
as the result:-PRESIDENT—Professor Murphy: WICE-PRESIDENTs—A. B.
Garrod, M.D.Lond, and J. F. Clarke, Esq. : CouncILLORs—Francis Hird, Esq.,
Francis Sibson, M.D.Lond., F.R.S., Benjamin Travers, Esq., jun., John Rose
Cormack, M.D.Edin, F.R.S.E., R. Greenhalgh, Esq. The above are the
new office-bearers; and along with the following of the old list, constitute
the Executive Council:—WICE-PRESIDENTs—E. Lankester, M.D., F.R.S., J.
F. Marson, Esq. : TREASURER—Augustus Sayer, M.D.: HoNoFARY SECRE-
TARIES-S. W. J. Merrinnan, M.D., C. H. F. Routh, M.D.Lond.: CouncILLORs
—W. Harding, Esq., F. R. Manson, M.D.Lond., T. H. Tanner, M.D., W. R.
Rogers, M.D., W. Harvey, Esq.

THE RETIRING PRESIDENT, Mr. Hird, having left the chair, Dr. Chowne
proposed that Dr. Murphy should take it in capacity of Vice-President,
that advantage might be taken of the crowded meeting, to mark the high
appreciation which the Society had of the eminent services rendered by
Mr. Hird, during his time of office, which would terminate at next meeting,
when the minutes of the present had been confirmed. The proposition was
carried by acclamation; as was likewise a formal vote of thanks to Mr. Hird,
to which that gentleman replied in a few elegant and hearty sentences. At
the conclusion of his speech, the Fellows rose en masse, and maintained, for
several minutes, the most enthusiastic cheering.
MISC EIAL ANIEOUS INTELLs. GEN CE.
Roy AL MEDICAL AND CHIRURGICAL SOCIETY. For some days past, it has
been currently rumoured, that at the ELECTION OF OFFICE-BEARERs on the 1st
March, an attempt will be made to modify the House-list in some of its lead-
ing features. The extent to which this endeavour may be supported, will
probably form but a feeble indication of the degree of dissatisfaction which
prevails; as, though the majority of the Society is notoriously adverse to the
present system of management and distribution of honours, yet to obtain an
amount of co-operation sufficient to cast out any one of the names published
by the council, can hardly be expected. To accomplish this, more than a
hurried organization is required. Whatever be the result of the ballot, and
whatever be the character of the discussion which may precede or follow it,
we sincerely hope it may conduce to the permanent good of an Institution,
which contains within it all the elements of greatness and utility; and that
from this day henceforth there may be secured an entire community of feel-
ings and interests between the ruling and the other Fellows. . Antagonism
between the rulers and the ruled, may be a normal condition in Royal Col-
leges founded in, and for, a by-gone age ; but it is neither necessary nor na-
tural in an institution, with so free a constitution as the Royal Medical and
MISCELLANEOUS INTELLIGENCE. 307
Chirurgical Society. As we said on a former occasion, (p. 178,) the most
needed reform is to abolish the noxious and illegal bye-law, which gives birth
to the House-list : and let there be an open nomination by the Fellows, the
ballot determining the election, as appointed in the charter, and not being a
mere farce, or necessitating a troublesome concert, when others than those
named by the Council require to be brought forward. There can be little
prosperity, or brotherly feeling, in the Society, till the President and Council
are the free choice of the Fellows, and the selection of papers for publication
be impartial.
THE ROYAL COLLEGE OF SURGEONs of ENGLAND is at present said to be in a
peculiar position with regard to its treasury, and to the increased probability
of a rival College being sanctioned by Government. This measure, it is to
be hoped, may not be required ; as, if an independent College examine in
Medicine, Surgery, and Midwifery, the General Practitioners, who now in
legions join the College of Surgeons—only (as they say) to be repudiated—
would for the future enrol themselves in the new College, by which they would
be fostered, and in which they might rise to professional distinction, apart
from seniority or favour. There is no need of new Colleges, if the old ones
were adapted to the age we live in, and to the more general diffusion of sound
professional knowlege. As the general practitioners are every day becoming a
more educated and scientific body, they can no longer be treated as their pre-
decessors, the druggists, of 1815. Time, perhaps, may yet adjust all questions
of Medical Reform; but, in the present transition state of the profession, it is
incumbent on all to study conciliation, and, if need be, to make personal
sacrifices for the common good.

Roy AI, CoLLEGE of SURGEONS OF EDINBURGH. A bill is now passing
through the House of Commons, entitled—“A Bill for enabling Her Majesty
to grant a new Charter to the Royal College of Surgeons of Edinburgh; and
for conferring farther powers on said College.” This measure relates, we
believe, entirely to private arrangements, and not to public questions. It
provides for bringing to a close the existing Widows’ Fund, and separating
the College from the Incorporated Trades of Edinburgh.
THE FACULTY OF PHYSICIANS AND SURGEONs of GLAsgow, we are sorry
to learn, are applying for a new Charter, and increased privileges, as a
licensing body. One incorporation, with the licensing power for the United
Kingdom, would be sufficient; but with a College of Physicians and Surgeons
in Scotland, the Glasgow Faculty is more than superfluous. It might, with
great propriety, be merged in, or united with, one or other of the Colleges in
Edinburgh.
Roy AL EDINBURGH MATERNITY HospitaL. The annual meeting of the
Governors and friends of this Hospital was recently held,—the LoRD PRO-
voST in the Chair.
Mr. BUCHANAN, S.S.C., the Secretary, read the Report of the Directors,
which stated that, owing to a falling off in the amount of subscriptions, they
had been under the necessity of drawing on the funds in the Bank to the
extent of £60. During the past year, 687 persons had had medical attend-
ance during their confinement; and 259 had, in addition, received shelter
and maintenance within the Hospital. The expenditure amounted to £385.
Two deaths had occurred during the year. *
BISHoP TERROT moved a resolution, to the effect that the Report be adopted
and circulated, and recommending the charity to the more liberal support of
the community; and suggesting that, since Edinburgh had become so dis-
tinguished in the obstetric art, there should be something more definite than
a simple recommendation for increasing the subscriptions, by bringing the
Institution under the notice of those strangers who were now continually
resorting to Edinburgh. Dean of Guild WILSON seconded the motion, which
was unanimously agreed to.-[From an Edinburgh Newspaper.]
308 MISCELLANEOUS INTELLIGENCE.
MEETING of THE CONFERENCE RESPECTING MEDICAL REFoRM. A meeting
of the delegates of the various medical associations appointed to watch over
the Medical Reform Question, was held on Tuesday, February 19th, at the
Hanover-square Rooms, NATHANIEL CLIFTon, Esq., in the chair. The an-
swer of the Council of the Royal College of Surgeons to the Council of the
National Institute, was submitted to the meeting.
The CHAIRMAN said that this document was only another illustration of
the shuffling conduct of the College Council. It was for the Conference to
decide, whether they would put up with such treatment any longer.
Mr. BottomLEY said that it was now quite clear that we must have a se-
parate and independent college, possessing full powers in every respect. It
would be quite absurd to attempt anything further with the Council of the
College. He should move, that “after the receipt of the letter from the
Council of the College of Surgeons, now read, it is inexpedient to make any
further application to that Council.”
Mr. Bowl ING seconded the resolution.
DR. WEBSTER (Dulwich) said that no one could now doubt what was the
course to be pursued. With respect to the letter from the Council of the
College of Surgeons, it was unkind, uncourteous, unfriendly, and unjust, and
calculated to produce great dissatisfaction and angry feelings throughout the
great body of the profession. They had gone to that Council, to entreat them
to do justice to the great mass of the surgeons of the kingdom, and this was
the answer | If the Council had agreed to all that the Conference required,
it would have left them, after all, in an unpleasant position. The profession
must be re-modelled, so that equal privileges should be granted to all who
had passed an adequate examination. Many gentlemen in practice were not
members of the College of Surgeons in London, but doctors of medicine,
licentiates, and Fellows of other bodies; and these should be privileged to
practice ; they were received into the army and navy, and why not to other
public offices ! If they all united, there could be no doubt of their attaining
their object. With respect to the assumption of the Council of the College
of Surgeons, that they had the full control over the examination of surgeons,
and were the only surgical body in the kingdom, he had to state that the
Scottish Universities had the power, after examination, of granting a diploma
of Magister Chirurgiae, and he believed the English Universities had the
same. The London University, at all events, by their Charter, had the power,
and did examine, in “medicine, surgery, midwifery, and pharmacy,” and he
believed, could grant degrees in these separate departments. On what grounds,
then, did the College of Surgeons assume their sole power over examinations
in surgery . It was evidently a mere assumption. This was a precedent, at
all events, with which they could go before Sir George Grey. (Cheers.)
The resolution of Mr. Bottomley having been put, was carried unanimously.
It was stated by Mr. ANGELL and Mr. BIRD, that the Council of the Na-
tional Institute had, on the part of that body, answered the letter of the
Council of the College of Surgeons: that letter would shortly be published.
They might observe that the Council of the National Institute were now de-
termined to obtain a new College, with full right to examine in all branches,
and to be independent of all other bodies. That Council, wishing to act on
the principle of mutual concession, had, at the suggestion of Sir George
Grey, agreed to certain principles; but this was under very different cir-
eumstances from those in which they were now placed ; and the consequence
was, they must agitate for an independent College. (Great cheering.)
The following resolution was proposed, seconded, and unanimously car-
ried :—
“That the resolution, empowering the deputation to wait upon Sir George
Grey, passed at the last meeting of the Conference, be acted on ; and
that a letter be written to Sir George Grey, requesting him to appoint a
time to receive the deputation.”
MISCELLANEOUS INTELLIGENCE. 309

Several gentlemen having expressed their determination to carry out the
objects of the meeting, the Conference separated, after making arrangements
for future action. [Abridged from the Lancet.]
CHOLERA SERVICEs. TESTIMONIAL To MR. R. H. WHITEMAN, SURGEON,
PUTNEY. On the 16th of January, Mr. R. H. Whiteman was presented with
a valuable testimonial, purchased by the subscriptions of numerous inhabi-
tants of Putney. It consisted of a handsome silver tankard and salver, and
a gold watch, upon each of which was engraved an inscription, indicating
the sense entertained by the donors of the “zealous and efficient services
rendered by Mr. Whiteman, as the medical officer of the district, during the
late visitation of cholera.” The presentation was prefaced by an address by
the Rev. Edward East, the officiating minister of the parish : and Mr. White-
man made a suitable reply. - -
SourcE of THE DIPLOMAs of LoNDON PHYSICIANS. A correspondent of the
Provincial Medical and Surgical Journal, has given the following analysis of
the sources of these honours of medical men, whose names appear in the
London department of the Medical Directory. It will be observed, that 509
have a degree of M.D., and 45 that of M.B. They are thus distributed to
the various universities.
Edinburgh M.D. ... . 178
London #. ; } tº º e 66
Oxford ...}#} º ... ... 25
Cambridge ... . . ...}} *: } g º º 41
Dublin & © tº {#. % tº e º 11
St. Andrew’s ... ... M.D. e tº © 68
Glasgow M.D. 35
Aberdeen M.D. 30
Paris e - e. M.D. ... ... 15
German ... ... ... ..., M.D. ... a. 59
Various Continental
Universities—Austria, M.D. 13
Prussia, Italy, etc.
America and U.S. ... ... M.D. ... ... 6
Nondescript (i. e.,)
the degree being given M.D. 6 7
without the University M.B. 1 ( “ ” “’ “
being mentioned ...
Total......... • * * * * * * * * * * * * * * * * * * * * 554
PROVIDENT DISPENSARIES. M.R. H. L. SMITH, of Southam, proposes to
renew the discussion of his favourite scheme, and has announced his inten-
tion of spending some months in London, that he may the more easily make
known his opinions regarding, and his experience of, these admirable insti-
tutions, of which he may be said to be the father. We have reluctantly
been obliged to defer the publication of Mr. Smith's lecture for another
month. - -
Royal SocIETY. The abolition of the Committees has given great satisfac-
tion to the majority of the Fellows: and is likely to conduce to the prosperity
of the Society. .
31()
AP POI N T M. E. N. T. S.
CoopFR, White, Esq., appointed by the Queen, Senior Surgeon to the Artillery
Company of London. - *
FREER, Dr., appointed Physician-Accoucheur and Lecturer on Midwifery in Mid-
dlesex Hospital, in the room of DR, WEST, resigned.
JEAFFRESON, Henry, M.D., appointed by the Queen, Physician to the Artillery
Company of London.
LATHAM, Dr., elected President of the Pathological Society of London.
LAW, Charles, Esq., appointed by the Queen, Surgeon to the Artillery Company.
STEWART, Dr. A. P., elected Assistant-Physician to the Middlesex Hospital, in the
room of DR. R. G. LATHAM, resigned.
WINSLOW, Dr. Forbes, Editor of the Journal of Psychological Medicine, elected a
Fellow of the Royal College of Physicians of Edinburgh.
O BIT U A. R.Y.
BUCKLE, Dickins, Esq., Deputy Inspector General of Hospitals, at Newport, Isle of
Wight, aged 88, on 15th February.
CRAVEN, Robert, Esq., F.R.C.S.E., Surgeon to the Hull General Infirmary, at Hull,
on the 24th January.
DIxoN, Thomas, Esq., many years Surgeon of the Hereford Regiment, at Park Place,
Chelsea, aged 82, on 14th February.
FERGUSON, Duncan, Esq., late House-Physician to King's College Hospital, at 32,
Sidney Street, Brompton, after a severe attack of typhus, aged 26, on 1st
February.
FITTON, Dr., drowned in the wreck of the Richard Dart, convict-ship.
GALE, Mr., Surgeon, drowned in the wreck of the Richard Dart, convict-ship.
GooD, Samuel, Esq.. one of the Surgeons in Ordinary, to H.R.H. Prince Albert,
and formerly Surgeon-Major to the Scots Fusilier Guards, at Worcester, on
22nd January.
LOWE, Richard, Esq., Senior-Surgeon to the Bristol Infirmary, after a severe illness,
on the 9th February.
OxDEY, Edward, M.D., at Exeter, of chronic bronchitis, aged 80, lately.
REYNOLDs, Cornwall, Esq., Surgeon R.N., at Mare Street, Hackney, on 13th Feb.
SWINSON, George, Esq., Surgeon, at his residence, Church Lane, Handsworth, aged
85, on 11th February.
IB O O & S R E CIE I'VE D.
BATCHELDER on Cholera. New York: 1849. DANIELL (Dr. W. F.), Medical
Topography and Diseases of Guinea. London : 1849. INSTRUCTIONS for Making
Unfermented Bread. By a Physician. 16th Edition. London: 1849. MACKNESS
on the Climate of Hastings. London: 1850. MILLER (Dr. James) on the Kidney
in Scarlatina. London: 1850. TENTH Annual Report of the Crichton Asylum.
Dumfries; 1849. TRANSACTIONS of the American Medical Association. Vol. II.
Philadelphia: 1849.
E. R. R. A." "U MI.
In the February number, p. 139, line 19 from the bottom, for “bee-hive”, read
bechic. The latter term is sufficiently absurd ; but, from the misprint, we have
represented the author as writing absolute nonsense.
TO CO R. R. E. S. PON ID E IN. T. S.
UNFERMENTED BREAD is wholesome : and, if common care be used, the fear of its
containing arsenic need not exist, as we will show next month.
I, () NID ON
JOURNAL OF MEDICINE,
A MONTHLY
3Retort of the ſºletical ºtientzg.
APRIL 1850.-No. XVI.
OR I. G. I N A Is C O M M U NI CATION S.
ON THE PROGNOSIS AND TREATMENT OF ORGANIC
DISEASES OF THE HEART.
By CHARLES J. B. WILLIAMS, M.D., F.R.S.
THERE is perhaps no group of internal structural diseases, which are
more accurately distinguished by their physical signs than those of the
heart. The modes of determining the condition and action of the
muscular substance of the organ, made known by Corvisart, Avenbrugger,
Laennec, and their successors, and the method of interpreting the val-
vular murmurs, which I first proposed in 1835, have rendered the Diagno-
sis of the more common ORGANIC DISEASES OF THE HEART comparatively
easy and accurate. But the general knowledge of the PROGNoSIs and
TREATMENT has not advanced in an equal degree ; and mistakes are often
occurring, in consequence of the misapplication of the long prevalent
notions respecting the prospects and treatment of heart disease to cases
which, although correctly diagnosticated as such, are not of the grave
nature which is apprehended. It is a satisfactory result of extended
experience on this subject, that organic lesions of the heart, even of
considerable amount and complexity, are not incompatible with prolonged
life, and, under favourable circumstances, with a moderate share of health
and comfort. For example: About fifteen years ago, I was consulted
by a medical man of middle age, who presented formidable signs and
symptoms of obstructive and regurgitant disease of the aortic orifice,
with greatly enlarged heart, and dilatation of the ascending aorta. The
symptoms, at that time, were not only those of inordinate action of the
heart, but the functions of the brain were occasionally impaired; exer-
tion or emotion sometimes causing confusion of thought and indistinct
articulation. Yet this gentleman has been engaged in a pretty exten-
sive country practice ever since; and within the past year, when I last
heard of him, he had not abandoned his professional duties. And when
at length death does occur in such cases, I have been often surprised
at the enormous amount of disease that had gradually accumulated,
yet sometimes without causing those alarming and distressing sufferings,
which occur in other instances, where the lesions are much less consi-
WOL. II. 21
312 ORGANIC DISEASES OF THE HEART.
derable. The largest human heart that I ever saw, weighed, when
ampty, 40; ounces, and measured in circumference of the ventricles, 143
inches; in length, from arteries to apex, 8% inches, and in thickness
of the walls of the left ventricle, from 1 to 13 inches; yet this monstrous
organ carried on the circulation of its owner, a man of fifty years of age,
with so little disturbance, that, until within a few weeks of his death,
he was able to perform his duties as hall-porter in the town-house of a
nobleman, and he had not failed to partake of the abundance of creature-
comforts which such situations commonly afford.
In many other examples, Ihave felt the heart's impulse extending from
the midsternum to the seventh or eighth rib, beyond the line of the left
nipple; I have heard the harshest and loudest valvular murmurs; and,
in the most tranquil state of the circulation, the walls of the chest have
been visibly shaken by the strong exaggerated movements of the diseased
organ; yet the patient has complained of little or no suffering, and,
under favourable circumstances, has survived, and even enjoyed life, for
years.
With such instances we may contrast others, in which, with signs far
less prominent—an impulse rather tumultuous and irregular, than ex-
tended and violent, and murmurs rather peculiar and deep-seated than
loud or long—the distress and disturbance of the circulation have been
sudden and serious, and death has occurred within a few days or weeks
from the first development of the symptoms.
It is, then, evident, that the pronounced character of the signs is no
measure of the severity or danger of a disease of the heart; and the
PROGNOSIS is to be determined by a consideration of other circumstances.
My experience leads me to point out the following, as the most signifi-
cant on this subject; and I shall afterwards show, that they are equally
important in relation to the treatment. They may be conveniently
grouped under the following heads:—
1. Circumstances relating to the Heart itself.
2. Circumstances relating to the state of the Blood, and to its General
Circulation.
Each of these heads will need some illustrative comments.
1. A Structural Disease of the Heart may be considered serious and
dangerous, in proportion as it impairs the power of the organ to carry
on the circulation. We may judge of this power, both by the physical
signs of the action of the heart itself, and by the condition of the circu-
lation at large. The power of the heart to carry on the circulation is
represented by its natural sounds; and so long as they are distinct,
with their proper characters, of comparative dulness or prolongation
of the first or systolic, and clearness or shortness of the second or dia-
stolic,+then, no matter how loud the accompanying murmurs, the heart
is doing its work,” and there is little ground of present alarm. If, on
* The true causes of the natural sounds of the heart have been so fully and satis-
factorily demonstrated by the experiments which I conducted in 1835, and which
have been subsequently repeated and varied by numerous observers, in Europe and
America, that it seems very strange that much difference of opinion should exist
about them. Yet, every now and then, we hear of new explanations proposed,
suggested by some crude experiment or observation of a monstrosity. A curious
instance of the latter, is the account of the sounds of the heart given by M. Cruveil-
hier, derived solely from the observation of the heart of a new-born infant, which,
BY CHARLES J. B. WILLIAMS, M.D., F.R.S. 3] 3
the contrary, the natural sounds are indistinct, or considerably altered,
being too faint to be audible in the usual position, or superseded (not
merely masked) by abnormal murmurs, then, whether there be loud
murmurs or not, whether there be palpitation or irregular action or
not, whether the impulse be strong or weak, it may be inferred that the
heart's action is seriously impaired; and the lesion must be considered
of a dangerous kind.
I have notes of more than a score of cases, such as the following:—
A physician of eminence was consulted on account of a young lady, who
had a slight pain in the chest, with moderate palpitation. On applying
his ear to the chest, he heard so loud and harsh a cardiac murmur, that
he was alarmed, and recommended that Ishould see her. On examination,
I found a very loud, grating systolic murmur, having its greatest inten
sity to the left of the sternum, between the second and third ribs, where
there was a palpable thrill. According to Dr. Hope's rules of diagnosis,
this must have been situated in the pulmonary artery; but finding the
murmur distinct also in the carotids, I considered it to be in the
aortic orifice; this opinion was confirmed by a perceptible thrill in the
pulse. But it is more to the present purpose, that this murmur, loud
as it was, did not supersede the natural double sound; and the impulse,
although stronger and more heaving than natural, was not far beyond
its proper position. I judged, therefore, that there was no present dan-
.ger; and the regularity and moderate frequency of the pulse, as well as
the absence of other serious symptoms, pointed to the same conclusion.
This lady had some years previously suffered from some inflammation
in the chest, and had ever since felt more or less palpitation on over-
exertion. Such an exertion was the cause of her present ailment, which,
to her own feelings, subsided after some days' rest and the use of very
simple remedies; yet the murmur remained nearly as loud as ever.
After being directed to pursue the rational plan of caution against all
circumstances likely to derange the circulation or general health, this
lady returned to the country quite well, and pursued her usual occupa-
tions and amusements. This was six years ago; I have seen her three
or four times since, enjoying her usual health ; but the murmur remained
nearly as loud as ever. In this case, I consider that there was a small body
projecting into the aortic orifice, and that, although causing noisy vibra-
tions in the current, it did not oppose the passage of the blood sufficiently
from deficiency of the walls of the chest, lay exposed to view. Some years ago,
I saw a precisely similar case at Bristol, with Dr. Symonds and Dr. O’Brien; and
to show how little observations in such a case are to be relied on, I may state, that
although we were all well practised in the examination of the heart, we could not
agree as to the order and succession of the motions and sounds in the turbulent
little object before us. In fact, with a heart beating from 130 to 160 in the minute,
and in continual motion, it is not possible accurately to analyse the visible or
audible phenomena. It is no wonder that, in such a case, M. Cruveilhier should
deny that there is any period of rest; but I do wonder that he should have applied
the same inference to a healthy heart, soberly beating some 60 or 70 per minute.
All my best observations were made on the hearts of large animals, when they were
beating slowly but vigorously, and every movement and sound could be deliberately
noticed. Under such circumstances, the true relations of the motions and sounds
soon display themselves clearly ; and being once well perceived and understood,
# phenomena become familiar and easily appreciable, even in cases of greater
difficulty.
21 2
314 ORGANIC DISEASES OF THE HEART.
*
to disorder the proper action of the heart and its valves. Hence these,
in their usual transition from slack to tight, in systole and diastole, still
produced their natural sounds; which were thus a proof of the sufficient
integrity of the heart in its functions."
The following case of regurgitant aortic disease bears on the same
point. A man, aged about thirty, who had formerly suffered from acute
rheumatism, was admitted into the hospital for a slight ailment, attended
with palpitation. The remarkable feature of his case was, a very loud
musical murmur, of a cooing tone, following the second sound. Although
most intense at and near the midsternum, it was distinct in every part
of the chest; it could be heard not only in the arteries of the neck, but
faintly even in the radial artery of the wrist. This patient was quite a
stethoscopic curiosity, and was kept in the hospital on that account,
rather than because he required special treatment. Accordingly, the
natural sounds of the heart were quite distinct, proving a fair perfor-
mance of the natural function; although the systole, in its duller sound
and extended and lifting impulse, implied some degree of hypertrophy of
the left ventricle. As far as regarded the heart disease, therefore, in
spite of the loudness of the morbid sound, the prognosis was not unfa-
vourable ; and we learned from his history, that for several years the
noise in his chest had been noticed, when his health had not materially
suffered. It happened, however, unfortunately, that he took a prevailing
typhus fever, and died in the hospital. On examination of the body,.
the ventricles were found moderately enlarged and thickened, and the
valves all healthy, except the aortic, one of which had the free margin
neatly retroverted, so as to leave a fine, smooth chink for regurgitation.
Some of those present at the examination, expressed themselves disap-
pointed at finding so little lesion to account for so remarkable a sound;
but, considered acoustically, it was precisely calculated to explain the
sign, by affording a narrow slit for a uniform refluent jet, producing the
rapid, equal, and prolonged vibrations, which constitute a musical tone.
Instances of noisy mitral regurgitation, without dangerous heart dis-
ease, are still more common. I have a great many patients on my books,
whom I have occasionally seen for several years past, who have the sys-
tolic murmur below the left breast, which, in 1835, I proved to be cha-
racteristic of mitral regurgitation; and which, provided it merely
accompany, and do not greatly supersede the natural double sound of
the heart, is by no means so formidable a sign as is generally supposed.
In some of these cases, the patients complain less of their heart than of
their breath, or their digestion, &c.; in others, nervous palpitation or
aim is a troublesome symptom, and aggravates the sufferings and fears
of the invalid: but none of these symptoms are adequately proportioned
to the cardiac lesion; and they may come and go, whilst this is constant.
* This is my explanation of the natural sounds, inferred from the experiments
before referred to. The ventricles, with their valves, at each systole, are suddenly
tightened on the contained blood, and thus produce the first sound, which is more
or less prolonged till the vibrating, and therefore sonorous tension, ends in the
diastole: then the ventricles are relaxed, but the parts suddenly tightened now are
the arterial valves, which simultaneously closing under the recoiling column of
blood, give the second or diastolic sound. -
BY CHARLES J. B. WILLIAMS, M.D., F.R.S. 315
But so long as the natural sounds of the heart are distinct, and the im-
pulse does not spread far beyond its natural limits, although the murmur
be loud and the symptoms distressing, we need not despair of amend-
ment and restoration to moderate health.
In all cases, however, in which the existence of a valvular lesion is
proved by the persistence of a murmur, the prognosis must take into
account not only the present amount of the lesion, but what it is likely
to become ; whether it be stationary or progressive; and whether, al-
though now it do not seriously affect the ordinary work of the heart,
as evidenced in its motions and sounds, it may not be so increasing, as
to tend to interfere with them, and thus to develop dangerous disorder.
To determine this point, we have to consider the recent history of the
case, and watch its progress for some time. Thus, if symptoms of dis-
ordered action of the heart have manifested themselves only recently,
in consequence of an accident, a sudden mental shock, or an inflamma-
tory attack in the chest, then it is possible that the disease, although
moderate now, may be on the increase; and even in a case of slight
lesion, a favourable prognosis cannot be pronounced, until further observ-
ation shall prove that there is no tendency to increase. But if the
history give no evidence of a sudden or recent affection of the heart,
and if examination, repeated after the lapse of a week or so, discover no
remarkable variation in the physical signs, it may be inferred, that the
lesion is stationary, and may be considered less formidable in proportion
as the natural sounds remain unaffected.
With the cases above described, as presenting through their physical
signs a favourable prognosis, may be contrasted those of an opposite
description, equally declaring themselves by their physical characters.
We have seen that it is not the loudness nor harshness of the morbid
murmurs, that proves the formidable nature of a cardiac disease; but
rather the degree and mode in which natural sounds are superseded, or
changed from that type in which they represent a healthy working
organ. Thus when, instead of the natural first sound and impulse, there
is only a soft blowing or musical murmur, with little or no impulse, or
when a murmur of any character supersedes completely the natural
second sound,-we have, at once, the proof of a serious and dangerous
alteration of structure: and this is commonly, but not constantly, evinced
by faintness, distressing palpitation, or irregular action, with other
symptoms of failing function in the centre of the circulation. The
most formidable cases of this description, are those in which the valves
of an orifice have been broken down, either by some violent exertion,
or by a sudden increase of endocarditis or degenerative softening. I
have met with several examples of this kind. There had been the signs
of a moderate lesion previously,–a murmur accompanying one or both
natural sounds; when, after a violent strain, or excessive mental excite-
ment, sometimes with the sensation of something suddenly giving way,
the action of the heart becomes tumultuous and irregular, with more or
less faintness or oppression; and the sounds of the heart are found to
have become changed, the natural sounds being indistinct, the rhythm
irregular, and the murmur altered in character, but not always increased
in intensity. In other instances, a similar change has occurred less sud-
denly, but still within a few days, by the rapid destruction resulting from
316 • ORGANIC DISEASES OF THE HEART.
acute endocarditis, or from fatty degeneration of the valves; in such
cases, general symptoms of cachexia, and of serious disorder of the
blood and excernent function are also present, to give warning of the
impending danger; for destructive endocarditis, and degeneration of
textures, do not occur in a healthy constitution. But the change in the
sound of the heart is here all the more sure token of evil, and the suf-
ferer seldom survives many days, or weeks at furthest.
When the lesion of the valves is slower in progress, and only gra-
dually impairs the natural sounds, its fatal influence is often successfully
counteracted, for a time, by the powers of nature. This they can do in
slow cases, by developing increased strength and substance in the mus-
cular walls of the heart. The more this is done by simple hypertrophy,
without degeneration, or much dilatation, the better will it accomplish its
end,—the augmentation of the damaged power of the heart to propel
the blood. It is thus that we sometimes find the most formidable kinds
and degrees of organic disease of the heart gradually developed, with-
out Sacrificing life, and, occasionally, without altogether precluding a
limited amount of health. We do, now and then, meet with examples
of most frightful amounts of change of structure—the normal sounds
superseded by all kinds of unnatural blowing, sawing, or grating noises
the impulse exaggerated into a wide, tumultuous heaving stroke,
which, with its almost equally violent diastole, so shakes the walls of
the chest, as to give a shock to the whole frame; yet the patients com-
plain of little or no palpitation or discomfort, and have far less of
suffering or fear, than most of those persons who are affected with merely
functional disorder. By substituting increased force for completeness
of mechanism, nature does manage to compensate for the defects for a
while, and, under favourable circumstances, to maintain the circulation to
a degree that is surprising, considering the amount of the lesion. But
this compensatory power is very uncertain and unruly; it is very apt
to exceed its due bounds, and further to damage the heart and adjoining
vessels by its vićlence; or to falter and suddenly fail, when exhausted
by an unusual effort: so that even these cases, the best of their class,
hold life by a very uncertain tenure. The machine, working at a high
pressure, to which it is not adapted, may suddenly stop from the expen-
diture of its power, or soon become worn out by the strain; and thus
we are justified in applying a more or less unfavourable prognosis even
to chronic cases, where the natural sounds of the heart are materially
impaired.
In many cases, the compensatory efforts of nature are even less suc-
cessful than in those last noticed; the hypertrophy of the walls is
frustrated by dilatation, which implies the expenditure of the force on
the cavities; or it is vitiated by fatty degeneration, which not only
deprives the muscular fibres of their contractility, but renders them
yielding and lacerable, and liable to functional failure or fatal rupture.
Hence, a dilated flabby heart is the worst addition to valvular disease,
and may render formidable even that which is not in itself dangerous.
In this case, the systolic sound may be distinct, and even loud, and heard
over a wide extent; but it is short, and with the brief knocking impulse,
expressive of the deficiency of contractile power. The rhythm is com-
monly irregular, and the pulse very weak and unequal.
BY CHARLES J. B. WILLIAMS, M.D., F.R.S. 317
2. The second group of circumstances that affect the prognosis of
organic diseases of the heart, are those relating to the Condition and
General Circulation of the Blood.
The mechanism of the heart is adapted to certain degrees of spissi-
tude and quantity of the blood, and the vital properties of the organ
are sustained by its richness and purity. Any considerable deviations
from the normal state of the blood, will disorder the action even of a
healthy heart, much more that of one, the structure of which is imper-
fect. Thus, a thin watery state of blood will mechanically exaggerate
the unnatural vibrations and regurgitations arising from valvular disease,
and will increase the murmurs which these occasion; whilst the vital
properties of the heart, being alternately irritated and exhausted by the
irregular quantity and quality of its sustaining fluid, will be still further
disordered, and raise the functional disturbance to its greatest possible
height. Hence there are no cases which are more distressing, or seem
more alarming, than those of valvular disease combined with anaemia ;
and many such instances have I seen, reduced to this condition by the
injudicious employment of an antiphlogistic or lowering treatment. But
so long as the natural sounds and impulse of the heart are distinct, and
there is no evidence of a worse complication than anaemia, although the
murmurs may be very loud, the palpitation very violent, the occasional
faintness distressing, and all manner of anginal pains and oppression be
present, and even although anasarca may have begun to appear, yet
these cases are by no means hopeless. In many instances, they improve
so much under a soothing and sustaining treatment (including sedatives,
chalybeate tonics, and nutritious diet), that the patients sometimes
think themselves cured: but the valvular lesion is still detected by its
murmur, although its diminished intensity shows that it is of minor im-
portance, now that a better state of blood has restored to the heart its
proper sustenance. It may be inferred, therefore, that simple anaemia,
although often greatly aggravating the symptoms, and exaggerating the
signs, of heart-disease, is not a dangerous complication, if it be season-
ably and properly treated.
The same observation will apply to general plethora, or simple excess
of blood. This too, by exalting the vital properties of the heart, and
by putting its mechanism to a strain, increases the intensity of the
symptoms of organic disease; and, if uncontrolled, tends to spread its
destructive effects. Under such circumstances, the prognosis is un-
favourable only when the proper antiphlogistic and sedative treatment
cannot be practised, or has been neglected too long; when these are
judiciously and seasonably employed, the amelioration of the symptoms,
and the diminution of the morbid sounds and impulse, are often very
remarkable.
But the most common of all the complications of heart disease, and
the most important to be considered in the prognosis and treatment, is
that with deteriorated quality of blood. Cachexia and toxaemia, in all
their varieties, uraemia, cholaemia, lithaemia (lithic acid in the blood),
oxalaemia, pyamia, and others, which it would be hard to name, might
be exemplified from clinical experience as constituting prominent ele-
ments in the history of cases of organic disease of the heart, and almost
stamping them with the proper indications for their treatment. The
3.18 , ORGANIC DISEASES OF THE HEART.
subject is too wide to be discussed in full, it must suffice to take the
more common examples of blood depraved by the retention of excre-
mentitious matter in it. -- .
Experienced practitioners have long been familiar with the fact, that
in organic diseases of the heart, and, in fact, in most chronic maladies,
it is of the first importance to attend to the state of the digestive organs,
and to the secretions of the liver and kidneys. In truth, so prominent
is this practical fact, and so manifestly does disorder of these several
organs give occasion to the troublesome symptoms in the heart, that both
practitioners and patients not uncommonly jump to the conclusion, that
the true seat of the disorder is the stomach, or liver, or kidneys, and that
the heart is only “sympathetically affected.” The auscultator avoids this
mistake; he is well assured, by the signs, that organic disease exists in
the heart; but he will fall into an error of equal practical importance,
if he neglect the consideration of those derangements of other viscera
which react on the damaged heart, and render its imperfections more
serious and distressing. The mode of their influence is, doubtless, in
Some cases, conveyed through the medium of nerves; and, therefore,
may be called “sympathetic”; as where a bit of shell-fish or bitter
almond in the stomach instantaneously causes palpitation or syncope,
(this may happen without any organic disease, but it is more likely to
happen with it). In other cases, the disturbing influence is merely me-
chanical; as where a stomach, inflated with gas, or distended with bulky
crudities, presses on the heart; or where an enlarged liver has a similar
effect. But most commonly, the medium which conveys the disturbing
influence is the blood; loaded with morbid matters, resulting from bad
digestion or imperfect excretion, it disorders the various organs through
which it is distributed ; and none more than the heart, whose injured
structure makes it most susceptible of the disturbing influence: hence
ensue attacks of palpitation or irregular action, and other symptoms of
disturbance, which magnify a disease, before quiescent and scarcely
observed, into a distressing and possibly dangerous malady.
Nor is the permanent affection of the heart unconcerned in producing
the functional disorders which react thus severely upon it. These
may be more or less owing to constitutional peculiarities, or accidental
causes; but they are, in part, the result of the disturbed circulation con-
nected with the cardial lesion. This always operates, in some degree,
by inducing congestions or irregular flows of blood in the several paren-
chymatous organs. The lungs, the liver, the kidneys, and the mucous
membranes, especially suffer from this disturbance ; and, although in-
sufficient to produce prominent symptoms, it sooner or later impairs or
disorders their functions. Hence, we find the subject of organic disease
of the heart occasionally, and in some instances almost periodically, suf-
fering from biliary or stomach disorders; from asthmatic or catarrhal
affections, or from some of those multiform rheumatic, gouty, and kindred
ailments, that are connected with imperfect elimination by the kidneys.
Any additional circumstances, tending further to lower the regular force
of the circulation, may prove co-operating causes; such as exposure to
cold, undue exertion or fatigue, irregularities of diet, and the like. And
under their superadded influence, the exacerbation of the heart disorder
will take place sooner, and with greater severity.
BY CHARLES J. B. WILLIAMS, M.D., F.R.S., 319
The primary pathological condition in the affected viscera thus in-
duced by a heart disease, is generally congestion. Often we have the
physical signs of congestion in the lungs, or liver, and, I may add, some-
times in the kidneys." Their functions are then more or less impaired;
and in no symptom have we better evidence of this, than in the state of
the urine, which generally becomes scanty, high coloured, and occasion-
ally turbid, and in severe cases, albuminous; less commonly, it is pale
and watery. As this proceeds, the action of the heart is more deranged,
until more or less of a paroxysm of inordinate or irregular action
is developed, with the usual distress and increased disturbance of all the
functions. Here we trace the influence of the defective excretion in
impairing the quality of the blood, and in developing and aggravating
the imperfections of the organ, which propels it. In the same cases
conjointly, in others separately, the liver may likewise suffer, and in
its increasing bulk and tenderness, it gives evidence of congestive enlarge-
ment; whilst, in many instances, a tinge of the conjunctiva, and even of
the skin, porphuria, and various other signs of bilious derangement,
affords proof of the presence of bile in the blood. Here the heart
soon feels the deterioration of its proper stimulus; and faintness or irre-
gular action, sometimes with a peculiar kind of breathlessness, is the
consequence.
These secondary disorders, arising from imperfections in the heart, and
reacting on and aggravating them, are, if opportunely and properly
treated, quite tractable in connection with the more moderate degrees of
cardiac lesion ; but, if neglected, they tend to become inveterate and un-
yielding, and to involve the system in a state of constitutional disease
and cachexia, which, in various ways, may hurry the malady to a fatal
termination. In my Principles of Medicine, I have pointed out the most
important steps in this process of extension and aggravation of disorder;
and did space allow, I could cite numerous histories of cases, in exem-
plification of various modes of this progress: but to avoid the tediousness
of detail, I will enumerate the several changes of structure and function,
which commonly precede the fatal termination of organic diseases of the
heart. Whilst the pathologist will not fail to perceive the mutual
relations of these changes, the practitioner will recognise in their symp-
toms, phenomena long empirically known as “bad signs”, marks of a
“breakup”, indications of failing vitality.
The following Table contains the elements of the complications most
commonly occurring in the progress of organic disease of the heart; and
it is sufficiently obvious, that in proportion as these secondary lesions
become permanent, they react on the original disease in the manner
described, and both by aggravating it, and by injuring other functions,
and the general health, they render the prognosis more unfavourable,
and even to lesions of moderate extent may give a fatal tendency.
1 The physical sign of congestion of the kidney is a temporary enlargement, ascer-
tained by palpation through the walls of the abdomen in the supine posture. In
persons that are not fat, I have generally been able to reach the body of the kidney
by gradual rotatory pressure, which, by displacing the intestines, brings the flat of
the fingers in apposition to the posterior walls of the abdomen. This mode of de-
termining the size of the kidney is much more feasible than that by percussion.
320 DR. C. J. B. WILLIAMS ON ORGANIC DISEASES OF THE HEART.
SECONDARY EFFECTS OF ORGANIC DISEASES OF THE HEART.
ON THE LIVEB. CHIEF SIGNS OR SYMPTOMS. COMMON RESULTS.
o Soft and varying enlarge- $ Increased secretion or de-
Congestion .................. ment ..................... } posits.
Deranged and interrupted | Bilious attacks—jaundice, $ Cholaemia, malnutrition,
secretion .................. etc. ........................ dyspepsia, etc.
Interstitial deposits ...... Enlargement.
* & Functional disorders, ge-
— soft—plastic ... — soft, uniform... C neral weakness, etc.
* achexia, dyspnoea, ge-
fatty...... — ditto............ neral dropsy. .
—hard—granular — hard, irregular Jaundice, cachexia, mal-
nutrition, purpura.
Size progressively de-
— contractile 3 creasing, with rounded
induration ...............
Intestinal haemorrhages,
ascites, cachexia.
ON THE KIDNEYS.
Determination of blood—
congestion ............... buminous or bloody— porary albuminuria,
Lumbar pains and ten- uraemia, etc.
derness.....................
Soft enlargement—Urine
diminished, and con-
taining casts of cells
and albumen ............
Increase and casting of
epithelial cells of tubuli
The same in a more con-
firmed degree.
Gradual filling of tubuli
with common granular ( Secretion less urinous,
* g ermanent albuminuria
cells, sometimes degen- more albuminous ...... P g gº 3.
tº º uraemia, and its con-
erating into fat .........
sequences, cachexia,
Exudation on vessels, spanaemia, dropsy, etc.
causing partial contrac-
tion and atrophy ......
Secretion first increasing,
| then diminished and al- | Disordered secretion, tem-
Secretion less albuminous,
more watery ............ J
ON THE LUNGS.
Congestion and determin-
Pulmonary catarrh, or
ation of blood............
structed breath-sounds,
emphysema.
moist crepitus in back,
wheezing, etc.
Confirmeddyspnoea. Sigms
as above, with partial
dulness and tubular
sounds.....................
Increasing dyspnoea and
and cough. Expector-
ation viscid, and some
times bloody ............ j
Interstitial deposits and
obstructions of vessels Hydrothorax and general
Dyspnoea, cough, catar-
rhal expectoration. Ob-
| dropsy, aggravation of
Pulmonary apoplexy and heart disease.
consolidation ............
ON THE ARTERIES.
Strong pulsation ; some-
distension—par- ) times murmurs. Pain ( Excitement and derange-
tial inflammation ...... or soreness. Jarring ( ment of function of part.
pulse .....................
* Irregular supply of blood,
Deposits on the coats...... Hard pulse—unequal...... ſ and liability to rupture,
Fatty and calcareous de- Ditto aneurism, gangrene,
generation ............... ; *” “” | atrophy, or mal-nutri-
tion.
(To be continued.)
7, Holles Street.
March 6, 1850. *
321
ON THE THERAPEUTICAL USES OF TEREBINTHINATE
MEDICINES.
By THOMAS SMITH, M.D., etc., Cheltenham.
IT has often occurred to me, and I have no doubt even to the most
cursory observers, how few of the medicines, out of our long catalogue
of remedies, are really found to answer the expectation in the hour of
need. The ills to which flesh is heir, are sufficiently numerous and
oftentimes puzzling enough; but the means of combating them, are
neither so ample nor so decisive, as the catalogue of our materia medica
would induce us to believe. It may fairly be questioned, if the present
generation has discovered (with the exception of chloroform) a single
specific, or invented any new remedy, however much it may have ex-
tended the use and improved the knowledge of the properties of those
already known. Chemical science, it is true, has succeeded in isolating
the active principles of some of our more potent remedies; but in
accomplishing this, it has not, in every instance, rendered the concen-
trated preparation equally efficacious with the old. Quinine cannot
always be considered as a substitute for bark; neither can morphine at
all times be prescribed for the same cases, and with the same beneficial
results, as opium. Notwithstanding these drawbacks, the chemist has
been of essential service to the medical practitioner.
It is an excellent habit to review, at stated periods, our past practice;
to compare the various epidemics and disorders which have occurred in
our times, with those of past ages—to investigate their causes, the means
which have proved most efficient in their treatment, and the reasons of
the success or failure of our remedial efforts. On looking over my notes,
I have been both pleased and gratified to find one class of medicaments
which have rarely failed to answer the object for which they were pre-
scribed. The Terebinthinate drugs have, from time immemorial, enjoyed
a high reputation as valuable auxiliaries in allaying, arresting, or remov-
ing disease. In private as well as in public practice, I have prescribed
them extensively, internally and externally, in the forms of potion, lini-
ment and lavement, with the happiest results. Hence I naturally feel
a strong partiality for their employment. I have had sufficient oppor-
tunity for testing their utility, in upwards of seven hundred cases; and
I do not recollect an instance of any unfavourable symptom supervening
on their exhibition, except in the following case : An aged female, who
had repeatedly taken large doses of turpentine for the expulsion of tape-
worm without effect, applied to me for advice. I prescribed the follow-
ing ; B. Olei terebinthinae 3i; olei ricini 3ss;–fiat haustus. To be
taken directly, and repeated in three hours. Shortly after the second
dose, she complained of vertigo, and vomited profusely; violent hyperca-
tharsis followed, with intense pain in the region of the kidneys; and the
worm was voided two hours after the second dose. In forty-eight hours,
she had completely recovered from these unpleasant symptoms; nor had
she ever, to my knowledge, occasion to regret the severity of the means
adopted for her relief.
The silence of writers on forensic medicine on the injurious conse-
322 THERAPEUTICAL USES OF TEREBIN THINATE MEDICINES.
quences, resulting from an overdose of the oil of turpentime, may be
considered as a strong corroborative testimony in its favour. Christison
has never heard of a fatal case. Mr. John Headman, however, men-
tions the case of a woman sixty-one years of age, whose death was occa-
sioned by this drug in twenty-five days—dose not stated. Dr. Duprés
is supposed to have fallen a sacrifice to inflammation of the urinary
organs, ºwned by too large a dose of this drug, continued for too long
a period.
HISTORY. The Terebinthinate drugs have, for centuries, had a high
and distinguished place in the materia medica. They belong to a family,
of which it has been justly observed by a writer in the Dictionnaire
de Matière Médicale, “C'est une des plus importantes du régne végétal
sous le rapport de ses produits, tous doués de beaucoup d'activité.”
In the works of Bºppocrates, Celsus, Dioscorides, Aretaeus, Avicenna,
Rhases, Galen, Sºon, Boerhaave, Van Swieten, etc., we find frequent
allusions to the Turpentines. The name, derived from the Greek reočw,
(I bore or perforate), in reference to the way in which it was obtained
from the tree, evidently implies a knowledge of the liquid species. In
that state, I believe it to have been generally used as an internal remedy.
Aretaeus distinctly alludes to the liquid form, and recommends it as
useful in enemata; he prescribed the Turpentines largely in various
maladies, and like the Roman Physician, Celsus, considered them espe-
cially valuable in pectoral disorders. Pliny, like Dioscorides, divides the
Turpentines into two species, “Gummae species dua, sicca et liquida.”
In the polypharmacy of the middle ages, the Terebinthinates and balsams
constituted some of the most active ingredients of which their multi-
tudinous formulae consisted.
Towards the close of the seventeenth century, the Turpentines, like
many other medicines of intrinsic value, lost their ground in public
estimation; nor was it until the dawn of the nineteenth century, that
physicians deemed them of sufficient importance to be employed as in-
ternal remedies in the treatment of other diseases than those of the
urinary organs. Yonge, and subsequently the celebrated Hunter, were
amongst the first to revive their use as styptics. The Dublin physicians
were not long in making trial of them in some of the most severe affec-
tions to which the human frame is obnoxious. In America, they have been
proved to be of eminent service in many febrile diseases. In France,
they soon attained a high position as remedies in neuralgic and rheu-
matic disorders. Amongst the Hungarians, they are considered a
sovereign remedy against all kinds of coughs and bronchial affections.
Some of the most eminent medical practitioners of Great Britain have,
within the last thirty years, strongly insisted upon their use in almost
every malady for which they had previously been regarded by the an-
cients as most efficacious. Without disparaging the labours of others,
the meed of praise is justly due to Dr. Copland for the high reputation
which the Terebinthinate preparations have now attained.

PHYSICAL AND CHEMICAL PROPERTIES, AND MODE of PREPARATIos.
In the market, there are several kinds of drugs known by the name of
Turpentime; and, though differing in many distinctive peculiarities from
each other, they nevertheless, in essential properties, are dependent
BY THOMAS SMITH, M.D. 323
upon the same principles—a volatile oil and a resinous residuum. The
true Turpentines are distinguished from the balsams, with which they are
not infrequently confounded, by the former containing succinic acid, the
latter benzoic. In distilling these Turpentines over caustic lime, a very
pure spirit is obtained, of low specific gravity, to which the name of
camphine has been applied, and which is now pretty extensively used
for the purpose of giving light in private dwellings, in lieu of oil. The
greater portion of the common Turpentine which is met with in this
country, is imported from America, and is chiefly procured from the
pinus palustris, in the following manner. A portion of the tree is
scooped out, a short distance from the ground, and the bark is removed
for several inches above. During the summer months, the Turpentine
flows into the hollows thus formed, and is then collected for exportation.
It has a warm acrid bitterish taste, a peculiar aromatic odour, is of a
soft consistency, and of a yellowish white appearance. Oil of Turpentine
is obtained from this substance, by distilling it with water in an ordinary
common still. Oil or spirit of Turpentine, as it is frequently called, when
prepared according to the directions of the London Pharmacopaia, that
is, by adding four parts of water to one of oil of Turpentine, and care-
fully distilling, ought to have a specific gravity 0.86 at 60 Fah., to boil
at 314, to have a slightly acid reaction, and to be completely soluble in six
parts of sulphuric ether. This oil is quickly dissolved by hot alcohol,
but readily separated in drops as the spirit cools. Oil of turpentine is
considered by Blanchett and Sell, to consist of two isomeric oils, dadyl
and peucyl ; but as the boiling point of oil of Turpentine is less than
the boiling point of those two oils, Pereira treats them as educts, not
products. An artificial camphor may also be obtained from highly
rectified oil of Turpentine, by passing a stream of oxygen gas through it.
The analogy between camphor and oil of Turpentine is very strong,
the leading characters of the former being those of a concrete volatile
oil.
Pure oil of Turpentine for medical purposes ought always to be dis-
tilled over caustic potash, lime, or soda. A specimen of the oil thus
prepared by Mr. Bullock, operative chemist, Conduit Street, which is
now lying before me, is perfectly pure, neutral, has rather a sweetish
taste, and a peculiar aromatic odour; and when its flavouris disguised by
a small quantity of the essential oil of bitter almonds, it is not particu-
larly disagreeable to the palate. This oil of Turpentine, as prepared by
Mr. Bullock, is very different from the camphine of commerce, which,
though neutral and of very low specific gravity 0.60 (Price's), has a dis-
agreeable Saponaceous taste. As an external counter-irritant, it is much
more rapid in its action than oil of Turpentine, and I always prefer it
where it can be obtained, where it is important to produce severe or im-
mediate counter-irritation. Perhaps one of the objections against the daily
employment of the oil of Turpentine in cases specially adapted for its
use, may have arisen from its nauseous flavour, and its tendency to im-
part its odour to the eructations which it not unfrequently occasions.
To obviate these inconveniences, Dr. Nimmo, of Glasgow, proposed a
method of freeing oil of Turpentine from all unpleasant taste and smell,
by a very simple process, without sacrificing any of its essential pro-
perties. There can be no doubt that oil of Turpentine, prepared according
324 THERAPEUTICAL USES OF TEREBINTHTNATE MEDICINES.
to this plan, may be kept for several months. I lately possessed a
specimen of the oil, devoid of all unpleasant odour, of which it had been
deprived more than six months previously. Oil of this description,
when exposed to light and air, very soon re-acquires the peculiar Tere-
binthinaceous character; it ought, therefore, to be preserved in small
bottles, well-corked, each containing not more than half an ounce each,
and only used for extemporaneous prescription. When flavoured with
any essential oil, such as lemon, cinnamom, verbena, or prussic acid, it
may be taken, without creating the slightest inconvenience, or disgusting
the most fastidious palate. To render this medicine free from smell or
taste, take eight parts of purified oil of Turpentine and one part of the
strongest alcohol; agitate briskly, and then let it stand some time;
pour off the alcohol, then add a fresh quantity to the Turpentine; pro-
ceed as before, and repeat the process until it has lost its peculiar taste
and smell. Turpentine, when thus prepared, leaves no residuum on
evaporation.
According to Pereira, the ultimate composition of the purified oil of
Turpentine, is
20 Atoms of Carbon—6 × 20. ... 120
16 * 2 Hydrogen ... ... 16
136
Nitric acid resinifies oil of Turpentine; and the resin, after long boil-
ing, is converted into crystals of Turpentine acid
Chian or Cyprus Turpentine is very often prescribed by some practi.
tioners where the Terebinthinates are indicated, because it does not
possess the same unpleasant taste, and easily can be given in the form
of pills. Though I have prescribed it frequently, I have never found
it so useful as the essential oil, in some states of the bladder and urinary
organs. This kind of Turpentine, the Canadian balsam or Venice Tur-
pentine, may have advantages; but, as a general rule, when the medicine
is deemed requisite, the purified oil ought to be given.
PHYSIologICAL EFFECTS. Turpentine, when taken internally, exerts a
peculiar action on the mucous surfaces, and the tissues superimposed upon
them: it increases the peristaltic motion of the bowels, inducing purga-
tion, and, in very large doses, hypercatharsis; it promotes the flow of
urine, impregnating it with a violet odour; and if its action be specially
directed to the kidneys, may produce strangury and bloody micturition. It
determines to the skin, producing copious and free diaphoresis, sometimes
attended with an itchy eruption. It also taints the pulmonary exhalation
with its characteristic smell. A large dose has been taken internally, and
failed to produce action of the bowels or kidneys; the vapour of the Tur-
pentine has then been discharged through the skin and pulmonary organs;
this was the case with the experiment that Dr. Copland instituted upon
himself. I once gave half an ounce to a boy of sixteen years of age, which
occasioned no other unpleasant symptoms, than an increase of the respi-
ratory movements, and acceleration of the circulation, with a tendency to
somnolency, followed by a profuse discharge from the urinary organs.
The breath and perspiration were tainted with a Turpentine odour for
upwards of a week; the bowels remained inactive until he had taken
BY THOMAS SMITH, M.D. 325
eight ounces of the compound infusion of senna, with ten grains of
calomel: the evacuations when passed were extremely foetid, black, and
slimy, but giving off no smell of Turpentine. Hertwig injected two
drachms into the veins of a horse; trembling, reeling, with inclination
to pass stools, and frequent micturition ensued. Fever and bronchitis
were set up, and the animal died in nine days. Schubert found that
two drachms given to a dog caused tetanus and death in three minutes.
I once saw half a drachm administered to a young cat: the poor crea-
ture mewed piteously, was extremely restless for several hours, and
had constant micturition, unaccompanied with diarrhoea; after some
hours, it fell into a profound lethargy, from which it awoke perfectly
well; its eyes remained injected for several days.
Turpentine seems peculiarly destructive to vegetable existence. Small
insects are speedily destroyed by it; indeed, no other drug appears to
exert so fatal an influence over the majority of parasites which infest
animal and vegetable life. &
When taken internally, it has been detected in the various secretions
of the human body. Todd and Johnson have met with it in the kidneys
of a patient who died from hamorrhage; it has also been detected in
the chyle of a dog and horse, to which it had previously been adminis-
tered, by Tiedemann and Gmelin.
THERAPEUTICAL EFFECTs. The diseases for which Turpentine has
been prescribed, and which have been materially relieved by it, are ex-
tremely numerous; there is scarcely one, whether acute or chronic,
sthenic or asthenic, which has not been successfully treated, if the testi-
mony of some of the first practitioners of the age is to be credited, by
the medicine under consideration. It would be a useless task to cite all
the cases and all the maladies, in which the admirers of this drug have
found it advantageous. Suffice it to say, that in every instance, where
prejudice has not interfered, and where ignorance has not prescribed,
this drug has obtained favour and proved itself a faithful friend.
In passing in review the numerous disorders for which it has been
ordered, as I wish this paper to have a practical bearing, I shall dwell
as briefly as possible upon all those which have not come under my own
immediate observation. Those who desire a more extensive acquaintance
with the nature, properties, and uses of this drug than is to be met with
in these sketches, will do well to consult the pages of our monthly and
weekly periodicals, which, for the last thirty years, have occupied a pro-
minent place in the medical literature of Europe and America. The
writings of Dr. Copland, Paris, Pereira, Eberle, Thompson, Brande, etc.,
the Dictionnaire de la Matière Médicale, and the records of ancient medi.
cine, contain an amount of valuable information regarding the properties
of Turpentine. In common with other medicines, its therapeutic effects
are liable to be modified by numerous circumstances: viz., the seasons
of the year, the idiosyncrasies, age, or sex, of the individual, the special
or general cause of the malady, or its occurrence before, or subsequent
to, any general or universal epidemic.' From a neglect of these pre-
* It is a remarkable fact, that after any severe visitation, such as epidemic cho-
lera, the human frame undergoes an extraordinary change. Many will, I have no
doubt, recollect how general was the custom to abstract large quantities of blood
in fevers and inflammatory disorders previous to 1831. Venesection was the prac-
326 THERAPEUTICAL, USES OF TERFBINTHINATE MEDICINEs.
cautions, many really valuable remedies have, though somewhat unde-
servedly, fallen into disrepute.
As a rapid and safe counter-irritant, there is no drug more efficacious
than warm oil of Turpentine or camphine. I have never known an in-
stance of its acting injuriously when thus applied; it never produces
strangury or any uneasiness of the urinary organs, like preparations of
cantharides; and here I fully coincide with the opinion expressed by the
late Dr. Ryan, that when counter-irritation is deemed imperatively neces-
sary in severe acute diseases, as cerebritis, hydrocephalus, pneumonia,
enteritis, peritonitis, or hepatitis, it is an extremely inert and unjustifi-
able practice, to wait for twenty-four hours for the irritating effects of a
blister, when the same may be produced in as many minutes by epi-
thems of warm oil of Turpentine.
Veterinary surgeons have condemned the external use of Turpentine
as an epispastic ; it has been asserted that, when applied to the horse,
it prevents the hair from growing. I do not think this correct. Some
years ago, I had a grey mare, which was seriously injured about the head
and fore legs by an accident. Contrary to the recommendation of my
veterinary surgeon, who insisted upon the application of tincture of
myrrh, and greasy unguents containing gunpowder, I determined for
once to try the experiment, if an injury to a horse might not be reme-
died by the same means as one in a human subject. I had the wounds
carefully formented and poulticed, and afterwards applied an ointment,
consisting of resin ointment, and oil of Turpentine. The animal re-
covered without any material disfigurement. Last year I had a black
horse consigned to me by a friend in Yorkshire, which met with a severe
accident in its transit on the railway. The horse was treated in the
same way as the one above, and in a few months was perfectly restored,
without any other blemish.
The liniment, by means of which the celebrated quack St. John Long
was supposed to have performed miraculous cures, was a mixture of the
oil of Turpentime, pyroligneous acid, and yolk of egg."
As a vermifuge, turpentine has been given in the form of Chabert's
oil. This is made by mixing one part of the empyreumatic oil of
hartshorn, with three of oil of Turpentine, allowing them to stand for
tice of the day. On the advent of the epidemic influenza of 1833, general bleeding,
even in maladies of a high phlogistic character, could not be adopted with safety;
numerous lives were doubtless sacrificed, ere this change in the human constitution,
—its inaptitude to bear excessive depletory measures, was fully appreciated and un-
derstood. We are now approaching an epoch (if we have not already entered it),
in which the vital phenomena of the animal organism will manifest themselves
differently under the influence of remedial agents. If my observation does not
deceive me, I am inclined to believe that this great climacteric change, on the com-
pletion of the cycle of the late formidable and universal epidemic, will mainl
develop itself, by inducing a lax condition of the intestinal tube. I have noticed,
that patients who have been accustomed to take large quantities of aperient medi-
cine, now rarely require it ; and when it is needed, a smaller portion is found suffi-
cient. This is not confined to the aged, for even in children I have witnessed a
similar alteration in their former habits.
1 This liniment is an excellent counter-irritant. We used it as an external
stimulant in some cases of cholera during the past epidemic, as recommended by
Dr. James Bird; and we frequently employ it as a counter-irritant in phthisis, and
other chest diseases. EDITOR.
BY THOMAS SAIITH, M.D. 327
three days, and afterwards distilling off three-fourths of the mixture by
the aid of a sand bath. It very soon becomes blackened, by exposure
to the air, and therefore ought to be kept well corked, and excluded
from the light. It is extremely nauseous; and, on that account, is not
likely to come into general use.
As a purgative, Turpentine ought never to be administered alone, in
large doses, during the winter, or in cold damp weather: because, under
these circumstances, it tends, in common with other hydrocarbons, to
supply fuel to the body for the evolution of animal heat, rather than
exert any therapeutic property. Indeed, I very much question the
propriety of giving it alone, as a purgative, under any circumstances
whatever. There are some writers who do not hesitate to recommend
it in doses which I consider unjustifiable. In winter, cerebral conges-
tion may supervene ; in summer, intractable diarrhoea, from over-excite-
ment of the mucous membrane of the bowels. The case of Dr. Copland
furnishes an instructive example on this head : ten drachms of the oil
of Turpentine were swallowed, and failed to induce action of the bowels
or kidneys; the consequence was, high cerebral excitement, followed
by a train of unpleasant symptoms, which it would be dangerous, in
Some constitutions, to excite.
Turpentine is, however, often a valuable addition to other purgatives,
as it possesses the faculty of increasing their activity in a remarkable
degree. I have known a lady, who, for forty years, was unable to pro-
cure an evacuation without the most drastic purgatives. She succeeded
in obtaining daily action, by the simple combination of a teaspoonful of
castor oil with ten drops of oil of Turpentine. I have had another case
under my care, where the same combination enabled me to relieve the
augmented suffering occasioned by obstruction of the bowels from
chronic meningo-myelitis of several years duration.
Whatever may be the object for which Turpentime is exhibited as a
purgative, whether for the expulsion of parasites infesting the human
body, or as a revulsive in cerebral affections, the dose should never
exceed half an ounce at one time; and to ensure its purgative action, it
ought to be united with some other aperient, as castor oil, compound
infusion of senna, sulphate of magnesia, or the decoction of the bark of
the root of the pomegranate. If prescribed in the above dose, in con-
junction with any other active purgative, we run little risk of inducing
strangury, or any other unpleasant symptom. It may be repeated at
intervals of four hours, with perfect safety. Though some authors have
stated that the dose of the oil of Turpentine may be from half an ounce
to two, or even four ounces, he must be a very bold practitioner, who
would take this suggestion for his guide. If the first-named quantity
will not suffice for the destruction and consequent expulsion of a taenia,
a larger amount given at one time, will equally fail; for it is not by the
aperient properties alone of the medicine, (as I shall hereafter shew)
that the death of the worm is effected. As a diuretic, the dose may
* There may be special cases, but they will be extremely few, in which an extra-
ordinary dose of any particular medicine may be peremptorily called for by the
condition of the patient. For instance, I once gave to a man labouring under
delirium tremens, seven grains of the acetate of morphia, in divided doses, within
two hours, ere I could allay the inordinate and convulsive movements, and restrain
WOL. II. 22
328 THERAPEUTICAL USES OF TEREBINTHINATE MEDICINES.
be from five to thirty drops, taken in any aromatic water, or mineral
saline. I have rarely found patients object to its use, when exhibited
..with the salines of either Cheltenham or Harrowgate; and the numerous
cases in which I have prescribed it, in conjunction with the waters
from these mineral springs, have convinced me, that this union is espe-
cially indicated where we are anxious to direct its influence to the renal
organs.
As an astringent, in doses varying from 20 minims to a drachm, ac-
cording to the urgency of the symptoms, and repeated every three or four
hours, Turpentine is one of the most efficacious remedies which we
possess. The best vehicle for its administration, in the first place, is
water, flavoured with syrup of orange, or any other agreeable aromatic.
It may afterwards be advantageously combined with any other thera-
peutic agents, which the special nature of the case may require: thus, in
epistaxis depending upon rupture of one or more small vessels, and where
much arterial blood has been lost, muriated tincture of iron will form a
valuable adjunct. In haematemesis and other sanguineous discharges
from the bowels, it may be united with compound infusion of roses,
sulphate of magnesia, iced-water, and solutions of tannic or gallic acid.
In some forms of haemoptysis, it may usefully be added to infusions of
matico; in haematuria, to the decoctions of uva ursi, chimaphila, pyrola,
etc.; or to tincture of sesquichloride of iron, etc. In purpura haemor-
rhagica, the decoctions or infusions of the barks form with it an excellent
adjuvant. In haemoptysis, it has speedily and effectually arrested the
haemorrhage; and is a much safer remedy than lead.
In my experience, there is no single medicine in the materia me-
dica, that can be compared with it as a styptic, either as to certainty of
action, or to the safety of its effects. It is compatible alike with acids
and alkalies.
The easternal use of Turpentine has been very general for a great
number of years, alone or combined with other rubefacients, such as
mustard, strong liquor ammoniae, pyroligneous acid, cajeput oil, wine of
hellebore, colchicum or opium, tartar emetic, croton oil, etc. It has
very frequently been found of permanent utility, when applied as a warm
epithem to the skin in pulmonary affections. Its action is twofold;
first, it induces rapid though often transient counter-irritation; secondly,
its vapour is inhaled into the lungs, and by its constringent operation
on the extreme capillaries of the pulmonary texture, is not infrequently
productive of great relief in some affections of these organs. For the
purpose of inhalation, I am in the habit of dispersing its vapour through
the room by evaporating water containing a portion of it, by the aid of
a spirit lamp. When thus diffused through the atmosphere, it may be
breathed for two or three hours in the course of the day, by the most
delicate-chested person, and often with the most marked and striking
amelioration of their pectoral symptoms. - -

the shrieks of the wretched sufferer. Again, at another time, I exhibited to a
female, in the presence of Dr. Logan, twelve ounces of sulphuric ether, when the
principles of etherization were first introduced, and kept this woman in a state of
insensibility for upwards of six hours. Although both these cases did well, they
are exceptional ones, and ought never to be imitated, except in emergencies of
the most urgent description.


BY THOMAS SMITH, M.D. 329
Long after the patient has left the room, he is conscious of the taste
and smell of the turpentine. I have often detected its presence some
hours after he had been submitted to its penetrating influence. I have
also employed camphine in the form of a bath, mixed with common
soda ; or two pounds of the latter with from quarter of a pint to half a
pint of camphine, and half an ounce of oil of rosemary, will form an
excellent bath. In delicate skinned patients, females and children, gii
of camphine will be sufficient. I may remark, in limine, that the alka-
line camphine bath possesses virtues peculiarly its own. In the coldest
day in winter, as I have verified in more than one instance, it may be
employed with the most perfect safety. Whilst the individual is in the
bath, he experiences, to my knowledge, no disagreeable annoyance from
the disengaged vapour; on the contrary, if we except the taste of the
Turpentime, which for some time remains in the mouth, a sense of calm-
mess and tranquillity very often follows a previously disturbed, irregular,
or excited condition of the respiratory or sanguiferous systems. After
five minutes recumbency in the bath, the pulse is found to become
fuller, softer, and slower; Ihave seen it fall from 100 to 80. The respira-
tion also becomes freer, deeper, and less laboured. On coming out of
the bath, the whole skin has a peculiar velvety, soft, and agreeable feel-
ing; the breath is strongly tainted with the terebinthinaceous odour.
If it have not been too hot, a pleasurable tingling warmth is experienced
throughout the whole cutaneous surface; and this, with the preceding
symptoms, may continue twenty-four hours. One great advantage of
this bath will be found in the circumstance, that it may be employed at
a heat from 10 to 15 degrees below the temperature of the ordinary
warm one, without inducing that sensation of chill to which some deli-
cate constitutions are so peculiarly obnoxious ; ten or fifteen minutes is
the length of time a patient ought to remain in a bath of this descrip-
tion. In the first instance, it is well for patients to commence with a
smaller quantity of the Turpentine and soda, say a pound of the latter
with two or three ounces of the former, and gradually increase its
strength on each repetition of the bath, to the first mentioned propor-
tions. This bath may be taken every second or third day, according to
the urgency of the symptoms and the nature of the affection for which
it is prescribed.
I come now to a more particular enumeration of the maladies for
which Turpentine and its preparations have been chiefly recommended.
They are—sanguineous exhalations from the mucous surfaces, epistaxis,
haemoptysis, melaena, purpura haemorrhagica;" consumption, chronic bron-
chitis, mucous or purulent discharges from the urethra;” grubs infest-
ing the urethra, taenia, ascarides;” typhoid, yellow and puerperal fevers,
plague; abdominal obstructions, strangulated hernia, tympanitis, colica
* Adair, Brooke, Cheyne, Clutterbuck, Copland, Elliotson, Hunter, Mage6,
Nichol (W.), Thompson, Vincent, Younge.
* Aretaeus, Celsus, Dioscorides, Van Swieten.
* Birkbeck, Cross, Fenwick, Fothergill, Gomés, Hancock, Hartle, Kennedy,
Knox, Laird, Lettsom, Maldon, Mello, Ozanam, Pereira, Saner, Winstone.
* Atkinson, Blundell, Brenan, Chapman, Copland, Cullen, Douglas, Farre,
Faulkner (Sir A. Brooke), Fernandez, Gooch, Hamilton, Holst, Johnson, Kinneir,
Moran, Payne, Physick, Pritchard, Wood.
22 2
330 THERAPEUTICAI, USES OF TRREBINTHINATE MEDICINES.
pictonum, biliary concretions;' traumatic tetanus, trismus;* apoplexy,
hydrocephalus, acute and chronic, epilepsy;” neuralgia, sciatica, rheu-
matism;’ diabetes, dropsy ;” inflammations of the eye;" cholera, renal
hydatids, suppression of urine;' burns, wounds, poisoning by prussic
acid or opium, salivation.”
ILLUSTRATIVE CASEs. My first observations will illustrate its efficacy
in the Haemorrhagic Diathesis. I do not coincide with the notion,
that haemorrhage, whether vicarious, or occasioned by a congestive con-
dition of an overburthened viscus, is a salutary effort of nature, and
that, therefore, caution is necessary in interfering with it. It has been
my invariable aim to arrest a haemorrhagic effusion as quickly as pos-
sible. We can in some measure calculate the worst consequences likely
to arise from a general or local abstraction of blood ; but we can never
foretell what irreparable lesions nature may occasion by prolonged San-
guineous exudation through an unnatural channel.
Haºmatemesis. This is a very common disorder, and often, when
improperly managed, lays the foundation for a train of symptoms which
not infrequently terminate in dropsical effusion. It has happened to
me to have several such cases, principally among females, in which the
usual treatment, by acetate of lead, mineral and gallic acids, etc., had
been adopted. Since, however, I have given the Terebinthinates in
this class of diseases, I have not had a single dropsical case supervening
on the original malady,
CASE I. Captain —, 82nd foot, aged 64, was engaged in active
service in India, and in the Peninsula, prior to the year 1812. He
was of stout athletic constitution, six feet two inches high, and rarely
if ever was known to complain, previous to an attck of fever, which he
experienced at the close of the Peninsular war, and which led to his
retirement from active military service. From that period to 1843, he
was a martyr to anomalous and painful sensations in the praecordial
region. The more prominent symptoms were—a short hacking cough,
without expectoration; an occasional momentary pain darting from
under the left nipple to the right shoulder, easily brought on by mental
excitement; his temper, which had formerly been under control, now
became irritable, fretful, and peevish. The functions of the bowels
were performed with regularity; the appetite in general was good; his
sleep short and disturbed. For a very long period, these symptoms
continued without any material alteration, though he had tried a variety
of remedies for upwards of twenty years, and had had issues of one
kind or another in different parts of the body. About the year 1831,
* Boerhaave, Durand, Gibbon, Green, Guyton de Morveau, Hall (Marshall),
. (C. B.), Kinglake, MacWilliams, Odier, Paris, Ramsbotham, Sewell,
prengel.
* Gibbon, Hutchinson, Mott, Phillips.
* Latham, Lithgow, Money, Moran, Percival, Pritchard, Young.
* Bonnet, Cheyne, Ducros, Dufour, England, Hild, Home, La Roque, Lenton,
Martinet, Maton, Pitcairn, Recamier, Thilenius.
* Darwin, Werlhoff,
* Burke, Carmichael, Foote, Guthrie, Hynam, Langier, Middlemore, Wright.
7 Bayle, Copland, Neale, Pereira.
* Emmert, Geddings, Hanold, Heister, Jenkins, Kentish, King, Orfila, Paré
(Ambroise), Percy, Pott.
BY THOMAS SMITH, M. D. 331
he parted with a small quantity of blood, which greatly alarmed him,
and for some weeks this continued with scarcely a day's intermission.
On recovering from this attack, he found great difficulty in remaining
quiet in a sitting posture. When in the house, he was constantly rock-
ing himself in his chair. A see-saw motion seemed to be essential to
respiration: if perfectly still, he complained of a feeling of suffocation.
In 1837, he experienced a second attack of Haematemesis, of a more
serious character. The haemorrhage continued for several days, unre-
strained by the remedies used. He was very much altered; convales-
cence was extremely slow, and he never regained his former status.
It was a few months after this attack that I first saw him. His appear-
ance was exsanguineous, lips livid, pulse 100, irregular and intermit-
ting, respiration short and laboured. He was in constant motion, rock-
ing himself to and fro in his chair, which he always had placed in a
diagonal line between the fire-place and the open door. Even at meals,
he continued the same to-and-fro motion, eating whilst rocking himself.
His tongue was large, thick, indented, and compressed, palish, and
mostly covered with a yellowish fur; the abdomen was exceedingly
painful to the touch, more especially in the right hypogastric region.
The bowels were easily acted upon by aperients. The evacuations were
bilious, often dark and foetid. The urine was high-coloured and scanty,
frequently throwing down a lateritious sediment, sometimes attended
with a pinkish deposit; sp. gr. 1:030. He had also swelling of the
ankles; constant teasing cough, with mucous expectoration; occasional
severe pain in the forehead; pain in the region of the heart. The phy-
sical signs were—chest Sonorous; occasional mucous rāle; extended dul-
mess over the precordial region; bruit de rape most distinct on the right
side, in a line upwards towards the sternum. Intensely severe parox-
ysms of dyspnoea now occurred at frequent intervals; these were re-
lieved by local depletion and antispasmodics. There was oedema of the
lower extremities; the urine was passed in small quantities. Towards the
close of 1840, haemorrhage from the stomach and bowels again recurred,
with great increase of pain in the abdomen. In his debilitated condi-
tion, general bleeding was inadmissible; and even local depletion was not
altogether unattended with risk. I prescribed ten leeches to relieve
the abdominal inflammation, and ordered warm epithems of Turpen-
time to be subsequently applied. Turpentine enemata were also ordered
to be administered twice daily, and the following mixture to be taken,
in doses of two table-spoonfuls, every four hours: Bº Infusi rosæ comp.
3viiss; magnesiae sulphatis 3viii; mannae optimae 3iv ; olei Terebin-
thinae purificati 3iss. M. On the following morning, I found him
much better; the bowels had been freely relieved, the pain had con-
siderably abated, and there had been no return of the haemorrhage.
He expressed himself as feeling decidedly better, and had never expe-
rienced so much relief in so short a time from any medicine as from
the Turpentine. He rallied from this attack rapidly; the swelling of
the ankles decreased; the urine became light-coloured, of lower specific
gravity, and more abundant in quantity; his complexion improved, and
his spirits became more cheerful. He continued the Turpentine, in
conjunction with the saline waters of Harrogate, for a considerable
time, with marked amelioration of his more painful symptoms.
332 THERAPEUTICAL USES OF TEREBINTHINATE MEDICINES.
About three years after this, domestic troubles increased the dis-
turbance of the heart. Peritonitis supervened, from which he sank in
a few days.
The autopsy revealed a very large amount of disease. The heart was
of an unusually large size; the walls of the right ventricle were much
dilated and thinned; the mitral and tricuspid valves were extensively
ossified. A small quantity of serosity was found in the pericardium.
The lungs were healthy in texture, but slightly congested; the peri-
toneal covering of the bowels was extensively inflamed. The transverse
arch of the colon was firmly attached to the lower surface of the stomach,
and bands of adhesion (evidently of long standing) passed from it to
several portions of the small intestines. In the stomach, were two
small ulcerations near its pyloric orifice, and it exhibited small puck-
ered places in several parts, evidently the result of some previous
ulceration ; there were also distinct patches of inflammation. The
liver was a completely soft pultaceous mass, easily breaking down under
the finger; it was of a bright yellow colour, and contained small pieces
of a white friable calcareous matter. The kidneys appeared larger than
natural, and much congested.
CASE II. Mr. M., aged 36, of florid complexion, stout conformation,
five feet ten inches in height, was seized on the 30th April, 1843,
whilst superintending his men, who were removing some machinery in
a mill, with a sensation of sickness and oppression in the praecordial
region. Feeling himself very ill, he immediately desired to be taken home;
but before this could be accomplished, he vomited a large quantity of
blood. On my arrival at his house, whither he had been removed, I
found him still complaining of considerable nausea. I immediately gave
him ten grains of the acetate of lead, to be repeated every three hours, if
the bleeding continued; infusion of roses with sulphate of magnesia and
tincture of digitalis was also prescribed; and bladders of ice were ordered
to be applied to the pit of the stomach. In the evening, I found him
considerably worse; the tongue was very much coated, the pulse quick
and thrilling, and he had severe pain, much increased on pressure, over
the colon. To be cupped to twelve ounces; to continue the medicine,
with the addition of a quarter of a grain of acetate of morphia to each dose.
May 1. Passed more blood during the night, and was extremely rest-
less. Tongue very much coated with a brown yellowish fur; great thirst;
pulse still quick and thrilling; bowels freely acted upon; evacuations dark,
pitchy, and foetid; urine high coloured. Whilst Iwasin the room with him,
he became very sick, and again ejected a considerable quantity of blood.
Before leaving the room, I gave one drachm of the spirits of Turpentine
in a little water. I ordered him to discontinue the other medicines, and
to take, instead, three tablespoonfuls of the following mixture every
three hours. R. Infusirose comp. 3viiss; tincture digitalis 5iss; mag-
nesiae sulphatis 3viij; olei Terebinthinae purificati 3iss. M. In the
evening, there had been no return of the bleeding; there was still
severe pain in the head: the bowels had acted five times; the pulse
was softer; the tongue much the same ; thirst very great. To drink
iced water, and to have ice applied to the head. To continue the mix-
ture, and to have hot Turpentine applied to the bowels.
May 2. Better in every respect; no return of the haemorrhage. From
this day he continued to improve.
BY THOMAS SMITH, M.D. 333
May 24. As there was some tenderness in the epigastrium, a seton
was ordered. He was subsequently sent to Harrogate; and, under a
course of the Cheltenham salines of that place, with small doses of
Turpentine, he rapidly regained his health, and has continued well ever
SIDCé.
CASE III. F. H., aged 40, residing in St. Mary's Row, was admitted
into the Leeds Public Dispensary, October 19, 1842. The following were
her symptoms: pain in the forehead; swelling of the abdomen, with-
out any particular pain; nausea, attended with sanguineous vomiting,
small in quantity, occurring every two or three days, and which had
already lasted a fortnight before she came under my care. Pulse soft;
tongue clean; catamenia irregular, generally very scanty, but, at the time
she applied to the dispensary, very profuse; bowels costive. I was at first
inclined to suspect uterine disease; but, on a careful examination with
the speculum, I could detect no evidence of it. She was ordered to take,
every four hours, the following pill: B. Plumbi acetatis gr. iij; mor-
phiae acetatis gr. 4. M. Two tablespoonfuls of the following mixture
were also ordered, every four hours. B. Acidi sulphurici diluti 3ij;
magnesiae sulphatis 3.j; misturae camphorae 3vijss. M.
Oct. 20. Much the same. Haemorrhage from the uterus very
profuse ; the vomiting of blood appeared to have ceased: the bowels were
freely opened; she complained of uneasy sensation round the navel, in-
creased on pressure. To continue the medicine; and to have eight
leeches applied to the abdomen, and a blister to the same region at
bed-time.
Oct. 21. Not nearly so well; tongue very much furred; gums appeared
sore; breath offensive; pulse sharp and vibratory; pain in the head and
bowels much increased ; had vomited a considerable quantity of blood;
slight strangury. To discontinue the lead. B. Olei Terebinthinae 3iss;
pulveris tragacanthae comp. 3ij; extracti conii 9ss; tincturae digitalis
3j; misturae camphorae 3viiss. M. Three tablespoonfuls every four
hours. Warm turpentine to be applied to the loins. B: Pulveris
ipecacuanhae compos. gr. x; hydrargyri chloridigr. j; fiant pilulae iij.
To be taken at bed time. &
Oct. 22. Passed a better night; pain in the head much relieved; the
catamenia have ceased ; she threw up a small quantity of blood after
breakfast; bowels inactive ; micturition still scanty, but not painful;
had perspired freely during the night. B. Olei ricini 3v.j; olei Tere-
binthinae 5ss...M. To be taken directly. To continue the last mixture.
Oct. 23. Still improving; no return of the bleeding, complains of great
weakness; is very much blanched from the loss of blood. B. Potassii
iodidi gr. i ; pulveris opii gr. ss; extracti lactucae gr. j; fiat pilula. To
be taken at bed time.
Oct. 24. Much better. To continue the pill. B. Olei Terebinthinae
3.j; tincturae gentianæ comp. 3ss; soda sesquicarbon: 9iij; pulveris
rhei 3ss; decocti aloes comp. ad 3xx. M. Two tablespoonfuls twice a
day. From this date she continued to mend; and was discharged cured,
Dec. 7, 1842.
CASE IV. M. H., aged 60, residing at Holbeck, was received into the
Leeds Public Dispensary, December 14, 1842. She had been ailing
for a long time, and latterly had become jaundiced; she had been much
334 THERAPEUTICAL USES OF TEREBIN THINATE MEDICINES.
troubled with pyrosis for some weeks, and informed me, that she had
noticed the abdomen to be considerably swelled, before she went to bed.
On the day of her admission, she was seized with sickness, and vomited
about a pint of blood; this, she stated, gave her great relief. There
was considerable tenderness over the stomach; the liver was painful to
the touch, hard, and apparently very much enlarged. The bowels were
lax, and had been so for some time. The urine was dark; she had a
bitterish taste in her mouth; the tongue was coated with a yellowish
white fur; the conjunctivae were yellow ; the pulse small, irritable, and
quick; the skin dry. She was ordered to have eight leeches applied to
the right side, and to take the following pills immediately. B. Pilulae
hydrargyri gr. iij; calomelanos gr. i ; pulveris ipecac. compositi gr. viij,
M. Fiant piluleij. B. Spiritús Terebinthimae 5i ; infusi juniperi comp.
3viiss; sodae sesquicarbonatis 3i. M. Two tablespoonfuls every four
hours.
Oct. 15. She had headache, occasioned by the opium; had parted
with more blood during the night; bowels not relieved since yesterday.
R. Oleiricini 5iv; tincturae rhei compositae 3ij; olei Terebinthinae m. xx.
M. To be taken directly. B. Unguenti hydrargyri fortioris 3ij; cam-
phorae 9ij. A small portion to be rubbed over the region of the liver
every might.
Oct. 16. Very much jaundiced; feels better; bleeding checked. To
continue the mixture. B. Pilulae hydrargyri gr. v ; extracticolocynthidis
compositi gr. iv. Fiant pilulae iſ. To be taken every night.
Oct. 20. Mouth tender; has had no return of the haemorrhage; symp-
toms improving; still troubled with waterbrash. B. Extracti taraxaci
3j; pulveris rhei 35 ; olei Terebinthinae 3.j; potassie tartratis 3i.; aquae ad
3Vij. M. Two tablespoonfuls every six hours. R. Bismuthi trisnitratis
gr. iij. ; extracti taraxacigr. j. M. To be taken twice daily. This patient
was discharged cured, January 4, 1843.
Epistaaris. Since I have prescribed Turpentine in this affection, I
have rarely seen the bleeding continue more than two or three days.
In these cases, I mostly combine the Turpentine with muriated tincture
of iron.
CASE v. A lady, considerably advanced in years, and who had from
infancy been subject to hamorrhage from the nostrils, consulted me about
two years ago, when labouring under one of her periodical attacks. She
informed me, that she had rarely of late had the bleeding arrested with-
out plugging, and even then the haemorrhage was liable to recur on the
most trifling excitement, or extra exertion At her request, I plugged
the nostril; and gave her the infusion of matico, with pills of acetate of
lead. The complaint proved troublesome, and it was three weeks before
the haemorrhage had completely ceased. This, she told me, was about
the length of time that these attacks generally lasted; they always left
her very much enfeebled. About fourteen months after this, I was sud-
denly summoned in the middle of the night to the same lady, who had
a recurrence of her complaint. After plugging the nostril, I gave her
a drachm of the oil of Turpentine, with ten minims of the muriated tinc-
ture of iron, in a little water, and ordered half the quantity of the same
medicine every two hours, if the bleeding continued. At my morning
visit, I found that the haemorrhage had been successfully arrested. In
BY THOMAS SMITH, M.D. 335
three days the plug was removed; and, up to the present time, she has
had no return of the bleeding.
My confidence in this remedy, for arresting atonic epistaxis, is un-
bounded. I have frequently trusted to it alone, without resorting either
to plugging, or to the employment of any other astringent.
CASE VI. A poor man (a bookbinder, residing in Union Street,) called
at my house, a short time age, bleeding profusely from the nose; a drachm
of oil of Turpentine was immediately given to him in water; as he had
a little distance to go, and it being a very cold night, I plugged the nos.
tril. In removing the plug on retiring to bed, he brought on a return
of the bleeding. Another drachm of Turpentine was administered. In
three days he was perfectly well.
Haematuria. The propriety of prescribing oil of Turpentine in Haemat-
uria has been doubted by many. It has been reported to have produced
the very disease which it was intended to alleviate. I have never seen
any ill effects from its use in this disorder: but, on the contrary, I re-
gard the judicious administration of Turpentine calculated to arrest its
course. There may be cases of organic change in the structure of some
parts of the urinary organs, which might render its employment objec-
tionable; but, hitherto, I have not met with any such. &
CASE vil. W. W., aged 19, of spare habit, slight stature, pale and
sallow complexion; works in a flax mill. His symptoms had lasted three
days prior to his appearance at the Leeds Dispensary, June 4, 1842.
They were dull, deep-seated, aching pain in the lumbar region, tenesmus
with frequent bloody micturition, anorexia and fever. He had been sub-
ject to these attacks for the last two years, and latterly they had recurred
at shorter intervals. B. Pulveris uvae ursi gr. x. To be taken three
times a day. R. Pulveris jalapae comp. gr. xv.; calomelanos gr. ii. To
be taken at bed time. - º
June 6. Haemorrhage still continues. B. Pulveris uvae ursi 3.j; olei
menthae piperitºm. ii; olei Terebinthinae 3ij; pulveris tragacanthae comp.
3j; aque ad 3viii. M. Two tablespoonfuls every four hours. B. Anti-
monii potassio-tartratis 3.j; olei tiglii şj; liquoris ammoniae fortioris
3iv ; spiritús Terebinthinge 3i M. Liniment to be rubbed into the loins
at bed time every night.
June 8. Much improved; liniment has produced a copious crop of pus-
tules; urine clear; no blood.
June 15. Discharged cured. Two years after, this patient informed
me, that he had not had any relapse.
CASE VIII. A. W., aged 68, a dispensary patient, admitted August
10, 1848. She had been ill about a week, and had had considerable pain
in the left side and shoulder, also diarrhoea, and blood in the urine.
B. Misturae cretae comp. 3vij; confectionis aromaticae 3.j; pulveris uvae
ursi 3iss. ; tinct, opii 3ss. M. Two table-spoonfuls every four hours.
Aug. 14. Bowels more comfortable; still parts with blood in the urine.
To repeat mixture, with a drachm of oil of Turpentine. * * * * * * * * *
Sept. 6. Had a slight relapse attended with nausea. R. Acidi nitrici
dil. 3iji olei Terebinthinge 3i; acidi hydrocyanici dil. (P.L. 1886);ss;
aqua ad 3viii. M. Two tablespoonfuls twice or thrice daily. This
patient was discharged cured, on the 19th. She died about a year
after, under the care of one of my colleagues, of another affection. An
autopsy was not allowed.
336 THERAPEUTICAL USES OF TEREBINTHINATE MEDIGINES,
CASE Ix. M. S., aged 26, married, a collier, was admitted January
12, 1843, as an out-patient to the Leeds Dispensary. He had been
ill for several days, with fever, attended with great thirst, headache, foul
tongue, and severe lancinating pain in the lumbar region, extending to
the left knee. , Urine in small quantity, bloody. Bowels constipated.
He was sounded for stone, but nothing was detected. He attributed his
ailment to cold. B. Pilulae hydrarg. gr. iij; calomelanos gr. i ; pilulae
aloes cum myrrhá gr. vi. M. ut fiant pil. ii. To be taken at bed time.
Ung. antimonii potassio-tart. 3i, to be rubbed into the loins every night.
B. Magnesiae sulphatis 3i: olei Terebinthinae 3i; pulveris uvae ursi 3i;
misturae camphorae 3viij. Two tablespoonfuls every four hours. This
patient was discharged cured, January 20.
Capillary Haºmorrhage. I have not witnessed many instances of this
disorder, but the following case may, I think, be fairly considered as an
example.
CASE x. J. C., residing at Burmandtofts, Leeds, consulted me on
the 19th of October, 1842. He was of a spare make, aged thirty-two,
and followed the occupation of a town missionary. He was frequently
attacked with ephemeral fever, arising, no doubt, from the daily expo-
sure to miasmatic influence, whilst administering religious consolation
to the indigent sick. It was immediately subsequent to one of these
attacks, that he was seized with jaundice, attended with an exacerba-
tion of all the febrile symptoms. The alvine evacuations were clay-
coloured and scanty, the urine in small quantity, and of a deep red
tinge, and the skin moist. As this patient was peculiarly sensitive to
the influence of mercury, I was cautious in prescribing it. He was
ordered to take the following pills at bed time:—B. Pilulae hydrargyri
gr. iij; pulveris ipecac. gr. ss. M. The following mixture was also
prescribed. B. Infusi Sennae 3viij; antimonii potassio-tartratis gr. i ;
magnesiae sulphatis 3i. M. Two table-spoonfuls every six hours.
Oct. 21. On this day I was urgently sent for to Mr. C., who was
reported to have burst a blood-vessel. Not being able to leave a female
patient, whom I was then visiting, I requested the messenger to call in
“some other medical man. At eleven o'clock the same evening, the
messenger informed me that they had called in the nearest neighbouring
practitioner, but the haemorrhage still continued. When I arrived,
I found that the doses of blue pill, which Mr. C. had taken the two
previous nights, had brought on ptyalism. The Saliva was mingled
with blood, which oozed from the upper surface of the tongue. On
examining the mouth, I found the tongue enormously swollen and dis-
tended. The patient seemed much exhausted and frightened, for the
bloody saliva, every now and then, gushed from his mouth in large
quantities. He had taken acetate of lead and nitric acid. I immedi-
ately gave him a drachm of the oil of Turpentine in water, and applied
creasote all over the upper surface of the tongue. In an hour, the
haemorrhagic secretion appeared less profuse; another dose of the Tur-
pentine was administered. At two o'clock in the morning I left him,
the bleeding having ceased. I ordered the Turpentine to be given in
half-drachm doses every hour.
Oct. 22. The patient was considerably better at my morning visit;
there had been no return of the hamorrhage, and the Salivation was
BY THOMAS SMITH, M.D. 337
materially lessened. The jaundice, however, still continued. R. Olei
Terebinthinae purif. 3.j; extracti taraxaci 3ss; soda sulphatis 3.j;
aquae ad 3v.j. M. Two tablespoonfuls twice daily. In a short time
Mr. C. was convalescent. I advised him, however, to continue the
Turpentine, in combination with muriated tincture of iron and infusion
of quassia. He subsequently enjoyed much better health than he had
for years previously.
During my house-surgeoncy at the Charing Cross Hospital,in 1836 and
1837, a little boy was admitted, under the care of the late Mr. Howship,
suffering from necrosis of the tibia. This child belonged to a family
in which the hamorrhagic diathesis was strongly developed. One, if
not two (I quote from memory), of the child's relatives had died from
sanguineous exudation after slight injuries. It was decided, on a careful
consideration of the case, to remove the dead portion of bone, to effect
which, it was necessary to make an incision of about an inch long,
through the integuments covering the tibia. The operation, which was
skilfully performed by Mr. Howship, did not occupy many minutes.
The boy was removed to his bed in high spirits, but, in a few hours, a
remarkable change occurred; the bleeding from the cutaneous vessels
continued, notwithstanding the application of powerful styptics, and the
child, who had now become pale and blanched, from loss of blood, sank
in a few hours after the operation. I have often deeply regretted that
Turpentine was not administered in this instance. I have alluded to
it, in order, that should a similar one occur, this remedy may not be lost
sight of.
"ºra Haemorrhagica. Until the year 1846, I had very few op-
portunities of testing the therapeutic properties of Turpentine in this
affection; but in the severe epidemic of this disorder, which took place
among the poor, from the deficiency of the potatoe crop, and scarcity of
vegetable food, in the winters of 1846 and 1847, I generally found
Turpentine, in combination with bark and full purgative doses of Chelten-
ham saline waters, a very effectual remedy.
CASE x I. R. H., aged forty-seven, a cook, unmarried, who for twelve
months had been out of a situation, applied to me for advice, Sept. 22,
1847. The following were her symptoms:—Bilious retching; pain in
the left side; pain darting from the left kidney to the brim of the
pelvis; great dyspnoea, pulse 96, small and weak; respiration 26, rapid
and short; bowels constipated; catamenia ceased three years; com-
plexion pale and sallow; tongue furred and indented; breath foetid;
gums spongy: urine high coloured, loaded with lithates; purplish peti-
chiae, most extensive on the left side of the body; ankles swollen; often
much annoyed with flatulency. This woman had eaten sparingly of
vegetables the previous winter; her diet had chiefly consisted of boiled
rice, a diminished quantity of bacon, salted fish, fresh meat, bread, and
tea. B. Pilulae hydrar. gr. iij; extracti colocynthidis compositi gr. v.j.
Fiant pilulae ij. To be taken at bed time. B. Acidi nitrici diluti 3i;
tincturae cinchonae 3iv ; infusi cinchonae ad 3viij. M. Two tablespoon-
fuls morning and evening. To eat freely of cooked vegetables, and
have cider or perry for dinner.
Sept. 26. Much about the same—mights disturbed. To take two
tablespoonfuls of the following mixture twice daily:—B. Acidi nitrici
338 THERAPEUTICAL USES OF TEREBIN THINATE MEDICINES.
diluti 3i; tincturae cinchonae 3iv ; olei Terebinthinae, tincturae hyos-
cyami aa. 5ii; infusi cinchonae ad 3vij. M. The pills to be omitted.
Oct. 2. Eruption declining—bowels costive. To have a nitro-hydro-
chloric acid bath. B. Pilulae hydrargyri 3i; extracti colocynth. compos.
5i; pilulae galbani comp. 9ij. M. et divide in pilulas xxx. Two to be
taken twice a week. To take 3xviij of the sulphuretted saline water
every morning.
Oct. 10. Decidedly improved. To repeat the warm bath; to continue
the saline aperient, adding to each morning dose a teaspoonful of the
following drops. R. Tincturae cinchonge 3i: olei Terebinthinge 3ss M.
This woman was perfectly well by the end of the month.
Hamoptysis. This affection is generally associated with pulmonary
phthisis, so that I shall treat of it in connexion with that disorder. As
the use of Turpentine is not new in the treatment of pulmonary con-
sumption, I shall condense my remarks as much as possible. I am not
aware that the inhalation of the vapour has ever been recommended in
pectoral disorders. I have not only found it useful in allaying the
cough in acute and chronic bronchitis, but I have also seen a very great
amendment follow its use in tubercular phthisis. The success which
attended the inhalation of tar vapour, first recommended by Bishop
Berkely, and so highly extolled by Sir A. Crichton, was, no doubt,
owing to its volatile principles, analogous, in some respects, to those of
Turpentine, from which it differs in containing a larger amount of carbon
and empyreumatic oil, and less of the essential oil. “Out of fifty-
four cases treated by Drs. Hufeland and Neumann, at the Hospital of
La Charité, Berlin, four were cured; six were greatly improved; sixteen
were unaffected by it; twelve became worse; and sixteen died.” I have
frequently resorted to the use of medicated vapours, containing Turpen-
time, conium, opium, and hydrocyanic acid, in every stage of this dis-
order. In the active form of pulmonary hamorrhage, as well as in the
distressing paroxysms of the morning cough, I have seen them produce
a very tranquillizing effect. From the inquiries which I have made at
the different Camphine and Turpentine manufactories, I have learnt, that
the individuals engaged in the distillation of these ingredients are
rarely on the sick list. Turpentine is considered by the men generally,
to possess very healing properties. Applied to the lungs, in the form of
vapour, or taken internally, I conceive that it exerts a benign influence
in an ulcerated condition of these organs; and by inducing a healthy
condition of the ulcerated surfaces, tends to produce cicatrization, after
the morbid contents have been evacuated from the vomica, and the
system improved by tonic or other remedies. It is known to exercise
a Salutary influence in chronic ulcers, indolent sores, and recent abra-
sions: cateris paribus, it will have the same effect on internal ulce-
rations when cautiously inhaled or judiciously prescribed. In the
following observations, in lieu of enumerating a variety of physical
phenomena as elucidatory of incipient or confirmed phthisis, I shall
confine myself to what is usually considered as the most unequivocal
symptom of this disorder. The physical phenomena deduced by ex-
ploration of the pulmonary parietes, do not always furnish criteria on
which we can depend with unbiassed confidence; but there is no sign
BY THOMAS SMITH, M.D. 339
so strongly confirmatory of serious thoracic mischief, as pulmonary
haemorrhage; and whether it be occasioned by a plethoric condition of
the heart or great vessels, or a congestive state of any of the cerebral
or abdominal viscera, or by disease inherent in the texture of the lungs,
the sequence too often proves its connexion with pulmonary consumption.
I do not profess to have cured phthisis in any of the instances which I
am about to narrate. All that I wish to imply is, that Turpentine has
been more successful in restraining the hamorrhagic tendency, and pre-
serving the patients in a condition of apparent health, and for a much
longer period, than any other remedy of which I have made trial. I have
purposely abstained from the narration of any case of very recent date,
knowing, that in a disorder of so deceptive a nature as phthisis, we
ought to be especially guarded as to our prognosis, and not be too rash
in forming our judgment of the future. . .
CASE XII. Mr. W., aged 36, cabinet-maker, consulted me on the 14th
of May, 1839, for a pain in his chest, attended with considerable dys-
pnoea. The physical signs denoted incipient phthisis; and this diagnosis
was confirmed a few weeks after, by the occurrence of haemoptysis.
Leeching, blistering, and counter-irritants were ordered, and a mixture
containing Turpentine and infusion of roses. He improved under this
treatment; and after a residence of some months in the Isle of Man, he
returned home, and pursued his usual avocation. Four years afterwards,
he was attacked with inflammation of the bowels, from exposure to cold
and damp, which proved fatal. On examination of the body, the right
lung contained a small cavity, which had a very healthy appearance ;
it contained a little yellowish matter; its lower edges were crossed and
united by bands easily rent asunder. There was a considerable amount
of miliary deposit in the apex of the same lung, but none in the other.
CASE xIII. A. S., aged 30, married, without family, a gardener, was
admitted to the Leeds Dispensary, July 6, 1842, suffering from profuse
haemorrhage of the lungs. There was considerable dulness in the upper
portion of both lungs; gurgling rhonchi. This case proved intractable
for some time, but the haemoptysis was finally subdued, and the man re-
sumed his usual employment, continuing, by my advice, to take daily a
few drops of Turpentine with infusion of quassia. When last I heard
of him, he seemed to be in tolerable health.
CASE xiv. A married lady consulted me in 1841, for supposed tuber-
cular disease. On examining the chest, there was slight depression to
the extent of about a quarter of an inch in the right infra-clavicular region.
The nipple on the breast of the same side, was the eighth of an inch
nearer the sternum than the one on the left. The respiration was masked,
and percussion elicited a damp sound. The left side was clear on per-
cussion, and respiration was puerile. The appetite was extremely capri-
cious, the bowels irregular, catamenia regular, nights restless, urine
turbid, yellow with deposit; there was constant teasing cough, with slight
haemoptysis. She had also a gnawing sensation in the pit of the stomach,
with a tendency to retching. To have six leeches applied to the chest.
B. Oleijecoris aselli 3iss: liquoris ammoniae fortis 3ss; linim. Saponis
compos. ad gij. M. To be rubbed on the chest night and morning.
To take two tablespoonfuls of the following mixture three times a day.
B. Infusi rosæ compos. 3v.j; magnesiae sulphatis 3v.j; olei Terebin-
340 THERAPEUTICAL USES OF TEREBINTHINATE MEDICINEs.
thinge 3ij. M. B. Extracti colocynth, comp. gr. v.j; morphiae acet. gr.
ss; pilulae hydrarg. gr. iij. Fiant pilulae iſ. To be taken at bed time.
The following day this patient passed several portions of tape-worm.
She recovered, and by perseverance in the following mixtures for some
time, together with a temporary residence at the sea side, she ultimately
regained her former health, and the last account I had was highly favour-
able; she has had no appearance of tape-worm since. B. Mist. ferri
comp. 3vijss; olei Terebinthinae 5ij; tincturae camphorae comp. 3ij. M.
Two tablespoonfuls twice a day.
CASE xv. A. O., washerwoman, complained of severe cough, with
mucous expectoration, which, a few days previously, had been mixed
with blood; there was great pain in the left side, with inability to lie
on it; pulse 100, sharp and thrilling; respiration 28, short; bowels
regular; catamenia regular; urine scanty, high coloured ; tongue pale
and dry; there was feverishness and restlessness. Both infra-clavicular
regions were slightly depressed; in the upper third of the left lung the
expiratory murmur was harsh and prolonged, with small crepitating
rāle; there was also slight dulness on percussion, anteriorly and pos-
teriorly. On the right side, there was increased expiratory murmur, and
clear percussion-sound. There was also bronchophony. The action of
the heart was more distinct than natural under the right clavicle; pos-
teriorly it was diffused. She was ordered to take the following pills
at bed-time. R. Calomelanos gr. iij; extr. colocynth. comp. gr.vj. M.
R. Potassae nitrat. §ss.; tincturae digitalis 5i; syrupi Scillae 3iv ; aquae
ad 3vij. M. A fourth part every four hours.
Nov. 19, 1843. Had rather a sharp attack of dyspnoea, with return
of pulmonary hamorrhage. A blister was ordered to be applied to the
chest, and two table-spoonfuls of the following mixture to be taken
every four hours: R. Olei Terebinthimae 5ij; tincturae digitalis 5i; de-
cocti aloes comp. 3vij. M. Under this treatment, this patient continued
to improve. She took occasionally linseed oil, cod-liver oil, and Sarsa-
parilla, with Turpentine and lime-water; and in the following summer
had become convalescent.
CASE xvi. Mrs. W., a married lady, aged 26, without children, had
for several years been in a declining state of health. I first saw her in
1848; she was extremely pale and emaciated, and had for some time
previous parted with small quantities of florid blood. These attacks of
haemorrhage mostly occurred in the morning. Her nights were very
much disturbed; she had paroxysms of flushing, succeeded by profuse
perspiration. Exploration of the thoracic viscera impressed me most
unfavourably with this patient's condition. Nearly fifteen months she
was confined to her room, and used Turpentine inhalations, infusions of
matico with Turpentine, infusions of the water hemlock, occasionally
replaced by cod-liver oil and emulsions of almond oil and hydrocyanic
acid. Her chest was assiduously bathed with spirits of Turpentine, and,
in addition, she had two galvanic issues established under each clavicle.
In the autumn of 1848, while improving in health, she had an attack of
scarlet fever, which confined her for some months longer to her room.
In the following summer, she rallied sufficiently to take a trip to the
sea-side, and after a residence there of some time, she was enabled once
more to join the ordinary duties of the domestic circle.
BY THOMAS SMITH, M.D. 341
CASE xvii. A. B., aged 21, a spinner in a flax-mill, was admitted
under my care, into the Leeds Dispensary. The catamenia were sup-
pressed, the skin moist, the bowels relaxed: pulse 100, sharp, small;
respiration 30, irregular; severe pain in the right side; constant cough ;
puriform expectoration ; profuse haemoptysis; papular eruption on the
right leg, with oedema of the ankles. She was cupped and blistered;
and, after the first febrile symptoms had subsided, she took ferruginous
preparations, with decoction of aloes, and Turpentine. In a few months,
this patient recovered sufficiently to return to her work.
CASE XVIII. M. C., aged 22, had the following symptoms: constant
teasing cough; greenish expectoration; severe pain in the heart and
chest; bowels loose; tongue clean ; night-sweats, and hectic fever.
May 3, 1843. She was ordered to take naphtha, with ling-liver oil,
and to have a blister applied to the chest.
May 10. Much worse; great dulness on the right side, with absence
of respiratory murmur ; crumpling sound in the right infrascapular
region; left side normal, with increased respiratory murmur. She had
haemoptysis, and the bowels were still loose. R. Pil. Saponis cum opio
gr. iv.; to be taken at bed-time. R. Olei olivae 3i ; spiritús Terebin-
thinae 3i ; tincturae digitalis 5i; liquoris potassae 5i; liquoris opii
sedativi 3ss; aquae ad 3viij. M. Two table-spoonfuls every two hours.
She improved under this treatment; and the following medicine was
ordered. R. Quinae disulphatis gr. v.j; acidi sulphurici diluti 3ss; olei
Terebinthinae 3i; tincturae camphorae comp. 5ij; infusi quassiae ad 3viij.
M. Two tablespoonfuls three times a day. In a few months, conval-
escence was established.
CASE xix. S. R., aged 19, dressmaker, was admitted, under my care,
into the Cheltenham General Hospital and Dispensary, in October 1846.
She had been, for some time, frequently seized with chills, alternately
with flushing; great pain and tenderness on the left side; cough with
mucous expectoration, accompanied sometimes with a small quantity of
blood of a bright florid colour; small weak pulse, 92; respiration la-
boured, 28; obstinate constipation ; urine scanty, opalescent, specific
gravity 1026. She was treated with liniments of pyroligneous acid
and oil of Turpentine; blisters; cathartics; and Terebinthinous medi-
cines. The bleeding was arrested, and convalescence established. She
took a course of the Pitville saline, with Turpentine, with great advan-
tage, and has hitherto had no relapse.
CASE xx. A youth, aged 18, apprentice to a grocer, was seized with
haemoptysis on the 6th March, 1842. He had previously been, for
some time, under my care, and had manifested indications of incipient
phthisis. After subduing the more prominent affection, the pulmonary
haemorrhage, by means of Turpentine mixtures, counter-irritation, and
local bleeding, I advised an early removal to the Isle of Man. The
youth inhaled freely the Turpentine vapour, and I daily tested the vital
capacity of the chest by means of the pulmoneter. This, I think, tended
considerably to his recovery. The habit of cautious prolonged inspira.
tion often acts beneficially on the system of phthisical patients; emphy-
sema may also occasionally be induced, and when this has resulted, tu-
bercular phthisis has been known to be arrested. Two years after, when
I examined this youth's chest, I could detect a marked difference in the
342 THERAPEUTICAL USES OF TEREBIN THINATE MEDICINES.
respiratory movements of the right and left side. He could, however,
with ease displace 3c of water in the pneumatic trough. When first I saw
him it required a very forcible expiration to effect the dislodgement of
3lxx. When I recently heard of him, he was alive, and enjoying a
tolerable share of health. - t
It is extremely difficult to lay down any plan for guidance in the treat-
ment of phthisis. I have tried several remedies with apparent benefit.
But though I have related the above cases, which varyin their dates
from ten to two years ago, I should hesitate ere I asserted that I had
cured one case of pulmonary consumption. Nevertheless, I believe the
disease capable of being favourably influenced by treatment, and even
of being often brought to a successful termination, as I have no doubt
some of the cases I have related will hereafter testify.
Parasitic Worms. I know of no remedy comparable to the oil of
Turpentine for the expulsion of parasitical animals. To accomplish this
object, I place little reliance on the purgative action induced by the me.
dicine, but I depend chiefly on the dissemination of the Terebinthinous
principles throughout the animal tissues. The only way effectually to
destroy these animals, is to render the aliment on which they subsist
unfit for them. In fevers of a low or putrid character, in scarlatina and
some of the exanthemata, worms are frequently expelled, per vias
naturales, prior to death, by the noxious emanations which often exist
in these affections, and which are destructive to parasitical life, . It ought
to be our aim to imitate nature; and where it can safely be done, to
taint the food on which the different species of the entozoa feed, with
such noxious ingredients as are known to be inimical to them. Thus Dip-
pel's animal oil, Chabert's oil, and similar nostrums, are valuable only
so far as they carry out this important object. Turpentine will effect
the entire destruction of any of the entozoa and their ova, provided it
be given in small doses, and continued for a sufficient length of time to
saturate the system with its odour. Purgative doses of Turpentine, or
enemata containing the same, decoctions of the bark of the root of the
pomegranate, and many of our most esteemed vermifuges, will often suf.
fice for the removal or destruction of lumbrici or ascarides. In tape-
worm, in many instances, a different treatment is required. We may
frequently succeed with the above remedies, but we occasionally fail.
This is owing to the habits of the animal. It forms a nidus of gelatinous
matter, into which it protrudes its head and neck after it has separated
itself from the remaining joints of the body, and then, on the first inti-
mation of danger, attaches itself to the intestine by means of its four
suckers so firmly, as to defy any reasonable force to detach it. The
tail of the animal is occasionally met with high up in the bowels, and
even in the stomach, whilst the head occupies a position in the intes-
tinal tract considerably lower. This may be a provision of nature
to warn it of the presence of any noxious or irritating ingredient in the
stomach, and thus to enable the animal to preserve its vitality. From the
fluted manner in which it sometimes lays along the intestine, it must
be extremely difficult to effect its expulsion, except by medicines which
exert a poisonous action on it through its food. Vermifuges, when taken
by the mouth, have frequently occasioned yards to be brought away by
vomiting; but the animal remains secure in his retreat. If, however,
BY THOMAS SMITH, M.D. 343
we give small doses of Turpentine, or any empyreumatic oil, the secre-
tions will at length become so tainted, that we cause its death and subse-
quent expulsion or absorption: and though we may never see it expelled,
we may be pretty confident that we have occasioned its death, by the
subsidence of all those symptoms and distressing sensations, which it
produces whilst alive. . . . . . -
CASE XXI. A female, who for upwards of twenty years had repeatedly
expelled considerable portions of tape-worm, applied to me, in 1843.
She had taken Turpentine in full doses, and had generally been much
relieved by it; but the parasite still remained. I ordered half an
ounce of oil of Turpentine, half an ounce of castor oil, and an ounce of the
decoction of the bark of the root of the pomegranate, to be taken every
morning, She parted with several yards of worm; but as I could not
detect the head amongst any portion, I advised her to take two table-
spoonfuls of the following mixture daily, for three months. R. Infusi
quassiae 3vij; olei Terebinthinge 3ij; tincturaeferri sesquichloridi 3i. M.
She attended to my advice ; and, two years after, she told me that she
had had no return of any of her uneasy sensations.
CASE XXII. A cook, in my employ, had for years been the subject of
tape-worm, and had taken Turpentine repeatedly, without deriving any
other than temporary benefit from it. I put her on a plan similar to the
former; and in a few months she found her health perfectly re-established,
and has hitherto had no return of the affection. -
I have seen two instances in which grubs have occasioned much an-
noyance and distress, by depositing their ova in the urethra. . .
CASE XXIII. A young gentleman, about 22 years of age, had intoler-
able itching at the end of the urethra, which generally occurred every
four or five weeks, lasted for three days, and subsided as soon as the
larvae (small white-bodied animalcules with black heads,) appeared. I
advised him to inject a few drops of Turpentine in mucilage, two or
three times a day, into the urethra; and to take ten drops of the same
in infusion of quassia twice daily. This plan succeeded, and he recovered.
Chronic Rheumatism. In this affection I have frequently found that
the Oil of Turpentine, combined with bark or guaicum, has given con-
siderable relief." . . .
Flatulent Distension of the Abdomen. This is a distressing symp-
tom, which often accompanies a dyspeptic state of the system, especially
in gouty patients. It is sometimes attended with nervous excitement
of the heart, sometimes accompanied by spasm of the bowels, and
dyspnoea. For the relief of this symptom, whether originating from
mal-assimilation of the food, or supervening on obstruction of the
bowels, or occurring after an operation for strangulated hernia, I have
found no medicine so efficacious in quickly dispelling the flatus, as Oil
of Turpentine. In gouty subjects who freely secrete lithic acid, and
who are much troubled with this kind of flatulency, I have rarely ever
experienced that small doses of the oil of Turpentine, with or without
* I have also seen the alkaline camphine bath of very great service, in some
long standing cases of this disorder. I have tried it in lumbago, sciatica, and gout,
and can speak highly favourably of it in these affections. Many of the parties who
have tried it, have derived so much benefit from it, in the alleviation of their aches
and pains, that I have known them to resort to it oftener than I had advised.
WOL. II. 23
344 THERAPEUTICAL USES OF TEREBINTHINATE MEDICINES.
colchicum, have failed to afford very great relief, more particularly when
accompanied by a mild diuretic course of our Cheltenham salines. It
is of the greatest importance to avoid active purgation in this state of
the system. - .
The following is a very interesting case of the removal of a large
biliary calculus, which for several days assumed a very serious aspect,
threatening the life of my patient. -
CASE XXIV. An elderly lady was seized with sudden sickness and
pain in the praecordial region, followed by obstruction of the bowels, Large
doses of calomel, croton oil, and other drastic purgatives, were given to
relieve the latter; creasote and hydrocyanic acid, for the former. Local
bleeding was employed, and stimulating applications and bladders con-
taining ice, were applied in turns to the abdomen. Enemata of Turpen-
time and rue were also administered, without producing any favourable
change. On the contrary, the sickness became so distressing, that on
the sixth day of the attack, it was decided in consultation, to abandon
all remedies by the mouth, and trust entirely to Turpentine clysters
and the local application of ice and of epithems containing cajeput oil,
Turpentine, opium, croton oil, liquor ammoniae, etc. On the seventh day,
the abdomen became enormously distended with flatus, a considerable
quantity of which was withdrawn from the bowels several times in the
day, by means of the tube of a stomach-pump introduced into the
rectum. After the gas was pumped out, upwards of a gallon of iced
water was thrown into the bowels; and as soon as this was evacuated,
about a quart of warm water, containing Turpentine, was immediately
injected. This plan was persevered in until the eleventh day; and
notwithstanding the supervention of hiccup, and several other unfavour-
able indications, the patient at last obtained relief. A hard substance
seemed suddenly to be disengaged from a portion of the small intestines.
Shortly after one of these operations, a regular action of the bowels
ensued; and on the fourteenth day she passed a biliary calculus, of the
size of a walnut, and weighing 5ii, gr. xi. Its upper surface was per-
fectly smooth and concave, and appeared to have been attached to a
smooth substance, such as the lining membrane of the gall-bladder.
For twenty years, this lady had complained of pain in the pit of the
stomach after eating, and had never had an action of the bowels without
strong drastic purgatives. A tea-spoonful of castor oil, with ten drops
of Turpentine, were ordered to be taken every morning; and in a few
days she became perfectly convalescent, and has continued well from
that day.
Puerperal Convulsions and Peritonitis. Those who see an analogy
between puerperal convulsions and peritonitis, will be inclined to re-
gard Turpentine as likely to prove extremely valuable in the former
disorder. Repeatedly have I treated puerperal convulsions, and puer-
peral peritonitis, as well as peritonitis independent of the parturient
state, with this medicine, and have attributed the rapid subsidence of the
more prominent symptoms to its influence.
CASE xxv. A. C., aged seventeen years and a half, residing at New
Town, Leeds, was seized with convulsions of a most formidable character,
a few hours after she had given birth to a male child. The gentleman
who attended her in the confinement, requested my advice in the case.
BY THOMAS SMITH, M.D. - 345
Detrahatur sanguis é brachio ad 3xx. Calomelanos gr. vi. To be taken
directly. R. Ol. Terebinthina 3iv ; magn. sulphat. 3i; aquae ad
3vij. Two tablespoonfuls every two hours. Enema of Turpentine and
gruel. In six hours, this patient recovered consciousness, and, from that
period, progressed favourably. -
CASE XXVI. M. C., aged twenty-nine, was seized, on the 5th of Feb.
1843, with intense pain in the head; great prostration of the vital
powers; small, weak, fluttering pulse; abdominal tenderness; retraction
of the lower extremities; constipation, and pyrexia. She had been con-
fined two days previously of a male child. Bladders of ice to be applied
to the shaven head; warm Turpentine to the bowels; Turpentine enema.
W. S. ad deliquium animi. Twenty-four ounces of blood were lost, before
fainting ensued. R. Calomelanos gr. iij : pulv. opii gr. ss. Fiat pilula.
To be taken every three hours. R. Olei Terebinthinae 3ss; mist. Sennae
comp.3viss. M. Two tablespoonfuls an hour after each dose of the pills.
This patient's mouth soon became affected, and she speedily recovered.
CASE XXVII. A female servant, residing with a patient of mine, was
taken ill a short time ago, with symptoms of diffused peritonitis.
The bowels were extremely obstinate, and the retching incessant. She
was largely bled, both locally and generally; mixtures containing Tur-
pentine, and pills of calomel and colocynth, were freely administered;
clysters and Turpentine epithems were also resorted to. Towards the
termination of the fourth day, the bowels regained their propulsive
power. Large quantities of faecal matter were evacuated; and by per-
sistence in small doses of castor oil and Turpentine, with vegetable
tonics, she soon recovered her former health,
Diseases of the Eye. The testimony of several celebrated oculists
has been adduced in favour of this drug in the treatment of many in-
flammatory affections of the eye. I am not able to say anything, either
for or against its use. As yet, I have never made trial of it in disorders
of that organ. - -
Diseases of the Nervous System. Turpentine has been considered
to be of eminent service in apoplexy, hydrocephalus, and epilepsy. One
case of hydrocephalus, a little boy, seven years of age, seemed to be
very much benefited after the administration of a few enemata contain-
ing this drug, and the child eventually recovered. In apoplewy, I have
witnessed a like result; but I do not consider this, and similar instances,
sufficiently decisive to warrant me in concluding that Turpentine
exercised a controlling power over the disease, otherwise than by its
purgative action. In epilepsy, depending upon intestinal irritation, such
as worms, purgative doses of, or enema containing, Turpentine, will
generally be found efficacious. Nevertheless, the majority of epileptic
patients will not derive any very great advantage from it. In such
examples, we must ascertain the cause of the malady, which may often
be of a character over which medicine possesses but little anti-con-
vulsive influence. . . . • -
Injuries occurring from Burns or Scalds. I have often seen these
much benefited by the Terebinthinous unguents, or liniments, which
I have recommended to be applied. .
CASE xxviii. A young female was dreadfully scorched by the sudden
ignition of some foul air, pent up in a water cistern. She hºl inad-
+ 23
346 DR. THOMAS SMITH ON TEREBINTHINATE MEDIC (NES.
vertently placed a lighted candle on the edge of the cisterm whilst she
removed the lid—an instantaneous explosion followed this act. She was
thrown down; and on examination, was found to be considerably burnt
about the hands, face, neck, and right arm. The following liniment was
applied to the denuded surfaces, and other appropriate treatment en-
joined. R. Pulveris opii gr. viii; liquoris calcis gi; olei Terebinthinae
3iv ; olei lini 3ss. M. ut fiat limimentum. She soon recovered from
these injuries.
Pertussis. In the second and third stages of this affection, I have
frequently found liniments of Turpentine, with opium, rubbed on the
spine and chest, of considerable value in mitigating the severity of the
paroxysms. The inhalation of the vapour has also appeared to me to
exert a calmative influence on the convulsive character of the cough.
CASE XXIX. Master C., aged 4 years, a stout, healthy-looking child,
was the subject of hooping-cough, in the spring of 1845. The paroxysms
were extremely violent, of frequent recurrence; and, as he had already
lost two brothers by the same affection, the case caused considerable
anxiety. I requested that he might be confined in a room, the tem-
perature of which should not be less than 65° Fahr., by night as well
as by day. To attain tranquillity of mind (a necessary item in the
treatment of this malady), I desired that all scenes of excitement should
be avoided; for I have known this to prolong the disorder, and even to
be the cause of a fatal termination. A bath at 100°, containing half
an ounce of the carbonate of potash to six gallons of water, was used
three times a week; and the back and chest were rubbed every night
with the following limiment. R. Olei Terebinthimae purif. 3iv ; liquoris
opii sedativi äij; oleisuccini şiss; limimenti saponis comp. ad 3iss. M.
The bowels were relieved by gentle laxatives, and the child was allowed
to drink, ad libitum, of the following potion. Bicarbonate of potash,
two drachms; extract of liquorice, half an ounce; honey, two ounces;
boiling water, one quart. The effect of this treatment was very appa-
rent in the altered and less suffocative character of the cough, which,
after the first fortnight, rarely occasioned much uneasiness, except after
a very long sleep. Change of air, with decoction of bark and small
doses of Turpentine, and the occasional exhibition of the compound kimo
powder at bed-time, completed the cure.
I have recently witnessed very great improvement follow the immer-
sion of the lower part of the body, as far as the chest, in an alkaline
camphine bath. The proportion of qamphine ought not to exceed, (for
children under six years of age), from two to three drachms with three
or four ounces of soda. The vapour of the bath, diffused through the
sleeping apartment, and inhaled into the lungs, has seemed to have
a very beneficial and tranquillizing tendency in this disorder. There
can be no doubt also, that the absorption of the alkali, by rendering
the pituitous secretion from the pulmonary organs less adhesive and
tenacióus, has contributed in no small degree to the relief obtained.
I have now concluded my remarks upon the medicinal properties of
this drug. In the evidence which I have adduced, I have endeavoured
to guard myself from an' over-weening' confidence in its virtues. In
the treatment of any case, however simple, much must be left to the
DR. E. J. T.I.I.T ON UTERINE AND OVARLAN DISEASE. 347
judgment of the practitioner under whose care it has come. Like many
other medicines, Turpentine may fail in producing the effects desired,
if all the circumstances which may modify its action be not duly taken
into account: but, when judiciously administered, I believe it to be
one of the most valuable remedial agents which we possess.
Cheltenham, March 1850.
ON THE CONNEXION OF UTERINE AND OVARIAN
DISEASE.
By EDWARD JOHN TILT, M.D., Physician to the Farringdon General
Dispensary, and to the Paddington Free Dispensary for the
} Diseases of Women and Children.
[Read before the Westminster Medical Society, March 9, 1850.]
WHY should the prognosis of Uterine Disease be more difficult than
that of other organs? Why should very slight Uterine lesions be
sometimes accompanied by intense reaction? Why should it ever
happen that patients, when cured of these lesions, still continue to
suffer as much as they did before treatment? It seems to me, that
speculists have chiefly to guard against the too narrow circumscription
of their field of investigation; for by this means they likewise circum-
scribe their comprehension of the disease, which they ought to study in
all its numerous bearings. The French pathologists are not free from
this reproach; and in proof of this assertion, the very interesting dis.
cussion on Uterine Disease, now proceeding in the French Academy of
Medicine, may be referred to ; a discussion in which many of those
who have taken part will, in future, be considered illustrious among
the founders of uterine pathology. Most of those who have spoken in
that discussion, seem to look upon the Womb as an unconnected organ,
to which alone is confided the whole task of generation; and, losing
sight of its intimate relation with the other organs which form the
reproductive system, they are often at a loss to explain the phenomena
of its diseases, and are, therefore, in their opinions, completely at
variance with each other. In the hope of suggesting an answer to the
questions proposed, I offer the following remarks on the connexion
between Uterine and Ovarian Inflammation.
The Ovaries are connected with the Uterus anatomically, physiologically,
and pathologically. Without alluding to many amongst the inferior
animals, wherein the Womb and Ovaria are always anatomically con-
nected, and merely mentioning, that, according to Müller and Rosen-
haller, they are likewise anatomically connected in woman during the
first months of foetal life, I shall remark, that whenever the system of
reproduction is called into full activity, the fimbriated extremities of the
Fallopian tubes clasp the Ovaries as if instinctively, and the generative
intestine becomes, for the time being, an apparatus which is one and
undivided, each organ being linked with the other to subserve the com-
mon end for which they are physiologically associated. The Uterus is,
therefore, an intermediate organ, receiving its stimulus from the external
348 CONNEXION OF UTERINE AND OVARIAN DISEASE.
organs of generation, which call on it to act, and also from the central
organs of generation, the Ovaries, from which it receives its power of ac-
tion, together with the ovum on which it is to react.
If we turn our view from the healthy to the morbid conditions
of the reproductive system, we shall find, that just as the Ovaries and
Uterus exert a physiological influence on each other, so they are capable
of mutually imparting and receiving a morbid stimulus. This subject
I propose to consider under the following heads:—I. The transmission
of inflammation from the Uterus to the Ovaries: and II. From the
Ovaries to the Uterus.
I. Is INFLAMMATION TRANSMITTED FROM THE UTERUs To THE OVARIEs?
That inflammation may be transmitted from the Womb to the Ovaries,
is admitted by all pathologists. They were first struck by the frequency
of this occurrence in the puerperal state; and further investigation has
convinced them, that at all times this transmission of inflammation is
not uncommon. In proof of this, I may refer to an example of extensive
ulceration of the neck of the Womb, which Madame Boivin has depicted
in her Atlas, and with which an inflammation of the right Ovary was
co-existent. Dr. Henry Bennet also assures us, that inflammation of
the uterine appendages may be reckoned among the natural terminations
of metritis. Dr. Doherty also states, that he has met with chronic
ovaritis supervening in the course of malignant diseases of the Womb.
But it is principally in that peculiar form of catarrhal inflammation of
the cavity of the neck, where no ulceration can be detected, and, where
a diminished uterine orifice is closed by thickened mucus, that the
transmission of inflammation to the Ovaries is most frequently observed.
This is a very tedious form of Uterine Disease; and, after it has lasted
some time, an additional source of suffering may arise; a deep-seated
pain is felt in the ovarian region of one or both sides, and this may be fol-
lowed by a distinctly perceptible swelling. Dr. Melier was the first
to draw particular attention to this succession of morbid phenomena
(Mémoires de l'Académie Royale de Médicine, vol. II). In a case which
he attended with Dr. Roche, the patient had, for a year, been affected
with catarrhal inflammation of the neck of the Uterus, accompanied by
pain behind the pubis, when she began to experience a totally different
kind of suffering in the iliac regions: and an ovarian swelling could be
distinctly felt on the right side. Whenever the pain in the cervix was
exasperated, the ovarian tumour became more painful; and on attempt-
ing to dilate the uterine orifice, Dr. Melier likewise increased the pain
of the tumour. Dr. Melier has seen several cases of this description;
and it has also fallen to my lot to witness some, in which, sº great a
community of feeling existed between the two organs, that any increased
inflammation of the Womb produced increased inflammation of the
Ovary; and by subduing the uterine irritation, the ovarian was abated.
Ovaritis is then often a secondary effect of metritis. Sometimes, how-
ever, the two diseases co-exist; and then ovaritis is masked by the
symptoms of metritis. Gendrin explains the simultaneous inflamma-
tory seizure of the Womb and the broad ligaments, by the fact of the
Womb, the Ovariés, and broad ligaments, obtaining their vessels and
nerves from a common source. e might have added the common
*...*
BY EDWARD JOHN TILT, M.D. 349
sympathies, by which they are united for the same purpose. If idiopa-
thic inflammation of the Womb can produce subacute ovaritis, it is
evident that the same result may follow the use of those active agents,
by which we seek to substitute a healthy inflammatory action for the
morbid state of a tissue. M. Gendrin, whose name carries weight in
such matters, states, that he has seen many cases of ovaritis, uterine
engorgement, and metro-peritonitis, caused by deep cauterization, and,
in some instances, even by the use of the nitrate of silver to the neck of
the Womb, or by styptic injections into its cavity. But we have not
only to fear the propagation of inflammation from the idiosyncrasy
of the patient, or from the injudicious use of active escharotics, but
likewise from the employment of various mechanical means which
have been lately invented, and are now so much in vogue. I be-
lieve that the ordinary pessaries effect no good purpose, while they
give rise to great irritation; and, with regard to the stem-pessary, I
have seen it entail so much Uterine and Ovarian irritation, that (without
denying the good results which may have followed its use in other
hands), I do not intend to employ it again. When it is remembered,
that many of the uterine deviations and flections, for which it is recom-
mended, are congenital, and therefore cannot be permanently redressed;
and that many of these deviations are as painless as they are frequent,
whilst, in some patients, it has produced a fatal termination, I trust
that I shall not be blamed for expressing so strong an opinion.1 Fur-
ther illustrations might be given from the works of Ricord, Mercier,
and others; but I will now proceed to consider the second division of
this paper.
II. Is INFLAMMATION TRANSMITTED FROM THE OVARIES To THE
Wom B? We know that the Ovaries, in virtue of their governing influence
over the Uterus, induce periodically a state of vascular turgescence in
the walls of this organ; and it is not surprising to find that Ovaritis
does induce frequently the exaggeration of this physiological state, or
the inflammation of the inner surface of the Womb and of its neck, ac-
companied by the secretion of false membranes. But should this
peculiar form of ovarian irritation last for some length of time, the
texture of the Womb itself becomes altered. The posterior wall is at
first felt to be soft, compressible, and painful to the touch; and, after
repeated engorgements, the tissue becomes harder and more solid, very
much like the tissue of an erectile tumour, or that of a fibrous growth.
Thus enlarged, the Womb becomes liable to retroversion; and some-
times, even when it is thus displaced, it excites inflammation in the
neighbouring peritonaeum. False membranes are formed, which fix the
Womb, and an irreducible retroversion may be the ultimate result.
These statements have been made both by Dr. Oldham and Dr. Rigby;
and as, on many other points of uterine pathology, these gentlemen are
at variance, their agreement, in this instance, even if their observations
had not been confirmed by others, goes far to prove their correctness.
The liability of the neck of the Womb to disease, under the influence
* I have more fully directed the attention of the profession to this and other
points treated of in this memoir, in a work on Diseases of Menstruation and Ovarian
Inflammation, now in the press. *
350 CONNEXION OF UTERINE AND OVARIAN DISEASE.
of ovarian irritation, will be better understood, if we consider its anato-
mical structure. The neck of the Uterus is said to be constituted of
muscular fibres, cellular tissue, and an external and an internal mucous
membrane; but there is another and very important element of its
structure, which has been overlooked even in our best and most recent
works on the subject, I mean the erectile tissue, which also enters into
its composition. Dr. Eugène Forget has lately asserted that the
erectile tissue (a continuation of that which lines the vagina), exists
in the normal cervix ; and that, as it forms a covering for the extremity
of the penis, so it covers the surgical extremity of the neck of the
womb. It is evident, that the various stimuli to which this organ is
liable, will exaggerate the condition of the normal structure which I
have described, and thus give rise to those swellings, which are by some
called inflammation, by others, engorgement; and which have been
long since termed erectile tumours of the cervix uteri, by Professor
Recamier. The correctness of this denomination will be evident, when
we consider that these swellings are at first, and often for a long time,
of an indolent, spongy, vascular nature, and only inflame when, from
the increased effect of irritating causes, their epithelial surface becomes
abraded. The immediate therapeutical bearings of the erectile tissue,
as one of the elements of the neck of the Uterus, are important.
In proof of the influence of ovarian inflammation in production of
these erectile tumours in the neck of the uterus, I quote the following
case, lately published by Professor Recamier.”
CASE. Inflammatory Swelling of the Ovary, with an Erectile En-
gorgement of the Neck of the Womb. I was consulted by Madame R.,
of Troyes, who, for the last eight years, had suffered considerably from
ovarian irritation, attended by much pain in the right iliac fossa; sexual
intercourse also produced intense, suffering. Such had been the gene-
ral state of the patient's health, though it varied for better or for worse.
On examination, I found to the right, a little above the Uterus, an
inflammatory tumefaction of the right Ovary, about the size of a hen's
egg, which was very painful, even when gently touched. This tumour
was distinctly felt by the double touch, the left hand pressing on the
hypogastric region. There was also considerable erectile swelling of
the anterior lip of the os-uteri. The patient had little fever; I applied
leeches to the right inguinal region, and ordered poultices, baths, etc.
When the ovarian tumefaction was diminished, as there still remained
some engorgement of the neck, it was cauterized three or four times, at
four days interval. After seven weeks' treatment, the patient re-
turned home perfectly cured.
The following case, similar in many respects, although varying in its
results, will be foundin Duparque's classic workon Diseases of the Womb.
CASE, Menstruation became scanty, and disappeared in a woman
*In the course of the discussion, on this paper, Dr. Snow-Beck'denied the pre-
sence of any erectile tissue in the neck of the womb ; and his intimate:acquaintance
with the structure of this, organ gives weight to his assertion. I have, however,
consulted our great micrºscopical authorit *... who admits the existence
of a layer of erectile tissue covering the neck of the Uterus.” He says that it is of
similar structure to that, of the penis, and to that which lines the vagina.
* Gazette des Hôpitaux, Feb. 1850. -

BY EDWARD JOHN TILT, M.D. 35 |
aged 25; she suffered from severe pain in the loins and in the left
ovarian region. On examining her, I detected a very slight engorge-
ment of the left angle and posterior lip of the Uterus; but I found a
manifest tumour about the size of a small egg, in the left ovarian re-
gion. The tumour was painful, and I thought it ovarian. Venesec-
tion, and the application of leeches to the neck of the Womb, brought
about a diminution of the uterine engorgement in the space of two
months; but the ovarian tumour still" remained the same. As the
patient was too weak to bear any further loss of blood, I gave calomel,
and ordered mercurial frictions to the -inguinal regions; and in two
months more, she had quite recovered from both affections.
The following case strengthens, still more forcibly, the position
which I defend. It was observed by Dr. Letalnet, and communicated
by him to Dr. Brierre de Boismont; they both believed that the Ovaries
were primarily inflamed, and that inflammation was thence transmitted
to the Uterus. It is to be regretted, however, that the state of the
Ovaries was not minutely investigated.
CASE. Acute Ovaritis; Metritis; 'Inflammation of the Oviducts, and
Peritonitis. Madlle. A., aged 21, of a lymphatic temperament, men-
struated for the first time, and without pain, at 13 years of age. At
seventeen, she was affected with chlorosis; and the diminution of the
menstrual discharge, which then took place, was accompanied with epi-
staxis. When in her eighteenth year, she felt, for the first time, a pain
in the right ovarian region, which augmented at each menstrual epoch;
and when the lady was under the influence of cold, hysterico-epileptic
fits constantly attended the menstrual flow, which, however, remained
regular as to the periods. She became afflicted with leucorrhoea, and
also with a fissure of the anus, for which an operation was performed.
At the menstrual period which immediately followed this operation, she
suffered considerably, and the dysmemorrhoeal symptoms became more
and more considerable. The menstrual discharge, instead of being red,
was now brown, then black, and at last ceased altogether to flow. When
Dr. Letalnet first saw the patient, the hypogastric region was painful,
the uterus was increased in size, heavy, and painful on being touched
through the rectum. This uterine congestion was accompanied at all
times by pains in the loins, particularly whenever the menstrual dis-
charge began to flow. The patient's breath was fetid, her respiration
rapid, she would lose her senses during an hour or two, and afterwards
remain in a lethargic state for thirty-six hours. Notwithstanding the
anaemic state of this young lady, bleeding (says Dr. Letalnet) was her
only relief. The flow of blood was immediately followed by a decided
improvement; and when the menstrual discharge appeared of its own
accord, or was solicited by remedial means, the patient was sure to be
well in two or three days. It was proved, not once only, but often,
that venesection, or leeches to the hypogastric region, brought on the
catamenia and epistaxis in this highly anaemic patient, and put an end
to the hysterical fits. t ->
Dr. Rigby affirms that he has never seen Ovarian Irritation to exist
without some derangement of the Uterus ; and Dr. Murphy informs us,
that in many cases of dysmemorrhoea, he failed in relieving the patients
while he addressed the whole of the treatment to the uterine elements
352 CONNEXION OF UTERINE AND OVARIAN DISEASE.
of the case (stricture or ulceration of the os uteri); and that it was only
after more minute attention, and on finding that, in those cases, painful
menstruation depended on subacute ovaritis, that he was able to cure it,
by directing appropriate remedies to the organs previously affected.
have seen similar cases; but knowing how easy it is to distort facts by
looking at them through the fascinating prism of one's own peculiar
views, I am gratified by having the sanction of high authority, when I
advance even one case in support of an opinion which is not generally
admitted.
CASE. A married woman, aged 25, was admitted as a patient at the
Paddington Free Dispensary for Women and Children. She was small
in stature, of a sanguine constitution, and she had been married three
years without issue. She complained of pains in the abdomen, of a
slight discharge, and of dysmemorrhoea, attended by a profuse or a scanty
flow. On examination, a little pain was caused by pressing the ovarian
regions; the neck of the Womb was sound, Considering that the general
health of the patient was in fault, I gave opening medicine and tomics,
and ordered frequent injections with a solution of alum. This treat-
ment was continued several weeks, the general health improved, and
the discharge almost disappeared; but the pains in the ovarian regions
became worse, and the dysmenorrhoea increased. I then ordered injec-
tions, mercurial ointment, and poultices to the inguinal regions, and the
pain abated; but a fortnight afterwards, leucorrhoea reappeared, with
pain in the back, and, on a second examination, I found slight ulcera-
tion of the cervix, which was red and swollen. Considering it therefore
to be an ordinary case of ulceration of the neck, I cauterised it with
nitrate of silver, then with the acid nitrate of mercury, and lastly with
potassa fusa. Such was the treatment employed during the space of
eight months, the patient being sometimes better, at other times worse,
and sometimes remaining without treatment for two or three weeks.
The ovarian pains likewise varied; but, three months ago, finding that
they were very intense, and that they were augmented by walking or by
pressure, and being tired by the pertinacity of the case, I made an explora-
tion per rectum, and found the ovaries swollen, and very painful on being
touched. I then ordered ten leeches to each inguinal region, and the
regular rotation of blisters and mercurial ointment, besides cold enemata
twice a day. The pains subsided, leucorrhoea ceased, and, a few weeks
after, the neck of the womb was merely congested, but offered no ulcer-
ation. After the following menstrual period, I ordered a repetition of
leeches, blisters, and ointment; and now the cervix is sound, the ova-
ries painless, and the patient well. . . . . .
In this case, I think that Ovaritis produced the inflammation of the
neck of the Womb, and kept it up until the primary disease was ener-
getically treated. Now it seems to me, that if my explanation holds
good, it may throw some light on Uterine Pathology. . . It is admitted,
by all those who have contributed to our knowledge in this department,
that one of the characteristic features of Diseases of the Womb, is their
exasperating uncertainty. In some of those who suffer extremely, we
find but very insignificant lesions; and when we have removed these,
the patient sometimes suffers as much as before. Now we may believe
that, in some patients, these symptoms are but a morbid reminiscence
BY EDWARD JOHN TILT, M.D. 353
in the nerves of the convalescent organ; and that a healthy excitement
of the whole system is all that is wanted to relieve these particular
nerves from their undue action, and to merge their own morbidly inde-
pendent feelings into the general fund of excitement. But in many
other cases of Uterine Disease, as in those observed by Dr. Murphy, or
in that which I have related, we cannot cure the disease of the Womb,
because we forget that beyond the Womb, preceding it in the develop-
ment of the organs of reproduction, and governing them through life,
are the Ovaries, which often participate in, and cause that uterine in-
flammation which we alone attack; and thus, while we temporarily seem
to cure the small visible lesion, a hidden one remains to bring on re-
lapses, and to perpetuate the patient's sufferings. In the treatment of
those painful states of the neck of the bladder, so often caused by dis-
eases of the kidneys, we depend much less on direct applications to the
neck of the bladder, than on those means by which we can attack the
kidney—the diseased organ. Should we not be governed by the same
logic in treating diseases of the organs of reproduction ?
Some may say, that I exaggerate the influence of the ovarian organs.
It may also be averred that, by the treatment employed, I have only
acted on the Womb, and that I have no post-mortem examination to offer
in confirmation of my views. This may be true; but if an incontestable
proof be required, that Ovarian Disease often exists unnoticed, and is
erroneously referred to the Womb, I would refer to the last number of
Guy's Hospital Reports, wherein Dr. Oldham relates a most melan-
choly case in point, and gives the particulars of a detailed post-mortem
examination. Such a case is interesting in a scientific point of view, as
representing similar cases not yet published, but which are talked, of l.
And if this mistaking of Ovarian for Uterine inflammation can be made
by men of eminence, may it not occur more frequently to the less
distinguished ? -
42, Gloucester Road, Hyde Park, March 1850.
CASES OF PERFORATION AND OTHER LESIONS OF .
THE STOMACH, OCCURRING IN CONNEXION -
WITH DIABETES ; . . . . . .
WITH REMARKS ON THE GASTRIC ORIGTN UF THAT DISEASE.
By WILLIAM MACINTYRE, M.D., Physician to the Western General Dispensary,
Lisson Grove.
(Read at the Royal Medical and Chirurgical Society, March 27, 1849.)
“Les maladies impriment à nos organes des altérations tout-à-fait identigues à
celles que certains agens physiques et chimiques peuvent déterminer. Il n'est
done pas Étonnant qu'il existe des altérations organiques entièrement semblables
a celles que produit sur nos tissus l'action d'un acide, et peut-être un commence-
ment d'altération cadavérique. D'où la difficulté, dans quelques cas, de distin-
guer les altérations physiques ou chimiques des altérations vitales.” CRUVEILHIER,
Anat. Patholog.—Maladies de l’Estomac.
THE researches of the anatomist have thrown less light on the nature
of Diabetes Mellitus, than might have been expected, considering the
very marked characters of that disease, the singularity of its pathogno-
354 LESIONS OF THE STOMACH IN 1) IABETES.
monic symptoms, and the opportunities for pathological investigation
afforded by its extreme fatality. The lesions which have been found in
fatal cases are common to other maladies; and, in their relation to Dia-
betes, may as justly be regarded in the light of secondary or accidental
complications, as of original or essential elements. Hence, though, in
individual instances, they may serve to account for certain symptoms,
they are too inconstant and diversified to be taken as exponents of the
specialities of this remarkable affection.
The information obtained from morbid anatomy proving so little
satisfactory, it is not surprising that a theory of Diabetes, founded solely
on a consideration of the phenomena observed during life, should have
received very general assent; and that mere functional derangement, in
which the assimilative processes are impaired or perverted, should have
been deemed sufficient to account for the most notable of its symptoms.
This doctrine of mal-assimilation, found faintly traced in the writings
of the ancients, was first clearly enunciated by Willis; but though
embraced by several succeeding pathologists, among whom were Syden-
ham, Cullen, Dobson, Home, and Cullen, it is in comparatively recent
times that it has received its full development, more particularly at
the hands of Dr. Prout. In conformity with the whole theory of assi-
milation, so lucidly propounded by this writer, Diabetes may consist in
an error of the primary assimilative processes, of the secondary, or of
both ; or in some unknown perversion of the proper functions of the
kidneys, which permits newly formed sugar, whether derived from the
aliments under erroneously exerted primary assimilation, or from the
destruction of the gelatinous and other tissues, to pass off with the renal
secretion unchanged.”
In support of these conclusions, may now be adduced the fact of sugar
having, in several, cases, been discovered not only in other secretions
besides the urine, but also in the circulating system, in the intestinal
canal, and, in one instance at least, in the stomach of a diabetic subject,
who had been fed on a diet exclusively animal. This detection of the
sugar, en route, as it were, to the kidneys, was, undoubtedly, an im-
portant step in the investigation, obviously leading us to look for the
source of the unnatural product, rather in a vice of those processes of
the animal economy which are engaged in elaborating, from alimentary
materials, the proximate principles of the body, than in any fault of the
emunctories through which it is cast out of the system.
These views, however, even if we admit them to be as true as they
* On the Nature and Treatment of Stomach and Urinary Diseases, p. 37. 1840.
It is curious to observe how closely the language employed by Willis, nearly two
hundred years ago, approaches, in some points, that in use with the iatro-chemical
philosophers of the present day, when applying the doctrine of primary assimilation,
and the ultimate metamorphosis and waste of tissues, to the explicatiºn of diseased
prºcesses, Hung effectum, (miram dulcedinem sc, uring), i.e6 dispiam oriri
pūtaret, quéd una'éuth sanguinis sero per renes excurrente, túň'liquor récens nutri-
tius, tum solidarum partium liquamina amandarentur; quare non improbabile
videtiir, dulcedinem istam ex succis hisce opimis, lotio permixtis, conciliari.”
(Pharmaceutica Rationis, sec. iv, cap. 5.) Willis goes on to explain, according to
the chemistry then in vogue, the subsequent conversion, under the play of chemical
affinities, of these bland and tasteless mingled juices, during their passage through
the circulation, into the material which imparts to the urine in Diabetes its sweet
and somewhat pungent qualities.

BY WILLIAM MACINTYRE, M.D. 355
are ingénious, fall short of removing the whole of the difficulties with
which the subject is beset. We have yet to learn what the precise con-
dition of the digestive and assimilative organs is, which is capable of
thus diverting them from the performance of their natural office, to play
so strange and fatal a part in pathology. If we appeal to the morbid
manifestations present during life, we find many of them, it is true,
unequivocally denoting a great amount of gastric derangement, but
neither singly nor collectively are they expressive of a special morbid
action. The evidénee from recorded dissections is equally inconclusive,
and not a little conflicting. Like the kidneys, the stomach and its
associated viscera have been met with as frequently sound as diseased.
Rutherford and Baillie found the stomach always healthy in structure;
Cullen and Home, generally so. In the second and third cases of three
examples of the disease, detailed by Dr. Bright in his Medical Reports, the
stomach and intestines presented either very little or no sign of disease;
and in two post-mortem examinations by my friends, Dr. Roxburgh and
Dr. Hare, at which I was present, these organs exhibited no very ma-
terial deviation from the healthy state. On the other hand, in some of
the recorded cases, indubitable proofs were found after death that the
stomach had been the seat of an antecedent disease, more or less active.
In one of Dr. Bright's cases, this viscus was small; while in the case
related by Dupuytren and Thénard, in their very interesting Mémoire, it
is said to have been greatly enlarged (eatrémement volumineua, cinque &
sia: pintes de capacité), with unusual vascularity of its internal surface;
and some degree of redness and thickening of the duodenum, the com-
mencement of the jejunum, and the coecum." In a case examined by
Dr. J. L. Bardsley, the organ was inflamed on its posterior surface, near
the cardia, the inflammation being confined to the inner membrane,
which was also slightly corroded by the gastric juice. One of the
kidneys, in this case, was much reduced in bulk, weighing only ten
drachms, but in other respects it was healthy. The same writer refers
to another fatal example, in which the only lesion that could be dis-
covered was a remarkably hypertrophied state of the duodenum.” In
four cases examined by Berndt, the kidneys were free from disease; in
two of them, the stomach was immensely enlarged,—a natural conse-
quence it was thought, of the enormous quantity of food and drink
swallowed.3 }
As far, therefore, as the testimony hitherto furnished by pathological
anatomy avails, we find ourselves either forced to give up the doctrine
of the gastric origin of Diabetes as untenable in the great majority of
cases, or to suppose that a function, essential to the maintenance of life,
may become fatally deranged without the occurrence of coincident lesions
of organization. There is, however, one source of information which
does not appear to have been sufficiently interrogated: I allude to the
‘gastric fluid, which, as the primary agent employed in converting ali-
mentary matters into the proper pabulum for assimilation, may not
unreasonably be supposed, in a disease like Diabetes, to have suffered
\
f
l
* Mem, aur le Diabete Sucré. Journ. de Méd. Août, 1806.
* Cyclopædia of Practical Medicine. Diabetes. * * }
* British and Foreign Medical Review, vol. ii, p. 180. *
356 LESIONS OF THE STOMACH IN DIABETES.
important changes in composition and properties analogous to those
observed in other secretions, when the organs which supply them are
structurally or functionally deranged. This notion is not new; it was
entertained by Rollo, whom we find explicitly referring Diabetes to an
increased morbid action of the stomach, with too great a secretion, and
an alteration of the gastric fluid, forming or evolving from vegetable
substances, Saccharine matter, which is quickly separated, and passes off,
as a foreign ingredient, by the kidneys.
Rollo seems to have been led to his conclusions solely by the cha-
racter of the general symptoms, and the effect of the particular dietetic
treatment which he so strenuously advocated. It still remains a point
undetermined, experimentally, whether the digestive fluid in Diabetes
is altered in its constitution or not ; for chemistry, in its exploration
of the primae via in this disease, has, as yet, limited itself to a search
after sugar among their contents; and anatomy, as we have seen, has
contributed little to solve the question. In this dearth of facts bearing
on the subject, it was not without some interest that, in three fatal cases
of the complaint which have fallen under my own immediate observa-
tion, I met with appearances in the stomach strongly significant of that
organ having been, at some period, subjected to the action of an ener-
getic and destructive agent. The detail of these cases I now submit for
consideration, as favouring that theory of the disease which seems to
accord best with the rise, character, and succession of its symptoms,
while it is, in the main, consistent with approved physiology.
CASE, I. J. W., a married man, of short stature and dark complexion,
consulted me on the 16th of March, 1841, for Diabetes. He gave the
following account of his illness. Five years before the above date, he
passed through a violent and protracted fever, which had nearly carried
him off. After recovering from the fever, his appetite became keen,
and he indulged it freely. He soon got very stout, weighing fourteen
stone, but did not regain strength in proportion. About fifteen months
ago, he began to be tortured with urgent thirst, which the most copious
draughts of liquids of every description, often to the extent of ten or
twelve quarts a day, could not quench. About the same time, he noticed
that he made water frequently, and in large quantities; but it was not
till within the last twelve months that the real nature of his complaint
was determined by a proper examination of his urine. When he applied
to me, he was passing twelve pints daily; it was of a pale colour, of
specific gravity 1038, very sweet, and of honey odour. It was slightly
acid, free from albumen, and apparently abounding with urea ; some of
it, concentrated in a watch glass, and treated with nitric acid, yielded
nitrate of urea largely, though no preliminary process had been em-
ployed to destroy the sugar. A pint gave, on boiling, one ounce and
six drachms of syrupy extract; and four ounces, allowed to evaporate
slowly, left a considerable residuum of saccharine matter in a granular
form. . . 3.
All the symptoms which mark an advanced stage of Diabetes were
now present; such as dry skin, red and glazed tongue, urgent thirst,
voracious appetite, emaciation, depression of spirits, and extreme pros-
tration of strength. There was also a teazing cough, with flatulence and
irregularity of the bowels, which were sometimes constipated, but gene-
rally relaxed.
BY WILLIAM MACINTYRE, M.D. 357
The patient had, for some time, observed a regulated diet, restricting
himself to two eggs and bread and butter for breakfast, half a pound
of beef-steak and rice for dinner, and the same quantity of meat, or
two eggs, for supper. He was not, however, able to put equal
limitation to his drinking, for he found thirst far more uncontrol-
able than hunger; but he now managed to do with six pints of liquid,
instead of twice that number of quarts, in twenty-four hours. His usual
beverage was small beer, and, at one time, he was a “tea-totaller”; but
before his first illness, he was in the habit of indulging to excess in
the use of spirits and malt liquors.
He was recommended to continue the diet at present in use. Dover's
powder was prescribed to be taken at bed-time, and castor oil every
morning, as, from a tumid state of the abdomen, faecal accumulation was
suspected; and such proved to be the case, for during several days in
succession, he passed enormous quantities of solid faeces of a dark colour.
Between the 16th and 25th, he also took three doses of calomel, always
feeling stronger and more lively after the bowels were unloaded.
On the advice of Dr. Watson, he was now ordered to take a drop of
creasote thrice a day, and to continue the Dover's powder.
Under this treatment the urine fell to nine pints, and, on the 4th of
April, its specific gravity was down to 1032. There was, however, no
corresponding improvement of the patient's general health; and, as he
was suffering from a catarrh or influenza, prevailing at the time, the
creasote was discontinued, and a cretaceous mixture prescribed to re-
strain a troublesome diarrhoea. Shortly afterwards, he removed into the
suburbs of town, and I heard nothing of him till called to see him on
the 18th, in consequence of his labouring under constipation. The
abdomen was then tumid and hard, but free from pain, and there was
not the slightest febrile movement. All the usual means for overcom-
ing obstruction were resorted to, but ineffectually ; he sank rapidly,
and died next day. The urine had continued at about nine pints daily, the
appetite had fallen off, but the thirst had abated nothing of its intensity.
The patient, who was a very intelligent man, retained his mental
faculties entire to the last.
Inspection. The body, which was examined by Mr. Anderson, was
extremely emaciated, and a quantity of dark brown fluid was seen
flowing from the mouth.
On opening the thorax, the presenting lungs appeared healthy, but,
on section, were found to be gorged with blood posteriorly. The left
upper lobe was broken down in the centre into a softened purulent
mass, more like the disorganization of unhealthy inflammation, than a
tubercular vomica; and neither around this space, nor in any other part
of the organ, could tubercles be detected. The pericardium was healthy;
the heart collapsed and flabby; its walls attenuated, those of the left
ventricle to a marked degree, scarcely equalling the right in substance.
The endocardium was pale, and the little blood which the organ con-
tained was uncoagulated and thin.
The small intestines, the ascending colon, and its arch, were prodigi-
ously distended with air; the descending colon, the sigmoid flexure
and rectum, were crammed with solid faeces. There were no marks of in-
flammation visible throughout the whole track of the intestinal tube,
but, on the contrary, an unusual bloodlessness.
358 LESIONS OF THE STOMACH IN DIABETES.
The stomach was greatly dilated, and its walls very thin; its cardiac
extremity presented a dark appearance under the peritoneal tunic, and
its liming membrane was soft, but free from ulceration or erosion. The
blood-vessels of the viscus were unusually large and turgid. The spleen
and pancreas were healthy; the liver was wanting in firmness, but
presented no other alteration from its natural appearance. The kid-
neys were much enlarged, of double the ordinary weight, and some
tº a lobulated. The bladder was matural; the vesiculae seminales
turgid. -
Mr. Dalrymple made an examination of both kidneys. The right
freely received an injection of coloured wax ; the left, on section, ap-
peared healthy, and, under the microscope, displayed the natural struc-
ture. He remarked that the blood in the veins had a bright brick-
dust tint. A similar remark had been made by Mr. Anderson, at the
dissection, respecting the blood in the vessels of the mesentery.
CASE II. This case I saw, with Dr. Cumming, on the 4th of March,
1843. The patient, aged 38, steward in a club-house, had been under
treatment, for a fortnight, for an extensive aphthous affection of the
mouth, tongue, and fauces, accompanied with much constitutional dis-
turbance, great debility, depression of spirits, and emaciation. Under
the use of the ordinary general and local remedies, the incrustations
fell off, leaving the mucous surface stripped of its epithelial covering.
The constitutional symptoms became aggravated, with the addition of
tenderness in the epigastrium, and irritability of the stomach, causing
the rejection of even the blandest liquids, as soon as they were swallowed.
The supervention of these gastric symptoms led to the belief of an ex-
tension of the throat affection to the stomach, resulting in diptherite,
of which the condition of the mouth, in general, was supposed to be the
harbinger. At my visit, the vomiting was going on, with prostration of
all bodily power, cold surface, feeble pulse, anxiety, and craving for
cold drinks. The tongue, the inside of the mouth, and the fauces
were red and glazed.
The patient, we were told, had been getting thin for some months,
but had wasted rapidly during the last fortnight. The bowels had been
kept regular by mild aperients. The urinary excretion was reported
to be natural ; but, on inspecting the chamber utensil, it was found
nearly full of limpid urine, which had been voided in the course of the
afternoon. On further inquiry it was ascertained, that he had been in
the habit of passing still larger quantities, which he attributed to the
use of sweet spirits of mitre. As the presence of albumen in the urine
was not manifested by heat, we inferred, from the eorrespondence of the
general symptoms with the profuse diuresis, that the disease was Dia-
betes. The treatment was directed solely in reference to the gastric
symptoms, but none of the measures resorted to availed in alleviating
these, or in averting the fatal issue, which took place twd'days after
this visit. The uſine was; in the meantime, subjected to the usual
examination, and found to be sweet, of specific gravity 1038, to yield
a syrupy, extract on evaporation, and to ferment briskly with yeast.
Inspection, forty-eight hours after death." The body'was much ema-
ciated. It was free from obvious ‘cadaverie decomposition; but exhaled
the peculiar odour generally perceptible in cases of Diabetes, and which
BY WILLIAM MACINTYRE, M.D. 359
had, in this instance, been observed in the patient's breath. The con-
tents of the chest were healthy. The small intestines were distended
with air, and of an erythematous hue, but free from effusion or agglutina-
tion. The stomach was observed to be remarkably large and flabby,
and, on being raised for further examination, it gave way posteriorly at
its large curvature, allowing the escape of a dark grumous fluid into
the cavity of the abdomen. Its walls around the rent thus made were
soft, and, throughout the entire splenic division, reduced to extreme
tenuity, being, in some places, almost diaphanous. The appearance of
softening and thinning lessened towards the pylorus, but could be traced
faintly some way into the duodenum, where it was lost. On the internal
surface of the stomach, several red patches were seen, some of them
verging to black, others covered with a dark grumous exudation. The
liver was hard, and of a dark colour. The left kidney, much larger
than natural, was congested; its exterior was rough and firmly adherent,
in places, to the investing membrane; its pelvis contained a purulent
fluid. The right kidney presented, in a less degree, the same appear-
8]]CéS.
CASE III. The subject of this case was a little girl, five years old.
She was brought to town for medical advice on the 25th of February,
1845, when I saw her for the first time. She then made no complaint
of pain, but betrayed signs of much languor and debility. She was
a good deal reduced in flesh; her eyes were dull, with drooping of their
upper lids; she sighed often, and exhibited an expression of unwonted
sadness, Both cheeks were flushed, but quite cool, and the temperature
of the surface generally was under the natural standard. The breathing
was short, and attended with the abnormal play of the alae nasi usual in
dyspnoea, but the patient was able to make a full inspiration when de-
sired. There was no cough, and the chest was resonant throughout.
The tongue was furred, the gums red, and the breath rather offensive;
the abdomen was tumid, but not tender on pressure.
I learnt from the child's father, who had been educated for the medi-
cal profession, that she had been five weeks under treatment, in the
country, for what was considered to be remittent fever; but that the
case was not well defined, and had resisted the ordinary remedies,
among which mercury, in the form of grey powder, was freely used.
He further stated, that ten days before she left home, attention was
drawn to her passing urine frequently and in large quantities, amounting
sometimes to several pints in the day; it was reported to contain
neither albumen nor Sugar.
On this visit, I merely prescribed an aperient of rhubarb with a few
grains of mercury and chalk, until an examination of the urine should
be made. That examination, instituted the same evening, cleared away
the obscurity which had hitherto veiled the case, by furnishing abundant
proofs of the existence of Diabetes Mellitus. The urine voided during
the day, on being boiled with liquor potassae, exhibited the rich claret
colour which results from the combined action of heat and caustic alkali
on grape and Diabetic sugars. Further evidence of the presence of
saccharine matter was supplied by Trommer's test; and in a short time,
the actual sugar was obtained by evaporation, in the form of a syrupy
extract, closely resembling homey in appearance and odour. The specimen
WOL. II. 24

360 LESIONS OF THE STOMACH IN DIABETES.
of urine operated on, was perfectly transparent, nearly colourless, of
acid reaction, and high sp. gr (1042). It contained no albumen.
Next day, March 1, the patient, after a restless night, was worse,
evincing increased debility, languor and exhaustion, with constant sigh-
ing, and the most marked dejection of spirits, but without making any
complaint of pain or uneasiness. The urine had been moderate in
quantity during the night, but beeame profuse after she left her bed, and
reached the high sp. gr. of 1045. Acting on the indications furnished
by the characters of the urine, the plan of treatment was now modified.
As the bowels had not acted recently, a dose of castor oil was given, the
patient ordered to bed, and the acetate of ammonia, with compound
tincture of camphor prescribed, to be taken at intervals, and a warm bath
in the evening.
On the 2nd of March, at the morning visit, some improvement was
observable. The patient had gone to sleep after the bath, passed a
tranquil night, and was now cheerful and inclined to join in the amuse-
ments of the other children. No perspiration had followed the bath. The
bowels had acted freely, discharging several flattened masses of clay-
coloured faeces. The urine was as copious as before, but had fallen in
density to 1035. This slight amendment, however, proved transient;
towards evening the languor and exhaustion returned, and, though another
tranquil night followed the bath, the prostration of strength was next
day so great, that she did not wish to leave her bed.
On the 4th, matters were not improved. The thirst continued urgent,
food was taken with avidity, but the strength continued to decline, and
the eyes looked sunken, rolling listlessly in their sockets. During the
night, she had had some sleep, but moaned frequently; and, for the first
time, complained of painin the left hypochondrium, where she occasionally
kept her hand applied. Some tumidity from flatus was observable in
this quarter, but no manifestation of pain was elicited by pressure.
On the 5th, it was agreed, in consultation with Dr. Ferguson, to give
small doses of the tincture of muriated sesquichloride of iron and laudanum
—five minims of the former, and two of the latter, every six hours.
The case, henceforward, rapidly pursued its fatal course. After the
third dose of the medicine, a tendency to drowsiness appeared, on which
account the opium was withheld; the appetite failed; and towards the
close of the following day, the power of swallowing was lost. The patient
continued to sink, and expired, exhausted, on the 7th. The condition
of the urine was examined daily, and found not to vary much in quantity
till the last two days, when it was reduced from its usual amount of four
or five pints, in twenty-four hours, to two. Rather less than a quart of
that passed on the lst, having a density of 1045, yielded a thick extract,
which had the appearance of homey, and in the course of a few days
granulated into a fine saccharine mass of a pure white colour.
Inspection. In consequence of some difficulty in making arrange-
ments for a post-mortem investigation, the body was not opened till
seventy hours after death. The examination was made by Mr. Shaw
and Mr. Forbes. There was considerable emaciation, but no sign of
cadaveric decomposition. The head was large and well formed. The
calvarium was easily detached from the dura mater, which was free from
undue vascularity. The vessels of the pia mater contained bright blood.
BY WILLIAM MACINTYRE, M.D. 361
There was a moderate effusion of serum between the convolutions. The
medullary portion of the brain presented a darker colour than natural,
with scattered red points. The substance of both the cerebrum and
cerebellum was unusually firm and dry, and no serum was found in the
ventricles; nor tubercles in any part of the organ or its envelopes. On
opening the chest, the upper lobes of the lungs appeared healthy. On
the right side, a few fibrinous filaments were seen connecting the pul-
monary and costal pleurae, but these membranes presented no other
vestige of pre-existing inflammation. Both lungs yielded a hollow sound
on percussion, floated in water, and were found perfectly free from
tubercular deposit; but their tissue, near the margins, had a con-
densed fleshy character, resembling that of very young children, in whom
the vesicular structure of these organs is not completely unfolded. The
inferior lobe on the left side was dark-coloured, and somewhat congested.
The colour of the left inferior lobe seemed to be owing partly to stasis,
and partly to this portion of the lung being steeped in a dark sangui-
neous fluid, which, to the amount of several ounces, occupied the lower
part of the pleural sac. When this fluid was removed, the cavity of the
chest was seen to communicate directly with the stomach by one large,
irregular hole in the walls of that viscus, and several smaller perforations
in the diaphragm, which were of an oblong shape, and separated from
one another by narrow strips of the muscle, still entire. The openings
in both corresponded exactly, but no adhesion existed between the ap-
posed surfaces around. The structures bordering on the perforations
were black and thin ; and the parietes of the stomach, throughout the
whole of its large division, partook more or less of the attenuation, but
the pyloric portion was of natural colour and consistence. In the lining
membrane were seen several ecchymosed spots, but no signs of active
inflammation. The organ was nearly empty, but it was ascertained
that none of its contents had escaped into the abdominal cavity. The
intestines were also nearly empty, with the exception of the rectum and
lower part of the colon, which contained numerous dry scybala. The
spleen was small, black, and readily lacerable; the liver and pancreas
healthy; the mesentery free from tubercles or glandular disease. The
fat surrounding the kidneys was remarkably dry and firm. These organs
themselves were also dry externally, but of normal size, appearance,
and structure. In the pelvis of the left kidney, a few drops of puriform
fluid were found. The bladder was capacious, and half-filled with urine.
The extravasated fluid taken out of the chest was free from smell; and,
on microscopical examination, was found to contain blood-globules
largely, epithelium, and textural detritus.
REMARKs. I am sorry I cannot dwell with any satisfaction on the
treatment of the foregoing cases. In all of them, the disease was fully
developed when they came under observation; and in two of them,
indeed, it had neared its close, not even admitting of palliation. The
first case afforded a brief space for the trial of remedies; and creasote,
the only article employed with a-specific intent, exerted, as I have
observed in other instances, a decided restraining effect on the evolution
of saccharine matter; but no permanent advantage accrued, owing to
serious complications in the lungs, kidneys, and other organs. )
24 2
362 LESIONS OF THE STOMACH IN DIABETES.
The structural changes found after death; however, claim more con-
sideration; and may, I trust, justify some remarks on those points
which appear to possess interest as mere facts, or séem to bear on the
subject of the pathology of this singular disease. * *
The examinations in Cases 1 and II, were conducted with due care;
but, as limits were put to their prosecution, they were necessarily
incomplete, though in one particular, at least, important, as disclosing
an unnatural condition of the stomach. - ºn
In the third case, the dissection supplied matter for more compre-
hensive details, all the great cavities having been minutely explored by
a practised anatomist. On this account, I will address myself to that
case in the first instance, though it is last in the order of narration;
referring, in commenting upon its prominent features, to the analogous
or identical appearances presented by the other two. The case is also, per-
haps, entitled to a leading position from some special passages of practical
importance in its history, as well as from its having been less com-
plicated than most cases of the disease with concomitant structural
changes, to which it is often difficult to allot a true place in the chapter
of causation. This little patient, at her age, and under the circumstances
of domestic comfort in which she was reared, could not have been ex-
posed to the usually alleged causes of Diabetes; such as cold, intem-
perance, and excesses of an enervating character. Hence the case may
fairly be regarded as a genuine type of the disease in its purest form,
and, as such, ehhancing the import, in an etiological respect, of the
only remarkable lésions discovered after death. t |
The first circumstance in the history of the case claiming notice is,
the tender age of the patient. Diuresis is not uncommon in children;
but though' è urine, under that condition, is changed from its natural
constitution, the 'ahtération usually consists in an excess of phosphates
or urea; and though examples of the saccharine impregnation have now
been seen in sufficient numbers to prove that Diabetes is not confined
to any particular period of life, the proportion is small in which it has
been shewn to have existed in a subject so young, to the amount it did
in the present instance. This child's urine attained a density which I
have not often met with in the adult. According to Dr. Henry's table,
the patient, with her urine at a specific gravity of 1,040, and 1045,
was passing daily, by one emunctory alone, no less than seven or eight
ounces of solid matter; the principal part of which, under a healthy
exercise of the natural functions, would have been appropriated to the
purposes and requirements of the system. ;" i
The next point to be noticed in the history of the case is, the rapidity
of its progress. Diabetes being, in its early stage, characterized by no
specially distinctive symptom, we have always a difficulty in assigning
a determinate date to its origin. In this case, however, I was ;
that, till three months before I was consulted, the child"wās 'high
health and spirits, with the exception of a short interváſ of Häynešin
the month of August, on the death of her mother." Tóthis event the
friends, onlinquiries being" made as to exciting causes, ascribed' the
present illness; and, oil being made acquai ted with the singular nature
of the disease, added, that the pâtient had been in the habit of indulg.
ing in the immoderate use of sligar, bºth as'an article of diet and a


BY WILLIAM MACINTYRE, M.D. 363
confectionary. The falling away from health did not attract serious
attention, till about the middle of January. The symptoms then par-
took so much of the character of remittent fever, that they were treated
by mercurials and the usual remedies indicated by hepatic and intestinal
derangement, The mercury, failing to make any favourable impression
on the complaint, had been discontinued for a week or ten days pre-
vious to her coming to town. It was before I had satisfied myself of
the real nature of the complaint, that I prescribed the grey powder, and
I could not help ascribing to its employment the increased prostration
observed next day. The improvement which followed a change of
treatment, gave a gleam of hope, which, however, was soon extinguished
by the urine again increasing in density, with corresponding aggravation
of all the symptoms.
Finally, the case affords an instructive illustration of the importance,
in all obscure and intractable complaints, of availing ourselves of the
diagnostic indications furnished by the urine, even when the existing
symptoms have no direct or obvious reference to the urinary organs or
their function. In such cases, it will not be enough to consult the
sensible qualities alone of the excretion, which frequently give but
vague and ambiguous information; the application of chemical, reagents
or tests, and, occasionally, analytical research, will be required to reveal
the morbid alteration. In Diabetes, we now fortunately possess means
of readily detecting sugar in the urine, even at an early stage of the
disease, and when the amount of the foreign ingredient is too incon-
siderable to give any intimation of its presence, by the colour, taste, or
density of the fluid. $ l
On entering upon the post-mortem examination of this case, the first
circumstance which struck us was the dry condition of all the tissues of
the body—integumental, membranous, and parenchymatous. Scarcely
any blood followed the division of the scalp or the removal of that
covering. The membranes of the brain were no less dry, and the cen-
tral cavities of the organ did not contain a drop of fluid. The unusual
firmness of the cerebral substance equally shewed the general deficiency
of moisture. This condition was not so evident in the lungs; but it
was the only deviation from the natural appearance of the kidneys that
we could discover, the fat in which they were imbedded having the look
and consistence of ordinary suet. Even the faces were fashioned into
hardened balls. There is, perhaps, no occasion to look for an explana.
tion of this arid, state of all the structures, beyond the profuse and
incessant drain which had been going on by the kidneys. Search was
made for tubercles, so commonly met with in protracted cases of
Diabetes; but none could be found, nor any analogous deposit, either in
the membranes or the parenchyma of the brain, lungs, liver, intestines,
or mesentery. In the lungs, the only abnormal appearance of any note
was the condition of the pulmonary texture, which I have likened to
fetallungs, and, which was probably the consequence of feeble, and
incomplete inspiration, rather than a result of positive disease., , , , ,
... We now come, in the course of the post-mortem examination, to con-
sider a group of appearances and changes, which, in interest and signi.
ficance, hāyāyet higher and, more direct claims on our attentionſ—I
allude to the extreme attenuation of the coats of the stomach in all the
364 PERFORATION OF THE STOMACH IN DIABETES.
cases, and the perforations in the diaphragm and stomach in one of
them; both conditions—the tenuity and loss of substance—allying them
to each other, and marking, apparently, but different degrees of a kin-
dred disorganization. In the first case, the stomach was much thinned,
and its cardiac extremity presented a dark appearance, but without either
abrasion or ulceration. In the second case, the walls of the organ,
throughout the whole of its large division, were singularly attenuated,
almost translucent, and tearing under the slightest force, the mucous
membrane immediately adjoining the rent being black and softened.
The condition here seemed to mark a much more advanced stage of a
change similar to that which had been going on in the former case; if
it did not amount to complete loss of substance, it had certainly reached
the limits of textural consistence and continuity. In the third example,
the same extensive attenuation was observed, and the wasting process
seen consummated in perforation, actual and unequivocal ; for, from the
order in which the dissection was conducted, the perforations in the
diaphragm and the breach in the stomach were brought into view before
either of these parts was disturbed by handling or traction.
In considering the nature and import of these appearances, the first
question to be solved is, whether they are to be regarded as pathological
lesions—the work of disease during life, or cadaveric changes—the
effects of a destructive process, set up and carried on in dead animal tissue.
As respects the actual perforations in the last case, I think we are
constrained to consider them as post-mortem appearances. Their extent,
irregular and ragged form, and the thin condition of their edges, distin-
guish them from the small, circular, and well-defined penetrating ulcer,
with which we are so well acquainted, as the result of chronic inflamma-
tion and malignant disease. The non-existence of extravasation into
the cavity of the peritonaeum, the absence of all traces of inflammation
of that membrane, or of adhesions between the stomach and diaphragm,
and the exemption of the patient from the tortures which invariably an-
nounce perforation and consequent extravasation, are circumstances not
less inconsistent with their having existed during life.
Under this view of their production, they might maturally be classed
with those perforations or erosions which, from the time of John Hunter,
have been attributed to the digestive or solvent action of the gastric
juice subsequent to death. The facts which led that distinguished ob-
server to this conclusion, occurred in cases of sudden death from violence,
injuries of the head, and strangulation. He supposed, that under such
circumstances, the stomach had been rendered incapable of resisting the
digestive powers of the fluids generated within it, in consequence of its
coats being suddenly deprived of their vitality at a time when the body
was healthy, and the gastric secretion in full activity—that, in fact, to
use the quaint phraseology of a French writer who adopts Hunter's
views, in these cases “the stomach devours itself.” This opinion would
seem to be corroborated by experiments subsequently made on the lower
animals, by Wilson Philip, Carswell, and others; but the subject is
not without its difficulties, not the least of which is the rarity of the
appearances in question, while the circumstances under which they were
first noticed are common enough. Even as to their comparative fre-
quency, there is a remarkable and unaccountable discrepancy among
BY WILLIAM MACINTYRE, M.D. 865
competent and trustworthy observers. Hunter represents their occur-
rence as very common, few bodies, according to him, being examined
without exhibiting more or less digestion of the stomach, and not unfre-
quently actual perforation, not only of its walls, but also of the conti-
guous diaphragm, allowing the contents of the stomach to pass into the
cavity of the chest. On the other hand, we find Mr. Taylor, in his work
on medical jurisprudence, stating, that during a period of fourteen years,
there is the record of only one case of spontaneous Perforation of the
Stomach being met with in the numerous inspections made at Guy's
Hospital. His statement is borne out by the testimony of several of
my professional friends, who have favoured me with the result of their
large experience in the dead-house and dissecting room. To some of
them, actual perforation has never presented itself; while those who have
observed perforation have not met with it so frequently, considering
their opportunities, as might have been expected, on the supposition
that Hunter's representation is correct.
It was probably from considerations like those just stated, that
Andral, Abercrombie, and others, hesitated to adopt Hunter's theory.
The whole subject, however, has acquired additional interest and in-
creased importance, from the fact that these perforations and the other
structural changes under review have, since Hunter's time, been noticed
in connexion with various diseases, some of them of a decidedly gastric
mature, others not primarily referable to the stomach, but, in most cases,
attended with gastric symptoms. i $
Softening and attenuation of the stomach would appear to be a fre-
quent lesion in phthisis. In ninety-six cases in which that organ was
carefully examined, Louis found it attenuated nineteen times, and in
some of these so destitute of firmness as to give way under the slightest
traction. He has several times seen the stomach perforated; but, from
the absence of peritoneal inflammation, is of opinion that the perfora-
tions had not existed during life. The details of five or six cases are
given in his work on Phthisis. In one of the most notable, which pre-
sented, on inspection after death, a rounded hole to the left of the cardia,
there had been, from the outset of the illness, marked loss of strength,
soon followed by Oedema of the legs; variable appetite, at first impaired,
subsequently keen, the patient constantly asking for food; red and dry
tongue for a period of four months, with clamminess of the mouth and
urgent thirst.
So far back as 1824, Dr. John Gairdner published an account of four
cases of infantile disease occurring in his own practice, and two from
Cruveilhier, in which softening, erosions, or Perforations of the Stomach
were found after death. In accounting for their production, he adopts
the Hunterian theory, so far, at least, as respects the perforations,
which he does not consider to be morbid lesions, but post-mortem
changes, The symptoms in these cases had been obscure, denoting
only slight febrile disturbance; but the prominent features indicated in-
tense irritation of the stomach and alimentary tube. Along with more
or less vomiting and diarrhoea, there were signs of ardent thirst, gene-
rally avidity for food, and, in all the cases, early and excessive languor
* Transactions of the Medico-Chirurgical Society of Edinburgh, vol. i.
366 ſº
LESIONS OF THE STOMACH IN DIABETES.
and debility. These characters cannot fail to remind us of the train of
symptoms which accompanies Diabetes, but the state of the urinary se-
cretion finds no place in the histories given. The same omission is
observable in the details by Louis; and, what is still more strange, this
great historiographer of disease, and the earnest advocate for the neces-
sity of our inquiring into the condition of every function, in order to
guide us to a correct estimate of post-mortem appearances, rarely records
the condition of the kidneys; for in sixty-one cases illustrating phthisis
under its various forms and complications, it will be seen that he notes
the state of the urine in no more than five or six, and in these very
cursorily.
Dr. Gairdner has also collected from other sources, and placed in a
tabular form, several cases presenting appearances closely resembling
those which fell under his own notice, and which he regards as having
been primary affections of the alimentary canal. To these he has added
a second series, presenting analogous appearances, but complicated with
other lesions, and occurring in diseases not directly nor primarily re-
ferable to the stomach and bowels; the most common being inflamma-
tion of the cerebral meninges, pneumonia, puerperal peritonitis, and
convulsions; and, next to them, tubercular disease of the lungs and
other parts. Of the first group, the subjects were infants or young
children, all but one being under two years of age ; of the second, or
consecutive series, several were adults.
In which of these groups we are to place the cases which I have de-
tailed, may admit of doubt. My own impression may be inferred from
my having brought them forward in support of the gastric origin and
nature of Diabetes. It is true, that the amount of facts is too small to
warrant deductions of conclusive force; but, in a rare disease, the coin-
cidence, in three successive cases, of appearances so remarkable and
nearly parallel, will hardly admit of being regarded as purely accidental;
while there are considerations which seem to connect such coincidence
with a common cause as yet unknown.
Though it is difficult to withhold our assent from the conclusions of
Hunter, under the particular circumstances which he mentions, his theory,
as we have seen, is, in some respects, unsatisfactory, and evidently not
applicable to cases like those just related and referred to. In many of
these cases, one of the first conditions upon which the theory is based—
the abundant presence of digestive fluids in the stomach—must have
been wanting, seeing that, for a long period before death, food, the
natural provocative to an out-pouring of the gastric juice, had either
not been taken, or, if taken, had been rejected as soon as swallowed.
Then, as to the lesions or changes in question, it may be observed,
that they bear but a distant resemblance to those effected on animal
matter when subjected to the action of the gastric fluid, either
in the interior of the stomach during ordinary digestion, or out of
its; cavity in the hands of the experimenter. There is a striking
difference between the brown, dark, grumous, and viscid liquids
usually described as constituting the contents of the stomach uader
these perforatiºns, and that light-coloured, pultaceous, and homogeneous
substance, which we regard as chyme, the product of digestion ; while
the charred and tattered appearance of the invaded structures of the organ,
seems to represent rather the rough vestiges of a destructive escharotic,
BY WILLIAM MACINTYRE, M.D. 367
than changes brought about by a slow physiological process, or a
gentle chemical solvent. This difference; alone, would lead us to take
a modified view of the theory of simple solution, and to regard the
successive changes from softening to attenuation; and from attenuation
to complete loss of substance, not as the work of the gastric juice in a
normal and healthy condition, but as the effects of that fluid in an al-
tered or vitiated state; or of other products secreted by, or generated
in the stomach, and endowed with corrosive properties; in 'fine, that
under certain diseased conditions of the system, a peculiar action is set
up in the organ, and carried on to an extreme point during life, but not
completed till after death, when the tissues, already enfeebled, and
wasted, and no longer defended by the vital forces, become the easy
prey of some destructive agent. The sweat, the tears, the nasal and
bronchial mucus, the bile, and the urine, are known to be capable of
acquiring acrid and deleterious properties. That the gastric juice is
susceptible of changes is not merely an inference deduced, long ago,
from observations on dyspepsia, but a fact demonstrated by experiment.
In the case of Alexis St. Martin, Dr. Beaumont found that errors in
diet, febrile excitement, fright, and other mental emotions, caused a
material alteration in the appearance of the digestive fluid, modified its
action, and sometimes entirely checked its secretion. That other fluids
of an injurious nature will, under certain states of disease, both general
and local, be secreted by the stomach, or evolved in its interior, is
equally a matter of observation. In Diabetes, the sugar abounding in
the primae viae will at once suggest a fertile source of products of most
active qualities. Those with which we are best acquainted are the lactic
and oxalic acids, both of them hostile to the constitution; the latter emi-
nently so. The probability of a development of deleterious agents of
the kind now alluded to, occurred to the reflective and philosophic
mind of Dr. Prout, irrespectively of any considerations based on mor-
bid anatomy. In treating of the general pathology of the assimilative
processes, that writer observes, that “derangements of the converting
function of the stomach occasionally constitute an original disease, the
effects of which are still more formidable than those arising from dis-
ordered reduction. Thus, in diabetic affections, the reducing function
of the stomach seems, in some instances, to be almost morbidly active ;
and farinaceous (and even other) matters, are reduced to the condition
of low, saccharine matter, which the converting function of the stomach
is incapable, as in health, of changing into the elements of chyle or
blood. The consequence is, that this reduced or dissolved saccharine
matter is taken up with the little chyle that may be formed; and after
producing various derangements in the transit through the system, is
ejected with the urine. Again, the converting process may be wrongly
performed; the saccharine matter, for instance, instead of being con-
verted into chyle, may be converted into oxalic, lactic, or other acid and
deleterious matter, which may not only produce much local discomfort,
but serious disorder in their subsequent passage through the sangui-
ferous system and kidneys, or even through the bowels i” l ; , ; , , ,
It must, however, be granted, that the evidence of demonstrative'
t * i i ; ; ; ; ) {{}, i < *** *
* Nature and Treatment of Stomach and Urinary Diseases; p. xliii.4% ºf
~ t , t
368 PROVIDENT DISPENSARIES.
chemistry is still required for the verification of these views and opinions.
How far they are supported by the limited number of facts now adduced
from anatomy, must be determined by future and more extended ob-
servations, which shall establish or disprove the general coincidence of
Diabetes with the lesions and alterations which I have described. I
therefore leave the inferences which I have drawn, as conjectures only,
which may or may not be well-founded, but which, in the present state of
our knowledge, will not, I trust, be deemed altogether unwarranted by the
premises. In diseases which are both mysterious and fatal, the temp-
tation to speculate is always strong ; and I may, on the present occasion,
have yielded too readily to the enticement, and so have given undue
extension to this paper. I am more at ease with respect to another
cause of the length which the communication has reached—the space,
namely, which has been devoted to the complications met with in the
several cases. It is scarcely necessary to observe, that no description
of a case can be complete without a full account of its complications.
These are rarely absent in any disease, however determinate and une-
quivocal its nature; and cannot, indeed, be disregarded by the practi-
tioner; for, in whatever relation they may stand towards the dominant
malady, they always constitute a serious element of perplexity or danger,
embarrassing the diagnosis, thwarting the best devised remedial mea-
sures, exasperating sufferings, and, in fatal cases, often precipitating
the inevitable crisis. In those diseases, again, whose nature is still
obscure and undetermined, they seem no less deserving, of attention
and commemoration from their bearings on a true pathology. The his-
tory of medicine shews that, in not a few instances, what had been
long known and received as a mere complication or frequent accessory,
has proved to be the primary and real malady; and it is thus, probably,
that, in the progress of pathological investigation, Diabetes will eventually
be withdrawn from the category of urinary diseases strictly so called,
and the kidneys, absolved from all blame in its production, be looked
upon as really engaged in the friendly office of ridding the system of a
pernicious poison.
London, March, 1850.
PROVIDENT DISPENSARIES : TEIEIR SOCIAL IMPORT-
ANCE, AND THEIR, ADVANTAGES TO THE
MEDICAL PROFESSION.
By HENRY L. SMITH, Esq., Surgeon to the Eye and Ear Infirmary,
Southam, Warwickshire.
THE formation of PROVIDENT DISPENSARIES is a subject to which I have,
for upwards of thirty years, directed my attention. The plan, therefore,
which I desire to propose is not a speculative opinion, but the matured
result of practical experience of the working of institutions of which I
have been, directly or indirectly, the founder.
Before entering on the general consideration of the subject, I will
BY HENRY L. SMITH, ESQ. 369
briefly state the circumstances which first directed my attention to the
formation of Provident Dispensaries.
In the early part of my medical career, I was for a short time attached
to the army; and there acquired those ideas of order and discipline,
which I have since endeavoured to carry out in the duties of practical
charity. Subsequently, I proceeded to establish an Eye and Ear Infirm-
ary in my native town; and soon received such an amount of support,
as to be able to calculate on an annual income of £120. This would be
sufficient to pay the rent of a house, also the matron and servants; but
it would not maintain the patients. The committee therefore determined
that the subscribers, or parishes sending patients, should pay sixpence
a-day for each child, eightpence for each woman, and tenpence for each
man. Up to the present time, we have been able to keep in constant
usefulness an institution, in which fourteen beds are made up ; and,
without any other aid, we have accumulated, from the profit on the pa-
tients' board and surplus subscriptions, nearly £500; a large sum in a
neighbourhood where the number of the rich is greatly limited. From
the success which attended this institution, I conceived the idea of re-
modelling the common method of supplying the poor with medical
attendance, by the establishment of self-supporting Dispensaries; and I
published a pamphlet, setting forth my views on the subject. The prac-
tical results of the plan proposed by me will be subsequently illustrated.
The necessity of remodelling the administration of our public medical
charity will be obvious, from a careful examination of the working of the
methods by which the poor are at present generally supplied with medi-
cal attendance. To make my remarks on this subject more intelligible,
society may be divided into three classes: +
1. Those who are able to pay for whatever they require.
2. Those who are willing, but unable to pay the usual charges of
medical attendance.
3. Those who are utterly unable to contribute anything, and not un-
frequently unwilling.
Of the first class I will merely observe, that the second has many
claims on their attention : and that this feeling actuates the members
of the first class, the number of charitable institutions which abound in
this country is a sufficient proof. They have, however, done great injury
by not making a sufficient separation, and confounding the second with
the third class—those who are unwilling to pay. It is from the first
class also, that medical men must expect payment for their labour: they
can expect no adequate remuneration from either of the other classes.
The second class, who are willing, but unable to pay for medical ad-
vice, are very numerous. That they are willing to procure medical advice
when it is brought within their reach, is proved by the fact, that in every
place where the plan proposed by me has been fairly tried, they have
done all that could be expected of them.
The persons belonging to this class are mostly in a condition, in which,
under the present system, they must either act dishonestly, by incurring
medical bills which they know they can never pay; or they must lose
their independence, and descend into the ranks of beggary, by soliciting
a charity ticket to some honorary Dispensary, or, still worse, by applying
to the relieving officer for a parish order. Or they may take quack
370 PROVIDENT DISPENSARIES.
medicines, or obtain medical advice from druggists. Many, again, have
too much intelligence, and too great a feeling of delicacy and independ-
ence, to submit to any of these degrading alternatives, and frequently
die without any assistance whatever.
The remedy proposed for these evils, is the establishment of Provident
Dispensaries, to which all those who are willing, but unable to pay a
bill for medical attendance, might periodically contribute a small sum,
in no case exceeding one per cent. of their earnings. By this means,
efficient medical aid would be secured to them in illness; and they
would still be enabled to maintain a feeling of independence on charity,
and at the same time have their minds relieved from that most uncom-
fortable incubus—a long bill.
It is evident that that can be easily done by the aggregate, which
would be perfectly ruinous to an individual. One penny per week from
each of one hundred persons will give an income of £21 13s. 4d. per
annum; a sum fully equal to pay for medical advice of the highest class.
It is probable that a hundred average adults may not have three months
of confinement to bed from sickness among all of them in the year; and
a few may require single doses of medicine, which will often ward off
more serious attacks.
The main feature in which Provident Dispensaries differ from the
generality of charitable medical institutions, consists, then, in this: that,
while the Dispensary is supported by the contributions of the more opu-
lent, each person who receives benefit from it has paid his or her share
towards its funds. They have, moreover, the advantage of not being
liable to the perversion of charity, which obtains to such an extent in
our hospitals and dispensaries. It is a notorious fact, that many of the
patients of these institutions are persons who can well afford to pay for
medical attendance; and that the system of admission by recommenda-
tion from governors has often, intentionally or unintentionally on their
part, the effect of utterly perverting the charitable objects which such
institutions may be expected to have in view. Is it wonderful, also, that
many of the poor are so, because they find it the best and only means of
obtaining the attention of the rich?
There is a class of Provident Institutions in many districts, in which
each member, by payment of a certain sum to the common fund, entitles
himself and his family to medical attendance and pecuniary aid during
illness. The management of these clubs is in the hands of those who
thus derive benefit from them; and the principle of mutual charity,
which, if properly regulated, they would tend to support, is often per-
verted by the admission of persons who, though perfectly able to pay
for medical advice on their own account, have not a sufficient sense of
their own dignity, or of justice towards their medical attendant, to pre-
vent them from availing themselves of the benefit afforded by such in-
stitutions, and to which their poorer brethren have mainly contributed.
łrovident Dispensaries, if properly managed by a committee selected
from the subscribers to ãº, fund, and by the medical men con-
neºted with them, obviate this evil, by preventing the admission of any
but those for whom they are originally intended. . . . . . .
... PIAS off, FoRMATION OF PROVIDENT DISPENSARIES. The following
plan is founded on the rules of the Royal Victoria Dispensary at

BY HENRY L. SMITH, ESQ. 371
Northampton. It will, of course, require modification in some of its
details, according to circumstances. 1. The funds of the institution are to
be derived from the subscriptions and donations of honorary members,
and the payments of free members. The honorary members to be
governors, according to a scale of payments. 2. The honorary fund
shall bear the general expenses of the institution ; 'the free members'
fund shall defray the cost of drugs; and the remainder, together with
such portion of the honorary fund as may be proper, shall be propor-
tionately divided among the medical officers. , 8. The institution shall
be managed by a president and committee, elected from the honorary
members, in such way as shall appear desirable. 4. The medical
officers shall attend daily in rotation: all legally qualified practitioners
practising in the neighbourhood shall be considered, unless they decline,
as medical officers. 5. The free members shall consist of working
persons and servants, their wives and children, not receiving parish
relief, and being unable to pay for medical advice in the usual manner.
Any such person wishing to become a free member, shall leave his or
her name, age, residence, and occupation, at the Dispensary, and
deposit one month's subscription, which will be returned if the depositor
be not admitted a member. Every free member, above fourteen years
of age, shall pay one penny, and under that age one half-penny a week;
but twopence a week will be considered sufficient for a man, his wife,
and all his children under fourteen years of age. Servants who may be
judged eligible by the committee, shall pay five shillings a year, in
not less than half-yearly payments. The payments of the free mem-
bers shall be made in advance. No one in arrear will be entitled to
the benefits of the institution; and each family or member shall pay a
fine of one penny for the arrear of every week. If any member be more
than five weeks in arrear, his or her name shall be erased from the
books. No one actually labouring under sickness can be admitted a free
member, unless he pay an entrance fee of five shillings, in addition to
the usual weekly subscription, and all his family enter at the same time.
If any free member shall, through improved circumstances or other-
wise, be, in the opinion of the committee, no longer eligible to the
benefits of the institution, his or her name shall be erased from the
books. Every free member shall have the choice of whichever medical
officer he may prefer; but he shall not change his medical attendant
during his illness, without the sanction of the committee. Those
patients who are able must attend at the Dispensary between
and o'clock in the morning, bringing their admission ticket.
Those who are too ill to attend at the Dispensary, must send their
ticket before nine o'clock in the morning; the medical officer by whom
they wish to be attended, will visit them at their own homes. In cases
of accident, or sudden illness, they can have the attendance of any one
of the medical officers, on sending their admission ticket to his resi-
dence. No free member will be visited at his own home, if he reside
beyond the limits of the parish. Any married woman being a free
member, subscribing with her family twopence a week, may have,
during her confinement, the attendance of whichever medical officer she
may prefer, on depositing at the Dispensary five (or ten) shillings three
months previously. The same amount will be added to the fee of the

372 PBOVIDENT DISPENSARIES.
medical officer out of the honorary fund. No woman is entitled to the
benefit of this rule, unless she has been a member at least six months.
Patients must find their own bottles. The children of the free members
may be vaccinated on any morning, at o'clock. The medical
officers will attend at the Dispensary every morning, except Sunday, in
rotation.
SoCLAL IMPORTANCE OF PROVIDENT DISPENSARIES. The advantages
conferred on all classes of the community by a well managed Dispensary
of the class under consideration, are numerous; it will, therefore, be
sufficient to call attention to a few of the most obvious.
1. As has been already pointed out, they offer material aid to those
who are able and willing to maintain themselves by their own labour,
but whose resources are not sufficient for the expenses incurred by ill-
ness. To such persons, they offer a ready means of obviating the alter-
native of either the degradation (to them) of applying for parish relief,
of incurring bills for medical attendance, which they can never pay, of
consulting ignorant and unqualified persons who pretend to treat diseases,
or of allowing disease to obtain, unchecked, the mastery over their con-
stitutions.
2. They tend to foster practical habits of forethought and economy.
Having once perceived the advantages derivable from Provident Dis-
pensaries, those who have received these benefits will be led to enter
into combination for provision against other necessities or casualties of
life, as clothing, old age, etc. Hence will arise, as has already been the
case in several places, the formation of Mutual Benefit Associations for
the Supply of food, clothing, etc., to those who are in need. During
any extraordinary epidemic visitation of sickness, also, the recipients of
the benefits afforded by a Provident Dispensary, will be easily led to
make some temporary provision to meet the additional wants which they
may incur. As an instance of this, I may mention, that during the
prevalence of cholera, in 1832, the free members of the Provident Dis-
pensary in Southam were induced to subscribe an additional sum of
sixpence per week for each family during the prevalence of the epidemic,
and the proportion which was found remaining at its termination, was
returned to them.'
3. These Institutions also leave the patients, to a great extent, unem-
barrassed in their choice of a medical attendant. Confidence in the
skill of the practitioner employed, is more or less essential to the suc-
cessful treatment of disease: but this can hardly be expected to be the
case when, as under the present system of parochial relief, the patient
is required to call in the parish medical officer. Under, the system of
Provident Dispensaries, each free member has the power of selecting
a medical attendant, and of changing the same at the end of a certain
period, or often, if there be sufficient reason, at any time. It moreover
enables them to easily have the combined medical skill of the Institu-
tion applied in cases of emergency. !
4. Provident Dispensaries obviate the indiscriminate abuse of medical
charity constantly practised in our Hospitals and Dispensaries. It is
well known, that in such institutions, little or no discrimination is
exercised by the governors in the granting of tickets of admission to
applicants for relief: and the natural consequence is, that the benefits
BY HENRY L. SMITH, ESQ. 373
of the institution are afforded to many who are well able to pay inde-
pendently for medical attendance, while those who are really destitute
are excluded. On this subject, I would refer the reader to the excellent
pamphlet on Sanitary Economics, by Dr. A. P. Stewart, who has ably
pointed out the evils of the present system of medical charity.”
5. Another benefit is, that the poor are led to apply for timely aid
against the inroads of disease. I have already referred to the fact, that
many of these prefer allowing disease to make progress—it may be
irrestrainable—in their constitution, rather than submit to the degrading
alternative at present offered to them. But the restraint thus imposed
on their spirit of independence and honesty, is removed by the power
of obtaining such assistance as is afforded by a Provident Dispensary:
and that this is actually the case, is proved by the large proportion of
applications for medical relief, made by persons labouring under latent
ailments, during the first year of the opening of such institutions.
6. Provident Dispensaries will tend to diminish the expense which
is incurred under the present system of poor-law relief. By enabling
many to obtain medical aid without applying to the parish, they will
directly diminish the burden of the poor-rates, which will thus be more
especially applied to the objects for which they are properly designed.
There will still be many of those who are able to provide for themselves
and their families, but yet have not sufficient honest pride to keep them
from falling into the ranks of pauperism. I do not anticipate a com-
plete reform in this respect; but the system which is the subject of this
paper, will tend to effect a separation between those who are embarrassed
by temporary necessity, and the pauper from obstinate improvidence.
And it is probable that Provident Dispensaries will be found to possess
such advantages, as to lead parish authorities to contract with them for
medical attendance on the paupers. By this means, many of the evils
arising from the farming of the sick poor will be averted.
7. The medical profession will also derive no small share of benefit
from the establishment of Provident Dispensaries. They will be spared
the irksome task of sending bills for attendance to persons who cannot
pay the usual fees, while, at the same time, they will receive a greater
amount of remuneration for their labour, provided care be taken to
admit mone but the really needy to the benefits of the institution.
The restraint imposed by the idea of unpaid bills, or by the fear
of incurring them, being removed, the patients will be led to apply at
a sufficiently early period to enable the medical man to use the proper
means of treatment, with some probability of success; and the result
of this may be an increased confidence in his skill on the part of his
patients.
The system will, moreover, tend to bring practitioners into closer
contact with each other; and, while it increases their mutual good-
feeling, will afford them opportunities of obtaining that improvement
in professional knowledge, which is better effected by a combination,
than by the unaided labours of a single individual.
Many other advantages arising from the adoption of Provident Dis-
* See a review of Dr. Stewart's pamphlet in the LONDON Journal, OF MEDICINE
for February, p. 173.
374 PROVIDENT DISPENSARIES.
pensaries might be pointed out; but I will content myself by quoting
some extracts from letters received by me from the vice-president, and
from one of the surgeons of the Dispensary at Northampton, illustrating
the practical working of the system in that town.
The following is an extract from the letter of H. B. Whitworth, Esq.,
Vice-President: it is dated 5th January, 1850. “The Northampton
Dispensary was commenced under very.unfavourable circumstances; but
the institution has now, I think, taken a firm, hold on the affections of
the classes for whom it was established, which has been proved beyond
all doubt within the last six months.
“About the month of August last, the cholera broke out in this place,
when, at the request of a self-constituted Board of Health, and of the
Improvement Commissioners, the Dispensary was thrown open to all
persons labouring under cholera and diarrhoea. This proved to be
very efficient, as upwards of 400 applications were made at the Dispen-
sary, and about three times as many visits were made by the medical
officers of the institution at the homes of the patients; but the
most surprising result, was the increased number of applications that
were made at that time to enter the Dispensary, viz., about 500 in
the four consecutive weeks after the opening of the Dispensary to the
public; and from that time to the present about 500 more : so that
upwards of 1000 new members have entered since August last; and
our receipts are now upwards of £10 per week from the poor, and our
total number of members is upwards of 4000.
“In a social point of view, I consider that the working of the provi-
dent principle is doing a great good; and I doubt not but that, in a
few years, the Dispensary will be considered, by all classes, as the most
important public institution connected with our town.
“With my best wishes for your success, believe me, dear sir, yours
sincerely, “ HENRY B. WHITwo RTH.”
Mr. Spurgin, one of the surgeons to the institution, writes as follows:
“I am decidedly of opinion that Dispensaries, based on the principles
referred to, are capable of affording incalculable benefit to our com-
munity. Considerable vigilance and care should be taken by the
executive committee in the selection of objects, or it would un-
questionably clash with the interests of the practitioners in the locality,
and of course with that of the officers themselves. The honest
man, having no other resources than his own industry, is the party to
admit. A second class of persons are admitted, who would not pay at
all, and in this way positive relief is afforded to the medical man; the
trouble of keeping accounts, of bill delivering, of bad debts, and of sore
mortification, is often and assuredly prevented, by the admission of this
class. I would also refer to a third class of patients, now very ge-
nerally admitted; these are domestic servants. I have given this
grade much thought, and am of opinion, that where they are receiving
a certain amount of wages, they ought not to be admitted. I have for
many years found them quite competent and very ready to pay; I should
not admit them when they are receiving over £9 or £10 a year. The
introduction of this system has a great tendency to prevent the illegal
and highly injurious, and frequently fatal practice of the druggist; and
MR. HENRY L. SMITH ON PROVIDENT DISPENSARIES. 375
I am sorry to state that I have met with many instances of mal-prac-
tice, attended with fatal consequences, a practice, too, which I feel it
my duty to prevent and expose, whenever and wherever it may come
fairly before me. Of course; for similar reasons, the administration of
quack medicine may be prevented. With regard to ºur own Dispensary,
f believe it is becoming more and more appreciated, as proved, not
only by the great and rapid increase of members, but also by the ex-
pressions of gratitude with which we, as its medical officers, are fre-
quently meeting. Yours very faithfully, B. SPURöIN.”
With these testimonies in favour of the system I advocate, I con-
clude. , If the remarks I have here-made, in any way, tend to the more
extended adoption of the plan in behalf of which I have so long laboured,
and which I am convinced is fraught with great benefit, both in the
avoidance of evil, and in the conferring of positive advantage on all
classes of the community, I'shall receive a great reward.
Southam, Warwickshire,
March 1850.
WOT. II. 25
376
IBIBLIOGRAPHICALs FIBCORID,
ObsBRVATIONS on some of THE PARTs of SURGICAL PRACTICE. By John
P. VINCENT, late Senior-Surgeon to St. Bartholomew's Hospital. pp. 364.
London, 1847.
FEw surgeons have enjoyed greater opportunities for observation than the
gentleman who, for so many years, filled the responsible office of senior-sur-
geon to our largest metropolitan hospital ; few can have discharged the
onerous duties which devolved upon them with greater advantage to their
patients, or greater credit to the establishment ; and, we may further take
upon ourselves to say, that mone can have carried with them, on their retire-
ment from public life, more general respect, or more richly deserved esteem,
than the author of the volume before us. Years have elapsed since we had
the advantage of reaping the benefit of his instruction, but we cannot forget
that the principles of practice, laid down by Mr. WINCENT, have been of
essential service to us in our subsequent career; nor that the kindness of
manner and gentlemanly feeling displayed by him on all occasions, exercised
a beneficial influence on the habits, and softened the manners of the students
who attended his wards. The volume before us contains the principles of his
practice, matured by experience and improved by reflection; as such, it has
pretensions of no ordinary character.
The first chapteris devoted to the consideration of the CLAIMS of SURGERY
To BE CLASSED AS A SciFNCE. It is ably written, and proves that Mr. Vincent
has thought much-and-read much on other subjects than the mere practice of
his profession. As wepropose to devote such space as is at our command, to the
essential features of the volume, we must content ourselves with this passing
remark on the chapter in question. Before proceeding further, we must ex-
press our regret, at the promiscuous manner in which the subjects are mingled
together without any plan or connection ; there are neither tables of contents
mor marginal references; hence the reader is perplexed in his search, and has
to turn to the index to discover any particular subject. In the next edition
we trust, that this want of order, which is a blemish on the book, will be
rectified.
As a preliminary to an exposition of his views on the treatment of diseases,
Mr. Vincent offers some valuable observations on muscular action, and on the
conservative powers of nature ; pointing out the immense importance of a
just comprehension of these, in reference to the management of fractures
and dislocations, and the healing of wounds. It is well remarked that “sur-
geons have puzzled their brains as to the best means of keeping the parts of
a wound of the tongue together, whether by stitches, &c. The fact is, all
meddling does harm. If the patient will keep the tongue quiet at the bot-
tom of his mouth, the wound will heal, as I have seen, better than anything
his busy hand can do to effect it.” (p. 18.) To many other injuries does the
same judicious principle apply. The vis medicatria, naturae is often far better
than the officious interference of what is sometimes miscalled medical “aid’.
A good test of a sound practitioner is to know when to hold his hand, and, in
the language of Dr. Johnson, not ‘ to encumber with his help'.

Mr. Vincent lays great stress, and justly, on the assistance rendered by the
muscles in the REDUCTION OF DISLoCATIONs—it is they, not the surgeon, which
complete the act of reduction ; his efforts are limited to drawing the bone
so near the socket, as to bring the muscles into a situation to resume that
association, in which all their actions have been accustomed to take place;
they do the rest, and it is the absence of their assistance which materially in-
creases the difficulty of reducing dislocations of long standing. The consent-
aneity of action between the muscles having been broken up, new associa-
BIBLIOGRAPHICAL RECORD. 377
tions are formed under new conditions, and they are no longer eager, as it
were, to resume their pristine condition of action, and cease to render valu-
able aid to the operator. Thus it is, by appropriate and judicious manipula-
tion, not by force, that old luxations are to be reduced. Mr. Wincent places
no reliance on bleeding, tartar emetic, or the warm bath, as auxiliaries in
these cases—such expedients he regards as quite nugatory. *
The most common fracture of the scapula, is that of the inferior angle and
part of the spine of that bone. These injuries are exceedingly painful at
first, but require no bandages—simply recumbency in bed. Infractures of
the ºniº also, repose in bed, with the arm to the side, is all that is recom-
InertCięCi. ' i ... " 2 ; • " ? 1 *
Mr. Vincent has not seen a recent case of luxation of the head of the
radius backwards, but from the old cases of this accident which have come
under his notice; he is of opinion, that the injury is apt, to be overlooked;
he, therefore, advises all surgeons to be most serutinizing in examining in-
juries of the elbow-joint, lest this derangement should escape detection.
Cases of fracture of the olecranon, which occur about the middle of the semi-
lunar notch, are treated by perfect extension, which leaves no inequality in
the union of the parts, and does not subsequently deteriorate the arm at all.
Another injury, when the fracture takes place just at the root of the coronoid
process, is accompanied with more pain, and leaves more imperfection than
the former. On fractures of the fore-arm, two observations are made. One
is, that the author has seen the greatest mischief arise from using bandages
in this injury, the broken parts of the two bones having been pressed toge-
ther and so united, that the limb has been made almost useless. He recom-
mends two splints simply, care being taken that the thumb be kept quite
vertical to the little finger. The other observationis, that the want of power
in the hand, and the pain which often attends oblique fracture of the lower
end of the radius, are attributable to bandaging. If pressure be made use of,
it is on that part of the radius where both the flexor and extensor, tendons
pass in grooves in the lower end of the bone. They become involved in the
inflammation and effusion of lymph consequent to the injury, and are thus
rendered useless. ,- J | 1 , .
Simple as the operation may appear, the reduction of dislocation of the
phalanges of the fingers and toes is often attended with vexatious difficulty,
if the true principles of action are not understood. They are as follows:
“If the lateral ligaments are entire, the phalanx that is dislocated lies over
and parallel to the other, and the lateral ligaments are now at right angles
instead of being in the same line as the bones; and, therefore, by the laws
established in the resolution of forces, any power to draw the bone in the line
of its axis, must only press the bones more closely together. The phalanx
must be first drawn at right angles over the upper bone, and then pressed
laterally, so that the end may be placed over the fixed bone, and then turned
upon this point into its place. This first cross position must sometimes be
made in the direction contrary to that of placing it over the end of the other,
and then brought into the straight line . . . . Some years ago, a patient was
brought into the hospital with a luxation of the first phalanx of the second
toe, upon the metatarsal bone ; a very long and powerful extension had been
made, and without any impression upon the displaced bone; I bent this
phalanx at right angles to the other bone, and with one finger pressed the
projecting end downwards, and then, made the other end revolve so as to
make a straight line with the fixed bone. Thus, without any pain and with
the utmost facility, the reduction was effected.” (p. 40.) l
FRACTURES.—When more than one rib has been fractured, Mr. Vincent re-
gards the injury as of importance, and, from his experience, anticipatés à fatal
termination when several are broken; but he does not regard the occurrence
of emphysema, per se, so grave a complication as is commonly *:::: Frac-
&
2

378 BIBLIOGRAPHICAL RECORD.
tures of the vertebrae are not alluded to, which we are rather surprised at,
considering the importance of injuries about the spine. A very singular acci-
dent deprived us of a near relative some years ago: whilst out shooting, he
leapt from a high bank into a rough ditch, and slipping, struck his back with
much force against the stump of a tree. From that time until his death,
about four months after, he suffered constantly from pain in the loins, bloody
urine, etc.; and post-mortem examination showed that a splinter had been
struck off the transverse process of one of the vertebrae, and had penetrated
the left kidney, there setting up such morbid action, that the kidney was re-
duced to a mere bag of pus.
In the treatment of the fractures of the femur, Mr. Vincent prefers the
position on the side, where the bone is broken just below the trochanter minor,
or in the middle of the shaft; but the straight position is adopted when the
fracture is just above the condyle. To the inclined plane and the long straight
splint, he has decided objection.
A troublesome accident, both for patient and surgeon, is dislocation of the
semilunar cartilages of the knee ; the case of course being marked by the
joint becoming locked on some sudden motion. The true way of manipulating
here, is to place the patient on the affected side, with the limb bent; and then
to rotate gently the tibia on its axis. This seldom fails to replace the luxated
cartilage.
In the treatment of fractures of the leg, Mr. Vincent employs the least
possible amount of apparatus, and allows most of his patients to get about a
little in three weeks; crutches he discards, for the patient has first to learn
the art of using them, and then he has still to learn the art of walking alone.
A case recently came under our notice, in which a lady had been placed on
crutches by an empiric, for a really trifling affection of the ankle. For
eighteen months, she had used them without the least hecessity on earth :
her figure had been completely spoiled; the leg had diminished in size nearly
one half for want of use; and no infant could have been more clumsy or help-
less, in its efforts to walk, than this poor lady without her crutches. We fear
that they are often recommended without a thought being bestowed on the
evils to which they give rise.
There are certain cases in which experience teaches us, that it is better to
trust to the vis naturae, than to be poking and meddling with instruments.
A child is brought with an ear of barley thrust up its nostril, or a bit of
potatoe in the ventricle of the glottis; use instruments, and the chances are
a hundred to one that you set up an immense amount of irritation and fail to
remove the foreign body ; let it alone, it will become covered with thick
mucus, and soon come quietly away.
In the treatment of CARBUNCLE, Mr. Wincent justly observes, that the first
object which should be held in view, is to soothe and tranquillize, by the em-
ployment of salines and sedatives. The chief derangement which we have to
combat, is an irritable excited state of system which has to be subdued. He
recommends only the most soothing applications to the wound, and is of
opinion that, in almost all cases, the sufferers are drinkers. According to our
experience, there are many exceptions to this rule. One of the most formid-
able cases which have fallen under our notice, occurred last autumn, in the
practice of an eminent surgeon, Mr. Poyser of Wirksworth. The patient was
a lady of delicate frame and exceedingly abstemious habits, but tormented by
dyspepsia. She had two carbuncles formed at the same time; one of immense
size on the right scapula, the other on the sternum. The treatment adopted
was that of bold incisions: dressing of tincture of tolu, effervescing salines
with tonics, and when she could bear it, liberal diet; which practice was at-
tended with the happiest results. We have seen her within the last few days,
and find that she is still subject to boils, and is sadly tormented by intense
itching in the cicatrices of the incisions: a troublesome but not uncommon se-
quence. The carbonate of manganese has been tried in her case with advantage.

<>
BIBLIOGRAPHICAL RECORD, 379
FISTULA. In a previous number we had occasion to advert to the opinions of
Sir B. Brodie and Mr. Syme, on the formation of fistulae. Mr. Wincent has had
many opportunities of seeing the abscesses which, in his opinion, give rise to
fistulae in ano. . When he feels a deep-seated doughy tumour in the mass of
fat, filling up the ischio-coccygeal space, he transfixes it at once, and in the
very centre of the mass a little pus is found ; this prompt measure stops all
further progress of the abscess, which would, otherwise, most probably find
its way to the rectum, and terminate in fistula. The opening in the rectum
can generally be detected by a small papillary growth projected into the canal.
There are several valuable observations on the formations of matter that occur
in the perimaeal region, but for them we must refer to the work itself.
In the treatment of PILEs, Mr. Vincent advises the puncturing external
piles, and lays great and just stress on squeezing out the coagula, by which
bleeding is prevented. Internal piles he also excises, and considers that there
is no fear of haemorrhage if two simple measures be adopted—namely,
making use of an injection of sulphate of iron, one grain to an ounce of
water, and carefully squeezing out the coagulum. This we should recom-
mend to the consideration of our readers, from actual experience of its value,
not only in arresting haemorrhoidal bleeding, but also in prolapse of the bowel.
The experience of Mr.Vincent in the management of DISEASEs of THE URIN-
ARY ORGANs, has been extensive, and his opinions, therefore, are deserving of
respect. In the treatment of strictures, the gentlest, means are advocated, but
the practice is decided when there is any appearance of effusion of urine.
When there is any hardness felt, indicating the barrier of lymph thrown out
against the extension of the effusing urine, a scalpel is to be plunged at once
into the tumour, and a free opening made, and thus is afforded the best pro-
spect for the speedy healing of the parts. No catheters are to be kept in the
passage, but the whole treatment should be directed to soothing the struc;
tures, the patient being kept in bed and his general health carefully attended
to. The prostate gland is, in the author’s opinion, more frequently the sub-
ject of derangement than is commonly imagined, being generally somewhat
inflamed even in cases of slight gonorrhoea. The remarks on the use of the
catheter are full of good sense, but our space will not permit us to do more
than direct attention to them. Mr. Vincent remarks, that cases of stricture,
with complete obstruction, seem to have been more common formerly than
now, and that he has many times punctured the bladder above the pubes with
the happiest effect. There has never been any infiltration of urine of any
consequence, and the wound has healed kindly. It is preferable to cutting
into the membranous portion of the urethra, which, in the author's opinion,
is far more difficult and much less successful.
On one point we venture to differ in opinion with Mr. Vincent, and that is,
as to the treatment of STRUMoUs OPHTHALMIA. The treatment here recom-
mended, when there is intense intolerance of light, is to give the child three
or four grains of hydrargyrum cum cretá, twice a day for about a fortnight.
In our experience, such a quantity of a mercurial preparation is hazardous,
and likely to produce constitutional effects which are not required. A few
doses of hydrargyrum cum cretà are most useful to-correct the secretions;
but when that is accomplished, tonics, sedatives, and the iodide of potassium,
combined with judicious counter-irritation, attain the object speedily and with
more safety than a course of hydrargyrum cum cretà, or any other mercurial.
The work is so pregnant with valuable matter, that almost every page may
be consulted with advantage. The limits of a review will only admit of a
selection of the more striking and salient points. These we have touched
upon, and feel confident, after a third perusal, that the old practitioner and,
the young student may alike glean sound and useful information from the
ripe experience and well-matured judgment displayed, in this admirable and
most practical volume.
380 BIBLIOGRAPHICAL RECORD.
ANNALs of ANATOMY AND PHYSIology. No. I. Conducted by John Good-
sIR, F.R.S.S. L. and E., Professor of Anatomy in the University of Edin-
burgh. pp. 95. Edinburgh : 1850.
We welcome this new scion of periodical literature with cordiality, from
the respect we bear to Professor GooDSIR, whose well-earned and solid repu-
tation has added a wreath to the laurels of the University of Edinburgh.
The work has nothing provincial in its appearanee, but, on the contrary, is
extremely well got up as regards paper, printing, and illustrations. It bears
upon the wrapper (which is similar in colour to our own) a mystic symbol—
a sweep resembling the form of the shell of Nautilus Pompilius—the mean-
ing of which we do not understand.
The following are the titles of the origiNAL ARTICLES:-A description of
the Muscular Structure of the Tongue of Man, and certain of the Mam-
malia, by Mr. Zaglas. II: On the Anatomy of Forbesia, by Mr. H. D. Goodsir.
III. An account of some Monstrosities, by the late Dr. John Reid. IV. On
the Structure of the Glands of the Alimentary Canal, by Dr. Allen Thomson.
v. Note on the Refracting Power of the Eye, by Professor J. D. Forbes.
v1. On the Structure of the Spleen, by Dr. Sanders. Thus we have specimens
of Anatomy, Physiology, Comparative Anatomy, and Natural Philosophy,
which we presume shadow forth the subjects to which the journal will be
devoted—subjects affording the most ample scope for investigation and elu-
cidation. Under the fostering care of so accomplished an editor, the work
deserves, and we trust will obtain, much success. There are no extracts
given from other works: but there is furnished a very useful BIBLIogRAPHY,
containing the “titles of Memoirs, and Papers in Transactions and Periodi-
cals, and of special Treatises on Anatomy and Physiology”. The Annals
are to appear quarterly." r "r .

INSTRUCTIows for Making UNEERMENTED BREAD : with Observations on its
Properties, Medicinal and Economic. By a PIIYSIGIAN. Sixteenth edi-
tion, with Additions. London : 1849.
In our number for February, p. 191, we copied an article from the Medical
Gazette, on arsenic being present in Unfermented Bread made with an impure
acid. In the Instructions for Making Unfermented Bread now before us, and
to which allusion is made in the article in question, we find the following
passage at p. 24, sixteenth edition: “The acid recommended is the muriatic
of commerce, as prepared for the London market. When the sulphur used
in the preliminary process is obtained from iron pyrites, as it is in several of
the manufactories in the northern counties, the acid is impure, and therefore
unfit, till purified, for making bread.” And again, at p. 27, “the wholesale
piice of the soda in London, at the present time, is 17s. per cwt., and of the
acid, 8s. per cwt.; and they may be obtained at these rates, and of the quali-
ties required, from the manufacturers, Messrs. C. Tennant, Sons, and Co.,
101, Upper Thames-street. The baker who supplies the author's family ob-
tains soda at 3d. per lb., and acid at 2d. per lb., in moderate quantities, of
Mr. Bainbridge, 60, i.eatheriane, Holborn.” We may add, that the proper
acid may be procured in like manner from the manufacturers; Messrs. White,
Castle-street, Saffron-hill, or fróm Mr. Wicstead, Battersea, or, as we believe,
from any of the other London makers—certainly from all who make the article
for medicinal purposes. There can therefore be no difficulty in securing a
supply of the ; material , either in large or in small quantities, and no
excuse fºr substituting an inferior, still less a noxious, preparation ; but we
concur with the Gazette writer in thinking, that the sale of the poisoned acid
should be altogether prohibited.
With reference to the superiority of Unfermented Bread, which has been
called in question by the writer in the Gazette, we avail ourselves of another
quotation from the instructions before referred to. “Bread so made (p. 11)

BIBLTOGRAPHICAT, RECORD. 38 l
contains nothing but flour or meal, culinary salt, and water. It has an agree-
able natural taste, keeps much longer than common bread, is more digestible,
and much less disposed to generate acid. Common bread, bike everything
that has been partially fermented, ferments easily again, to the great discom-
fort of many stomachs; and not only so, but, by acting as a ferment, it com-
municates a similar action to the food in contact with it, when the digestive
power is too weak to control or counteract the operation of the chemical affi-
nities, as ‘a little leaven leavens the whole lump. Unfermented Bread, being
free from this defect, is beneficial to those who suffer from headache, acidity,
flatulence, eructations, a sense of sinking at the pit of the stomach, disten-
sion or pain after meals, and to all who are subject to gout or gravel.”
We have heard the truth of much of this statement, confirmed, by those
who have had long experience in the use of Unfermented Bread, We have
met with dyspeptics who had been obliged to abandon commonlread entirely,
and to substitute biscuits; but who are able to make use of Unfermented
Bread, not only without inconvenience, but with great comfort in feeling and
improvement in health. . The quotation just given furnishes the explanation.
Common bread ferments in the stomachs of the weak, which the other and
biscuits do not. . For a similar reason, Unfermented Bread is often very salu-
tary in cases of irritable and relaxed bowels. The brown, variety of this
bread, it is well known, has cured multitudes of habitual constipation.
We strongly reeommend this little pamphlet to the attention of our readers.
It is an important contribution to the science of dietetics. Chalmers has well
said:—“Philosophy is never moreusefully and more honourably directed, than
when multiplying the stores of human comfort and subsistence.” t

* y f f

Hastings Considered as A Resort for INVALIDs: with Tables illustrative
of its Temperature, Salubrity, and the General Character of the Climate,
showing its suitability in Pulmonary and other Diseases. By JAMEs
MAGKNEss, M.D. Second Edition. pp. 187. Londºn: I'850. f
l # 2
Wehavefound this work of DR, MAGKNESS, written though; it be for popular
rather than professional perusal, full of most valuable an interestin inform-
ation., Hastings is one of those home resorts for invalids which, in hygienic
advantages, far excel many of the more famous places in foreign parts, whither
it has become too much the fashion to transport pulmonary and other in-
valids. Physicians, who wish to know the advantages of Hastings as a resort
for the sick, will find everything pertaining to the subject fully treated of in
the work before us. ſ
# f iſ
FSSAYS on THE PUERPERAL FEvKR ; and other Diseases Peculiar to Women :
selected from the writings of British authors previous to the close of the
eighteenth century. Edited by FLEETwood CHURCHILL, M.D. Printed
for the Sydenham Society. pp. 552. London: 1849.
This is a valuable volume ; it contains the following works: I. Historical
sketch of the Epidemics of PUERPERAL FEVER. By the Editor. II. Reprints
of works on the same subject: by—1, Thomas Denman; 2, Nathaniel Hulme;
3, John Leake; 4, Charles White; 5, Thomas Kirkland; 6, Butler; 7, Joseph
Clarke; 8, John Clarke; and 9, A. Gordon. III. MISGELLANEous Essays.
l, Fothergill on Management proper at the cessation of the Menses; 2, Dr.
Macbryde's cases of Tumefaction of the Labium after Delivery; 3, Dr. John
Clarke on Cauliflower Excrescence of the Uterus; 4, Dr. John Clarke's two
cases of Tumour of the Uterus; 5, Dr. Denman's Account of an Excrescence
from the Womb. The usefulness of the volume is much enhanced by a
copious index.
382
GRITICAL DIGEST OF THE BRITISH AND FOREIGN MEDICAL,
JOURNAIaş.
PRACTICE OF MEDICINE AND PATHOLOGY.
*
GRISOLLE ON THE RECIPROCAL INFLUENCE OF PREGNANCY AND PHTHISIS.
THE following is a translation of an article by Dr. A. GRIsol.I.E, physician to
the Hospital of Saint Anthony, in Paris, published in the Archives Générales
de Médecine for January 1850,
It is generally admitted, that if Pregnancy occur in a phthisical patient, the
progress of the Consumption is retarded; but that, after delivery, the organic
lesion proceeds more rapidly, and death more speedily ensues. This doctrine
reckons among its advocates, Bordeu, Cullen, Joseph Frank, Portal, Baumes,
and other authorities of note. The question has received various solutions
in our own time. If Bayle and Laennec said nothing about it, most authors
have admitted the common opinion. M. Andral, in the first edition of his
Clinical Medicine, considered, from the observation of nine cases, that Preg-
nancy did not influence the progress of Phthisis in the manner generally
supposed; but, in the following editions, having observed a larger number
of cases of a contrary nature, he has adopted the opinion, that the symptoms
of Phthisis are suspended, or at least remain stationary, during the course of
pregnancy.
When M. Louis, in 1843, published the second edition of his Récherches sur
la Phthisie, he did not possess the documents necessary for the solution of
the problem : but in referring to the single instance which he had observed,
and which was contrary to the generally received opinion, he makes an appeal
to the zeal of physicians, to settle a question of so great importance. More
recently (1847) #. Hervieux and Robert (of Strasbourg), have published
in the Unión Médicale the histories of two cases which, like that of M. Louis,
show that Preg flicy exerts no modifying effect on (ne modifie point) the
progress of Phthisis; but these few and isolated facts might be considered
as exceptional, and have not changed the generally spread opinion.
Having been fortunate enough, during several years, to collect from several
hospitals, and especially from that of S. Antoine, the histories of seventeen
cases of pulmonary Phthisis developed during Pregnancy; being indebted
also to the friendship of M. Louis, for the communication of ten other um-
published cases, I have thought myself in a position to elucidate, if not to
entirely solve, the difficult question which I have proposed to consider.
Consumption did not appear in all the cases under the same conditions.
In twenty-four, the organic disease commenced during Pregnancy, at a period
more or less near its cominencement ; while in three, the rational signs of
tubercle already existed, but the disease did not manifest itself till a later
period. In none of these cases was the pulmonary affection retarded; on the
contrary, 1t made rapid progress."
It would be important to have a large number of equally well-marked
eases; but they are rare. When, indeed, we reflect on the profound influence
which pulmonary tubercles exert on the constitution, as well as the uterine

* In a foot-note appended to the termination of his paper, M. Grisolle states, that
he has met with three additional cases of the development of Phthisis during
Pregnancy. In two females, the disease progressed rapidly, and had arrived at its
third stage at the time of delivery. In two cases, delivery took place at the full
term ; and in one, at the end of the eighth month. One of the females gave birth to
a strong child, which she suckled for two months, and which grew as well as an infant
placed in better conditions. This anomaly may be explained by the slow progress
of the tuberculous affection, and by the perfect integrity of the digestive functions.
CRITICAL DIGEST OF THE JOURNALS. 383
disorders which so generally supervene at an advanced period of the disease,
we can understand why conception should be rare in phthisical women. In
almost all the cases in which Phthisis coexists with Pregnancy, it is found
that the latter has occurred first, and that it is in a more or less advanced
period of its course, that pulmonary tubercles have suddenly manifested their
presence. These facts are very important, as showing that there is really no
antagonism between Pregnancy and Phthisis; but the subsequent progress of
the affection proves also, that gestation has neither modified the symptoms,
nor exercised any tardative effect on the pulmonary lesion. In fact, the
symptoms of tuberculization, whether local or general, are developed in the
same order, and with the same regularity and constancy, in women who have
become phthisical during Pregnancy, as in those who have contracted the
disease under ordinary circumstances. On the other hand, Pregnancy has
not increased the violence or frequency of certain accidental symptoms of
Phthisis. It might be thought, for instance, that the abdominal distension
would render the dyspnoea more painful, and haemoptysis more frequent;
but it is found that the bronchial haemorrhage, far from being more common,
is even somewhat less frequent in the females of whom I speak, than in the
phthisical patients, aged from 19 to 40 years, whose cases have been analysed
by M. Louis. The progress of the disease has then progressively increased
in all the cases; and its total duration has been diminished rather than
augmented. Thus, in all, the disease has terminated at from the eighth to
the fifteenth month from the commencement of the symptoms; its mean du-
ration has been nine and a half months, which is lower than in an equal
number of non-pregnant females of a similar age. But what is still more
conclusive, this average of duration is lower than that which M. Bayle, and
especially MM. Louis and Andral, have laid down as the mean period for
the working class.
We are hence led to conclude, that Pregnancy cannot exercise that tarda-
tive power on the progress of Phthisis, which is attributed to it. Instead of
tending to prolong life, Pregnancy hastens the progress of the organic lesion;
and, indeed, we cannot understand how it should be otherwise, for the system,
weakened by diarrhoea, by nocturnal sweats, and by expectoration, and inces-
santly undermined by hectic fever, is not in a condition to support two
lives. Various accidental symptoms also, often occurring in the course
of Pregnancy, and increasing the sufferings of the patient, oppose a further
obstacle to nutrition, and must hence favour the progress of Phthisis. It is
scarcely correct to say, with the physicians whose doctrines I oppose, that
during Pregnancy all the organic activity is concentrated on the uterus,
and that this organ prevents or retards disease in all the others. It is
difficult to understand, how this opinion has been so generally entertained.
We could easily understand it, if Pregnancy, without influencing the found-
ation and the progress of the disease, only rendered some of its principal
symptoms less evident or more obscure; but this is by no means the case;
and, whether we consider the local disturbances, and the phenomena furnished
by the different methods of exploration, or study the general and sympathetic
symptoms, it is impossible to discover any essential difference between the
Phthisis of pregnant and non-pregnant women. The facts which I have
analysed have been so similar and constant in their occurrence, that it is
rational to consider the results furnished by them, as evidences of the correct-
ness of my observations.
We have now to inquire whether, as is generally asserted, accouchement
and the puerperal state accelerate tuberculization, and render the approach
of death more speedy. I think that here, also, the exceptions have been taken
as the rule. Without doubt, a latent Phthisis may suddenly become active, or a
well-marked case of the disease may proceed more rapidly after delivery ; but
the same fact is often observed in convalescence from various diseases, or on
the occasion of certain organic changes or disturbances. If we see some
phthisical females die a few days or a few weeks after delivery, either at the
38.4 CRITICAL DIGEST OF THE JOURNALS.
full time, or premature, it no less happens in those who, having arrived at the
extreme limits of the last stage, worn out by hectic fever, by sweats, and
by diarrhoea, die, as if exhausted by the last effort of nature to expel the
foetus. But, I repeat, such cases are rare. Thus, twelve females, some of
whom, at the time of delivery, were in the second, and most in the third
stage of Phthisis, have continued to struggle, on an average, four months,
against the progress of Consumption ; and in all, the symptoms have been
those observed in ordinary cases. In three, out of ten phthisical females, who
were only in the first, or at the commencement of the second stage, the pro-
gress of the disease after delivery was slow ; two only manifested a notable
aggravation; while five, or one half, shewed in the general symptoms, and
one even in the local symptoms, a sensible amelioration, so as to be able to leave
the hospital, and resume, their occupations. I must, however, add, that this
amelioration was not sufficient to allow a hope of cure, or of the suspension
of the disease for any length of time. It then results, that delivery and the
puerperal state have not that influence on the progress of Phthisis, which is
generally attributed to them; that, most commonly, tuberculization goes on
as before, till death ensues; while sometimes, when the disease is less intense,
it is more or less perfectly arrested.
It may now be interesting to inquire whether Phthisis, in its turn, does
not modify Pregnancy, and produce certain important effects on the act of
labour, on the sequelae of delivery, and on the nutrition of the foetus. It is
incontestable, that phthisical females have less chance of bringing their Preg-
nancy to a successful termination than those who are in health : but it is
worthy of remark, that the former have not that tendency to abortion which
we would expect. Thus, out of twenty-two females who were carefully
watched, three only aborted at the fourth and sixth months; three others
were prematurely delivered at the eighth month ; while all the rest went
to the full term. In almost two-thirds of these latter, however, tuberculization
had set in during the early months of gestation, and had induced extreme
cachexia. In this point, there is a great difference between Phthisis and acute
pulmonary diseases. In 1841, I pointed out that pneumonia, in pregnant
females, provoked abortion or premature labour in more than half the cases
in which it occurred. The facts which I have since observed have confirmed
these results. This difference between an acute and chronic affection, is
naturally explained by the great constitutional disturbance produced by the
suddenness and violence of the attack of pneumonia, while Phthisis is slow
in its development, so that the system seems to become accustomed to it, and
is not so readily affected as by the sudden invasion of an acute disease.
The females to whom I have referred, suffered very slightly from labour
pains in their delivery. Excepting one, who was in pain for twenty-four
hours, all the rest, even primiparae, expelled the foetus after three or four
hours of very moderate suffering. The shortness of the labours may be gene-
rally explained by the smaller size of the child, but perhaps better by the
diminished resistance offered by the weakened tissues to their distension.
The children were, indeed, often weak and meagre; but in more than a fourth
of the cases, they were strong, their tissues were firm, their forms round, and
their plumpness presented a striking contrast to the phthisical appearance
of the mother. There is nothing very extraordinary in the fact, that women
who have suffered severely during Pregnancy, and have been almost constantly
harassed with vomiting, are sometimes, notwithstanding their enfeebled state,
delivered of well-formed, and even strong children. But when the same
thing occurs in females whose constitution has not been impaired by func-
tional disturbances, but by one of those organic lesions which are the expres-
sions of a diathesis, and, which produce a most profound alteration of the
nutritive function ; when we see a foetus live, and become normally developed
in a body which is in a state of decay, and whose powers are irrecoverably


* Traité de la Pneumonic, p. 480.
CRITICAL DIGEST OF THE JOURNALS. 385
diminishing day by day, I confess that we have here one of those preserva-
tive acts of nature, which we must admire without pretending to explain.
With the exception of a few patients who were in the last stage of Phthisis,
and who died a few days or weeks after delivery, the lacteal secretion was
established in sufficient quantity in almost all the cases. But one or two
weeks, or a month at most, had scarcely elapsed, before the flow of milk was
considerably diminished, and even entirely suppressed. For however short
a time lactation was prolonged beyond this, it had always the effect of
sensibly aggravating the Phthisis. . This depended not only on the expendi-
ture of nutritive material through the milk, but also on the additional fatigues
to which women are exposed during lactation. This disastrous result is the
less surprising, when we sometimes see the same causes induce pulmonary
Phthisis in women who previously appeared healthy. 3.
Suckling has also been very injurious to the children. The milk, being
entirely serous, and deprived of nutritious matter, has soon excited copious
diarrhoea; and the little patients, if not placed under the care of a nurse, have
died in a few days with ramollissement of the intestinal mucous membrane.
No tubercles have been found in any part of their body; and yet, how can
we find circumstances more favourable to the development of these morbid
products These children, in fact, had lived in the uteri of females in the
various stages of pulmonary Consumption, and, after their birth, had been
furnished with insufficient, and probably deleterious aliment—a double reason
for the production of tubercles. Their absence, in these cases, arises from the
infrequency of tubercles in the lungs before the first dentition. Those who
have maintained a contrary opinion, have mistaken the hepatisation from a
subacute pneumonia for tuberculization: but an attentive examination by
the naked eye and by the microscope, have shewn me that there is nothing
common to these two states. These negative results of autopsies also demon-
strate that the child, when born, seldom or never has the material germs of
the malady, or miliary granulation, but only a special organic disposition, and
an aptitude for their production in the lungs at a more or less distant period.
Such are the principal results at which I have arrived. We must conclude
that it is rare for conception to take place in women labouring under con-
firmed Phthisis; while, in a pretty considerable proportion of cases, the
first symptoms of pulmonary tuberculization occur during Pregnancy, and
especially in the first three or four months. Unfavourable hygienic condi-
tions, mental affliction, and misery, may appear sometimes to explain the
development of the organic disease; but it is certain that, in most of these
cases, Pregnancy was the only change in the condition of the females which
could be supposed to act as a determining cause. But Pregnancy has not
produced the disease ; it has only put the predisposition in an active state,
just as any other physiological or pathological change would act. Preg-
nancy and Phthisis, having had a nearly simultaneous origin; have proceeded
without appearing to influence each other: but I have proved, from a com-
parison of other facts, that the Phthisis was rendered rather more rapid than
in the non-pregnant state. The unfavourable influence of Pregnancy is also
proved by the fact, that after delivery, provided always that the disease had
not reached a too advanced stage, the organic disease is observed to be miti-
gated, or at least to remain stationary. On the other hand, pulmonary
tuberculization does not modify, at least in a great majority of cases, the
progress of Pregnancy. This point has been already perfectly established by
Desormeaux and Paul Dubois.”
Such are the principal conclusions at which I have arrived. I do not offer
them as absolutely correct; for they must be supported by more extended
observation. The uniform results, however, which my observations have fur-
nished, under whatever aspect we view them, must lead us to hope that they
will be confirmed by subsequent investigations.


* Dictionnaire de Médecine. Art. GROSSESSE, t. xvi, p. 389.
386 CRITICAL DIGEST OF THE JOURNALS.
BELLADONNA IN HOOPING-COUGH, EPILEPSY, AND OTHER NERVOUS
OR SPASMODIC AFFECTIONS.
M. DEBREYNE has been in the habit of prescribing Belladonna in affections
of the nervous system since 1815. The following extract from a communi-
cation, made by him to the Journal des Connaissances Médico-Chirurgicales,
contains some observations on the employment of this medicine in Hooping-
Cough, Epilepsy, Hysteria, and other diseases in which the nervous element
predominates.
Hooping-cough. Belladonna has been eminently useful in the epidemics
of Hooping-Cough, which M. Debreyne has observed ; but the success attend-
ing its administration depends on the observance of the following rules. The
dose of Belladonna should be proportioned to the number of months repre-
senting the child's age; and the quantity to be taken in twelve days, (the
ordinary duration of treatment) will be five centigrammes (# of an English
grain) multiplied by the number of months. Thus, for an infant six months
old, the dose will be thirty centigrammes (4% grains) in twelve days ; for
one of two years and a half, the dose will be 1% gramme (23 grains) in the
same period. For children above six years of age, the quantity of three
grammes (46% grains) is not exceeded. The medicine is always given three
times in the day. For instance, the prescription for a child three years old
would be—powder of the root of Belladonna, two grammes; to be divided
equally into twelve powders, of which one is to be given daily, in three divid-
ed doses. If there be vomiting, it should be given immediately after a fit
of vomiting and coughing. Recourse should not be had to this remedy, un-
til the inflammatory element has been overcome by leeches, emetics, etc.; in
other words, it is not to be employed before the tenth or fifteenth day, when
the Cough will have assumed its specific character.
Epilepsy. M. Debreyne has found Belladonna most useful in those cases of
Eſſº the attacks occur frequently, and even daily. In young
subjects, it is not rare to find them affected with worms at the same time;
and M. Debreyne even supposes that this coincidence is constant, the worms
being either a cause or a complication of the epileptic convulsions. Hence,
he combines vermifuge medicines with Belladonna, with the effect of gene-
rally producing a rapid alleviation of the symptoms. In Epilepsy, the dose
for the first day should be ten centigrammes (1% grains) of aqueous extract
of Belladonna ; five centigrammes morning and evening : on the second and
third days, five centigrammes, morning, noon, and evening ; and on the re-
maining days, ten centigrammes are to be taken morning and evening. M.
Debreyne refers to patients who have thus taken sixty-five centigrammes
(10 grains) of the extract, in twenty-four hours, without experiencing the
least inconvenience. In all cases, the use of the remedy must be continued for
some time. An epileptic patient, aged 48 years, took twenty centigrammes
of extract of Belladonna daily, during twenty months, with the effect only
of diminishing the duration of the attacks : the treatment was persisted in,
and they gradually became less frequent, and at last completely ceased. In
a little girl, aged eight years, the attacks began to become less frequent on
the fourth day of the treatment; and at the end of a month, the patient was
cured. As a precautionary measure, however, she continued to take five
centigrammes of extract, of Belladonna daily, during two months.
Hysteria. This affection, receives marked benefit from Belladonna. The
following is M. Debreyne's formula : camphor, twelve grammes; assafoetida,
twelve grammes; extract of Belladonna, four grammes; aqueous extract of
opium, one gramme; syrup of gum, a sufficient quantity to make 120 pills.
One pill is to be given the first day, two on the second, and the dose is to be
gradually increased to six pills in twenty-four hours.
Neuralgia. M. Debreyne relates several cases of the successful employment
of Belladonna in this affection. One patient had suffered during seven or

CRITICAL DIGEST OF THE JOURNALs. 387
eight years from very severe neuralgic pains in all parts of the head. All
the usual remedies had been tried without effect ; a pommade of Belladonna
was applied, which produced marked relief on the first day, and cured the
patient in a month. Another case was one, in which daily paroxysms of
frontal Neuralgia had obstimately continued for eleven years. The Belladonna
pommade was applied: the pain suddenly ceased, and had not re-appeared
two months after the employment of the remedy. The pommade which M.
Debreyne uses is highly charged with the active principle. It consists of
extract of Belladonna, lard, of each 12 grammes; opium 2 grammes; to be
mixed accurately. It is rubbed over the seat of pain, especially during the
exacerbations, or three times a day. On each occasion, a piece of the size
of a hazel-nut is to be rubbed in for five or six minutes, until it is perfectly
absorbed : this may be furthered by adding a little saliva from time to time.
Affections of the Eye. . M. Debreyne has successfully used the pommade
above described, in nyctalopia ; and in such cases, as well as in all affections
of the eye requiring the use of Belladonna, he also prescribes the extract in
the form of collyrium (two grammes of the extract to 125 grammes of rose-
water.)
In asthma, convulsive spasmodic cough, hiccough, constriction of the oeso-
phagus, of the larynx, of the neck of the bladder or uterus, in paraphimosis,
in strangulated hernia, etc., M. Debreyne has seen benefit derived from the
use of Belladonna. In nervous cough, he has given a pill of five centi-
grammes of extract of Belladonna, morning and evening, "In spasmodic con-
striction of the orifice, in paraphimosis, and in strangulated hernia, he uses
extract of Belladonna in the proportion of from 4 to 15 grammes to 15
grammes of Galen's cerate. . The following is the formula of pills for internal
use, which is most commonly employed by him in the abovementioned dis-
eases: Extract of Belladonna, 8 grammes; powder of gum acacia, 2 grammes;
with a sufficient quantity of some inert powder to form 120 pills, which are
to be taken as directed for the anti-hysteric pills, up to 30 centigrammes of
the extract in the day, provided that the patient experience no remarkable
disturbance of vision. If this occur, the dose is diminished, or entirely sus-
pended, to be resumed after the interval of a few days. [Journal de Médecine
et de Chirurgie Pratiques, February 1850]. f
GRANULAR CORPUSCLES IN THE ENCEPHALON AND SPINAL CHORD OF HEMI-
PLEGIC PATIENTS. {
DR.LUDwig TUERCK has described the microscopic appearances presented
by the brain and spinal chord of three Hemiplegic patients. His observa-
tions tend to show the necessity of employing other means than the unaided
eye, in the investigation of parts supposed to be the seat of disease. We not
unfrequently hear of post-mortem examinations, especially of the nervous
centres, in which no morbid appearances have been detected either by the
eye or by feel. The state of the brain or spinal chord is also often vaguely
described as being “somewhat hardened”, “ of rather firmer consistence than
usual”; and nothing more is said about the subject. Now we have no doubt,
that if a microscopic examination were made in such cases, we should often
find unequivocal proofs of disease. The first and second of the cases related
by Dr. Türck, entirely prove the correctness of this assertion. In them, the
spinal chord was apparently healthy, and of proper consistence ; but when
examined with the microscope, was found to be the seat of disease.
CASE I. The first case was that of a woman aged 73, who had had paralysis
of the left side for six months. There was an apoplectic cyst on the outer
side of the right corpus striatum and optic thalamus, with white softening
of the latter ; and numerous granular corpuscles (körnerkörperchen) were
met with as deep as the crus cerebri. The spinal chord appeared healthy to
the naked eye; but on dividing it into its lateral halves, it was found, under
388 CRITICAL DIGEST OF THE JOURNALS.
the microscope, to contain a large number of sinular bodies. The left lateral
half contained a large number, while they were much fewer on the right side:
Dr. Türck then made fine vertical sections from without inwards ; and found
that the most superficial sections on the left side showed the granular cor-
puscles in great number, while in a similar situation on the right side they
were entirely absent, and only began to appear singly towards the middle
line. From this examination, the interesting result was brought out, that
the disease in the chord was limited to the same side as that on which the
paralysis had existed—the opposite side to that on which the brain was
diseased.
CASE II. The second case was that of a man, forty years of age, who had
laboured under paralysis of the right side for half a year. There was an
apoplectic cyst in a similar situation to that mentioned in the first case; the
right thalamus had undergone white softening as deep as the crus cerebri,
and presented an abundance of granular corpuscles. The pons Warolii, which
was not examined in the first case, also contained them; the medulla oblon-
gata presented them in abundance on the right side, but more sparingly on
the left; and on the left side of the spinal chord they were very abundant,
while they were wanting on the right. From the pons downwards, all the
parts were of normal consistence, and appeared to the naked eye to be healthy,
both entire and in section.
REMARKs. Two explanations may be given of the origin of these bodies.
They either arose from an extension of the disease from the crus cerebri
downwards, or they were the effect of the hemiplegia, produced by disease
of the brain, which induces a process of exudation in one half of the spinal
chord. As to the first of these suppositions, it is difficult to understand why
the extension of the disease should be confined to one side, and especially
why it, should not have extended to the opposite side at the point of decus-
sation. . With regard to the second explanation, it is to be observed, that in
both cases there was a high degree of paralysis of motion, while sensation
was but little affected : and hence, if this explanation be adopted, the exud-
ation process would have to be considered as having a connexion with para-
lysis of the motor elements.
In several other cases of Hemiplegia, from cerebral diseases, the spinal
chord has been found healthy.
CASE III. The third case is one of a woman, forty years old, who had had
Hemiplegia of the left side for a year and three quarters. The upper extre-
mity was perfectly paralysed; the lower one less so ; sensibility appeared
normal. There was an old apoplectic cyst in the right corpus striatum and
optic thalamus. Numerous granular corpuscles were observed, which rapidly
decreased in proceeding downwards; so that the right crus cerebri, the pons
varolii, the medulla oblongata, and the upper sections of the left half of the
cervical portion of the chord, only presented them singly. They were much
more numerous from the origin of the third to that of the seventh cervical
nerves. From this point downwards, they again decreased, but at the lower
part of the dorsal portion again began to increase, until they reached their
maximum at the origin of the lumbar nerves. From this point they again
diminished, and at the origin of the lower sacral nerves they entirely disap-
peared. The nerves on the diseased side were found perfectly free from the
corpuscles, even a few lines from their origin. The right half of the spinal
chord presented them only in the middle line, the medulla oblongata only a
very few: the left half of the pons, as well as the left crus cerebri, contained
IROIA6.
The fact, that in this case the disease was not equally extended, the parts
between the shoulder and hip-joints, as well as that between the brachial
plexus and the encephalic cyst, shewing very few of the corpuscles, tends to
point out, that the disease of the spinal chord cannot be considered as an
extension of that which existed in the brain. [Zeitschrift der K. K. Gesell-
schaft der Aerzte zu Wien. January 1850.]

CRITICAL DIGEST OF THE JOURNALS, 389
EPILEPSY COINCIDENT WITH EXOSTOSIS OF THE LEFT PARIETAL BONE.
The following interesting case occurred in the practice of M. GAMBERINI,
of Turin. *
A banker, aged 34 years, had a fall on the left Parietal Bone, and subse-
quently felt frequent cephalalgia, followed by slight convulsive movements.
Epilepsy soon supervened; the attacks of which became more and more
severe and frequent. The patient had a sad countenance, his physiognomy
was anxious and expressive of suffering, and his look dull and askance. He
complained from time to time of an indescribable pain, preceding an epileptic
attack. This sort of aura, which was often absent, commenced in some points
of the upper limbs, and proceeded rapidly towards the heart. The attacks
occurred twice or thrice in the week, sometimes even several times on the
same day. Drastic purgatives, local bleeding, valerianate of quinine, artifi-
cial cinnabar, and nitrate of silver, were employed without any success. The
patient then complained of a dull pain at the part of the parietal bone on
which he had fallen. A periostosis was observed, which was only painful at
night ; and, as it increased in size, the epileptic attacks seemed to diminish
in frequency and intensity. As the patient had had blennorrhagia some
years previously, M. Gamberini thought that the periostosis might have had
a syphilitic origin. He therefore ordered a blister to be applied to the swel-
ling, and prescribed the iodide of potassium, internally and externally. Under
this treatment, the periostosis diminished in size, and the attacks became at
the same time less frequent, and more easy to master. The persistence of
nocturnal cephalalgia caused M. Gamberini to decide on employing mercury:
but he had scarcely commenced this, when the patient was seized with a
severe attack of pneumonia. The energetic treatment which this affection
called for, cured at the same time both the periostosis and the Epilepsy.
When M. Gamberini last saw the patient, he had been free from attacks
during three months. [Bulletino delle Scienze mediche di Torino, April 1848:
and Annales Médico-Psychologiques, January 1850.]
In quoting this case, the editor of the Annales remarks, that the Exostosis
is sufficiently explained by the fall on the parietal bone, without having re-
course to the blennorrhagia. He further inquires, whether the favourable
influence of the energetic treatment required for the pneumonia, does not
tend to shew that the periostosis was, in fact, nothing more than simple san-
guineous infiltration in the diploe, which first produced compression of the
brain, and then epileptic convulsions
SURGERY.
-*-
DR. R. W. SMITH ON DISJUNCTION OF THE EPIPHYSIS OF THE HUMERUS.
In the Dublin Quarterly Journal of Medical Science for February 1850,
Dr. R. W. SMITH has published an article on Disjunction of the Epiphysis of
the Humerus—an accident which he considers to have been generally con-
founded with supra-condyloid fractures of the bone, or with luxation of the
fore-arm backwards. The author points out, from the writings of Malgaigne,
Vidal de Cassis, and others, the error into which they have fallen, as well as
the incorrectness of the idea that the line of the junction of the epiphysis
with the shaft is above the condyles; whereas these belong to the shaft of the
bone, while the epiphysis comprises nothing but the capitulum and trochlea,
Dr. Smith then proceeds to observe:
“The lower articular surface of the Humerus in the young skeleton differs
from that of the adult bone in the following remarkable particular; namely,
that the capitulum, or that portion which articulates with the head of the
radius, is nearly double the size of the trochlea ; so that the inferior surface
of the former is nearly upon the same level as that of the latter process; and

390 CRITICAL DIGEST OF THE JOURNALS.
the Humerus, when placed resting by its lower extremity upon a horizontal
plane, assumes nearly a vertical position. In short, the radial is fully deve-
loped long before the ulnar portion of the epiphysis; and, as will hereafter
appear, the knowledge of this fact is not destitute of practical importance in
º: diagnosis of that embarrassing accident, fracture through the line of
junction of the epiphysis with the shaft, or, in other words, fracture of the
Humerus immediately below the condyles. A description of the signs which
characterize this lesion must also be, to a certain extent, an enumeration of
those which accompany dislocation of both bones of the fore-arm backwards;
many of the symptoms likewise belong to the transverse fracture, immedi-
ately above the condyles. -
“The injury usually results from a fall upon the elbow, but I have known
it to occur from a fall upon the palm of the hand, the fore-arm being at the
time extended upon the arm. The limb immediately becomes powerless,
severe pain is experienced in the elbow, and the following signs present them-
selves:–The fore-arm is flexed, and the hand in a middle position between
supination and pronation. The olecranon, drawn upwards and backwards by
the triceps muscle, mounts above the level of the condyles of the Humerus,
these three processes forming the points of a triangle, the base of which is
below. The antero-posterior diameter of the elbow is greatly increased, and
the lower end of the Humerus can be felt projecting in front. The applica-
tion of a gentle force is usually sufficient to restore the normal appearances
of the limb, but when the parts are abandoned to themselves, the deformity
soon recurs. If, after the removal of the displacement by extension, the fore-
arm be rotated upon the Humerus, or if the surgeon, as recommended by
Dupuytren, grasps the arm in one hand, and the fore-arm in the other, and
then moves them backwards and forwards upon each other, the crepitus which
characterizes fracture can generally be elicited. The motions of flexion and
extension are exceedingly limited and painful.
“The signs above enumerated are sufficient to demonstrate, that the injury
in question may readily be confounded with transverse fracture of the Hu-
merus above the condyles, or with luxation of the fore-arm backwards. The
former would be a mistake of comparatively slight importance, inasmuch as
the same treatment is applicable to both lesions; but the latter must be con-
sidered as a grievous error, the results of which are nearly as lamentable as
those of leaving a true luxation of the joint unreduced. The observations of
Dupuytren respecting the danger of confounding fracture immediately above
the elbow, with dislocation backwards, apply with peculiar force to the injury
we are considering. ‘If', says this distinguished surgeon, “the opinion that
the case is one of luxation be acted upon, extension and counter-extension
are employed, the reduction is accomplished without much difficulty, a roller
is applied, and the surgeon congratulates himself upon the ease with which
he has restored the bones to their places. But soon, the displacement is re-
produced, and at the end of a few days, in the midst of the swelling, some-
thing unnatural is felt. This accident is generally ascribed to the patient,
who is charged with being intractable; the reduction is again effected, but
the deformity soon recurs, and considerable swelling then supervenes. As
long as this condition lasts, the surgeon continues secure; but when the
swelling has disappeared, after the lapse of a few weeks, he discovers the
error which he has committed, but the mischief cannot now be repaired, the
.* the joint are never perfectly regained, and the deformity is in-
Cllrà,016, -
“In cases of fracture traversing the line of the epiphysis, the transverse
diameter of the tumour which projects in front, is equal to that of the oppo-
site humerus, measured anteriorly from condyle to condyle; in this respect,
the accident resembles the dislocation of both bones backwards, but differs
from fracture above the condyles. The outline of this osseous tumour is
rounded, and presents to the feel none of the irregularities or sharpness of an

CRITICAL DIGEST OF THE JOURNALS. 39 L
ordinary fracture, and upon its inferior surface, which is convex, and limited
at either extremity by the condyles, neither trochlea nor capitulum can be
distinguished. When the joint is viewed posteriorly, two osseous prominences
are seen, and can be distinctly felt ; they are both placed above and behind
the plane of the condyles, but are themselves situated (if the patient be not
more than six or eight years of age) nearly upon the same level,--the internal,
however, being always a little higher up than the external. At a more ad-
vanced age, the distance between these two prominences is observed to be
greater, in consequence of the increased development of the internal, which
is formed by the olecranon, the summit of which process grows by an epiphy-
sis. At no period of life, however, at which it is possible for the accident in
question to happen, is the distance between the two projections nearly as
great as it is always found to be between those which, in cases of luxation of
both bones of the fore-arm backwards, constitute so marked a feature of the
injury. In the latter accident, the distance averages about one inch and a
half: while, in the former, it is seldom more than three quarters of an inch ;
the external tumour, in this case, being formed by the capitulum of the Hu-
merus, still surmounting the head of the radius, for which, in consequence of
the concave form of its superior surface, it is extremely liable to be mistaken,
if attention be not paid to the diagnostic sign which has just been mentioned.
“For the history of the following case I am indebted to my friend, Dr.
James S. Hughes, one of the surgeons of Jervis-street Hospital:
“CASE. Michael Fleet, aet. 12, was admitted into Jervis-street Hospital on
the 24th of August, 1847. He stated that whilst standing in the fruit
market, a boy, running against him with great violence, threw him down;
and that having, in the act of falling, stretched out his arm to save himself,
the other boy fell with all his weight across the back of the extended limb.
On his being raised from the ground, it was found that his arm was power-
less, and he was at once brought to the hospital, where he was seen by Dr.
Hughes, in twenty minutes after the occurrence of the accident, and conse-
quently before the characteristic features of the injury had become obscured
by swelling. The fore-arm was semiflexed, and the hand in the position of
half supination ; the olecranon, which formed a remarkable projection, was
placed above and behind the condyles of the humerus. A second osseous
tumour, the upper surface of which was concave, and which was supposed at
first to be the head of the radius, could be distinguished behind the outer
condyle. The lower extremity of the humerus formed a considerable pro-
minence in front. Judging from these appearances, Dr. Hughes' first im-
pression was, that he had to deal with a case of dislocation of both bones of
the fore-arm backwards, but finding that the joint admitted of a much
greater amount of flexion than can usually be communicated to it in such
cases, he began to suspect the existence of a fracture. Extension was, there-
fore, made by an assistant, while Dr. Hughes, grasping the arm with one
hand, and the fore-arm with the other, moved them in opposite directions,
and thus succeeded in producing a distinct crepitus. The diagnosis was
therefore made, that the injury consisted in a fracture of the humerus
through the line of junction of the epiphysis with the shaft, with displace-
ment of the bones of the fore-arm, along with the epiphysis, upwards and
backwards.
“A moderate degree of extension and counter-extension was sufficient to
remove the deformity; the limb was placed in the semiflexed position, and
secured by angular splints and a roller. It was, however, found extremely
difficult to prevent a recurrence of the deformity; and when the patient left
the hospital, a slight degree of displacement still existed. Shortly after his
dismissal I saw him, in consultation with Dr. Hughes and Dr. Power, and
having made a very accurate examination of the limb, I came to the conclu-
sion that the original injury had consisted in a simple Disjunction of the
Epiphysis; for, although the deformity was now not considerable, the prin-
WOL. II. 26
392 CRITICAT, DIGEST OF THE JOURNALS.
cipal characteristic features of this lesion, as they have been described in the
preceding pages, could still be recognized. The boy had recovered very con-
siderable use of the limb ; he was able to extend the fore-arm perfectly, and
could flex it beyond a right angle. The antero-posterior diameter of the
joint was greater than that of the opposite side; the tendon of the triceps
was in relief: the outline of the tumour which projected in front was
rounded, but it was impossible to feel distinctly either the capitulum or the
trochlea of the humerus. Two osseous tumours, formed by the olecranon
and the capitulum, were seen posteriorly; but although they were still
situated somewhat behind the plane, they were not now above the level of
the condyles. The callus which had been effused, obscured, in some degree,
the features of the injury. About this time, the patient was also seen by
Mr. Adams, who adopted the same views as to the nature of the accident.
“From what has been above stated, it is manifest that (contrary to what the
statement of authors would lead us to infer) implicit reliance is not to be
placed upon the loss of the normal relation between the olecranon and the
condyles of the humerus, as a means of distinguishing between luxation of
the fore-arm backwards, and fracture of the lower extremity of the humerus.
It is evident that there is an accident of the elbow, in which the bones of
the fore-arm lose their natural relations to the condyles, and yet that accident
is not necessarily a dislocation, but may be a fracture through the line of the
lower Epiphysis of the Humerus, which line is situated below the condyles.
“It is a matter of practical advantage to be acquainted with the periods at
which the different Epiphyses unite with the shafts of the bones to which they
belong ; for instance, the lower Epiphysis of the Humerus becomes identified
with the shaft long before the superior : the separation of the latter by ex-
ternal violence, may, therefore, occur at a period of life when the disjunction
of the former would be impossible.
“The symptoms which belong to this injury, in common with fracture above
the condyles, may be thus briefly enumerated: shortening; crepitus; the
removal of the deformity by extension, and its tendency to recur when the
extending force is relaxed ; the presence of an osseous tumour in front of the
joint; the increase in the antero-posterior diameter of the elbow. It differs
from the supra-condyloid fracture, in the greater transverse breadth and
regular convex outline of the anterior tumour: in the existence of two tu-
ºteriorly ; in the loss of the normal relation of the olecranon to the
condyles.
{{ }. resembles dislocation of both bones of the fore-arm backwards, in the
following particulars: The transverse diameter of the anterior tumour is the
same in each case ; so also is the antero-posterior breadth of the elbow; and
in both the olecranon ascends above the condyles, the limb is shortened, and
two osseous prominences can be distinguished posteriorly. It differs, however,
from luxation, in the existence of crepitus, in the tendency of the deformity to
recur, in the anterior tumour being destitute of trochlea and capitulum, and
in the circumstance of the two posterior tumours being nearly upon the same
level”.
OBSTETRICS.
UTERINE HYDATIDS—ANOMALOUS NERWOUS SYMPTOMS.
DR. J. G. DAVEY, of the Ceylon Medical Service, has published in the Indian
Register of Medical Science, and also as a separate pamphlet, an account of a
case of Uterine Hydatids, which occurred to him at Colombo, in the end of
1847. The interest of the case lies in its exceptional character—in the pe-
culiarnature of thenervous symptoms which accompanied it. These symptoms,
in our opinion, must be attributed to idiosyncrasy, to constitutional peculi-
arity; and cannot be considered as unobserved indications of Hydatids.
Uterine Hydatids are generally connected in their origin with blighted
CRITICAL DIGEST OF THE JOURNALS. 393
ova; and the usual symptoms are those of moles, etc., more or less simulating
pregnancy. The author judiciously enough remarks, that “however much
the practical physician or surgeon may be inclined to refer to authority, ere
he step out of the beaten track, yet unless he, occasionally, think and act
for himself—and upon his own responsibility—the well-being, even the life
of his patient, will prove the penalty of his indecision of purpose.” It would
be interesting to know, whether the lady, who was the subject of the case,
has experienced any anomalous symptoms during pregnancy, if she have been
in that condition.
The following is an abridgement of Dr. Davey's contribution.
CASE. Mrs. T., aged about 24, a lady of sanguineous temperament, usually
in the enjoyment of excellent health, and very recently married, applied to
Dr. Davey, in November 1847, suffering from an unusual degree of the dis-
eases of pregnancy, in the form of gastric irritation, uncontrollable by the use
of saline effervescing draughts, hydrocyanic acid, creasote, opium, etc. The
patient getting daily more exhausted, the induction of premature labour was
proposed ; but, as a previous resort, nitrate of silver was applied to the os
uteri and parts adjacent, and the same remedy was administered in the form
of pills.
Premature labour was at last decided on ; and the os uteri was dilated by
the introduction of a large male catheter ; this was repeated at the end of
forty hours, after which uterine action set in, and in a day and a half pro-
duced a sudden and alarming expulsion of “waters”, mixed with coagula,
as Dr. Davey was informed.
The patient went on improving till the eighteenth or nineteenth day after
the escape of the uterine contents, when Dr. Davey was informed that the
size of the uterus had rather increased than diminished. The vaginal dis-
charge had also assumed a sanguineous appearance. He considered that
some portion of the ovum had been retained, after the first expulsion.
“On my next visit, after three days, I found all the symptoms much aggra-
vated ; the size of the uterus had, very evidently, much increased. Mrs. T.
complained of a painful sense of distension of the organ, as if were about to
‘ burst'; and told me, moreover, that she was losing the use of her fingers,
the extremities of which had become insensible to feeling. The voice was
reduced to a mere whisper ; and the act of deglutition was performed with
some difficulty. The repetition of the induction of uterine action was pro-
posed, but was overruled.
“A week had hardly elapsed ere the case became so alarming, and all its
symptoms so much aggravated, that further delay would have been only cri-
minal. The uterine tumour had risen, by this time, to the umbilicus, and
was exquisitely tender. The hands and feet, arms and legs, from the elbows
and knees downwards, were completely paralysed—not a single fibre in any
one muscle could be called into action. The extensors and flexors of both the
thigh and upper arm were almost powerless. The nerves of sensation, al-
though not absolutely paralysed, were much affected; the extremities felt,
for the most part, inflated and softened ; and now and then pricking pains
were experienced in different parts of the limbs. Both respiration and deglu-
tition were much impaired ; in consequence, doubtless, of the abstraction of
nervous power from the muscles concerned in these respective acts.
“The dilatation of the os uteri was performed on two different occasions.
Expulsive pains came on ; and, after continuing very regularly for two or
three and twenty hours, terminated in the evacuation of a large quantity of
Hydatids / I was now led to hope that the parts affected would, in the
course of time, re-acquire their normal condition ; nor did the progress of
the case, immediately succeeding to the escape of the Hydatids, do else than
encourage this hope ; for thirty hours had scarcely elapsed, ere the act of
deglutition was unattended with the slightest difficulty or inconvenience.

Q6 3
394 CRITICAL DIGEST OF TIIE, JOURNALS.
It is worthy of remark, that from the third to about the tenth day, the lacteal
secretion was continued.
“At the expiration of a week, the extensor and flexor muscles of the thigh
and upper arm had regained considerable power; nor were the flexors and
extensors of the fore-arm altogether useless ; the digital extremities were
capable of being very slightly moved. The lower extremities, although im-
proved, and their motive power sensibly increasing, yet did not at this time
keep pace with the upper. The nerves of sensation everywhere appeared
recovering their natural tone, and the sense of touch was described as return-
ing to its original and healthy state; at the same time, the slightest degree
of pressure along the course of the radial and ulnar nerves, in either arm,
caused much uneasiness and pain. Mrs. T.'s general health was steadily im-
proving. A tonic regimen was pursued with apparent advantage. On the
sixteenth day from the escape of the Hydatids, she was removed from her
home to a more desirable locality ; and quickly afterwards, the voice began
to re-assume its original character—it lost the faint whisper which before
characterized it.
“In order to facilitate the restoration of the functions of the spinal sys-
tem, I now employed galvanism. Repeated shocks were thrown along the
chord and extremities, and active friction of the parts affected was recom-
mended. Stimulating liniments were also applied. This treatment was
directly followed by an extreme restlessness and sleeplessness—the cerebro-
spinal functions becoming much affected. Successive hours were passed in
a kind of delirious excitation, and in an involuntary jactitation of the mus-
cular system, particularly of the lower extremities; the latter was commonly
accompanied with acute neuralgic pains. It is worthy of remark, that the
fingers and toes were scarcely, if at all, affected by this peculiar and painful
chorea. The galvanism was now omitted ; and in its stead sedatives, parti-
cularly morphia, were prescribed, with a view of allaying the irritation of
the brain and spinal chord ; for there were no indications of anything like
vascular repletion,-far from it. Blue pill and aperients were occasionally
used to preserve a healthy state of the primae vice, and the carb. ferri with
quinine were internally administered. The effects of this altered treatment
were every way satisfactory, inasmuch as all cerebral excitement and inco-
herence ceased, and a proper amount of sleep was insured, the painful and
involuntary muscular action was duly controlled, the tongue became cleaner
and yet more healthy looking than before, the appetite improved, and the
bowels were preserved in a proper state. The constitutional powers also ap-
peared strengthened ; but nevertheless much remained to be done towards
the complete recovery of the spinal functions of the extremities: for although
the flewion and extension of both the upper and fore-arm, and pronation and
supination, were now little short of perfect, yet the deeply-seated muscles of
the fore-arm, those attached to the phalanges, the flexors and extensors of
the fingers, and those belonging to the thumbs, were capable of only very
slight movements; and those of the lower extremities, particularly those
muscles attached to the inferior phalanges, were in a similar condition.”
At the end of between four and five months from the expulsion of the
Hydatids, during two of which the patient had experienced some benefit from
the change of air, Dr. Davey determined to Mesmerise her, with the view of
restoring the muscular function. He is evidently one of those who imagines
that “posthoº, ergo propter hoc"; for he attributes the recovery which took
place to the Mesmeric passes which he made. As in many other cases, faith
in the potency of the means employed was probably of great service. On the
day after the fourth Mesmerism, the patient found that she could nearly raise
one of her hands. In December 1848, only a slight degree of stiffness re-
mained in the fingers, when much exercised with music ; and one of the
ankles was slightly weak. The general health was perfect.
CRITICAL DIGEST OF THE JOURNALS. 395
RUPTURE OF A THROMBUS OF THE WUILWA D'URING PARTURITION : FATAL
HAEMORREIAGE.
The occurrence of Thrombus of the Vulva during labour is not absolutely
rare : but it is very uncommon to see it arise and burst in a few moments,
inducing almost instantaneous death by frightful Haemorrhage. Peu is the
first who has reported a case of this kind. Deneux has, with some trouble,
been able to collect some others. The following case, related by M.WYFFELs,
in the Annales de la Société d’Emulation de la Flandre Occidentale, is hence
interesting:—
CASE. On the night of the 6th September, I was called to a woman who
had been a few hours in labour. She was robust, of sanguine temperament,
possessed considerable embonpoint, and enjoyed perfect health : she had had
eight children, all the labours having been easy. During, however, the last
weeks of the present pregnancy, walking had become very painful, and the
lower extremities were very oedematous. On examination, I found the os
uteri well dilated, the membranes entire, and the head of the child not yet
descended. The uterine contractions being powerful, and the position of the
child good, I prognosticated a prompt delivery. My surprise was great, when,
after some well-marked pains, I perceived the labium majus of the right side
become suddenly distended, rapidly increase in size, and become, in a few
instants, tense and fluctuating. At first, I imagined it was a hernia: but
soon afterwards the tumour, which had gone on increasing in size, in spite of
manual compression, so as to attain the size of a closed fist, burst, during a
pain, with such violence, that the blood was projected to the distance of several
feet. Believing this to be a very serious case, I sent in haste for my forceps,
which I had neglected to bring, in consequence of the facility of the former
labours. In the meantime, blackish venous blood continued to flow from the
aperture, which was in the external and middle part of the labium majus,
and was of sufficient size to easily admit the thumb. During uterine con-
traction, the blood was thrown out in jets, but did not flow with intensity in
the intervals. From this moment, and after several pains, the woman began
to complain of suffocation, and at last said she was going to die for want of
air. In a few minutes she died. In three quarters of an hour my forceps
were brought, with which I extracted a dead child.
M. Wyffels does not think the woman died of Haemorrhage, although it
was abundant, but prefers to attribute the death to the absorption of air, or
7ts introduction into the veins. It seems rather to have arisen from the Hae-
morrhage having been left to itself, without any attempt to arrest it by com-
pression or plugging: the Haemorrhage might not have been easy to arrest.
Osiander reports a case which, in spite of all his efforts, even after labour
was terminated, ended fatally ; but perhaps this case is unique. In that of
Peu, and in some others, death only occurred in the absence of the accoucheur,
or because he had been called too late. In general, the accomplishment of
parturition is sufficient to arrest Haemorrhage: sometimes it is advantageous
to use astringent injection, and it seems scarcely probable that compression
and plugging can fail. [Revue Médico-Chirurgicale de Paris. Decem-
ber 1849.]
RETENTION OF URINE AFTER DELIVERY : EXTRAORDINARY DISTENSION OF
THE BLADDER PECULIAR CONFORMATION OF THE URETHRA.
M. MALGAIGNE relates the following case in the Revue Médico-Chirurgicale
de Paris, for December 1849 –
In contradistinction to the accumulation of an enormous quantity of urine
in the bladder for several weeks, the following case presents an instance of
rapid accumulation to an unprecedented extent —
On the 16th August, I was called, by my friend M. Drache, to a woman who
3.96 CRITICAL DIGEST OF THE JOURNALS,
had been delivered four days, but had passed no urine. The midwife had
several times attempted, but without success, to introduce the catheter.
M. Drache also made the attempt, but found an obstacle some lines from the
orifice of the urethra, and he was unwilling to use force. On my arrival, the
abdomen was so distended, and so much resembled that of a woman at the
full period of º that my first thought was, to make sure that there was
not another child. On this subject, however, there could be no doubt ; be-
sides, the patient had not passed urine for four days, and was suffering
intense desire for micturition. I learned that she had never had any disease
affecting the urethra. But her husband informed me, that in her the stream
of urine, instead of being directed downwards and forwards, passed forwards
and upwards ; and that her eldest daughter had the same peculiarity. .
From this I concluded, that the urethra mounted higher than usual behind
the symphysis pubis, and that the ossa pubis presented the obstacle to the
passage of the catheter. Having placed the woman in front of her bed, I
introduced an ordinary catheter, by first passing it from below upwards, then
directing it upwards and backwards. I assured myself that there was not
the least trace of prolapsus of the bladder or urethra. The bladder was emp-
tied at once, without inconvenience or difficulty ; the quantity was truly
astonishing. I had it weighed immediately : it was 3,300 grammes (nearly
107 ounces, English apothecaries' weight). I have often had to treat severe
cases of Retention of Urine, even requiring puncture; but I have never before
known the bladder to contain such a quantity of urine,
CoNDITION OF THE OVARIES AND UTERUS, OBSERVED IN A YOUNG WOMAN
ASSASSINATED SHORTLY AFTER MENSTRUATION.
The researches of MM. Pouchet, Bischoff, and others, have placed beyond
a doubt the spontaneous detachment of ovula during menstruation. The
following case, recorded by Dr. JANZER, in the Medicinische Annalem, vol.
xiii, part 4, is an additional proof; it moreover illustrates the changes which
the mucous membrane of the uterus undergoes during the menstrual period.
CASE. The young girl who was the subject of the observation, had men-
struated four days before being murdered. She had never been pregnant.
The autopsy was made sixteen hours after death. The surface of the left
Ovary presented a deep red spot, surrounded by finely injected vessels. This
spot was formed by a small globular mass, imbedded in the Ovary, and of an
intense red through its whole thickness. The mass in question was separated
from the tissue of the Ovary by a thin yellow envelope, and was composed of
fibres like those of areolar tissue, arranged in superimposed layers. The
yellow envelope was formed by the same kind of fibres, among which there
was a pretty considerable quantity of fat, not contained in cells. Near this
body, there was seen a small yellow, spherical, modulated mass, composed of
areolar tissue and fat. The right Ovary contained two yellow bodies. The
Fallopian tubes, which did not embrace the Ovaries, were tumefied in the
upper thirds. On slight pressure, a white matter issued from them, resem-
bling pus, and entirely composed of round epithelial cells, some of which were
º with vibratile cilia. No ovule, nor any traces of spermatozoa were
Oli TiO,
The uterine mucous membrane, between the body and the neck, was much
swollen. In the Uterus itself, it formed a velvety membrane, glossy and bril-
liant, easily detached with £he handle of the scalpel, and presenting a fine
network of vessels. This mucous membrane was evidently thickened ; it
was composed of the uterine glands, ranged perpendicularly alongside each
other, and fitted with cylinder epithelium, not ciliated. The structure be-
tween the uterine glands was composed of a network of delicate fibres, of some
nucleated cellular fibres, and of amorphous tissue. The surface of the uterus
was covered with a thin layer of mucus, and lined with cylindrical epithelium,


CRITICAL DIGEST OF THE JOURNALS. 397
without cilia. The orifices of the Fallopian tubes were open. The vaginal
mucous membrane was pale, but was only covered with a thin layer of mucus,
containing epithelial cells.
It results from this observation, that the mucous membrane of the uterus
presents, during menstruation, characters analogous to those which exist
during gestation; such as the hypertrophy of the uterine follicles, and the
disappearance of vibratile cilia. [Gazette Médicale de Paris, 23rd March, 1850.]
TOXICOLOGY.
CASE ILLUSTRATIVE OF THE TREATMENT AND FATAL DOSE, IN POISONING
WITH HYDROCYANIC ACID.
By DR. RoBERT CHRISTISON, of Edinburgh.
The following is one of the most interesting and instructive cases of Poison-
ing by Hydrocyanic Acid, with which we are acquainted. We copy, with
some slight verbal curtailments, DR. CHRISTIson's communication from the
Edinburgh Monthly Journal, for February 1850,
A gentleman, about sixty years of age, whose mind had begun to give way
under the pressure of dissipation and misfortune, and who had several times
threatened to commit suicide, hastily summoned his wife one evening, told
her he had just taken Prussic Acid to put an end to his miseries, and imme-
diately ſell down senseless on a sofa, without either cry or convulsion, but
drawing his breath deeply, forcibly, and slowly. Medical aid was instantly
sent for in all directions. Nearly half an hour appeared to have elapsed be-
fore I reached him. Dr. Adam Hunter and Mr. Carmichael had arrived,
however; the stomach-pump had been immediately resorted to; and the first
stroke of the pump was made as I entered the room.
The convulsive respiration at the outset,had been soon succeeded by regular
breathing, with smorting inspiration, and moaning expiration. The insensi-
bility was complete from the first ; the body was excessively relaxed, and
without any convulsive movement ; the eyes were wide open, staring straight
forward upon vacancy, injected, watery, and with the pupils somewhat con-
tracted, but not more so than they often are naturally in persons of his age;
and the face and head were congested and hot. The introduction of the tube
of the stomach-pump did not elicit the slightest sign of consciousness. In
this state I found him on my arrival—wholly unconscious under all ordinary
mechanical stimulation, totally relaxed and powerless, and breathing deeply,
laboriously, and stertorously, but with ordinary frequency. The pulse was
above 100, very small, feeble, yet regular.
The first liquid withdrawn by the stomach-pump, amounting to six ounces,
was a colourless, nearly clear, watery fluid, being little else than water intro-
duced by the pump upon an empty stomach; for he had taken no food since
breakfast. My two friends could not observe any odour of Hydrocyanic
Acid in this fluid, even while warm and fresh drawn ; and I could detect it
only faintly, and, I must admit, equivocally, on whiffing it slowly and steadily
for some seconds. Nor was there any Hydrocyanic Acid odour in his breath,
or near him, or in any part of the room.
The stomach was quickly and repeatedly cleared out, and ammonia was
applied to the nostrils from time to time, but without any sign of reviving
consciousness. His head was then brought to the edge of the sofa, and,
while it was held over a bucket, a stream of cold water was gently and
steadily poured over it for two minutes from a large jug, a foot or so above
him. During this proceeding, the breathing rapidly became deeper and
softer, and without snoring. The head and face, very much cooled, presented
less turgescence. The eyes were suddenly turned in a lateral direction, and
then an attempt seemed to be made to fix them upon any one who put a
question in a firm voice. From this time he slowly recovered without any
further treatment ; and, in an hour and a half from the time when he gave
398 CRITICAH, D1 GEST OF THE JOURNALS.
the alarm, he was able to mutter Yes and No correctly when questioned, and
he could turn on his side without assistance. When not roused, however, by
being spoken to, he fell into a restless sopor, with moaning and tendency to
shivering. In three hours he was tolerably sensible, but drowsy ; he slept
profoundly all the subsequent night ; and next morning he was quite sensi-
ble, though still sleepy. His mind was evidently unhinged, but not more
than before the act ; and it has continued more or less so ever since, render-
ing seclusion from general Society indispensable.
As, in this instance, no bottle could be found in the room or under the
window, and no satisfactory Hydrocyanic odour could be perceived in the
apartment, in the breath, or in the fluid first withdrawn from the stomach, a
doubt might justly have arisen whether Hydrocyanic Acid had been really
swallowed. The symptoms, however, were so similar to those described as
attending the slower cases of poisoning with this substance, as to leave at
the time scarcely any doubt in my mind. Accordingly, on examining the
liquid first withdrawn, I detected the poison in it by chemical analysis. It
was first subjected to distillation, after the addition of a few drops of sul-
phuric acid ; and half an ounce of clear fluid was thus drawn off. This had
only a very doubtful Hydrocyanic odour, although there was no other odour
strong enough to cover it. But on adding two drops of the pharmaceutic
solution of potash, then a few drops of the two sulphates of iron, mixed in
the proportion of one equivalent of sesqui-oxide-sulphate and two of protoxide
sulphate, and lastly a single drop of sulphuric acid, a considerable precipi-
tate of Prussian blue was obtained instantly and characteristically. Mean-
while the patient gradually admitted, that he had asked, in the morning of
the act, at a certain druggist's, for a sufficient dose of Prussic Acid, of full
strength, to kill a dog, and that he got a drachm. The druggist afterwards
supplied Dr. Hunter with what he believed to be a similar quantity from the
same stock. This I found to amount to forty-five minims : and, on applying
the very convenient test of the Edinburgh Pharmacopoeia, I ascertained that
it was of the due strength, so that our patient had taken between a grain
and a half and two grains of radical Hydrocyanic Acid.
THE PRACTICAL DEDUCTIONs to be drawn from this case are various and
not unimportant.
1. The intensity of the symptoms, while there still remained some poison
unabsorbed in the stomach, renders it probable that the treatment saved the
patient; and, therefore also probable, that a grain and a half might prove
fatal in less favourable circumstances.
2. That the odour may not be detected in the breath, even in the first fluid
drawn from the stomach.
3. A piercing cry does not invariably usher in the action of a poisomous
dose of Hydrocyanic Acid.”
4. The case shows that the cold douche to the head is an energetic remedy,
when the other means available in so urgent an emergency are inefficacious.

MATERIA MEDICA AND PHARMACY.
"ALMond oil. As A SUBSTITUTE FOR cod-LIVER OIL.
Dr. P. M. Duncan, Physician to the Essex and Colchester Hospital, and
MR. R. S. NuNN, Surgeon to the same Institution, have communicated to the
Provincial Medical and Surgical Journal for March 20, the following remarks
* The test referred to is the precipitation of a cyanide of silver, by means of a
solution of the nitrate. EDITOR.
* Both in men and animals, a piercing cry has been generally observed to usher
in death by Prussic Acid, and the recorded exceptions to this rule are, we will ven-
ture to say, very few indeed. It must be remembered, that the case detailed in the
text is not one of fatal poisoning, and that this fact, and the smallness of the dose,
make it difficult to believe that the toxicological phenomena were developed in all
their completeness. EDITOR.
CRITICAL DIGEST OF THE JOURNAL.S. 399
on the applicability of the common sweet Almond Oil to all cases for which
Cod-liver Oil is prescribed.
“In a flat and damp agricultural district, where, amongst a certain class,
intermarriage is very frequent, where intermittent fevers, scrofula, and all
kinds of disease characterised by the presence of an adventitious product in
the system, are very common, and where, on account of scanty food and
clothing, diseases are generally of an adynamic type, it is not to be wondered
at, that medicines which enhance the nutritive powers should be very largely
prescribed.
“We have always subscribed to that opinion, which denies the specific
agency of the Oleum Jecoris Aselli, in tuberculous and like diseases, and
attributes the benefit conferred to its influence on the assimilative processes.
We have prescribed the Cod’s-liver Oil with great success, both in hospital
and in general practice, and consider that its only drawbacks are its nauseous
flavour and high price. In June last, we agreed to prescribe a vegetable oil
instead of the Oleum Jecoris; and our experience is highly favourable to the
therapeutical virtues of the Oleum Amygdalae. We have reason to declare
that the Almond Oil and the Cod’s-liver Oil act precisely in the same man-
ner; and the first-mentioned oil has anything but a disagreeable taste, and can
be obtained for at least one-third of the price of the best Cod’s-liver Oil.
Our experience of the beneficial effects of Almond Oil has been derived from
upwards of two hundred and fifty well observed cases; in no one case has it
purged,and;the contrary effect is very frequently produced. We are in the habit
of prescribing the oil without any adjunct, at first in one drachm doses, half an
hour after every meal. The dose is gradually increased. A drop of Eau-de-
Cologne, or of some essential oil, renders the ‘meat' oil anything but disagree-
able to the taste. It is an excellent vehicle for the exhibition of iodine in
small doses, the latter being rubbed down with a small quantity of olive oil,
and then added to a larger amount of Almond Oil. The following formula
has been of great use in several cases of syphilitic diseases of the bones and
skin, in broken-down constitutions, in chronic pleurisy, and in many cases of
chronic enlargement of the glands of the neck :-R. Olei amygdalae 3 ss;
olei olivae 3ij; iodinii gr. A. M. A third part to be taken three times a day.
“The influence of half an ounce of this Oil of Almonds, taken daily, upon
the weight of some patients progressing in health under its exhibition, is very
remarkable. In one case, there was a weekly increase of 21bs., and in another,
of 4lbs. Care must be taken to attend to the biliary secretion during the
exhibition of the oil, which is contraindicated when there are evidences of
local congestion, or of inflammation.”
MINERAL SPRINGS CONTAINING MANGANESE.
In the LONDON Journal of MEDICINE for 1849, pp. 871 and 881, we gave
an abstract of the researches of M. HANNoN on the Therapeutic uses of Man-
ganese, a remedy which he considered equal, and often superior, to iron. The
Academy of Medicine in Paris, as stated in the Gazette Médicale de Paris for
23rd March, received from M. Caventou, reporter of their Committee on
Mineral Waters, a statement that the waters of Fraisse, in the valley of
Cransac, contain Manganese. It would be desirable to study the physiolo-
gical and therapeutical properties of these springs. The Editor of the Gazette
Médicale has several times witnessed their successful use in chronic glandu-
lar engorgements, which had previously been treated by various medicines
without any good results.
CITRATE OF IRON AND MAGNESIA.
The Citrate of Iron and Magnesia appears, to M. WAN DER CoRPUT, likely to
come into general use among ferruginous preparations, being easy of adminis-
tration, and not liable to produce constipation. It is prepared by dissolving
400 CRITICAI, DIGEST OF THE JOURNALS.
two parts, by weight, of recently precipitated hydrated oxide of iron in a solution
of three parts of citric acid : the liquor is then saturated with Carbonate of
Magnesia, and evaporated to dryness. The salt is in the form of shining
brown scales; the taste is sweetish, very slightly inky, and not at all disagree-
able. It is perfectly soluble in water: it is not deliquescent, so that it may
be given in the form of powder. It may be prescribed in doses of 15, 30, or
60 centigrammes (2%, 5, or 10 grains).
Syrup of Citrate of Iron and Magnesia is prepared by dissolving 8 grammes
in 15 grammes of orange-flower water, with 180 grammes of simple syrup.
This is one of the most agreeable preparations of Iron.
Saccharine Confection of Citrate of Iron and Magnesia.
Take of Citrate of Iron and Magnesia ... ... ... 1 drachm
Powdered Sugar ... ... ... ... ... 7% “
Powder of Canella ... ... ... ... ... l. “
Mix, and divide into powders, each containing twelve grains.
Lozenges of Citrate of Iron and Magnesia.
Take of Citrate of iron and Magnesia ... "... }, a drachm
Powdered Sugar ... ... ... ... ... 74 drachms
Saccharine Confection of Vanilla ... ... }, a drachm
Mucilage of Tragacanth, a sufficient quantity.
Mix, and divide into lozenges of twelve grains. [Journal des Connaissances
Médico-Chirurgicales, 1st March 1850.]
ALKALL OBTAINED FROM THE KELAYA SENEGALENSIS (SWIETENIA
SENEGALENSIs) A CHEAP SUBSTITUTE FOR QUININE.
M. CAvKNToU has obtained an Alkali from the above-named tree, which he
thus describes. It is non-crystalline, solid, opaque, of resinous aspect, yellow,
very bitter, slightly aromatic, and easily soluble in water. If this salt pos-
sess the powerful anti-periodic properties of the bark from which it is derived,
it must become a valuable article of the materia medica, as the price of Qui-
nine (from the alleged scarcity of the cinchona bark) is becoming dearer
every year. Accoording to M. Servant, the inhabitants of Senegal cure the
worst cases of intermittent fever by a watery decoction of the bark of the
Khaya. [Journal de Pharmacie et de Chimie, Nov. 1849.]
MIISCELLANIEOUS INTELLIGENCE,
MEETING OF THE GRADUATEs of THE UNIVERSITY OF LONDON. A large
and influential meeting of the Graduates of the University of London was
held on Tuesday, 26th February, at the Freemasons' Tavern. The chair was
occupied by DR. SIBSON, F.R.S., who, in his introductory remarks, forcibly
alluded to the anomalous position in which the University at present stands;
its degrees being of great intrinsic value, as obtained at the price of a large
amount of knowledge and intellect, and yet being unappreciated by the world
at large. The obscure situation of the University, which sometimes did not
possess sufficient room for holding the examinations, and the non-participation
by the graduates in its government, were alluded to as the great reasons for
the indefinite position of the Institution. The admission to a share in the
government was referred to by Dr Sibson, as being desired by the graduates,
and as being an object worthy of attainment. Several resolutions were passed,
but the following declaration, the adoption of which formed the second resolu-
tion, expresses the objects which the graduates have in view. “That one
great principle recognized by the Government on the foundation of the
University of London, was to accord to the new University ‘an equality in
all respects, with the ancient Universities, freed from exclusions and religious
distinctions.” That, according to the present constitution of the University
of London, the Senate forms the corporate body, and not only administers all
MISCELLANEOUS INTELLIGENCE. 401
*
its affairs, but has practically a large power of altering its constitution by
petitioning for and accepting such new charters as Her Majesty may be
pleased to grant. That the members of the Senate not being connected
with the University by education, have a less direct personal interest in its
prosperity than those dependent on it for their academic rank. That the
Graduates are the persons chiefly interested in the welfare and honourable
reputation of the University, yet have no corporate existence, and are not
admitted to any voice in University affairs. That while the undersigned ac-
knowledge, with gratitude, the services rendered to the University by its
founders and present authorities, and admit that some constitution like the
present was necessary at its outset, they are convinced, that such a constitu-
tion was not intended to endure beyond the time, when the number of the
Graduates would afford the materials for establishing the University upon a
wider and more permanent basis. That the undersigned are of opinion that
the lapse of further time will not tend to secure a more efficient assembly of
Graduates, as every year is, in their present unorganised state, loosening the
connexion between the holders of degrees, weakening their interest in the Uni-
versity, and lessening their knowledge of its affairs. That, as the number of
the Graduates now amount to 546, and the number of the undergraduatesto 802,
including 112 who have passed the first examination for the degree of Bachelor
of Medicine, the undersigned consider that the time has now come, when they
may justly claim to be no longer excluded from the body corporate of the
University. That the fact that the Graduates do not possess any power or
collective voice in the University, tends to impair the value of their degrees,
and to lower their social standing as compared with that of the Graduates
of other English Universities; and that a change of constitution in this
respect is likely to secure for their degrees a higher and more widely-spread
reputation. That the simple admission to the present Senate, of individual
Graduates, is not, in the opinion of the undersigned, calculated to secure all
the advantages which would result in investing the Graduates with cor-
porate powers.”
THE “SAMUEL CoopFR” TESTIMONIAL. The commission for executing a
marble bust of the late distinguished and highly respected surgeon, MR,
SAMUEL CoopFR, has been entrusted to Mr. Butler, the eminent sculptor.
The working-model, from which the bust is to be executed, is highly credit-
able to the artist, and forcibly brings to mind the great and good qualities
for which Mr. Cooper was conspicuous. The place of deposit of the bust will
not be decided on until it is completed; but we believe that its destination
will be the Royal College of Surgeons. The committee intend (if the funds
allow) to present a reduced copy of the bust, in Parian, to each subscriber of
one guinea and upwards. The Honorary Treasurer (Mr. W. A. Hillman, 1,
Argyll Street), and the Honorary Secretary (Dr. Wood, Bethlem Hospital),
still continue to receive subscriptions from those who are desirous of express-
ing their respect for the memory of one of the brightest ornaments of Bri-
tish Surgery.
THE “LISTON” TESTIMONIAL. A meeting of the subscribers to the fund for
erecting a memorial to the late Mr. LISTON, was held on the 8th March, in
Old Burlington-street. The Marquis of Anglesey presided. The Honorary
Secretary, Mr. George, read the Report, from which it appeared that the sum
subscribed towards the object in view, amounted to only 750l., which sum
was insufficient for the erection of a statue, as originally intended ; that it
was therefore proposed that four marble busts of Mr. Liston should be exe-
cuted—one to be placed in the Royal College of Surgeons, another in Uni-
versity College, London, a third in the Royal Infirmary at Edinburgh, and a
fourth to be presented to the family of the deceased ; and that the residue of
the money should go to pay for a gold medal, to be awarded annually by the
Council of University College, London, to the best proficient in surgery. The
402 MISCET,LANEOUS INTELLIGENCE.
Report, and a resolution in accordance with it, were carried unanimously,
and a committee to carry out the intention of the meeting, consisting of the
Dukes of Beaufort and Buccleuch, the Marquis of Anglesey, Lord Kinnaird,
and Count D'Orsay, formed ; after which, thanks were voted to the Chairman,
and the business terminated. [Lancet, March 9.]
NEW HospitaL FOR DISEASEs of THE CHEST.-The Commissioners of
Woods and Forests have granted a piece of ground near the Victoria Park
for a new Hospital for Diseases of the Chest.
LEGAL ACTION FOR DEFAMATION OF CHARACTER BROUGHT BY A HomoeoPA-
THIST.-An action was tried before the Bailiff and Jurats of the Royal Court
of Guernsey, on the 9th March, in which JoHN OZANNE, Esq., a gentleman
practising homoeopathy, was plaintiff, and DE BEAUVoIR DE LISLE, Esq., sur-
geon, defendant. The action set forth, that on the 24th of August, 1849, in
the presence of a patient and other persons, Mr. De Lisle declared to Mr.
Ozanne that he was “no professional man, an impostor, a quack, nothing but
an impostor”;-the whole being of a tendency to injure Mr. Ozanne in his
profession as a medical practitioner, and being without any provocation on
his part. The case was opened by the Queen's Comptroller, who presented
an Act of the Court, dated March 1840, authorising Mr. Ozanne, who had
obtained his diploma from the University of Paris, to practise medicine in
that island. The authenticity of the Parisian diploma being disputed by the
Queen's Procureur delegate, for the defence, the Court certified the validity
of the objection. In the course of the trial, which occupied five hours, evi-
dence was adduced to prove that Mr. Ozanne practised homoeopathy ; that
Mr. De Lisle had refused to consult with him; and Drs. Magrath, Hoskins,
Collenette, and other practitioners, severally denounced homoeopathy as a
system of quackery. The Queen's Procureur delegate, in the defence, cited
numerous authorities, British and Foreign, who had expressed their strong
disapprobation of the homoeopathic system. The Bailiff, in summing up,
said—“That by the Act of Court, Mr. Ozanne was authorised to practise his
profession in the island. The words in the indictment imputed to Mr. De
Lisle, had been proved by the evidence of witnesses ; but it had not been
proved that Mr. Ozanne was a quack. Many witnesses had been heard, and
a heap of books had been produced which did not bear upon the case, although
both were unanimous in sentiment that homoeopathy is an imposture. But
that was not the question for the Court to settle, inasmuch as that would be
to decide without the required evidence. If Mr. De Lisle had satisfied him-
self with attacking homoeopathy as a system of imposture, without descend-
ing to personalities, he could not have been cited before the Court; but when
one individual told another who is practising that system, “you are an im-
postor”, it was necessary that he should prove that he is such. But no such
proof had been tendered. Looking at the position of the parties, it was
necessary to inquire whether any provocation had been given The words
were uttered in answer to a question from Mr. Ozanne. He did not think
there was provocation to justify the words used, inasmuch as they followed in
the course of conversation. An opinion prevails among the faculty that
homoeopathy is a quackery, but when a person takes upon himself to prefer a
charge against those who adopt that system, he takes upon himself the
responsibility of proving his own words.”—The Jurats were unanimous in
declaring, that the Act of Court sufficiently established the quality of physi-
cian taken by Mr. Ozanne in his action. They also considered that Mr. De
Lisle's words were not justified, but were used without premeditation ; that
Mr. Ozanne's conduct had been moderate and forbearing, and concluded by
sentencing Mr. De Lisle to pay 5l. damages to the plaintiff, an écu (2s. 6d.)
to the Queen, and costs. The method adopted by Mr. DeLisle for expressing
his opinion of homoeopathy was incautious. The course adopted by Dr.
Williams, as described in the next paragraph, was milder, and at least equally
cfficacious.
MISCELLANEOUS INTELLlgENCE. 403
CoRREspon DENCE BETWEEN DR. C. J. B. WILLIAMS AND A HomoeoPATHIC
PRACTITIONER. The Lancet of March 23rd, contains the following corres-
pondence.
THE LETTER.
46 Street, Friday, 22nd February, 1850.
“DEAR SIR,--I am very desirous of having your opinion in a case of sus-
pected disease of the heart. The patient is the Hon. Mrs. , at present
residing with Lady——, Square. Will you have the goodness to inform
me at what hour on Monday it would be convenient for you to see Mrs. 7
“I think it right to state that Mrs. —— has been for many years a convert
to homoeopathy, and that I, as you possibly may have heard, practise that
system of treatment. I mention this, because you may have some objection
to meet a homoeopathic physician in consultation, and I should much regret
if I were the means of inducing you to do anything distasteful to you in
ignorance of the above facts. I may, however, mention that it is as a matter
of diagnosis rather than of treatment that your opinion is desired, and that
my friends, Sir — and Dr. , have seen the case with me on former
occasions. I remain, dear Sir, your very obedient servant,
“To Charles J. B. Williams, Esq. M.D. etc.” & 4 .”
THE REPLY.
“7, Holles Street, Cavendish Square, Feb 33, 1850.
“DEAR SIR,--I am obliged to you for your courtesy in wishing to have my
opinion on the diagnosis of the case of the Hon. Mrs. , and for your
candour in apprising me that she is under homoeopathic treatment; but
under these circumstances I must beg you to excuse my attendance.
“Believing, as I firmly do, that the so-called “homoeopathic system” is an
entire fallacy, and therefore calculated to do much injury to those on whom
it is practised, I consider it to be my duty to do nothing that can, directly or
Žndirectly, countenance or aid it; and it appears to me, that to meet a homoeo-
pathic physician in consultation, and to assist in the diagnosis of a case pro-
fessedly under homoeopathic treatment, would have such an effect.
“I need scarcely add, that I have no personal feelings in the matter. And
hoping that you will soon return to the legitimate domain of rational
medicine, “I remain, dear Sir, yours faithfully,
“To Dr. tº “ C. J. B. WILLIAMS.”
DR. WILLIAMs' conduct in this case is most honourable and worthy of
imitation: but the adoption of any other course by a leading physician,
would have been a heavy blow and a great discouragement to the practition-
ers of legitimate medicine. Minor men may (for their guinea bribes) be
allowed to dally with “entire fallacies”, but the consulting physician, who
meets a homeopath, a hydropath, a chrons-thermalist, or any charlatan, must
be carefully repudiated by the profession. We wish this hint to be acted
upon : a laxity prevails.
FRAUD IN obTAINING A DIPLOMA FROM THE CoILEGE OF SURGEONs of
EDINBURGH.—The following account of a trial, which took place at Edin-
burgh on the 9th March, before the High Court of Justiciary, we abridge
from the Caledonian Mercury:—William Duncan, Amble, Northumberland-
shire, and Alexander Cumming, surgeon and druggist, Broughton Street,
Edinburgh, were then placed at the bar, charged with forgery; as also
using and uttering as genuine a false and forged writing; as also falsehood,
fraud, and wilful imposition ; as also conspiracy to commit the said crimes;
in so far as in October, November, or December 1844, they entered into a
conspiracy to procure a diploma from the Royal College of Surgeons of Edin-
burgh to enable the aforesaid William Duncan to practise surgery and phar-
macy without his actually appearing before the examinators appointed by
the College to take the candidates for diplomas upon trial, by means of Curn-
ming personating Duncan, and undergoing the necessary examination. In
furtherance of this design, Cumming obtained from the Conservator of the


404 AIISCELLANEOUS INTELLIGENCE.
College a printed form of a schedule required to be filled up and properly
attested by the candidate, exhibiting the full extent of his professional edu-
cation, which he falsely and fraudulently filled up, and appended to it the
signature of “William Duncan”, and thereafter delivered it to the President
of the College, pretending that he was the person whose signature was at-
tached to the document. Cumming afterwards attended and passed the usual
examination appointed by the College, on the 4th December 1844, and by
representing that he was the William Duncan represented in the certificate,
he obtained a diploma in Duncan's name, qualifying him to practise surgery
and pharmacy, which he immediately delivered to Duncan, to be used by
him as a diploma in his favour, and which was accepted by Duncan for this
purpose. The parties were apprehended about the beginning of January
last. Both prisoners pleaded not guilty.
The Lord Justice Clerk, after hearing an argument by Counsel, stated that
from the manner in which the charge was stated in the indictment, the Court
were under the necessity of directing the acquittal of Duncan. The indict-
ment set forth that Duncan and Cumming, in carrying out their conspiracy,
were both in Edinburgh, but no evidence had been adduced to show that this
had been the case in regard to Duncan. The Solicitor-General then addressed
the Jury for the prosecution, and was followed by Mr. Logan for the prisoner
Cumming ; after which the Lord Justice Clerk summed up. The Jury,
without retiring, delivered a verdict finding Duncan not guilty, in respect
that the Court had directed that the facts proved did not support the charges
set forth in the indictment, and finding Cumming guilty of all the charges
as libelled. Cumming was then sentenced to one year's imprisonment.
Duncan was dismissed from the bar.

QUACK PILL-MAKERS SEEM To BE AS LITTLE PROTECTED BY LAW AS REGU-
LAR PHYSICIANS AND SURGEONs | Such an announcement may surprise our
readers: but it seems to be true. In an action lately tried at the Northern
Circuit, before Mr. Baron Alderson, in which a druggist named Kirkus was
plaintiff, and another named Atkinson was defendant, the action was to
recover damages for manufacturing and selling pills called “Torr's Family
Pills”. The plaintiff married the daughter of Torr, and thus came into pos-
session of the recipe. He sold the pills under the title of Torr's Family
Pills, manufactured by Kirkus. The defendant succeeded to Torr's business,
and he sold the pills also, but as Torr's Family Pills, manufactured by Atkin-
son. The labels were the same in both instances. The counsel for the
defence contended that, so long as the defendant did not profess to sell Torr's
Pills, as manufactured by Kirkus, he had a right to manufacture and sell
Torr's Pills, as manufactured for himself. The judge charged for the defend-
ant, who obtained the verdict. Thus, then, the right to a patent or quack
medicine may be defeated by the person making it merely adding to the label,
“ as manufactured by — '''
REMUNERATION of MEDICAL MEN when SUMMONED To GIVE Ev1DENCE AT
QUARTER SESSIONs. In a case of action for assault (Dillon v. Reedy), tried
before the Assistant-Barrister, W. E. Major, Esq., at the Kilrush Quarter
Session for January, Dr. Foley of Kilrush was summoned by the plaintiff, to
testify to injury received. On being called upon to be sworn, he applied to
the barrister for an order for remuneration for loss of time, and stated that
he had been frequently examined in the Superior Courts, as well civil as
criminal ; that in every instance the Judges awarded compensation for loss
of time, and hoped his worship would extend the same protection to him.
The barrister replied, that the claim was a fair one ; that his time was as much
lost to him there as at the assize or at any other court, and he would award
to him the same remuneration as the Judges were in the habit of doing. He
called on the plaintiff's attorney, Mr. Mat. Kenny, to pay the witness. Mr.
Kenny asked the witness, what payment he required The reply was, “At
MISCELLANEOUS INTELLIGENCE. 405
least a guinea.” The fee was refused. Dr. Foley told the Court, that his
object was to assert a principle. It was now established; thanks to his
worship for the willingness and readiness he evinced to protect professional
rights, and left the Court without being sworn.
TESTIMONIAL To WILLIAM BUSH, Esq. A very handsome silver library
inkstand has been presented to the above gentleman, bearing the following
inscription :-‘‘Presented to William Bush, Esq., one of the medical officers
of the Bath Union, by 456 contributors, consisting chiefly of the poor of
Weston, with whom the subscription originated, in grateful testimony of the
kindness, skill, and unwearied attention, with which he devoted himself to
the service of the sick in that parish, during the prevalence of cholera in the
year 1849”. The idea of presenting a testimonial to Mr. Bush, emanated, in
this instance, from the poor, many of whom experienced his valuable and
zealous attention during the time of the late epidemic ; but the subscription
was by no means confined to this class.

Hospit AI, FoR. SICK CHILDREN.—Dr. West, Dr. G. Burrows, Dr. Robert
Ferguson, Dr. Bence Jones, and Dr. Latham, with the assistance of others,
are zealously endeavouring to accomplish the establishment of a Hospital to
contain 100 beds for sick children, between the ages of two and twelve.
Such an institution is much wanted as a Clinical School, though but little
comparatively can be learnt of many of the diseases of very young children
in an hospital. Calm observation of large numbers of children in their homes,
during health and in disease, and among the rich as well as the poor, is in-
dispensably necessary to one who aspires to treat successfully this most
numerous and most interesting class of cases upon whom the family physician
is called to attend.
FOREIGN PLAGIARISMS.
The Gazette Médicale for March 23, in the report of the Academy of Sciences of
Paris, states that M. SEDILLOT, of Strasbourg, has communicated a new method of
operating in Staphyloraphy, with the account of a successful case. This “new
operation ” is nothing more nor less than the division of the abductor muscles of
the palate,_an operation proposed and described by Mr. FERGUSSON, in the Medico-
Chirurgical Transactions for 1845, further noticed in the second edition of his work
on Practical Surgery, also in the Medical Times for 6th and 13th March, 1847; and
lastly, forming the subject of two papers in the LONDON JOURNAL OF MEDICINE for
January and February 1849. Our French confrères have either an astonishing
amount of self-complacency, or are in a lamentable state of ignorance of the labours
of Englishmen in the medical sciences. M. Sédillot is pre-eminently in this con-
dition; and we can only say of his conduct, that, if acquainted—and we can scarcely
believe him to be otherwise—with Mr. Fergusson's publications, he has acted in a
manner far from honest; if he has not, we know not what excuse to imagine for
such deplorable—we may say disgraceful—ignorance.
In DR. OPPENHEIM's Zeitschrift for November 1849, we have met with “Contri-
butions to the Pathology and Treatment of Tropical Fevers, elaborated (bearbeitet)
from the newest sources, by DR. HELFFT.” At the third page there is a reference,
in a foot note, to “James Bird, Report of the European General Hospital at
Bombay.” The first few sentences of the article struck us as being very similar to
something which we had read before; and on referring to DR. JAMES BIRD's papers
on Tropical Fevers, published in this Journal, in January and February 1849, we
found that, with the exception of a few omissions, principally of the pathological
views of the English author, the whole of Dr. Helfft's elaborate undertaking is a
nearly literal translation of Dr. Bird's papers, commencing at the second page, with
the observations on “Tropical Fever in General.” Wherever Dr. Bird's name is
introduced, it is only as an occasional contributor, in common with Mr. Gray, Dr.
Mardon, and the other authorities cited by Dr. B. himself. The resemblance is so
exact, that Dr. Bird's papers would almost, if not entirely, supersede the use of
a dictionary for the translation of Dr. Helfft's article.
This appears to us one of the most barefaced instances of plagiarism with which
we have ever met. We have not made this statement, without duly examining and
406
comparing the two articles; but the German production affords such incontestable
internal proof of having been directly derived from the source to which we have
referred it, that we cannot restrain our expressions of disapprobation at such a
flagrant breach of all the rules of literary honesty. Such conduct can never con-
duce to the reputation of any one who commits it.
We call the attention of the Editors of Foreign Journals to the thefts, which are
constantly being made by their contributors from the pages of British Medical
Periodicals, in the hope that they will assist us in holding up such conduct to the
scorn and contempt of the profession in all nations. For our own part, we must
protect our countrymen; and insist on having their names mentioned when their
works are appropriated, or their discoveries adopted.
A P POI N T M E N T S.
BUDD, Dr. S., elected Physician to the Exeter Dispensary, in the room of DR.
BARHAM, resigned.
HARE, C. J., M.D., Senior Physician to the St. Marylebone Infirmary, appointed
Assistant-Physician to University College Hospital.
JEMMETT, Dr. Benjamin, elected Physician to the Westminster General Dispensary,
in the room of Dr. WEGG, resigned.
MALGAIGNE, M., elected, after a severe concours, Professor of Médecime Opératoire
in Paris, in the room of the late M. BLANDIN. The numbers at the final
scrutiny were-for M. Malgaigne, 8; for M. Nélaton, 4 ; for M. Robert, 3.
TAYLOR, Dr. R., elected Physician to the St. Pancras Royal General Dispensary,
and to the Central London Ophthalmic Hospital, Gray's Inn Road.
O BIT U A R Y.
ALLEN, John, Esq., Surgeon, aged 60, at Epsom, on 6th March.
BoLEY, R., Esq., of Ashley Hill, Bristol, suddenly, while attending a patient, on
11th March.
BoyRENSON, T., M.D., at Kaira, Bombay, of jungle fever, on 6th February.
CARVER, Walter, Esq., Half-pay Surgeon to the 4th Veteran Battalion, aged 74,
on 27th February.
DIX, Robert, Esq., Surgeon, at Brighton, aged 76, on 20th February.
GRAY, John, Esq., Sherborne, Dorset, on 24th February.
HUTCHINSON, William, M.D., at Isleworth, aged 57, on 18th March.
MALYN, John, Esq., F.R.C.S., many years Surgeon to the Western Dispensary, and
Lecturer on Anatomy and Physiology at the Westminster Hospital School of
Medicine, aged 48, at Kentish Town, on 9th March.
M“LEOD, Charles, Esq., Surgeon H.E.I.C.S., at the Free Church Manse, Snizot,
N.B., on 4th March.
MARJOLIN, M., Professor of Surgery in the Ecole de Médecine at Paris, aged 70, on
the 4th March.
PARDOE, Geo., M.D., at Little Holland House, Kensington, aged 40, on 9th March.
PREVOST, M., at Geneva, lately. He was distinguished for his valuable contribu-
tions to physiology and medicine.
STOKES, J. J. Esq., Acting Superintending Surgeon, of the Nizam's army, at Elich-
poor, on 30th December, 1849.
STUART-Cooper, Dr., formerly chef-de-clinique of the Faculty of Medicine in Paris,
of diabetes mellitus, lately.
TAYLOR, Thomas, Esq., Surgeon, at his residence, Bethnal Green Road, aged 39,
on 7th March.
YoUNG, Edward, Esq., Surgeon, wrecked in his passage from Wellington, New
Zealand, to Port Victoria, Akaroa, in August last.
B O OFC S R E C E I V E D.
APPEAL to the Public in behalf of a Hospital for Sick Children. By a Provisional
Committee. London: 1850. APPEAL to the Medical Profession in behalf of a Hos-
pital for Sick Children. By P. M. LATHAM, M.D., G. BURRows, M.D., R. FERGUSON,
M.D., H. BENCE Jones, C. WEST, M.D. BLAIR on Yellow Fever. London : 1850.
HUNT on Diseases of the Skin. London: 1850. PARKER on the Treatment of
Secondary Syphilis. London: 1850. REGULATIONs of the Society of Apothecaries.
London: 1850. WILSON on Diseases of the Skin. London: 1850.
I, ON DON
JOURNAL OF MEDICINE,
A MONTHLY
3Retort of the ſūtūital $5ttenttä.
MAY 1850.—No. XVII.
O R. I. G. I. N A La C O M M U IN II CAT I O N S.
ON CONICAL CORNEA.
By W. WHITE COOPER, Esq., F.R.C.S., Senior-Surgeon to the North London
Eye Infirmary, and to the Artillery Company, etc.
My attention was some years ago directed to that singular change in the
eye, to which English writers have applied the term CoNICAL CoRNEA ;
and I communicated with many eminent ophthalmic surgeons on the
subject, besides instituting experiments myself. The information which
has resulted, though throwing less light than could have been desired
on the true nature and management of this intractable disease, possesses
a considerable amount of interest, and, combined with other materials,
will form the subject of this article. --
Comical Cornea does not seem to have attracted the attention of
oculists until within the last hundred years; and the first writer who
makes mention of it is John Taylor, in his Nova Nosographica Ophthal-
mia, printed at Leipsic, in 1766. Leveillé has usually had the credit
of the first recorded observation, but Taylor preceded him. Von Am-
mon was the first to notice the circumstance of its being, in some
instances, a congenital defect, and also an hereditary peculiarity. He
connected with it a singular form of the head. “It is worthy of re-
mark”, says he, “that also in this hyperkeratosis congenita, a peculiar
form of the head obtains; viz., the so-called pointed head (spitskopf).
I have once noticed this in a family of sisters, who were all affected
with congenital hyperkeratosis”. Mr. Wilde also inclines to this opinion;
but in Anne Reeder, whose case will hereafter be mentioned, the head
was singularly elongated in the antero-posterior direction. There are
not sufficient data yet to decide whether Conical Cornea and Conical
Crania have any constant co-relation.
Conical Cornea appears to be peculiar to the human species; and so far
as my inquiries have gone, it is limited to civilized races To ascertain
whetherit exists in the brute creation, I applied to Mr. Percival, the dis-
tinguished veterinary surgeon, who states that it certainly is not found in
horses, and in his opinion, does not appear in any of the lower animals.
WOL. II. 27
408 CONICAL CORNEA.
There are not, however, sufficient grounds for denying the possibility of
its occurrence amongst them, especially if, as will hereafter be shewn,
it is one of the results of inflammation; for with Squirrels, staphyloma,
and leucoma, other results of inflammation, are common diseases; and
in Lemurs also, I have observed examples of the same. In one instance
there was a very fair specimen of a “conoidal globe”.
It would appear as if Conical Cornea were a disease prevailing most
in warm climates and warm situations, and becoming more and more
rare as we approach the colder latitudes. Sir John Richardson informs
me, that he “observed no cases of Conical Cornea among the inhabitants
of the northern regions of America. Conjunctival ophthalmia is ex-
ceedingly common among the Indians and Esquimaux, and often ter-
minates in blindness and opacity; but diseases of the humours, or ball
of the eye, are not common”. Conical Cornea is almost unknown in
the north of Germany; and Himly, who has written on the subject,
never saw a case. In the north of England it is less common than in
the south and west, and in Scotland rarer than in England. Dr.
Mackenzie has communicated to me, that of 15,924 cases treated at the
Glasgow Eye Infirmary, only four were Conical Cornea. Dr. A. Ander-
son, of Glasgow, has only seen two cases since 1842. Dr. Cadenhead,
of Aberdeen, says that, “out of upwards of at least 8000 eye patients
who have applied to the Aberdeen Ophthalmic Institution, and to the
Royal Infirmary Ophthalmic Wards, under my charge, I have only seen
three cases—two females and one male”; and Mr. Walker, of Edin-
burgh, tells me that, of 7679 patients at the Edinburgh Eye Dispensary,
there was not one instance of Conical Cornea. Compare with this the
returns from China, where, of 6787 cases, no less than twenty-two were
examples of this disease; from Dublin, where, of 4050 cases, ten were
Conical Cornea; and from Plymouth, where, of 5118 cases, thirteen
were Conical Cornea. Moorfields, too, presents a large number—as
many as twelve in one year, and ten in another. Mr. James Dixon, the
able surgeon to that noble institution, mentioned to me a curious fact,
that he had been looking out for an example of this disease during a
whole year without success, when, on a certain morning, no less than
three patients presented themselves quite independently of each other,
and each with the disease well marked. In the table of returns (see meat
page), I have only given those of Moorfields for the Metropolis, as
patients suffering from Comical Cornea would be likely to seek relief at
several institutions, and might thus be reported from each. Mr. Smith,
of Southam, communicated to me, in 1847, that within the preceding
year or two, he had seen no less than eight cases; and observes, that
“they have generally agreed in a few things; they have been temperate,
generally water drinkers, they lead sedentary lives, and have all come
: a district of the country where a soft brown stone prevails in the
earth”.
APPEARANCES AND FREQUENCY. The terms, ‘Cornea Conica’, ‘Sta-
phyloma Pellucidum Conicum', and “Conical Cornea', are expressive of
the alteration in the form of the Cornea which forms the distinguishing
characteristic of the disease. But before the change in the outline of
the cornea is sufficiently marked to be obvious to the casual observer,
an unusual brilliancy of the eye is visible; a lustre which has been
BY W. WHITE COOPER, ESQ. 409
TABLE, SHOWING THE PROPORTION OF CASES OF CONICAL CORNEA.

Total | Con. Total | Con. Total | Con.
Cases. Corn. Cases. |Corn. Cases. Corn.
GLASGOW EYE ROYAL LONDON BRISTOL EYE
INFIRMARY, OPHTELALMIC INFIRMARY.
June 1824 to HOSPITAL, 1814............ 107| 1
Jan. 1847 ...|15924| 4 || MOORFIELDS. 1815......... ...] I'70|| 1
- 1839............ 4891] 2 | 1816............ 208; 0
*...*. 1840............ 5355) 10 | 1817........... 467| 0
nºtawºry. 8000| 3 || 484… 5528| 5 | 1818....... .....| 488| 1
1842............ 6085| 7 | 1819... ........ 516|| 0
EDINBURGH EYE 1848............ 6572| 0 | 1820............ 706| 0
INFIRMARY. 1844............ 6874 12 | 1821............ 679| 2
Jan. 1842 to 1845............ 7005| 4 || 1822........ ... 751| 0
Jan. 1850 ...} 7679| 0 | 1846............ 7010| 9 | 1823............ 895| 3
MACAO 1847............ 7672 5 | 1824............ 1153| 0
HOSPITAL. 1848............ 8382| 6 | 1825.......... 1239|| 0
1841 to 1842 | 1288, 7 1826........... 1294| 3 |
1844 to 1845 5499. 15 || LIVERPOOL EYE #. tº º ſº e º e º 'º # I
º INFIRMARY. tº tº gº tº e e g º ºs e e 85| 5
ST. MARK"S 1834............ 1770| 2 | 1829............ 1174| 0
º 1835............ 1986 0 | 1830............ 1245) 5
isiºn. 980) 2 1836............ 1965| 4 | 1831............ 1227| 0
1846............ 1526|| 6 1837............ 2186| 0 | 1832............ 1374; 1
1347............ 1544| 2 1838............ 2189 0 | 1833............ 1350, 0
as gº & º º ºs & e º gº tº gº 1839............! 2230|| 0 | 1834............| 1388. 2
PLYMOUTH EYE 1840............ 2186| 0 | 1835............ 1516. I
INFIRMARY. 1841............ 2224| 2 | 1836............ 1647| 1
1845............ 936| 3 | 1842............ 2244| 2 | 1837........ tº gº tº e # 3
1846............ 848| 0 | 1843............ 2287| 1 | 1838............ 1911| 0
1847............ 918| 3 | 1844............ 3078| 3 | 1839............ 1921] I
1848............ 1203| 4 | 1845............ 3462| 3 | 1840............ 2151 4
1849............ 1213| 3 | 1846............ 3510| 2 | 1841............| 2141| 2
1847............ 3721| 0 | 1842....... .... 2363| 1
rº, 1848............ 3798| 1 | 1843............ 23.93| 4
1844............ 22.45| 4
1834............ 1383| 1
1845............ 2346| 2
1837............ 1486|| 1
1846............ 2I 60 4
1843............ 1638|| 1
1847...... tº e & c. e. e. 2095| 3
1844............ 1156] 1 184 2110| 1
1845............ 1536 2 848............
aptly compared to the sparkling of a diamond, especially in a well-
lighted room at night, and which, by adding to the expression of his
eyes, afforded considerable consolation to an actor who was the subject
of this malady." The brilliancy partly arises from the great number of
rays reflected, and partly from the excessive refraction of those rays
which penetrate the cornea. If we examine an eye in which the disease
is commencing, it will be seen that the anterior chamber is unusually
large, the cornea more prominent than natural, and that the outline,
having lost its sphericity, has a pyramidal form (Fig. 1). The position
of the iris is not altered; as the disease advances (its progress being
* “The most pointed cone I ever saw was in a clever comedian ; he could only
see to read three inches from his eye, and it gave the most peculiar character to the
expression of his face on the stage I ever beheld: he thought the disease serviceable
in that way.” Extract of a letter from H. L. SMITH, Esq. &
27 2
410 CONICAL CORNEA,
usually very slow), the change in form becomes more decided, and the
---- cornea assumes such an appear-
ance as would be presented were
a dew-drop attached to the front
of the eye. Mr. Wilde is of
opinion, that when this conform-
ation is congenital, the axis of
the come is seldom in the middle
of the cornea, but is either above,
below the centre, or to one side.
No further change may take
place, and the cornea may re-
Fig. 1. main in the condition described,
for a very long period, as happened in the case of an old lady, at Plymouth,
related to me by Dr. Butter, in which the Conical Cornea had undergone
no change during thirty years; or the deformity
may attain so large a size as to prevent the
closure of the lids, as was the case in a cook, a
patient of Mr. Isbell, of Stonehouse (Fig. 2).
A common change, however, is the formation
of a speck of opacity at the extremity of the
cone, and a considerable amount of lymph is
at times deposited about that spot (Fig. 3). Fig. 2.
§ Instances have occurred in which there are opaque
spots scattered over the cornea, as was observed
in a schoolmaster, whose case was mentioned to
me by Mr. Walker, of Manchester; and occasion-
ally, though rarely, the whole cornea becomes
opaque, as described by Dr. Farre, in a case which
will be hereafter referred to. In the great ma-
jority of instances, a depression exists at the cen-
Fig. 3. tre of the apex, as if a small piece had been
chipped out.
To the unassisted eye, the surface of the cornea appears smooth and
even ; but under a lens, it is seen to be broken up by elevations and
depressions, as pointed out by Sir David Brewster. Of the existence
of these irregularities, I have many times satisfied myself; and, in one
case of double Comical Cornea, there were five dimples distinctly seen
in one eye, and seven in the other. This condition is probably dependent
on unequal absorption, some portions having been removed whilst others
I'êITQ3.II].
The change of form generally implicates the whole cornea, but there
are exceptions, of which the following is an interesting example. “I
have seen”, says Mr. Middlemore,” “one instance of this affection occur-
ring only very partially, for the conical portion of the cornea was only
as large at its base as the plane surface of a small split pea. It existed
at the lower part of the cornea, resembled a small and extremely
conoidal portion of beautifully transparent glass placed upon the surface
of the cornea, and occasioned great confusion of sight from the unequal
* A Treatise on the Diseases of the Eye, vol. i., p. 533.



BY W. WHITE COOPER, ESQ. 411.
refraction of the rays of light”. A somewhat similar case fell under
my own observation, where the disease was clearly
traceable to an ulcer, which, in healing, had left a
dimple, or loss of substance in the cornea, and
this dimple became the apex of the cone. A just
distinction has been drawn between true Conical
Cornea, in which the alteration in figure is con-
fined to that membrane, and another change in A.
form, the conoidal eye, which commences in the lift
sclerotic at the insertion of the recti muscles, W
and is the consequence of inflammation. Fig. 4,
taken from a patient of mine, is a good illustra-
tion of this disease. -
In almost all the cases I have seen, both eyes Fig. 4.
have been affected, although seldom to the same degree. The disease
usually attacks one first, and sooner or later, the other. Mr. Wilde
states, that “when congenital, both eyes are usually affected, whereas,
when it occurs in after life, it is very frequently in but one”. I have
not been able to satisfy myself that any of the cases examined by me
have been congenital, nor does the frequency of its being confined to
one eye accord with my own experience; and I believe that it is occa-
sionally overlooked in the early stage. Of forty-eight cases, three pre-
sented it in the right eye, eleven in the left, and in thirty-four, both eyes
were affected, as will be seen by reference to the table. (See meat page.)
It would seem to develop itself most frequently about the period of
puberty, and to be rare in children and old people. The respective
ages of fifty-six patients were as follows:—
Under 10 ... ... ... ... 2 Between 40 and 50 ... ... 5
Between 10 and 20 . . ... 15 50 and 60 ... ... 0
20 and 30 ... ... 24 Above 60 ... tº º º 2
— 30 and 40 ... ... 8
I have no doubt that in the cases entered as above sixty, the disease has
been of old standing, and I think it rarely commences much after forty.
The total number of ophthalmic cases from which my, calculations have
been made, is 208,970. Of these, one hundred and ninety-four only
were examples of Conical Cornea, giving a general average of 1 in
I077°16.
The averages of the special returns are as follows:—
Macao i in 308'50 London 1 * , T089°56
Plymouth 1 33 393-69 Manchester 1 in 1199-83
Dublin I 2 3 405.00 Liverpool 2 3 1941.80
Bristol 1. 3 y 857-19 Scotland I 33 4514*7i.
SYMPTOMs. Conical Cornea from its earliest commencement renders
the individual near-sighted ; and if the change in the configuration be
considerable, the eye is rendered almost useless. The patients can then
only discern objects when held very close and to one side. When
looking at a book, for instance, they regard it obliquely, a peculiarity
which gives a singular expression to the countenance. The gentleman.
who favoured me with the drawings, from which figures 5, 6, 7, 8, and
9 have been taken, stated, that although under ordinary circumstauces
he could not distinguish objects further from the eyes than three inches,

412
CONICAY, CORNEA,
TABLE OF CASES OF CONICAL CORNEA.
No. Name. Age. i. Occupation|| No. Name. Age. º: Occupation
1 Mary Boys ...... 27 |Both Dressmr. 37 Emma Roberts 14 || –
2 Louisa Wright. . 24 |Both Milliner ||38 Louisa Gill ... 20 | – |Unknown
3 Female ......... – |Left| Milliner || 39 Female ......... — | – |Housem.
4 Female ......... 17 |Left| Sempst. ||40 Female ......... — | – |Cntry. gl.
5 Female ......... 25 |Both Sempst. ||41 Lady ............ 71 |Both
6 Female ......... 17 | – | Sempst. ||42 Lady ............ 35 | – | —
7 Female ......... — |Both Milliner ||43 Lady ............ 16 || – *-*mmamºm.
8 Mrs. Saker ...... 40 |Both Cook ||44 Lady ............ 14 |Bothl —
9 Margaret Fitch . 25 |Both Cook || 45 Harriet Smith| 8 |Both —
10 Female ......... — |Both Cook ||46 Lady ............ 19 |Bothl —
11 Female ......... — |Left | Cook ||47 Lady ............ 31 |Both
12 Jane Matthews 38 || – | Cook ||48 Mr. Chapman.| – |Both Med. stu.
13 Harriet Melrose 29 |Left | Cook || 49 Male ............ 17 |Both] Tailor
14 Eliza Richardson 27 |Left | Cook || 50 Male ............ 29 |Both Shoemak.
15 Female ......... — | – |Lady's m. 51 Joshua B, ...... 47 |Both|Unknown
16 Female ......... 25 Both Unknown||52 John Bentley. . 28 |Both Unknown
17 Female ......... — | – ||Unknown||53 Joseph Diggles — Both Unknown
18 Female ......... 16 || – ||Unknown 54 Robert Ingram 20 | – Unknown
19 M. E. ............ 22 |Both Lady || 55 Evan Folks ... 52 || –
20 Hannah Hudson 28 Left Unknown|| 56 Wm. Matthews 29 |Both Unknown
21 Anne Holland... 21 Both Unknown||57 Thos. Kennedy 47 | – Unknown
22 Phoe. Greenhalgh 28 Both Unknown||58 Wm. Harrison 38 | – | Seaman
23 Margaret Evans 14 | – |Unknown||59 Male ............ — | – | Baker
24 Elizth. Oxford... 25 | – |Unknown||60 Male ............ — — | Grocer
25 Emma Housley. 26 |Both Sempst. ||61 Male ............ — | – | Farmer
26 Jemia. Smithson 31 |Left| Glover || 62 Male ............ — |Both Unknown
27 Mary Hall ...... 18 |Left Shoebind || 63 Mr. J. D. ...... 20 |Both Med. Stu.
28 Hannah Rogers 24 Rt. Servant || 64 M. —...... ... — |Both|Comedian
29 J. Macnamara..! 11 | Rt. 65 John Parker... 19 |Both Glassblr.
30 Arabella Thomas 19 |Both Servant ||66 Geoffry Carter 26 || – |Blacksm.
31 Maria Martin ...| 23 Both Servant || 67 James Cook ... 32 |Left | Tailor
32 Ann Reeder ... 17 |Both Servant | 68 Rd. Macdonald 40 | Rt. Surveyor
33 Female ......... 70 |Both 69 Male ............ 30 Left |Schoolm.
34 Mrs. H............ 40 |Both Lady || 70 Luke Gibbon... 23 |Both Carpetww
35 M. A. Roberts...] 18 |Both 71 Jas. Crawford . 9 |Left
36 Margaret Gibb | 22 | – |Unknown 72 E. H. G......... 31 Both Solicitor
yet, by making pressure upon the temples, vision was increased to six
inches. The integuments were pushed forward so as to press slightly on
Fig. 5.
Appearan.ce of halo surroundi. Ig a
parlour-lamp.
the globes, and I ascertained that the object
was equally attained by direct pressure upon
the temporal side of the globe, thus altering
its antero-posterior diameter. Luminous
objects are frequently described as being
surrounded by rings or belts, and are some-
times multiplied in number; phenomena
arising from the irregular refractions caused
by the elevations and depressions of the sur-
face of the Cornea. In some instances
the vision is much benefited by dilating
the pupil with belladonna, as in the case
of an old clergyman, mentioned by Mr.
Lawrence, who was, for thirty years, the sub-
ject of this affection; and yet was able, by

BY W. WHITE COOPER, ESQ. 413
the use of belladonna and the nitrate of silver, to continue his duty in
the pulpit, with tolerable accuracy, up to the time of his death. In
several instances in which I tried it, not
the slightest advantage was derived. In
a few instances vision has been improved
by looking through a pin-hole aperture ;
but in many others this also has failed.
The descriptions attached to the five
figures are those written by the patient at
the foot of each.
CAUSEs. Much uncertainty prevails as
to the precise nature of the changes which
take place in those cases of Conical Cor-
nea, which bear no satisfactory history, nor
are traceable to any evident exciting cause.
In a large majority of such cases, we
find that the disease is in connexion with
an enfeebled state of constitution, and a
low condition of the nervous energy; a
condition, therefore, in which the vis vitae
is impaired, and some at least of the or-
ganic functions are imperfectly performed.
It has been demonstrated that the cornea, Fig. 6.
in its natural condition, is not traversed . Usual appearance of belts surrounding
:- uminous bodies. After gazing at an
by blood-vessels; that the arteries and tº gazing at any
ight for a short time, the belts and rays
veins from which it derives its nutriment are so increased in number as to present
form a circle around it, but having barely the appearance of a mass of fire.
penetrated its circumference, go no further. We may, therefore, con-
clude, that the cornea would speedily become sensible of any defi-
ciency in the supply of new material, should the exudation of that
material be interrupted. The materials for the repair of the waste of
the membrane, (which waste, in common with that of other tissues, is
ºf
5
F
F.
E.
sº
º
-3
º
-:
º
Fº
E
&
E.
Fig. 7.
Appearance of belts surrounding the flames of three candles placed equi-distant from each other.


414 CONICAL CORNEA.
constantly in progress), are derived from the blood, each tissue being en-
dowed with the power of selecting such constituents of the blood as are
best suited to its composition. If then, there should be any interruption
to the supply of particles capable of entering into the composition of
the cornea, we might expect to find a change taking place in the struc-
ture of that membrane: the old material is being constantly removed
by the absorbents, but the supply of new material to repair the waste is
arrested; and as the centre of the cornea is the point furthest removed
from the source of supply, it might be expected that that part of the
membrane would exhibit the change consequent upon the interruption
of supply in the most marked manner.
The effect then would be, that the pressure of the muscles of the
globe acting upon its contents, would squeeze them forward; and the
Gentre of the cornea, being the point of least resistance, would be pro-
jected into a conical form.
We have good reasons for supposing, that, in many instances, Conical
Cornea is the result of congestion. Of forty-two cases in which the
occupation of the parties was known, there were seven cooks, ten dress-
makers and needle women, three tailors, a carpet-maker, a surveyor, a
schoolmaster, a glass-blower, a blacksmith, and a baker, all employments
having a direct influence in causing determination of blood to the eyes.
Strong presumptive evidence of the existence of congestion is afforded
by the uneasiness in the eyes which often accompanies this disease.
This symptom has scarcely ever
been absent in the cases which have
fallen under my own observation;
and it has varied in degree from a
sensation of discomfort to a posi-
tive pain of a dull aching character.
A cook, whom I have recently seen,
with Conical Cornea in both eyes,
complained of pain, tenderness, and
sense of distension of the globes.
Another symptom indicating con-
jestion is the frequent occurrence
of muscae volitantes. Of seven
patients whom I questioned, six
described the appearance of these
Fig. 8. annoying phantasms as being of
Musca, volitantes seen on looking at a daily occurrence. We have, there-
luminous object. fore, sufficient ground for connect-
ing the comicity of the cornea, in many cases, with congestion, occurring
in combination with deficient nervous energy
and feeble power. Persons who appear most
subject to Conical Cornea, are those in whom
asthenic choroiditis is frequently observed; and sº-Hº-E
the supposition is not unreasonable, that the Fig. 9
* * * * - e e 1g. 9.
same influences which produce congestion of Fixed Musea, ºn chiefly during
the choroid, may be exciting causes of Comical reading. . . . .
Córnea, by interrupting the circulation in the corneal zone of vessels.
If the vessels of a part are deficient in mervous energy, they will be
e-

BY W. WHITE COóPER, Esq. 4.15
in a condition favourable for the occurrence of congestion, their power
of vital resistance or tonicity being impaired. Excitement of the sen-
sitive nerves of the cornea calls forth antagonistically, according to
Henle’s principle, a state of depression—a temporary paralysis of the
motor nerves of the contractile fibres of the walls of the small arteries,
opening into the capillary network of the conjunctiva and sclerotica ad-
jacent to the cornea ; the effect will be, first, relaxation and dilatation
of those arteries, and then accumulation and stagnation of blood in the
capillaries. If the capillaries which surround the cornea and supply
it with nourishment are thus deficient, congestion will speedily arise,
and the effect will be to diminish the exudation of nutrient fluid from
them, and consequently to interrupt the process of assimilation in
the membrane. Then the centre of the cornea, being the most distant
point, will exhibit the deficiency in the most marked degree; and the
balance of nutrition and absorption being lost, attenuation of that part
will occur. If we suppose the congestion to go somewhat further, and
lymph to be thrown out, we may expect to find the margin of the cornea
thickened, whilst its centre is unusually thin. .
Ulceration of the cornea is sometimes followed by that membrane
assuming the conical form. It is not surprising, that a spot deprived
of the anterior elastic lamina, should be thereby weakened, and less
able to resist the pressure from behind. In such cases, the dimple or
cicatrix of the ulcer usually forms the apex of the cone.
Conical Cornea is, undoubtedly, a frequent consequence of inflam-
mation of the membrane; particularly when modified by struma. Dr.
Mackenzie informs me that he has seen it associated with scrofulo- .
catarrhal ophthalmia, with opacities, and with pterygium ; Dr. Butter
of Plymouth has seen it after purulent ophthalmia, and after ulcers of
the cornea ; such also has been my experience. Dr. J. C. Hall relates a
case in which it followed syphilitic iritis; and it has been pointed out
by that gentleman, and also by Mr. Wilde, that when Conical Cornea
is the sequel to inflammatory action, the abnormal curvature is not
limited to the cornea, but commences about the insertion of the recti
muscles in the sclerotic. I have seen a well-marked example of this,
and the form of the eye has been aptly compared to that of the eyes of
raptorial birds. The opinions of Dr. Jaeger of Vienna are, at all times,
entitled to the highest respect, and I may hereintroduce an interesting
and important letter with which he favoured me.
& “Vienna, June 1, 1847.
“Sir, Having had occasion to observe cases of staphyloma pellucidum
during a space of forty years, I consider it to be the result of a specific
inflammation of the cornea veritatis, or a symptom of this inflammation.
In the first case, excepting a Conical enlargement and greatly increased
expanse of the cornea, with more or less opacity of the projecting part,
there is nothing morbid, and the functions of the eye would be well per-
formed, were it not for the faulty form of the cornea. In the second,
besides the conical form of the cornea there is inflammation of the
eye present, but especially of the cornea, and the opacity and conical
shape of the cornea are merely symptoms of the inflammation. The
opacity of the cornea may be looked upon as the redness of inflammation
elsewhere, and the come is induced by the loss of elasticity in the tissues,
and the softening of the cornea itself.
4 16 CONECAL CORNEA.
“The thickness of the cornea varies. In the first series of cases it is
thin and membranous at the apex: in the second class, it is double,
or even three times its natural thickness, the tissues being soft, loose,
and swollen. -
“The character of the inflammation which gives rise to staphyloma
pellucidum, is generally scrofulous, such as affects fibrous and cartila-
gimous tissues; but rheumatic and syphilitic inflammations, especially
when combined, also tend to induce this deformity. It may be observed,
and that not uncommonly, as a result of gonorrhoeal ophthalmia. The
loss of the outer or conjunctival layer of the cornea will give rise to
this affection; but the why and the wherefore are not yet sufficiently
explained. Staphyloma pellucidum is rarely congenital; it is generally
developed during the first years of life, and sometimes at a more ad-
vanced period; but being once developed, it is never lost. The pro-
gnosis is doubtful. A cure is only to be thought of in the commence-
ment of the disease—the inflammatory stage; this past, treatment is
for the most part useless.
“The indications are, to treat rationally the existing inflammation as
regards its nature, degree, and character. If the staphyloma be a resi-
duum morbi, medicinal application we find avail not; neither can benefit
be afforded by operative means. Extraction of the lens and formation
of artificial pupil, accomplish nothing towards a cure—or something
very imperfect. The same may be said with respect to the partial re-
moval of the cornea. This is all that I am able to say upon this
subject. DR. F.R. JAEGER.”
By Dr. Jacob, of Dublin, who is a high authority, Conical Cornea is
considered as a decided result of true corneitis. “I am prepared (says
he) for a denial of the correctness of this statement, that the staphyloma
pellucidum or Conical Cornea, is owing to the disease under discussion
(true corneitis); but I nevertheless venture to insist upon it, because I
have seen and traced the change from its commencement to its termi-
nation, more than once. That there should be doubt and difference of
opinion on the subject is not surprising, because true corneitis is not a
wery common disease, and the change in shape to the comical is not a
frequent consequence of it. The alteration takes place in childhood;
for the disease generally occurs at that period of life, and, after the in-
flammation has disappeared, and the opacity has been dissipated, no
defect except this conical state remains. . . . . That I have seen the
cornea become opaque from corneitis, then conical, and finally perfectly
transparent, I am quite positive; but not only have I seen this, but
also have I seen it become distinctly conical, in a case of a common
idiopathic inflammation of the eyeball in a man of middle age, although
not transparent or resembling the true staphyloma pellucidum.”
Dr. Mackenzie also has known it to arise from corneitis, and informs
me of an interesting case—that of a young lad in whom it followed a
blow with a snow-ball.
Several authorities agree that it may be the result of excessive weeping,
the most striking illustration of which, is afforded by the following case,
related to me by Dr. Farre, the Nestor of English ophthalmic physicians.
1 A Treatise on the Inflammation of the Eye-ball, p. 196.
BY W. WHITE COOPER, ESQ. 4.17
“Many years ago I was called in to see a young lady under the follow-
ing circumstances. She was one of two sisters who were devotedly
attached and scarcely ever apart. Her sister died; and so excessive was
the poor girl's grief for her loss, that for several months she never ceased
to weep—tears constantly stood in her eyes. The effect of this constant
excitement of the organs of vision, was to produce, first, Conical Cornea
in a marked degree, and secondly, opacity not only of the apices of the
cones, but of the whole of the cornea, rendering them quite leucoma-
tous; and this condition could only be relieved in a very trifling degree.”
Mr. Square, of Plymouth, informs me that he has seen a great many
cases of Comical Cornea, that the subjects of it were principally delicate
females, and that the cause has apparently been traceable to grief and
the depressing emotions of the mind. Mr. Tyrrell told me, shortly
before his death, that he had seen a case very similar to that related
by Dr. Farre. That excessive weeping should induce Conical Cornea
is not surprising, when we bear in mind that it would have the effect of
keeping up a continued state of congestion of the eyes, combined with
compression of the globes, circumstances highly favourable for the
development of the disease under consideration.
Conical Cornea is described by many writers as the occasional result
of violent muscular contractions and convulsive efforts. A case of a
man who was hanged, recorded in the first volume of Haller's Disputa-
tiones Chirurgica, is generally quoted as a striking illustration. It was
addressed from Rostock, by C. Burgmann, to Heister, in 1729, and is
illustrated by a plate, which fortunately enables us to form our own
opinions as to the probability of the case. The globes of the eyes are
represented as retaining their proper form, but the corneae have been
squeezed into two processes, which reach to the end of the nose, and in
shape, resemble the swim-bladder of certain fishes. The length of
each would be about an inch and a half, and the breadth at the base
about half an inch ; and the question which naturally arises is, with
what can these sacs have been filled? The globes retaining their form,
it cannot be lens and vitreous humour; and aqueous humour would not
be secreted so quickly, or distend the corneae so violently, without burst-
ing them. My own impression is, that the case has been much exag-
gerated; for if hanging produced such effects, the case would scarcely
be a solitary one. -
PATHology." The late Sir William Adams, with more confidence
than accuracy, gave it as his decided opinion, that Conical Cornea was
the result of a morbid growth and thickening of the substance of the
cornea. In this opinion he stands nearly, if not quite alone, and every
fact that has been ascertained, is adverse to it. The rarity of the affec-
tion renders opportunities of examining such diseased eyes after death
very uncommon; consequently, much interest attaches to the autopsies
which have taken place. It may be mentioned, that a difference of opi-
nion exists as to the precise form of the healthy cornea. Kraise, of
* I regret that I have not been able to refer to the writings of M. Sichel on
Conical Cornea ; he informed me by letter that they are contained in the Second
Supplement to the Annales d'oculistique for 1843. Singular to say, the supple-
mentary numbers are not contained in any of the sets to which I have had access
in London, and I have therefore been unable to consult the papers in question.
4.18 MR. W. WHITE COOPER ON CONICAL CORNEA.
Hanover, states that the cornea is thicker at the circumference than
the centre, rendering the exterior surface nearly spherical, the interior
parabolic. Mr. Bowman and others are of opinion, that the thickness
of the cornea is equal throughout, and that the two surfaces are per-
fectly parallel. I have taken some pains to satisfy myself on this point;
and, I incline to the latter opinion, though, from the difficulty attending
the examination of the cornea in what may be considered its perfectly
natural state, the point is not yet satisfactorily established.
More than one instance is recorded, where a Conical Cornea has been
burst; and the tenuity of the membrane when the disease is far advanced,
but before it has become opaque, may be ascertained by pressing upon it
with a probe. The sharpness of the margins of the depressions, and
the absence of that toughness which characterises the natural Cornea,
sensibly indicate its thinness, which is fully confirmed by the following
accounts of necropsies. Mr. Middlemore states, “I have had one oppor-
tunity of examining, after death, the state of the cornea, which was
affected with Conical Cornea in an extreme degree; and in that instance,
its laminae were less moveable, its circumference was of a natural and
ordinary degree of thickness, but its apex was much thinner than usual,
and rendered opaque on its exterior only, for its neural surface, even at
the apex, was perfectly transparent; in other respects, it did not appear
to have undergone any change, unless I mention that alteration in the
evenness and equality of its surface, discovered by Dr. Brewster, but
which was not visible to the naked eye.” The late Mr. Walker, of
Manchester, informed me that he had examined a similar eye. “There
was", said he, “great attenuation of the cornea throughout its entire
substance, especially at its central portion.” From Dr. Butter I learn,
that in cases which he has examined, the cornea became thicker towards
the base, and thinner in the centre. Dr. J. C. Hall writes,—“Some years
ago I examined a case after death. I cannot, at this moment, find a
note of the case; but I am certain that the circumference of the cornea was
of the usual thickness, and that the apex was very much thinner than
natural. The changes also appeared confined to the exterior; the
neural surface was bright even at the circumference”. Professor Jaeger,
of Erlangen, has published the result of the dissection of a case, as
follows: “When the cornea was taken between the fingers, there was
distinctly perceived a depression in the centre, surrounded by a thick,
prominent ring. On making a section of the cornea through its centre,
the middle third was found three times thinner than natural, like thin
writing paper; the two outer thirds were manifestly thickened, a con-
dition which was especially conspicuous in the central lamellae, but not
in the most external or internal. The middle substance was homoge-
neous; the thickening of the external part was gradually lost in that
which had become thin, so that the diameter of the latter was about
equal to that of the expanded pupil.” -
It would appear, therefore, that the principal changes which take
place, are in the anterior elastic lamina, and cornea proper; the former
losing its toughness and power of resistance, the latter being diminished
in thickness and cohesion towards the centre, and, in some cases, thick-
1 A Treatise on the Diseases of the Eye, vol. i., p. 532.
DR. J. BIRD on THE TYPEs of DELIRIUM TREMENs. 419
ened towards the circumference. In future cases, it will be interesting
to ascertain whether the anterior elastic lamina and its filaments of
connexion, can still be traced, and what is the precise condition of the
cornea proper during the various stages of the disease. -
The treatment of Conical Cornea will form the subject of another
communication.
(To be continued.)
19, Berkeley Square, March 1850.
THE TYPES OF DELIRIUM TREMENS, THEIR
PATHOLOGY AND THEATMENT.
By JAMES BIRD, A.M., M.D.
IN the following paper, I propose to consider the types of DELIRIUM
TREMENS, or rather the pure form of this disease in relation to sequent
and kindred affections of the brain, caused by the intemperate use of
alcoholic drinks, aided by other predisposing causes. The types of the
disease are at present variously arranged, in nosological systems, as
Delirium Tremens nervosum et traumaticum, phrenesia potatorum, ence-
phalitis tremefaciens, delirium afebrile tremens, and irritative fever of
drunkenness. I am not aware that there exists any description of Deli-
rium Tremens, embracing its modifications and complications, which can
be considered practically applicable as a guide to the treatment of the
disease in all its varieties. I shall, therefore, describe the disease in its
simple form and in its complications, characterizing each by a distinct de-
finition; so that the relations and differences of the modifications may be
at once seen, and made the foundation of a like modified treatment. The
facts and illustrations of this paper are taken from numerous cases,
received into the European General Hospital at Bombay, from the
beginning of 1836 to the end of 1840, and which were treated either by
the hospital assistants or myself.
The most usual divisions of this disease have been into two species;
the one succeeding the excitement of hard drinking, without any interme-
diate abstinence from the accustomed stimulus; the other, attacking
habitual drunkards soon after the accustomed stimulus had been with-
drawn. The former may be considered as a state of hyperasthesia, and
increased vascular action in the nervous centres, or in the remote organs
* Many of the erroneous principles acted on, at various times, in practical medi-
cine, have been drawn from narrow-minded views of the specialities of diseases,
considered as entities, and without reference to the analogies of their phenomena.
Nosology, to be of real practical utility in medicine, must have its foundation in the
relations which exist between modified states of disease, each leading to important
points of practice. The influence which one class of morbid functional derangements
has in modifying the conditions of subordinate functions in other classes, should
be made an important consideration in our study of diseases affecting different tissues,
but associated in their phenomena and progress, as originating in derangements
common to all their modifications. -
420 THE TYPES OF DELIRIUM TREMENS.
acting on them; the other, a state of hypasthesia, or exhausted nervous
sensibility and diminished vascular action of the capillaries, more nearly
akin to congestion than inflammation. Dr. Stokes, of Dublin, thinks
that the pathological condition of the former consists of gastritis, accompa-
nied by excitement of the brain and nervous system; and recommends that
its treatment should be that of gastritis: but that in the other case, the
functions of the brain are disturbed, by the abstraction of an accustomed
stimulus, and that the appropriate treatment must be to restore that
stimulus, and administer porter, wine, brandy, and opium. The division
of the disease into stages, as adopted in Dr. Blake's well known and
excellent monograph, is chiefly applicable to the pyrexial variety, wherein
constitutional predisposition has been established by typhoid influences,
or whatever impairs the vitality of the system, such as inanition, im-
moderate mental exertion, intemperate habits, impoverished food, and
malarious emanations; but these stages are altogether absent, or, in
general, imperfectly developed in the other forms. The sedative
influence of malaria and of alcoholic stimulants on the nervous system,
has a natural tendency to produce a stage of depression or temporary
collapse, followed by one of erethism, and terminated by one of nervous
and capillary relaxation, such as characterize the pyreasia, ; and though,
like fever, Delirium Tremens is frequently a compound affection of the
nervous, circulating, and secretory systems, it is frequently met with
without being associated with any derangement of the latter, and without
the characteristic stages of febrile disease. The only divisions of it,
therefore, should be such as are founded on leading differences of cha-
racteristic phenomena, and which may guide us to some practical
modifications of treatment. These differences seem to point out the
modifications of Delirium Tremens under four forms—the simple,
inflammatory, pyreasial, and epileptic; which, with the predisposing
and exciting causes of the disease, the character of the nervous erethism
and mental alienation accompanying the several forms, their pathology
and treatment, I now propose to consider.
There is no one symptom which may be considered as an essential
character of the disease; its leading features are insomnia, excited
agitated manner, constant loquacity and reverie, with tremor of the
hands, and sometimes a fidgetty employment of them. The patient,
who has lost the power of attention and association of ideas, when
awakened to a sense of consciousness by a question addressed to him,
answers generally to the purpose, and does whatever is required of him ;
but, being unable for any length of time to fix his attention, or control
his volition, he immediately after wanders from the scene around him,
and relapses into incoherency.
It is difficult to give any true or concise description of Delirium Tre-
mens. Tt may, however, be thus defined.
DEF. A disease which manifests itself, after hard drinking, or the long-
continued and free use of narcotico-stimulant substances; and is charac-
terized by insomnia, ea'alted sensorial function, rapidity of thought,
mental hallucination or illusions of sense, tremor of the tongue or limbs;
delirium occasionally associated with inflammation or fever, a cold clammy
perspirable state of the cutaneous surface, seldom recovered from without
a critical sleep, and prone, in its worst forms, to terminate in coma.
BY JAMES BIRD, A.M., M.D. 421.
MODIFIED FORMS.
I. Simple. This must be considered as the purely nervous variety, de-
pending on mere erethism of the system, either of centric or peripheral
origin, which runs a certain course, and has a tendency to subside of
itself in a given time.
DEF. It is marked by insomnia; busy mental earcitement and loqua-
city ; psychical hallucination or incoherent muttering; illusions of sense;
timid suspicion of imagined conspirators; tremor of the tongue or hands;
hepatic erethism or irritability of stomach ; impaired urinary function;
occasional headache and precordial anariety; tongue sometimes clean, at
others loaded ; pulse frequent, irritable, sometimes natural ; a perspirable
state of the skin, and pain of the limbs: the disease varying by the occa-
sional absence of mental incoherence or tremor.
The first tabular statement of forms will best illustrate this variety
of the complaint; which, as has been shown by Dr. Ware of Boston,
has a natural tendency to terminate in a spontaneous and salutary sleep,
at a period seldom less than sixty or more than seventy-two hours from
the commencement of the paroxysm, which may extend, however, to six
entire days. The generality of cases composing the first table, seldom
ran a course beyond the beginning of the fourth day; though, in some
of them, the nervous erethism and increased vascular action of the cere-
brum extended beyond this period. In one, the symptoms did not sub-
side until the ninth day; but in this instance, perhaps, the exalted
nervous sensibility was accompanied by functional exhaustion of the
nerves of the cerebral blood-vessels, followed by relaxation of the capil-
laries akin to inflammation. This is a point of practical importance,
in observing the phenomena of the various forms of Delirium Tremens,
which may vary from slight tremor with spectral illusions, depraved
sense of hearing, or deranged common sensation, to aggravated forms
of inflammation, muscular agitation, fever, and vital depression: all of
which must be viewed by the discriminating practical physician, as trans-
itions only from lesser to greater degrees of disease. In most cases of
indisposition among drunkards, an attack of Delirium Tremens may be
looked for as a probable event; and cerebral erethism, which constitutes
the lesser degree of this complaint, may supervene on peripheral irri-
tation of the skin, stomach, intestines, or thoracic contents. Dr. Stokes,
in illustrating sympathetic affections of this kind, cites a case from
Andral, where the symptoms of gastritis were suspended on the super-
vention of tetanus, which proved fatal; and on dissection, the brain and
spinal cord presented no morbid appearances, though the mucous surface .
of the stomach was intensely inflamed. In another case, which occurred
at the Meath Hospital, the patient laboured under symptoms of cerebral
inflammation, though there was no epigastric tenderness, vomiting, or
symptom of gastritis; yet, on dissection, extensive inflammation of the
digestive tube was discovered, but none of the brain or its membranes.
Where symptoms of erethism do not subside so quickly as usual in the
simple forms, we must not too hastily ascribe them to the existence of
inflammation. I have seen attacks of Delirium Tremens brought on in
drunkards by the application of blisters. It is well known that wounds
and other injuries bring on the traumatic form of the complaint, to which
Dupuytren first called attention; but this celebrated surgeon too hastily

422 THE TYPES OF DELIRIUM TREMENS.
inferred it to be in all cases a species of emcephalitis. The disease fre-
quently occurs in those subject to hepatie erethism, or copious biliary
secretion, accompanied by irritability of stomach, and frequent vomiting;
but, in such patients, its phenomena quickly disappear under the depur-
ating effect which such increased secretion produces in the constitution.
Similar critical evacuations, from the kidneys, skin, and intestines,
during the convalescence and recovery from mania, were observed by
Pinel, who says, that such patients were less liable than others to re-
lapse. The tabular statement appended, shows that the disturbed
state of sensation and intellectual action was sometimes considerable,
in cases where there were no tremors; and again, tremors existed in
some, where there was no sensory disturbance.
II. INFLAMMATORY. This is the next form of the disease with which
we meet in the tropics. It is one marked by a greater degree of vas-
cular determination to the brain and its connexions, or to some of the
remote organs, either the stomach or lungs, which may act sympatheti-
cally on the nervous centres.
DEF. Characterised by great restlessness and impatience of manner;
maniacal violence, and busy psychical hallucination or muttering
delirium ; flushing of the countenance, heat of head, and contracted
pupils; convulsive twitching of the muscles, heat or pain at the epi-
gastrium; a frequent full, or hard pulse ; generally, a dry, hot skin,
but sometimes, a cool, perspirable, cutaneous surface; a dry, red,
parched tongue; and much thirst.
The transition from simple erethism, or disturbed sensation, accom-
panied by a slight degree of derangement in the capillary circulation of
the brain, or peripheral organs, to a higher degree of nervous irritation
and increased vascular action, constituting an inflammatory state of
either the nervous centres or their peripheries, must be viewed as an
important ground of distinction in the various phases of the same dis-
ease. That this distinction is one well marked, the various cases of
Delirium Tremens, which compose the second tabular statement, will
show; and it should not be lost sight of, either in the pathology or
treatment of the complaint. It is important in all inflammatory affec-
tions of the brain, and of its subordinate nervous centres, to determine
whether nervous or vascular derangement has the precedence; for on
the predominance of one or the other, the treatment must be regulated.
The primary assimilation of individuals attacked by Delirium Tremens,
will be generally found defective previous to the occurrence of the
attack; and as the processes of nutrition, both in the nervous and vascu-
lar systems, has been imperfectly performed, it is necessary to keep in
mind, that imanition, and other predisposing causes of the disease, are
debilitating ones, which give to the inflammation set up, a character of
exhausted constitutional power, strongly disposed to pass into suspended
functional action of the nervous centres, by terminating in coma,
apoplexy, and cerebral effusion. If the attack has been preceded by
long-continued habits of intoxication or great mental excitement, this
state of innervation and exhausted power will be more apparent in par-
ticular symptoms, as the low, muttering character of the delirium; the
anxiety of the respiration; the frequency, feebleness, and irritability of
the pulse; the pallor of the countenance; the cold and clammy moisture

BY JAMES BIRD, A.M., M.D. 423
of the cutaneous surface, and the dryness of the tongue. Every in-
creased action and excitement of the nervous centres involves, as would
appear, a disintegration of their substance, and corresponding demand
of reparation, without which, immediate suspension of their functional
operations must follow. Attention to this law of the constitution will
be found of great importance as ground for modified treatment of this
disease.
III. Pyreaial. The third form of the complaint, which occurs more
generally in the malarious seasons of the year, from July to October, is
frequently met with, during the other months, in constitutions rendered
irritable by long residence in warm climates, or in persons previously
subject to intermittent and remittent fevers.
DEF. It is accompanied by wakefulness, anariety, and restlessness;
following a stage of depression, chilliness, or shivering ; succeeded by
febrile heat of skin, or cold clammy perspiration ; tremor, muttering
delirium, and illusions of sense; frequent sighing ; rapid, irritable pulse ;
furred tongue; scanty wrimary secretion ; complicated with inflamma-
tion and pyreasial paroaysms, and prone to terminate in collapse or
epilepsy. - - *
Most of such cases might be viewed as forms of irregular remittent
fever, which, accompanied by irritability of the sensorium and nerves, are
apt to terminate in suspension of the nervous functions. Among recently
arrived Europeans, during the hotweather in India, this form is met with
as the product of elevated temperature and excessive spirit-drinking,
and assumes many of the characters of an inflammatory remittent,
in which accelerated vascular action has predominence over nervous
erethism. In the asthenic modification of it, however, the vertigo,
dilated pupil, oppressed and weak pulse, and other symptoms of de-
pressed nervous energy, (which characterize cases of Delirium Tremens),
with a well marked tendency to syncope and feeble action of the heart,
point it out as a disease of innervation. Modifications of this variety,
in debilitated constitutions, rendered irritable by long residence within
the tropics, are also frequently met with during the cold months. In
a practical point of view, it is useful to arrange such cases as modifica-
tions of Delirium Tremens; for though, with equal propriety, they
might be classified as varieties of remittent fever, they should be sepa-
rated in the mind of the physician, from more pure remittent fevers,
caused chiefly by malarious influence. . -
Iv. Epileptic. This is the fourth and last form of the disease.
DEF. Insomnia ; psychical hallucination, or illusions of sense; ea:-
treme tremor; and sometimes convulsive twitching of the muscles, passing
into sudden loss of consciousness and sensation, accompanied by clonic
spasms of the muscles, recurring in paroarysms, which terminate in
recovery of consciousness and sensation, or in apoplectic annihilation of
the cerebral functions. - - -
In the fourth tabular statement, seven of these cases are given, five of
which proved fatal. The symptoms were analogous generally to the
delirium, coma, and epileptic convulsions, induced by certain narcotic
poisons, as belladonna and stramonium. Regarding the poisonous effects
and symptoms of these last, I shall have, presently, occasion to speak.
WOL. II. - 28
424 THE TYPES OF DELIRIUM TREMENS.
The retention of these poisons in the system gives rise to a disturbed
state of intellectual action and sensation, similar to what takes place in
common epileptic attacks; and epileptiform symptoms of Delirium
Tremens, are, as would appear, the combined result of the poisonous
action of the alcoholic stimulant on the system, and the retention of
important excretions, particularly the biliary and renal, which, when not
eliminated by their own proper organs, cause the body to become a
source of poison to itself.
PREDISPOSING AND EXCITING CAUSES.
Attacks of Delirium Tremens seem to depend, in many cases, on
peculiarity of temperament, and individual constitutional excitability,
either of hereditary or acquired origin. They happen most frequently
among men of irritable dispositions, who are subject to precordial
anxiety; or may be brought on by habitual indulgence in strong alco-
holic drinks, and certain other marcotics, or stimulants. Whatever
debilitating causes exhaust the energy of the nervous and circulating
systems, and reduce the normal condition of the nutritive functions of the
body, such as insufficient alimentation, inordinate mental exertion, and
the immoderate use of various narcotic irritants, aided by the elevated
temperature of tropical climates, are well marked predisposing causes
of the disease. They render more effectual the influence which alco-
holic drinks have in disturbing the intellectual, sensory, and motor
functions of the brain and medulla oblongata. In such cases, immode-
rate spirit-drinking becomes an exciting cause of the disease; but in
other cases, immoderate and continued habits of debauch become the
predisposing causes of the phenomena which accompany the attack, but
which are not developed in the system until some additional cause of
exhaustion produces them. In this manner, losses of blood will often
produce, in men of intemperate habits, all the phenomena of Delirium
Tremens; and these are seen to follow, in many cases, haematemesis, or
the bleeding from a wound." Other predisposing causes, such as imper-
fect ventilation, malarious emanations, and the exhausting effects of
fear and disease, seem to operate as predisposing causes; which, by
enfeebling the vigour of the circulation, and impairing the energy of
the nervous system, give efficacy to intemperance as an exciting cause
of the disease. Sometimes, elevated temperature, or habitual expo-
sure to the sun, act in this manner as predisposing causes, and give
efficacy to immoderate drinking as the exciting one ; but all these
causes may be seen to occasionally change places with each other, while
all of them agree in exerting the same morbific influence, by pro-
ducing defective innervation, and consequently, unequal distribution of
blood in the central or peripheral sensory organs.
Regarding the influence which elevated temperature has in producing
the disease, Dr. Morehead, in some sensible observations appended to
his Pathological Anatomy of the Diseases of Bombay, observes, that of
* Discontinuance of the immoderate and habitual use of ardent spirits, by pro-
ducing a like state of exhaustion, becomes an immediate cause of the disease; the
stimulus of alcohol being here the predisposing, and the cessation of its action the
immediate cause of an attack.
BY JAMES BIRD, A.M., M.D. * 425
twenty-nine cases where increased serous effusion and abnormal cere-
bral vascularity existed, within the cavity of the cranium, only three of
these happened in the cooler months of the year, from November to
March; and that the remaining twenty-six cases were distributed over
the hot months, from the beginning of April to the end of October.
In the tabular statement, given by him, of the percentage of admissions
for Delirium Tremens, on the total of diseases in hospital for five years,
the comparative frequency of the former, in the different months, is thus
shown.
Jan. Feb. Mar. Apr. May. June. July. Aug. Sept. Oct. Nov. Dec.
3-2 5-3 2-1 4-4 4-7 3-1 2-3 1-9 3-3 1:2 2-3 3-5
Now the greater fatality of the disease, from April to October,
may, in part, arise from the decrease of electricity in the air, during
these months; Professor Faraday having lately expounded the decrease,
obtained in degrees of M. Pelletier's electrometer. From these nu-
merical results, Dr. Faraday finds that, in European climates at least, the
quantity of electricity is at its maximum in the winter months, until it
finds its minimum in June, and then again rises to its maximum in the
succeeding January. The greater prevalence of Delirium Tremens in the
cold months, as indicated by Dr. Morehead's table, would seem, however,
to militate against the truth of any such inference; but the preponder-
ance of the disease in hospital, at this time, may probably be explained by
the fact, that the greater number of cases of Delirium Tremens admit-
ted, are from among the seamen in the harbour, and that, in these parti-
cular months, there are more than the usual proportion of ships at Bombay.
Dr. Blake, in his essay on the disease, decides somewhat hastily, that
neither season nor climate has any material influence on its prevalence,
while he quotes Rayer's opinion, that twice as many attacks of the com-
plaint occurred in the month of May, as in any other month. Dr. Bang,
on the other hand, found, that June and July were as fertile in its pro-
duction as the month of May. Additional facts are yet wanting-for
the satisfactory solution of this interesting question, as to the influence
which negatively electric states of the air have in rendering attacks of
the disease more frequent or fatal in particular months; and an exten-
sion of Pelletier's investigation of this matter might be advantage-
ously carried out in India.
Predisposing causes of the worst types of the complaint, the pyrexial
and epileptic, will be found in some forms of organic disease of the brain
or its membranes, of the heart or lungs, of the liver, and more particu-
larly of the kidneys. Examples of these several causes are given in the
two last tabular statements; which show, that organic renal disease is
a much more frequent source of the worst symptoms of Delirium Tre-
mens than is generally suspected; and lead to the inference, that when
the elements of the bile and urine are not separated by their excreting
organs in normal quantity, or when the brain, by the continued narcotism
of alcoholic drinks, softens or is atrophied, the imperfect action of the
liver and kidneys, being unable to free the blood from the excrementi-
tious poisons accumulated in it, and not compensated by a suitable
increase of the other excretory functions of the skin and lungs, tends
to coma, asphyxia, and death.
28 2
426 . THE TYPES OF DELIRIUM TREMENS,
DIFFERENTIAL DIAGNOSIS OF THE SYMPTOMS of DELIRIUM TREMENs,
AND THOSE OF POISONING BY STRAMONIUM, AND OTHER NARCOTICS.
Supervening as Delirium Tremens frequently does on the puerperal
state, or on febrile attacks in the intemperate, and productive as are
other stimuli and marcotics of complaints attended by nervous depres-
sion, restlessness, obscurity and perversion of the senses, delirium, and
deranged states of the circulation, it is important to mark attentively
their peculiar symptoms; so that the physician may be enabled to dis-
tinguish between them and those of the complaint now under con-
sideration. The limits of this paper, will not permit me to do more
than briefly notice the character of the mental alienation, as compared
with other kinds of mania. I must, therefore, chiefly confine this Dif.
ferential Diagnosis to the symptoms of Delirium Tremens, which are
liable to be confounded with those disorders caused by stramonium, and
other narcotics. &
Before proceeding to the latter, I may here notice the characteristic
mental alienation of Delirium Tremens, confounded with other maniacal
states, and not always altogether inseparable from them, particularly
in the monomaniacal cases of irresistible propensity to habits of in-
toxication; which, under the influence of extreme tropical heat, and
maniacal idiosyncrasy, are occasionally met with. In cases of this na-
ture the patient is violent, maniacal, and unmanageable; ready to
injure himself, and dangerous to others when unrestrained. Some of
the inflammatory forms of the disease are of this kind; but in such pre-
disposed maniacal constitutions, we must not hastily conclude that the
delirium is attendant on encephalitis, as it may proceed from temporary
erethism of the brain, caused by alcoholic stimulants. In the table of
the simple form, the case of J. A., admitted 19th June, 1838, is a good
illustration in point. The patient, though very violent and maniacal during
the paroxysms, inflicting on himself several wounds, became quiet and
rational on the second day, without the use of any decisive antiphlogis-
tic measures. The symptoms which serve best to distinguish the sim-
ple erethismal type from the cerebral inflammatory one, may be found
in the state of the skin; which is soft and covered with perspiration in
Delirium Tremens, generally hot and dry in encephalitis; in the pulse,
which is soft and compressible in the former, sharp, strong, and resist-
ing in the latter; in the pallor of the countenance and frequent absence
of headache in one, contrasted with the flushed face, contracted pupil,
intolerance of light, and throbbing of the temples common to the other ;
in the tongue, which is moist, loaded, and not greatly altered from a na-
tural state, in exalted sensibility of the brain, but is dry and furred in
inflammation of this organ ; in the tremors, which, though so common
to one, as to give it a distinguishing name, are replaced in the other by
convulsive twitching of the muscles; and above all in the character of the
delirium, which consists in obscure perceptions and weakened volition,
illusions, erroneous convictions, and a busy bustling train of false ideas,
opposed to unmanageable maniacal violence, which cannot be recalled from
its reverie to a temporary sense of consciousness, accompanied by per-
sistent incoherent loquacity. The simple form of the complaint again
presents many of the characters of acute dementia, from which it dif-
fers but little, I believe, in pathological condition. Each renewed
BY JAMES BIRD, A.M., M.D. 427

attack of the former malady seems to bring the symptoms nearer and
nearer to those of the latter. In both diseases there is the same lost
power of perception and attention, the brain being no longer susceptible
of receiving and obtaining impressions transmitted to it, and consequently
incapable of associating the relations or preserving the recollection of
objects presented to it. The history of the manifestation of the symp-
toms, and an inquiry into the predisposing and exciting causes, will
always enable us to form a probably correct diagnosis of the two diseases
in cases of difficulty and doubt. . -
But it is now time to turn attention to the chief object of this section,--
the difference between the symptoms of alcoholic poisoning and of that
from othernarcotic substances. The phenomena attending the cumulative
morbid influence of alcoholic drinks, are in many instances similar to
those of other marcotic poisons, which act more immediately and directly
on the grey or vesicular and white or tubular matter of the brain. Alcoholic
fluids absorbed into the blood may therefore be considered indirect poi-
sons; the primary effect of which, in large doses, seems to be irritant and
stimulant, followed by a secondary sedative action on the brain, which
constitutes them narcotic poisons. The symptoms of their poisonous
effect most closely resemble those which proceed from poisoning by
various species of datura, indigenous to India: of which Dr. Herbert
Giraud, professor of chemistry in the Grant Medical College at Bombay,
has given the best and most intelligent description. -
Dr. Giraud informs us that in 1848, fifty-one cases in which stramo-
nium poisoning had been inferred on presumptive evidence of its cha-
racteristic symptoms, were treated in the Jamsetjee Jeejeebhoy Hospi-
tal at Bombay. The seeds of the species of datura supposed to have
been used, were those of the “ datura alba” and “datura fastuosa", both
indigenous to India. The general character of the symptoms closely
resembled those induced by datura stramonium, exhibiting, in several
instances, the three distinct stages, 1. of primary delirium, 2. of Sopor
or coma, and 3. of secondary delirium, which have been observed to
mark the action of henbane, belladonna, and other solanaceous plants.
The patients were seldom brought to hospital before the second stage
had commenced, and very frequently not until the third stage—that of
secondary delirium—had supervened. In the majority of cases, either
from the small quantity of the poison, from the large amount of food
ingested with it, or from peculiarity of constitution, only a single stage
of delirium was observed.
The following is Dr. Giraud's description of the general course of the
cases in which the full effects of the poison were manifested:—“The
patient, in the primary stage of delirium, is found in a state of extreme
restlessness, usually attempting to wander about as if in search of some-
thing, but frequently, from giddiness and extreme muscular weakness,
he is unable to walk or even to stand; he either vociferates loudly, or
is garrulous and talks incoherently; sometimes he is mirthful, and
laughs wildly, or is sad and moans, as if in great distress; most gene-
rally he is observed to be very timid, and, when most troublesome and
unruly, can always be cowed by an angry word, frequently putting up
his hands in a supplicating posture. When approached, he suddenly
shrinks back, as if apprehensive of being struck, and frequently he
428 THE TYPES OF DELIRIUM TREMENS,

moves about as if to avoid spectra. But the most invariable accompani-
ment of this, and of the final stage of delirium, and frequently also of
that of sopor, is the incessant picking at real and imaginary objects. At
one time the patient seizes hold of parts of his clothes or bedding, pulls
at his fingers and toes, takes up dirt or stones from the ground, or as
often catches at imaginary objects in the air, on his body, or on any-
thing near him; very frequently he appears as if amusing himself by
drawing out imaginary threads from the ends of his fingers; and occa-
sionally his antics are so varied and ridiculous, that I have seen his
near relatives, although apprehensive of danger, unable to restrain their
laughter. Many of these singular movements appear to originate in a
curiously-impaired or disordered state of vision, in which distant objects
seem to the patient as if very close to him, and those that are near as if
highly magnified; for frequently, after gazing for some time at a distant
object, he will attempt to grasp it, as if it were close at hand; and he
starts back when approached, as if he thought the person approaching
would, the next moment, touch him. This state of vision may, in part,
depend upon the widely-dilated pupil, which, as in poisoning by other
Solanaceous plants, is an invariable symptom in all cases, and is persist-
ent through each stage, and even continues for some time after com-
plete recovery. With the foregoing symptoms, great diversity in the state
of the circulation is met with in different individuals, and even in the
same individual at different periods. In the greater number of cases, the
temperature of the surface, and the strength of the pulse are natural:
although the rate of the latter is usually somewhat accelerated, (90 or
100). In other instances, the pulse is much quicker than natural (112
or 120), full, firm, and even sharp; the temples throb, the respiration
is hurried, and the surface of the body is hot: whilst, as a third and
less frequent condition, the pulse is quick, small, and feeble ; the respi-
ration slow, and the surface cold.
“The second stage, that of Sopor, is the state in which a great num-
ber of cases are first brought under notice. They are then found either
in a state of profound Sopor, or in one of excessive drowsiness, from
which they may be partially and momentarily aroused to some degree
of consciousness; there is low muttering delirium, tremors, subsultus
tendinum, and, most usually, the characteristic catching at objects,
although the patient's eyes may be closed at the time.”
The diagnosis of the simple erethismal type of Delirium Tremens,
from like cases of narcotic poisoning, will be found in the history and
development of the two diseases from their respective exciting causes;
in the persistent insomnia of the one, contrasted with the somnolency,
or rather somnambulism of the other; in the manner of the patient,
which is busy and active in the former, sluggish and inactive in the
latter; in the greater power of controlling the thoughts for a moment,
which those labouring under drunken cerebral erethism possess over
those affected by the narcotism of stramonium; and in the more busy
character of the delirium of the first, compared with the drowsy, low mut.
tering, and catching at objects of the last. In the form of Delirium Tre-
mens, caused directly by the abuse of intoxicatinghiquors, the more sthenic
character of the nervous sensibility, and of the vascular excitement, is
at once so strongly marked, as to prevent any possibility of mistaking
the two affections. 4.
BY JAMES BIRD, A.M., M.D. 429
POST-MORTEM APPEARANCES AND PATHology.
The Morbid Appearances of the brain and peripheral organs of the
chest and abdomen, as they occurred in the fatal cases of the tabular
statements here given, will be found briefly narrated in the column of
results. Dr. Morehead, also, in his Pathological Anatomy of the
Diseases of Bombay, published in the Transactions of the Medical and
Physical Society of that Presidency, has recorded the necroscopic ap-
pearances of the body in several cases. The chief cerebral lesion, in
those not addicted to long-continued intoxication, consisted of moderate
turgescence of the membranes, opalescent thickening of the arachnoid, an
abnormal vascularity of the substance of the brain, and copious serous
effusion into the sub-arachnoid areolar tissue, with occasional bullae of
air in this tissue, or in the vessels of the cerebral membranes. Dr.
Todd, in his valuable Treatise on the Anatomy of the Brain and Spinal
Cord, observes, that Cotunnius and Magendie deduce, from their ex-
periments on this cerebro-Spinal fluid, that two ounces of it may be
regarded, in a state of health, as a minimum quantity; and that twelve
ounces of it may sometimes be obtained from the cranio-spinal cavity,
according as there is a greater degree of atrophy of the brain. In the
necroscopic examination of fatal Delirium Tremens cases, as they oc-
curred in India, I am not aware that any accurate estimate of the total
quantity of this effused fluid has ever been made. The quantity generally
effused in the cranial cavity, was, however, abnormally great, amounting
often to four ounces. The effusion occupied the sub-arachnoid tissue
in the depressions of the cerebral convolutions, so as to give them a
smooth, uniform appearance. The cerebral convolutions, too, were ab-
normally shrunk and flattened, not by distension from within, but as if
they were abnormally shrivelled from atrophy of the cerebral matter;
a result, probably, of the increased vascular action which had been
repeatedly set up in the brain by excess of spirit-drinking. Mr. Stovell,
the present surgeon of the European General Hospital, at Bombay,
records the case of John Powell, an apothecary, thirty-nine years of age,
of very dissipated habits, who died of Delirium Tremens; and in whom, on
necroscopic examination, the brain was found unusually small, weighing
2lbs. 10oz.” Future observations on this point, made in India, should
be specially directed to ascertaining the usual average weight of the
brains of those who die of this disease; some of the worst symptoms
of which are certainly associated with atrophy of the cerebral matter.
The serum has been found occasionally sanguineous; and generally, the
arachnoid, which was thickened, was of an opaque, milky appearance.
In the inflammatory, pyrexial, and epileptic forms, the appearances were
frequently of a better marked inflammatory character; viz., vascularity
and thickening of the dura mater and pia mater, bloody effusion on the
former, adhesion of the arachnoid to the pia mater by a thick layer of
lymph, and abundant serous effusion within the cerebral membranes, or
into the substance of the brain. The appearances in the mucous mem-
* Transactions of the Medical and Physical Society of Bombay, No. ix, p. 120.
* The average weight of the encephalon, estimated from Professor J. Reid's careful
observations, made at the Royal Infirmary, Edinburgh, is 31b. 20Z. 34.dr. in the
male; and 21b. 12oz, 8%dr. in the female.
43) THE TYPES OF DELIRIUM TREMENS.
brane of the stomach and small intestines, were generally of a chronic
inflammatory character. The liver was sometimes enormously enlarged,
and compressed the right lung. The kidneys were often converted into a
uniform fleshy mass, or in a state of fatty degeneration of the cortical
substance, encroaching much on the tubular portion. The lungs, in a few
cases, were emphysematous, and gorged with blood, as in asphyxia. The
bubbles of air in the vessels of the pia mater, or in the sub-arachnoid
tissue, as observed by Dr. Morehead, were found in two of the cases,
five hours after death, and appeared to be evolved from the animal
fluids during life. Future observation should be directed to ascertain
the chemical nature of the gas evolved, as it may result from the usual
metamorphosis of the inspired oxygen and expired gases, in the peripheral
system of the kidneys and liver, being arrested by this disease.
Pathology. An immoderate use of alcoholic drinks causes primarily
excitement of both the nervous and circulating systems, followed, gene-
rally, by secondary depression of the functions of the brain; but when
this nervous depression does not supervene, and the increased action of
the circulating vessels continues, this may gradually subside without
consecutive depression, as in some of the simple forms of Delirium
Tremens; or it may terminate in cerebral inflammation and fever, such
as characterize the inflammatory and pyrexial varieties of the disease.
The derangement of the capillary circulation of the brain or its depend-
ent nervous centres, and of the peripheral organs, is accompanied by
exaltation of the sensorial function; so that these nervous centres and
peripheries react on each other in producing various degrees of erethism
and increased vascular action, observable in various states of the disease.
Whether the nervous erethism be of centric or peripheral origin, it is
accompanied by a mild or violent delirium, according as the deranged
vascular action is of an asthenic or sthemic kind; and may be accompa-
nied by excitement of the senso-motory function and muscular irrita-
bility; terminating in nervous exhaustion and depressed action of the
heart, with coma and apoplectic death, or suspended function of the pul-
monary capillaries, or asphyxia. The sthenic or asthenic symptoms,
which become the objects of treatment, predominate according as the
general nutrition of the system has been well or ill performed; or as
the nervous centres are in a state of healthy energy or defective innerv-
ation, and according to their degrees of normal capacity and nutrition.
In the young and robust, whose blood is rich in fibrin, and whose nerves
are well nourished and exalted in tone, increased vascular action gene-
rally takes precedence of the nervous erethism; but in the old, and in
those worn down by the effects of climate and their own intemperate
habits, exhausted nervous power, and asthenic vascular action, will be
leading features in the complaint.
The indirect narcotic action of alcoholic drinks is exerted on the cen-
tral organs of the nervous system, the brain and spinal marrow, and is
analogous in effect to that of more direct narcotics. This is shown by
the loss of sensibility and volition, the convulsions, coma, and death,
which follow previous excitement. The suspension of the respiratory
movements, or the asphyxia, seems to be sometimes primary, sometimes
secondary; but both the coma and asphyxia, in the worst cases of Deli-
rium Tremens, are generally contingent on anterior conditions of the
BY JAMES BIRD, A.M., M.D. 431
system, and the suspension of its usual eliminating processes. The
exhausted nervous power, and asthenic vascular action, which character-
ize particular attacks of the complaint, are found essentially connected
with such conditions, which must not be neglected in the treatment;
and are of more importance as the foundation of therapeutic indications,
than the one too exclusively and absolutely acted on in many cases, that
of interfering with the regular course of the erethismal paroxysm, by
administering large doses of opium, chloroform, and other sedatives,
instead of depurating the poisoned blood, and removing diseased secre-
tions by means of purgatives and diuretics. Under the head of epileptic
forms of the disease, seven such cases are recorded; of which, five
proved fatal. A necroscopic examination of four of these revealed, that
one of them was fatal by coma, two by asphyaſia, and one by syncope.
The comatose case was associated with cerebral disease and organic
heart-affection of long standing; the latter organ being affected with
fatty degeneration of the right side, and softening of the left. The
two asphyxiated cases were connected with organic disease of the kidney
or liver; and the case of death by syncope presented enlargement and
softening of the heart, with Ossification of the semilunar valves of the
aorta.
TREATMENT.
Ihave thus endeavoured to bring into review all the varied aspects which
Delirium Tremens presents under different anterior conditions of the
system, arising out of diseased changes of the organism, or from the nature
of the predisposing causes to which this may have been exposed. It will
be obvious, from the exposition given, that the indications of judicious
treatment must be founded on a correct diagnosis of particular cases,
and on a sound knowledge of the existing pathological conditions asso-
ciated with the morbid phenomena. Such can be alone obtained from
a strict pathological analysis of the symptoms, combined with a know-
ledge of the previous habits of the patient. It should not be too hastily
inferred, that the sole and leading indication of the treatment must be to
induce sleep by heroic doses of opium; for this, when given too largely in
order to cut short the exalted sensibility of the brain, without reference to
the conditions of other remote organs, particularly the liver and kidneys,
is fraught with much danger to the patient, by causing convulsions,
coma, and death. Dr. Ware's two admirable memoirs on the Natural
History and Treatment of Delirium Tremens, are most important contri-
butions to a philosophical knowledge of the disease; and the conclusions
arrived at, are essential elements in our comprehension of its true pa-
thology and treatment. These conclusions are fully supported by the
progress and termination of the forty-one cases reported in the first
tabular statement. The paroxysm of the disease commences with cer-
tain obscure signs of depression, followed by excitement and delirium,
which run a certain course, and terminate in sleep. This may be consi-
dered as much sequent of the stage of excitement, as is the secondary
delirium to the stage of coma in cases of poisoning by stramonium. As
a favourable termination of the symptoms generally follows a sound
sleep, it has been concluded, somewhat erroneously, that sleep, induced
by whatever means, is the cause of the salutary change which takes
place, and by which the patient is relieved from excitement and restored
432 THE TYPES OF DELIRIUM TREMENS.
to reason. A profuse warm sweat may be observed to accompany this
critical sleep; but when no such crisis is observable, and sleep has been
procured at all hazards by means of large doses of opium, the patient
passes into a state of apoplectic coma, from which he may never awake.
The excitement of the system does not altogether depend on the loss
of sleep; and we must not proceed too vigorously in endeavouring
artificially to induce it by means of opium or chloroform, till the im-
paired secretory and excretory functions of the body have been restored
to healthy exertion.
The indications of treatment to be generally acted on are: 1. To
allay the exalted sensibility of the central nervous organs or their peri-
pheries, by reducing vascular derangement and inflammation, by means
of mild antiphlogistic remedies, and by the removal of all irritating
diseased secretions of organs that react on the brain. 2. To restore
the organs of assimilation to a healthy condition, so as to supply fresh
nutrient materials to the blood; and to prevent nervous exhaustion by
a moderate allowance of stimuli, combined with such materials. 3. To
eliminate poisoned products from the blood, by restoring the proper ex-
cretory functions of the liver and kidneys.
In fulfilling the first indication, it will be prudent to seclude the
patient in a quiet and partially darkened apartment, and let him be
watched by some well instructed nurse or attendant, who is capable of
quieting his impatience, and can manage him without physical restraint.
I have known many cases, in which the mental emotion and nervous
exhaustion, caused by coercion, were followed by the utmost danger to
the patient, by bringing on an epileptic seizure. In particular instances,
where the vascular action preponderates over the nervous erethism, the
cautious use of general or local bleeding is admissible; but it must be
remembered, that, though in such instances of inflammatory or pyrexial
complication, blood-letting may be had recourse to, it must be used
sparingly, as having a natural tendency to aggravate the nervous ere-
thism, and those symptoms of exhaustion with which the disease is so
usually associated. In most cases, therefore, the local application of
ice or cold douche to the head is a preferable and safer means of sub-
duing the cerebral sensibility and increased vascular action, which are
so characteristic of this peculiar disease. The cold douche may be
repeated three or four times in the day; and frequent general cold
affusion, where the temperature of the skin is not below the natural
standard, the pulse is of moderate strength, and there are no local com-
plications, is had recourse to in India with the best effect. In many
cases, even where there were indications of a feeble circulation, but
much cerebral excitement, I have seen the cold douche to the head used
with most beneficial effects, while the rest of the patient's body was
immersed in a warm bath. The water used in India, where the mean
temperature is high, was never artificially cooled; but when used in
European climates, particularly in winter, it may be prudent, occasion-
ally, to take off the extreme chill of the water before using it. In
further fulfilment of this indication, the administration of tartar emetic
solution, in the proportion of half a grain of the tartrate of antimony,
with a drachm of the tincture of opium, and an equal quantity of nitrous
ether, may be had recourse to with the greatest advantage in allay-
BY JAMES BIRD, A.M., M.D. 433
ing the excitement of the brain, and in inducing a healthy secretory
action of the skin and kidneys. When the biliary secretion is morbidly
increased, emetics will be of the greatest use in relieving the stomach
from the irritation of unhealthy bile; and should purgatives be thought
more applicable, calomel in large doses, or combined with antimonials
and opium, followed by castor oil, may be advantageously employed.
Sometimes the exhibition of stimulating enemata after the calomel and
opium may be preferred to purgatives, which, when used too freely, are
apt to produce an increase of excitement. 4
The fulfilment of the second indication is to be accomplished by admin-
istering moderate quantities of thin Sago or arrow-root, combined with
wine or brandy, according to circumstances. From five or eight ounces
of port wine in the course of twenty-four hours, with occasionally a
quarter of a pint of brandy or gin, adapted to the greater or less nervous
exhaustion of the patient, will be generally found sufficient to fulfil all
that is here required in particular cases. Should the appetite, as is
often the case, admit of more solid ingesta being used, mutton chop,
grilled chicken, etc., may be given to the patient.
The third and last indication, that of removing poisoned elements
from the blood, is partly effected by the latter part of the first indication
of removing irritating secretions from organs that react on the brain.
The special object in view, however, should be steadily promoted, by
freely administering calomel, aided in its action by diuretics, in order to
restore the impaired excretory functions of the liver and kidneys, and
thus eliminate urea from the blood. In cases of peripheral erethism,
arising from the retention of biliary matters, calomel will be found an
invaluable remedy; and Mr. Corfe's late experience of its good effects,
in cases of this kind, and of deranged gastro-hepatic function, establishes
the fact, that it will succeed in subduing general erethism after all other
remedies have failed. The whole of my experience in India can bear
testimony to its good effects, and would justify Mr. Corfe's well-grounded
reliance on this as a special remedy. More might be added as to the
relative value of particular remedies; but enough has been already said
practically to guide the judgment of all who may be called on to treat
the disease.
[TABULAR STATEMENT.

TABULAR STATEMENT OF THE FORMS, CHARACTERISTICS, AND TREATMENT OF DELIRIUM TREMENS.
NO. I. SIMPLE FORM.
No. of , Syria ºthi ic
Date |Name Age ... GeºIGS (5.5 aft, §. #. Treatment }. Result
Feb. 24, W.J. 37 | First Severe pain in Peripheral | Fear of be- Sensibility Tongue clean, General cold affu-| — Cured.
1835 |stomach after and ſing murdered exalted (inter-great thirst, bow-sion, occasional purg.
drinking; pain spinal mittent) els loose, stoolstinct. opii.3iij in mist.
at base of skull; watery camph. every 4 hours,
tremor of limbs increased on 5th day
(being violent) to 3ss
every 3 hours, with
good effect
Feb. 15, H. C. 39| Not Excitement, Cerebral || Rapid inco- Hyperaesthe- Natural. General cold affu-| 4th Cured.
1836 known tremor, restless- herent mut-|sia of cereb. sion, laudanum 3iss, day
ness, insomnia, tering & its connect. morning and evening;
pain in joints with spi. cord, sleep and coherency
mot, power of returned on fourth
lingual n. ex. day
May 31, D. B. 25 | Not Vomiting, pain Cerebral | Psychical Convulsive Tongue clean, Cold affusion, lau- — Cured.
1836 known in stom., conv. hallucination twitching of stools nearly na-ldanum
starting of mus., in dreams; muscles. Notural, pulse 74
frightful dreams supposed him-tremors
self in prison
June 5, J. B. 35 | Not Diarrhoea, epi- Peripheral Reverie ; Cerebral Tongue loaded, General cold affu- — Cured.
1836 known gastric pain and during sleep, sens. exalted, stoolswateryandsions, cal. and op, at
vomiting, broken dreams motor funct.|yellow bed-time, purgatives
slumbers, fright- not affected
ful dreams
June 8, W.M.C. | First Excitement, Cerebral Spectral Motor func- T. furred, yel- General cold affu-| 4th Cured.
I836 36 flushed counte- illusions; ſtion little dis-ſlow, thirst, p. 78,sion, opium, occa- day
nance, eyes red dreams turbed, tong.full, soft; sk.soft, sional purgatives
and bloodshot |tremulous very perspirable,
appetite much
impaired
June 21,
1836
Aug. 23,
1836
Oct. 11,
1836
Aug. 22,
1836
Dec. 4,
1836
Mar. 11,
1837
Feb. 10,
1837
W. M. 29
Ditto
Ditto
E. S. 26
G. P. 30
Mr.W,33
M. S. 34
First,
Second
Third
First -
First
First
Second
|fulness, trem. of
suspici. express.
Pain at vertex,
tremoroftongue,
wakefuln., pain
in cardiac region
Tremor, wake-
fulness, mental
excitability, de-
lirium 2d day of
admis., languor
Anorx., watch-
t.&limb., nodel.,
slight headache
Spasmod, pain
of stomach, vom-
iting & purging,
restless. Deliri-
ous 3d day, after
appl. of a blister
Excitement,
insomnia, con-
tracted pupils,
bloodshot eyes,
tremor
Tremor, wake-
fulness, agitated
manner, a wild
of countenance
Lost power of
perception and
attention, insom-
nia, numbness of
limbs, and trem.
after drinking
Cerebral
Cerebral
Peripheral
Peripheral
Cerebral
Cerebral
Def. cere-
bral sen-
sibility
None
Not noted
None
Incoherent
loquacity,
spectral
illusions
Suspicious
dread of
conspiracy
against him
Quite cohe-
rent, but
troubled by
imaginary
VOICES
Incoherent
imbecility
Motor funct.
slightly affect.
Motorfunct.
more affected
than before.
Motor funct.
slightly affect-
ed.
Motor funct.
little disturb-
ed.
Motor func-
tion little dis-
turbed.
Not much
disturbed.
Slight tremor
P. 110, resp.
nearly norm., t.
load., yell.; bow.
slightly derang.
Bowels consti-
pated
Pulse.90, weak;
bowels consti-
pated
Pulse 88, full,
compressible;sk.
soft, perspirable;
ton. Slight. coat.;
bowels at first
Resp. normal,
sk. Soft, moist;
p. 100, rising as
excite, increased
to 130; b. loose
Resp. normal,
skin soft, bowels
confined, tongue
loaded
Pulse small &
feeble, respirat.
andskin natural,
tongue loaded
and red at the
edges
loose, then cºsional purgatives
Tart. emet. Sol.,
purg. anod., doses of
tinct. of op. and hy-
oscy. at bed time
Cal. and op., with
purg.;afterwards,tar
emet., laud., cold af.
fus., brandy & water.
Del. became intermit.
Tart, emet., cold
affusion, occasional
purgatives, and anod.
of op. and hyoscy.
Warm bath, cal. &
op., blister to epigas.
After delirium, gene-
ral cold affusion, lau-
|danum, and occa-
Emet. anod., warm
bath; afterwardstart.
emet. Sol. every third
hour, small quantities
of gin and water, cold
douche to head
Purgatives, drachm
doses of tinct, op.
every hour till sleep
was induced, cold
douche to the head
Opium, with calo-
mel and purgatives;
warm bath
4th
day
6th
day
6th
day
4th
day
4th
day
5th
day
2nd
day
Cured.
Cured.
Cured.
Cured.
Cured.
Cured.
Cured.





No. I. SIMPLE FORM (continued).
Date of
& * º Se Bººl ni
Date |Name Age *:::: Geºm, (śr Aś, :#. Fº Treatment Amend. Result
Feb. 6, T. K. 40 || First Insomnia, lo- Cerebral || Spectral illu-' Tongue and Appetite good, Tartar emet. Sol. 3rd Cured
1838 quacity, busy sions; strange handsverytre-bowels open, and with tinc. hyoscyam. day
agitated man- imagination mulous tongue clean ſevery four hours, an
ner, tremor, ac that he had opiate at bed-time,
comp. by cynan- been burned and one dose of castor
che tonsillaris to death on oil
after drinking board ship
Feb. 19, J. C. 45 Not Insomnia, rest- Peripheral || Spectral il- Tongue P. Small, wiry; Cal. and op. with 2nd Cured
1838 known lessness, tremor lusions, sus- tremulous, frequent sighing, purg., tart. emet. Sol. day
and biliary purg- picious dread loaded copious cold per-ſwith tinct. hyoscyam.
ing after drink- of conspira- |spiration, and in-Cold douche to head
ing; pain at nape tors creased biliary
of neck secretion, appe-
tite good
Mar, 19 |N. A. 38 || Not Headache, Cerebral || Spectral il- Exalted sen-| Pulse and skin Cal. & purgatives, 3rd Cured
1838 known tinnitus aurium, lusions, suspi-sibility, inter-normal, tongueſtart. emet. Sol. with day
restlessness, red cion of conspi-mittent, slight|thickly loaded anodynes
suffusion of eyes, rators tremor
suspicious look
of dementia
Mar. 28, J. T. 49 | Not Insomnia and Peripheral Timid Motor func- Pulse, skin and Cal. and op., tart. 3rd Cured
1838 known tremor, nausea suspicion ſtions not much respirat. normal, emet. Sol. and anod. day
and irritability affected tongue clean, Cold douche to head
of stomach appetite good
June 10, A. B. 36 | First. Insomnia, rest-|Peripheral | Dreaming Convulsive Pulse and skin Emetic, purgatives, 3rd Cured
1838 lessness, spectral and spectral twitching of natural, tonguelleeches to epigast., day
illus., trem. after illusions muscles loaded tart. emet. Sol., with
drink. ; nausea, anod, and cold douche
|irritab. of stom., to the head
pain of epigast.
June 19,
1838
Feb. 10,
1837
April 19,
1838
April 24,
1838
May 8,
1838
Feb. 19,
1838
J. A. 30
M. S. 34
Ditto
J. H. 37
Ditto
J. C. 45
First
Second
Third
First
Second
Not
known
Insomnia, ma-
niacal violence,
incessant loqua-
city after drink-
ing
Insomnia, lost
power of percep-
tion and atten-
tion, numbness
of limbs, tremor
after drinking
Childish imbe-
cility, insomnia,
and tremor after
Insomnia, rest-
lessness, pervert-
ed perception &
slight nocturnal
fever after drink-
ing
Insomnia, flush-
ed countenance,
throbbing in the
|head, frightful
dreams, convul-
of muscles after
drinking
Excitement, in-
Somnia, restless-
ness, tremor, bi-
liary purg. after
drinking, pain at
nape of neck
sive twitchings
Cerebral
Defective
cerebral
sensibility
Ditto
Cerebral
Cerebral
Peripheral
Violent de-
lirium, during
fits of which,
he wounded
himself in se-
veral places
Incoherent
imbecility
Ditto
Spectral
illusion
Ditto
Spectral il-
lusion, suspi-
cion of conspi-
racy
None.
Slight tremor
Ditto.
None.
Convulsive
twitchings
Tongue
tremulous
stomach, bowels
frequent sighing,
|secretion, tongue
Pulse full but
soft, skin cover-
ed with perspir-
ation
Pulse small &
feeble, resp. and
skinnat., tongue
loaded in centre
and red at mar-
in
Ditto
Resp. and skin
normal, nausea,
irritability of
loose
Skin bathed
in perspiration,
tonguefoul, grip-
ing, and confined
bowels
P. small& wiry,
good,
appetite
biliary
copious
Tart. emet. Sol.,
second hour ; purga-
tives
Cal. op. and pur-
gatives; warm bath
Tart. emet. Sol.,
and purgatives
Tart. emet. Sol.,
with anodynes, thrice
daily; cold douche to
the head
An emetic, purga-
tives and anodynes,
tart. emet. Sol. every
4 hours; cold douche]
to the head
Cal. and op. with
purgatives, tart.emet.
sol. with hyoscyam.;
cold douche to the
head
with anodynes every
with anod., diuretics
loaded
2nd
day
2nd
day
6th
day
4th
day
9th
day
2nd
Cured
Cured
Cured
Cured
Cured
Cured




No. I. SIMPLE FORM (continued).
e tººl ethi €1080 d *
Date |Name Age ..., | *.*.* |&#. ai..., | .º. rºl. Treatment
Mar. 19, N.A. 32| Not Heada., tinnit. Cerebral || Spectral il: Slight tre+ Pulse and skin Calomel and pur.
1838 known aurium, susp. lusion, and mor, sensibi-natural, *sº tart. emet.
imbecile look, dread of a con-lity alternate-thickly loaded sol. with anodynes
insomnia, rest., spiracy ly depressed
w |suffus, of eyes and exalted
Mar. 28, J. T. 49 | Not Nausea, irrita- Peripheral | Mingled Motor func- P., sk., resp. Cal, and op., tart.
1838 known bility of stomach, dread and ſtion little afºnat, tong, clean, emet, sol. and anod.
* insomnia, trem. suspicion fected appetite good cold douche to head;
May 26, J. C. 31 | First Insomnia, ex-| Cerebral None Tremor and Pulse and skin Tart. emet. sol.
1838 cit., slight head- subsultus ten-natural, tongue with anod. every 3
ache, muscular dinum |loaded, bowels|hours, purgatives,
starting, loqua- confined with croton oil; cold
city after drink. douche to the head
July 15, Ditto Second Insomnia, ex- Cerebral None None Skin moist, An emetic, cal.,
1838 |citement, nau- tongue loaded, James's powder and
sea, dilatation of yell, bow, conf., op., purgatives and
pupils aft. drink. urine scanty warm bath
June 4, J. S. 38 | Second | Headache, in-| Peripheral | Frightful | Convulsive Pulse rapid, An emetic, with
1838 Somnia, restless- dreams and twitching of skin moist, nau-purg., tart, emet. Sol.
ness, and tremor spectral muscles sea at stomach, with anodynes; cold
after drinking illusions tongue loaded douche to the head
Nov. 2, H. H. 32| Not Insomnia, ex-| Cerebral | Hallucination. No tremor P. freqt. and Cal. and purg. tart.
1838 known cit., flushed coun- that he had var., skin persp., emet. Sol., with tinct.
|tenance, dilated been accused tongue dark red, opii, cold douche to
pupils aft. drink. of murder b. conf., ap. goodhead
Dec. 13, J. J. 38 || First Nausea, excit., Cerebral | None, but Slight tremor | Pulse soft, skin Leeches to temples,
1838 flushed count., II].3.IIIlêT SllS- cool, byls. open, cal. with tart. emet.
headache, in- picious tongue furred and op. purg., cold
Somnia, heat o
skin after drink.
douche to head, and
anod.
Date of
Amend. Result
3rd Cured
day
3rd Cured
day
6th Cured
day
3rd Cured
day
5th Cured
day
3rd Cured
day
3rd Cured
day
:
QN)
Sº
Dec. 13,
1838
Dec. 18,
1838
Feb. 8,
1840
April 5,
1840
April 8,
1840
April 14,
1840
R. M. 38
J. J. 36
A. C. 38
W. E. 29
J. T. 26
J. K. 24
First
Not
known
|Not
known
Not
known
Not
known
Not,
known
|insomnia,
Insomnia, rest-
less., loquacity
and tremor after
drink. Hadinter.
fever in July
Insomnia, irri-
tability of stom.
and purg., ten-
derness of colon,
and tremor after
drinking
Nervous de-
press. aft. drink.,
succeeded by
rest-
lessness, and un-
manage. violence
of manner, with
illus., after drink
Nervous de-
ress. aft. drink.,
ollowed by exci-
tability and illu-
sions
Nerv. depres.
after drink., and
cessa. from hab.
op.-eating, succ.
by irrit. of stom.,
insom., restless.,
and illusions
Insomnia, rest-
less., and delir.
after drinking
Cerebral
Peripheral
Cerebral
Cerebral
Cerebral
Cerebral
Hallucination
that he was
pinioned
Muttering to
himself, and
catching at
objects
Reverie and
illusions
Reverie and
illusions
Illusions of
the usual cha-
racter, red suf-
fusion of the
sclerotic coat
of the eye
Busy delirium
Tremor slight
Tremor
Restless agi-
tated manner
No tremor
No tremor
Much tremor
Pulse 80, soft,
confined, tongue
clean
Pulse 60, soft,
moist, and co-
yellow crust
Pulse variable,
slow
Pulse variable,
perspirable,
tongue loaded
Pulse feeble,
damp,
foul
tongue
Pulse feeble,
skin
with clammy
perspiration
. cool and cal.&op., carb.ammo.
vered with a thin mix. & brandy4times
daily, mod, allowance
skin soft, bowels with anodns., a small
skin warm and tart. emet. Sol., with
skin cold and gast., efferves. drţs.
covered withtinct. op. & diur.,
Cal. tart, emet. &op.
skin cool, bowelspurg., antimon. mix.
with anod, every 3
hours, tepid doucheto
head, weak br. & W.
100 leechestoabdom,.
gr. x, with camph.
of port wine & enem.
Tartar emetic solut.,
allowance of brandy,
cold douche to the
head, a purgative
and enemata
Cal. & op., cast. oil,
anod., cold douche to
|head, small allow. of
brandy diluted
A blister to the epi-
with an oz. of brandy
& a drum. of tinct, op.
every 3 hours, cal. &
op. with cast. oil, cold
douche to the head
Purg., tart. em. Sol.,
br. & water in mod.
quant., cold doucheto
|head, & Sul, quin. Sol.
4th
day
3rd
day
3rd
day
3rd
day
4th
day
9th
day
Cured
Cured
Cured
Cured
Cured
Cured





No. I. SIMPLE FORM (continued).
Date |Name Age ..., | *ś" |(}."p| A. | ...}: rº, Treatment [...] Result
April 22, C. F. 31 | Second Insomnia, rest- Cerebral Busy delirium. Much tremor | Pulse feeble, Purg., tar. em.sol., 9th Cured
1840 lessness, and skin cover. with with tinc. op. & diur., day
delirium after clammy perspir-brandy & w. in mod.
drinking ation quant., c. douche to
head, sulph. quin. Sol.
May 14, T. R. 42 Not Incoherent lo- Peripheral Incoherent | Much tremor | Pulsesmalland Leeches & blist. to 6th Cured
1840 known quacity, tremor, loquacity feeble, stomachiepigast., cal. and op. day
insomnia, and irritable, bowels with purg., effervesc.
epigastric ten- loose, tongueldraughts with tinct.
derness after coated yellow op. and diuret., cold
drinking douche to the head
May 31, W. C. 33. Not Insomnia, ex- Cerebral Illusions of Much tremor | Pulse soft and Cal. camph. & op., 4th Cured
1840 known cited agitated and the usual frequent, skinlwith purg., blister to day
manner, tremor, peripheral character moist and cool, nape of neck, leeches
illusions after tongue white, to epigast., w. bath &
drinking, epigas. anorexia, c. douche to head, tar.
pain, red suffus. eme. Sol., with tin. op.
of the eyes diuret., Sul. quin. Sol.
July 20, T. E. 29 | Not Insom., impa- Cerebral Illusions of Tremor not | Pulsesmalland Cal., James's pow., 4th Cured
1840 known tientagitat.man- the usual great feeble, skin cov-op. & purg., w, bath day
ner, illus., trem., character ered with pers- and c. doucheto head,
epi. pain, dilated piration, bowelstart. emet. Solu. with
pupils aft. drink. confined tinct. Op., brandy &w.
Aug. 6, C. M. 47 | Not Incohe. mutt., Cerebral Illusions and | Tremor Pulse of vari- Leeches to epigast. — sºmºsºme
184 known fidgetty employ. and mental inco- able frequency and a blister to the
of hands, as if peripheral herence of an and strength, nape of neck, calom.,
drawing threads intermittent skin moist, bow.hydrochlor. of mor-
from ends offing. character loose, and vom-phia, with purgatives,
trem, inso., abd. iting of dark cold douche to the
tend. aft. drink. bilious matter head, port wine

NO. II. INFLAMMATORY FORM.
#
No. S w & Date of
Date |Name Age Nº.: | *ś" |G:...) | A., |\º rº, Treatment A.A. | Result
Dec. 14, T. F. 44 | First Hepatic ten-|Peripheral, Thought hel Tightness Tongue dry Leeches and blister Cured
1828 derness, wake-| ending in had seen the of head, and parched, to side, cal. as purg.,
fulness, delirium, encephalitis W. Mary, lo- transient slight diarrhoea, bleeding for injury of k
tremor tremulenta quacious, rest- tremor biliary secretion|head, coldlot. to head,
less, impatient dark green camph. and op., mer.,
leeches and blister to
head for hepat. tend.
f and tightnessin head ||
April 18, E. D. 33 || Not Wound of el-l Cerebral, Maniacal Tremor, Tongue dark General cold affu- Died 18th May
1836 known bow joint, vio- traumatic violence, convulsive red, much thirst, sion, leeches to tem- Tubercles in lungs
lence, incohe- delirium muttering twitching urin. Sec. affec., ples, blister between p
rence, screams of muscles, p. 100, of mod. Scap., tinct. muriat.
contraction strength; persp. morph., purgatives
of pupils copious, clammy; -
- resp.diffi. onl&th
day when mind
was collected,
cough, purulent
expectoration,
scrofulous con-
& stitution -
Aug. 12, W. K Diarrhoea, shi- Cerebral | Incoherent |Intermittent | Pul. 120 after Warm bath, cal. 2nd Cured
1836 yering tremor, and spinal | loquacity, exalt, sens, delir, frequentlop. and ipecac, at day
fluttering feeble fancied his motor funct. sighing, occas.admission; after de-
pulse. On fourth bed was being not much aſ dry skin, respir.lirium, cupping tol
day, delir., pain| pulled from |fected, pupils oppressed on ad-spine and "epigast.,
in right breast under him contracted mission, bowelstart. emet., tepid af.|
on inspiration, r conf., epigast.fusion and laudanum|
uneas. In spine tender, urine in at bed-time. " -
mod: quantity

No. II. INFLAMMATORY FORM (continued).
* le gº d tº
Date |Name Age ..., | *:::::::" (š...) | A. | #.º. Fº. Treatment |. Result
Feb. 2, S. B. 44 | Not Insomnia, im- Peripheral | No delirium, Tongue Pulse full and! An emet. at admis. Died. Effusion
1838 known patient violence and but restless tremulous strong, skin cov-with purgat. of cal. of blood on dura
and tremor after cerebral impatience ered with moist-castor and croton oil, mater, venous con-
nausea, hiccup, ure, bowels con-|cold douche to head, gestion of cerebral
vomiting & feel- stipated, inspira-ſleeches to left chest, membr., serous ef-
ing of nervous tion painful. tart. emet. Sol, and sion into subst. of
depression tinct. morph. Col- brain, pulm, apop.
lapse on third night, left lung, lymph
ldeath soon after effused between
pleurae on both
ſides
Oct. 13, W.M.C. Second Acute epigast.|Peripheral | Muttering Motor func- Pulse 120,soft, Leeches to epigast- Died on 4th day.
1836 36 pain & tend. in- delirium tions little respiration quick|rium, cold douche to Pleur, pulmon. Vas-
|creased by deep disturbed and painful, skinhead, tartar emetic, cular over mid. lobe
inspiration, oc- soft, perspirable; calomeland opiates of right lung, which
cas, cough and tongue coated, was hepatized; fi-
viscid mucous yellow; abdo- brinous coag. in all
expector.dulness men distended cavities of heart,
at fifth rib in with flatulence, muc. coat of stom.
respiratory mur-
|latation of ribs,
|tion in left lung,
right pect. re-
gion, absence of
mur, slight di-
puerile inspira-
wakefulness,
then delirium,
|collapsed fea-
tures
bow. loose, stools
darkgreen, bilio-
In U10OU8
uniformly diffused
redness, liver ver-
tically enlarged,
9lb. 1202.
Oct. 23, G. O. 20 | First Insom., severel Cerebral | Incoherent | No tremor Skin alternate- Leeches & blist. to 11th Cured
1838 ont. headache, and wandering ly cool, moist, epigast., 1 gen, bleed.| day
dilatation of pu-| peripheral of thoughts and dry, warm ; to 20 oz., w, bath & c.
pils and intoler- pulse 104, sharp, douche to head, blist.
ance of light, tongue furred to nape of neck, merc.
epigastric pain, and red at edges, to consti. effect, tart.
and numbness urine scanty and emet. & op., afterw.
of limbs after hot, slight cough, comb. with sul., quin.
drinking painful inspirat. and aloes, diuretics
May 28, P. C. 25 | Not Insomnia, in- Cerebral || Incoherent | No tremor | Pulsesmalland Leeches to epigast. 7th Cured
1840 known coherent loqua- and , loquacity, with feeble, skin cool, and right side, merc.| day
city, vertigo, pain peripheral hallucination tongue furred to its constitu. effect,
at the vertex of of being on and red at the purg., warm bath and
head, abdominal board ship edges, anorexia cold douche to head,
tenderness after camph. mixture with
drinking, pupils tinct. op. and diuret.,
dilated Sago and wine
No. III. PYREXIAL FORMS.
Dec. 26, A. D. 34 || First Inflam. of foot, Peripheral | Thought him-| Tremor of | Pulsefull, skin Venesect. to 3xvj, | – Cured
1823 delir. on 29th, self about ord. hands slight hot, bowels confleeches to head, cam-
insomnia, anxie- duties, mutt., - motions darkphor and opium
ty, restlessness del. hurry, anx yellow -
Nov. 19, J. C. — | Not Insomnia, flush- Cerebral | Intermittent|Musc. ofarms|| Respiration | Tar. eme. Sol, twice 7th Cured
1836 known led counten., agi- reverie, fear of tremulous natural, bowels daily, with cold affu., day
tated manner, & conspirators |constipated anod. at bed-t., purg.,
trem. aft. drink. latterly Sul. quin. sol.
July 31, J. P. 33 First Wertigo, lan- Cerebral || Spectral illu- Motor func- | Pulse rapid, Purgat. at admis- 5th Cured
1837. guor, nau., Wom., sions, violent tions not feeble, respirat.sion, blister to nape of day
coldskin, violent delirium, much affected natural, skin at neck, cold douche to
del., flush, coun., dread of con- first cold, after-head, pills of calom.,
trem., freq. firm spirators wards warm and tart, emet, and op.
p. 3d day aft. ad. bathed in persp., after delirium




Prev. in hosp. for
remit.fev.accom.
with tremor
ton. thickly fur.,
urgent thirst,
defect. appetite






No. III. PYREXIAL FORM (continued).
No. of Gen. S & -- &
Date |Name Age . ººm- dº# | Aſſº, sº. #. Treatment *:::::: Result
Jan. 9, S. H. 41 || First Insomnia, flush- Cerebral Thought | Motor funct. Pulse frequent, An emet. at adm., 4th Cured
1838 ed countenance, distressed and not much wiry, skin moist, tart, emet. Sol. and day
excitement, and |anxious, ac- affected respirat. normal, anod.; after inc. symp.
tremor companied by bowels confined on 3rd day, cal. tart.
muttering, emet. and op., cold
continued douche to head, and
dread of con- allow. of bitter beer
49 | spirators
April 6, T. W. 39| Not Insomnia, rest- Cerebral || Spectral illu-| Starting of | Cough with Cold douche to head 35th Cured
1838 known lessness, & trem. sions, dread muscles febrile parox., and warm bath, purg. day
after drinking ; of conspiracy, tongue furred, and colchi. with other
much frontal frightful bowels confined, diuretics and anod.,
headache and . dreams urin. Sec. scantyrepeated leeching and
pain at base o cupping at base of
occiput occiput
July 13, A. O. 47| Not Headache, in- Cerebral | Muttering, | Subsultus | Pulse variable, Camphor mixture, Death 3rd day.
1838 known somnia, spectral delir., spectral tendinum from 96 to 120, antim. wine, diure. Wenous congest. of
illusion & trem- illusions, kick- skin alternatelytics, cold douche to pia mater, much
or, with febrile ing at bed- hot and perspir., head, leeches to tem- lserous effusion be-
paroxysm clothes tongue clean, ples, blister to nape tween it and tunica
tremulous, urin. of neck. Died coma- arachnoidea and
scanty tose after 3 drachms into the ventricles,
tinct. Opii, given to vascular redness of
produce sleep mucous coat of
stomach, and in-
|testinal canal,
substance of kid-
ney converted in-
to uniform fleshy
In 8 SS, .

Aug. 12, A. W. 38|| First Pain in tem- Cerebro- Muttering, Mot, funct. | Pulse frequent, Blister to head and — | Death, 3rd day.
1838 ples and base of spinal delirium not noted feeble, skin cold|nape of neck, camph. Wasc. red. of cereb,
occiput, extend- and covered with mixture, with antim. membr. and subst.
ing down the perspirat., ton.wine and colchicum, of brain, milky opa-
neck, insomnia, slightly furred other diuretics, lat- city of arachnoid,
flushed counte- and red at edgesterly cal., with aloes thickening of pia
nance, indistinct and small doses of mater, which, at
pyrex. parox., |sulphat. quinine the optic thalami,
of a rheumatic chiasma of optic
diathesis and in- nerves, crura-cere-
temperate bri, pons Warolii, &
|med. oblon, was
|adhe.byathicklay.
of lym.; serous effu.
into theca vertebr.,
cont. flakes of lym.
* e «» - Bright's dis. of kid.
Mar. 14, F. H. 29 | . Not Insomnia, rest- Cerebral |Illusions and | Tremors P. variable in Leeches & blist. to 16th Cured
1839 known lessness, illusions and mental inco- freq. & stren., sk.abdomen, cal. and op. day
and tremor, with peripheral herence of an gen. moist, some-with purgat., w, bath
irritability of the intermittent times dry, bow. |& c. douche to head,
|stomach after character conf., attend. by tart, emet. Sol., tinct,
drinking abd.tend.&anor.op., sulph. Quin.mixt.,
tongue coated Sago and wine
No. IV. EPILEPTIC FORM. º
April 4, J. B.E.46 . Not | Insom., restles. Cerebral, Impatient but Vertigo and Skin warm and Leeches to temples, Death. Red vascul, and
1838 known flushed counte., and spinal manageable | convulsive dry, resp. not blister to nape of thickening of pia mater,
- bloodshot eyes, delirium, mut-|-twitching of much affected, neck, cold douche tolopacity of tunica arach. and
dilat.pupils, pain tering and muscles tongue loaded, head, calomel, with much serous effu. into sub.
at base of occip., |kicking at the bowels constip. ſtartar emetic, opium of brain, old adhes. of left
irritabil. of stom. bedclothes and purgat. Death lung, fatty degen. of r. side
aft, drink. Two on tenth day by an of heart &soften. of l., fibr.
epilep, fits day of epileptic fit polypiinlft. ventric., thick.
admiss., another
the 3rd day
ofaorta, enlar. of liv. & red
vasc. of muc. mem. of stom.






No. IV. EPILEPTIC FORM (continued).
º g Iºl and rganic
Dale |Name age ºf | *.*.* |&#: aft. ºf: | #. Treatment |. Result
June 28, W. K. 38|| Fourth || Insomnia, rest: Cerebral Mental hal- Not noted Not noted Tartar emetic sol., Died 2nd night.
1838 lessness, and lucination of with tinct. hyoscyam. Wascul, redness of,
mental halluci- the usual cha- ëvery second hour. cerebral membra.,
# lmation for several racter Became very restless much serous effus.
days before ad- and incoherent on into the ventricles
mission, caused second night after ad- & at base of brain;
by hard drink- mission, and died sud- |heart enlarged and
ing, for which denly in a fit soften, semi-lunar
he had taken an valves of aorta os-
emetic, and been sified; posterior
bled and leeched portion of lungs
gorged with blood;
muc. coat of stom.
- pale and softened.
April 28, W. M.D. Fourth Restlessness, Cerebral None Tongue and |Tongue loaded, , Cal., James's pow; 3rd Cured
1839 35 flushing of coun- limbs tremul thirst great, der and purgatives at day
tenance, blood- lous stools dark admission, leeches to
shot eyes and bilious nape of neck
tremor after
drinking. Pain
at nape of neck
May 12, J. N. 36: Not Insomnia, pallor Cerebral Illusions of Excessive tre-Pulse frequent, Cal. and opium fol- Death. Permis-
1840 known of countenance, usual charac-mor of tongue feeble, skin cold lowed by castor oil at sion to examine the
and extreme ter and limbs, and moist, adm., small quant. of body not obtained
tremor, after convuls. fits. of tongue loaded ſtart. emet. Sol., with
|drinking epilep. char., tinct. hyoscy, brandy
after one of punch, cold douche to
which he be- head and sinapisms to
came quite feet. Died in an epi-
rational leptic fit on 2nd day

May 18,
1840
June 5,
1840
April 7,
1840.
C. W. 38
W. A. 37
J. D. 36
Not
known
Not,
known
Not
known
Severe frontal
headache, ac-
companied by
heat and dryness
of skin, uneasi-
ness in loins, and
much tremor
after drinking
Epigastric pain
and vomiting,
followed by in-
somnia, pallor of
counten., dilated
pupils, illusions,
general excite-
ment, and tremr.
after drinking
Insomnia, ex-
citement, trem.,
illusions & much
irritability of
stomach after
irinking
Cerebral
Cerebral
and
peripheral
Cerebral
27, Hyde Park Square, London, March 1850
None
Illusions of
usual charac-
ter
Illusions of
usual charac.,
temp. insens.
of pupils of
eye, following
convulsions,
Extreme
tremor
Much tremor
of hands, and
occas. Oramp
Extreme tre-
mor, and im-
paired muscu-
lar power of
the right side
Pulse small and
feeble, skin dry,
tongue coated
white, bowels
confined, urine
Scanty, hot
Pulse feeble,
skin covered
with perspiratn.
Pulse feeble,
skin moist,
tongue clean,
bowels open
count. flushed
|cupping, cold douche
Cal. with ipec, and
hydrochlor. morph.,
castor oil, warm bath,
effervesc. draughts,
with diur., cupping
and leeching of tem-
ples, blister to nape
of neck, cold douche
to head. Death by
epileptic fit on second
day
Blister to epigast.,
cal., ipecac, and hy-
drochlor. morph., cas-
tor oil, small quant.
of brandy and water,
with tinct. opii, local
abstraction of blood
from nape of neck by
to head and hot foot-
bath. Died on third
day
Emet. of sulph. zinc,
blisters to epigast. &
nape of neck, efferves.
drats. with br. & nit.
ether, afterw. antim.
mix., with tinct. op. &
cold douche to head
3rd
day
Death. Fatty
lesion of cortical
subst. of both kid-
neys, extend. into
tubular portion be-
tween the calices;
liver much enlarg.,
muc. coat of stom.
of grey leaden col.,
lungs emphysem.
and congested as
in asphyxia, mod.
congest of cerebral
vess., serous effus.
between arachnoid
and pia, mater.
Death by epilep.
Arboresc. vascula-
rity of cereb. mem.
more than normal
proport. of bloody
points on incised
sub. of brain, which
much
was softened, much
serous effusion into
ventricles, liver
enlarged,
lungs distended as
in asphyxia.
asp Cured




448 ILLUSTRATIONS OF DISEASES OF THE NERVoUS SYSTEM.
CLINICAL ILLUSTRATIONS OF DISEASES OF THE
NERVOUS SYSTEM ; AND OF OTHER AFFECTIONS
SIMULATING THEM DURING LIFE.
By ROBERT HUNTER SEMPLE, M.D.
[Read before the Westminster Medical Society, March 16, 1850.]
NoTWITHSTANDING the rapid advances which medical science has made of
late years, the subject of CEREBRAL DISEASEs lies still wrapped in con-
siderable doubt and uncertainty. The pathology of such affections is
often ill-defined, the diagnosis obscure, and the treatment very un-
satisfactory. It is therefore with great diffidence that I offer my hum-
ble contribution to this department of practical medicine; and I am
compelled to admit, in limine, that the cases and the remarks which I
am about to offer will, in some instances, rather increase than diminish
the difficulty of investigations connected with the Diseases of the
Brain. But I believe, that a full confession of ignorance is one step
towards the acquisition of knowledge; and that a careful consideration
of facts, although it may increase our scepticism as to the opinions and
theories developed in some books, will not make us less efficient prac-
titioners of the healing art. I believe that medicine, as a science, is
far from being complete ; and that, like geology, it consists, at present,
of a vast multitude of facts, collected by the labours of faithful observers,
which are now being grouped together and arranged, and may some day
be reduced to a definite system.
With these observations, I proceed to the immediate purpose of this
paper; and I may mention, as an apology for entering upon so difficult
a subject, that I have had considerable opportunities, during many
years' connexion with a large public practice, of investigating the Dis-
eases of the Brain and Nervous System, during life and after death;
and the difficulty of the subject has, in my mind, invested it with par-
ticular interest. The remarks which I am now about to offer, are alto-
gether practical, and I shall relate only such cases as have come under
… my own notice.
The Diagnosis of cerebral disease is exceedingly difficult, and no
very definite rules can at present be laid down for the guidance of the
practitioner. The most formidable symptoms are sometimes unaccom-
panied with any perceptible organic lesion; while at other times, the
most serious and extensive alterations of the cerebral structure have
given rise to no symptoms whatever during life. These remarks will
be illustrated by the two following cases:—
CASE I. ExTENSIVE DISEASE of THE BRAIN, witHouT ANY SYMPTOMs
DURING LIFE. F. C., at. 61, a pauper in the Islington Infirmary, had
always enjoyed good health, and never applied for medical relief, except
upon one occasion, for a slight ulcer on one of his legs, which was
speedily healed. On Monday, March 21, 1842, he was in his usual
state of health, when, after taking his tea, he complained of general
pain and uneasiness; and, before any assistance could be rendered, he
expired. A post-mortem examination was made four days after death,
when the following appearances were observed:—Head. There was
considerable congestion of the scalp; the dura mater was in some parts
BY ROBERT HUNTER SEMPLE, M.D. . 449
adherent to the inner surface of the skull, and congested. On the sur-
face of the left hemisphere, beneath the dura mater, and above the
arachnoid membrane, there was found an adventitious membrane, per-
fectly organized, of a tough consistence, similar to the buffy coat of blood,
thick in the central portions, and gradually becoming thinner at the
sides and ends. In the thickest part, the thickness was about three
lines: the whole membrane was seven inches long, and two and a half
broad, and completely concealed the left hemisphere of the brain, which
was flattened and compressed where it lay beneath it. On the upper
surface, this adventitious membrane exhibited a dark red appearance,
the under surface was more pale. On closer examination, it was found
to consist of two layers, enclosing a cavity of considerable size between
them. Both the upper and under surfaces were perfectly smooth and
polished, and corresponded to the two layers of the arachnoid membrane.
The arachnoid membrane beneath this adventitious formation, and also
on the other side of the brain, was thickened and opalescent; and a con-
siderable quantity of thin, serous fluid, was found lying beneath it, as
well as in the ventricles. The minute vessels of the brain were con-
gested, but the substance of the organ itself was of healthy structure
and consistence.—Chest. The left lung exhibited some old adhesions,
and the cavity of the right pleura contained a considerable quantity of
thin, serous fluid; the bronchial tubes were congested. The heart was
rather above the natural size; and the parietes of the left ventricle
were thickened; there was also a slight thickening of the aortic valves,
but the aorta itself was quite healthy; as were also the other valves.
The viscera of the abdomen were all generally healthy.
REMARKs. Whatever may have been the cause of this man's
sudden death, it is evident that a large adventitious growth must
have existed for some years upon his brain, without producing any
symptoms during life. It appears to me that the above case was, origi-
nally, one of true arachnitis, attended by the effusion of coagulable
lymph, which eventually became organized, then separated from the
membrane by which it was first secreted, and formed the adventitious
growth above described; but Mr. Solly, who describes a somewhat
similar case, considers the appearance to be due to a coagulum of blood,
the colouring matter of which has been absorbed. gº
CASE II. ACUTE MENINGITIs WITHOUT ANY SYMPTOMs of CEREBRAL
DISEASE DURING LIFE. Sarah C., ast. 20, was attacked with peritonitis on
the 8th of March, 1842, and was dischargedcured, on the 20th of the same
month. She was again attacked with illness on the 26th of April, when
I was called to see her. She was then lying in bed, complaining of
great pain in the abdomen, which, however, was not aggravated, but
relieved, on pressure; pulse feeble; tongue slightly furred. She was
ordered to take five grains of calomel and fifteen of jalap, and a draught
every four hours, consisting of half a grain of emetic tartar with Epsom
salts and infusion of senna. She was much relieved by taking these
medicines, and seemed to be rapidly recovering. On the 29th of April,
she again applied for medical relief. She was now sitting up, and com-
plained only of pain in the abdomen, not increased, but relieved, upon
pressure. As I felt pretty certain that the pain was not owing to a

450 ILLUSTRATIONS OF DISEASES OF THE NERVOUS SYSTEM.
fresh attack of peritonitis, I treated it as if it were neuralgic, and
ordered a draught to be taken every four hours, consisting of ten minims
of tincture of opium, with half a drachm of Epsom salts and an ounce
of infusion of Senna. On the 30th, she was worse; pain in the abdo-
men still very severe, but relieved upon pressure; bowels confined,
much vomiting, some thirst, pulse feeble. She was now ordered to take
four grains of calomel in sugar, every four hours. At half past six the
same evening, she was much worse; she screams out in consequence of
the severity of the pain, which, however, is still relieved upon pressure;
pulse 120, not full or strong; has vomited all the powders and the mix.
ture, and cannot retain even toast and water on the stomach; tongue
white and furred. To take immediately, a pill, consisting of five drops
of croton oil with five grains of rhubarb. This pill was rejected in a
quarter of an hour. At half past nine the same evening, is worse; has
constant vomiting, but no alvine evacuations, and still complains of ex-
cruciating pain. Under the impression that the symptoms were owing
to some obstinate intestinal obstruction, she was ordered to have a clyster
administered, consisting of gruel and salt; she was also ordered to take
a minim and a half of hydrocyanic acid (Scheele's strength) immediately,
and, if rejected, to be repeated until the vomiting should be allayed. A
blister was also applied to the epigastrium, and a powder was given,
consisting of ten grains of calomel and one of opium. The blister
caused a little vesication; the clyster brought away no feculent matter;
the hydrocyanic acid draughts were nearly all thrown up : and the powder
of calomel and opium was likewise rejected. She continued in great
pain during the whole night, but retained her intellect throughout; and
when asked if she felt any pain in her head, she replied that she did
not. She died at eight o'clock the next morning, only two days from
the fatal seizure. A post-mortem examination was made twenty-three
hours after death, when the following appearances were observed:—
Head. The scalp, skull, and dura mater, presented no morbid ap-
pearances. The vessels of the arachnoid membrane and of the pia
mater were very minutely injected, presenting a highly inflammatory
appearance. The former membrane was thickened and opalescent, and
a quantity of serous fluid was poured out upon making an incision.
There was about an ounce and a half of thin serum in the cavity of the
skull and theca vertebralis. The ventricles contained rather more than
the natural quantity of thin, serous fluid. The brain itself was of
natural colour and consistence, except that, on cutting into the white
matter, a great number of small bloody points were discernible.
Chest. There were no remarkable appearances in the cavity of the
chest, with the exception of some congestion of the bronchial tubes,
connected with an attack of bronchitis, for which I had attended her
about a month before her death. The heart was perfectly healthy
throughout.
Abdomen. The liver was quite healthy; there were some adhesions
between this organ and the parietes of the abdomen, resulting, of course,
from the attack of peritomitis above mentioned. The stomach contained
only some gruel and toast and water; its mucous membrane was gene-
rally quite pale, with the exception of a few patches of congestion. The
intestinal canal was healthy throughout, and contained only a moderate

BY ROBERT HUNTER SEMPLE, M.D. 451
quantity of gas, and some feculent matter in no great abundance, and
of the natural appearance. No ulceration, constriction, or dilatation,
could be discovered anywhere, after the most minute and careful exami-
nation. The peritoneal surface of all the viscera was generally healthy,
with the exception of a few slight adhesions, the results of the attack
of peritonitis from which she had entirely recovered. The pancreas,
spleen, and kidneys were healthy. The uterus was small and healthy;
the right ovary was very much dilated, being as large as a hen's
egg, and when opened, it was found to contain about an ounce and a
half of pus, which was enclosed in a sac lined by a smooth membrane.
There was no effusion whatever into the peritoneal cavity.
REMARKS. It is very difficult to explain the cause of the symptoms
and the rapid death of the patient; and I can come to no other
conclusion upon this very curious and anomalous case, than that this
young woman's death was caused by an attack of meningitis, the peculiar
symptoms of which were wholly absent during life. In the heart and
lungs, there was no morbid appearance sufficient to account for the fatal
result; nor was there detected in the abdominal cavity any indication of
disease, which could explain, satisfactorily, the horrible pain which she
experienced in the abdomen, to which region she referred the whole of
her malady. The suppuration of the right ovary, which was probably
contemporary with the previous attack of peritonitis, was the only
important morbid appearance in the abdominal cavity; and, as this
abscess did not in any way communicate with the surrounding parts, it
cannot, I think, be considered as the cause of death. The greatest pain
was felt at the epigastrium, and pressure over the whole of the abdo-
men was attended with relief, not with aggravation of the symptoms;
and I therefore refer it to nervous sympathy with the diseased mem-
branes of the brain.” -
After relating the above cases, in the first of which there were no symp-
toms at all during life, and in the second the symptoms were referred
to a totally different region, I need hardly refer to others where the most
excruciating pain has been felt in the head, and where, nevertheless,
upon the death of the patient, no cerebral disease whatever has been
manifested. In the following case, it will be perceived that the most
marked symptoms of cerebral disease existed during life, and yet no
structural disease of the brain was discovered.
CASE III. DISEASE OF THE KIDNEY WITH ALBUMINoUs URINE, SIMULAT-
ING CEREBRAL DISEASE. Elizabeth W., act. 70, an inmate of the Isling-
ton Infirmary, was first seen by me on the 6th of January, 1848.
I found her labouring under symptoms which appeared to indicate a
cerebral affection. She was occasionally violent, uttering loud noises,
and complaining of great pain in the head; pupils fixed, somewhat
dilated; tongue brown, dry, and cracked; great thirst; pulse about
104, very weak and irregular. The limbs were in a state of spasmodic
rigidity, resisting every effort to change their position. I recommended
her head to be shaved, and a blister to be applied to the nape of the
* I confess that I have still some doubts as to the real nature of this case; but
whatever may be its true pathology, I can vouch for the strict accuracy of all the
facts. R. H. S. -
452 ILLUSTRATIONS OF DISEASES OF THE NERVGUS SYSTEM.
neck, and one to each temple. On the 8th of January, she was rather
better, and more quiet; the rigidity of the right arm had disappeared,
and the left was now rigid, with the fingers extended and separated.
Her urine was passed under her, and none could therefore be collected for
examination. On observing this woman, on several successive days, it
was found that the rigidity of the limbs was not constant, but varied on
different days, sometimes existing on one side, sometimes on another.
She remained in a hopeless state, with a fluttering, irregular pulse, and
dry cracked tongue; the intellect was wandering, but she sometimes
put out her tongue when asked to do so, and sometimes she answered
questions. She lingered till January 15, when she died.
Post-mortem eacamination. Head. The scalp and skull were healthy;
the dura mater was rather congested; the arachnoid membrane presented
no morbid appearance; the surface of the brain was healthy. The
brain itself was found to be healthy throughout, and of firm consistence.
Chest. The heart and lungs presented no peculiar appearance, except
that the former was somewhat thickened, and the mitral valves were
slightly diseased. Abdomen. The liver was of natural size, and of nut-
meg appearance. The kidneys were small, and their proper coat easily
separated, exhibiting a pale, mottled appearance beneath; the substance
of each kidney was firm, but granular and pale. Some urine was taken
from the bladder and examined. I should here observe, that there was
mo opportunity afforded for examining this fluid during life, as it dribbled
away from her without any apparent consciousness on the part of the
patient. The urine was turbid; and on the addition of nitric acid, a
copious deposit was produced, which was increased by heating the mix-
ture. Corrosive sublimate also threw down a copious white precipitate,
A small portion of the urine was examined by the microscope, and it
exhibited the tubular casts which are frequent in albuminous urine
accompanying renal disease. -
REMARKS. This case, therefore, which during life exactly resembled
one of structural disease of the brain, was really one of poisoning of
the blood by urea. There can be no doubt that the simple apopleary,
as it is called, is the result of albumimuria ; the albumen of the blood
in that disease being excreted by the kidneys, and the urea of the urine
remaining in the blood, and acting as a poison to the nervous centres.
This case is remarkable for the spasmodic rigidity exhibited by the mus-
cles, a symptom which is often described as characteristic of cerebral
softening; whereas in death from albuminuria, the patient is generally
in an immoveable or comatose condition.
CASE Iv. EPILEPSY ATTENDED BY HYPERTROPHY of THE CRANIAL
BonEs. Margaret Y., at. 46, formerly a servant, was obliged to leave her
place, many years ago, in consequence of frequent attacks of Epilepsy.
She was for many years a patient in the Islington Infirmary, and under
constant medical treatment for the above disease : the fits were frequent,
occurring at irregular intervals, and of a very violent character. In the
intermissions between the fits, her health was tolerably good, with the
exception of occasional headache; her intellectual faculties were quite
unimpaired. As she always derived benefit from blood-letting, her dis-
ease was considered to be of a congestive character, and a strict anti-
phlogistic regimen was adopted and maintained. She was on several.
BY ROBERT HUNTER SEMPLE, M.D. . 453
occasions cupped between the shoulders; blisters were applied, and kept
open in the same situation, and purgatives were administered. Her diet
was of the lightest character; no solid food or beer was allowed, and she
derived her support entirely from milk, eggs, bread, and thin broth, or
beef-tea. This treatment continued for several years with some advan-
tage, but no decided improvement. In May 1842, the fits became
more frequent and severe, typhoid symptoms supervened, and she died.
Post-mortem ea amination. The body was plump and well-formed,
and there was a layer of fat beneath the skin, about three quarters of an
inch in thickness over the abdomen; a rather remarkable fact, con-
sidering the tenuity of her diet. Head. The scalp was natural. The
skull externally presented no peculiar appearance, and no difficulty
was experienced in sawing it through. On removing and examining it,
however, it was found that there existed a remarkable want of uniformity
between the two surfaces of the skull in some parts, owing to thickening
of the Osseous structure, particularly of the internal table, which, instead.
of being thin and brittle, was thick and solid. Along the line of the
circular incision made by the saw, the skull was of about the average
thickness. The os frontis was then sawn through, immediately in front
of the coronal suture. Along the line of incision made in the usual
process of removing the calvarium, the thickness of the cranium was
one line and a half; but the part corresponding to the right frontal
eminence was half an inch thick; and the same part, on the left side,
was five lines in thickness. All the prominent bony processes were
much increased in thickness and asperity, as the crista galli, the pos-
terior clinoid processes, the bony ridge of the petrous portion of the
temporal bone, the ridges on the internal surface of the occipital, etc.
The dura mater was congested; the vessels of the arachnoid membrane
were also congested, and the membrane itself opaque and thickened;
beneath the arachnoid there were two or three drachms of bloody serum.
The brain was flattened in front, the flattening exactly corresponding
to the thickening of the internal table of the skull. The substance of
this organ was very firm in its consistence, and the grey part was of an
unusually dark colour; in other respects it presented no remarkable
peculiarities. The other organs were carefully examined, but no morbid
appearances of importance were discovered. -
CASE v. HYDATIDs LYING BENEATH THE ARACHNOID MEMBRANE.
Elizabeth B., aet. 46, an inmate of the Islington workhouse, of diminu-
tive stature, of bloated, leucophlegmatic appearance, and of rather torpid
intellect, who, although long a resident in the workhouse, had not
suffered from any remarkable ailment, was brought to the surgery on
Monday, Dec. 28, 1846, in consequence of serious illness. At that
date, her face was swollen, the lips were livid, and the whole body was
amasarcous. She complained of cough and difficulty of breathing, and
general uneasiness. On examining her chest, I found no morbid
sound over the region of the heart; but sibilant rāles were heard over
the region of the lungs. She was ordered some medicine, and to be:
removed to the infirmary. The next day, she was much worse, the
bloated anasarcous appearance still remained, and, in addition, she.
seemed to be sinking into a state of coma, her breathing being sterto-.
454 ILLUSTRATIONS OF DISEASES OF THE NERWOUS SYSTEM.
rous, her pulse very feeble, and her extremities cold. An attempt was
made to administer some medicine, but she was unable to swallow.
Mustard poultices were ordered to the feet. The pulse, however,
became wholly imperceptible, the breathing quiet, the pupils in a fixed
state between contraction and dilatation, and she died Thursday, Dec. 31.
Post-mortem ea amination. The body, generally, was oedematous;
the subcutaneous areolar tissue being infiltrated with serum.—Head.
The scalp and skull presented no morbid appearance, but the surface of
the dura mater exhibited considerable congestion. The arachnoid mem-
brane was generally healthy and transparent, and only a small quantity
of fluid was effused between its layers. On examining the surface of
the brain beneath the arachnoid membrane, I observed some semi-
transparent masses in one or two places: I at first considered them to
be local effusions of serum, but on examining them more closely, I
found that they could readily be detached from the surrounding tissues,
and were, in fact, hydatids, each consisting of a flask-shaped mass,
having a thick skin and gelatinous interior. I now instituted a diligent
search for these hydatids in all parts of the brain. Many of them were
found on the exterior, lying between the sulci, and overlapped and hid-
den by the convolutions, all being beneath the arachnoid membrane.
One hydatid was found lying free and unattached in the left ventricle;
this was much softer than the others, and resembled a small oval mass
of jelly of a yellow colour; another, much smaller and rather hard, was
found lying upon the optic nerve, on the right side, at the part where
the nerve winds round the crus cerebri. Altogether, about eighteen of
these hydatids were collected, varying in size from that of a bean to
that of a small pea; there were also a number of others scattered about
in various parts of the brain, but so small, that they could not be ex-
tracted entire. They did not exist so abundantly in the white as in the
cineritious substance, and they were wholly wanting in the cerebellum.
No hydatids were found in any other part of the body. Chest. The heart
was quite healthy. The lungs were also healthy, except that the mucous
membrane of the bronchial tubes was thickened and reddened, and con-
tained a considerable quantity of frothy mucus. Abdomen. The viscera
of the abdomen were all healthy. As the bloated anasarcous appear-
ance of this woman gave rise to some suspicion of renal disease, the
kidneys were carefully examined, but were found perfectly healthy.
Some of the hydatids were sent to my friend Dr. Sharpey, who
recognised them as examples of the cysticercus cellulosa ; and the speci-
mens are now preserved in the museum of University College, London.
REMARKs. The presence of hydatids in the brain is, no doubt, a
very rare occurrence; and although the fact of their existence in that
organ has been mentioned by some writers, yet it would appear that they
have often been confounded with common cysts, and that, in particular,
a beaded or vesicular appearance of the choroid plexus has sometimes
been mistaken for a cluster of hydatids. I have, however, seen a
coloured plate, by Dr. Carswell, in the museum of University College,
which represents a number of subarachnoid hydatids, similar to those
which I have above described. Dr. Copland, in his excellent Dictionary,
article “ Brain,” mentions the fact of the existence of hydatids on the sur-
face of the brain, but does not quote any case from his own experience.

BY ROBERT HUNTER semiple, M.D. 455
Dr. Abercrombie, in his work upon the Diseases of the Brain and Spinal
Cord, alludes to the existence of hydatids on the brain, but gives no
case from his own investigations; and he moreover appears to include
the vesicular appearance of the choroid plexus among hydatid growths,
or at least he considers that this appearance has been mistaken for
hydatids by those who have described such formations. Mr. Solly, the
most recent writer upon the brain, alludes also to the existence of
hydatids in that organ, but gives no case from his own practice. Cru-
veilhier states that he has met with hydatids beneath the arachnoid
membrane, but gives only one illustration, which appears, however, more
like a large cyst, than a true example of a cysticercus.
CASE vſ. CongBSTIVE DISEASE, AFFECTING THE FIFTH PAIR OF NERVES
oN THE RIGHT SIDE. Elizabeth B., atat. 54, a healthy-looking woman,
has generally enjoyed good health, with the exception of suffering occa-
sionally from indigestion, and once from an attack of pneumonia, two
years ago. About six weeks from the date of the present report (early
in October 1841), she first experienced slight dimness of sight in the
right eye, which, however, on examination, did not present any peculiar
appearance. At that time she also complained of a pricking, shooting
pain in the same eye, together with pains in her forehead, face, and right
ear. Since that time the pain has become gradually worse, and her
health has been much impaired. - .
On a careful examination, on the 13th October, the following were
the features of her case. She complains of a shooting, throbbing,
burning pain in the right eye, and a sensation, as she expresses it, as
if the eye-ball were too large for its socket. The same kind of pain
extends to the forehead as far as the vertex, backwards to the ear and
occiput, and down the neck; to the right side of the nose, as far as
the external aperture of the right nostril, and to the upper maxillary
bone; the pain originating at the situation of the infra-orbital foramen.
The upper eyelid is completely drawn over the ball of the right eye, so
as entirely to obstruct vision. She has no power to lift it up; and
the attempt to draw up the lid causes excruciating pain and violent
action of the orbicularis palpebrarum. When the lid is elevated, although
this is done with great difficulty, she is able to see very distinctly; there
is no peculiar appearance presented by the eye itself; except that the
pupillary aperture is oval instead of round. -
She states that, since her illness, her hearing on the right side has
been impaired : the power of smelling and of taste are, however, quite
perfect. The pain in the parts above described is not constant, but
subject to remissions and violent exacerbations, and is much increased by
pressure on the regions affected. She complains of derangement of her
general health; she has a sour taste in her mouth; no thirst, nor any
desire for food; she has vomited several times this morning; bowels
moderately open ; urine scanty and high-coloured; tongue covered with
a thick white fur; pulse 84, regular. -
From a review of these circumstances, I came to the conclusion, that
this woman was suffering from a neuralgic affection of the fifth pair of
nerves, the ophthalmic division of that pair being chiefly concerned.
The pain of the surface of the eye was evidently neuralgic, the spasmodic
WOL. II. 3
456 ILLUSTRATIONS OF DISEASES OF THE NERWOUS SYSTEMI.
closure of the lid was produced by reflex action; the oval shape of the
pupil was due to sympathetic irritation of the lenticular ganglion. At
that time, I considered the case to be a combination of neuralgia and
dyspepsia, and perhaps hysteria; but its progress convinced me that
the disease was more deeply seated, and affected the origin, not the
extremities, of the nerves. Acting under the impression that the dis-
ease was neuralgic or dyspeptic, I directed a blister to be applied to the
right temple, and she was ordered to take, every four hours, a draught
composed of ten grains of carbonate of magnesia and one drachm of
sulphate of magnesia, in peppermint water.
Oct. 15. Feels rather better; and, on the whole, the pain is somewhat
diminished. She can lift the upper eyelid to the extent of about a
quarter of an inch, but with pain and great effort. The eyelid is very
tender to the touch. The general health is much improved; tongue
much cleaner, but still slightly furred ; vomiting has ceased; bowels
open ; no sour taste in the mouth; pulse 84, regular.
Oct. 16. Feels much worse; has had no sleep the whole of last night,
in consequence of excessive pain in the parts above described. As I
now believed that the symptoms were owing to inflammatory action or
congestion at the origin, or in the course of the ophthalmic division of
the fifth pair of nerves, I ordered the following: five grains of pilula
hydrargyri to be taken twice a day, and a draught to be taken every four
hours, consisting of two-thirds of a grain of tartar emetic, half a drachm
of sulphate of magnesia, and an ounce of infusion of senna.
7 P. M., same day. She has taken two doses of the medicine; the first
produced no marked effect; the second excited copious vomiting, fol-
lowed by a violent convulsive fit, attended with foaming at the mouth.
On my visiting her soon after this attack, she was lying in a state of
torpor, and could not answer the questions put to her. I could now lift
up the right eyelid without apparently exciting any pain, but the eye-
ball was drawn in different directions by the convulsive action of the
recti and obliqui muscles. The pupil contracted and dilated, but its
margin was irregular, assuming a somewhat triangular appearance; pulse
100, strong and incompressible. She was now bled to sixteen ounces.
While the blood was being drawn, she was seized with violent attacks
of rigidity of all the muscles, which ceased after lasting a few minutes.
She appeared now to be only partially sensible, groaned occasionally,
and drew her breath heavily and laboriously.
11 P.M. Breathing now hardly perceptible, except at intervals, when
she takes two or three deep inspirations. There is constant rigidity of
both lower extremities; the upper extremities are also rigidly fixed,
although they are now and then relaxed for a short time. The lower
jaw is firmly closed, and any attempt to draw it down is opposed by the
violent contraction of its muscles. The muscles of the face are not
rigid, and both the lips and eyelids can be freely drawn in any direc-
tion. The pupil of the right eye varies very much in figure, but is
never round. There is not much spasm of the muscles of the back or
abdomen, although both appear slightly rigid when pressed upon; pulse
80, soft and compressible.
Oct. 17. The rigidity of the muscles has continued with intermissions
throughout the night, during a part of which she was delirious. Blood
By ROBERT HUNTER SEMPLE, M.D. 457
not buffed nor cupped; pulse 80, soft. Since seven o'clock this morn-
ing, she has been sensible, and answers questions quite rationally. She
has now perfect power over all the voluntary muscles, except that she
is unable to raise the right eyelid. The pain caused by the attempt to
draw it up with the finger is more intense than formerly; tongue dry,
and covered with fur; no thirst ; skin dry; bowels not relieved since
six o'clock last night, when she had a copious foetid evacuation; has
passed no urine for twenty-four hours; breathing natural. The follow-
ing course was now adopted: a solution of the extract of belladonna
(gr. v to 3i of water) was dropped into the eye, poured upon the blistered
surface on the right temple, and applied to the whole of the right eyelid,
and adjacent parts, by means of a linen rag. The following was also
ordered: calomel gr. j, blue pill gr. iij; a pill to be taken every four
hours. In three minutes after the application of the solution of bella-
donna, as above described, the pain in the eyeball ceased, and she ex-
pressed it as being benumbed.
Oct. 18. Feels rather better. The fits of spasmodic rigidity occurred
last night nearly every ten minutes, but they ceased at 1 A.M.; and after
that time she had some tranquil sleep. She is now quite sensible, and
has passed about a pint of urine, which has deposited a copious white
sediment. The pain in the eyeball is less; she says it is benumbed,
but exposure to light gives considerable pain; there is pain in the left
lumbar region; bowels confined; pulse 76, rather hard. To have half
an ounce of castor oil immediately, and to continue the pills of calomel
and blue pill. -
8 P. M. Feels much better, and the pains are much relieved. The
right eyelid can be lifted up without much suffering, but she cannot
raise it by her own exertions. The bowels have been opened, and the
stools are copious; she has passed urine once, which is dark-coloured
and of an offensive ammoniacal odour; pulse 80, soft and compressible ;
tongue and skin dry; she is now quite sensible. She has had three
spasmodic fits since the morning, but they lasted a very short time.
Oct. 19. Improving; has had no spasm since the last visit; has slept
from two till six o'clock this morning; the pain in the right eyeball and
eyelid is diminished, and these parts are less tender on pressure; the
attempt to raise the lid by the finger is also less opposed by the action
of the muscle, but she is still unable to raise it herself; pulse 80, soft
and full; gums rather tender. The solution of belladonna was again
applied to the blistered surface of the right temple. To continue the
pills. - -
p Oct. 20. Considerably improved; she has had no spasms during the
might; the pain is relieved, and she does not now suffer any inconve-
nience in any part of the body; the eyelid is still drawn down, and the
tenderness of the eyeball remains, but not so remarkably as before.
As her gums were sore, she was now directed to discontinue the pills,
and to take some aperient and diuretic medicine. Under this treatment
she rapidly improved : the secretions became natural, the tenderness of
the eyeball wholly disappeared, and she regained the perfect power of
raising the lid. She was discharged cured on the 26th of November;
and although I had frequent opportunities of seeing her afterwards, she
never had any return of the complaint. an a
30
458 ILLUSTRATIONS OF DISEASES OF THE NERVOUS SYSTEM.
OBSERVATIONs. I think that there can be little doubt, that this was
a case of local congestion of the brain, involving the origin of the fifth
pair of nerves on the right side. It will be seen that all the parts sup-
plied by the ophthalmic branch of this nerve were acutely painful, and
that the pain was also traced to the parts supplied by the superior
maxillary nerve ; the motor part of the inferior maxillary nerve was
also affected, as was proved at one period of the disease, by the spasmo-
dic closure of the jaw. The pain and spasms in other parts of the body
are explicable, by recollecting the numerous communications of the
ramifications of the fifth pair with other nerves. That it was not a case
of mere neuralgia is, I think, proved by the foregoing detail of the
general symptoms, by the incessant pain and tenderness of the parts
supplied by the ophthalmic nerve, and by the decided benefit afforded
by blood-letting, purgatives, and mercury; for it will be observed, that
the abstraction of blood was attended by marked relief, and that as
soon as the mouth became affected, the symptoms began to disappear.
It is almost needless to remark, that the case could not have been one
of hysteria, which, in some respects it nearly resembled; for the patient
never had any similar attack either before or since, and she was of rather
advanced age ; and the reasons just adduced to prove that the case was
not one of neuralgia, will a fortiori prove that it was not hysteria; for
hysterical affections are not relieved by bleeding, purging, and mercury;
nor do they allow of so complete a cure as that which was effected in
the present case. The state of the pulse, the absence of heat of the
head, and other obvious circumstances, preclude the supposition that
the case was one of inflammation of the brain; and on the whole, I am
inclined to adhere to the idea that it was one of local congestion ; a view
which, I think, will explain satisfactorily both the symptoms of the case
and its successful treatment.
GENERAL OBSERVATIONS ON CEREBRAL DISEASEs. I do not pre-
tend to draw any general deduction from the foregoing cases, which
are altogether of an anomalous character. They are quoted chiefly
for the purpose of illustrating the extreme difficulty of investigating
satisfactorily the phenomena of Cerebral Disease. But, while I re-
serve to myself, upon some future occasion, the further inquiry into
the pathology, the diagnosis, the varieties, the classification, and the
treatment of the Diseases of the Nervous System, I think I may add
the following practical observations, which, though somewhat indefinite,
are perhaps as precise as the nature of the affections, now under consi-
deration, will allow. . -
1. Symptoms. It must be always borne in mind that cerebral symp-
toms, although exceedingly alike in their manifestations, proceed from
causes wholly different from one another. Convulsions may arise from
dentition, from inflammation of the cerebral membranes, from the pres.
sure of exostoses, or of a spiculum of bone, from the presence of undi-
gested or indigestible matter in the alimentary canal, from worms, from
uterime irritation, or from toxaemia. The abolition of sense or motion,
or that condition called coma, may be caused by narcotic poisons, by the
inhalation of deleterious gases, by drunkenness, by congestion of the
cerebral vessels, by effusion of blood or of serum within the cranium, by
BY ROBERT HUNTER SEMPLE, M.D. 459
softening of the brain, or by the presence of tumours or hydatids, and
also by toxaemia. The perversion of the intellectual powers may be due
to causes purely mental, as sudden and violent emotions of joy or sor-
row; or to the immediate effects of alcoholic drinks, cocculus indicus, and
other drugs, as in delirium ferox; or to the abuse of intoxicating liquors,
as in delirium tremens (a disease which depends upon the exhaustion
of the powers of the Nervous System by excessive and long-continued
stimulation); or to inflammation of the brain or of its membranes.
2. Classification. It follows from the foregoing remarks, that the
only true basis of the classification of the Diseases of the Nervous Sys-
tem is pathology; and that such terms as apoplexy, epilepsy, and hydro-
cephalus, (words embracing in each case a group of symptoms which
may proceed from very different causes), should be discarded from our
Nosology, and be employed only to conveniently express certain classes
of associated phenomena.
3. Pathology. The pathology of the diseases of the Nervous System
is to be diligently sought for by post-mortem examinations. In making
this remark, it must be admitted that, in the present state of our know-
ledge, the seat of disease in the nervous centres cannot always be pre-
cisely determined by the scalpel of the anatomist. But in all fatal
cases, the inquiry should be made; and I have no hesitation in stating,
that no person can give a positive opinion upon a fatal case of Nervous
Disease, unless such an examination have taken place. I should also
add, that he who undertakes the task of investigating the morbid
anatomy of the nervous centres, ought to prepare himself, by becoming
thoroughly acquainted with the appearances and peculiarities of the
healthy structures, and should likewise examine the phenomena pre-
sented by the brains and spinal chords of persons who have died with-
out any known or recognized symptoms of Nervous Disease. No post-
mortem eaſamination can be considered complete, unless the state of the
brain at least has been carefully investigated, even although the patient
has died of some disease apparently wheonnected with the nervous system.
Chemistry and the microscope are probably destined to throw much new
light on the morbid anatomy of the Nervous System.
4. Diagnosis. It is of the utmost importance that the diagnosis of
cerebral diseases, although exceedingly difficult, should be as accurate
as the circumstances will allow; for upon correct views in this particu-
lar, will often depend the life of the patient and the credit of the prac-
titioner.
5. Treatment. It cannot be too strongly insisted upon, that the
treatment must depend, not upon the name given to the disease, but upon
its pathology as indicated by its diagnosis. One case shall be benefited
by emetics and cold affusion ; a second shall yield to opium and brandy;
a third shall require physical restraint; a fourth shall be subdued by
copious bleeding; a fifth shall require in addition the use of calomeland
purgatives; a sixth shall with propriety be left to take its course. All
these modes of treatment, judiciously pursued, are advisable in particu-
lar cases; but when erroneously applied, may lead to irreparable mis-
chief. Upon the details of treatment, it is not my intention at
present to enlarge; but I cannot conclude without emphatically con-
demning the indiscriminate employment of the lancet in all cases of
460 ORGANIC LISEASES OF THE HEART,
cerebral disease, attended with insensibility, or with perversion of the
intellectual powers; while, on the other hand, I cannot too highly
extol the copious abstraction of blood in appropriate cases. The state
of the pulse I believe to be an unfailing criterion as to the necessity of
blood-letting, which, when performed judiciously, and in time, has often
in my own experience, and no doubt in that of many others, succeeded
in averting the most formidable and fatal attacks of Cerebral Disease.
8, Torrington Square, March 1850.
ON THE PROGNOSIS AND TREATMENT OF ORGANIC
DISEASES OF THE HEART.
By CHARLEs J. B. WILLIAMS, M.D., F.R.S.
[Concluded from last Number, p. 320.]
WE find, then, that STRUCTURAL DISEASEs of THE HEART are by no
means universally dangerous or fatal in their tendency; but that they are
so in proportion as the circulation becomes seriously impaired, either
through the extent of the cardiac lesion, or through the additional dis-
ordering influence of an ill-proportioned quantity, or a depraved quality,
of the blood. It is therefore obvious, that it should be the object of the
TREATMENT, in maladies of this nature, to counteract or correct, so far
as is possible, those influences which may give to each case a formidable
character, and to place the patient under circumstances that shall favour
and aid the damaged organ in carrying on the work of the circulation.
Nor are these objects so unattainable in the plurality of cases, as might
be expected from the vital value of the organ implicated. I know of
few instances of structural disease of an important viscus that admit of
more mitigation, under judicious treatment, than many Organic Affec-
tions of the Heart; and the examples, to which I have already alluded,
of these affections enduring for a very long period, gradually increasing
to a prodigious extent without destroying life, and sometimes without
greatly sacrificing the comfort of the patient, give further proofs that
the powers of adaptation and endurance, in this most vital of all organs,
are far greater than is commonly imagined.
It may readily be inferred from my former remarks on Organic Dis-
eases of the Heart, that the benefit which the subjects of them derive
from medical treatment, depends on neither the activity or energy of
the practice employed, nor on any uniformity of plan. In this, as in
most intelligible cases of disease, the best practice is that rationally
adapted to varying elements of disorder, with a view to restore that
balance of functions which is most favourable to the easy action of the
defective organ. .
I have already noticed the prevailing tendency among many practi-
tioners to treat Organic Diseases of the Heart by sedatives, and other
lowering or reducing measures; but, according to my experience, such
treatment is applicable only to periods of excitement or exacerbation,
and the plan most generally useful, is one calculated to sustain the
BY CHARLES J. B. WILLIAMS, M.D., F.R.S. 46 l
powers of the circulation. There is much that is fictitious and partial
in the inordinate action and palpitation of a diseased heart. The violent
knock against the ribs, and the strong throbbing in the large arteries,
are evidences of a force that is misdirected and ineffectual rather than
excessive; for, at the same time, the pulse of distant arteries is scarcely
to be felt, the extremities are cold, and the capillary circulation generally
feeble. Hence, although sedatives may be beneficial as temporary
expedients, measures of a sustaining and strengthening nature are more
permanently useful. Organic lesions of the heart, in most instances,
impair its propulsive power; and it is quite reasonable to expect most good
from the means which shall have a contrary influence, by augmenting
the steady strength of the organ, by improving the quality of the blood,
and by promoting its equal distribution by the removal of obstructions
and congestions. It is equally apparent, on the other hand, that these
objects are not to be fulfilled by mere stimulants and tonics. The
fact is quite familiar to practitioners, that in many instances of Heart
Disease, the common spirituous and ethereal stimulants, and the stronger
tonics, such as iron and quinine, aggravate the symptoms, and induce
attacks of palpitation, oppression, and lividity. Yet this, as well as the
opposite class of remedies, is not only borne, but proves most salutary
at a proper season and under fitting circumstances. In order to know
these seasons and circumstances, it is necessary to revert to the sketch
of the pathology of Diseases of the Heart, already given in relation to
Prognosis, and to consider it again in its application to practice.
We may conveniently consider the subject under the following heads
of INDICATIONS OF TREATMENT. -
1. To regulate and promote the moderate and efficient Action of the
Heart itself.
2. To improve the Quality, and regulate the Quantity and Distribution
of Blood throughout the body.
3. To prevent or counteract the Lesions of Function and Structure
which supervene in other organs, in the progress of Heart-Disease.
1. The treatment addressed to the Condition of the Heart itself will
vary considerably, not only in different cases, but in the same case at
different times. At early periods of organic disease, whether of the
valves, investments, or muscular structures, there is commonly a ten-
dency to excitement, manifested by increased action, palpitation, and
sometimes pain or some kind of uneasiness in the cardiac region. In
inflammatory and plethoric subjects, this excitement may either amount
to inflammation, or assume some of those forms of excessive and vitiated
local nutrition, which tend to further disorganization of the organ.
Under such circumstances, there can be no doubt of the propriety of
antiphlogistic measures, proportioned to the severity of the symptoms.
In the absence of marked plethora or decided pyrexia, local depletion
or counter-irritation will generally suffice, especially if aided by the
means afterwards to be noticed for reducing the stimulating property
of the blood. -.
The instances in which general blood-letting is called for in Organic
Diseases of the Heart, are, according to my experience, rare. I do not
deny that it will often, for the time, relieve strong action of the heart
and vascular excitement more promptly than any other means; but it
462 ORGANIC DISEASES OF THE HEART.
generally leaves afterwards a weakness and irritability of the organ,
which unfits it for the regular work of the circulation, and which, there-
fore, so tends to the recurrence of congestion, oppression, and excitement,
as to call for a repetition of the blood-letting. Thus the blood becomes
impoverished, and the constitutional powers lowered; and not only is
there added the complication of anaemia, which I before noticed as a
common result of such treatment, but the power of the excreting organs
fails also, and cachaemia, dropsy, and degenerations, may ensue. Asin other
cases of defective organization, it is a great object to sustain the consti-
tutional powers; and we must not lose sight of this in our endeavours
to reduce local inflammation and temporary excitement.
Cupping, leeching, and blistering in the region of the heart, aided by
mild mercurials, antimonials, sedatives, and Salines, with moderate diet
and rest, will be found safer measures than venesection, and are gene-
rally adequate to reduce the excitement of the heart, even in inflamma-
tory and plethoric subjects. Dry cupping extensively used,” and counter-
congestion by hacmostatic ligatures on one or more limbs, (as for vene-
section), are also available means for relieving the heart from the weight
and stimulus of the blood, during periods of temporary sthenic excite-
ment.
But in many examples, particularly in persons of nervous tempera-
ment, in females, and in connexion with dyspeptic and other sym-
pathetic disorders, the excitement of the heart is much more nervous
than vascular. The suddenness and variability of the paroxysms of
palpitation or painful action; their disproportion to other symptoms;
the prevalence of other signs of nervous excitement or disturbance, such
as 'spinal or superficial cutaneous tenderness, various spasms, globus
hystericus, copious diuresis, etc., will generally guide to the distinction
of this kind of inordinate action : and if the subject be not positively
anaemic, there will generally be sufficient evidence of the absence of
any real strength in the vascular system, in the general pallidity and
low temperature of the surface and extremities, and the weakness of the
pulses in the limbs, as compared with those of the palpitating heart.
Under such circumstances, nervous sedatives are more appropriate than
depletion; and local irritation or partial fulness of blood is sufficiently
counteracted by derivants, evacuants, and means which increase the
natural excretions. Of the class of nervous sedatives, those which have
an obvious influence on the Heart are to be preferred, especially the fol-
lowing, which I place in the order in which I find them most effectual :
hydrocyanic acid, aconite, digitalis, camphor, and henbane. The sedative
action of all these is promoted by combining them with an alkaline car-
bonate, which fulfils another indication to be noticed hereafter. In the
hysterical, or otherwise more nervous kinds of palpitation, the medicines
generally called antispasmodic, such as the foetid gums, valerian, bella-
*To save the blood by dry cupping, the exhaustion of the glass should not be
carried so far as to induce much ecchymosis. If blood be extravasated, it is lost as
blood; and if reabsorbed, can be useful only through a new process of solution and
assimilation. Even in the process of counter-congestion, the blood may be injured
by long stagnation; as I have shown it to be spoiled and unfit for further use, after
it has been long pent up in congested organs in intermittent and adynamic fevers.
Principles of Medicine, second edition, pp. 118, 196. & . . *


BY CHARLEs J. B. WILLIAMS, M.D., F.R.S. 463
donna, stramonium, and aether, mostly in conjunction with the volatile
alkali, will be found to afford more relief. It is curious to observe how,
under the influence of some of these which may be considered stimulant,
the heart's action sometimes becomes calmed; but it would be com-
monly found in such cases, that although the organ throbs violently, it
does not effectually expel its contents, and the pulse of distant arteries
is extremely weak: the diffusible stimulant, by exciting a more emergetic
contraction, propels the oppressive load of blood, and restores the
equality and quietude of the circulation. The combination of the two
kinds of medicaments, the nervous sedatives with the muscular stimu-
lants, is neither irrational in theory, nor inefficacious in practice; for I
have frequently obtained from the united operation of hydrocyanic acid
and Valerian, aconite and galbanum, or digitalis and aether, marked
advantage, which the agents separately failed to afford. Another
expedient which, in a few instances, has proved very effectual in sub-
duing the violent action of a palpitating heart, is a copious draught of
cold water. This may operate sympathetically, by soothing the heated
and irritable surface of the stomach; but I am inclined to consider its
operation in some measure direct on the heart itself, which is quite near
enough to the stomach and aesophagus to receive the impression of
cold from a large bulk of water. Small pieces of ice swallowed in
succession have a similar effect.” This measure would not be expedient
in persons liable to syncope; for this opposite condition may result
from the sudden reduction of the palpitation by cold. •
The measures hitherto recommended are chiefly of a temporary
nature, to subdue or moderate excessive action of the heart, when it is
first developed, or aggravated during seasons of excitement. There
are others of more permanent operation, inadequate and even unsuited
for these occasions, but applicable in the intervals between the attacks,
to which they in some measure may prove preventives. I allude to
the agents generally called tomic, which are, much more generally than
is commonly supposed, applicable to the treatment of the Organic Dis-
eases of the Heart. Much caution and discretion are necessary in their
selection and administration. Thus, in the more inflammatory cases,
nothing stronger than the mineral acids or weak vegetable astringents may
be borne. A class somewhat less sthenic may tolerate and receive bene-
fit from salts of zinc or silver, tannic or gallic acids, and weak chalybeates
combined with salines. A third group, bordering more on the anaemic
and irritable condition, with much action but no strength, bear the
more decided tonics of iron and quinine; especially when guarded by
some of the sedatives before noticed, such as hydrocyanic acid, aconite,
etc. But for the useful and even safe administration of all tonic reme-
dies in connexion with an injured and irritable heart, it is essential that
the secretions be free; and, in order to ensure this, it is often necessary
to resort to the means to be presently noticed, as tending to maintain
the purity of the blood. It is quite intelligible that tonics, which, in
a relaxed system with free secretions, fortify the muscular and vascular
* In my experiments on animals, the power of slight applications of cold water,
to moderate the turbulence and increase the steady force of the exposed heart, was,
in some instances, very remarkable; but when freely used, it caused a quivering
contraction, which soon suspended all movement. .
464 ORGANIC DISEASES OF THE HEART.
fibres by bracing them and promoting their contractile power, may
further obstruct those secreting organs whose function is imperfect, and
thus add to the disorder which their failure occasions.
We have next to notice the opposite dynamic condition of the Dis-
eased Heart, that of defective action. In many instances, this is com-
bined with irregularity of rhythm, or inequality of pulse; but the
irregularity and the failure are by no means proportioned to each other;
for weak hearts sometimes show no intermission in their action; and
considerable irregularity may occur without any prominent signs of
weakness. Still, as a general rule, it may be laid down, that irregularity
of rhythm, and inequality of strength in the pulse, belong to the class
rather of defective than of excessive power of the heart, especially as
regards its efficiency in carrying on the circulation. More or less irre-
gularity or inequality of pulse is commonly observed in connexion with
the following organic lesions, which distinctly impair the propulsive
power:—Extensive valvular disease, especially of the mitral orifice:
dilatation with or without moderate hypertrophy; fatty degeneration
and softening, connected with partial obstruction of the coronary arteries.
Advanced stages of severe pericarditis, and adhesions of the pericardium,
present a remarkable kind of inequality, and even intermission, in the
radial pulse, whilst the heart's pulsations are quite regular; in fact,
some of the latter are too weak to reach the wrist, hence the irregularity;
and I have distinctly ascertained that the weak, or deficient beats, are
those corresponding with inspiration, whilst the stronger pulses are
those enforced by the expiratory act, which thus helps the weak heart,
and augments its propulsive power. So it often happens, that the act
of coughing gives a momentary strength to a weak pulse.
It must not be inferred from the preceding remarks, that irregular
action is necessarily connected with organic disease. Nothing is more
common, than to find the heart acting irregularly when exhausted from
fatigue or other undue excitement; or when disturbed by deranged
digestion, bilious disorder, or a gouty, or otherwise depraved state of
the blood. These conditions are only temporary, and amenable to
treatment; but if the irregularity should continue for several weeks, in
spite of treatment, there is reason to suspect the existence of structural
disease; and, in the absence of signs of valvular lesions and dilatation,
fatty degeneration or softening may be apprehended.”
It may well be anticipated, that the chief remedies to be recommended
for defective and irregular action of the heart, are of the stimulating
and sustaining kind; but although this so far holds good that it may be
taken as the rule, it cannot be applied without considerable qualification
* Obstructive lesions more particularly. In my experiments on animals, I
found that nothing disturbed the regularity of the heart's action so much as obstruc-
tion of the left auriculo-ventricular orifice, by pushing the walls of the auricle into
it with the finger. -
* A very complete and interesting memoir on Fatty Diseases of the Heart has
recently been read to the Royal Medical and Chirurgical Society, by my friend Dr.
R. Quain; and, when published, will be found to contain the most valuable inform-
ation on the history and pathology of these affections. Dr. Quain has completely
verified my inference, that fatty degeneration is a chemical change, like the spon-
taneous change of muscle into adipocere. [An abstract of this paperwill be given in
our Reports of Societies, which, from the unexpected length of the Original Articles
in the present number, we are reluctantly obliged to defer till June. EDITORs.]

BY CHARLES J. B. WILLIAMS, M.D., F.R.S. 465
and tact. The same organic lesion in the heart which forms an objection
to the unguarded use of depletion and reducing means during inordi-
nate action, is an obstacle to the free administration of stimulants and
tomics during depressed or irregular action. It must not be forgotten
that we have to deal with a damaged mechanism, which, in a state of
weakness, may as ill bear the goad of a stimulant, or the bracing of a
tonic, as, in a state of excitement, it can sustain the loss of much blood,
or of that which contributes to its regular support. In syncope, or
extreme weakness, with a healthy heart, we need not fear to excite its
failing powers by strong stimulants, and to maintain them by the most
bracing tonics; but in a diseased organ, similar forced excitement may
strain, irritate, or rupture the faulty structure, before it can restore the
balance of the wanting power.
It often happens, therefore, that we have to premise or combine with the
use of stimulants and tonics, means to relieve the heart of some of the op-
pressive load which it cannot propel. A few leeches, a moderate cupping,
or a blister over the heart, or, in slighter cases, derivants to the extremities
and secreting organs, may accomplish this end, and enable the stimulant
to operate on the contractile power of the organ with greater certainty
and safety. So, too, the various aids to an embarrassed circulation,
afforded by warmth to the surface and extremities, gentle friction, and
appropriate changes of posture or exercise, will generally be needed
during the continued action of tonics. With due attention to these
points, most cases of Organic Disease of the Heart with defective action
may be bettered for a time with tonics; and if under this treatment the
local lesion, being of the nature of chronic inflammation, should show
any tendency to increase, counter-irritation, with the moderate internal
use of mercury or iodide of potassium, may be employed to counteract
it. The tonics most suitable to augment the strength of the heart have
already been noticed; for the condition of habitually defective action,
the strongest kinds, if borne, are to be preferred, such as iron, quinine,
tannic and gallic acids. Advantage sometimes results from combining
two of these that do not form an insoluble compound, as sulphates or
citrates of quinine and iron or zinc, and tannate of quinine. But the
selection must also much depend on the condition of the blood as well
as on that of the heart, and to this subject we now proceed.
2. The regulation of the Quantity and Condition of the Blood is an
object of great importance in diseases of the organ which, more than
any other, is liable to be influenced by the blood. But it will not be
needful to dwell long on the means by which this indication is to be
fulfilled, because they are the same as are usual in diseases of the blood.
Thus, in states of plethora, the excessive quantity and richness are
reduced by depletion, evacuants, and low diet; but, for reasons before
stated, it is needful to take care that these be not carried too far. In
asthenic plethora, the purification of the blood, by increasing the secre-
tions and promoting its more active and steady circulation, is of more
avail than depletion; this subject will again claim our attention. A
cause of temporary plethora, which often seriously operates in aggravat-
ing Heart Disease, is too liberal an indulgence in liquids of any kind,
especially during meals. Experience often teaches patients the ad-
vantage of moderation in this respect; and as copious libations at meals
466 OHGANIC DISEASES OF THE HEART.
are more the result of habit than of real want, and are frequently sub-
stituted for slow and careful mastication, there is good reason to dis-
courage them. If thirst should prevail, or if a freer supply of liquid .
is wanted to help the processes of elimination, water, or some very
simple beverage, may be taken on an empty stomach, when it is more
speedily distributed through the alimentary canal, and, being absorbed,
promptly passes off by the kidneys and skin.
I have already adverted to the common combination of structural
Disease of the Heart with anaemia or chlorosis. As before hinted, the
scantiness and poverty of the blood is frequently the result of the inju-
dicious employment of depletion, low diet, confinement, and other
lowering measures, by which it has been erroneously supposed that
Diseases of the Heart are to be controlled. In other instances, however,
especially after rheumatism, by whatsoever means treated, the anaemic
condition arises spontaneously; and apparently proceeds from want of
power in the system to renew the blood that becomes depraved and effete
by the morbid changes which have taken place in it. After other acute
diseases, such as inflammations and fevers, which injure the quality of
the blood, the same deficiency of red particles often occurs; and if
there be a lesion of the heart present, its impairing influence on the
circulation is more seriously felt. The treatment usually proper for
anaemia is required for these cases; and I have before mentioned, that
the heart symptoms are ultimately relieved, as the heart and vessels be-
come invigorated by more and better blood: but here too, the presence of
the Heart Disease renders it necessary to proceed cautiously and slowly
in the administration of iron and other tonics. The first doses often
aggravate the pain and palpitation of the heart; and it is therefore ex-
pedient that they should be small, and combined with hydrocyanic acid
or some other sedative, and increased gradually, so soon as they are
tolerated. As, in most cases of chlorosis, the secreting organs commonly
require the aid of gentle aperients and diuretics, so these are particularly
needful here, where any retention of excrementitious matter would tend
to irritate the damaged organ, and render it intolerant of the bracing
influence of iron. Under similar circumstances, the iodide of iron has
appeared to answer better than other preparations, probably from its
influence on the capillary circulation and secretion ; or a combination
of iodide of potassium with the citrate or acetate of iron, which is less
liable to decomposition than the iodide of iron itself. In the anaemic
state of the system with structural Disease of the Heart succeeding to
rheumatism, this combination is especially salutary.
It is not necessary to dwell on further details of the treatment cal-
culated to improve the quantity and quality of the blood in connexion
with Heart Disease; but it would not be right to omit the mention of
the salutary influence of pure country air, and the full effulgence of a
sunny sky, on the sanguiferous system. I have known several instances,
in which, with considerable organic disease, invalids have attained a
degree of strength and constitutional vigour, by passing the greater
part of the day sub dio, which they never could gain from any system
of medication. A long sea voyage has a like Salutary influence, but it
would not be safe for those liable to severe sea-sickness.
Further in relation to the blood, we have to notice the means by
BY CHARLES J. B. WILLIAMS, M.D., F.R.S. 467
which its quality is to be improved by the removal of excrementitious
and other noxious matters. Of the importance of these we have already
had so many proofs in almost every bearing of the subject, that we have
been obliged to anticipate much of what belongs to this head. In every
degree and kind of Organic Disease of the Heart, we find that a deficient
quantity or vitiated quality of the excretions is the common precur-
sor or concomitant of aggravated symptoms; and from the marked
manner in which remedies which augment and improve the secretions
bring relief, we are constrained to infer, that the failure of this purifying
process, and the consequent accumulation of noxious matters in the
blood, is the common cause of the exacerbations of Heart Disease. And
in truth, it will be found that most of the various disturbing influences
that may be regarded as the ladentia in Heart Disease, agree in this
respect, that directly or indirectly, they impair the processes of elimina-
tion, and that their permanent operation is chiefly connected with this
effect. Thus over-exertion of the body, or agitation of the mind, bring
on palpitations, pain, and other severe symptoms; but rest and tranquil-
lity will generally remove these, provided the secretions continue free.
But if the secretions have become impaired, which they commonly are
where the fatigue or excitement have been considerable, then no relief
ensues till these functions are restored. A fit of indigestion, exposure
to cold, or confinement in an impure atmosphere, may bring on a severe
aggravation of the symptoms of Heart Disease. This will be transient
or enduring, generally in proportion as the processes of secretion by
the kidneys, bowels, and skin, are slightly or seriously deranged. In a
similar manner, the onset of febrile diseases, influenza, gout, rheuma-
tism, erysipelas, and the like, attended as they always are by impaired
secretions, never fails to bring on an exacerbation of the symptoms of
Organic Disease of the Heart. : -
This very general fact with regard to the aggravations of Heart Dis-
ease renders intelligible what is quite familiar to experienced practi-
tioners, although they may explain it in different ways, that the best
remedies under these circumstances are those which increase the secre-
tions of the liver and intestines, the kidneys, and the skin. A few
doses of mercurial aperients, with Salines and other diuretics and dia-
phoretics, do more to relieve the symptoms than any treatment exclu-
'sively addressed to the heart; and if they do not succeed in mitigating
the more distressing parts of the malady, they at least prepare the
system for sedatives, antispasmodics, and tonics, which then act with
safety and effect. |
In cases, therefore, of exacerbation of the symptoms of Organic Dis-
ease of the Heart, sometimes in addition to, sometimes without the mea-
sures before recommended to affect the organ primarily, we commonly
administer a mercurial purgative every night or every other night, until
the secretions from the intestines give evidence of a free elimination of
bile. We may combine with the mercurial a little squill and digitalis,
with the view to excite a fuller flow of urine; and to promote the same
object, we exhibit various saline solutions with an excess of alkali or of its
carbonate," during the day. These are the medicines which I find most
* The salts of soda, potash, and ammonia, with vegetable acids, or with nitric or
phosphoric acid, answer the best. * .
468 ORGANIC DISEASEs of THE HEART.
constantly useful in relieving the exacerbations of Heart Disease,
through their action on the secretions; but there are many others
capable of giving supplementary or succedaneous aid, or that are spe-
cially suited to particular cases. Of these I would mention colchicum,
iodide of potassium, hydrochlorate of ammonia, benzoate of ammonia
or potash, taraxacum, tincture of cantharides, compound spirit of horse-
radish, and infusions of uva ursi, pareira, and digitalis, as those which
have the least frequently disappointed me in their effects. So soon as
some or other of these medicines, alone or in combination, have suc-
ceeded in restoring the secretion which was defective or depraved,
something of a strengthening kind, such as a bitter tonic, or chalybeate,
may be advantageously added, as it will counteract the weakening opera-
tion of the eliminatory medicines, and improve the powers of digestion
and assimilation.
Besides improving the quality of the blood, we have, comprised under
the present head, the indication to promote, regulate, or equalize its
distribution. The means which best contribute to the fulfilment of this
indication, are chiefly the various expedients which promote the circu-
lation of the surface and extremities, such as gentle exercise, friction,
warm clothing, and artificial warmth. In proportion as these means
augment the quantity and accelerate the flow of blood in the superficial
and extreme vessels, the heart will be lightened of some of its load, and
internal organs will be relieved of some of their congestion. It is
obvious that these measures will be more salutary in cold, than in warm
seasons: in fact, in very hot weather, they may become hurtful, by with-
drawing from the heart too much of its proper stimulus, and thus
inducing faintness and extreme weakness. Under these circumstances,
cool astringent applications to the surface, as by sprinkling with water,
sponging with vinegar, and the refreshing influence of a cool breeze,
with the horizontal posture and rest, will restore the circulation and
help the flagging heart.
3. The last indication is to prevent or counteract the Lesions of Func-
tion and Structure, which supervene in other organs in the progress of
Heart Disease. The measures which we have just recommended as
suitable to improve the condition of the blood, are those also which
succeed best in correcting functional disease, and preventing structural
changes; but a glance at the tabular sketch before given, of the second-
ary effects of Diseased Heart on other organs, suggests the importance
of directing the treatment especially towards any of these that give signs
of suffering. It may be observed, that the first morbid condition of the
organs thus secondarily affected is, for the most part, congestion, or
irregular flow of blood with disordered secretion: then follow exuda-
tions or deposits, altering the structures, and more permanently impair.
ing the functions: lastly ensue the contraction, induration, or fatty or
calcareous degeneration of these deposits, still further subverting the
organisation and reducing the vitality of the structures. It is not
necessary to discuss systematically the means by which we might hope
to retard the development of these formidable evils: in some instances,
these will sufficiently suggest themselves, on a rational consideration of
the subjectin its pathological and therapeutic bearings; in others, science
and art fail to help us. But I will conclude this paper by the mention

BY CHARLES J. B. WILLIAMS, M.D., F.R.S. 469
of a few expedients which have sometimes succeeded in rescuing patients,
for a time, from the fearful emergencies into which Organic Disease of
the Heart, with secondary complications, tends to plunge them.
In case of structural Disease of the Heart, complicated with affection
of the liver, in addition to the treatment for the former, it is necessary
to use mercury more freely, with a view to its cholagogue effect. The
combination of blue pill, squill, and digitalis, is commonly suitable,
and may be given from once to three times a day, until the gums are
slightly affected, or a slight bilious diarrhoea or copious diuresis ensues.
In most instances, the addition of a little narcotic, such as extract of
conium, henbane, or poppy, is useful, to prevent the irritation of the
medicine on the bowels. Cupping, blisters, and other counter-irritants
to the right hypochondriac region, often do good for a time; after their
use, and that of mercury, nitro-muriatic acid lotions and foot-baths, and
the internal exhibition of extract of dandelion, with muriate of ammo-
nia and nitrate of potass, will sometimes in a decided manner promote
the secretion and ameliorate the condition of the liver. Saline purga-
tives, which derive freely from the portal system, are also occasionally
useful, especially if there be any tendency to hamorrhoids or ascites.
The complication of kidney-disease, evinced by the presence of albu-
men in the urine, is, in its early stage, by no means so intractable as is
commonly supposed. Cupping and large blisters to the loins, with a few
doses of hydragogue purgatives, have often succeeded in restoring the
urine to a healthy state, and removing all symptoms of this complica-
tion, even where it had proceeded to the length of causing dropsy. The
hydragogue most suitable to these cases, is the bitartrate of potass, in
doses of from half an ounce to an ounce taken fasting, with a little
ginger syrup in water. Its operation, if tardy, may be quickened by the
addition of a few grains of gamboge or jalap, or a drop of croton oil;
but these offend the stomach and injure the appetite more than the
cream of tartar alone. The same objection exists against elaterium,
which has the further disadvantage of sometimes seriously depress.
ing the heart's action; but when other means fail, we are constrained
to resort to it; and although it gives him a terrible shake, it will some-
times rescue a patient from the rising waters of the dropsical flood. It
has appeared to me to disorder least, when given in the dose of from a
quarter to half a grain in a pill, with two or three grains of calomel
and a drop of creasote. Mercury is generally considered unsuited to
cases of albuminuria, on account of its tendency to cause excessive and
depressing salivation, even in small doses: but this effect is, I believe,
confined to the more advanced stages of kidney disease, in which
the urine is of low specific gravity as well as albuminous. Where,
together with albumen, there is a considerable amount of urinary mat-
ter, whether dissolved as urea, or precipitated as lithate of ammonia,
and especially when the urine is also acid, I find mercury to induce no
such excessive influence, but to be valuable in aiding the operation of
other purgatives and diuretics. After blisters and hydragogue purga-
tives, sometimes aided by the warm bath (which, however, I have found
very uncertain), have somewhat relieved the congestion of the kidneys,
they become amenable to the influence of some diuretics, particularly
digitalis, taraxacum, scoparium, diosma, with iodide of potassum, acetate
470 ORGANIC DISEASES OF THE HEART.
of potass, benzoate of ammonia, or some of the saline diuretics before
mentioned. The tincture of cantharides is also suited for this period of
the treatment; and although an uncertain diuretic, and one that should
not be continued if it do not speedily operate, it sometimes restores the
lost powers of secretion better than any other remedy. It may be given
in doses of from ten to forty minims, combined with bicarbonate of
potass, mucilage, and a little hembane or conium. The longer the
renal complication lasts, the more it impairs the quality of the blood, and
produces spanaemia and tendency to dropsy ; and it becomes an object
to counteract this by the exhibition of iron. Generally, this remedy is
not well borne; soon causing a diminished flow of urine and increase of
albumen: but in some instances, a few grains of citrate of iron, or a few
drops of the muriated tincture, have been added to a diuretic draught
with Safety and advantage. In proportion as the renal disease becomes
confirmed and permanent by the substitution of exudation matter for
the proper secreting cells, and by the subsequent fatty degeneration of
this matter, or by its off-casting and the atrophy of the organ, the case
becomes less and less susceptible of relief. The blood, impoverished,
yet loaded with excrementitious matter, irritates all the organs and vessels
through which it passes; and not only are the cavities and cellular tex-
tures distended with dropsical effusions, but low inflammations occur
there also, and harrass the patient with a variety of new sufferings, before
his final deliverance. In many instances, I have ascertained the pre-
sence or urea and uric acid in the serum thus effused ; and I have
known the impregnation so strong, that the liquid, oozing from punctures
in the legs, or from an unhealed tap-wound of the abdomen, has had a
strong urinous smell, and has been found actually to contain more urea
than the serous fluid which has passed by the kidneys. It is not mar-
vellous if medicine can do little in such a subverted order of function
and structure; but it has appeared wonderful to me how life has been
retained, and the diseased heart has gone on working, in some instances,
for days, and even for weeks, in apparent defiance of all that are com.
monly considered as the haws of the functions. Almost the only useful
treatment in this extremity, is by stimulants: and in addition to the
usual vinous and spirituous forms, which are often tried in their most
attractive varieties, as they may best please the palate of the poor
sufferer, I may mention the chlorate of potass, as a medicine which
seems, sometimes, to have a kind of reviving effect even in such extreme
states. In doses of from five to fifteen grains, with carbonate of am-
monia and a little syrup and water, it may be given every hour or two :
it sometimes seems to rekindle the dying embers of life so distinctly,
as to make one again reflect on a parallel (which has been only revived
by Liebig) between vital chemistry and the process of combustion.
Pulmonary complications with Diseased Heart, in their moderate
degrees and early stages, are readily reduced by cupping and blisters,
or extensive rubefacients on the dorsal surface of the chest, mercury,
antimony, salines, and expectorants. Attacks of asthma, connected
with Diseased Heart, commonly depend on pulmonary congestion, some-
times exciting bronchial spasm, and ending in bronchial flux, and are
relieved by blisters, or other counter-irritants, antispasmodics, and ex-
spectorants or derivants. More intense degrees of congestion pass into
BY CHARLES J. B. WILLIAMS, M.D., F.R.S. 471
pulmonary apoplexy or hepatisation, which, if extensive, may seriously
impede the passage of air and blood in the lung, and may proceed to
degeneration and further disorganization. These are among the most
formidable complications of Diseased Heart; and, unless treated before
they have involved much of the lung, they are among the most rapidly
fatal. - * * - - - - . . . . .
Disease of the larger arteries, when in connexion with organic lesions
of the heart, requires due consideration in the treatment. At its early
period, it is usually more or less inflammatory, and may require moderate
antiphlogistic treatment, by small local bleedings, mercury, and iodide
of potassium, with salines. But there is an early tendency to deposits,
degeneration, and partial dilatation in the coats of the arteries; and to
counteract these, tonic, astringent, and génerally invigorating remedies,
are more suited. Combinations of iodine, with nitric acid, preparations
of zinc, tannic and gallic acids, and astringent chalybeates (such as the
muriated tincture, and sulphate of iron with alum), have appeared to be
serviceable in some of these cases, in controlling the undue pulsation
and disturbance in parts. The cod liver oil, too, has proved beneficial
in a few instances; probably, by softening the solid fatty matter of dege-
nerating deposits, and thus rendering them more amenable to the pro-
cesses of absorption and healthy reparation. Where more serious
disease in the arteries, such as ossification, partial obliteration, aneurism,
or great dilatation, has taken place, it becomès of great moment to
keep the circulation as equal as possible, but without reducing its strength
or impairing the quality of the blood; and in this way may be averted
the further degeneration, wasting, and even death, of textures, which
are apt to ensue in parts nourished by the injured vessels. .
These observations have extended much further than I originally
intended, yet the subject is far from being exhausted. The length of the
paper, however, warns me to conclude the subject with a few words on
the general regimen suitable to cases of Organic Disease of the Heart.
Throughout this paper I have endeavoured to keep in prominence
the general fact, that Organic Diseases of the Heart tend to weaken,
rather than to excite the bodily powers, and that therefore they are the
proper objects for a sustaining and invigorating, rather than a lowering
plan of treatment. The same position holds good as a general rule with
regard to diet and regimen. Although exceptional deviations must be
made in case of temporary plethora, inflammation, considerable conges-
tion, and feverish states of the system, yet the diet should generally be
as nutritious as the appetite and power of digestion can comfortably
bear. On this subject I will quote the following conclusion of a lecture
of mine, delivered fourteen years ago. - - - , ,
“The diet should generally be of as nourishing a quality as will suit
the digestive organs, and will not produce plethora or inflammation. It
is a great mistake, to suppose that Diseases of the Heart are to be cured
by starving. Except when inflammation is actually present, or in case
of hypertrophy with continued increased action, or where pulmonary
haemorrhage or apoplexy is threatened, the diet should be one of mode-
ration, but not abstemiousness. In most cases, real strength in the
organs of circulation, and in the muscles generally, is defective, whilst
the irritability of the nervous system is undiminished. Nº. if tone
WOL. II. l
472 DR. C. J. B. WILLIAMS ON ORGANIC DISEASES OF THE HEART.
and strength are to be given to the muscular system, and tranquillity to
the nervous, by any mode of diet, it is by one of a nutritious character,
with a due proportion of good animal food; and whilst it may be neces-
sary to limit the proportion of the meat, and vary its mixture with less
nutritious articles, especially farinaceous, according to the state of the
digestive organs and the wants of the system, it is particularly important
that in no case should the food, whether solid or liquid, be bulky in
quantity. A distended stomach is apt, both mechanically and sympa-
thetically, to excite or disorder the heart's action; and many are the
individuals who suffer from palpitation under such an influence, while,
at other times, they are scarcely sensible of it. The quantity of liquid
food should also be limited, for a reason that I have already stated, to
keep down the mass of the circulating fluid. It is very common for
patients with diseased hearts to suffer severely from drinking too freely,
although it be only of tea or water. The appetite for excessive quan-
tities of drink, is more the result of habit than of real want : by exer-
cising a little self-denial in the first instance, the feelings of thirst
gradually abate; and comfort and health are alike retained by drinking
sparingly.
“The expediency of avoiding active exertion is so obvious, that I need
not dwell on it; but there are particular kinds of exertion, which,
without appearing to be violent, greatly try the heart's powers. I would
instance walking up stairs or up hill, or using even moderate exertion
in a constrained posture. Against these the patient must be particularly
cautioned. I have known great improvement ensue on a patient re-
moving from a house and country in which he encountered stairs or
hills at every turn, to those in which all was nearly on a level. This
Hoint is the more important, because moderate exercise is in most cases
highly beneficial; and the more of this that can be taken in open,
healthy air, without inducing fatigue, the better for the strength and
regularity of all the functions. This must be done in some cases only
on foot; but it is desirable to vary the mode of exercise, and to those
accustomed to ride, no motion is more suitable or salutary than the
gentle paces of an easy horse. Where riding is not borne, carriage
exercise is the only other resource; and it may well be combined with
walking, but when taken alone, it is inferior to either of the others.
Travelling by easy stages about a pleasant country, is sometimes bene-
ficial in many ways—by the amount of moderate exercise, the change
of air, and the mental amusement which it affords. In the intervals of
exercise, which constitute the greater part of the day, it is very essen-
tial that the body should really be at rest; and by easy horizontal or
inclined postures, on sofas, couches, or other contrivances, that the
labour of the heart be aided as much as possible in propelling the blood
to all parts. When the capacity for exercise fails, it is proper to assist
the defective circulation, particularly in the extremities, by daily friction.
In all cases this may prove salutary, by promoting the function of the
extreme vessels and the skin. With the same object, it is highly im-
portant to have a sufficiency of woollen clothing; and if the skin is
habitually dry, its condition may be improved by warm salt water baths.
In a relaxed state of the surface, sponging freely with tepid or cold salt
water or vinegar, followed by friction, proves equally salutary.
DR. ALEX. KNOX ON A CASE OF MUCO-ENTERITIS. 473
“Moral and mental quietude is most desirable, but here again not
inactivity. According to the natural dispositions, various degrees of
mental occupation and social intercourse are necessary; and so strongly
is the action, and thence the structure of the heart, influenced by meta-
physical causes, that there is no morbific circumstance more permicious
than violent mental passions, and no medicine, in chronic cases, so
salutary as the calm enjoyment of agreeable social relations, and of
amusing intellectual pursuits. We speak practically not less than
poetically, when we place these passions in the human heart; and as we
hear of many a whole heart rent and broken with grief and trouble, or
burst with unbridled passion, we may well judge what havoc these feel-
ings may cause in a heart already unsound. It is not often ours to
“minister to a mind diseased, or cleanse the stuffed bosom of that
perilous stuff that weighs upon the heart;” but we may often enlist the
patient's understanding and well-grounded fears on our own side, when
we counsel him sobriety in his sorrow, and calmness in his care : on us
may devolve the privilege and responsibility (and in no case does the
conscientious physician, with his best exertions, more need Divine help
to direct his judgment aright) of advising and deciding with regard to
important changes in the relations and occupations of his future life.”—
London Medical Gazette, 1838. -
7, Holles Street, Cavendish Square.
A CASE OF MUCO-ENTERITIS, FOLLOWED BY ACUTE
PERITONITIS, TERMINATING IN EFFUSION -
INTO THE ABDOMINAL CAVITY, . . .
RELIEVED BY PROFUSE SEROUS DISCHARGE FROM A SPONTANEOUS
OPENING OF THE UMBILICUS BY ULCERATION, FOLLOWED BY
PROLONGED SUPPURATION, REPEATED HAEMORRHAGE,
AND STERCORACEOUS WOMITING. -
By ALEXANDER. KNOX, M.D., Physician to the Dispensary, Strangford,
County Down, Ireland.
CASE. J. S., an agricultural labourer, about thirty years of age, had enjoyed
good health, until about a fortnight before his application at the Strang-
ford Dispensary. At the period alluded to, he had been confined to bed
for two or three days, but the precise nature of his indisposition had not
been ascertained. It had, however, caused much debility, from which he
was not yet recovered. When I first saw him, Oct. 26, he complained of
acute pains about the umbilicus, and costiveness; for which a draught of
castor oil and laudanum was administered, and he was directed to have
hot fomentations repeatedly applied to the abdomen. The bowels were
moved with considerable difficulty, and the constipation was followed
by obstinate faecal diarrhoea; but the discharges were neither scybalous,
mucous, nor bloody, nor was any tenesmus present. The patient, how-
ever, was flushed, the pulse was quick, and there was obscure abdominal
tenderness, increased by pressure. Leeches and fomentations were
3 || 2
474 A CASE OF MUCO-ENTERITIS, ETC.
assiduously employed, and calomel and opium, and afterwards hydrar-
gyrum c. creta, combined with the hydrochlorate of morphia, were pre-
scribed in repeated doses, with the view of effecting mercurialization of
the system. On the sixth day, acute tenderness, on the slightest
pressure on the surface of the abdomen, and tympanites, clearly indi-
cated the extension of the inflammation from the mucous and muscular
intestinal tissues to the peritoneum. The treatment above indicated
was pursued with renewed energy, with the addition of the production of
full and extensive blistering over the site of the inflamed viscera, with
Brown's cantharidine, which acted very efficiently; but all failed to
arrest the acute peritomitis, which had supervened on his original dis-
ease. In four days from the appearance of the peritoneal symptoms,
and on the tenth of the patient's illness, I became satisfied that effusion
had commenced, and indeed proceeded to some extent, as the feverish-
ness had in Some degree abated, and the tympanitic distension was re-
placed by a more firm condition of the abdominal swelling.
The indication now was of course to promote absorption, and support
the patient's strength. Mild but nutritious food, chiefly farinaceous,
was liberally allowed, as the faecal diarrhoea still continued unabated,
causing many times in the day a profuse discharge, which opium, rhatany,
kino, catechu, the diacetate of lead, and various other astringents,
alone, or combined with gentle aperients, had failed to moderate. Mer-
cury was continued in the form of the grey powder: but his constitution
was scarcely affected, either by this, by calomel, or by the application of
strong mercurial ointment, which had been applied both as a dressing
to the blistered surfaces, and by inunction to the interior of the thighs.
The presence of fluid, hitherto a matter of inference, now became certain,
as distinct fluctuation could be felt within the abdomen; and the question
was placed beyond doubt, by the profuse discharge of serous fluid from
a spontaneous opening at the umbilicus. This event, however rare, a
prominence at that point had led me to anticipate, and, in consequence,
to prepare the mind of the patient, mow weakened and anxious from his
severe illness, to expect what might happen. The anticipated rupture
occurred on the night of the twenty-first day of the patient's illness.
The fluid, poured out in considerable quantities, nearly resembled, for
the first day or two, pure water; it then assumed the appearance, both
in consistence and colour, of unboiled oat-meal flummery, and finally
became simply-purulent. The pulse meanwhile fell from 120, success-
ively to 90, 80, and 74 beats in the minute. Emollient poultices were
applied to the umbilicus; wine and broth were allowed, and a mixture
containing the tinctures of opium, cinchona, and catechu, combined with
spirit of nitrous ether, given in full doses. The purulent discharge
from the umbilicus from time to time assumed a brownish colour,
evidently from the admixture of some blood. All the medicines hitherto
used had failed in arresting the profuse diarrhoea, which was latterly
mixed with mucus, and occasionally of a watery nature; and as this dis-
charge, together with the abundant formation of pus, began to tell on
the patient's strength, who became hectic, and subject to profuse night
sweats, the diacetate of lead in three-grain doses, combined with one
grain of opium, was now prescribed, with occasional draughts containing
the compound tincture of rhubarb. A line of treatment which first
BY ALEXANDER KNOX, M.D. 475
seemed to control the symptoms. But the discharge of pus, sometimes
mixed with blood, and at other times pure, still continued; and pure
blood, although not in large quantities, came away at intervals from the
small opening at the navel. :
On the whole, however, the patient was gaining ground; when, on
visiting him on the 29th of November, in company with my friend Dr.
Hunter, of Bryansford, we found the patient very low and much debili-
tated, from the effects of loss of blood, free haemorrhage having taken
place from the umbilical perforation during the night. The discharge
had, however, ceased either spontaneously, or from the effect of apply-
ing cloths, dipped in cold water, and a mash of matico leaves to the
opening—measures which his attendants had been directed to use, in
anticipation of what actually occurred. When the haemorrhage took
place, the remedies above indicated had completely arrested the most
urgent symptoms, and the patient had been perfectly free from pain and
diarrhoea for the preceding five days. No additional light was thrown
on the condition of the viscera, by the most careful examination ; ex-
cept that the liver, especially at its margin in the left hypochondriac
region, seemed more dense and firm to the touch, than it had appeared
to be on previous examinations. No pain, however, was felt on pressing
it, and the increased density was probably only the result of congestion.
Perspirations and hectic still continued. The continued use of matico
to the part, and the most perfect quietude in the horizontal position,
were enjoined, to guard, as far as possible, against a recurrence of the
haemorrhage, which, in the weakened condition of the patient, might
have been attended with fatal consequences. Wine in due quantities,
and opium in full doses, at bed-time, were allowed. *
In three days the patient had rallied considerably, no recurrence of
haemorrhage having taken place, but a horribly foetid chocolate-coloured
sanies continued to ooze from the umbilical opening. This dark admix-
ture, with the pus, and the sickening foetor, probably arose from the
putrefaction of the blood, which had been discharged into the cavity of
the abscess, from whence issued the purulent matter, and some of
which had lodged there, not gaining a free exit at the umbilicus. It seemed
pretty evident that a circumscribed abscess had formed, which had, by
glueing its anterior borders to the parietes of the abdomen, directed
the purulent matter to the exterior, and prevented thereby the fatal re-
sults to be apprehended from its diffusion through the cavity of the
abdomen. On the fifth of December, there had been no return of
haemorrhage, nor was the pus which continued to flow, although still of
intolerably foetid odour, much tinged with blood. His bowels were re-
gulated with small doses of castor oil; and an accidental recurrence of
the diarrhoea was checked by a draught containing tincture of rhubarb,
calcined magnesia, and laudanum. On several occasions, a very consider-
able quantity of pus, mixed with gas, escaped when pressure was applied
around the opening, especially on the left side of the umbilicus. The
free exit of the matter seemed also to be promoted, when the patient,
as he was directed, lay, from time to time, on his face. On the 20th of
December, the discharge had nearly ceased, wine and opium being still
allowed with evident benefit; and in two days more he was able to sit
up; his strength was improved, his night-sweats completely gone, and his
476 A CASE OF MUCO-ENTERITIS, ETC.
appetite good. This improvement was in part attributed to the use of
an infusion of cascarilla and decoction of chirayita (by the way a most
excellent and agreeable bitter) which he had been taking for some days.
On the night of the 25th, he again complained of pain in his bowels,
which were rather costive, and for which he took a draught, containing
Epsom salts, calcimed magnesia, and rhubarb, to be repeated every two
hours if necessary. When I visited him in the afternoon of the same
day, I found that the medicine had not remained on his stomach, and
he was suffering most acute agony from pain in the abdominal region,
and he also complained of tenderness, on pressure, over the right hypo-
chondriac region. Calomel, in three-grain doses, followed by half an
ounce of castor oil, guarded with laudanum, was ordered. Hot fomenta-
tions were applied to the abdomen; leeches to the part where the
greatest tenderness was manifest ; and I further directed emollient in-
jections, containing spirits of turpentine, to be administered, until the
obstruction in the bowels should be overcome. On the following morn-
ing, although the pain was considerably abated, neither the medicines
nor the injections, carefully repeated, had acted. I then ordered ten
grains of grey powder to be made into two pills, with three drops of
croton oil, and one given immediately, and the other, if necessary, in
two hours; administering, at the same time, by Read's syringe, as much
of a turpentine and warm water injection as the patient could bear,
and which, when about threepints were thrownup, came away and brought
off some scybalous and faecal matter. The pain in the hypochondriac
region, however, still continued ; the pulse was 140, and all the symp-
toms most unpromising. December 27, pulse 144 ; most profuse
and uncontrollable stercoraceous vomiting had taken place; bowlfuls of
almost pure faces being thrown up from time to time. The turpen-
time injections were repeated at intervals, and calomel and opium given
in a pill every four hours; and the vomiting gradually ceased in the
course of the day, free action of the bowels having taken place. Hy-
drocyanic acid seemed to have no effect in tranquillizing the stomach.
December 28, pulse 110. Repet. pilulae et enemata. 29. Patient better,
and had some sleep last night. H. S. habeat hyd. c. cretá, gr. vi; pulv.
opii, gr. j; able to take a little gruel. 30. Pulse 94, strength im-
proved, no return of the vomiting, pains in the abdominal region quite
gone, slight discharge from the umbilicus, and frequent diarrhoea.
Habeat misturam astringentem c. tinctură opii, cujus capiat cochleare
parvum post singulas sedes liquidas.
The patient now went on favourably until the 6th of January in the
present year, when he had some recurrence of the abdominal pains, with
vomiting of greenish fluid. His bowels, notwithstanding every care to
regulate them, having become again costive, he was directed to use
castor oil and laudanum, and to repeat the injection. As I was confined
to bed by indisposition, he was kindly visited for me, by my friend Dr.
Filson, of Portaferry, who found the pulse to be 96; some discharge of
matter, not foetid, taking place from the umbilicus, and without any
symptoms of hectic fever, or stercoraceous vomiting. The remedies
employed had opened his bowels. - -
Jan. 8. As he still complained of pain, an anodyne draught was
ordered by Dr. Filson, with good effect, and diarrhoea, with foul secre-
BY ALEXANDER KNOX, M.D. 477
tions, having supervened, he also directed grey powder, with chalk and
opium, to be taken three times a day, linseed poultices to be applied
over the umbilicus, and the result of pressure effected by means of a
bandage and graduated compresses, so as to direct the purulent discharge
to the umbilical opening, tried; a measure which had also been previously
suggested by Dr. Hunter. In about ten days more, the symptoms were
in every respect much improved; but finding him still suffering from
diarrhoea, I ordered compound powder of kino, and tincture of rhatany,
with laudanum, which gradually brought his bowels into good order,
interposing, at the same time, a teaspoonful of castor oil occasionally,
when it seemed requisite. -
Feb. 10. On visiting Smith this day, I found him able to sit up, his
strength greatly improved, his bowels regular, no pain or uneasiness
whatever, his pulse regular, the only remnant of his disease being a
very slight occasional discharge of true non-foetid pus from the opening
at the umbilicus; so that after his long, varied, and severe sufferings,
there is every reason to hope for his complete restoration to health,
if no relapse should unfortunately recur. I should have observed, that
after his last attack, on the 6th of January, the occurrence of pus in the
stools led to the suspicion, that the abscess had effected a communica-
tion with the bowels, as well as with the exterior at the umbilicus.
REMARKs. This case, as faras my experience and reading extend, is quite
unique. It is true, I find six instances recorded by M'Cormac (Methodus
Medemdi, p. 265), Blackall, Peter Frank, and Dugès, where a discharge
of sero-purulent fluid, consequent on peritonitis, took place through the
umbilicus, and in most of which recovery took place. Dalmas also mentions
one case, where the evacuation took place through the intestinal canal,
and Abercrombie another, where the point of exit was at the ring of the
external oblique muscle. But the profuse haemorrhages, the intolerably
foetid nature of the discharges, and the intense stercoraceous vomiting,
seem peculiar to Smith's case; and, combined with the other varying and
protracted symptoms, the disease having lasted, to the present time, for
more than four months, form a combination of symptoms occurring
in the same case, to which I am not aware of any parallel. The due
observation of the phenomena, at the time of their occurrence, has led
me to arrange them as occurring in the following order. Inflammation
attacked the mucous and muscular tissue of the intestinal canal, and
subsequently extended to the peritoneum. The sero-purulent effusion
having got exit from the ulceration occurring at the umbilicus, a cir-
cumscribed abscess would appear to have been formed, from which
the purulent matter, in the subsequent stages of the disease, ap-
pear to have been discharged; the hamorrhage taking place, possibly
by exhalation, as observed by Andral, but more probably from ulce-
ration of some vessel; and the blood, not being entirely discharged
at the opening, giving rise, by its stagnation and putrefaction in the
abscess, to the most insupportably foetid odour I ever remember to have
perceived. The appearance of pus in the stools, in the latter stage of
the disease, would, as already stated, lead to the inference that the
abscess had also communicated with the alimentary canal. Although
some congestion was observed in the liver, I do not think that the
478 DR. ALEX. KNOX ON A CASE OF MUGo-ENTERITIS.
abscess had any connexion with that viscus; and cases have been
recorded by Abercrombie and others, where circumscribed purulent
abscesses, supposed to exist in the liver, have, on dissection, been found
to be totally unconnected with that organ.
In offering this explanation of the probable causes of the successive
phenomena, I do it with the diffidence naturally inspired by all cases
in any degree obscure, where no opportunity has arisen for elucidating
them by a careful examination after death. At all events, the leading
phenomena are faithfully recorded from notes made at the time; for being
very much interested in the case, I visited the patient more than sixty
times during its progress, and the reader has therefore an opportunity
of explaining the symptoms in his own way. The recovery of this poor
man, and his restoration to his wife and family, were greatly aided by a
full supply of the necessary neurishment, placed at his disposal by the
benevolence of a lady of rank in the neighbourhood.
Strangford, April 1850.
479
BIBLIOGRAPHICAL RECORD.
THE HUNTERIAN ORATION for 1850. By FREDERICK C. SKEY, F.R.S. 8vo,
pp. 44. London : 1850. * .
REGULATIONS To BE obsRRVED BY STUDENTS INTENDING To qualify THEM-
SELVES TO PRACTICE AS APOTHEGARIES IN ENGLAND AND WALEs. 1850.
AT the termination of the last century, and at the commencement of the
present, the MEDICAL PROFESSION was in a most deplorable condition in this
country; and the ailments of the great mass of the public were entrusted to
the management of grossly ignorant, and uneducated practitioners. Of the
number of those who professed to practise the art of medicine, the physicians
alone were under the control of collegiate authority, and subject to profes-
sional examination. The rest were left entirely to their own tastes; some,
more conscientious than their fellows, devoted themselves to the routine of
lectures and hospital practice, and a few, fired with a praiseworthy ambi-
tion, actually presented themselves for examination at Surgeon's Hall—an
ordeal, however, which, we are well assured, was by no means one of great
severity. Under this system, a few great physicians and surgeons were un-
doubtedly produced ; but their brilliant talents served only to show in darker
colours the profound ignorance of their contemporaries.
In these circumstances, some honourable and high-minded individuals, la-
menting the degraded condition of the science and practice of medicine, formed
themselves into an association, the objects of which were to place the pro-
fession in a better and nobler position, to improve the individual standing of
its members, and to secure efficient medical attendance for the middle and
lower classes of society. These objects they pursued with unwearied perse-
verance, and amidst innumerable difficulties, owing chiefly to the opposition
of the medical corporations, but partly to the apathy of the community.
However, they finally succeeded in inducing the legislature to pass an Act,
known as the Apothecaries’ Act of 1815, by which Act, some of the objects
in contemplation were attained ; while others were frustrated by influences
to which it is not necessary at present to advert. Such as it was, however,
the Act passed both the Houses of Parliament, and received the Royal assent;
and since that time, it has been the law of the land. It is hardly necessary
perhaps to state that the powers, conferred by the Act, were successively
offered to the Colleges of Physicians and Surgeons, and declined by both
these bodies ; they were at last offered to the Society of Apothecaries, and by
them they were accepted. The Society were thereby empowered to appoint
annually twelve examiners from their own members, whose duties were to
consist in examining candidates for their certificate, and also to direct the
course of study to be followed by the pupils. The Act moreover conferred
upon the Society the power of prosecuting unqualified practitioners.
Since the Act of 1815, a great and striking change has been effected in
the profession. The heterogeneous multitude who practise medicine, are
now subjected to certain rules, are expected to attend lectures and clinical
instruction, and are compelled, before entering into practice, to submit to an
examination. This examination, which at first was imperfect and superficial,
has gradually become more and more extensive and stringent, in proportion
to the increased facilities offered to the student for the acquisition of medical
knowledge. Hence has arisen a marked improvement in the status of the
general practitioner. The knowledge of anatomy, physiology, chemistry,
medicine, surgery, obstetrics, and pathology, has been widely diffused ; and
in every corner of the kingdom, in every provincial town, and even almost
in every village, are to be found conscientious and scientific professors of the
healing art in all its branches. The metropolis can no longer claim a mono-
poly of the talent of our profession.
480 BIBLIOGRAPHICAL RECORD.
The advantages which have accrued to the community, from this im-
provement in medical education, are incalculable ; the middle and the
lower classes (including , the meanest pauper), who were formerly com-
mitted to the mercy of the charlatan or the druggist, or left to their fate,
are now provided with competent Inedical attendance at a moderate, and,
we regret to add, too often, a most inadequate remuneration. Nor have
these advantages been confined to the general practitioners ; for their eleva-
tion has given a vast stimulus to those who style themselves pure physicians
and pure surgeons. The College of Physicians have relaxed many of their
former vexatious restrictions, and have thrown open their doors to all bond
fide graduates, and to others who are not graduates, if they can pass the
very efficient examination which, of late years, has been instituted : the
College of Surgeons have gradually improved the curriculum of education
required of their students, and have instituted examinations, which, though
lax and defective, are much more efficient than in former years. The just
celebrity of the University of London, although little more than ten years
have elapsed since its foundation, already sheds lustre upon the British me-
tropolis ; and among its graduates we could point to the best hopes of our
profession.
We by no means assert, that all these beneficial changes have resulted from
the Act of 1815; much is no doubt due to the spirit of the age, rousing the
torpor, and infusing a more generous feeling into the Colleges. But it is
certain, that the improvement of the general practitioner is clearly to be
attributed to the operation of that Act of Parliament, imperfect and faulty
'as it undoubtedly is.
Such being the changes which have been effected in the constitution of the
medical profession during the first half of the present century, it was with
no small degree of amazement that we heard Mr. SKEY, the Hunterian orator
for 1850, gravely and emphatically declare that the profession of medicine,
at the present day, is “a degenerate pursuit !” He appears himself to feel
that the use of such a phrase is open to criticism and liable to objection, and
he, therefore, in his preface, proceeds to justify it in the following terms.
“In justification of the term “degenerate,' I would urge on the recollection
of the reader, the condition of the profession at the latter end of the seven-
teenth century. At that time, the physician monopolized the entire rank and
name of the practitioner of medicine :-the surgeon was a mere operative,
identified with a menial trade ; and the apothecary a drug-vender, having,
like the surgeon, no claims to medical knowledge, quoad the treatment of
disease, as may be inferred from the following lines of Dryden:
‘Physicians from the tree have found the bark;
They labouring for relief of human kind,
With sharpened sight some remedies may find,
The apothecary-train are wholly blind.’”
In the present day; the physician no longer monopolizes “the entire rank and
name of the practitioner of medicine,” but shares that rank with a multitude
of others, who are not physicians; the surgeon is no longer “a mere opera-
tive, identified with a menial trade”, but is an educated gentleman, and a
member of a Royal College; the “apothecary-train” are no longer “wholly
blind”, but have their eyes pretty widely open : THEREFoRE, (says Mr. Skey
triumphantly), “am I not justified in assuming that, taking our profession as
a whole, the entire body is degenerate from its former eminence " '' .
Is Mr. Skey serious in penning the above lines' For if so, he must surely
leave it to be inferred, that if the apothecaries of the present day were again
to be reduced to the condition of “drug-venders having no knowledge of
disease”; if the members of the Royal College of Surgeons were again to be
reduced to the rank and to the employment of barbers; and if the bag-wig
and the gold-headed came of the physician were again to be considered as the
symbols of the concentrated medical knowledge of the empire—then the dream

BIBLIOGRAPHICAL RECORD. 481
of his Hunterian Oration, concerning the degeneration of the medical profes-
sion, would be abundantly realized. - - -
Having pronounced the profession of medicine to be a degenerate pur-
suit in the present day, Mr. Skey proceeds to point out the causes of its
decline, and of the low estimation in which it is held by the community.
He begins by declaring, that “by far the greatest of all the difficulties
under which the profession of medicine labours, may be referred to the want
of EDUCATION ;” and he proceeds to show, in very eloquent and appro-
priate language, the great benefits of literary and scientific attainments in
those who are intended for the medical profession ; and then he goes on to
state his opinion, that “the almost universal neglect of these pursuits in early
life, and the want of cultivation, both of philosophy and general science, are
among the chief causes by which medicine is degraded in the present day.”
In these remarks we most heartily concur with Mr. Skey; and we also coin-
cide with him, in thinking that some form of preliminary knowledge should
be rendered compulsory on those who are destined to become members of the
medical profession. But the language of Mr. Skey on this point, really con-
veys the most bitter reproof against the governing body of his own College;
for, with the full power of demanding at least some evidence of preliminary
knowledge from the candidates for their diploma, they have uniformly ne–
glected to do so; and the only evidence of Latinity which is required at the
College, from their alumni, is a very superficial and imperfect examination in
that language, in the case of the few students who are articled at the College.
For fifty years, the College has shown itself wholly indifferent to the prelimi-
nary education of its members ; and it is a notorious fact, that the most idle
and ignorant students invariably prefer trying their chance at the College to
attempting any other examination ; because, among other reasons, they escape
the Latin at the former place. ... We are credibly informed, that many of
the members of the College of Surgeons are rejected by the “apothecary-
train,” at Blackfriars, for gross ignorance of the very rudiments of the Latin
language. But we are doing injustice to the Royal College of Surgeons ; the
Council of that learned body have suddenly awoke from their mesmeric sleep,
and have lately startled the world by demanding from the candidates for their
fellowship, not only a knowledge of the Latin language, but also of the
Greek, German, and French, together with mathematics, optics, and hydro-
statics | As this is a step in the right direction, we are by no means disposed
to find fault with it ; on the contrary, we most highly approve it, and we
only regret, in Mr. Skey's own words, “that this important requisition is not
made referable to the first, rather than to the last stage in the career of the
student.” We would ask in addition, why, if classical, and mathematical,
and philosophical, and philological knowledge are so necessary and so desir-
able, (as they undoubtedly are), in the Fellow of the Royal College of Surgeons,
are they so utterly valueless in the Member £ Why is the Member to be
encouraged in his utter contempt for the mere elements of Latin grammar,
while the Fellow is to translate Greek and Latin into English, and English
back again into Latin and Greek, and is to be conversant, moreover, with the
modern languages, and with mathematics, and natural philosophy 7 Is IT
BECAUSE THE CouncIL of THE CoILEGE DESIRES To FIX A BRAND OF DEGRADA-
TION UPON THEIR MEMBERS, WHo ForM BY FAR THE GREATEST NUMBER or
THEIR Body, AND CONTRIBUTE Most LARGELY TO THEIR FUNDS ; AND THUs To
SECURE, AS FAR As POSSIBLE, A MARKED INFERIORITY--IN FACT, THAT DEGEN-
ERACY WHICH THE ORATOR so ELoquENTLY DENOUNCES 7
The next important point to which Mr. Skey alludes, is the system of
APPRENTICESHIP, which, according to him, is “little more or less than an in-
genious device by which to exhaust or render nugatory, four or more invaluable
years of the early life of the student.” “During these four or more years, the
so-called student is compelled to practise the art of manipulation, which con-
sists in the wielding the important instruments placed at his command ;
482 BIBLIOGRAPHICAL HECORD.

while he holds converse with the languages of the philosophers and orators
of the past world, in a refined Latinity obtained from his master's day-book.”
“To this disgraceful system of officinal drudgery, the medical profession has
lent itself in direct contravention of the laws of moral right, of reason, and
of common sense”; and he continues: “I ask you whether the rooted injury
thus perpetrated by four or more long years of personal servitude, in which the
only distinction discoverable between his lot and that of an ordinary servant,
consists in the fact, that he is made the purchaser of his own degradation,
does not inflict a wrong on the mind and habits of a youth, which, in a very
large majority of cases, no future opportunities of study, no future discipline,
can redress or justify.” Upon these passages, we shall remark in the first
place, that the whole of them are gross exaggerations, while some of the
statements are positively erroneous ; but we are saved the trouble of many
remarks upon this subject, by simply quoting the following lines from the
regulations of the Court of Examiners of the Society of Apothecaries, pub-
lished in 1835, and which have now, therefore, been in the hands of the
profession for fifteen years.
“The legislature having made an apprenticeship of five years imperative
upon all students, and having permitted them to present themselves for ex-
amination at the age of twenty-one, obviously intended that the greater part
of their medical education should be included within that period ; and the
Court have great pleasure in stating that, in very many instances, students
have actually completed their course of study, and have been admitted to ex-
amination, within a few weeks after the termination of their apprenticeship.
It is, however, to be regretted, that this advantage has been frequently lost
sight of, and that a great proportion of this valuable time, and not unfre-
quently the whole of it, has been passed exclusively in practical pharmacy.
The Court are desirous of impressing upon parents the necessity of prevent-
&ng this waste of time, by making such arrangements with practitioners, with
whom they place their sons, as may enable the young men to commence their
attendance wpon lectures in the course of the third year of their apprenticeship.”
Such are the recommendations issued by the Society of Apothecaries, with
whom rests the administration of the Act of 1815: with these recommenda-
tions, the professors and teachers of the medical schools, and the pupils them-
selves, are all thoroughly acquainted. Mr. Skey, as an Hospital-Surgeon and
a Professor, knows, perfectly well, that hundreds of students annually present
themselves at the College of Surgeons and at Apothecaries' Hall for exami-
nation at the age of twenty-one, having completed the whole of their studies
(including three years, and often more, of attendance upon lectures and
hospital practice); nevertheless, in the year 1850, Mr. Skey declares that the
“so-called student is compelled to practise the art of manipulation for four
or more years;” that “a rooted injury is perpetrated by four or more long
years of personal servitude;” and that the profession has “lent itself to this
disgraceful system of officinal drudgery.” -
Now, as we are as much opposed as Mr. Skey can be, to any system of per-
sonal servitude, or of officinal drudgery, which we are convinced was never
either contemplated by the legislature or sanctioned by the profession, we
are happy to quote the following passages from the Preface to the Regulations
of the Court of Ealaminers of the Society of Apothecaries for the year 1850,
which sentences place the matter in question in a still stronger light.—“The
Court of Examiners have always regarded the term of apprenticeship required
by the Act of Parliament of 1815, as a period of study, to be employed by
the pupil, under the superintendence of a practitioner, not merely ºn dis-
pensing medicines, but also in attendance upon lectures and hospital practice:
and they have felt justified, after careful consideration of the clause in the
Act relating to apprentices, in giving to it this enlarged and liberal interpre-
tation. In repeating their opinion at the present opportunity, they are in-
duced to hope that parents, in selecting the practitioners with whom they

BIBLIOGRAPHICAL RECORD. 483
place their sons, and in the arrangements made between them, will bear in
recollection, that the Court do not require a servitude of five years to practical
pharmacy; but that they recommend every possible opportunity to be afforded
to the pupils for their moral, intellectual, and professional advancement.”
It is not our intention to enter into any defence of the system of appren-
ticeship ; it appears that the clause in the Act relating to apprentices, was
introduced by the House of Lords during the passage of the Bill through the
different branches of the legislature, and that it was not solicited or recom-
mended by any of the parties who were anxious for the success of the mea-
sure. But we cannot help remarking, that it appears to us, that the evils of
this system have been grossly exaggerated ; and while we willingly admit
that an extensive course of collegiate education in classics and mathematics,
followed by a strictly medical education extended over many years, is far
better than any apprenticeship : yet, as such a course of study is incompati-
ble with the means and the expectations of the great bulk of medical students,
we do not regard the present system with such utter abhorrence as some of
our contemporaries. Nay, we may go a little farther, and may agree, that if
the pupil, at the commencement of his career, is “compelled” for a year or
two, “to wield the important instruments placed at his command,” by which,
we apprehend, is meant the art of compounding medicines, together, probably,
with learning how to bleed, draw teeth, dress wounds, apply bandages, read
prescriptions, etc., we cannot conceive that the pupil will make a worse
practitioner in after-life. We know, and could point out instances, where
persons, in the highest rank of the profession, have made the grossest mistakés
from the want of knowledge of the rudiments of pharmacy; and we there-
fore think it desirable, even in cases where no apprenticeship exists, that the
pupils should “wield,” for a short time, the implements which, if he does not
use them himself, he is afterwards to recommend in the treatment of disease.
We cannot but remark, also, that where the pupil is diligent, and the master
conscientious, the period of apprenticeship is not only passed without incon-
venience, but is attended with positive advantage: for, in the familiar inter-
course of domestic life, a vast mass of information may be conveyed to the
pupil in the most pleasing form, and it would be a libel upon the general
practitioners of this country, to maintain that many such conscientious in-
structors of youth are not to be found. If, indeed, parents are actuated
merely with a view to pecuniary saving, and bind their sons to the lowest
members of the profession, on the distinct understanding that the pupils are
to work in proportion to the Smallness of the premium, we cannot see that
any parties have a right to complain; and if such pupils do spend four or
more years in personal servitude, we have no sympathy for them, and leave
them to the compassion of the Hunterian Orator. -
Another remarkable feature in the Hunterian Oration, is AN ATTACK UPoN
THE GENERAL PRACTITIONERS of this country. “The general practitioner”, says
Mr. Skey, “is an amphibious link between a profession and a trade. ... He is
permitted a remunerative profit on the materials of his druggist, on the me-
chanical agents of treatment, not on the exercise of the judgment that selects
them. For his loss of time, or his knowledge, however superior to others, he
attains no certain compensation. . . . I do not hesitate to assert, that it is
impossible, in many cases, for the medical attendant to be remunerated, but
by the resort to means, which high principle must proclaim in his own breast
to be indirect, and even disingenuous.” Now, like many other portions of
Mr. Skey's oration, a great part of his remarks upon the state of general
practice in England may be set down to exaggeration, and some to misrepre-
sentation; and it must be observed throughout, that he is fond of representing
the errors and defects of any given system, as forming its intrinsic essence.
Thus, because among those who are styled general practitioners, some do, and
some do not dispense their own medicines, and a third class adopt a plan
(which we greatly disapprove) of charging so much for the medicines they
484 BIBLY O GRAPHICAL RECORD.
supply; “therefore,” says Mr. Skey, “the general practitioner is an amphi-
bious link between a profession and a trade.” But we must examine Mr.
Skey's statements rather more closely. “If,” says he, “the law award pay-
ment for physic only, of necessity the medical attendant disposes of as large
a quantity as is compatible with the digestive capabilities of the patient.”
No doubt “if the law award payment for physic only,” then the practitioner is
tempted to send as much medicine as his patient's stomach and pocket can bear;
but the law does no such thing; and it has been decided over and over again in
the courts of justice, that a medical man may obtain compensation for his
professional services, independently of his drugs; and we really cannot help
expressing our amazement that Mr. Skey should venture upon an assertion
which has not the slightest foundation. We thus proceed to demolish, by
argument, the whole structure of Mr. Skey's denunciation of general practice.
“If,” say we, “the law affords compensation for medical services independ-
ently of drugs, as it undoubtedly does, then the practitioner need not consult
the digestive capabilities of his patients as to the amount of physic they are
able to swallow ; therefore, he may claim a compensation for his medical ser-
vices independently of drugs, and, therefore, (as trade consists in the mere
selling and buying of commodities), the general practitioner is not necessarily
an amphibious link between a profession and a trade.” It is very far from our
intention to defend the sale of drugs by the members of a learned profession ;
we confess to a feeling of abhorrence at seeing (as we have seen), the diploma of
the College of Surgeons of England, placed in a shop-window in juxtaposition
with lozenges, barley-sugar, soap, perfumery, and antibilious pills; but we
cannot view in the same light, the custom prevailing among many medical men,
of providing the necessary medicines for their patients, and charging for their
attendance; and we believe that such is the practice of many of the most
respectable members of the medical profession in this country, Employed
in this manner, medicines are nothing more nor less than the instruments in
the hands of the practitioner, and he is no more to be blamed and insulted
for employing his calomel pill or his opiate draught, than Mr. Skey, the pure
surgeon, is to be ridiculed and abused for using his catheter, splints, or lancet :
in neither case does the party claim remuneration for the instruments used,
but for the skill required in using them,
Without entering into any elaborate defence of general practice, it may be
safely argued, that it is very well adapted for the wants of the great bulk of the
community. In the metropolis, and a few other places, where wealth is abundant
and talent diversified, a division of labour commands a sufficient remunera-
tion, and finds ample scope for exertion. The Countess of A., or Mrs. B., the
city millionaire's wife, has a physician for one complaint, a surgeon -for
another, a physician-accoucheur for a third, and an apothecary, probably,
provides the medicines and attends the children and the servants. But how is
this possible for a person in ordinary circumstances, and, d fortiori–how im-
practicable for the lower classes It is, therefore, absolutely necessary, that,
to supply the wants of the middle and lower classes in the metropolis, and
of nearly all ranks in the provincial towns and villages, there should exist
a branch of the profession, the members of which must be generally com-
petent to undertake the management of all diseases. Whether this branch
of the profession do, or do not supply their patients with medicines, is, in
our opinion, quite immaterial. If any practitioner inundate his patient's
house with draughts and mixtures, it is quite competent for the patient—
nay, it is his duty,+to dismiss the “amphibious" gentleman, and avail himself
of the services of another who adopts an opposite system ; but that the mere
fact of a patient being supplied by his medical attendant with the necessary
medicine, should subject the practitioner to be insulted and reviled, spoken
scornfully of as a pedling tradesman, and almost accused of dishonesty, ap-
pears to us to be as monstrous, as it is a ridiculous perversion of common
sense. In some cases, it is highly necessary and desirable, that the medicines
BIBLIOGRAPHICAL RECORD. 485
should be supplied by the medical attendant ; where, for instance, very active
drugs are employed, their preparation and composition should be superim-
tended by a man possessing some scientific knowledge. Again, in many situa-
tions, as in country villages, or at sea, in military practice, or in the colonies,
the medical practitioner must, in nine out of ten cases, be the dispenser of his
own medicines; and why this circumstance, perse, should fix the brand of un-
professional conduct or of inferiority, on the character of a medical man, we
are wholly at a loss to conceive ; and, therefore, we emphatically deny.
If Mr. Skey had availed himself of the opportunity afforded him of recom-
mending the discontinuance of the system of charging for drugs, he would
have done no more than his duty; but, as he has º: advantage of his posi-
tion to indulge in an indiscriminate and ill-timed attack upon general practice,
we cannot wonder that he has drawn upon himself the just indignation of a
most meritorious, a most ill-used, and a most ill-paid, and, as yet, unprotected
class of his profession.
At the commencement of page 32, Mr. Skey declaims as follows: “I con-
ceive that so long as the general practitioner consents to subject his profes-
sional practice to such degrading conditions, he is unworthy the rank and
estimate of a professional man. Medicines should be dispensed at their real,
not their adventitious value. With one voice, this department of the whole
profession should cry aloud, and claim their indisputable right to repudiate
a practice so vicious, both as regards their own high claims, and their utility
to others; and obtain from Parliament the title to a remuneration, more con-
sistent with the real services they have rendered, and less derogatory to the
repute of the high profession to which they belong.” Now, as a piece of
rhetorical flourish, this is all very well; but what are the “degrading con-
ditions” to which the practitioner is obliged to submit 2 We have already
shewn that the dispensing of medicines is purely a matter of convenience and
of private arrangement, and that no practitioner need do so, unless he choose,
as the law allows him to claim compensation for his services, either with or
without medicines. But general practitioners are to “cry aloud” and “obtain
from Parliament the title to a remuneration more consistent,” etc. What
are the general practitioners to “cry aloud” for 7 and what are they to expect
to obtain from Parliament ' There is no occasion to cry aloud for a title to
a remuneration which the law already allows them | But is it intended that
Parliament is forcibly to separate the supply of drugs from the practice of
physic, to abolish dispensing on the part of the practitioner, and throw it.
entirely into the hands of the druggist || If this be done, we are then tempted
to ask, moreover, whether it is intended that Parliament is to arrange a tariff
of fees for the payment of the practitioner? and on what principle this tariff
of fees is to be arranged 7 whether, as in the case of Solicitors, all persons,
whether peers, judges, merchants, tradesmen, servants, or labourers, are to
be equally charged six shillings and eight-pence a visit 7 or whether the fee
is to be regulated according to the rank, or station, or wealth, or poverty of
the patient 7 or according to the rank or the abilities of the practitioner?
In France, and in Scotland, where the dispensing of drugs is principally
1 The druggist, be it remembered, generally prescribes medicines to all who come
with ready money, too often strives to injure practitioners who supply medicine to
their patients, and patronizes others who send prescriptions to his shop. The chief
business of the petty druggists is prescribing. We find the following morceau in
the Registrar-General's Report for the week ending Saturday, April 20, 1850. “In
Charing Cross sub-district, at 22, Salisbury Street, a gentlewoman, aged 37 years,
died of “aneurism, and extensive disease of the aorta, spasmodic collapse (thirty-five
minutes). Post-mort.” Mr. Leonard states, that ‘the deceased retired to bed, having
previously taken a draught, made up by a chemist, on the verbal report of her servant;
was seized with vomiting and violent pains in the bowels, and soon died, exclaim-
ing, ‘Am I poisoned £’ just before death.”
486 BIBLLOGRAPHICAL RECORD.
in the hands of the druggists, is the emolument or social rank of the profes-
sion higher than in England 7 - *,
We leave these questions for Mr. Skey's meditation; and, in the mean
time, we may as well express our opinion, that the remuneration of the me-
dical profession must, after all, for the most part, be a matter of arrangement
between the patient and his medical attendant, and must depend upon con-
ventional usages, upon the circumstances of the times, and upon the mutual
honour of the parties. - - .
One word more, and we have done with the Hunterian Oration. There is
in this composition, amidst a great quantity of clap-trap, some really good
writing, and it also contains sentiments in which every upright medical prac-
titioner must cordially concur. Yet we cannot but express our regret, that
Mr. Skey did not submit his manuscript, before its publication, to the
pruning-knife of a judicious friend, acquainted with the present transition-
state of medical practice,—a course which might have prevented him from
offering much unprovoked insult, and from making many erroneous state-
ments, calculated to exasperate the great body of his brethren, and to un-
justly lower them in public estimation.
THE REGULATIONS of THE CourT of ExAMINERs of THE SocIETY of Apo-
THECARIES for 1850, form a very important, although a very unpretending, pro-
duction. The Society of Apothecaries possess no prestige to render themselves
attractive to the medical public; they have silently and unostentatiously per-
formed, for upwards of thirty-five years, the duties delegated to them by the
Legislature in 1815. They have done more to elevate the tone of medical
education than any of the Colleges; and until some better system, or one as
good, be generally adopted and sanctioned by the Legislature, it is to be
hoped that they will be encouraged in their laudable efforts to maintain the
high standard of medical education which they have endeavoured to establish.
We are by no means disposed to pass an unqualified eulogium on the
Society of Apothecaries; but we must, in common justice, offer a few remarks
which may, perhaps, remove some very erroneous impressions entertained in
respect to the Society. In the first place, the Society, it appears, derive no
benefit whatever from exercising the Act of Parliament, beyond the power
of electing the Examiners; and it is therefore evident that, whether they
retain their privileges or abandon them, they can have no interested views
in the result. The Examiners are chosen from the members of the Society,
and must be practitioners of ten years' standing; they are not chosen by
seniority, but are selected on account of their talents, and are liable to removal
from time to time. Now nothing can be fairer than such a system, for the
Examiners are neither self-elected nor irresponsible; and the only question
is, whether the system has been fairly worked out. It has been objected to
the composition of this Court, that its members are undistinguished in the
eyes of the medical profession; and this objection would have more weight
were it not known that, by a bye-law of the Society, “no Member of the
Court of Examiners will be recognized as a Teacher on any branch of Medi-
cal Science”. However competent, therefore, a man may be as a lecturer, he
is utterly forbidden to exercise his talents so long as he remains in the Court
of Examiners; and hence, as Hospital Surgeons or Physicians, or as Lec-
turers or Professors, the members of the Court of Examiners never can be-
come known to the profession. But by this regulation, the Court of Ex-
aminers are placed in a position of great independence, and their integrity
must be unquestionable; for, as they have no personal interest either in the
schools or in the pupils, they are able to perform their duties to all, without
favour or affection to any. The “Regulations” which they have lately pub-
lished, afford, we think, a convincing proof of the soundness of their views
and the correctness of their intentions. -
Desirous of elevating the character of the medical student, they urge most
BIBLIOGRAPHICAL RECORD. 487
strongly the great importance of preliminary knowledge, and they lay much
stress upon the lamentable fact, that a great number of the rejections which
take place, are owing to a total ignorance of the Latin language. They then
proceed to state : “In accordance with recommendations, published many
years since, the Court consider that the pupil, before he enters upon his medical
studies, should possess a competent knowledge of the classics, so as to be able
to translate any easy Greek or Latin author ; and that he should also be
acquainted with the elements of mathematics and of natural philosophy, and
º acquire one or more of the modern languages—French, German, or
Italian.”
On referring to copies of former regulations, issued by the Court, we find
sentiments expressed of a precisely similar nature. In page 3, of the Regu-
lations of 1830, the Court “beg seriously to impress upon parents and
guardians, who destime the youth, under their care, to the study of medicine,
that a familiar acquaintance with the Latin language is indispensable, and
that a knowledge of Greek is scarcely less so.”; and they also recommend
their pupils to study natural history, and the ea'act sciences. In 1832, they
recommend a familiar knowledge of Latin and Greek, together with an ac-
quaintance with the mathematical sciences, and with the French and German
languages. These recommendations are repeated in all the subsequent regu-
lations. But the Court have not been satisfied with merely recommending
this preliminary knowledge: in the case of the Latin language, they have
systematically enforced it, as is proved by the number of rejections which have
taken place, solely for ignorance of Latin.
We have, lying before us, a copy of the regulations, dated July 31, 1815,
wherein the candidate for examination is required to possess a competent
knowledge of the Latin language, and to evince it by translating parts of
the Pharmacopoeia Londônensis, and physicians' prescriptions. In 1827, the
candidate for examination is required “to translate, grammatically, parts of
the Pharmacopoeia Londinensis and physicians' prescriptions”, and “should
any doubt arise as to the candidate's possessing a competent knowledge of
Latin, he will be required to translate a passage or passages from some one of
the easier Latin authors.” In 1830, the candidate is required to translate
parts of Celsus de Mediciná, or Gregory's Conspectus Medicinae Theoreticae, in
addition to the Pharmacopoeia Londinensis, and physicians' prescriptions;
and in 1850, they have recurred to a plan which they originated, we believe,
in 1839, of volunteering to institute a separate Latin examination on a day
distinct from that of the general examination ; a plan which has the two-
fold object of relieving the student from the Latin test at an early period of
his medical studies, and of ascertaining carefully that he understands not only
the mode of translating the language, but also its grammatical construction.
In this conflict with the powers of darkness, the Court of Examiners, so
far as England is concerned, have fought the battle single handed. The
College of Surgeons, the only other corporation with which the general prac-
titioners, as a body, are in any way connected, have never considered it worth
their while to urge on their candidates the importance of the Latin, or any
other language; indeed, the only opportunities that the general practitioners
enjoy, of knowing that any branch of human science is expected of them by
the College, except anatomy and surgery, are when they are called together
to be abused and ridiculed by the Hunterian Orators, for not knowing what
the College never required them to learn.
In that part of the Regulations of the Court of Examiners of the Apothe-
caries’ Society, which refers to purely medical subjects, the object seems to be
to direct the attention of the students to practical science; and we perceive,
with great pleasure, two or three very important alterations in their present

* The College of Surgeons of Edinburgh are deserving of the highest praise for
what they have done to elevate the tone of the preliminary and professional studies
of their students. -
WOL. II. - 32
488 BIBLIOGRAPHICAL RECORD.
regulations as compared with those issued in former years. In the first place,
we perceive that the subject of practical chemistry is now brought promi-
nently forward; and this regulation, which enforces upon each student a
course of distinct chemical manipulations performed by himself, in addition
to the mere attendance on the systematic course, must tend most materially
to impress the facts of this most important and most delightful science upon
the minds of the pupils. It can never be too strongly urged upon the atten-
tion of medical students, that the science of medicine is not only one of
theory, but also one of observation and experience; and that those things
which are seen and felt, make far more impression than those which are merely
heard from the lecture-table. -
“Segniūs irritant animos demissa per aures,
Quâm quae sunt oculis subjecta fidelibus.”
Believing, therefore, as we do, that chemistry is equally important with
anatomy, and that they form, together, the basis of scientific medicine, we
hail with great pleasure the prominent place which, chemistry is now made to
occupy, as a practicaſ pursuit.
The next subject to which we may advert, is of still greater importance;
and this is the direct encouragement now given to the STUDY of CLINICAL
MEDICINE, which stands in the same relation to the theory and practice of
medicine, as practical chemistry does to the systematic lectures on that sub-
ject. It is notorious that hitherto clinical teaching has been most grossly
neglected in the metropolis, notwithstanding the abundant opportunities
afforded for its cultivation, by our splendid and richly endowed hospitals;
and the consequence has been, that the best of our students have been in
the habit of resorting to Edinburgh or to Paris, for that instruction which
they have been unable to obtain in London. There can be no doubt that a
course of systematic lectures on medicine is highly important to the student
in paving the way for his practising, in future, with safety and advantage;
but it is equally important, that he should verify, by the evidence of his own
senses of sight and touch, at the bed-side, and in the anatomical inspection-
room, the facts or doctrines which have been enunciated in the lecture-hall.
Students have been compelled to attend too many lectures, and, amidst the
multiplicity of oral discourses, have too generally neglected that practical
study to which the lectures merely form the introduction. But on this point
we cannot do better than quote the following passage from the regulations.
“The Court would also invite the student to test, by his own experience,
and the exercise of his reasoning powers, the truth of the facts and theories
which are offered to his notice. While, therefore, they strenuously urge a
diligent attendance upon the various lectures delivered by the teachers, and
a careful study of the works recommended by them, they would as strongly
recommend an unremitting devotion to the practical duties of the hospital,
the dead-house, the chemical laboratory, and the dissecting-room.”
The Court appear to be dissatisfied with the present system of teaching at
the medical schools, and we confess that we do not wonder at their dissatis-
faction. Teaching is too often undertaken, not for the purpose of instructing
the student, but in order to bring the teacher into public notice. Hence,
the lecturers are by no means sufficiently impressed, that the duty de-
volves upon them, not merely of delivering their lectures, but of ascertaining
afterwards, by oral examination, whether the student has understood their
import. The Court, therefore, strongly recommend that a friendly and cor-
dial feeling should be cherished between the teachers and the pupils, and
that the former should subject their classes repeatedly to catechetical instruc-
tion, conveyed by questions and answers; a plan which, if generally adopted,
would, in their opinion (and also we may add, in ours), contribute very ma-
terially to obviate the practice of grinding, by doing away with its necessity.
The custom of grinding, in fact, is a necessary evil, resulting from the laxity
of the teachers, who, if they cannot perform their duties themselves, should
delegate their performance to others. In short, let the grinders be recog-
BIBLIOGRAPHICAL RECORD. 489
nized as auxiliary teachers at the medical schools. Thus, a system would be
established similar to that of private tuition at Oxford and Cambridge,_a
system, which has never, so far as we know, produced any prejudicial result
either to the attainments of the pupils or the reputation of the Universities.
Whatever objections may be raised to particular portions of the “Regu-
lations”, they are evidently dictated by a sincere desire to improve the status
and increase the usefulness of the General Practitioners. As the Court of
Examiners are, for reasons above stated, quite above the suspicion of inter-
ested motives, we feel bound to accord them our hearty meed of approbation,
and to thank them, on behalf of the profession and of the whole community,
for their earnest endeavours, under many discouragements, to elevate the
character of that class of medical practitioners to whose charge is committed
the entire pauper population, and a majority of all classes of society.
A TREATISE on DISEASEs of THE Bon Es. By EDw ARD STANLEY, F.R.C.S.,
President of the Royal College of Surgeons of England, and Surgeon to
St. Bartholomew's Hospital. Post 8vo. pp. 367. London: 1849.
If a man steadily apply his powers of observation during a long period, to
any subject, he cannot fail to be rewarded for his diligence, by gaining an
amount of knowledge beyond his fellows. Such is the case in the pre-
sent instance. Mr. STANLEY has for many years been investigating the
diseases of the Osseous structures, with all the advantages which a command
of the wards of the largest hospital in London, and an unlimited admission
to anatomical collections, public and private, could afford. For more than
ten years has the book been expected; but the delay in its appearance is by
no means to be regretted, for it has enabled the author to avail himself of
recent pathological and microscopical discoveries, which have been neither
few nor unimportant.
HYPERTROPHY AND ATRoPHY OF Bon E are first considered. The former
disease is most frequent in the bones of the face, and is familiar to most sur-
geons who have the opportunity of observing hospital practice. When Hy-
pertrophy occurs in the long Bones, it may cause increase in length as well as
in bulk, giving rise to inequality between the limbs, and much inconvenience.
Atrophy, on the other hand, may arrest the development of Bones, and cause
a shortened limb. A very remarkable case is mentioned, in which the growth
of the lower jaw was arrested in a child at the age of two years, causing, in
after-life, a singular deformity. As regards treatment, but little can be done
in these cases. •
NEURALGIA OF BONE, is a term applied by Mr. Stanley to a painful condi-
tion of these structures, which, we suspect, comes under the class of hysterical
affections. Three cases are mentioned;—all of females under thirty, and the
general symptoms are those characteristic of hysteria. In one, amputation
was performed ; but with the exception of certain dark patches, resembling
ecchymoses, in the cancellous structure of the condyles of the femur, nothing
abnormal was found. - -
INFLAMMATION OF BONE. Enlargement of Bone is the general effect of
Inflammation of its tissues; but its characters vary with the circumstances
giving rise to the inflammation. It may be accompanied by expansion or
induration of the Bone, or by osseous deposits on its surface; and, according to
recent observation, expansion of tissue is one of the most frequent alterations
to which it is liable. The result is softening of the bone by separation of the
walls of the cells and widening of their interstices. Mr. Stanley believes
that a bone, once so enlarged, will permanently remain so. Another change
is, that after the separation and widening have taken place, the lamellae
become thickened, hardened, and consolidated—producing induration of the
tissue; the solidity being due to the formation of concentric osseous laminae
#
32 2
490 Bi BLIOGRAPHICAL RECORD.
upon the insides of the Haversian canals, narrowing some, and obliterating
others. Accordingly, indurated Bone is less vascular and oily than healthy
Bone, and sometimes acquires the colour, as well as the compactness and
weight of ivory.
No structure of the body surpasses bone in the perfection with which it
exemplifies the singular law of symmetry of disease. The two sides of the
pelvis will present changes, the very counterpart of each other. The long
bone will enlarge equally, and present evidence of morbid action identical in
every hollow, ridge, and swelling; and from no disease are such results so
frequent as from rheumatic inflammation. On such enlarged and indurated
bones, medicines have no effect: the unhappy subjects are doomed to drag
about with them, for the remainder of their days, the heavy and misshapen
limbs:—
“Monstrum horrendum, informe, ingens !”
Mr. Quekett has observed, that with induration of the articular ends of
bones, their surfaces, when deprived of cartilage, become smooth and polished
with a porcellanous appearance, from the blocking up of the Haversian canals
with earthy substance.
SUPPURATION IN Bon E is of two kinds, circumscribed and diffused. The
latter is a very formidable disease, causing great constitutional disturbance,
and much local mischief, as proved by several cases related. The circum-
scribed suppuration is less formidable; but its diagnosis is of importance, as
it may be confounded with simple inflammation, and also with the neuralgic
or hysterical affection before alluded to. As regards the treatment of Sup-
puration in Bone, there is nothing deserving of special mention for its novelty,
although the rules laid down are excellent.
CARIES. By Caries, Mr. Stanley designates those changes which, under
certain circumstances, are consequent on chronic suppuration in the cancel-
lous texture of Bone. He distinguishes the simple, scrofulous, syphilitic,
and phagaedenic varieties. The following is the description of the pheno-
mena attendant on the progress of Caries. “Inflammation extends from the
bone to its investing soft parts, which become swollen, thickened, and tender,
and abscesses are formed in them which contract into fistulous passages, lead-
ing to the diseased bone. The periosteum covering the diseased bone be-
comes thickened, very vacular, and readily separable from it. The bone itself
is at first very vascular, then its cells become filled with a reddish brown
fluid, apparently a mixture of blood and pus, and occasionally combined with
oily particles. Absorption of the bone, but chiefly of its animal part, ensues;
that which remains is porous and fragile, and of a grey brown or black colour,
probably from decomposition of the matter within its cells ; to which cause
likewise, the foetid odour of the matter discharged through the fistulous
passage may be ascribed. The diseased bone may gradually disappear, either
by ulceration, or by its discharge in fragments through the fistulous passages
in the surrounding soft parts. Ulceration in some instances commences within
the bone, hollowing it out and reducing it to a thin shell ; in others, ulcera-
tion commences in the outer surface of the bone and extends progressively
inwards. Whilst these changes are in progress, granulations, very loose and
spongy, and bleeding on the slightest touch, often arise from the diseased
bone, filling the cavities in its interior, and protruding through the fistulous
passages in the soft parts covering it.” (p. 52.)
With respect to the treatment of Caries, incisions through the soft parts to
let out the matter, and soothing applications, are chiefly recommended. Ope-
rative measures are to be resorted to with caution, but great stress is laid on
absolute quietude of the limb. In certain cases, the iodide of potassium is of
great service, by arresting the inflammation of the periosteum covering the
diseased bone. - -
ULCERATION of Bone. On this, valuable remarks are made ; and the fol-

BIBLIOGRAf'HICAL RECORD. 491
lowing points of diagnosis may be advantageously borne in mind. “The
Ulceration of Bone, which is the effect of single inflammation in its tissue,
usually begins at a simple point, and spreads equally in width and depth.
When, however, the ulceration is consequent on inflammation of the perios-
teum, it spreads widely over the surface of the bone, but does not in general
deeply penetrate its substance. Syphilitic ulceration usually begins at many
points, distinct yet close together, giving to the appearance of the bone a
worm-eaten appearance. Malignant Ulceration of Bone is generally irregular
in its outline and surface ; and it extends in a manner to form excavations
in the bone of unequal length, width, and depth, with sharp over-hanging
margins” (p. 60.) Ulceration of Bone is sometimes a distinct and primary
disease ; and as such, attacks the head of the femur but capriciously. It only
occurs in adults, and always in males, being often traceable to local injury and
to rheumatism. The chief symptoms are, weakness and uneasiness, scarcely
amounting to pain in the hip joint; its progress is exceedingly slow, but
it eventually destroys part of the head of the femur.
The observation that reproduction of the compact substance of Bone re-
moved by ulceration never occurs, is, we believe, due to Mr. Stanley, and was
made by him many years ago. In cases where there appears to be repro-
duction, dense fibro-cellular tissue—not bone—is the new formation. *
NEGROSIS. To this a considerable space is devoted, and it is well worthy
of careful perusal. Necrosis usually attacks the compact tissue of bone, and
the tibia is most frequently its seat. Next in frequency ranks the femur, and
the lower jaw is often subject to it. One of the latest observations on the
subject is, that the manufacture of lucifer matches is very apt to give rise to
Necrosis of the jaw-bones, probably from the phosphorous acid vapour given
off. The precise modus operandi is not yet positively known, although the
probable explanation is, that the fumes of the acid give rise to inflamma-
tion of the periosteum of the jaw, the general health being at the same time
greatly depraved. The phenomena of exfoliation have been greatly elucidated
within the last few years by the labours of Professor Goodsir, Mr. Bransby
Cooper, and Mr. Gulliver, although it is but justice to John Hunter to state,
that the accuracy of his views has been strikingly confirmed by the light thrown
on the subject by these able microscopists and observers. The Haversian
canals which immediately bound the dead, or dying bone, are enlarged contem-
poraneously with the filling of their cavities with a cellular growth. As this
proceeds, contiguous canals are thrown into one another; and at last the dead,
or dying bone is connected to the living by the cellular mass alone. It is
now loose, and has become so in consequence of the cellular layer which sur-
rounds it, presenting a free surface and throwing off pus. Mr. B. Cooper has
ascertained, that a large quantity of the solid constituents of bone are con-
tained in the disease arising from diseased bone. We must pass over the
mode by which the old bone is removed, and that by which its loss is repaired,
and proceed to the treatment of Necrosis. As a general rule, soothing appli-
cations are the best; but it occasionally happens that a moderate stimulant is
required, and when such is the case, Mr. Stanley recommends mercurial
ointment mixed with soap cerate. The old practice of soaking necrosed bone
with dilute mineral acids, to hasten its removal, is not approved; but, in some
cases of superficial Necrosis, the application of potassa fusa or nitric acid, is
admissable. In cases where the Necrosis is clearly superficial, and where the
exfoliation is at a stand still, the removal of the dead bone by operation is
expedient, and also in internal and deeply seated Necrosis, when the dead
bone is ascertained to be loose.
When the shaft of a bone is necrosed and separated, its removal is advis-
able;—but in such operations, as little as possible of the walls of the new bone
must be injured, as there will be no reproduction of it. The treatment of
Necrosis of the Bone of a finger or toe, was, in former times, to amputate it ;
but modern experience has shown that all that is necessary, is to divide the
492 BIBLIOGRAPHICAL RECORD.
soft parts covering the dead bone sufficiently to permit its extraction. The
finger will be shortened, but still its form will be retained, and it will be a
useful member. There are well-marked and instructive cases introduced to
illustrate the various positions laid down, in this, a very important section of
the volume.
TUMoURS of BonE. Cartilaginous Tumour occurs in the early and middle
periods of life, and presents two distinct forms, one peculiar to the outside of
a Bone, the other to its interior. The latter form occurs in the smaller bones,
the former attacks the larger. The substance composing these tumours is of
a blueish or greyish white colour, and chemical analysis obtains from it the
same results as from pure cartilage; such tumours are of slow growth, and
strictly local. In the early stage, preparations of iodine and mercury may
effect their gradual dispersion. Every other variety of tumour, to which the
osseous tissue is subject, is passed in review ; and the subject is concluded
with a summary of facts, which cannot fail to be of service in assisting the
diagnosis of these, often obscure, cases. Whilst on the subject of Pulsating
Tumours of Bone, Mr. Stanley brings evidence to show that such tumours
may be arrested in their progress by the ligature of the main artery of the
limb ; and that moreover, in two known instances, the ligature of the artery
was followed by reparative processes in the bone, effecting the restoration of
its natural size and firmness.
SCROFULA IN Bon E. It appears to Mr. Stanley, that the bones are prima-
rily affected in only a proportion of the Scrofulous Diseases of Joints, for in
cases which he has carefully watched, and which exhibited the local and
constitutional characters of Scrofula in a marked degree, inflammation was
found in the synovial membrane, with tuberculous deposit in and about the
joint, whilst in the bone no unsoundness existed. When, however, destruction
of bone has taken place from Scrofula, no reproduction ever takes place.
MoRBID GRowTHS FROM THE LOWER J Aw. Eight varieties are described,
which are accurately detailed. The following remark is not to be lightly re-
garded in these days of chloroformization.
“One consideration, it has appeared to me, belongs to all operations per-
formed for the removal of either a portion or the whole of the Superior
Maxillary Bone ; namely, that they are cases in which a serious objection
lies against the use of either chloroform or ether ; for, inasmuch as by the
influence of these agents in annihilating sensibility, the irritability of the
glottis is weakened, if not wholly lost, there must be danger of a trickling of
blood from the mouth into the glottis, without the excitement of a cough to
expel it from the windpipe.” (p. 288.) This objection does not apply so
forcibly to operations upon the lower jaw;-but to guard against the possibility
of blood descending towards the larynx, the patient, during the operation,
should sit upright, without reclining in the least.
In taking leave of this volume, we must express our opinion, that it pos-
sesses the merit of being essentially practical, lucid, and well arranged. The
materials, selected with judgment, indicate extensive observation and careful
reflection; and the book is altogether of so useful a character, that no profes-
sional library will be complete without it.
SKETCHEs of THE MEDICAL Topography AND NATIVE DISEASES OF THE
GULF or GUINEA, WESTERN AFRICA. By WILLIAM F. DANIELL, M.D.,
Assistant-Surgeon to the Forces, etc. pp. 200. London: 1849.
A lengthened residence on the Western Coast of Africa has given DR.
DANIELL many opportunities of observation; and in the present volume we
have the fruits of his research and inquiries presented in the form of a highly
interesting and instructive treatise, on the general and medical topography,
the natural history, diseases, and customs of the inhabitants of the coasts of
BIBLIOGRAPHICAL RECORD. 493
the Bights of Benin and Biafra, and the islands of Fernando Po, Prince’s,
St. Thomas, and Anno Bona. The regions which he describes have an un-
enviable notoriety for insalubrity : yet the following paragraph well explains
much of the fatality among Europeans visiting these parts. “Could those
causes of disease which have been hitherto ascribed to climatorial alternations
be more thoroughly investigated, I apprehend we should discover that no
Small number were founded on very inconclusive data. It is a well-known
fact, that the notorious insalubrity of Africa has frequently served as the
scape-goat on which the blame of those evil consequences (resulting from the
reprehensible indulgence of dissipated courses) might be unreservedly thrown,
without the risk of their being disputed or even questioned. When we seri-
ously reflect on the impaired constitutions of two-thirds of the human beings
who frequent these colonies, recklessly indifferent as to the price of human
life, we require no further argument for the rational explanation of those ab-
normal states of the system that so largely swell the amount of victims, in
the occasional and almost inexplicable pestilences which prevail in these re-
gions.” (p. 13.)
We hope that Dr. Daniell will one day favour his professional brethren
with a good practical treatise on the Diseases of Western Africa. He is emi-
nently qualified for the task; and will thereby confer a great benefit. In the
meantime, we heartily recommend his “Sketches of the Medical Topography
of the Gulf of Guinea”, as a work combining interesting topographical infor-
mation, with knowledge likely to be of service to all engaged in the treat-
ment of disease in those regions. ſº

THE PHYSIOLOGY of DIGESTION, considered with relation to the Principles
of Dietetics. By ANDREw CoMBE, M.D. Ninth Edition, Edited, and
adapted to the present state of Physiological and Chemical Science, by
JAMES CoxE, M.D. pp. 191. Edinburgh: 1849. *
Of the manner in which DR. CoMBE has performed his task, of popularly
explaining the Physiology of Digestion, and applying it to the Principles
of Dietetics, and, consequently, to the preservation of health, there can be but
one opinion. Whether we consider the book before us as a scientific treatise,
or as a popular physiological work, it stands unrivalled for completeness of
information, correctness of deduction, and clearness of diction. The labours
of the most eminent contributors to our knowledge, in the various subdivi-
sions of the subject, and the practical deductions, are expressed in a correct,
simple, and convincing manner. The author and the editor show a praise-
worthy caution in drawing deductions from meagre or uncertain data. . .
DR. CoxE has ably discharged the trust bequeathed to him by Dr. Combe, of
revising his work, and incorporating with it what was useful in recent researches.
The latest discoveries and observations are skilfully embodied and applied.
We can detect no omissions. Among the additions, we observe the observa-
tions of M. Bernard on the use of the pancreatic juice, and some observations
on cod-liver oil, which are principally founded on the essay of Dr. C. J. B.
Williams, published in this Journ AL for January 1849.
MICRoscoPIC ExAMINATUoN of THE WATER supplied To THE INHABITANTS
of LoNDoN AND THE SUBURBAN DISTRICTs ; illustrated by Coloured
Plates, exhibiting the living Animal and Vegetable Productions in the
Thames and other Waters, as supplied by the several Companies ; with
an Examination, Microscopic and General, of their Sources of Supply,
as well as of the Henley-on-Thames and Watford Plans, etc. By
ARTHUR HILL HAssALL, M.B., F.L.S., etc. 8vo. Pp. 66. London: 1850.
The work is so fully described in the title-page now transcribed, that it is
not necessary for us to do more than commend it, as one well deserving of
perusal. The horrible nature of the compound fluid, which the Londoners
drink under the name of water, is well set forth. -
494
CRITICAL DIGEST OF THE BRITISH AND Foreign M13 DIGA is
. JOURNAIaş.
PRACTICE OF MEDIGINE AND PATHOLOGY.
REPORT OF THE CATHERINE HOSPITAL AT STUTTGART, ON THE DISEASEs
OF CHILDREN.
The following valuable Report on the Diseases of Children, is extracted
from the General Report of the Lying-in Department of the the Catherine
Hospital at Stuttgart, from 1st July 1847, to 30th June 1848. It was com-
municated by Dr. ELSAESSER, superintendent of the department. -
There were born, in the above period, 290 children (157 males and 133
females); of these, 48 (25 m. and 23 f.) were premature, and 11 (7 m. and 4f.)
still-born. The deaths were 37 (23 m. and 14 f.). The proportion of the
still-born to the total births, was 1:26:36; of the still-born to those born
alive, 1:25-36; of the deaths to the live births, 1:7:54. jºy
ICTERUS NEONATORUM was observed in 93 males, and 69 females.
APHTHE were found in 34 males, and 23 females.
INFLAMMATIONS OF THE EYE were observed, sometimes alone, sometimes
complicated with other affections, in 35 newly-born children, 21 males and
14 females. The termination was generally favourable: in a few cases only,
ulcers formed in the cornea, leaving more or less opacity. In one case, violent
inflammation of the left eye occurred on the eleventh day after birth, and
was treated by leeches, calomel, etc. The disease, however, made progress,
and on the tenth day, produced ulceration of the cornea, which was followed,
in seven days, by prolapsus of the iris.
A fatal case of atrophy with syphilitic corneitis, occurred in the prematurely
born child of a syphilitic woman, who had numerous condylomata. On the
fourth day, violent inflammation of the eye took place, with profuse suppura-
tion ; leeches had no effect in moderating the inflammation, but it continued
to increase, and an abscess formed on the cornea. A collyrium of nitrate of
silver, with laudanum, in distilled water, was ordered : the atrophy was treated
with a mixture containing disulphate of quinine ; and aromatic baths and
arrow-root were prescribed. The abscess in the cornea burst in two points,
the child gradually wasted, and death took place on the tenth day after birth.
On post-mortem examination, a notable quantity of serum was found in the
i. cerebral ventricle: the lungs and the other principal viscera were
ealthy.1 - - -
iºn, (Lebensschwäche). Thirteen maturely born children died of
this—seven males and six females. The children refused the breast ; the
rejected with pain, whatever was administered to them ; but slept well.
Womiting, convulsions, and coldness of the extremities supervened; and
finally, death. The autopsies generally revealed anaemia, rarely hyperaemia
of the brain, with oedema and effusion into the ventricles. One of these
children had petechiae on the eighteenth day, and the muscles of the gluteal
regions and feet felt of a stony hardness. On post-mortem examination,
ecchymoses were found beneath the capsules of the kidneys, and miliary
granulations on the surface of the spleen. -
PLEURO-PNEUMONIA. This proved fatal to two children ; to a premature
male child, on the fourth day after birth, and to a mature twin male, on the
second day. The first manifested only slight signs of life; on the day after
- 1 The Editor of the Journal für Kinderkrankheiten suggests that, in this case,
Dr. Elsåsser should have employed small doses of calomel and iodide of potassium,
in conjunction with the tonic and nutritive remedies.
CRITICAL DIGEST OF THE JOURNALS. 495
birth it was jaundiced and soporose, but still it swallowed, and took the breast.
There was an absence of any individual symptoms, especially of those which
should denote a severe affection of the lungs. On post-mortem examination,
the brain and its membranes were found much hyperaemiated, and the sub-
stance of the brain was of a yellow colour. The right lung was healthy; the
lower lobe of the left was mostly in a state of atelectasis; it could be inflated.
The upper lobe, with the exception of the apex, was perfectly hepatized; the
tissue here was very soft, and, on making.a section, a large quantity of reddish
fluid escaped : this part of the lung was incapable of being inflated. On the
upper surface of this lobe there was a layer of recent, yellowish-grey plastic
exudation, which could be easily removed. The costal pleura on the left
side was strongly injected, of a dark red colour. The foramen ovale con-
tained a plug of coagulated fibrin. The second case was that of a strong, well-
developed twin-child, weighing 7lbs, which was born apparently dead, but
soon revived and cried lustily. On the first day, it took the breast frequently
and eagerly. On the second, it was drowsy, sucked no more, and did not
even swallow milk squeezed into its mouth ; the whole body was of a greyish-
yellow colour. The abdomen was full and constipated. In the evening, the
head felt hot ; two leeches were therefore applied, which diminished the heat,
but did not remove the drowsiness. On the morning of the third day, strong
collapse was observed ; the body became cold, and the child remained in a
state of stupor until death. During life, the child had neither cough nor
dyspnoea, nor any symptoms of general febrile disturbance ; it only appeared
somewhat thirsty at times. The autopsy revealed hyperaemia of the brain
and of its membranes, with yellowness of the substance of the former. In
the right pleural cavity there were two or three tablespoonfuls of reddish-
brown flocculent exudation, coagulable by heat. The lung on this side was
hard and compact ; the greatest part of the upper lobe, a small part of the
middle, and nearly the whole of the lower lobe were hepatized, granular on
section, brittle, readily sinking in water, and not capable of being inflated.
The surface of the lung was covered with a thin, reddish yellow exudation:
the costal pleura was much injected, and likewise covered with a thin layer
of plastic exudation. *- - -
This case affords some peculiar points of interest. 1. Pneumonia is not
uncommon in newly-born children. Clermont-Lombard (Archives Générales
de Médecine), makes this remark ; and further observes, that pneumonia, or
its sequelae, are the cause of death in more than one-sixth of the children
who die in the first week after birth. Wernois found hepatization of the lungs
113 times in 114 cases. On the other hand, pleuritis—at least the simple
form, is rare. In the case before us, however, the pneumonia was accom-
panied with pleurisy. 2. It is remarkable, also, that cough (which is gene-
rally absent in the pneumonia of newly-born children), disturbance of respi-
ration, and febrile reaction (except some thirst), in short, all symptoms of
pulmonary congestion, were at least unobserved ; while all the symptoms of
congestion were referred to the brain. Moreover, the dyspnoea and accelerated
respiration should standin direct relation to the extent of hepatization ; and
here there was indubitable lobar pneumonia, and hepatization, without any
disturbance of respiration. Walleix observes, that in complicated cases of pneu-
monia in newly-born children, there is scarcely any increased heat of skin ;
and relates a case of simple pneumonia, in which the heat of the surface was
not raised during the whole course of the disease. Kluge, of Berlin, remarks,
in his essay on the Pneumonia of Newly-born Children (Medizin. Zeitung,
1835, Wo. 34), that newly-born children lose their warmth and the red colour
of their skin, become cold and bleached, and assume an ashy lead colour in
pneumonia, even before thére are any symptoms of impeded respiration.
Perhaps the reaction in the pneumonia of children is imperfect, so that not
even the presence of congestion, much less of inflammation, can be detected.
Billard observes, that fever is absent in the parenchymatous inflammations

496 CR1TICAL DIGEST OF THE JOURNALS.
of newly-born children: Leger says, that pneumonia is almost always latent
in children ; and Valleix asserts that he found, in fourteen cases of pneu-
monia in newly-born children, one which was truly latent. Or, which seems
more probable, the symptoms of reaction are often feebly developed through
the frequently rapid progress of the disease, and the tender constitution of
the patients, and thus quickly pass into collapse; or they are masked by com-
plications, as by the cerebral affection in the present case. Hence many cases
in newly-born children cannot be detected. 3. In the case under considera-
tion, the left half of the thorax was larger than the right ; aud also, at least,
. the last twenty-four hours, the complexion was of a greyish-yellow
COIOUllſ,
That pneumonia and pleurisy may even occur in the foetus, is placed be-
yond a doubt by trustworthy observations. But, in the present case, it must
be regarded as equally certain, that the inflammation commenced more than
twenty-four hours after birth, and then ran a rapid course. Walleix has
related cases, in which hepatization became perfectly developed in from
twenty-four to thirty hours,
PERITONITIS. Of this affection there died a male child, who, for two days
after birth, was perfectly healthy, but was then seized with distension of the
abdomen, tormina, and convulsions, refused the breast, and died on the third
day, remarkably collapsed. On inspection of the body, the peritoneal cavity
was found to contain about two tablespoonfuls of a yellowish serous plastic
exudation, which was precipitated as a false membrane on the liver and spleen,
but not on the intestines. The cerebral membranes were much injected.
ERYSIPELAs. Two children were seized with erysipelas of the face; one of
whom, a male, died. He was taken ill on the seventh day, with erysipelas of
the left eyelid, became drowsy, and frothed at the mouth. The erysipelas
extended over the whole of the left cheek; violent fever and strong coma set
in, and death occurred on the third day. No abnormal symptoms were found
on dissection. -
Four children, of whom three died, had erysipelas in the vicinity of the
genital organs. Of those who died, one was a mature female child, the second
a mature male, and the third a premature male. The history of the first and
third cases is not remarkable ; an anaemic state of the brain was the only
abnormal appearance found on dissection. The second child was seized, on the
fourteenth day after birth, with erysipelas of the genital and gluteal regions,
great thirst, frequent pulse, and constipation. It was ordered to have a mild
laxative, with aqueous tincture of rhubarb. On the seventeenth day after
birth, an ill-looking abscess had formed at the root of the penis; the scrotum
was of a dark blue colour; the erysipelas extended from the knees upwards,
on the abdomen and back, as far as the lower ribs. On the eighteenth day,
the abdomen was extremely tense, with distended veins; the scrotum was
gangrenous; the upper part of the thigh also of a dark red colour, very
tense; and death occurred, during a fit of convulsions, on the evening of this
day, the fourth of the illness. Post-mortem examination revealed nothing
abnormal in the cranial or thoracic cavities. The peritonaeum was thickened
and opaque in its parietal portion, and covered with dark red stellated
patches of injection; in the cavity, especially at the bottom of the pelvis,
were were four tablespoonfuls of exudation, consisting of greenish briny
serum and many yellow flocculi, which latter partly swam in the serum, and
partly precipitated on the intestines. The liver was very large, about the
size of that of a child five years old. The lining membrane of the right um-
bilical artery was somewhat discoloured, and contained a firm coagulum, but
In O OllS.
dºw APOPLEXY. Five children were seized with symptoms of congestive
apoplexy, of whom three (mature males) died. One of these had been brought
into the world by gentle traction with the forceps. Three hours after birth,
it began to moan, and would not take the breast ; the abdomen was distended,


CRITICAL DIGEST OF THE JOURNALS. 497
.*
though not painful on pressure, and there was much eructation; convulsions
soon came on, and death took place on the second day. The autopsy brought
to view hyperamia of the meninges and of the brain; the latter exhibited,
on section, much punctiform vascularity. In the right pleural cavity there
were three loth (one and a half ounce) of clear serous fluid.
The two other fatal cases were seized, on the tenth and twelfth days after
birth, with drowsiness, vomiting, heat of head, and convulsions. The latter
and the drowsiness increased, the body became cold, and death followed on
the second day from the attack. In both these cases, the brain and its mem-
branes were found hyperaemiated, and in one there was also a clear fluid ex-
udation in both pleural cavities and in the peritonaeum.
A mature child was born in a state of lividity and sopor. In a short time,
it had stertorous breathing, a small pulse, cold skin, dilated pupils, and died
twenty-six hours after birth. On post-mortem examination, the meninges
were found much injected ; and the lateral ventricles contained a large quan-
tity of water. On the inferior surface of the left posterior lobe of the brain,
between the membranes, there was a large coagulum of blood; and a similar
one, of larger size, on the inferior surface of the left lobe of the cerebellum.
The treatment consisted in leeching the head, cold applications, hip-baths,
stimulant enemata; laxatives, small doses of calomel, oxide of zinc, etc.
CoNVULSIONS. This disease occurred singly, without any other, in eighteen
children (ten males and eight females); only one case was fatal. A mature
female child was perfectly healthy up to the eighth day after birth ; but on
the eighth day it refused the breast, became pale, livid, soporose, and breathed
with difficulty : the pulse was small, and there was vomiting and constipa-
tion. It was ordered to have laxatives, as well as small doses of calomel and
oxide of zinc, with magnesia. No improvement resulted; and it was only
after the use of musk and ammoniated spirits of aniseed in small doses, with
baths, that there seemed to be any amendment. On the sixth day, however,
the child suddenly became, towards the evening, blue and cold, the pulse was
scarcely perceptible, frothy mucus exuded from the nostrils at each expira-
tion, and death occurred at eight P.M. On post-mortem examination, the
brain was found hyperaemiated, and there was a large quantity of clear serum
effused in the lateral ventricles and at the base of the brain. The lungs were
congested and Oedematous, and gave exit, on being cut into, to a quantity of
sanguineous frothy fluid. The liver was very full of blood.
ATELECTASIS PULMonum. This was observed in a high degree in four
mature children (three males and one female). The first died on the third
day, with symptoms of vital debility ; on the second day, there was com-
mencing induration of the cellular tissue, and it was constantly in a state of
stupor. The brain and its membranes were found hyperaemiated, and the
lower lobe of the right lung in a state of atelectasis. The second child lived
two days, and gave only very slight signs of life; it died in convulsions. The
brain was found in a state of anaemia; and there was perfect atelectasis of
the whole of the left lung, with oedema of the right. The third was brought
into the world by the forceps; it was apparently dead, but was immediately
revived. It moaned ; mucus, stained with blood, flowed from the mouth ;
the hands were blue and swollen ; and death occurred twelve hours after
birth. On inspection, the brain was found highly cedematous, the lateral
ventricles filled with serum, the left lung in a perfect state of atelectasis, and
oedematous ; the right contained air, but was oedematous. This case is very
similar to the fourth, which occurred in a male child, who was born after an
easy labour, but died after six hours. Just after birth, he cried aloud once,
but afterwards moaned until death. Respiration was irregular ; there was
constant sopor; the face was livid, and the body cold. On post-mortem exa-
mination, the brain and its membranes were found much injected. The sub-
stance of the brain exhibited much watery infiltration; the lateral ventricles
were filled with serum. The lungs were compact, with sharp edges, and were
498 CRITICAL DIGEST OF THE JOURNALS.
in a state of atelectasis. Only a portion of the upper lobes contained air.
The pleural cavities contained some serum. There was a moderate quantity
of dark blood in the cavities of the heart.
These two latter cases are instances of an important complication of imperfect
expansion of the lungs, with acute hydrocephalus and serous infiltration, in
a high degree, of the cerebral substance. It is very probable, that the first
morbid change was the production of congestion of the brain, soon amount-
ing to congestive apoplexy, and, as a consequence, pressure on this organ.
In this manner, the sensory function being impeded, the susceptibility of the
lungs to the stimulus of the atmospheric air was destroyed ; but especially
the infantile organism was so weakened, that a perfect expansion of the
chest, and, consequently, complete respiration, was impossible. "
CEDEMA of THE LUNGs. A male child was born at the full term, but after
a tedious labour; it was apparently dead, but immediately revived. It ap-
peared blue all over, and moaned in an extraordinary manner. Some blood
was allowed to flow from the umbilical chord, sinapisms were applied to the
calves of the legs, and enemata of camomile, with oil, were administered. The
child, however, soon died. On post-mortem examination, there was found to
be moderate hyperaemia of the brain, and some serum in the ventricles. In
both pleural cavities there was some bloody serum. The upper lobe of the
left, and the upper and middle lobes of the right lung, were oedematous, but
still floated in water. The lower lobe of the left lung contained no air; the
tissue was weak, soft, and in an extreme state of watery infiltration. The
lower lobe of the right lung presented an analogous appearance, but in a less
degree. There was nothing abnormal about the heart. -
TUBERCULosis of THE BRAIN. A very weakly female child refused the
breast on the second day after birth, and became soporose. Both eyes were
slightly inflamed. A mixture containing musk, with a few drops of liquor
cornu cervi succinatus, was prescribed ; hip-baths and sinapisms were also
ordered. The drowsiness and weakness still increasing, half a drachm of
Malaga wine was ordered to be added to each dose of the medicine. On the
eleventh day, vomiting and diarrhoea set in ; and the child died, extremely
emaciated, on the twelfth day. At the autopsy, after both hemispheres of
the brain were removed, the centrum ovale of Vieussens was found to contain
small punctiform tubercles, of the size of millet-seed, or linseed ; and one of
the size of a pea, in a state of purulent softening. In the left optic thalamus
there were many small miliary granulations, as large as pins'heads. Around
these deposits, there was much small punctiform vascularity ; the choroid
plexuses were much injected. In the cerebellum, there was a rather large
apoplectic clot. The ventricles contained some serum; on the posterior lobe
of the cerebellum, between the membranes, there was a patch of yellowish
exudation. Many of the mesenteric glands were found enlarged. .
TETANUs. A mature male child was seized, on the sixth day after birth,
with inflammation of the umbilicus: the chord had become separated on the
preceding day. The inflammation soon proceeded to suppuration, and the child
became strongly jaundiced, and very restless. On the night between the eighth
and ninth days, the child cried frequently and loudly, but towards morning
this crysubsided into a peculiar moan; and, at the same time, clonic convulsions
occurred in the muscles of the face and jaw. The muscles of the eyes, neck,
and arms were slightly convulsed; the feet were stiff. The paroxysms
occurred, after the tenth day, every four or six minutes, and lasted half a
minute each time. The application of leeches to the back part of the head,
and the administration of small doses of tincture of opium, rendered the
paroxysms less frequent ; but they still returned every quarter of an hour,
the pulse became weaker, the countenance livid, the pupils much dilated, and
death imperceptibly supervened. On post-mortem examination, a large quantity
of clear fluid was found beneath the dura mater of the spinal chord, especially
in the lumbar region. The arachnoid membrane of the chord was through-



CRITICAL DIGEST OF THE JOURNALS. 499
out of a yellowish-grey colour, with single hyperamic spots. Between it and
the pia mater in the lumbar legion, there was a considerable amount of yel-
lowish exudation ; the pia mater was much injected. The substance of the
spinal chord, and of the brain, was very firm. On the surface of the brain,
as well as in the lateral ventricles, there was an effusion of yellowish watery
fluid ; the brain and its membranes contained much blood. No abnormal
appearance was observed in the pleural or peritoneal cavities, or in the umbi-
lical vessels. - .
SoFTENING OF THE BRAIN. A well-developed male child gave only slight
signs of life after it was born : it was in a constant state of torpor, and had
a blue, livid countenance. On the second day, it was seized with violent
epistaxis, and died. The membranes and substance of the brain were much
injected; there was a little fluid in the ventricles; the brain itself was in a
state of watery infiltration ; the substance of the cerebellum was soft, like
jelly, and formed a reddish grey mass (local softening). The posterior lobes
of the cerebrum were in the same condition, but in a less degree ; the heart
was full of blood. This red softening must evidently be considered as the
consequence of apoplexy, with effusion of blood in the cerebellum, as a
mingling of blood with broken-up cerebral matter. A flow of blood from the
Schneiderian membrane, in the form of epistaxis, produced death suddenly.
The post-mortem appearances in this case explain clearly the low vitality
perceived in the child though born at the full term, and properly developed.
This form of softening of the brain (not dependent on inflammation) is, ac-
cording to Billard, peculiar to new-born children, and a secondary result of
congestion of the brain. -
There were also noticed two cases of CHOLERA, two of HYDROCELE, two of
SWELLING OF THE MAMMARY GLANDS in male children, and two remarkable
cases of CoRYZA. On this Coryza, which is peculiar to children, Dr. Elsåsser
remarks :-" In children at the breast, especially when newly-born, inflam-
mation of the Schneiderian membrane manifests some peculiar symptoms,
which depend on obstruction of the nostrils, especially at the upper orifices.
A child, who has a severe attack of this disorder, does not breathe through
the nose : it cannot suck and inspire air at the same time, so that it
lets go the nipple as soon as it seizes it, and utters a pitiful cry. The same
thing happens if it attempt to suck a finger introduced into the mouth ; but
fluids poured in readily pass down. Before it heaves the breast (and some-
times even independently of the act of sucking, especially at night), it shews
all the symptoms of increasing dyspnoea, the countenance becomes blue, and
the child is in a state of suffocation ; and all the symptoms are renewed so
often as it tries to suck. Temporary weaning during the height of the dis-
ease, and the use of cow's milk, diluted with anise tea, alleviate this condi-
tion, which will be removed by the internal use, several times a day, of small
doses of calomel, with magnesia and sugar.”
MALFoRMATIONs. Of these are to be noticed:— -
1. UMBILICAL HERNIA. This case occurred in a prematurely born male
child, weighing three pounds, which died a few minutes after birth. The
sternum was absent, so that the chest presented a depression in the middle
line in front. The lungs were small, undeveloped, and contained a little air—
the child having made a few feeble inspirations. The heart and diaphragm
were normally developed; the peritoneal cavity was collapsed, and felt empty.
At the umbilicus there was a hernia in the integuments of the chord, which
were yellow and transparent. The sac of the hernia was about the size of an
orange : it contained the liver, stomach, and the whole intestinal canal. At
the limits of the swelling, and interiorly to the umbilicus, the spleen was
found ; it was remarkably large, much elongated, as was also the pancreas.
The spleen and liver were very soft ; the gall-bladder and the cystic duct
were absent ; the hepatic duct opened immediately into the duodenum ; the
venous canal was obliterated ; the stomach was like an intestime in form.


500 CRITICAL DIGEST OF THE JOURNALS.
The insertion of the diaphragm was deep below the inferior ribs, so that the
thoracic cavity was much elongated, and the abdominal compressed. The
intestines seemed to have a blind termination, at some distance in the abdomen
from the anus. The kidneys were situated very high up ; the femur and
humerus were short, thick, and knotty ; there was a varus in the left foot. On
examining the head, the parietal and occipital bones were found covered with
firm coagula, beneath the pericranium ; the fontanelles were very large; the
substance of the brain was normal. At the bottom of each orbit there was
much firm cellular tissue, and a sac with amorphous contents, representing
an eye. The eyelids were closed.
2. WARUS. One case of this was observed, in a female child, who was
otherwise well formed. [Medizinischer Correspondenzblatt, Stuttgart, Bd. xix,
No. 15; and Journal fir Kinderkrankheiten, Jan. and Feb. 1850.]

SULPHUR IN CHOI,ERA.
DR. LoRIE, of Pont-le-Woy, speaks favourably of the medicinal use of
Sulphur in the Journal des Con. Médico-Chir. (October 1849); and in the
same journal for the 1st of January, 1850, there is a paper by DR. CABARET,
entitled “Du Soufre sublimé dans le Période algide du Cholera.” Notices
on the same subject are given in our volume for 1849, pp. 345, 673, and 1116.
THANSIENT ALBUMINURIA.
We find the following report of a discussion at the Societé de Biologie in
the Gazette Médicale for February 10, 1849 –“ M. BouchAT detailed a case
of Transient Albuminuria, dependent on passive sanguineous congestion.
The patient laboured under an organic disease of the heart, and had general
anasarca, accompanied by a red and congested condition of the surface. In
these circumstances, albumen appeared in the urine. Bleeding to nearly ten
ounces, removed the symptoms of general hyperaemia ; and the urine forth-
with ceased to be albuminous.
“M. Blot called the attention of the Society to the frequent production,
during labour, of Transient Albuminuria, arising from the impeded circula-
tion, and disappearing spontaneously. M. Gubler has several times observed
the fact, already pointed out by M. Rayer, that obliteration of the renal veins
can produce Albuminuria. M. Lebert insists on the necessity of combining
microscopical with chemical examination. It would thus be easy to deter-
mine, whether the albumen exists in the urine in an amorphous state, or is
partly furnished by the corpuscles of blood or of pus.” -
We believe that to Dr. Robinson, of Newcastle, belongs the merit of having
first pointed out the important fact, that ligature of the emulgent veins in-
duces Albuminuria, as a consequence of congestion of the kidneys. This,
and other analogous facts, are fully set forth in Dr. Cormack's paper on
PUERPERAL Convulsions, contained in the June number of this Journal for
1849, as well as in other parts of our first volume.
It is now pretty generally known, that Albuminuria is not an absolute sign
of organic renal disease; but that it rather is a sure indication of general
hyperaemia, which may be the concomitant or precursor of an alteration in
the structure of the kidney, or may merely be associated with a temporary
congestion of that organ.
50 L
RE Po RTs of so c 1 ET1 E. s.
ROYAL MEDICAL AND CHIRURGICAL SOCIETY,
TUESDAY, FEBRUARY 12, 1850.
DR. ADDISON, PRESIDENT, IN THE CHAIR.
CASE OF STRICTURE OF THE CESOPHAGUS, FATAL Two YEARS AND THREE
MONTHS AFTERACGIDENTALLY Swallowing SoAP-LEEs. By W. R. BASHAM,M.D.
A woman, aged 22, was admitted into the Westminster Hospital, July 16, 1847,
suffering from the ordinary symptoms of poisoning by a corrosive irritant.
Five days previously she had drunk, by mistake, some of the soap-lees used
in marble polishing, which consisted of a caustic solution of impure carbonate
of soda. An oesophagus tube at this time passed readily into the stomach.
Under a soothing plan of treatment, with blisters, and calomel with opium,
she steadily improved, and was discharged, at her own request, ten days after
admission. Eleven months afterwards, on June 8th, 1848, she was again ad-
mitted, emaciated and weak, and unable to swallow either solids or fluids.
The oesophagus being examined with a small gum-elastic catheter (No. 8), a
trifling obstruction was felt at a point corresponding to about an inch below
the cricoid cartilage ; and about an inch and a half or two inches lower down,
another impediment was met with, which it required steady and prolonged
pressure to overcome. The catheter was passed into the stomach daily, its
size being gradually increased. After the first day of this treatment, the
patient was able to swallow liquid food; but she could not obtain a passage
for any solid portions of food. She increased in flesh and strength ; and, on
June 30th, was made an out-patient, but neglected to attend, and on July
18th was re-admitted, with aggravation of the symptoms. A blister was
applied, and the catheter again passed with the same good effect as before.
At the end of August she was made an out-patient, but remained as nurse in
the hospital. In January, 1849, she left it. On the 10th of September, 1849,
she was admitted for the fourth time. She was now more attenuated and ex-
hausted : was quite unable to swallow even fluids, and the Stricture could not
be passed. She died on the 19th September. -
Autopsy. The body being examined, the upper third of the oesophagus was
found much dilated, and its cords thickened. Between the first and second
Stricture, the tube was contracted to about the diameter of a No. 8 catheter.
The second Stricture would not admit a probe from above; it was only from
below upwards that a passage could be obtained. The author suggested the
propriety of commencing in such cases the use of the oesophageal bougie, as
soon as the inflammatory condition of the parts has been subdued, though no
positive symptoms of dysphagia, yet present themselves, and of continuing
its use daily for months, with the view of preventing the formation of Stric-
ture. ...” .
CASE of STRICTURE OF THE EUSTACHIAN TUBE, AND THE APPEARANCES
PRESENTED ON A Post-MoRTEM EXAMINATION ; WITH REMARKS on THE USE
of THE OToscope, IN THE DIAGNoSIs of DISEASEs of THE EAR. By Joseph
ToyNBEE, F.R.S. The Otoscope consists of an elastic tube eighteen inches
long, and about half an inch in diameter, each extremity having attached to
it a piece of ivory or ebony. One end of this tube being placed in the ex-
ternal meatus of the patient, the other is inserted in that of the surgeon,
and by this means sounds emanating from the tympanic cavity of the patient
can be distinctly heard by the medical man. The sound produced by the
passage of air into the tympanic cavity, when the organ of hearing is healthy,
consists of a series of very faint cracks, which are distinctly appreciable by
the otoscope, -
502 REPORTS OF SOCIETIES.
TUESDAY, FEBRUARY 26, 1850.
DR. ADDISON, PRESIDENT, IN THE CHAIR.
PRox1MATE CAUSE OF ALBUMINoUs URINE AND DRoPsy : PATHoLogy of
THE RENAL BLooD-WESSELS IN BRIGHT's DISEASE. By GEORGE JoHNson,
M.D., Assist ANT-PHYSIGIAN To KING's CoILEGE HospitaL. The author,
in accordance with Henle’s description of the arterial tunics, had observed,
that the renal arteries contain two layers of muscular fibres, the inner being
longitudinal, and the outer circular. In all cases of chronic renal disease,
with greater or less destruction of the secreting cells and tubes, the author
had observed great hypertrophy of the arterial walls, the canal of the vessels
remaining pervious, and of the normal size, until the extreme stage of the
disease, when an accumulation of oil-globules frequently occurs within them.
The Malpighian capillaries, in the same cases, are also much thickened, but
present no appearance of muscular fibre. In the last stages, oil-globules are
occasionally seen within or upon them. The intertubular capillaries and the
veins, present no appearance of thickening. The author referred to the late
Dr. John Reid's observations on the phenomena of asphyxia, and to Dr.
Alison's on the capillary circulation, and its dependence on the vital attrac-
tion exerted upon the blood by the processes of nutrition and secretion. The
escape of serum from the Malpighian capillaries, and its consequent mixture
with the urine, and the serous effusion into the areolar tissue and the serous
cavities, result from impeded capillary circulation, consequent on the reten-
tion of urinary excrementitious matters in the blood, the obstruction being
analogous to that which Dr. Reid proved to exist during the process of
asphyxia. The obstruction occurs in the intertubular capillaries of the
kidney, and is the cause of the remarkable hypertrophy of the Malpighian
capillaries, and of the arterial tunics. The obstruction in the systemic capil-
laries would account for the hypertrophy of the left ventricle of the heart, so
frequently observed in cases of chronic renal dropsy, without manifest disease
of the valves or of the vessels. The author then referred to some patholo-
gical phenomena, probably connected with impeded capillary circulation, and
in this respect analogous to those before mentioned—e.g., serous effusion into
the pulmonary cells in slow asphyxia ; hypertrophy of the right ventricle of
the heart in cases of chronic asthma, ; sudden death from the entrance of air
into the veins; and the frequent connexion of cerebral haemorrhage with
renal disease. *
Dr. CHARLEs J. B. WILLIAMS said that, Dr. Johnson, in his former paper,
had described Dr. Bright's disease of the kidney, as a state of fatty-degenera-
tion of that organ. The author's present views more nearly coincided with
those expressed by him (Dr. W.) in the discussion on the former paper; when
he had stated, not only that other kinds of deposits were often met with, but
also that more influence ought to be attributed to the state of the blood-ves-
sels. He could not agree with the author, that the congested state of the
vessels was secondary to the derangement in the excreting cells of the kidney;
he believed that the latter state was only the result of the altered action of
the blood-vessels. He was warranted in this view by frequently observing
albuminuria to result as a secondary affection, from disease of the right side
of the heart, causing a general congestion of the venous system. He had
the greatest respect for his friend, Professor Alison, but he could not admit
the existence of his vital attraction and repulsion. In observing what occur-
red on applying any irritant to the web of the frog's foot, under the micro-
scope, it was found that the minute arteries were first greatly contracted, and
that the congestion occurred afterwards.
DR. SNow, MR. LE GRos CLARK, DR. BLACK, MR. PAGET, MR. BRANSBy
CoopFR, DB. CoPLAND, and DR. DANIELL made some remarks having, more or
ess, reference to Dr. Johnson's paper.


BOYAL MEDICAL AND CHIRURGICAL SOCIETY, 503
ANNIVERSARY MEETING, MARCH 1, 1850.
DR. ADDIson, PRESIDENT, IN THE CHAIR.
REPORT OF THE PRESIDENT AND CouncIL. We have only room for an ab-
stract of this document. . - -
The total number of Fellows on March 1, 1849, was 578—at the present
time it is 587—26 new Fellows having been elected into the Society, while
the number of those who have ceased to be Fellows, whether from death or
other cause, is 17. Of the 587 Fellows who now compose the Society, 30 are
Honorary Fellows, 11 British, and 19 Foreign, and 557 are Ordinary Fellows
—308 Resident, and 249 Non-Resident.

The Years. 1843-4, 1848-9. 1849-50.
Total Number of Fellows in
August .............................. 501 578 578
Number of Fellows who have paid 235 284 292
the Annual Subscription.........
Receipts from Annual Subscrip- -
tions, Admissions, and Compo- 973 : 7 : 0 || 1102:10:
sition Fees...........................
1108 : 16 : 0
0
Receipts from Sales of Transac-
tions, etc., Fines and Interest || 109 : 18: 10 || 103:19: 9 || 115: 12 : 0
of Funded Property ...............
Total Income ........................ 1083: 5: 10 | 1206: 9: 9 || 1224 : 8 : 0
Total Expenditure, exclusive of tº ºf tº • U & * . . . .
the Purchase of Stock............ 954: 14: 1 || 1104: 9:10 | 1075: 7 : 6
Amount of Stock purchased ...... 100 : 0 : 0 || 500 : 0 : 0 -*sº
Amount of Stock in the Funds ... 1100 : 0 : 0 |2700 : 0 : 0 |2700 : 0: 0
While the total income of the Society has increased, the actual expendi-
ture has been less than in the preceding year. The diminution has taken
place in Current Expenses, Incidental Expenses, and Expenses of the Volume
of Transactions; while the sum expended in adding to the property of the
Society, exclusive of money funded, has been much larger than in the pre-
ceding year.
ANALYSES OF EXPENDITURE.
Current Expenses. # 8, d. #3 s. d.
Rent ... ... ... ... ... ... ... ... 202 15 0
Insurance of Library ... ... ... ... 13 10 0
Sub-Librarian's Salary ... ... ... ... 140 0 0
Petty Cash... ... ... ... ... ... ... 64 0 3
Page's Wages and Clothes ... ... ... 29 11 6
Printing and Stationery ... ... ... ... 24 18 3
Gas ... ... ... ... ... ... ... ... 3 2 3
Coals ... ... ... ... ... ... ... ... 20 0 0
Glazier ... ... ... ... ... ... ... 7 11 0
Chandler ... ... ... ... ... ... ... 10 19 3
Winding and Cleaning Clocks & e º O C & I 11 6
Carried forward — 5.17 19 0
WOL. II. 33
504 REPORTS OF SOCIETIES.
Current Expenses, brought forward ... ... ... ... £517 19 0
Incidental Expenses.
Printing New Bye-laws, Supplement to Catalogue, Car- 37 17 5
penter, Ironmonger, etc. ... ... ... ... ... ...
Expenses of Volume XXXII ... ... ... ... ... ... 130 12 0
Additions to the Property of the Society.
Books Purchased 354 12 4
Binding of Books ... ... ... ... ... 23 2 9
Sydenham, Cavendish, and Ray Societies 9 9 O
Pedestal for the Bust of Dr. Elliotson ... l 15 0
388 19 1
Total Expenditure... ... 391,075 7 6
The Council have still held in view the object of rendering the library as
perfect as possible, and the librarians, during the past year, have been
actively engaged in carrying into effect the recommendations of the Library
Committee appointed in 1847. In the last twelve months, 800 works (up-
wards of 1,000 volumes) have been purchased ; and, in the course of the last
three years, more than 1,600 works have been added to the library, which
now includes nearly 22,000 volumes. It will be observed that nearly two-
fifths of the whole expenditure has been applied to the improvement of the
library. A manuscript classed “Catalogue of the more Important Works in
the Library”, has been compiled and presented to the Society by Mr. Williams,
#. sub-librarian. This volume is highly creditable to the Society's sub-
ibrarian.
NEW BYE-LAws RECOMMENDED BY THE CouncIL, AND ConFIRMED BY THE
SocIETY. 1. “Every person elected a Fellow of the Society, and living within
seven miles of the General Post-office, shall, previously to his admission, pay
to the Society the sum of six guineas as an admission-fee, and shall also
further contribute the sum of three guineas annually. But every Fellow
may, after the payment of the admission-fee, compound for his annual con-
tribution, by paying at once the sum of forty-five guineas; every Fellow who
has paid five annual contributions may compound for all future annual con-
tributions by paying at once the sum of thirty-nine guineas ; every Fellow
who has paid ten annual contributions may compound for all future annual
contributions by paying at once the sum of thirty-three guineas ; every
Fellow who has paid fifteen annual contributions may compound for all future
annual contributions by paying at once the sum of twenty-seven guineas;
every Fellow who has paid twenty annual contributions may compound for
all future annual contributions by paying at once the sum of twenty-one
guineas; every Fellow who has paid twenty-five annual contributions may
compound for all future annual contributions by paying at once the sum of
fifteen guineas ; and every Fellow who has paid thirty annual contributions
may compound for all future annual contributions by paying at once the sum
of five guineas.
2. “All sums of money, paid to the Society as composition-fees in lieu of
annual contributions, shall be invested in the names of the trustees in such
government, or other securities, as shall be approved of, and directed by the
Council. The principal of these sums of money shall not be expended with-
out the Sanction of a general meeting of the Society, but the interest thereof
shall be paid by the trustees to the treasurers for the purposes of the current
expenditure of the Society.” -
ELECTION OF OFFICE-BEARERS. DR. WEBSTER, in a luminous and unan-
swerable speech,” exposed the vicious effects of the present system, as mani-
fested from year to year in the “House-lists”, and objectionable proceedings
of the Referees, as regarded the Transactions. A great muster having been
* Fully reported at p. 310 of the Lancet for 9th March.
MISCELLANEOUS INTELLIGENCE, 505
anticipated of reformers, and a rumour being afloat that they were tolerably
organized, and might try to change certain names in the House-list, the
attendance of all parties was very large ; and, strange to say, the nominees
of the Council were with difficulty carried . It is painful and invidious to
attack bad laws through individuals, and we hope that ere another 1st of
March, the abolition of the House-list will avert such another trial of strength
—one so dangerous, not only to the peace, but to the existence of the Society.
In analyzing the division, it must be recollected, that the twenty-one
members of the late Council, the ten new members, the twenty-three mem-
bers of Committee of Referees, all used their influence against the reformers.
Take away these fifty-four (one of the referees is also a councillor), and where
is the majority SEVENTY-FIVE FELLows recorded their votes against a
self-elected executive.
THE LIST of OFFICE BEARERs. President: Thomas Addison, M.D. Vice-
Presidents: George Burrows, M.D., F.R.S.; John Thomson, M.D.; Henry
Alexander, F.R.S.; Samuel Solly, F.R.S. Treasurers: Robert Bentley Todd,
M.D., F.R.S.; Benjamin Phillips, F.R.S. Secretaries : Seth Thompson, M.D.;
Charles Hawkins. Librarians: John Hennen, M.D.; James Dixon. Mem-
bers of Council: George Cursham, M.D.; George Gregory, M.D.; William
Macintyre, M.D.; Alexander John Sutherland, M.D., F.R.S.; Charles J. B.
Williams, M.D., F.R.S.; James Clayton ; Thomas B. Curling; William Fer-
gusson, F.R.S.; Henry Charles Johnson ; Samuel A. Lane.
MISCIELIAANEOUS IINTELLIGENCE,
STATISTICs of THE PARISIAN HospitaLS For THE INSANE. 1. Charenton.
On January 1st, 1849, there were 445 inmates—228 males and 217 females.
During the year, there were 171 admissions—107 males and 64 females;
discharged cured, 24 males and 20 females; escaped, 2 males and 1 female ;
discharged at the request of friends, or transferred to another establishment,
35 males and 28 females; died, 45 males and 16 females. On January 1st,
1850, the population was 445—231 males and 214 females.
2. Salpêtrière. On January 1st, 1849, there were 1471 insane patients in
this institution. During the year, there were 694 admissions ; 219 were dis-
charged cured ; 72 were improved; Il escaped ; 33 were dismissed at the
request of friends, or transferred to other establishments. The severity of
cholera in the institution raised the cypher of mortality to 599. On January
1st, 1850, the population was 1231. -
3. Bicêtre. On 1st January, 1849, the number of inmates was 796; ad-
missions during the year, 657; total 1453. There were dismissed cured, 211;
ameliorated, 27; escaped, 21; transferred to asylums in the departments, 16;
at the request of their family, or sent to their native country, 73 ; deaths
289;-leaving, on the 1st January 1850, a population of 816.
The number of admissions into the Salpêtrière and Bicêtre in 1849 (1350)
is rather less than that for 1848 (1354). The numbers for 1847 and 1846
are 1230 and 1331. These statistical results afford a sufficient reply to the
assertion, that the late political disturbances have increased the number of
the insane. [Annales Médico-Psychologiques, January 1850.]
THE METROPOLITAN POLICE. According to the Parliamentary Report just
published, the medical expenses incurred on behalf of the Metropolitan
Police, amounted, during the past year, to 2376/.6s. 7d. The salary of the
Superintending-Surgeon, Mr. Fisher, is 600l., and there are sixty-two district-
surgeons, at Salaries varying from 4!. to 721. per annum, making a total of
1860. 7s.6d. Medical attendance, medicines, etc., for destitute prisoners,
and for poor persons in cases of accidents, etc., in the public thoroughfares,
cost 519. 15s. 1d.
ROYAL CoILEGE of SURGEONs. Two JACKsonIAN PRIZEs have been
awarded by the College. Henry Lee, Esq., of Dover-street, Piccadilly, has
506 MISCELLANEOUS INTELLIGENCſ.
obtained one, for a work on the Causes, Consequences, and Treatment of Pu-
rulent Deposits; the other has been adjudged to Peter Hincks Bird, Esq., of
Birmingham, for an essay on the Nature and Treatment of Erysipelas.
RUMoURED UNION OF THE ROYAL MEDICAL AND CHIRURGICAL, witH THE
PATHological, SocIETY. We understand that some of the best and most
active friends of both institutions are anxious to bring about a junction. It
is proposed, that the united societies meet weakly, and that each alternate
meeting be entirely devoted to Pathology and Pathological Anatomy.
TESTIMONIAL To THOMAS S. FLETCHER, Esq., BRoomsgrove. On Saturday,
9th March, a silver tea-service was presented to Thomas Fletcher, Esq., in
testimony of his assiduous exertions during the prevalence of the cholera, in
the summer of 1849. The coffee-pot and tea-pot bore the following inscrip-
tion :-" Presented to T. S. Fletcher, Esq., surgeon, by the inhabitants of
Stoke Prior and a few other friends, to mark their sense of his unwearied ex-
ertions, professional skill, and great kindness to the poor, during the preva-
lence of the cholera in the summer of 1849.”
A PP O I N T M. E. N. T.
GooDFELLow, Dr. S. J., appointed Lecturer on Medical Jurisprudence in the Middle-
sex Hospital School of Medicine, in the room of Dr. R. G. LATHAM, resigned.
O BIT U A R.Y.
ANDERSON, Thomas, Esq., Surgeon, at Selkirk, aged 63, on 7th April.
BELLINGHAM, Dr. W. H., at Pisa, on 31st March.
BURRow, T. D., Esq., Surgeon, at Settle, Yorkshire, aged 53, on 14th March.
CAPURON, M., the distinguished medical jurist, of Paris, last week.
GARRIE, James, Esq., Surgeon, at Morningside, Edinburgh, on 9th April.
HARRINGTON, HENRY, M.D., son of the late J. H. Harrington, Esq., Member of the
Council, Bengal, 10th April, at Pisa.
Holt, H. T., Esq., Surgeon-accoucheur, at Great College Street, Westminster, aged
66, on 26th March.
LAUDEN, Dr. W. P., at Sloane Street, Chelsea, on 1st April.
MACDoNNELL, Dr. G. B., H.E.I.C.S., on board the Indus steamer, off Malta, on
9th April.
NEVILLE, Edward, Esq., House-Surgeon to the Westminster Hospital, aged 22, on
the 20th March.
PAYNE, -, Esq., Surgeon, of Plymouth, drowned in the wreck of the Royal
Adelaide steamer, off Margate, on the 30th March.
Potts, Dr. L. H., aged 60, on 23rd March.
PROUT, William, M.D., F.R.S., in Sackville Street, aged 64, on 9th April. The
deceased was well celebrated for his valuable contributions to medical science.
RobFRTs, William, Esq., Surgeon R.N., on the coast of Africa, on 6th Dec., 1849.
RogFRSON, -, Esq., Surgeon and Coroner of the borough of Wigan, of diseased
heart and apoplexy, lately.

. . . . Books RE cr: Ivº D.
BALFour, Statistics of Cholera. Madras: 1849. CoMBE (Dr. A.) on the Physio-
logy of Digestion. Ninth Edition. By JAMES CoxE, M.D. Edinburgh : 1849. Cox
on Cholera. London and Bridgend: 1850. For BEs’ Physician's Holiday. Second
Edition. London: 1850. HASSAEL, Microscopic Examination of Water supplied
to London. London; 1850. NELSON on the Principles of Health and Disease.
London: 1850. PROCEEDINGS of Edinburgh Obstetric Society for 1848-49. Edin-
burgh: 1850. REDFERN, Abnormal Nutrition of Articular Cartilages. Edinburgh :
1850. REPORT (second) of Somerset County Asylum. Wells: 1850. THOMson
(Spencer, M.D.) on Temperance and Total Abstinence. London: 1850. TILT on
i)iseases of Menstruation. London: 1850. WRIGHT (Samuel), Pathological Re-
searches on Death from Snffocation, etc. London: 1850.


I, ON DON
JOURNAL OF MEDICINE,
A MIONTHLY
3Betort of the ſºletítal Sºtienteg.
JUNE 1850.-No. XVIII.
OR I. G. I. N A Is C O M M UNI CATION S.
CASES OF SUCCESSFUL OPERATION FOR STRANGU-
LATED HERNIAIN OLD PEOPLE: WITH REMARKs.
By T. B. CURLING, Esq., Surgeon to the London Hospital, etc.
CASE I. STRANGULATED SCROTAL HERNIA—DIVISION OF THE STRICTURE
ExTERNAL TO THE SAC–RECOVERY. Abraham Joshua, aged 81, a stout
man, of the Jewish persuasion, who had always enjoyed good health, was
admitted into the London Hospital on the 9th of February, 1849, at
8 A.M., on account of an irreducible Oblique Inguinal Hernia. He had
been subject to rupture for some years; and, until lately, had worn a
truss. The swelling had appeared a few hours previously, but he had
been unable to reduce it as usual. His bowels had been relieved the
day before. There was a large tumour occupying the left side of the
scrotum; it was tense, and received no impulse on coughing. The
taxis was applied by the dresser whilst the patient was in bed, and after-
wards in a warm bath, without effect. A dose of castor oil was given
at noon; and subsequently a bladder of ice was applied to the tumour.
In the evening, the old man became sick, and complained of pain in
the tumour; and about 9 P.M., in consequence of the increasing urgency
of the symptoms, I was sent for. Having failed in my attempts to
reduce the Hernia, I determined to operate without further delay. An
oblique incision, about three inches in length, commencing an inch and
a half above the external abdominal ring, was carried downwards over
the neck of the sac. The tense margin of the outer ring, girting the
neck of the sac, was divided; and, as this gave but partial and insuffi-
cient relief, some bands of fascia were cut through, and the protruded
parts were then readily returned, without the hermial sac having been
opened. The operation was borne extremely well; and the patient felt
so comfortable after refnoval to a warm bed, that no medicine of any
kind was given him. The bowels acted next morning. He was then
ordered to take a draught of camphor mixture, with m. xx of aromatic
spirits of ammonia, three times a day. He was put upon a nutritious
diet, and allowed eight ounces of wine. On the second day after the
WOL. II. 34
50S OPERATſ ONS FOR STRANGUI,ATED HERNTA IN OLD PEOPLE.
operation, the patient being restless in bed, the rupture returned. It
was reduced without difficulty by Mr. Holman, the House-Surgeon.
This accident did not interfere with the healing of the wound, which
united partly by the first intention, and soon entirely closed. A truss
was ordered; and he was discharged on the 24th February, the fifteenth
day after the operation.
CASE II: STRANGULATED LARGE UMBILICAL HERNIA—OPERATION.—
SLOUGHING OF THE HERNIAL SAC AND INTEGUMENTs—REcovKRY. Ann
Hanson, a large fat woman, at. 79, married, was admitted on the evening
of Sunday, February 18th, 1849. She had been subject to a Rupture at
the Umbilicus for thirty-four years, but had worn a truss for it only
during the last four. The tumour, however, had been but partly re-
ducible. She had lived very temperately, had enjoyed excellent health,
and through a long life had never been confined to her bed except at
the birth of her children. The rupture had caused but little incon-
venience until the Thursday preceding, when it increased in size, and
became rather painful. This did not, however, prevent her getting
about on Friday, although she suffered pain in the back and loins. The
bowels acted on Thursday, and slightly on Friday morning. On Satur-
day, the pain in the tumour increased, and nausea came on. She sent
for a surgeon, who attempted to reduce the swelling by the taxis, with-
out success, and afterwards applied a bladder of ice, with no better
result. He advised her being carried to the hospital; but she refused
to go. In the evening she became sick and had hiccough ; she con-
tinued in this state during the night. She was worse next day; and
was at length persuaded to go to the hospital, where she arrived at half-
past 6 P.M. On examination, a tumour of the size of a large orange,
and of an oval form, was found at the umbilicus, hanging downwards.
The integuments were of a dark colour. The swelling was very pain-
ful, and received no impulse on coughing. It was soft on the surface,
but towards the neck felt very hard. The pulse was quick and small,
and the countenance anxious. A freezing mixture was applied until
my arrival at 8 P.M. After investigating the case, I arrived at the con-
clusion, that a portion of intestine was strangulated beneath a quantity
of omentum, and had been in this state so long, that it was useless to
try the taxis. I accordingly determined to operate at once. An in-
cision, three inches long, was made over the centre of the upper part of
the neck of the tumour, through a thick mass of fat, and an attempt
was made to divide the stricture without opening the sac, or by making
a small opening at the neck without exposing the contents. . This
proved very difficult, owing to the great depth of the stricture (about
two inghes from the surface), and the small size of the abdominal open-
ing; it was therefore abandoned. The incision was extended to the
bottom of the tumour, and then measured about six inches in length.
The hernial sac was opened freely, and found to contain a large mass of
omentum closely condensed and matted together. On tearing through
this mass, a dark knuckle of intestine was exposed. The stricture was
divided, the intestine returned into the abdomen, and the omentum,
which was adherent to the sac, left in situ. The wound was closed by
sutures, and the patient sent to bed. No medicine was ordered; but
BY T. B. CURLING, ESQ. 509
she was allowed beef-tea, and wine and water, as soon as the stomach
would bear food. Shortly after the operation, in consequence of her
complaining of much pain in the abdomen, Mr. Holman, the House-
Surgeon, ordered her to have immediately the following pill: B, Calo-
melanos gr. v ; pulv. opii gr. j.
19th, 1 P.M. Bowels had not acted; abdomen tender and painful. In
the evening, the tenderness and pain in the abdomen having increased,
the following pill was ordered: B, Calomelanos gr. j; pulv. opii gr. 4.
To be taken every four hours.
20th. The bowels had been freely relieved, and the pain in the abdo-
men had subsided. The patient was much depressed; the pulse was
small and quick; the tongue dry and brown. The calomel and opium
were discontinued. Eight ounces of port wine, and a pint of beef-tea,
were ordered.
21st. The patient was extremely feeble, and the wound in a sloughy
state. She was ordered to take the following draught three times a day:
R. Misturae camphorae 3i; tincturae cardamomi comp. 3.j; ammoniae ses-
quicarbon. gr. v ; and, besides the wine, to have two pints of porter,
and an additional pint of beef-tea. &
22nd. The powers of the system were not so depressed, and the
tongue was moister. The whole of the hermial sac and its integuments,
and the greater part of the protruded omentum mortified, and, in the
course of time, separated in sloughs. The patient was placed on a water
bed, and supported with stimulants and a nourishing diet. The immense
wound left after the detachment of the dead parts granulated and
healed, though very slowly. The skin around became the seat of a
troublesome eczema, which resisted various applications, but yielded to
the following lotion: B. Acetatis plumbi., gr. xv.j; spiritús vini rect.
3ij; acidi hydrocyanici diluti, 5ij; aquae 3 xij. She gradually recovered
her strength ; and, having been fitted with a truss, was discharged
cured April 28th.
CASE III. STRANGULATED FEMORAL HERNIA—OPERATION.—RECOVERY.
Ambrose Goodin, a spare old man, aged 69, was br&ght to the hospital,
on the 24th of March, 1849, suffering from a Strangulated Femoral
Hernia, of rather large size, on the right side. He had been subject to
the rupture for 20 years, and had long worn a truss for it. It came
down on the 20th, since which he had been unable to reduce it, but had
kept the truss pressing on the tumour during all that period. The
swelling was tense, and received no impulse on coughing; and the
general symptoms of strangulation were urgent. He vomited continu-
ally, had hiccough, a feeble pulse, and cold extremities. I had visited
the patient at his residence, and tried the taxis; and having again
failed in a slight attempt made after his admission, the operation was
decided on. I cut down on the neck of the hermial sac, and carefully
divided all the bands which appeared in any degree to constrict the neck,
but without being able to reduce the hernia. The sac was, therefore,
opened; and, after the division of a tight stricture formed by its neck,
a portion of small intestine, a good deal congested, was returned into
the abdomen. As soon as the sac was opened, about four drachms of
dark bloody serum escaped. After the operation, the patient was very
34
510 OPERATIONS FOR STRANGULATED HERNIA IN old PEOPLE.
low, and continued to suffer from hiccough. He was carried to a warm
bed; heat was applied to the extremities; and he was ordered the fol-
lowing draught : B. Mist. camphorae 3.j; spiritās atheris sulphurici
comp. 3.j; tincturae opii m. xxx, Beef-tea was ordered to be given
when the stomach could bear food.
25th. The bowels not having acted twenty-two hours after the opera.
tion, he was ordered a drachm of sulphate of magnesia in an ounce of
peppermint water every second hour, until the bowels acted ; but not to
exceed four doses, before he was again seen. The bowels acted in the
evening after two doses. He was allowed eight ounces of wine in addition
to the beef-tea. Under this treatment, his pulse improved in strength,
and he recovered without any unfavourable symptom. The wound
was dressed on the 28th. It was found to have united by the first in-
tention throughout, except at one spot, where a sinus opened. This
continued to discharge for some time, but closed by the 15th of April,
when he was discharged cured.
CASE IV. STRANGULATED FEMORAL HERNLA of LARGE SIZE-OPERA-
TION.—SAC OPENED–Sloughing of the Sac and Omentum—Recovery
from the Operation—Epithelial Cancer of the Strangulated portion of
Intestine, and Death eight weeks afterwards. Harriet Barnett, a widow,
aged 81, residing at Stratford, of lean appearance, but who had always
enjoyed excellent health, was admitted into the London Hospital, at 9 P.M.,
December 2nd, 1849, suffering from a Strangulated Femoral Hermia on
the right side. She had been subject to a rupture for twenty years;
but had always been able to return it without assistance, excepting upon
one occasion, eight years ago, when she was brought to the hospital and
got relieved in a warm bath. She had since that time worn a truss.
She stated that the rupture came down whilst she was in bed, about
three o'clock on the morning of her admission. This was shortly fol-
lowed by pain and sickness, which continued throughout the day. She
sought the assistance of a surgeon in the neighbourhood, and was at-
tended by his assistant, who, according to her account, used considerable
force in attempting ſeduction. A tobacco injection and tobacco smoke
having been introduced into the rectum without effect, she was sent to
the hospital, a distance of four miles. Upon her admission, she was
placed in a warm bath, and the taxis was again tried, but without suc-
cess. I was summoned; and, on my arrival at 10 P.M., found a large
Femoral Hernia, about the size of a cricket ball, which was tense and
rather painful. She complained of some uneasiness at the umbilicus:
but the 'abdomen was soft. Her pulse was rather weak. I directed a
bladder of ice to be applied to the tumour for a quarter of an hour ;
and, having made steady but gentle pressure on the part without effect,
decided on operating. The stricture was divided chiefly external to the
sac ; but, in doing so, I made a small opening at the neck, which
allowed the escape of a quantity of serum tinged with blood. Being
unable to return the protruded parts, I opened the sac, and exposed a
large mass of omentum, and about six inches of small intestine, and
found the principal obstacle to the reduction to arise from the swollen
condition of a portion of the intestine, the coats of which were infiltrated,
in a remarkable manner, with extravasated blood. So great was the

BY T. B. CURLING, ESQ. • 511
effusion, that it was surprising that the serous coat had not given way.
With some trouble, the intestine was carefully returned. Being un-
willing to replace the large mass of omentum, I excised a considerable
portion of it. This was followed by free bleeding from several small
arteries, and no fewer than five required tying. During the operation,
the pulse was intermittent, and became very feeble. She took some
wine, which was rejected. She was removed to a warm bed, warmth
was applied to the feet, and I prescribed the following draught to be
taken immediately: B. Misturae camphorae 3.j; spiritús aetheris sulphu-
rici comp. 3]; tincturae opii m. xxx. Warm brandy and water, and
beef-tea, were ordered to be taken when the stomach would bear them.
December 3rd. She had been much relieved by the operation, and felt
tolerably comfortable. Her pulse was very quick, and there was con-
siderable tenderness of the abdomen, but no tension. She had taken
four ounces of brandy since the operation. This was discontinued;
and, at the patient's request, a pint of porter was substituted. A grain
of calomel with half a grain of opium was ordered to be taken night
and morning, and a castor oil injection to be given at night.
December 4th. The bowels had been freely relieved after the injec-
tion; but the stomach continued rather irritable. In consequence of
pain at the umbilicus, Mr. Wyatt, the House-Surgeon, ordered four
leeches to be applied. The sickness continuing, she was ordered a
draught of camphor mixture, with twenty drops of aromatic spirits of
ammonia and ten drops of laudanum. Two ounces of brandy were
given in place of the porter. The calomel and opium were discontinued.
December 5th. The wound was dressed, and looked healthy. The sac
containing the omentum was rather tender, and distended with fluid.
She was placed on a water bed. Although the upper part of the wound
continued to heal favourably, the appearance and smell of the discharge
from the sac below, and the state of the integuments, led me to suspect
that mortification was taking place. . . . . .
December 10th. I laid the part freely open with a bistoury, and found
the sac and omentum within in a sloughy state. A few days afterwards,
she had an attack of bronchitis, which reduced her strength considerably.
The chest symptoms were relieved by suitable remedies; and she was
supported by stimulants, being allowed four ounces of brandy; in addi-
tion to eight ounces of wine and a pint of porter daily. She rallied a
good deal under this treatment. The mortified parts by degrees sepa-
rated, and the wound made by the operation quite healed up by the 25th.
This part bulged a good deal, in consequenee of a hermial protrusion at
the original seat of rupture. She improved so much, that there ap-
peared a good hope of her final recovery. During, however, the cold
month of January, she became very feeble. She also complained of
severe pain in the seat of the rupture, attended with considerable
uneasiness in the back, which occurred at intervals. The pain was
accompanied with extreme languor, faintness, and cold perspirations.
The bowels had been at times sharply relaxed, but latterly had been
tolerably regular. She was at length able to take scarcely any nourish-
ment besides stimulants, became much emaciated, and depressed in
spirits’; and, after gradually sinking day by day, expired on January
24th, seven weeks and four days after the operation. At this time,
512 OPERATIONS FOR STRANGULATED HERNIA IN OLD PEOPLE.
there was only a small triangular sore remaining at the bottom of the
wound, occasioned by laying open the lower part of the sac a few days
after the operation. -
SECTIo CADAVERIs TWENTY HOURS AFTER DEATH. There were marks of
bronchitis in the lungs. The abdominal viscera generally were healthy.
On the right side, the omentum was adherent to the femoral ring, and to
the bottom of the closed sac; and a small portion of the ascending colon
protruded into the cavity. The coats of this part of the great intestine
were thickened and indurated, and the peritoneal coat was slightly
puckered. On passing the finger through the gut, the passage was
found to be slightly contracted ; and, on dividing it longitudinally, I
found a large raised ulcer of an oval shape, the long diameter of which
was in the transverse direction, and nearly two inches in length, and
the short diameter an inch and a quarter. The edges of the ulcer were
everted, and the base indurated. The surface presented small irregular
spongy-looking granulations or excrescences, more or less congested. A
section being examined microscopically, the raised granulations were
found to consist of epithelial growth, the base of the ulcer being formed
chiefly of indurated areolar tissue.
REMARKs. These four cases, three of which occurred within six weeks,
are examples of Successful Operation for Strangulated Hermia on
persons of advanced age,_a time of life at which the operation does
not commonly succeed in saving the patient. I have the reports of fif-
teen cases (out of a table of two hundred and eight) in which the
operation of Hernia was performed in the different hospitals of London,
on individuals of the age of seventy and upwards; and of these, only
four recovered.
. In the first of the cases just related, independently of the great age
of the patient, the circumstances were favourable. The Hernia was
recent, and the sac was unopened in the operation. In the third
case, strangulation had existed for four days, and the great prostra-
tion made me apprehend mortification of the protruded parts. This
fortunately had not taken place; and, with the aid of stimulants and a
mourishing diet, the patient rallied, and recovered rapidly without a bad
symptom. The second and fourth cases are by far the most remarkable.
In the second, the patient incurred not only the ordinary and serious
perils of a Strangulated Umbilical Hernia of large size, requiring an
operation for its relief, but also those consequent on mortification of a
large mass of omentum, and of the whole of the hermial sac and its
integuments. She owed her recovery, under such unfavourable circum-
stances, in great measure to a sound constitution, carefully preserved by
an abstemious life. In the fourth case, in which the patient had attained
the age of eighty-one, the operation was also followed by sloughing of
a large piece of omentum and of a great part of the hermial sac. She
bore up surprisingly under all this, and even rallied from a sharp attack
of bronchitis at the coldest season of the year; but she sank at last,
chiefly from the effects of a remarkable disease of the intestine, which
we may presume was engendered partly through the agency of the stric-
ture, but more especially by the rough attempts to reduce the Hernia
by the taxis, made previously to the patient's admission into the hospital.
BY T. B. CURLING, ESQ. 5 13.
In the large number of operations for Hernia which I have witnessed,
I have never seen a portion of intestine exhibit such striking marks of
violence, as existed in this instance. The peculiar ulcerated sore which
was found at the part, gives much additional interest to this case. The
disease presented the characters of epithelial cancer, resembling, in its
microscopical appearances, the growths occasionally developed in various
parts of the skin. I do not recollect having seen any description of
this rare form of ulcer in the intestine by an English writer; certainly
I have met with no account of any such disease occurring in a portion
of intestine injured in rupture. The following description given by
Rokitansky, of the characters of certain Sores occurring in the large in-
testines, corresponds exactly with the appearances of the ulcer in the
above case. This eminent pathologist does not appear to have fully
satisfied himself as to the nature of the disease. “There are certain
ulcers which occur only in the large intestine, and especially in the sig-
moid flexure and the rectum, and are nearly allied to cancer, and
particularly to cutaneous cancer. They are generally solitary, but there
may be two, three, or four at a time. They invariably give rise to in-
tense pain, and appear etiologically connected with an abuse of ardent
spirits. Although in many respects analogous to the ulcers hitherto
considered, they offer distinctive characters. They are invariably zonular,
and have a callous base, upon which, occasionally, a discoloured brownish
grumous discharge is visible, and they are surrounded by a thick tumid,
spongy, carneous, and irregularly sinuous margin of mucous membrane.
They generally cause a diminution of the capacity of the intestine,
though not to any considerable degree. A further-investigation into
their nature still remains a desideratum.” +
It may be a question, whether such extensive disease in the mucous
membrane of the colon could have been developed in so short a period
as that which intervened between the operation and the patient's death;
and her feeble condition, and the slow progress of the affection of the
skin, which seems analogous to this, would strengthen the doubt on the
point. Nor is our knowledge of this disease of the intestine, sufficient
to determine the question satisfactorily. The previous healthy condi-
tion, however, of the patient, the bruised appearance of the intestine at
the time of the operation, and the severe pain experienced in the part
for three weeks before death, lead me to conclude that this large epithe-
lial sore was recent, and owed its origin to the local injury.
After operating for Strangulated Hernia, I very seldom give aperi-
ents until sufficient time has passed to enable the intestines to resume
their functions naturally, after the interruption caused by the stricture.
In many cases, this takes place spontaneously within twenty-four hours.
after the bowel has been released,—occasionally later; but, by waiting,
we may avoid disturbing the injured intestine and irritating the parts, at
a time when repose is desirable to promote their recovery from conges-
tion and inflammation. The propriety of this practice, as a general
rule, has recently been enforced by several writers.” In old people, the
* RoKITANSKY. Manual of Pathological Anatomy. Translated for the Sydenham
Society, vol. ii, pp. 100-1. -
* CoCK. Guy's Hospital Reports. HANCOCK on Hernia: London: 1849.
514 OPERATIONS FOR STRANGULATED HERNIA IN OLD PEOPLE.
disadvantage of exhibiting aperients shortly after the operation is de-
cidedly greater than in persons less advanced in life; for, besides the
reasons just stated, the system often becomes so depressed from the
effects of strangulation—from the vomiting and interruption to the ali-
mentary functions, that after the addition of the shock of the operation,
anything which lowers still further the powers of life, materially tends
to prevent recovery. I have witnessed cases in which the operation
for Hernia has been performed on old people, and an aperient given
shortly afterwards, where this treatment, by actively disturbing the
bowels, has seriously interfered with the chances of recovery. It has
either helped to produce a fatal collapse within a few hours, or has con-
tributed to depress the constitutional powers to such an extent, that the
repair of the injured bowel has not proceeded, and the patient has
gradually sunk in the course of two or three days. The degree of
shock to the system, which may be occasioned by a Strangulated Hernia,
will be illustrated by the following case :
Strangulated Femoral Hermia—rapidly fatal. Ann Wood, a woman
of spare habit, aged 60, was admitted into the London Hospital, in
July 1836, labouring under symptoms of Strangulated Hernia. She
had been subject to a reducible Femoral Hernia for several years.
The Hernia was small, and had been down less than forty-eight hours.
She was in a state of great prostration; so much so, that slight attempts
at reduction having failed, it became a question whether she would be
able to bear the operation. She was taken into the operating theatre,
but after dividing the integuments and a layer or two of fascia without
loss of blood, I considered it advisable to desist, being apprehensive
that she would die on the table. In a few minutes after being carried
back to bed, she expired. On examination of the body, I found slight
marks of peritoneal inflammation. The sac contained a knuckle of in-
testine, strictured and deeply congested.
In this case, the strangulation of a portion of intestine appears to
have proved fatal within the short period of forty-eight hours.
Whilst objecting to the early administration of aperients after an
operation for Strangulated Hernia, I must observe, that there are evils
attending an obstinate and inactive condition of the bowels, which, in
old people especially, cannot be disregarded. After the rejection from
the stomach of every kind of nourishment for some period previously,
evacuations are generally followed by a desire for food; and the suste-
nance taken at this time of debility greatly contributes to the patient's
revival. Whereas, if the stomach and bowels be suffered to remain
torpid, or be kept so by opiates, the indisposition for food, and indolent
state of the digestive organs, may prevent a healthy reaction. The best
mode of obtaining evacuations at this period, is by enemata; but mild
aperients are not to be altogether set aside ; and those who so strongly
advocate the advantage of opiates, must take care that in endeavouring
to avoid one source of danger, they do not incur the risk of producing
exhaustion, by indisposing the alimentary canal to imbibe nourishment
and support. - -
In February 1847, I operated for Strangulated Femoral Hernia on
a lady aged 70; the sac was not opened, and she recovered favourably.
In November of the same year, I operated for Strangulated Femoral
BY T. B. CURE.ING, Esq. - 515
Hernia at the London Hospital, on a woman aged 73, and on a man
aged 77. In the former, strangulation had existed for three days, and
the sac was opened. She was much depressed at the time of the opera-
tion, and survived it only twenty-one hours. In the latter, the stricture
was divided external to the sac, and the patient recovered. In the
January following, I operated also for Femoral Hernia on a female
aged 78, and opened the Sac. She recovered from the immediate effects
of the strangulation and operation, but was subsequently attacked with
erysipelas, of which she died on the ninth day after the operation. These
cases, added to the four I have previously detailed, make eight cases of
operation for Strangulated Hernia in advanced age. Of these, five
recovered and three died : the case of death from disease of the intes-
time, at the end of eight weeks, being included in the latter. •
Old persons, when affected with Strangulated Hernia, do not suffer so
acutely as younger subjects. The injury to the intestine does not so
readily lead to inflammation of the peritoneum, and the symptoms of
constitutional disturbance are more subdued, so that the active treatment
often called for in other cases after the operation, is rarely required, and
can seldom be tolerated. Indeed, when called to such cases, I have
often been struck with the mildness of the symptoms and the slowness
of their progress; the absence, or slightness of pain in the abdomen;
the little tenderness in the Swelling; the small degree in which the
pulse is disturbed, and the comparatively tolerant condition of the
stomach. But the evil to which I have adverted, the threatening failure
in the powers of life, though not so forcibly presented to the notice of
the surgeon, is no less dangerous, and requires his skilful and judicious
management. The remedies which are obviously indicated, are external
warmth, opium, ammonia, beef-tea, and often wine, or even brandy.
The patient requires, in fact, to be supported under the depressing
influence of his complaint." These remarks are not intended to apply
to cases of mortified intestine; for the necessity of support in such
cases is too urgent, to need any recommendation of the treatment. But
my object has been to strengthen the objections which have been offered
to the use of aperients shortly after the operation for Hernia, by
shewing their peculiar inappropriateness for persons in advanced age;
to point out, that when Hernia occurs at this period of life, greater
danger is to be apprehended from a failure in the powers of the consti-
tution, than from inflammation of the bowels, or of the peritoneum;
that treatment, which would be improper or hazardous soon after an
operation performed in early or middle life, is sometimes absolutely
required to prevent the aged patient from sinking; and that depletive
remedies can seldom be resorted to without risk. . . . . . . . . . .
37, New Broad Street, City.
* The greatest age at which a successful operation for Strangulated Hernia has
been performed, that I know of, is the case of a man aged 107, who was operated
on for Inguinal Hernia, by Mr. Caesar Hawkins, in St. George's Hospital. The
symptoms were not severe: the wound united by the first intention, and the
patient recovered. It is stated that “nourishment was given him from the first.”
London Medical Gazette, vol. xxxi, p. 376. - -
516
ILLUSTRATIONS OF DISEASES OF THE NERVOUS
SYSTEM.
By WILLIAM H. MADDEN, M.D., Physician to the Torbay Infirmary
and Dispensary, etc.
NO. II. GENERAL SOFTENING OF THE MEDULLA SPINALIS.
CASE. Miss C. first came under my care on November 8, 1843.
According to the history I received, she had been subject for many years
to frequent attacks of inflammation of the coats of the liver, but had
not lately suffered from any acute affection of the kind. At the time
of my visit, she complained of a dull, heavy pain in the right hypochon-
drium and epigastrium, the parts being tender on pressure. There was
no enlargement of the liver, nor any tenderness in any other part of
the abdomen. She had no cough, and could draw a full breath without
pain; but the lower part of the right chest did not expand so well as
the left. There was no headache. On the preceding night, she had
had rigors, followed by fever. When I saw her, the skin was perspiring
freely. She complained of slight nausea. The tongue was covered
with a white clammy fur, and indented by the teeth; the bowels were
open, without the aid of medicine. Pulse 98, soft. She felt restless,
and had no appetite. The complexion was sallow. She had not men-
struated for five weeks. These symptoms were in a great measure
relieved by local bleeding, alterative aperients, and occasional sedatives;
but the pain and tenderness did not leave her, and, on the 14th, she
had, in addition, severe pain in the lower lumbar and Sacral regions.
There was also a spot about one inch to the right of the umbilicus,
where pressure caused much suffering, and where there was an obscure
feeling of hardness. A few days after this, she began to complain
much of pain in the region of the heart ; and this symptom was long
persistent, being frequently accompanied by irregular action of the
organ; but there were no murmurs, nor any other evidence of structural
change. The catamenia appeared, with much pain, on the 22nd.
During the next month, matters remained in much the same condi-
tion. The digestive organs were sometimes in a more healthy state;
but the improvement was only transient, and there were rigors almost
every night. - -
In January 1844, the cardiac pains were so severe, as almost to merit
the appellation of angina pectoris; and in this form they continued to
manifest themselves, in spite of all treatment, until the end of April.
Nor, when this symptom had at length disappeared, was my patient
much benefited; for if the chest was more easy, the back was worse,
the lumbar and sacral regions being very tender on pressure, and the
seat of frequent acute pain, which extended along the right sciatic
nerve, and into the right hypogastrie region. The latter was more espe-
cially affected during the catamenial periods, which were always charac-
terized by intense suffering. - -
It would be tedious to narrate with any minuteness the progress of
this wearisome and most unsatisfactory case. My notes record a melan-
choly succession of aggravations and partial improvements; of spasms
DR. MADDEN ON SOFTENING OF THE MEDULLA SPINALIS. 517
in the limbs, and spasms in the chest; of violent palpitations, and Sud-
den momentary arrests of the heart's action; of headache, and inflamed
eyes, and gastric disorder; and the ever-recurring terrible dysmemor-
rhoea, against which all medicines but opium were utterly powerless.
The general health, of course, gradually deteriorated. Motion, of any
kind, so greatly increased my patient's suffering, that, after long perse-
verance, she gave all efforts up, and was allowed to remain almost con-
stantly in bed.
At the beginning of 1845, her aspect had become very cachectic, re-
sembling that of a person afflicted with malignant disease. The pains
were intense; and, in the hope of affording some temporary relief, I
ordered, on February 16th, the tincture of Indian hemp. She took
three doses, of ten drops each ; after which, she complained of creeping
sensations in her limbs, and fancied that a mouse was in the bed. The
medicine was then discontinued. An hour or two afterwards, while
getting out of bed to relieve the bowels, she suddenly became insensible.
General convulsions then ensued, and lasted during twelve hours, when
she died. -
Before describing the appearances found on dissection, I must say a few
words regarding the treatment. It, of course, varied from time to time,
as particular symptoms seemed to demand special appliances; but, on
the whole, it partook more of a tonic character than of any other. The
cardiac pains, after resisting all other means, yielded at last to arsenic,
and remained absent for a considerable time; but they subsequently re-
curred on several occasions, though scarcely with the same violence or
frequency. The severe pains in the back and right hypogastrium, were
most effectually relieved by small local bleedings; sedative applications
did no good, and counter-irritants proved rather injurious than beneficial.
The preparations of steel were found to be the most useful tonics, and
morphia the only trustworthy sedative. The long progress of the case
afforded me many opportunities of testing the efficacy of various new
remedies, which were highly lauded in the journals of the period; while
its extreme obstinacy not only warranted, but seemed to demand a trial
of anything which held out a prospect of relief. I cannot, however,
say that I had ever any reason to congratulate myself on having made .
the experiments. The succus conii, strongly recommended by Dr.
Neligan, proved a very inefficient sedative. The tincture and extract of
cymara, of which Dr. Baddesley speaks very highly, produced no effect,
excepting a transient unpleasant sensation in the head and eyes, the
latter feeling as if they were too large. The terchloride of carbon,
which was stated at the time to be a remarkably powerful local and
general sedative, proved an utter failure; it had no action whatever. I
tried the Indian hemp two or three times, both as a hypnotic, and for
the purpose of relieving the dysmemorrhoea, but without any good effects
in this case ; though, at the same time, it acted like a charm with a sister
of my patient's, who suffered very severely at the menstrual periods,
and with whom opium always disagreed. On one occasion, two grains
of the extract caused much disturbance of the action of the heart, and
then affected the head with confusion, giddiness, etc.; but these symp-
toms soon passed off, after the administration of a little ammonia. -
5 18 SOFTENING OF THE MEDULLA SPINALIS.
SECTIO CADAVERIs, THIRTY Hours AFTER DEAFH. Head and Spine.
There was sub-arachnoid effusion in the head, and the brain was some-
what oedematous, but otherwise healthy. There was also considerably
more fluid than usual in the spinal sheath. The spinal arachnoid was
spotted with numerous white scales, about a line in diameter, some
smooth, others scabrous and feeling gritty, as if from commencing bony
deposition. The cord, throughout nearly its whole extent, was in a
state of ramollissement, its true structure being scarcely discernible.
The nerves of the cauda equina were covered with innumerable granules,
about the size of a pin's head.
Chest. The right lung was intensely congested, and united to the
parietes of the chest, over its entire surface, by old adhesions. The
left lung was free, and less congested. There were no tubercles. The
heart was healthy. $º
Abdomen. The omentum was found firmly adherent to the parietes in
the right iliac region, the attachment being of old date. The liver was
perfectly healthy, both in its substance and tunics. There was a small
cyst in each ovary.
REMARKs. This case, as regards its symptoms, stands in marked con-
trast to the one which I recorded in my former paper." In that, it will
be remembered, the most prominent manifestation of disease consisted
in diminution of the sensibility of the cutaneous surface ; there was
much pain in the back, when the spine was exposed to succussion, or
other violent motions, but want of feeling was the great and pressing
ailment. In the case now brought forward, the very opposite state of
matters obtained,—intense and Scarcely mitigable pain was its chief
feature. And yet the difference between the pathological conditions of
the cases, as revealed by dissection, was not great. In both we found
morbid softening of the spinal cord. In Mr. P.'s case, this ramollisse-
ment, confined, or nearly so, to the cineritious matter, was complete in
its degree, the centre of the organ being reduced to the consistence of
thick cream ; in Miss C.'s, all the tissues were involved, but the soften-
ing had not proceeded so far. It was sufficiently decided to render the
structure almost indistinguishable by the naked eye, but not enough to
convert it into a pulp. And herein, perhaps, we may find the means of
reconciling the symptomatic discrepancies; for it is quite conceivable,
nay, demonstrable, that the same disease of a nervous centre may, in
different stages of its progress, produce results of the most opposite
character. The great difficulty which lies in the way of this explanation,
is involved in the fact, that the first symptom in Mr. P.'s case was the
anaesthesia; at least, the first of which I had any cognizance.
But, setting this aside, and not attempting to speak dogmatically of
what is probably insusceptible of absolute proof, the case just narrated
appears to me of especial interest, as showing that there may be more
organic mischief going on than is commonly suspected, in that class of
cases to which the term spinal irritation is usually applied. That this
was the nature of my patient's disease, all who saw her were, I believe,
thoroughly convinced. It presented the phenomena generally regarded
1 LONDON Journal of MEDICINE, January 1850, p. 10.
BY WILLIAM. H. MADDEN, M.D. 519
as diagnostic of that affection. There were the variable neuralgic pains;
sometimes seizing on the chest with intense severity, and giving rise to
the tortures of angina pectoris; sometimes localized in the hypogas-
trium, or darting down the Sciatic nerve, or fixed in the back itself, and
rendering motion almost impossible. In addition, there were the ute-
rine disturbance, scanty menstruation, with intolerable suffering, and
the various indications of disordered functions, which are almost never
absent under circumstances of that nature. Moreover, on more than
one occasion, we had manifestations of those anomalies, which so fre-
quently characterize purely nervous disorders. Being strongly im-
pressed with the views of the case just noticed, and anxious every way
to give tone and strength to the system, I encouraged and urged my
patient to persist in leaving her bed, and going into the open air as
much as possible. Of course, this was done cautiously, all unnecessary
motion being avoided; and she persisted in it, although she affirmed
that on every movement the pains were much aggravated. I confess I
scarcely believed this (imagining that, in common with most patients of
the same class, she unconsciously exaggerated her sufferings), until, on
one occasion, my visit happened to be paid while she was out of doors.
I found her lying on a stretcher in the garden. She had been carried
there as gently as could be accomplished; but the pale, anxious, ghost-
like face, the feeble pulse, and cold clammy hands, convinced me that
my suspicions were not correct, and taught me’ to be less urgent in
future. And yet, in spite of all this, we had conclusive proof that she
did, more than once, get out of bed unaided, and walk to various parts
of the room to procure what she wanted, without any evidence of such
increased suffering as, at other times, was induced by simply lifting her
from the bed to a sofa. It is not easy to explain these things.
The most commonly received view of the pathology of spinal irrita-
tion is, that it depends upon a congested state of the medulla; and the
relief so frequently afforded by local blood-letting, is a strong argument in
its favour. I have seen the most obstinate and incessant vomiting,
which had for days resisted all treatment, at once removed by the appli-
cation of a few leeches to the spine. But the case before us shows,
that a more serious local mischief may give rise to symptoms of pre-
cisely the same nature. It shows that they may have, as their cause,
something more than mere vascular congestion,--that there may be
actual perverted nutrition of the cord itself. And it is well to bear this
in mind; for it is clear that, in such a case, if the disease be not arrested
in its progress, the issue may be paralysis. .
We come then to consider, what was the cause of the spinal affection.
Some years before she came under my care, my patient fell down some
stairs, and hurt her back a good deal; but the immediate effects soon
passed off, and she had no symptoms indicating mischief in the parts.
Nevertheless, it is quite possible that this accident may have laid the
foundation of her future ailments. . . . - - -
But there is another hypothesis to which I would direct attention for
a few moments, because, though perhaps it is unneeded in, or even
inapplicable to, the explanation of the preceding case, it yet, as appears
to me, will prove of much value in the elucidation of the majority of
instances. Dr. Todd, in his Lumleian Lectures for 1849, contends for
520 SOFTENING OF THE MEDUILA SPINALIS.
the humoral origin of chorea and epilepsy; and the writer of a very
admirable article on the “Physiology and Diseases of the Nervous
System,” in the January number of the British and Foreign Medico-
Chirurgical Review, while examining, and in a great measure supporting
Dr. Todd's views, extends them also to the protean disease, hysteria.
The idea, as my readers are doubtless aware, is, that in these cases
there exists a depraved and perhaps a poisoned state of the blood,
whereby the nervous battery is irregularly or abnormally excited, and
thus the phenomena of the disease are produced. To my mind, this
appears a much more satisfactory method of accounting for the morbid
manifestations, than the vague nonentities, nervous irritation, functional
disturbance of the nerves, etc., to which they are usually referred. A
short time ago I had, in my own person, a proof of the correctness of
the general principle. I was suffering from a severe attack of hemi-
crania, the pain being seated in the right side of the head. When it
was at its height, I was seized with a most unpleasant sensation through-
out the whole of the left side of the body, and the extensor muscles of
the left leg were excited to clonic contractions. The action was entirely
automatic. I could control them by a determined effort of volition; but
the moment the influence of the will was withdrawn, the motions recom-
menced, and the limb was gradually and forcibly extended to its full
length. I observed, also, that there was a perfect absence of the feeling
of muscular fatigue which accompanies voluntary movements. Now,
in this instance, the exciting cause was, very manifestly, imperfect
elimination of bile, which had existed for some days previously; and
the attack was at once ended by a gentle mercurial alterative, which
restored the right action of the liver.
Here, the disturbance of the nervous system was both slight and
transient; but in the case to which I shall now briefly refer, it was of
a very much more severe, and even, at one time, alarming character.
The subject of it was a lady, who had been for many years in bad health,
suffering from a complication of maladies, which it is not necessary to
particularize. The attack for which I was consulted commenced as
severely acute bronchitis. She was first seen by my friend Dr. Battersby,
on Nov. 27, 1843, having been ill for some days. I was called in on
the 30th. She was then apparently almost moribund, with a death-like
countenance; orthopnoea; loud tracheal rattles, which could be heard in
every part of the room; a dry tongue; quick, compressible pulse; and
no strength to expectorate. From this very depressed state she gra-
dually rallied, under the use of senega, wine, etc., and was able to re-
lieve herself of a quantity of muco-purulent secretion. Her progress
was fluctuating for several days, but on the whole, she appeared to gain
ground slowly, though the brain was often oppressed, and there were
fits of extreme restlessness, in which she sometimes rolled the head from
side to side with great rapidity. On the evening of January 9th, she was
found throwing her arms about violently, with rigidly extended fingers:
she was sensible, but dull: the head was cool. Next morning, she had
violent convulsions, and there was much stupor: during the day, the
paroxysms became shorter, and in the evening, the spasms left the
limbs; but the muscles of the face became frightfully affected, and there
was almost trismus. These symptoms continued more or less for many
days, but gradually passed off, and the patient satisfactorily recovered.
BY WILLIAM H. MADDEN, M.D. 521
Now here, I apprehend, it is also abundantly clear that the blood was
the element at fault. Our patient was habitually asthmatic; her lungs
were emphysematous, and she had suffered from an inflammatory attack
which nearly destroyed life by suffocation. That the blood must have
been most imperfectly decarbonized, there can be no doubt; and that
the secretions generally were in a most disordered condition, we had
ocular proof in the unhealthy evacuations. Moreover, each temporary
improvement was coincident with a free discharge from the stomach and
bowels; and there was nothing either in the past history, or the imme-
diate antecedents of the case, to render it probable that there was actual
disease of the nervous centres. -
The sequence of causation would, therefore, I imagine, be somewhat
of this nature. The blood, not originally of the most healthy character
(as was evidenced by the history of our patient, and more especially by
the fact, that she was subject to frequent attacks of eczema), had become
imperfectly arterialized from the long-continued and severe obstruction
to the respiration. This half-venous blood, carried to the various secre-
ting organs, proved an abnormal and insufficient pabulum, and was, in
consequence, not thoroughly purified by the separation of the ingredients
of the secretions: and being thus still further deteriorated, it acted as
an unnatural stimulus to the nervous centres, disturbing, in Dr. Todd's
language, their polar state, and thus inducing the convulsive phenomena.
May not something analogous to this be the operative agent in many
cases of spinal irritation? May it not be found that these cases too, as
well as those we have already noticed, own a true humoral origin?
Much may be said in favour of such a view. The subjects of the disease
are, for the most part, persons of weak constitution, delicate females,
who do not menstruate properly; and in almost all, there are evidences
of depraved nutrition, and of disordered function of important depurat-
ing organs. The phenomena of the disease too, the sudden shifting of
the pains from one part of the body to another, the tendency to periodi-
city not unfrequently exhibited, and the common complication with the
regular hysteric paroxysm, appear to me to point in the same direction.
The character of the remedies found to be most successful in the treat-
ment, and the general juvantia and laidentia, will equally receive their
most correct exposition on such an hypothesis. Nor am I prepared to
affirm that, even in cases like the one which has been the subject of
this paper, where absolute organic change is found after death, the same
explanation is altogether inapplicable; for it is quite conceivable that
the continued stimulation may, under certain favourable conditions,
induce abnormal nutrition in the organ thus acted upon, precisely as in
some cases of gout and rheumatism, the materies morbi, directed during
a long period to particular joints, leads to the deposition of what are
called chalk-stones, and to other positive structural changes.
Torquay, May 1850.
522
TWO CASES SIMULATING DISEASE OF THE LIVER,
By ALEXANDER KNOX, M.D., Physician to the Dispensary,
Strangford, County Down, Ireland.
CASE I. INTESTINAL CONCRETION, SIMULATING DISEASE of THE LIVER,
Mrs. H., the wife of an officer in a dragoon regiment, had suffered much
from bad health, and had, on several occasions, been under my care for
severe and occasionally dangerous attacks of bronchitis. From change
of residence and other circumstances, she had ceased to be a patient of
mine; but on one occasion, being in Dublin, I was requested to visit her
at Kingston, where she had been long confined to bed, by disease which
was considered, in consultation, to arise from an affection of the liver.
Her case, as I was informed, was considered hopeless, and her death
was looked for as an impending event. She was certainly labouring
under extreme debility, but not, in my opinion, affected with any symp-
toms denoting speedy dissolution. On careful examination, I ascer-
tained that there were considerable abdominal swelling and partial
obstruction of the bowels, and the diagnosis arrived at, on careful con-
sideration, was to the effect, that the hepatic symptoms, which were
evident enough, were not owing to any organic affection, or incurable
disease of the liver, but symptomatic of the pressure and irritation of
that viscus by some intestinal concretions, of the existence of which I
fully satisfied myself. Being merely consulted as a friend, I did not,
of course, interfere with the treatment, which appeared to be perfectly
appropriate; but she was led to hope that her case was not, by any
means, to be despaired of, and that if the intestinal obstructions were
got rid of, there were good grounds to expect her ultimate recovery.
She was, as I subsequently learned, ill for a considerable time, and a large
Intestinal Concretion, the composition of which I could not ascertain,
was at length expelled from the rectum, when perfect recovery took
place, and she lived for several years afterwards.
CASE II. TUMoUR IN THE RIGHT HYPOCHONDRIUM, SIMULATING DisFASE
of THE LIVER, Mrs. , the wife of a physician, had suffered from
the symptoms of hepatic disease from time to time, combined with indi-
gestion, and occasional very severe attacks of gastralgia. A solid per-
sistent tumour had existed for a considerable period in the right hypo-
chondriac region, which was supposed to be either a chronic enlargement
of the right lobe of the liver, perhaps of the lobulus Spigelii, or else a
biliary calculus. My attendance on her became necessary, on account of
acute tenderness supervening at the site of the tumour, and a violent
attack of acute symptomatic fever. She had, in fact, all the symptoms
of enteritis, for which pretty active antiphlogistic treatment was neces-
sary. - Among the remedies employed, were full doses of calomel,
followed by castor oil. During their exhibition, the supposed hepatic
tumour shifted its ground, and then disappeared permanently from the
position it had so long occupied. It was ultimately expelled per anum,
and found to be a mass of indurated faeces, firmly agglutinated, consti-
tuting a specimen of the enterolithus scybalum of Good. Its nidus had
probably been in the transverse colon: although I had satisfied myself of
the continued existence of this tumour for several years, it remained
MR. W. WHITE COOPER ON CONICAL CORNFA. 523
quiescent all the time, until the period alluded to, when from some
cause or other it appears to have excited an attack of inflammation,
which indirectly led to its expulsion. Perfect recovery followed the
attack; and, at the distance of several years, there has been no appear-
ance of a tumour in the site which it formerly occupied, nor any trace
of fulness of the liver, or other symptom of hepatic disease. Attacks
of dyspepsia, however, recur from time to time; but the gastralgia has
greatly abated both in severity and frequency. -
ON CONICAL CORNEA.
By W. WHITE COOPER, Esq., F.R.C.S., Senior-Surgeon to the North London
Eye Infirmary, and to the Artillery Company, etc.
[Concluded from last Number, p. 419.]
MR. JAMEs Dixon, Surgeon to the Royal Ophthalmic Hospital, Moor-
fields, has, like myself, devoted much attention to the subject of Conical
Cornea. On the publication of the first part of this paper, he, in the
most handsome manner, placed at my disposal the result of his observa-
tions; and I cannot but feel, that any value, which my communication
may possess, is greatly enhanced by the contribution of so accomplished
an ophthalmic surgeon as Mr. Dixon. The following are his remarks:—
“Conical Cornea particularly engaged my attention about six or seven
years ago. The rarity of the disease, and the consequently limited
opportunities that had occurred for investigating it anatomically, and
the contradictory theories on the subject, made me curious to learn more
of this opprobrium medicina. I hoped to be able to determine for my-
self the real nature of the morbid change, but in vain; and, in the
absence of any original researches into its true pathology, the notes I
now send can be only regarded as mémoires pour servir à l'histoire, rather
than as history itself. I can at least offer you a complete table of the
cases recorded at our hospital since its first establishment. ... You will
observe that the disease is first mentioned in 1819; before that time it
was probably classed with staphyloma. . i
“As regards the earliest notices of Comical Cornea, a curious mistake
has been made by almost every writer on eye-diseases, from Wardrop
downwards, in attributing to Leveillé the authorship of what he merely
translated—namely, a note in Scarpa's Treatise on Diseases of the Eyes:
but if the first edition of that work (Malattie degli Occhi, fo. Pavia,
1801), be referred to, the so-called ‘mote by Leveillé' will be found
entire at page 215. Our own countryman, Ware, however, had de-
scribed the disease so early as 1795, in his “ Appendia, and Notes anneared
to the third edition of Remarks on the Ophthalmy, Psorophthalmy, and
Purulent Eye' (p. 26), where he speaks of ‘those rare cases, in which
the cornea undergoes a change from its round figure, and assumes a
conical or sugar-loaf shape'. For the cure of this, he says “he had
tried a variety of remedies—evacuation of the aqueous humour, followed
by application of compresses;' but adds, that ‘the cornea always resumed
its projecting figure. - - -
WOL. II, 35
524 CONICAL CORNEA.
“It is uncertain whether the motorious John Taylor had really seen
true Comical Cornea, when he designated a certain diseased condition of
the part by the unmeaning term ‘Ochlodes'. That the word was sono-
rous, and Greek, was quite sufficient to commend it to him whom Dr.
Johnson cited as ‘an example how far impudence could carry ignorance.’
“Burgmann's often-quoted case is curious for its absurdity; and the
best explanation of it was furnished by a non-professional critic, as
related in Himly’s “Diseases and Malformations of the Human Eye'
(Krankheiten und Missbildungen, etc., Berlin, 1843). “The corneae were
black, as hard as horn, and hung down as far as the mouth. The
learned have racked their brains to explain this phenomenon. Richter
attributed it to expansion of the corneae; Brandis, to the congestion
produced by hanging; Blumenbach cites, in opposition to Brandis, a
similar appearance in the eyes of a man whose head was cut off and
then stuck on a pole; Heinlein thought that even in the latter case
post-mortem expansion of the cornea might have occurred. The true
theory of these Staphylomata is, doubtless, that of the Göttingen
executioner—'the crows made them.”
“CASES OF CONICAL CORNEA REGISTERED AT THE ROYAL LONDON
OPHTHALMIC HOSPITAL (FORMERLY INFIRMARY), MOORFIELDS.

Year. Patients cº, Year. Patients|c *:::::..
March 1805 , 1827 4955 5
º;; 600 | None ... iś28 547: 3
,, 1807 1526 ,, 1829 5266 4
,, 1808 2126 ,, 1830 5429 6
, 1809 || 2357 1831
Mºchiº) |gº, ... iś; 10550 | 10
to Jan. 1, 1810 g 1833 10609 6
Jan. 1 to 2907 ,, 1834
Dec. 31, 1810 1835 | 5154 Report not
Jan. 1 to 2 3 classified
p. 31, 1811}| 2920
,, 1836 5016
,, 1812 3085
,, 1837 5586 Report not
,, 1813 3392 classified
,, 1814 || 3016 ,, 1838 4874 2
,, 1815 3445 ,, 1839 || 4891 2
,, 1816 || 3634 ,, 1840 5355 10
,, 1817 3470 ,, 1841 5521 5
,, 1818 3575 ,, 1842 6086 7
,, 1819 3701
,, 1820 3704
,, 1821 || 3383
,, 1822 3608
,, 1823 3523
,, 1824 || 37.11
,, 1825 | 4078
,, 1826 4366
,, 1843 6572 None
,, 1844 | 6874 12
,, 1845 7005 4
,, 1846 7010 9
,, 1847 7672 5
,, 1848 8382 6
,, 1849 | 8418 2
I add the names of such patients in the annexed list, as came under
my own care: 1844, I. John Cottrell, aged 84; II. Anne Child, 33;
III. Catherine Richardson; IV. Henry Burgess, 24; 1845, W. Samuel
Lewis, 23; 1846, WI. Wilhelmina Jackson; VII. Isabella Barnes, 27;
*==s*
* I am entirely of this opinion, W. W. C.
BY W. WHITE GOOPER, Esq. 525
VIII. Sarah Corsan, 31; IX. Maria Reeves; 1848, X. Robert Moore,
28; XI. Emma Read, 22; XII. Jane Hammond, 18; XIII. Sarah
Habberfield, 27 ; 1849, XIV. Maria Burr, 25. *
“I have found a table on the following plan useful for registering,
within a small space, the chief points of interest in cases of Comical
Cornea.

Opacity at Reading f
Right | Left Aº. º: êie. Age when first º: * impºlent,
Name Age Occup. G. __\ noticed by
ye. eye. - patient — Concave Small
Right. Left. - Right | Left. glass. ºperture.
1844. R. L. R. L.
J. C. 34 |Paint. Compl. Partl. 0 0 29 0 7 || 0 || 0 || 7 | 12
1848. |
E. R. 22 |Servi. Compl. Compl. 0 |Dense * 2 0 || 0 || 0 || 6 || 0
“CAUSEs. The various opinions as to the changes which a cornea
undergoes in becoming conical, may be classed under three heads:—
protrusion, from over-secretion of aqueous humour; central thickening;
central thinning.
“The first opinion, advocated by Lyall and others, is altogether hypo-
thetical, and is disproved by the fact, which you must have constantly
noticed, that in even extreme cases of conical deformity, the plane of
the iris is vertical. Any pressure strong enough to push the firm cornea
forwards, would surely be sufficient to thrust the yielding iris backwards;
and the concave form which the iris really assumes in true inflammatory
dropsy of the anterior chamber, is, as far as my own experience goes,
never accompanied by any corresponding prominence of the cornea.
“No one, I believe, who has actually dissected a Conical Cornea, has
found the centre thickened. Jaeger, of Erlangen (not F. Jaeger, the
Vienna professor) has, on the contrary, described that part as being
extremely thin; and his description (in Schmidt's Thesis), short as it is,
is the fullest I can meet with.
“The difficulty of assigning a constitutional cause to the disease must
be very great, when we consider the widely different aspects of those
who are the subjects of it. A greater contrast could not be found than
between No. X and No. XII in the foregoing list: the former, a pale,
unhealthy-looking London workman; the latter, a fresh-coloured, robust
country girl.
“The statement, advanced by Sichel—that Comical Deformity of the
Cornea is always preceded by a central ulcer—needs to be confirmed by
careful observation: but I may quote one case which seems to support
this view, and is otherwise remarkable as an instance of Conical Cornea
at a very early age. Priscilla Saunders, aged four years, was brought
to me April 9th, 1847, with an opacity at the centre of the left cornea,
the result of a small ulcer which had cicatrized. The cornea was very
slightly conical. On February 8th, 1849, she was brought again, the
sight of this eye having become very defective. I found the small
cicatrix in the same state as before, but the cornea had assumed a com-
pletely conical form. Had I now seen the case for the first time, I
might have thought that the central opacity had been ". ºsult of
3
526 - CoNICAL CORNEA.
friction upon the apex of the cone. The child saw perfectly with the
right eye, but could not distinguish large letters with the left, although
the opacity hid only a portion of the pupil.
“On the other hand, in the case of Cottrell (No. 1. supra), the corneal
deformity was not preceded by any inflammation, and it commenced
when the patient was of an age to notice and describe his symptoms.
He had been fond of shooting, and always shot from the right shoulder,
until he found himself becoming short-sighted with the right eye: he
was then about twenty-nine, and the short-sightedness gradually in-
creased, until he came to me with a cornea as conical as any I ever
S8.W.
“As regards the TREATMENT of Conical Cornea, I have never found any
of the astringent drops and lotions, recommended by ophthalmic writers,
of any service whatever. Operative means I have always avoided. A
metal plate with a small hole in it, or, what is better still, a transverse
slit, fitted into a spectacle frame, has been the best mechanical contriv-
ance I could find, and of more service than any form of concave glass.
I have, however, met with two or three cases of conical deformity, seem-
ingly uncomplicated with any other disease of the eye, in which the
perforated plate and the concave glass were equally unavailing. -
“The treatment I should feel least inclined to try, is that termed by
its advocates “the emeto-purgative plan,’ which consists in giving the
patient a scruple of sulphate of zinc, and two or three drachms of sul-
phate of magnesia, daily for the space of a year or more. It seems
strange to give these substances together; for, if the patient is to be
purged, why give him that which will cause the purgative to be vomited
up 2 If the stomach, after a certain time, gets so accustomed to the
sulphate of zinc as to retain it, the treatment becomes simply ‘purga-
tive', without the ‘emeto'. How will the daily scruple of the sulphate
of zinc affect the stomach, when it ceases to produce sickness? I can-
not answer the question from my own experience ; but I have seen a
case where the system was followed, and at the end of twelve months
the patient's corneae were precisely in the same state as at first. -
“ London, May 2nd, 1850.” J. D.”
TREATMENT. The various modes of 'treatment recommended for
Comical Cornea are now to be considered.
ARTIFICIAL PUPIL. The first who proposed to assist vision in this
disease, by extending the pupil to one side, was the late distinguished
surgeon, Mr. Tyrrell. “Within the last six years,” says he, “I have
succeeded in relieving such cases to a considerable extent by a plan so
simple, that I am surprised that it had not been previously tried. It
consists in altering the position of the pupil, and removing it from be-
neath the centre of the cornea, or that part which has its figure most
changed, to near the margin, where the least change has occurred ; the
error in refraction is consequently much lessened, and the vision be-
comes more perfect and the focus lengthened.” Mr. Tyrrell states, that
he had performed this operation seven or eight times with benefit,
which, in two instances, was very marked. It is to be regretted, that a
more particular history is not given of the cases. Three, I succeeded
in tracing. Of these, one had recovered good vision, a second derived
BY W. WHITE COOPER, ESQ. 527.
no ultimate benefit, while in the third the eye was lost by destructive
inflammation. Thus, however encouraging the results might have at
first appeared, the expectations, in two cases at least, were not destined
to be realised. The experience of Some authorities of eminence, with
whom I have been in correspondence, is as follows. Dr. Butter, of
Plymouth, states, that “we have tried to drag the pupil to one side of
the centre, by making a small opening in the cornea and introducing a
barbed hook, but seldom Ithink, with very marked success.” Mr. Barton,
of Didsbury, has treated this disease by various operations, viz.: “evacu-
ating the aqueous humour frequently, by puncturing the cornea with a
needle, or cataract knife : extracting the lens, enlarging the pupil at
the lower margin by cutting off a piece of the iris, or strangulating it
in the incision, according to the circumstances which have presented
during the operation. The benefit, however, resulting from any of
these operations, has never been commensurate with the risk, and many
cases were rendered worse by the treatment.” Mr. Neill, of Liverpool,
has met with better success. “You ask me,” says he, “of my means
of cure. There were three cases cured by me: in one, after pursuing
the system of puncturing the cornea every two or three weeks, evacu-
ating the aqueous humour, and using pressure, the eye became flattened
and vision was useful; the other two cases had each the cornea punctured
and a fibre of the iris removed, an oblong pupil being thus formed
at the outer and lower edge of the cornea, where it was tolerably flat,
and in both these cases very good sight was gained. This practice I
shall hereafter pursue, when two eyes are similarly affected, or when
one is lost and Conical Cornea exists in the other. Such a case I have
now under my care. The hostess of a large hotel, in opening a soda-
water bottle, which burst in her hand, had one eye dreadfully torn.
The other eye has a Comical Cornea. When the inflammation of the
wounded eye is sufficiently removed, I will proceed to alter the form of
the pupil in the other, and have no doubt that the sight, in this case
also, will be rendered useful.” Mr. Wilde, in his admirable Report on
the Progress of Ophthalmic Surgery,” gives an interesting case, illus-
trated by a woodcut. “The only case,” he says, “in which we have
ever produced permanent benefit, was one in which we performed an
artificial pupil, as recommended by the late Mr. Tyrrell. In this in-
stance, the lady was scarcely able to find her way through the streets.
She had consulted the principal oculists in these countries, and had
undergone several courses of treatment. She had been for a long time
under the care of the late Mr. Wardrop, who tapped the cornea several
times. In the summer of 1842, assisted by Mr. Cusack, we performed
an artificial pupil in her right eye—not as recommended by Mr. Tyrrell,
by cutting out a portion of the iris, but by drawing its pupillary margin
through an incision in the cornea, made close to its insertion with the
sclerotic externally. This lady now reads very well by holding the
book towards the right side.” The late Mr. Walker, of Manchester,
informed me that “in one case in which both eyes were affected to an
extreme degree, I first performed the operation (as practised by Middle-
more and Tyrrell) of displacing the pupil and afterwards extracting the

* Dublin Quarterly Journal of Medicine, vol. xxxiv, p. 491.
528 CONICAL CORNEA.
lens. That operation answered beautifully in one eye; but the other eye
was attacked with violent inflammation, and was destroyed. I should
not hesitate again to perform that operation in a suitable case. All the
cases I have since seen, have been such as have only had one eye ex-
tremely affected, the other being only slightly so; and consequently I
have not felt justified in recommending an operation of that magnitude
and importance. The mere displacement of the pupil I do not think
much of.” Mr. Walker was so good as to favour me with the particu-
lars of the case alluded to, which possesses considerable interest.
CASE. Joshua B., act. 47. His sight had begun to fail after an attack of
inflammation, and during seven years had gradually become worse. In
August 1841, he placed himself under the care of Mr. Walker. He
could find his way about, and read moderate sized type at a distance of
two inches; with the right eye, when the lids were almost closed, he
could read at a greater distance, but not so with the left. A luminous
body appeared to be multiplied ten or eleven times, but no chromatic
aberration was observed. This multiplication of images was confined
to luminous objects, and these appeared single when the eyelids were
nearly closed ; the point of the cone in each eye was opaque—the
opacity being densest in the left. Neither concave glasses nor a pin-
hole improved vision. On the 25th September, 1841, Mr. Walker
punctured the cornea of the left eye and removed a portion of the iris,
extending the pupil to the inferior margin of the cornea; very little
irritation followed, but the amendment of vision was only such as to in-
crease the reading distance to three inches. Mr. Walker now removed
the lens. Some trouble was subsequently experienced from opaque
capsule blocking up the pupil, but the ultimate result was, that the
patient nearly recovered the perfect sight of the eye. He could read
small print at the ordinary distance, and see surrounding objects a great
way off; moreover, the comicity of the cornea was almost entirely re-
moved. Similar proceedings were adopted towards the right eye, but
there followed destructive inflammation, and the eye was lost.
Dr. J. C. Hall tells me that he has “seen no good from operations, with
the exception of frequently evacuating thc aqueous humour, not even
from dislocating the pupil”; and other correspondents have expressed
themselves as adverse to the operation. Dr. Billett, of Taunton, says,
“I once made an artificial pupil through the sclerotic, which enabled
the patient to see a strong light, which was all that he asked for.” This
case, however, could not have been one of Conical Cornea, in the strict
sense of the term; for in such cases the perception of light is not ex-
tinguished.
My own experience of the value of an artificial pupil extends to three
cases, which I will proceed to relate. It will be seen that in one there
was improvement; in the second also improvement, but very slight;
whilst in the third neither the simple extension of the pupil, nor the
combination with it of removal of the lens, assisted the vision of the
patient.
CASE I. ARTIFICIAL PUPIL, Arabella Thomas, aged 19, a delicate
looking girl, applied to me May 5th, 1848. For many years her
vision had been imperfect, especially with the left eye, which had in.
deed become almost useless, as she could only discern objects by hold-
BY W. WHITE COOPER, ESQ. 529
ing them quite close to the outer side of the organ. The sight of the
right eye, though very obscure, was better than that of the left. Lumi-
mous objects were multiplied and surrounded by belts and rays. The
left cornea was very conical, the apex of the cone presenting a dimple
surrounded by a nebulous haze ; a magnifying glass displayed several
irregularities and facets, especially on the upper part, near the apex.
The right eye presented the phenomena of the disease in a less degree.
On dilating the pupil with atropine, and causing her to look through a
pin-hole, it was found that when the aperture was opposite to the lower
and outer third of the expanded pupil, a very decided improvement in
her sight took place." She could then read with facility at five inches,
whereas, before, she could only make out letters at two inches distance.
It was then decided to extend the pupil at the point mentioned. On
the 28th of May, an incision was made with a curved Scott's knife,
just beneath the transverse diameter of the cornea at the outer side,
and a fibre from the margin of the pupil, being drawn out with fine for-
ceps, was snipped off. There was a little haemorrhage into the anterior
chamber, which speedily subsided under the influence of cold.
No ill consequences followed the operation; and, after the lapse of
three months, the patient could read and work at the distance of four
inches from that eye, and could discern features tolerably distinctly at
four feet. . . .
CASE II. ARTIFICIAL PUPIL. Jane Robertson, aged 27, of delicate
and poverty-stricken appearance, came under my notice January 11,
1848. She was a milliner, but for nine months she had been unable to
work from imperfection in her vision. About eighteen months prior
to her application, she first perceived a difficulty in distinguishing objects
clearly with the right eye when looking directly at them, but by turning
her head a little on one side they appeared clearer; at the same time
she was much annoyed with muscae volitantes, and occasionally felt an
uneasiness and fulness in the eye. The sight gradually became worse,
and in about six months the left eye was in like manner affected. The
difficulty in discerning objects increased, until she was obliged to hold
her work quite close to her eyes and to look at it obliquely. Being
dependent on her needle for subsistence, she was compelled to work
many hours each day, until at length she could no longer see, and was
obliged to yield to her rapidly increasing blindness.
The unmistakeable sparkle of the eyes at once proclaimed the nature
of the case; for, in each, Conical Cornea was well marked. The apex of
the right cone was somewhat more opaque than that of the left, and each
come presented a dimpled point. She could only discern capital type by
holding it at about an inch and a half from the eyes, but through a pin-
hole, could see it at three inches. On dilating the pupils with atropine,
there was some improvement, which decided me to attempt relief by
an artificial pupil. On the 20th January, I operated on the right eye,
making an incision at the outer margin of the cornea. A considerable
gush of aqueous humour took place, the cone collapsed, becoming some-
* Secale cornutum, used as a snuff, has been said to cause contraction of the pupil.
I have tried it in many instances of dilatation of the pupils, natural and artificial,
but have not observed the effect in question, .
5:30 CONICAL CORNEA.
what corrugated, and the iris fell forward. With a pair of fine forceps,
the margin of the pupil was drawn out, and a few fibres snipped off. On
the following day the cornea was moderately filled, and there was a
decided improvement; but the reduction of the size of the come being
considered, little stress was laid on the amendment. The recovery was
rapid, and the vision was certainly somewhat improved, but not suffici-
ently so to enable her to work, and I did not therefore think it desir-
able to adopt any further operative measures.
CASE III. ARTIFICIAL PUPIL AND DESTRUCTION of THE LENs. Anne
Reeder, aged 17, was sent to me from the country, in September 1847.
Her head was unusually long in the antero-posterior direction, as if she
had suffered from hydrocephalus. The vision of her right eye had
been imperfect from early youth, and had gradually become useless;
the vision of the left eye was also imperfect; the eyes were remark-
ably deeply set, and the palpebral fissure small; the comical form
of the right cornea was strongly marked, that of the left decided, but
less prominent than the right; the apices of both were slightly turbid;
the surface of each was smooth, and neither halos nor multiplication of
images had been perceived; vision was not improved by a pin-hole, nor
by any kind of lens.
On the 22nd of October I made a puncture at the inferior third of
the outer side of the right cornea, and drawing out a small portion of
the margin of the pupil, snipped it off. There was considerable hæmor-
rhage into the anterior chamber, but it yielded to the application of
cold. So rapid was her recovery, that she left the Eye Infirmary on
the 29th of October, with a very good artificial pupil, but without any
amendment in her sight. She came in again on the 8th November,
and the recovery from the previous operation was so complete, that I
determined to try the effect of destroying the lens, as recommended by
Mr. Walker and others. On the 10th November the lens was destroyed
with a cutting needle; no unpleasant symptoms followed, and the
fragments became in due time absorbed, but there was no material
amendment in her sight, either then or in June 1848; since which time
I have not seen her.
If artificial pupil be contemplated, it should be ascertained whether
dilatation of the pupil improves the sight, and whether there is any
point through which the vision is better than elsewhere. When irre-
gularities of the surface exist, some spots are freer than others, and
here the cornea is best adapted for the transmission of visual rays.
REMOVAL of THE CRYSTALLINE LENs. In reference to this operation,
it must be borne in mind, that perfect vision is due to the combination
of accuracy of form of the cornea and crystalline, with that beautiful
arrangement of the fibres and layers of the lens, by which the rays
undergo gradual refraction in their course through it, and are united in
foci exactly upon the retina. The imperfection of vision in Conical
Cornea, is caused less by alteration in the actual refractive power in the
eye, than by the vicious manner in which refraction is performed; the
alteration in figure of the cornea prevents the formation of foci at the
proper points, and causes unbounded confusion in the images depicted
on the sentient membrane. Though, by removal of the lens, the refrac-
tion within the eye is lessened, the harmonious bending of the rays
BY W. WHITE COOPER, ESQ. 53 b
accomplished by the crystalline, cannot be attained, nor can the condi-
tion necessary for the formation of images be recovered. It is justly
remarked by Dr. Pickford, in his able treatise, that the sphericity
of the cornea, so to speak, is totally lost, saving so much of its obtuse
apex as approximates to the form of the healthy cornea; and that we
have no longer to treat an ellipsoid of revolution, but a plane surface,
—the slant sides of the cone. Thus the alteration in the conditions for
refraction anterior to the lens, is not of a nature to admit of compensa-
tion by the removal of that body.”
Destruction of the crystalline lens was proposed with great confi-
dence by Sir W. Adams, as a cure for Conical Cornea. The cases which
he has related are highly flattering to his skill; but, independently of
the optical objections, and the formidable character of the proceeding,
it has been strongly condemned by high authorities. The late Mr.
Tyrrell said, “It was thought that the removal of the crystalline lens,
by getting rid of that convex and highly refractive body, would afford
better vision in such cases; but the practice has not in the least degree
supported the theory; for it does no good.” Mr. Lawrence “would not
think of proposing any such operation, unless the affection had gone so
far as to render the eye useless, and he would then expect no good from
it. The proceeding has not been employed with advantage in any in-
stance.” Dr. Pickford is of opinion, that the removal of the lens is
uncalled for, injudicious, and indefensible.
That the removal of the lens is sometimes of service, is proved by the
following evidence; but my impression is, that such cases form the ex-
ception, not the rule. - k
In 1847, Dr. Butter, of Plymouth, wrote to me as follows: “I
couched a woman, thirty years since, who had cataracts and Conical
Cornea. She has seen well ever since, with or without flat (?) glasses.”
In a similar manner I was informed by Dr. Robertson, of Edinburgh,
“I have operated in one case of cataract, conjoined with a highly Conical
Cornea. The apex was irregular on its surface and slightly opaque.
The patient could afterwards read the smallest print, the book being held
somewhat to the side, but in looking at any object held directly in a line
with the centre of the cornea, the centre of the object was scarcely visi-
ble. The glasses usually required after the removal of the lens, were,
as was naturally anticipated, injurious, the conical form of the cornea
compensating for the loss of the lens. The operation performed was
that of reclination.” When speaking of artificial pupil, I have men-
tioned a case related to me by the late Mr. Walker, of Manchester, in
which he combined extraction of the lens with artificial pupil with suc-
cess; but he particularly mentions, that the conicity of the cornea was
almost entirely removed by the operation,-doubtless by the Section of
the cornea.” - -
* The figure of the healthy cornea is an ellipsoid of revolution about the major
axis, through which the curvature of all its sections is equal, and it presents in
every direction an arc of 960 55' 20". -
* Mr. Estlin of Bristol thus writes: “One case occurred to me, where the lens
of an eye, with Conical Cornea, was wounded by a needle, which ruptured the
capsule and produced a cataract, which became absorbed by the effect of the acci-
dent which occasioned it. The loss of the lens improved the power of seeing.”
§32 CONICAL CORNEA.
Though doubting the efficacy of the proceeding, I considered it my
duty, after the foregoing statements, to give the patient the benefit of
the chance in two instances, and am bound to state that the result was
not sufficiently encouraging to induce me to recommend the operation;
unless, of course, cataract should chance to be combined with Conical
Cornea, in which case it would be perfectly justifiable.
CASE IV. DESTRUCTION OF THE LENs. Luke Gibson, carpet-weaver,
aet. 23, came under my care in March 1847. Both eyes presented Conical
Cornea, the right being more prominent than the left. The usual symp-
toms were present, and he found so much inconvenience, that he was eager
for any means which afforded a chance of relief. All milder measures
having failed, and there appearing to be some cloudiness in the right lens,
I determined to try the effect of removing that body. The anterior opera-
tion for solution was therefore performed with a broad needle, on the 26th
April. On introducing the needle, there was a considerable gush of aque-
ous humour, and the cone became flaccid. After completing the operation,
I availed myself of the opportunity of examining the collapsed cornea,
and satisfied myself that, near the apex, it was scarcely thicker than
silver paper. Absorption proceeded satisfactorily, but it became neces-
sary to repeat the operation on the 27th July, to remove some fragments
of capsule which obstructed the pupil. On the 26th August the aper-
ture was clear, but I was sorry to find that little, if any benefit, had been
gained, nor were glasses of more use than before the operation. The
rapidity with which the aqueous humour is secreted, was well shown in
this case, for the cornea was plump and distended twenty-eight hours
after the operation.
The second case, that of Anne Reeder, has been already related.
REMOVAL OF SEGMENTS OF THE CORNEA. One case only, in which
this step has been adopted, has fallen under my notice. It was com-
municated to me by Mr. Maling, of Sunniside, as follows: “I discharged
the aqueous humour by making a section of the lower half of the cor-
nea, and cut away a small portion of it, with a view of diminishing the
anterior chamber; but the result did not answer my expectations,
although the patient was certainly less myopic. The apex of the cone,
after the operation, inclined downwards. I wished to operate in a
similar manner on the upper portion of the cornea, but my patient
would not submit.” -
By removing the apex of the cone somewhat to one side, especially
the inner, and by combining with this treatment, the use of a fissured
diaphragm, with or without a lens, benefit may probably be derived.
The Bulletino delle Scienze Médiche, of Bologna, for December 1839,
contains the particulars of a case of Comical Cornea, treated in an un-
usual manner by an Italian surgeon, M. Fario. With a double-edged
cataract knife, he made an incision at the outer side of the cornea, and
a second, meeting the first at the point, in the form of the letter V re-
versed. The flap was cut off with scissors. There resulted a gap, through
which the aqueous humour continually drained. The lids were closed
with sticking plaster, and the patient kept in bed in a dark room for
eight days, no other dressing being applied to the eye. At the expira-
tion of that time, the lids were opened, when the breach in the cornea
was found closed, and the cornea itself a little flattened. The same
BY W. WHITE COOPER, Esq. 533
operation was repeated at the lower part of the cornea with a similar re-
sult, but the flow of the aqueous humour continued longer this time,
and the iris became entangled in the wound, but withdrew under the in-
fluence of belladonna. A third excision was performed at the upper
and inner part of the cornea; and it is stated that the eye became
flattened, and the patient cured. . -
The main objection to such a proceeding as that described, is the
great risk of prolapse of the iris. It occurred in the present instance,
and although the membrane is said to have retracted, such an event is
by no means to be expected after it has been prolapsed eight or nine
days; belladonna would then have but little effect in causing its retrac-
tion. Another objection is, the leucomata that would be produced by
the cicatrices of the wounds. The new material formed to fill up the
gaps in the cornea being fibrous instead of lamellated, and opaque
instead of translucent, would leave permanent cicatrices of such a mag-
nitude as would be unsightly, and obstructive to vision.
PUNCTURING THE CORNEA. This, as might be expected, has been
resorted to in a great number of instances, but has failed to afford relief. I
know of no more marked illustration of the rapidity with which the aque-
ous humour is secreted, than is presented under such circumstances; on
the needle being introduced, the fluid spirts out freely, and the cone
collapses. If the eye be examined about twenty-six hours afterwards,
the cone will usually be found plump and distended: when about two-
thirds filled, there is often marked improvement in the sight, but the
hopes thus raised are dispelled in a few hours. Mr. Evans, of Belper,
says, “I have treated about a dozen cases of Conical Cornea, I am
sorry to say, without materially benefiting any of them. The treatment
of my early cases consisted in evacuating the aqueous humour, in one
case more than ten times, astringent lotions, etc. Latterly, I have
given up all local remedies as being utterly useless in my hands, and
confined the treatment to the improvement of the general health.” Not
more encouraging is the report of Mr. Soden, formerly of Bath. “In
the course of thirty five years that I have been connected with the Bath
Eye Infirmary, I think that I have not seen more than fourteen or
fifteen cases of Comical Cornea. In two cases, I tried frequent evacuation
of the aqueous humour, in the hope that the cornea might be somewhat
flattened by the anterior chamber being emptied; but no advantage
ensued, although in one instance I repeated the operation about thirty
times, at intervals of two or three days. No injury, however, resulted
from this treatment.” I might multiply such accounts, but these ex-
amples are sufficiently confirmed, as they are most fully, by my own
experience; for though evacuation of the aqueous humour is of service
when combined with fluid pressure, it is absolutely useless by itself.
PRESSURE. M. Desmarres thus writes: “Some have tried puncture
of the cornea to evacuate the aqueous humour; if, with this, they had
joined a compression, methodical, immediate and long-continued, as we
daily use with opaque staphyloma, and as we have practised with great
advantage in two cases of transparent staphyloma, such means would,
perhaps, have been attended with the best results.” Puncture of the
cornea, followed by direct compression, appears to me the best means
DESMARREs, L. A. Traité Théorique et Pratique des Maladies des Yeux.
534 CONICAL CORNEA.
known for the treatment of this disease, but the compression should be
light, exactly made, and long continued.” The correct principle is em-
bodied in these views of M. Desmarres. Strong pressure by a solid
body is injurious. It is support, rather than actual compression, which
is needed. The thin and weakened cornea, unable to resist the pressure
from behind, has been projected into a cone, and is incapable of recover.
ing itself unless relieved from that pressure. Evacuation of the aqueous
humour affords merely temporary relief, for the membrane is speedily
again distended. John Hunter thus wrote: “We find very different
effects from the same quantity of pressure; for when from without, pres.
sure rather stimulates than irritates, it shall give strength, and produce
an increase of thickening; but when from within, the same quantity of
pressure will produce waste, for the first effect of pressure from with-
out, is the disposition to thicken, which is rather an operation of strength;
but if it exceeds the stimulus of thickening, then the pressure becomes
an irritator, and the power appears to give way to it, and absorption of
the parts pressed takes place.” It may be doubted whether this doctrine
is altogether correct; for, as pointed out by Professor Paget, the results of
pressure, whether from within or from without, appear to depend on its
Constancy or occasional application. In Comical Cornea, the pressure
should be constant, but not limited to the apex of the cone, or it will
excite irritation; it should be so managed as to afford firm support to
the whole cornea, thus counteracting the force of the muscles of the
globe, removing the tension from the weakened membrane, and placing
it in the most favourable condition for restoration to its natural thickness
and figure.
Fluid pressure alone can perform this satisfactorily, for if this be
properly applied, every part is equally supported, and the support is
maintained under all circumstances, movements, and positions. I en-
deavoured to carry out these principles in the following manner. An
apparatus was constructed, consisting of an air-cushion of fine membrane,
fitted to the orbit and acted on by a spring which passed half round the
head, the point of counter-pressure being the occiput. The spring was of
just sufficient strength to cause as much pressure on the eye as could be
borne without inconvenience, and it was supplied with an adjustment to
increase or diminish the force. Anterior support being thus provided,
the pressure from behind the cornea was removed by letting out the
aqueous humour. Immediately on its ceasing to flow, the apparatus
was applied. Could the air-cushion have been made impervious to
moisture, and perfectly air-tight, the improvement which took place in
One case, after three weeks' trial, leads me to believe that much benefit
would have been derived, but, unfortunately, the cushion invariably col-
lapsed after a few days' wear. Vulcanized india-rubber, or some form of
gutta percha, may, perhaps, answer better, but no description of animal
membrane is adapted for the purpose. I ascertained, however, that the pad
could be worn immediately after the cornea had been punctured, without
exciting the least pain or irritation. If a perfect cushion can be obtained,
its use should be persevered in for at least two months, the cornea being
punctured from time to time. With this treatment, careful attention
should be paid to the general health, strength and tone being imparted
1 HUNTER's Works. Edited by James F. Palmer, London: 1837. Vol. iii, p. 466.
BY W. WHITE COOPER, Esq. 535
if needed, and congestion abated if it appear to exist. The various
preparations of iron with aloes and myrrh, and the carbonate of man-
ganese (of which I can speak favourably), are indicated in the first of
these conditions. Counter-irritation by blisters and rubefacient lini-
ments, is best calculated to remove the second.
EMETo-PURGATIVE TREATMENT. This practice was introduced by Dr.
Pickford, and advocated by him in a work of remarkable ability." The
principles which have guided him are thus laid down. “I believe
Conical Cornea to depend upon some disturbance in the functions of the
great sympathetic, spinal nerves, and par vagum, producing, through the
medium of the lenticular ganglia and fifth pair of nerves, faulty action
of the nutrient capillaries and absorbent vessels of the cornea itself.
Emetics and purgatives, by the powerful influence which they induce
upon the gastric associate and consensual nerves, restore the healthy
functions of the weakened nutrient and absorbent vessels, the result of
which is a slow but progressive retraction of the diseased corneal
growth, and a consequent restoration of vision.” The medicines recom-
mended, are a scruple of sulphate of zinc combined with half an ounce
of sulphate of magnesia, to be taken every morning, or less frequently
according to circumstances. Besides the cases recorded in the work, I
am indebted to Dr. Pickford for the results of his further experience to
1848. “Since the publication of my paper on Conical Cornea, I have
had many opportunities of treating the disease. The result, so far as
the treatment has gone, has been most satisfactory, but I shall not at-
tempt to conceal the fact, that patients become exceedingly tired of so
disagreeable and so lengthened a remedy, and are disposed after a time
to intermit it. When this has been the case, I have invariably observed
an increased prolongation of the corneal cone, or an increased opacity of
its apex. To say the least of it, my remedy has the power, when taken
ever so irregularly, of keeping the disease in check, or of arresting it
altogether. The late Mr. John Scott told me that he had successfully
adopted my plan of treatment. In no instance have any ill effects fol-
lowed the lengthened use of the emetics; on the contrary, the general
health and strength have invariably improved. I have now a young
woman under treatment, in whom I tried the nauseating effect of the
remedy merely, short of vomiting; but under this modification the dis-
ease increased, and at her earnest solicitation the full effect of the medi-
cine was again resorted to.” 2 y.º. *
In two instances in which I attempted to give the emeto-purgative
treatment a fair trial, the patients were of opinion that the remedy was
worse than the disease, and neither argument nor persuasion could in-
duce them to follow it up for a sufficient length of time to enable me to
judge of its real merits. It will be seen that Mr. Dixon has formed a
strong opinion on the subject.
LoCAL APPLICATIONs.8 These comprise two classes, simple astrin-
* PICKFORD, J., M.D. On Conical Cornea. Dublin: 1844. s
* Just before going to press, an opportunity was afforded me of perusing the
paper by M. Sichel, in the second supplement of the Annales d'Oeulistique. M. Sichel
is of opinion, that Conical Cornea is invariably the result of ulceration, which
weakens the cornea; and in proof of this, he asserts that a small cicatrix is constantly
to be found at the apex of the cone. This is at variance with the experience of
536 CONICAL CORNEA.
gents and escharotics. With very rare exceptions, little or no benefit
has resulted from such remedies; every known combination seems to
have been tried and to have failed. The most favourable reports are
those of Mr. Ware, Mr. Gibson, Mr. Lyall, and Mr. Gervis. Mr. Ware
states: “In Some instances I have punctured the cornea and evacu-
ated the aqueous humour, after which, by the application of thick com-
presses to the outside of the eyelids, I have endeavoured to counteract
the morbid propensity; but, when this humour has been regenerated,
which usually takes place in a short space of time, the cornea has
always resumed its projecting figure. The greatest relief I have
hitherto given, has been by the application of a few drops of strong in-
fusion of tobacco; by a perseverance in the use of this remedy, three
or four times every day, the conical appearance of the eye has in a
few instances been diminished and the patient's sight greatly mended.”
Mr. Gibson, of Manchester, used collyria of alum and oak in four cases,
and in these no increase took place; one patient, indeed, thought his
vision was improved. As, however, the disease often comes to a stand-
still after having arrived at a certain point, but little stress can be laid
upon the influence of the treatment in these cases.
A curious case is related by Mr. Lyall. A young woman suffering
from Conical Cornea in both eyes, was suddenly attacked with severe
headache, great pain in the left eye, and a copious discharge of Scalding
tears. The apex of the cone became quite opaque in two days; shortly
after, Mr. Lyall applied nitrate of silver, when violent action was excited
and the opacity partly disappeared. Mr. Lyall then punctured the cornea
several times, and used strong astringent collyria, the result being
diminution in the size of the cone and decrease in the opacity; but (it
is important to remark), the vision was not improved.
Mr. Gervis, of Tiverton, has been fortunate in his management of
this disease. A young woman at 25, had suffered for two years from
Conical Cornea in the right eye, and has been under medical treatment
for a year and a half. Mercury had been exhibited freely, and had pro-
duced much debility. The plan adopted by Mr. Gervis was continued
counter-irritation by means of blisters, full doses of carbonate of iron
for two months, compound galbanum pill, and liberal diet. The
cornea was several times punctured, and the come swept with nitrate
of silver thrice a week. Some opacity of the projection resulted,
Mr. Dalrymple, Mr. Dixon, and myself. We have each repeatedly seen instances
of Conical Cornea, in which no opacity whatever existed.
The treatment recommended by M. Sichel, to give solidity to the weakened mem-
brane, is as follows. The projection is to be touched once or twice a day with
vinum opii, and the lids being immediately closed, are to be bathed with cold water.
Subsequently there may be used with this, an ointment of red or white precipitate,
ten or twenty grammes to two grammes of lard. Every two or three days, if the
eye will bear it, a pencil of nitrate of silver is to be swept lightly over the opacity,
especially the summit of the cone, but not over the sides. The surface having been
wiped with fine rag, a little cerate is to be applied. These cauterizations may be
continued during one or two months, being suspended from time to time, if neces-
sary. Should the progress of cure be slow, and the cone large, puncturing and
compression may be employed, the one alternating with the other, and with the
cauterization. Measures for the improvement of the general health should be com-
bined with this treatment. We are not aware that this practice has found favour
on this side of the Channel, nor can we speak from experience of its efficacy. w
* WARE, Jas. Chirurgical Observations Relative to the Eye, vol. ii, p. 77. 1805.
BY W. WHITE COOPER, ESQ. 537
and the unguentum hydrargyri nitrico-oxydi was applied daily to the
eyelid. At the expiration of three months, the cornea had recovered its
natural shape, and the sight was completely restored. In another in-
stance similar treatment, in combination with emeto-purgatives, ren-
dered much service. To the judicious combination of general treatment,
with local remedies, must the happy result of these cases be ascribed,
rather than to the predominating influence of any application in parti-
cular. - - --
It occasionally happens that the apex of the cone will become opaque
in cases of old standing, from Some slight exciting cause quite indepen-
dent of friction of the lid. Such attacks are amenable to treatment,
and it is important that the opacity should be speedily removed. The
following case, for which I am indebted to my friend Mr. Dalrymple, is
a good illustration of these attacks, and the means by which they are
to be arrested.
CASE v. OPACITY REMOVED BY LOTIONS OF ACETATE of ZINC, AND IRON
INTERNALLY. A lady, aged 35, consulted Mr. Dalrymple on 18th March,
1850. She had suffered from Conical Cornea for twelve or fifteen years,
and some years ago consulted many eminent men without relief. Until
lately she had been able to read with either eye, at two inches focal dis-
tance. The cone was strongly developed in the right eye, but perfectly
transparent. The left cornea was still more sharply conical, and until
within three weeks of the above date, was also clear. She supposes that
she caught cold during the recent severe weather, for, without any red-
ness of the eye, opacity supervened, invading the apex of the cone of
the left eye; she had been in the habit of reading over much, her health
was feeble, and circulation languid. A doubtful prognosis was given as
to the probability of the opacity becoming absorbed, but she was recom-
mended to take 10 drops of the tinct. ferri sesquichl. thrice a day,
with aloes and myrrh, and to frequently drop into the eye a collyrium,
containing one grain of acetate of zinc to an ounce of distilled water.
Twelve days afterwards, she reported by letter, that the opacity had dis-
appeared, and that she had begun to see as well as before the attack.
NITRATE OF SILVER AND TINCTURE OF IoDINE TO THE EYELIDs. Mr.
Smith, of Southam, speaks favourably of this description of counter,
irritation: “In two cases,” says he, “I have given considerable satis-
faction by the application of argenti nitras, on the external surface
of the upper lids, and so keeping up a little scaly eruption or desqua-
mation of the skin: one girl found great relief, having suffered from
the complaint for two years.” In two cases in which the disease was
clearly connected with struma, and was accompanied with intolerance of
light, I made trial of the daily application of the tincture of iodine to
the lids with decided benefit to the photophobia. It may be remarked,
that this remedy is of great value in ordinary strumous ophthalmia.
HYDROCYANIC ACID WAPOUR. To this I gave a full trial in several
cases. The only effect was diminution in the opacity when such existed.
ELECTRO-MAGNETISM. No visible change followed the use of this
agent, though persevered in for several weeks. - i
OPTICAL APPARATUS. The ingenuity of opticians has been severely
taxed, to endeavour to remedy the defective sight in Conical Cornea, by
artificial means. It being found that in some cases vision was improved
when looking through a pin-hole, various forms of apparatus have been
538 CONICAL CORNEA.
constructed on this principle. Mr. Travers has recommended a frame
of black wood, half or a quarter of an inch in depth, having a small
aperture; opake diaphragms have been varied in form, and pierced with
a fine slit in the centre, or removed somewhat to the side. In several
instances, I have seen decided benefit from the use of such an apparatus,
either singly or combined with lenses. The diaphragm should be a thin
plate of horn or metal, fixed in a spectacle frame. No precise rule can
be laid down as to the size, direction, or position of the aperture, for
there are scarcely two cases precisely alike, and each requires to be
carefully tested with apertures of various forms and dimensions. Such
an instrument improves vision by limiting the number of rays impinging
on the cornea, and thereby lessening the confusion of foci in the inte-
rior of the eye. When neither the diaphragm nor a lens separately
succeed, the two together will sometimes prove effectual. The number
ll double concave, fixed to a diaphragm pierced with a narrow slit, will
occasionally render valuable assistance, but the power of the lens and
the size of the slit are quite matters of experiment. In one instance,
and only one within my knowledge, did a double convex glass answer
better than the concave; on its being fixed to the diaphragm the patient
and optician were alike surprised at the great improvement which it
caused in a very bad case." -
Sir John Herschell has suggested the adaptation to the eye of a lens
of nearly the same refractive power as it, and having the surface, next the
eye, an exact intaglio facsimile of the irregular cornea. Should, says he,
“any very bad cases of irregular cornea be found, it is worthy of conside-
ration whether at least a temporary distinct vision could not be pro-
cured, by applying in contact with the surface of the eye, Some transpa-
rent animal jelly contained in a spherical capsule of glass; or whether
an actual mould of the cornea might not be taken and impressed on
some transparent medium. The operation would be delicate, but cer-
tainly less so than that of cutting open a living eye and taking out its
contents.” This proceeding seems to me more simple in theory, than
easy of practice. -
Lenses ground to different forms have been tried with more or less
success. Dr. Hull states that in a very bad case, much benefit resulted
from the use of an instrument, formed of two lenses, with an adjust-
ment; the lens nearest the eye being small and doubly concave, the
other large and convex. *
Could but the rays of light (as Dr. Pickford justly remarks), reach
the lens, with accustomed regularity of convergence, all would be well;
a deep double concave glass, by occasioning a prior divergence, would
remedy the defect of vision; but could they do this, one of the very
péciliarities of the disease itself would vanish and cease to exist. Be-
.#. jdifficulty, there is another; namely, that though a correct
S



haped lens might be obtained, it would not answer unless placed at the
exact, distance from the eye that is required; and always retain the
same relative position, Should a person be desirous of really deriving
benefit from lenses he might proceed thus: First, let him try a plano-
of diaphragms, etc., for Conical Cornea.
* Mr. Hawes, 79, Leadenhall.street, has had much experience in the manufacture
. * Article, “Light”, Encyclopædia Metropolitana. . .
BY W. WHITE COOPER, ESQ. 539
Re
convex lens, the concavity being about equal to the convexity of the
cornea, taking care that the curve is as nearly parallel to the curve of
the cornea as possible, when placed at the most suitable distance from
the eye. It is obvious that every distance has its peculiar curve—
the greater the distance, the less the curvature, as it is in concentric
circles. If that form should not be satisfactory, he might then try, in-
stead of a plano-convex, a convexo-concave, and afterwards a double con-
cave, only taking care that the two concaves partook of the form of the
curve of the cornea ; that is, both the inner and the outer curves should
be similar in form to that of the cornea, but of less curvature; or, in
other words, instead of being portions of spheres as is usual in lenses,
the curves should be portions of parabolas or hyperbolas as the case may
be, varying the amount according to the distance of the lens from the
eye, and according to the form of the Comical Cornea.
It will be seen by this survey of the various modes of treatment,
that there is not one which offers more than prospects of success.
Patients have rarely determination sufficient to carry them through the
discomforts of the emeto-purgative course ; and although the operations
of artificial pupil and destruction of the lens have each their advocates,
the amount of success which appears on impartial examination is not
sufficient to counterbalance the formidable nature of either proceeding, or
to justify their employment unless as a dernier ressort. On the whole,
I place most trust in the combination of puncturing with fluid pressure,
judicious attention being at the same time paid to the general health,
It has at least the recommendation of simplicity, and if unsuccessful,
the patient is not left in a worse condition than before. Prior to any
operative measures, all the points of the case should be fully considered,
and it is proper to ascertain whether the vision be assisted by the
limited aperture or by the use of belladonna. A card blackened with
ink and pierced with a large pin, makes an excellent experimental dia-
phragm ; and the most elegant preparation for dilating the pupil, is a
solution of from two to four grains of the neutral sulphate of atropine
in an ounce of distilled water.
19, Berkeley Square, March 1850.
.NotE. To the following gentlemen, my cordial thanks are rendered
for the valuable information which has formed the groundwork of this
paper. Dr. F. Jaeger, Vienna; M. Sichel, Paris; Sir John Richardson,
Mr. Dalrymple; Mr. James Dixon; Mr. Ranald Martin; Sir John Fife;
Mr. H. L. Smith, Southam ; Dr. Butter, Plymouth; Dr. Billet, Taun-
ton; Professor Andrew Anderson, Glasgow; Dr. Mackenzie, Glasgow ;
Dr. Cadenhead, Aberdeen; Dr. Keith, Aberdeen; Dr. Pickford, Brighton;
Dr. J. C. Hall, East Retford; Mr. Square, Plymouth; Mr. W. Walker,
Edinburgh ; Mr. Gervis, Tiverton; Mr. Isbell, Stonehouse; Mr. Soden,
Sunbury; Mr. Evans, Belper; Mr. Mould, Plymouth; Mr. Neill,
Liverpool; Mr. Estlin, Bristol; Mr. Barnes, Exeter; Mr. Delagarde,
Exeter; Mr. Cleobury, Oxford; Mr. Maling, Sunniside; Mr. Braith-
waite, Leeds; Mr. Greenhow, Newcastle; Mr. Barton, Didbury; Dr.
J. A. Robertson, Edinburgh; Mr. Percival, 1st Life Guards; Mr.
Ryland, Birmingham; and Mr. W. R. Wilde, Dublin.
WOI, II, 36
540
ON THE HEALTH OF LONDON, DURING THE SIX
MONTHS TERMINATING MARCH 30th, 1850.
By JOHN WEBSTER, M.D., F.R.S., Consulting Physician to the St. George and
- St. James's Dispensary.
[Read before the Westminster Medical Society, April 18, 1850.]
BELIEVING that some observations on the Health of London, during the
last six months, in continution of those which were previously brought be-
fore the Westminster Medical Society," may be interesting, I have pre-
pared this paper. During the period from the 29th September, 1849, to
the 30th March, 1850, the health of the metropolis has been, on the whole,
very satisfactory. The number of deaths from all causes has been
below the ordinary average, and less than those which occurred during
the corresponding months of the years 1848-49; the mortality for the
last-named period having amounted to 30,160, and that for the corre-
sponding six months just ended being 26,096. The latter season thus
exhibits a diminution of 4,064 deaths, or about 13% per cent. In the
first three months of the current year, 2,219 fewer deaths have occurred
in London, than during the same quarter of 1849. This favourable
aspect of the public health has been due both to various causes to which
I shall hereafter refer, but chiefly to the diminished mortality of several
diseases which were very prevalent and fatal during the years 1848-49.
DISEASEs whſoH HAVE ExHIBITED A DIMINISHED RATE OF MORTALITY.
Scarlatina, which carried off 2,541 individuals during the two quarters
ending the 31st March 1849, proved fatal to only 685 patients in the
corresponding months of the recent season; being a decrease of 1,856
deaths. Typhus has exhibited a mortality of 962 in place of 1,582 ;
being a diminution of 620 deaths. Small-pox has likewise proved
much less fatal than previously; only 194 persons having died from it
in the two quarters just ended, instead of 641 during the parallel six
months of 1848-49; being a decrease of 447, or more than two-thirds.
Cholera was very fatal during last summer and autumn, and did not
subside till towards the close of 1849; 494 persons having died in
London from it during the fourth quarter of that year; while, in the
corresponding three months of 1848, the deaths, from the same cause,
were only 26 fewer. But during the first quarter of the current year,
the contrast has been marked, and highly satisfactory; not more than
eight persons having died of cholera since the 1st of last January, in-
stead of 516 during the first three months of 1849. The fact now
stated is highly important, and may, I hope, be taken as an indication
that cholera will not prove so epidemic and pestilential during next
summer and autumn, as it was last year. . - - -
Influenza, which, in the six winter and spring months of 1847-48,
carried off 1,739 persons, proved fatal to only 77 in the same period of
1848-49, and to 87 in 1849-50. Hence this malady, which prevailed
almost like a pestilence two years ago, has since been a comparatively
mild complaint. - - : . -
1 London J ouisa, OF MEDIGINE for 1849, pp. 992 and 1068.
DR. WEBSTER ON THE HEALTH OF LONDON. 5 ſ 1
Diseases of the chest, including phthisis, which always prove so com-
mon and fatal during cold and inclement weather in this climate, have
lately been less so, especially during the last quarter; 4,428 persons
having died from diseases of the respiratory organs, instead of 4616
during the corresponding three months of 1849; being a difference of
188 deaths.
Diseases of the brain and nervous system, which are also usually
prevalent and fatal, have shown a comparative diminution; 3,092 per-
sons having died of these affections within the last six months, being
60 fewer than the number of deaths (3,152) which occurred in the cor.
responding period of 1848-49. . . .
Hooping-cough has proved fatal in 715 cases; being a decrease of .
652 cases upon the number (1,377) registered in the corresponding
period of last year, or nearly one half.
The diseases of the puerperal state exhibit a smaller mortality than
in the two corresponding quarters ending 30th March 1849. During
the last-named period, 339 females are reported to have died from these
causes; whereas, during the six months just terminated, the number of
deaths from the same diseases has been only 242; being a decrease of
97, or of upwards of one-fourth. This fact seems worth mentioning, as
the danger attending parturition sometimes becomes much augmented,
in a town population; and especially in lying-in institutions, where ter-
rible epidemics have so often prevailed.
DISEASEs which HAVE EXHIBITED AN INCREASED RATE OF MORTALITY,
Notwithstanding the general Salubrity of London, and the aggregate
diminution of deaths from all causes, some of the ordinary diseases
have exhibited an opposite feature.
Measles have proved more fatal in the last six months, than during
the corresponding period of 1848-49; 64.1 persons—chiefly infants and
children, having died lately from that complaint, as compared with 391,
during the winter and spring of 1848-49. There has thus been an
excess of 250 deaths from measles in the six months just past.
Diarrhoea and dysentery have exhibited very little difference, although
there has recently been a slight increase in the number of deaths from
these causes. During the last six months, 811 persons have died of
these maladies, the number for last year being 775, or 36 fewer deaths
than recently. !
DISEASEs ExHIBITING AN UNIFORM RATE OF MORTALITY. Diseases of
the heart and blood-vessels, during the two quarters ending 30th March
1849, were fatal in 1,002 cases; while the deaths from these causes,
during the corresponding period of 1849-50, have amounted to 1010.
The rate of mortality of these complaints may then bé said to have
been almost identical during both periods.
One case of hydrophobia has recently occurred in London. Formerly,
this intractable disease was more frequent than of late years; and it
appears, from the early Reports of the Registrar-General, that twelve
persons died from it in the year 1888. Subsequently, up to 1847,
from one to four individuals are reported to have been its victims each
year. Since that period, the disease has happily proved fatal in only
two instances; one in January 1848, and the second in February of the
36
542 ON THE HEALTH OF LONDON.
present year, Both patients were young. The most recent case was a
girl aged 4, who is stated to have been bitten by a rabid dog a hundred
and one days previously, as appeared from the evidence given at the in-
quest, when it was stated, that the patient was bitten on the 15th of
November 1849, and died on the 24th of the following February;
hence the poison must have remained latent in the system much longer
than is commonly supposed. This fact is interesting, and seems to
show, that a patient must not be considered wholly free from the super-
vention of canine madness, although forty days may have elapsed since
the infliction of the bite of a rabid animal.
The recollection of the former frequency of hydrophobia, which, in-
deed, seems to have been at one time so common, that the weekly
average of deaths from this cause was stated to be much higher than
at present, renders its diminution the more gratifying. This disease
has always baffled the skill of medical practitioners, notwithstanding the
vaunted reports occasionally put forth in some countries, that a cure had
actually been discovered. It would be of much benefit, if these assertions
were realized; and whether the specific come from a remote province
of Russia, or the more distant wilds of Abyssinia, humanity must re-
joice at such a discovery. But until we have better evidence than mere
assertion, we can only trust to immediate excision of the wounded part,
and the subsequent application of cupping-glasses: by these measures
alone, which should be used whenever any suspicion exists, the safety of
an individual bitten by a rabid dog can be guaranteed. -
The present rarity of hydrophobia is mainly to be attributed to the
operation of the Act of Parliament, brought in by Mr. Fox Maule;
whereby dogs are not now allowed to draw any vehicle in London. One
of the reasons assigned for passing the above-mentioned judicious mea-
sure was, that the canine race, when employed in drawing vehicles,
particularly in hot dry weather, often get so excited as to become rabid,
and then to communicate the disease, not only to other dogs and ani-
mals, but also to man. Since the prohibition became law, hydrophobia
has almost disappeared from London, or, at least, is a very rare disease;
and this happy result is, I think, so much owing to Mr. Maule's exer-
tions, that it would be desirable to make the measure general throughout
the whole empire—for the malady prevails elsewhere more frequently
than in the metropolis, to which alone, the Act now referred to applies.
Hydrophobia is still a prevalent disease in many parts of Europe,
especially throughout the northern provinces of the continent. For in-
stance, in Prussia, this dreadful malady annually causes the death of
70 or 75 persons: as is shown by the fact, that during fifteen years
ending 1834, according to the Government Mortality Tables, 527 males
and 546 females, making a total of 1,073 individuals, fell victims to
hydrophobia. Having resided some time in Berlin, and made inquiry
on the subject, I can testify to the prevalence of this affection in the
Prussian states. It is also worthy of remark, that the medical practi-
tioners, resident in those districts, ascribe the frequency of canine rabies
to the number of famished and sometimes rabid wolves, which come
from the forests and deserts of Poland during severe weather, in search
of food; when they bite domestic dogs, and thus give rise to the pro-
pagation of hydrophobia among the inhabitants. . . . . . .
BY JOHN WEBST1. It, M.D., F.R. S. 543
MoRTALITY AMONG CHILDREN. It appears that, of the 13,219 deaths
from all causes, registered during the first quarter of the current year,
5,484, or about 41% per cent, occurred in persons under fifteen years
of age. Having already alluded to several of the diseases which
usually prove fatal, especially to children, as scarlatina, measles, and
pertussis, it would be superfluous to notice them again. Hydrocephalus
and convulsions, however, demand some attention. Convulsions are re-
ported to have been the cause of death in 482 persons during the past
quarter, only three of whom had reached the age of fifteen. From hy-
drocephalus, 370 individuals, of whom only three had attained the age
of puberty, have died during the quarter just ended. These facts are
interesting and instructive, as they unequivocally demonstrate that
these two diseases are almost exclusively confined to infancy and child-
hood. The danger attending them seems to bear a direct ratio to the
youth of the patient ; and the prognosis will be most unfavourable in
.infants, or in those of tender years and feeble constitutions. The large
number of children who annually lose their lives from accidents is de-
serving of notice. Not fewer than 79 young persons under fifteen years
of age have died from burns and scalds during the last three months.
Privation of breast-milk proved fatal to forty infants. This circum-
stance is most significant; and when it is also known, that during the
years 1848 and 1849, no fewer than 347 infants died from a similar priva-
tion, the statement now made deserves serious consideration. This large
mortality is, without doubt, chiefly owing to the practice, so prevalent
among many of the middle and upper classes, of employing wet-nurses
to suckle their infants, instead of following the dictates of nature, which
enjoins each mother to feed and nourish her own offspring. Further,
as the milk of a recently delivered woman is more serous than after-
wards, it is more fit for her new-born infant, than that of another female
who has been nursing for a longer period. Moreover, the human milk
progressively becomes more nutritious, and is better adapted to support
and strengthen the growing infant. It should also be remembered,
that the child of the person employed to act as wet-nurse, being fre-
quently fed by hand, and very generally neglected, if not starved, often
falls a sacrifice. All circumstances being considered, it may be empha-
tically said, that, excepting in cases where the mother is unable to afford
sufficient or proper nourishment to her own offspring, the custom of
employing wet-nurses should be discountenanced, not only on physical,
but on moral grounds.” It is no answer to assert that parents, especially
* The practice of employing wet-nurses is not only contrary to the laws of nature,
and of an injurious tendency both to mother and child, but also holds out a pre-
mium to immorality. Hired nurses are liberally paid for their services, always
well fed, and often luxuriously pampered in a manner quite at variance with their
previous position: hence, especially if unmarried, they are tempted to again become
qualified for obtaining a similar situation. That this is not an overdrawn picture,
may be proved from the experience of medical practitioners. It is also astonishing
to observe the encouragement which this demoralizing custom receives from persons
who are frequently, most charitable, and otherwise desirous of improving the condi-
tion, both moral and religious, of the lower orders. If the subject were carefully
considered in all its bearings, much beneficial alteration would be accomplished.
Antiquity might, perhaps, be cited in favour of wet-nursing; but it should be re-
membered that the custom was, even then, strongly condemned. Thus, Tacitus
complains of the degeneracy of the Roman matrons, who too frequently entrusted
544 ON THE HEALTH OF LONDON.
in the fashionable world, are unable to suckle their infants, and frequent
society at the same time. Most assuredly these are incompatible: but
this only strengthens the argument against wet-nursing, as mothers em-
ployed in suckling their own children, could not frequent hot rooms, mix
in crowded assemblies, keep late hours, or join in any species of dissipa-
tion. They would have to remain more at home, to take care of their
own health and of that of their infants; which would greathy conduce to
the benefit of all parties.
The great mortality among children, from all diseases, demands most
serious attention. If the chief causes can be pointed out, which produce
such a disastrous influence, a great step will then be made towards their
mitigation. Unquestionably, improper feeding, defective clothing, and
exposure to the vicissitudes of weather, in this variable, though otherwise
healthy climate, materially contribute to the production of disease, and
to the consequent augmentation of mortality, amongst infants and chil-
dren, even in the wealthy classes, or those in comfortable circumstances;
but still more so among the poor and dissolute. Hygienic measures,
and judicious medical treatment, greatly diminish the mortality among
all classes, but especially in infants and children; whilst greater atten-
tion to the clothing and diet of children would certainly give a more
favourable aspect to the mortuary tables of London.
MoRTALITY AMONG THE PAUPER POPULATION. A few general remarks
may now be made upon the large mortality among the inmates of hos-
pitals, workhouses, and prisons, nearly one-fifth of the whole deaths
having taken place in these establishments. Thus, of the whole 13,219
deaths during January, February, and March of the present year, 2,353,
or 17% per cent. were individuals supported, or at least medically treated
by the public, or by unpaid medical officers. The number now mentioned
does not comprise the deaths among dispensary patients, out-door parish
paupers, or the numerous persons frequently attended gratuitously by
medical practitioners. At least one-third of the deaths recorded were
of this description.
INFLUENCES WHICH HAVE CONTRIBUTED TO THE IMPROVEMENT of THE
PUBLIC HEALTH. The chief features characterizing the sanitary condi-
tion of London during the last six months, show that the public health
has been, on the whole, satisfactory, as compared with the corresponding
period of 1848-49; and more especially so, if contrasted with the six sum-
mer and autumn months immediately preceding, viz., from the 1st of
April to the 30th September 1849. During the later period, the mor-
tality was enormously augmented by the great prevalence of cholera and
diarrhoea, 40,117 persons having died from all causes during this period,
and only 26,096 in the more recent period. But the difference appears

the care of their infants to Grecian girls, or other inferior domestics. Pliny notices
the advantages attendant on the nursing of children by their own parents; and
other authorities, both ancient and modern, might be quoted. Van Swieten also
informs us, that one of the queens of France, who suckled her own infant, having
ascertained that a lady of the court had surreptitiously given the royal child her
breast, was so much offended on hearing of the fact, as to excite vomiting by intro-
ducing her finger into the infant's mouth, being unwilling that her son should re-
ceive any nourishment but from herself. - - - -
BY JOHN WEBSTER, M.D., F.R. S. r 545
even more extraordinary, when the three months of July, August, and
September of last year, are compared with October, November, and De-
cember. In the former period, the total deaths from all diseases were
27,109, but in the latter they decreased to 12,877, being a diminution of
more than half, or 54 per cent. Cholera and diarrhoea continued to pre-
vail throughout October and November of last year, though in a rapidly
decreasing ratio, so that 976 individuals died of these diseases during
the entire quarter; nevertheless, this period, and the first three months
of the current year, have proved, as formerly stated, more healthy than
the corresponding period for several previous years.
The chief influences which have contributed to produce this favourable
result are–1. The improved physical condition of the population:
2. The abundance of good and cheap provisions: 3. The less variable,
and hence more Salubrious, condition of the atmosphere : 4. The in-
creased attention recently given to sanitary measures: 5. The greater
care paid by individuals to their own health, in consequence of the alarm
experienced during the previous pestilence : and, 6. The removal, by the
recent epidemic, of a large number of the debilitated, dissipated, and
diseased portion of the population, so that there remained less pabulum
morbi as compared with former years; while the survivors were also
better able to resist the inroads of disease. ; : -
Most of the circumstances above alluded to, as influencing public health,
are so obvious, as to require little or no comment. Although much has
been recently said respecting Sanitary measures, and a few judicious
improvements have been commenced, very little advance in the right
direction has as yet been made. As I have previously adverted to this
subject, and shewn its importance, it is unnecessary for me to repeat
my arguments; but I would now again assert as strenuously as formerly,
that all nuisances, whether public or private, must be abated. Wested
rights, and individual interests, must yield to the health of communi-
ties. On this point, salus reipublica est suprema lea: ; and, as on such
question there can be no mistake, there ought assuredly to be no com-
promise. - •
The removal of food for disease by the cholera epidemic of last year,
and its consequentinfluence in producing a diminished rate of mortality,
is analogous to what has been formerly experienced. Similar results
followed the disappearance of influenza, which prevailed so severely
during the winter of 1847-48. In the quarter ending June 30, 1848,
the number of deaths was 3,510 fewer than in the preceding three
months. Again, after the cessation of Scarlatina, which was unusually
prevalent and fatal during the winter of 1848-49, the aggregate mor-
tality decreased; the deaths from all causes registered in the quarter
ending June 30, 1849, being 2,422 fewer than those in the three months
ending 31st March. Hence, it may be generally predicted, with some
confidence, that whenever any epidemic malady prevails, and removes
numbers of the population, the subsequent season or year will probably
be more healthy, and fewer deaths will occur than under other circum-
stances. This arises much from the removal by the previous epidemic
of the subjects most liable to disease ; but there may be also other evi-
dent causes in operation, although it is often impossible to point out, and
546 ON THE HEALTH OF LONDON.
still less to define precisely, the association of every influence, however
consistent the results may seem with general experience.
ExcEss of BIRTHs ovKR DEATHS. The remarkable excess of Births
over Deaths, which has taken place in London during the last two
quarters, is worthy of notice; particularly as history informs us, that in-
creased fecundity is the ordinary sequence of a pestilence. In the first
three months of the above period, 4819 more persons were born than
died in London ; and during the second quarter, the excess was 5,428,
thus making a total of 10,237 more births than deaths in six months.
And if to that number we add the 4,067 fewer deaths registered during
that period, as compared with the corresponding six months of 1848-49,
the vacuum made by the cholera will be found already fully filled
up; the excess of deaths during July, August, and September 1849, as
compared with the same months of 1848, amounting to 13,606, having
been replaced by 14,304 persons—10,237 more births and 4,067 fewer
deaths. In fact, excluding immigrants from the provinces, who may be set
off against emigrants to the colonies or elsewhere, there are 698 more
human beings now resident in London than after the devastating dis-
ease of last autumn. This fact is highly consolatory, and tends to shew
the compensating power of the laws of nature, at the same time that it
indicates the power and care of our beneficent Creator.
ATMOSPHERIC INFLUENCE. In describing the peculiar weather pre-
valent during the most unhealthy period of last summer, I especially
directed attention to the oppressive and ungenial feeling produced by
the London atmosphere; which was then hazy, and, at times, appeared
like a thick mist, the air being, at the same time, generally very dry.
Scarcely any wind prevailed; and when it did, it was often south-west or
southerly, with diverging currents. But the most remarkable pheno-
menon observed at that season, in reference to the atmosphere, was the
frequent and daily very extensive fluctuations exhibited by the ther-
mometer; the lowest temperature of the month of August, when so
many deaths occurred by cholera, being 42, the highest 82 ; thus making
a difference of 40 degrees. In some nights, there was even so great an
alteration as 30 degrees between the warmth of the night and day time.
These interesting and instructive facts are again mentioned, in order to
illustrate the influence which the weather and peculiar state of the at-
mosphere then exerted upon public health, during the prevalence of
cholera and diarrhoea; and, as many of the atmospheric phenomena have
been of quite a different character, throughout the three months ending
the 30th of March in the present year, when London has otherwise
proved healthy, it becomes more important to notice the principal fea-
tures exhibited recently, as they evidently influenced the improved
sanitary state of the metropolis. During the last three months, when
2,219 fewer deaths have been registered than in the corresponding
quarter of the previous year, the temperature, although low, has neither
been very cold, nor subject to great fluctuations. The range of the
thermometer has proved unusually small, especially throughout the first
half of the quarter, never having exceeded 20 degrees in one day; and
very frequently, the difference between the temperature of the day and
night time was much less, being often only four or five degrees,
BY JOHN WEBSTER, M.D., F.R.S. 547
sometimes from seven to nine, or up to thirteen degrees. Towards the
end of the quarter, but especially during the latter part of March, the
variation of temperature, between the day and night time, became much
greater than previously : the extent being then frequently twenty-two
degrees, occasionally twenty-three; and on one night, the variation
reached twenty-four degrees, which proved the most extensive range of
the thermometer remarked in one day, during the whole quarter.
Throughout the entire three months, the lowest point observed was
22°, on the 8th January, the mean temperature of the week being then
30-3°; whilst the highest elevation registered was 58°, on the 2nd of
February, when the average heat of the week was 41-8 degrees. Again,
during the whole quarter, although cold, the weather was not inclement,
the sky being generally cloudy or overcast. The wind, in the early part
was often south-west or southerly. Electricity was positive; there was
moderate rain and snow occasionally. About the middle of the quarter
much rain fell, and in the sixth week the wind was always south-west, at
first very stormy, the sky overcast, and electricity absent. This was also
the case during the seventh week, the weather being then very rainy and
cloudy, whilst the wind was still south-west. -
The range of the barometer should be likewise noticed, in conjunction
with other phenomena, as its elevation or depression always exerts con-
siderable influence upon public health, even in salubrious seasons.
During last winter, the atmospheric pressure generally ranged high,
especially in the first three months of the current year, although it was .
less elevated in January than subsequently. In the four weeks of this
month, ending the 26th, 4,388 deaths took place in London, the baro-
meter being then always under 30 inches. On the other hand, during
the four weeks ending the 16th of last March, when the range of the
barometer generally varied from 30 1-10 inches to 30 4-10 inches, the
metropolis became particularly healthy, only 3,649 deaths having then
occurred; thus making a diminution of 789, or nearly one-sixth. The
influence which atmospheric pressure exerts upon the health of indivi-
duals, seemed still more apparent when the weather became calm, and
the barometer ranged under 30 inches. This was noticed during the
last two weeks of March, when the mortality again increased, the deaths
being then 2,193, or exactly at the same rate registered in the month
of January. During the fortnight now mentioned, the atmosphere was
generally cloudless, although sometimes it became overcast; the wind was
generally north or east; and in six of the above fourteen days, the
weather continued calm; the electricity seemed slight; very little rain
fell; but in the last week, on three different days, there was some snow
and sleet, afterwards followed by showers. - . . . . . . . . . . . .
These particulars tend to explain the salubrity of the recent season,
especially towards the middle of the quarter, when the atmospheric
phenomena were different from those noticed at the early or latter
parts. During the first-named period, the thermometer exhibited very
moderate variations of temperature between the night and day time.
But the investigation becomes even more instructive, when collateral
circumstances are also considered. Thus, according as the weather got
more dry or calm, and the wind assumed a southerly direction, whilst
the electricity was slight, and the barometer low, the number of deaths
548 ON THE HEALTH OF LONDON.
augmented, and sickness became more prevalent than previously. As
an additional illustration, it may be mentioned, that during the four
weeks ending the 30th of last March, (at which period the weather was
generally cloudless, or more clear than ordinary, also calm, dry, and at
the same time exhibited considerably greater variation between the heat
of the day and night time, than throughout the four weeks immediately
preceding), the total deaths in London amounted to 4,035; whereas,
during the period, also comprising four weeks, terminating on the
2nd of March, the number of fatal cases from all causes did not exceed
3,702, making a diminution of 333 deaths, or 9 per cent. in favour of
the month of February as compared with the subsequent March. During
the former month, the weather was of a different description; whilst,
throughout the night and day time, the thermometer indicated a much
smaller variation of temperature.
The peculiar features of the recent season, and the marked increase
of mortality consentaneous with some of the changes in the atmospheric
phenomena, are important, as they account, in my estimation, very much
for the great alteration noticed in the amount of deaths recorded at the
different periods above quoted. Indeed, according to the views I enter-
tain respecting the influence of such agents, but which I have only
adopted after careful observation during several years, and more espe-
cially of late, I think that we may correctly conclude that, whenever
the variation between the day and night temperature is unusually great,
with cloudless, or even hazy weather, or if a calm, or only slight southerly
winds prevail; and further, should the amount of electricity be small,
and the quantity of moisture so inconsiderable as to make the air particu-
cularly dry, with a low barometric pressure, then sickness will most
probably abound, and more deaths be registered in consequence, than
when the opposite atmospheric phenomena prevail.
The influence of atmospheric phenomena on health and disease is,
doubtless, a very difficult subject to investigate, and one on which it
may seem premature to give a decided opinion in the present state of
our knowledge. Yet, I consider that the conclusions now enunciated
are borne out by the facts brought forward. Further investigation is
desirable; and I feel convinced, that if practitioners will carefully note
the changes in the atmospheric phenomena during various consecutive
seasons, conjointly with any decrease or augmentation of disease, and
with the concurrent rate of mortality, a series of accumulated observa-
tions will thus be made, from which useful practical deductions may be
derived.” - -
* Even in the earliest ages, eminent writers discussed the questions now mooted;
and amongst such authorities, Hippocrates and Aristotle may be cited as having
paid considerable attention to the subject. The latter philosopher, although not a
member of the medical profession, in his Problems, particularly the section headed
Iatrika, examines, besides meteoric phenomena, the effects produced by rains,
droughts, cold, heat, wind, vapours, and many other influences, such as food,
drink, or locality, which may produce or modify disease. In addition, I would
mention the works of Galen, Aretaeus, and others, as containing information on
these subjects. The examples of Hippocrates and Aristotle among the ancients, and
especially that of Sydenham among more modern observers, are worthy of imitation
by every practitioner. If this were done, much valuable knowledge might be obtained,
which could not prove otherwise than highly useful in the study of the origin,
nature, and treatment of epidemics, as well as of many ordinary diseases. . .

BY JOHN WEBSTER, M.D., F.R.S. 549
The influence which particular states of the atmosphere exert upon
the action of remedies employed in the treatment of disease, is also an
important subject for consideration. Mercury produces a much more
powerful and rapid effect upon the human frame, and hence proves more
efficacious in the treatment of diseases, in mild weather, if the air be moist,
the wind south-west, the barometer low, and the temperature equable,
than in dry frosty weather, with a north wind and a rising barometer.
Purgatives, likewise, act more effectually in the former condition of the
atmosphere. Buttonic remedies seem to have their action promoted by
atmospheric influences of a quite contrary nature. If prescribed in dry,
cold, or frosty weather, with a high barometer, and northerly wind, they
become more efficacious than under an opposite condition of the atmos-
phere. Bleeding, again, depends much on the state of the weather for its
beneficial influence in inflammatory complaints; whilst depletion may be
employed to a greater extent at one time than at another. As a gene-
ral rule, it may be affirmed, that patients bear bleeding better in cold dry
weather, with a northerly wind, and high barometric pressure, than
under other circumstances; and in all inflammatory diseases, requiring
venesection, it will prove more beneficial in these conditions, than when
the weather is moist, the wind southerly, the barometric pressure low,
the temperature elevated, and the atmosphere clear. I might extend
these remarks to other classes of remedial agents; but enough has now
been said to shew the influence which the state of the weather and
atmosphere exert in modifying the action of remedies upon the human
constitution.
CLIMATE. The state of the barometer, hygrometer, and thermometer,
‘should be always examined, especially in connexion with any prevailing
epidemic, as well as the direction of winds, the electrical condition of
the atmosphere, and the aspect of the air, whether clear, overcast, or
cloudy. Much important information may be thus obtained, which will
prove of the greatest value both to the philosopher and the practical
physician. Indeed, I would assert, that the utility of such inquiries can
hardly be rated too highly.
The effects of climate in modifying the type, and determining the
mortality of diseases, admits of many illustrations, from the changes
which take place in the same country in different seasons, and from the
special characters which it presents in certain regions of the globe.
The relation, also, which temperature and meteorological conditions of
the atmosphere bear to the suitableness of various medicines and arti-
cles of diet, is an interesting study, teeming with practical lessons in
connection with the great subject of public hygienics. For example, in
the north of Europe, mercury is more safely given in large quantities
than in the south; alcoholic stimulants are less baneful in Russia than
in Italy; whilst animal food is more essential in Lapland than in Spain.
The effects of certain Winds upon health are well known. In Great
Britain, the dread of the East-wind is as universal as it is just : in the
smiling regions of Provence, and the south of France, the Mistral is as
great and as dreaded a foe to health and life: and in Italy, so much
over-lauded for its climate, a continuance of the Sirocco seems to anni-
hilate the energies both of body and mind. .
Madrid, perhaps, furnishes more striking illustrations of the effects
550 s ON THE HEALTH OF LONDON.
of winds and temperature than any other place in the whole world.
There, the Solano, or south-east wind, produces most powerful and sud-
den changes in the health of the Madriléfios; and the icy northern
blasts from the Guadarrama mountains, give rise to acute inflammatory
affections of the lungs, which rapidly cut down thousands of the people.
In the winter of 1829-30, the deaths from pulmonial are stated to have
been about thirty thousand. Dr. Cormack, of Putney, has kindly shown
me his MS. diary, written in the Spanish capital during the winter of
1839-40, in which he notices the hospitals being suddenly crowded with
cases of pneumonia, as a result of the piercing north winds, which were
then, for weeks, continually whistling through the streets and common-
stairs. The same gentleman also informs me, that palsies and apoplexies,
notoriously so common in Madrid, occur with greatest frequency when
the wind blows from the snow-clad Guadarrama mountains. From the
want of trees and other topographical peculiarities, the air of Madrid is
generally dry and Searching, which has given birth to the well-known
Castilian proverb— *
“El aire de Madrid estan sotil,
Que mata à un hombre, y no apaga a un candil.”
This piercing air, while it is most lethal to the acclimated, is still more
deadly to strangers, who are slow to learn that in Madrid, in all seasons,
it is needful to be provided with the ample cloak, as a shield from the
arrows of death. I cannnot help thinking that, in our country, all
classes are strangely reckless in their winter clothing.”
The great alternations of temperature which prevail in Madrid, and
also in large districts of Spain, explain the common custom of the
Spaniards, wrapping themselves in cloaks, even in the middle of sum-
mer,-embozandose en las capas, to use the popular phrase; and this
custom is fully justified by the truthful couplet already quoted.
From various causes, but particularly from those alluded to, Madrid
is the most unhealthy capital in Europe, the population being sustained
by constantly absorbing the inhabitants"of the provinces. The average
mortality is at least one death in every twenty-eight inhabitants; whereas
* The term usually applied to the pulmonary inflammations, which, like an
epidemic pestilence, so often desolate this city, having about 200,000 inhabitants.
* Thus translated:— The air of Madrid is so subtle, that though it will not put
out a candle, yet it will extinguish a man's life.
.* The following interesting passage I have much satisfaction in quoting from
Dr. Cormack's diary, as it bears out the above remarks. “20th January, 1840.
The miserable look and melancholy cry of the Aguadors (without partaking of
their beverage), has made me shiver all day. What can the loungers at the Puerta
del Sol mean in such weather, by drinking tumblers of cold water? The air is
most cutting. It reminds me of the ‘east hadrs’ of Edinburgh; for, like them, it
makes me feel as if being dried and flayed, outside and inside. In the streets of
Madrid, the people wisely avoid breathing, except through the folds of a handker-
chief or veil, or both. The chest, too, is well protected, particularly by the men,
whose ample cloaks are doubled across their breasts and brought up over the throat
to the mouth. The women, Iobserve, have generally the head ill-covered; but they
never expose the throat and chest, like the ladies of England, so scornful of health
in their devotion to an unseemly fashion. The scanty covering of the heads of the
Madriléſias is certainly surprising. In ordinary weather, they go out with merely
a fold of the slight veil (mantilla) embracing their hair. A few, but I am told an
increasing number, have the mantilla so constructed, as to afford a warm cover or
hood to the head. At night, and in very cold weather, it is common to tie a hand-
kerchief round the head, under the mantilla.” - . . . . . ;

BY JOHN WEBSTER, M.D., F.R.S. . 551
in London, it is only one in every forty-two persons, or, in other words,
actually less by one-third. The difference between the temperature of
the day and night, and even between different sides of the same street,
are causes of mortality, which well illustrate some points in our own
vital statistics, and which are applicable to the explanation of many
sudden variations in the rate of mortality and prevalence of disease.
In Madrid, the Manzanares is often covered with ice at night, which
disappears during the day; and in summer, when the Solano blows,
the city is a furnace, the thermometer being often above 90° F., where-
as in winter, it frequently falls below 32° F. During the forenoon of
the same day, there sometimes prevails so much as twenty degrees of
difference in temperature between the two sides of one street!
Speaking generally, in º: to the salubrity of different climates,
very erroneous notions are frequently entertained on the subject, parti-
cularly by non-medical observers. Opinions are too often formed from
the sensations made upon the individual's own physical frame, not
from well-founded and enlarged experience. An agreeable climate is
not always the most Salubrious, although the animal feelings are cer-
tainly often thereby more gratified than in countries where the atmos-
pheric impressions seem of a different description; whilst good health
and longevity are more frequent in the latter than in the former. Take
the south of France or even Italy, so much esteemed as salutary retreats
for invalids. Having visited both these regions, and made inquiry among
the inhabitants, into their greatly over-lauded climates, I soon satisfied
myself that the views commonly entertained, were founded on exag-
gerated reports. The conclusion I came to was adopted after much per-
sonal communication with the medical practitioners of many parts of
Italy, and after attendance in various Italian hospitals and visits to the
cemeteries, where foreigners, but English chiefly, were laid in their
lonely graves. It is indeed sad to think how many of our countrymen,
who cross the Alps in search of health, in place of it find only a tomb in
the reputed Elysium of Italy. The climate, especially of the southern
districts, is no doubt delightful; and visitors, if in health, enjoy its balmy
breezes, splendid sky, and exhilarating atmosphere ; at the same time
that surrounding nature seems, in many places, like an earthly paradise.
Nevertheless, diseases are here quite as serious as elsewhere, are generally
more rapid in their course, and often equally uncontrollable by treatment;
whilst the average limit of human life is, by no means, prolonged to the
same term of years, which we so frequently meet with in the more
northern and bleaker countries of Europe. Animal life seems far more
rapid in the Italian peninsula, and the physical frame becomes quicker
developed; but it decays sooner than in England, where longevity is much
oftener observed amongst the inhabitants than in the former country.
TYPE of DISEASE. The common type, or diathesis, of most diseases
during the last six months, has proved, as has been commonly observed.
for several years, asthenic ; and accompanied in many cases with great
debility and exhaustion. So much has this been marked, that the pa-
tients have often required support and tonic treatment, although the
symptoms have appeared to partake of such an inflammatory charac-
ter, as to warrant antiphlogistic measures. This feature, though mani-
552 DR. WEBSTER ON THE HEALTH OF LONDON.
fested in a very large proportion of the cases met with during the recent
season, has been less observed than in the period immediately prece-
ding, when almost every form of malady assumed, if not in its early
stage, at least soon afterwards, a decided asthenic character. This re-
sult was especially noticed when influenza proved so prevalent and fatal,
more than two years ago. Again, a similar peculiarity was perceived in
the malignant epidemic of Scarlatina, which occurred in the winter of
1848-49. Lastly, the same feature was exhibited, but in a still more
remarkable degree, in the cholera, diarrhoea, and dysentery, which pre-
vailed during the months of July, August, and September of last year,
and carried off 15,512 persons. Thus was produced a much larger com-
parative amount of mortality than had ever been previously recorded in
London, since the great plague, upwards of 184 years ago; at which
time, as in last autumn, infinitely more deaths were reported, than,
it is fervently hoped, will be ever again witnessed in this mighty metro-
polis of England, now teeming with its 2,300,000 inhabitants, the
emporium of intellect, the centre of civilization, and forming the largest
mart for commerce which exists, or ever has existed, in the universe.
24, Brook Street, Grosvenor Square,
April 1850.
553
BIBLIOGRAPHICAL RECORD.
-*mmy sº
A LETTER CONCERNING THE PRESENT STATE of PHYSICK AND THE REGULA-
TION OF THE PRACTICE OF IT IN THIS KINGDoM. Written to a Doctor
here in London. London: 1665.
A SHORT VIEW OF THE FRAUDs AND ABUSEs CoMMITTED BY APOTHEGARIES,
As WELL IN RELATION TO PATIENTS As PHYSICIANs, AND of THE ONLY
REMEDY THEREOF BY PHYSIGIANs MAKING THEIR own MEDICINEs. By
CHRISTOPHER MERRETT, Dr. in Physick, Fellow of the Colledg of Physi-
cians, and of the Royal Society. London: 1669.
A DIscourSE SETTING ForTH THE UNHAPPY ConDITION of THE PRACTICE of
PHYSICK IN LONDON, AND OFFERING some MEANS TO PUT IT INTo A
BETTER : For THE INTEREST of PATIENTs, No LESS, or RATHER MUCH
MoRE, THAN of PHYSIGIANs. By JonATHAN GODDARD, Dr. of Physick,
Fellow of the College of Physicians, and of the Royal Society, and Pro-
fessor of Physick in Gresham College. London: 1670.
PRAXIS MEDICoEUM ANTIQUA ET Now A : THE ANCIENT AND MODERN PRACTICE
oF PHYSIC ExAMINED, STATED, AND CoMPARED. THE PREPARATION AND
CUSTODY of MEDICINES, As IT was THE PRIMITIVE CUSTOM witH THE
PRINCES AND GREAT PATRONs of PHYSICK, ASSEBTED, AND PROVED To
BE THE PROPER CHARGE AND GRAND DUTY of EveRY PHYSIGIAN suc-
CESSIVELY. By E. MAYNWARING, Doctor in Physick. London: 1671.
THE PRESENT ILL STATE of THE PRACTICE of PHYSICK IN THIS NATION
TRULY REPRESENTED. By A MEMBEB of THE CollBGE OF PHYSICIANs.
London : 1702.
At a very recent period,' we took occasion, in reviewing the Hunterian
Oration by Mr. Skey, and the Regulations of the Society of Apothecaries for
1850, to draw the attention of our readers to the state of the medical pro-
fession in the present day, and to state, in pretty strong terms, that the
science and practice of medicine had advanced most materially of late years,
and that the utility of our profession to the public was daily increasing.
In the present article, we propose to consider the same subject in another
light, by comparing the state of medical practice as it now exists, with that
which prevailed at the end of the seventeenth century. We shall also take
occasion to touch upon some matters which were, from want of space, only
casually considered in our former review.
We may preface our remarks by observing, that the epoch in which the
publications, whose titles are prefixed, were written, was, according to Mr.
Skey, the golden age of medicine: “When,” says that eminent authority,
“the physician monopolized the entire rank and name of the practitioner in
medicine; when the surgeon was a mere operative, identified with a menial
trade; and the apothecary was a drug-vender, having, like the surgeon, no
claims to medical knowledge, quoad the treatment of disease”, and when,
indeed, according to Dryden, “he was wholly blind.’”
At the close of the seventeenth century, the physician was, indeed, the
only lawful attendant upon the sick, and was the only person practising the
medical profession who received a liberal education : the Surgeons were
incorporated with the Barbers; and the Apothecaries, who had lately been
dissociated from the Grocers by an Act of James I, were formed into a separate
corporate body. It may be remarked, by way of illustration of the social
position of the surgeons, or chirurgeons of that period, that their duties con-
sisted, in addition to their tonsorial functions, in “letting of blood, applying
leeches, plasters, cupping-glasses, syringing, and salivation,” etc. (Pamphlet
* LoNDON Journal of MEDICINE, May 1850, p. 479.
554 HIBLIOGRAPHICAL RECORI).

by Dr. Merrett, page 40); in fact, in performing the “ordinary exigencies” of
medical practice, for which the members of the Royal College of Surgeons
of England of the present day, were declared to be alone competent, in a
manifesto published by the College in 1845. We do not, of course, allude to
the Fellows of that College, who, from the extent of their classical, mathe-
matical, and philosophical acquirements (which, however, are yet to be tested),
in addition to their purely anatomical, pathological, physiological, and surgi–
cal attainments, are the only surgeons of the present day.
In the year 1850, the aspect of affairs has, in many respects, been remark-
ably altered. The Physician still retains, as he undoubtedly ought to do, the
respect and esteem of society, founded—not upon the prestige of this or that
university, or upon the favour of this or that côterie—but upon a high
moral character, and a solid knowledge obtained in the wards of hospitals, in
the laboratory, and in the dissecting-room. With regard to the Surgeon of
the present day, we find some difficulty in defining his true status; for the
greater part of the practice, both of Fellows and Members of the Royal Col-
lege of Surgeons, is not surgical, but purely medical ; and though, perhaps,
the Fellows represent the concentrated essence of the surgery of the nineteenth
century, a large number of the Members occupy pretty much the same posi-
tion as they did at the end of the seventeenth, except that they are not now
associated with the barbers. The apothecary, while he unluckily retains the
name, has wholly changed his character, and instead of being the uneducated
retailer of drugs, has become the legitimate and recognised medical attend-
ant upon all ranks of society, but especially upon the middle classes and the
poor. But the elevation of the apothecary to the rank of a professional
man, has excited the jealousy, and kindled the opposition of a class with
which he was himself once inseparably associated, namely, the druggists, or,
as they usually, but improperly, style themselves, the chemists.
There is a parallel between the relative positions of the apothecary and
the druggist of 1850, and of the physician and the apothecary of 1770. The
complaints made in the present day by the apothecaries against the drug-
gists, are the exact counterparts of those made by the physicians against the
apothecaries in the seventeenth century; with this important difference, how-
ever, that the apothecary of the present day is far better acquainted with the
practice of medicine than the physician was two centuries ago. Dr. Merrett,
one of the learned authorities whose work now lies before us, thus exposes
the frauds and abuses of apothecaries in the year 1669:—“They use,” says
the doctor, “medicines quite contrary to the prescription ; mushrooms rubbed
over with chalk for agaric, privet and dog-berries for spina cervina, sheeps'
lungs for fox lungs, the bone of an ox's heart (?) for that of a stag’s heart,
damsons for Damasc prunes, syrup of lemons for that of citrons, bryony roots
for Mechoacan, (?) etc.” The indignant language in which these frauds are
denounced, proves the value attached to the therapeutical virtues of such
choice articles of the materia medica in that day. sº
It appears, however, upon indisputable evidence, that the state of the
medical profession at the period to which we are now referring, was extremely
unsatisfactory, as indeed may be gathered from perusing some of the titles
of the works enumerated at the head of this article, and which, it will be per-
ceived, are couched in the language of complaint. The physician did, indeed,
“monopolize the entire rank and name of the practitioners of medicine,”
and those who could not pay him his fees, were handed over to the tender
mercies of the barber-surgeon or the “wholly blind” apothecary. From the
very necessity of the case, therefore, the two latter were compelled to under-
take the management of many of the sick,--with what success need not be
recorded. Hence, arose a warm contest between the physicians and the
apothecaries, the former accusing the latter of usurping their province, and
the latter continuing the usurpation, until the dispute was finally set at rest
by the decision of the House of Lords, in 1703, in the case of William Rose,





BIBLIOGRAPHICAL RECORD. 555
'an apothecary, in which case it was decided, that the duty of the apothecary
consisted not only in compounding and dispensing; but also in directing and
ordering the remedies employed in the treatment of disease.] -
Such is a brief sketch of the relative positions of the different branches of
the medical profession at two somewhat distant periods of its history; and
the contrast is introduced to shew that, mutato nomine, there was, two hun-
dred years ago, the same conflict between knowledge and ignorance, between
collegiate rights and popular necessity, between presumed privilege on the
one hand, and the presumed want of it on the other, as exists in our own day.
The subject might be illustrated in an interesting manner at much greater
length, but the limits assigned to this review oblige us to pass on to other topics.
We therefore proceed to consider, in more detail than we were able to do
in our last number, the abstract principle of APPRENTICESHIP, and the system
of what is called GENERAL PRACTICE. In doing so, we shall derive no small
advantage in our inquiries, from the perusal of the quaint publications now
before us, written, be it remembered, during what was, in Mr. Skey's opinion,
the Augustan Age of the Medical Profession in England. .
We would heartily rejoice, were a better system of apprenticeship than the
present devised ; yet we must confess, that it has numerous advantages, and
that many of the objections raised against it, are founded upon exaggeration,
misconception, or absolute misstatement through ignorance. For ourselves,
we have no strong feeling in the matter. It appears, that a clause requiring
an apprenticeship found its way into the Apothecaries’ Act of 1815; and it
is therefore necessary to ask, whether the operation of this clause, as inter-
preted by the competent authorities, and acted upon, is as mischievous as
Mr. Skey and others have maintained. " .
In examining some of the objections seriatim, we would first remark that
it is possible that an exception may be taken to the name; but the name,
after all, is a very harmless one. It is derived, as the Dictionaries tell us,
from the French word apprendre, to learn, and it signifies a person who is
engaged in learning. That it does not necessarily involve the learning of a
trade, it requires little argument to prove; for the articled pupils of the sur-
geons of the London hospitals were (and are, for anything we know to the
contrary), called the apprentices of the hospital, and barristers were formerly
designated apprentices of the law. º - - .
In our former article we proved, by reference to facts which are known to
* The apothecaries, by this decision of the House of Lords, were restored to what
appears to have been their ancient and legal rights; for Henry VIII, after the
grant of the Charter to the College of Physicians, appointed John de Soda to be
apothecary to the Princess Mary, who was delicate and unhealthy, at a salary of
40 marks a year, “pro meliore curá et consideratione sanitatis sua.”; and John de
Soda continued apothecary to Mary when she became Queen. The cursory per-
usal of certain works, published in the fifteenth and sixteenth centuries, might lead
to a very imperfect motion of the duties of the apothecary. In illustration of this,
we select the following quotation from C. Bullein's work, entitled “Bulwarke of Dé.
face against all Sicknes, Sornes, and Woundes, that dooe daily assaulte Mankinde.”
(London: 4to, 1562.) . . . . . . . . . . .
“That he neither increase nor diminishe the phisicias bille; and kepe it for his
.* owne discharge. , . . . . . . .
“That he neither buie nor sell rotten drugges. -
“That he peruse often his wares, that thei corrupt not.
“That he put not in quid pro quo without advysement.
“That he maie open well a veine, for to helpe the pleurisy. -
“That he medle omely in his vocacion. - . .
“That he delite to rede Nicolaus Myrepsi, Valerius Cordus, Johannes Placaton
ye Lubik, etc. . - -
“That he doe remember his office is omely to be the phisicids coke.
“That he use the true measure and waight.” Apoticaries rules, by **
WOI, II.
556 BIBLIOGRAPHICAL RECORD.
the whole profession, that such statements as the lot of the apprentice being
“that of an ordinary servant”, that he passed “four or more long years of
personal servitude”, that he was “the purchaser of his own degradation”, etc.,
were mere figures of speech. In fact, the five years of the so-called appren-
ticeship include, or at least may include, the whole of the student's career as
a pupil ; the law evidently contemplates such an arrangement: and those
who administer the law appear to have facilitated it by every means in their
power. But it is possible, that the opposition is made to the surveillance
necessarily exercised over the young student of medicine, by one who is
older, and, consequently, more experienced than himself. If such be the ob-
jection, it surely is an unreasonable one; for, in every employment of life, the
junior members must obtain their knowledge from their seniors, and submit
to their control. In the army and navy, this is universally known to be the
case; in the law again, the future attorney is articled for five years to one of
his own grade in the profession; in the church, the student must not only
conform for a series of years to collegiate discipline, but must afterwards
serve for a definite period as deacon (from the Greek word Suákovoc, a servant)
before he can be admitted as a priest. It is not therefore very strange,
that the future practitioner of medicine should serve a pupilage with an older
person, who practises the same branch of the profession which he himself
intends to adopt. We leave out of the question the education of physicians ;
we do not consider an apprenticeship quite so necessary for them, although
we believe that it would tend to fit them more speedily for practice.
A thorough college education, followed by a prolonged course of medical
study, is necessary for those who aspire to the higher walks of the profession;
but such a prolonged and expensive course of study is quite incompatible
with the pecuniary means of the mass of students, who enter the profession
as a means of soon gaining their livelihood, and who dare not, like metropolitan
physicians, spend one fortune in the hope of making a larger, at the end of
a weary period of probation. For such honest and humble men, domestic
pupilage seems the best resource ; but for all practitioners it offers a good
school for training.
We conceive, therefore, that we have satisfactorily proved, that the system
of apprenticeship, when dispassionately considered, is not very objectionable;
and that a very few immaterial alterations would entirely remove every
ground of complaint. If the term apprenticeship be distasteful, it might
be altered to pupilage ; but that some such training, either in a private
house with a practitioner, or in a well-arranged medical collegiate establish-
ment, should be made compulsory upon every student destined for family
practice, is, in our opinion, absolutely essential to the well-being of the pro-
fession, and to the safety of the public. If it be argued, that under such a
*ēgime, many turn out idle and unprofitable pupils, it may be replied, that it
is impossible, under any system, to alter the condition of human nature, and
to make all teachers conscientious, and all young men studious ; but it is far
more probable, that a beneficial effect will be produced under the wholesome
restraint of domestic or collegiate discipline, than by liberating the young
student from all control, and allowing him to pursue his studies or his amuse-
ments in the manner most pleasing to himself. But the latter alternative
seems so absurd, that we shall not waste any further words upon the subject,
and will conclude our remarks upon apprenticeship by quoting the following
passage from the pamphlet first on our list, which was published in 1665
—one hundred and eighty-five years ago. “Nor let any man think to dis-
grace this method as mechanical, by the imputation of taking apprentices,
since the word apprentice is entertained by the honourable profession of the
law, whose younger students have been called apprentices to the law; but,
however this be, it were very fond, for so poor an occasion, to neglect a thing
that is founded upon the evidence of true reason itself. Nor indeed should
they be received in the capacity of servants, or under that name, but rather


BIBLIOGRAPH1CAL RECORD. 557
of young students, friends, or virtuous companions to be instructed in this
worthy profession; the drudgery of all things resting wholly upon some
ordinary servant, kept by every one for the uses of his family; and I make
no doubt but there are very many ingenious young men in England, who
would be very glad, and take it for a great honour, to be thus received by
some of the grandees and great practitioners; and their friends believe what-
ever is bestowed on them in this way very well and honourably employed.”
These views—advanced in relation to the education of physicians in the
seventeenth century—we consider perfectly applicable to that of all classes
of medical practitioners of the present day.
In defending general practice, we do not wish to exalt it above the other
branches of the profession. We desire, however, to call attention to social
changes now in progress, by which many, educated for the highest depart-
ments of practice, find it essential to their interests to act as general prac-
titioners among the wealthy classes, as has long been the case in Edinburgh.
It is notorious, that the examinations for the Medical Degree of the Univer-
sity of London are more difficult and searching than that of any other board
in the kingdom ; yet many gentlemen pass through that ordeal, as the most
important qualification for success in general practice among the upper
classes of society. We think that the whole profession might be received
within the portals of the two colleges, namely, that of the physicians and
that of the surgeons ; and that the rank and sphere of practice of each
member of the medical community might be left to his individual tastes
and talents. The sanction, or call, of the profession, should be the chief
qualification for the rank of a consultant. Superior skill, when associated
with honourable conduct, commands success more certainly than artificial
class-distinctions; and, in this enlightened age, the public and the profession
respect collegiate status, only when associated with individual worth. Does
Sir Benjamin Brodie owe his pre-eminent position to his sterling character,
and matchless skill, or to his collegiate honours ? Is it the recently con-
ferred fellowship which has given to Marshall Hall an undying name? Or,
did the withholding of the fellowship diminish by one iota the glorious
renown of a William Hunter, or an Edward Jenner } The colleges,
in their jealousy of the claims set forth by the unincorporated prac-
titioners, have little sympathy from the public ; who, while they recog-
nize a distinction of grades, and the importance of the study of specialities,
are slow to perceive, why these differences should require to be maintained
by coercion, and jealously defined by artificial rules.
It is highly advantageous that consulting physicians and surgeons should
exist, who, from the superiority of their intellect and the extent or spe-
ciality of their studies, may be called in, to advise and assist their profes-
sional brethren ; BUT IT IS ALSo FAR MoRE NECESSARY, that the vast mass of
the medical community be so educated, as to be enabled, in situations where
no assistance can be obtained, (as at sea, in the colonies, and in the pro-
vincial towns and villages of England), to minister, and to minister effi-
ciently, to all the diseases incident to humanity. On the respectability, the
education, the talents, and the judgment of this class, (in London called
general practitioners,”) depends, in a very great degree, the health of the com-

* In Edinburgh, many general practitioners do not practise midwifery, and of
late the majority have relinquished pharmacy (and therewith many patients) to the
druggists. With the exception of Mr. Syme, the Hospital Surgeons are family
attendants.
* The term General Practitioner is hardly understood in the provinces. In a
recent official conference with Sir George Grey, Mr. Noble made the following
explanation at the request of his colleagues, the medical and surgical practitioners
residing in various parts of the kingdom :—“He would make a few remarks on the
use of the term general practitioner—a term which had given rise to much unne-
cessary complication. It was an error to suppose that such a tripartite division of
558 BIBLIOGRAPHICAL RECORD.
munity. The wealthy indeed, and the inhabitants of the large cities, may
command the services of men exclusively eminent in surgery, in medicine, or
in midwifery; but the middle classes, for pecuniary reasons, and the majority
of the humble classes by compulsion, must avail themselves of the services
of the general practitioner. It is, therefore, essential that every scheme of
medical legislation should provide for the efficient education, and suitable
examination, of this very large and important branch of the medical profes-
sion ; unless, indeed, we assent to the proposition, that the welfare of the
masses of the population is of no importance in the eyes of the legislature,
º º the advantages of medical science are to be conferred only upon
the rich. -
We speak advisedly when we state, that the attainments of the majority
of the general practitioners are far below the standard which ought to exist in
the present day, amidst the innumerable opportunities of advancement
afforded by the general diffusion of science, by the talents of the medical
professors, and by the abundant stock of information contained in our great
hospitals: and it is to us abundantly plaim, that any attempt to degrade
this large body of professional men, must inflict the deepest injury upon
medical science, without in any degree benefiting the public.
Admitting, therefore, that the consulting physician and the consulting
surgeon are necessary components of the medical community, we insist upon
the co-equal importance of the general practitioner, nor can we tolerate the
idea, that the latter is in any way degraded. But on high authority we have
been told, that a mark of degradation is affixed to this or that medical
practitioner, not because his education is inferior, not because his moral cha-
racter is suspicious, not because his intellect is more feeble, not because his
physical efforts are less strenuous, but (and we blush to write it in the sun-
shine of intelligence which illuminates the nineteenth century) because he dis-
penses his own medicines / Why, Podalirius and Machaon dispensed their own
medicines; and our great father Hippocrates distinctly recommends physicians
to have all kinds of medicines always ready in their own keeping, which
plan, he says, will make a physician more confident in his practice, and more
ready to apply himself to the sick. “A physician,” says he in his book
rept voxmuoguvic, “ought to have his shop or Imrpstow provided with plenty of
all necessary things, as lint, rollers, splints; let there be likewise in readiness
at all times, another small cabinet of such things as may serve for occasions
of going far from home; let him have also all sorts of plasters, potions, and
purging medicines so contrived, that they may keep some considerable time ;
and likewise, such as may be had and used while they are fresh.” Galen,




the professson existed out of London as in it. The only terms that were so much
as understood were, physician, and surgeon. Nobody in the country used, nobody
knew, the term general practitioner. The physician was understood to be he who
restricted his practice to internal maladies, with a view to consultation practice,
and the surgeon was regarded as making no such restriction. The practice of
pharmacy was very much a matter of accidental circumstances. The surgeon who
would exclude it in a large community would, from the necessity of the case,
include it...if practising in a locality differently circumstanced. General prac-
titioners (if the term be understood of those who practise without either a degree
in medieinē or a surgical diploma) do not form a twentieth part of the body of the
profession. Great mistakes have arisen from confounding the apothecary licensed
to practise medicine, with the surgeon in general practice, some employing the term
general practitioner in relation to the former, and others to the latter.” Sir George
Grey and the Lord Advocate seemed to be struck with Mr. Noble's explanation,
and requested, as early as possible, to be furnished with the promised memorial.
The deputation then withdrew. Lancet, May 1850, p. 576.
* We give part of the passage from Hippocrates in the original Greek. IIpokarao-
révágów Śē got kai HaMayuárºv yewéa trgöc rāg écſiorov, xpſigiac, Toriipuara
réuveuv Švvápºva # dvaygagic tokevacušva trpèc rã Yêvéa irposrouágéa, 38


BIBLIOGRAPHICAL RECORL). 559


also, not only recommended physicians to dispense their own medicines, but
he himself kept a repository, or Atroëhkm (whence is derived the name of
apothecary), where he informs us, his medicines were always under his own
eye or in his hand. And without quoting the examples of Hermes Tris-
megistus, Diocles, Scribonius Largus, Andromachus, Oribasius, and a multi-
tude of others, who pursued the same mode of practice, we may at once
come down to our day, and state that Cullen, William Hunter, and Aber-
crombie, all dispensed medicines to their patients. We shall now pro-
ceed to quote some passages from the pamphlets cited at the head of this
article, which are nearly all written by Graduates in Medicine and Fellows of
the College of Physicians of London, and which all advocate the propriety
and necessity of the physicians dispensing their own medicines. Let us first
hear Dr. Jonathan Goddard, Fellow of the College of Physicians, and Pro-
fessor of Physick in Gresham College. -
“The dividing and separating of that part of the Art of Physick, which
concerns the Preparation and Composition of Medicaments, from the body of
it, so as to put the practice of it into other hands, was never heard of in the
ages of Hippocrates, Galen, and other ancient physicians; and hath been
judged by some of the chief authors in physick, to be of unhappy consequence to
7t, upon several accounts.” (p. 8.) . Again the same author writes at page 30;
“And it will not be hard for a physician, making use only of a servant or
servants, to oversee and with his own hands prepare and compound what is
necessary for himself to do; and by this means, though he be in full practice,
at the expense of a few spare hours, to store himself sufficiently for all his
occasions, of such great remedies and secrets of importance . . . Nor can it
be any dishonour to a physician thus to employ himself between whiles, in
the making of such choice and important medicines; as it is upon record, that
Hippocrates and his sons, Galen, and other ancient physicians, did the like.”
“Besides the securing of the Practice of Physick to Physicians, and the
preventing its falling into other hands, which is a more necessary advantage,
there is another of happy consequence and more honourable, which, by this
course of physicians making their own medicines, may be attained: that
is, a great improvement in the art itself, before hinted. For when judicious
physicians come to be more familiarly acquainted with the materials of
medicaments, and also to experiment and observe operations and processes
upon them, especially the more accurate and artificial, as in chymical pre-
parations, they will discover the most advantageous ways of preparation,
and the most rational proportions in order to composition; and come to
contrive and invent new medicaments, exceeding others in their kinds, and
improve, beyond what they can imagine of themselves before they have
entered this way, and what they can never otherwise attain, as some learned
and ingenious physicians have done.” (p. 34.) -
The next quotations are from a very learned and elaborate pamphlet by
Dr. Maynwaring, who thus, at page 4, adduces the authority of the ancients,
in favour of the physicians preparing and dispensing their own medicines:
“Famous Quercitan, upon this question, An medicum deceat pappuakotrousiv
affirms that the ancients were very industrious and diligent in the prepara-
tion of their medicines, which they kept in readiness by them, to serve their
practice: ‘Hippocrates ipse eorum faciem conspuisset, qui praeparandorum
suorum remediorum scientiam illi detraxissent, quorum veteres vigiles fuerunt
custodes.’ This, also, is affirmed by Sennertus, a judicious, moderate, and
faithful writer, who, handling this question, An medico. liceat componere
medicamenta ? holds the affirmative, both from the antiquity of the custom,
as also the utility and advantage to patient and physician: ‘Neque etiam
praeter dignitatem medici esse componere medicamenta, antiqui illi viri pru-


kai rā ºrpóc pappudkinv $g rāg ka94powag #ixnupéva & tró rôtrov rejv caffnkórov
ãorsvaguévar its év 33 rpárov trgèg ré yévía kai rā psyś0ea ic traXatógiv
peptéMèrmušva. • * . . . - . . . . ."
56ſ) BIDLIOGRAPHICAL itiºCORD.
dentissimi, medicique peritissimi satis docuerunt. . . . . Ipsi domi swa medi-
camenta composuerunt, neque sibi dedecori, Sed laudi esse dwarerunt, si rei
humano generi utilissimae operam impenderent, neque plus rationis manuum
suarum, quam animi haberent ; imú ignaviorum potitis esse videtur, omnia
ministris committere, quorum vel awaritiã vel improbitate factum est saepiùs,
ut medicamenta præstantissima, quae 8stºv xéipac antiqui appellant, vel
indoctis empyricis communicarentur, vel corrupta et vitiata authoritatem
suam amitterent, nec vires, ob quasab antiquis praedicabantur, haberent.’”
Dr. Maynwaring then proceeds to prove, that the preparation of medicines
was the general custom among the ancient physicians, and that it was con-
tinued, in all ages, by their successors, among whom he cites Paracelsus,
Libavius, Basil Walentine, Hartman, Wan Helmont, Glauber, etc. : and he
enforces the adoption of this plan upon his contemporaries, upon the follow-
ing grounds: I. The improvement and advance of the art itself; II. The
security and utility to the sick; III. The advantages and satisfaction to the
professors. He then argues very strongly, that the pharmaceutic art is the
foundation, upon which the whole success of medical science mainly and
chiefly depends, and that the origin and invention of physic, sprang at first
from an empirical knowledge of medicines. He then lays down the three
following positions: “I. That pharmacy, or the dextrous preparation of
medicines, is the most excellent and necessary part of physic; and the main
stress of curing lies chiefly in the compleat medicinal apparatus. II. That
true skill in pharmacy, and a certain knowledge of medicines, is not gained
by reading, but by manual preparations and tryals; personally observing
through the whole process of the medicine, and noting all the circumstances
appertaining to it. III. That the preparation of medicines is the proper and
special business of every physician, without which experience and certain
knowledge in medicines, he cannot be compleat in his profession, but very in-
sufficient ºn the §. and most weighty part of the medical science.” (p. 8.)
The same author, at page 17, argues that “the true knowledge of medi-
cines, and improvement in pharmacy, depend upon practice in preparation,
and that, therefore, this knowledge and improvement ought to spring from
the physician, and be reposited in him; else he cannot be able to direct, cor-
rect, and improve medicines; that, without such knowledge, he is very unfit
to undertake the management of the sick; very unskilful to adapt, order, and
appoint medicines; very unable to perform a cure : that his title and abilities
are very incongruous, and more properly he deserves the character of an
empirick, in the worst sense, than Doctor Medicinae; because he is medicamen-
torum imperitus.” He then, again, quotes Quercitan, to the following effect:
“‘Quâm turpe est medico, sibi doctoris titulum arrogare, et materiam, quâ,
uti debet, modumque illius parandae ac administrandae ignorare, patique se
à ministris suis superari ? an ignoras experientiam rerum esse magistram 7
.#. pharmacopoeius eam callens magister erit, tu veró bruta statua cathedra,
affigeris.’”
He next quotes the authority of Doctor Thompson, whom he styles “a
learned physician and expert operator in medicines,” and who says, “‘ that
physicians ought to make their own medicines; for thereby they shall pre-
pare them with a satisfactory elegance and exactness, improve them to the
greater advantage, understand their vertues more clearly, administer them
with more discretion, and acquire a far greater confidence of their success ;
then may he be styled 6sparsvrucog tarpoc, an officious physician indeed ;
otherwise, he can deserve no other title than of a mere trifler in his function,
acting &ksösoróg, carelessly, perfunctorily, and cruelly.’” (p. 20.)
Dr. Maynwaring thinks (page 43) that the doctor “is not required to toil
in the drudgery of the servile works that belong to medicines, but that he
should supervise and take care there be no neglect, mistake, or abuse; he
may have workmen to do the work, but, in the interim, he must be work-
master, to design the medicine, to appoint, correct, and overlook the whole.



BIBLIOGRAPHICAL RECORD. 561
business; he is pyoğuşkrmc and 3pxtrékrov : and where the curiosity, mystery,
and intrigue of the art lies, that is to be done by his own hand, that is his
closet business.” -
To sum up a great quantity of matter in a few words, it seems to be evi-
dent, from the contents of the pamphlets now lying before us, that the whole
of the medical learning of England in the seventeenth century, was confined
to the members of the College of Physicians of London, who, no doubt, were
able, learned, and accomplished men, but, in point of medical acquirements,
far below the general practitioners of the present day; that, owing to the
expensive collegiate education of the physicians, and to their rank and style
of living, they practised almost entirely among the rich and powerful; that,
from the very necessity of the case, the poor, and many of the middle classes,
were obliged to have recourse to the apothecary (who, in that day, was little
better than a tradesman), or to quacks and mountebanks, for the treatment of
their diseases; and that the physicians endeavoured to remedy this state of
things, by recommending their brethren of the London College to take the
preparation and dispensing of medicines into their own hands; and it can-
not be denied that reason, justice, and expediency, were on their side of the
argument. - -
It is impossible, in this place, to avoid remarking, that the ignorance of
the apothecary and the mountebank (who, however, were the accepted medical
attendants upon the poor and many of the middle classes) was a standing
subject of reproach till the beginning of the present century, but that the
Act of 1815 entirely altered the condition of the profession; and we cannot
acquit of deliberate misrepresentation, those who endeavour, by the mere
use of a name, to confound the Apothecary of the nineteenth century
with the Apothecary of the seventeenth. Those who do so, know perfectly
well, that the educated apothecary of our own day, is the counterpart of the
physician in the time of Charles II, and that the apothecary of that day is
the counterpart of the druggist of the present; and know, moreover, that
the educated physician in 1850, owes his just elevation to the honourable
position which he holds in science and in society, to the vis à tergo communi-
cated by the education of that numerous and meritorious class, which some
authorities affect, with equal want of reason and justice, to treat with
contempt. -
We shall conclude these extracts with the following curious medical ad-
vertisement from a newspaper called the Postman, of January 16, 1700. (The
italics are our own). - - -
“At the ANGEL AND CRow N, in Basing Lane, near Bowlane, lives J. PECKEY,
a Graduate in the University of Oaford, and of many #. standing in the
College of Physicians, London: where all sick people that come to him may
have for 6d. a faithful account of their diseases, and plain directions for diet
and other things they can prepare themselves: and such as have occasion for
medicines may have them of him at reasonable rates, without paying #.
for advice: and he will visit any sick person in London, or the Liberties
thereof, in the day-time for 2s. 6d., and anywhere else within the Bills of
Mortality for 5s.” w
Notwithstanding the above quotations, we by no means advocate the neces-
sity of physicians dispensing their own drugs in the present day, Our only
object has been to shew, both from the authority of antiquity and from the
dictates of common sense, that there is nothing which is derogatory or de-
grading in such a practice; and admitting, as we do, the propriety and
advantage of the division of labour, we are disposed to respect a class of
men who do not dispense their own medicines, but, at the same time, we can-
not join in depreciating those who do. It is also our fixed opinion, founded
upon no small amount of experience and observation, that every member of
the medical profession, from the court-physician to the union-surgeon, and
whether he be physician, surgeon, obstetrician, general practitioner, or spe-




562 . BIBLIOGRAPHICAL RECORD.
cialist, should be instructed in practical pharmacy, in the early part of his career.
We care not whether this be accomplished by an apprenticeship, by service
at the hospitals, or by attendance upon a union: we are convinced that it
ought to be done, and that those who depreciate the knowledge of pharmacy,
are inculcating principles which are as absurd in theory, as they are dangerous
in practice ; absurd in theory, because pharmacy, although not the only
foundation of therapeutics, is a very necessary and a very important one; and
dangerous in practice, because ignorance of practical manipulation may lead
prescribers into serious errors. We repeat the opinion expressed in our last
number, that every student should be compelled to wield, for some time, the
instruments so contemptuously denounced by Mr. Skey: that he should be able
to compound medicines, to make tinctures and infusions and decoctions, and
to roll up pills; and if he be too proud to submit to these occupations for a
short period of his career, he ought not to enter into the medical profession
at all. We do not advocate, and we never have advocated, the justice or
the expediency of anybody devoting five years to such avocations; but con-
sidering as we do, that medicine and surgery are practical sciences, that
many of the duties performed by the practitioner are necessarily repugnant
to human nature, and only to be reconciled to him by his ardent desire to
benefit his fellow-creatures, we are convinced, that the most able and the most
successful professor of the healing art will be the man who has not hesitated,
but who has cheerfully consented, to perform all the manipulations of his art ;
who has himself sought, in the structure of earths, minerals, and plants, the
powers which are antagonistic to disease, and who has himself separated or
united their component parts in seeking for new or effective forms or combina-
tions: and we maintain, that such practical knowledge is an admirable and
essential preparation for his researches into the anatomical structure and
physiological laws of that marvellous economy, whose derangements are to
become the study of his after life.
We therefore conceive, that it is quite ridiculous to endeavour to fix a
brand of inferiority upon those members of the profession who dispense their
own medicines. The plan is, we believe, often one of great convenience to
all parties, both practitioners and patients, and is, in some cases, the result of
imperative necessity. It is, when judiciously carried out, a great boon to
those who cannot afford to pay separate accounts to the doctor and the drug-
gist, and who prefer to give their fees to the man of skill. Drugs, judici-
ously administered, are the instruments used by the practitioner in the cure
or alleviation of disease; and it is of no consequence, as regards the success
of the treatment, who dispenses them, so that their composition be superin-
tended by persons possessed of competent pharmaceutical knowledge. -
But while we have thus argued (and we hope effectually) against the absurd
and ungenerous attempts which have been made to lower one branch of the
profession, in order arbitrarily to exalt another, we are not disposed to defend
the abominable abuses to which the system of sending out medicines, and of
charging for those medicines, has too frequently given rise. We are no friends
to that miserable system of medical remuneration, which is founded upon the
plan of sending enormous quantities of medicines, which, if composed of
inert materials, can do no good, and if of active ingredients, may do much
harm. There is nothing whatever in the present constitution of the medical
profession, which necessitates the sale of drugs, for the purposes of professional
yemuneration ; and, if the whole of the members of the medical community
were to abandon the system of charging for drugs, there is no law whatever to
prevent them from doing so. We believe that such a desirable consummation
is not very far distant, as the system of charging for attendance, with or with-
out drugs, is becoming daily more and more general. -
Believing, as we do most sincerely, that medical science has advanced, and
is advancing by rapid strides; feeling, as we do, that the medical profes-
sion is inferior to no other, we are anxious that all its professors—whether




BIBLIOGRAPHICAI, RECORD. 563
-they minister in peace, or amid battles, in the palaces of kings, or in the cabins
of the poor—should be deeply impressed with the dignity, the sacredness,
and awful responsibility of their high calling. Were we each, as individuals,
to correctly realise our position, the profession as a whole would at once be
elevated in utility and public estimation, far above that point to which the
most disinterested and enlightened legislation could raise it. “The sphere of
other men's labours is bounded by time. The great paintings, and sculptures,
and temples of this world ; its fleets and its arsenals, its handiworks of all
kinds, will be left behind on the shore of this dead earth, and be found not
in the world to come. But to our calling belongs this strange peculiarity,
that the objects of our art are as immortal as ourselves. They will gobefore
us, or accompany us, or follow us, and be all forthcoming at the great day.
We shall meet our patients again, and have to answer to God in their hearing
for all that we did to them, whilst we were together upon earth.”.1

The education of the medical profession solicits our careful attention,
in relation to the topics considered in this and a previous article ; but the
limits assigned to us having now been almost reached, we must leave it
for future discussion.
In the meantime, we would conclude with three short paragraphs, which,
though they may appear mere truisms or platitudes to many, are neverthe-
less so generally lost sight of, that it cannot be useless to give them promi-
nence in this place. . . -
1. Medicine, Surgery, and Midwifery are not distinct sciences, but inse-
parably and essentially one : for the convenience of the public, and
the interests of individuals, they may be honourably practised either
collectively by the same, or separately by different persons. The scientific
physician, the scientific surgeon, and the scientific obstetrician, as
well as the scientific professor of medicine, surgery, and midwifery—
if equally competent in their respective spheres, and equal in moral
qualities—are of equal importance in their profession, and of equal
value to society.
2. The physician, surgeon, obstetrician, or general practitioner, who sup-
plies his patients with the necessary medicines, does not ipso facto
offend against professional propriety: and those only who sell drugs,
who levy fees with reference to the quantity of physic sent in, deserve
the opprobrium of being half tradesmen, and half professional men.
3. The highest rank in the medical profession ought to be conceded to
those who (being of blameless life, and strict honour) are pre-eminent
for their learning and their skill. To such men only ought medical
teaching to be entrusted; on such men only ought collegiate fellow-
ships and state honours to be conferred. . . . . . . . . . . . . . . * *
DESCRIPTION or AN IMPROVED TRUss, construcTED BY STAFE-SURGEON
G. R. DARTNELL, and now in general use in the Army. London: 1850.
The inventor does not pretend to claim for this instrument any originality,
except as a combination. It consists of a light and elastic spring of the semi-
circular kind, the fulcrum being placed behind, near the top of the sacrum,
and the resistance in front. It has a graduated downward curve at its an-
terior extremity, which brings the pressure of the rupture pad directly upon
the upper hermial opening and the inguinal canal. The spring has a casing
-*— - —x-
* WILSON, George M.D. on the Sacredness of Medicine. In Lectures on
* . . . . . . Medical Missions, p. 206. Edinburgh : 1849. . . . .
564 BIBLIOGRAPHICAL RECORD;
of padded leather, continuous with which is a strap of the same materials
which, passing round the opposite hip, and buttoning to the pad in front, is
intended to steady the fulcrum, and keep the instrument in its place.
The anterior or rupture pad is formed (like Dr. Chase's American truss)
of hard wood polished, and has a flattened oval shape.
The back pad is flat, formed of strong leather, padded on the inner face,
and furnished with two bridles on the outer one for connection with the
spring. This pad rests in the hollow of the back, or a little below it; but if
the patient be not emaciated, and the spring required be not a strong one, the
back pad is liable to slip off altogether. -
The advantages of this truss may be stated as follows:— -
1. It is lighter than any other instrument of the kind with which the in-
ventor is acquainted; the average weight of the single truss being about
four ounces.
2. From its lightness, small size, and close fitting to the person, when pro-
perly adapted and applied, it is worn by the patient almost without his being
aware that he has such an instrument on him ; and it is imperceptible under
any dress—a matter of some importance with military officers who wear the
shell jacket.
3. It is simple in its construction, and therefore of comparatively low
price, and easily altered or repaired by any ordinary mechanic. “A simple
instrument,” says Lawrence, “when well made, answers every end which can
be accomplished by more complicated ones, and is therefore preferable, for
reasons that must be obvious.”
4. The rupture pad being of hard wood (box is the best) or of ivory, is
imperishable, as it does not absorb the perspiration, and will not chafe or ex-
coriate the skin; if preferred, however, this pad may be covered with a cap
of chamois leather or flannel, renewable at pleasure.
5. A material advantage derivable from the wooden pad, is the facility with
which it can be modelled, or altered, or a new one made, by any handy person,
to the size or form required for any special case. When the pressure, for in-
stance, is to be made on any one particular spot, the pad may be more
rounded; if the pressure is to be general, it should be flatter; when the
hernia is old, and the protrusion takes place near the pubes, the pad should
have something of a triangular shape ; or if the hernia be what is called
“direct”, the pad may be modelled with a rounded prominence or nipple on
any required part of its face, in imitation of M. Malgaigne's mushroom pad.
This nipple being applied exactly to the spot where the protrusion takes
place, fills up the aperture like an operculum, and effectually prevents any
protrusion of the bowel.
6. By the small size of the anterior or rupture pad, as compared with
those of most other trusses, and the place it occupies when properly applied,
the spermatic cord is effectually preserved from injury ; and the pressure
being made on the inguinal canal, and the upper hernial opening, instead of
the lower, there is no pressure on the pubes, nor is there any danger of
strangulation or injury of the gut within the inguinal canal.
7. By a trifling modification of the anterior curve of the spring, and a
slight alteration in the shape of the wooden pad, the truss is equally appli-
cable to a femoral, as to an inguinal hernia; and has been worn by many
female patients with the greatest efficiency and comfort. -
The following Report is selected from a large number of recommendatory
notices : . - - .
“Fort Pitt, Chatham, 11th July, 1846. Proceedings of a Board of Medical
Officers, held by order of the Director-General of the Army Medical Depart- .
ment, to report upon a Truss for Inguinal Hernia invented by Staff-Surgeon
Dartnell, as to its claims as compared with the trusses hitherto in use.
The Board have seen satisfactory trials of the truss, made in this and the
Detachment Hospitals, and are satisfied that it is the most efficient instrument




BIBLIOGRAPHICAL RECORD. 565

of the kind they have seen; and in their opinion is peculiarly adapted for
general use in the Army. The truss is strong and durable, and so simple in
its construction that it may without difficulty be made or repaired by an
armourer-sergeant ; and is, in the opinion of the Board, calculated to give
the most perfect security, as well as greater comfort than others, to the
wearer. (Signed) J. FRENCH, M.D., Principal Medical Officer, President.
WM. FoED, Staff-Surgeon, 1st class. SAMUEL PIPER., M.D., Surgeon, Provi-
sional Battalion.”
ON THE NATURE AND TREATMENT of DISEASES OF THE KIDNEY, CONNECTED
witH ALBUMINoUs URINE (MoRBUS BRIGHTII). By. G. Owen REEs,
M.D., F.R.S., London: 1850.
The present treatise by DR. REES, is one of the best of the many works
which have been published upon that numerous class of diseases, compre-
hended under the name of Bright's Disease. The author is, for many reasons,
admirably suited to the elucidation of this important branch of pathology;
for he is an excellent chemist and physiologist, an acute observer, and an ac-
curate and logical thinker. His position at one of our largest metropolitan
hospitals, has given him great advantages which he has not failed to improve;
and all his writings, while they are far from being deficient in sound theory,
bearin addition the marks of practical experience. The book now before us is
but small in compass, but it is rich in information, and every page will amply
repay perusal.
In treating of the MoRBID ANATOMY of the kidney in albuminuria, the
author, after alluding to the different conditions of the organ described in
this disease, by Bright, Rayer, Christison, and Rokitansky, proceeds to ex-
amine with great acumen the views advanced in very recent times by Dr.
Johnson and Mr. Busk; the former considering that the Morbus Brightii is
“primarily and essentially an exaggeration of the fatty matter, which exists
naturally in small quantities in the epithelial cells of the healthy organ”:
and the latter, that adhesive inflammation of the tubuli uriniferi and venous
plexus of the kidney is “by far the most frequent cause of chronic albumi-
nuria, and what is termed granular degeneration of the kidney.” Dr. Rees,
however, combats the first view upon chemical grounds; and, taking advantage
of the power possessed by ether of abstracting fatty and oily matters from
the surrounding textures, shows from his own experiments, that an oily or
fatty appearance by no means indicates the presence of fatty matter; and in
one very striking example, in which he examined chemically a kidney pos-
sessing a greasy appearance, he found less fat than in a kidney which was
known to be perfectly healthy. -
Dr. Rees considers, that it is now pretty certainly established that the
greater number of cases of Kidney Disease, connected with albuminous urine,
are the results of inflammation, probably of an adhesive character, affecting
the organ and causing deposit in its substance, thus constituting a state
which may or may not be followed by contraction. He admits that con-
gestion may in some cases precede or even accompany this cachectic deposit,
but does not consider it probable that congestion is a necessary antecedent to
all chronic forms of the disease.
The presence of ALBUMEN in the urine is almost always an indication of
some disordered condition of the kidney, although there are a few instances
where the urine is found albuminous without the presence of renal disease,
as for instance, during the last hours of life, in serious obstructions to the
passage of the blood through the heart or great vessels, and in haematuria.
But Dr. Rees does not believe that dyspepsia, a full meal of animal food, or
the free administration of mercury (all which causes have been described as
giving rise to albuminous urine) can really produce the alleged change in
the constitution of the renal secretion. In illustration of the statement that

566 BIBLIOGRAPHICAL RECORD.
mercury does not give rise to albuminuria, Dr. Rees gives the result of fifteen
cases of persons under the influence of mercury, in not one of whom was
albumen found in the urine ; and he has moreover observed cases, in which
the urine contained albumen, but became freed from that substance under
the use of mercury.
The tests for albumen are carefully described, but they do not differ from
those which are now well known to the profession. -
In treating of the PATHoLogy of the Disease, Dr. Rees very properly
throws out the suggestion, that its intimate nature is probably to be sought
more in some depraved or altered condition of the blood itself, than in lesion
of any organ, but at the same time admits that the chemistry of the present
day is not sufficiently accurate or refined to enable us to determine the aber-
ration from the healthy constitution of the vital fluid ; and he concludes,
that “so far as our present knowledge extends, it is in the tissue of the
kidney that we first trace the deviation from healthy action for the produc-
tion of albuminuria.”
In considering the state of the Blood in this disease, its most obvious and
important change is of course described as consisting in the loss of its
albumen; and the deficiency of the red corpuscles, which marks the advanced
stages of the malady, is accounted for by the following very ingenious theory.
The fundamental propositions of this theory are: “I. In health the corpuscle
is supplied with nourishment by the chyle. II. The chyle is of lower specific
gravity than the liquor sanguinis in which the corpuscles float. III. In the
early stages of the Morbus Brightii, the specific gravity of the liquor san-
guinis is greatly diminished.” The author then proceeds to argue, that in
Albuminuria, the chyle is of greater density than the liquor sanguinis, and
therefore than the contents of the corpuscles, the consequence of which is,
that as by the laws of endosmosis and exosmosis the heavier fluid passes in
more slowly than the lighter fluid passes out, the chyle is unable to pene-
trate the corpuscles, which are thus deprived of their nutrient matter and
consequently of their haematosine, and hence the pale and watery condition
of the blood. -
In treating of the state of the Urine, the average quantity excreted, the
specific gravity, and the physical appearances are all carefully described, as
also the peculiar structures discernible by the aid of the microscope, such as
blood-corpuscles, epithelium scales, mucus-corpuscles, and the casts of the
smaller uriniferous tubes. Dr. Rees considers the presence of oil-globules in
albuminous urine to be rather a concomitant of the disease, than necessarily
connected with it. -
The DIAGNoSIs of this disease is attended with considerable difficulty,
especially in the early stages, for the symptoms are often so inconsiderable
as to escape the notice of the practitioner and even that of the patient; nor
have any certain means been hitherto discovered, to enable us to distinguish
the different morbid conditions of the kidney, which, however distinct in
their anatomical characters, agree in producing an albuminous state of the
urine. . . We ought however carefully to discriminate, if possible, the acute
from the chronic form of the malady: because the former, by timely mea-
sures, may frequently he cured ; while the latter too often baffles the skill of
the most accomplished practitioner, and sooner or later terminates the life
of the patient. The chronic form is characterised by a far less degree of
severity in the symptoms, as compared with the acute; and indeed so obscure
is this form, that it has often been overlooked altogether, and even the
anasarca, which by some is considered a pathognomonic sign, is sometimes
wholly absent. The following advice is thereforevery appropriate; “When-
ever cases of debility, with tendency to nausea, present themselves to your
notice, it is well to inquire into the state of the urine ; and, in such cases, if
you also find that the patient complains of frequent desire to pass urine
during the night (even though there be no pain in the loins, or anasarca any-


BIBLIOGRAPHICAL RECORD. 567
where), you will often find albumen in the urine, and all the symptoms of
kidney disease may manifest themselves within no great length of time.”
A point of great practical importance, also, is to be careful not to confound
the pallor of albuminuria with the anaemic condition observed in young girls
at or soon after puberty; and the only mode of drawing the distinction, is by
the chemical examination of the urine. . . . . .
The CoMPLICATIONs of Albuminuria are treated at some length. The existence
of anasarca and of passive effusion into the cavities and tissues of the body
are prominently noticed, as among the most usual concomitants of the dis-
ease. Diarrhoea, which was stated by Dr. Christison to be more frequently
observed in Edinburgh than in London or Paris, is now, according to Dr.
Rees, a very common attendant upon the disease, as he has observed very
many cases of it in his own experience. The Affections of the Brain, of the Heart,
of the Liver, the supervention of Bronchitis, Pleuritis, Peritonitis, Pneumonia,
and Phthisis, are all briefly adverted to ; but we are not aware that the views
adduced upon this part of the subject contain any matter for special remark.
The CAUSEs of the disease are very briefly alluded to, as the author con-
siders that they have not yet been very satisfactorily ascertained. Among
the principal predisposing causes, however, he enumerates the scrofulous
habit, and intemperance; and among the chief exciting causes, exposure to
a cold or damp atmosphere, or the presence of any condition tending to in-
terfere with the proper discharge of the function of the skin. The author
regards the Albuminuria which follows scarlatina in rather a serious light,
because he is of opinion that although it is often cured, yet it sometimes
insidiously leads to severe or even fatal disease ; and that, in cases which
have been apparently cured, the kidney affection has nevertheless returned,
and has eventually destroyed the patient. .
The TREATMENT must depend upon the greater or less severity of the
symptoms, upon the constitution and previous habits of the patient, and
upon the acute or chronic form assumed by the disease. As a general rule,
we should avoid blood-letting in every form, in all cases where the patient is
anaemiated, even though inflammatory complications of the acutest character
may be present. The treatment of the acute and early forms of the disease
by Dr. Rees, does not differ materially from that recommended by other
authors ; but it is judicious and sensible, and consists in moderate cupping
to the loins, Saline purgatives, diaphoretics, the vapour-bath, and antimonials.
The best form of purgative is the compound jalap powder of the Guy's Phar-
macopoeia, consisting of powdered jalap, cream of tartar, and a small propor-
tion of capsicum ; and the best antimonial is the vinum antimonii potassio-
tartratis, in doses varying from twenty minims to half a drachm, combined
with the liquor ammoniae acetatis. The compound powder of ipecacuan may
also be used with great advantage, as it will often assist in allaying irrita-
bility, and quieting the action of the heart. The use of diuretics is by no
means to be recommended; and mercury, in all its forms, is to be carefully
avoided in the treatment of Albuminuria. With a view to supplying red
corpuscles to the blood, the use of iron is strongly recommended, more
especially when we at the same time relieve the blood of its superabundant
water, which may be effected by means of elaterium. The best form of iron,
according to Dr. Rees, is the mistura ferri composita of the London Phar-
macopoeia ; and, when the stomach will not bear this, recourse may be had to
the vinum ferri, in doses of from one to three drachms, or to the ammonio-
citrate or ammonio-tartrate of iron. “The great indications to be answered
in chronic cases, are : I. The relieving the blood of its superfluous water ;
and II. Supplying it with iron to assist in the production of the red
corpuscles of the blood.” Astringent remedies have, occasionally, been em-
ployed with beneficial effect, being administered with the view of stopping
the discharge of albumen, and so protecting the blood from farther degener-
ation. The best astringents are tannin, catechu, and gallic acid. -
568 B1.BLIOGRAPHICAL RECORD.
The treatment of the complications of this disease, must depend upon the
nature of the organ or tissue specially attacked, and must be directed by
general principles, regard being always paid to the condition of the blood,
the urine, and the kidneys, which are always primarily involved.
Considering the great prevalence of Kidney Disease, accompanied by the
secretion of albuminous urine; the insidious nature of its attack, and its fre-
quently fatal termination ; the numerous complications which mark its pro-
gress, or accelerate its march ; the modification of treatment required by
ordinary diseases, when associated with this formidable malady; and the
importance of detecting its existence, if possible, in its earliest stages, we
hail with pleasure the appearance of the present contribution, by Dr. Rees,
to our knowledge of, the nature and treatment of these important affections,
and we consider that every medical man ought to give the volume a place in
his library. **.

ANORMAL, NUTRITION IN THE HUMAN ARTICULAR CARTILAGES: with Experi-
mental Researches on the Lower Animals. By P. REDFERN, M.D. London,
Lecturer on Anatomy, Physiology, and Histology, and Examiner at the
University and King's College, Aberdeen. 8vo, Mumerous Wood-cuts.
pp. 86. Edinburgh: 1850. -
This is an elaborate and able monograph, which originally appeared in
detached papers in the Edinburgh Monthly Journal.
THE ConcLUSIONs at which the author has arrived are thus stated :-
“1. That the whole of the known forms of disease in articular cartilages
are connected with changes in the texture, which are essentially simi-
lar to each other. -
“2. That during the progress of these changes, the cells of the cartilage
become enlarged, rounded, and filled with corpuscles in lieu of healthy
cells, bursting subsequently, and discharging their contents into the
texture on the surface ; whilst the hyaline substance splits into bands
and fibres, the changed hyaline substance and the discharged cor-
puscles of the cells afterwards forming, in many cases, a fibro-nucleated
membrane on the surface of the diseased cartilage.
“3. That these changes are alone referrable to an anormal nutrition as
their immediate cause, and in no case to mechanical or chemical actions,
such as attrition or digestion in a diseased secretion.
“4. That most extensive disease may be going on in many joints at the
same time, and may proceed to destroy the whole thickness of the
cartilage in particular parts, without the patient's knowledge, and
whilst he is engaged in an active occupation. $.
“5. That the disease commences most frequently upon the free surface;
but it may proceed from the bone to affect the attached surface, or it
may take place in the middle of the thickness of the cartilage.
“6. That it is at least very doubtful, if the symptoms which are believed
to indicate the existence of ulceration of articular cartilages, are not
really dependent on a morbid change in the bone.
“7. That disease of the whole thickness of an articular cartilage, at par-
ticular parts, admits of a natural cure, by the formation of a fibro-
nucleated membrane from the substance of the cartilage, without the
occurrence of any new exudation.” pp. 65.

PRINCIPLEs of HEALTH AND DISEASE : an Inaugural Dissertation of the Uni-
versity of Edinburgh. By DAVID NELson, M.D., Edinburgh, Physician
to the Queen’s Hospital, and Professor of Clinical Medicine in Queen's
College, Birmingham. 8vo. pp. 113. London: 1850.
This Thesis reflects great credit upon the author. It is correctly written,
and contains, in a well-arranged form, and within a small compass, much
sound information and excellent reasoning.
569
CRITICAL DIGEST OF THE BRITISH AND FOREIGN MEDICALs
JOURNAIaş.
PRACTICE OF MEDICINE AND PATHOLOGY.
gºssºmsºmº
TWO CASES OF ECLAMPSIA NUTANS.
THE following cases of Eclampsia. Nutans, recorded by DR. FABER of War-
tenberg, in the Journal fir Kinderkrankheiten for March and April 1850,
will be interesting, in connexion with the paper read by DR. WILLsh.IRE, at
the Westminster Medical Society, on 30th March, and reported at p. 590 of
this number. - jºr
Very little mention has hitherto been made of this remarkable affection,
which evidently bears a relation both to convulsions and to paralysis. Of
the German writers, only Romberg, I believe, has noticed it. I do not know
whether it is identical with, or only akin to, the paralysis agitans, which has
been noticed for some time in England, I believe by Elliotson. I will merely
relate the two cases which have occurred to me, without offering any
remarks.
CASE I. This was a girl, aged three years, the daughter of a reduced trades-
man, who managed some small agencies, but was of weak mind, and in whose
family several cases of mental disease had occurred. This was his only sur-
viving child. An elder child, a boy, had died of convulsions at an early age;
but of what form these were, I was unable to ascertain. The subject of this
case was at first healthy, but was rather late in her first dentition, and was
also weak on the legs. She always looked pale, but was apparently healthy.
About three months before I saw her, she began to complain frequently of
headache, slept much, and had less appetite than usual ; the tongue was also
somewhat coated. Mild aperients were prescribed, but with little good effect.
The child suddenly began to squint a little with one eye, and sometimes to
nod with the head, especially towards the left side, as if the left sterno-mastoid
muscle drew the head by starts in that direction. These bowings of the head
at first occurred three times daily, and lasted some minutes each time, during
which the head remained bowed. The attacks increased in number and fre-
quency; sometimes the head fell into a series of truly alarming tremulous
convulsive motions (Zittern und Schwirren), in which the bowing forward
was pre-eminently conspicuous. The child was treated, but without success,
by purgatives, baths, cold affusions, antispasmodics, embrocations, etc. It
became drowsy, and was attacked, soon after awaking, with slight convul-
sions in the arms and legs; and on careful observation it was found, that
these convulsions were on each occasion preceded by a brief loss of conscious-
ness, lasting perhaps one or two minutes. These attacks increased, and the
child is now quite epileptic. It has each week one, or perhaps two, slight
epileptic attacks, instead of which there is sometimes a violent convulsive
bowing of the head, without, as it appears, any loss of consciousness. It has
an imbecile appearance, and its mental faculties are less developed than is
usual in children of the same age.

CASE II. This was a boy, six years old, the son of a respectable citizen of
this place, who enjoys excellent health, and in whose family there have
not been any particular nervous or mental affections. The mother is a
healthy woman. During her pregnancy, she appears to have been much
alarmed by a fire which broke out in the neighbourhood of her habitation ;
this Imerely mention, without laying much stress on it. She was only able
to suckle her child for a few weeks. Having lost her milk through a violent
diarrhoea, which was subdued by a somewhat rigorous diet and antiphlogistic
treatment, she was obliged to employ a nurse. The nurse appears to have been
570 CRITICAL DIGEST OF THE JOURNALS.
very quarrelsome and passionate, and subject to nervous attacks. Neverthe-
less, the child throve excellently; it cut its teeth easily and quickly, and
learned to walk early. When the boy was four and a half years old, he had
measles, from which he recovered favourably. At the commencement of his
sixth year, he was sent to school, and gave evidence of excellent mental
capacity, I was first consulted about him when he was nearly six years old.
I was told, that while playing with some other boys near a large pit filled
with water, he had slipped in walking over a narrow wooden bridge, and had
fallen into the pit, from which he was removed with difficulty. Being quite
wet, he was carried home; and, having been dried, was put to bed, where he
passed several days in a continual drowsy state, without having any true
febrile symptoms. Whether from the fright or the chill, he was not from this
time so cheerful and lively as before. He cried out frequently in his sleep,
and had disturbed rest :"his bowels were costive. One day, being scolded
rather severely by his father for some slight offence, he suddenly began to
nod with his head, and continued to do so for two or three minutes, the face
being at the same time somewhat distorted. At first this was thought to be
a trick, or evidence of stubbornness ; but the bowings recurred several times
in the day; since which they had increased, and were often so violent, that
even eighty bowings could be counted in a minute. The child henceforth
wasted, and had a peculiarly decayed appearance. On seeing the child, I
found all this description confirmed. The patient, generally quiet and some-
what melancholy when moving about, suddenly began to nod with the head.
The head bent forward as in familiar salutation, at first at intervals, but soon
more and more quickly, as if the child were violently excited ; the face was
also distorted. This attack lasted about two or three minutes; then the
movements ceased, and the child appeared much fatigued. On many days,
there was only one attack, generally at 11 A.M.; and there was sometimes
an additional paroxysm in the evening. As far as I could ascertain, the
child retained his consciousness during the attacks: they were not sudden,
but he felt their approach, and sought something to lean or sit on. He had,
for some weeks lately, become evidently weaker ; he seemed pale and suffer-
ing, and had a certain expression of stupidity in his countenance.
As to the nature of the bowing: is it a partial chorea º Does the almost
regularly recurring bowing of the head belong to the category of choreic
convulsions, or is it a convulsion sui generis? It cannot be classified with
epileptic convulsions, for a principal symptom—the loss of consciousness—is
wanting, at least in the latter of the two cases. Does the disease proceed
from the brain, and only re-act on the spinal chord, or is the latter its ori-
ginal seat The most careful examination of the subject of the second case
has failed to afford any explanation. The child never has pain; there is no
tenderness either in the head or spine, and besides this there is nothing
abnormal. The bowels are indeed sluggish, but the child has been suffi-
ciently purged. There is no trace of worms. Friction of the nape of the
neck with tartar-emetic ointment, as well as dry rubbing, have proved inef-
fectual; the internal use of quinine and antispasmodics has produced no
improvement ; cold affusions and gentle douches in a warm bath seemed to
aggravate the malady. At present the child is taking iron, and seems to
x:
improve.
GRANULAR coRPUSCLES IN THE optic CHIASMA IN AMAUROSIs.
At page 387 of last number for April, we gave an account of the dis-
covery of Granular Corpuscles in the Nervous Centres in cases of Hemi-
plegia, by DR. TuFROK. The Zeitschrift der K. K. Gesellschaft der Aerzie
zu Wien, for November and December1849, has since reached us, in which
Dr. Türck describes similar bodies as having been found by him in the Optic
Commissure in cases of Amaurosis. The following is an abridged translation
of Dr. Türck's communication, –4

CRITICAL DIGEST OF THE JOURNALS. 57 L
I have lately carefully examined the optic apparatus in three amaurotic
patients in my practice, and have found in all one and the same morbid con-
dition of the commissure of the optic nerves. The individuals were from
eighteen to 24 years old, and of feeble constitution. One of the patients, (a
journeyman baker), attributed the disease to the influx of the dazzling light
of a glowing oven, to which he was exposed more frequently and constantly
than usual, for a fortnight before being attacked. The Amaurosis was more
or less perfect, in one case amounting to entire inability to perceive light; in
all the cases, it had commenced with cloudiness of vision for one or two weeks,
and in one, had suddenly become worse during the night. In all, there was
remarkable irregularity of the power of vision. The pupil was greatly dilated
in the most intense case, and in two, it was angular in one eye: it often alter-
nately contracted and dilated when light was stéadily held before the eye,
but was unaffected by the change from light to shade. The motor power of
the iris was not lost ; yet, from paralysis of the optic nerves, the impression
was not conveyed from the retina to the central organ of the motor nerves of
the iris. During transient improvement of vision, the pupil was obedient to
the stimulus of light. The movements of the eyeball and eyelids were
normally performed. The baker had complained of pain in his eyes, at the
time when he was exposed to the extraordinary influx of light. Pain in the
head, and vomiting, were observed in all the cases. The connexion of these
symptoms with the disease of the commissure, could not be traced in two of
the cases, in which there was also chronic disease of the brain; but it was
very evident in the third patient, who died at a later period, from inflamma-
tion of the spinal chord. - - -
The optic commissure, externally, appeared normal, with the exception of
slight enlargement, and a few conspicuous fawn-coloured spots on the cut
surfaces of the divergent optic nerves. On being cut into, it was found
infiltrated with a sero-saline fluid ; its substance was remarkably spongy, and
presented fawn-coloured spots. The nervous matter was partly undistin-
guishable, partly recognisable, under the microscope, and presented, as well as
the fluid matter, a large number of granular corpuscles and elementary
granules, like those which are found in cerebral or spinal inflammation :
hence evidently arising from a recent process of inflammation, or at least
of exudation, in the optic commissure. The morbid changes extended
three or four lines along the origin of the optic nerves : the remaining part
of the nerves, the retina, and the remaining parts of the eye, were healthy;
so also were the corpora striata, the optic thalami, the corpora quadrigemina,
and the tuber cinereum, as well as the whole base of the brain. The Amaw-
'rosis therefore depended on a perfectly limited inflammation or exudation in
the commissure of the optic nerves. - .
The affection was complicated, in one case, with acute inflammation of the
spinal chord, of a later date ; in a second, with chronic hydrocephalus of long
standing, and recent apoplexy ; and in a third, with old cerebral cancer and
consecutive hydrocephalus. The external and opposed surfaces of the con-
volutions in the two latter cases, presented signs of pressure. This would
formerly have been taken as explanatory of the Amaurosis, especially in the
second case, where the left optic thalamus, and the left pair of the corpora
quadrigemina, had been pressed forwards and to the right side by an apoplectic
clot in the left posterior lobe. But the explanation can only be found in the
state of the commissure which has been described. In both patients, as was
shewn both by symptoms during life, and by post-mortem examination, com-
pression had existed for a considerable time, without producing Amaurosis.
In other cases, also, pressure on the brain has not induced Amaurosis.
In connexion with the above remarks, I may mention, that I found a simi-
lar condition in a man, of whom I could only learn that he had been blind
in one eye for several years. The left anterior part of the commissure, as
well as a portion six limes in length from the commencement of the left
WOL. II.
572. CRITICAL DIGEST OF THE JOURNALS.
optic nerve (especially the latter), were atrophied, of a reddish grey colour,
and contained numerous granular corpuscles and elementary granules. With
the exception of slight atrophy of the remaining part of the left optic nerve
in its pºse to the eye, the other portions of the visual apparatus were
In OTIſlal, .
Although the number of observations has been few, yet, as the same ap-
pearance was found in all the cases, it is reasonable to expect, that the disease
of the chiasma, just described, will be in future frequently found, and will
effect a change in the doctrine of the cause of Amaurosis.
[More extended observations by unprejudiced observers, are required, before
this point can be considered established. In the case of the baker, retinitis
was probably induced. The fawn-coloured, or buff deposit, as a result of
inflammation of the retina and optic apparatus, has long since been observed,
especially by Langenbeck and Wardrop ; but interesting as the above cases
are, they are wanting in the details of symptoms which are necessary to
enable us to form a judgment upon the precise influence of the changes de-
scribed, and the relation held by them as to cause and effect.]
& tºmsºmºs
TREVALENCE OF MEASLES, WITHOUT ERUPTION, IN PARIs, DURING THE
FIRST QUARTER OF 1850.
The Gazette Médicale for 20th April, in the quarterly Report of the Sani-
tary Condition of Paris, has some interesting remarks, of which the following
is a somewhat abridged translation :-
A large number of cases of eruptive fevers have lately appeared in Paris,
principally since the commencement of March. Pulmonary catarrh and
pleuro-pneumonia have also been remarkably common, especially among
children; and, which is an important fact, though often not sufficiently
attended to, there have been cases which have seemed to form the meeting-
point of the eruption and thoracic affection.
The children have for several days presented all the premonitory symptoms
of an acute attack of measles, or scarlatina; viz., coryza, Sneezing, redness of
the conjunctiva, lacrymation, angina, dry cough, and sweats towards the
second or third day. In a certain number, the eruption appeared, and fol-
lowed its usual course. In others, however, the disease appeared to be deter-
mined to the air-passages: some presented unequivocal spots of measles on
the neck and chest, which very soon disappeared, while the lungs became
engorged—a manifest proof of the identity of the disease affecting such dif-
ferent situations, Moreover, the bronchial and pulmonary affections resem-
bled the external eruption, in being diffused and erratic. Bronchitis would
be denoted by the existence of Sonorous rhonchi all over the chest ; these
would be followed by crepitant rhonchi, which would sometimes spread rapidly,
and sometimes almost suddenly leave one side, to appear, perhaps definitively,
in the other. The pleura has been sometimes affected, but perhaps less com-
monly than usual. - - -
In some cases, the local chest symptoms have disappeared, with extraordi-
nary rapidity, under the action of a large blister;-a fact which supports the
view of the eruptive nature of the affection. Sibilant and sonorous rhonchi
have sometimes entirely disappeared, and sometimes have been heard on the
opposite side of the chest. In most cases, whether the pulmonary affection
were localised at once, or erratic, the usual remedies have proved of little
service. General bleeding has been very useless; aided by blisters, it has
brought about partial amendment, quickly followed by relapse. The Rasorian
method of treatment, usually so efficacious, has given moderately satisfactory
results. The most successful treatment has been by repeated emetic doses
of ipecacuanha and tartarized antimony, with a moderate amount of opium.
The effect of these remedies has been to free the air passages from the abun-
CRITICAL DIGEST OF THE JOURNALS. 573
dant mucous secretions which obstructed them, and to promote perspiration—
an important object in the treatment of a disease, apparently the substitute for
a cutaneous eruption. Dover's powder has well fulfilled both the indications.
It hence appears, that Paris has lately furnished a large number of exam-
ples of a disease, which is not recognised by all pathologists—measles without
eruption. It was described by Dehaen, Gregory, Guersant, and Blache; but
º: i. disbelieved by many. The cases lately observed can leave no room
or doubt. -

SURGERY.
CONTRIBUTIONS TO THE DETERMINATION OF THE SEAT OF CATARACTS
BEHIND THE LENS. BY M. KERST.
In a man, aged 32, who was considered to be affected with Cataract, there
was an extensive, more or less transitory, white spot behind the pupil—it
might be said, on the anterior surface of the vitreous body. The flame of a
candle produced an erect image in the eye; M. KERST thought he could even
perceive the second inverted image of the flame in the opaque spot ; but
neither this nor the third image were apparent. On the other hand, the
opacity became more apparent, and changed its situation as often as the light
was shifted, always appearing directly opposite to the body of the flame, so
that it could be perceived at all points of the posterior chamber, according
as the situation of the light was changed. This could only arise from the
opacity occupying the whole surface which could be perceived through the
pupil, and becoming apparent from one point to another. The patient was
examined by several practitioners. On dilatation of the pupil, he was found
to have a so-called amaurotic cat's-eye (Katzenauge). -
In a sound eye, when light is held at some distance from it, the rays con-
verge, and form an inverted image of the flame on the retina; but if they
are interrupted before they reach the retina (as in opacity of the vitreous
body) they form a circle, which illuminates a part of the opacity in the situa-
tion directly opposite the flame. In the present case, the opacity must have
been behind the lens, in the vitreous body; for if it were more anterior, some-
where in the lens itself, the circle of unconverged rays would occupy the whole
extent of the pupil, and then a partial illumination, and the concomitant
apparent charge of position, would be impossible. The smaller the illumin-
ated circle is, the deeper must the opacity lie in the vitreous body. As the
luminous appearance described by Purkinje and Sanson was not present, but
the circle of non-converged rays which has been mentioned, the idea of an
operation for Cataract could not be entertained. [Meerlandsch Lancet, as
quoted in Zeitschrift für die gesammte Medicin, November 1849.]
Had the symptoms as well as the appearances been described, a better
opinion might have been formed as to the true nature of this case ; the
“shifting spot” is one of the characteristics of glaucoma, and, combined with
other symptoms, assists the diagnosis of the case. The decision not to operate
was judicious.

CUTTING INTO THE PERINAEUM FOR THE DIVISION OF STRICTURE.
MR. syME's CHALLENGE TO THE HOSPITAL SURGEONS OF LONDON.
Our readers are already familiar with the recent discussions which have
arisen regarding the treatment of Stricture. In the paper before us, Mr.
Syme roundly reiterates the opinion, that Strictures which are “impermeable”
in London, are “permeable” in his hands; and that his “operation is founded
on the fact, that there is no Stricture of the urethra which can resist the
introduction of instruments sufficiently small, and guided with sufficient “
care.” As Mr. Syme stakes his surgical reputation upon the truth of his
38 2
574 CRITICAL DIGEST OF THE JOURNALS.
views, and the safety and success of his method of curing bad Strictures, we
place the following remarkable challenge before our readers.
“Any Stricture which resists the attempt of a surgeon to pass an instrument
through it, though impermeable as far as he is concerned, may not necessarily
be so in the hands of others. During my incumbency at University College
Hospital, there was admitted under my care, a Stricture of the Urethra which
had proved impermeable to the diversified efforts of many gentlemen in the
naval service for nine years, and finally led to the patient's dismissal as
incurable. But, at the very first attempt in this case, I passed a bougie into
the bladder, and, in the course of a few weeks, removed all trace of the con-
traction. Five months ago, a gentlemen from Ireland came over in quest of
relief for a Stricture, on account of which, two years before, he had been six
weeks under the care of Mr. Liston, who, notwithstanding many attempts,
did not succeed in passing any instrument; and although the symptoms
denoted a great aggravation of the disease during the time which had subse-
quently elapsed, I passed a grooved director, divided the Stricture, and was
happy to learn, from a letter received to-day, that the patient ‘is as well as
ever he was in his life.” In the Royal Infirmary of this city, there is at
present under my care, a young man who, six years ago, was dismissed from
the army of the East India Company, after five years' service, as incurable,
on account of Stricture. He had been under the care of various practitioners
without obtaining relief, and for the last sixteen months had, once a week,
passed a steel bougie fairly into the bladder, as he thought. Finding the
symptoms indicative of something more than mere obstruction, and suspect-
ing that there was a false passage through the prostrate, I carefully ex-
amined the canal, and succeeded in passing a small instrument into the real
cavity of the bladder, where a stone was detected. Chloroform having been
administered, I performed the requisite operation upon the small director,
which had been introduced, and extracted a stone weighing three ownces and
a half. The patient had no unpleasant symptom, and has now the prospect
of being quite well in a few days. In many more cases which I could men-
tion, the Stricture was deemed impermeable without truly being so; and
perhaps those lately reported in the Lancet as thus regarded, might have
proved no less amenable to treatment. I firmly believe that they would, and
therefore feel most anxious to impress the conviction, that the alleged imper-
meability has no real existence.
“Since the public profession of this belief, founded upon more than twenty
years’ hospital practice in the largest medical school of her Majesty’s domi-
nions, seems to have had no effect in awakening the attention of London
surgery, further than to elicit some incredulous sneers and flat denials, I beg
to express my readiness to receive into the Royal Infirmary of Edinburgh,
any patients who may bring with them certificates from a London hospital,
of labouring under impermeable Stricture. I shall be happy to pay their
expenses in coming and returning by the steamboats, which sail twice a week,
and would afford the most comfortable conveyance for invalids frequently
disturbed with calls to make water. They will be treated under the observa-
tion of students from all parts of the country, and the results of their cases
shall be published. If any more satisfactory mode of establishing the truth
can be suggested, I shall be happy to adopt it.” [Lancet, May 1850.]
VALUE OF THE FULCRUM OF MR. GILBERT.
MR. G. Robins has published the following in the Lancet. Lieut. C., R.N.,
had been for some months under the hands of one of our most eminent dentists,
in consequence of severe suffering induced by inflammation of the angle of the
lower jaw on the left side, extending to all the neighbouring parts. He was.
cutting the dens sapientiae ; and, as is not unusual with that tooth, great
trouble and difficulty attended its passage through the jaw and soft parts,
*
y-- CRITICAL DIGEST OF THE JOURNALS. 575
Several attempts were made to extract the offending tooth, more especially by
means of the elevator, every such attempt being accompanied with intense
suffering and increased inflammation, and all failing to remove the tooth.
A proposal was then made to extract the molar tooth immediately in front of
the other, so as to afford more facility for the application of the elevator.
Lieut. C., worn out with suffering, consented, and the key was applied; but
so firmly was this sound tooth imbedded in its socket, that it resisted all the
dentist's efforts to wrench it out, and, finally, the claw of the key gave way,
snapping in the middle. Dispirited by so many failures, Lieut. C. returned
home and sent for me, I found him in great suffering, and the whole of
that side of the mouth in a state of intense inflammation, the tonsils and
fauces being also involved. The gums were much bruised and lacerated.
Having seen in The Lancet a very favourable notice published of Mr.
GILBERT's Chair and Fulcrum, and knowing him to be a highly educated
surgeon, I advised the lieutenant to go with me to see him. To this he at
once consented; and, after careful examinination of the mouth, Mr. Gilbert
removed the dens sapientiae (which was not carious) with the aid of a pair of
forceps adapted to his patent Fulcrum, with great skill, and without being
obliged to sacrifice also the other molar tooth. A few days more restored
Lieut. C.’s mouth to a healthy condition; and he has since enjoyed a state of
health and comfort to which he had previously been long a stranger, and is
now on duty. -
The difficulties experienced in the extraction of this tooth were caused
greatly by its extraordinary size, it being the largest molar I had ever seen;
the existence of exostoses of the fangs, which were hooked and irregular in
shape; the partial covering of the tooth by the gum, and the swollen mucous
membrane of the mouth ; and, finally, because the tooth itself had scarcely
risen above the alveolus, which, at this part, is both thick and unyielding.
In consequence of the intense and severe inflammation and swelling which
existed, the patient was unable to open his mouth to the full extent, and of
course this added to the difficulties attendant on the extraction.
ºtº º WN
\a **
The above is a good illustration of the tooth and the jaw. [From Lancet,
February 2, 1850.] -



576 CRITICAL DIGEST OF THE JOURNALS.
OBSTETRICS.
CAZEAUX ON THE CAUSE AND MODE OF PRODUCTION OF THE SO-CALLED
- PLACENTAL MURMIUP.
DR. CAZEAUx has published, in the Archives Générales de Médecine for
March 1850, a memoir on the subject of the cause of the Placental or Wentral
Murmur heard during pregnancy. He refers to the varying situation of the
sound, and agrees with M. Depaul, that there is no relation between the place
where it is heard and the insertion of the placenta. Its character also varies,
sometimes consisting of abrupt sounds, separated from each other by a complete
interval of rest; sometimes it is a true bruit de diable, having its period of
commencement and increase without any interval. “In a word, it presents
all the varieties of rhythm, which have been described in the chlorotic mur-
mur. Most commonly, it is simple and intermittent; sometimes continuous,
with reduplication (bruit de diable); and sometimes, again, simple and con-
tinued. I have not yet found it to possess a doubly intermittent type. Like
the carotid murmur, it may vary its type in a few moments, presenting in
succession several modifications. It also varies in pitch, not only in different
women, but even in the same, and during the course of a single auscultation.
It is sometimes sibilant, resembling the sound of wind passing through the
chinks of an imperfectly closed door; sometimes it resembles the sound pro-
duced by the vibration of a bass chord; in other cases, it resembles the coo-
ing of a dove.”
The author next enters on an examination of the opinions which have been
held, as to the extra or intra-uterine situation of the murmur. The proofs ad-
duced in support of the view, that it is produced externally to the uterus, are, the
production of a similar sound by the pressure of tumours, its non-appearance
until the uterus has risen sufficiently to press upon the iliac vessels, its being
heard most commonly at the lower and lateral part of the abdomen, generally
on the right side, and finally, “as has been proved by Dr. Jacquemier, and
subsequently by myself, by the circumstance that if, after having auscultated
pregnant women in the supine position, they are placed on their knees, with
their elbows resting on the ground, so that the weight of the uterus rests on
the anterior wall of the abdomen, the murmur, which was before distinctly
heard, cannot now be perceived.” M. Cazeaux next makes some observations
on the supposed intra-uterine production of the sound, as advocated by Ker-
garadec, Hohl, Dubois, Corrigan, and Laharpe, the latter of whom refers it
to the greatly increased number of vascular currents in a given space. His
opinion is thus summed up : “In a word, a liquid cannot circulate in a tube,
without producing a certain sound by the friction of its molecules against
the sides of the tube: the sound, however, is not perceptible to the ear when
the tube is isolated, and only becomes so when an infinite number of little
channels are congregated on the same point.”
M. Cazeaux thus expounds his own theory of the production of the Wentral
Murmur :
“The most probable opinion, to me, is, that the murmur is produced in the
vessels of the posterior wall of the abdomen, most commonly the iliacs; but
I think also that it depends on several causes, and not only on the pressure of
the uterine tumour on the great vessels. This is, without doubt, one of the
most active causes; but I am also convinced that the abdominal murmur of
pregnant females, like that of chlorotic patients, is partly due to the modifi-
cations which the blood has undergone. Whatever be the theory received as
to the mechanism of the vascular murmurs in chlorosis, we cannot forget the
great analogy which exists between the blood in chlorosis and in pregnancy.
The ventral murmur also presents an unmistakeable analogy to that of chlo-
rotic patients. It has the same varieties in rhythm and tone ; both present
the same changes of existence, of rhythm, of intensity, and seem equally in-
CRITICAL DIGEST. OF THE JOURNALS. 57.7
fluenced by pressure with the instrument, or by sudden disturbance of the
circulation, from violent motion or other causes. ..º.
“But it may be asked why, if, in chlorosis, the bruit de Soufflet is heard
most strongly in the cervical region, the bruit of pregnancy should be chiefly
heard in the abdomen In answer to this, I will state that the cardiac and
carotid murmur is sometimes heard in pregnant women; but I allow that, in
most cases, the abdominal murmur alone is heard. This is easily compre-
hended. It is rare for the blood to be so much altered in pregnancy as in
chlorosis ; the globules are not so much diminished, nor is there so great a
proportionate excess of water. But if it be correct to suppose, with M. Andral,
that the production of abnormal murmurs implies an advanced degree of
change, it will be easily understood how they should not be heard in the
carotids, where the impoverishment of the blood alone can produce them.
But in the abdominal vessels, there is, superadded to the alteration in the
blood, a considerable diminution in the calibre of the vessels, from the pres-
sure of the uterine tumour; and the combination of these two circumstances
produces a murmur, which they could not do if isolated.”
With regard to the objection that the bruit in chlorosis is accompanied by
a distinct impulse, M. Cazeaux remarks, that this is due to an extension of
the first sound of the heart into the neighbouring vessels, which, however, is
unable to reach those which are more distant : and moreover, that the cer-
vical murmur is often unattended by any impulse.
Although the abdominal murmur is often lost when the woman is
placed on her hands and knees, still this is not always the case, as has been
proved by MM. Depaul, Carrière, and Cazeaux. It is very difficult, and often
impossible, to prevent the uterus from pressing on some of the large arteries;
and in young primiparae, the unresisting abdominal walls keep the uterus
strongly pressed against the parts situated posteriorly. The abdominal mur-
mur is also, according to M. Beau, heard independently of pregnancy." In
a patient, affected with ovarian cysts, as determined by autopsy, it was impos-
sible to place the tumour in a position where it did not press on the arteries
in the pelvis, and consequently give rise to a murmur. Admitting, also,
that compression is not the only cause of the murmur, but that the serous
polyaemia of pregnancy also contributes a share, the latter may be supposed
capable, if of sufficient intensity, of producing the murmur, even after pres-
sure has been removed from the vessels. When the woman is placed on one
side, the murmur sometimes ceases, but is sometimes continued. In the first
case, the state of the blood alone is incapable of producing the sound; in the
second, either the pressure of the uterus has not been entirely removed, or the
alteration in the blood has been competent of itself to cause the murmur. The
occasional diminution, and even disappearance of the murmur under pressure,
is analogous to what sometimes occurs in the murmurs in the carotids. There
is a certain degree of compression, below or above which the murmurs are
increased or diminished. Moderate pressure often increases the murmur,
both in the neck and in the abdomen. -
In some cases, the murmur can only be heard at the neck of the uterus,
by means of the metroscope of M. Nauche. In such cases, the murmur may
be supposed to be produced in the hypogastric arteries, which are nearer to
the cervix uteri than to the abdominal walls. Besides, the epiploon and
intestines, lying between the uterus and the abdominal parietes, would be bad
conductors of sound.
M. Cazeaux thus sums up : “Like M. Beau, in his excellent memoir on
Arterial Murmurs, I admit that the abdominal murmur of pregnancy is
partly due to the compression of the large vessels on the posterior wall of the

* DR. MEIGs, in his Treatise on Obstetrics, in speaking of the uterine murmur,
says: “I have certainly heard the same sound after delivery, as before the child
was born ; and I have heard it, as dependent upon pressure by tumours within the
abdomen.” (p. 240.)
578 CRITICAL DIGEST OF THE JOURNAf.S.
abdomen; but I believe that the change in the blood contributes, as in chlo-
rosis, to the production of the phenomenon. Most commonly, these two
causes act simultaneously; but in many cases, one will suffice.” • ,
With regard to the seat of the murmurs, in chlorosis especially, M. Cazeaux
believes that all abnormal murmurs are arterial: but he does not think that
the theory of their production in veins at all opposes the explanation which
he gives of the nature and seat of the abdominal souffle. Independently of
the iliac veins, the large size of, and the absence of valves in, the uterine
veins, will readily allow us to suppose that the murmurs heard during pre-
gnancy may be produced in them. -
FREQUENCY OF ULCERATION OF THE CERVIX UTERI : PATHOLOGICAL
VALUE OF THE TERM “ULCERATION.” BY HENRY BENNET, M.D.
(From the Lancet, 18th May 1850.)
In The Lancet (April 20) there has appeared a paper by Dr. Tyler Smith,
previously read at the Westminster Society, on the “Supposed Frequency of
Ulceration of the Os and Cervix Uteri”, to which I trust you will allow me
briefly to reply.
I would remark, that the title of Dr. Smith's paper ought not to have been
“On the ‘presumed’ frequency of Ulceration of the Cervix,” but rather “On
the pathological meaning of the term Ulceration, as applied to solutions of
continuity of the organ in question.” The in reality erroneous title of
Dr. Smith's paper implies a negation, on his part, of the frequency of the
lesions which I have described in my work on Inflammation on the Uterine
Organs, under the generic head of Ulceration; whereas such a negation is
not to be found in any part of his paper. On the contrary, he admits, in a
dozen places, the probable frequency of these lesions, but differs from me in
thinking that the term ulceration ought, in sound pathology, to be applied to
them. - -
This is a most important feature in the discussion raised by Dr. Smith ;
inasmuch as, by thus correcting the title of his paper, and making it really
agree with the contents of the latter, we reduce the question at issue to what
it actually is, one of words only—viz., Are the lesions I describe in my
work to be considered forms of ulceration, or are they not
Before I proceed to the examination of this question, I must observe, that
although evidently written with a very different purpose, Dr. Tyler Smith's
Essay, from first to last, substantiates and supports my views. By a process
of mental reasoning and reflection, if not by clinical experience, he has
clearly become a convert to my doctrines respecting uterine pathology, and
so fully appreciates the influence of the various causes of inflammatory dis-
ease to which the uterine organs are exposed, at the various periods of uterine
life—causes which I have developed at length in my work, and which he
rapidly enumerates—that he absolutely states: “If we consider eacoriation
or abrasion as genuine ulceration, probably no woman ever passes through life
without suffering from this form of disease.” Surely this is outheroding
Herod. Although my clinical experience has enabled me to say that out of
300 women presenting decided uterine symptoms, and observed in the course
of two years’ special practice at a large public institution, 222 offered some
form or other of ulceration (including abrasions and excoriations), I sheuld
be very sorry indeed to make such a sweeping assertion as the above; uterine
lesions, even of this description, not existing long, without making known
their presence by local or constitutional disturbance at least, in the immense
majority of cases. Were this assertion true, we then should find nearly
every other female we meet, labouring under uterine disease, as, I hear, some
practitioners facetiously state to be the case at present. I leave Dr. Tyler
Smith, however, to reconcile his theory of what ought to be the state of
uterine pathology with what it is clinically found to be; and will only add, that
CIRITICAL DIGEST OF THE JOURNALS. 579
*
for my part, although convinced of the frequency of inflammation, and of in-
flammatory ulcerative lesions of the cervix in women presenting uterine
symptoms, I still have great confidence in the power of nature to carry
through her operations, generally speaking, without hurt or accident. Icon-
sequently decidedly think, that the very great majority of women pass through
all the trials of uterine life, without being affected either with abrasions or
excoriations. Inflammatory lesions are no more the rule with the uterus than
with the brain, the liver, or the lungs, although they may be as frequently, or
even more frequently, the exception.
With regard to the main question at issue, the proper interpretation of
the term ulceration, in applying it generally to all solutions of continuity of
the cervix and its cavity, whether slight or considerable, I have followed
both the highest authority and the bent of my own mind. I have always
considered divisions and distinctions in the nomenclature of disease as use-
less, and obstructive to progress, unless founded on some real and therapeu-
tically important difference. Thus, were I to write a treatise on diseases of
the skin, I should throw aside, without scruple, one-half of the forms of dis-
ease now admitted, because they are merely founded on a species of botanical
consideration of the visible appearance of the disease, and are, in reality,
only different modes of manifestation, and different stages of development, of .
a malady identically the same, and requiring the same treatment.
Applying these principles of general pathology to the ulcerative lesions
produced by inflammation of the cervix and its cavity, instead of describing
abrasions, excoriations, and luxuriant ulcerations, as distinct morbid con-
ditions, (which they are not,) I have embodied them all in the general term
ulceration, adding, by way of explanation, “that ulceration occupying
the cervix uteri may present all the various modifications which suppurating
surfaces offer in any other part of the body, from the minute granulation of
a slight abrasion to the livid vegetations of an unhealthy sore.”
That I am warranted in applying the term ulceration even to a mere abra-
sion, the result, not of physical violence, but of inflammation and of morbid
vital action, must be evident to all who are acquainted with the classical
literature of the profession. “Ulceration,” says Samuel Cooper, “is the
process by which Sores or ulcers are produced in animal bodies.” J. L.
Petit defines an ulceration, or ulcer, “as a solution of continuity, from which
is secreted pus, or a puriform, sanious, or other matter.” Boyer states, that
“ an ulceration is a solution of continuity of the soft parts, more or less
ancient, accompanied by a purulent secretion, and kept up by some local or
internal cause.” Any of these definitions apply quite as truly to a mere
abrasion or excoriation, secreting pus or sanies, as to the chronic excavated
cutaneous ulcer, which Dr. Tyler Smith most unaccountably expects to find
on the cervix uteri.
Indeed, it is with extreme surprise that I find Dr. Tyler Smith saying, that
to be able to apply the term ulceration to the cervix uteri, “we must look
for a solution of continuity with a secreting surface, separated from the
healthy structures, having defined edges, everted or inverted,—for an ulcer,
in fact, (query, a cutaneous ulcer 7) in the common pathological meaning of
the term.” Had not Dr Smith commenced by stating that he is in the
habit of using the speculum, I should be inclined to think that he was rea-
soning from analogy only ; for the fact is, and he ought to know it, if his
opinions are the result of practical experience, that the form of ulcers thus
described is scarcely ever met with on the neck of the uterus, except as the
result of syphilitic chancre or of corroding ulcer. Owing to the tenuity of
the mucous membrane lining the cervix and its cavity, the margin of an
inflammatory ulceration is scarcely ever, if ever, either everted or inverted.
So much is this the case, that it is generally most difficult to say where the
ulceration finishes, until, by the application of the nitrate of silver, the margin
of the sore, or the point where the epithelium finishes, be revealed. In my
580 CRITICAL DIGEST OF THE JOURNALS,
work (see page 103). I have distinctly stated, and now repeat, that “what-
ever the character of an inflammatory ulceration of the cervix, the ulcerated
surface is never excoriated ; it is always on a level with or above the non-
ulcerated tissues that limit it, and its margin never presents any abrupt
induration. Owing to this circumstance, it is always impossible to determine
by the touch the precise point at which the ulceration terminates.”
Thus Dr. Tyler Smith's criticism of my position respecting the frequency
of uterine ulceration is founded, on the one hand, on a frivolous negation of
the term ulceration to abrasions and excoriations, these lesions being strictly
and legitimately within the pale of all classical definitions of ulceration ;
and, on the other, on the establishment of a visionary ideal of uterine ulcer-
ation, drawn from chronic cutaneous ulcers of the leg, such sores or “ulcers”
not being met with at all, in reality, on the cervix uteri.
In the course of the above argumentation I have not alluded to the French
writers on uterine diseases, because I did not require their assistance to esta-
blish my position. I may now, however, add, that all who have written in
France on the subject of uterine inflammation, have applied the word ulcera-
tion to the lesions to which I apply it. Some have called abrasions and
excoriations, exulcerations, or granular ulcerations, which I have not thought
proper to do; but this is the only difference between me and them. I have
thus not only reason and pathology on my side, but also antecedents, and
the example of my seniors—men of the first eminence and talent, such as
Lisfranc, Gendrin, Jobert, Duparcque, etc.
Dr. Tyler Smith, in common with all those who are now vainly endeavour-
ing to arrest the strong current of professional feeling towards a correct and
sound uterine pathology, appears to think that I, and those who adopt my
views, are discarding all constitutional treatment, and directing our atten-
tion solely to local lesions. This, however, is a most unwarranted “petitio
principii.” I would ask, where is the proof? Certainly not in my work on
Uterine Inflammation, for a large portion of it is devoted to the minute and
careful investigation and elucidation of general and constitutional symp-
toms, to which I strenuously and continually direct the attention of my
readers. Nor have I observed any evidence, in the practice of those medical
men, converts to the modern doctrines, with whom I came in contact, that
constitutional means of treatment are by them neglected.
Dr. Tyler Smith lays great stress on the results of the post-mortem exami-
nations at St. George's Hospital, which seem to me, on the contrary, to com—
pletely corroborate my views. He states, that only seven instances of ulcer-
ation of the cervix (excavated with distinct edges, I suppose) have been
found on the post-mortem examination of the females who die annually in
the hospital. In the same paragraph, however, he is obliged to confess, that
slight abrasions, discolorations, and granulations, were frequently observed.
The severe ulcerations alluded to appear to have been scrofulous sores, the
result of the softening and emptying of tubercular masses, or malignant
ulcerations.
I cannot conclude these remarks without entering my protest, in the most
forcible and energetic manner, against a statement made by Dr. Tyler Smith,
at the conclusion of his paper. He says :-" At the present time, a veritable
uterine panic affects the upper and middle classes of society, and every
woman, with the slightest ache or discharge, is not satisfied until the peccant
organ has been ocularly inspected.” I have no hesitation whatever in stat-
ing, that this assertion is a libel on our countrywomen, which, I trust, has
only escaped from Dr. Smith in the hurry of composition. The change that
has taken place, in the arguments brought forward by those who adhere to
the prejudices and errors of days which we shall soon be able, I firmly believe,
to call past, is truly remarkable. Five years ago, when I published the first
edition of my work, I was greeted by the observation, that Englishwomen
were too modest and reserved to submit to physical examination, and that I

CRITICAL DIGEST OF THE JOURNALS. 581.
should only destroy my professional prospects by advancing views which
required it. . Now, however, that Englishwomen suffering under uterine dis-
ease are beginning to become aware that there is relief to be found, and that
they need no longer be handed from practitioner to practitioner in a vain
search after health; now that they show themselves willing to control agony
of mind and pain of body, for the sake often of those who are dear to them,
an odious accusation is thrown in their teeth, and they are told that they
are ready, nay, anarious, to submit to uterine examinations, nearly without a
cause or pretext. I can only say, that I meet with no such females, either
in the higher or the lower ranks of my countrywomen, and that I blush for
those who thus asperse them.
MANIA CO-EXISTING WITH UTERINE DISEASE.
DR. IEvKR narrates (Guy's Hospital Reports, vol. ii, Second Series, p. 32),
two cases illustrative of the following propositions:
1. Mania developing itself in the female, is sometimes associated with, and
depends upon organic disease and irritation of the sexual organs.
2. Unless remedial measures be applied to relieve such disease or irritation,
the insanity will be permanent.
3. In selecting the proper treatment, attention must be specially directed
to the nature of the local disease.
4. In most cases, there is a diminution or cessation of the catamenial flux.
5. At the close of the treatment, counter-irritation in the neighbourhood
of the sacrum is a valuable auxiliary.
6. By pursuing this plan of treatment, before the symptoms of insanity
become confirmed, in many cases, it will be attended by success.
EXPLOSION OF A CYST OF THE CERVIX UTERI UNDER CAUTERIZATION.
A woman, aged 23, the mother of two children, had, on the anterior lips of
of the os uteri, a sessile tumour, of the size of a small nut, firm, elastic, not
fluctuating, not tender to the touch, and having the same colour as the sur-
rounding parts. After various measures had been fruitlessly tried, it was
resolved by MM. Marjolin and Melier to apply the actual cautery. M.
Melier applied the iron at a white heat, when the tumour burst with a loud
report, showing its cystic character. A stringy fluid, resembling white of
egg, exuded. The patient regained her health, which had been very bad
since the tumour appeared, from the pain in the hypogastrium, loins, an
vulva. Mem. de la Société de Chirurgie, t. i., p. 293.] .
582
R. E. P. O. R T S OF SO C I ETI E S.
WESTMINSTER MEDICAL SOCIETY.
SATURDAY, FEBRUARY 23, 1850.
EdwarD WILLIAM MURPHY, M.D., PRESIDENT, IN THE CHAIR.
For EIGN BoDY IN CESOPHAGUS, SIMULATING DISEASE of THE BRAIN. DR.
RouTH related the following case. It was that of a young lad, aged about
13, who had suffered from head symptoms more or less since his birth.
Indeed, he had had acute hydrocephalus when an infant. The symptom
which chiefly annoyed him was intense headache, coming on at irregular
periods. Lately, however, he had been much better in this respect. On the
24th of December last, it appears that he was playing with some of his com-
rades, having in his mouth a piece of a spectacle frame made of bone. The
piece was right angled, consisting of about one-quarter of the ring for the
glass, with the adjoining portion, about one inch in length, at one end of
which was a piece of metal remaining, originally the rivet. This, in a
moment when he was not aware, he swallowed. He stated at the time, that
he felt as if something was sticking low down in his throat, but the feeling
soon disappeared, and he thought nothing more of it. Three days afterwards,
haemoptysis came on. The blood brought up was small in quantity, about a
teaspoonful, intermixed with frothy sputa; the latter continued for several
days afterwards, streaked with blood. At the same time, he complained
of a dull heavy pain deep in the thorax, beneath the upper part of the ensi-
form cartilage, with occasionally a pricking sensation in the neighbourhood
of the larynx. The head symptoms now again developed themselves with
increased severity. There was intense headache, increased in the recumbent
position, sleeplessness, loss of memory, and occasional delirium, especially at
might. This was accompanied with a great feeling of weakness, and he was
unable to stand upon his feet. The pupils were dilated, the face flushed, the
pulse much accelerated ; but there was no vomiting, and the intellect was
ordinarily, except during delirium, quite clear. There was slight bronchitis,
indicated by occasional sonorous and sibilant rhonchi, and large crepi-
tation. The right clavicle was duller on percussion than the left, and the
respiration was weak. Above the clavicle and over the supra-spinous fossa,
the reverse was the case, and the expiration on the left side was also propor-
tionally too loud. The difference in dulness was, however, by no means well
marked. No abnormal sounds were heard over the trachea and larynx, nor
was his voice affected. Towards the beginning of January, Dr. Routh first
saw him, when he was enabled to make the above observations. Consider-
ing the case as one of tubercle of the brain, probably complicated with some
acute attack and with perhaps incipient phthisis, he ordered him to be cup-
ped to #vi, to have a blister applied the next day to the nape of the neck,
and to take some drastic purgatives. Two other blisters were subsequently
applied. The urine was natural in colour, sp. gr. 1016, acid, with some
excess of phosphates; no albumen. Head to be shaved, and cold lotions ap-
plied. Under this treatment, he so far recovered in about seven or eight
days as to be able to sit up. The cough had disappeared. Pulse about 90.
The head symptoms were almost quite gone, he was able to walk, and the only
disagreeable feeling he complained of, was unusual warmth, so that he could
not bear a fire in his room. After a few days, he became again delirious, and
complained of intense pain in the hepatic region, which was also tender on
touch. He was now cupped on this part to 3iv, and a mercurial purge was
given. He was again able to walk about, and seemed comparatively well in a
couple of days, and continued so. On the 22nd of February, he became again
WESTMINSTER MEDICAL SOCIETY. 583
delirious, and suddenly very faint and sick. This was soon followed by the
vomiting of a large quantity of pus and blood (almost 0.j.), in the midst of
which was the piece of bone before described. The next day, however, all
the symptoms had disappeared, and excepting a feeling of weakness, he
stated that he felt quite well. Dr. Routh concluded from the above history,
that the foreign body must have lodged somewhere in the oesophagus, and not
fallen in the larynx. The body was too large for this: moreover, it could
not have been lodged in or near it, else more urgent laryngeal symptoms would
have been produced. Had it passed into the stomach, it would have been in
part digested ; and in this case Dr. Routh was at a loss to understand, how
and where this large quantity of pus should have been produced, and retained
for so long a period in the stomach. The case was interesting as an eccentric
simulation, by a foreign body in the oesophagus, of symptoms completely re-
sembling local and cerebral disease ; the imitation being also rendered more
perfect by the relief afforded by the treatment.
CoNNExION BETWEEN GouT AND RELEUMATISM. By DR. A. B. GARRod.
Many physicians consider Gout and Rheumatism as diseases so closely
allied, as to be merely varieties of the same ; others, as differing essentially
from each other; while a third set believe, that although the well-marked
attacks of acute Gout differ widely from those of acute Rheumatism, yet the
two diseases may, as it were, imperceptibly merge into each other, so that,
in a given case, it may be impossible to diagnose between them. The object
of this paper was to point out the differential diagnosis. +.
Gout is a disease of advanced age ; rheumatism, of youth. Gout is more
common among men ; rheumatism affects both sexes alike. Gout, at first
at least, attacks the plethoric, and those who live high ; rheumatism, gene-
rally, the debilitated from any causes. Gout is frequently hereditary ;
rheumatism, if at all so, incomparably less so than gout. The exciting
causes also differ. Gout is induced by high living, certain indigestible food,
or by local injury in those strongly predisposed ; cold is the principal
exciting cause of rheumatism. The rich are more subject to gout ; the poor
to rheumatism. Gout frequently presents premonitory symptoms, affecting
the digestive organs, which is not the case in rheumatism. Gout attacks the
small joints; rheumatism, the larger. In gout, one joint, generally, only is
affected ; in rheumatism, many. In gout of long standing, the large joints
may be attacked, and also more than one ; sometimes, again, in rheumatism,
the smaller joints are involved. In both diseases, the affection of the joints
is accompanied by pain, redness, and swelling ; but in gout, the pain is
generally more severe, and the redness and swelling greater than in rheu-
matism. In gout, we have oedema and subsequent desquamation, which do
not occur in rheumatism. The fever in gout is proportioned to the local
inflammation ; but it greatly exceeds it in rheumatism, and there is fre-
quently profuse sweating, of an acid character. Metastasis rarely occurs in
acute gout, and when it does, the brain or stomach suffers, the heart seldom
or never; in rheumatism, the heart is frequently inflamed, and the secondary
affection becomes the most important. Chronic rheumatism is more fre-
quent than chronic gout ; the latter is frequently accompanied by the secre-
tion of a milky fluid, which constitutes chalk-stones or tophaceous deposits.
Their composition is peculiar, consisting almost entirely of urate of soda,
and sometimes phosphate and carbonate of lime. In the fluid state, the
needle-like crystals of the urate of soda can be readily detected under the
microscope. They are met with on the joints of the hands and feet, which
they distort, and even dislocate, also in and around the sheaths of tendons,
and even in the cancellous structure of the heads of the bones. (Specimens,
one weighing two ounces when fresh, were exhibited.) Colchicum possesses
an almost magic power in relieving the pain in gout, but is not attended
with such marked benefit in the acute form of rheumatism. There are,
584 - REPORTS OF SOCIETIES.
however, a class of cases, in which, even with the utmost care, the diagnosis
cannot always be made. These are called rheumatic gout ; and it would
seem either that the patient suffered from both diseases at once, or that the
two merged into one. Dr. Garrod considered it a matter of great interest to
ascertain the true nature of these cases, and to find out whether or not cases
of true gout and those of rheumatism may not present similar, and almost
identical symptoms, and yet in their real nature be quite distinct. In a paper
read before the Medical and Chirurgical Society, Dr. Garrod had proved the
existence of uric acid in the blood ; in the healthy fluid, traces of it only
could be found, but in pure gout it was greatly increased, so that from 1000
grains of serum it could be crystallized and weighed. It could also be pro-
cured in the form of urate of soda. This was not the case in acute rheu-
matism, and in that disease no more uric acid was found than in the healthy
fluid. This, then, formed a marked difference between the two diseases.
Uric acid, in Dr. Garrod's experiments, was abundant in the blood in cases
presenting symptoms of true gout, deficient in those of well-marked rheu-
matism. This he had lately used as a test of the two diseases. A labourer
being admitted into the hospital with a complaint in one hand, which had been
previously treated as rheumatism, but presenting characters of gout, as Dr.
Garrod supposed, he directed a small quantity of blood to be drawn, and dis-
covered uric acid in abundance. The man afterwards said that he had had a
similar attack in the toes, and that he could at any time bring on an attack by
drinking beer freely. The plan for detecting uric acid in the blood, detailed
in the paper read before the Medical and Chirurgical Society, being very
difficult, Dr. Garrod recommended the following, as being more simple: He
takes a small quantity of blood, say from half an ounce to an ounce, in a
wide tube or small glass, and allows it to remain for some hours, to separate
into clot and serum. The serum is then decanted, and from half a drachm
to a drachm put on a watch glass, then acidulated with five minims of acetic
acid, and a fibre of hemp from a piece of linen or tow introduced. In about
forty-eight hours, when the serum has become solid from evaporation, if uric
acid be present, the fibre will be covered with crystals of uric acid in the
form of rhombs: an idea of the amount of uric acid present may be obtained
from the number of crystals. (A drawing of the fibre covered with the
crystals was exhibited.) That these crystals are uric acid, can be proved by
adding a little water, when, by care, the fibre can be removed with a small
pair of forceps, with the crystals adhering to it. Nitric acid and ammonia
will at once determine their nature, by the production of the murexide or
purpurate of ammonia. Dr. Garrod then mentioned, as an indication of
gout, the presence of chalk-deposits in the ear, a sign be has often observed.
Sir C. Scudamore gives the tophaceous deposits as being only ten per cent.,
but Dr. Garrod had met with them in the ear much more frequently,–so
much so, as in chronic cases to form a valuable sign of diagnosis. He had
himself often diagnosed the disease from this mark alone, and found his
opinion confirmed afterwards by the discovery of uric acid in the blood. In
many chronic cases of gout, the condition of the urine will aid the diagnosis;
and when there are tophaceous deposits, the kidneys appear to have lost the
power of excreting uric acid, so that the urine is at all times free from lithic
deposits. When the chalk-stones are forming very freely, he had often
found that not 1-100th of a grain of uric acid was eliminated in the urine
in the twenty-four hours. At the same time, the urine may present an acid
reaction. -
DR. S.Now regretted that Dr. Garrod had not explained the reason why the
kidneys did not separate the lithic acid from the blood, and thus prevent a
fit of the gout. Dr. Garrod had said, that the kidneys did not appear able to
effect this elimination; but he (Dr. Snow) thought that this inability did
not arise from mere local disease of the kidney, but that some constitutional
cause was present. Might not the lithic acid remain in the circulation, from
WESTMINSTER MEDICAI, SOCIETY. 585
the want of ammonia to combine with it? Phosphate of ammonia was a
valuable medicine in the treatment of gout, , Might it not act by the
ammonia combining with the lithic acid, and producing lithate of ammonia 7
Colchicum, in acute rheumatism, was often useful, when given freely, in
cases which had been called sthenic. In the country, among strong labour-
ing men, he had seen half a drachm of the wine of colchicum seeds given
every four hours, until it produced violent catharsis and vomiting, attended
by much depression. A remission of the symptoms followed these effects.
DR. Ross, in his own person, had found no good effects from colchicum in
the first attack of gout, though he persevered in its use for three weeks. .On
adding the bicarbonate of potash and morphia, to the remedy, however, it
immediately afforded him relief. In his case there was no uric acid in the
urine, the specific gravity of which was about 1012. How did the uric acidget
out of the blood during the attack " He had found much benefit from a local
liniment, consisting of two drachms of distilled vinegar, two ounces of col-
chicum wine, and eight grains of morphia, applied by means of a piece of
lint to the affected part.
DR. LANKESTER, DR. DANIELL, and others addressed the Society; after
which DR. GARROD replied to the criticisms of the various speakers.

SATURDAY, MARCH 2, 1850.
EDWARD WILLIAM MURPHY, M.D., PRESIDENT, IN THE CHAIR.
ACUTE SYNow ITIS of THE KNEE-Joint IN AN INFANT DURING DENTITION.
By MR. GoRDON BAILEY. The subject of this case came under the notice of
Mr. Gordon Bailey on the 8th of January. There was great thirst, heat of
head, irritable bowels, hot skin, and the usual precursors of teething. These
symptoms were succeeded by drowsiness, and a tendency to sickness of the
stomach. The child was apparently very much out of health ; its skin was pale
and flabby; the folds between the thighs and vulvae were very much chafed ;
its alvine secretions were dark and fetid, and it was very irritable. The
bowels were opened by small doses of mercury with chalk and rhubarb ; the
gums were freely divided ; the head was ordered to be frequently sponged
with vinegar and cold water, and the body was placed in a warm bath, and
some sudorific medicine was prescribed. The child was relieved by this
treatment, and continued to improve for a few days, when the symptoms
again supervened : the gums were much swollen, and the child was very
irritable. The gum-lancet was again used. Small doses of sulphate of
magnesia and nitrate of potash were prescribed, which had the effect of bring-
ing away some watery stools, after which the child became more lively. On
the 12th of January, the left knee began to swell: it was large and white on
the following day, and the integuments presented the shining appearance of
phlegmasia dolens, without, however, any of the excessive degree of pain
attending that affection. The child was exposed to no accident or cold, and
had had great care bestowed on it by its parents and nurse. The brother of
this child is also very delicate, cutting his teeth with great disturbance to the
system, such as congestion of the brain, enlargement of the cervical glands,
etc. The limb was ordered to be kept quiet, and to be fomented frequently
with decoction of poppies, etc. The bowels were opened, and the child sup-
ported by isinglass dissolved in milk. This palliative treatment was judged
most suitable from the weak state of the child, and the swelling of the knee
was looked on as constitutional, having for its exciting cause the process of
painful dentition in a strumous habit. Mr. Hancock, who saw this case in
consultation, also concurred in this view ; and it was agreed on to procure
absorption of the fluid, if possible, by the application of tincture of iodine in
the neighbourhood of the joint, and also the internal exhibition, of iodide
of potassium. This treatment was continued for nearly a week. In the
interim the child cut two teeth, when the irritation became much less: how-
ever, the limb did not appear to get smaller. Fluctuation became more dis-

586 REPORTS OF SOCIETIES.
tinct; and ared spot, at the side of the joint where the integuments were
thin and soft, showed were the matter would soon escape. After this spot had
been poulticed for two or three days, an incision was made, and about two
ounces of pus flowed out. The discharge continued some days. The limb
was placed in a moulded gutta percha splint ; water-dressing was substituted
for the poultice, and the use of cod liver oil commenced. The discharge
ceased after seven or eight days; the four incisors came up, and, with the
latter, all the restlessness and sympathetic disturbance ceased; the knee has
assumed its former size and shape, and there appears to be no stiffness or im-
pediment to motion, for the little patient flings the legs about as if nothing
had occurred.
This case derives its chief interest from the fact, that it occurred in so
young a subject. Synovitis in young children, as a complication of dentition,
is not described in any of the works on Diseases of Children; and Sir B.
Brodie, one of the highest authorities on the subject of Diseases of the Joints,
in speaking of the inflammation which begins in the synovial membrane itself,
and is not communicated to it from other textures, says, that “the disease
very seldom attacks young children, but is frequent in adult persons.”
PATHoLogy AND TREATMENT OF DELIRIUM TREMENs. By DR. JAMEs
BIRD. [This paper is embodied in the Memoir published at p. 419 of last
number.]
SATURDAY, MARCH 9, 1850.
EDWARD WILLIAM MURPHY, M.D., PRESIDENT, IN THE CHAIR.
DEATH FROM HAEMORRHAGE INTO THE BLADDER. D.R. WARDELL exhibited
a diseased bladder, with the left ureter and kidney attached. The deceased was
a patient of Dr. B. Smith of Kensington, by whom he was requested to make
an examination of the body. George Emmerton, a farm labourer, 73 years
of age, of middle stature, and well-developed muscular system for his time
of life, but pale and sunken in the features, complained, on the 26th of
January, of frequent and very painful desire to micturate, followed by the
passing of only a few drops, chiefly of blood. The catheter passed without diffi-
culty, and, on entering the bladder, it felt as if penetrating a loose and easily
lacerable coagulum, or a thick viscid substance. No fluid escaped, except a little
blood. Pulse 80, weak, and the countenance was blanched. In March last, the
deceased had injuršd the left hypogastric region, by running forcibly against
the corner of a low door. During the six weeks previous to his decease, the
urine was mixed with varying quantities of blood, which increased in quantity
for the last ten days of his life. He sought no medical advice previous to
calling in Dr. Smith, on the 26th. Three weeks before his death, he had
been an inmate of the Middlesex Hospital, for hydrocele. He was tapped,
and speedily recovered. On the morning of the 27th, the catheter was again
passed, and it still seemed to pass through some substance offering a slight
resistance. Some fluid dribbled away, consisting of blood and urine. He com-
plained of no pain, nor desire to micturate. The pulse was weaker, and the
general symptoms of a more alarming character. He took, every three hours,
doses of lead, opium, and acetic acid. In the evening, he was much in the same
state. The following morning (28th) he was reported to have slept continuously
during the night. The bowels had been freely opened. The pulse was smaller
and quicker. Towards morning he had a fit, apparently of an epileptic charac-
ter. During the day he had several fits of a similar nature; and in most of
these, the facial twitchings were very considerable.
The post-mortem inspection was made fifty hours after death. The bladder
was enormously distended, and its colour of a dark pinkish hue, evidently
imparted by its contents. On introducing the catheter, no fluid passed; con-
sequently a puncture was made high up in the lateral aspect of the organ,
when a pint of clear urine was removed. Another pint of fluid was thus
WESTMINSTER MEDICAL | SOCIETY. 587
taken away, but this partly consisted of blood. Other four and a half pints
of blood, partly fluid and partly in dark, easily-broken coagula, were removed.
On carefully introducing the hand, a soft, irregular, roughened surface was felt,
extending over a considerable space on the left side, and near the sphincter
vesicae. On further exploration, a small orifice, admitting the little finger,
could be felt, opening into a cavity, apparently of sufficient size to admit a
small orange. On slight pressure, two or three ounces of blood flowed from
this orifice. By turning the viscera aside, both ureters were brought into
view. The left was tensely distended, and nearly as thick as the little finger;
a small slit was made near its union with the kidney, and the contained fluid
was found to consist of limpid urine. A gum catheter was straightened, and
made, without any obstruction, to pass out at the uretral orifice into the
bladder. The right ureter was not at all distended. The bladder was then
removed ; and, on its being freely laid open, extensive disease was manifest,
consisting of considerable thickening, at Some places to the extent of seven or
eight lines, and presenting an ulcerated surface, not covered with much puru-
lent matter. On manipulation, no very notable hardness was felt, but there
was induration in some parts. The Sacculated cavity spoken of, was found
to have a lining membrane possessing all the characteristics of the bladder
when in a healthy condition. The prostrate gland was healthy. On careful
examination of the diseased mass, no bleeding orifices could be traced. The
left kidney was much smaller than the right. On being cut open, its pelvis
was distended with clear urine. The calices and infundibula were consider-
ably dilated; the cortical and tubular substance greatly absorbed; the papillae
ill-defined. Right kidney perfectly healthy, and of the normal size.
On first examining the morbid product, from the considerable-thickening
of the bladder at the seat of ulceration, the blueish red, roughened surface,
the induration felt in several places, the streaks of purulent matter, and other
features, in no slight degree simulating carcinoma, it was not unreasonable
to deem it a true instance of ulceration of the viscus. There were certain
negative facts opposing such opinion, especially the unaccompaniment of
general cachexia, the absence of pain throughout the progress of the com-
plaint, the healthy condition of the adjacent organs, some of which are almost
invariably cancerous when carcinoma of the bladder exists, especially the
rectum, the prostrate gland, and vesiculae seminales in males, and uterus in
females. Sometimes the sub-mucous tissue of the vesical parietes at the
fundus, or near the neck, was the first seat of the malignynt change, and the
neighbouring organs were found of normal character; but such instances are
very rare, and constituted mere exceptions to a general rule. . The next par-
ticular was the orifice and cavity, spoken of in the account of the post-mortem.
On laying it open, the lining membrane of this sacculated pouch was found
uite healthy. A condition of the viscus resembling the one now seen on the
table, had, by some authors, been termed vesical hernia ; by others, a diver-
ticulum. A diverticulum might be congenital, or the result of disease. The
manner in which this had been formed was undoubtedly by disease ; by the
apposition and ultimate union of the ulcerated edges, which had gathered
up a fold of the vesical wall, and the orifice had been kept patulous by the
passage of the urine to and from the bladder. On placing portions of the
diseased mass under the microscope, none of the caudate, nucleated cells, so
indicative of carcinoma, could be detected ; and Mr. Bowman could not
detect the true cancerous cells. Dr. Wardell, therefore, considered the speci-
men as simple hypertrophous ulceration, where the thickening, from long-
continued disease, had become considerable. With regard to the extent of
haemorrhage, a large quantity of blood had been poured out from inconsider-
able vessels: on careful examination, it was found, that none of the larger
branches had been eroded. -
CoNNEx1ON BETwºBN UTERINE AND OvaBIAN DISEASE. By DR. TILT.
[This paper was published in our number for April, p. 347.]
WOL. II. 39
588. REPORTS OF SOCIETIES.
DR. HENRY BENNET had listened with much pleasure to Dr. Tilt's paper,
the great merit of which consisted in its placing in a very strong light the
pathological connexion that really existed between the uterus and the
ovaries. Inflammation, no doubt, often extended from the uterus to the
ovaries, as he (Dr. H. B.) had shewn in his work on Uterine Inflammation ;
whilst in Ovarian Disease the uterus and its neck were so frequently also the
seat of inflammation, that it was of the greatest importance to marrowly
investigate the state of these latter organs. Indeed, he had repeatedly
found, that by curing chronic disease of the uterus or cervix uteri, he had
materially contributed to arrest morbid action in the ovaries. He did not,
however, think that when inflammatory disease existed in the neck of the
uterus alone, a similar morbid condition was often developed in the ovaries
sympathetically or by metastasis. . He thought that in these cases the
ovaries were nearly always affected by “extension of tissue”, that is, by its
extension from the neck to the body of the uterus, and from thence to the
lateral ligaments and ovaries. He would also remind his hearers, that pain
in the ovaries and their vicinity, as also tenderness on pressure, were nearly
invariably characteristic of inflammatory ulcerations of the neck of the
uterus, and not of acute or subacute ovaritis. Owing to some inexplicable
cause, the pain produced by ulceration of the neck of the uterus was very
seldom experienced in the real seat of the disease, but at a distance, in the
ovarian regions. The pains appeared with the ulceration, lasted for years
along with it, and disappeared with it, scarcely ever leaving behind any
evidence of Ovarian Disease.
DR. SNow BECK remarked, that he had looked for the erectile tissue said to
exist in the cervix uteri, but had not been able to find it. With care and
patience, it was easy to trace the layer of erectile tissue along the side of the
vagina, and to follow it to its termination at the upper part, but he had not
been able to discover any erectile tissue in the cervix uteri. Referring to
the pain which existed a little above the inguinal region in affections of the
cervix uteri, which pain had been called ovarian, he considered this a most
mischievous appellation, as it led to erroneous views in the pathology and
treatment of the diseases of which it was an index. The pain referred to was
a painful affection of the ilio-inguinal nerve. . And that this was the case was
proved, 1. By the course of the pain ; for although it is described as located
at the lower side of the abdomen, yet on careful examination it will be found
to commence in the lumbar region, pass round a little above the crista of the
ilium, and thence downwards and forwards to the inguinal region ; 2. By
the situation : as on exercising gentle pressure with the hand, the patient
informs you that the pain is not deep in the pelvis, but very near to the
hand; whilst pinching the integuments gives no inconvenience, and shows that
it is not situated there ; 3. By direct experiment; as by placing the fingers
on the cervix uteri and exercising gentle pressure, the pain is increased
along the whole course of the nerve, but especially at its distribution on the
lower part of the abdomen, or where the pain is chiefly complained of.
These facts were readily understood by a reference to the anatomy of
the uterus. We must remember, that the uterus is supplied by tubular
nervous fibres, or branches from the spinal nerves, as well as by gelatinous
nervous fibres derived from the sympathetic nervous system ; and that the
branches of the spinal nerves—the tubular fibres—are derived from the
lumbar plexus, pass to the lumbar ganglia, from thence to the hypogast-
ric plexus, and finally, in company with the sympathetic fibres, reach
the uterus. On any affection irritating these fibres, the irritation was
carried upwards to the lumbar plexus, and thence reflected in the form of
pain along the different nerves derived from this plexus, i.e. upon the lower
part of the abdomen, over the hips, and along the muscles on the inner part
of the thighs. The situations of these reflected pains were most important as
a means of diagnosis in disease. For instance, the pain in the lumbar region,
WESTMINSTER MEDICAL SOCIETY. 589
and along the nerves derived from the lumbar plexus, indicated an affection
of the uterus, the pain in the sacrum and along the nerves derived from the
sacral plexus, indicated an affection of the vagina and not of the uterus, as
has been so generally stated. Nay, further, the portion of vagina affected was
exactly indicated by the seat of the pain in the sacrum. Affections of the
upper part of the vagina causing pain in the upper part of the sacrum, and
affections of the lower part, caused pain in the lower part of the sacrum.
These facts ought to cause some to hesitate, before they attributed everything
to affections of the neck of the uterus, and to pause on the improper haste
with which they submitted females to instrumental examination without
sufficient reason.
That inflammation of the ovaries and uterus sometimes existed together,
was a fact which could not be denied ; but considering the numerous cases
of inflammation of the uterus which occurred in London during the year,
and the rarity with which they were met with together, he considered it
must be a very exceptional case. And even then, it was a question whether it
was not a mere coincidence, without any connexion existing between the two.
DR. Snow Beck stated, in reply to Dr. Sibson, that the ovaries were chiefly
supplied by nerves from the renal plexus, which passed down in company
with the spermatic artery. Sometimes, however, a branch passed from the
uterus to the ovaries. The uterus was chiefly supplied with nerves from
the hypogastric plexus, which plexus was composed of sympathetic nerves,
and branches of spinal nerves derived from the lumbar plexus.
MR. NUNN said, that the ovaries were supplied with branches of the sym-
pathetic, from the sacral ganglia accompanying the uterine artery : and not
only by offshoots from the renal plexus. He thought that Dr. S. Beck was
in error, when he said that pain extending down the thigh was indicative of
vaginal and not of uterine disease; when present in uterine disease, it
depended upon the uterine nerves being connected with the sacral plexus.
The sacral ganglia were connected on the one hand with the uterus, and on
the other with the sacral spinal nerves.
DR. S.Now BECK asked, how it happened that the hypogastric plexus left
the uterus and pursued a separate course round the pelvis, if, as Mr. Nunn
stated, the sympathetic nerves always accompanied the arteries'
SATURDAY, MARCH 16, 1850.
EDWARD W. MURPHY, M.D., PRESIDENT, IN THE CHAIR.
ON DISEASEs of THE NERVous SysIEM. By DR. SEMPLE. [This paper is
published at p. 448 of our number for May.] DR, SIBSON, DR. R. CHAMBERs,
DR. DANIELL, DR. WEBSTER, DR. S.Now, MR. HUNT, and MR. WING, made
speeches more or less bearing upon DR. SEMPLE's paper.
SATURDAY, MARCH 23, 1850.
Edward W. MURPHY, M.D., PRESIDENT, IN THE CHAIR.
THE ENTRANCE of AIR BY THE OPEN MoUTHS OF THE UTERINE WEINs,
CoNSIDERED As A CAUSE OF DANGER AND DEATH AFTER PARTURITION. By
DR. CoRMACK. The paper consisted of three parts:–1. The various effects
caused by the entrance of air into the veins, and the appearances found on
dissection. 2. Statement of facts, proving that the entrance of air by the
open mouths of the uterine veins may cause dangerous symptoms, and even
death. 3. Suggestions as to the prevention and treatment of such accidents
after parturition; with remarks upon the precautions required in injecting
the uterus after delivery for uterine haemorrhage. The opinion, that the
entrance of air into the uterine veins might be a source of danger and death
after parturition, had been enunciated by Legallois, in 1829, and subsequently
by Ollivier; it had likewise been supported by Dr. Cormack, in his Graduation
Thesis, published at Edinburgh in 1837. Dr. Cormack had attended cases,
in which air had been drawn into the womb after delivery by the sudden
39 2
590 REPORTS OF SOCIETIES.
relaxation of the organ; and occurrences of this kind, he supposed, must be
frequent. Dr. Cormack quoted Dr. Meigs' very graphic description of the
way in which air was often drawn in, and then expelled with noise by the
womb after delivery. Dr. Cormack wished to prove, that if any impediment
existed to prevent the exit of the air which had been drawn in, it must, when
the uterus acted, be thrown into the large orifices of the uterine veins, pro-
vided they were not secured by coagula, or by the apposition of their parietes
from contraction of the organ. He also showed, by anatomical facts, and by
referring to the experiments made by Dance, that the communication between
the cavity of the womb and the current of blood in the vena cava inferior,
was direct and easy, and that air, once introduced into the uterine veins,
must soon be carried to the right auricle of the heart; there, if in sufficient
quantity, to cause frothing of blood, aeriform distention of the right side of
the heart, obstruction of the pulmonary artery, and congestion of the pul-
monary capillaries. Cases of this kind had actually taken place. One had
been published by Lionet, and another by Wintrich. A case had also been
published by Dr. Bessems, in which air had been thrown accidentally into
the uterine veins, when injecting the uterus to arrest haemorrhage. The
woman died suddenly with symptoms of Suffocation, and the right side of the
heart was found distended with air. Dr. Cormack showed, by a detail of expe-
riments which he had performed, and also by cases, that the entrance of air
into the veins, even in considerable quantity, was not necessarily fatal. A
case, communicated by Sir B. C. Brodie to Dr. Cormack, illustrated this fact.
The general treatment for uterine haemorrhage, by inducing contraction of
the uterus, also plugging, would be the means by which the entrance of
air into the uterine veins would be prevented. Should the accident occur,
and the circulation and respiration become affected, and asphyxia be immi-
ment, it would be necessary to unload the heart and pulmonary capillaries,
by taking blood, following up the advantage so gained, by aspersion of the
face with cold water, the application of stimulating embrocations, sinapisms,
etc., and the internal use of various stimuli. Dr. Cormack stated, that in a case
which he had watched for some hours after the accidental entrance of a large
quantity of air into one of the veins of the neck, no advantage was got from
stimuli, till the heart had been somewhat relieved by venesection. This is the
case which occurred at Barnes, in 1848, and an account of the inquest on
which appeared at the time in the Lancet. In some cases, little or no treat-
ment might be required. If the air was in small quantity it would be absorbed,
if the patient survived a sufficient time, and no bad consequences might
ensue. At the same time, in some animals experimented on, Dr. Cormack had
found, that though they recovered from the immediate danger, they ultimately
died from pneumonia. The cases mentioned by Dr. Simpson, in a communi-
cation to the late Dr. John Reid, and published in his collected Memoirs,
were examined, and stated to belong to a different class from those of Bes-
sems, Lionet, and Wintrich. Letters were read from Dr. Collins, of Dublin,
and from Dr. Lever, of London, to Dr. Cormack. The former knew of no
cases of death from air entering the uterine veins; the latter had seen three.
SATURDAY, MARCH 30, 1850.
EDWARD WM. MURPHY, M.D., PRESIDENT, IN THE CHAIR. -
ON ECLAMPSIA NUTANS, OR SALAAM Convulsion. By DR. WILLSHIRE.
The author stated, in his introduction, that of this peculiar malady of child-
ren, only four well-authenticated and detailed cases were on record;1 and for
these, and our chief information concerning the affection, we were indebted
to Mr. Newnham, of Farnham.” He (Dr. Willshire) intended to add another
1 Two additional interesting cases, detailed by DR. FABER of Wartenberg, will be
found at p. 569 of this number. -
* MR. NEWNHAM's paper appeared in DR. CLAY's Obstetric Record, a periodical
which has been discontinued. - -
WESTMINSTER MEDICAL society. 591
case to the above; it had occurred in his practice at the Infirmary for Child-
ren, in an infant six months old. The primary, essential, or pathognomonic
sign of the disease in question, is a peculiar “ bowing” forward and down-
ward of the head, sometimes almost to touch the knees: this progressively
increases in frequency and severity, until the motion of the head becomes a
quick “nodding,” repeated even as many as one hundred and forty times
during the day, as in one of Mr. Newnham's cases, and in his own, fifty times.
Sooner or later, this so-called “Salaam Convulsion” becomes complicated
with more general automatic movements, sometimes of the epileptiform, at
other times of the tetanoid variety or type. The more severe attacks of the
“bowings” are generally preceded by sleep; and it has been noticed that their
severity has been in proportion to the depth and intensity of that sleep. As
the disease progresses, paralysis occurs either in the form of paraplegia or
hemiplegia, and, finally, complete mental imbecility or idiocy follows, or so
severe a shattering of the intellectual element, that it is recovered from but
slowly and with great difficulty. The case which had occurred to the author
of the paper differed in some important particulars, however, from those
related by Mr. Newnham. It agreed in the following points, viz.: in the
peculiar movement of the head; in that movement being observed to occur
immediately after sleep, and never, it was believed, during the somno-
lent condition; in that movement becoming allied, during the progress of
the malady, with an intercurrent form of general convulsive or automatic
action: in the marked effect which appeared to be produced upon the intel-
lectual powers. It differed in the following particulars, viz.: in not being
accompanied with paralysis in any form ; in not being followed, so far as
could be judged, by permanent injury to the intellectual element, or the
occurrence of a fatal result; and in being apparently influenced by what
seemed to be a right mode of treatment. The therapeutic means chiefly put
in force were, the application of blisters behind the ears, keeping the bowels
relaxed by castor oil, and the internal administration of the iodide of potas-
sium and the disulphate of quinine. After entering, with some detail, into
the pathology of the disease, and its relation to presumable centric and ex-
centric causes in respect to the nervous centres and the peripheral nervous
system, the author stated, that he considered it probable, that the disease was
purely centric in its origin, having its first seat in the sensorium, or in those
important parts placed between what are termed, by Mr. Solly, the “hemi-
spheric ganglia” and the top of the spinal chord ; and that afterwards the
lower, or non-sensorial, portion of the spinal apparatus was affected, as proved
by the general automatic movements being, in some cases, of a decided tetanoid
character. In others, these movements were distinctly epileptiform ; and,
moreover, hemiplegia had followed; the former circumstance still further
indicating, as the seat of mischief, the assemblage of ganglionic centres
between the cerebrum and spinal chord; whilst the latter and the Supervening
affection, or obliteration, of the intellectual powers, appeared to prove the
secondary involvement of the great, “hemispheric lobes.”. In one of the
cases alluded to by Mr. Newnham, there was reason for believing that the
hemispheres, or lateral lobes of the cerebellum, were specially included in
the cycle of lesional disturbance. As to what may be the nature of this dis-
turbance, wheresoever it may be primitively situated, and whatsoever it may
secondarily draw within its sphere, much doubt must exist, seeing that no
post-mortem investigations had hitherto been made. Mr. Newnham inclined
to the opinion, that the essential character of the malady was inflammatory
action, of a weak and strumous nature, of the membranes investing the me-
dulla oblongata, afterwards extending to other parts. Dr. W. thought that
it may be a change in the circulation of the minute vessels, and this of a
scrofulous character; following upon which change, there occurred alterations
of structures, deposits upon or in them, and conditions in the nutritive forma-
tion and reparation of the nervous centres, not only little compatible with

592 REPORTS OF SOCIETIES.
the performance of their normal actions, but, in truth, causative of others
intensely abnormal in their character. -
SATURDAY, APRIL 6, 1850. -
EDWARD WILLIAM MURPHY, M.D., PRESIDENT, IN THE CHAIR.
PRESUMED FREQUENCY OF ULCERATION of THE Os AND CERVIx UTERI.
BY TYLER SMITH, M.D.. [We give the whole of this paper, and also Dr.
Bennet's reply at p. 587, because the subjects discussed are at present exciting
much controversy and comment in London. Our opinions regarding the
speculum, will be found at p. 650 and 1031 of vol. for 1849.] “MR. WHITE-
HEAD, of Manchester, in his work on Abortion and Sterility, states, that of
2,000 women whose cases he investigated, on their application to the Man-
chester Lying-in Hospital, 1,116 had the whites at the time the inquiry was
made, and a considerable number more had suffered under a similar ailment
at some former period. In 936, or eighty-three per cent., the discharge bore
undoubted evidence of the presence of pus, or of sanies; and in some instances,
it was more or less mixed with blood.’ Mr. Whitehead traces these discharges
to “disease of the lower part of the uterus, this disease being found to exist
in almost every instance ; and he further declares, that “this lesion of struc-
ture constitutes the true pathological seat of leucorrhoea, and of all its asso-
ciated phenomena.’
“DR. HENRY BENNET states, in his recent work on “Inflammation of the
Uterus and its Appendages, and on Ulceration and Induration of the Neck of
the Uterus', that of three hundred cases presenting ‘uterine symptoms',
among the patients of the Western Dispensary, he found that ‘243 were
suffering from decided inflammatory disease of the cervix, or its cavity; and
that in 222 ulceration was present.” Thus, in Mr. Whitehead's cases, in 936
out of 1116 cases of leucorrhoea, the discharge was purulent or ulcerative ;
and in Dr. Henry Bennet's cases, 222 out of 300, or more than two-thirds,
were also suffering from uterine ulceration. Dr. Bennet states, that the same
proportions are preserved in the cases he has treated in private practice.
“It is well known that this is widely at variance with the experience of
previous observers in this country. Does this discrepancy arise from the
superior modes of investigation adopted by the authors I have quoted 7 or,
does it happen from some misapprehension as to what really constitutes
ulceration of the Os and Cervix Uteri ? Is there simply some mistake about
the nature of ulceration ; or is the difference explained by the more general
use of the speculum ?
“Practising as a physician-accoucheur, Imust get the same class of patients
as those treated by Mr. Whitehead and by Dr. Bennet. I am in the habit of
using the speculum in cases of obstinate leucorrhoea in married females, and
I trust with a desire to observe truly and faithfully ; but I do not myself find
uterine ulceration—at least not what seems to me to warrant this term—so fre-
quently as Dr. Bennet, Mr. Whitehead, and some other gentlemen who have
written upon the subject, in leucorrhoeal cases—purulent or muco-purulent.
I find inflammation, engorgement, induration, excoriation, patches of aphtha,
epithelial abrasions, and granulations often enough, but very seldom what I
could call ulceration, in non-malignant and non-syphilitic cases.
“The clearest description I can find of the so-called ulceration, is in Dr.
Bennet's work (pages 102 and 103), which I take the liberty of extracting,
and certain expressions in which I have italicised: it occurs under the head-
ing—‘Inflammatory Ulceration.—Inflammation may exist for years in the
cervix and its cavity, without giving rise to any other anatomical changes
than those which have been enumerated. This, however, is seldom the case.
The mucous membrane lining these regions, and more especially that portion
of it which is near the os, appears to be peculiarly liable to take on ulcerative
action. Consequently, the existence of inflammation in the great majority of
2nstances is soon followed by the manifestation of the ulcerative process.
~.
WESTM INSTER MEDICAL SOCIETY. 593
Ulceration generally appears first round the os, and just within the cavity of
the cervix. Many different forms or species of ulceration are described by
continental writers, but, in my opinion, without necessity or advantage. An
ulceration occupying the Cervix Uteri may present all the various modifica-
tions, which suppurating surfaces offer in any other part of the body, from the
minute granulations of a slight abrasion, to the livid vegetations of an un-
healthy sore ; but these modifiations of the ulceration require in reality no
division or classification.’
“‘When an abrasion or excoriation only is present, the cervix is generally
of a vivid red, and the granulations are often so minute, that it is at first
difficult to ascertain whether the mucous membrane is abraded or merely con-
gested, or to perceive the limit of the ulceration when once it has been
ascertained to exist. The doubt, however, may be solved by lightly touching
the suspected surface with the nitrate of silver. The abrasion immediately
assumes a much whiter hue than the region which is merely congested, and
its margin becomes well defined and evident. An abraded or excoriated con-
dition of the mucous surface is generally the form wºnder which ulceration
presents itself in the cavity of the cervia, granulations of any size being seldom
met with in this region.
“‘In its more decided form, Ulceration of the Cervix Uteri is susceptible
of presenting every possible variety. The granulations may be firm, of a
vivid red hue, scarcely bleeding on pressure, or they may be large, fungous,
livid, and bleeding profusely at the slightest touch. These fungous ulcera-
tions are generally connected with torpor of the local circulation ; when they
are present, the congestion of the vagina and cervix is often very great, of a
livid venous character, and the non-ulcerated surface of the cervix may pre-
sent dilated varicose veins.”
“Now, this portrait, the general fidelity of which I admit, does not appear
to me to warrant the profuse use of the term ‘ulceration,’ which in itself,
and when applied to other parts of the body, has a definite and unmistake-
able meaning. It cannot truly be said, that mere abrasions or excoriations
caused by irritating leucorrhoeal discharges, are “ulcerations.” We do not
call the excoriation which occurs from similar causes in other parts of the
body ulceration.” . We do not call granulations upon mucous membranes
‘ ulcerations,’ whether they secrete mucus or pus, or whether they bleed or
not upon mechanical irritation. If we analyse this important passage closely,
we shall find that granulations at the os and cervix uteri is the strongest
fact testified to in support of the theory of ‘ulceration.” Dr. Bennet states,
that “an ulceration occupying the cervix uteri may present all the various
modifications which suppurating surfaces offer in any other part of the body,
from the minute granulations of a slight abrasion, to the livid granulations
of an unhealthy sore.’ But, immediately afterwards, he negatives this by
adding, ‘An abraded or excoriated condition of the mucous membrane is
generally the ſº under which ulceration presents itself in the cavity of the
cervix, granulations of any size being very seldom met with in this region.’
Thus, it is evident, that even in the absence of granulations, Dr. Bennet
calls ‘an abraded or excoriated condition” a “form’ of ‘ulceration.” From
his own descriptions, it is evident that Dr. Bennet classes abrasions, excoria-
tions, and granulations together, as forms of ulceration,--a proceeding which,
it appears to me, is utterly opposed to all sound pathology. . In this way we
may explain the great frequency, with which ulceration of the os and cervix
uteri is declared to be met with.
“If we consider excoriation or abrasion as genuine ulceration, probably no
woman ever passes through life without suffering from this form of disease.
In the virgin uterus, the circulation is frequently modified by the recurrence
of menstruation, ovarian irritation, mental emotion, the varying conditions
of the bladder and rectum; and in constitutional ailments, the vaginal and
uterine secretions, in common with the other secretions of the body, are fre-
594 REPORTS OF SOCIETIES.
quently depraved. Excoriation and abrasion of the mucous membranes are
easily accounted for under such circumstances. Menstruation alone, in the
turgidity of the uterus and ovaria, before the catamenial flow is established;
in the exudation of blood from the surface of the uterus; and in the perfora-
tion of the peritonaeal membrane for the elimination of the ovule from the
ovary, trenches very nearly upon pathology. The slightest divergence from
the ordinary function merges into disease. -
“In married women, and in those who have borne children, other prejudicial
causes, in addition to these, are in operation; such are the mechanical irri-
tation of coitus, the risk of lacerations of the os uteri during the passage of
the child in parturition, and the state of the uterine orifice which obtains
after labour, and the return of the organ to quiescence. After labour, the
orifice of the uterus does not contract smoothly, so as to leave the os uteri
regular and even, but it becomes puckered and contracted unevenly. In
irritable conditions of the mucous membrane of the uterus and vagina, or in
a morbid state of the utero-vaginal secretions, these folds or corrugations are
very liable to be chapped or excoriated, and I believe this is often mistaken
for ulceration. All these, and other causes which I might enumerate, ex-
plain the frequency with which the os uteri deviates, in colour, form, and
secretion, from the strictly healthy standard. In fact, we may compare the
upper part of the vagina to the fauces, which is seldom found perfectly
healthy in any subject who may be examined. Some of the indurations and
enlargements of the os and cervix uteri appear to resemble enlarged tonsils,
and, like them, to increase in size without any amount of active inflammation.
“The granulations which are sometimes found surrounding the os uteri—
which may secrete mucus or pus abundantly, and which may bleed on being.
roughly handled—are, I have no doubt, the result of inflammation ; but they
resemble the granular state of the conjunctiva, rather than the granulations
of a true ulcer, the granular os uteri offering no edges or signs of solution of
continuity, by which we might satisfactorily declare it to be an ulcer. The
granular os uter would be a more correct designation, in such cases, than
“ulceration’ of the os uteri. Some of the so-called ulcerations appear to be
nothing more than patches of thickened epithelium, or portions of the os and
cervix, from which the epithelium has been melted away by acrid or irritating
secretions. We can imitate this condition of the parts by the slight applica-
tion of the nitrate of silver—sufficient to affect the epithelial covering, but
not sufficient to injure the mucous membrane beneath.
“It appears to me, that we can neither receive the existence of excoriation
or abrasion, of granulation or fungous growths, of the secretion of pus or
muco-purulent matter, as affording undeniable evidence of the existence of
‘ulceration' of the os and cervix uteri. We must try ulceration in this
part of the body, by the same tests which we apply to ulcers in other parts
of the economy. We must look for a solution of continuity, with a secreting
surface, separated from the healthy structures, having defined edges, everted
or inverted,—for an ulcer, in fact, in the common pathological meaning of
the term. We find ulcers having these characters in the air-passages, mouth,
stomach, intestines, bladder, and other mucous surfaces. There is no mis-
taking the characters of an intestinal ulcer after dysentery, and there ought
to be no mistake about an ulcer of the uterus. Indeed, in the corroding
ulcer of the uterus, we unfortunately see that this organ is but too capable of
taking on all the qualities of ulceration, in a degree only equalled by its ex-
traordinary vitality, the organ being scooped out, or eaten away, in a com-
paratively short space of time. Cases are also met with, in which the OS uteri
has been destroyed by the sloughing ulceration, and loss of structure, some-
times following the application of the more powerful caustic agents. We
are, however, called upon, by the unlimited believers in uterine ulceration,
to admit that ulcerative disease may exist for years, in its common form,
without any perforation, excoriation, serious loss of substance, or altered con-
WESTM INSTER MEDICAL SOCIETY. 595
figuration. Whether we test the so-called ulceration of the uterus by ulce-
ration occurring in other mucous surfaces, or in the uterus itself under
undoubtedly ulcerative disease, the distinctive characteristics are wanting
in the great majority of cases; and they certainly are not found, unless I am
most egregiously mistaken, in the enormous proportion of 222 cases of ulce-
ration to 300 cases of promiscuous uterine disease. -
“In all that I have said, I do not wish it to be supposed that I question the
frequency of irritation, chronic inflammation, and subacute inflammation, in
connexion with leucorrhoea ; recent writers would, however, treat leucor-
rhoea merely and solely as a symptom, not as an independent disorder.
But I am well assured that it is often the disease itself, or at least all.
of it that we can appreciate ; and that the irritable or inflammatory
condition is excited secondarily, and mainly, by the morbid leucorrhoeal
secretion. Some change in the innervation or nutrition of the organ oc-
curs; or it sympathizes with a malady in some remote organ, and the secre-
tions are consequently depraved. These depraved secretions irritate the
surfaces with which they come in contact, and produce the visible signs of
irritation or inflammatory action. We see these discharges sometimes in-
flame and excoriate even the external integument, but we should never
dream of saying that the inflamed condition of the skin was the essential part
of the disorder. The same observation applies to the uterus. Thus it is not
pathological, nor useful, always to consider leucorrhoea as a mere symptom;
and the old plan of astringent injections, though sometimes mischievous,
cannot quite be dispensed with ; for in some, even profuse leucorrhoeas, an
astringent injection, by arresting the utero-vaginal discharges, does more
than any other plan to soothe inflammatory conditions, or rather, to suspend
their causes.
“Notwithstanding the use of the speculum,_notwithstanding the use of
lamps and glasses, there is often considerable difficulty in ascertaining the
precise condition of the cavity of the uterine cervix, engorged as it is, and
deep in colour from irritation, or other disease, and from the interruption to
the circulation in the uterine organs, which is almost necessarily dependent
on the introduction and expansion of the speculum within the vagina. But
in the dead subject no such difficulties exist; and it might certainly be ex-
pected, since leucorrhoea is a malady so very common, that uterine ulceration
would be frequently revealed by post-mortem examinations. The only place
in which, so far as I am aware, post-mortem examinations have been con-
ducted in considerable numbers, with special reference to the determination
of the frequency or infrequency of ulceration of the os and cervix uteri, is at
St. George's Hospital. For several years past, the condition of the uterus
has been examined with great minuteness and accuracy in the dead subject
at this hospital. -
“Mr. Pollock, one of the lecturers on Anatomy at St. George's Hospital,
informs me, that for more than three years during which he was Curator to
the hospital museum, he examined the uterus, internally and externally, in
all the female subjects in the dead-house. During this time, upwards of 100
women died in the hospital annually. In each case, the uterus was laid
open, and carefully inspected. Mr. Pollock only detected actual and unmis-
takeable ulceration in four cases. Of these, three were scrofulous subjects,
and scrofulous ulceration existed in other parts of the body; and in one of
them, the ulceration involved the vagina extensively, as well as the os uteri.
“Mr. Gray, who succeeded Mr. Pollock as Curator, informs me that, during
his curatorship, he examined the bodies of 180 women, who had died of all
diseases in St. George's Hospital, with a distinct view to ascertain the pro-
portion of cases in which ulceration of the uterus existed. These examina-
tions were also conducted with great care and minuteness. Out of the 180
subjects, distinct ulceration of the os and cervix was found in only three in-
stances. Slight abrasions, discolorations, and granulations were frequently

596 REPORTS OF SOCIETIES.
observed ; and this accords with the observations of Mr. Pollock. One or two
other curators to St. George's Hospital, besides Mr. Pollock and Mr. Gray,
have arrived at the same results. . It is only by pathological investigations
of this kind that we can arrive at infallible results.
“But, it may be asked, why bestow so much pains on proving that abrasion,
excoriation, and ulceration are not ulceration ? Why dispute as to terms ?
Simply because a name rules treatment, and because the name of ‘ulcera-
tion’ being first given, an heroical treatment, not without danger, is fre-
quently resorted to where milder local applications or constitutional treat-
ment would be equally efficacious. After Mr. Abernethy wrote his celebrated
work on the Constitutional Treatment of Local Disease, his idea was pushed
to its extreme, and local remedies were often most improperly neglected.
Now, in all that relates to the uterine organs, the doctrines of Mr. Abernethy
are in danger of being entirely refuted, and we are in some risk of utterly
neglecting constitutional treatment, and of being entirely absorbed by local
applications. This we cannot do, without impeding the improvement of the
treatment of this class of affections. When a patient is told she has an ulce-
ration of the womb, she often thinks of an ulcer of the leg, or the cheek, etc.,
and is proportionably frightened, because of the importance of the organ
which is the seat of the presumed disease. There is nothing women will not
submit to, to be freed from such a dire malady. At the present time a verit-
able uterine panic affects the upper and middle classes of society, and every
woman with the slightest ache, or discharge, is not satisfied until the peccant
organ has been ocularly inspected. I do not believe that this state of things,
or its inevitable results, will conduce to the dignity and respectability of our
profession. I do not hesitate to affirm, so far as I have eyes to observe and
a judgment to weigh facts, that much exaggeration prevails respecting the
frequency of this same ulceration of the os and cervix uteri—an exaggeration
which should be calmed, so that the legitimate methods of examination
may lead, not to a suspicion of our profession, but to a real improvement in
the diagnosis and treatment of uterine disease, as it actually exists. We
cannot safely repudiate either the local or the constitutional treatment of
uterine disease. I have seen cases, in which the local ailment has been as
far as possible cured ; nevertheless, the constitutional symptoms remained
unrelieved. I have seen others, in which judicious constitutional treatment
has cured the local malady without any topical treatment whatever. But in
the combat against disease, we require both constitutional and local weapons;
and any views which will disparage either the one or the other, must cripple
the resources of our art.”
MR. HIRD said, that specular examinations, in women of all ages, were
carried, at the present day, to an unnecessary, indeed to a most unwarrantable
extent. He could not believe in the common existence of ulcers in the os
and cervix,−genuine ulcers with loss of substance, and inverted or everted
edges. Caustic was too indiscriminately used. In two cases to which he had
been called, the application of nitrate of silver had produced the most serious
mischief.
DR. TILT did not believe that any one, familiar with uterine disease, would
#. *tie. in such a manner as to produce the evils described by Mr.
II’C.
DR. JAMES REID believed that many of the cases now treated so heroically,
would do well by the use of astringents. He had seen great benefit result
from the application of a strong solution of the diacetate of lead to the os
and cervix uteri.
DR. KING related several cases, in which the use of the speculum was of
great service. He objected very strongly to its use in the virgin.
MR. CHIPPENDALE said, that from large experience, he could aver, that
cases of leucorrhoea generally did well under the use of common injections.
DR. MURPHY, in the absence of Dr. Henry Bennet, would state, that
WESTMINSTER MEDICAL SOCIETY. 597
although the affections of the uterus commonly met with, were granulations
and abrasions (such as those which Dr. Smith believed were mistaken for
ulceration), yet they required the application of caustic remedies, and would
get well under no other treatment. He thought that all the censure which
had been lavished on the speculum, applied to its use, and not to its abuse.
Its proper use never involved any indecent exposure. Much stress had been
laid on the post-mortem appearances, and the absence of the signs of ulcera-
tion after death. He could readily conceive, that the raised appearances seen
in leucorrhoea, and the congested and indurated surface, might quite dis-
appear in the dead subject. At the same time, he must admit, that if a
positive ulcer, with loss of substance and distinct edges were required, he
was certain that such an ulcer was not a common affection of the uterus.
DR. TYLER SMITH having made a few remarks, the Society adjourned.
SATURDAY, APRIL 13, 1850.
EDWARD WM. MURPHY, M.D., PRESIDENT, IN THE CHAIR.
PERFORATING ULCER OF THE STOMACH : DISEASE of ARTERIES, KIDNEYs,
ETC. CASE RELATED BY DR. TAYLOR. John Dynes, aged fifty-three, was
admitted as a patient of the St. Pancras Royal General Dispensary, April 2nd,
complaining of cough, dyspnoea, and dropsical swelling of the legs. He
informed Dr. T. that seven years ago he had an attack of rheumatic gout in
the right knee, which confined him to bed for three weeks. For the last two
years and a half he has suffered from gradually increasing cough, dyspnoea,
and occasional palpitation, much increased by exertion; and within the
last twelve months he has been unusually drowsy, frequently falling asleep
during the day. Six weeks ago, after exposure to wet, he became much
worse: the dyspnoea increased to such an extent as to prevent him from lying
down night or day ; the cough was constant, and accompanied with copious
frothy expectoration ; and the legs and thighs began to swell ; the chest was
dull on percussion, from the level of the third rib, on the left side, as far as
the stomach ; the dulness extended two inches to the right of the sternum,
and completely round the lower part of the chest, for two or three inches
above the attachments of the diaphragm ; the natural sounds of the heart
were replaced by a very loud and harsh double murmur, extensively audible
over the front of the chest : the first murmur was propagated upwards, and
was very loud in the neck; the second was most intense at the base and apex
of the heart. While examining the chest, I found that he had slight tender-
mess of the epigastrium ; and upon questioning him further, he told me that
for the last few weeks he had had occasional pain in this region, darting
through to the left scapula. Early on the morning of the 7th, he was seized
with vomiting of blood. In the course of a few hours, he had vomited suffi-
cient to fill a large wash-hand basin, and he died in about eight hours after
the commencement of the haemorrhage.
April 9th. Autopsy. The cavity of the pleura on each side contained
about six ounces of clear serum, and the lungs were emphysematous. The
heart was considerably enlarged, pale and flabby; it was covered with nume-
rous white spots and streaks, especially in the track of the coronary vessels.
The walls of both ventricles were much thickened ; the columnae carneae
were hypertrophied, and the cordae tendineae were thick and rigid. The
septum, towards the base of the heart, was an inch and a half in thickness.
There were some thickening and deposit on the margins of the mitral valves.
The right auricle and auriculo-ventricular orifice were much dilated. Two of
the aortic valves were consolidated into one large, irregular, bony mass, so as
nearly to block up the aortic opening; the third, which was also the seat of
a large bony deposit, was partly separated from its attachment to the aorta,
leaving an aperture through which the circulation had been in part carried
on, as was shown by a clot of blood which it entangled. The stomach was
distended with coagulated blood. Two inches and a half from the pylorus,

598 REPORTS OF SOCIETIES.
on the lesser curvature, there was a large, excavated, circular ulcer, an inch
in diameter, with smooth and regular edges. This had completely destroyed
the rhucous and muscular coats of the stomach, and penetrated the coronary
vein, thus giving rise to the hamorrhage which was the immediate cause of
death. The liver was small, and presented some fatty deposit in its structure.
Both kidneys were in an advanced stage of Bright's disease. On closely
questioning the friends of the deceased, Dr. Taylor learned, that for the last
year and a half he had occasionally complained of uneasy sensations in the
stomach ; these, however, were so slight as not to attract much attention, and
do not appear to have amounted to pain till within five weeks of his death.
Even then, had the epigastric tenderness not been discovered, he would not
have considered it as worth mentioning. Till within two days of his death, his
appetite was good, and he never suffered from vomiting or increase of pain
after eating. Previous to the attack of rheumatism, he had been in the habit
of drinking beer rather freely, but very seldom to intoxication. For the last
four or five years, he had been very abstemious. -
HEALTH of London DURING THE SIx MonTEIS ENDING 30TH MARCH 1850.
By John WEBSTER, M.D., F.R.S. This paper appears entire, as an original
article, at p. 540 of this number. -
SATURDAY, APRIL 20, 1850.
EDWARD W.M. MURPHY, M.D. PRESIDENT, IN THE CHAIR.
WALvULAR MALFoRMATION OF THE HEART IN A MAN WHO DIED OF Con-
FLUENT SMALL-Pox on THE FOURTH DAY of THE ERUPTION:—AND ABOUT
TEN wºrks AFTER RECEIVING A BLow. By MR. J. F. MARSoN. Edward
Walker, aet. 41, was admitted at the Small-Pox Hospital, on the 9th of
April, 1850, with confluent small-pox, on the second day of eruption. Ten
weeks ago, he was struck over the pit of the stomach, by the pole of a van,
and two hours afterwards he began to have palpitation of the heart, which
continued more or less ever after. During the first fortnight, he went on
with his work, under medical care, and subsequently became a patient at
St. George's Hospital. His health having improved there, he returned to
work for nearly a fortnight, when he was attacked by small-pox. On ad-
mission at the Small-Pox Hospital, he was unable to lie down in bed, from
the great disturbance of the heart ; his pulse at the wrist was extremely
irregular, no three consecutive beats being alike, and 120 in a minute. On
examining the heart with the stethoscope, it was found pulsating with
great violence, and very irregularly, and might be heard over a considerable
part of the chest. He died on the fourth day of the eruption of small-pox.
The patient attributed the disease of his heart entirely to the blow he
received ; he had never had rheumatism.
Autopsy. The heart was greatly enlarged, and weighed twenty-one ounces,
when separated from the pericardium ; the lungs were very much gorged
with blood, but otherwise healthy; the liver was not enlarged ; the aorta was
healthy. From a table given of the average weight of hearts, in the last edi-
tion of Quain's Anatomy, (vol. ii. p. 1124) from an extensive examination of
healthy hearts, made by Drs. Clendinning and Reid, it appeared that the
weight, as given by them, was nine and a half ounces, by the former writer,
ten and a half ounces by the latter, of men at forty years of age ; so that
this heart was double the weight of a healthy heart. The man was six feet
four inches in height, well-proportioned, and not stout. There was cartilagi-
mous deposit at the base of the mitral valve. Instead of three, there were
only two valves situated at the commencement of the aorta ; this seemed to
have been an original malformation. The edges of the aortic valves were
thickened, having some cartilaginous deposit in them, especially where they
met at one end. The valves on the right side of the heart were healthy.
[The heart was exhibited.] ~. -
WESTMINSTER MEDICAL SOCIETY. - 599
DR. LANKESTER said that the tables of the weight of the heart, referred to
by the author, did not mention the height of the individuals; and judging
from the researches of Mr. Hutchinson into the relation of the lungs to the
stature of the person, it might be concluded that the heart of a man of six
feet four inches ought to weigh 21 ounces.
OBSERVATIONS ON somE REMARKABLE CASEs of HystERIA. By DR. F. R.
MANSON.
SATURDAY, APRIL 27, 1850.
EDWARD WM. MURPHY, M.D., PRESIDENT, IN THE CHAIR.
CASE OF HYSTERIA (INSANITY }) IN THE MALE, IN WEHICH BoſTH TESTICLES
were REMOVED successFULLY. By DR. CHowNE. [These unjustifiable opera-
tions were not performed by Dr. Chowne.]
PHospitate of AMMONIA IN THE TREATMENT of GouT AND RHEUMATISM.
By DR. EDWARDS. -
t SATURDAY, MAY 4, 1850.
Edward W.M. MURPHY, M.D., PRESIDENT, IN THE CHAIR.
DISEASE of THE ARTERIES OF THE BRAIN ; GREAT WENous CoNGESTION OF
THE THORACIC AND ABDOMINAL WISCERA, IN A GENTIEMAN who DIED WITH
SYMPTOMs of APOPLEXY. By DR. CoRMACK. DR. CoRMACK remarked that
cases, such as that which he was going to describe, were not of unfrequent
occurrence in practice ; but yet they were sufficiently interesting to justify
a short description, in connection with the recent preparations which he exhi-
bited. Scarpa, Cortesius, Morgagni, Abercrombie, Cruveilhier, Dr. Bright,
and, more recently, Mr. Paget and others, have illustrated the connexion
which exists between disease of the cerebral arteries and apoplexy ; and in
the Edinburgh Monthly Journal for June 1842, Dr. Cormack described a case
of disease of the arteries of the brain, which he had seen with Dr. John Camp-
bell and the late Dr. Abercrombie of Edinburgh. In that, as in too many
similar cases, the post-mortem observations were confined to the head.
CASE. D. G., a person in good health and comfortable circumstances, was,
two years and a half ago, when in his seventy-eighth year, attacked with
hemiplegia; since which time he had no power in the right arm, and very
little in the right leg. The power of speech, which was at first much affected,
was soon perfectly restored. His mind and memory became much impaired ;
but, if trifling ailments be left out of consideration, it may be said, that he
went on for two years and three months pretty comfortably,–eating heartily,
and sleeping soundly. About the beginning of March, he was observed to
be in an unsatisfactory state, though he made no complaint of illness. He
was generally drowsy : the paralytic side seemed to have lost the strength
which it had regained ; he had frequently, for days at a time, incontinence
of urine ; he often lost consciousness for several minutes at a time; and occa-
sionally, but especially on waking from sleep, he talked deliriously, but was
generally, by conversation, restored to mental tranquillity. Dr. Cormack was
first consulted on the 24th of April, principally on account of his imperfect
respiration, extreme drowsiness, and incoherent conversation. The symp-
toms had suddenly become very urgent. , Dr. Cormack found him sitting on
an easy chair, with a feeble pulse, somewhat contracted pupils, and a vacant
bewildered expression of countenance. It was difficult to engage his atten-
tion; but, as the reward of some trouble, pertinent answers were obtained to
a few questions. His voice was feeble, and his chest expanded very imper-
fectly at each inspiration. He frequently put his hand to his head as if in
pain; but uniformly stated, when asked, that he had no pain there or else-
where. His condition at this time is best described by the word torpor. The
treatment consisted of aperients by the mouth and rectum, a mustard bath
to the legs, and a blister to the chest. Next morning, he was decidedly more
600 REPORTS OF SOCIETIES.
alive, and complained, without being asked, of griping pains in the bowels, as
well as of some headache ; he also said that the blister, which had risen well,
caused great discomfort to him. During that day, he took a small quantity
of beef-tea; and to relieve the chest from the accumulation of mucus, one
or two doses of an expectorant mixture were given. On the following day,
the torpor returned; but the urine continued to flow in natural quantity, till
it suddenly became entirely suppressed, and, during the last twenty-four
hours of his existence, there was not more than a tablespoonful in the urinal.
On the 28th, a large blister was applied to the nape of the neck; but it did
him no good. His respiration became slower and slower, and the chest ex-
panded very imperfectly. Soon after the flow of urine ceased, he fell asleep;
and this sleep passed into death about noon on the 29th. For some hours
before death, a fetid and unctuous discharge was visible on the skin all over
the body. During the first part of his last sleep, the palsied limbs became
flaccid ; but, shortly before death, they again became rigid. The hand
was firmly clenched. The eyelids, but especially the left, were so firmly
shut, as to be difficult to open; and the jaws were immoveably locked.
Post-mortem. Eacamination, forty-eight hours after Death. There was no ap-
pearance of decomposition. Ayery considerable deposit of fat existed evéry-
where. Head. There was great venous congestion of the encephalon ; the
greater part of the hemispheres of the cerebrum were of natural consistence ;
but a portion of the base, and the cerebellum, were soft and pulpy. No
apoplectic clot, nor any tumour, was found. The choroid plexus had a gritty
feel, as if it contained particles of sand. The coats of the cerebral arteries
of all sizes were studded with calcareous deposit, which surrounded some
parts of the larger vessels in their entire circumference. The vessels in the
upper part of the cerebrum appeared least diseased. Chest. The lungs were
chiefly remarkable for their great sanguineous engorgement. The upper lobe
of the left lung adhered firmly to the costal pleura anteriorly; and in its
superior part, there was a calcareous deposit as large as a shilling. The right
lung was adherent posteriorly to the walls of the chest, but was free anteriorly.
The heart was large, of somewhat paler appearance than usual, and loaded
with adipose tissue. Upon making a careful microscopic examination of the
tissue of this organ, it was evident that there was no fatty degeneration. The
valves were all competent, even though in the aortic valves there was some
calcareous deposit. The heart weighed fifteen and a half ounces, Abdomen.
The liver was dense, but not cirrhosed. The gall-bladder was much thickened,
and contained no bile. The spleen was hard, and rough ; and in one place, it
was much puckered ; where there was also a dense mass of contractile tissue
of almost cartilaginous consistence. The mesenteric veins, and the whole vas-
cular net-work of the intestines, were turgid with blood. Kidneys. The con-
gestion described in other organs was still more striking in the kidneys.
The tubular portion of the left, when bisected, presented a black and almost
glistening appearance, of which some idea may be formed by comparing it
to tar, or printer's ink. The cortical portion was also of deeper colour than
natural, and contained several inky spots—extravasated blood. The left
kidney contained a cyst of about the size of a large walnut. The right
kidney was congested, but in a less degree than the left.
REMARKs. Dr. Cormack thought that this was a case, in which death
arose from all the functions being gradually arrested by deficient vital energy,
consequent upon death of that portion of the brain which was found in a
softened state; that condition of the brain, again, being caused by the athe-
romatous condition of the arteries. “Pathological anatomy has furnished
very striking illustrations of the effect produced by atheromatous deposit in
arteries, upon the organs they supply. It has been stated, that in the smaller
arteries the atheromatous mass is deposited in such wise, as to occasion more
or less coarctation. This is most frequently observed in the arteries of the
leg, of the brain (especially in the arteriae fossae Sylvii), and of the heart, and
WESTMINSTER MEDICAL SOCIETY. 601
it is accompanied at certain points by ossification of the arterial walls. These
circumstances combined serve to diminish, and, if the stoppages happen in
several branches at once, entirely to cut off the supply of blood—the natural
consequence of which is atrophy, and eventual mortification of the parts im-
plicated. . . . . Many instances of gangrene of the lower extremities, and a
certain form of cerebral softening, are probably due to a similar cause.””
In the case of D. G., the diminished sensibility, the absence of pain, the
sanguineous congestion of the kidneys and other organs, were ascribed by
Dr. Cormack to the cerebral softening. The respiration was primarily in-
fluenced by the diseased state of the brain; and the deficient aeration of the
blood must, in turn, have caused an increase in the severity of the cerebral
symptoms. The immediate cause of the cessation of the function of the
kidneys was their engorgement. The calcareous deposit in the lungs, the
pleural adhesions, and the cyst in the kidney, were evidently not connected
with his paralytic seizure, or fatal illness.
ON ENTROPIUM. By HAYNEs WALTon, Esq. M.R. WALTON considered En-
tropium to be produced by the abnormal action of a portion of the orbicularis
palpebrarum muscle, situated on the free edge of the tarsal cartilage, for
about two and a half lines. This portion of muscle was thicker than any
other part, and its fibres were more compact and redder : it did not appear
to have been described by any author. The operation proposed by Mr. Walton,
as suitable for those cases commonly met with, consisted in removing this
portion of the muscle, with a sufficient quantity of the skin of the lid as
would, by the tension arising from its loss, overcome the bending or curving
of the tarsal cartilage produced by the unnatural action of the ciliary muscular
fibres. He made an incision along the edge of the tarsus, and close to its
cuticular margin, from one angle of the lid to the other, and a second nearly
parallel to it, about three lines distant, and joining it at the extremities. In
both, he carried the point of the knife at once through the skin and muscle
down to the cartilage ; he then raised one of the angles of the flap, and dis-
sected off the skin and muscle at the same time, by vertical strokes of the
knife, taking care that the cartilage was completely bared. He then brought
the edges of the wound together by two or three sutures. Mr. Walton had
performed the operation with good results in fifteen instances.
OBSERVATIONs on THE DISEASE USUALLY GALLED PUERPERAL FEVER.
By DR. LIGHTFoot.
A. YoUTH witHouT A STERNUM. DR. CHowNE exhibited and described
this interesting person, who has now been seen by vast numbers of the pro-
fession.
SATURDAY, 11TH MAY, 1850.
Edward W.M. MURPHY, M.D., PRESIDENT, IN THE CHAIR.
NoMINATION OF OFFICE-BEARERs. In accordance with the terms of union
adopted at a Special Meeting held on the 18th April, the Westminster
Society had the right of electing as office-bearers of the amalgamated
Societies two Vice-Presidents, ten Members of a Council, and a Secretary ;
and the following gentlemen were proposed for these offices, to be balloted
for at next meeting. As Vice-Presidents, Dr. Garrod, Mr. Clarke, Dr. Lan-
kester, and Mr. J. F. Marson. As Councillors, Dr. E. W. Murphy, Mr. H. H.
Walton, Dr. F. Sibson, Dr. J. R. Cormack, Dr. F. R. Manson, Dr. Tyler
Smith, Mr. W. Harvey, Mr. W. Harding, Mr. R. Greenhalgh, Dr. Samuel
W. J. Merriman, Mr. B. Travers, Jun., Dr. T. H. Tanner, Dr. W. R. Rogers,
Dr. Henry Bennet, Mr. J. F. Marson, Dr. E. Lankester, Mr. J. Chippendale,
and Mr. E. Canton. . As Secretary, Dr. Routh. [The Medical Society of
London have the right of electing from their body the first President of
the United Societies, also the Librarian, two Vice-Presidents, the Coun-
cillors, and a Secretary.] -
* HASSE's Pathological Anatomy. Trans. in Sydenham Society, pp. 82-3.
602 REPORTS OF SOCIETIES.
METHOD of DETECTING CHLoRoroRM IN THE BLooD. By DR. John
SNow. DR. SNow placed on the table the apparatus, which he used for de-
tecting the presence of chloroform in the dead body. He said that the pro-
cess was a modification of that described in the Journal de Chimie Médicale
for March 1849. The blood or portion of the body to be examined was put
into a flask, from which there proceeded a tube, which was made red-hot in
part of its course. Another glass tube, attached to the extremity of the
latter, was moistened inside with a solution of nitrate of silver, and termi-
nated in a Wolf's bottle, the interior of which was also moistened with the
same solution. Heat being applied to the flask by means of the chloride of
calcium bath, the vapour given off had to pass through the red-hot tube, and
any chloroform which might be present was decomposed, and the chlorine
and hydrochloric acid gas being set free, were arrested in the next tube,
where they formed a white precipitate of chloride of silver, which became
rapidly darkened in colour by the action of light. The nature of the preci-
pitate could be further proved by cutting the tube with a file, and intro-
ducing a drop or two of nitric acid into one portion, and of solution of
ammonia into the other. He had distinctly detected the presence of chloro-
form by this process in two kittens, killed by inhaling the vapour, on six
successive days after the death of the animals, although no precautions were
taken to protect the bodies from the air, and the quantity inhaled by each
kitten must have been less than one minim. The parts of the animals examined
were the viscera of the chest and abdomen, the brains, and the muscles of
the body and extremities. From all these parts, clear evidences of the pre-
sence of chloroform were obtained. He had also obtained a precipitate of
chloride of silver, by operating on some portions of the muscles taken from
the leg of a child amputated under the influence of chloroform at St. George's
Hospital. The process, indeed, was one of such delicacy, that he had been
able to clearly detect the presence of the hundredth part of a grain of chloro-
form when dissolved in a thousand grains of water. The only substances
which could yield chloride of silver by this method were, Dutch liquid,
chloride of ethyle, and some other bodies similar in composition and effects
to chloroform, and which, however, were not in common use, or even kept
on sale. There were chlorides in the human body, but these could not be
decomposed below a red heat, and certainly not till the part became dry;
whilst, in the process he employed, the heat to which the part under exami-
nation was exposed was only that of boiling water, or a very little more, and
it could not become dry in the most protracted examination, as the greater
part of the moisture given off became condensed in the tube, which inclined
upwards, and flowed back into the flask. The method, therefore, was liable
to no fallacy or objection. He had received from Mr. John Parrott some
portions of the viscera of a woman, lately found dead, under very mysterious
circumstances, in the Wandsworth-road. The parts had been closed up air-
tight from the time they were taken from the body. They included a por-
tion of the brain and of the liver; and, though they were kept boiling for two
or three hours in their own serosity, not the least trace of chloride of silver
was obtained, whilst in the instances where chloroform had caused death,
the precipitate began to appear when the heat to which the part was exposed
reached to about boiling point. In the muscle taken from the child's leg,
the chloroform was only a few minutes longer in being detected, although
the quantity present must necessarily have been much less than in a case
where death had been caused by it. He therefore concluded, that the death
in the Wandsworth-road could not have been occasioned by chloroform.
A CASE of DISEASE of THE SPINAL CHoRD, IN which THE SYMPTOMs suPER-
VENED Upon A RECENT CoID ; SMALL-Pox HAD PRECEDED BY ONE YEAR, AND
INJUlty To THE SPINE TwPLVE YEARs. By MR. J. F. MARSoN. Joseph
Thomas, a black, a native of Nova Scotia, twenty-two years of age, was
WESTAilNSTER MEDICAL SOCIETY. 603
attacked in the beginning of March 1845, with symptoms such as are pro-
duced by a common cold. He had been employed as a servant in the wards
of the Small-pox Hospital for about twelve months, subsequently to being a
a patient there with small-pox, which disease he had in a mild form. He
was an active, intelligent man, of middle size, and rather slight form.
During the first few days of his illness, he was allowed to sit up, and amuse
himself without doing any work; but his symptoms of disease increasing, he
was, with some reluctance, prevailed on to confine himself to bed. His pulse
at that time was soft, and from 90 to 100 in the minute. He had thirst, a
furred tongue, and copious perspiration. At the end of the week, he com-
plained of stiffness in the neck, and pain on attempting to move his head from
side to side ; and he stated that he had had flying pains in his neck and
shoulders at night, occasionally, for a month or six weeks past. After being
confined to his bed for about a fortnight, he began gradually to lose the use
of his arms, and subsequently of his lower extremities. This was followed
by retention of urine, and the stools were passed involuntarily. His bladder
was emptied night and morning by the catheter, for ten days, after which he
passed his water also unconsciously; and from this time there was a constant
dribbling of urine, the bladder remaining in a contracted state. He had
complete loss of voluntary motion in all parts, supplied from the nerves below
the fourth cervical pair. Sensation, however, did not appear to be in
any respect altered, either in increase or diminution. His respiration was
easy and free ; his deglutition was good, and he was without pain in any part
of the body, except in the neck, and only there on motion; his appetite was
good, and he slept well; he had no pain on percussion over the spinous pro-
cesses of the vertebrae, no rigors, and no headache; his intellect was in no
way affected all through his illness, nor was there any indication of his brain
being in the least implicated. Amongst the most common and most striking
symptoms described by Ollivier and Abercrombie, in their works on Diseases
of the Spinal Chord and Membranes, are muscular rigidity, twitching, or con-
vulsions ; yet there were no such signs to guide us in the case now under
consideration. No movements could be excited in either the upper or lower
extremities, by tickling the soles of the feet or palms of the hands, or other
parts of the body, with a feather. It was, however, tolerably evident, from
the symptoms detailed above, that there was some mischief going on insidi-
ously in the spine, most likely of an inflammatory nature. From the softness,
however, of the patient's pulse, and the profuse perspiration, it was not judged
proper to employ general bleeding ; and there was no pain nor tenderness
on percussion over the spinous processes, to indicate where local bleeding might
be of service. Purgatives and saline medicines were administered, and the
patient was kept in bed, and on low diet. Bleeding not seeming to be admis-
sible, he was very early brought under the influence of mercury, so as to
make his gums tender, which was continued for more than a fortnight, and a
narrow blister was applied from the nape of the neck to the lumbar region.
The greatest care was taken to keep his bed as dry as possible, by the use of
the urinal, etc.; but from his constantly lying in the same position, without
the power of moving in any way, he soon had a sore formed over the sacrum.
Directly that this sore was discovered, he was placed on an India-rubber
collar, or crescent ; but a large slough was formed, which appeared to be the
proximate cause of death, after an illness of seven weeks. Not the least pain
was ever felt in the wound over the sacrum, although sensation was good in
all other parts of the body. Owing to the great pain felt in moving the head
forward, Mr. Marson predicted, three weeks before the patient’s death, that
there was pus in front of the cervical portion of the spinal chord, but that, in
all likelihood, the chord itself was not materially diseased in this part, because
the muscles of the chest and abdomen were used in breathing, which would
most likely not have been the case, had the chord been seriously diseased in
the upper part of the spine. This opinion was proved to be correct on dissection.
WOL. II. 40




604 REPORTS OF SOCIETIES.
Post-mortem. Eacamination, twenty-four Hours after Death. The spine and
its contents were carefully examined in their whole course. There was purulent
deposit on the anterior surface of the theca vertebralis, occupying about five-
sixths of the whole of the cervical portion of the canal, but the chord itself
in this part was not diseased. About six inches of the membranes of the
dorsal portion of the chord were congested, and the cellular tissue infil-
trated with a gelatinous effusion, opposite to the lower dorsal vertebrae. The
entire chord was somewhat softer than natural, and portions of it, of variable
extent, were completely disorganized, and reduced to a semi-fluid condition.
The fluid found in the vertebral canal, could not be said to be in unusual
quantity. The medulla oblongata and pons Warolii appeared to be quite
healthy. Some years ago, when a boy, about ten years old, this man received
an injury from a horse, by being thrown down and trampled upon, but there
was no breach of surface ; and, at the time, he appeared only to have been
bruised ; but now, the two right transverse processes of the seventh and
eighth dorsal vertebrae were discovered to have beenfractured, opposite to the
softened and congested part of the chord and membranes, and in the areolar
tissue, surrounding these transverse processes, there was slight but evident
purulent infiltration. The processes were loose, and the separated or disunited
ends were in a state of ulceration ; they did not appear ever to have united
after the fracture, but of this it is impossible to speak with certainty. Ample
evidence being found at once, on opening the spine, to account for all the
symptoms during the fatal illness, other parts of the body were not examined.
REMARKs. The patient had been at work, just before his illness appeared,
cleaning the balusters of a staircase on a cold windy day, with a window
open at the top of the staircase, and another at the bottom. It is likely, how-
ever, that the mischief thus done would have passed away as a common cold,
but for the predisposition to disease, arising from the injury received from the
horse some years previously, probably also influenced somewhat by his late
attack of small-pox. Injured parts are disposed to take on morbid action
when brought under exciting causes ; of this, all must have seen examples.
Some might think that bleeding ought to have been employed at the onset of
the illness ; there were, however, reasons against it, viz.:-a soft pulse, pro-
fuse perspiration, and the constitution of the blood. Sir B. Brodie is averse
generally to blood-letting after injuries to the spine, and states that patients
do not bear bleeding so well after injuries to the spine, as after injuries to the
head ;' but he makes exceptions. There was often great difficulty in detecting
the seat of inflammation, the diseased part being surrounded by a strong
bony covering, so that pressure upon it frequently would not produce pain.
Mr. Copeland” has suggested an admirable means of assisting us in our dia-
gnosis of these intricate cases; the part being more susceptible of the stimulus
of heat, he has suggested that a sponge should be wrung out of hot water and
carried down the spine, which will often give an acute degree of pain while
passing over the diseased parts. This test, it need scarcely be remarked, will
be of no use where sensation, as well as motion, has been lost. . r
We should watch such cases with great vigilance, at the commencement,
in order to make out as early as possible the exact seat of the inflammation ;
and in general, in young people, it will be right to take blood, at least topic-
ally, if not generally, at the beginning of the illness, but not after it has
existed some time. It is only in the early stage that the disease is much
under our control. It should also be borne in mind, that such inflammation
is sometimes of a scrofulous character.
Abercrombie,” in his admirable work on Disease of the Spinal Chord, says,
* Med. Chir. Trans., vol. xx, p. 162.
* Qbs. on the Symptoms and Treatment of the Diseased Spine, p. 35. 1815.
* Pathological and Practical Researches on Diseases of the Brain and Spinal
Chord. Second Edition, p. 415.
WESTMLNSTER MEDICAL SOCIETY. 605
“several very remarkable cases have occurred to me, which presented all the
characters of extensive Disease of the Spinal Chord, while nothing could be
found, either in the brain or the chord, that could in any degree account for
the symptoms.” After relating these cases, he mentions others, with similar
symptoms, which recovered.
There was the possibility of this Disease of the Spinal Chord having been
the result of, or in some way owing to, the attack of small-pox. Two other
cases had been lately mentioned to Mr. Marson, of Disease of the Spinal
Chord, believed to have been caused by small-pox. There was, however, no
post-mortem examination of either of them.
In the able treatise of Ollivier," three cases are alluded to of disease of
the chord, two occurring after petechial, and one after intermittent fever. He,
however, did not see any of them. There is a fourth case related in the work
of Racchetti,” of a girl, ten years old, who died of petechial fever, who had
inflammation of the Spinal Chord and membranes, and puriform matter about
the cauda equina.
SATURDAY, MAY 18, 1850.
EDWARD WM. MURPHY, M.D., PRESIDENT, IN THE CHAIR.
TEMARKS ON THE PRESENT TREATMENT of WENEREAL DISEASES IN THE
IIospit ALS OF PARIS, AS OBSERVED DURING A RECENT VISIT To THAT CITY.
By WILLIAM ACTON, ESQ. In preparing a second edition of his work on
Venereal Diseases, Mr. ACTON had thought it desirable to visit Paris, to
observe what progress M. Ricord had made during the last two years in the
treatment of those affections. The following is a table of the Syphilitic
cases in M. Ricord's wards on the 2d of April, 1850.
Indurated Chancre ....... © tº e º º ºs e tº ... 33 | Gonorrhoea Praeputialis ............ 3
Vegetations..................... ..... 2 Scrofulous Affection of the Testis 1
Secondary Symptoms ............... 21 | Blennorrhagia ....... • tº ſº e º ſº e º is tº e º 'º e º 'º º 3
Bubo................ ................... 8 | Stricture ....... ........... & © e e º e º e < e e 3
Vesical Catarrh ..................... 4 | Chancre of the Anus ............... 3
Phagedenic Chancre ............... 2 | Gonorrhoeal Rheumatism ......... 1
Epididymitis ........................ 7 | Albuminuria ..................... .. 1
Urimary Fistula . ................... 1 Haemorrhoids ....................... ... 1
Tertiary Symptoms.................. 8 *-*.
Iritis........ . . . e º ſº tº a º º ſº º e s ºn tº G & º is a tº ſº ſº tº tº gº º I Total ........................ 114
Simple (non-indurated) Chancre 11
Indurated Chancre. A large number of chancres were indurated. This
arose from the admission into the Hôpital du Midi of cases of this descrip-
tion, as being the most important. The treatment consisted in the internal
use of the proto-ioduret of mercury, continued long after all induration has
disappeared. It was often necessary to continue it for three or six months,
to prevent the recurrence of constitutional syphilis.
Fumigation. Mr. Acton referred to the re-introduction of cinnabar fumi-
gations into English practice. He explained the proper plan of their appli-
cation, and the reason of their having fallen into disrepute in the treatment
of secondary symptoms, in the more obstinate forms of which they were em-
ployed on the Continent with signal success.
Phagedenic Chancre. This included the large class of irritable slough-
ing, unmanageable sores, described by English writers. M. Ricord treated
it with iron, according to the following formula : B. Ferri Potassio-Tartratis,
3i ; Aquae 3vi. Two teaspoonfuls to be taken three times a day. Mr.
Acton had prescribed this remedy for the last two years with the most
marked success, in cases in which he had been consulted as to the propriety
* Traité de la Moelle Epinière et de ses. Maladies. 2me edit. pp. 584, 657.
* Della Struttura, delle funzione, e delle Malattie della Medolla Spinale, p. 374.
1816.
606 REPORTS OF SOCIETIES.
of continuing a mercurial course, or of commencing it after all other treat-
ment had failed.
Vesical Catarrh was treated by emptying the bladder, and injecting,
every fourth or sixth day, by means of a catheter and glass syringe, a solu-
tion of two drachms of nitrate of silver in four ounces of water. The effect,
at first, was to produce bloody urine ; but the cases rapidly recovered. Mr.
Acton had witnessed the result of this treatment.
Strictures. In the more simple cases, M. Ricord employed dilatation by
means of conical elastic bougies, with olive-shaped bulbs. In the more
severe cases, or if the stricture be undilatable, he used nitrate of silver, or
performed incision of the urethra. He objected to the employment of potassa
fusa. Mr. Acton also, in common with those who had enjoyed the most ex-
tensive opportunities of studying the subject, was opposed to the use of the
latter remedy. Sir Charles Bell relates the case of a person, who died of
another disease, to whom he had applied the potassa fusa three times. On
examining the urethra, he found no marks of erosion, or even partial destruc-
tion of the wall. Having armed a bougie, he forced it against his arm, and
found the effect very slight; whence he concluded, that the oil used is
saponified by the potash, forming a slightly caustic soap, which cannot do
much harm or good when small quantities of the alkali are used. This
opinion is corroborated by the length of time which some cases take for their
cure. If larger portions of the potassa fusa were used, there was great danger
of the caustic escaping, and falling on any part of the urethra, so as to pro-
duce most untoward consequences. In cauterizing the os uteri, even when
aided by the speculum, we were obliged to guard the healthy parts by means
of lint dipped in vinegar. That it produced mischievous effects in the ure-
thra, no one could doubt, who had read the accounts given by the writers who
witnessed its use at the end of the last century. When these objections to
its use had been obviated, Mr. Acton would not hesitate to employ potassa
fusa. - -
Mr. Acton thought, that the practice of incising the stricture through the
perinaeum might be called for in certain instances. M. Ricord had re-
marked to him, with reference to the ill-success with which this operation
was attended in London, that dangerous consequences often followed what-
ever plan was employed, and that he was not certain but that retraction of
the stricture might return after the perinaeum was divided.
Tertiary Symptoms. Iodide of potassium was given in much larger doses
in Paris than in London. Mr. Acton had successfully prescribed larger doses
of this medicine, in bitter infusions, in several cases, in which small doses had
been ineffectually administered. -
Mr. Acton, in reply to a question by Mr. B. Travers, junr. said that he gave
from eight grains to a scruple of the iodide of potassium three times a day, in
a tumbler of the infusion of quassia. -
In answer to a question by Mr. Erichsen, Mr. Acton said, that Ricord
cut the stricture by pushing, by means of a spring, a cutting edge
against it. -
MR. HANGock advocated the use of smaller doses of the iodide than those
mentioned by Mr. Acton. He thought that Mr. Acton condemned far
too sweepingly the use of caustic in the treatment of stricture. He was
anxious to state that, from a more extended trial, he had found it necessary
greatly to modify the unfavourable opinion which he formerly held, (and
had expressed), regarding this method of cure. In a very severe case, after
six applications of caustic, a No. 6 catheter passed. In a case where a
common elastic catheter produced violent haemorrhage, none followed the
use of potassa fusa; and after two applications the catheter entered the
bladder. - - - -


1 Specimens of these bougies were exhibited by Mr. Acton.
WESTMINSTER MEDICAL SOCIETY. 607
DR. RICHARD CHAMBERs said, that the dose which he commonly prescribed
was two or three grains of the iodide of potassium; but in syphilitic cases,
or when it was of importance to get a rapid effort, he would decidedly be in
favour of larger doses. He thought the medicine ought to be administered
largely diluted.
DR, WILLSHIRE said that, unless the salt be largely diluted, it was not
absorbed. All practical men, he said, were aware of this fact ; and he referred,
in particular, to the writings of Dr. Golding Bird.
MR. ERICHSEN said that Mr. Acton's paper was satisfactory, inasmuch as
it showed that we were not much behind French surgeons. He disapproved
of Ricord's plan of cutting through strictures: and he also disapproved of
conical gutta percha bougies, as their points were too flexible. He preferred
steel or wax bougies. Mr. Erichsen commended Donovan's solution (iodine,
mercury, and arsenic) in tertiary syphilis, and preferred the iodide of potas-
sium in mild cutaneous syphilis, and syphilitic affections of the perios-
teum.
MR. B. TRAVERs, Jun., thought that if all were true which he had heard in
this Society, he ought to go to school again. He considered the iodide of po-
tassium had been immensely overpraised : it was often useless, and not unfre-
quently produced much mischief. He had seen it, when given in two-grain
doses for a long period, accumulate in the system, and induce scurvy of the
gums, and disease of the bones. Mr. Travers had seen few cases of stricture,
in which cutting or caustic were proper; but he admitted the existence of
such cases, º
DR. CoEMACK said, that his experience of the iodide of potassium was very
different from that of Mr.Travers. He had seen it given in a very large number
of cases of syphilis, both in Paris and in Edinburgh; he had also used it very
extensively in his own practice, and he regarded it as a safer and surer cure
for syphilis, in the majority of cases, than mercury, which it might generally,
though certainly not always, supplant. He could not allow the statements
of Mr. Travers to make any impression upon his mind, till he was satisfied that
the medicine administered in the cases referred to, was really the medicine
prescribed, and not one of those fraudulent compounds sold in the shops as
iodide of potassium. Although Dr. Christison had long ago pointed out the
disgraceful manner in which the medicine has been adulterated, the practice
is not discontinued; and it ought to be known, that in some of the specimens
examined by Dr. Christison, there was not more than 94 per cent. of the pure
salt. Carbonate of potassa is the principal adulteration ; which may be sus-
pected when the salt is deliquescent. The pure drug is not deliquescent.
Iodate of potassa is another adulteration. In reply to a question asked by a
Fellow, Dr. Cormack said that the dose and method of administration which
he preferred, was from two to three grains three times daily, in distilled
water, or some simple bitter infusion. Larger doses might be safe, but he
thought that they were seldom necessary; and he doubted if large quantities
could be absorbed.
MR. ACTON made some observations upon the remarks of the different
speakers, in the course of which he complained that three points, on which
he had laid special stress, had not been discussed;—viz., 1. Fumigation; 2.
Iron in phagedaena ; and, 3. The Injection of Nitrate of Silver into the
bladder.

TERMINATION of THE SOCIETY. THE PRESIDENT was unable to address
the Society in a speech of any length, from the lateness of the hour, occasioned
by the scrutiny of the ballot; the result of which is as follows:
ELECTION. Vice-Presidents. Dr. Garrod and Mr. J. F. Clarke. Cown-
cillors. Dr. E. W. Murphy, Dr. F. Sibson, Dr. Samuel W. J. Merriman, Dr.
Tyler Smith, Dr. Cormack, Mr. Greenhalgh, Mr. B. Travers, jun., Dr. E. Lan-
kester, Mr. E. Canton, and Mr. Harvey.
608 MISCELLANEOUS INTELLIGENCE.
Hearty and unanimous votes of thanks having been carried, to Dr. Murphy,
the retiring President ; Dr. Sayer, the retiring Treasurer; and Dr. Merriman,
the retiring Secretary, the Westminster Medical Society ceased to exist.
[The above-named gentlemen, along with the following, elected by the
other Society, constitute the executive of the MEDICAL SocIETY of LonDoN,
by which name the amalgamated Societies are to be called. President.
J. Risdon Bennett, M.D., Vice-Presidents. W. H. Willshire, M.D., F. Hird,
Esq. Treasurer. N. Clifton, Esq. Secretary in Ordinary. W. Cogswell, M.D.
Secretary for Foreign Correspondence. T. Davidson, M.D. Members of Coun-
cil. John Bishop, Esq., W. D. Chowne, M.D., W. C. Dendy, Esq., H. Hancock,
Esq., E. Headland, Esq., J. Middleton, Esq., G. Pilcher, Esq., W. Smith, M.D.,
Silas Stedman, Esq., Theophilus Thompson, M.D.
[It will be among the first and most important duties of the office-bearers
to prepare a code of laws, and effect the removal of the Library from Bolt
Court to the premises in George Street, Hanover Square, which will be opened
in October next. It is proposed that the meetings be held in the new rooms
every Saturday during the Session, at 8 P.M.]


MIISCEIRIAA.NEOUS INTELLIGENCE,
WESTERN MEDICAL AND SURGICAL SocIETY. This Society celebrated its
fourth anniversary on the 12th April, by a numerously-attended conversazione,
in the large room in the Cadogan Gardens, Sloane Steeet. SIR. B. C. BRODIE,
President of the Society, was in the Chair, and delivered an excellent address.
He advocated the “maintenance of friendly and generous feelings among
those who are engaged in the same useful and honourable pursuit, tending to
supersede those feelings of distrust, jealousy, and petty rivalry, which are
unworthy of a liberal and scientific profession, but which are too apt to exist
in any class of society, the members of which are not brought into personal
communication with each other. For this reason, and putting aside all other
considerations, he was convinced that a Society, such as that over which he
presided, must tend, in no small degree, to the comfort and happiness of the
individuals of whom it is composed.” Sir B. Brodie referred to the diffi-
culties attendant on the progress of the practitioner of medicine; and shewed
that the solicitor, the barrister, the clergyman, and the merchant, had each
difficulties and dangers to contend with, often producing as much effect on the
minds and progress of the individuals, as those which obstructed the paths
of the medical man. In speaking of the influence which should be exerted
by the medical profession on the minds of those who devote themselves to it,
he made the following remarks:
“Their immediate object is always to do good to others—they are engaged
in the pursuit of an important science, which concerns the highest interests
of mankind in their present state of existence. The medical practitioner
must, for his own sake, always aim at the attainment of truth, and endeavour
to observe, to think, and reason correctly. All this is good for his moral and
intellectual character; and the result is, that, with all our errors, and all the
imperfections which belong to us, there is, perhaps, no class in society, on the
whole, more liberal, more free from prejudice, and more disposed to render
disinterested service to others, than the great body of the medical profession.
Then, there is no other profession, in which the individuals belonging to it
have to depend so entirely on their own character and conduct. Whatever
advantages we may obtain in life, we earn them for ourselves. We require
the good opinion of the public of all classes; but we neither owe, nor can
owe, any obligations to the favour of the great.
“The medical practitioner who has laboured to obtain an adequate know-
ledge of his art, and who honestly and diligently performs his duties, has a
right to consider himself one of the most independent members of society.

MISCELLANEOUS INTELLIGENCE. 609
It seems to me, that this sense of independence is not sufficiently impressed
on the minds of a large proportion of our profession. There is no one who
thinks it worth his while to place himself under our care, to whom we are
not really of more importance than he can be to us. But if we would have
others do us justice, we must first do justice to ourselves;–and how is that
to be accomplished ' It is by shaping our conduct with a view to the gene-
ral result, and obtaining the good opinion of society at large, of persons of
all classes, high or low, rich or poor, without reference to what may be said
or done in particular cases, or by different individuals. We cannot fail often
to meet with perverseness or caprice, or to find, that when we have done that
which it is possible, we have not done that which it is impossible for us to
perform. But all this need be no more than a temporary annoyance to the
upright and diligent practitioner, who is conscious that he has laboured to
obtain an adequate knowledge of his art, and that, on all occasions, he
endeavours to do his best. But if we claim, as claim we must, that allow-
ance should be made by others for our own failings and imperfections, much
more are we called upon to make allowance for the failings and imperfections
of those who labour under the inflictions of bodily disease. We have, to a
great extent, the power of relieving pain and preserving life; but our power
is limited. On the other hand, there is no limit to the desire of obtaining
relief, and the anxiety to live may still linger in those who are at the point
of death. Under these circumstances, it seems almost a matter of course
that those to whom we can render no further aid, and whose minds are pro-
bably weakened by previous illness, should be easily induced to seek for aid
elsewhere, and be ready to listen to any promises of cure, however vain and
absurd, or even dishonest, those promises may be.”
This address was listened to throughout with the deepest attention, and
the applause at the close was loud and long-continued.
The following gentlemen were then elected to fill the various offices during
the ensuing year:-President. Dr. Robert Lee, F.R.S. Vice-Presidents.
Dr. Aldis, Mr. Barnes, Mr. Gaskell, Mr. Godrich. Treasurer. Dr. Woolley.
Council. Dr. Barclay, Mr. Bullock, Dr. Christian, Mr. Douglas, Mr. Ince,
Mr. Martyn, Mr. Muller, Mr. Philips, Dr. Simpson, Dr. Traquair, Mr. Whit-
more. Secretary. Mr. Seaton. Auditors. Mr. Keen, and Mr. Webb.
The formal business being concluded, Dr. Mantell, at the request of Sir
Benjamin Brodie, favoured the meeting with an address on the osteology and
physiology of the colossal reptiles from the south-east of Eugland, of which
there were some unique and most interesting specimens, and in conclusion,
briefly considered that most interesting and mysterious physiological problem
—the appearance and extinction of species and genera.
SWISS CRETINISM.–DR. GUGGENBUEHL's TREATMENT or IT on THE ABEND-
BERG. We extract the following from an Edinburgh newspaper. “About
eighteen months ago, we commended to the favourable notice of our readers
a brief account of Dr. Guggenbühl's benevolent labours, published here
under the title of ‘The Abendberg; an Alpine retreat founded by Dr. Gug- .
genbühl for the treatment of infant Cretins. W. P. Kennedy, 1848.” Dr.
Guggenbühl is now in Edinburgh, for the purpose of advocating the claims
of his institution on the attention of the friends of suffering humanity, as
well as with a view to extend his own knowledge of those phases of mental
alienation, to the treatment of which he has devoted himself. A meeting of
gentlemen interested in Dr. Guggenbühl’s object was held on Wednesday,
8th instant, at the Religious Institution Rooms, 6, York Place, the Lord
Provost in the chair. Dr. Guggenbühl having stated his views of the nature
and curability of Cretinism, and an account of the origin and progress of
the hospital on the Abendberg having been read by Dr. Coldstream, resolu-
tions, expressive of confidence in Dr. Guggenbühl's proceedings, and of willing-
ness, to aid him in the carrying out of his plans for the amelioration of
Cretinism and idiocy, wherever these exist, as well as of the desirableness of
6] 0 MISCELLANEOUS INTELLIGENCE.
something similar being done for the young affected with idiocy in this
country, were moved and supported by Professors Alison, Forbes, and Millar,
Sir W. Newbigging, William Brown, Esq., Dr. Spittal, and Robert Paul, Esq.
A small Committee was formed to maintain a correspondence with Dr. Gug-
genbühl; and Mr. Paul, of the Commercial Bank, intimated his willingness
to receive and transmit any monies that may be contributed for the support
and extension of the Abendberg Retreat.
A PP O I N T M E N T S.
BARNES, Dr. Robert, elected Obstetric Surgeon to the Western General Dispensary,
Lisson Grove, in the room of DR. HENRY BENNET, resigned.
ELLIS, G. Winer, Esq., appointed Professor of Anatomy in University College,
London, in the place of MR. QUAIN, resigned.
LANG, Dr. elected Physician to the Exeter Dispensary, in the room of Dr. TUTHILL
MASSY, resigned.
TUNSTALL, Dr. elected Physician to the Eastern Dispensary, Bath, in the room of
DR. LINDOE, resigned.
O B I. T. U A. R.Y.
BREWSTER, George, M.D., Royal Navy, son of the Rev. G. Brewster, D.D., at Port
Royal, Jamaica, on the 5th April.
BUCHANAN, Dr. J. G., in Edinburgh, on 6th May.
DE BLAINVILLE, M., at Paris, aged 71, lately. This eminent Naturalist was the
successor of Cuvier in the Chair of Natural History of Paris. He was
found dead in a railway carriage, while travelling from Paris to England.
ELLIOTT, Dr. Robert, late Surgeon to the Tempo Dispensary, at Kandy, Ceylon,
lately.
GAY-LUssAc, M., the celebrated chemist and philosopher, in Paris, on 8th May.
GRANTHAM, Mr., Surgeon, 23rd regiment, drowned lately on Lake Erie, through
the collision of two Canadian steam-boats.
HEALY, Dr. B., in Dublin, on 26th March.
HEALY, Dr., of the 1st Punjaub CaAalry, at Kohat, killed by the Afreedees, lately.
HUGHES, William, Esq., Surgeon, of 14, Basing Lane, Cheapside, aged 38, at
Leicester, on 8th May.
HULL, Thomas, M.D., late of Beverley, Yorkshire, at Lytham, aged 75, on April 27.
LAwson, Stephen, Esq., Surgeon 7th (Queen's Own) Hussars, and formerly of the
87th and 30th Regiments, suddenly, at Cork, on 4th May. -
MILLAR, John, Esq., Staff-Surgeon of the North British District, at Glasgow, on
3rd May.
MILLs, G. Ireland, Esq., late Deputy-Coroner for the County of Middlesex, of
ramollissement of the brain, aged 47, on 20th May.
MoUNTFORD, John, Esq., Surgeon, of Gloucester Street, Queen's Square, suddenly,
aged 68, on 13th May.
PooDE, Charles, M.D., at London, Canada West, aged 47, on 24th February.
STAFFORD, W. W., Esq., Surgeon, at Brighton, aged 57, on 10th April.

B O OFK S R E C E IV E D.
Bowman's (John E.) Medical Chemistry. London: 1850. CHURCHILL(Fleetwood),
Outlines of Midwifery. Second Edition. Dublin: 1850. Fown Es’ Manual of
Chemistry. Third Edition. By DR. BENCE Jon Es. London : 1850. MARSHALL
on the Anterior Weins. (From Philosophical Transactions.) London: 1830, ORR's
Principles of Surgery. Dublin : 1850. REES (G. A.) on Atelektasis Pulmonum.
London: 1850. REICHENBACH's Researches on Magnetism, etc. Translated by
Professor GREGORY. London: 1850. . --
L ON DON
JOURNAL OF MEDICINE,
A MONTHLY
38ttort of the ſºletical Sºtientzg.
JULY 1850.-No. XIX.
O R. I. G. I. N.A. L. C. O M M U NI CAT I O N S.
CASE OF FIBRO-CYSTIC TUMQUR OF THE UTERUS,
WHICH REQUIRED TAPPING ; WITH REMARKS.
By PRESCOTT HEWETT, Esq., F.R.C.S.Eng., Assistant-Surgeon to St. George's
Hospital.
CASE. M. G., act. 47, single, was admitted into St. George's Hospital, under
the care of Dr.Wilson, with great swelling and distension of the abdomen.
The symptoms, which had existed about twelve months, had been at
first confined to the left iliac fossa, but had subsequently spread over
the greater part of the belly. Fluctuation was very evident in various
regions, and the disease presented all the characters of ovarian dropsy.
OEdema of the legs was present, as well as pain in the region of the
heart, and difficulty of breathing in going up stairs. The general
health had not been much affected, but of late she had lost flesh ; the
catamenia had been absent for the last six months; the urine was
scanty and highly acid. She was put on diuretics and good diet. After
five days, it was found that she had decreased two inches in circum-
ference round the abdomen, and that there was also much less swelling
of the feet. Under this plan of treatment, she, at first, continued to
improve slightly; but the symptoms and consequent distress having
subsequently increased, Mr. Hawkins tapped the abdomen, and drew off
fifteen pints of thick fluid, of a reddish colour, and mixed, towards the
last, with blood and some flakes of lymph. After the operation, it was
observed, that the decrease in size had occurred principally on the left
side, and two masses of solid substance were detected, which appeared
to form part of a tumour, rising from the pelvis. The operation was,
at first, followed by marked relief; but, two days afterwards, symptoms
of low peritomitis appeared, and the patient died, on the eighth day
after having been tapped. “s. -
ExAMINATION of THE BODY, EIGHTEEN Hours AFTER DEATH. The
cavity of the peritoneum contained a large quantity of dark-coloured.
fluid, mixed with flakes of recently effused lymph, which served to glue
together the convolutions of the intestines. In its lower two thirds,
WOI, II. 41
612 CASE OF FIBRO. CYSTIC TUMCUR OF THE UTERUS.
the abdomen was occupied by a large tumour, which, rising out of the
pelvis, had displaced the intestines, and become attached, by slight
adhesions, to the anterior wall of the belly. The upper part of this
tumour was composed of large, membranous-looking cysts, with thin
walls, the interior of which was inflamed, and filled with a quantity of
thick, dark-coloured fluid. It was one of these cysts which had been
tapped during life. Towards its lower part, the tumour was principally
formed of a more solid substance, and filled with an enormous number
of cysts, varying from the size of a pin's head to that of a large orange.
These cysts, which were all lined with a thin, smooth, delicate-looking
membrane, were filled with clear fluid, containing a large quantity of
albumen. The diseased mass was, at first, thought to be connected
with one of the ovaries, but both these organs were found to be lying
behind it, and quite healthy. On further inspection, the tumour was
traced to the right side of the fundus of the uterus, to which part it
was connected by means of a pedicle, two inches in breadth, and an
inch and a half in length, formed by the fibres of the uterus, which
were traced upwards some distance, and then lost. Among these fibres,
were several vessels of a large size. Here and there, in the lower part
of the tumour, were scattered some spots of fibrous tissue, hard, dense,
and without any cysts. In the body of the uterus, deeply imbedded in
its structure, there was a common fibrous tumour, of the size of a bean.
There was no affection whatever of any of the glands. The other
viscera contained in the abdomen, as well as those in the thorax, were
all quite healthy. -
Microscopic examination proved that the tumour was essentially of
a fibrous character.
REMARKs. Accumulations of fluid, in connection with Fibrous Tu-
mours of the Uterus, may occur under various forms. As they present
all the characters of ovarian dropsy very strongly marked, such cases are
of great importance, for they have sometimes led to errors in diagnosis,
and to useless operations; especially those cases in which the fluid is
poured out into numerous small cysts.
The fluid is sometimes contained in a single cavity, formed by the
softening and subsequent removal of the centre of the tumour, the
place of which becomes filled up by serum. This, by gradually dis-
tending and thinning the outer part of the tumour, may make the
disease appear as if it had been, from its origin, a cyst. The quantity
of fluid contained in cavities thus formed may be very great.
In other cases there are several cysts containing fluid, which are pro-
duced in a different manner. Here, the cavities, lying between the fibres
constituting the tumour, are generally towards its circumference, and
that principally in cases where the mass, having grown more rapidly than
usual, has acquired a large size. In a Fibrous Tumour of the Uterus,
weighing fifty-four pounds, which I dissected some time ago, I found
several cavities, which were all situated towards its circumference.
Some of these were round, others of a semi-lunar shape—the latter
appearing to have been the original shape of the greater number of the
cysts. Their formation may be thus explained. The tumour was of a
pear-like shape, and composed of layers of fibres, presenting a somewhat
looped appearance. The extremities of these layers, being firmly con-
MR. LEE ON INFLAMMATION OF THE WEINs, ETC. 613
nected, formed a perfectly solid mass; whereas the centre of the loops,
towards the circumference of the tumour, being but loosely connected
by thin cellular tissue, had, in many places, left inter-laminar spaces,
which had subsequently become filled with fluid. The cysts thus formed
were of various sizes, and few in number; their cavities were perfectly
smooth, and not subdivided by bands of cellular tissue.
There is another class of Fibrous Tumours, which appear to
have been formed by the union of several smaller ones by means of
loose cellular tissue, in the meshes of which, fluid has been thrown out,
and has subsequently formed cavities or cysts. In these cases, the
cavities, generally speaking, are not of any great size, and the mass
looks like a large oedematous Fibrous Tumour. When punctured, but
little fluid escapes from them; but, if incisions be made in several
places, the greater part of the fluid will drain off in a few hours, leaving
a coarse cavernous-looking tissue.
The Fibro-Cystic Tumour described in the case of M. G., cannot, I
think, be looked upon as belonging to either of the three varieties
already mentioned. From its earliest formation, the tumour was most
probably of a fibro-cystic nature, and exactly resembled that form of
disease so commonly observed in the ovary, which is composed of uni-
locular cysts, of various sizes, closely aggregated together, with more
or less delicate fibro-Serous walls; in fact, so close was the resemblance,
that for some time the mass was taken for a diseased ovary. Portions
of it also closely resembled the simple cystic disease of the testis, as
well as one form of fibro-cystic disease which I have met with in a large
tumour of the breast. The accumulations of solid fibrous tissue observed
in the case of M. G., were scattered, and small in comparison to the
size of the tumour; whereas the mass of it was made up of cysts, which
existed in every part, even close to the root.
ON THE CAUSES, CONSEQUENCES, AND TREATMENT
OF INFLAMMATION OF THE WEINS :
WITH CASES II.LUSTRATING THE EFFECTS OF PURULENT INFECTION OF
THE BLOOD. -
By HENRY LEE, Esq. , F.R.C.S.Eng., Assistant-Surgeon to King's College
Hospital, etc.
PART II.
(Concluded from page 240.)
VIII. The experiments cited in the first part of this essay, illustrate
the power possessed by the blood of preventing certain foreign sub-
stances from circulating with it. They shew that pus, in particular,
has a tendency to coagulate the blood; and that by this means, when
introduced into the vessels, its progress is arrested in some part of the
circulating system. This fact, which, taken by itself, might appear of
little consequence, assumes considerable importance when considered
as one of the inherent properties of the blood, at all times-ready, under
favourable circumstances, to be called into action in the living body.
41
614 INFLAMMATION OF THE VEINs, ETC.
The conditions under which pus will determine the coagulation of
the blood, and those under which it will circulate in the living vessels,
require to be accurately ascertained, in order to reconcile the discordant
evidence which we at present have upon this point.
Dr. Sédillot," in a work recently published, mentions, that a great
number of cases are met with, in which pus is poured into the general
circulation without meeting with any obstruction, and states that, in
such instances, he can detect the globules of pus in different parts of the
circulating system. He even affirms that he can recognise a disease
caused by purulent infection, by examining, under a microscope, a portion
of the blood abstracted from the body.
M. Dance, and, since his time, equally accurate observers, have, on
the other hand, failed to detect the characters of pus in the blood, even
when that fluid had been injected into the veins of living animals.
The results of these different observations may perhaps be reconciled,
by considering the influence exercised upon the globules of pus by the
blood, before its coagulating power has been impaired. This subject
appears not to have hitherto occupied the attention of pathologists.
In all the cases quoted by Dr. Sédillot, in which he detected the
globules of pus in the blood, the patients had died of the disease; but
in the researches instituted by M. Dance and others, the experiments
were made upon animals in perfect health. In the latter, the pus
cannot enter the circulation, as has already been shewn, or can only do
so after the blood has partially or entirely coagulated round it, and the
coagulum has subsequently become broken up. &
In the act of coagulation under these circumstances, the appearances
of the globules of pus are changed,—these being perhaps mechanically
compressed by the contraction of the fibrine,—so that the most experi-
enced eye can no longer recognise them.
Pus, mixed with healthy recently drawn blood, out of the body, will
entirely lose its characters in this way; and as the coagulation, under
similar circumstances, is by no means retarded in the living vessels, we
may, without fear of contradiction, affirm, that globules of pus cannot
be detected when introduced into the vessels in small quantities, and
mixed with healthy blood.
In cases where, from long-continued disease and the repeated introduc-
tion of vitiated fluids into the circulation, the blood has lost its power,
there appears no reason to doubt the correctness of Dr. Sédillot's observ-
ations; and it is probable that pus-globules may then circulate with
those of the blood.
In experiments upon animals, it has always been found that the
power of the constitution, in resisting the effects of the injection of pus
into the veins, was much greater at the first than at any subsequent
operation. This circumstance would appear to associate itself directly
with the observations now made, and to afford another illustration of
the power of healthy blood in resisting the entrance of some foreign
matters into the system.
From the consideration of these facts, and of the experiments previ-
ously recorded, it becomes evident, that the introduction of pus into the
—r-
* De l'Infection Purulente, p. 399.
BY HENRY LEE, ESQ., F.R.C.S.ENG. 615
system through an injured or inflamed vein, can rarely be the first step
towards purulent infection of the system. Some change must pre-
viously have passed in the blood, by which its coagulating power is
impaired, or some unusual mechanical means must have been employed,
before the pus can find its way in the course of the circulation. The
contradictory statements which have been made by those who have
injected pus into the veins, may thus be reconciled, by taking into
account the power exercised by the blood in the experiments which
have been made. There can be little doubt that, while, in some in-
stances, a portion of the pus has been forced into the general circulation,
in the great majority of cases it has been detained in the vein into
which it was first introduced, and has never become part of the circu-
lating fluid. We accordingly find some experimenters recording the
secondary diseases which they observed, while in other hands these
appearances were not produced.
Dr. Sédillot" has attempted to prove that the globules, or solid parts
of pus, must be introduced into the system, in order to produce well-
marked indications of purulent infection. But this hypothesis would
not only appear to be at variance with the oft-repeated experiments of
MM. Gaspard and Cruveilhier, in which similar effects were produced
by the injection of mercury and of putrid fluids, but would also leave
unexplained the mode of the introduction of these globules, where there
is evidence of the disease originating through the lymphatic system.
The changes which all substances undergo in their passage through the
absorbent glands, would at once forbid the idea that globules of pus
could be thus introduced unchanged into the circulation; and yet we
have direct evidence (Case xxix) of irritating fluids being conveyed in
this way into the system, and leading to the formation of secondary
abscesses. -
Another class of cases, in which there would be difficulty in admit-
ting the doctrine of the introduction of pus in substance into the circu-
lation, presents itself, where, in the primary affections (as in Case VI), no
evidence can be obtained of the original lesion having suppurated. The
fluids effused in such cases may be serum, lymph, or blood, mixed in
different proportions; and yet the constitutional symptoms will be
exactly similar to those which follow the formation of pus in other cases.
There may exist, both in the primary and in the secondary affection,
every intermediate gradation between the healthy secretion of a part,
and the formation of pure pus, or pus mixed with blood or lymph,
without any of the essential characters of the disease being absent. An
inflamed bursa, or a punctured wound, without the formation of pus,
(Cases IV and v), may give rise to symptoms as severe, and consequences
as fatal, as any that arise from the direct introduction of pus into the
system. The secondary affections, in such cases, may run their course
* In deducing general conclusions from experiments upon animals, it must be
borne in mind, that in them suppuration is induced with great difficulty. Many
of the appearances produced by the injection of putrid fluids (as in Experiment
XIV) would, in man, probably have terminated in suppuration. Dr. Sédillot has
nevertheless established the fact, that, generally speaking, a different class of post-
mortem appearances may be expected from the introduction of decomposed serum,
to those produced from fluids containing solid particles.
616 INFLAMMATION OF THE WEINS, ETC.
and prove as speedily fatal, as where well-formed purulent deposits have
taken place. The most severe constitutional symptoms will sometimes
be followed by the effusion of bloody fluid only, in one of the serous
cavities (Case xxx). It would be unphilosophical, even were it practi-
cable, to refer such cases to a different disease, merely because the acci-
dental circumstance of the formation of pus is wanting. The origin
of the affection in such instances may be as well-marked, the poison can
often be traced as distinctly into the system, and the secondary disease
may be as clearly connected with the primary, as in any case where pus
has been originally formed. In some cases again, the constitutional
symptoms which accompany, or are followed by, effusions into distant
parts of the body, begin before sufficient time has elapsed to allow the
supposition that pus can have been fully formed at the original seat of
injury. Such instances occasionally, although rarely, present themselves
in extensive burns and scalds, occurring in enfeebled habits, and after
amputation of the limbs in scrofulous children. -
In nearly all cases, when the origin of the constitutional disease
cannot be traced to the introduction of diseased fluid into the system
through an open vein, it will be found that the part primarily injured
has wanted the degree of vigour, requisite to establish and maintain
healthy adhesive inflammation. &
In the first part of this paper, I have endeavoured to show that,
where lymph is effused around a poisoned wound, the virus will find its
way less easily along the absorbent vessels, than when no such effusion
has taken place; and that when, in such a wound, the effusion of lymph
is checked or prevented, as by the administration of mercury, a larger
proportion of cases will indicate an affection of the lymphatic system,
than when the natural process has not been interfered with. There
can be little doubt, that the same principle may be observed with regard
to ordinary wounds. The number of cases in which the absorbents
inflame, will be in inverse proportion to the number of those in which
the original wounds are circumscribed by healthy adhesive inflam-
mation. In Case xxvii, it is mentioned, that the surface of a muscle,
implicated in the original lesion, was as cleanly dissected as if with
a scalpel, thus showing the total absence of any surrounding effusion
of lymph. The absence of, or defect in, the process of adhesion may
thus be associated with inflammation of the absorbents, as the want
of “union by first intention” has been shown to be connected with
inflammation of the veins (Section ii.) .
The minuteness of the absorbent vessels, and the changes which
their contents undergo in their glands, prevent any unhealthy fluids
from being as readily recognised in them as in the veins. But when
the progress of inflammation can be traced along these vessels from a
wound, towards the centre of the circulation, marked, as it often is, at
intervals, by the formation of abscesses, we cannot doubt that an irri-
tating fluid has found its way along their canals: and when the con-
stitutional symptoms, which arise at the same time, terminate in the
formation of purulent deposits (as in Case xxix), we cannot but admit
that the absorbent vessels are the direct means by which, in such cases,
* LoNDON Journal OF MEDICINE, vol. i., p. 799.
BY HENRY LEE, ESQ., F.R.C.S.ENG. 617
diseased secretions are poured into the blood, and the system becomes
infected. It would, therefore, appear that there are two principal
conditions, under which local disease may produce a general infection
of the system by the direct introduction of vitiated fluids into the
blood. The first of these is connected with defective union in injured
veins; the second is associated with want of healthy adhesion in in-
flamed lymphatics.
The period of invasion of the attack differs in some degree in the
different classes of cases, but it is generally marked with great pre-
cision : even when apparent recovery has been followed by a second
attack, the occurrence has in each instance been accurately noted by
the sudden appearance of constitutional symptoms (see Case XXXVII).
When one of the large veins has been originally affected, the period
which elapses before symptoms of infection of the system manifest
themselves, is comparatively short (Case 1). In cases occurring after
child-birth, it is usually longer, extending to the end of the second
week. After surgical operations or accidents involving some portion
of bone, the access of the disease will be marked by a rigor during
the third or fourth week; and finally, when the absorbent system is
primarily affected, the period of the occurrence of the constitutional
symptoms may be much farther removed from that of the original
injury (if any such existed), and is by no means so accurately defined.
At the time of the occurrence of the general disturbance of the
system, the local injury or wound will generally put on an unhealthy
appearance. The skin in the immediate neighbourhood will sometimes
assume a dull brownish-red appearance, which will gradually fade into
the colour of the surrounding parts. This symptom will usually com-
mence near the termination of those vessels, which are derived from
the same trunk as those which supply the injured part. When the
original injury is complicated with a wound upon the surface of the
body, it will usually become dry and glazed, and the blush upon the
skin will commence in its neighbourhood, or a short distance from it,
and will usually extend towards the centre of the circulation, without
presenting any very defined margin : occasionally it will extend, in the
form of erratic erysipelas, over a large part of the body."
IX. The commencement of constitutional disease, after direct infec-
tion of the blood, is marked by a sudden change in the manner and
appearance of the patient; a severe rigor is usually the most pro-
minent symptom, and is followed by much febrile excitement, or by
extreme depression; a very peculiar heat of skin (Case XXII) will some-
times be present, while, at other times, the surface will be covered by a
profuse clammy perspiration. The rigor may be repeated at irregular
intervals, but occasionally it will recur about the same hour for three
or four days in succession (Case xxxvii), and in a few instances it will
not be observed at all. - -
Great depression frequently accompanies even the first stages of this
disease, indicated by a want of tone in the pulse, by an extremely listless
* In a case of fracture of the femur into the knee joint, I saw a dark ill-defined
erysipelatous blush extend from the affected limb to the body, and thence to the
head. Purulent deposits formed in various parts of the body, of which the patient
died. - - - e
6|| 8 INFLAMMATION OF THE VEINS, ETC.
manner, and sometimes by a tendency to syncope (Case 1). The
countenance becomes anxious, the tongue dry and brown in the centre,
and red at the edges, or, in other instances, it presents a coating of a
pasty yellowish-white colour; a dusky yellow hue frequently pervades
the skin, and sometimes the conjunctivae of the eyes. This may or
may not depend upon an accompanying affection of the liver. The
pulse varies much in frequency in different cases, and at different times
in the same case: generally it is very rapid, especially when accom-
panied with much heat of skin. -
The pain is sometimes severe, and may be referred exactly to the
spot which subsequent examination shows to have been the seat of
secondary inflammation ; at other times it is not confined to any
particular situation, but consists of general ill-defined feelings of
short duration, and recurring at irregular intervals. The peculiarity
of such sensations is best expressed by the terms applied to them by
the patients themselves, “Catching pains all over”, “soreness of the
stomach”, and “thrilling in the blood”, not unfrequently accompany
this disease.
Vomiting may occur, either as a symptom of constitutional disturbance,
or as indicative of inflammation of an abdominal organ (Case xxvi).
In the latter case, it is extremely obstinate, and the fluid ejected is
generally of a green colour. Diarrhoea is a symptom of frequent occur-
rence, and appears to exercise a considerable influence on the course
of the disease. Its appearance will not unfrequently be accompanied
by relief of the other symptoms (Case III); when it occurs, it is gene-
rally profuse, and little under the control of medicine, but, if checked,
may be followed by a sudden change for the worse in the condition of
the patient.
The intellect is seldom affected during the first stages of the com-
plaint; but subsequently, in severe cases, restlessness, delirium, and
coma, seldom fail to succeed each other. These symptoms are all
peculiar, both in regard to the rapidity with which they make their
appearance, and also the sudden manner in which they occasionally
disappear. The disease may seem, within a few hours, to leave a part
which it has first attacked, and to fall upon a different organ in some
remote part of the body.
X. The post-mortem appearances observed in those who die in con-
sequence of the introduction of vitiated fluids into the blood, cannot,
for the most part, be distinguished from similar changes produced by
other causes; yet there are some effects which are peculiar, and may
be directly associated with the reception of foreign matter into the cir-
culation. The most characteristic circumstance, attending the extension
of disease to different organs of the body through the medium of the
blood, is that several parts of these organs, or even different organs,
will be simultaneously attacked. The disease will appear at once in
various spots, which will become rapidly disorganized, while the sur-
rounding textures will remain unaltered, either in structure or colour.
The appearances observed upon dissection will vary according to the
part attacked, and the stage of development in which the disease is
found. - 4. . -
The lungs are the organs in which the successive changes may
best be observed. When puriform fluid has entered the circulation,
BY HENRY LEE, ESQ., F.R.C.S.ENG. 619
the first appearance produced in the structure of the lungs, is that of
one or more congested or dilated veins" of very small diameter. This
will be followed by a well defined spot, of much darker colour than the
surrounding texture (see Plate, facing p. 624.) Several of these
spots will probably appear at the same time, and each one of them will
soon become surrounded by a hard spherical patch of purple congestion.
Effusion of lymph will now take place, commencing in the centre of
each affected portion, and gradually extending towards its circum-
ference. If the disease continue, each spot will suppurate, and the
different parts will become softened and broken down, in the same
order in which they were previously solidified. . . .
The liver frequently becomes the seat of secondary inflammation. In
the early stage, brownish-red spots may be observed scattered through
its substance. These, as they extend, assume a bluish or slate-colour;
and the structure of the liver thus affected is found to have lost its con-
sistence, and to be very easily broken down by pressure. Every part
affected here, as in the lungs, proceeds rapidly to suppuration; and the
usual appearance presented after death, is that of several small circum-
scribed abscesses, around which the structure of the liver has been
condensed only to a very small extent. It sometimes happens, that the
larger veins in the liver become inflamed. These vessels, being held
open by the firm structure of the part, are not so readily obliterated as
in other situations; and it consequently happens, that the lymph and
pus poured into them become irregularly mixed with the blood, more
or less perfectly coagulated, which they contain : a very peculiar mottled
appearance, resembling granite, is thus occasionally produced.
Affections of the spleen, produced by the introduction of foreign
matter into the blood, are probably not so readily recognised as similar
affections in the lungs and liver. For, although the spleen is often
found to be diseased in those who die from infection of the blood, yet it
is comparatively seldom that secondary abscesses have been found in it.
In the accompanying table, containing twenty-three cases, some morbid
appearance, not recognised as peculiarly the result of secondary inflam-
mation, was observed in the spleen in no less than eight instances. So
large a proportion of cases renders it probable, that the alterations ob-
served have more than an accidental connexion with the disease of which
the patient died, although they presented no characters which could be
said to be peculiar to that disease. In well-marked cases of secondary
affections of the spleen, one or more well defined, but frequently irre-
gular indurations, of a chocolate colour, may be recognised; such patches
are usually seen soon after the commencement of the complaint, and
very soon become softened or broken down. The rapidity with which
they lose their original character, may probably account for their being
comparatively seldom observed in post-mortem examinations.
Deposits of lymph are sometimes met with in the kidneys; but these
are of small extent, of a light colour, and resemble lymph deposited in
consequence of ordinary inflammation. The patches of congestion, so
characteristic of this disease in other organs, are not here observed.
* For the knowledge of this fact, I am indebted to Mr. Caesar Hawkins, of St.
George's Hospital. . . . . --
620 INFLAMMATION OF THE WEINS, ETC.
This may depend upon the peculiar disposition of the capillary system
of the kidney. The blood has to pass through the Malpighian tufts,
and may be purified, or altered in character, before it reaches the proper
venous system of the organ. - -
In cases where purulent infection of the blood has been purposely
produced, portions of the kidney will not unfrequently be found inflamed
and firmer than natural ; but, if the origin of the disease were not
known, these appearances could not be distinguished from those pro-
duced by inflammation of the kidney from other causes. -
The skin is liable to be affected in three different forms. (See Cases
I, II, III, IX, X, and xxxiv.) The first of these occurs very rarely, and
consists of small deposits of matter in the structure, or upon the surface
of the skin, resembling in many respects the pustules of small-pox.
The second form is also of rare occurrence, and consists of small con-
gested spots on the surface of the skin. These are generally of a dark
purple hue, but I have seen one case in which they were of a bright red
colour. In this instance, a secondary abscess had formed in the knee-
joint, and some pustules appeared upon the skin in the neighbourhood.
A fortnight before the death of the patient, a number of small bright
red spots made their appearance in different parts of the thigh and
upper part of the leg; some of these were three or four lines in diameter,
while others were so small as not to be seen without attention; they
appeared in accurately defined spots, of a brighter colour than the mu-
cous membrane of the lips, and continued unchanged in appearance till
death. The third form presents itself much more frequently than
either of the others, although it has not hitherto much attracted the
attention of pathologists, in connexion with purulent or other infection
of the blood. It commences very suddenly, and frequently without any
particular attention being directed to the part. A large circular patch
of congestion, livid or purple in the centre, but becoming of a lighter
colour towards the circumference, will form, usually upon some part of
the lower extremities. The skin of the calf of the leg is perhaps more
frequently attacked than that of any other part. In the centre of the con-
gested portion, mortification very rapidly takes place, and is indicated by
the part assuming a black or dull leaden colour. In some cases, it would
be difficult to say where the mortification ceases, and the congestion
begins; but in other instances, there is a distinct line of demarcation
formed: a zone of bright red congestion will then occasionally surround
the mortified part. -
Some modifications of this third form of affection of the skin may be
met with occasionally in the course of the disease. Blotches assuming
a livid or dusky red appearance (which gradually fades into the colour
of the surrounding skin), will present themselves in different parts
(Case XXXVI). In some instances, the superficial portions only of the
skin are destroyed, and the parts beneath appear comparatively unaf.
fected; small circumscribed portions of the outer layer of the skin will
exfoliate, and the subjacent parts will heal without suppuration, by a
process similar to that of scabbing (Case III). -
It is remarkable in this disease, that the most vascular parts are
those which soonest lose their vitality. Thus, in the case last referred
to, portions of the surface of the skin perished, while the deeper layers
BY HENRY LEE, ESQ., F.R.C.S.ENG. 621
recovered; again, it is not unusual to observe the whole thickness of the
skin destroyed, without any corresponding affection of the cellular mem-
brane beneath. The quantity of blood sent to a part would thus appear
to favour mortification in this disease. The reason of this peculiarity
will be considered in the next section. - -
In two of the instances recorded in the Appendix (Cases xxi.1 and
xxvi), the lining membrane of the rectum was found of a very dark
colour, and in one it had assumed a greenish appearance. This dis-
coloration was at first looked upon as some accidental complication, or
as depending upon previous disease. But M. Gaspard has noticed a
similar condition, after the artificial introduction of putrid fluid into the
blood." In one of the experiments referred to, the mucous membrane
of the intestines was everywhere healthy, except in the rectum and
duodenum. In the former situation, the rugae were prominent, and of
a violet colour; in the latter, the membrane was of the colour of pale
lees of wine. From the coincidence thus observed, we are led to believe
that the same condition which produces congestion in the skin, may
produce an analogous affection of the mucous membrane. Nor must
we omit to note, in connexion with this subject, the fact of the mucous
membrane of the vagina being occasionally found of a dark purple colour
in those who die of puerperal affections. " .
In the cellular membrane, serum, lymph, and pus, may be deposited,
mixed with each other in various proportions. The surrounding vascu-
larity, in these cases, is unusually small, and the lymph effused not
properly organized; there is, consequently, no natural boundary to the
disorganizing process, and the fluid secreted becomes infiltrated in the
surrounding parts.
When the muscular structure is affected, suppuration takes place
with great rapidity; portions of muscles may be found quite soft, and
sometimes pultaceous, in circumscribed patches, around which the fibre
is perfectly healthy. Pus is occasionally deposited on the exterior of
muscles; and it will be then smeared over the surface, and rather in-
filtrated in the cellular tissue, than contained in a cyst. In the interior
of muscles, there is the same absence of the natural limit to the inflam-
mation; but, owing to the more compact structure of the part, the depo-
sits of matter generally remain circumscribed. . .
The brain and its membranes frequently present diseased appearances
in those who die from secondary inflammation; these, for the most
part, may be altogether independent of any peculiar effects of the dis-
ease; but, in some cases, it appears probable that they are not altoge-
ther unconnected with it. In one of the accompanying cases, the pons
Warolii and medulla oblongata were found of a pink colour, in conse-
quence of congestion, where the system had become contaminated by the
absorption of diseased secretion; and, in another, a layer of purulent
lymph was found within the cavity of the arachnoid, accompanied by
marks of inflammatory action in the fourth, and in one of the lateral
ventricles. - - |
The serous membranes are peculiarly liable to be attacked by second-
ary inflammation; and, when affected, suppurate with the greatest readi-
* Journal de Physiologie, t. iv, p. 45.
622 INFLAMMATION OF THE WEINS, ETC.
ness. They generally exhibit but a slight degree of vascularity, and
sometimes scarcely appear more injected than in their natural condition.
In the peritoneal cavity, large quantities of unorganised lymph are
frequently poured out, mixed with turbid serum or pus. The synovial
membranes of joints, when affected, appear to run directly into suppur-
ation, and will become distended with pus in a very short space of
time. The pleura, on the other hand, will seldom suppurate at first;
but lymph will be deposited upon its surface, and its cavity will contain
turbid serum, occasionally mixed with blood.
XI. In the first sections, the changes produced in the blood, both in
and out of the body, by the admixture of purulent or diseased secre-
tions, were considered; and, in the last section, the post-mortem appear-
ances observed in the different organs of those who have died in conse-
quence of secondary inflammations, have been described. It now
remains to connect these two series of observations, and to trace the
relation that they bear to each other.
The most direct way in which diseased blood produces disease in the
parts to which it is conveyed, is by communicating to them its own con-
dition. Even foreign substances, which have no natural connexion with
the body, may, in this way, be conveyed in the blood, and deposited in
the organs of the body. Hunter relates a case,” in which a house-painter,
who had been paralytic in his hands and legs for a considerable time,
had his thigh broken, and died, about three weeks after, of the accident:
“On examining the body, after death, the muscles, particularly those
of the arms, had lost their natural colour; but, instead of being liga-
mentous and semitransparent, as happens in common paralysis, they
were opaque, resembling exactly in appearance parts steeped in a solu-
tion of Goulard's extract. From this case it appears, that the lead had
been evidently carried along with the blood into the muscles themselves.
The blood can thus receive and retain extraneous matter capable of
destroying the solids.”
If foreign matter may, in this way, be conveyed to different parts of
the frame, and there produce its chemical effects, it will readily be ad-
mitted, that a mechanical or vital action commenced in the blood,” may
be continued in it when moved to a different part of the body.
In those who die of secondary inflammations, the result of such
actions may frequently be traced from the seat of the primary injury
even to the heart itself; and, as it has already been shown that conta-
minated blood will communicate morbid action to the vessels in which
it is contained (section III), there no longer remains any difficulty in
accounting for the sudden way in which this disease may fall upon a
particular organ, or the unexpected manner in which the symptoms
may shift from one part of the body to another. The conditions of the
blood, which may be observed upon dissection, in this disease, so far as
they tend to illustrate the present subject, may be included in two
general expressions: 1st, those in which the blood has had a preter-
natural tendency to coagulate impressed upon it; and, 2nd, those in
* Op. cit. p. 99. - - -
* It may appear unusual to speak of action going on in the blood; but, in so doing,
we only illustrate the principle with which we commenced, viz., that “the blood
has the power of action within itself.”
BY HENRY LEE, FSQ., F.R.C.S.ENG. (523
which its coagulating power has, to a greater or less extent, been
impaired. In one case, the blood is generally found of a dark colour,
with firm, and sometimes adherent coagula in the vessels; in the other,
it is thin and fluid.
When a preternatural tendency to coagulate has been impressed upon
the blood, it will lodge in different parts of the vascular system, in situ-
ations which are most favourable to such an action; when, on the con-
trary, it has lost its coagulating power, extensive effusions may be
expected, and the symptoms included under the term “gangrenous dia-
thesis” will generally manifest themselves. -
As the aggregate diameter of the vessels in the body decreases, the
blood in them flows with greater rapidity and force; and when near
the heart, it is placed in circumstances unfavourable to coagula-
tion, in consequence of the rapid motion there communicated to it;
and we accordingly find that, although adherent coagula may be formed
in the veins leading from the seat of injury, and may be traced thence
through other larger vessels, they will usually terminate abruptly, when
these open into the vena cava. But when the blood arrives in the cavi-
ties of the heart, the tendency to coagulate may again manifest itself.
Diseased coagula, presenting a “mottled appearance, partly brown, and
partly of a dirty yellow colour”, or “dark coloured, and partly com-
posed of a yellowish grey opaque substance”, or “with portions ine-
lastic, and of an opaque yellow colour”, will be found entangled among
the projecting fibres of the auricles and ventricles. In the arteries, the
blood is in the most unfavourable circumstances for coagulation during
life, in consequence of the comparative smallness of their diameters, and
the succession of impulses communicated to their contents; but even
here, diseased and adherent coagula may be found in cases of secondary
inflammations.
M. Cruveilhier' relates an instance in which, after child-birth, the
pulmonary artery was found filled with coagula following its divisions.
The principal clot had lost its colour, and was adherent to the sides of
the vessel, and contained in its centre puriform fluid.
In another case, following the operation for necrosis, the following
post-mortem appearances were observed. The left lung presented, in
several places, patches of red hepatization, perfectly defined, and resem-
bling so many spots of lobular inflammation. When cut into, these
patches presented several puncta of puriform fluid. The veins of the
lung contained fibrinous-looking coagula blocking up their cavities;
and in the centre of these coagula was a whitish purulent looking fluid.
The diseased condition of the blood may thus be traced visibly from
the original wound, through the larger vessels, to the heart, and again
from the heart to the capillary system. The disposition to coagulate,
once impressed upon the blood, is not destroyed by that fluid being
conveyed to a different part of the body: the action may be retarded
by motion in, as well as out of the body, but will nevertheless occur
when it is placed under more favourable circumstances.
These circumstances, in the living vessels, are when the bloodZ
becomes separated into small quantities, and when it moves slowly

* Op. cit. p. 669.
624 INFLAMMATION OF THE VEINs, ETC.
along the capillaries. The blood will then coagulate in circumscribed
patches, as illustrated in the first characteristic marks of secondary
disease which have already been mentioned as occurring in the lungs,
the liver, the spleen, and the skin. The accompanying plate is taken
from the lung of a donkey in which purulent fluid had been made to
circulate with the blood. The stagnation of the blood, when the pus
was first introduced, was mechanically prevented, and the livid spots
produced by its subsequent coagulation in the capillaries of the lungs
has been very faithfully represented. (See Experiment No. VI.)
“Besides the disposition for coagulation,” observes Mr. Hunter,
“the blood has, under certain circumstances, a disposition for the
separation of the red globules, and probably of all its parts; for I have
reason to believe, that a disposition for a separation of the red part
and coagulation, are not the same thing, but arise from two different
principles. This is always observable in bleeding; for if we tie up
an arm and do not bleed immediately, the first blood that flows from
‘the orifice, or that which has stagnated for some time in the veins, will
soonest separate into its three constituent parts: this circumstance
exposes more of the coagulating lymph at the top, which is supposed
by the ignorant to indicate more inflammation, while the next quantity
taken suspends its red parts in the lymph, and gives the idea that the
first small quantity had been of such service at the time of its flowing,
as to have altered for the better the whole mass of blood. Rest, there-
fore, may be regarded as one of the immediate causes of the separation.”
Hunter, p. 29. - -
This disposition of the blood to separate into its constituent parts is
evinced in a very marked degree in one class of secondary affections.
Extensive effusions of serum, lymph, and pus, mixed in different pro-
portions, will take place in the serous cavities of the body, and become
infiltrated in the cellular membrane, accompanied with very little vas-
cular action in the parts. The colouring matter of the blood will also
sometimes become effused with its other parts; but when this is the
case, they will be found to have lost altogether the power of coagulation :
in this respect presenting a direct contrast to the blood effused from
a healthy wounded vessel. The lymph deposited will be found lying
in unorganized flakes, wanting its usual adhesive properties, and very
slightly attached to parts, presenting little or no increased vascularity,
The rapid manner in which these effusions take place, shows that they
are separated from the blood without undergoing any very elaborate
process. In this condition of the system, any organ upon which the
disease falls, may rapidly become disorganized and will readily mortify,
and, after death, a tendency to rapid decomposition will be manifested.
The veins on the surface of the body may frequently be traced as dark blue
lines, as though the skin covering them were stained by the colouring
matter of the blood. The lungs and other organs may, under these
circumstances, be found in every grade of disorganization, till they pre-
sent all the characteristics of gangrene: even the peculiar fetor which
accompanies mortification of the lung, will, in some instances, be pre-
1 The term ecchymosis does not appear appropriate to the discoloured condition
of parts observed in the commencement of this disease; the blood is not at first
extravasated from the vessels, as the term frequently employed would indicate.
PLATE shºwing the Fºst monent appearance enopuced
BY THE STAGNATION OF viºla TED ELoop in The capillants of The Lungs.
Surface of Lund with Pleura removed.
----------------------


BY HENRY LEE, ESQ., F.R.C.S.I.N.G. 625
sent. In this condition may also be observed a tendency to the
formation of petechial spots in different parts; and even the organs
which do not appear to have been the peculiar seat of the disease, will
be found to have lost their consistency, and to break down upon com-
paratively slight pressure.
Mr. Hunter found, that in proportion as the blood retained the
power of coagulation, it had the power of resisting putrefaction; and
conversely, we observe that, in this class of cases, the deficiency of the
former is accompanied in a marked manner with the absence of the
latter.
The two conditions of the blood which have now been mentioned,
appear to bear a direct relation to the two classes of post-mortem
appearances, observed in cases of secondary inflammations: the first
being generally connected with congestion of different organs during
the first stages of the disease, the second with extensive effusions,
accompanied with comparatively little vascularity.
XII. The treatment of secondary inflammations naturally divides
itself into local and constitutional, both as regards the primary lesion
and the subsequent affections. The circumstances which interfere
with union by the first intention in veins, have been shown to be the
same as those which precede the formation of purulent deposits, in a
large class of cases. Whatever then tends to favour the healthy
reparation of a wounded vein, may be regarded as affording security
against any subsequent disease; but the chief point in the local treat-
ment is, perhaps, to prevent any accidental circumstances from inter-
fering with the matural process of repair. When the powers of the
constitution are enfeebled, even the natural motions of a part may
interfere with recovery, and rest sometimes becomes an important
object in the treatment. How necessary this is after child-birth, when
the divided veins are being closed, every one who has attended such
cases practically knows.
Again, after bleeding, the arm will inflame in a much greater
proportion of cases, when the patient is obliged to follow his usual
occupation, or when, from accidental circumstances (as from the pain
experienced in Case 1), the arms are kept in motion. It has oc-
curred to me, to see the symptoms of purulent deposits set in, on
the day following prolonged attempts to bring fractured portions of
bone into position. In all such cases, any external violence (as in
Experiment No. VI), or even the motion of the body, as in Dr. Davis's
case (section Iv) may loosen the coagula formed, either between the
wounded edges, or in the cavities of veins. In the treatment of the
local injury, a valuable hint has been left us by Mr. Hunter, connected
directly with the consideration of the pathology of the disease. “The
way in which sore arms after bleeding come on, shows plainly that they
arise from the wound not healing by the first intention"; and he recom-
mends that the two sides of the vein should be approximated by a
compress, until union of the divided edges has taken place.
It has been shown upon very high authority, that the sides of a vein
do not unite after venesection (as has sometimes been presumed to be
Mr. Hunter's opinion); but that the divided edges only of the vessel
are agglutinated by the coagulum, which “serves as a bed to the new
626 IN FLAMMATION OF THE WEINs, ETC.
membrane.” But the case is different, should this first attempt at
union fail; the sides of the vessel may then become united, and its
cavity for a time obstructed (section IV). The approximation of the
sides of the veins would materially facilitate this action, which is the
natural security, under the circumstances, against the admission of
foreign matter. When an abscess is suspected to have formed in a
vein, a similar mode of treatment is recommended by Hunter; the
compression, in this case, being placed between the inflamed part and
the centre of the circulation. In the pathological museum of the
College of Surgeons, one of Mr. Hunter's preparations (No. 1728) ex-
hibits such a case, where, from the imperfect union of a vein, the con-
tents of the abscess had become mixed with the blood.
As the process of reparation has been variously described by authors,
so the different theories propounded have led to different kinds of treat-
ment. At the Veterinary College, even within the last few years, it
was publicly taught, that a coagulum in a vein was a foreign substance,
and ought to be removed; and the jugular vein in horses which had been
bled, was sometimes slit up for several inches, in order to remove the
coagula which formed in successive portions of its course.
That a coagulum in a vein may be an irritating substance has been
fully proved (sections I and II); but the irritation depends upon the acci-
dental admixture of foreign matter: and the process that consequently
takes place requires to be carefully distinguished from the natural mode
of union by the first intention.
To remove coagula which have formed round purulent secretion (if
such could be recognised), might be to remove a cause of irritation; but
to remove them in ordinary cases, is to remove the very means prepared
by nature for the restoration and safety of the part. In operations
involving large vessels, the local conditions which may influence the
actions in the veins, appear not to have been fully determined; for
while some surgeons regard the tying or cutting of a vein as a serious
operation, others are in the constant habit of doing it with impunity.
In operations upon haemorrhoidal tumours, the veins involved are of
Some size, and in two of the instances recorded in the Appendix, a liga-
ture applied to them was followed by purulent deposits. In the usual
operation of passing a needle armed with a double ligature through the
base of such a tumour, the haemorrhoidal veins are necessarily sometimes
wounded, and there is danger that, in tying the ligatures, the sides of a
wounded vein may be drawn asunder. The vessel may thus be held
open, and be in a similar condition to the vessels contained in bony
Structures.
A Safe way of performing this operation, when admissible, is to
destroy a portion of the mucous membrane with strong nitric acid.
The blood in the vessels them becomes charred, and their cavities
obstructed, till they are permanently closed by adhesive inflammation.
Every means of treating a local injury which tends to produce healthy
union or adhesion, may be considered in some sort as a preventive mode
of treatment. Position, topical applications, bandages, and tempera-
ture, may all have their influence in producing these healthy actions;
but, as the wounds which precede purulent deposits are generally cha-
racterized by feeble powers, those conditions which tend to invigorate
BY HENRY LEE, ESQ., F.R.C.S.ENG. 627
the parts are principally indicated. “When action is greater than
strength, whatever has the tendency to raise the power above irritability
should be used: the object of this practice consists in bringing the
strength of the constitution and parts as near upon a par with the action
as possible, by which means, a kindly resolution or suppuration may
take place, according as the parts are capable of acting.” The irrita-
bility of a wound frequently appears nothing else than a series of at-
tempts to bring about an action, which it has not the power to accomplish:
as soon as that is fulfilled, which the necessity of the parts demands for
their healthy condition, irritation will cease. In such cases, everything
that will confer strength to carry out the intended action, will prevent
inflammation. But no local applications will be sufficient to produce
this effect, unless the powers of the constitution are supported at the
same time. -
A heavy man received a wound in the back of his head from an iron
spike; he was kept very low, complaining occasionally of want of food.
Repeated hamorrhage took place at intervals of a day or two, which no
local applications could suppress, and he ultimately died from loss of
blood. The wound was found to extend through the bone into the
lateral sinus, which contained only some fluid blood. No inflammatory
action had taken place within the skull.
The constitutional treatment of wounds, liable to be succeeded by
purulent deposits, is most important; for during the healing of the
primary wound, the system may be influenced by remedies, which may
be subsequently quite useless. It is evident, observes M. Cru-
veilhier," that the treatment of phlebitis ought to be concentrated on
the first period of the disease, viz., that of the coagulation of the
blood; for as soon as pus has become mixed with the circulating blood,
medicine is generally of no avail. When there are indications of
the extension of inflammation along a vein, the mode of treatment
usually adopted in this country has been the administration of calomel
and opium; and, in France, general bleeding, but especially the
application of large numbers of leeches. “We may subdue inflam-
mation of veins, whatever their situation, by general blood-letting,
and especially by local bleeding, repeatedly sufficiently often and in
sufficient quantities "* It is true that patients recover after such treat-
ment; but the published records of cases not unfrequently terminate with
such a description as the following: “The patient was repeatedly bled,
and with apparent relief every time, the blood being extremely sizy.
Two days, however, previous to death, the vital principle was so eahausted
as to need the use of cordials!!”
If the explanation of the mode of adhesion in veins already given
be correct, neither the propriety of bleeding, nor of the administration
of mercury, as a rule, derives much support from a consideration of the
pathology of the disease. Careful comparative experience is required,
before either of these plans can be adopted as a recognised mode of
treatment. Satisfactory evidence in favour of the employment of these
remedies is still wanting; and, indeed, the numerical evidence which we
have in some instances, tends to indicate an opposite plan of treatment.
* Op. cit. p. 662. - 3 Ibid.
WOL. II. 42
628 INFLAMMIATION OF THE WEINS, ETC.
At a period when puerperal fever was rife, forty cases, attacked with
some form of the disease, “were treated without any bleeding or leeching,
or without any attempt to induce the constitutional effects of mercury;
and of these, only two died.” “In irritable habits, when the inflammation
becomes more diffused,” says Mr. Hunter, “bleeding should be performed
with great caution: even a quick, hard pulse, and sizy blood, are not
always to be depended upon as sure indications of bleeding being the
proper method of the resolution of the inflammation; more must be
taken into the account. The kind of blood is of great consequence to
be known; for although it should prove sizy, yet if it lies squat in the
basin, and is not firm in texture, and if the symptoms at the same time
are very violent, bleeding must be performed very sparingly, if at all;
for I suspect, that under such a state of blood, if the symptoms con-
tinue, bleeding is not the proper mode of treatment. If we had
medicines which, when given internally, could be taken into the consti-
tution, and were endowed with a power of making the vessels contract,
such, I apprehend, would be proper medicines. Bark has certainly this
property, and is of singular service, I believe, in every inflammation
attended with weakness; and therefore, I conceive, should be oftener
given than is commonly done.”
In bleeding women suffering from puerperal fever during an epi-
demic, in which the disease frequently terminated in purulent deposits,
I have frequently seen an irregular transparent bluish layer form upon
the surface of the blood, almost immediately after the operation; in
consequence of this, a repetition of the bleeding was sometimes had
recourse to, when the subsequent stages of the disease appeared to indi-
cate that it had not been required. The transparent layer of lymph on
the surface of the blood, may, in such instances, be only an indication
of its tendency to separate into its different parts, as previously described.
Large bleedings, under such circumstances, inasmuch as they tend to
diminish the already enfeebled power of coagulation in the blood, may
predispose to the infection of the system, and to the formation of puru-
lent deposits. The action of mercury upon the system, as illustrated
in Case XXVI, may have the same tendency. -
The action of mercury, so far as it can be traced upon the surface of
the body, is certainly unfavourable both to union by the first intention,
and to adhesive inflammation; and, inasmuch as the safety of the patient
depends upon the due performance of these processes after an injury or
wound, its effect upon the system must be regarded as of at least doubt-
ful advantage.
When salivation has been induced, serum is poured out, and the
texture of the gums is loosened and rendered spongy. When lymph is
effused upon the iris, the action of mercury loosens its adhesions, and
dissolves its connexions; it cannot, therefore, be supposed that its
action upon the system should render the union of divided vessels
stronger, or the newly-formed adhesions in wounds firmer. The cases in
which purulent deposits usually form, indicate a debilitated state of con-
stitution. They are of much more frequent occurrence in large towns
than in the country, and in hospital than in private practice. The de-
* FERGUSON (Dr.) On the Diseases of Women. These cases formed one-fifth of
the whole number treated.
BY HENRY LEE, ESQ., F.R.C.S.ENG. 629
pressing influences which they give to erysipºlas, or puerperal fever, will
also predispose to the formation of these abscesses; and as scanty diet, loss
of blood, debilitating surgical operations, and over-crowded rooms, have
been found among the causes of the former, so may they be looked upon
as favouring the production of the latter. The Treatment of Inflamma-
tion of the Weins, in which purulent deposits frequently originate, is thus
spoken of from the result of lengthened observation: “All the experi-
ence that I have had on the subject, would lead me to believe that, like
erysipelas, it has its origin in a low asthenic state of the system, and
that those persons are especially liable to it, who have been much lowered .
by hamorrhage at the time of an operation, or by too scanty a diet after-
wards. An operation is a shock upon the system, making a great de-
mand upon the vital powers. The effects of this shock are often much
aggravated by loss of blood, and a very scanty diet actually makes the
patient more liable to some kinds of inflammation. Our mode of prac-
tice ought to be rather to sustain his powers by allowing him wholesome
nourishment, and not to add to the influence of the other depressing
causes, the still worse one of starvation.” But as there are many cir-
cumstances, besides mere debility, which tend to produce a depressing
effect upon the vital powers, so tonic medicines, and a generous diet,
must not be looked upon as the only preventive modes of treatment.
Each case that occurs in practice may present some peculiarity; in one
case, the patient will be found to have previously suffered from diabetes;
in another, from disease of the spleen ; and in a third, from organic
disease of the kidney ; and, in each of these, a peculiar mode of treat-
ment may be required. The general treatment of this disease, after the
formation of purulent deposits has commenced, is probably as little
satisfactory as any that come under the notice of the surgeon. The
whole character of the affection is characterized by what has been aptly
designated as action without power. The excitement of the system will
imitate all the acts of genuine inflammation, without any of its healthy
results; and loss of energy will appear immediately after, or even arise
in conjunction with, the first symptoms of increased action.
In the treatment of such deposits, it must be borne in mind, that
they are not the disease, but the effects of a concealed cause, which may
develope itself in any part of the system; and that, while the relief of
one organ is sought by depletion, additional vigour may be given to the
latent evil, so as to render it more ready to develope itself in some
other part. When purulent deposits occur, the sudden congestions,
which indicate their commencement, are not accompanied by any
reparative actions, and the lymph, which is effused in the subsequent
stages of their formation, is not so disposed as to circumscribe and
limit the inflammation; there is, therefore, no natural process by means
of which such collections of fluid can be evacuated; hence, when situated
near the surface, they should be opened as soon as they are detected.
It will sometimes happen, that, after the symptoms of secondary inflam-
mation of internal organs have commenced, an abscess will present itself
near the surface of the body, and relief will be afforded to the part first
affected; at other times, an obstinate and violent diarrhoea will precede
* BRODIE (Sir B. C.) Medical Gazette, vol. xxxvii, p. 642. 2
- - 42
{}30 IN FLAMMATION OF THE WEINS, JETC.
recovery. Although the mode of treatment adopted may have little influ-
ence either in bringing on, or checking, such salutary actions, it is im-
portant to watch their occurrence, and perhaps still more important, to
be careful not to mistake a remedial action for a symptom of the disease.
“What treatment,” says Cruveilhier, “shall we oppose to purulent in-
fection? To this question experience is as yet dumb, while theory would
seem to point to diffusible stimuli and tonics; to ammonia, quinine,
and sudorifics; to hot external applications, to the vapour baths, to pur-
gatives, and especially to emetics; to tartarized antimony, in large doses;
to vesicatories, and to strong diuretics. Calomel has been extensively
employed, to create a fluxion from the intestinal mucous membrane;
but all these means have failed as signally in my hands as in those of
others; yet, when the injection of putrid matters into the veins of living
animals has been followed by abundant and very fetid evacuations, they
have usually got well. It is a fundamental fact of pathology, that the
intestimal canal is chiefly affected in diseases caused by miasmata. I
am certain that diseases resulting from purulent infection would not be
stamped with the seal of incurability, and that nature, seconded by art,
would triumph in the majority of cases, if the pus, which is incessantly
renewed, did not incessantly renew the sources of infection. As soon as
constitutional symptoms manifest themselves, neither general nor local
bleeding affords any advantage. A portion of the materies morbi is, no
doubt, abstracted with the blood; but, as it is constantly being repro-
duced, the constitution is only deprived of the power it would otherwise
have of resisting the disease.” In accordance with this remark, M.
Gaspard found that animals, which recovered after the injection of a
certain quantity of pus into their veins, often died when the experiment
was repeated. The recovery was usually preceded by black, liquid, and
extremely fetid evacuations, which often seemed to afford immediate
relief. When such evacuations have taken place in other diseases, the
gall-bladder has been found distended with black bile;” and it appears
probable that the liver, in these cases, is one of the principal organs
through which the cleansing of the system is attempted. If the supply
of morbid matter to the system could be checked, mercurial action, in this
stage of the disease, might be of service, by enabling the liver, or other
organs, to throw off their vitiated secretions. When patients recover
from purulent deposits (Cases III and xxvii), they are often left in a debili-
tated and languid state, in which ordinary tonics exercise little influence.
The consequences of the disease appear to hang about the system, long
after the cause which gave rise to it has ceased. The pulse will some-
times continue irritable, and there will be a tendency to derangement
of the secretions of the skin, bowels, and other organs, accompanied by
occasional slight attacks of fever. In this condition, an alterative course
of mercury, combined with Sarsaparilla, has been found beneficial.
These remedies, by stimulating the activity of the excreting organs, may
assist the constitution in throwing off the disease ; and their mode of
action may be the same as in other cases, where the system has been
infected by an animal poison.
* Op. cit p. 662.
* I have observed this condition after injuries of the spine which proved fatal,
by causing inflammation of other parts.
BY HENRY LEE, ESQ., F.R.C.S ENG. 631
A PPIE N DIX OF CA. SE, S.
A. CASES OF SECONDARY INFLAMMATION, ACCOMPANIED BY MORTIFICATION
OF THE SKIN.
CASE I. William Ford, 33, an apparently healthy man, was seized
with the symptom of strangulated hernia, at Harrow, December 28th.
He was bled in both arms; but, as the hernia remained unreduced, he
was sent to town, in a state of considerable restlessness and suffering.
During his journey, the hernia returned of its own accord. He left
quite relieved, and remained well till the 31st, when he had a rigor.
On the 1st of February, there was a considerable degree of febrile excite-
ment, and the anterior part of the left arm was red, swollen, and pain.
ful upon pressure. The tenderness and pain soon extended up the
arm, in the course of the cephalic vein : the redness assumed the cha-
racter of erysipelas. On the 3rd, he suffered from sickness, the matter
vomited being green and acid. He had two severe rigors, followed by
great heat of skin, and a quick full pulse. The orifice in the left arm
discharged a thin serous fluid. On the 4th, he complained of stiff.
ness in the right arm ; also of being very feeble and faint, 5th.
Wandered much during the night. The right arm was a good deal
swollen about the end of the elbow-joint, and presented a patch of a
bright red colour above the condyle. The pulse was weak and tremu-
lous; motions of the hands was occasionally observed. He complained
of pain in the ring-finger of the right hand, and in the ball of the right
great toe. The skin, in both these situations, had assumed a red
appearance. 6th. Was delirious during the greater part of the night;
countenance expressive of much anxiety; pulse very weak; tongue
covered by a brown dry fur; profuse perspiration; complaimed of severe
pain in the calves of his legs. He died during the following night.
Post-mortem appearances. A small deposit of thick pus was found
on the external surface of the left cephalic vein. The blood was coagu-
lated in its cavity, its coats were thickened, and its liming membrane
appeared very red. This redness could be traced, though in a less
degree, through the whole extent of the vena innominata. On the
right side, the cellular tissue, both above and below the elbow-joint,
was greatly distended with serum. The cephalic vein of the right
arm presented marks of having been inflamed; but not nearly to the
same extent as upon the opposite side. The joints in which pain had
been experienced during life, were distended with turbid pus; deposits
of pus were also found in the anterior mediastinum, and between the
oesophagus and trachea. A large gangrenous spot was observed in the
skin of the calf of the right leg. The subjacent cellular tissue was
much distended with serum.
CASE II. Richard Mason had a small cancerous tumour removed
from the lower lip. The operation was performed in the usual way,
and the wound appeared to heal by the first intention; a small abscess,
however, followed by some ulceration, subsequently appeared in the
neighbourhood of the cicatrix, Nine days after the operation, he com-
plained of sore throat and general uneasiness, and three days afterwards
he was seized with rigors, followed by cold perspiration and coma.
Post-mortem appearances. A small deposit of matter was found,
632 INFLAMMATION OF THE VEINS, ETC.
situated beneath the fascia of the left thigh. The synovial membrane
of the left knee was highly inflamed, and contained a large quantity of
pus. On the right side, the skin of the whole inferior extremity pre-
sented a dark livid appearance, with the exception of that situated upon
the fore part of the thigh. The same dark colour was observed in the
muscles of the limb, which were infiltrated with blood and serum.
The arteries and veins were discoloured, but in other respects presented
nothing remarkable. It was ascertained, that, two years previously,
this patient had suffered from diabetes; and upon examining the urine
found in the bladder, it was found to contain sugar.
CASE III. Jane Thornton, aet. 32, came under treatment on the 22nd
of March. A week previously, her right ancle had become red and
painful, and inflammation subsequently extended up the inner side of
the leg. When first seen, she was evidently much out of health, although
no one organ could be said to be particularly affected. On the 28th of
March, she was attacked with severe rigors, and experienced pains in
different parts of her limbs: the rigors were repeated for several days
in succession. The inflammation of the leg now entirely disappeared,
and she complained of pain in the right knee, which was slightly swollen.
On the 31st, her bowels became much relaxed; there was great general
depression, and much nervous agitation. Both knees were swollen. The
general symptoms now became somewhat relieved; but on the 4th April,
she was attacked with vomiting, which recurred frequently during the
day, and was accompanied with great depression, and severe pain in the
epigastrium. On the 5th, the sickness continued, apparently quite un-
influenced by any remedies. She passed considerable quantities of blood
by stool: her countenance presented a dusky yellow hue: the pulse
Was excited, without power, and the sense of depression was greatly in-
creased. On the 7th, the vomiting still continued, and she still passed
blood by stool. Some spots of a dark purple colour now made their
appearance upon her face. The hands both became slightly swollen;
and upon the right one, some small, dark, livid spots, similar to those
upon the face, made their appearance. She was much troubled with
hiccough. On the 9th, the countenance was very anxious, the com-
plexion more sallow: some more livid spots appeared upon the face and
cheeks. The right hand and arm were swollen and painful: some fresh
livid spots appeared, upon the knuckles. Complained much of faintness:
had extreme debility with occasional hiccough : pulse extremely weak:
the surface of the body was covered with cold perspiration. The sickness
had entirely ceased, and there was no blood in the motions: the tongue
was rather dry in the centre, but tolerably clean. 10th. She wandered
slightly during the night, and vomited once: some blood again appeared
in the motions; the right hand and arm were less swollen. 11th. The
countenance was anxious, the pulse about 90, and intermitting irregu-
larly. The vomiting recurred several times. The livid spots on the
right hand had not increased in size, but appeared like distinct small
black superficial sloughs of the skin; these all scabbed off, without sup-
puration. 12th. The pain and swelling of the arm had nearly subsided.
The bowels acted very freely with the aid of medicine, and she expressed
herself much relieved. From this time the patient slowly but gradually
improved, with one or two slight intermissions, till the beginning of
BY HENRY LEE, ESQ., F.R.C.S.ENG.
633
May, when she again complained of pain at the inner part of the right
arm, above the elbow.
Some hardness could here be felt in the course
of the basilic vein. Some small collections of matter were now deposited
upon the back of the right hand, resembling, in some respects, the erup-
tion of confluent small-pox.
On May 11th, she had regained much of
her strength, but still felt some pain in the elbow upon motion.
She
also complained of the joints of one of her fingers. She now left Lon-
don for change of air.
*
The following Table is formed of Cases taken consecutively
during One Year.
Heads of Cases.
Period of second.
ary inflammation.
Post-mortem appearances.
CASE IV. Elizth. Mackintosh,
aet. 25. Inflamed bursa patellae;
erysipelatous inflammation in
the neighbourhood of the right
axilla ; sudden suppression of
the catamenia; rigor; perito-
nitis; tongue covered with
yellowish white coating ; sick-
ness; “ catching pains” in the
epigastric region.
CASE v. James Stevens, aet.
46. Punctured wound of the
finger whilst opening a rabbit;
diffuse cellular inflammation of
the right arm ; spasmodic and
“ catching pains”, principally
referred to the epigastrium;
expectoration of bloody fluid.
CASEVI. William Collins, aet.
36. Bruise of the patella,
caused by the wheel of a car-
riage; apparent recovery ; ery-
sipelatous redness over the left
knee; rigor; rapid pulse ; hot
skin, followed by perspirations,
pains in the head, restlessness,
delirium. -
CASE VII. Maria Martin, aet.
39. Caries and necrosis of the
tibia, with large ulcer of the
leg.
CASE VIII. George Mason,
aet. 42. Compound commin-
uted fracture of the metacarpal
bones; inflammation of the
absorbents; erysipelatous red-
ness of the skin; secondary
abscess in the affected arm;
rigidity of the muscles of the
tongue; trismus; universal
affection of the muscles.
A few days |
after the ap-
pearance of the
erysipelatous
inflammation ;
three days be-
fore death.
Twenty-seven
days after the
injury; about
seven days be-
fore death.
Twenty days
after the acci-
dent ; three
days before his
death.
Several
months after
the occurrence
of caries of the
tibia; a few days
before death.
Nine days af.
ter the injury;
twenty-two
days before
death.
Dark-coloured serum, mixed with
shreds of recently effused lymph, in
the cavity of the left pleura ; large
quantities of sero-purulent fluid,
with recently effused lymph, in the
peritoneal cavity.
Bloody fluid in the cavity of the
left pleura ; pus in the left elbow-
joint.

Cavity of the knee-joint contain-
ing a quantity of thick grumouse
fluid, apparently a mixture of
blood and synovia ; fibrous degen-
eration of a portion of the carti-
lage of the patella; turbid serum
in the sub-arachnoid cellular tissue;
bloody puncta in the brain, larger
and more numerous than natural ;
posterior part of both lungs gorged
with blood.
The skin of the upper part of the
leg and the whole of the thigh of a
mottled appearance, caused by ex-
tensive dark patches of incipient
gangrene ; the cellular tissue of the
limbinfiltrated with lymph and pus.
Increased degree of congestion,
both in the grey and white sub-
stance of the brain; substance of
the pons Warolii and of the medulla
oblongata of a pinkish colour, and
presenting irregular streaks of in-
|creased vascularity; spleen soft,
and somewhat congested.
634.
VEINS, ETC.
INFLAMMATION OF THE
Heads of Cases.
Period of second-
ary inflammation.
Post-mortem appearances.
CASE Ix. Sarah Leg, aet. 50.
Necrosis of a portion of the
tibia, accompanied by a large
foul ulcer.
CASE X. Elizabeth Moleno,
aet. 42. Strangulated femoral
hernia of the left side ; oper-
ation ; erysipelatous blush
around the wound upon the
third day, followed by sick-
ness, cold perspiration, and de-
lirium ; several dark patches
upon the skin of the right leg.
CASE XI. Jane Cox, aet. 60.
Scalp wound ; erysipelas of the
head and face; transverse frac-
ture of the external malleolus,
followed by suppuration of the
ankle-joint.
CASE XII. Bartholomew Sul-
livan, aet. 27. Lacerated and
contused wound of the leg, fol-
lowed by diffuse cellular in-
flammation, and inflammation
of the absorbents; delirium ; a
separate large patch of morti-
fication, surrounded by bright
red congestion, appeared in
the right groin the day before
his death.
CASE XIII. George Foscutt,
aet. 24. Fracture of the femur
into the knee-joint ; rigors;
erysipelas of the limb, ill de-
fined and very slow in its pro-
gress; coma, ; abscesses in the
leg and thigh ; mortification of
the skin on the dorsum of the
foot, and over the left hip.
CASE XIV. William Wright,
at. 30. Fracture of the pa-
tella; erratic erysipelas; diar-
rhoea ; abscesses in the leg, and
in the knee-joint.
CASE XV. Henry Bateman,
aet. 19. Fracture of the fibula;
diffuse cellular inflammation
of the leg; suppuration in the
knee-joint; necrosis of a por-
tion of the fibula.
A few days
before death.
Eight days
after the opera-
tion; four days
before death.
A short time
before her
death.
Five days
after the acci-
dent ; eight
days before
his death.
Six days after
the accident;
twenty-two
days before his
death ; pain
in the chest
the day before
his death.
Erysipelas
appeared a
month after the
fracture of the
patella, and
about the same
time before his
death.
Three months
after the acci-
dent ; three
weeks beforehis
death.
Effusion of serum and lymph in
the cellular tissue, which surrounds
the pharynx and oesophagus; in-
flammation and ulceration of the
mucous membrane of the larynx ;
slight inflammation of the lungs;
the spleen of a greyish red colour,
more solid and more easily lacerated
than natural.
The lining membrane of the right
internal saphenic vein of a dark
livid colour throughout, the cavity
of the vessel filled with a large
quantity of coagulated blood mixed
with puriform fluid ; pus in the
common iliac vein; effusion of se-
rum around the veins of the leg;
liver large and congested; mottled
degeneration of both kidneys.
Mortification of the skin of the
lower part of the leg, ankle, and
foot; slight extravasation of blood
into the arachnoid cavity, and into
the substance of the brain ; kidneys
coarse in structure, and remarkably
soft.
Mortification of the skin and cel-
Iular tissue of the right leg; the
veins of the limb healthy; spleen of .
a pale colour, and very soft.
Hepatization of both lungs, with
Secondary abscesses in the left one ;-
kidneys soft and coarse in texture,
the left presenting a small deposit
of apparently tubercular matter;
spleen large, pale, and soft.
Effusion of lymph in the pleura ;
secondary abscesses in different
stages of formation in both lungs,
and deposit of lymph in one kidney.
Recent effusion of lymph upon
the pleura ; incipient secondary abs-
cess in both lungs; the tibia ex-
posed, and its structure of a black
'colour, and soft. º
BY HENRY LEE, ESQ., F.R.C.S.ENG.
635
Heads of Cases.
Period of second-
ary inflammation.
Post-mortem appearances.
CASE XVI. John Clark, aet.
45. Large scalp wound; rigor;
followed by paralysis of one
side; a portion of bone exposed,
of a darkish green colour, and
when removed of a putrid
odour.
CASE XVII. Matthew Elmes,
aet. 37. Injury of the wrist ;
diffuse cellular inflammation ;
abscesses in the cellular tissue,
and in the wrist-joint; lower
extremity of the radius de-
nuded ; pains in various parts
of the body, especially the head
and abdomen. -
CASE XVIII. Mary Hopkins,
aet. 19. Ulceration of the car-
tilages, followed by suppura-
tion of the knee-joint; ampu-
tation ; erratic erysipelas over
various parts.
CASE XIX. John Wilkinson,
aet. 56. Compound fracture of
the right tibia ; inflammation
around the wound, with collec-
tions of matter; slight deliri-
um ; sickness.
CASE XX. James Bryant, aet.
20. Scalp wound, denuding
the bone; puffiness of the scalp
upon the eighteenth day; ri-
gors, followed by profuse per-
spirations; restlessness; deli-
rium; projection of the eyeballs.
CASE XXI. James Williams,
aet. 41. Fracture of the lower
extremity of the left radius;
diffuse cellular inflammation of
the arm at the expiration of
four weeks ; abscesses in the
limb, one of which communi-
cated with the fracture ; di-
arrhoea ; vomiting; tongue dry
and brown.
CASE XXII. John Munday,
aet. 36. Prolapsus ani; hae-
morrhoids; rigor; anxiety of
countenance ; great heat of
skin ; pulse 150.
Nineteen days
after the acci-
dent ; three be-
fore death.
The tenth day
after his admis-
sion into the
hospital ; four
days before his
death.
Erysipelas ap-
peared a week
after amputa-
tion ; sixteen
days before
death.
Pain in the
right side a
week after his
admission.
Twenty-four
days after the
accident ; five
days before
death.
Ten weeks
after the acci-
dent; one week
before death.
The eighth
day after the
operation for
haemorrhoids;
the fourth be-
fore death.
Effusion of lymph between the
dura mater and the bone, and of
pus and lymph between the cavity
of the arachnoid; pus, mixed with
blood, in the superior longitudinal
sinus; deposit of lymph in the struc-
ture of the pia mater; recently
effused lymph in the cavity of the
left pleura ; secondary abscesses of
the left lung.
Secondary abscesses, in various
stages of formation, in both lungs;
suppuration between the different
bones of the carpus; both kidneys
large, coarse in texture, and flabby;
the spleen soft, easily lacerated, and
of a pale colour.
Low inflammation of a portion of
the left lung; dark-coloured patches
of deposit in the spleen.
Turbid serum in the right pleu-
ral cavity; incipient secondary abs-
cesses in both lungs; large cysts
in the kidney.
Bone exposed to the extent of a
shilling, of a yellow colour, and
with a very dark diploë ; effusion of
lymph and pus between the dura
mater and the bone, extending to
the base of the skull, and through
the sphenoidal fissures into the or-
bits; effusion of pus into the arach-
noid cavity; , incipient secondary
abscesses in the lower lobe of the
left lung: Spleen large, and very
soft, mottled; degeneration of both
kidneys.
Large cavity containing foul mat-
ter, in contact with the sacrum,
which was exposed; abscesses be-
tween the bones of the left wrist
and hand ; spleen soft, congested,
and grumous.
The mucous membrane of the
whole of the large intestine of a
very dark colour; congested patches
of it thrown up into prominent
folds; recently effused lymph upon
the right pleura ; secondary abs-
cesses in both lungs.
636
INFLAMMATION OF THE WEINS, ETC.
Heads of Cases.
Period of second-
ary inflammation.
Post-mortem appearances.
CASE XXIII. Esther Polley,
aet. 50. Lacerated wound of
the foot ; separation of a small
portion of the base of one of
the metatarsal bones; pain in
chest; rapid pulse; depression,
with delirium.
CASE XXIV. Henry Lacy, aet.
26. Scalp wound, exposing the
bone; fracture of the skull ;
signs of nausea; pains in the
head; “Soreness of the sto-
mach”; drowsiness and insen-
sibility; paralysis of one side;
muscular twitchings; portions
of bone removed by the tre-
phine, near the top of the
head.
CASE XXV. Thomas Meed, aet.
15. Injury of the leg; small
suppurating sinus upon the
outside of the limb; erysipelas;
diarrhoea; coma.
CASE xxvi. Thomas Dafféy,
aet. 42. Haemorrhoids; opera-
tions; rigors; sickness; great
abdominal pain ; diarrhoea ;
hiccough. This patient had
been salivated previous to the
operation for the haemorrhoids.
The tenth day
after the acci-
dent; the third
before death.
The eighteenth
day after the ac-
cident ; and a
week before
death.
The tenth day
after the opera-
tion; and ninth
before death.
A double fracture of the fifth
metatarsal bone ; inflammation of
the right pleura ; secondary abs-
cesses in right lung.
Yellow matter in the diploë of
the parietal bones, in the neighbour-
hood of the part where the trephine
had been applied; effusion of lymph
upon the surface of the dura mater;
pus and lymph in the posterior half
only of the longitudinal sinus; effu-
sion of pus in the cavity of the
arachnoid; some bloody serum in
both pleural cavities; incipient se-
condary abscesses in the liver.
Wessels on the surface of the
brain congested; lateral ventricles
distended with fluid; a thick layer
of purulent lymph upon the arach-
noid membrane at the base of the
brain ; some slight spots of ecchy-
mosis on the anterior surface of
both lungs.
Incipient secondary abscesses in
the right lung ; liver studded,
throughout its whole extent, by se-
condary abscesses; mucous mem-
brane of the rectum of a dark
greenish colour; effusion of pus and
lymph into the haemorrhoidal and
inferior mesenteric veins; cavity of
the left knee-joint distended with
pus; spleen soft, pultaceous, and
thickly-studded with dark-coloured
blotches.
CASE XXVII. George Burton, aet. 22, a stout navigator, was first seen
September 18th, 1848.
He had an enormous slough of the skin and
cellular membrane, covering the lower part of the abdomen on the right
side. He gave a most imperfect history of himself, and seemed fre-
quently incapable of comprehending the questions which were put to
him. The skin was hot and dry, the pulse 130. For several days, he
remained in the same apathetic condition. The bowels were particu-
larly obstinate, and the purgative medicines which were administered
roduced no effect whatever.
When the slough separated, the surface of the external oblique
muscle was left as clean as if recently dissected. The skin was under-
mined for some extent, and no attempt was apparently being made to limit
the progress of the disease, by the effusion of lymph. Fresh portions
of cellular tissue consequently became affected, and the whole surface
ultimately exposed was full six inches in diameter. Sept. 25th. Com-
plained of some pain in the chest and upper part of the abdomen; has
a constant short cough; perspires very freely. 26th. The pulse has
BY HENRY LEE, ESQ., F.R.C.S. ENG. 637
become weaker, but remains of the same frequency (130). It communi-
cates a peculiar jerking sensation to the finger. 28th. Pulse 96,
weaker; slight diarrhoea; he vomited several times during the day.
29th. Restless, with delirium. 30th. Passed another restless night,
but became better in the course of the day; his appetite returned.
Aug. 5th. His appetite again failed; complained of a sense of dis-
tension in the abdomen. 8th. An abscess was discovered at the lower
and back part of the right leg; the skin over this presented various
shades of yellow and brown, giving the appearance of having been
extensively bruised. About two ounces of discoloured pus were
evacuated, together with a considerable quantity of grumous blood.
10th. Has much improved since the last report; the wound discharges
dark semi-coagulated blood. 13th. A second abscess now presented
itself in the same leg, and the skin covering it presented the same
discoloured appearance as in the first instance. When opened, it
discharged dark-coloured semi-coagulated blood with the matter. He
now rapidly improved in health, and at length perfectly recovered.
CASE xxvii.I. Samuel Todd, at. 58, fell from a wagon fifteen miles
from town, and was brought up in an open cart, during a sharp frost.
There was a compound fracture of the left leg. Two days afterwards,
he suffered from cellular inflammation around the wound. On the
24th day, he had a slight rigor, and complained of slight stiffness in
the right shoulder. He ate and drank well till within two days of his
death, which took place on the thirty-fourth day.
Post-mortem appearances. Both lungs contained secondary absces-
ses, in various stages of formation. The left external iliac and common
femoral veins were blocked up with firm coagula, and confined by these
was a quantity of purulent-looking fluid ; an adherent layer could, for
some distance, be peeled off the internal surface of these vessels.
CASE xxix. James Howard, aet. 33, had a small abscess in the
dorsum of the right foot, which was followed by inflammation of the
absorbents; abscesses subsequently formed in the right thigh and
groin. Two months after the first appearance of the abscess on his
foot, he was seized with rigors, vomiting, and profuse perspiration.
He complained also of pain in the lower part of the left lung, and it
was said that the respiratory murmur was deficient in this situation.
He died on the 23rd day from the appearance of the symptoms of the
secondary affection.
Post-mortem appearances. The skin and conjunctiva were of a light
yellow colour; there were incisions in the right groin. In the cavity of
the right pleura, were some patches of recently effused lymph, of a
yellowish colour. In the lower lobe of the right lung, were several
patches of secondary deposit: these were found in different stages of
their formation, and some of them were of considerable size ; some of
the pulmonary veins, in the neighbourhood of those which had suppur-
ated, were found to contain a fluid resembling pus. On the left side
was a small abscess, under the pleura costalis. The liver was healthy
in structure, rather larger than usual. Kidneys healthy. The veins
in the groin presented a healthy appearance. - -
CASE xxx. A gentleman was operated upon for haemorrhoidal tumours
in the usual manner, and died shortly afterwards, with effusion of
638 INFLAMMATION OF THE WEINS, ETC.
bloody serum into one of the pleural cavities. The only peculiarity
that could be detected in the appearance of the rectum was, that the
blood was still fluid in one of the largest veins. This vein led directly
to an ulcer produced by the operation; and, even at its extremity, it
contained no appearance of coagulum.
B. CASES IN WEHICH WITIATED FLUIDS WERE OBSERVED IN THE WEINS OF
THE UTERUS AFTER CEIILD-BIRTH.
CASE xxxi. On the second day after a natural labour, a woman had
prolonged rigors, which were followed by abdominal pain and much
perspiration. On the fourth day, she was affected with syncope and
bilious vomiting, accompanied by extreme prostration. On the fifth
day, the abdominal pain, which had subsided, re-appeared with agita-
tion and delirium. On the sixth, she had cold sweats, irregular pulse,
rapid breathing, and vomiting. She died on the following morning.
Post-mortem appearances. There was a small quantity of limpid
serum in the cavity of the peritoneum. Some of the uterine veins were
found to contain a turbid fluid. The heart was half filled with brown
blood. The lungs were congested, and the other organs natural.
CASE xxxII. A woman, twenty-two years of age, of a nervous tem-
perament, miscarried at the expiration of the first month. She was
almost immediately afterwards attacked by rigors and bilious vomiting,
accompanied by pains in the loins and in the hypogastrium. On the
following day, there was coma, with indications of extreme debility.
On the third day, consciousness returned. There was difficult articu-
lation, and moaning. The extremities became cold, the pulse imper-
ceptible, and death occurred upon the same day.
Post-mortem appearances. The peritoneum was slightly injected, and
contained a small quantity of reddish serum. The cervix uteri was
covered with a layer of pus. Semi-transparentlymph was found in some
of the uterine veins. The brain, and other organs, were found healthy.
CASE xxxHII. A feeble girl, 21 years of age, was confined at the
expiration of the eighth month. On the fourth day, there was shivering
and prolonged fainting. The following morning, she had acute abdo-
minal pain, fever, and diarrhoea. On the seventh day, the symptoms
had all subsided, but on the eighth the abdominal pain returned, accom-
panied by syncope. She died two days afterwards.
Post-mortem appearances. The peritoneum was slightly injected, and
contained about a pint of red-coloured serum. The uterus was large,
white, and firm, its veins half filled with fluid blood; its lymphatics
natural; its inner surface lined with a layer of fetid brown blood, but
otherwise healthy; the cervix covered with a grey, thin exudation. The
Iungs, heart, brain, and other organs, were quite sound.
CASE xxxiv.” Anne Biggs, aet. 39, confined March 18th, 1830, eighth
child. On the evening of her confinement, her manner was much
excited. On the 19th, she was incoherent, and complained of pain in
the calf of the right leg, which was tender on pressure. The pulse
being hard, she was bled to eight ounces. On the 28th, the leg was
swollen and white; the pain in it much increased: towards evening the
1 This, and the two following cases, are taken from Tonellé. The author is
repºsite for the accuracy of all the preceding cases.
* Dr. Ferguson.
BY HENRY LEE, ESQ , F.R.C.S.ENG. 639
calf of the limb became black, while, at the tendo-achillis, the skin was
hot, tender, dry, and mottled. The bowels were much opened, the head
giddy, the pulse quick and strong. She was again bled, to twenty-six
ounces, and twelve leeches were applied to the temple. On the 21st,
there was nausea, vomiting, and diarrhoea. On the 23rd, she com-
plained much of the confusion in her head, the leg was tolerably easy,
but the upper and inner part of the thigh was very tender. On the
24th, the diarrhoea continued, and there was increased weakness. A
hard swelling, about half as large as an egg, appeared at the wrist, and
one of the orifices made by venesection was black and painful. She
died in the evening. , - .
Post-mortem appearances. All the ventricles of the brain were
dilated with serum, and there was a good deal of effusion into the
arachnoid and pia mater. The viscera were perfectly healthy, except
the heart and spleen : the latter was very large, and on pressing it,
a large quantity of dirty red pulpy matter exuded. The lining mem-
brane of the right auricle and wentricle, when washed, had a dark red
hue. The femoral vein, just at the ingress of the Saphaena, and the
superficial vein in the back of the leg, had their coats much thick-
ened, so as to cut like arteries. Their lining membrane was similar
to that of the right cavity of the heart. When they were divided,
purulent matter, mixed with thin light-coloured blood, escaped. The
cellular tissue forming the sheath of the femoral vessels, and on the
calf of the leg, shewed marks of recent inflammation; but there was
no appearance of pus in these situations. None of the glands in the
groin or ham were enlarged. The inferior vena cava appeared healthy.
C. CASES OF PURULENT DEPOSITS, CONNECTED WITH INFLAMMATION OF THE
VEINS AFTER DELIVERY, RECORDED BY DR. ROBERT LEE
IN THE MED.-CHIR. TRANSACTIONS.
CASE xxxv. Mrs. Mayhew, aet. 33, was delivered on the 2nd March
1829. On the 5th, there was a discharge of blood from the uterus.
From the 6th to the 20th, she made no complaint of uneasiness in any
region of the body, though her strength rapidly declined. The coun-
tenance was of a dusky yellow hue. The heat of the surface slightly
increased; the respiration hurried, particularly on bodily exertion, and
the pulse above 130, and feeble; the tongue pale and glossy, with loss of
appetite. The lochial discharge had a peculiarly offensive smell. She
died upon the 28th of March.
Post-mortem appearances. When the uterus was laid open, there was
found to be a portion of the placenta, about the size of a nutmeg, in a
putrid state, adhering to its inner surface. The substance of the uterus,
to the extent of an inch around this, was of a peculiarly dark colour,
almost black, and as soft as a sponge. On cutting into it, about a tea-
spoonful of purulent matter escaped from the veins, and a small addi-
tional quantity was pressed out from them. . . On opening the capsular
ligament of the right knee-joint, about six ounces of thin purulent matter
escaped, and the cartilages of the femur and tibia were extensively eroded.
There was no appearance of inflammation, however, on the exterior of
the capsular ligament. The right wrist was swollen, and the cellular
membrane around it was unusually vascular, and infiltrated with serum.
CASE xxxvi. Mrs. Pope, aet 40, was delivered, on the 26th of Oct.,
640 INFLAMMATION OF THE WEINs, ETC.
of her fourteenth child, and appeared to recover favourably until the
3rd of Nov., when she was suddenly attacked with a severe rigor. This
was followed by intense head-ache, vomiting, general soreness of abdo-
men, and suppression of lochia. Nov. 6th. Great prostration of strength;
laborious respiration, with pain at the bottom of the sternum, and
frequent hacking cough; pulse 135, extremely feeble; skin hot and
dry. ... Occasional retching and vomiting. Several hard, lumpy cords
were found running up in the inside of the thigh, in the direction of the
Superficial veins. 7th. Delirium ; general debility greatly increased ;
the surface of the body was covered with a yellow suffusion; the middle
finger of the left hand was much swollen around the second joint, and
the skin covering it was of a dusky red colour.
CASE XXXVII. Mrs. Edwards, aet. 35, was suddenly attacked, three
weeks after delivery, with pain in the calf of the right leg, and loss of
power in the whole right inferior extremity. On the 5th day from the
attack, a considerable swelling, without induration, had taken place from
the ham to the foot, and great tenderness was experienced along the in-
ner surface of the thigh to the groin. The extremity became universally
swollen, painful, and deprived of all power of motion. The temperature
along the inner surface of the limb increased; the integuments were pale
and glistening, not pitting upon pressure. The femoral vein, from the
groin to the middle of the thigh, was indurated, enlarged, and exqui-
sitely sensible; pulse 80; tongue much loaded; thirst; bowels open.
On the 23rd day from the attack, the disease was apparently declining.
The femoral vein could no longer be felt, but there was still a sense of
tenderness in its course down the thigh, and she experienced considera-
ble uneasiness between the umbilicus and pubes, as well as in the loins.
She now, for the first time, began to have rigors, accompanied by a
quick pulse, loaded tongue, and thirst. From this period to the 31st
day, the swelling of the limb and tenderness in the course of the femoral
vessels subsided, but she experienced attacks of acute pain in the um-
bilical region, loins, and back, which assumed a regular intermittent
form. Every afternoon there was a rigor of an hour's duration, fol-
lowed by increased heat, and profuse perspiration: the skin was hot and
dry; pulse 125; tongue brown and parched; bowels open. These fe-
brile attacks gradually declined in severity, and she appeared to recover
till the 43rd day, when she had a long and violent fit of cold shivering.
The countenance now became expressive of great anxiety, and the pulse
extremely weak and feeble. 45th day. Vomiting; pain upon the left
side, increased upon taking a deep respiration. 46th day. Another Se-
were and prolonged rigor; skin hot and dry; pulse 140; tongue brown
and parched; diarrhoea; respiration hurried, with frequent cough ; sur-
face of body presenting a peculiar yellow tinge. The conjunctiva of
the right eye now suddenly became of a deep red colour, and so much
Swollen, that the eyelids could not be closed. On the day following,
the left eye also became red and swollen, the surface of the body was cold
and clammy, pulse 140, extremely feeble, with great debility, and re-
peated attacks of vomiting. From this date, the patient lived nearly
three weeks, but for the last fortnight the vision in both eyes was en-
tirely destroyed.
Post-mortem appearances. The left pleural cavity contained upwards
of two pints of a thin, purulent fluid. The inferior lobe of the left lung
BY HENRY LEE, ESQ., F.R.C.S.ENG. 641
was of a dark colour, and soft in texture. In its centre, about an ounce
of thick cream-coloured pus was found deposited in its dark and softened
texture. This was not contained in any cyst or membrane, but was in-
filtrated into the pulmonary tissue. The coats of the vena cava inferior
were considerably thickened; its whole cavity was occupied by a coagu-
lum, terminating above in a loose pointed extremity. The left common
iliac vein was plugged up, by a continuation of the coagulum from
the cava. The coagulum was continued beyond the entrance of the
internal iliac, which it completely closed, and terminated in a pointed
extremity about the middle of the external iliac. Neither the remainder
of the vessel, nor the femoral vein, exhibited any morbid changes. The
right commoniliac vein was contracted to more than one-half its natural
size ; it was firm to the touch, of a greyish blue colour; to its internal
coat adhered an adventitious membrane of the same colour, containing
within it a firm coagulum. The internal iliac was rendered quite im-
pervious by dense, dark-coloured bluish membranes; and, at its entrance
into the common iliac, it was converted into a solid cord. The contracted
external iliac contained within it a soft yellowish coagulum ; its coats
were three or four times their natural thickness, and lined with dark-
coloured membranous layers. The right femoral vein, from Poupart's
ligament to the middle of the thigh, was diminished in size, and almost
inseparable from the artery. Its tunics were thickened, and its interior
coated with a dense membrane, surrounding a Solid purple coagulum
strongly adherent to it. -
D. CASE, SHEWING THE PERIOD AT WHICH A COAGULUM MAY GIVE WAY
- IN A WOTINDED WESSEL. -
CASE xxxvii.I. George Haydon, aetat. 37, received a wound about
half an inch in length over the right radial artery, on March 5th, 1848.
The haemorrhage was arrested by pressure. On the 12th, a small slough
formed in the bottom of the wound, the edges of which were inflamed
and painful. On the 14th, slight bleeding from the wound occurred,
which at first was arrested by the application of cold; but in the evening
it recurred in considerable quantity, and again was checked by cold and
pressure; during the night, however, profuse haemorrhage again took
place, and was only stopped by the application of the tourniquet above
the elbow. On the 15th, the radial artery was tied; but as this did
not prevent the hamorrhage from returning, when the tourniquet was
relaxed, the original wound was enlarged. The opening in the radial
artery was now with some difficulty discovered; it extended two-thirds
round the circumference of the vessel, leaving one-third undivided.
E. CASES SHEWING THE ORGANISATION OF THE OUTER LAYER OF
EXTRAVASATED BLOOD ; REPORTED BY MIR. HEWETT.
CASE xxxix.) A middle-aged man received a severe injury of the
chest ; he lived eleven days after the accident, and during this time he
never presented a single inflammatory symptom. The cavity of the left
pleura was found completely filled with bloody fluid, and was subdivided
into two compartments, by a portion of coloured fibrine, presentingahoney-
combed appearance, which passed from the ribs to the lung. The lower
compartment was itself subdivided into several others, by layers of
—re-
* Med.-Chir. Transactions, vol. xxviii.
642 ON THE MECHANISM OF TEXTURAL. NUTRITION.
coloured fibrine intersecting each other. Large portions of loosely coagu-
lated blood were found in all the cavities; some of these clots were of
a rusty colour, others approached nearer to the natural colour of the
blood. The lung was compressed against the spine, and the whole sur-
face of the pleural sac was coated by a false membrane, about two lines
in thickness, formed by coagulated fibrine. The fibrine which lined
the pleura pulmonalis and pleura diaphragmatica, presented on its inner
surface a smooth and polished appearance, and in colour exactly resem-
bled the yellowish fibrine found in the clots of the heart of this patient.
So uniform was the coating, and so continuous was it throughout its
whole extent, that it looked at first merely like thickened pleura; but
this appearance was easily destroyed, by peeling off this adventitious
membrane from the serous tissue, which there presented the same ap-
pearances as the pleura on the opposite side, with the exception of not
being quite so smooth: there was neither thickening nor the slightest
increase of vascularity in this pleura. A large rent, from which the
haemorrhage had proceeded was found in the substance of the lung.
CASE XI. A man was attacked with diffuse cellular inflammation of
the inferior extremity, which terminated in two days with extensive
gangrene of the skin. In the superficial and common femoral veins
were extensive coagula; these did not completely fill the veins, but
slightly adhered at different points to their internal coats. These clots
still retained, in some places, the colouring matter of the blood, whilst
at others the colourless fibrine alone remained; in both veins, the
clots were enveloped in a perfectly transparent, smooth, and polished
membrane, presenting the appearance of a serous tissue. In the struc-
ture of these membranes were several distinct arborescent vessels, mi-
nutely injected;" some of these vessels were of sufficient size to allow of
the blood being made, by gentle pressure, to circulate through them ;
but no communication could be traced between these vessels and the coats
of the veins. The membranes were easily peeled off from the surface
of the clots with which they were in contact. The interior coats of the
veins presented their natural colour and polished surfaces, except at the
points where the slight adhesions above-mentioned existed.
ON THE MECHANISM OF TEXTURAL NUTRITION.
By RUDOLF HAAS, M.D., late Lecturer on Epidemiology in Vienna.
THE first step in the actual process of nutrition, is the attraction of the
homogeneous part of the blood by the tissues.” The blood being con-
tained in the vessels, that part only which transudes through their walls
into the parenchyma of the organs can contribute to nutrition. Hence,
even though a large quantity of rich healthy blood be circulating through
the vessels, the textures will be imperfectly nourished, unless sufficient
* Mr. Gray, the Curator of the Museum of St. George's Hospital, has recently
shewed me the outer layer of an effusion of blood into the arachnoid cavity, injected
from the middle meningeal artery. - i
* VALENTIN's Physiologie, Band 2, Sect. 2068. MUELLER's Physiologie, p. 75.
BY RUDOLF HAAS, M.D. 643
exudation takes place; but nutrition will be restored, so soon as an
adequate quantity of blood is made to pass through the walls of the
vessels. An excessive exudation of serum into the parenchyma, no
doubt, likewise impedes nutrition, by producing pressure on the textures,
and thus impeding their attractive power. That this is probably the
case, may be inferred from the following considerations: 1. The evolu-
tion and nutrition of organs is impeded by pressure from without; and
the same effect is no doubt produced by pressure from within. 2. The
textures become atrophied, whenever they are pressed on by an adjoin-
ing part which has had its bulk enlarged by inflammation or other
causes. 3. Inorganic processes are retarded by pressure; thus, crystal-
lization can only take place when sufficient space is afforded. The
organic processes, then, consisting in a selection and attraction of sinular
parts, have the greater need of sufficient space. -
The process of nutrition may then be supposed to be modified by all
those forces, which cause an alteration in the quantity or quality of the
blood effused into the parenchyma ; or rather, by those influences which
affect the transudation of the nutritive part of the blood through the
coats of the vessels. The forces which modify the exudation of blood
through the coats of the vessels are the following:— . -
1. The Quantity of Blood Circulating in the Wessels. The larger
this quantity is, the more the vessels and their pores are distended, and
more blood passes into the parenchyma, and vice versá. If a fluid be
driven through an elastic tube, the latter will be distended in proportion
to the force applied.
2. The Quantity of the Blood-Corpuscles. Many blood-vessels (vasa
serosa) are of smaller diameter than the blood-corpuscles; and hence
must be distended when they pass through them. It is incorrect, and
quite in contradiction to physical laws, to assert, with some physiologists,
that the corpuscles are compressed and become elongated, in passing
through these vessels. Being propelled by a vis à tergo, they must
become broader, but never more slender. On pressing an elastic globe
through an elastic tube, the former will not become thinner, but both
will be distended. Hence, the more corpuscles there are in the blood,
the more the vessels and their pores are distended.”
3. The Energy of the Forces which Propel the Blood into the Small
Vessels. The capillaries and their pores are distended in direct propor-
tion to the energy with which the blood is sent into them by the heart
and large vessels. This may be demonstrated by forcing, with varied
pressing power, a quantity of fluid through an elastic tube.
4. The Temperature. Within certain limits, a high temperature
favours distension of the vessels, while a low one causes them to contract.”
We find, in the above principles, the explanation of many of the
phenomena of health and disease. -
I. The similarity between the symptoms of anaemia and those of
hyperamia, is evidently accounted for. In both diseases, nutrition is
interrupted; in anaemia, by want of blood; in hyperamia, by its super-
* HAAS (Dr.) Ueber die Function der Blutkörperchen. CEsterreichischer Jahr-
bücher, Jan. 1848. -
* WALENTIN's Physiologie. Band i, sect. 1086.
WOL. II. - 43
644 ON THE MECHANISM OF TEXTURAL. NUTRITION.
fluity, which produces pressure on the tissues, and impedes their power
of selection and assimilation. In hyperamia, the vessels are over-
distended, and too much blood passes through their coats into the
parenchyma.
II. We find an explanation of the general organic weakness, which
is constantly observed in fevers. The heart being, in these diseases,
too energetic in action, the vessels are over-distended, and an excessive
quantity of blood is effused, producing effects similar to those which
occur in hyperaemia. -
III. The secretions, as the urine, sweat, and saliva, are impeded in
fevers by this pressure of the blood on the textures. In spite of the
presence of a large quantity of blood in their parenchyma, the organs
are in want of material to furnish the secretions; for they require a
large proportion of water, which is not afforded by the blood which
passes through the pores of the vessels in a fibrinous state. Bruck's
experiments shew, that a large proportion of water and soluble salts,
and very little albumen, pass through small pores; but that through
large pores, such as there are in fevers, there pass very little water and
saline matters, and much albumen. The parenchyma of the secreting
organs, then, contains very little water in fevers. This impediment to
the secreting functions, causes the retention in the blood of a large
quantity of urea, saline matter, etc.; but after the fever had subsided,
when the action of the heart has diminished, and the vessels are less
distended, the quantity of blood is not only diminished, but becomes
more watery: the secreting organs are stimulated to action by the
matters which have been retained, and the blood is also more able to
remove them. The urea and salts increase in the urine, producing a
sediment, the appearance of which denotes a crisis.
IV. A diminution in the quantity of blood is the cause of the summer
sleep of the amphibia. Berthold and Davy found the temperature of
these animals always lower than that of the atmosphere: this is pro-
duced by the evaporation of water from their bodies increasing with the
temperature. Hence, in a high temperature, the quantity of blood in
these animals is much diminished by their losing a large quantity of
water; and, in circulating through the vessels, it does not distend them
sufficiently to allow the nutritive part to exude. Nutrition, then, being
partially suspended, the animals fall into a lethargic state. This ex-
planation is an accordance with the fact, that the amphibia creep into a
hiding place in dry, and awake in wet weather. They are not awaked
by being carried into a cold room, but by being immersed in water.
V. A similar explanation will account for the fact, that animals are
unable to live longer than twenty days on dry food, without any fluid,
while they can exist for fifty days when supplied with water alone, but
in sufficient quantity. As long as the animals get no fluid, the blood
loses water daily in the urine, saliva, sweat, and breath. This loss can
never be repaired by dry food, for the stomach cannot digest a sufficient
quantity. The blood, thus reduced in quantity, passes through the
vessels without being able to distend them, and afford nutritive material,
as in the summer-sleep of amphibia. The want of water also causes a
thickening of the blood, which co-operates with its want of power to
distend the vessels. But if the animals. are supplied with a sufficient
BY RUDOLF HAAS, M.D. 645
quantity of water, without any food, they survive for a longer time.
Although water contains no nutritive material, and cannot be transformed
into nervous or muscular tissue, it nevertheless indirectly contributes to
nutrition, by increasing the quantity of the blood. The vessels are
sufficiently distended, and the blood passes into the parenchyma, and
supports life longer, in spite of its possessing very low nutritive power.
WI. The winter-sleep of animals has its origin, like the summer-sleep,
in an interruption to nutrition. The summer-sleep is caused by the
loss of water; the winter-sleep by the diminished activity of the heart's
action, consequent on the influence of cold. It has been found that in
hybernating animals, at the commencement of the winter-sleep, the
pulsations of the heart subsided from 200 to 50 in a minute. The
heart being thus weakened, is not able to propel the blood with suffi-
cient force to distend the vessels, which are much more contracted in
cold weather. In such circumstances, no blood passes through the
pores into the parenchyma, nutrition is interrupted, and the animals
fall into a state of asphyxia, losing the power of feeling and perceiving.
The reason why some animals only are subject to hybernation, is to be
found in their various degrees of sensibility. Those whose heart is
unable to resist the weakening influence of cold, are seized on by
winter-sleep. This explanation is confirmed by the fact, that we
observe young animals asphyxiated by a degree of cold, which they
would bear with impunity if full-grown. Legallois observed this in
rabbits, six or eight weeks old. 4
The cold-blooded animals are also very soon overpowered by cold;
but this is dependent on two causes. Not only are they more sus-
ceptible of the influence of cold, but their small quantity of blood acts
at a disadvantage. The quantity of blood would be sufficient, if the
heart acted with sufficient energy: but the heart's action failing, the
blood merely circulates in the vessels, without being able to pass
through their coats.
VII. The diminished activity of the heart, and the contraction of
the vessels, in cold weather, explains why we are compelled to take a
larger quantity of food in winter, or when living in a cold climate.
We endeavour to supply the want of one force which contributes to
nutrition, by increasing others—to make up for the insufficient action
of the heart by increasing the quantity of blood. If a fluid be pressed
through an elastic tube, its walls will be less distended as the force is
diminished, but more distended if the quantity of fluid be increased.
If the quantity of fluid be increased in the same proportion as the pro-
pelling force is decreased, the distension of the vessels remains the
same. The degree in which cold impedes nutrition, may be observed
in the inhabitants of the frigid zones. They are stinted in growth;
their bodies are short, their muscles thin, their senses obtuse, their
mental faculties very weak, and the sexual instinct, the catamenial flow,
and the fecundity, are much less than in other people. The same quan-
tity of blood, which is sufficient for nutrition in a warm climate, is not
so in a cold one. In the latter also, the heart is less active, and
the vessels more contracted. For effecting adequate nutrition, a
certain quantity of blood must pass into the parenchyma; and if the
heart cannot act with sufficient energy to propel sufficient blood to dis-
43 2
646 ON THE MECHANISM OF TEXTURAL. NUTRITION.
tend the vessels, the absolute quantity of blood must be increased :
otherwise a general stinting of growth results.
As the blood is the carrier of animal heat, we encourage, by increas-
ing its quantity, and especially its penetration through the walls of
the vessels, not only the nutrition of the tissues, but also the sensation
of external warmth. We possess more blood in winter than in
summer, and are hence more disposed to inflammation in the former
season. We more easily, and for the same reason, bear a high tem
perature in the winter than in the summer. Warmth excites the
heart's action, and promotes distension of the vessels: and if these at
the same time contain much blood, congestions and inflammations are
liable to occur.
The opinion of Liebig, that we are obliged to eat more in winter
than in summer, because we inspire more oxygen, is not adequate to
explain the facts above referred to : 1. According to Liebig, we possess
in summer more blood than in winter, in which latter season the
oxygen consumes more of the blood. If it were so, the tendency to
inflammation ought to be greater in summer than in winter. 2. It
ought not to be easier to bear a high temperature in summer than in
winter. 3. Liebig's view does not explain why the amphibia and
young animals become more easily asphyxiated in cold weather. The
oxygen cannot have consumed a sufficient quantity in such a short
time. 4. If an organ be subjected to the influence of cold, it loses
sensation, as if deprived of blood.
VIII. The same instinct which compels us to take more food in
winter, also invites us in the same season to make use of spirits.
These, by exciting the heart to more frequent and emergetic contrac-
tion, directly oppose the influence of cold, which weakens the heart, and
prevents it from contracting with energy. By increasing the activity
of the heart's action, spirits cause the greater distension of the vessels,
and thus contribute to the nutrition of the organs. But, though to a
certain extent equivalents to food, they never contribute directly to
textural nutrition.
The protection which spirits afford against cold, is produced by the
diffusion of animal heat by means of the effusion of blood into the
parenchyma. Liebig explains this phenomenon, by the evolution of
warmth from the combustion of spirits by the oxygen: but this opinion
is liable to the following objections: 1. If the increase of animal heat
by the use of spirits were dependent on this chemical action, the same
quantity of spirits should produce the same amount of heat in all per-
sons. But experience shows that this is not the case. Individuals,
who are not accustomed to spirits, feel very warm, and even perspire,
on taking a small quantity, while those who are addicted to their use,
feel no effect from the same quantity. This agrees entirely with the
statement above given,_that the effect produced by spirits is the con-
sequence of their stimulating action on the heart: 2. Spirits are never
burnt at such a temperature as is generally found in animals: 3. They
are expired generally by the lungs, and not therefore burnt: 4. Fat is
likewise burnt as by the oxygen; and yet we do not feel warmer after
making use of it. *-
In the preceding theory, we find the explanation of the fact that
BY RUDOLF HAAS, M.D. . 647
drunkards live on a small quantity of food. A small quantity of blood
affords as much nutrition to them, as a larger quantity to other per-
sons; for, in consequence of their taking spirits, the heart propels this
small quantity of blood into the small vessels with such energy, that
they are as much distended by it, as by more blood, with the normal
activity of the heart. After having abstained from spirits for some
hours, the drunkard feels very weak, and is not better till he has again
taken liquor. He does not feel strengthened by taking food, as other
individuals do. The reason of this is his general anaemia. By the use
of spirits, the heart is caused to propel the blood forcibly, so as to distend
the vessels, and the tissues are nourished. But the stimulus being
removed, the activity of the heart subsides to its normal standard; the
blood in the parenchyma is partly consumed by the tissues, partly
absorbed by the lymphatic vessels. As the normal activity of the
heart is insufficient to propel the small quantity of blood, the tissues
are soon in want of food: hence the individual feels weak. But the
simple use of food cannot strengthen him, because the quantity of blood
cannot be restored with sufficient rapidity, as has been explained in
my observations on the starving of animals by the use of dry food.
The drinking of water or other fluids is more effectual than taking
food. The quantity of blood is increased ; and the vessels and their
pores being distended, nutritive material is more exuded into the paren-
chyma. In this way we may explain the cure of delirium tremens by
drinking a large quantity of water. The want of appetite in drunkards
is a natural consequence of the chronic inflammation of the stomach.
IX. In the same manner as spirits, warmth supports animal life.
Animals partially starved, and already insensible, can be roused by
artificial warmth. After ten minutes, the animal rises up, takes food,
passes faces and urine; and is, during the application of warmth,
lively and merry. Warmth excites the heart, and distends the vessels:
so that the blood, in spite of being reduced by fasting to a very small
quantity, passes through the walls of the vessels more readily than
before heat was applied. In this way the tissues obtain nutritive mate-
rial ; and the organs again recover their activity.
X. But animals die sooner after being subjected to artificial warmth,
than when left insensible. This is to be explained by the same
remarks as I have made in speaking of summer-sleep, and of the
starving of animals when restricted to the use of dry food. In all
these circumstances, the animals die from the want of blood in the
parenchyma, produced by the loss of water. For, when awaked, they
part with a large quantity of water in the urine, sweat, and breath;
all which secretions are, like the nutritive material, furnished by the
blood. The blood is thus much more diminished, than if the animals
had been left in their state of asphyxia. Chossat asserted, that pigeons,
which were undergoing starvation, lost twice as much weight when
roused by artificial warmth, as when left quiet.” This is more the
effect of secretion, than of the process of nutrition. -
XI. In the principles which I have laid down, we find an explan-
ation of the changes which the blood undergoes under various circum-
* CHOSSAT. Récherches sur l'Inanition, p. 121. r
648 ON THE MECHANISM OF TEXTURAL. NUTRITION.
stances. There can be no doubt, that any impediment to the process
of nutrition must produce an alteration in the blood in the vessels; for
those materials, which ought to be applied to nutrition, and trans-
formed into different textures, remain in the blood. It being esta-
blished, that the quantity of blood in the vessels, the number of blood
corpuscles, the energy with which the propulsive agents in the circula-
tion act, and the amount of temperature, produce modifications of the
nutritive process, it is equally probable that they tend to alter the
blood in the vessels. º:
In order to show what parts of the blood increase with the augment-
ation, and decrease with the diminution of nutrition, we must show
what materials are subservient to this process. These are, besides
some Salts, fibrin and albumen. The corpuscles, being unable to pass
through the walls of the vessels, cannot be considered as affected by
the increase or diminution of nutrition.
The albumen and fibrin, though both subservient to nutrition, are
destined for distinct purposes. The fibrin nourishes the tissues; but
the albumen is transformed into fibrin and corpuscles. That the
blood-corpuscles are formed from albumen, is proved by considering
that they must be formed in the vessels, as they cannot pass through
their pores; and as they are similar in composition to albumen, they
are without doubt formed of it. That the fibrin is formed from
albumen, can be demonstrated by the following facts: 1. The chyle
contains more albumen and less fibrin, than the blood; consequently,
a part of the albumen must have been transformed into fibrin. 2. The
chyle, immediately after being absorbed by the lacteal vessels from the
intestines, contains more albumen, and less fibrin, than that which has
passed through the mesenteric glands. 8. Lymph contains much more
fibrin, and less albumen, than blood-serum. But as the lymph is
formed in the parenchyma of the organs from the blood-serum, which
contains but little fibrin, the fibrin in it must be formed from albumen.
4. The arterial blood contains more fibrin, and less albumen than the
blood in the veins; and this can only result from the transformation of
the latter material into the former.
The albumen is therefore not only consumed for the purposes of
nutrition, but is in a great measure transformed into fibrin and blood
corpuscles. Hence any increase or decrease in the quantity of albumen
is not only dependent upon the various degrees of activity of the nutri-
tive process, but also on the extent to which it is transformed into
fibrin and blood-corpuscles. If this action be impeded, the albumen
must, if it be restored by food, increase in quantity, in spite of the
apparent performance of textural nutrition.
Fibrin differs from albumen, in its mode of reparation. Albumen is
only restored by food; and if none be taken, the albumen is not
renewed. But fibrin, being formed from albumen, is restored even if
no food be taken. It is nevertheless to be remembered, that the chyle
also contributes a share to the formation of fibrin.
We are now able to point out some laws, which regulate the increase
or diminution of the albumen and fibrin. -
The albumen increases: 1. When food is taken as before, if either
the nutrition of the textures, or the formation of blood-corpuscles or of
BY RUDOLF HAAS, M.D. 649
fibrin be impeded. In consequence of this, the albumen increases: (a)
In chlorosis, where the formation of blood-corpuscles is impeded by
the want of iron, or from some other cause. But if less food be taken
than before, the albumen cannot be increased, (b) In many toxaemic
diseases, as typhus, intermittent fever, bilious fever, &c., the poisons of
these diseases in general impede the formation of fibrin: l and if the
attack takes place on the same day on which food has been taken, the
albumen will be restored by the chyle, and must increase. But
if an animal be seized after fasting for Some days, or if the blood
be drawn three or four days after the toxaemic influence have first
acted, we shall not find an increase of the albumen. The influence of
food accounts for the albumen being sometimes in excess in chlorosis,
and in toxaemic diseases, and sometimes in defect. 2. If, while the
nutrition of the textures, and the formation of corpuscles and fibrin,
are performed as before, more food is taken. In consequence of this,
the albumen is increased in plethora.
The fibrin increases: 1. If, while it is being formed as before,
nutrition is impeded. In consequence of this, it increases: (a) In all
inflammatory fevers, where nutrition is impeded by the violence of the
circulation, but where no cause operates to retard the formation of
fibrin, which is still formed from albumen, even though very little food
be taken. (b) After bleeding, when nutrition is impeded by the blood
not being in sufficient quantity to distend the vessels. This increase
is only relative, in proportion to the other parts of the blood ; the loss
of all parts has been equal, but the fibrin is soonest restored. The
blood-corpuscles require time for renewal, and the albumen can only
be supplied by food. (c) In abstinence, where the albumen is not
restored by food, but the fibrin continues to be formed from albumen,
the same phenomenon takes place as after bleeding. (d) In all dis-
eases in which the blood-corpuscles are diminished, the vessels are not
distended sufficiently to allow the fibrin to pass into the parenchyma
of the various organs. This is the case in chlorosis, scirrhus, morbus
Brightii, the latter months of pregnancy, and tuberculosis. Under all
these circumstances, an access of fever determines an increase in the
quantity of fibrin. 2. If, when the formation of fibrin continues to be
performed as before, a large quantity of fibrinous food be taken. This
is the result of an animal diet; for in this case, the chyle contains
much more fibrin than when a mixed diet is used.
The albumen decreases, whenever its expenditure is greater than
its supply by the food. This takes place in fasting; where, though
but little albumen passes through the coats of the vessels, it is con-
sumed in the formation of fibrin and corpuscles. -
The fibrin decreases only if its formation be impeded. This takes
place in various narcotisations and poison-diseases, as poisoning by
opium, hydrocyanic acid, typhus, miasma, etc.
It is here the place to refer to the causes of the increase or decrease
of the blood-corpuscles in different diseases. We have first to point
out how they are spoiled, in the healthy state. On this point, we have
* It does not follow that every poison impedes the formation of fibrin; for all
poisons are not alike.
650 DR, HAAs on THE MECHANISM of TEXTURAL. NUTRITION.
only hypothetical ideas: but as it is established, that the small vessels
are distended by the passage of the corpuscles, an amount of friction
must be exercised, which must tend to render the corpuscles unfit for
use. It follows, that the oftener the corpuscles circulate through the
vessels, the more they are spoiled: but this rule is not without excep-
tions. It may happen, that the corpuscles are often propelled through
the vessels without being injured; this occurs if the walls of the
vessels are soft, and capable of yielding. In this case, the corpuscles
must increase, if their formation be not impeded. They must decrease,
if their formation be impeded, or the vessels be resistant, and the heart
âct more frequently. Hence they decrease in fevers, because the con-
tractions of the heart are more frequent. They increase in typhus and
other toxaemic diseases, where the vessels are yielding, which is denoted
by the softness of the pulse; for as the vessels do not resist the press-
ure of the finger from without, they cannot be supposed to oppose the
pressure from within. This is the result of the action of the poison.
If, however, the formation of the corpuscles be impeded, they decrease,
notwithstanding the softness of the vessels. This sometimes happens
in chlorosis. g .
(To be continued.)
651
BIBLIOGRAPHICAL RECORD.
THE LoNDoN UNIVERSITY CALENDAR. 1850.
REGULATIons of THE Royal, CoLLEGE of SURGEons in London. 1828, 1835,
1838, 1839. -
REGULATIONs of THE Roy AL CoELEGE of SURGEONs of ENGLAND. 1843, 1849.
REGULATIONS FOR THE EXAMINATION OF APOTHECARIEs (issued by the Court
of Examiners of the Society of Apothecaries in London). 1815, 1826,
1827, 1828, 1830, 1832, 1835, 1839. . . . . .
IN our last number, we took a dispassionate review of the condition of the
Medical Profession in the present day, as contrasted with the position which
it occupied in the seventeenth century. Our object was most especially to
show, that the science of medicine, which was formerly understood and prac-
tised only by a few, was now extensively diffused over the empire; and that
this result was in great measure attributable to the improved education of
the General Practitioners, who, while they form a very important and neces-
sary branch of the profession in the large cities, are the only medical attend-
ants of the inhabitants of the provincial towns and villages. We also showed,
that while a subdivision of labour in the medical profession was appreciated
and rewarded by the rich and powerful, the middling classes and the
poor were yet necessarily dependent, for relief from the complicated ailments
which afflict human nature, upon the skill, the humanity, and the honour of
those members of the profession who combine in their education such an
amount of knowledge, as renders them efficient advisers in all the branches
of the healing art. We therefore came to the conclusion, that while it was
just that the highest honours and emoluments should be conferred upon those
specially eminent in medicine, surgery, or midwifery, it was yet far more
essential, that the legislature should provide for the efficient education and
examination of the great mass of the profession—the general practitioners—
to whom the lives and the health of at least nine-tenths of the community
are entrusted.
We propose, on the present occasion, to consider the system or systems
of education which have been devised, and are now in operation, for the
qualification of the general practitioner. We purposely omit, for the
present, the education of the pure physician, and of the pure surgeon; and for
the following reasons. The success of practice in either of these special
departments, must depend upon the talents and ability of the practitioner,
who can rise in the social scale only by the favour and countenance of his
professional brethren, who are generally competent to form a pretty just
estimate of his claims to their confidence; and who do not, as a rule, raise in-
ferior men to distinction. Hence, a man who professes to practise what are
called the higher branches of the profession, will of necessity soon find his
level, and will rise or fall according to his genius or his energy. However much,
therefore, we applaud the efforts made to improve the education of the pure
physician, or pure surgeon, and to render their superiority real instead of
artificial, we nevertheless think it far less imperative to insist upon this,
though a much needed reform. The general practitioner exercises his vocation
very often among, and is dependent upon, the ignorant and the illiterate, who,
being unable to form any estimate of intellectual powers and educational
status, cannot form sound opinions as to the acquirements of those whom
they are by necessity obliged to consult. The wealthy denizen of the great
city can deliberate whether he shall trust his own life, or the life of those who
are dear to him, to Sir John This, or Dr. That ; but the pauper, the prisoner,
the lunatic, the soldier, the sailor, the artizan, and the small tradesman, have
652 BIBLIOGRAPHICAL RECORD.
no such power of selection, and they are completely at the mercy of those who
undertake to provide for them efficient medical relief. Hence we maintain,
that the education and testing of the general practitioners of medicine, ought
to be an object of paramount solicitude with the Parliamentary representa-
tives of a generous and enlightened nation.
The UNIVERSITY OF LONDON is the first body which claims our considera-
tion, in connexion with Medical Education. Its curriculum is compre-
hensive and carefully arranged; and the examinations are so distributed
over a number of years, as to lead the mind of the student from step to step
in science, until the time of obtaining his diploma. This plan of subdi-
viding the examinations, while it fixes the mind to study for a lengthened
period, obviates that miserable and inefficient plan by which many are enabled,
on the eve of an examination, to force so much knowledge into their heads as
is just sufficient to gain their certificate or license, but is far from being
adequate to make them safe and useful practitioners in after life. One most
admirable feature in the curriculum, is the establishment of the Matriculation
Examination, which must be passed by every pupil at the commencement of
his studies, whether he intend to graduate in Arts, Law, or Medicine. On a
former occasion, we ridiculed the plan adopted by the Royal College of Sur-
geons of England, in demanding a knowledge of Latin, Greek, French, Ger-
man, mathematics, and much more, at the termination of the pupil's career;
but we now express our unqualified approbation of the practice pursued at
the University of London, of demanding such knowledge at the beginning.
We beg also to offer our most emphatic and decided opinion, that no person
whatever should be allowed to commence the study of medicine, unless he
have received a good preliminary education, and have proved his proficiency
before some competent authority. The study of the classical and of the modern
languages refines the taste and enlarges the boundaries of thought ; the pur-
suit of the mathematics, or of logic, strengthens the reasoning powers and
restrains the vagaries of fancy : the cultivation of chemistry and natural
history makes us acquainted with the structure and peculiarities of the objects
composing the material world, and gives us an insight into the boundless
magnificence of nature: in fine, a liberal education elevates the moral cha-
racter, and prevents its possessor from being guilty of those many meannesses,
peculiar to narrow and ignorant minds.
The Matriculation Examination of the University of London lasts nearly
a week, and includes questions in classics, mathematics, and natural philo-
sophy. On the first day the student is examined in mathematics (com-
prehending common arithmetic and algebra), and in English history. On
the second day, the subjects are Greek classics, and history, and chemistry.
On the third day, the student is required to demonstrate some of the proposi-
tions contained in the first book of Euclid, and to answer questions in natural
philosophy; and the last day of the written examination is devoted to Roman
classics and history, and the structure and origin of the English language.
In the case of medical students, two years must elapse after their matricu-
lation, before they can present themselves for their first medical examination.
Before the time appointed for the examination, they must bring evidence of
having attended certain lectures, and of having dissected for nine months; of
having attended a course of Practical Chemistry, and having attended to Prac-
tical Pharmacy during a sufficient length of time to enable them to acquire a
practical knowledge of the preparation of medicines.
The candidates are examined in Anatomy, Physiology, Chemistry, Botany,
Materia Medica and Pharmacy; and the examination lasts more than a week.
The second examination for the medical diploma cannot be passed until
upwards of two years have elapsed since passing the first, and the student
must bring proof of having attended certain other courses of lectures; of
having, subsequently to his first examination, dissected for six months; of
having conducted at least six labours; of having attended to hospital prac-
tice, and clinical lectures on medicine and surgery; of having, subsequently

#
BTBLIOGRAPHICAL RECORD. 653
to the completion of his attendance on surgical and hospital practice, attended
to practical medicine in an infirmary or dispensary for six months; and of
possessing a good moral character. The examination is upon Physiology
and Comparative Anatomy, General Pathology, Therapeutics, Hygiene, Sur-
gery, Medicine, Midwifery, and Forensic Medicine. When the student has
passed this examination, he becomes a Bachelor of Medicine.
The last examination is for the diploma of Doctor of Medicine : and on
this occasion, the candidates are examined in Logic and Moral Philosophy, and
in Medicine. They are also required to write a commentary on a case in
Medicine, Surgery, or Midwifery.
To the whole of this extensive course of study, candidates for the degree"
of Doctor of Medicine of the University of London are now obliged to submit,
While we consider the plan of education here proposed as one of the very best
schemes of medical examination hitherto devised, we are by no means so
Utopian in our views as to advocate the propriety or possibility of rendering
such a system compulsory upon all medical students; for the intellectual
calibre, and the pecuniary means of the majority would, we know, be un-
equal to the task. The University, indeed, appears to be extremely liberal
in allowing the student to pick up his knowledge where and how he can ;
but the long duration, the variety, and the stringency of the examinations,
and the notorious rejection of many candidates of very fair, if not of striking
abilities, naturally deter a great multitude of students from entering upon a
career, which will certainly involve them in a great expense of time and
money, and may perhaps at last terminate in disappointment. The candi-
dates for the London University degrees and honours are generally the most
advanced, and the most ambitious students.
From a careful examination of the proceedings of the University from year
to year, and a diligent perusal of the questions, both general and professional,
proposed to the candidates, it is, we think, evident that the governing body
do not wish to open the doors of the University to the mass of the profession,
but rather to propose a species of intellectual struggle to the most accom-
plished students. We may also remark, that the obstacles thrown in the way
of obtaining a degree by those who are in practice, may almost be styled
vexatious; thus the examinations are held only once a year, although the exa-
miners are very handsonnely paid for their attendance, and might, with very
little inconvenience, hold them more frequently ; in the case of candidates,
therefore, who are unable to attend upon any one of the numerous specified
days or hours, their examination is deferred for a whole year, and no plea, even
of illness, however well authenticated, is of any avail; added to which, no
distinction whatever is drawn, in the questions proposed, between the student
just fresh from the schools (of which, too, many of the Examiners are
teachers), and the practitioner of many years' standing in the profession,
who may perhaps undergo the mortification of being snubbed for not being
able to give the generic distinctions of a carex, or the minute anatomy of the
muscles of the back. But we have perhaps no right to blame the autho-
rities of the University for upholding the character of their diploma, and
upon principles of strict justice their proceedings may perhaps be defended.
With our best wishes for the continued and increased prosperity of this
great national institution, we proceed to other matters.

A comparison has been instituted between the curriculum of the University
of London and that of the APOTHECARIEs’ SocIETY ; but the comparison is
obviously unfair and uncalled for. The University grants its degrees to the
most highly educated ; the Society of Apothecaries gives its license to those
who possess a competent amount of knowledge; the first educates the few,
the second educates the masses. Many of those who pass the examination at
* Those who commenced their medical studies previous to 1839, are exempted
from the Matriculation Examination, and can pass the Medicallºxamination within
a shorter period.
654 BIBLIOGRAPHICAL RECORD.
Apothecaries' Hall, would probably be rejected at the University; and in
truth, many may fairly be pronounced competent to practise medicine with
safety to the community who may be incompetent to grapple with those
higher branches of science, an acquaintance with which is demanded by the
University.
We have so lately considered the circumstances under which the Court of
Examiners of the London Society of Apothecaries became empowered to
direct the education and conduct the examination of the general practi-
tioners of England and Wales, that it is unnecessary again to advert to that
subject. We now intend to show the manner in which they have carried
out the provisions of the Act of Parliament of 1815; and we believe that it
is impossible to deny that their efforts have been attended with signal
success, although every species of discouragement has been opposed to them
in the performance of their duties.
The following is the state of the medical profession before 1815, as depicted
by Dr. George Mann Burrows, in his Evidence before the Parliamentary
Committee in 1834: “Persons were allowed to practise as surgeons, apothe-
caries, and midwives, to dispense medicines, and to compound prescriptions
in England and Wales, who had never received any education to fit them to
exercise those functions ; whereby the public were much injured, and the cha-
'racter of the medical profession was lowered.” The same gentleman is asked,
nearly twenty years after the passing of the Act : “What do you say of the
manner in which they” (the Court of Examiners of the Society of Apothe-
caries) “ have exercised their powers ?” and he replies, “I think they have
carried the Act into effect, in the most material matters, in a manner which
has been most highly conducive to the benefit of the members of the pro-
fession, and to the benefit of the public.” [Report on Medical Education,
Part iii. p. 17.]
We have now lying before us the Regulations of the Court of Examiners
of the Apothecaries’ Society, from the year 1815 to the present time; and we
cannot but remark the diligence which they seem to have evinced, during
successive years, in extending the education, and thereby improving the
character and rank of the medical practitioner. The Court seem to have
been impressed, from the beginning, with the absolute necessity of certain
branches of science to the completion of the education of the general prac-
titioner; and we accordingly find, that they consistently insist from first to
last upon the necessity, 1st, of preliminary knowledge ; 2nd, of Anatomy and
Physiology; 3rd, of the Theory and Practice of Medicine ; 4th, of Che-
mistry; and 5th, of Materia Medica.
In the first regulations issued by the Court of Examiners, dated July 31,
1815, we find that the candidate “is expected to possess a competent know-
ledge of the Latin language, and to have attended lectures on Anatomy and
Physiology, on the Theory and Practice of Medicine, on Chemistry, and on
Materia Medica, and to have attended medical practice in an hospital, infir-
mary, or dispensary.” The examination, we find, consisted in translating
the Pharmacopoeia Londinensis and Physicians’ prescriptions, in the Theory
* of Medicine, in Pharmaceutical Chemistry, and in the Materia
€ClO3,.
In the year 1826, the Court of Examiners published the following note in
capital letters; and to this note we beg to direct the particular attention of
our readers:
“The Court are extremely anxious to impress upon those persons, who
may be intending to present themselves for examination before them, a con-
viction of the absolute necessity of such knowledge of the Latin language,
as may enable them to translate the Pharmacopoeia Londinensis and pre-
scriptions of Physicians, which they consider as a qualification indispensable
to the apothecary, and which the fifth section of the Act expressly requires.
“They are particularly induced to give greater publicity to this regula-

BIBLIOGRAPHICAL RECORD. 655
tion, because they have had the distressing duty imposed upon them, of
withholding certificates of qualification from several persons, principally
from their great deficiency in this most important pre-requisite to a Medical
JEducation.” -
In this year, the candidate is examined in Anatomy and Physiology, and
in Medical Botany, in addition to the subjects prescribed for examination in
1815.
In 1827, in addition to the other subjects of study, the candidates are
“earnestly recommended to attend one or more courses of lectures on Mid-
wifery and the Diseases of Women and Children, on the latter of which sub-
jects they will be examined.” The Court determines also that the candidate
shall translate grammatically parts of the Pharmacopoeia Londinensis and
physicians’ prescriptions, and “should any doubt arise as to the candidate's
possessing a competent knowledge of Latin, he will be required to translate
a passage or passages from some one of the easier Latin authors”; and in
this year, the Court repeat their admonition to the candidates of the risk of
rejection if they fail in this particular.
In 1828, the student is required to attend two courses of anatomical
demonstrations, in addition to the lectures on Anatomy and Physiology.
In the year 1830, the most important advances are made, and the regu-
lations of the Court are accompanied by a preface, which is characterized
by moderation and good sense. The following extracts are perfectly appli-
cable to the circumstances of the present times.
“The Court of Examiners, in instituting the following regulations, do not
by any means conceive that they are requiring the maximum of knowledge
that might be expected from the apothecary, but merely that quantity of
information which the general advancement of science demands, and cer-
tainly not more than is requisite to afford a just degree of security to those
whose lives are entrusted to his care, including the majority of the inha-
bitants of every large city in the kingdom, and the bulk of the population
throughout the country. :
“In addition to the studies mentioned in the following pages, the Court
beg seriously to impress upon parents and guardians who destine the youth
under their care to the study of medicine, that a familiar acquaintance with
the Latin language is indispensable; and that a knowledge of Greek is scarcely
less so, since most of the terms of art employed in medicine and the collateral
sciences, are derived from that expressive language. Natural history may
be said to be essential to the proper study of the Materia Medica ; and an
acquaintance with the exact sciences will not only enable the student to
understand more readily the admirable structure and functions of many
parts of the human frame, but also assist him materially in acquiring habits
of precise and correct reasoning. -
“It is of great importance, that the parent who apprentices his son to an
apothecary, as well as the master who receives him, should previously ascer-
tain that the youth has been liberally educated, and that his classical attain-
ments, more especially, are such as enable him to pursue his subsequent
studies with credit and advantage.
“The Court have too much reason to know and lament, that notwith-
standing all their precautions, the attendance upon lectures, and more espe-
Gially upon hospital practice, is often grossly eluded or neglected; and they
deem it their duty to express a hope that the teachers of the various
branches of medical science, with whom the correction of this abuse must
principally rest, will turn their attention to the removal of an evil of such
magnitude. It would be competent to the teachers to insist upon periodical
Signatures from their respective classes, proving that the pupils are actually
in attendance; and it would be equally in their power entirely to withhold
certificates from those who have neglected their attendance, or to qualify
the testimonial in such a manner, that the Court may apply to those who
656 BIBLIOGRAPHICAL RECORD."
have been negligent that degree of rigid scrutiny which the justice of the
case might appear to demand.”
In this year, the candidate is required to devote at least two years to attend-
ance on lectures and hospital practice; the attendance on lectures upon
Chemistry is doubled in amount ; the same is the case with the lectures on
Materia Medica; and a specific course of lectures on Botany is added to the
curriculum ; and we now find that the course of study includes Midwifery,
and the Diseases of Women and Children, and Forensic Medicine. The exa-
mination is now found to consist in translating parts of Celsus de Mediciná,
or Gregory's Conspectus Medicinæ Theoreticae, in addition to the Pharmaco-
poeia Londºnensis, and physicians' prescriptions; in Chemistry, in Materia
Medica, and Therapeutics; in Botany, in Anatomy and Physiology, and in
the Practice of Medicine.
In the year 1832 the Court of Examiners again revise their curriculum, and
again append a preface characterized by the same good sense and moderation
as we have had occasion to notice in the previous address. The following
extract is an excellent specimen : “It can need no argument to prove that
the apothecary should have a sound and liberal education, and be practically
acquainted with the duties of his profession, when it is considered that he
ministers to the great mass of the people in the function of the physician,
and, by the usage of society, has the immediate superintendence of the pub-
lic health entrusted to him. In the metropolis, and in the large provincial
towns, he can be aided, in cases of difficulty, by the learning of the physician.
Elsewhere, he cannot avail himself of such valuable assistance; but in cases
of danger, which are of frequent occurrence, he is obliged to rely exclusively
upon his own resources, and can therefore alone be sustained, under this
i. responsibility, by a well-founded reliance on a knowledge of his pro-
ession.”
In the address of this year, the Court again urge upon the student the
indispensable necessity of a sound classical education, of a knowledge
of the mathematical sciences, and of the French and German languages.
They also point out the necessity of making the period of apprenticeship the
season of study, and strongly condemn the impropriety of wasting it in
practical pharmacy. They also urge upon the teachers of medicine and
the collateral sciences, the advantages of practical knowledge to the pupils;
and they especially direct the attention of both teacher and student to the
important subjects of practice, chemistry, and clinical medicine. The curri-
culum of this year presents no important variation from that of 1830; but
we now find that the courses of Anatomy and Physiology, and of Anatomical
Demonstrations, are directed to be of the same extent as is required by the
Royal College of Surgeons of London, evincing an evident desire, on the part
of the Society of Apothecaries, to act in harmony with the College. The
examination in this year, includes, for the first time, the important subject of
the Diseases of Pregnant and Puerperal Women, and the Diseases of Children.
In the year 1835, the Court again make most important alterations in
their curriculum, and their mode of examination. The principle is distinctly
enunciated, that the term of apprenticeship may and ought to include the
whole period of medical study; and the attendance upon lectures and hospital
practice, which, in former years might be accomplished in six months, is now
made to extend over a period of three years, and to consist of three winter
and two summer sessions. The Court thus restrict the term of actual ser-
vice as an apprentice to two years; and they argue, and, we think, very
justly, that to a youth previously well acquainted with the classics, the ele-
ments of the mathematics, and the modern languages, “this period of
apprenticeship is by no means of small importance; for, during that time,
it is incumbent upon the master to take care that his apprentice keeps up,
and extends, by a regular course of reading, both his classical and general
knowledge. It is also his duty to ascertain, by occasional examinations, that

BIBLIOGRAPHICAL RECORD. 657
his pupil is acquiring the elements of professional knowledge, and that oppor-
tunities should be afforded him of watching the progress of disease, and of
noticing the effects of remedies.” The Court proceed to show that their cur-
riculum has been drawn up in strict conformity with the regulations of the
College of Surgeons, so that the two courses required, the one by their own
regulations, and the other by those of the College, may be completely har-
monized, and the students subjected to no inconvenience in preparing them-
selves for the diploma and license necessary to enable them to practise their
profession. A most important feature introduced into the examination dur-
ing this year, is the separation of the Latin from the general examination,
whereby the student is enabled to pass his Latin test at the commencement
of his medical studies at the schools.
No important alteration is now observed during several successive years;
and it is generally understood that the Court of Examiners refrained, for
some time, from offering any observations upon the subject of medical educa-
tion, in the expectation that some comprehensive measure of medical reform
would receive the sanction of the legislature; but the discussions upon that
subject have given rise, unhappily, to the utmost dissension, and have un-
questionably retarded the progress of sound education. The minds of the
students having been distracted by theoretical questions of medical reform,
the attention to accurate scientific principles has been relaxed in proportion;
and the public have been the sufferers, in the diminished standard of profes-
sional attainments reached by their medical advisers. But as year after year
rolled away, and the whole question of medical reform appeared as far as ever
from a satisfactory adjustment, the Court of Examiners of the Society of Apo-
thecaries have again, in the year 1850, proceeded to make some very important
and beneficial changes in their curriculum. The Latin examination is now
held upon a separate day from the general examination; and the student is
required not only to translate the language, but to explain its grammatical -
construction, the object evidently being to encourage a sound knowledge of
the language, rather than that parrot-like acquaintance with it which may
be acquired by the help of translations and the exercise of mere memory. The
pursuit of Practical Chemistry, which was formerly an indefinite appendage
to the course of lectures on that subject, is now made a distinct and separate
course, and includes the actual instruction of the pupils in the manipulations
of the science, in determining the presence of poisons, in analysing gaseous
compounds, and in examining the different secretions of the body. We are
informed that the student is now examined in Practical Chemistry in the
examination-room, by means of tests and other re-agents, which are placed
in his hands. Another subject which the examiners have prominently en-
couraged, is the study of Clinical Medicine; and the Court now express their
readiness to receive, “in place of a second course of lectures on the theory
and practice of medicine, a certificate of attendance on a course of Clinical
Lectures, provided such lectures be delivered in a recognised hospital, by a
distinct professor, and consist of not less than seventy-five lectures.” The
object of defining the number of lectures, is stated to be the abolition of the
loose and inefficient manner in which clinical lectures have been hitherto
given, and to cause a definite system of instruction to be pursued in this most
important and essential department of medical science. Another change,
which is observable, is the transference of the lectures on Materia Medica
and Midwifery from the winter to the summer session; but to this change
we by no means yield our cordial approval; for, although the Court state
that this alteration was arranged after a conference between the authorities
of the College of Surgeons and the Hall, and that it is intended to give the
student more time for the study of Anatomy and Chemistry, we yet fear that,
under present circumstances, the result will be, to discourage the cultivation
of materia medica and of midwifery; departments of medical science of essen-
tial importance to the general practitioner.
658 BIBLIOGRAPHICAL RECORD.
THE REGULATIONS of THE COLLEGE of SURGEONs are in striking and re-
markable contrast with the Regulations of the University of London and
those of the Society of Apothecaries. We do not intend, for reasons given
at the commencement of this article, to enter upon the education of the pure
surgeon, as he is absurdly called, and we therefore intend to make no remarks
upon the Fellowship of the College, or the Regulations which have been
issued in regard to it. Our only object, at present, is to shew the relation
which the College of Surgeons bears to the general practitioner; and here
we may remark, that if the College repudiate and despise general practice,
we cannot see why it should continue to examine general practitioners.
Let the College become what it professes to be, an institution for the cultiva-
tion of pure surgery, and we are willing and anxious to give it our warmest
support. We cheerfully admit the distinguished talents of many of its
Examiners, Council, and Professors: we admire its magnificent museum,
and the assiduity exhibited in its maintenance and enrichment: we applaud
the zeal and munificence which have raised its splendid library, may more,
we think that the Government ought to endow so noble a National Institute
with sufficient funds to carry out the praiseworthy intentions of its founders.
It certainly ought not to be upheld, as at present, by the examination fees of
general practitioners. The system is alike injurious to the dignity of the
College and the safety of the public. But as the College, while denouncing
and ridiculing general practice, actually derives its principal emoluments from
the very class which it despises, we are by no means stepping out of the path
of fair criticism, when we examine the claims it possesses to confidence and
support as an educating and examining body.
In perusing the Regulations of the College of Surgeons of England, from
the year 1828 down to the present time, we look in vain for any expression
of sympathy for the members of the profession, any indication of a desire for
their improvement, or any remarks about their preliminary education. In
not one of these Regulations is the subject of classical knowledge ever
alluded to in the most distant manner, nor indeed is it hinted in any part,
that the College requires any preliminary education whatever. The importance
attached by the Council of the College to these and other trifles, is reserved
for the Hunterian Orations, when a great deal of fun is excited by the orators,
and a great deal of amusement afforded to the Members of Parliament and
others of the laity who assemble on those occasions, by the witty allusions
made to the people who “wield” the pestle and mortar, who converse with
their apprentices in dog-Latin, and who make young gentlemen pay them a
large sum for the privilege of brushing their shoes and opening their shop-
shutters: then, when the merriment has a little subsided, a serious turn is
given to the discourse ; the giant evil of the profession is declared to be the
want of preliminary education, the orator, however, always forgetting to
mention that his own College has, by its culpable negligence, encouraged that
very ignorance which it now affects to discover and deplore.
In the Regulations of the College of Surgeons published in 1828, we
find that the candidate is required to have completed his twenty-second
gear, and to prove that he has been engaged six years at least in the
acquisition of professional knowledge, and of having regularly attended three
or more winter courses of Anatomy and Physiology, and two or more winter
courses of Dissections and Demonstrations delivered at subsequent periods;
together with two or more courses of lectures on the principles and practice
of Surgery. He is likewise required to prove that he has attended lectures
on the Theory and Practice of Physic, upon Materia Medica and Botany,
upon Chemistry, and upon Midwifery; and that he has attended, during one
year, the surgical practice of certain specified hospitals in England, Ireland,
or Scotland.
The examination, we should remark, consisted at that time, of questions in

BIBLIOGRAPHICAL RECORD. 659
º and Surgery; and it consists of precisely the same subjects at the pre-
Se72% da/.
*hese Regulations, considering the time at which they were issued,
and notwithstanding the total omission of the slightest mention of prelimi-
nary education, are to a certain extent commendable ; and those who passed
the ordeal may be said to have offered some guarantee as to their compe-
tency to practise surgery. We might fairly have expected that the Court
of Examiners would, from time to time, have made such alterations and
improvements in their curriculum, and in their examinations, as the circum-
stances of the times, and the increased facilities offered to students, might
seem to justify or to suggest. But, to our utter astonishment, the College
diminishes its standard of education, in exact proportion to the increasing
diffusion of professional knowledge. Thus we find, in the above Regulations,
that the student must have spent at least six years in the acquisition of pro-
fessional knowledge; but, in 1835, the College requires him to study only for
five years, and in 1838, four years are considered sufficient. So that in 1828,
when the anatomy taught, consisted of little more than a catalogue of the
structures of the human body—when surgery was comparatively unformed—
when physiology was in its infancy—when comparative anatomy was almost
unknown as a distinct branch of science—when pathology and morbid ama-
tomy were generally neglected—when the microscope was only in the hands
of the few—when clinical surgery had not yet been taught in this country:-
at this period, we say, six years were considered to be necessary for the
manufacture of a surgeon ; but from 1838 to the present time, when anatomy,
general, special, comparative, and morbid ; surgery, practical, theoretical,
and clinical ; physiology, both animal and vegetable, have all advanced with
rapid strides, and have swelled the bulk of the student's labours to at least
one hundred times their former extent, four years are considered amply suffi-
cient for the purpose ! We shall not waste words upon this portion of the
Regulations, as its absurdity speaks for itself. Again, the College requires
in 1828, that the student who presents himself for examination, shall be
twenty-two years of age. Now, there was a very obvious advantage in this
Regulation; for as students were allowed to present themselves at Apotheca-
ries' Hall at twenty-one, the extra year was exceedingly well employed in
acquiring a more complete knowledge of anatomy, and in attending more
closely to hospital practice than could be accomplished while they were learn-
ing some of the preliminary branches of knowledge, such as Latin, Pharmacy,
Chemistry, Botany, etc.; and independently of this consideration, the age of
twenty-two is quite early enough for any man to receive a diploma to practise
surgery. But in 1838, we find that the candidate is required to be only twenty-
one years of age. We fear the effect of these changes has been mischievous in
the extreme ; for in former times, the pupil commenced his medical career
perhaps at sixteen years of age : for two or three years he probably served.
an apprenticeship, during which time he acquired a facility of reading pre-
scriptions, of compounding drugs, and of recognising their most striking
characters; and he would also be made acquainted with the symptoms of
various common ailments, and with, at least, the minor operations and mani-
pulations of surgery. . This sketch puts the apprenticeship in the lowest
point of view ; but where the master was an intelligent and conscientious
man, in extensive practice, a large portion of time would be occupied in
obtaining from books, and orally, much practical information in connexion
with the subjects of interest passing under his daily notice. At eighteen or
nineteen, the pupil came to London; he commenced his collegiate or hospital
career by studying Anatomy, Physiology, Chemistry, and Materia Medica,
and afterwards the other branches of science in their prescribed order. At
twenty-one, he was enabled to present himself for examination at Apotheca-
caries' Hall, and was examined, (as every medical or surgical student ought
WOI,... II. 44
660 BIBLIOGRAPHICAL RECORD.
to be) in Latin, Chemistry, Materia Medica, Practice of Physic, etc.; and as
we have just remarked, he had then a whole year for a farther pursuit of the
higher branches of Anatomy, Physiology, Pathology, and Surgery, before he
could present himself for examination at the College of Surgeons. -
Now the student so educated and so examined, was very fairly qualified to
practise the profession with credit to himself and with advantage to the pub-
lic; and the systematic manner in which his studies were pursued, must have
had no small influence in the discipline of his mind. Butat present, the student
may offer himself for examination at the College of Surgeons at twenty-one,
and he requires only four years of professional study. When, therefore, a
student comes of age, he reflects upon the examination which it is most con-
venient for him to pass; and if he be totally ignorant of the classics, wholly
unacquainted with chemistry, materia medica, and the practice of physic,
he of course selects the College of Surgeons, upon the strength of a smattering
of anatomy and an infinitesimal proportion of surgery. He them issues forth
from the stately portals in Lincoln's Inn Fields, with his diploma in his hand,
and considers himself lawfully qualified to practise his profession l Now, in
all seriousness, ought this state of things to exist Is a man competent to
practise the medical profession upon such slender acquirements as those we
have just noticed ? Admitting, as we cheerfully do, the immense and para-
mount importance of anatomy, and the great utility of surgery, are these all
the branches which a student of the present day ought to acquire / We re-
peat, that a student may pass the College of Surgeons of London with a
smattering of anatomy and a little surgery; and we ask again, is a man so
examined fit to practise the profession, in which nine-tenths of the cases he
will be called to attend, are purely medical ? During the present century, a
flood of intellectual light has illuminated the domains of medical science ;
the brilliant discoveries of Priestley, of Black, of Cavendish, of Davy, have
paved the way to that comprehensive science of chemistry, which, interwoven
at it is with almost every process either of nature or of art, is more particu-
larly connected with physiology and with medicine, inasmuch as most of the
operations of the body, both in health and disease, are governed by its laws.
The genius of Laennec, and the labours of the other eminent pathologists of
this country and the continent, have brought to light innumerable forms of
disease, formerly enveloped in impenetrable obscurity; the researches of prac-
tical physicians have revealed a vast variety of remedies calculated to assuage
pain, to arrest disease, and to prolong human life; and the science of hygienics
has in many cases detected the subtle forms of poison lurking in the waters
and in the air; and while it has revealed their presence, it has often baffled or
mitigated their malignity. But to not one of these sciences need the candidate
for examination at the College of Surgeons give any practical attention; for
although it be true, that the College direct him to attend lectures upon some
of the subjects, it does not demand any proof that he has understood their
meaning, or appreciated their importance ; he is merely required to shew that
he has paid for the lectures: for if present, he may have been asleep upon
the benches, or what is just as probable, may have been absent altogether.
The practice and policy of the Royal College of Surgeons of England appears
to be, to admit, as members, as great a host as possible, at the minimum
expenditure of time, and the minimum exertion of intellect ; and we have
no hesitation in expressing our opinion, that taken by itself, the diploma of
this College is, as a testimonial of professional ability, the very worst in the
United Kingdom of Great Britain and Ireland; and that the whole proceed-
ings of the College, so far as the general practitioners are concerned, have been
calculated to degrade the medical profession in this country.”

1 The case of the Taunton pastry-cook (now in practice as a charlatan), may be
remembered by our readers. This man, by imposing on the College by forged
certificates of study, was received on trial, and of course obtained his diploma
BIBLIOGRAPHICAL RECORD. 661
Strong as this language undoubtedly is, it is quite consistent with the
truth ; and, indeed, it is curious enough that its justice is admitted by the
College itself. In a manifesto published in 1845, it was first announced
that the College considered the great bulk of its own members as qualified
only for the “ordinary exigencies” of surgical practice While, as to medi-
cal practice, of course, the College never took any trouble in the matter.
Now, the plain English of this is, that the College of Surgeons considers its
members as qualified to bleed, draw teeth, and set bones, and regards its
diploma simply as a certificate of fitness for such manual and mechanical
performances. In a manifesto from the College recently published, the same
view is maintained, although in language exceedingly ornate, often ambiguous,
and always mystical. In this communication, it is not very difficult to dis-
cover, that the object is to shew the propriety and expediency of degrading
the standard of professional education and examination; and an anxiety is
tenderly expressed, that if the standard of qualification be made too high, the
remuneration for professional sciences will be thought too low, and the lower
orders of people will be compelled to have recourse to the quacks and the
druggists. This argument is wholly hypothetical, and entirely fallacious ;
but as it is somewhat specious and plausible, it requires a few remarks.
In the first place, we may observe, that we never heard of any difficulty
being experienced by persons in procuring efficient medical assistance, if they
thought proper to seek it. The meanest pauper may procure the attendance
of the Union medical-officer ; the grade just above the pauper procures relief
at the hospitals and dispensaries ; and the class who are able to pay a little,
may obtain the services of well-qualified practitioners, especially of young men,
who rarely display any reluctance to attend for a small remuneration, as
the system initiates them into practice, and leads honourably to a better pro-
fessional connexion.
But, regarding the subject in another point of view, let us ask what would
be thought of our universities of Oxford and Cambridge, if they were to reason
in the following manner concerning the Church 7 “We annually send forth
from our colleges several hundreds of young men, many of whom will enter
the Church of England ; now, the mass of these our graduates must neces-
sarily take curacies, and this ill-paid majority will probably pass their lives in
preaching the gospel to the coarse bumpkins of a country village—very few
can become bishops, deans, or prebends: therefore, let us alter our system,
let us create an intellectual aristocracy of the profession—let us examine the
select class in Latin, Greek, Hebrew, and mathematics; but, as the rest are
only to exercise the ordinary duties of country curates, let us relax our regu-
lations so far as they are concerned, let their examination be merely nominal,
and the real examination be reserved for those who are to occupy the higher
walks of the profession.” But the universities never reasoned in so criminal
a manner, or ever proposed so shameful a scheme ; they very properly fix a
standard which is uniform for all their candidates, and the country curate
knows that he has passed the very same kind of examination as the bishops
and the archbishops.
Again, it has been argued, that if the qualifications for a profession be raised
too high, the difficulty of obtaining them will deter so many from the pursuit,
that an insufficient number will be found to supply the wants of the commu-
nity. Now this argument is proved to be entirely fallacious, by the most positive
evidence; for it was found, that when the Court of Examiners of the Society
of Apothecaries gradually extended their curriculum, and were progressively .
rendering their examination more and more difficult, the number of registered
students was annually increased. Again, we conceive, that no one will accuse
our universities of undue laxity in the granting of degrees to those, who are to
become ministers of the Church. It is well known, that the education for the
duties of the ministerial office is both expensive and laborious, and yet the
number of clergymen is enormous; and that emolument is not the ºnly object
44
662 BIBLIOGRAPHICAL RECORD.
which can induce so many to enter the Church is evident from the fact, that
several thousands of the clergy have salaries under £100 a-year. .
Let us now gather together the substance of the preceding pages. There
are three examining institutions in London, connected with the general
practice of this country: the University of London, which examines, search-
ingly and efficiently, in every branch of medical as well as general science;
the Society of Apothecaries, which, as far as the act of Parliament will allow,
examines efficiently in Medicine, Chemistry, Anatomy, and Materia Medica;
and the College of Surgeons, which examines most inefficiently in Anatomy
and Surgery. The first enforces a preliminary examination, of a very compre-
hensive character, from those who are to become its graduates ; the second
requires, at least, a knowledge of the Latin language, to be evinced by parsing
and translating certain Latin classical authors ; the third, unlike any other
collegiate institution in the civilized world, requires no preliminary education
at all.
Notwithstanding the present confused and chaotic state of medical educa-
tion, much might be done for its improvement by a very slight alteration of
existing laws and privileges. The University of London, having the com-
plete power of examining in all departments both of general and medical
education, might very fairly be resorted to by all ambitious students of medi-
cine, whatever branch of the profession they may intend to pursue ; and if
it be answered, that the emoluments of the corporations would suffer by such a
system, it might be conceded to those who possess the University degree, that
they should obtain their license to practise upon the payment of the fees,
and upon passing a merely nominal examination. For those, however, who
do not possess the University degree, we would make it compulsory that they
should obtain the license of the Apothecaries' Company, and the diploma of
the College of Surgeons. With only one of these testimonials, no person should
be licensed to act as a general practitioner. We would also make it compul-
sory, that no person whatever should receive the diploma of the College of
Surgeons, without giving proof that he possesses some classical and general
knowledge.
The license of the Apothecaries' Company by no means entitles a man to
practise, either legally or morally, all the branches of the medical profession,
because surgery issnecessarily (owing to the terms of the act of parliament)
excluded altogether from the curriculum, and from the examination ; and
the science of midwifery does not meet with the consideration to which it is
entitled. But imperfect as the education enforced by the Society of Apothe-
caries undoubtedly is, it is infinitely superior to that enjoined by the College
of Surgeons, which sends forth its members upon the strength of a little
anatomy and less surgery (which may be picked up, and often is picked up,
in a few months), to practise all the branches of the profession, if not at
home, yet in the army, the navy, the East India Company’s service, and in
the colonies; although the members so licensed may be, and very often are,
wholly ignorant of medicine, midwifery, chemistry, materia medica, and botany.
Therefore we argue, that as long as the present corporations continue to exist,
the general practitioner ought only to obtain his license to practice, after passing
the examination both of the College and of the Hall. The examinations ought to
be divided, and a preliminary examination should be instituted for all students
whatever. The Apothecaries' Hall might relinquish examination in anatomy
and physiology; and on the other hand, the examination of the College of
Surgeons should not be hurried over in an hour, but be made a really good
and efficient one, comprehending a thorough investigation of the candi-
date's acquirements in anatomy, physiology, pathological anatomy, and sur-
gery. This plan would not only be decidedly useful to the College in a
pecuniary view, but it would likewise be beneficial to all parties; for we
£onsider, that the present system of sending forth a host of half-educated

Bibl.,IOGRAPHICAL RECORD. 663
men is highly injurious to the social status of our profession; and unsafe to the
public, who are not aware that a member of the College of Surgeons is only
examined in Anatomy and Surgery.
Our desire is not to destroy existing institutions, but to urge the necessity
of fortifying their weak points, and of rendering them fit for the age we live in.
In conclusion, we would remark, that our silence in these articles regarding
the Scotch and Irish Colleges, has not arisen from an insensibility to their
importance, but simply from a desire not to obscure striking facts by com-
plicated details.
THE TREATMENT OF SEconDARY, CoNSTITUTIONAL, AND ConFIRMED SyPHILIs,
By A SAFE AND SUCCESSFUL METHOD, WITH NUMEROUS CASEs AND CLI-
NICAL OBSERVATIONS. By LANGSTON PARKER, Surgeon to the Queen's
Hospital, and Professor of Anatomy and Physiology in Queen's College,
Birmingham. London: 1850,
The present work is not intended, says the author in his preface, to illus-
trate the nature and the varieties of Syphilitic Diseases, but to point out an
easy and efficacious way of curing them. This method consists in mercurial
fumigations, a plan not altogether new, but one which has fallen into perhaps
unmerited neglect. The “mercurial vapour bath” is thus described by the
author. “The method I employ consists in surrounding the patient with an
atmosphere of mercurial vapour in a moist state. It has all the advantages
attributed to the best conducted, most successful, and least hurtful mercurial
treatments conducted in the ordinary modes; it has none of their disadvan-
tages; it neither produces mercurial fever, salivation, ulcerations of the
mouth, erethism, debility, or any form of cachexia, so common from prolonged
ordinary mercurial treatments. It has the superior advantages of effecting
speedy and permanent cures, without confinement and without risk.
“The patient is placed on a chair, and covered with an oil-cloth, lined with
flannel, which is supported by a proper framework. Under the chair are
placed a copper bath, containing water, and a metal plate, on which is put
from one to three drachms of the bisulphuret of mercury, or the same quan-
tity of the grey oxide or the binoxide. Under each of these is a spirit lamp.
The patient is thus exposed to the influence of three agents, heated air,
common steam, and the vapour of mercury, which is thus applied to the
whole surface of the body in a moist state. After the patient has remained
in the bath from five to ten minutes, perspiration generally commences; and
by the end of twenty or thirty minutes, beyond which I do not prolong the
bath, it is generally excessive. The lamps are now removed, and the tempe-
rature gradually allowed to sink: when the patient has become moderately
cool, the coverings are removed, and the body rubbed dry : the patient is
suffered to repose in an arm-chair for a short time, during which he drinks a cup
of warm decoction of guaiacum, sweetened with syrup of Sarsaparilla.” (p. 4.
“I am in the habit of using four mercurial preparations for the bath; the
bisulphuret of mercury, the grey or black oxide, the binoxide of mercury, and
the iodide. These may be used singly or combined in different ways, to suit the
peculiarities or emergencies of each particular case. The first three prepara-
tions are milder than the last, and from half a drachm to four drachms may be
used with perfect safety. In one case, half an ounce was used for each bath, and
two applications were sufficient to bring the system fully under the influence
of the remedy. The iodide must be used in smaller quantities: nearly the
whole of this preparation is rapidly converted into vapour, and, unlike all
the other preparations, leaves scarcely any ash behind it. From five grains
to half a drachm of the iodide is sufficient, and it is better to use it in small
quantities, mixed with a larger proportion of either of the other preparations.
In affections of the testes (sarcocele), and of the bones (the various forms of
ostitis or periostitis), a combination of a scruple of the iodide, and one or
two drachms of the bisulphuret or binoxide, would be a proper form. For
664 BIBLIOGRAPHICAL RECORD.
local application to the cavities of the nose or mouth, a few grains only should
be employed, as the vapour of the iodide of mercury is more irritating and
more powerful than that of either of the other preparations I have men-
tioned.” (p. 7.
Mr. Parker illustrates his treatment, by the record of thirty-two cases in
which the mercurial bath was employed with marked success. The only
objection to the plan, appears to us to be the inconvenience of its adoption in
private practice; but in hospitals, where the requisite apparatus can be kept
always in readiness, we have no doubt of its efficacy. As we are among those
who think that a moderate mercurial treatment is sometimes necessary, or
at least is the best method of treating certain cases and forms of syphilitic
disease, (both primary and subsequent), and as we believe the endermic to be
a very speedy and a very efficient method of administering remedies, we
commend this little book to the favourable notice of our readers.
AN Account of some DISCOVERIES RELATIVE TO CoNSUMPTION. By JoHN
GARDNER, M.D., Fellow of the Chymical Society, Founder of the Royal
College of Chymistry, Editor of Liebig’s Letters, and Lecturer on Organic
Chymistry, etc. Pamphlet, pp. 43. London : 1850.
We have serious doubts as to the propriety of even noticing this pamphlet.
When an author studiously insults the profession to which he belongs, making
parade of his choice of the public for his audience, avowedly by reason of
the presumed ignorance of his professional brethren, he can scarcely complain
if his lucubrations meet with the contemptuous silence they deserve. We
shall, however, put our readers in possession of what Dr. GARDNER proclaims
as his discovery : and that we may not be suspected of misrepresentation, we
shall quote his own words.
“Amid this diversity of causes, general and local, is there any common
circumstance or condition traceable, which is the first step towards the pro-
duction of consumption—the first link in the chain of morbid actions —the
primary proximate cause of the disease ? There is. It consists in the for-
mation of a £5pm, a leaven, or ferment, by an incipient, putrefactive process,
a molecular change, the transformation of a portion of albuminous matter,
which first leads to its self-propagation, and afterwards, or simultaneously,
determines the formation of tubercle. This is the key-truth to a just
theory of Consumption”, etc. (p. 31.)
“When, therefore, by the operation of those general causes above enumer-
ated, the Züpım, or ferment, is produced in any part of the body, it is conveyed
by the blood-vessels into the lungs, and there permeating or exerting its
influence through the membranous septa (known to be amongst the most
delicate in the body), a chymical change, or transformation, is set up, the
albumen in the loose, spongy texture of the lungs is ready, and tubercle is
formed ; which being an insoluble compound, is there detained, and under-
goes further changes, softening, etc., more nearly approaching, in fact,
towards absolute putrefaction.” (p. 33.)
The presence of this &üpım, we are told, can be ascertained by chemical
analysis of the secretions, including the expired air, how we are not yet
informed, the revelation of this, and of the cure, being reserved for a future
pamphlet. Cautious reticence 1 Our readers will at once perceive, that the
Čdea involved in Dr. Gardner's expositions is not new. Dr. Madden, in his
recently published work, argued strongly in favour of the dependence of
Phthisis on a special morbid poison; and the same has been more or less
distinctly hinted at by some other observers.
The pamphlet being intended for the public, that same learned body is
favoured with translations of various technicalities: e.g., Emphysema (i.e., air
entangled in the texture of the lungs.) Pulmonary apoplexy (i.e., fulness of
blood). Aneurism of the aorta (i. e., tumour upon a great blood-vessel). We
trust the public will be duly grateful for this accession to its available
knowledge.
BIBLIOGRAPHICAL RECORD. 665
A MANUAL OF ELEMENTARY CHEMISTRY, THEORETICAL AND PRACTICAL. By
GEORGE Fown Es, F.R.S. Third Edition. pp. 605. London: 1850.
The study of Chemistry is of paramount importance in the investigation of
disease; and we may safely assert that no one can now arrive at eminence in
the medical profession, who is not acquainted with that science. All the
functions of the human body are governed by chemical laws; and, although
their exact nature is still in some measure concealed from our view, enough
has been done of late years to encourage us to farther attempts in this most
ample field of inquiry. Believing as we do, that a knowledge of Chemistry
is indispensable to every student of medicine or surgery, we hail with
pleasure the appearance of the work before us, as being well suited to
facilitate the acquisition of a competent knowledge of this science. The ,
work of Dr. Fownes has long been before the public, and its merits have been
fully appreciated as the best text-book on Chemistry now in existence. We
do not, of course, place it in a rank superior to the works of Brande, Graham,
Turner, Gregory, or Gmelin, but we say that, as a work for students, it is
preferable to any of them. The time allotted to most students for acquiring
a knowledge of their profession, is too short to allow them to master elabo-
rate treatises; and therefore many of the manuals lately published, are
exceedingly useful, in giving a condensed view of the more prominent and
essential departments of medical science. If the student were, during his
attendance on lectures, to make himself thoroughly acquainted with Dr.
Fownes's manual, and at the same time to perform for himself many of the
experiments which are therein described, he would thus acquire a knowledge
of Chemistry, which would be of infinite service to him in after-life.
The present edition differs but little from its predecessors; but, as a warranty
of its being on a level with the present state of Chemistry, we may state
that Dr. Bence Jones has corrected the press, and made the few alterations
and additions which were necessary. -
A PRACTICAL HANDBook of MEDICAL CHEMISTRY. By JoHN E. Bow MAN,
Demonstrator of Chemistry in King's College, London. pp. 276.
London : 1850.
This well written work of Mr. Bowman's, treats of the Practical Applica-
tions of Chemistry to Medicine. One great feature is, that the microscopical
appearances presented by various organic substances, are, in it, faithfully
delineated. The work consists of 246 pages, of which, 166 are occupied by
the chemical and microscopical characters of the blood and urine ; and we
cannot too highly commend the very elaborate, yet clear and distinct manner,
in which the appearances of these fluids, and their variations in disease, are
described.
Mr. Bowman's work is not calculated for the beginner; but the student who
has made himself master of the principles of Chemistry, will peruse it with
pleasure and advantage. To the practitioner, the book is to be specially
recommended, as giving a very clear account of many chemical matters, which
must be ever coming before him in his daily practice. Every practitioner,
and every student of clinical medicine, should endeavour to enrich his col-
lection of books by adding to their number Mr. Bowman's little volume,
666
c1,Assiri BID catalogue of THE PAPERs which Have
APPEARED IN THE BRITISH AND FOREIGN MEDICAL,
PERIODICALS FROM JAIN.UARY 1849.
In fulfilment of our promise, we commence our CLAssified CATALOGUE of
the papers which have appeared in the British and Foreign Medical Journals
since the commencement of 1849. The portion given this month consists of the
articles on Pathology and Medicine, contained in most of the British and
American Journals. As we wish to render this Catalogue, in connexion with
our elaborate Indices, a perfect key to the Medical Literature of the World, we
have to request our readers to inform us of any errors or omissions which they
may discover in this or subsequent chapters.
CHAPTER I.
PRACTICE OF MEDICINE AND PATHOLOGY : BRITISH AND AMERICAN
Journals, FROM JAN. 1849 TO JUNE 1850.
BY ALEXANDER HENRY, M.D.
The following is a list of the Periodicals, with the abbreviations used in
referring to them —
London Journal of Medicine ... ... ... ... Lond. Journ. of Med.
Medico-Chirurgical Transactions ... ... ... Med.-Chir. Trans.
British and Foreign Medico-Chirurg. Review. B. and F. Rev.
Lancet ... ... ... Lancet.
Medical Gazet ... ... ... ... ... ... Med. Gaz.
Medical Times ... ... ... ... ... ... Med. Times.
Journal of Psychological Medicine... ... ... Journ. Psych. M.
Provincial Medical and Surgical Journal ... Prov. M. and S. Journ.
Edinburgh Medical and Surgical Journal ... Edin. Med. and Surg. J.
Monthly Journal of Medical Science ... ... Edin. Month. Journ.
Dublin Quarterly Journal ... ... ... Dub. Quart. J.
American Journal of Medical Science ... ... Amer. Journ. of Med. Sc.
Philadelphia Medical Examiner ... ... ... Phil. Med. Ex.
Transactions of American Medical Association. Amer. Trans.
CONGEN ITAL MALFORMATIONS.
MALForMATION of Cranium, Encephalon, and Spinal Chord. DALTon (J. C.)
Amer. Journ. of Med. Sc., April 1850, vol. xix, N.S., p. 340. -
CoNGENITAL Deficiency of Superior Portion of Cranium. TRUGIEN (J. W. H.)
Ibid., Oct. 1849, vol. xviii, N. S., p. 407.
of Posterior part of Cranium and Spinal Column : De-
formity of Genital Organs, etc. BREED (J. E.) Ibid., p. 408 (wood-cuts).
ACEPHALous Monster born at the full period of Pregnancy. HARVEY (Mr.)
Lond. Journ. of Med., Oct. 1849, vol. i. p. 974. -
THoRAcic and Abdominal Viscera, case of Transposition of. CLAPP (W.)
Med. Gaz., Jan. 25, 1850, vol. xlv., p. 145.
WiscERA, case of Congenital Malformation of CHARD (O. E. P.) Med.
Times, Feb. 2, 1850, vol. xxi, p. 75.
URINARY BLADDER, Congenital Extrophy of. MacKAy (Dr.) Edin. Month.
Journ., July 1849, vol. iii, N.S., p. 934. Abs. in Lond. Journ. of Med.,
August 1849, vol. i., p. 789.
—— case of Congenital Extrophy of Jones (John). Prov. M. and S.
Journ., Jan. 9, 1850, p. 10.
Dise ASEs of THE BLOOD, AND OF THE NUTRITIVE AND Excreto Ry Fu NCTIONs.
ANEMIA and its Consequences: Enlargement of the Thyroid Gland and Eye-
balls. Anaemia and Goitre—are they related 2 BEGBIE (James). Edin.
BRITISH AND AMERICAN JOURNALS. 667.
Month. Journ., Feb. 1849, vol. iii, N. S., p. 495. Abs. in Lond. Journ.
of Med., March 1849, vol. i., p. 273. . . . .
ANEMIA and Goitre, Protrusion of the Eyes in connexion with. Cooper (White).
º May 26, 1849, p. 551. Abs, in Lond, Journ. of Med., July 1849,
vol. i., p.658.
-— and Dyspepsia, followed by Haematemesis, Clinical Lect. on. WALSHE,
(W.H.) Ibid., March 31, 1849, p. 331.
INFLAMMATION, unhealthy, Essay on. GALLwFY (M.B.) Ibid., vol. ii, 1849,
pp. 307, 418, 472, 549, 571, 655. . . . . .
HAMoRRHAGE, Observations on. NELIGAN (J. Moore). Dub. Quart. J., May
1850, vol. ix, N. S., p. 347. - - a --
DRopsy, Clinical Lectures on. Todd (R. B.) Med. Gaz., 1849, vol. xliii,
pp. 309, 582. -
Blood, unusual number of White Corpuscles in, in connexion with Enlarged
Spleen, Clin. Lec. on Case of PARKER (E.A.) Med. Times, June 15, 1850,
vol. xxi, p. 431. Abs. in Lond. Journ. of Med., July 1850, vol. ii, p. 691.
ExUDATION, and Elementary Forms of Morbid Products, Preliminary obser-
vations on. CLARK (A.) Med. Gaz., 1849, vol. xiii, pp. 448, 490.
—— Simple, Cancerous, and Tubercular; their Pathology and General
Treatment (numerous wood-cuts). BENNETT (J. Hughes). Edin. Month.
Journ., Feb. 1850, vol. i., 3rd S., p. 149.
STEAtosis: or Adipification of Muscle. HALLETT (C.H.) Edin. Med. and
Surg. J., April 1849, vol. lxxi, p. 257. Abs. in Lond, Journ. of Med.,
May 1849, vol. i., p. 489. -
TUBERCULosis, intense acute general, with Perforation of Stomach. BENE KE
(W.) Lancet, Dec. 22, 1849, p. 664. -
OBEsiTY, remarks on. WARDELL (J.R.) Med. Gaz. 1849, vol. xliii, pp. 494,535,
and 589. - s
CARCINoMATous LESIONs, contributions to the Pathology of BLACK (J.)
Ibid, July 6, 1849, vol. xliv, p. 21.
ANIMAL CHEMistry, Course of Lectures on, specially illustrating the Diagnosis
and Treatment of Stomach and Renal Disease. Jon Es (H. Bence).
Lancet, vol. i., 1850, pp. 1 (Truth in Medicine), 37 (Food), 69 (Digestion),
103 (The Blood), 137 (Calculi), 164 (Quantity and Acidity of the Urine),
197 (Uric or Lithic Acid), 225 (Oxalate of Lime and Sulphates; Sulphuric
Diathesis, or Excess of Sulphates in the Urine), 259 (Alkaline and Earthy
Phosphates), 287 (Alkalescence of the Urine), 324 (Albuminous Urine;
Microscopic Appearance of the Urine in Bright's Disease), 349 (Diabetes
and Diuresis), and 375 (Relation of the Urine to the Food and System ;
Method of Examining the Urine).
AcIDITY and ALKALINITY of certain Liquids of the Human Body, in Health
and Disease. ANDRAL (M.) Edin. Med. and Surg. J., Jan. 1850, vol.
lxxiii, p. 124. From Ann. de Chimie et de Physique, 3me Série, tome
xxiv, p. 116. Paris: 1848.
URINE, Oxalate of Lime Crystals in. WALSHE (W.H.) Edin. Month. Journ.
Jan. 1849, vol. iii, N. S., p. 453.
—— Vesicles and Torulae in. THoMson (Spencer). Med. Times, March 16,
1850, vol. xxi, p. 194. -
—— Total Suppression of, during Seven Days, terminating in Recovery.
Oke (W. S.). Prov. M. and S.J., May 16, 1849, p. 259. Abs. in Lond.
Journ. of Med., June 1849, vol. i., p. 580.
Suppression of HALL (J. C.) Lancet, vol. i., 1849, pp. 581 and 631,
and vol. ii, p. 4. Abs, in Lond. Journ. of Med., Aug. 1849, vol. i., p. 750.
GouT and Rheumatism, connexion between. GARRoD (A.B.) Lond. Journ.
of Med., June 1850, vol. ii, p. 583.
RHEUMATISM, Acute, with Arachnitis and Pericarditis, supervening on Chronic
Arachnitis and a remarkably Diseased Heart. ANCELL (H.) Edin. Month.
Journ., Jan. 1849, vol. iii, N. S., p. 446.
———- case of, with Pericarditis, etc., Clinical Lecture on. WALSHE (W.H.)
Lancet, Feb. 10, 1849, p. 141. - - . . . -
668 CLASSIFIED CATALOGUE.
RHEUMATISM, case of, followed by Pleurisy, Clinical Lecture on. WALSHE
(W. H.) Ibid., April 14, 1849, p. 387. -
—— Nitrate of Potash in ; with Suggestions for the use of External
Saline Applications in Chronic Rheumatism. BashAM (W. R.) Med.-
Chir, Trans., 1849, vol. xxxii, p. 1; Lond. Journ. of Med., Jap. 1849,
vol. i., p. 106. *
RHEUMATIC GouT, case of treated by Lemon juice. REEs (G.O.) Med.
Gaz., Jan. 26, 1849, vol. xliii, p. 156. -
DIABETEs, case of in a Child. PARsons (J.) Prov. M. and S. Journ., June
27, 1849, p. 342.
MELLITUS, Perforations and other Lesions of the Stomach connected
with. MACINTYRE (W.) Lond. Journ. of Med., May 1849, vol. i., p. 501,
and April 1850, vol. ii, p. 353. .
—— Treatment of: Substitute for Bread. PERCY (John). Lancet, March
17, 1849, p. 289. Abs. in Lond. Journ. of Med., April 1849, vol. i., p. 379.
ScuRVY, Observations on, in Bath and its neighbourhood, in the Spring of
1847. BARRETT (John). Prov. M. and S. Journ., March 21, 1850, pp.
148, 173, 21 1. - - -
—— Digest of Memoirs on, by ANDERson (A.), BALY (Dr.), BELLINGHAM
(Dr.), CHATIN et Bouvier (MM.), CHRIST isos (Dr.), CURRAN and ALD-
RIDGE (Drs.), FAUVEL, BECQUEREL, and Rodi ER (MM.), Foltz and
FRICK (Drs.), GARRod (Dr.), LAYCOCK (Dr.), Lonsdale (Dr.), RITCHIE
(Dr.), SHAPTER (Dr.), STIFF (Dr.). Lond. Journ. of Med., Feb. 1849,
vol. i., p. 181.
—— at York Factory, Hudson's Bay. SMELLIE (William). Edin. Month.
Journ., Sept. 1849, vol. iii, N. S., p. 1061. -
——— respective value of Lime-juice, Citric Acid, and Nitrate of Potash, in
the Treatment of BRyson (A.) Med. Times, 1850, vol. xxi, pp. 212
and 435. -
Goit RE, cases of, with Observations. Alison (Scott). Lond. Journ. of Med.
June 1849, vol. i., p. 518.
GLANDERs from Infection. KELLY (Dillon). Dub. Quart. J., Nov. 1849, vol.
viii, N. S., p. 442.
DISEASES OF THE SKIN.
SKIN, Contributions to the Pathology of BURGEss (T.H.) Med. Gaz., 1849,
vol. xliii, pp. 315, 412, 595, 758, 933; vol. xliv, p. 314.
SKIN-Diseases, Pathology and Treatment of NELIGAN (J. Moore). Dub.
Quart. J., Nov. 1849, vol. viii, N. S., p. 340.
——— Classification and Diagnosis of BENNETT (J. Hughes). Edin. Month.
Journ., April 1850, vol. i., 3rd S., p. 345.
——— on the Treatment of some : (viz., Psoriasis and Lepra). GRIFFITH (S.)
Lancet, May 26, 1849, p. 559.
Action of Acetate of Potash in. Easton (J. C.) Edin.
Month. Journ., May 1850, vol. i., 3rd S., p. 422.
EczEMA and IMPETIGo, Local Treatment of Chronic. BENNETT (J. Hughes).
Edin. Month. Journ., Aug. 1849, vol. iii, N. S., p. 963. Abs, in Lond.
Journ. of Med., Sept. 1849, vol. i., p. 793.
RINGwokM, or Trichophyton Tonsurans." MALMSTEN (P.H.) Edin. Med. and
Surg. J., Jan. 1850, vol. lxxiii, p. 50. From Müller's Archiv., 1848, p. 1.
ERYTHEMA Nodosum, and its connection with the Rheumatic Diathesis.
BEGBIE (Dr.). Edin. Month. Journ., May 1850, vol. i., 3rd S., p. 487.
SPEDALSKHED of Norway. DANIELssEN (D. C.), and BoECK (C. W.) B. and
F. Med. Chir. Rev., Jan. 1850, p. 171. An Analytical Review of the
Norwegian Works on the above Disease, which is allied to Elephantiasis.
ELEPHANTIASIS in Tracadie, New Brunswick, Essay on. BAYARD (R.) Lancet,
vol. ii, 1849, pp. 225, 256. -
FEVERS,
Fever, Irish Epidemic, especially as it prevailed in 1847-48, Dub. Quart. J.,
February, May, August, and November 1849, vol. vii, N. S., pp. 64 and
BRITISH AND AMERICAN JOURNALs. 669
340, and vol. viii, pp. 1 and 270. This elaborate and valuable report con-
sists of original papers by numerous observers in different parts of Ireland,
arranged and digested by the Editor. -
FEveR, Edinburgh, of 1843–44. Corm Ack (John Rose). Med. Gaz., April
13, 1849, vol. xliii, p. 653. Abs, in Lond. Journ. of Med., May 1849, vol.
i, p. 492.
**i. the Coleraine Union Workhouse, and in the Union, co. London-
derry, Ireland, in 1847 and 1848. BABINGTon (T. H.) Med. Gaz.,
Dec. 7, 1849, vol. xliv, p. 962.
—— in South Wales. MAssy (Tuthill). Dub. Quart. J., Nov. 1849, vol.
viii, N. S., p. 438.
- in the Garrison of St. Ann, Barbados. DAvy (John). Edin. Med. and
Surg. J., October 1849, vol. lxxii, p. 277.
Endemic, of Ceylon, Practical Remarks on. CAMERON (J. C.) Ibid.,
Jam. 1849, vol. lxxi, p. 70. v.
—— Lectures on. MACIlwai N (George). Med. Times, 1849, vol. xix, pp.
207, 227, 263,283, 299, 331, 351,427, 485, 543, 599; vol. xx, p. 46.
—— Patients, Distribution of, in a Hospital. CHRISTIson (R.) Edin.
Month. J., March 1850, vol. i., 3rd S., p. 282.
— Case of Slow Action of the Heart in. HALPIN (Chas.) Dub. Quart. J.,
May 1849, vol. vii, N. S., p. 501.
—— Tropical, Contributions to the Pathology and Treatment of BIRD
(James). Lond. Journ. of Med., Jan. & Feb. 1849, vol. i., pp. 43 & 152.
Continued, a Series of Papers on the Causes and Nature of. Todd
(George). Lancet, vol. i., 1849, pp. 8, 200, 453, 690; vol. ii, pp. 229,
453, 658.
——— Atonic Continued, Clinical Lecture on. WALSHE (W. H.) Ibid.,
Feb. 24, 1849, p. 193.
Typhus and Typhoid: An attempt to determine the Question of their
Identity or Non-identity, by an Analysis of the Symptoms, and of the
Appearances found after Death in sixty-six fatal cases of Continued Fever,
observed at the London Fever Hospital from January 1847 to February
1849. JENNER (William). Edin. Month. Journ., April, May, June,
August, October, and Dec. 1849, vol. iii, N. S., pp. 663, 726, 816, 954,
1095, 1264; also Feb. and April 1850, vol. i., 3rd S., pp. 106 and 308.
Typhus, Typhoid, Relapsing, and Febricular, the Diseases commonly
confounded under the name Continued Fever: illustrated by cases col-
lected at the Bed-side. JENNER (William). Med. Times, 1849, vol. xx,
pp. 401, 418, 456; and 1850, vol. xxi, pp. 15, 113, 135,233, and 433.
—— Typhus or Ship-Fever, in America, Report on. Amer. Trans., 1849,
vol. ii, p. 135.
—— Typhus, at Bellevue, New York. REESE (D. M.) Amer. Journ. of
Med. Sc., Jan. 1850, vol. xix, N. S., p. 95.
Typhoid. Upshur (G. L.) Phil. Med. Ex., Oct. 1849, vol. v., N. S.,
. 576.
––– Typhoid, Diagnosis of: Chemical and Physical Characters of the Stools
considered as Aids to Diagnosis. PARKEs (E. A.) Med. Times, June 1,
1850, vol. xxi, p. 395.
Typhoid, Account of an Epidemic of, which prevailed in Bath during
Sept. and Oct. 1849. DAvies (William). Prov. M. and S. Journ., Feb.
6, 1850, p. 60. -
— — Cerebro-Spinal Typhus, or Meningitis, cases of SARGENT (Josh.)
Amer. Journ. of Med. Sc., July 1849, vol. xviii, N. S., p. 35.
— occurring during the prevalence of Epidemic Catarrhal Fever.
scruggs (R.I.)" Phil. Wied. Ex, Jan. 1849, vol. v., N.S., p. 17.
- in America, Report on. Amer. Trans., 1849, vol. ii, p. 152.
—— Bilious, as it prevails in the Eastern portion of New Jersey, U.S.
FITHIAN (J.) jº. 1849, vol. ii, p. 203.
—— Yellow, in New Orleans, in 1848, Report on. Ibid., 1849, vol. ii, p. 159.
670 CLASSIFIED CATALOGUE.
FEveR, Yellow, in Staten Island, in 1848, Report on. Ibid., 1849, vol. ii, p.
162.
Yellow (supposed) in Natchez, Mississipi, U.S., in 1848, Repprt on.
Ibid., 1849, vol. ii, p. 164.
Intermittent, Observations upon. HARVEY (William). This paper
is reprinted from the MS. Memoirs of the Dublin Medico-Philosophical
Society, vol. iii, p. 236. It was read at a meeting of that Society on the
1st of Aug. 1782. Dub. Quart. J., Nov. 1849, vol. viii, N. S., p. 455.
Intermittent and Remittent, Etiology of GAYLEY (James F.) Amer.
Journal of Med. Sc., Jan. 1849, vol. xvii, p. 53.
Miasmatic, and Pulmonary Consumption, alleged antagonism of Bou-
DIN, GREEN (Horace), and HElffT. Edin. Med. and Surg. J., April
1849, vol. lxxi, p. 344.
——— Intermittent, on the use of Tartar Emetic in. MooRE (Mr.) Med.
Gaz., Sept. 11, 1849, vol. xliv, p. 445.
— Intermittent, treated by Turpentine with Castor Oil. WARD (N.)
Amer. Journ. of Med. Sc., Oct. 1849, vol. xviii, N. S., p. 548.
Infantile Remittent, case of, terminating in Hydrocephalus; Urea in Blood.
CoRMACK (John Rose). Lond. Journ. of Med., Oct. 1849, vol. i., p. 920.
Remittent, Quinine in. PARRISH (Dr.), Jewell (Dr.W.), BELL (Dr.),
JAckson (Dr. S.) Phil. Med. Ex., Feb. 1850, vol. vi, N. S., p. 78.
PUERPERAL. See the chapter on Diseases Peculiar to Women.
CHOLERA, Review of Books and Pamphlets on. Lond. Journ. of Med., Jan.,
April, Dec. 1849, vol. i., pp. 72, 339, and 1115.
— Analysis of Pamphlets on. Lancet, vol. ii, 1849, pp. 14, 94, and 149.
Review of Works on. Med. Gaz., Jan. 12, 1849, vol. xliii, p. 64.
——— Review of Books and Memoirs on. Edin. Med. and Surg. J., July
1849, vol. lxxii, p. 197.
Review of Memoirs on. Edin. Month. Journ., Jan. 1849, vol. iii,
N. S., p. 469.
Review of Treatises on. Amer. Journ. of Med. Sc., Oct. 1849, vol.
xviii, N. S., p. 437.
——— Progress of Asiatic. GRAVEs (Robert J.) Dub. Quart. J., Feb. 1849,
vol. vii, N. S., p. 1. There is a postscript to this paper at p. 242 of the
same number.
——— Reports and Statistical Tables of, at the Hospital of St. Giles in the
Fields in 1832. PINcKARD (R.) Lond. Journ. of Med., April 1849, vol. i.,
p. 397. (Paper read at Medical and Chirur. Soc., with discussion.)
in London, from March 30th to Sept. 29th, 1849. WEBSTER (John).
Ibid., Nov. 1849, vol. i., p. 992.
——— in the Metropolis in 1848-49, Statistics of SMITH (Benjamin). Med.
Times, Nov. 3, 1849, vol. xx, p. 355.
——— Sketch of, as it broke out in Mr. Drouet's Establishment, Tooting.
BAILEY (J. G.) Ibid., 1849, vol. xix, pp. 250 and 354.
——— among the Pauper Children at Tooting. Edin. Med. and Surg. J.,
April 1849, vol. lxxi, p. 310.
in Plymouth. SolTAU (W. F.) Med. Gaz., 1850, vol. xlv., pp. 49,
368, 1018, 1060. s
Chole RA in Plymouth, Supplementary Statistics of HAMILTON (Dr.W.) Ibid.,
Jan. 18, p. 103. ... - -
——— progress of, in Scotland. Edin. Month. Journ., Feb., March, May, June,
July, August, 1849, vol. iii, N. S., pp. 564, 635, 777, 854, 940, and
1009. . . - -
——— Statistics of Hospital in Surgeons' Square, Edinburgh, from Oct. 28th,
to Dec. 1848. RoberTson (Wm.) Ibid., Jan. 1849, vol. iii, N. S., p. 455.
Observations on, as it prevailed in the 13th Medical District of the
City of Glasgow Parish. ADAMs (J. M.) Ibid., Aug. and Sept. 1849,
vol. iii, N. S., pp. 1012 and 1087. - -
Report of, in the Sixteenth District of the City of Glasgow, from Dec.
*
*
BRITISH AND AMERICAN JOURNALS. 67 |
20, 1848, to Feb. 21, 1849. MºETHERAN (John). Ibid., Oct. 1849, vol. iii,
N. S., p. 1165.
CHOLERA, Report on, in the 17th District of the City Parish of Glasgow, during
Nov., Dec., Jan., Feb., and March, 1849. ADAMs (A.M.) Edin. Med. and
Surg. J., Oct. 1849, vol. lxxii, p. 285.
Practical Observations on, as it appeared in Dumfries in 1832 and
1848. GRIEVE (James). Med. Times, 1849, vol. xix, pp. 584,630, 668.
— in the 47th Regiment, in Ireland, from 1832 to 1834. SAUNDERs (G.)
Ibid., Jan. 20, 1849, vol. xix. p. 249. -
in Russia in 1848. MACKENzie (Dr.) Med. Gaz., 1849, vol. xliii,
pp. 499, 539, 587, 635.
—— Observations on, as it appeared in St. Petersburgh in 1848. MARGULIES
(M.) Edin. Month. Journ., March 1849, vol. iii, N. S., p. 620.
— Indian Village, Brief Notes on. MooRE (Mr.) Med. Gaz., 1850,
vol. xlv., pp. 534, 708, 840, 893, 982, 1069. (To be continued.)
appearance of in America, in Dec. 1848. Amer. Journ. of Med. Sc.,
Jan. 1849, vol. xvii, N. S., p. 263; also Amer. Trans., 1849, vol. ii, p. 173.
in New Orleans. FENNER (E. D.) Ibid., April 1849, vol. xvii, N. S.,
p. 541. - -
in the Mississippi Valley, brief Account of the Origin, Progress, Symp-
toms, Mortality, and Treatment of SHANKS (L.) Ibid., July 1849, vol.
xviii, N. S., p. 13.
in Philadelphia, New York, Boston, New Orleans, Missouri (St. Louis),
and Cincinnati. Ibid., Oct. 1849, vol. xviii, N. S., p. 555 et seq.
History of, at Philadelphia Almshouse, Blockley, U. S., in the summer
of 1849. STILLE (M.) and MAYER (E. R.) Phil. Med. Ex., Nov. 1849,
vol. v., N. S., p. 650. : -
at Nashville, Tennessee, U.S. Bucha NAN (J.) Lond. Journ. of Med.,
Oct. 1848, vol. i., p. 953. From Boston Med. and Surg. Journ., June 6,
1849. - -
——— Case of, at Cape May, U. S. WEST (Francis). Phil. Med. Ex., Nov.
1849, vol. v., N. S., p. 641.
Cases of FINLEY (Clement). Ibid., July 1849, vol. v., N. S., p. 398.
—— Three Lectures on. CHAMBERs (W. F.) Lancet, vol. i., 1849, pp. 137,
165, and 221; also Med. Gaz., 1849, vol. xliii, pp. 244, 288, and 325.
Clinical Lecture on. Budd (G.) Med. Times, Oct. 20, 1849, vol. xx,
. 3 15. -
—º Lecture on. LAY.cock (Thomas). Med. Gaz., Sept. 7, 1849, vol.
xliv, p. 397. -
—— Remarks on. HALL (Wn.) Med. Times, Dec. 29, 1849, vol. xx, p. 501.
——— Contributions to the Pathology and Treatment of BIRD (James).
Lond Journ. of Med., April, August, and Sept. 1849, vol. i., pp. 313,715,
and 829. -
Pathology and Mode of Communication of SNow (John) and others,
Ibid., Nov. 1849, vol. i., p. 1077.
Contagion of Spooner (E. O.) Prov. M. and S. Journ., 1849, pp.
34, 62, and 91.
Pathological Anatomy of Levy and THolozAN (MM.), Ibid., Oct.
1849, vol. i., p. 929. From Gaz. Méd. de Paris, July, Aug., and Sept. 1849.
Pathological Anatomy of RAIKEM (M.) Ibid., August 1849, vol i,
p. 755. From Gaz. Méd. de Paris, July 7, 1849.
Pathological Anatomy of GAIRdNER (W. T.) , Edin. Month. Journ.,
July 1849, vol. iii, N. S., p. 901. Abstract in Lond. Journ. of Med. Aug.
1849, vol. i., p. 749. -
Condition of Mucous Membrane of Intestinal Canal in persons dying
of Report of the Committee of College of Physicians of Philadelphia.
Amer. Journ. of Med. Sc., April 1850, vol. xix, N. S., p. 542.
—— Pathological Condition of Blood in. GARRod (A.B.) Lond. Journ.
of Med., May 1849, vol. i., p. 409.
tº-
672 CLASSIFIED CATALOGUE.
Choi.ERA, Analyses of Blood in. Robertson (Wm.) Edin. Month. Journ.,
May 1849, vol. iii, N. S., p. 765. Abs. in Lond. Journ. of Med., Aug.
1849, vol. i., p. 785. -
— Intestinal Discharges in. PARKEs (E. A.) Lond. Journ. of Med., Feb.
1849, vol. i., p. 134.
— Bile in Stools of, and in first Urine after Algide Stage. PARKEs (E. A.)
Edin. Month. Journ., Oct. 1849, vol. iii, N. S., p. 1127. -
Vibriones in Intestinal Discharges, and Muscular Fibre of a patient
labouring under. BurneTT (Waldo M.) Amer. Journ. of Med. Sc.,
July 1849, vol. xviii, N. S., p. 283 (Abs. in Lond. Journ. of Med., Oct.
1849, voli, p. 950); and Jan. 1850, vol. xix, N. S., p. 261.
Observations on Urine in. BEGBIE (James W.) Edin. Month. Journ.,
Nov. 1849, vol. iii, N. S., p. 1207.
Documents on the Hypothesis which ascribes it to the presence of
Fungi. Edin. Med. and Surg. J., Jan. 1850, vol. lxxiii, p. 81. A full
account of the views of Cowdell, BRITTAN, WILLIAMs (Thomas), PARKEs
(Nicholas), BASHAM, BUDD (W.), Busk; and the Report of the College
of Physicians.
——— Cryptogamic Theory of Lond. Journ. of Med., Nov. 1849, vol. i., p.
1048. (Digest of views of BRITTAN, SwayNE, Cowdell, Alison (S. S.),
and MITCHELL.)
— Treatment of in the London Hospitals. Lancet, August 11, 1849, p. 154.
Treatment of in the Parisian Hospitals. Lond, Journ. of Med., June
and July 1849, vol. i., pp. 569 and 667. From Gaz. Méd. de Paris, May
1849. -
——— Treatment of PIGNE (J. B.) Amer. Journ. of Med. Sc., Oct. 1849,
vol. xviii, N. S., p. 565. From New Orleans Med. and Surg. Journ.
July 1849.
—— Treatment of by small and repeated doses of Calomel. AYRE (Joseph)
Lancet, vol. ii, 1849, pp. 145, 217, 327, 379, 408, 491.
——— Calomel in Treatment of Lond. Journ. of Med., Oct. 1849, vol. i., p.
956. Critical Digest of papers by Dr. Ayre and others.
— Tables illustrating Effects of Blood-letting in Treatment of. BE LL
(G. H.) Edin. Med. and Surg. J., Jan. 1849, vol. lxxi, p. 146.
Treatment of by Quinine and Iron. STRANGE (W.) Prov. M. and S.
Journ., Nov. 28, 1849, p. 652; and BELL (C. W.) Ibid., Dec. 26, 1849,
. 706. -
p Treatment of by the internal use of benumbing Cold. AR Norr (James).
Med. Gaz., Aug. 31, 1849, vol. xliv, p. 373. - -
—— Acetone or wood-naphtha in. CHILD (H. T.) Phil. Med. Ex., Aug.
1849, vol. v., N. S., p. 457. -
—— Cases of, treated successfully with Chloroform. Bourno NVILLE (An-
thony.) Ibid., Aug. 1849, vol. v., N. S., p. 459.
—— Sedative plan of treatment of ADKINs (J. L.) Ibid., Sept. 1849, vol.
v, N. S., p. 525. -
- Diet in. HANDY (W. R.) Ibid., Oct. 1849, vol. v., N. S., p. 585.
—— Cramps, Bandaging in. KENNEDY (Evory). Dub. Quart. J., Nov.
1849, vol. viii, N. S., p. 451. -
—— Questions for Investigation of Lond. Journ. of Med., Nov. 1849,
vol. i., p. 1040. - -
ExANTHEMATA, Febrile, in America during 1848, Report on. Amer. Trans.,
1849, vol. ii, p. 148. - -
VARIOLOUs Epidemic of 1844, brief Notices of GREGoRy (G.) Med. Times,
July 28, 1849, vol. xx, p. 71.
-—s - - of 1847-48, Retrospect of, as it appeared in London.
GREGoRY (George). Ibid., June 16, 1849, vol. xix, p. 637.
SMALL-Pox, Report of Cases of, in Philadelphia City Hospital in 1845–46.
SARGENT (F. W.) Amer. Journ. of Med. Sc., April 1849, vol. xvii, N. S.,
p. 349.
**-
BRITISH AND AMERICAN JOURNALs. 673
SMALL-Pox and Measles in Alnwick, Epidemics of RANSFORD (Dr.) Edin.
Month. Journ., July 1849, vol. iii, N. S., p. 933.
appearing in a family without any previous chance of Contagion.
BANKs (E.C.), Phil. Med. Ex., Sept. 1849, vol. v., N. S., p. 518.
——— case of, in which the Eruption was found on the Mucous Membrane of
the Colon. PATERson (George). Edin. Month. Journ., Feb. 1849, vol.
iii, N. S., p. 549. Abs. Lond Journ. of Med., March 1849, p. 298.
Ectrotic Treatment of BENNETT (J. Hughes). Edin. Month. Journ.
Jan. 1850, vol. i., 3rd S., p. 60. - - -
and Vaccination, Statistical Observations on. Lond. Journ. of Med.,
Sept. 1849, vol. i., p. 875. *
VARIOLA and Vaccine. UPSHUR (G. L.) Phil. Med. Ex., Oct. 1849, vol. v.,
N. S., p. 579.
WAccINATIon, its Origin and Efficacy. OKE (W. S.) Prov. M. and S. Journ.
April 3, 1850, p. 169. -
———— Remarks on. New NHAM (W.) Ibid., May 1, p. 230.
Observations on, suggested by Mr. Newnham's Remarks. (DANIELL)
(W.) Ibid., June 12, p. 320.
ScARLATINA, Epidemic, Practical and Pathological Recollections of ANNAN
(R.) Med. Times, June 23, 1849, vol. xix. p. 657. -
——— Essay on. TRIPE (J. W.) Ibid., 1849, vol. xix, pp. 6, 21, 40, 72,
108, 127, 213, 303, 412,453, 672, and vol. xx, pp. 6, 177, 195, and 235.
the Kidney in its relation to. MILLER (James). Lancet, vol. ii, 1849,
pp. 1, 57, 113, 197,281, 524, and 685. This series of papers has since
appeared as a separate publication.
— Clinical Observations on the Pathology and Treatment of the Dropsy
which follows it. Alisos (S.S.) Lond. Journ. of Med., March 1849,
vol. i., p. 224. .
Ascites and Albuminuria after: Epilepsy. RouTH (C. H. F.) Med.
Gaz., Nov. 16 and 30, 1849, vol. xliv. p. 825, 913.
Convulsions in. GREGoRY (G.) Lond. Journ. of Med., April 1849,
vol. i., p. 396. -
—— Fatal Dropsy after, and Convulsions. SMITH (Henry). Ibid., Oct.
1849, vol. i., p. 975.
case of Albuminous Nephritis in, with Two Abscesses in the Left Kid-
ney. CoryſACK (John Rose). Ibid., May 1849, vol. i., p. 451. -
——— Case of, followed by Purulent Deposits. RouTH (C. H. F.) Ibid.,
Oct. 1849, vol. i., p. 980. &
——— Coagulability of Urine in. BEGBIE (James W.) Edin. Month. Journ.
Jan. 1849, vol. iii, N. S., p. 443. -
———- Notes on. NEwBIGGING (P.) Ibid., Sept. 1849, p. 1046.
On the External use of Acetic Acid in Preventing the Dissemination of.
WEBSTER (John). Ibid., Dec. 1849, p. 1295.
——— Treatment of BRowN (G. W.) Phil. Med. Ex., Feb. 1850, yol vi.,
N. S., p. 98. ... •
Treatment of BRow N (I. B.) Lond. Journ. of Med., Oct. 1849,
vol. i., p. 967.
ScARLATINA, Treatment of by rubbing with fat Bacon. ScHNEEMANN (Dr.)
Lancet, Sept. 15, 1849, p. 285. •
—— Case of, successfully treated by Hot water Applications. BULLEY (F.
A.) Med. Times, Aug. 25, 1849, vol. xx. p. 153.
EPIDEMic of a peculiar character at Sparta, Georgia, U.S., Report on. Amer.
Trans., 1849, vol. ii, p. 139. -
PLAGUE of Milan in 1630. MANzoNI. Translation by M. Do Nov AN. Dub.
Quart. J., Aug. 1849, vol. viii, N. S., p. 217.
——— in relation to the Question of its Nature, whether or not a Contagious
Disease. Davy (John). Edin. Med. and Surg. J., July 1849, vol. lxxii,
p. 20. - .
*
*
674 CLASSIFIED CATALOGUE.
ERYSIPELAs, Report of Epidemic, in America, during 1848. Amer. Trans.,
1849, vol. ii, p. 141. - - -
as it prevailed in the Eastern portion of New Jersey, U.S., with some
Remarks on Erysipelas of the Respiratory Mucous Membrane. FITHIAN
(J.) Ibid., p. 207.
—— Nitrate of Silver in. HALL (J. C.) Lancet, vol. ii, 1849, p. 169
and 253. - - -
——— Nitrate of Silver in. HIGGINBOTTOM (John). Ibid., Nov. 24, 1849,
p. 558: and Jan. 19, 1850, p. 75. -
DISEASES OF THE ORGANS OF CIRCULATION.
HEART, on the Prognosis and Treatment of Organic Diseases of. WILLIAMs
§" . B.) Lond. Journ. of Med., April and May 1850, vol. ii, pp. 311
and 460. -
Contributions to the Pathology of. Dougi,As (H.) Edin. Month.
Journ, June, Sept. and Nov. 1849, vol. iii, N. S., pp. 808, 1033, 1196 ;
also Jan. and May 1850, vol. i., 3rd S., pp. 30 and 442.
Clinical Contributions to the Pathology, Diagnosis, and Treatment
of certain Chronic Diseases of RITCHIE (Charles). Edin. Med, and
Surg. Journ., Oct. 1849, vol. lxxii, p. 325; and Jan. and April 1850, vol.
lxxiii, pp. 1 and 257. (To be continued.)
—— Lectures on Diseases of, delivered at St. Vincent's Hospital, Dublin,
during the Session 1849-50. BELLINGHAM (O’Bryen). Med. Gaz., 1850,
vol. xlv., p. 1, 89, 177, 265, 353, 441, 529. 617, 726. (To be continued.)
and Great Wessels, Contributions to the Pathology of BLACK (J.)
Ibid., May 25, 1849, vol. xliii, p. 889.
PERICARDITIS. Position of Internal Organs in. SIBSON (Francis). Lond.
Journ. of Med., Oct. 1849, vol. i., p. 893.
——Rarity of Pericardial Adhesion in comparison with the Fre-
quency of KIRKEs (W. S.) Med. Gaz., April 5, 1850, vol. xlv.,
p. 581.
-*.
— Case simulating. HUDSON (Alfred). Dub. Quart, J., Aug.
1849, vol. viii, N. S., p. 241.
— Treatment of ; especially on the efficacy of Blood-letting and
Mercury. TAYLOR (John). Med. Times, Jan. 19, 1850, vol. xxi, pp.
32, 73, 96; and Lond. Journ. of Med.; August 1849, vol. i., p. 779.
ENDoCARDITIS, case of, with unusual Enlargement of Liver and Spleen. Ion
(J. H.) Lancet, June 16, 1849, p. 642. - -
HEART, case of Hypertrophy with Dilatation of, supervening on Pulmonary
Emphysema, Cl. Lect. on. PARKEs (E. A.) Med. Times, Jan. 12, 1850,
vol. xxi, p. 13. -
Valvular Disease of, Cl. Lect. on. PARKEs (E. A.) Ibid., 1850, vol.
xxi, pp. 52, 94, 131, and 157.
—— Fatty Degeneration of, Observations on Clinical History and Patho-
logy of ORMERod (E. L.) Med. Gaz., 1849, vol. xliv, pp. 739, 787, 831,
873, 917. - - **:: ... "...º
- Case of Malformation of JACKSON (Dr.) Amer. Journ, of Med. Sc.
. April 1849, vol. xvii, N. S., p. 338.
Case of Disease of Ibid. p. 339. - - -
— Aneurism of Left Ventricle of. Douglas (H.) Edin. Monthly Journ.
Feb. 1849, vol. iii, N. S., p. 550. Abs. in Lond. Journ, of Med., March
1849, vol. i., p. 299. - - -
— Wound of, the patient living ten days. Bow ERs (W. S.) Amer.
Journ. of Med. Sc., Oct. 1849, vol. xviii, N. S., p. 551.
case of Death from Wound of. DREw (J.) Lancet, Dec. 29, 1849,
. 691. - - -
p Needle found in. NEILL (John). Phil, Med. Ex, Feb. 1849, vol. v.,
N. S., p. 93. - . .
-
*
BRITISH AND AMERICAN JOURNALS. 675
HEART-CLoT. MEIGs (Charles D.) Ibid. March 1849, vol. v., N. S., p. 141.
ANGINA PECTORIs. KNEELAND (Samuel). Amer. Journ. of Med. Sc., Jan.
1850, vol. xix, N. S., p. 43.
AoRTA, Wound of, through the CEsophagus. MoRGAN (W. F.) Prov. M.
and S. Journ., Oct. 3, 1849, p. 538.
ANEURISM, Motions and Sounds of ; the Mechanism of their Production, and
their Diagnostic value. LYONS (Robert D.) Dub. Quart. Journ, May
1850, vol. ix, N. S., p. 319.
—— Dissecting, Pathology of PEACOCK (T. B.) Edin. Month. Journ.,
Sept. 1849, vol. iii, N. S., p. 1052.
—— Dissecting of Aorta. GAIRDNER (W. T.) Ibid., Sept. 1849, vol. iii,
N. S., p. 1084. Abs. in Lond. Journ. of Med., Aug. 1849, vol. i., p. 794.
— BENNETT (J. Risdon). Lond. Journ. of Med.,
Aug. 1849, vol. i., p. 781.
—— of Arch of Aorta, simulating Laryngitis. KINGDON (C. H.) Prov.
M. and S. Journ., Sept. 5, 1849, p. 483.
— of Thoracic Aorta, case of ELLERTON (J. E.) Lancet, June 9, 1849,
p. 603.
—— of Descending Aorta, with Fibro-fatty Tumour in;Mediastina, Cl.
Lect. on. WALSHE (W. H.) Ibid., Feb. 3, 1849, p. 117.
of Aorta, cases of (three abdominal ; one thoracic). HARTSHORNE
(Henry). Amer. Journ. of Med. Sc., Jan. 1850, vol. xix, N. S., p. 108.
—— Abdominal, treated by the method of Walsalva. BENNETT (J. Hughes).
Edin. Monthly Journ., Feb. 1850, vol. i., 3rd S., p. 169.
of Coronary Artery. PEAcock (T. B.) Ibid., March 1849, vol. iii,
N. S., p. 592. Abs. in Lond. Journ. of Med., April 1849, vol. i., p. 377.
—— of Superior Mesenteric Artery, opening into Duodenum 22 months
before death. GAIRDNER (W. T.) Ibid., Jan. 1850, vol. i., 3rd S., p. 83.
of a branch of the Epigastric Artery, bursting into the Scrotal Sac.
KREIDER (M. Z.) Amer. Journ. of Med. Sc., Jan. 1849, vol. xvii, N. S.,
p. 258. From Ohio Med. and Surg. Journ., Nov. 1848.
of Wessels at Base of Brain. Douglas (H.) : Edin. Monthly Journ,
Feb. 1849, vol. iii, N.S., p. 551. Abs. in Lond. Journ, of Med., 1849, p. 299.
WENA PoETAE, Inflammation, Obliteration, and Ossification of RAIKEM (M.)
Edin. Med, and Surg. J., April 1850, vol. lxxiii, p. 350. From Mem. de
l'Acad. Roy. de Méd. de Belgique, tome i. Bruxelles : 1848.
—— Account of an instance of Occlusion and Obstruction of Cavity of.
CRAIGIE (David). Ibid., April 1850, vol. lxxiii, p. 412.
DISEASES OF THE ORGANS OF RESPIRATION.
CHEST, a course of Lectures on the Physical Diagnosis of the Diseases of.
DAVIES (Herbert), Lancet, vol. i., 1850, pp. 4, 39, 71, 105, 165, 199,
228, 261, 377.
THORACIC DISEASEs, Diagnosis of FITZPATRICK (Thomas). Dub. Quart. J.
Feb. 1850, vol. ix, N. S., p. 74.
—— Position of the Wiscera, Configuration of the Body, and the Move-
ments of Respiration in. SIBSON (F) Lond. Journ. of Med., Nov. 1849,
vol. i., p. 1065.
— Falling in of the Chest during Inspiration, in SIBson (F.) Ibid.,
Jan. 1850, vol. ii, p. 83.
LUNgs, Contributions to the Pathology of Diseases of BLACK (J.) Med. Gaz.
1849, vol. xliii, pp. 803 and 849.
NASAL Fossa, Peculiar Disease of GAIRDNER (John). Edin. Month. Journ.
April 1850, vol. i., 3rd S., p. 384.
CATARRH, new Treatment of. Lockwood (J. A.) Amer. Journ. of Med. Sc.,
Jan. 1849, vol. xvii, N. S., p. 21.
– Nasal, Treatment of, by the Injection of Solution of Sulphate of
Zinc, PRETTY (J. R.) Med. Gaz. July 13, 1849, vol. xliv, p. 66.
WOL. II. 45
676 CLASSIFIED CATALOGUE.
EPIGLOTTITIS, KESTEVEN (W. B.) Ibid., May 4, 1849, vol. xliii, p. 761.
GLOTTIS, Spasm of, on Change of Air as a Remedy for. RobāRTON (J.)
Ibid., Jan. 5, 1849, vol. xliii, p. 6.
LARYNGISMUs STRIDULUS, Case of, from Hypertrophy of the Thymus Gland.
KEAL (W. T.) Lancet, Feb. 9, 1850, p. 178; also Med. Times, same
date, vol. xxi, p. 98.
LARYNGITIS, Acute, Cases of. EveRETT (M. G.) Med. Gaz. Feb. 9, 1849,
vol: xliii, p. 235.
—Tracheotomy—Death from Bronchitis and Pulmonary Conges-
tion. JACKSON (J. B. S.) Amer. Journ. of Med. Sc., Jan. 1849, vol.
xvii, N. S., p. 28.
—— QEdematous, successfully treated by Scarifications of the Glottis and
Epiglottis. BUCK (Gurdon). Ibid., p. 240.
—— Pseudo-Membranous. WAN BIBBER (W. C.) Ibid., Oct. 1849, vol.
xviii, N. S., p. 545.
CROUP, history of five cases of, in three of which Tracheotomy was per-
formed, and in two successfully ; with Remarks. Meigs (J. Forsyth).
Ibid., April 1849, vol. xvii, N. S., p. 307.
and certain allied Affections of the Respiratory Organs, Diagnosis of.
KESTEVEN (W.B.) Med. Gaz., Mar. 29, 1850, vol. xlv., p. 542,
Treatment of. KESTEvKN (W. B.) Ibid., June 21, p. 1065.
Membranous, treated by Cauterization of Fauces and Larynx with
Nitrate of Silver. CLARK (Dr.) Amer. Journ, of Med. Sc., Jan. 1849,
vol. xvii, N. S., p. 26.
Hoop1NG-Cough, Practical Remarks on, with the suggestion of a New Method
of Treating that Disease. WATSON (Eben.) Edin. Month. Journ., Dec.
1849, vol. iii, N. S., p. 1287.
BRONCHITIS, case of Acute Epidemic, in an Infant thirteen days old. RobTN-
son (R. R.) Med, Gaz., Feb. 15, 1850, vol. xlv., p. 275.
LUNgs, Inflammatory Effusions into Substance of, particularly as modified by
Fevers. (Plates). AITKEN (William). Edin. Med. and Surg, J., Jan.
1849, vol. lxxi, p. 1.
Apoplexy of, and its Results. GAIRDNER (W. T.) Edin. Monthly
Journ., April 1849, vol. iii, N. S., p. 696.
—— Gangrene of, Clinical Researches on. STOKES (William). Dub.
Quart. Journ., Feb. 1850, vol. ix, N. S., p. 1.
Cancer of, also of Liver, and Spinal Column. BENNETT (J. Hughes).
Edin. Month. Journ, April 1849, vol. iii, N. S., p. 701. Abs. in Lond.
Journ. of Med., 1849, p. 693.
Case of long standing Disease of, simulating Phthisis: Death by
Inanition, from a Pouch at the lower end of the OEsophagus. NoRMAN
(G.) Prov. M. and S. Journ., May 15, 1849, p. 253.
*::::::: Remarks on. EcoLEs (A.) Med. Gaz., Oct. 19, 1849, vol. xliv,
p. 657.
——, singular case of BETToN (Thomas F.) Phil. Med. Ex., Oct. 1849,
vol. v., N. S., p. 594.
PHTHISIS, (Essay on.) HALL (J. C.) Med. Gaz., 1850, vol. xlv., pp. 494,
586, 713 and 883 - --
—— Law of Mortality in, and Influence of Moral Causes in producing.
DUNGAN (James F.), Dub. Quart. J., Nov. 1849, vol. viii, N. S., p. 253,
and Feb. 1850, vol. ix, N. S., p. 22.
Clinical Lectures on the Diagnosis of Cotton (R.P.) Med. Gaz.
1849, vol. xliii, pp. 846, 903, 942, 991, 1038, and 1089.
Diagnosis of FITZPATRICK (Thomas). Dub. Quart. J., Feb. 1850,
vol. ix, N. S., p. 74. -
on the value of Haemoptysis as a Symptom of PARKEs, (E. A.)
Med. Gaz., March 30, 1849, vol. xliii, p. 535.
Incipient, Observations on some Alleged * of... THOMPson (Theo-
philus). Edin. Monthly Journ., June 1849, vol. iii, N. S., p. 828.
ſºmes
BRITISH AND AMERICAN JOURNALS. * 677
PHTHISIs, Acute. LAw (Dr.) Dub. Quart. Journ, May 1850, vol. ix, N. S.,
p. 470. Universal development of miliary tubercles in both lungs.
-- and Gout, simultaneous progress of GARRod (A.B.) Lond. Journ.
of Med., Oct. 1849, vol. i., p. 969. -
preparations, illustrative of the course of, in the Lungs. Bennett
(J. Hughes). Edin. Monthly Journ, July 1849, vol. iii., N. S. p. 935.
Abstract in Lond. Journ. of Med., 1849, p. 789. - -
Clinical Lecture on Cases of PARKEs (E. A.) Med. Times, March
1850, vol. xxi, pp. 191, 271. -
TUBERCLEs in Lungs of a very young child. RogHRs (Dr.) Lond. Journ. of
Med., Dec. 1849, vol. i., p. 1173. -
PHTHISIS, Prevention of, and properTreatment in the Early Stage; with Cases
occurring in children. HALLOWELL (Edward), Amer. Journ. of Med,
Sc., Jan. 1850, vol. xix, N. S., p. 13. - • * -
Treatment of BENNETT (J. Hughes). Edin. Monthly Journ., March
and May 1850, vol. i., 3rd S., p. 232 and 401. -
:- Curability of TURNBULL (James). Lond. Journ. of Med. Feb. 1850,
vol. ii, p. 105.
> Cod-Liver Oil in. WILLIAMS (C. J. B.) Lond. Journ. of Med., Jan.
1849, vol. i., p. 1.
Cod-Liver Oil in, beneficial effects of at Bellevue, New York. REESE
(D. M.), Amer. Journ. of Med. Sc., Jan. 1850, vol. xix, p. 98.
——— Cod-Liver Oil in. YoUNG (J.) Amer. Journ. of Med. Sc., Jan. 1849,
vol. xvii, N. S., p. 235.
——— Tuberculous, Oleaginous Aliments in. CAREY (J.) Prov. M. and S.
Journ., Feb. 21, 1849, p. 97. - - -
PNEUMo-THoRAx, case of RoHERTson (Wm.) Edin. Monthly Journ., March
1850, vol. i., 3rd S., p. 296. - - . . .
— Utility and necessity of performing Paracentesis Thoracis in certain
cases of RoH (Hamilton). Lond. Journ, of Med., July 1849, vol. i.,
p. 678. -
PLEURISY, Latent and Circumscribed, with Effusion. DURRANT (C. M.)
Prov. M. and S. Journ., Sept. 5, 1849, p. 480.
———— Case of, with Effusion into the Left Side of the Chest, and Dis-
placement of the Heart. ALDIs (C. J. B.) Med. Times, July 14, 1849,
vol. xx, p. 27. -
PLEURAL EFFUSION, cases of, with some difficulties of Diagnosis. HUGHES
(H. M.) Edin. Monthly Journ, Jan. and March 1850, vol. i., 3rd S.,
pp. 22 and 201.
EMPYEMA, Case of, in which nineteen and a half pints of Fluid were removed.
TUCKER (John). Prov. M. and S. Journ., March 21, 1850, p. 153.
PLEURA, Tuberculous Perforation of, Clinical Lecture on. WALSHE (W. H.)
Lancet, June 2, 1849, p. 575.
*
DISEASEs of THE ORGANs of DIGESTION.
Tongue, case of Idiopathic Inflammation of; with Remarks. SELKIRK (A. C.)
Edin. Month. Journ., Feb. 1849, vol. iii, N. S., p. 520.
MoUTH and FAUces, Erysipelatous Inflammation of, treated by Chlorate of
Potash. Scruggs (R. L.). Phil. Med. Ex., April 1849, vol. v., N.S., p.227.
PHARYNx and Tonsils, Diphtheritic Inflammation of RAMSAY (H.A.) Ibid.,
June 1849, vol. v., N. S., p. 335. -
—Abscess behind. FLEMING (Christopher). Dub. Quart. J., Feb. 1850,
vol. ix, N. S., p. 223. -* •
OEsophagus, case of Stricture of, fatal two years and three months after acci-
dentally swallowing soap-lees. BASHAM (W. R.) Lond. Journ. of Med.,
May 1850, vol. ii, p. 501. • * : - - - - - - --
.*
- 45 ° . . . .
678. # * CLASSIFIED. CATALOGUE.
OEsophagus, case of Foreign Body in, proving fatal by producing an Ulcerated
Passage into the Trachea. PATERSON (Robert). Edin. Med. and Surg. J.,
Jan. 1849, vol. lxxi, p. 125.
- Foreign Body in, simulating Disease of the Brain. RouTH (C. H. F.)
Iond. Journ. of Med., June 1850, vol. ii, p. 582. -
and TRACHEA, or Air-passages, Summary of cases of Unnatural Com-
munication between. W1GLA. Abs. of Récherches sur les Communications
Accidentelles de l’OEsophage avec les Poumons et les Bronches, in Arch.
Gén. de Méd., Oct. 1846. Edin. Med, and Surg. J, Jan. 1849, vol. lxxi,
p. 130.
Abdominal ViscERA, Contribution to the Pathology of BLAck (J.) Med.
Gaz., June 22, 1849, vol. xliii, p. 1080.
EPIGAst Ric REGION, on certain Morbid Conditions of WALFORD (T. L.)
Prov. M. and S. Journ., Feb. 7, 1849, p. 67. r
GASTRIT is, case of LANGLEY (J.) Lancet, Sep. 22, 1849, p. 309.
SToMACH, perforating Tuberculous Ulcer of See Tuberculosis.
INDIGESTION, Insensibility as an Attendant of HINTON (J.) Med. Gaz.
Oct. 26, 1849, vol. xliv, p. 706. -
Stom Achand Nervous Disorder,as connected with the Oxalic Diathesis. BEGBIE
(James). Edin. Month. Journ., August 1849, vol. iii, N. S. p. 943. Abs.
in Lond. Journ. of Med., 1849, vol. i., p. 792.
GASTRIC AFFECTION, case of, produced by a Dislocated Rib. STARK (James).
Edin. Med. and Surg. J., April 1850, vol. lxxiii, p. 388.
ABDominAL DISEASE, Remarkable case of HESLop (T. P.) A communica-
tion existed between the rectum, bladder, and left ovary; there was likewise
found, on dissection, a calculus in the bladder, and enlargement of the
liver. Dub. Quart. J., Feb. 1850, vol. ix, N. S., p. 220. :
RUPTURED INTESTINE, case of; with Observations on the Cause of Pain in
Perforation of Serous membranes. Collis (Maurice Henry). Dub. Quart.
J., August 1849, vol. viii, N. S., p. 245. -
CECUM, Case of Ulceration of WARD (Ogier). Lond. Journ. of Med., Oct.
1849, vol. i., p. 982.
— Ulceration of; Haemorrhage; Death. RAMSAY (H. A.) Phil. Med.
Ex, Feb. 1850, vol. vi., N.S., p. 100.
FLATULENT Distension of Abdomen, Chloroform in. JAckson (Dr.) Amer.
Journ. of Med. Sc., April 1849, vol. xvii, N. S., p. 549. From Trans. of
Philad. Coll. Phys., vol. ii, No. 6.
HAEMoRRHAGE, Intestinal, in Newly-born Infants. RILLIET (Dr.) Lond.
Journ. of Med., March 1849, vol. i., p. 261. From Gaz, Méd. de Paris.
—— Gastro-Intestinal, fatal Case of Coope R (White). Ibid., Jan. 1850,
vol. ii, p. 19. - - -
INTus-suscEPTION, Cure of, by Distension of the Intestines. THoMson (John).
Lancet, June 9, 1849, p. 608. .
DIARRHOEA, on the Efficacy of Rectified Spirit of Turpentine in Treatment of.
TRAYER (J. J.) Med. Gaz., Nov. 23, 1849, vol. xliv, p. 882.
Dºg Epidemic. JAckson (Samuel). Phil. Med. Ex, Dec. 1849, vol.
v, N. S., p. 701.
mºs ºsmº ºmsºmº Biš. Epidemic of, in 1846, 47, 48. MAYNE (R.) Dub. Quart. J.,
May 1849, vol. vii, N.S., p. 294.
(Choleroid 2) Epidemic of, in Penzance, in 1848. Couch (R. Q.)
Med. Times, Feb. 24, 1849, vol. xix, p. 337.
—— Epidemic in America in 1848, Report on. Amer. Trans., 1849, vol.
ii, p. 150. *
ºt of, as it prevailed in Cambridge, Mass., U.S., in 1847 and
1848. WyMAN (M.) Ibid., 1849, vol. ii, p. 197. - *.
— and Miasmatic Fever. UPSHUR (G. L.) Phil. Med. Ex., Oct. 1849,
vol. v., N.S., p. 575. - - - ; .
——— Observations on. Fish ER (Dr.) Amer. Journ. of Med. Sc., Jan. 1849.
vol. xvii, N. S., p. 27.
º
BRITISH AND AMERICAN JOURNALS. 679
Dysentery, peculiar Post-mortem appearances in. JAckson (Dr.) Ibid., Jan.
1849, vol. xvii, N.S., p. 27.
cases of, treated by Enemata of warm water. IRVING (James).
Edin. Med. and Surg. J., Jan. 1849, vol. lxxi, p. 99.
——— Treatment of Tropical, by Enemata of Tepid water. HARE (E.) Ibid.,
July 1849, vol. lxxii, p. 26. - -
Muco-ENTERIT is, case of, with Abscess at Umbilicus. KNox (A.) Lond.
Journ. of Med., May 1850, vol. ii, p. 473. -
ConstipATION, Prevention of WARREN (John C.) Amer. Journ. of Med. Sc.,
April 1850, vol. xix, N. S., p. 291. -
OBSTRUCTIon of Bowels, Foecal. TRAVERs (R. B.) Dub. Quart. J., Feb.
1849, vol. vii, N. S., p. 252. -
——— Remarkable case of PUREFoy (T.) Ibid., Nov. 1849, vol. viii, N. S.
. 449. -
Recº, Obstructions of, from Diseased Potatoes. PoPHAM (John). Lancet,
Jan. 19, 1850, p. 80.
INTESTINAL Concretions, case of SHARP (Mr.) Edin. Month. Journ.,
Jan. 1850, vol. i., 3rd S., p. 79. - s -
— of Extraordinary size, in a Young Female. Ritch iE (Dr.) Edin. Month.
Journ., July 1849, vol. iii, N. S., p. 931. Abs. in Lond. Journ. of Med,
August, 1849, vol. i., p. 787. - •
CALCULUs, Intestinal, case of HARRISS (Alexander). Dub. Quart. J., Feb.
1849, vol. vii, N. S., p. 248. - º
AbdoMINAL TUMour, Clinical Lecture on Case of WALSHE (W. H.) Lan-
cet, June 23, 1849, p. 659. - - w
WoRMs in the Human Subject; Observations on. CRUMMEY (L. F.) Med.
Times, July 7, 1849, vol. xx, p. 6. . -
PERITon ITIs, Acute, case of, without Diagnostic Symptoms. PUTNAM (R.G.)
Amer. Journ. of Med. Sc., April 1850, vol. xix, N. S., p. 546. From Bos-
ton Med. and Surg, J., Jan., 1850. -
. Granular or Tubercular, case of MºSHERRY (R.) Ibid., April 1850,
vol. xix, N. S., p. 399. -
—— Case of Tubercular, followed by perforation of the Abdominal Parietes.
Crooke (E. G.) Lancet, Dec. 22, 1849, p. 61. - -
PERiton EUM, Scirrhous Disease of GAIRDNER (W. T.) Edin. Month. Journ.,
Sept. 1849, vol. iii, N. S. p. 1083. Abs. in Lond. Journ. of Med. 1849,
... 794. -
Asoº case of, in which the patient was tapped, in ten years, 186 times, and
had 751# gallons of water drawn off. GRIFFIN (John H.) Amer. Journ.
of Med. Sc., April 1850, vol. xix, N. S., p. 401. -
LIver, ENLARGED, in Children. BATTERsby (Francis). Dub. Quart. J.,
May 1849, vol. vii, N. S., p. 308. • '
——— and Right Kidney, Hydatid Tumour of HESLOP (T. P.) Edin.
Month. Journ., Feb. 1850, vol. i., 3rd S., p. 123. . .
—— Hydatid Disease of, Clinical Lecture on. Rees (G. Owen). Med.
Gaz. June 29, 1849, vol. xliii, p. 1101. - -
cases simulating Disease of KNox (Alexander). Lond. Journ. of
Med., June 1850, vol. ii, p. 522. . . . . .
HEPATITIs, acute, in India. MAGAULAY (R.) Med. Gaz., Feb. 16, 1849,
vol. xliii, p. 275. -
Subacute, with Abscess, Clinical Lecture on case of WALSHE (W. H.)
Lancet, May 19, 1849, p. 523. - -
JAUNDice, Nitrate of Silver in. PEEBLEs (J. F.) Amer. Journ. of Med. Sc.,
July 1849, vol. xviii, N. S., p. 59. -
GALL-BLADDER, Rupture of M*Dowel (Dr.) Dub. Quart. J., May 1850,
vol. ix, N. S., p. 468. - . . . . . . . . . .
PANCREAs and Stomach, Cancer of; Jaundice; Rupture of the Gall-bladder.
M“Dowell (Dr.) Ibid., May 1850, vol. ix, N. S., p. 468.
*
680 CLASSIFIED CATALOGUE.
SPLEEN and Thymus Gland, Enlargement of, connected with Extreme Anaemia.
GAIRDNER (W. T.) Edin. Month. Journ., Sept. 1849, vol. iii, N. S.,
, 1086. -
p Enlarged, in Children. BATTERSBY (Francis). Dub. Quart. J., May
1849, vol. vii, N. S., p. 308.
——— Enlargement of, connected with the presence of an Unusual Number
# of White Corpuscles in the Blood. PARKEs (E. A.) Med. Times, June
15, 1850, vol. xxi, p. 431. -
, Rupture of Autopsy. WHITNEY (M.G.) Phil. Med. Ex., Jan. 1850,
vol. vi, N. S., p. 20. -
—— case of Abscess of, Opening through the Left Lung above the Clavicle.
NewNHAM (W.) Prov. M. and S. Journ., July 25, 1849, p. 401.
——— case of Supposed Abscess of, emptying itself through the Abdominal
Parietes and Bronchial Tubes. PINcott (R.) Med. Times, March 23,
1850, vol. xxi, p. 211.
DISEASES OF THE KIDNEYS.
KIDNEY, Transposition of left. THoMPson (Henry). Dub. Quart. J., May
1850, vol. ix, N. S., p. 484. --
case of Encephaloid Disease of left. ToPHAM (J.) Lancet, Feb. 9,
1850, p. 175.
case of Disease of, with Obstructed Emulgent Artery and Albuminous
Urine. WoodFALL (Dr.) Lond. Journ. of Med., Oct. 1849, vol. i., p. 968.
Granular Degeneration of, and its relation to Scrofula. CorMACK
(John Rose). Ibid., August 1849, vol. i., p. 699.
Calculi in. Cases. LEEs (Cathcart). Dub. Quart. J., Nov. 1849,
vol. viii, N. S.,p. 355.
HAEMATURIA, Clinical Lecture on. Todd (R. B.) Med. Gaz., Jan. 19, 1849,
vol. xliii, p. 96.
and its Diagnosis. VENABLEs (R.) Med. Times, July 21, 1849,
vol. xx, p. 51.
ALBUMINURIA, General view of the Causes of, Clinical Lecture on. WALSHE
(W. H.) Iancet, April 21 and 28, 1849, pp. 415 and 441.
— Clinical Lecture on, delivered in the Leeds Public Dispensary. HEATON
(J. D.) Prov. M. and S. Journ., April 4 and 18, 1849, pp. 169 and 203.
and Dropsy, Proximate cause of; Pathology of the Renal Wessels
in Bright's Disease. Johnson (George). Lond. Journ. of Med., May
1850, vol. ii, p. 502.
—— with Pneumonia and Hepatic Congestion, case of RouTH (C. H. F.)
Med. Gaz. Sept. 21, 1849, vol. xliv, p. 481.
with Irregular Menstruation, and Enlargement of Spleen, case of,
Routh (C. H. F.) Ibid., Oct. 5, 1849, p. 563.
Acute, followed by Rheumatism, Endocarditis, and Pericarditis. RouTH
(C. H. F.) Ibid., Oct. 19, p. 649.
——— with Ascites, Anasarca, incipient Cirrhosis of Liver, and other affec-
tions. RouTH (C. H. F.) Ibid., Dec. 14 and 28, 1849, vol. xliv, pp.
1001 and 1089.
and Oxaluria, case of Marasmus from. HERAPATH (W. B.) Med.
Times, Feb. 10, 1849, vol. xix, p. 305.
— and Oxaluria (Desquamative Nephritis) : with General Anasarca, As-
cites, Hydrothorax, and Phlegmonous Erysepelas. HERAPATH (W. B.)
Ibid., May 12, 1849, vol. xix, p. 549.
——— Treatment of by Gallic Acid. SAMPson (G.) Lancet, Dec. 4, 1849,
. 577. . . *
Reft ToxEMIA, case of RouTH (C. H. F.) Lond. Journ. of Med., Nov.
1849, vol. i., p. 1069. . . .
SUPRA-RENAL CAPsule, Malignant Tumour of. CRAIG (W.), and GAIRDNER
(W. T.) Edin. Month. Journ., April 1850, vol. i., 3rd S., p. 382.
BRITISH AND AMERICAN JOURNALS. 681
DISEASES OF THE NERVOUS SYSTEM.
NERvous SystEM, the Diastaltic. HALL (Marshall). Lancet, May and June
1850, pp. 469, 495,521, 554,615. The Croonian Lectures, delivered at
the College of Physicians in 1850.
—— Diseases of, Clinical Illustrations of; and other Diseases Simulating
them. SEMPLE (R.H.), Lond. Journ, of Med., May 1850, vol. ii, p. 448.
CEREBRAL Diseases of Children. DeNDY (Walter C.) This work appeared
simultaneously as a separate work, and as a Monograph appended to the
Psychological Journal for 1848. 4.
ARACHNoid, Haemorrhagic Membrane within. GAIRDNER (W. T.) Edin.
Month. Journ., April 1850, vol. i., 3rd S., p. 383.
HYDRocBPHALUs, case of, with Hypertrophy of Cranial Wall; Necroscopic
Examination. Mason (E.) Phil. Med. Ex., May 1849, vol. v., N.S., p.286.
BRAIN, Softening of, with Chronic Meningitis, Clinical Lecture on. Walsh E
(W. H.) Lancet, Jan. 13 and 20, 1849, pp. 27 and 58.
——— Acute Softening of, Clinical Lecture on. WALSHE (W. H.) Ibid.,
May 5 and 12, 1849, pp. 469 and 495. -
Softening, of case of WILMoT (Samuel G.) Dub. Quart. J., Aug.
1849, vol. viii, N. S. p. 242. - -
—— Softening of, Remarks on case of Wells (E.) Med. Gaz., Jan. 19,
1849, vol. xliii, p. 107.
case of Tubercular Softening of REEs (G. O.) Ibid., Jan. 26, 1849,
vol. xliii, p. 157. - . . -
—— Post-mortem examination of a case of Atrophy of BARLow (W. F.)
Lancet, Jan. 27, 1849, p. 92. - -
—5. gº; of CARLINE (Henry). Dub. Quart. J., Aug. 1849, vol. viii,
. S., p. 247. -
Hyº"ittennial, Observations on. GREGoRy (G.) Med. Times,
March 3, 1849, vol. xix, p. 353.
BRAIN, Fatty Degeneration of Blood-vessels of, in relation to Apoplexy.
PAGET (James). Med. Gaz., Feb. 8, 1850, vol. xlv., p. 229.
— case of Disease of Vessels of CoRMACK (John Rose). Lond. Journ.
of Med., June 1850, vol. ii, p. 599.
ApoPLExy associated with Calcareous Deposits in the Communicating Artery
of the circle of Willis. CARLINE (Henry). Dub. Quart. J., Nov. 1849,
vol. viii, N. S., p. 453.
Observations on a Case of, in which Death apparently commenced
at the Heart. Boult (E.) Prov. M. and S. Journ., March 6, 1850,
. I 18. -
—t Cerebral, in Childhood, Histories of two cases of; with Observations on
the Causes of the Disease, and the Relative Frequency of its Occurrence
at different Periods of Life. QUAIN (R.) Lond. Journ. of Med., Jan.
1849, vol. i., p. 27. -
—— in Cerebellum, case of. DuNN (R.) Med.-Chir. Trans., 1849, vol.
xxxii, p. 107. Abs. in Lond. Journ. of Med., May 1849, vol. i., p. 498.
——— Cerebral Affections simulating. HUGHEs (H. M.) Med. Gaz., April
20, 1849, vol. xliii, p. 671. -
PARALysis of EARLY LIFE, some of the Forms of. KENNEDY (Henry). Dub.
Quart. J., Feb. 1850, vol. ix, N. S., p. 85. !---
case of General. Hollingsworth (S. L.) Phil. Med. Ex., April
1849, vol. v., N. S., p. 229. -
-— of Insane, or Partio-General. EARLE (Pliny). Amer. Journ. of Med.
Sc., Jan. 1849, vol. xvii, N. S., p. 73. r -
— Paroxysmal. HALL (Marshall). Lond. Journ. of Med., April 1849,
vol. i., p. 371. - -
- Algo, or Spasmo. HALL (M.) Ibid., July 1849, vol. i., p. 612.
—— Muscular, Diagnosis of different kinds of. Hall (Marshall). Lancet,
Aug. 25, 1849, p. 200. -
682. CLASSIFIED CATALOGUE.
PARALysis and Anaesthesia of Right Side of Face, case of. Rogers (W. R.)
Med. Gaz., April 27, 1849, vol. xliii, p. 717. Abs. in Lond. Journ. of
Med., Oct. 1849, vol. i., p. 984. - t -
——— of the Motores Oculorum, caused by a Tumour within the Crus Cerebri.
BRowNE (S.) Dub. Quart. J., May 1849, vol. vii, N. S., p. 496.
HEMIPLEGIA, case of, associated with great Hypertrophy of the Heart, termi-
nating by Rupture of the Aorta, producing Dissecting Aneurism. BEN-
NETT (J. Risdon). Med. Chir. Trans., 1849, vol. xxxii, p. 157. Abs. in
Lond. Journ. of Med., August 1849, vol. i, p 781.
PARAPLEGIA and Hemiplegia, Lectures (Gulstonian) on. GULL (W. W.)
Med. Times, 1849, vol. xix, pp. 371, 391, 407, 468, 505, and 563.
——— Seat of HALL (M.) Lond. Journ. of Med., July 1849, vol. i., p.612.
after Gonorrhoea and Syphilis, Clinical Lecture on. WALSHE (W. H.)
Lancet, Mar. 10, 1849, p. 249.
—— Cervical, in an Infant. DAVIES (Henry). Ibid., May 1849, vol. i., p.500.
DELIRIUM and Coma, Pathology and Treatment of (Lumleian Lectures for
1850.) ToDD (R. B.) Med. Gaz. 1850, vol. xlv., pp. 703, 745, 789, 833,
877, and 921.
DELIRIUM TREMENs, Pathology and Treatment of the Types of BIRD (Jas.)
Lond. Journ. of Med., May 1850, vol. ii, p. 419.
Neck, the, as a Medical Region. HALL (Marshall). Ib., April 1849, vol. i., p.371.
Seizu REs, various Forms of HALL (M). Ibid., July 1849, vol. i., p. 611.
Hidden. HALL (Marshall). Ibid., July 1849, vol. i., 610.
Hidden, case of HALL (Marshall). Lancet, Dec. 22, 1849, p. 663.
EPILEPsy following Injury of Cranium, Clinical Lecture on. SolIY (S.)
Ibid., Jan. 5, 1850, p. 8.
-— from Pressure on the Brain. MEIGs (J. A.) Phil. Med. Ex, Nov.
1849, vol. v., N.S., p. 648.
- Treatment of, by the Expressed Juice of the Cotyledon Umbilicus.
SALTER (T.) Med. Gaz., March 2, 1849, vol. xliii, p. 315; and BULLAR
(Joseph). Ibid., May 18, p. 858; also Prov. M. and S. Journ., May 30,
1849, p. 289.
Convulsive Diseases, Pathology and Treatment of. Todd (R. B.) Med.
Gaz., 1849, vol. xliii, pp. 661, 724, 766, 815, 837.
EclampsIA NUTANs, or Salaam Convulsions, Cases of WILLsh IRE (W. H.)
Lond. Journ. of Med., June 1850, vol. ii, p. 590.
CE REBRALIRRITATION, case of SQUIBB (E. R.) Amer. Journ. of Med. Sc.,
Oct. 1849, vol. xviii, N.S., p. 383.
HYDRoPHoBIA, Observations on, with Cases; in one of which Chloroform was
successfully administered. JAckson (Samuel). Ibid., April 1849, vol. xvii,
N. S., p. 294. -
case of, in which Chloroform was used unsuccessfully. CURTIs (Dr.)
Ibid., April 1849, vol. xvii, N. S., p. 336; also, DENToN (S. B.) Prov.
M. and S. Journ., Oct. 31, 1849, p. 596.
Report of a case of, and Post-mortem examination. FIFE (George).
Laucet, Mar. 31, 1849, p. 335. -
- Two Cases of, with Remarks. DAwson (C.) Med. Gaz., June 1,
1849, vol. xliii, p. 928. - -
——— case of Lucas (Dr.) Discussion at Edinburgh Medico-Chirurgical
Society. Edin. Month. Journ., July 1849, vol. iii, N.S., p. 936. Abs. in
Lond. Journ. of Med., 1849, vol. i., p. 790.
case of CoALE (Dr.) Amer. Journ. of Med. Sc., Jam. 1849, vol. xvii,
N. S., p. 30.
——— case of BEMIs (C.O.) Ibid., April 1850, vol. xix, N.S., p. 372.
TETANUs, Idiopathic, case of, successfully treated. PEAcock (T. B.) Lond.
Journ. of Med., Jan. 1850, vol. ii, p. 16. - -
—-— Idiopathic, case of, treated by Galvanism. HAILEY (H.) Med. Gaz.,
Feb. 22, 1850, vol. xlv., p. 324.
— — Traumatic, case of, DYER (S.) Prov. M. and S. Journ., Oct. 17, 1849,
p. 568. . . - - -
+-
BRITISH AND AMERICAN JOURNALS. 683
TETANUs, Traumatic, case of, cured by Inhalation of Ether. SMITH (G. H.)
Lancet, Dec. 22, 1849, p. 667.
Traumatic, successfully treated. THoRNToN (S. C.) Amer. Journ. of
Med. Sc., Jan. 1849, vol. xvii, N. S., p. 255. From New Jersey Med.
Rep., Oct. 1848. • *
— Traumatic, treated with Chloroform; Recovery. ClaRKE (E. H.)
Ibid., July 1849, vol. xviii, N. S., p. 75. -
——Traumatic, Chloroform in : Recovery. Sloman (S. G.) Prov. M. and
S. Journ., Sept. 5, 1849, p. 482. - - - --
TRIs Mus, partial, from the Prick of a Needle under the Thumb Nail. Hil-
DRETH (S. P.) Amer. Journ of Med. Sc., Oct. 1849, vol. xviii, N. S.,
p. 552. From Ohio Med. and Surg. Journ., Jan. 1849.
— Nascentium, case of, illustrative of the Influence of Position. CLEMENT
(F. W.) Ibid., April 1849, vol. xvii, N. S., p. 533; also CHAMBERLAINE
(Samuel). Ibid., Oct. 1849, vol. xviii, N. S., p. 547.
HYSTERIA, remarkable case of, in the service of M. Guéneau de Mussy, at
Paris. WEIR (J. H.) Phil. Med. Ex., June 1849, vol. v., N. S., p. 331.
——— case of Cataleptiform, apparently induced by Mesmerism: with Re-
marks. DAVIEs (W.) Prov. M. and S. Journ., June 12, 1850, p. 314.
SPINAL AFFECTION (Hysteria P), Anomalous case of BIRD (Golding). Lond.
Journ. of Med., Jan. 1849, vol. i., p. 55.
CHOREA, case of, cured by Salivation. REEs (G. O.) Med. Gaz., Jan. 26,
1849, vol. xliii, p. 154.
-—— after Ascarides, Clinical Lecture on. WALSHE (W. H.) Lancet, Jan.
27, 1849, p. 83.
PAIN along the Spine. Hall Qº Lond. Journ. of Med., July 1849, vol.i, p.614.
SPINAL IRRITATION, Nature and Treatment of PATon, (George). Edin. Med.
and Surg. J., April 1850, vol. lxxiii, p. 313.
SPINAL CHORD, Case of partial Ramollissement of MADDEN (W. H.) Lond.
Journ. of Med., Jan. 1850, vol. ii, p. 10.
, General Softening of. MADDEN (W. H.) Ibid., June 1850,
vol. ii, p. 516.
—, Case of Disease of; the symptoms supervening on a severe
cold. MARson (J. F.) Ibid., June 1850, vol. ii, p. 602.
NEURALGIA of three years continuance, from Disordered Action of the Diges-
tive Organs. STARK (James). Edin. Med. and Surg. J., April 1850,
vol. lxxiii, p. 390.
, Periodical, Chloroform in. BRAINARD (Daniel). Amer. Journ.
of Med. Sc., Jan. 1850, vol. xix. N. S. p. 272. -
HEMicra NIA, Theory on the Production of AuziAs DE TURENNE (Dr.) Lancet,
Aug. 18, 1849, p. 177. -
Tic-DoulouREUx of fifteen years standing, dependent on Disordered Func-
tion of the Digestive Organs. STARK (James.) Edin. Med. and Surg.
J., April 1850, vol. lxxiii, p. 390. -
DigiTI Semi-mortui, Note on. HALL (M.) Lond. Journ. of Med., April 1849,
vol. i., p. 327. -
RETINA, #iºn of, from Irritation of Dental Branch of Fifth Pair of
Nerves. HAYs (Isaac). Amer. Journ. of Med. Sc., Jan. 1850, vol. xix,
N. S. p. 271. -
EAR, Statistical Researches on Diseases of KRAMER (W.) Edin. Med. and
Surg. J., April 1849, p. 283. (Abs. from Beiträge zur Ohrenheilkunde,
Berlin, 1845; and Archives Générales, 1847.)
, Pathological Researches into Diseases of ToyNBEE (Jos.) Med.-Chir.
Trans. 1849, vol. xxxii, p. 69. Abs. in Lond. Journ. of Med., April 1849,
vol. i., p. 395. • -ºº:
DEAFNESs attendant on Old Age; Pathology and Treatment of; illustrated by
Dissections and Cases. Toy NBee (Joseph). Edin. Month. Journ., Feb.
and March, 1849, vol. iii, N. S., pp. 521 and 567. Abs. in Lond. Journ.
of Med., March and April 1849, vol. i, pp. 276 and 368. - • *
smºs = *=
684. CLASSIFIED OATALOGUE.
MEDICAL STATISTICS.
STATISTICAL MEDICINE, Elements of: with a Tabular view of the Births and
Deaths in the Metropolis for the first half-year of 1849; the several Dis-
eases, Births, and Deaths, of Males and Females, Ages, Districts, Tempe-
rature, and Meteorology. Also the Deaths in eight years, from 1840 to
1847. GREGoRy (G.) Med. Times, August 4, 1849, vol. xx, p. 88.
LoNDoN, Health of, during the winter of 1848-49. Webster (John). Lond.
Journ. of Med., Nov. 1849, vol. i., p. 1063.
during the six months terminating 29th Sept. 1849. WEBSTER (John).
Ibid., Nov. 1849, vol. i., p. 992.
during six months terminating March 30th, 1850. WEBSTER (John).
Ibid., June 1850, vol. ii, p. 540.
TAUNTon, Climate and Sanitary Conditions of PEEBLEs (J. H.) Edin. Med.
and Surg. J., Jan. 1849, vol. lxxi, p. 47.
EDINBURGH and LEITH, Mortality of, for 1848. STARK (James). Ibid., April
1849, vol. lxxi, p. 380.
GLAsgow Royal INFIRMARY, Statistics of, 1848. STEELE (John C.) Ibid., Oct.
1849, vol. lxxii, p. 241.
EMIGRANTs to CANADA, Notes on Sickness and Mortality among. STRATTo N
(Thomas). Ibid., Jan. 1849, vol. lxxi, p. 92.
EMIGRANT SHIPs to North America, Medical Remarks on. STRATToN (Thos.)
Ibid., Jan. 1850, vol. lxxiii, p. 33.
REMARKs on some of the Diseases which prevailed in the 2nd Regt. Mississippi
Rifles, for the first six months of its service. Love (T. N.) Amer. Journ.
of Med. Sc., Jan. 1849, vol. xvii, N. S., p. 251. From New Orleans Med.
and Surg. Journ., July 1848.
North-AMERICAN INDIANs, Contributions to an Account of the Diseases of.
STRATTon (Thomas). Edin. Med. and Surg. J., April 1849, vol. lxxi,
p.269.
THERAPEUTIC ACTION OF MEDICINES.
AdoNITUM NAPELLUs, Therapeutic Action of TEssie R (M.) Lond. Journ. of
Med., June 1849, vol. i., p. 583. From Gaz. Méd. de Lyon.
BEBEERINE and QUININE, Comparative Therapeutic Powers of STRATToN
(Thomas). Edin. Med. and Surg. J., Oct. 1849, vol. lxxii, p. 315.
CHLoRoform, its Uses in Various Diseases. Lond. Journ, of Med., April 1849.
vol. i., p. 361.
ELDER, J * of Fresh, Root of, in Dropsy. WANoye (Réné). Ibid., April
1849, vol. i., p. 380.
ELECTRICITY, An Account of some Experiments on the Remedial Action of.
Jon Es (H. B.) Ibid., Feb. 1849, vol. i., p. 125.
Electro-GALVANISM for the cure of Neuralgic Affections after Accidents.
Tuson (E. W.) Med. Times, 1849, vol. xix, pp. 335 and 377.
GlycERINE in Diseases of the Ear. WAKLEY (T. H.) Lancet, June 16,
1849, p. 631. w
— — — ——— Brown (J.) Ibid., July 28, 1849, p. 93.
LUPULIN as an Anaphrodisiac. PAGE (Dr.) Amer. Journ. of Med. Sc., July
- 1849, vol. xviii, N. S., p. 293.
TANNIC ACID, Use and Administration of in various Diseases. ALISON (Scott),
Lond. Journ. of Med., Jan. 1850, vol. ii, p. 1.
THERMic TREATMENT, its Value in Various Diseases, especially in certain
forms of Neuralgia, Paralysis, and Rheumatism. DAY (G. E.) Med.
Times, August 11, 1849, vol. xx, p. 110.
TRANSFusion of Blood, Statistical and General Remarks on. Routh (C.H.F.)
Ibid., August 11, 1849, vol. xx, p. 114.
TURPENTINE, Therapeutic Uses of SMITH (Thomas). Lond. Journ. of Med.
April 1850, vol. ii, p. 321. --
Zinc, Chloride of, as a Counter-irritant. SMITH (Thomas). Ibid., Sept. 1849.
vol. i., p. 826.
685 . . . . . . ^.
CRITICAL DIGEST OF THE BRITISH AND FOREIGN MEDICAL,
Journals.
ANATOMY AND PHYSIOLOGY.
*-ºs
DISCOVERY OF CASEIN IN THE BLOOD.
The following is a translation of a highly interesting paper by DR. PANUM,
published in the Bibliothek for Laeger for January 1850.
DR. PANUM's MEMOIR. On the 14th of last October, on pouring some blood-
serum into a glass of water, I found with surprise that the mixture became
whitish and opaque, like diluted milk and water. The same phenomenon
occurred, when I used distilled water ; hence it could not depend on the
presence of saline matters. The opacity began to appear, when there were
about four parts of water to one of serum; and it gradually increased till ten
parts of water had been added. After this, the liquid remained of nearly the
same colour, notwithstanding the gradual addition of ten other parts of water.
On allowing the opaque liquid to stand for twenty-four hours, a pretty copious
white sediment was precipitated, which could be collected on good filtering
paper, while the fluid portion passed through quite clear. A very small
quantity of acetic acid dissolved the precipitate, as did also the caustic alka-
lies and their carbonates: it was insoluble in water, cold alcohol, and ether.
Ferrocyanide of potassium threw down a precipitate from the solution in
acetic acid; this precipitate, when collected in a filter and washed with dis-
tilled water, soon became a transparent, yellowish, very tough, and glutinous
mass; and, by further drying, it became hard, brittle, and glistening on the
external surface, as well as on that of a broken portion. On being triturated,
it produced a white powder: when burnt on a platina plate, it was dissipated,
with a strong smell of burnt horn, leaving only a small quantity of incom-
bustible salts. Under the microscope, the sediment appeared as an amorphous
granular mass, like albumen coagulated by alcohol. The clear liquid which
remained, had an alkaline reaction, and contained a quantity of albumen,
which was precipitated by boiling. It was, therefore, evident, that the sedi-
ment thrown down on adding water to the serum—being insoluble in water,
ether, and cold alcohol, and being precipitated from its solution in acetic
acid by ferrocyanide of potassium—possessed the characters of a coagulated
protein-compound. º -
The patient, whose serum manifested the above-mentioned phenomena, was
suffering from epiglottitis, and shortly after had the operation of tracheotomy
performed. His urine contained, for a short period, a pretty considerable
quantity of albumen; the effect, probably, of a large blister, which was ap-
plied to his neck. . As I had previously, in several patients labouring under
Bright's disease, found the serum of very low specific gravity, and opaque
from the presence of the so-called “molecular fibrin of Simon and Scherer”,
I suspected that opacity of the serum and water, and the molecular fibrin,
might have one and the same origin. It was indeed probable, that this opacity
in the serum, from molecular fibrin, arose from an unusual attenuation. It
was also probable, that this material, which sometimes appeared distinctly in
the blood, and at others was manifested on the addition of water, might bear
a certain relation to the phenomena of Bright's disease. The alteration in
the renal secretion might produce a simple deposition of this material in the
urinary passages, and hence give rise to the degeneration of the kidneys
peculiar to the disease.


686 CRITICAL DIGEST OF THE JOURNALs.
A great number of observations soon convinced me, that the grey colour,
produced by the mixture of serum with water, far from being a peculiarity
attendant on Bright's disease, was observed in the numerous cases in which
impoverishment of the blood was conspicuous; and that in no case could se-
'rum, when mia!ed with about ten parts of water, be observed, either immediately,
or after being earposed to the air for some hours, not to be rendered opaque, #
the separation of a protein-compound, which in all respects behaved as in the
case above-mentioned. •
In some instances, when the opacity did not immediately appear on mix-
ing serum with distilled water, it became perceptible when the mixture had
stood for some time, (from a few hours to a day), exposed to the free access
of air ; and in all instances, where the opacity appeared at once, it increased
under the influence of the atmosphere, and more especially when I breathed
air from the lungs into the liquid. In order to determine which of the con-
stituents of the atmosphere, oxygen or carbonic acid, produced the precipitate
in so remarkable a manner, I constructed an apparatus, by which I could
subject the serum to the action of a current of air deprived of its carbonic
acid by means of lime water; and, by means of another apparatus, I subjected
it to the action of carbonic acid, procured from chalk and hydrochloric acid,
and washed with water. The serum, which was subjected to the action of
air deprived of its carbonic acid, underwent no change, and gave only a slight
greyish tint on being mixed with ten parts of water, in the same manner as
normal serum, hermetically closed immediately after a venesection. On the
other hand, the serum through which I had transmitted a stream of carbonic
acid, became, on being mixed with water in the same proportions, perfectly
opaque, almost like milk, and quickly deposited, on standing, a very copious
sediment, which was acted on by re-agents in the same manner as has been
already mentioned. On carefully adding acetic acid to the diluted serum, a
cloudy sediment was formed, which disappeared entirely when the liquid was
shaken, and was not reproduced on adding more acid. I then made use of
acetic acid diluted with 100 parts of water. On adding this in drops, a white
precipitate was formed, which rendered the diluted serum perfectly opaque,
and almost as white as milk. This precipitate increased, until a certain num-
ber of drops of the diluted acid had been used. On my desisting from the
addition of acetic acid, the precipitate collected in flocks, and sank to the
bottom of the vessel, in the form of a thick white sediment. When I con-
tinued to add acetic acid beyond the point at which the opacity reached its
maximum, it diminished, and entirely disappeared on adding more acid. It
was then evident, that a material was contained in the serum, which was pre-
cipitated by acetic acid, but was easily redissolved in a very small excess.
I have found this precipitate to be produced by dilute acetic acid in every
case which I have examined, whether the simple addition of water produced
a sediment or not. Independently of various diseases of more or less impor-
tance—pneumonia, pleurisy, bronchitis, chronic heart-disease, morbus Brigh-
tii, delirium tremens, phthisis, gastric fever, lumbago, pleurodynia, hyperamia
of the brain, etc.—I have found a copious deposit formed in the blood-serum
of comparatively healthy persons of all ages, who were plethoric, and accus-
tomed to be bled; not one negative result occurred in upwards of forty ex-
periments. The white sediment furnished by an ounce of serum, formed a
layer two lines in thickness, at the bottom of a cylindrical glass two-and-a-
half inches in diameter. Every doubt as to the physiological, as well as the
pathological, constancy and importance of the precipitated material, was re-
moved by its being found in the blood-serum of calves, oxen, sheep, and
swine. This gave, after dilution with water, a very copious precipitate with
highly diluted acetic acid, as well as a perceptible opacity on simple dilution
with water. . . . . .
The precipitate, formed by the addition of dilute acetic acid to diluted se-
rum, could be very easily collected on a filter, while the fluid portion passed

CRITICAL DIGEST OF THE JOURNALS. 687.
through perfectly clear. The latter had a neutral reaction, when acetic acid
was carefully added ; and on being boiled it threw down albumen, in greater
quantity than before the addition of acetic acid, and the removal of the ma-
terial collected on the filter. This first became, on being dried, diaphanous
and glutinous, then diminished in volume, and became glittering, hard, and
brittle, so that it could be easily reduced to a white powder. Sometimes,
instead of being transparent when dried, it assumed a fallow or a green colour.
This difference of colour seemed to depend rather on accidental circumstances
than on any essential difference; for I found in some cases, that one portion
of the same serum became yellow or brown on drying, while another assumed
a green colour. Future observations may further elucidate this point.
With the exception of this occasional variation of colour, the protein com-
pound, precipitated by the addition of water, was acted on by re-agents in
the same manner as that produced by acetic acid. Both were easily soluble
in an excess of acetic, or of other strong acids, and were precipitated from
this solution by ferrocyanide of potassium, but not by ammonia, potash, or
soda. Both were easily soluble by the caustic alkalies and their carbonates,
as well as by solutions of phosphate of soda, sulphate of magnesia, Sal
ammoniac, common salt, chlorides of calcium and barium, and other salts.
When the solution in phosphate of soda was diluted with water, acetic acid,
in either case, again produced a precipitate, soluble in an excess of the acid.
Both precipitates were insoluble in ether, cold alcohol, and water. This
uniformity of behaviour with re-agents, seems to establish the identity of
the precipitate produced by water, with that afterwards obtained by adding
very dilute acetic acid. Pure undiluted serum gave, at first, no precipitate
when treated with acetic acid ; but I have since found it to be produced, and
to be soluble in an excess of the acid. - - -
When the white of an egg is poured into a glass of water, a quantity of
matter is separated in the form of filaments and membranes, sometimes in
the form of molecules, so as to render the liquid opaque : it might hence be
imagined, that this substance is identical with that which is furnished from
serum. A. careful investigation has convinced me that the two are very
different. The filaments and membranes, which appear on pouring the albu-
men of an egg into water, bear a perfect resemblance, under the microscope,
to fibrillated fibrin. They swell out and become transparent on being digested’
with acetic acid, but are dissolved with great difficulty, even in the concen-
trated acid, in these respects resembling fibrin. That portion which is
dissolved by acetic acid, is precipitated by ferrocyanide of potassium. No
precipitate is formed, or at least slowly and imperfectly, by phosphate of
soda and other medicinal salts. The molecular precipitate appears only when
the eggs have been kept for some time, and increases with their age, while
the quantity of filamentous and membranous matter decreases. It does not.
disappear on the addition of acetic acid or its salts, and only after a long.
time when treated with alkalies. -- • , ,
The question now arises, whether we can deduce any more accurate con-
clusions as to the chemical nature of this substance, beyond what we have
already shewn, that it is a protein-compound, insoluble in water 3 Fibrin
has hitherto been the only constituent of the blood, which could be asserted
with certainty, to possess the power of passing from a soluble to an insoluble
state, whether in or out of the body. It has hence necessarily arisen, that an
unlimited amount of physiological and pathological importance has been
ascribed to fibrin. The albumen of serum can be brought, when out of the
organism, to pass from the soluble to the insoluble state by various methods,'
such as heat, alcohol, and most acids, provided they act in a sufficiently con-.
centrated form. But the circumstances, under which albumen is coagulated
out of the body, can scarcely operate within it. The substance which has
been described, is precipitated by simple dilution with water, and by acetic
acid so highly diluted, that it may easily be imagined capable of being formed


688 CRITICAL DIGEST of THE Journals,
in the body itself. The manner in which fibrin coagulates in the form of
filaments, the circumstances under which it passes from the soluble to the
insoluble condition, and finally, the different manner in which it is affected
by re-agents, separate it so essentially from the substance which is being
treated of, that the latter will have, in future researches, to be described as
entirely distinct. I think it necessary to insist on this, on account of the
confusion which has arisen from the description of many different things
under the term fibrin : and this has become so important, that most have
mistaken the primitive signification of the word fibrin, which, on physiological
and pathological grounds, there is good reason for retaining, while there is
no cause for rejecting it on purely chemical grounds.
This protein-compound is essentially distinguished from the albumen of
serum, by being precipitated by water and acetic acid, which cannot coagu-
late albumen. It can scarcely be the product of a transformation of albumen:
for after the substance precipitated by water and acetic acid has been removed,
the liquid still contains a large quantity of albumen: indeed, this appears.
more plentiful on boiling, than before the addition of acetic acid and the
removal of the precipitated material. Besides, after this substance has been
separated by filtration, water and acetic acid may be added in any proportions,
without producing more sediment; but if the material were derived from
the action of water and acetic acid on the albumen of the serum, there would
be no reason why the transmutation should cease, after a certain quantity of
albumen had been changed into this insoluble substance.
There can then be no doubt, that our protein-compound is distinct from
albumen and fibrin, and easists in the serum in a state of solution with the salts'
and alkalies, but is separated when the saline matter is diluted, and the alkali
wnited with acetic acid. This can only be asserted of deutoxide of protein,
albuminate of soda, or casein.
With regard to the deutoxide of protein, almost the only circumstance
with respect to its chemical reaction which seems to have been noticed, is its
insolubility in water. It would therefore seem premature to assert of an
unknown protein-compound, that it is not deutoxide of protein. But the
difficulty will be removed, when we remember that oxygen produced no effect.
on the solution of serum in water, while carbonic acid caused a copious pre-
cipitate. Albuminate of soda is precipitated, as Scherer and Lehmann have
shewn, by acetic acid, but is soluble with difficulty in an excess of acid.
This establishes at once a marked distinction between it and our protein-com-
pound. It hence appears, that it can be nothing else than CASEIN, on the
chemical properties of which, new light has been thrown by the researches
of Scherer (Annalen der Chemie und Pharmacie, Bd. xl), and more lately by
those of Rothleder (Ibid., Bd. xl, p. 253), carried on in Liebig’s laboratory.
Their investigations have shewn, that casein is always insoluble in water; and
that the so-called soluble casein is a combination of casein with potash, soda,
or lime, and that hence the coagulation of the soluble casein by acids, is:
merely the effect of the union of the acid with the potash, soda, or lime,
which was in combination with the casein. Direct experiments on casein,
procured from milk by treating it with ether and alcohol, have further con-
vinced me that it is perfectly and easily soluble by phosphate of soda. The
chlorine salts, on the other hand, dissolved it with difficulty and imperfectly:
this was naturally enough explained by the fact, that the casein which was
employed had been treated with ether and alcohol, and perfectly dried,—
circumstances sufficient to render all protein-compounds much more difficult
of solution, than when they are first precipitated.
We may thus, at least provisionally, regard the substance as casein, as its
behaviour with acetic acid hitherto seems characteristic of that protein-com-
pound. The diagnosis has depended only on this, in those instances in
which casein has been occasionally detected in the blood. Gmelin was the .
first, who thus found a small amount of casein in the blood, in some rare

CRITICAL DIGEST OF THE JOURNALS. 689
cases. Marchand next found it in some instances, both males and females.
Finally, Hünefeldt seems to have discovered it in cases in which the secretion
of milk was arrested ; but he does not state whether the precipitate formed
by adding acetic acid was soluble in an excess, so that no certain conclusion
can be drawn from his observations.
... The reason why the constant presence of casein in the blood has hitherto
escaped the notice of observers, appears from the circumstances already
mentioned. Only when the amount of casein in the serum is very great, or
the quantity of salts, especially phosphate of soda, is very small, can the
casein be precipitated from undiluted serum by acetic acid. But when the
proportion of saline matters to the casein is not so small, they retain the
casein in the solution, even when it is separated by acetic acid from its com-
bination with soda. It is only when the solvent power of the salts is weak-
ened by dilution with water, that acetic acid can precipitate casein in any
quantity; and even then the phenomenon escapes notice, unless very dilute
acid be employed, otherwise the precipitated casein is re-dissolved in the
excess of acid. When there is more casein in the serum than is combined
with an alkali, so that some is held in solution by the salts in the serum, a
portion is at once precipitated on the simple addition of water, and appears
first as an opacity, and soon as a sediment. When it is not free, but united
with an alkali, simple dilution with water produces no precipitate, until
dilute acetic acid is added, which, uniting with the soda, precipitates the
casein as a substance insoluble in water.
The great importance which a material with these properties may possess,
and very probably actually has, with regard to the healthy or diseased.
organism, render necessary a far more careful and extended series of re-
searches on its chemical relations. Thus it will be of the first importance
to discover a convenient method for performing its quantitative analysis,
which has hitherto only been accomplished by an extreme dilution of the
serum and by the very careful addition of a highly diluted acid.” It will
also be important to determine whether carbonic acid alone can separate
casein from its combination with soda. But the interest of the subject
appears to me so great, that I have been led to publish my observations,
imperfect as they are. It is, however, a point of the greatest interest with
regard to physiology and pathology, that this material, which occurs in the
blood constantly and in notable quantity, can be acted on by re-agents,
which are constantly in operation within the organism ; and that, after
his been precipitated by them, it can be re-dissolved by many different.
Salts.
A number of important questions here arise: but I can only refer to a
few of them. M. - -
The relation which this substance may bear to the processes of nutrition
and cell-development, in health and disease, can scarcely yet be accurately
determined. There are, however, some points which tend to show that this
relation must be very important. The following are some of them : (1.) The
method in which cell-development is generally performed, commencing, as is.
well known, by the formation of molecules in the clear mother-liquor:
(2.) The facility with which the casein is precipitated from the clear serum.
in the form of molecules, by re-agents which are constantly in action within
the organism—a peculiarity which is possessed by no other of the known con-
stituents of the blood: (3.) The agreement in chemical properties between
casein and the cell-membranes of the blood-corpuscles, and of the globules of
milk and pus; which agreement is so great, that several chemists have de-
scribed these cell-membranes as a modification of casein. Finally, (4.) The
1 By this process I analysed the blood of a puerperal woman, who had a quantity
of milk in herbreasts, but did not suckle her child. Two days after delivery, 1000.
parts of serum gave 9.9 parts of dry Casein, and 53-7 of dry albumen. .
690 CRITICAL DIGEST OF THE JOURNALS.
remarkable faculty which casein posesses of inducing transmutation in
organic substances may lead to a well-grounded suspicion, that it acts in
the same way within the limits of the organism.
In the next place, it will be very interesting to point out the relative
quantity of casein in the blood during lactation ; and it will likewise be very
important to point out the proportion which it bears to the other consti-
tuents of the blood, and to the ingesta.
In a pathological point of view, it will be highly important to observe
what relation the amorphous molecular mass, which is found in notable quan-
tity in nearly all pathological exudations and deposits, bears to this sub-
stance, which may be very well imagined to play a principal part in a great
number of organic diseases. Perhaps also, the solvent and antiphlogistic
action of saline medicines in many of these diseases will find an easy explan-
ation, in their faculty of dissolving the deposits of this morbid material.
In the meantime, it is not to hypotheses, but to new researches, that we are
to look for a solution of the many important questions connected with this
subject. -
The presence of a material, precipitated from serum by water and acetic
acid under various circumstances, seems to have been recognized by Liebig,
Zimmermann, Henle, and Vogel ; but none of them appear to haye an idea
of its real nature. - -
ANOMATIES IN THE MUSCLES OF THE ARM.
The following case is recorded by DR. LENTE, Resident Surgeon to the New
York Hospital :— -
P. C., a native of Ireland, admitted into the New York Hospital with diar-
rhoea, presented the following curious anatomical anomalies. In both upper
extremities, the brachial and radial arteries are superficial, being only covered
by the integument, and looking much like distended superficial veins. The
bifurcation of the brachial into the radial and ulnar, is at the usual situation.
The ulnar dips under the superficial flexors and pronators of the fore-arm, as
usual; while the radial, following its ordinary direction, is superficial, being,
like the brachial, only covered by the common integument. In the left upper
extremity, there appears to be a total absence of the biceps flexor cubiti
muscle ; there being only the brachialis anticus, which occupies its usual
situation, between the integument and bone, and is not unusually developed.
Flexion of the fore-arm upon the arm is performed mainly by the Supinator
longus and extensor carpi radialis muscles. When the man attempts to flex
the fore-arm, with a heavy weight in the hand, the former muscle appears
like a tense cord stretched from the commencement of its origin in the arm,
to the middle of the fore-arm, there being no angle at the elbow in front.
The tendon of the left brachialis anticus appears to be inserted lower down.
on the ulna than usual, and, of course, to assist more in flexion of the fore-
arm. In the right arm the biceps exists of the usual size. In both extre-
mities, when the fore-arm is extended upon the arm, they form a continuous
line with each other; there being no external lateral angle at the elbow-
joint, as there should be in a well-conformed extremity. No arterial or mus-
cular anomalies are discoverable in the lower extremities.
Anomalies in the muscular system are comparatively uncommon, and, when
met with, are usually “confined to their symmetrical absence.” The above
case presents an exception to this rule. A case is related, as one of great
rarity, by Mr. Lucas, lecturer on anatomy in London, in which one palmaris
longus was absent, and one present ; one pyramidalis (which is not very un-
common), and one psoas parvus. [Wew York Journal of Medicine, May 1850.]
* Simon refers the globulin, forming the envelopes of the blood corpuscles, to
Casein, and plainly calls it “Blood-casein.” It is, however, essentially different
from that which we are describing as existing in the serum : and it would there-
fore be preferable to restrict to it the term globulin.
CRITICAL DIGEST OF THE JOURNALS. 69 L
PRACTICE OF MEDICINE AND PATHOLOGY.
IDIOPATHIC ENLARGEMENT OF THE SPLEEN ; UNUSUAL NUMBER OF WHITE
COBPUSCLES IN THE BLOOD.
The Medical Times for June 15, 1850, contains a CLINICAL LECTURE by Dr.
PARKES, on a case which presented an interesting pathological state of the
Blood ; viz., the occurrence of an unusual number of White Corpuscles, in
connexion with Enlargement of the Spleen. We reprint Dr. Parkes' lecture
with very slight abridgment; agreeing with him, that “it is by the obsery-
ation of such cases as these, in which the ordinary operations of the body
seem to be reversed or suspended, that pathology tends to throw such light
on the healthy processes, the nature of which is often best detected by the
study of the deviations from them.”
CASE: J. S., aged 69, admitted December 13, 1849; an Irishwoman, but
has lived in London sixteen years. A fruitseller in the streets; much ex-
posed to cold and wet ; had never drunk spirits nor smoked ; had always
lived well; had taken meat every day, except on Fridays, and a little beer.
Appeared never to have had any serious illness; never had ague, or anything
which seems to imply any kind of malarious disease. Towards the end of
1848 was in St. Bartholomew's Hospital for swelled feet and legs, but was
discharged well in a fortnight, Shortly after her discharge, she began to feel
severe pain low down in the left side, and one day, on examining the side,
she found a considerable swelling below the false ribs on that side. She
had no shivering, sickness, or fever. She then, January 1849, entered Uni-
versity College Hospital, under Dr. Williams. At this time she was thin,
weak, with a yellow skin, but clear conjunctivae ; and with a large and
tender swelling, extending from the margin of the left false ribs to the
crest of the ilium. For this she was treated with blisters, iodide of potas-
sium, and morphia to relieve the pain, which appears to have been severe.
The urine at this time was non-albuminous; at first alkaline and with phos-
phates, afterwards acid, and with deposits of uric acid and lithates. She
had, on several occasions, morning sickness, and vomited a little blood. She
left the hospital at the end of February, feeling stronger and easier, but
with the tumour undiminished in size. She continued at her occupation
till November, when she was knocked down by a cart, the wheel of which,
according to her account, passed over the pelvis. She suffered severe pain
in the abdomen from this accident, and was unable to leave her bed for four
weeks. When she was able to walk, she became an out-patient of Dr.
Jenner's, who, on discovering the nature of her complaint, sent her into the
hospital. On admission, on the 13th December, 1849, she was thin and
shrivelled, without oadema or enlargement of veins; there was a peculiar
dusky, yellowish-brown colour of the skin, most evident on the trunk, and
less marked on the face and extremities; the conjunctivae were clear; there
were no head symptoms ; and no pulmonary symptoms, with the exception.
of a little dry friction low down on the left side ; there was a feebly acting
heart, in its right position, and without bruit; the pulse was 72, regular.
A large tumour, evidently an enlarged spleen, filled the left side of the
abdomen, descending from the lower border of the seventh rib, nearly to the
ilium, bulging into the posterior left lumbar region when she lay on her
back, and reaching nearly to the umbilicus on the right ; falling over con-
siderably to the right of the umbilicus when she lay on the right side ; with
a prominent, ridged, smooth lower border; very hard throughout, and
tender; the extreme length of the dull percussion note was 8 inches ; no
splenic murmur was ever audible. The height of the hepatic dulness (ver-
tical line from nipple) was 43 inches; the lower edge was 13 inch below the
WOT.. II. 46 -
692. CRITICAL DIGEST OF THE JOURNALS.
false ribs; to the left of the middle line, the hepatic dulness confounded
itself with the splenic, that is to say, with the dulness of the tumour. There
was no fluid in the peritonaeum, no nausea; the appetite was good, the
tongue clean ; there were no intestinal or uterine symptoms. She had had
no haemorrhage, except a little haematesis, apparently, when she was in the
hospital previously. During the patient's stay in hospital, she remained
nearly in the same condition. Occasionally she suffered from severe frontal
headaches ; she also had, on several occasions, sharp stabbing pains in the
abdomen, over the spleen and liver, for which leeches were applied, the
bleeding from which was profuse and not very easily arrested. On four or
five occasions, also, she had moderate shivering, followed by heat and sweat-
ing; these attacks were not very regular, seemed to observe no certain times,
and were separated from each other by long intervals. On the 27th Feb-
ruary, according to her own account, she passed a pint of blood with a stool ;
but this, and another stool passed subsequently, were thrown away acci-
dentally ; the next stools were free from blood. With this exception, she
had no bleeding from any part of the body, and none into the substance of
the skin. On the 17th of March, the patient left the hospital, nearly in the
same state as on admission.
ExAMINATION OF THE BLOOD, The blood was examined microscopically
many times, a drop of blood being taken from the end of the finger for this
purpose ; the appearances noted were always the same. When the drop was
put under the microscope, the red particles, as in health, ran together in the
usual time and formed rouleaux, and presented no appreciable deviation
from the healthy standard. But interspersed among the meshes formed by
the rouleaux, were an immense number of pale corpuscles. On many occa-
sions, when examined with a power of 350 diameters, there were at least
from 240 to 300 of these corpuscles in the field at once : at least 60 were
counted in a quarter of the field on one occasion, and 60 in a sixth of the
field on another ; and these were not all. At other times they were rather
fewer in number, perhaps from 100 to 120 in the field. They were very
variable in dimensions, ranging from a size three or four times as large
as, to a size hardly larger than, a red particle. The majority, however,
were large. They differed considerably in transparency, some being very
opaque, comparatively dark-coloured, and slightly granular on the surface;
others were more transparent and smoother. As a general rule, the larger
ones were darker and more granular-looking ; the smaller more transparent.
They were round or slightly oval ; some few were indented on the side.
Nuclei could not be seen in the larger darker cells without re-agents; but
in some, there appeared to be an aggregation or collection of the granular
contents at one particular point, which was generally at the side. In the
transparent cells, nuclei were very indistinctly seen. Acetic acid dissolved
the opaque contents, made the cell-wall transparent, and in every case
brought out nuclei. The nuclei, which were small for the most part, were
very well defined, with dark borders, slightly oval, were seated generally ec-
centrically, but sometimes towards the centre, and varied in number from one,
or more usually two, to four or five. Often there was a single nucleus of a
horse-shoe or reniform shape, deeply indented, as if it were about to cleave
into four or five smaller nuclei; in other cases, there was a crescent-shaped
nucleus, with no apparent indentations or divisions. In many cases, if a.
reniform or crescent-shaped nucleus, with the deep indentations, had sepa-
rated into smaller parts, each separate part would have accurately corre-
sponded in size and appearance with the smaller separate nuclei, which were
seen in other cells. In some cases, the small oval nuclei were crowded
together eccentrically, so as to make the cell look very much like some pus
cells. In addition to these cells, Dr. Jenner noticed some cells with large
central nucleolated nuclei, which did not bear nearly so much resemblance
CRITICAL DIGEST OF THE JOURNALS. 693
to ordinary white corpuscles, as the more numerous cells which I have just
described to you. I also noticed, on one occasion, some very small, not very
well defined white corpuscles, smaller than red particles.
These white corpuscles could be obtained in various ways; they were seen
quite readily by placing at once a drop of blood under the microscope; also
by heating the blood and separating the fibrine: the heavy red particles
subsided to the bottom of the vessel, while above them, and below a layer of
perfectly clear serum, floated a thick white layer, composed entirely of white
corpuscles. Finally, by allowing the blood to coagulate in a small evapo-
rating basin, the surface of the clot became quite white in the course of a
few minutes; and on examination, this was found to depend on the entangle-
ment of a vast number of pale corpuscles in a most delicate web of fibrine.
When the blood was drawn into a long narrow vessel, or allowed to coagulate
in a flat-bleeding basin, it did not, however, exhibit this phenomenon, or
show any disposition to buff or cup. These corpuscles were carefully
compared with the pale corpuscles, seen in healthy blood ; and with the
exception of their much greater numbers and larger size, I could discern no
difference.
The other of the physical characters of the blood were as follows: When
drawn from a vein, the blood coagulated as rapidly as usual; it formed a clot
which was firm, but rather voluminous ; in some forms of vessels, the pale
corpuscles appeared at the surface of the clot a few minutes after coagula-
tion. In other cases they did not. The serum was separated in good quan-
tity, had a light greenish tint, and was perfectly transparent.
The venous blood was analysed on two occasions. First, on the 20th Dec., the
blood being taken three hours after food. The fibrine having been separated
by beating, was washed, boiled in alcohol, and then dried and weighed ; the
red particles were estimated by subtracting the weight of the fibrine and the
solids of the serum in 1000 of blood from the weight of the whole solids in 1000
of blood; the coagulable matters of serum (albumen) were obtained by coagu-
lating the serum, washing with boiling alcohol and water, drying and weighing;
the salts of the serum, by evaporating the washings, and burning off the organic
matter; and the incoagulable organic matters of serum were estimated, by
deducting the weight of the albumen and salts from the weight of the whole
solids of the serum. I shall point out to you directly, that this method,
which, like all other methods, is defective, was especially so in the present
analysis.
º composition of the blood in 1000 parts was then as follows:—
Fibrine (with probably adherent white corpuscles) ... ... 7-08
Red particles, with a number of white corpuscles which
could not be separated ... ... ... ... ... ... ... 101-63
Coagulable organic matters of serum ... ... ... ... ... 63-03

Incoagulable ... ... ... ... ... ... ... ... ... ... 3:08
Soluble salts of the serum ... ... ... ... ... ... .. 8-63
Insoluble salts of the serum tº e º e e g º ºs e º º ſº & e º 'º º º *48
Water ... ... ... ... ... ... ... ... ... ... ... 81607
*-*mºseºm-
1000-00
The composition of the serum was as follows. The reaction was strongly
alkaline :—
Coagulable organic matters ... ... ... ... ... ... ... 70-71
Incoagulable ... ... ... ... ... ... ... ... ... ... 3:46
Soluble salts ... ... ... ... ... ... ... ... ... ... 9.68
Insoluble (obtained by incinerating the dried albumen) ... •55
Water ... ... ... ... ... ... ... ... ... ... ... 915-6
1000-0
A small portion of serum was examined for uric acid in the ingenious
46 2 -
694 CRITICAL DIGEST OF THE JOURNALS.
method devised by Dr. Garrod, viz., by the addition of a little acetic acid to
a portion of serum in a watch-glass, at the bottom of which lies a fine hair.
No crystals of uric acid could, however, be perceived. **,
On the 15th of February, the patient was bled again three hours after
food; the fibrine was estimated by washing the clot. The composition was
as follows:
Fibrine (with probably adherent white corpuscles) ... ... 4-75
Red particles (with undetermined white corpuscles) ... 97-73
Organic solids of serum ... ... ... ... ... ... ... 69.27
Inorganic solids of serum ... ... ... ... ... ... ... 8'25
Water ... ... ... ... ... ... ... ... ... ... ... 819.8
1000-00
In the first analysis, the solids are in rather higher proportion (18393 to
1802), the fibrine rather in excess (7-08 to 4-75), the red particles in some-
what greater abundance (101-63 to 97-73), the salts are nearly the same, or
in slight excess (9-11 to 8:25). But the agreement between the analyses is
very considerable. The special fallacies of the analyses were these ; although
I did not microscopically examine the fibrine, it yet seemed likely that its
apparent great abundance might have been in part owing to adherent white
particles; also many of these particles were evidently mixed up with the red
particles, as was proved by the thick white layer above the heavier red parti-
cles in the defibrinated blood, and I could devise no means of separating them.
I could, indeed, have drawn off the white particles with a pipette from the red
layer below, but then I could not free them from the serum, and therefore could
not in any way estimate them. The proportions, therefore, of fibrine and of
red particles, as given in the analyses, are unduly high, although it is diffi-
cult to say to what extent this is so. These inferences may, however, be
safely drawn; viz., 1, that the blood was poor in solids; 2, that it was not
deficient in fibrine; 3, that it was poor in red particles; 4, that it was very
rich in white particles; 5, that the albumen was at nearly the natural stand-
ard, and the incoagulable matter of serum rather small in amount ; 6, that
the serum was rather more plentifully supplied than usual with soluble salts.
ExAMINATION of THE URINE. The condition of the urine was carefully
noted every day, and the following was the usual state:—It was generally
copious; sixty, eighty, and even a hundred ounces being often measured in
the twenty-four hours; and, in addition, there was generally some passed in
the closet. It was generally acid, rarely neutral, of pale amber colour, with
deposits of pale lithates, and incidentally of phosphates, and now and then
of oxalate of lime; it contained albumen, in very variable quantity, a small
quantity of oil-globules on two occasions, and once gave an indication of bile.
I had only time to make one chemical examination of it. From the 25th
to the 26th of December, the urine of twenty-four hours was most carefully
collected; it measured 90 oz. It was nearly colourless, with a neutral re-
action, and a deposit of pale lithates perfectly soluble by heat. The specific
gravity (by bottle) was 10261 (temp. about 45°. Fahr). It gave no tint with
nitric acid, but threw down albumen by heat and nitric acid. The urea was
estimated as nitrate (48.93 per cent.) after the albumen was separated; the
; ingredients in the usual way. The composition in 1000 parts was as
Olio WS :-
Urea ... ... ... ... ... ... ... ... ... ... ... 1057
Uric acid ... ... ... ... ... ... ... ... ... ... •75
Albumen. s a s tº º º e e s © º º tº e g e 6 & gº tº º © tº o tº º º © tº Q 2.
Extractives ... ... ... ... ... ... ... ... ... ... 12:18
Soluble salts, of which about 4:56 was phosphate of soda ... 10-07
Phosphate of lime and magnesia ... ... ... ... ... ‘59
Water ... ... ... ... ... ... ... ... ... ... ... 963-84
ºsmºsºma -
1000-00
CRITICAL DIGEST OF THE JOURNALS. 695
We also endeavoured to determine the diurnal changes of the urine ; but
the examinations did not disclose any very striking points. It is interesting,
in connexion with the lowered amount of red blood particles, to observe, that
the urine was, throughout, deficient in colouring matter, as indicated by the
continual appearance of white lithates; it was also too copious; the albumen
varied in amount on different days and at different periods of the same day
very considerably ; it was never associated with casts of tubes or renal
epithelium, and did not appear to imply true Bright's disease. No remark-
able features were observed in the perspiration, stools, or saliva.
REMARKS. The condition of the spleen, in cases similar to the one under
consideration, has not been very accurately determined. After death, the
organ is found large, very hard, dark-coloured on the surface, with a mottled
section, which seems frequently to be caused by fibrinous exudation, thrown
out into the interstices of the organ. Sometimes, as noticed by Virchow,
there are large fibrinous masses.
There are various interesting points arising from the consideration of this
case, to which I must now shortly allude.
1. That the simultaneous occurrence of an extraordinary number of colour-
less cells in the blood, and of a great enlargement of the spleen (not conse-
quent on ague, and probably special in its nature), is something more than a
mere coincidence, appears certain, from the number of times that it has been
observed. Virchow has assembled the majority of cases hitherto recorded,
and has added some himself; altogether, he has collected eleven. We may
add to these, four other cases,” which are not included in this list, and,
with the present case, the number is raised to sixteen. Now, although the
white corpuscles of the blood are liable to very great variation in number,
and, although their changes are very imperfectly known, it yet would seem
but fair to infer, that when two rather uncommon phenomena, (viz., the
immense number of cells in the blood, and idiopathic enlargement of the
spleen), occur together in sixteen cases, and either phenomenon separately,
has been only once noted, that there is some intimate connexion between
them. Yet mere congestion and hypertrophy of the spleen will not cause
increase of white corpuscles, as is proved by a case recorded by Vogel (CanSt.
wnd. Eisenm. Jahresb. 1849, p. 11).”
2. It is probable, also, that of these two phenomena, the enlargement of
the spleen is the anterior, and stands more or less closely in the relation of
cause to the other condition. At least, there is one argument for this view.
Admitting that there is some causal relation, it might be supposed, & priori,
that the spleen, by its change, might give rise to the development of the
pale corpuscles, or that the pale corpuscles, formed in some unknown way,
might occasion the enlargement of the spleen. But an interesting observa-
tion, made by Virchow, seems conclusive against this last supposition ; for he
has noticed (Archiv, 1849, p. 567), that in a case in which there was an
extraordinary hypertrophy of the lymphatic glands, both internal and on the
extremities and neck, the white corpuscles were in such numbers as to make
* The references to the literature on this subject are Froriep's N. Notizen, 1845, p.
780; Med. Vereinzeitung, 1846, Nos. 34, 36 ; 1847, Nos. 3, 4 ; Canstatt whd Eisenm.
Jahresbericht, 1846, p. 23; Virchow's und Reinhardt's Archiv., 1848, p. 563; Ibid.,
1849, p. 587; Transactions of the London Pathological Society (cases by Dr. T. K.
Chambers), p. 109; Dr. Fuller's case (Med. Gaz. 1846, p. 404), is included in Vir-
chow's list. In the Monthly Journal of Medical Science (May 1850), Dr. Bennett
alludes to a case under his care. A case occurred in University College Hospital
in 1846, under Dr. Taylor, and was carefully recorded, but has not been published.
* Since this Lecture was delivered, Dr. Fuller exhibited to the Pathological
Society of London a specimen of encephaloid disease of the abdomen, taken from a
patient in whose blood there were numerous white corpuscles. The inference in
the text appears, however, still to hold good.
{j96 CRITICAL DIGEST OF THE JOURNALS.
the blood, found in the right auricle after death, look quite purulent in
appearance; they were in as high proportion to the red corpuscles as 2 to 3.
In this case, the spleen was not at all enlarged. Therefore it appears fair to
infer, that if, in this case, the white corpuscles, in such numbers, could not
cause any enlargement of the spleen, the cases, in which the spleen was
enlarged, were not dependent on the condition of the blood. It would seem,
therefore, that, admitting a connexion between the two phenomena, the en-
largement of the spleen in one set of cases, and of the lymphatic glands in
Nºw'. case, will be proved hereafter to be anterior to the change in the
OOCl.
3. As to the nature of these white corpuscles, the first question is, as to
their relation to the ordinary pale corpuscles. I have already stated, that,
as far as I could see, there were no differences, beyond those of numbers and
larger size, between these cells and the ordinary corpuscles of the blood.
Indeed, on examining some specimens of healthy blood, there appeared to be
greater differences as to size and transparency between any two cases, than
between either specimen and the corpuscles of the diseased blood. The
next question which suggests itself is, the degree of resemblance between
these cells and pus-cells. Virchow and Vogel have already expressed an
opinion, that the white corpuscles in healthy blood, and in this splenic dis-
ease, cannot be distinguished from pus mixed with the blood. And certainly,
if we take the characters which have been held to distinguish pus-cells from
white corpuscles, we find them to fail altogether when we apply them to the
case before us. For example, Lebert and Sédillotl have laid down the fol-
lowing distinctive marks between pus-cells and white corpuscles:” that the
pus-cells are larger, of a more yellow colour, perfectly spherical, have a
rougher and more granulated surface, and have much larger and better de-
fined nuclei. But, however true these distinctions may be between well-
marked pus-cells, and some of the white corpuscles of healthy blood, they
will not apply to many of the cells in our diseased blood; for we had cells
of extraordinary size, very granular on the surface, and darkish in colour,
though not yellow, with nuclei after the addition of strong acetic acid,
better defined and larger in appearance than the nuclei of the pus-cells. So, .
also, it could not be perceived, that these cells were flattened ; they appeared
as spherical in shape as pus-cells are. And as to drawing any distinction
between the grouping of the nuclei in these cells and in pus-cells, it
can hardly be ventured upon, in the face of the observations of H. Müller
and Henle, who have indicated the remarkable differences which can be
artificially produced in the nuclei of pus-cells and lymph corpuscles by the
addition of acetic acid of various degrees of strength.3 But although there
were some corpuscles in this blood which could not, I think, be distinguished
from pus-cells by physical characters, yet, if all the pale corpuscles could
have been separated from the red particles, and shown to any one, I do not
think that they would have been mistaken for pus. There seemed to be
perceptible differences in the very variable size, in the smoothness and com-
parative transparency of many of them, and in the white colour of the
Smaller ones, between them and pus. And of course, although the distinc-
tions cannot be well drawn, it would be as wrong to call these cells pus-cells,
as to give that title to the ordinary white corpuscles of the blood.
No transition from these pale corpuscles into red corpuscles could, as far
as I could see, be made out. The white corpuscles varied infinitely in size,
* De l'Infection Purulente ou Pyoémia. Par le Docteur C. Sédillot. Paris: 1849.
Page 267.
* Ibid., p. 404-5.
* I am aware that Reinhardt and others have disputed the supposed splitting of
the nucleus under re-agents, but the positive observations of Henle seem unan-
swerable.
CRITICAL DIGEST OF THE JOURNALS. 697
yet there was no difficulty in referring every white or red particle to its
proper class. We did not see, either, how these white particles retrograded,
whether by fat metamorphosis, or some kind of pigment transformation—
changes which have been observed by Virchow and others.
4. The exact nature of this disease is still obscure. The only conclusion
we are entitled to draw from the facts before us, is, that there is some inti-
mate connexion between these affections of the spleen and of the blood ; but,
when it is remembered how little known are the changes which the healthy
spleen produces upon healthy blood, how completely unexamined at present
are the changes which spleens, diseased in various ways, produce on the
blood, and how little examined the white corpuscles of the blood have been,
it must be confessed that we are not entitled to go farther than this. The
very fact, that every enlargement and congestion of the spleen is not at-
tended with excess of pale corpuscles in the blood, should make us hesitate
at present to do more than record the facts as a basis for some future inquiry.
Virchow has spoken of the disease as a kind of interruption, or arrest of the
development of the red blood cells; and our case so far supports this, as
proving that the red particles are notably diminished in amount. But this
opinion of Virchow is, of course, simply a conjecture.
5. In comparing the phenomena of this case with those of the cases already
reported, we find a considerable resemblance. A tendency to inflammations
and haemorrhages seems generally to exist, and our patient had frequently
pains over the spleen and liver, which appeared inflammatory; she had also
haemorrhages from the digestive mucous membrane (certainly from the sto-
mach, and, according to her own account, from the intestines), and the pro-
fuse bleeding from the leech-bites pointed also to an haemorrhagic tendency.
There did not appear to be any disorder or perturbation in the system from
this condition of blood. Digestion in the stomach was performed with-
out apparent difficulty ; and, although there was emaciation, it was not
greater than might be accounted for by the age of the patient. As far as
the urine was concerned, the proper quantity, or even an excess of uric acid,
urea, and indeterminate organic matters, appeared to pass out of the system.
Although there was a dusky yellowness of the skin, there was no true jaun-
dice. The pulmonary functions did not appear altered.
6. The causes of this peculiar disease are quite unknown. In almost all
the cases, the splenic enlargement has ensued without obvious cause. In
one of Virchow's cases, the patient had had ague fifteen years previously;
beyond this there appears no reason to suspect a malarious cause for the
enlargement. Our patient was certain she had never had ague, and she had
resided for sixteen years in London, where ague is very uncommon. While
in the hospital she had some irregular shivering fits, followed, as such fits
usually are, by heat and sweating ; but there was no attack of true ague.
7. The treatment adopted in this case was not much varied. I was desir-
ous of trying, in the first instance, the effect of the disulphate of quinine ;
at first, half a drachm, and subsequently, 45 grains were given every twenty-
four hours for forty-two successive days, without any apparent change in the
size of the tumour, or in the amount of colourless corpuscles. All this time,
also, iodine ointment was rubbed over the spleen. She took, also, six grains
of iodide of potassium with nine grains of disulphate of quinine, for twenty
days, without effect. Finally, seven days before she left the hospital, we
began to give iodide of potassium, with the intention of pushing the dose.
She took 3ss in the twenty-four hours during these few days, without effect,
and continued, also, the iodine externally. Occasionally, the spleen either
varied in size, or the intestines encroached upon it, and caused an apparent
difference; but, on subsequent examinations, the abdominal tumour used to
be found as large as ever, and the blood examined about four days before the
patient went out, contained as many pale corpuscles as usual. I intended to
have tried various other remedies, iron, mercury, etc., had the patient not
quitted the hospital.
698 CIRITICAL DIGEST OF THE JOURNALS.
8. After death, it would appear, that the separation between the red and
white corpuscles gives a whitish or yellowish-white colour to the blood in the
heart and large vessels. Hence Virchow has termed the disease “Leukaemia”,
white blood, a term which has also been used to designate that condition of
the blood in which, from various causes, the serum is milky. The propriety
of calling this splenic disease “Leukaemia”, may be questioned. The blood
in our case was not in the least white; the serum was perfectly transparent;
and, although occasionally the white particles would collect on the top of the
recent coagulum, and give a pseudo-buffed appearance to the clot, this did
not occur on all occasions, and usually the pale corpuscles were uniformly
intermixed with the red in the clot, and there was not the least trace of
whiteness about any portion of the blood. The phrase “white blood” having
been appropriated to milky-looking serum, it is, perhaps, desirable to leave
the disease, which we have now considered, for the present unnamed.
DIGITI SEMI-MORTUI : THEIR CONNEXION WITH CHLOROSIS, AND WITH
DISEASE OF THE BRAIN AND SPINAT, CEHOTRD.
M. GILLET DE GRANDMonT has addressed a letter to the editor of the Gazette
Médicale for May 25th, 1850, of which the following is a translation :-
The Digitus Semi-mortuus, mentioned by Dr. Marshall Hall, is never other-
wise than the symptom, or one of the symptoms, of another disease, which is
met with in young people, in adults, or in old persons.
CoNNEXION WITH CHLoRosis. It is most commonly one of the symptoms of
Chlorosis in young girls ; I have also observed it in pregnant women who
had an anaemic appearance. In young females, sometimes one finger, but
most generally several together, are affected. The temperature is decreased,
as is easily ascertained by the hand or by the thermometer. The fingers are
insensible to pretty strong pressure ; a prick with a pin gives no pain, and
does not draw blood, or gives a very slight rosy tint. The power of motion
remains, but it is embarrassed, and appears to the patient as if mechanical.
The appearance of the skin is that of wax; life seems to have deserted the
organ. This condition is of varying duration; it is principally observed at
rising from bed, and in the course of the morning; it more rarely appears
during the day. Dry or alcoholic stimulating frictions, immersion in slightly
tepid water, exercising the hand, as with a shuttlecock or skipping-rope,
cause it to disappear; but in proportion as the other symptoms of Chlorosis
disappear under the influence of proper treatment, this singular symptom
occurs less and less frequently, and at last disappears. Some of the chlorotic
patients, who are subject to this singular affection, have their teeth of a dirty
white colour, which indicates a predisposition to spasmodic convulsive affec-
tions. The patients who are affected with Digiti Semi-mortuº, complain more
particularly, among the other symptoms of Chlorosis, of pain in the head, of
involuntary stretching of the limbs, and sometimes of violent tremors of an
hysterical nature. For several years I have very often met with this affec-
tion in chlorotic patients. My attention was first directed to it by a young
lady of my family, who pointed out to me that “her fingers were dead”. She
used to strike them, rub them with a brush, or plunge them in very hot.
water; and it was only after a certain time that the affection disappeared,
after continuing for half an hour, or even for more than an hour. This symp-
tom is not constant ; it appears at more or less distant intervals, according
to the general state of the constitution ; but it almost always accompanies,
precedes, or follows, the nervous convulsive condition. Several young females
have predicted an aggravation of their malady, on observing the phenomenon
become more frequent or intense. As I have already said, the same treat-
ment which removes the cause of Chlorosis, causes this affection to disappear.

* LoNDoN Journal, OF MEDICINE, April 1849, vol. i., p. 327.
CRITICAL DIGEST OF THE JOURNALS. 699
But when, as is often the case, patients, who are nearly cured, neglect to
continue the use of iron, the dead fingers are among the premonitory symp-
toms of a return of the Chlorosis.
CoNNEx1ON witH DISEASE OF THE NERyous CENTREs. The Digitus Semi-
mortuºus, which is met with in adults and in old persons, differs in its cha-
racters from that which I have just described. In the latter case, the
symptom is preceded by very slight formication, and the cooling is more
gradual, but much more persistent; it is sometimes accompanied by a slight
flexion of the finger on the palm of the hand, or of the phalanges on each
other. In these cases, the finger does not seem so deprived of life as in the
other ; but the condition continues longer, and when sensibility returns, it
seems like the result of a slight internal electrisation, or succession of small
electric shocks, as is observed in neuralgic affections. At other times, the
finger trembles, and becomes slightly painful at the extremity. There is
seldom more than one finger affected at first,-principally the middle finger.
The finger often remains straight, and cannot be easily bent by an effort of
the will; it also seems affected with a sense of itching, or slight internal
retraction. This affection is the precursor of a malady which proceeds slowly
but continuously,–an affection of the cerebral and spinal nervous cen-
tres. Too much attention cannot be paid to these slight premonitory symp-
toms; patients often do not observe that terrible diseases are often ushered
in by them. I knew a man, once celebrated, who now drags out a painful
existence, from not listening to the advice of his physician to cease from
work. He considered his own malady as a slight nervous affection; and yet
the Digitus Semi-mortuus was the first symptom of a severe disease of the
cerebellum and medulla oblongata. -
HAY FEVER : ITS CAUSE, AND ITS GURE BY N UX WOMICA.
HAY FEVER or HAY ASTHMA is (in England) a well known complaint, by
which many—especially females, and those of irritable surface—are annually
distressed during the droughts of summer. Daily, or more frequent, paroxysms
of difficult respiration, severe prolonged sneezing, and a burning pain in the
nostrils, eyes, and face, are the usual symptoms. Dr. Craigie and others
doubt the common explanation of the cause of the affection, viz.: that it de-
pends upon irritation of the peripheral extremities of the imperfectly protected
nerves of the nostrils, etc., by the subtile pollen of the innumerable flowers,
especially the grasses, which bloom in May and June, and with which the
atmosphere must, in some localities, be greatly charged. In the vicinity of
hay fields and wild pasturage, if the weather be dry, those who are susceptible
are certain to suffer; whereas, a rainy season, or sojourn on the sea-coast, will
enable such persons to escape. Observation of many such facts has fully satis-
fied us, that there is no good ground for the incredulity expressed in the fol-
owing passage by Dr. Craigie. “A particular variety,” says he, “ of catarrh,
most prevalent in the summer months during the inflorescence of the hay
crop, in certain situations, has been believed to be connected with some irri-
tative vapour exhaled from the flowers of some of the grasses, and has there-
fore been distinguished by the name of Hay Fever. It is doubtful whether
this idea of the origin of the disorder be well founded ; and it seems quite as
likely that it is produced, as other varieties of catarrh, by imprudent exposure
during excessive heat. The liberties which are often taken during extreme
hot weather, are sufficient to induce catarrhal disorders, without having re-
course to the assumption of a peculiar emanation.” (Practice of Physic, vol.
i, p. 824: Edin. 1837). We will venture to say, that no one who had seen
such cases of Hay Fever as abound at this season, and as we have had to deal
with during the present and former seasons, and who has carefully investi-
gated into their personal and topographical peculiarities, could have written
the paragraph just quoted. The popular theory is correct, that Hay Fever

700 CRITICAL DIGEST OF THE JOURNALS.
bears no relation whatever to common catarrh from exposure to cold. We
feel assured that the cause and the cure in the two complaints are totally
different.
We have been led to make these remarks, from having just perused a short
note by Mr. G. T. Gream, in the Lancet of June 8th, 1850, p. 692, in which he
recommends Nux Womica as a cure for this troublesome complaint. He cor-
rectly remarks, that the efficacy of this method is not generally known.
The following is the essential part of Mr. Gream’s paper : “I am indebted to
my friend Mr. Hammerton, of St. George's IIospital, for suggesting to me the
NuxWomica as a remedy in this complaint, which has frequently caused me,
personally, much annoyance. It was administered by a friend of his to large
numbers of the country people in his neighbourhood, who flocked to him an-
nually for relief, having experienced so much benefit from it. Having taken
it for three years with decided effect, and having for nearly that time pre-
, scribed it for others, with equal success, I feel bound to publish it through
your columns, if you will do me the favour to insert this letter, the results of
its use in a harassing disorder, with which many persons are at this time
threatened. The preparation recommended, and which I have always pre-
scribed, is the tincture of nux vomica of the “Dublin Pharmacopoeia.” Ten
drops of this should be given for a dose, in water, and increased gradually to
twenty drops, three times a day: the action of it should at first be watched.
It is an agreeable light bitter; increases the appetite ; and influences the
Schneiderian membrane, no doubt through the medium of the nerves. I have
accompanied the administration of the tincture with the application of an
ointment (as high up in the nostrils as possible) composed of one drachm and
a half of Goulard's extract, two ounces of spermaceti cerate, and a few drops
of-oil of roses or of bergamot.”
OBSTETRICS.
SRODA. ON THE CAUSES OF PUERPERAL FEWER—EXPERIMENTS ON ANIMALS.
In a paper read before the Medical and Chirurgical Society of London, on
November 28th, 1848, and published in Volume xxxii. of the Transactions
of that Society, Dr. Routh brought before the notice of the British Medical
public, the discovery by Dr. Semmelweis, of Vienna, of the cause of the
great frequency of Puerperal Fever in the Lying-in Institution of that city:
viz., the introduction of poisonous animal matter into the uterus by the
hands of the accoucheurs ; and he also referred to the success which had
attended the preventive means recommended by Dr. Semmelweis, of washing
the hands with chlorinated water after making post-mortem examinations."
DR. SKoDA, of Vienna, has also examined the subject, and has laid before
the Academy of Sciences of that place the result of his investigations, which
have been published in the Zeitschrift der K. K. Gesellschaft der Aerzte zu
Wien, for February 1850. The first part of his communication refers to
the circumstances which led to the discovery made by Dr. Semmelweis :
and his remarks are confirmatory of what has already been laid before the
profession in this country by Dr. Routh.
The second division, of which we shall give a translation, refers to the
measures necessary for ascertaining the correctness of the results at which
Dr. Semmelweis has arrived. On this subject, Dr. Skoda writes as follows:
When the washing of the hands in chlorinated water had been for some
time in use, with apparently highly successful results, Dr. Semmelweis
communicated his idea to Professor Rokitansky, myself, and other phy-
sicians of the Hospital. We did not doubt for a moment that his view
For an abstract of Dr. Routh's paper, see the LoNDON Journal of MEDIGINE
for January 1849, p. 108. -
CRITICAL DIGEST OF THE JOURNALS. 701
would prove correct : and I lost no time in making the discovery known to
the Director of Medical Studies, in the expectation that a committee would
be appointed to inquire into such an important fact. But my representation
appears to have been merely made known. A more probable opportunity of
bringing the matter publicly into notice, was the great number of deaths in
the Lying-in Hospital at Prague, which were probably due to the same
cause as those at Wienna. I therefore recommended the use of chlorinated
water in Prague ; but as it seemed to be the general opinion in that place,
that Puerperal Fever was propagated by epidemic influences, the means
recommended by me seem to have had little or no trial.
Dr. Semmelweis applied to the obstetric professors in foreign countries, to
test the correctness of his observations: but the only precise answer received
was from Kiel. Dr. Michaëlis, the superintendent of the Lying-in Institu-
tion of that place, reported on the 18th March, 1848, that the hospital had
been closed from the 1st July to November, 1847, on account of the great
mortality which prevailed. At the latter period, it was again opened, and
the disease broke out as severely as before. In December, 1847, Dr.
Michaëlis heard of the discovery of Dr. Semmelweis, and forthwith insti-
tuted the use of chlorinated water. Subsequently to that period, there was
only one case of Puerperal Fever; and that one is attributed by Dr. Michaëlis
to the use of a catheter which had not been properly cleaned. On the other
hand, Professor Kiwisch, of Würzburg, stated that he had frequently
attended pregnant and puerperal women, immediately after making post-
ſmortem examinations, without observing any untoward results.
At my suggestion, a commission of the Professors of the College was ap-
pointed to examine into the following questions:
(a) From the construction of tables, in which were given the name of each
assistant or student attending on the cases, to determine whether the
number of cases of Puerperal Fever bore any relation to the employment of
the assistants and students in the dead-house. (5) To examine into the
so-called street-births (Gassengeburten). When a female enters the hospital
soon after being delivered, no further manual examination is made, except
for the purpose of removing the placenta, or of treating some disordered
condition of the generative organs. If the opinion of Dr. Semmelweis be
correct, these cases should present but few examples of disease. (c) To in-
quire of the Lying-in Institutions in Austria and elsewhere, whether the
mortality is less, where there can be no source of infection from the handling
of dead subjects. (d) To make experiments on animals. My suggestion
was adopted by a great majority of the Professors, and a committee was
appointed, but the Government forbade the proceeding of the committee.
Under these circumstances, I requested Dr. Semmelweis º . the
iments on animals. These were accordingly performed ºn, rabbits.
º: I. On March 22, 1849, a female rabbit, which had been de-
livered for a quarter of an hour, was operated on: A brush, dipped in some
ill-coloured exudation from a case of endometritis, was introduced into the
cavities of the vagina and uterus. The animal appeared well up to the 24th
* n it died.
Aºi. Appearances. The plicated mugous membrane of the cornua
uteri was covered with a dirty reddish-grey fluid exudation. The left pleural
cavity contained some fluid; the lower lobe of the lung on that side W.
covered with a pale yellowish, false membrane. Its parenchyma, as * a.S
that of the posterior and lower third of the uppº lobe, was in a state 2 *.
hepatization; the rest of this lung, as well as the right, contained *...
was of a vermillion-red colour. The heart was enveloped in.” finely-villous
layer of pale yellow exudation, and there Werº a few drops of i. matter. .
ExPERIMENT II. On the 12th April, a female rabbit was treate º a. #.
lar manner to the last, about twelve hours after having been dº . º:
young ones; and the application was repeated daily. On the 14th April,
702 CRITICAL DIGEST OF THE JOURNALS.
animal expressed pain on the introduction of the brush, the uterus contracted
with force, and some thick yellowish-white exudation was pressed out. On
April 17th the animal appeared decidedly ill; on the 22nd, diarrhoea set in ;
and the animal was found dead on the 24th. The brush had been introduced
once daily, up to the time of death.
Post-mortem. Appearances. The peritoneal cavity contained false mem-
branes, glueing together some of the intestinal convolutions. There was a
stiff yellow exudation on the mucous membrane, and in the tissue of the
vagina and uterus; the cornua of the uterus were moderately distended, and
filled with a dirty reddish-grey exudation. The colon contained some follicles
in a state of suppuration; its mucous membrane presented spots of the size
of a lentil, partly suppurated, partly infiltrated with yellow exudation: each
of the spots was surrounded with an injected vascular area. The lungs were
of a clear vermillion red; the upper lobe of the left lung contained a con-
densed spot, of the size of a bean, infiltrated with blood, and having a puru-
lent point in the centre. .
EXPERIMENT III. On the 15th April, a female rabbit, which had been de-
livered about ten hours, was treated in the same way; and the application
was repeated daily up to the 21st. On the 17th, the animal gave signs of
pain, and expressed some purulent exudation from the uterus. On the 26th,
diarrhoea occurred.
Post-mortem. Appearances. The abdominal cavity contained a moderate
quantity of fluid and membraniform exudation, glueing together some of the
intestinal convolutions. The mucous membrane of the vagina and uterus
Was covered and infiltrated with a yellow intimately adherent deposit ; the
cornua of the uterus were much distended, and filled with a reddish-grey
dirty matter. The liver presented some spots of the size of lentils, infiltrated
with a purulent exudation. Near the termination of the processus vermifor-
Żnis the mucous membrane of the colon presented a spot larger than a lentil,
surrounded by an injected area of vessels; it was ulcerated, and covered
with a pale yellowish exudation.
EXPERUMENT IV. On May 24th, a strong rabbit was operated on, an hour
after being delivered of five young ones. The brush was dipped in the blood
(mixed with water) of a man who had died of marasmus thirty-six hours
previously. . On the 25th, it was charged with some pleuritic exudation; and
on the 26th and 27th, with some exudation from the peritoneum of a tuber-
culous patient. The brush was not again introduced; the animal continued
apparently in perfect health, and again brought forth young on the 24th June.
EXPERIMENT V. On the 2nd of June, some of the peritoneal exudation
which had been used in Exp. IV, was applied to a rabbit about twelve hours
after delivery ; and the application was repeated on the 3rd, 4th, and 5th of
the month, after which it was discontinued. The animal appeared in good
health. On the 28th, it again brought forth young, and the brush was again
applied on the 29th and 30th, charged with pleuritic exudation. The animal
continued well, and was killed on the 17th July in performing another ex-
periment. No alterations referable to pyaemia were observed on necroscopic
examination. . -
EXPERIMENT VI. On the 10th of June, some purulent exudation from the
pleura of a man was introduced into the uterus of a rabbit, some hours after
delivery ; and from the 11th to the 30th, the brush was dipped in some peri-
toneal exudation from a man who had died of typhus. The animal continued
well, and again brought forth young on the i3th July. On the latter day,
the brush was again introduced, and the application was repeated daily up
§ the * The animal became lean, had diarrhoea, and was found dead on
the 30th. -
Post-mortem appearances. The pericardium contained a few drops of floc-
culent serum. There was a dirty whity uneven vegetation, of the size of a
pea, on the tricuspid valve, pressing against the conus arteriosus; and a
similar body was situated on the free margin of one of the divisions of
CRITICAL DIGEST OF THE JOURNALS. 703
the valve, intimately united with the endocardium covering its muscle.
The inner surface of the right ventricle was covered with a yellowish white
granular false membrane. The peritoneum contained some pseudo-mem-
branous and fluid exudation. In the periphery of the liver, near the lower
surface, there was a spot of the size of a pea, infiltrated with a stiff yellowish
deposit. . In the uterus, several veins of remarkable thickness, between the
body and the right cornu, were found filled with a stiff yellow exudation.
ExPERIMENT VII. On June 16th, some hours after parturition, the brush
was applied, charged with pus taken from an abscess between the ribs of a
person who had died of cholera. The operation was repeated daily up to the
3rd of July ; but the animal remained well, and was again delivered on the
18th of that month. The experiment was now modified, so as to avoid the
chance of producing mechanical irritation with the brush. The fluid was
injected by means of a gonorrhoea syringe, with a tube three inches in length.
Soon after the injection, the animal again ejected the fluid. It was daily
repeated up to the 24th of July, and the animal was found dead on the 29th.
Post-mortem appearances. Both pleural cavities contained some thickish
yellow exudation. In the peritoneum, there were two ounces of exudation,
partly coagulated in the form of a membrane; the uterus was normal, but pale.
EXPERIMENT VIII. On June 24th, the same animal was operated on, as
had been the subject of Experiment IV. The brush was applied daily until
July 8. The animal wasted away, was seized with diarrhoea, and died on the 25th.
Post-mortem appearances. The peritoneum contained some yellowish exu-
dation. Closely adhering to the posterior wall of the uterus there was a thin
dirty-yellow false membrane ; the cornua contained some dirty reddish grey
fluid exudation; and, on the border between the vagina and uterus, corres-
ponding to the orifice of the urethra, there was a superficial sloughed spot of
the size of a bean, infiltrated with purulent exudation. The ulcer in this
situation had uneven undermined edges, and the base was covered with a
layer of exudation. The substance of the vagina, for an inch in length, was
infiltrated with a deposit of a line in thickness.
ExPERIMENT IX. On August 8th, some exudation from the peritoneum of
a male subject was injected, a few hours after the animal had brought forth
young. It was soon rejected ; and the operation was repeated daily until
the 15th. The animal appeared ill on the 13th, became lean, and was found
dead on the 20th. -
Post-mortem appearances. There was some floculent exudation in the
peritoneum, and numerous yellow inflammatory spots, mostly of the size of
hemp-seeds, on the periphery of the liver. On the mucous membrane of the
posterior wall of the uterus, there was an excoriated spot of the size of a
lentil : the substance of the organ was infiltrated with yellow exudation as
far as the peritoneum. The right cornea was so much infiltrated as to be
of double its normal size. There was some free exudation on its mucous
membrane. The veins in both broad ligaments were filled with exudation.
REMARKS. It is scarcely necessary to mention, that the changes found in the
bodies of the rabbits, were the same as those which occur in the human body
as a consequence of puerperal disease and of pyaemia in general. It might be
objected to these researches, that in them a greater quantity of putrid matter
was employed, and that it was, in eight of the experiments, introduced for
several days in succession, while on the other hand, the quantity of putrid mat-
terremaining on the hands, when they have been washed—as is always the case
—after making post-mortem examinations, can be but very small. But this
objection does not appear to me to possess much weight, seeing that the
operation of putrid matter on the blood does not depend on its quantity; for
infection not unfrequently takes place through a wounded part, which is
almost imperceptible from its minuteness. It would be judicious, in order to
remove all doubt, that more extensive and varied experiments on animals
should be performed. *
704 ". CRITICAL DIGEST OF THE JOURNALS.
LANGENBECK ON THE APPLICATION OF LIGATURES TO UTERINE AND OTHER
POLYPI. DANGER OF PURULENT INFECTION.
The following remarks, which form part of a paper published by Professor
LANGENBECK, of Berlin, in the Deutsche Klºnik for 6th April 1850, are highly
important. The occurrence of pyaemia after the Ligature of Uterine Polypi,
seems to have scarcely yet attracted notice: yet we cannot doubt the possi-
bility of its occurrence, and of its producing a train of symptoms analogous
to those described under the name of puerperal fever or peritonitis. We by
no means wish to discourage the system of applying ligatures to Uterine
Polypi (on which subject an elaborate essay by Professor Simpson will be
found in our Reports of Societies): but we would recommend a careful con-
sideration of the views of Langenbeck to the notice of our readers.

PROFESSOR LANGENBECK's REMARKs. The numerous instruments which
have been contrived for Ligature of Polypi of the uterus and pharynx, shew
the great apprehension of haemorrhage from their excision or evulsion.
Even the assurances of Siebold, Dupuytren, and other distinguished sur-
geons, that there is no greater danger of haemorrhage from the excision of
Polypi than from other operative methods, have not removed this apprehen-
sion ; and the Ligature of Uterine Polypi is rapidly gaining ground, in spite
of the difficulty of its performance. It is true, that the excision of large
fibrous tumours from the pharynx and uterus may be complicated with con-
siderable haemorrhage; but this generally ceases of itself when the operation
is ended, or may be quickly and surely restrained by the continued injection
of cold water, by compression with the finger, or, in the most obstimate cases,
by plugging. The cases, in which actual danger arises from the patient
becoming exhausted by haemorrhage through the cut pedicle of the tumour,
are very rare. But the dangers attending on Ligature of the Polypi are
far greater; and this operation would certainly be had recourse to only in
exceptional cases, if the fatal cases following it were not less apparent than
those from the much-dreaded haemorrhage. A death, occurring some days or
weeks after a bloodless operation, seems less terrible than one occurring Sud-
denly from haemorrhage, under the hands of the operator. The danger of
purulent infection, after the application of a Ligature to Uterine Polypi is
so obvious, that I have not yet been able to determine on performing this
operation. During the last ten years, there have occurred, to myself alone,
ten fatal cases of pyaemia after Ligature of Polypi. The larger polypous
(fibroid) tumours of the uterus and pharynx are furnished with large veins
with thin parietes, doubtless arising from the impediment to the return of
blood caused by the dependent position, or constriction by the ostincae, of
the tumour. As the firm parenchyma of these tumours can only be slowly
cut through by a Ligature, the blood must still circulate in one part, while
another is in a sloughed and softened state. As long as the pedicle is not
entirely cut through by the Ligature, pyaemia is to be feared. Entirely inde-
pendent then of the danger of convulsions, suffocation (in Polypi of the
pharynx), secondary hamorrhage, etc., the application of the Ligature ought
to be entirely rejected on account of the danger of pyaemia. But if it be
still determined, in spite of the marked success attending the excision of
Polypi, and in opposition to which, scarcely a single case of unrestrainable
haemorrhage can be related, to apply a Ligature, I consider it indispensable
that the polypus should be immediately excised, that the Ligature should be
used only as a precautionary measure, and that it should be removed as soon
as the danger of haemorrhage appears to have been obviated.
It is not my purpose to enter on a critical examination of the various
methods and instruments employed in applying the Ligature to Uterine
Polypi; as, for the most part,they possess only an historical interest. With very
few exceptions, they are all faulty in being difficult of application, in tending
to produce violent irritation of the neighbouring parts, and in the Ligature
being unable to be removed until the pedicle of the tumour is entirely divided.


RE PORTS OF SOC I ETI E. S.
ROYAL MEDICAL AND CHIRURGICAL SOCIETY,
- TUESDAY, MARCH 12, 1850,
DR, ADDISON, PRESIDENT, IN THE CHAIR.
ON FATTY DISEASEs of THE HEART. By RICHARD QUAIN, M.D., Assistant-
Physician to the Hospital for Consumption, etc. (Communicated by C. J. B.
WILLIAMs, M.D., F.R.S.) The author commenced by referring to the cir-
cumstances which had directed his attention, five years ago, to the subject
of these diseases, to the want of information which then existed, and to the
essays which had since been published. He said there were two forms under
which fat occurred, as a disease of the heart. In one form, “fat tissue” grew
upon and amongst the fibres—concealing them, in some cases, to such an
extent, as to lead to the supposition that the heart's walls were composed of
fat. In such cases, the fibres may still be found unchanged in structure,
when the part is examined with the microscope, but more or less distorted in
their course, by the existence of large fat cells amongst them. He referred
to the circumstances which seemed to direct the distribution of fat on the
heart, and the parts where it was most abundant. In the second form, the
muscular fibre became disintegrated, and degenerated into a granular or
molecular fatty matter—in such cases, there was not of necessity any fat
growth on or about the heart. He traced the progress of this change in the
fibre, as shown by the microscope, and presented in drawings the appearances
described. He showed the effects which the presence of this fatty matter in
the place of muscular fibre must have on the physical characters of the
heart, on its colour, its consistence, etc. He pointed out the circumstances
by which the appearances were modified, as well as those which guided us in
ascertaining its presence. In the next place, under the head of “Preceding
Observations on these Diseases,” the author gave a very complete account of
the extent of our previous knowledge on the subject. He followed by successive
steps the progress of our information, from the period of the oldest authors
whose writings bore thereon, to the age of Harvey, through subsequent
writers, to the present time : he showed that the disease here described as
true fatty degeneration of the fibres of the heart, had been recognised, though,
like fatty degeneration of the liver, the exact change in the fibre has not
been distinctly ascertained. For information on this latter point, we are
indebted to the researches of Williams, Peacock, Rokitansky, Paget, Ormerod,
and others. The author took occasion here to contrast the characters of
fatty degeneration of the heart, with those of fatty degeneration of voluntary
muscles. *
Thirdly, he traced the circumstance under which these diseases occurred.
He showed the relation which the growth of fat on the heart bore to the
presence of its elements in the blood, and to the influence of the age, sex,
habits of life, etc., of the individual on this condition. On the other hand,
he described fatty degeneration as being a process of decay or true degenera-
tion. He established this conclusion, by a series of observations on the
microscopical and chemical characters of the substance called adipocere; by
experiments made by himself and others, on the artificial formation of fatty
matters in albuminous and fibrinous textures external to the body, and by
the identity of the appearances in the artificial and the natural processes.
He mentioned a great variety of circumstances under which this change
took place in the living body, in which it must have occurred independently
of any direct communication with the vascular system. He quoted the
names of several authorities on these points, but more particularly in refer-
706 REPORTS OF SOCIETIES.
ence to their pathological import, those of Williams, Paget, and Rokitansky;
and established the inference, that when the vital properties of these higher
animal substances were impaired, they yielded to the physical influences by
which they were surrounded, and fell into a class of more simple compounds,
shared by them with plants and minerals. . He showed, by reference to Mr.
Paget's observations, that the first step in this process was an impairment of
the nutrition of the organ ; and then he showed how this impairment
occurred: 1st, the heart participating in a general mal-nutrition of the body;
or, 2ndly, suffering locally by disease of the coronary vessels, or as the ulti-
mate effects of endo- and peri-carditis. Numerical illustrations of these facts
were given. The author then referred to the diseases which were found in
association with this condition, they being chiefly degeneration of other
organs, blood-vessels, etc. The most frequent seat of the disease, the age,
the sex, the station in life of the individuals, and various facts in connexion
with the history of the disease, were also numerically illustrated. The cha-
racters of the so-described soft, flabby hearts, and the difference of opinion
as to their nature, were discussed, and their relation to fatty degeneration
considered.
Fourthly. The effects of these diseases were described as being those con-
nected with impairment of structure and function, causing derangement of
the circulation, etc. It was shown, that of fifteen cases of extreme accumu-
lation of fat on the heart, five had suffered from giddiness and coma, eight
from syncope, and nine from short breath, languid circulation, etc. Of the
fifteen, fourteen had died suddenly—viz., by syncope, or in an analogous con-
dition, ten ; by rupture of the heart, three ; by coma, one. In reference to
the effects of fatty degeneration on the structure and functions of the heart,
the author showed that it was found in connexion with hypertrophy in
thirty-nine out of sixty-eight cases. He believed this to be due to hyper-
trophied hearts suffering from impaired nutrition more readily than other
hearts—not, as Rokitansky supposed, to a disturbance of the balance of the
nervous functions. The heart may be found unchanged in size, or decreased.
The diminished consistence of the tissue, permitted the occurrence of some of
the most fatal lesions to which the organ is liable—viz., rupture, which took
place in twenty-five of the sixty-eight recorded cases. In twenty cases, the
rupture perforated the walls of the heart. In five other cases, it was incom-
plete, being confined either to the internal surface, the external surface, or in
the substance of the heart. Rupture in the substance gave rise to the
appearance called by Cruveilhier cardiac apoplexy. The blood effused in
these cases may become encysted, and, losing its colour, give rise to the
appearance of an abscess. Cardiac aneurism may also be formed. Illustra-
tions of these facts were given from the tables of cases. The effects of fatty
degeneration on the heart's functions gave rise to coma, and even apoplexy.
The power of the right side of the heart being weakened, its cavities became
filled, and the circulation obstructed. Illustrations from preceding writers
on this point were given. The impaired powers of the left side of the heart
were, on the other hand, a frequent cause of faintness or syncope; it was
present in fifteen cases. This syncope may amount to a mere feeling of
faintness, or to so complete an arrest of the vital powers as to cause death.
Sudden death occurred in fifty-four of sixty-eight cases, in twenty-one of
which it was by syncope. Pain in the region of the heart and breathlessness,
with certain peculiarities in each, were also numerically illustrated, and the
causes on which they depended considered. The syncopal feelings, the pain,
and the breathlessness, may occur independently of each other, or in combina-
tion; they may thus give rise to the phenomena known as angina pectoris.
It appeared to the author, that this condition of the heart afforded, in many
cases, a sufficient explanation of the pathology of this disease ; and he ex-
pressed his opinion, that many of the cases in which no disease of the heart
had been observed, in which the symptoms were attributed to disease of the


MEDICO-CHIRURGICAL SOCIETY OF EDINBURGH. 707
coronary arteries, or to fat on the heart, were, in all probability, examples of
this fatty degeneration, which had so long been overlooked. He confirmed
this opinion by the details of cases in the tables.
Hereditary predisposition, and the duration of the disease, were treated of
so far as the facts permitted.
Fifthly. The symptoms and diagnosis of these diseases, more particularly
in reference to fatty degeneration, were described. A distinction was drawn
between those cases in which the heart, participating in the general impair-
ment of the health, was perhaps equal to the demand made on its functions,
and those in which the heart, being impaired by local causes, suffered out of
proportion to the system generally. . In the latter case, the symptoms were
very unequivocal. In addition to the phenomena referred to in the pre-
ceding section, the pulse almost always gave indications of the condition of
the heart. It was recorded, in thirteen cases, as being irregular; in fourteen,
as being weak; in eight, slow ; in a few, as being full, regular, or quick; in
none, strong. The feeling of fatigue, from slight causes, particularly from
ascending heights, the breathlessness, etc.;_all progressive, from being so
slight as scarcely to attract notice, to the most extreme suffering on exer-
tion, were mentioned. An anxious expression of countenance, mental irrita-
bility, and copious sweats from trifling causes, were also noticed. The
physical signs of the disease—viz., feeble impulse, feeble first sound, extended
dulness, perhaps a murmur with the first sound, from disease of the columnae
carneae, or imperfection in the second sound, were also discussed.
Sixthly. The treatment, which in some cases had been found more success-
ful than might have been supposed, was such as was calculated to improve
the condition of the blood. We could not restore lost fibres, but we could
render those which remained more effective; we could improve the material
to be supplied by the blood, and we could render this fluid a better stimulant.
The author referred particularly to the management of the digestive organs,
to the use of iron, and the relief of paroxysmal attacks by the use of anti-
spasmodics. Narcotics were not borne, and he mentioned examples of their
injurious effects, as also the ill effects of exertion or of over-exercise. Leeches
to the region of the heart, followed by counter-irritation, had, in some in-
stances mentioned, been found very useful in preventing the return of distress-
ing paroxysms of dyspnoea and pain. The author concluded by a quotation
from Boerhaave, aptly illustrating the formidable effects of this otherwise
inoffensive material, when it occurs in a situation to which it does not belong.
He apologized for the length of his communication, which was due to the
importance of the subject and its numerous relations. The paper was accom-
panied by tables, containing the abbreviated histories of eighty-three cases
of these diseases, and by a number of beautifully executed drawings.
[Dr. Quain's elaborate and able communication occupied the whole sitting,
so that there was no opportunity for discussion.] - -
MEDICO-CHIRURGICAL SOCIETY OF EDINBURGH.
NovKMBER 21, 1849.
JAMES SYME, Esq. PRESIDENT, IN THE CHAIR.
DETECTION AND TREATMENT of INTRA-UTERINE POLYPI. By J. Y. SIMPson,
M.D. [The dilatation of the os uteri, by sponge-tents, was formerly advocated
by Dr. Simpson ; and in the present paper, the same practice is recommended
and enforced by the details of some very interesting and important cases.
The communication appears as an original article in the Edinburgh Monthly
Journal for January, 1850, from which we subjoin some ::::::::: wº
“The sponge-tents used by myself and my professional brethren in Edin-
burgh, are manufactured by Duncan, Flockhart, and Co. They are of a
narrow conical, or pyramidal form ; and are used of many different sizes and
WOL. II.

ºf 08 REPORTS OF SOCIETIES.
lengths, according to the object in view. These tents are made by dipping a
piece of sponge, in a strong solution of gum-arabic—tying and compressing
this sponge around a central wire, as its axis, into the required conical form,
by a continuous layer of whip-cord, drying it thoroughly, removing the
cord, and, subsequently, slightly coating the surface of the tent with tallow,
or axunge and wax, to facilitate its introduction. The central wire passes
only for half-an-inch or an inch, into the base of the cone, and the opening
left by it serves as an aperture to transfix the tent with the tip of the metallic
director, used for guiding and introducing the tents through the os uteri.
They are introduced like the uterime sound or the catheter ; the handle of
the metallic director, with the sponge affixed to it, is held and manipulated
by the left hand, while the fore-finger of the right hand touches the os uteri,
- in order to guide and direct the apex of the tent into that opening. The old
forms of sponge-tent used by surgeons, and made of sponge steeped in pre-
parations of wax, required, for their expansion and development, the aid of
heat, in order to dissolve their retaining ingredient. The tent I have de-
scribed, made by steeping sponge in a solution of gum, requires moisture, and
not heat, for the solution of its retaining material, and for the expansion of
the sponge. Very generally, the secretions of the surrounding mucous canal
afford a sufficient quantity of moisture for these two purposes; but, if not, a
small quantity of tepid water may be injected from time to time into the
vagina. Usually, a well-made tent takes twenty or thirty hours to expand to
its full extent in the os uteri; and dilates to four or five times the diameter
it presented in its original compressed state. Generally, the first tent opens
up the os and cavity of the cervix, and allows the finger ample space to
examine sufficiently its contents, and the state of its parietes. If it be
necessary to open the uterine cavity higher, so as to enable the finger to pass
into the cavity of the body of the organ, a succession of tents is usually
required; and they must be passed completely through the os internum or
-narrow portion, lying between the cavity of the cervix and cavity of the
body of the organ. The use of the tent for a day, generally, as I have
already stated, dilates the os uteri and cavity of the cervix sufficiently ; and
the employment of the sponge is accompanied with little or no feeling of
uneasiness. When it is necessary to examine the state and condition of the
interior of the cavity of the body of the organ, the persevering use of a
series of larger and larger tents for several days, is usually requisite; and
the dilatation of the os internum and body of the organ, sometimes, but not
always, causes a feeling of uneasiness and pain, which may require the use of
- an opiate. The tent is always prepared with a string affixed to its base, to
allow of its easy removal. In using sponge-tents, it should be remembered,
that, when sponge is in contact with the maternal passage for some hours, it
always exhales, when removed, a very foetid odour.
“For dilatation of the unimpregnated os uteri, the tent should be selected
as regularly conical as possible; and with the apex neither too blunt and
rounded to pass the os, nor too slender and flexible so as to double back in
the attempt. The spirally grooved surface of the tent, resulting from the
compression of it by the whip-cord during its manufacture, tends to retain
it in situ, till its expansion commences. It, perhaps, ought to be added, that
the introduction of the sponge-tent into the os and cavity of the uterus,
should be effected without the use of the speculum. The sense of touch
serves, in this, and some other analogous operations, infinitely better than
the sense of sight.
“By the use of sponge-tents introduced daily, and of increasing size and
length, we may reach a polypus, when affixed and sessile even upon the
fundus uteri. One of the first cases in which I dilated the uterine cavity to
... its extreme height, was the following:—
“CASE. In 1844, a patient, aet. thirty-six, under the care of Dr. Graham,
of Dalkeith, had a miscarriage, from the effects of which she never satisfac-
MEDICO-CHIRURGICAL SOCIETY OF EDINBURGH. 709
torily recovered. Previously, she had borne four children. When I first
saw her, two or three years afterwards, she was emaciated and extremely
pallid, from the excessive loss of blood which she had been sustaining for
some time; and her weakness was such, that it was with difficulty she could
rise and walk across her bed-room. In August, 1847, I dilated fully the
interior of the cervix and body of the uterus, by a succession of sponge-
tents, and at last, felt a hard, round fibrous polypus, seated at the very
fundus of the uterus, and projecting, of the size of a walnut, into the upper
part of the cavity of the organ. Dr. Ziegler, Dr. Toogood of Torquay, and
other professional friends, confirmed this diagnosis. It was impossible to
ascertain how it was pediculated, or to operate upon the pedicle. "We could
only reach the round body of the tumour; and that I compressed strongly
and repeatedly in the blades of a lithotomy forceps, with the view of breaking
down its tissue, so as to destroy the vitality of the polypus. A purulent
discharge followed, and three largish pieces of organised structure were
Subsequently cast off. Her recovery of health, after these discharges ceased,
was gradual, but perfect. There has been no return of menorrhagia. About
a year ago, she called upon me; and the change from excessive pallor and
emaciation of the face, to the hue and ruddiness of health, was so great that
I had difficulty in being convinced of the identity of my former patient.
“The polypus, while still included within the uterus, is principally liable to
give rise to the following groups of symptoms:—
“1st. Menorrhagia, in consequence of the discharge of blood from the
surface of the tumour. . The attendant haemorrhages take place particularly
at the menstrual periods, but are apt to recur also at other times; and the
blood is sometimes fluid, sometimes coagulated; occasionally, there is an
almost constant red stained discharge. The effects of these repeated flood-
ings upon the constitution of the patient, vary with their amount ; but if
they go on increasing (as they usually do) in quantity and frequency, the
patient's constitution gradually becomes more and more shattered and broken
down by the amount of haemorrhagic discharge ; and all the symptoms of
anaemia, in their most marked degree, at last supervene, as pallor of the face
and lips, great muscular debility, palpitation, vertigo, dyspepsia, oedema, etc.
“2dly. The discharge of mucous, purulent, or serous matter from the
cavity of the uterus, in consequence of the mucous membrane of the organ
becoming often irritated, inflamed, and even ulcerated by the presence and
pressure of the polypus. If a severe leucorrhaeal discharge is present, and
we ascertain by the speculum that it does not originate in ulceration or other
morbid state of the external surface of the cervix, or of the vagina ; and if
we further detect, with the speculum, the discharge issuing from the cavity
itself of the uterus, the probabilities of it originating in some pathological
irritation within the uterus, will be necessarily increased. Sometimes the
discharge, in cases of polypi, is foetid, especially if it be retained, or mixed
with decomposing blood.
“3dly. Increased size of the cervix and body of the uterus, in consequence
of its interior being distended by the presence of the polypus, is traceable in
those cases in which the polypus is of any great size. Not unfrequently,
intra-uterine, like vaginal polypi, are found combined with the presence of
fibrous tumours in the walls of the uterus; and by these tumours, the mag-
nitude of the organ is increased, and its shape rendered more or less irregu-
lar. Fibrous tumours of the uterus are seldom or never situated in the walls .
of the cervix ; and if the swelling and distension affect the cervix, there
is consequently much more chance of its being a polypus, and not an intersti-
tial fibrous tumour, than when we have similar symptoms attendant upon
a similar augmented state of the body of the organ. Further, the proba-
bility of the disease being intra-uterine polypus would be increased, if, on
successive examinations, we had an opportunity of ascertaining that the
large and distended state of the cervix was descending gradually lower and
7 10 . . . . REPORTS OF SOCIETIES.
lower down towards the os; for polypi, in their progress and descent, gradually
dilate the cervix from above downwards, in the same way as happens in
pregnancy or abortion. They are born by a kind of chronic labour.
“4thly. There may be symptoms of irritation and pressure upon the bladder,
rectum, etc., if the polypus happen to be so large as to exert mechanical
compression upon these or other parts; or dysmenorrhoea, if it fill up the
cavity of the cervix. And sympathetic pains may be present in the loins,
limbs, etc.; or there may be sympathetic disturbance of the stomach, heart,
etc., if the uterus be much irritated and excited by the présence and disten-
sion of the polypus.
“But one or more of the preceding groups of symptoms may be altogether
absent, though the uterus contain an intra-uterine polypus. The mechanical
and sympathetic symptoms, last alluded to, are the most uncertain of all.
For while almost all uterine diseases, however intrinsically different, give
rise to similar secondary and sympathetic symptoms, we have often, in other
instances of the very same diseases, these same symptoms entirely wanting ;
just as in one woman, during pregnancy, we sometimes see severe, even serious,
local and constitutional symptoms; and in another woman, or even in the
same woman in another pregnancy, we see the same condition of the uterus
unattended by any special local or constitutional disturbance. Again, there
may be no ascertainable increased volume of the uterus, as the polypus,
especially if it be vesicular, and originate in the interior of the cervix, may
be far too small to lead to any appreciable augmentation in the size of the
organ, although, notwithstanding, the memorrhagia may be great ; for the
extent of flooding does not depend on the size of the polypus, Small polypi,
like small haemorrhoidal excrescences, often being the source of severe and
repeated haemorrhages. Further, the leucorrhoeal discharge which is some-
times attendant, may be entirely absent, as the polypus may not be irritating
the mucous surface of the cavity in which it is inclosed. And lastly, polypi,
occasionally, though not very frequently, are present for a long series of
years without producing any degree of haemorrhage or menorrhagia. In one
case, for example, there was a state of long standing amenorrhoea, instead of
menorrhagia, co-existent with presence of a polypus, though the two condi-
tions (the amenorrhoea and polypus), had, probably, no causal relation to
each other.
“No remark could be, pathologically and practically speaking, more sound
and true than that which Sir Charles Clarke many years ago made –“The
true character of any disease of the internal female organs can only be
ascertained by examination.” With this view, in order to enable the finger
to reach and examine the cavity of the uterus, the os and cervix must be
opened up by a succession of sponge-tents, in the way already described.
When an adequate degree of dilatation is obtained, the finger will be enabled
to touch the tip of the polypus; and then the pediculated or polypous
character of the tumour may be farther made out, by passing either the
finger or a uterine sound between its body and the containing cavity of the
uterus. In making this examination, as in making most other examinations
of the uterus, a rule requires to be followed which is too often forgot, namely,
to use both hands for the purpose. For if we are examining the uterus
internally, with the forefinger, or fingers of the right hand, the facility and
precision of this examination will be found to be immensely promoted by
placing the left hand externally over the hypogastric region, so as to enable
us, by it, to steady, or depress, or otherwise operate upon the fundus uteri.
The external hand greatly assists the operations of that which is introduced
internally ; and farther, we can generally uneasure between them, the size,
relations, etc., of the included uterus.
“If without, or before using sponge-tents, we are desirous to examine at the
* Diseases of Females, vol. i., p. 250.
MEDICO-CHIRURGICAL SOCIETY OF EDINBURGH. 7 11
time when the os uteri is naturally most relaxed, we shall find that time to
be either immediately after a menstrual discharge, or immediately subsequent
to any severe attack of intercurrent haemorrhage. Under such circumstances,
we can sometimes introduce the finger partially into the os uteri, and ascer-
tain the presence of any morbid body in the lower segment of the cervix;
when, in the same patient, at other times, this orifice is so completely shut
as to prevent entirely such a proceeding. Sometimes, indeed, a small or
elongated intra-uterine polypus will pass through the os uteri at these times,
so as to be felt by the usual vaginal examination; but will become retracted
into the cavity of the cervix, during the interval between the haemorrhagic
discharges. - -
“THE TREATMENT of Intra-uterine polypirequires to be varied according to
different circumstances, but particularly by the tendency or probability of
the tumour passing downwards or not through the os ; by the effects of
the symptoms or the urgency of the case ; and by the size and site of the
olypus. - -
p #. plans of procedure may be followed, according to the nature and
necessities of the case, viz: First, to wait till the polypus descend farther;
or, secondly, to remove it immediately. It is a generally acknowledged prin-
ciple in obsteric surgery, that a polypus of the uterus should be extirpated
as early after its discovery as possible. But when such a tumour is discovered
still included within the uterine cavity, and the polypus seems gradually but
certainly making its way downwards through the cervical cavity, and the
haemorrhage and other symptoms are not urgent, it will assuredly be better
to wait for its descent through the os ; for, after that, its removal becomes
much more easy and simple. The dilatation of the os and cervix by the
sponge-tents will promote and facilitate its descent ; and perhaps the internal
use of the ergot of rye may aid it. But the degree of attendant haemorrhage
and debility may be too great to entitle us to postpone the removal of the
polypus ; or the tumour may be attended by such a short pedicle, as not to be
capable of leaving the uterine cavity without dragging down with it, or in-
verting the fundus or some parts of the parietes of the uterus; or it may be
retained in its descent by adhesions formed between the surface of the uterus
and the surface of the polypus. I once witnessed the dissection of a case of
a large fibrous polypus included in the cavity of the uterus, and where in-
flammation had been present before death ; the surface of the polypus was
adherent to the surface of the uterus through the medium of a recently
effused false membrane. Even when an intra-uterine polypus has descended
so far as even partially to open up the os uteri, it may remain in that situa-
tion for such a length of time, and with such results, as to place the patient
in no small degree of danger. - -
“But, secondly, the severity of the attendant haemorrhages, or the improba-
bilities of the speedy and entire descent of the intra-uterine polypus, may
induce us to remove the tumour at once ; and certainly this may be effected
in most cases, though with greater difficulties than in cases in which the
polypus has passed down into the vagina. To admit at all of the removal of
an intra-uterine polypus, of any considerable size, the os uteri must be pre-
viously very fully dilated by sponge-tents; and perhaps it will sometimes be
found necessary, at the time of operating, to gain additional freedom, by
dividing any obstructing band of the os or cervix that may not have been
fully dilated by the tents. Afterwards, we shall require to proceed differently
in different cases, in order to destroy or remove the polypus. We may only
be able to accomplish this object by contusing and crushing the tumour. In
the instance in question, I grasped the polypus, for this purpose, with strong
lithotomy forceps. In another similar case, after fully dilating the os and
cervix, I seized a large intra-uterine polypus between the jaws of a screw-
propelled lithotomy instrument—invented for the purpose of crushing vesical
calculi—and was enabled, by it, to crush and destroy readily the structure
712 REPORTS OF SOCIETIES.
and vitality of the included tumour. Qccasionally, we may be enabled to
divide the stalk of the polypus with a silver wire or ligature, acting on the
principle of the chain-saw ; or we may reach it with very curved blunt-
pointed scissors.
“The instrument employed (in a detailed case)is a modification of one kindly
sent to me by my friend, Dr. Sabine, of New York. I am told it has been
successfully used by various American practitioners, for the removal of polypi
in the vagina. The advantage which it possesses over the instruments of
Niessens, Gooch, Davis, and others, in the removal of intra-uterine polypi is,
that the screw power, with which it is furnished, enables us to use it with the
power of a small chain-saw, for the immediate division of the pedicles of the
polypi. And it is almost superfluous to observe, that if we can finish our
operation, it will be much safer for our patient than leaving a rough instru-
ment within the cavity of the uterus. The instrument itself consists of two
parts, viz., two hollow canulae, like those pertaining to the instruments of
Niessens and Gooch ; and of a second part, resembling the polypus instru-
ment of Graefe of Berlin, with this difference, that it has a ring affixed to its
top, of a heart-shaped figure, and intended, first, to receive the two canulae,
with their contained ligatures, and afterwards to serve as a point of resistance
during the cutting action of the ligature upon the pedicle of the tumour.
The canulae and ligatures are first applied in the same way, and according to
the same rules, as those of Niessens and Gooch. After the pedicle is en-
circled by the ligature, the two lower extremities of the canulae and included
ligatures are passed through the ring of the second portion of the instrument.
This second portion of the instrument is then run up, with its ring surround-
ing the included canulae, till it reaches the pedicle of the tumour; the pro-
jecting side of the ring being turned towards the pedicle. The canulae are
then slipped off, and withdrawn, leaving the wires or ligatures alone in the
terminal ring of the instrument. Subsequently, these wires are twisted
around, and fixed upon, the knob attached to the screw. Lastly, by moving
the knob downwards, by the operation of the screw, the ligature is made to
cut into and through the pedicle. [Plates of the instruments are É.
“The preceding remarks, relative to the treatment of intra-uterine polypi,
principally refer to these tumours when they happen to be of a large size.
But uterine polypi are often too small to be removed by the knife, scissors,
or ligatures ; and yet these small polypi not unfrequently lead to severe and
long-continued memorrhagia. From the analogy of haemorrhoidal tumours,
we know that the mere size of a polypus is not to be taken as any measure of
its capability of producing haemorrhage. Small vesicular, mucous, or cellular
polypi sometimes grow from the fundus uteri, giving rise to considerable and
long-continued haemorrhagic discharge. I have preserved specimens of them
from the dead subject, and have met with them in the living. They can
hardly be properly termed polypi, as they are scarcely pediculated at their
attachment, and sometimes short, but, in other cases, long and slender in their
body. The following case may be cited as an illustration.
“CASE. A lady, the mother of ten children, became irregular in her menstrual
discharge during her forty-fourth year. At times it was wanting at the usual
monthly periods, at others it amounted to menorrhagia. About a year after
this irregularity commenced, such an amount of fluid blood and coagula
escaped, as at first to lead, on her part, to some suspicion of miscarriage ; but
it continued to go on profusely for two or three weeks. At the end of that time,
I visited her, with Mr. B. Bell and Dr. Malcolm. On examining the uterus,
we found a small vesicular polypus attached to the inner surface of one of the
lips of the os, and it was easily removed by avulsion. The discharge, however,
was not abated in consequence, as we expected. A series of sponge-tents
was then introduced, so as to open up, first, the cavity of the cervix (which
was found free from additional polypi), and ultimately the cavity of the body
of the uterus. When the distension of the whole uterine cavity was at last
MEDICO-CHIRURGICAL SOCIETY OF EDINBURGH. 713
completely effected, both Dr. Malcolm and I found that we could touch two or
three small slender polypoid bodies,hanging from the very fundus of the uterus.
I removed them cautiously from the surface to which they were attached,
with the nail of the first finger. After this the haemorrhage ceased, but some
local treatment was required to cure the ulcerated state of the cervix. The
polypi were removed in April. The patient went soon afterwards to spend
the summer in the country, where she soon gained strength, and enjoyed
much-improved health. I saw her lately. The menorrhagia had not recurred,
but she still looked anaemic, having never recovered her colour since the
haemorrhages in spring.
“The most common site for the origin of small vesicular polypi, is the inte-
rior of the cervix uteri. In fact, the small cellular or vesicular form of
cervical polypus, is infinitely the most common form of polypous disease of
the uterus. These cervical vesicular polypi are generally of a small size, like
a pea, or orange pip, and vary from this to the size of a hazel-nut. Some-
times they are sessile ; and sometimes pediculated. Occasionally they are
single, or they form a single complex cluster ; but more frequently they are
gregarious. Indeed, it is the rule rather than the éxception to it, that when
we find one, we shall find, on further search, that there are others, sometimes
to the number of four, five, or six, springing from other points of the interior
of the cervix, and not discoverable till the cavity of the cervix is dilated by
a sponge-tent. When hanging from the os uteri, their stalk is sometimes so
loose and long, and the small depending polypus is itself so small and soft,
that it moves away before the finger in making a tactile examination ; and
one unaccustomed to this peculiarity, will not feel perfectly sure of the pre-
sence of such a polypus till the speculum is used, when the body of the polypus
will be easily seen, generally of a cherry-red or purplish colour. Such polypi,
though small, are often apparently the source of much menorrhagia and leu-
corrhoea, for they almost always co-exist with, and probably produce, some
degree of ulcerative inflammation of the contiguous surface of the cervix.
“In trying to remove these small vesicular polypi of the cervix, it is, there-
fore to be held in recollection, that there are generally more than one present ;
and that, to ascertain this point with any precision, it is necessary to dilate
and expand the cavity of the cervix with a sponge-tent.
“In more than one instance, I have found these polypi (when their pedicles
were perhaps long and easily broken) come off, imbedded in the surface and
foramina of the sponge, which had torm them off during its expansion. But,
in twenty-nine out of thirty cases, more methodic measures are required for
their removal,—as scratching them off with a sharp nail, seizing and tearing
them off with polypus forceps, or dividing their stalks with a pair of scissors.
If we can use the speculum, these modes of removal are greatly facilitated
by the sense of sight. Indeed, if we require to use the polypus forceps or
scissors, for the removal of these small polypi, guided by touch alone, we
shall generally find the operation, though apparently simple in principle, one
which is tedious and difficult to perform in practice.
“We find, in some cases, these vesicular polypi in all their stages of forma-
tion, from small shut cysts, up to pediculated vesicular tumours. When such
is the state of matters, we can only remove those that are more fully formed,
by the nails, scissors, or forceps. To effect a complete cure, we require other
means; and for this purpose the application of caustics to the mucous mem-
brane of the cervix answers every indication. Nitrate of silver generally
proves too weak for this purpose, unless repeated very often, and combined
with scarification of the mucous surface. We possess a far more potent and
certain caustic for the purpose, and one that is perfectly manageable, in
potassa fusa. The surfaces of the os and cervix, when small vesicular polypi
exist, are often found to be the seat of chronic inflammatory ulceration ; and
sometimes the submucous tissue, and the structure of the cervix, is also the
seat of chronic inflammatory hypertrophy and iuduration. When such a
7 14 - - REPORTS OF SOCIETIES.
combination exists, the potassa fusa is doubly useful, as its application at
once destroys the polypi, and sets up a new and healthy action in the affected
and morbid tissues of the cervix. I have described, elsewhere, its great
value and mode of application in inflammatory induration of the cervix," and
the power we have of immediately arresting and limiting its action by the
neutralizing effects of acetic acid. I need only add here, that I have now
repeatedly found this caustic of the greatest possible use in obstinate and
complicated cases of vesicular polypil of the cervix, such as I have above
alluded to. In illustration of its effects, I shall cite only one instance, and
that because it was a case which was peculiar in several respects.
“CASE. On the 1st October last, I was called to see a lady who had been
losing large quantities of blood for three weeks previously, despite of all the
means which had been tried for its suppression. The patient's strength had be-
come greatly exhausted. She was between forty and fifty years of age ; was
the mother of a family, and for some years past had suffered under occasional
menorrhagia. Three years ago, a uterine polypus had been detected at Brus-
sels, and afterwards removed in London, apparently with some difficulty, as
the first physician, who attempted it, failed. Her present attack of haemor-
rhage was much more long-continued and severe, than those that had occurred
previously. Before being able to make a tactile examination of the uterus,
I had to remove several large clots of blood lying in the vagina. I found
the anterior lip of the os uteri very much enlarged, indurated, and roughened
on the surface. By the speculum we saw this lip greatly enlarged, and
dotted over with small pediculated red-coloured polypi like red currants;
and the use of the mop showed them to be the source of the flooding. About
a dozen of these small red polypi were within the field of the speculum, but
others could be felt on the internal aspect of the enlarged lip. As it seemed
hopeless to attempt to detach them all one after another by the forceps, and
as doing so would not remove the suspiciously indurated and enlarged an-
terior lip of the cervix, I at once had recourse to the application of potassa
fusa to the diseased lip itself, and melted it down, with the polypiattached,
by decomposing upon it a couple of sticks of potassa, of above an inch in
length each, and followed this immediately by the free and abundant injec-
tion of vinegar to neutralize the alkali. Subsequently, under the use of
astringent injections and medicated pessaries, the surface took on a healthy
cicatrisation, and her health greatly improved under the kind and able care
of Dr. Anderson (of Jedburgh). I saw the patient in Edinburgh two months
afterwards, on her way home to London. There were no remains of the in-
duration or polypi. The uterus felt natural in size, and the surface of the
cervix was entirely cicatrised. There has been no recurrence of the menorr-
hagia. The menses have been present once, but not in unnatural quantity.”
- o B ITU A RY. -
BURNS, Dr., F.R.S., the eminent and much respected Regius Professor of Surgery
in the University of Glasgow, aged 74, drowned on board the steamer Orion,
on 18th June, in her passage from Liverpool to Glasgow. This ill-fated vessel
struck the rocks close to land, on a clear morning, and went down in a few
minutes. The loss of life was very great ; but probably all might have been
saved, had there been a proper provision of boats or life preservers.
CROSSE, John Green, Esq., M.D., F.R.C.S., Senior-Surgeon to the Norfolk and
Norwich Hospital, and one of the Vice-Presidents of the Provincial Associa-
tion, at Norwich, on 9th June. Dr. Crosse, acquired a well-earned reputa-
tion, not only in the provinces, but in London, by his numerous and valuable
contributions to the advancement of science, published principally in the
Transactions of the Provincial Association. His chief work was the “Essay
on Urinary Diseases”, for which he obtained, from the Royal College of Sur-
geons, their Jacksonian prize in 1833. Dr. Crosse was a member of several
distinguished societies, both at home and abroad, and an M.D. of St. Andrews.
* Edinburgh Monthly Journal of Medical Science for 1847 -8, p. 71.
LONDON
JOURNAL OF MEDICINE,
sº A MONTHLY
3ºztortſ of the ſºlºbital Sºtienteg.
August 1850—No. XX.
o RI G IN A I, Co M M UNI CAT I on s.
ON THE MECHANISM OF TEXTURAL NUTRITION.
By RUDOLF HAAS, M.D., late Lecturer on Epidemiology in Vienna.
(Concluded from page 650.)
IX. FROM the preceding observations, we can understand the cause of
the different characters of the exuded matter in inflammation and in
congestion; the product of congestion being non-fibrinous, while that
of inflammation contains much of this substance. Pathologists have
ascribed this phenomenon to different dyscrasies, which, according to the
preponderance of fibrin or albumen in the exudation, they have termed
the fibrinous or albuminous dyscrasies. These are only hypothetical,
and are incapable of demonstration, either d priori or à posteriori. The
retention of the fibrin in the blood, and its free exudation through the
pores of the vessels, depend, as I have already shewn, on the state of
distension of the capillary vessels, and upon the various substances
which are mixed with the blood. If the blood contain substances which
impede the formation of fibrin, as is the case in typhus and other
toxaemic diseases, the fibrin must decrease, and the exuded matter
cannot contain much of it. The amount of albumen in the exudations
also depends on the distension of the vessels, and on the quantity in
the blood. In cases where the blood has not been poisoned, the exuded
matters will contain a quantity of fibrin, proportionate to the distension
of the vessels of the inflamed part. Hence all those causes which assist
the distension of the vessels, also promote the exudation of fibrin. In
persons with much blood, containing many corpuscles, and with increased
action of the heart, an exudation of much fibrin is produced; while in
feeble individuals, possessing a small quantity of blood, poor in cor-
puscles, and in whom the heart acts feebly, and the vessels are not
distended, the exudation will contain but little fibrin, although the
blood be rich in it. When some poison impedes the formation of fibrin,
as in typhus, etc., the exuded matter contains much albumen.
In winter, the body generally contains more blood, and the exudation
VOL. II. 48
716 ON THE MECHANISM OF TEXTURAL. NUTRITION.
is more fibrinous, from the distension of the vessels by the greater
quantity of the blood. In summer, the body contains less blood, the
vessels are less distended, and the exuded matter is poor in fibrin. In
childhood, where a great part of the blood is employed in the evolution
of the organs, only a small quantity remains in the vessels, as is proved
by our finding it only in the larger veins and in the heart: the matters
exuded contain very little fibrin, the vessels being very little distended.
Moreover, the blood in the child contains a smaller proportion of fibrin
than that of the adult, on account of the greater amount of vegetables
in the food." In chlorosis, in spite of the presence of much fibrin in
the blood, the exuded matters contain but little of it. The reason of
this is the non-distension of the vessels, from the deficiency of blood-
corpuscles. In typhus and other toxaemic diseases, the exuded matter
contains very little fibrin, the blood being poor in it; but it contains
much albumen. But the condition of the vessels has also a great
influence on their power of distension, and hence on the quality of the
exuded fluid. *
X. From the preceding observations, the following practical rules
may be deduced:
A. In all diseases, where there is an indication to increase the pene-
tration of the blood through the pores of the vessels into the parenchyma.
of the organs, we must use means to augment the quantity of the blood
and of its corpuscles, the activity of the heart and large vessels, and the
animal heat. -
The quantity of the blood is increased: a, By taking a large quantity
of aliment; either by the stomach, if it be able to digest a sufficient
amount; or by nutritive baths and enemata. b. By the ingestion of a
large quantity of water, either by drinking, or by enemata. Although
the water is soon removed by the kidneys, it must in any case first
enter into the blood-vessels; for it is unreasonable to imagine the
existence of via clandestinae, leading directly from the stomach to the
kidneys. While, then, the water is in the vessels, these are more
distended, and a larger amount of the nutritive part of the blood passes
into the tissues. That water remains for some time in the vessels, and
is not immediately removed by the kidneys, can be proved from the
following experiment. If one animal be bled six hours after drinking,
and another only half-an-hour after, the blood of the latter will be found
much more watery than that of the former. The retention of the water
in the blood, for some time previous to its elimination, is also proved
by the circumstance, that a sweat breaks out on the surface of the body,
after drinking several glasses of water; and also by the fact, that
animals will survive for some time, when supplied with water alone.
i. * latter case, it can only act by increasing the quantity of the
blood. . - -
The number of blood-corpuscles is increased by the use of iron; as
is proved by the observations of Andral and Gavarret. -
The activity of the heart and of the vessels is increased; a. By exer-
cise. This is proved by the well known circumstance, that in violent
motion of the body, the activity of the heart is much increased, the
—z–
• , &
* Lemass, Physiolog. Chemie. 1842. Bd. i. p. 104.
BY RUDOLF HAAS, M.D. 717
vessels are more distended, and a sweat breaks out on the surface of
the body. b. By the use of spirits and of various other stimulants.
The temperature of the body is increased by means of warm clothing,
by warm baths, by warming the air which surrounds the body, and by
friction.
If one of the forces which assist the exudation of the nutritive part
of the blood be diminished, its deficiency must be compensated by the
increase in intensity of the others. Hence, after losses of blood, we
administer spirits with Water, apply friction, and employ means for
producing warmth : we also give iron, and use baths containing nutritious
matters, and advise the patient to take exercise, if he be not too weak.
We follow the same plan after long abstinence from food, and in con-
valescence from diseases of long standing; and the same thing is to
be done in chlorosis. The asphyxia produced by cold, arises from the
want of nutrition; hence the same remedies are to be employed. In
these cases, water, spirits, artificial warmth, iron, and exercise, act as
equivalents to food. This may be witnessed in animals, confined to the
use of water, which are revived from their apathetic state by artificial
warmth; in drunkards, who live on a very small quantity of food; and in
chlorotic patients, who gain strength from the use of iron, and from
exercise. After loss of blood, spirits are the best remedy, as they seem.
to cause an increased flow of blood in the vessels of the brain, which is
thus kept in a sufficient state of stimulation, in spite of the small
quantity of blood in the vessels.
It will be in place here to answer some objections to the use of spirits,
from the effects, real or supposed, produced by them in drunkards. In
these persons, the blood is thick and dark-coloured. The thickness arises,
not from the coagulation of the albumen by the blood," as Budge and
others suppose, but from the large quantity of fat contained in the
blood. The dark colour has its rise in the impaired power of the heart
and lungs, by which the circulation is impeded, and the carbonic acid
is not sufficiently removed from the blood. But all this is far from
being a legitimate object of dread, in the moderate use of spirits.
Remedies which increase the exudation of the blood are also to be
* The assertion of Budge (Allgemeine Pathologie), that spirits produce coagulation
of the albumen of the blood while in the body, is opposed to experience. They
cannot produce this effect in the living body, provided their quantity be kept
within certain limits. If they generally had this effect, they would be most active
and dangerous poisons; yet we find persons, who habitually use them, living to a
great age. Orfila, having injected alcohol into the veins of animals, found the blood,
coagulated in the immediate vicinity of the injection, while that in distant parts.
of the body remained fluid, although as much in contact with the spirit as if the
latter had been drunk. We can never assert that substances always produce the
same effects in, as out of the body. There are certain circumstances in the living
organism, with the nature of which we are not yet acquainted, which are capable
of impeding and modifying the chemical action of some substances. The aggregate
of these modifying circumstances is termed the vital force. As an example of this,
the blood, when removed from the body, is decomposed by oxygen into carbonic acid,
ammonia, hydrosulphuric acid, and water; but in the living body, carbonic acid,

urea, uric acid, and water, are the products. The oxygen always acts according to
chemical laws; but there are certain circumstances in the body, which compel it to
produce urea and uric acid instead of ammonia. If we knew what these are, we
should be able to produce urea and uric acid. We can imitate digestion; but we mºst
use pepsin taken from the stomach, because we are not able to make it artificially.”
7 18. ON THE MECHANISM OF TEXTURAL. NUTRITION.
$.
employed in catarrhal inflammation. The process which here takes
place is as follows. Distension of the vessels of the mucous membrane
being produced by any cause, the blood stagnates in the vessels: but as
it is pressed on by the blood, which is still flowing, it is obliged to pass
through the pores of the vessels, as far as the cells of the epithelium,
by which it is prevented from passing out. After some time, the epithe-
lium becomes relaxed, and the thinner part of the blood is enabled to
exude through its cells, in the form of a thin mucus. Subsequently,
the epithelium, being quite spoiled, is thrown off, and the thicker part
of the exuded blood escapes. When the part is thus freed from the
exudation, the pressure is removed, and a new epithelium is formed;
after which the part is restored to the healthy exercise of its functions.
The sooner, therefore, the epithelium can be removed, the sooner
recovery takes place; and this occurs in proportion to the rapidity with
which the blood in the congested vessels can be caused to exude. In
this first stage, spirits, or other stimulants, warmth, cold water, or
vigorous exercise, are the best remedies. But when the thickened
mucus has begun to appear, shewing the removal of the epithelium,
remedies of another character are indicated. -
B. In all cases, where exudation is to be retarded, remedies of an
opposite character to those before mentioned must be used. We have
to diminish the quantity of blood and of blood-corpuscles, the activity
of the heart and large vessels, and the temperature of the body.
The quantity of blood and of blood-corpuscles is diminished by
bleeding; and we have no means which act so rapidly in decreasing the
proportionate quantity of the latter. The blood may also be diminished
in quantity by increasing the secretions. All remedies which act as
stimulants to the activity of the secreting organs, diminish the quan-
tity of the blood. These include laxatives, diuretics, diaphoretics,
emetics, and sialagogues. All these remedies diminish the blood, but do
not produce a decrease in the corpuscles. From the effect of diuretics
and diaphoretics, the blood loses only water and Saline matters ; by
emetics, purgatives, and sialagogues, it also loses a portion of albumen.
. The activity of the heart is diminished by some narcotics, as digitalis,
etc., and by acids. Cold has the effect of increasing the contraction of
the vessels, and of diminishing the activity of the heart. Tranquillity
is also necessary to be observed. .
Bleeding, which diminishes the blood and its corpuscles, is to be
employed in all inflammations, when the exuded matter cannot be
thrown out, but not in individuals, who are exhausted and very much
weakened. By this operation, we not only diminish the exudation,
but we render it more watery, and capable of dissolving the old
exudation, so that it may be absorbed. The vessels are not so much
distended, and thus less albumen and-fibrin, and more water and salts,
penetrate into the parenchyma. But in exhausted and weakened
persons, where there is only a small quantity of blood, and the fibres
of the tissues are relaxed and soft, bleeding may be followed by dropsy,
from the exudation of water and saline matters through the lax fibres.
Dropsical symptoms appear generally after the subsidence of fever:
because, while the fever is active, the energy of the heart causes the
vessels to be kept distended, so that the exuded matter is albuminous, and
BY RUDOLF HAAS, M.D. 719
is too thick to pass between the fibres of the tissues. But when the
fever is past, the activity of the heart subsides; and, the quantity
of the blood being small, the vessels are very little distended, so that
only water and saline matters exude, and, by gravitation, tend to the
lower parts of the body. - - - .
The remedies which increase the secretions and excretions act
altogether in another way: particularly diuretics and diaphoretics, by
the action of which the blood loses water and saline matter. The blood
becomes thickened, like cholera-blood. In such circumstances, scarcely
any water passes through the pores of the vessels into the parenchyrha
of the organs. The effect, therefore, is quite opposite to that produced
by bleeding. - * -
It is easy to understand how, though bleeding and evacuant reme-
dies both diminish the quantity of the blood, they cannot be always
used in the same circumstances. In inflammations with fever, in
robust and athletic individuals, where the exudation contains much
fibrin and albumen, and is deficient in water, so that it requires a new
watery exudation to dissolve and absorb it, bleeding, which promotes
such an exudation of water, will be most useful. But evacuants, which
impede the exudation of watery matter, protract the disease. But in
inflammation without fever, or in exhausted and bloodless individuals,
where the exudation is not thick, and wants no other exudation to
render it soluble, bleeding is either superfluous or dangerous, while
the evacuants mentioned above are useful. The same is the case in
inflammations of those parts, where the exudation is in general only
watery. In the same way, evacuants are remedies against dropsical
diseases, by diminishing the exudation of water. The water which has
been already exuded will be absorbed, if the lymphatic vessels are in a
state of health. The lymphatic vessels, after having absorbed the
exuded serum, bring it back to the blood; and so the blood becomes
thin in spite of its losing much water by the use of evacuants. But if
the lymphatic vessels of the part, where the inflammation is, are unable
to absorb the exuded liquid, and to return it back to the blood, this
must become, by the continuous use of evacuants, very thick, so that
very little can pass through the vessels. The individual must become
weak, and the lymphatic vessels of the whole body, having no blood to
absorb, must absorb the fat of the organs; and this is the reason that,
under the use of evacuants in dropsy, if the dropsical tumour do not de-
crease, the fat in the whole body gradually disappears. Evacuants act
most beneficially in all chronic inflammations. In these diseases, the
vessels are generally unable to contract: but the blood is not entirely
stagnant. By the use of evacuants, the quantity of blood is diminished,
and the vessels are less distended, so that they have an opportunity of
being restored to their functions. Evacuants are to be given in cases
of hypertrophy, especially in that of the heart. Bleeding is sometimes
beneficial : but it is liable to induce dropsy, which does not follow the
use of evacuants. . -
I do not desire to be a panegyrist of purgatives, as I consider that they
are not only used sufficiently, but even too often, and without sufficient
reason. But I think that diuretics, and probably diaphoretics, should
be more used than they are at present. The perspiration consists of
720 scARLATINA MALIGNA : DEATH FROM HAEMORRHAGE.
water and carbonic acid, and amounts to thirty-four ounces in twenty-
four hours; being the same quantity of water as is removed by the
kidneys. - sº, , - .” ~ :*
. If the normal perspiration, which disappears without being noticed,
amounts to thirty-four ounces, it is obvious, that the increasing per-
spiration, which appears in the form of Sweat, must be in great quan-
tity. We are therefore able to diminish the quantity of blood in a
very considerable degree by diaphoretics. This is the reason why we
feel very weak after sweating any time, for the quantity of blood is
very much diminished, and the same effect is produced as after a large
loss of blood by bleeding. * . - . .
I think the cold water-cure acts merely as a diaphoretic. The ves-
sels of the cutis being first contracted by the cold, become, by being
excited, very weak, as is the case after every application of a strong
stimulus. They become lax and distended, and a great sweat follows;
during this, the cold bath is repeated, and the vessels, which are
yet not quite restored, are again excited. The relaxation of the
vessels must now occur to a greater degree than before ; and the sweat
does not cease for several hours. Besides this, we must remember
the exercise which the patients take in climbing hills, etc. The vessels
of the cutis are relaxed tâ such a degree, that even a stasis of the
blood takes place in some parts of the cutis, and spontaneous blisters
are produced. Warm bath produces relaxation of the vessels of the
cutis, but not in such a marked degree as cold applied in the way
just mentioned. Sweating baths act in the same way. By these
different kinds of baths, we are enabled to rapidly diminish the quan-
tity of blood without danger of dropsy. They have doubtless other
effects; but the diminution of the quantity of blood is the first.
CASE OF SCARLATINA MALIGNA: ABSCESS IN NECK,
EXTENDING OVER RIGHT PECTORAL MUSCLE:
DEATH FROM HAEMORRHAGE FROM ULCERATION OF INTERNAL JUGULAR
ar . AND BRANCH OF SUBCLAVIAN VEINS.
By R. J. HALE, M.D., Extra-Licentiate of the Royal College of Physicians;
- Physician to the Islington Dispensary. . - -
CASE. On the 5th of February, I was called to attend J. W., at. 8, the
son of a gentleman. He had been indisposed for two days, complaining
of slight sore throat and pyrexia. On examining the throat, I found it
congested, and almost black; the tonsils and uvula were much swollen,
and covered with a tenacious secretion; the skin was dry and hot; the
pulse 130; the tongue greatly furred, white and creamy, with enlarged
papillae. He had not slept for two nights, and his breathing was
laborious. An emetic of tartarized antimony with ipecacuanha was given;
this produced slight vomiting, which was followed by profuse purging.
Calomel with ipecacuanha, followed by a saline draught, were adminis-
téred during the rest of the day; leeches were applied to the throat.
8 p.m. The throat was relieved, and he could breathe more freely.
BY B. J. HALE, M.D. 72]
February 6th. There had been great restlessness during the night.
There was ulceration of the uvula and tonsils as large as a fourpenny-
piece, with great foetor; the tongue was drier; the skin harsh and hot.
The sloughs were partially removed by a sponge. dipped in a solution of
nitrate of silver. He was ordered to have a hot bath at night, with a
Saline mixture containing chlorate of potass; also a gargle of hydro-
chloric acid and chloride of Soda. An embrocation of poppy-heads and
sal-ammoniac was ordered to be applied, by means of a hot flannel, to
the glands of the neck, which were hard and painful. --
7th. The patient passed a sleepless night; the uvula had sloughed,
and portions of the tonsils were removed on applying the sponge; the
urine was found to be albuminous for the first time; the pulse was rapid
and weak; the tongue dry; the strength was much reduced. Quinine
was prescribed, and he was ordered to have beef-tea, and milk with
isinglass, and wine occasionally. -
8th. The tonsils were entirely removed, with portions of the arches
of the palate, leaving a ragged edge. The patient had some refreshing
sleep. He complained of no pain in the throat, but there was slight
uneasiness on pressure, in the right sub-clavicular region. On exami-
nation, slight fluctuation, was perceived. An exploring needle was
passed, and, subsequently, a small opening with a lancet was made.
About a pint of healthy pus was evacuated, which continued to flow in
greater or less quantity until the 13th of the month.
18th. On this day, a large slough came away, and the discharge then
ceased. The throat had not, since the last report, caused any uneasiness;
the redness had entirely disappeared, and no pain had been complained
of; the urine had greatly increased in quantity, but was still slightly
albuminous. - -
14th. The countenance was much improved, and the patient felt a
desire for food. The wine was ordered to be discontinued.
15th. The patient's health was progressing rapidly; the skin was
moist, the urine abundant, without albumen, and presenting a large
deposit of lithates. He was ordered to have a mutton chop.
18th. (9 a.m.) He was progressing, and his strength was much in-
creased. (10 p.m.) I was summoned hastily to the little patient. A fit
of coughing had caused the cicatrix of the abscess to give way, and
about twelve ounces of blood gushed through the wound. The haemor-
rhage was restrained by pressure, and by a compress of lint, held down
by strapping, and a bandage was left on the part. ..a
19th. The countenance was rather blanched; he had slept well; there
had been a slight oozing of blood during the night. A mixture of
gallic acid was prescribed, and he was ordered to have port wine, etc.
24th. (9 a.m.) There had been occasional oozing of blood since the
last report, together with a small amount of pus, the whole averaging
from two to three ounces in the twenty-four hours. The pressure had
been kept up with the compress and strapping as before. Notwith-
standing this drain on the system, the child was progressing; he slept
well, and was gaining strength. The chief difficulty was to restrain
him from exertion. (9 p.m.) There had been a little more blood than
usual, and no pus. In consequence of the difficulty of keeping the
strapping adherent, I plugged the wound with along thin strip of lint,

722. SCARLATINA MALIGNA : DEATH FROM HAEMORRHAGE.
without any loss of blood. I had not left the bed-side above a few
seconds, when the child, in a paroxysm of rage, pulled the lint out of
the wound, thus tearing it open ; above a pint and a half of blood
gushed out in a stream. With the aid of some ice, which was on the
table, and by pressure, the haemorrhage was soon restrained. A small
plug of lint was afterwards introduced, and compresses were applied as
before. - - .
25th. He was much reduced by the haemorrhage; the pulse was
small, quick, and thready; the countenance blanched; and there was a
constant oozing of blood. Myfriend Mr. Anderson now saw him with
me, to consult as to the propriety of any surgical interference. On
removing some of the plaster, we could see the sac gradually fill with
blood. From the state of the little patient, the uncertainty as to what
vessel was ruptured or ulcerated, and other difficulties which surrounded
the case, we determined on continuing the pressure as before. He
complained of slight pain in his right knee.
26th. Mr. Anderson again saw the case, but decided that no surgical
interference would be safe. On my visit in the evening, the patient
complained of cough, and urgent dyspnoea, amounting to orthopnoea.
On percussing the right side of the chest, I found dullness in the
lower part, with absence of the respiratory murmur ; the upper portion
was clear. From the pain, and difficulty of moving him, a further exami-
nation was not made. He was now placed on a water-bed, his hips and
sacrum being a little sore. He complained of pain in his right knee,
which was much swollen. The urine was scanty, albuminous, and dark
coloured. About 3iv had been passed during the last twenty-four hours.
A catheter was introduced, but the bladder was found empty. It was
with much difficulty that he could be persuaded to take anything except-
ing water, and that in very small quantities. He was very irritable,
and the slightest exertion caused an increase of the haemorrhage.
27th. There had been slight hamorrhage since my last visit; the
voice was weak; the pulse 140; there was slight subsultus; the dull-
ness on the right side of the chest was found to be increased to about
an inch above the mamma. That side was immoveable during inspira.
tion, except at the apex. The intercostal spaces were bulging; the
urine was scanty. - • *
28th. He had slight cough when he changed his position; the breath-
ing was easy; he had slept better, and his countenance had improved,
The urine was much more copious, high coloured, but contained no
albumen; the right knee was swollen and painful, the left slightly so.
March 1st. He passed a restless night. In consequence of picking
the edge of the plaster, it became detached from the skin; a gush of
blood, which Saturated the bed, followed, and the little sufferer expired
shortly afterwards.
SECTIO CADAVERIS, TwPNTY-EIGHT HouRs AFTER DEATH. Eacternal
Appearance. The body was much emaciated; the right side being much
more prominent than the left, Immediately above the opening of the
abscess, were two other openings, formed by sloughing of the integu-
ment, and a third one above the clavicle. On carefully dissecting the
integument from the pectoral muscle, the abscess was seen to extend
BY R. J. HALE, M.D. . . - 723
over that muscle into the axilla, thence upwards over the clavicle into
the neck, as far as the mastoid portion of the temporal bone, passing
along to the angle of the jaw. The pectoral muscle was much softened,
and, in parts, reduced to a pulpy mass. A clot filled up the axillary
space, and there was another clot above the clavicle. On removing the
latter, there was seen the ulcerated opening of a branch leading into
the subclavian vein; its mouth was partly closed by a clot. On making
pressure on the sheath of the deep vessels of the neck, a jet of blood
issued. This was found to proceed from an ulcerated opening in the
internal jugular vein, with thickened and everted edges; it was some-
what square in shape, and rather more than half an inch in length. In
the opening was a clot of fibrine, almost entirely filling it up, and ex-
tending upwards and downwards about four inches. -
Thoraa. The right pleural cavity contained upwards of a quart of
sero-purulent matter. The lung was pressed against the back part of
the chest ; it was solid, impermeable to air, and not more than three-
fourths of an inch in thickness: in cutting into it, it resembled flesh.
The left side was healthy. The Pericardium contained an ounce of
sero-purulent fluid. At the base of the heart was shreds of lymph,
binding it loosely to the pericardium, as well as other portions floating
in the fluid. The heart was otherwise healthy; the right ventricle
contained a clot of fibrin. The Kidneys were considerably congested,
and somewhat soft. The Right Knee contained rather less than an
ounce of pus. On dissecting into the muscles of the thigh, pus was
found in the cellular tissue between them, and also among the muscular
fasciculi. On examining the vessels, no trace of phlebitis could be seen.
REMARKS. In relating the preceding interesting case, my object has
been not only to direct attention to the rapid destruction of parts, which
takes place during some forms of scarlatina, and the insidious mode in
which ulceration proceeds under the apparent well-doing of the patient;
but to shew that the renal affection is frequently among the primary
phenomena of the disorder. In this case, as in ordinary “Scarlatina
maligna”, the eruption was entirely absent; there was albumen in the
urine on the third (?) day; the throat and the kidneys were affected at
one and the same time; and we may reasonably infer from these facts,
that the presence of excrementitious matter in the blood gave intensity
to the general symptoms.
In looking over the case, the first thing that strikes us is, the rapid
destruction of parts; for we find that from the first evening to the third
morning of my attendance on the patient, a period only of fifty-six hours,
ulceration had commenced, and had proceeded so far as to remove the
uvula, tonsils, and the soft and portions of the hard palate: during this
time also, pus had been forming, and making its way between the mus-
cles of the neck, until an abscess was found, on the fourth day of my
attendance, pointing in the sub-clavicular region. On the ninth day of
attendance, the slough came away, and the little patient rapidly improved
until the evening of the fourteenth day, when the firsthamorrhage took
* See papers entitled, “The Kidney in its relation to Scarlatina”, by JAMEs
MILLER, M.D., Lancet, August 1849. Also republished in a separate form ; and
reviewed in this Journal for March, 1850, p. 276. - --
'724 DR. R. J. HALE's CASE OF SCARLATINA MALIGNA, ETC.
place. As to the cause of the last-named occurrence, it would appear,
either that the ulceration must have been progressing during the whole
time, or, that the cellular texture about the vessels of the neck had been
removed by the destructive action of the disease, and that the vessels
themselves only required some slight increase of distending force from
within, as for instance, during a violent fit of coughing, to rupture them.
The serous inflammations are clearly secondary to the scarlatinal nephri-
tis. , Dr. Golding Bird mentions, that “the train of effects following
scarlatina, are almost all referrible to the retention of the nitrogenized
elements of urine in the blood”; and adds, that “the recognisable
sequelae of scarlatina, referrible to this category, are characterized by the
tendency to the setting up of serous inflammation, especially of the peri-
cardium, pleura, and arachnoid”. These remarks are borne out in this
case ; for we found, on the 26th, that serous inflammation had taken
place, with effusion of pus into the cavity of the pleura, as shewn by dull-
ness of percussion, and absence of respiratory murmur about the lower
part of the right side of the chest. I may here remark, that the dys-
pnoea was most urgent, when only a small part of the lung was rendered
unfit for its office, during the first few hours of the effusion: but that
the dyspnoea passed off, or nearly so, when the whole lung was destroyed.
This was an instance, of not very unusual occurrence, shewing that the
system does, under certain states, accommodate itself to the impeded
state of respiration or of other functions. -
The presence of pus in the knee-joint is remarkable. An examination
of the veins in the neighbourhood, did not reveal any inflammatory ap-
pearance. May not the pus have found its way through the ulcerated
opening of the internal jugular, and have deposited itself in the knee-
joint, without any phlebitis? Or may it not have been a secondary
inflammation, analogous to the serous inflammation within the cavity of
the chest ?
There is a case narrated in the Edinburgh Monthly Journal for March
1848, by Dr. Alexander King of Glasgow, which he attended along with
Mr. John Brown of that city, in November 1842. The description of
the case is illustrated by a drawing of the parts, as seen on dissection.
Dr. King's case resembled mine in some respects, and occurred after
Scarlet fever. The patient was progressing favourably, after a small
abscess had been opened in the neck. Haemorrhage took place, without
any evident cause. Pressure on the carotids did not alter the state of
the tumour; but it could not be effectually applied, as cough was induced
from the situation of the tumour. The post-mortem examination shewed,
on cutting through the substance of the parotid gland, that nearly an
inch of the external wall of the internal jugular vein, commencing two
lines below the base of the skull, and extending downwards, had been
completely removed, as if by a sharp scalpel.

3, Finchley Road, St. John's Wood, June 15, 1850.
725
ON MEDICAL OBSERVATION.
By R. G. MAYNE, M.D., Surgeon to the Lock Hospital, Leeds.
THE familiar word used as the heading for the following remarks, has
a fuller and more complete substantive meaning, than is assigned to it
in ordinary acceptation ; for it signifies not merely a looking-at, or
noting—a note, or remark, but a watching diligently and curiously with
the eyes of the mind and body (oculis mentis et corporis servo), a mark-
ing and weighing. In this latter and more comprehensive sense, it is
here employed. It will not, Surely, be held presumptuous to assert, that
the distinction pointed out is not always regarded. -
Our profession's true objects, and the successful administration of
remedies, are so dependent upon the due exercise of observation, that
little, it may be supposed, need be said to establish its importance in
the medical man's career; and yet, though such supposition be ever
so generally entertained, very slight consideration will shew how fre-
quently the belief it implies, is not acted on. From earliest medical
instruction, we are taught not only to listen attentively to the patient's
own, or his friends' uncertain and often erroneous history of his ailments,
but to weigh and consider for ourselves each connecting circumstance,
to scrutinize the condition of each organ, sense, and faculty, the heart,
lungs, liver, kidneys, intestines, the tongue, the eyes, the skin, the
voice, speech, perception, judgment, intelligence, etc., and from a close
and busy, though silent observation of these, their functions, secretions,
powers, and operations, to arrive at well-drawn conclusions whereby to
pursue and regulate the treatment we adopt. Peaceful may that man's
breast be, who can always reflect on having diligently thus performed
his duty to his fellow-man, although in vain.
Many causes interfere with, or are allowed to hinder the exercise of,
observation. The medical student, by his position as such, is, in too
many instances, careless of the instructions given in the class-rooms,
trusting to get all up in time for his easamination; and if he thinks,
beyond the hour of their being addressed to him, of those more particu-
larly alluded to, he does so, as of something connected with the future,
when he shall be in practice for himself, but with which at present,
when bothered with so many things, and only attending dispensary
patients, he need not trouble himself. In this way, habit, which so rules
us all, is imbibed in one of its objectionable forms—that of slurring
over an essential duty, of avoiding the trouble of thought and reflection,
by selecting for treatment some prominent sign or symptom, instead of
the diseased condition it indicates, and without any reference to its
anatomical relations, its physiological dependence, or pathological ten-
dencies—of jumping to a conclusion from hastily Snatched impressions.
Temperament and mental incapacity may go far to produce the same
result; and, in either case, the young practitioner will enter upon his
duties an empirical symptomatist, a mere routinist, prepared to do as
he has seen done in similar cases, but without the wit to discriminate,
or to know when or where the supposed similarity fails. Such he may
726 ON MEDICAL OBSERVATION.
continue to be through a long life, unless the conviction of his culpable
neglect and its disastrous consequences stir up within him a better re-
solution, and there dawn upon his mind the light of an imperative
necessity for inquiry, oral, visual, and mental, and for earnest, deliberate
reflection upon all that he has beard, seen, and thought,-for these are
the true constituents of observation. -
The too prevalent existence of this habit of neglect cannot be denied,
while the proneness to its indulgence, even in the most observant, can be
detected on a little self-examination. The practitioner may have em-
ployed, as it seemed, his best powers of discernment in forming his dia-
gnosis, and in accordance therewith, may have treated disease assiduously
on the legitimate principles of his art, through a protracted term, yet
without any marked improvement in the condition of the patient. Dis-
appointed, wearied, and annoyed, he at length concludes the case to be
anomalous; and either by his own desire, or that of the sick man, or
his friends, another is called in consultation, who after examining for
himself, and ascertaining the few particulars of treatment, perhaps by
a single suggestion, unravels the mystery. The former, internally
blaming himself for having suffered so plain a point to escape his notice,
becomes conscious of having allowed himself to be misled in giving too
great weight to some mere symptom; resolves to watch more closely,
and to keep this instance in view on the occurrence of any other resem-
bling it; forgetting that this resolution strongly tends to the mainten-
ance of the very habit it professes a determination to overcome. But
the circumstances might have turned out differently; the practitioner
called in consultation might himself have been empirical, and have
satisfactorily vouched for his respected brother's talents and acuteness;
the patient might have lingered and died in the happy confidence of
an anomaly, and even if matters were at last made very plain by a post-
mortem examination, all might have been arranged and conveniently
explained. “ .
| Such an instance, it may be remarked, shews the benefit which may
be obtained from a consultation, in cases of doubt and tedious progress.
Not that there lies that infallible resource for the dying, which seems
to dwell in the popular imagination, in a formal presence at the bed-
side, of the “M.D.” or “doctor of advice”, as he is fancifully termed by
the vulgar, apart from all notions of status, acquirements, habits, and
experience. But when the mind, embued, perhaps in the outset, with
special views not easily to be relinquished or changed, becomes jaded
with long watching and ineffectual effort, grows uneasy, doubting;
and self-accusing, how gladly it seeks and finds relief in the fresher
judgment of some clear, calm, well-trained, and observant intellect,
no matter whether of one styled “physician”, “surgeon”, “general
practitioner”, or simple “apothecary”. There is no special virtue in
walls of stone or of brick, nor superiority in the distinctive parchments
vended within them, provided only they be honestly dealt out. The
man, his mind and intellect, are what the sick have to do with ; not his
license, neither its source, nor its cost. - -
But whatsoever the causes which produce neglect of the exercise of
observation, we may feel assured, that according to our consciousness of
BY R. G. MAYNE, M.D. '727
its importance, (and what man capable of thinking can be ignorant of
this?), so is our responsibility for its neglect. Simply to read the
expression of such a sentiment, carries little force, attracts small regard;
for the very dereliction, a censure of which is implied in its terms,
precludes its being properly received, or provokes its rejection altogether.
Still will the truth remain, however, in the integrity of its momentous
import. No mere question of professional etiquette is concerned ; no
single act of petty rivalry; no silly point of precedence, as to grade or
status; no foolish pride, arrogant assumption, nor burning jealousy;
nothing less considerable than the preserving of a life, or of health,
entrusted for a time to our care. How greatly may the issue affect the
interests of many for the present; how very greatly those of at least
one for the future. - - - - -
It will be conceded, that most of us are inclined to practise empiri-
cally, in greater or less degree; that is, that when we happily succeed.
in a marked manner by a particular mode of treatment in one case, we
are apt, perhaps from a natural addiction to think well of ourselves and
our proceedings, to prescribe, or adopt the same course, during the as-
cendancy in our estimation of that kind of treatment, in all other cases
which can be construed into an analogy. Nor can it have failed to strike
any one as wonderful, that there always occur a number of cases about
the same time, so very like each other, that we seem to have nothing to:
do but apply the same remedy. It may indeed be said in explanation,
that many affections are dependent on atmospherical and other general
influences, and that, therefore, it is exceedingly probable that several
similar instances of disease may occur about the same time, nor need
it surprise that, in these, the same remedies should be indicated and
prove suitable. The reasoning is just, but is applicable only to a cer-
tain extent; for allusion is made not only to epidemic diseases, but to
those that are sporadic in every variety, and even comprehends hidden
surgical disorders, cancers, strictures, tumours, ulcerations, etc. We
thus perhaps avoid a little trouble, and, not unlikely, flatter ourselves.
with the pleasant conceit that we have hit upon something valuable, in
the way of discovery in the symptoms, or in the treatment of a certain
class of maladies—a conceit which we reluctantly abjure, only when
some palpable example of non-obedience to our fancied specific evinces.
the danger as well as absurdity of indulging, however slightly, in the
whim of a universal medicine. So well-founded is this fact, that it is
no unusual thing to remark physicians in extensive practice, who intro-
duce for a period into almost every prescription they write, some favoured
item of the materia medica, or over-rated pharmaceutical novelty: or
to find surgeons setting their professional affections upon the rectum-
bougie, or the uterime sound, for which, or the like, they, during a sea-
son, meet constant occasion. - -
Special examples of this aptness to empiricize, to the exclusion of
any attempt at observation, and consequently to the neglect of the only
right means whereby the sick are to be healed, might now be offered;
but these will readily present themselves to recollection in individual
experience. There is one, however, appallingly memorable,_like some
huge monster, that lately stalked among us in open day, scattering terror
728. ON MEDICAL OBSERVATION.
and death, and whose shadow has scarcely yet passed away, which may
be more particularly noticed. .
It were idle to detail the so-called remedies recently reputed as
curative of cholera. We may better indicate the truth, by asking what
remedies were not tried and severally vaunted by their proclaimers
as specific, from chloroform and oxygen, back through the range of
the materia medica, to the Coffinish dose of cayenne and ether, down,
down to very quackery, homoeopathic and hydropathic, drops, pow-
ders, mixtures, and nostrums innumerable? And was there one
of the entire catalogue, that deserved the commendations heaped
upon it by its patrons, the deceivers, or the duped ? Experience
solemnly declares, not one ! Because cold—an icy-coldness—was
present, and diffusible stimuli were known to excite warmth, brandy
was “poured” into the stomach; because pains and torturing cramps
were suffered, opium was liberally administered; because thirst was
urgent, drinks were given in profusion; and because the fluids were
largely evacuated, cold water was sent down in gallons to supply their
place, but only to be thrown back with a characteristic accession to its
quantity. In all this, was there not the very perfection of empiricism 2
The proportion of deaths in many districts was excessive. Who shall
truly say, how many of these were the result of uncontrollable disease,
or only the natural consequence of disease uncontrolled, because un-
combated, may, left to run riot among the helpless, defenceless sick, by
the non-application of proper remedial means, by their too late applica-
tion, or by the deceptive administration of mock-cures? These last
were everywhere thrust upon the attention of the ignorant by base, life-
pandering, quack-druggist compounders, and others, non-medical, but *
vain and presumptuous, who having seen cholera abroad, undertook to
cure it, forsooth, at home, with no other qualification for the purpose
than the regnant nostrum of a former day.
Even with calomel—the only substance which seemed endowed with
some degree of power to check the devastation—the failures were
dishearteningly numerous; more so, indeed, than is to be accounted
for by the difference of circumstances in various cases, such as lateness
in having recourse to the remedy, deteriorated constitution from other
diseases, depraved habits, etc. The heavy amount of loss of life in
certain districts, as compared with others, suggests serious and painful
reflections as to its causes, some of which were, unhappily, palpable
enough to the commonest apprehension. But, from the observation of
Cholera, whether left to its own course, or combatted by medicines,
much was learned of its character and natural history; while by pur-
suing the same exercise with regard to the various modes of treatment,
judicious or injudicious, our knowledge of the disease, though far from
being perfected, must have been improved.
In reference to the particular fact which has led to so lengthened a
digression, an observation, which was amply verified afterwards, occurred
to my mind, and probably may have presented itself to others, although
in none of the numerous experiences detailed, or theories propounded,
which have come under my notice, has it been alluded to. It was the
very marked distinction in the issue, between patients in cholera, who
BY R. G. MAYNE, M.D. 729
were of a calm, firm, enduring temperament, or who had courage to
bear, with martyr-like patience, the tortures of parching thirst and
agonizing cramps, the sensations of a leaden apathy, slowly, surely,
stealing “upward and upward”, the terrible sense of semi-death—and
those of an excitable, restless, and irritable habit, who obstimately dis-
regarded all entreaties to keep perfectly still; who, with the most
earnest warnings of certain dissolution as the consequence, reiterated in
their ears, would yet heave and toss themselves about, on every racking
impulse of pain, to the utmost of their power. This is not the place toº
give cases in illustration, but they were numerous; the former, in many
instances, recovered; the latter, never—though, to all seeming, both
had the disease in equal degree of severity, and both were treated alike.
So surely did the distinction appear, that the result, favourable or fatal,
could with general exactness be prognosticated. Is there not something
here for physiological and pathological consideration ? -
Observation constitutes the most valuable attribute of the medical
practitioner; it is at once the calm investigator and the eager promoter
of Science. It forms the essential means by which experience is ren-
dered profitable; the unfailing source whence come knowledge, wisdom,
and professional skill; the element, as it were, which sustains, aye,’
and sometimes raises to dazzling intensity, the steady flame of the
discoverer's lamp; but also, it is his strongest, his paramount duty. How
grave the consideration, that, through its neglect, human life may have
been lost And who is there among us that, looking back upon his
arduous course, knows no cause of regret, and truly feels that he him-
self is not chargeable with some instance of neglect of observation?: The
circulation, vaccination, the diastaltic nervous system, the application of
the stethoscope, the special uses of ergot, of quinine, of iodine, and cod-
liver oil—each important discovery, or just adaptation of remedial means,
has been the product of persistent and untiring observation. Great, then,
is the stimulus thus presented to intellectual exertion, in every profes-
sional relation in which we may be placed, to acquit ourselves worthily.
in our difficult and responsible vocation.
Leeds, July, 1850.
780
ILLUSTRATIONS OF THE DIFFICULTIES WHICH BESET
THE DIAGNOSIS OF SOME CASES OF DISEASE.
By THOMAS POYSER, Esq., Fellow of the Royal College of Surgeons of England.
INTRODUCTORY REMARKS.
I HAVE been much gratified by the perusal of a paper in the LoNDON
Jour'NAL OF MEDICINE for May, by DR. SEMPLE, on “Diseases of the Ner-
vous System.” The cases which he so candidly and graphically describes,
are familiar to all who are in extensive practice, and show but too clearly
that, in a great variety of cases, which terminate fatally, the symptoms
during life do not develope the true seat and nature of the malady.
The great attention that has of late years been paid to general and
morbid anatomy, and to pathology, with the mechanical aids that have
been had recourse to, for the investigation of diseases, as well as the
more patient and inductive method of studying them by those who prac-
tise medicine as a science, have no doubt tended materially to render
diagnosis and symptomatology more clear and specific; yet there is still
a wide field open, in this most important department of medical prac-
tice, for future explorers. - -
... To ascertain the true pathological cause of disease is confessedly the
most difficult, as it is the most important, part of medical practice.
Indeed, as Celsus has well observed, “aestimatio causae saepe morbum
solvit.” Many causes, however, concur in practice, but more especially
in the country, to render the patient observation of disease difficult, if
not almost impracticable. Extensive practice, while it renders the
practitioner familiar with the phenomena of disease and its terminations
and best means of cure, leaves rarely much leisure for the miceties of
physical and chemical exploration, required in obscure cases. They
who have the most extensive field of practice, are apt, in the hurry of
business, to depend on tact, a sort of intuitive gift, like the tactus
eruditus of the surgeon : and hence their examination of cases is apt to
become habitually superficial, and a routine mode of prescribing is also,
from the same cause, too often allowed to usurp the place of rational
treatment. - -
I do not state this to the disparagement of the general practitioners,
than whom a more painstaking, intelligent, or conscientious body of
men does not exist, in our own or any other profession. But we cannot
expect impossibilities; and the multiplicity and diversity of cases which
the well-employed medical man has to visit daily, if spread over a great
extent of country, forbid that minute attention and examination which
are frequently required. -
Another hindrance to the complete investigation of disease, when it
terminates unfavourably in the country, is the great repugnance to post-
mortem examinations. In large towns and public institutions this pre-
judice is not so strong; but in some rural districts, a request to have a
post-mortem inquiry almost invariably gives offence to the relatives, and
is very rarely permitted. The country practitioner has seldom, there-
fore, an opportunity of verifying his diagnosis by a post-mortem examin-
ation ; and if he had doubts on his mind as to the cause and seat of the
MR. Poyser on DIFFICULTIES of DIAGNOSIs of some DISEASES. 731
disease, during the life of his patient, those doubts have little chance of
being cleared up by his death.
Occasionally, however, a post-mortem examination is allowed, and
then we sometimes find that the true seat of the disease is revealed,
which during life was not suspected, nor indicated by the symptoms.
These unlooked-for terminations of disease are seldom given to the
public; as they imply, (though often unjustly), a want of skill, or per-
spicacity, in the medical attendant: while periodical works teem with
cases terminating favourably, or where the examination after death
proves the diagnostic skill of the narrator. In systematic treatises too,
and monographs on particular diseases, the general history of the
symptoms, treatment, and termination of the ailment, proceeds too
smoothly to meet the exigencies and stern realities of actual practice.
Untoward and unlooked for terminations of disease are seldom adverted
to, or recorded; and yet these furnish the most important and instruc-
tive part of the history, as they are beacons or landmarks to future
Inquirers. {e
In the short but elegant preface to the transactions of the College of
Physicians, written, as is generally supposed, by the late Dr. Heberden,
is this paragraph : “It is to be wished, that writers would not confine
themselves to relate only their successful practice. A physician of
great experience might write a very useful paper, if he would have the
courage to give an account of such methods of cure only, as he had found
to be ineffectual or hurtful.” With the wish to further a suggestion
coming from such high authority, I published a few years ago, in the fifth
volume of the Transactions of the Provincial Medical and Surgical Asso-
ciation, some cases and dissections “to shew the uncertainty and diffi-
culty of diagnosis; from the symptoms during life not being indicative
of, or bearing any proportion to, the extent of morbid lesion discoverable
after death”. The cases to be offered to the readers of the LoNDoN
Journal, of MEDIGINE, may be regarded as a continuation of these
reports. Having no system to establish, or theory to support, they will
be selected indiscriminately, from notes taken at the time: and although,
perhaps, but little may be learned from them in the way of practice, yet
I trust that, from the reasons above stated, they will not be found uninter-
esting or useless. An important object will be answered by their publica-
tion, if it induce others, whose opportunities of observation from public
hospitals and other sources are much greater than mine, to publish such
results of their experience, as may illustrate the difficulties which beset
the diagnosis of some cases of disease. &
CASE I. OBSCURE NEURALGIG PAINs: DISEASE of THE BRAIN, AND
ENLARGEMENT OF THE LIVER, Mrs. —, aged 40, the mother of a large
family, and a lady of great intellectual attainments, who had usually
been in the enjoyment of good health, was attacked in the Autumn of
1844 with acute pain in the right groin, or rather in the inner and
upper margin of the ilium. The pain was limited in extent, and might be
covered, as she expressed it, with her finger, but was so acute as to deprive
her almost entirely of sleep, and to render any motion of the part nearly
insupportable. There was no swelling, redness, nor any appearance of
WOL. II. - 49 &
732 MR. POYSER ON DIFFICULTIES OF DIAGNOSIS OF SOME DISEASEs.
inflammation. This pain continued some months, without varying its
seat or character, and but little controlled by treatment.
It was considered to be neuralgic ; and every means that could be
suggested, both constitutional and local, were tried by an eminent
surgeon who them attended the case. During the progress of this
affection, Mrs. — herself discovered, while in bed, (to which she had
long been confined by the neuralgic pain), a swelling in the right side
below the liver. On examination, this viscus was found much enlarged,
extending four or five inches below its normal size and situation, of a
stony hardness; but unattended with pain or tenderness on pressure. It
seemed to account for the pelvic pain, inasmuch as the pressure from
this indurated mass on the nerves might occasion it. Mercury with
taraxacum, and iodine and mercurial frictions, were therefore had recourse
to, without any alleviation of the pain, or diminution of the hepatic
disease.
In the Spring of 1845, the patient was removed to her mother's
house in this neighbourhood, and on April 5th I saw her. In addition
to the enlargement of the liver, and the acute pain on the inner margin
of the crista ilii, there was now tympanitis, the bowels being enor-
mously distended with flatus. There was no pain in the head, no fever,
and the pulse and tongue were natural: but there was a degree of irrita-
bility of mind and fretfulness which was remarkable, as Mrs. —'s natural
disposition was peculiarly placid and gentle. It is unnecessary to detail
the treatment, as but little or no relief was obtained from it.
The tinctura cannabis indicae soothed and tranquillized the nervous
feelings; and the unguentum aconiti as a local application, (suggested
by Sir Benjamin Brodie, who was consulted), in some degree assuaged
the pain; but the general character of the symptoms continued unabated,
till about the middle of April, when the pain began to diminish, and, in
two or three days, went off altogether. After the removal of the pain,
Mrs. —'s spirits and appetite improved ; she was able to sit up and walk
about her room; and although the tympanitic swelling and enlargement
of the liver did not diminish, yet she was cheered by the freedom from
pain, and the prospect of recovery.
On the 28th of April, while sitting in her chair, Mrs. — had an
apoplectic seizure, which deprived her of speech and the power of swal-
lowing, from which she never rallied. She expired May 3rd.
A post-mortem ea amination was made thirty-six hours after death.
On removing the calvarium, the external part of the brain presented
no diseased appearance; but, on cutting into the left hemisphere, it was
found to be quite degenerated in structure. The whole of the anterior
lobe was converted into a thick purulent fluid; and, in the middle of
this large abscess, there was a clot of blood of the size of a walnut. This
coagulum appeared to be of recent formation. The left middle lobe
was pulpy and diseased, but the other parts of the cerebrum and cere-
bellum had a firm consistence and healthy structure. The abdomen was
very large, from the bowels being enormously distended with flatus, but
there was no extravasated fluid or gas in the cavity. The left lobe of
the liver presented a very diseased appearance. It was enlarged to more
than twice its usual size, had almost a stony hardness, was mottled and
tuberculated externally, and on cutting into it, its texture was gristly
ORATIO HARVEIANA, A.D. MDCCCL. 733
and exhibited that diseased structure termed mammary sarcoma. The
inner edge of the ilium, where the pain had existed so many months,
was carefully examined, but there was no morbid appearance discovera-
ble in the part, or in the nerves leading to it. The thorax was not opened.
REMARKs. This case is, I think, interesting, and worthy to be re-
corded. It shows that the symptoms did not point to the true seat of
disease, till a short time before the patient's death; and that exten-
sive disorganization may be going on in the brain, without impairing its
functions, or manifesting those signs by which it may be detected. The
fretful and altered manner of the patient led to the apprehension that
softening of the brain might be going on; but the total absence of pain in
the head, and Öf rigors, or any indication of inflammatory action, rendered
the diagnosis very difficult. It is highly probable, that the pain in the
right side of the pelvis was occasioned by disease of the left side of the
brain, and furnishes an additional instance to those recorded by Sir
Henry Halford, where neuralgia was the effect of cerebral disorganiza-
tion. When the latter disease had so far advanced as to disqualify the
nerves from suffering so, exquisitely, then the pain ceased. This case
shows the importance of attending to the brain, in all long-continued
and obscure neuralgic pains, although the functions of that organ may
not be impaired. -
Wirksworth, July 4, 1850.
ORATIO HARVE IANA,
IN AEDIBUS COLLEGII REGALIS MEDICORUM HABITA,
DIE JUNII XXIX, MDCCCL.
A JACOBO ARTURO WILSON, M.D.
ANNo, quo nullus post hominum memoriam fumestior, jam exacto, vos
iterúm, Praeses et Socii, Harveius ille noster dilectus, in festum suum
aestivum haud immemores convocat ; iterüm in amorem et amicitiam,
scientiae causã, ut pater liberos, amanter vos hortatur; necnon in scien-
tiam experientiae vià solā adeundum esse, vos, ut philosophus discipulos,
fideliter admonet. Ad hunc finem, ipsius jussu institutae, et veteri
nostro curriculo de anno in annum repetitae, ex suis ipsius verbis sit,
pace vesträm, hujusce orationis exorsus. Attendite igitur, Socii, hospites,
et, quicumque huic festo favetis, fratres medici nec vereamini, pro hac
saltem vice, aures adhibere in verba, non mei Londinensis, linguà non
meå balbutientis, et Latino pede claudicantis, Sed Anglica, Harveiana, ex
ore suo ipsius, octogenarii, et, quasi e sepulchro, prose et suis in omne
aevum loquentis. - - - * * , ,
“To maintain friendship, there shall be at every meeting, once a
month, a small collation, as the president shall think fit, for the enter-
tainment of such as come; and, once in every year, a general feast for
all the Fellows; and on the day of such feast shall be an oration, in
Latin, by some member, to be appointed by the President, two eldest
Censors, and two eldest Elects, so as not to be appointed two * toge-
4
734 ORATIO HARVEIANA, A.D. MDCCCL.
ther, in commemoration of the benefactors by name, and what in parti-
cular they have dome for the benefit of the College, with an exhortation
to others to imitate, and an exhortation to the members to study and
search out the secrets of nature, by way of experiment; and for the
honour of the profession, to continue mutually in love.” -
O lepidum, præclarum, et ter dilectum caput ! Håc voce tuá ama-
bili dum aures nostrae adhuc personant, quâm te, ex cordis motu,
per sanguinis affluxum, in pectora nostra recipere videmur ! Te talem
mos mon diligamus, non admiremur, non omni ratione praeponendum
putemus 2 Id unum tibi objicio, quðd, natu Anglus, in håc Anglorum
concione, pro te, stirpe, moribus, indole, (si quis unquam) Anglico, de
medicină et medicis Anglicis hanc orationem aggressurus, linguæ alienae,
nec mea, nec tuæ, compedibus obstrictus sim. {
Profectd, Socii, piget me quam vehementer quëd in foro Londinensi
Romanas has agere partes, jam in provectione aetate, et sine ullá in hoc
genere dicendi exercitatione, designatus fuerim. Quâm libenter au-
tem (si ita inter nos de more esset licitum) verba nostra, quotidiana,
spirantia, Viventia, natalijure propria, materno usu consecrata, ad Har-
veii votum explendum, in vestram indulgentiam et ex animi copiā.
commendarem Pro tarditate et debilitate hujusce mei oris in linguà
adoriendà quae semper mihi in deliciis legenti, perdifficilis et in fastidio
loquenti fuit, veniam a singulis vobis, quantam impetrare fas sit, libenter
quaeso, Habetis confitentem reum. Nequeid wellem a vobis putari, quéd,
ex hoc concursu hominum literatissimorum, mihi Ciceronis linguam
aggressuro ulla praeter modum Sollicitudo inciderit, quasi, hisce utens
tam limatis judiciis, mimore indulgentiã condonandus essem. Immö
etiam, ex hac frequentiá judicum lectissimorum, fiduciam, et, qualis
cunque sit, dicendi copiam recipere videor.
Quo magis enim quisque ingenio et studio in litteras humaniores est
proclivis, eo minis mihi in his molestiis luctanti favere recusabit.
Nemo, nisi non expertus, se in tali labore validum profiteatur. Scriptores
et oratores Romani mihi multó cariores et multó magis admirandi Sunt,
quàm ut eos e pusillā mea ingenii facultate aemulariin propositum veniat.
De “Latinitate”, ità dictá, si ulla sit, aut mulla sit, cujus compos esse
videar, quid mihi, interlondinenses Londimensi, curae est? In håc meåpro
Harveio magno allocutione, id primūm respicio, ut verum sit id quod
dicam, ut quod sentiam sit sincerum. Id maximé wereor, ne quod dicam
perinde intelligi auditu possit, atque ego ipse cogitans sentio. Faustum
sit mihi, utpote trepidanti, Omen, quðd non primus ego Wilsonus coram
hoc collegio orator pro Harveio adsto. Nam paucis diebus post Har-
veii excessum, verba haec, inter alia quae in laudem Harveii Georgius
Entius, amicus ejus conjunctissimus, conscripserat, Wilsonus, Socius
et doctor, recitavit: “Fessà tandem fractâque senectute, funeri suo
propinquus, rerumque aliarum omnium securus, pulsuum suorum
rhythmos explorabat ; ut qui vivens valensque vitae exordia, ejusdem
progressus, alios docuisset, ipsemet jam denascens mortis praeludia
addisceret. Tandemque Octogesimum annum emensus, qui tertius
praeteriti mensis erat, occubuo sole, placidissimo animo mortalitatem
exuit, fatique necessitatem explevit.” Wilsonum illum Socium, annis
abhinc feré ducentis, de Harveio vix id temporis mortuo, coram afflu-
enti medicorum frequentiá tali Voce perorantem, quanta gratia, quantae
A JACOBO ARTURO WILSON, M.D. 735
lâcrymæ insecutæ fuerint, quis nostrùm etiam nunc eadém verba auscul-
tantium non ex corde sentire videtur?
Favete auribus, favete adhuc animis, sodales et Socii ! Alterum
Wilsonum, Harveianæ indolis, si quis unquam alius, conscium, fortem,
mansuetum, generosum, veritatis præ cæteris amantissimum, Harveio
ipsi studiis anatomicis haud imparem, de sanguine et cordis motu, ut
de corporis totius fabricâ et usu per annos triginta prælectorem et scrip-
torem, Hunterii Gulielmi et fratris ejus Johannis alumnum, Bailliaeo
nostro benefactori familiarem, et laborum cónsortem, Jacobum Wilsomum,
chirurgum, his recentioribus temporibus præreptum, memoriâ vestrûm
plurimorum adhuc lugenti expetitum, ante ora omnium, gratus, et quò
ad hoc superstes, lætus, repono. Favete ejus nomini, præsertim hoc
die, Socii et medici fratres ! Eorum enim omnium, qui amatomiam in
hoc Angliæ regno excoluerunt, nemo per longiorem seriem annorum,
ad cumulandam Harvéii nostri laudem magis sedulò et majore fructu
enixus est.
Mi Pater ! Videor mihi videre patrem meum, eo habitu vultûs, eo
vestitu quo vivebat, in Lyceo Hunteriamo, coronâ discipulorum, immò et
virorum in medicinâ principum,—nam a plurimis semper audiebatur,—
die kalendas Octobris circumsessum. In visum et auditum interiori
animi sensu jam nunc recipere eum videor, sublato fronte, oculis, præ
amore et reverentiâ, cùm humidis tum fulgentibus, dum de Harveiiin-
gemio, fide, constantiâ loquebatur, cor omnium auscultantium, ut suum,
ex imo suscitantem.
Ignoscite, Socii, cui filio res, locus, dies ipse suppeditat, si, orans
pro Harveio, de patre, viro Harveiamo, quòd memini obstat, paulò libe-
riùs locutus fuerim. Hodie de mortuis, pro honore, agitur. Sed ne
diutiùs morer in ejus laude, quæ mihi soli in hoc concursu est carissima,
vestra expectatio me jampridem, etsi indulgenter, admonet.
De rebus hoc proximo amno gestis et factis, (orationes enim, ut hæc
quæ mune habetur, ab Harveio in perpetuum institutæ, Collegii nostri
quasi annalia et fasti esse videntur), e quibus aliquid lucri vel damni,
honóris vel incommodi, communitati nostræ acciderit,—de. statu, pro-
gressu, et futuris artis medicæ fortunis,—de morum inter nosmet-
ipsos disciplinâ et consuetudine, a me pro meis viribus, dicendum est.
Respicite, igitur, in annum vix præteritum, vos, Præses et Socii !
qui mecum huic solenni orationi inserviatis ! In triviis—per vicos—per
aperta rura—apud ipsas Baias, qui pavor ! quantus luctus ! quæ fre-
quentia funerum ! Quæ hæc est immanis morbi species ! hæc mortis
imago nova ?—Annus nefastus!—Collegio nostro, præ cæteris, heu !
sine gloriâ memorabilis. Annus, in quo, huic urbi insolitâ et sævissimâ
peste diu ingruente, tum postea universum Angliæ regnum vastante,
Collégium hoc Regium Medicorum Londinemsium, neque a senatu,
nequè à consiliariis reginæ intimis, neque a prætore. regio ad res
domesticas administrandas designato, me unâ quidem vice vel voce, im
auxilium salutis publiéæ vQcatum est! Neque in curiâ, neque in foro,
prævalente morbo, vox nostra audita est. A nullis nostri periculum
factum est consilii!
Per cor et sanguinem Harveii! Quid est, si hoc mom contumelia est!
Nec $atis erat hanc aciem mostram medicorum instructam, in morbo
insolito oppugnando, ne ad suiccursum quidem adhibere,—nos sic negli-
786 ORATIO HARVEIANA, A.D. MDCCCL.
gere, et sic negligendo pro nullis efficere ; quinetiam ex adverso, nobis,
Apolline duce, im pestem dimicantibus, ad Mercurii fabri officinas in vico
proximo Aulæ Candidæ constitutas, signa, si operosa et sanitaria, certè
nom medica, consiliarii regii, ad hoc delecti, sustulerunt. ** Diversæ
voluntates civium fuerunt, distractæque sententiæ. Non enim éonsiliis
solùm et studiis, sed armis etiam et castris dissidebamus. Erat autem
obscuritas quædam, erat certamen inter clarissimos duces, multi dubita-
bant quid optimum esset, multi quid sibi expediret, multi quid deceret,
nonnulli etiam quid liceret.” Post hanc tam turpem immeritamque
repulsam, post hanc quasi ignominiæ notam parietibus nostris auctoritate
publicâ affixam, nunc iterùm ad Harveii festum in hâc concione domes-
ticâ congregati, nos invicem et ex corde gratulemur, quòd, dum pesti
oppugnandum erat, domus nostra ab ipsis suis nullam interiorem
maculam suscepit.
In his molestiis, nec sibi nec nobis sociis suis defuit Præses noster
Parisius; qui, si Parisiis ipsis Galliæ juvenis medicinæ præfuisset, ab
eo concionabulo, cui salus publica permissa fuit, non magis alienatus
esse potuisset. Consiliarios illos regios Mercuriales, doctorum in
medicinâ partes agentes, ultrò, pro dignitate hujusce Collegii et suâ,
decenter compellatus est; omne quod consilii et opis apud nos erat, ad
morbum tractandum vel præcavendum, id nobis properè et libenter in
commune allaturis promissum dedit. In concionem, sub adventum
morbi, nullâ morâ interpositâ, convocati fuimus,—ad exquirendam ejus
rationem plerique e nostro numero delecti sunt, qui experientias suas e
mosocomiisILondimensibus redundantes,in unum afferrent,—immò etiam,
qui per litteras passim in provincias missas, omne, quod in promptu
erat, ad omnium medicorum usum colligerent. Unusquisque nostrùm,
libet dicere, ultrò et pro virili suo perfunctus est officio.
INeque id solùm de medicis hujusce nostri ordinis affirmo, sed etiam
de omnibüs in omni genere per universum Angliæ regnum medicinam
exercentibus. Profectò de nobis ipsis in medicinâ doctoribus vel omninò
tacendum est, dum fratres nostros, quàmvis sime doctoratu, medicos
respicimus, in nosocomiis, in carceribus, in ergasteriis, in vicis et
angiportibus omni illuvie inquinatis, nocte dieque, per menses æstivas
et autumnales, decies vel centies pro unâ vice nostrâ im peste oppu-
gnamdâ occupatos. Quæ fortitudo ! Constantia, fiducia, quàm admi-
randæ! Quæ vigiliæ ! Quanta dispendia et rei et virium ! Quæ incuria sui!
Pro hâc ordinis nostri medici sedulitate in laboribus, quàm sæpè sine
mercede vel minimâ susceptis,—pro tantâ amoris et officii perseverantiâ
in maximo civium discrimine, annon grata eorum mens esse debet,
quibus reipublicæ nostræ cura committitur? an tituli, honores, imagines,
laus publica, tali virtuti nom conveniunt ? Quæret, de his rebus, annalia
hujusce Angliæ perlegens, aliquando quispiam? Prandia, orationes,
“ testimonia", inter omnes ordines ob facta, dicta, merita et immerita
ómnia, ob res gestas vel non gestas, ex omni parte invicem âguntur.
Ob pugnas, trucidationes, rixas theologicas, ob cantilenas, ob aurum
e ferro viis publicis instrato impudenter conversum, hujus vel illius est
famæ recordatio. De medicis, in se pro salute communi mille molestias
et vitæ pericula suscipientibus, in fastis publicis nulla fit mentio !
Sursum corda, Socii! Collegium nostrum Londimense, si, majestate
per alienos læsâ, hoc proximo anno aliquanto minùs regium fuerit,
A JACOBO ARTURO WILSON, M.D. 737
attamen in rebus suis, auctoritate suâ, est nunc vel maximè medicum.
Sursum corda ! Quot modis contempti, spreti! Repudiati, tandem
repetemur.
Quòd, ingruente morbo, materia ad auxilium consiliariorum regiorum
de salute publicâ sollicitorum abundè apud nos suppetiisset, indicio sint
eorum nomina, quos, nostræ societati hoc proximo anno præreptos, heu !
frustrà quærimus. Vespere quinto Idus Octobris, anno hoc superiore,
primus ad hasce ædes, nobis tum primùm in concionabulum convo-
catis, de morbi in Divi Thomæ nosocomium invasione, archiater ejus
hospitii, Henricus Burtonus nuntiavit. Ultrò, et inter primos, æstate
sequente, morbo jam tum inveterato se opposuit; inter primos, Deo
sic volente, morbo occubuit. Et vitæ et mortis exemplo sit nobis
ille frater noster delectus,—cùm in omni tempore, virtutibus, industriâ,
ingenio, a memine obliviscendus, tùm, hoc præcipuè die, merito atque
optimo jure suo, in pathologiâ sanguinis exquirendâ, cum Harveiò
ipso celebrandus. Nam sanguinis cursum, auctore et duce Harveio,
duplici viâ insecutus, attigit, et ratione et oculis, lineam istam cæruleam
margine gingivarum circumscriptam, quâ teste, venenum Saturninum
im vemis et visceribus penitùs receptum quasi in conspectum medici
proponitur. Profectò, ex hâc tam simplici ratione rei, Henricus noster
monumentum sibi exegit, quàmvis e plumbo, ære peremmius. Inter
nos medicos de arte nostrâ naturam ritè exquirentes, metallorum nullum
est vulgare, nulla e splendore nobilitas.
Prout hic, sic ille alter, quem e nostro numero amissum hodie luge-
mus, per vires ingenii et industriæ insitas, materiem naturæ, ab aliis
rejectam vel minimè expetitam, sibi et suæ famæ inservire coëgit.
Præclarus hic plumbo, Proutius ille urinâ ! Ad scientiam excolendam,
tanta est ex rebus omnibus laboris occasio et copia. In materiâ morbi
indagandâ, lex nostra philosophiæ recens haud minùs quàm avidè de
minimis curat. De philosopho illo sexagenario, mensibus abhinc tribus
adhuc vivo, sedulo, operoso, quomodo, nisi ut de philosophiâ ipsâ, licet
loqui? In foro et triviis hujusce nostræ Romæ, dum ad clientelam
suam incedebat, quis et qualis, si non philosophus, ante ora hominum
exstare visus est?—gressu properante, sed tacito,—vultu demisso,—ha-
hitu humili,—vestitu quàm modesto!—infumo etiam pallore candidus,—
ad strepitum surdus,—ad opes non magis quàm modicè attentus. Me
semper pigebat,—et, inter colloquia nostra, annos abhinc viginti, sæpe
eum sic alloquebar,—quòd, in succis animalibus a sanguine excretis tam
assiduè et tam feliciter versatus, a sanguine ipso, vivo, universo, omnia
omnibus ministrante,—a sanguine non solùm passim recipiente, sed
etiam passim agente, quasi animo aversus foret.
Grata et, constans sit Proutii nostri apud nos memoria, non solùm
quòd im pathologià chemicâ ferè primus viam medicam instituerit, sed
quòd alios ad se ipsum æmulandum viribus ingenii sui suscitaverit.
INon ommis, Socii, non omnis ille noster morietur ! In hæreditatem
ejus in studiis pathologicis acuminis et industriæ, ne dubitetis quim
alii de die in diem sint successuri. Apud mos, consensu omnium, jam-
dudum salva res est. Uno, qui volitavit per ora hominum, pennis im
altiùs elatis, remoto, non deficit aureus alter avis.
Amici et sodales ambo, haud ampliùs in hoc cœtu nostro videndi,
inter gemitus et lachrymas valete! Coronas vestras laureatas, heu !
788 ORATIO HARVEIANA, A.D. MDCCCL.
atris lictoribus comitantibus, hoc solemni die in domum vestram re-
porto,—insignia artis vestræ ad effigies Harveii, Sydenhami, Bailliæi
Hîc im perpetuum repono.
Salvete ! ambo, Harveio jubente, idem ego vos iterùm compellor.
Salvete ! ob beneficia in ordinem et domum nostram iterùm recepti,
et, eo titulo, hoc festo die gratâ voce commemorandi ! Laus, honor,
scientia, apud nos, hæc sunt in loco divitiarum,—benefaetores e mostrùm
numero præ cæteris illi, qui virtute, ingenio, doctrinâ, industriâ, sibi
et huic societati suæ gratiam conciliant, existimationem comparant !
Omnibus igitur, qui fundos, ædificia, supellectilem, qui aliquam argenti
vim ad nostrum usum aliquando contulerumt,—vel qui, veræ: medicimæ
scientiam excolentes, in hâc mostrâ vitæ ratione, quotidianâ, assiduâ, labo-
riosissimâ, humanitatem animi, et mores suos integros servare student,—
omnibus, qui homestè pauperes vivere optant, potiùsquàm homoeopathicis,
hydropathicis, mesmericis, etiam ad normam empiricè exquisitis artibus
divitias parere,—omnibus his bene moratis sociis nostris, quamvis spe
humili, et opibus præcisis, gratias hodie ut benefactoribus, Harveio ipso
indicente, pro debito et solenniter agamus: Bene fecerunt, qui bene
vixerunt.
Ne vereamini, Præses et Socii, ne pro consuetudine hujusce rostri,
Linacrum, Caium, Harveium (et quot, longo ordine, alios !) patientiæ
vestræ oppositurus sim. De tot et tam diversis viris, quomodo, ut
quisque mereatur, et sine invidiâ, loqui possum ? Eximii omnes pro hâc
vice salvete, et valete ! ' Cum tanta sit vestrùm fama, quis dubitet quin,
etiam me tacente, in biennium fuerit superstes? Quàmvis non nominatim
et singulatim in vota nostra more solito invocati— attamem, et nunc
et semper, benefactores omnes, quicumque fueritis, adeste nobis, ad omne
memoratu dignum grato animo intentis, et ad veram scientiam per ex-
perientiæ vias enixè simul incedentibus.
Quàm frequenti et quàm liberali manu in domùs hujusce usum et
honorem de anno in ammum a suis effusum est, e parietibus hisce ipsis
patet, qui, nostris propriis sumptibus extructi, gratias, ut videtur, agere
gestiunt. En coram vobis, oculis sublatis, Bailliæi munificentia per totam
interiorem domum reposita !—in re amatomicâ, opera quàm multa et
varia !—manu ipsius, se ipso teste, et patris mei (haud temerè loquor), il-
lum pro amicitiâ subinde adjuvantis, elaborata. Quanto dispendio argenti
et laboris exquisita, et adhuc conservanda ! Sed, quòd ad munificentiam
attinet, quid moror in hoc velim illo, inter sociorum nomina? Per longam
annorum seriem, nemo fuit e nostrùm mumero qui non censum gravem
in se suscepit, quò res publica mostra non majus acciperet damnum. Ut
ratio et summa munificentiæ in domum nostram collatæ gratè dignos-
cantur, tabulæ istæ auratæ theätri parietibus affixæ perlegendæ sunt.
Quot momina illustria ! Quot pecunias operosè partas, e privatis com-
modis desumptas, et in usum communem ultrò collatas ! -
Satis, superque, in hujusmodi antehàc orationibus, ut mihi videtur,
laudationis fuit,—parùm fortasse laudis. Ut pro laude ex hoc rostro
valeat laudatio, sit præter laudationem aliquid semper in proposito; sit
in ]audatione modus ad mensuram et pro ratione laudis, de eo quod nom
est laudandum; sit etiam dicendi copia, neque in his fastis Collegii nostri
conservandis, absit, invidiæ metu, illa modestiæ et pudoris magistra,
censoria severitas. Absit, procul absit ab eo, qui ex Harveii jussu hoc
4*- w
A 3ACOBO. ARTURO WHLSON, M.D. 739
solenni die vos alloquitur, omnis assentatio, non modò in vivos, sed etiam
in mortuos ! Ambitiosi, vafri, gloriosi, heu ! piétatis etiam simulatores,
quorum imcredibili vi mendacii vita adhuc viventium typis publicis in
exemplum nobis ante oculos proponitur, hoc saltem die, hic saltem loci sine
laude discite vivere!—Blanditiæ, officiosæ sedulitates, quibus inhiantes
magis magisque de dieim diem sufflamini, non mei pro Harveio orantis hæc
sunt officii. Signa ærea, ad pretium de semetipsis ex ære computandum,
“spirantia" ligna, ad ligneas suas effigies a solis radiis expressa, fumambuli
in quovis genere vel medicinæ vel chirurgiæ eximii, per universum terra-
rum orbem, oblectamento suo, ut libeat, diffundi curent,—immò etiam
vitas suas cum pecuniariarum rerum ratione implicitâs chirographo pub-
lico in aures dictitent. De hujusmodi singulorum laude et famâ, de ** tes-
timoniis" ita dictis ob beneficia in semetipsos a viris prosperis collata,
quem nostrùm nom usque ad nauseam mumc dierum pertæsum est ! Bono
amimo sis, quisquis es, orationi huic qui ades! De mortuis hodie est
quæstio. Sit ergo nulla inter nos famæ opinio, nisi quæ sepulchro inve-
teravit. Fautores, satellites, assentatores, omne id genus molestum caveat
id, de quo numc agitur. Harveio festum indicente, haud vivos depascimur!
De mortuis, ita aiunt, nil nisi bonum ! immò, ex hâc ipsâ sententiâ, nil
nisi verum; quid enim est bonum, si non sit verum ? Excidat potiùs ex
ore mihi lingua, quàm ut laudi hominis illius nequissimi, quo regnante,
Collegium hoc nostrum institutum est, vel uno verbo inserviat. Quid?
** illud fumestum animal, ex nefariis stupris, e civili cruore, ex omnium
scelerum importunitate et flagitiorum impuritate concretum,” eodem loci
et temporis vestigio, quo animæ niveæ Harveium nostrum, sapientiâ,
doctrinâ, benevolentiâ, omni laudis genere præstantem,—eodem.die et
spiritu, hunc civem philosophum, Deo carum, a suis veneratum, et illum
regem tyrannum, fastis Angliæ semper execrandum, coram vobis in
lucem proferrem, et vestro favori commendarem? -
In Harveii nomine continetur omnis omnium fama eorum qui Collegio
nostro benefecerunt. De Harveio igitur solo, cùm exorsum, tum etiam
exitum oratio hæc mea Harveiana, pace vestrâ, deducat. *
Eorum, qui Collegio nostro maximè benefecerunt, umus est, Socii,
præter Harveium, quem non cum Harveio hoc die singulatim momimare,
est de Harveio ipso tacere, et quasi aliquid gratiæ famæ ejus detrahere.
Inter Lumleium nobilem, et Harveium ex instituto Lumleii in medi-
cimâ et chirurgiâ prælectorem, quis nescit quàm arctum est humanitatis
et ingenii vinclum ? - -
Suadente Caldwallo, Lumleius veræ scientiæ intentus prælectiones ex
suis sumptibus instituit. Harveius, id temporis nondum matus, ammis vix
quadraginta elapsis, prælector Lumleiensis eligitur. Res prælecta est
sanguis per corpus e corde circumactus ! Lumleio nobili, senatori, in
civitate principi, post longa æva, eorum qui restant, prælectore ejus
Harveio quis nunc est conjunctior?
Immò inter nobilem et medicum est in futurum per sanguinem ipsum
cognatio quædam et quasi affinitas.
Tituli, æra, imagines, qùo mune tibi, mobilis noster, reponuntur?
Tui im memoriam, inter tuos, quid denique restat?
Hic saltem loci, apud nos medicos, quæ nobis in custodiam tradidisti,
sub tutelâ nominis tui religiosè conservantur, et ad gloriam tuam, quò
magis usitata, magis redundant. -
740 ORATIO HARVEIANA, A.D. \IDCCCL.
In Harveii domum nobilitas tua (quid melius aut aptius?) se tandem
recepit. Laus, virtus, honor tuus sunt mobis pro nostris. ' Sis hospes
im perpetuum, inter nos medicos Londinenses, quos, amantissimus artis
et scientiæ nostræ, honore afficere haud dedignatus es! Lumleianis
viris, si adhuc extent, bene instituti, matu mobiles, et ingenio ad medici-
nam veram proclives, ubi est nobis ad conveniendum locus? Aut hæc,
aut nulla domus patet. In Curiâ enim de Medicinâ est, annua taci-
turnitas,—silentium perpetuum. Vox nostra in foro nunquam auditur.
In aulâ regiâ, ut videtur, vix publici juris digni censemur.
Quod ad optimates hodierni temporis nostros attinet, vel natu, vel
divitiis, civitatis principes, sematores, equestres, magistratus,—heu! etiam
sacerdotales,—si in veram medicinam conjurati essent, quomodo majori-
bus damnis, aut magis contumeliosè nostrum ordinem afficere possent?
Profectò, ignorantiâ, arrogantiâ, et negligentiâ virorum qui circumstant
forum, ex omni parte obruimur;—ignorantiâ, plenâ dedecoris et risùs,
et, cùm proterva sit, in rebus medicis minùs ignoscendâ;—arrogantiâ,
quæ etiam in morbo sibi assentationes et patrocinium quàm avidè captat,
medicum liberum, liberalem, simcerum, in propinquo vix vel ægrè
patiens; servum, libertum, fautorem, empiricum, quàm libemter!—negli-
gentiâ, cui nulla hominum solertia comparanda est, cui nulla patientia ad
sustentandum sufficere possit ! Certè equidem, nihil est tam molle, tam
tenerum, vel exiguum, quod exilitati optimatum plurimorum nostrorum
ingenii, in Anatomiâ, Physiologiâ, Medicinâ, adæquari potest; nihil tam
ingens aut crassum, quod eorum ignorantia et credulitas mom facilè
superent. Nullus sit invidiæ metus, quin hanc alienationem principum,
Victoriâ Reginâ, in civitate nostrâ, virorum, a nobis et studiis nostris,
cum Lumleii et hominum illius ævi ejusmodi benevolentiâ, ex adverso
comparem. Res patet; de die in diem crescit, et se petulanter pro
Sapientiâ jactat. Typis publicis quotidianis exprimitur. ** Tempora"
proclamant mores. Se ultrò in quæstionem tradit.
Hic comes, ille dux, hujusce rei uterque et dux et comes, mosocomium,
cujus, ipsis dicentibus, medicina, et chirurgia infinitesimæ vel proximæ
nihilo futuræ sunt, epulis datis, inaugurant. Ad nomina præsidum,
mobilitate insignium, more apud nos Anglos philosophorum inveterato,
quantâ frequentiâ comcurritur ! Mensæ, pares impari appositæ, instru-
untur ; in sedes, ** όμοιος πρὸς όμοιον", convenitur; locus est etiam
pluribus, heu ! pietas, heu ! prisca fides, umbris sacerdotalibus! Cibus,
qualis et quantus, ex quâ ratione, sive infinitâ sive infimitesimâ, distri-
butus fuerit, (absit hoc omen a nostris jam incalescentibus epulis !) quis
hic curat discere? Gloria mobilitatis superiori mensæ præsidentis in
capita convivarum homoeopathicè, et per stillicidium, deorsùm infum-
ditur, et a singulis, infinitesima cuique, pro suâ recipitur. Pecunia
(quàm vellem dicere, infimitè infinitesima !) heu ! bona, solida, ad plu-
rima millia sestertiùm corraditur. Prandii et post-prandii recensio,
finitis rationibus, computatur. Medicina et chirurgia infinitisimæ, pro
futuro, promittuntur. Gratiæ infinitæ invicem aguntur. In domum
disceditur., Apud conjuges et liberos de pacto singulis gratulandum est.
De his ineptiis quid magis severum dici potest, quàm ipsas ineptias
sime commentario enarrare ?
Prætor ille urbanus, qui dat natalitia Hahnemanniim tabernâ,—hydro-
pathicus iste nobilis Belgraviensis, qui Apollinem esse medicum omninò
A JACOBO ARTURO WILSON, M.D. '741
negãt,—qui Aquarium ipso sole præstantiorem ad morbos curandos vehe-
menter affirmat,—quid minus merentur quàm animadversionem seriam
ab illis hominibus scientiæ veræ studiosis, et gnaviter operosis, quorum
vitæ et doctrinæ tam petulanter, tam insulsè insultant ! -
De mulierculis istis protervis, omni insolitæ methodo vel medicinæ,
vel chirurgiæ, vel artis obstetricæ se confestim immiscentibus,—pro hoc
vel illo obstetrico in deliciis habito, contra Harveii doctrinam, mores,
et innocentiam, per publicas vias impudicè clamitantibus;—de duce hoc
vel illo, de comitibus, senatoribus, equestribus, in mesmericarum vel
obstetricarum istarum impudicarum muliercularum clientelam se et
conjuges et filias suas tradentibus, de episcopis mesmericis, de archie-
piscopis arehi-mesmericis,—præ fastidio, præ pudore, præ religionis stu-
dio liceat mihi medico saltem inter medicos hoc die tacere ! .
Nec præter rem et quæstionem orationis hujusce nostræ hæc alienatio
optimatum nostrorum a doctrinâ et studiis Harveii ab aliquo medico
censeatur ! Ex hâc in re medicâ pravitate ingenii, plurima illa labes
conditionis et quasi interitus auctoritatis nostræ. Hinc illud discidium
inter nosmetipsos semper renascens, quando de re communi consulen-
dum est. Dividimur et imperamur; immò a quibusdam subdolis et
ambitiosis nostris dividimur ut imperemur. Hinc illa injuriæ vis mun-
quam defessa, nunc huic, nunc illi ordini nostro, ob petulantiam, ab
aliis illata. Hâc illuvie, in nos et nostra studia tam diligenter con-
versâ, non modo externè foedati in risum vulgi exhibemur, sed etiam
interiorem et graviorem labem per ipsum spiritum et venas nostras re-
cipimus. Inter laudum omnis generis avidos, laudibus omninò caremus.
Sunt inter nos, qui honestam laudem quærentes, ob animi et ingenii
infirmitatem in probrum alliciuntur. Sunt etiam, qui, de verâ laude
nuspiam solliciti, ex hâc in rebus medicis profligatâ principum nos-
trorum licentiâ, occasionem quæstús sibi sedulò exquirunt,—et sese
perniciosæ isti otiosorum genti, a quibus ars nostra tam impudenter
affligitur, clientes inhonestè commodos libenter præstant. Parasitaster
ille parvolus, assentando, serviendo, dignitatem artis suæ tradendo,
seipsum vendendo, ad honores ita dictos, ad divitias, etiam ad titulum
in re civili omnium imum et postremum, medicinâ fretus, quàm sæpè
obrepsit ! Principibus enim quibusdam nostris, Gnathones, Balliones,
Phormiones, maximè cùm medici sint, suppeditant. Neque in moribus,
neque ingenio, neque etiam in colloquio, si modò faciles simus, nos
fastidiunt,—fide et severitate planè.
Heu ! quot modis et quàm facilè, per artes non suas, a medico sic
volente in principum gratiam itur ! Amne macula ista Romana servi-
tutis tam inveterata, tam inusta nostro ordini est, ut etiam nunc, inter
mos liberos Anglos, se aliquando in lucem proferat? An aliter quàm
servire est, quod sub lege “de pauperibus medendis" dictâ, a prætoribus
rusticis et suburbanis annos viginti indignè patimur? An fratres nostri
medici, copiis regiis navalibus adscripti, qui tam insulsâ, tam pertinaci
arrogantiâ ab iis qui res publicas curant circumventi, per maria orbis uni-
versa indignatione et spei abjectione marcescunt,—an illi, quoad medici,
pro liberis censendi sunt? Neque id mihi objiciatur, quòd lex illa “de
pauperibus” non nostri intersit,—quòd incommodis navalibus nos doctores
Londimenses nullo modo afficiamur. Pro universo ordine medicorum,
in tali imperii acerbitate, ab omnibus dimicandum est. Arma ipse
742 ORATIO HARVEIANA, A D. MDCCCI..
Harveiùs ministrat. Experientiâ, ad verum inter omnia péricula inda-
gändum et extrahendum, mos præcipuè instruit;—amore et amicitiâ,
ad veri inter nosmetipsos communitatem mos indui jussit,—immò etiam
fortitudine, pro amoris indicio et in amicitiâ tuendâ—* Courage to
make love known,” • • -
Ignaviâ, sit sine invidiâ verbum, Socii,—ignaviâ, cui momen modestiæ
supponitur, jamdiu tabescimus et perdimur. Sit fortis, constans, áni-
mosus ille, cui in rebus medicis laus vera ambitioni est! Quid, si
Harveius ignavus, si minùs quàm audax fuisset? Quid scientia, quid
ingenium, quid benevolentia ejus, sine fortitudine animi valuissent? Sit
igitur omnis veræ laudis ad Harveii gressum in medicimâ sectator, cùm
in vitæ et studii ratione suscipiendâ sapiens, tùm in eâ susceptâ fortis :
fortis, non solùm ad inimicitias et simultates malevolorum repellendas,—
sed fortissimus, assentatione et vanitate adversus se et suos prævalen-
tibus;—fortis, ne illecebris otii, ne falsâ studii et agendi specie, a disci-
plinâ ad veram doctrinam pertinentè àlliciatur; me a nobilitate urbis
ad mimiam cogmitionem devocetur. .
Se in optimatum nostrorum gratiam receptum fuisse, id nullus sibi
laudi medicus apponi censeat; pro nummatione, quantum quisque valeat,
ad computandum facilis est ratio,—quàmvis etiam in re argentariâ a
nostris studiis tam alienâ, tanta est complurium invidia, ut particulam
penè vicesimam honorarii per longa æva præscripti in sua commoda a
nobis soleant divertere. Quàm invitus hæc verba profero, Socii, a mullo
dicendum, mihi soli sentiendum est. Contumeliam,—ut scitis, qui me
moscitis,—non damnum imsector, ne in posterum incidat.
Pro dignitate et otio medicimæ veræ abhorreat quisque, in eâ conse-
quendâ, a ratione negotii et quæstùs in rebus frumentariis illâ mutabili,
sub quocunque nomine et prætextu ad merces nostras ingenii, doctrinæ,
et experientiæ comparandas translata fuerit!
Etiam medicis suffragantibus, maxima laus persæpe est maximum
opprobrium.
Profectò, ex mullâ aliâ re majus recipimus damnum, medullisve pro-
pius, quàm a quibusdam effusè petulantibus, qui indole et animo empirici,
medicimæ legitimos se esse filios in aures omnium assiduè, et quàm altâ
voce, proclamant; chirurgi,—obstetrici,—prout res se habeat, vel etiam
in medicinâ doctores, ad normam et regulam exácti, homines effrænatæ,
inter alia, audaciæ, quam efficaciam solertem dicunt, in medicamentis,
periculo non suo, præscribendis;—nec modum,—nec rationem,—nullum
*discrimem, nullam cogitationem, immò nullam etiam misericordiam in
morbis tractandis adhibentes. Ejusmodi gens illa est, quæ, insperatis
et répentinis pecuniis sumptuosiùs insolentiùsque se jactitans, bilem in
integrum nostrum ordinem adstantibus haud cessat commovere. -
Quòd nullus Lümleius é principibus reipublicæ viris ad sustentationem
hujusce domùs nostræ, hodiérn6 die renascitur;—quòd homoeopathici,
hydropathici, mesmerici,—quòd empirici, quot et quales nullo tempore
àntehàc, ex hydrâ geriitrice etiam ad hunc porticum Apollinis éonvomum-
tur,—causa hujusce labis et contumeliæ nóstræ im hos jactatores,
violentos, conturbatores, quàmvis ad normam èt quoad nomen exactos, re
verâ empiricos, a plurimis, per cogitationem, refertur ;—ad eorum præ-
ter fas et solitum càtharses, vomitiones, venesectiones, et in omni genere
haustuum, pulverum, misturarum, et pilularum veneficiâ.

A JACOBO ARTURO WILSON, M D. 743
Ex nimiâ in medendo diligentiâ, ex præter modum in medicaminibus.
abundantiâ, in remedium quod ad salutem valet, aut vix suppeditat,
nausea ! Præ atrocitate et odio diluvii fastiditur fons ! - .
Profectò, sine doctrinâ parùm medicina valet. Obstetricus ille solers
et popularis, eò quòd inter quasdam summi loci mulieres, “ non Apol-
linis magis verum atque ejus responsum" sit, non idcircò, im masculinis
morbis dignoscendis et tractandis repentè fit medicus. Attamen horum
et hujusmodi medicima est præ omnibus dicax, audax, impudentissima,
minimè excogitata, maximè sui profusa. - • .
Quod ad chirurgos attinet, quanto purior est chirurgiæ scaturigo,
tanto magis præceps, turbidus, lutulentus, est medicimæ rivus. Dòc-
trinâ planè medicima caret. - . . .
Ex hâc turbâ, ex hâc caligine quibus domus nostra regia, (anne un-
quam evasura ?) jamdiu opprimitur, ad Harveium et Lumleium, quasi
in lucem, redeamus. Date locum, hujusce ævi patroni, homoeopathici,
hydropathici, mercuriales, mesmerici! Inter hos duos, inter hunc
nobilem, et medicum illum, stirpis veteris illius Anglicæ et sinceræ
propaginis clientela non morum est vestrùm, non vestri est ingenii.
Ineptiæ, arrogantiæ, impudicitiæ, quibus artem nostram divinam.
jamdiu opprimitis et penè obruitis, hâc saltem adjuratione, (de sanguine
nunc agitur) in tenebras actæ conquiescant!
Sanguis, sit mobis in memoriâ, Socii, sanguis, in quo ipso vivo et vitæ
suæ conscio vita omnis continetur, sanguis,—ab omni ævo immutatus,
immortalis, “ humani generis sanguis cognatus et idem”,—fons iste et
rivus perpetuus heroum, poetarum, philosophorum, ubicunque scatet
indoles, natorum,—sanguis Ipsius Dei hanc terram visentis in cor et
venas pro suo humaniter receptus, im hæreditatem perpetuam nobis ab
Harveio committitur, cogitatione, præ cæteris, gravi et vehementi, pro
hominum salute et ad Dei gloriam excolendus. - -
Mihi de rebus nostris, ut par est, cogitanti, hoc sæpe in animum in-
cidere solet. Quid si noster Harveius,—quid si nunc iterùm inter mos,
in hisce ædibus, ille vivus adstaret ? Quid de hâc re diceret, quid de
illâ ? An laudi, ac vitio verteret? - - - •
Videor mihi videre dilectum illum senem hasce ædes quàm avidis
oculis perlustrantem ! Soleo eum ante oculos ponere ex quovis obvio
percontantem,—Quid mei ! quid Collegium ! quid Præses, Electi, Cen-
sores? Consiliarios nescio. Quid Socii? Quomodo, peste Asiaticâ
ingruente et invadente, se gesserunt ? Quid de sanguine? Am in
morbis dignoscendis et tractandis apud medicos Londimenses vivit et
valet? - - * .
Immò, prænobilis dux et auctor, quâcunque incedimus viâ, ad sangui-
mem, tanquam ad arcem pathologiæ et veræ medicimæ, ab omnibus quibus
medicina re verâ cordi est, nunc denique est concursum. Immò, nunc
primùm, in ratione symptomatum instituendâ, medicinæ isti anatomico-
pathologicæ, quæ ** infelix operis summâ, quia totum pomere nescivit,”
corporis partibus et particulis penitùs implicita est, e sanguinis universi
theoriâ, scientiæ universæ lux oboritur. Quòd in sanguinis studio, utpote
vitæ materiem et sanam et morbidam præbentis, medici mostri, (perinde
ac debeant) jampridem se occupant, em signa adsunt,—quàm varia, et
exquisita ! quæ Garrodius doctor, et medicinæ professor, ob reverentiam
74£ ORATIO HARVEIANA, A.D. MDCCCL.
in Harveii momen, hoc festo die officiosè in$truxit !' Ecce etiam, quod
perrarum doctor noster ille “ per æthera motus" Nix mihi in manus ad
vestram delectationem nuperrimè tradidit.* . - -
Gratiæ fratribus nostris pro tantâ comitate suâ, et mei oratoris, et
omnium hîc præsentium, ex animo agantur !
Quantâ admiratione, quantâ ingenii acie hisce novarum rerum for-
mis per artem chemicam et microscopicam explicatis, Harveius noster,
si nunc hîc adforet, imhiaret !—sed mitto—(heu ! præ temporis inopiâ),
chemica, microscopica, ponderosa et alia, ad sanguinis compositionem
pertinentia, quæ nobis quotidiano usu familiaria ab Harveio vix suspecta
quidem, vel penitùs ignota erant. :
In sanguine vivo, dum integer sit, quanta vis insita ! quanti nisus
formativi, quanta et quàm continua ἐνεργε£a ad virium explicatiomem
prompta ! O ! quanta nobis patefacta sunt, quæ illius temporis phi-
losophia nondum insomniaverat. E sanguinis particulis, invicem in se
agentibus, vis, electrica, ut nuper patet, per universam corporis fabricam,
immò in ipso fabricandi opere, continuè et universè gignitur, Lux ipsa,
e radio in radium diversè inflexa,—vel, ut dicunt, ** polarizata", non
solùm de aliquo albumine præsente testatur, sed insuper, quænam sit
albuminis ratio ex angulo radii deflexi et e spectro colorato indicat.
Quædam medicamenta, injecta per arterias cruris, impotentiam musculo-
rum infrà positorum,—quædam alia amæsthesiam,—alia iterùm impoten-
tiam et amæsthesiam inducunt. Calor amimalis e carbone oxygenato san-
guinis per totum corpus nutritioni inservientis, ratione exactâ continuò
et continuè evolvitur ; nam eadem est constantia mutritionis per san-
guinem in eorporis fabricâ ad aliquod temporis spatium agentis, ac aëris,
gravitationis legibus subjecti, vel virium chemicarum et electriearum in
maturâ rerum externâ. Proutin aëre, sic in sanguine, incrementa et decre-
menta mutritionis et scatent et latent. Porrò autem, quò calor et nutritio
eorporis primordia sua instaurant, ibi, æquè ac nutritio constans, motus
ille sanguinis a pondere aëris et cordis contractionibusim circulum postea
agendi, formis mascentibus simul ipse mascens oboritur. Quis dubitet
quin, si Harveius medicimæ studiis nunc interfuisset, satiùs putaret
sanguinem ipsum et ejus motus internos, quàm sanguinis cursum in
vemis, studio et experientiâ exquirere ? - .
Nec pudori sit mihi, etiam de me ipso loquenti, si honestè mihi gra-
tulari possim, quòd, hujusce communitatis jamdiu socius, Harveio et
sanguini im nullo tempore defui. In prælectionibus, annis abhine viginti,
de Materiâ Medicâ, et nuper in Lumleianis de Anatomiâ et Chirurgiâ, ad
hanc sententiam, ad hæc ferè verba, Socios persæpe allocutus sum: “ A
medico Harveiano, sanguis qui ei subjicitur, ad medicimæ praxin
utiliorem exquirendam, non modò quoad singulis corporis partibus in
circulo actus suppeditat, perspiciatur,—sed etiam per se, quasi orgamon,
(vel potiùs * panorgamon') omnes sensus, omnes motus, omnes functiones
* Uric acid and urate of soda, from the blood of gouty patients. Traces of uric
acid and urea from healthy human blood. Urea from blood in various diseases, as
albuminuria, cholera, gout, etc. Fibrim from blodd. Albumen from blood. Pure
hæmatosin from blood, and its solution. Oxide of iron from blood. Microscopic
specimen, showing the crystallization of uric acid on a hempem fibre in serum of
blood from a gouty patient. . . , ' . ' : , ' • : .
* Chloride of silver, of which the chlorine was recovered by Dr. Snow from the
blood of an animal, killed by imhaling the vapour of chloroform.
A JAGOBO ARTURO WILSON, M.D. 745
omnium corporis partium, in se continens ; formativum,—electricum,—
mervosum,—ex suis particulis, suis propriis viribus, contractilitatem,
calorem, cujusvis sensus facultatem in singulis organis generans ;—deni-
que, per molem suam integram suo modo vivens,—recipiens,—agens, et
vel minimo temporis spatio plurima persentiens. Accipite nunc animis,
Socii, sanguinis rivum corporis universum, universo aëri in pulmonibus
proximum, universæ corporis fabricæ, mole eâdem et continuâ, penitùs
circumfusum. Sanguis, vivus, continuus, ex his principiis constans,—
et aëri et corporis fabricæ intermedius,--quid est, si non aër ipse, ad
intimum nutritionis usum, inclusus, et commodus ! corporis intermæ
fabricæ atmosphæra, ut lubet dicere, alia et interior?”
Sed ne in prælectionem de sanguinis usu et materiâ oratiuncula
hæc, ad fastidium audientium, protrahatur, sine morâ cavendum est.
Ah ! quàm vellem !—Sed de cæteris taceam ;—dummodo mihi fas sit
perpaucis verbis, sed iis preces et gratias agentibus, iterùm coram
vobis, Socii, donum illud cœleste extollere, ab Auctore cujusvis boni ad
solatium hominum divinitùs missum, cujus vis ætherea in nervos per
sanguinem diffusa, dolori, utcunque atroci, in principiis obstare valet.
En, quod a viris nostris principibus et mulierculis otiosis, æquè ac
manipulatio mesmerica dignum est, ut im patrocinium et clientelam
recipiatur,—a religiosis philosophiæ faventibus æquè pro miraculo
habendum, et gratâ mente excolendum ! In nervis duplicibus ad sem-
tiendum propriis, quorum nutritioni sanguis ætheris vapore vel ter-
chloridi Formyli suffusus per incrementa suppeditat, utcunque fuerint,
laniati vel aliter læsi, dolor vel quàm minimus gigni non potest! -
Res planè mirabilis, res Dei! et cui potest par oratio nulla inveniri.
EIeu ! inter plerosque mostrùm, quàm crasso ingenio, quàm sine reli-
giome, in mamus, sed non in animam receptum. Indigni! ingrati!
An egestas hujusce animi nostri Anglici, in mummationem et titulos
semper proclivis,—am angustiæ pectoris pathologici, particulis partium
semper occupati,—an levitasingenii medico-chirurgico-obstetrico-practici,
haud, ut in tempore præterito, simplicis et concentrati, Deum in ipso.
opere præsentem mom possunt perferre?
Quid, si hoc munus anæsthesiæ, anmis abhinc vix quatuor hominibus
mucroni chirurgico subjectis concessum, quid si humanis legibus in
usum humanum munc repentè prohiberetur? Quantus tum denique
horror et luctus! Quàm sæva indignatio ! Quæ misericordia puerorum,
femimarum, infamtium de movo sub chirurgi cultello luctantium ! Quantæ
lacrymæ, cum gemitu, parentum et propinquorum circumstantium !
Tum denique pro beneficio dato si gratiæ non priùs actæ fuerint, ad
domum recuperandum preces pro certo agerentur ! -
Nom sic pius moster Harveius sanguinem, per ætheris vaporem, de
dolore in nervis triumphantem im mentem suam oculis recepisset.
Nom ille, medicus, philosophus, poëta, hoc pro adoratione indicium,
quasi nebulam æstivam, sine admiratione singulari prætermisisset.
Ubi ! ubi ! est ea Religio Medici? aio8nouc illa artis suæ et ejus pro-
positi, quæ his verbis exprimitur, “ Homines numquam ad Deos propiùs
accedunt, quàm Deinaturam contemplando, et salutem hominibusdando."
Ingenium medici, cùm sit in omni re ad facultatem agendi præcipuè
excolendum, sit semper æstheticum. Id quàm multis et variis modis
Harveius noster mos admonet! Homo, si ullus, virilisimgenii, cujus scien-
746 ORATIO HARVEIANA, A.D. MDCCCL.
tia famae aeternitati suppeditat, homo principibus reipublicae necessarius,
qui scivit etiam regibus uti, quid nobis Sociis, ha redibus suis, jam nunc
moriturus, praecipuè injungit? Estote amantes ! estote amici! Quis,
magis quàm ille medicus octogenarius, compertum habuit, ut haec
quotidiana, laboriosa, nostra vita, inter mortuos, moribundos, animi et
corporis dolore miserrimè excruciatos, perpetuò acta, affectuum lenium
solamine perpetuò eget; ut, sine amore et amicitià, plane intolera-
bilis foret! Nae ille Harveius noster, prae omnibus, scivit et sensit,
sine corde et sanguine nullam esse cerebri vitam. An majore sapientià,
vel in longius aevum pro domis nostrae honore et auctoritate, ab ullo
prospectum esse potuerat ?
Neque pro dubio sit, Socii, Harveium, cùm inter nos amorem et
amicitiam quasi testamento suo praecepisset, non solum doctores in
medicinà Londinenses, sed insuper medicos totius Angliae regni, domi,
foris, terrà, marique, artem suam exercentes respexisse; illis enim
temporibus Collegium hoc nostrum universa, medicinae Anglicae domici-
lium fuit. Harveius ipse, nonne per longos annos Anatomiae et
Chirurgiae praelector fuit? Nonne constat, Socii, venerandum illum nos-
trum, cùm nos in festum suum annuum convocavit, non coenas illas taber-
narias quorundam in concionabulum symbolis adscriptorum respexisse,
–non prandia illa, fastidii, arrogantiae, invidia plena, certatim fastuosa,
ab uno in alterum, a singulis vice suá expletà, quasi pro debito et
censuimposita;–nonista vana amoris et amicitiae simulacra,–sed animi,
voluntatis, propositi conjunctionem,-qualem ipse cum suis dilectis,
Georgio Entio, et sociis aliis ejusmodi,-qualem cum fratribus suis, per
tot et tanta rerum discrimina, de anno in annum servavit.
Catholicum istum amorem Harveianum erga fratres suos umiuscujus-
que ordinis medicorum non omnino in corde et venis haeredum ejus
extinctum esse, indicio sit supplicatio hujusce Collegii nostri, tribus
mensibus vix exactis, ad senatum, pro auxilio chirurgorum juniorum
navalium ab iis qui imperant indigna vitae ratione et disciplinae lege
jam diu afflictorum, una voce decreta et ad curias utrasquerelata. Pro
futuro faustum sit omen !
Odia, simultates, objurgationes, etiam inter hujusce ordinis medi-
corum principes aliquando innasci, quis sanus et sincerus se nescire
profitetur ? Inter nosmetipsos Harveii vocem paternam nunquam
non desiderari,-numquam silere debere, –heu! nuperrimè et quam
publicè patet! Crimina in socium falsa, conficta, a quibusdam nostris
temerè credita, quàmvis per se absurda,-epistolae, aliquà offensione
interposità, in medium prolatae,–joca, inepta, in deteriorem partem
accepta,–omnia haec typis publicis commissa ad ludibrium etiam alum-
norum puerorum perlegentium assiduè pervulgata sunt. In jus pub-
licum ab auctoribus ipsis tradita, et quasi praeconibus ultrò subjectae,
protervitates illae et omnes ejusmodi in hoc medicinae Anglica foro
publicè condemnentur, et, sine invidia, a communitate nostrà repu-
dientur. - -
Quid me respicitis, Socii, dum ha c invitus loquor? In hàc allocutione
pro nihilo sum. Censor est Harveius;–non ego, qui ex rostro judicium
ejus vicarius proclamo.
Quid diceret Harveius?–Adhujus sententiae normam, (licetne verbum
recordari?) omne quod in proposito huic meae orationi fuerit, redigere
A JACOBO ARTURO WILSON, M.D. 747
2
conatus sum. An melius possem? Noscite eum, perlegite eum, Socii.
Dignus est, quem ex solertià, indulgentiá, vitae communis scientiá,
in quâvis rerum juncturá consiliarium adhibeatis;–cui amico, tutori,
patri obtemperetis, Harveii vitam atque epistolas legenti, et de ejus
ingenio, de mirabili ejus constantiã cogitanti, hoc mihi quâm saepe
intercidit ! Eğpmka tandem hominem Contumeliis ab iis, quibus
maximé sententia ejus immortalis serviebat, assidué insectatus;–in
clientelâ et in re pecuniariä multilm ex eådem causã imminutus;–
amentia etiam, quia totă non errabat vià, accusatus, nunquam vitae in-
nocentiam amisit, sed benevolentiam constantiae suae adaquari et pari
passu incedere usque ad finem curavit. Principibus viris placuisse,
jure morum, ingenii, doctrinae, ei prae caeteris contigit; sed horum
favor ultima ejus laus erat. Quâmvis parvolus, non parasitaster, nullis
divitum liminibus vel coenaculis, ad clientelam intentus, insedit. -
Regis archiater, philosophus evasit. - -
Ad risus aulicorum, ad blanditias muliercularum exquisitarum susci-
tandas nunquam se instruxit. Neque chirurgorum, neque obstetricorum,
nec pharmacopolarum favoriinserviit, quð exalicujus subdoli vel ambitiosi
amplitudine praesidia et adjumenta Sibi conciliaret. Nempé Harveio,
Anglo, medico, philosopho, servitus omnium malorum postremum erat.
Ex ineptiis, nummatione, arrogantiá, servilitate, hujusce aevi nostri,
quam jucundum, quâm utile,_immö etiam nobis medicis quâm neces:
Sarium, quemgue aliquando se abstrahere et quasi renovare, mores et
vitam per alicujus viri Harveiani, vel, ut nunc, ipsius Harveii recorda-
tionem contemplando. - -
Necmon in viris temporis acti principibus eaden est ratio laudis
falsae ac veræ, eadem infrequentia singularis in singularibus virtutis.
Profectd, veteris illius Angliae fastos perlegentibus quâm mirum nobis
incidit, ut haec patria nostra adhuc superstes manet !
Delirant reges, perfidi, truculenti, furit plebs, rauca, varia, immanis,
Interimperatores,-magistratus, Sacerdotes,—senatores,-inter omnes
officiis publicis fungentes, quanta fraus! quae insidiae in amore sui,
quae pertimacia 1—pietatis in Deum simulatio quâm sordidaſ Heu!
etiam quae Sævitia 1—flagitia quâm immania et varia 1—quotuplex in-
famiae species -
Confer Harveium nostrum, philosophum, amicum, amantem, octo-
genarium,_omni officio vel civis wel medici perfunctum,-tranquillam
vitam degentem, de die in diem omnibus suis cariorem,-e marmore,
inter compares suos, etiam manente spiritu, constitutum; confer illum
nostrum medicum, quamvis nullo titulo, nedum equestris ordinis, in-
signitum, cum illo Verulamio praenobili, in omni doctrinae genere
praeclaro, summi magistratăs officiis perfuncto, regi et principibus
necessario, -imminente autem senio, abjecto, contempto, debilitato,
conscientiá. Suá convicto, ignominias, quales nemini antea contigerant,
ob flagitia sua, se meritum esse confitente. “Homini homo,” philo-
sophophilosophus, “quid praestat!”
Respicite etiam illum alterum Harveio temporis consortem, Cokium
Edvardum, summi ingenii causidicum, summâ potestate judiciali prae-
ditum, ejus awaritiam, inhumanitatem, saevitiam, servilitatem; quibus
quid acrius, tetrius, libero homine indignius dici vel excogitari potest!
Quae causa est, Socii,-quomodo fit, cum Harveii et horum duorum.
WOT. II. * > 50
'748 *' ' ORATIO HARVEIANA, A.ID. MDCCCI,.
temporis ei consortium fama, quàmvis in diverso genere, sit, summa et
aequalis,—quòd medicus à causidicis tantùm verâ laude et existimatione
apud posteros distet.
Ei duo, et unus et alter, ambitione et cupiditate excordes erant.
Ille moster, affectus lenes simul cum ingenio excolens, in omni quod
volebat, studebat, agebat, cordis et sanguinis humani rationem semper
adhibuit.
Est, sit Deo laus, est adhuc quod redundat im gente nostrâ Harveiani
ingenii, judicii, morum, et fidei, quæ mole suâ singulorum protervi-
tates comprimit, pravas ambitiones adumbrat, rem publicam contra
audaciam virorum ejus principum singularium defendit, et hanc Angliam
nostram, qualis et quanta sit, efficit et conservat!
Depascatur animo is cui curæ est virtutem Anglicam contemplari,
Harveii vitam et mores, necnon illi temporum comsortis Hampdeni,
patriæ servatoris,—et mobilis illius Falklandi, ob horrorem belli civilis
animam suam libenter effundentis.
Hæc enim est virorum indoles illa Amglica, integra, mera et vera,
solo nostro indigena, constans, gravis, animosa, Wellingtoniana, ex quâ
respublica nostra, inter gentium cæterarum damna et excidia, vires et
incrementa capit. Hæc est ea inter nos vis opinionis publicæ, quæ
potiùs ex multitudinis in omne paratæ inertiâ quàm ex ordinis vel
principis cujusvis imdustriâ, conficitur.
Ex iis, quibus respote multis nullum tempus suppeditat, quæ de
nostro dilecto adhuc dicenda restant, hoc saltem unum, Socii, si nullum
præter hoc, accipite, quæso, verbum. Terræ hujusce Anglicæ, immò
etiam Londimensis, solum, quod nos incedimus, consors temporis, loci,
coeli, fortasse etiam sententiæ et colloquii, ίμίθεος ille Shakespeare
unà cum Harveio per longos annos imcessit. De motu cordis, de san-
guinis circuitu sententiam, ab Harveio medico, arte, experientiâ,
præceptis, doctrinâ, mox in omne ævum confirmandam, quot miris
modis ille poëta dramaticus, maturâ ipsâ validus, et mentis viribus
excitatus, et quasi divino quodam spiritu inflatus, ut ex imo corde et a
sanguine ipso audientium sentiretur, expressit, et ante ora hominum
ex scenâ per actionem præfiguravit!
Nec lateat vos, Præses et Socii, in annum proximum prospicientes,
im hanc arcem gentium, in hoc domicilium clarissimi imperii Britan-
mici, ex omnibus terræ regionibus homines longinquos et alienigenas
ad festum solemne artium et scientiæ celebrandum jam diu accersitos
esse,—immò, se et sua jamdudum ad iter accingi. -*
Laus et honor Principi illi generoso et illustrissimo, cui primo in
mentem venit, ut familiam gentis gnavæ et industriæ universam per
totum terræ orbem dispersam, pro unâ saltem vice, Britannia mater-
familias in hanc domum suam communem fraternè convenire juberet.
“ Felices certè artes, cùm virorum in republicâ principum ingeniis ex-
coluntur!” -
Hasce ædes nostras, hanc domum Harveii, advenæ isti medici certè
visuri, sive Gallici, sive Germanici, e Columbiâ trans æquor At-
lanticum Anglo-Germanici, sive ab oris Russicis Sclavonici,—liberi, servi,
sive libertini, Collegium hoc nostrum medicorum Londimensium, neque.
urbe Londinensi, neque imperio Britannico indignum esse libenter
fateantur ! Divitiæ pathologicæ, a Bailliæo apud nos repositæ,—picturæ,
A JACOBO ARTURO WILSON, M.D. 749
busta, supellex omnis,—tabellæ istæ præsertim amatomicæ ab Har-
veio ipso, Paduæ, ut dicunt, elaboratæ, et nuper a nostro Sedgwickio
partim restitutæ,—omnia sint im promptu, et ad lustrandum parata.
Am dubium est, quin hic ordo noster in urbe Londimensi medicimæ
doctorum, se im occursum hospitum, fratrum et sodalium, sedulò accim-
gere debeat ? Solertes, artis medicæ dignitati intentos, amicos præsertim
inter nosmetipsos et amantes, advenæ medici mos ultrò agnoscant. Pro
cognitione et hospitio, quibus conveniat, in epulas solemnes vocentur,—
immò etiam quidem, ob ætatem, experientiam, et mores eximios in
Hanc societatem nostram honorificè recipiantur.
Am decet ? Nonne constat ?. Ah ! desine, qui veræ laudis amantes mos
sic lactares, et falsâ spe produceres! Cùm tantis injuriis, tam crebris re-
pulsis, tam usitatâ neglectione ab iis qui imperium exercent in foro
imminuimur,—cùm pro vitâ nostrâ etiam adversus nostros de die im
diem dimicandum est,—anne in officia humana et liberalia, honoris erga
exteros causâ, hoc proximo anno vacare poterimus !
Præterea, vectigalia desunt. Etiam ad festum hoc hodiermo die ab
Harveio inter socios præscriptum, non suppetit res. Laus et honor
impransis ! Temeatis risum ! honesta est paupertas ! In ratione morbi
Asiatici, pro salute communi, exquirendà, omne quod nostri in promptu
erat jamdudum est impensum ! In seria, in rem veram, redeamus !
Ut de summâ Collegii hujusce nostri, ut de salute et vitæ ratione
omnium nostrùm in his diebus agitur, quis, re verâ medicus, se inscium
profiteri potest? Fides, reverentia, auctoritas, existimatio, medicinæ
haud, ut antea, incedunt comites. Eruditio, artium liberalium amor et
studium, literarum decor ille sine pretio æstimandus, inter practicos et
mummatos pro nihilo habentur. Caremus foro, caremus curiâ, caremus
publico. Publico carentes, nulli et nuspiam sumus ! Nimiùm, nimiùm
diu, Socii, aciem auctoritatis nostræ hebescere nos patimur. <**
Quare quasi ex somno nos invicem excutiamus, et expergefacti pro-
videamus, ** me longiùs populo, fratribus, nobismet ipsis deesse videamur,
me præ ignaviâ et socordiâ diutiùs circumspectantes omnia, quidquid
increpuisset pertimescentes, diffidentes nostris rebus, sine voce, sine
libertate, sime auctoritate, aliquando abjecti, contempti a cæteris, a
nobismet ipsis desperati et relicti fuerimus.” .
Ut in religione, sic in Medicinâ, quæ duæ in omnibus sæculis habent
commune quoddam vinculum, et quasi cognatione quâdam inter se com-
timentur ;—ut in rebus sacris, sic in rebus medicis, experrecta tandem
virtus illa antiqua Anglica im pristinam auctoritatem suam se suo jure
vindicet. -. - •
Contra has violentias, contemptiones, repulsas, quibus noster ordo
jamdiù affligitur, quæ vires opponendæ, quibus armis contendendum ?
Auctoritatem nostram ad potestatem pristimam recuperamdam privilegiis
*et judiciis in futurum amplificandam esse, nemo sibi in propositum ad-
sciscatur. Neque diplomata passim in provincias mittendo, nec pocula,
collatis medicimæ forensis auctoribus, præmium, e testamento medici
insani porcimi adjudicando;—nec diplomati nostro ad licentiam in urbe
practicandi concesso titulum in medicimâ doctoratús supponendo ;—
neque chirurgos in nostra consilia de rebus nostris propriis accersendo,
—(eos chirurgos haud impuros respicio, nostræ conditionis æmulos,
50 2
750 ORATIO HARVEIANA, A. D. MDCCCL.
atqui nostram medicinam haud puré agentes;)—neque quartum id
genus, mistum, varium, turbulentum sollicitando ;—nullis ejusmodi ra-
tionibus nobis ad salutem via reperienda est. Ad defendendum omne
quod ab Harveio et aliis nostrùm benefactoribus tantâ gloriâ recepi-
nmus (quod non tueri et conservare posse esse turpissimum,) semper
nobis persuasum sit, Collegium hoc nostrum ad morbos curandos, ad
hoc opus, diplomate regio institutum fuisse ;—ad hanc salutis pub-
licæ glebam im perpetuum lege publicâ nos esse adscriptos ;—porrò
etiam sit semper nobis in præsenti, nostram hanc communitatem
medicorum Londimensium omnes alios medicos, omnes ejusdem facul-
tatis homines virtute suâ im se continere.
NMedicinam operosè et in foro agere,—ducere potiùs quàm sequi,
quâcunque incedimus ad medicinæ disciplinam viâ,—hæc suntjuris mostri
et officii; his prætermissis, tabescimus et perdimur.
Quimetiam benevolentiâ et caritate civium universorum, ad bene et
viriliter agendum, mos septos esse oportet;—neque id nos celari, quòd
mom minùs opinione famæ, quàm aliquâ certâ ratione in re medicâ
vulgus commovetur ; quòd non im tabellis paucorum judicum, sed in
semtentiis omnium civium fama nostra et fortuna repositæ pendent.
Talia cogitanti, et ex hisce cogitationibus in ammum proximum pros-
picienti, quanta, et quàm subita, mihi lux oboritur!
Diploma regium, de novo nobis concessum, em domitandem recipimus!
Quæ hæc est turba comitantium? Pateant portæ !—Im limine sit
JPræses !—Assurgite Socii!—Victoria ipsa ingreditur fores !
Salve Regina !—Regina nostra, ter, terque ter, atque iterùm, salve!
Dilapsa hæc domus nostra, et sine te caduca, te receptâ, in fortunam
recipitur suam !
Collegii nostri, diplomate regio (faustè sit dictum !) jam tandem post
longa æva renovandi, et fructus suos in salutem publicam de novo red-
dituri, ad quem primitias deferre præstat, quàm ad illum, qui, amoris
et comsilii particeps, amore et consilio imperii consors, quotidianis
precibus, parens et maritus, in thalamo regio instauratur ;—ad illum
Albertum, quem inter nostros, præ cæteris, Principem omnes libenter
agnoscimus.
Accede, Princeps, ad dexteram Præsidis nostri, in sellam honoris et
gratiæ causâ tibi soli præpositam. Comitiis nostris, socius inter socios,
civis inter cives saluti publicæ consulentes, prout libeat, subinde in-
tersis ;—institutis nostris si qua bona fuerint, in auxilium venias,—
'concionibus ob beneficia recepta solemniter, ut mune, habitis, auctori-
tatem regiam impertiri ne fastidias. -
JEorum, qui, diplomatis regii Tudorii jure, pro Harveio nostro oratores
exstiterunt, alter et ultimus ego Wilsonus, ad subsellia e rostro jam
descensurus, fausta omnia, pro hâc vice cordis et sententiæ uniuscujus-
que Socii interpres, in Collegium nostrum haud irreverenter, et quasi
flexis gemibus imprecor. *.
Sit domus hæc nostra, cùm universis publica, tum singulis ut sua!
Domùs dominam scientiam lenitas et indulgentia morum, ancillæ
comitentur! Scientia sit vera, severa, fervida, constans, operosa, stu-
diis humanioribus haud arroganter, sed penitùs imbuta !
, “ Instituti rebus optimis mon poetarum voce commoveamur !” Hæc
A JAooBo ARTURó WILSON, M.D. 75]
studia enim medici Harveiani ** adolescentiam alumt, senectutem ob-
lectant, secundas res ornant, adversis perfugium et solatium præbent,
delectant domi, non impediunt foris, pernoctant nobiscum, peregrinantur,
rusticantur." • - -
— In nostrâ republicâ, quod verum est, sit pro re,—pro imperio, religio
veri,—pro lege supremâ, populi-salus! Sit unitas in communitate,—
in communitate unitas! - -
Ad hæc tuenda et conservanda sit nullum inter nos jusjurandum !—
si ullum, in verba hæc ; ** Experientia!—Amor!—Amicitia!" verba ipsius
Harveii,—verba omnium ætatum, temporum, locorum !—Leges, mores,
etiam diplomata regia, humana omnia mutantur. Amor et amicitia a
Deo sunt, et manent;
Veniam date !
BIBLIoGRAPHICAL REcoRD.
THE UNITY OF NATURE. By CHARLEs BLAND RADCLIFFE, M.B., Lecturer on
Wegetable Physiology and Botany at the Westminster Hospital, etc. pp.
150. London : 1850. - .
It is not difficult for the educated mind to perceive a wonderful simplicity
and a complete uniformity of plan, amidst the numerous and apparently
complicated works of creation. The notion of the Unity of the Godhead, as
it is inculcated in the Sacred Wolume, is corroborated in every particular by
the researches of science. The objects composing the animal, the vegetable,
and the mineral kingdoms, appear to the careless or superficial observer to
consist of a multitude of forms, capriciously varied in a thousand ways, and
bound together by no common tie: but to the student who penetrates beneath
the surface, who investigates nature in her inmost recesses, who traces her
footsteps by the aid of the microscope, the scalpel, the crucible, the blow-
pipe, and the test-tube, the chaotic elements arrange themselves into definite
order, confusion gives way to system, and the apparent discord melts into har-
mony. The beings which compose the material world are found to compose
the numerous and varied links of a continuous chain, which extends from
man to the monad, from the mountain to the grain of sand, from the forest-
oak to the fucus on the sea-shore.
The present work exhibits, in a short and comprehensive form, a view of
the Unity of Nature; and, in the execution of his task, the author has
reflected the highest credit on himself as a scholar and a philosopher. He
has not allowed himself to be led away into the nebular region of false analo-
gies, loose reasonings, and forced comparisons, into which many, pursuing the
same fascinating theme as himself, have permitted themselves to be betrayed;
but he has followed, throughout, the path of sound and cautious induction,
and his conclusions, therefore, are for the most part just and well-founded.
The author first considers the Unity of Form displayed in the Animal and
Vegetable Kingdoms; and he gives a very good abstract of vegetable mor-
phology,the first development of which he justly attributes to the poet Göthe.
He shews the identity of the cotyledon with the leaf; of the latter organ
with the sepal and the petal; of the petal with the stamen and with the
carpel; thus proving, that the leaf is in fact the type of all the other organs
of the plant. The ovules, again, are shewn to be leaf-buds analogous to
those which appear on the edges of the leaf in malaxis paludosa, bryophyl-
lum calycinum, etc.; and the leaf-bud is the analogue of the flower-bud;
and the flower with its envelopes is therefore composed of several whorls of
metamorphosed leaves arranged around a common axis. The leaf is also
shewn to be analogous to the tendril and to the root. As an instance of
Unity of Form in the Animal Kingdom, he adduces the instance of the com-
mon prawn, in which there is a series of appendages, some developed into
prehensile limbs, some into locomotive organs; but these parts in the cepha-
lic and caudal regions become converted, in the former, into the oral and
manducatory apparatus and into the antennae and eyes, and, in the latter,
into the rudimentary false legs to which, sometimes, the eggs are ap-
pended. From this humble crustacean, the author ascends to the other and
more highly developed forms of being ; and from the appendages of the
prawn are derived the legs and wings of insects, the fins of fishes, and the
hands of man. Ascending from the separate parts to the whole, it is next
shewn that the stem of plants is only a highly developed leaf or assemblage
of leaves, and, like those organs, capable of producing buds upon its surface;
and the analogy of the stem with the root is completely established by the
vicarious functions occasionally performed by those organs, and by the ex-

BIBLIOGRAPHICAL RECORD. 753
istence of structures intermediate in position and office between stems and
roots, such as tubers and rhizomes. In like manner it is shewn, that the body
of the animal is to be considered as a series of its organs. In the lobster, the
caudal part of the body is an instrument of motion ; the posterior part of the
scorpion becomes a slender poison-spiked tail; the caudal prolongation in
some of the vertebrata becomes an organ of swimming, in others of prehen-
sion, or of support. In the cephalic region, the suctorial disc of the leech
is the analogue of a limb, and the anterior prolongation of the cephalic axis
is seen in the sucker of the lamprey, the weapon of the sword-fish, the snout
of the gavial, the bill of the swan, and the proboscis of the elephant.
The visceral region of the bodies of animals is now considered in another
point of view, and the whole series of animal forms are divided into the
vertebrate and the annellose type, in the first of which the skeleton is internal,
in the latter external. But in some cases, the characters of both become
blended together, as in some of the cephalopoda, where the skeleton is both
external and internal ; and in the chelonian reptiles, where, although the
type is vertebrate, yet the annellose form is traced in the external bony invest-
ment of the body. º
The animal and vegetable are shewn to resemble one another in many
important and striking particulars; and the following passage, although
perhaps too fanciful for the severity of philosophical induction, deserves to
be quoted as a favourable instance of the author's style:—
“The unity of creative design in animal and vegetable forms is not ob-
scurely revealed in nature. In the orchidean family, the transition to the
animal character is very marked—roots hang loose and free, as careless to
infix themselves in the earth, and animal-like flowers tremble in the breeze
as if about to escape from the stem which imprisons them. The peristeria
elata, or dove plant, a form in which the flower is the perfect image of a dove
with outspread wings embosomed in a rose-like crown of white sepals, is,
indeed, the symbol of the communion of the plant with the higher members
of the animal kingdom—the embodiment, in a visible form, of the dream
which inspired the song of Ovid in former days. In the mantis siccifolia, or
the walking-leaf, on the other hand, the wings and the wing-like legs so
closely resemble leaves and petals in colour and venation, that the insect
seems an emancipated orchis flower. And other animals are equally sug-
gestive of the memories of the orchideae: thus in the balanoids, or acorn-
like cirripedes, the shells are arranged in a flower-like whorl : the crustacean
animal lies within this whorl, as the dove within the flower of the peristeria
elata, and the entire animal is connected with the earth by a peduncle, or
root.”
We regret that our space will not allow us to follow our author farther in
his very interesting reasonings and illustrations; and we lay down the little
volume with the same feeling of regret, as one would feel on parting with an
agreeable and intelligent friend. The tone of the work is excellent ; the
knowledge of comparative anatomy and botany which it displays, is accurate
and extensive; the language is elegant, sometimes almost soaring into poetry;
and a deep sentiment of religion gracefully pervades the whole.


PATHoLogic AL RESEARCHES ON DEATH FROM SUFF00ATION AND FROM SYNCOPE,
AND on WITAL AND Post-MoRTEM BURNING. By SAMUEL WRIGHT, M.D.,
Professor of Clinical Medicine in Queen's College, Birmingham. pp. 34.
London : 1850.
These researches, which are highly interesting in a medico-legal point of
view, were suggested by a suspicious death at Bridgnorth, under circum-
stances of peculiar obscurity. The deceased had been in her usual good
health three or four hours previously to the discovery of her remains, and
the body exhibited the marks of severe burning. The post-mortem examina:
tion revealed congestion of the brain, excessive congestion of the lungs, and
754 BIBLIOGRAPHICAL RECORD.
engorgement of the right cavities of the heart with black semi-coagulated
blood. Ba.ºrg.HT, who was called to give evidence on behalf of the crown,
expressed his belief, that the woman had died of suffocation, and that the
burning was post-mortem.
This little work is divided into Six Sections, in the first of which the
author notices the Morbid Appearances after Death from Suffocation ; and
he comes to the conclusion, that they consist of fulness of the vessels of the
brain, congestion of the lungs, and complete engorgement of the right cavi-
ties of the heart; and that, of all these conditions, the last is the most constant
and obvious. Dr. Wright also states his conviction, founded upon experi-
ments and numerous observations, that the appearances just alluded to are
the constant results of death from suffocation, and that they cannot, indeed,
when they occur together, be attributed to any other cause.
In the next section, the author considers the question, whether poisoning
by the gaseous products of combustion leaves morbid appearances resembling
those occasioned by suffocation ? and he comes to the conclusion, that
although they are similar, they are by no means identical. The following
were found by the author as the principal appearances after death by carbu-
retted hydrogen: the cavities of the heart filled with bright red blood;
lungs slightly collapsed, and marked with red and whitish patches; trachea
and bronchi containing a little frothy mucus ; brain, pinkish upon its
surface, and its vessels moderately filled with florid blood. In poisoning by
carbonic acid, the brain is mºst implicated ; in suffocation, the heart and
lungs are the chief organs affected. Carbonic acid owes its poisonous pro-
perties in great measure to its sedative action, and in some of the cases
noticed, of poisoning by this gas, the cavities of the heart were found empty.
There is therefore a broad distinction between suffocation and poisoning by
the gaseous products of combustion ; although upon this point the author
refrains from expressing an absolute opinion.
In the next section, the author considers the mode in which sudden death
occurs from burning, and he concludes that the fatal result in such cases is
due to syncope ; and that, when internal congestions exist, they are observed
in cases where the patient has survived for some time. Dr. Wright con-
siders, and, we think, justly, that the instantaneous production of congestion
in the capillary and other vessels of an organ, is a physical as well as a phy-
siological impossibility. Several cases of fatal syncope are then recorded,
in all of which the heart was empty.
In the fourth section it is asked,—How are the internal organs affected by
sudden and permanent collapse of the superficial vessels? The answer
given is, that the result in such cases is the undue filling of the deep-seated
organs with blood more florid than that which they usually contain. In a case
where death had taken place twenty minutes after a severe burn, Dr. Wright
found all the large internal veins and sinuses of the brain full of bright red
blood; the lungs were almost scarlet, but scarcely turgid enough to be called
congested ; the mucous membrane of the trachea, bronchi, stomach, and
intestines, was extensively marked with patches of redness and with florid
capillary vessels, and the liver was engorged with blood much brighter than
usual. The same results were obtained in an experiment performed upon a
rabbit, killed by a smart blow upon the back of its head, and then thrown
upon a bright fire, and burnt for half a minute. -
In the fifth section it is shown, that burning, during life, in a health
subject, is never unattended with marks of redness; and that, when suc
marks are absent, the patient has been diseased. It is shown, that in a morbid
or depressed condition of the system, it is impossible to produce redness in the
skin by the actual cautery, by boiling, by strong mineral acids, by hot tur-
pentine, or by aqua ammoniae. -
In the last section, the author discusses the question, whether a blister
can be produced by post-mortem burning " This effect appears to depend


BIBLIOGRAPHICAI, RECORD,. 755
upon the mode of death, and the period which has elapsed since death; but
it seems to be proved, that such a result may ensue under certain conditions.
Dr. Wright has succeeded, after many trials, in producing a post-mortem
blister by means of a spirit-lamp, which he considers the best agent for the pur-
pose, as it is clean, and may be regulated at will. He made two experiments
upon the body of a female, thirty years of age, who died suffocated from acute
congestion of the lungs. “Three hours and a half after death, when the body
was quite warm, and the joints flexible, the flame of a spirit-lamp was applied
to the lower and back part of the left leg, and to the lower and anterior part
of the left thigh. After the lapse of an hour, blisters had arisen, filled with
serum of a pale straw-colour, and readily coagulable by heat. But neither
around nor beneath these blisters, was there the least shade of redness.” In
the second experiment, made ten hours after death, when the body had become
rigid and cold, flame was again applied, and the application was repeated at
the end of fifteen and twenty hours. In each instance, only a gaseous blister
was produced.
Dr. Wright therefore considers, that sudden death by burning is caused by
syncope and emptiness of the cavities of the heart, not by congestion of the
internal organs and by suffocation; and that if a person be just suffocated
and then thrown upon a fire, it is quite possible to produce such vesications
as may somewhat resemble those produced by burning during life; although
he points out the distinctions which may be drawn between the two conditions.
On the whole, this little work contains a great quantity of original and
useful matter, and it will undoubtedly add to the well-earned reputation of
the accomplished author.
THE CAUSEs, SYMPTOMs, AND TREATMENT OF EccENTRIG NERVous AFFEC-
TIONs. By W. S. ANDERSON, F.R.C.S. Post 8vo., pp. 199. London: 1850.
The subjects embraced in this little book are numerous and important,
comprising all those many disorders of the nervous system, which depend
upon other causes than absolute disease or injury of the central organs, the
brain, and spinal cord. This is a large field, and one which, for its successful
exploration, demands not only a considerable amount of personal experience,
but also the power of tracing out indications of common origin, that lie
hidden beneath the surface, analogies and differences which are not percep-
tible at first sight, nor to be found without diligent search and clear-sighted
philosophical investigation. Mr. Anderson has not attempted anything of
this kind. He has chosen the easier and more common path; and therefore,
while presenting us with a very fair sketch of the external phenomena of
the disease in question, and describing and enforcing rules of treatment
which are quite established and perfectly judicious, he has not added any-
thing new to our stock of knowledge. -
The work is divided into six chapters. The first is anatomical, and should
have been left unprinted. It is a great mistake to suppose, that such neces-
sarily meagre accounts can add to the value of any book. To those who
know anything of anatomy and physiology, they are altogether needless; to
any readers who might be previously ignorant of the subjects, they would be
worse than useless.
In the second chapter, we are presented with the differences between cen-
tric and eccentric nervous affections; a difference illustrated by two cases,
one of fungoid tumour in the right cerebral hemisphere, the other of chest
disease and fever. We might take exception to the latter case, as not falling
correctly under the class of eccentric diseases, as defined by Mr. Anderson
himself; for it can scarcely be affirmed, that the nervous symptoms were in-
duced “by direct irritation, either of the peripheral extremities of nerves,
or of the nervous trunks themselves, connected with the cerebro-spinal sys-
tem.” They were probably toxaemic phenomena, dependent on the morbid

756 BIBLIOGRAPHICAL BECORD.
blood irregularly and abnormally stimulating the central organs, brain, and
cord. But on this, we do not insist. Mr. Anderson then speaks of the effects
of mental emotion; illustrates the fact that poisons may be received from
extraneous sources, or generated in the system itself, and that in both ways
the nervous system is affected secondarily ; and then narrates some experi-
ments devised to show the difference between reflex action and the motions
of irritability.
The third chapter treats of hysteria, chorea, and hypochondriasis. The
fourth is devoted to epilepsy. In the fifth, collapse, delirium traumaticum,
and tetanus, come under review. And in the sixth, we have the nervous
diseases which are especially dependent upon a poisoned state of the blood,
among which are enumerated delirium tremens and hydrophobia.
DE Col.1cA ScoRToRUM DISQUISITIo. Autore MARTINo HAssING, Dr. Med.,
Medico Secundario Nosocomii Communis et Legionis Civilis Havniensis,
Regiae Societatis Medicae Havniensis Socio. pp. 100. Havniae: 1848.
This dissertation contains the history of ninety-two cases treated in the
Hospital of Copenhagen. The patients were all prostitutes; and the author
considers that the disease, under which they laboured, originated almost en-
tirely from the peculiar mode of life adopted by the class to which these
persons belonged. He supports his views by some anatomical and physiolo-
gical reasoning, and also by the fact, that some of the patients had repeatedly
suffered from the disease while pursuing their avocations, while, on marrying
and becoming orderly in their life and conduct, the complaint entirely left
them. The affection appears, from the author's account, to differ little from
ordinary colic : and it yields to ordinary remedies. It does not seem to be
a fatal or even a very dangerous disease, as none of the patients died. The
author is inclined to attribute it to the irritation of the sexual organs, and to
the connexion between those organs and the colon, through the medium of
the sympathetic system. We hardly think that the author has succeeded in
establishing the existence of a distinct form of disease ; but we must do
him the justice to say, that his Thesis is written in classical language,
that it offers a good example of medical reasoning, and that the treatment
recommended is judicious.
MEMOIR ON THE INFLUENCE OF HYPERTRoPHY AND DILATATION ON DISEASEs
oR THE HEART, AND ON SOME POINTS IN THEIR DIAGNoSIs AND TREAT-
MENT. By A. HALLIDAY Dougi,As, M.D., Fellow of the Royal College
of Physicians, Edinburgh, Physician to the Royal Infirmary, Lecturer
on Clinical Medicine, etc. pp. 49. Edinburgh : 1850.
This is a very valuable contribution to clinical medicine, because it con-
tains the history of several cases of interest recorded with care. We confess,
however, that we do not understand the meaning of the title prefixed to the
work, namely, “the Influence of Hypertrophy and Dilatation on Diseases of
the Heart.” Surely Hypertrophy and Dilatation are Diseases of the Heart;
and therefore the meaning must be, that Hypertrophy and Dilatation influence
themselves. But we are the more astonished at the title, when we read in
the first page that “Hypertrophy and Dilatation of the Heart have been
long and justly regarded as conditions secondary in their nature, and depend-
ing on some obstruction to the circulation. They may arise from causes
widely different from each other: but the most usual, as well as the most
important, are the organic affections of the heart, and few of these exist
without more or less hypertrophy or dilatation.” Here again, there is another
ambiguity of expression ; for hypertrophy and dilatation are said to arise as
“complications of the organic diseases of the heart,” although we should
imagine that both hypertrophy and dilatation are themselves organic diseases
BIBLIOGRAPHICAL PECORD. 757
&
of the heart. We strongly recommend the author to alter the title of his
work, which in many respects merits commendation ; and to revise his patho-
logical reasonings.
In the first section of the work, the author relates the history of four cases
of hypertrophy with dilatation, which diseases he considers, and we think
justly, to accompany each other in the great majority of cases. Death
ensued in all the cases, and the post-mortem appearances are given in three.
The author considers that the application of leeches to the scrobiculus cordis
is beneficial in this form of cardiac disease. He also gives it as his opinion,
that hypertrophy acts temporarily, and causes local effects upon some dis-
tant organ, such as the brain, producing apoplexy ; and that dilatation.
causes more permanent effects on the entire system, through the impeded
circulation.
In the second section, we have the account of four cases of aneurism of
the heart, all of which were associated with hypertrophy and dilatation of the
organ. The diagnosis of the aneurism was of course obscure during life,
owing partly to the uncertainty which hangs over this lesion of the heart,
and partly to the complications existing in the cases recorded. The author
does not consider that he has elucidated the diagnosis of this disease, and of
course all treatment must be unavailing ; but the cases are interesting, and
are well recorded.
The rest of the work is devoted to the consideration of contraction and
incompetence of the valves: the three first cases were all attended with
hypertrophy and dilatation, and all terminated fatally. The author then
gives the leading facts of sixteen cases of valvular disease; of whom three
were known to be alive at the time of the report, but were suffering from the
usual symptoms characterizing obstructed circulation through the heart,
three were lost sight of, and ten were known to have proved fatal.
The author concludes his work by giving a series of cases of incompetence
of the valves, in which those structures, although not seriously diseased, were
nevertheless unable to perform their proper function. These cases are
considered by him to be the more dangerous in proportion as they are
complicated with hypertrophy and dilatation ; and indeed he believes that
valvular incompetence, or in other words, that condition which produces
regurgitation, is not generally of itself productive of an obstructed circula-
tion, even though the disease may have been of considerable standing.
We may close our notice of this little work, by repeating what we have
said before, that although the cases recorded form a very valuable addition
to our clinical knowledge of diseases of the heart, yet the remarks of the
author are often loose, ambiguous, and even, sometimes, contradictory. Had
Dr. Douglas bestowed as much pains upon his, commentaries as upon his
cases, his memoir would have claimed a very high meed of praise.
A MUCH INESS PAINFUL AND MORE SCIENTIFIC METHOD of ExTRACTING
TEETH. By HENRY GILBERT, Esq., Surgeon-Dentist. Third Edition.
pp. 24. London: 1850.
MR. GILBERT's method possesses many and obvious advantages. The
instrument is used independently of the gums, teeth, or jaw, and the teeth
are extracted perpendicularly, or in the line of their axis. -
758
CLASSIFIED CATALOGUE or THE PAPERs which HAve.
APPEARED IN THE BRITIs H AND Foreign MEDICAL
PERIODICALs FRom. JANUARY 1849.
--- CHAPTER II.
SURGERY. BRITISH AND AMERICAN JOURNALS, FROM JANUARY 1849 To
JUNE 1850. BY ALEXANDER HENRY, M.D.
The following is a list of the Periodicals, with the abbreviations used in
referring to them —
London Journal of Medicine ... ... ... ... Lond. Journ. of Med.
Medico-Chirurgical Transactions ... ... ... Med.-Chir. Trans.
Guy’s Hospital Reports ... ... ... ... Guy's Hosp. Rep.
Lancet ... ... ... ... ... ... ... Lancet.
Medical Gazette ... ... ... ... ... ... Med. Gaz.
Medical Times ... ... ... ... ... ... Med. Times.
Provincial Medical and Surgical Journal ... Prov. M. and S. Journ.
Edinburgh Medical and Surgical Journal ... Edin. Med. and Surg. J.
Monthly Journal of Medical Science ... ... Edin. Month. Journ.
Dublin Quarterly Journal ... ... ... ... Dub. Quart. J.
Dublin Medical Press ... ... ... ... ... Dub. Med. P.
American Journal of Medical Science ... ... Amer. Journ. of Med. Sc.
Philadelphia Medical Examiner ... ... ... Phil. Med. Ex.
Transactions of American Medical Association. Amer. Trans.
GENERAL SURGICAL PATHOLOGY AND PRACTICE,
REPAIR and Reproduction. after Injuries, Course of Lectures on, delivered at
the Royal College of Surgeons of England. PAGET (James). Med. Gaz.,
1849, vol. xliii, pp. 1013 and 1064; vol. xliv, pp. 27, 70, 116, and 133;
also Med. Times, 1849, vol. xix, pp. 654, 671 ; vol. xx, pp. 21, 67, 173,
212. Lecture on. HUMPHRY (G.M.) Prov. M. and. S. Journ., July 25,
1849, p. 393.
HYPERTRoPHY, Lectures on. HuMPHRY (G. M.) Prov. M. and S. Journ.,
1850, pp. 197, 309, and 337.
——— Congenital, of Toes. BATTERS BY (F.) Dub. Med. P., June 26, 1850,
vol. xxiii, p. 403.
ATRoPHY, Lectures on. HUMPHRY (G. M.) Prov. M. and S. Journ., 1850,
- pp. 1, 29, 85, and 141. . .
ScRofula, Lectures on. HuMPHRY (G. M.) Ibid., 1849, pp. 561, 647, 673.
INFLAMMATION and its Results, Lectures on. HUMPHRY (G. M.) Ibid., 1849,
pp. 32, 57, 85, 113, 141, 197, 225, 281, 309, and 365. , Lectures on, deli-
vered in the Theatre of the Royal College of Surgeons of England. PAGET
(James). Med. Gaz., 1850, vol. xlv., pp. 965, 1009, 1053.
——— of the Cellular Tissue, on the use of Tartar Emetic in. MILTON (J. D.)
Lancet, March 23, 1850, p. 353. --
, Wounds, and Ulcers, Directions for using Nitrate of Silver in the cure
of HIGGINBOTToM (John). Ibid., Jan. 19, 1850, p. 74.
CERVICAL ABScEssEs, their treatment in reference to Haemorrhage. HARGRAVE
(William). Dub. Quart. J., Aug. 1849, vol. viii, N. S., p. 86.
ULCERs of Lower Extremity, on Treatment of CHAPMAN (H.) Lancet, Feb.
1849, p. 124. -
2 wº. of Marjolin. SMITH (Robert W.) Dub. Quart. J., May 1850,
vol. ix, N. S., p. 257.
GANGRENE, Sphacelus and Mortification, Lectures on. GUTHRIE (G. J.) Lan-
cet, April 6 and May 25, 1850, pp. 401 and 617.
I}|RITISH AND AMERICAN JOURNALS. 7.59
GANG RENE following Erysipelas, Injuries, and Operations. Cock (E.) and
others. Med. Gaz., April 27, 1849, vol. xliii, p. 735.
, Cases of dry. WILMoT (Samuel G.) Dub. Quart. J., Feb. 1850, vol.
ix, N.S., p. 226. Of Foot: Autopsy. CLARK (F. Le Gros.) Lancet, June
15, 1850, p. 720. .
GANGRENOUS ULCERATION of Hands, case of, with Clinical Remarks. Solly
(S.) Ibid., Jan. 12, 1850, p. 55. -
GANGRENE HospitaL, Lectures on. GUTHRIE (G. J.) Med. Times, 1849, vol.
xix, pp. 210, 301, 580. -
CREEPING PHAGEDENA of Face, two cases of DREw (Joseph). Lancet, Feb.
16, 1850, p. 206.
TUMoURs, Lectures on. Cooper (B. B.) Med. Gaz., August 31, 1849, vol. xliv,
p. 353. -
Recurrent TUMours. SYME (J.) Edin. Month. Journ., Feb. 1850, vol. i.,
3rd S., p. 194.
TUMour, (Malignant), of Head. O’FERRALL (Dr.) Dub. Quart. J., May 1850,
vol. ix, N. S., p. 466. Of Face, Case of Operation on. FERGusson (W)
Lancet, Dec. 22, 1849, p. 679. In the Parotid Region, operated on with
success. MACDoNNELL (Mr.) Dub. Med. P., March 6, 1850, vol. xxiii,
p. 150. Medullary Sarcomatous, on Right II and, Cl. Report of Case of.
WHITTALL (T.) Prov. M. and S. Journ., June 12, 1850, p. 321. Con-
genital Encysted on Right side of Chest, successfully treated by the Seton.
GRoss (S.D.) Amer. Journ. of Med. Sc., Jan. 1849, vol. xvii., N. S., p.
22. Encephaloid, in a Child five years old, Gould (Dr.) Ibid., April,
1849, p. 343. Malignant, in the Neck of an Infant five months old.
BATTERsby (F.) Dub. Med. P., July 25, 1849, vol. xxii, p. 53. Con-
genital Carcinomatous, on Left Arm; Extirpation at Eighth week; Re-
production; Death. Cotton (C.) Prov. M. and S. Journ., May 16, 1849,
. 267. - -
Maº: Disease, on the Propriety of Excision in. PAGET (Thomas). Prov.
M. and S. Journ., March 20, 1850, p. 150. ..
CANceR of the Skin, on some cases of PARTRIDGE (R.) Med. Times, May
18, 1850, vol. xxi, p. 365.
FUNGus HEMATodes. HAMILTON (John). Dub. Quart. J., Aug. 1849, vol.
viii, N. S., p. 98. X-
CHELoIDEA, Case of, with large Tumour in Occipital Region. CHALK (W.O.)
Iond. Journ. of Med., Feb. 1849, vol. i., p. 211.
MALIGNANT PUsTULE, or Charbon, Observations on. Von IFFLAND (A.) Dub.
Med. P., April 10, 1850, vol. xxiii, p. 230. From Brit. Amer. Journ.
LACERATED Wounds, Use of Nitrate of Silver in. HigginboTToM (John).
Lancet, Dec. 22, 1849, p. 661. - -
GUN's Hot Wound, Cases of LoNEY (John). Dub. Med. P., Nov. 7, 1849,
vol. xxii, p. 292. Phil. Med. Ex, Dec. 1849, vol. v., N. S., p. 726. FER-
Gusson (W.) Lancet, Feb. 2, 1850, p. 153. By an air-gun. SYME (James).
Edin. Month. Journ., March 1850, vol. i., 3rd S., p. 244. At Shoulder-
Joint, successful Amputation under Chloroform. Eve (Paul F.) Amer.
Journ. of Med. Sc., Jan. 1849, vol. xvii, N. S., p. 257. From South. Med.
and Surg. Journ., Nov. 1848. Of Chest : case. BLANToN (A.B.) Ibid.,
Jan. 1849, vol. xvii, N.S., p. 23. Fox (George). Ibid., p. 45. -
PoisoxED. Wound of Throat: extensive mischief in Pectoral and Deltoid Re-
gions; Recovery. HAN cock (H.) Lancet, June 1, 1850, p. 663.
WIPER, horned, of Western Africa, bite of SAVAGE (T. S.) Amer. Journ. of
Med. Sc., Jan. 1849. From Proc. of Acad. of Nat. Sc. of Philadelphia,
April 11, 1848.
EMPHYSEMA, Traumatic, Cl, Lect. on. ADAMs (John). Med. Gaz., Nov. 2,
1849, vol. xliv, p. 737. .
BED-SoREs, Treatment of BERNARD (Dr.) Lond. Journ, of Med., Jan., 1849,
vol. i., p. 94.
760 CLASSIFIED CATALOGUE.
BURNs and Scalds, Treatment of. WARREN (John C.) Prov. M. and S. Journ.
June 27, 1849, p. 353. -
Extensive, successfully treated by the Application of Nitrate of Silver.
B Row N (Thomas). Ibid., Oct. 17, 1849, p. 569.
Treatment of Contraction of Fingers after. GAY (John). Lancet,
Feb. 9, 1850, p. 184.
PURULENT INFECTion after Surgical Operations, two cases of, in the service of
M. Roux. WEIR (J. H.) Phil. Med. Ex., Oct. 1849, vol. v., N. S., p.
582. See also Diseases and Injuries of Blood-vessels.
ANIMAL Poisons, advantages of Solutions of Caoutchouc and Gutta Percha as
a means of protecting the skin from. ACTON (W.) Lond. Journ. of Med.,
Jan. 1849, vol. i., p. 108. .
Local Disease, effects of on Constitution. HUMPHRY (G. M.) Prov. M. and
S. Journ, Jan. 24, 1849, p. 29.
- DISEASES AND INJURIES OF BLOOD-WESSELS. -
ARTERITIs, Lecture on. CoopFR (B. B.) Med. Gaz, May 25, 1849, vol. xliii,
. 881. .
Aarº. Wounds of, and Ligature. CoopFR (B.) Ibid., 1849, vol. xliii,
pp. 974, 1057; vol. xliv, pp. 1 and 89. GUTHRIE (G. J.) Lancet, vol.
i, 1849, pp. 55, 111, 168, 224, 254, 303, and 497; vol. i., 1850, p. 325.
DiEFFENBACH (J. F.) Med. Times, 1849, vol. xx, pp. 308,339, and 383.
CoMMON CARotid Artery, Case of Scrofulous Ulceration of . Robinson (F.)
Med. Gaz., March 1, 1850, vol. xlv., p. 376. Ligature of, for Haemorrhage
from Suicidal Wound of Throat: Recovery. Eves (A.) Lancet, May 26,
1849, p. 556. Ligature of HARGRAve (William). Dub. Quart. J., Aug.
1849, vol. viii, N. S., p. 86. METTAUER (J.P.) Amer. Journ. of Med.
Sc., Oct. 1849, vol. xviii, N. S., p. 348.
SubcLAvi AN Artery, Ligature of HARGRAVE (W.) Dub. Quart. J., Feb. 1849,
- vol. vii, N. S., p. 53. Ligature of: Anatomical Phenomena in a Case of,
four years subsequently to the operation. AINsworth (F.S.) Amer.
Journ. of Med. Sc., Jan. 1850, vol. xix, N.S., p. 83.
BRACHIAL ARTERY, Ligature of, for Suppuration beneath Palmar Fascia and
Haemorrhage from Incision. TRASK (J. D.) Amer. Journ. of Med. Sc.,
July, 1849, vol. xviii, N. S., p. 95.
RADIAL Artery, Wound of: Consecutive Haemorrhage: Ligature of Brachial
Artery. No RMAN (H. B.) Lond. Journ. of Med., August 1849, p. 777;
and Med. Gaz., Oct. 5, 1849, vol. xliv, p. 569. Case of Wound. BIRD
(P. H.) Prov. M. and S. Journ, Sept. 19, 1849, p. 518. - -
FEMoRAL Artery, Ligature of for secondary Haemorrhage on 18th day after
Amputation above the knee; return of Haemorrhage; Ligature of external
Iliac Artery; Recovery. BELLINGHAM (O’B.) Dub. Med. P., March
28, 1849, vol. xxi, p. 193. Rupture of PARKMAN (S.) Amer: Journ.
of Med. Sc., April 1849, vol. xvii, N. S., p. 338. Statistics of Mortality
following the Operation of Tying. Norris (G. W.) Ibid., Oct. 1849,
vol. xviii, N.S., p. 313.
ILIAC Artery, Case of Rupture of Right Common. HICKs (J.) Med. Gaz.,
May 3, 1850, vol. xlv., p. 763.
INTERNAL ILIAC Artery. Ligature of, for Traumatic Aneurism of the Glutoid.
BIGELow (J. H.) Amer. Journ. of Med. Sc., Jan. 1849, vol. xvii, N. S.,
p. 29.
Extern AL IL1Ac Artery, cases of Ligature of WILLs (Santiago). Lancet,
Feb. 10, 1849, p. 148. NuNN (T. W.) Ibid., May 5, 1849, p. 476. At
the Hôtel Dieu, for Wound in Upper Part of the Thigh. Ibid., July 21,
1849, p. 60. * > . -
ANTERIOR º, Artery, Punctured Wound of: Ligature of Femoral Artery.
MAssEY (Dr.) Med. Times, April 7, 1849, vol. xix, p. 461.
BRITISH AND AMERICAN JOURNALS. 761
ANEURISM, Lectures on. Cooper (B.B.) Med. Gaz., May 25, and June 8, 1849,
vol. xliii, pp. 888 and 969. On the Operation for. DIEFFENBAcH (J. F.)
Med. Times,Dec.29, 1849, vol.xx, p. 509; vol.xxi, p.222. Treatment of by
Compression. TUFNELL (J.). Dub, Med. P., May 16, 1849, vol. xxi, p.
305. Phil. Med. Ex, Feb. 1849, vol. v., N.S., p. 83. Treatment by im-
posing weights on the Compresses. Amer. Trans., 1849, vol. ii, p. 228.
New Instrument for Treatment of CARTE (Dr.) Dub. Med. P., May
16, 1849, vol. xxi, p. 309. Cases cured by Compression with Dr. Carte's
instrument. HUTToN (Edward). Ibid., p. 310. Of Carotid Artery, case
of: Ligature: Death. GELSTon (Dr.) Med. Times, May 5, 1849, vol.
xix, p. 532. Of Carotid Artery : Ligature of Primitive Carotid below
the Omohyoid Muscle. Fox (George). Amer. Journ., Oct. 1849, vol.
xviii, N. S., p. 381. Of Left Subclavian Artery: Ligature : Remarkable
Deviation of the Wessel, and change in its relations. WARREN (J. Mason).
Amer. Journ. of Med. Sc., Jan. 1849, vol. xvii, N. S., p. 13. Abs. in Lond.
Journ. of Med., April 1849, vol. i., p. 381. Of Axillary Artery : Cases.
HAN.cock (Henry). Lond. Journ. of Med., March 1849, vol. i., p.296; and
Lancet, July 7, 1849, p. 7. (Ligature of Subclavian.) SYME (James).
Edin. Month. Journ., March 1850, vol. i., 3rd S., p. 240. CLARK (F. Le
Gros). Med. Gaz., July 13, 1849, vol. xliv, p. 61. CRoMPton (D. W.)
Ibid., Oct. 19, 1849, vol. xliv, p. 665. Inguinal, Case of: Suicide
by Wound of the Tumour. MILLER (James). Edin. Month. Journ., April
1850, vol. i., 3rd S., p. 318. In Groin : Compression: Failure: Ligature
of External Iliac Artery: Cure. Fox (George). Amer. Journ. of Med.
Sc., Oct. 1849, vol. xviii, N.S., p. 377. Of Femoral Artery: Cases.
TUFNELL (J.) Dub. Med. P., March 7, 1849, vol. xxi, p. 145. Of
Popliteal Artery: Case in which the Femoral Artery was tied after the
Sac had burst. WRIGHT (J. D.) Med.-Chir. Trans., 1849, vol. xxxii,
p. 167. Abs. in Lond. Journ. of Med., July 1849, vol. i., p. 689. Cases
cured by Compression. Thompson (Henry). Med. Times, Dec. 22, 1849,
vol. xx, p. 484. BANoN (Mr.) Dub. Med. P., Nov. 28, 1849, vol. xxii,
p. 338. Case: Ligature of Femoral Artery, and subsequently of Ex-
ternal Iliac. ADAMs (J.) Lancet, vol. i., 1850, pp. 366, 453, and 659.
Case communicating with Knee-joint: Amputation of Thigh. ADAMs
(Mr.) Dub. Med. P., Feb. 21, 1849, vol. xxi, 1849, p. 114.
Traumatic, case of, successfully treated by Compression. CRAMPTON
(Sir P.) Ibid., Sept. 12, 1849, vol. xxii, p. 161.
—— Spurious, Cl. I.ecture on. ADAMS (John). Med. Gaz., August 10,
1849, vol. xliv, p. 221. Treatment: Case of the late Mr. J. G. Andrews.
ADAMS (John). Ibid., Sept. 14, 1849, vol. xliv, p. 470.
—— by Anastomosis, Lecture on. CoopFR (B. B.) Med. Gaz., May 25,
1849, vol. xliii, p. 884. º
ANEURISMAL VARIx in a Stump. CADGE (William). Lond. Journ. of Med.,
Feb. 1850, vol. ii, p. 126.
VEINs, Lectures on Diseases of Cooper (B. B.) Med. Gaz, August 3 and
17, 1849, vol. xliv, pp. 177 and 265. Inflammation of, Causes, Conse-
quences, and Treatment of: with Experiments and Cases illustrating the
effects of the mixture of Pus and Foreign Matters with the Blood. LEE
(Henry). Lond. Journ. of Med., March and July 1850, vol. ii, pp. 218
and 6i5. Diagnostic Signs of Inflammation of Report of Committee of
New York Pathological Society. Prov. M. and S. Journ., Oct. 3, 1849, p.
553. Cases of Inflammation of, after Injuries and Operations. PAGE
(W. B.) Ibid., Jan. 10, 1849, p. 16. Cases of Purulent Inflammation
of, following Injuries and Operations. CovenEY (Mr.) Med. Gaz., Jan.
19, 1849, vol. xliii, p. 125. External Jugular and Weins of Arm, Inflam-
mation of: Albuminuria. EADE (P.) Prov. M. and S. Journ., Jan. 9.,
1850, p. 17. Of Neck, Upper Limb, and Thorax; Inflammation and
Fibrinous Obstruction. Russell (Dr.). Ibid., Sept. 19, 1849, p. 524.
762 CLASSIFIED CATALOGUE.
VEINs, Varicose, with Phlebolites, case of SyME (James). Edin. Month. Journ.,
April 1849, vol. iii, N. S., p. 699. &
On the entrance of Air into. Cooper (B. B.) Med. Gaz., August
º, vol. xliv, p. 265. LANE (G. F.) Ibid., May 31, 1850, vol. xlv.,
p. 920. - - r
Nævi MATERNI, Observations on the Treatment of; with Cases of Removal
of these Growths from different parts of the Face without Deformity.
C.RLING (T. B.) Med. Gaz, Jan. 25, 1850, vol. xlv, p. 133. With
Dilatations of the Vessels of the Integument. Coore (Holmes). Ibid,.
March 8, 1850, vol. xlv., p. 412. +
Nevus in an infant, removed by the External Application of Solution of Iodine,
BULTEEL (J. C.) Ibid., August 24, 1849, vol. xliv, p. 319.
**
DISEASTES AND INJURIES OF BONES.
Diseases of Bon E, Site of Morbid Action in. Goodsir (John). Edin.
Month. Journ., Feb. 1850, vol. i., 3rd S., p. 99. Abs. in Lond. Journ. of
Med., March 1850, vol. ii, p. 277.
Exostosis of Femur, case of Operation for. CLARK (F. Le Gros). Lancet,
Dec. 15, 1849, p. 641. -
Necrosis of Lower Jaw in Lucifer-match Makers, cases of. Med. Times,
Nov. 17, 1849, vol. xx, p. 394. TAYLoR (H.) Lancet, Nov. 10, 1849,
p. 498. Abs. in Lond. Journ. of Med., Dec. 1849, vol. i., p. 1153. Simon
(John). Lancet, Jan. 12, 1850, p. 41. Of Femur after Amputation at
Lower Third of Thigh : Amputation at Hip Joint. SYME (James). Edin.
Month. Journ. April 1849, vol. iii, N. S., p. 699.
ExFoll ATIon of Anterior Arch of Atlas. WADE (Robert). Med.-Chir. Trans.
1849, vol. xxxii, p. 65. Abs, in Lond, Journ. of Med., April 1849, vol. i.,
. 395.
CARIES, Morbid Specimens of, from excised Head of Femur. SMITH (H.)
Lond. Journ. of Med., March 1850, vol. ii, p. 296. WALTON (H.) Ibid.,
p. 301. Caries of Anatomical Neck of Humerus, and of Elbow-joint:
Amputation at Shoulder Joint: Cure. NEwHAM (T.) Med. Gaz, August
3, 1849, vol. xliv, p. 212.
Disease of ANTRUM, case of, produced by a Fall. LEvison (J. L.) Lancet,
Jan. 6, 1849, p. 13. ... •
OstEo-CARTILAGINous Tumour (Osteo-chondrophyte), removed from the
Femur, Clinical Lecture on. QUAIN (R.) Med. Times, Oct. 13, 1849,
vol. xx, p. 299. .
Osseous TUMoURs growing from Walls of Meatus Auditorius Externus.
Toy NBeE (J.) Prov. M. and S. Journ., Oct. 3, 1849, p. 533. Of Cervical
Vertebrae, producing Obstruction of Pharynx. HAMILTON (John). Dub.
Med. P., May 1, 1850, vol. xxiii, p. 277. -
OSTEo-SAR.com.A, benign of Scapula: Excision of Portion of Bone. MAC-
DoNNELL (Mr.) Ibid., March 6, 1850, vol. xxiii, p. 151. -
FUNgoid TUMoUR of Spine. LEEso N (Dr.) Lancet, Dec. 22, 1849, p. 678.
FRActures, Lectures on. HUMPHRy (G. M.) Prov. M. and S. Journ. Aug.
22, 1849, p. 449, 505. Of Skull: Partial Return of Consciousness:
Loss of Speech: Perversion of Voluntary Power. BANNER (J. M.) Med.
Gaz., May 18, 1849, vol. xliii, p. 868. Of Skull, in a Child. PHILLIPs
(B.), Lancet, June 1, 1850, p. 671. Of Skull: Inflammation and Sup-
puration in Brain: Death. Neglect of Trephine. . Knox (Alexander).
Dub. Med. P., May 22, 1850, vol. xxiii, p. 328. Of Skull, Compound,
with Depression. HALL (J. C.) Lond, Journ. of Med., August and Sept.
1849, vol. i., pp. 704 and 817. Of Skull, Compound, case of: Hernia
Cerebri: Recovery. CRICHToN (R. W.) Lancet, April 6, 1850, p. 405.
Of Skull, Compound, by Puncture: Wound of Brain : Trephining:
Recovery. KIRBY (J.). Dub. Med. P., June 12, 1850, vol. xxiii, p. 369.
Of Skull, Compound: Escape of Cerebral Substance. HoRNBeck (Elias).
BRITISH AND AMERICAN JOURNALS. 763
Amer. Journ, of Med. Sc., Jan. 1849, vol. xvii, N.S., p. 239. From
Charleston Med. Journ., Nov. 1848. Of Skull, Fissured: Scalp-wound:
Secondary Inflammations, Clinical Lecture on. SiMon (John). Lancet,
Feb. 2, 1850, p. 138. Of Skull, followed by Epilepsy: Clinical Lecture.
Solly (S.) Ibid., Jan. 5, 1850, p. 8. Of Os Frontis: Escape of Cerebral
Substance: Recovery. WALKE (J. W.) Amer. Journ. of Med. Sc.,
Jan. 1849, vol. xvii, N. S., p. 238. Of Base of Skull; Clinical Lecture.
ADAMS (John). Med. Gaz., June 1, 1849, vol. xliii, p. 925: and Ibid.,
August 24, 1849, vol. xliv, p. 309. Of Spine: Clinical Lecture. ADAMs
(John). Ibid., July 13, 1849, vol. xliv, p. 52. Of Spine : Extravasation
of Blood in Chord : Softening. Lancet, Feb. 2, 1850, p. 153. Of Lower
Jaw, cases of, with Remarks. BIRD, (P. H.) Prov. M. and S. Journ.,
May 30, 1849, p. 294. Of Lower Jaw, Compound: Mild Concussion :
Otitis: Impaired Mastication: Deafness: Cure. Cotton (C.) Ibid.,
May 30, 1849, p. 295. Of both Clavicles, case of QUAIl (W.) Phil.
Med. Ex., Feb., 1850, vol. vi., N. S. p. 19. At Shoulder-Joint: Removal
of Head of Bone. HAN.cock (H.) Med. Gaz., May 25, 1849, vol. xliii,
p. 918. Of Epiphysis of Humerus. (Disjunction). SMITH (Robert
William). Dub, Quart. J., Feb. 1850, vol. ix, N. S., p. 63. Abs. in
Lond. Journ. of Med., April, 1850, vol. ii, p. 389. Of Arm, Compound:
Laceration. HARGRAVE (William). Ibid., May 1850, vol. ix, N.S.,
p. 477. Of both Bones of Arms, Compound Comminuted : Cyanuret
of Iron found in the Purulent Discharge. BUTcHER (R. G. H.) Dub.
Med. P., April 25, 1849, vol. xxi, p. 263. Of Ribs, treated without
Bleeding or Bandages. HANGock (H.) Lancet, May 4, 1850, p. 534.
Of Pelvis, case of: Rupture of Urethra: Fistula in Groin : Recovery.
Phil. Med. Ex, April 1849, vol. v., N. S., p. 232. Of Pelvis, case of
Gibb (G. D.) Dub. Med. P. Oct. 3, 1849. vol. xxii, p. 211. From
Brit. Amer. Journ. (See also Diseases and Injuries of Bladder.) Of
Thigh, three cases of, treated by keeping up Extension by a Weight
and Pulley. Lloyd (E. A.) Med. Times, May 19, 1849, vol. xix, p.
569. Of Thigh, Compound, Treatment of: Modification of Long Splint
of Desault. HAYs (A.) Phil. Med. Ex., July 1849, vol. v., N. S., p. 397.
Oblique, of both Condyles of Femur, united. NEILL (John). Amer.
Journ. of Med. Sc., July, 1849, vol. xviii, N. S., p. 118. Of Lower Ex-
tremities, Description of a Bedstead for the Treatment of on Board Ship.
JAckson (W. F.) Phil. Med. Ex., June 1849, vol. v., N. S., p. 329. Of
Leg, cases of, with Observations. BIRD (P. H.) Prov. M. and S. Journ.,
May 2, 1849, p. 238. Of Tibia, Treatment of. ALLison (Wm.) Ibid.,
July 11, 1849, p. 378. Of Right Leg, Compound, case of: Severe Lace-
ration: Secondary Amputation : Death. Crooke (E. Gylles). Ibid.,
May 29, 1850, p. 285. Of Bones of Leg, Section of the Tendo Achillis
in some cases of DE MoRGAN (C.) Lond. Journ. of Med., Jan, 1850,
vol. ii, p. 78. Of posterior Extremity of Astralagus, ununited. NEILL
(John)." Amer. Journ. of Med. Sc., July, 1849, vol. xviii, N. S., p. 119.
TEETH, Alteration of the Position of in the Adult. BATE (G.S.) Med. Gaz.,
May 3, 1850, vol. xlv., p. 773.
DISEASES AND INJURIES OF JOINTS.
SYNovi TIs, Acute, of Shoulder-joint. MAcDon NELL (Mr.) Dub. Med. P.,
Feb. 27, 1850, vol. xxiii, p. 130. Of Knee-joint, in an Infant, during
Dentition. BAILEY (J. G.) Lond. Journ, of Med., June 1850, vol. ii,
p. 585. Chronic, case of, with Remarks. WHITTALL (Thomas). Prov.
M. and S. Journ. Oct. 17, 1849, p. 570. Disease of Patellar Bursa.
BANoN (Mr.) Dub. Med. P., April 18, 1849, vol. xxi, p. 241.
ARTHRITIS, Chronic Rheumatic, of Shoulder and Hip-joints, Post-mortem Ap-
pearances in a case of CANTon (E.) Lond. Journ. of Med., Oct. 1849,
vol. i., p. 983. - ºr
VOL. II. 51
674 CLASSIFIED CATALOGUE.
ScroFULous DISEASE of Elbow-joint. HAMILTON (John). Dub. Quart. J.,
May 1850, vol. ix, N. S., p. 472.
MoRBus CoxARI Us. (See Excision of Head of Femur, p. 765.) Case success-
fully treated by Mercury in first stage : Remarks. BEllingHAM (O’B.)
Dub. Med. P., May 30, 1849, vol. xxi, p. 345.
Wound of KNEE-Joint; Phlebitis: Cure. STEINER (J. M.) Phil. Med. Ex.,
July 1849, vol. v., N.S., p. 392.
CARTILAGES, Loose, in the Elbow-joint, removed successfully. Solly (S.)
Edin. Month. Journ., May 1849, vol. iii, N.S., p. 745.
ANorMAL Nutrition in Articular Cartilages. REDfERN (Peter.) Ibid., August,
Sept., Oct., and Dec., 1849, vol. iii, N. S., pp., 967, 1065, 1112, 1275 ; and
Feb. 1850, vol. i., 3rd S., p. 214. - r - -
DEFoRMITIES, on some of the more practical points connected with the Treat-
ment of Lonsdale (E. F.) Med. Gaz., 1849, vol. xliii, p. 1072; vol.
xliv, pp. 14, 145, 232, 359, 574, 1013. . . . .
SPINAL DISEASE, on certain physiological and other facts connected with the
Treatment of HARE (SAMUEL). Prov. M. and S. Journ, Oct. 31, 1849,
p. 591. Remarks on an additional means of treating, the invention of
Drs. Brown, Boston, U.S. LiTTLE (W. J.) Lancet, Feb. 17, 1849, p.
177. -
Dislocation of Neck, case of successful Treatment of Ibid., June 30, 1849,
p. 692. Of Cervical Vertebrae, Partial : Fracture of Os Hyoides. SPRY
(E. J.) Prov. M. and S. Journ., Oct. 3, 1849, p. 539. Of last Cervical
Vertebra, without Fracture: DREw (Joseph). Lancet, May 18, 1850, p. 599.
Of Inferior Angle of Scapula. ADAMs (J.) Med. Gaz., April 5, 1850, vol.
xlv, p. 609; and Rose (C.B.) Ibid., April 12, p. 633. Of Humerus,
Reduction of by Counter-extension from the opposite wrist. SMITH (N. R.)
Amer. Trans., 1849, vol. ii, p. 223. Of Elbow-joint, with Severe Injury
of, successfully treated. Roberts (H.A.) Lancet, Jan. 27, 1849, p. 96.
Congenital, of Upper End of Radius. ADAMS (Mr.) Med. Times, April 7,
1849, vol. xix, p. 456. Of Metacarpal Bone of Thumb. TRASK (J. D.)
Amer. Journ. of Med. Sc., July, 1849, vol. xviii, N.S., p. 97. Of Coccyx :
Large Punctured Wound of Rectum. BLIck (T. O.) Lancet, Jan. 19,
1850, p. 79 Of Hip-joint, Spontaneous. RAMSAY (H.A.) Amer. Journ.
of Med. Sc., July 1849, vol. xviii, N.S., p. 127. Of Hip-joint, reduced un-
der the influence of Chloroform. GREENHow (T. M.) Prov. M. and S.
Journ., Oct. 17, 1849, p. 569. Of Right Knee inwards. HARGRAVE
(William). Dub. Quart. J., May 1850, vol. ix, N. S., p. 473. Of Astra-
galus, Compound: Removal of the Bone. NUNN (R. S.) Prov. M. and
S. Journ., August 24, 1849, p. 461. Of Great Toe. HARGRAve (William).
Dub. Quart. J., Feb. 1849, vol. vii, N.S., p. 58.
TEN Do Ns, Evulsion of: Case. SYME (James). Edin. Month. Journ., March
1850, vol. i., 3rd. S., p. 241. Long, of Biceps, Rupture of BELLINGHAM
(O’B.) Dub. Med. P., Dec. 5, 1849, vol. xxii, p. 353.
OBLIQUE LACERATION of Flexor Carpi Radialis and Palmaris Longus, Case of.
GRANTHAM (John). Med. Gaz, June 29, 1849, vol. xliii, p. 1107.
AMPUTATIONs: Excisions of Bon E.
AMPUTATION, Lecture on. Cooper (B. B.) Med. Gaz., 1849, vol. xliv, pp.
439, 523, 605, 693, and 781. Amputations and Compound Fractures.
STONE (J. O.) Dub. Med. P., Jan. 9, 1850, vol. xxiii, p. 25. From N.
Y. Journ. of Med. In Gun-shot Wounds McSHERRY (R.) Amer.
Journ. of Med. Sc., Jan. 1849, vol. xvii, N.S., p. 96. Dissection of
Stumps after. SPENCE (James). Edin. Month. Journ., July 1849, vol.
iii, N. S., p. 930. Abs, in Lond. Journ. of Med., August 1849, vol. i.,
p. 787. Spongoid Inflammation in a Stump after. MAssy (R. T.)
Med. Times, Feb. 10, 1849, vol. xix, p. 311. At Shoulder-joint, fol.
lowed by Tetanus. GRAHAM (Dr.) Med. Gaz, August 24, 1849,
BRITISH AND AMERICAN JOURNALS. 765
vol. xliv, p. 311. At Shoulder-joint, successful case of, in consequence of
an Injury sustained fifteen years previously. Page (W. B.) Phil. Med.
Ex, August 1849, vol. v., N. S., p. 451. Of Shoulder joint, in consequence
of Serious Injury of Right Upper Extremity by Machinery: Recovery.
SPENCE (James). Edin. Month. Journ., May 1849, vol. iii, N.S., p. 736.
Of Elbow-joint, HANcock (H.) Lancet, Feb. 9, 1850, p. 183. Of Thigh,
at Hipjoint. Jones (G. M.). Med. Times, March 31, 1849, vol. xix, p.
434. Of Thigh, in Case of Scrofulous Disease: Recovery. Knox (A.)
Dub. Med. P., June 12, 1850, vol. xxiii, p. 370. Of Thigh, in a Case of
Disease of Knee-joint. FERGUsson (W.) Med. Gaz., June 7, 1850, vol.
xlv., p. 1000. Below the Knee, Clinical Remarks on. SYME (James).
Lancet, April 28, 1849, p. 452. At Ankle-joint, case of SPENCE (James).
Edin. Month. Journ., May 1849, vol. iii, N. S., p. 742. At Anklé-
joint, by Internal Lateral Flap. MACKENzie (R. J.) Edin. Month.
Journ., August 1849, vol. iii, N.S., p. 951. At Ankle-joint, Clinical Lec-
ture on. SYME (James). Ibid., Feb. 1850, vol. i., 3rd S., p. 171.
Excision of Superior Maxilla, Modified Operation for. HoRNER (W. E.)
Phil. Med. Ex., Jan. 1849, vol. vi., N.S., p. 16. Of Superior Maxilla,
case of Lancet, Feb. 23, 1850, p. 247. Of Lower Jaw, for Osteo-
Sarcoma. BLACKMAN (G. C.) Amer. Journ, of Med. Sc., Jan. 1849,
vol. xviii, N. S., p. 93. Of the Sternal Half of the Clavicle (Dis-
articulation.) SPENCE (James). Edin. Month. Journ., May 1849, vol.
iii, N. S., p. 740. Of Clavicle. PoTTER (H. G.) Med. Gaz., April 6,
1849, vol. xliii, p. 594. Abs. in Lond. Journ. of Med., June 1849, vol. i.,
p. 587. Of two Carious Ribs and Lower Portion of Sternum, suc-
cessful case of McCLELLAN (G.) Phil. Med. Ex., Feb. 1850, vol. vi,
N.S., p. 75. Of Head of Femur. Morbus Coxarius. SYME (James).
Lancet, vol. i., 1850, pp. 266,625. FERGusson (W.) Ibid., Jan. 20 and
April 7, 1849, pp. 61 and 359; and Med. Times, April 7, 1849, vol. xix,
p. 447. SMITH (Henry). Lancet, vol. i, 1849, pp. 299, 490, 597; and
Med. Times, August 25, 1849, vol. xix, p. 144. No RMAN (H. B.) Lancet
April 28, 1849, p. 447. MoRRIs (Edwin). Med. Times, Jan. 19, 1850,
vol. xxi, p. 35; and Prov. M. and S. Journ., Feb. 6, 1850, p. 57. Cotton
(C.) Prov. M. and S. Journ., Dec. 12, 1849, p. 683. Abs. in Lond. Journ.
of Med., Jan. 1850, vol. ii, p. 58. WALTON (H. Haynes). Med. Times,
March 31, 1849, vol. xix, p. 433. Of Malleolus and part of Astragalus.
WAKLEY (T. H.) Lancet, May 25, 1850, p.642. Of Os Calcis. HANcock
(Henry). Lond. Journ. of Med., Oct. 1849, vol. i., p. 976.
DISEASES AND I NJURIES OF THE HEAD,
INJURIEs of THE HEAD, Observations on. TRAVERs (B. Jun.) Prov. M. and
S. Journ., Oct. 31 and Nov. 28, 1849, pp. 589 and 645.
HEAD, Iron Rod weighing 134 lbs. driven through : Recovery. HARLow (J.
M.) Amer. Journ. of Med. Sc., April 1849, vol. xvii, N. S., p. 546.
From Boston M. and S. Journ. Dec. 13, 1848. *
CoNcussion of Brain, Clinical Lect. on. ADAMS (J.) Med. Gaz, March 23,
1850, vol. xliv, p. 485.
ENCEPHALITIs from a Blow on the Head, case of, with Remarks. BIRD (P. H.)
Prov. M. and S. Journ., Sept. 5, 1849, p. 488.
BRAIN, Tolerance of Injuries occasionally exhibited by. MAY (G. P.) Ibid.,
Jan. 9, 1850, p. 8.
EAR, Purulent Discharge from, followed by Cerebro-Spinal Meningitis. BEL-
LINGHAM (O’B.) Dub. Med. P., August 29, 1849, vol. xxii, p. 132.
PERFoRATION of Membrana Tympani, on the Treatment of HARVEY (W)
Med. Times, Feb. 23, 1850, vol. xxi, p. 135. YEARSLEY (James). Ibid.,
March 9, 1850, vol. xxi, p. 176.
* See also the Section on DISEASES AND INJURIES OF BONES.
51 2
766 CLASSIFIED CATALOGUE.
DISEASES AND INJURIES OF THE EYE AND ITS APPENDAGEs.
Eye, Lectures on Diseases of MACKMURDO (Gilbert). Lancet, vol. i., 1850,
pp. 437, 497, 587, 656, 713.
OPERATIve Ophth ALMic SURGERY, Lectures on. Walton (H. Haynes). Med.
Times, 1849, vol. xx, pp. 2, 69, 105, lä1, 193, 302, 331; 1850, vol. xxi,
pp. 1, 272, 331, and 447.
ORBIT, Case of Impaction of a Foreign Body in for two months. Med. Gaz.,
April 5, 1850, vol. xlv., p. 606. -
EYELIDs, Symmetrical Swelling of, from Protrusion of the Orbital Fat. Bow-
MAN (William). Lond. Journ. of Med., Nov. 1849, vol. i., p. 989. Conge-
nital Fungoid Disease of, and of Lacrymal Gland. Med. Times, May 18,
1850, vol. xxi, p. 368.
Ptosis, Cases of FRANCE (J. F.) Guy's Hosp. Rep., Oct. 1849, vol. vi, part
2, p. 243. Hysterical, case of CANTON (E.) Lond. Journ. of Med., Feb.
1850, vol. ii, p. 199.
ENTRoPIUM, new Operation for. WALTon (H. H.) Med. Times, May 25, 1849,
vol. xxi, p. 383. Abs. in Lond. Journ. of Med., June 1850, vol. ii, p. 601.
EcTRoPEoN, Paralytic. FRANCE (John F.) Lancet, Jan. 5, 1850, p. 14. Of
Lower Eyelid: Plastic Operation. DURHAM (W. W.) Phil. Med. Ex.,
Jan. 1849, vol. v., N. S., p. 21.
MEIBoMLAN GLANDs, curious Secretion of Black Matter by. Hewlett (T.)
Prov. M. and S. Journ., Oct. 3, 1849, p. 542.
LACHRYMAL DUCT, Tube impacted in for nearly Nine Years. CoopFR (White).
Lond. Journ. of Med., April 1849, vol. i., p. 322.
BLINDNEss, Statistics of PRICHARD (A.) Prov. M. and S. Journ., Jan. 23,
1850, p. 35.
EYE, Dislocation of, from Tumours in Brain. TAYLOR (Hibbert). Med. Gaz.,
March 9, 1849, vol. xliii, p. 429. Wound of Globe of LANDREAU (Rivaud).
Lond. Journ. of Med., June 1849, vol. i., p. 587. Congenital Tumours
on. TRAYER (J. S.). Dub. Quart. J., May 1849, vol. vii, N.S., p. 499.
Malignant Disease of: Cases, with Observations. WINDso R (J.) Prov.
M. and S. Journ., April 17, 1850, p. 225, Inflammation of from Injury.
Remarks on. JAcoB (A.) Dub. Med. P., Jan. 31 and March 21, 1849,
vol. xxi, pp. 65 and 177. Inflammation of, Phlebitic and Puerperal.
JAcob (A.) Ibid., April 25, 1849, vol. xxi, p. 257. Neuralgic Inflam-
3. mation of JAcoB (A.) Ibid., Sept. 5, 1849, vol. xxii, p. 145.
CoNicAL CoRNEA. Cooper (White). Lond. Journ. of Med., May and June
1850, vol. ii, pp. 407 and 523.
ARcus SENILis, or Fatty Degeneration of the Cornea, Observations on. CAN-
toN (E.) Lancet, May 11, 1850, p. 561.
STAPHyloma, on some Varieties of Dixon (J.) Lancet, May 25, 1850, p.
621. - -
ANTERIoR CHAMBER of Human Eye, Cysticercus Cellulosae in. MACKENziE
(W.) Med.-Chir. Trans., 1849, vol. xxxii, p. 41. Abs. in Lond. Journ. of
Med., Jan. 1849, vol. i., p. 111. - -
Aqueous HUMoUR, Congenital Deficiency of FRANCE (J. F.) Med. Gaz.
Jan. 8, 1850, vol. xlv., p. 11.
IRIs, Congenital Defects of PRICHARD (A.) Prov. M. and S. Journ., Sept.
19, 1849, p. 512. Inflammation of HALL (J. C.) Med. Gaz., 1850,
vol. xlv., pp. 240, 320, and 404. *
Closed PUPIL, peculiar variety of DELAGARDE (P. C.) Lond. Journ. of
Med., July 1849, vol. i., p. 689. * -
CRYSTALLINE LENs, Congenital Absence of PRicha RD (A.) Prov. M. and
S. Journ., April 18, 1849, p. 214.
CATARACTs, Osseous, on Removal of Cooper (White). Lond. Journ. of
Med., July 1849, vol. i. p. 623. Congenital, mistaken for Myopia and
Amblyopia. Cooper (White). Ibid., June 1849, vol. i. p. 505. Con-
genital, Cases of, with Imperfect Development of the Lenses. WALKER (W.)
BRITISH AND AMERICAN JOURNALS. 767
Edin. Month. Journ., April 1850, vol. i., 3rd S., p. 305. Hereditary, case
of DYER (S.S.) Prov. M. and S. Journ., Feb. 20, 1850, p. 91.
AMAU Rosis, Clinical Lecture on. Solly (S.) Lancet, Feb. 9, 1850, p. 168.
Case of, with Remarks. STEGGALL (J. W. B.) Ibid., March 16 and
April 13, 1850, pp. 327 and 435.
RETINA, Irritability of, from Irritation of the Dental Branch of the Fifth pair
of Nerves. HAys (Isaac). Amer. Journ. of Med. Sc., July 1849, vol. xviii,
N. S., p. 291; and Jan. 1850, vol. xix, N. S., p. 270.
DISEASES AND INJURIES OF MOUTH, CESOPHAGUS, AND AIR-PASSAGFs.
ToNGUE, Cancer of, existing four years; Cervical Glands affected : removal by
§º Cure. KEITH (W.) Edin. Month. Journ., Nov. 1849, vol. iii,
. S., p. 1213.
CLEFT Fº Staphyloraphy; Cases. FERGUsson (William). Lond. Journ.
of Med., Jan. and Feb. I849, vol. i., pp. 19 and 117. Clinical Lecture on
Cases. QUAIN (R.) Med. Times, Nov. 10, 1849, vol. xx, p. 373. Abs.
in Lond. Journ. of Med., Dec. 1849, vol. i., p. 1157.
Uvula, GEdema of BIRD (Golding), Med. Gaz., May 18, 1849, vol. xliv,
p. 875.
CEsophagus, Foreign Body in for nearly five months: Ulcerated Passage into
Trachea: Death. PATERson (R.) Edin. Med. and Surg. J., Jan. 1849,
vol. lxxi, p. 125. Impaction of Foreign Body in. ADAMs (John). Med.
Gaz., April 5, 1850, vol. xlv., p. 607. .*
LARYNGoToMY and TRACHEoToMY in Acute Affections of the Larynx. Hewett
(Prescott). Lond, Journ, of Med., Feb. 1849, vol. i., p. 129.
LARYNGoToMY, cases of HILtoN (John.) Med. Gaz., June 1, 1849, vol. xliii,
p. 955. ERICHSEN (J. E.) Lancet, April 27 and May 4th, 1850, pp.
498 and 525.
TRAcHeoToMy. SMITH (H.) Med. Gaz., Feb. 16 and March 2, 1849, vol.xliii,
pp. 280 and 370. On the Operation and Application of ; with Description
and Plates of a New Instrument. HALL (Marshall). Lancet, April 7,
1849, p. 367. Performed three times, for Disease of Larynx: Portion of
Necrosed Ossified Cartilage coughed up through the artificial opening.
HUMBY (E.) Ibid., Jan. 19, 1850, p. 78, and Lond. Journ. of Med., Aug.
1849, vol. i., p. 777. For Scalded Glottis: Artificial Respiration for 54
hours: Recovery. Poland (A.) Lancet, June 1, 1850, p. 670.
Foreig N Body in Larynx (Dog's Tooth): Observations. GEoghegAN (T. G.)
Dub. Med. P., Jan. 24, 1849, vol. xxi, p. 49. In Trachea. Popha M.
(John). Dub. Quart. J., Feb. 1850, vol. ix, N. S., p. 215. In Bronchi,
case of Solly (Samuel). Lond. Journ. of Med., July 1849, vol. i., p. 680.
In Right Bronchus. Forbes (J. G.) Ibid., Dec. 1849, vol. i., p. 1168.
In Bronchus (accidental introduction of Puff-Dart): Abscess : Recovery.
NuNN (R. S.) Prov. M. and S. Journ., July 25, 1849, p. 402. In
Bronchus. MacSwiney (Dr.) Dub. Med. P., Dec. 12, 1849, vol xxii,
p. 370.
DISEASES OF THE BREAST.
BREAST, Lectures on Diseases of Cooper (B. B.) Med. Gaz., 1849, vol.
xliii, pp. 617, 705, and 793. On Inflammation of NUNN (T. W.)
Lond. Journ. of Med., March 1850, vol. ii, p. 302. On certain Tumours
of BIRKETT (John). Ibid., July, 1849, vol. i., p. 688: and Guy's Hosp.
Rep., Oct. 1849, vol. vi, part 2, p. 327.
DISE ASES AND IN J U RIES OF THE ABOOMEN.
Wound of INTESTINE, returned without Suture : Union. PEN Nock (B. J.)
Phil. Med. Ex., March 1849, vol. v., N.S., p. 153. -
CASE of STABBING: Protrusion of Omentum : Strangulation of a portion of
Intestine: Operation and Recovery. TeaGUE (James). Lancet, Dec. 22,
1849, p. 666.
768 CLASSIFIED CATALOGUE.
CALculus passed from the Umbilicus, case of. STEwART (H. C.) Ibid.,
Sept. 15, 1849, p. 294. &
ARTIFICIAL ANUs, case of Operation for. WARREN (J. M.) Amer. Trans.,
1849, vol. ii, p. 229. Case of M. Amussat's Operation. Caompton (D. W.),
Med. Gaz, July 20, 1849, vol. xliv, p. 107. Case of Closure of FER.
Gusson (W.) Med. Times, August 4, 1849, vol. xx, p. 92. Case.
MAGLAGAN (Douglas). Edin. Month. Journal, Sept. 1849, vol. iii, N.S.,
p. 1027. Case, terminating favourably. CREIGHToN (Dr.) Dub. Med.
P., May 23, 1849, vol. xxi, p. 323.
STRANGULATION, remarkable case of, caused by a Diverticulum. PIRRIE (Wil-
liam). Edin. Month. Journ., July, 1849, vol. iii, N.S., p. 887.
HERNIA, Clinical Ilecture on. KNowles (G. B.) Prov. M. and S. Journ.,
Dec. 26, 1849, p. 701. Select Cases. Cock (Edward). Guy’s Hosp.
Rep. Oct. 1849, vol. vi., part 2, p. 309. ERICHSEN (John E.) Lancet,
Jan. 5, 1850, p. 10; and Lond. Journ. of Med., Jan. 1850, vol. ii, p. 100.
Incipient; its Treatment. SPONG (W. N.) Lancet, August 11, 1849,
p. 143. Treatment of, with Opium. LANE (Butler). Prov. M. and S.
Journ, May 30, 1849, p. 287. Strangulated, cases of successful Opera-
tion for in Old People: with Remarks. CURLING (T. B.) Lond. Journ.
of Med., June 1850, vol. ii, p. 507. Strangulated, on Petit's Operation
for. HAN cock (H.) Lancet, vol. ii, 1849, pp. 62, 173,263,499, and 599;
and Lond. Journ, of Med., Nov. 1849, vol. i., p. 1072. Inguinal : followed
by Intestinal Obstruction, removed by Mechanical Means. TownsenD (R.
W.) Amer. Journ. of Med.Sc., Oct. 1849, vol. xviii, N.S., p. 546. Inguinal:
Inflammation and Suppuration of Sac. MEADE (R. H.) Med. Gaz.,
Oct. 19 and 26, 1849, vol. xliv, pp. 661 and 700. Cases of, reduced en
masse. LUKE (James). Med. Gaz., Feb. 16, 1849, vol. xliii, p. 272:
also Ibid., Feb. 8, 1850, vol. xlv., p. 236. REID (James). Prov. M. and
S. Journ., Jan. 24, 1849, p. 41. Abs. in Lond. Journ. of Med., March,
1849, vol. i., p. 278. Strangulated Inguinal: Operation : Artificial Anus:
Cure. JENNETTE (M.) Med. Gaz., Sept. 28, 1849, vol. xliv, p. 544.
Strangulated Inguinal: Operation: Chloroform. TRASK (J. D.) Amer.
Journ. of Med. Sc., July, 1849, vol. xviii, N.S., p. 90. Strangulated In-
guinal : Operation, in a woman aged upwards of 100 years: Recovery.
MoRRIs (John). Lancet, May 5, 1849, p. 478. Strangulated Inguinal :
Remarks. B1Rd (P. H.) Prov. M. and S. Journ., June 27, 1849, p. 346.
Strangulated Inguinal, case complicated by Imperfect Descent of the Tes-
ticle. FEATHERSTONHAUGH (H.) Lancet, June 8, 1850, p. 693. Strangu-
lated Femoral in the Male, case of: Operation : Recovery. BELLINGHAM
(O’B.) Dub. Med. P., Sept. 19, 1849, vol. xxii, p. 177. Femoral,
Strangulated 13 days: Operation : Success. Johnston (D.) Edin.
Month. Journ., Nov. 1849, vol. iii, N.S., p. 1217. Femoral : Enterocele:
Operation: Cure. KNox (A.) Dub. Med. P., June 5, 1850, vol. xxiii,
p. 355. Strangulated Femoral, case of. STARR (H.) Prov. M. and S.
Journ., Sept. 19, 1849, p. 514. Case, strangulated within the Abdomen :
reduced by Operation. SyME (James). Edin. Month. Journ, Jan. 1850,
vol. i., 3rd S., p. 1. Ascending or Intermuscular, case of, with Observa-
tions. LUKE (James). Med. Gaz., March 15, 1850, vol. xlv., p. 458.
Mesocolic, cases of PEAcock (T. B.) Lond. Journ. of Med., Oct. 1849,
vol. i. p. 910. Sudden Abdominal : Injury of Diaphragm. Cooper (B.
B.) Lancet, May 11, 1850, p. 569. Obstructed, cases of: Remarks.
GAY (John). Edin. Month. Journ., March, 1849, vol. iii, N. S., p. 580.
EPIPLocBLE, Irreducible, treatment of HUGHEs (J. S.) Dub. Quart. J.,
May, 1850, vol. ix, N. S., p. 309. -
HAEMoRRholds, Treatment of, by Nitric Acid. LEE (H.) Lond. Journ. of
Med., Jan. 1849, vol. i. p. 92. Treated by Nitric Acid. Massy (R.T.)
Med. Times, June 30, 1849, vol. xix, p. 674.
RECTUM, Prolapsus of, case. SyME (James). Edin. Month. Journ., March,
1850, vol. i., 3rd S., p. 242, Extraction of a Glass Goblet from. Rºſs-
*.
BRITISH AND AMERICAN JOURNALS. 769
CHENBERGER (W. S. W.) Amer. Journ. of Med. Sc., April 1849, vol.
xvii, N. S., p. 409.
SPHINCTER ANI, Sub-mucous Section of, for Spasmodic Contraction with Anal
Fissures, ANDERSON (W. J.) Lancet, Sept. 15, 1849, p. 291.
IMPERFORATE ANus, successful Operation on the third day after birth. Hoope
(John). Med. Times, August 18, 1849, vol. xx, p. 137. g
INTESTINAL OBSTRUCTION, complete, two cases of, from Disease of Sigmoid
Flexure of Colon, and of Rectum : Descending Colon opened in the
Loin. FIELD (F.) and CLARKSON (J.) Lond. Journ. of Med., Feb.
1850, vol. ii, p. 195. Cases of, with Remarks. ERichsen (J. E.) Lancet,
Jan. 26, 1850, pp. 108, 142, 171,235. Ball-valve of Rectum, by Scyba-
lous Masses. SIMPson (J. Y.) Edin. Month. Journ., April, 1849, vol. iii,
N. S., p. 705.
DISEASES AND INJ U RIES OF THE URINARY AND GEN ITAL ORGANS.
BLADDER, Chronic Inflammation of: Treatment by injection of Nitrate of
Silver : Cases. MAcDoNNELL (R. L.) Dub. Med. P., July 4, 1849, vol.
xxii, p. 4. From Brit. Amer. Journ. Abscess at Neck of: Retention of
Urine. Dub. Quart. J., May 1850, vol. ix, N. S., p. 479. Irritable,
Clinical Lecture on. SIMON (John). Lancet, March 9, 1850, p. 289.
Haemorrhage into, Death from. WARDELL (Dr.) Lond. Journ, of Med.,
June 1850, vol. ii, p. 586. Sloughing of, after Fractured Spine, and for-
mation of an Adventitious Membrane, taking the place of the Bladder.
Gibb (W.) Med. Gaz., March 29, 1850, vol. xlv., p. 559. Malignant
Disease of LAN KESTER (E.) Lond. Journ. of Med., March 1850,
vol. ii, p. 298. Fungoid Disease of. KESTEvEN (W. B.) Med. Gaz.,
Oct. 12, 1849, vol. xliv, p. 617. THoMPso N (H.) Dub. Quart. J., May
1850, vol. ix, N. S., p. 485.
Rupture of, from Fracture of the Pelvis. TAYLoR (John). Edin.
Month. Journ., May, 1849, vol. iii, N. S., p. 748. Cases of Phil. Med.
Ex., Dec. 1849, vol. v., N. S., p. 728. STAPLEToN (M. H.) Dub. Quart.
J., Feb. 1850, vol. ix, N.S., p. 217. Clinical Lecture on case of. So LLY
(S.) Lancet, March 23, 1850, p. 351. Ten cases of Hewett (P.)
Ibid., May 11 and 18, 1850, pp. 573 and 606. Case, with seven Fractures
of Pelvis: Death on forty-second day. PEASLEE (G. R.) Amer. Journ.
- of Med. Sc., April 1849, vol. xix, N. S., p. 383.
URINARY Concretions, Considerations connected with the Pathology and Sur-
gery of Cooper (B. B.) Guy's Hosp. Rep., Oct. 1849, vol. vi, part 2,
. 263. -
Uniº PASSAGEs, Dilatation of, from Calculus, case of SPENCE (J.) Edin.
Month. Journ., April, 1849, vol. iii, N. S., p. 700.
CALculus in Bladder: Lectures on Operations for. Cooper (B. B.) Med.
Gaz., 1849, vol. xliii, pp. 1, 89, and 177. Case of BIRD (P. H.) : Prov.
M. and S. Journ., August 22, 1849, p. 462. Cystic Oxide : Operation.
MILLER (James). Edin. Month. Journ., June 1849, vol. iii, N.S., p. 791.
Note in reference to this case, Ibid., July, p. 886. In a Boy : Operation:
Clinical Remarks. ADAMs (J.) Med. Gaz., March 8, 1850, vol. xlv., p.
432. In a girl three years old. HILTON (J.) Lancet, June 22, 1850, p. 757.
Cases of Operation for. FERGusson (W.) Med. Gaz., April 12, 1850,
vol. xlv., p. 651. LUKE (James). Lancet, Feb. 16, 1850, p. 218. Cock
(E.) Ibid., March 30, p. 391. HILtoN (J.) Ibid., p. 392; and May 18,
p. 602. LAwar.NcE (Wm.) , Ibid., April 27, 1850, p. 509. STEwART
(Dr.) Dub. Med. P., March 14, 1849, vol. xxi, p. 162. Encysted :
Lithotomy: Death. NewHAM (T.) Med. Gaz., Oct. 5, 1849, vol. xliv,
p. 594. With Necrosis of Os Pubis. ADAMS (J.) Lancet, March 9,
1850, p. 308; Case of Lithotomy: 117 Calculi, weighing 44 ounces, suc-
cessfully removed. Eve (P. F.) Amer. Journ. of Med. Sc., April 1849,
vol. xvii, N.S., p. 539. &
LithotoMy (and Lithotrity), Report of the Committee of the American Medical
-*
770 - CLASSIFIED CATALOGUE.
Association on. Phil...Med. Ex., Feb. 1849, vol. v., N. S., p. 79. Use of
Ether in. WARREN (J. M.) Amer. Journ. of Med. Sc., July 1849, vol.
xviii, N. S., p. 47. Description of an Instrument for the Performance
of SMITH (N. R.) Amer. Trans., 1849, vol. ii, p. 226. Modification of
Bilateral Operation. FERGusson (W.) Lancet, March 30, 1850, p. 392,
LITHoTRITY, successful Case of. JEAFFREson (W.) Prov. M. and S. Journ.
July 25, 1849, p. 402. .
LITHoNTRIPSY, cases of RANDoLPH (Dr.) Phil. Med. Ex., May, 1849, vol. v.,
N. S., p. 288. McCLELLAN (G.) Ibid., Sept. 1849, vol. v., N. S., p. 513.
PROSTATE GLAND, Acute Inflammation of, after use of Nitrate of Silver Injec-
tion. SMITH (H) Med. Times, June 23, 1849, vol. xix, p. 656. Acute
Inflammation of HAMILTON (John). Dub. Quart. J., May 1850, vol.
ix, N. S., p. 275. Enlargement of Third Lobe of: Transposition of Left
Kidney. THoMPson (Henry). Ibid., May 1850, vol. ix, N.S., p. 484.
Disease of WILMoT (Samuel). Ibid., May 1849, vol. vii, N. S., p. 261.
Retention of Urine from Disease of: Clinical Lecture. HUGHEs (J.S.)
Dub. Med. P., June 19, 1850, vol. xxiii, p. 385.
URETHRA, Laceration of, Clinical Lecture on. ADAMs (John). Med. Gaz.,
May 11, 1849, vol. xliii, p. 800. Injuries of : Retention of Urine: Clinical
Lecture on. ADAMs (J.) Ibid., April 13, 1849, vol. xliii, p. 623. Expul-
sion of Larvae from. DREw (Joseph). Lancet, Jan. 19, 1850, p. 83.
Vascular Tumour of Norman (H. B.) Edin. Month. Journ., June
1849, vol. iii, N. S., p. 795. Cellular Tumour of, in a Female. MACK-
MURDo (G.) Ibid., April 13, 1850, p. 451. Treatment of Haemorrhage
from. HUGHEs (J. S.) Dub. Quart. J., May 1850, vol. ix, N. S., p. 309.
STRICTURE of URETHRA, Clinical Lecture on. SolI.Y (S.) Med. Gaz. Feb. 2,
1849, vol. xliii, p. 185. Hughes (J. S.) Dub. Med. P., June 5, 1850,
vol. xxiii, p. 353. Mistaken for Gomorrhoea. BARTLETT (T.) Lancet,
March 24, 1849, p. 313. Permanent : Prolonged Retention of Urine :-
Puncture of Bladder. TRAVERs (B. junr.) Lond. Journ. of Med., Oct.
1849, vol. i., p. 985, Treatment of HolT (Barnard). Med. Times,
1849, vol. xix, pp. 489, 528, 566, and 603. Treatment and Cure by means
of a simple apparatus. MACHELL (T.) Lancet, August 25, 1849,
p. 203. Report on Gutta Percha Bougies in. Amer. Trans., 1849,
vol. ii, p. 225. On Use of Gutta Percha Bougies. TUFNELL (J.) Dub.
Med. P., Nov. 28, 1849, vol. xxii, p. 340. Danger of Gutta Percha
Catheters in. HAwKINs (Caesar). Med. Gaz., Oct. 26, 1849, vol. xliv,
p. 699. Treatment of, by “Extraduction” of the Bougie, after Puncture
of Bladder. BRAINARD (Professor). Amer. Trans., 1849, vol. ii, p. 225.
With Fistula in Ano and, Scrotal Abscess. Solly (S.) Med. Gaz.,
Feb. 2, 1849, vol. xliii, p. 184. Treatment of, by the Perinaeal
Section. SYME (James). Lancet, Feb. 17, 1849, p. 180, and May 18, 1850,
p. 605. FERGUsson (W.) Lancet, May 11, 1850, p. 570; and case with
Lithotomy. Ibid., Feb. 16, 1850, p. 217. SMITH (Henry). Med. Times,
Sept. 15, 1849, vol. xx, p. 215, and May 4, and 25, and June 1, 1850,
vol. xxi, pp. 334, 381, and 400. PARTRIDGE (R.) Lancet, April 13,
1850, p. 452. Cock (E.) Ibid., June 29, 1850, p. 775. WADE (R.)
Ibid., Jan. 26, 1850, p. 115. THoMPson (Joseph). Med. Times, 1849,
vol. xxi, pp. 548, 583, and 618. -
SCROTUM, Elephantiasis of CHILD (Dr.) Med. Gaz., Feb. 1, 1850, vol. xlv.
p. 192. Lecture on. Cooper (B. B.) Ibid., March 30, 1849, vol. xliii,
p. 533. Case of Cancer of Cox (W. Sands). Prov. M. and S. Journ.,
March 7, 1849, p. 127. Chimney-Sweepers' Cancer, Lecture on. Cooper
(B. B.) Med. Gaz, March 30, 1849, vol. xliii, p. 530. Case of Dixon
(J.) Lancet, March 16, 1850, p. 337. Melanotic Cancer of CURLING
(T. B.) Lond. Journ. of Med., March 1849, vol. i., p. 220. Prurigo of,
Lecture on. Cooper (B. B.), Med. Gaz., March 30, 1849, vol. xliii, p.
534. Remarkable Disease of CANTo N (E.) Lancet, March 31, 1849,
p. 345. Abs, in Lond. Journ. of Med., May 1849, vol. i. p. 497. -
BRITISH AND AMERICAN JOURNALS. 771
SPERMATocelle and Hydrocele, Clinical Lecture on. Syme (James). Edin.
Month. Journ., Jan. 1850, vol. i., 3rd S., p. 63. -
HYDRocFLE. HUNTER (John). Copy of original letter. Med. Times, Jan.
27, 1849, vol. xix, p. 267. Lecture on. Cooper (B. B.) Med. Gaz.,
1849, vol. xliii, pp. 357 and 441. Case of Large, with Thickened Sac :
large Circular Opening in Lower Part, with well-defined thickened Edge,
on which was a Prolongation of Membrane filled with the fluid of the
Tunica Vaginalis. RYAN (W.), Lancet, Jan. 12, 1850, p. 54. Of Tu-
nica Vaginalis. MAcDon Nell (R. L.) Dub. Med. P., April 18, 1849,
vol. xxi, p. 245. From Brit. Amer. Journ. Spermatozoa in the Fluid
of CURLING (T. B.) Edin. Month. Journ., Sept. 1849, vol. iii, N. S.,
p. 1023. Of Tunica Vaginalis: Spermatozoa in the Fluid. MacDonne LL
(R. L.) Med. Gaz., Dec. 21, 1849, vol. xliv, p. 1049. Of Tunica Wa-
ginalis: Injection twice unsuccessful: Incision successful. KNox (A.)
Dub. Med. P., June 19, 1850, vol. xxiii, p. 388. Case: Iodine In-
jection unsuccessful: Seton. ERICHsen (J. E.) Lancet, March 9, 1850,
. 292.
Hºnºre, Lecture on. Cooper (B. B.) Med. Gaz., March 30, 1849,
vol. xliii, p. 529. -
VARicocelle, Lecture on. Cooper (B. B.) Ibid., March 2, 1849, vol. xliii,
p. 355. - -
SPERMATIC CHoRD, case of Abscess of BRookEs (W. P.) Ibid., Feb. 2,
1849, vol. xliii, p. 192: also Lancet, August 11, 1849, p. 147. Abs. in
Lond. Journ. of Med., Sept., 1849, vol. i., p. 878. -
TEstis, Lectures on Diseases of, Cooper (B. B.) Ibid., Feb. 16 and March
2, 1849, vol. xliii, pp. 265 and 353. Abscesses in. THoMPson (H.)
Dub. Quart. J., May 1850, vol. ix, N. S., p. 479. Clinical Lecture on
some cases of Disease of QuAIN (R). Med. Times, Dec. 15 and 22,
1849, vol. xx, pp. 467 and 483. Tumours of: Remarks on a case of
Haematocele. GRIMSHAw (A. H.) Phil. Med. Ex... Sept. 1849, vol. v.,
N. S., p. 520. Medullary Sarcoma of Cock (G.) Lancet, June 15,
1850, p. 721. Fungoid Disease of TUFNELL (H.) Dub. Med. P., Jan.
17, 1840, vol. xxi, p. 33. Fungus Haematodes of: Hydrocele: Opera-
tion. KNox (A.) Ibid., May 15, 1850, vol. xxiii, p. 308. Two Cases of
Removal of CUTLER (E.) and Hewett (P.) Lancet, April 27, 1850,
. 51 1. -
Pesº. Unusual Affection of KIRBy (J.) Dub. Med. P., Oct. 3, 1849, vol.
xxii, p. 209. Case of Dangerous Haºmorrhage from. Dixon (J.) Lancet,
June 8, 1850, p. 671. Case of Fracture of Rusch ENBERGER (W. S. W.)
Amer. Journ. of Med. Sc., April 1149, volazvii, N. S., p. 409. -
PREPUCE, case of Horny Excrescence from, cured by Application of Sesqui-
chloride of Antimony. SPRY (E. J.) Prov. M. and S. Journ., Oct. 3,
1849, p. 540.
PHIMoSIs, Congenital. , DELANEY (M. G.) Amer. Journ. of Med. Sc., July
1849, vol. xviii, N. S., p. 72. Operation for. Colles (W.) Dub. Quart.
J., Feb. 1849, vol. vii, N. S., p. 250. -
SPERMATorrhoea, Three cases of: Entophytes in Urine with Spermatozoids.
Jones (T. W.) Lancet, May 19, 1849, p. 527.
INvolunTARY SeminAL Disch ARGEs, and the Disorders attending them.
M‘Dougall (H. J.) Med. Times, 1849, vol. xix, pp. 378, 413, 470, 551;
vol. xx, pp. 85 and 375: 1850, vol xxi, p. 152.
SYPHILIS AND GONORRHOEA.
SYPHIlis, Lectures on. CoopFR (B. B.) Med. Gaz., 1849, vol. xliv, pp. 869,
957, 1945: 1850, vol. xlv., p. 45. Remarks on. Skey (F. C.) Med.
Times, June 2, 1849, vol. xix, p. 601 : July 7, vol. xx, p. 3. CHRISTO-
PHERs (J. C.) Lancet, Jan. 13, 1849, p. 38: Sept. 15, p.289. Treatment
of in the Hospitals of Paris. Acton (W.) Lond. Journ. of Med., June
1850, vol. ii, p. 605. Sketch of cases of, in the 47th Regiment. SAUNDERs
(George). Med, Times, April 21, 1849, vol. xix, p. 490.
772 CLASSIFIED CATALOGUE.
PRIMARY VENE REAL ULCERs, not curable by Mercury. TBAvers (B. jun.)
Lond. Journ. of Med., Feb. 1850, vol. ii, pp. 200 and 206.
SYPHills, Constitutional, Remarks on. Cooper (G. L.) Lancet, April 14,
1849, p. 398.
CREEPING BuBo, Observations on, illustrated with cases. Solly (Samuel).
Lond. Journ. of Med., May 1849, vol. i., p. 437.
SYPHILIs, Secondary, Statistical Analysis of 166 cases of, observed at the Lock
Hospital in the years 1838-39, LEE (Henry). Ibid., Sept. 1849, vol. i,
p. 797. Cases of, with Remarks. WHITTALL (Thomas). Prov. M. and
S. Journ. Oct. 3, 1849, p. 542,656. Case of; bearing on the question
whether an infant so affected can be suckled by a healthy nurse without
infecting her. Poggio (Ramon Hernandez). Lancet, April 6, 1850, p.
411. Translated from the Gaceta Medica by Mr. G. B. Childs. Nodes:
Acne Punctata, Psoriaris, etc., case of. RouTH (C. H. F.) Med. Gaz.,
June 7 and 14, 1850, vol. xlv., pp. 996 and 1046. Cutaneous, Clinical
Illustrations of: having especial reference to its Pathology and Treatment.
Wrlson (Erasmus). Lancet, vol. i., 1850, pp. 237, 381,472, 526. Peri-
ostitis from, cases of: Phagedænic Ulceration in Lower Limb : Practical
Observations. CRITCHETT (G.) Edin. Month. Journ., April 1849, vol.
iii, N. S., p. 680. Disease of Larynx, Bones of Skull, and Meninges:
Case: Clinical Remarks. So LLY (S.) Lancet, April 13, 1850, p. 346.
Ulceration in Perinaeum, case: cured by large doses of Conium. LLoyd
(E. A.) Med. Times, Jan. 6, 1849, vol. xix, p.215. Sarcocele : Node in
Throat. HAMILTON (John). Dub. Med. P., May 1, 1850, vol. xxiii.p. 278.
Gonor RHOEA and Syphilis in the Female, Statistics of. FENwick (Dr.) Med.
Gaz., April 27, 1849, vol. xlii, p. 737.
GoNorrhoea L. BRONCHITIs, case of; GRAHAM (Thomas). Ibid., April 5,
1850, vol. xlv. p. 610.
GLEET and its Treatment. Johnson (C.) Amer. Journ. of Med. Sc., April,
1850, vol. xix., N. S., p. 341. --
SURGICAL INSTRUMENTS AND APPLIANCES.
ANAESTHETIC Agents, on the Application of to Surgical Purposes. FLEMING
(Dr.) Dub. Med. P., June 6, 1849, vol. xxi, p. 354.
CHLoRoFoRM in Surgical Operations. SNow (John). Lond. Journ. of Med.,
Jan. 1849, vol. i., p. 50. Safety and Suitableness of, as an Anaesthetic
Agent in some of the more Complex and Serious Operations in Surgery;
with Illustrative Cases and Remarks on Lithotrity, and on the Lateral
and High Operations of Lithotomy. Kel TH (William). Edin. Month.
Journ., April 1849, vol. iii, N. S., p. 655) In Surgery, Report on. Amer.
Trans., 1849, vol. ii, p. 212. Facilitating Reduction of Dislocations.
WILDE (W. R.) Dub. Quart. J., Nov. 1849, vol. viii, N. S., p. 454.
Collodion, uses of in Surgery. Lond. Journ. of Med., Feb. 1849, vol. i., p.
197. (Digest, from various Medical Journals, of the cases in which Col-
lodion was reported to have been applied).
ELASTIc RING-BED for Invalids, Description of an. LUKE (J.) Iancet, Nov.
24, 1849, p. 553.
FoREIGN Bodies, Extraction of DIEFFENBAcH (Johann F.) Med. Times,
July 21 and 28, 1849, vol. xx, pp. 57, 77, and 95.
GUTTA PERCHA, Surgical Uses of JAcob (A.) Dub. Med. P., Jan. 2, 1850,
vol. xxiii, p. 1. Employment of in Orthopoedic Surgery. Amer. Trans.,
1849, vol. ii, p. 224.
LEECHEs, Application of DIEFFENBAcH (J F.) Med. Times, Sept. 1, 1849,
vol. xx, p. 185. Proposal for the Propagation of, in Ireland. Donov AN
(H.) Dub. Med. P., Sept. 26, 1849, vol. xxii, p. 196. Mechanical, De-
scription of Apparatus for Employing. Tweed (J. J.) Med. Times,
Jan. 19, 1850, vol. xxi, p. 36. - - -
TRUsses, means of making more durable by Galvanising their Springs. STRAT.
Ton (Thomas). Edin. Med. and Surg. J., Jan. 1849, vol. lxxi, p. 145.
Observations on. TEALE (T. P.) Med. Gaz., Feb. 1, 1850, vol. xlv., p. 194.
773
CRITICAL DIGEST OF THE BRITISH AND FOREIGN Medical.
JOURNAL.S.
ANATOMY AND PHYSIOLOGY.
*
oN THE STRUCTURE OF THE MEMBRANA TYMPANI IN THE HUMAN EAR.
MR. JosłPH ToyNBEE, in a paper, read at the Royal Society on the 20th
June, describes the Membrana Tympani as consisting of the following layers,
quite distinct from each other, both as regards their structure and functions.
1. Epidermis.
2. The proper fibrous layer, composed of
a. The lamina of radiating fibres.
6. The lamina of circular fibres.
3. Mucous Membrane.
One of the principal objects of the paper is to describe the structure and
functions of the fibrous laminae. Since the time of Sir Everard Home, who
pronounced the layer of radiating fibres to be muscular, anatomists have
differed in their views of the nature of the fibrous element of the Membrana
Tympani. The lamina of radiating fibres, the outer surface of which is
covered by the epidermis, is continuous with the periosteum of the external
meatus. With the exception of the uppermost fibres, which, on account of
their being somewhat flaccid, have been considered as a separate tissue, under
the name of “membrana flaccida”, the radiate layer is composed of fibres
which extend from the circular cartilaginous ring to the malleus, and they
interlace in their course. These fibres are from the 4000th to the 5000th
parts of an inch in breadth.
The lamina of circular fibres consists of fibres, which are firm and strong
towards the circumference, but very attenuated towards the centre. These
fibres are so attached and arranged, as to form a layer of membrane which,
in a quiescent state, is saucer-shaped. The fibres composing the circular
are smaller than those of the radiate lamina, being from the 6000th to the
10000th part of an inch in breadth. *
The facts that appear to be adverse to the idea of the fibres of either layer
being muscular are:—
1. The absence of distinct nuclei in the fibres.
2. Their great denseness and hardness,
The four laminae forming the Membrana Tympani are continuous with the
other structures, of which they appear to be mere modifications, and not one
is proper to the organ.
The tensor tympani ligament, which had not been previously noticed by
anatomists, is particularly described by Mr. Toynbee in the paper read before
the Royal Society. It is attached externally to the malleus, close to the
insertion of the tensor tympani muscle, and internally to the cochleariform
I’OCéSS.
p The latter part of the paper is occupied by observations on the functions
of the fibrous laminae, and of the tensor ligament of the Membrana Tympani;
and it is shown that by these two antagonistic forces, the one tending to
draw the Membrana Tympani outwards, the other inwards, this organ is
maintained in a state of moderate tension, and is always in a condition to
receive ordinary sonorous undulations. - -
774 CRITICAL DIGEST of THE JOURNALs.
PRACTICE OF MEDICINE AND PATHOLOGY.
DR. BEGBIE ON ERYTHEMA NODOSUM, AND ITS CONNEXION WITH THE
**. EEIEUMATIC DIATHESIS. - -
It is wisely remarked by Dr. Gooch, in his admirable essay “On some
Symptoms in Children erroneously attributed to Congestion of the Brain”,
that “in observing disease, two sets of symptoms may be noticed, which are
mixed together in the case, but which require to be discriminated to form a
correct opinion of it. The one consists of the striking symptoms which form
what may be called the physiognomy of the disease ; the other consists of
those symptoms which indicate the morbid state of organisation, on which the
disease depends. The former only are noticed by the common observer; but
the latter are the most important, and the skilful physician takes them for
his guides in the treatment.” “He notices not only where the hour hand of
nature's clock points, but also the run of its minute and second hands.”
These judicious reflections apply with marked propriety to many diseases
of the skin, and perhaps to none more than to that singular affection, a short
notice of which I now offer to the Society.
The variety of Erythema, to which the term nodosum has been applied by
systematic writers, is characterized by red elevated patches, of an oval form,
varying in size from an inch to an inch and a half in length, by half an inch
or more in breadth, their long diameter being uniformly parallel to the axis
of the limb on which the eruption appears; and this part is generally the
anterior of the legs, or shin as it is called, over which, I have observed that
the patches are distributed with symmetrical regularity; occasionally, also,
but more rarely, they appear on the forearms. I have never seen them on
any other part of the body. The affection occurs most commonly in young
women; but it is not limited to them, as some authors suppose, but is ob-
served in young men, and in children of both sexes. The eruption is pre-
ceded and accompanied by more or less febrile disturbance, by moist furred
tongue, deranged bowels, and scanty high-coloured urine ; often by pains in
the joints and muscles, and always, when severe, by feelings of depression
and great disorder. The patches continue for some days to rise above the
level of the surrounding skin, becoming more elevated towards the centre,
and forming painful bumps or protuberances, which appear, when pressed on
by the finger, to offer a fluctuation, and promise a suppuration, which never,
however, takes place. With the resolution, the red colour fades, and is suc-
ceeded by a bluish or dusky hue, resembling somewhat the appearance of a
bruise; the tumefactions soften and disappear, the general indisposition sub-
sides, and the case usually runs its course in ten or fifteen days. In some
instances, however; the protuberances have continued hard and painful for a
longer time; and the blue discolorations have lasted several weeks. The
disease is apt to recur, and its premature retrocession, or natural decline, have
been noticed as the period of the invasion of serious internal disease.
Such is a general description (as given by authors, and verified by observa-
tion) of a malady, which by many is considered more curious and rare than
interesting and instructive ; to whose history little or no importance has
been attached by most of the recognized authorities on cutaneous diseases;
whose associations with marked disordered function and morbid action have
been nearly overlooked, and a knowledge of whose real character is only be-
; to be developed, by the steady advance of an enlightened humoral
athology. *. * -
p In iºtation of the form in which the disease occurs in practice, I offer
a passing notice of two cases, the last which have come under my observation.

* Gooch's Account of some of the most Important Diseases of Females. 2nd Edit,
p. 344.
CRITICAL DIGEST OF THE JOURNALS. 775
CASE I. This was a boy, aged 13, said to belong to a healthy family, and
to be free from any predisposition to disease, who had been living hitherto in
the country, and had only lately come to town, to pursue his education at the
New Academy. He was tall and strong for his age ; but his friends had
remarked that, for some time past, his countenance was pallid, and his ap-
pearance cachectic, and that he had evinced much disinclination for mental or
bodily exertion. I saw him on the second or third day of a febrile attack, and
in the early stage of the eruption of the Nodose Erythema; the patches were
large and numerous, tender, painful, and hot, distributed over the fore part
of the legs, and also over the forearm, with symmetrical regularity, accom-
panied by headache, languor, and lassitude, and by deep-seated pains in the .
joints and muscles of the extremities. The pulse was frequent and full, and
compressible; the tongue loaded with a creamy fur; the skin hot, soft, and
moist; the bowels inactive, and the dejections dark and offensive; the urine
scanty and high coloured, and gradually depositing more and more of the
lateritious sediment. The disease pursued its course, apparently unmoved,
by antiphlogistic treatment; the tongue continued foul, the bowels disordered,
and the urine defective and deranged; the febrile state had somewhat sub-
sided, and the bright red discoloration had faded into a bluish or livid tint,
when, about the seventh day of the eruption, the sulphate of quina, as
recommended by Dr. Watson, was prescribed, and its exhibition appeared to
produce a marked impression on the features and progress of the case. The
tongue, which had yielded nothing to calomel and jalap, now rapidly divested
itself of its thick coating; the bowels assumed a more healthy action, and
the evacuations a more natural appearance ; the urine became copious and
clear ; the protuberances of the eruption softened and disappeared, the
bruised marks vanished, and after a week of convalescence, the patient
returned to his books and his play. l
We have, in this case, a well-marked instance of the Erythema Nodosum in
a boy of 13, previously healthy, but manifesting before its occurrence the
characteristic signs of a peculiar diathesis, as exhibited in the pallid and
cachectic look, the defective excretions, and the deep-seated pains in the
limbs and joints. We remark, also, the beneficial effects of quina in the
treatment, as corresponding with the experience of Dr. Watson in this disease.
CASE II. The other case, to which I shall at present allude, occurred in the
person of a domestic servant, a young woman of 20 years of age, of pallid com-
plexion and delicate appearance, and subject to irregular and defective men-
struation. When seized with an attack of a febrile character, followed by
copious patches of the Nodose Erythema, distributed over the fore part of the
legs, and accompanied by the usual tenderness, heat, and pain of the erup-
tion, she had requested the attendance of a respectable practitioner in the
neighbourhood of her master's residence, who had prescribed rest, diapho-
retics, and laxatives, under which the disease appeared to yield. On the
eighth or tenth day of her illness, however, I was requested to see her, in
consequence of an attack of acute pain in the lower part of the left side, with
impeded breathing, rapid pulse, and increase of fever. The bright blush of
Erythema had at this time sunk into the dusky blue ; the protuberances had
softened and declined ; but the general derangement of health, manifested
by the pale sickly look, the loaded tongue, and disordered excretions, had
not given way; and to these were now added the symptoms of thoracic in-
flammation,-the general and physical signs of acute pleurisy. By means
of moderate bleeding, the employment of calomel and opium, and counter-
irritation, these latter were overcome; and, after a short attendance, the patient
was dismissed, with instructions to persevere in rules of diet and regimen,
and in means calculated to improve digestion and nutrition, and to regulate
the menstrual discharge.
We remark, in this case, the occurrence of the Erythema Nodosum in con-
junction with amenorrhoea and other signs of cachexia, and the supervention
776 CRITICAL DIGEST of THE JOURNALs. \
of acute pleurisy. In connexion with this, we may note a case, related by
Mr. Wilson, of a young woman, aged 22, who enjoyed good health until nine
months before, when she obtained service in London as housemaid. From
that period she suffered constant illness; sometimes her bowels were con-
stipated, sometimes she had nausea, at other times cough ; menstruation was
disturbed, becoming scanty and light coloured; she had leucorrhoea, and
copious deposits in her urine, with difficulty in passing it. Associated with
these symptoms, she had a constant feeling of languor, loss of appetite, and
indisposition to make any exertion. While in this state, she was seized with
a dry hard cough, accompanied with headache, and the usual train of febrile
symptoms, and a copious eruption of Erythema Tuberosumi made its appear-
ance on the forearm, knees, and legs. The majority of the spots were of
the size of a shilling piece, they were distributed irregularly over the skin,
and were very tender to the touch. On their first appearance they were
vividly red, but soon became purplish and yellowish, and by the third or
fourth day they were on the decline. This patient recovered at the end of
three weeks.” In this case we remark also the evidences of a cachectic consti-
tution accompanied by defective menstruation, and other symptoms, such as
are frequently observed in females resorting to large towns, and indulging
in modes of living contrary to their previous habits in the country.

REMARKS. Keeping in mind the leading features of these cases, let us
turn to the writings of some recent authors, with the view of discovering
whether any uniformity of observation, or correspondence in views, in regard
to the nature of this affection, are found to prevail.
MR. PLUMBE informs us that a high degree of derangement of the secre-
tions, and disordered state of those organs in which the process of chylifica-
tion is carried on, has been noticed constantly when the disease has come
under his observation.8
DR. Joy says he has known it to return frequently in the same individual,
attended with considerable oedema, and often terminating in desquamation,
succeeded by severe pains in the limbs, which demanded the employment of
pediluvia, bandages, etc.4
DR. ToDD says, “I am not aware that any cutaneous disease occurs in con-
nexion with this (rheumatic) diathesis ;” but subsequently he notices that
an eruption, resembling Erythema Nodosum, and occurring chiefly or exclu-
sively on the lower limbs, is occasionally witnessed in rheumatic fever.”
RAYER has seen the skin affection in connexion with acute rheumatism.6
DR. WATson connects it with disturbance of the menstrual functions, and
has seen it occur in connexion with acute rheumatism ; and mentions, that
a patient of his in the hospital was attacked with the affection of the joints
immediately on the cessation of the Erythema Nodosum ; and that, in another,
this order was reversed."
DR. CoPLAND notices, that it is sometimes connected with the approach of
the catamenia ; and that its premature disappearance is sometimes followed
by dangerous internal disease.
* “I consider Erythema Papulatum, Tuberosum, and Nodosum” (says Mr. Wilson)
“so closely allied to each other, that were it not for the fear of creating confusion,
I should include them under the same name. The two former are commonly asso-
ciated in the same patient, and I have more than once seen erythema papulatum
on the face and hands, while Erythema Nodosum existed on the legs.” Wilson on
Diseases of the Skin, p. 144.
* Wilson on Diseases of the Skin. 2nd. Edit., p. 169.
* Plumbe on Diseases of the Skin. 4th Edit., p. 503.
* Cyclopaedia of Practical Medicine. Art. Erythema. Vol. ii, p. 120.
* Todd on Gout and Rheumatic Fever, pp. 110 and 123.
* Rayer, Traité des Malad. de la Peau. Tom. i, p. 123.
7 Lectures on the Practice of Physic. Vol. ii, p. 836.
CRITICAL DIGEST OF THE JOURNALs. 777
*
MR. DENDY saw prleumonia suddenly supervene on its retrocession."
MR. WILSON mentions that the Erythema Papulatum is usually associated
with irritation of the gastro-pulmonary mucous membrane, and sometimes
with rheumatism ; the Erythema Tuberosum with disordered menstrual func-
tion; and that the Erythema Nodosum (all nearly allied) is observed also in
connexion with rheumatism.”
WILLAN, BATEMAN, THOMSON, and BIETT, are nearly silent on the subject
of the complications of Erythema. Nodsum ; and little can be gathered from
writers of an early date,” but enough has been culled of available materials,
to demonstrate the connexion of this form of Erythema with a marked dia-
thesis ; and opportunity sufficient is afforded for a reasonable conjecture,
that this is the rheumatic constitution, and that the skin affection is sympto-
matic of the blood disease.
These conclusions may fairly be arrived at, for the following reasons:—
1st. The skin affection is most prevalent in, if not confined to, the young,
and those under thirty—the chief subjects of the rheumatic diathesis
and rheumatic fever.
2dly. It occurs very frequently in females suffering from menstrual de-
rangement, confirming the views of Drs. Todd, Rigby, and Locock,
as to the intimate connexion of disorder of the uterus with rheumatic
affections.
3dly. It occurs in connexion with disorder of the general health, charac-
terized by pallor, cachexia, and defective excretion; and subsequently
developed in febrile excitement, pains in the joints and muscles, and
the copious deposition of lithates in the urine—a state of matters
analogous to what takes place in rheumatism.
4thly. It is associated frequently with rheumatic fever, co-existing or
alternating with it.
5thly. It is often complicated with those internal disorders with which
rheumatism is allied, particularly with pleurisy and pneumonia. I
have not hitherto noticed it in connexion with cardiac disease.
Lastly. Erythema Nodosum yields to a plan of treatment (I mean the use
of bark*) which was long extensively and successfully employed in the
treatment of rheumatism, and still has its advocates among the best
informed physicians of the day.5
But the question will, no doubt, occur, Of what value is the knowledge
* Dictionary of Practical Medicine. Art. Erythema.
* Wilson on Diseases of the Skin, p. 162-4.
* In that curious store-house of medical facts, furnished by Dr. Parry, under the
head of “Relation of Diseases by Conversion”, it is recorded that rheumatism often
alternates with cutaneous eruptions; and in speaking of this relation, after giving
many examples of a similar kind, he says, “In all these instances, which have been
derived solely from my own observation, and to which many others might be added
from medical writings, the several forms of disorder appear to be vicarious affec-
tions, consisting of different modifications of one common action, directed from
unknown and spontaneous causes to different parts.” Elements of Pathology, p. 392.
* “I once had a housemaid (says Dr. Watson) in whom the disorder (Erythema
Nodosum) appeared, and was attended with unusually high fever and much indis-
position. I treated her, therefore, antiphlogistically; i. e., I kept her on low diet
and gave purgatives; but the disease went on. Fresh knots came out as the old.
ones faded. At length, I do not remember why, I prescribed some quina for her,
and the improvement was immediate and very striking. She relapsed, however,
once or twice, upon leaving off the bark, but by persisting subsequently in its use
for some days after she appeared to be well, a permanent cure was effected. Since
that time—now twelve or fourteen years ago—I have seen a good many examples
of Erythema Nodosum, and I have treated them all alike, viz. first with an aperient
and then with the sulphate of quina, and they have all rapidly got well.” Lectures
on the Practice of Physic, vol. ii, p. 836.
* Copland's Dictionary of Practical Medicine, vol. iii, p. 630.
778 CRITICAL DIGEST OF THE JOURNALS.
of this relation existing between the affection of the skin, and the rheumatic
diathesis, admitting that the connexion were satisfactorily established . I
answer, Of great practical value. Let it be understood, that the cutaneous
disease is generally found associated with evidences of defective assimilation
and cachectic condition of the system, such as precede or accompany an attack
of rheumatism ; that it not unfrequently co-exists or alternates with a pa-
roxysm of that disease; and that, during the course of the erythematous
eruption, or on its decline, or by its sudden retrocession, some of those acute
affections with which rheumatism is allied, such as pneumonia and pleurisy,
are apt to supervenes and ºre is the practitioner who will not watch with
jealous eye the origin, and progress, and termination, of every such case ?
while, at the same time, from possessing correct views of the pathology of the
disease, he will be in a position to treat, not those symptoms which constitute
the physiognomy of the case, but that morbid action which is its essence,
which is so productive of extensive mischief, and so often followed by dis-
astrous consequences. He will look upon the skin affection as a symptom
only of a great constitutional disorder in which many vital organs are apt to
suffer, remembering that the disturbance consequent on their serious lesion is
often the first circumstance which arrests the attention of the patient or his
friends, and will be ready to avail himself of every appliance for the discovery
of obscure or insidious disease, and of every means of treatment by which
the morbid element may be eliminated from the blood, and the peculiar
diathesis to which it has given rise entirely overcome.
It is an important fact, which cannot be too much kept in mind, that all
the phenomena which constitute the characteristics of rheumatism may be
present in a case, with the exception, at one time, of fever, and, at another,
of the affection of the joints, or of both these together ; and that all the dan-
ger, and all the damage, which a paroxysm of rheumatic fever is capable of
producing, may be equally, though much more silently and stealthily, brºt
about, when the materies morói circulating through the blood has as yet
unknown causes, failed to induce the febrile action ; or, in raising it, to su-
peradd the affection of the joints. It is in this way that we can account for
the occurrence (in those of the rheumatic diathesis) of chorea and diseased
heart, conjointly or separately, so often met with in young people ; and,
again, of copious effusion into the sac of the pleura in others, of which I have
seen many instances, particularly in boys, who, though somewhat ailing, have
been able to continue their attendance at school, and engage in play, till some
symptoms of impeded breathing have arrested the attention of friends, . . .
exploration has discovered the lower half of one side of the chest dulº
percussion sound, and exhibiting the other signs of pleuritic effusion;-an
effusion which appears to have taken place in a maanner somewhat analogous
wº
zºº' -
to, or identical with that, which often, in the same character of constition,
rapidly and unexpectedly fills and distends the synovial capsule of the ºee
joint.
In all the boys alluded to, the evidences of a cachectic state had been
viously noticed, and I believe the same condition is observable in those aſ
with effusion into the joints. For instance, some days ago, after prescº
for a lady in town, my attention was called to a domestic in the family, wº
had been complaining for several weeks. She was pallid and sickly; suffººd
* On the subject of the connexion of rheumatism and chorea, I am happy ºfte
knowledge that, in the views I entertain, and which I laid before the Sºº
(“Monthly Journal” for April 1847), I have been in name measure anticipatéº º
Dr. Todd, of London, [On Gout and Rheumatic Fever, p. 115.] whose notice of th
relation I had not seen when that communication was read, and subsequently pub-
lished. It is gratifying to me to find that I have independently arrived at the same
opinions as those held by that able physician, from whose writings I have derived
much valuable information, and in whose views of the nature of rheumatism I en-
tirely concur. - - -













CRITICAL DIGEST OF THE JOURNALS. 779
from dyspeptic symptoms, from obstinacy of bowels at one time, and, at ano-
ther, from relaxation; was feeble, and readily fatigued ; and felt unable to
continue her duties. On examining her urine, it was highly acid, and loaded
with urate of ammonia. She had formerly had rheumatic pains. Iventured
to predict an attack of this character, and, to ward it off, prescribed a simple
and limited, but nutritious diet, with alterative medicine, and full doses of
the nitrate and carbonate of potash. I was requested to visit her this evening
(April 2, 1850), when I found the synovial capsule of the left knee distended
with fluid, and the joint affected with pain and stiffness; symptoms which
had all come on in the course of twenty-four hours.
In regard to rheumatic fever existing without any articular affection, 1 a
case is passing under my observation while I now write, which powerfully
illustrates the fact, and a short notice of which may not be uninteresting to
the Society.
On the 16th of January last, during the prevalence of keen frosty weather,
which called many of the admirers of the art of skating and curling to the
pond, a gentleman of the legal profession, approaching the age of thirty-five, of
stout make, and full habit of body, and, by hereditary right, strongly disposed
to rheumatism,” repaired to Duddingstone to enjoy his favourite amusement.
He spent the early part of the day in keenly contested games of curling,
in which he was alternately chilled and heated; and left the ice, complaining
of an aching pain in his right side, which he at once attributed to the free
and unwonted use of his arm, in pursuing his athletic exercise. , Before he
reached home, however, the pain amounted to a severe stitch; and, towards the
hour of dinner, he waited on me for advice. On examination, I considered
him labouring under pleurodynia, and dismissed him with instructions to re-
tire early to bed, to apply a large sinapism, and take a full dose of Dover's
powder. His pulse at this time was 72, full and soft ; his skin was cool and
moist ; and his tongue somewhat loaded. An aperient draught was also pre-
scribed for the morning. Late in the evening of the same day, however, I
was summoned to his bedside, and found him much indisposed ; his pulse
had risen to 96, it was still full and compressible; his skin was hot and
moist ; the pain, which was seated in the lower part of the side, and inclining
towards the back, was severe, and greatly increased by motion, by full inspir-
ation, or the effort of coughing. The physical signs at this time gave no
clear indication of pleurisy ; but judging, from general symptoms, that the
costal pleura, at least, was affected, I ordered him to be cupped, and added

* DR. GRAVES (see Clinical Lectures, vol. ii, p. 159) was the first, I believe, to
direct the attention of the profession to this interesting point, and, though the car-
rectness of his views has been doubted, and men of large experience have not
observed such cases, I am confident that they are by no means uncommon, and
that the following extract from the work of the eminent physician referred to, con-
tains truths of great practical value:—“In truth”, says he, “in rheumatic fever,
the quickness of the pulse, heat of the skin, tendency to profuse sweating, debility,
restlessness, and thirst, may all exist without any inflammation of the joints, and
may be resolved without such inflammation ever occurring, as I have witnessed in
several well-marked cases of individuals liable to rheumatic fever, and who had
previously suffered from attacks of fever, with arthritis, in the usual form, and
subsequently, on exposure to cold, were seized with symptoms of pyrexia, which,
in intensity, duration, and every other particular, were identical with their former
fevers, save and except that, from beginning to end, not a single joint was inflamed.”
* His family experience had been signally painful and disastrous. He had lost
his mother in consequence of inflammation attacking the heart, previously damaged
by rheumatic carditis; he had also lost a brother and sister, in early life, by car-
ditis, accompanying rheumatic fever; a paternal uncle, by diseased heart; and a
cousin (a daughter of this last), by acute pericarditis, unconnected with articular
affection, but with all the other evidences of rheumatic fever; and, lastly, he had
seen his only remaining brother, from time to time, afflicted with the malady which
had been permitted to prove so great a scourge to his family.
WOL. II. 52
780 CRITICAL DIGEST OF THE JOURNALS.
to the Dover's powder five grains of calomel, with instructions to repeat the
dose early in the morning, before taking the aperient. On the 17th ; he was
not relieved ; the pain was unsubdued, and more extended towards the base
of the scapula; the friction sound was audible over a limited space ; the
pulse was 100, full and soft ; the tongue moist, and loaded ; the skin bedeved
with sour-smelling perspiration ; and the urine, small in quantity, depositing
a brick-dust sediment. The bowels had been freely moved ; the evacuations
were dark, and highly offensive. A second abstraction of blood by cupping
was prescribed, to be followed by calomel and opium in the usual form, and
the free use of nitre in solution, as a drink. On the 18th, there was dulness
on percussion over the inferior and lateral portion of the chest, with distant
respiratory murmur, and imperfect aegophony; the general symptoms of
rheumatic fever continued ; but no joint was affected. During the three
following days, there was little change in the symptoms; the pain had in a
great measure subsided, and the signs of effusion were quite distinct, limited,
however, to the lower half of the right side of the chest ; the pulse continued
to range from 100 to 108; the urine and perspiration, the tongue and bowels,
still manifesting the same high degree of rheumatic character. The calomel
and opium were continued till slight ptyalism was induced ; and large and
increasing doses of the carbonate and nitrate of potass, together with colchi-
cum, were prescribed, in order to favour elimination by the kidney. Towards
the 25th, ten days from the date of seizure, considerable absorption of the
effused fluid had taken place, the kidneys acting vigorously, and the excre-
tion depositing, day after day, large and increasing quantities of the lithate
of ammonia. Convalescence advanced ; and for some days before the 31st, he
was able to leave his bed, and spend some hours on the sofa. On that day,
however, by imprudent exposure near an ill-fitted window, he sustained a
chill, and all his symptoms quickly revived. The disease now lighted on the
opposite side of the chest, and pursued there a course corresponding with
; followed on the right. It was rheumatic fever, with inflammation of,
and effusion into, the left sac of the pleura. The same practice was renewed;
the same results followed; and on the 14th of February, a fortnight from
the relapse, and one month from the original seizure, he was again convales-
cent. On the 18th, while still confined to bed, and exercising the most
exemplary care and caution, as regarded the juvantia et loºdentia, he was
seized with acute pain in the praecordial region, followed by anxious hurried
breathing, rapid, feeble, and irregular pulse, cold, clammy perspiration, and
inability to maintain the recumbent posture. His expression of countenance
was singularly distressing, and he indicated by his looks, more than by words,
that this second relapse could not fail of a fatal result. I feared the worst
in a constitution so strongly rheumatic, and with the morbid element now
fixed on the pericardium. The to and fro sound was audible over the prae-
cordial region, and the impulse there was unnatural and extended. Blood
was immediately taken from the region of the heart, and calomel and opium
given every alternate hour, till salivation should take effect. A second
abstraction of blood followed, after six or seven hours: the pulse improved
in strength ; the pale, anxious, distressed countenance revived; the, præcor-
dial pain, and catch in the breathing, subsided ; the physical signs gave way,
and disappeared ; and in three days, the patient seemed rescued from his
impending doom. It was only, however, to be subjected to another, but a
less severe and threatening trial. On that day, there occurred renewed pain,
of a deep-seated kind, in the region of the first pleuritic effusion, which had
remained dull on percussion, and free from respiratory murmur, up to this
period. To the pain, now succeeded cough, for the first time, followed by
bloody expectoration, and some hurry in breathing ; but exploration dis-
covered no abnormal signs beyond the limits of the original pleuritic effusion;
and, the symptoms not becoming aggravated, the hope was entertained that
only a small portion of the lung was implicated in this pneumonic attack.

CRITICAL DIGEST OF THE JOURNALS. 781
Those hopes have been realised. The pulmonary symptoms have gradually
disappeared; and now, at the close of ten weeks from the date of the origi-
nal attack, the patient is again, and more than ever, a promising convalescent.
He carries about with him, no doubt, a partially adherent pericardium, and
a doubling adhering pleura, as well as a partially condensed lung; but his
life has been spared ; his infirmities, we know, are compatible with existence,
even long extended; and his age will, ere long, grant him immunity from
future attacks of the malady which has proved so disastrous to his family.
It is worthy of remark, that during this long illness, the manifestations of
the rheumatic habit never entirely left the system, nor appeared to yield to
treatment, until the close of the tenth week, when they may be said to have
declined, and disappeared. The tongue continued thus long foul, the bowels.
disordered, and the quantity of the lithates and purpurates in the urine was
greatly beyond what I ever witnessed in any case of rheumatic fever, how-
ever lengthened in duration or severe in character; while the acid sweats
annoyed, not only the patient himself, but even the bystanders, by their
constancy and the pungency of their odour.
It also deserves notice, that this gentleman, who had hitherto enjoyed
uninterrupted health, and suffered no obstruction in the discharge of profes-
sional duty, or in the practice of daily exercise, for a long series of years, had
been observed, for some weeks before the seizure just described, to be pallid
in looks, and somewhat languid in spirit, and indisposed for mental or bodily
exertion ; and I have ascertained that, during this time, his digestion was
imperfect, and his urine constantly loaded with the lateritious deposit—an
assemblage of symptoms which is too much overlooked in cases of this class,
and which I refer to the more, as it has been attempted to establish a diagno-
sis between rheumatism and gout, on the ground that the latter frequently
presents premonitory symptoms affecting the digestive organs, which is not
the case in the former; a statement which I believe to be contrary to fact,
and involving the risk of serious evil. The premonitory symptoms of rheu-
matism may possibly be slight ; so slight as to fail in attracting the notice
of the ordinary observer; but I apprehend that they will always be dis-
covered, if sought after; for no attack of rheumatism can take place without
evidences of previous imperfect digestion and defective assimilation.
This disorder of the digestive and assimilating functions is often, indeed,
the only departure from health which the physician is called upon to treat
for days—it may be for weeks—before a paroxysm of rheumatic fever occurs.
I cannot forget my own want of due attention to this class of symptoms in
a case which, not many years ago, proved fatal under my care. The subject
of it was a young lady of twenty-one, who had been ailing for some time
before I was called to see her. She was then pallid in countenance, and
depressed in spirits. She owned no illness beyond a feeling of loss of strength,
an occasional aching head, a want of appetite, and unrefreshing sleep.
Her tongue was foul, her bowels disordered, and her urine scanty, and greatly
loaded. The catamenia were suppressed. These symptoms went on from
day to day; no local pain, no febrile movement, threw light upon their real
nature, and no family predisposition pointed to their true character. By
and by, a degree of fever was lighted up ; and then a degree, a slight degree,
of redness, pain, and swelling of the right ankle-joint, proclaimed itself, and
revealed the latent disorder which lurked within, and which was now deve-
loped in great intensity. The fever, however, exceeded far the amount of
articular complication; the endocardium by and bye declared its participa-
tion in the general derangement by the distinctive murmur; and ere long
the pericardium also, through the to and fro sound. No remedy availed to
save life, though suffering was protracted, painfully protracted, for many
weeks; when tumultuous palpitation and laborious breathing, and dropsical
swelling, closed the scene. No examination of the body was permitted.-
[Edinburgh Monthly Journal, June 1850.]


52 *
782. CRITICAI, DIGEST OF THE JOURNALS,
CHRONIC HYDROCEPHALUS, ACQUIRED, SANGUINEOUS, AND CONGENITAL ;
WITH THEEE CASES IN WHICH THE HEAD WAS PUNCTURED.
BY DR. FRANCIS BATTERSBY.
Modern French writers have divided Chronic Hydrocephalus into two forms,
the congenital and the acquired. The latter is much more rare than the
former. Barrier thinks that the greatest number of cases of hydrocephalus
which are developed before the closing of the fontanelles, and in which the
separation of the sutures takes place early and easily, should be ranged with
congenital hydrocephalus. I shall first consider acquired Chronic Hydroce-
phalus, premising, what seems to have been overlooked by Dr. West, that
MM. Barrier and Rilliet and Barthez take into consideration only acquired
Chronic Hydrocephalus, no children under two years of age being admitted
into the Hôpital des Enfans Malades, of which they were internes. Barrier
says that acquired Chronic Hydrocephalus is rarely essential, idiopathic, and
analogous to other essential dropsies; at other times, it is symptomatic of
another disease, and in this case the most frequent organic lesion is the pre-
sence of one or of many tuberculous masses in different points of the brain.
This has escaped the observation of previous writers. One of the most fre-
quent causes of this dropsy, says MM. Rilliet and Barthez,” following Barrier,
is the development of a tumour in the cranial cavity, most commonly tuber-
cular, but sometimes cancerous or of another kind. They think, then, that
Hydrocephalus has most often as its cause compression of the veins of Galen,
or of the straight sinus; and they cannot even conceive any other mode for
its formation.
Tulpius, Wepfer, Bonetus, Walsalva, and Lieutaud, remarked that acquired
Chronic Hydrocephalus is developed most frequently from the age of two
years to seven ; and it is precisely at that epoch of life, that tubercles of the
brain are most common. Certain organic affections of the brain have been
Iong noted as causes of the disease, such as scirrhous and tubercular tumours,
encysted collections, and other morbid products in the substance of the cere-
bellum and other nervous centres. Facts of this kind are related in the
Sepulchretum of Bonetus, in Morgagni's Letters, in the Historia Anatomica of
Lieutaud, and in the Anatomie Médicale of Portal. But it is to be regretted
that, in most of these cases, there is no precise indication either of the seat
of the tumours, or of their projection above the cerebellum. It is uncertain
whether they were, or were not, adherent to the lower surface of the tentorium
cerebelli, or whether they were prolonged towards the terminations of the
veins of Galen in the straight sinus. It is evident, that the compression of
the straight sinus, and the entirely mechanical mode of formation of ventri-
cular hydrocephalus, has been completely misunderstood.” Lallemand, John
Hunter, Dance, and Constant, relate cases in which tumours existed in the
cerebellum, together with fluid in the ventricles ; but it is not said whether
there was or was not a compression of the straight sinus. Tonellé4 has not
completely misunderstood the influence which the obliteration of the sinuses
exerts on the serous exhalation of the brain ; since, in speaking of pseudo-
membranous concretions in them, he puts forward the opinion, that the dis-
orders resulting from their presence are, either a simple stasis of the blood in
the veins of the pia mater, and of the substance of the brain, or a serous
effusion within the ventricles. - .
Mr. Edward Ford” has recorded two cases—one in a child aged 9, the other
in a child aged 4 years—of hydrocephalus resulting from a scirrhous mass in
the cerebellum and pons Warolii; and although he makes no mention of
* Traité des Maladies de l'Enfant, t. ii, p. 588.
* Traité des Maladies des Enfans, t. i., p. 808. :: *
* Barrier, l.c., p. 593. * Gazette Médicale de Paris, 1834. P. 104,
* London Medical Journal, 1790, p. 56.
CRITICAL DIGEST OF THE JOURNALS. 783
compression of the straight sinus, yet he observes that hydrocephalus internºs
is in many cases not to be considered as a disease sui generis, or as the sole
cause of the mischief which ensues to the constitution, but that it is often
the effect of those diseases which it has been said to produce. Magendie," who
attributes hydrocephalus, amongst other causes, to obstruction to the flow of
the cerebro-spinal fluid through the ventricles, comes very near the explana-
tion of M. Barrier. He has given different cases, in individuals aged above
nine years, of hydrocephalus with compression of the fourth ventricle by a
tubercle of the cerebellum ; with compression made by an aqueous tumour
upon the aqueduct of Sylvius, the valve of Wieussens, and the fourth ventri-
cle ; and again, with compression upon the mesocephalon and the fourth
ventricle, by an exostosis of the basilar portion of the occipital bone. And he
moreover alludes to cases of hydrocephalus, with compression of the fourth
ventricle by a fibrous tumour in the valve of Vieussens, or by tumours of
different kinds in the annular protuberance. Barrier” gives three cases of
hydrocephalus from compression of the straight sinus, in children aged 3,4},
and 5 years. The anatomical conditions necessary to this kind of hydrocepha-
lus, are, he says, 1st. That the tuberculous tumour should occupy the middle
lobe of the cerebellum ; 2nd. That it should project upwards sufficiently
to throw up the tentorium cerebelli, and to compress the straight sinus. The
quantity of fluid in the brain of those cases of acquired Chronic Hydroce-
phalus never exceeds eight or ten ounces, and is in general much less.
Many authors have considered Chronic Hydrocephalus as a particular form
of meningitis. But the inflammatory character of the disease is too latent, or
is effaced too soon for any practical advantage to follow the adoption of this
opinion. It may be true in some cases; but the disease mostly consists cer-
tainly in a dropsy analogous to that observed in all the serous membranes,
and in the areolar tissue. This is Barrier's opinion, who does not think, like
Billard, that Chronic Hydrocephalus succeeds almost constantly to acute
meningitis. Rilliet and Barthezº have never seen Chronic Hydrocephalus
purely inflammatory. They have not even seen acute cerebral diseases, ac-
companied by serous effusions into the ventricles, pass into the chronic state,
and produce augmentation of the size of the head. Copland does not even
refer to such a notion. Breschet states, that we have no well authenticated ex-
ample of internal Chronic Hydrocephalus, which succeeded to acute hydro-
cephalus, or dropsy of the brain. But Dr. West4 affirms, that sometimes the
lining of the ventricles is roughened and granular, presenting an appearance
closely resembling shagreen, and communicating a very perceptible roughness
to the finger ; and concludes that these, and other similar alterations of the
lining of the ventricles, afford conclusive evidence of the inflammatory origin
of most cases of Chronic Internal Hydrocephalus. In four cases, dissected
by me, there was no such adventitious membrane, which I think, may be, in
the few cases in which it exists, explained by the irritating nature of the fluid
collected in the ventricles. The same occurrence is observed in dropsy of the
abdomen, speaking of which, Dr. Copland observes, “This fluid, owing to
interruption of the depuration function, is often possessed of properties which
induce inflammātory irritation in the healthy peritoneum, and which are more
likely to have a similar effect when this membrane is punctured or otherwise
divided.”5 Spengler and Barruel, having each analysed fluid from hydroce-
phalic heads, agree in thinking it not to be a product of inflammation, but
simply the ordinary cerebro-spinal fluid, enormously increased in quantity.”
*—
* Sur le Fluide Cephalorachidien, p. 74. 1843.
* L. c. p. 594–603. * L. c. t. i., p. 807.
* On the Diseases of Infancy and Childhood, p. 88; also Dr. Todd, Cycl. Ana-
tomy, Part xxvii, p. 720. -
* Dictionary of Medicine, vol. i., p. 632. Portal states (sur l’hydropisie, t. ii, p.
xxiv), that the fluid is sometimes “de mauvais goût ou d'une extrème acreté.”
° Medical Gazette, N. S., vol. ii, 1846, p. 627.
784 - CRITICAL DIGEST OF THE JOURNALS.
Breschet and Legendrel attribute to inflammation all affections, the result of
haemorrhage into the cavity of the arachnoid; which effusions, Dr. Todd.”
states, are very rare. Rilliet and Barthezº have seen three cases of hºmor-
rhage, from sanguineous exhalation into the arachnoid, simulating hydroge-
phalus. The coagulum divides into two portions, one serous, the other solid.
This assumes the appearance of a thin false membrane,—elastic, more or less
resistent, and simulating occasionally the arachnoid. Sometimes it is really
a fibrous membrane. The clots are found over all the circumference of the
brain, but most frequently on its convex surface, either anteriorly or pos-
teriorly, or at its sides. Most commonly they adhere to the parietal surface
of the arachnoid, more rarely to its visceral surface; but whatever the con-
nexion, their adhesion is slight, and they may be removed by the least traº-
tion. Sometimes the fluid is serous, transparent and limpid, more or less
yellow, entirely resembling the liquid effused into other serous membranes.
Occasionally it is muddy, yellowish-red, and contains bloody particles, sº
pended in it. Less frequently, it preserves its transparency, but has a reddish
colour. This is blood mixed with serosity, and consequently more liquid
than natural. On other occasions, the liquid is thick, muddy, brown, ºr
chocolate-coloured, and like a sanguineous effusion of an old date. Blood,
pure and liquid, is seldom observed. Rilliet and Barthez once estimated the
fluid on both sides to amount to a litre, or nearly two pints. Enormous
quantities like this are only found in very young children, whose heads are
unossified. When the sanguineous effusion is so great, it forms a purebyº-
cephalus, presenting all the characters of Chronic Hydrocephalus. This
effusion presents no well-marked characteristic signs, which can separate it
from serous ventricular effusion. Legendre, however, states that the first
stage is marked by symptoms of cerebral fever or acute hydrocephalus, the
second by those of Chronic Hydrocephalus, but that the first stage is not
always followed by the second. He observed seven cases, between the ages
of two and three years. The age appears to Rilliet and Barthez to establish
a difference between acquired Chronic Hydrocephalus, tubercular, or other,
and sanguineous Chronic Hydrocephalus. They have never seen an infant
of two years of age, or less, die of hydrocephalus in consequence of cerebral
tubercles. Always at this age, sanguineous effusion has been its cause:
The elder Monro4 used to employ many arguments against puncture in cases
of hydrocephalus, except when water is accumulated between the membranes
of the brain or in the arachnoid, from a conviction of the fatal consequences
of this operation. Neither are Barrier, Rilliet and Barthez, or Legendre,
advocates for the operation in acquired Chronic Hydrocephalus, the probable
result of a cerebral tumour, or of a profound alteration of the brain; and I
do not think it likely to succeed in cases of acute hydrocephalus, attended
with convulsions and strabismus.5 Rilliet and Barthez are, on the contrary,
of opinion that it could only be advantageous in cases of arachnoid hºmor-
rhage. The nature of the liquid to which the instrument would give issue,
and the depth to which it would be necessary to penetrate to reach the effusion,
would point out almost certainly the seat of the disease. It is very evident
that if the puncture gave issue to blood, to sanguineous, or even albuminous
serosity; this would at once determine the form of the hydrocephalus. The
diagnosis does not appear to Rilliet and Barthez less positive, if the instru-
ment gave issue to liquid after having passed through the dura mater alone.
The importance of diagnosis in like cases is such, that they do not hesitate
to propose the employment of this method.6 w
* Revue Médicale, Dec. 1842.
* Cyclop. Anatomy, Part xxv, p. 644, and Part xxvii, p. 717.
* L. c, t. ii, p. 32.
* Monro on Hydrocephalus, p. 95.
* Dublin Medical Press, February 20, 1850, p. 116. * L. c, p. 47.
CRITICAL DIGEST OF THE JOURNALS. 785
Such advice, from such men as Rilliet and Barthez, I felt anxious to test
by experience ; the more so, as Legendre intimates that the favourable ter-
mination of certain cases of punctured hydrocephalus depended, most pro-
bably, on their being of this form. The following case soon gave me an
opportunity of tapping the head.
CASE I. CoNGENITAL CHRONIC HYDROGEPHALUS, PUNCTURED EIGHT TIMEs.
MALFORMATION of THE BRAIN. Eliza Deering, aged nine weeks, was
admitted to the Institution for Diseases of Children, 31st January, 1849.
Her mother stated, that her head had been getting large since she was a
fortnight old. . It was nineteen inches and three-quarters in circumference,
and twelve inches from the tip of one ear to that of the other. It was soft
from the root of the nose to the occiput; and in the centre there was a hand’s
breadth between the frontal and parietal bones. Her eyes were straight; the
pupils were half sunk below the lower lids, the whites of the eyes being
nearly all that was visible of them ; vision was perfect. She fed well. Her
person and limbs were plump and well nourished. Her countenance was
plump and fresh coloured. She had no complaint except her large head ;
was constantly dozing ; bowels generally confined. Her parents were young
and healthy. I strapped the head with adhesive plaster, and applied over
it a double-headed roller. February 27. Head twenty-one inches by fourteen
and a half. I strapped the head again ; it was very soft ; she cried much
while it was being done. The strapping had diminished the horizontal mag-
nitude of the head, which was not so long from before backwards. It was
larger superiorly, the diameter between the ears being much more than for-
merly. March 12. She seemed in good health, and was getting fat. The
head was globular, and increasing rapidly in size, with a feeling of fluctua-
tion. The roof of each orbit was thrust out perpendicularly, and the eyes
were so sunken, that it was only by an effort she could look at objects above
her. The eyes were lower, and the portion of the orbits next the nose
crepitated on pressure with the finger ; bowels confined. 20th, The mother
consenting to the operation, I this day, assisted by Drs. Churchill and Colles,
introduced an exploratory needle in the situation of the anterior fontanelle,
about half an inch to the left of the longitudinal sinus. Fluid at once came
away; and, withdrawing the needle, I passed in a very fine trochar, and with-
drew seventeen ounces of clear serum, slightly tinged with blood, which did
not come from the scalp. The fluid appeared to be directly under the dura
amater. The scalp was quite soft and baggy, after the fluid was withdrawn.
During the operation, Mr. Colles held the head compressed between his
hands. The child cried strenuously, but did not appear to suffer much. I
reapplied the roller. 21st. She vomited in half an hour after the operation,
and was cross in the evening. Eyes raised well. She slept last night well
as usual, but was easily frightened, and started out of sleep. 22nd. Was
very pale ; grasped firmly anything placed in her hands. The arms con-
stantly started, and she cried often ; was very hot and restless; pulse too
rapid to be counted. 23rd. Slept none till three o'clock A. M ; had not
started since, but seemed restless ; pulse 160; skin hot ; could not suck,
but swallowed fluid well; the jaws were drawn together, and firmly closed ;
eyes sunk, and in constant motion. 24th. She slept some last night ; this
morning sucked a little by the lips, her jaws being closed ; audible hemming ;
no sensibility ; quivering of hands, which were occasionally strongly clenched.
25th. Took the breast in her lips last evening, and twice to-day; drank also
six cups of wine whey and of milk : was rather cold. She had sudden fits
of clenching of the hands, with rigidity of the arms, and hemming. Ap-
peared asleep, and would not swallow anything. 26th. Shortly after my
visit yesterday, she took the breast in her gums, sucked well, and continued
to do so. Slept well last night; is not hot now ; cried this morning for the
first time since the operation ; was then disposed to sleep ; looked pallid;
protruded the tongue; the thumbs and hands flexed. 27th. Very easy
786 CRITICAL DIGEST OF THE JOURNALS.
to-day, and sucked better than ever; now twisting the mouth; hands supple;
thumbs turned in. - - - -
This was the only inflammatory attack she had in consequence of the ope-
rations, which I performed eight times between March and August. I with-
drew eighty-nine ounces of fluid, which was each time of a paler colour,
until at last it was quite limpid and colourless.
On the 29th of March, she got an acute attack of muguet, which continued
ten days. The thumbs were then natural and extended, the index fingers
alone being flexed ; these in their turn soon lost their flexure, and continued
natural to the end. The head was ossifying rapidly at the back, where the
new bone could be felt to crepitate under the finger. During the entire
progress of the case, I kept the head bandaged ; but so readily and quickly
did the bandage fall off, that, on the 9th of July, I smeared the folds of the
bandage with starch, which kept it immovably fixed its place.
July 24th. Head twenty-three by sixteen inches. The irides were below
the lower lids; there was vascularity of the eyes, with watery and mucous
discharge. She lay sleeping the entire day; for a few days had been vomit-
ing constantly. Was nearly motionless, and cold, no matter, how much
clothes covered her. The bandage had never moved ; and the back part of
the head, where uncovered by it, was highly Qedematous and bluish. Slept
sometimes with the eyes open. I loosened the bandage, and re-applied it
over the entire head ; but the oedema continued till her death, which oc-
curred on the 4th of August, two days after the last tapping. I saw her on
the 3rd, very well, smiling and good humoured ; and she unexpectedly died
at eight o'clock next morning. At the time of her death, she was aged nine
months, one week, and four days ; death taking place four months and fifteen
days after the first, and two days after the last puncture of the head. After
the second, and all the subsequent punctures, the head rapidly regained its
original size, so as on the day succeeding to be as large as before the opera-
tion : she never had the least power of supporting her head.”
Post-MoRTEM ExAMINATION Twelve Hou Rs AFTER DEATH, by Dr. Churchill
and myself. The oedema of the back of the head had disappeared. It
seemed smaller than during life. The scalp was bloody posteriorly. On
dividing the dura mater, the brain at once appeared. It was quite smooth
on its upper surface. There was no median fossa; at its inferior surface
were some convolutions.
More than two quarts of clear serum were contained in one large central
cavity, all traces of separation between the lateral ventricles being annihi-
lated by the absence of the fornix and septum lucidum and the falx ; the
corpus callosum and choroid plexus were also absent. The posterior cornua
of the lateral ventricles were also absorbed in this central cavity, on looking
down into which, through the fluid, from an opening in the upper part of
the brain, we could observe, in the situation of the left optic thalamus, two
small very thin sacs, formed of the medullary portion of the brain, raised by
fluid underneath. The third ventricle was very shallow ; there was no soft
commissure nor Pineal gland. An ill-formed narrow band of nervous struc-
ture-stretched from the left side of this large cavity obliquely forward to
join the right corpus striatum. The corpora striata and optic thalami were
flattened. There was no lymph, nor any evidence of inflammatory effusion,
on the inner surface of this cavity, which, formed of the white structure of
the brain, was lined by a dense serous membrane, under which were observed
small red vessels. The brain at its upper surface was not more than a few
* This patient, who survived the operation so long, proves the error of Petit,
who expresses his sorrow that all patients who underwent this operation died; for
if a large quantity of water were drawn off, they expired in four or five hours after
the discharge; if less be drawn off, they died more slowly, but never survived the
operation above forty hours. Van Swieten’s Commentaries, vol. xii, p. 248.
CRITICAL IDIGEST OF THE JOURNALS. 7S7
lines in thickness. The cerebellum was very soft. The nerves were all per-
fect. The points at which the trochar entered the brain were completely
closed ; they could not be discovered on the outer surface of the brain, but
were marked at its inside by very small dark cicatrices.
Dr. Watson states,1 that the fluid of hydrocephalus does not coagulate ;
and the analysis of Bostock, Marcet, Barruel, Berzelius, and John shew that
this fluid is of the lowest specific gravity, and contains the smallest quantity
of albumen and of saline ingredients, of all the dropsical fluids; according to
Dr. Marcet,” its specific gravity is 1006-7. The changes in the specific gravity
of the fluid, extracted at each puncture, sufficiently indicate the alteration in
the amount of albumen. The examination of the fluid, after each operation,
was kindly undertaken by Mr. Moore :
1st Puncture, March 20th, amount withdrawn, 17 * sp. gr. 1007
6 © Wº tº

2nd ... May 10th tº º ſº tº tº gº 1014
3rd ... ... 24th tº s ſº tº º º 9 ... 1012
4th tº gº º June 4th º, º º © & © II ... 1010
5th ... ... 21st © tº º • U → 13 ... 1008-5
6th tº º º July 5th tº dº ſº. tº gº tº 114 ... 1006-5
7th © C. L. ... 23rd tº e tº As e e 10 ... 1007
8th tº Q & August 3rd ... gº tº º 11 ... 1006'5
Albumen was always present, but in very variable proportions; the quan-
tity was sometimes very great, as at the second and third punctures, when it
nearly equalled that in the fluid of ascites, forming, when heated, a solid mass
like coagulated white of egg. It sometimes amounted to a mere trace, and
the specific gravity was influenced by the amount of it present, so that the
former became a measure of the quantity present. Nearly the same salts
were found in all the specimens, and generally in about the same proportions,
viz., a large amount of the chlorides of potassium and sodium, small quantities
of the sulphate of soda and phosphate of lime, and a little free alkali, which
always gave the fluid an alkaline re-action. On one occasion, Mr. Moore
observed, on examining the fluid with the microscope, a crystal of oxalate of
lime ; and among the occasional matters observed by the same instrument,
were bodies resembling mucous granules, flakes of coagulated albumen, blood-
corpuscles, a few fat vesicles, vibriones in the warm month of July, and after
the fluid had rested twenty-fours hours, and scales resembling epithelium.
The next case was more speedily fatal, from the effects of inflammation.

CASE II. CongºNITAL CHRONIC HYDRocBPHALUs. PUNCTURE OF THE HEAD.
BRAIN MALFORMED. John Webb, aged nine months, was admitted under my
care on the 26th March, 1849. The mother had had but one other child,
which died of convulsions when a few weeks old. The father was rather silly.
This child had been born prematurely, and was very small at birth. He had
slight divergent strabismus since his first month, but his head had been of
abnormal size until he was two months old, when he had some fits. He had
not vision since. The eyes were greatly depressed, and the eyelids covered
with mucus ; the pupils were nearly concealed by the lower lids. Above thé
eyes, the orbital plate of the frontal bone, pressed downwards and forwards,
crepitated under the finger. The head was of enormous size, twenty-four
inches by fourteen inches and three quarters; there were very large blue veins
in the scalp ; one in particular on each side in a wide and deep groove in the
skull, on each side, down the side of the head to the front of the ears. His
head was enlarging daily ; he could not support it. His flesh was partly
wasted, and very flabby. He at night felt fits of pain, from which he cried and
roared. Since his seventh month, he had got two lower incisor teeth. Pulse
72, very weak, small, and irregular ; stools natural ; he passed much water ;
recognized no one, but used sometimes formerly to laugh; eat nothing. . . The
mother was very delicate, with very little milk, 31st. Pulse 86. Did not
* Library of Medicine, vol. v., p. 141. - * Copland. l. c. p. 606,
788 CRITICAI, DIGEST OF THE JOURNALS.
now sleep overmuch, as he used ; he often vomited his food; (he had been
weaned since last report ;) drank and eat much ; yawned repeatedly; head
tense. I this day, in presence of Dr. Churchill, introduced the trochar, as in
the preceding case, but without using the exploratory needle. The point of
the trochar had scarcely entered, when a clear fluid began to flow, of which
I removed nine ounces. The child got pale and vomited in a quarter of an
hour. I closed the head in a double-headed roller. April 1st. He slept only
a couple of hours last night ; mouth hot ; lips dry ; very thirsty. Pulse 120.
Head hot ; skin cool ; cried lustily; saliva ran from the mouth ; bowels free ;
no stiffening. 4th. Pulse not to be felt ; legs and arms straightened ; thumbs
and fingers flexed. No unnatural heat of body or of head. Could not open
his mouth, the jaws being firmly closed ; eyes half open, and glassy; breathed
naturally. Left pupil dilated ; he took some drink at 10 o'clock last night.
5th. Had been perfectly inert, only moving his head from one side to the
other. Breathed easily this morning, but latterly with a catch. Heat of
skin rather below natural. The head appeared much smaller than before the
operation. Hands clenched, arms and legs rigidly extended. At 12 o'clock,
I directed him to get a continuance of wine whey and weak chicken's neck
tea; but at 6 P.M. I found he had had nothing since I saw him in the morning.
He was then breathing naturally, but was entirely cold. I had some wine-
whey made, of which he swallowed some ; but soon afterwards breathing ceased
by degrees, and he died in my presence, without the possibility of fixing on
the period.
Post-MoRTEM ExAMINATION, 13 hours after death. The head measured
twenty-two by fourteen inches. Body not rigid. There was some attempt
at completion of the parietal, frontal, and occipital bones; but the greater
part of the head was covered by nothing but skin and dura mater. I stripped
off the scalp in the usual way, and, with a pair of common dressing-case scis-
sors, I easily made the horizontal section of the bones and dura mater, previous
to which I in part emptied the head of the fluid by an opening at its top, by
which it was at once seen that the fluid was in the brain, and not within the
arachnoid membrane. There was little blood in the longitudinal sinus. The
falx was very shallow and imperfect. The convolutions on the upper surface
of the brain were obliterated. The brain formed a large bag, containing more
than two quarts of clear fluid. It was, about the falx, so very thin, as not
to be discernible. It was generally hard, and of a greyish colour. At its
back part, the white substance, to the depth of a line, was perceptible. In
some parts in the interior, it was softened, and presented large red vessels
ramifying under its serous lining. There are large, loose, soft flakes of lymph
covering these vascular patches, which were principally on the left side, and
posteriorly; they were less on the right. None of the central white parts of
the brain were present. There was no corpus callosum, fornix, septum luci-
dum, fifth ventricle, or choroid plexus ; and the same may, to a certain extent,
be said of the optic thalami and corpora striata, from their flattened and
unnatural appearance. The third ventricle was greatly enlarged, from the
separation of these parts by the contained fluid. There was no soft commis-
sure. The optic and olfactory nerves were yellowish and easily torn. The
other nerves were healthy. The medulla oblongata, cerebellum, pons Warolii,
and crura cerebri, were healthy and hard. The specific gravity of the fluid
withdrawn was 1006:5; it contained the same salts as were present in the fluid
of the preceding case.

These and other cases have proved to me the extreme rarity of Hydroce-
phalus in children, from sanguineous effusion into the archnoid. With the
exception of the cases of sanguineous effusion observed by MM. Serres, Le-
gendre,” and Rilliet and Barthez, I know of no others observed in children.
1 Annuaire Méd. Chir., p. 189. 1819.
* Révue Médicale, Dec. 1842—March 1843.
CRITICAL DIGEST OF THE JOURNALS. 789
Mr. Prescott Hewett, and Dr. Burrowes” are the only persons in this country
who have noticed it in adults. Dr. West never saw a case, proved by dissec-
tion, of external or arachnoid Hydrocephalus ; yet he says, “I should regard
any case as favourable for operation which, on the whole, there was good
reason for believing to be one of external Hydrocephalus, or in which the
enlargement of the head had not been attended with indication of active cere-
bral disease. Though less promising, I should not reject the operation simply
because enlargement of the head had been congenital ; while I should always
be more ready to operate if nutrition were well performed, than if the child
were emaciated.” The post-mortem examination of Deering's case, could
alone convince me it was not one of arachnoid Hydrocephalus. The fluid
withdrawn was bloody up to the last tapping, although congenital ; nutrition
was very well performed, and the child had the exercise of all its organs.
Again, Dr. West states, “I regret I cannot answer, so satisfactorily as I could
wish, as to the applicability of pressure in these cases. It is my belief, how-
ever, that cases of external Hydrocephalus would be found better adapted
than any others, to treatment by mechanical means.”* I believe that it was
unsuited to, and even the cause of death in the same case, by forcing the
fluid in the inferior cornua of the lateral ventricle, through the optic
thalamus, into the two sacs found protruding that part into the large cen-
tral bag. In a case of Trousseau's, the ethmoid bone was detached from
its connections, and the infant died from the effects of compression by adhesive
laster.6
p It is my opinion, therefore, that in cases of Congenital Chronic Hydroce-
phalus, with enlargement of the head, neither pressure nor puncture are to
be relied on as a means of cure. These may be employed with effect, possibly,
in cases arising from sanguineous effusion; but we have still to learn what are
the characteristic types of this affection. Patients with congenital Hydroce-
phalus, in which either of these methods have been tried, are supposed to
have been cured thereby ; but hydrocephalic patients will survive without
either of these means being adopted; and if they do, it is only to be a burden
to themselves and their friends. Mr. Dendy is of the same opinion.6 The
truth is, that effusions of fluid, constituting Chronic Hydrocephalus, are, com-
paratively speaking, very rarely found in the bag of the arachnoid, or between
the membranes of the brain. Dr. Monro says, “As I have not met with a
single case in which the water was entirely on the outside of the brain, I can-
not help suspecting that this happens much more rarely than is supposed by
authors.” Breschet states that the fluid may be found, 1st. Between the
dura mater and the internal periosteum; 2nd. between the dura mater and
the cranium ; 3rd. between the dura mater and the arachnoid ; 4th. in the
cavity of the arachnoid ; 5th. in the ventricles; 6th. in the laminae of the
pia mater. This division is only made in obedience to the views of systematic
writers on the subject. In all the examples given by him, the fluid was con-
tained in the ventricles. Peter Frank divides internal dropsy of the head
into hydrocephalus meningeus, where the fluid was found between the mem-
branes of the brain ; and into hydrocephalus encephaloides, where it was found
in the cavities of the brain itself. This last is the most frequent. Dr. Watsons
says, “When the cerebral ventricles are distended with water, we express the
* Medico-Chir. Trans., vol. xxviii, p. 45. 1845.
* Medical Gazette, vol. xvi, p. 710. A case of haemorrhage into the arachnoid
is given in the Medical Press, vol. v., p. 326, by W. S. Stanley; and in the Gaz.
Méd. de Paris, 1834, p. 526, a case of Hydrocephalus from this cause is detailed
by Bérard.
* On Diseases of Infancy and Childhood, p. 93. * L. c., p. 92.
* Journal de Médecine, April 1843.
* Winslow's Psycholog. Journ., Monograph, p. 12. See also Van Sweiten's
Commentaries, vol. xii, p. 248.
* On the Brain, the Eye, and Ear. ° Library of Medicine, vol. v., p. 97.
790 CRITICAL DIGEST OF THE JOURNALS.
diseased condition by the term Hydrocephalus”; and Mauthner states, that
the fluidin congenital Hydrocephalus is found in the lateral ventricles; and
Meckel,” that “all observers agree in this, that in ventricular Hydrocephalus
the brain represents a thin membranous bladder filled with water, whose
quantity varies according to the stage of the disease, and which by its form
and structure appears to indicate at one time a more early, at another a later
period of its development.”8
I have seen nowhere described a case of External Encysted Hydrocephalus
like the following. The subject of it was a young male, found in the dis-
secting-room of the Royal College of Surgeons of Ireland, of whom no history
could be procured. The preparation is preserved in the museum of the Col-
lege. It consists of a bag of extremely delicate and semitransparent texture,
capable of holding about six ounces of fluid, and tacked at several remote
points by fine membranous adhesions to the serous surface of the dura mater
lining the parietal bones. This bag was perfectly insulated, except from the
adhesions first-mentioned. When first examined, it was plump, and filled
with a clear thin fluid, which by its pressure, had produced a fossa, propor-
tionate to its size, on the upper surface of the brain, and which fossa, or
depression, remained when removed from the influence of the bag. The brain
and membranes were otherwise perfectly sound.4
Neither have I anywhere seen, with the exception of a case by Dr. Houston,
a description of Internal Encysted Hydrocephalus, such as existed in the two
following cases, in both which, the brain was malformed.5 The brain of the
first of these cases, I lately exhibited to the Surgical Society of Ireland.
CASE III. CongBNITAL HYDRocBPHALUs. BRAIN Occupied BY CYSTS AND
SCROFULOUS MATERIAL. MALFoRMATION OF BRAIN. Catherine Markey,
aged six months, was admitted to the Institution for Diseases of Children,
July 9, 1849. Her parents were young and healthy, and she was their first
child. She was seized with fits shortly after birth; they continued to be
repeated for some time. Her head had been of natural size until three or four
weeks after birth. It was seventeen inches and a half in circumference, by
ten and a quarter from the tip of one ear to that of the other. The frontal
bone was divided into two portions, and the head was open from the root of
the nose to the occipital bone eight inches, and four inches and a half laterally
between the sphenoid bones. She could not hold it erect ; it fell to what-
ever direction it was inclined. There was no power of vision, and the eyes
were very much depressed, but were straight; the pupils were natural, and
in great part concealed by the lower lids; the thumbs were turned in. The
infant was very cross, except when in her mother's arms; food composed
entirely of her mother's milk; she slept in day-time, not at all at night;
she yawned continually ; head hot. August 15th. I this day tapped the
head, introducing a very fine trochar, about an inch from the central line, in
the situation of the anterior fontanelle, and removed two ounces of a per-
fectly clear and transparent fluid. She cried during the operation. The
reason I withdrew no more fluid was, what surprised me much at the time,
but is explained by the post-mortem examination, that no more of it would
come off. This fluid was examined by Mr. Moore, who described it as “per-
£ectly clear, and nearly as colourless as water. It was slightly alkaline: sp.
gr. 1006. It contained but a trace of albumen, becoming milky on the addi-
tion of dilute nitric acid, but forming no decided precipitate. It contained
a large amount of chlorides, with some sulphate and phosphate of lime.
This specimen contained more chlorides and sulphate than the former one,
* Die Krankheiten des Gehirns, etc. Wien : 1844.
* Dict, des Sciences Médicales. Art. Hydroceph. Chronique.
8 Pathologischen Anatomie, Bd. i., p. 269.
* Catalogue, Museum Royal College of Surgeons, vol. ii, p. 206.
* Wide Dublin Medical Press, February 20, 1850.
CRITICAL DIGEST OF THE JOURNALS. 7.91
and much less albumen.” October 1st. Her head is twenty inches by twelve.
(Her mother's head was only one inch and a half in circumference larger,
and was less than twelve inches from ear to ear). The infant was constantly
grinding her gums. The orbital plates, instead of forming a right angle
with the frontal portions, formed a circle with these parts. The eyes were
partly sunk below the lids; the left was lower than the right, and was not
closed during sleep. Her head, where unossified, was diaphanous; on apply-
ing the stethoscope to it, nothing could be heard. Wovember 5th. Head
twenty-one by thirteen inches; it had increased in size much superiorly.
The openings of the head were eleven by seven inches. There was a space
of nearly two inches between the parts of the frontal bone; the frontal bones
projected much over the face, and laterally, and the entire head was manifestly
greatly enlarged. The eyes were constantly in motion when awake, and
generally strongly directed to the right, but I never saw them turned up-
wards; she slept with the eyes half open ; they nearly closed when a candle
was approached to them. Her legs and arms were rigidly flexed, and on
trying to extend them, she cried; the fingers were stretched and separated.
She started frequently ; rolled the head about, and chewed. The veins of
the scalp laterally, and of the forehead, were much distended, and the root
of the nose, between the inner corners of the eyes, was black from the same
cause. Her hair was very thin, jagged, and partly erect ; the back of the
head was nearly bald, apparently from the pressure of her mother's hand in
keeping the head up in her arms. Her mother gave me, as an objection to
taking her out, that whenever she did so, the child always got severe fits of
dyspnoea from the wind. As a matter of curiosity, I one day gently blew
upon her face, when, to my surprise, every time it was dome, she drew with a
noise a deep sigh, during which her tongue was slightly protruded, both arms
were thrust forwards, and she appeared to suffer considerable distress. The
same result followed every repetition of the experiment. December 31st.
The infant was much quieter; arms rigidly flexed; hands elevated and pro-
nated ; legs flexed and rigid ; she constantly moved the mouth and lips, as if
tasting something; great projection and tenseness of the soft parts of the
head; bowels too free. She continued in the same state until the 24th of
January, when she died, without convulsions, aged one year and four days.
I considered it useless to repeat the operation of tapping the head. She
never made an attempt at uttering an articulate sound; could not reco-
gnize her parents, and it seemed to me very doubtful if she had the sense of
hearing. -
Cn the 22nd of November, Mr. Moore examined the urine of this child.
It contained a small proportion of urea ; was alkaline and ammoniacal ; a
deposit found in it contained numerous prismatic crystals of triple phosphate
and some phosphate of lime. On November 30th, it was feebly acid, con-
tained some urea, exhibited oil-globules under the microscope, and yielded
fat to ether, -
Post-MoRTEM EXAMINATION, eight hours after death, by myself and Mr.
Leeper. The limbs were quite rigid, occupying the same position as during
life; the head very soft, the bulging of the soft parts having disappeared;
emaciation excessive, the integuments of the buttocks lying literally in bags;
the belly was very large and tympanitic ; the glands of the mesentery were
greatly enlarged; the lungs were quite sound. The integuments of the head
were very thin ; no fluid was contained within the sac of the arachnoid; the
convolutions were indistinctly marked. There was nearly a quart of fluid in
the lateral ventricles, in various cells anterior to them, and in the centre of
the brain. The cells in each hemisphere communicated indirectly and in-
distinctly ; they were of all sizes, the largest holding more than two ounces
of fluid, and they were lined with a fine smooth serous membrane. In
puncturing the brain, the trochar had entered one of these cells. The brain
over these cells was exceedingly thin, being not thicker than a sheet of
792 CRITICAI, DIGEST OF THE JOURNALS.
writing paper. The inferior cornua of the lateral ventricles were lined by
serous membrane, under which appeared long fine red vessels, and were largely
dilated by liquid; but they did not communicate, as between the two was a
large transparent distended sac, holding four or five ounces of fluid, lying
directly under the lower edge of the falx. On the anterior part of this sac,
for about one inch, were a few very indistinct whitish transverse fibres, repre-
senting probably the remains of the corpus callosum. Underneath this cyst,
was still another one. No part of the substance of the hemispheres was of a
natural density. It was tough from the various cells, or hard and resistent
to the knife at the outer parts of the lateral lobes, in which were imbedded
irregular-shaped yellowish nodules, of the size of a garden bean, much harder
than the central substance, which around them was quite fibrous. These
nodules had much the appearance of scrofulous tubercles, but they were not
separable from the surrounding brain, as these usually are. That they are
closely allied so scrofulous exudation, would, however, appear from the result
of the examination of a portion of them by my friend Dr. Carte, who found
it composed of “compound granular cells and molecular matter. There were
not observed either brain-vesicles or nerve-tubes.” The interior of the brain
was without blood, except the small veins underneath the serous lining of the
lateral ventricles; there was a small quantity in the longitudinal sinus, much
more in the straight and lateral sinuses. The brain was unnaturally adherent
to the base of the skull from the optic nerves posteriorly to the medulla
oblongata, which was firmly united to the surrounding bones by a structure,
essentially fibrous. The falx, which was perfect and very deep, was also
unnaturally adherent to the hemispheres by old adhesions, which readily gave
way by pressure with the handle of the knife. Between the medulla oblon-
gata and left hemisphere of the cerebellum, in the subarachnoid space, was
a cyst capable of holding more than an ounce of fluid ; it had separated the
convolutions of the cerebellulm. The cerebellum was of natural size, but
was very soft, as were also the crural cerebri. The pons Warolii was very
diminutive, being scarcely larger than the medulla oblongata, which was very
hard. The olfactory nerves were very soft ; the optic seemed natural, as also
the third and fourth ; the fifth, sixth, seventh, eighth, and ninth, could
scarcely be distinguished, being intermixed with the fibrous morbid growth
already described as surrounding the medulla oblongata. There was no
fornix, septum lucidum, fifth ventricle, soft commissure, choroid plexus, optic
thalami, corpus striatum, or pineal gland. The tubercula quadrigemina were
very indistinct; there was no iter e tertio ad quartum ventriculum, the fourth
ventricle forming a little sac, closed on all sides.'
Dr. Houston, in the fifth volume of the Dublin Hospital Reports, has
given the description of a very rare form of Hydrocephalus, somewhat similar
to this case. The patient, a healthy-looking female infant, was affected on
the day after its birth with slight convulsions. About the sixth week, the
convulsions ceased, but the child became more stupid, and the head began to
enlarge. Its ears were sensible to sounds, and the sense of taste seemed un-
impaired; but its eyes, which were rolled downwards, appeared incapable of
being affected by light. When a year old, the head was enormously large
and heavy, the fontanelles broad, and fluctuation was perceptible all through
the cranium. At intervals, the infant voided large quantities of urine, the
evacuation of which was manifestly followed by a diminution in the size and
tension of the head, and by alleviation of the stupor. The bowels were always
costive, and it slept continually, except when affected by hunger and thirst.
It lived for one year and seven months; and, for several days before death, it
had severe convulsive twitches. The weight of the head appeared equal to

* A preparation of the malformed parts of this case, along with the tubercular
material, and a cast of the head, is preserved in the Museum of the Royal College
of Surgeons of Ireland.
CRITICAL DIGEST OF THE JOURNALS. 793
the entire weight of the body. A preparation of the brain, preserved in the
museum of the Royal College of Surgeons, presents the convolutions broad
and flattened; and such was the quantity of fluid in the interior, that on the
removal of the membranes, the brain could with difficulty be supported entire.
In the situation of the corpus callosum, a transparent membrane existed,
scarcely concealing the fluid underneath. The lateral ventricles were vastly
dilated by a limpid fluid, and thrown into one common cavity by the absorp-
tion of the septum lucidum ; they were likewise, as here shown, rendered
multilocular by the presence of several firm, opaque, projecting folds. But,
in addition to the ventricular accumulations, various sized cysts exist inde-
pendent of them, and which continued to hold a fluid after the evacuation of
the water from these cavities. There are two such cysts, each of the size of
an almond, in the site of the fornix and optic thalami. Two others exist in
the anterior lobe of the right hemisphere, each capable of holding from one
to two ounces of water, and perfectly distinct from each other and from the
neighbouring ventricle. Those cysts were distended with fluid, and lined
with membranes of the same character as those of the ventricles. The cere-
bral matter in their neighbourhood had undergone little or no change from
that observable in other parts of the brain. The cerebellum and pons Warolii
were both very small, and much softened in texture. The nerves were per-
fectly formed and distinct at the point of their exit from the skull, though
their origins from the brain could with difficulty be traced."
CASE IV. ENCYSTED INTERNAL HYDROCEPHALUs. BRAIN MALFoRMED.
Robert Carroll, aged seven months, was admitted under my care, July 16,
1849. His head was not larger at birth than natural, nor until he was six
weeks old. He was the fourth child of his parents, who were both young;
the father was addicted to drinking. Two of their children had died at birth,
another was alive and healthy. This child had a fit when one month old.
Since his third month, the head had remarkably enlarged. It was now twenty
inches and three quarters by twelve inches. He could not support it, nor
even turn it; it was very tense. The body was well formed, except an
inguinal hernia; hands clenched; he seemed to have the use of his legs;
the eyes looked healthy, but he did not appear to see. The pupils were not
dilated, and contracted when placed in the sun's light; he cried much, and
was very stupid. October 6th. He preferred to have his head hanging on his
mother's arms, lower than his body. Head twenty-one by twelve inches; face
yellowish ; the eyelids closed in the sun, and when asleep he directed his
eyes from side to side, but never raised them upwards, or the pupils above
the lower lids. He used to vomit more than now, which was not much. He
frequently started as if frightened, but used to do so more often ; slept well
at night; legs stiff, hands contracted. His mother stated that he did not
seem at all sick. Movember 15th. Head diaphanous, twenty-one by twelve
inches and a half. The sagittal and coronal sutures were nine and five
inches in length. Frontal bone not divided. The lamdoid suture unclosed.
Flesh very soft and wasted; he started up frequently; legs and arms flexed
and he cried whenever an attempt was made to straighten them. The ante-
rior fontanelle was distended, and tense. Bowels habitually confined; con-
stant yawning. Urine muddy; examined by Mr. Moore, it was found feebly
acid, sp. gr. 1014; urea normal; no albumen; deposit of triple phosphate
and phosphate of lime. January 26th, 1850. Head twenty-one and a half
by thirteen inches. The soft parts of the head were more distended and
tense. Slight convergent strabismus of left eye. The stethoscope indicated
nothing. February 1st. Had a number of spots of purpura on his head, face,
and back of neck; none on his legs. 20th. Died this morning, the purpura
having become faint, with vibices on his head and legs. For some days had
purging of a slimy bloody matter. He was aged one year and one month.

* Dublin Hospital Reports, vol. v., p. 327.
794 . CRITICAL DIGEST OF THE JOURNALS.
Post-MoRTEM ExAMINATION, nine hours after death. Head excessively
soft ; no fluid in the arachnoid ; convolutions flattened. The brain was su-
periorly very thin ; at the posterior part of the left hemisphere, for the space
of an inch, none of it existed, the fluid within being visible under the arach-
noid. The fluid, a perfectly clear liquid-like water, to the amount of nearly
a quart, was contained in both hemispheres, in a distinct, smooth, serous cyst,
unconnected with the ventricles. These cysts had, on the left side, three or
four very fine and tough strings running from one side to the other ; on the
right side there was but one, nearly a quarter of an inch in diameter. These
cysts occupied the whole of each hemisphere, from front to rear; they did not
communicate ; the falx between them was very perfect and very deep, and
was united to each hemisphere by old and easily fragile adhesions. There
was no blood in the longitudinal sinus, very little in the veins of the pia
mater, and none in the brain which altogether was very solid. The pons
Warolii and medulla oblongata might be said to be unnaturally so. The cor-
pus callosum, very tough, existed. The lateral ventricles contained about
one ounce of fluid. The soft commissure and tubercula quadrigemina, the
anterior commissure, and the anterior pillars of the formix, all distinctly
existed ; but a strange alteration possessed the other parts of the lateral ven-
fricles. Apparently from the compression of the cysts on each side, the cor-
pora striata, instead of being, as natural, nearly horizontal, were perpendicular;
the optic thalami were very small; and the left thalamus had connected to
it, nearly its entire length, the corresponding part of the fornix ; the right
thalamus was also connected, but to a less degree, with the right side of the
fornix, which was very narrow and hard, and which, by its connexion with
the optic thalami, interfered with the connexion of the velum interpositum
and choroid plexus ; the right side of the fornix was imperfect. The choroid
plexus was natural, but hard ; the walls of the fifth ventricle, nearly half an
inch in depth, were very hard and thick, and were posteriorly entirely sepa-
rated from one another, forming a direct communication with the third ven-
tricle. The hippocampi majores were very large, and carried forward into
the anterior cornua of the lateral ventricles; they were not symmetrical, and
the taeniae hippocampi were not visible. There was no pineal gland." On
the surface of the brain, in the right temple, was a clot of blood of the size
of a threepenny piece, adherent to the arachnoid, and some blood was diffused
on the skull in its vicinity. The petechiae traversed the skin, and were seen
at its under surface. .* -
Such cases as the two last, we have no means of distinguishing from ventri-
cular Hydrocephalus. The symptoms of both are the same ; and the appear-
ance of the head is identical in both. The parents of Case No. 3 would not
again consent to the operation, from which I could promise no good result ;
and, for the same reason, the parents of Case No. 4 were not induced to agree
to its performance, which indeed I regard as very fortunate, as it would have
proved utterly useless.
These two cases disprove an error of Breschet's, who says, that the urine
only deposits a whitish sediment during the course of internal Chronic Hydro-
cephalus, when the symptoms of acute dropsy of the cerebral ventricles are
manifest.” In both there was such a deposit. -
As to the cause of this encysted internal Hydrocephalus, I entirely agree
with Dr. Carte ; who, from a conversation I have had with him on the subject,
is of opinion, that it is a form of hydrocephalus quite independent of inflam-
mation, and arises from what may be termed an arrest of development of the
proper brainy material. Fourcroy has noticed the large admixture of water
* A preparation of the cerebellum and malformed part is preserved in the
Museum of the Royal College of Surgeons.
* Dict, de Médecine.
*
CRITICAL DIGEST OF THE Journals. 795
with the cerebral substance, and has pointed it out as one of those animal
substances in which water exists in the largest proportion ; constituting three-
fourths or four-fifths, and, in many instances, seven-eighths of its entire
weight. This fact, as well as the small proportion of its other constituents,
is well seen in the following table by L'Héritier:—
Infant. Youth. Adults. Old Men. Idiots.
Albumen ............... 7:00 10-20 9°40 8°65 8’40
Cerebral fat ..... ‘e g º ºs e º º 3°45 5:30 6-10 4’32 5:00
Phosphorus ............ 0-80 I-65 I '80 L-00 0.85
Osmazome and Salts... 5'96 8'59 10-19 12" i8 14'82 :
Water..... tº º & Cº º ºs e º 'º e º a ºn tº & 82-79 74-26 72°51 73-85 70-93
100.00 100:00 100:00 100:00 100.00
Dr. Carte thinks it not improbable, that some one of these principles is
wanting in the young subject; and that the water being, on the contrary, in
excess, and not meeting the other constituents in a proper chemical propor-
tion to form the brainy material, this disease is produced in the same manner
as rickets, from want of a due proportion of phosphate of lime. From the com-
parative analysis above stated, it appears that the minimum of phosphorus
exists in infancy, in idiotcy, and old age ; and that the maximum of water is
found in the infant. This latter fact, says Mr. Anderson, is of practical
interest, and affords some explanation of the greater tendency to liquid effusions
in early childhood than in more advanced life. I cannot help regretting my
inability to procure a correct quantitative analysis of the brains in Cases 3
and 4. At all events, this explanation of the cause of encysted, as well as
ventricular Chronic Hydrocephalus, would confirm the views of Spengler and
Barruel, as well as those of Barrier, Copland, Breschet, and Rilliet and Bar-
thez, relating to the non-inflammatory origin of Chronic Hydrocephalus. . .
In the London Medical Gazette, April 15, 1842, Dr. West has drawn up an
account of sixty-three cases of Chronic Hydrocephalus, in which the head was
punctured. In two of the cases the puncture was accidental ; while in five
instances, the results were not such as would justify classing the cases either as
fortunate or as unsuccessful. Fifty-six cases then remain, in forty of which the
patients died ; while in sixteen they are alleged to have recovered : in other
words, the proportion of recoveries to deaths was as 1:3-5, or two out of seven
of the total cases, a comparison which Dr. West, still considering as correct,
has adopted in his recent work on Diseases of Children. These figures
would indeed indicate a very favourable result of the operation of tapping the
head; but a careful examination of the so-called successful cases, cited from
Monro, Lizars, Russell, Graefe, Bedor, Marsh, and Conquest, renders their
success very doubtful. * 4 f -
Ten of the cases are those supposed to have been cured by Dr. Conquest,
all of which I cannot admit to have been successful. Meither does Dr. Con-
quest himself assert, that he cured ten cases out of nineteen. He says ten were
living when last heard of, and nine were dead, “but it is only fair to state,
that as most of these children were amongst the lower classes of society, who
are continually changing their residences, several have been lost sight of, and
may now very probably bedead, although when last seen, sometime subsequently
to their being operated on, they were living.” Before any case can be ad-
mitted to have been cured by the operation, it must be shown that a consi-
derable time elapsed since its performance, and that during this period the
health of the patient was perfectly good. Dr. Conquest, in his total number,
operated seven times, once; five times, twice; three, thrice; twice, four times;
twice, five times. The three cases given as cured, he punctured, once, twice,
and five times. In the others only temporary relief was afforded, from the

r—r
1 Todd's Cyclop. of Anatomy, etc., Part xxv, p. 588.
* Medical Gazette, vol. xxi, p. 969.
WOL. II. 53
796 CRITICAL DIGEST OF THE JOURNALS.
reluctance of the patients to have the operation repeated. One of the cases
reported as cured was brought to America, aged two years six months. In
another, five years after the operation, ossification was incomplete at the
posterior fontanelle, and there were two openings in the coronal suture. In
the third, eight years after the operation, the head was too large, but not
larger than before she was operated on. In fifteen out of the nineteen cases
of Dr. Conquest, no particulars are given beyond the mere statement of the
number of punctures, and the quantity of fluid removed. His directions,
moreover, for performing the operation of tapping the head, are very vague
and unsatisfactory. . -
The table of Dr. West's cases shows, he says, that sometimes the puncture
was followed by an almost immediate aggravation of the cerebral symptoms,
and by death; usually, however, a degree of apparent improvement followed
the puncture, but the fluid soon collected again, and less marked relief fol-
lowed the second operation. With its repetition, the quantity of fluid increased;
and, while the size of the head continued undiminished, or even grew larger,
the body of the patient became emaciated, and death either took place from
exhaustion, or cerebral symptoms came on, and life was terminated either by
coma or convulsions." Mr. Fergusson says,” that in one of his own cases,
there was no improvement after half a dozen different operations, while sixty
ounces of fluid were evacuated ; and though the child was yet alive, and the
proceeding had not been repeated during twelve months, he doubted if the
operation was of the smallest permanent service. The undiminished size of
the-head, in consequence of tapping it, was remarkable in another of Mr.
Fergusson’s cases, as it was in case No 1. of my own. Mr. Holbrook3 despaired
of curing a case after he had punctured the head three times; and Kilgour,4
after repeating the operation four times, and withdrawing fifty-one ounces
of fluid, left the case to nature, perceiving that the head was steadily growing
larger, notwithstanding the punctures. In Dr. Conquest's three cases reported
as cured, the head was not diminished in size; in Graefe's, it is reported to
have had the same circumference (18% inches) as before the operation. In
Mr. Kitsell's, it is stated to have retained its diminished size; while, in Dr.
Whitney's, it was too large, and in Edwards' case, there is no account of the
size of the head.
According to Mr. Fergusson, tapping the head is a proceeding which can
be thought of only in early infancy, while the over-distended cranium is yet
soft and pliable ;5 and this is the general view of all the operators, with the
exception of Dr. Conquest, who states, that “in no instance has clearly-marked
congenital disease been permanently benefited, and those cases have done
best, in which effusion manifestly resulted from inflammatory action, and in
which cerebral excitement followed the operation”, an opinion not seconded
by any one. The conclusion we are justified in holding, from an examination
of the sixteen cases reported by West, is, that not more than four of these
(Graefe’s case, and three of Conquest's, which I still look on as doubtful)
were cured. .
There are three other cases reported as cured by Drs. Whitney,” Edwards,"
and Kitsell.8 Whitney punctured the head twice, and withdrew nine ounces
the first, and five ounces the second operation. Dr. Edwards' case was aged
fourteen months when he tapped the head, and drew off eight ounces of red-
dish fluid. The trochar was introduced an inch, and there ensued an oozing
of blood from the nostril for twenty-four hours. After the lapse of seven
years, the child is reported as a fair scholar, and with every faculty good, but
* Medical Gazette, 1842, p. 138. * Syst. of Pract. Surgery, p. 490.
* London Medical Repository, vol. xxiv, p. 345. -
* Edinburgh Med. and Surg. Journal, vol. liii, p. 303. * Loc. cit.
6 American Journal of Medical Sciences, October 1843, p. 303.
* Edinburgh Monthly Journal, p. 398. 1846. .
* American Journal, January 1850, p. 218.
cRITICAL DIGEST OF THE JOURNALS. 797
to be increasing in height more slowly than is usual at his age. Mr. Kitsell's
case was his own son, on whom he operated but once, at the age of eight
months; sixteen ounces of a limpid colourless fluid were withdrawn. Instead
of closing the wound with a compress and retentive bandage, the discharge
of the fluid was encouraged by occasionally cleansing and opening the punc-
ture, thus allowing it to escape probably as fast as it was secreted, and which
continued about five days and nights, gradually subsiding after soaking a
large number of napkins; the total quantity being computed at about four
pints. At the end of nearly four months, the account is given of his being
restored to perfect health, the head retaining its diminished size, the various
sutures being closed, the anterior fontanelle much contracted and flaccid, and
the cerebral pulsations being distinctly felt. I look on four months as too
short a time, to record a patient cured by the operation of tapping the head.
The forty unsuccessful cases quoted by Dr. West are not the only cases on
record in which paracentesis of the head had failed. From an examina-
tion of ancient and modern medical writérs, we discover numerous cases
unsuccessful, which, along with the forty cases in Dr. West's table, give about
100 unsuccessful against seven alleged successful cases, or, in other words,
one patient in fourteen was cured by puncturing the head. But this propor-
tion I do not regard as by any means exact, as I have known of the operation
having been performed in Dublin about ten times unsuccessfully, and I have
heard of others in the country in which it was undertaken ineffectually.
Unfavourable results are seldom recorded. We can now understand why the
operation has been denounced by Portenschlag, Borsieri, Mercati, Dupuytren,
Physick, Portal, Paré, De la Motte, Boyer, Heister, Boerhaave, Breschet, etc.,
and only wonder at the error of one of the writers of the British and Foreign
Medical Review, who says, “Making allowance for the fallacy of medical tes-
timony in wonderful cases, which we are fully inclined to do, we will estimate
the successful cases at one-third, and ask if any other remedy in this disease
has been equally fortunate P” In abdominal dropsies, “it must be remem-
bered that paracentesis can seldom be contemplated as a mode of cure, but
simply of temporary relief from distress”;” “and although it should not be
proscribed from practice”, says Dr. Copland,3: “I believe the cases are few
that will be benefited, and still fewer that will be cured by it.” In hydrocele
of the tunica vaginalis testis, it is long since a radical cure of it has been
attempted, by the inflammation produced by incision, excision, tents, setons,
and injections: and if, in these two forms of dropsy, in which the containing
parts naturally return to their proper position after the withdrawal of the
fluid, a cure by its simple removal is so rare an occurrence, a reason is affordéd
us why dropsy of the brain, the parts of which cannot reassume their natural
position or structure after the withdrawal of the fluid, is not to be cured by
paracentesis of the head. - r
To induce inflammation in the brain is death. The operation “is certainly
one attended with considerable immediate danger, not from the puncture,
which is a very simple matter, nor from the sudden escape of a fluid, nor
from the wounding either a vessel or the brain, but from the inflammation
likely to succeed.” [Abridged from Edinburgh Medical and Surgical Jour-
mal, No. 184.] -
AUSCULTATORY SIGN OF ENLARGED LIVER,
DR. WALSHE has described in the Lancet, a stethoscopic indication of
enlarged liver, under the name of “hepatic compression rhonchus.”
“It coexists with inspiration only, or indeed, seems to be rather superadded
to it, not commencing until the inspiration-murmur appears almost at an end.
* British and Foreign Medical Review, vol. xii, p. 119. - •
* Watson, loc. cit., vol. v., p. 155. * Loc. cit. p. 632.
* Fergusson's Surgery, p. 490.
532
798 CRITICAL | DIGEST OF THE JOURNAL8.
Its evolution is peculiarly slow, drawling, and (if I may be allowed the ex-
pression) lazy, being, in this respect the exact reverse of that of the crepitant
rhonchus of pneumonia. It consists of a variable (but commonly a great)
number of excessively fine, dry crepitations, rather superficial than deep-
seated; is rendered audible by forced inspiration only, and may be heard in
front, at the side, and in the back of the right half of the chest (least com-
monly in front, however), at or near to, the upper edge of the liver. Its
existence is completely independent of any lung-affection; and I have never
found it on the left side, in these cases of liver-enlargement. The characters
of this rhonchal sound are so peculiar, that a mere tyro would be able to dis-
tinguish it from all other varieties of rhonchus, it differs essentially, as I
have just proved, from crepitant, subcrepitant, and dry crackling, pulmonary
rhonchi, and from pleural rhonchus. Of its mechanism I am not prepared,
at present, to offer any demonstration ; but it appears to me to be most
feasibly explicable as follows:—The lower portions of the lung, pressed upon
by the enlarged liver, undergo a sort of creasing, or condensation, which, in
ordinary breathing, interferes with their expansion. By forced inspiration,
the portion of lung implicated will readily be understood to be uncreased, and
so conceivably a series of sounds, such as I have described, is produced.
Another fact strongly corroborates this hypothesis—namely, that it often
ceases to be audible, for a time, after from one to five or six forced inspira-
tions: the lung seems to require rest and time to be again creased up.
Should further experience confirm this view of its mode of production, we
shall, have collateral support given to the doctrine I have long taught (and
which, so far as I know, has not been refuted), that the crepitant rhonchus
of pneumonia is formed, not in the air-cells or capillary bronchi, but in the
pulmonary parenchyma itself. I am not able, as yet, to make any positive
assertion concerning the frequency with which the rhonchus under consider-
ation attends enlargement of the liver; but, on the other hand, I am in a
position to affirm, that in no single case of notable increase of bulk of that
organ which has fallen under my observation, since my first discovery of the
rhonchus, have I failed to substantiate its existence. The sound may, it is
true, escape detection on one or more occasions, but has never been absent for
a series of days. On the other hand, I have not met with it in other condi-
tions of disease; though doubtless, if my theory concerning its formation be
well founded, it will probably be ascertained to accompany a variety of con-
ditions, causing slight compression of the lung.” - -
Poisonous EXHALATIONS FROM AN APPARENTLY HEALTHY MAN.
, We quote the following from p. 77-78 of the second volume of the Trans-
actions of the American Medical Association. . - - -
“Some curious cases are related by Dr. C. E. Lavender (New Orleans Med.
and Surg. J., July 1848), which, in his judgment, go to show that the exhala-
tions from one human body in a state of health may be poisonous to another.
P. K. was married successively to two healthy young women. His first wife
soon became pregnant, began to decline, grew pale and hydropic, and finally
miscarried. She conceived a second time, and was a second time delivered
of a still-born child, by a premature birth, the labour being marked by the
singular circumstance, that no red blood followed the cutting of the chord, or
theºremoval of the placenta. Her feebleness increased : pulse 110, compres–
sible, and undulating: sighing, roaring, and uneasy feeling in the head:
light, and all white objects appeared to her yellow, and the next day, red. She
finally died without any well-marked affection. His second wife, in like
manner began to decline soon after becoming pregnant, and died in about
ten minutes, after suffering with a train of symptoms similar to those of the
first. The optic illusions were strikingly similar, She could see but one
half of an object, and that appeared to her green, or green with red spots: and
cRITICAL DIGEST OF THE JOURNALS. 799
finally all light and white objects appeared red. In both cases, without any
apparent fixed disease, the emaciation went steadily on, and the symptºms,
even to the singular affection of the retina, were nearly identical. The hus-
band is a man whose cutaneous exhalations, especially under excitement, are
so offensive, that all the civet of the apothecary would not sweeten him... Dr.
L. refers to a third case, analogous in its symptoms, terminations, and all the
attending circumstances. He concludes that some morbific matter, secreted
by the systems of their husbands, was the cause of the obscure malady in
these females.” § :
SURGERY.
gºsmºs-sº
PETREQUIN ON BLACK CATARACT.
The occasional existence of Black Cataract (cataracte moire) has not been
referred to by several distinguished writers on Ophthalmology, many of
them having never seen it. Others, as Freytag, Gendron, Montain, etc.,
refer to it without having witnessed it. Janin of Lyons relates three cases,
occurring in his own practice. In a woman, seventy years of age, he
removed a large black crystalline lens, of hard consistence, enclosed in its
capsule ; and which, when viewed through a light, appeared of a brown red
colour. In another case, in the year 1767, he extracted from each eye a
crystalline lens possessing similar characters. (Mém, sur l’OEil, 1772, pp. 259
and 261.) Wenzel and Pellier, Marc-Antoine Petit, Coze, Cloquet, Riberi,
and others, have also met with cases. - -
The existence of Black Cataract being established, other questions arise
for investigation. Dupuytren correctly remarks : “The greatest difficulty,
in cases where the existence of Black Cataract may be presumed, is presented
by the diagnosis. If the lens be totally black, it is difficult to determine
whether there be cataract or not.” (Lec, Clin. Chirurg, t. i, p. 49.) The
extreme rarity of the disease prevents us from completely observing its pro-
gress; and this is easily understood, when we reflect that Demours, Scarpa,
Delpech, and Dupuytren, never met with it in their extended practice, and
that not one case is recorded in the Annales d'Oculistique. For the complete
demonstration of the disease, we require careful observations of such a nature
as to furnish a rigorously exact diagnosis. We require such an examination
of the affection, in harmony with the modern progress of ophthalmoscopy, as
will satisfy the requirements of science, and leave no important desiderata.
In proportion to the rarity of our opportunities of verifying theory by prac-
tice, they ought to be eagerly seized; and this is what I have borne in mind
in observing the three cases which have come under my notice within the
last twelve years, in the Hôtel Dieu at Lyons. The research is not an idle
one ; for it is capable of important application. An error in diagnosis may
lead to most mischievous results: for instance, if an amaurosis be mistaken
for Black Cataract, as happened to Dupuytren, a useless and even dangerous
operation may be performed, which may destroy all chance of restoring the
function of the eye. If, on the contrary, a Black Cataract be mistaken for
*amaurosis, not only is time lost in superfluous treatment, but the patient is
subjected to unnecessary suffering from blisters, purgatives, the cautery, and
setons, while a simple operation might cure him. These considerations must
give additional importance to the cases, which will be now related.
CASE I. BLACK CAPSULO-LENTICULAR CATARACT: DIAGNoSIs: ExTRACTION:
ExAMINATION of THE LENs. M. B. of Chapelle (Saône-et-Loire,) was admitted
into the Hôtel-Dieu at Lyons, under my care, on the 24th September, 1847.
His sight had been weak for several years, without any known cause. He
never had headache ; but sometimes had a sensation as of gravel in his eyes.
The left eye began to be affected twelve or thirteen years before, and for the
last six years the blindness had been stationary. The patient was not only
800 CRITICAL DIGEST OF THE JOURNALS.
unable to see her way, but could very imperfectly distinguish the presence
of light. She had a black capsulo–lenticular cataract : the interior of the
eye did not exhibit the brilliant reflexion, which is usually observed in view-
ing it through the pupil; the pupillary aperture, instead of presenting a
brilliant velvety dark appearance, was of a dirty obscure black, not reflecting
light. The patient's intellect was much impaired, so that we could not
ascertain whether she saw better in the morning or evening than in the mid-
dle of the day, nor what colours objects presented at these times. The
appearance and motions of the eye denoted cataract: the pupil was regular
and mobile, which is not the case in amaurosis. The cataract was not of an
inky blackness; but, when viewed through a lens, it appeared as a dark opaque
body covered with soot, or rather as if it had been macerated in a solution
of Soot. In addition, a pretty large opaque triangular segment of the
capsule, with its apex towards the centre of the pupil, was observed to
be covered with blackish striae, distinctly raised, when viewed in profile,
from the rest of the cataract. When examined from the side, these striae
were found to be too near the cornea, to allow of the supposition of their
being situated in the vitreous body, or, a fortiori, in the retina. On viewing
it in profile, a convexity was observed ; but the shadow of the iris was not
thrown on it, as is asserted by some observers. On holding a candle before
the eye, only the first of the three images was produced. On the 30th Sep-
tember, I performed extraction, by making an oblique incision to the exterior
of the cornea, and through five-sixths of the semi-circumference of that mem-
brane. The cataract being very large, I extended the opening with small
scissors: I adopted the proceeding of Wenzel, by making an incision in the
lens before finishing the section of the cornea. The lens did not escape
spontaneously, nor when careful pressure was made on the eyeball: but I
easily extracted it with a Dupuytren’s needle. There was no prolapse of the
iris, nor escape of the vitreous humour; and the operation was perfectly
successful.
The cataract was black, of a dull hue, voluminous, hard, and enveloped in
an equally opaque and blackish capsule, as if the whole crystalline system
had been immersed in a dilute solution of Indian-ink. I preserved the speci-
men in alcohol: and, at the present time, after it has remained two years in
the liquid, the blackness has given place to a reddish-brown : the cataract is
shrivelled, and has become less voluminous and less opaque than at the
beginning.
CASE II. BLACK CATARACT of LENS : DIAGNOSIS. A woman, named B.,
had Black Cataract of the right eye; but the capsule did not appear affected.
The disease was not of such long-standing as in the former case, and the
brown tint was more uniform. The usual lively dark colour could not be
distinguished at the bottom of the eye. The pupil was regular and mobile,
the look natural, and not dull as in amaurosis. A convexity could be reco-
gnized, which, when viewed in profile, assumed a less deep and more grey
colour, without presenting any opaque point on the lens, either to the naked
eye or to a lens. The black opacity was more homogeneous than in the left
eye, and the loss of sight was more advanced: the patient could distinguish
the day and the shades of light. A candle held before the eye gave two
images. An operation was performed, at the earnest request of the patient:
but she produced staphyloma by constantly applying her fingers to her eyes.
This was somewhat relieved by remedies. From her irritating the eye, how-
ever, inflammation resulted, which produced deformity of the iris and opacity
of a portion of the cornea. She sank into a state of senile idiocy, and left
the hospital, on the 25th October, with little or no benefit.
CASE III. Double CATARACT-BLACK IN THE LEFT EXE, GREY IN THE
RIGHT. J. T., aged 60, native of Ailloz, in Savoy, was admitted, under my
care, into the Hôtel-Dieu, at Lyons, for double Cataract. In the right eye, the
cataract was lenticular, greyish, with an amber-coloured softish and large
nucleus. It had existed for six months, and the sight was more affected than
CRITICAL DIGEST. of THE JOURNALs. 801
on the left side, where the eye had been diseased for eight years. In the left eye,
the cataract was black, but not so perfectly but that some difference of shade
could be discovered on viewing it attentively through a lens. The centre
was of a deeper shade than the circumference: the pupil was moveable and
regular, and the appearance of the eye, in other respects, was natural. The
opacity was not very deep, and appeared, when viewed in profile, to be
situated at the level of the pupil. "On careful examination from the side,
some convexity could be observed ; but the shadow of the iris was not thrown
on it. The cataract was of a dull black tint, like chimney-soot : it was
mostly homogeneous, but a few isolated points towards the centre appeared
more opaque, which made me suppose that the lens was affected in that
situation. On viewing it in profile, it assumed a more reddish, and even
greyish shade. The experiment with a lighted candle gave two images, of
which the second was very confused, and disappeared in several places: my
diagnosis was thus confirmed. A great number of medical men agreed with
me, that there could be no doubt of the existence of Black Cataract. It was
remarkable, that vision was less affected in this eye than in the right ; for
with this one, the patient could see to guide himself, and could distinguish
the shapes and colours of objects. He even asserted, that vision had been
improving in this eye for four or five months, and that it was less affected
than in the early period of the disease. He also saw better on some days,
and at certain times of the day; but could give no precise information on
that subject. The cataract appeared hard, but less voluminous than that
described in Case I.
REMARKs. After describing the catoptric test, first proposed by Purkinje,
in 1823, and revised by Sanson, in 1837, and shewing its importance, in
the diagnosis of Cataract from Amaurosis, M. Pétrequin makes the following
observations: y
The experiment was performed on our patient (Case III) several times, in
the presence of several physicians and pupils; and a comparative examina-
tion was made of several diseases of the eye. I have referred to a remarkable
fact, and one which gives rise to an interesting question. The patient ima-
gined that his vision had improved in the eye which was affected with Black
Cataract. To explain this, it may be supposed that when the right eye was
scarcely affected, its comparatively sound state caused the vision in the left
eye to appear more impaired; and that latterly, when the left eye became in
its turn the seat of a confirmed grey cataract, the right appeared, though
there was no actual difference, to have improved in power of vision, there
being not an absolute improvement, but merely a relative one, such as is often
the result of erroneous comparisons. - t
I have also been enabled to distinguish the degree of opacity, as well as
the colour, of a cataract. Blackness is not sufficient to entirely prevent the
perception of light. Thus, I observed that vision was not entirely destroyed
in two of my patients; the woman operated on by Janin in 1767 perceived
objects, and distinguished the flame of a candle as an object of a deep red
colour; while the patient of M. Coze, operated on in 1818, could see to walk
about the roads with which she was acquainted, especially in the morning
and evening. In fact, a Black Cataract acts simply as a blackened lens; being
almost analogous to the smoked pieces of glass used for viewing the sun.
These do not altogether intercept the luminous rays, but only absorb those
which are too intense. The use of coloured glasses is constantly ordered to
patients, in order to attenuate the intensity of the light. Their use is too
general to render it necessary for me to insist further on the analogy.
The black colour of the cataract is not sufficient to explain the partial
blindness which accompanies it. We must take into account the opacity of
the lens : this seems to be less than in some cases of cataract; and attentive
observation has proved to me, that some lenticular cataracts, as they advance,
802 CRITICAL DIGEST. OF THE JOURNALs.
become harder, and are rendered sensibly less opaque by the thickening of
their constituent parts. This phenomenon cannot have escaped notice ; and
it is possible, that it was one of the causes which contributed, in Case III, to
the amelioration of sight. It can also be understood, that the lens, in be-
coming hard, will become smaller; and that the diminution in volume will
permit more light to pass to the interior of the eye, either through the lens
or its circumference. This phenomenon was apparent in Case III. By
the aid of a lens, it was easy to recognize, while the pupil was dilated,
that the black crystalline lens did not entirely fill the field of vision; but
that there was a crescent-shaped free space at the lower part, through which,
notwithstanding its narrowness, a sufficient number of rays of light pene-
trated to become, by habit, adequate for vision. This may be proved by a
very simple experiment. If a black bandage be placed over the eye, and a
small fissure be left in it, a small quantity of light will be admitted, which
will at length become sufficient for vision. . . . " . -
The cause of the colour of Black Cataracts is thus explained in a note by
M. Pétrequin: - - - * -
Many hypotheses have been framed to account for the colour. Rosenmüller
thinks it due to melanosis: but M. Carron des Willards, who has examined
a great number of horses labouring under this affection, has never found the
crystalline lens black. M. Sichel refers this deep colouring of the crystalline
to the different degrees of aggregation of its particles, and to the consistence
of the cataract. But then, the lens ought to become blacker as it becomes
harder: this is not the case, for the contrary often occurs. M. Langenbeck,
junior, attributes it to the presence of manganese, which has been found in
lenticular cataracts. For my own part, I am disposed to agree with M.
Carron des Willards, that the colour is due to the predominance of black pig-
ment, which penetrates into the lens by imbibition or endosmose, as is ob-
served in the yellow tinge of icteric patients, and in the redness, from san-
guineous exhalation or stasis, of asphyxiated children. It is very important
to distinguish true Black Cataract from those brownish, striated, partial tints,
which are called choroidal or pigmentary cataracts. This has been pointed
out by M. Cartoni of Pisa, in the notes added to his Italian edition of Richter's
Surgery. [Révue Médicale, 28th February, 1850.] +
MEDICAL versus SURGICAL TREATMENT OF CATARACT.
DR. WILHELM RAU, Professor in the School of Medicine, at Berne, believes
that ophthalmologists have been in error in rejecting the idea of healing
Cataracts, even lenticular, in any other way than by operation. His conclu-
sions are founded on the observation of ten cases, of which a few are here
analysed. - - . -
CASE I. A woman, aged 56, who had for some time been subject to rheu-
matic pains, was attacked with inflammation of the capsule of the lens, which
produced opacity and extreme feebleness of vision, but not, fortunately,
adherence of the pupil. As internal remedies, corrosive sublimate and wine
of colchicum were prescribed; and for external use, mercurial frictions to
the eyelids. At the end of three weeks from the commencement of this treat-
ment, the patient already saw better. At the end of a month, the opacity
was perceptibly diminishing; and in three months, there were only some
dotted patches, almost imperceptible, remaining on the capsule. The patient
then read large print without difficulty, and her general health was much
improved. Polygala was then prescribed instead of corrosive sublimate, and
the mercurial frictions were continued. After five months, the dotted patches
remained, but the rest of the pupil was perfectly transparent, and the sight
did not seem in any sensible degree affected. The patient remained in this
state. - - -
Case II. A man, aged 60, was affected with weakness of vision, which pre-

GRITICAL DIGEST OF THE JOURNALs. 803
vented him from reading: and it was soon perceived that he had incipient
double cataract. He had had rheumatic pains some time previously, and
they still continued, though in a less degree. He was ordered to take pills of
polygala with sulphuret of antimony and extract of arnica. At the end of
two months, the cure was so complete, that there was no trace of opacity,
and the eyes had regained their full power. - - -
CASE III. A man, aged 34, subject to haemorrhoids, and to frequent transient
attacks of congestive iritis, was seized, in January 1847, with chronic iritis,
and with an excessive haemorrhoidal flux. Leeches were applied to the anus;
sulphur and neutral salts were administered. In a short time, iodide of
potassium was prescribed internally, in doses of from 15 to 30 centigrammes
(2% to 4% grains) repeated morning and evening; and frictions with antimo-
nial ointment were made on the nape of the neck, and behind the ear of the
affected side. The inflammation of the eye was dissipated, and the pupil
regained its mobility; but the opacity, nevertheless, persisted, and the patient
had great difficulty in reading large print. He was moreover troubled with
intense photophobia. The capsule of the lens was covered with a multitude
of small opaque isolated spots; the intervening spaces were transparent. Dr.
Rau prescribed corrosive sublimate, combined with mercurial inunctions.
The opacity was suddenly arrested in its progress, and had nearly disappeared
at the end of a month. The occurrence of an attack of gastralgia then
caused the mercury to be discontinued, and for it were substituted bitter
tonics, and a course of the waters of Homburg. Six weeks of this treatment
entirely removed the opacity; and in eight months after, the sight was per-
fectly regained. - - *
CASE Iv. A blacksmith, aged 50, of athletic build, somewhat addicted to
liquor, consulted Dr. Rau for a dimness of vision, which had been gradually
coming on for six months, without any assignable cause. He had incipient
cataract of the lens in both eyes. Pills of polygala and sulphuret of anti-
mony were prescribed, as well as mercurial frictions to the eyelids; and he
was prohibited from working before the fire, and from indulging in the abuse
of spirits. No manifest change having been produced at the end of two
months, Dr. Rau prescribed iodide of potassium in gradually increasing doses.
In a few weeks, the improvement was so great, that there only remained a
slight cloudiness, and the patient could see to read large print. The iodide
of potassium was continued, in decreasing doses; and, in three months, the
cure was complete. 3 * . * * .
CASE v. A man, aged 57, of an apoplectic constitution, and who had been
affected for three years with suppression of the perspiration in the feet, had
had, for three years, a gradual weakening of sight, so as not to be able to
distinguish a person at the distance of three paces. The pupil was opaque
in the centre, and transparent at the circumference: the patient was consti-
pated. Dr. Rau prescribed pills of rhubarb with extract of aloes; the legs
were sprinkled with a mixture of quick-lime and sal-ammoniac, with the yiew
of reproducing the perspiration in the feet, but without success. At a later
period, pills of sulphur and rhubarb, with cream of tartar, were prescribed.
In two months, only very slight amendment had been produced, and the
opacity of the lens remained in the same state. Iodide of potassium was
then given, which produced a rapid amelioration, and, in six months, all
opacity had disappeared. The patient has since assured the author, that he
can see better at the distance of a hundred paces than formerly at three.
REMARKs. It is to be remarked, that the Cataracts were incipient in the
cases related. If we may hope, and in this we are encouraged by the facts
brought forward, to arrest the progress of a certain number of cataracts in
the early stage, it would be preferable to treat them actively at that period,
instead of waiting patiently till they are ripe for an operation. .
Of the remedies mentioned, the object of some was to combat the rheu-
804 CRITICAL DIGEST OF THE JOURNALS.
\
matic diathesis, to which the Germans attach much importance in diseases of
the eye. The remedies referred to are, corrosive sublimate, arnica, polygala,
colchicum, sulphuret of antimony, and iodide of potassium. Hufeland
regards corrosive sublimate as one of the most powerful anti-rheumatic
remedies, especially when combined with guiacum, but he prescribes it in
infinitely less doses than in syphilis. He used to divide ten centigrammes
among sixty pills, of which the patient had to take from three to five daily.
Arnica has long been employed in chronic rheumatism, and in all diseases
arising from it. The dose is four grammes (about one drachm) infused for an
hour in a quart of boiling water. Polygala has been also employed in rheu-
matic affections, and in intense ophthalmia. The ptisan is prepared by in-
fusing 8 grammes (2 drachms) of the root, for two hours, in a quart of boiling
water. The sulphuret of antimony is prescribed by Rau in pills, with poly-
gala and extract of armica. Colchicum and iodide of potassium are well
known : the latter is prescribed by Dr. Rau in small doses, in the form of
pill, with marshmallow and guiacum. [Journal des Connaissances Médico-
Chirurgicales, 15th April, 1850; from Journal der Chirurgie und Augen-
heilkunde.]
LANGENBECK's OPERATION FOR PHARYNGEAL POLYPI.
The case of fibroid tumour of the Pharynx, which I shall presently relate, and
in which the patient had been rendered pulseless by hamorrhage, led me to
apply the Ligature to the treatment of Polypi, in imitation of the subcuta-
neous plan of Ricord for the treatment of varicose veins. This method can be
applied without any difficulty to polypi with long pedicles, and the ligature
can be tightened from hour to hour, and can be easily loosened at any time.
In applying the ligature to Pharyngeal Polypi, I proceed in the following
Iſlan Il CI’.
An elastic catheter with a fenestrated extremity, and two threads of strong
waxed silk, are required. The patient sits in the usual position for all opera-
tions on the throat. The body of the polypus fills, as we suppose, the space
behind the velum palati, and extends more or less downwards, while its pedi-
cle is attached within reach of the posterior nares, or to the posterior wall of
the pharynx. The catheter, having been previously oiled, is introduced
through one nostril, (the choice of which is determined by the inclination of
the tumour to the right or left), into the pharynx ; it is then guided with the
fingers of the left hand so far forwards in the mouth, that the ligature can be
passed without difficulty through the holes in its fenestrated end. The liga-
tures are previously arranged, each in a simple sling with ends of equal length.
The free ends of the first thread are passed through the holes of the catheter
while in the mouth, and then drawn back through the nose, while, with the
fingers of the left hand, the portion closed in the form of a sling is pushed
high up behind the polypus, yet so that the end of the noose still remains
visible in the mouth. The catheter is again introduced through the nostrils,
and the sling-like end of the second ligature is drawn outwards towards the
nose, while the fingers of the left hand push the free ends of this second liga-
ture high up in front of the tumour. The operator now passes in the mouth
the free ends of the second ligature through the noosed end of the first, and
an assistant does the same to the ends which are hanging from the nostril.
While the operator and his assistant now each gently draw the free ends of
the ligature, the former, with the fingers of his left hand, keeps up the liga-
tures in the pharynx, before and behind the polypus, so that they cannot
slip down. The polypus is now seized in the ligature, and this may now be
drawn tight. For this purpose, the operator takes hold of the ends hanging
from the mouth with his left hand, and those hanging from the nostril with
his right, and draws the latter so tight, that the mooses reach to the point of
insertion of the pedicle. The same is done to the ends of the ligature in the
CRITICAL DIGEST OF THE JOURNALS. 805
mouth, by means of the index finger of the left hand. The nooses, when once
drawn tight, cannot again become loose ; the ligature is felt with the finger,
behind the velum, surrounding the pedicle of the tumour, which can imme-
diately be divided beneath the ligature. To perform this latter operation
with security, the operator gives the ends of the ligature to an assistant, to
hold them tightly drawn, while he seizes the polypus from the mouth by
means of Muzeux's forceps, and cuts through the pedicle close below the
ligature, with a pair of strong slightly curved polypus scissors. Should there
be difficulty in reaching the pedicle with the latter, the excision may be per-
formed by means of a straight knife, introduced either through the mouth or
nostril. When the polypus has been removed from the mouth, the ends of
the ligature are secured with strips of plaister. After two or three days, the
ligature may be removed without danger. To effect this, the threads which
form the ends of the ligature are separated, and one of each is divided as high
as possible. The remaining single thread is easily drawn out, and the whole
ligature is instantly untied : one thread being drawn through the mouth, the
other through the nose. No further explanation seems necessary to shew,
that this form of ligature can be applied in the same way to uterine polypi,
after they have been seized by means of Muzeux's forceps.
CASE. J. F. K., aged 23, of large and powerful conformation, appears to
have suffered in his fifteenth year from dropsy after scarlatina. After this,
he was ruddy and strong. In the Autumn of 1845, he first perceived an im-
pediment to the passage of air through the nose, and soon was altogether
unable to draw air through the right nostril. The affection had rapidly
increased in severity, up to the time of his admission into the Frederick Hos-
pital at Kiel, on 13th January, 1846. The following was then his condition.
He breathed with his mouth open, the respiration through the nose being
entirely impeded. Respiration was loudly stertorous; the face was blue and
swollen, and the veins of the conjunctiva much distended. The difficulty of
breathing increased during sleep, and the patient often awoke with a sensation
of suffocation. Deglutition, especially of solid food, was greatly impeded, and
a portion of what was swallowed was returned through the left nostril. When
the mouth was opened, the velum palati was observed to be much pressed
forward, and its lower border was in a line with the fourth molar tooth ; it was
also highly hypertrophied, and the uvula was elongated and thickened. On
pressing down the tongue, the tumour, of the size of a goose's egg, was seen
behind the velum. It was roundish and pyriform, with a reddened surface,
with radiated excoriations, firm and elastic to the touch, and tender on pres-
sure. The broad base reached as far downwards as the epiglottis; the pedicle,
which was as thick as a finger, was attached in the vicinity of the posterior
nasal spine. The nostrils were free ; and the finger, when introduced through
them, reached the tumour, which could be felt behind the velum palati. On
the night between the 20th and 21st January, a very violent haemorrhage
took place from the tumour, and was only suppressed with much trouble by
means of injections of cold water, pressure on the tumour, and simultaneous
compression of the carotids. . The patient fell into a state of syncope, which
lasted for some time. In the morning he was very weak, and his pulse
scarcely perceptible. *
January 21. The fibroid tumour was ligatured in the manner described
above; the threads were introduced through the left nostril. After I had
drawn the running knots very tight, the swelling assumed immediately a dark
blue colour. I then introduced a strong pair of polypus scissors, curved on
the surface, upwards behind the velum, and divided the pedicle of the polypus
immediately beneath the ligature. . No haemorrhage took place; and the
patient in no way suffered inconvenience from the operation. A microscopic
examination, made on the same day, gave the following results. The surface
of the polypus was covered with a thick layer of pavement epithelium, in
the large pale cells of which, pale excentric nuclei were disclosed by acetic

806 CRITICAL DIGEST OF THE JOURNALS.
acid. On section, the tumour appeared of a yellowish-white, very elastic
fibrous structure. Numerous blood-vessels, of the thickness of crow-quills,
pervaded the tumour in such close ramification, that the cut surface, on being
examined with a lens of low power, appeared porous, not unlike the corpus
cavernosum. The entire fibrous parenchyma exhibited besides only the ele-
ments of areolar tissue in very various degrees of development, and numerous
cell-nuclei, which were not affected by acetic acid. - - -
January 27. The ligature was drawn tighter. The patient had had great
ease since the operation, and had slept well. A purgative of sulphate of
magnesia with oxymel was prescribed for some symptoms of angina.
January 28. Since the previous day, the patient had two slight attacks of
rigor, followed by sweating: pulse 100, small. The face was pale and anxious,
and the tongue coated with a yellowish fur. The patient complained of a
foul taste and smell, arising from the sloughing of the remaining portion of
the pedicle. This was withdrawn, with the ligature, by means of slightly
curved polypus forceps. He was given liquor chlori for drink. The febrile
symptoms disappeared in a few days, and the patient left the hospital, per-
fectly cured, on the 10th of February. Up to the winter of 1848, there had
been no return of the polypus, (Deutsche Klinik, 6th April, 1850.)
ANEURISM OF THE ANTERIOR PALATINE ARTERY.
Two cases of this unusual affection have been lately recorded : one in the
Lancet for July 6th, by DR. A. C. CASTLE, of New York; and the other in
the same Journal for 13th July, by DR. W. B. HERAPATH, of Bristol. Both
cases were at first mistaken for abscesses or tumours, and were only dis-
covered to be of an aneurismal nature by the gush of arterial blood, which
followed, in one case, the introduction of the lancet, and in the other, the
removal of the tumour by means of scissors.
In DR. CASTLE's case, the patient was a gentleman for whom a partial set
of artificial teeth had been made, to complete the superior maxillary row.
The swelling appeared on the palate, at the edge of the gold plate : and
gradually increased to the size of a large pea, not being pulsatory, and pre-
senting the character of a varicose tumour from impeded circulation. Dr.
Castle snipped off the sac with a pair of scissors, when a gush of blood fol-
lowed, which at once showed the tumour to have been an aneurismal sac.
Pressure failed to arrest the haemorrhage ; but, on reflecting that the anterior
palatine artery occasionally passes through a hole in the centre of the palatine
suture, instead of immediately behind the alveolar plate, Dr. Castle was
enabled, by plugging the foramen in the former situation, to effectually
arrest the haemorrhage. . . . - -
In DB. HERAPATH's case, there does not appear to have been an irregularity
in the course of the artery. The tumour, which was in the roof of the
mouth, was soft, puffy, red, hot, and apparently an abscess under the pala-
tine membrane. The first molar tooth, being loose and somewhat decayed,
was extracted, and the supposed abscess punctured. Wery little pus ap-
peared : and the principal effect of this operation seemed to be the pro-
duction of excessive haemorrhage from the alveolus, and not from the abscess.
In two or three days after, Dr. Herapath, being summoned to the patient,
who was suffering intense pain, plunged a lancet deeply into the tumour,
supposing it to be an abscess which had not fully formed. Arterial blood
immediately issued out per saltwm. The haemorrhage could be controlled
by pressure; and was effectually arrested by means of a large wine-cork cut
as an arch on the superior surface, shielded with lint, and fastened to a
narrow bandage, which was secured by being carried over the head. At the
time of making the report, ten months after the occurrence, all traces of the
aneurism had disappeared.

807
Miscer.Laneous INTELLIGENce.
MEDICAL REFORM. During the present session of Parliament, some mea-
sures have been passed of considerable local importance. The College of
Surgeons of Edinburgh have obtained an Act, by which Fellows on their
entrance are not obliged to subscribe to the Widows’ Fund; and by which,
also, the College is separated from the Trade Corporations. The Faculty of
Physicians and Surgeons of Glasgow have considerably strengthened their
position. The bill “for better regulating the privileges of the Faculty of
Physicians and Surgeons of Glasgow, and amending their Charter of Incor-
poration,” has received the Royal assent, and is now the law of the land. The
ancient charter of the Faculty, granted by King James VI, in 1599, has
been again ratified, and the licensing powers of that body have not only been
fully recognized, but the status and privileges of its licentiates better defined.
They are in future to be precisely the same as those enjoyed by the licentiates
of any other College in Scotland which is now, or may hereafter, be entitled
to grant diplomas in surgery. The right of practice within the three coun-
ties, which formed the ancient bounds of the Faculty, is granted to all
practitioners legally licensed. The MEMBERs are now to be designated
FELLows of the Faculty of Physicians and Surgeons of Glasgow. As it is
no longer to be compulsory to subscribe to the Widows’ Fund, and as the
standing of the Faculty has by this new Act been greatly exalted, it is thought
that most of the physicians and surgeons of Glasgow and the neighbourhood
will soon be enrolled among its Fellows.
The Society of Apothecaries have recently taken the profession somewhat
by surprise, by their liberal proposals. We quote the following from an
official letter addressed by Mr. J. B. Eyles, Master of the Society, to the
Home Secretary, the Right Hon. Sir George Grey.
“The Act (of 1815) requires that the members of the Court of Examiners
should be elected from members of the Society of not less than ten years’ stand-
ing. The Society propose, that in future all licentiates of the Society of ten
years’ standing (whether members of the Society or not) shall be eligible for
seats, in the Court of Examiners, and that not less than one half of the
members of the Court shall be licentiates who are not members of the Society.
“The Society propose that power should be given to the Court of Exami-
ners, to divide the examination for their certificate into one or more examina-
tions at proper intervals, with a view to relieve the student from the incon-
venience of being subjected to an examination in all the branches of study
on which he has been engaged, on one and the same occasion.”
“At present, the fee paid for a certificate of qualification for practice in
London is ten guineas, and for practice in the country six guineas. The
Society propose that the fee should be equalized for the whole kingdom.
“The Court of Examiners are at present required to hold their meetings
at Apothecaries' Hall. The Society suggest that this restriction should be
removed, and that the Court should be authorized to sit in any building
which may be provided for them, not being beyond a limited distance from
the General Post Office.
“No person is admissible for examination, under the present Act, who has
not served an apprenticeship of five years to an apothecary. The Society
propose that the service of an apprenticeship shall be no longer compulsory
on the student.
“The Society propose that there should be a registration of all persons
admitted to practise as apothecaries, after examination by the Court of Ex-
3.III IIlêſs. - -




808 MISCELLANEOUS INTELLIGENCE.
“That all persons holding a degree in medicine, granted by any British
university, and all members of Scotch or Irish colleges which are authorized
by law to grant a license or certificate of qualification to practise in medicine
after examination, such license or certificate conferring the right to practise
medicine in those countries, should be admitted to registration without fur-
ther examination, on payment of a small registration fee. -
“That all surgeons and assistant-surgeons in the army, navy, and East
India Company's service, should be admitted to registration after not less
than five years’ actual service. -
“The Court of Assistants of the Society of Apothecaries, in whom the con-
trol of the Society is vested, is a self-elected body. The Society would not
be indisposed to adopt any change in the mode of election of that body which
might, upon due consideration, be thought advisable, but the subject has
been found one of considerable difficulty. An election by the members of
the Society at large appears fraught with numerous objections, and the crea-
tion of a limited class, for the purposes of the franchise, has been found, in
practice, to be productive of great dissatisfaction. The Society, in truth,
are not prepared, at the present. moment, to suggest any specific change in
the mode of election of their governing body; but they would be willing to
give the most favourable consideration to any alteration, in this respect,
which you might recommend for adoption.”
The LoNDON Journal of MEDICINE has, we rejoice to learn, already done
good service in the cause of real Medical Reform ; and has impressed some
of those in high places, with the duty and necessity of improving the social
and scientific status of general practitioners. The articles which appeared
in our May, June, and July numbers, have been very largely circulated.

SELF-SUPPORTING DISPENSARIES. In our next, we may have some inform-
ation to communicate on this subject. This evening, at 8 P.M. (29th July),
a public meeting is to be held, at the Hanover square Rooms, of a society
formed by Mr. T. D. Hawker, of 33, Edward-street, Portman-square, with
the object of promoting the establishment of Self-Supporting Dispensaries
throughout the United Kingdom and Ireland. The Earl Spencer, who has
given £50 to the Society, is announced, in the circulars, as the President, and
the Lord Portman as the Vice-President. The chair is to be taken by Mr. Benj.
B. Cabbell, M.P. ; and from the advertisements we likewise learn, that Mr. H.
L. Smith, of Southam, the philanthropic Founder of Self-supporting Dispen-
saries, is also to be present. Self-supporting Dispensaries, if honestly and
judiciously promoted, may be productive of immense benefit; but they are,
from their very nature, particularly liable to abuses: and therefore it is evi-
dently the first duty of a society formed for their general establishment, to
give some distinct guarantee that it is not, in any case, to plant its insti-
tutions in opposition to the wishes or pecuniary interests of the majority
of the medical practitioners of a neighbourhood. And it ought also to be
distinctly understood, that all legally qualified practitioners should, after a
certain period of residence in any neighbourhood, say two years, be
allowed, ipso facto, to connect themselves with these dispensaries. Without
the careful supervision of an influential central society, with good and strin-
gent ethical rules, there would be great risk of pecuniary injury being done
to general practitioners labouring among the humbler classes of society,
who, with this new opposition, added to that of the druggist, might in some
districts be at once ruined. In our anxiety to benefit one class, let us not
bring misery upon another. Confiding in the sound judgment of Mr. Smith,
we sincerely trust that his truly noble views may be realized. Everything,
however, must depend upon the wisdom of the measures adopted by the
Society.
THE EPIDEMIOLOGICAL SoCIETY is now formed, with Dr. Babington as its
President. We wish it every possible success.
TO CORRESPONDENTS. * 809
A PP or N T M. ENTs. - .
ARNOTT, Jas.M., Esq., elected President of the Royal College of Surgeons of England.
Coulson, W., Esq., elected one of the Consulting Surgeons to the German Hospital.
DAVEY, J. D., M.D., appointed one of the Resident Physicians to the New Asylum
at Colney Hatch. - - º
ERICHSEN, John, Esq., appointed Professor of Surgery in University College, and
Surgeon to the Hospital, in room of J. M. ARNOTT, Esq., resigned. . . .
HANCOCK, Henry, Esq., Surgeon to the Charing-Cross Hospital, elected Surgeon
to the Royal Westminster Ophthalmic Hospital. - - .
HAWKINS, Caesar, Esq., elected one of the Vice-Presidents of the Royal College of
Surgeons of England. - -
HITCHMAN, J., M.D., elected Superintendent-Physician to the Derby County Asylum.
KIERNAN, Francis, Esq., elected a Member of the Council of the Royal College of
Surgeons of England. -
LAWRIE, James Adair, M.D., presented by the Queen to the Chair of Surgery in
the University of Glasgow, vacant by the death of Dr. BURNs.
MACDONALD, Wm., M.D., F.R.S.E., presented by the Marquis of Ailsa to the Chair
of Natural History (formerly Civil History) in the University of St. Andrews,
vacant by the death of the Rev. Dr. FERRIE.
MACKMURDO, G. W., Esq., elected a Member of the Council of the Royal College of
Surgeons of England.
NICHOLS, W. P., Esq., elected Surgeon to the Norwich Hospital, in room of the
late J. G. CROSSE, M.D.
PILOHER, G., Esq., elected a Member of the Council of the Royal College of Sur-
geons of England. *-*.
SouTH, J. F., Esq., elected one of the Vice-Presidents of the Royal College of Sur-
geons of England.
ob ITU ARY. -
BROMET, Dr., late Surgeon of H.M. 1st Regt. of Life Guards, at Bologna, on 7th July.
CASTILLO, Dr., Chief Physician to H.M. the Queen of Spain, at Madrid, June 30th. .
CARRINGTON, Benjamin, M.D., Resident Medical Officer to the Holloway and North
Islington Dispensary, at Holloway, on 28th June.
GREENWOOD, Jonathan, Esq., Surgeon, at Kirkdale, Liverpool, on 11th July.
MAXTON, James, M.D., of Kincardine, at Crieff, N.B., on 21st July.
PHILLIPSON, F. B., Esq., Assistant-Surgeon to the Forces, at Accra, Western Coast
of Africa, aged 31, on 12th April. }
Powell, D., M.D., at New York, aged 27, on 17th June.
SHELTON, John, Esq., at Wraysbury, near Staines, aged 39, on 28th June.
STANDART, H. C., Esq., of Taunton, at Teignmouth, aged 68, on 15th June.
VINCENT, S. B., Esq., Surgeon, at Rickinghall, aged 58, lately.
WILKS, Thomas P., Esq., at Charing, Kent, aged 79, on 4th July.
WYATT, Peter, Esq., of Islington, at Exeter, aged 62, on 1st July.

- TO CO R. R. E S P O N ID E IN. T. S.
CLASSIFIED CATALOGUE. Our thanks are due to many Correspondents for com-
munications with reference to this elaborate work. It is necessary to remind our
readers, that the Classified Catalogue of this volume occupies a much larger amount
of space than will ever be required for subsequent Catalogues, in consequence of
the present embracing eighteen in place of six months.
BIBLIOGRAPHICAL RECORD. The following and other works will be reviewed in
the September number –REICHENBACH on Animal Magnetism : THOMSON (A. T.)
on Skin Diseases, and TILT on the Ovaries. It is our wish to notice books sent for
review as early as possible ; but the original articles sometimes occupy more space
than was calculated on ; and thus, our plans are temporarily deranged.
ORIGINAL COMMUNICATIONS. The following will appear in early numbers of the
LONDON Journal, OF MEDICINE.
1. CoRMACK, JoHN ROSE, M.D., F.R.S.E. On the Entrance of Air into the
Uterine Weins, as a Cause of Danger and Death after Parturition.
. GARROD, ALFRED BARING, M.D. Pathology, Diagnosis, and Treatment of Gout.
. HANCOCK, HENRY, Esq. On the Perineal Operation for Stricture of the Urethra.
. KNOx, ALEXANDER, M.D. Examination of the Present State of our Knowledge
regarding Vaccination and Re-vaccination.
. PEACOCK, THOMAS BEVILL, M.D. On Empyema.
:
810 - To eCORRESPONDENTS.
6. QUAIN, RICHARD, M.D. Description of the Stethometer, a New Instrument
for Measuring the Chest. [Illustrations on Wood.]
7. SEATON, EDWARD CATOR, M.D. Case of Softening of the Cervical Portion of
the Spinal Cord: with Remarks. -
8. SEMPLE, ROBERT HUNTER, M.D. Softening of the Brain and Spinal Cord.
9. SIBSON, FRANCIS, M.D., F.R.S. On Pericarditis. [Illustrations on Wood.]
10. WILDE, W. R., ESQ. On Congenital Cataract, and other Congenital Diseases
and Malformations of the Eye. [Illustrations on Wood.]
11. WILLIAMS, C. J. B., M.D., F.R.S. On the Physical Examination of the Abdomen,
*...* THE LONDON MEDICAL GAZETTE forcibly calls attention to an extraordinary
practice which now prevails, of gentlemen allowing their names to be advertised as
patrons of rival weekly Journals / Though we occupy an intermediate position
between the weekly and quarterly Journals, and are therefore quite honestly and
sincerely supported by their friends, we can fully sympathize with our contemporary;
for what would the profession think, if two rival London Monthly Journals were to
be .. by the same parties?
contemporary, the Medical Gazette (28th June), makes the following com-
mentary upon Mr. Churchill's circular, announcing that the Medical Times “has
assumed a truthful tone” and “scientific position.”—“We have been rather taken
by surprise, in finding that the names of many of our old and valued correspondents
have recently been displayed in the columns of a contemporary, as gentlemen who
intend to give to that Journal their literary support. We have made inquiry of
several who have been thus advertised, and have ascertained, that while the NAMES
of the writers thus appear in the pages of our contemporary, their lectures and
papers will be sent as heretofore to the LONDON MEDICAL GAZETTE | If the profes-
sion are satisfied with this mode of dispensing literary patronage, we have nothing
to say to it. It is to be regretted, however, that professional men should allow
their names to be advertised as “eminent supporters” of a journal, to which they
do not intend to contribute at all, or to send perhaps one paper in a volume, just
to carry out the appearance of support. It has a bad effect with the profession;
for unless such expectations be realised, it gives the character of puffing even to
boné fide announcements.”
LoNDON SURGEONS CALUMNIATED. Several correspondents call our attention to
Mr. Syme’s attacks on the integrity of London Surgeons. With regard to the im-
putations of Mr. Syme, we hope to see them withdrawn. It cannot be the wish of
the Edinburgh University Professors and others who, along with Mr. Syme, are
Conductors of the Edinburgh Monthly Journal, to allow the following unparallelled
passage to remain on record, as an expression of the sentiments of all or any of
their number. “I knew that in that city” (London) “there were some shoulders well
jitted to wear the tattered mantle of Sir Everard” (Home), “ and I was not so san-
guine as to look for any speedy improvement in the practice of men, whose sole object
is to squeeze money out of their patients.” We will venture to say, that a charge
more odious and more unfounded never before emanated from the medical press.
It occurs as part of Mr. Syme's editorial commentary upon old “Letters on the use
of Caustic for the Treatment of Strictures of the Urethra,” which are published in
the July number of our northern cotemporary. Wrath and personal crimination
may mingle in the present discussion on the treatment of stricture; but the contro-
versialists, who use such weapons, shall find no place for their opinions in our pages,
- B O O K S REC, E IV E D. -
ANDERSON on Eccentric Nervous Affections. London: 1850. BIRKETT on Dis-
eases of the Breast, London: 1850. Dougi,As (A. H.), on Diseases of the Heart,
Edinburgh: 1850. GRAY on Development of Retina, etc. From Philosophical
Transactions. London: 1850. HARVEY on Enlarged Tonsils. London: 1850.
HASSING de Colicá Scortorum. Copenhagen: 1848. Hogg on the Management of
Infancy. London: 1850. HookER's Physician and Patient. Edited by Dr. BENT.
LEY. London: 1850. HoDLAND's (G. C.) Cases of Cure of Consumption and
Indigestion. London: 1850. Jon Es (H. Bence) Animal Chemistry. London: 1850.
RADCLIFFE (C.B.) on the Unity of Nature, London: 1850. THOMSON (Anthony
T., the late) on Diseases of the Skin ; edited by Dr. PARKES. 8vo, London: 1850.
TUNSTALL on the Bath Waters. London: 1850. TURNBULL (James) on Consump-
tion. London: 1850. WALLACE (William C.) on the Adjustment of the Eye to
Distances. New York: 1850. WHITTLE on Cholera. London; 1850.
LONDON
JOURNAL OF MEDICINE,
A MONTHLY
3Reſort of the ſºletical Sºttenſtg.
SEPTEMBER 1850.-No. XXI.
o RI G IN A I, Co M M UNICATION s.
CLINICAL ILLUSTRATIONS OF DISEASES OF THE
NERVOUS SYSTEM.
By ROBERT HUNTER SEMPLE, M.D.
NO. II. SOFTENING OF THE NERVOUS CENTRES.
In a former communication,' I offered some general observations upon
the subject of the Diseases of the Brain and Spinal Cord, and I illus-
trated my remarks with the detail of some cases, taken promiscuously
from my notes, to shew the great difficulties which attend our investi-
gations in this part of pathology. In the present paper, I intend to
illustrate the subject of Softening of the Nervous Centres; and Iregret
to observe, that the obscurity which hangs over the affections of the
cerebro-spinal axis generally, is more particularly noticeable in that
peculiar form of disease, which the following cases and observations are
intended to bring into view.
CASE I. SoFTENING OF THE BRAIN–CEREBRAL CONGESTION.—APO-
PLECTIG CELL. M. T., a tat. 54, formerly a shoe-maker, of dissolute
habits, but of rather cultivated mind, was seized on the 2nd of July,
1845, while an inmate of the Islington Workhouse, with a paralytic
attack. For this complaint he was bled to 3xxx, and took purgative
medicines; and by these, and other usual means, he partially recovered,
but his intellect became almost obliterated, he passed his urine uncon-
sciously, and became in consequence so offensive, that he was placed
in a ward by himself. He remained bed-ridden from the above date
until the morning of May 23, 1846, when he was again seized with an
attack resembling apoplexy; the pulse was 180, full and strong, and
he had stertorous breathing. There was paralysis of the left side. He
was bled to 3xvj; and, during the bleeding, the stertorous breathing
ceased, and did not subsequently return. At noon on the same day, he
was still insensible; his pupils were fixed in a state between contraction
* LoNDoN Journal, of MEDICINE, May 1850, p. 448.
WOL. II. 54
812 SOFTENING OF THE NERVOUS CENTRES.
and dilatation; pulse 160, rather feeble ; bowels confined; urine passed
involuntarily. To take Saline purgatives.
May 24. Bowels still confined ; tongue not examined, as he was un-
able to protrude it. To have two drops of croton oil immediately.
He died on the 25th of May.
PoST-MORTEM ExAMINATION FORTY-Two HOURS AFTER DEATH. The
body was covered with a rather thick layer of adipose tissue, and a con-
siderable quantity of fat was found in most of the parts where it usually
occurs. The skin was discoloured at the inferior part of the back, and
a large bed-sore existed in that situation. The penis and scrotum ex-
hibited an appearance of incipient gangrene.
Head. There was very little congestion about the scalp. The
vessels of the dura mater were turgid with blood. The arachnoid
membrane was slightly thickened and opaque; a large quantity of serous
fluid, tinged with blood, was found beneath it, and flowed copiously
both from beneath the membranes of the brain, and from the theca
vertebralis. A large quantity of fluid was also found in the lateral
ventricles, and in the third ventricle. The vessels of the brain itself
were not congested ; and the brain presented a tolerably healthy appear-
ance, except in the parts about to be described. At the posterior part
of the corpus callosum, immediately above the tubercula quadrigemina,
there was a considerable amount of softening, the cerebral substance in
that situation being of the consistence of thick cream, but of a white
colour. In the anterior part of the right corpus striatum, there was a
cavity of about the size of a hazel-nut, lined with a smooth membrane.
On the left corpus striatum, there was a large, but not deep, excavation,
of about the size of a half-crown, presenting a ragged appearance, and
of a dark brown colour. The texture of this ulcerated portion was
much softer than that of the surrounding tissue, from which it was not
separated by any distinct line of demarcation.
Thoraa, and Abdomen. The viscera of these cavities were most
carefully examined, but they exhibited no marks of disease; the kidneys
especially were remarkably healthy.
REMARKs. This was a case of chronic disease in a middle-aged person,
confined altogether to the brain, and producing palsy, mental imbeci-
lity, involuntary discharge of urine, apoplectic seizures, and eventually
death. The primary disease was probably a hyperamic condition of the
vessels of the brain; and that there had been a distinct effusion of blood
at one time, was proved by the existence, in the right corpus striatum,
of a true apoplectic cell. The palsy, it will be seen, was in the left
side. After this first attack, it would appear that, while the hyperaemic
condition of the cerebral vessels remained, the structure of the organ
itself broke down, and its functions became gradually extinguished, and
that life was destroyed by an attack of congestion of the membranes.
This is a peculiarly fatal form of disease, when the congested state of the
vessels of the brain is associated with a softening of its structure, and
no treatment is likely to be of much avail; yet I cannot but maintain,
that as the pulse was full and strong, and the breathing stertorous, the
abstraction of blood was perfectly justifiable, as the symptoms positively
indicated cerebral congestion, while the softening could be, during life,
only a matter of conjecture. .
BY ROBERT HUNTER SEMPLE, M.D. 813
CASE II. SoFTENING OF THE BRAIN–PNEUMONIA—DISEASE of THE
MITRAL VALVE. On the evening of November 16, 1841, I was sent
for to attend Sarah T., a tat. 52, a tall, pale, Sallow-looking woman, in
the Islington Infirmary. When I arrived, I was informed that she had
had a fit, and had been insensible about a quarter of an hour. When
I saw her, however, she was in full possession of her mental faculties;
but she spoke very indistinctly, in consequence of an accident she had
met with several years before, and by which she lost, by exfoliation,
large portions of the left upper jaw-bone and of the nasal bones. Her
mouth, in consequence of the same accident, was habitually distorted.
She had not been inclined to sleep previously to the attack, but, on the
contrary, had suffered from the want of sleep. She complained of total
inability to move the left arm; and when it was lifted by another person,
as soon as the hold was relaxed, it fell down like an inanimate mass;
but when the skin of the hand or arm of this side was pinched, she
immediately complained of the pain. She was able to move the left leg
as well as the right, and both legs seemed endowed with the usual
amount of motory and sensitive power. The pupils presented no unna-
tural appearance, but were of the usual size and shape; she complained
of great pain in the abdomen, with flatus and a disagreeable taste in
the mouth ; tongue moist; not much thirst ; pulse rapid and irregular;
bowels rather confined. The action of the heart was very irregular; a
loud blowing murmur, heard chiefly at the apex, accompanied the first
sound; there was no murmur in the neck. B. Magnesiae carbonatis
gr. v ; essentia menthae piperitae m. w; magnesiae sulphatis 3ss; in-
fusi Sennae 3.j, Fiat haustus quartà quáque horá Sumendus.
Nov. 17. I examined her again very carefully this morning, in order
to form, if possible, a correct diagnosis; but although the paralysis of
the left arm gave me reason to suppose that some disease of the brain
existed, the other symptoms were too vague and unsatisfactory to point
out the precise nature of the cerebral lesion. The pupils were of their
natural appearance; she had passed a sleepless night; she was in full
possession of her mental powers. The left arm was still perfectly sen-
sible, though it had entirely lost the power of motion; no paralysis
existed in any other part. The patient complained of great pain in the
abdomen and back, which she said was increased on pressure; but as
this external sensibility was general over the whole body, it was con-
sidered to be neuralgic. She was directed to take, every four hours, a
draught consisting of ten minims of tincture of opium, and one ounce of
peppermint water. -
Nov. 19. The symptoms are much the same, but she seems to be
sinking; pulse very feeble, but the action of the heart remains strong,
the murmur loud, and its movements irregular; tongue dry and furred;
great thirst ; head-ache, and occasional nocturnal delirium. She was
ordered a glass of port wine daily, and the following draught to be
taken every four hours: B. Spiritās ammoniae aromatici m.xx; spiritús
lavandulae compositi m.x; aquae menthae piperitae 3.j. M.
Nov. 20. On a physical examination of the chest, which I cursorily
made, I detected a crepitant rhonchus at the lower and posterior part
of the right lung. There was no cough, dyspnoea, or expectoration ;
but the presence of pneumonia was clearly indicated by º, physical
54
814 SOFTENING OF THE NERVOIJS CENTRES.
signs, and by them alone. The state of the pulse precluded the possi-
bility of abstracting blood; and in consequence of the general depres-
sion of the vital powers, I considered it inexpediént to discontinue the
administration of the wine and the stimulant mixture. But I ordered
her to take immediately three grains of calomel, and half a grain of
opium.
On the two following days, the symptoms remained essentially the
same ; the crepitant rhonchus continued, but, as at first, without any
cough, expectoration, pain, or any other rational symptom of pneumonia,
adding another instance to many observed and recorded, in which the
only evidence of this formidable disease is to be derived from the phy.
sical signs, and proving the necessity, in all cases, of examining the
condition of the lungs and heart, whether those organs appear to be
affected or not. The calomel and opium were repeated, together with
the other treatment above-mentioned, but without any amelioration of
the symptoms. She gradually sank until November 23, when she ex-
pired, having been in the full possession of her mental faculties for many
hours before her death, complaining of excessive tenderness of the abdo-
men and back, but never referring her complaint either to the head or
the chest, which were the real seats of disease, and which were so con-
sidered by me during life, although the violent pain complained of in
other parts was calculated to mislead.
Post-MoRTEM EXAMINATION. Head. The skull-cap, skull, and dura
mater presented no remarkable appearance. The vessels of the arach-
noid membrane were very minutely injected; the membrane itself pre-
sented an opalescent appearance, owing to a quantity of thin, transparent
serous fluid effused beneath it, which escaped in great abundance from
the surface of the brain and spinal cord during the dissection. The
substance of the left hemisphere was healthy, and of its natural con-
sistence; the ventricle on the same side contained an unusual quantity
of thin serous fluid. On examining the right hemisphere, a patch of
softening was discovered in the anterior lobe, above the roof of the ven-
tricle, and not extending to the surface of the brain; the softened part
was two inches in length and one in breadth, and of a curved form; it
had a dirty brown colour, and a ragged, ulcerated appearance. On
inspecting the right ventricle, it was found that the corpus striatum of
this side was softened, its surface presenting a ragged appearance, and
being uncovered by the layer of membrane which lined the rest of the
cavity. On tracing the diseased mass, it was found that the softening
involved the whole of the right corpus striatum, and extended as far as
the inferior surface of the brain. The whole of the softened part was
of a pulpy consistence, and of a dirty ash-grey colour, the grey and
white substances being apparently mixed up together in a confused
IYläSS.
Chest. The right lung was adherent to the parietes of the chest by
strong bands: the left lung was not adherent. The heart, on a Super-
ficial view, appeared larger than usual. The right auricle and ventricle,
the pulmonary artery, and the venae cavae, contained a large quantity of
half-coagulated blood, together with large coagula of fibrine of a straw
colour. The parietes of both ventricles were rather thick, and the
columnae carmeae, were increased in size. The tricuspid valve and the
BY ROBERT IIUNTER SEMPLE, M D. 8] 5
semilunar valves of the aorta and pulmonary artery were healthy, but
the mitral valve was diseased. The left auriculo-ventricular opening
was very much contracted, so as scarcely to admit one finger, and the
mitral valve was thickened and indurated so as to form a strong,
narrow tube. The right lung was generally congested ; and the pos-
terior part of the inferior lobe was highly inflamed. The cut surface
presented a dark red colour, and a large quantity of frothy fluid flowed
from the incision. The substance, however, was not hepatized, but
crepitated as usual, showing that pneumonia had not proceeded beyond
the first stage.
Abdomen. The liver was congested; the kidneys somewhat enlarged;
the intestines perfectly healthy.
REMARKs. In this curious case, there was extensive softening of the
brain, without any remarkable symptoms during life. It will be ob-
served that the disease occupied the right hemisphere ; while, during
life, the left arm was powerless. Before my first visit to her, she had
had a fit, but I had no means of knowing the exact nature of the attack.
The mental faculties were unimpaired almost throughout ; there were
no convulsions; no rigidity; no pain in the head; no vomiting; and the
only symptoms which were caused by the cerebral lesion, appear to
have been immobility of the left arm, and pain in the abdomen and back.
Of the treatment, of course, little can be said; for with such a compli-
cation of diseases, softening of the brain, disease of the mitral valve,
and inflammation of the lung,-no plan could have been attended with
the slightest success.
CASE III. SOFTENING OF THE BRAIN–MEDULLARY SARCOMA IN THE
BRAIN–PHTHISIs—GRANULAR DISEASE of KIDNEY. Harriet D., ast. 48,
married, an inmate of the Islington Workhouse, first came under treat-
ment in April 1848. She stated that her husband struck her a very
violent blow on the head about two years ago: this blow, according to
her statement, was near the vertex; it stunned her, and the wound
bled profusely. She had had several children, and had suffered for
the last eight years with prolapsus of the uterus. She had lately fallen
away much, and had several times spit up blood in large quantities.
The appearance of this woman's face was very peculiar, owing to the
great prominence of the eyes, which were large and globular, and
appeared to be starting out of their sockets; the pupils were dilated,
and the eyes altogether had a dull appearance as in amaurosis; the
sight was impaired, but not lost. She stated herself that this affection
of the eyes came on soon after the blow just mentioned. She suffered
from excruciating pain in the head, so that she was compelled to Scream
out ; and her cries were so loud as to disturb the other patients. She
had also great pain in the chest, and superficial tenderness beneath
the clavicles: she suffered from continual cough, and expectorated
thick, hard sputa, which were sometimes stringy, gluey, and frothy,
and occasionally streaked with blood. Appetite very bad, and con-
stant retching after every attempt to take food. Bowels irregular,
sometimes very much open, at other times confined. Urine rather
scanty, fetid, albuminous. Cavernous respiration beneath each cla-
vicle: Sonorous, sibilant, and mucous rhonchi in all parts of the lungs.
Action of the heart normal, and without morbid sound. The hair was
816 SOFTENING OF THE NERVOUS CENTRES.
ordered to be cut close, and rags dipped in vinegar to be applied to the
head. A blister was ordered for the chest, and the following medicine
was ordered : B. Antimonii potassio-tartratis gr. ii.; tincturae hyos-
cyami 3ij. ; liquoris ammoniae acetatis, et misturae camphorae, àääij.
M. Sumat cochlearia ii. magna quartis horis. B. Calomelanos, et pul-
veris ipecacuanhae, aā gr. iij. Fiat pulvis ter in die Sumendus.
Under this treatment, the symptoms were a little relieved; the pains
in the head became less constant; the sickness and retching were at
first increased, but afterwards gradually subsided; she began to sleep
better, and the bowels became more regular. The appetite also im-
proved, and the chest symptoms were relieved.
May 20. The calomel was now discontinued, and the blue pill was
ordered to be taken twice a day, in doses of five grains.
May 22. An eruption of purpura broke out over the body. To dis-
continue the other medicines, and to take the following draught every
four hours: B. Liquoris potassae, et vini colchici, aſſi m. xx; aquae
menthae piperita 3.j. M. She continued this mixture for several days,
and appeared to be improving.
May 29. She was seen at ten o'clock in the morning of this day, when
she did not seem so well. The nurse went to bring her some medicine
which was ordered; but before she obtained it, the patient suddenly
turned black in the face, and died.
PoST-MORTEM ExAMINATION FORTY-EIGHT HOURS AFTER DEATH. Head.
Scalp and skull of the usual appearance. When the calvarium was
removed, the vessels of the dura mater appeared congested, and the
veins of the brain, seen through the membranes, were turgid with blood.
The arachnoid membrane was not thickened. On proceeding to remove
the brain in the usual manner, by dividing the nerves and vessels from
before backwards, I found that the optic nerves were small and atro-
phied, but not softened, at the line of my incision, which was between
the commissure and the optic foramina. After dividing the tentorium,
and cutting through the medulla oblongata, and then drawing out the
cerebral mass, I found that I had left in the middle fossa of the skull,
on the right side, a large portion of cerebriform substance, which I
feared at first was a portion of brain accidentally detached, although
I felt sure that I had been very careful in removing it entire. I soon
discovered, however, that it was a large soft tumour, distinctly present-
ing the characters of medullary sarcoma. This diseased mass was of
about the size of a small orange, and it weighed two ounces and a half;
it was adherent to the falx cerebri and tentorium ; its external portion
rested upon the temporal bone : and superiorly it was covered in by the
middle and posterior lobes of the brain. The cerebral substance around
this morbid growth was softened, and it was excavated so as to allow
the growth of the tumour; so that, on looking at the inferior surface
of the hemisphere (the brain being placed on a dish, with its base
upwards), it was seen to be excavated into a cup-shaped depression,
and, at the bottom of this depression, there was a communication into
the lateral ventricle; the floor of which was therefore partly formed by
the adventitious substance, which had taken the place of the proper
cerebral structure. The right lobe of the cerebellum was smaller than
the left, owing to the presence of the tumour; and, from the same
By ROBERT HUNTER SEMPLE, M.D. 817
cause, the right thalamus opticus and the right corpus striatum were
very much diminished in size: . On examining the base of the brain
anteriorly, it was found that the olfactory nerves were softened; the
commissure of the optic nerves themselves was so soft, that they could
not be traced round the crura cerebri. The portion of the brain above
the optic commissure was also softened. The other portions of the
organ were apparently healthy. The tumour was subsequently more
particularly examined. It had a soft doughy fluctuating feel; and,
upon microscopical investigation, it presented the usual nucleated and
caudate cells peculiar to this form of carcinoma.
Chest. On both sides, there were recent adhesions, and about half a
pint of fluid was contained in each pleura. The right lung was volu-
minous, dark-coloured, crepitating in Some parts, emphysematous on
the anterior edge. The upper portion was solidified by tuberculous
deposition : one cavity as large as a walnut, and several smaller ones,
were found near the apex. The left lung was rather small, with a
cavity at the apex as large as an egg The bronchial tubes of both
lungs were intensely reddened, and filled with muco-purulent fluid.
The heart was small and flabby; all the valves healthy.
Abdomen. The viscera of the abdomen were generally healthy. The
left kidney was small and flabby. The proper coat peeled off easily,
showing a dark, mottled, granular structure, the internal portion of the
kidney exhibited abundant granular deposition. The right kidney was
healthy. * -
REMARKs. In this case, it was evident, during life, that there was
serious organic disease of the brain, from the peculiar appearance of
the eyes, the impaired condition of vision, and the long-continued and
violent pain in the head. I was prepared to find some lesion of the
cerebral structure about the origin of the optic nerves; but there was
nothing whatever which could lead me to suppose, that there was so
large a tumour of medullary sarcoma; and I think the case curious and
interesting, and one of no common occurrence. The treatment, of
course, could be only palliative, but it seemed to be attended with a
certain amount of relief to the more urgent symptoms.
CASE IV. SoFTENING OF THE BRAIN–HYPERTROPHY of THE EIEART-
GRANULAR DISEASE of THE KIDNEYS. J. R., at. 62, an inmate of the
Islington Workhouse, a married man, of middle size, but stout and
with short neck; rather pale, but not presenting any oedematous ap-
pearance, said to have been of intemperate habits, was seen by me,
April 22, 1850. His wife informed me that he had been out of
health for some time; that he had complained of giddiness at various
periods; she also said that he was unable or unwilling to speak; he was
also observed to have an unmeaning Smile upon his countenance. When
I saw this man on the above date, he was brought to me by his wife,
merely for the purpose of telling me that he and she were going out of
the Islington Workhouse, and asking me whether I thought it would
be safe for him to do so. He had a bewildered air, but was quite able
to answer questions, which were put to him ; but his appearance was
dull and heavy. The head was rather hot, and he complained of great
pain; the pupils were fixed between contraction and dilatation. Pulse
100, full and strong, tongue clean, bowels rather confined. There was
8 || 8 SOFTENING OF THE NERVOUS CENTHES.
no paralysis, convulsion, nor spasm of any part of the body, although I
made every inquiry of his wife concerning these points. My impression
was, that he was on the point of having an apoplectic attack; and I
therefore strongly urged his wife not to take him out of the workhouse,
but to place him in the infirmary; but, in giving this advice, I had no
means of knowing whether it would be followed. I recommended him
to be bled to 3xvj, which was done; and to take some saline purgative
medicine, to be kept quiet, and his head to be kept cool; diet to
be moderate. *
April 23. Felt much better; head free from pain. He left the
workhouse, against my advice, on the 29th of April. He was, however,
brought in again on the 8th of May, as he had not improved since he
Went Out.
May 9. He did not present any peculiar appearance, but his intellect
seemed rather dull; he however answered questions quite rationally.
He was not paralysed, and had no rigidity, nor convulsions in any part.
I was satisfied of this from my own observation ; and although I fre-
quently sought for and eaſpected some of these symptoms, mone made
their appearance. The head was quite cool and moist, tongue clean
and tremulous. Pulse 80, weak, and occasionally intermittent. Bowels
confined. Hair to be cut close, and a blister to be applied to the nape
of the neck; some saline purgative medicine to be given. The urine
was albuminous. -
May 10. He tore off the blister, but it had risen previously. Pulse
80, feeble, but not intermittent. Tongue, when protruded, tremulous;
bowels open. To have some saline medicine.
May 13. Had passed a restless night, frequently getting out of bed.
A blister to be applied to each temple. To have some Saline purgative
in camphor mixture.
May 14. Rather more quiet; the blisters had risen.
May 15. Much in the same state.
May 17. 8 A.M. Was attacked with violent epistaxis of the left nos-
tril, which was therefore plugged. He rapidly, and somewhat unex-
pectedly, sank, and died the next day, May 18.
PoST-MoRTEM ExAMINATION, SEVENTY-Two HOURS AFTER DEATH.
Body well formed, not emaciated; no Oedema in any part.
Head. No particular appearance about the scalp and skull. Dura
mater pale. The arachnoid membrane was generally pale; but there
was some vascularity on the left side of the vertex. The surface of the
brain was pale. The brain was removed entire ; a small quantity of
limpid fluid flowed from the theca vertebralis. The whole surface of
the brain was carefully examined, and it was found that its arteries
were generally diseased, their internal surface being lined with an
atheromatous deposit, and the vessels generally having a feeling of
hard, rigid tubes. The consistence of the surface of the brain was
almost universally healthy, but at the inferior part of the middle lobe
of the right hemisphere, there was a small opening which led into a
jagged cavity of a very irregular shape, from which a small quantity of
limpid fluid was poured out. This cavity, it may be mentioned, ap-
peared to communicate with the lateral ventricle of the right side.
The brain was now examined from above downwards, in order, if pos-
BY ROBERT HUNTER SEMPLE, M.D. 819
sible, to observe the exact relations of the cavity just described. The
upper portion of the brain was removed on a level with the corpus
callosum ; here the substance was of the usual consistence, but, on
examining the ventricles, it was found that the formix, the optic thalami,
the corpora striata, and the cerebral substance adjoining, were all in a
softened state, and of about the consistence of clotted cream ; but the
colour was not changed even in the immediate vicinity of the jagged
cavity. It was found impossible to trace the exact boundaries of the
cavity above described, owing to the very soft condition of all the parts
around it. A portion of the diseased cerebral mass was examined
microscopically by Dr. Jenner, who discovered a great number of fat
globules, and a diminished number of nerve-fibres. It should be
mentioned, that there was no smell whatever from the brain, nor was
there any disease of the bone in the vicinity of the softening. w
Chest. The lungs presented no remarkable appearance. The heart
appeared very large; and, upon examining the whole of its structure, it
was found that the left ventricle was hypertrophied to a very great
extent, the parietes being twice as thick as usual. The valves, how-
ever, were all healthy. The colour of the heart was quite natural, and
its consistence quite firm.
Abdomen. The organs in the abdomen presented no remarkable ap-
pearance, with the exception of the kidneys. The left kidney was
small, with a tuberculated appearance externally, owing to the presence
of a number of cysts, containing a thick, yellowish, transparent, sizy
matter. The investing membrane was removed readily, and the surface
below presented a mottled appearance. . The organ itself was very
small; the cut surface was of a very dark colour, and was congested;
and there seemed to be an atrophy of the cortical structure. The right
kidney was not so much diseased as the left, but agreed generally with
it in appearance.
REMARKS. In this very obscure case, there was softening of the
brain, hypertrophy of the heart, and granular degeneration of the kid-
meys. The softened state of the brain was probably due to the rigid
condition of the cerebral vessels, which prevented the organ from receiv-
ing a due supply of blood. The symptoms of softening of the brain
were not at all marked; and although there was extensive disease of
the kidneys, there were none of the ordinary symptoms indicating
granular disease during life. At first, I imagined that the symptoms
indicated a threatening attack of apoplexy ; and I treated the case
accordingly; but I subsequently entirely abandoned that idea, and I
attributed the malady to some organic disease of the brain. It is very
probable, that there existed during life a hyperaemic condition of the
brain, for the symptoms at first decidedly indicated such a state; and
the paleness of the brain after death is of course attributable to the
copious haemorrhage which took place on the day previous to his decease,
and which was probably an effort of nature to relieve the congested
Organ.
CASE v. SoFTENING of THE SPINAL CoRD. Mr. J. T., aet. 59, a
gentleman engaged in a considerable mercantile business, of strictly
moral character, and perfectly sober and temperate in his habits, became
820 SOFTENING OF THE NIERVOUS CENTRES. *
affected, about five years before my attendance upon him, with diminished
power of voluntary motion in his lower extremities. At first he ex-
perienced only a slight difficulty in walking, but gradually this inability
increased, and he was compelled to support himself upon a stick, and
to lean upon another person. His movements were very irregular,
owing to a want of control over the voluntary muscles; and at last he
was obliged to leave off walking, and to confine himself to carriage exer-
cise. He also suffered from occasional violent pains, shooting from his
back to his abdomen, and sometimes from his feet upwards. He had
consulted several medical men, among whom were some of the most
eminent members of the profession; but he had not received any per-
manent relief from their advice. He had also resorted to homoeopathy
with as little success; and, by the recommendation of some of his
medical attendants, he had repeatedly tried change of air, and had re-
sided for some months in Jersey, with slight benefit.
I was first called in to attend him on the 6th of January, 1847, when
I found his condition to be the following. He was sitting up, and, at
the time of my visit, was free from pain or uneasiness; he however told
me that he was unable to use his lower extremities, and could not walk
up or down stairs without assistance. Although, however, he was de-
prived of voluntary motion, his legs were frequently convulsed by invo-
luntary movements, over which he had no control whatever. He stated
that he suffered very violent pains of a most excruciating character,
coming on suddenly, and ceasing also suddenly. His digestive system
was occasionally deranged, and he was subject to violent attacks of
vomiting: but, in general, his appetite was very good, and he sat down
with his family every day to dinner, of which he partook heartily: he
also slept well, when free from the attacks of pain. His intellect was
quite unaffected, and he never suffered from headache: his bowels were
pretty regular: his urine was passed regularly, and was under the con-
trol of the will. He had the complete use of his upper extremities, and
could write and feed himself with perfect ease. On examining the sen-
sibility of the body, it was found that, below the last dorsal vertebra,
pinching could be borne without any manifestation of pain, or indeed of
sensation; but above that point, he was sensible of the impression.
His tongue was quite clean: pulse 80, and moderate. The heart and
lungs were examined by auscultation and percussion, but were found
quite healthy: the liver, also, was of its usual size, and not tender upon
pressure: all the other abdominal organs were quite Sound. Among
other remedial means which had been proposed, he had been recom-
mended to apply a blister along the spine ; but this had so aggravated
the pain, that he was compelled to heal it up.
Under these circumstances, I became convinced that he was labouring
under some organic disease of the spinal cord; and, as I believed it
impossible to cure the malady, I adopted only a palliative treatment. I
recommended him to ride out in an open carriage when the weather
would allow, to use friction along the spine, and to have nutritious food,
together with a moderate allowance of wine or weak brandy and water.
I also recommended him to take, every morning, a pill, composed of
two grains and a half of blue pill, and the same quantity of compound
rhubarb pill,
By RoberT HUNTER SEMPLE, M.D. 821
Jan. 10. I was sent for in the morning to see the patient, as he was
labouring under a paroxysm. I found him in bed crying aloud from
pain, with his legs tossed about involuntarily and spasmodically: the
pain in the abdomen was intense, but was relieved on pressure: he had
also incessant vomiting: his tongue was clean, his pulse 80, and mode-
rate. I ordered the following medicines: B. Acidi hydrocyanici
dilutim, w; aquae menthae piperita 3.j. Fiat haustus urgente vomitu su-
mendus. R. Liquoris opii sedativi m. xx; aquae menthae piperitae j.
Fiat haustus secundis wel tertiis horis Sumendus, donec dolores cessave-
rint. By the adoption of this treatment, the vomiting was allayed and
the pains were in some measure controlled; and, in about a week, the
system became tranquillized, although the spasmodic pains still recurred
at intervals.
When these paroxysmal symptoms had abated, I directed my atten-
tion to the general health, and recommended the sedative solution of
opium to be given when the pains returned, and also pills to be taken
at night, sometimes consisting of extract of hemlock, sometimes of ex-
tract of henbane. I also prescribed a pill to be taken an hour before
dinner every day, consisting of two grains of disulphate of quinine and
two of rhubarb ; and although his bowels had been habitually costive
for years, I yet found that by the use of this pill, which he continued
for several months, they were kept moderately open, and his appetite
was preserved, until within a few weeks of his decease. I would here
observe, that an habitual use of purgative medicines appears to me to be
the reverse of beneficial ; for their continued administration tends to
depress the system, thus weakening the peristaltic action of the intes-
times and continuing the morbid condition which they are given to
correct: whereas, on the other hand, tomics, judiciously employed, invi-
gorate the system, promote the processes of absorption, assimilation, and
defaecation, and thus render the use of purgatives unnecessary. Such
certainly was the case in the present instance; for this gentleman in-
formed me that he was previously in the habit of taking strong purgative
medicines every day for years; and although he frequently asked me to
prescribe purgatives, I uniformly refused to do so, and the opposite plan,
which I adopted, was attended with alleviation. -
In about six weeks from this period, the patient, finding that the
spinal symptoms were not removed, was induced to call in consultation
with me, a gentleman who had devoted much of his time to the special
study of spinal complaints, and who recommended the use of the prone
couch, the occasional administration of croton oil, and the attention to
the general health by the means already adopted. This plan was there-
fore followed for some months, with the exception of the use of the
croton oil, the first doses of which caused such excessive disturbance of
the system, that it was necessarily discontinued. In addition to this
treatment, two issues were made with potassa fusa, one on each side of
the lumbar vertebrae, which issues were kept open for upwards of two
months, but without any benefit; indeed the patient sometimes imagined
that they increased, or even originated, the violent spasmodic pains of
which he still complained, and which shot from the back to the abdomen,
and also proceeded from the lower extremities towards the trunk. I
therefore allowed the issues to heal.
822 DR. SEMPLE ON SOFTENING OF THE NERVOUs CENTREs.
On the 11th of July, he was seized with erysipelas of the head and
face, from which he recovered by the adoption of the usual remedies.
After this attack, however, he became decidedly weaker; he was unable
to leave his bed, although he still retained the use of his upper extre-
mities, and the full possession of his intellectual faculties; his appetite
also improved, but the spasmodic pains again become most violent and
agonizing. Various narcotics were employed to allay these sufferings,
but with only partial success. Battley's solution of opium, pills con-
taining one grain of opium, and pills containing one-third of a grain of
hydrochlorate of morphia were repeatedly given, and without producing
either head-ache or costiveness, although he took sometimes as much as
four grains of opium in one night. Large bed-sores now appeared on
the lumbar region and on both his hips, and he gradually sank from
exhaustion, and died without pain on the 6th of October, 1847.
Post-MoRTEM ExAMINATION of THE SPINAL CORD, THIRTY-THREE HOURs
AFTER DEATH ; weATHER cold. The spinal canal was laid bare from the
first cervical to about the third lumbar vertebra. The spinal cord, invested
by its membranes, presented no unusual appearance, and was removed
for farther examination. On opening the dura mater, and afterwards
laying open the arachnoid coat and pia mater, a large part of the cord
was found in a state of complete softening, the ramollissement being
most remarkable from opposite the seventh cervical vertebra to the
cauda equina, and presenting the appearance of a diffluent pulp, of about
the consistence of thick cream. Between the seventh cervical vertebra
and the foramen magnum, the cord was not so soft, and its consistence
increased as it approached the brain.
REMARKs. The symptoms, exhibited by this case during life, agree very
completely with those described as characteristic of softening of the
spinal cord. Dr. Abercrombie, in his “Pathology of the Brain and
Nervous System”, relates five cases of this affection, but none of his
cases are exactly similar to that now described. It will be observed that
the softening commenced at about the seventh cervical vertebra, and
extended to the cauda equina; hence the spasmodic pains of the abdo-
men and the vomiting, also the convulsive movements, the loss of
voluntary motion, and the anaesthesia of the lower extremities: while
the greater consistence of the upper part of the cord explained the fact,
that the power over the upper extremities was retained till a very late
period. - -
* The toleration of opium, under certain diseased conditions of the system, is
quite extraordinary. In a case recently attended by myself, in consultation with my
friend Dr. G. O. Rees, the patient, who was suffering from acute rheumatism, was
ordered to take two grains of opium every four hours, and afterwards, one grain of
hydrochlorate of morphia at intervals of six. and eight hours; and although this
system was followed, at intervals, for upwards of a fortnight, it did not produce the
slightest ill effect. The patient was a young lady, and had never before taken
opium.
823
INTESTINAL OBSTRUCTION GIVING RISE TO
SYMPTOMS SIMULATING THE PAINS OF LABOUR.
By ALEXANDER. KNOX, M.D., Physician to the Dispensary, Strangford,
County Down, Ireland.
EARLY in the summer of 1847, an application was made to me to visit
the sister of a small farmer, who was stated to be suffering from a
“stoppage”, and to be in great danger, as scammony, castor oil, jalap,
croton oil, with other purgatives and aperient injections, had been ad-
ministered without effect. I found the patient in bed, somewhat
flushed and heated, but the symptoms of acute abdominal inflammation
were absent. She was, however, suffering intense agony at intervals of
a few minutes, accompanied by great expulsatory efforts of the abdo-
minal muscles, very closely resembling the regular pains of labour.
The history of the case, however, as well as the character of the pa-
tient, who was not married, led to the conclusion, that I had not an
uterine affection of any description to deal with—an opinion which I
confirmed by examination. The abdomen was not tympanitic, but
enlarged, and presenting to the touch something of a feeling of solidity.
Connecting this with the expulsatory efforts before-mentioned, I was
led to form the opinion, that there was obstruction arising from some
solid body impacted in the alimentary canal, causing a reflex excite-
ment of the abdominal muscles, which were thereby strongly stimulated
to get rid of the source of irritation. The presence of one of those
enterolithes, or intestinal concretions, so well described by Good, and
more recently by the younger Monro, whose descriptions are chiefly
drawn from the observations and specimens collected by his father,"
suggested itself. Having oiled my hand, I introduced it as far as pos-
sible into the anus, for the purpose of exploration, when I detected some
firm bodies completely plugging up the rectum, and succeeded in re-
moving a number of them, some entire, and others broken down by the
fingers and the shank of an iron spoon, in the process of extraction.
They were of a spheroid form, and each about the size of a small apple,
and of a deep grass-green colour, and firm tenacious consistence. Hav-
ing hooked out as much of the entire mass as I could with my fingers,
to the great and immediate relief of the patient, I administered a large
emollientinjection with Read's syringe, which was then perfectly effectual
in unloading the lower bowels, although it had produced no effect when
previously employed. A course of enemata and gentle aperients left
the patient, within a week, perfectly restored to health. ... I naturally
felt curious to ascertain the composition of these green balls, to which
I had never seen anything similar. I found them, by breaking one
or two of them down on a clean towel, to consist entirely of green
vegetable matter, firmly agglutinated with the natural mucous excretion
of the intestines. When this connecting medium was removed by fre-
quent ablution, the entire residue was found to consist of the fibres and
minute fragments of a green vegetable substance, which, on farther
* Cyclop. Prac. Surgery, Part I.
*
824 ANEURISM of PoSTERIOR communicating ARTERY.
examination and inquiry, I found to be that of the early cabbage, which
had then come into season; and, as there were no potatoes at that time,
Had, together with bacon, constituted the primcipal part of the patient's
food for several days previously. Not the slightest trace of bile was
apparent in the entire mass; nor, in fact, was there anything which I
could detect, besides the vegetable matter alluded to, and the mucus,
which formed the cementing medium. Denman, under the appellation
of ball-stools, describod bodies similar as to form and size, but totally
differing in composition, and points out the necessity of removing them
by raking, as they cause extraordinary action of the intestines, and pain,
periodical in its returns, and violent in a degree. In the present case,
as the strongest purgatives and repeated injections had failed to give to
the peristaltic action of the bowels a sufficient stimulus for their expul-
Sion, it is manifest that if mechanical relief had not been afforded, or
had been too long delayed, a dangerous and perhaps fatal attack of in-
flammation must have followed. The ball-stool, according to Denman,
if proper and timely means are not used, sometimes proves fatal, by
bringing on a sphacelation of the parts.
Strangford, Ireland, August 1850.
CASE OF COMPLETE PARALYSIS OF THE MOTOR
* OCULL OF THE LEFT SIDE;
DEPENDENT UPON ANEURISM of THE LEFT PostERIoIR
COMMUNICATING ARTERY.
BY CHARLES J. HARE, M.D. Cantab.; Licentiate of the Royal College of
Physicians, Assistant-Physician to University College Hospital.
ANEURISMs of the cerebral arteries are of sufficiently rare occurrence to
make a record of the symptoms to which they have given rise, and of
the pathological appearances accompanying them, both desirable and
interesting; and as, in the case which has recently fallen under my
notice, the peculiar position of the Aneurism gave rise to some pheno-
mena during life, and to some circumstances in the mode of death, which,
together, tended to throw light on the diagnosis of the particular lesion
present, I have thought that the following details might not be un-
acceptable. -
CASE. Rosa H., at 18, unmarried, first came under my care as
an out-patient at University College Hospital, April 18, 1850. By
occupation a milliner, working principally at a house of business, and
consequently much confined in-doors; hours late, especially during the
London season, when, often, she did not get home till from 9 to 11
o'clock at night: a skilful and industrious worker; of regular habits;
had sufficient food and clothing. For some time past—about a couple
of years—she had resided with her mother in their present lodgings, a
front room, second floor, in an apparently healthy situation ; the room is
of moderate size, airy, not damp. Stature shortish ; moderately stout;
conformation good; complexion rather pale; hair dark brown; pupils
BY CHARLEs J. HARE, M.D. - 825
hazel; habitual state of mind said to be, both by herself and friends,
very cheerful and hopeful, but her temper naturally hasty and passionate.
Her cast of countenance, however, did not, when I saw her, indicate a
cheerful disposition. Her father died of “decline” (had bad cough, etc.),
after an illness of seven years: her mother, for two years before, had
at times been under the care of a physician-accoucheur for some “inter-
mal” (probably uterine) disease. Had five sisters and one brother, none
of them strong, though none absolutely ill; several of the sisters, one
especially, are subject to headaches; two of them, whom I saw, were
anaemic. Her mother had lost six other children, but none of them, so
far as was known, from cerebral disease. The patient had usually
enjoyed pretty good health, and had not been laid up with any disease or
illness which she could remember, till the end of June 1848, when she
was attacked with “brain fever.” She stated that the attack commenced
suddenly with pain over the whole head, very severe, so as to make her
scream. From her mother's account, it appeared that she was not con-
fined to bed during the first week of her illness, that is, while she re-
mained at home. She was, however, excited in her manner; much excited
by any little event in-doors, or by what was passing in the street; was vio.
lent, destroyed various articles, wasted much food, while, at the same time,
she eat voraciously ; she complained much of coldness of the feet and
legs, and, to ease this sensation, attempted to, and actually did, pour
some boiling water over them. After having been thus ill at home a
week, a certificate, which I saw, and which stated “that she was not fit
to be left where she could not properly be watched and attended to, as
she required restraint for the present”, was written by Mr. Collins,
who attended her, in order to procure her admission into the St. Pancras’
Infirmary. She was placed under restraint while in the Infirmary, and
remained there altogether two months; but it was fully three months
from the commencement of her illness before she was able to get about ;
and for several months she was not able to work. For some time after
her admission into the Infirmary, it appears that she was delirious, and
for nearly a month or quite that time she was unable to recognise indi-
viduals around her. Her head was shaved once, and a lotion was applied
to it; she had two blisters to the back of the neck (kept open), but was
neither bled, cupped, nor leeched; she did not remember that her gums
were made sore. No cause for the attack is known. When she re-
covered, she worked at millinery, as already stated.
She had never been so well after this attack as before, though she
had not since suffered from any serious illness, up to the time of the
attack for which she sought advice at the hospital. As regards her
disposition, she was naturally a proud girl, and in temper was hasty
and passionate ; her temperimproved after her illness, (that is, she was
less passionate), but she became more “spiteful” from any trifling cause,
than previously. There was also this peculiarity—that she would some-
times play with children as a child, not as a girl of her years; so that her
sister has remarked to her, “Well, I think you can't be right in your
mind.” Formerly she was never subject to headaches, but since her
illness had been much troubled with them, especially across the fore-
head, sometimes at the vertex, less frequently about the occiput; the
pain being heavy and very severe. These attacks became more and
826 ANEURISM OF POSTERIOR COMMUNICATING ARTERY.
more frequent, besides being more severe : at first she would be a fort-
night free from them, but more recently, and especially within the six
months before I saw her, they had been much more frequent, so that she
had not been a day free from them. Occasionally she had vertigo; and
she stated, that about a month or a little more, previously to my seeing
her, on returning home from her work, about 11 P.M., (after a hard
day's work at sewing), she would have fallen in consequence, had she
not been with a young friend who supported her; she was, at the time,
very pale. Since her illness also, when she was at home during the
daytime, or when she returned home from her work in the evening, she
often used to lie down, owing to headache. One of her sisters, who
slept with her last summer, stated (without the question being put) that
she then always preferred lying with her head high, and that she was a
light sleeper, easily disturbed. Her mother however said, that of late,
when she lay down during the daytime, she evidently preferred having
the head rather low. She never had any fit, nor loss of consciousness,
nor paralysis of any part, nor numbness or tingling in the arms or legs.
On Thursday, March 28th, she was at work, and felt as well as usual.
On Friday, the 29th, she continued at work, and did not remark any-
thing unusual till the evening, when she found that the sight of the
left eye became dim, as if there were a mist before it; there was, how-
ever, no double vision, nor has there been any since. At the same time,
the left upper eyelid became partially closed, but not entirely so; this
was noticed at the time by her fellow work-people, and mentioned to
her. . I understood her to say also, that the eyelid became entirely
closed at a later period of that evening, and continued so ; but on this
point I am not quite certain. -
During the ensuing week she continued at her work, notwithstanding
the complete ptosis of the left side, for which, however, she did nothing,
with the exception of applying some lotion without benefit. On the Friday
or Saturday following, (April 5th or 6th), she came to University College
Hospital without a letter of recommendation, but saw the resident medi-
cal officer, Mr. Clover, who ordered her to apply three leeches to the
left temple; they were not put on, however, till the Saturday evening,
(April 6th), and only two of them took. Next day (Sunday) morning, the
eyelid was partially open, but it again closed entirely in the evening, and
never opened again up to the time when I saw her. On that Sunday
she vomited two or three times, and afterwards also, (before I saw her);
but no notice of the circumstance was taken, as she had previously been
subject to sickness occasionally, when she had the headaches. Before
her illness in 1848, and indeed when a child, she not unfrequently
vomited, which was often ascribed to her eating much sweets, of which
she was particularly fond. - . . . -
On Saturday, April 18th, she again applied at University College
Hospital, and was ordered a saline mixture, with two doses of pilula
rhei cum hydrargyro, which were again repeated on the 25th. It was
on Thursday, April 18th, that I first saw her, and finding the case to
be an interesting one, and serious also in its nature, I asked her to come
the following day, that I might také more accurate notes than I then
could, when occupied in seeing the out-patients generally. The following
notes therefore refer to her state on Friday, April 19th.
BY CHARLEs J. HARE, M.D. 827
There was nothing unusual in her attitude, but she had the appear.
ance of a person somewhat languid and fatigued ; the expression of her
countenance was rather heavy ; her temper had not altered of late, but
her spirits were decidedly worse than usual; her mother, however,
afterwards told me that they even then still continued good. She slept
very indifferently, the sleep being often interrupted by headache; and
she said that she often did not get an hour's rest all night in conse.
quence; she did not dream ; was not so strong as formerly; suffered
from much lassitude. Colour of skin generally pale; moderate amount
of fat; no anasarca. . . . . . . . . . . . . . . .
The eyebrows were equally arched, and of equal height. There was
complete ptosis of the left upper eyelid; by no effort of the will could she
open it in the least. When she voluntarily closed the right eye, the left
eye appeared the more prominent, in consequence of slight oadema of
the left upper eyelid. It was doubtful whether the left eye-ball were
more prominent than the right. The left upper eyelid was a little redder
—deeper flesh-coloured—than right. There was some epiphora of left
eye; no redness of conjunctiva. When the left eyelid was raised, the
eyeball was seen to be everted to the left side (outwards); so that when
the right eye was directed exactly forwards, the axis of the left pointed
outwards at an angle of 609. She was unable to move the left eyeball
in the least, either upwards, downwards, or inwards, but could turn it
quite readily to the outer angle of the eye; it was therefore only when
the right eye was moved to its inner angle, that the axes of the two eyes
were in the same direction: by the greatest effort she could not direct
the axis of the left eye forwards—it still looked outwards. By noting
the position of any given mark on the iris, the following phenomena were
observed. When she was told to look downwards, the right eyeball obeyed,
of course, the will; the axis of the left eye, however, did notin the least
alter its direction, but the eyeball was nevertheless rotated on its own
axis, to the amount of about one-sixteenth of an inch, in such a direction
that its outer part became more superior, and its superior more inward;
its motion therefore being outwards, upwards, and inwards, (owing to
the action of the superior oblique muscle). No motion however in the
opposite direction took place, when she attempted to look upwards
(owing to paralysis of the inferior oblique); but the left eye remained
perfectly motionless, while the right one obeyed volition. The right
iris acted well under the stimulus of light; the outer part of the iris
was, however, observed to be rather broader than its inner part. The
left iris did not act at all, either under the stimulus of light, or consen-
taneously with the motions of the other eye; the pupil was considerably
dilated, but unequally so, the iris being considerably narrower at its
upper and inner angle, than at the rest of the circumference, where its
width was uniform, though considerably less than that of the right iris;
the left pupil therefore was uniformly nearly two-thirds more in diameter
than the right one, with the exception of that diameter from its upper
and inner to its outer and lower angle, where it was nearly double that
of the right pupil. She complained of having considerable pain in the
left eyelid of an aching character, and sometimes of shooting pain in it.
I observed no derangement of intellect; she answered all my questions
quite accurately, so far as could be judged. There was no paralysis of
WOT, II. 55 w
828 ANEURISM OF POSTERIOR COMMUNICATING ARTERY.
any part, beyond what has been already stated, nor was there any
derangement or perversion of any of the senses, except a rather consi-
derable dimness of vision in the left eye, so that she saw objects very indis-
tinctly when the right eye was closed. Her appetite was indifferent, and
had been so for three weeks before. She had never been subject to any
cough, even on taking cold; had a good and powerful voice for singing,
and could sustain her notes for a considerable time. The catamenia
were usually quite regular and sufficient; her mother subsequently
told me, that when the leeches were applied on the 6th of April, the
catamenia were present, but stopped rather suddenly afterwards. Four
leeches were ordered to be applied to the left temple. -
It would appear, from some erroneous statements which she made
after she returned home on that day, that she must then have wandered
somewhat in her mind, at least for a while; but otherwise, her manners
did not seem different from usual, with the exception of her being rather
impetuous while the leeches (of which three took) were being applied.
Her mother stated, too, that she looked paler, and that her features ap-
peared “drawn”. The headache, of which she complained, continued,
not being relieved by the leeches. Frequently after the ptosis took
place, she had requested her mother, in order to relieve the headaches,
to tie her head as tightly round as possible with a handkerchief, and
sometimes she wished this to be done as often as three or four times a
day. The last time her mother did this for her, was on the Thursday
evening. -
On the Friday night she did not take anything likely to disagree with
her; she had no beer for supper. On the Saturday morning, she was
up at 6 a.m., to make some breakfast for herself and her sister (who
was going to her work), but she afterwards went to bed again. During
the forenoon, she did not complain of anything unusual. About 1 o'clock,
she was lying on the bed, and had been speaking to her mother within
two or three minutes, when her mother, happening to look towards her,
saw her head drop. Her face and neck became very red, and “the left
eye was as wide open as the other, and continued so". Mr. Welch, Sur-
geon, who lived near, was called to see her, and immediately attended;
and he has assured me that the eye was quite open when he saw the
patient, thus confirming the statement of the mother. The attack was
unaccompanied by any scream or struggling; there was only a slight
twisting of the left hand and of the head; the lower limbs are said not
to have moved at all. Her face then turned deathly, and she died
within ten or fifteen minutes from the commencement of the attack.
POST-MORTEM ExAMINATION, APRIL 23, SEVENTY-FIVE HOURS AFTER
DEATH. Weather moderately dry; average temperature of preceding
three days 47° ; but the body had been kept in a room in which the
family partially lived, during that time. -
Rigor mortis continued in all the limbs, upper and lower, perhaps
slightly more, however, in the legs than in the arms. When I first
saw the body, about two hours after death, the upper extremities were
supple, but rigor mortis was very distinct in the legs—in both equally.
. A well formed body, rather large chest for size of person: no emacia-
tion: fat under integuments from half to five-eighths of an inch in
thickness; color of skin pale; cutaneous veins not unusually marked;
BY CHARLES J. HARE, M.D. 829
some purple discoloration at posterior part of body; no apparent de-
composition had commenced; no oadema; color of muscles darkish.
Neither eye was completely closed; one eyeball was not more prominent
than the other; the left pupil was very slightly more dilated than the
right one ; neither of them was more dilated than natural.
Chest. The lungs were perfectly healthy; not a single tubercle was
discovered; no unusual redness of bronchial mucous membrane. The
heart was of apparently natural size and weight; the right side contained
dark coagula; no disease of valves; no disease of the aorta, nor any
atheromatous deposit in its coats.
Abdomen. Stomach natural in position, shape and size: it contained
fully six or seven ounces of a thickish fluid, like gruel or arrowroot; its
mucous membrane was of an ash grey colour and very much softened,
but there were no ulcers. Intestines not opened throughout; where
opened, they presented nothing anormal. Spleen of very dark colour;
surface a little corrugated. Liver of natural size; general color dark
purplish; on closer examination it presented tolerably well marked
hepatic congestion. There were no traces of inflammation or other
disease of the peritoneum. *
Both kidneys were of a dark reddish purple colour throughout their
whole substance; cortical and tubular portions equally so; no granular
appearance; the capsule came off without tearing the substance. Uterus
of usual size, and apparently of natural consistence. One ovary (I
think both ovaries) contained two or three small cysts filled with a
serous looking fluid. One of them contained a false corpus luteum.
Brain. The vessels of the dura mater were large; some dark fluid
blood escaped from the torn vessels. The dura mater itself was very
opaque, and its surface presented a somewhat opalescent appearance ;
the small vessels were minutely injected. No enlargement of the
Pacchionian bodies. There was no opacity of the arachnoid covering
the superior parts of the hemispheres. Both the small and large ves-
sels of the pia mater were congested, as well over the anterior as over
the posterior part of hemispheres. The general appearance of the
brain, as seen in situ, was of a pinkish cream colour, owing to this con-
gestion of the pia mater; but scattered over the surface of the hemi-
spheres—more over the right than left, and more along their borders
than elsewhere—were patches of a deep red colour, varying in size from
a pea to that of a shilling, or still larger, and produced by a more con-
siderable injection of the small vessels of the pia mater than existed
over the surface generally. Over the convolutions situated in the
longitudinal fissure between the hemispheres, these red patches were
still more abundant and redder, than over the superior cranial aspect.
There was very considerable congestion of the whole of the pia mater
at the base of the brain, and there were also patches of redness similar
to the above, but much larger; while, along the posterior half of each
anterior lobe, the pia mater was of one uniform deep red colour. -
At the base of the brain, whder the arachnoid, there was a considera-
ble clot of blood, most abundant from the commissure of the optic
nerves, backwards over the pons Varolii, and on each side of the medulla
oblongata; the clot also completely filled up the fourth ventricle, so as
to separate the medulla from contact with the cerebellum by a Histance
55
830 ANEURISM OF POSTERIOR COMMUNICATING ARTERY.
of half an inch; the clot in the fourth ventriclé was of a dark purplish
black colour, and of the consistence of jelly, and, from its position, must
have caused considerable pressure on the respiratory tract. In each
lateral ventricle, there was a little bloody serum, with a very small quan-
tity of darkish coagulum in one of them; the septum between the lateral
ventricles was broken down. The substance of the brain, and especially
of the corpora striata and optic thalami, was somewhat softer than natural;
but there was no clot in any part of the substance of the brain itself.
Near the anterior extremity of the left posterior communicating
artery, and at a short distance from its junction with the carotid, that
vessel (the posterior communicating artery) became suddenly dilated
into an aneurismal and somewhat egg-shaped sac, about six-tenths of an
inch in length, and four-tenths of an inch in its transverse diameter,
its long axis being in the direction of the vessel. It was partially filled
with dark-coloured softish coagula; air could be blown into it both
from the basilar artery, and from the left carotid; at its cerebral aspect,
there was a small fissure in it, from which the blood had probably
escaped. .*
The right third nerve presented a perfectly natural appearance; but
the left one, where it crossed under the posterior communicating artery,
just at the point of aneurismal dilatation, had been so pressed upon by
the aneurism as to have become almost completely atrophied, the
remaining fibres of it being seen to be spread out upon and in a manner
incorporated with the walls of the aneurism. Beyond this part, the
nerve reassumed its natural appearance. The aneurism likewise
pressed, by its right border and superior surface, upon the left optic
nerve, a little posterior to the commissure.
Portions of the internal carotid and of the basilar arteries were exa-
mined under the microscope; both these vessels were free from fatty
degeneration, and there was no atheromatous deposit in either; in one
of them, two or three small scales of cholesterine were detected. The
arachnoid covering was considerably thickened, and more opaque than
natural.
REMARKs. The most remarkable feature presented by the case, when
I first examined the patient, was the complete paralysis of every part
supplied by the left motor oculi, while the functions of the other nerves
appeared altogether or almost altogether unimpaired. She had not the
slightest power of raising the left eyelid; the paralysis of the superior,
internal, and inferiorrectiof the same side was shown by the utter motion-
lessness of the eye when she endeavoured to move it upwards, inwards, or
downwards; there was an entire absence of that rotation of the eye
which is produced by the action of the inferior oblique; while the iris,
being likewise supplied by filaments from the third nerve, was dilated
and immoveablé. On the othér hand, the external rectus (supplied by
the sixth nerve), and the superior oblique (by the fourth), continued to
perform their duties; the action of the former, not being counteracted
by that of the internal rectus, caused a permanent outward squinting of
the eye, while the rotation described in the notes of the case showed
the persistence of the functions of the latter. The functions of the
fifth and seventh nerves appeared likewise to be unimpaired. Accom-
BY CHARLES J. HARE, M.D. 831
panying the paralysis of motion, however, there was a decided impair-
ment of vision of the left eye, which might depend either upon the
dilatation of the pupil, or upon some affection of the optic nerve, or
partially upon each of these causes. The amount of dimness of sight
was, however, such as to lead me to suppose that the optic nerve was,
to a slight extent, probably involved by the same cause which gave rise
to the paralysis of the third. With reference to the condition of her
sight, it is worthy of remark that there was not, when I saw the patient,
nor had there at any time been, even when the attack first came on,
any double-sight—which is a symptom often accompanying paralysis of
the motor oculi. ºr *
From a consideration of the symptoms which presented themselves,
it appeared probable, that the lesion of the third nerve existed posteriorly
to its point of division into two branches within the orbit; for had the
cause existed within the orbit, one branch might have retained its
functions while the other was implicated ;-ptosis, for example, might
have existed without paralysis of the internal or inferior rectus or
dilatation of the pupil; while, if a tumour had existed there, so as to
have pressed upon both branches of the nerve, it would, probably, like-
wise have caused some protrusion of the eyeball, or would have involved
also the fourth or sixth nerve. Again, as, in the cavernous sinus, the
motor oculi is in such close relationship with the fourth, the ophthalmic
division of the fifth, and the sixth nerves, had the paralysis depended
upon a growth, or other disease, within that part, it is very likely that
in this case too, some one or other of the neighbouring nerves would
also have been involved. On the whole, therefore, the probability was
that the disease was situated between the cavernous sinus and the crura
cerebri, or within the latter. . - - “. . . .
The history of the patient, in conjunction with her present attack,
seemed clearly to point to a chronic cerebral affection of some standing.
Two years previously, she had suffered from an attack termed at the
time, “Brain-fever”, and during which she certainly was so delirious
as to require some restraint; since then, her health had been worse
than before, a change in her disposition had taken place, and in
her manners she was more childish than formerly. She had also
been subject to gradually increasing headaches, from which, for six
months before her death, she had scarcely been a day free ; and vertigo
was another of her symptoms. All these tended to make the prognosis,
which, in complete paralysis of the third nerve, is generally unfavour-
able, peculiarly so in this case ; but they were not sufficient to point
out the exact nature of the lesion. - -
One of the most remarkable circumstances which occurred in the
course of this case, was connected with the mode of death. From the
time when the ptosis first came on, up to the period of the fatal apoplectic
seizure, the paralysis had been constant, with the exception of the day
after the first application of the leeches to the temple, when she was ena-
bled partially to open the eye, though the symptoms soon after returned
as before. Immediately, however, that the apoplectic stroke occurred,
the left eye was observed to be quite open, and the squinting ceased;
nor did Mr. Welch, who was immediately called in, and who remained
with her till she died, observe any notable difference in the appearance of
832 DR. HARE ON ANEURISM OF POSTERIOR COMMUNICATING ARTERY.
the two eyes, so that the pupil must have regained its contractility at the
same time, These circumstances, together with the previous history
of the patient, the symptoms she presented, and the temporary relief
afforded by the abstraction of blood, led me to conclude that the
paralysis had most probably been caused by the pressure of an aneurism
upon the third nerve, and that its rupture had simultaneously produced
the apoplexy, and, by diminishing the bulk of the aneurismal tumour
itself, had allowed the nerve to reassume its function. The post-
mortem examination, in which I was kindly assisted by my friends Dr.
Jenner and Mr. Welch, confirmed the opinion I had expressed; for we
found an aneurism of the left posterior communicating artery, fully
half an inch in length, very considerably compressing the motor oculi
of that side, without apparently implicating any other part except by
pressing slightly upon the optic nerve, just posteriorly to the commis-
sure. In a case of paralysis of the third nerves, recorded by Mr.
Brown in the Dublin Quarterly Journal for May, 1849, in which both
pupils were dilated, though unequally so, they remained after death as
fully dilated as during life. This, indeed, is the rule in such cases;
but, in the present instance, the difference in the size of the two pupils,
which before had been so great, was scarcely perceptible, owing to the
cause of the paralysis having been removed just prior to the patient's
death. Amongst the post-mortem examinations which I have made, or
at which I have been present, the only instance of aneurism of the
cerebral vessels which I have met with was in a man, aged 49, who
died in University College Hospital under the care of the late Dr. A. T.
Thomson, and who, previous to admission, had had a fit, accompanied by
paralysis of the left side and dilatation of the right pupil. He survived
a fortnight; and, after death, the anterior lobe was found much softened,
there being also a slight effusion of blood into one part of it; the basilar
artery was opaque, hardish from bony deposit, and distended with
blood; there was an aneurism of the right middle cerebral artery, just
where it lies in the fissure of Sylvius, about the size (or nearly so) of a
nutmeg, with one or two smaller aneurisms of the same artery; the
left middle cerebral artery also formed an aneurism, not globular like
the other, but consisting rather of a general dilatation of the vessel (to
the thickness of an ordinary quill), and extending from near its com-
mencement to its great curve, that is, for about the length of an inch :
from this some enlarged branches proceeded into the substance of the
brain. The coats of the cerebral vessels were, in this case, very much
diseased, and there was also ossific deposit in the arch of the aorta, and
in other arteries; but in the case of Rosa H., not only were the aorta
and larger vessels healthy, but there was neither any ossific nor athe-
romatous deposit in the cerebral arteries, nor did they show any traces
of fatty degeneration, so that the formation of an aneurism was the
more remarkable. -
The post-mortem examination also fully accounted for the very rapidly
fatal termination of the apoplectic attack; for the blood was so effused
at the base of the brain, and the quantity in the fourth ventricle was
so considerable, that it must necessarily have caused very great pressure
upon the respiratory tract. -
9, Langham Place, August, 1850.
833
BIBLIOGRAPHICAL RECORD.
RESEARCHES ON MAGNETISM, ELECTRICITY, HEAT, LIGHT, AND CHEMICAL
ATTRACTION, by KARI, BARON. von REICHENBACH. Translated by W.
GREgoRy, M.D., Professor of Chemistry in the University of Edinburgh.
pp. 455. London: 1850. - , - . . .
It was well said by the late Rev. Sidney Smith, that one of the rarest sorts
of understandings we meet with in this world, is an understanding fairly and
impartially open to the reception of truth, coming in any shape and from any
quarter. The minds of men are so hampered by prejudices, and so occupied
by preconceived notions, that it is quite the exception for a new and startling
discovery to meet with fair and impartial investigation. Doubtless, there are
two causes which contribute materially to close the outlets of men's charity;
namely the charlatanism which almost always becomes mixed up with things
new and remarkable, and the credulity and love of the marvellous which causes
that which is really true to be distorted and exaggerated, so as not to be re-
cognisable, except at the cost of tedious and wearisome labour, and much
stripping off of fictitious attire. The expression “naked truth’ is more forcible
than is commonly supposed ; for it is quite the exception to behold truth in
all the beauty of her fair proportions—simple and unadorned.
The present publication is announced as the first volume of a work in
which the whole of the observations made up to this time by BARON voN
REIGHENBACH on the subject of which it treats, are to be placed on record.
It is divided into two parts. Of the first, an abstract was published in 1846
by DR. GREGORY, which attracted a good deal of attention at the time. The
second part consists of several sections: in the first, the author enumerates by
name upwards of fifty new sensitive persons, of whom thirty-five were healthy
and vigorous, yet among whom are to be found all degrees of sensitiveness;
in the second section, the author institutes a minute comparison of the new
influence, to which he applies the term odyle, with the known influences or
imponderables, heat, electricity, and magnetism, and points out the points of
analogy to these, and the differences which distinguish it from them. The
third section of the second part is a minute description of the various
forms, characters, and properties of the light said to be given out by magnets,
and which is visible in the dark to the sensitive. It is said that fully one-
third of people in general are more or less sensitive; and Dr. Gregory adds,
that so far as his observations extend, this statement is not exaggerated.
The last section is an application of these most remarkable phenomena to
the explanation of the Aurora Borealis.
The mode of investigation pursued by the author, has been the inductive;
the conclusions being deduced from carefully observed phenomena, varied
by experiments of different sorts; and Baron von Reichenbach would seem,
(by Dr. Gregory's account,) to be well qualified to conduct such an investiga-
tion. He is certainly earnest and indefatigable in his inquiries, and zealous
in the cause he has undertaken.
The first point stated is one which is simple enough, and within the power of
any one to ascertain; but on its existence depends much of the chain of reason-
ing which follows. “If we make downward passes with strong magnets, having
a supporting power of about ten pounds, along the persons of from fifteen to
twenty individuals, but without touching them, we shall always find one or
perhaps more among the number affected thereby in a peculiar manner;” the
impression is rather unpleasant than agreeable, and is associated with a gentle
feeling, sometimes of cold, at other times of warmth, and resembles a cool or
tepidaura or current of air, with, occasionally, a dragging or pricking sensation.
834 BIBLIOGRAPHICAL RECORD.
The passes should be made from head to foot, and not too quickly; also, as
near the surface as possible, and without contact with the dress. ”
This, we repeat, is in the power of all to ascertain, and when sensitive per-
sons are found, some of the points next mooted can be put to the test. Baron W.
Reichenbach, found two persons who possessed the sensitiveness in an eminent
degree, Mdlle. Nowotny, a patient subject to catalepsy, headaches, and spasms;
and Mdlle. Reichel, also subject to nervous attacks. There were other persons
experimented on, but these two are especially mentioned, and the summary
of the conclusions drawn from a great number of experiments is as follows:
Those who are highly sensitive to this peculiar influence, are able to perceive
luminous and flame-like appearances in the magnet; the pole — M. gave the
larger, the pole + M the smaller flame in the latitude of Vienna ; according
to the form and structure of the magnet, the flame divides at each pole into
flames of iridescent colours; the positive and negative flames show no ten-
dency to approach each other or to unite. The flame may be mechanically
bent hither and thither like common light, it gives out flame which is red, acts
on the plate of the daguerreotype, may be concentrated by a lens, but has no
appreciable warmth; and there is a great resemblance in the flame and the
light to the Aurora Borealis. We must say, that as the experiments seem to
have been fair enough, and as a sufficient number of persons have taken part
in them, (their names being mentioned), to be a guarantee to their honesty,
we are neither disposed nor entitled to throw the book aside with premeditated
incredulity as some seem to have done. It certainly deserves examination,
and nothing in the first part of the volume appears to be incredible.
It would be improper to deny the possibility of the retina, when in a state
of exalted sensibility, appreciating luminous appearances connected with
magnetic currents; on a large scale we are already familiar with them in
the Aurora Borealis; and that the retinae of different individuals differ ma-
terially in their power of appreciation, is proved by the numerous persons
who cannot distinguish particular colours: that such colours do exist is with
them matter of faith, founded on the assertion of others. That the undula-
tions of magnetic light are inconceivably more rapid than those of any of
the ordinary luminous rays is probable enough, therefore they usually fail
to produce an impression on the retina, but the reason that we do not see the
calorific rays is the same ; and yet undoubtedly some persons can perceive
them. Consequently it appears to us, that we are not warranted in denying,
that the magnetic light may be visible to some persons under particular
circumstances. - . . . .
The experiments of Faraday, on dia-magnetism, have shown that the
human body is not devoid of certain influences; but Baron Reichenbach
goes much further. “The adhesion of a living limb to a magnet, is a fact
altogether unknown in the sciences of physics and physiology, and few per-
sons have convinced themselves of it by actual ocular demonstration; it is
therefore necessary to explain and illustrate it in some degree. When Mdlle.
Nowotny, in the cataleptic state, lay without consciousness or motion, but
without spasm, and when a horse shoe magnet, capable of supporting about
20 lbs., was approached to her hand, the hand adhered so firmly to it, that
when the magnet was raised or moved sidewards, backwards, or in any direc-
tion whatever, her hand stuck to it as if attached in the way in which a piece
of iron would have been. She remained utterly unconscious all the time;
but the attraction was so strong, that when the magnet was moved towards
her feet, farther than her arm could reach, she did not let it go, but although
insensible, raised herself in bed and followed the magnet with her hand as
far as she could possibly do; so that the effect was the same as if some one had
seized her hand, and by means of this, drawn, or bent the body forwards
towards the feet. When the magnet was at length moved so far that her
body could not be moved or bent further, so as to enable her to follow it, she
was compelled to let it go, but remained then in the manner always observed
BIBLIOGRAPHICAE, RECORD. 835
in cataleptics, fixed and immoveable in the position into which she had been
brought.” (p. 25.) - . . .
We have extracted the passage entire, as in a work of this kind, (which is
as full of novelties as a horticultural exhibition at Chiswick,) it is dangerous
to trust ourselves to an attempt at rendering the author's meaning. We con-
fess to have drawn rather a long breath as Mdlle. Nowotny was drawn up in the
bed, and nearly pulled out of it by the magnet ; and it was a relief to us to
find that the latter catastrophe did not take place. We shall abstain from
ridicule, which would be unbecoming; but we must confess, that as page after
page announced phenomena which had never entered our imaginations, we
involuntarily exclaimed, with Dominie Sampson, PRO-DI-GI-GUS 1
The description given of this phenomenon by the patient herself, is, that
she was conscious of an irresistible attraction which she felt herself involun-
tarily compelled to follow, and was forced to obey. It was an agreeable sen-
sation, combined with a soft cooling breeze or aura, flowing downwards
from the magnet on the hand, which felt as if attracted to it, and drawn
forwards by a thousand fine threads. The whole was a peculiar, indescriba-
ble feeling, which, when the magnet was not too powerful, had in it something
infinitely refreshing and agreeable. The same phenomena were subsequently
observed in Mdlle. Reichel and also in M. Sturmann, so that the author is
convinced of the fact, that in certain diseases, especially where catalepsy is
present, there exists a decided attraction between the human hand and a
powerful magnet. But it seems that the mutual reciprocity between such
patients and magnets does not close here, they become as it were, apostles of
the awra, and are so thoroughly imbued with it, that, inconvenient though it
must doubtless be at times, they can, by holding knitting needles in their
hands, convert them into magnets capable of attracting and lifting other
needles. We are bound to say that, though the patients themselves and
their physicians have asserted the possession of this power, the Baron does
not admit its existence as an established fact.
We now come to a passage which we quote with some interest, because the
feelings there described are similar to those which have been felt by ourselves
at the clairvoyant juggles and other impostures that have from time to time
been brought forward in London; and we are bound to say that, the
majority of persons of authority in such matters, have shared those feelings
with us. “I have mentioned above, magnetized water, which the patient
instantly distinguished from ordinary water, even when she knew nothing of
what had been done. Wothing could be ºnore repulsive to me than the reappear-
ance of a thing apparently so absurd, the mere mention of which fills all
chemists and natural philosophers with disgust. But in spite of this prejudice,
I could not deny, or annihilate to my own mind by denying, that which I
saw before my eyes as often as I tried it; namely, that Mdlle. Nowotny always
accurately, decidedly, and without one failure, distinguished a magnetizéd
glass of water from one not magnetized ; we cannot contend against the
force of facts by any argumentation. I was therefore obliged to admit the fact,
though I was unable to comprehend it. But when the same fact presented
itself at a subsequent period in the cases of Sturmann, Maix, Reichel, and
others, nay, when I saw it in some of these in a still higher degree, Irelin-
quished my doubt and my resistance to a phenomenon, the actual existence
of which admitted no longer of any rational doubt. The strangeness of the
phenomena was yet to reach the acme of incomprehensibility; when it ap-
peared, namely, that not only the magnet, but a mere magnetized glass of
water possessed the power of carrying with it the hand of Mdlle. Nowotny.”
(p. 31.) A person who opened the book at this page would probably feel some
surprise at this statement, but such was not our case; we had ceased to be
astonished several pages before reaching this point, much in the same man-
ner that the audience of a conjuror gradually exhaust all their stock of
wonder, sink into a pleasant state of apathy, and are quite prepared for any-

886 B1.BLIOGRAPHICAL RECORD.
thing; or like the sailor, who was blown up by an accidental explosion
during a theatrical performance, but who, when he recovered his scattered
senses, did not betray the least discomposure, being perfectly satisfied that
it was a legitimate part of the performance.
Baron Von Reichenbach observing this aqueous attraction, and feeling
convinced that (what he rightly calls) so strange a phenomenon could not
exist isolated in nature, submitted all sorts of minerals, drugs, and other ob-
jects to the action of the magnet, and found that all of them immediately
acted on the patient, just as the magnetized water had done, but with various
differences in their mode of action. Some caused general spasms through the
whole body, others only in the arm, others only in the hand, and so on, until
Some produced hardly any effect at all ; and on further investigation it
appeared, that all the bodies which produced these spasms were crystallised,
and that the active group comprehended all single detached crystals, and
those where the crystals, which if in groups, had their principal axis parallel,
or nearly so. It further appeared, that when a rock-crystal was drawn from
the wrist over the palm of the hand to the point of the middle finger, a
pleasant cool sensation was produced; if drawn in an opposite direction, a
warmth was perceptible; and this was performed on various persons, who,
without the possibility of collusion, agreed in their account of the facts.
A very curious feature in this book, is the zeal with which the author seems
to have endeavoured to unravel many stories of ghosts and supernatural
appearances, by referring them to causes simple and within the power of
all to test. We, therefore, at the sacrifice of some space, subjoin the full
account given by him, of what would certainly appear to be as fair a
ghost story as Mrs. Radcliffe herself could have desired, although the expla-
nation does away with the supernatural character of the phenomena. We
may also mention that Mdlle. Reichel accompanied the Baron to a cemetery,
and there perceived on the graves, a delicate, fiery, breathing flame. On
many graves this light was about four feet high, and when she thrust her
hand into it, it was as if putting the member into a dense fiery cloud. The
Baron remarks, that all who are to a certain degree sensitive, will see the
same phenomena in cemeteries, and especially in the crowded burial-grounds
of large cities. If the premises be correct, opportunities will not be wanting
to prove the fact in our metropolitan church-yards, for the reeking mass
of corruption which emits its pestilential vapours from too many of these,
ought, according to our author, to exhibit one burning fiery flame extending
from one end to the other. . . . . . .
“A case which occurred in the garden of the blind poet Pfeffel, has been
widely circulated by the press, and is well known. Pfeffel had engaged a
young Protestant clergyman, of the name of Billing, as amanuensis. The
blind poet, when he took a walk, held Billing by the arm, and was led by
him. One day, as they were walking in the garden, which was at some dis-
tance from the town, Pfeffel observed, that as often as they passed over a
certain spot, Billing's arm trembled, and the young man became uneasy.
He made inquiry into the cause of this, and Billing at last unwillingly con-
fessed, that as often as he passed over that spot, he was attacked by certain
sensations, over which he had no control, and which he always experienced
where human bodies lay buried. He added, that when he came to such
places at night, he saw strange (Scotice, uncanny) things. Pfeffel, with the
view of curing the young man of his folly, as he supposed it to be, went that
night with him to the garden. When they approached the place in the dark,
Billing perceived a feeble light, and when nearer, he saw the delicate appear-
ance of a fiery ghost-like form hovering in the air, over the spot. He de-
scribed it as a female form, with one arm laid across the body, the other
hanging down, hovering in an upright position, but without movement, the
feet only a few hands' breadths above the soil. Pfeffel, as the young man
would not follow him, went up alone to the spot, and struck at random all





BIBLIOGRAPHICAL RECORD. 837
round with his stick. He also ran it through the spectre, but it neither moved
nor changed to Billing's eyes. It was as when we strike with a stick through
a flame; the form always appeared again in the same shape. Many experi-
ments were tried during several months; company was brought to the place,
but no change occurred, and the ghost-seer adhered to his earnest assertions,
and in consequence of them, to the suspicion that some one lay buried there.
At last, Pfeffel had the place dug up. At a considerable depth, they came
to a firm layer of white lime, about as long and as broad as a grave, tolerably
thick, and on breaking through this, the bones of a human being were dis-
covered. It was thus ascertained that some one had been buried there, and
covered with a thick layer of lime, as is usually done in times of pestilence,
earthquakes, and similar calamities. The bones were taken out, the grave
filled up, the lime mixed up with earth and scattered abroad, and the surface
levelled. When Billing was now again brought to the place, the appearance
was no longer visible, and the nocturnal ghost had vanished for ever. It is
hardly necessary to point out to the reader what I think of this story, which
caused much discussion in Germany, because it came to us on the authority
of the most trustworthy man alive, and received from theologians and psycho-
logists a thousand frightful interpretations. To my eyes, it belonged entirely
to the domain of chemistry, and admitted of a simple and clear scientific
explanation. A human corpse is a rich field for chemical changes, for fer-
mentation, putrefaction, gasification, and the play of all manner of affinities.
A layer of dry quick-lime, compressed into a deep pit, adds its own powerful
affinities to organic matters, and lays the foundation of a long and slow action
of these affinities. Rain-water from above is added ; the lime first falls to a
mealy powder, and afterwards is converted, by the water which trickles down
into it, into a tallow-like external mass, through which the external air
penetrates but slowly. Such masses of lime have been found buried in old
castles, where they had lain for centuries; and yet the lime has been so fresh,
that it has been used for the mortar of new buildings. The carbonic acid of
the air, indeed, penetrates the lime, but so slowly, that in such a place a
chemical process occurs which may last for many years. The occurrence in
Pfeffel's garden was therefore quite according to natural laws; and since we
know that a continual emanation of the flames of the crystalline force accom-
panies such processes, the fiery appearance is thus explained. It must have
continued until the affinities of the lime for carbonic acid, and for the remains
of organic matter in the bones, were satisfied, and finally brought into equi-
librium. Whenever, now, a person approached who was, to a certain degree,
sensitive, but who might yet be, or appear, in perfect health, and when such
a person came within the sphere of these physical influences, he must neces-
sarily have felt them by day, like Mlle. Maix, and seen them by night, like
Mlle. Reichel. Ignorance, fear, and superstition, would now give to the
luminous appearance the form of a human spectre, and supply it with head,
arms, and feet; just as we can fancy, when we will, any cloud in the sky to
represent a man or a demon.”
The question of identity of odyle with magnetism and electricity is treated
of at some length, and the author arrives at the conclusion that there is no
identity between them. . “As", says he, “we shall never be able to dispense
with either of the words, electricity, or magnetism, so we shall never be
able to do without the word odyle, or some equivalent term, on the adoption
of which men may agree.”
A very long and very elaborate inquiry is entered into respecting the
colours and qualities of the odylic light. It is quite impossible for us to
consider these, (or half the subjects of the work), in extenso; but, so far as we
understand the author, there are a multitude of minute peculiarities in which
the odylic light and odylic phenomena differ from those of magnetism, and
there are others in which there seems a great affinity between the two ; not
the least is, that the odylic nature of the positive magnetic north pole of the

838 BIELIOGRAPHICAL RECORD.
earth, that of the east and that of the ground, have a general character of
agreement, in which they stand directly opposed to the negative magnetic
south pole of the earth, to the west and to the heavens.
Meteorites are supposed to be of planetary origin, small stars in fact,
revolving in their paths round the sun. There is no difference, says the
author, between a planet and a meteorite except in size, and the law which
presided at the formation of meteorites and fixed their structure and com-
position, presided also at the formation of our globe. Meteorites, it is well
known, are metallic masses, mostly iron with nickel, cobalt, &c., but the
author points out, as an essential feature, that in the large majority of
meteorites the abundant iron is not in the form of irregular, accidental, and
scattered portions, but a coherent network of cells pervading their mass,
that, in like manner, the earth has an internal constitution resembling the me-
teorite, and that, in all probability, it is in this iron, that the magnetism of the
earth resides. The Baron possesses, perhaps, the finest collection of meteorites
in the world, and therefore his practical remarks upon them are interesting.
It is not for us to say how far this idea respecting Terrestrial Magnetism
may be correct, but it certainly is ingenious, and must not be lost sight of.
The author enters at considerable length into the question of the nature of
the Aurora Borealis, and arrives at the conclusion, that the polar light is to be
regarded as a vast manifestation of magnetic odylic flame, odylic vapour, and
odylic light. That it has relation to terrestrial magnetism is now generally
admitted; but whether the just explanation is that offered by Baron Reichen-
bach, or whether it depends on causes hitherto veiled from the knowledge
of man, time, and further investigations will perhaps determine. However
this may be, these observations may be considered as one link in that vast
chain of inquiries which is coeval with the intelligence of man, and which,
continually increasing in length, will terminate only with the existence of
OUllr Ta,C6. *
It has been reserved for Baron Won Reichenbach to explain that which
has hitherto been supposed to rest on more poetic grounds. Poems have
been written on the subject of A KISS, and its fascination described under
every figure, and trope –but we feel that we are rather trespassing on Mr.
Dickens in at all alluding to the subject, for a kiss undoubtedly belongs to
“Household Words”. Be that as it may, we should not feel that we were
discharging our duty towards our readers, did we not 'enlighten them as to
the true mature and significance of that tenderest of all salutes. “The lips
(says our author) are one of the foci of odyle, and the flames which our poets
describe as belonging to them, do in fact play there. It may be asked, how
can this be consistent with the fact that the mouth is negative But, in
fact, the two statements harmonise very well, for the kiss gives nothing, but
rather seeks; strives after an equilibrium which it does not attain. It is not
a negative, but physically, as well as psychically, its state is one of nega-
tivity”. (P. 193.) How far this explanation will be acceptable, or how far
it is consistent with experience, are points which it would not be decorous for
us ea cathedrá to decide. Our readers must investigate the subject, and test
the phenomena for themselves.
If we have been almost tempted to mirth occasionally, the author must
pardon us : for we would fain give him every credit for a strong desire to
arrive at the truth. The very nature of the inquiry, to say nothing of the
elaborate character of the reasoning, has prevented us from entering into a
more detailed account of the subject, which could not have been done satis-
factorily in ten times the space which we have at our command; but we are
rather disposed to recommend the profession to read and reflect upon this
work. That much which is stated is contrary to all accepted doctrines, is
most true; but the experiments themselves are easy, and sensitive persons
would appear to abound. It would, therefore, be an act of justice to a
BIBLIOGRAPHICAL RECORD. 839
conscientious writer, and moreover advantageous to science, if impartial
and competent persons would submit his observations and experiments to
the test of repetition on a large scale. The chaff would thus be separated
from the corn, and the truth, vindicated. We conclude by thanking Dr.
Gregory for the able manner in which he has laid Reichenbach's researches
before the scientific men of this country.
ON DISEASEs of MENSTRUATION AND OVARIAN INFLAMMATION, IN connexion
witH STERILITY, PEIyIG TUMoURS, AND AFFECTIONs or THE Wome, By
EDWARD JoHN TILT, M.D., Physician to the Farringdon General Dispen-
sary, etc. London, 1850: pp. 250.
There are two modes by which medical science advances; the one, by the
discoveries of individual minds, which stand out in bold relief from the level
of the age in which they are made ; the other, by gradual and progressive
improvements, resulting from the workings of the general medical mind upon
particular subjects. The first class of discoveries makes individuals famous,
the second distinguishes a medical epoch, or distributes reputation to a large
number of its contributors. If we were asked to name a particular instance
of progress, to which many minds have contributed equally, or almost equally,
we should point to the supremacy now asserted for the ovaries in the female
economy, and the development of Ovarian Physiology or OVARIology. It is
only by an extraordinary succession of interpretations, that the hieroglyphical
signs presented by the ovaries have been deciphered. Had all indeed been
the work of one man, we do not hesitate to say, that it would have constituted
one of the greatest discoveries ever made in physiological science. We may
slightly indicate the steps of this great advancement. Nearly two hundred
years ago, De Graaf explored those vesicles which have received his name.
Before this time, an extraordinary adumbration had surrounded the ovaries.
Won Baer, in our own day and generation, detected the ovules in the vesicles
of De Graaf. The physiology of menstruation or ovulation, dimly hinted at
by Everard Home and Cruikshank, and exhibited theoretically by Dr. Power,
has been made out by the researches of Dr. Robert Lee and by M.M. Gendrin,
Raciborski, Pouchet, Bischoff, Chereau, and many others of all countries. Dr.
Tyler Smith has investigated the influence of the ovaries upon pregnancy and
labour, and has gone far to prove that in ovarian excitement we have the
true cause of labour. Following Won Baer, we have a host of eminent names,
who have contributed largely to the history of the development of the ovules,
before and after conception. Amongst these, honourable mention must be
made of M. Purkinje, who discovered the germinal vesicle, of MM. Coste,
Rudolph Wagner, Wharton Jones, Schwann, Henle, Martin Barry, and nu-
merous other scientific investigators of the highest rank.
We have said enough to windicate the importance of Ovariology, if that
were necessary. But many talented and industrious men have engaged
themselves in the digestion of the results of these labours, and in the appli-
cations of our knowledge of the ovaria, to the contingencies of actual practice.
Of these works, that by Dr. Tilt, now before us, is the most recent, and
the most complete. It is, in many respects, similar to the treatise on the
same subject, published in 1844 by M. Chereau, a highly talented physician
and physiologist of Paris.
Dr. Tilt first demonstrates that which needs but to be mentioned to be
accepted; namely, that what are called the disorders of menstruation, as
amenorrhoea, dysmenorrhoea, menorrhagia, etc., are in reality only the symp-
toms of certain morbid conditions of the general system, or of the gene-
rative organs; in this category, he also, very properly, includes hysteria,
chlorosis, sterility, etc. There can be no doubt, that to consider these disor-
ders, and to treat them as substantive pathologies, instead of as symptoms, is
to work confusion, and to do no little mischief.
840 BIBLIOGRAPHICAL RECORD.
Our author next proceeds to expound his views relative to the frequency
and importance of Ovarian Inflammation, as a disease per se, and of the influ-
ence of the ovaria, as a cause of amenorrhoea, dysmemorrhoea, menorrhagia,
hysteria, sterility, chlorosis, and other disordered conditions of the female
generative system. These are in fact the chief objects of Dr. Tilt's work.
It is our duty to inquire—how far he is correct in his views .
The section which relates to the Different Modes of Ovarian Inflammation,
is of considerable importance. It enters pretty fully upon the subjects of
abdominal examination, vaginal exploration, and the combination of abdominal
and vaginal exploration ; the exploration per rectum, and the combination
of the rectal and vaginal examinations. Dr. Tilt dwells particularly upon
what he terms the “double touch”, a method employed by Recamier, and
which consists in the introduction of the index finger into the rectum, and
the thumb into the vagina ; but this, in our opinion, is only valuable in cases
in which the ovary is displaced, or in which the pelvis is encroached upon
by ovarian enlargement. Many valuable observations are made by the author
respecting ovarian exploration and diagnosis, a confessedly difficult subject,
and one which deserves great attention from the obstetric practitioner. In
this part of his work, Dr. Tilt has introduced a very graceful eulogium of his
teacher and friend, the venerable Recamier, with all of which we can sympa-
thize, though we may not quite agree with the writer. The following sentence
strikes us, for instance, as rather wide and large. “All the modern improve-
ments in the treatment of diseases of women originated with Recamier, for he
invented the speculum. . . . To him also we are indebted for the treatment
of ulceration of the neck of the womb by caustic.” In reply to this we would
observe, that the speculum is a very ancient instrument; and that Harvey
described long ago a case of ulceration of the womb, in which he employed
the speculum, and treated with caustic | But though we are not exactly
indebted to Recamier for the speculum, we owe to him, at least indirectly,
some of the modern excesses both of speculum and caustic.
We proceed to consider Dr. Tilt's description of Acute and Sub-acute
Ovaritis. We cannot do better than quote the author's own words.
“By sub-acute inflammation, as distinguished from acute, we do not so much
imply a difference in the intrinsic nature of the morbid phenomena, as a limit-
ation of the inflammatory action to certain distinct parts of the ovaries, as
the ovarian follicle, and to portions of the ovarian tissue so small, that they
give rise to little swelling, and to no febrile action; and here we may point
out, as peculiar properties of the sexual system in women, the liability to
inflammation of certain portions of the generative apparatus, in which the
others may not participate—a peculiarity to which the ovary is still more
liable, on account of its complex structure.
“Sub-acute ovaritis, whether primarily developed as such, or supervening
on the acute inflammation of the ovaries, is necessarily a chronic disease, from
the circumstance of the ovaries being subject to a periodical augmentation of
nervous and sanguineous excitement. Chronic ovaritis is always sub-acute;
and as sub-acute inflammation of the ovaria is often present without being
chronic, we have thought it best to adopt the appellation common to them
both, instead of that generally made use of. Sub-acute ovaritis is by far the
more common, and, therefore, we will first proceed to its investigation.
“It is evident, however, that in the determination of causes, in the
symptoms, and in the treatment of these two diseases, we shall find a great
similarity; we shall also find that they may pass the one into the other, the
sub-acute being exasperated into the acute, while acute ovaritis sometimes
becomes sub-acute, or chronic, as it is then generally termed.” (pp. 39-41.)
Dr. Tilt gives an interesting account of the Causes of Ovarian Inflamma-
tion, with which we cannot but entirely agree; the chief are, excessive
sexual intercourse, immoral practices, (which singularly enough, Dr Tilt calls
“moral causes”) suppressed menstruation, difficult parturition, inflammation


BIBLIOGRAPHICAI, RECORD. 84 I
of the os and cervix uteri, gonorrhoea, etc. To these may be added, the
application of caustics to the os and cervix uteri, and the frequent use of the
speculum. We have seen several cases in which the use, or rather the abuse
of the speculum, in leucorrhoeal cases, had caused ovarian irritation and
inflammation of a far more distressing character than the original disorder.
Dr. Tilt adduces facts which bear out these remarks, and which are now
almost universally assented to by the profession. He says, “Wé have heard
of practitioners in this country, who submit their patients to speculum exa-
minations daily—nay, twice a day ! O tempora, O mores . With regard to
caustics, it would be also useless to deny the evils produced by these when
handled by imprudent or inexperienced men. Retention of menstruation
has been produced by the cauterization of the external portion of the os
uteri, adhesion not unfrequently having taken place between the external
portion of the os uteri and the vagina, causing the close adaptation of the
orifice of the os uteri to the sides of the vagina. It is then necessary to
destroy the cicatrix, but that is the least part of the matter, the greatest
difficulty in the treatment being to hinder the edges of the wound from again
uniting, as in a case published by J. P. Frank. This has been shown by Dr.
Bernutz, who, after alluding to the cause of retention here indicated, remarks,
“But these are not the only cicatrices produced by these cauterizations, of
which so extensive a use is now made ; the excretion of the menstrual flow
from the neck of the womb is often rendered difficult, and sometimes impos-
sible, by cicatrices (coarctations) situated at the inferior orifice of the os
uteri, and even in the higher position of the canal.”—Archives Gén. de Méd.
Feb. 1849.” (Note, pp. 68-69.)
In some cases in which caustic agents have been used freely during preg-
nancy, the os uteri has been completely obliterated, and the uterus has been
found hermetically sealed at the time of labour, so as to require operative
Iſleå,SUITeS.
We have carefully perused Dr. Tilt's chapter on the Symptoms of Sub-
acute Ovaritis ; and while we admit with him that ovarian disorder is more
frequent and more important than is generally considered to be the case, we
incline to the opinion that he has extended the term “inflammation”, as we
understand it, over too wide a surface. From the symptoms as described by
Dr. Tilt, and from our own experience, we believe that many conditions
which ordinary practitioners would not designate as inflammatory, whether
acute or sub-acute, are included by Dr. Tilt in one general category. In
fact, we entertain some objections to the term “Sub-acute Ovaritis” as not
admitting of precise definition, and as quite capable of including states of
the ovary, of perfectly different, or even opposite characters.
Our talented author speaks of the amenorrhoeal, dysmenorrhoeal, menor-
rhagic, and hysterical types of sub-acute Ovarian Inflammation. Now, in
such a nomenclature, there is much that is striking and novel, but it is
necessary to introduce certain qualifications. With reference to the amenor-
rhoeal type”, he observes, “When sub-acute ovaritis attacks the patient
previous to or in the midst of the menstrual flow, it may be arrested or pre-
vented, but an inflammatory tendency is thereby originated”; and again,
“But if under the influence of the morbid stimulus, the ovaries draw to
themselves the blood they usually cause to be propelled to the uterus, the
disease may give rise to the local symptoms previously described, and may
likewise be accompanied by chlorosis.” Dr. Tilt, it will be seen, uses the word
chlorosis as synonymous with amenorrhoea, which is not quite in accordance
with our own opinions. Generally, chlorosis is a constitutional condition
giving rise to amenorrhoea. It is only in rare cases, and very gradually,
that amenorrhoea as a primary disorder, gives rise to confirmed chlorotic
symptoms. Dr. Tilt very properly refers many cases of amenorrhoea to arrest
of the development of the ovaries, but he also alludes to cases in which
chlorosis, or amenorrhoea supervenes “in the midst of perfect health” in
consequence of sudden suppression of menstruation accompanied by phe-
842 BIBLIOGRAPHICAL RECORD.
nomena which lead us to admit a high state of ovarian engorgement. Sub-
acute ovaritis produces in these cases what an arrest of development pro-
duced in the first.”. With every respect for Dr. Tilt, it has seemed to us
that in these cases, the suppression has been the cause of the congestion and
inflammation, if such exist, and not the inflammation the cause of the sup-
pression, as we should infer is Dr. Tilt's view from the first sentence on this
subject. “When sub-acute ovaritis attacks the patient previous to, or in
the midst of, the menstrual flow, it may be arrested, or prevented.” The
most common modes in which sudden suppression takes place is from cold,
or mental emotion, but the suppression is too sudden to be referred to the
intermediate production of sub-acute ovaritis. Weincline to the opinion, that
the suppression depends upon nervous rather than inflammatory conditions,
and that the congestion of the generative system, which undoubtedly ensues
in such cases, is produced by the suppression of the catamenial flow. When
sub-acute ovaritis does cause amenorrhoea, it is, according to our experience,
gradually produced, generally after the long persistence of dysmenorrhoea or
even menorrhagia. Though on these points, wesomewhat differ from Dr. Tilt,
we nevertheless entertain a very high respect for his opinions.
In all that Dr. Tilt says relating to the dysmenorrhoeal type of ovarian irri-
tation or inflammation, we fully agree. We believe that the most frequent
cause of this malady is to be found in the morbid states of the ovaria. In the
main, too, we coincide with him in all that he says of ovarian memorrhagia,
or excess of the catamenial secretion from excess of the ovarian stimulus.
We also feel well assured, that much of hysteria depends, we would not say
upon sub-acute ovaritis, but on the influence of Ovarian Irritation upon the
emotions, and upon the ganglionic system.
In regard to the Treatment of Sub-acute Ovaritis, Dr. Tilt discusses seriatim
the respective merits of local blood-letting, purgatives, injections, blisters,
medicated unctions, bathing, etc. He also refers to the special treatment of
what he terms the amenorrhoeal, dysmenorrhoeal, menorrhagic, and hysteric
types of the malady under consideration. The observations respecting steri-
lity deserve much attention; but, we think, they might have been extended
with advantage. In conclusion, we strongly recommend Dr. Tilt's valuable
treatise to the notice of the profession.


A PRACTICAL TREATISE on DISEASEs AFFECTING THE SKIN. By the late
ANTHONY ToDD THOMson, M.D., F.L.S., Professor of Materia Medica
and Medical Jurisprudence in University College, and Physician to
University College Hospital. Completed and Edited by EDMUND A.
PARKEs, M.D., Professor of Clinical Medicine in University College, and
Physician to University College Hospital: pp. 436, London: 1850.
The study and treatment of Cutaneous Diseases was one of Dr. A.T. THoM-
SON's favourite pursuits; and he was engaged in the preparation of a treatise
upon the subject for more than a year previous to his fatal illness. At the
time of his death three hundred pages had been written and printed; and as
it was necessary that the work should be completed, the task was undertaken
by his nephew, DR. PARKEs, who most worthily occupies the post of Physician
and Professor of Clinical Medicine in University College Hospital ; and who,
by his acquaintance with Dr. Thomson's opinions and methods of treatment
in cutaneous diseases, was peculiarly well qualified for this duty.
Prefixed to the work is a memoir of Dr. A. T. Thomson, (written, as we
understand, by his widow), which is a very interesting and instructive piece
of biography. We conceive that the following sketch of Dr. Thomson's
career will not be unacceptable to our readers.
Dr. Thomson was born in Edinburgh in 1778. His mother died when he
was a year old, leaving him in such a feeble and precarious state of health,
that he was consigned to the care of a female relative, who subsequently be:
BIBLIOGRAPHICAL RECORD. 843
came his step-mother. His father held a lucrative situation in the American
post-office under the British government ; but when the war broke out, he,
in common with other American loyalists, resigned his situation, and returned
to Great Britain, and lived in the vicinity of Edinburgh upon a small pension,
with which he maintained and educated his family. Dr. Thomson received
the rudiments of his education at the High School of Edinburgh ; but the
greatest part of his subsequent knowledge must have been attained by his
own application. As his father's means would not allow him to educate young
Anthony at the University, the ambition of the aspirant for medical honours
was gratified in the following manner. He obtained, through the influence
of his godfather, Anthony Todd, a clerkship in the Edinburgh post-office,
which secured him a small salary, while it required but little mental appli-
cation, and no great expenditure of time. By these means, he became a
student of the University of Edinburgh ; attended the lectures of Monro,
Gregory, Black, and Dugald Stewart; and, not confining his thoughts to
subjects purely medical, he joined the Speculative Society in 1798, where
politics, literature, and metaphysics were discussed by Jeffery, Horner,
Brougham, Lord Lansdowne, and others, who were destined to play a con-
spicuous part in the history of their country. Dr. Thomson left the University
in his twenty-first year, and repaired to the great metropolis, where he com-
menced his professional career as a general practitioner. He established
himself at Chelsea, where he remained twenty years; and, although his success
was at first doubtful, he succeeded eventually in acquiring a very large and
lucrative practice. During this period of his career, he honourably distin-
guished himself, not only by his zeal and assiduity towards his patients, but
by his devotion to the science and literature of his profession, which at that
time was too generally neglected. It was while engaged in the laborious
duties of his profession, that he found time to compose some of those works
which have gained for him an European reputation, viz., the Conspectus Phar-
macopoeiae, which was published in 1810, and the London Dispensatory, which
appeared in 1811. Public opinion has already affixed the stamp of its ap-
probation upon these elaborate works; and those who have studied the
immense mass of matter contained in the Dispensatory, will readily believe
the statement of his biographer, that it was chiefly composed during hours
Snatched from necessary rest ; and we are told that the author was in the
habit of rising at five o’clock in the morning, to complete a portion of the work
before the commencement of his professional duties. Ten editions of the Dis-
pensatory have appeared ; it has been translated into most of the Continental
languages; it is used extensively in the great German universities; it has
been circulated in America; and its utility has extended even to St. Peters-
burgh, from the Imperial Academy in which city Dr. Thomson received, in
1838, a diploma in acknowledgement of the great merits of the book. While
he was writing these works, he was promoting the study of Botany, then very
little understood or appreciated by the profession, by delivering lectures on
the subject at Chelsea: and we are told that he was the first lecturer on botany,
who ever addressed a medical class in this country. He also published some
lectures on Botany, which obtained for him a considerable degree of reputa-
tion on the Continent, and gained him the acquaintance of De Candolle and
Wom Martius. Through his instrumentality, likewise, a Dispensary was
established at Chelsea, of which he was appointed one of the medical attend-
ants, and at which, we are told, he first became impressed with the great
difficulties attending the diagnosis and treatment of the diseases of the skin,
and resolved to pay especial attention to that department of medical practice.
In alluding to this most active and useful portion of Dr. Thomson's life,
while he was in full and lucrative employment as a general practitioner—
while he was writing those great works on which his fame is built—while he
was lecturing on botany to a distinguished class of his professional brethren—
while he was endeavouring to alleviate the sufferings of the amiº poor—
WOL. II. 5

844 BIBLIOG RAPHICAL, HECORD.
we must not forget that he was also labouring, together with his friend Dr.
George Mann Burrows, to elevate the rank of that class of the profession to
which they both, at that period, belonged. He saw, what no enlightened man
can fail to perceive, that the medical profession was in the most degraded
condition in this country, and he sought to elevate it, not by the establishment
of fictitious distinctions, but by the influence of education; and he had the
gratification of witnessing the partial fulfilment of his wishes by the passing
of the Apothecaries' Act of 1815, which measure, imperfect and faulty as it
undoubtedly is, has effected a most important and a most beneficial change
upon the practice of medicine in this country.
In the year 1826, he left Chelsea, and commenced practice as a Licentiate
of the College of Physicians of London: but we believe that his emoluments,
in this new career, were by no means equal to those which attended his ex-
ertions as a general practitioner. He was the first professor of Materia Medica
in University College, then the University of London; was subsequently
appointed Professor of Medical Jurisprudence in the same institution ; and,
upon the opening of the University College Hospital, he was appointed one
of the physicians of that establishment. He was also appointed Professor of
Botany at the Pharmaceutical Society, and he held this appointment, together
with the others just enumerated, up to the time of his death. During, the
whole of this latter portion of his career, he was distinguished by his exem-
plary punctuality in the performance of his multifarious duties. For several
winter sessions, he lectured to the class of materia medica at University College
at eight o'clock in the morning ; and, when he was upwards of seventy years
of age, we have seen himperambulating the Botanical Gardens in the Regent's
Park, at seven o’clock in the morning, and lecturing to his class with all
the energy and enthusiasm of youth. To his habits of early rising, to his
love of exercise, to his temperance, may be attributed the excellent health
which he enjoyed for many years, although his constitution as a child was
naturally delicate : but in the autumn of 1848, his health and spirits began
to decline ; and, in the beginning of 1849, he was seized with an attack of
bronchitis, for which he tried change of air, with temporary benefit. Another
attack of inflammation, however, supervened, and he died at Ealing on the
third of July, 1849, in the seventy-second year of his age, in humble submis-
sion to the will of Providence. We are happy to quote the following passage
from his biography, as it appears to us to represent precisely what the cha-
racter of a physician ought to be.
“So calm, so blessed were the last hours of one, who may truly be called a
Christian Physician. A few words more may, perhaps, be permitted upon a
character so exemplary. It was strengthened and guided by a sincere belief
in Divine Revelation. His researches and attainments had confirmed his
faith. It was his greatest pleasure, to refer to design as exhibited in the great
system of nature. It was this pervading sentiment which ever accompanied
him into the business of life, and which gave such mental dignity, and main-
tained such integrity and purity of conduct. The fear of God was ever before
his eyes. The principles of his life were truth, charity, reverence; and from
these he departed as rarely as human frailty permitted. His nature was all
nobleness and kindness; he could not retain a resentment, nor cherish a
meanness. It was this high moral tone which made him so valuable a model
for the young practitioner, and so invaluable a friend, as well as instructor,
to his pupils. It was this which procured him their respect, and brought
them, unbidden, mourning to his grave. It was this which made him the
friend of his patients; it was this that bound his family to him, and which
has left in their hearts a life-long sorrow for their loss. It was ever his opinion,
that the study of medicine was one of the finest and most comprehensive of
studies, and that it neither implies nor conduces to scepticism, but the reverse;
and his life, his death, proved the sincerity of this conviction. When, a week
before his death, an alarming paroxysm of suffering occurred, he summoned

BIBLIOGRAPHICAL RECORD. 845
*
to his bed-side his youngest son, a youth of seventeen. He solemnly addressed
him thus: “Above all, keep the purity of your mind and heart. Be religious;
receive the sacrament frequently ; let your conduct be pure ; your conscience
unstained'; and he repeated earnestly, “And recollect, without religious faith
this cannot be l’”
We may conclude this brief sketch of Dr. Thomson's life by stating, that
he was of a most liberal and charitable disposition, and that he was especially
benevolent towards the younger members of the profession, more especially
those who had composed his class. “His pupils,” writes one of them, “ looked
up to him with nearly the affection of sons; and, on many occasions, the part-
ing from his class, at the close of the session, resembled more the separation
of a family, than the temporary suspension of a course of academical lec-
tures.’
Dr. Thomson's Treatise on the Diseases of the Skin is a very valuable con-
tribution to our knowledge of this important, but difficult department of
pathology. It is evidently the result of great and extensive practical expe-
rience, matured by sound theory and excellent judgment. To say that Dr.
Thomson has cleared up all the difficulties which beset the subject, would be
to assert that he alone has succeeded in an attempt in which every one else
has failed; but it must be admitted that, by the clearness of his style, the
simplicity of his classification, and the accuracy of his diagnostic characters,
he has removed many of the obstacles which formerly existed. He follows,
to a certain extent, in his classification, the system of Willan, making, how-
ever, such alterations as the increased knowledge of facts, and the advanced
state of pathology have suggested to his mind.
In his First Chapter, he treats of the ExANTHEMATA, under which head he
includes not only scarlatina and rubeola, but also variola, varicella, and vac-
cinia, together with frambaesia, and the petechial eruptions observed in typhus
and typhoid fevers. All these are considered to be febrile contagious diseases,
non-recurrent, earcept in earceptional cases.
In the Second Chapter, which is devoted to FEBRILE CoNTAGIOUs DISEASEs
capable of recurrence many times during life, he treats of ERYSIPELAS.
In the Third Chapter, among the NoN-FEBRILE ContAGIOUS DISEASEs are
included the different species of Porrigo, as P. Favosa, P. Lupinosa, and P.
Scutulata, and Scabies.
In the Fourth Chapter, the NoN-CoNTAGIOUS FEBRILE DISEASEs compre-
hend Erythema, Urticaria, Roseola, Miliaria, Pompholyx, and Pemphigus.
The Fifth Chapter treats of a great number of diseases very different from
one another, but which agree in being NoN-CoNTAGIOUS AND NON-FEBRILE,
chiefly connected with, and characteristic of, Derangements of the Digestive,
Assimilating and Secreting Organs. These are divided into six orders : I.
The PAPULAR ERUPTIONs, Lichen, Strophulus and Prurigo: II. The PUSTULAR
ERUPTIONs, which include only Impetigo and Ecthyma : III. The WESICULAR
ERUPTIONs, consisting only of Herpes, Eczema, and Rupia : IV. SQUAMoUs
ERUPTIONS, Psoriasis, Lepra, and Pityriasis: W., TUBERIFoRM OF TUBER-
CULAR ERUPTIONS, which comprise Lupus, Elephantiasis, and the Aleppo
Evil: WI. The HAEMORRHAGIC DISEASEs of THE SKIN, the principal of
which is Purpura. The other chapters treat of diseases which cannot be
included in the former divisions ; such as Ichthyosis, Pellagra, the Syphi-
litic Eruptions of the Skin, Acne, Sycosis, Mentagra, Lentigo, Ephelis,
Chloasma, etc. *
This arrangement is supported by much ingenious argument, and reflects
great credit upon Dr. Thomson's sagacity and discernment; but we confess
that we do not altogether agree with him in the opinion which is strongly
maintained, that Wariola,Varicella,and Vaccinia are totally different diseases, as
we think that there are strong grounds for believing, that these three affections
are probably modifications of one disease. Nor do we agree with Dr. Thom-


56 2
846 B1.BLIOGRAPHICAL RECORD,
son in considering Erysipelas as necessarily a contagious disease; for although
we admit that, under certain circumstances, erysipelas spreads rapidly from
one patient to another, yet we believe that it more usually occurs as an
isolated disease. In our own experience, we can perfectly well recollect an
epidemic form of erysipelas which occurred at University College Hospital
in the year 1835, when almost every wound received by the patients, as in
surgical operations, bleeding, cupping, etc. was followed by a severe and
often a fatal attack of erysipelas; but, in all our subsequent experience, we
have not observed that the disease assumed a contagious or infectious cha-
racter, but that it occurred as an idiopathic affection, and without any trace
of contagion. Although erysipelas is always attended with a certain amount
of danger, yet we believe that the type of disease which prevails in Hos-
pitals is far more fatal than that which occurs in private practice, and that
it is important, in a practical point of view, to constitute species founded
upon its infectious or non-infectious character.
Among the Exanthemata, Dr.Thomson describes the two forms of cutaneous
eruption which respectively characterize the Spotted Fever and the Typhoid
Spotted Fever; and, as this distinction is exceedingly important in a practical
point of view, we are induced to copy the descriptions given by the author.
In the Spotted Fever, the Typhus Maculata Petechialis, there are perceived
upon the thorax and abdomen, and occasionally upon the thighs, legs, arms,
and even the face, a number of small rose-coloured spots of an oblong or
lozenge form, scarcely elevated above the surface of the skin, into which
they fade without any definite margin. For two or three days, they only
partially disappear under pressure; and, after that time, they do not dis-
appear at all, whilst at the same time they become circumscribed, become
also deeper in colour, and assume the true petechial character. The
presence of this petechial eruption is a certain indication that there is no
ºulceration of Peyer's glands: a fact which post-mortem examinations of
fatal cases at the Fever Hospital have amply verified. In the Spotted
Typhoid Fever (the Febris Typhoides Maculata) the spots are few, sometimes
not more than three or four, generally appearing upon the abdomen, the
thorax and back, rarely or never upon the extremities: and never upon the
face. The eruption is in the form of a small circular or lenticular spot of a
bright rose-colour, fading into the natural colour of the skin, disappearing
upon pressure during the whole time of its existence, and never displaying
the petechial character. The appearance of this eruption always indicates
morbid changes of Peyer's and the solitary glands : the ulceration of which is
always ... with danger.
In the Introduction to the fourth chapter, we find the following excellent
observations, which we are happy to transcribe entire, as it cannot be too
strongly impressed upon the mind of the Dermatologist, that however import-
ant it may be to discriminate the external characters of cutaneous diseases,
yet that most of those affections are to be considered rather as indicating
some derangement of the whole system than of a single organ, and that the
treatment should be directed accordingly. “These eruptions can generally
be traced to some morbid condition, either of the digestive organs, or the
secreting or assimilating systems; and consequently, independent of fever,
they may still correctly be regarded as symptomatic of constitutional affec-
tions. It is scarcely necessary to remark, that every deviation from the
healthy condition of the skin, if it cannot be traced to the direct influence of
some external agent, such, for example, as great solar heat, which produces
Eczema solare ; or to dry powders and alkaline solutions, which produce two
distinct local forms of psoriasis, and similar causes, must be regarded as
depending on some morbid change, either in the function of digestion, or
assimilation, or secretion, or in some derangement of the general constitu-
tion. This truth was indeed known to Hippocrates, who classed cutaneous
eruptions as local, and general or constitutional. The former are few compared
with the latter: and there is reason for suspecting that even the former,
B I BL IOGRAPHICAL RECORD. 847
with some exceptions, are also connected with general derangement of the
system. With respect to the latter, it is well known that the blood occasionally
becomes changed in its composition, owing to the nutrient matters from which
it is formed not being in their natural state ; hence, either depositions of
morbid matter take place in the tissue of the skin, or inflammations are set
up in it, both productive of various cutaneous eruptions. Many diseases of the
mucous membrane are occasionally excited by the action of external injurious
agencies on the skin ; and, from sympathetic influence, derangements of the
mucous membrane cause diseased conditions of the skin, not only in relation to
its circulation, but in inducing an altered and morbid state of its secreting
function. This sympathetic influence of those two important organs has been
well ascertained; indeed, on no other principle can we explain the repulsion of
some cutaneous eruptions affecting internal organs, and the relief occasionally
afforded to internal diseases by their sudden appearance. I have seen deeply-
seated pains in the chest, which have been mistaken for and treated as pleu-
risy, suddenly disappear, on the breaking out of a crop of herpes on the skin
over the seat of the pain, which probably was in the serous membrane, as
the symptoms closely resembled those of pleurisy. There is no doubt that
the skin and serous membranes sympathize, although in a less degree than
the skin and the mucous membranes; we nevertheless observe inflammation
of serous membranes sometimes excited by the action of hurtful influences
on the skin, and the latter suffering from derangements of the former. The
stomach, and the digestive and secreting organs, however, are generally the
primary sources of the altered conditions of the capillary circulation, and of
the cuticular secretions, that produce many of the eruptions which appear
on the skin.”
When the author is guided by such sound physiological principles, we
may expect that the treatment, which he recommends for adoption in cuta-
neous diseases, should be judicious and efficient : and this indeed is the fact.
We find throughout, that the management of the case is made to consist
more in constitutional than in local remedies, and that it varies in accordance
with the general symptoms exhibited by the patient. Where the secretions
of the chylopoietic viscera are in fault, mild alteratives and antacids are
recommended; where an inflammatory diathesis prevails, bleeding, either local
or general, together with calomel and saline purgatives, are indicated: and
where the disease has become inveterate and obstinate, then the iodide, the
biniodide and the bichloride of mercury, the iodide of arsenic, and the liquor
arsenicalis, may be administered, with the usual precautions to be observed
in the use of such active remedies. In debilitated conditions of the system,
and where the inflammatory symptoms are absent or have disappeared, then
a course of the mineral acids, of the preparations of iron, or of cinchona and
the vegetable bitters, is very properly recommended.
The use of the bath is also strongly indicated in several forms of cutaneous
disease; and it is to be hoped, that the beneficial effect of this important agent
is beginning to be appreciated in this country.
The author condemns, in general, the use of greasy applications in the
treatment of skin-diseases; and in this condemnation we heartily join, as we
believe that there is hardly any form of eruption, which is benefited by
having recourse to such means; and we even agree with the author, that
some of these greasy ointments which contain irritating ingredients, such as
the unguentum hydrargyri nitratis, do more harm than good. When there
are crusts or scabs on the skin, they may be removed by a bread and water
poultice, or one made of decoction of poppies; where the disease affects the
hairy scalp, the hair should be cut close before the poultice is applied ; and
after the scabs are removed, lotions containing the acetate of lead, the car-
bonate of potash, the bichloride of mercury, etc., may be applied, according
to the circumstances of the case.
In the treatment of Lupus, Dr. Thomson was remarkably successful; and
848 BIBLIOGRAPHICAI, RECORD.
we believe that we are only doing an act of justice to his memory, in giving
the following sketch of the plan adopted by him in the management of this
very formidable and intractable disease.
He used but few local applications, and relied chiefly on three medicines,
viz., iron, iodine, and arsenic, together with biniodide of mercury, and the
occasional use of cod-liver oil and quinine. When a patient first came under
treatment, if the general health were at all lowered, and if there were any
anaemic symptoms, cod-liver oil and iodide of iron were given for ten or four-
teen days, the diet being at the same time nutritious, and other means being
adopted to invigorate the system. Afterwards, the alterative treatment com-
menced with the administration of the biniodide of arsenic in doses of one-
twelfth of a grain; and Dr. Thomson considered it the safest plan to adhere
to these small doses, as in large ones it often produces gastrodynia, and when
this has once occurred, the stomach is extremely intolerant afterwards of the
smallest dose. If any gastrodynia came on, the medicine was at once left off,
and opium and hydrocyanic acid were administered. Conium was after found
useful, and was frequently combined with the biniodide. If the latter, how-
ever, could not be borne in any form, the liquor potassae arsenitis, of the
London Pharmacopoeia, was given in small doses of from four to eight minims,
and iodine was rubbed in over the healthy skin to promote absorption. Al-
though local caustic applications were very little employed by Dr. Thomson,
yet he occasionally applied the strong nitric acid to the edges of the ulcer,
or a strong solution of nitrate of silver (3ij or 5iij to 3.j of water) over the
tubercles, and subsequently acetate of lead-wash to lessen the temporary
heat and swelling which followed. If unhealthy, pale, fungous granulations
arose, an ointment of iodide of sulphur, or a very weak ointment of the
biniodide of arsenic, or of either of the iodides of mercury, was employed.
Four cases are recorded in the work, in which the above treatment was
adopted, and with perfect success in every instance.
The last 132 pages are written by Dr. Parkes, and they comprise the his–
tory of several diseases which are unknown in this country, such as Ele-
phantiasis, the Aleppo Evil, Pellagra, and Pachydermia. The elephantiasis
is considered by Dr. Parkes as identical with the leprosy of the ancient wri-
ters. This portion of the work does great credit to Dr. Parkes's industry and
judgment, and in its composition he has availed himself of all authentic
sources of information. Purpura is justly considered by him to be not so
much an elementary form of disease, as an accompaniment or consequence of
several diseased conditions of the system ; and the treatment must, of course,
depend upon the peculiarities of each individual case.
As bearing upon the present subject, we now notice some very interesting
remarks upon the subject of Cutaneous Diseases, lately advanced by DR.
HUGHES BENNETT, and published in some recent numbers of the Edinburgh
Monthly Journal of Medical Science. This accomplished pathologist considers
that the classification of cutaneous diseases, which is best suited to the stu-
dent, is still that of Willan and Bateman, with such modifications, however,
as are suggested by the advanced condition of pathological science.
Dr. Bennett proposes to exclude altogether from the classification of skin-
diseases, such affections as Scarlatina, Rubeola, and Wariola, as he considers
them to be influenced by laws of a peculiar character, and different from those
which regulate other eruptions. He in fact would class them under fevers,
rather than under skin-diseases. Varicella he likewise excludes from the
arrangement, as he considers this disease, and we think justly, to be only a
modification of small-pox. He proposes to abolish the order of Bullae, and
to place pemphigus or pompholyx among the Wesiculae, and rupia among
the Pustulae. Among the Papulae, he considers strophulus only as lichen
occurring in the child; and among Squamae, he regards lepra only as psoriasis
occurring in an annular form. While thus abolishing some of the diseases
established by Willan, Dr. Bennett adds some new ones, which the advance

BIBLIOGRAPHICAL RECORD, 849
of pathology and histology seem to establish. . He proposes the terms Derma-
tozoa and Dermatophyta for those diseases which depend upon the presence of
parasitic animals and plants. The acarus scabiei is placed among the Der-
matozoa, and favus is removed from the pustules and placed among the
Dermatophyta, for reasons which will presently be noticed. Dr. Bennett
states that the diagnosis of skin-diseases should be founded upontheir primitive
and essential appearance, as whether it be a rash, vesicle, pustule, and so on :
the crust they present, whether laminated or prominent, composed of epidermis
only, etc.: ulceration, whenever present or absent, etc. He also admits that
the classification of Willan, like any other classification, is quite inadequate
to clear up the difficulties of diagnosis, which can only be accomplished by
minute and assiduous attention.
In another lecture, Dr. Bennett considers at large the pathology and treat-
ment of favus. From his experiments and observations, he concludes that
the disease is of the nature of a vegetable parasite, an opinion which is con-
firmed by his microscopical investigations. Dr. Bennett also made a num-
ber of experiments, to ascertain whether the disease was capable of being
communicated by inoculation; and, after several trials upon himself and others,
he at last succeeded in producing a genuine eruption of favus upon the arm
of one of the students attending the clinical class. He therefore considers
that the disease is inoculable, and capable of being communicated by conta-
gion; but that it does not readily extend to healthy persons, and that there
must be either a predisposition to its existence, or that the peculiar matter
of favus must be kept a long time in contact with the skin.
It is a rather curious circumstance, mentioned by Dr. Bennett, that while
the porrigo favosa and lupinosa, (considered by Dr. B. as mere varieties), are
common in Edinburgh, the porrigo scutulata is exceedingly rare. In London,
we believe the reverse to be the case; for the latter is with us very common,
and the two former comparatively unfrequent.
Dr. Bennett, in treating this disease, regards it not only as a local affection,
but in many cases as a constitutional malady, dependent upon the causes
which induce scrofulous disease in general. He therefore recommends the
use of such remedies as are calculated to remove the tendency to tubercular
exudation, and he more especially relies upon cod-liver oil, given internally
and applied externally. The local treatment consists in poulticing the
affected scalp for several days, until the favus crusts are thoroughly softened
and fall off. Then the head is to be carefully shaved, cod-liver oil is to be
applied with a soft brush, and the head covered with an oil-skin cap, to pre-
vent evaporation and exclude atmospheric air. This treatment, in the hands
of Dr. Bennett, appears to have been attended with considerable success;
but it must be recollected, that the form of favus which prevails in London,
is a very different disease from that described as occurring most frequently
in Edinburgh.


1. NATURE AND CURE of ConsumpTroN, INDIGESTION, SGROFULA, AND NERVous
AFFECTIONs. By G. CALVERT Hol.I.AND, M.D.; lately Physician to the
General Infirmary of Sheffield. 8vo. pp. 208. London: 1850.
2. CASEs ILLUSTRATIVE of THE CURE of Consumption AND INDIGESTION.
By G. CALVERT Holland, M.D. 12mo. pp. 104. London : 1850.
In our volume for 1849, (p. 748), we noticed a pamphlet by DR. CALVERT
HoHLAND, intended to prove, that the great purpose of the hair in the animal
economy is to act as a safety valve, by carrying off any excess of nervous in-
fluence, and forming “extensive and vital relations with the great principle
pervading the universe.” The books now before us are not so grotesquely at-
tractive as that production, but are simply such as are regarded by the profession
as advertisement books, baited in the present instances with a little homoeopa-
thy, in addition to the usual trash contained in the advertised publications
850 BIBLIOGRAPHICAL RECORD.
of professed curers of indigestion, scrofula, consumption, and nervous affections.
It pains us so to write of an author who once stood well in the ranks of science;
but we must warn the young and the unwary, by reminding them that, though
the applause and the guineas of the London coterie of globulists (over whom
Lord Robert Grosvenor presides), may be pleasant and satisfactory to many,
they can only be enjoyed by those who renounce the good opinion of their
brethren, and openly proclaim themselves as aliens from the domains of legi-
timate medicine.
The first of Dr. Calvert Holland's volumes is dedicated to “Frederick
Foster Quin, M.D., by his sincere and obliged friend the author.” Both
books are replete with Quinism, by which term we may, for want of another,
designate that mongrel species of homoeopathy now in vogue, which inter
alia advises large doses of camphor in cholera, and common quantities of
aloes, or castor oil, as “adjuvants” to the globules, when the bowels are consti-
pated. A lady, who lately consulted us, produced a pot chiefly consisting of
Barbadoes aloes, given to her by a London homoeopathic accoucheur. She
designated the drug, “the homoeopathic paste for constipation”, and took it
nightly in five-grain doses. A second lady, with pulmonary tubercles, in de-
tailing her medical history, informed us, that a homoeopathic physician at
Brighton had ordered her to take cod-liver oil. A third lady assured us, that
a well-known homoeopathic doctor had prescribed for her castor oil | These
cases, and others of like nature which we could enumerate, as well as the
recent tone of homoeopathic writings, convincingly testify, that homoeopathy,
as a system of medical practice, is almost extinct; the name and the globules
being retained, chiefly as topics of discourse and sectarian insignia—insignia
of no mean pecuniary value to those who can adroitly display them.

ExCISION of THE ENLARGED TonsiL, AND ITs CoNSEQUENCES IN CASEs of
DEAFNESS. WITH REMARKs on DISEASEs of THE THROAT. By WM.
HARVEY, Esq., Surgeon to the Royal Dispensary for Diseases of the Ear.
pp. 121. London : 1850.
This little book is the result of experience and reflection, and is therefore
well deserving of the attention of the profession. A review of the entire
subject of Excision of Tomsils, and in particular of 116 cases in which this
operation was performed for the purpose of relieving deafness, has led MR.
HARVEY to declare himself as an opponent of this practice. ... “That occasions
may arise when operations may be called for, in order to afford relief for the
distress occasioned by enlarged tonsils, he does not mean to deny ; but that
deafness could be one of these occasions—at least as long as the anatomical
relations of the tonsil, and the aperture of the Eustachian tube continue the
same as they now are—he can by no means admit.” The following proposi-
tions are illustrated by cases.
. “I. The enlarged tonsil, or elongated uvula, does not, per se, give rise to
imperfect hearing.
“2. Its extirpation does not only not remove deafness, but on some occa-
Sions causes it.
“3. In cases wherein the tonsil is enlarged, the disease is in the mucous
membrane generally, and its morbid condition, when remediable, is so only
by means of a judiciously-regulated constitutional treatment.
“4. The tonsils are not merely secreting organs, but play a further and
most important part in the animal economy, holding most intimate sympa-
thies with important, though distinct, organs.
“5. Extirpation of the tonsil in the young has led to pernicious results,
such as giving rise to bronchial and pulmonary disease, with other mischiefs
mentioned in this work ; and, notwithstanding high authorities in favour of
extirpating the tonsils or uvula for the relief of deafness, the operation has
almost uniformly proved a failure.” (p. 22.)
THE TREATMENT is well explained in the following passage, from which
BIBI.IOGRAPHICAL RECG HD. 851
also may be gathered Mr. Harvey's opinion as to the relation which exists
between chronic enlargement of the tonsils and the rheumatic diathesis. We
invite the profession to make trial of this new therapeutic application of col-
chicum ; and to pay attention generally to the recommendations contained
in the subjoined extract.
“With respect to the line of treatment which I would recommend in cases
of enlarged tonsil, whether such tonsil be hypertrophied or indurated, I
would, in the first instance, administer the bichloride of mercury in small and
divided doses, combined with tincture of rhubarb and of bark, to be taken at
bed-time; I also advise tincture of colchicum (the wine of the seeds) internally;
enjoining at the same time an external application of the colchicum, combined
with soap liniment, to be rubbed on the neck. There are cases, as already
stated, of tonsillar enlargement, in which much benefit has been derived from
the internal use of cod-liver oil. This treatment, however, seems more par-
ticularly adapted to cases, where a decided scrofulous character predominates.
This condition, I think, prevails more in children under puberty, and in whom
the health is very much below the ordinary standard.
“No single remedy can be relied upon, nor do I hold out any specific power
in colchicum as a panacea ; but of all those medicines that have been recom-
mended for the discussion of these troublesome glandular affections in a
chronic state, I think it will be found the best. But as the change of the
constitution is to be promoted, I have found also a change in the remedy
sometimes necessary, the habit approaching very much that of the scrofu-
lous diathesis; of course all means adapted to amend that condition should be
employed.
“I have long since thought, from many specimens of these diseased tonsils
which I have examined after extirpation, having had also the opportunity of
investigating their history, that their contents resemble very much those
concretions found in the joints of gouty and rheumatic patients, and hence
it occurred to me that these concretions might be amenable to the same mode
of medical treatment, and the control of the same medicine, viz., Colchicum,
as the gouty concretions themselves.” (pp. 76–77.)
In speaking of “Scrofulous Sore Throat”, Mr. Harvey has the following
remarks :
“In the affections which we are now considering, influenza, as has just
been noticed, is a very important agent, particularly during the autumn and
winter months, producing disease in the throat, and, as a consequence, deaf-
ness in either one or both ears. This affection more frequently exhibits a
rheumatic character, and the structures of the ear are particularly subjected
to its aggression ; the membrane becomes sometimes dry, and sometimes
granular; this appearance is continued up to the internal lining of the tym-
panum, after having produced a thickening of the sides of the pharynx, and
frequently enlargement of the tonsil. The same consequences are observed
to take place in the scalp and pericranium, and perhaps even in the meninges.
But as the attack is generally attended with an asthenic condition of the
constitution and great debility, we are precluded from treating it more actively
than by blisters, or by colchicum, the latter to be applied both locally to
the part most affected, and to be given internally also. I have also known
otitis to occur, and sometimes abscess to form in the glandular system, more
frequently in the parotids, producing great pain over the head, with tender-
ness of the pericranium, and accompanied by catarrhal and laryngeal irrita-
tion in the chronic form : when the patient experiences a dryness of the
nostrils and soreness of the throat, accompanied with a dry cough, and pain
of the ears of one or both sides, then it is that our attention is more particu-
larly called for.
“This condition now described is attended with considerable dulness of
hearing ; it may occur suddenly, or come on very gradually, during the course
of the influenza attack, affecting one or both ears, until it arrives at so high


852 BIBLIOGRAPHICAL RECORD.
a degree, as to occasion considerable inconvenience to the patient. It may
so happen that one ear only suffers, the other not participating in the diseased
action. Noises in the ears are present during the whole course of the disease,
which often continue to distress and harass the patient for some time after
the convalescence. This symptom, however, does not necessarily indicate
any serious or unfavourable change in the structure of the organ, whilst the
symptom may be referrible to chronic inflammation about the fauces and soft
palate ; they appear swollen, and the uvula considerably relaxed.
“The indications of treatment appear better carried out by the exhibition
of colchicum, both externally and internally, and by warmth to the head.
There is an exacerbation ordinarily towards evening, the affection assuming a
remittent character. The disease so much resembles rheumatism in its pa-
roxysms, that, without objecting to the treatment ordinarily adopted for that
affection, I cannot help observing that in the treatment, both as respects the
ears and the throat, the colchicum combined with quinine is the only remedy
we can rely upon, exhibited internally, and used externally in the form of
embrocation.
“I have for some time relied upon the wine of the seeds, and given it for
a continuance in small doses, never exceeding five drops, three times in
twenty-four hours. The granular appearance of the mucous membrane is
tedious in yielding, but the most troublesome symptom, and one that con-
tinues most obstinately to distress the patient, is the noise in the ears, the
most effectual remedy for which I have found to be the colchicum. As the
normal condition of the membrane returns, so also will the audition. It is
at this period we are more perhaps induced to look to the Eustachian passage,
as the only means to relieve our patient. But in so far as my experience has
been directed to this point, a much greater reliance can be placed upon the
constitutional treatment, than upon either local or instrumental interference;
instrumental aid being deemed as a dernier ressort.” (pp. 91-93.)
For interesting remarks upon “the dependence of speech on hearing” and
other topics, we must refer our readers to the author's treatise. Our object has
mainly been to direct attention to what is both the most novel, and the most
important part of the treatment recommended. We have had no experience
of colchicum in chronic enlarged tonsils; but we have long principally relied,
in such cases, upon constitutional remedies, and can sincerely and strongly
testify in favour of a long continued course of small doses of iron; the patient,
at the same time, taking occasionally, (for weeks at a time), one or two tea-
spoonfuls of cod-liver oil twice or thrice daily. The preparations of iron,
which we prefer, in such cases, are the syrup of the iodide, and the citrate of
iron with quinine. It answers well to alternate them. From four to twelve
drops three times daily of the syrup of the iodide of iron, of the Edinburgh
Pharmacopoeia, is a sufficient quantity. It ought (immediately before adminis-
tration) to be largely diluted with water; and taken at meals. From gr. ss. to
gr.jss. of the citras ferri c. quiná, is, we think, a sufficient dose for a child under
twelve years. Larger doses sometimes, but not commonly, give more rapidly
beneficial results; but generally, they cannot be long borne, and a good medi-
cine thus runs the risk of being discontinued before it has had a fair trial; for
under weeks, or even months, a satisfactory result cannot always be obtained.
PRINCIPLEs of SURGERY. By JAMES MILLER, F.R.S.E., Professor of Sur-
gery in the University of Edinburgh. Second Edition, 8vo., pp. 803. Il-
lustrated by 238 Engravings on wood. Edinburgh : 1850.
We have examined this work with care, and can commend it to our readers
as up to the present state of knowledge. The matter, besides being well
condensed and digested, is clothed in remarkably clear and readable lan-
guage. For students, we think it most suitable as a text-book; and practi.
tioners will generally find in it a sufficiently copious exposition of the prin-
ciples of the modern science of Surgery.
HIBILIOGRAPHICAL RECORD, 853
*.
GouT : ITS CAUSEs, CURE, AND PREVENTION, BY AN ORIGINAL AND Most
SUCCESSFUL TREATMENT, FounDED ON THE ORGANIC CHANGES IN THE
HUMAN Solips, AND on THE FUNCTIONs of THE SKIN, witHouT THE
Use of CoICHICUM. By ABRAHAM ToulMIN, M.D., Member of the Royal
College of Surgeons of England; Surgeon, for nineteen years, to the Tower
Hamlets' Dispensary; and late Consulting Accoucheur to the Universal
Medical Institution for Lying-in Women. pp. 112. London: 1850.
The suspicions excited by this title are confirmed by the very first words of
the preface,—“In submitting to the public what, I flatter myself, will be
found to be a greatly improved method of treating Gout,” etc., and esta-
blished, beyond all question, by the concluding paragraph of the introduc-
tion, in which we are told of various subjects necessary to be discussed at the
outset, because a preliminary consideration of them “will be so important in
enabling us to point out satisfactorily to the general reader" the causes of
Gout.” We know, therefore, at once, with what sort of a book we have to
deal ; and, speaking as plainly to the author as he has spoken to us, we take
leave to tell him, that, in writing a work of this character, he has grievously
sinned against the profession to which he belongs. Some subjects connected
with medicine may be legitimately treated in a popular style, adapted to the
popular understanding; but we affirm, without fear of contradiction by any
right-minded person, that when a practitioner has, or thinks he has, disco-
wered a new or improved method of treating any disease, he is bound by all
the laws of honour to submit it, first and specially, to the judgment of the
profession. The general public are incompetent to judge of its rightness or
its wrongness; and, in appealing to such a tribunal, the author is seeking a
verdict which is of no scientific value whatever.
Having premised this, and thus delivered our conscience, we shall state,
as succinctly as we may, DR. ToULMIN's views and treatment. His theory of
Gout is given in the following words: “The formation, then, of urate of soda
in the animal organism may be considered as originating the gouty diathesis;
and its deposition in some one or other of the joints, as the proximate or
exciting cause of the acute attack.” (p. 24.) The insolubility of this salt
prevents its excretion by the kidneys, and therefore it is retained in the
blood; and, being of a highly irritating nature, it causes all those uneasy feel-
ings and anomalous sensations which aré so well known to the gouty subject.
“As it increases in quantity,” Dr. Toulmin remarks, “the system would
naturally feel the importance of getting rid of a matter so injurious to its
healthy action ; and, not being able to expel it by either of the usual outlets,
would adopt the only alternative left her, that of depositing it in some part
of the body, out of the way of her operations,” and farthest removed from the
centre of vitality; and hence the extreme joints of the feet and hands are
generally first affected.” (p. 22.) But these districts of her government,
though out of the way of the good old lady, Nature's, operations, rebel against
the unwelcome intruder; for “ º: will have no difficulty in con-
ceiving the immense irritation that the deposition of a concrete earthy mat-
ter in the joints, must produce in parts peculiarly smooth and hard in tex-
ture, and intended by nature to have free motion on their articular surfaces.
Thus, no sooner is such deposit made, than inflammation of a peculiar kind
is set up ; when, after a longer or shorter period, the absorbent vessels of the
part are stimulated to increased action, and again decompose it. It now
once more enters into the circulation under new affinities, and becomes ulti-
mately excreted in some soluble form.” (p. 23.) It is a pity to knock such
a pretty little theory on the head; but we are provokingly reminded of vari-
ous other abnormal presences in the blood, which the system does vigorously
resent, but without having the good sense to put thus out of the way, for the
purpose of being taken in again in a more manageable shape. We would be


* The italics are our own. * The italics here are Dr. Toulmin's,
854 BIBI, IOGRAPHICAL, HECORD.
glad also if Dr. Toulmin would condescend to inform us, by what sort of in-
creased action the absorbent vessels succeed in reducing to a more comfort-
able shape this troublesome invader of the peace of the distant parts.
Dr. Toulmin's treatment has for its chief object the removal of urate of
soda from the system ; and as the kidneys, according to him, refuse to excrete
it, and it cannot find an outlet by the alimentary canal, the skin is the only
channel left. To bring about a free discharge from the cutaneous surface is,
therefore, the great desideratum ; and this is effected by the use of the
Thermaclin,_that is to say, a hot-air bath. The following is then the way in
which an acute attack should be managed. “In all cases, it will be neces-
sary to prepare patients for the use of the thermaclin, by exhibiting some
kind of aperient medicine; in general, a few grains of blue pill or of calomel
over night, with a saline purgative in the morning, will be sufficient ; but in
others, the preparation will require a longer time. No general practice can,
therefore, be laid down that is applicable to every case. If, in addition to
the usual arthritic inflammation in the part affected, there be a sthenic dia-
thesis present, characterized by a quick, full, and hard pulse, venesection at
the arm is a prerequisite essentially necessary; long experience having taught
me, that to attempt the use of the thermaclin, in such a state, is useless. . .
But in the majority of cases, this state of system will not be found to exist;
in such, having previously emptied the bowels by a suitable aperient, and
abstinence from solid food having been enjoined, for at least five hours, the
patient is placed in an alkaline warm bath, at 98° F. where the skin is well
cleansed with soap. This not only answers the purpose of ablution, but pre-
pares the skin for diaphoresis, whilst the absorption of the alkali into the
blood has an important and beneficial effect. The patient may remain in the
warm bath half an hour, and it is here, also, that the bleeding, when required,
can be best performed; the blood flowing more freely, from the heated
medium in which the patient is resting. He is then dried and removed from
the bath to the thermaclim, the temperature of which will depend on the
peculiar symptoms present. After a longer or shorter period, profuse perspi-
ration will appear, when, if the apartment be small, or the atmosphere mild,
the door and windows may be thrown open, and the patient be supplied with
copious draughts of cold water, which, instead of checking, will materially
facilitate the flow of perspiration. After a period of time, varying in dura.
tion from one to three hours, he may be taken out, wiped dry, and placed in
a warm bed, and subsequently have given him some light nourishment, in a
fluid form, and then be left to his repose.
“The first thermaclin is always attended with less easy feelings than any
succeeding one ; there is, at first, greater difficulty in inducing free perspira-
tion ; the exhalent vessels, also, throw out a more offensive odour than after-
wards, which, in some cases, is indeed very powerful, and affords a criterion
of the state of the patient's health. In the morning, it will in general be
found, that he has passed a very comfortable might; that the pain and red-
ness of the limb are much diminished, and that he can now bear pressure
with a degree of impunity, compared with the preceding day. He is now
again to be placed in the thermaclin, which he will find more pleasant than at
first. The perspiration will flow with greater freedom, and the peculiar odour
above mentioned will be less offensive. On the termination of the second
thermaelin, all the symptoms will be most materially mitigated; pain will
have ceased, and the swelling of the limb be much diminished. By this
time he will, in general, be able to walk about his room; but as the cutaneous
pores are open, he had better not quit it. His diet should be of a light
description, avoiding animal food. '
“When the thermaclin should be again repeated, must depend on the pecu-
liar circumstances of each case; usually three or four repetitions of it will
be found sufficient to remove all traces of the recent attack; by which time, if
the constitution be good, and the gouty disposition of not very long standing,
I31 BillOGRAPHICAI, RECORL). 855
even the stiffness will also have greatly disappeared. What medicine may
be necessary, must depend on the peculiar symptoms present in each case, and
particularly on the state of the urine. If there is much deposition of lithic
acid in that fluid, a saline, containing citrate of ammonia, may be exhibited
with advantage; in some cases, a few grains of Dover's powder will be use-
ful, and in others, a saline aperient will be required, but on no account col-
chicum. . . . When the pain, redness, and tumefaction, have all entirely
subsided, the patient may take his last thermaclin (which, for this purpose,
should be given in the morning), and on getting out of it, he may, without
loss of time, immediately step under the shower-bath; after which, he must
be well rubbed down with coarse towels, and dress quickly. The process is
now completed ; the patient may expose himself to the open air with perfect
safety, and it is desirable that he should take some exercise. He may then
sit down to a hearty breakfast, to compensate for his previous abstinence.”
Several cases are related, showing the successful operation of this plan.
PRACTICAL OBSERVATIONS ON THE PATHOLOGY AND TREATMENT OF CERTAIN
DISEASEs of THE SKIN GENERALEY PRONOUNCED INTRACTABLE. Illustrated
by upwards of Forty Cases. By THoMAS HUNT, M.R.C.S.Eng., F.S.A.,
etc. pp. 156. -->
In this work, the author does not profess to throw any new light upon the
Pathology or the Classification of Cutaneous Diseases; and indeed his whole
object seems to be to prove, that for certain chronic and inveterate affections
of this class there is only one remedy, namely ARSENIC,
Although we do not wholly approve of the plan of writing a book, for the
purpose of proving that any one remedy is an infallible cure for a large
group of diseases, we are, on this occasion, inclined to overlook the fault, as
many of MR. Hunt’s observations are well worthy of attention.
The diseases which Mr. Hunt considers as most likely to be benefited by
his plan of treatment are Lichen, Prurigo, Lepra, Psoriasis, Pityriasis, Chronic
Urticaria, Purpura, Impetigo, Ecthyma, Eczema, Acne, Sycosis, Lupus, and
non-congenital Naevus; all which, “differing widely, one from another, in
their eruptive forms, and searcely presenting one positive, palpable, and dis-
tinctive point of resemblance to each other respectively, may yet be regarded
as one disease, manifested in different individuals by different kinds and
degrees of cutaneous inflammation or irritation.” (Page 4.)
Mr. Hunt's treatment consists in first preparing the system of the patient,
by rectifying any local or constitutional disorder which may coexist with
the cutaneous eruption. He then commences the arsenical treatment by
giving the Liq. Potassae Arsenitis of the London Pharmacopoeia, in doses of
five minims three times a day. He points out the necessity of continuing
the remedy in diminished doses for a considerable time, and he states, as the
result of his experience, that he has never observed any unfavourable symp-
toms to follow the long-continued employment of the mineral under these
circumstances. He recommends that it should be given with the beverage
taken with or after meals; that its effects should be watched, and the patient
examined at least twice a week. He lays great stress upon the fact, that
before the system is injuriously affected by the arsenic, the patient feels a
pricking sensation in the tarsi, and the conjunctiva becomes slightly inflamed.
* At this crisis,” says Mr. Hunt, “the disease is brought under arrest, and
generally from this period appears to be shorn of its strength.” (P. 12.) He
then diminishes the dose, but perseveres in the use of medicine for a length-
ened period; indeed, until the cutaneous affection disappears. The cases in
which arsenic has failed have been, according to Mr. Hunt, 1st, Those which
are of a syphilitic character, and which are remedied by mercury, not by
arsenic ; 2nd, Those in which arsenic is given during an inflammatory or
febrile condition; 3rd, Those in which it is given upon an empty stomach,
and in which, therefore, it is apt to produce gastro-enteritis; 4th, Those in
which it is given in too large or in gradually increasing doses.

856
CLASSIFIED CATALOGUE OF THE PAPERS WHICH HAVE
APPEARED IN THE BRITIs H AND Foreign MEDICAI.
PERIODICALs FRom JANUARY 1849.
CHAPTÉR III.
OBSTETRICS, AND DISEASEs PECULIAR To woMEN.
BRITISH AND AMERICAN Journals, FROM JANUARY 1849 TO JUNE 1850.
BY ALEXANDER HENRY, M.D.
The following Journals are referred to in this Chapter.
London Journal of Medicine ... ... ... ... Lond. Journ. of Med.
Medico-Chirurgical Transactions ... ... ... Med.-Chir. Trans.
British and Foreign Medico-Chirurg. Review. B. and F. Med.-Chir. Rev.
Guy’s Hospital Reports ... ... ... ... ... Guy's Hosp. Rep.
Lancet ... ... . . ... ... ... ... Lancet.
Medical Gazette ... ... ... ... ... ... Med. Gaz.
Medical Times ... ... ... ... ... ... Med. Times.
Provincial Medical and Surgical Journal ... Prov. M. and S. Journ.
Edinburgh Medical and Surgical Journal ... Edin. Med. and Surg. J.
Monthly Journal of Medical Science ... ... Edin. Month. Journ.
Dublin Quarterly Journal ... ... ... ... Dub. Quart. J.
Dublin Medical Press ... ... ... ... ... Dub. Med. P.
American Journal of Medical Science ... ... Amer. Journ. of Med. Sc.
Philadelphia Medical Examiner ... .. Phil. Med. Ex.
Transactions of American Medical Association. Amer. Trans.
PHYSIOLOGY AND PATHOLOGY OF THE REPRODUCTIVE FUNCTION,
PRocKEATIVE Power, in relation to Population, etc. RouTH (C. H. F.) Lond.
Journ, of Med., March 1850, vol. ii, p. 240.
REFLEx FUNCTION, Application of, to Parturition and Obstetrics. Power
(John). Lancet, Jan. 26, 1850, p. 113.
PREGNANCY, Duration of, in the Human Female. REID (James). Ibid.,
April 13, and May 18, 1850, pp. 438 and 596.
MILK, Early Secretion of, in Pregnancy. TRAYER (J. J.) Med. Gaz., Jan.
25, 1850, vol. xlv., p. 144.
FoETUS IN UTERo, Attitudes and Positions of, Natural and Preternatural ; Acts
of the Reflex or Excito-Motory System. (Plates.) SIMPson (J.Y.) Edin.
Month. Journ., Jan., April, and July, 1849, vol. iii, N. S., pp. 423, 639,
and 863. As inoculating the Maternal with the Peculiarities of the Paternal
Organism; Influence exerted by the Male on the Constitution and the
Reproductive Powers of the Female. HARVEY (Alexander). Ibid., Oct.
1849, vol. iii, N. S., p. 1130.
MENTAL INFLUENCE of Mother on Child. LANE (Butler). Prov. M. and S.
Journ., March 7, 1849, p. 124.
UREA in Liquor Amnii and Foetal Urine. M'CLINTock (Alfred H.) Dub.
Quart. J., Feb. 1849, vol. vii, N. S., p. 39.
PLACENTA, Construction of; Mode of Communication between Mother and
Foetus. ADAMs (F.) Med. Gaz., Jan. 26, 1849, vol. xliii, p. 150.
SUPERFOETATION. HENRY (Alexander). Lond. Journ. of Med., Dec. 1849,
vol. i., p. 1087. Case of in a Negro Woman, who gave Birth to Twins of
Different Colours. CABTER (R.) Phil. Med. Ex., Sept. 1849, vol. v., N.
S., p. 523. Cases of, in a Negress. TAYLOR (T. B.) Amer. Journ. of
Med. Sc., April 1849, vol. xvii, N. S., p. 549. From N.O. Journ., Nov.
1848. (Quoted in Lond, Journ. of Med., 1849, p. 1096.)
BRITISH AND AVIERICAN JOURNALS. 857
ExtRA-UTERINE FOETATION, Case of Thomas (Evan). Med. Times, May
19, 1849, vol. xix, p. 570.
STERILITY, Clinical Reports of Cases of . LEE (R.) Lancet, vol. i., 1849, pp.
550,662, and 688; vol. ii, p.264. Some of the Causes of, remediable by
Mechanical Means. GREAM (G.T.) Fbid., Jan. 27 and Feb. 24, 1849,
pp. 90 and 204. Abs. in Lond. Journ. of Med., April 1849, vol. i., p. 383.
New Method of Treating, by the Removal of Obstructions of the Fallopian
Tubes. SMITH (Tyler). Ibid., May 19 and June 9, 1849, pp. 529 and
603; and Aug. 4, p. 116. Abs. in Lond Journ. of Med., June 1849, vol.
i, p. 590; July, p. 677.
PREGNANCY AND ITS DISEASES.
PREGNANcy, Vomiting in, Treatment of Stoltz (Dr.) Lond. Journ. of Med.,
Jan. 1842, vol. i., p. 100. From Bulletin Général de Thérapeutique, 1848.
With Chorea, Cases of LEVER (J. C. W.) Guy's Hosp. Rep., Oct. 1849,
vol. vi, part ii, p. 233. Sudden Death, connected with; Phlebitis and
Duodenitis. GeoRGE (R. F.), Prov. M. and S. Journ., Jan. 24, 1849,
p. 44. . Malingered, Delivery, Case of LEveR (J. C. W.) Guy's Hosp.
Rep., Oct. 1849, vol. vi, part ii, p. 239. Denied, Case of LEveR (J. C.
W.) Ibid., p. 240, GEdema in. DEVILLIERs and REGNAULT (MM.)
B. and F. Med.-Chir. Rev., Jan. 1849, vol. iii, p. 273.
Abortion, Induction of, in a Case of Contracted Vagina from Cicatrization.
CI. Lect. on. OLDHAM (H.) Med. Gaz., July 13, 1849, vol. xliv, p. 45.
Produced by Metastasis in Cynanche Parotidaea. SALTER (Thomas). Ibid.,
July 20, 1849, vol. xliv, p. 106.
PREMATURE LABoub, and Symptoms similar to those of Irritant Poisoming,
induced by Excessive Indulgence in Ardent Spirits. ConMAck (John
Rose). Lond. Journ. of Med., Feb. 1849, vol. ii, p. 203. Cases of, from
Unusual Causes, with Remarks. PostFR (Isaac G.) Amer. Journ. of
Med. Sc., Jan. 1849, vol. xvii, N. S., p. 33.
PuerperAL CoNVULsions. See Accidents and Diseases after Delivery, p. 859.
IXISEASES OF THE FOETUS.
Double MonstERs, Contributions to the Anatomy of Poland (A.) Guy's
Hosp. Rep., Oct. 1849, vol. vi, part il, p. 248.
Monstros1TY, Case of HARRISON (J. B.) Lond. Journ. of Med., Jan. 1850,
vol. ii, p. 79.
SMALL-Pox, Intra-Uterine, Case of SIMPson (J. Y.) Edin. Month. Journ.,
April 1849, vol. iii, N. S., p. 694. Abs, in Lond. Journ. of Med., April
1849, vol. i., p. 407.
Liquor AMNII and Meconium both Bloody. Moir (Dr.) Edin. Month.
Journ., April 1849, vol. iii, N. S., p. 708.
PLACENTA, Observations on Diseased States of, as influencing the Process of
Parturition. BREMNER (John). Edin. Med. and Surg.J., July 1849, vol.
lxxii, p. 56. Case of Disease of; Apoplectic Effusion. ELKINGTON (F.).
Prov. M. and S. Journ., May 30, 1849, p. 301.
LIGATURE of CoRD after Delivery. WooD (A.) Edin. Month. Journ., June.
1849, vol. iii, N. S., p. 853.
HAEMoRRHAGE from Umbilicus after Separation of the Funis. MANLEY (J.)
Med. Gaz., May 3, 1850, vol. xlv., p. 755.
INFANTILE_Asphyxia, Curious Treatment of at Smyrna. M'CRAITH (James).
Med. Times, April 28, 1849, vol. xix, p. 509.
DIFFICULT AN D COMPLICATED LABOURS.
PROTRACTED LABours, Treatment of Women in. CRAIG (John). Med. Gaz.,
May 24, 1850, vol. xlv., p. 888.
DIFFIcult PARTURITion. BuBDEN (Dr.) Dub. Med. P., June 20, 1849, vol.
xxi, p. 385. Illustrations of DAvis (J. HALL). Lancet, 1849, vol. i,
pp. 39, 342; and vol. ii, pp. 292, 480, 604. From Ovarian Tumour;
858 CLASSIFIED CATALOGUE.
Operation; Successful Termination. MooRMAN (W.) Ibid., July 14,
1849, p. 30. From Large Fleshy Tumour of Pelvis; Chloroform ; Death
on Seventh Day. ELKINGTON (F.) Prov. M. and S. Journ., May 30,
1849, p. 302. From Intra-Pelvic Tumour. Lewis (Samuel). Phil. Med.
Ex., Aug. 1849, vol. v., N. S., p. 455. From Prolapsus of the Bladder;
Vesico-Vaginal Fistula; Craniotomy; Recovery. M*Con MACK (M. J.)
Lancet, Feb. 16, 1850, p. 204. From Permanent Occlusion of Uterus.
Fog ARTY (F. W.) Ibid., March 2, 1850, p. 264. From Stricture of
Uterime Parietes round Child's Neck. SKAE (D.) Edin. Month. Journ.,
April 1850, vol. i., 3rd S., p. 391. From Large Size of Foetus. M'Sw1NEY
(Dr.) Dub. Med. P., Feb. 21, 1849, vol. xxi, p. 116. From Great Foetal
Disfigurement. Holt (W.) Med. Times, August 25, 1849, vol. xx, p.
155.
HEAD PRESENTATION, New Form of Obstruction in, from Posterior Displace-
ment of the Arm. SIMPson (J. Y.) Edin. Month. Journ., April 1850,
vol. i., 3rd S., p. 389.
SPONTANEous Expulsion of Child in an Arm Presentation, Peculiarity observed
in. SIMPson (J. Y.) Ibid., Feb. 1849, vol. iii, N. S., p. 560. Case ;
Remarks on this Form of Delivery, and on the Treatment of the Placenta
under extensive Morbid Adhesions. Dyce (Robert). Ibid., May 1850,
vol. i., 3rd S., p. 433.
LABou R accomplished through the Perinaeum. Ellis (S. C.) Amer. Journ.
of Med. Sc., Jan. 1849, vol. xvii, N. S., p. 260. From New York Journ.
of Med., 1848. Abs. in Lond. Journ. of Med., July 1849, vol. i. p. 597.
PLACENTA PRAEvia, Cases of BARKER (T. H.) Prov. M. and S. Journ.,
April 4, 1849, p. 178. WALLER (C.) Med. Times, April 14, 1849, vol.
xix, p. 470; Oct. 20, 1849, vol. xx, p. 319; June 8, 1850, vol. xxi, p.
415. BURNs (R.) Phil. Med. Ex., Dec. 1849, vol. v., N. S., p. 720.
Report on Treatment of, as proposed by Dr. J. Y. SIMPson. Amer. Trans.,
1849, vol. ii, p. 239. Complete; Separation of Placenta; 'Application of
Electro-Galvanism. SKINNER (W. A.) Guy's Hosp. Rep., Oct. 1849,
vol. vi, part ii, p. 347. With Unavoidable Haºmorrhage; Extensive Lace-
ration of Placenta. KEILLER (Dr.) Edin. Month. Journ., March 1850,
vol. i., 3rd S., p. 301. With Foot Presentation, Case ; Bourse (T.) Med.
Gaz., Feb. 22, 1850, vol. xlv, p. 326.
PLACENTA Expelled before Child, Case of KYLE (Dr.) Edin. Month. Journ.,
Feb. 1850, vol. i., 3rd S., p. 196.
FUNIs, Prolapse of, Lecture on. MURPHY (E. W.) Med. Gaz., May 4, 1849,
vol. xliii, p. 752.
RETENTion of PLACENTA, Remarks on, with especial reference to Hour-Glass
Contraction of the Uterus. Hopg|Es (R.) Prov. M. and S. Journ., May
29, 1849, p. 283.
GRAvid UTER Us, Prolapse of, during Labour. WATson (E. T.) Ibid., Jan.
24, 1849, p. 53. From Phil. Med. Ex., April 1848. k
UNAvoidABLE HAEMoRRHAGE, Lecture on. MURPHY (E. W.) Med. Gaz.,
Jan. 12, 1849, vol. xliii, p. 45.
OBSTETRIC oper ATIONS, INSTRUMENTs, AND MEDICINES.
OPERATIVE MIDwiFERY, Letter on. SIMPson (J. Y.) Lancet, Dec. I5, 1849,
. 648. -
Foº on the Employment of, in Midwifery. STEwART (C.) Ibid., Sept.
22, 1849, p. 309.
ATMosPHERIC PRESSURE, Application of, to aid Delivery. JAMEs (J. H.)
Med. Gaz., March 16, 1849, vol. xliii, p. 478. Suction-Tractor, a new
Mechanical Power, as a Substitute for the Forceps in Tedious Cases.
SIMPson (J. Y.) Edin. Month. Journ., Feb. and March 1849, vol. iii,
N. S., pp. 556 and 618. Abs. in Lond. Journ. of Med., March. 1849, vol. i.,
p.283. Correspondence between Drs. SIMPsoN and MitchELL respecting
**
IBRITISH AND AMERICAN JOURNALS. 859
Priority of Invention. Med. Gaz., March 23, April 6 and 13, 1849, vol.
xliii, pp. 519, 609, 656. Abs. in Lond. Journ. of Med., April 1849, vol.
i, p. 386, and June, p. 595.
TURNING, Memoir on, as an Alternative for Craniotomy and the Long Forceps
in Deformity of the Brim of the Pelvis, etc. Simpson (J. Y.) Prov. M.
and S. Journ., 1849, Jan. 10, p. 9. Also KING (George). Ibid., Dec. 12,
. 681. ;
Cºx, Cases of BARTRUM (J. S.) Ibid., June 12, 1850, p. 318. Cra-
niotomy Forceps, a New Form of ZIEGLER (Dr.) Edin. Month. Journ.,
May 1849, vol. iii, N. S., p. 770.
CAESAREAN Section, Successful Case of, with Remarks. RADFord (Thomas).
Edin. Med. and Surg. J., Jan. 1850, vol. lxxiii, p. 62. Prov. M. and S.
Journ., Aug. 22, 1849, p. 456. Case of, under the Influence of Chloro-
form. CAMPBELL (John). Med. Gaz., June 29, 1849, vol. xliii, p. 1105.
Case of SHIPMAN (A, B.) Amer. Journ. of Med. Sc., July 1849, vol.
xviii, N. S., p. 122.
SECALE Cohn UTUM, Use of, in Third Stage of Labour, where there is Reten-
tion of the Placenta. MAcq REGOR (J. J.). Lancet, June 16, 1849, p. 638.
In Third Stage of Labour. MoncKToN (S.) Ibid., Sept. 8, 1849, p. 267.
Opium in Practice of Obstetricy, Uses and Advantages of LEver (J. C. W.)
Med. Gaz., Nov. 23, 1849, vol. xliv, p. 902.
ANAEsthetics in Midwifery, Letter to Dr. Meigs on the Use of Si MPson
(J. Y.) Phil. Med. Ex., April and May 1849, vol. v., N. S., pp. 205 and
269. Report on. Amer. Trans., 1849, vol. ii, p. 241. ETHERIZATION in
Childbirth. CHANNING (W.) Amer. Journ. of Med. Sc., June 1849, vol.
xvii, N. S., p. 99; and Ibid., April 1849, p. 343. Objections to Indiscri-
minate Use of Montgomery (W. F.) Dub. Quart. J., May 1849, vol.
vii, N. S., p. 321. Observations on. WALLER (Charles). Med. Times,
Nov. 10, 1849, vol. xx, p. 374.
CHLoRoform in Midwifery. SNow (John). Lond. Journ. of Med., June 1849,
vol. i., p. 50; and Ibid., Oct. 1849, vol. i., p. 976, et seq. (Discussion at West-
minster Medical Society.) In the Practice of Midwifery, further Observ-
ations on. MURPHY (E. W.) Edin. Month. Journ., Nov. and Dec. 1849,
vol. iii, N. S., pp. 1167 and 1239; and Lond, Journ, of Med., Nov. 1849, vol.
i, p. 1084. (Discussion at Westminster Medical Society.) Use of Rigby
(Edward). Med. Times, March 2, 1850; vol. xxi, p. 153. Influence
exerted by it on Motor Powers concerned in Parturition. SMITH (Tyler).
Lond. Journ...of Med., Dec. 1849, vol. i., p. 1107. In Midwifery, and as
a Sedative of Uterine Pain generally. BeNNET (Henry). Ibid., March
1850, vol. ii, p. 265. In Fifty-Six Cases of Labour in Dublin Lying-in
Hospital. DENHAM (John). Dub, Quart. J., Aug. 1849, vol. viii, N. S.,
p. 107. In Natural Labour; Cases and Remarks. STIMson (Edwin B)
Amer. Journ, of Med. Sc., Jan. 1849, vol. xvii, N. S., p. 260. From New
York Journ. of Med., Sept. 1848. Analysis of Fifteen Cases. Burwell.
(G. N.) Ibid., p. 261. From Buffalo Med. Journ., Nov. 1848. In Puer-
peral Convulsions. Nor RIs (W.) Edin. Month. Journ, May 1849, vol.
iii, N. S., p. 767. Case. Amer. Journ. of Med. Sc., Jan. 1849, vol. xvii,
N. S., p. 262. From Buffalo Med. Journ., Sept. 1848. Case. TURNER
(J.S.) Lancet, Jan. 12, 1850, p. 53. Alleged Consequences of the Inha-
lation of CUMMING (W.) Edin. Month. Journ., May 1849, vol. iii, p. 767.
ACCIDENTS AND DISE ASES AFTER DELIVERY.
CoNvALESCENCE after Parturition, Lecture on. MURPHY (E. W.) Med. Gaz.,
Feb. 8, 1850, vol. xlv., p. 221.
DEATH after Delivery, in the Case of Her Royal Highness the Princess Char-
lotte of Wales, Observations on the Cause of. EEE (Robert). Lancet,
April 28, 1849, p. 450; and Lond. Journ. of Med., Dec. 1849, vol. i. p.
1139. SIMs (John). Lond. Journ. of Med., in Review of Collins, Dec. 1849,
p. 1138.
VOL. II. 57
860 CLASSIFIED CATALOGUE.
SUDDEN DEATH during Labour, Case of DRUMMOND (Dr.) Edin. Month.
Journ., April 1849, vol. iii, N. S., p. 704. After Delivery, Case of M*CowAN
(Dr.) Ibid., May 1849, vol. iii, N. S., p. 766. BuchanAN (Dr.) Ibid.,
May 1850, vol. i., 3rd S., p. 489.
ENTRANCE of AIR into Uterine Sinuses after Delivery. SIMPson (J. Y.) Ibid.,
April 1849, vol. iii, N. S., p. 707. Considered as a Cause of Danger and
Death after Parturition. CoRMACK (John Rose). Lond. Journ. of Med.,
June 1850, vol. ii, p. 589.
UTERINE HE MoRRHAGE, Cases, with Remarks. SYME (James). Lancet, Jan.
12, 1850, p. 49. From Purpura, Case of; Effectual Mode of Arresting
Haemorrhage in all Cases. LYELL (John). Ibid., March 30, 1850, p.
384. Case, supervening Fourteen Days after Delivery. CAMPBELL (John).
Med. Gaz., Oct. 26, 1849, vol. xliv, p. 732. Apparatus for Checking.
SLYMAN (W.) Lancet, Jan. 13, 1849, p. 37. Treated by Oxide of Silver.
BENNETT (F.) Ibid., Jan. 19, 1850, p. 77. Cases successfully treated by
the Injection of Cold Water into the Uterus. SMITH (Tyler). Ibid., July
7, 1849, p. 6; and Dec. 29, 1849, p. 693. CHAvAssE (Thomas). Ibid.,
Dec. 29, 1849, p. 692.
VENous HAEMORRHAge from Pudenda, Fatal Case of KYLE (Dr.) Edin.
Month. Journ., Feb. 1850, vol. i., 3rd S., p. 195.
LACERATION of Perinaeum, Case of, cured by Operation. RogFRs (Joseph).
Lancet, May 26, 1849, p. 555. Of Vagina and Os Uteri, Lecture on.
MURPHY (E. W.) Med. Gaz., April 6, 1849, vol. xliii, p. 575.
RUPTURE of Uterus, Lecture on. Mu RPHY (E. W.) Med. Gaz., March 9,
and April 6, 1849, vol. xliii, pp. 397 and 573. Spontaneous; Recovery.
CHURCH (James). Lancet, May 19, 1849, p. 531. Cases. M'CRAITH
(James). Med. Times, April 28, 1849, vol. xix, p. 509. STOBo (A.) Ibid.,
April 6, 1850, vol. xxi, p. 253. Extraordinary Case of ; Partial Repara-
tion before Delivery. Jones (J. D.) Med.-Chir. Trans., 1849, vol. xxxii,
p. 59. Abs. in Lond. Journ. of Med., Jan. 1849, vol. i., p. 112. Of Uterus
and Vagina. GREENHALGH (R.) Lond. Journ. of Med., Oct. 1849, vol.
i, p. 979. LEveR (John C. W.) Ibid., Feb. 1850, vol. ii, p. 131.
INVERsion of Uterus occurring Four Days after Delivery. IMLAch (Dr.) Med.
Gaz., Jan. 12, 1849, vol. xliii, p. 80.
Post-PARTUM IN FLAMMATIONs, Lecture on. MURPHY (E. W.) Ibid., Feb.
22, 1850, vol. xlv., p. 309.
PhlegmAsia Dolens, Lecture on. Murphy (E. W.) Ibid., March 8, 1850,
vol. xlv., p. 397.
TETANUs after Abortion, Case of WooD (A.) Edin. Month. Journ., April
1850, vol. i., 3rd S., p. 387.
PUERPERAL FEVER, Lectures on, MURPHY (E. W.) Med. Gaz., 1849, vol.
xliii, pp. 485, 661,940. Causes of, in Vienna. RouTH (C. H. F.) Med.-
Chir. Trans, 1849, vol. xxxii, p. 27. Abs. in Lond. Journ. of Med.,
Jan. 1849, vol. i., p. 108. Cases of UPSHUR (G. L.) Phil. Med. Ex.,
Nov. 1849, vol. v., N.S., p. 637. At Bellevue, New York. Reese (D. M.)
Amer. Journ. of Med. Sc., Jan. 1850, vol.xix, N.S., p. 99. Contagiousness
of, and connexion with Erysipelas. SYME (James). Lancet, May 19, 1849, p.
537. BENNETT (Ezra P.) Amer. Journ. of Med. Sc., April 1850, vol. xix,
N. S., p. 376. Practical Observations on. LIGHTFoot (T.) Med. Times,
June 29, 1850, vol. xxi, p. 463. Erysipelas and Puerperal Fever; Cases
illustrating their Contagious Nature and Intimate Pathological Connexion.
HILL (Dr.) , Edin. Month. Journ., March 1850, vol. i., 3rd S., p. 299.
Suggestions for an Improved Method of Treatment. FAusseTT (William).
Dub. Quart. J., May 1850, vol. ix, N. S., p. 286.
PUERPERAL CoNvulsions, Lectures on. Murphy (E. W.) Med. Gaz., Jan.
26 and Feb. 9, 1849, vol. xliii, pp. 133 and 221. Cases of: Dependence
on Toxaemia: Explanation of their more common Occurrence in Primi-
para. CorMACK (John Rose). Lond. Journ. of Med., June 1849, vol. i.,
BRITISH AND AMERICAN JOURNALS. 861
p. 522. Relations to, and Differences from Epilepsy. SMITH (Tyler).
Lancet, vol. i., 1850, pp. 13,46, 109, and Lond Journ. of Med., Jan. 1850,
vol. ii, p. 87. Cog MAck (John Rose) and others. Ibid., p. 91. (Dis-
cussion at Westminster Medical Society). Remarks on. KING (G.)
Prov, M. and S. Journ, March 6, 1850, p. 113. Case, with Puerperal
Mania, terminating successfully. WILLIAMs (H.) Ibid., March 6,
1850, p. 117. Case treated successfully by Copious Depletions. IANGLEY
(John). Lancet, April 27, 1850, p. 500.
PUERPERAL MENTAL Disorders. CHURCHILL (Fleetwood). Dub. Quart.
J., Feb. 1850, vol. ix, N. S., p. 38.
PUERPERAL MAN1A, its Nature and Treatment. LIGHTFoot (Thomas). Med.
Times, April 13, 1850, vol. xxi, p. 273. Case, followed by Insanity.
Hastings (H.) Ibid., April 28, 1849, vol. xix, p. 51 1.
PUERPERAL INSANITY, Remarks on the Statistics, Pathology, and Treatment
of WEBsTER (John). Lond. Journ. of Med., Oct. 1849, vol. i., p. 971.
MISCET,LANEOUS I, ECTURES AND PAPERS.
OBSTETRICs, Introductory Lecture to a course on. BARNEs (Robert). Med.
Gaz., Nov. 23, 1849, vol. xliv, p. 889.
STAT isTics of the Obstetric Practice of Dr. LAwRENCE of Montrose. Edin.
Month. Journ., Feb. 1849, vol. iii, N. S., p. 551.
SUPERSTITIONs and Popular Practices relating to Midwifery, and some of
the Diseases of Women and Children, in Ireland. WILDE (W. R.)
Edin. Month. Journ., May 1849, vol. iii, N. S., p. 711.
PHYSIOI,06; Y AND DISEASES OF MENSTRUATION.
MENSTRUATION, an Examination into the Grounds of the Ovular Theory of
KESTEven (W.B.) Med. Gaz., Nov. 30, 1849, vol. xliv, p. 930. Early,
Cases of Lond. Journ. of Med., Jan. 1849, vol. i., and B. and F. Med.-
Chir. Rev., Jan. 1849, vol. vi., p. 276.
MENSTRUAL SECRETION Accumulated and Retained, Case'of SIMPson (J.
Y.) Edin. Month. Journ., April 1850, vol. i., 3rd S., p. 388.
Vica RIous Lochial Discharge, Case of. Dub. Quart. J., Feb. 1850, vol. ix,
N. S., p. 232. g
cº Disease in Women : a Paroxysmal Affection occurring at the
Decline of the Catamenia. SMITH (Tyler). Lond. Journ. of Med., July
1849, vol. i. p. 601. Cerebral Disturbance, the result of Uterine Disorder.
Corfe (G.) Med. Times, April 7, 1849, p. 451. Abs. in Lond. Journ.
of Med., May 1849, vol. i., p. 497.
Menorrhagia, Üterine Congestion, &c. BALLARd (E.) Prov. M. and S.
Journ, Sept. 5, 1849, p. 486. Use of Oxide of Silver in certain forms of:
with Cases and Remarks. THwBATT (J. J.) Amer. Journ. of Med. Sc.,
July 1849, vol. xviii, N. S., p. 69.
DysMENNoRRHOEA, Practical Remarks on : Treatment by Application of
Caustic to, and Dilatation of, the Uterine Neck. EdwarDs (S.) Lancet,
April 7 and 14, 1849, pp. 369 and 396. Congestive : New Cupping Ap-
paratus for the Uterus. WHITE HEAD (James). Med. Gaz., April 13,
1849, vol. xliii, p. 628.
STRUCTURAL DISEASES OF THE OVARIES, UTERUS, AND APPENDAGES.
CoRPoRA LUTEA, Early: State of Ovaries during Menstruation. SIMPson
(J. Y.) Edin. Month. Journ., Feb. 1849, vol. iii, N. S., p. 561.
OvARIT is : Nature and Treatment of the Various Forms of. TILT (E. J.)
Lancet, vol. i., 1849, pp. 232,263, 338, 399, 423, 444, 499, 554, 616, and
636. Abs. in Lond. Journ. of Med., Dec. 1849, vol. i., p. 1161. Sub-acute,
and Inflammation of Fallopian Tubes, as one of the causes of Functional
Sterility. Tilt (E. J.) Lond. Journ. of Med., June 1849, vol. i., p. 510.
Chronic, Pathology of TILT (E. J.) Lancet, vol. ii, 1849, p. 627; vol. i.,
1850, pp. 173,356, 715. 2
57
862 CLASSIFIED CATALOGUE.
Ov ARIAN and Uterime Disease, Connexion between. Tilt (E.J.) Lond.
Journ. of Med., April 1850, vol. ii, p. 347. Malignant Disease; and of
Rectum. NUNN (T. W.) Ibid., March 1850, vol. ii, p. 297. Case of
Enormous. JACKSON (Dr.) Amer. Journ. of Med. Sc., Jan. 1849, vol.
xvii, N. S., p. 33.
OvARIAN TUMour, Case of, containing Teeth and Hair. CLAPP (W.) Med.
Gaz, Aug. 17, 1849, vol. xliv, p. 282.
Ovarian DRopsy, Diagnosis of BRowN (I.B.) Lond. Journ. of Med.,
Jan., 1850, vol. ii, p. 81; and Lancet, June 8, 1850, p. 691. Case
of, with Remarks, PEAslee (E. R.) Amer. Journ. of Med. Sc., April
1849, vol. xvii, N.S., p. 374. Monocystic, Case of LEVER (J. C. W.)
Guy's Hosp. Rep., Oct. 1849, vol. vi, part II, p. 221. Simulated by Dis-
eased Liver. HARVEY (W.) Med. Gaz., Feb. 16, 1849, vol. xliii, p. 300.
Paracentesis: Death. KENNIon (George). Prov. M. and S. Journ.
July 11, 1849, p. 377. New Operation for. BRowN (I. B.) Lond.
Journ. of Med., Feb. 1850, vol. ii, p. 202. Treated by Pressure. BROWN
(I.B.), Lancet, vol. i., 1849, pp. 315,371,471; vol. ii, p. 9.. Spontaneous
Cure of, by an Ulcerative Opening of the Cystinto the Bladder. BENNETT
(J. Hughes). Edin. Month. Journ., Feb. 1849, vol. iii, N. S., p. 508, Abs.
in Lond. Journ.of Med., March, 1849, vol. i., p.285. Cyst accidentally rup-
tured by a Blow : Partial Effusion of Contents into Abdominal Cavity :
Violent Acute Peritonitis fatal eleven weeks afterwards: Post-mortem Ap-
pearances: Chemical Examination of Contents of Cyst. HERAPATH (W.
B.) Edin. Med. and Surg. J., Jan. 1849, vol. lxxi, p. 108. Cured by
Pregnancy. PEDDIE (Dr.) Edin. Month. Journ., April 1849, vol. iii,
N. S., p. 706. Complicated with Pregnancy, Appendix to a Case of Sue-
cessful Removal of Burd (H. E.) Med. Chir. Trans., 1849, vol. xxxii,
p. 64. Abs. in Lond. Journ. of Med., Feb. 1849, vol. i., p. 213. Fibrous
Tumour of Right Ovary, Case of: Successful Extirpation by the Large
Peritoneal Section. At LEE (W. L.) Amer. Journ. of Med. Sc., Oct.
1849, vol. xviii, N. S., p. 336; and April 1850, vol. xix, N. S., p. 318.
Ov ARIoToMy. CRouch (John). Prov. M. and S. Journ., Nov. 14, 1849, p.
522. Case. BRANsoN(Dr.) Ibid., March 7, 1849, p. 130. Successful Case:
Multilocular Cyst weighing 40 pounds. ELKINGTON (F.). Ibid., Sept.
19, 1849, p. 522. Cases: Remarks. SwayNE (J. G.) Ibid., April 17,
1850, p. 205. Successful Case: Large Abdominal Section. CROUCH
(John). Ibid., Sept. 5, 1849, p. 475, and Med. Gaz., August 31, 1849,
vol. xliv, p. 366. '
LEFT FALlopiaN TUBE, case of Fibro-Cartilaginous Tumour in. MYRTLE
(J. Y.) Edin. Month. Journ., May 1849, vol. iii, N. S., p. 772.
PELvis, Abscesses of, unconnected with Parturition. BARTRUM (J. S.) Prov.
M. and S. Journ., May 16, 1849, p. 261.
UTERINE DISEASEs, new views on the Treatment of, and of their associated Ner-
vous Affections. Holland (G. Calvert). Med. Times, August 11, 1849,
vol. xx, p. 108. Mania as co-existing with. LEVER (J. C. W.) Guy's
Hosp. Rep. Oct., 1849, vol. vi, part II, p. 320.
CERVIx AND Os UTERI, Ulceration of, Observations on the Supposed Frequency
of SMITH (Tyler). Lancet, April 20, 1850, p. 473. Abs. in Lond.
Journ. of Med., June 1850, vol. ii, p. 592. BENNET (Henry). Lancet,
vol. i., 1850, pp. 594 and 598. Abs, in Lond. Journ. of Med., June 1850,
vol. ii, p. 578. LEE (R.) (Discussion at Medical and Chirurgical Society.)
Lancet, June 8, 1850, p. 701. Modern Treatment of Diseases of:
WILLIAMs (T.) Med. Gaz., March 15, 1850, vol. xlv., p. 453. Use and
Abuse of Instrumental Examinations in. BeNNET (H.) Lancet, June
8, 1850, p. 690. Treatment of Engorgement and Ulceration of MAL-
GAIGNE (M.) Lond. Journ. of Med., Feb. 1849, vol. i., p. 204. From
Journ. de Méd. et de Chir. Prat., Dec. 1848. Congestion and Erosion of,
Iodine in. CHURCHILL (F.) Med. Times, May 19, 1849, vol. xix, p. 571.
BRITISH AND AMERICAN JOURNALS. 863
UTERINE DiscHARges, Sanguineous, Tincture of Indian Hemp in. CHURCH-
Ill (F.) Ibid., May 19, 1849, vol. xix, p. 571 Leucorrhoeal, Lectures on.
(Leucorrhoea Infantilis, and from disease of Os and Cervix Uteri).
WALLER (C.) Ibid., Jan. 27, 1849, vol. xix, p. 265. Oak-Bark and
Alum Injections in : Concretion of Coagulated Albumen. Cooke (T. W.)
Lancet, May 11, 1850, p. 562. #
UNDERsized Womb, Observation on : Sterility: Uterine Phthisis: Displace-
ment: Mechanical Treatment of Sterility. OLDHAM (H.) Guy's Hosp.
Rep., Oct. 1849, vol. vi, part II, p. 364.
UTERINE Polypus, Vesicular, cases of LEVER (J. C. W.) Guy's Hosp.
Rep., Oct. 1849, vol. vi, part II, p. 201. Co-existing with Pregnancy:
Spontaneous Expulsion of the Tumour. WILLIAMS (H. L.) Prov. M. and
S. Journ., June 20, 1850, p. 342. Polypus and Inversion of: Ligature:
Excision of a large portion of the Uterus: Recovery. MoRLAND (W.W.)
Amer. Journ. of Med. Sc., April 1849, vol. xvii, N. S., p. 339. Inversio
Uteri induced by Polypus : Successful Extirpation with the knife. Hig-
GINs (C. H.) Edin. Month. Journ., July 1849, vol. iii, N. S., p. 889.
Detection and Treatment of . (Four Plates.) SIMPson (J. Y.) Ibid., Jan.
1850, vol. i., 3rd S., p. 3. Abs. in Lond, Journ. of Med., July 1850, vol.
ii, p. 707. Observations on Ligature of: Danger of Pyaamia. LANGEN-
BECK (Professor). Lond. Journ. of Med., July 1850, vol. ii, p. 704.
From Deutsche Klinik. *
UTERUs, Tumour of MURPHY (E. W.) Lond. Journ. of Med., Oct. 1849, vol.
i, p. 981. Fibrous Tumour of: Perforation and Inflammation of the Perito-
neum. BALLARD (E.) Prov. M. and S. Journ. 27, 1849, p. 345. Case:
Gastrotomy. DEANE (J.) Amer. Journ. of Med. Sc., Jan. 1849, vol.
xvii, N. S., p. 258. From Boston Med. and Surg. Journ., Oct. 11, 1848.
Fibrous Tumour and Cancer of, with Remarks. BALLARD (E.) Prov.
M. and S. Journ., May 2, 1849, p. 234.
CANOR R of Uterus and Bladder. BALLARD, (E.) Ibid., May 16, 1849, p. 256.
Of Uterus, Wagina, and Portion of Urinary Bladder. TocA (Melchor
S. de.) Lancet, Dec. 29, 1849, p. 690. Translated from Gaceta Medica
de Madrid.
CAULIFLower ExcrescENCE from Os. WATson (Eben). Edin. Month. Journ.,
Nov. 1849, vol. iii, N. S., p. 1183. Of Uterus. TUFNELL (J.) Dub. Med.
P., Dec. 26, 1849, vol. xxii, p. 401.
CoRRoding ULCER of Uterus, with Remarks. BALLARD (E.) Prov. M. and
S. Journ., March 21 and April 4, 1849, pp. 155, 179. &
TUBERCUlosis of Uterus. CoorE (Holmes). Med. Gaz., June 14, 1850, vol.
xlv, p. 1025.
HYDATIDs of Uterus, Three Cases of Hislop (P. B.) Edin. Month. Journ,
April 1850, vol. i., 3rd S., p. 326. Case: Anomalous Nervous Symptoms.
DAvEY (J. G.) Lond. Journ. of Med., April 1850, vol. ii, p. 393.
EPIPHYTEs, Development of, in Uterus. WILKINson (J. S.) Lancet, Oct. 27,
1849, p. 448.
HYDRom ETRA, Case of PURDON (C. D.) Dub. Quart. J., Feb. 1850, vol. ix,
N. S., p. 232. In an Unimpregnated Uterus. GRANDIDIER (Dr.) B.
and F. Med. Chir. Rev., April 1849, vol. iii, p. 539. From Neue Zeitschrift
für Gebürtskunde.
HyPERTRoPHY and INDURATION of Uterus, Bichloride of Mercury in ; with
Remarks on Retroversion and Retroflexion. OLDHAM (H.) Lond. Journ.
of Med., Jan. 1849, vol. i., p. 95. From Guy's Hosp. Rep., Oct., 1848.
ANTEveRsion of Uterus. Edwarps (Samuel). Prov. M. and S. Journ., May
16, 1849, p. 253. A Cause of Sterility. RIGBY (E.) Med. Times, 1849,
vol. xix, pp. 304, 526, 582; vol. xx, p. 109.
RetroversIon of Uterus. Edwards (S.) Prov. M. and S. Journ., June 27,
1849, p. 337. Case of: Description of a New Instrument for its Restor-
ration: Observations on the Displacement of the Organ. Bon D (H.)
864 CLASSIFIED CATALOGUE.
Amer. Journ. of Med. Sc., April 1849, vol. xvii, N. S., p. 401. A Cause
of Sterility. Rigby (E.) , Med. Times, 1849, vol. xx, pp. 109, 175,281,
332, 432, 450; 1850, vol. xxi, p. 14. Retroversion and Retroflexion,
Remarks on. OLDHAM (H.) Lond. Journ. of Med., Jan. 1849, vol. i., p.
95. From Guy’s Hosp. Rep., Oct. 1848. Retroflexion of Post (A. C.)
Amer. Trans., 1849, vol. ii, p. 253. M'CREADY (B. W.) Ibid., p. 255.
INVERSION of Uterus, Lecture on. MURPHY (E. W.) Med. Gaz., May 4,
1849, vol xliii, p. 749. Cases. SKAE (D.) Edin. Month. Journ, May
1849, vol. iii, N. S., p. 773. ZIEGLER (Dr.) Ibid., p. 775. Case of Com-
plete Inversion and Expulsion. YARDLEY (T. H.) Amer. Journ. of Med.
Sc., July 1849, vol. xviii, N.S., p. 126.
ProLAPsus of Uterus, Treatment of. NuNN (T. W.) Lancet, April 6, 1850,
p. 406.
WAGINA Imperforate : Malformation of Superior Portion: Operation : Cure.
SHIPMAN (A.B.) Amer. Journ. of Med. Sc., Oct. 1849, vol. xviii, N. S.,
. 401. Vagina and Rectum opening into a Common Cloaca, Case of.
LevKR (J. C. W.) Guy's Hosp. Rep., Oct. 1849, vol. vi, part ii, p. 224.
Aphthous Inflammation of LEVER (J. C. W.) Ibid., Oct. 1849, vol. vi,
part ii, p. 222. Sloughing of, after Measles. PARKER (Mr.) Med. Gaz.,
March 9, 1849, vol. xliii, p. 429. Operation for Occlusion of HAYNE
(A. P.) Amer. Trans., 1849, vol. ii, p. 237. Fistula opening into Bladder,
relieved by the Ordinary Hare-Lip Operation. SMITH (H. H.), Phil.
Med. Ex., March 1849, vol. v., N. S., p. 155. Pessary impacted in for two
years. LEACH (J.) Prov. M. and. S. Journ., April 4, 1849, p. 177. Abs.
in Lond. Journ, of Med., July 1849, vol. i., p. 675. Pessary long retained
in, Case of BURRows (John). Prov. M. and S. Journ., Dec. 12, 1849,
. 680.
Laº, Sloughing Phagedæna of Left, extending over Left Thigh : New
Local Treatment: Death. CRowTHER (Thomas). Lancet, April 7, 1849,
p. 365. Tumours of, Cases. LEveR (J. C. W.) Guy's Hosp, Rep., Oct.
1849, vol. vi, part ii, p. 226. Encysted Tumour of, Successfully Treated
by the Application of Nitrate of Silver to the Interior of the Cyst. , MAC-
Do NNELL (R. L.) Dub. Med. P., May 2, 1849, vol. xxi, p. 278 ; and Med.
Gaz., Dec. 21, 1849, vol. xliv, p. 1052. From Brit. Amer. Journ.
CLIToris, Case of Superabundant Development of STANILAND (S.) Lancet,
July 28, 1849, p. 89.
PElvic CELLULITIs, Cases of LEveR (J. C. W.) Guy's Hosp. Rep., Oct.
1849, vol. vi, part ii, p. 211.
INSTRUMENTS USED IN UTE RINE DISEASES.
TRuss, Improved Uterine, with Elastic Gutta Percha Pessary. RITCHIE (Chas.)
Edin. Month. Journ., July 1849, vol. iii, N. S., p. 899.
UTERINE Sound and PEssaRy, Dr. SIMPson's, Report on. Amer. Trans., 1849,
vol. ii, p. 235.
INTRA-UTE RINE Pessary, Case of Employment of. CUMMING (W.) Edin.
Month. Journ., May 1849, vol. iii, N. S., p. 773.
SYPHoN FEMALE Syringe, an Uterine Douche, and an Universal Injection
Apparatus. Description, with Engravings. Jones (W.) Lancet, Feb.
17, 1849, p. 176.
SPECULUM, Improved, for Vesico-Vaginal Fistula. KEILLER (Dr.) Edin.
Month. Journ., Feb. 1849, vol. iii, N. S., p. 559. Speculum and Digital
Examination; their Uses and Abuses. MALGAIG NE (M.) Lond. Journ.
of Med., Feb. 1849, vol. i., p. 203. From Journ. de Méd. et de Chir. Prat.,
Dec. 1848. See Diseases of Os and Cervix Uteri, p. 862.
ExploriNG NEEDLE, Use of, in the Diagnosis of Doubtful Forms of Pelvic
and other Tumours. SIMPson (J. Y.) Edin. Month. Journ., Feb. 1850,
vol. i., 3rd S., p. 196.
CRITICAL DIGEST OF THE BRITISH AND FOREIGN MEDICALs
JOURNAIAS.
PRACTICE OF MEDICINE AND PATHOLOGY.
gºmºmº
INUNCTION IN SCARLET FEWER - WITH RULES FOR THE WHOLE
TREATMENT, AND PROPHYLAXIS OF THE DISEASE.
DR. ScHNEEMANN, physician at the court of His Majesty the King of Hano-
ver, has published an important paper, satisfactorily proving the benefit to be
obtained from Inunction of the Whole Surface. The eruption is so much
modified, that the skin is enabled to perform better its essential functions.
We abridge a translation of the paper, in the Lancet of 15th Sept. 1849.
The advantages of the treatment about to be laid down, are, the annihila-
tion of the injurious effects of the exanthem on the functions of the skin.
The eruption is so modified, that scarcely any desquamation takes place; and
the skin, instead of burthening other functions, produces, by continuing in a
state of comparative integrity, so beneficial an influence on the organs
attacked, particularly the throat, that the normal condition is, in every case,
and in every part, speedily restored.
DESCRIPTION OF THE TREATMENT. As soon as we are certain as to the
nature of the illness, the patient must be rubbed, every morning and evening,
over the whole body, with a piece of bacon, in such a manner that, with the
exception of the face (?) and hairy scalp, a covering of fat is everywhere
applied. In order to make this rubbing-in somewhat easier, it is best to take
a piece of bacon of the size of the hand, choosing a parts till armed with the
rind, that we may have a firmer grasp. On the soft side of this piece, slits
are to be made in various directions, in order to allow the oozing out of the
fat; and this is still further promoted by placing the bacon, for some time
previously to using it, near the stove, in the oven, or on the hob. But the
fat must be allowed to cool before being used.
The rubbing must be so performed, that the skin may be regularly, but not
too quickly, saturated with fat. During the process, only that part being
rubbed is to be uncovered, or the whole can be done under the bedclothes;
but this precaution is unnecessary. Although this plan, from the mess it
makes, is not calculated to find favour, as it dirties bed and linen, as well as
the persons of the children, yet the first few days yield results which make
all this forgotten, and inspire the mothers with enthusiasm. With rapidity
the most painful symptoms of the disease are allayed ; quiet, sleep, appetite,
and good humour, return. Other things, however, are necessary besides in-
friction with fat; but still the most important share of the merit may be
imputed to this treatment. The truth of this will appear from a citation of
the first results which follow :
1. The improbability, I might say impossibility, of the patient getting
cold. Were this the sole benefit of the Inunction, it would be great.
2. The dry brittleness of the skin, and the tormenting itching, are not
only materially alleviated, but, for the most part, fully put a stop to. Hence,
children generally like the rubbing-in, and often ask for a repetition of it
before the time is come.
3. The influence on the physiological functions of the skin is still more
important. During the coming on of Scarlet Fever, the skin becomes dis-
eased, in consequence of which it dies off; and, until a new covering is pre-
pared for the surface, the functions of the skin are ill performed, or, during
the desquamation, probably not performed at all. To appreciate the import-
ance of the imperceptible functions of the skin, merely mechanically viewing
866 CRITICAL DIGEST OF THE JOURNALS.
the matter, I refer to the experiments of Seguin, which fix the quantity of
matter thrown off from the outer skin at eleven grains per minute in a grown
person, and therefore more than two pounds per day. , What efforts it must
cost the organism to lead so large a quantity into other paths, in order to
throw it off when the skin is incapable of doing so | To give a striking proof
of the bad influence which the interrupted functions of the skin produce on
the healthy activity of relative, even of distant, organs, I may cite the fact,
that death is always the result, where more than one-half of the skin has been
destroyed by fire or boiling liquid. A similar destruction of the skin ensues
in Scarlet Fever, with this difference, that it takes place gradually, and
thereby the organism is better enabled, by employing all the activity of the
body, to find aid against the mischief which, to the injury of the patient,
must result from the cessation of the functions of the skin.
4. The oxidation of the blood is thus considerably promoted, the inter-
rupting of which is the cause of such serious phenomena. As the disease of
the throat is not improbably, in great part, due to the interruption of the
functions of the skin and lungs, it must naturally disappear, or not present
itself, where these are continued in integrity; and such is found, in practice,
to be the case.
5. Owing to the fatty covering, the skin is kept moist, and the cuticle can-
not be driven about the room by currents of air; and thus one fertile source
of infection is kept closed up, it being well known that infection is most easily
communicated at the period of desquamation. The danger of infection, under
any circumstances, is materially lessened with the disappearance of the
eruption from the skin, inasmuch as the process of generating infectious
material is interrupted by restoring the skin to its normal state.
6. By shortening the period of desquamation, and protecting the patient
against the sequela of the disease, the duration of the treatment can be
shortened to a period of from six to ten days.
7. The remedy is (cheap), harmless, practical, and is perhaps never coun-
terindicated. The linen must not be too frequently changed, as a clean shirt
takes up more of the fatty matter than one already saturated, and hence the
skin is sooner deprived of its fatty covering. The rubbing-in is to be kept
up twice a-day for three weeks, and once a-day during the fourth. The
patient is, after this, to be daily washed with cool water and soap, and then
only is the warm-bath to be commenced. This process does not (as has been
argued in some colleges) interfere with the natural course of the malady, and
expose the individual to second and third attacks. In severe cases, the
remedy may be repeated three or four times within the twenty-four hours.
The main point is, to keep the skin always cool and moist ; and here, even
with all possible precaution, the skin will sometimes come off in certain
places. The practitioner will do well to fix the exact hours at which the rub-
bing-in is to take place; it will then most probably be better and more regu-
larly performed.
Other points, which are also important enough, now remain to be noticed:
8. Temperature. Experience proves that it requires no great daring to
keep the patient cold instead of hot. Cold washing is not to be employed,
as it promotes desquamation. Cool air seems to have a bracing influence on
the system, and a soothing one on the respiration; and all danger is avoided
by the fatty covering. The temperature of the bed-room should never be
above 139 R. The idea of throwing back the eruption by mere cold air, is an
error. Great heat is much more likely than cold to throw in the eruption.
In fact, the fatal cases of this kind are principally those where, through keep-
ing the patient too hot, the cerebral affection has been brought on ; this has
given rise to paralysis, which appears sooner in the skin than in other parts,
and thus to the withdrawal of the eruption,-for the skin dies sooner than
other parts, as shown in collapse, where mustard poultices do not act as in
other states.
CRITICAL DIGEST OF THE JOURNALS. 867
9. Bed. The patient should not remain in bed any longer than is absolutely
necessary. As soon as the fever, headache, and a desire to remain in bed, are
gone, he may quit it, for in bed the skin is between two fires, and the func-
tions of the body do not go on so well as in moving about. Hence, even
when the patient must lie down an hour or two daily, he should still go about
the rest of the time.
10. Diet. The diet should be light, but there must be no starvation, and
as rapid a return as possible to the usual food.
ll. Washing. Although it brings on desquamation, it will be as well to
let the patient occasionally wash his hands and face with water and soap.
It reconciles him to the dirt attendant on the rubbing-in. -
12. If constipation ensue, it must only be combated with medicines; when,
at the end of forty-eight hours, it makes no semblance of disappearance, then
a clyster of poppy oil is the best remedy.
The author enters his protest against a partial employment of his remedies.
CoMPLICATIONS REQUIRE A MoDIFICATION OF THE SYSTEM. 1. Severe
cerebral symptoms at the commencement. The above treatment can only be
applied, where time is allowed for the development of the restorative process.
Occasionally the case is accompanied at its very outset by severe cerebral
affection, and convulsions. Here bleeding may be employed, and, if necessary,
unhesitatingly repeated. To support this view, Dr. Schneemann instances
the authority of Armstrong, Bernd, Stieglitz, Hammond, Hingeston, etc.
Venesection is, accordingly, the sheet anchor. The other remedies are—1.
The application of concentrated cold to the head ; and the best form for this
is ice. The cold dash is often more hurtful than useful, on account of the
serious reaction which follows it, and exposes the patient more to the dangers
of an apoplectic attack, although its results for the minute are often very
flattering. At the end of every two hours, the bladder of ice should be removed,
in order that the uninterrupted effect of the cold may not weaken too much
the tone of the vessels of the brain. Warm mustard plasters to the shins are
a most valuable remedy. Internal remedies are generally of little use where
the above-given remedies fail; the only one of any importance is the carbon-
ate of ammonia. Mercury is of little value, except just to open the bowels;
for its specific action never comes into full play, till the system is throwing off
the affection. There are, however, much better purgatives than calomel; the
saline, for instance. Emetics ought not to be tried in cases complicated with
cerebral affection; in others they may. The aconite failed in the author's
hands, both in tincture and solution. With regard to the treatment by leeches
and ammonia, so many writers have already pointed out its good results, that
the author can safely recommend it, but with the proviso, that in urgent
cases bleeding be substituted for leeches.
2. The Affection of the Throat. Primary. As this is but a link in
the whole, so must the measures taken for its removal be such as will remedy
the general affection. Secondary. For this, the rubbing-in, as it acts by pro-
phylaxis, is the best possible remedy; but where this has not been brought
into use, or where, from keeping the patient too warm, desquamation has
come on, and the secondary sore-throat has set in, the best remedy is the use
of emetics. They not only remove the tough glazy slime, but excite the
secretions and excretions to more normal disposition, and this is especially
the case if the disorder have a gastric character. Many, by confounding the
employment of emetics in the early and latter stages, have brought them into
discredit. For the swelling of the tonsils, an excellent remedy is, a solution
of nitrate of silver, (twenty grains to an ounce of water), with which they and
the soft palate are to be painted; but so many varieties present themselves
in these secondary attacks following on Scarlet Fever, that no general rules

* Here it will be as well to state, that in Germany a feather-bed is frequently
substituted for bed-clothes. 4.
868 CRITICAL DIGEST OF THE JOURNALS.
can be laid down. Here everything depends on the discrimination and judg-
ment of the practitioner.
PROPHYLAXIS. Warm clothing, separation from school, and above all, light
diet, are the best preventatives. That the younger children, as more predis-
posed than the others, must be more carefully separated from the sphere of
infection, is doubtful practice. Not only are many children never infected,
who, however, by adopting this system, require to be as carefully secluded as
the others, thus causing great inconvenience ; but the mºldening influence
and actual advantage of a gradual accustoming to the infection are thereby lost,
and consequently the attack, when it comes, is so much the more severe. The
free communication with the patient is good, in order that constant exposure
may, as in the case of physicians and nurses, blunt and wear out the disposi-
tion to the disease; for as it now is, children are separated from the patient
during the first period, which is the mildest, and exposed to contact with him
during the process of desquamation, which is the source of the most dangerous
infection. Many preservatives have been vaunted against this malady during
its epidemic appearance ; of these, however, the only one apparently deserving
of much credit is the belladonna. Its action appears to be, “by altering the
relations of the nervous system, to diminish the disposition to the disease.”
The author's prescription is—Take of extract of belladonna, one to two grains;
distilled water, one ounce. Mix. Give to each child, morning and evening,
as many drops as it has years, and continue to do so at least fourteen days.
But not to confine himself to his own testimony, Dr. Schneemann gives that
of Jördens, Ettmuller, Hedenus, Gumpert, Hufeland, Martius, Pormey, Behr,
Benedix, Thaer, etc., who have testified to the value of belladonna ; and
though he admits that as many opponents might be found, he thinks it
scarcely credible that all the former had deceived themselves. In certain
sections of the circle of Bayeux, Dr. Feron preserved from Scarlet Fever all
the children who had not been attacked before he commenced operations.
In 400 cases near Walenciennes, treated with belladonna, not one person was
attacked. Hahnemann has, however, only recommended it where the erup-
tion is smooth, bright-red, and in large patches. But where there are rough-
ness and purpleness of the skin, it seems to be useless; and it may be that
the bad success of many cases was owing to the neglect of this distinction.
The author requests all who may avail themselves of his plan, to commu-
nicate the results to the world. His theory, he says, is of little consequence ;
but that the facts are invaluable. Spilsbury recommended this system of treat-
ment in the wasting fever and night-sweats of the consumptive ; and Dr.
Schneemann hints that it might be of use in measles and cholera. We have
not observed that the views of Dr. Schneemann have obtained that attention
from practitioners which they merit. We therefore invite our readers to com-
municate for publication in the LONDON Journal of MEDIGINE,any observations
which either already have, or have not been laid before the profession. We
think we discover in the essay, of which we have given an ample abridgment, a
very material improvement in the treatment of Scarlet Fever. At present, the
combined experience of independent observers is required. In the Boston
Medical and Surgical Journal, (15 May, 1850, p. 309,) Dr. H. Lindsly has
the following paragraph : “Scarlet Fever has been exceedingly fatal in this
section of country during the past winter, sweeping off whole families of six,
seven, and in some instances eight children; and bidding defiance to all the
ordinary modes of treatment. It was under these appalling circumstances,
that I met with the article in the London Lancet, detailing Dr. S.’s mode of
treatment. I at once determined to give it a thorough trial, and have ac-
cordingly employed it in every case that has since occurred in my practice,
with the exception of three or four that had the disease very lightly. Some
of these cases were of great severity, and just such as I had repeatedly lost
under the ordinary treatment ; yet they all recovered rapidly after the em-
CRITICAL DIGEST OF THE JOURNALS. 869
ployment of inunction. So far as I can judge from this very limited expe-
rience, I have come to the conclusion that the introduction of this simple
mode of medication will probably be found the most important improvement,
that has been made for many years in the management of Scarlet Fever.”
We are inclined to concur in the hopes of Dr. Lindsly, from having seen
in one case apparently very great benefit result from frequent smearing of
the surface with olive oil ; and from having been informed of the very great
success which attended the treatment of an aged and now retired practitioner,
whose habit, in many Scarlet Fever epidemics, had been to cover the surface of
his patients with a thick, and often renewed, lather of soap, laid on with such
a brush as is used in shaving.
SCARLATINAL WAGINITIS, WITH MUCO-PURULENT DISCHARGE.
Two papers have recently appeared, on this subject, in the London Medical
Gazette, the one by DR. ROBERT BARNES, July 12, p. 65; and the other, (a
commentary on it,) by DR. CoRMACK, August 2, p. 198. Though, perhaps,
the subject is not possessed of quite so much novelty and medico-legal difficulty
as are attached to it by Dr. Barnes, it has sufficient interest to justify our
quoting the short and practical communications of both gentlemen.
DR. BARNES’ PAPER. “ In the summer of 1843, I witnessed, in the wards
of M. CHOMEL, at the Hôtel-Dieu, a case of Scarlatina in a girl about sixteen
years of age. Owing to an unfortunate accident, by which I lost the greater
part of the notes I made in the Paris hospitals, I cannot give a detailed
account of this patient. She presented one symptom, which, on account of
its novelty, and its important relations to forensic medicine, is, I think, par-
ticularly interesting. After the decline of the eruptive stage, and when
apparently convalescent, there occurred a muco-purulent discharge from the
vagina, similar in character to the discharge which not uncommonly flows
from the nares, as one of the sequelae of Scarlatina.
“There was evidence to show that this discharge did not exist at the time
of the girl's admission, and that it was first observed at the period I have
mentioned,—viz., after the decline of the eruption, when she had been some
days in the hospital. -
“I believe that the discharge was not blennorrhagic, but a newly-observed
feature in the pathology of Scarlatina.
“It is in the suspicion of blennorrhagia, that lies the interest of this symp—
tom in relation to forensic medicine. In this case, for example, an unmerited
stigma might attach to the girl's character, were it not admitted that the dis-
charge might be the result of Scarlatinal Waginitis. Numerous other charges
of a grave nature might be founded upon such an appearance. Accusations
of rape even might receive corroborative proof from its presence. About
two years ago, I saw a child of eleven years old, who was recovering from
Scarlatina. It was then observed, for the first time, that she had a discharge
from the vagina, and suspicions were immediately excited that she had been
abused by a lad in the neighbourhood. This discharge might have been a
sequela of Scarlatina. , I believe it was. -
“The importance, then, of determining the possibility of a muco-purulent
discharge as a consequence of Scarlatinal Waginitis, is obvious. I am not
acquainted with any author who notices this symptom. DR. TwPEDIE has
informed me that his attention has never been directed to such an occurrence,
and that when a purulent discharge from the vagina has been noticed in
scarlatinal patients, he has concluded it to be blennorrhagic.
“My colleague, DR. MILLER, whose elaborate work on Scarlatina has thrown
so much light on the pathology of the disease, has favoured me with the fol-
lowing interesting remarks :
“‘I have never seen Waginitis during the eruptive period of Scarlatina, nor
even among the sequelae. I am inclined to think that it is an uncommon

870 CRITICAL DIGEST OF THE JOURNALS,
occurrence. Still, during a smart attack of the eruptive fever, when the
mouth, nares, and pharynx, are implicated, it seems not unlikely that the
inflammatory action should affect the vagina, there being a less abrupt merg-
ing of skin into mucous membrane (as in the mouth) than in other mucous
outlets. Yet we know that the mouth, nares, and fauces, are specially impli-
cated in this exanthem ; and, were the other local affection more common, I
think our attention would be drawn to it more frequently. In our dispensary
patients, especially among strumous children, muco-purulent discharges from
the vagina (slight Waginitis) are common ; and I have never had reason to
suspect gonorrhoea, though it has been alleged. It is essentially a scrofulous
disease of the mucous surface (me judice), and occurs in connexion with
ascarides, accumulation in the large intestines, as a sympathetic affection,
just as otorrhoea occurs during dentition in these subjects.
“‘Recurring to the Waginitis in Scarlatina, I should rather expect it to
occur where there had been a very full eruption and good peeling, than in
any other case. Did not the affection exist before, on careful examination
of the child’s friends, we might safely set it down to Scarlatina. But I can-
not deem it a specific mark of the disorder, as the affection of the mouth, nares,
and throat, will alone mark the disease, without the cutaneous eruption.’
“I am quite prepared to accede to the opinion of Dr. Tweedie and Dr. Mil-
ler, that a muco-purulent discharge from the vagina in Scarlatina is a very
rare occurrence ; but this very circumstance increases the importance of the
symptom in relation to questions of legal medicine. The more rare the
symptom, the less likely is it to be recognised as an effect of Scarlatina, and
the more probable that it will be set down as a proof of contamination.
“I will not dwell too much on the two observations I have cited, as I can-
not expect that they will carry the same conviction to others which they
do to myself. I will therefore beg permission to refer to such points in the
pathology of Scarlatina, as seem to give support to the view I have taken of
these cases:
“1. The inflammatory action in Scarlatina attacks a wide extent of mucous
membrane as well as skin. It invades a large portion, at least, of the alimen-
tary tract: the mouth, fauces, pharynx, oesophagus, and, doubtless, sometimes
the stomach and small intestines, are affected. The rectum and anus are
commonly involved.
“The respiratory mucous tract is not less extensively implicated. The nares,
larynx, trachea, and even the bronchi, have been repeatedly observed to be
inflamed. The urinary mucous tract is equally affected : the bladder, the
ureters, the pelvis of the kidneys, and even the tubuli uriniferi, are involved.
The only mucous tract remaining, is the genital. Analogy forcibly points
to the inference, that this will not be exempted from an inflammation which
invades every other mucous tract in the body. I see no reason why the
vagina (and also the urethra of both male and female) should not be as fre-
quently and as essentially inflamed as the rest of the mucous membranes.
“2. The Discharge. A common sequela of Scarlatina is an inflammatory
thickening of the Schneiderian membrane, accompanied by profuse secretion
of an acrid muco-purulent matter.
“Even before the febrile symptoms are abated, a similar secretion, but gene-
rally of a more viscid mucous character, is abundantly thrown out by the
mucous membrane of the throat.
“A viscid secretion, often containing flakes of lymph, is also frequently
coughed up from the trachea. In short, the obstruction of the throat, mouth,
and nares, by muco-purulent secretions, is one of the most distressing and
alarming symptoms of Scarlatina.
“Scarlatinal inflammation, then, of portions of the alimentary and respira-
tory mucous tracts, is attended by morbid products similar in character to
those attending severe inflammation arising from any other cause.
“Ordinary inflammation of the vagina and os and cervix uteri is most com-
CRITICAL DIGEST OF THE JOURNALS. 871
monly productive of mucous or muco-purulent discharges. It is, then, rea-
sonable to expect that Scarlatinal Waginitis should produce similar results. .
“I further believe, that a muco-purulent discharge from the vagina may also
arise in connexion with small-pox and other exanthematous diseases, which
affect large tracts of mucous membrane as well as skin. -
“Such a discharge, arising from Scarlatina or small-pox, may frequently be
overlooked ; or, when detected, be erroneously attributed to blennorrhagic
infection. .
“I have another observation to make in reference to this subject. Like the
discharge from the mares, the vaginal discharge may persist for a lengthened
period after convalescence from the fever. It may constitute a new form of
leucorrhoea, the true origin of which may never be suspected. In such a
case, the treatment would be simple. I have found nothing succeed so readily
in inducing a healthy action of the Schneiderian membrane, when affected
by Scarlatina, as the application of nitrate of silver; and I have no doubt
that a few injections of a solution of nitrate of silver into the vagina, so as
to reach the os and cervix uteri, would effect a cure.
“In conclusion, I freely admit that the occasional occurrence of a muco-
purulent discharge from the vagina, as a consequence of Scarlatina, has yet
to be established. Observation alone can decide this. Extensive inquiry
will soon determine the existence of this affection, and the relative frequency
of its occurrence. These points established, the practitioner may often expe-
rience the grateful opportunity of dispelling unjust imputations against
female virtue, and of defeating false accusations of criminal violence.”
DR. CoRMACK's PAPER. “In 1844 I published, in the Edinburgh Monthly
Journal, a memoir, entitled, ‘Gonorrhoea and Syphilis with reference to
Forensic Medicine and Therapeutics', in which I directed attention to vari-
ous topics, including non-venereal Waginitis. Since that period, several cases
in my own practice, and others which have been mentioned to me by profes-
sional friends, have convinced me that exposure to cold, and other causes
enumerated in the memoir referred to, are even more frequently the sources
of inflammation and purulent discharges from the vagina, than I supposed
at the period of its publication.
“At present, I only wish to say a very few words with reference to a paper
which appeared in the Medical Gazette, July 12, p. 65, by Dr. Robert Barnes,
entitled, “On the Occurrence of a Muco-Purulent Discharge from the Vaging
&n Scarlatina,and the importance of this symptom in relation to Forensic Medi-
cine'. Dr. Barnes attaches a much greater amount of importance to such
cases than I was aware they possessed. He considers them very uncommon;
and, in support of this doctrine, he cites two eminent authorities, Dr. Tweedie
and Dr. Miller. I do not write in a controversial spirit, but simply with the
view of inducing others, for the future, to inquire into the presence or absence
of Waginitis in Scarlatina. Dr. Barnes says: ‘I am quite prepared to accede
to the opinion of Dr. Tweedie and Dr. Miller, that a muco-purulent discharge
from the vagina in Scarlatina is a very rare occurrence; but this very cir-
cumstance increases the importance of the symptom in relation to questions
of legal medicine.’ * . -
“During the last epidemic (1848-49) of Scarlatina,' I had, under favourable
circumstances, considerable, though not a very large experience of the dis-
ease ; and of all my cases I have preserved a record. Waginitis I frequently
met with, and I regarded it in no way as an unexpected or rare occurrence;
but, on the contrary, as a not unlooked-for extension of the exanthematous
inflammation of the skin, analogous in its nature to what is often met with
in the mucous linings of the nose, ear, air-passages, and intestinal canal. In
* Much information regarding this epidemic will be found in Dr. Miller's admir-
able monograph, lately published. * X- -
872 CRITICAL DIGEST OF THE JOURNALS.
the epidemic of 1848-49 I had under my charge twenty-three female patients,
all of whom were cleanly, well nursed, and in a respectable social position.
In twelve of the whole number, there was well-marked Waginitis ; and so
impressed was I with the importance of averting or preventing this affection,
that, in every female patient, I directed, from the very first, careful ablutions
of the parts to be performed at least twice in twenty-four hours. Of the
twenty-three female patients, two only were above fourteen years, and these
were respectively twenty-six and twenty-eight, and both married. Now both
of these patients had acute Waginitis, much more severe than any of the
children. In one lady, for forty-eight hours, the discharge was so abundant
as to require the nurse to change the towels at least every hour; and it was
of so acrid a nature as to excoriate the thighs and anus, notwithstanding
every precaution being taken to protect these parts. The other had it more
mildly; but the Waginitis was also in her a source of great suffering and
discomfort. The first lady aborted: the second was not in the family way.
The first was the most dreadful case of Scarlatina, which I have ever seen
issue in perfect recovery ; the second was one of moderate severity.
“Speaking, as I now do, from a very limited number of facts, I have no
right to give an absolute opinion as to the frequency or rarity of Scarlatinal
Waginitis; but I would venture to suggest, that the non-observance of this
affection by the practitioner is no proof of its absence; for patients suffering
from scarlet fever are often too ill to make complaints : and, in other cases,
-the affection is managed by the nurse, without her thinking it necessary to
trouble the doctor. The question must be decided by future experience of
a large number of cases, carefully observed with a special view to its eluci-
dation.
“The whole treatment required is generally frequent ablution with tepid
water, and, if pain be complained of, the use of opiate fomentations. The
children, with one exception, required very little special treatment ; but
one, of strumous habit, continued to have a profuse muco-purulent discharge
long after convalescence was in all other respects complete. Chalybeate
medicines, cod-liver oil, and astringent lotions, at last effected a cure. The
two adults were both treated by injections of nitrate of silver, and the keep-
ing apart the labia by a piece of lint soaked in the same. I believe that, in
severe cases, the nitrate of silver will be found the best local remedy : but
the injury which it occasions to the limen of the patient, and of her bed, na-
turally occasions a prejudice against its use.”
ACETATE OF POTASH IN SOME DISEASES OF THE SRIN.
DR. J. A. EASTON, of Glasgow, having been led, by a perusal of Dr. Golding
Bird’s Lectures, to employ Acetate of Potash in some Diseases of the Skin,
has published the results at which he has arrived, in an important practical
paper in the Edinburgh Monthly Journal for May 1850. The following cases,
out of several in which the Acetate of Potash was used, have been selected
by him as illustrating the skin-diseases most commonly met with. They are
abridged from the reports of the Royal Infirmary of Glasgow.

CASE I. Psori ASIs DIFFUSA. Ann M'Intyre, aet. 16, servant, admitted 18th
September, 1849. About five months ago, without assignable cause, patient ob-
served some small red patches on the lower extremities, which were soon covered
by whitish scales, which fell off, leaving the surface red, shining, and tender
to the touch. The patches gradually enlarged, till at length they formed an
almost continuously affected surface. Two months after the patches had ap-
peared on the lower extremities, some were observed on the upper; these soon
extended, so as to cover the arm from the wrist to above the elbow. On
admission, the upper and lower extremities had the usual appearance of
psoriasis. The elbow, wrist, and knee-joints, but especially the last, were
deeply fissured, and covered with thick yellowish crusts. One or two patches
CRITICAL DIGEST OF THE JOURNALS. 873
had also appeared on the face. To use the alkaline warm bath every day; to
take five grains of the iodide of potassium thrice daily, and a Plummer's
pill every night. Under this treatment, the disease continued to increase in
intensity and diffusiveness till the 13th October, when she was ordered the
following mixture: Acetate of Potash 5v, water 3xij. Mix. Of this mixture
take an ounce thrice daily. Omit the other medicines. Was dismissed cured
on 7th December. Duration of disease from commencing Acetate of Potash,
less than two months. In this case, iodide of potassium and Plummer's pill,
though persisted in for nearly a month, failed to make the slightest impres-
sion on the disease. No record was kept of the state of the urine.
CASE II. Psor[ASIS DIFFUSA. Sarah Miller, aet. 18, factory worker, of full
habit of body, admitted 19th September, 1849. About two months ago, an
eruption of small red patches, covered with white scales, appeared on the lower
extremities, and three weeks ago on upper extremities. On admission, the
lower extremities presented the usual appearance of psoriasis diffusa, and
the eruption was not so general or intense on the upper extremities. Skin
hot ; pulse 72, full. She was ordered the warm bath, and to take 4 ounces of the
following mixture morning and evening: Nitrate of Potash 2 drachms; sul-
phate of magnesia 1 ounce ; water 24 ounces; Mix. On the 24th September,
she was put on the Acetate of Potash, and the diuretico-cathartic mixture
was discontinued. She was dismissed cured on the 14th November, the
disease having lasted nearly two months from the time when the use of the
Acetate of Potash was commenced. No record was kept of the state of the
ll. TIIl62.
CASE III. PSORIASIS DIFFUSA. Margaret Lindsay, aet. 40, laundry-woman,
widow, admitted 26th November, 1849. On admission, the whole dorsum of
the left foot and lower half of the leg were covered with a scalyeruption, having
numerous fissures. The scales being removed, the subjacent surface presented
a red shining appearance, and the scales were quickly reproduced. The right
leg and both arms were similarly affected, but in a milder degree. She was
ordered an ounce three times daily of the following mixture: Acetate of
Potash 6 drachms; water 12 ounces. Mix. Patient was cured of the psoriasis
in less than four weeks, but remained in the hospital a fortnight longer, in
consequence of cephalalgia. Average quantity of urine passed per diem, 74
pounds avoirdupois. Average sp. grav., 1.016.
CASE IV. ECZEMA IMPETIGINoDEs. Margaret M’Callum, aet. 21, unmarried,
bleacher, admitted 19th January, 1850. Two months ago, after some pyrexial
symptoms, patient observed a vesicular eruption on the upper extremities. It
was attended with some itching, and, when scratched, gave exit to a clear
fluid, which concreted into yellowish crusts. Of late, however, the eruption had
assumed a pustular character. On admission, the skin between the wrist and
elbow-joints, and on the forehead and cheeks, was covered with a continuous
yellow crust. Pulse 116, full; tongue dry; skin hot. This patient was first
bled to 12 ounces, and had a smart purge of calomel and jalap. The blood
drawn was buffy. On the next day (the 20th), the pulse being 96, and the
febrile symptoms considerably abated, she began the use of the Acetate of
Potash in half-drachm doses thrice daily; and I may here mention, that this
is the quantity which I now invariably prescribe to adults. This woman left
the hospital cured on the 23rd of February, having been under treatment by
the acetate one month and three days. It is of consequence to note, that
the urine voided during the first twenty-four hours after admission, and
before any medicine was given, was only eight ounces, high eoloured, and of
sp. grav. 1:032; the average amount under the use of the salt, was 54 ounces,
of average sp. grav. 1-019. Within the last few days I have been informed
by my friend Mr. Menzies, one of the surgeons to the city poor, that the
disease re-appeared a short time after the patient left the hospital.
CASE v. ECZEMA IMPETIGINoDEs. Rachel M*Allister, aet. 31, single, dye-
worker, admitted 19th January, 1850. This case was so similar to the fore-

874 CRITICAL DIGEST OF THE JOURNAI.S.
going, that I think it unnecessary to transcribe the details. There was no
febrile exacerbation, however, in this case as in the former, the pulse on
admission being 84, the tongue moist, and the skin cool. Amount of urine
voided during the first twenty-four hours—no medicine having been given—
was 32 ounces, of sp. grav. 1:013. She was put on the usual treatment, and
subsequently, the average quantity of urine was 78 ounces, of average sp.
grav. 1.016. She left the hospital all but cured on the 2d March.
CASE VI. PSORIAsis, witH ExTENSIVE DESQUAMATION OF CUTICLE. Wm.
Dorrington, aet. 28, tailor, single, admitted 14th December, 1849. Patient
was treated in this house four years ago, for an affection similar to the present.
On admission, the skin of the face was dry and covered with white scales,
giving the appearance as if a quantity of flour had been applied. There was
also extensive desquamation on the back and arms ; the lower extremities,
from the knees downwards, being red and somewhat swollen. The gums
were slightly tender, which the patient ascribed to the slight use of mercury
before admission. As this man was considerably debilitated, I deemed it
advisable to improve his general health before having recourse to the Acetate
of Potash. Accordingly, for a few days after admission, he was ordered
nutritious diet, and the citrate of iron and ammonia. His condition being
ameliorated by these means, he began the use of the Acetate of Potash, com-
bined with infusion of gentian, which treatment was continued till he left
the hospital cured on the 23rd January, 1850. Duration in hospital, one month
and nine days. No record kept of urine. When this patient was treated in
the hospital for a similar affection four years ago, he remained there for
thirteen weeks.
CASE VII. ECZEMA RUBRUM. George Morris, aet. 39, weaver, married, ad-
mitted 29th November, 1849. A small patch of vesicles was situated on the in-
side of the right forearm, a little above the wrist. This eruption had appeared
about two weeks before, and was attended with considerable prurigo, and
when scratched, gave exit to clear fluid. An eruption of about twelve
months’ standing was situated on the lower extremities, from a little below
the knee downwards. This was stated to have commenced in exactly the
same mauner as the eruption on the arm ; it had a bright red appearance,
and the affected surface, especially if scratched, exuded a clear fluid. General
health good. Acetate of Potash was administered as usual ; and the amount
of urine, which, during the first twenty-four hours after admission, amounted
to the unusually large quantity of 4% pounds, or 72 ounces, speedily and
steadily increased, till on one occasion it rose to as high as 11 pounds, or 176
ounces. Under the use of the salt, the average quantity was 120 ounces, of
average sp. grav. 1:012. It ought to have been stated, that the sp. grav. of
the 72 ounces voided before any medicine was given, was 1.016. This man
was dismissed cured on the 22d December 1849, having been in the hospital
three weeks and two days.
CASE VIII. PSORIASIS PALMARIs. Michael Dyer, aet. 14, admitted 29th
January 1850. This was a case of psoriasis palmaris of five months’ dura-
tion, and is presented merely because the patient, being a boy of only four-
teen years, took less Acetate of Potash than the usual quantity, the medicine
having been given in doses of 10 grains thrice daily. The average quantity
of urine voided under the influence of the salt, was 56 ounces, of average
sp. grav. 1:017. He remained in the hospital five weeks, and was then dis-
missed cured.
CASE IX. LEPRA VULGARIS. J. B., aged 15% years, flesher's apprentice.
Five years and eight months ago, an eruption appeared on his hands and
head, at first red, and afterwards covered with white shining scales. He was
put on the use of vegetable tonics, without benefit, and afterwards sent to sea-
bathing, where he remained only a few days, until he was completely covered
with the eruption. He was then removed to town, and placed under the care
of a medical man, who prescribed the warm bath every night, and the use of
CRITICAL DIGEST OF THE JOURNALS. 875 .
various ointments, some of which were supposed to contain some preparation
of mercury. This treatment had little or no effect. The bed-clothes were
filled with white scales in the morning. After a considerable interval, he
commenced the use of Fowler's solution, and continued it until he had taken
several ounces with no benefit. Eight months ago, he began to use the iodide
of starch, and continued it for about four months with slow improvement.
About the beginning of October last, the appearance of his hands and face
was so repulsive, that he was about to be dismissed from his employment.
About the beginning of December last (1849) he was seen by me, when I
suggested a trial of the Acetate of Potash. The suggestion was adopted, the
boy began gradually to improve, and by the end of January, the eruption
had entirely disappeared, and has shown no symptoms of return up to the
16th March, 1850.
REMARKS. Two circumstances are worthy of notice in these cases, viz:
1. The comparative shortness of the duration of the individual diseases, in
pleasing contrast with the proverbial inveteracy of skin-diseases in general :
and 2. That the benefit produced in these cases was entirely attributable to
the Acetate of Potash. The alkaline warm bath, and fomentation of the
affected extremities, were employed pretty generally, in the acuter cases
always; but, with the exception of blood-letting in Case IV, of the catharto-
diuretic mixture in Case II, to subdue general plethora, and the iron and
gentian in Case VI, no other medicine was administered than the Acetate of
Potash.
Dr. Easton next proceeds to consider the more prominent effects of the
medicine, and how far these may be held to indicate its physiological action,
and to explain its remedial efficacy.
1. The administration of the salt was followed by a great increase in the
amount of urine. Making allowance for differences in season, and in the
state of the atmosphere, and for other causes which are known to influence
the secretion of urine, the average quantity voided during twenty-four hours
is about 40 ounces, or 2% pounds. Now, the smallest amount of urine which
was voided in the cases under review, was 54 ounces, as in Case IV ; while the
greatest was 7% pounds, or 120 ounces, as in cases III and VII, there having
been, in the case in which the amount was lowest, an increase of 14 ounces;
and in those cases in which it was highest, an augmentation of 80 ounces,
over the ordinary quantity. These facts speak conclusively as to the diuretic
power of the Acetate of Potash. But the term diuretic is of vague significa-
tion; at all events, two very different results follow the administration of
different classes of remedies, both which are comprehended under the general
appellation of diuretics. Thus, some of these increase merely the amount of
the water of the urine; others, the amount of its solid constituents, urea,
lithic acid, and the salts. Under the former, may be ranked broom, juniper,
squill, digitalis, and, to use the language of Dr. Golding Bird, “all those
agents which, out of the body, exert no chemical effect on animal matter”.
Such substances, which Dr. Bird calls renal hydragogues, appear to influence
exclusively the Malpighian bodies of the kidneys, that delicate expanse of
capillaries which, as has been shown by Mr. Bowman, separate the water
that is discharged from the blood by the renal glands. The facts submitted,
then, warrant the conclusion, that the Acetate of Potash increases the
water of the urine,—in other words, that it acts as a renal hydragogue.
2. Acetate of Potash possesses also the property of increasing the quantity of
the solid constituents of the urine, in so remarkable a degree, as fully to
entitle it to be considered a renal alterative or blood-depurant, as well as a
renal hydragogue. The elimination from the blood of the solid constituents
* Philosophical Transactions for 1842.
WOJ,. l I. 58
876 CHITICAL DIG lºST OF THE JOURNAI.S.
found in the urine, may be considered the function of the kidney par excel-
lence; for, while this gland undoubtedly separates superfluous water from the
circulating mass, it cannot be said to possess a monopoly in that respect, see-
ing that superfluous water is likewise discharged by the lungs and the skin.
But it is specially the office of the kidney, as well to de-acidify the blood, as to
rid it of redundant nitrogen-effecting the former of these objects by loading
the urine with acid salts; the latter, by elaborating and excreting urea and
lithic acid. Accordingly, the amount of these nitrogenous compounds in the
urine, both of which, according to Dr. Bird, are produced from the metamor-
phosis of nitrogenised elements of worn-out tissue or mal-assimilated food,
may be assumed as a measure of the amount of the destructive assimilation
of nitrogenised tissues or other matters in a given time ; for it may be re-
garded as a general exceptionless fact, and be enuntiated with the emphasis
of a general law, that all soluble matters in the blood, which are either not
able, or are not needed, to contribute to the growth and reparation of the
tissues, are ejected by the kidneys. Now, while the investigations of Mr.
Bowman! have shown, as already stated, that the Malpighian capillaries
separate the water of the urine, it has also been established by the same
distinguished physiologist, that the separation of the solid constituents, or
peculiar urinous principles, is effected by the cells which line the tortuous
uriniferous tubes, exercising their secreting power for that purpose on the
blood of the portal capillary plexus, with which the bodies of these tubes
are in intimate contact.” The amount of these urinous principles influences,
of course, the density of the urine ; and while the exact amount of them,
which is voided in a given time, can only be determined by a quantitative
analysis of that fluid, still, by attending to its specific gravity, we can ascer-
tain whether they be above or below the normal amount. The specific gravity
of water being estimated at 1:000, that of healthy urine ranges, as is generally
understood, between 1-015 and 1.025; but, from a very painstaking and very
extensive observation of this matter, Dr. MacGregor has come to the conclu-
sion, that 1:016 most correctly expresses the specific gravity of healthy urine.
If, then, 40 ozs. of urine, of sp. grav. 1:016, be voided on an average in twenty-
four hours, is there any mode, short of performing a quantitative analysis, by
which we can estimate, more precisely than by merely contrasting the dif-
ference between 1-000 and 1.016, the waste of tissue which has taken place
during that period On this point, Dr. Bird supplies practically important
information. After urging the necessity of ascertaining the integrity of the
blood-depurating function of the kidney, and acknowledging, at the same
time, the practical difficulties of doing so by evaporating the urine to as dry
an extract as can be obtained, he calls attention to the advantages presented
by the more rapid and easy determination of the quantity of solids from the
specific gravity of the urine, and then subjoins a table, which he has con-
structed, for the purpose of ascertaining that point. The peculiarities and
the mode of applying this table to practical purposes, will be best gathered



* Philosophical Transactions for 1842.
* The views of Mr. Bowman regarding the separate functions performed by the
Malpighian bodies, and the portal capillaries which issue from them and invest the
tubes, are supported by the anatomical arrangement—first pointed out, I believe,
by that gentleman—of the renal vessels in the boa constrictor. (Philosophical Trams-
actions, 1842.) Additional evidence of the accuracy of Mr. Bowman's opinion has
been adduced, incidentally, in a paper by Dr. George Johnson, in vol. xxx of the
Medico-Chirurgical Transactions, 1847, in which Dr. J. remarks: “Within the last,
two months, I have examined the kidneys of two persons, who died jaundiced, and
in whose urine there had been a quantity of bile. Many of the urinary tubes were
stained of a deep yellow colour, by the bile in their epithelial cells. This yellow
colour ceased abruptly at the neck of the Malpighian bodies, and in no instance did
I observe it in the Malpighian bodies themselves.”
CRITICAL DIGEST OF THE JOURNALS. 877
from the following sentences —“Thus, if the specific gravity of any specimen
of urine be expressed in four figures, the two last will indicate the quantity of
solids in a fluid ounce of the urine, within an error of little more than a grain,
when the density does not exceed 1-030 ; above that number, the error is a
little greater. To illustrate this, let us suppose that we are called to a patient,
the integrity of the depurating functions of whose kidneys we are anxious to
learn. The quantity of urine excreted in twenty-four hours amounts, we will
suppose, to three pints, or sixty ounces, and the density of the mixed speci-
mens passed in the time alluded to is 1-020; now, we merely have to multiply
the number of ounces of urine by the two last figures of the specific gravity,
to learn the quantity of solids excreted, or 60x20 = 1200 grains.” We may
now see how far the function of the kidneys was influenced by the Acetate
of Potash in the cases under consideration ; in other words, to what extent
the solid constituents, as well as the water, of the urine, were increased by that
salt. In the cases in which least urine was voided—being 54 ozs. in the
lowest (Case IV), and 56 ozs. in the second lowest (Case v1.11), the specific
gravity was respectively 1-019 and 1:017; while in those in which the amount
was highest, the specific gravity was 1:012 in one of them (Case v1.1), and 1:014
in the other (Case III)—the average quantity voided by each of these patients
having been 120 ozs. To those who take but a superficial view of this matter,
the results just stated in reference to the specific gravity in these cases—par.
ticularly in reference to that of the two last—may appear inconsistent with
the statement, that the Acetate of Potash increases the solid constituents of
the urine, and thereby promotes the depuration of the blood. If such be the
case, why, it may be asked, is the specific gravity not above the normal
standard, instead of being below it ! A moment's reflection will explain the
reason, and show that the salt under consideration acts powerfully in pro-
moting the elimination of those peculiar urinous principles, which result from
the secondary destructive assimilation of effete tissues, mal-assimilated food,
and all abnormal products of low vitality and imperfect organisation. In all
the cases, the amount of water holding these solid constituents in solution
was materially—in Cases III and VII enormously—increased ; and it must
never be forgotten that, if the same amount of solid matter be dissolved in a
larger or smaller quantity of water, the specific gravity will be proportionally
lower or higher. Thus, when the menstruum is much increased, the specific
gravity may not be above the normal standard, and yet the activity of the
kidneys, as blood-depurating organs, may be very great; for with the increased
amount of water, there is washed out from the blood an increase of the solid
urinous constituents also. Connecting this fact, then, with Dr. Bird's table,
we shall find that, when 54 ounces of urine were voided, of the sp. grav. 1-019,
as in Case IV, the blood was depurated to the extent of 991 grains in twenty-
four hours; while, when 120 ozs. were passed, of the sp. grav. 1.011, as in
Case VII, the separation of salts and waste of tissues, as indicated by the cri-
terion of the specific gravity, amounted to 1440 grains in the same period.
These results furnish abundant evidence of the power which the Acetate of
Potash possesses, in promoting the metamorphosis of tissue, thereby in-
creasing the solid constituents of the urine, and proportionally depurating
the blood.
III. This salt is also itself altered in its progress through the organism ;
it being well known that the salts of the vegetable acids are all converted in
the system into carbonates, and are found as such in the urine. Now it is
susceptible of proof, almost of mathematical demonstration, that the benefit
derived from the Acetate of Potash in skin-diseases, is owing substantially to
its being converted into the carbonate of that alkali. But, before adverting
to this change, there are some circumstances connected with the action of
the carbonate of potash that require to be noticed. That the carbonate of
potash can exercise a transforming influence over organic compounds out of
- 58 2
878 CRITICAL DIGEST OF THE JOURNALS.
gº
the body, is undeniable. Thus, albumen, digested with an alkali, is broken
up into secondary compounds, yielding leucine, formic acid, and the bodies
allied to gelatine, called protid and erythroprotid. In like manner, casein
is broken up into tyrosin, leucine, valerianic acid, and other substances.
These being some of the effects which this salt produces out of the body, is it
too much to presume, with Dr. Golding Bird, “that, when we cause an alka-
line carbonate to circulate through the blood, it exerts an influence on the
nascent elements of those matters less highly influenced by life, allied to that
which it exerts on dead matter, aids their resolution into substances allied to
those produced out of the body, and actually causes the matter to assume so
soluble a form as to allow of its ready excretion ?” This notion may be ob-
jected to as Savouring of materialism, and as tending to lower the controlling
influence of the vital principle from its high place in the creed of the phy-
siologist as a cardinal doctrine of his faith. But every one knows that, so
long as the body is endowed with the vital principle, it can resist, in manner
most mysterious, those humbling alterations, which so speedily ensue when,
separated from its nobler associate, it becomes the subject of resistless change
and elemental resolution. Chemical affinity can effect great changes—but it
is not omnipotent; for where is its potency, when the acid gastric juice is not
permitted to prey on the living stomach, and what power is it, but life itself,
which gives to that otherwise unprotected organ a perfect immunity from such
a corrosive fluid'. But it can scarcely be doubted, that the vital force is not
the sole agent in producing the chemical phenomena of life ; or that, in bodies
of low vitality and imperfect organisation—such as the noxious matters which
are produced in the system by disease—the laws of chemical affinity, or of
chemical tendency rather, as Dumas expresses it, are uncontrolled. If proof
were needed to establish this point, it might be derived from the circumstance,
that many compounds, as urea, valerianic acid, etc., which, at one time, were
supposed to result entirely from unseen processes in the laboratory of nature,
and to be incapable of being formed by any other, are now elaborated with
ease by the manipulations of the chemist.
But it may be asked, if the beneficial results be owing to the circulation
of the carbonate of potash in the blood, why not administer the carbonate
from the first, rather than trust to its production in the system from the
decomposition of the acetate 1 The answer to this objection is found in the
fact, that the exhibition of the carbonate, as carbonate, does not produce the
effects which follow the administration of the acetate. No doubt, the urine
may be rendered alkaline by the use of the carbonate, and the aggregate
quantity of the excretion may be somewhat increased—in short, the car-
bonate may alter the reaction of the urine, may act occasionally as a renal
hydragogue, but very inefficiently as a renal alterative. We may then
legitimately conclude, that the physiological action and therapeutic efficacy
of the acetate are connected in some manner—unknown at present—with
the metamorphosis which takes place in itself. With the view of elucidating
this matter, it may be advisable to look at the chemical composition of the
acetate, and the difference which exists between it and the carbonate. Put-
ting the base out of view, we find that acetic acid is composed of C4 Ha Os ;
* While conducting a series of experiments, with the view of establishing this
point, my zealous clinical assistant, Dr. James Wallace, observed, in two cases,
that the urine contained copious deposits of the triple phosphate, and, what is
singular, that these appeared immediately after the use of the acetate had been
stopped. These deposits were probably owing to the urine, now diminished in
quantity by the withdrawal of the salt, being no longer able to hold the phosphate
in solution. Be this the explanation or not, the observation of such deposit is of
practical interest, and imposes the necessity of examining the urine microscopically
in all cases when giving the acetate, and immediately to intermit its use when a
phosphate makes its appearance.

*---, CRITICAL DIGEST OF THE JOURNALS. 879
and that carbonic acid is composed of CO2. Now, as the hydrogen and .
oxygen are in equal proportions in the acetic acid, it is clear that these
elements will unite to form water, and will leave, consequently, four atoms
of free carbon to unite with any body for which it has an affinity. But we
are not left in doubt as to the individuality of the body with which the
carbon combines; for we find that carbonic has been substituted for acetic
acid; and this could only have resulted from the union of carbon with
oxygen. We know, further, that eight atoms of oxygen must have been
furnished, to convert the four equivalents of carbon of every atom of acetic
acid into carbonic acid. The changes which acetic acid undergoes will be
made more apparent from the subjoined diagram :
CONVERSION OF ACETIC ACID INTO CARBONIC ACID AND WATER.
1 eq. Acetic Acid - - C, O3 H3 || 4 eq. Carbonic Acid - C, Os —
8 eq. Oxygen - - - – Os — 3 eq. Water - - - - – O3 Ha
wº- Total - - C4 O 11 H3 Total * gº C4 Oil H3
It becomes a matter of great interest, then, though unfortunately one of
great difficulty also, to ascertain whence this large amount of oxygen is sup-
plied. Any opinion on this point, must, in the present state of our know-
ledge, be purely conjectural ; yet we may hazard a few speculations on the
subject, which, though they may not carry conviction, may excite inquiry,
elicit discussion, and perhaps conduct to knowledge.
There are only three sources whence the oxygen can be furnished—from
the food, the atmosphere, or the organism ; including, by this last term, all
the products, normal and abnormal, which exist for the time being in the
system. For obvious reasons, there was no great likelihood of the oxygen
having been derived from the food of the patients. It is the opinion of
Liebig, that the salts of the vegetable acids, which are converted in the
system into carbonates, obtain the supply of oxygen necessary for the pur-
pose during respiration. This, however, is merely an opinion—certainly not
supported by demonstrative evidence, and not even by a reason why these
salts should appropriate oxygen in their passage through the lungs; and
there are one or two circumstances which are entitled to consideration as
militating against it. In the first place, the speculation assumes that the
decomposition and reconstruction of these salts are effected in the lungs, and
leaves out of view the more likely influence of digestion. Again, this
opinion presupposes a greater activity of the respiratory process, while such
salts are making the transit of the lungs—an event not appreciable, certainly,
by any increase in the number of the respirations. And, if morè oxygen be
not withdrawn from the air, and it be maintained, notwithstanding, that the
supply of the gas necessary for converting acetates, etc., into carbonates, is
furnished during respiration, then the advocates of that opinion are shut
up to the conclusion that, in order to effect the alteration of certain salts,
some part or parts of the organism are deprived of a portion, or, for anything
we know to the contrary, of all their oxygen, a procedure scarcely in accord-
ance with the general tendency of nature's operations. A theory at least as
plausible as this, and one as much in unison with ascertained facts, can be
constructed, by supposing that the necessary oxygen is derived from the
organism itself. That the effete portion of the organism is being continually
disintegrated and resolved into a variety of new forms in the capillary labo-
ratory of the system, is well known and undeniable; is it too much, there-
fore, to suppose that, amid these ever-varying transitions, a vegetable acid
may be broken up and altered, by being brought within the sphere of nascent
oxygen, evolved from compounds yielding to the resistless influence of the
secondary destructive assimilation ? But the solution of this interesting
problem in the chemistry of therapeutics must be left to future observers.


880 CHITICAL DI GlºST OF THIE JOU RNALS.
OXIDE OF SILVER FOR THE EXPULSION OF TAPE-WORM.
Mr. H. T. WHITTELL, of Birmingham, suggests, in the Lance: for June 29,
the use of Oxide of Silver in cases of Tape-Worm. He says: “I am induced
to suggest this remedy in consequence of having seen, in two cases under my
care, the most beneficial results from its employment; and, so far as I may form
an opinion from so small a number of cases, I am disposed to prognosticate
a favourable issue from the trial. The first case which came under my
motice, was that of a female of middle age, who, at different times, for the
space of about ten months, had been under my care, complaining of various
anomalous symptoms, which were supposed to arise from the presence of
worms in the intestinal canal. I administered turpentine, on two different
occasions, for three successive mornings; but although slight benefit was
obtained on each occasion, I only succeeded in bringing away some few joints.
At the end of the tenth month, I had occasion to prescribe for this patient,
who was then suffering from memorrhagia, one grain of the oxide of silver
three times daily, with an ounce of mixture containing six drachms of bitar-
trate of potash in the half-pint. After she had taken the fourth dose, I was
agreeably surprised to learn that she had evacuated a large quantity of tape-
worm, and that she felt better than she had done for many months pre-
viously. After this time she remained free from the symptoms she had
before manifested for some nine or ten months. A few weeks ago, she again
applied to me for a repetition of the dose; the oxide was again given, with the
same effect as before. In both instances, the worms were dead when passed.
“The second case is that of a married lady, who came under my care a
short time ago, complaining of dyspeptic symptoms. She explained to me
that she had suffered from tape-worms for some years, and had taken occa-
sionally medicines, with the view of their removal, but she had never taken
turpentine. I prescribed one grain of the oxide three times daily, with a
mixture of bitartrate of potash as a purgative. After the third dose, she
passed a large mass of the worm, and continued to do so for one or two days
afterwards, during the use of the remedy. Marked alleviation of the symp-
toms was the result. In this case, as in the former one, the parasite was
dead when passed.
“Although nothing conclusive can be obtained from these two cases, I
think the effects so marked in each, that it would be well for some gentleman,
who has a large public practice, to endeavour to ascertain what may be the
value of this agent in the cases named ; and, if found as successful in other
hands as it has been in the two cases given above, the oxide will prove to be
an invaluable remedy in cases which, at the present time, we all find to be
sufficiently perplexing.”
FEVER IN HOSPITALS AND OUT OF THEM.
DR. JAMEs ADAMs of Glasgow has published, in the Monthly Journal of
Medical Science for August 1850, a valuable statistical paper on the above
subject. We extract from his communication a summary of results, referring
our readers to the original paper for the statistical evidence forming the
groundwork of his remarks.
The chief conditions likely to affect the mortality in fever are, 1. The type
of fever; 2. The sex and age of the patients ; 3. The duration of illness prior
to coming under treatment. -
Allowing for the circumstance, that many of the more severe cases of con-
tinued fever, in the practice of district surgeons, are described as typhus, it is
still abundantly evident, that the number of cases of typhus, or the malignant
form of fever treated in hospital, does not exceed the number treated in out-
door practice.
The greater mortality of feverin hospitals over out-door practice, is notowing
CRITICAL DIGEST OF THE JOURNALs. 88.1
to an excessive proportion of cases of that sex (male), and at those periods of
life, in which fever proves most fatal.
The mortality from fever, both in hospital and in out-door practice, is
lessened when the cases are brought under treatment at an early period of the
disease. But the greatest proportion of cases are brought under treatment
at as early a period as could be reasonably anticipated. Moreover, statistical
evidence, as well as personal testimony, shews that no unnecessary delay takes
place on the part of the district surgeons, in sending their cases into hospital;
for fully one-third of the cases thus sent into the Glasgow Fever Hospitals,
were sent within a few hours of being attacked, and not more than a tenth
are removed to hospital after the third day from being first seen. Both in
out-door and in hospital practice, the mortality steadily increases with the
lateness of the period at which the patients are first seen ; but the rate of
mortality in hospital is so disproportionately large, from the very commence-
ment, that, although all the cases treated there had been received within the
first few days, the gross mortality would not be greatly diminished.
The aggregation, in one building, of a number of human beings in a state
of disease, re-acts with deleterious influence, and lowers the general tone of
vitality of the whole inmates. In 1847, the ratio of mortality increased and
diminished simultaneously with the increase and decrease of the number of
patients in the Glasgow Royal Infirmary. The mortality in the temporary
hospitals was less than in the infirmary ; but it would probably have been
equal, if the buildings had been previously occupied as fever hospitals, and
their wards impregnated with miasmata engendered by long concentration.
The structure of these buildings, which were temporary wooden sheds, and
were consequently well ventilated, also probably had a salutary influence.
Some influence must also be ascribed to the moral effects upon the weak-
ened mind of a patient, who finds himself suddenly removed from his friends,
and tended by strangers, and surrounded by the dying and the dead of the
hospital ward.
The mere transference of fever patients to hospital, has an immediate effect
on the general mortality. From statistical evidence, it is shewn, that while
the ratio of mortality is regular and progressive in out-door practice, there
is in hospital an irregularly and suddenly increased proportion, who die within
the first few days after their admission, and prior to the critical period. Dr.
Adams has “been told of patients dying on their way to the hospital ; of
others, who, on their arrival, were in such an extreme state of exhaustion,
that there really was not time to have their names transferred to the medical
books ere they expired; and he has seen entries in fever hospital books of pa-
tients, who, on their arrival, were placed in the customary warm bath, and
who actually ‘died in the bath !”
Fever hospitals are in many respects injurious ; but they are necessary
evils, and Dr. Adams would even approve of their number being increased
in Glasgow, provided that the barriers which prevent the prompt and free
admission of patients were done away with. “I would approve”, he says, “ of
the erection of district hospitals (as first recommended by Dr. Cowan), small,
unpretending edifices, capable of accommodating fifty or sixty patients, and
established in those situations where fever is known most to prevail. Cases
do occur—and will, it is probable, always occur—where, but for the fever hos-
pital, our senses would be outraged by the spectacle of the sick, miserable
poor, clogging our streets and bye-lanes, and dying unrelieved, under circum-
stances which precluded the possibility of effectual relief being afforded. A
readier admission into hospital would secure a larger proportion of early
cases, an increased number of hospitals would lessen the distance which
the fever patient is to be carried, and so far lessen the exhaustion, and con-
sequent risk, incurred by the fatigue of removal,—while the increased
accommodation made available, would lessen the dangers connected with
overcrowding, defective ventilation, and a necessarily vitiated atmosphere.”
882 C{{ITICAI, DIGEST OF THE JOURNALS,
PARALYSIS OF THE BLADDER THEATED BY STRYCHN INE.
CASE I. A man, aged 68, one day indulged, contrary to his custom, in
excessive drinking, and returned home in the cold very late at night. On
experiencing a sudden desire to pass urine, he was astonished to find that
his efforts were unavailing. The next day, the catheter was passed by M.
LEGLUYSE. Numerous medicines, among which were copaiva, turpentine,
stimulant diuretics, cantharides, and ergot, were tried without effect. M.
Lecluyse then administered strychnine, of which the dose was gradually in-
creased to five centigrammes (.77 of a grain) in the day. This induced spas-
modic contractions of the trunk and limbs, but the bladder remained unaffected.
Its use was then intermitted for a fortnight, at the end of which time M.
Lecluyse resolved to try its effect in injections. He dissolved thirty centi-
grammes (forty-six grains) in a little alcohol, and further diluted it with
five hundred grammes (about sixteen ounces) of water. Of this he injected,
on each of four occasions, thirty grammes, having previously emptied the
bladder. The organ at first seemed insensible to the remedy; but, in a few
days, the patient found that the urine escaped from between the catheter and
the urethra. On removing the catheter, the patient found himself enabled
to pass urine in the natural manner. The affection has not returned. [Journal
des Connaissances Médico-Chirurgicales, 15 April, 1850; from Annales de la
Soc. Méd. d’Emulation.]
CASE II. In a case of Paralysis of the Bladder, following concussion of the
spine produced by a fall on the back, strychnine was administered, by the
endermic method, fourteen days after the accident. A quarter of a grain
was sprinkled twice daily on denuded surfaces on the arms and legs. In two
minutes, painful contractions of the extremities were produced. The strych-
nine was increased to three grains per day in a week, and to four grains in a
fortnight. The contractions of the limbs became more violent; and, on the
twenty-fifth day, the urine began to pass freely. The patient has remained
cured for four years. [Ibid., 15 June, 1850; from Medicinisches Correspondenz-
Blatt Bayerischer Aerzte.]
IDR. C. FLEMING ON A PECULIAR FORM OF GLOSSITIS.
In a paper on Diseases of the Tongue, published in the Dublin Quarterly
Journal of Medical Science for August 1850, DR. CHRISToPHER, FLEMING de-
scribes a form of inflammation, comparatively rare, but deserving of notice
from the special symptoms attending on it. It is an inflammation, circum-
scribed or diffused, originating in the loose areolar tissue between the genio-hyo-
glossi muscles; commencing first like ordinary Glossitis, but soon characterized
by peculiar features. It generally attacks adults. Dr. Fleming has seen it
once or twice, in a mild form, in children, but probably not as a primary
affection. It is isolated, and apparently idiopathic.
The SyMPTOMs of the affection are thus described by Dr. Fleming :
The first symptom is that of uneasiness in the movements of the tongue,
and the sensation as if there were a lump or ball at its base, which creates
a desire for frequent acts of deglutition. In its earliest stage, the motions
of the jaws are painful and much curtailed. These local symptoms are soon
accompanied by ordinary symptomatic fever, usually of the sthenic type, yet
not unfrequently assuming the typhoid or asthenic character. Another train
of local symptoms, in the vicinity of the affected organ, also supervenes.
There is fulness under the chin, between it and the os hyoides, giving the
appearance of a double chin. Pressure here, especially near the os hyoides,
is very painful, and often leaves a dimple of oedema in the integuments,
which, in other respects, are healthy-looking. Should the case advance with-
out interference, the countenance assumes a peculiar aspect. Articulation
and deglutition are more and more interfered with, and, at last, almost wholly
C RíT1CA], [...] I GlºST ( ; F THE JOURNALS. 883
obstructed; the voice is guttural, and the saliva dribbles over the chin. The
integuments now become more engaged, and gradually assume a diffused red
appearance, circumscribed or otherwise, according to the stamp of the inflam-
mation. The swelling, in some cases, spreads laterally, so as to occupy the
whole fore part of the throat; and, in some rare cases, an attempt at point-
ing is manifest, and in others, still more rare, an absolute gangrene of the
integuments takes place. . Of this, I have seen but one case. These symp-
toms, though severe, are the least important. Independent of the prostra-
tion attendant on the fever, on the impeded respiration, and on the loss of
power of deglutition, the risk from mechanical pressure on the epiglottis is
seriously to be apprehended. Suppuration advances; and, whether circum-
scribed or diffused, tends towards the base of the tongue. It dissects the
extrinsic muscles, injures the periosteum, and lays bare the inferior maxilla.
If the inflammation be diffuse, the fever will probably destroy the patient
long before the local symptoms have reached their acme.
The DIAGNoSIs cannot be difficult, if the prominent features of the case are
borne in mind. The sensation of fulness at the base of the tongue, the ten-
derness on pressing its dorsum, the gradually-limited motion of the jaws, the
fulness and tenderness under the chin, the increase of that fulness, ultimately
and rapidly complicating the integuments, all these local symptoms, com-
bined with severe constitutional disturbance, can leave little doubt as to the
nature of the case.
The TREATMENT is simple, but must be decided. In the first stage, ordinary
antiphlogistic remedies may be employed, and great relief will be obtained
from free leeching under the chin ; but should the symptoms not yield
readily, or the case not be seen till an advanced stage, no means can compete
with an incision in the median line, through the integuments and fasciae
under the chin, and fairly through the raphe of those muscles which delay
the advancement of the suppurating process. Here free incisions must be
made ; and the passage of the finger through the wound, to a considerable
depth, will discover the muscles flabby and detached from each other, and
the interstices filled with purulent matter, occasionally very fetid. The after-
treatment and progress of the case must be obvious. Should the periosteum
have been engaged, and the bone denuded, a proportionate delay will take
place in the reparative process, and more than probably exfoliation will occur.
DR. C. FLEMING ON TUBERCULAR AFFECTION OF THE TONGUE.
The following is a further extract from the paper by Dr. FLEMING, on
Diseases of the Tongue, above referred to.
“Cases are occasionally met, where the tongue is studded with Tumours,
apparently developed in its substance, and gradually extending towards its
upper or lateral surface, or both. These tumours grow imperceptibly, and
acquire some size before they attract attention. Of this, the following cases
are examples:
“CASE I. M. D., a married woman, aged about thirty years, applied to me
complaining of all those sensations attendant on diseases of the mouth,
painful deglutition, rendered more so by any stimulating or solid food, and a
feeling on the tongue as if it were blistered. Her mouth was always filled
with saliva, often distressingly and profusely, especially during sleep; her
articulation was painful and thick, and her health was breaking down, as well
from this ailment as from the mental anxiety attendant on its obstinate
resistance to treatment. Various gargles had been recommended, and various
remedies used, without benefit ; and she was pallid, anxious-looking, and
attenuated. On examining the mouth, the tongue, at its apex, and extending
an inch or so towards the dorsum, was full, irregularly swollen, and the
mucous membrane abraded in small patches, both on its upper and under
aspect. Some of these patches were clean and raw-looking, while others were
884 CRITICAL DIGEST OF THE JOURNAI.S.
covered with a whitish tenacious substance. On touching them with the
finger, tumours, about the size of ordinary garden peas, could be felt, corres-
ponding with each abrasion ; others, again, were to be found imbedded in the
substance of the tongue. No other morbid lesions could be detected, and no
ground existed for the slightest suspicion as to syphilitic taint. -
“CASE II. Thomas Hayden, aged 35, an hostler, dates the affection of th
tongue, under which he labours, to April 1849. It then commenced in the
form of a blister, and he was disposed to attribute it. to smoking. He had
medical advice from a practitioner in his neighbourhood in the country, by
which he was temporarily relieved; after four or five months, he came to town,
the disease in the interim having gradually advanced to its present stage.
He is a married man, and has healthy children. About four years back, he
had gonorrhoea, but he never had any venereal sore, excoriation, or bubo.
His health is good, and he is free from any additional ailment.
“When the man presented himself to me in the month of August, he stated
that his tongue was his sole complaint, that he felt it full and too large for
his mouth, that its motions were painful and stiff, and its several functions
impaired. He was obliged to use fluid or soft nutriment, and to avoid any-
thing stimulating. He was much annoyed with the profuse secretion of saliva,
and has occasional lancinating severe pains in the ears, and along the back
of the neck, darting towards the temples. He had no disagreeable discharge
from the mouth, and was free from much pain if he avoided any local irrita-
tion. On questioning him closely as to the mode in which this disease com-
menced, he stated that he first felt a tumour in the tongue near its centre,
about the size of a small marble; that a blister formed on its surface ; that
it ultimately ulcerated, and that a succession of these were superadded.
The aspect of the disease was very formidable; the organ was generally
hypertrophied, its central portion occupied by a deep ulcerated cleft, ex-
tending about an inch and a half in its longitudinal axis, and more than
half an inch in depth, and branching off into irregular fissures on each
side. The edges of the ulcerations were rugged and hard, and the surface was
of a dirty white colour. The intervening portions of the tongue were of a
fiery red hue, extremely tender to the touch, and almost devoid of any
appearance of papillae; on compressing the tongue between the fingers,
isolated tumours of various sizes, from that of a pea to that of a horse-bean,
could be distinctly felt ; and both on its upper and under surfaces, the epithe-
lium in the site of these tumours was abraded where ulceration did not exist.
There was no evidence of any other lesion in the neighbourhood. The aspect
of the man was as healthy as could be expected from the description of food
to which he was necessarily limited, and he found himself fully equal to his
work. -
“The local treatment used was the occasional application of nitrate of
copper, alternately with oxymel aeruginis; and the constitutional remedies
employed were blue pill, hemlock, and iodine, in combination with potash
and preparations of iron. The improvement in the ulcer, from the appli-
cation of the nitrate of copper, was rapid, and that before any effect could be
calculated on from the other remedies. The cure, at one period apparently
effectual, has since been retarded by returns of ulceration at irregular points
of the cicatrices; but these were immediately checked by the nitrate of copper,
and, I have no doubt, will ultimately yield to a persistence in the constitu-
tional treatment suited to cases of the kind.
“CASE III. P. G., aged 22, unmarried, a teacher in one of the National
Schools, applied in March, 1850, with a disease of the tongue, which rendered
his articulation so thick and so indistinct, as to cause him to dread the loss of
his situation. To particularize his prominent symptoms, would be in reality
little more than a recapitulation of those noted in the last case. The disease
commenced about two months previously, in the shape of small kernels, as
he termed them, in the substance of the tongue, These became identified
CRITICAL DIG FST OF THE JOURNALS. 885
with the mucous membrane, which was abraded over some, and ulcerated
over others, and they subsequently assumed their present character; the
portion of the tongue in their interstices becoming swollen and painful. He
had always enjoyed excellent health, and his general appearance was indica-
tive of it. He had never been exposed to syphilis, and was free from any
other local or general complaint. The only discernible lesion was that in
the tongue. The left half of the tongue was hypertrophied, so as to project
beyond the apex on that side ; about its centre, approaching the median line,
was a deep ulcerated cleft, with irregular edges, afoul surface, of a dirty whitish
colour, with the sides firm and solid. The substance of the tongue around
was full and swollen, and of a bluish pink colour. Its whole aspect was that of
a formidable and painful disease, yet the latter character was comparatively
absent. On compressing the tongue, small, solid, and fixed tumours were to
be felt deeply imbedded in it; and on looking more accurately at both the
dorsum and under surface, the epithelium could be seen abraded in one spot,
the mucous membrane ulcerated in another, and in a third a small ulcerated
slit, through which a probe entered and made its appearance in the cleft at
the top. Each of these spots, when pressed on, gave the sensation of a hard
pea, and they were similar in all respects to those mentioned above. I touched
the ulcerated spots with nitrate of copper, directed in the intervals a borax
wash, and put the man on iodide of iron and hemlock. This occurred on the
25th of March. I did not see him again until the 13th of April, when I find
the following memorandum in my note book: “Improvement most striking
and most rapid. Nitrate of copper acted almost magically, and from merely
one application; the benefit of the iodide of iron and hemlock most marked ;
he has taken of each about one drachm. The tubercles which were in pro-
gress have diminished in size and in consistence ; and the seats of ulceration
have in part absolutely healed, leaving their cicatrices smooth, and the adjoin-
ing structure of the tongue much softened, and less irregular.'. On the 11th
of May I find it noted, that the progress of the case was equally favourable,
and all ostensible marks of the disease removed, under the same general reme-
dies, with little variation as to dose; but, as in all the cases I have seen, it is
curious enough that just at this stage there is a disposition to partial relapse.
“REMARKs, I have selected the above cases, as being good illustrations
of this Tubercular Affection of the Tongue. It is by no means a common
form of disease ; yet a year seldom passes, during which one or more cases
will not be met with in extensive dispensary or hospital practice. In private
practice, it is still more rare. It would appear to ine to be a form of lupoid
disease attacking the tongue. It is as insidious in its outset; it commences
not unlike it, in the form of an adventitious deposit ; its progress is equally
protracted, and its cure deceptive ; and it also bears a very striking resem-
blance to it in its comparatively painless character, when we consider its
formidable-looking appearance, and in the perfect listlessness and apathy
with which it is borne. I may add, moreover, that the similarity is not
lessened by reflection on the treatment suited to both. Children and adults
are most commonly the subjects of this affection, the former by no means as
rarely as we might be disposed to think; and I have seen the disease in
them in its most aggravated form, although the subjects of it have all
the ordinary features of good bodily health, in the common acceptation of
the term ; yet there is often present some indication of the strumous dia-
thesis. The symptoms are so fully described in the cases I have now narrated,
that it is unnecessary to enter into further details. From them, it is evident
that the tongue may be partially or wholly engaged, that the adventitious
deposits may be single or otherwise, and that, in several stages, they will
assume peculiar characters. The disease is not malignant; it is curable,
but often very slowly so, and more especially when ulceration has been
established. In the latter instance, the appearance of the organ when
886 CRITICAL DIGEST OF THE JOURNALs.
healed is very characteristic ; smooth, cicatrized sulci, totally devoid of even
the semblance of papillae, occupy the seats of the former ulceration, and are
permanent there, dividing its surface into so many deep furrows of different
shapes.
# is affection may be confounded with syphilitic or cancerous disease,
and hence the surgeon should be on his guard. Its diagnosis from the
former may be occasionally attended with some difficulty, especially in its
more advanced or ulcerating stage ; but, even admitting that the syphilitic
affection should be a solitary symptom, which is rare, I think that attention
to the rules laid down by writers must enable the surgeon to come to a
proper decision. His mistake, if he err, will, however, be remedied by sub-
sequent results, and the agents used are comparatively innocent, and are
likely to be beneficial, in most instances, to both diseases. Not so as regards
cancer; here his diagnosis is all-important, and requires the greatest cir-
cumspection. Respecting it, however, I am satisfied there can be no diffi-
culty, if the main outlines of the affection to which I have alluded are borne
in mind, especially its almost painless character and slow progress, and the
trifling inroad it makes on the surrounding textures or on the constitution,
even after a very prolonged duration. -
“The treatment which I have found most successful, is that specified in
the above cases; and the combination of iodide of iron with hemlock appears
to be the best. In obstinate forms of the disease, some of the milder prepa-
rations of mercury may be requisite; but, in all, the means employed must
be continued for a lengthened period. I have tried many local applications,
and amongst others, the acid nitrate of mercury, but I have found none equal
to the nitrate of copper. It is most invaluable as an application to this class
of ulcer; and I may remark, that it will be found equally so in many of those
small excavated ulcers of a semi-phagedenic character, which occur on the
genital organs both of the male and of the female. It is a very deliquescent
salt, and can be applied only in the liquid state. The surface of the ulcer
should be well dried before it is applied, and afterwards covered with oil; and
it should be borne in mind, as regards the tongue, that the Superficial appear-
ance of the ulcerated surface is often most deceptive, as the disease burrows
very deeply. The best mode of fixing the tongue, for the purpose of applying
the caustic, is by means of the fingers and thumb, a portion of lint, linen, or
a towel being interposed, so that it cannot slip ; and the best instrument for
the application is a small piece of cedar, as prepared for paint-brushes, the
ends of which may be covered with lint or French wadding, one end being
dipped in the nitrate of copper, the other in the oil, whereby no delay or con-
fusion can ensue.”
DR. STOKES ON GANG RENE OF THE LUNGS.
In a paper on Gangrene of the Lungs, published by DR. STOKES in the
Dublin Quarterly Journal of Medical Science for February 1850, we find the
following conclusions drawn by him, as apparently justifiable from the present
state of our knowledge on this subject.
1. Gangrene of the Lung is met with under a variety of forms, differing
from one another, not only in the duration and violence of their symptoms,
but also in their relations to various local and constitutional diseases. 2. In
a great proportion of cases, the disease is attended with putrefactive action
engaging the necrosed portion of the lung, and affecting the secretions. 3. In
the progress of a case, we may observe the septic action singularly variable.
It is increased by over-stimulation of the system. 4. We cannot explain the
symptoms in many cases of this disease, without assuming, either that a spot
of mortification, so small as to be undiscoverable by physical means, causes
severe symptoms, and is attended with super-secretion ; or that a process of
putrefactive secretion precedes, in many cases, the death of the lung. 5. Pain
of the most extreme kind may attend this disease ; and, in the remittent
CRITICAL DIGEST OF THE JOURNALS. 887
form, may appear on each access of the affection with unmitigated violence.
6. The contact with air is not necessary for the formation of a gangrenous
eschar or cavity. 7. Haemoptysis commonly attends each access, of the re-
mittent disease. 8. In the earlier periods of this disease, auscultation and
percussion often fail in detecting any signs of organic change; or if such be
discovered, it appears incommensurate with the gravity of the symptoms.
9. In many cases, the evidences of congestion and parenchymatous infiltration
seem to follow, rather than precede, the symptoms of gangrene. 10. Dexio-
cardia, from diminished volume of the lung, may occur in gangrene of the
right lung. 11. Gangrene may attack a lung previously hepatized from
ordinary inflammation, or in a chronic tubercular condition. 12. From the
pre-existence of signs and symptoms of the stages of pneumonia, or from the
early appearance of signs of excavation, we may be able to distinguish between
fetid abscess of the lung and gangrene. 13. In certain cases of chronic bron-
chitis, the breath and expectoration may become fetid, and yet no gangrene
appear to have formed. 14. The diseases, with which gangrene may be found
complicated, are divisible into general and local affections; but its occurrence
in the class of general diseases, termed putrid or asthenic, is much more rare
than might be expected. 15. It is rarely observed in the typhus fever of
this country, even where the secondary bronchial affection is intense; but in
typhoid pneumonia it may be occasionally present. 16. It may complicate
a previously existing disease of the lung, such as pulmonary tubercle, or an
unresolved hepatization. 17. It may be directly induced by the pressure of
a tumour on the nutrient vessels and nerves of the lung : so that, in cases of
cancerous or aneurismal tumour, the patient may die, not from the extension
of the original disease, but from its inducing a rapid mortification of some
portion of the lung. 18. The disease, though always of a formidable cha-
racter, is not necessarily fatal. -
CHRONIC EMEPYEMA CURED BY PARACENTESIS THORACIS.
DR. PEDDIE relates the following case in the Monthly Journal of Medical
Science for August 1850. -
CASE. R. N., aged 26, a picture-frame maker, was suddenly affected in Jan-
uary 1846, after complaining for some weeks of slight cough, with what he
understood to be pleurisy of the left side. He was cupped and blistered, took
mercury and iodide of potassium, and tried sea-bathing, but without benefit.
He was admitted into the Minto-House Hospital on the 27th of October,
1846. r:
On admission, he was found labouring under very considerable debility,
and distressing breathlessness, and palpitation on the slightest exertion.
The left side of the chest was greatly enlarged; the intercostal spaces were
filled up, and inspiration produced no movement of expansion on this side.
Percussion on this side was universally dull, and especially stone-like beneath.
the mammary region ; and not the least vocal vibration could be felt with
the hand. On auscultation, bronchial respiration and bronchophony were:
distinctly and extensively heard ; but there was no aegophony. On the right
side, there was dulness on percussion and indistinct respiratory murmur in
front ; but the latter was clear and puerile in other parts. The heart lay
between the sternum and mamma on this side, its apex striking the chest
about an inch below and external to the nipple. The impulse and sounds
were normal, except a very slight prolongation of the second sound, not
amounting to a bruit. Paracentesis was considered to hold out the only pro-
spect of recovery; and the operation was accordingly performed by Mr. Syme,
and repeated by him and Dr. Peddie at various intervals. The instrument
employed was a trocar, about one-eighteenth of an inch in diameter, and 2%
inches in length. The parts selected for operation were different points,

888 CRITICAL DIGEST OF THE JOURNALS.
tº
between three and four inches external to the nipples, in the sixth and
seventh intercostal spaces. The following table exhibits the dates of the
operations, with the amount of purulent matter drawn off each time.

No. of Date Drawn off No. of Date Drawn off
Oper. g in Oz. Oper. g in Oz.
I ... Oct. 31, 1846 ... 21 7 ... Sept. 30, 1847 ... 112
2 ... Nov. 7, − ... 50 8 ... Feb. 1, 1848 ... 72
3 ... — 14, − ... 34 9 ... May 18, - ... 57
4 ... April 9, 1847 ... 40 10 ... Aug. 19, - ... 37
5 ... — 15, – ... 26 11 ... Feb. 27, 1849 ... 67
6 ... July 8, - ... 79 12 ... Jan. 4, 1850 ... 26
Total amount removed ... ... 621 ounces.
Each operation was followed by improvement in the health and strength ;
and the configuration of the chest, and the respiration, underwent steady
improvement. The left side regained at last some power of movement ; and
the heart was close to the sternum on the right side. In the three last tap-
pings, some force was necessary to introduce the trocar, probably from the
thickness and hardness of the pleura. The quantity of fluid, which was se-
creted at the rate of fifty-six ounces per month, from November 1846 to
September 1847, came down gradually after the latter period, until, on the
4th January last, it had arrived at the rate of little more than two ounces
per month. The fluid was sero-purulent at first, then pure pus; but, at the
first tapping, a considerable amount of serum separated from the pus.
The patient considers himself cured, and has felt so strong and well, that
he has married. He states that he is capable for any ordinary exertion, and
can lie on either side without oppression of breathing : and he does not con-
sider that there is any material change in the configuration of the chest,
except slight depression of the shoulder, and a tendency to stoop, which he
states to have existed before the inflammation occurred. Of course it must
be admitted, that probably less than a third of the lung of the left side is
fitted for respiration ; that there is an enormously thickened pleura, with
strong adhesions; and that the heart is permanently dislocated from its own
compartment of the thorax. Notwithstanding this, the case must be consi-
dered as satisfactorily cured, since the functions of respiration and circulation
are carried on compatibly with existence ; the strength is re-established, and
fully adequate for the duties of his calling; and, instead of feeling life as a
burden, he is now in a condition, and is seeking, to enjoy it. -
Dr. Peddie is in favour of performing the operation of paracentesis, as a
general rule, whenever pus is detected in this way ; and says, that the opera-
tion should be repeated from time to time. In the case of N., the fluid was at
first drawn offin divided portions; but it was soon found, that the whole could
be removed safely at once. To prevent the admission of air, he uses a very
small trocar and canula, so that any large rush of air is impossible ; he pro-
hibits conversation during the flow of the fluid, so as to maintain equal and
easy respirations, and prevent any suction power. The effects of admission
of air have been much exaggerated ; and the experiments of Nysten and
Speiss prove that, when introduced into the pleura, it is removed by absorp-
tion in a few days. Dr. H. Roe, when he speaks of the difficulty of preventing
the admission of air, if more fluid be withdrawn than can be replaced by the
expanding lung, seems to Dr. Peddie to have overlooked the collapse of the
thoracic parietes on all sides by atmospheric pressure.
In pointing out that this case showed very clearly the diagnostic marks of
pleural accumulation, Dr. Peddie observes, that the duration or chronicity of
the affection, may suggest the quality of the fluid contents of the chest, and
thus form a valuable aid to diagnosis. A purulent product may be formed early
in pleuritis; but then it is generally in unhealthy, strumous subjects, and the
amount of fluid is not large. In the more chronic cases, many are no doubt
purulent from the first ; but it is probable that, in most cases, the membrane

CRITICAL DIGEST OF THE JOURNALS. 889
has first secreted serum, then pus. This, Dr. Peddie thinks, may be proved
from cases in which an early operation produced serum ; a second, serum
with albuminous matter floating init; and a third repetition of the operation,
sero-purulent matter, or true pus. The rapidity of this change will depend
on the constitution of the individual.
Dr. Peddie thinks the following to have been the order of progress of patho-
logical change and recovery in the case related. Layer after layer of adven-
titious membrane was formed on the pulmonary and costal surfaces of the
pleura, especially the latter, adding progressively to their thickness : that,
after each tapping, agglutination took place from above downwards, and that
this, with a slight re-expansion of the lung, the ascent of the diaphragm, and
a very complete collapse of the thoracic walls, effected obliteration of the
cavity, with the exception of the supra-mammary and vertebral regions;
which were no doubt walled in by stout adhesions at a very early period. . .
MR. W. F. BARLow ON CERTAIN REMARKABLE PHENOMENA obsBRVED AFTER
DEATH FROM CHOLERA.
The occurrence of several interesting phenomena, in persons who died of
Cholera, has been made the subject of the following communications by Mr.
W. F. BARLow. - -.
1. On the Muscular Contractions which are occasionally to be observed
after Death from Cholera. (Read before the Westminster Society, Oct. 20,
1849; Med. Gaz., Nov. 9, 1849, p. 798, and London Journal of Medicine,
Nov. 1849, vol. i., p. 1080.)
2. Observations on the Condition of the Body after Death from Cholera.
(Medical Gazette, July 5, 1850.)
These papers have also been published in a separate form. The following
is a brief abstract of Mr. Barlow’s observations.
MUSCULAR CONTRACTIONs AFTER DEATH. We gave, in the LONDON Jour-
NAL OF MEDIGINE for November 1849, an outline of the cases in which this
phenomenon had been observed by Mr. Barlow. He, as well as others, have
observed the voluntary muscles to contract after death, in such a manner as
even to lead to the idea among the friends of the deceased, that the patients
were not actually dead. He suggests the following inquiries, as forming fit
subjects for investigation. e
“Do the muscular movements happen exclusively in those cases where
patients expire in ‘ collapse'? Are those persons most prone to them who
sink with unusual rapidity, and suffer to an uncommon degree from cramps?
Are strong and muscular persons especially subject to them 7 Do they more
particularly affect the muscles, which were the chief seats of cramp in life-
time ! What is the most usual time of their occurrence 7 What is the
longest period known to elapse between death and their commencement 7
What is the greatest extent of their duration at present known Can they
be readily excited and aggravated 7 and, if so, what stimulants are most
efficacious ! In what proportion of instances do they occur ! Supposing
them to affect many parts, in what locality do they, generally speaking, first
appear ! Are they a renewal of those actions, which, during life, occasion
the cramps whereby so many are tormented 7 or are they to be considered
as peculiar movements occurring in the dead body alone º’’
Mr. Barlow points out, that these movements must be distinguished from
all actions artificially excited ; and, if they should be proved to be excited or
aggravated by certain artificial stimuli, a distinction must be drawn between
those which happen and those which are provoked. He believes them to be
caused by a stimulus acting within the muscles, and to most resemble the
spasms which occur during life in cholera. They resemble rigor mortis in
at least one respect, viz. in affecting parts in succession.
890 CRITICAL DIGEST OF THE JOURNALS.
RETENTION AND INCREASE OF TEMPERATURE. In a case which occurred
at Bristol in October 1849, and on which an inquest was held, the following
phenomena occurred after death. The account was given to Mr. Barlow by
Dr. Green, Surgeon to the Bristol Infirmary.
“At 6 A.M., Oct. 13th.” (five hours after death) “I saw the body. The
skin was warm, limbs not rigid ; features not collapsed. 6 P.M. The body
was taken from the coffin, in which he had been screwed down ; it was found
still warm and in the same condition as in the morning. The entire body
and extremities were then closely packed in saw-dust. Oct. 14. Had re-
mained in the saw-dust; the warmth still continued ; there was no rigidity;
a vein in the arm was opened, but no blood came. 12 A.M. Tepid salt and
water were injected slowly in a vein in the arm ; powerful galvanic shocks
were passed from the back of the neck, in the direction of the heart, for half
an hour. The sawdust was then removed, and the body laid out in the usual
way: 15th, Heat less. 16th. Body cool. , 17th. Body quite cold ; limbs
rigid ; appearance of decomposition over the abdomen. To be interred.”
The retention of heat was no doubt owing in some measure to the packing
of the body in saw-dust ; but it also appears that the corpse was very slow
in cooling even when this was removed. The temperature was moderately
low (45° to 60°), the wind east, the window open in the day time, and the
body lightly covered. In deaths from other diseases, the most exposed por-
tions cool most rapidly. Dr. John Davy, in his Researches, gives a case of
death from pulmonary consumption, in which the temperature of the dorsum
of the foot, eighteen hours after death, was 44°, while that of the central
substance of the right Iobe of the liver was 65°; the other internal organs
being also of high temperature. The effect of covering must then be esti-
mated: imparted must be distinguished from self-generated heat.
But the most curious matter is not the maintenance of temperance, but
its rise. This may happen simultaneously with muscular contractions; but
the occasional independent appearance of each shews that their occur-
rence at the same time ise merely a coincidenée, and that they cannot be
supposed to stand in the relation of cause and effect. Neither is it likely,
that putrefaction is the cause of the increase of heat ; for the rise of tem-
perature by no means keeps pace with advancing putrefaction. Mr. Barlow
believes that “chemical changes, of which the chief is the formation of car-
bonic acid, go on in the body after dissolution, and give rise to that amount
of temperature which is occasionally noticed.” In reply to inquiries made
of him by Mr. Barlow, Dr. Garrod has given the following opinion as to the
cause of the rise of heat . . . . “I think that it is impossible, that putrefac-
tion should have any share in the production of the phenomenon, as the
time, at which it occurs, shows: and also the fact, that cholera bodies are
not at all prone to decomposition. I conceive that the following must be
the explanation : During the collapsed stage of the disease, the blood, from
imperfect circulation, etc., is prevented from being properly oxygenised,
and hence a venous blood is circulating in all the vessels of the body, ac-
counting for the cold stage. After death, however, the blood in the super-
ficial capillaries becomes acted upon by the oxygen of the external air, and
the formation of carbonic acid, with the production of heat, ensues: this
heat often, for a time, much exceeds in amount that which is abstracted by
the cooling influence of the surrounding air. After death from most other
causes, the blood having become oxygenated during life, no further heat is
evolved, and the ordinary cooling process commences.” . If this view be
correct, the skin would be probably found warmer than the parts beneath.
This is in some measure confirmed by the experiments of Dr. Bennet Dowler,
who, in his Eaſperimental Researches on the Post-morten Contractility of
the Muscles, etc., relates a case in which, five hours after death, the tempera-
ture of the brain was 93*, of the epigastrium 100°, of the chest 93*, of the
thigh 999; and another, in which, one hour and a half after death, the epi-
CRITICAL DIGEST OF THE JOURNAI.S. 891
gastrium was at 106}", and the brain at 101°. With regard to this point
also, Mr. Barlow suggests “that it would be interesting to know whether
the augmentation of heat be invariably accompanied by change of colour,
and whether those bodies become most elevated in temperature, which are
most livid at the time of death. It would also be of moment to know the
relative effects of exposing some parts to the air, and of keeping others, as
far as possible, excluded from it.” The changes of the blood in the capil-
laries may explain the maintenance of heat ; but there the effect is purely
chemical, the oxygen acting on the stagnant blood in the superficial capil-
laries in the same way as on a clot of blood drawn from the body.
Mr. Barlow then draws a comparison between the embarrassment of respi-
ration after division of the pneumogastric, and in cholera. In the former
instance, impressions on the periphery of the nerve are useless, its trunk
being disabled from conveying them ; in the latter, the periphery cannot be
properly stimulated. But also, in the first case, the blood is affected because
of the impaired respiration ; in the latter, the respiration suffers and labours
because of the damaged blood. He then makes some observations on the
subject of post-mortem increase of temperature, which, from the experi-
ments of Dr. Davy in the hospitals at Waletta, and the researches of Dr.
Dowler, he believes to occur much more frequently than we have any idea
of. Injuries of the spine, especially, have been observed by M. Chossat, Sir
B. Brodie, Dr. Gull, and Mr. Barlow, to be attended with increase of tempe-
rature. Yet Cruveilhier has observed dislocation of the atlas, with compres-
sion of the cord and hemiplegia, to be attended by a feeling of coldness.
We have yet much to learn of animal heat. In what cases heat absolutely
rises after death, and in what also it rises most, remain to be ascertained.
According to Dr. Dowler, the rise in question is not peculiar to cholera ; and
it is important that the subject should be investigated, both on account of
its interesting relations to the signs of death, and also because it may give
rise to important medico-legal inquiries. - - .
LoNG DELAY of RIGOR MoRTIS. Although, in the Bristol case, the reten-
tion of heat and absence of rigor mortis coexisted, yet it does not appear
that there is any constant relation between them. M. Ollivier has found
some bodies dead from cholera at once very warm and perfectly rigid. The
varying time at which rigor mortis sets in after death from cholera is referred
to the very opposite states of muscular irritability, which exist at the time
of dissolution ; and, for the same cause, the force with which it will be
exerted, and the period of its duration, will be far from uniform. Rigor
mortis, not only in cholera, but in death from other diseases, may be influ-
enced by several circumstances. - -
1. Muscular persons are most likely to exhibit the phenomena in the most
marked and lasting way: while atrophy leads to a less palpable and abiding
form of it. Paralysis does not destroy it, unless the nutrition of the muscles
be impaired. Fatty degeneration doubtless exercises much influence on it.
2. The remedies given for the disease may influence the rigor mortis. This
is exemplified by chloroform, which not only impairs the irritability of the
muscles during lifetime, but leads to unusually early rigor mortis. 3. The
degree of swiftness with which a man dies, and the circumstance of death
happening in the cold stage or not, must be considered with reference to the
question of rigor mortis. Rapid dissolution may be supposed to leave the
muscles more irritable than they would otherwise have been, had the disease
been more protracted.
With respect to the positions in which bodies are sometimes found after
death, Mr. Barlow allows that some trifling alteration may be attributed to
* Dr. Dowler's observations seem to have been principally made on persons dying
of yellow fever.
WOL. II. 59
892 CRITICAL DIGEST OF THE JOURNALS.
the effect of rigor mortis, but thinks that we have a much better explanation
in the post-mortem muscular contractions which sometimes occur; and more-
over observes, that we must remember that the body tends to stiffen in the
position in which it was left at the moment of death,
Rigidity of the involuntary muscles, after death from cholera, has been
observed in the heart, the bladder, and the intestinal canal: but no form of
rigor mortis of the involuntary muscles is peculiar to cholera. Drs. Baly
and Kirkes, in their Supplement to Müller's Physiology, consider that there
is sufficient evidence that the involuntary muscles are affected by a post-
mortem rigidity, in all essential respects comparable to that which is seated
in the voluntary muscles. ... •
In considering the duration of rigidity, regard must always be had to tem-
perature.
Mr. Barlow thus contrasts some features of rigor mortis with post-mortem
muscular contractions. “Rigor mortis does not ensue till the irritability of
the muscle is entirely or almost exhausted ; but these movements are signs of
irritability, sometimes of a great degree of it, and are, in some cases at least,
to be excited, whereas nothing can excite this form of rigidity, but its one
common cause. Rigor mortis influences both sides of the body equally,
producing effects not less symmetrical than the disposition of the muscles
themselves, and repeats itself in various subjects, making allowance for occa-
sional differences, with striking sameness; but the contractions are diversi-
fied as to form and power, affect different muscles in different subjects, cease
and return repeatedly; whereas the contraction of rigor mortis being once
over, is never renewed.”
RETARDATION OF PUTREFACTION. This may add to the doubts entertained
as to the actual occurrence of death. But, in the case at Bristol, it must
be remembered, that the death happened in a young subject, was accom-
plished with celerity, and effected by a disease wherein the dead are slow to
putrefy. The temperature was not high, and fresh currents of cool air were
frequently admitted. With regard to the relation of putrefaction to the
temperature of the dead, Mr. Barlow inquires whether though prolonged
heat and extremely tardy putrefaction have been observed together, the body
has been seen at the same time quick to putrefy and slow to cool '!
AsPECT of THE CountENANCE. This was placid, like that of one asleep,
in the Bristol case. This was certainly unusual; but it must not be sup-
posed, that the countenance is always strikingly haggard after death from
cholera. Sometimes the face becomes less livid ; this is doubtless owing to
alterations in the blood of the superficial vessels. -
The following are the principal points which have been noticed as to the
state of the bodies of persons dead from, Cholera.
1. The aspect has been unusually cadaverous, varying much, however, in
degree ; but the features have been more than once observed in a very dif-
ferent state. 2. The whole body has looked extremely shrunken, the hands
have been very shrivelled ; and the distinction between the age of corpses
has been less easy than in general. 3. The colour has been dusky, often re-
markably livid ; and has been noticed to become lighter and even to redden;
sometimes, however, presenting a mottled appearance. 4. Rigor mortis has
presented extreme variety as to the period of its occurrence and its degree,
and has been observed in the involuntary muscles. 5. Contractions of the
voluntary muscles have been observed, varying considerably in their time of
occurrence, progress, appearance, and effect ; and have been most marked
in males. 6. There seems no doubt that the heat of the body, in some cases,
has risen considerably after death. 7. Putrefaction has been more tardy
than usual. None of these points, however, can be said to be peculiar to
cholera; for the lividity, the change of colour, the varieties of rigor mortis,
the lingering temperature, the rise of the same, and the muscular contrac-
tions, have all been observed in death from other causes. •
CRITICAL DIGEST OF THE JOURNALS. 893
PLUG of FIBRIN IN THE CRANIAL PORTION of THE RIGHT INTERNAL
CAROTID, CAUSING ATROPHY OF THE BRAIN AND soft'ENING OF
THE CORPUS STRIATUM OF THE SAME SIDE.
MR. BRINDLEY has published (Provin, Med., and Surgical Journal, 10
July, 1850, p. 383) a case, of which the title prefixed to this notice is a sum-
mary. The patient was an old lady, aged 72. Three or four years ago, after
some disturbing cause, she had a slight paralytic seizure. Her left arm and
leg remained somewhat defective in power; her memory became impaired,
as well as her hearing, taste, vision, and power of articulation. She suffered
much from vertigo, and staggered in her gait, but was quite able to go about.
She died, a few days previous to the report, of diarrhoea.
SURGERY.
FRACTURE OF THE NECK OF THE THIGH BONE: FLATTENING of THE
NATIS DIAGNOSTIC.
MR. JoBIN LIZARs states in the Med. Times (July 6th, p. 8), that the dia-
gnosis of fracture of the neck of the thigh bone is “very far from being
sufficiently understood, either by those holding the responsible situations of
operative surgeons in hospitals, or by clinical professors.” After this flourish
of trumpets, which might properly have been dispensed with, he proceeds to
make some clinical remarks which will repay perusal. His aim is to show
that, although generally the diagnosis is simple, yet there is often no altera-
ration in the limb for days or even weeks. Mr. Lizars is of opinion that, in
all cases of injury of the hip-joint, in individuals upwards of forty years of
age, if there be flattening of the natis, we ought to look for fracture of the
neck of the thigh-bone, and apply DESAULT's long wooden splint, and retain
it for six or eight weeks, if the state of the skin over the sacrum, and the
health of the patient, permit.

IRON ROD DRIVEN THROUGH THE HEAD : RECOVERY.
DR. H. J. BIGELow relates, in the American Journal of the Medical Sciences
for July 1850, the case of a man, twenty-five years of age, who, on September
13, 1848, had an iron rod driven through his head by the exploding of some
gunpowder, while engaged in preparing a rock for blasting. The iron passed
from the angle of the lower jaw to the centre of the frontal bone, near the
sagittal suture. He was at first rendered insensible, and was slightly con-
vulsed; but soon recovered his consciousness and power of speech. There
was considerable haemorrhage. The daily progress of the case is reported by
DR. HARLow, under whose care the patient was. No remarkable symptom
appeared till the 18th September, when he became delirious ; and, from the
23rd of that month till the 3rd October, he lay in a semi-comatose state,
answering only in monosyllables when spoken to. During this time, also, he
had lost the sight of the left eye, and an abscess had formed under the occi-
pito-frontalis muscle. After this, he recovered gradually, with the exception
of the effects of a chill, from getting wet in the feet while walking out on
14th November. The symptoms were subdued in a few days; and, on the
18th, he was reported as in a fair way of recovery.
In January 1850, he was seen by Dr. Bigelow. There was ptosis of the left
eyelid, and the eye was incapable of being moved outwards or upwards. The
situations of the orifices of the wound were occupied by cicatrices.
Dr. Bigelow has performed some experiments on the dried skull, to ascer-
tain precisely what parts must have been injured. He finds that the iron
entered beneath the zygoma, removing the orbital portion of the sphenoid,
the anterior part of the squamous portion of the temporal bone, and the
internal surface of the zygoma and malar bone laterally. In º ºrbit, the
59
894 CI& ITICAL DIGEST OF THE JOURNALS.
sphenoid bone, part of the superior maxillary, and a large part of the frontal,
are removed, leaving the optic foramen intact. At the base of the skull, the
frontal, temporal, and sphenoid bones are cut. In the brain, the central part
of the left anterior lobe, and the front of the middle lobe, must have been
destroyed, laying open the lateral sinus. The falx and longitudinal sinus
must also have been lacerated. The experiments made by Dr. Bigelow are
illustrated by plates, representing the position of the rod.
The instrument weighed thirteen pounds and a quarter, was three feet
seven inches in length, and was one inch and a quarter in diameter. At
the end which entered the head, it tapered off for seven inches, till its dia-
meter was a quarter of an inch at the point.
REMOVAL OF AN IMMENSE CELLULAR TUMoUR OF THE LABIUM.
Mr. E. A. LLoyd, of St. Bartholomew's Hospital, narrates the following
case in the Med. Times of July 13, p. 29.
Sarah Holland, aged 28, (the offspring of an European father and dark
mother), was admitted into St. Bartholomew's on the 24th January, 1850.
She stated, that the tumour commenced fourteen years ago as a small, hard
swelling in the right groin, very near the labium externum. It slowly in-
creased for nine years; after that time, it grew much more rapidly, till at
last she resolved to come to England to have it removed. During the voyage,
she suffered very much from sea-sickness; and by her arrival, the tumour
had considerable diminished in size. On admission, she had a pendulous
tumour of a pyriform shape, the neck of which extended from the right
labium externum to the anterior superior spine of the ilium on the same
side, the bulk of the tumour hanging down in front of the thigh. It was
about a foot in length, and measured twenty-two inches in circumference at
the largest part. It did not impede any function, and the organs of genera-
tion were perfectly healthy. The skin which formed the surface of the
swelling was of the natural colour, but the sebacious follicles were greatly
enlarged. There was no impulse on coughing, nor any symptom to induce
the belief that there was any communication between the tumour and the
abdominal cavity. She had never suffered pain in the tumour; but, on account
of its weight, was obliged to keep it suspended. The tumour was removed on
the 22nd Feb. After the administration of chloroform, several double liga-
tures were passed through the neck of the tumour, about one inch distant
from each other; then two strong gutta percha bougies were fastened tightly
(one on each side of the neck), by means of these ligatures, after the manner
of a quilled suture. The tumour was then removed by cutting through the
neck just below the ligatures, and not more than an ounce of blood was lost.
In the middle of the wound was found a lymphatic gland, which was removed.
A piece of wet lint having been applied to the wound, the patient was taken
to bed. There were several attacks of haemorrhage and erysipelas, which
continued for a month, retarding the healing process. The wound, however,
is now closed, and the patient is in good health.
... Mr. Lloyd applied the quilled suture to the neck of the tumour, to strangle
it, and prevent any great loss of blood during the operation. He agrees with
others, in considering these tumours to depend upon hypertrophy of the skin
and cellular tissue, the interstices of the latter being filled with serum.
OPIUM OR CHLOROFORM IN THE STRANGULATED HERNIA OF INFANTS 2
DR. Joseph REID, of Southam, details a case (Lancet, July 13, p. 50)
attended by him along with Mr. H. L. Smith, in which the bold administration
of opium averted the necessity of an operation. As the infant’s age was only
eleven months, the exact quantity of opium given ought to have been stated
by Dr. Reid, but he only tells us that “a mixture containing a considerable
quantity” was ordered. We think that, both in adults and in children, a
CRITICAL DIGEST OF THE JOURNALS. 895
more complete relaxation of the parts concerned in a strangulated hernia
can be obtained by the inhalation of ether or chloroform than by opium.
Children bear chloroform better than opium, which, in full doses, is always
exceedingly hazardous to infants under one or two years of age.
EXTENSION OF GONORRHOEAL INFLAMMATION TO THE BLADDER.
PUS IN THE URINE.
In a paper in the Dublin Quarterly Journal of Medical Science for August
1850, Mr. W. Col.I.ES expresses his belief, that gonorrhoea is not, as was sup-
posed by John Hunter, confined to the first two inches of the urethra, but that,
commencing at the orifice, the affection may extend along the entire canal,
and often attack the lining membrane of the bladder itself: and even some-
times extend to the ureters and kidneys. The testicles might also be easily
affected, producing hermia humorales. The extension of the affection to the
bladder is proved by the general symptoms, and by the appearance of pus in
the urine. These symptoms are most severe in catarrh of the bladder; at
other times, they will be very slight. The attack of the bladder may com-
mence with a severe rigor, with slight feverishness or uneasiness towards
evening, and with dull, heavy pain across the pubis, extending to the sacrum
and anus, and even to the region of the kidneys. The patient has frequent
and painful micturition, the pain being referred chiefly to the neck of the
bladder, and extending to the perinaeum and anus. The urine is sometimes
clear, but generally slightly cloudy, and throws down a copious yellowish or
cream-coloured deposit of pus, after standing for one or two hours. If a drop
of the urine be examined with the microscope immediately after being passed,
it will be found loaded with pus-globules. Sometimes, clusters of pus-globules
and epithelial scales will be found, in the form of yellowish shreddy particles,
floating through the urine. The pus cannot be from the urethra alone,
because the canal, probably, resists any retrograde movement, and because it
could not furnish the quantity which is observed. g
Dr. Fleming has tested the direct passage of the pus from the bladder, by
introducing a catheter, allowing the first ounce or so of fluid to escape, and
then examining the urine drawn off. He has by this means found pus-
globules. In equivocal cases of haematuria, the same results, as regards blood-
globules, have attended the use of this test.
In the case which first drew the attention of Mr. Colles to this subject, the
patient had, a few days after infection, a severe rigor, with considerable pain
and irritation of the urinary organs, and a copious deposit of upwards of eight
or ten ounces of pus in twenty-four hours. The previous good health of the
patient, and the absence of symptoms indicative of a collection of matter,
precluded the idea that an abscess could have burst into the bladder. Since
that time, Mr. Colles has found pus in the urine, in cases of gonorrhoea, much
oftener than he had reason to suspect; sometimes even in two or three days.
In two or three cases, also, the urethral discharge has continued, and the
urine has been purulent nearly two years. - *
With regard to the treatment, Mr. Colles thinks that, though the injection
of strong stimulants, as abortive remedies, may at times prevent the extension
of the inflammation, yet, if they fail, they aggravate the subsequent stages.
When pus has appeared in the urine, the treatment must be antiphlogistic ;
and when inflammation has subsided, we may employ the balsams, or cubebs ;
the latter being preferable. If these means fail, it is customary to resort to
tonics, astringents, alkalies, acids, preparations of iron, etc. . Yet no single
remedy appears to possess much control over the secretion of pus from the
bladder. Injections, if used, should be applied to the whole diseased surface;
not only the urethra, but the bladder itself, should be injected with weak
solutions of sulphate of zinc, of nitrate of silver, or even of balsams.
896 CRITICAL DIGEST OF THE JOURNALS.
ENCYSTED TUMIOUR OF TEEE LABIUM SUCCESSFULLY TREATED BY SETON.
MR. E. C. CoTTINGHAM details the following case in the Lancet, July 6,
1850, p. 16. A widow, aged 32, had an encysted tumour, the size of a large
walnut, situated on the right labium, which had existed for some time, and
had gradually increased, in spite of the internal and external administration
of iodine. Mr. Cottingham recommended excision, but she refused permission,
but allowed him to introduce a Seton. He passed a small curved needle,
armed with six silk threads, completely through the tumour, when a small
quantity of glairy fluid, resembling white of egg, escaped. At the end of
three weeks, the Seton was removed, when the cyst was found to be entirely
obliterated.
MATERIA MEDICA AND PHARMACY.
*===sº
THE KOSSO OR BRAYERA ANTHELMINTICA. BY JONATHAN PIEREIRA, M.D., F.R.S.
HISTORY. Kosso has been in use in Abyssinia, as an anthelmintic, for
more than two centuries; for Leutholf (Ludolfi, Historia A&thiopica, lib. i,
cap. ix, sect. 31, 1681) says, that “N. Godingus praises another tree as being
very efficacious against lumbrici, which are produced by the use of raw meat.
But the Abyssinians purge themselves every month with the fruit of this tree,
and thus,” he says, “ destroys these worms.” Now there can be little doubt,
I conceive, but that this passage refers to the Kosso. Bruce, in his Travels to
discover the Source of the Wile, from 1768 to 1773 (vol. v., p. 73), published
at London in 1790, mentions this medicine, which he calls cusso, and proposes
to name the tree Banksia Abyssinica, after Sir Joseph Banks, the then presi-
dent of the Royal Society. But the younger Linnaeus, in the Supplementum
Plantarum, published at Brunswick in 1781, had already appropriated the
name of Banksia to a New Holland genus of proteaceous plants, and he has
been followed by all succeeding botanists ; so that Bruce's proposed botanical
name for the Kosso cannot be adopted. Bruce gave a very good popular
account of Kosso, accompanied by what he justly terms “a true and exact ’’
figure of the plant. I have compared his figures with a specimen of the plant
collected in Abyssinia by Schimper, and contained in the herbarium of my
friend Mr. N. B. Ward, and with the commercial flowers, and find that they
are fair representations of the plant.
Bruce states that the Abyssinians evacuate once a month “a large quantity
of worms; these are not the tape-worm, or those that trouble children, but
they are the sort of worm called ascarides.” This statement agrees with that
of Godingus just quoted ; but it does not accord with the observations of
other travellers, who tell us that the worm with which the Abyssinians are
troubled, and for which they employ the Kosso, is the tape-worm. The accu-
racy of this latter statement has been proved by Dr. Hodgkin (Medical Times,
October 26th, 1844, p. 74) who gave oil of turpentine to an Abyssinian in the
service of Dr. Beke, and thereby expelled a Taenia solium—the same kind of
tape-worm which prevails in England, and which is understood to prevail at
the Cape of Good Hope. • * -
In the Encyclopédie Méthodique (Botanique, Supplem. t. ii, p. 423, 1811
Lamarck has described the Cusso d’Abyssinie, which he named after Dr. C.
G. Hagen, a professor at Königsberg, the Hagenia Abyssinica. He says the
tree was discovered by Brown—but I presume that this a typographical error,
and that for “Brown” should be read “ Bruce”;-for the figures of the plant
given by Lamarck (pl. 311) are obviously copied from those of Bruce, though
he does not refer to this distinguished traveller as his authority. It is re-
markable that Lamarck's proposed generic name (Hagenia) has been applied
by the late Professor Eschweiler (Systema Lichenum, 1824) to a proposed
genus of lichens usually included in that of Parmelia ; and by Monch (Me-
thodus, 1794) to a caryophyllaceous plant now regarded as a species of

CRITICAL DIGEST OF THE JOURNALS. 897
Gypsophila. Willdenow (Species Plantarum), and Sprengel (Syst. Veget. ii,
220, 1825) have each adopted Lamarck's name (Hagenia Abyssinica) for
kosso. --
Dr. Brayer, a French physician, who resided for a considerable time at
Constantinople, and who had witnessed the valuable anthelmintic properties
of Kosso, and had himself successfully employed this remedy, sent,on his return
to Paris, in 1823, some fragments of the male flowers to the late celebrated
Prussian botanist, Kunth, who ascertained that the plant which yielded them
formed a new genus, near to, but distinct from, that of Agrimonia.1 To this
genus Kunth gave the name of Brayera, after the physician who sent him
the flowers, and the species he called B. anthelmintica. This generic name
has been adopted in the systematic works both of De Candolle (Prodromus,
vol. ii, p. 588) and Endlicher (Genera Plantarum, 6395). Kunth does not
appear to have been aware either of Bruce's notice of Kosso, or that Lamarck
had previously given to this genus the name of Hagenia, otherwise, doubtless,
he would have referred to them, and have adopted this designation. Dr.
Brayer published a little pamphlet (Notice sur une nouvelle Plante de la Fa-
mille des Rosacées, Paris, 1823, 8 pages) on this medicine, but which I have
not been able to get a sight of. According to the information furnished by
Dr. Brayer, it appears that Kosso is carried by the caravans to Egypt, and
from thence finds its way to Constantinople.” The identity of the genera
Hagenia and Brayera was first recognised by Fresenius (Museum Senkenber-
gianum, vol. ii, p. 162, 1837).
In 1839, Buchner (Repertorium, 2te Reihe, Bd. xviii, S. 367) gave a notice
of three Abyssinian remedies which he had received from Engelmann. One
of these was the Kosso, (called koso), which was stated to be the flowers of
the Bracera [Brayera] anthelmintica. In 1840, Wittstein (Buchner's Reper-
torium, 2te Reihe, Bd. xxi, p. 24) published an analysis of Kosso, which he
calls Bracera anthelmintica. -
Riecke's Die neuern Arzneimittel, published in 1840, contains a notice of
the Brayera anthelmintica by Dr. Plieninger, who obtained his information
respecting it from some missionaries returning from Abyssinia ; and the same
notices includes some botanical and pharmacological account of this medicine
by Dr. Kurr. In 1841, Dr. Aubert, who had spent some time in Abyssinia,
read a Mémoire sur les Substances Anthelmintiques usitées en Abyssinie, before
the Académie Royal de Médecine, at Paris, and which was published in the
Memoirs of the Academy for that year. His account of the anthelmintic
virtues of the Kosso confirms the statements of preceding writers. A very
interesting Report on his memoir was drawn up by Mérat, and published in
the Bulletin de l'Académie Royale de Médecine, tom. vi., p. 492, 1840–41.
M. Rochet d’Hericourt, in his Second Voyage sur les deuz Rives de la Mer
Rouge dans le Pays des Adels et le Royaume de Choa, published at Paris in
1846, gives a very brief notice of the Kosso, with a lithograph of the flowers
and leaves. This traveller is the present holder of the entire European stock
(about 1400 lbs.) of Kosso. Drs. R. Quartin-Dillon and A. Petit, the natural-
ists of the French expedition to Abyssinia in the years 1838-43, collected
the Kosso ; of which a botanical description has been published by A.
Richards, in the Tentamen Florae Abyssinicae, which forms the fourth volume
of the Voyage en Abyssinie, edited by M. Th. Lefebvre. The forty-eighth
* In the first volume, p. 470, of the Mémoires de l'Academie Royale de Médecine,
it is erroneously stated that Kosso is the Agrimonia orientalis of Tournefort, who
saw it in Abyssinia. Now, in the first place, Tournefort never was in Abyssinia ;
and secondly, the A. orientalis (A. repens, Linn.) is a creeping herb, whereas the
Rosso is a large tree - • - "
* In the Journ. de Pharmacie, t. ix, p. 160, 1823, is an Extrait du Bulletin de la
Société Philomathique, 1822, containing a notice of Dr. Brayer's observations re-
specting Kosso, and of Kunth's determination of the plant. -
898 CRITICAI, DIGEST OF THE JOURNALS.
plate of the “Botanique” of this “Voyage” contains an excellent figure of
the plant, with dissections of the flower.
NATIVE NAMEs. My friend Dr. Beke, the well-known Abyssinian traveller,
has given the following note respecting the native names for this remedy —
“The tree, of the flowers of which you have a sample, is called in the Am-
haric language kosso," and in that of Tigre, hkābbe.” In the Gafat language
it is styled kossish, and in the Gonga, kosbo *; in the Agau of Waag, sika ;
in that of Agau-mider, Shine: ; and in Falasha, Sakikana ; while in Galla, its
name is bet. In the countries further to the south, it has other names,4
which, however, I have not collected in my vocabularies of the languages of
those countries. But it is best known in Abyssinia and Europe by its Am-
haric designation, kosso.” Dr. Beke further observes, that “the tape-worm,
for which the Kosso flowers are a remedy, is known in the languages of
Amhara and Tigre by the same names respectively as the medicine itself,
viz., kosso and hkābbe. So, too, in the Gafat and Ginga, in which respectively
both are called kössish and kósbo. In the Waag-Agau, likewise, the name
sika is the name for both ; but in the dialect of Agau-mider, the worm is
called turo, and, in the Falasha, saka, whilst in the Galla, it is minui.”
BotANY. The first accurate botanical description of the flowers of Kosso
was given by Kunth, whose account has been adopted in De Candolle’s Pro-
dromus. Kunth, however, was acquainted with the male flowers only. The
most recent systematic notice of the genus Brayera is that of Endlicher, which
I shall adopt.
BRAYERA KUNTH. Brayera Kunth in Brayer Notice, in 8vo, 1824, Paris;
Dict. Class. Hist. Mat. vol. ii, p. 501, cum icone. DC. Prodr. ii, 588. Meisner
Gen. 103 (73). Fresenius in Mus. Senkerb. ii, 162; Endlicher, Gen. Plant.,
p. 1248, 6395; HAGENIA Lamarck Encycl. Méth. Bot., Suppl. t. ii, p. 423 ;
Willdenow, Sp. Pl. ii, 331. Cusso, BANKESIA, Bruce's Travels, vol. v., p. 73.
Calya, with the tube bitracteolate at the base, turbinate ; throat con-
stricted internally by a membraneous ring; limb, 10-partite ; the segments
in two series, the five outer ones much larger, oblong-lanceolate, obtuse, re-
ticulate-veined, stellately patent, the five inner ones alternate, smaller,
spathulate. Petals 5, inserted in the throat of the calyx, small, linear.
Stamens from fifteen to twenty, inserted along with the petals. Filaments
free, unequal in length. Anthers bilocular, dehiscing longitudinally. Carpella
two, placed at the bottom of the calyx, free, unilocular, containing one or
two pendulous ovules. Styles terminal, exserted from the throat of the calyx,
thickened upwards. Stigmas subpeltate-dilated, erenato-oblong.
Mat. Ord RosacEA. Jussieu. De Candolle places it in tribe v, Dryadede.
Endlicher, in his suborder, Spiraeaceae.
BRAYERA ANTHELMINTICA, Kunth, 1. c. DC. l. c. ; A. Richard, Tentamen
Florae Abyssinicae; Hagenia Abyssinica, Lamarck, l.c.; Cusso, Bankesia
Abyssinica, Bruce, l.c. -
The only species. .. i
An Abyssinian tree, twenty feet high. Branches round, rusty, tomentose-
villose, marked by the annular cicatrices of the fallen leaves. Leaves crowded,
alternate, interruptedly imparipinnate and sheathing at the base. Leaflets
oblong, or elliptical lanceolate, acute, serrate, villose at the margin and on
the nerves of the under surface. Stipules adnate to the petiole, which is
dilated at the base and amplexicaul. Flowers dioecious, small, greenish, and
* This word is variously spelt by different writers, cusso, cosso, cow880, coso, koso,
and kosso. Dr. Aubert says it should be pronounced (in French) cousso.
* According to Dr. Plieninger, who obtained his information from the Abyssinian
missionaries, the Tigre name is hepah. Wittstein writes it habi. J. P.
3 Written cobso by some persons. J. P -
* Dr. Brayer gives cotz or cabotz, as vernacular names: according to Dr. Aubert
(Bullet. de l'Acad. Royale), these names are erroneous. --
CRITICAL DIGEST OF THE JOURNALS. 899
becoming purple; repeatedly dichotomous ; the pedicels with an ovate bract
at the base. . -
The so-called male flowers may be regarded as hermaphrodite flowers, in-
asmuch as the carpels are well developed. The female flowers are somewhat
different in their structure. The outer segments of the calyx are much more
developed than in the male flowers, and are four or five times larger than
those of the inner row, and are placed somewhat below them; the petals are
entirely wanting ; the stamina are rudimentary and sterile. The ripe fruits
are unknown. .
The tree grows in Tigre, Agame, and Shoa ; it is cultivated everywhere.
DR. BEKE Writes, that the tree is “found throughout the entire table-land
of North-eastern Abyssinia, but appears to require an elevation of upwards
of six thousand (perhaps of seven thousand) feet for its growth. Where I
found it most luxuriant, was in the vicinity of the source of the river Abai
(Bruce's Nile), at an elevation of close upon nine thousand feet. Tigre, the
northern portion of Abyssinia, being, on the whole, of lower elevation than
the rest of that country, the tree is only found there in a few places.”
Bruce describes the flowers as being of a greenish colour, tinged with
purple; and, when fully blown, of a deep red or purple. The petals, he says,
are white. -
PREPARATION. Mr. Johnston states, that the Kosso is gathered, for medi-
cinal purposes, before the seeds are quite ripe, whilst still a number of florets
remain unchanged. The bunches are suspended in the sun to dry; and, if
not required for immediate use, are deposited in a jar. --
PHARMACOGRAPHY. I have seen only one package of Kosso (flores brayerae
anthelminticae). This was kindly opened in my presence by M. SIMOND, of
the firm of Caylits, Simond, and Co., the agents of M. Rochet d’Hericourt.
It was a deal box, containing about thirty pounds of the dried flowers, wrap-
ped up in a large skin of red leather. On removing the lid of the box, and
untying the leather package, the fragrant or balsamic odour of the dried
flowers was very powerful. It appeared to me to be somewhat similar to the
combined odours of tea, hops, and senma-leaves. The flowers had apparently
undergone no preparation beyond that of desiccation. The bunches of flowers
were perfect and unbroken, though of course compressed. The general colour
of the dried mass was greenish-yellow ; but when the flowers were more
closely examined, the edges of the petals were seen to have a reddish or pur-
plish colour. The taste of the dried flowers is at first not very marked; but
after a few minutes a feeble, Senna-like, acrid, unpleasant taste becomes per-
ceptible. By soaking the dried flowers in water, they may be unfolded suf-
ficiently to determine their botanical characters, which have been already
described. When submitted to microscopic examination, the hairs are per-
ceived to be simple lymphatic hairs, tapering at the distal extremity.
In Abyssinia, two sorts of Kosso are distinguished, viz.: 1st, the red Kosso
produced by the female flowers; 2ndly, the male flowers, known as Kosso-
esels. In commerce, the two sorts are always mixed together.
ADULTERATION. Considering the enormous price (about £1 15s. per ounce)
at which Kosso has hitherto been sold in Paris, and the very limited quan-
tity originally supplied by M. Rochet d’Hericourt, it cannot be surprising
that the article should be extensively adulterated. Indeed, I have been
assured, on credible authority, that the powder now selling as “Kousso” is,
in fact, the powder of pomegranate bark; and that legal proceedings have
been commenced in Paris to put a stop to the fraud, which is well calculated
to injure the reputation of the genuine Abyssinian remedy. I have no doubt
but that the microscope would readily detect the substitution; but the surest
way of obtaining the genuine article, is to purchase the dried flowers in the
entire state, not in the form of powder. .
CHEMISTRY. The flowers of the Brayera (i. e. Kosso) have been analysed

&
900 CRITICAL DIGEST OF THE JOURNALS.
by WITTSTEIN (ante cit.) and by MARTIN (Journ. de Chimie Äſed, t, vi, 2nde
sér., p. 579, 1840). The following are the results obtained:
WITTSTEIN's ANALYSIs.
Fatty Oil cº- - 1:44 Tannin striking a blue co-
Chlorophylle lour with iron - - 15-46
Wax - - - - 2:02 Vegetable fibre - - 40°47
Bitter acrid resin - - 6:25 | Ashes *- - -> - 15-71
Tasteless resin - - - 0-77 *-*-
Sugar - - - - 1:08 99.86
Gum - - , - 7-22 || Loss * - - - 00:14
Tannin striking a green co- --
lour with iron - - 8-94 100.00
MARTIN's ANALYSIS.
Starch Green very odorous resin
Saccharine matter Crystalline substance, called
Vegetable extractive matter kwoSeine.
The ashes consist of potash, magnesia, lime, oxide of iron, sulphuric and
phosphoric acids, chlorine, and silica.
With regard to the two kinds of tannin, Wittstein observes, that, as far as
he knows, this is the first instance recorded of a plant containing simultane-
ously two kinds of tannin, striking, the one a blue, the other a green colour,
with the salts of iron. Although it is not improbable that the anthelmintic
property of Kosso may, in part, depend on tannin (since the pomegranate bark,
which contains this principle in abundance, is, like Kosso, also an anthelmin-
tic), yet what may be termed the peculiar property of the Kosso, probably
resides chiefly in the bitter acrid resin. This is soluble in alcohol and in
ether, and appears to be a neutral body, manifesting neither distinct alkaline
nor acid properties. The crystalline principle, to which Martin has given
the barbarous name of Kwoséâne (from Kwoso, the supposed name for Kosso),
is described as consisting of white silky crystals, having a styptic taste, and
as being soluble in alcohol and sulphurie ether. They are said to redden lit-
mus paper, and to dissolve, without undergoing decomposition, in sulphuric,
nitric, and muriatic acids. By boiling the dried plant in water, a fragrant
odour is evolved. No doubt this, as well as the odour of the dried plant
itself, depends on the presence of a volatile oil, of which, however, no mention
is made in Wittstein's analysis, the oil being present in too small a quantity
to admit of its collection when small quantities of the flowers are operated
on. It is not improbable that the anthelmintic properties may, in part, de-
pend on this oil; for SCHIMPER states, that in Abyssinia, the plant is consi-
dered to have lost its anthelmintic powers in the third year after its collection.
In Europe, however, it retains its powers for a longer period (on account of
the cooler climate 7); for the flowers which have been used for all the recent
experiments have been collected more than four years; and we are told,
in the shop-bill of a Parisian pharmacien, that they may be kept for an inde-
finite period :
An infusion or decoction of Kosso strikes a dark green olive tint with a
solution of the sesquichloride of iron.
MEDIGINAL PROPERTIES. Neither botanical characters, sensible qualities,
nor chemical composition, would have induced us to suspect that Kosso pos-
sesses the valuable anthelmintic properties which experience has shown
that it does. The general and prevailing quality of the Rosaceae is astrin-
gency, dependent on the presence of tannic and gallic acids. This is observed
in the flowers (e.g., rose petals), as well as in other parts of the plants. In
this quality, Kosso agrees with its congeners. But it can scarcely be on this
that its vermifuge property solely depends; otherwise rose petals, or any
other equally powerful astringent, would be as effective in expelling worms
as these Abyssinian flowers. But in Rosaceae, as in many other families of
CRITICAL DIGEST OF THE JOURNALS. 90 l
the vegetable kingdom, anomalies exist; and to this head we must, for the
present, be content to refer Kosso. Our confidence in the anthelmintic pro-
perties of Kosso rests, then, on experience only ; and the evidence on this
point is very strong. All modern travellers in Abyssinia are agreed on the
great success of the remedy on the natives of that country; and the expe-
rience of physicians in France, England, Germany, and Switzerland, con-
firms the favourable reports made by those who have seen the Kosso used in
its native country. In Paris, it has been employed with great success by
Chomel and Sandras (Ann. de Thérap. pour 1847), as well as by numerous
other distinguished physicians. In London, our experience of it is much
more limited ; but the successful results of its use in King's College Hos-
pital, in the hands of Drs. Budd and Todd (Lancet, March 16th, April 20th,
and May 25th, 1850), and of Dr. Gull (Lancet, May 25th), in Guy's Hospital,
confirm the favourable reports of its efficacy, which had reached this country
from abroad.
The physiological effects of Kosso are not in general very great. Some-
times it excites a slight sensation of heat, nausea, or even vomiting, creates
thirst, and frequently, perhaps usually, a gentle action on the bowels. But
the latter is commonly so slight, that in a considerable number of cases, it is
necessary to follow its administration by a mild purgative. It is obvious,
therefore, that the efficacy of Kosso as an anthelmintic does not depend on
purgative or evacuant influence, but on its poisonous or toxic action on the
worm ; in fact, it is a true vermicide. In one case, that of a woman in
France, it brought away ten worms, of which one only manifested evidences
of vitality, and that for a few minutes only.
Kosso appears to be an effective anthelmintic in both kinds of tape-worm,
viz., the Taenia solium, and Bothriocephalus latus. In most of the reported
successful cases, the Taenia solium was the parasite expelled ; but in one of
Chomel’s cases, the worm which was evacuated was the Bothriocephalus latus,
and I am informed, that Kosso has proved most effectual in Switzerland,
where, as is well known, the Bothriocephalus is the prevailing tape-worm.
The dealers in Kosso assert that one dose will, in every case, effect the
radical cure of tape-worm. But this must be obviously an error. Even
supposing that it invariably destroys all the worms in the alimentary canal
at the time of its exhibition, it can in no way prevent their recurrence, pro-
vided the patient retains his predispositions (which there is no reason to
suppose are affected by the Kosso), and is subjected to the same influence.
It certainly does not radically cure the Abyssinians, since, as several writers
tell us, they resort to this remedy monthly. Schimper, the governor of
Adoa, says it does not completely expel the taenia, or at least rarely does so.
But, he adds, that possibly in Europeans, in whom the verminous disposition
is not so pronounced as in the Abyssinians, it may perhaps act in a more
complete manner. In the Abyssinians this verminous disposition is innate,
and is dependent, he adds, on the regimen which they adopt.
Hitherto, the great drawback to the use of Kosso has been the difficulty
of procuring the remedy, and its enormous cost. At the time when it could
be purchased in Paris, its price was £1 15s. per oz., or 17s.6d. per dose.
M. Rochet d’Hericourt, the sole holder of the medicine at the present time,
refuses to sell any quantity less than his entire stock, at the rate of one
guinea per ounce His nephew tells me that his uncle possesses 1400lbs.
of it, which, at one guinea per ounce, will cost 22,400 guineas | | | . The im-
possibility of effecting a sale on such terms will, I doubt not, ultimately
compel the holder to reduce his demands to something approaching to reason.
It does not appear that the remedy is very costly in Abyssinia. Schimper,
writing from Adoa, in Abyssinia, says that it is found in commerce at a very
low price. At Yangaro (commonly called Zingaro) the sovereign has the
exclusive use of it, his subjects being prohibited from employing it ; but in
other parts, free trade in Kosso is permitted. Considering the frequency


902 CRITICAI, DIGEST OF THE JOURNALS.
and rapidity of our communications with Egypt (to which place, according
to Dr. Brayer, Kosso is conveyed by caravans) no difficulty, I apprehend, will
be experienced in obtaining an abundant supply of it. Its present price is a
virtual prohibition of its use.
The flavour, though not very strong, is by no means agreeable ; and is
sufficiently powerful in some patients to create disgust and excite vomiting.
In one case, under M. Chomel (Ann. de Thérap., pour 1847), the whole of
the remedy was rejected by vomiting.
No ill effects have resulted from its use in this country ; nor have I met
with any statement of its injurious action, except in Mr. Johnston’s Travels
in Southern Abyssinia (vol. ii, p. 272, 1844), where it is stated that its
“operation is speedy and effectual ; and to judge by the prostration of
strength it occasioned in my servants when they employed this medicine, it
must be dreadfully severe. I can answer for this, that it occasions frequent
miscarriages, often fatal to the mother, and even men have been known, after
a large dose, to have died the same day from its consequences. I am, there-
fore, surprised at the noise this remedy has occasioned the last few years in
Europe, as if it promised to be a valuable addition to our Materia Medica.
This, I conceive, can never be, for no civilized stomach could bear the bulk
of the drug necessary to produce its effects. Even in Abyssinia, it is but
barely tolerated ; and let another remedy equally efficacious for dislodging
tape-worm be introduced into that country, and the use of Cosso will be
soon abandoned. In fact, several other vegetable productions are now em-
ployed, to escape the punishment of a dose of this violent cathartic.”
ADMINISTRATION.—Both Bruce (op. ante cit.) and Schimper (Bouchardat,
Annuaire de Thérapeut. pour 1849, p. 257) tell us that the Abyssinians take
a handful of the dried flowers as a dose. In Paris, the dose has varied
from four to six drachms. In general, however, half an ounce (Troy weight)
is considered a dose for an adult.
For different ages the doses are thus adjusted :
Adults.......................................... I dose = 240 grs. (half an ounce)
Children of from 7 to 12 years...... # of a dose = 160 grs.
95 25 3 to 7 , ...... } of a dose = 120 grs.
, not exceeding 3 2, ...... # of a dose = 80 grs.
The Kosso should be taken in the morning fasting. The only preparation
necessary is, that the last meal of the previous evening should be slight.
The evacuation of the bowels by a mild purgative, or a lavement is also
desirable.
The mode of administering the remedy is as follows: The powdered
flowers are to be mixed with luke-warm water (for an adult about ten
ounces), and allowed to infuse for a quarter of an hour. A little lemon juice
is then to be swallowed, and, the infusion being stirred up, the whole is
taken, liquid and powder, at two or three draughts, at short intervals, being
washed down by cold water and lemon juice. To promote the operation, tea
(without sugar or milk) may be taken. In three or four hours, if the remedy
has not operated, a dose of castor oil or a saline purgative should be admi-
nistered. (Pharmaceutical Journal, July 1850.)

903
RE PORTS OF SOC I ETI E. S.
ROYAL MEDICAL AND CHIRURGICAL SOCIETY,
TUESDAY, MARCH 26, 1850.
DR. ADDISON, PRESIDENT, IN THE CHAIR.
CASE of SUPPURATION of AN HyLATID CYST of THE LIVER, IN whiciſ
THE ABSCESS openED THROUGH THE LUNGS ; AND ONE IN which THE HYDATID
Cysts were ExPECTORATED. By T. B. PEACOCK, M.D. The first case was
that of a female, aged 20, who was a patient at the Royal Free Hospital
with symptoms of bilious remittent fever ; and, after partial recovery, was
seized with pain in the right side, dyspnoea, and foetid bilious expectoration.
After death, a large cyst, containing a thick, purulent fluid, with a collapsed
acephalocyst, was found in connexion with the upper part of the liver. It
had perforated the diaphragm. Two other cysts were also found in the
liver; one of which had suppurated ; the other was deeply tinged with
bile. The second case was that of a man, aged 31, a patient at the City
Hospital for Diseases of the Chest. He profusely expectorated, yellowish
coloured matter, with shreds of membrane, which proved to be portions of
hydatid cysts. He had enlargement of the lower part of the right side, and
evidences of a cavity there. He continued to expectorate the hydatids for
some time ; but this gradually diminished under the use of tonics; and for
ten weeks he had so far improved as to give hopes of recovery.
SUMMARY OF DISCUSSION. Dr. C. J. B. WILLIAMs had met with three or
four cases of hydatids. The differences which hydatids produce as to symp-
toms, were remarkable ; these being in some cases prominent and intense,
while, in others, there is no evidence of the existence of the hydatids until
they are discovered after death. He referred to the apparent attempts of
nature to circumscribe the adventitious body, as shown by the putty-like
matter, resembling softened tubercular matter, found in old cysts. Under
the microscrope, we find rhomboidal scales of cholesterine, globules of fat,
and traces of the elementary tissues.
In answer to an objection made by DR. ToDD, that the cyst became impre-
gnated with the elements of the bile, he stated that cholesterine was also
found in hydatids of the lungs, and in other old deposits in other parts.
MR. B CoopFR related the case of a lady, in whom a swelling had formed
on the gluteal region in consequence of a blow. The clear colourless fluid
evacuated from it by puncture, was found to contain numerous echinococci.
DR. THEoPHILUs THoMPson believed that hydatid cysts, though they might
occasion inconvenient pressure, rarely produced formidable irritation till
they ceased to live, or till the contained fluid came into contact with the
natural tissues of the body. He believed, with Dr. Todd, that they were, in
some cases at least, formed within the biliary ducts; and that, in many
instances, they owed their production to mechanical injury. Some articles
of diet, especially green food, he thought to be more likely to engender the
disorder. Dr. Thompson relates some cases in support of his observation.
DR. ADDISON had seen many cases in which hydatids were expectorated
from the lungs ; and alluded to some cases.

TUESDAY, APRIL 9, 1850.
DR. ADDISON, PRESIDENT, IN THE CHAIR.
ScroFULous ABScESS OF THE ANTERIOR MEDIASTINUM, CoMMUNICATING
WITH BoſTH SIDEs of THE CHEST, THE TRACHEA, AND PERICARDIUM., AND
FoRMING A TUMoUR ABOVE THE CLAVICLE, SIMULATING ANEURISM OF THE
INNoMINATE ARTERY, or of THE ARCH of THE AORTA. By D. MAGLACHLAN,
M.D. The patient was an old soldier, aged 61, who was admitted into the
904 - REPORTS OF SOCIETIES.
Infirmary of Chelsea Hospital with an elastic tumour immediately above the
external end of the right clavicle. It produced symptoms of compression
of the vessels and nerves in the vicinity, with difficult deglutition and re-
spiration. There was universal dulness on the right side of the chest ; yet
there were circumstances which rendered the existence of pleuritic effusion
doubtful. On puncturing the swelling, some days after admission, sero-
purulent curdy matter was discharged; and sero-purulent matter continued to
escape, whenever he coughed, until his death. The anterior mediastinum
was found enormously thickened ; and in the centre of the diseased mass,
an almost empty abscess, of the size of a billiard-ball, was found. It com-
municated with the right side of the chest, with the pericardium, with the
tumour in the neck, and with the trachea. The right side of the chest con-
tained several pints of sero-purulent fluid ; there was a small quantity in
the left side, and the pericardium contained about a pint.
CASE of MoDLITIES AND FRAGILITAs OSSIUM, ACComPANIED WITH URINE
STRONGLY CHARGED witH ANIMAL MATTER. By WILLIAM MACINTYRE, M.D.
The patient was a tradesman, aged 47, who suffered severely from pain in
the chest, back, and loins. These had ceased, and returned at various times.
The urine, when examined by Dr. Macintyre, was found to contain much
albumen, and to present some remarkable characters. Treated by heat it
gave no indications of albumen till near the boiling point (instead of 160° or
1709). 2. Nitric acid caused no immediate precipitation, but rather rendered
the urine, if previously turbid, perfectly clear. It retained its transparency
and fluidity for an hour or longer, and then consolidated into a firm yellow
mass, which underwent complete solution on being heated, but again formed
on cooling. After death, there was found to be softening and fragility of
i.º. sternum, and spine. The viscera, and especially the kidneys, were
ealthy.
TUESDAY, APRIL 28, 1850.
DR. ADDIson, PRESIDENT, IN THE CHAIR.
CASE of VERY LARGE HAEMATOGELE of THE SPERMATIC CoRD, FATAL AFTER
10 YEARs. By WILLIAM Bow MAN, Esq., F.R.C.S.E. LARGE HEMATOGELE
of TUNICA WAGINALIS IN AN OLD MAN, TERMINATING FATALLY. By T. B.
CURLING, Esq., F.R.C.S.E. M.R. Bow MAN's case was that of a farmer, aged
60, in whose right groin a tumour appeared after a fall from a horse. After
seven years, the tumour began to increase, so as to form in December 1848, a
large mass reaching from the groin to the patella. It was twice tapped,
giving exit to blood, mixed, on the second occasion, with putrid fluid and gas.
The man died a few days after the second operation. MR. CURLING's patient
had suffered for many years, and had undergone no treatment till compelled
by inflammation, and retention of urine. Three pints of dark grumous blood
were discharged by tapping.
SUMMARy of D1scussion. Pathology of haematocele. MR. CURLING and
DR. BLACK attributed the haemorrhage to rupture of diseased arteries. MR.
Bowman considered that the blood was effused from the dilated and varicose
spermatic veins; and that, especially in his case, the sudden increase of the
tumour, three years before death, was due to the rupture of one of these ves-
sels. Mr. Moore supposed that, although at first the rupture of a vessel
from injury might give rise to effusion, yet the subsequent increase of the
tumour might arise from haemorrhagic exudation, favoured by congestion, from
the delicate vessels of the false membrane resulting from the deposition of
the fibrin of the blood originally effused.
Treatment. MR. Bowman spoke in favour of early and free incision of the
sac, so as to evacuate the blood, when a fair trial had been made of the ordi-
nary milder measures. MR. CURLING thought that many cases could be cured
by repeated tappings, except where the blood acted in a foreign body, pro-
ducing irritation. MR. ARNOTT drew a comparison between haematocele and
ROYAL MEDICAL AND CHIRURGICAL SOCIETY. 905
cystic collections of blood in the neck and other parts of the body. When
the blood was coagulated, he believed free incision the best treatment; but
when it was fluid, he would be inclined to try injection of iodine.
TUESDAY, MAY 14, 1850.
DR. ADDISON, PRESIDENT, IN THE CHAIR.
ExCISION OF THE OS CALCIS, IN INCURABLE DISEASE of THAT Bon E, As A
SUBSTITUTE FoR AMPUTATION of THE Foot. By W. B. PAGE, Esq. (Com-
municated by T. B. CURLING, Esq.) The patient, whose case was related,
was a scrofulous boy, 16 years of age, affected with caries of the os calcis,
arising from injury. Several sinuous passages reached to the diseased bone,
from an ulcer situated below the inner ankle. Having improved the boy’s
health by nourishing diet and cod-liver oil, Mr. Page determined to remove the
os calcis. This he effected by making an incision from below the ulcer across
the sole of the foot to just below the fibula. Having reflected this flap, and
divided the attachment of the tendo Achillis, he separated the os calcis from
its attachments on each side and to the astragalus. He then separated from
the under surface of the bone, a flap, formed by two incisions along the side
of the foot from the margin of the first as far as the attachment of the os
calcis to the cuboid bone, and divided the attachments of these bones. The
astragalus and cuboid bones appeared quite healthy. The patient subsequently
suffered from inflammation and erysipelas, but made a satisfactory recovery,
and left the hospital in fourteen weeks. In sixteen months, the foot, con-
tinued sound, and he was able to extend it perfectly when sitting.
CASE of STRICTURE OF THE RECTUM, IN WEHICH AN ARTIFICIAL ANUs WAS
SUCCESSFULLY ESTABLISHED IN THE LEFT LUMBAR REGION. WITH REMARKs.
By CROKER PENNELL, M.B. Lond. (Communicated by B. PHILLIPs, Esq.)
The patient was a gentleman aged 50, labouring under stricture of the rec-
tum. From violent and repeated straining at stool, the bowels ulcerated, and
the faeces escaped into the urethra and bladder. He had, moreover, a very
narrow structure of the urethra. He suffered much from an inflammation
and frequent obstruction of the urethra, and also from inflammation and
partial suppuration of the testicles. The operation of forming an artificial
anus in the left lumbar region was performed by Mr. Pennell, on Nov. 4,
1849; and, in seven weeks, the patient was entirely relieved of his sufferings,
and able to walk about with ease.
}
TUESDAY, MAY 28, 1850.
DR. ADDISON, PRESIDENT, IN THE CHAIR.
ON THE USE OF THE SPEGULUM IN THE DIAGNoSIS ANDTREATMENT or UTERINE
DISEASEs. By ROBERT LEE, M.D., F.R.S. The author commenced by refer-
ring to the ancient history of the speculum, and exhibited a representation, in
the work of Vulpes, of the speculum magnum matricis, found in Pompeii.
He then noticed the use of the speculum in France, in the hands of Recamier
and Lisfranc ; and referred to its employment in that country and in Ger-
many as an instrument of police, in the examination of prostitutes. The object
of the paper was to define its legitimate use and real value. DR. LEE had
derived little or no aid from the Speculum in the diagnosis and treatment of
malignant and non-malignant organic diseases, and of displacements of the
uterus. He used it in unmarried women, only when there was severe pain
in the uterine region ; but he frequently employs it in morbid females, in
cases of obstinate leucorrhoea. As to the alleged frequency of ulceration of
the os and cervix uteri, Dr. Lee made some statistical statements, for the
purpose of shewing that the disease was not nearly of such frequent occur-
rence as had been represented. He had never met with ulceration of the os
and cervix in the living body, except of a specific character, especially scro-
fulous and cancerous; but he had met with a considerable number of cases in
which, though absent, it had been affirmed by others to exist, after they had
made a careful examination with the speculum.
906 - REPORTS OF SOCIETIES.
SUMMARY OF DISGUSSION. Use of the Speculum. DR. AsHwBLL denounced
the use of the speculum uteri, as subversive of female safety and delicacy,
and as having become almost a professional dishonour. MR. ACTon, Dr.
MURPHY, DR. H. BENNETT, and DR. Locock, defended its use, as a valuable
instrument, and as being capable of employment without outraging feelings
of delicacy. At the same time, they admitted that it was liable to abuse ;
which, however, was by no means a ground for its total suppression.
Frequency of Uterine Ulceration. DR. AsHwBLL stated that post-mortem
examinations shewed that ulceration of the os and cervix uteri was much less
frequent than is generally supposed ; it having been found in only twenty-
five cases out of 1000. MR. ACTON, DR. MURPHY, DR. H. BENNET, DR.
STEwART, and DR. LocoCK, considered the statistics of Drs. Lee and Ashwell
incorrect, as they had met with the affection much more frequently. The
post-mortem examination referred to, had been made on patients taken indis-
criminately, in general hospitals; and moreover, the appearances of inflam-
mation might disappear after death. -
Use of Escharotics. The objection made by Dr. Lee to the use of escharotics
to the os uteri, because granular affections of conjunctiva were produced by
caustic, was opposed by MR. ACTON, DR. MURPHY, DR. H. BENNET, DR,
STEwART, and DR. LocoCK. They considered their use indispensable in many
cases; but admitted that caution was necessary.
EPIDEMIOLOGICAL SOCIETY.
A very numerous and influential meeting of the friends of this Society was
held on Tuesday, the 30th of July, at 8 P.M., in the Hanover Square Rooms.
LoRD ASHLEY was in the Chair. Excellent addresses were delivered by the
noble Chairman, and other speakers. DR. BABINGTON stated, that the honour
of originating the Society belonged not to him, but to Mr. TUCKER of Berners
Street. -
The following resolutions were unanimously carried :—
1. That a Society beforthwith established for the investigation of Epidemic
diseases, to be called “The Epidemiological Society”; and that all
gentlemen interested in its objects shall be eligible as Members.
[Moved by DR. BABINGTON, and Seconded by DR. ADDISON.]
2. That the Society shall be governed by a President, Vice-President,
Councillors, and other officers. [Moved by DR. GoLDING BIRD, and
Seconded by MR. J. PROPERT.] - *
3. That Dr. Babington be requested to accept the office of President.
Moved by MR. R. D. GRAINGER, and Seconded by DR. SIBSON.]
4. That the following gentlemen be requested to act as Vice-Presidents:—
Dr. Addison, Dr. Bright, Sir B. C. Brodie, Sir William Burnett, Sir C.
M. Clarke, The Rev. T. Dale, Mr. R. D. Grainger, Sir Charles Hastings,
(Worcester), Dr. Haviland, (Cambridge), Sir James MacGrigor, Mr. J.
Nussey, Mr. J. Propert, Dr. Roupell, Dr. Thomas Southwood Smith,
Colonel Sykes, and Dr. Thomas Watson. [Moved by Mr. CHARLES
HAWKINs, and Seconded by MR. WILLIAM RogFRs.]
5. That the following gentlemen do constitute the Council :–Mr. Jacob
Bell, Dr. James Bird, Dr Golding Bird, Dr. A. Bryson, R.N., Mr. G.
Busk, Dr. W. B. Carpenter, Mr. R. Greenhalgh, Dr. W. W. Gull, Mr.
E. Headland, Dr. A. Halsham, Mr. T. Hunt, Dr. W. Jenner, Dr. R. G.
Latham, Dr. H. B. Leeson, Dr. J. O. MºWilliam, Mr. J. Marson, Dr.
E. A. Parkes, Mr. W. Percivall, Dr. E. C. Seaton, Dr. Francis Sibson,
Dr. E. Sieveking, Mr. J. Simon, Dr. J. Snow, and C. R. Walsh, Esq.
[Moved by DR. Roupe LI, and Seconded by MR. C. B. LoRD.]
SE.I.F-SUPPORTING D ISIPENSAR ES. 907
LONDON SOCIETY FOR ESTABLISHING SELF-SUPPORTING
DISPENSARIES.
The meeting to which we adverted in our last, p. 808, was held on Monday,
the 29th July, at 8 P.M., in the Hanover-square Rooms, MR. BENJAMIN B.
CABBELL, M.P., in the Chair. . The Chairman having, in a short and forcible
address, stated the objects of the Society, called for the Report of the Council.
MR. T. D. HAWKER, the Secretary, then read the Report. It had been
pleaded, that Self. Supporting Dispensaries might be injurious to private
practice; but this could not arise, as they would only be open to those who,
while they were utterly unable to pay the usual, or what might be termed
the proper remuneration for medicine and medical advice, had a wholesome
and honourable repugnance to apply as paupers to the relieving officer for an
order on the parish doctor. By weekly subscriptions, of about one per cent.
on their earnings, the working classes (who would otherwise have to remain
neglected, or seek charitable relief in sickness), would at all times, when
attacked by indisposition, be entitled to receive medieal assistance from a
practitioner of their own choice. The Society proposed, that Self-Supporting
Dispensaries should be everywhere established, and that all the medical prac-
tioners of any district should be allowed to enrol themselves as medical
officers of the Self-Supporting Dispensary of that neighbourhood: the mem-
bers, at their entrance, having the right of selecting their own medical
attendant. The Report pointed out the mischiefs which flow to society, and
the wrong done to the medical profession, by the system which now obtains
in the London Hospitals and Dispensaries, two-thirds of the applicants to
which are able, and generally not unwilling, to pay something for medicine
and attendance, as Dr. Stewart had correctly stated in his pamphlet.
DR CoRMACK (of Putney) had great pleasure in moving—“That the thanks
of the meeting are due to the Council for the ability and diligence with which
they have discharged their duties; and that their Report now read be re-
ceived, and entered on the minutes of the Society.” He had been a convert
to Mr. Smith's principles from his first acquaintance with them ; but he
confessed that he had till now feared that their practical application was
beset on every side with difficulties, so serious as to appear nearly insur-
mountable. He was inclined to hope, however, that a Society—having for
its basis the Report now read—would be an effectual check on all abuses, as
well as a rallying point from which to derive advice in all circumstances of
doubt. The Society must at once form, and from the commencement of its
operations be guided, by a stringent code of ethics; and no Dispensary should
be recognized as under the wing of the Society, unless all the officers placed
themselves under its jurisdiction. If the 'Society refused to sanction a Dis-
pensary in any district, till there had been obtained the approbation of a
majority of its legally qualified practitioners; and if all qualified practi-
tioners were entitled to participate, on an equal footing, in the medical
management, he (Dr. Cormack) did not see how the profession could oppose,
or be in any way jealous of Mr. Smith's schemes. It was only upon the
distinct understanding that the Self-Supporting Dispensaries, or Provident
Dispensaries, as he preferred to call them, were to be open to the whole profes-
sion, and to be so conducted as not to injure legitimate practice in poor neigh-
bourhoods, that he (Dr. C.) gave his support to the present movement. He
thought that the boon, proposed by Mr. Smith, might be extended to the in-
dustrious classes, without injuring even the humblest members of the medical
profession.
J. PROPERT, Esq. in seconding the motion, warmly advocated the philan-
thropic objects of the Society. IIe had formerly been opposed to these Dis-
pensaries on theoretical grounds, but the evidence afforded by the working
of these institutions in various places, and a careful examination of the whole
WOL II. 60

908 REPORTS OF SOCIETIES.
subject, had now made him their warm advocate and supporter. To the
utmost of his ability, he would promote the objects of the Society.
The motion was put from the Chair, and carried unanimously.
The REv. DAVID LAING, A.M., at the close of an eloquent and convincing
speech, proposed the first resolution, to the effect, “that these Dispensaries are
well calculated to secure for the working classes adequate medical assistance
at a cost within their means, and to promote among them habits of frugality,
forethought, and independence.”
DR. MooRE (of Saville Row) seconded the resolution. He was a decided
enemy to the Dispensary system now prevailing, and he would gladly assist
in supplanting it by something better ; for it was deeply injurious to the
medical profession, and, as he well knew, demoralizing to the common people.
He saw in the vigorous carrying out of Mr. Smith's plan, a remedy for most
of the existing evils in our medical charities.
H. L. SMITH, Esq. (of Southam) having been called on by the Chairman
came forward and was received with loud and prolonged cheers. [In place
of giving a meagre report of Mr. Smith's admirable address, we refer our
readers to p. 368 of this volume, where will be found a paper by Mr. Smith,
in which are embodied his leading facts and arguments.] Mr. Smith pointed
out how Self-Supporting Dispensaries, if fostered by Government, might be
made signally instrumental in the regeneration of Ireland.
MR. BECKE, of Northampton, who had come to town to attend the meeting,
bore the strongest testimony to the excellent effects produced in his town by
the operations of the Self-Supporting Dispensary. It had been of advantage
to the profession ; and had greatly improved the condition and the comforts
of the labouring classes,
MR. J. BAcot (of Portugal-street) warmly advocated the objects of the
Society. He had enlisted in the cause from a thorough conviction, that it
was in every respect worthy of the patronage of all who have at heart the
character of the medical profession, and the good of the labouring classes.
The independent labourers were the pride and the stay of the nation, and to
preserve that class of the community in their independence, was true patriot-
ism. Mr. Smith’s plan he regarded as capable of being made a great political
engine for the regeneration of the mass of the people.
MR. SAMUEL GREGson (Chairman of the Committee of the Self-Supporting
Dispensary, Charlotte-street) though not a member of the medical profession,
was anxious to say a word in support of the resolution. He had long, and
with much sorrow, observed the decline of self-reliance among the working
classes, especially as regarded a provision for sickness, or adversity, in any
form. He was sanguine enough to believe that the Self-Supporting Dispen-
saries would, if subjected to proper control, go far to redeem the degeneracy
to which he had alluded, and which had arisen in a great measure from bad
legislation, and mistaken philanthropy.
The Resolution was put from the Chair, and carried unanimously.
The REv. W.M. Owen (of Islington) proposed “the thanks of the meeting
to H. L. Smith, Esq., for his disinterested and untiring exertions in the cause
of humanity, especially as evinced in his endeavours to diffuse the benefits of
Self-Supporting Dispensaries.” Statesmen and warriors were applauded and
rewarded when living ; and, after their death, monuments were reared to
commemorate their deeds: but the benefactors of the human race who have
arisen in the medical profession have generally died unrewarded and forgotten.
Mr. Smith had, however, fortunately reared for himself many monuments,
for his name was already inscribed on the grateful hearts of thousands of his
fellow countrymen.
DR. J. BoMPAs (of Camberwell) seconded the resolution, which was carried
by acclamation.
MR. H.L.SMITH having returned thanks, and a hearty vote of thanks to MR.
CABBELL having been passed, for his conduct in the chair and his kindness
in taking it, the meeting separated.
PROVINCIAL MEDICAL AND SURGICAL ASSOCIATHON.
909
PROVINCIAL MEDICAL AND SURGICAL ASSOCIATION.
THE EIGHTEENTH ANNIVERSARY MEETING was held at Hull, on Wednes-
day the 7th, and Thursday the 8th of August, 1850. The following gentlemen
were present.
IBARTON-ON-HUMBER. W. H. Eddie, Esq.;
John Morly, Esq.
BATH. Edward Hodges, M.D.; James
Tunstall, M.D.
BECCLES, SUFFOLK. Henry Davey, Esq.
BEVERLEY. R. G. Boulton, Esq.; Thos.
Sandwith, M.D. ; H. Llewellyn
Williams, M.D.; J. Williams, M.D.
BOSTON. Edward Ingram, Esq.
BRIGG. James B. Moxon, Esq.
CAMBRIDGE. G. M. Humphrey, Esq.
CANTERBURY. James Reid, Esq.
CRAYKE. H. Y. Whitehead, M.D.
CROYDON. George Bottomley, Esq.
DoRCHESTER. G. Curme, Esq.
FARNHAM. William Newnham, Esq.
GREAT GRIMSBY. John Bell, Esq.; Thos.
Bell, Esq.
HANWELL. J. Conolly, M.D.
HARROGATE. G. Kennion, M.D. ; Thos.
Parry, Esq.
HASTINGs. James Mackness, M.D.
HAYES, MIDDLESEx. W. Conolly, M.D.
HEDON. H. Cantly, M.D.; W. Kirk, Esq.
HELMSLEY. John Ness, Esq.
HESSLE. F. B. Anderson, Esq.
HILLINGDON. A. Stilwell, M.D.
HULL. A. O. Arden, Esq.; R. Atkinson,
Esq.; C. Beckett, Esq.; J. P. Bell,
M. D.; Dr. Breslin (46th Regt.); F.
W. Casson, Esq.; Henry Cooper,
M.D.; R. M. Craven, jun., Esq.;
Owen Daly, M.D.; J. Dossor, Esq.;
H. Gibson, Esq.; John H. Gibson,
Esq.; R. Hardy, Esq.; W. B. Hay,
Esq.; E. Healey, Esq.; F. R. Horner,
M.D.; F. Huntington, Esq.; C. A.
Lee, Esq.; J. A. Locking, Esq.; G.
Lowther, Esq.; W. J. Lunn, M.D.;
John MºMillan, Esq.; G. Millin,
Esq.; H. Munroe, Esq.; J. L.
Nicholson. Esq.; J. Parkinson, Esq.;
W. Quin, Esq ; H. Sandwith, M.D.;
R. L. Slight, M.D.; Edw. Wallis, Esq.
HUNSLET, NEAR LEEDs. R. Pullan, Esq.
KEYINGHAM. George Houlton, Esq.
KIRKELLA. Thomas Hobson, Esq.
LEEDs. R. P. Bell, M.D.; C. Chadwick,
M.D.; J. P. Garlick, Esq.; William
Hey, Esq.; W. Price, Esq.;
Standidge Shackles, Esq.
LEICESTER. J. Barclay, M.D.
LONDON. J. Churchill, Esq.; S. Hare,
Esq.; C. A. Newnham, Esq. (Guy's
Hospital); F. Sibson, M.D.
MANCHESTER. S. Crompton, Esq.; J.
Hatton, Esq.; Edmund Lyon, M.D.
MARKET WEIGHTON. Matthew Jackson,
Esq.; R. Jefferson, Esq.
MUCH WENLock. W. P. Brookes, Esq.
NoRTHAMPTON. Archd. Robertson, M.D.
NOTTINGHAM. Booth Eddison, Esq.
OLLERTON. J. W. Lilly, Esq.
OswesTRY. Peploe Cartwright, Esq.
PATRINGTON. Thomas Smith, Esq.
PoCKLINGTON. Thomas Hornby, Esq.
RETFORD. Edward Ballard, M.D.
RUGBY. James Paxton, M.D.
SHEFFIELD. Fergusson Branson, M.D.;
W. Jackson, Esq.
SKIRLAUGH. C. Richardson, Esq.
SouTH CAVE. Edward Des Forges, Esq.;
John Hill, Esq.
STOCKPORT. Richard Flint, Esq.
SUNBURY. J. S. Soden, Esq.
THORNE. Tom Guy, M.D.
THRAPSTON, NORTHAMPTONSHIRE.
Leete, Esq.
TIMSBURY. James Crang, Esq.
ToRQUAY. C. Radclyffe Hall, M.D.
WETTON. Thomas Jackson, Esq.
WoRCESTER. Sir Chas. Hastings, M.D.;
#. P. Sheppard, Esq.; J. H. Walshe,
ºsq.
Yanºn. C. L. Robertson, M.D.
YoRK. J.W. Metcalfe, Esq.; T. Simpson,
Esq.; Caleb Williams, M.D.

J. G.
THE FIRST GENERAL MEETING
was held in the Lecture Hall of the Hull Literary and Philosophical Society,
on Wednesday forenoon, at ten o’clock.
Dr. F. R. HoRNER, on taking the chair, delivered the following address:–
“GENTLEMEN,+I give you my best thanks for the honour—the very high
honour, you have now conferred upon me.
I am acutely sensible, how many
and how manifest must be my shortcomings in performing, in an efficient
and worthy manner, the duties of my office; especially as those who have
preceded me, were ever men who not only occupied the highest ranks in pro-
fessional standing, but who were, moreover, eminent for their general literary
and scientific acquirements.
It was to such activity and vast scope of mind
that this Association owes its own institution ; for, many as were the then
6() 2
9 || 0 RFIPORTS OF SOCIETIES.
existing societies of learned bodies of men, it was the penetrating mind of Sir
CHARLEs HASTINGs that discovered yet another field, on indigenous or provin-
cial soil, capable of yielding rich store of knowledge ; and how fruitful has
been that field, the records of medical and surgical science bear ample testi-
mony. Nay, so important have been the results, so vast the benefits, which
have accrued from this Association, and which to future ages may accrue to
the profession, to medical science, and to the community at large, that justly,
I conceive, is our learned founder entitled to exclaim, with the poet of old,
monumentum evegi Gere perennius / I cannot but congratulate you on this
noble work of eighteen years, nor forbear expressing a due tribute of respect
to one whom even Majesty itself delighteth to honour, and through him, those
with whom he is associated.
“In any allusion to those learned presidents who have preceded me in
office, and who have, in an especial manner, promoted the great aims and
objects of the Association, I cannot but refer, with feelings of the deepest
mourning and respect, to one whose career on this earth has closed for ever.
It is but four years since the late MR. CROSSE, of Norwich, addressed you
from the chair; and all of you will well call to mind his luminous remarks,
his energy and zeal for the cause. He then congratulated you that in his
own, the Eastern Branch, you had not that year been deprived of one mem-
ber by death; would—would that it had been reserved for me also again so
to speak! But, where now is his own great mind that clear judgment, that
penetrating intellect, that skilful hand, and that warm heart, overflowing
with kindliest feeling Alas ! the silver cord is loosed, and the wheel is
broken at the cistern. There are other valuable members, of whom we have
this year been deprived by death, but I shall not further indulge in such
mournful reflections; though surely it is a good and wise thing, sometimes
to school the heart by thinking on the virtues of the great and good who
have trod the path of life before us. The most sincere tribute to their memory
is imitation of their example.
“I need not now speak of what has already been accomplished by the
Association ; it is with the future that we have now to do. The future
standing of this Association before the world, and the amount of benefit that
shall accrue from it, depend wholly upon the efforts which you are now pre-
pared, or are willing to make. A great and responsible duty lies before you,
not only to uphold the present structure in all its entireness, but to en-
large and to build upon the great foundation which has been laid. To this
end, duty to ourselves, to each other, and to all, demands of you the single
and the united effort. To this end I could wish that every member should
cast at least one mite into our treasury of knowledge. Thus, let the hospital
physician and surgeon, by careful record of well-selected cases, add to our
knowledge and treatment of disease by practical deduction and suggestion ;-
let those gifted with the talent for scientific research, make known the result
of their enlightened investigation ;-let the practical physician and surgeon,
of acute observation and reasoning—let those who delight in physiological
inquiry—the pathologist, the anatomist—yea, let all the existing talent
amongst us be but exercised, and then will the Provincial Medical and Sur-
gical Association, (the ten talents committed to us,) yield to future ages one
hundred-fold.
“All honour be to those (and they are not a few) who have so laboured ;
and who have thus earned for themselves the well-merited honour and esteem
of men. But the medical labourer, whose mental toil is devoted to the
virtuous and noble purpose of alleviating the burdens of others—the burdens
of sickness and suffering—knows yet a higher reward than the applause of
men. His is the reward of the still small voice—the approval of his own
heart’s feelings. Influenced by such feelings, our profession does indeed
become the ars divina ; imitating in its application the precepts and ex-
ample of Him who healed the sick and the afflicted, and went about doing
good; and inasmuch as it is done unto Him, verily the reward is not lost.

PROVINCIAL MEDICAL AND SU RG iOAL ASSOCIATION. 9 | 1
“Benevolence is the characteristic of our profession ; and that this bright
virtue has erected her stronghold in your Association, the existence of its BENE-
voDENT FUND is at once alone the warrant and the testimony. I am assured,
that it has already a far stronger advocate in your own hearts than it
could have in any mere words of mine ; yet the best of us sometimes require
to be reminded of duty. Bear ye each other's burdens, is the language of
Scripture itself; yea, rather it is the command of Scripture ; for it is not
written that you may, or you can, or you should, but the word is imperative—
it is commanded, bear ye each other's burdens. It will, I believe, be seen by the
report which your excellent Honorary Secretary, Mr. Newnham, will read to
you, that a somewhat larger amount of support has this year been given to
the Benevolent Fund than heretofore. It will also be seen by that report,
down how many sweet channels the pure streamlets of benevolence have
flowed; how it has now gladdened the heart of the widow, now brought suc-
cour to the orphans of our once fellow-labourers, and now given assistance to
those of our brethren, who have been overtaken by distress and affliction.
Surely, gentlemen, these are delightful things ; may they come home to each
of us, and strike the sweet chords of charity in every heart.
“On the subject of MEDICAL REFORM, I cannot refrain from expressing my
regret, that those judicious and well directed efforts, so perseveringly exerted
by the Association, should hitherto have ended in disappointment. Medical
Reform seems to have been clogged by its own weight, or rather by the adverse
weight of others, not of our body; it appears indeed that it is the quot ho-
mºnes tot sententiae—diversity of opinion—that is the true let and hindrance.
But surely it was not to be looked for, that there should be perfect unanimity
of sentiment, amongst so large a body of men as that which comprises the
medical public. Let us hope, however, and by perseverance in effort endea-
vour, to obtain the practical consideration, by the minister, of this great
question.
“There is one species of reform, however, closely connected with our pro-
fession, on which I can offer you the fullest congratulation ; it is SANITARY
REFoRM. It is not too much to say that Sanitary Reform, in the widest
acceptation of the term, and in its fullest practical bearing, is by far the most
important measure that marks the present era, nor can we place a limit to the
present and prospective good which is comprised therein. We should take
but a very inadequate view, did we confine its operation simply to the removal
of diseases from the dwellings of the poor, or from the path of the rich. It
asserts a much wider influence ; it compasses also the elevation of the moral
and intellectual condition of the poor. Doubtless there is a connexion and
dependency between physical and moral purity. Small indeed would be our
success, in attempting to implant sentiments of morality or religious or educa-
tional knowledge, in the minds of those who are surrounded by an atmosphere
of filth, squalor, and neglect. Such scenes tend to lower or degrade the mind,
and blunt its sensibilities and feelings; whereas cleanliness leads to order and
decency, to industry, and to self-respect; to a state of mind and feeling, in fact,
which renders it more fit for the good seed which the sower goes out to sow—
for the seeds of morality, of religion, and of knowledge.
“Doubtless it was the Asiatic Cholera, that quickened the progress of sani-
tary reform. It was there seen, that neglect of the poor was also the endan-
gering of the rich ; and that it was better, because it was cheaper, to preserve
the poor man in health and life, than to maintain his widowed and orphaned
children. Yet I would bear willing testimony, that the higher classes in this
town, and, I trust, elsewhere, were ever ready to come forward with pecuniary
aid to succour those smitten with the disease, or to ward off its attacks from
others. Let us hope that the sanitary regulations eommanded by Parlia-
ment, may be efficient in staying or modifying its future approach. And let
us further hope, if I may venture the remark, that, in any reappearance of
the disease, medical men will lather seek to investigate, and to treat, the dis-
912 REPORTS OF SOCIETIES.
ease on something like rational principles, than to place, without thought or
care, all their reliance, and that in every case, on the vaunted though mis-
taken efficacy of one single mineral.
“The Asiatic Cholera may justly, I conceive, be looked upon as a most
merciful dispensation to this country, though, by reason of our blindness and
ignorance, we are unable to perceive the dealings of Providence. How apt
are the words of the poet : -
“All nature is but art unknown to thee,
All chance, direction which thou can'st not see ;
All discord, harmony not understood,
All partial evil, universal good;
In spite of pride, in erring reason’s spite,
One truth is clear, whatever is, is right.”
“Terrible, indeed, is the lesson by which we have been taught wisdom ;
by which we have been made to see that we cannot pollute the pure air of
heaven, without suffering the effects of pollution and disease ; that we cannot
mingle the matters of corruption and decay with the pure waters of the
earth, without drinking in, and assimilating, the pollutions in our own
bodies;–in a word, that we cannot do violence to the laws of nature, without
suffering the penalty of broken laws. It is well that a nation should humble
itself in fasting and prayer, when the Almighty chides; but it is only by
obedience to the laws which He has given us, and by the fulfilment of our
duty to the poor, to our fellow men, and to all, that we can expect immunity
from His chastisement.
“I shall now conclude by performing towards you the most pleasing duty
of my office,—that by, in bidding you, not only in my own name, but in that
also of all my medical brethren, both in the town and neighbourhood, a most
sincere, a most cordial, and a most hearty welcome to our good town of Hull.”
(Dr. Horner concluded by calling the attention of the members to the build-
ings and other objects of interest in Hull and its neighbourhood)
SIR CHARLEs HASTINGs. MR. CALEB WILLIAMS moved, and DR. J. Conolly
seconded, the following resolution, which was carried by acclamation.
“That the members of the Association wish, at the commencement of
their proceedings on the present occasion, to express to their esteemed Presi-
dent, Sir Charles Hastings, its founder, their cordial congratulations on the
honour recently conferred upon him by Her Majesty; and to record the feel-
ings of sincere gratification which it has afforded them, whether regarding it
as an honour eminently deserved, or as a most gracious acknowledgement on
the part of the Queen, of those accomplishments, exertions, and virtues which
best contribute to adorn and dignify the medical profession.”
REPORT of THE CouncIL, read by J. P. SHEPPARD, Esq. [We can only give
extracts from this document.]
FINANCIAL STATEMENT. The Receipts for the past year, together with
#16 2s. 6d., the balance in hand. in 1849, amounted to £1632 6s. 8d. ; the
Expenditure was £1522 8s. 2d., leaving a Balance of £109 18s. 6d. There
was every reason to assert, that the Association was never more prosperous in
this respect than at present.
ARSENIC CoMMITTEE. The Arsenic Committee have made their Report to
the Council, in which they state that, after a laborious investigation, they
recommended a Memorial to Sir George Grey, and a petition to both Houses
of Parliament, praying that a remedy might be found for the great evils con-
nected with the indiscriminate sale of arsenic. The Committee appointed
two of their members, Dr. Hodgkin and Dr. Sibson, to confer with a Com-
mittee appointed by the Council of the Pharmaceutical Society; and, after
attentive consideration and frequent conferences, resolutions, which will be
found at p. 913, were adopted unanimously by the joint Committee, as the
basis upon which a legislative enactment should be framed,
PROVINCIAL MEDICAL AND SURGICAL Associatios. 9 || 3
After the Council had received this Report, they lost no time in forwarding
a memorial to the Secretary of State for the Home Department, and petitions
to both Houses of Parliament, in compliance with and embodying the re-
solutions. -
DR. RoBERTSON moved, and Mr. Soden seconded, the adoption and printing
of the Report ; which motion, after some discussing on the appointment of
Editors to the Journal, was carried unanimously. -
DR. Conolly, of Hanwell, moved, and MR. Boot H EDDIson, of Nottingham,
seconded, “That the thanks of the meeting be given to the retiring Presi-
dent, Sir Charles Hastings, and that he be appointed a Vice-President of the
Association.” It was then moved by Dr. STILWELL, and seconded by DR.
RADCLYFFE HALL, “That the thanks of the meeting be given to the Coun-
cil of the Association for their services during the past year, and that
they be requested to continue the same, with the following additional
members: Dr. Cumming, Denbigh ; John Lloyd, Esq., Llangefni ; Dr.
Williams, Wrexham ; D. K. Jones, Esq., Llangefni ; Dr. J. Roberts, Bangor;
Dr. O. Roberts, St. Asaph ; P. Williams, Esq., Holywell; Owen Richards,
Esq., Bala ; T. B. Winter, Esq.. Brighton; Dr. Tunstall, Bath : J. Garstang,
Esq., Clitheroe; W. P. Jones, Esq., Holywell; T. Dorrington, Esq., Man-
chester; G. Southam, Esq., Manchester; W. Bridsall, Esq., Northampton; J.
M. Bryan, Esq., Northampton; Dr. C. Bell, Manchester; M. S. Barton, Esq.,
Market Raisen; Dr. A. Stilwell, Moorcroft House, Middlesex; Dr. Jenks,
Brighton.” Both these resolutions were carried by acclamation.
THE EDITORSHIP. After reading a letter from the President and Secretary
of the South Eastern Branch of the Association, complaining of the tone of
the articles relating to Medical Reform, which had lately appeared in the
Journal, SIR CHARLES HASTINGs proposed the following resolution, which
was seconded by DR. RoberTson, and carried : “That the appointment of
Editors made by the Presidents and Vice-Presidents be confirmed ; and that
a Committee of five members of the Association be appointed, to consider
whether any and what further improvements can be effected in the publica-
tions of the Association; and that the letter from the President and Secretary
of the South-Eastern Branch be referred to the Committee.” Dr. Robertson,
Mr. Soden, Dr. Conolly, Dr. Lyon, and Sir Charles Hastings, were named as
the five members of the Committee.
ARSENIC CoMMITTEE. DR. Tunst ALL, of Bath, next read the following
report of the Committee, appointed last year to consider what means could be
adopted with the view to stop the indiscriminate sale of poisons.
“The Committee on the Sale of Poisons, appointed by the Central Council
of the Association, have the honour to submit the following report to the
Anniversary Meeting. Your Committee, in conjunction with a Committee
appointed by the Pharmaceutical Society, to co-operate with them, have
agreed to three resolutions as the basis upon which a legislative enactment
should be framed. -
“Ist. That the retail sale of arsenic should be restricted to chemists and
druggists and apothecaries.
* 2nd. That arsenic should only be sold to male adults or to their written
order. -
“3rd. That the vendor should enter the sale in a book, with the date and
object for which it was required, to which the applicant and a witness,
one or other being known to the vendor, should sign their names,
unless a written order be brought in a handwriting known to the ven-
dor, which order should be pasted in a book.
“These resolutions formed a portion of your Committee's Report, which is
printed at page 183 of the Journal of your Association for 1850. A copy of
this report was presented by the Central Council to the Right Honourable
the Secretary of State for the Home department, in March last, in complianze
914 . * REPORTS OF SOCIETIES.
with his request, he being at that time unable to receive a deputation on the
subject in consequence of his absence from London. Petitions, embodying
the three resolutions of the Joint Committee, have been presented to both
Houses of Parliament. Your Committee in conjunction with that of the
Pharmaceutical Society, have accumulated a mass of facts which strikingly
and conclusively show the great necessity of an enactment to put a stop to a
system of Secret poisoning, which, from the reports of the present assizes,
appears to be unabated. Your Committee have the satisfaction of knowing,
that the government has already in preparation, a hill for the wholesomé
regulation of the sale of poisons, and hope that another session will not pass
without the adoption of an effectual law upon the subject. In conclusion,
your Committee would urge upon the members of the Association the great
importance of again petitioning the Legislature, and of individually impress-
ing the great importance of the subject upon the several members of Parliament
with whom they may possess any personal influence. CHARLEs HASTINGs, M.D.,
President; JoHN HELE FUGE, F.R.C.S.; THoMAs Hodgkin, M.D., F.R.S.;
*fººtas ToogooD, M.D.; FRANCIS SIBSON, M.D., F.R.S.; JAMESTUNSTALL,
.D.”
DR. TUNSTALI, then moved “That a petition against the indiscrimate sale
of poison be presented to both Houses of Parliament, similar to that pre-
sented in March last, and that the Branches of the Association be recom-
mended to adopt similar petitions.” The motion was seconded by Dr. SIBSON,
and adopted.
DR. RoBERTSON proposed, and MR. FLINT seconded, “That the thanks of
the Association be given to the Arsenic Committee, and that they be requested
to continue their labours until a satisfactory legislative enactment be obtained.”
A vote of thanks was carried by acclamation.
SEcond GENERAL MEETING.
The Association re-assembled in the same place at 2 p.m., DR. HoRNER in
the Chair.
BENEVoIENT FUND. M.R.NEWNHAM read the Report. DR.W. Conolly moved,
and MR. HEY, of Leeds, seconded, the following resolution, which was carried
unanimously : “That the report now read be approved, and that the thanks
of the Association are eminently due, and are hereby given, to Mr. Newnham,
for his great and important exertions in increasing the funds, and that he
be requested to continue his valuable services as Honorary Secretary.” DR.
CoNoLLY called the attention of the meeting to the intended removal of the
Committee of the Benevolent Fund to London. The following gentlemen
were proposed as the Committee for the ensuing year, with power to add to
their number: John Bacot, Esq.; Dr. Bernard; Dr. G. Burrows; Dr. Cannon;
John Churchill, Esq ; Sir James Clark, Bart. ; Dr. William Conolly; Dr.
John Conolly; T. C. Cook, Esq.; Thomas Copeland, Esq.; Dr. Forbes;
Thomas Hudlett, Esq.; Thomas Hunt, Esq.; John Ince, Esq.; Dr. Lear;
Frederick Salmon, Esq.; John Soden, Esq.; Jos. Toynbee, Esq.; Dr. Charles
West ; Dr. Charles J. B. Williams.
REPORT ON CHOLERA. M.R. SHEPPARD, the Secretary of the Association,
read the report of the Committee appointed last year, as to the nature, history,
treatment, and prevention of Asiatic cholera, which had been prepared by
Dr. Williams. It was then moved by DR. SIBson,
“That the thanks of this meeting be given to Mr. Hunt, of Bedford Square,
London, for having made such strenuous exertions to obtain information from
the members of the Association relative to the spread of the late epidemic
cholera in this country; and also to Dr. Williams, of Worcester, for having
made the abstract from the replies, which has been read at this Anniversary;
and that the same be published in the ensuing volume of Transactions of the
Association.” MR. WALSH, of Worcester, seconded this motion, which was
carried unanimously.
EPIDEMIOLOGICAL SOCIETY. 9 15
DR. CHARLEs RADGLYFFE HALL then read a paper on the “Action of the
Muscular Coat on the Bronchial Tubes.” The thanks of the Association
were, on the motion of DR. PEARSoN BELL, of Hull, seconded by MR. Booth
EDDISON, accorded to the author. The meeting then adjourned.
THIRD GENERAL MEETING.
MR. NEwNHAM, of Farnham, read a paper by CHAs. MAyo, Esq., of Win-
chester, on a “Case of Malformed and Imperforate Wagina.” -
ADDRESS IN MEDIGINE. DR. HENRY CoopFR, of Hull, read the Annual
Address in Medicine. The subject was “Secondary and Associated Diseases.”
PLACE of MEETING for 1851. It was determined that the meeting of the
Association for 1851 be held at Brighton, a numerously-signed invitation
having been received from that place. -
MILITARY Honours To MEDICAL OFFICERS. M.R.W. PENNY BRookes moved
the adoption of a memorial to Her Majesty's Government, advocating the
claims of medical officers in the public services to military honours. The
proposition was seconded by MR. SoprN, and adopted.
ADDRESS IN MEDICINE, 1851. MR. NEWNHAM moved, and MR. BottomLEY
seconded, “That, DR. KING, of Brighton, deliver the Address in Medicine at
the annual meeting in 1851.”
1MEDICAL Topography. DR. Lyon, of Manchester, drew the attention
of the Association to the long suspension that had taken place in the
preparation of papers on the “Medical Topography of the Country”;
and proposed, “that next year, in the district to be visited by the Associa-
tion, a request be made that the subject be revived, either by adding to the
papers already published in the Society's Transactions, or viva voce, or by
some voluntary way, such as may meet the convenience of the party or parties
on whom the performance may devolve.” Dr. SIBSON seconded the motion.
DR. SIBsoN moved, “That DR. MACKNESs, of Hastings, do prepare a paper
on the Medical Topography of the county of Sussex, for the Anniversary
Meeting of 1851.” This motion was adopted unanimously.
DR. SIBson delivered an interesting extemporaneous lecture, with illus-
trations, “On the Configuration of the Body in Health and Disease.” It was
listened to with great interest, and, at the close, warmly applauded.
DR. PAxTon, of Rugby, read a paper “On the Disintegration of the
Blood”, with illustrations. On the motion of the President, the thanks of
the Association were voted to Dr. Paxton.
DR. H. SANDw1TH, of Hull, read a report of a case of Plastic Bronchitis,
which had come under his notice. Thanks were voted to Dr. Sandwith.
Both these papers were, by request, handed to the Secretary, to be pub-
blished in the Transactions of the Association.
MR. C. BECKITT, of Hull, read a paper on Therapeutics. And a paper by
F.T. PROBERT, Esq., M.D., of Bury St. Edmunds, on “Diseases of the Lungs”,
was read by DR. TUNSTALL.
A full account of the proceedings, and of the dinner, is given in the Pro-
vincial Medical and Surgical Journal for August 21st.
9 16
MIscELLANEous INTELLIGENCE.
HOUSE OF COMMONS. August 2, 1850. THE DEPUTY-CoRoNER For
MIDDLESEx, AND HOMOEOPATHY. LORD R. GROsvKNoR rose, in accordance
with a notice given on a former day, to present a petition from the members
of the English Homoeopathic Association and others, complaining of the
conduct of the deputy-coroner for Middlesex, in the case of an inquest upon
the body of the late Richard David Pearce. The circumstances of the case
to which the petition referred were so notorious, that it would not be neces-
sary for him to detain the house by repeating them; he would therefore con-
fine himself to the complaint of the petitioners. They stated that the hon.
member for Finsbury, who was the coroner for Middlesex, had appointed a
deputy-coroner in the person of his son, who on the occasion of an inquest
on a Mr. D. R. Pearce, evinced so little knowledge of the duties of his office,
that under his direction a verdict of manslaughter was found against a
brother of the deceased, an accomplished and amiable gentleman, who was
in consequence incarcerated in the felon's cell at Newgate for two days.
Mr. WAKLEY rose to order. The noble lord had said he would not read
the petition, but he was now stating the circumstances, and stating them
incorrectly. (Hear.) -
The SPEAKER informed the noble lord that he must confine himself strictly
to the statements contained in the petition. •
LoRD R. GROSVENOR. The petitioners stated that this Mr. Pearce was com-
mitted to Newgate, and there confined for two days, and that when the case
came before the grand jury, they ignored the bill, and that Mr. Justice Maule,
at the trial, stated his opinion this way: “How any person can say this man
has been guilty of manslaughter, I cannot imagine.” The petitioners con-
cluded by praying that a law might be passed to prevent coroners from
appointing their own deputies, but making the appointment dependent on
election by the freeholders of the county, in the same way as coroners.
Perhaps he might be allowed to state, that as the petition complained of the
conduct of the son of an hon, member of that house (Mr. Wakley), he had
thought it his duty, not only to give notice to that hon. gentleman of his
intention to present it, but to place it in his hands, in order that he might,
if he could, take exception to it.
Upon the motion of Mr. WYLD, the petition was read at length by the
clerk at the table.
It was then ordered to lie on the table.
Mr. WAKLEY expressed a hope that, if he was not exactly in order, he
would be permitted, through the kind indulgence of the house, to address
them on the subject of this petition. (Loud cries of “Hear, hear,” and “Go
on”.) He would only occupy their attention for a few minutes. The petition
contained allegations of a very trumpery character, and he was really sur-
prised that the noble lord (R. Grosvenor), though he was the president of the
Homoeopathic Association, and ought to have informed the house of that fact,
should have presented it. The affair to which it alluded took place last
October ; Pearce was tried at the end of October. Now, if the deputy-coro-
ner had been guilty of any illegality at the inquest, why had not an attempt
been made to quash the inquisition ? (Hear, hear.) Surely that house was
not the place to complain of it. He contended that the deputy-coroner had
been guilty of no illegality upon the occasion, and that not a single person
whose name appeared in the petition, would dare to state that he was at the
inquest, or that he had heard a syllable of the evidence. That house was
considered a better and a cheaper place for advertising the quackery of the
Homoeopathic Institution than the courts of law. He hoped, however, that
hon. members would set their faces against this impudent proceeding. He
called it “impudent”, for he believed that a more audacious set of quacks

MISCELLANEOUS INTELLIGENCE, 917
(loud laughter) did not exist, and could not be found on the surface of the
globe, than were to be found in the Homoeopathic Institution. It consisted
partly of noodles and partly of knaves. (Great laughter.) The noodles formed
the majority, and the knaves used them as tools; and if they could contrive
to get into their hands some amiable noble lord, and stick him up as a presi-
dent, they advertised their Association over the world, and then, as it often
unfortunately happened in such cases, too many dupes were found to become
the victims of their abominable designs. (Laughter, and applause.) Now,
in this case, they had had the audacity to come to that house, and to make a
charge against a public officer, who had simply discharged his duty, and dis-
charged it properly. It was, perhaps, quite right that they should have a
dread of coroners (and they had a natural dread of them ; and now their
object was, not only to advertise their Association by means of this petition
at the cheapest possible rate, but to terrify coroners from the faithful discharge
of their duties to the public. He knew not how far the house would allow
them to succeed in their first object, but he knew that they would not succeed
in their second. (Hear, hear.) Having read their petition, he sent for the
constable employed in the case, and he desired him to go to the jurymen who
sat upon the occasion, and to obtain their statement as to the conduct of the
deputy-coroner. He now held in his hand the answer he had received from
the jurymen touching the allegations contained in this trumpery document,
and with the kind permission of the house he would read the answer of the
twelve jurymen to the false allegations of the petitioners.
“We, the undersigned, having been twelve of the jurymen who acted at
an inquest held on the 9th day of October last, in the parish of St. Pancras,
Middlesex, on the body of the late Richard David Pearce, hereby willingly
testify that the deputy-coroner, Henry Membury Wakley, Esq., who presided
on that occasion, performed his duty in a most patient, able, and impartial
manner; that he more than once stated to us in his summing-up that he did
not consider there was evidence to sustain a charge of manslaughter ; and
afterwards, on attending at our request in the room where we were delibe-
rating on our verdict, to explain a point of law, and to point out the technical
form in which our verdict should be framed, on being told by us, when he
entered the room, that twelve of us were for a verdict of manslaughter, he
several times expressed a very strong opinion that it was much better that
such a verdict should not be returned, because there was not sufficient evidence
to justify and sustain such a verdict.” (Hear, hear.)
This statement was signed by the jurymen, and their addresses were
attached to their signatures. He was unacquainted with those gentlemen,
and so was his son. They had not been seen by him on this occasion, and
no application had been made to them except by the constable, and after
the refutation they had given of the allegations of the petitioners it was
unnecessary, in fact, it would be an insult to the house, to offer any further
remarks on that part of the subject. (Loud cries of hear, hear.) But seeing
the right hon. baronet, the Secretary of State for the Home Department, and
also the noble lord at the head of the government, in their places, he thought
it right to embrace the opportunity thus offered for making them and the
house acquainted with the manner in which prosecutions at the Old Bailey
were conducted. (Mr. Wakley here described the mode of proceeding at the
Old Bailey, and the interference of a person who called himself a solicitor,
and his attempt, after the trial, to obtain from the constable and witnesses a
subscription as a reward for his labours. The description appeared to excite
surprise in the house, and it elicited, on Wednesday last, a very able leading
article in the Times newspaper.) Mr. Wakley concluded by observing, that
this was a disgraceful state of things. (Hear, hear.) He trusted the right
hon, the Secretary for the Home Department would take the subject
maturely into consideration during the recess; and then, out of this trum-
pery petition, the community would be the gainers by having a public pro-
secutor employed. (Hear, hear.)

9 18 MISCELLANEOUS INTELLIGENCE.
LoRD R. GROSVENOR hoped that, after the terms in which the Association
of which he was president had been spoken of, he would be indulged for a
few minutes while he vindicated that body and himself. (Hear.) He quite
admitted that it was very inconvenient, generally speaking, that that house
should be made the arena for attacks upon men in the performance of their
public duties ; but sometimes it became necessary to bring forward com-
plaints of the kind. He thought the circumstances of the present case were
sufficiently grave to warrant his interference. The grand jury had ignored
the bill, and the trial took place on the corroner's inquisition. The conse-
quence of that was, that a man who had been suffering from a recent severe
attack of cholera, and who was labouring under all the anxiety of mind inci-
cent to his position, was committed to a felon's cell in Newgate, where he
had no opportunity of seeing his wife and family, and where he was com-
pelled to sleep on a mat and a horse-cloth. He was kept there for two days,
until a judge in chambers could be seen, in order that a change in his con-
dition might be effected. He was eventually removed, with the view of
making room for the Mannings in his cell. (Hear, hear.) With regard to
the Association which the honourable member for Finsbury had stigmatized
as being composed of knaves and dupes, he (Lord R. Grosvenor) could only
say that that Association was composed of gentlemen of high attainments,
excellent medical education, and extensive practice, and therefore they
could afford to pass by such attacks as had now been made upon them. He
trusted the house would consider him justified in bringing so serious a case
forward. Hear.)
MR. ROEBUCK hoped that the house would be protected in future against
the presentation of such wholly irregular and improper petitions as these,
which, got up to promote personal objects under public pretences, were so
managed as to evade the rules of the house by a sidewind. (Hear, hear.)
The House of Commons was not a court of appeal from the Old Bailey. (Hear.)
MR. HuME was glad of the occurrence of anything which directed the
attention of the Government and of the house to the expediency of instituting
a public prosecutor, an officer, as every day’s experience manifested, eminently
needed to protect the innocent, and to enforce the prosecution of the guilty.
(Hear, hear.) He stated that the power of appointment to the deputy-coron-
ership of Middlesex, was really vested in the lord chancellor.—[Daily News,
Aug. 3..]
HoNouns To MEDICAL PRACTITIONERs. State honours are rarely conferred
on members of our profession ; and, as a general rule, Knighthoods or dis-
tinctions, of any kind, have been considered as unmerited, even by the most
renowned and the most faithful of the medical officers of the army and
navy. A civic knighthood has frequently fallen upon a physician or a sur-
geon, from his having been accidentally entrusted with the presentation of a
congratulatory address to the Crown ; and probably such occurrences fully
explain the small estimation in which is held the prefix of Sir, among our
brethren. Within the last few weeks, however, the Queen has conferred
the honour of Knighthood upon three very eminent and deserving men—DR.
(now § RoBERT CARsweLL, Physician to the King of the Belgians, and DR,
(now Sir) CHARLEs HASTINGs, the founder (and during last year the Presi-
dent) of the Provincial Medical and Surgical Association, and Dr. (now Sir)
B. F. OUTRAM, C.B., Retired Inspector of Hospitals and Fleets. We see no
propriety in restricting such honours to three individuals; for, without the
slightest disparagement to Sir Robert Carswell, Sir Charles Hastings, and
Sir B. Outram, we must say that there are others among us equally deserving
of Royal favour. We have heard it hinted, that more than one of our eminent
physicians and surgeons have declined the honour of Knighthood; but for
what reason, we know not.
MISCELLANEOUS INTELLIGENCE. 9 9
THE ORDER OF THE BATH. The Queen has been pleased to ordain a special
statute of the Order of the Bath, for authorizing the admission into the Mili-
tary Divisions of the Second and Third Classes of that Order, “such officers
of the Commissariat and Medical Departments of the Army and Navy, and of
the East India Company's army and navy, as by their meritorious services
have already, or may hereafter be deemed by Her Majesty to have, deserved
that distinction.” Her Majesty has accordingly appointed to be ordinary
members of the Military Division of the Second Class, or Knights Com-
manders of the said Order:-
BURNETT, Sir W., Knt., M.D., Director-General of the Medical Department
of the Navy.
M“GRIGoR, Sir James, Bart., M.D., Director-General of the Medical Depart-
ment of the Army. -
THOMSON, James, Esq., Inspector-General of Hospitals on the Bengal Esta-
blishment of the East India Company’s Service.
The Queen has also appointed to be ordinary members of the Military
Division of the Third Class, or Companions of the Order, the following
gentlemen :- -.
FRANKLIN, Henry, Esq., Inspector-General of Hospitals.
FRENCH, James, M.D., Inspector-General of Hospitals,
GRANT, Sir James Robert, Knt., M.D., Inspector-General of Hospitals.
GUNNING, John, Esq., Inspector-General of Hospitals. -
HILLY AR, R. P., Esq., Retired Inspector of Hospitals and Fleets.
HUME, John R., M.D., Inspector-General of Hospitals.
LIDDELL, Sir John, Knt., M.D., Inspector of Hospitals and Fleets.
M*ARTHUR, Duncan, M.D., Retired Physician of the Fleet. -
MAGLEOD, B.W., M.D., Superintending Surgeon on the Bengal Establishment
of the East India Company's Service. -
MAGRATH, Sir G., Knt., M.D., Retired Inspector of Hospitals and Fleets.
OUTRAM, Benjamin Fonseca, M.D., Retired Inspector of Hospitals and Fleets.
RENNY, Charles, Esq., Superintending Surgeon on the Bengal Establishment
of the East India Company’s Service,
RICHARDSON, Sir John, Knt., M.D., Inspector of Hospitals and Fleets.
STRAKER, C. D., M.D., Superintending Surgeon to the Bombay Establish-
ment of the East India Company's Service. º
WEBB, Sir John, Knt., Director-General of the Medical Department of the
Ordnance.
WooDRICHE, Stephen, Esq., Inspector-General of Hospitals.
WYLIE, John, M.D., Inspector-General of Hospitals on the Madras Establish-
ment of the East India Company’s Service. - . .
STUDY of MENTAL DISEASEs AT BETHLEM HospitaL. Some years ago,
through the exertions of Dr. Webster and other Governors, considerable alter-
ations were made respecting the admission of pupils at this institution ; and,
from recent reports made by the physicians, it appears that the advantages
offered are appreciated. Last year, the school was better attended than
during any former period. Lectures have been delivered by Sir A. Morison
and Mr. Lawrence, and during the last session, Dr. Monro was engaged in
giving a clinical course on the nature, the causes, and the treatment of
insanity. We strongly advise medical students to take a course at Bethlem,
Hanwell, or other Hospital where clinical lectures are given on insanity.
MEDICAL TEACHING For THE MILITARY AND NAVAL SERVICEs. In the
military hospitals of France,—viz., those of Paris, Lille, Metz, and Stras-
burgh, the medical schools have been suppressed, from the present pressure
on the treasury of the republic. In Great Britain, on the other hand, SIR
GEORGE BALLINGALL and others assisting him, are urging upon Government
the propriety of establishing chairs of military medicine and surgery in Lon-
don and Dublin. *
920 . MISCELLAN EQUS INTELLIGENCE. .
PopULAR PREJUDICE AGAINST WAGGINATION. Extraordinary as it may
appear, it is still true that great prejudices unfortunately prevail amongst
the common people respecting Cow-Pox, and its efficacy as a preventive against
Small-Pox. From the last Quarterly Report of the Registrar General, it
appears, that, in various parts of England, although variola has been very
prevalent and fatal, there exists very great aversion to Vaccination. The
extent to which this feeling is carried by the lower orders, will be shewn by
the following extracts from the Notes appended to the Report. The facts are
both curious and instructive, and well deserve the serious attention of the
Legislature.
At Lewisham, in Kent, Small-Pox prevailed to a most unusual degree, and,
except in about five instances, all the fatal cases were unprotected. In East
Maidstone district, Small-Pox was very prevalent, and proved fatal to eleven
persons, eight of whom had not been previously vaccinated. At Acton, in Hamp-
shire, six persons died from Small-Pox, none of whom had been vaccinated
more than eight days previous to the attack. At St. Thomas's, East Budleigh,
in Devonshire, eleven individuals died from this malady, which had been pro-
pagated throughout the district by persons most violently opposed to Vaccina-
tion, who had inoculated their own families and those of neighbours, thus
exposing others to the influence of the disease. In Walcot district, Bath, four-
teen deaths occurred from Small-Pox, twelve of whom had never been vacci-
nated, and the other two, only a short time before, being infected with the
variolous poison. In Bath Eastern district, four deaths occurred, all without
previous Vaccination. In this and other localities of Bath, according to the
Sub-Registrar, the lower orders are strongly prejudiced against Cow-Pox, many
persons refusing to have their children vaccinated. A man was committed to
prison for inoculating his own children with Small-Pox. In Wolverhampton,
eastern district, twenty-two deaths occurred from Small-Pox, all without pre-
vious Vaccination, excepting two cases, in which it was doubtful whether the
persons had ever been vaccinated. In Nottingham, St. Ann's district, six
deaths occurred from variola, none of the patients having been vaccinated. It
is also reported, that in one house, a family of eleven children were ill of
Small-Pox at the same time, of whom three died, none had been vaccinated,
excepting two infants, and even these had taken the complaint before vac-
cination, or immediately after. In the Exchange district of the same town,
ten persons died from variola, eight of whom had not been vaccinated, as
great prejudice prevails amongst the lower orders against Cow-Pox. The
report states that a woman, in this locality, who had lost a child by Small-
Pox, assured the sub-registrar, “she would rather lose half a dozen by it, than
fly in the face of Providence, by having one vaccinated.” Other examples
might be quoted, but the above references will suffice to show to what extent
popular prejudices still prevail in many parts of the country.
IMPROVEMENT IN THE Col.I.EGE of SURGEONs. In our recent articles on
Medical Education, we adverted to the laxity of the examiners being such
as to make it easy for the illiterate and ignorant to obtain the diploma. We
rejoice to learn that within the last two or three weeks a more wholesome
stringency has been introduced into the trials of candidates, by which the
value of the diploma will be very greatly enhanced. Another important
alteration, which we recommended, has also been adopted, viz., allowing can-
didates for the Fellowship, to go up for their examination in Latin, Greek,
French, and Mathematics, “at any period after they have attained the age
of eighteen.”
SUPPRESSION OF QUACKERY. A Society has been formed at Durham, “for
theprosecution of unqualified practitioners,and for the suppression of quackery
in all its forms, whether in the profession or out of it.” The name of the
Society is the Durham County Medical Association ; and Mr. W. Green,
Senior Surgeon to the Durham Infirmary, is Chairman.
NILSCELLANEOUS INTELLIGENCE. A 92 l
WETERINARY DocToRs are, it is well known, in some districts, competitors
with country surgeons for human practice. It would appear, that in Scotland,
the former have considerable status, and are educated by human doctors.
The following paragraph extracted from a Scotch newspaper, is illustrative
of this statement. “Mr. Falconar, of Carlowrie, in the absence of Mr. Burn
Murdoch, read the report of the committee on the Veterinary College, which
was as follows:—“The examinations were conducted as usual by the élite
of the medical profession in Edinburgh, and a number of veterinarians,
among whom Mr. Legrew, the veterinary surgeon of the 13th Light Dragoons,
now quartered at Jock's Lodge, should be specified as having given very
valuable assistance. The examination lasted three days, and twenty-seven
individuals received the diploma of the college. The proficiency of the
students was such, as to call forth the approbation of all who were present ;
and Mr. Gabriel, the secretary of the London College, who attended the ex-
amination, expressed himself highly gratified at the correctness and variety
of the students' acquirements.” There cannot be a doubt that the Edinburgh
Veterinary Examination, embracing as it does trials in pharmacy and anatomy,
entitles to an honourable diploma.

PUBLIC Monum ENT TO THE DUKE of CAMBRIDGE. Meetings have been
held for the purpose of raising a subscription to erect a monument to the late
Duke of Cambridge, and few Royal personages have better claims to such a
distinction, if a life spent in meritorious actions is the basis on which such
claims should rest. Intellectually, the duke was not remarkable; but he had
a fund of good sound common sense, which he brought to bear with great
effect on several occasions where discord reigned in united charities. The
number of charitable institutions with which he was connected was large, but,
unlike many Royal and some noble persons whom we could name, he gave his
money like a prince. With him it was not* vow et praeterea nihil,” but the
substantial reality. If he put his name down for £20, he backed it with a
note, and took care, moreover, to see that the money was properly expended.
His curiosity was great, and his inquiries sometimes difficult to answer ; for
instance—that into the statistics of the ladies’ “Cloak Room” at Kew Gardens!
He came out with great force as a chairman at public dinners. We have him
now before our mind's eye, with his bald head, and good humoured face
flanked with snow-white whiskers, bright blue coat and star, white waistcoat
crossed by the blue ribbon of the garter, and tall figure bent with age, stand-
ing up, pleading in that odd, loud, unmanageable voice of his, in behalf of
some insolvent charity, or asking some millionaire “whether ’twasn’t hard
enough to get money, and harder still to keep it, hey "" But he is gone, and
another bears his mame and honours. To the present Duke of Cambridge
the nation has been liberal, and we trust that he will follow in his father's
footsteps, so far as the poor are concerned. Military glory may be dazzling,
but at the close of life, when the “silver cord” is well nigh snapt, he will find
more comfort in the retrospect of happiness, he may have diffused by his
generosity, than in the empty fame of the warrior. -
BRITISH Associ ATION. The Annual Meeting was held last month at Edin-
burgh, under the Presidency of Sir David Brewster. It was well attended.
The next meeting is to be held in 1851, at Ipswich.
- A PIP O I N T M E N T S. -
BRIGGS, º appointed Demonstrator of Anatomy in University College,
London.
CADGE, William, Esq., appointed Assistant-Surgeon to University College Hospital.
JoNES, T., Wharton, Esq., F.R.S., appointed Ophthalmic Surgeon to University
College Hospital.
QUAIN, Richard, Esq., F.R.S., appointed Consulting Ophthalmic Surgeon to Uni-
versity College Hospital.
RANKING, W. H., M.D., elected Physician to the Norfolk and Norwich Hospital,
922 MISCELLANEOUS INTELLIGENCE.
- - - O BIT Uſ A R Y.
AINGE, James, Esq., Surgeon, at Fareham, Hants, aged 63, on 28th July.
AYLwARD, Henry, Esq., Surgeon, of Chiselhurst, Kent, at the Vicarage, Chesham,
Bucks, on 30th May.
Bow, W. F., M.D., formerly of Alnwick, at 7, South Gray-street, Newington, on
- 2nd June.
CANSTATT, Dr. C., Professor in the Faculty of Medicine at Erlangen, aged 43,
recently. He was well known for his contributions to Medical Literature,
and was the editor, conjointly with Dr. Eisenmann, of the Jahresbuch. iiber
die Fortschritte der gesammten Medicin in allen Ländern. The profession
is also indebted to him for a work on the Diseases of Old Age.
CoGGINS, Isaac, Esq., M.R.C.S., at St. Thomas' Hospital, of pulmonary congestion,
aged 21, lately.
CROFT, John C., Esq., Surgeon, late of Hayes, Middlesex, at Ealing, aged 28, lately.
DAVIS, Thomas, Esq., Surgeon, at Hampstead, aged 73, on 25th July.
EDWARDs, R. C., M.D., at 90, Oxford Terrace, Hyde Park, aged 37, on 19th Aug.
GRANT, C. C. Hamilton, Esq., Surgeon, Royal Newfoundland Company, in Cam-
bridge Street, Hyde Park, on 16th August.
GRATTAN, Copeland, Esq., Staff-Surgeon, late 65th Regiment, in Dublin, on 27th
May.
GRAY, Dr., of the 44th Regiment, at Malta, of cholera, lately.
KENT, C. W., Esq., formerly Surgeon to the Surrey Dispensary, aged 35, on 27th
Ma
y.
LARKworTHY, Dr. at the Presidency, Bombay, of cholera.
M“CABE, James, M.D., at Cheltenham, aged 59, on 5th August.
MILES, John, Esq., Surgeon, of 78, Gracechurch Street, on 30th July.
M“NAB, David, M.D., H.E.I.C., at Auchadeshenaig, Mull, aged 53, on 5th June.
MUDIE, Patrick, M.D., at St. Andrew's, on 11th July. -
PATERSON, Henry, Esq., at Dalswinton, Dumfriesshire, aged 39, on 13th July.
PEATIE, William, Esq., Surgeon R.N., at Durham Bank, Bonnyrigs, near Edinburgh,
on 10th May.
PHILIPs, B. L. M.D., at Panola County, Mississipi, U.S., on 9th June.
Port ER, W. Ogilvie, M.D., in Portland Square, Bristol, aged 76, on 15th August.
PRITCHARD, John, Esq., Surgeon, of Great Yarmouth, on 19th July.
REECE, Richard, Esq., F.S.A., F.R.C.S., at Cardiff, aged 78, lately.
RoquEs, Dr. Joseph, of Montpellier, formerly Physician to the Empress Maria
Louisa, and author of “Medical Phytography”, and “History of the Poison-
ous Mushrooms”, at an advanced age, lately. .
SNELL, James, Esq., at Kingston, St. Vincent's, West Indies, aged 55, 6th August.
THOMPSON, William, Esq., of Kingston, Herefordshire, at Aberystwith, aged 43, on
30th July. -
WEAL. William, Esq., Assistant-Surgeon H.E.I.C.S., at Umballah, East Indies, on
9th April.
WHEATLEY, William, Esq., late Surgeon R.N., aged 45, on 9th August.
WHITCOMBE, William, Esq., Surgeon, at Presteign, Radnorshire, aged 39, lately.
B O O K S R. E. C. E. I. V. E. D. -
BUSHNAN on Cholera. London : 1850. MILLER's Principles of Surgery. Second
Edition. Edinburgh : 1850. RAPPORT sur les Traitements Orthopédiques de M.
le Dr. Jules Guérin. Paris: 1848. -
TO CO R. R. E S P O N D B N T S.
CoLICA SCORTORUM. With reference to this alleged disease, and our notice of
DR. HASSING's thesis at p. 756 of our last number, DR. TYLER SMITH remarks:–
“The disease is, I suspect, merely the neuralgic inflammation of the tubes and
ovaria, common to prostitutes, an affection of the generative, instead of the intes-
tinal canal.” The suggestion of Dr. T. Smith is good, and probably correct.
HEALTH of LONDON. The very interesting and valuable half-yearly Reports of
the principal facts connected with the public health and prevailing diseases of the
metropolis, will be regularly continued by DR. WEBSTER in this Journal. The next
paper will appear in Tour December number. Dr. Webster's remarks on the six
months terminating March 30, 1850, will be found at p. 540 of the current volume.
. I, () NI) () N
JOURNAL OF MEDICINE,
A MONTHLY
3Retort of the {{\tbital Sºtientzg.
OCTOBER 1850.-No. XXII.
O R. I. G. I. N.A. L. C. O M M U N I CATION S.
THE STETHOMETER :
AN INSTRUMENT FOR FACILITATING DIAGNOSIS, BY MEASURING THE DIFFER-
ENCE IN THE MOBILITY OF OPPOSITE SIDES OF THE CHEST.
By RICHARD QUAIN, M.D., Assistant-Physician to the Hospital for Diseases of
the Chest at Brompton, etc.
IT is well known, that the movements of the walls of the chest, during
respiration, correspond to, and are influenced by, the state of the
organs placed within or beneath them. Hence, then, in our investi-
gations of the diseases of these organs, we invariably, and frequently
in the first instance, examine these movements. In many cases, the
modifications produced by disease are so great as to be at once evi-
dent to the eye, or to the eye assisted by the hand. In other, and
much more numerous cases, the eye and hand cannot detect these
alterations, Indeed, nothing is more common than to find observers,
at the same moment, differing in opinion as to the greater or less mobi-
lity of a portion of one or other of the sides of the chest. Even the
indefinite terms here used, “greater” or “less”, become sources of fal-
lacy and doubt. It is, therefore, very desirable that a mode of inves-
tigation, admitted by all to be most important, should be exact for
observation, and definite for description. I felt this more particularly
some years ago, when engaged in clinical demonstrations to students,
of the different modes of investigating diseases of the chest; and I at
that time endeavoured by various contrivances, constructed chiefly
on the principle of the callipers, to surmount the difficulty. My
friend, Dr. Sibson, was, however, then more successful than myself;
and he introduced an instrument which, in his hands, has afforded very
important results in the investigation of the respiratory movements of
the chest and abdomen, both in health and disease.” Subsequent con-
sideration led me to believe that an instrument, simple, portable and
economical, capable of ready application and of affording very valuable
* Medico-Chirurgical Transactions, vol. xxxi.
WOL. II. 6]
924 THE STETHOMETER.
information, might be constructed, on a different principle to any
which I had previously seen. I explained my requirements to Mr.
Delolme, chronometer maker, whose ingenuity has supplied many in-
genious and beautiful contrivances of an analogous kind. The result
has been the little instrument which I am now going to describe, and
which has, in the hands of those who have used it, as well as in my
own, been found very efficient for the intended object: viz., to measure
the comparative mobility of opposite sides of the chest. It is suscept-
ible of many other applications, to some of which I shall again refer,
and which will, no doubt, suggest themselves to those into whose hands
it may fall. -
DESCRIPTION. The little instrument (see fig. 1") consists of a flat
case, not unlike a watch-case : on its upper Sur-
face is a graduated dial and an index, which
stands at a maximum number, that may be
considered a “Zero.” This case contains a very
simple movement, by means of which the index
can be acted on. A silk cord, which may be
of a sufficient length to surround one-half, or
the whole circumference of the chest, passes
through an aperture in one side of the case. This
cord acts on the index. When the cord is
drawn out, or extended for the space of one
quarter of an inch, it will be observed that the
point of the index will once traverse the circum-
ference of the graduated dial. In other words,
when the index has gone once round, it shows
Pig. 1. that the cord has been extended one fourth of an
- inch. It will be further seen, that the dial is
graduated, or divided, into fifty equal parts. Each of these parts is,
therefore, equal to the fiftieth part of a quarter of an inch; that is, to
the 1-200th of an inch.” The index is further capable of going round a
second time, on an additional quarter inch of the cord being drawn out.
Hence, two revolutions of the index are equal to half an inch of move-
ment—an extent of motion sufficient for all practical purposes. The
pedestal and circular foot, shown in the same figure, will be subse-
quently referred to. -
MoDE of APPLICATION. It is quite evident, that if the instrument be
so placed that extension be made on the cord, the amount of the exten-
sion will be shown by the movement of the index on the dial. For
example (as in fig. 2) if the instrument is laid flat on the spine, and
held in its place by the first and second fingers of the left hand, whilst
the cord is carried round the chest, and pressed on one of the ribs, or
the sternum, by the fingers of the right hand, then, when the individual
under examination expands the chest during inspiration, the amount of
expansion will be communicated to the cord, and thus indicated on the
dial. The cord may then be directed around the opposite side of the
* The instrument is reduced in this sketch to half size.
* In making and recording observations with this instrument, I am in the habit
of expressing a fact thus: right apex, 30; left, 15. It will be understood that
the motion is as 15 to 30, without reference to these figures being eighths, fiftieths,
or two hundredths,

BY RICHARD QUAIN, M.D. 925
chest, and thus will be at once seen any difference which exists in the
relative mobility of the two at the point under examination. It will,
of course, be absolutely necessary in every examination, such as this,
that corresponding parts
of the chest be compared.
For all useful purposes it
may be said, that the move-
ments of the opposite sides
of the chest, in health, are
identical—the difference
which exists over the re-
gion of the heart, at the
left side, is too immaterial
to interfere with practical
conclusions. The instru-
ment may be applied to
any part of the chest in the
mode here described. In
figure 3 it is shown as ap-
plied on the sternum, and
beneath one of the clavi.
cles. The latter position
is one of considerable im-
portance, from its con- JFuſell.
nexion with the deposition -
of tubercle towards the Fig. 2.
summit of the lung. I find
that on applying the instrument here the cord may, in this instance, be
directed towards the arm more conveniently than in any other direction,
as shown by the black line,
and pressed against a point
near the insertion of the del-
toid muscle. The cord may
also be directed downwards,
or outwards, and upwards,
or inwards, (as shown by the
dotted lines,) and retained
on any fixed point. Nor, as
is evident, need this point be
a part of the body. It may
be on the bed, or on a chair,
etc., always providing that
the direction of the cord be
º such as to receive the im-
§
yº ... fº º pression of the movement of
4% ºn H" sº * - the part of the body under
- examination, and that its po-
sition be symmetrical at both
sides. -
The use of the pedestal, which can be fixed in the side of the
case with the foot attached, is shown in Figure 4. The instrument
61
Fig. 3.


926 | THE STETHOMETER.
thus used is intended to ascertain the modifications of the move-
- ments over a limited or circumscribed spot.
On this spot, the foot is placed and held, (as
shown in the figure,) by the fingers of the left
hand, the cord directed towards this point is
held between the fingers of the right hand.
These fingers, being thus made the fixed point,
must be kept steady and not allowed to touch
the part under examination. The spring in the
Fig. 4. instrument is sufficiently strong to resist the
gentle tension made by the fingers, and the
instrument itself being pushed forward or raised by the elevation of the
part during inspiration, the movement of the index, as when the case
is applied on the flat surface, becomes the measure of this elevation.
Such being the mode of using the instrument, it will be necessary to
say a few words on the precautions which are required in securing
accuracy in the result. 1st. It is absolutely imperative that corre-
sponding portions of the chest be examined, and that the mode of ap-
plying the instrument, and the point at which it is applied at each side,
be identical. 2nd. Care must be taken that the patient breathes in
the same manner whilst opposite sides are being examined. 3rd. It
should be seen that the cord, when the observation is commenced,
is held sufficiently tense to act on the index. -
All this requires attention and some little effort; for, as in all other
matters, there is little that is of any value which can be obtained
without some labour. Though to some few patients these carefully con-
ducted examinations may be irksome, yet to the vast majority they are
far otherwise. In the latter, they beget confidence in the medical at-
tendant, and frequently at once inspire a feeling which renders all
future intercourse not less pleasing than it is conducive to successful
treatment. -
USEs of THE INSTRUMENT. The expansive movements of the
chest during inspiration may be said to be the measure of the capacity
of the lungs for air. So they are; and by an accurate measure-
ment of the one, we might estimate tolerably correctly the other, and
thus be able to compare the relative breathing powers of different
individuals. It is exceedingly difficult to make this comparison by
external measurement; for the movements of analogous or correspond
ing parts of the chest, even in those with unimpaired respiratory powers,
are remarkably different in different individuals. For not only are
such movements modified by age, sex, and occupation, but they are
influenced by peculiarities beyond the influences apparently of any
fixed or recognized rule. I therefore do not propose to use this instru-
ment in testing whether A has a better breathing power than B. . The
spirometer of Dr. Hutchinson is a far more correct means of estimating
this quality. I propose my instrument as a means of ascertaining any
want of symmetry, independently of malformation, and therefore indi-
cative of disease, in the movements of the corresponding parts of the
same chest. It is not my intention to discuss here the various con-
ditions, under which this want of symmetry may occur. Obstruction,
for example, of a bronchus by a foreign body in, or by a tumour press-

BY RICHARD QUAIN, M.D. 927
ing on it, will interfere with the movements of the side of the chest
containing the lung to which such bronchus is distributed. Disease of
the substance of the lung, tuberculous, malignant, or inflammatory,
and emphysema affecting the air-cells, also prevent the free expan-
sion of the lungs or parts of them affected. Diseases of the pleura,
viz., acute or chronic pleurisy; bands binding down the lung; pleu-
ritic effusions or tumours in the pleura, have a like effect. Pleuro-
dynia, and diseases of the external walls of the chest, may, of course,
interfere with their free movements. However trifling the degree
of limitation of motion, which may be produced by any of these dis-
eases, or by many others not here enumerated, I believe this instru-
ment, if properly used, will inevitably indicate it. When such limita-
tion is thus observed, recourse must be had to the study of the general
symptoms, and to the other means of physical diagnosis, to discover on
what the irregularity depends. Thus, then, attention may be, in the
first instance, directed by the use of the instrument to the seat of dis-
ease; or, when disease has been suspected or discovered by other means,
mensuration will be useful in confirming the diagnosis, and expressing
the extent of the local lesion. In both these senses, I have found the
instrument an exceedingly valuable aid in the diagnosis of the earlier
stages of phthisis. Indeed, it is quite remarkable how early, and to
what an extent, the respiratory movements are modified by tubercular
deposit. I hope, however, on some future occasion to return at some
length to this and some allied subjects connected with the disease. It
will, of course, be evident that if both sides of the chest are equally
diseased, we lose the means of comparing them; but such an event is
one of very rare occurrence. The instrument can also be used in inves-
tigating the movements of diaphragmatic or abdominal respiration, and
in taking notice of any irregularity which may be produced in it by
disease of any of the organs placed beneath the diaphragm.
My friend, Dr. Alex. Henry, has suggested to me, that not only can
the instrument be used for measuring dynamical movements, but it can
also be applied in following changes of volume, whether of increase or
diminution, in solid tumours or other swellings. For this purpose, the
instrument should, on every occasion of an examination being made, be
placed on the same spot, and a definite length of cord should be used
in encompassing the part examined; any increase of volume will, of
course, be shown by the movement of the index. When it is required
to follow a diminution of volume, the index, being made to revolve
once or twice, should be thus retained, when the examination is com-
menced; the stages of its return to the zero point will be then the
measure of decrease. Having thus given a brief description of this
little instrument, of its mode of application, and of its uses, I pre-
sent it to my professional brethren, with the desire that it may prove as
useful to them as it has been to myself, and to those who have already
used it." - *
23, Harley Street, September 1850.
* The instrument must have a name, and I have thereforecalled it a Stethometer.
(Žrij60c, the chest, Merpśw, I measure.) It may be procured from Mr. Coxeter, sur-
gical instrument maker, 23, Grafton-street East, Fitzroy-square. -
928
THE ENTRANCE OF AIR BY THE OPEN MOUTHS OF THE
UTERINE WEINS, CONSIDERED AS A CAUSE OF
DANGER AND DEATH AFTER PARTURITION."
By JOHN ROSE CORMACK, M.D.Edin.; F.R.S.E.; Fellow of the Royal College
of Physicians of Edinburgh ; formerly Physician to the Royal Infirmary and
Fever Hospitals of Edinburgh; Physician to Putney College, etc.
IN connexion with the subject specially indicated by the title of this
paper, it will be necessary to consider with attention, though briefly,
the phenomena which follow the Introduction of Air into the Weins; and
especially to call attention to the fact, that these phenomena vary ex-
ceedingly in character and degree according to certain circumstances,
most of which seem to be explained by cases and experiments. The
errors of opinion which have arisen as to some published cases, from
inattention to the fact, that air may be generated within the blood-vessels
during life, and after death, want of space will prevent me from consi-
dering upon this occasion.
The following remarks are divided into sections, so that the different
topics may, as much as possible, be considered separately. The cases
and experiments are introduced in the most convenient places, but of
course they will often aptly illustrate particular points in all the sections.
I. The various Effects caused by the Entrance of Air into the Weins,
and the Appearances found on Dissection. Tetail of Experi-
ments and Cases. .
II. Statement of facts, proving that the Entrance of Air by the open
mouths of the Uterine Weins may cause Dangerous Symptoms,
and even Death. History and Critical Examination of some of
the alleged Cases. -
III. Prevention and Treatment of such accidents, after Parturition.

I. THE WARIOUS EFFECTS CAUSED BY THE ENTRANCE OF AIR INTO THE
WEINS, AND THE APPEARANCES FOUND ON DISSECTION.
DETAIL OF EXPERIMENTS AND CASES.
Till very recently, the opinions which have been entertained regard-
ing the effects produced by the entrance of air into the organs of circu-
lation, have been vague and contradictory. Even now, perhaps, they
are not quite settled. There are several ways in which hazard arises,
or death ensues, from the entrance of air into the veins. The pheno-
mena and the issue are materially influenced by a variety of circum-
stances; but especially by the quantity of air introduced, the rapidity
and force with which it enters, and the relation which the aperture,
through which it gains admission, bears to the calibre of the vein in
which is the aperture.
Bichat, Sir Charles Bell, and others, have maintained that extremely
small quantities of air introduced into the veins prove fatal: but this
1 This paper was read before the Westminster Medical Society on the 23rd of
March, 1850; and a short abstract of it appeared at p. 589 of this Journal for June
1850. It was likewise shortly reported in the Lancet, Medical Times, Medical
Gazette, Edinburgh Monthly Journal, Provincial Medical and Surgical Journal,
Dublin Medical Press, as well as in several foreign medical periodicals.
*.
ENTRANCE OF AIR BY THE UTERINE VEINs, ETC. 929
notion has been completely disproved. The entrance of air, even in con-
siderable quantity, into the circulation, is by no means necessarily fatal.
Experiments on animals, and cases which have occurred in the human
subject, alike testify to the accuracy of this statement.
The following is an exact account of an experiment which I per-
formed on a rabbit:—
ExPERIMENT. A large quantity of air was injected into the jugular
vein. Very violent effects were produced; so violent, indeed, that the
animal seemed for twenty minutes to be in a moribund, or at least in
a very critical state. To our astonishment, however, it gradually came
round; and, in about an hour, the respiration, which was at first very
laboured, became tolerably natural, and the rabbit was soon little out
of sorts. In a few hours afterwards, the breathing, as far as I could
judge, was quite natural, and the animal ate food with avidity. I kept
it for sixteen days, and never observed anything wrong, except an
abscess which formed in the seat of the operation. Upon dissection,
immediately after killing it, the lungs were found to be perfectly
healthy, and there was no air in any of the blood-vessels." .
I believe it often happens that air enters the veins during operations;
sometimes the quantity is so small, as to produce no notable manifesta-
tions; and at other times, after the characteristic symptoms of the
accident have been produced in an alarming degree, the case has, with-
out any special treatment, terminated favourably.
A very apt illustration of this remark has been kindly communicated
to me in the following letter from Sir B. C. Brodie.
- “21 March, 1850.
“MY DEAR SIR,--I send you the case, which is quite at your service.
“CASE. A young lady consulted me in the year 1842, on account of a
large tumour occupying one side of the neck. The tumour was fully
covered by the sterno-cleido-mastoideus muscle; but it was quite move-
able on the parts below. In the operation for the removal of the tumour,
I found it necessary to divide the muscle, which lay over it. In the
course of the dissection, it was discovered that the internal jugular vein
was so intimately connected with the under surface of the tumour, as to
be inseparable from it; the tumour itself lying in contact with the
carotid artery and pneumogastric nerve. Under these circumstances,
I was led to apply a ligature to the vein above, and another to the
vein below the tumour, and then remove about three inches of that
vessel with the tumour. Towards the conclusion of the operation, on
dividing some parts near the clavicle, a branch of the principal vein
was wounded, and immediately a hissing sound was heard, which I
concluded to have been produced by air entering the wounded vessel.
The patient became faint, so that the pulse at the wrist could scarcely
be felt, and she was at the same time insensible. I caused her to be
laid on the floor, where she remained insensible and faint for half an
hour, and then gradually recovered, so that she could be removed to
bed. On the following day she was apparently well, but wholly un-
conscious of what had occurred, from the time of her becoming faint,
until the expiration of several hours. The tumour was of a fibrous
* Author's Inaugural Dissertation on the Presence of Air in the Organs of Cir
culation. Edinburgh, 1837, pp. 28-29.
930 ENTRANCE OF AIR BY THE UTERINE WEINS, ETC.
structure, not apparently malignant; and two or three years afterwards,
there had been no return of the disease. No inconvenience had ever
arisen from the removal of the internal jugular vein. -
“Mr. Kennedy, of Tavistock Square, attended the patient with me.
“Yours truly, B. C. BRODIE.”
Another interesting illustration of the good hope which there is of
recovery, when the quantity of air admitted is small, occurred in 1848,
in the practice of Mr. Gay; and has been detailed and commented upon
in an instructive manner by Mr. G. F. Lane, in the Medical Gazette
for May 31, 1850, p. 926. The following is a slightly abridged ac-
count of the case.
CASE. Admission of Air by a Wound in a Branch of the Aazillary
Wein. Alarming Symptoms. Complete Recovery.
Mrs. Simkiss, aet. 46, a married woman, of light complexion, usually
of good health, and the mother of eight children, had a painful tumour
in the axilla, which had first appeared on weaning her youngest child
six years ago. On the 7th of February, 1848, it was removed by Mr.
Gay, the patient being under the influence of chloroform. In dissecting
out the tumour, a tributary branch of the axillary vein was wounded
near the chest; the opening was small. Air was seen, both by Mr.
Gay and myself, to enter the orifice, accompanied with a peculiar noise,
sufficiently loud to be audible to all present: the sound being quite
characteristic of the entrance of air and fluid through a contracted
opening, or of air drawn through fluid, something between gurgling
and hissing, and resembling the sound heard when, in drawing the last
portion of a fluid from a vessel into a syringe, some air accompanies it.
A great change was immediately noticed in the condition of the patient:
the powers of the circulation sank; the woman, who had nearly re-
covered from the effects of chloroform, became exceedingly faint, and
sank down in the chair. Mr. Gay instantly detached the portion of
gland he was engaged in removing, and applied pressure above the
opening in the wounded vein. The pulse was now imperceptible ; the
face deadly pale. Brandy was freely given, the wound closed as speedily
as possible, the arm brought to the side, and the woman placed in the
recumbent position. The surface of the body became cold, and the
patient seemed scarcely to breathe, Ammonia was held to the nostrils;
bottles of hot water were applied to the feet; the legs and arms were
rubbed continuously ; the feet and hands immersed in hot water; hot
brandy and water poured down the throat in considerable quantities,
and subsequently some sulphuric ether. After the lapse of an hour
and a half, during which these measures were continued, the pulse at
the wrist could be detected beating regularly, and the woman began to
regain her consciousness, which she had lost immediately after the
entrance of air into the vein. After this, she fell into hysterical fits,
which soon passed off again, and after two hours she was placed on the
bed, so far recovered as to admit of a compress being applied, and the
arm bandaged to the side ; the pulse beating 80 in a minute, regular,
but feeble. She was ordered spiritus ammoniae aromaticus, in mistura
camphorae, every four hours. She recovered without any bad symptoms.
There has been no return of the disease ; and her general health has
been better since than before the operation.
BY JOHN ROSE CORMACK, M.D., F.R.S.E. - 931
Regarding the circumstances which modify the effects produced by
the entrance of air into the veins, I entertain, substantially, the same
opinions which I expressed in 1837, and which have been largely noticed
by numerous subsequent writers, and likewise pretty fully adopted by
the two authors who have most elaborately discussed the subject, viz.,
Professor Wattmann of Vienna, and the late Professor John Reid of
St. Andrew's. As my Thesis has been long out of print, I give the
following passage at length. -
“Very considerable quantities of air may be introduced into the cir-
culation without producing death. The concurrent testimony of a
variety of experimenters establishes this beyond the possibility of doubt.
Sometimes the patient to whom the accident happens, or the animal
experimented on, suffers only transient inconvenience, or makes a com-
plete recovery; and, in other instances, death ensues so late as some
days after the admission of the air. Two very interesting subjects of
investigation are thus presented to our notice. In the first place,
what are those circumstances which thus modify the result 2 And,
then, what is the nature of the modifications which occur under these
varying circumstances?
“The different modifying causes are:—
1. The quantity of air admitted:
2. The rapidity of its admission : and -
3. The situation of the orifice through which it enters. .
“That the result is modified, to a very great eatent, by the quantity of
air admitted, it is unnecessary to insist upon at any length. The ex-
periments of Nysten, Magendie, Wing, and others, clearly shew that it
is only when introduced in considerable quantity that there is a fatal
issue. This I have satisfied myself of by repeated experiments. The
same fact has also been stated by Dr. Blundell, in his memoir on the
transfusion of blood. It is probable, that when slowly introduced,
the oxygen is either in whole or in part absorbed, and the volume of
the elastic fluid thus materially diminished. That such absorption does
really take place, there can be no doubt; for the experiments of Dr.
Christison distinctly prove that the oxygenation of the blood is a purely
chemical process, and that even out of the body venous blood absorbs a
large quantity of oxygen, and changes its purple for a florid hue.
Nysten infers from various experiments, that some of the injected gas
may be thrown off by the lungs.”
To shew the truth of these remarks, I will now relate three of the
many analogous experiments which I have performed on animals.
ExPERIMENT. Sudden Introduction of Air into the jugular vein of a
horse : convulsions: death in three minutes. Enormous distension of
the right auricle with frothy blood: air in every visible vein.
The subject of this experiment was a horse about seventeen hands
high, and in pretty good condition, but which was condemned to death
on account of an incurable cancer of the foot. - A tube, a quarter of an
inch in diameter, was introduced into the left jugular vein. The man
who blew filled his chest twice, and continued to blow for a minute.
He then stopped, on account of the symptoms of uneasiness which the
* Op. cit., pp. 22-23.
932 ENTRANCE OF AIR BY THE UTERINE VEINs, ETC.
animal exhibited. In a few seconds, the horse staggered and fell; and
in three minutes, from the commencement of the introduction of air, he
was quite dead. During the period he survived after falling, he made
great and violent efforts to respire, and during that time was strongly
convulsed, the convulsions commencing soon after he fell. It was
computed that he lost about eight quarts of blood, which is the quantity
usually taken at an ordinary venesection. .
Sectio. Air was found in every visible vein over the whole body.
The chest was opened an hour and a half after death, when the lungs
were seen to be collapsed, and in no degree emphysematous. All the
cavities of the heart, but particularly the right auricle, were distended,
and had a tense elastic feel. The right side was first examined. The
auricle was enormously distended ; and, upon a small opening being
made with the scalpel, frothy blood, with which the cavity seemed to
be entirely filled, instantly rushed out. The greater part of the ven-
tricle was filled with fluid and coagulated blood, but there was also
some in a frothed state. The left auricle contained frothy blood, and
Some coagulated masses. In the left ventricle, the quantity of air was
just sufficient to make its existence appreciable; but there was a great
quantity of blood, both fluid and coagulated, in this cavity."
ExPERIMENT. Introduction of Air into the jugular vein of a rabbit:
convulsions: death in two minutes. Right side of heart distended with
air unmia!ed with blood, as well as frothy blood: fluid blood in left side.
Irritability of heart nearly lost. Bubbles of air in vena cava and larger
abdominal veins.
A tube, almost equal in diameter to a crow-quill, was inserted into
the right jugular vein of a rabbit. In the course of two minutes, I in-
troduced three or four full expirations. During this time the animal
lay quite tranquil, and did not struggle in the least, but the breathing
was difficult, and the heart's action feeble and fluttering. Just as I
desisted from blowing, I observed some slight convulsive movements
of the limbs, and in a few seconds more they recurred. Respiration
now ceased, and there were no more convulsions. The thorax was im-
mediately laid open. Great venous congestion everywhere presented
itself. The heart was enormously distended. Upon puncturing the
right auricle and ventricle, air unmixed with blood issued forth; and
in the auricle there was a good deal of frothy blood. The froth was
not nearly of so light a consistence as in the former experiment, owing,
probably, to the blood and air not having had sufficient time to be tho-
roughly agitated together. The left side of the heart contained fluid
blood. It is worthy of remark, that the irritability of the heart was
almost extinct. Even though rapidly relieved of its load of blood and
air, the contractions, excited by pricking it with the knife, were unu-
sually trifling. In the horse, again, the contractions of the heart con-
tinued very forcible, long after it had been cut out of the body. The
lungs were next examined, and were found to be quite healthy. They
were collapsed, and in no degree emphysematous. In the vena cava,
and some of the larger abdominal veins, bubbles of air were observed;
but in most of the other vessels examined, none could be detected."
* Op. cit. pp. 10-11.
BY JOHN ROSE CORMACK, M.D., F.R.S.E. 933
ExPERIMENT. Injection of Air into mesenteric vein of a rabbit. Air
found in the veins of the liver: none in any other part of the body.
I threw a quantity of air into one of the mesenteric veins of a rabbit,
and in eight minutes afterwards killed the animal. The liver was in
a state of almost complete anaemia; and, upon slicing it, minute bub-
bles of air appeared at every point on the incised surfaces. There was
no air apparent in the heart, nor in any part of the body, except the liver.
I will now detail the case of a man whom I had the opportunity of
watching for some hours after the entrance of air into a vein of the
neck, and whose body I inspected after death. The leading facts are
already well known to the profession; the case having been noticed,
with more or less particularity, in all the medical journals, at the time
of its occurrence. The various phenomena which presented themselves
in this case were watched with intense interest; for if the accident had
been an intentional experiment, it could not have been more suited to
illustrate the physiology, pathology, and treatment of this class of cases.
CASE. Entrance of Air by a rigid Vein in the Neck, opened accidentally
by a setom-meedle. Asphyaſia, and convulsions: death in seven hours.
Congestion of the right side of the heart found on dissection. [This
case was described in the daily newspapers, in the Lancet, and other
journals, at the time of its occurrence. References to these imperfect
reports have been made by scientific writers.]
William Richards, aged 39, labouring under chronic laryngitis, ap-
plied to Dr. R. Willis, of Barnes, for advice, in the spring of 1848.
He was first treated by leeches, then by blisters; and lastly it was re-
solved to introduce a seton, as Dr. Willis had found this, in other cases,
a completely successful method. On the 25th March, the deceased
came to Dr. Willis about 9 A.M. Dr. Willis set him in a chair, in-
structing him as to the proper attitude. He threw back his head,
which, by keeping the parts tense, he being much emaciated, was in-
convenient. Dr. Willis having desired him not to do this, pinched up
the skin with the finger and thumb of the left-hand, and immediately
thrust in a Seton-needle, about the size of a common bleeding-lancet,
armed with a strip of lint. It entered horizontally, about two inches
and a half above the breast-bone, and not at all near any important
blood-vessel. What followed was thus related by Dr. Willis to the
coroner. “At the instant of its entrance, I heard a slight momentary
hissing sound. At first I thought I had opened into a subcutaneous
abscess communicating with the windpipe; but, almost at the same
moment, I looked in the poor man's face, and saw that another, and
far more serious event had occurred; that the rushing of the air was
not from the windpipe, but into some small vein which had been im-
plicated in the operation. The man was deadly pale; his features
were set; he fainted; and subsequently became rigid and convulsed.
I kept my fingers on the openings, to arrest the farther entrance of air
during inspiration: I caught the man, and laid him down on the floor.”
It was in these circumstances that Dr. Willis sent for me; and in half
an hour I was with him. The muscles were then rigid, and moment-
arily convulsed. The man seemed as if in an agony for breath: the
* Op. cit. pp. 11-12.
934 ENTRANCE OF AIR BY THE UTERINE WEINS, ETC.
muscles of respiration were in a state of frightfully violent, and some-
what spasmodic and intermitting action. The sound of air and fluid
being, as it were, churned in the heart, was heard with, and also with-
out the stethoscope. Dr. Willis and I entirely agreed as to the
nature of the accident; and we were also of opinion that it was our first
duty to relieve the oppressed lungs, and over-distended heart, by blood.
letting, and then to use such stimuli, internally and externally, as the
progress of the case might warrant or suggest. We hoped that in this
way the rapidly increasing congestion of the lungs, and therefore impend-
ing asphyxia, might be averted. We judged it dangerous to open the
jugular vein, because we feared that, during the deep and violent in-
spirations, more air might be drawn down into the heart, as, from the
rigid state of the fascia of the neck, it was evident that the tube might
be kept gaping and patulous. If we had had any one to aid us, we
would have freely opened the jugular vein, and, by mouth-suction at
the wound, relieved the right side of the heart. In the circumstances,
it was determined to open a vein at the elbow; and, in three or four
minutes after my arrival, I performed this operation. Before the bleed-
ing, he was almost pulseless; but after it the pulse immediately re-
vived, and the ammonia and brandy, which had previously produced no
benefit, caused, when now repeated, a manifest improvement in the
pulse and respiration; and the action of the diaphragm became less
convulsive. Death, which before the bleeding had seemed to be mo-
mentarily impending, was certainly delayed, for a time, by the measures
which we adopted. We now sent to London for Mr. Syme, who was
with us about noon. He found us applying, at intervals, warmth to
the feet, dashing cold water on the face, and giving stimulants. The
patient was in a more hopeful state, just as Mr. Syme entered, than he
had yet been. Mr. Syme entirely concurred in the view we had taken
of the nature of the case, and of its treatment. Shortly after Mr.
Syme’s arrival, I was obliged to leave the patient for an hour and a half.
I returned at 2 P.M.; and, to my great surprise, found that the man
was not only alive, but apparently better. The pulse was good, and
the breathing was quieter, and more regular; but the locked-jaw, and
opisthotomic arch of the back, proclaimed that the case was still despe-
rate. Violent convulsions came on at three o'clock; the features were
distorted, and the bleeding tongue was pushed up against the teeth, so
as partly to protrude through their crevices. The last time he swal-
lowed, was about a quarter past two o'clock. After several violent fits
of convulsions, he expired a few minutes before 4 P.M., the body having
previously become colder and colder, and the surface more and more
livid. He died in a state of asphyxia. Up to a very short time before
death, the churning sound was distinctly heard through the stethoscope;
but it was much feebler, and more confused than in the early part of
the day.
In reply to a question by the coroner, Mr. Syme said that a post-
mortem examination was “not necessary to explain the cause of death;
but that, for the sake of science, it was important that there should be
one made.” Immediately after the inquest, at the request of Dr. Willis,
in his presence, and with the concurrence of the relatives, I made an
anatomical inspection of the body. *
BY JOHN ROSE CORMACK, M.D., F.R.S.E. 935
General Appearance. The body was much emaciated. Some very
slight indications of incipient putrefaction were present. -
Neck. The great vessels of the neck were uninjured. The skin
was carefully dissected away from the parts through which the needle
had passed, when it was found that a vein, running almost exactly in
the mesial line upwards and downwards, was the vessel which had been
injured." Its coats were thickened and rigid. Its calibre was such as
readily to admit a bougie, of the size of a crow-quill. It had been trans-
fixed by the seton-needle, which had made a gap in the anterior wall,
leaving posteriorly about two-thirds of the rigid tube uninjured.
The diseased vein which had been wounded, came down nearly in a
straight line from the under surface of the chin; about the lower third
of the neck, it began to diverge fo the right, till it joined the external
jugular immediately above where that vessel dipped to join the internal
jugular vein, under the sternal origin of the sterno-cleido-mastoid muscle.
Chest. The lungs were considerably gorged, and entirely filled the
cavity of the thorax. There were strong pleural adhesions posteriorly,
but none anteriorly, on both sides. Before proceeding with the exami-
nation, double ligatures were applied to the venæ cavae. The heart
occupied a large space. The right auricle had an elastic feel, and be-
fore it was opened it was evident that it was distended with air : the
left auricle was flaccid. On pushing a scalpel into the right auricle, a
small quantity of blood bubbled out, with at first a slight hissing
noise. On fully opening up this chamber of the heart, the contents
were found to be partially congealed blood, intimately mixed with bub-
bles of air. They were very numerous, notwithstanding the air which
had escaped by the opening made by the scalpel. Most of these bub-
bles of air were about the size of a millet-seed ; but a few of them were
as large as small shot. There was also, in the right auricle, one small,
pale, consistent, fibrinous clot. The pulmonary artery was likewise
filled with blood and air intimately commingled : it did not contain any
clots. Saving the presence of a minute quantity of fluid blood, the ven-
tricles were empty. If permitted, I would have examined the veins
over the whole body, and also the brain and liver. Unfortunately, the
length of time occupied in exploring what has been described, rendered
the relatives impatient, and made it necessary to close the inspection.
I am not aware of any recorded case of death from the entrance of
air into a vein, so full of instruction as that now detailed ; and probably
this is because in no other instance was the opportunity for observation
so long, and so ample. If an experiment had been deliberately planned,
and skilfully performed, it could not have shed more light upon the
subject. The characteristic and immediate effects were strikingly exhi-
bited: they subsided ; and then the secondary or asphyxial phenomena
became equally well manifested. The first shock which the vital
functions sustained, was caused by the rapid distension of the right auri-
cle and its inability to contract upon its elastic contents. Had the dis-
1 This vessel was the anterior jugular vein. In place of a single vein, there are
generally two. Professor Schuh of Vienna, in his paper from which I am about to
quote, incidentally states, that upon one occasion, in performing the operation of
tracheotomy, he opened the middle jugular vein, and that some air was drawn
into the circulation. The effects produced are not stated. i -
936 ENTRANCE OF AIR BY THE UTERINE WEINS, ETC.
tension been a little more complete and rapid, instant death would have
been the result. As it was, the heart partially regained its power; and
although the condition of the heart, and frothy blood in the auricle, pul-
monary artery, and its branches, produced an obstruction to the passage
of the blood through the lungs, adequate ultimately to induce fatal
asphyxia, the obstruction was yet sufficiently moderate to enable us to
analyse all the phenomena as they presented themselves, and to point
out to us, that had this obstruction been still more moderate, the difficulty
might have been surmounted, and recovery from the accident might have
occurred.
The history of this case clearly shows, that in such accidents, after
the first danger is over, the patient may perish from asphyxia, induced
by a gradually augmenting pulmonary obstruction. What I saw in this
case, along with a careful reperusal of Mr. Erichsen's experiments
(Edin. Med. and Surg. Journ, Jan. 1844) has fully satisfied me that,
in a large number of the deaths which occur from the entrance of air
into the veins, asphyxia is the principal and immediate cause of death.
It may be stated as a conclusion from this case, from numerous other
cases, and also from experiments on animals, that if the first shock of
the accident be got over, the degree of subsequent immediate danger is
in proportion to the amount of obstruction to the passage of the blood
through the lungs.
More remote subsequent danger may arise from inflammation of the
lungs. Some of the animals which I experimented upon, recovered from
the immediate effects of the introduction of air, but ultimately died from
pneumonia.
On the other hand, when death takes place after the lapse of a week
or ten days, the fatal result may be wholly independent of the entrance
of air, and may depend upon purulent matter entering the circulation at
the seat of the operation. In a case recorded by Professor Schuh, of
Vienna, in a paper on Steatomatous Tumours, published in the Deutsche
Klinik for 6th April, 1850, this actually happened. During the re-
moval of a steatomatous tumour from the neck, a sound was heard
resembling that known to be caused by the entrance of air into a vein.
A finger was immediately placed upon the spot at which the air was
supposed to have entered, when the sound ceased. No remarkable
symptoms were witnessed in the patient. After a pause, the operation
was resumed, when, a second time, air was heard to enter, and was in
a similar manner a second time as promptly arrested. The effects
were slight, but characteristic. I subjoin the history of this interesting
case, as it has not yet appeared in any of the English or French medical
journals. -
CASE. Entrance of Air into the Subclavian Wein, during an Opera-
tion: Survival for ten days: Purulent Deposits.
A tanner, aged 50 years, had been three times operated on for a
swelling in the region of the right pectoralis major muscle. The last
operation had been performed three months ago, but the disease had
returned. He had a tumour of the size of two fists: it was painless,
had a very uneven surface, and was firmly connected with the pectoral
muscle; it extended very nearly to the clavicle, and could not be moved
BY JOHN ROSE CORMACK, M.D., F.R.S.E. - 937
by drawing aside and raising the arm. The skin over it presented
cicatrices, (the result of former operations), extending as far as the
axilla, and inseparably united with the substance of the tumour. The
consistence was generally hard; but two of the most projecting lumps
were soft, very elastic, and apparently fluctuating: the skin over them
was healthy, and moveable. An examination from the axilla shewed
an unevenness and hardness on the posterior surface of the pectoral
muscle. As the patient persisted in his resolution to have the tumour
removed, Dr. S. loosened the mass, and removed the greater part of the
pectoral muscle, which was inseparably united with it. While Dr. S. was
endeavouring to divide the last remaining attachments of the growth,
at the lower edge of the clavicle, and for that purpose was pushing it
upwards, and somewhat dragging on it, he suddenly heard the sound of
the entrance of air into an opening in the subclavian vein, without
hamorrhage. He immediately placed his finger on the spot where he
had last cut, and watched the patient. He was already recovered from
the insensibility produced by chloroform, and shewed no signs of the
entrance of air. There was not even any change in his countenance.
There was, indeed, some inclination to vomit; which, however, as well
as the slow pulse, Dr. S. ascribed to the chloroform. The operation was
concluded, and an assistant was directed to keep up pressure with his
finger. Dr. S. endeavoured to apply a ligature; but, as soon as the
finger was removed, the blood gushed out in such quantity as to render
it impossible to see the wound. A small compress was then laid above
the clavicle, another pushed under it, and the two were held together
by Hesselbach's compressorium. In two hours, being summoned on
account of haemorrhage, Dr. S. removed the compressorium, and was
about to introduce his finger under the clavicle. Before he could do
this, air was again distinctly heard to enter the vein. He felt the
pulse immediately, and found it much accelerated, very weak, and ea:-
tremely irregular; but this continued only a few seconds. At the same
time, the patient felt slight nausea, and inclination to vomit: but these
symptoms passed away with the acceleration of the pulse. Haemorrhage
was restrained by the application of Dupuytren's intestine forceps, which
were left on for forty-eight hours. .
On the first days after the operation, the patient felt well, with the
exception of unquenchable thirst; the pulse was normal. Fourth day.
Slight Sopor; delirium at night; pain in the chest; and difficulty of
breathing. Fifth day. The wound was dirty, and moderately inflamed;
heat of skin normal; the right arm was much warmer; and the pulse, on
this side, not accelerated, but stronger. The muscles of the right fore-
arm exhibited involuntary contractions. There was great thirst, and
the head was warm : the urine was normal. Siath day. Wound cleaner;
pulse normal; thirst great; tongue covered with a white fur. The
patient had a feeling of exhaustion, and of great heat, although the skin
was only of normal warmth. Right arm hot; muscular contractions fewer.
Pain in the left axilla; head warmer; sleep interrupted by dreams;
urine very thick. Seventh day. Night restless, from severe pain in
right knee, increased by the least motion, or pressure: wound clean;
head and right arm warmer, the other parts of normal warmth; pulse
normal; thirst great; urine thicker; frequent complaints of cold.
938 ENTRANCE OF AIR BY THE UTERINE VEINs, ETC.
Eighth day. Delirium in the night. The left knee very tender, and
swollen about the patella; the right knee had also begun to be painful,
without exhibiting any swelling. Wound clean; eye coloured yellow;
pulse slightly accelerated; heat of skin, normal, except in head and
right arm, in which last frequent subsultus was observed. The patient
suddenly lost his power of speech, and had a grinding motion of the
lower jaw; the movements of the sound hand were unsteady, and there
was a red painful swelling on the left fore-arm. There could be no
doubt now of the presence of purulent deposits. Speech returned in
the afternoon. The patient was very loquacious, and laughed at his
own figure, during his delirium. Ninth day. Pulse somewhat accele-
rated; heat of skin increased over whole body. The patient was bathed
in Sweat; did not speak; and had a sunken countenance, with yellow-
ness of the face. There was oedema at the inner side of the right
upper arm ; respiration accelerated; urine suppressed. No pain was
produced by pressure in the region of the wounded vein. Tenth day.
The patient died.
Post-mortem. Appearances. The subclavian vein was plugged with a
clot of blood, commencing at the wound, and extending two and a
half inches towards the axilla. The coagulum had already undergone
purulent softening in the centre. The length of the wound in the vein,
which was plugged by coagulum, was two or three lines. The fibri-
nous coagula in the heart were of a yellow colour. At the apex of one
of the lungs, there was a metastatic deposit of the size of a nut. The
left knee-joint contained pus, which was also found in the cellular tissue
of the left fore-arm. There were two ounces of clear serum in the
lateral ventricles of the brain. (Deutsche Klinik, 6 April, 1850.)
CONCLUSIONs. From the preceding cases, experiments, and arguments,
some important pathological facts and practical lessons clearly flow. The
subject becomes simple both in theory and practice. In the three following
paragraphs, an attempt is made to give the essence of the previous pages.
1. The entrance of air into the veins does not necessarily give rise
to exactly the same symptoms; the intensity of the effects de-
pending upon the degree in which the action of the right side
of the heart is arrested or impeded by its over-distension, and
upon the degree of asphyxia induced by the impediment to the
passage of the blood through the lungs.
2. The indications of treatment are threefold; first, to relieve the dis-
tended right auricle: secondly, to treat the impending or actually
present asphyxia; and lastly, to prolong life by every possible
means, in the hope that the air may be all absorbed, and the
passage of the blood through the small vessels of the lungs
again be made easy. .
3. In the most rapid class of cases, in which death is suddenly
threatened from paralysis of the heart from over-distension,
we must first strive to relieve the organ from that condition;
when the phenomena are chiefly those of asphyxia from more
gradually increasing obstruction in the lungs, the various means
for treating asphyxia must be resorted to, and among these, in
many cases, I believe the alternate use of the hot and cold
douches will be found to be very valuable, especially if com-
BY JOHN ROSE CORMACK, M.D., F.R.S.E. 939
bined with stimulants judiciously varied and skilfully adminis-
tered externally and internally. In many cases, repose, dashing
cold water in the face, keeping the surface warm, and TIME may
be the only means which ought to be used. The case furnished
to me by Sir B. C. Brodie clearly establishes this latter position.
Being now disembarrassed of much matter, which might (had this
section not been prefixed) have inconveniently obtruded itself upon our
notice, we are prepared to enter upon the discussion of the topics more
immediately referred to in the title of this paper.
II. STATEMENT OF FACTS PROVING THAT THE ENTRANCE OF AIR BY THE
OPEN MOUTHS OF THE UTERINE WEINS MAY CAUSE DANGEROUS
SYMPTOMs, AND EVEN DEATH. HISTORY AND CRITICAL
EXAMINATION OF SOME OF THE ALLEGED CASES.
Legallois, in 1829, when experimenting upon animals, with a view
to elucidate the effects of loss of blood, and abstinence, during ges-
tation, observed, in three different cases, that air penetrated into the
vena cava inferior and uterine veins; and that this was followed by
instantaneous death. He was naturally much struck with the coin-
cidence; and properly connecting the two circumstances as cause and
effect, he has asked, in the memoir which contains the experiments
referred to, whether, in some of those sudden and unexpected deaths which
have occurred after delivery, and in which no explanatory lesions have
been found on dissection, the entrance of air into the veins has not
been the cause of death * Ollivier has also suggested a similar ex-
planation of certain cases of sudden death after parturition.” In my
Graduation Thesis, published at Edinburgh in 1887, in noticing these
opinions of Legallois and Ollivier, I made the following remarks:
“There are various circumstances which render it possible, that in
some instances in which women die unexpectedly after parturition,
when all seems to be going on well, death is owing to air entering the
circulation by means of the open mouths of the veins communicating
with the uterine sinuses. These orifices, immediately after the separa-
tion of the decidua, are very large. They have been made the subject
of investigation by many modern as well as old anatomists and obste-
tricians; and, upon the whole, the various descriptions correspond.
Burton (writing in 1751) says, that the uterine sinuses in the ninth
month of gravidation are so large as to admit the end of the biggest
finger; and their orifices that open into the cavity of the womb will at
the same time admit the end of the littlefinger. (New System of Midwifery,
p. 19, Ed. 1751.) Now, the uterus not unfrequently contracts and ex-
pands alternately with considerable energy after the expulsion of the
foetus; and it is quite reasonable to suppose, that air may sometimes be
sucked into the gaping mouths of the uterine vessels, in sufficient quan-
tity to prove fatal to a woman exhausted with the fatigues of labour.”
Thirteen years have elapsed since the Thesis now quoted from was
published: but, though during that period numerous systematic trea-
1 LEGALLOIs. Ann. Hebdom. de Méd. t. iii, p. 183. Paris: 1829.
* OLLIVIER. Dictionaire de Méd. Art. Air. 2nd Ed. Paris.
3 Op. cit. p. 18.
WOT.. II. 6:
2
940 ENTRANCE OF AIR BY THE UTERINE WEINs, ETC.
tises on Obstetrics have appeared, I am not aware that in any one of
them even a single line has been devoted to this subject. Being con-
vinced that, notwithstanding this remarkable neglect, the subject is
one of great practical importance, as well as of deep scientific interest,
I again bring it before the notice of the profession, trusting that the
meagreness of the information to be communicated may be largely sup-
plemented by others, of ampler experience, to whom the following con-
siderations are respectfully addressed. . - - ye”
Many authors refer to this sucking in of air by the uterus, without
however in any way connecting it with the immediate subject of this
paper; but it may be sufficient to give a single quotation from a recent
work. The following passage is from Dr. Charles Meigs' Letters
to his Class, on Females and their Diseases. “I have,” he says,
“often been present at the discharge of large quantities of gas from
the genitalia. A woman shall be seized with her first labour-pains,
and, bearing down with great violence, thrust not the child only, but
the placenta also forth upon the bed; and in bearing down with the
violent force of the labour-tenesmus, she pushes the very womb itself
to the bottom of the pelvis, shortening the vagina in so doing, wrinkling
and crushing it down to the os magnum. As soon as the tenesmus is
over, the resiliency or elasticity of the tissues recovering its power, the
womb rises again to a certain height within the excavation of the pelvis;
but, as it is a cul-de-sac that rises, it is natural for air to follow it, and
the vagina and the womb itself may thus contain air that has been
drawn up within them, upon the same principle as that which makes it
follow the movement of a piston in a cylinder. Then comes a new
pain—an after-pain; or else I may apply my hand to the hypogastrium,
and make sure of a good contraction of the womb. If I compress the
womb with my hand, and particularly if I push it downwards in the
pelvis, I am very apt to cause a quantity of air to rush out at the
ostium vaginae, with considerable noise. This I have heard a great
many times. So, in making the examination per vaginam, when the
uterus is very low down, or when, in making use of the speculum, I
push the ostincae far away from the os magnum, air enters the passage,
and follows the retreating womb. If it be left there, and the woman
be seized with a fit of coughing, or if she move quickly, or change her
position, the air is pressed out with the sound of the pet-vaginal.
There is no other way to account for it that is reasonable. So, also, a
woman has a heavy womb, with a large loose vagina; she lies on the
couch or bed; and the uterus retreats, as La Motte says, drawing air
after it; but she rises, or coughs, or turns, and the air is expelled” (p. 289).
... If it be admitted, that air is drawn into the uterus in the way de-
scribed, what ground is there for supposing that it may thence pass by
the uterine veins into the vena cava, and so on to the right auricle of
the heart? The uterine veins, it must be remembered, are large
canals, some of them with open mouths, sufficient to admit the little
'finger. Nature generally closes them firmly by a coagulum; but an
accession of haemorrhage may dislodge this; or the coagulum may con-
tract and fall out, and thus leave the orifices of the veins patent. This
accident may occur hours, days, or, in some exceptional cases, even
weeks after delivery. - s -
BY JOHN ROSE CORMACK, M.D., F.R.S.E. 941
Of the freedom of the communication between the cavity of the womb
after delivery, and the vena cava inferior, any one may be informed by
the most cursory examination of the parts on the dead body of a puer-
peral woman. Dance says, in his Essay on Phlebitis; “If even a
thick injection be thrown into the vena cava inferior below the emulgent
veins, it is immediately poured forth in abundance into the cavity of
the womb, and overflows from the vulva; thus proving, that after
delivery, the large uterine veins are open in the uterine cavity, and
communicate freely with the large abdominal veins.” * : -
... It might, therefore, be anticipated, a priori, that air might get into
the vena cava, and so onward to the heart of a woman recently delivered,
by being sucked into the uterus by the sudden dilatation of that organ,
and by thence passing into the orifices of the uterine veins. When
the uterus is relaxed, these large openings are gaping, the structure
of the parts effectually preventing apposition of their parietes. Unless
closed by a plug of coagulum, they are (as I have satisfied myself by
examination) perfectly patent. If any obstacle exist,--such as a large
clot, or contraction of the circular fibres of the cervix, or of the sphincter
of the os uteri, after the air has rushed into the relaxed uterus, it
must, of necessity, be propelled into these openings, should the body of
the uterus contract without being able to force the air through the os.
I have repeatedly seen the womb, after delivery, become inflated with
air; and when the organ has contracted, I have heard the air hissing
through the vulva. I have, therefore, not only no difficulty in believing,
but am constrained to admit, that, should any impediment be offered,
in such cases, to the free exit of the air by the os uteri, it must be
forced into the uterine veins, were their mouths not protected by coa.
gula; and thence it would rapidly pass, by the current of the circula-
tion, up the vena cava into the right auricle. -
But, that cases of this kind may occur, is not all. They have occur-
red; though, from attention not having been sufficiently drawn to the
possibility of such accidents, fewer may have been recognized than have
actually occurred. At the same time, it seems probable that the acci-
dent is a very rare one.
Dr. Collins of Dublin, Dr. Murphy of London, and others, long in
extensive practice, inform me that they have never seen such an occur-
rence as the death of a woman from the entrance of air into the uterine
veins. Dr. Lever, however, who views the matter in a different light,
has addressed to me the following letter.
“12, Wellington Street, London Bridge, March 16, 1850.
“My DEAR SIR,-When in Ireland, my library was cleaned; and, in
consequence, my papers became so disarranged that I am unable to lay
my hand on the rough notes of the cases about which we were convers.
ing, and have therefore to trust entirely to memory. All the women
were multiparae; the labours had not been over-tedious; the placentae
were thrown off without assistance; and an inert state of uterus, with
haemorrhage, ensued. This viscus seemed like a softened India-rubber
bottle: and the period at which the air was supposed to have entered it,
was when the hand was withdrawn from the abdomen, after employing
* DANCE. De la Phlebite. Arch. Gén. de Méd., t. xviii, p. 481. *: 1828.
- 62
*
942 ENTRANCE OF AIR BY THE UTERINE WEINS, ETC.
forcible compression. There was an accompanying noise, very similar to
that heard when a caoutchouc enema bottle is squeezed, and then allowed
to fill with air; in fine, I may describe it as a rushing Sound. All three
patients died speedily; the quantity of blood lost not being, in my
opinion, sufficient to account for death. Two were examined; one in
cold weather, the other in the very height of summer. The latter pre-
sented signs of commencing putrefaction. In neither was there any
large quantity of blood in the uterus; but in the sinuses, uterine veins,
spermatic veins, and left renal vein, there was indubitable proof of air.
This, in the former case, emitted no offensive smell when liberated.
All these women had been exposed to marsh malaria; and all had en-
larged spleen. I am grieved to furnish you with so meagre a report:
but I cannot do more from memory.
“Believe me, dear Sir, yours very truly, JoHN C. W. LEVER.”
I have now to mention cases, which have been minutely described.
CASE. Sudden Death following injection into the vagina of chlo-
turetted water in a case of uterine hamorrhage. On dissection, dis-
covery of the appearances which are characteristic of death from sudden
Entrance of Air into the Weins. The following case is detailed by Dr.
J. Bessems, of Antwerp.; and his explanation of the cause of death is
similar to that which I adopt.
On the 14th October, 1841, a woman, aged 35, suffering from uterine
haemorrhage, was admitted into the hospital of St. Elizabeth, under the
care of Dr. Bessems. She was the mother of three children. When
at the fifth month of her fourth pregnancy, she had some flooding, in
consequence of strong mental excitement; medical assistance was called
in, but abortion took place on the 10th of October, between three or
four days before her admission into the hospital. Being alone, she
pulled the cord, and broke it. A midwife afterwards arrived, who in-
troduced the hand to complete the delivery; but, being baffled in her
attempts, she withdrew. The patient remained in this state, without
haemorrhage, till the 14th ; when, in consequence of a great loss of
blood, she was taken to the hospital. On admission, her general con-
dition was tolerably satisfactory: the face was slightly pallid; and the
pulse, though of adequate strength, was a little too rapid. On examin-
ing the abdomen, no marked symptom presented itself, except the
large bulk of the uterus, which was very appreciable in the hypogas-
trium. The cervix, which was very soft, was still open; two fingers
were easily passed up to the placenta, but, although the attempt was as-
sisted by the contractions of the uterus, it was not found possible to
drag out the mass, which had perhaps formed adhesions with the in-
ternal surface of the organ. By means of Levret's forceps, some very
small portions of the placenta were got away. The haemorrhage had
at this time almost ceased. Dreading to irritate the womb too much
by prolonged manipulations, Dr. Bessems injected into its cavity
slightly tepid water, and prescribed other measures, which are merely
alluded to as being those ordinarily employed in such cases. On the
15th, the following day, the state of the patient seemed to be better.
She had lost no more blood; and the pulse was firm and tranquil.
The gentleman in attendance (M. Stevens) having tried in vain to ex-
BY JOHN ROSE CORMACK, M.D., F.R.S.E. 943
*
tract the remainder of the placenta, prescribed chloruretted injections,
which were administered in the morning, at noon, and in the evening,
by the surgeon in attendance, by means of a gum-elastic catheter placed
within the womb, and adapted at its other end to the pipe of a syringe
filled with the fluid to be thrown in, all bubbles of air being carefully
excluded. On the 16th, little change took place, and the treatment
was continued. In the night between the 16th and 17th, the patient
had (about 4 A.M.) considerable haemorrhage; at 8 A.M., the hour of
visit, it had ceased; but the countenance was perceptibly paler, and
more yellowish, and the pulse was smaller, and more rapid. By digital
examination, the cervix was found dilated as formerly, and the placenta
was somewhat engaged in it. Some fragments were removed, and the
chloruretted injection was repeated, with the same precautions as had
been adopted on the two previous days. In an instant, the patient,
who had been lying in bed, sprang into the sitting position, with her
arms extended, crying out that she was being suffocated. The head
was thrown backwards; the face became livid; the eyes were con-
vulsively turned upwards; and the expression became fixed. From
Some convulsive movements of the throat, it was for a moment believed
that she was in an hysterical condition. But respiration, became jerk-
ing, and slower and slower; the body fell backwards; the pulse fled;
and, in spite of aspersion with cold water, and the putting in force of
the usual means of restoring from syncope, she was dead in three
minutes from the time when the injection had been thrown into the
uterus.
Dissection, twenty-eight hours after death. The body was stiff, and
presented no trace of putrefaction. Nothing morbid was found upon
examining the peritonaeum, and the abdominal viscera. The womb was
as large as a good sized fist ; and in its texture there was no trace of
inflammation or suppuration. Its cavity still contained a portion of pla-
centa of the size of a hen's egg, partly detached, and partly strongly
adherent. The inferior vena cava was distended, and contained in its
abdominal portion several bubbles of gas of considerable size, which
could be distinctly seen through the parietes of the vessel. The pleura,
lungs, and pericardium, were healthy. The heart appeared large ;
but, on examining it more carefully, it was seen that the increased size
principally depended upon the distension of the right cavities, which
ea:hibited an elasticity of a peculiar character. The vessels leading to
and from the heart having been tied, that organ was opened under water,
when there escaped a large quantity of gas mia!ed with blood. The
encephalon presented no morbid appearances. *
Dr. Bessems, from the state of the right side of the heart and of the
great vessels leading thereto, does not hesitate to ascribe the sudden
death to the entrance of air into the circulation, by the uterine veins.
It may be asked, If no injection had been practised, and no possibility
had existed of air entering the circulation in the way conjectured, might
not an anaemic woman have died as suddenly, and in precisely the same
circumstances, from syncope 2 The anaemic condition of the woman
was, we cannot doubt, a predisposing or accessory cause of the fatal
issue, inasmuch as anaemia is of itself sufficient to induce irregular
action of the heart, and adequate to render disturbing agencies, which
944 ENTRANCE OF AIR BY THE UTERINE WEINs, ETC.
would be harmless in a normal condition of the blood, suddenly fatal.
When, along with the anaemia induced by loss of blood after parturition,
there is a diseased heart—Softening of the tissue, or some structural
change in the valves—it is easy to conceive slightcauses, mental emotions
for instance, which have not been disclosed by words or outward acts,
all at once bringing the action of the heart to a stand, and perplexing
the attendants by the abrupt termination of apparent convalescence in
sudden death. Numerous instances of sudden death after parturition, and
when all seems to be going on well, certainly depend upon the facility
with which trifling causes may disturb the circulation in women with
diseased heart, and suffering from recent loss of blood. In the case of
Dr. Bessems, a similar explanation might have been sustained, had the
narrative been less circumstantial, and had there been no record of the
appearances found on dissection; but, with the facts before us, we must
believe that, however much other causes may have been accessory or
predisposing, the injection of air into the uterine veins was the imme-
diate cause of death. This is established by the distended condition of
the right auricle, and by the large quantity of air found in the vena
cava inferior. -
M. Lionet, of Corbeil, has published a case, which claims attention
in this place.
CASE. Sudden Death after Natural Delivery, without known cause: Air
in the Weins. A lady, aged 27, of ordinary height, stout, fresh, and well-
looking, but very excitable and subject to attacks of hysteria, in the
eighth month of her pregnancy, while looking at her husband who was
getting into a carriage, saw the horse fall down; she uttered a cry of
terror, became very pale, and lost, at the instant, the power of speech.
The midwife first made her use a pediluvium, then an entire bath. The
aphonia persisting, M. Lionet was summoned three or four hours after
the accident. The power of motion and the intellect were unimpaired;
the patient made herself understood by signs or by writing. A copious
bleeding, and several cups of infusion, having failed in restoring
the voice, at the end of five or six hours, a large sinapism was applied
to the cervico-dorsal region. The pain was so acute, as to cause convul-
sive movements; but speech was this time restored. The pregnancy
continued its natural course, and the movements of the foetus were felt
until the appearance of labour-pains, twenty-three days after. The mid-
wife only observed that the patient was paler and more feeble than usual :
she had to be carried to bed. The os being very slightly dilated, the
midwife left the patient for some time; on returning in about half-an-
hour, she found the head in the vulva, and the child, although well-
formed, was born dead. The placenta soon followed; the uterus con-
tracted properly, but the patient's strength did not return ; she remained
extremely pale, and the midwife, having exhausted her resources, sent
for M. Lionet. ... • - -
He did not see the patient till three hours after her delivery; she was
extremely pale, was making efforts to vomit every minute, and breathed
with difficulty. The circumstances attendant on the delivery were
related to him ; he was assured that there had been no hamorrhage,
and, on examining the linens, they did not seem to have imbibed an
unusual quantity of blood. The uterus formed an ovoid mass, which
BY JOHN ROSE CORMACK, M.D., F.R.S.E. 945
raised the abdominal walls; a little serous exudation escaped from the
vulva. On introducing the hand into the cavity of the uterus, M. Lionet
found a few clots; and, fearing that a rupture had occurred, he used a cold
injection. He removed the pillows, so as to place the patient in a hori-
zontal position; and he compressed the aorta, not only with the view of
arresting the haemorrhage, supposing that a rupture had taken place,
but also to favour the flow of blood to the head, and to the heart, the
pulsation of which was irregular. The hands were plunged into a warm
mustard bath, and cordialdrinks and an ether draught were administered:
ammonia and hot friction were applied externally. The patient con-
stantly complained of being suffocated, calling for air, or she should
die. In an hour, M. Lionet sent for Dr. Petit, Sen., who again examined
the uterus. The patient expired under their hands, after two hours of
constant attendance, five hours after being delivered, without having
experienced any relief, beyond the grateful impression of the currents
of air which were directed in her face.
The child was of average strength, and well formed ; its limbs were
contracted and rigid, as if they had just been convulsed; and this con-
traction lasted for eight or ten hours after its expulsion.
The Post-mortem. Eacamination was made about thirty hours after death,
at a temperature of 12-14 R., by M.M. Petit, sen. and jun., Surbled,
and myself. The body was of a yellowish white, like wax. The sto-
mach and intestines were distended by a large quantity of gas; the
mucous membrane was pale, and perfectly healthy. The uterus was
slightly ecchymosed at the sides; it presented no trace of laceration,
and contained no clots; when water was introduced, it did not escape
by any aperture, although the organ was strongly compressed. The
surface where the placenta had been attached had a velvety appearance,
and exhibited a large number of venous sinuses, without any appear-
ance of rupture.
The vena cava seemed to be enormous, and of a slaty appearance;
but as it had been wounded by the scalpel in removing the uterus, the
nature of its contents could not be determined. In the supposition
that it might contain air introduced from the uterine simuses, the inves-
tigations were directed to ascertain this fact. Having found nothing of
importance in the chest, the heart was carefully examined: some bub-
bles of air mixed with a small quantity of blood were found in the ventri-
cles, especially in the right. On lifting the calvarium, the arachnoid
appeared raised by small transparent patches, which were recognised
as bubbles of air; they were easily removed by pressure. The mem-
branes and vessels were but slightly covered; and, in several of the
veins ramifying among the cerebral convolutions, small columns of air
separated by columns of red blood were seen: on pushing these with
the finger, they could be united, so as to give to the veins the appear-
ance of fragments of vermicelli, several centimétres in length. The
same appearance was observed in the veins at the base of the brain.
The veins in the limbs were not examined. The following then is a
summary of the appearances observed —No appreciable lesions in the
uterus or other viscera; air in the heart, perhaps in the vena cava,
and certainly in several of the cerebral veins.
M. Lionet, after various remarks, puts this question ; can it be ad-
946 ENTRANCE OF AIR BY THE UTERINE WEINS, ETC.
#3
mitted that, in the anaemic state of the patient, the uterine sinuses
being empty of blood and not plugged with clots, the introduction of
the handfavoured the admission of air during uterine inertia? He replies
—I do not know whether this be possible : it is for physiologists to
determine. (Journal de Chirurgie, 1845, p. 234.)
CASE. Rapid Death after Partwrition. Death attributed to the
Entrance of Air into the Uterine Weins. Dr. Wintrich, in 1848,
communicated to the Medical Society of Erlangen a case of rapid
death after parturition, which he attributed to the introduction of air
into the uterine veins. Death was preceded by some convulsive move-
ments and Suffocation, which symptoms followed the expulsion of the
infant and the partial separation of the placenta. Dissection, we are
told, satisfactorily demonstated that air had penetrated into the venous
system by the uterine veins." I regret that I have failed in obtaining
the original record of this case, and that I am only able to give this
very meagre abstract from a French journal.
Professor Simpson has communicated the following remarks, as an
appendix to Dr. John Reid's Essay on Death from the Entrance of Air
into the Veins:—
“Several years ago I saw”, says Professor Simpson, “a case of death
a few hours after delivery, which first gave me the idea that death may
Sometimes occur from the introduction of air into the uterine veins.
The patient was an inmate of the Lying-in Hospital, and was delivered of
twins. Dr. Ziegler was called to see her, in consequence of Some
difficulty connected with the birth of the second child. Post-partum
hamorrhage, with alternate contractions and relaxations of the uterus,
supervened; and she seemed to rally very imperfectly from the effects
of the flooding. I saw her in an hour or two afterwards. She had
then a very weak and rapid, almost imperceptible pulse; an extremely
anxious countenance; and here and there was an evanescent Scarla-
tinoid rash over the surface of the body. The body was opened a few
hours after death, as we were anxious to know if there was air in the
veins; and we were, of course, desirous not to incur the fallacy of air
arising from decomposition. The abdominal contents were exposed
under water. The uterine and hypogastric veins, and lower vena cava,
were full of frothy blood, and the air bubbled up. The large veins of
the extremities were in the same state.”
Nothing is said of the condition of the heart and lungs; the only
organs in which the characteristic and certain evidence of the accident
having caused death is to be found. The mere presence of air is no proof
that it has caused death.
Dr. Simpson has the following remarks upon the mechanism of the
introduction of air in such cases. “I think we can understand it, when
we remember that the interior of the uterus after delivery, especially
opposite the late seat of the placenta, is studded with venous orifices;
and that, if air does once become introduced into the uterine cavity,
from relaxation of the walls of the organ, it will be liable to be forced
into these orifices, and hence into the general venous circulation, pro-
1 Journal de Médecine et de Chir. Prat., Nov. 1848, p. 609,
BY JOHN ROSE CORMACK, M.D., F.R.S.E. - 947
vided the uterus, in again contracting, is unable to expel its contents
through the os uteri.”
The cases and comments of Professor Simpson are chiefly valuable as
an intimation from so eminent an authority that the ideas of Legallois, as
to the reality of this accident, deserve credit. The cases may or may
not have been, though they probably were, examples of the accident.
It must be felt that the descriptions are not absolutely convincing;
for the symptoms, during life, are not sufficiently detailed, and the
frothy blood in the uterine veins, hypogastric veins, and vena cava in-
ferior, can with difficulty be understood, except by Supposing that, not-
withstanding the short time which had elapsed since death, when the
body was examined, some decomposition of the blood, and evolution of
gases, had commenced. In experiments on animals, and in cases
in the human subject, in which rapid death has followed the introduc-
tion of air into the veins, frothy blood has only been found in the right
side of the heart and pulmonary artery: in other parts of the body, the air,
if found at all, has not been intimately mixed with the blood, but has ex-
isted in distinct bubbles. This is easily understood; for it is the
churning of the struggling heart, unable to propel its elastic contents
along the pulmonary artery, which causes the frothing of the blood.
It would be endless to relate all the cases, which might be cited as
furnishing a strong probability that air had entered the uterine veins
after delivery, inducing, in some instances, transient, but alarming
symptoms; in others, occasioning almost mortal effects, and in others,
causing, or, along with uterine hamorrhage, contributing to cause Sud-
den and unexpected death. Such cases would not furnish data of suffi-
cient accuracy to support, far less on which to found conclusions.
Some of them, however, have seemed to be entitled to the consideration
which they have received in this paper.
This seems to be the most convenient place to notice the red appear-
ance of the skin, which is described as having occurred suddenly in some
cases of the entrance of air into the veins. Dr. Warren of Boston re-
lates two cases which occurred in his own surgical practice. The first
patient recovered, after being insensible for a considerable time. While
still comatose, “the leaden colour in the cheeks”, says Dr. Warren,
“assumed a reddish tinge, and the alarming character of the symptoms
was evidently diminished.” In the second case, during the period elaps-
ing between the entrance of the air, and the death of the patient, says
Dr. Warren, the “livid colour of the cheeks gave place to a suffusion of
vermillion red, and no glow in the cheek of a youthful beauty ever gave
one so much pleasure as that flush. But the flush soon passed off:”
and the patient died.” -
In several cases of death occurring two or three days after delivery,
(some of which had been considered as malignant scarlet fever, by the
medical attendant), Dr. Simpson states, that “a red or scarlatinoid
eruption was seen upon the cutaneous surface of the patient.” In the
1 REID (Dr. JoHN). Physiological, Anatomical, and Pathological Researches, pp.
579-80. Edinburgh: 1849; also in Edinburgh Monthly Journal, April 1849, p. 707.
* WARREN, Dr., in American Cyclopædia of Practical Medicine, as quoted by Dr.
J. Y. SIMPSON in Edinburgh Monthly Journal for April 1849, p. 707. -
948 ENTRANCE OF AIR BY THE UTERINE WEINS, ETC.
case quoted from Dr. Simpson, at p. 946, which is the only one of the kind
fully detailed, there was post-partum haemorrhage, and “an evanescent
red scarlatinoid rash over the body.” Dr. Simpson asks the following
question : If the red or scarlatinoid rash, which appeared in the preced-
ing obstetric case upon the surface of the skin, were owing to the entrance
of air into the uterine veins, might this symptom be accounted for on the
idea, that the introduced air directly mia!ed with, and owygenated, the
blood in the capillary vessels 3
The “rash” described by Dr. Simpson, and the “reddish tinge” and
“suffusion of vermillion red”, mentioned by Dr. Warren, may or may
not refer to the same phenomenon, but it seems reasonable to infer that
they do ; and such is evidently, the opinion of Dr. Simpson. Granting
that the red appearance was in all the cases of the same nature, grant-
ing likewise that air had entered the veins, granting even that it had
caused death, I am not prepared to admit that, necessarily, the red
appearance was the result of the entrance of air.
My difficulty in connecting the two phenomena, as cause and effect,
does not arise exclusively from a priori reasoning on the subject, but
from what I have recently seen in three cases, in none of which, I be-
lieve, air existed in the veins; and in one of which, at least, the entrance
of air was impossible. I now notice these cases, in the hope that others
will, when opportunities occur, make and record their observations, with
the object of elucidating this point. In the mean time, the elements on
which to found a positive or exclusive opinion are wanting; and as a con-
tribution towards the facts required, and as my reason for not answering
Dr. Simpson's question in the affirmative, the following particulars of
the cases referred to are here subjoined.
About twelve months ago, I was entering one of the quadrangles of
St. Thomas's Hospital with Mr. Solly, when he was suddenly hurried
into one of his wards where a man, (labouring under syphilitic disease
of the larynx), was urgently suffering from want of breath. Tracheo-
tomy, being imperatively called for, was quickly resolved on and per-
formed; and the patient was, for the time, at once relieved from the
distress and jeopardy of his position. This relief, however, was of
short duration, for in two or three minutes after the tube had been in-
troduced, the man gave a sudden movement, which dislodged the tube
from its position in the windpipe. From the tube being plugged up
with clotted blood, and from other unavoidable causes, several minutes
elapsed before air could again be made to enter the lungs through it.
The visage became leaden-coloured, the tongue protruded, the teeth
were clenched upon it, the face was convulsed, the pulse disappeared
from the extremities, and at last the whole body became pulseless and
cold. The man lay for some time cold, with bloated visage, protruded
tongue, and in a state of suspended animation from asphyxia. By Mr.
Solly's well-directed, and persevering efforts, life was made to return.
Sinapisms to the legs, the mechanical assistance of the diaphragm in
expiration, etc., were the means used ; and it was beautiful to observe
that, when the respirations commenced, and especially as they became
fuller and more numerous, warmth gradually returned to the previously
ice-cold limbs, and the pulse again beat in the arteries. A more inte-
resting and instructive spectacle could not have been witnessed. Re-
BY JOHN ROSE CORMACK, M.D., F.R S.E. 949
covery was complete. Now, as life was returning to this man, I witnessed
exactly what Dr. Warren saw in one of his cases of air in the veins—
“ the livid colour of the cheeks giving place” (not steadily, but in sudden
fits) “to a suffusion of vermillion red.” The phenomenon in both cases
was probably analogous to blushing, or was indeed mechanical blushing
caused by the enlargement of the capillaries of the surface, and their
sudden distension with oxygenated blood, in consequence of the asphyxia
tending to cease, from the return of respiration and the freer passage
of the blood through the lungs. . . -
Some months ago, I had to treat a case of uterine haemorrhage in
which, immediately after delivery, an enormous quantity of blood was
poured out within a few minutes, drenching the bed and flowing in
streams upon the floor. There was prolonged syncope, alternating
with short fits of catching and stertorous respiration, during which the
countenance was for one moment ghastly pale, at another, purple, and
then at intervals suffused for an instant with a deep vermillion red,
which was not confined to the face, but several times appeared in
transient patches upon the neck and upper part of the thorax, which
happened to be exposed. The uterus was ultimately made to contract,
and the patient made a tolerable recovery, and is now well and nursing
her infant. I think it likely, that in this case air entered by the uterine
sinuses: but, though at the moment I had the red cases of Drs. Warren
and Simpson vividly in my mind, I was so impressed with what I had
seen at St. Thomas's, and in another case of an entirely different cha-
racter (which I then had and still have under treatment), that I adopted
at the time the explanation which I now give of the rapidly-changing
colours of the surface. The ghastly countenance depended on spas-
modic constriction of the capillaries—the purple and vermillion re-
placed the pallid hue when the spasm ceased, and the capillaries
suddenly became relaxed, the patches depending upon the whole ex-
osed surface of capillary net-work not being equally and simultaneously
affected with spasm, and the purple or red hue being determined by
the goodness or badness of respiration at the moment. ... It is not im-
probable, as I have already admitted, that the impediment to the
passage of the blood through the lungs in this case depended on the
entrance of air by the uterine veins, and presence of frothy blood in the
branches of the pulmonary artery; but still I think the vermillion patches
cannot be explained by an affirmative answer to Dr. Simpson's question,
because a dangerous quantity of air introduced into the venous system,
in place of oaygenating the blood, tends to cause a more or less complete
state of asphyasia, by rendering the passage of the blood through the lungs
difficult or impossible. The tendency of the accident, even in its
mildest forms, is to impede the exit of the blood from the right ventricle.
I have at present a patient, the subject of ovarian and uterine disease,
who on slight emotional causes, and sometimes without any obvious cause,
falls into a state of trance or unconsciousness, the duration of the
seizures lasting for minutes, or sometimes for many hours. The counte-
nance is generally placid, though, on two or three occasions, there have
been spasmodic affections of the muscles of the mouth and neck, and
twice violent convulsions of the extremities. However, on various occa-
sions when I have been present, and on many more described to-mé; the
950 DR. CORMACK ON ENTRANCE OF AIR INTO THE WEINS.
eyes have become suddenly fixed, the visage overspread with a deep
blush, and a state of entire unconsciousness has commenced, from which
no pinching could rouse her. I have watched this condition often, and
have seen red patches appear suddenly on the surface, and have observed
the face to become fitfully suffused with a delicate blush, superseded
quickly by an extreme pallor; and these changes have generally been in-
dicative of the fit being likely soon to terminate. Dr. Henry Bennet
once saw this case with me, and witnessed such an attack as I have de-
scribed. In this patient, I have seen the evanescent red on the surface
so precisely similar to what I saw in the lady with uterine haemorrhage
that I adopt in both cases the same explanation, and connect it with
the condition of the capillary vessels.
The idea of the red hue, in the cases of Dr. Warren and Dr. Simpson,
depending upon Super-oxygenation of the blood, seems at all events to
be untenable ; for the effect of introducing air into the circulation in
sufficient quantity to cause inconvenience, is, beyond question, to prevent
the adequate aération of the blood. The red hue is therefore no evi-
dence in any obstetric case, that air has entered the veins. The red ap-
pearance may possibly be often seen in cases in which air has entered
the veins; but it is a phenomenon depending upon a particular state of the
nervous system induced by various causes, and giving rise to a capillary
relaxation, identical with the condition of the small vessels in blushing
from emotional causes. It can have nothing to do with oxygenation of
the blood by the air which has entered the veins.
III. DEDUCTIONS AS TO THE PREVENTION AND THEATMENT OF ACCIDENTS
ARISING FROM THE ENTRANCE OF AIR BY THE
UTERINE WEINS AFTER PARTURITION. -
From the facts already stated, it is plain that the Treatment, both
preventive and curative, is to obtain natural and permanent contraction
of the uterus after delivery. As it is extremely probable that loss of
blood, and the entrance of air, in many cases conjointly cause death, it
is satisfactory to feel assured that the proper treatment for the one is
the best also for the other, so far as the one thing primarily essential is to
strive to get the uterus to contract. Plugging will also be specially proper
when there is convulsive contraction and expansion of the uterus, with or
without much haemorrhage; for then there exists the greatest aptitude
for the atmospheric air to enter, or be forced into the uterine veins.
If a large quantity of air have entered the circulation, unequivocal
evidence of this will be found by listening to the heart, when the
churning sound will be heard. If death does not almost at once close
the scene, the phenomena of asphyxia will set in; their rapidity and
violence depending upon the quantity of air which has entered, on its
passing up to the heart in one large volume, or in divided quantities,
on the presence or absence of haemorrhage, and on the strength of the
patient. The distension of the right side of the heart, and the present,
or impending asphyxia, must be met by an application of the general
rules given at the close of the first section of this paper, so far as they
are consistent with the special circumstances of each case. In fact,
there is no uniform routine practice which can be rationally recom-
mended in this formidable class of cases. If the practitioner under-
DR. TYLER SMITH ON THE EFFECTS OF THE BOFAREIRA. 95l.
stand the nature of the accident, he will be able to adapt his remedial
measures to the emergency. The special means adopted may infinitely
vary, (as in uterine haemorrhage); but the general principles of treat-
ment are immutable, and simple, and ought to be engraven in the mind
of every accoucheur. The amount of success attending their applica-
tion must depend upon the promptness, nerve, and Sagacity of the
practitioner.
Essex House, Putney, September 1, 1850.
ON THE GALACTAGOGUE AND EMMENAGOCHUE EFFECTS
OF THE LEAVES OF THE BOFAREIRA (RICINUS
COMMUNIS, OR PALMA CHRISTI).
By TYLER SMITH, M.D., Licentiate of the Royal College of Physicians; one
of the Physicians to Queen Adelaide's Lying-in Hospital, etc.
DR. W. O. M*WILLIAM has often mentioned to me, that he had become
aware of the galactagogue properties of a plant common in the Cape de
Verde islands, and expressed his intention of publishing an account of
a phenomenon so novel and important. In August, just passed, Dr.
M*William submitted to me a paper which he proposed to read at the
Edinburgh meeting of the British Association for the Advancement of
Science. Struck by the facts related in Dr. M'William's paper, and
learning for the first time that the plant is no other than the ricinus
communis, which grows as an annual plant in this country, I determined,
according to Dr. M*William's wish, to ascertain whether the plant,
when growing in our latitudes, preserves its remarkable properties of
stimulating the mammary glands.
In Dr. M'William's interesting paper, read before the Physiological
sub-section of the British Association, and subsequently published in
the Lancet (Sept. 7th, 1850), the following description of the mode of
using the Bofareira or Ricinus, the plant referred to, is given:
“In cases of childbirth, when the appearance of the milk is delayed
(a circumstance of not unfrequent occurrence in those islands), a decoc-
tion is made by boiling well a handful of the white Bofareira in six or
eight pints of spring water. The breasts are bathed with this decoction
for fifteen or twenty minutes. Part of the boiled leaves are then thinly
spread over the breasts, and allowed to remain until all moisture has
been removed from them by evaporation, and probably, in some mea-
sure, by absorption. This operation of fomenting with the decoction
and applying the leaves, is repeated at short intervals until the milk
flows upon suction by the child, which it usually does in the course of
a few hours.
“On occasions where milk is required to be produced in the breasts
of women, who have not given birth to or suckled a child for years, the
mode of treatment adopted is as follows:
“Two or three handfuls of the leaves of the Ricinus are taken and
treated as before. The decoction is poured, while yet boiling, into a
large vessel, over which the woman sits so as to receive the vapour
952 GALACTAGoGUE AND EMMENAGOGUE EFFECTS of THE BOFAREIRA.
over her thighs and generative organs, cloths being carefully tucked
around her so as to prevent the escape of the steam. In this position,
she remains for ten or twelve minutes, or until, the decoction cooling a
little, she is enabled to bathe the parts with it, which she does for
fifteen or twenty minutes more. The breasts are then similarly bathed,
and gently rubbed with the hands; and the leaves are afterwards applied
to them in the manner already described. These several operations
are repeated three times during the first day. On the second day, the
woman has her breasts bathed, the leaves applied, and the rubbing re-
peated three or four times. On the third day, the sitting over the
steam, the rubbing, and the application of the leaves to, with the
formentation of, the breasts, are again had recourse to. A child is now
put to the nipple, and, in the majority of instances, it finds an abun-
dant supply of milk. •
“In the event of milk not being secreted on the third day, the same
treatment is continued for another day; and if then there still be want
of success, the case is abandoned, as the person is supposed not to be
susceptible to the influence of the Bofareira.
“Women with well-developed breasts are most easily affected by the
Bofareira. When the breasts are small and shrivelled, the plant then
is said to act more upon the uterine system, bringing on the menses,
if their period be distant, or causing their immoderate flow if their
advent be near.”
In directing the use of the Bofareira leaves, which I have procured
from the Botanical Gardens at Chelsea, Kew, and the Regent's Park, I
have followed as nearly, as possible the description of Dr. M*William,
with the exception of the application of the steam of the decoction to
the generative organs. The following are the cases in which the agent
has been used under my directions. k
The following case was conducted by Mr. C. Stillman, one of the
House Surgeons of Queen Adelaide's Lying-in Hospital.
CASE I. Mrs. C , twenty-four years of age, rather tall and thin,
mother of two children, had weaned the last about six weeks, and had still
a little milk, of a very thin serous character, left in the breasts. She
commenced the use of the Bofareira, on the morning of Wednesday,
August 21st, by bathing the left breast only, with a strong decoction of
the leaves. The leaves themselves were afterwards applied to this
breast. In the evening, she repeated the bathing; after which, she
perceived, on squeezing the nipple, that her milk, which was at first
thin and watery, had now become quite thick. After repeating the
application on Thursday the 22nd, she felt throbbing pains in the breast,
accompanied by sickness and pains in the back, which she described as
being like after-pains, and the areola surrounding the left nipple had
become much darker than the right; the glandular follicles were also
larger than in the nipple which had not been under the influence of the
Bofareira. The difference between the two breasts was very marked.
Having at this time no more leaves, she was unable to continue the
application. On the following day, a fresh supply of the leaves was
obtained, and she again bathed her left breast as before. After two
applications, the catamenia appeared, before the regular time, and the
formentations were not afterwards continued. - . -
BY TYLER SMITH, M.D. - 953
CASE II. Mrs. H , mother of four children, her youngest child
aged one year and five months, had been weaned more than six months.
During the latter months of lactation, she had little milk; the breasts
were small, and the nipples contracted. Before applying the Bofareira,
the breasts were carefully examined, to learn if they still contained any
traces of milk. After much trial, she could Squeeze from her left breast
the smallest points of serum from the mouths of two or three of the
galactophorous ducts, as is the case with most women who have suckled;
but from the right breast not a trace of moisture could be expressed.
The Bofareira was used night and morning for four days, by bathing
with the decoction, and the application of the hot leaves to both breasts,
in the manner described by Dr. M*William. After the second applica-
tion, thick milk, like the colostrum, could be squeezed from both nipples,
the breasts were considerably swollen, the glands in the axillae were
also painful, and pains extended down the arms. There were, in fact,
in this case, all the symptoms present, in a minor degree, which are
usually observed in the establishment of the milk after parturition.
Mrs. H–— had also distinct periodical pains in the back and abdo-
men, which she compared to after-pains. A leucorrhoeal discharge was
also produced. At the end of the fourth day, milk flowed so freely
into a breast-pump, that there was no doubt she could have suckled a
child; but at this point the application of the Bofareira was omitted,
and the milk has since gradually disappeared.
CASE III. Mrs. D——, a married lady, without family, hearing of the
use of the Bofareira in the last case, wished it tried upon herself. As
there was no possibility of injury she was supplied with some of the leaves,
and proceeded to use it. The application, and the use of the decoction,
produced swelling of the breasts, pain in the back, and an increase of
8, leugorrhoeal discharge, to which she is subject; but there was no
appearancé of milk in the breasts. At the time of using the Bofareira,
the catamenial discharge had ceased about a week.
CASE IV. M. L–—, a young woman, who had been delivered three
weeks, but whose milk, though profuse, was so poor as to be little more
than serum, used the Bofareira three times. Under its use, the secretion
from the breasts became markedly thicker; but the child was unfortu-
mately attacked with diarrhoea, and it was not thought advisable to con-
tinue the use of this agent longer.
CASE v. L. M. , a young woman, mother of one child, but who
had weaned her infant about a year and a half, applied the Bofareira in
the form of decoction and poultices two or three times; but the pain
and swelling were so considerable, that she refused to go on with it.
She had a little serum in the breasts, at the time when the use of the
Bofareira was commenced. The secretion speedily became milky. This
patient had a leucorrhoea, which had been present ever since the wean-
ing; and the uterine and vaginal irritation, upon which the leucorrhoea.
depended, had kept up, in all probability, the serous secretion from the
breasts, which is common enough in leucorrhoeal cases.
Dr. M'William makes the following observations on the botanical
name and characters of the Bofareira :
“The Bofareira grows in most, if not in all, the Cape de Verde Islands.
954 GALACTAGOGUE AND EMMENAGOGUE EFFECTs of THE BOFAREIRA.
That used by the natives for the purposes I have mentioned, is called
by them the white Bofareira, to distinguish it from what appears to be
nothing more than a variety of the same species, the red Bofareira.
The white, or that which possesses galactagogue qualities, is recognized
by the natives by the light green colour of the stem of the leaf, whilst
the leaf stem of the red is of a purplish red hue. The latter plant
is carefully avoided, as it is said to be a powerful irritant, and if applied,
as it occasionally has been, by mistake for the white, it produces an
immediate and often immoderate flow of the menses.
“I regret not having been informed of the alleged difference in the
action of the white and red Bofareiras, while I was at the Cape de
Verde, that I might have examined the latter plant upon the spot.
“The seeds of each plant were, however, kindly forwarded to me by
Mr. George Miller, and Sir William Hooker most readily and obligingly
examined them. Sir William, in a mote to me, says, “What you mark
as red Bofareira, and as white Bofareira, are both not only of the genus
* Ricinus,” but also of one and the same species—viz. Ricinus communis,
the common palma Christi, or castor-oil plant. In our gardens, as
well as abroad, the plants vary; and your two plants vary a little in the
form and size of the seed, and especially in the colour, but they are
one and the same species.’”
I have now used the leaves of the plants from the Botanical Gardens
at Kew, the gardens at Chelsea, and the Botanic Gardens in the Regent's
Park. At the garden in the Regent's Park, there are two fine plants,
and I was struck with the red appearance of the stalk, and of the leaf
stems and ribs of the leaves. The colour was nearly as deep as that
of the common rhubarb. The leaves of these plants were also larger
than any others I have seen. Inquiring of one of the gardeners, I was
informed that there were two varieties, the ricinus communis pmajor,
and minor, and that the major was always of the same red colour.
The smaller variety is of the green colour described by Dr. M*William.
This probably is the explanation of the red and the white Bofareira of
the Cape de Verd Islands.
Hitherto, the control we have had over the mammary secretion has
not been very complete ; a priori, there would seem no reason why we
should not possess special excitants and sedatives of the mammary
glands, as well as of other secretory organs. Abstinence and saline
purgatives, local frictions and applications, have generally been relied
on as lactifuges, when the arrest of the secretion has been desirable,
either after parturition or at the close of lactation; but we have had no
means of equal efficacy as galactagogues, in cases requiring increase of
the milk secretion.
I believe Dr. Fleetwood Churchill has used opium as a galactophorous -
remedy, believing that it stimulates the mammary glands in common
with the skin, while it diminishes all the secretions of the internal glands.
Some persons have also given castor-oil as a purgative, with an idea
that it increases the milk; but it has been thought that it produces this
effect by moderating febrile excitement. In cases of arrest of the secre-
tion from the breast in fever, and inflammatory diseases, all the febri-
fuge and antiphlogistic means become indirect restorers of the mammary
secretion. There is a popular notion, that a fish diet produces more
BY TYLER SMITH, M.D. 955
milk than a meat diet. Fluids of all kinds stimulate the breasts during
lactation, in common with the kidneys; but their effects in increasing
the flow of milk are mechanical. It is a common plan for cow-keepers
to give the milch-cows drink before milking them.
Some considerable control over the secretion of the breasts is given
by the synergies or sympathies which exist between the breasts and
other organs. It is known that the Arabs procure a supply of milk
from their mares by irritating the vagina. In the human subject, irri-
tation of the vagina and uterus in disease, will excite the secretion of
milk. Milk is frequently found in the breasts in cases of tumours, in
gonorrhoea, and in leucorrhoea. No doubt it is the irritation of the uterus
during gestation, that causes the changes in the breasts incidental to
pregnancy; and there is still less doubt that the secretion of milk after
parturition is due to the irritation of the generative canal which obtains
during and after labour. In women who menstruate during lactation,
each menstrual period is accompanied by an increase, or “renewal”, of
the milk, as it is popularly called.
The sympathy, or synergy, between the stomach and the breasts is
also very marked. After parturition, eating or drinking produces an
immediate sensation in the breasts, which accompanies the after pains.
Long after labour, and, indeed, during the whole of lactation, the
“draught” in the breast is immediately produced by swallowing cold
or hot drinks. This does not depend merely upon the passing of -the
fluid into the circulation, and its excretion by the mammae. The sen-
sation of the draught in the breasts follows too immediately upon the
injection of food or drinks into the stomach, to admit of such a suppo-
sition; nor does the intensity of the sensation of the draught depend
upon the quantity of drink taken, which it would necessarily do, if the
circulation were the channel by which the stomach excited the breasts.
It depends, on the contrary, either upon the intensity of the impres-
sion made upon the gastric nerves, a wine-glass of hot drink, or a
small quantity of ice, exciting the breast more than a hearty meal of
food or drink at the ordinary temperature.
What is called the “draught”, consists of two elements, the sensa-
tion and the secretion. The sensation is a purely nervous phenomenon,
and always precedes the secretion.
Another mode in which the breasts are excited to secrete, is through
the influence of emotion. During the establishment of the secretion
of milk after labour, the sight of the child excites the sensation of the
“draught”; and during lactation, when the mother is absent from her
child, the mere recollection of the infant is sufficient, in many cases, to
produce it.
Mechanical irritation of the nipple is another mode of producing and
increasing the flow of milk. Cases are on record in which even child-
less women have, by allowing the suction of an infant, had a secretion
of milk established.
Does the Bofareira act according to a new principle? Has it a spe-
cific influence upon the mammary gland; or does it merely act by irri-
tating the gland, as any other irritant would do? I believe it must be
granted, that this plant has a specific galactagogue action; for it is upon
irritating treatment and friction, that we depend for a diminution of the
WOJ,. II. 63
956 DR. TYLER SMITH ON THE EFFECTS OF THE BOFAREIRA,
flow of milk, when excessive, after parturition, or in weaning, at the
end of lactation.
The leaves of the euphorbiaceae all contain an acid principle. The
leaves of Bofareira evidently contain castor-oil. The leaves are greasy
upon the surface, and the taste of castor-oil is perceptible; but there is
besides this an acid taste in the infusion of the leaves, probably depend-
ing on some essential oil. The infusion is not unlike senna in taste
and smell:
Since the foregoing cases occurred, I have used the remedy in a case of
scanty menstruation of a remarkable kind. Owing to exposure to marsh
malaria, some years ago, the patient had scarcely a sign of coloured dis-
charge at the usual catamenial periods. She used the infusion of the
leaves of the red Bofareira at the date of her period, applying the infusion
and leaves to the breasts, and the vapour to the genitals, with the effect of
producing, in two days, considerable flow of the catamenia. From the
effects in this case, and in one of the cases already related, the Bofa-
reira promises to be of considerable value as a direct emenagogue; at
all events the cases in which I have tried it, show that the plant does
not lose its efficacy in this climate. I hope that, in America and other
parts in which the plant is common, perennial instead of annual, exten-
sive trials of its efficacy both as an emenagogue and a galactagogue,
will be made.
7, Bolton Street, September 1850.
95.7
BIBLIOGRAPHICAL RECORD.
ON ANIMAL CHEMISTRY IN ITS APPLICATION To STOMAGH AND RENAL Drs-
EASEs. By H. BENGE JoWEs, M.D., A.M., Cantab., F.R.S., Fellow of the
Royal College of Physicians, Physician to St. George's Hospital. 8vo.,
pp. 139. London: 1850.
This volume consists of twelve Lectures, delivered, last year, at St. George's
Hospital, at the conclusion of the course of Chemistry. The author informs
us, in his preface, that he had intended to illustrate them by cases, and to
form them into a treatise on Stomach and Renal Diseases. We heartily wish
he had accomplished this project ; for, valuable as is the work now before
us, we feel that its utility would have been greatly enhanced by its extension
and illustration. DR, PROUT's deservedly celebrated work is both too large
and too profound for the busy practitioner, the man who can only read by
Snatches, and therefore needs his information to be presented in a small
compass, divested of every thing that is not strictly essential.
FooD. The First Lecture is occupied with this subject; and is admir-
able for its clearness and freedom from useless and perplexing speculations.
All substances, vegetable and animal, which are fitted to sustain animal life,
consist of ingredients belonging to the four following divisions : 1st, water;
2nd, Salts, or ashes; 3rd, organic substances containing very little or no
nitrogen,_as fat, vegetable acids, starch, sugar, etc.; 4th, organic substances
rich in nitrogen, as fibrin, albumen, vegetable albumen, etc. No two differ-
ent articles of food probably contain these ingredients in the same propor-
tions ; and, accordingly, they vary in their nutritive qualities, those being
most nutritious which have the largest supply of nitrogenous compounds.
But the absence of any of them is destructive of the perfect fitness of the
substance as an article of diet, when taken by itself. “On olive-oil, linseed-
oil, or cod-liver oil, an animal may grow fat, but he cannot work on such food
alone. For the work of the muscles, it is requisite that the food should be
albuminous, not fatty. A horse, for example, for hard work, must have corn,
and not hay. To do work, food rich in nitrogen is necessary; to grow fat,
food rich in carbon is required.” But neither will nitrogenous substances
alone suffice for food. Animals fed on white of egg died of starvation. There
must be a due admixture of all. This is shown in the composition of milk,
the type of the food for infants; and in that of wheat, which may equally be
regarded as the type of the food for man, with this exception, that water is
requisite in addition to the latter.
One great object of vegetables is to prepare the food for animals. “Wege-
tables, from the air, the water, and the soil, make compounds which animals
require, substances, that is, which, with the least possible change, can be
formed into parts of the animal. Vegetables, from carbonic acid, ammonia,
water and salts, form albuminous substances, fatty matters, starch, sugar,
whereby the various organs of the body are nourished and enabled to perform
their actions. The power of forming higher compounds out of more simple
ones, is, in vegetables, unlimited. Their power of thus compounding simple
substances into more complex ones, is most extensive ; whilst, in animals, the
power of conversion is probably limited to a simplifying change, the power
of forming higher organic compounds out of lower ones is at present un-
proved. But, you might say, cannot animals make nervous substance,—the
noblest substance in creation, whose action so utterly forbids our comprehen-
sion ? If we examine this nervous substance, we find it also consists of the
four classes, viz., albuminous substance, fatty substance, ash, and water ; and
the highly-organized muscle contains the same substances in different pro-
63 :
958 BIBLLOGRAPHICAL RECORD.
portions. The power of animals is shown in their forming the substances
which they obtain from vegetables into complex structures and organs;
whilst the power of vegetables is shown in the production of new compounds,
new arrangements of the elements into higher and more complex bodies,
as vegetable acids, alkaloids, neutral substances, albuminous and fatty mat-
ters. The power of adapting forms, and making organs, the formative and
organizing power, is more seen in animals than in vegetables. The power of
building up new compounds, new substances—the compounding, or substance-
making power, is, with some exceptions, perhaps limited to vegetables.”
This is a very important distinction, which should be always kept in mind.
DIGESTION is the subject of the Second Lecture. Rejecting the divisions
usually recognized, DR. Jon Es adopts the following as the steps in the process
of digestion : 1, solution ; 2, absorption ; 3, assimilation. Before any sub-
stance can be absorbed, and made part of the system, it must be dissolved.
The solvent of the food is the gastric juice, a highly acid fluid, secreted by
the stomach. It consists of water and free acid, salts, non-nitrogenous organic
substances, and albuminous, or nitrogenized substance. “Of these sub-
stances, the most important is the free acid. What the free acid is, has not
yet been determined. Hydrochloric, phosphoric, acetic, lactic, and butyric
acids, have each been said to exist in the gastric juice. The hydrochloric
and phosphoric acids are mineral or inorganic acids. The rest are organic
acids, possibly arising from starch, sugar, or fat, or other compounds of the
non-nitrogenized part of our food. Thus these organic acids might beformed;
but whence can the inorganic acids come 7 Hydrochloric and phosphoric
acids exist only in the food and blood, combined with soda, potash, or lime,
as in common salt, phosphate of soda, or phosphate of lime. To set free the
acids, the alkalies must be separated. If one equivalent of hydrochloric acid
is set free in the stomach, one equivalent of soda must be set free in the
blood. The greater the quantity of acid in the stomach, the greater the
quantity of alkali in the blood, and the more alkaline the serum must be-
come. Whether this separation is effected by galvanic action, nervous action,
or muscular action, is at present altogether unknown. Those who say any-
thing, say it is by vital action...... When digestion is completed, the acid is
reabsorbed with the food, and the alkalescence of the blood must be altered
in the opposite direction. When the stomach is empty, there is little, if any,
acid there then ; when food is taken, the quantity of acid begins to increase,
and gradually reaches the greatest amount poured out.”
The next most important constituent of the gastric juice, is the albuminous
substance. Its exact nature is not known. Dr. Jones does not believe it to
be epithelium, but most probably a peculiar substance like diastase. Was-
mann called it pepsin. The non-albuminous organic substances are the
organic acids and fatty matter, the last probably in very small quantity.
This complex gastric juice acts differently on nitrogenized and non-nitro-
genized food. “Strong acids easily dissolve albuminous substances; and the
dilute acid of the stomach, in consequence perhaps of some influence of the
nitrogenized pepsin, or animal diastase (?), is made to act as energetically on
the albuminous food, as strong acid would do. In this action there is nothing
vital; it takes place as well out of the body as in it. The elements of the
albumen cannot be converted so as to form water, salts, sugar, or fat. There
is no formation of incipient albumen. If you please to call solution, reduc-
tion, or combination of water with the substance dissolved, you may say the
albumen is reduced. To me it is far more simple, and quite as comprehen-
sible, to speak of it as a process of solution, and as nothing else.” In this we
thoroughly agree with our author.
Starch is perfectly insoluble in water and in dilute acids; but by the
action of dilute acid it easily undergoes a change, by which it is rendered
soluble, becoming what is called dextrine. A continuation of the same action
BIR LIOGRAPHICAL RECORD. 959
converts the dextrine into sugar. “A portion of the sugar, which is taken
as such, or is formed from starch in the stomach, without doubt passes into
the blood as sugar ; but it appears to me highly probable, from Fremy's
experiments, that a portion is changed into some of the vegetable acids.
The acetic and lactic acids may thus be formed ; and these, in part, per-
haps may become lactates and acetates of soda in the blood. And we know,
from direct experiment, what happens to vegetable acid salts injected into
the blood, or taken into the stomach : they are oxidized, or burnt, giving
heat, and carbonic acid salts, which pass off in the urine. All free vegetable
acids are probably changed partly into carbonic acid in the blood. Thus,
then, probably the progress of a grain of starch may be traced. It forms,
first, dextrine ; secondly, sugar; thirdly, vegetable acid ; fourthly, carbonic
acid. The ascending conversion of sugar into albumen cannot be admitted
until it is proved. There is not an experiment which renders such a change
probable.”
The pancreatic fluid and the bile are generally considered as the agents
which make the fat and oil of the food soluble.
The BLOOD is treated of in the Third Lecture. We quote the following
pregnant observations: “There is not, mor, indeed, can there be, any stand-
ard analysis of blood, to which all others may be referred. The blood has
been called an internal atmosphere ; and, in its constant, momentary varia- .
tions, in its unceasing change, it may well be compared to the atmosphere.
Each moment its composition, as a whole, is changing; each respiration pro-
duces its change on the blood ; each time food is taken, a great change in the
blood must occur; you cannot add a pound or two of matter to the blood
without changing it; each action of a muscle, or nutrition of any part of the
body, must take something from the blood, and thus change its composition.
So, also, each excretion from the blood must effect its peculiar changes on
that blood, out of which each excretion is taken. These are the broad out-
lines of the causes of the changes of blood. The water is always changing;
the nitrogenized and unnitrogenized substances are always varying in amount;
even the Salts, even the alkalescence of the blood, is in a perpetual state of
variation ; at no two moments of the day is it the same. The quantity, then,
of the various substances present in the blood is constantly changing ; and
the variations in the state of health require to be far more minutely studied
than they have been, before deductions as to the variations in disease can be
safely trusted.”
To detect uric acid in the blood, Dr. Jones recommends the following pro-
cess: “The clear serum is poured into a basin, and evaporated, at 2129, to
perfect dryness. The mass is to be reduced to the finest possible powder,
and then heated, at the temperature of 1000 F., with distilled water for an
hour. By this means, everything soluble in the residuum is obtained in solu-
tion, and the urate of soda, being soluble, is dissolved out. The solution
is then to be evaporated to a very small bulk, and strong acetic acid should
be added. Acetate of soda is thus formed, and uric acid is set free ; and, in
the course of a few, or many hours, according to the quantity of uric acid,
and the dilution of the mother liquor, the uric acid crystallizes out on the
sides or bottom of the tube. To the eye, the crystals look like small grains
of cayenne pepper ; through the microscope, they look like some uric acid
crystals from the urine ; and, if a few of them are taken and treated with
mitric acid and ammonia, in the usual way, the diagnostic pink reaction is
obtained.”
CALCULI. The Fourth Lecture contains an admirable account of the different
CALCULI found in the urine, with the methods to be employed for their ana-
lysis. For these we must refer to the work itself, as any epitome would be
meagre and unsatisfactory.
96() BIBLIOGRAPHICAI, RECORD.
THE QUANTITY AND ACIDITY OF THE URINE are considered in the Fifth
Lecture. After showing how it is not possible to determine the quantity of
solid ingredients by the tables which have been constructed for that purpose,
the specific gravity being the guide, Dr. Jones relates several experiments
from which the following conclusions are drawn. “From these experiments
it appears that, immediately before each meal, the urine showed the highest
degree of acidity; and the water passed two, three, or more hours, after
food, always showed a lower degree of acidity. The decrease was greatest
three hours after breakfast, and five or six hours after dinner, when it
reached the lowest point. The acidity of the urine then increased, until
immediately before food, when it again reached its highest limit. If no
food was taken, the acidity of the urine did not decrease, but remained nearly
at the same degree of acidity for twelve hours; but, then, directly after
food was taken, the acidity fell. When animal food only was taken, the
diminution of the acidity after food was more marked and more lasting than
when a mixed diet was taken. The increase of acidity before food was
hardly so great, as when mixed diet was taken. When vegetable food only
was taken, the decrease in the acidity was not so great as when animal food
was taken, that is, though the urine became neutral after food, it did not
become highly alkaline. The increase in the acidity of the urine was higher
before vegetable food than it was before animal food was taken. Dilute sul-
phuric acid was taken in large doses, but it did not produce a very decided
effect. Nine drachms of dilute sulphuric acid, in three days, slightly dimi-
nished the decrease in the acidity of the urine after food; but the acidity
before food was very slightly, if at all, increased thereby. By comparing
the acidity of the whole quantity of urine passed in twenty-four hours for
three days when no sulphuric acid was taken, with the acidity when nine
drachms of dilute sulphuric acid were taken during three other days, the
increase in the acidity, though not very marked, was decidedly apparent.
The average quantity of carbonate of soda required to neutralise the whole
of the urine made in twenty-four hours, when no sulphuric acid was taken,
was 15' 39 grains. The average quantity required when sulphuric acid was
taken, was 20:38 grains. There was but little difference in the quantity of
ULI'IIlé.
“Tartaric acid, in large doses, produced a decided effect on the acidity of
the urine. Three hundred and fifty-four grains of dry and pure tartaric
acid, taken in three days, increased the acidity of the urine ; but, in that
time, it did not render the effect of digestion on the reaction of the urine
less apparent than it was when no acid was taken.
“Liquor potassae, in large doses, produced a decided effect in diminishing
the acidity of the urine ; but it by no means renders the urine constantly
and permanently alkaline. Its effect seems to pass away rapidly. An ounce
of strong liquor potassae, taken in three days, did not counteract or conceal
the influence of digestion on the reaction of the urine.
“Tartrate of potash produced a most decided and rapid effect on the acidity
of the urine ; one hundred and twenty grains of pure dry tartrate of potash,
dissolved in four ounces of distilled water, made the urine alkaline, in thirty-
five minutes. . In two hours, the alkalescence had disappeared ; but after the
next meal, the effect of the tartrate of potash was again apparent. Ten
drachms of tartrate of potash, in three days, produced but little, if any,
º: §n the acidity of the urine after it had been omitted for twenty-four
OUITS. -
Dr. Jones does not speak positively as to the cause of the acidity of the
urine, though he considers that it probably results, generally, from the pre-
sence of acid phosphate of soda.
URIC or LITHIC ACID is the subject of the Sixth Lecture. According to
our author's observations, the uric acid exists in combination with ammonia,
the urate of ammonia being modified in form and in solubility by the pre-
BIBLIOGRAPHICAL RECORD. 961
sence of common salt, and other saline substances. He has not been able
to prove the existence of two compounds of uric acid and ammonia, and
suspects that the super-salt, described by Dr. Bensch, was a mixture of uric
acid and urate of ammonia. That the acidity of the urine is not caused by
such a super-salt, as Dr. Prout supposed, is evident from the fact, that the
variations of the acidity of the urine and of the uric acid, instead of coin-
ciding, have an inverse relation to each other: when the urine is very acid,
there is usually but little urate of ammonia present ; when there is much
urate of ammonia, not unfrequently the urine is nearly alkaline.
The quantity of urate of ammonia varies remarkably during the day. A
few hours after any food, the amount is increased ; long after all food, it is
excessively diminished. It is but little affected by differences in the kind
of food. A slight excess or increase in the acidity of the urine will cause
the precipitation of urate of ammonia. If it be highly acid, a precipitate
may occur, even when no excess of the salt exists. If the urine tend to
alkalescence, an excess of urate of ammonia will be dissolved, and will show
no appearance of a superabundance of urates. The precipitation of uric
acid crystals depends only on the acidity of the urine, and is quite inde-
pendent of the quantity of the urate of ammonia excreted. They constitute
by far the inost delicate and trustworthy test of an over-acid state of the
ll IIIlê.
In regard to the treatment of these two kinds of deposit, Dr. Jones writes,
“If uric acid crystals are present, there are two things to be done, namely,
to give alkalies, and to forbid and remove all that may become acid. For
the first, caustic alkalies, carbonated alkalies and earths, saline draughts,
and phosphate of soda ;-these must be regulated according to the peculiar
symptoms of the patient: for the second, vegetable acid, sugar, and starch
in the food, should as far as possible be prohibited. The removal of acids
by the skin, and of carbonic acid by free respiration and exercise, is of still
greater benefit; shortly, the uric acid crystals indicate that acidity must be
removed, neutralized, and prevented. .
“When uric acid crystals are absent, and urate of ammonia is deposited
alone, it is a proof that no great excess of acid is present in the urine, other-
wise uric acid would be found ; and though, by lessening the acidity of the
urine, we can keep the urate of ammonia dissolved in it, and so hinder it
from appearing, yet this is not the best mode of proceeding for effecting even
this purpose. An extra glass of water, or soda-water, or some slight diuretic,
as nitre, is more sure to keep the urate of ammonia in solution by increasing
the quantity of urine, and this is the best palliative treatment ; whilst the
curative treatment consists in lessening the quantity of food taken, by
smaller meals, and in lessening the acidity of the urine, by increased exer-
cise. Thus you will best prevent deposits of urate of ammonia, and the
alkalies may be kept until uric acid crystals appear, when they are as ne-
cessary, as in urate of ammonia deposits they are unnecessary, for the
treatment.” -
OxALATE of LIME AND SULPHATEs form the subject of the Seventh Lec-
ture. Octahedral crystals of oxalate of lime are so often found, in cases
of such very different characters, and even when there is no evidence of
disease, beyond some indigestion, that Dr. Jones (and in this we fully agree
with him) does not consider that they are of more importance than a deposit
of urate of ammonia. In the treatment, “ammonia, mineral acids, quinine,
and iron are indicated. Animal diet, cold baths, and brandy and water,
appear frequently to give much benefit. When there is irritable bladder,
with excess of mucus and epithelium, camphor and compound tincture of
camphor have proved very useful. If blood-globules occur with the octo-
hedral crystals, the presence of gravel or calculus in the bladder or kidneys
becomes probable. Whether sugar gives rise to oxalic acid in the urine, is
far from being determined. When no sugar at all has been taken, and the
962 BIBLſ OGRAPHICAI, RECORD.
patient has lived on animal food alone, I have found oxalate of lime in plenty
in the urine. I have already stated to you, that sugar is most probably con-
verted into some acid in the stomach; and that sugar should therefore be
avoided in some cases of indigestion, is most certain. That the use of dis-
tilled water, instead of spring water, will lessen the quantity of lime passing
through the body, is also most certain. By this means, the oxalate of lime
may be somewhat lessened; but by air, exercise, and careful diet, the disorders
which accompany it may be cured.”
It is impossible to determine, from simple inspection of the urine, whether
there be or be not present an excess of sulphates, because they never form a
deposit. The fact may, however, be ascertained by the following method.
About five hundred grains of urine are weighed, and chloride of barium is
then added in excess, and a few drops of nitric or hydrochloric acid are em-
ployed to ensure the solution of the phosphate of baryta. Heat is then
applied, and the liquid is boiled for a few minutes briskly. The sulphate of
baryta is then filtered, and well-washed, until the clear liquid is perfectly
free from chloride of barium. The filter is burnt, and the residue weighed ;
and thus the amount of sulphate of baryta in a known quantity of urine is
determined.
Proceeding in this way, Dr. Jones has ascertained, I. That the sulphates
in the urine are much increased by food, whether it be animal or vegetable.
2. Exercise does not produce so marked an increase in the sulphates. 3. Sul-
phuric acid, when taken in large doses, increases the sulphates in the urine ;
in small quantity, it produces little or no effect. 4. Sulphur, when taken,
increases the sulphates in the urine; and sulphate of soda or magnesia pro-
duces the greatest effect on their quantity.
ALKALINE AND EARTHY PHOSPHATEs are treated of in the Eighth Lecture.
Dr. Jones considers that the term phosphatic diathesis is incorrectly applied to
those cases, in which there is a deposit of earthy phosphates, because such
deposits merely show that the urine is not acid enough to retain them in
solution; they by no means give any indication of the quantity of phos-
phatic salts present. He, therefore, would call such urine alkaline, if the
deposit result from excess of fixed alkali; ammoniacal, if from the presence
of carbonate of ammonia.
The alkaline phosphates exist in the urine in much larger quantity than
the earthy; but they never make their appearance as deposits, and therefore
can only be measured chemically. Their excess constitutes the true phos-
phatic diathesis. The following is the method to determine the quantity of
phosphates and their variations. “About one thousand grains of urine are
weighed, and the earthy phosphates precipitated by pure ammonia free from
carbonate. They are filtered, washed with ammoniacal water, and heated to
redness, adding a drop or two of nitric acid; then the earthy phosphates are
determined by weighing the residue. The alkaline phosphates are estimated
by taking about five hundred grains of urine, adding an excess of chloride of
calcium, and then pure ammonia. Thus all the phosphoric acid is preci-
pitated as phosphate of lime. This is filtered, well washed, and the filter
and precipitate burnt with a drop or two of nitric acid. If the filtration has
been slow, it is necessary to re-dissolve the residue in the platinum crucible
by hydrochloric acid, and to re-precipitate by pure ammonia, after which the
filtration will take place very rapidly. After being burnt, the crucible is
weighed, and by deducting the previously determined earthy phosphates,
the difference may be taken as alkaline phosphate.” Proceeding in this way,
Dr. Jones ascertained, that the amount of earthy phosphates depends chiefly
on the amount of earthy matter taken into the body, and that the amount
of alkaline phosphates depends chiefly on the food, being increased by vege-
table diet, but that exercise also causes some increase.
After a long inquiry into the total amount of phosphates in various dis-
eases, he has arrived at the following conclusions.—“1. The variations of the
BIBLIOGRAPHICAL RECORD 963
earthy phosphates are so dependent on the earthy matter (lime or magnesia)
present in the urine, that no deduction from them as to the nature or state of
the disease is possible. 2. Neither the earthy phosphates, nor the alkaline phos-
phates, are permanently increased in spinal diseases. 3. In fevers, and acute
inflammations of fibrous, muscular, or cartilaginous tissues, the total amount of
earthy and alkaline phosphates is not increased. 4. In chronic diseases, in
which the nervous tissue is not affected, no deduction can be drawn. 5. Chronic
cases of mania, melancholia, and general paralysis of the insane, gave no
marked results. 6. In chronic diseases of the brain, and in chronic and even
acute disease of the membranes, there is no increase in the totalamount of earthy
and alkaline phosphates. 7. In fractures of the skull, when any inflammation
of the brain comes on, there is an increase in the total amount of phosphates.
When there are no head symptoms, no increase of the phosphates is observed,
even when other acute inflammations supervene. 8. In acute inflammation
of the brain, there is an excessive amount of phosphates in the urine. When
the inflammation becomes chronic, no excess of phosphates can be shown to
exist in the urine by the method of analysis that was employed. 9. In some
functional diseases of the brain, an excessive amount of phosphates is observa-
ble ; this ceases with the delirium. Delirium tremens shows a remarkable
deficiency in the amount of phosphates excreted, provided no food is taken.
When food can be taken, the diminution is not apparent.”
THE ALKALESCENCE OF THE URINE, from fixed and volatile alkali, is dis-
cussed in the Ninth Lecture. All urine, after standing for a time, which is
exceedingly variable in respect of length, becomes alkaline, the elements of
the urea being re-arranged so as to form carbonate of ammonia. It is probable,
that the chief agent in this change is the mucus; and it is certain that the
greater the quantity of mucus present, the more rapid is the decomposition.
Hence alkalescence of the urine follows speedily on irritation of the mucous
membrane of the bladder. But the urine is often alkaline without the pro-
duction of any carbonate of ammonia, this condition being caused by the
presence of carbonate or phosphate of soda. The following sketch shows the
comparative characters of the urine under these circumstances.
Alkalescence from carbonate of am- Alkalescence from fixed alkali caused
monia caused by local disease. by general disorder.
Blue paper made red on drying. Blue paper not made red on drying.
Alkalescence constant. Alkalescence variable.
Excess of mucus and pus present. No pus. Rarely much mucus.
Prismatic crystals generally seen. whº, first made, granular deposit
ODIW Seen.
The iridescent film has prismatic The #: film consists of thin
crystals. plates only.
These distinctions are of importance in the way of diagnosis, and therefore
of treatment. In either case, the diseased condition which produces the
alkalescence of the urine should be the subject of treatment, not the mere
symptom itself. The rest of this lecture is occupied with the chemistry of
lilſea,
ALBUMINoUs URINE is the subject of the Tenth Lecture. Heat and nitric
acid together form the best, and indeed the only safe test for albumen, and the
above is the order in which they should be employed. Either alone may
give rise to mistakes. Dr. Jones very properly insists upon the importance
of using a perfectly clean tube. A small quantity of strong acid will prevent
the coagulation of the albumen by heat ; and it even appears, that the same
test may fail when the urine is very acid, without anything having been
added to it. Albumen is never present in healthy urine, but by itself it
merely indicates excessive congestion of some part of the urinary organs; to
determine what disease is really present, the microscope must also be em-
964 BIBLIOGRAPHICAL BECORD.
ployed. By this means, we detect the presence of blood-corpuscles, or pus-glo-
bules, or fibrin. If the fibrin be moulded into the urinary ducts of the kidney,
and if albumen be also present, with or without blood-globules, there must be
congestion of the cortical structure of the kidneys; and most probably the
disease is Bright's disease, or the result of scarlet fever. If blood-globules be
found, and no fibrinous cists, it is most probably that the congestion is not in
the secreting structure of the kidney; and if crystals of uric acid or oxalate
of lime be seen, then probably some calculus is causing abrasion of the vessels
of the mucous membrane. Whether the calculus is in the pelvis of the kidney,
the ureter, the bladder, or prostate, must be determined by the general
symptoms. The nature of the epithelium that occurs in the urine, will also
sometimes help to determine this question. The occurrence of the blood only
on exertion tends to confirm the diagnosis of a calculus. If pus-globules be
found with albumen, then suppurative inflammation is going on ; if, at the
same time, fibrinous moulds are seen, then probably Bright's disease and in-
flammation of the pelvis co-exist. If there be no moulds, but blood-globules
and pus-globules, then probably a calculus has caused not only abrasion, but
inflammation of the mucous membrane. When fibrinous moulds, blood-
corpuscles, pus-globules, albumen, and crystalline deposit were seen, then de-
generation of the kidney, inflammation, and calculus, were found on post-
mortem examination. In one case, Dr. Jones found the urine albuminous
from spermatozoa.
A peculiar substance, closely relating to albumen, has also been found in
the urine, as well as in the buffy coat of inflamed blood. It is not precipitated
directly by heat, nor by nitric acid, but if, after boiling, the urine is cooled,
the precipitate falls, and is re-dissolved by heat. The nature of this sub-
stance is detailed by Dr. Jones in the Philosophical Transactions for 1847.
Our author then relates the following interesting case : “The patient had
for some time been passing the so-called chylous urine; but I have fully
satisfied myself that the presence of fat in the urine, on which the white colour
depends, is an accident only, and by no means the most peculiar part of the
disease. The fat passes off in the urine, making it milky only after food;
but previous to any food, albumen, fibrin, alkaline salts, and more rarely a
few blood-globules, are thrown out by the kidneys, and their appearance in
the urine depends on the increased force of the circulation, consequent on
waking, on getting up, and on exertion; for, during sleep, the albumen, fibrin,
etc., entirely disappear from the urine, and, by directing the patient to lie in
bed, or to get up and exert himself, totally different kinds of urine were passed.
When perfectly quiet, the albumen and fibrin were prevented from appearing
in the urine ; and, when he exerted himself before breakfast, these substances
transuded in very considerable quantity. The urine sometimes, previous to
any food, even formed a jelly-like clot, transparent, and perfectly free from
the appearance of fat. I satisfied myself that the disease does not depend on
chyle or on fat, but on a slight alteration in the state of the kidney, and on
the circulation of the blood through it. Under treatment, the urine became
perfectly healthy.”
DIABETES AND DIURESIS are the topics of the Eleventh Lecture. The
best tests for sugar in the urine, are the oxide of copper and oxide of silver.
To a drachm of suspected urine, add two or three drops of a saturated solu-
tion of sulphate of copper, and then two drachms of caustic potash; the
hydrated oxide of copper, which first is precipitated, re-dissolves if sugar or
many other organic substances are present, becoming of an intense blue; and
when heat is applied, if grape-sugar be present, the oxide of copper is rapidly
reduced, and reddish-yellow sub-oxide of copper is precipitated. This re-
duction is effected by the carbon of the sugar. With cane-sugar, the changes
do not take place until after a long application of the heat; and, under these
circumstances, both uric acid and albumen will also effect a slow reduction of
the oxide of copper. The rapidity of the change is consequently the test.
BIBLIOGRAPHICAL RECORD. 965
If silver be used, the following is the method to be employed. A few
drops of a saturated solution of nitrate of silver are to be put in a test tube,
and a single drop of caustic ammonia added; if a brownish oxide of silver
fall, a single drop of the suspected urine is to be added, and the test-tube
then heated, and its contents well shaken. In a few seconds, the sides of the
tube will be coated with silver, and the metallic lustre will be seen.
The theory of the disease is as yet unknown. Sugar, as we saw before, is
constantly formed in the body from starch; from some cause, with which we
are not acquainted, the progress of the starch may be arrested at this point.
In cases where the urine is excessively acid, the changes have advanced
another step ; as thus:— .
In health the changes are, starch, dextrin, sugar, vegetable acid, carbonic
acid. -
In excessive acidity; starch, dextrin, sugar, vegetable acid.
In diabetes; starch, dextrin, sugar.
But the starch taken in food cannot account for all the sugar in diabetic
urine; for when the disease is fully established, total abstinence from starch
and sugar will not cause the sugar entirely to disappear. Dr. Bensch has
shown, that sugar of milk is invariably present in the milk of carnivorous
animals fed exclusively on meat; and by boiling with water, the livers of
animals fed exclusively on flesh have furnished positive proof of sugar.
There is a form of diabetes to which the term insipidus has been applied.
In these cases, the urine contains a substance closely allied to sugar, but
tasteless, and which may be converted into grape-sugar by the action of acids.
In some cases of the ordinary disease, the urine has been found to contain
these two saccharine bodies alternately; and therefore the term is a needless
OIlê.
THE RELATION OF THE URINE TO THE FooD AND SystEM, and the general
method for its examination, are considered in the Twelfth and Last Lecture.
Any organ that is used must be repaired, and the substance that has been
used must be removed. Take the muscles for example; the muscles consist
of water, salts, non-nitrogenous fat, and a highly compound arrangement of
carbon, hydrogen, nitrogen, oxygen, sulphur, and phosphorus. Carbonic
acid, ammonia, water, sulphates, and phosphates are the last products of
muscular action, and of the action of oxygen on the muscle. The inter-
vening products, probably, are innumerable; as kreatin, kreatinine, uric
acid, urea, choleic acid. Some of the products are thrown out of the body
by the lungs, others by the kidneys. If the removal of some of these pro-
ducts by the lungs is stopped, the circulation through the lungs ceases in
two minutes; the functions of the heart and brain are arrested, and from
the mechanical stoppage in the lungs, death ensues. If their removal by
the kidneys is stopped, in two days the patient is poisoned; the nerves and
muscles are affected by the poison, and chemical death ensues. “If beef-
steaks (the muscles of an ox) are given to one who has taken strong exercise,
and is in perfect health, they are dissolved, and pass into the blood, and
their chief use is to repair the muscles and nerves, not to form uric acid and
urea, the constituents of the urine. The waste of the muscles, and other
organs, passes off in the urine, whilst the food nourishes the wasting organs.
Such I conceive to be the clearest ideas I can give you of the relation of the
urine to the system, and to the food; and, theoretically, I consider this is the
true healthy relation, and perhaps, in a state of full bodily labour, when
enough food, and no more than enough, is taken, this may be the only rela-
tion; but provision has been made for too little labour and for too much
food. If too much food is constantly taken, and too little exercise, plethora
and haemorrhage must take place, if some escape for the excess of food be
not provided. You have seen that the phosphates, urates, and sulphates
are generally increased in the urine after food has been taken. If more food
is taken than is required for the wants of the system, the excess is thrown
966 BlBLIOGRAPHICAI, RECORD.
out by the same organs that remove the waste of the muscles and other
structures. If even excess of water alone is taken, the excess is thrown out
partly, at least, by endosmotic laws not yet clearly applied. How the quan-
tity of substances to be thrown out is determined, I do not yet distinctly see.”
The great agent in affecting these changes is oxygen. Of this there are
many familiar proofs, as the production of carbonate of potash in the urine
after the citrate of potash has been taken. “Wery lately, Professor H. Rose,
of Berlin (Phil. Mag., July 1849), has made some most interesting experi-
ments on the inorganic constituents of organic bodies, chiefly as regards
their degree of oxidation. He divides the degrees of oxidation into fully
oxidized, partially oxidized, and unoxidized. He compares the food, the
blood, the flesh, and the urine. The food, if it consists of wheat and other
grain, contains organic substances, the inorganic constituents of which exist
partly in an oxidized, partly in an unoxidized state. Wegetable food, then,
is partially oxidized. The blood is a partially oxidized body. The flesh is
a partially oxidized body; but the quantity of unoxidized matter in the
blood is larger than in the flesh, and the quantity of fully oxidized matter is
Smaller in the blood than in the flesh. The urine is a perfect and fully ox-
idized substance. The inorganic constituents of the urine are as highly ox-
idized as it is possible for them to be.”
The length to which our analysis of these lectures has extended, notwith-
standing the wide circulation which has already been given to them in the
Lancet, is a sufficient proof of the very high value which we attach to them.
Still, it is only simple justice to the author, and to our readers, to urge the
latter to obtain them, if they wish to possess the most lucid and satisfactory
exposition, in our language, of the subjects of which they treat. We hope
soon, again, to meet the accomplished author in the same important, but
most difficult, field of inquiry: a field which can only be cultivated with ad-
vantage by one who possesses, like him, the rare qualifications of being alike
thoroughly accomplished as a chemist and as a practical physician.
CHOLERA AND ITS CUREs. An Historical Sketch. By J. STEVENSON BUSHNAN,
M.D., Member of the Royal College of Surgeons of England,and Fellow of
the Royal College of Physicians, Edinburgh. 8vo., pp. 169. London: 1850.
This is not a regular treatise on Cholera, but in reality a sketch, as the
title truly indicates. In attempting to deduce from the work itself the pur-
port of its publication, two prominent objects are apparent, one, to advance
the progress of what has been termed Sanitary Reform ; the other, to defend
the author, and advocate the adoption of a particular remedy, to the exclu-
sion of all others. Indeed, so ardent an admirer is DR. BUSHNAN of one
peculiar mode of treatment, that the preliminary step of depreciating all
other remedies, is not delayed beyond the first page of the preface, in which
it is asserted, without any modification, “that the mortality of Cholera has
not been diminished a single iota, by the means usually employed, and that
nearly half of those attacked have been cut off in every part of the world.”
This is sufficiently explicit, and discouraging at the same time; but it is con-
solatory to know that “if the ignorant will submit to be enlightened, and
the prejudiced will listen to reason”, Cholera “may be shorn of its terrors,
and brought completely under medical control”. The reader, with some
pardonable misgivings, will naturally inquire, how such a consummation, in
every respect so desirable, and so diametrically opposed to all past experience,
is to be effected? and in reply, he will be told by Dr. Bushman, that the cure
of Cholera, by the saline remedies, introduced into practice by Dr. Stevens,
is so certain, that it may be looked on as an axiom in medical science, or, to
employ the quotation of the learned writer, “demonstratum est quod era:
demonstrandum”.
So far all appears satisfactory ; but, when we come to examine the
BIBILIOGRAPHICAL RECORD. 967
amount of evidence, on which this very important alleged demonstration
is made to rest, it may be permitted us to suggest, without appearing
hypercritical, that the foundation seems rather slender, for supporting the
weight of the superstructure erected on it. For, leaving apart all mere
opinions (not very numerous), in favour of the saline treatment, which are
unsupported by facts, we find the cases actually adduced by the learned
author, in proof of its efficacy, to be those treated by Dr. Stevens himself,
in conjunction with his assistant, Mr. Crooke, and Mr. Wakefield, at the
Coldbath-fields prison ; by Dr. Kendrick, at Warrington; by Mr. Bossey,
on board the Woolwich convict-ship ; and by Dr. Marsden, at the Greville-
street Hospital—all occurring in the year 1832, and amounting on the whole
to about 1,000 cases . The statement with respect to the first-mentioned insti-
tution, is, that of 446 patients treated on the Saline plan, 201 of whom were in
a state of collapse, only eight died, and 438 recovered, showing a mortality
of less than three per cent. This enumeration includes the results obtained
by Dr. Stevens in the first irruption of the disease, at which period, of 159
patients affected with Cholera, 158 recovered, and only one died. This is a
degree of success, beyond what most practitioners could show, in the treat-
ment of any disease whatever, and exhibits Cholera as the most manageable,
instead of the most terrible and intractable of all maladies, which are per-
mitted to afflict the human race. But most sober-minded physicians, who
have derived their knowledge from a practical acquaintance with the disease
in question, will, we are disposed to think, conclude with us, even at the risk
of being ranked among the “ignorant and prejudiced”, that the results
referred to prove a great deal too much. Of Dr. Kendrick’s experience,
limited to thirty cases, it is only necessary to observe, that even as far as it
goes, it is not favourable to the pure saline treatment, which was less success—
ful in his hands, when used alone, than when conjoined with blood-letting.
In Mr. Bossey's practice, too, the success of the saline remedies alone, and
when employed along with bleeding, was nearly on a par. Dr. Bushnan,
therefore, in claiming the entire credit for the saline treatment in these cases,
either overlooks altogether the influence of so powerful an auxiliary as general
blood-letting, or else he attributes to it no share in the successful result. The
testimony of Dr. Marsden, however, is more favourable than that of the two
last-mentioned practitioners; for out of 81 collapsed patients, treated solely on
Dr. Stevens' plan, seven only died, showing a mortality of about 8.6 per cent.
Such is a brief resumé of the entire statistical facts adduced in support of
Dr. Bushnan’s views. For the history of the saline treatment, and the con-
troversy between Dr. Stevens and his friends on one side, and the late Sir
David Barry and his coadjutors on the other, we must refer the reader to the
elaborate statement of Dr. Bushnan, as we have neither space nor inclination
to enter into the subject. This, however, is the less necessary, and would
perhaps be premature, as further communications are promised ; and, after
the statements of Dr. Bushnan, it does not seem likely that the question will
be allowed to rest in its present position.
With reference to the more important topic, the practical value of the
saline treatment, it is to be observed, that Dr. Bushnan has confined his advo-
cacy entirely to one side of the question; and that, whilst his work professedly
embraces the history of the recent irruption of Cholera, all his testimony in
favour of Dr. Stevens' remedies is deduced from the epidemic of 1832. In a
fair discussion of the point at issue, surely some notice of more recent expe-
rience might naturally have been looked for, before the learned author arrived
at conclusions so positive ; and it certainly would not have been unreasonable
to expect, that some notice at least would have been taken of the unsuc-
cessful results of the saline treatment in the hands of Dingham, Richardson,
Ross, and others, during the last epidemic. Were the arguments and evi-
dence of the writer sufficient to establish the very important point for
which he contends, we are certain that his success would be hailed by
every member of the medical profession with unequivocal delight, whilst the
968 BIBLIOGRAPHICAL RECORD.
discovery would constitute for Dr. Stevens a lasting claim to universal grati-
tude, as one of the greatest benefactors of the human race. As it is, however,
and in the present state of our knowledge on the subject, we fear that Dr.
Bushnan has as far over-estimated the efficacy of the saline treatment, as he
has under-rated the value of other remedies, although we admit that he has
castigated with just severity some of the unmitigated quackeries called forth
by the last epidemic.
The erroneous estimate of treatment, into which he, as well as many others,
has been betrayed, probably depends on a difference of opinion as to what
zeally constitutes the disease in question. Malignant Cholera, we fear, has
not yet been divested of all its terrors; and, in our opinion, the infallible
remedy still remains to be discovered.
This is the general plan of the work before us. The first chapter contains a
succinct sketch of the progress of the various epidemics of Cholera since
1817. The second chapter refers to the nature and causes, and to the more
early history of the disease. The author correctly adopts the opinion of
several previous writers, that Cholera was known to the ancients, and that
the popular classification into English, Bilious, and Asiatic, or Malignant
Cholera is erroneous, except as far as it implies the different degrees of in-
tensity assumed by the malady. In support of this view, he quotes the
opinion of a recent writer on the subject, to the effect “that if we go beyond
this, we are inferring a difference, unfounded-in fact, unsupported by observa-
tion and legitimate deduction, and of injurious practical tendency.” In
passing, we may observe, that Dr. Bushman incorrectly attributes the quotation
which he here makes use of, to the author of the article Cholera in the Cyclo-
paedia of Practical Medicine, whereas it is really to be found at page 33 of
“An Enquiry into the actual state of our knowledge of Cholera,” by Dr.
Alexander Knox.
In the author's discussion on the causes of the disease, little novelty is of
course to be looked for. The views of many previous writers are given, and
the sources from which they are derived are generally distinctly referred
to. The only alleged causes, bearing even the semblance of novelty, are
impregnation of the atmosphere with sulphuretted hydrogen, the continued
use of a diet deficient in sulphur, and the transmission of the disease through
the medium of impure water, according to Dr. Snow, or of impure water only,
in common with various other causes, as asserted by M. Pellarin. We may
allude further to the experiments and observations of Brittan, Swayne, and
Budd, tending to shew that Cholera depends on peculiar microscopic bodies,
of various forms, and of a fungoid mature, found in the choleraic discharges,
as well as in the air and water of Cholera districts. We have not space for
any detailed consideration of these theories, but it is difficult to understand
how sensible and clever writers can persuade themselves of the truth of views,
however ingenious, founded on data manifestly imperfect. How many readers,
we may ask, are likely to adopt the conclusion of Professer Webb, (to be found
in his Pathologia Indica), that of all the causes of Cholera, sulphuretted
hydrogen is the most potent. Truly, the objections to this theory are so
obvious, that it appears little more feasible than the cause assigned by the
Puharrees of the hills, who, as the Professor tells us, attribute the disease to “a
demoniac seizure, and believe that the evil spirit springs suddenly upon the
unwary from dark thickets, and shady fountains and water courses especially.”
We are further informed, that nearly all cases are fatal with them, as may
readily be credited, “the treatment being to get five or six strong lusty fel-
lows to shake out the devil, and frighten him by loud cries”! It is not neces-
sary, however, to pursue this part of the subject further, as Dr. Bushnan
deals effectively and well with theories of this stamp, although he passes by
almost without remark the doctrine of contagion, and the question of qua-
rantine,
Nearly one-half of the entire volume is occupied with details relative to

t
BIBLIOGRAPHICAI, RECORL). 969
the miserable condition of the dwellings of the poor, especially in London,
extracted from the Report and Evidence of the Sanitary Commission of 1847,
the Report made to the General Board of Health, established by the 11 and
12 Vic. c. 63; the reports of Dr. Gavin Milroy, and of the Registrar-General
of Births, Deaths, and Marriages, and other sources, and illustrated by a
number of elaborate statistical and meteorological tables. Enough, and per-
haps much more than enough, is adduced to shew, that the mortality of epi-
demics falls heavily on that part of the population which is aggregated in
large masses in insufficient space, and that amelioration in this respect is
imperatively required. The harrowing details will be read with much in-
terest, at all events, by those who have not been previously conversant with
those sources from which Dr. Bushman chiefly derives his information.
The seventh chapter, which must have been compiled at a very consider-
able expenditure of labour, exhibits in a tabular form, extending over several
pages, the various modes of treatment published in 1848-9. We think, in
justice to the profession to which he belongs, Dr. Bushnan ought to have
stated that a large number of those whom he cites were young and inex-
perienced, and restless scribblers, rather than practitioners of medicine.
Cannabine, the plant Zhorabia, the wet sheet, extreme cold, dusting with lime
(or white-washing), bisulphuret of carbon, placing the patient in hot sheets,
or over the boilers of steam engines, injection of water into the bladder,
chlorate of gold, tincture of rye and tannin, are the greatest novelties in
this strange catalogue.
On the whole, however, the sketch of Dr. Bushnan is a valuable contribu-
tion to medical literature, as bringing up to the present time our history of the
disease, from the point where it was necessarily left incomplete in the trea-
tises of Parkes, Knox, and other writers, published early in last year, before
the epidemic had completely run its course.
The style of the author, although occasionally a little inflated, is, gene-
rally, fluent and perspicuous. He possesses a desirable facility of lucidly
stating elaborate statistical deductions. Were we disposed to be fastidious,
we might object, that in a strictly professional work, the poetical quotations,
though perhaps appropriate, are rather too numerous, as Horace, Juvenal,
Shakespeare, Byron, Heber, La Fontaine, and several others, are each made
to contribute his quota ; but this blemish, in point of taste, is not sufficiently
glaring to justify severe criticism, even if it were not counterbalanced by
the more valuable qualities of the work. We thank Dr. Bushnan for his
little volume.
THE PRINCIPLEs of SURGERY. By JoHN A. ORR, A.B., F.R.C.S.I.; one of
the Surgeons of the City of Dublin Hospital. pp. 496. Dublin : 1850.
This contribution to surgical science by one of our brethren across the
channel, is a highly creditable production. Without aiming at originality,
it gives a very fair abstract of the state of surgery in the present day: the
style is terse and luminous, and the practical precepts are sound and judi-
cious. At the end of every chapter, reference is made to the sources from
which the author has derived his information, or to which he deems it advis-
able to refer the reader for fuller particulars upon each subject than a ma-
nual can comprise. We are by no means opposed to works like the present,
which give, in a condensed form, the subject-matter of innumerable treatises
and monographs; for we consider that they tend most materially to smooth
the path of the student, whilst they are hardly less useful to the practitioner
engaged in the active duties of his profession, who may resort to such books
in order to refresh his mind with the principles of medical and surgical sci-
ence. The best sources have evidently been consulted by MR. ORR in the
composition of the present volume, as the numerous references at the end of
the chapters, and the soundness of the principles inculcated, abundantly
testify.
970 BIBL106 RAPHICAL RECORD.
A PRACTICAL SYNoPSIs of THE DISEASEs of THE CHEST AND AIR-PASSAGEs,
wiTH A REVIEW OF THE SEVERAL CLIMATES RECOMMENDED IN THESE
AFFECTIONs. By JAMES BRIGHT, M.D. pp. 271. London: 1850.
The author of this work informs usin his preface, that his object in writ-
ing it is to submit to his professional brethren the results of his experience
upon the best means of alleviating the diseases of the chest. We are accord-
ingly informed in the first page, that “thé chest is separated from the head
by the neck, and from the abdomen by the diaphragm. It is composed of
thirty-seven bones, namely, twelve dorsal vertebrae, twenty-four ribs, and the
breast-bone or sternum. The posterior wall of the chest, concave from above
downwards, is formed by the bodies of the twelve dorsal vertebrae and the
posterior ends of the ribs,” etc., etc. The whole work is full of the same kind
of information for the benefit of the author's professional brethren ; and we
have in vain endeavoured to discover any views or opinions which have not
been repeatedly offered to the notice of the profession. We must, however,
do the author the justice to state, that although the work contains nothing
new or important, it offers nothing objectionable.
NEW AND SUCCESSFUL TREATMENT OF FEBRILE, AND OTHER DISEASEs,
THROUGH THE MEDIUM of THE CUTANEOUS SURFACE. By WILLIAM
TAYLOR, Surgeon to the Clerkenwell Infirmary. pp. 170. London: 1850.
In our last number, p. 865, we favourably noticed Dr. Schneeman's plan of
inunction in scarlatina. The author of the work before us states, that he has
followed a method substantially the same, for twelve years, in the treatment
of all febrile diseases. He states that, “from 1837 to 1849, between two
and three hundred cases of fever occurred in the Clerkenwell Infirmary,
without a single death in idiopathic cases; whereas in 1836 alone (before
his plan of treatment was adopted), twelve patients died of typhus in one
month.” This is rather a loose way of giving medical statistics. There is
an important difference between two and three hundred cases; and there
may be other ways of explaining the extraordinary mortality of one month,
than by attributing it to the author's treatment not having then been in use.
On the other hand, the subsequent success may not have been wholly owing
to its employment. We all know how much the gravity of one epidemic
differs from that of another. We are decidedly favourable to the general
principles on which the author's treatment is based; but we could have
wished that his treatise had been more elaborated, and more statistically com-
plete in its account of his own experience. The subject is deserving of more
careful and extended clinical investigation.
The book before us consists of an introduction; nine short chapters; and
some concluding remarks
In the introduction we learn how the author made his discovery ; and also
that the use of greasy frictions belongs to antiquity. The substances used
for inunction were various; but Mr. Taylor “eventually mixed lard and suet
in equal proportions, melted them carefully over a slow fire (or a water bath),
and this combination having acquired about the consistence of common
tallow, was, on extensive trial, found to answer every requisite. No mixed
ointment that liquefies at a temperature below that of the blood, being
equal to it” (p. 7).
The First Chapter is on the anatomy and physiology of the skin.
The Second Chapter treats of the connexion between the functions of the
skin and fever.
The other Chapters describe the application of the inunction treatment to
typhus, measles, dropsy, phthisis, insanity, delirium tremens, and hydroce-
phalus.
97 |
CLASSIFIED CATALOGUE OF THE PAPERS WHICH HAVE
APPEARED IN THE BRITISH AND FOREIGN MEDICAL,
PERIoDICALs PRom. JANUARY 1s49.
CHAPTER IV.
ANATOMY AND PHYSIOLOGY.
BRITISH AND AMERICAN Journals, FROM JANUARY 1849 To JUNE 1850.
BY ALEXANDER HENRY, M.D.
The following Journals are referred to in this and the succeeding Chapters.
Philosophical Transactions ... ... ... ... Phil. Trans.
Medico-Chirurgical Transactions ... ... ... Med.-Chir. Trans.
British and Foreign Medico-Chirurg. Review. B. and F. Med.-Chir. Rev.
London Journal of Medicine ... ... ... ... Lond. Journ. of Med.
Lancet ... ... ... ... ... ... ... ... Lancet.
Medical Times ... ... ... ... ... ... Med. Times.
Medical Gazette ... ... ... ... ... ... Med. Gaz.
Journal Óf Psychological Medicine ... ... Psych. Journ.
Edinburgh Medical and Surgical Journal ... Edin. Med. and Surg. J.
Monthly Journal of Medical Science ... ... Edin. Month. Journ.
Goodsir's Annals of Anatomy and Physiology Goodsir's Annals.
Dublin Quarterly Journal ... ... ... Dub. Quart. J.
Dublin Medical Press ... ... ... ... ... Dub. Med. P.
American Journal of Medical Science ... ... Amer. Journ. of Med. Sc.
GENERAL ANATOMY.
ELEMENTARY Tissues of Animals, Chemical Characters of ALDRIDGE (Dr.)
Med. Times, March 24, 1849, vol. xix, p. 406: May 26, p. 587.
MILK, HUMAN, Coagulability of MooRE (William D.) Dub. Quart. J, May
1849, vol. vii, N. S., pp. 275 and 492. '
SUGAR, Source of, in the Animal Economy. Bern ARD (C.) Prov. M. and S.
Journ., Feb. 7, 1849, p. 79. From Arch. Gén. de Méd. Grape Sugar,
constant Presence of in the White of Eggs. ALDRIDGE (Dr.) Med.
Times, March 31, 1849, vol. xix, p. 437.
Blood, Physiological Researches on. HEALE (J. N.) Med. Gaz. Oct. 12,
1849, vol. xliv, p. 639. Blood-Corpuscles of Human Embryo. PAGET
(James). Ibid., Feb. 2, 1849, vol. xliii, p. 188.
FAT, Observations on Development of HAssaLl (A. H.) Lancet, Jan. 20,
1849, p. 63. Jones (C. H.) Med. Gaz., May 31, 1850, vol. xlv, p. 933.
CoRPULENCE. Gulstonian Lectures for 1850. CHAMBERs (T. K.) Lancet,
vol. i., 1850, pp. 523, 557, 581, 651, 687.
Muscle, Undescribed, of Scapula. BRown (J. W. D.) Med. Gaz., May 3,
1850, vol. xlv., p. 753.
Muscular SystEM, Varieties of HALLETT (C.H.) Edin. Med. and Surg.
J., July 1849, vol. lxxii, p. 1.
Muscular Fasciculi, Arrangement of Areolar Sheath of Leidy (Joseph).
Amer. Journ. of Med. Sc., April, 1849, vol. xvii, N. S., p. 537. Abs. in
Lond. Journ. of Med., June 1849, vol. i., p. 568. Muscular Fibre, Irritabi-
lity of HALL (Marshall). Lond. Journ. of Med., August 1849, vol.i, p. 710.
BoNE, Purkinjean Corpuscles in, Development of LEidy (Joseph). Amer.
Journ. of Med. Sc., April, 1849, vol. xvii, N. S., p. 536. Abs. in Lond.
Journ. of Med., June 1849, vol. i., p. 568. Occipital and Superior Max-
illary of African Cranium. Neill (John). Amer. Journ. of Med. Sc.,
Jan. 1850, vol. xix, N. S., p. 78. Interinaxillary in Human Embryo.
Leidy (Joseph). Ibid., April 1849, vol. xvii, N. S., p. 537. zº
WOL. II. 64
972 CLASSIFIED CATALOGUE.
MAKRoceph ALI of Kertsch in the Krimea. RATHKE (H.) Edin. Med. and
Surg.J., Oct. 1849, vol. lxxii, p. 339; from Zeitsehrift für Physiologie
von Tiedemann und Treviramus, band v, heft 1.
ARTicſ, LAR CARTILAGE, Intimate Structure and History of LEIDY (Joseph).
Amer. Journ of Med. Sc., April 1849, vol. xvii, N. S., p. 277. Abs. in
Lond. Journ. of Med., June 1849, vol. i., p. 561. Structure of Synovial
Membrane of ToyNBEE (Joseph). Lond. Journ. of Med., March
1849, vol. i., p. 217. Swayne (J. G.) Prov. M. and S. Journ., June 27,
1849, p. 341. $ *
URINE, Variations in Acidity of Jones (H. Bence). Phil. Trans., 1849,
p. 335. Simultaneous Variations of Amount of Uric Acid in: Acidity of
Urine in State of Health. Jones (H. B.) Ibid., p. 245, Variations of
Sulphates in, in Health; Influence of Sulphuric Acid, Sulphur, and Sul-
phates, on Amount of Sulphates in Urine. Jon Es (H. B.) Ibid., p. 252.
ORGANS OF DIGESTION.
To NGUE, Muscular Structure of in Man and Mammalia. ZAGLAs (John).
Goodsir's Annals, Feb. 1850, p. 1. Structure of Papillae of HAssaLL
(A. H.) Lancet, March 3, 1849, p. 234. RIDGE º Ibid.,
April 21, 1849, p. 427. Minute Structure of the Papillae of the Nerves
of, in the Frog and Toad. WALLER (Augustus). Phil. Trans., 1849, p. 139.
GLANDs of Alimentary Canal, Structure of THOMson (Allen). Goodsir's
Annals, Feb. 1850, p. 33.
Liver, Structure and Development of, in Vertebrate Animals. Jones (C.H.).
Phil. Trans., 1849, p. 109; and Med. Gaz., August 24, 1849, vol. xliv,
p. 313. Abs. in Lond. Journ. of Med., Dec. 1849, p. 1147.
SPLEEN, Structure of SANDERs (W. R.) Goodsir's Annals, Feb. 1850, p. 49.
PANcreatic Juice; recent Discoveries of M. Bernard. HALL (J. C.) Med.
Gaz., April 13, 1849, vol. xliii, p. 640.
ORGANS OF CIRCULATION. #
HEART, Ganglia and Nerves of LEE (Robert). Phil. Trans., 1849, p. 43.
Investing Fibrous Membrane or Fascia of LEE (Robert), Med. Gaz.,
1849, vol. xliv, p. 224. Movements of, under the Receiver of an Air-Pump.
TIEDEMANN (F.) Lancet, August 25, 1849, p., 201: . From Müller's
Archiv., 1847. Sounds of Experimental Inquiry into Causes of BRAKYN
(Harris C.) Lancet, Nov. 24, 1849, p. 554. . . .
WEINs of Neck, Irregular Distribution of Coote (Holmes). Ibid., Feb. 3,
,1849, p. 124. - - A
CIRéulation of the Blood, on the Causes of BIGGER (Dr.) Dub. Med. P.,
April 4, 1849, vol. xxi, p. 209. ... ', -
ORGANS OF RESPIRATION.
LUNgs, Structure and Functions of WILLIAMs. (Thomas). Lancet, 1849,
vol. i., p. 92: vol. ii, pp. 70, 141 : 1850, vol. i., pp. 440, 528. Minute
Structure of, in Man, and the Principal Mammiferous Animals. Ros-
sIGNoL (M. le Dr.) Edin. Med. and Surg. J., July 1849, vol. lxxii, p. 88.
* | From Mém, des Concours et des Savants Etrangers publiés par l'Acad.
tº Roy. de Méd. de Belgique, tome i, Bruxelles, 1847. ‘Of Bird, minute
**Anatomy of RAINEY. (G.) Med.-Chir. Trans., 1849, vol. xxxii, p. 41 :
Hºstandi Lond. Journſ of Med., Jan. 1849, vol. i., p. 110. Air-Cells of, Minute
2 & Anatomy of HALL (C. Radclyffe). Prov. M. and S. Journ, Feb. 7,
1849, p. 743 t; 2
REspinArion, Movements of, Physiological and Pathological Phenomena con-
nected with : Synchronous Action of Lungs in New-Born Children.
TRAYER (J. J.) Med. Gaz., March 1, 1850, vol. xlv., p. 372. Excited
tand Mpdified º BARLow (W. F.), Lancet, June 23, 1849,
, #3 e 2 ; : * * * Éd ! # 24 *
i p.ºſ. and Méd. Gaz, July 20, 1849, vol. xliv, p. 97.
BRITISH AND AMERICAN JOURNALS. 97.3
NERVOUS SYSTEM. * } .
NERVous System, Physiology and Diseases of. B. and F. Med. Rev., Jan.
1850, vol. v., p. 1. Supplement to Mr. A. Walker's Essay on. LAING
(Thomas). Lancet, June 9, 1849, p. 610. Diastaltic Nervous System:
Croonian Lectures for 1850. Hall (M.) Lancet, vol. i., 1850, pp. 469,
495, 521, 554, 615, 649.
BRAIN, the Sole Centre of the Human Nervous System. IEE (Edwin). Edin.
Med. and Surg. J., Jan. 1849, vol. lxxi, p. 60. Usé of White and Grey
Matters of Swan (Joseph). Med. Gaz., May 17, 1850, vol. xlv., p. 845.
SPINAL CoRD. Swan (Joseph). Ibid., April 19, 1850, vol. xlv., p. 669.
Art of making Transparent Preparations of, for shewing the Roots of
Nerves. Swan (J.) Ibid., Oct. 12, 1849, vol. xliv, p. 615. Abs. in Lond.
Journ, of Med., Dec. 1849, vol. i., p. 1145; also Med. Gaz., Dec. 7, 1849,
vol. xliv, p. 967.
NERvous CIRCLE of Sir C. Bell. HALL (M.) Lond. Journ. of Med., July
1849, vol. i., p. 613.
CHoRoi D PLExUs: Considerations tending to prove that it is the Organ of
Sleep., OSBornE (Jonathan). Med. Gaz, June 8, 1849, vol.xliii, p. 977.
PACINIAN CoRPuscles; Nervous Papilla of Water. STRAHL (J. Carl). Edin.
Med. and Surg, J., Jan. 1850, vol. lxxiii, p. 118,
EYE, Anatomy and Physiology of Oblique Muscles of, in Vertebrate Animals,
STRUTHERs (John). Edin. Month. Journ., Oct. 1849, vol. iii, N. S.,
p. 1143, Dimensions and Refractory Power of For BEs (J, D). Good-
sir's Annals, Feb. 1850, p. 44. º
RETINA, Luminous Spectra excited by Pressure on, and their Application to
the Diagnosis of the Affections of WALLER (Augustus). Edin. Med.
and Surg. J., April 1849, p. 337. Abs, in Lond. Journ. of Med., May
1849, p. 495. –3
Ocular SPECTRUM, indicating a Slight Obliquity of the Lens with respect to
the Axis of the Eye-Ball. MacdoxAld (J. D.) Med. Times, July 7,
1849, vol. xx, p. 5.
OPT icAL ExPERIMENT: means of Ascertaining the Relative Power of the Eye,
and indicating the first Onset of Morbid Changes interfering with Vision.
MAcDoNALD (J. D.) Ibid., Sept. 1, 1849, vol. xx, p. 176.
ORGAN of HEARING, Development and Comparative Anatomy of MAcDonald
(J. D.) Med. Gaz, April 13, 1849, Vol. xliii, p. 637. Abs, in Lond.
Journ; ºf Med., Sept. 1849, vol. i. p. 869, .
Coch LEA, Office of, as the Special Organ for the Mental Discrimination of the
Pitch and Agreements of Musical Sounds., MacDosald (J. D.) Med.
Times, July § and Aug. 11, 1849, vol. xx, pp. 70, 113. g
ToNGUE, Distribution of the Nerves of the. Bourgery (M.) Lond. Journ. of
Med., April 1849, vol. i., p. 358. From Gazette Médicale de Paris, Dec.
16, 1848. rºº &
Tough, Sense of: its Relation to the Vitality of the Blood. STUART (H. L.)
Lancet, May 5, 1849, p. 477. *
.* REPRoduction. <!
PENis, Membranous Sheath of Buck (Gurdon). Amer. Journ. of Med.
Sc., Jan. 1849, vol. xvii, N. S., p. 249. From Transactions of American
Med. Assoe., vol. i., p. 367. Abs. in Lond. Journ. of Med., 1849, p. 360.
GENERATION and Development of the Invertebrate Animals. Owen (Richard).
Med. Times, 1849, vol. xix, pp. 503, 523, 545, 579, 615, 651 : vol. xx,
pp. 43, 83, 131, 191, 371,411 : 1850, vol. xxi, pp. 91, 171,231, 411.
PARTHENOGENEsis, Lecture on. Owen (Richard). Ibid., April 14 and 21;
1849, vol. xix, pp. 467 and 483.
: , , * MISCE L LANE GUS. . . . . .
Lectures on the Question, Whether New Species of Organized Beings have
Appeared since the Creation of Man? Forbes (E) Ibid., ‘March 10,
1849, vol. xix, p. 373. 64 2
j4
.
974 CLASSIFIED CATALOGUE,
;
RACEs of MEN, Lectures on. KNox (Robert). Ibid., 1849, vol. xix, pp. 247,
315. Contrast between the Bones of the Skull and Face of the Celt and
Saxon. Massy (R.T.) Ibid., Jan. 13, 1849, vol. xix, p. 232. Contrast
between the Conformation in the Foot of the Celt and the Saxon. MAssy
(R. T.) Ibid., Feb. 3, 1849, vol. xix, p. 285.
Monstrosities, account of some. REId (John). Goodsir's Annals, Feb.
1850, p. 27.
MisDEVELOPED Lower ExtREMity, Anatomy of BRINToN (W.) Med.
Times, Sept. 8, 1849, vol. xx, p. 195.
THoRACIC and Abdominal Viscera, Case of Transposition of CLAPP (W.)
Med. Gaz., Jan. 25, 1850, vol xlv., p. 145.
URINARY BLADDER, Case of Malformation of McWHINNIE (A. M.) Ibid.,
March 1, 1850, vol. xlv., p. 360.
RAPID Decomposition of Human Body: Remarks on Putrefaction, and alleged
effects of Lime in accelerating that Process. TAYLoR (A. S.) Ibid.,
Jan. 5, 1850, vol. xlv., p. 17.
CAMEL, Anatomy of the Foot of HARRIsoN (Professor). Dub. Med. P.,
April 11, 1849, vol. xxi, p. 225.
CHEMIco-GE LATINoUs Injection: its Employment in Anatomical Preparations.
GoADBY (Henry). Lancet, March 17, 1849, p. 287.
CHAPTER W.
MATERIA MEDICA AND PHARMACY.
MATERIA MEDICA, Lectures on, at Royal College of Physicians. BIRD
(Golding). Med. Times, 1849, vol. xix, pp. 487, 565, 6i/, 635: vol. xx,
pp. 24. 136.
GENERAL THERAPEUTIGs, Lectures on. MAcLAGAN (D.) Edin. Month. Journ.,
March, April, and May, 1850, vol. i., 3rd S., pp. 272, 352, and 463.
CHEMISTRY of THERAPEUTics. Review of Pereira, Trousseau, Mialhe, Garrod,
and G. Bird. B. and F. Med.-Chir. Rev., April 1849, vol. iv, p. 285 :
July 1849, vol. iv, p. 128.
PHARMAcoPOETA, National Decimal, Suggestion for a. HALL (Marshall).
Edin. Month. Journ., Jan. 1849, vol. iii, N. S., p. 441. Abs. in Lond.
Journ. of Med., Feb. 1849, vol. i., p. 209.
FERMENTed Preparations or Wines. LANE (Butler). Lancet, July 7, 1849, p. 13.
ADANsonIA DIGITATA and Adansonine, substitutes for Cinchona Bark and
Quinine. DUCHAssaing (Dr), and HEPBURN (R.) Lond. Journ. of
Med., Jan. 1849, vol. i., p. 102.
ALcohol, Methyle, Amyle, Cyanogen, and Ammonia. MUSPRATT (Sheridan).
Med. Times, Oct. 20, 1849, vol. xx, p. 317.
ALMond-OIL as a Substitute for Cod Liver Oil. DuNCAN (P. M.) and NUNN
(R. S.) Prov. M. and S. Journ., March 20, 1850, p. 164. Abs. in Lond.
Journ. of Med., April 1850, vol. ii, p. 398. ,
ALUM, improved use of: New Method of using Gargles. MURRAY (Sir J.)
Dub. Med. P., Jan. 24, 1849, vol. xxi, p. 52. º
CAMPHoR, Solution of, in Chloroform. SMITH (T. and H.) Lond. Journ. of
Med., Jan. 1849, vol. i., p. 102. From Edin. Month. Journ., Nov. 1848.
CHLoRoRo RM, and Strong Chloric Ether, Effect of as Narcotic Agents.
WARREN (J. C.) Med. Gaz, April 20 and 27, and May 6, 1849, vol.
xliii, pp. 679, 712, and 755. Chloroform, Preparation of KING (James).
Lancet, June 16, 1849, p. 641. Purification and Properties of GREgo Ry
(W.) Edin. Month. Journ., May 1850, vol. i., 3rd S., p. 414.
CINCHONA Harvest. Von Tschudi (Dr.) Lond. Journ. of Med., March
1849, vol. i., p. 287. From Travels in Peru.
Collopron, History, Preparation, Properties, and Mode of Application of
Lond. Journ. of Med., Feb. 1849, vol. i., p. 206.
BRITISH AND AMFRICAN JOURNALS. 975
*
ETHER Glue, or Liquor Constringens. SchoeNBeis (C. F.) Lancet, March
17, 1849, p. 289. Abs. in Lond. Journ. of Med. 1849, vol. i., p. 382.
Electric and Magnetic Fluids. STEvenson (W. F.) Lancet, June 8,
1850, p. 693.
Electro-MAGNETic Machine with Single Coil, and Counter-Inductive Tube.
WRGBT (Thomas). Edin. Month. Journ., Feb. 1850, vol. i., 3rd S., p. 127.
IRoN and Alumina, New Salt of MURRAY (Sir G.) Dub. Med. P., March
14, 1849, vol. xxi, p. 162,
LEECH, Mechanical, Apparatus for Applying. Tweed (J. J.) Med. Times,
Jan. 19, 1850, vol. xxi, p. 36.
MAGNESIA, Citrate of LARBAUD (M.) Lond. Journ. of Med., April 1849, vol. i,
p. 381. From Rép. de Pharm., Feb. 1849.
PRUNus VIRGINIANA, Observations on Bark of. MACLAGAN (D.) Edin. Month.
Journ., April 1850, vol. i., 3rd S., p. 375.
QUININE, Method of depriving, of its Bitterness. THoMAs (R.H.) Amer.
Journ. of Med. Sc., April 1850, vol. xix, N. S., p. 541.
Silver, Nitrate of, removal of Stains of Collins (Thomas). Dub. Med. P.,
August 8, 1849, vol. xxii, p. 83.
SULPHUR, on the Adulteration of BAGoT (Dr.) Ibid., Dec. 12, 1849, vol.
xxii, p. 369.
CHAPTER VI.
HYGIENICS.
PUBLIC Hygiene, Lecture on. Royer-Collard (M.) Med. Times, 1849,
vol. xix, p. 333.
TEA and CoFFEE : Influence upon Health of their Introduction in large pro-
portion into the Dietary of Children and the Labouring Classes. JACKso N
(Samuel). Amer. Journ. of Med. Sc., July 1849, vol. xviii, N. S. p. 79.
SEMOLA as an Article of Diet. BULLock (Lloyd). Lancet, Dec. 15, 1849, p.
627: March 9, 1850, p. 293.
WATER supplied to London and Suburbs, Organic Analysis or Microscopic
Examination of HAssALL (A. H.) Ibid., Feb. 23, 1850, p. 230.
WINDs, Influence of, on the Human Constitution. ATKINso N (J. C.) Lancet,
vol i, 1849, pp. 207, 318, 533; vol. ii, p. 91. Influence of, in producing
Disease. DRUMMOND (James). Ibid., April 14, 1849, p. 410. Levison
(J. L.) Ibid., June 23, 1849, p. 682.
HEATING AND VENTILATING Hospitals and other Buildings by Steam and Hot
Water. KIRKBRIDE (T. S.) Amer. Journ. of Med. Sc., April 1850, vol.
xix, N. S., p. 298. * *
SEA-LIFE, Influence of, upon Health. McSHERRY (R.) Amer. Journ. of
Med. Sc., Oct. 1849, vol. xxiii, N. S., p. 404.
ClFANLINEss, Personal and Domestic, primary influence of, in the Prevention
of Typhus, Cholera, etc., compared, with that of the Removal of Sewers,
Cesspools, etc. DAvidson (W.) Edin. Month. Journ., Feb. 1849, vol.
iii, N. S., p. 512. - f
MoRTALITY of the People of England, Inquiry into the Law which governs it.
Edmonds (T. R.) Lancet, March 9 and 16, 1850, pp. 297 and 328.
SANITARY STATE of Metropolis, Suggestions, for Improvement, of. MERRY-
weATHER (G.) Med. Gaz., April, 19, 1850, vol. xlv., p. 694,
MALTA, Climate of, considered with reference to the Diseases of the Natives,
English Residents, and Invalids. WELls (T. S.) Ibid., 1849, vol. xliii,
pp. 17, 110.
CHAPTER VII.
F O R E N S I C M E D I C IN E.
TOXICOLOGY. A. "
CHEMISTRY of Poisons, or Practical Toxicology, Lectures on ; Shewing the
Applications of Chemistry to the Discovery of Crime. LETHEBYi (H.)
Med. Times, 1849, vol. xx, pp. 1, 22, 49, 103, 134, 171,211, 231,391,
447, and 499: 1850, vol. xxi, pp. 31, 71, 132, 251, 291.
976 * : ' ' CLASSIFIED OATALOGUE.
E}{PEREMENTs performed by MM. Magendie and Bernard in the College of
* France. “ANDERson § H.) Amer. Journ. of Med. Sc., Oct. 1849, vol.
xviii, N. S., p. 368. (This paper contains the results of experiments on
the toxicological effects of strychnia, nicotine, Prussic acid, opium, digitalis,
quinine, arsenic, and ether.)
Poiº Actions of BLAKE (James). Ibid., July 1849, vol. xviii, N. S.
p. 97.
Poison ING, Cases of, with remarks. ILIFF (W. T.) Lancet, Dec. 1 and 15,
1849, pp. 574 and 630. Accidental Poisoning, Case of: Life saved by
Neutralizing'a Corrosive Acid, and Subduing Subsequent Inflammation.
MuRRAY (Sir J.) Dub. Med. P., Feb. 21, 1849, vol. xxi, p. 113. Irritant,
Symptoms of: Death: Failure of Chemical Analysis to detect Poison.
MACLAGAN (D.) Edin. Month. Journ, March 1849, vol. iii, N. S. p.
574.
ALcohol, Poisoning with. Williamson (W.) Med. Times, March 17, 1849,
vol. xix, p. 395.
ALMonds, Essential Oil of, Poisoning by. ILIFF (W. T.) Lancet, Dec. 1, 1849,
. 575.
Anº Solution of, Poisoning by: Recovery. ILIFF (W. T.) Ibid., Dec.
1, 1849, p. 575.
ANTIMony, Potassio-Tartrate of, Fatal Poisoning by. Pollock (J. E.) Med.
Gaz., May 10, 1850, vol. xlv, p. 801.
ARSENIC, Results of Experiments on, by MM. Magendie and Bernard.
ANDERson (W. H.) Amer. Journ. of Med. Sc., Oct. 1849, vol. xviii,
N. S., p. 375. Discovery of Two Antidotes to Poisoning by. CATTell
(Thomas). Lancet, Jan. 5, 1850, p. 15. In Agriculture. FULLER (W.
H.) Lond. Journ. of Med., Jan. 1849, vol. i., p. 103. From Lancet. In
Sulphuric Acid. Davis (A. W.) Prov. M. and S. Journ., Dec. 26, 1849,
p. 718. In Unfermented Bread. Med. Gaz., Feb. 22, 1850, vol. xlv, p.
347. Abs. in Lond. Journ. of Med., Feb. 1850, vol. ii, p. 191 ; also Ibid.,
April 1850, p. 380. Observations on Sale of, and on Prevention of Secret
Poisoning. TUNSTALL (J.) Prov. M. and S. Journ., August 22, 1849,
p. 467. Cases of Poisoning by. DE BARTolomé (M. M.) Ibid., Feb.
7, 1849, p. 72. KNoTT (G. A.) Lancet, July 7, 1849, p. 1. Case:
Recovery. CoRNISH (W. R.) Ibid., Jan. 18, 1849, p. 35. Case:
Narcotic Symptoms prominent at commencement. MoREHEAD (C.)
Med. Gaz., June 15, 1849, vol. xliii, p. 1055. From Trans. of Bombay
Medical Society. Case: Death in thirty-six hours: Influence of Arsenic
on Digestion: Remission of Symptoms. GREAVEs (A. C.) Med. Gaz.,
April 19, 1850, vol. xlv., p. 677. Case: SILíIMAN (B.) , Ibid., May 10,
1850, vol. xlv., p. 831. From British Amer. Journ. Trial and Conviction
for Poisoning by. Edin. Month. Journ., March 1850, vol. i., 3rd S. p. 289.
Detected in the Remains of a Dead Body Fourteen Years after Interment.
WEBSIER (J. W.) Med. Gaz., May 25, 1849, vol. xliii, p. 894. Detected
in a Body after Eight Years' Interment. Ibid., July 27, 1849, vol. xliv,
“p. 168. - g
Assº. of CoPPER in Confectionary, Poisoning by. FERGUs (Walter).
* Ibid., Feb. 16, 1849, vol. xliii, p. 304. Bulley (F. A.) Med. Times,
* “April 28, 1849, vol. xix, p. 507. #
BELLADon NA, Poisoning by. Idiff (W. T.) Lancet, Dec. 1 and 15, 1849,
* pp. 576; and 631. Tº * J
BRAssica NApus or Wild Corn Kale, Toxicological Effects of Popham
ºi (John). Ibid., Dec. 15, 1849, p. 635. Abs. in Lond. Journ. of Med.,
' '''Feb. 1850, vol. ii, p. 192.
CANT HARIDEs, Acquittal on a Charge of Administering. Med. Gaz., Dec. 28,
ºf 1849, vol. xliv, p. 1105. Powdered, two cases of Poisoning by. SAUNDElts
'(G.) Med. Times, Feb. 3, 1849, vol. xix, p. 287.
CAR Bosic Acid, Poisoning by : Recovery. THoAIPson (Henry), Dub. Mod
' ' 'P., Jaa, 31, 1849, vol. xxi, p. 69. **
$
BRITISH AND AMERICAN JOURNALS. 97%
CAYENNE PEPPER, Poisoning by. SNAPE (R. F.) Méd. Times, May 12, 1849,
vol. xix, p. 553. Inflammation and Ulceration of Stomach from. Pickop
(Eli). Prov. M. and S. Journ., Feb. 20, 1850, p. 93.
CHLoRoroRM, Death from, during a Surgical Operation. . Solly (Samuel).
Med. Gaz., Nov. 2, 1849, vol. xliv. p. 757. Alleged Death from, at Leeds.
Ibid., Nov. 16 and 23, 1849, vol. xliv, pp. 804 and 905. Death from, in
Jamaica. Edin. Month. Journ., April 1850, vol. i., 3rd S., p. 377. From
Jamaica Despatch. Unintentional Suicide by. JEFFBEYs (J.), Edin,
Month. Journ., March 1850, vol. i., 3rd S., p. 287. From Boston M, and S.
Journ. Discussion on deaths front, in the Académie de Médecine of Paris.
Lond. Journ. of Med., March 1849, vol. i., p. 303. Remarks on. SNow
(John). Ibid.; April 1849, vol. i., p. 324. On Fatal Cases of Inhalation
of SNow (John). Edin. Med. and Surg. J., July 1849, vol. lxxii, p.
75; and Lond. Journ. of Med., Nov. 1849, vol. i., p. 1062. Effects of, as
a Narcotic Agent. WARREN (John C.) Amer. Journ. of Med. Sc., April
1849, vol. xvii, N. S., p. 379. [An examination of the fatal cases which
had resulted from the use of Chloroform.] New Method of Remedying
Accidents caused by. RicoRD (M.) Lancet, Feb. 16, 1850, p. 209.
CINNAMon, Poisonous effects of Essential Oil of MITschERLIGH (G. C.)
Med. Gaz, Nov. 23, 1849, vol. xliv, p. 911. From OEsterr. Wochenschrift.
CoALs, Smoke of, Danger of Exposure to. TAYLER (M. W.) Med. Gaz., June
1, 1849, vol. xliii, p. 937. &
CoLou RED ConFECTIONARY, cases of Poisoning by: Remarks. LETHEBY (H.)
Med. Times, June 1, 1850, vol. xxi, p. 399. See also Arsenite of Copper.
CREASOTE, case of Poisoning by. MACNAMARA (Mr.) , Dub. Med., P., March
7, 1849, vol. xxi, p. 150,
CRoton OIL applied to Human Hair, Effects of KING (George). Prov. M.
and S. Journ, Feb. 21, 1849, p. 98.
DIGITALIS PURPUREA, Poisoning by Root of EDWARD (James). Lancet,
July 14, 1849, p. 31. Recovery from Large Dose of. DE ColleviLLE (M.)
Med. Gaz., May 11, 1849, vol. xliii, p. 835. From Journ. de Méd. de
Bourdeaux. Tincture of, influence of Large Doses of in Cases of Insanity.
JoNEs (G.M.) Med. Times, May 19, 1849, vol. xix, p. 568.
ETHER, Results of Experiments on by MM. Magendie and Bernard. ANDER-
son (W.H.) Amer: Journ. of Med. Sc., Oct. 1849, vol. xviii, N. S.,
p. 375. Deaths from Inhalation of. Eve (R. F.) Ibid., July 1849, vol.
xviii, N. S., p. 293. From South. Med, and Surg. J., June 1849.
GUANo, presumed, Poisonous Effects of WEARNE (J.) Lancet, June 29,
1850, p. 774. . . . . * x
HYDRocBLoRIC Acid, Poisoning by: Recovery: Carbonate of Soda as an An-
tidote. Med. Gaz., Dec. 28, 1849, vol. xliv, p. 1098.
HYDRocyANIc Acid, Results of Experiments on, by MM. Magendie and
Bernard. ANDERSON (W. H.) Amer. Journ. of Med. Sc., Oct. 1849,
vol. xviii, N. S., p. 370. Poisoning by, Case illustrative of Treatment
and Fatal Dose. CHRISTIson (R.) Edin. Month. Journ., Feb. 1850,
vol. i., 3rd S., p. 97. Abs. in Lond. Journ. of Med., April 1850, vol. ii,
. 397. ~ ;
Leº PoisonING at Claremont. Mussy (H. Gueneau De), Dub. Quart. J.,
May 1849, vol. vii, N. S., p. 405. Same author in Arch. Gén. de Méd.,
July 1849, p. 283. Case: Recovery. DALTon (J. C.) Amer. Journ. of
Med. Sc., Oct. 1849, vol. xviii, N. S., p. 356. Flour, Poisoned with, at
Stourbridge. BANCKs (Thomas). Lancet, May 5, 1849, p. 478. NoHRIs
(W.) Ibid., August 25, 1849, p. 205. Sulphate of, Toxicological Pro-
perties of PLEIsch L (Dr.) Med. Gaz., Dec. 14, 1849, vol. xliv, p. 973.
. From CEsterr. Medicin. Jahrbücher. r . . ;
LIME, Action of, on Animal and Vegetable Subsances. Davy (John). - Med.
Gaz., Jan. 25, 1850, vol. xlv., p. 172. From Jameson's Edint Journal.
LobellA INFLATA, Case of Poisoning by : Trial. Med. Gaz., August 31, 1849,
vol. xliv, p. 383. Supposed Death from, at Northampton: Inquest. Prov.
M. and S. Journ., June 26, 1850, p. 355.
978 . CLASSIFIED CATALOGUE.
Nicotin.E, Experiments on by MM. Magendie and Bernard. ANderson
(W. H.) Amer. Journ of Med. Sc., Oct. 1849, vol. xviii, N. S., p. 369.
Nux Wom IcA, Poisoning by : Recovery. ILIFF (W. T.) Lancet, Dec. 15,
1849, p, 630.
OPIUM, Experiments on, by MM. Magendie and Bernard. ANDERson (W. H.)
Amer. Journ. of Med. Sc., Oct. 1849, vol. xviii, N. S., p. 371. Habitual
Use of LITTLE (R.) Edin. Month. Journ., June 1850, vol. i., 3rd S.,
p. 524. CHRISTIsoN (R:) Ibid., p. 531. Poisoning by : Successful
Treatment by Electro-Galvanism. ILIFF (W. T.) Lancet, March 24,
1849, p. 314. Tincture of Cases of Poisoning by. Iliff (W. T.) Lancet,
Dec. 1, 1849, p. 574. Case, in the advanced stage, successfully treated by
Bleeding. HUGHEs (James S.) Dub. Quart. J., Nov. 1849, vol. viii,
N. S., p. 446. Poisoning by: Detection of Morphia: Absence of Meconic
Acid in Fluid Contents of Stomach. OSBoRN (H.) Med. Times, March
17, 1849, vol. xix, p. 397.
OxALIC ACID, Case of Accidental Poisoning by. Med. Gaz., March 30, 1849,
vol. xliii, p. 569. Poisoning by : Detection in the Heart. Osborn (H.)
Med. Times, Feb. 16, 1850, vol. xxi, p. 115.
QUININE, Experiments on by MM. Magendie and Bernard. ANDERson (W.
H.) Amer. Journ of Med. Sc., Oct. 1849, vol. xviii, N. S., p. 372.
RHUs WENENATA or Poison-Sumach, Effects of STRATTon (Thomas). Edin.
Med. and Surg. J., April 1850, vol. lxxiii, p. 327.
RUMEX ACETosa, Injurious Effects of HANKS (Henry). Med. Gaz., June
22, 1849, vol. xliii, p. 1094.
STRYCHNIA, interesting Experiment with by Professor Agassiz. WELLs (David).
Amer. Journ. of Med. Sc., April 1850, vol. xix, N. S., p. 547. Results of
Experiments on, by MM. Magendie and Bernard. ANDERson (W. H.)
Ibid., Oct. 1849, vol. xviii, N. S., p. 368. Poisoning by, relieved by Chlo-
roform. DRESBACH (Dr.) Ibid., April 1850, vol. xix, N. S., p. 546.
SULPHURIc Acid, Case of Poisoning by. WALKER (John). Edin. Month.
Journ., June 1850, vol. i., 3rd S., p. 538.
VERDIGRIs intermixed with Food : Acute Inflammation of Stomach and Bowels.
MooRE (Mr.) Med. Gaz, Sept. 21, 1849, vol. xliv, p. 487.
ZINC, Chloride of, Cases of Poisoning by. STRATToN (Thomas). Dub. Med.
P., Jan. 3, 1849, vol. xxi, p. 7. From Brit. Amer. Journ.
MISCELLANEOUS. TRIALS AND INQUESTS,
DEATH from Injury of Head, Medico-Legal Report on Case of. EASTo N
(J. A.) Edin. Month. Journ., March 1849, vol. iii, N. S., p. 586.
ALLEGED MURDER from Wounds of Genital Organs in a Female. Ogston
(F.) Med. Gaz., Nov. 9, 1849, vol. xliv, p. 813.
ALLEGED RAPE and Murder. OGSTON (F.) Ibid., Jan. 4 and 11, 1850, vol.
xlv., pp. 38 and 72.
HoMoEoPATHY, Alleged Case of Manslaughter by : Trial. Ibid., Nov. 2, 1849,
vol. xliv, p. 773.
MALAPRAxis : Death and Inquest. PEARson (J.) Lancet, May 5, 1849.
p. 475.
HomncIDE or Suicide, Case involving question of Robbs (W.) Med. Gaz.,
Sept. 7, 1849, vol. xliv, p. 414.
PSYCHO LOGY.
CoNNEXION between Physiology, Psychology, Natural Theology, and other
Sciences. Ogilvie (G.) Psych. Journ., April 1849, vol. ii, p. 309.
LETTER to Lord Chancellor from Commissioners in Lunacy, with Reference to
their Duties and Practice. Iljd., Oct. 1849. vol. ii, p. 608.
I.Aw of LUNAcy, Report of Society for promoting Amendment of Ibid., Jan.
1849, vol. ii, p. 178. Amendment of Robinson (George). Med. Gaz.,
Sept. 14, 1849, vol. xliv, p. 448.
BRITISH AND AMERICAN JOURNALS. 979

CRIME, Analysis of Horne (R. H.) Psych. Journ., Jan. 1850, vol. iii, p. 94
JUVENILE DELINQUENCY and Degeneration in Upper Classes of Society. BUSH
(W. M.) Ibid., July 1849, vol. ii, p. 428.
HUMAN MIND, considered in some of its Medical Aspects. HARRIsoN (J. B.)
Ibid. April 1850, vol. iii, p. 246.
MADNEss as treated by Shakspeare. HoRNE (R. H.) Psych. Journ., Oct.
1849, vol. ii, p. 589.
CoMMissions in Lunacy: Cases, Ibid., July 1849, vol. ii, p. 468 et seq.
INSANITY. Croonian Lectures for 1849. Conolly (John). Lancet, vol. ii,
1849, pp. 387,415,443, 469,495, 521. Medico-Legal Relations of B.
and F. Med. Chir. Rev., April 1850, vol. v., p. 372. Impulsive Insanity:
the French Vampire. SIGMOND (G. G.) Psych. Journ., Oct. 1849, vol. ii,
p. 577. Partial Insanity. BRough AM (Lord). Ibid., April 1849, vol. ii,
p. 323. (From the Jurist.) Transient Insanity. Ibid., April 1849, vol. ii,
p. 329. Puerperal Insanity, Statistics, Pathology, and Treatment of.
WEBSTER (John). Lond. Journ. of Med., Oct. 1849, vol. i., p. 971.
PLEA of Insanity: Reports of Criminal Cases. Psych. Journ., April 1849,
vol. ii, p. 331 et seq.
INSTINCTIVE IMPostume, Cases of Kinglake (Hamilton). Edin, Month.
Journ., Jan. 1850, vol. i., 3rd S., p. 36.
SUPPosED DEMonTACAL PossEssion, Case of Psych. Journ., July 1849, vol. ii,
p. 462: and April 1850, vol. iii, p. 262.
Double Consciousness connected with Hysteria, Case of WARD (T. O.)
Ibid., July 1849, vol. ii, p. 456.
TRANCE, or Human Hybernation. BRAID (James). Med. Times, 1850, vol.
xxi, pp. 351, 401, 416.
NERvous, Spasmodic, and Convulsive Diseases, Psychology of SMITH (W.)
Med. Gaz., May 10, 1850, vol. xlv., p. 795, 976.
CRETINISM in Switzerland. Coldstream (Dr.) Edin. Month. Journ., June
1850, vol. i., 3rd S., p. 594. §
MENTAL DISEASE, Causes and Morbid Anatomy of WEBSTER (John). Med.-
Chir. Trans., 1849, vol. xxxii, p. 115; and Lond. Journ. of Med., July 1849,
vol. i., p. 686. Pathological Appearances observed in the Bodies of the
Insane. HITCHMAN (John). Psych. Journ., April 1850, vol. iii, p. 228.
BRAIN, Essential Pathological Conditions of, in Insanity. PALMER (Edward).
Lancet, August 4, 1849, p. 119. Softening of, from Anxiety and Undue
Mental Exercise, resulting in Impairment of Mind. WINSLow (Forbes).
Monograph in Psych. Journ., July 1849, vol. ii. Abs, in Lond. Journ. of
Med., Aug. 1849, vol. i., p. 776.
Blood in Neuroses, Chemical Investigation of MICHéA (M.) Trans. of
Memoir presented to Acad. of Sciences at Paris. Psych. Journ., Jan. 1849,
vol. ii, p. 118.
LUNAcy AND LUNATIC ASYLUMs, Present State of: Nature and Treatment of
Mental Derangement. SMITH (W.) Med. Gaz., vol. xlv., p. 58,271,
316, 447, 627.
Medical Topog RAPHY, as connected with the Choice of a Site for a Lunatic
Asylum in a Tropical County. MACFADYEN (James). Edin. Med. and
Surg. J., Jan. 1849, vol. lxxi, p. 114.
INSANE, Practical Observatious on the Treatment of SMITH (William). Med.
Gaz., Feb. 2, 1849, vol. xliii, p. 189: vol. xliv, pp. 464, 708, 846, 1007.
Solitary Confine MENT, Effect of, on Insane. WINslow (F.) Psych.
Journ., Jan. 1849, vol. ii, p. 115.
SEDATIVE TREATMENT of Insanity. Psych. Journ., April 1849, vol. ii, p. 319.
Opium as a Therapeutic Agent in Insanity. MichéA (M.) Lond. Journ. of
Med., April 1849, vol. i., p. 392. From l’Union Médicale, 15 Mar. 1849.,
CRETINISM, Treatment of. GUGGENBUEHL (Dr.) Lond. Journ. of Med.,
April 1849, vol. i., p. 388. From Annales Méd.-Psych, Nov. 1848.

cRITIcAI, DIGEST of THE BRITIs H AND For BIGN MEDICAL
} Journals.
ANATOMY AND PHYSIOLOGY.
MR. H. GRAY ON THE DEVELOPMENT OF THE RETINA AND OPTIG NERVE.
The following observations are intended to demonstrate the evolution and
mode of development of the Retina in the embryo chick, and they will, I
think, confirm in a most striking manner the account that has been given
of the structure of this part by Mr. Bowman, in his Lectures on the Anatomy
of the Eye. - i
DEVELOPMENT OF THE RETINA. It is not until the thirty-third hour of
the incubation of the chick, that there is any indication of the evolution of
the Retina or of the rudimentary eye. At the thirty-firsthour, the cephalic
extremity of the embryo is indicated by a slight dilatation, but no protrusion
can be observed in the situation where the eye is to be formed. At the
thirty-third hour, there is, on each side of the cephalic extremity, a protru-
sion of its walls. At the thirty-sixth hour, this has become elongated and
protruded outwards, presenting a somewhat dilated end, and being slightly
constricted at its connexion with the cerebral cell from which it arises.
The whole embryo is now enlarged, and there is a distinct division of the
brain into its several primitive cells ; this protrusion is the first distinct
indication of the mode of development of the Retina. In a chick, examined
at the forty-sixth hour, from the cerebral aspect, the future brain consisted
of several cells; the anterior, which was the largest, corresponded to the
cerebral lobes; the middle, smaller in size, to the future optic lobes; and
the posterior, the smallest, but most elongated, to the medulla oblongata.
From the most anterior one, there arose a protrusion on each side, having a
somewhat dilated extremity: this protrusion I will call the optic vesicle.
The cavity of the cerebral cell, from which it arose, was very distinct, and
its wall clear and pellucid, appearing to communicate with the optic vesicle,
which was also hollow. - * ... ...
As the cavity of the cerebral cell passed outwards into the optic vesicles,
it became less distinct, the wall of the vesicle being darkly, granular, whilst
the cavity in the cerebral cell itself was distinctly seen, fróin the thinness of
its wall on its ventral aspect. If the embryo be examined from its dorsal
surface (its natural position in the egg), the cerebral Gell presents an external
convex surface, whilst, projecting from each side, are seen the optic vesicles.
The cavity of the cell, and its communication with the optic vesicle, cannot
of this surface be distinctly demonstrated, on account of its wall being
thicker than on the ventral side. The optic vesicle is bounded externally
by a well-defined line, which lines the outer surface of the protrusion, and
seems to be connected with the envelopes of the cerebral mass ; this is again
bóünded by the tegumentary layer of the embryo. When examined with a
high magnifying power, the vesicle presented a pale granular texture without
º indication of cellular structure. This description of the origin of the
Rétifia, although confirmed by similar observations, described by Baer in the
Encyclopédie Anatomique, tom. viii., is not in accordance with that of
Wägner and Huschke. From many observations, I could never see what
these observers have described; and my conclusions regarding the origin of
the Retina would seem to be confirmed by the coincidence of my observations
with those of Baer. On examining a chick at the fifty-fifth hour of incu-
bation, the cavity, in the anterior cerebral cell, was much less apparent ; the
walls of the cell also now not only projected upwards but laterally, so as
partly to cover the inner portion of the protruded optic vesicle, which at the






CRITICAL DIGEST OF THE JOURNALS. 981
second day was so distinctly seen ; the head had also become more curved,
which rendered a good examination of the eye somewhat difficult. On ob-
taining a view from above downwards, the embryo..]ying on its ventral sur-
face, the outer portion of the protruded vesicle was distinctly seen, bounded
by a clear defined inner border and ari outer paler one; the dark inner one
was lost in the dark granular mass, which, by its circular form, indicated
the rudimentary eye ; the outer layer was the external tegumentary mem-
brane of the embryo. At the sixty-second hour, the optic vesicle appears
to be situated between the anterior and middle cerebral cells; this, I believe,
depends on the great increase of development of these cells, and the curved
form which the head now assumes, making its apparent origin to be from
both, as stated by Wagner. On carefully examining it, the exterior dark
line was beautifully defined all around, and presented the appearance of an
outer covering to the eyeball; in this apparent cavity was seen a pyriform
vesicle, the future Retina, presenting a distinct outline, except at its inner
side, where it became constricted and of a tubular form, and, to all appear-
ance was continuous with the cerebral mass ; this constricted portion, the
tubular end, I suppose to be the optic nerve, the dilated portion the Retina.
Internal to the Retina was the circular crystallime lens, with its central but
indistinct nucleus. Huschke describes the capsule of the lens as being an
inverted portion of the common integument, which pushes inwards the
dilated end of the optic vesicle, and thus forms a double layer; the outer
one he describes as Jacob’s membrane, the inner inverted one the true
Retina. In order to ascertain the correctness of this statement, I examined
the eye at four successive periods between the second and third days, at the
forty-eighth, fifty-fifth, sixty-second and seventy-second hours. I examined
the embryos laterally, and also on their dorsal and ventral aspects; and if
the lens had been an inversion of the integument pressing in the dilated end
of the optic vesicle, both the latter positions would have been most favour-
able for demonstrating it. The lensis, however, formed in quite a different
manner; it is first seen as a rather ill-defined granular mass in the cavity of the
vesicle itself, containing in its centre a nucleus : this is seen on the first half
of the third day. On the third day, it becomes more distinct, a well-defined
line now bounds its mārgin; between the fourth and fifth days, the granules
become darker and 'moré aggregated towards the centre, leaving a space
bounded by a dark outer line: this is now the capsule of the lens, the inner
one the bounding margin of the lens itself. Nor could I ever see satisfac-
torily any doubling-jñof the Retina so as to form two layers, for in no
position that I put the embryo, in each of the several examinations that I
made, could I ever detéét but á' single layer; and besides, as I shall show
hereafter, Jacob's membrane is not developed until a much later period.
Bischoff, on this point, says, “Je dois avouer qu'il m'a 6té impossible même
chez de très jeunes embryons de chien, de lapin, et de rat, d'apercevoir sur
la face antérieure de l’oeil aucune trace d'une semblable intromission des
téguments extérieurs, quoique dans certains cas, je sois resté incertain de
savoir s'il existait déjà une capsule cristalline et un cristallin.”
At the seventieth hour, the circular outline of the eyeball has become
quite distinct externally, and the line may also be traced internally, where
previously it was only indicated by the dark circular granular mass, the
forming eyeball. The lens is also more distinctly seen, bounded by its well-
defined circular border, indicating its forming capsule, and the nucleus in
its centre is plainly visible. When examined on its under surface, the
original protrusion is seen to have become still more pyriform in shape and
more constricted at its inner part, so that the more dilated portion now
clearly resembles the future Retina, the constricted and tubular portion the
optic nerve; the more gradual contraction of this protrusion and separation

.*
* Anatomie Encyclopédie, tom. viii, p. 324.
982 CRITICAL DIGEST OF THE JOURNALS.
of it from the cerebral mass is also now more clearly seen. The cavity,
which on the second day existed in the cerebral cell, and communicated
with the protrusion, is now closed in, with the exception of a distinct fissure,
which, commencing by curved borders at the margin of the lens, is con-
tinued inwards in the direction of the cerebral mass through the tubular
portion of the protrusion.
The fissure seems connected (as Bischoff also supposes) with the separation
which is effected between the ocular vesicle and the pedicle by which it is
connected with the cerebral cell, the fissure at first being wide, and extend-
ing as far as the anterior part of the eye, at its inferior and inner side ; but,
as the tubular portion of the protrusion becomes more solidified and con-
verted into the true optic nerve, the fissure becomes much narrowed. No
doubt this is analogous to the fissure which exists, permanently in the Retina
and optic nerve in fishes, as is seen in the cod. In the turtle the fissure
exists in the nerve, though not in the Retina; whilst in birds it appears to
be the same slit which is here described, through which the pecten gains
admission into the interior of the eye.
On the first half of the fourth day, the whole organ seemed increased in
size: the exterior lamina was distinctly continuous all round, of a dark granu-
lar texture ; the second layer, the Retina, presented a different appearance
to what was seen on the third day. It had become more spherical in shape
and increased in size ; it now appeared to commence at the margin of the
lens, which was situated at the more anterior part of the eye ; it could not
be traced around it, as in some of the preceding observations, but only over-
lapped it slightly by a thin beveled border, so that it appeared, that the
most external part of the original protruded vesicle had become absorbed to
complete the formation of this rapidly developing membrane. The tubular
portion of the original protrusion (the optic nerve), from the great develop-
ment of the cerebral mass, was hidden from view.
On the fourth day, the eye had become more spherical in form. The
outer envelope was distinct, and darkly granular; it appeared now to termi-
nate at the edge of the lens, whilst a paler line could be traced over this
body, an evident indication of the formation of the sclerotic and cornea.
The Retina was now less distinctly marked, on account of the dark granular
tinge beneath the outer envelope; from the formation of the pigment in the
epithelial cells of the choroid, it could now only be traced to the edge of the
lens, not overlapping it as in the last examination. A distinct fissure was
still perceptible on the under surface.
On the fifth day, the eye had greatly increased in size ; and, along its
under surface, the fissure was seen running, from its anterior part at the
margin of the lens, to a line which bordered the back part of the sclerotic ;
the capsule of the lens was distinctly formed, and separate from the lens
itself. Both optic nerves were seen : they were tubular in form, and pre-
sented a pale granular appearance ; they passed inwards, in the direction of
the under surface of the corpora quadrigemina ; but they were not united
together in the chiasma until the seventh day. At this period, on making a
vertical section of the organ, the Retina was, with the naked eye, distinctly ob-
served to arise from the margin of the lens, and could be detached from the
other membranes as a perfectly distinct and separate layer.
From these observations it is seen, that the Retina is originally a protru-
sion from the anterior cerebral cell, being hollow, and communicating with
its cavity; that, as the progressive development of the brain takes place,
the optic vesicle becomes more separated from its parent cell, and assumes
a pyriform shape, presenting a dilated extremity (the future Retina), and a
tubular portion (the optic nerve). In progress of development, a fissure is
observed on its under surface, which is evidently connected with the separa-
tion which is effected between the ocular vesicle and the tubular pedicle (the
optic nerve), which connects it with the cerebral cell. As this tubular pro-

CRITICAL DIGEST OF THE JOURNALS. 983
sº
longation becomes solidified, so as to form the optic nerve, no communication
can be traced between the optic vesicle and the cavity from which it is an
offset. By degrees, the spherical end of the protrusion is absorbed, and the
Retina, now fully formed, becomes attached to the margin of the lens, having
previously completely surrounded that body. The optic nerve can then be
seen not only to be connected to the anterior cerebral cell, but, uniting with
its fellow at the under surface of the optic lobes, is seen partly to terminate
in those bodies.
RETINA of THE CHICK AT THE EIGHTH DAY OF INCUBATION. The Retina
may, at this period, be distinctly separated, as a thin transparent layer from
the other membranes. Its choroidal surface appears to be composed of a
closely-aggregated mass of globular nuclei; these bodies are about the size
of the red corpuscles of the blood, and form about one-half of the entire
thickness of the membrane. They apparently correspond to the “agglomer-
ated granules', mentioned by Bowman as forming a considerable portion of
the membrane in the normal state: they are highly refractive, and of a slight
yellow tinge. The deep surface of the membrane consists of some fine granu-
lar matter, and a mass of pale and exceedingly delicate nucleated cells, pre-
cisely similar to those surrounding the meshes of the fibrous lamina in the
normal structure of the membrane. No trace, at this period, exists of either
the membrana Jacobi, or the fibrous lamina of the Retina.
DEVELOPMENT of THE MEMBRANA JACOBI. Between the thirteenth and
fourteenth days, the choroidal surface of the Retina presents an exceedingly
fine, pale, granular stratum, which covers in the ‘agglomerated granular mass'
beneath. On the fifteenth day, numerous exceedingly minute and highly-
refractive yellowish granules are imbedded in it; they vary in size, from the
5000th to the 8000th part of an inch in diameter, and around some of these
a fine delicate cell-wall can be traced. If a good view can now be obtained,
this surface presents the appearance of a delicate epithelial layer. This I
believe to be the first stage in the development of Jacob's Membrane; for,
on the eighteenth day, the cells, which were previously of a circular form,
have now become elongated,—some being of an oval shape, whilst in others
the almost perfect rod-like body is formed. They now lie in a slightly
imbricated manner, and their nuclei, which are of a bright yellow colour, are
placed at the apices of the rods: in some cases, however, they occupy the
middle of these bodies; their deep ends are larger than their choroidal ends,
and are strongly attached by this surface to the ‘agglomerated granular
layer' beneath. So intimate is their connexion, that it is difficult to get a
good view of a single rod, probably on account of their perfect separation
from this layer not having yet taken place. On the twenty-first day, Jacob's
Membrane is similar to what is seen in the full-grown bird: the rods are now
closely packed together, standing perpendicularly upwards, and all of an
elongated cylindrical form, their tips being occupied by the brilliant yellow
bodies before noticed.
DEVELOPMENT of THE FIBROUs LAMINA, The first trace of the Fibrous
Lamina is seen between the fourteenth and fifteenth days. On examining
the deep surface of the Retina at this period, it is seen to be composed of a
very fine pale granular lamina, marked by numerous faint longitudinal striae :
on the eighteenth, this lamina, when separated from the rest of the mem-
brane, is composed of numerous fibrillated bundles, which, interlacing with
each other, form numerous meshes, in which are deposited the gray nucle-
ated vesicles, which are seen as early as the eighth day. On the twenty-first
day, this lamina presents the same structure as is found in the full-grown
bird. *
The preceding observations can, I think, be applied in explanation of some
lately disputed points in connexion with the anatomy and physiology of the
Retina and Optic Nerve.
…”
984 CRITICAL DIGEST OF THE JOURNALS,
The Retina has been seen to arise as a protrusion from the cells forming
the future brain. Bowman states the vesicular layer of the Retina to be
analogous to the vesicular layer of the hemisphere of the brain, whilst Henle,
and other anatomists of great note, consider the elements of this layer to be
more analogous to epithelium. From the circumstance of the Retina arising, as
it undoubtedly does, from the cerebral cells, being in fact part of them and
performing a similar function, we have, I think, a great proof of the similarity
in the structure of these two parts. There is another point also, which proves
that the opinion of some modern anatomists is incorrect, in stating that mone
of the fibres of the optic nerve can be traced to the optic thalamus. The
origin of the retina is from the anterior cerebral cell, and, at a future period,
the optic nerve can be traced uniting with its fellow of the opposite side
beneath the optic lobes. It is in the anterior cerebral cell that the thalamus
is subsequently formed, which makes it exceedingly probable that some of
the fibres of the optic nerve are connected with it, although the greater
majority may be traced to the optic lobes.
These facts are of some importance, and prove how deductions, formed
from microscopic embryology, may be applied to confirm dissections or
microscopic investigations made on the same parts in the mature animal.
[Abridged from Philosophical Transactions, part i, 1850.]
MR. H. GRAY ON THE DEVELOPMENT OF THE MEMBRANOUS LABYRINTH AND
AUDITORY NERVE.
The essential part of the Membranouslabyrinth and Auditory Nerve consists,
like the retina, of a fibrous lamina formed of the terminal axes, cylinders of
the nerve tubules, or of terminal-loops of nerves, which are in intimate rela-
tion with a layer of dark and closely-set nucleated cells, not unlike those
found lying between the meshes of the fibrous lamina of the retina ; like it
also, it may be regarded as a protruded portion of the brain, modified some-
what in its texture, and connected with an appropriate apparatus, which
receives and transmits its peculiar impressions. The following observations
are intended to demonstrate the mode of development of this membrane; and
they not only confirm the description given of the structure of this part, but
show the striking analogy which exists between it and the refinal expansion.
At present, two opinions exist regarding the evolution of the ear-bulb. It
is stated by Baer, that it arises soon after the eye, in the form of a tubular
prolongation of the brain, communicating with the cavity of the fourth ven-
tricle, its peripheral extremity forming a vesicular dilatation, which is gradu-
ally separated from the brain. Into this vesicle, which is the analogue of
the labyrinth, there is protruded inwards a reflection of the integument, which
forms all the accessory parts of the organ of hearing. Huschke's account is
entirely different ; he says that the Membranous Labyrinth does not arise from
the brain, but is originally a blind sac of the skin with an excretory duct,
which, gradually contracting, is at last separated from the common integu-
ment, and exists as a separate sac beneath it. The following observations
coincide partly with the description given by Baer; at the same time, I shall
state Some facts which, I believe, have not been previously noticed. !



...TºyºpopMENT OF THE AUDITORY NERVE. In the embryo chick at the fiftieth
hour, the medulla oblongata, presented, above, a large open shallow cavity,
the iniºgue of the fourth ventricle. At the cephalic extremity, it eommu-
nicated with the optic lobes and the anterior cerebral cell, by a small circular
orifice. From the central part of the wall of this cavity, and exactly opposite
to the second branchial cleft, the first rudiment of the auditory sac was visi-
bje, in the form of a small protruded vesicle of a somewhat flattened circular
shape; this vesicle was hollow, clear, and pellucid, and, communicated with
the vehicular cavity by a small circular orifice. This communication was
CRITICAL DIGEST OF THE JOURNALS. 985
most distinctly seen on examining the embryo from the dorsal aspect. In
order to satisfy myself of the correctness of this observation, and to test the
accuracy of Huschke's statement, I examined numerous embryos every second
hour, from the thirty-sixth hour to the time when the above appearances were
observed, but in none could I detect a protrusion of the tegumentary layer in
that situation; and, coinciding as my observations do with those of Baer as
regards the origin of this membrane, they justify, I think, the conclusions
which are above stated.
At the fifty-sixth hour, the auditory vesicle occupies its usual position; it
has become, however, increased in size, and has assumed a pyriform shape,
so that now it presents a narrow, contracted tubular portion, the rudiment
of the Auditory Nerve, and a dilated spherical extremity, the auditory sac, or
rudimentary vestibule. This latter portion projects into and becomes encased
by the muscular and tegumentary layers of the embryo, forming a distinctly
marked projection beneath the integument ; the vesicle itself has become
darkly granular and more opaque, but the cavity in its interior is still dis-
tinctly seen communicating with the ventricular cavity, through the tubular
prolongation of the vesicle (the Auditory Nerve); the aperture of communica-
tion is however much smaller, having become more contracted, and this con-
traction apparently increases as the separation between the auditory vesicle
and its parent cell takes place. At the sixty-fifth hour, the ear-bulb has
increased considerably in size, and a more marked separation is now seen to
exist between the Auditory Nerve and the expanded vestibular sae ; the latter
has assumed an oval shape, and is now directed slightly backwards, the cavity
in its interior still existing ; but the Auditory Nerve has become now quite
solidified, so that no communication exists at this period between it and the
ventricular cavity. From the description which I have already given, a
marked similarity may be observed between the origin of this membrane, and
that of the retina and optic nerve; these parts arise in both cases as a pro-
truded portion of the cerebral mass, being hollow, and communicating with
the cavity of the parent cell; in process of time, a gradual separation takes
place between them and the parts from which they arise ; they then assume
a pyriform shape, but still commmunicate with the cerebral cavity; as, how-
ever, the nerve becomes solidified and more fully formed, and the separation
between them is more fully effected, then no communication can be traced
between the two cavities. It is in this stage of the development of the audi-
tory apparatus in the bird, that a remarkable similarity is to be observed
between it and the normal condition of the same part in some of the lower
animals. There are in fact now formed the two elementary portions of this
apparatus, the Auditory Nerve and its vesicular bulb (the analogue of the
vestibular sac). Such is the simple condition of this organ in the crustacea.
and in the cephalopod mollusks.

DEVELOPMENT OF THE MEMBRANous LINING of THE SEMICIRCULAR CANALs.
At the seventy-second hour, the vestibular sac has become more distinctly
separated from the cavity from which it originated, but is connected with it
by the auditory nerve, which is fully formed and of large size; the vesicle is
still quite hollow, and contains a thin limpid fluid; but its oval form is lost,
from a distinct contraction of its apparent entire circumference, which is
observed about its centre; this contraction is seen to exist both on the outer
and also on the inner wall, and is the first indication of the separation of
the vestibule from the membranous semicircular canals, which are ultimately
formed from the terminal portion of the vesicle. At the eighty-second hour,
the contraction is observed to have become more marked, so as partially to
subdivide the vestibular sac into two unequal portions; the lower one, that
connected with the auditory nerve, is the future vestibule, the upper terº
minal one being developed into the semicircular canals; the cavity, still
exists in the interior of the vesicle, and the auditory nerve has increased in
size. At the close of the fourth day, the terminal bulbous portion of the ori-

986 CE. ITT CAI, DIG FST OF THE JOURNALS.
ginal vestibular sac has become very considerably enlarged, and of an oval
elongated form; the contraction originally existing and separating it from
the vestibule itself has increased very considerably, so that now a well-
marked separation is seen to exist, although both cavities communicate with
each other. A slight depression or shallow pit is now observed to exist at
the end of the terminal vesicle, which soon becomes very distinct. This, I
believe, indicates the first rudiment of one of the semicircular canals; no
trace of the folding-in or depression of the integument in this situation could
be observed.
About the sixth day, this depression is more marked, and it is apparently
from the amalgamation of this reflected portion and the inner wall of the
vesicle with each other, that the membranous semicircular canals are formed.
At first they appear to retain the same diameter throughout, but between
the twelfth and thirteenth days they become somewhat contracted in parts,
leaving some portions of their original diameter: it is these that apparently
ultimately form the ampullae. At about the same period, a cartilaginous
nidus is deposited on the outer side of the membranous labyrinth, which is
soon developed into the various parts of the osseous labyrinth : at the same
time also a small quantity of calcareous matter is deposited in the vestibular
sac. It is interesting to observe, that the membranous labyrinth, between
the eighth and thirteenth days, like the retinal expansion of the same period,
consists of a distinct but very delicate fibrous mesh, in the spaces between
which are deposited a quantity of granular matter and numerous nucleated
cells, its exterior surface being composed of a dense mass of nuclei, almost
precisely analogous to the “agglomerated granules” which form so large a
portion of the entire substance of the retina.

From the preceding observations, the following conclusions may be drawn.
The Membranous Labyrinth, like the retina, is a protruded portion of the
brain, being hollow and communicating with the ventricular cavity from
which it arises. As the progressive development of the brain proceeds, the
auditory sac becomes more elongated and of a pyriform-shape, the dilated
portion being analogous to the vestibule, the contracted tubular portion to
the Auditory Nerve; this subsequently becomes solid, and the cavity in the
vestibule does not then communicate with the ventricle, from the wall of
which it is an offset. This representative of the normal condition of the
organ in some of the lower animals, now takes on a higher form of develop-
ment ; for the membranous semicircular canals are now added to the vesti-
bule, being formed by a contraction, and, subsequently, a folding inwards
and union of a portion of the walls of the vesicle itself; lastly, the walls of
these canals becoming in parts contracted, the dilated ampullae are formed.
[Philosophical Transactions, Part 1, 1850.]
HORN ON THE TERMINATION IN I.OOPS OF THE OLFACTORY NERVES.
Like the auditory and optic nerves, the Olfactory Nerve forms loops at its
peripheral extremity. This can be observed in the nasal mucous membrane
of the frog. If a piece of this be removed, with a part of the trunk of the
Olfactory Nerve adhering to it, and viewed between two flat pieces of glass
with a magnifying power of 216 or 300 diameters, the Olfactory Nerve is
observed to divide into twigs; these, at their peripheral extremity, partly
form club-shaped figures, and partly are extended into large segments of a
circle. On the periphery, they are looped, and run back to the original stem.
Stellated pigment-cells and ciliated epithelium are laid over the expanded
nerve-fibres. A few twigs of other nerves, of wider diameter, are also found
imbedded here and there in the mucous membrane. These have the pro-
perties of the finer cerebral nerves. [Müller's Archiv., 1850, Heft. 2, p. 74.]
CRITICAL DIGEST OF THE JOURNALS. 987.
CALCAREOUS TUMoUR OF CRANIUM IN A CHILD : RELATION OF DEVELOP-
ING FUNCTION OF THE CEREBELLUM TO OSSIFICATION.
In the Medical Times for August 17, 1850, MR. R. F. BATTYE, of Pimlico,
relates the case of a child, 12% months old, who had a tumour on the left
side of the head, immediately below the parietal eminence, and extending to
the base of the mastoid process, and to within an inch of the occipital pro-
tuberance; and anteriorly to about the centre of the squamous portion of
the temporal bone. It was at first soft and fluctuating; but earthy matter
was gradually deposited, and, on the ninth day of being observed, it was
converted into a solid calcareous mass. The child had experienced no symp-
toms of any importance during its progress.
Mr. Battye takes the opportunity, afforded him by this case, to make some
observations on the function of the Cerebellum, as the seat of consensual
volitionary movements. He seems, however, not to have been aware that
this theory was long ago enunciated by Rolando, Flourens, Longet, and
other physiologists. He explains the occurrence of the tumour, by supposing,
that when a child begins to gain the power of combining muscular move:
ments, the Cerebellum becomes enlarged: as a consequence, there is increased
ossification, and vascularity of the periosteum, which may, under certain
circumstances, take on an inflammatory action; and that this happened in the
case related.
PRACTICE OF MEDICINE AND PATHOLOGY.
CHILOROFORM : ITS USES IN VARIOUS DISEASES. NO. II.
(Continued from Vol. 1, 1849, p. 361.)
ASTHM.A., MR. J. L. BEARDSALL (Lancet, March 31, 1849) relates three
cases of asthma successfully treated by Chloroform. The first case was that
of a clergyman, aged 37, who had been suffering for six years from asthma.
On the 20th of June, 1848, when he had been suffering from difficulty of
breathing for three weeks, a drachm of Chloroform was administered by in-
halation. In five minutes, the breathing was much relieved. Half a drachm
more of Chloroform was now administered. On the 22nd, he reported his
breathing so much improved, as to enable him to walk up steep hills without
being distressed. On the 26th, the difficulty of breathing having returned,
Chloroform was again administered as before : and, on July 17, his breathing
was reported to be most satisfactory. The second case was that of a woman;
aged 34, who had been subject to asthma as long as she could remember,
which had lately only been relieved by morphia. The inhalation of a
drachm of Chloroform, on each of two separate occasions, was attended with
similar results to those mentioned in the last case. The third case was that
of a gentleman, aged 21, who had been asthmatic for several years. Chloro-
form, in drachm doses, was twice inhaled, with marked relief. In all the
cases, copious expectoration followed the administration of the remedy.
CHoLERA. At a meeting of the Royal Medical and Chirurgical Society, on
Feb. 23, 1849 (Lancet, March 17, 1849), DR. BALy said that, in his experi-
ence of cholera at Millbank Prison, “as a mere palliative of symptoms, Chlo-
roform had been most beneficial. Administered by inhalation, it immediately
relieved all pain and spasm, and sometimes, for a time, checked the vomiting.
The comfort it in some cases afforded the patient was most remarkable.” A
similar result attended its use, in a case recorded by DR. W. M. FAIRBROTHER
(Lancet, August 4, 1849). After about an ounce had been used, the full
effect of anaesthesia was produced, and the cramps, which had been most
severe, gradually subsided. The patient recovered. DR. JoHN DAVIES
(Lancet, Sept. 22, 1849) recommends it, both in the premonitory diarrhoea,
and in the collapsed stage, in doses of from five to fifteen minimis, every
WOL. II. 65


988 (JRITICAL DIGEST OF THE JOURNALS.
hour or two, in mucilage. One dose, he says, will frequently stop the diar-
rhoea and sickness.
The Camphor-chloroform mixture of Messrs.T. and H. Smith, of Edinburgh,
(see Lond. Journ. of Med., Jan. 1849, p. 102), has been also found productive
of great benefit in cholera, as well as in the alleviation of intestinal spasmodic
affections in general.
CoNvu IsroNs (PUERPERAL). MR. TURNER (Lancet, Jan. 12, 1850) admi-
nistered Chloroform in a case of post-partum convulsions, occurring in a
primipara. The fits were prevented by its administration ; and, on two or
three occasions, when the Chloroform was omitted to be given, they returned.
After its use had been persevered in, by using it as a preventive of the con-
vulsions, for eight and a half hours, there was no recurrence of the fits.
In the Medical Times for March 23, 1850, a case of severe convulsions is
related. They had come on during labour, and had continued, with undi-
minished severity, till the middle of the next day; the patient having had
thirty-three confirmed attacks. No means having been effectual in allaying
them, ten or twelve drops of Chloroform were applied to the nose on a
piece of rag, immediately upon the appearance of rigidity of the lower ex-
tremities, which preceded the fits. The effect was the immediate alleviation of
the general spasm, and the entire destruction of the contraction of the facial
muscles: at length, the whole body was rendered perfectly passive, after a
steady application of Chloroform for three hours and a half. The patient
ultimately recovered. MR. NoFRIs communicated to the Edinburgh Obste-
tric Society (Monthly Journ. of Med. Sc., May 1849), a case of a woman who
suffered from convulsions during, and after parturition. In the last fit, Chlo-
roform was administered with success.
CYNANCHE. A correspondent of the Prov, Med. and Surg. Journal for
April 4, 1849, says that he has used Chloroform in the form of gargle, in
cymanche, with good result. One drachm, to one ounce of distilled, or rain
water, is the proportion for the gargle.
DELIRIUM TREMENs. MR. G. HYDE (Lancet, June 9, 1849) relates the
following case. Mr. B., aged 40, of plethoric habit, was attacked with deli-
rium tremens, on June 3rd, 1849. He was treated with opium, morphia,
tartar emetic, and spirits of wine, up to the morning of the 6th, when it was
determined to administer Chloroform. About a drachm and a half was held
to the nostrils on a sponge. Spasmodic respiration and violent plunging of
the body were almost immediately produced ; but he was soon in a state of
anaesthesia. He remained to all appearance in a placid sleep for about eight
minutes, then awoke, yawned, and looked about him inquisitively. After a
few moments, he talked a little incoherently. He continued in a restless
state, raving for about half an hour, and then fell into a quiet deep sleep,
remained so for nearly fourteen hours, and awoke with clear and sound intel-
lectual faculties. The case afterward progressed to recovery. In a case
recorded by Dr. SELKIRK, (Lancet, Dec. 15, 1849), opiates had been used for
four days, without success. Chloroform was administered by inhalation.
Violent convulsions of the whole body ensued, and continued for some seconds;
gradually the muscular system relaxed, the head dropped on the pillow, and
the patient slept almost uninterruptedly for twelve hours. The next day, he
was nearly well.
HYDROPHOBIA. DR. S. JACKSON (Amer. Journ. of Med. Sciences, April
1849) relates a case of hydrophobia occurring in a lady, aged thirty. Chlo-
roform was inhaled, with the effect of relieving the spasms: it was also admi-
nistered in the form of enema (two drachms with two scruples of Dover's
powder in starch water). The Chloroform was inhaled whenever the spasms
threatened to come on, with the effect of restraining them. The patient ulti-
mately recovered; but the excision of the cicatrix of the wound which had
been inflicted by a dog, also probably contributed to this result. In the same
journal, Dr. PARKMAN gives a case, in which the inhalation of Chloroform
CRITICAL DIGEST OF THE JOURNALS. 989
was unsuccessful, though anaesthesia was produced; and the patient rapidly
sank. The Edinburgh Monthly Journal for August 1849, contains the fol.
lowing—“We have received from Dr. G. SMITH, Bengal Horse Artillery, a
strong testimony to the efficacy of this anaesthetic, in subduing the Spasms
and alleviating the sufferings of a boy affected with hydrophobia. The lad
was kept alive rather more than two days; the spasms were much modified
by the anaesthetic, and the impression left upon the practitioner's mind is,
that the disease might ultimately have been subdued, had not his stock of
Chloroform most unfortunately failed him, just when perseverance was most
required. In the intervals between the administration of the Chloroform, the
patient drank liquids most freely, to the extent of several pints, without any
difficulty, and without any consequent recurrence of spasm.” In a case of
hydrophobia at Dalkeith, Chloroform was also administered without success.
LARYNGISMUs STRIDULUs. In the Lancet for Sept. 1, 1849, MR. W. J. Cox
states, that he has found Chloroform and hydrocyanic acid pre-eminently
useful in laryngismus stridulus. With regard to Chloroform, he says: “It
is to be employed during the paroxysm. When the spasm of the glottis is
passing into convulsion, the ingress of air nearly suspended, the head thrown
rigidly back, the veins of the neck turgid, the face livid, the hands clenched,
etc., and when, the usual remedies having failed in producing relaxation,
danger of Suffocation is imminent, a piece of lint dipped in Chloroform
should be applied in a handkerchief over the mouth. In a few seconds, the
muscles will be relaxed, the spasms will be over, and the little patient will
breathe freely. The sudden effect is often almost magical.”
NEPHRITIC Colic... Dr. STILLE (Trans. Phil. Coll. of Physicians, vol. ii)
stated, that Dr. Bowditch, of Boston, related to him a case ...nephritic colic,
occurring in an individual who had previously suffered from several attacks.
Chloroform was administered with the effect of inducing entire relief from
the pain, without abolishing consciousness. The influence of the Chloroform
was kept up for several hours, when, at length, the stone passed through the
ureter.
NEURALG10 AFFECTIONS, MR. F. G. BRoxHolm E (Lancet, June 9, 1849)
administered Chloroform to a young lady, aged thirteen years, suffering from
quotidian hemicrania. The pain was confined to the parts within the cra-
nium, and the paroxysms, which lasted from two and a half to three hours,
were attended by intense vascular excitement. The pain would suddenly
cease, and be followed by an attack of spasmodic dyspnoea, resembling asth-
ma, and continue for about three-quarters of an hour. This having gradually
subsided, was followed by sleep. Quinine was administered, and suspended
the paroxysm for a day. The paroxysm having returned, apparently with
greater intensity, Mr. Broxholme administered half a drachm of Chloroform
by inhalation, the effect of which, in inducing quiet and repose, was instan-
taneous. She remained under its influence for a quarter of an hour. On the
following day, there being a return of the paroxysm, but of less severity, the
Chloroform was repeated; she remained under its influence three quarters of
an hour. The patient had no return of the pain, and ultimately recovered,
the use of quinine being continued. In another similar case, which would
not yield to aperients and quinine, Mr. Broxholme employed Chloroform with
similar results.
In the Medical Times for February 17, 1849, MR. J. HuTCHINson relates
the case of a lady who had an attack of brow-ague, which was removed by
quinine and change of air. About twelve months after, the disease again
returned, on the day following her confinement. On the next morning, when
a paroxysm was coming on, Mr. Hutchinson bathed the part with a few
drops of Chloroform, and afterwards laid on it a cloth saturated with some.
The application had the immediate effect of converting the pain from a throb-
bing to a benumbed sensation. The paroxysm was shorter and less intense.
65 2
990 CRITICAL DIGEST OF THE JOURNALS.
On the two following days, the application was repeated when the pain
threatened to return, after which the patient remained quite well.
The following case is related by MR. C. B. BARRow (Medical Times, April
20, 1850). A delicate young lady, of nervo-lymphatic temperament, had been
suffering from facial neuralgia for several days. The pain was excruciating,
occupying the tract of the temporal and facial branches of the right facial
nerve. It was somewhat of an intermittent character, and throbbing, but,
for the most part, continuous. She took the citrate of quinine and iron, etc.,
but without any impression being made upon the disease. A few drops of
Chloroform were applied to the part on a linen cloth. In this way, about
thirty drops were used, the effect of which was almost instantaneous relief.
The patient complained of a stinging, burning pain during its application, and
for a moment could not bear it ; but this passed off, and she has not had the
slightest return of the neuralgia. She certainly continued her tonic treatment
for some time. Such was the marked relief, that the patient entreated to have a
few drops left with her, lest the pain should return. In the same Journal, for
April 27th, MR. W. E. C. Nourse states, that Mr. Wilde, of Dublin, has applied
Chloroform in neuralgia with great success. His method is, not to put it
upon linen, but upon a piece of spongio-piline coated externally with India-
rubber, thus preventing evaporation, and confining its action more strictly
and effectually to the part. When first applied, it causes a burning sensa-
tion, by no means pleasant ; but this shortly subsides into rather an agree-
able warmth, and the pain begins to dull in a few minutes, nearly or quite
ceasing. The skin is much reddened by its use for a short time afterwards.
There is no sort of objection to its employment in the case of the most deli-
cate person ; but it has the disadvantage of partially losing its effect on repe-
tition, like all other local remedies in such cases. This can only be obviated
by constantly alternating its use with something else, such as tincture of
opium, or hyoscyamus in hot water, 5.j. to 3.j.; lotions made with extract of
conium or belladonna, smearing with extract of belladonna or veratrine'oint-
ment, or a morphia lotion, 2 grs. to 3.j. Ether might be tried in the same
manner as Chloroform.
It is stated by DR. BRAINARD (N. W. Med. and Surg. Journ., Sept 1848, as
quoted in Amer. Journ. of Med. Sc., June 1850) that he has frequently found
periodical neuralgia to resist quinine, but that it has readily yielded to Chlo-
roform. He relates two cases of periodic facial neuralgia, in which the inha-
lation of Chloroform was attended by immediate and permanent cessation of
the pain ; and a case of irregular neuralgia, in which the use of this remedy,
inhaled in doses of about twenty minims daily for two weeks, caused the
attack daily to become milder, and at last to cease altogether. DR. Isa AG
HAYs (Trans. Phil. Coll. of Phys., vol. ii) employed Chloroform to produce
local anaesthesia, with the most happy effects, in the case of a gentleman,
fifty years of age, who had long suffered from neuralgia of the foot, in which
all the remedies that had been employed failed to produce relief. Dr. Hays
found the patient in intense pain, which had deprived him of sleep the whole
of the preceding night. Dr. Hays directed the affected parts to be enveloped
with a pledget of lint, or a few folds of muslin, wet with Chloroform, and the
whole to be covered with a portion of oiled silk, to prevent evaporation. On
the next morning, he found him entirely free from pain, which did not return.
Whether the relief was to be ascribed to the local anaesthesia produced by
the Chloroform, or was to be considered as a mere coincidence, Dr. Hays did
not pretend to decide.
OTALGIA AND ODoNTALGIA. A correspondent of the Prov. Med. and Surg.
Journal for April 4, 1849, says that he has constantly found relief to be
afforded by Chloroform in these affections. In otitis, and in the painful
rising of the teeth in children, before they are sufficiently near the surface
to obtain any relief from lancing the gums, he has found the most pleasing
effect. In #. former case, he places a drop or two on some scraped lint,
CRITICAL DIGEST OF THE Journals. 991
and applies it to the ear or tooth ; in the latter, he rubs the gums with the
finger moistened with the liquid. • , -
TRAUMATIC TETANUs. DR. SELKIRK (Lancet, Dec. 15, 1849) administered
Chloroform by inhalation, from the fourteenth day of the disease, every six
hours, in a case of traumatic tetanus. It acted as a prophylactic to spas-
modic action : but its action was merely palliative, and the patient died on
the twenty-second day of the disease. In the same Journal for Dec. 1st.
an unsuccessful case is also related by MR, SoLLY. Mr. S. G. SLoMAN (Prov.
Med, and Surg. Journal, Sept. 5, 1849, relates a case of traumatic tetanus
following laceration of the right ear, and some injury of the neck, in a man
who had been run over by a cart. The tetanus set in fifteen days after the
accident. On the fourth day, he had rigid spasm in every limb, and in the
abdominal muscles, considerable opisthotonos, and trismus. Mr. Sloman
administered one drachm of Chloroform on a handkerchief. The patient soon
expressed himself as perfectly easy, then became delirious, and in a very
short time quite unconscious, and slept soundly for two hours. When he
awoke, the spasms began to return, and Chloroform was again administered
with success : and was repeated in two and a half hours. After this, the
Chloroform was repeated on several occasions during the next day : but it
appeared to lose its effect in subduing the spasms, each time it was admi-
nistered. Calomel and bimeconate of morphia were then given. The spasms
after this became less frequent and intense, and the patient was, three weeks
after, in a fair way of recovery. DR. E. H. CLARKE (Amer. Journ. of Med.
Sc., July 1849) relates the case of a man, aged 27, who had tetanus from a
wound on the back of the thumb. Chloroform was administered by inhala-
tion ; and the patient was kept uninterruptedly under its influence for
twenty-five hours, during which period there was slight stertor, but not
always total unconsciousness. After an interval of forty hours, the tetanic
convulsions recommencing, inhalation was resumed, and continued for six
hours. No perceptible ill effects followed this prolonged inhalation. The
tetanic symptoms were immediately alleviated, and the patient recovered in
a few days.
DR. A. KILGOUR ON THE TREATMENT OF CARDIAC DROPSY.
In a paper on Disease of the Heart, and the Dropsy following it, published ,
in the Monthly Journal of Medical Science for September 1850, DR. ALEXAN-
DER. KILGour makes the following remarks. In the treatment of Cardiac
Dropsy, every practitioner has his favourite remedy, taken from the class chiefly
of diuretics or purgatives, or both. Of the former, I have found the follow-
ing combination the most efficient. B. Infusi Digitalis 3iv ; Acetatis Potas-
sae 3ij; Spiritās AEtheris Nitrosi 3ij; Aquae Cassiae 3iss, Capiat cochleare
magnum quartà quáque horá.
At last there comes an attack, in which this and other diuretics cease to
act, and we must then fall back on purgatives. Of the latter, unquestionably
the most powerful is elaterium. But there surely must be a very great diver-
sity in the strength of this medicine. Some practitioners, from the days of
Sydenham, and long before him, downwards, appear to have given it in the
dose of two grains, or even more ; but I have found a single pill, according
to the following formula, generally very powerful :—B. Elaterii gr j; Ex-
tracti colocynthidis comp. 9ijss ; Extracti Iiyoscyami gr. xij. M. Divide
in pilulas xij. Capiat unam nocte maneque. The great objection to the elate-
rium is the intense sickness, even in this small dose, produced by it. Do the
large doses produce less sickness than the smaller ? It may be so ; but, in the
few instances in which I have tried large doses, the sickness was not less. Is
there any mode by which this sickening property in this valuable medicine
could be removed 7 r . . . .
It is the opinion of some, that the elaterium acts as a diuretic, as well as
992 CRITICAI, DIGEST OF THE JOURNALS.
a hydragogue cathartic. I remember, when in consultation with Dr. Adams,
of Banchory, in a case of cardiac dropsy, having my attention called by him
to a formula, where the elaterium was combined with a diuretic, which he
had seen prescribed with very great success. It acted most powerfully by stool
and urine (being composed of several of the most powerful of the diuretics,
along with the elaterium); but I always found it to cause much and violent
sickness. B Extracti Elaterii, gr. ij; Spiritus AEtheris Nitrosi 3ij; Tinc-
turae Scillae, Oxymellis Colchici, fia 3ss; Syrupi Rhamni 3i. M. Ft. Solutio.
Capiat drachmam unam ex aquae pauxillo, ter quaterve in die.
The combination of a bitter purgative with a saline one composed of the
vegetable alkali and a vegetable acid, is, in my experience, much more efficient
than any single purgative, or than a bitter with a salt formed of a mineral
acid. The old compound powder of jalap is a well-known instance of a mix-
ture of this kind, and is still one of our best purgatives in all dropsies where
this class of medicines may be suitable. Ferriar used, as did also Home, a
combination of half an ounce of the bitartrate of potass with two grains of
gamboge. The infusion of senna with bitartrate of potass is also an old-
fashioned and valuable remedy; but the insolubility of the salt is an impe-
diment to the efficiency of this formula. The senna infusion with tartrate of
potass, or with the tartrate of potass and soda, is not liable to the same ob-
jection ; and I can testify to the advantage of the frequent use of this com-
bination in cardiac disease having a tendency to dropsy, or in the dropsy
itself attending that complaint.
The preparations of mercury have proven, no doubt, very successful in
the treatment of this form of dropsy. Without wishing at all to detract from
the merits of this most valuable agent, I must confess that, in chronic dis-
eases of the heart, I do not like it, and cannot speak from experience of its
efficacy in cardiac dropsy.
There comes a time, in the treatment of this complaint, when not only diu-
retics in all forms, but even purgatives, cease to remove or even to keep in
check the anasarca. And this brings me to speak of another mode of treat-
ment, which often proves palliative for a time, viz., puncturing the lower
extremities, and thereby draining off the fluid. This is not a new mode of
treating the disease, though it has at various times fallen into unmerited neg-
lect, and perhaps at the present time more so than at any other. I have not
only often seen it of great benefit to a patient labouring under anasarca, no
matter what the pathological cause of that disease, but have also in some
cases seen it prove a cure, or, at any rate, that, after recourse had to it, inter-
nal medicines, which previously exerted no effect on the dropsical effusion,
began to act, and the anasarca did not reappear. I do not, however, recom-
mend it until all internal remedies have failed.
There are two modes in which the opening for draining off the fluid may
be made,-either a puncture with the lancet, or with a good stout sewing
needle. From a single puncture by the latter, a quantity of water will some-
times run out, so as to pass through the bed in a few hours, and require to be
collected in vessels placed below it.
Heberden has evidently seen the danger attending this mode of treatment,
though he does not say specifically in what it lies. The danger consists in
the inflammation of an erysipelatous character, which not unfrequently takes
place, extending up the limb, sometimes bringing on sphacelation, and for the
most part ending in the death of the patient. But from one incision, and
one, or at the most two punctures, in the proper place, erysipelas is not so
apt to occur. The state of the skin—its low vitality during the existence of
the dropsy under it—is singularly favourable for this form of inflammation :
but a small clean cut, or one or two punctures,--and, if there be two, at a
distance of not less than two inches from each other, is not so likely to be
followed by this as when, in the anxiety to get the water all off speedily,
several have been made. Several writers recommend fomentations to be ap-
CRITICAL DIGEST OF THE JOURNALS. 993
plied to the wound ; but I have often found the evaporating lotion very suc-
cessful in keeping down any disposition in the part to erysipelas. Frequent
ablution also with tepid water, and the removal of any cloths that may be
soaked with the serum that has run out, will serve to prevent, so far, any
irritation from being set up in the skin.
When the operation, even with the needle, has to be often repeated, as is
sometimes the case, for the ease of the patient, especially in cardiac dropsy,
there is sometimes a degree of inflammatory action set up in the cellular tis-
sue, by which its interstices become obliterated, and the skin and it become
quite closely adherent to the fascia below. I remember this occurring in a
gentleman, who had been kept alive for some months by punctures, and who
was at last dropsical everywhere, except below the knees, where the adherent
and thickened integuments would not distend,--thus giving him, however,
not a little pain. It has of late been recommended to have recourse to this
treatment much earlier in the disease than was the custom ; and it has been
said, that the chances of success from it are much greater, than when the
patient's strength has been exhausted, and the vitality of the skin has been
impaired by the long existence of a dropsical effusion. This reasoning is fair;
but the fluid does not flow so freely from the incisions, as when the areolar tissue
has become more open and less resilient, from the long existent pressure of the
effused serum. And, little as the danger of erysipelatous attacks may be from
puncture of the skin in the early stage of anasarca, still there are few that will
subject the patient to this chance of danger, until all the other more usual and
often successful modes of treatment have been tried in vain.
As to the application of blisters to the anasarcous legs, with the view of
draining off the serum—I would have scarcely thought it necessary to speak,
believing that none, now-a-days, would adopt this practice ; but lately I met
a very intelligent country practitioner, who told me that he occasionally had
recourse to this application. The exciting of a vesication, by means of a
blister, is much more likely to be followed by dangerous, than by curative
effects in all anasarcous limbs, from whatever cause the dropsical effusion may
have arisen.

FATAL OBSTRUCTION OF THE INTESTINAL CANAL FROM PERITONJEAL BANDS.
ARE SUCH BANDs somETIMES CONGENITAL 2
The two following cases are reported by Mr. C. R. THoMPson, in the London
Medical Gazette (July 12, p. 61), as having recently occurred in St. Bartholo-
mew's Hospital. We abridge the details.
CASE I. Mary G., aged 20, was admitted 13th Nov., 1848. Condition on
Admission. Pulse 120, small, and rather sharp ; tongue moist, coated on
dorsum with very thick brown fur, clean at the edges; bowels not opened for
seven days ; slight vertigo and nausea when on her back; abdomen distended,
generally dull on percussion, intolerant of pressure, especially in the umbi-
lical region.
History. Was a single woman in domestic service. She always enjoyed
good health till a fortnight ago, when she got wet feet, which checked the
catamenia. The next day she became very sick, vomited her food, and
suffered from severe griping in the umbilical region. She entrusted herself
to a druggist.
Treatment, etc., in Hospital. Wenesection on 13th Nov. to 12 oz. Attempts
by purgatives (administered by mouth and anus) to relieve the bowels. She
died on the 18th, delirium and feculent vomiting having preceded death.
Post-MoRTEM APPEARANCEs 65 Hours AFTER DEATH. Abdomen. Peritoneum
generally rather vascular; about four ounces of slightly turbid fluid, contain-
ing flakes of lymph, in the sac ; some deposits of puriform matter at the
bottom of the pelvis. Small intestine greatly distended ; the peritoneal coat
vascular and thickened; a broad line of redness ran along the border of the
994 CRITICAI, DIGEST OF THE JOURNALS,
intestine where the coils lay in contact with each other; a few slight
shreds of lymph, here and there, held the coils slightly together at their
surfaces of contact. Large intestine pale, contracted, and nearly empty.
The transverse portion of the colon was drawn down with the right iliac region,
by a short narrow band proceeding from its lower border, and attached to
the spine by means of the portion of mesentery corresponding to the last
part of the small intestine. This band passed in front of the small intestine
about an inch before its termination in the caecum, compressing it against
the spine, and constricting it so as to render it impervious. The portion of
the colon, from which the band originated, was closely and rather firmly ad-
herent to the constricted part of the small intestine, the thinner and more
friable bands passing from one intestine to the other. The mesentery imme-
diately surrounding the constricted part was inflamed, thickened, and matted
around the intestine.
The entire length of the small intestine, as far as the constriction, was
filled with liquid bilious matter, such as had been vomited during life. The
mucous membrane was reddened and swollen in the neighbourhood of most
of Peyer's patches, the individual glandulae of which had burst, leaving
spaces surrounded by a thickened border of mucous membrane. Each Peyer's
patch thus presented a broad oval surface, the mucous membrane of which
appeared worm-eaten, and as if irregularly removed by ulceration.
Here and there a swollen red solitary gland was seen. As the small intes-
tine approached the seat of constriction, it became very vascular, and pre-
sented discoloured streaks and spots, as if from commencing sloughs. The
piece of small intestine between the constriction and the caecum was pale
and contracted, and its mucous membrane irregularly ulcerated. Stomach
distended with liquid bilious contents. Liver natural ; gall-bladder dis-
tended with a quantity of thin dark bile; spleen natural ; no morbid appear-
ance of uterus or ovaries; kidneys large, heavy, and congested, but appa-
rently of healthy structure.
CASE II. Hannah R., aged 23, was admitted in the morning of the 7th
Feb., 1850. Condition on Admission. Pulse from 140 to 150, very small,
and thready ; lips and tongue dry; respiration about 25, and natural ; pain
from the most gentle pressure on any part of the abdomen, but especially in
the hypogastric and iliac regions; abdomen generally soft, except in the
umbilical region, where it was rather tense; tympanitic resonance over the
colon, and on the epigastrium, but marked dulness in the umbilical and
hypogastric regions. The patient was restless, lay indifferently on either
side, with the knees slightly drawn up. Occasionally she vomited a light
coloured frothy fluid, of decidedly feculent odour, and resembling working
yeast in appearance.
History. She was a delicate married woman, by trade a toy-painter. She
had been confined four times. The last labour occurred five months ago, and
was at the seventh month of utero-gestation. Since that time she had
suffered frequently from troublesome constipation, for which she had been
under medical care : during the last three months, the motions had been of
unusually small calibre. Four days ago, the bowels were but very imperfectly
opened after a three days’ constipation. Since that time, she had had pain
in the abdomen, constipation, and stercoraceous vomiting.
Treatment, etc. Two ounces of thick high-coloured urine were drawn off
by the catheter. Copious enemata were thrown into the rectum by a tube
eight or ten inches long. Wine, beef, and brandy were allowed ad libitum ;
but she died at 4 p.m. on the 8th, the day after admission.
Post-MoRTEM APPEARANCES 20 Hours AFTER DEATH. Abdomen. On ex-
posing the peritoneal cavity, an extremely foetid odour was perceptible. The
parietallayer of the peritoneum was dotted with numerous small circular milk-
white spots, more distinctly seen after exposure to the air; these spots were
in the substance of the serous membrane, and not removeable except by
CRITICAL DIGEST OF THE JOURNALS. 995
carefully dissecting it from the subjacent cellular tissue. The great omentum
was gorged with dark blood, and looked, at its lower part, like a bag of large
distended veins. On raising it, it was found to be adherent to the subjacent in-
testines by recent lymph ; on separating these adhesions carefully, there
appeared an aperture in a mesenteric vessel of considerable size, freely giving
exit to blood, of which about half a pint had escaped into the pelvis, pro-
bably during life. The contiguous surfaces of the intestines, both large and
small, were also agglutinated together, and to the parietes of the abdomen,
by recent lymph, which was easily broken down by the handle of a knife.
The greater part of the small intestine was of a deep red colour, very much
distended in the upper part, and contracted below ; about two feet of its
length appeared more distended, and of a darker colour, than the rest of the
intestine, almost black, or dark claret-coloured: in the middle of this dark
part was an ash-coloured slough, about three inches long, with a well defined
margin : the extremities of this congested fold of intestine were tightly girt
by a firm band, passing from the surface of another portion of intestine of
the mesentery at the point of constriction: this band was very strong, and
firmly attached at both its extremities.
The contents of the strangulated portion of intestine gave to the finger
the sensation of hardened faecal matter, which was found to be caused, how-
ever, by the congestion and enlargement of the valvulae connivertes; for, on
opening the canal, it contained only about one point of dark fluid blood. The
mucous membrane presented even a darker aspect than the exterior, and the
internal surface of the ash-coloured spot was scarcely to be distinguished
from the adjacent membrane : the mucous membrane was easily stripped off
in various points. A considerable quantity of blood was also contained in
the intestine, for a short distance above and below the stricture. The seat
of constriction corresponded nearly to the umbilicus; but the coil of included
intestine reached to the right lumbar region. It was a part of the lower
end of the jejunum. Stomach healthy; also the large intestine, which con-
tained, near the caecal valve, a few hardened scybala. Pancreas and spleen
of normal size and aspect. Liver showed some portal venous congestion :
otherwise healthy. Kidneys rather large, but apparently normal.

REMARKs. Rokitansky has found abnormal peritoneal bands, or rents in the
mesentery, to be the most frequent cause of internal incarceration. These bands
are probably, in most instances, the result of some previous inflammation of
the peritoneum. In many recorded cases, we find a distinct history of
mesenteric mischief; in the case related by Mr. Hilton, in Med.-Chir. Trans-
actions, vol. xxx, the patient, 20 years of age, was the subject of mesenteric
disease in early childhood, and, some time subsequently, suffered from
symptoms which indicated peritonitis; here, from the history, the nature of
the obstruction was accurately diagnosed, and found after death to be a band
of false membrane, including a knuckle of the ileum. Mr. Druitt also re-
cords an instance, where a boy, eleven years old, died after the operation of
gastrotomy for the relief of the intestinal stricture; and old adhesions were
found in the peritoneal sac, one of which was the cause of the constriction. The
boy was stated to have suffered for eight years with occasional severe attacks
of pain in the abdomen, subsiding under the use of medicine.
In the two cases above related, there was no evidence of former peritoneal
mischief; indeed, from patients of this class, it is always difficult to get a
clear account of their ailments. In both instances it was carefully observed,
that the abnormal band forming the constriction was the only one discovered
of any strength or consistence, which seems to disprove the inflammatory
origin of the bands, and raise a suspicion of their being congenital. Roki-
tansky mentions the frequent congenital occurrence of unusual length of
the duplicatures of the peritoneum, or of supernumerary folds and pouches
of that membrane. These pouches are chiefly found, he says, in the hypo-
996 CHITICAL DIGEST OF THE JOURNALS.
#. and more especially in the iliac and inguinal regions, and about the
undus vesicae ; and communicate with the peritoneal cavity by a well-
defined fissure or ring, frequently surrounded by a tendinous band, lying in
the duplicature.
CANCER IN POSTERIOR MEDIASTINUM . PHLEBITIS,
The following case, related by PROFESSOR LARSEN, is published at p. 151
of the Bibliothek for Lager for January 1850.
A woman was admitted into hospital, at Copenhagen, with slight varicose
ulcers in one leg, which were soon healed. In a short time, her appearance
became cachectic, and she was seized with phlebitis in the left arm. The
superficial veins were obstructed; but the symptoms were removed by anti-
phlogistic treatment. Some time after, she was seized with symptoms of
phlebitis in the thigh. The whole limb swelled; the crural vein felt like a
hard cord; the superficial veins were obstructed ; the disease extended ; and
she died in a state of increasing weakness and cachexia. After death, the
brachial veins were found almost entirely obstructed, and filled with coagula :
the morbid appearances extended into the vena cava. A probable cause of
the phlebitis was found, in the form of a cancer, in the cellular tissue along
the aorta and vena cava, and extending as far as the diaphragm.
PULMIONARY CANCER OBSCURITY OF PHYSICAL SIGNS.
A labourer, aged 34, was admitted into the General Hospital at Copenha-
gen, on 14th October. A month previously, he had commenced to be affected
with emaciation and sweats. A fortnight before admission, he first perceived
chest symptoms, which began with a violent, irritating cough and frequent
dyspnoea. When seen, he had also palpitation, anorexia, and thirst ; his
pulse was 100, and his strength failing ; expectoration was difficult, and the
sputa were scanty, white, and frothy. He complained of pain in the neck; but
nothing could be discovered on examining the throat. The percussion-sound
was normal; and the stethoscope only revealed some sibilant rhonchus. His
condition became worse on the subsequent days. The cough was more fre-
quent, the expectoration more abundant, the respirations from 50 to 54, the
pulse 130; diarrhoea had set in, the perspiration increased, and was accom-
panied, in three days, by chills. His sleep was disturbed by orthopnoea;
emaciation advanced more rapidly than could be explained by the other hec-
tic symptoms; the countenance was sharp and anxious; the stethoscopic signs
remained the same. After he had been in hospital for five days, he was
observed to have a swelling of the veins under the left clavicle, extending
over the shoulder. Two days later, he was seized with oedema lower down
in the arm, which rapidly spread upwards, but was unattended with pain or
swelling of the veins. Percussion was now dull under both clavicles, respira-
tion was as before, and the expectorated matters contained some purulent
clots. Some days later, the glands along the clavicle, and in the axilla, were
hard, and swollen to the size of hazel-nuts. The dyspnoea and orthopnoea
remained, the pulse was from 120 to 130, and the respiration from 46 to 50.
The case was diagnosed to be one of Pulmonary Cancer, on account of the
aspect of the countenance, the varicose veins, the swollen glands, and the
oºdema, although auscultation gave no great support to this opinion. The
Cancer was considered to be diffused, or to be situated in the centre of the
lungs. Some days later, oedema appeared in the ankles, On examining the
patient, the percussion-sound was found less clear, and the heart was higher
than usual, evidently in consequence of the increase of the cancerous growth.
The patient died, under symptoms of general exhaustion, on November 4.
PosT-MoRTEM APPEARANCEs. Both mediastina were found filled with me-
dullary Cancer, which seemed to have originated in the bronchial glands.
The surrounding cellular tissue was emphysematous : this had prevented the
seat of the Cancer from being discovered by percussion. On the pleura, also,
CRITICAL DIGEST OF THE JOUHNALS. 997
nearest the pericardium, there were large carcinomatous masses. The lungs
were universally heavy, and appeared, externally, as if hepatised ; but no
hardened portions could be felt in them. On section, they were found to be
in the first stage of so-called cancerous infiltration. There was a remark-
able development of cellular tissue, in the form of thick rings, round the
entrances of the divisions of the bronchial tubes into the lungs On scraping
the cut surfaces, there exuded, from numerous small, white, scattered carci-
nomatous spots, a creamy fluid, which, as well as the bronchial glands, con-
tained cancer-cells. (Bibliothek for Loeger, January 1850.)
DR. Polak on THE ACCOMPANYING DISEASES, SEQUELAE, AND METASTASES
OF CHOLERA.
The observation of the epidemic or endemic diseases which accompany
Cholera, possesses scientific and practical interest. During my charge of
Cholera patients for two months in Klobauk and Tessan, I either personally
treated or else witnessed twelve hundred cases. The following are the results
of my observations:
1. I noticed thirty-one cases of Dysentery, of which five were consecutive
on Cholera, the rest were idiopathic. As the persons attacked lived in
houses where cases of Cholera had occurred, it is probable, that both were
modifications of the same disease. Cholera patients are sometimes attacked
by dysentery. The identity of the two diseases is farther confirmed by the
circumstance, that in both the bile-pigment is absent from the stools, and that
its reappearance may be considered as a sign of returning health. Epidemic
dysentery, also, does not differ from Cholera in the manner in which it at-
tacks patients. It is true, that the pathological appearances are different ;
but this may be explained by supposing, that Cholera runs its course too
rapidly to admit of localization. Few pathologists, indeed, will seek for the
causes of typhus in the infiltration of Peyer's patches, or of dysentery in the
ulcers of the large intestine.
2. In the province of Tessan, Measles prevailed at the same time. Nearly
all the children who had this disease, were attacked with Cholera—several
during the premonitory symptoms, several after the eruption, several in the
period of desquamation. Many who had recovered from Cholera, passed
through an attack of measles. A young man had a bad attack of Cholera :
there were severe cramps, extensive cyanosis, and pulselessness. He was
treated by frequent cold ablution of the whole body; and recovered. Three
days after, fever and catarrh set in, and measles appeared over the whole
body, and ran their usual course to desquamation. It is important here to
observe, that I have not confounded measles with roseola.
3. The relation of Cholera to Intermittent Fever was remarkable. In
this district, which at an earlier period was covered with extensive marshes,
most of which have been dried and reclaimed for cultivation, epidemic ague
prevails in various, and often malignant forms. In July, it was observed by
myself and other physicians, that there was a considerable diminution in the
number of cases ; in August, when Cholera broke out, the intermittent fever
was, as it were, cut off, so that occasional cases only occurred here and there.
In five cases, the first cold stage was attended by a severe choleraic paroxysm,
which ended favourably: the paroxysms on the third day had their normal
character. In my examinations of Cholera patients, I often found, that they
had suffered from intermittent fever some weeks previously, from which they
recovered spontaneously. A case came under my notice, in which a boy,
fourteen years old, had intermittent fever for two months, the paroxysms at
last becoming mild : in one of these, he was attacked by Cholera, and died.
Of the various remarkable phenomena, metastases, and sequelae, which
were observed, haemorrhages were most frequent. These occurred (a.) In two
cases, as bleeding from the nose. (b.) In seven cases as otorrhagia. The
patients complained for several days of pain and noise in the ears. A large
998 CRITICAL DIGEST OF THE JOURNALS.
quantity of blood was discharged, with considerable relief. In some cases,
where the pain was very severe, a quantity of pus or lymph was discharged
instead of blood. (c.). In two cases, which terminated fatally, there was
haemorrhage from the lungs.
The following were the metastases. (a.) In several cases, there was furun-
culus, which, however, might in all cases have arisen from rubbing with hard
materials. (6.) Parotitis occurred in six cases: in five, it proceeded to sup-
puration, and, in a sixth, which I scarified at an early period, it ended in
resolution. (c.) Blennorrhoeal otitis occurred in several instances. (d.) Iritis
was observed in one case. A man, who had passed through a slight attack
of Cholera, was attacked, a short time after, with severe iritis, which might
very probably be considered as metastatic, from analogy with the otitis.
(e.) A young man, who had passed through a very severe attack of Cholera,
had, during convalescence, furunculus, and inflammation of the right shoulder-
joint. (f) In two cases, delirium remained after Cholera ; but was removed
by bleeding and derivants.
With regard to the absorbent power in this disease, the following fact is
worthy of note. A woman, who had been confined to bed the greater part
of several years with ascites, was attacked with Cholera in August. In two
days, she was free from the swelling and Cedema ; but, as I afterwards learnt,
the fluid collected again. This fact deserves notice, as, in several pregnant
women who died of Cholera, I performed the Caesarean section, and found
the liquor amnii in the usual quantity; and other women, who aborted
during the disease, discharged the normal quantity of this fluid. [Zeitschrift
der K.K. Gesellschaft der Aerzte zu Wien, February 1850.]
TURPENTINE AS A STYPTIC IN ACTIVE AND PASSIVE EIAEMORREIAGES : THE
DOSE, AND MODE OF ADMINISTRATION.
DR. THOMAS SMITH, of Cheltenham, ably directed the attention of the
profession to the value of Terebinthinate Medicines in a memoir, published
in our number for April 1850, p. 321 of this volume. After entering into
some details regarding its power over various haemorrhages, he thus sums up
his account of its styptic properties. “In my experience, there is no single
medicine that can be compared with it as a styptic, either as to certainty of
action, or to the safety of its effects. It is compatible alike with acids and
with alkalies.” In the Medical Times, 17 Aug. 1850, p. 167, DR. WILLIAM
BUDD, of Bristol, has published a paper entitled “Case of Purpura; with Re-
marks on the Styptic Properties of Oil of Turpentine”, which contains much
that is confirmatory of Dr. Smith's statements.
Dr. Budd justly remarks, that the efficacy of Turpentine in purpura is
not dependent upon it as a remedy for the blood lesion : its action is not
against purpura as purpura, but against purpura as haemorrhage. He says
that the styptic virtues must depend on its exerting some direct influence
on the contractible power of the blood-vessels. This he regards as the only
plausible explanation of the equal efficacy of this medicine in restraining
bleeding, under so great a variety of pathological conditions. He believes it
to be better adapted to cases of passive than of active haemorrhage.
Dr. Budd has some practical remarks upon the dose, and mode of admini-
stration ; the substance of which we subjoin. In common cases, such as those
of purpura, for instance, where time does not press, he has found doses
varying from ten minims to half a drachm quite effectual; but in cases of
rapid loss of blood, where sometimes every minute is of importance to life, it
is better to give half an ounce, or an ounce at once, to be followed up by
smaller doses at shorter intervals. The use of this medicine is not without
its drawbacks. Few drugs are more repugnant to delicate stomachs. In
many it excites vomiting: in others it causes painful strangury; and the
irritation of the urinary organs is sometimes so great, that blood is passed
with the urine. He has found that half a drop or a drop of creasote to each
GRITICAL DIGEST OF THE JOURNALS. 999
dose, almost entirely covers its nauseous taste, and prevents the risk of
sickness. Ten or twenty drops of spirit of rosemary will help to make the
prescription less disagreeable. Common mucilage is the best vehicle for
keeping the Turpentine in suspension. The risk of strangury is not easily
obviated; but it may be diminished by the free use of diluents. When the
use of the medicine is stopped, the strangury, however severe, quickly ceases.
SURGERY.
THE OPHTHALMIA OF NEW-BORN CHILDREN, AS OBSERVED AT THE
FOUNDLING. HOSPITAL OF ST. PETERSBURG.
The following is an abridged translation, from the Journal für Kinder-
krankheiten for March and April 1850, of the abstract of an interesting report
drawn up by DR. FROEBELIUs, of the cases of Ophthalmia Neonatorum ob-
served at the Foundling Hospital in St. Petersburg, from 1st September 1846,
to 1st September 1848.
STATISTICAL ABSTRACT. From the 1st September 1846, to the same date
in 1848, 882 children were treated for Ophthalmia, of whom 474 were males,
and 408 females, being in the proportion of about 6 to 5. The greater ten-
dency of male children to be affected, is more plainly shown by the fact, that
from September 1846, to September 1848, 5,929 male children were admitted,
of whom 474 suffered from Ophthalmia; and 6,149 females, of whom 408
were affected: the males being thus in the proportion of 4 to 3 to the females.
It will be also seen, that 7 per cent. of the total number of children had Oph-
thalmia.
The ages were as follows:
In 110 children under 4 days. In 9 children from 4 to 5 months.
— 271 53 from 4 to 8 days. — 3 25 » 5 to 6 ,
— 188 25 , 8 to 14 days. | – 2 22 2, 6 to 7 ,
— 102 33 ,, 2 to 3 weeks. — 1 25 » 8 32
— 70 59 2, 3 to 4 , — 1 35 » 9 92
— 59 39 , 1 to 2 months. — 1 35 , 10 92
— 45 35 9, 2 to 3 , * *
– 20 55 2, 3 to 4 , 882 (total).
The duration of disease was various, and depended on the individual
sequelae. In the two years, one case of blepharitis was observed, which dis-
appeared in twenty-four hours. The longest duration was three months;
most frequently the disease terminated in from fourteen to forty days. The
average period was twenty-three days, **.
With regard to the type of disease, 827 cases of the 882 were admitted in
the inflammatory stage. Of these, 115 had conjunctivitis palpebrarum, with
photophobia and blepharospasmus; 479 had conjunctivitis of the eyelids and
sclerotic, with photophobia and blepharospasmus; 233 had, in addition, con-
junctivitis of the cornea. In all, then, conjunctivitis of the eyelids was pre-
sent ; in 712, the sclerotic was also affected ; and, in 233, the cornea. In
connexion with the great frequency of conjunctivitis of the eyelids, is to be
observed the remarkable number of cases in which granulations occurred as
sequelae. The remaining 55 children were above three months old, and were
already the subjects of various sequelae of inflammation in different combin-
ations, viz.: granulations of the conjunctiva, softening of the cornea, ulcers of
the cornea, partial staphyloma, entire leucoma, with synechia, and atrophy of
the bulb. In the 827 children admitted during the inflammatory stage, the fol-
lowing sequelae were observed during the course of the disease, and remaining
after it : granulation of the conjunctiva, keratomalacia, ulcers of the cornea,
partial staphyloma of the cornea, various degrees of opacity (nºwbeculae and
maculae), leucomatous cicatrices, with synechia, atrophy of the bulb, phthisis of
1000 CRITICAL DIGEST OF THE JOURNALS.
the bulb, and ectrophy of the upper eyelid. Of the 827 &hildren, 463 had
the complications before their admission.
The following table exhibits the results of the cases admitted during the
two years referred to :
FIRST YEAR. SEcond YEAR.
Cases admitted ſº & 460 | Cases admitted . * 422
Cured c * 305 Remaining from 1st year 43
Blind & g 16 — 465
Dead © º 96 Cured . * 266
Remaining tº 43 Blind . o 6
* Dead g & I65
Total & 460 Remaining . 28
Total º — 465
The following statement includes the cases of blindness in the preceding
table, and also those observed in the Lazareth. There were 21 cases of blind-
ness in one eye, of whom 4 died, and 4 remained blind; and 43 in both eyes,
of whom 21 died, and 6 remained blind.
The diseases which appeared simultaneously with Ophthalmia, or were de-
veloped during its progress, and influenced its result, were premature birth
in 88 cases ; aphthae in 300; jaundice in 222; crusta serpiginosa in 216 ;
and syphilis in 36. The diseases next in order of frequency, were : bronchitis
and pneumonia in 82 cases; enteritis and peritonitis in 36; encephalitis and
meningitis in 22; and atrophy in 39.
Among the 88 prematurely born children, there was not one case in which
the Ophthalmia was fully developed; the swelling of the eyelids had not
arrived at its highest degree, nor was the purulent secretion so profuse as
in healthy, well-nourished children: but there was observed, in the most
important cases, an unusually rapid softening of the cornea, ending in ulcer-
ation and total destruction of the eye. The secretion was always a thin fluid
pus, frequently mixed with blood, and the abraded surface of the membrane
of the eyelids was livid, but did not present firm granulations, such as are
observed in other children suffering from this disease. The swelling of the
eyelids was soft, oedematous, and livid, and not of a remarkably high temper-
ature. In the 88 cases of premature birth, 40 of which also laboured under
jaundice, the following sequelae occurred : granular conjunctiva in 12, kera-
tomalacia in 9, ulcers of the cornea in 11, staphyloma of the cornea in 1, and
atrophy of the bulb in 1. That inflammation of the eye is by no means
most frequent in premature children, is shown by the fact, that the number
affected (88) was only one-tenth of the total number of cases. The sequelae
just now mentioned, which were mostly observed in those prematurely born
children who were affected with jaundice, shew the prejudicial influence of
the latter affection on the ophthalmic disease; for softening of the cornea
occurred only once, and ulceration only three times, in children who had not
jaundice.
Aphtha, formed the most frequent and unfavourable complication of Oph-
thalmia, one-third of the patients being thus affected. The prejudicial influ-
ence of this complication was evident in the sequelae; for, in the aphthous
cases, there were found granulations in 194, softening of the cornea in 56,
ulceration in 85, staphyloma in 19, and atrophy of the bulb in 25. One-third
of all the patients had aphthae; and in this third, one-half of all the sequelae,
and two-thirds of the cases of blindness, were observed.
The jaundice, which was observed in new-born children during the first
days of their life, exercised no prejudicial influence on the progress of the
Ophthalmia, provided the children were mature and well-nourished ; but in
weak and immature children, where the vital powers were not great, the
result was much more untoward, as it also was in children of the same cate-
gory, who had not jaundice.
Crusta seroidinosa seldom appeared befo: e the first month, and was gene-

CRITICAL DIGEST OF THE JOURNALS. 1001
rally observed after the removal of the Ophthalmia, or, in older children,
during its progress. In these it frequently retarded the cure, the granula-
tions on the conjunctiva becoming affected through the extension of the in-
flammatory process, from the skin covering the eyelids, and the sclerotic
conjunctiva and the deeper structures becoming affected. Of the 216 cases
of crusta serpiginosa, none were under one month old, 91 were in the second
month, and the rest were older.
Syphilis was a very untoward complication. Thirty-six children were thus
affected, and the following sequelae occurred in them : granular conjunctiva
in both eyes, in 13 cases; softening of the conjunctiva in both eyes, in 10;
swelling of the cornea in one eye, once, and in both eyes in 18 cases; sta-
phyloma of the cornea in one eye, once ; atrophy of the bulb in one eye,
once; in both eyes, six times. Two per cent. of the syphilitic children be-
came blind; hence, although 1-22 of all the patients had syphilis, 1–9 of the
cases of blindness occurred among them.
The other diseases which have been mentioned, are rather to be considered
as accidental complications, than as holding any causal relation to the Oph-
thalmia. There was not a single case of communication of the inflammation
from the eye to the cerebral membranes; but there were several instances,
in which the development of an erysipelatous inflammation on the face, or
even on distant parts of the head, caused a metastasis to the meninges, and
acute meningitis of remarkably rapid progress, as shewn by the purulent
exudation found on post-mortem examination. The most frequent inflam-
matory attacks were those of the thoracic organs; and these were most usually
developed after the appearance of crusta serpiginosa, when hepatisation
rapidly set in, and was followed by death. Atrophy was often the result of
an uncleanly, poor living ; but it was also observed as a result of Ophthalmia,
especially in fifteen patients, who wore blind in both eyes. DR. Döpp has
frequently met with this form of death in blind children.
Influence of the Season of the Year. The observations made on this head
have not yet led to any satisfactory results. The occasional remarkably in-
creased intensity and contagiousness of Ophthalmia seem to depend less on
the season, than on the great number of admissions, and the insufficient num-
ber of nurses. In the latter case, nutrition was defective, one nurse having
to feed two children, and to support, at the same time, an increase of duty.
The number of children admitted in each month, were, in September 1846,
23; October, 36; November, 44; December, 27; January 1847, 38; Febru-
ary, 43; March, 31; April, 28 ; May, 35 ; June, 50; July, 34; August,40;
September, 48; October, 50; November, 25; December, 27; January, 1848,
39; February, 29; March, 33 ; April, 24; May, 31 ; June, 34; July, 41;
August, 31 ; which, with 33 cases under treatment at the commencement of
the period, make 882. In November 1846, there was damp and cold weather,
and the thermometer sank from 29 to 5° Reaum. The Ophthalmia manifested
an extraordinary malignity: children who were getting better, became worse,
and the contagion also affected two nurses. The epidemic began to abate,
when a part of the children were moved into another room, and thereby less
heat and purer air was obtained ; for, although the quantity of fuel was
diminished, the thermometer in the rooms frequently stood, in the evening,
at 18° R. In the course of this month, two children became blind in one eye,
and four in both eyes. In June 1847, the disease became remarkably epidemic
during damp, cold weather, north-west winds, low barometer, and a temper-
ature not exceeding 8° to 12° R. : eight children became blind. Twelve
nurses were seized with Ophthalmia. In 1848, the months of June and
July showed similar states of weather; at this time, also, cholera pre-
vailed, in consequence of which, the number of nurses was diminished by
death and other causes. During this period the Ophthalmia was very malig-
nant, so that in two and a half weeks six children became blind. On the
whole, these data point out that the season of the year does not appear to
exercise any remarkable influence on the disease.
1002 CHITICAL DIGEST OF THE JOURNALS.
PATHoLogy. Dr. Fröbelius considers the vascular areolar tissue under
the epithelium of the palpebral conjunctiva to be the seat of the disease;
the glands of the eyelids becoming only secondarily affected. The part
which seems especially to be the seat of the Ophthalmia, is that portion
which forms the transition from the palpebral to the sclerotic conjunctiva.
If the upper eyelid be everted at the commencement of the attack, when the
external covering of the palpebrae is not yet very red and swollen, and when
there is only a small amount of mucous secretion between the lids, the
tarsal portion is found quite clear, bright, and of a light red, while in the fold
of the conjunctiva there is a long, livid, soft tumour, evidently formed by
cellular tissue filled with blood, and perfectly resembling the exudation of
blood produced by a bruise. If this tumour be opened, a remarkable quan-
tity of venous blood escapes, and the swelling of the eyelids instantly dimin-
ishes. In a more advanced stage, the redness is darker and more extended,
but least intense at the tarsal border; the livid swelling is also more resistent,
and has an uneven granular structure of a dark red colour. Still later, when
the swelling and redness have made some progress externally, and the eye-
lids are opened with difficulty, but the upper lid is still easily everted,
there are observed, on the fold of the conjunctiva before referred to, roundish
granulations of a deep red colour, which diminish remarkably both in number
and in size towards the tarsal border. With the extension of the granulations,
their appearance also is changed : they increase so remarkably in size, that
the number of individual granules, in proportion to the surface which they
occupy, is diminished, and their round form, evidently from the pressure of
the lids and of the bulbs, is flattened, and their apices become broader. In
the lower eyelid, which is less subject to pressure, irregular tumours are
formed, which increase, and exhibit great hyperaemia. It is very character-
istic in this exudation into the conjunctival areolar tissue, that the fold of
the membrane becomes more and more level, and at last the eyelid is so far
removed from the eye, that ectropium is produced.
When the granulations have lasted for a longer time, they are firm and
hard, and exhibit greyish plastic exudation, when a section is examined with
a lens. As long as the sanguineous congestion is considerable, the granula-
tions remain of a dark colour; but as soon as the quantity of blood is
diminished, (and at this period the inflammation is often mitigated by the
occurrence of spontaneous haemorrhages), they lose their colour, and become
pale ; and there appear greyish yellow, round, more or less flattened eleva-
tions, with a still congested deep-red ground between them. The eyelid now
gradually loses its hardness and thickness, so that, on eversion, conspicuous
oblique furrows are formed in the parts where the exudation is already re-
absorbed, while the granulations remain on the raised parts of the eyelids.
The masses of exudation assume an entirely different appearance as they
become chronic ; they can no longer be recognised as single granules, but
form large excrescences of a pale red or yellow grey colour, and obtain,
according to the quicker or slower absorption in different spots, a quite regu-
lar appearance. Between these masses, smooth patches of the conjunctiva,
which has regained its normal condition, can here and there be recognised ;
these gradually extend, until at last the excrescences disappear : the mem-
brane is smooth, but much reddened, and, for some time, pours out an excess
of mucous secretion. The so-called papillary bodies in the Ophthalmia of
new-born children are thus shewn to be a pathological product, and not
merely the enlargement of the papillae which already exist in the corium ;
for the latter are never found in the fold of the conjunctiva, which is the
chief seat of the disease. The pathogeny of the affection may be described as
follows: There is first congestion in the cellular tissue of the eyelids: the
vessels are gradually increased, and new ones are formed; these exude plasma,
the numerous aggregations of vessels already existing in the cellular tissue
form still thicker networks, and there is a proportionately considerable exud-

CRITICAL DIGEST OF THE JOURNALS. 1 003
w
ation, giving rise to the resistance to incision and the remarkable haemor-
rhages. With the disappearance of this mass of blood, the exudation also
ceases, while the venous circulation becomes more free, and the remaining
symptoms—swelling, redness, and secretion—disappear. Examination after
death always exhibited the infiltration of the cellular tissue, and the plastic
exudation-masses on the excrescences and on the conjunctiva.
... When the inflammation has attacked the sclerotic conjunctiva, the photo-
phobia, spasmodic contraction of the eyelids, and the swelling increase. On the
sclerotic conjunctiva, there is very quickly formed a fine thick network of ves-
sels, extending to the cornea. In twenty-four hours, a chemotic swelling has
generally formed on the cornea, and the latter soon loses its transparency,
and has an appearance like glass which has been breathed on. These changes
sometimes proceed so rapidly, that the cornea is rendered perfectly opaque
in twenty-four hours. It is then still possible, though more difficult, to open
the eyelids. Under the microscope, the dull whitish cornea shows a loosening
of the epithelium, which is raised into bladders in particular places; and
this takes place most early in the centre of the opacity, where it is most
intense. In from twenty-four to forty-eight hours, the epithelium is thrown
off, and washed away by the purulent secretion, in the whole extent of the
cornea, so that only a narrow border remains. When this occurs, the lamellae
of the cornea are observed to be attacked ; rarely only the superficial layers
are affected, but generally its entire thickness is destroyed, but to a smaller
extent than the epithelium. The deeper the lamellae, the smaller is the
extent of the destruction; so that the point at which the cornea is perforated
is only of the size of a pin's head, forming the apex of a funnel. Several
autopsies have shown the existence of a funnel-shaped cavity, with the pro-
lapsed iris at the apex. The whole of this process bears a remarkable re-
semblance to the death of the cornea, after section of the trigeminus nerve,
as observed by Longet and Pappenheim. In this case, the rapid softening
of the cornea might be produced by the impediment to the circulation, as
well as paralysis of the nutritive nerves of the cornea in consequence of the
chemosis of the sclerotic conjunctiva. wº
These cases, in which the disease was concentrated on the conjunctiva
covering the sclerotica and cornea, were neither observed to be preceded by
a phlegmonous swelling of the eyelids, nor accompanied by a profuse secre-
tion of pus; while the cases of the highest degree of palpebral conjunctivitis,
with profuse purulent secretion, often continued long, and disappeared with-
out leaving any trace of opacity of the cornea. Only in very tedious cases of
granulations, when the purulent secretion was very gradual in diminishing,
the access of crusta serpiginosa brought on a relapse, in which the globe of
the eye was attacked, and then the softening process sometimes took place.
TAnother evil result of the implication of the globe in this disease, is the
formation of ulcers on the cornea, which were produced by the extension of
the disease from the conjunctiva of the sclerotic and cornea, in the phlegmo-
nous inflammations of well-fed children. Several bundles of vessels extended
from the borders of the cornea, and extended into a fine thick network, in
the middle of which a phlyctenula formed, generally towards the circum-
ference of the cornea. This phlyctenula soon burst, leaving a small abscess,
which, if it were not sufficiently protected from the destructive influence
of pus, rapidly penetrated deeply, without extending much in breadth: it
usually showed a slight opacity in the vicinity, and sharply defined borders.
Blepharospasmus, photophobia, and a more watery secretion accompanied it.
This process of ulceration soon ends in performation, and prolapse of the iris,
if it sets in when Ophthalmia is at its height. Yet the prognosis in these
cases was more favourable than in those of softening : and deep ulcers were
frequently observed to be perfectly healed, with a slight lateral displacement
of the pupil and synechia anterior partialis, without any essential impediment
to vision.
WOL. II. 66
1004 CRITICAL DIGEST OF THE JOURNALS.
In healthy children, it is sometimes possible to arrest the progress, both
of the ulceration, and of the process of softening. The inflammation then
recedes, the chemosis disappears, the network of vessels is diminished, and
the cornea gradually becomes clearer, leaving, however, a certain unevenness,
but without opacity, at the spot which has been denuded of epithelium. If
the cornea itself have been destroyed at this point, a central spot is formed,
which gradually decreases in breadth. After perforation has taken place,
there remains a leucomatous cicatrix with synechia, and often a staphyloma,
so that sight can only be regained by the formation of an artificial pupil.
Dr. Fröbelius recognizes two forms—blepharo-blennorrhoea and ophthalmo-
blennorrhoea—in children, as in grown persons; the latter form is that, in
which the disease of the eye precedes that of the eyelids. An accurate line
of demarcation cannot be drawn between the two forms.
PROGNoSIs. This depends on the complications, as well as on the activity
and extent of the inflammation. Even a moderate degree of inflammation
becomes unfavourable, if apththae appear; the inflammation then increases,
and assumes an erysipelatous character, so that this sudden increase may
lead us to infer the presence of aphtha. It is only by energetic antiphlo-
gistic means that this disease is now to be subdued; and if we wait for a
single day, for the further progress of the aphthae, the bulb will be already
attacked, and the patient will not escape without sequelae. In icteric children,
the eyelids were livid, especially towards the edges, the swelling of which
was moderate and soft. The conjunctiva, when turned up, was seen to be
yellow-red only in the vicinity of the swelling before described ; the secre-
tion was watery, of a bright yellow colour, mixed with some flocks of mucus;
it coloured linen yellow. This complication was dangerous only when the
yellowness of the skin remained, the bowels were constipated, and the respir-
ation impeded ; the strength then rapidly diminished, and the Ophthalmia,
was destructive, if the child did not first die from the impeded respiration.
CAUSEs. The causes of the Ophthalmia of new-born children are con-
sidered by Dr. Fröbelius not to exist in the Foundling Hospital, but much
rather in the removal of the children to it, they being freely exposed to light
and air on the road ; and still further in the miserable domestic condition of
the lower classes, to which by far the greater number of children belong,
who are admitted into this institution.
TREATMENT. 1. In the commencement of the disease, while the swelling,
redness, and secretion of mucus, are moderate, and if the intestimes are regular
in their function, the eyes should be frequently and carefully cleaned with
tepid water; they should also be protected against hurtful external influ-
ences, and this is best effected by dropping almond-oil into them twice a-day.
At the beginning of the disease, especially before purulent secretion com-
mences, cold applications are much to be recommended, especially when they
can be very diligently renewed. 2. If the palpebral conjunctiva were very
remarkably swollen, the redness darker, and the secretion of pus so much
increased as to flow during sleep from the inner angle of the eye, a solution
of corrosive sublimate in the proportion of gr. i to 3i of water, with 5ss of
tincture of opium, was applied. 3. If the redness were very vivid, and the
hard swelling of the eyelids increased, so that they were difficult to open,
and if there was discernible swelling and redness of the sclerotic conjunctiya,
especially when the mucus appeared mixed with blood, a leech was applied
to each temple, and almond-oil was continued as an emollient remedy, and
to prevent the agglutination of the eyelids. 4. For photophobia and spasms
of the lids, a solution of 3ss of extract of belladonna in 3ii of water was
used: ten drops of which were poured on the hand, and rubbed into the
supra-orbital and temporal regions several times daily, according to circum-
stances. 5. When the swelling of the lids, the photophobia, and the spasms,
have disappeared, and when the inflammation of the bulb has ceased,
but there is still profuse purulent secretion with commencing granulations,
then a solution of gr. i to ii of nitrate of silver in 3i of water is applied
CRITICAL DIGEST OF THE JOURNALS. 1005
several times, 6. The treatment of granulations of the palpebral conjunc-
tiva varies according to the degree of the disease and its prevailing
type : and it is further influenced by the character and duration of the
disease. The blue red swelling in the fold of the conjunctiva, as soon as
the eyelids exhibit congestive redness, and the secretion principally con-
sists of a white mucus, is opened in its long diameter. The bleeding which
follows is encouraged by means of tepid water, and finally cold applications
are used to prevent reaction. Dr. Fröbelius here mentions, that the artificial
leech, introduced a short time before by Knusmann, had been found of great
use. This instrument not only perfectly supplies the place of leeches, but also
seems to possess some advantages over them. If the granulations are scarlet
red, with an elastic inflammatory swelling of the eyelids, and much purulent
secretion, photophobia, and spasm of the lids, and if, as is usually the case,
the child be strong, leeches, followed by the artificial leech to each temple,
are the most successful remedies. The emollient remedies before-mentioned
are to be also employed, together with friction of mercurial ointment and
belladonna on the region of the eyebrows. This treatment is more particu-
larly demanded, if spontaneous haemorrhages or aphtha appear. 7, When the
granulations are pale red, the granules indistinctly developed and irregular,
and the purulent secretion profuse, but the swelling of the eyelids soft, the
redness of the external skin, and the photophobia and spasms, slight, the
sclerotic white, and the cornea clear, and if the child can open the eyelids,
cauterisation with nitrate of silver in substance, and cold fomentations to
prevent inflammatory reaction, have proved of great utility. A single sudden
washing out is better than several dabbings, or the application of a brush to
any single part of the eyelids. Immediately after cauterization, oil must be
applied to the lids. If the fungosities on the conjunctiva appear fleshy, so
that large masses of them project when the upper eyelid is everted, they
must be excised. After this, cauterization is sometimes necessary, to over-
come the fungous growths. 8. The ulcers of the cornea must be variously
treated, according to circumstances. If, in severe cases of Ophthalmia,
there was rapidly produced opacity of the cornea, and ulceration, antiphlo-
gistic and emollient remedies were found more useful than stimulants and
astringents. Ulcers of this kind were transparent, had sharply defined
edges, and penetrated rapidly, before they had extended much. But if they
had a dull whitish ground, with irregular edges, and if the surrounding
cornea had a panmous opacity, with, however, indistinct inflammatory symp-
toms, the solution of nitrate of silver was found very useful. The use of
lapis divinus, sulphate of zinc, and sulphate of copper, with tincture of
opium, was also successful, though in a less degree. The application of
calomel in powder appeared of no advantage. 9. The treatment of kerato-
malacia was generally unsuccessful, as soon as the lamellae of the cornea were
implicated, and the disease had attacked more important parts. At the
commencement, the evil was guarded against by antiphlogistic treatment,
while this was still indicated, with frictions of grey ointment, and calomel
internally. But if the softening had extended much, especially in weakly
children, applications of lapis divinus with tincture of opium appeared to
answer best, with the internal use of aqua oxymuriatica, especially when
aphthae were present. In several cases of incipient softening, Dr. Fröbelius
employed the aqua oxymuriatica, without any other external means than
dropping in oil, with the most happy results. 10. The iris, when prolapsed,
was cauterized, and belladonna was applied several times to dilate the pupil.
Dr. Fröbelius considers a timely use of the latter remedy as likely to prove
of the greatest service in preventing greater injury to the eye. All cases of
staphyloma which were forming, were cauterized. 11. The internal treat-
ment was regulated by the condition of each individual child. In plethoric
children, with a very red countenance, and considerable Ophthalmia, ab-
straction of blood, and the internal use of castor oil were employed. When

66 2
I ()06 CRITICAL DIGEST OF THE JOURNALS.
the biliary secretion was impeded, and thé bowels were scantily moved,
calomel was given in doses of half a grain once or twice daily. In mild
cases of aphthae, borax was applied with a brush, and rhubarb with magnesia,
in fennel water, administered internally. In very considerable diphtheritis
of the mouth, the aqua oxymuriatica was applied externally with a brush,
and was also administered in teaspoonful doses three times daily, in some
mucilaginous decoction.
PROFESSOR SYME ON THE EXCISION OF ENILARGED TONSILS.
Professor Syme, in a paper published in the Edinburgh Monthly Journal
of Medical Science for September 1850, states his objections to the treatment
of simple Enlargement of the Tonsils by escharotics or ligature, and proceeds
to make some remarks on excision, which we give without much curtailment.
The method of excision dates so far back as the time of Celsus, who advises,
when other means have failed to remove Enlargement of the Tonsil, “hamulo
evcüpere, et scalpello eacidere.” It does not appear to have been systematically
or extensively employed until the middle of last century, when various French
surgeons devoted much attention to its practice and improvement. Of these,
M. Caqué, surgeon of the Hôtel-Dieu of Rheims, and his colleague, M. Muzeux,
seem, from the excellent papers of M. Louis, in the Memoirs of the Academy
of Surgery, to have been most successful in their exertions. The former of
these gentlemen operated in many cases with great success ; and the latter,
in order to facilitate the process of removal, contrived a peculiar sort of for-
ceps, which still retains his name. This instrument is about seven inches in
length, and, from the handle of the blades to their junction, resembles that
employed for the evulsion of nasal polypus. The extremities of the blades
are slightly curved, and each terminates in a double hook, so fashioned as to
take a sure hold of any soft substance such as the tonsil. Though the opera-
ation was thus rendered wonderfully easy and safe, it still retained a charac-
ter of difficulty and danger that opposed its general introduction into practice,
and in this country precluded its employment entirely until comparatively
a very recent period.
In the year 1821, during my residence in the Royal Infirmary of Edin-
burgh, as House Surgeon, one of the female patients suffered from Enlarge-
ment of a Tonsil. After trying sulphate of copper, and similar applications,
without success, I attempted the ligature, but without being able to accom-
plish it ; and then, as the tumour was of no great size, resolved to remove it
by excision, which was accordingly done very readily by means of a hook
and curved scissors. This, as far as I know, was the first instance of a tonsil
being cut out in Edinburgh. Next year I went to Paris, and there found M.
Lisfranc in his course of operative surgery on the dead body, treating excision
of the tonsil as an established operation. He employed for the purpose a
straight narrow blunt-pointed bistoury, of which the blade was sheathed,
except for rather more than an inch from the point, and explained that if the
tumour was pulled inwards from the side of the fauces or merely held steady
in its natural position, the knife might be carried with perfect safety through
its base, as the blade must then be parallel with the carotid artery, and at such
a distance from it as to render any injury of the vessel quite impossible.
Much impressed with the advantages of the operation as thus performed, I
endeavoured, on my return home, to promote its adoption ; and, having car-
ried with me the forceps of Muzeux, placed them in the hands of Mr. Liston,
who afterwards did all in his power, by precept as well as example, to establish
the practice. Abundant opportunity has been afforded for determining the
merits of the operation, by extensive and long continued experience.
In no instance has haemorrhage or any other unpleasant accident occurred.
The excision is accomplished with hardly any pain ; and children, who are
sometimes induced with difficulty to submit, in the first instance, seldom

| Tom. v., p. 423.
CRITICAL DIGEST OF THE JOURNALS. | 007
offer any objection to removal of the second tonsil. I never employ a specu-
lum of any sort, even in the youngest and most obstreporous patients,
the forceps sufficiently keeping down the tongue, and the wide opening of
the mouth preparatory to the emission of a cry, affording ample space for the
knife to act. In the whole course of my practice, I haye only on two occa-
sions failed in accomplishing the object in view, through the excessive size of
the tongue, and contraction of the mouth. The knife should possess a very
keen edge, as the glandular substance is sometimes indurated, and a partial
division of it would lead to great embarrassment, from the blood trickling into
the pharynx, and causing such cough or convulsive efforts as must render a
fresh seizure of the tonsil next to impossible. I generally remove the left
tumour first, and then the right one, by crossing my hands so as still to retain
the knife in the right. The process is instantaneous. and the relief imme-
diate. The bleeding seldom exceeds a teaspoonful or two, and no after-treat-
ment is required.
ENCYSTED TUMIOUR OF THE LABIUM, SUCCESSFULLY TREATED BY THE
APPLICATION OF NITRATE OF SILVER TO THE INTERIOR OF THE
CYST. BY DR. R. MºDONNELL.
Having met with some cases of Encysted Tumours of the Labium, which
presented greater difficulty in diagnosis than is stated by writers on diseases
of females to exist, and having derived the greatest satisfaction from a pecu-
liar method of treatment of these Tumours, Iam induced to lay the particulars
of the following case before the profession, in illustration of these two points.
I was consulted, March 16, 1846, by a lady aged about thirty-six. She
stated that, three years before, after a severe and long journey in the winter,
during which she suffered much from the bad state of the roads, she was
attacked with violent vomiting, which lasted for a fortnight. After it ceased,
she noticed, for the first time, a small Tumour inside the left Labium, which
she considered a rupture produced by the efforts at vomiting, having formerly
been subject to inguinal hernia. This Tumour gradually increased up to
the present time; it was not, at any period, painful, never receded or dimi-
nished in size, never emitted any gurgling sound, nor was it ever the seat of
oedematous swelling, heat, or redness. It had gradually increased, and had
latterly interfered with her movements; and, for some time previous, had
prevented her sitting down, except with the body reclining far back ; and,
when she sat on a hard seat, pain of an acute kind used to shoot upwards,
from the Tumour through the sacrum. Latterly, she has been annoyed by
a sensation of dragging from the loins. The Tumour itself had never-been
the seat of pain, nor had there been any discharge from the vagina, or any
irritability of the bladder. The catamenia had been absent for years. She
had never been pregnant but once, and then she had a miscarriage.
On examination, a Tumour, of an oval shape, was found occupying the left
labium ; it was about the size of a goose-egg, running along the labium from
the anterior fourchette to the perinaeum, and sending a process upwards, for
about two inches, along the wall of the vagina. The skin covering it was de-
void of any inflammatory appearance, and moved freely over it. There was
no pain complained of when pressure was employed. On coughing, an im-
pulse was given to the tumour when it lay in its usual position; but, when it
was lifted up, it did not receive any. On percussion, it yielded a dull sound.
All attempts at making it enter the abdominal cavity completely failed. No
irregularity was noticed on its surface ; no rumbling heard at any time, nor
was there the least change produced by the varying conditions of the bowels;
when ºnstipated the Tumour was as soft and as small as when they were
relaxed.
March 20. An exploratory puncture was made, and matter of a dark olive
colour, devoid of odour, escaped. The opening was enlarged, and a tumbler
1008 CRITICAL DIGEST OF THE JOURNALS.
full of thick fluid flowed out, which was of a creamy consistence; and, on
microscopic examination, was found to be composed of decomposed pus-glo-
bules, with a large quantity of what appeared to be epithelial scales inter-
mixed. The sac of the Tumour was freely cauterized with nitrate of silver,
conveyed on a probe, and the orifice kept open by means of a plug of lint.
March 27. The sac of the Tumour has been filled up with solid secretion,
and has undergone great diminution in size. No general disturbance,
April 1. Scarcely any trace of the Tumour to be detected, except some
thickening of the labium, giving to it a greater fulness and prominence than
the other. Ordered to apply mercurial ointment.
April 10. Perfectly recovered. No traces of the disease left.
REMARKs. With the exception of Dr. Ashwell, no writer on diseases of
females, that I have consulted, speaks of the points of similarity presented
by some cases of Encysted Tumours of the Labium, and vaginal and pudendal
hernia. He remarks, “that he has known much difficulty arise in diagnosis of
this Tumour, from a hernia”; and, in the case I have detailed, the size of the
Tumour, its shape, supposed origin, and apparent connexion with the inte-
rior of the pelvis (by means of the ascending process already described), toge-
ther with the fact, that the patient was predisposed to rupture, and that the
Tumour received some impulse from coughing, made me proceed cautiously
with an exploratory puncture before laying open the cyst.
It is true, that, for one case which will present any difficulty in diagnosis,
we may meet with a dozen where no such obscurity exists; yet, from the
occasional occurrence of such cases, the practitioner should examine all with
care, before attempting a cure ; for it is strange, that, though the differential
diagnosis between inguinal tumours and hernia, in the male, is insisted upon
with great force by all writers on these subjects, yet, in works especially
devoted to diseases of women, little attention is paid to the matter. But it
was more especially with the view of illustrating a method of treatment,
which I have found invariably successful, and productive of little annoyance
to the patient, and of easy application,-that I have laid the foregoing case
before the profession.
Four plans of treatment have been recommended for the cure of these
Tumours: 1. Complete dissection out of the whole of the cyst—a plan which
must be extremely difficult in most cases, in all extremely painful, and in
such a case as mine, quite impracticable. 2. Laying open the cyst, and
filling it up with charpie. 3. Seton ; and 4. Removal of the fluid, and then
compression, so as to bring the walls of the cyst into close apposition. The
plan of treatment which I have employed for some years past, has been to
cauterize, with nitrate of silver, the lining of the membrane of the cyst, so as
to cause adhesive inflammation; and this process I have found to be so readily
excited by the caustic, that I have never been obliged to repeat it a second
time. In some instances I have touched the granulations, occasionally,
during the progress of the cure, for the purpose of hastening the filling-up
of the sac ; and these were instances where I believed that the nitrate of
silver had acted, not by inducing adhesive inflammation, but by effecting a
change in the functions of the membrane, in consequence of which, it threw
out granulations, instead of secreting, as formerly, a peculiar fluid. In every
case in which I have used the nitrate of silver in this manner, a speedy cure
has followed, unattended by any bad consequences, and the patient has not
been aware, in the majority of instances, that anything beyond the mere
puncture of the cyst has been attempted. When we reflect for a moment
upon the difficulty of dissecting out a cyst even of moderate size, and upon
the excessive pain the patient must endure, both in this operation and in
the second and third I have mentioned, and when we recollect the extreme
difficulty, if not impossibility, of applying accurate pressure, it will be al-
lowed, that the method I propose, is, at least, unattended with any of these
inconveniences; and if it should prove in the hands of others, as successful
CRITICAL DIGEST OF THE JOURNALS. 1009
as it has done in mine, and I have little doubt but it will—it must be con-
sidered a plan of treatment preferable to any recommended for the cure of
this disease.
The method of preparing the caustic may not be known to some of my
readers, and I shall therefore make no apology for describing it : A large-
sized probe should be dipped in caustic, which has been readered fluid by
melting in a watch-glass, over a spirit-lamp or wax candle, until there is a
complete coating of the caustic on the probe. When this cools, we have the
nitrate of silver, in a form well suited for being conveyed through a small
opening and into a deep cavity, and by bending the probe, we suit it to the
shape of the cyst, and thus it can be brought into contact with all parts. In
large cysts, such as that under consideration, I have had two or three probes
thus prepared, as the quantity of caustic coating one, is not enough for the
extent of surface to which it must be applied.
This method of destroying cysts, I have been in the habit of employing
in other diseases, as in the encysted tumours of the eye-lids, and in sebaceous
encysted tumours; and lately I succeeded in curing a lady of a tumour of
the shape, and about twice the size of an almond, which had been growing
for some months on the left jaw, and which had resisted every plan of treat-
ment proposed by her former attendant, who had at last recommended its
extirpation. A small puncture was made into it, and its contents, which
were composed of a reddish jelly-like substance, were squeezed out. A probe,
coated with caustic, was introduced, and freely applied to its interior. For
the next few days, a small quantity of bloody serum oozed out, but the
tumour gradually diminished in size, and now, no trace of it remains, nor is
there the least scar visible, which, I need not say, is a matter of some im-
portance. •
The discovery of this method of conveying lunar caustic to deep recesses,
has been ascribed by some of the writers in the Dublin Quarterly Journal of
Medicine, to my friend Mr. Wilde; but the paper in which he first alludes
to it, was submitted to myself as Editor of that periodical, before its manage-
ment fell into his hands; and in a note referring to the matter, he attributed
the discovery to Mr. J. Morgan, from whom he had learned it. I mentioned,
at the time, that Mr. Morgan was not the discoverer, for the plan was quite
familiar to myself and other surgeons long before Mr. Wilde's paper was
written, and had been spoken of at a meeting of the Surgical Society, in con-
nexion with the treatment of small naevi. The paper was published, and the
obligation to Mr. Morgan omitted; and hence the origin of “Mr. Wilde's
method of applying caustic.” [British American Journal of Medicine, 1849.]
*=====s* =w=s.
DR. LORINSER ON THE MAXILLARY NECROSIS PRODUCED BY
PHOSFHORUS WAPOLjR.
The London Journal of Medicine for October 1849 contained, at p. 961,
an abstract of the views of DR. HELFFT on the Maxillary Necrosis of lucifer-
match makers; and the December number contained the abridgments of
a paper on the same subject by MR. H. TAYLOR, and of a clinical lecture
by MR. STANLEY. In the Zeitschrift der K. K. Gesellschaft der Aerzte zu Wien
for July 1850, we find a statement of the results at which DR. LORINSER has
arrived, from an examination of thirty cases of the disease.
Dr. L. considers the disease as a general affection, with a marked tendency
to attack the lower jaw. That the whole organism is affected, is proved by
the ashy countenance; by the diarrhoea, and bronchial catarrh ; by the pain
in the joints, as well as by tuberculosis of the lungs in the progress of the
disease. The lower jaw is affected in a remarkably larger proportion of
cases than the upper jaw, or the other bones of the face. The first symptom
is swelling and tenderness, at a point in the lower jaw : , osteophytes are
formed, first as irregular homogeneous porous masses, attached to the bone,
10 I 0 CRITICAL DIGEST OF THE JOURNALS.
of a dirty green colour, in the dried preparation, and containing fine canals,
at right angles to the long axis of the bone. In the further progress of the
disease, they become more massy and compact, have a lamellar structure,
adhere more firmly, and have canaliculi running parallel with the bone.
In the meantime, pus and ichor are formed, which dissolve and remove a
portion of the new osseous formation, especially of the first-named kind.
The bone is denuded of its periosteum, and becomes necrosed: but a firm
shell forms over it. In some cases, even the condyle of the jaw is restored.
This was observed in some patients who died, at a later period, of pulmonary
phthisis—a disease, which Dr. Lorinser has seen to attend all the more
severe forms of the affection of the jaw. In the upper jaw, there is scarcely
any reparation: the periosteum here seems to have less vital activity, and
the osteophytes are thin and pulverulent, and easily removed with the pus,
so that their existence has been denied. Dr. Lorinser, however, has found
them not only in the upper jaw, but also in the other bones of the face.
With regard to the treatment, Dr. Lorinser is opposed to resection of the
diseased part of the bone, on account of the difficulty of determining its
extent, because reparation is imperfect, and because, if an affected portion be
left, the disease will still extend. He prefers enucleation of the jaw, especi-
ally in advanced stages of the disease. In any case, the patients must be
removed from exposure to the vapour of phosphorus, and be taken into the
country; the abscesses and sinuses must also be opened, to give exit to the pus.
MATERIA MEDICA AND PEIARMACY.
cºmmemº
LINUM CATHARTICUM, OR PURGING FLAX.
This is a well known indigenous annual, belonging to the natural family
Linaceae, and pentandria pentagynia in the Linnaean system. It has a slender
stem, and small white flowers. It is used as a popular remedy in rheuma-
tism, and other complaints. Dr. BUTLER LANE thinks that it deserves more
notice from the profession than it at present receives. The following is an
abridgment of hiſ remarks in the Medical Times of July 13th, p. 31.
The extractiveBäätter of the linum catharticum appears to be very soluble
in water, and but partially so in alcohol. By the action of hot water, the
dried plant yields rather more than one-sixth of its entire weight as an ex-
tract, leaving merely inert and tasteless vegetable matter. The medicine
has usually been administered in the form of an infusion, but its nauseous
flavour renders it very objectionable ; and as an aqueous extract of proper
pill consistence is readily obtainable, it is the best form for administra-
tion. The dose of this is from five to ten grains twice or three times a day ;
in such quantities, it exerts a mild but efficient cathartic action, generally
unattended by griping, and, at the same time, it sensibly promotes the secre-
tion of the liver. The cathartic action appears to influence both the mucous
and muscular structures of the alimentary canal, more especially the upper
part of the small intestines. The linum catharticum produces no specific
effect on the nervous system.
In catarrhal and rheumatic maladies I have found the linum catharticum
very effectual. The benefit is more slow in the latter ; and seems to depend
on the diuretic action. In chronic rheumatism, especially when affecting
muscular structures (as in lumbago), it is, I think more efficacious, than any
other simple medicine. The diuretic action is readily manifested when the
medicine is given at short intervals. In cases of ascites connected with
hepatic disease, I have found it very efficient. It is a very safe medicine.
10 1 1
RE PORTS OF SOC I BTI E. S.
ROYAL MEDICAL AND CHIRURGICAL SOCIETY,
TUESDAY, JUNE 11, 1850.
BENJAMIN PHILLIPs, Esq., W.P., IN THE CHAIR.
ON Fungus CEREBRI. By GEORGE: Low E, ESQ., M.R.C.S. (Communicated
by FREDERICK SKEY, Esq., F.R.S.) CASE I. C. K., a groom, was kicked on
the forehead by a horse ; this produced compound and comminuted fracture
of the skull, with laceration of the brain. Several pieces of bone were removed.
Inflammation supervened; and, ten days after the accident, there was a
dirty white pulsating tumour, of the size of a nutmeg, protruding through
the wound : from its surface, there was a copious oozing of serous fluid. The
patient suffered also from drowsiness and vomiting. Mercury was given ;
lint was applied to the wound, and cold dressings to the head. This treatment
subdued the disease ; the tumour became more and more fibrous, and at last
sloughed away; and the patient recovered, apparently retaining the full pos-
session of his strength of mind and body.
CASE II. This was a lad, aged 19. The history was somewhat similar to
that of the preceding case : but, at the beginning of the fourth week, when
convalescent, he ate heartily of beef and other things for dinner. Local and
constitutional symptoms again set in ; the fungous tumour returned ; coma
came on, and the patient died.
REMARKs. The author referred to the varieties of hernia cerebri, as men-
tioned by authors ; and contended that the only form of the disease was a
fungous growth or excessive granulation from the brain, and not a protrusion
of part of the brain itself; for it was not probable, that a piece of the brain
of the size of a large orange could be removed, without severe injury to the
functions of the organ. Mr. Lowe believed Fungus Cerebri to be the result
of cerebral granulation, and that the period at which it appears is dependent
on the occurrence and co-existence of granulation and ammation ; and
he pointed out the physiological reasons which led him to this conclusion.
In the treatment, the author advocated the early and careful removal of
splinters of bone. If inflammation and Fungus supervened, antiphlogistic
means were to be employed ; and the only application to the Fungus should
be dry lint covered with oiled silk, so as to allow the use of refrigerants to
the scalp. If, after inflammation had subsided, the Fungus should not de-
crease, tonics, and gentle pressure on the tumour might prove beneficial.
DR. WEBSTER related a case, in which he had seen Fungus Cerebri excised
many years ago. The patient had, thirty years after, presented himself to
Dr. Webster, in good health, and with his intellect not at all impaired.


CASE of FATAL PorsonING BY SIR. W. BURNETT's FLUID. By H. LETHEBY,
M.B. (Communicated by T. B. CURLING, Esq.). The symptoms and post-
mortem appearances were those of irritant poisoning ; and zinc was detected
by chemical tests.
RETENTION of URINE IN THE BLADDER FOR NINE DAYs. By A. W. GABB,
Esq. (Communicated by H. BENCE, Jon Es, M.D., F.R.S.) . In this case, a
small oxalate of lime calculus, weighing less than half a grain, escaped with
the urine which first passed. Mr. CHARLES HAWKINS regarded the case as
unique; and considered the retention to have depended on spasm, and to
have been in the kidneys or their pelves.
CASE IN which THE URACHUS REMAINED OFEN, AND A RING-SHAPED CAL-
culus, FoRMED on A CURVED HAIR IN THE BLADDER, WAS EXTRACTED THROUGH
THE UMBILICUs. By THoMAS PAGET, Esq. (Communicated by WILLIAM
1012 FEPORTS OF SOCIETIES.
Bowman, Esq., F.R.S.) J. C., aged 40, had suffered for more than a year
from painful micturition : and a calculus was readily detected on sounding.
There was an opening at the umbilicus, through which urine sometimes
escaped. Through this passage, Mr. Paget extracted the calculus with his
finger. In the linea alba, there is a circular opening of an inch in diameter,
with a thick, hard margin. A hernia, of the size of a goose-egg, protrudes
through this, and is covered by mucous membrane. When the hernia is out,
no urine can be passed, until, by the efforts required for micturition, the
whole of the hernia has been drawn within the abdomen. When this is
done, urine escapes freely both by the opening and by the urethra. He can
retain a pint of urine.
TUESDAY, JUNE 25, 1850.
DR. ADDIson, PRESIDENT, IN THE CHAIR.
Two CASEs of IDIOTS WITH ABSENCE OF THE THY ROID GLAND, AND SyM-
METRICAL SweLLINGs of FAT TISSUE AT BOTH SIDEs of THE NECK. By T. B.
CURLING, Esq., F.R.S. In two cases of idiotic children, who had during life
present soft symmetrical swellings at the sides of the neck, these were found,
after death, to consist of fat-tissue, without any investing envelope, and
loosely connected to the surrounding parts. The thyroid gland was also
absent ; and Mr. Curling thought it very probable, that the abnormal de-
posits of fat in the meck were dependent on the absence of those changes
which result from the action of the thyroid, or on some imperfection in the
assimilating processes, consequent on the want of this gland.
CASE of HEMIPLEGIA, IN which Loss of SPEECH was A PROMINENT Symp-
ToM. By RoBERT DUNN, Esq. The patient was a woman, aged 65, who had
three apoplectic seizures, in the last of which she died. She recovered from
the first attack, and regained the full use of her arm and leg, but had the
peculiarity of using one word for another. After her second attack, she
had paralysis of the right side, and was unable to speak, though her mind
was intact. The upper two-thirds of the anterior lobe of the left hemi-
sphere were disorganized ; the corpus callosum was nearly destroyed, and so
was the upper half of the corpus striatum on the left side. The optic
thalamus was shrunken ; the anterior commissure and fornix were gone, but
the corpora geniculata remained. On the right side, the hemisphere was
healthy; but there was a small recent apoplectic clot in the lateral ventricle,
on the upper and anterior surface of the corpus striatum. The whole upper
portion of the corpus, as well as the outer surface of the thalamus, were in
a state of softening. The cerebellum and base of the brain were healthy.
Mr. Dunn considered this case to support the view of Gall, that the seat of
the faculty of speech is in the anterior lobes of the brain. He considered
that, in the case related, the functional power of the left anterior lobe was
entirely abolished; and that, although the right hemisphere was healthy,
and probably exercised its function as a centre of intellectual action, still
the volitional power was wanting, to give utterance to the passing thought,
for the corpus striatum was not in its integrity.
ON A CASE of so-CALLED CHYLous URINE. By H. BENCE JONES, M.D.,
F.R.S. The patient was a man, aged 32, who passed milky urine, which
contained fat, albumen, fibrin, blood-corpuscles, and alkaline salts. Dr. Bence
Jones made some series of observations, to determine the effect of various
modes of treatment. The following is the general average per 1000 on the
observations. 1. Animal food ; Urine chylous 968 times, free from chyle
32 times: 2. Vegetable food; chylous 910, free from chyle, 90: 3. With
pressure, belt loose; chylous 667, free from chyle 333: 4. With pressure, belt
tight; chylous 638, free from chyle 362; 5. Matico; chylous 474, free from
chyle 526; 6. Gallic acid; chylous 17, free from chyle 983; 7. After Gallic
ROYAL MEDICAL AND CHIRURGICAL SOCIETY. 1013
*
acid; chylous 0, free from chyle 1000. Gallic acid was taken for 53 days;
on the third day, the albumen and fat disappeared from the urine : and for
69 days after the medicine was left off, the disease did not reappear.
PROLONGED ExPIRATORY MURMUR. As A SIGN of INCIPIENT PHTHISIS. By
THEOPHILUs THoMPson, M.D. The author had noticed 308 cases among the
out-patients at the Hospital for Consumption, in whom prolonged expiratory
murmur was the most prominent symptom, and in 288 of the cases, was
almost invariably heard near the apices of the lungs. It was most accom-
panied by haemoptysis in 91 cases out of the 288. Assuming that 43 per
cent. of the hospital patients have haemoptysis before softening takes place,
he observed that, while the co-existence of haemoptysis with prolonged expir–
ation pointed to a connexion between it and phthisis, yet the low frequency
of haemoptysis in these cases points out, 1. That prolonged expiratory
murmur takes place of other signs: 2. That haemoptysis more frequently
precedes than follows the deposition of tubercle. Dr. Thompson believed
that, in the absence of such sources of fallacy as emphysema and bronchitis,
this º rhythm of the murmurs is the most early and significant sign
of Phthisis.
CASE of ABSCESS IN THE WESICULA. SEMINALES, PROVING FATAL BY PER-
FoEATION of THE BLADDER, AND ExTRAVASATION of PUs INTo THE ABDo-
MINAL CAVITY. By MITCHELL HENRY, Esq. The patient was a sailor twenty
years old. The symptoms during life simulated hip-joint disease, with puru-
lent, and afterwards bloody urine. He died with symptoms of peritonitis.
After death, the remains of an abscess were found in the left vesicula semi-
malis, which was nearly destroyed by suppuration. The abscess had per-
forated the bladder by a small rounded hole ; the peritoneum reflected from
the side of the bladder also became perforated, so that the pus had found its
way into the abdominal cavity, and set up fatal peritonitis.
CASE of ILEUS AND STRANGULATED HERNIA occuRRING IN THE SAME INDI-
VIDUAL. By SAMUEL SoLLY, Esq., F.R.S. The patient was a young man,
aged 21, who had been suffering from obstinate constipation. Strangulated
inguinal hernia occurred, for which he was operated on by Mr. Solly, the
external and internal abdominal rings being divided, and the sac opened.
After death, a foot and a half of small intestine was found enormously dis-
tended, and very black, lying in the pelvis ; it was girt by a band about
an inch and a half long, connected with the caecum on one side, and with the
peritoneum covering the iliacus externus muscle, close to the internal abdo-
minal ring, on the other. The band was round and firm, and seemed to be
either a result of old adhesive inflammation, or the remains of the omphalo-
mesenteric duct. Mr. Solly believed it to have been the cause of the pre-
vious obstinate constipation. ** .
SPECIAL GENERAL MEETING, THURSDAY, JULY 11, 1850.
DR. ADDISON, PRESIDENT, IN THE CHAIR.
CHANGES IN THE BERNERs STREET House. The Council reported, “that
in pursuance of a resolution passed at a Special General Meeting, held
May 1st, 1849, they have concluded an agreement under which they are
now in possession of the whole house (in which they hitherto had apart-
ments, only, at £210 per annum), for a period of upwards of forty years, at
#160 per annum. The Council have carefully considered how they could
most advantageously increase the accommodation at present afforded to the
fellows; and they are of opinion that it is extremely desirable that a larger
amount of space should be provided in the meeting room, with improved
ventilation. A plan has been procured from Messrs. Wigg and Pownall,
architects, by which the necessary accommodation can be obtained, at an
estimated cost of £1000. The present meeting room is thirty-two feet long,
by twenty-eight feet wide, and seventeen feet six inches in height, the super-
1014 MISCELLANEOUS INTELLIGENCE.
ficial area is eight hundred and ninety-six feet, and the cube contents six-
teen thousand feet ; as altered, it will be fifty feet long, by twenty-eight
feet wide, and twenty feet high, the superficial area one thousand four hun-
dred feet, and the cube contents thirty thousand feet. They are of opinion
that the present council room might be advantageously appropriated as a
room in which those fellows who wish to read and write, free from interrup-
tion, might be accommodated. The substantial and ornamental repairs
necessary for the rest of the premises are estimated to cost £600. These
alterations the Council beg to recommend to the Society for adoption, and
that they should empower the trustees of the Society to sell as much stock
as will produce such a sum (not exceeding £2,000) as may be required for
defraying the expenses of these alterations, and for the payment (already
authorised by the Society) of £300 to Mr. Scott for his interest in the lease
of the premises.”
The Society, after an animated debate, refused to sanction the proposed
expensive alterations, and decided that the house should simply be put in a
state of efficient repair.
WIISCELIANEOUS INTELLIGENCE.
APPROACHING SESSION of THE MEDICAL SocIETY of LoNDoN. The first
meeting will take place on Saturday the 12th instant, when the proceedings
will be opened by a paper from the President of the Society. This meeting,
our readers are aware, is the first since the amalgamation of the old Medical
with the late Westminster Medical Society. We cannot but congratulate
the Fellows, and the profession at large, upon the pleasing prospect which is
now opening. At last, the metropolis may look forward, with confidence, to
the establishment of a Society so constituted, as, in every respect, to meet
the exigencies of the times. It is a fact, curious yet not less true, that,
numerous, great, and deservedly-esteemed, though the scientific societies in
London are, there is yet not one in itself capable of carrying out the mani-
fold objects of an Academy of Sciences. Societies that might have taken the
initiative in carrying out such views, have so long neglected or refused to
act, that they have ceased to be in a position to do so; while others, governed
by monopolising bodies, are too deservedly unpopular to undertake the task
with any chance of succes. None of these objections apply to the Medical
Society of London. With antiquity, and the most active portion of the me-
* talent of the metropolis on its side, it is preeminently qualified to supply
the void.
The Library and Hall of meeting are now in a most central position, at
No. 33 George-street, Hanover-square. The meetings are to be held, (as for-
merly, in the Westminster Medical Society.) on Saturday evening, and are to
continue weekly, until the end of May. But the advantages of the Society
have been greatly extended : several new and most wholesome measures have
been adopted. An old custom in the Medical Society has been also revived,
namely, the appointment of Sectional Committees, consisting of distinguished
and active Fellows: one for Medicine, one for Surgery, and a third for Mid-
wifery. OtherSectional Committees are in contemplation. The departments of
Chemistry, of Materia Medica, and of Statistics, will be duly represented. From
the labours of these Sectional Committees, much public and professional ad-
vantage may be expected. We would suggest that, in future, the Sectional
Committees consist of thirteen in place of seven members; and that they be
elected by the Society. The aggregate Sectional Committees ought then to
form the Executive Council. It has been proposed to open direct relations with
Government, in relation to sanitary or other measures connected with medical
science. Companies and individuals, moreover, requiring information and ad-
vice on any point of vital statistics, on new discoveries, or other improvements
MISCELLANEOUS INTELLIGENCE. 1015
made, will have the opportunity, in this way, to obtain the advice and assistance
of a Sectional Committee especially appointed for the purpose of giving the in-
formation. Herein, it is hoped, will be developed a valuable agency:—a board,
whose opinions, unbiassed by Collegiate partialities, or Government control,
may ultimately—and the sooner the better—supersede the Board of Health,
or, at least, carry out the intentions of that ill-constituted institute in
stricter accordance with truth and science,—a task which can never be
accomplished by untrained Sanitary amateurs. In this way we hope to see
Public Hygienics prevented from continuing (as at present) little better
than a branch of quackery, and a field for jobbing.
Two Lettsomian Professorships have also been established. Though these
appointments are, owing to the limited means at the disposal of the Society,
only as yet honorary, it is to be hoped that they may not always remain so.
Those who obtain them will at least have reason to be proud of the distinc-
tion. They have been named in honour of the distinguished benefactor of
the old Medical Society. Their object is to enable Fellows who have become
distinguished in any particular branch, to communicate their views in a
more public and satisfactory manner—precisely as the lecturers at the Royal
Colleges do, only that hereafter men shall not be elected by the partiality of
a few high in office, but by general suffrage, merited through their own
intrinsic and distinguished knowledge. We hope to see the Lettsomian Pro-
fessorships become objects of high ambition, honourable emulation, and some
emolument. .
The library of the old Medical, towards the support of which all available
means will be employed, is a great advantage. It is hoped that it may be
enriched now, not only in the older standard works, but also by those of
more recent publication. Large presents of this kind, from many of our
most esteemed modern authors, have already been promised. The Reading
Room will remain open, we understand, from 11 A.M. to 10 PM, and will thus
afford ampler facilities for the study and consultation of books, than London
has ever yet afforded to the medical profession.
The Fothergillian Medals are well known. This year an additional medal
is offered, to commemorate the occasion of the amalgamation.
The number of papers already promised is unusually large; and we may
thus look for a very interesting and instructive session. The papers, it is
hoped, will be issued at the close of the session in a volume of transactions.
Papers only of value should be read ; and all those read should be printed in
a good but inexpensive form, provided the authors supply their manuscripts
when required, and do not cause delay in bringing out the volume.
All these are great, very great advantages, and entitle to gratitude
those who planned and carried out the amalgamation. We trust that the
motives of the council of the Society, and their exertions during the recess,
will be appreciated by every medical practitioner in or near the metropolis.
The profession may rest assured, that the Medical Society of London will, if
it obtain the support it merits, be surpassed by no other Society ; that it will
not only take the lead among the Societies of London, but gain a preeminent
position among the most famous and the most learned academies of the world.
We therefore earnestly advise all who love medical science, and all who desire
(easily and unexpensively) to keep pace with its progress, to rally round
the banner of the London Medical Society. Let all metropolitan practitioners,
who are not now Fellows, with one consent enter the Society, and then all
that could be desired will be accomplished.
MoRTALITY AND PUBLIC HEALTH OF Oxford. An excellent example has
recently been set in the city of Oxford, by the publication of monthly and
quarterly reports of its sanitary condition, together with classified lists of
deaths in the Infirmary. These instructive reports are now regularly issued
under the patronage, and at the expense, of the Ashmolean Society, being
I016 MISCELLANEOUS INTELLIGENCE.
compiled by DR. GREENHILL and MR. ALIEN, who have appended some valu-
able editorial remarks. We hail their appearance with satisfaction, and trust
that other towns will not fail to adopt a similar publication: Much useful
information, now lost to the profession, would thereby be put upon record,
and conduce greatly to the advance of sound knowledge and practical expe-
rience. According to the Quarterly Report, for the spring of 1850, the state
of the public health at Oxford was highly satisfactory ; the deaths being
proportionally fewer than in the metropolis; although London then proved
also very healthy. A comparison even of the mortality from zymotic dis-
eases in the two cities, shows a slight superiority in favour of Oxford. The
diseases from which the greatest number of deaths occurred, were phthisis,
fever, convulsions, and disease of the heart. The deaths from fever proved
more numerous than in the similar period of any of the previous years ;
whilst those from erysipelas were more than double the average. No fatal
case of small-pox has been reported at Oxford in any spring quarter since
1845; an immunity, doubtless, greatly owing to vaccination. The classified
list of deaths in the Infirmary contains a short statement of the most import-
ant cases, with the chief symptoms, and the pathological appearances observed
on dissection. The profession are much indebted to Dr. Greenhill and Mr.
Allen for these useful statistical tables. If every hospital and infirmary
throughout Great Britain would periodically publish similar official reports,
far more correct notions respecting the mortality in public institutions
would be acquired, than we at present possess. We believe that the deaths
in hospitals are more numerous than they ought to be.

DISGUSTING LIBEL on THE MEDICAL PROFESSION, PUBLISHED BY ORDER of
THE Hous E of Commons. Blue Books are often full of worthless and irrele-
vant opinions; they are also sometimes made vehicles for libel. MR. SADLER,
an undertaker, states in his evidence, that “it is known that surgeons take
commission on funerals.” This may be true in some exceptional instances,
for within the pale of our profession, as in others, improprieties and crimes
are committed ; but it was grossly wrong to convert an unsupported charge
into a disgusting libel on the entire medical profession, as is done by pub-
lishing it in the Blue Book. If Mr. Sadler had been asked, “Is it known
that clergymen have committed adultery, and lawyers forgery?” he could
only have replied in the affirmative. But would this reply have been pub-
lished at the expense of the country It is most discreditable for members
of the House of Commons thus wantonly to put forth so revolting, and so
false and disgusting a libel on the medical profession.
TESTIMONIAL To DR. J. Conol.I.Y., of HANWELL. As an amiable and up-
right men, and as a learned and accomplished physician, Dr. Conolly is
worthy of all praise ; but it is in the nobler position of a great benefactor of
his species, that he peculiarly deserves the honour and the gratitude of his
fellow men. Honour and gratitude never were more richly merited. We
are therefore rejoiced to find that a committee has been formed for present-
ing to him a testimonial “ commemorative of his invaluable and most suc-
cessful labours in ameliorating the condition of the insane.” *
TESTIMONIAL To MR. G. A. WALKER. We hope that a large sum of money
may be collected for this most proper object. The newspapers recently
announced, that a numerously attended and influential public meeting had
been held for the purpose of taking steps to collect a fund “ to present Mr.
Walker with a Testimonial of the public sense entertained by the community
of his energetic, unwearied, and successful labours in the cause of sanitary
reform, and of the removal of the dead from the centre of the homes of the
living.” We are glad to learn that the subscription is going on prosperously.
MISCELLANEOUS INTELLIGENCE. 101.7
LANGET BIOGRAPHIES of LIVING MEDICAL MEN. There is at present in
course of publication in the Lancet, a series of one hundred biographies of
eminent living members of our profession. Objections may at first be taken
to the project, on the plea of its indelicacy or general impropriety; but so
far as it has already been executed, there is not much for the most captious
to complain of. There have already appeared, interesting and instructive
memoirs of Sir Benjamin C. Brodie, Dr. Chambers, Mr. Guthrie, Dr. Marshall
Hall, Dr. Clutterbuck, and Mr. Bransby B. Cooper. The seventh of the series
will be Sir James M'Grigor. A portrait accompanies each biography.

BIOGRAPHIES OF EMINENT DEGEASED MEDICAL MEN. The Medical Times
has commenced a series of biographical sketches. The memoir of John Green
Crosse, F.R.S., late of Norwich, is well written, and full of interest.
ST. MARY's HospitaL, PADDINGTON. The medical and surgical staff are
to be appointed about the close of the present year. The candidates are not
very numerous.
SIR BENJAMIN C. BRODIE AT DUBLIN. This eminent surgeon was honoured
by a public banquet by the Royal College of Surgeons of Dublin on the 29th
of August.
STATUE OF LARREY. A marble statue has been erected to the memory of
this illustrious surgeon in the court-yard of the Wal-de-Grâce of Paris. The
inauguration was recently celebrated with much pomp and ceremony.
CHEAP MEDICAL SCHOOLS. If Cheap Medical Teaching have degraded the
status of the teacher and the taught in England, what are we to expect in
America. 7 In the Rush Medical College of Chicago, Illinois, the students
only number 107, yet the following are the terms. Full course of seven pro-
fessors, 35 dollars; matriculation and clinical instruction, gratis ; dissec-
tions, 5 dollars; graduation, 20 dollars. So much for competition
THE MIDDLESEx MAGISTRATES AND THE Coron ER’s CourT. The Middle-
sex Magistrates have a resolution under consideration to the following effect :
“That this Court is of opinion that measures should be taken for the substi-
tution of a fixed salary, in lieu of fees to the Coroner, and for the appointing
of a Medical Officer to the Coroner's Court, at a fixed salary, for making post-
mortem examinations.”
HUNTERIAN ORATOR. For 1851. RICHARD ANTHONY STAFFORD, Esq., sur-
geon to the St. Marylebone Infirmary, a member of the Council of the Royal
College of Surgeons, is the gentleman appointed to deliver the annual oration
in the theatre of that Institution, on the 14th of February next, in memory
of the immortal genius of John Hunter.
BRIsToI. Several inhabitants of this city have raised a subscription to
increase the efficiency of the Guinea-street Hospital. Mr. Eaton has con-
tributed 5,000l., and Mr. George Thomas 1,000. for that purpose,
sº- as mºmen's
A PP O I N T M E N T S.
DUVERNAY, M., appointed Professor of Comparative Anatomy in the Jardin des
Plants, Paris, in the room of the late M. DE BLAINVILLE.
HULME, Edward C., Esq., elected Surgeon to the Blenheim Street Free Dispensary,
in the room of Mr. T. M. GIRDLESTONE, resigned.
ST. HILAIRE, M. Isidore, appointed Professor of Natural History at the Sorbonne,
Paris, in the room of the late M. DE BLAINVILLE.
1018 MISCELLANEOUS INTELLIGENCE.
O BIT U A R Y.
BULLEY, John, Esq., Surgeon to the Reading Infirmary, at Reading, aged 76, on
the 30th August.
BURMAN, Hugh Francis, M.D., at Henley-in-Arden, aged 35, on 28th August.
CLARKE, H. T., Esq., Surgeon, aged 40, on 23rd August.
GRIFFITHS, Mr. W., aged 27, in Bedford Square, on 11th September. He destroyed
himself by prussic acid.
MARSHALL, John, Esq., many years Surgeon in the H.E.I.C.S., late Physician-
General of the Bengal Presidency, aged 67, at Falmouth, on 30th August.
MORGAN, D., Esq., Assistant-Surgeon H.E.I.C.S., at Nainee Tal, Bengal, on 21st June.
NEVILLE, Joseph, Esq., Surgeon, at Croydon, aged 47, on 12th September.
TAYLOR, Alexander, Esq., Surgeon R.N., at Queenstown, Ireland, on 7th Sept.
YoUNG, G. W., Esq., Surgeon, at 37, Mortimer Street, Cavendish Square, aged 75,
on 30th August.

IB O O K S JR E C E I V E ID.
BRIGHT (James) on Diseases of the Chest. London: 1850. CARPENTER (W.B.)
on Alcoholic Liquors. London: 1850. CHAMBERS (T. K.) on Corpulence. London :
1850. HoDLAND (G. C.) on Phthisis. London : 1850. HowARD on the Eye.
Montreal and London: 1850. SMITH (Thomas) on Terebinthinate Medicines. [Re-
printed and enlarged from this Journal.] London : 1850. TAYLOR (William) on the
Treatment of Febrile Diseases through the medium of the Skin. London: 1850.
YEARSLEY on Deafness. London: 1850.
TO CO R. R. E S P O N ID E IN T S.
MR. MARTIN OF REIGATE, AND THE STATE OF THE MEDICAL PROFESSION. Our
recent articles on the State of the Medical Profession, have called forth letters from
various parts of the country. The general tenor of these is alike gratifying to
ourselves, and creditable to the profession. Several suggestions have been made to
us, and shall receive our best attention. We have to thank MR. MARTIN for his
letter, and the accompanying address, on apprenticeships, delivered at a recent
medical meeting at Reigate. Mr. Martin agrees with us in thinking that the
system of apprenticeship, although liable to abuse, and requiring beneficial modi-
fication, is by no means so essentially objectionable as it is sometimes represented
to be ; and that if properly carried out, the three years now usually spent as an ap-
prentice, may be made the most valuable period of the student's career. We are
happy to find our views upon this important subject confirmed by one of so much
experience and weight.
CLASSIFIED LISTs. We must request several correspondents, who have addressed
us regarding the Classified Lists, to remember that they are neither intended to
supersede an Index as copious as that of our volume for 1849, nor to diminish the
space at present devoted to the monthly Digest of the Journals. We hope,
however, to save much space by a greater condensation of the Reports of Societies,
and by so doing, we expect to give the Classified Lists as so much additional matter.
Most papers of value mentioned in Dr. Henry's lists have been, or will be given in
an extended or abridged form in our pages; and therefore, for purposes of research,
the Annual Indices must be consulted, as well as the Classified Lists of papers ;
the one will be found to be an essential supplement to the other. While we make
our Journal a key to the medical literature of the world, we take care (for the
sake of those who have not access to large collections of books) to render it like-
wise a rich and complete Library of Medicine—a perfect repertorium of all that is
new and useful in the various sciences embraced in, or accessory to, Medicine,
Surgery, and Obstetrics.
COMMUNICATIONS FOR THE EDITOR to be sent to 100, St. Martin’s Lane.
* E. R. R.A.TU NI.
DR. HALE was styled (in the title of his paper, p. 720), “Extra-Licentiate of the
College of Physicians”, in place of “Licentiate”. The error arose from the designa-
tions of the list of contributors on the cover having been made up from the
Medical Directory, in which Dr. Hale is erroneously styled “Extra-Licentiate”.
The error thus adopted, unfortunately crept in at p. 720.
L ON DON
JOURNAL OF MEDICINE,
A MONTHLY
3Retort of the ſūtūital $tienteg.
November 1850—No. XXIII.
O RIGINA. I. C. O M M UNICATION S.
OBSERVATIONS ON WATLVUILAR DISEASE OF THE
HEART: ILLUSTRATED BY CASES.
By ROBERT HUNTER SEMPLE, M.D.
[Read at the Medical Society of London, Oct. 19th, 1850.]
There is, perhaps, no department of medical science in which such
rapid and satisfactory progress has been made of late years, as in the
Diagnosis and Pathology of the Diseases of the Heart. At the com-
mencement of the present century, very little accurate knowledge was
entertained concerning the morbid conditions of this important organ;
and it is painful to reflect upon the serious errors in practice, which
must have arisen when cardiac pathology was in a state of obscurity.
The great work of Laennec, while it investigated and described with
considerable accuracy the diseases of the lungs, and threw a flood of
light upon their treatment, failed in giving a similar degree of pre-
cision to the physical examination of the central organ of the circulation.
When I was a student in this metropolis, the Diseases of the Heart
were in progress of investigation by a number of acute and laborious
observers; but, even in the best schools of medicine, the nature of the
healthy sounds was still a matter of doubt, speculation, and discussion;
while the morbid sounds, although attentively observed and accurately
described, were not attributed, in all cases, to their real causes, or
connected with their true pathological conditions. -
At the present day it may be said, I think without exaggeration,
that the diagnosis of the Diseases of the Heart is now so well under-
stood, that it may be almost ranked among the number of the exact
sciences. The labours of our illustrious countryman Dr. Hope, and the
no less important researches of Dr. C.J. B.Williams, have left hardly any
room for doubting the accuracy of the laws which are now laid down as
guides for the physical investigation of the Heart. The healthy sounds
have been referred to their true causes by experiments and reasonings
so satisfactory and conclusive, as to carry conviction to all rational
minds; while the morbid sounds have not only been accurately con-
nected with their true pathological phenomena, but have been localised
WOL. II. 67
1020 VALWULAR DISEASE OF THE HEART.
with such precision, that it may be almost said, that we could hardly
discern the morbid condition of the Heart with greater clearness, if the
organ itself, and its thoracic coverings, were constructed of transparent
materials.
By this species of knowledge, diligently acquired and faithfully fol-
lowed up,-the facts and conclusions of our great writers being carefully
stored in the mind, and subsequently confirmed by physical examination
during the life-time of the sick, and by the revelations obtained by the
scalpel after death, by such means, the knowledge of the nature and
treatment of cardiac disease has been improved to an incredible extent:
human sufferings have been often alleviated, or abridged; latent mis-
chief has been detected, and arrested in its progress; and life in many
instances, has, undoubtedly, been prolonged. But it may, I think, be
fairly asked, whether this branch of medical science has not been
pushed somewhat too far in modern days; and whether, led away by
the brilliancy of the researches into cardiac diseases, and fascinated
by the simplicity which now attends their physical investigation, some
practitioners do not now lay too much stress upon the aids derived from
auscultation, and neglect the attendant phenomena, which modify the
healthy and morbid conditions of the central circulatory organ 2
The structural derangements of the Heart have always been justly
regarded as matters of the highest importance, and as demanding the
utmost attention on the part of the medical profession. The deep in-
terest attached to this class of diseases, by the profession, has been
‘extended to the public in general; and an anxiety, of the most painful
nature, is often entertained by patients, and their relatives, regarding
the real, or supposed, existence of organic Disease of the Heart.
It would be insulting to a Society so enlightened as that which I have
now the honour to address, to point out the marks of distinction which
exist between real, and supposed Disease of the Heart; between the
symptoms which sometimes spring from the exalted imagination of the
patient, and those which denote actual organic mischief; between the
indications which involve only partial and, perhaps, transient derange-
ments of its functions, aud those which prove an alteration in its struc-
ture. But I may be permitted to observe, that notwithstanding the
excellent books and lectures published upon the subject, and notwith-
standing the facilities offered by our great hospitals, the diagnosis of
Heart-disease is by no means so generally accurate as it might be; and
it has fallen to my own lot to find members of our profession, even
among those who hold a very respectable rank, commit rather serious
errors in this respect. Still, setting aside the mistakes of inaccurate
observers, there can be no doubt that organic affections of the Heart
are at present among the most common, as well as among the most
fatal diseases. *
Of all the organic diseases of the Heart, the morbid conditions of
the valves have, perhaps, been regarded as the most formidable. It is
easy to conceive that either hypertrophy or dilatation, or both, may
exist, and yet, if the valves be sound, the life of the patient may not
be seriously threatened, nor his health materially impaired; the chan-
nels of the circulating fluid are still free and patent, and the condition
of the heart's muscular structure would not appear, arguing a priori, to
BY ROBERT HUNTER SEMPLE, M.D. 1021
influence the current to a dangerous extent. But when there exists a
diseased state of the valves, whether it consist of thickening, of rigidity,
of ossification, of vegetations upon their surface, of malformation, or of
deficiency; then it is clear that a material impediment is opposed to
the circulation of the vital fluid, just as the current of a river would be
impeded if a mechanical obstacle were placed across the stream. When
we observe the beautiful mechanism of the cardiac valves, and contem-
plate their functions in health—the facility with which they make way
for the passage of the blood, and immediately stretch themselves across
the aperture to prevent its return—we could not but conclude, if we
argued from physiological data alone, that any causes which should
mechanically impede the onward passage of the blood, or which, by
preventing the closure of the valves, should allow of its regurgitation,
would be followed necessarily, and rapidly, by the most alarming and
fatal consequences. But clinical observation teaches us, that while
distressing symptoms, and fatal results often follow hypertrophy and
dilatation without any disease of the valves, yet that the most serious
diseases of the valves may be unattended with any remarkable symp-
toms, and may not tend either to shorten life, or to derange materially
the health. I wish that I may be understood not to express an opinion
that any organic diseases of the heart are without danger; but, I think,
I may appeal to the records of clinical medicine to support the pro-
positions just laid down.
The fact that murmurs of a very loud and distinct character have
often been heard during the course of several years, without serious de-
rangement of the patient's health, has been admitted, and commented
upon, by authors; but, as far as I can learn, the explanation usually
given is, that the morbid condition, whatever it may be, is only in a
nascent or a rudimentary state, and that its development has been
arrested by the conservative powers of the system, or by the appliances
of medical art; and, indeed, it cannot be denied, that such an explan-
ation is, in many cases, quite satisfactory. And it has been very
correctly stated that the loudness and distinctness of the murmurs are
by no means proportionate to the extent or importance of the diseases
which originate them; and a very trivial cause, such as the presence of
a slight vegetation upon one of the valves, has often produced a very loud
murmur. Dr. C. J. B. Williams, in a very valuable paper on Organic
Diseases of the Heart, published in the LoNDON Journal, of MEDIGINE
for April last, gives an admirable case in illustration of this point. The
patient was a man aged about thirty, in whom there was a very loud
murmur, following the second sound; it was most distinct in the mid-
sternum, but it was also heard in every part of the chest, in the arteries
of the neck, and, although faintly, even in the radial artery at the wrist.
This patient, as Dr. W. informs us, was kept in the hospital as a kind
of stethoscopic curiosity. But it unfortunately happened that he
caught typhus fever, of which he died; his death being quite uncon-
nected with any severity of cardiac symptoms. On examining the body,
the ventricles were found moderately enlarged and thickened. The valves
were all healthy, except the aortic; and the only morbid appearance
was, that one of them had the free margin neatly retroverted, so as to
leave a fine, smooth chink for regurgitation.
67 3
1022 WALWULAR DISEASE OF THE HEART.
It is evident, I think, from the tone of Dr. Williams's remarks, that
he considers the loudness of the murmur to be no criterion of the
extent or importance of the cardiac disease, in which opinion he is
undoubtedly confirmed by abundant facts : but I think that he, and
many other authors, conclude that, when a patient exhibits for a con-
siderable period a cardiac murmur, the disease is generally of a slight
or rudimentary, and therefore not of a dangerous character. I think I
am in a condition to prove that Valvular Disease of a most formidable
and eatensive mature, may eaſist for several years without compromising
health to a serious eatent, and without abridging the usual term of
human easistence.
The cases which I am about to adduce are, I think, quite decisive, and, I
believe, free from objection. I have carefully excluded the cases of per-
sons still living, and also cases in which I had no opportunity of making
a post-mortem examination; because I maintain that however veracious
may be the character of the observer of cardiac disease, it is impossible,
without observation of the phenomena exhibited after death, to consider
any case as complete and wholly satisfactory. I may here observe, in
passing, that without absolutely discrediting the accounts of cases which
are continually published, wherein the patients have recovered, or in
which no post-mortem examination has taken place, I am extremely
sceptical upon the subject; and when I read of wonderful cures of fatal
diseases, such as phthisis, and cancer, by the appliances of hydropathw
or the trivialities of Hahnemannism, I am led to say “Credat Judaeus
Apella, non ego.” The fact is, that our knowledge of pathology is still
in its infancy, and the most accomplished and eminent members of our
profession are as much distinguished for their modesty as for their
splendid abilities:—but “fools often rush in" where “angels fear to
tread.”
My cases therefore are limited to three. In all of them I think it
must be admitted that Valvular Disease of the most serious character
had existed for a considerable number of years, without entailing
upon the patients any remarkable amount of suffering, and without
shortening the period to which human life is generally extended. Such
cases as those I am about to offer to the notice of the Society may be,
and no doubt are, often met with and described; but I confess that the
history of chronic diseases and of latent organic defects in the human
system has hardly seemed to me to meet with the attention which their
importance deserves.
With the first patient I was but little acquainted, having seen him
only for a few days before his death ; with the second, I was acquainted
for upwards of ten years, although not in a medical capacity, and simply
because the patient never felt any symptoms requiring professional
notice; with the third patient, I was also well acquainted for about ten
years, and had abundant opportunities during that period of studying
the stethoscopic phenomena. *.
CASE I. DISEASE OF AORTIC AND MITRAL VALVES, APPARENTLY of
LoNG STANDING. DEATH AT SEVENTY YEARS OF AGE. J. H., at. 70,
formerly a seafaring man, had been ill for some months before I saw
BY ROBERT HUNTER SEMPLE, M.D. 1023
him, which was in November 1846. I was asked to see him at a house
where he lodged; he was standing up and dressed, but he complained
of great debility, with cough, and some expectoration. He made no
particular complaint concerning his chest, but on applying the stetho-
scope, I found that he was affected with serious Valvular Disease of the
Heart, the indications of which will be presently noticed. I recom-
mended his removal to the Islington Infirmary, in order that he might
have more care taken of him than he experienced in his lodging, and
also that I might examine the progress and result of the case with
greater accuracy. He was accordingly removed, and I saw him again
on the 9th of November 1846, when the following symptoms presented
themselves. He was lying in bed, still complaining of great debility,
with cough and some difficulty of breathing. The urine was scanty
and high-coloured, but he had no swelling of the legs, nor any appear-
ance of dropsy in any other part. The pulse was 104, very feeble and
regular, the bowels open, the tongue moderately clean.
Physical Sigms. Percussion gave no peculiar sound. Auscultation
of the lungs gave no morbid indications. Auscultation of the heart
gave a distinct but not very loud bellows murmur, accompanying the
first sound of the heart, and prolonged so as in great measure to conceal
the second. This murmur was heard at the apex of the heart as well
as at the base, and there was no appreciable difference in the quality
of the sound in either situation. The murmur was not to be traced far
above the base of the heart, and it was not heard at all over the carotid
arteries. The impulse of heart was not increased.
Diagnosis. Disease of mitral and aortic valves. I find it recorded
in my notes made at the time, that the general appearance of this man
was not indicative of the serious disease under which he laboured, and
he merely looked like a person suffering from age, poverty, and priva-
tion. He was ordered to have a light and nutritious diet, and to take
a mixture containing some tincture of hembane and a little ipecacuan
wine; but he died the next morning rather suddenly and unexpectedly,
after passing a restless night.
Post-mortem. Ea:amination twenty-four hours after Death. The body
was that of a somewhat spare man, but was not emaciated. The Head
was not examined. Chest. There were numerous adhesions between
the costal and pulmonary portions of the pleura, which membrane was
thickened in some parts. The lungs themselves were not materially dis-
eased. The heart was somewhat enlarged, the apex being situated below
the sixth rib. The right auricle and wentricle, with their valves, were
quite healthy. The left ventricle was slightly thickened. The mitral
valves were thickened with a cartilaginous deposit, but the auriculo-
ventricular opening was patulous. The aortic valves were excessively
diseased. Viewed from above, they appeared to be stretched entirely
across the aorta, meeting in the centre, and allowing only a very small
chink for the passage of the blood. Each valve was encrusted by a
thick osseous deposit, of a nodulated character, which rendered the valve
perfectly rigid. Viewed from below, the convex surfaces of the valves
were seen to be also thickened with osseous deposit. There was like-
wise a deposit of bony laminae in the aorta itself, a little above the valves.
Abdomen. The liver was of natural size, but congested, and when
1024 WALWUIAR DISEASE OF THE HEART.
cut, it presented the nutmeg appearance. The kidneys were healthy.
The other viscera were not minutely examined.
In this case, there was obstructive disease of the aorta of the most
formidable character, together with regurgitant disease of the mitral
valves. It is, I think, impossible to doubt that the disease must have
lasted for a considerable time, and yet the man attained an average old
age, and did not, so far as I could ascertain, suffer any very severe or
distressing symptoms.
The next case, however, is more satisfactory, because I was personally
acquainted with the patient, and I know that she suffered no remark-
able symptoms whatever.
CASE II. DISEASE of THE MITRAL AND AORTIC VALVES, APPARENTLY
oR LONG STANDING. SUDDEN DEATH WITHOUT ANY PREVIOUS ILLNESS AT
SIXTY-NINE YEARs of AGE. Mrs. K., at. 69, was a lady of very active
habits, of mild and benevolent disposition, temperate and abstemious, of
rather tall stature and spare figure; she had always enjoyed good health,
with the exception of an inflammatory attack about twelve years before
the date of the present history, but the exact nature of the disease I
had no means of ascertaining. Although intimately acquainted with
her and her family for ten years previous to her death, and although I
was the medical attendant of the family, I had never known her to
complain of any illness. Since her death, however, I was informed
that she suffered occasionally from slight attacks of dyspepsia, and also
from difficulty of breathing and faintness, but the symptoms were very
transient, and never required medical assistance. From personal know-
ledge I can state, that she was by no means a person of sedentary habits,
as she was continually attending to the duties of a large house, and
I met her walking in the streets almost every day. On Monday,
June 27, 1843, about four in the afternoon, I was requested to see her
immediately, as she had fallen down in a fit, although she had been
previously in perfect health. At the time of the attack she was stand-
ing in the kitchen, superintending the affairs of the family, when she
suddenly fell down. As I lived at that time next door to her, I arrived
immediately upon being summoned, and found her lying on the floor
with a pale countenance and very feeble pulse, and quite insensible.
I was wholly at a loss how to account for her condition, as I had never
known her to be ill during my whole acquaintance with her. I suc-
ceeded, with assistance, in placing her upon a sofa. Mustard poultices
were immediately applied to the feet, and spirits of hartshorn held to
the nose, but we had scarcely laid her down, when she expired.
Post-mortem. Eacamination forty hours after Death. There was lividity
on many parts of the body, apparently from gravitation, the lividity being
chiefly observable on the under surface. Very little fat beneath the
skin. Head. The vessels of the scalp were somewhat congested.
The skull presented no remarkable appearance. The dura mater was
slightly adherent to the inner table of the skull on the left side. Some
fluid blood was found lying between the skull and the dura mater.
The arachnoid membrane was somewhat opaque, and there was a con-
siderable quantity of thin serous fluid effused beneath it; the veins of
the pia mater were congested, especially in the posterior part of the
BY ROBERT HUNTER SEMPLE, M.D. 1025
brain. The brain itself, with the exception of being a little softer than
is usual in persons of the age of the deceased, was quite healthy;
and the only appearances worthy of notice were the effusion of some
fluid and the congested state of the meningeal vessels above described.
Chest. The lungs were quite healthy, with the exception of slight
congestion. The heart appeared externally to be larger than usual,
but not remarkably so. There was very little fluid in the pericardium.
The right auricle and ventricle, with their valves, were perfectly
healthy. The left auricle was also healthy. The mitral valves were
thickened by a deposition of semi-cartilaginous substance. The parietes
of the left ventricle were very much thickened, but the cavity was of
the usual size. The aortic valves were found very much diseased, and
on looking at them from above downwards from the aorta, they ap-
peared completely to close the passage. They were found to be con-
verted into masses of bone, which nearly filled up the valvular orifice,
leaving only a small chink for the passage of the blood. These bony
masses were rough and modulated, and were deposited apparently
within the sinuses of the valves, and one portion of great size extended
from one of the valves down into the cavity of the ventricle. The
lining membrane of the aorta also presented a great number of bony
plates. Abdomen. The liver presented no remarkable appearance. The
stomach was full, the deceased having eaten her dinner a short time
before the fatal occurrence. The kidneys were congested, and their
cortical substance presented a somewhat granular appearance.
In this case of remarkable disease of the valves, the patient had en-
joyed almost uninterrupted good health, and was in much better health,
indeed, than most persons at her age. Nor can it be said that her
immunity from unpleasant symptoms, and the delay of the fatal ter-
mination, was owing to care on the part of her friends, or to the in-
dulgence of rest; for she was a person of great activity, both of mind
and body.
The next case, however, is the most satisfactory of all; for the
patient, who suffered from Valvular Disease of the Heart to an enormous
extent, actually lived to the age of eighty-three 1 and died, eventually,
of another complaint. With the history of this case I was well ac-
quainted. I made the diagnosis of serious Valvular Disease nearly ten
years before her death; and in the spring of this year, 1850, I had
the gratification of confirming the correctness of my diagnosis, as well
as of strengthening the opinion which I have been lately induced to
entertain, that Valvular Disease, to a very great extent, may exist with-
out shortening human life, or much impairing its comfort. I brought
the heart, with a great portion of the aorta, and of the arteries of the
head, to the Westminster Medical Society; and those who were present
on the occasion will recollečt the immense accumulation of osseous
matter in the aortic valves, along the course of the aorta, and in the
carotid and cerebral arteries.
CASE III. ExTENSIVE DISEASE of AoRTIC AND MITRAL VALVES.
DEATH AT THE AGE of EIGHTY-THREE. Grace Darton died on the 4th
April, 1850, aet.83. The history of the case was as follows. The patient
was a thin, emaciated woman, of a pale complexion, and mild, submissive
appearance, who had long been an inmate of the Islington Workhouse.
1026 VALvULAR DISEASE OF THE HEART.
I began to attend her in 1840, and had seen her from time to timé
since that period. She stated that she had had several attacks of
rheumatism previously to my attending her, and that she had been
bled three or four times for those attacks. She had not suffered from
any of those symptoms which are usually considered among the pro-
minent rational indications of Heart-Disease; such as swelled legs,
palpitation, shortness of breath, etc.; and although she came into the
infirmary at various times, for several ailments, it was never on account
of any cardiac symptoms: and it was only by auscultation that I be-
came aware that she had any affection of the heart. In fact, I was
disbelieved as to the existence of any serious disease in her heart; and
although I frequently recommended that she should be kept in the in-
firmary, and be constantly under medical superintendence, my recom-
mendations were disregarded.
In the year 1840, (aet. 73,) she had an attack of diarrhoea in March,
which readily yielded to medicines. In August, she had an attack of
chronic rheumatism, for which she was ordered a dose of calomel and
jalap, and a purgative mixture: under this treatment she recovered,
and was reported cured on the 11th of September.
Feb. 8, 1841. She had an attack of influenza; for which she was
ordered a mixture, consisting of tinct. hyoscyani 3ij, sulph. magn. 3ss,
inf. Sennae, aq. menth. aä. 3iij. During this attack she had some
dyspeptic symptoms, for which she took carb. of magnesia, with sulph.
of magnesia, and aqua menthae. She was reported cured on Feb. 20.
January 1842. She was seized with an attack of catarrh, for which
she was treated with mild purgatives: but an attack of chronic bron-
chitis supervened, for which a blister was applied to the chest, and she
was ordered to take gr. xij of ipecacuan immediately, and afterwards
to take the following: B. vin. ipecac. 3ij; Sulph. mag. 3ij; inf. Sennae
3v.j. Sumat coch: if magna 4tis horis. During this attack the state of
the heart and lungs was particularly examined, when it was found that,
besides mucous, sibilant, and sonorous rattles over the lungs, there was a
loud rasp sound over the region of the heart. This sound was very loud,
and much prolonged, taking the place of the first natural sound, and
almost obscuring the second. This sound was heard most loudly over
the base of the heart, and extended over the region of the arch of the
aorta, and the right side of the neck. The impulse of the heart was
not stronger than natural ; pulse 80, regular. I should here notice
that the pulse was always regular, and feeble, whenever I examined it.
The treatment was directed, in the first place, to the relief of the
bronchitic symptoms, which were removed by the measures indicated
above, and by others of the same nature; and on the 4th of Feb. 1842,
the expectoration had diminished, and the râles had disappeared. The
rasp sound, however, still remained as loud as ever, and I was con-
vinced that the woman had confirmed and serious disease of the aortic
valves. I thenceforward, therefore, always adopted a somewhat tonic
method of treatment; recommending vegetable tonics, with light nu-
tritious diet, and avoidance of exertion.
May 30, 1842. She had an attack of lumbago. A mixture was
thus prescribed:—B. vin, colch. 3ij; inf. gent, co. 3v.j, Sum. coch. ii
magnæ 4tis horis. Under this treatment she was again reported
BY ROBERT HUNTER SEMPLE, M.D. 102.7
cured. On the 19th of October 1842, she had an attack of English
cholera, which was successfully treated by carbonate of magnesia, and
sulphate of magnesia in peppermint-water. On the 2nd of July 1848,
she had an attack of common fever, from which she suffered for a week,
but eventually recovered, by the use of febrifuge medicines, and diluent
drinks.
Sept. 8, 1845. She had a cutaneous eruption, attended with great
itching, which I determined to be prurigo senilis. This was treated by
mild aperients.
June 12, 1846. She had another cutaneous affection, attended with
itching, which I regarded as lichen, and for which I ordered her twenty
minims of liq. potassae, in one ounce of compound infusion of gentian,
three times a day. This treatment was continued till the 17th of June,
and the eruption disappeared.
Oct. 5, 1846. She now complained of faintness, nausea, want of appe-
tite, and a disagreeable taste in her mouth. She said that she had
lately suffered from palpitation of the heart, and difficulty of breathing,
when she exerted herself. She passed her water freely; never spat any
blood; and had no swelling of the legs : bowels open, tongue clean, no
thirst, pulse 58, quite regular, and weak. Physical Signs. The impulse
of the heart was not increased, but the loud, sawing murmur was heard
over the base, completely superseding the first sound, and was much pro-
longed ; but a second, though much shorter murmur, was heard after it.
Towards the apex of the heart, this murmur was also heard, but not so
distinctly; it was distinctly heard over the region of the arch of the aorta,
and over the right carotid artery. The diagnosis was still, of course,
that the chief disease lay in the aortic valves. She was directed to
take a moderate diet, consisting of mutton-broth, bread, milk, and tea;
and to take the following medicine : R. Acidi sulphurici diluti, m v.;
inf. gent, co. 3i. Quartis horis Sumend.
Oct. 7. Much the same ; dyspeptic symptoms remain; she com-
plains of great faintness. She was ordered, in addition to the above
treatment, to have half-a-pint of porter daily, and to remain in the in-
firmary.
From that time, until very lately, I had not many opportunities of
seeing this woman; and I heard that she died (without manifesting
any particular symptoms beyond those resulting from her great age) on
the 4th of April 1850, aged eighty-three.
Post-Mortem. Ea:amination thirty-sia, hours after Death. The body was
emaciated; the legs were slightly occlematous; right side dull on percus-
sion. Head. Scalp natural; cranium very thick, especially at its posterior
part; sutures all obliterated; dura mater healthy, very firm, and dense;
arachnoid membrane of a pearly, opalescent appearance, due to the
presence of serum below its surface, which escaped on making an incision.
The brain itself was moderately healthy; no softening, nor extravasation,
in any part; arteries of the brain rigid and patent, owing to osseous and
cartilaginous deposition,-this was especially the case in the ophthalmic,
vertebral, and internal, carotid arteries; very little fluid in the ventri-
cles. Chest. Left lung appeared of its natural colour and consistence ;
right pleural cavity contained a large quantity of fluid. About 3xx of
serous fluid were removed from this part; and in the fluid there was a
1028 WALWULAR DISEASE OF THE HEART.
large mass of coagulable lymph, very soft, and of the consistence of
thin jelly. Right lung healthy, and crepitant at the apex; but below,
'the texture was of a very dark colour, friable, and heavy, so that it sank
in water. On cutting into this portion of the lung, it was found very
much congested, did not crepitate, and, on Squeezing it, a bloody sero-
sity flowed out. On this side, therefore, there was acute pleuro-
pneumonia, which was probably the immediate cause of the woman's
death. The heart, seen in situ, occupied its natural position, and
the apex was placed between the fifth and sixth rib. After remov-
ing the lung on each side, the heart, with the arch of the aorta,
the innominata, the left subclavian and carotid, and the whole of the
thoracic aorta, were all carefully dissected out, and removed together.
The right auricle was natural ; the tricuspid valves were patent, and
admitted three fingers; but the attached margins were rather hard,
and thickened. The semilunar pulmonary valves were natural; but
the orifice was somewhat contracted. The left auricle was natural; the
mitral valves admitted two fingers, but they were thickened and hard.
ened, and contained a considerable quantity of Osseous matter; the
walls of the left ventricle were rather thickened, but not very consider-
ably. The aortic valves were completely rigid, and converted into
bone; and they met in the centre, leaving only a small chink at their
juncture in the middle line. Looked at from above, the valves were
seen stretched across the aorta, and each of the valves contained, in its
sinus, a large mass of bony deposit. The ascending and transverse
aorta were very much dilated, being, at least, twice their natural dia-
meter; the innominata was also very much dilated. The lining mem-
brane of all these parts was most extensively diseased, part being
converted into atheromatous matter, part exhibiting numerous plates of
bone, and part being ulcerated. These appearances were found in many
other arteries, not only in the cerebral arteries already described,
but also in the subclavians and carotids. Abdomen. Liver congested,
of very dark colour, and friable; spleen very small, congested; kidneys
small, but not apparently diseased.
This, then, was a case of extensive Valvular Disease of the Heart, in
a patient who suffered hardly any of the rational cardiac symptoms, but
who was attended, at different periods, for various ailments, as diarrhoea,
chronic rheumatism, catarrh, chronic bronchitis, lumbago, prurigo senilis,
dyspepsia, and, finally, died at the advanced age of eighty-three, of an
acute attack of pleuro-pneumonia.
1. GENERAL REMARKs. The cases which I have ventured to bring
before the notice of the Society, are of very considerable practical
importance. Whatever theoretical views may be entertained to account
for the endurance of life, and the possession of a moderate degree of
health, under circumstances apparently so unfavourable to either, it is
impossible to deny that the facts themselves are of great value.
In the first place, if it can be proved that actual organic Disease of the
Valves of the Heart may exist for a considerable period, and without
shortening the average duration of life, such a conclusion may tend to
divest this class of maladies of some part of the terror which their exist-
ence now so commonly inspires; and a patient, who is unfortunately
BY ROBERT HUNTER SEMPLE, M.D. 1029
labouring under a disease of this description, may nevertheless be en-
couraged by the reflection, that a Disease of the Heart, although of a
decidedly serious character, may not prematurely put a stop to his
career. And if such be the consolation which may, I think, fairly be
afforded to those suffering under confirmed and extensive disease, how
much more applicable is it to those who are affected only by some of
those minor affections of the heart and its valves, which occur so fre-
quently among the sequelae of rheumatism?
In the second place, the subject is one of great importance in its
relation to the average duration of human life, and the practice of life
insurance. The existence of any disease of the heart is, I believe, an
insurmountable barrier to effecting a policy of insurance ; but I think
it probable, that in proportion to the accumulation of facts bearing upon
the subject, the deductions drawn only from the physical exploration of
the heart, will not be so exclusively regarded as they have been of late
years. But upon this point I wish to be understood as offering a very
guarded opinion; for I have no wish whatever to undervalue the im-
portance of the information derived from auscultation; nor do I pretend
to assert that the existence of cardiac disease is a matter of slight
moment. All I presume to argue is, that cardiac disease, even of a
very decided and extensive character, may be compatible with long life
and with moderate health.
2. THE TREATMENT of Valvular Disease of the Heart is a subject of
too great extent and importance to allow me to offer more than a few
very general observations in the present paper. Notwithstanding the
opinions which I have ventured to express, I consider the existence of
Disease of the Valves to be a matter deserving the closest attention of
the practitioner, and the most zealous application of the resources of his
art. Hence it is essential that the disease should be checked, if possible,
at its commencement.
“Principiis obsta ; serö medicina paratur
Cum mala per longas convaluére moras.”
In the early stage of Valvular Disease, the stethoscope is invaluable;
it gives us the earliest intimation of its existence, and we are supplied
with means for its repression. The patient suffering under the agonies
of articular rheumatism is often unconscious of the mischief going on at
the fountain-head of life; the stethoscope reveals the latent evil—vege-
tations of albumino-fibrine are encrusting the surface of the valves—
but the judicious administration of mercury causes the absorption of the
peccant lymph, and the channel of the blood is restored. And even
when the disease of the valves is unfortunately confirmed, medical
appliances may do essential service in alleviating the sufferings which
often ensue, and in delaying or averting the fatal catastrophe. The
palliative measures which ought them to be adopted, it is almost unne-
cessary to insist upon. The injunction of the necessity of rest, both of
mind and body, will be frequently repeated; and the state of the diges-
tive system will, of course, form a prominent subject of inquiry and of
treatment. The use of digitalis, which I believe to be of the utmost
value in some of the organic Diseases of the Heart, is, I think, contra-
indicated in most cases of Valvular Disease, in which the current of the
1030 SOFTENING OF THE GERVICAL PORTION of THE SPINAL coRD.
blood is diminished, and the vital energies consequently impaired; in
such instances, digitalis must undoubtedly do more harm than good, by
lowering the force of the heart, and still farther enfeebling the circula-
tion. In such cases, it is better to rely upon those measures which
are calculated to strengthen the system, and to stimulate the heart to
propel the blood through its diminished channel; and I adopt a some-
what tonic System of treatment under such circumstances, as the best
calculated to counteract the effects of the valvular obstruction.
8, Torrington Square, October 1850.
.*
CASE OF SOFTENING OF THE CERVICAL PORTION OF
THE SPINAL CORD. -
By EDWARD C. SEATON, M.D.
[The substance of the following Communication was read before the Western Medical
and Surgical Society of London, October 4, 1850.]
IT is remarked by Dr. Graves, that “Inflammation of the Spinal Marrow
is a disease so liable to be confounded with a great variety of painful
affections, that every ascertained case of it ought to be recorded, for the
purpose of rendering more perfect a department of pathology already
diligently, but not completely, cultivated.” Obeying the injunction
laid down by this great authority, and believing that the following case
is not without its points of special interest, I venture respectfully to
submit it to the notice of the profession through the pages of the
LoNDoN Journal, OF MEDIGINE, in which so many valuable contribu-
tions to our knowledge of Diseases of the Nervous System have lately
appeared.
Mr. H. W., act. nearly 50, by trade a wholesale and retail cheese-
monger, and a man whose circumstances enabled him to command
every comfort of life, consulted me on the 29th of July 1848. He was
a spare man and rather short, of very temperate habits, married, and the
father of a large family. He had enjoyed good general health, though
he came of a rheumatic stock, and had himself suffered occasionally
from rheumatic pain. During the preceding year and a half or two
years, he had noticed that his urine was frequently turbid, and he had
had one or two attacks of gravel. The complaints for which he sought
relief of me were stiffness in the arms and thighs, and excessive de-
bility on undertaking any exertion, so that he was hardly capable of
lifting anything, and could not work in his shop for half an hour with-
out becoming tremulous and unable to continue his labour. He had
frequent cramps in his legs, but no persistent pain anywhere. At all
times irritable in temper, he had become latterly much more so. His
appetite failed him of a morning, but not in the latter part of the day.
He said that his digestion was good, his bowels regular, and his urine
at present clear. His pulse was feeble. - - .
At the end of a fortnight his condition was the same. I thought I
BY EDWARD C. SEATON, M.D. 103.1
noticed one day a tendency to droop in the left eyelid; but if this con-
dition really existed, it must have been very transitory, for it was never
afterwards observed. There was no difference as to sensation and
power between the two sides of the body, and there were not then, as
there were not indeed at any period throughout the case, any head
symptoms.
He went into the country for a week, and his symptoms disappeared,
but came back almost immediately on his return to town. The stiffness
and debility, however, were now confined to the upper extremities (in
which they had all along been most pronounced), and were felt chiefly of
a morning when he began to work, or at any time when he began to take
exertion: and he specially remarked to me that as soon as he got warm
in walking, the stiffness went off, and he became comparatively strong,
and that as soon as he got warm in his bed at night, there was absolutely
nothing whatever the matter with him. A variety of treatment was
tried with little or no impression ; and on the 11th of September he
again went into the country.
I next saw him on the 27th of November, when the pain and stiff.
ness were increased in the upper arms, and had once more attacked
the thighs. They were still influenced in the same manner by tem-
perature. I had had some doubts, when I first saw him in July, as to
the nature of the case with which I had to deal; but, after twice or
thrice seeing him, I satisfied myself that the symptoms were more
those of chronic rheumatism than of any other disease, and the treat-
ment then had been adapted to this view of the case. Feeling now no
reason for changing my diagnosis, I gave him again antirheumatic
remedies, but of other kinds, which were continued till the 26th of
December without any benefit, when he resorted, of his own accord, to
cod-liver oil.
This was taken for two months, by which time (Feb. 26, 1849) his
former symptoms were aggravated, and new ones superadded. The pain,
stiffness, and powerlessness were greatly increased both in the upper and
lower extremities, but were still confined nearly entirely to the upper
arms and thighs. In these also, sensation was benumbed, and he said
they felt to him as if stuffed out with straw. He had tripped many
times of late, and fallen occasionally when walking, and he could not
lift his feet far from the ground ; warmth, however, still relieved his
pain and gave him power. The cramp, of which he had all along had
more or less, had been excessively troublesome to him lately. My
original doubts as to the real nature of the case now returned with in-
creased force; and I requested the opinion of Dr. Bright. We examined
together with great care, as I had often done by myself before, the
whole length of the spine, but found no tenderness whatsoever; neither
did he refer to it any sensation of pain. But he informed us of this im-
portant fact (which he had not hitherto remembered, or had not thought
of in connexion with his disorder), that about a fortnight previously to his
first consulting me he had fallen forwards on the deck of a steam-boat,
alighting on the palms of his hands, the arms being stretched out, and
that he had thus received a shake which he felt through his whole sys-
tem. On a review of the entire case, Dr. Bright was inclined to regard
it as probably one of chronic inflammation of the spinal cord, or its
1032 SOFTENING OF THE CERVICAL PORTION OF THE SPINAL CURD.
membranes, and recommended a succession of blisters down the spine,
and the administration of bichloride of mercury.
This plan was pursued for a fortnight with no amendment, but rather
increase of the symptoms: and it may serve as an illustration of the
great difficulty of arriving at a satisfactory diagnosis of the case, that
on a second careful examination at the end of that period, Dr. Bright
considered it one of chronic rheumatism, and he mentioned to me a
case in which the stiffness and the pain, and the powerlessness had
been more pronounced, but which had eventually entirely recovered
after anti-rheumatic treatment. He therefore recommended a return
to remedies of this kind, and they were pursued steadily from 16th
March to 24th April.
On this latter day, as he had made no progress, and his general ap-
pearance was anaemic, Dr. Bright recommended a trial of iron, and
the mist. ferri comp. was administered in doses of 3vi. three times a
day. He became more powerless and felt much worse after com-
mencing this medicine; he suffered from a sensation of gnawing and
sinking about the praecordia, and his hands became daily more useless
and were invaded by cramp. His urine deposited lithate of ammonia
in large quantity. The iron was therefore discontinued, and salines
substituted.
During the next fortnight, though the urine became clear, and the
sense of sinking disappeared, more and more ground was lost, and some
symptoms appeared which left the seat of the disease no longer doubt-
ful. A difficulty in getting out his words, and, on some occasions, a
difficulty in masticating and swallowing, pointed to some affection of
the upper portion of the Spinal Cord or of the roots of the nerves:—and
this was the diagnosis given by Dr. Watson, who was now consulted.
It seemed more difficult to state precisely what the nature of that
affection was. There had never been, and was not, the smallest pain
referable to the cord itself, nor tenderness of any portion of the spine.
His leading symptoms had been all along those of diminished and not
of increased action; his pulse was always very feeble, and his appear-
ance throughout pale and anaemic. Dr. Watson thought that a tonic regi-
men was indicated, and gave him first nitro-muriatic acid with tincture of
lytta, and afterwards the sesquichloride of iron. He still got no better.
On the 23rd of June he was seen by Dr. Pidduck. On now examining
the spine, a spot was found very tender over the atlas vertebra, and
our patient said that for some months past he had felt severe pain there
whenever he lifted his head from the pillow suddenly or without sup-
port. But I think that his recollection as to the duration of this
symptom must have been at fault; for he had so repeatedly been ques-
tioned about pain and always denied it. He experienced even now no
pain or difficulty in rotating, flexing, or extending the head. Dr. Pid-
duck agreed in the opinion that there was an affection of the Cord, but
believed it to be of an inflammatory nature—the result of the injury
received in the fall a week or two before the accession of the first
symptoms. He recommended perfect rest, leeches to the tender part,
and an alterative treatment.
The leeches were applied the next day, and that night, being the
first night for many months, he had no cramp. On the 1st of July,
BY EDWARD C. SEATON, M.D, 1033
four more leeches were applied, and he had next day less numbness
and more power of his arms, so that he was able to lift his cup to his
mouth without assistance, (this he had not been able to do before for a
long while). After this, he had leeches on several times, with the
general result of diminishing his nervous irritability, and perhaps
alleviating the pain felt in his thighs and arms, but with no further
benefit; and the weakness increased. This was his condition up to
the 28th of July, after which, in consequence of his having removed to
a considerable distance from my neighbourhood, I only saw him occa-
sionally,
The remainder of the history is soon narrated. The amendment
which leeches and the antiphlogistic regimen at first produced not
having continued (except that the cramp never returned), he was in-
duced to try galvanism. After this, by the advice of Mr. Lonsdale,
he had a seton. I saw him on the 21st of December, much more
helpless, having been confined to his room for two months: he was
then about to try homoeopathic treatment. His homoeopathic attendant,
unable to relieve him, soon transferred him to his brother, a spinal
surgeon, by whom he was induced to leave his comfortable home and
become an inmate of a spinal institution. Here, though he received
from day to day the flattering assurance that he was improving, he
became more and more hopelessly paralytic, and died from exhaustion
on the 27th of February, 1850.
Post-mortem Eramination. His body was removed home, and an
examination made sixty hours after death (on March 2, 1850), by myself,
in the presence of Mr. Derbyshire and Mr. Theophilus Taylor.
The body was emaciated. The head and spine only were examined.
The surface of the cranium was very exsanguine; the skull was rather
thick and firmly adherent to the dura mater. The pia mater was
rather congested. The brain itself, cerebellum, and medulla oblongata,
were quite healthy; the ventricles were empty. The arches of the ver-
tebrae in the centre of the back (about the sixth and seventh dorsal)
were a little softer than natural, the rest were of the usual firmness.
The theca spinalis was distended with serous fluid ; the arachnoid
lining it was quite transparent. The Spinal Cord was not unusually
vascular, but healthy apparently, except about two inches of its cervical
portion, beginning not quite two inches below the pons Varolii. This
was softened into a putrilage, without any appearance to the eye of
nervous structure. Examined under the microscope immediately
afterwards, by Mr. Clover, of University College, it was found to con-
tain exudation corpuscles in moderate abundance; but no pus globules.
REMARKs. The foregoing is one of a class of cases which are alluded
to by Dr. Abercrombie' as presenting instances of a remarkable modifi-
cation of ramolissement of the Cord; were described more particularly
by Dr. Darwell in 1830, under the designation of a peculiar species of
paraplegia; and which formed the subject of a portion of the interesting
Gulstonian Lectures delivered by Dr. Gull before the Royal College of
Physicians in 1849, and were by him termed, not inaptly, cervical
paraplegia.” There are many cases of this form of disease now on record.
* On Diseases of the Brain, etc. Fourth Edition, p. 345.
* Lecture III. Medical Times, vol. xix, p. 505.
1034 SOFTENING OF THE CERVICAL PORTION OF THE SPINAL CORD.
They agree generally in this, that it is in the superior extremities and
adjacent organs that the symptoms first manifest themselves, the lower
extremities being affected at a later period, or not at all; that the
deltoid and muscles of the shoulder are those which suffer first ; and
that in a limb, the parts next the trunk are earlier and more com-
pletely paralytic than those more remote; the upper arm, for example,
than the fore arm or hand: but their progress is by ho means uniform;
their duration and mode of termination are very uncertain, and their
pathology is still a matter of doubt and obscurity.
The pathological explanation of them which is given by Dr. Aber-
crombie, is this: that they are dependent on disease of the Cord ana-
logous to a form of disease of the brain in which there was originally
inflammatory action of a low chronic character seated in a small part
of the cerebral substance. “This,” he says, “may continue for a con-
siderable time in a state of simple inflammation, and subside; or it may
terminate in a permanent change in the structure of the parts, gene-
rally with some degree of induration, in which condition it is found
when the patient dies of another disease, but if it is itself the fatal dis-
order, it seems to be so by passing either into ramollissement or into
partial and unhealthy suppuration.” “It is probable”, he adds, “that the
same character of disease takes place in the Spinal Cord ; and it is found
in the same manner sometimes in a state of ramollissement, sometimes
in the state of induration, and sometimes one part is found indurated
and another softened.” 1
A totally different view of these cases is presented by Dr. Gull.
The disease is regarded by him as one not having its origin in the
nervous centres at all, but in the periphery; “a primary affection”, he
says, “of the muscles”, or an affection both of muscle, and of the nerve
distributed to it; and he thinks that the disease spreads by travelling to
adjacent muscles (and I presume in cases where ramollissement take 3
place, to the Cord), through the neurilemma. The cases which he cites
in illustration of this position are ten in number; five of which were
recorded by Dr. Darwell, and five occurred under his own observation.
With one exception, they were all due either to a strain, or a blow upon
the particular muscle or muscles, or to rheumatism. None of them
had been fatal, but several had not terminated at the period ºf the
report. It had been already contended by Dr. Graves,” that ramol-
lissement and structural degeneration of the spinal marrow might
arise, especially in the gouty diathesis, from the extension of inflamma-
tion from the extremities of the nerves along the neurilemma. He
asserts this generally, and not with special reference to cervical para-
plegia: but one of the cases narrated by him resembled this disorder,
in the arms being affected for two months before the lower extremities,
differing from it, however, in so far as the affection began in the fingers
and extended up the arm.
The facts of the present case would seem, at first sight, to be not
inconsistent with this view of the subject. My patient was of a rheu-
* Op. cit., p. 348. Dr. Abercrombie offers this as a general explanation of chronic
• ramollissement, whether commencing in, or confined to, the upper extremities
(cervical paraplegia), or commencing in the lower.
* Clinical Lectures, vol. i., p. 475.
BY FDWARD C. SEATON, M.D. 1035
matic family, and had himself had, occasionally, rheumatism. The
disease first made its appearance in the muscles which elevate the
arms, and, excepting a transitory affection of a similar kind in the
muscles of the thighs, was confined to them for nearly four months:
the stiffness and want of power of which he complained, resembled
rheumatism, by disappearing when the body was heated: and even
when, at the end of six months, the affection had extended over the
limbs generally, it so closely simulated this disease, that one of our
most experienced physicians was unable to make a satisfactory diagnosis.
In the view taken by Drs. Graves and Gull, the disease would all this
time have been local; it would, about the period to which I have just
referred, have invaded the Spinal Cord, by extension along the neuri-
lemma, and would have caused that aggravation of existing symptoms
and appearance of new ones, which took place about this time, but which
did not, until nearly a twelvemonth afterwards, lead to a fatal termination.
But a closer examination of all the phenomena manifested, will, I
think, show that a fuller and more accurate explanation of them is
afforded by the older hypothesis. The commencement of the disease
by the equal and simultaneous affection of both arms, coincident with
an affection of exactly similar character in the thighs, appears to me
to point to some central, or, at all events, some general and constitu-
tional cause; and that this was not rheumatism, affecting a number of
muscles at a time, seems probable, 1. From the powerlessness being
out of all proportion greater than the stiffness and pain; 2. From the
disease having originated, apparently, from the shock communicated to
the whole system by a severe fall; and 3. From the existence, from
the outset, along with the other symptoms, of one which was eventually
proved to have been due, in this instance, to direct irritation, or in-
flammation of the spinal marrow; viz., cramp. I say eventually proved;
for, having been one of the most constant, painful, and distressing
symptoms throughout the whole course of the malady, and having re-
sisted every remedy, and been scarcely alleviated by any, it at once
yielded to the application of a few leeches over the inflamed portion of
the Spinal Cord. Nor is it inconsistent with this view, that the
symptoms, after three weeks duration, should cease, when my patient
went into the country, and that, when he came back to town, they
should return in the arms only, the thighs being no longer affected.
I presume that, under the influence of rest, change of air, and freedom
from excitement, the inflammatory, or congestive condition of the cord
was spontaneously subsiding, and would probably have subsided alto-
gether, had not premature exertion recalled it, and caused that, which
was at first a diffused state of irritation, or congestion, to become local-
ised as an inflammation in a particular portion of it.
Neither is it inconsistent with this explanation, that power should
be restored to the muscles for a while, on excitement or the application
of warmth, though it was this symptom, so common in one form of
rheumatism, which tended more than any other to obscure the case.
Moderate warmth is one of the most powerful excitants both of the
muscular and nervous systems; and its influence in exalting the ner-
vous energies, and elevating the vital powers, is referred to constantly
by physiological writers.
WOL. II. 6S
1036 DR. SEATON ON SOFTENING OF THE SPINAL CORD.
In a case of Ramollissement, recorded by my friend, Dr. Madden, in
the LONDON JOURNAL OF MEDICINE for January 1850, in which anaes-
thesia was the most prominent symptom, it was observed, that under
the influence of a fit of excitement, followed by an attack of erysipelatous
fever, the sensibility was greatly increased. “Was this”, he pertinently
asks, “due to the cerebral excitement? or might not the quickened
circulation, in which the cord, in common with other organs, must have
shared, have stimulated for a time its half-destroyed emergies?”
And, lastly, it is no objection to this explanation, that so long a
time should have elapsed before pain, or tenderness, of the spine came
on. Little reliance is to be placed on these as signs of inflammation,
or ramollissement of the cord. Of six cases occurring to Dr. Aber-
crombie, they were absent altogether in two, and there was pain only
on pressure in one. And of eleven cases of inflammation, ramollisse-
ment, undefined suppuration, or abscess, to which he refers, they were
absent, or not mentioned as being present in eight; and mentioned as
present in only three. In my own case there was some evidence of an
inflammatory state of the cord, in the remarkable aggravation of the
symptoms caused by the administration of steel, for months before
pain was complained of, or tenderness observed.
The conclusion to which I, therefore, incline is, that there was in
this case, from the commencement, a state of low inflammatory action
in a portion of the Spinal Cord, which, whether it did or did not pass
through the series of changes presumed by Abercrombie, ended, at all
events, in inflammatory softening. Whether this view be right or
wrong, and whether the disease in question be central or peripheral in
its origin, is obviously not a matter of mere pathological curiosity, but
one of the deepest practical importance. By applying our remedies
away from the real seat of the disorder, we are not only losing time,
but are losing, probably, the only opportunity we have of effectually
relieving; for when the series of changes, which we denominate soften-
ing, has once taken place, we know of no means whereby the nervous
structure may be restored to its integrity.
I am far, however, from wishing to extend the conclusions I draw
from my own case to all cases, or to say that cervical paraplegia may
not have a peripheral origin. I assert only that such is not invariably,
nor, I believe, very frequently the case, and that, therefore, it is not a
correct statement of its pathology to say that it is a disease primarily
of the muscular tissue. Of the five cases occurring under his own ob-
servation, which Dr. Gull has related in his Gulstonian Lectures, three
had symptoms indicative, more or less, of disease of the nervous cen-
tres. In the first, there was, during the whole course of the case, pain
in the head, which was stated to have been peculiar, and to have ori-
ginated apparently in the upper part of the neck. In the second, there
was weakness, though transitory, of the legs, and an equally transitory
numbness in one side of the face. In the fourth, there was uneasiness
low down in the neck, on flexion or rotation of the head, and the patient
was improving on a treatment, directed under the idea of disease of the
the spine, when he got an attack of rheumatic fever, after which his
paralysis was so greatly relieved, that he was able to return to a very
laborious occupation.
77, Sloane Street, October 1850.
I 037
ON THE EXISTING STATE OF OUR KNOWLEDGE OF
WACCINATION AND REVACCINATION, AS
PREVENTIVE OF SMALL-POX.
By ALEXANDER. KNOX, M.D., Physician to the Dispensary, Strangford,
County Down, Ireland.
THE preventive influence of Vaccination, questioned even at the period
of its discovery, and especially from the year 1804 onwards, has acquired
additional claims to the most careful and dispassionate consideration,
from the increased prevalence of epidemic Small-pox of late years. A
re-examination of the subject, therefore, would appear peculiarly appro-
priate, not only with the object of attempting to Satisfy the natural
anxiety of the public, but also with the hope of contributing to a greater
unanimity of professional opinion on the questions—How far does the
artificial Cow-pock actually secure the constitution against a subsequent
attack of casual Small-poa º and, Whether it is possible, by any means,
to confer an additional degree of security ?
To the examination of a subject, manifestly of the greatest practical
importance, not only intrinsically, but as occurring to us almost daily
in our professional life, I shall therefore address myself with all the
deliberate attention and impartiality which the difficulty of the investi-
gation properly demands.
1. CASUAL SMALL-POx—ITS HORRORS–PROPORTIONAL ATTACKs, AND
MORTALITY-I.EADING TO THE PRACTICE OF WARIOLOUS INO CULATION.
HISTORY OF INOCULATION–ITS PHENOMENA, AND EFFECTS IN ABATING
THE RAVAGES OF SMALL-POx—REPLACED BY WACGINATION, OR THE ARTI-
FICIAL PRODUCTION OF COW-POCK.
Casual Small-poa. It has been disputed by writers of the highest
authority in medicine, whether Small-pox was known to the ancients; the
affirmative of the question having been maintained, by Rhazes, Salma-
sius, Willan, Baron, and others; whilst, on the opposite side, are found
the names of Friend, Mead, and Good, no mean authorities on such
a subject. But there is too little of practical utility in the question,
to induce us to take part in its discussion. Rhazes, who wrote in the
ninth century, appears to have been the first to treat distinctly of the
disease, although the occurrence of both Small-pox and measles as early
as the year 572 (the era of the birth of Mohammed), is expressly men-
tioned in an Arabic manuscript, preserved in the University of Leyden;
but, whether that document be certainly genuine, or not, at all events,
from the allusions made by Rhazes to the opinions of Ahron, and
others of his predecessors, we cannot err in dating the appearance of
Small-pox anterior to the period of the Hegira, as it frequently broke
out, during the seventh century, in the wild, fanatic legions led forth by
the great prophet of Mecca, to propagate the doctrines of the Koran
by the edge of the sword. Thenceforward, at all events, Small-pox
has proved one of the most destructive of human maladies, whether
appearing in its sporadic form, or in those terrible epidemic irruptions,
in which it has smitten its victims as fatally, as numerously, and scarce
* Hamilton's History of Medicine, vol. i. 2
68
1038 v.AccINATION As A PREVENTIVE OF SMALL-Pox. .
less suddenly, than the destroying angel who passed of old over the
doomed hosts of the Assyrian camp. - - .
A few illustrations of what we have asserted will suffice. When intro-
duced into Mexico, not long after the discoveries of Columbus, this
fearful pestilence cut off, within a brief period, not less than three mil-
lions, of the unfortunate natives; and it is well known, that whole tribes
of the Red men of Western America, who, from this and other causes,
are fast disappearing from the footfalls of their fathers, have been swept
away by the same malady. In England, 40,000 individuals are said
to have perished annually ; and two millions, on one occasion, in Russia
in a single year. Haygarth attributed to this cause one half of all the
deaths taking place in children under ten years of age ; and, of all per-
sons attacked by Small-pox, one-fourth, or at least one-fifth, are believed
to perish ; whilst, according to the experience of Dr. George Gregory,
the mortality is even greater than this. At the Small-pox Hospital,
for the last half century, the fatal cases have ranged from eighteen to
forty-one in the hundred; averaging, on the whole, about thirty per
cent." Nor is this all, for one attack of the malady, even in its severest
form, does not invariably protect the survivor from a second, as is clearly
shown by ample experience. The extent of this consecutive liability,
however, has been variously estimated by different authorities: thus,
the proportion of secondary attacks of Small-pox, to the primary, is
computed, by La Comdamine as 1 in 50,000; Heberden, as 1 in 10,000;
other authorities, as 1 in 8,000; Eichorn, as 1 in 250; and Mohl, in
his description of the Copenhagen epidemic, asserts that every sixth
person who suffered from the disease, had it for the second time.
The calculations just quoted are evidently too widely discrepant to do
more than establish, generally, the fact, that the disease may occur a
second time ; and, on some occasions, as in the Danish physician's
experience, in a high proportion ; but they shew conclusively, at the
same time, that we have no data for determining any law as to the
frequency of the occurrence. The general proposition, however, of the
liability to a second attack, was known as early as the times of Rhazes
and Avicenna; and probably there are few practitioners who are not,
from their own experience, cognizant of it ; but, at all events, Baron,
in his life of Jenner, alludes to no less than one hundred and thirty
different writers, who have given examples of this occurrence. Were
it necessary to strengthen the evidence on this point, we might refer to
the reports of Heim and the Wirtemberg physicians, showing, that of
297 persons who bore evident marks of the Smallpox, Vaccination
failed in only 126 cases, succeeding perfectly in 95, and affecting the
remaining 76 in a modified form. Indeed, the entire statistics of the
authorities referred to, show that more than a half of all the individuals
operated on, after Small-pox so severe as to leave their persons marked
by Scars, had again become liable to the disease. In coming to this con-
clusion, they assume, perhaps correctly, that susceptibility of the con-
tagion of Cow-pock indicates an equal liability to that of Small-pox: this,
however, is a debateable question, to which we shall return hereafter.
But not only is the possibility of the recurrence of Small-pox, in the
I Cyclopædia of Practical Medicine. - Art. & 4 Smallpox", p. 742. ----
BY ALEXANDER KNOX, M.D. - 1039
same individual perfectly established, but equally so the fact, that the
secondary attack may be extremely severe, and even fatal. A well-
known instance of this unfortunate result occurred in the person of
Louis XV of France ; and at least one fatal case has happened within
our own observation. The experience of Macintosh supplied twelve
instances of secondary attacks; and he adds, “all my cases of second-
ary Small-pox, with the exception of two, have been remarkably severe,
whereas, I have not seen a severe case after Vaccination.” And when
to the fearful mortality just described, are added not only the viru-
lently contagious nature of the disease, but the long catalogue of
melancholy results which follow in its train, including tubercular con-
sumption, various forms of scrofula, hideous disfiguration of the counte-
nance, and blindness, it may readily be believed that any feasible plan
of mitigating its horrors was calculated to excite intense interest; and
this plan was found in the practice of variolous inoculation.
Variolous Inoculation. The artificial production of Small-pox by
Inoculation, is a practice alleged to have existed amongst the Chinese
and the inhabitants of Hindostan from remote ages, and to have been
also long known to the people of various countries of Europe; but its
power of ameliorating the virulence of the casual disease was first for-
mally announced in a communication made to the Royal Society of
Edinburgh, early in the eighteenth century. About the same period,
the observations of Pylarini, Venetian consul at Smyrna, and a notice
of the letter of Dr. Timoni, on Inoculation, written from Constanti-
nople, were published in the Philosophical Transactions. Further
attention was drawn to the subject by the writings of Mr. Kennedy,
but without any practical effect, until the pen and personal influence
of Lady Mary Wortley Montague seriously attracted the notice of
the public. The practice of Inoculation, thereafter, gradually made
its way in England, although violently opposed by many eminent
members of the medical profession, and denounced from the pulpit
as the offspring of atheism, and a diabolical invention of Satan. Sub-
sequently, however, to the year 1780, it fell into almost total dis-
use in these kingdoms; and was actually prohibited by law in France.
In 1754, a declaration was made by the London College of Physicians
in favour of the practice, but without any decided effect, until its suc-
cessful results in the hands of the Brothers Sutton rendered it generally
popular for some time. In 1746, the Small-pox and Inoculation Hos.
pital of London was founded, for the purpose of extending the benefits
of the discovery to the poor; and the results, in that establishment,
were favourable. In the following year, Inoculation was powerfull:
supported by the influential pen of Mead;" and Baron Dimsdale” fol.
lowed the Suttons with much success. His plan of operating, which
has not been improved on, was generally adopted for the next twenty
years, and with increasing popularity, until Jenner, in 1798, announced
to the world his great discovery of Vaccination. Since that period, the
general practice of Variolous Inoculation has fallen into disuse.
With reference to the individual, the advantage of Inoculation, how-
ever, was fully established. It abridged, by several days, the incubative
stage of the disease: it lessened the quantity of the eruption; and so
* De Variolis et Morbillis. * Present Method of Inoculatin for Small-pox.
1040 WACCINATION AS A PREVENTIVE OF SMALL-POX.
greatly abated the malignancy of the symptoms, that the deaths in the
Inoculation Hospital only amounted to three in one thousand cases,
whilst the mortality from the casual disease at that time, and even now,
according to Gregory, amounted to three in every ten persons attacked
by the malady. The following phenomena, usually occurring after
Variolous Inoculation, may be contrasted with the unameliorated hor-
rors of the casual disease.
Inoculated Small-poa. About the third or fourth day, a slight
redness, and a trifling degree of induration, perceptible to the finger,
may be observed at the point of operation. On the fifth day the red-
ness is more vivid; and on the sixth, the cuticle is generally elevated
by the effusion of serum, a central depression being observable at the
same time. On the seventh day, irritation of the superficial lymphatic
vessels occurs, the arm in the vicinity of the puncture becomes painful,
and the general symptoms of fever are developed. The eruption,
whether local or general, commences to decline from the twelfth to the
fifteenth day, after the date of the operation; the pustule being re-
placed by a scab, which falls off in a week or ten days more, leaving
behind it an indelible cicatrix.
The question then arises, why a practice, so manifestly beneficial,
came to be almost completely abandoned, at all events, by the medical
profession ? Several circumstances contributed to this result. It was
found, on examination, that the malady produced by Inoculation, al-
though mild in the majority of cases, was not invariably so; for many
persons, after the operation, passed through a very severe form of
Small-pox; and no inconsiderable number died of the disease thus arti-
ficially produced. Like casual Small-pox also, the engrafted malady
was found to excite in the system various consecutive disorders, and,
especially, to arouse into activity any lurking scrofulous taint. These
were serious risks for the practitioner to incur by his own act; and as
it was impossible to foresee, in any given case, what might happen, the
objection to the production of a disease artificially, which in the com-
mon course of events might, probably, never occmr at all, became
very strong; for, even at the worst, it appeared that a vast majority of
the people, without any precautions whatever, escaped altogether an
attack of casual Small-pox. Another objection, and, as regards the
public, a very weighty one, was the unquestionable tendency of Inocula-
tion, without careful seclusion and proper precautions, to promote the
diffusion of contagion. It may be true, as Adams," Watkinson, and
Schwenke, have attempted to shew, that the danger has been over-
rated; but the sources of infection were so much multiplied by the
practice, as Dr. Gregory justly remarks, that the casual Small-pox,
which formerly visited country places at long and uncertain intervals,
was now to be met with in all parts, at all times; 45,000 persons being
annually cut off by its virulence.”
Experience also taught, that Inoculation, however confidently asserted
to prevent a second attack of the malady, had, by no means, invariably
this effect; on the contrary, many writers affirm that secondary attacks
* Inquiry into the Laws, etc., of Epidemic Diseases.
* Cyclopædia of Practical Medicine. Article, “Small-pox.”
BY ALEXANDER KNOX, M.D. 104 l
were more frequent after the artificial, than the casual disease. This
last statement has been controverted by the high authority of Dimsdale;
but, at all events, as has been more recently shewn by Baron, death
occurred in the proportion of one in every fifty of the inoculated.
Inoculation was prohibited, by Royal authority, in France in 1763;
but the death-blow to the practice was not given, as already intimated,
until the promulgation of Jenner's discovery, about a quarter of a cen-
tury later.
II. WAGGINATION, HISTORY OF–SYMPTOM'S AND OBJECTs—ARGUMENTs
IN FAVOUR OF ITS PROTECTIVE INFLUENCE—OBJECTIONs—How FAR, AND
IN WHAT MANNER, IT HAS BEEN SHEWN TO FAIL.
History. After a lengthened investigation of the subject, Jenner first
announced, in 1798, in his well-known Enquiry into the Causes and
Effects of the Variola, Vaccina, that the Cow-pock, having passed through
the human system, after being transferred from the teats or udder of
the cow, by the process of Inoculation, ever after guards individuals,
so operated on, from the contagion of casual Small-pox; and that, by
the universal adoption of Vaccination, this dreadful disease might not
only be divested of its all terrors, but be finally extinguished from the
list of human maladies. Residing at Berkeley, in Gloucestershire, in
one of the great dairy districts of England, his attention was first turned
to the subject by a knowledge of the popular belief, which he found
prevalent, that Cow-pock, when casually transferred to the hands of the
milkers, subsequently protected all persons so affected from an attack
of Small-pox. And to the establishment of this doctrine, by accumu-
lated observations and arguments, as tending to confer incalculable
benefits on the human race, he devoted a great part of the remainder
of his long, honourable, and useful life. Jenner did not, however,
escape the common fate of great discoverers; for although the majority
of the medical profession eagerly and gratefully adopted his views, yet,
by a few, the value of his announcement was depreciated, his motives
questioned, and even his character maligned. Time, however, has done
justice alike to him and his traducers; and even if it could be shewn,
unequivocally, that his views were partially erroneous, enough would
still remain to entitle him to the undying gratitude of the human race,
whilst his ardent desire for the good of his kind, and his patient and
Christian bearing under the detraction of his enemies, as well as the
untiring industry, the deep Sagacity, and profound reasoning, which he
displayed in the defence of what he conceived to be true, will for all
time to come confer celebrity on his name. “Tá Švopa Śviror' 6A6Met.”
In 1799, Vaccination was introduced into America by Dr. Waterhouse;
and, in the same year, a testimonial of confidence in the discovery of
Jenner was signed by a large number of the most eminent physicians
and surgeons of London, including the distinguished names of Cline,
Cooper, Baillie, and Abernethy.
In 1800, the practice was adopted in France. Amongst the warmest
of its advocates on the Continent, we may enumerate Sacco of Milan,
and De Carro of Vienna, by the exertions of the latter of whom, Vacci-
nation reached Bombay, and was thence diffused all over India. As
early as 1801, six thousand persons had been successfully vaccinated
in Great Britain alone, In the year 1802, a remuneration of £10,000
I 042 WAGCINATION AS A PREVENTIVE OF SMALL-POX.
was voted to Jenner by the British parliament, and a further sum of
£20,000 in 1807, sixteen years before his death, which took place in
1823, when he had reached the advanced age of seventy-four years.
In 1833, a Committee of the House of Commons made a report on
the Vaccine Board, and on the practice of Vaccination generally, which
contained the latest information on the subject, up to the period in
which it was drawn up. More recently, the question has been ably dis-
cussed in Dr. Baron's Life of Jenner, and in the Report of the Com-
mittee, appointed by the British Association, to investigate the subject
in 1839. Within the last few years, a short Act of Parliament was
passed, commonly called the Vaccination Act, with the praiseworthy
object of promoting the more general diffusion of Cow-pock, by pro-
viding remuneration, to be made out of the poor-rates, for each success-
ful operation. In Norway and some of the other continental kingdoms,
Vaccine Inoculation is enjoined by law, and the practice is more or less
prevalent throughout every country in the world.
Effects. The doctrines of Jenner have been maintained, since his death
up to the present hour, by many distinguished writers, not the least cele-
brated of whom is Dr. Baron, his able biographer, who was principally
concerned in drawing up the Report already alluded to, as emanatin
from the British Association. The views there advocated will briefly
appear, from the following abstract of the petition, founded on the report,
and directed to be presented to Parliament: “Your petitioners have
learned by the concurrent testimony of a very large proportion of their
members, that Cow-Small-Pox, if duly and carefully communicated,
lias an enduring influence in protecting the constitution ; they admit
that this protection is not in all cases complete, but they have unques-
tionable proof of its being capable, if generally and properly employed,
of mitigating, controlling, and they might almost say of extinguishing,
Small-Pox in any district.” *
Many observers, however, both on the Continent and these countries,
—and the number has been increasing for some years, only partially
subscribe to the doctrine of Jenner, contending that Vaccination,
although it may impart the protective influence to an unascertained
proportion of those submitted to the operation, by no means does so to
all; and that even where imparted, it is liable to wear out, and leave
the system again susceptible of the contagion of casual Small-Pox. A
few maintain that the Cow-pock, in its most perfect form, confers neither
permanent nor temporary protection. In addition to the grand object
of destroying the liability to Small-Pox, or at least mitigating its
severity by Vaccination, the practice has been advocated, by aseribing
to it several subsidiary advantages, the chief of which is the compara-
tive safety of the operation as compared with Variolous Inoculation,
both to the individual and the community, from the tendency of the
latter to multiply the sources of contagion, and consequently to extend
the ravages of the disease.
Minor benefits derivable from the artificial production of Cow-pock,
are alleged to be, an occasional tendency to ameliorate the process of
dentition, and occasionally to effect a cure of various cutaneous dis-
See the Report; also, British and Foreign Medical Review, No. xvi, p. 613.
BY ALEXANDER KNOX, M.D. 1043
eases. These collateral benefits of Vaccination we shall dispose of first,
and thus leave the space clear, for the discussion of the grand question
of protective influence.
It is asserted by Heim that the process of dentition is, in many
cases, accelerated by the development of the Cow-pock, and Capuron
admits, that it is, at least, not rendered more troublesome. Jenner, and
several other writers, bear testimony to various chronic affections of the
skin having been rendered milder, and even actually removed by Vac-
cination. Amongst the diseases specified, are scabies, herpes, porrigo,
and impetigo; and Valentin adds ophthalmia, and scrofula ; nor does
there seem to be any valid objection against trying the effects of Vacci-
nation in such cases, provided we do not allow the lymph, resulting from
the operation, to be made use of for the transmission of the Cow-pock to
others. We do not, however, advise our readers to hope for any very
striking success from this practice, as it will be found, in the majority
of instances, as unsuccessful in arresting the progress of any severe
cutaneous diseases, as it turned out, in the hands of Dr. M'Cormac,
when experimenting on its effects, in a case of hooping-cough.”
Other advantages possessed by Vaccination are the absence of that
tendency to produce, in any case, a number of confluent pustules with
their consequent deformity, and to rouse into activity, the germs of
scrofula and other constitutional diseases, which is well known to
mark the course of Small-pox, whether arising casually, or de-
pendent on inoculation. We are aware that it is alleged, that even
Vaccination may produce a deterioration of the blood, and give rise,
also, to a variety of cutaneous affections. This alleged deterioration
of the blood, however, is a mere hypothesis, and, as such, deserving
of no further remark. That boils, pustules, certain cutaneous eruptions,
and smart inflammation, may now and then follow the Cow-pock,
although rarely, where the health of the patient is in a satisfactory
state, we are assured from personal experience; but even here a com-
parison of the operation, with that for variolous inoculation, is in favour
of the former, for such diseases are much more frequently observed after
Small-pox, and, as pertinently observed by the late lamented Professor
Burns, whose memory is deservedly held in the highest respect, no
new cutaneous affection has followed the introduction of Vaccination.
But, even at worst, when compared with the great advantages of Vacci-
nation, this objection would scarcely be worthy of notice, except with
the view of correcting a vulgar error, viz., that the cutaneous affections
alluded to, depend on impurity of the virus employed. Manifestly, in
the majority of cases, this is not so—but the result is dependent on the
state of the constitution at the time of the operation; for the same
lymph will produce the effects in question in one child, and not in
another, as I have, over and over again, had the opportunity of ob-
serving.
The tendency of Vaccination to diminish the prevalence of Small-pox,
by rendering less numerous the sources of infection, is so self-evident,
that we need not dilate on it here, although, as regards the community,
it is a matter of very great importance.

* Methodus Medemdi.
1044 WACCINATION AS A PREVENTIVE OF SMALL-POX.
And, even in point of safety, the operation for Cow-pock has an im-
mense advantage over variolous inoculation, for, to say nothing of the
comparative mildness of the symptoms of the former, it is not to be over-
looked, that a considerable mortality arose from the artificial Small-pox,
even after the most careful preliminary preparation for the operation.
The average number of deaths from this cause, at the Inoculation Hos-
pital, is stated to have been three in one thousand cases, and the mortality
consequent on Vaccination is certainly very much less than this, although
little or no medical treatment, either preparatory, or during the pro-
gress of the disease, is either practised, or, indeed, considered necessary.
Many practitioners, of considerable experience in this branch of practice,
have never seen a single case of Cow-pock terminate fatally in the human
subject; still, the possibility of such an occurrence has been sufficiently
determined. In Germany, according to Heim, of 208,322 children
submitted to the operation, 70 died; and at Baden, 79 deaths occurred
out of 98,198 cases, The proportion of one fatal case therefore in rather
more than 2,000 individuals is not large, even if it could be unequivo-
cally shown, that all the recorded deaths were necessarily dependent on
this cause, and the results might therefore be advantageously contrasted
with the mortality arising from variolous inoculation. But in these
kingdoms, we are able to infer with certainty, after extended inquiry,
that the fatality is infinitely less; and in my own personal experience,
extending to a thousand cases in one year, I have never seen the
operation terminating in death, even in a single case, and Dr. Baron
has only seen one. Nothing further need therefore be advanced as
to the superiority of Vaccination in point of Safety.
Protective Influence of Vaccination. The great practical question
—Whether, and how far, does Vaccination protect from a Subsequent
Attack of Casual Small-poa, 3 now remains for discussion. And first,
with reference to the groundless assumption, that Vaccination affords
no protection whatever, we believe it to be so directly contravened by
the most conclusive testimony, and by well-established facts, that no
other reply seems necessary, but to adopt the language of Capuron—
“Experience and observation constitute an answer to their foolish and
absurd declamations.” The evidence in favour of the protective and
modifying influence of Vaccination may be arranged as follows.
a. Popular ea perience, as to the immunity enjoyed by those who have
casually contracted Cow-pock from the cow, horse, or camel.
The discovery of Jenner, as before stated, arose out of the popular
'belief, prevalent in the dairy counties of England, that the casual
transfer of a peculiar form of disease from the udder of the cow to the
hands of the persons engaged in milking, defended such persons, ever
after, from the liability to Small-pox; and it was only after a long
and patient investigation of this point, that that eminently sagacious
physician came to the conclusion, that the popular belief was founded
in truth. His researches have, therefore, tended to lighten, greatly, the
labours of subsequent investigators, by clearly pointing out the precise
characters of the pock, which alone can impart the desired impunity, and
which it is therefore necessary carefully to discriminate from a variety
of diseases having a general resemblance to the genuine malady, but
conferring no exemption from a subsequent attack of Small-pox. Jenner,
BY ALEXANDER KNox, M. D. . . . . . 1045
however, erred in supposing the casual variolae vaccinae to be, invariably,
a purely local disease, whereas it is frequently a constitutional febrile
affection, generally mild, and accompanied by an eruption; but occa-
sionally severe, and even fatal. Thus, at Moorshedabad, the pustules
appeared all over the body, about the fifth or sixth day after the animal
became indisposed, with fever and much distress, and went on to ulcera-
tion, the hair falling off wherever a pustule had run its course. The
mouth and fauces (which, being one mass of ulceration, impeding masti-
cation), were the principal seats of the disease, which proved fatal, appa-
rently from imanition, in the proportion of from fifteen to twenty per
Cent. - . . . - - s : . . . . . . .
According to Ceely,–to whose minute and correct history of the symp-
toms, collated, however, with various other accounts, we are principally
indebted for the following description,-the casual Cow-pock appears
most generally in the spring, and in a sporadic form. The disease
is, however, occasionally epizootic ; but Mr. Ceely has not been able to
trace it to the equine vesicle, and he adds, that in England, fever is
rarely observed. The first perceptible symptoms are heat, tenderness
and induration of the udder, followed, about the fifth day after expo-
sure, by small papulae, affecting also the teats. In cows with white
skins, circumscribed indurations appear about the sixth and seventh
days, of a reddish colour, as large as a pea, and circular, ovoid, or
lozenge-shaped, with a central depression, in which is visible a small
dirty yellowish-white discoloration, surrounding a still darker dot or line.
The indurations are often interspersed with minute red papula, of a
darker colour, rather acuminated, and frequently abraded at the summits.
Some of the tumours have a slender amber-coloured, yellowish-brown,
or black central crust, and are less prominent than those without the
crusts. On the eighth and ninth days, the central depression, frequently
of a blueish tint, becomes more apparent, as well as the elevation of the
margin, which is solid, uniform, tense, and shining, of a glistening
pearly, or silvery hue. An areola of a pale rose, or light damask-
colour, a line or two in width, is frequently apparent round the base.
In others, the central crust has increased, and is yellow, brown, or
black; some appear a little pustular in their centres. A few small
conoidal vesicles, some of them with a slight depression on the apex,
appear to have subsequently arisen on the teats, but in general, the
majority of the tumours on these parts are more or less abraded, and
lymph is seen exuding from their centres, the cuticle being loose, or
partly detached, whilst brown and black incrustations, and other altera-
tions from the natural characteristic appearance, are manifest. About
the tenth and eleventh days, the disease usually reaches its acme, when
the tumours are often eight or ten lines in diameter, the centres and
central edges of the intumescent margin are of a deep blue or slate-
colour, and the areola, under which the integuments are deeply indurated,
generally of a pale rose-colour, is seldom more than four or five lines in
extent. The lymph, now abundant, raises the cuticle, and forms a
globular or conoidal vesicle, or freely flows out from its rupture. From
this period the induration subsides, and the incrustation and desicca-
tion proceed, until the crusts spontaneously separate, from the twentieth
to the twenty-third days, leaving shallow, smooth, oval, or circular
1046 VACCINATION AS A PREVENTIVE OF 'SMALL-Pox.
cicatrices, of a pale rose, white, or yellow colour. When the process is
disturbed, we may observe on the teats, large black, solid crusts, often
more than an inch or two in length, or they appear abraded, ulcerated,
and bleeding." - - - .
It has been affirmed by Reckleben and Thar in Germany, as well as
by some observers in this country, that milch-cows are alone subject to
Cow-pock, but Heim has shewn that this is not consonant with fact.
The truth is, that milch-cows, from causes that must be obvious, are
certainly more liable to the disease than young cattle, which are less
exposed to inoculation by the hands of the milker; but the latter are by
no means entirely exempt. -
The lymph from the genuine vaccine vesicle just described, when
accidentally transferred to any abraded surface on the milker's hand,
and absorbed, reproduces the disease usually termed casual Cow-pock
in man, which is marked by an eruption of inflamed spots, the tendency
of which is to terminate in suppuration. The pustules are bluish, and
circular, with elevated edges; and the consecutive phenomena include
swellings in the axilla, fever, headache, vomiting, and, occasionally,
delirium. These symptoms decline in three or four days; but the
sores are painful, and very frequently heal with difficulty. .
Bastard forms of Cow-pock, on the hands of the milkers, arising from
spurious varieties of the disease in the cow, are of frequent occurrence,
and, from their incapability of imparting any protection to the system,
have proved a frequent source of error. The most usual forms of the
spurious disease are described in another part of this paper: by con-
trasting which, with the above minute description of the genuine disease,
they may be readily distinguished from each other. . . . -
But, rigidly speaking, this popular belief in the general immunity,
conferred by casual Cow-pock, cannot be admitted as a conclusive argu-
ment, until it shall have been determined, by a sufficient body of sta-
tistical information, to be certainly true. This, hitherto, in our opinion,
is by no means the case; but, at the same time, the proposition has
been rendered so probable, by the investigations of Jenner, and others
since his time, as to entitle it justly to the place of a strong corrobora-
tive argument, in favour of the efficacy of Vaccination. It is not, how-
ever, to be looked for, as a result of further examination of the subject,
that the protection, which Cow-pock is capable of conferring, shall be
invariably present in all cases. This was an error into which Jenner
fell; for the immunity, arising even from casual and inoculated Small-
pox, is liable to numerous exceptions; and no other result can reason-
ably be expected in the case of Cow-pock.
Having thus pourtrayed the casual disease, as it displays itself, both in
the cow, and in man, we shall now minutely describe the symptoms,
which follow the transference of genuine lymphºto the human subject.
This is a part of the subject of great importance; because all our
reasoning, as to the protective influence, has reference to the genuine
character of the disease; and the truest test of this is the complete
and regular process of the vesicle, with its attendant symptoms, through-
out its entire course. • . . . . . . . . . . . . . . .
* British and Foreign Medical and Surgical Review, No. xx, p. 465.
13Y ALEXANDER KNOX, M.D. 104.7
b. Symptoms of inoculated Cow-pock. After the insertion of the
genuine virus, the puncture ceases to be apparent for a few days, which
may be termed the period of abeyance; but it has been observed by
Gregory to assume a vesicular form, under the microscope, within eight-
and-forty hours. On the third, or fourth day, an inflamed speck becomes
visible to the naked eye, which gradually increases in size, and forms
a small, slightly prominent tumour, presenting in its centre a dark
point, formed by the commencing secretion of the lymph. This point
gradually increases in size, and becomes a small transparent vesicle,
either of a dull white colour, something like a pearl, or, occasionally,
yellowish, with a circular, or sometimes an oval base, especially if the
operation has been performed with a longitudinal scratch. The margin
is well defined, being rounded, turgid, red, and shining; the centre is
umbilicated, or dips instead of being polarized; and this form remains
until the eighth, or ninth day, when the vesicle sometimes becomes
more elevated in the centre than at the circumference. Frequently
there is scarcely any perceptible fever; but more usually, about the
eighth day, a degree of constitutional disturbance takes place, which
is indicated by slight headache, and lassitude, and possibly by shiver-
ing, loss of appetite, heat of skin, increase of pulse, disordered bowels,
pain of the arm-pit, and occasional enlargement of the axillary glands.
These febrile symptoms may be present for a day, or two, but they
almost invariably then subside, leaving no trace behind. About the
eighth day, a little sooner or later, the vesicle is surrounded with a cir-
cular, inflamed halo, or erythematous areola, marked by intense itching,
redness, and slight swelling of the surrounding membrane, and varying,
in diameter, from one to two inches, in different cases. The areola is,
occasionally, the site of a number of small vesicles. This local inflam-
mation is the pathognomonic proof of the system being affected with
the disease. About the ninth, or tenth day, the vesicle acquires its
greatest magnitude, and is equal in diameter to the third or fourth
part of an inch, and about the size of a split pea. About the eleventh
day, all the symptoms decline; the hue of the areola becomes gradu-
ally fainter, and, in a day or two, as it begins to fade imperceptibly
away, it leaves two or three concentric rings, of a bluish light grey.
It is scarcely distinguishable on the thirteenth day after the operation;
at which time the vesicle hardens into a dark brown, circular scab;
the fluid for two or three days previously having begun to dry up, first
at the centre, and to assume something of a purulent consistence.
This, if not rubbed off, or interfered with, falls off towards the twen-
tieth to twenty-fourth day, leaving the skin perfectly whole, but
marked by a permanent cicatrix, about the third, or half of an inch in dia-
meter, which is marked by a number of pits, corresponding to the cells
of which the vesicle had been composed. Each puncture produces but
a single, multilocular vesicle, the little cells of which communicate with
each other, and secrete a perfectly transparent, colourless lymph, not
however, as stated by Good, during the entire progress of the disease.
For, although Cow-pock is considered rather a vesicular, than a pustular
malady, the vesicle becomes turbid towards the close, and actually
secretes genuine pus. Such is the usual progress of the genuine Cow-
pock. It may, however, present various deviations from the regular
1048 v.AccLNATION As A PREVENTIVE of SMALL-Pox.
course, which may be looked on as immaterial, and which are, therefore,
to be carefully distinguished from such aberrations as would interfere
with the due impregnation of the system. In the former class we may
enumerate the following peculiarities: more or less violent inflamma-
tion, sometimes even extending to the trunk of the body, is occasionally
observed, terminating in a profusely discharging ulcer, instead of the
characteristic scab; but this, though requiring local applications, and at
times even general remedies, of a cooling nature, does not, in the opinion
of Gregory, militate against the protecting influence of the vaccine
operation: my own experience is to the same effect. The same physi-
cian describes a papular eruption, appearing about the tenth day, occa-
sionally spreading from the extremities to the trunk, and most usually
occurring where numerous vesicles have been raised on the arm, indi-
cating, as he alleges, a full effect upon the system. The lichen, here
described, is by no means unfrequent, but it may follow spurious, as
well as genuine Vaccination, and cannot therefore be looked on as any
certain test of the efficacy of the operation.
The occurrence of vesicles, except on the points punctured, is very
rare; but if present, they may be considered as a proof of the energetic
operation of the virus on the system. In certain cases, these super-
numerary vesicles have been attributed, by Cazenave and Schedel, to
transference of the matter by the nails, after scratching; but this ap-
pears to be a very questionable cause, and, at any rate, the effects may
occur quite independently of it.
The phenomena of Vaccination in the adult are the same as in the
child, with a few unimportant variations, which have been correctly
described by Gregory. Thus the vesicles are thinner, and consequently,
more easily ruptured, the lymph generally presents a yellowish tinge,
and the areola is more extensive, the axillary glands more frequently
become swollen, and the consecutive fever is greater, with less tendency
to secondary lichen, than in children. But such slight anomalies
neither interfere with the protective power, nor the contagious pro-
perties of the lymph, although, for reasons which will appear hereafter,
we should avoid selecting it for transmission of the disease.
c. The Identity of Cow-pock and Small-poa, an argument in favour
of the protective influence of Vaccination.
It was maintained by Jenner, on theoretical grounds, that the dis-
eases in question were identical, the Small-pox being merely a malig-
nant variety of the Cow-pock; but it is of importance to show, that the
correctness of his opinion, in part at least, has been established by evi-
dence, both sufficient in point of amount, and satisfactorily attested, to
gain the assent of all those who are not unreasonably and pertinaciously
sceptical. In asserting the identity of the variolae vaccinae and Small-
pox, Jenner has found supporters in Wedekind, Henry, Baron, and
many others. But no actual experiment in favour of their opinion,
however rational, was adducible, until Dr. Sonderland, of Bremen,
communicated the disease to a cow, by enveloping her in a woollen
bed-cover removed from a patient, who had died of Small-pox;” and fine
vaccine lymph was procured in Egypt in the same way. As the ex-
On the Laws of Contagion. * Petition of Provincial Medical Association.
BY ALEXANDER KNOX, M.D. 1049
periment, however, was not followed by like results in the hands of
Gregory, Numann, and Macpherson, the statement of Dr. Sonderland
became unjustly discredited, until Gassner, Fomin, and Dr. Basil
Thiele, of Kasan, succeeded in producing the genuine vaccine disease
in the cow, by inoculation with Small-pox matter. Finally, the ques-
tion must be looked on as settled by the unexceptionable experiments
of Mr. Ceely, of Aylesbury;" for, the virus of human Small-pox having
been communicated by inoculation to the cow, a pock was the result,
resembling in all essential particulars the Cow-pock, and which, like
the original vaccine disease, afforded a lymph with which some hun-
dreds of persons have been successfully vaccinated, and the efficiency of
which has been subsequently tested, both by inoculation of the persons
vaccinated, and by their exposure to the contagion of the casual disease.
Nor is there anything very remarkable in Retro-vaccination, or the arti-
ficial communication of Small-pox to the cow; for M. Viborg had pre-
viously succeed in producing the disease in dogs, apes, and swine, in
the same manner.” In the dog, the vesicle, although evidently smaller,
runs the same course as in man. In Lombardy, and in Persia, it has
been observed in the sheep as well as the cow, and also in South
America by Humboldt and others.” The camel too, is susceptible of
the disease, as we learn from the communication of Dr. Winchester, in
the Indian Journal of Medicine, quoted in the nineteenth number of
the British and Foreign Medical and Surgical Review.
It appears that, in the province of Lus, the camel milkers are sub-
ject to a malady termed “Photo-Shootur,” the Small-pox of the camel,
that complaint being designated by the term Photo, in the district in
question. This is a pustular disease, affecting the hands and arms of
the milkers, which is derived from a similar affection on the udder of
the camel, closely resembling that on the udder of the cow. No one
is ever known to die from this disease; and it is remarked by the natives
that those who have been subject to this camel-pock are invariably free
from Small-pox, which occasionally prevails as an endemic in that dis-
trict. It is generally known, that Jenner attributed the sole origin of
the disease in the cow, to a complaint affecting the heels of horses,
which he erroneously supposed to be the grease, but which has subse-
quently been ascertained to be a peculiar vesicular disorder affecting
not only the heels, but the limbs and body of that animal, and capable
of communicating the Cow-pock either to the cow, or directly to man,
as fully shown by Loy, Sacco, and De Carro. Of this equine form of
the disease, or pferdemauke, Professor Hering adduces two instances
exhibiting all the characters of perfect identity with the vaccine malady.
But this is not the only source of the complaint affecting the cow, for
it is well ascertained, as stated by Griva, that it has been observed to
occur in that animal spontaneously in Switzerland, the north of Italy,
Rome, Germany, Wirtemberg, Holland, France, and Ireland. Dr.
M'Cormac suggests, that the disorder in the horse may have been
1 See Mr. Ceely's Experiments; British and Foreign Med. Rev., No. xvi, p. 614,
et seq., and vol. xiii, p. 781 ; also, Med.-Chir. Rev., Jan. 1834.
* Med. and Phys. Journ., Sep. 1802.
* Baron's Life of Jenner, vol. i., p. 239.
1050 WACCINATION AS A PREVENTIVE OF SMALL-POX.
derived from the cow, but it would be extremely difficult, if not im-
possible, to determine whether the disease originated in man, or in the
horse, or the cow ; and, at any rate, it is sufficient to know the fact, that
it may now occur independently in each, and that it is mutually com-
municable from the one to the other. In giving an impartial view of
the subject, however, we should not omit to state the arguments which
have been advanced against the identity of the diseases we have been
considering, although such objections must now go for nothing, since
the establishment of the point at issue by authentic experiments. The
first of the objections in question to which we shall allude, is the
comparative mildness of the vaccine disease; but the force of this argu-
ment, if it have any force, is obviated by knowing that the variolae vac-
cinae have prevailed, as in the year 1825, in as severe and fatal a form,
as the Small-pox in man. It must be admitted, however, indeed it is
on this that the value of Jenner's discovery entirely depends,--that, in
general, the character of the malady has been rendered infinitely
milder, by its transmission through the cow. Another point of differ-
ence well established between the two forms of the disease is, the
atmospheric transmissibility of the contagion arising either from the
casual or inoculated Small-pox, whereas it is not known that the Cow-
pock can be conveyed, except by direct contact. It has also been
asserted, that the vesicles arising from the vaccine lymph are invariably
confined to the points of puncture; and, as a general rule, this must be
admitted to be true. But, from whatever cause arising, this is not in-
variably the case. Thus it sometimes occurs, that Vaccination is per-
formed on individuals exposed to the variolous conta_ion, and, in such
cases, an eruption, more or less abundant, may appear on various parts
of the body. Cazenave and Schedel explain this, by saying that the
eruption is only Small-pox modified by the process of Vaccination.
But it has been further alleged by some physicians, that they have
employed the lymph taken from this supposed Cow-pock eruption, and
produced therewith genuine vaccine vesicles; in commenting on which,
the authors in question observe, that in such cases, the operators have
either grossly deceived themselves, or that the malady thus developed
has truly the appearance of Cow-pock. Admitting this, they inquire,
what becomes of the distinction between Cow-pock and Small-pox?'
By the German physicians, a secondary eruption has been observed
to accompany the vaccine process, presenting variously the appearance
of a spotted rash, or a papuliform, vesicular, or even pustular disease ;
occurring usually between the eighth and fourteenth days, and remain-
ing for two or three days, or even for a week. In some cases, the erup-
tion assumes the appearance of chicken-pox; and in others, partially,
or even entirely, resembles the genuine Cow-pock, and appears on vari-
ous parts of the body.
Still, such appearances as these last are extremely rare, as I have
not observed more than two, out of some thousand cases, in which the
pock was not limited to the point of insertion. At one time, Dr.
Geo. Gregory was directly opposed to the doctrine of the two varieties
of pock being identical, inasmuch as no direct experiments had proved
* Maladies de la Peau, p. 79.
BY ALEXANDER KNOX, M.D. 1051
that Cow-pock can be communicated from man back to the cow;1 but
his statement is not in accordance with the experiments of M. Fiard.”
At the same time, on the grounds that diseases which mutually produce
each other, are clearly referable to the same source, he admitted the
identity of Cow pock and swine-pox ; but, in the same train of argument,
he denied that Cow-pock and Small-pox were identical, as the former
never produced the latter in the human system; and Small-pox, how-
ever mild, never approaches to the character of Cowpock. The incon-
sequential character of this mode of reasoning is apparent, but need not be
insisted on, as Dr. Gregory has since admitted, that late observations
have established the identity of the two diseases; and it is difficult to
see how any other inference could be arrived at, after the conclusive:
experiments of Ceely, unless we are prepared to assert that one malady
is capable of producing, by inoculation, another of a totally different
nature. #
This identity unquestionably supplies a powerful argument in favour
of the efficacy of Vaccination; for those who believed that Small-pox
and Cow-pock were essentially distinct diseases, might very justly object to
the belief in the impunity alleged to be conferred by the latter, that
there was no known instance of any one malady having the effect of
destroying the liability to another. But the fact, as now established,
both obviates the objection, and explains what was previously very
mysterious ; so much so, that a conviction of the non-identity of the
two diseases would go far to shake, in toto, our belief in the real effi-
cacy of Vaccination. Cow-pock, therefore, being determined to be essen-
tially the same disease as Small-pox, which is confessedly one of that
class of maladies in which a first attack destroys the liability to a
second, the inference appears unavoidable, that Cow-pock should confer
a like immunity; but the extent of that immunity can only be deter-
mined by the result of experience. Reasoning from analogy, and the
observed effects in other diseases, we should be led to the conclusion,
that the amount of the protection imparted by an attack of Small-pox,
whether in its severe and casual, or in the mild and modified form of
Cow-pock, would be the same ; for we find that the constitution is equally
protected from a second attack of scarlatina or measles, whether the
primary disease may have been of the most malignant, or the mildest
nature. But, as already stated, this is a question which can only be
satisfactorily determined by extensive and accurate observation. p
(To be continued.)
* Medical Gazette, vol. i., p. 781-2.
* La Lancette Franç., 1835. Report of M. Gérardin on Vaccine, 1833. British
and Foreign Medical and Surgical Review, No. iii.
WOI, II, 69
1052
CASE OF ABSCESS OF THE PANCREAS.
By JAMES KILGOUR, M.D., Physician to the Ludlow Dispensary.
CASE. T., Esq., act. 41, unmarried, of indolent habits, a large eater,
fond of sweetmeats, addicted to masturbation, and one of whose sisters
was carried off by phthisis, was subject, for some years, to periodical
attacks of bilious dyspepsia, usually occurring in the autumn, and often
attended by a white condition of the alvine evacuation, along with a
liability to sickness and vomiting, more particularly in the morning.
In September 1849, he suffered as usual; but, instead of getting well
after a little dietetic discipline and laxative medicine, as had been the
case in former years, his symptoms increased; and, when I first saw
him, on the 21st of March last, he was emaciated, feeble, and dispirited.
The symptoms under which he then laboured were sufficient to account
for this condition : the most prominent were, frequent vomiting, with-
out much nausea, great sense of distension in the stomach and bowels,
which secreted much gas, almost total loss of appetite, and restlessness,
with want of sleep at night. With reference to the vomiting, it usually
took place in the morning, either before or after taking food; but,
during the day, it generally occurred after food,—sometimes imme-
diately, sometimes after the lapse of two or three hours. The mat-
ters rejected were the ingesta, mingled with, and followed by, a
quantity of thin, ropy mucus, the whole being intensely acid. The
amount discharged varied from a quart to an ounce, and seemed, in
general, to depend upon the time during which the acid secretions had
been permitted to accumulate. The act was attended with little effort;
and, as has been already stated, was not accompanied by much, nor
Sometimes by any, nausea. The skin was dry and unperspiring, of a
slightly yellow tinge, which was more pronounced in the sclerotic ; the
tongue white, but moist, though stated to have been red and dry previ-
ously; there was no thirst ; the bowels were slow, but easily moved by
medicine; the stools consistent, never fluid, unmixed with bile, and
remarkably fetid; the urine was passed in proper quantity (sp. gr.
1.022), sometimes much loaded with lithates, and generally containing
a good deal of urea and colouring matter. No bile could be detected
in it; but the microscope showed it to contain fat." The pulse was about
100, small ; no pain whatever was complained of; even firm pressure
over the abdomen failed to elicit signs of tenderness at any point, the
only inconvenience occasioned by its exercise, arising from its producing
a tendency to vomit. Moreover, there was no unusual prominence of
its walls, either general or partial; but percussion revealed much tym-
pamitic resonance over the stomach and right side of the abdomen;
while the left yielded a dull sound, from the lower border of the sto
mach to the ilium, and felt doughy, inelastic, and, towards the median
line, knotty.
The region over which this absence of resonance prevailed, had no
* Dr. Bright mentions three cases in which fatty discharges from the bowels
took place, and in which there was found, after death, a seirrhous condition of the
Pancreas, and a fungous disorganisation of the duodenum.
DR. KILGOUR ON ABSCESS OF THE PANCREAS. I (): 3
sharply-defined limits, nor could the form of any tumour or substance
beneath the abdominal walls be traced. There was neither pulsation
nor fluctuation, to aid the diagnosis; and the general impression which
an examination of the abdomen, at this time, conveyed, was, that some
abnormal growth, occupying the greater portion of the left side of the
abdomen, had pushed the intestines over to the right side, and the
stomach up towards the thorax. The liver, whose secretion we have
seen to be absent from the stools, though recognizable in the colour of
the skin, could not be connected with this abnormal state. It appeared
to be of ordinary bulk, not exceeding its natural limits in any direction,
and bore pressure with the same impunity as other portions of the
abdomen.
The case, as now described, proceeded, with slight and varying alter-
ations in some of the symptoms, but with a decided downward tendency
upon the whole, until about the middle of May, when its progress
became accelerated by the occurrence of something like irregular inter-
mittent. There were rigors, at uncertain intervals, of from one to
three days, each being followed by a hot fit, and terminating by sweat-
ing; there was also a tendency to sweat at night. The vomiting, from
which the patient had experienced occasional and temporary relief by
the use of bismuth, now returned in all its intensity, and bade defiance
to remedies; the wasting and debility, which heretofore had advanced
with a gradual step, became painfully apparent from day to day; the
appetite grew weaker; while the pulse rose in frequency (to 114), and
sank in power. The bowels, no longer slow, acted of their own accord
about twice daily; the quality of their contents remaining, as already
described, devoid of bile, and horribly fetid, but never fluid. The
tongue became red and clean, with numerous aphtha on its back part
and edges; the urine and saliva were natural in quantity and in quality;
a little thirst was complained of, but no pain. It is to be remarked of
the matters vomited now, that they were less sour than formerly, some-
times consisting of thin, glairy mucus, with something like yelk of egg
intermixed; sometimes of a colourless fluid, neutral to test-paper, and
slightly coagulable by heat. At the same time, the condition of the
abdomen, as discoverable by palpation and percussion, became much
changed; the dulness descending no lower than the umbilicus, and not
rising higher than the ordinary situation of the lower border of the
stomach, but rather stretching backward to the left flank. The cause
of this dulness still remained undefinable as to form; and the abdo-
men, at that part, gave no other sensation to the fingers than what 1
have already described, namely, a doughy, inelastic feel. Pressure still
failed to excite pain in any part of the abdomen; but some slight pain,
or rather uneasiness, had been experienced in the left lumbar region.
The next epoch, which it is important to mark in this case, may be
dated from the end of May. The rigors then ceased, and the abdomen
returned to its usual condition, except at one point, about an inch
above the umbilicus, and rather to the left of the mesian line, where
pressure caused a feeling of soreness, or, as the patient expressed it,
as if a boil were there. Over this spot, which was about two inches
in diameter, the abdomen felt resistant, and India-rubber like. This
apparently favourable change brought no improvement to ºption.
64
1054 ARSCESS OF THE PANCREAS.
because it was not accompanied by any mitigation of the mortal symp-
toms exhibited in the disorder of the stomach, liver, and duodenum,
and the wasting consequent thereon. Neither did the pulse fall with
the subsidence of the febrile fits; on the contrary, it beat 120 in the
minute, and some hurry of breathing became now evident for the first
time. The bowels continued to act without medicine, and a slight
trace of bile was now discoverable in their contents, but their fetor re-
mained unabated. The patient continued to be much annoyed by the
quantity of gas secreted by the stomach and intestines; which, besides
giving the sensation of uneasy fulness, helped to excite vomiting, now
become more frequent than ever, though still unaccompanied by strain-
ing or retching. As might be looked for in such circumstances, wasting
and muscular debility made rapid progress; and the appearance of the
patient became altered, in proportion to their advance. No noticeable
change, however, took place in the principal symptoms, until about the
beginning of July, when a sudden and considerable swelling of the feet
and legs occurred, which was followed by much relief. The vomiting
became less frequent, and the appetite improved a little, but still the
processes necessary for nutrition remained imperfect; bile did not find
its way into the duodenum, except in very minute quantities, and, al-
though what was eaten was not so constantly rejected as formerly, it
did not contribute either to strengthen the patient, or to arrest the
progress of the dépérissement which proceeded unchecked unto the
end. Shortly after this, some decay in the memory and perception
became obvious; there was tendency to somnolency, and the pupils
occasionally dilated; the patient was sunk down in bed, and declined
the least exertion; the features were pinched, and cadaveric, and it be-
came apparent that the cessation of the severer symptoms was only an
evidence of the waning powers of life. On the evening of the 26th,
the vegetable-like monotony of the patient's existence was broken, by
the occurrence of a severe rigor, from which he recovered, to experience
a second on the following evening, and a third on the morning of the
28th, which last extinguished the feeble and flickering flame of life.
The post-mortem examination was made fifty-eight hours after death,
when decomposition had already made some progress, and, from circum-
stances, in a very hurried manner. The limbs were extremely emaciated,
the trunk much less so, and half an inch of fat was found to cover the
muscles of the abdomen, which alone was opened. Much fetid gas
escaped upon puncturing its cavity, and some fat was found in front of
the intestines. The stomach was very large and distended with gas,
its walls were extremely thin, and some inflammatory patches were
observed near the pylorus, on the lesser curvature. The pylorus itself
was slightly thickened, and its orifice narrowed. The duodenum bore
the marks of intense inflammation throughout, which had proved
most destructive in that portion most contiguous to the Pancreas, which
broke down into pultaceous shreds in the most cautious attempts to
examine it. The inflammation extended for a short distance into the
jejunum, and there stopped. The liver was slate-coloured, of ordinary
bulk, and normal texture. The gall-bladder was healthy, and contained
about three teaspoonfuls of orange-coloured bile. The ducts were all
pervious. The spleen was not less than one-third larger than usual
. BY JAMES KILGOUR, M.D. . 105.5
but healthy. The Pancreas, with its envelopes greatly thickened;
formed a mass whose diameter would somewhat exceed that of a large
breakfast cup. It adhered to the left supra-renal capsule, but to no
other of the adjoining viscera. When cut into, a creamy pus flowed
out; and, upon further investigation, the entire gland was found to be
converted into a cyst, filled with the pus just mentioned, and a few
cheesy masses about the size of a bean." Remains of septa in the cyst
were visible, from which it would seem that the suppurative process
was first completed in one portion of the organ, and then in another.
The kidneys were healthy; only that part of the left kidney in con-
nexion with the diseased Pancreas was red. I had no opportunity of
examining the contents of the cyst, nor any part of the diseased struc-
tures, with the microscope.
REMARKs. In remarking upon the above case, which is not one of com-
mon occurrence,” the most obvious features which strike the eye are the
vomiting and wasting, which commenced at an early period of the disease
and accompanied it to its close. The absence of pain is also remark-
able ; and the more so, as it was certain from the physical signs, that
the various phenomena, which the case presented, were not altogether
dependent upon functional derangement of the abdominal viscera.
Again, the immunity of the nervous system and integrity of many of
the secretions, adds one to the occasional proofs which are afforded to
us, of the great extent to which the destruction even of an important organ
may go, without compromising any other system than the one imme-
diately concerned. The pulse was increasingly quick throughout, but
its acceleration did not seem to depend upon any particular phase of
the complaint, but rather on the increasing debility of the patient.
Most writers who have treated of Pancreatic disease have admitted
the frequency of vomiting,” and some have considered it an essential
symptom. Morgagni points out how Disease of the Pancreas may pro-
duce vomiting; but, in his third book, he says, “I even confess that this
viscus has been found diseased by me and by others without a vomiting
being the consequence of it.” Dr. Abercrombie inclines to the same opi-
nion, as does also Dr. Claessen of Cologne, who has reported upon 322
cases of Disease of the Pancreas. Indeed it seems reasonable to suppose,
that in many cases of this nature, particularly when the morbid change
has not proceeded far, vomiting should not occur as a constant symp-
I According to Gendrin, in large purulent deposits in the Pancreas, the pus has
generally been found creamy and inodorous; Portal, on the other hand, states, that
in complete suppuration of the Pancreas, the pus is sometimes of an intolerable
smell, and in very large quantity, amounting to two pounds or upwards. The
same authority speaks of such abscesses as occasionally the result of disease of the
testicle; and M. Tonellé mentions two cases of puerperal peritonitis, attended with
like consequences.
* Among the 322 cases of Diseased Pancreas recorded by Dr. Claessen, thert
is not one case of abscess.
3 The fact of large quantities of watery fluid being vomited, when the Pancreas
has been found diseased, led to an opinion, at one time generally entertained, that
the fluid rejected consisted principally of the secretion of that organ. This idea
later writers have held to be incorrect, and have argued that the stomach is the
source of the secretion, an opinion which this case puts beyond doubt, as it is certain
that, long before death, the Pancreas ceased to be a secreting organ.
1056 ABSCESS OF THE PANCREAS.
tom, inasmuch as neither the mechanical nor other condition for
producing this effect, may exist in the required degree. In cases
where obstinate vomiting does occur, where that vomiting has princi-
pally, or partly, a mechanical character, and where it can be made out
that an enlarged liver or spleen is not the exciting cause; further, when
the matters rejected are thin, ropy, sour, tasteless, or salty, and in con-
siderable quantities; and when theseconditions exist with pain, hardness,
or tumefaction at the situation of the Pancreas, we should then, I con-
ceive, be warranted in setting down the Pancreas as the fons et origo
mali. Wasting, also, has been much insisted on, particularly by Dr.
Pemberton, as indicative of Pancreatic disease. The record of this case
agrees with that opinion, but I should be inclined to modify it generally
upon the same principles which I have assumed as likely to determine
vomiting. For instance, in cases when the functions of the stomach, liver,
and duodenum escape the profound alteration which this case shows they
sometimes undergo, Ishould not be prepared to expect a rapid emaciation;
and in this view I am borne out by the reports of some of Dr. Abercrom-
bie's cases, where the bodies were found after death to contain much fat.
This question, however, involves another, viz., the extent to which the
Pancreatic juice is necessary to nutrition. The experiments of M. Bernard
have tended to shew, that its function is to digest the fatty matters, con-
tained in the food, and facilitate their absorption; but the confirmation, or
disproval of this opinion will rest with the statistics of Pancreatic disease.
It would seem, then, that we can hardly estimate the value of emaciation,
per se, as a diagnostic mark of this complaint; but, in conjunction with the
other signs enumerated as collectively presumptive of its presence, it be-
comes significant and valuable. Jaundice has often been found to accom-
pany an abnormal condition of the Pancreas, which state may be presumed
to influence the liver as it does the stomach, both mechanically and sym-
pathetically. That it acts in the latter way is probable, from the experi-
ments performed by Brunner upon dogs, from which he cut out a portion
of the pancreas, and so produced death by bilious vomiting. In this
instance, the jaundice was slight, and dependent upon the more or less
complete arrest of the flow of bile into the duodenum, yet neither diar-
rhoea nor obstinate constipation, one or the other of which is stated gener-
ally to accompany this disorder, occurred. A very fetid condition of the
stools existed throughout, which may probably be assigned to the absence
of bile as a chief cause; yet I do not recollect to have ever observed the
white evacuations of jaundiced subjects so offensive. Pain is much in-
sisted on by Dr. Claessen as evidence of this disorder, but we have seen
that this case forms an exception to his rule. The secretion of the
salivary glands, which has been represented as vicarious of that of the
Pancreas, when the latter has become suppressed, was not affected; and
the circulation, which has been usually stated as seldom implicated in
the general disorder, was much quickened on this occasion, its excite-
ment being apparently proportional to the duration of the disease.
Before concluding this resumé, it may be worth while to speculate
for a moment upon the probable programme of the morbid actions,
which at length converted the Pancreas into a bag of pus. Keeping in
mind the previous history of the patient and his habits, and particularly
the facts that white stools, and vomiting chiefly in the morning, gener-
BY JAMES KILGOUR, M.D. 105.7
ally accompanied his annual dyspeptic visitation, we are, rather led to
conjecture that an enlargement of the Pancreas had existed for some
years, probably dependent upon, or connected with, a low kind of in-
flammation; that disturbances of the other viscera, such as usually occur
in the autumn, roused the slumbering fire into temporary activity, and
each succeeding year with increasing effect; that the habits, of the
patient, favouring the morbid tendency, prevented a complete, and only
permitted an apparent recovery, and that thus the way was paved for the
last final effort of the destructive process. If further, we should try to
connect that process with the physical signs which furnished, so im-
portant an aid to the diagnosis, I should be inclined to presume, that
an extensive inflammatory swelling of the Pancreas took place, as we
see to happen to the parotid in mumps, by which the intestines became
displaced, and dulness upon percussion resulted. That then this swel-
ling subsided, upon the occurrence of suppuration, as marked by the first
series of rigors reported, and the process lay dormant for a season, again
finally resuming its activity, to become completed almost with the last
breath of the sufferer.
It seems strange, that so decided an inflammatory action, as the
necropsy gave us the evidence of, should have been unaccompanied by
pain. I can only endeavour to account for it upon the supposition, that
the inflammation was of a scrofulous nature, and the temperament of
the patient sluggish and phlegmatic. This, however, can only be ac-
cepted as a partial explanation of a very curious fact in the pathology
of this class of complaints.
I shall conclude this case by mentioning a fact which seems to pos-
sess some interest in connexion with it. Since the date of the matters
here referred to, I have been consulted by a gentleman, aged 30, of
active habits, a first cousin of the deceased, for a deep seated pain felt
at the situation of the Pancreas, which is neither constant nor periodic,
but somewhat capricious in its onset, and apparently uninfluenced by
any plan of medical treatment or diet heretofore adopted. It is repre-
sented as being of a dull aching character, and is rather relieved by
light, but aggravated by heavy pressure. It sometimes changes its
situation to a small extent, but not for any length of time. It has oc-
curred on several occasions, lasting from three to six weeks during
spring or autumn. It has not been accompanied by any dyspeptic
symptom, but seems to stand alone, producing no effect but that arising
from the sensation of pain. Here, perhaps, we have a first indication
of pancreatic disease, and if so, we may learn that a derangement of its
organism, sufficient to produce a tolerably severe pain, may not give
rise to any recognisable derangement of its functions, nor to any sym-
pathetic disturbance of adjoining organs.
Ludlow, October 1850.
1058
BIBLIoGRAPHICAL Record.
Ös THE USE AND ABUSE OF ALCOHOLIG LIQUoRS IN HEALTH AND DISEASE.
Prize Essay. By WILLIAM B. CARPENTER, M.D., F.R.S., F.G.S., etc.
pp. 283. London: 1850. .
TEMPERANCE AND ToTAL ABSTINENCE, or THE USE AND ABUSE OF ALCOHOLIG
LIQUORS IN HEALTH AND DISEASE. By SPENCER THOMSON, M.D.,
L.R.C.S.E. pp. 184. London: 1850.
Early in the year 1848, advertisements appeared offering a Prize of One
Hundred Guineas for the best Essay on the “Use and Abuse of Alcoholic
Liquors in Health and Disease”; and it was stated that the Essay must con-
tain answers to the following questions:—
“1. What are the effects, corporeal and mental, of Alcoholic Liquors on
the healthy human system "
“2. Does physiology or experience teach us, that Alcoholic Liquors should
form part of the ordinary sustenance of man, particularly under circum-
stances of exposure to severe labour, or to extremes of temperature. Or, on
the other hand, is there reason for believing that such use of them is not
sanctioned by the principles of science, or the results of practical observation ?
“3. Are there any special modifications of the bodily or mental condition
of man, short of actual disease, in which the occasional or habitual use of
Alcoholic Liquors may be necessary or beneficial 7
“4. Is the employment of Alcoholic Liquors necessary in the practice of
medicine . If so, in what diseases, or in what form and stages of disease, is
the use of them necessary or beneficial 7”
It is now matter of history, that the prize of a hundred guineas was awarded
to DR. CARPENTER ; but the adjudicators of the prize recorded their opinion
of the great merits of another essay, which proved to be the production of
DR., SPENGER THoMSON. It is far from our intention to question the strict
justice of the adjudication ; but, as the two essays are now before the public
in a printed form, we consider that a few critical observations upon them will
not be unacceptable to our readers.
The great reputation which Dr. Carpenter has acquired as a physiologist,
invests every production which emanates from his gifted pen, with peculiar
interest; and if, in the course of our remarks, we venture to dissent from
some of the conclusions at which he arrives, we shall do so with that defer-
ence which is due to high attainments, though with that freedom which may
fairly be used in the discussion of a debateable question. It is also due to
Dr. Spencer Thomson that we express, in common with the adjudicators, our
very high opinion of the merits of his essay ; and we may go a step farther,
and state that, were the two works placed anonymously before us for a deci-
sion as to their relative excellence, we should feel considerable difficulty in
giving judgment. We should be inclined to award the palm to both, saying
with the adjudicator in the Bucolics:

“Et tu vitulá dignus et hic”:
and we might close the discussion, not inappropriately, in the words of the
same rustic judge:
“Claudite jam rivos, pueri: sat prata biberwnt.”
Dr. Carpenter is in practice, as well as in theory, a tea-totaller, and we
heartily congratulate him upon the excellent bodily and mental health which
he enjoys by an adherence to his system. Undoubtedly, the fact which Dr. C.
brings before us, that his own elaborate literary productions have been
achieved without any assistance from the use of fermented liquors, is a very
strong argument in favour of the system of total abstinence. We quote the
BIBLLOGRAPHICAL RECORD. 1059
following passage as an interesting piece of autobiography. “Having for
several years past been himself performing an amount of steady mental
labour, which to most persons would appear excessive, the writer may be
allowed to refer to his own experience, which is altogether in favour of total
abstinence from Alcoholic Liquors, as a means of sustaining the powers of
performing it. Having been brought up as a water drinker, he never accus-
tomed himself to the habitual use of Alcoholic Liquors: scarcely ever tasting
them, except when occasionally led to do so by social influences, or when he
believed that a small amount of stimulus would improve the ‘tone' of his
system, which is liable to a peculiar relaxation in certain states of the atmos-
phere. On determining, about four years since, to give up the occasional use
of wine, etc., as a social indulgence, he still held himself free to employ it
when he might think it likely to increase the general powers of his system ;
and for some time he continued to have occasional recourse to Alcoholic
Stimulants, (never exceeding a single glass of wine, or half a tumbler of bitter
ale), when he felt himself suffering under the peculiar depression just referred
to. He gradually, however, found reason to doubt the utility of the remedy;
and has, for the last two years, entirely given it up. Turing these two years,
he has gone through a larger amount of mental labour than he ever did
before in the same period of time ; and he does not hesitate to say, that he
has performed it with more ease to himself than on his former system ; and
that he has been more free than ever from those states of depression of
mental energy which he was accustomed to regard as indicating the need of
a temporary support to antagonize the depressing cause. In fact, he now
finds that when these do occur, the use of Alcoholic Stimulants, (taken even
in very small amount), is decidedly injurious to him ; diminishing, rather
than increasing, his power of mental exertion at the time, and leaving him
still less disposed for it after their effect has gone off.” (pp. 128-9.)
The essay of Dr. Carpenteris, from beginning to end, a denunciation of the
use of fermented liquors, the employment of which is not only wholly un-
necessary, according to the author, but is, in almost all cases, positively inju-
rious, the exceptions being admitted in a very few cases of adynamic fevers
and sudden shocks to the system, when the administration of Alcoholic Sti-
muli is admitted to be beneficial. Dr Spencer Thomson, however, does not
go to so great a length. He reprobates, indeed, very strongly, the abuse of
fermented liquors; but the moderate use of them he seems rather disposed
to commend. Dr. Carpenter appears to us to be like a barrister, who is
retained to say as much as possible upon one side of the question ; Dr. S.
Thomson is like a judge, who calmly reviews the evidence on both sides, and
then sums up to the best of his ability. Dr. Carpenter's volume will be wel-
comed with enthusiasm by the tea-totallers; and his advocacy is, no doubt,
calculated most materially to strengthen their cause. The work of Dr. S.
Thomson will be read with pleasure and profit by those who do not adopt
such extreme views, but whose object is simply to learn the beneficial or
injurious effects of fermented liquors upon the human system in health and
disease. The personal characters and pursuits of the respective authors will,
we think, afford some clue to the different conclusions at which they appear
to have arrived. Dr. Carpenter is an author, and, we rejoice to add, a highly
successful one ; he has long relinquished the practice of physic as an active
pursuit, and he is, therefore, wholly free from the annoyances, the fatigue,
the anxieties of mind and body, which are inseparable from the pursuit of
medicine as a profession. He can regulate his hours of meals, of exercise,
and of study, in the manner most convenient and pleasant to himself; he
can lie down at night without any fear of having his rest disturbed by cla-
morous applicants for professional assistance; and he is, moreover, blessed
with a vigorous constitution, which needs no stimulation to make it compe-
tent to carry on the business of life. Dr. S Thomson, on the other hand, is,
as we gather from the perusal of his book, a country practitioner, exposed to
1060 BIBLIOGRAPHICAL RECORD.
all the toils, the anxieties, and the vicissitudes, to which a medical man, in
the country, is necessarily subjected ; getting his meals at irregular inter-
vals, and sometimes not at all; liable to constant interruption of his nightly
rest; and, perhaps, badly remunerated for his harassing toil. . We do not,
therefore, wonder that Dr. S. Thomson does not join in the enthusiastic love
of weak tea and cold water, under all circumstances. We quote the following
passage as a fair specimen of his views:–
“We have still another class of labourers to consider—those who, from
necessity, from the peculiarity of their worldly calling, are obliged to forego
at times the proper amount of sleep, and who are called upon for a great
amount of continued exertion in a limited time. If any cases require, or
derive benefit from a stimulant judiciously administered, it is such as we
have just now adverted to. If rest first, and then nourishment, can be taken,
it should by all means be the plan followed. But at times this cannot be
done ; the nervous system is exhausted from want of repose and overstrain-
ing, and yet repose cannot be given it. Such is frequently the case in
the medical and in other professions and occupations; a succession of nights
of entire or partial loss of rest is endured, and yet the body and mind
must both be active for the day's duties. In these cases, no nourishment,
no other stimulant, is so efficacious in supporting the nervous system and
constitution, as a glass of sound wine or porter. The temporary use of these
stimuli under such circumstances does not excite ; the vis vitae is merely
raised to its proper level. Without them, nourishment may be taken ; but
in the absence of rest it will not be duly digested. It may be said, substi-
tute tea and coffee: in such cases, these stimuli are sometimes worse than
nothing. If alcohol is to be called a poison under all circumstances, tea and
coffee used as nervous excitants are worse poisons still. Granted, they may
for a time keep off sleep, but they do so by their peculiar action on the
nervous system, which leaves it irritable and disordered to an extent so
great, that sleep will not come when the fatigue is over. Under the circum-
stances we have been considering, a glass of wine, porter, or table beer, will
not cause drowsiness or excitement ; that is, if not taken as long as the
system holds up by its own natural vis; when, however, it gets below par,
if rest cannot be obtained, and exertion is then called for, then a moderate,
judiciously chosen alcoholic stimulant, is of much service ........ It has been
said that where exhaustion cannot speedily be remedied by repose, the
gentle stimulation of a hot fluid, such as coffee, and nourishment, ought to
be the means of restoration. In some cases, however, even when exertion
ceases, when sleep can be indulged in, but will not visit the overwearied
frame, and the appetite fails from mere exhaustion, there is nothing which
will do more to restore both than a moderate dose of wine ; and that man's
judgment is to be pitied, who would refuse either to himself or to another,
thus, as it were, ‘ready to perish,’ the benefit of so valuable a gift to man.”
The first hundred pages of Dr. Carpenter's essay are occupied by the ex-
amination of the effects of Alcohol upon the physical, chemical, and vital
properties of the animal tissues and fluids; and of the immediate and remote
consequences of the excessive use of Alcoholic Liquors taken into the system.
Under these heads, we have the usual description of the chemical effects of
Alcohol upon the living textures. The phenomena of intoxication and of
alcoholic poisoning are fully and minutely detailed; and the catalogue of
diseases which befal the drunkard, such as delirium ebriosum and tremens,
insanity, inflammation of the brain, apoplexy, epilepsy, dyspepsia, acute
and chronic inflammation of the liver, hypertrophy and atrophy of the same
organ, diseases of the kidneys and skin, gout, rheumatism, diseases of the
heart, etc., etc., are all duly and circumstantially described. We pre-
sume that this part of the work is intended entirely for the genéral public,
and we think it by no means unadvisable, that the destructive effects of
Alcoholic Liquors should be held up to public abhorrence, to deter the incau-
BIBLIOGRAPHICAL RECORD. 1061
tious from the vice of excessive drinking; but we pass it over as being
uninteresting to the profession, inasmuch as every medical man knows per-
fectly well that the abuse of alcoholic drinks is the fruitful source of innu-
merable forms of disease.
In the succeeding portion of his work, Dr. Carpenter replies at length to
the question, whether there are any peculiar circumstances which render the
use of Alcoholic Liquors expedient or advisable ; as, for instance, under ex-
posure to extremes of temperature, or to morbific influences, or when the
mind or body is called upon to endure great or unusual exertion ? We need
hardly say, that our author answers this question in the negative ; and it is
only doing an act of justice to Dr. Carpenter, to state that his reasonings
upon this part of the subject are characterized by the greatest acuteness and
sagacity, and are supported by a mass of evidence which has been collected
together with the utmost care and the most indefatigable labour.
In another part of the book, it is considered whether there are any cir-
cumstances, short of actual disease, which render the use of Alcoholic
Liquors necessary or beneficial; and this question Dr. C. is also disposed to
answer in the negative, with, however, a few exceptions. Now here we are
compelled to join issue with Dr. Carpenter; for although we admit, with him,
that there is no necessity for administering alcoholic stimuli to healthy
children, that it is not justifiable to recommend them to all nursing women,
and that they are not indispensable to old persons, yet we maintain that
there are numerous instances, short of positive illness, in which a mo-
derate use of fermented liquors is decidedly beneficial. Let us take, for
example, the period of lactation; and judging and acting from experience,
rather than theoretical views, we cannot condemn, nay, we highly approve
and recommend, the employment of a moderate quantity of fermented liquor,
especially of good beer, during this epoch of a woman's existence. If we
argued a priori, we might indeed agree with Dr. Carpenter, that good whole-
some food is quite sufficient to produce an abundant supply of breast-milk,
and to give to the woman adequate energy for the nourishment of her off-
spring; but we have too often seen the attempt made in vain, to be persuaded
that the plan should be enforced by any judicious practitioner. We have
frequently witnessed, among the lower orders of society, the emaciation, the
neuralgic pains, the utter prostration of body and mind, produced by lacta-
tion under circumstances of privation ; and the administration of a moderate
daily allowance of porter has removed these symptoms, as if by magic. Dr.
Carpenter indeed tells us, that if a woman cannot nurse her child without
drinking beer, she ought to wean it; and that “a judicious system of feeding,
gradually introduced from a very early period in the life of a child, will
generally be preferable to an imperfect supply of poor milk from the mother”;
but these views are so purely theoretical, and if carried out they would lead
to so much practical mischief, that we enter our solemn protest against
their adoption. If ninety-nine women out of a hundred are able to nurse
their children by drinking a moderate allowance of beer, which neither Dr.
Carpenter, nor any other writer, has proved to be in the slightest degree preju-
dicial to their health, either present or prospective, then we conceive that such
a plan, pursued by multitudes of our countrywomen, is far preferable to the
inhuman proposition of tearing the infants from the breasts of their natural
parents, and consigning them to the tender care of wet-nurses, or the pre-
carious and dangerous experiment of bringing up by hand. There is not a
shadow of evidence that the moderate use of fermented liquors, as employed
by the women of this country, ever produced the slightest injury to either
mother or child; while the positive danger incurred by artificial feeding is
too notorious to require comment. ---
In the last chapter, Dr. Carpenter treats of the use of Alcoholic Liquors in
the treatment of disease; but this most important branch of the subject is
despatched in rather less than eighteen pages, which form the most meagre

! 062 IBIBLIOGRAPHICAL RECORD.
and unsatisfactory part of the volume. In truth, the author is too much
biassed by theoretical views, to offer any useful remarks upon a purely prac-
tical subject; and we accordingly find that in his zeal for tea-totalism, and
his disgust for alcohol, he actually allows himself to speak slightingly
of the legitimate practice of medicine, and to defend the absurdities of
hydropathy. “We may”, says he, “keep our patient in town at his usual
occupations, practise all kind of experiments upon his stomach, recommend
fat bacon or lean chops, prescribe blue-pill and senna-draught, or quinine
and calumbo, and ring the changes upon all the wines, spirits, and malt-
liquors which the cellar can furnish, without effecting any permanent benefit.
Whereas, if he can be induced to give himself a complete holiday ; to betake
himself to some agreeable spot, where there is sufficient to interest, but no-
thing to excite ; to inhale the fresh and invigorating breezes of a mountainous
country, in place of the close and deteriorated atmosphere of a town ; to
promote the copious action of his skin by exercise, sweating, and free ablu-
tion ; to wash out his inside, and increase the tonic power of his stomach,
with occasional (but not excessive) draughts of cold water ; and to trust
to the natural call of appetite alone, in preference to artificial provocatives;
we shall be giving him the best possible chance of permanent restoration to
health. There is, perhaps, no class of cases in which the benefits of the hy-
dropathic treatment are so strikingly displayed, especially when it is carried
on in a spot where all other aids concur to make it most effectual ; and
reasoning from analogy, the writer is strongly inclined to believe that it
would be of similar efficacy in re-invigorating the system exhausted by other
forms of chronic disease, and would, in most cases, be preferable to any
form of alcoholic stimulants for procuring an increase of digestive and assi-
milative power.” (pp. 269-70.)
Upon this passage we shall only remark, that no respectable practitioners
keep their patients in town to make experiments upon their stomachs; and
that the medical profession are quite alive to the advantages of pure air and
change of scene. They do not certainly recommend their invalid friends to
the experiment of the damp sheets and the other tender mercies of the Gräf-
enberg quack, and his English disciples, who, being unable to live by the
respectable practice of their profession, keep hotels and lodging-houses under
the more genteel name of Hydropathic Establishments.
The following passage, from the essay of Dr. S. Thomson, is more to our
taste : “Let it not be supposed, that it is here meant to advocate either the
cure, or the alleviation, of dyspeptic affections of any kind, being trusted to
Alcoholic Stimuli, when they can be dispensed with; when we can substitute
the better natural stimuli of air, exercise, relaxation, travelling, and such
like; neither to suppose neglect of proper medical treatment: but, as society
is now constituted, many, most men, cannot pick and choose their times and
their seasons. They must keep on the ‘battle of life’, with its depressing
anxieties and cares, amid the depressing physical influences of our large
towns, from month to month, or from year to year, with little or no relaxa-
tion : these are the men who suffer from atonic dyspepsia. By all means, if
they can, let them seek health and renewed vigour in the tonic natural
stimuli we have just alluded to ; but, if they cannot, it is folly, and worse
than folly, to refuse to the exhausted nervous system, to the pale, flaccid
stomach, a provision for the exigencies of civilized life, which will do much
to improve comfort, to add to the power of mental and physical exertion,
and to prevent disease.”
We had intended to offer some observations of our own upon the relative
merits of the two systems of Temperance and Total Abstinence; but the fol-
lowing passage from Dr. S. Thomson’s work so fully explains our own opi-
nions upon the subject, that we conceive we cannot do better, in concluding
this review, than to quote it entire:-
“Unquestionably, pure water is the natural drink of man ; and to man in

BIBLIOCRAPHICAL RECORI). 4 063
a state of nature, it may be well adapted ; but when he begins to experience
the benefits, but, at the same time, the wants and necessary accompaniments
of civilization, variety is looked for; and, being looked for, it is found, in
wholesome abundance, in milk, in the juice of fruits, in the sap of trees, or
the infusions of various vegetable products, which furnish pleasant and whole-
some beverages. True, man, amid his discoveries, has found out and used
many articles of food and drink which are injurious ; but this fact does not
render the others less wholesome. Man has been blessed with the capability
—which, more than any other, raises him above the mere animal—of becom-
ing a religious being; he has been endowed with in elligence, with reason,
and with judgment; and, by the exercise of these, he must learn to choose
the good and reject the evil, not only in generalities, but as an individual.
We know, that what will agree and be beneficial to one, will prove hurtful
to another ; and the man who, knowing, feeling, that he is injured thereby,
continues the use, even in moderation, of Alcoholic Liquors, or of some of the
less active stimulants, such as tea and coffee, - is almost equally culpable
with those who habitually use alcohol, opium, or hemp, to produce intoxica-
tion But yet he may err in using water alone; for, not only may the
requirements of the constitution, especially in civilized man, call for the use
of some more nutrient or stimulant beverage, but, like compound drinks, the
quality of the water itself, which he is compelled to use, may be bad, and
productive of disease. Probably, in many instances, the quality of the water
has been the real cause of man’s resorting to the practice of qualifying it by
various additions. The arguments which would reduce man to the state of a
mere water drinker, are, perhaps, somewhat akin, in their origin, to those
poetic ideas which have delighted to paint, in glowing colours, the advan-
tages and virtues of savage life. If man was intended by his Creator to be
a mere water-drinker, let him, by all means, return to the simple element;
but, at the same time, to be in conformity, he ought to confine himself to the
root, berry, and acorn diet of our ancestors, and exchange his comfortable
broadcloth for the natural sheep-skin. But if man has been endowed with
faculties, by means of which he may investigate, and reduce to practice, for
his own comfort and enjoyment, the varied qualities of those things which
make up the sum of the beautiful creation with which he is surrounded,—
then should it be his duty gratefully to use, without abusing, to enjoy, with-
out exceeding, the gifts of his Maker.”
ON THE PULSE. By DR. W. A. GUY. [Being an article in the Cyclopædia.
of Practical Anatomy, edited by DR. RoBERT B. ToDD.]
The treatise of DR. GUY is most valuable; and contains in one view the
most recent and authentic information on the subject, founded on the obser-
vations of others, along with numerous statistical tables, carefully compiled
by the author. As the Cyclopaedia, from its great extent, and consequently
large price, is not likely, we fear, to make its way generally into the hands
of the medical profession, we have extracted from the elaborate article
alluded to, all the most important results, and we now present them to our
readers, as a treasury of information which they may find of use in every
hour of their professional life.
We place the following digest, sufficient for most practical purposes, before
the profession, with the more confidence in its utility, from the impression, a
well-founded one we believe, that many practitioners, even of competent skill
and acquirements, are scarcely up to the knowledge of the day on this impor-
tant subject. Those who desire to study, it more profoundly, will derive
much assistance from referring to Dr. Guy’s article at length, and also the
following sources of information;–Dr. Harden, Amer. Journ. of Med. Sc.,
vol. v., and Dr. Pennock for July 1847; the Treatise of Quetelet, Sur l’Homme ;
Dr. Graves, Dub. Hosp. Reports, vol. v.; Walleix, Mém. de la Soc. Méd. de Paris,
1064 - BIBLIOGRAPHICAL BECORD.
vol. ii, p. 312; Hourmann and Deschambre, Archiv. Gén. de Médecine, 2de
série, tom. ix. ; Dr. Macdonnell, Trans. of Brit. Assoc., 1837, p. 97; Dr.
Knox, Edin. Med, and Surg. Journ, vol. xi, and Nos. 131 and 146; Guy in
Guy's Hosp. Rep., Nos. 6 and 7; Mr. Blackley, Dub. Journ. of Med, and
Chem, Science, July 1834; Med. Gaz, June 10, 1839.
THE FREQUENCY of THE PULSE was first alluded to by Kepler, and then
observed more fully by Floyer; followed at a later period by Bryan Robin-
son, Falconer, Knox, Graves, Nick, and Quetelet The facts recorded by
these authors, have first been brought together in the article of Dr. Guy, and a
clear exposition of the frequency of the pulse, as it is affected by age, sex, pos-
ture, exercise, food, and other natural causes, as well as of its relation to respir-
ation, has been attempted, with the following results. The maximum fre-
quency is found in early infancy—the minimum in robust old age. The pulse
continues to fall from infancy to adult age—attains its lowest point about 50
—rises again afterwards, if feeble as well as robust persons are included in
the estimate. In infancy, the frequency is variable ; the maximum being
165, and the minimum 104. The average is about 140 at birth, falling
rapidly during the first weeks of life, the mean being, according to Billaud,
106 from one to ten days of age ; 103 from one to two months; and 87 from
two to three months, but the maximum is considerably higher and the mini-
mum lower than the numbers indicated. The results of Walleix, Gorham,
and Trousseau, however, show a higher range than Billaud. The following
table exhibits the frequency of the pulse at quinquennial periods, indicating
at the same time a law of progressive decrease, from the beginning to the end
of life, with an increase during the period of decrepitude :

Age 2 to 5 Mean 105 Age 30 to 35 Mean 73 Age 60to 65 Mean 72
, 5–10 , 93 , 35–40 , 73 , 65–70 , 75
, 10–15 , 88 , 40–45 , 75 , 70–75 , 74
, 15–20 , 77 , 45—50 , 71 , 75–80 , , 72
,, 20–25 , 78 , 50–55 , 74 , 80 and upwards 79
,, 25–30 , 74 , 55–60 , 74
The irregularities observable in the above table are probably due to an
insufficient number of observations. The average frequency of the pulse at
the several leading periods of life is as follows:
At birth.................. 140 Adult Age............... 75
Infancy.................. 120 Old Age.................. 70
Childhood............... 100 Decrepitude ...... 75 to 80
Youth .................. 90
SEx. During the first seven years of life, there is little difference in the
pulse of the male and female. After that period, the mean pulse of the
female exceeds that of the male by an average of about nine beats, its
maximum frequency at all periods being above that of the male, as shown
by the investigations of Leuret and Mitiviè, Hourmann and Deschambre, and
Dr. C. W. Pennock. To assist the memory, the average pulse of the adult
male may be stated at 70, and of the adult female at 80. The lowest number
recorded in the table in healthy males is 46, and in healthy females 52; but
Heberden counted it 42, 30, and even 26 in healthy males, the latter being
in a man aged 80, and Fordyce counted it in two old men at 26 and 20 re-
spectively. Falconer found the pulse in two healthy females to be 36 and
24; and Dr. Graves in another to be 38. Pulses as low as 16 or 14 have
been counted, but it is doubtful if they occurred in a state of health.
TEMPERAMENT. Nothing is yet known of the influence of temperament
on the frequency of the pulse; and the effects of stature also remain to be
determined.
PosTURE. The effects of posture has been very carefully examined by Bryan
Robinson, Dr. Macdonnell of Belfast, Dr. Robert Knox, Hate of Edinburgh,
#
BIBT,IOGRAPHICAL RECORD. - 1065
Dr. Graves and Dr. Nick. The Pulse is greatly influenced by posture, in most
cases, although there are some exceptions to the rule. The following are
the leading results observed. In the healthy adult male, the mean numbers
of the pulse are as follows: standing 79, sitting 70, lying 67, including all
exceptions to the rule ; and excluding such exceptions, standing 81, sitting
71, lying 66. In the healthy adult female, standing 89, sitting 82, lying 80,
including all exceptions to the rule; and excluding such exceptions, stand-
ing 91, sitting 84, lying 80. In both sexes, the extremes are very remote
from the mean results; and the exceptions to general rules numerous : in
both sexes, the effect of change of posture increases as the frequency of pulse
increases; this effect is much greater in the male than in the female, and
is less in early youth than in the adult, the exceptions to general rules at
the former period being also more numerous. The effect of change of pos-
ture is greatest in the forenoon—the inverted posture of the body lessens
the frequency of the pulse; and the varying frequency in different postures,
is due to muscular contraction, as asserted by Robinson, Falconer, and
Knox, and not to the varying position of the heart and its valves, or to
the effects of gravity. The effect of change of position on the pulse is not
transient, but continues as long as the respective postures are maintained;
and does not depend on the muscular exertion employed, as proved by
Graves, who effected the change of posture, without any effort on the part of
the persons examined.

ExERCISE. Muscular action increases the frequency of the pulse more
than any other cause, according to Bryan Robinson, who found it 64, 68, 78,
100, 140, and 150, under the respective conditions of lying, sitting, standing,
walking two miles an hour, walking four miles an hour, and running at the
top of the speed. Passive Exercise, as in riding, or in carriages, has also a
marked effect on the pulse ; partly from the varying action of the muscles,
exerted in supporting the different postures into which the body is thrown,
and partly from mechanical causes influencing the circulation, as pointed out
by Dr. Arnott.
TIME of DAY. Haller, Gregory, Zimmerman, Hufeland, Quetelet, Foderé,
Bostock, and others, represent the frequency of the pulse as greater in the
evening than in the morning ; but contrary to the experiments of Keill,
Robinson, and Falconer, it has been established as a general law, first pro-
pounded by Dr. Knox, and confirmed by the experiments of Nick, Guy,
Sanders, Harden, and Hohl, that the pulse is less frequent ºn the evenings
than the mornings, but with numerous exceptions. The difference is very
various, being from 18 beats to 1. This diminished frequency seems to depend
entirely on the exhaustion of the strength, being a less degree of that marked
diminution of frequency, which often accompanies convalescence ſ: Sø2)6.7%
disease; and not on the effect of continued rest. It has likewise been proved
experimentally by Dr. Knox and the author, that the pulse is also very
much less excitable in the evening than in the morning, a fact which accounts
for the greater influence on the circulation, of food and spirituous liquors in
the fore part of the day.
REST. Rest diminishes the frequency of the pulse. --
SLEEP, FooD, AND TEMPERATURE. The pulse falls considerably in young
children, and slightly in adults during sleep. Food excites the pulse, espe-
cially in infancy, and vegetable less than animal food; so do the mental
emotions. Cold lowers, heat-quickens the pulse ; at a temperature of 2600,
Sir C. Blagden's pulse rose to 144. At a high elevation, the pulse rises; but
it is not determined how far the change depends on diminished density of
the air, and how far on the exertion used in the ascent.

INTERMISSION of THE PULSE, in some persons, is caused by every slight
attack of indigestion, especially when attended by flatulence. The relation
1066 BIBLIOGRAPHICAL RECORD.
of the pulse to the respiration has been variously stated as 4,4}, and 5 to 1.
The average ascertained by the writer's experiments, 3:47 to l; by Hourmann
and Deschambre, in aged females, 365 to 1. According to Quetelet, at birth,
3.09; at five years, 338; fifteen to twenty years, 372; twenty-five to thirty
years, 443; and at thirty to fifty, 3-88 to 1. In females, at birth, 3.09 to 1;
fifteen to twenty years of age, 4:10 to 1; twenty to twenty-five years, 4.52
to 1 ; and at thirty to fifty years, 392 to 1. The proportion, according to
the same author, of the pulse to the respiration, is lower in the same persons
during sleep. The proportion also, in the same posture of the body, dimin-
ishes as the frequency of the pulse increases. The effect of posture on the
proportion which the pulse bears to respiration is very marked; thus, the
pulse being 64, the proportions were, standing, 2.95 ; sitting, 3:35; and
lying, 497 to 1. The proportion which the pulse bears to the respiration is
greater in the erect than the sitting posture, and in the sitting than in the
recumbent posture. The respirations are also more numerous in the evening
than in the morning.
ANATOMY, PHYSIology, AND PATHOLOGY OF THE EYE. By HENRY HowARD,
M.R.C.S.L., Surgeon to the Montreal Eye and Ear Institution. pp. 514.
Montreal : 1850. *
A few years ago, some excitement was created in the medical circles by
the statement, that cataract could be cured by exposing the eye to the
vapour of prussic acid; and a London practitioner, backed by a non-profes-
sional Scottish journal, turned this impression to good account. The experi-
ment was fully tried at our leading eye-infirmaries, but completely failed;
and met with no better success in the hands of many of our leading oph-
thalmic surgeons, although found to be undoubtedly useful in the removal
of corneal opacities. As a remedy for cataract, therefore, hydrocyanic acid
lost credit in this country, being nearly forgotten, when we were not a little
surprised at finding, in the work before us, its boasted virtues re-appearing
in all their pristine vigour, as seen at Montreal. To be sure, the vapour is
assisted by veratria, electricity, and iodinic counter-irritation; but as these
all go on merrily together, it is difficult to say to which agent the surprising
result is due.
“By the above treatment”, says Mr. Howard, “long persevered in, I have
not only succeeded in curing hundreds (?) of cases of incipient cataract, but
have also in very many cases succeeded in giving old people, who could not
make their way alone, such sight as enabled them to read a moderate sized
print” (p. 355). Three cases are related, which are indeed remarkable; but
it is strange that in England such happy results have not followed treatment
similar to that described in Mr. Howard's book. In these so-called cures of
cataract, the question naturally arises, were they cataracts at al!? and when
a surgeon speaks of curing incipient cataracts by hundreds, the question
presents itself in double force. We do not mean to imply that there is in-
tentional deception on the part of the author; but may he not, like many-
others, have been mistaken in his diagnosis $ We presume that the treatises
of Messrs. Mackenzie, Lawrence, Middlemore, and Tyrrell, are not common
in Canada, and that this work is intended to supply their place. Although
not to be placed in competition with either of the first three, it is in many
respects meritorious. But we entreat the author to be a little more
correct in his orthography of names, should a second edition be printed.
The eminent physician of Glasgow is spelt Mackenzie (105), Makenzie
(432); Mr. Lawrence is Mr. Laurence (231). The late Dr. Hocken figures
as Dr. Hocker (303); Janin is Jannin (409); Maunoir is Maunior (410);
Mr. T. B. Curling is Mr. J. B. Curling (200); Dr. Marshall Hall is Dr.
Marshal Hall (192); and Dr. Todd is several-times mentioned as Mr. Todd,
where, in fact, Mr. Bowman’s name should have appeared. The commonest
HIBILIOGRAPHICAL RECORD. 1067
attention in correcting the sheets would have prevented these palpable
blunders.
In conclusion, we would recommend to the author a careful revision of his
work, in its substance, its grammar, and its arrangement. It might thus be
made creditable to the author, and to the Montreal press.
DEAFNESs PRACTICALLY ILLUSTRATED. By JAMES YEARSLEY, M.R.C.S. Eng.,
Surgeon to the Metropolitan Eye and Ear Infirmary, Sackville Street.
Third Edition. pp. 244. London: 1850.
The following is a summary of the contents of Mr. YEARSLEy’s book. 1.
Anatomy of the ear. 2. Outline of the diseases which produce Deafness.
2. Catheterism of the Eustachian passages—safe, painless, and efficient. 4.
Deafness from derangement of the stomach. 5. Deafness from morbid con-
dition of the mucous membrane of the throat and ear. 6. Pathological con-
nexion of the throat and ear, 7. Obstruction of the nose in connexion with
Deafness. 8. Statistics of Deafness. 9. Best means of compensating for
incurable Deafness. 10. Ear-trumpets. 11. Modes of treating Deafness
when attended by partial, or entire loss of the membrana tympani, associated,
or not, with discharge from the ear. Mr. Yearsley has relieved many cases
of this description by gently inserting a small pellet of moistened cotton-
wool, and carefully applying it to the remains of the membrana tympani.
We observe that the author puts in a strong claim to the gratitude of the
profession and the public, for having almost suppressed ear-quackery. He
says, “I trust I have said enough to show the absurdity of the indiscriminate
syringing, and the application of acrid ear-drops, irritating acoustic oils,
and ointments, which were almost the sole local means of treatment among
the race of aurists previous to the first promulgation of my views. If I had
only done this, I should rest satisfied that I had not written in vain. It is
lamentable to think that a legitimate branch of medical science should have
been thus left to unqualified pretenders, whose sole hold upon the public
consisted, not in the benefits they could confer, but in reiterated advertise-
ments and self-laudation.” (p. 243.) Mr. Yearskey's treatise contains matter
for reflection, and practical instruction.
HYDROCEPHALUs RECQNSIDERED, AND ITS RELATIONS To INFLAMMATION ANB
IRRITATION OF THE BRAIN DEFINED ; with Cases from Hospital and
Private Practice, in Exemplification of its Pathology, Prevention, and
Successful Treatment. By THoMAs WEEDEN CookE, M.R.C.S. Eng. ;
Medical Officer for the Diseases of Children at the Royal Free Hospital,
etc. pp. 112. London : 1850.
The objects which Mr. WEEDEN CookE had in view in writing this treatise
on Hydrocephalus, appear to have been, first, to insist on the importance of
distinguishing cerebral irritation, a disease of asthenia, from cerebral in-
flammation, a sthenic affection; secondly, to point out the impropriety of
using the term Hydrocephalus as designative of a disease, whereas it is
merely an effect, which is often absent, or does not appear until the disease
has passed beyond that stage in which it can be easily treated; thirdly, to
shew that cerebral disease in children is not so formidable in its effects as is
commonly supposed ; fourthly, to bring prominently into notice the use of
iodide of potassium, and chlorate of potash, as highly efficacious remedies in
the collapsed stage of cerebral inflammation, and in irritation. 2
The leading ideas contained in the book are good; but we must regret
that Mr. Cooke has not given them a more extensive development than a
hundred and twelve sparsely printed pages. Indeed, after deducting twenty-
four pages for the introduction, and for some remarks on the general patho-
logy of inflammation and irritation, as well as forty-two pages at the end,
occupied with details of cases, we find only forty-six pages devoted to the eon-
WOL. II. 7()
1068 BłBI,[OGRAPHICAI, RECORD
sideration of the symptoms, causes, treatment, results, and pathology of
cerebral inflammation, and of cerebral irritation. This is too little for such
important subjects. In his desire to be brief, too, the author necessarily be-
comes, at times, somewhat obscure : and his pathological views, especially
of tubercle, at pp. 42–44, are somewhat heretical. We are surprised at
finding no reference to the able observations of Drs. Marshall Hall, Aber-
crombie, Gooch, etc., on the Hydrencephaloid Disease; a common result of ex-
haustion and anaemia, and, as Dr. Hall has pointed out, indicating the use
of nutritious food and stimulants; while Mr. Cooke has, no doubt, found
the iodine and chlorine salts useful in cases of cerebral irritation from tuber-
cle, or other forms of cachaemia. The author evidently includes all these
cases under the head of irritation; a term, in our opinion, somewhat too vague.
While we make these remarks, we would not be thought hypercritical;
and we willingly concede to Mr. Weeden Cooke the merit of endeavouring
to make the cases, which have fallen under his notice, available for the instruc-
tion of his professional brethren, and of having, to some extent, succeeded.
But we would have much preferred that he had developed his ideas on the
subjects of cerebral inflammation and irritation in children, in a more extended
form, and presented us with the well digested results of his experience, ren-
dered more valuable by sound reasoning, and by careful collation with the
opinions of other writers on the same subject. Such a work, from a com-
petent author, would be a valuable addition to our medical literature.
PATHoLogy of THE HUMAN EYE. By JoHN DALRYMPLE, F.R.S. Fasciculi
W and WI. London : 1850.
Just complaint has been made of the irregular appearance of several
medical and scientific works now publishing in numbers. Mr. DALRYMPLE
and his publisher, however, keep faith with their subscribers, and show an
example which might be most advantageously followed by those entrusted
with certain high publications, which for the present we forbear to name.
The fifth and sixth fasciculi fully maintain the character of the work, and
justify the opinion we have already expressed as to its merits (vol. i., p. 356).
Fasciculus W is devoted to Iritis and Aquo-Capsulitis. Congestion of the
Choroid, and Glaucoma, form the subjects of Fasciculus VI. We never re-
member to have seen anything more truthful than the representation of
Iritis, Fig. 1, Pl. XVIII. The proper tint and extent of the corneal zone is
admirably depicted, and so is the dull and discoloured iris. Fig 4, too, in
Plate XXII, most faithfully renders the appearances presented in an eye where
Choroiditis is passing into true amaurosis and incurable blindness.
The instructions for treatment are clear and judicious, fully demonstrating
the ripe experience and sound practical knowledge of the talented author.
RAPPoRt ADRESSÉ A Mons. LE DéLégué Du GouvBRNEMENT PROVISOIRE
sur LEs TRAITEMENTS ORTHoPédIQUES DE M.I.E DocTEUR JULES GUERIN.
pp. 202. 4to. Paris : 1848.
This, as the title expresses, is the Report of a commission issued to inves-
tigate the treatment, by subcutaneous section, of Strabismus, Wry-neck, and
other muscular contractions, together with rachitic deformities and cica-
trices. The conclusions at which they have arrived are highly favourable
to the practice. The subject, however, has been so fully investigated in
this country, and the practice is so well established, that any comment, or
analysis of the book, would now be superfluous. The Report is highly flat-
tering to the skill and dexterity of M. JULES GUERIN. This work we only
Sceived a few weeks ago, although it was accompanied by a letter bearing
date December 1848, and was evidently intended to have reached us in time
for notice in an early number for 1849 |
1069
CRITICAL DIGEST OF THE BRITIS H AND FOREIGIN MEDICAL,
JOURNA is S.
PRACTICE OF MEDICINE AND PATHOLOGY.
gºmºsº
DR. A. J. CUMMINGS ON TANNIN AS A MEDICAL AGENT.
Dr. A. J. CUMMINGs of Roxbury, Massachusetts, has published, in the
Boston Medical and Surgical Journal for August 14, 1850, a paper on the
therapeutic uses of Tannin, which is especially valuable as a confirmation,
by an independent observer, of the value attached to this medicine by DR.
Scott ALIson, in the January number of this Journ AL. It will be seen,
however, that Dr. Cummings confines his observations to the astringent pro-
perties of the remedy, and that he prefers it to all other medicines of this class.
In dysentery, Dr. Cummings has used it extensively, either alone or com-
bined with opium in some form, and finds it, so far as an astringent is indicated,
the most prompt in its action and salutary in its application. He has given it
in more than one thousand cases of dysentery, diarrhoea, cholera, cholera
infantum, and other bowel affections, and in no case has he regretted having
given it, and in very few indeed did it fail. Dr. S. S. Whitney, of Dedham,
uses it almost exclusively in dysentery, whenever an astringent is indicated.
Tannin has advantages in its freedom from danger, and in its possess-
ing the astringent property in so concentrated a form, that very small doses
are sufficient ; which, especially in children, is a great desideratum. The
following are the formulae given by Dr. Cummings. B. Tannin Bj.; opii
pulv. 9ss. ; secalis cornuti gr. xv. ; sacchari albi 3ss. M. Divide in chartas
x. For adult males, and females, where the ergot is admissible. B. Tannin
gr. x. ; pulveris ipecacuanhae c opio Bj. ; pulveris cretae comp. 5Ss ; sac-
chari albi 9j. M. Divide in chartas x vel xv. For children from one to
five years old. B. Tannin gr. xxv ; pulv. opii gr. x ; extracti cicutae gr. viii;
pulv. ipecacuanhae gr. x. M. Ft. pilulae x. One three or four times a day.
In some cases, in prescribing for children, he gives the tannin com-
bined with Dover's powder, ground down with white sugar; and of course
the prescription must be so altered, as to conform to the nature and circum-
stances of the case.
Dr. Cummings has successfully used it in the sweating of the last stages
of phthisis, or low continued or typhoid fever. In a case of tubercular
phthisis treated about two years since, the patient, a corpulent man, aged 46,
sweated so profusely as to deprive him of rest, and weaken him rapidly.
After trying the diluted acids, etc., Dr Cummings gave him at night a pill
of Tannin and opium, containing one grain of each. On the second night the
sweating was checked entirely, and from that time to his death he was not
troubled with sweating, except when he omitted the pill. In another case,
the patient, a young man, had been ill for several weeks with typhoid
fever, and, on becoming convalescent, he was severely troubled with night
sweats. Tannin, in one grain pills, at once checked the sweating, and his
health rapidly returned.
In haemorrhage, in almost all its forms, Dr. Cummings has used Tannin
with success. In haemoptysis, Tannin combined with opium and ipecacuanha,
in form of a pill or powder, has, in almost every case, proved successful.
The ipecacuanha and opium are old and well-established remedies; but they
often fail, when given alone, to produce the desired result. Having, in a
practice of ten years, used numerous articles of this class in the materia
medica, Dr. Cummings gives Tannin the preference over all other medicines
in this disease. In haematuria, haematemesis, and other forms of haemor-
rhage, Dr. Cummings finds Tannin superior to any other remedy. Espe-
cially in haemorrhage from the bowels, as the result of dysentery, producing


70 2
1070 CRITICAL DIGEST OF THE JOURNALS.
abrasions of the mucous membranes, or the rupture of small vessels from
other causes, the Tannin will be found to act like a charm in arresting the
bleeding. In uterine haemorrhage produced by threatened abortion, when,
in the early months of pregnancy, the ovum and its membranes become par-
tially or wholly detached, or in that brought on by premature labour, Dr.
Cummings has frequently used Tannin. It is true that, when abortion is
unavoidable, the use of ergot may stop the bleeding. But it is always de-
sirable, if possible, to arrest the haemorrhage without producing abortion.
Tannin acts upon the muscular fibres of the uterus, sufficiently to close the
mouths of the bleeding vessels without expelling the contents of the uterus.
Dr. Cummings relates the following case : He was hastily called to visit a
lady who was said to be “bleeding to death”. She was about three months
advanced in her second pregnancy. The os uteri was dilated to the size of
a twenty-five cent piece, with the membranes of the ovum resting over the
mouth of the uterus. She had, by imprudently getting up several times,
discharged a large quantity of blood; pulse very weak and trembling, coun-
tenance pale and haggard, ringing in her ears, thirst, faintness, and extreme
prostration. Dr. Cummings gave her Tannin in two grain doses, combined
with ipecacuanha and opium, every fifteen minutes, until the blood ceased to
flow. In a short time the haemorrhage was arrested ; she passed a good
night, had no return of the flowing, and did not miscarry. Sometimes it is
necessary to use either the Tannin in larger doses, or combined with ergot,
when the ovum is entirely detached, and abortion is inevitable.
In haemorrhoids, Dr. Cummings has great confidence in this remedy. A
clergyman who had been afflicted for many years, and had tried various
articles, told him, after using Tannin, that he was completely relieved, and
believed himself cured. It may be used in the form of an ointment, or a
wash, as is most agreeable. B. Tannin 9ss. ; tincturae krameriae, 3ss. ; aquae
rosarum 3.jss. M. Ft. lotio. Or, R. Tannin 5ss. ; sulphuris sublimati 9ss.;
spermatis ceti 3.j. ; adipis puri 3.j. ; olei lavanduli gtt. v. M. Ft. unguent.
Or, B, Tannin 9ij. ; sacchari albi pulv. 3ss. ; olei lavand. gtt. v.; adipis
puri 3.j. M. Ft. unguentum.
In epista.cis, Tannin may be used in powder, and snuffed into the nares, or
blown through a tube or quill, and it will be found in almost every case to
prove efficacious. In severe salivation from mercury, this article will also
be found of great importance. In aphtha, and other diseases of the mouth,
where there is sponginess of the gums, or bleeding, as in scurvy, Tannin has
no equal in the whole list of astringents. It may also be used as a gargle in
relaxation of the uvula and tonsils, and the soft parts contiguous, in the pro-
portion of from gr. vi to gr. x, to an ounce of rose water, with tincture of
krameria. The krameria is, in itself, a powerful astringent, but it does not
answer, alone, any very valuable purpose.
As an antiseptic in cleansing old sores and phagedaemic ulcers, and that form
of ulcer that so frequently follows varicose veins, Tannin, in the form of
powder, especially in cases accompanied with haemorrhage, immediately
arrests the bleeding, and renders the ulcers clean and more disposed to fill
with healthy granulations, and ultimately to heal. As an astringent colly-
rium, Dr. Cummings has also used the Tannin with marked relief, and con-
siders it preferable, in all cases of purulent ophthalmia, to any other article
with which he is acquainted.

DR. MARSHALL HALL's TARLE OF PARoxysMAL SEIZURES.
DR. MARSHALL HAIL has published the subjoined table in the Lancet for
July 20, 1850, in the course of his interesting series of papers on the Neck
as a Medical Region. It exhibits a comprehensive and very intelligible
epitome of his views. He regards Blushing and Sick-headache as phases of
Paroxysmal Seizures.
PAROXYSMAL SEIZURES.. [TYPEs—1. Blusively ; 2. Sick-headache.]
*
I.
CAUSE'S.
I.
. Emotion, Ex-
citement ;
Intra-cranial
Disease;”
. Abnor, cond.
of Blood ;
. Sleep;
II. III
MODE OF '
ACTION.
:
ſ
II.
. Dental+–
. Gastric—
. Intestinal—
, Uterine—
1. Catame-
nial—
2. Puerpe-
ral—
th
º
1. Trifacial—
2. Pneumo-
gastric—
3. Spinal—
Nerves,
:
i
i
f
* Qr this cause may act diastaltically through the
meningeal branches of the Trifacial.
+ In this case there are tetanoid irritation of the
nerves, and erethism of the spinal centre.
# Also induced in extreme diseases of the Heart with
impeded “arrière" circulation.
* This paralysis is paroxysmal and transient, if there
be only congestion; it is permanent, if there be rupture
or softening:
| The epileptoid paroxysm exhausts the excitability;
the patient is therefore safe for a time, except there be
the presence of a powerful exciting cause. Afterwards
re-action takes place, which proceeds to excess, and there are augmented excitability of the
spinal centre, and susceptibility to renewed seizures. The type of all this is presented by exposure to the north-east wind, or drinking col
|
|
MEDIUM OF ACTION,
(1. Facial—
sory—"
3. Descendens
1. Recurrent,
2. Sp. Ageº. Cleido-mas-
ſ IV.
TRACHELISMUS—
usually Torticollis.
1. Platysma
myoides;
toid, *Omo-
hyoid, etc.;
3. *Trapezius,
Noni—” Scaleni, etc.;
4. Spinal— 4. Subclavius;
* Nerves. \
W.
2. Intercostal,\LARYNGISMUS—
( VI
SPECIAL
PHLEBISMUS—
of
1. External
Jugular—
2. Internal
Jugular—
3. Wertebral—
4. Subclavian
Weins.
VII.
GENERAL
3. Abdominal, With Efforts of PHLEBISMUs,f
Nerves.
Expiration.
VIII.
CONGESTION.—
of
1. Face, Eyes,
&c. suffusion,
ecchymosis,
distended
veins;
2, Cerebrum ;
ecchymosis--
redpoints; or
clot; soften-
Ing;
3. Medulla, ob-
longata ;
4. Hand; lividi-
ty, distended
* veins.
S
r
I
IX.
TEIE SYMPTOMS.
ſi. Focci ; tinni-
tus ; aura ;
2, Headache;
vertigo; ob-
livium; stu-
por; deliri-
um ; stertor,
laryngeal or
nasal;
U3. Falling; nu-
tàtio; loss of
speech;para-
lysis of hand;
hemiplegia;$ |
^1. Spasms; tor-
sion of face,
eyes, neck,
limbs;
2. Bitten tongue,
lip, or cheek,
3. Convulsions,
general or
partial ; ex-
pulsion of
urine, feces,
semen ;
4. Spasmo-para-
lysis;
5. Syncopal
4
ſºAL
\ Seizure.
X.
ERETH-
ISM-||
\
J
1. Avoidin
XI.
PREVENTION,
TREATMENT—
consisting in
ging
Exciting
Causes;
2. Removing
Erethism ;
3. Removing
Congestion;
4. Use of
Specific
Remedies.
*
experiments. With this erethism, there is º excitability of the larynx, so that
water, induces laryngismus.


107.2 CRITICAL DIGEST OF THE JOURNALS.
CLIMATE OF DARTMOOR IN CONSUMPTION.
DR. W. C. RADLEY, of Newton Abbott, in the Lancet, for September 7th,
1850, says, that “an elevated open region is more congenial to the health of
the Consumptive than a low, and sheltered situation; that the interior of a
country is infinitely better than the vicinity of the sea-shore; and that the
restoration of our pulmonic patients to health is more certainly insured by
their inhaling an atmosphere in its purity, than by any other remedial
means.” He believes that, in these respects, Dartmoor possesses pre-eminent
advantages. Its mean elevation is nearly two thousand feet above the level
of the sea; it is more exposed to the rays of the sun, and possesses purer air,
than the lower lands. Dr. Radley thinks the objections futile, that the
moor has fogs, and is very wet, cold, and bleak. The fogs are beneficial to
health, being charged with electricity; not resembling the fogs arising from
rivers, or marshes. The rain is, indeed, abundant; but it falls rapidly, and
percolates immediately through the sandy soil. The cold is at times great,
but it is bracing; and, moreover, invalids might expose themselves to, or .
avoid it, at their convenience. The water is also pure. The soil is pure
silex, with felspar and peat ; and in this, together with the scantiness of
vegetation, Dr. Radley believes much of the salubrity of the district to de-
pend, there being no chalk, limestone, nor dense trees, to give out carbon.
The peat, as an article of fuel, is also peculiarly fit for the organs of respira-
tion, as it freely evolves naphtha.
Dr. Radley concludes, by strongly and confidently recommending Con-
sumptive invalids to be sent to Dartmoor. The residence, however, must be
wpon the moor. The bleakness, the cold, and the fogs appear to us to be
formidable objections to any resort for invalids; but we would recommend
the subject to the consideration of all our professional brethren, who may
require to advise change of climate to their Consumptive patients.
w ——
DR. BETZ ON GoITRE IN NEW-BORN CHILDREN.
Goitre, in new-born children, is a disease as yet little noticed. The
children affected with it are generally fat, and well-nourished. The Goitre
sometimes has the form of a swelling resembling the thyroid gland, stretch-
ing across the neck, and liable to be mistaken for a simple fold of fat ; some-
times the neck only appears broader than natural ; and sometimes no re-
markable appearance is observed. The symptoms to which it gives rise, are,
difficulty of breathing, soon after birth; inspiration is prolonged, accompa-
nied with a moaning tone; expiration is also difficult, and sometimes ac-
companied with crying; sometimes the breath is entirely arrested, and there
is danger of Suffocation. In the more severe cases, sucking is impossible, or
very difficult; it induces dyspnoea, which also results from the mere act of
drinking. The dyspnoea, or rather asthma, comes on in paroxysms. The
Goitre consists in a simple hypertrophy of the thyroid gland; sometimes the
whole is affected, sometimes only the two lateral lobes, sometimes only one
lobe, or even only the apex of one. The swollen lobes penetrate behind the
commencement of the oesophagus, or the pharynx, press these on the larynx,
and, at the same time, by means of the tumour which they form at the back
of the throat, narrow, more or less, the glottis; hence the dysphagia, and
danger of Suffocation. The affection seems to be hereditary. The so-called
asthma laryngeum depends, in many cases, on hypertrophy of the thyroid
gland; and many cases of atelectasis of the lungs may arise from this cause.
When the danger is imminent, Dr. BETZ applies leeches to the thyroid gland,
administers an emetic, and orders the mouth to be diligently washed out; in
chronic cases, he employs iodine internally and externally. (Henle und
Pfeufer's Zeitschrift, bd. ix, heft 2 and 3, as quoted in Journal fir Kinder-
Arankheiten, July and August, 1850.)



CIRITICAL DIGEST OF THE JOURNALS. 1073
THE DIAGNOSIS OF TAPE-WoRM, FROM THE CHARACTER OF THE NERVOUS
SYMPTOMS INDUCED BY ITS PRESENCE.
M. LEGENDRE has published an interesting memoir, upon the Nervous
Symptoms produced by Tape-Worm, in the Archives Générales de Médicine
for June 1850. He places the facts of this department of diagnosis in a
very clear point of view ; and, on this account, we think it right to call the
special attention of our readers to the following brief abstract of his paper.
When anomalous Nervous Symptoms perplex the physician, it is always right
to compare them with those which are known to be caused by Tape-Worm ;
and, if any room for suspicion of its presence exist, it is always imperative to
administer a vermifuge. We say always, because the experiment is at least
harmless, as the perfect safety, as well as the general success of the kousso
has now been fully established on unimpeachable authority. We would, in
in all cases, prefer this medicine, or the oil of the male fern, to the bark of
the root of the pomegranate, which is considered by M. Legendre to be the
best. The latter is likewise, undoubtedly, a most valuable drug for dislodg-
ing the taenia; but it is not quite equal to the kousso, or the male fern.' The
following is the substance of M. Legendre's paper.


Thirty-three fully reported cases are carefully analysed.” J.
Disorders of the cerebro-spinal nervous system occurred most frequently;
viz., in twenty of the thirty-three cases. They were, in twelve cases, of a
convulsive character, occurring several times, or oftener (being eight times
epileptiform, and four times hysterical). In eight of the cases the convul-
sive movements were partial, being confined to the face, or to a single limb.
In fourteen of the thirty-three cases, the convulsions were succeeded by ver-
tigo and cephalalgia.
Swooning, complete or incomplete, was noted in about a fifth of the cases;
viz., seven times.
Disturbed vision was noted in six of the thirty-three cases. This consisted
in double vision, or in the presence of flocculi, of muscae volitantes, and of
luminous flashes. One patient is mentioned as having had periodical blindness.
Buzzing ºn the ears is only mentioned as having occurred in three of the cases.
A pricking, or gnawing sensation at the epigastrium existed in fourteen of
the thirty-three patients. The symptoms, now enumerated, rarely existed
singly in one patient, and two, or three of them were generally present in
the same individual.
Whenever one or more of the above symptoms are observed, and no
other explanation can be given, an investigation should be made, to deter-
mine whether they may not depend upon Tape-Worm. If the physician
discover that the patient have a gnawing at the stomach, capricious, or in-
satiable appetite, abdominal pain, a feeling of general prostration, or itching
at the entrance of the nostrils or anus, there can be little doubt of the pre-
sence of the parasite. M. Legendre believes, that the best time for giving
vermifuge is when the symptoms are most urgent, or when some parts have
been spontaneously voided. He says, that Wawruch, of Vienna, in an
analysis of two hundred and six cases, attributes such occurrences to lunar
influence; asserting that they occur most frequently at the full moon, or
during its decline, and that it is, likewise, at these times that the patient
suffers from an exacerbation of the symptoms. It was not till M. Legendre
had finished his researches that he became acquainted with the analysis of
M. Wawruch's paper, published several years ago; and which, from its value,
we subjoin. *-
* LoNDoN Journal, OF MEDICINE, vol. for 1850, p. 896.
* The following are stated to be the sources whence the cases have been derived.
“Archives Gén. de Méd., 1840. Gazette Méd., 1839, p. 601; 1840, p. 633; 1843,
p. 38. Louis, Observations recueillies à l’hôpital de la Charité sur la Taenia.
Archives Gén. de Méd. Mérat, du Taenia et de sa cure radicale par l'écorce de
racine de grenadier, obs. 14, 15, 17, 18, 19, 22, 24, 25, 26, 27, 82, 108, 119, 120,
121, 142, 154, 155. 157.”
I ()74 CRITICAL DIGEST OF THE JOURNALS.
WAWRUCH ON THE CARJSES AND SYMPTOMS OF TAPE-WORM.
The following is an extract from an abstract, contained in the Gazette
Médicale for 2nd October, 1841, of a paper published by PROFESSOR WAwRUCH
in the Medicinische Jahrbücher der OEsterreichischen Staaten.
During the period of twenty years, Dr. Wawruch treated 206 persons
affected with Taenia; 71 men, and 135 women. The oldest person was aged
fifty-four; the youngest, three and-a-half years. Twenty-two were under
fifteen years of age; and among these were six girls who had not menstruated.
Most of the patients were from fifteen to forty years old. The patients be-
longed to the middle and lower classes; they nearly all inhabited the district
lying along the Danube, or lived in low and damp dwellings. They followed
very different occupations, and their mode of life was various. It is remark-
able, that the same conditions which give rise to scurvy in Vienna also pro-
duce Tape-worm. The articles of food which seemed chiefly to engender
Tape-worm, were bad bread, meals of milk, butter, cheese, potatoes, pork and
mutton, and bad water. The diseases which preceded the formation of Taenia
were gastric and cutaneous affections, but especially gastric and intermittent
fevers. There were observed, forty-three cases of intermittent fever, twenty
of gastric fever, sixteen of typhoid fever, ten of ringworm and herpes, forty-
two of itch, eight of scarlatina, thirteen of measles, and two of chronic urticaria.
Scurvy, syphilis, chlorosis, and other diseases which affect digestion, were
also observed to precede Taenia ; but, in general, few of the individuals
affected with Tape-worm had not had lumbrici when young. The influence
of hereditary predisposition is very doubtful. Dr. Wawruch only saw two
instances; in one, a mother and daughter, in another, a father and son, had
Taenia. Irregularity of the menstrual function seemed common; thus, thirteen
females had only menstruated at the age of 16 years, twelve at 17, nine at 18,
seven at 19, and one at 20. The duration of the disease was from a few
months to ten, twelve, fifteen, twenty, twenty-five, and, in one case, even to
thirty-five years. Of the 206 patients, three only, who were foreigners, had
bothriocephalus ; the others had taenia solium.
SYMPTOMs. The symptoms of Taenia are very various : the following are
stated by Dr. Wawruch to be the most constant.
1. Dull pain in the frontal region, vertigo, noises in the ears; and, in some,
a kind of idiosyncrasy for music. 2. Eyes dull, surrounded by a blue ring ;
oedema of the upper eye-lid; pupils dilated ; frequent involuntary action of
the muscles of the eye; various aberrations of sight, as amblyopia, diplopia,
or muscae volitantes. One patient complained of a periodical blindness
during the day. 3. Frequent change in the colour of the face ; lips lead-
coloured ; a peculiar look about the mouth and nose ; the appearance of
general cachexia is not constant, for the patients often preserve a flourishing
aspect for some time : many of them say they have become thinner. Ano-
rexia, alternating with such a voracious appetite, that the patients faint if
they are not supplied quickly enough with food; desire for certain articles,
as carrots, milk, wine, bread, etc. 5. Fetid breath, clayey taste, loaded tongue,
salivation, nausea, and even vomiting of liquid, as clear as water, in the
morning. 6. Itching of the nose and anus, and of the vagina in females;
grinding of the teeth, especially during sleep ; accumulation of a clear fluid
in the mouth ; transient heat, languor, palpitation. The sensation of a cold
hand pressing on the heart (considered as a pathognomic symptom by Rein-
lein) has never been observed. 7. Abdomen tumefied; borborygmi ; a sen-
sation of suction, constriction, and pricking, around the umbilicus, and
undulatory movements, as of a foreign body in the intestines, especially in
the morning ; cessation of these symptoms after taking farinaceous food, hot
bread, or café au lait; frequently diarrhoea, alternating with constipation.
8. When the disease has continued for some time, and the patients are of an
irritable temperament, there often arise a train of nervous symptoms, as
melancholia, syncope, aberrations of the senses, disturbed sleep, frightful
CRITICAL DIGEST OF THE JOURNALS. 1075
dreams, partial and general convulsions, chorea, epilepsy, aphonia, and loss
of speech. 9. The most certain pathognomonic symptom is the evacuation
of one or more portions of Tape-worm, either spontaneously, or after certain
severe illnesses, as scarlatina, typhoid fever, pneumonia, etc.; or after the
use of certain articles of food, as garlic, horse-radish, cucumber, etc.; or
after the administration of anthelmintic medicines. The portions are some-
times evacuated at indeterminate periods, but generally at new moon, or at
the decrease of the moon ; and, at these times also, the other symptoms are
increased in severity.
NEW METHOD OF APPLYING NITRATE OF SILVER TO THE LARYNx,
OR TRACHEA.
DR. J. C. THOMAs, of Baltimore, U.S., thus writes in the Lancet for July
13th, 1850. Every one who has tried must be aware of the difficulty of in-
troducing Nitrate of Silver into the Trachea, or Larynx, either in powder,
or solution, according to the plan proposed by the French physicians.
If a piece of lunar caustic be held, with moderate firmness, on a small
grindstone which is revolving rapidly, a very fine dust from the salt is thrown
off in considerable quantities into the air. . By holding the open mouth
within a few inches of the stone, and drawing in the breath, any desirable
amount of the powder may be inhaled. I am not in the habit of directing
more than four or five inhalations at a time. A very simple, portable
machine for the purpose, contained in a box, may be made by any mechanic
of tolerable skill. All that is required is a stone about five, or six inches in
diameter, half-an-inch thick, on the same shaft with a small pulley, which
is connected by an elastic band with a wheel six, or eight times the size of
the pulley. The caustic, which should be free from copper, or nitrate of
potass, may be held on the surface of the stone by the hand, or by a spiral
spring adjusted by a screw. I have been much pleased with the effects of
this method, in recent catarrh, obstinate chronic cough, and various affec-
tions of the Larynx, and I have little doubt that it will be found useful in
all cases where the use of the Nitrate of Silver is indicated.
DIAGNOSIS AND TREATMENT OF PULMONARY CONSUMPTION.
DR, John HUTCHINson, Assistant-Physician to the Hospital for Consump-
tion and Diseases of the Chest, truly remarks, that it has become too common
to trust entirely to the ear in the diagnosis of thoracic disease, to the neglect
of the three great symptoms of pulmonary lesion, viz.:-
1. Loss of weight.
2. Diminished thoracic mobility.
3. Abnormal breathing sounds.
Each of these topics is instructively illustrated by the author. “A person
may lose weight, and not have consumption ; but he cannot have consump-
tion, and not lose weight. This striking feature of consumption, viz., loss
of weight, is now met in the all-prevailing treatment of this day, the admin-
istration of cod-liver oil, a medicine intended to increase the weight by the
deposition of fat, which arrests the deposition of tubercular matter, as if fat
and tubercle were the antitheses to each other.” “It is wonderful to contem-
plate to what an extent phthisis can rob the body of matter; one man fell from
ió8 lbs. to 89 lbs. ; and Freeman, the American giant, from 271 lbs. to 141 lbs.
(nearly 50 per cent.), and shrank nearly four inches in stature | Such is the
effect of phthisis pulmonalis. In fact, the great feature of this disease is
Loss of weighT. All other abnormal conditions are but secondary to this ;
and if our patient have not lost weight, we have no right to say that con-
sumption is present. We have not seen an exception to this in one thou-
sand cases. The scales are therefore the most important instrument for
diagnosing in this disease.” [Medical Times, Aug. 10, 1850, etc.]
1076 CRITICAL DIGEST OF THE JOURNALS,
OBSTETRICS.
DRS, BARNES AND SACHS ON ANAESTHESIA IN MIDWIFERY.
DR. RoBERT BARNEs has published, in the Lancet for July 13th and 20th,
1850, a tabular analysis of twenty-seven cases of Natural Labour, in which
Chloroform was administered by Dr. SACHs, in the Berlin Lying-in Hospital,
and has appended some comments on the use of Anaesthetic agents in Mid-
wifery. He is a strong opponent of this practice; and, in seeking to sub-
stantiate his opinions by the facts contained in Dr. Sachs' cases, he some-
times slightly transgresses the bounds of legitimate deduction. Allowing,
however, for his being occasionally led away by preconceived notions, his re-
marks are worthy of much attention. The registered opinions of the oppo-
ments of Anaesthetic midwifery now before us, are particularly valuable, as
they are accompanied by a statement of facts, from which the reader may
draw his own conclusions. The time is approaching, when, from a full and
honest comparison of data, the proper mean of the use of Anaesthesia in ob-
stetric practice will become fixed. The antagonism of parties is rapidly sub-
siding : for now the intoxication by chloroform of all parturient women,
(as a matter of routine,) has happily very few advocates: though an in-
creasing number of sound practitioners are in favour of the practice in certain
CàSeS,

The following is the table of Dr. Sachs’ cases, as drawn up by Dr. Barnes:
TABULAR ANALYSIS OF TWENTY-SEVEN CASES OF NATURAL LABOUR, IN
WHICH CHLOROFORM WAs ADMINISTERED BY DR. SACHS.

Effects of Inhalation on Result to
Age, State of T –"- ~ 2–"-
No| ºff. i. Rºº. Uterus. sensation. Remarks. Mo. Chd.
1| 24, 24 hrs., P.r.from 78 Pa. stopped Lossof cons. ... ... R. R.
prim. pains to 102; f. to for 7 min. ; and sens.,
strong ev. 90. Resp. ret. weaker screamed at
3 min. r. fr. 24 to land seldomer passg. of
36, f. to 28.] than bef in- head.
hal. ; rec.
strength
when eff. of
inhal. had
gone off.
2 21, 20 hrs., | P. some- 1st. inh.; pa. Groaning Quiv.oflips, R. R.
prim. memb. what dim. repeatedly and shuddering
rupt., in freq. stopped by weeping. dur. pains.
pa. of renewed Shiver.
uncertain inhal. 2nd after del.
freq. and inh., compl.
strength. relax. ; no
percept. eff.
on pains.
3| 21, 20 hrs. ; P. 90, some- Did not aff, Groaned as Some fever; R. B.
prim. memb. what incr. contr., or in pain. headaches alive,
(twins) rupt. ; hd. retard del. aft. del. º
very down; pa. after.
ple- ev. 2–3
thoric. min. ; str.
y reg.
4 29, Hä. ent. ... ... Seemed to Shrieked at ... ... R. R.
mult. pelvis. incr. intens. pass. of
* of contr. and head: recol.
lab. nothing.
CRITICAL DIGEST OF THE JOURNALS.
1077

12ffects of Inhalation on Besult to
..] Age, State of ~ —- -S
No. . Labour. #. Tſterus. sensation | *. Mo. Chd.
5 27, Hä. deep | 1st inh., P. Pa. arr. at Groaning; R. R.
prim. in pelv. ; 92, f. to 72; first; ret. of at onetime
memb. last inh., full str. gt. rest-
rupt. ; os | Snortg. lessn. and
ut.com.pl. resp., 44; tossing
dilat. p. 68. abt. ; recol.
nothing.
6 || 23, 12 hrs. ; P. 82, f. to Pa.. compl. Cried out R. R.
prim. |hd. deep ;|76; r. to 80 arr. 7 min. ; as shoulders
memb. on awakg. then ret. passd, while
rupt. ; pa. still under
str., ev. 2 Chl.
to 3 min.
7 || 33, 9 hrs. ; P. 82, r. to 1st inh., pa. Groaned ; R. R.
mult. hd. high ;|96, f. to 80.] arr. 6 min. tossedabout
two memb. then ret. just before
former|not rupt. ; 2nd inh. pa. | birth.
lab., OS ut. not arr. 9 min. ; Recoll. no-
easily fully dil, ; ret., and thing.
term. |pa. Short, memb.broke.
in 6 lev. 4 min. 3rd inh., pa.
hours. arrest.
8 20, Hd. near ||P.96, unalt. Pa.. not R. R.
mult.; ext. parts, arrest.
form. very
lab. strong pa.
quick. every 2 to
3 min.
9 prim. | Memb. P. 81, r. to Pa. arr. Groaned; Metritisand R. B.
(twins)|not rupt. ; 102. 3 times, ret. recoll. feel- dysentery alive,
OS ut. weaker as ing pain. after deliv. º
ptly, exp. ; Chlor. after.
pa. mode- went off.
rate.
I0 25, Hä. near ||P. 68, r, to Lab. slightly Groaned; 2 hrs. after | D. R.
prim. outlet; pa. 88 and 96, arrested. recoll. no- del, had
strong. became irr.; thing. conv.; had
resp. r. to been epil. ;
48, f. to 24. d. in 19 hrs.
11 || 33, Hd. abovel P.96, then | Pa. arr. for Uneasy ... ... R. R.
prim. |outlet, pa. 90 to 86; 11 min. movements
good and resp. incr. during pa.
str., ev. to 36.
2 to 3 min.
12 24, Hä. at P. 112, f. Pa. arr. for Perin.some-| R. R.
prim. outlet; to 88 ; a time. what torn.
(Absc. memb. resp. 60.
of rupt. ; Os
labia.) fully open;
pa. ev. 2 to
3 min.
13 | Prim. || Ha. at Lab. not R. Pu-
outlet, arrested. trid.
emerging.
14 27, Hä. mear ||P. 88, f. to Pa.. compl. Groaned R. R.
mult. outlet; 84—92; arr.; uter. and com-
memb. resp. 20, r. relax. ; ret. plained at
rupt. ; pa.) to 28–42. when Chl. ev. pa.
strong, went off. Eff.
freq. on lab. com-
plete failure.
T078 CRITICAL DIGEST OF THE JOURNALS.

-- ----- Effects of Inhalation on 3. Result to
__*- -*—-
No Age, State of A Pulse and & -N Remarks.
etc. Labour. Respiration. Uterus. Sensation. Mo. | Chd.
15 30, Hd, at P. not af. Pa. delayed| Answered R. R.
mult. mid. of fected; somewhat. quest., felt
(4 easy pelv. ; resp. accel. no pain.
lab. memb.
rupt. ; Os
exp. ; pa.
str. ev.
2—3 min.
16
17
19
20
21
22
23
24
QUANTITY OF CHLOROFORM SMALLER ; LESS DEGREE OF NARCOTISM
INDUCED.
Mult. Hól. at Lab. not
outlet; pa. delayed.
strong.
22, Hd. at Pa.. slightly
prim. outlet; affected.
(period memb.
head- rupt. ; pa. t
aches,) str., very
painful,
inclin. to
delir.
Sec. Hö. at Pa. stopped
child. outlet ; 5 min. ; ret.
(1st memb. as before
labour| rupt. ; when Chl.
ain- |pa. every discontinued.
| ful.) | 3 min. ſº
37, 14 hrs. In P. 112, f | Pa., slightly
prim. | lab.; hd. to 75, r. to enfeebled at
at outlet;|100 ; resp. 1st inhal.
memb. 55, f. to 48.
rupt. arti-
ficially ;
pa. Teg.
ev. 2 min.
24, Hd. at | P. 76, r. to Pa.. slightly
prim. |outlet, pa. §13 resp; aff.
str. and 20, r. to 24.
tº freq.
21, Hö. at ... ... Pa. weak at
prim. outlet. gº. first ; afterw.
TeCOV.
26, Hd. at Pa. in- 3 t
2d chd. outlet; pa. creased.
(1st. str. ev. 1
labour 2, 3, 4 min.
easy.)
32, Hä. at P.104, r. to Pa.. not
prim. outlet. 120, f. to affected.
96; resp. •
32, 30, 48. rº
27, Hă, at ||P. 72, r. to Hd. quickly
2d chd. outlet; 82; resp. expelled.
- pa. ev. 2 º r. to 36.
min.



Groaned. Strong
shivering
foll. deliv.
Refused to
renew inh.
Perin.some-
what torn.
Perin. torn
to ext. of
1 in.
Hd. nearly
born-when
Chl. comi-
menèed. .
Under infi.
11 min.
Hd. at point
of expuls.
when Chl,
COIOIſl.
Ditto.
Ditto. *
R. Pu-
trid.
R. R.
R. not
mntd.
R. R.
R. R.
R. R.
R. R.
R. - R.
R. R.
CRITICAL DIGEST OF THE JOURNALS. 1079

Effect Of Inhalation OIt Result to
Age, State of T —S
No. #. Labour. Rºº. Uterus. Sensation. Remarks. Mo. Chd.
25 24, Hd. ap- ||P. 60, r. to Pa.. some- - - - - - - ... ... R. R.
prim. |proaching|68, then f ; what ret. ^
outlet; pa. resp. 30, at first :
ev. 2 min. r. to 38. chd. b. 39
min. after
inh. consc.
26 35, Hä. near ||P. 88, f. to Pa. arr. at Groaned Perin. torn R. R.
prim. outlet. 72; resp. first. during pa. sev. lines.
(chron. Snorting,
bronc., deep, 30.
anasa.)
27 | 20, |Hä. appr. P. and resp. Pa.. slightly ... ... ... ... R. R.
prim. outlet. little aff. I retarded.
We now proceed to give an abstract of the remarks made by Dr. Barnes
on the various points of interest presented in the above table.
1. EFFECTs of CHLoRoFORM ON THE UTERINE ContRACTIONs. Dr. Barnes
says: “Out of fifteen cases in which complete Anaesthesia was induced, in
eleven the Uterine Contractions were stopped, or enfeebled, and the labour
consequently retarded. Out of twelve cases in which a minor degree of nar-
cotism was induced, in eight the Uterine Contractions were retarded. The
Chloroform appears to have been given very cautiously; its administration
was, in most cases, withheld until the membranes were ruptured, the os
uteri fully expanded, and the head pressing on the perinaeum ; in short, until
the delivery was on the point of completion. Whenever inhalation is prac-
tised early in labour, that is, before the expulsive stage is advanced, Uterine
Contraction is always impaired, and labour retarded. If the inhalation be
deferred to a later period, the arrest of contraction in the womb is not so
constant. So great is the accumulated excitability of the spinal marrow at
the epoch of parturition,-so intense is the excitation of the esodic nerves,
distributed in profusion about the orifice of the vagina, by the contact of the
foetal head, that a moderate inhalation is quite ineffectual in subduing the
vehement activity of the diastaltic function.1 The diminution of the Uterine
Contractions under Chloroform, shows conclusively that Chloroform exercises
a depressing effect, analogous to that of shock, on the spinal centre. It also
proves, beyond a doubt, that Chloroform exerts a poisonous action upon
the spinal and ganglionic system at the same time as it does upon the brain.”
2 LACERATION OF THE PERINAEUM. This occurred in four cases; and Dr.
Barnes hence considers that Chloroform does not prevent this accident. The
relaxation induced by Chloroform, he says, is probably simply a relaxation
of the muscular fibre; whereas the natural relaxation extends to the cellular
tissue, and to the skin. He further observes: “The physiologist will also
observe in this stage a proof, that pain—the psychical perception of pain—
has its use. The abolition of pain has its danger. It has been remarked,
that Chloroform inhalation, towards the completion of the expulsive stage,
does not always arrest the action of the expiratory muscles. These cannot
act efficiently, unless the chest contain a certain quantity of air, shut in by
the closure of the glottis. It is by means of the powerful action of the ex-
piratory muscles, added to the contraction of the uterus, that the head is
driven through the ostium vaginae. The danger of Laceration of the Peri-
1 DR. TYLER SMITH thinks it proved, that “under the influence of Chloroform,
stimulation of the spinal marrow is produced in the first instance....... In some
cases, when the anaesthetic is used in great moderation, its effects, however long
continued, may, perhaps, be slightly stimulant.” LONDON JOURNAL OF MEDICINE,
December 1849, p. 1111. ;
1080 CRITICAL DIGEST OF THE JOURNALS.
naeum would, in many cases, be great, had not Nature provided a safeguard
against excessive, and untimely expulsive energy—that safeguard lies in
pain. It did not escape the acute philosophic observation of Denman, that
a cry, uttered at the acme of a bearing-down effect, uncontrollable by the
will, by opening the glottis, and permitting the escape of the retained breath,
at once broke the force of the expulsive nisus, reduced the pressure on the
perinaeum and uterus, and saved both from rupture. ... Emotional influence
is annulled when Anaesthesia is induced; when the sensation of pain is re-
moved, the system takes no alarm at impending danger; the glottis remains
closed ; the expiratory muscles continue to act with all the blind violence of
the diastaltic function ; the order of parturition is subverted ; an essential
link in the chain of the phenomena of labour is wanting ; the head is driven
with irresistible fury upon the perinaeum, before the process of dilatation is
complete. It is not surprising that laceration is the result. It is fortunate
that, at this stage of labour, the perinaeum more readily gives way than the
uterus.”
Dr. Barnes certainly has not proved that the Chloroform is chargeable
with the Laceration of the Perinaeum in the four cases in the table. The
women were all primiparae ; one was 37 years of age, and another 35 ;-
patients therefore particularly liable to the accident.
3. CoNVULSIONs. These followed delivery, in one case, in two hours, and
the patient died in nineteen hours. No doubt, the patient was predisposed
by her previous epileptic attacks. In another case (2) quivering of the lips
and shivering occurred during the anaesthetic state, and shivering fits were
renewed after delivery. In case 17, also, strong shivering followed delivery.
Ether and chloroform have been found the most effectual means of exciting
a fit in epileptic patients: and Dr. Barnes thus sums up his remarks on the
probability of chloroform inducing puerperal convulsions in an epileptic
WOIO all—
“Labour is the exciting cause of Convulsions in epileptics.
“Chloroform is a certain exciting cause of a fit in epileptics.
“Combine these two conditions; give Chloroform to an epileptic patient
in labour. What will be her chance of success 7”
These remarks of Dr. Barnes are excellent, so far as they point out the
danger of administering chloroform to epileptic women : but the argument
must be confined to this class of cases. -
4. METRITIs AND DYSENTERY. Dr. Sachs refers to Metritis as one of the
diseases following the use of Ether: and M. P. Dubois, having observed two
cases of Puerperal Fever in which Chloroform had been employed, concluded
that they must stand in the relation of cause and effect. Dr. Barnes does
not seem to lay much stress on this point.
5. By ADMINISTERING CHLOROFORM, Do WE OBTAIN FOR THE PATIENT
EscAPE FROM PAIN, AND FROM THE CONSEQUENT SHOCK TO THE SYSTEM | We
have here to consider the following questions:
a. Is the pain of labour physiological or pathological—that is, is it inju-
rious or beneficial in its action ? -
b. Is the abolition of the sensation of pain in the parturient woman unat-
tended by danger ? -
c. Is it true that the anaesthetic agents in use really annihilate pain, and
save the system from the consequent shock ->
(a) Dr. Barnes refers to a lecture published in the Medical Gazette, Oct.
1849, for some of the considerations which tend to prove that the pain of
labour is physiological, and subservient to a useful end.
(b) Dr. Barnes answers this question in the affirmative. He believes that,
in addition to other dangers, there is a shock, ofttimes a deadly one, from
Chloroform, as well as from pain. In Dr. Sachs' cases, at the commencement
of inhalation the pulse was frequently raised 20 or 30 beats in the minute,
and the respirations were increased to 40, 50, or 60 in the minute; the after
CRITICAI, DIGEST OF THE JOURNALS, 108)
effect being to lower the pulse and respiration below the natural standard.
This seems to Dr. Barnes still more dangerous, as it indicates a depressing
action on the spinal and ganglionic systems. He thinks it moreover proved,
that the sudden impulse of blood, and that containing a poison, may produce
a shock to the nervous centres; and he refers to the occurrence of apoplexy,
puerperal convulsions, fatal syncope, and puerperal mania. -
(c) In reply to the third query, Dr. Barnes observes, “What mean those
groans, that agitation, those suppressed mutterings or open cries, which all
have observed in patients undergoing surgical operations in the depth of so-
called anaesthetic stupor 7 Are they the expression of suffering, or are they
not Can it be maintained, that because patients on awaking express no
recollection of that suffering, there was therefore no painful impression con-
veyed to the sensorium ? In the case of parturition, the unconscious mother
is as ignorant of her delivery as of its painful accompaniments. It might
as reasonably be urged on that account that the child itself had not been
born. Should we be justified in flogging a drunken man, acting on the
anaesthetic principle, that since he might not feel the infliction at the time,
or remember it afterwards, he could not be hurt 7 Is there no constitutional
injury in this case independent of consciousness " The law of the sequence of
shock on the nervous centres upon excitation of the peripheral nerves is as
inevitable, as the sequence of effect upon cause. It has been erroneously
concluded that Chloroform simply narcotises the brain, or rather, induces
a deep sleep, during which state there is complete unconsciousness of pain,
and a consequent avoidance of the shock which pain produces on the system.
It is further assumed, that chloroformisation, carried to the extent which is
necessary to subdue pain, does not affect the spinal marrow or the sympa-
thetic system. A strict analysis of the nervous system, aided by experiment
and observation, will show the fallacy of these conclusions.......
“In parturition as in surgery, in physiology as in pathology, the physical
shock of nervous excitation of injury cannot be escaped from. In parturition
as in surgery, the emotional shock of nervous excitation, or injury, may be
avoided. In surgery, this may be an invaluable boon. Is it so in parturi-
tion ? It is more than doubtful. The emotional influences, both those ex-
cited by the sensation of pain, and those independent of pain, are of immense
importance in this complicated function. The voluntary power, too, is often
of the highest utility. In woman, at least, the brain should be allowed to
retain its integrity, to exert its beneficial controlling influence over her own
conduct, as well as its salutary aid in attaining a safe delivery.......
“There is nothing better established in physiology, than the strict depend-
ence of all the functions of the economy on the nervous system. Further
than this, the nervous system itself is dependent for its healthy powers upon
the mutual action and reaction of its component parts. The experiments of
Dr. Marshall Hall demonstrate the analysis of the nervous system into three
elements; the brain, the spinal system, the ganglionic system : they show,
indeed, that each executes distinct functions. But they execute them only
long enough to prove the physiological law. No one of the nervous centres
can long continue to act or to live separately from the rest. The diastaltic
power of the spinal marrow is soon exhausted, if the brain be removed. The
peristaltic power is soon expended, if the viscera be cut off from their con-
nexion with the spinal marrow. Inversely, the brain also soon ceases to act
if severed from the spinal and ganglionic systems. Parturition is normally
effected by the combined, or successive agency of all the nervous centres.
Peristaltic, diastaltic, and voluntary motion, all contribute to the expulsion
of the child, and the subsequent safety of the mother. Not one of those
forces can be properly manifested in due proportion as to power, time, or
succession, without the integrity of the others.......
“I am not aware that the most distinguished advocate for anaesthetic
midwifery has modified his opinion, or his doctrine, as to the extent to which
Chloroformisation should be carried in labour. The extent which he de-

1082 CRITICAL DIGEST OF THE JOURNALS.
scribes, corresponds with the fourth degree of Dr. Snow : in this degree, nar-
cotisation is complete. Anaesthesia, therefore, as recommended by Dr.
Simpson, is an unmistakeable reality. There can be no hesitation in con-
cluding, that were the practice generally carried out to that extent, numerous
deplorable and fatal accidents must occur. But a simple explanation lies in
this fact ; viz., that Chloroform is very rarely given to the extent necessary
to produce its characteristic effects; in other words, that anaesthetic mid-
wifery is no longer a reality.”
- In concluding, Dr. Barnes makes the following remarks. “In the facts this
paper contains, I have offered a complete vindication of what has been called
the ā prior?—i.e., the physiological—argument against Anaesthesia in partu-
rition. A priori and ā posteriori reasoning, have, at length, though travel-
ling by different roads, met at the same point. But the d posterior convic-
tion has been obtained at a fearful cost. Dr. Sachs refers to fifteen cases of
natural labour, in which anaesthesia was induced by ether. Arrest of the
pains was the common effect. In one case, it became necessary to use the
forceps in consequence. Metritis and death followed the Anaesthetic and in-
strumental interference. In one case, convulsions ensued. Out of the
twenty-seven Chloroform cases, in eighteen, more or less diminution of the
uterine contraction was induced ; in four, there was laceration of the peri-
naeum; in one case, metritis followed; in twelve, there were uttered groans,
and other manifestations of suffering, although the patients did not remember
it on recovery ; in one case, puerperal convulsions occurred, and death ensued
in nineteen hours; in two others, there was ominous threatening of the same
appalling catastrophe.” +

DR. HIDPOLY THE BI.OT ON ALBUMINURIA AND PUERPERAL CONWUILSIONS. '
In the Union Médicale for October 10, 1850, DR. HIPPOLYTE BLOT states
that he has arrived at the following conclusions, from an examination of 205
patients, seen during his internat at the Maternité.
1. Albuminuria is frequent in pregnant women (41 out of 205).
2. In almost every case it is produced by simple renal hyperaemia.
3. Primiparae are remarkably predisposed to this affection: but this has
not been yet explained." a
4. To the pathognomonic sign of albuminuria, the presence of albumen in
the urine, there are added other more or less variably concomitant
symptoms; as (a) Dropsy, either of the cellular tissue (oedema) or of
the serous membranes. This dropsy is very often absent; and, when
present, disappears very rapidly after delivery, sometimes in an hour.
(b) Lumbar pains, which are scarcely ever observed, and of which it is
very difficult to understand the signification during pregnancy.
* The readers of the Journals may remember, that a reasonable explanation was
offered by DR. CoRMACK, in his paper on Puerperal Convulsions, published in the
LONDON Journal, OF MEDICINE for 1849, p. 522. Having pointed out the way in
which toxaemia is induced by pressure on the emulgent veins causing renal conges-
tion, Dr. Cormack remarks, at p. 533:—“In primiparous women there is—as a gene-
ral rule—a greater tenseness and rigidity of the abdominal parietes; and therefore
in them the gravid uterus is much more apt, by its inward pressure, to cause dan-
gerous renal congestion. This obviously explains why primiparae are the most liable
to Puerperal Convulsion3 : and why convulsions in them are chiefly of a renal, and
therefore of a severe epileptoid character. It is probable that, in them, albuminuria.
is associated with the Cedema of the face and the upper part of the body, which is
sometimes seen in many of them who escape convulsions: for it must be remem:
bered, that the albuminuria and a dema are simply signs of congested kidney, and
that congestion may exist—and indeed often does exist—to an extent quite suffi-
cient to cause-these phenomena, and yet be inadequate to produce toxaemia of
sufficient intensity to cause convulsions.”
CRITICAL DIGEST OF THE JOURNALS. 1083
5. The albuminuria of pregnant women is almost always unaccompanied
by general reaction. Dr. Blot has not met with a single case of
àIſlä,üTOSIS.
6. In the majority of cases, the albuminuria of pregnant women disappears
almost immediately after delivery.
7. Contrary to the generally received opinion, the albuminuria of preg-
nancy is often of little importance, when it is not accompanied by
cerebral congestion (34 cases out of 41 were unattended by any com-
plication). It has no marked influence on the progress of pregnancy,
on abortion, on premature delivery, on the development and life of the
foetus, on the duration of labour, on the progress and sequelae of
parturition, or on the secretion of milk. CEdema is not constant;
about one-half of the women who had albuminuria, had no infiltra-
tion whatever.
8. All the cases of puerperal convulsions which Dr. Blot has seen have
been accompanied by albuminuria; but the converse is fortunately
far from being the case.
9. The relation between albuminuria and eclampsia cannot be doubted, but
its nature is unknown. Perhaps, Dr. Blot thinks, these morbid states
depend on the same cause,_a simultaneous congestion of the cerebro-
spinal axis and of the kidneys.
Dr. Blot then relates at length a case, in which a primiparous woman was
attacked with Puerperal Convulsions. Her urine was albuminous, but there
was no trace of oedema. The albumen disappeared on the day following
delivery; but she died with tetanic symptoms ten days after. On post-
mortem inspection, the kidneys were found to be the seat of slight vascular
injection. M. Rayer examined then, and found no traces of nephritis. The
calices and pelvis contained a slightly transparent red liquid, which was
found to consist of epithelium cells of various forms and sizes, such as Tºr. Blot
had already found in the bladders of two women who had had albuminuria.
From this case, he draws the following conclusions: 1. That albuminuria
may exist without structural renal disease. 2. That eclampsia can oecur
when albuminous nephritis is entirely absent.
LOSS OF SPEECH Lju RING THE LATTER WEEKS OF PREGNANCY : CONWUL-
SIONS FOLLOWED BY MANIA : RECOVERY,
MR. SIDNEY HENSoN relates, in the Lancet for July 27th, the case of a
young woman, pregnant with her second child, to whom he was called on
the 29th of last December, but found her labouring under spurious pains.
These continued till the 1st of January, when convulsions occurred for about
two hours. The next day she was delirious, and remained so till the morning
of the 5th. On the evening of the 6th, the pains being very violent, sixty
minims of laudanum were administered, and followed by mxx of solution of
acetate of morphia, and a drachm of chloric ether. This produced a deep
sleep for eight or nine hours, after which she awoke quite conscious. She
had not spoken since she had the convulsions: but could now articulate
a few words with some difficulty. On January 17th, she was delivered of a
living, but feeble female child, and was immediately able to speak without
any difficulty whatever, and rapidly recovered.
DR. E. WILLIAMS ON A JAPANESE REMEDY FOR STERILITY.
Among the many botanical remedies which popular experience has made
common in Japan and China, is one that is believed to exert specific influence
upon the uterus, more particularly in cases of sterility and checked menstrua-
tion: and, from the numerous cases in which I have administered it with
advantage, I am inclined to think it will become a valuable addition to our
WOL. II. 7 I
1084 GRITICA1, DIGEST OF THE JOURNALS
materia medica. The tree from which the preparation is made is one of the
order Termstroměacia, growing to the size of the English laurel, with leaves
somewhat larger than the congou tea : they are alternate, lanceolate, serrated,
downy on the under side, and emit, when bruised, a strong odour resembling
pulegium and Sabine. . Its properties are said to vary considerably with the
age of the tree, likewise as to its being gathered at the full or wane of the
moon, and as to the season of the year. It is perennial, and grows best in
moist and sheltered places. The mode of preparation is to take a quantity
of the leaves, macerate them in as much rice-spirit (Samshu) as will just
moisten them, for six hours; then express and give about a teaspoonful every
hour. Two or three doses will invariably bring on the menstrual secretion,
which can be maintained by a dose or two daily for any length of time.
That the root is aphrodisiac in its effects, I have not the slightest doubt, as
I have administered it to animals with obvious results, and without any ill
effects even to mules and castrati.
Having brought home some of the plant, I shall feel happy to forward
some of the preparation to any established member of the profession, on the
promise of giving me the result of the trial, and presenting it according to
the instructions which I will forward with it. [Lancet, September 14, 1850.]
DISTORTION OF PELVIS . ANTEVERSION AND PROLAPSUS OF GRAVID UTERUS :
CAESAREAN SECTION.
MR. R. W. SANNEMANN relates the following case in the Lancet for July
13. 1850.
Case. Mrs. Y., aged 42, of diminished stature and antiquated features,
had given birth to six children, the last of whom was delivered by craniotomy
seven years ago. Eleven years since, she had struck her spine on a sharp
edged surface, in consequence of a stool slipping from under her. Malacos-
teon, with contortion of the spine, and diminution of stature, supervened :
the general health was also impaired by dyspeptic symptoms, and her urine
was loaded with phosphates, -
In January 1848, when she was in the seventh month of pregnancy, an
examination per vaginam was made. The pelvis was greatly deformed,
the acetabula being pushed backwards and inwards towards the Sacrum, and
the ossa pubis forming a projecting angle at the symphysis: the uterus was
greatly anteverted. At 2 a.m. on the 28th February, moderate labour pains
commenced. The uterine tumour formed a large pendulous body projecting
over the symphysis pubis, with its lower border lying between the thighs: it
could be elevated or moved to either side with ease. The abdominal walls
were very thin. On examination per vaginam, the tip of the finger could
just reach a spongy mass, apparently the placenta: there was considerable
haemorrhage during the pains. The small dimensions of the pelvis, and the
debilitated state of the patient, precluded the possibility of delivery except
by the Caesarean section, which was performed twelve hours after the accession
of pains. The uterus was at once exposed by an incision, five inches in
length, over the most projecting part of the tumour, to the right of the
mesial line. The uterus was next opened, and the child with its secundines,
which presented at the os uteri with the shoulder of the child, were extracted.
The organ contracted rapidly and firmly. The child was dead; and the
mother expired at 2 o'clock on the following day, twenty-three hours after
the operation, after having had three epileptic attacks. No bad symptoms
appeared till twelve hours after the operation. At the autopsy, the uterus
was found firmly contracted, and containing a coagulum. The dimensions
of the pelvis were—antero-posterior diameter scarcely two inches, transverse
-three inches; the acetabula projected upwards and inwards towards the
sacrum, considerably lessening the oblique diameter. The other viscera
appeared healthy.
CRITICAL DIGEST OF THE JOURNALS. 1085
THE ALLEGED GALACTAGOGUE AND EMIMENAGOGUE EFFECTS OF THE LEAVES
OF THE CASTOR-OIL, PLANT.
Since the publication of Dr. Tyler Smith's paper in our last number, p.
951, two notices have appeared in the Lancet which certainly tend to confirm
the belief that the Leaves of the Castor-Oil Plant really have, to a great
extent, the properties imputed to them.
In the Lancet for 12th October, p. 439, DR, CoRMACK says: “In corrobora-
tion of the statements of DRs. MºWILLIAM and TYLER SMITH, in the Lancet
and LONDON Journal of MEDIGINE, it is interesting to know that the Galac-
tagogue properties of the Leaves of the Castor-Oil Plant are appreciated by
the negresses of Jamaica. A gentleman, intimately acquainted with the
popular remedies and nostrums of that island, in reply to my inquiries, writes
as follows: “I have seen the oil-nut leaf used by the negro women (particu-
larly by the young women), to poultice their breasts, to use their own lan-
guage, to make piccaninny suck belly-full easy, or in other words, to cause a
copious flow of milk.” As the Castor-Oil plant can be easily grown in the
neighbourhood of London, I hope that during next season many practitioners
may test the Galactagogue properties of the Leaves.”
DR. M*WILLIAM, in the Lancet of 26th October, calls attention to the follow-
ing extract from the narrative of a voyage to the coasts of Chili and Peru,
performed during the years 1712, 1713, and 1714, by M. Frezier, engineer in
ordinary to the French king, from which it would appear that the Spaniards
of Peru were acquainted with the Galactagogue qualities of the Leaves of
the Castor-Oil Plant, so far back as the early part of the eighteenth century.
M. Frezier, in his description of San Vincente, in the Cape de Verde islands,
states, that among other plants, he saw there the “Palma Christi, or Ricinus
Americanus, by the Spaniards in Peru called Pillerilla; and they affirm that
the leaf of it applied to the breasts of nurses brings milk into them, and
applied to their loins, draws it away. The seed of it is exactly like the
Indian pine-apple kernel. In Paraguay, they make oil of it.”
MATERIA MEDICA AND PHARMACY.
sºmsºmºsºme
CAZENTRE ON THE THERAPEUTIC PROPERTIES OF CEDRON.
The seeds of Cedron are employed, in Central America, as a remedy for the
bites of serpents, for hydrophobia, and for intermittent fevers. The tree is
of the size of an elm ; it is of the family of cedars, and grows in the whole of
Central America, but most abundantly in the neighbourhood of Carthagena.
The seeds nearly resemble a large bean; they are inclosed in a matty, thick,
ovoid drupe, of the size of a lemon. When fresh, these seeds contain an oily
matter. The whitish farina which is obtained from them is extremely bitter;
the bitterness is more lasting and disagreeable than that of sulphate of qui-
nine. The following are the purposes to which they are applied.
1. BITEs of VENOMOUS REPTILEs. The seeds of Cedron are the most power-
ful antidote known against the bites of the most dangerous serpents; the
remedy is said to be infallible, if immediately applied. The natives of the
country where it grows, always carry some of it with them when they go
into districts infested with reptiles; hence fatal accidents are seldom heard
of, although bites must be frequent.
Mode of Administration. Three or four seeds are scraped, and the farina
is collected in a spoon, mixed with a little water or spirits, and immediately
swallowed. Some of the powder, prepared in the same manner, is then
applied to the wound, and covered with a piece of linen. The natives act
more simply, by mixing up the grated seed, in the palm of the hand, with
saliva, and swallowing it; they then immediately mix more, and apply it to
the wound. A tincture, of rapid and certain effect, is also prepared by macer-
ating the seeds in brandy. The first dose is often sufficient ; but, generally,
71 °
1086 CRITICAL DIGEST OF THE JOURNALS.
.it must be repeated twice or three times, according to the severity of the bite,
and the subtilty of the poison introduced.
2. INTERMITTENT FEVER. Cedron is frequently employed, at Panama, for
this affection ; and, in some localities, it is the only remedy used. Dr.
Cazentre has often heard persons speak of having been cured by it of ague,
which had resisted quinine. He recommends an inquiry into the efficacy of
Cedron as a substitute for cinchoma.
3. HYDROPHoBIA. Dr. Cazentre has been informed by persons, that they
had seen mad dogs cured by the administration of this remedy, and that a
bitten animal would be preserved, if it were administered during the period
of incubation. This subject Dr. Cazentre recommends to be also carefully
investigated. . [Abridged from Journal des Connaissances Médico-Chirurgi–
cales, 1st October 1850.]
HYDRO-IODIC ETHER.
It is now about twenty-five years since GAY-LUSSAG discovered Hydro-
Iodic Ether, yet this substance, though so volatile and rich in iodine, has
never been employed medicinally. M. HuRETTE thinks that it is a powerful
remedy, and has performed numerous experiments for the purpose of deter-
mining its physiological effects. The mode of administration is simple. One
or two scruples of the Ether are introduced into a small bottle, and then
covered with an extremely thin layer of water. The bottle is next applied
to the nostril, and inspiration effected, the Ether passing up through the
aqueous covering. Fifteen or twenty inspirations are sufficient. Absorption
takes place so rapidly, that iodine may be discovered in the urine a quarter
of an hour afterwards. The physiological effects are those of iodine in their
highest degree ; yet the author never experienced any other inconvenience,
after numerous trials, than a slight coryza. It does not appear that M.
Hurette has made any clinical experiments with the Hydro-iodic Ether; but
he has proved that it may be employed without any inconvenience, and ana-
logy warrants us in recommending it to the notice of the physicians attached
to the Brompton Hospital. (Medical Times, Sept. 14, 1850; abridged from
Gazette Médicale, July 27th.)
MR. NuNNELEY’s experiments on Hydro-iodic Ether (Trans. of Prov. Assoc.
vol. xvi, pp. 204 and 315) suggest caution in the use of this substance. In
eight experiments, six of the animals died; all, with one exception, some
hours after the effects had apparently passed off, and even when insensibility
had not been produced. Mr. Nunneley believes that, “whatever anaesthetic
property it might possess, it never could be employed in practice.” Addi-
tional experiments on the lower animals would be required, before its admi-
nistration to the human subject could be warranted.
PREPARATION OF ATROPINE BY MEANS OF CHLOROFORM.
At a meeting of the Academy of Sciences of Paris, on 14th October, M.
Bussy presented a communication from M. R.A.BourDIN, druggist at Orleans,
on the preparation of Atropine by means of Chloroform. The following is
M. Rabourdin's process.
Fresh belladonna, gathered when commencing to blossom, is bruised in a
marble mortar, and the juice pressed out; the latter is then exposed to a
temperature of from 176° to 1949 Fahr, to coagulate the albumen, and filtered.
When the liquid is cold, four grammes (3i) of caustic potash, and thirty
grammes (3vii and gr xliij) of Chloroform are added to each litre (13 pint);
the whole is shaken for a minute, and then set aside. At the end of half an
hour, the Chloroform, charged with Atropine, is deposited, having the ap-
pearance of a greenish oil; the supernatant liquid is decanted off, and
replaced by a little water. The water is successively added, and removed,
till it becomes clear; the Chloroform solution is then received into a tubular
retort, and distilled by a sand-bath until all the Chloroform has passed
into the receiver. The residue is then treated with a little water, acidulated
CRITICAL DIGEST OF THE JOURNALS. 1087
with sulphuric acid, which dissolves the Atropine, leaving a green, resinoid
matter: the solution, when filtered, is colourless. To obtain the Atropine
pure, it is sufficient to add carbonate of potass, slightly in excess, to collect
the precipitate, and to dissolve it in rectified alcohol, from which, by evapo-
ration, beautiful groups of needles of Atropine are deposited.
When the fresh plant cannot be obtained, well-prepared extract of bella-
donna may be employed. Thirty grammes of extract of belladonna, obtained
from the purified juice of the plant, are dissolved in one hundred grammes
of distilled water. The solution is filtered ; and two grammes of caustic
potash, and fifteen grammes of Chloroform, are added. The remainder of the
process is analogous to that already described.
M. Rabourdin believes this method applicable, in general, to substances
containing organic alkalies. If it do not become an economical means of
preparing these products, it will at least serve, in some cases, to determine
their proportion in certain materials. [Gaz, Méd. de Paris, 19 October, 1850.]
CANTHARIDAL ETHER, AND SOME VESICANT PREPARATIONS OF CANTHARIDES.
By treating Cantharides with a small quantity of Sulphuric Ether, a green
liquid is obtained, very rich in Cantharidine, which easily combines with
resins, fats, or collodion. M. OETTINGER, of Munich, proposes to employ this,
in various forms, for producing vesication.
CANTHARIDAL ETHER. This is formed by digesting one part of coarsely
powdered Cantharides in two parts of sulphuric Ether, for three days, and
expressing. The Ether is charged with Cantharidine, with a green oil, and
with a yellow, wax-like matter. When applied to the skin with a camel's-
hair brush, the Cantharidal Ether produces abundant blisters, in one or two
hours in children, and in three or four hours in adults.
CANTHARIDAL TAFFETAS AND PAPER. A double layer of aqueous solution
of isinglass is spread on silk, or paper; when this is quite dry, the following
is applied. Cantharidal Ether, sulphuric ether, of each four parts; turpentine,
colophony, of each one part. A brush, dipped in this, is passed over the pre-
pared material twice, with a short interval between the applications, and
always in the same direction. After twenty-four hours, a third layer is
applied ; and, at the end of a similar period, a fourth. After some days,
a layer of isinglass is applied. At the time of application, a wet rag is
passed over it to remove the gelatine.
CANTHARIDAL OINTMENT. This is prepared with equal parts of Cantharidal
Ether and of lard. It acts intensely on children, after being rubbed in two
or three times, and being applied for two hours.
CANTHARIDAL CoILODION. M. Oettinger prepares this by mixing equal
parts of Cantharidal Ether and collodion. [Bulletin Général de Therapeu-
tique, 30 Sept. 1850.]
PROTECTION OF PILLS OF IODIDE OF IRON FROM THE AIR.
M. BLANGARD, in a memoir lately submitted to the Academy of Medicine
in Paris, describes a process for the preservation of Pills of Iodine of Iron,
so as to prevent the iron from becoming peroxidized.
This process consists in covering the pills with a sort of varnish, made with
an ethereal solution of balsam of Tolu, deprived of benzoic acid by digestion
in water. The rationale of the process is founded on the volatility of ether,
and on the insolubility in it of the substance which it is desired to protect.
The pills, thus prepared, are of a dark iron-grey, shining, and have no
disagreeable smell, or taste. When held in the mouth for some minutes,
they give no evidence of the presence of a salt of iron. No iodine is dis-
engaged. The commission, appointed by the Academy to report on the pro-
cess, kept several hundreds in a bottle; the silver at the bottom of the
* We gave an abstract of M. Hisch's account of this preparation, at p. 962 of the
LONDON Journal, of MEDICINE for Oetober, 1849. -
1088 CRITICAL DIGEST OF THE JOURNALS.
stopper, which acted as a permanent test, had not changed colour at the
end of several months. The pills contain a small excess of iron.
The commission reported favourably on M. Blancard's process; and it
was resolved that his memoir should be published entire in the Bulletin de
l'Académie.
M. BouchARDAT suggested, that the pills might be rendered difficult of
solution in the stomach. This might, however, be an advantage when it was
desired that a medicine should reach more distant parts of the alimentary canal
without being modified. [Abridged from Gaz, Méd. de Paris, Aug. 17, 1850.]
PSYCHOLOGY.
CASE OF LUNACY : BRIEVE OF FATUITY AND FURIOSITY : A SCOTCH TRIAL.
An important Lunacy case was tried in the Sheriff's Court at Dumfries,
in the first week of October, by the direction of Her Majesty's Court of
Chancery, for inquiring into the mental condition of Mr. Pulteney William
Mein. lately residing in Glencartholm, parish of Canonbie, and now an inmate
of the Crichton Asylum.
From the evidence adduced, it appeared that Mr. Mein was originally of
good parts, was highly educated, and had made considerable progress in the
fine arts, but had shown for some time symptoms of unsoundness of mind.
The origin of this was fixed as being in July 1849, although the mental dis-
ease had probably made encroachments before that time, and then became
more marked.
Dr. W. A. F. Browne, physician and medical superintendent of the Crichton
Poyal Institution, deposed, that Mr P. W. Mein had been admitted as an
inmate on the 11th of June last. He considered him labouring under inco-
herence or imbecility of mind, on the following grounds : his aspect was
vacant, stupid, and inexpressive ; his conversation rambling, and on frivolous
subjects ; and his conduct frivolous, and characteristic of imbecility of mind.
His conduct and conversation were characteristic of persons labouring under
the first stage of dementia. Mr. Mein’s memory was also much impaired ;
he did not recollect the names of persons with whom he had conversed half
an hour before. He had extravagant ideas of his horses and dogs, and of
every thing belonging to him. He also laboured under various delusions, as
of having seen the devil, and of being able to make a coat ; his articulation
was also indistinct. He had materially improved since his admission, but
still laboured under mental imbecility. Dr. Browne believed him quite in-
competent to manage the ordinary affairs of life. His imbecility was con-
tinuous, not intermittent; and, though occasionally better, and occasionally
worse, even at the best he laboured under delusions. . The indistinctness of
articulation, and the idea that everything belonging to him was the best, were
symptomatic of the first stage of general paralysis of the insane. Dr. Browne
could not determine how long Mr. Mein’s mental faculties had been impaired ;
but it was probable, that he had for months, and it might be for years,
laboured under melancholia, before he was affected with the mental imbeci-
lity deposed to. He had no hope of the patient's ultimate recovery, as,
although there had been a partial improvement, yet Dr. Browne was not
aware of a case of recovery in general paralysis of the insane.
Corroborative evidence was given by Drs. M'Culloch, Baker, and G. Mein,
and other witnesses. The jury gave a verdict to the following effect:-
“Find unanimously that the said Pulteney William Mein is at present fatuous
and insane, and that he is not fit to be trusted regarding the management of
his own affairs, or the affairs of another, and that he has been in that state
since the 31st of July, 1849, at least ; also, that Pulteney Mein, father of
P. W. Mein, is provident of his own estate, and capable of managing the
estate of another ; also, that the brieve of furiosity, stating that the said
P.W. Mein is incompos mentis, prodigus, et furiosus, is not proven.” [Abridged
from Dumfries and Galloway Standard and Advertiser, October 9, 1850.]
1089
**.
REPORT'S OF SOC IIBTI E S.
*
MEDICAL SOCIETY OF LONDON.
OCTOBER 12, 1850.
J. RISDON BENNETT, M.D., PRESIDENT, IN THE CHAIR.
The first meeting of this Society, since its amalgamation with the West-
minster Medical Society, was held on Saturday, October 12, at the new rooms
in George Street, Hanover Square. The meeting-room was crowded to excess,
although many left without being able to obtain admission. The number
actually present was 181, of whom 160 were Fellows, and 21 were visitors.
DR. J. R. BENNETT's INTRODUCTORY ADDRESs. After expressing a hope that
the exertions of the members would be continued, the President referred to the
manner in which the Society had been developed—not by demolishing old
institutions to rebuild them on new and untried foundations, but by inter-
weaving the old with the new, as the changes produced by time and social
progress seemed to demand. He then spoke of the utility of such an insti-
tution, not only to the profession but to the public at large, in fostering
brotherly feeling, in promoting the mutual improvement of the cultivation
of medical science, and in testing the truth of new doctrines and practices.
The true interpretation and right application of facts might be said to be more
needed than the facts themselves. Every fact in medicine required to be
examined in various lights and points of view, before it could be safely made
available. In concluding, he expressed a hope that the proceedings of the
Society would be characterized by no spirit of detraction or petty jealousy;
and that the discussions would be conducted in such a way as to conduce to
the elucidation of truth, and their own improvement, and consequently the
advancement of their profession, and the welfare of mankind.
LETTSOMIAN LECTURERS. The President stated that two Lettsomian Lec-
turers had been appointed : G. J. GUTHRIE, Esq., F.R.S., on Surgery, and
Dr. G. Owen REES on Medicine. The subject of the first surgical lecture
would be “The means adopted by Nature for stopping Haemorrhage from
Large Arteries”; and Dr. Rees would lecture on some “Pathological Indi-
cations afforded by the Urine”.
Two CASEs of ExTRA-CAPsulAR FRACTURE of THE NECK of THE FEMUR
were exhibited by MR. Coulson. Both patients were aged : one was a man,
aged 77, the other a woman, aged 76. In both cases there was double frac-
ture—a fracture through the neck, extending down the shaft of the bone,
and a second through the inter-trochanteric space. This agreed with the
statement of Mr. Smith, in his work on Fractures in the Vicinity of Joints,
that in upwards of a hundred cases of extra-capsular fracture of the neck of
the femur, which he examined, he found, without a single exception, a
second fracture traversing some portion of the inter-trochanteric space.
ANGINA MEMBRANACEA AND ITS TREATMENT. By J. R. BENNETT, M.D.
The author remarked, that the form of Pharyngeal Inflammation, described
by Bretonneau as Diphtheritis, was comparatively little known in this country.
It had usually appeared as an epidemic rather than a sporadic affection ;
and had probably hence varied in its aspects. Hence it had been described
by some as croup, and more frequently as angina maligna: and it was evident,
that diseases primarily of the pharynx, had been described under these or
analogous terms by our countrymen. The investigations of Bretonneau had
demonstrated that the epidemic angina, or diphtherite, was, except very rarely,
unattended by sloughing, or even ulceration. The comparative infrequency
of the disease in this country, might, to a certain extent, account for the want
1090 REPORTS OF SOCIETIES.
of any precise information regarding it as a British disease. To supply this
deficiency, Dr. Bennett related some cases which had come under his observa-
tion during the present year, and offered some remarks on their pathology and
treatment.
The disease was epidemic ; all the cases mentioned, as well as others,
having occurred at the same period of the year. With regard to contagion,
Dr. Bennett would not decide: some of the patients were in families where
there were other children, who were not separated, and some of whom took
the disease. With one exception, all the children seemed in good health
when attacked ; in all, the disease was adynamic, and the throat affection
had become serious before there was much difficulty of breathing or of swal-
lowing, or much external swelling. There was no preceding catarrh. Stoma-
titis prevailed at the same time; and Dr. Bennett was disposed to concur with
the French pathologists in assigning a close relationship, if not an absolute
identity, between the affections. The alleged existence of ulceration in
stomatitis was not an indication of pathological distinction. Fibrinous
exudation occurred in both diseases; and in stomatitis, ulceration was often
more apparent than real. It must, however, be admitted, that, while ulceration
rarely attended the disease when confined to the fauces and soft palate, it was
more or less present when stomatitis occurred. In the general and constitu-
tional symptoms, and probably in the treatment, there was the closest resem-
blance. In the treatment, he deprecated mercurial agents, and recommended
the local application of nitrate of silver, and the internal use of the chlorate
of potash, with a tonic regimen. In conclusion, Dr. Bennett said that he
looked on the disease as the result of a specific epidemic influence, operating
on the system through the blood, characterized by an adynamic type, and
calling for special treatment. However much the general symptoms might be
modified by the occurrence of laryngeal complications, the secondary croup
which then set in was a distinct affection from the common sporadic croup of
this country. Local treatment, whether in the simple or complicated forms,
was of the utmost importance; and the more common form of stomatitis
was essentially the same affection as that which attacked the pharynx.
DR. WEBSTER referred to the practice of Bretonneau in severe cases, of
opening the trachea, and applying the solid caustic, through the wound, to
the interior of the larynx. He, as well as Drs. G. Webster, T. Thompson,
Crisp, Murphy, Chowne, and Glück, and Mr. Hird, agreed with Dr. Bennett
in his views regarding the treatment of the disease.
OCTOBER 19, 1850.
J. Risdon BENNETT, M.D., PRESIDENT, IN THE CHAIR.
WALvULAR DISEASE of THE HEART. By DR. SEMPLE. The author related
the history of three cases of Disease of the Heart, in old persons. In one, no
signs of Disease of the Heart had been indicated during life; in the other
two, Dr. Semple was acquainted with the existence of Valvular Disease some
time before death. The patients had not manifested any, or very few, cardiac
symptoms. In all, extensive and serious cardiac lesions were discovered,
consisting of ossification of the aortic valves, rigidity of the mitral valves,
and a dilated, ossified, and rigid condition of the large arteries. The author
concluded that these diseases were not so rapidly and invariably fatal as they
are generally supposed to be. [Dr. Semple's paper is published at length,
as an original article, at p. 1019 of our present nºf
SUMMARY OF DISCUSSION. M.R. NuNN drew a distinction between those
cases of Valvular Disease, in which the deposit was on the surface, and those
in which it was between the layers of the membranes.
DR. CRISP observed, that the influence of the lesion on life would depend
much on the age of the patient ; and he thought that many of the diseases
accompanying old age were even salutary, in diminishing the power of the
heart in proportion to the failing powers of the system.
MEDICAL SOCIETY OF LONDON. F091
T)R. GoLDING BIRD thought that the cases described by Dr. Semple might
be merely instances of the changes incident to advanced age, and hence
could scarcely be called abnormal. The regurgitant disease of the mitral
valve might be regarded as a “safety-valve” in the obstructive aortic disease.
DR. SIBSON observed, that the treatment in heart-disease should be directed
to remove the obstruction of the capillaries.
MR. DENDY believed, that, with quietude, disease of the heart might go
on for a long period without interfering with life. -
MR. CANTON had found incipient bony deposit in the lower portion of the
aortic valves common in elderly persons. The sinuses of Walsalva were
enlarged in these cases, and aided the safety-valve function of the regurgi–
tant mitral valves by admitting more blood.
MR. BARLow believed that, in diseased heart, life might be prolonged by
quiet and care ; and that the result would depend much on the condition of
the muscular fibre of the heart.
MR. STREETER believed that there was a power of adaptation in growth,
by which children with disease of the mitral valve might do well, under pro-
per care. Hope should be sustained, to avoid accelerating the fatal termi-
nation. *
OCTOBER 26, 1850.
J. RISDON BENNETT, PRESIDENT, M.D., IN THE CHAIR.
ON CERTAIN AFFECTIONs of THE NERVoUs SystEM SIMULATING CHOREA.
By G. PILCHER, Esq. CASE I. In August 1847, Mr. Pilcher saw a young man,
aged 20, in Berkshire, born of healthy parents, and living in a healthy dis-
trict, who was affected with slight erratic movements of the upper limbs and
face. There was also apparently extreme dyspnoea; the breathing was ster-
torous, and inspiration appeared to require the most laborious exertion of the
muscles; expiration was less laborious. This had lasted for several months
without interruption, except during sleep. Walking was very difficult,
though the patient could keep himself erect with very little assistance. He
was treated in various institutions, and had now in a great measure recovered,
the following being his condition on October 20, 1850. The bowels, urine,
and appetite, were all well; sleep good; pulse rather quick; face flushed;
he blushed easily, and considered himself very nervous. No cause could be
assigned for the affection.
CASE II. Mr. J. M., a respectable tradesman of Chelmsford, in 1837, had a
severe attack of bilious fever; and in the next year, had occasional very
unpleasant feelings in his head when sitting in a confined posture. Two
years after this, the feeling had become more intense; he could not sit at
ease without putting his hand to his head, though without being able to
assign a reason. After this, when he was sitting in a confined posture, the
head would “give a sudden snatch” to the left side: and this was always
prevented when he was able to keep his hand applied to his head. In 1841,
the affection had become much more severe ; but frequently did not occur
when the patient most feared it. Various remedies, as leeches, aperients, iron,
nitrate of silver, electricity, etc., had been tried, but with at most only
temporary success; and the disease still continued unabated up to the present
time. It was mitigated in severity by mild tonics, and occasional aperients;
and increased by nervous excitement, powerful purgatives, and depletion.
There was an elevation of the right shoulder, with fulness over the right
scapula, probably arising from the excessive action of the muscles of that
side, especially the trapezius. The trapezius and sterno-mastoid muscles of
the left side appeared partially paralysed. The patient had felt no pain in
the head or neck.
Two analogous cases, in females, furnished to Mr. Pilcher by Dr. Lavies,
were also read. The patients had recovered under tonic treatment.
REMARKs. Mr. Pilcher believed that ordinary Chorea was an affection of
the excito-motor system, and mostly produced by excentric irritation. But
1092. - REPORTS OF SOCIETIES."
in the cases:now related, no excentric cause could be assigned: the disease
seemed essentially functional. He compared the choreic affection, to a certain'
extent, with the hysterical affection of joints, described by Sir B. Brodie ;
the alliance appearing to exist in the disorders being similar in character,
commencing in the brain, but affecting different parts of the nervous system,
the sensory nerves being affected in one series of cases, and those of volition
in another. That they were brain, or mental affections, seemed proved by
their occurrence in persons of weak mind, or whose intellects, naturally.
powerful, had been over-worked; and by the success obtained by renovating
the mind, either through the medium of the body, or by directing it to more
healthy occupations. No tenderness of the spine had been observed by Mr.
Pilcher in the first two cases, nor could any mental cause be assigned. -
SUMMARY OF DISCUSSION. M.R. HIRD thought that Chorea might have
various causes. In children, derangement of the alimentary viscera was the
most common cause; other cases required tonics. He believed that sham
operations were useful in some cases."
DR. THEOPHILUS THOMPson believed, that these cases were distinct from
Chorea, inasmuch as in the latter there was an existing, though imperfect,
Subserviency to the will, power not being impaired. He related the case of
a boy, in whom the least motion brought on extreme dyspnoea. The boy had
fallen into the water, and narrowly escaped drowning. There was tenderness
along the sides of the lower cervical and upper dorsal vertebrae; there might
be disease of the spinal chord, as had been found in a case mentioned by:
Ollivier. He had seen much benefit, in some anomalous nervous affections,
from the use of cod-liver oil. - -
MR. HUNT believed that cases might arise from excentric causes, but that
centric lesions might afterwards be induced. He related a case, which had
improved under the use of cod-liver oil, and also of arsenic, given for psoriasis.
DR. FoEBEs WINSLow had seen cold affusions to the spine very useful in
cases of true Chorea; hence he considered this disease to have a centric
Origin. -
DR. R. CHAMBERs recommended chloroform, after all other means had been
employed. - .
MR. DENDY considered that in these cases there was unequal concentration
of nervous power. The primary cause was probably in the cerebro-spinal axis.
DR. CRISP believed that there was a local affection of the nerves, consist-
ing in a want of balance of nervous power. -
MR. PILCHER believed his cases to have had a centric origin. He could
scarcely believe the affection seated in the spine, but thought it rather a
disease of volition ; and in this view he was confirmed by the influence exer-
cised by the mind in some cases. - -
MEDICO-CHIRURGICAL SOCIETY OF EDINBURGH.
- - NovKMBER 21, 1849.
JAMES SYME, Esq., PRESIDENT, IN THE CHAIR.
CASE of HERNIA, STRANGULATED witHIN THE ABDoMEN, AND REMEDIED
By OPERATION. By JAMEs SymF, Esq. Mr. Syme, upon the 13th of October
last, was asked by Mr. Sidey and Dr. Newbigging, to see a man about fifty
years of age, a butler, stout, and rather corpulent. For eleven years he had
been troubled by an inguinal hernia of the right side, and had worn a truss
until the last six weeks, during which he had not observed any swelling,
although the bandage had not been used. At twelve o'clock on the pre-
ceding night, he had suddenly been attacked with intense abdominal pain,
with quick pulse, cold perspiration, and vomiting. A tumour, about the
size of a hen's egg, was felt by Mr. Sidey in the right iliac region, without
any external enlargement or thickening of the parietes. Leeches were
applied, and several injections administered during the night, with some

MEDICO-CHIRURGICAL SOCIETY OF EDINBURGH. 1093
appliation; but the symptoms continued until about two o'clock in the
afternoon—fourteen hours from the commencement of the attack. All that
could be perceived on examination, was a slight induration or resistance,
opposite the internal ring, over a space not much larger than the point of
a finger. In these circumstances, Mr. Sidey's detection of a tumour in the
first instance, afforded sufficient ground for surgical interference. Having
divided the coverings of the cord, Mr. Syme brought into view a dark
coloured mass, at the internal ring, and readily drew out a hermial sac, about
the size of a hen’s egg, which was found to contain a portion of the small
intestine." Searching for the stricture, he encountered a difficulty from the
sac yielding to the slightest pressure, and returning, with its contents, into
the abdomen. He, therefore, seized it with a pair of forceps, until he suc-
ceeded in passing the edge of his nail beyond the stricture, and, guiding
the bistoury upon it, effected the dilatation necessary for accomplishing
reduction of the strangulated part. The patient recovered completely.
CASE of INTESTINAL CoNCRETIONs. By MR. SHARP, of Cullen. [Communi-
cated by DR. TAYLOR.] The patient, a boy of six years of age, son of a
crofter, was seized with pains in the bowels, on the 5th July, and passed a
concretion of irregular shape, and measuring four and a half inches in
circumference. On the following day, his mother gave him a dose of
castor oil, and in the afternoon some obstruction in the rectum was experi-
enced, which Mr. Sharp found to proceed from the impaction of other two
concretions above the sphincter ani. One of these was with some difficulty
broken up and extracted. The other was drawn out entire by means of the
curved handle of an iron table-spoon. It was an irregular mass, six inches
in circumference, and two and a half inches thick. A second dose of castor
oil caused the expulsion of a third concretion. The concretions were found
to consist of fine fibres, interlaced in every possible direction, firmly com-
pressed, and in some places resembling silicious matter. The fibres doubtless
consisted of mill-dust, the substance derived from the tissue between the
cortex and kernel of the oat. He had, for some time, been complaining of
occasional pains in the side,-and was obviously weaker and less robust than
other children of his age.
MR. GooDSIR thought, that the formation of intestinal concretions was,
in certain individuals, favoured by the form of the colon. When the gut
was large, and furnished, like that of the horse, with complicated sacculi,
stasis of its contents might occur, and concretions be formed round a nucleus.

DECEMBER 5, 1849.
JAMES SYME, Esq., PRESIDENT, IN THE CHAIR.
INJURy of THE PELVIS DURING PREGNANCY. By DR. ANDREws. The patient,
a woman aged 30, was admitted into the Royal Infirmary on Sept. 4, 1849,
with a large swelling of the right labium, and a large tumour on the left side of
the abdomen, having a doubtful resemblance to an uterus at the sixth month ;
there was also a mass, resembling the fundus uteri, felt on the left side, on
examination per vaginam. She believed herself pregnant. She died on the
17th October. After death, the uterus was found to be displaced to the left
side, and to contain a male foetus of about the sixth month : the umbilical
cord was presenting in the vagina. There was also an irregular lobulated mass
in the pelvic cavity; in removing the pelvic viscera, this gave way, and coagula
escaped, with a considerable quantity of dark, reddish-brown, grumous fluid.
The mass extended to the lower margin of the kidneys, and was adherent in
front to the abdominal walls for about three inches above the pubes. It
occupied the entire pelvic cavity, displacing the bladder upwards and for-
wards. It was mostly behind the peritoneum, except on the left side, and
behind the uterus. It presented, on section, large masses of dark coagula,
enclosed in imperfect cysts, together with dark grumous fluid. In all direc-
4
109.4 REPORTS OF SOCIETIES.
tions, it broke down easily under the finger. It appeared to have arisen from
a violent blow which the woman had received on her hip, from the violent
slamming of a door.
ANEURISM of THE SUPERIOR MESENTERIG ARTERY opFNING INTO THE Duo-
DENUM TwenTY-Two MonTHS BEFoRE DEATH. By DR. W. T. GAIRDNER. On
January 4, 1848, the patient, a woman aged 26, was admitted into the Royal
Infirmary of Edinburgh, suffering from vomiting of blood. She was dismissed
apparently cured in a month ; and died suddenly on November 28, 1849. On
examination, a coagulum of blood, weighing two and a half pounds, was found
in the peritoneal cavity, and was traced to a ragged lacerated opening in the
angle between the lower part of the duodenum and the head of the pancreas.
The coats of the duodenum were very thin in the immediate vicinity of this
opening; and there was at this point a very small ecchymosed spot, slightly
elevated, and perforated in the centre by a minute opening. The opening
of the superior mesenteric artery was a little irregular in form ; and, on
passing a probe through it, a considerable dilatation was discovered in the
line of the vessel, occupying the whole first portion of its trunk, and corres-
ponding in situation with the tumour above described. By a little manipu-
lation, a probe was pushed downwards, through the ragged opening in the
peritoneum. The sac was composed of a thick and strong fibrous cyst,
slightly oval in form, and not larger than a hen's egg, somewhat flattened
antero-posteriorly, and with its long diameter in the axis of the artery. This
cyst had evidently ruptured at its lowest point, and the blood had made its
way through the cellular tissue between the coats of the duodenum, breaking
up the muscular coat into two layers, and finally perforating the serous
coat by a ragged opening. The sac contained a number of irregular and
half-decolorised coagula.
DECEMBER 19, 1849.
JAMES SYME, Esq., PRESIDENT, IN THE CHAIR.
TUBEROLE of THE UTERUs. DR. J. Y. SIMPson produced a specimen,
taken from a patient who had been, for some time before death, under the
care of Dr. Skae, in Morningside Asylum. A deposit of tubercle lined the
inner surface of the Uterus and of the Fallopian tubes ; the ovaries were free.
The woman was about forty-five years of age, and, during her insanity, had
manifested symptoms of sexual excitement.
NoN-MALIGNANT RECURRENT TUMoURs. MR. SYME called the attention
of the Society to a kind of Tumour, which he had frequently met with.
When cut into, it exhibited a yellow-grey appearance, somewhat resembling
adipose tumour; but it had a firmer feel, and seemed to contain some fibrous
tissue. These tumours were apt to grow again after removal, and, although
certainly not cancerous in the first instance, were apt ultimately to degenerate,
fungate, and even cause death. When one was removed, several new ones
sometimes sprang up in the same situation. They were more common on the
trunk of the body than on the extremities.
JANUARY 2, 1850.
DR. RobHRT HAMILTON IN THE CHAIR.
DR. J. Hugh Es BENNETT read a paper on the Treatment of Phthisis Pul-
monalis, with illustrative cases. . [This essay has been published as an
original article in the Monthly Journal of Medical Science for March and May
1850, pp. 323 and 401 ||
FEBRUARY 6, 1850.
DR. Hugh Es BENNETT, W.P., IN THE CHAIR.
VoITArc BATTERY FoR MEDICAL Use. Dr. WRIGHT exhibited two new
forms of the Woltaic Battery, for medical purposes. It was with the view of
testing the therapeutic effects which might result from the passage of a large
&
MEDICO-CHIRURGICAL SOCIETY OF EDINBURGH. 1095
volume of electricity, in a high state of tension, through the human body,
that Dr. Wright had constructed the galvanic arrangements now exhibited.
The most powerful of these consisted of a number of small glass bottles,
charged with a solution of bichromate of potash, acidulated with sulphuric
acid, into which were lowered, by means of a simple apparatus, arcs of zinc,
tipped at one extremity with platinum. The other variety consisted of smali
ink-glasses, containing, in a similar solution, carbon (ordinary cinders were
used), and pieces of zinc attached to platinum, by means of threads of gutta
percha. The physiological effects of these arrangements were stated to be
as follow —lst, on completing the circuit, a shock of great energy; followed,
2dly, by a sensation of warmth in the hands and wrists, when the conductors
were grasped ; 3dly, while contact was maintained, the current continued to
pass, but the subject of experiment was unconscious of its flow; 4thly, on
breaking contact, there was a second shock, followed, 5thly, by a repetition
of the calorific sensation.

CASE or PNEUMo-THoRAx. By W. RoPERTson, M.D. C. L., twenty years
of age, a sempstress, was admitted into the Royal Infirmary, on the 16th
January. She had for six months suffered from cough and pain at the
chest. There was extreme prostration of strength, languor, and inability to
sustain attention when questions were put, but no delirium. The respira-
tions were short and hurried, causing pain in the left side of the chest. The
patient complained much of want of breath, and of a frequent painful cough
without expectoration. The action of the heart was exceedingly rapid, but
regular. No pulsation could be felt at the wrist. The face was livid, and
the lips swollen. The patient refused food, but her thirst was very urgent.
Her position in bed was on her left side, and she could not, without assist-
ance, change this posture. She had not slept for several days and nights.
The physical signs were:—1. Distinct contraction of the left side of the
chest, with almost total immobility during the acts of respiration. 2. Per-
cussion sound normal over the whole right side, and over the upper third of
the left ; highly tympanitic, even upon the slightest tap, over the middle
third of left side from the mamma nearly to the spine ; dull from about the
sixth left rib downwards. 3. Respiratory murmur puerile on the right side,
and mixed with sonorous and sibilant ràles; faintly audible in the upper
fourth of the left side; in middle third, intensely bronchial, and accompanied
both during inspiration and expiration with amphoric buzzing and metallic
tinkling, the cough, the voice, and Sonorous ràles, in the same region, all
partaking of the metallic character. No respiratory sound below the seventh
left rib. The position and sounds of the heart seemed normal. The patient
died within fourteen hours after her admission into the hospital.
Sectio Cadaveris. The heart appeared healthy. The right lung was
rather emphysematous, and its outer and lower border presented a patch of
recently effused lymph. Its bronchi contained some frothy mucus. The left
lung adhered very firmly by its upper third to the parietes of the chest, and
below to the diaphragm. The upper lobe was contracted, but still contained
air, and seemed unaltered in texture. The lower lobe was much contracted,
carnified, and void of air. A large cavity had been formed between the
thickened surfaces of the pleura, in the left mammary and lateral regions;
it contained a small quantity of turbid fluid, and a large quantity of air,
which escaped with some violence when the cavity was opened into. At the
part of the carnified lung corresponding with the top of this cavity, there
was a patch of greenish lymph (?), about the size and shape of a half-crown,
strongly resembling a slough, but exhaling no putrescent odour. When the
parts were removed from the chest, and immersed in water, and when air
was forcibly thrown into the left bronchus with an injecting syringe, it escaped
in small bubbles from a minute aperture between the upper edge of the sup-
posed slough and the substance of the lung. It seemed, however, to require
some little effort in pressing on the piston in order to effect this rupture,

1096 REPORTS OF SOCIETIES.
..and when the parts were afterwards roughly handled, its dimensions con-
siderably increased.
The nature of the case was made sufficiently obvious by the dissection. A
sacculated empyema had found vent, through an ulcerated opening, into the
bronchi. The contracted state of the left lung, and of the whole left side of
the chest, showed that either this communication must have been formed a
considerable time before the patient's death, or that the absorption of the
effusion must have been far advanced before the perforation of the lung took
place. The immediate cause of death seems to have been bronchitis of the
other lung.
In his remarks on the case, Dr. Robertson supported the view of Skoda,
advanced ten years ago, that, for the production of the metallic and amphoric
sounds within the chest, all that is essential is a large cavity, full of air,
with parietes capable of reflecting sound, not necessarily communicating with
the cavity of a bronchial tube, or containing a single particle of fluid.
FEBRUARY 20, 1850.
DR. HughES BENNETT, V.P., IN THE CHAIR.
CAVITY IN THE LUNG. DR. SPITTAL exhibited the left lung of a woman
who had been found dead, in the apex of which was a cavity of the size of a
walnut, not communicating with the bronchi. It was surrounded by small
hard and grey masses, resembling tubercle in the chronic state. He believed
it to be an example of the spontameous cure of tubercular disease of the
lungs.
TUMoUR of SUPRA-RENAL CAPSULE. By MR. CRAIG. (Communicated by
Dr W. T. GAIRDNER.) The patient had had a severe bruise on the loins
when thirty-four years old. Twenty-six years after, in February 1846, he
passed some bloody urine, with much pain, but apparently recovered in a few
days. In April 1849, he began to suffer from neuralgic pain of the right
hip and leg; no urinary symptoms were observed. In July, the course of the
left sciatic nerve was the seat of pain, which was increased by pressure over
the left kidney. He had flatulent distension, capricious appetite, and restless
nights. Towards the end of the month, a hard moveable tumour was felt in
the right hypochondrium. The urine contained large crystals of oxalate of
lime, uric acid crystals, and amorphous matter, Emaciation rapidly pro-
gressed; and the patient died in January 1850.
Description of the Tumour. It was situated behind the descending colon,
occupying the whole of the left hypochondrium, displacing the spleen towards
the centre of the cavity. It adhered firmly to the lower dorsal and to the
lumbar vertebrae, and to the lower ribs near their articulations. Large portions
of bone were laid bare : and there were extensive exfoliations of the vertebrae.
The tumour was attached to the Upper part of the kidney, and was of a
tolerably firm consistence, and yellowish grey colour, tinged very deeply
at the upper part with blood. It contained cells, fibres, and a large quantity
of granular matter; but none of these elements were in any way character-
istic. In the kidney, two or three rounded masses of morbid matter, similar
to the tumour, lay between the infundibula, among the cellular and fatty
tissue exterior to the pelvis. Dr. Gairdner was disposed to think the tumour
cancerous—a view which he considered supported by the presence of nodules
in the lymphatic system of the kidney.
HAEMORRHAGIC MEMBRANE WITHIN THE ARACHNOLD. D.R. W. T. GAIRDNER
detailed the appearances found in the case of a melancholic patient in the
Edinburgh Asylum. . The arachnoid, both cerebral and lining the dura mater,
was covered with a thin fibrinous membrane, mostly of a yellowish white, or
very pale rust colour, and involving here and there small portions of coloured
fibrin, resembling clots of blood. Its microscopic appearance was that of
decolorised fibrine, with some indefinite nuclei, and some granular matter.
MEDICO-CHIRURGICAL SOCIETY OF EDINBURGH, 1097
There was no distinct appearance of vessels, or of regularly organised fila-
mentous tissue.
MARCH 6, 1850.
DR. BEGBIE, W.P., IN THE CHAIR.
INGUINAL ANEURISM. Professor MILLER related a case of Inguinal
Aneurism, in which the patient committed suicide by perforating the tumour
with a pocket corkscrew. [The case is published as an original article in the
Monthly Journal of Medical Science for April 1850.]
HAEMORREIAGE FROM A UTERINE PolyPUs. DR. PATRICK BROWN detailed
a case, in which a Uterine Polypus had given rise to alarming haemorrhage.
The Polypus was removed, and proper means employed to prevent haemor-
rhage, and recover the patient from her prostration. She ultimately recovered,
though presenting a most ghastly appearance for years.
PECUIIAR DISEASE of THE NASAL Foss A. The patient was a gentleman
above fifty years of age, of healthy constitution, who, in the course of a fever-
ish cold, had a very copious fetid discharge from the right nostril, with much
pain in the right superior maxillary region. This soon left him at the time;
but hung about him, in a subdued form, for years, being always increased
by any inflammatory cold. After the acute symptoms had subsided, he had
ordinarily a constant sense of partial obstruction of the right nostril; excess
of discharge from it, increased by bending the head forward ; fetor, but not
constant, nor frequent, and always accompanied by the sensation of the dis-
charge of some fluid into the nostril; dull pain in the right superior maxil-
lary region, not constant, but seldom absent more than a day. The secretion
of the right nostril contained pus-globules. The disease had ceased, after an
attack of catarrh, seven years and a half from the first invasion of the dis-
order. His brother, and probably his mother, had laboured under a similar
affection.
INFLAMMATORY ERUPTIONs on THE MUcous MEMBRANE of THE CERVIx
UTERI. Professor SIMPson had observed Eruptions at the Cervix Uteri and
top of the vagina, referable to the vesicular, pustular, tubercular, papular,
and erythematous orders of Wilan and Bateman. He had thus noticed ute-
rine and vaginal herpes, acne, lichen, prurigo, eczema, and aphtha.
MARCH 20, 1850.
DR. John GAIRDNER IN THE CHAIR.
CICATRICES IN THE LUNGs. DR. W. T. GAIRDNER produced a number of
specimens and drawings, illustrative of the effects of tubercular softening,
ulceration, pulmonary apoplexy, and gangrene in the lungs. When cure
followed any of these lesions, the appearances found after death were so
nearly identical, that, from simple inspection of the parts, it was often im-
possible to draw any just conclusion as to the nature of the disease under
which the subject had originally laboured. Dr. Gairdner expressed his belief,
that some specimens, generally regarded as illustrative of bronchial dilata-
tion, were, in fact, examples of cavities resulting from gangrene or ulceration
of the lungs. *
PorsonING BY ARSENIG. DR. Dougi,As MAGLAGAN produced three stomachs,
in which arsenic had been detected. Although several months old, and not
kept in any preservative fluid, they were still of firm consistence, and toler-
ably fresh.
APRIL 3, 1850.
JAMES SYME, Esq., PRESIDENT, IN THE CHAIR.
ERYTHEMA NoDosu M. DR. BEGBIE read a communication on Erythema
Nodosum, and its connexion with the rheumatic diathesis. [This paper was
published as an original article in the Monthly Journal of Medical Science,
for June 1850; and a copious abstract was given in the LONDON Journal of
MEDICINE, for September 1850.]
1098 REPORTS OF SOCIETIES.
ANAEMIA AND GoITRE. The PRESIDENT informed the society that there
was at present, in his female ward in the surgical hospital, a very curious
example of the complication of Anaemia with bronchocele, and prominent
eyeball. The patient, a girl from Shetland, had been exceedingly exhausted
by frequent menorrhagia and diarrhoea, as well as by depletion effected by
medical means. Although now convalescent, she still presented the following
symptoms, which, it appeared, had existed for many months :—pale, sickly
appearance; considerable swelling at the root of the neck, evidently de-
pending upon a uniform enlargement of the thyroid gland; the extraordi-
nary prominence of eyeball ; palpitation; and a humming sound in the neigh-
bourhood of the great vessels of the neck.
APRIL 17, 1850.
JAMEs SymF, Esq., PRESIDENT, IN THE CHAIR.
FATTY TUMoURs. The PRESIDENT exhibited a very large Fatty Tumour,
recently removed from the neck of a man, who was still under his care in
the infirmary. The tumour had been of slow growth, and not only caused
inconvenience from its size and situation, but was also the seat of painful
sensations; thus differing from the descriptions of Fatty Tumours usually
given in books. The Tumour, although very large, had been attached by a
narrow base, and its attachments, as usual, were subcutaneous. Hence there
had been no difficulty in effecting its removal. But in another case, on
which he had occasion to operate lately, a Fatty Tumour, of seven pounds
in weight, situated on the back, was covered by the trapezius and latissimus
dorsi muscles, and attached beneath the scapula, between the ribs, and to
the long muscles of the back. In this case, of course, careful dissection was
required in order to remove the whole mass. Both cases were doing well.
MAy 1, 1850.
SIR WILLIAM NEwBIGGING IN THE CHAIR.
CRETINISM IN SwitzERLAND. DR. CoIDSTREAM read a communication on
the present state of Cretinism in Switzerland, and on the progress recently
made in its treatment on the Abendberg, by Dr. Guggenbühl. He gave a
detailed account of the origin, nature, and success of Dr. Guggenbühl's
labours. His theory was, that the deplorable state of mental degradation
denominated “Cretinism” could be best prevented by removing children,
who manifested any liability to this condition, from the valleys where they
were born, and by placing them in such an institution as that on the Abend-
berg, where they enjoyed all the advantages of pure mountain air, cleanli-
mess, regular exercise, proper nourishment, and suitable mental training.
By improving the physical condition of such children, the tendency to Cre-
timism was often overcome.
DR. GuggRNBUEHL stated that he had now had ten years experience of the
efficiency of the system which Dr. Coldstream had described. . Last autumn,
he had an opportunity of visiting in their homes a number of children, who
had been inmates of his institution on the Abendberg. The success of his
treatment, in a considerable proportion of these cases, had been most encou-
raging. For some months past, he had been travelling on the continent and
in England, informing himself as to the state of Cretinism in the different
localities which he visited. In Germany, institutions similar to his own had
been for some time in existence, and report spoke favourably of their efficiency.
He had seen well-marked cases of Cretinism in Yorkshire, Lancashire, Somer-
setshire, at Chizzleburgh, etc.
In some localities, dogs had been observed to become affected with goitre:
and cattle, brought to certain valleys, as those of the lesser Rheinthal, did
not thrive, but degenerated and became weak. In a great part of Switzer-
land, the ordinary food of the peasant consisted of maize, which, in the form
of “poleata”, was consumed at all his meals—three or four times a day.
MEDICO-CHIRURGICAL SOCIETY OF EDINBURGH. 1099
The pellagra of Tessino and Lombardy was believed to be attributable to
the excessive use of “polenta.” Of late years, efforts had been made to
improve the diet of the peasant class, and turnips, carrots, etc., were now
very generally used. Although inclined to attribute a permicious influence
to insufficient or improper nourishment, he could not regard it as essential
to the production of Cretinism. The gradual degeneration and extinction
of the old haute noblesse of Switzerland could not have been due to this
cause, but probably to their frequent intermarriages, and to the climate of
the valleys in which they lived. In the valleys of Switzerland, the population
must be renewed by the infusion of new blood, from time to time, or degene-
ration of the race would be soon observed. &
MAy 15, 1850.
JAMES SYME, Esq., PRESIDENT, IN THE CHAIR.
CASES IN MIDWIFERY. DR. CHARLES BELL read an account of two
cases in midwifery requiring manual and instrumental interference. In the
first, it was found necessary to pass the hand into the uterus, in order to
effect the removal of the placenta. For several days after delivery, the case
appeared to go on favourably. On the evening of the seventh day, the patient
was suddenly seized with trismus. She continued in this state for upwards
of six hours, when the spasms ceased, and did not return. On the tenth
day, she had loss of speech, and hemiplegia of the whole right side of the
body, but not of the face. Six weeks after her confinement, the patient was
able to go into the country. She could now walk and speak nearly as well as
before her illness, the only remaining trace of her complaints being an
apparent difficulty in finding words to express her ideas.
The second case was one of twins. The head of the first child, a remark-
ably small female one, presented in the third position, and, the labour-pains
being ineffectual, was finally extracted by the forceps. The child at birth
showed but faint signs of life. By the use of the warm-bath, artificial in-
spiration, and stimuli, respiration was, in about half an hour, fully estab-
lished. The uterine contractions were not renewed for two hours, and were
at first lingering and ineffectual. What appeared to be the second bag of
membranes was therefore ruptured ; but the fluid which came away proved
to be blood, which, it was afterwards ascertained, had been contained in a
cavity between the two sets of membranes. The second set having heen
ruptured, a loop of umbilical cord descended, and was followed immediately
by the head of the child. Every effort was made to protect the cord from
pressure by pushing it upwards during the intervals of the pains; it ceased,
however, to pulsate a few minutes before the delivery of the head; and the
child, a remarkably large one, was still-born.
JUNE 5, 1850.
JAMES SYME, Esq., PRESIDENT, IN THE CHAIR.
CASE of CAESAREAN SECTION. By GEORGE HARLEY, Esq., AND DR. NIMMO.
PROFESSOR SIMPson read a case of Caesarean Section, recently performed by
Mr. Harley in the Edinburgh Maternity Hospital. The mother died from
effusion into the air passages, consequent upon disease of the heart. The
Caesarean operation was had recourse to by Mr. Harley, a few minutes after
her death, and the child was now doing well. *g
DR. SIMPson read another case of Caesarean Section, performed upon the
living mother, by Dr. Nimmo of Dundee. In this case there was extreme
deformity of the pelvis. The mother died a few days after the operation.
The child was saved. The pelvis, a fine example of malacosteon, was exhi-
bited to the Society.
TREATMENT or AFFECTIONs of THE LARYNx. DR. JoHN Scott read a
communication on the treatment of certain affections of the Larynx, by the
local application of the nitrate of silver in solution, by means of a sponge.
VOL. II.
I 100 REPORTS OF SOCIETIES.
JUNE 19, 1850.
JAMES SYME, ESQ., PRESIDENT, IN THE CHAIR.
CASE of LARYNgo-TRACHEITIS TERMINATING FAvour ABLY AFTER TRA-
CHEoToMY. DR. JAMES GILLESPIE read an account of a case in which he
had recently performed Tracheotomy successfully. [It is published at p. 25
of the Monthly Journal of Medical Science, for July 1850.]
PATHologICAL STATES OF THE LUNG CONNECTED WITH BRONCHITIS. DR.
W. T. GAIRDNER read a paper on this subject. [This communication, in an
extended form, is being published in the numbers of the Monthly Journal of
Medical Science.]
Evulsion of TENDONs. The PRESIDENT read the following case, recently
communicated to him by Mr. Gerard, surgeon at Troup, near Banff:-John
Laird, a middle-aged labourer, while turning a grindstone with his left-hand,
on which he wore a thick worsted glove, or “mitten,” suddenly felt his
thumb tightly fixed around the iron handle. He immediately attempted to
stay the velocity of the machine, and, to his astonishment, discovered the
injury. The second phalanx of his left thumb was very neatly separated at
the joint, and had attached to it the tendon of the flexor longus, the mus-
cular fibres which had given way being traceable at the point of separation.
From the time of the injury to the healing of the stump (which was effected
by the warm-water dressing alone) he never complained of the slightest un-
easiness in the fore-arm ; nor did pressure along the course which the tendon
had occupied, produce any feeling of tenderness.
URINARY AND SALIVARY CALGULI. The PRESIDENT exhibited two curious
specimens of Urinary and Salivary Calculi. The urinary concretion had
been sent to him by Dr. Paul, of Elgin. It was remarkable for the beautiful
arrangement of the concentric layers of which it was composed.
The Salivary Calculus, which was of unusual size, had been sent by Dr.
John Traill, of Arbroath, who likewise had furnished the following account
of the case :—“A stout healthy man, aged 35, by trade a blacksmith, applied
to me about ten days ago for a tumour at the angle of the lower jaw. On
passing the finger into the mouth, its situation was felt to be under the root
of the tongue, and within the ramus of the jaw. The man had been sensible
of its existence for upwards of ten years, during which time it had gradually
increased in size. In general, it caused but little inconvenience; but, on
several occasions, had become enlarged and painful. These attacks had
always been relieved by leeching and other treatment. On careful examina-
tion, I thought I detected a rough point ; and, on making an incision, the
nature of the disease became at once evident. Although I made a very free
opening, I found much difficulty in removing the Calculus, and was finally
obliged to break it up with strong forceps. A good deal of it was lost, and
when entire the stone must have weighed about three drachms, and measured
about an inch and a half in length. A small flat stone lay in a smooth
cavity on one side, perhaps at the orifice of the duct. The Calculus seemed
to occupy the situation of the body of the sub-maxillary gland, altogether
posterior to the duct of Wharton.”

ATRoPHIED PANCREAs. DR. W. T. GAIRDNER exhibited a specimen of re-
markably Atrophied Pancreas, from the body of a man who had died of
diabetes. The duct was of the usual length, but no glandular tissue remained,
except a piece of the size of a small hazel-nut. Bouchardat considered that
diabetes was essentially a vitiation of the pancreatic secretion. This view
might be too exclusive; but there was now little doubt that diabetes was
generally connected with derangement of the duodenal digestion, of which
this case might be considered an illustration.
SDRGIC VT, SGCIETY OF IRELAND. 1101
SURGICAL SOCIETY OF IRELAND.
JANUARY 12, 1850.
THoMAs RUMLEY, ESQ., IN THE CHAIR.
Cop-LIVER OIL: PULMoNARY CONGESTION CAUSED BY IT. DR. BENSON had
found, in almost every patient under his care, who had died of phthisis while
using Cod-liver Oil, that the lungs were congested and consolidated, not
only in the vicinity of the tubercles, but nearly throughout the entire organs.
He thought, also, that he had frequently observed symptoms of congestion
during life in those who used the oil. In many cases, the rational symptoms
improved, especially as shewn by increase in weight, more rapidly than the
physical signs. Several cases were given in illustration of his remarks.
Summary of Discussion. DR. BAGoT had observed similar results, and
thought congestion more likely to occur when the patients were confined in
hospital.
#. SPEAR had observed some cases in the Hospital for Consumption at
Brompton, under Drs. Williams and Walshe, in which pneumonia of the
upper lobes of the lungs could be traced to the use of Cod-liver Oil. He
agreed with Dr. Bagot as to the probability of hospital confinement being a
predisposing cause.
TUMoURs of THE EYE AND ORBIT. DR. JAcoB exhibited the following
preparations. 1. A black, flattened, spongy tumour, about two inches in
diameter, which grew from the conjunctiva, in front of the eye. He could
not determine whether it were malignant. It was removed by the knife,
and the divided parts healed kindly ; the remaining structures of the eye
appeared healthy. 2. A black tumour, removed from the eyelid. This he
did not consider malignant, any more than warts or similar tumours which
were obstimate in growth, and could only be removed by the knife, or by
caustic. 3. A gigantic wart, which grew from the lower lid of the eye of an
aged man. Dr. Jacob had at first thought it to be carcinomatous ; but a
careful examination of its appearance, and the non-appearance of the disease
elsewhere, led him to form a different opinion, and to consider it as a cuti-
cular or epidermic growth. He exhited a drawing of a true malignant
tumour, which illustrated the difference between the cases.
JANUARY 26, 1850.
ANDREW ELLIS, Esq., IN THE CHAIR.
PopLITEAL ANEURISM TREATED BY COMPRESSION. M.R. JoHN MADDEN
related the case of a corporal, 32 years of age, who had Popliteal Aneurism
of the right-leg. Dr. Carte's instrument was applied to the femoral artery,
below the origin of the profunda, and Messrs. Read's to the vessel as it passes
over the ramus of the pubis; the pressure of the instruments being alter-
nated. The patient died on the twelfth day after the application of the
pressure. On post-mortem examination, the sac was found to contain fibrine
in concentric layers to the thickness of three-fourths of an inch ; the centre
was filled with coagulated blood. The femoral artery was pervious, except
until within one and a half inch of the Aneurism, where the coats were
thickened, and there was a pedicle of fibrine. There was a small Aneurism,
of the size of a nutmeg, on the arch of the aorta, opposite the origin of the
left subclavian artery; and also one of the gastro-duodenalis artery, the
lººse from which had been diffused into the psoas muscle of the .
right side.
The following conclusions were drawn by Mr. Madden :—1st. That the
patient died from the bursting of the abdominal aneurism; but whether
72 *
1102 REPORTS OF SOCIETIES.
accelerated or not by the attempted cure of the popliteal one, by no means
appears. 2nd. That no treatment could have saved the patient ultimately
from death by the cause stated., 3rd. That the treatment of Popliteal
Aneurism in this case, by pressure in the groin, or three inches below it, did not
morbidly affect the part of the artery pressed on, which remained pervious,
and exhibited no change of structure whatever, 4th. The healthy and
unaffected condition of the artery at the point of pressure, refuted the
statement of those pathologists, who state that pressure injures the vessel
in case it should be subsequently necessary to operate on it. 5th. That
the aneurism in the ham was in process of cure by the gradual deposition of
layers of fibrine proceeding from the surface to centre of the sac. 6th. That
the inch and half of vessel, immediately above the aneurism, was rendered
impervious by a pedicle, or cone of fibrine.
SUMMARY of DISCUSSION. M.R. TUFNELL and DR. MACDoNNELL thought
the case favourable to the employment of compression ; and the latter gen-
tleman considered that it removed, as far as a single case could do, the objections
that the artery sustained injury at the seat of compression, and that it was
rendered unfit for the subsequent application of a ligature.
DR. BANON suggested caution in the application of compression, when an
internal aneurism was known to exist. If employed at all, it should be
gradual. In a case, cured by compression in four days, which he had related,
the artery was found pulsating to within two or three inches of the aneu-
rismal sac, immediately after the solidification of the aneurism.
DR. HARGRAVE approved of Mr. Madden’s treatment. No evidence of in-
ternal aneurism had been detected ; and he doubted whether this could
have been done, though it was just possible that the aortic aneurism might
have been discovered.
DR, MADDEN had been unable to detect the slightest stethoscopic indica-
tions of internal aneurism.
The PRESIDENT was of opinion, that when an internal and a Popliteal
Aneurism co-existed, it would be better to let the patient alone, unless the
aneurism in the ham were on the point of bursting. He would probably
have pursued the same treatment as Mr. Madden in his case ; yet the subject
of treatment, under such circumstances, was worthy of the most serious
consideration.
FEBRUARY 9, 1850.
DR. JAcob IN THE CHAIR.
CoMPLICATIONs of FEVER IN DUBLIN. DR. H. KENNEDY related two cases.
1. A woman, aged 30, was admitted into hospital in a dying state ; cold,
nearly pulseless, semi-comatose, and suffering from urgent dyspnoea ; she died
four hours afteradmission. On post-mortem examination, pneumonia of theright
lung was discovered; it had commenced at the upper lobe, which was in a
state of grey hepatisation; the middle lobe was red, while the lower lobe
and the left lung were free. This was a very fatal form of pneumonia, pro-
bably on account of the rapidity of its course. 2. A woman, aged 40, died
of a relapse; the breathing becoming very laboured only towards the last.
Physical signs of effusion into the chest were detected on the third day:
and, after death, two points of effusion were found in the left pleura, which
presented all the marks of recent pleurisy. The lung was compressed; and
contained six or seven small abscesses situated close to the pleura. The
centre of the lower lobe of the lung was spongy, apparently proceeding to
suppuration. The veins were filled with a firm deposit, resembling plaster
of Paris. Dr. Kennedy considered the inflammation in this case as allied
to what is now called diffused inflammation. The author then made some
observations on the latency of symptoms of chest-diseases ; shewing that,
although the external symptoms may be present, the stethoscope often fails
to discover any physical signs till the lapse of twenty-four, forty-eight, or
even 'sixty hours.
SURGICAL SOCIETY OF IRELAND. {103
HYDRoCEPHALUs. DR. BATTERSBy related the case of Chronic Hydroce-
phalus with Scrofulous Deposit in the Brain, which was given at p. 790 of
this Journal for August.
FEBRUARY 23, 1850.
ANDREW ELLIS, ESQ.. IN THE CHAIR.
STRANGULATED HERNIA SIMULATING HYDROCELE. DR. MACDoNNELL re-
lated a case of Scrotal Hernia, which resembled Hydrocele in being trans-
lucent when viewed by the aid of a candle. This was the first time he had
observed such a case; but several had occurred to Sir P. Crampton. The
tumour was reduced while the patient was in bed, after having been in a
warm bath.
DR. STAPLETON related a case, in which Hernia and Hydrocele co-existed
in a boy, in whom the former was evidently kept up by the latter, as by a truss.
RETENTION of URINE : IMMENSE ACCUMULATION. DR. BENson related a
case of Retention of Urine from Paralysis of the Bladder, communicated to
him by Mr. B. Lane, of Articlave, Coleraine. It occurred after labour; and,
after three days, six quarts of urine were drawn off by the catheter.
ON THE Cop-LIVER OIL OF COMMERGE, AND THE BENEFICIAL EFFECTs of
THE CHEAPER FISH OHLS. DR. BAGoT believed that much train-oil was sold
as “Oleum Jecoris Aselli”; and that the effects were similar to those pro-
duced by Cod-Liver Oil. He related a case, in which the patient gained
weight under its use. He felt quite certain, that other fish oils were equally
useful in the treatment of phthisis ; and if this proved to be true, the dis-
covery would be invaluable to those in poor circumstances. Sperm and whale
oils could not be substituted for Cod–Liver Oil, both from their smell and
taste. Neither did they afford the violet colour with sulphuric acid. Whether
those oils, which are procured from the mammalia, have the same fattening
powers which the fish oils possess, had not been yet ascertained.
SUMMARY OF DISCUSSION. D.R. JACOB believed that a liver oil was got
from the liver of the basking shark, and sold in the shops. He thought it
not at all unlikely, that it would form a pretty good substitute for the genuine
Cod Oil. It was well known, that oil was largely extracted from the intes-
times of herrings by the persons employed in curing them. The oils which
came from Newfoundland were not all derived from the Gadus Morrhua,
but were procured from many other gadidae, amongst which the hake and
the ling were, in all probability, included, and also probably the haddock,
which was a gadus ; at all events, there was some reason to believe that it
was not absolutely essential for medicinal purposes to procure the oil from
any particular species of the cod.
DR. H. KENNEDY observed that the remarks which had just fallen from
Dr. Jacob were fully borne out in the work of De Jongh. This writer men-
tioned several fishes from which oil, identical in properties with that pro-
cured from the liver of the common cod, might be obtained ; and not long
since, the Medical and Surgical Journal contained an account, similar to that
... in Dr. Bagot's paper, of a number of cases in which different fish oils were
found to act fully as well as the genuine Cod-Liver Oil.
DR. STAPLETON was of opinion, that whenever pure Cod-Liver Oil could
be had, they ought to use it. The liver of the cod had been found peculiarly
efficacious in the treatment of rheumatic affections amongst the Norwegian
fishermen. In Norway it was not used as oil alone, but was taken in the
liver itself. The latter was extracted from the fish, was put into the stomach,
which was removed from the cod for the purpose, and, some salt and pepper
being added, the stomach was filled up with water, and tied at one end.
The whole was then boiled, and the liver thus prepared, being used as an
article of diet, was found highly beneficial in the treatment of rheumatism.
But there was only one period of the season, at which the liver of the cod

I 104 REPORTS OF SOCIETIES.
yielded the oil in a state of purity; namely, just in the beginning of the
season, when the liver was of a light cream colour. As the season drew to-
wards its close, the liver gradually acquired a reddish hue ; and when such
was the case, scarcely any oil could be obtained. In the beginning of the
season it was obtained by “cold expression”; but towards the close, it could
only be procured by boiling the livers, in which case, the product was ex-
ceedingly thick, had a most disagreeable odour, and would not sit easily
upon the stomach.
DR. JACQB thought the quality of the oil at different periods of the season
was probably more or less connected with the generative functions of the fish.
If they wanted to obtain the oil pure and comparatively free from a disagree-
able odour, it must be procured by pressure; for the oil was not diffused
throughout the structure of the liver, but confined within cells. If they en-
deavoured, by chemical agency, or a moderate temperature, to extract the
oil, their efforts could not be attended with much success, because it was
confined in the fat cells, and these could only be ruptured by compression.
Having learned the exact season of the year when the oil is contained, in
purity and abundance, in the liver of the cod, the question arose: whether
their best course would not be to give the liver itself to the patient to be
eaten, after the custom of the Norwegian fishermen ; The value of the oil
Imight depend very much upon the nature of the food upon which the fishes
lived; for some fish probably subsisted upon a kind of food that could not
furnish it with the elements of oil; and even if it did, the oil might not be
of the right description.
MARCH 9, 1850.
ANDREW ELLIS, Esq., IN THE CHAIR.
ORGANIC ELECTRIC ACTION of THE SPIEEN. SIR JAMES MURRAY read a
paper, in which he expounded his views on this subject. The following were
Some of his deductions. 1. Series of electric currents emanate from the
Spleen to the stomach during digestion. 2. The activity of these currents
Varies, according to the degree of splenic distension by the blood through
the vessels of the Spleen. 3. The currents of electricity are intense, in direct
proportion to the blood's heat, to the pressure exerted on the Spleen during
inspiration, and to the impulse and friction of the circulation in the large
splenic arterial branches. 4. In a minor degree, similar phenomena ensue,
even out of the animal; when a recent Spleen is insulated, and then injected
with warm water, but still more so, with hot liquors, containing such saline
ingredients as prevail in the blood. 5. A Spleen thus treated, determines a
positive current towards its gastric surface, when tested delicately by gold
and silver wires. 6. Contraction of erectile tissue ensues when the extremi-
ties of a gold and silver wire touch at one point the nerve, and at another
the erectile tissue of the Spleen. 7. Contraction, to some extent, seems to
be produced when two cups filled with water are united by a metallic arc, one
end of a Spleen being immersed in one of the cups, and the opposite ex-
tremity in the other cup. But more experience is required on this point.
8. Discs, or slices of spleen, placed upon each other, were, in most instances, .
better voltaic piles than similar batteries constructed from equal weight of
brain, liver, kidney, pancreas, or even of muscular flesh. 9. Slices of Spleen
were better conductors than equal sections of any of the above materials,
particularly when moistened by warm saline fluids, or even by tepid distilled
water. 10. The intensity of galvanic currents along the vasa brevia, from
the Spleen to the stomach, continues through the gastric coats in the recently-
swallowed ingesta, and the gastric juice seems thereby to derive and exert
some galvanic influence upon the pulpy aliment. li. The stomach and its
contents are to be considered as passive receivers or conductors of galvanic
influence, but the Spleen is endowed with active powers of generating or
creating voltaic evolutions, under favourable degrees of repletion of its vessels,
tension of its erectile tissue, and of auxiliary thermo-electric principles.

SURGICAL SOCIETY OF IRELAND. II05
MARCH 23, 1850.
DR. JAcob IN THE CHAIR.
CASE of CoMPLETE MoRTIFICATION OF BOTH FEET AFTER ExPosurE To
CoLD, witH REMARKs. By O’B. BELLINGHAM, M.D. CASE. D. M., a
labourer, aged about 30, was admitted into St. Vincent's Hospital, February
23, 1850, labouring under Gangrene of both feet. He had worked at his
employment as a labourer up to Christmas week. He was much exposed to
wet, but had a sufficiency of food, which consisted of bread and stirabout.
On the 3rd of January he was in his usual health, and went to bed quite
well. In about two hours, he began to suffer from pain and heat, referred
particularly to the instep of both feet, and he had no sleep that night.
In the morning, both feet and legs, as high as the calves, were swollen and
of a purple colour; they felt hot and sore; he could not put on his shoes,
nor stand ; sensation, however, was perfect, and continued to be so for two
days. The swelling, which extended at first to the calves of the legs, dimi-
nished subsequently; and in two days the feet had become of a black colour,
and had lost all sensibility.
The following was his condition on admission. The patient was a poor
emaciated creature, the hands and chest presenting a copious eruption of
scabies. Both knees were flexed, the patient could not extend them, and
the ham-string tendons were very tense. The feet were perfectly black,
hard, shrivelled, and dry, except about the ankles; there the parts were
moist, and gave out the usual offensive smell of gangrene; the separation
had been as complete through the tendo-Achillis and the other tendons of
the leg, as in the surrounding soft parts. About two inches above the ankles,
the tibia and fibula of both legs were perfectly bare to an extent of between
two and three inches, and almost exactly at the same part in each. The
bones, where exposed, were white, dry, and destitute of periosteum. At the
points above where the gangrenous had separated from the living parts,
granulations were abundant. The patient lay upon his back, with the legs
drawn up, and the gangrened feet resting upon the bed. His appetite was
very good, but there was a tendency to diarrhoea ; the tongue was dry; he
slept badly, but was not kept awake by pain; hé complained only of Soreness
and heat in the lower part of the legs; the pulse was 90, rather feeble.
March 1st. Operation. The tibia and fibula of the right leg were sawn
across at the part at which the bones were bare. There was no bleeding from
the bone; the medullary canal of the tibia contained a quantity of healthy
pus. 2nd. The right limb had been easier since the bones were sawn across.
On Sawing across the other limb, the medullary canal of the tibia appeared
to be dry; there was no pus' in it. 9th. The patient appeared to have
gained flesh: his appetite was very good ; the tongue was clean ; there was
no thirst or diarrhoea; he slept well; and the discharge from the stumps
consisted of healthy pus. 21st. The patient had no pain; he was able now
to extend the limbs, which he could not do on his admission ; the exposed
portions of the tibia and fibula were white and dry; the discharge from the
granulating surface was healthy; the patient had gained strength, ate and
slept well, and was able now to sit up in bed.
REMARKs. The gangrene in this case would appear to have had its origin
in exposure to cold. The coldest day in Dublin last winter was the 31st of
December, when the thermometer descended to 19° F , that is, thirteen de-
grees below the freezing point ; and for two days previously, it had been as
low as 22, while at the period at which the gangrene supervened in this
case, viz., on the 3rd of January, the thermometer in Dublin was not below
35°, or three degrees above the freezing point, and in the warmest part of the
twenty-four hours of that day it rose to 47° F. Gangrene does not so often
ensue during the prevalence of severe cold as after it, if the temperature
suddenly rise some degrees above the freezing point. When it does occur
during severe cold, it is owing to the imprudence of the persons in exposing
1106 REPORTS OF SOCIETIES.
the part to an elevated temperature. This has been noticed by Larrey, in
his Military Surgery. Parts, which have been frost-bitten very soon pass
into gangrene if exposed suddenly to heat. The most intense degree of cold
does not apparently destroy the vitality of the part at once ; when a portion
of an extremity has been frost-bitten, it can almost always be restored by
using proper measures.
In the subsequent treatment, should the case be left to nature, or should
amputation below the knees be performed Larrey recommends the latter
proceeding, if the gangrene have caused the death of the entire thickness of
the limb. The efforts of nature are then insufficient, the vital organs become
enfeebled by the process of exfoliation, and before this happens, the patient
dies of exhaustion, or of the effects of resorption. This applies with more
force to a case in which both extremities have become gangrenous. If, in-
deed, recovery take place by the unaided efforts of nature, it is not unlikely
that the patient would suffer so much inconvenience, that after a time he
would be glad to have amputation performed below the knees.
CASE of PERINEAL ABSCESS, IN WHICH THE PUs MADE ITS WAY INTo THE
SCROTUM. By MR, RUMLEY. A man, who was engaged as a clerk in a
solicitor's office, told Mr. Rumley, the 19th of March, 1850, that he had
suffered from severe pain about his fundament during the last five or six
days, and that he was apprehensive he was about to have a fistula. On making
an examination, Mr. Rumley found, between the tuberosity of the ischium
and the ramus of the os pubis, a red, painful, and fluctuating tumour.
There could be no doubt at all that matter had collected in this situation,
and accordingly he advised the man to have it opened without loss of time.
He declined to allow the operation to be performed then, having some press-
ing business. On his way home in a car, the wheel came against a brick,
but the jolt he received caused him scarcely any pain, and in fact, from that
moment, he could sit much easier upon the car. At half-past five on the
following morning, he was visited by Mr. Rumley, who found him suffering
violent pain in the scrotum. The scrotum was very much enlarged, reddened,
and tender to the touch. On examining the perineum, the tumour was
nearly gone, but the part still retained more or less of a doughy feel. It now
occurred to him for the first time, that the matter might have found its way
into the scrotum. He made an incision into the perineum, on doing which
exit was given to a small quantity of a rather good description of matter.
Two days after, he observed a small blue spot upon the scrotum, about the
size of a fourpenny piece, and he then made an incision into the scrotum,
and gave discharge to a small amount of matter. Two days later, a slough
appeared on the scrotum ; a large portion of the cellular substance beneath
the integuments had sloughed away. During the whole progress of the case,
there were none of the signs of urinary irritation present. The patient lost
a portion of his scrotum of about the size of a half-crown piece. From day
to day the patient became better and better ; granulations started up from
the tunica vaginalis, and he made a favourable recovery.
APRIL 6, 1850.
ANDREW ELLIS, Esq., IN THE CHAIR.
CASE of MILK IN THE BREASTs of A MALE INFANT. By DR. F. BATTERSBY.
After referring to instances cited by authors, in which milk had been found
in the breasts of virgins and men, as well as of male animals, Dr. Battersby
related the following case.
CASE. J. K., aged three weeks, was brought to Dr. Battersby on the 3rd of
last May by his nurse, who informed him that she received him from his mother
eight days before. She then found the breasts swollen and hard, and with
milk in them. The breasts had since become smaller, but were still of the
size of large walnuts, with the soft hardness peculiar to breasts full of milk,
SURGICAL SOCIETY OF IRELAND. 1107
They were quite round and moveable, seemed tender to the touch, and were
rather red on the surface. The nipples were of a size proportionate to that of
the breasts. The child had some bronchitis. , 7th. Dr. Battersby pressed some
milk out of the breasts. 12th. He withdrew, by gentle pressure on the breasts,
nearly a drachm of milk. It was precisely similar in appearance to woman's
milk. Mr. Moore examined it, with the following result. It was alkaline, threw
up a cream, was not rendered viscid by caustic potash, nor did it coagulate
when heated. Viewed under the microscope, it was seen to consist of normal
milk-globules of various sizes; on the whole, Smaller than those contained
in ordinary human milk, floating in a colourless fluid. It contained a very
few colostric bodies, and some epithelium.
It was to be regretted, that the presence of casein was not here determined.
The quantity of milk submitted to examination was so small, that many ex-
periments could not be tried. The fact of heat producing no coagulation,
and of the fluid remaining unaltered on the addition of caustic potash, proved
the absence of the colostric character. The breasts subsided, and the child
was healthy.
SUMMARY OF DISCUSSION. DRs. GEOGHEGAN and DARBY had seen milk
extracted from the nipples of very young male children. In one case, Dr.
Geoghegan examined the supposed milk, and found it to contain the oil-glo-
bules and granular bodies observed in the colostrum, or first milk after par-
turition, but he did not submit the specimen to a chemical analysis. Nurse-
tenders look upon the thing as by no means uncommon ; and are in the
habit of rubbing the swelling surrounding the nipple, to facilitate the escape
of the fluid.
DR. BUTCHER had, on one occasion, found a distinct mammary gland in a
male cbild which he dissected; the mammary apparatus of this child was
fully two inches in circumference.
ON THE AMoUNT of RESPIRATION HEARD IN THE ORDINARY DISEASES of
THE CHEST. By HENRY KENNEDY, A.B., M.B. . It had long been a recog.
nized fact, that the lungs might be quite pervious, and yet the amount of
respiration heard by the stethoscope might be comparatively little or none. Dr.
Kennedy did not speak of idiosyncrasies, where the intensity of the respiratory
murmur, even in health, presented such differences; but he alluded to disease,
as, for example, cases of bronchitis. Frequently, in these, the respiration
at first appeared quite natural and free; and yet a more prolonged examina-
tion showed the râles to exist extensively. This often occured in the adult, but
more frequently in the child. In cases of fever it was very common ; so much
so, that it was a point for which one should be prepared; for these were cases
in which it might be much more readily overlooked. The lungs being only par-
tially filled, under such circumstances no råles might be audible, though
at the very same moment they might become so, if, by any means, the respi-
ration got stronger. In children suffering from almost any general derange-
ment, the breathing was almost universally performed with great rapidity. It
was what might be called shallow respiration: the number of inspirations
making up, as it were, for the slower breathing of health. Both bronchitis
and pneumonia might hence exist, and yet be overlooked ; because the air
did not reach the affected portion of the lung, unless a deep inspiration were
made. Some cases of phthisis, too, presented examples of the same point.
In the child, pneumonia might more readily be overlooked than bronchitis.
With regard to the alleged perfect disappearance of respiration, in solidi-
fication from pneumonia, Dr. Kennedy expressed his conviction that an ex-
ample of absolute solidity could not be found, as the result of pneumonic in-
flammation. However parts of the organ might be solidified, the larger bron-
chial tubes, and some of the smaller ones too, still remained open. Hence, as
far as the lung was concerned, there was no reason why the air might not tra-
verse these open tubes, and so be made manifest to the ear; and no example of
pneumonia had come under his notice, where all forms of respiration were
1108 REPORTS OF SOCIETIES.
completely absent, although he was well aware that high authority had stated
this to be the case when the entire lung was solidified. That the respiration
under these circumstances was weak, and hard to catch, was admitted; but
there was a difference between weakness of respiration and its entire absence.
The patient, either from pain or weakness, might not make an exertion capable
of drawing the air into the parts of the lung still permeable.
In the majority of instances, the diagnosis between pneumonia and pleuri-
tis was comparatively easy, but the exceptional cases were sufficiently frequent
to entitle them to a particular notice. Once, indeed, any signs of displacement
of the surrounding viscera took place, the case was put beyond any doubt;
but short of this, cases had occurred to Dr. Kennedy repeatedly, where days
had passed without his being able to satisfy himself on this point. The dif-
ficulty mostly arose, from the same case presenting the symptoms both of
pneumonia and of pleuritis. Effusion, to a considerable extent, in a good many
cases, did not prevent the respiration from being heard. A considerable
difference existed in this respect. Thus, in some, he had found it impossible
to detect any sort of breathing longer than forty-eight hours after the attack
commenced, except of course towards the root and upper portion of the
lung; while, in other instances, the respiration continued to be distinctly
audible below, at a time when the effusion was as distinctly on the increase;
and that this was not due to any adhesions, was plain from the subsequent pro-
gress of the cases. The only explanation he could offer of this was, that possi-
bly the lung had much greater powers of resistance to the pressure of fluid
surrounding it than was commonly supposed; and that hence it might
have the power of expanding; the whole side of course dilating with it,
though at the next moment it yielded to the pressure exercised by the ribs
and the surrounding fluid. As some confirmation of this view of the question,
two points might be mentioned ; 1. When pleuritic effusions occurred in
children, the lung, as far as Dr. Kennedy saw, did not appear to yield to the
pressure of the fluid, in the same degree as took place commonly in the adult.
2. In cases where passive effusions occurred, an amount of respiration was
commonly heard much greater than what might be expected, from the quan-
tity of fluid poured out.
The following were Dr. Kennedy’s conclusions: 1. That in no stage or
form of pneumonia was respiration entirely absent. 2. That in some cases of
pleuritic effusion, respiration over the side continued to be heard, after the
fluid had accumulated to such an extent as to give complete dulness on per-
cussion from top to bottom.
CASE of WRY-NECK : DIVISION of THE STERNAL ORIGIN of THE STERNO-
MASTOID MUSCLE : CURE. By O’B. BELLINGHAM, M.D.
CASE. James Fitzpatrick, aged 15, was admitted into St. Vincent's Hospital,
September 22, 1849, labouring under Wry-Neck. The affection commenced
when he was five years old, at which period he suffered for some time from
pain in the left ear, which caused him to incline his head towards that side.
Two years afterwards, the deformity was quite perceptible, and it had in-
creased much within the last four years. The head was drawn downwards
towards the left shoulder; the right shoulder was elevated ; the sternal por-
tion of the left sterno-mastoid muscle, from its origin to the mastoid process,
was very tense and prominent ; its edge forming a sharp ridge from the one
point to the other. As the patient looked straight forward, it formed almost
a right angle with the clavicle, while the right sterno-mastoid muscle formed
a very acute angle. The left sterno-mastoid muscle, from its sternal origin
to the mastoid process, measured three inches, while the right measured four
inches and a half. The right side of the face was much better developed
and fuller than the other, apparently as if the two sides of the face were
those of different persons; the chin was inclined towards the sound side, the
right eye, the right side of the mouth, and of the nose, were upon a plane
higher than on the other side ; a difference of half an inch was found upon
SURGICAL SOCIETY OF IRELAND. 1109
measurement on each side; from the angle of the mouth to the outer angle
of the eye on the sound side measuring three inches, while on the diseased
side it was only two inches and a half. Behind the insertion of the sterno-
mastoid muscle, there was a considerable hollow upon the affected side.
The right side of the cranium appeared to be larger than the left, and the
right side of the thorax likewise seemed to be better developed than upon
the diseased side.
October 5th. The sternal origin of the sterno-mastoid muscle, being that
which was engaged in keeping up the deformity, was divided to-day by the
subcutaneous section, a very narrow straight knife being used. A little col-
lodion was put upon the incision in the skin, some adhesive plaster over it,
a high and stiff stock was then put round the patient's neck, and a double
headed roller round the head, and the patient was placed in bed, with the
head upon a low pillow, and the ends of the roller were fastened behind his
head to the legs of the bed above. After a few days, he was allowed to get
up, and the only apparatus used was a high and stiff stock, higher upon the
affected side than the other, which he wore night and day. The wound
healed by the first intention, leaving scarcely any mark; and the patient
left the hospital November 5th, the head being quite straight, but the face
still preserving much of the peculiar appearance which it had before the
operation.
This case served to strengthen the opinion advanced by M. Guérin, that
the sternal portion of this muscle is alone engaged in keeping up the de-
formity in the majority of cases of Wry-Neck.

APRIL 20, 1850.
DR. JACOB IN THE CHAIR.
CoNGENITAL HYPERTROPHY of THE FINGERS AND Tops. By FRANCIS
BATTERSBY, M.B. After referring to a case of Hypertrophy of the Hand,
exhibited to the Surgical Society by Mr. R. F. Power in 1839, and the cases
described by Mr. Curling in the twenty-eighth volume of the Medico-
Chirurgical Transactions, Dr. Battersby related the following case. W.
Walsh, aged 16 months, was born with the second toe of the left foot in
length and breadth far exceeding the others. It had since grown apace with
the other toes, and retaining its unnatural size, gave the foot a very remark-
able appearance. It was seven-eighths of an inch longer than the great toe,
which was five-eighths of an inch less in circumference. It was one inch and
two-eighths larger than the corresponding toe of the opposite foot. The third
toe was slightly hypertrophied, and inclined outwards from the second. The
soft commissure between these toes, looking at the dorsal aspect of the foot,
was advanced half an inch from its natural position. The sole of the foot
was occupied by a large fatty protuberance, making the circumference of the
foot an inch in extent more than the right foot. The mother had no idea
of anything being wrong with the child when it was horn, and neither of
the parents ever knew of such a malformation before. The child was a very
fine one in every other respect. He walked as well as other children of his
age, but his toes, owing to their size, and the large soft ball in the centre of
the foot, were not then flexed, like the toes of the right foot, although the
joints of the enlarged toes were naturally moveable.
EARLY OPERATION IN CASEs of HARE-LIP. DR. O’B. BELLINGHAM read
the notes of several cases, in which he had operated for Hare-lip on children
at an early age ; after which, he made the following remarks. The attention
of the profession was first called to the advantages of an early operation in
cases of Hare-Lip in 1842, by the late Dr. Houston. Since that period, the
operation had been performed in numerous instances in this country, and
sometimes upon infants of a very tender age, as a few days, or a few weeks
after birth. In only two of the cases which he detailed, the operation was
1110 REPORTS OF SOCIETIES.

performed within a few weeks after birth; in the others the patients were
not brought to him until they were some years old. When a fissure in the
upper maxillary bone and palate complicated the Hare-lip, Dr. B. said, that
if the infant were operated upon a few days, or a few weeks after birth, the
fissure in the bone would gradually diminish, and become almost completely
obliterated as the child grew up ; whereas if the operation were deferred until
later in life, the fissure in the bone would rather become wider. Again, the
earlier the operation was performed, the more quickly would the wound unite,
owing to the vascularity of the parts; hence the cicatrix would be slighter,
and the mark would become almost imperceptible as the child grew up. In
the very young infant, the operation was less severe, the parts which required
to be excised had not the thickness or the firmness which they acquired later
in life; they yielded also more readily, and bore a greater stress from the
needles used in the operation, than when the child was older. Besides, the
resistance offered by an infant of only a few weeks old, both during and after
the operation, was much less than of one a few months old ; the operation was
therefore performed with greater facility; while its success became more
certain, because the feeble crying of an infant at that age had a less tendency
to divaricate the edges of the incision than would be the case if it were older.
The only objection of any force which had been urged, was the liability of in-
fants to convulsions at this period of life from trifling sources of irritation.
Dr. Bellingham was not aware of any case recorded within the last few years
where the death of the infant could be referred to this cause, although the
operation had been performed in numerous instances at a very early age. If
the child was very irritable after the operation, particularly if it cried much,
the drag upon the needles would be increased, and the operation might fail
in consequence.
SUMMARY OF DISCUSSION. DR. JACOB was in the habit of operating in
congenital cataract before the teething period commenced, and he found
that the little patients got on far better than when he used to operate at a
later period, owing, he believed, to the fact, that the process of absorption
went on with greater rapidity, and that children seemed to be less liable to
inflammation in the former instance than in the latter. - - -
PROFESSOR SMITH brought forward five or six cases, in half of which the
operation for Hare-Lip was performed when the children were less than one
year old, and the remainder at a different period, and it appeared that, so
far as the operation was concerned, they all did exceedingly well; but in
the late operation, the patients did not become restless, so as to require the
administration of anodynes.
DR. H. KENNEDY was able, from his own observation, to testify in favour
of the early operation. It was more easily performed, and the danger at-
tending it was much less, when the child was but a few days old, than it
was at eight weeks. In addition, should haemorrhage occur at the time of
the operation, it would be easily controlled. His impression was, that there
was no period of early childhood, from the first week to the end of the first
two months of the infant's existence, at which the operation might not be
performed with perfect safety. -
11 II
MISCELLANEOUS INTELLIGENCE.
FINANCIAL STATE of THE Roy AL CoILEGE of SURGEONs of ENGLAND, AT
MIDsumMER 1850. From a statement (just published) of the receipts and
expenditure of this Institution, during the past year, it appears that the
former amounted to £11,722: 2:7, and the latter to £11,03i: 18: 2. The
following are the sources of income, with the amount from each :—
Fees from Court of Examiners – - - - - £8,705 15 0
Fees on admission to the fellowship - º gº enº 430 10 ()
Certificates of having received the diploma sº tº- 5 5 0
Fees on admission to Council and Court of Examiners 105 0 0
Sale of Lists of Members, Catalogues, etc. gº º 55 10 9
Dividends on investments in Government Securities -
Produce of Policy of Assurance on life of Mr. Clift - 1,450 0 0
Total - - £11,722 2 7
The disbursements are divided under the following heads, viz.:-College
Department, including council, court of examiners, auditors, fellowship,
diploma stamps, list of members, law expenses, salaries, wages, coals, etc.,
£5,576:8:8. Museum Department, including catalogues, specimens, spirit,
bottles, studentships, salaries, wages, etc., f2,122 : 5. Library Department
including purchase and binding of books, salary, etc., f:407: 3:4. ificeſ:
laneous, including taxes, insurance, furniture, etc., $491 : 3: 7. Repairs
and painting, £132: 5: 7. Under Deeds of Trust, including oration, lectures,
and prizes, £388: 4:6. Purchase of £500, 3 per cent. consols, £464: 7 : 6.
Purchase of £1,518 : 6: 6 reduced 3 per cents. in trust for Mrs. Owen, £1,450.
Balance due to the bankers, 30th June, 1849, #65 : 15 :4. Balance at the
bankers, Midsummer-day, 1850, £624: 9:1. Total £11,722. From the
published statement it will be perceived, that the incidental income amounts
to £10,752 : 0: 9 ; the permanent income to £970: 1 : 10. The incidental
expenditure to £7,525: 16:6; and the permanent expenditure to £3,506:1:8.
MEDICAL SocIETY OF LONDON. This institution has commenced its meetings
for the session with most favourable prospects of success, if we are to judge
from the large attendance of members, and from the excellence of the papers
which have been already read. The energy which the officers of the amalga-
mated societies have lately shewn, will no doubt have a beneficial effect on
those who have the control of the Royal Medical and Chirurgical Society. A
little friendly rivalry often promotes the development of powers which would
otherwise remain latent. We hope to see both societies go on increasing in
prosperity and usefulness.
In the Medical Society, G. J. Guthrie, Esq., F.R.S., and Dr. G. Owen Rees,
have been elected Lettsomian Professors; and the following members of
Sectional Committees have been appointed:
Medicine. Surgery. Midwifery.
Dr. Webster. Mr. Hancock. Dr. Murphy.
— Sibson. — Dendy. — Chowne.
— J. R. Bennett. — Pilcher. — Merriman.
— Copland. — Erichsen. — Smiles.
— Garrod. — Hird. — T. Smith
— Lankester. — Hilton. — Lever.
Mr. Headland. — Toynbee. Mr. Greenhalgh.
1112
MISCELLANEOUS INTELLIGENCE.
The following CoMMITTEES OF REFEREEs have also been appointed:
Medicine. Surgery. Midwifery.
Dr. Lankester. Mr. Hancock. Dr. Murphy.
— Sibson. — Hird. — T. Smith.
— Webster. — Pilcher. — J. H. Bennet.
— Sayer. — Coulson. — Tilt.
— Snow. — Robarts. Mr. Greenhalgh.
— Woodfall. — Wade. — Brown.
Mr. Streeter.
— Headland.
IETTSom IAN PROFESSORs.
G. S. Guthrie, Esq., F.R.S., will lecture on the 6th, 13th, and 27th of
February, at four o'clock, on the Means adopted by Nature to Assist Haemor-
rhage from the Larger Arteries.
DR. O. REEs will lecture in May on the Pathological Indications afforded
by the Urine.
RETIREMENT of SIR. JAMES M*GRIgor FROM THE OFFICE OF INSPECTOR-
GENERAL OF THE MEDICAL DEPARTMENT of THE ARMY. Sir James M*Grigor,
having for thirty-five years worthily discharged the duties of Inspector-
General of the Medical Department of the British Army, has lately retired.
An excellent account of his life, and of the services which he has rendered,
in promoting the diffusion of professional knowledge among the medical
officers of the army, as well as in raising the department over which he has
presided to its present admirable state of organization, will be found in the
Lancet for October 12, 1850.
MEDICAL FACULTY of MADRID. By a decree, of date August 20, 1850,
the Queen of Spain has created three new special clinical professorships, viz.,
for Syphilis, Skin Diseases, and the Eye. The first appointments have been
conferred on Drs. Salasar, Alonso, and Calvo, at salaries of 12,000 rials each,
which is about £120 sterling. Future appointments are to be filled up by
concours. This is a movement in the right direction ; but medical science
is at a low ebb in Madrid, globulism, and other forms of quackery as non-
sensical and audacious, being more painfully visible in the profession than
in any other capital of Europe.
MEDICAL Journal.ISM IN SPAIN. From an official document, published at
Madrid, it appears that the various medical periodicals of Spain, collectively,
possess a circulation scarcely sufficient to enable one journal to pay its way
in London. Nine works share among them 929 subscribers | | The following
list shows how they are apportioned :
Boletin de Medicina & cº e e . 369
Union . tº o e & º e º . 160
Revista Quimico–Farmaceutica º e º . 136
Restaurador-Farmaceutico . tº sº e 107
Gaceta Medica º g e g e © 64
Echo de la Medicina 32
El Parte Medico I9
Two pseudo-medical journals, the Propagador Homoeopatico, and the Boletin
Hahnemanianno, have between them fifty-two subscribers.
SANITARY PROGEEDINGS AT HULL. At a meeting of medical practitioners,
resident in Hull, held on Saturday, the 19th inst., at the General Infirmary,
it was unanimously resolved, in reply to a letter received from the mayor,
on the subject of cholera,_That this meeting, although fully cognizant of
*
MISCELLANEOUS INTELLIGENCE. 1113
the prevalence of cholera in Hull, and deeply aware of the necessity of care-
fully watching its progress, is not of opinion that any necessity exists to
adopt decisive measures on the subject. It would, however, suggest to the
Sculcoates' Board of Guardians the desirableness of imitating the Hull Board,
in requesting their medical officers to attend to all cases of emergency, with-
out an order. According to the returns of the superintendent registrars, it
appears that forty-two fatal cases have occurred, since the 1st of September,
in Hull and Sculcoates conjointly.
ATTEMPTED DARING ROBBERY BY THE AID of CHLoRoRoRM. Both the
Rendal Mercury and the Carlisle Journal contain an account of an attempt
made, in Kendal, on Sunday week last, to rob an elderly clergyman by the
aid of Chloroform. The clergyman, who was temporarily visiting the town,
had taken up his residence at an hotel, to which also the person charged
with the nefarious act resorted, as is supposed, for its express purpose. The
aged gentleman had retired to bed early on the night of the 13th inst., and
being unable to lock his door, had secured himself against intruders, but
inefficiently; he was subsequently awakened by the attempt of a person to
render him powerless by placing a cloth over his mouth ; and at the time of
his rescue by those whom his cries brought to the apartment, a strong smell
of Chloroform is reported to have been perceptible, and two bottles of that
substance are said to have been discovered. The matter will undergo in-
vestigation at the sessions. It is not the first time than an agent of good has
been converted into an instrument of evil.
SIGNOR SARTI, late the proprietor of the Florentine anatomical and other
models in wax, formerly exhibited in the metropolis, and, since then, in vari-
ous other towns of England, has lately died at Boston, in the United States.
He was a native of Florence, and is stated to have been an accomplished
man, and married to an English lady. Signor Sarti was the first to intro-
duce into this country the ingenious and elaborate specimens of Florentine
art, showing the structure of the human frame.

BURIAL CLUBS : THE NEW ACT of PARLIAMENT. In the new Friendly
Societies’ Act, there is an important provision respecting Burial Clubs. In
future the money to be paid on the death of a child under ten years old
must be under £3, and can only be paid to the undertaker for actual ex-
penses occurred. No money must be paid on the death of a husband, wife,
or child enrolled, except on production of a certificate from a physician,
surgeon, apothecary, or coroner, according to a form annexed to the Act,
that the party had not been deprived of life by any person interested in ob-
taining the burial money. If any officer of a Society pay the money without
such a certificate, he will be liable to a penalty of £10, one-half of which will
go to the informer.
MURDEROUs ATTACK on A PHYSICIAN. The Union, Médicale for October
17th, quotes the following from the Gazette de Cambrai. Dr. Eugène Delporte
was summoned one morning lately, between four and five o’clock, under the
pretext of visiting a patient. While proceeding to the house, an individual,
armed with a sword, rushed on him and wounded him in the head; a second
stroke removed three of the fingers of his left hand, together with one ear,
and a part of his cheek; a third stroke wounded his skull, and was probably
only prevented by his wig from injuring his brain. His cries having alarmed
the neighbours, the assassin fled, but has been since arrested. No cause is
assigned for the perpetration of this act.
“INSTITUT URo-CHIRURGICAL.” An institution under this name has been
recently opened in the immediate neighbourhood of Paris. It is a specula-
1014 MISOELLANEOUS INTELLIGENCE.
/
tion of M. Mercier, and its object is to afford billiards, baths, boating, and
all sorts of amusements to those who may thither resort for the cure of affec-
tions of the genito-urinary organs ! The rate at which Hydropathic Esta-
blishments, Lunatic Asylums, and Sanatoriums of various descriptions are
multiplying both at home and abroad speaks volumes as to the present dis-
tressed state of the medical profession.
A P JP O I N T M IE IN T S.
BURTON, Dr., appointed, by the Lord Lieutenant of Ireland, Resident Physician
and Governor of Maryborough District Lunatic Asylum.
GUTHRIE, G. J., Esq., F.R.S., appointed Lettsomian Lecturer on Surgery to the
Medical Society of London.
HUNTER, Dr., elected Lecturer on Surgery in the Andersonian University, Glasgow,
in the room of Dr. LAWRIE, elected Professor of Surgery in the University
of that city.
REEs, Dr. G. Owen, F.R.S., appointed Lettsomian Lecturer on Medicine to the
Medical Society of London. ,
WATson, Dr. Ebenezer, elected Professor of the Institute of Medicine in the An-
dersonian University, Glasgow. The number of votes were, for Dr.WATSON,
30 ; for Dr. JosePH BELL, 27.
O BIT U A. R.Y.
BATEs, William, Esq., Surgeon, of George Street, Blackfriars' Road, aged 58, on
14th October.
Booth, Dr. W. L., Assistant-Surgeon, United States Army, at Monterey, California,
on 14th August.
BURTON, Dr. Ed. W., Staff Surgeon, Senior Resident Medical Officer at the General
Military Hospital, Dublin, on 11th October.
ELLIOTSON, Dr. Thomas, at Malta, on 1st August.
Fogo, T. M., M.D., late of the Royal Artillery, at Tiverton, Devon, on 18th Sept.
FouquTER, M. le Dr., Professor of Clinical Medicine to the Faculty, at Paris, aged
74, lately.
GIBSON, Thomas, Esq., Surgeon R.N., late of Doune, Scotland, at Hobart Town,
Wan Diemen's Land, on 15th April. jº
GRAHAM, Dr. R.N., on board the Hon. E.I.C. steamer Phlegethon, at Whampoa,
aged 32, on 13th July.
GRUBB, Dr. Robert, of Dalston, aged 55, on 30th September.
MAGINNIs, Dr. Isaac, of Savannah, drowned at sea, on 4th October.
M“CREA, Farquhar, M.D., late of the 6th or Enniskillen Dragoon Guards, at Sidney,
N.S.W., on 20th April.
Swift, James, Esq., Surgeon R.N., at Worcester, aged 76, on 5th October.
TAYLOR, John, Esq., Surgeon, at 8, Abercrombie Place, Edinburgh, on 10th Sept.
THOMPSON, Mr., Surgeon, 69th Regiment, at Malta, lately.
B O O K S R E G E IV E D.
ADDRESs to a Medical Student. Oxford: 1850. BARKER (Dr. T. H.) on the
Diet of Infancy and Childhood. London: 1850. CookE(Weeden) on Hydrocephalus.
London: 1850. ERICHSEN, Introductory Lecture on the Study of Surgery. London:
1850. GALLOWAY's Manual of Qualitative Analysis. London : 1850. GROVE,
Epidemics Explained and Examined. JENNER'(Dr. W.) on Typhus and Typhoid
Fevers. London : 1850. MoWRO (H.) on Insanity. London : 1850. SiMON (John)
Lectures on General Pathology. London: 1850. SYMONDS (Dr. J. A.) Introduc-
tory Address at the Bristol Institution. London and Bristol: 1850. WEBB (Allan)
On the Relations of Hindu, Ancient, and Modern Medicine. Calcutta : 1850.
WRIGHT (T.G.) on Cholera in the West Yorkshire Lumātic Asylum. London: 1850.
L ON DON
JOURNAL OF MEDICINE,
A MONTHLY
3Retort of the ſūtūical Sºcienteg.
DECEMBER 1850.-No. XXIV.
O R. I. G. I. N A Is C O M M UNI CAT I O N S.
ON THE HEALTH OF LONDON DURING THE SIX
MONTHS TERMINATING SEPTEMBER 28, 1850.
By JOHN WEBSTER, M.D., F.R.S.; Fellow of the Royal College of Physicians;
Consulting Physician to St. George and St. James's Dispensary, etc.
[Read before the Medical Society of London, November 2, 1850.]
THE approval which has been expressed, in several quarters, of my
previous half-yearly Reports on the Health of the Metropolis, published
in the LoNDON JOURNAL OF MEDICINE, induces me again to resume
the subject. In doing so, I gratefully acknowledge the favourable
notice which medical writers, and others, have taken of my former
papers; and, as the facts then collected, and my commentaries, were
considered valuable, I here follow the method formerly adopted. I
also believe with practical physicians, that medical Science and prac-
tice, and sanitary improvements, are greatly promoted by the accumula-
tion of evidence, on a large Scale, respecting the diseases and mortality
of so immense a population as that of London. Deductions drawn
from the innumerable data contained in the Registrar-General's im-
portant Reports, have become of very great value to the philanthropist
and the physician, from the more accurate knowledge which they impart
of the fatality of certain diseases in particular localities, and during
different seasons. Few subjects, in my opinion, are more instructive
than the investigation of questions connected with public health, of
the causes of disease, and especially of the means best adapted for their
prevention and cure. It ought to be kept constantly in view, that to
point out the existence of an evil, is often not only the first but the
greatest step towards its removal or alleviation.
I will now proceed to offer some remarks on the State of Health
noticed amongst the metropolitan population during the six months, ter-
minating on the 28th of September in the present year; thereby furnish-
ing a continuation of the reports which I have already published. And it
affords me much satisfaction at once to state, that the late summer and
autumn have been unusually healthy, even if compared with ordinary
seasons, but particularly so, when contrasted with the year immediately
WOL. II,
1116 THE HEALTH OF I.ONDON.
preceding. Throughout the second and third quarters of the present
year, that is, from the 30th of last March to the 28th of September,
22,816 persons have died in London from all causes; whereas, during
the parallel period of the year 1849, not fewer than 40,117 persons died
from different diseases, being a diminution of 17,301 deaths, or 43' 12
per cent, in the recent, compared with the previous season. Testricting
the comparison, however, to the last three months of the above period,
or to the quarter terminating on the 28th of September, the difference
is most remarkable; 27,109 deaths having been reported in London
during the months of July, August, and September of 1849, in contra-
distinction to 11,578 in the parallel seasons of the current year; being
a decrease in the latter of 15,531 deaths, or nearly three-fifths of the
previous mortality.
DISEASEs WHICH HAVE LATELY Exhi BITED A DIMINISHED RATE OF
MoRTALITY. The great difference already noticed in the amount of
deaths throughout the metropolis in the two periods, was chiefly owing,
as is well known, to the severity of the epidemic Cholera, so fatally
prevalent last year in London; but which, fortunately, has this year
been of very rare occurrence, compared with the epidemic of last season,
only 96 persons having died from this disease during the entire six
months referred to in the present communication, instead of 13,115 in
the same period of last year. The contrast is more extraordinary, if
the first two weeks of the month of September in each year be com-
pared. In 1849, cholera proved fatal to 3,708 individuals in this short
period; whereas, in the parallel two weeks of September in the current
year, only twelve persons died of that malady.
Diarrhoea and Dysentery, so severe in 1849, have proved, this year,
much less frequent. During the second and third quarters of last year,
2,946 persons died in London from these diseases; but throughout the
similar six months of the current year, the deaths from the same causes
amounted only to 1,459. Of these, almost half, or 691 fatal cases,
were reported during August.
Measles have also been less fatal than in 1849. During the past six
months of the current year, 410 persons died of that disease, in contra-
distinction to 642 during the former period. Scarlatina has this season
been comparatively mild, only 550 fatal cases having been reported,
instead of 883 during the parallel six months of last year. If com-
pared, however, with the same six summer and autumn months of 1848,
the difference in respect of fatality is very great. No fewer than 2,376
individuals then died of scarlatina, which continued to prevail, even
more intensely, during the last three months of 1848 than previously,
having carried off 1,765 persons during that short period of time; hence
proving a much more destructive malady than had been known in the
metropolis for many years. Since that season, scarlatina has gradually
declined, as indicated by the small amount of deaths now reported.
Hooping-cough, another affection often fatal to young persons and chil-
dren, has likewise prevailed less frequently this year than the last;
706 deaths by that complaint having been reported from the 30th of
March to the 28th of September in the present year, instead of 1,167
during the same six months of 1849.
BY JOHN WEBSTER, M.D., F.R.S. J 117
Typhus Fever, which I have elsewhere designated a good mosometer
of public health, has likewise been of late less prevalent than previously.
There is no circumstance more indicative of the salubrity or unhealthi-
ness of places and seasons, than the amount of typhus fever prevalent
amongst the inhabitants; hence it is satisfactory to state, that in the
metropolis, this disease has proved less fatal than in former seasons.
During the six months embraced in the present report, 900 persons
have died from typhus; whereas, during the parallel period of 1849,
the deaths, by the same cause, were 1,222, being 35-47 per cent., or
rather above one-third more numerous than recently. On comparing
the recent period with the six summer and autumnal months of 1848,
the difference is still more evident; as the deaths from typhus fever
which then occurred in London, amounted to 1,764, being nearly double
the number (900) reported during the last two quarters.
Phthisis has likewise been the cause of death in a smaller number
of persons than during last year; 3,056 individuals having died from
this in London during the last six months, instead of 3,214 in the
corresponding two quarters of 1849; making a decrease of about 5 per
Cent.
Pneumonia and Bronchitis come also within the category of diseases
which have exhibited a diminished rate of mortality. Thus, during
the summer and autumn of 1849, the deaths from these two pectoral
complaints amounted to 2,569; whilst in the parallel six months
ending the 28th of last September, only 2,227 deaths are reported,
being a diminution of 342 cases, or more than one-seventh. Convul-
sions are reported to have proved fatal in 839 persons, during the last
six months; in contradistinction to 1,028 during the same period of
the year 1849; being a diminution of 189 in the number of deaths, or
22:53 per hundred. Erysipelas is sometimes a very serious disease,
especially when the patients in an hospital become attacked, as it is
difficult to eradicate from the institution, and often rebellious to
treatment; nevertheless, it has proved less fatal recently than in
former seasons. Thus, during the six months embraced in the present
report, erysipelas caused death in only 168 patients; whereas during
the corresponding two quarters of 1849, the number of fatal cases, by
the same disease, amounted to 213, being a decrease of 45, or 26-78
per cent. in the more recent period.
Besides these illustrations, it may be mentioned, that Diseases of the
Heart and Blood-vessels produced, in the aggregate, fewer casualties
than last year; the comparative numbers being 896 deaths, during the
recent six months, instead of 942, in the corresponding six months of
the year 1849.
DISEASES WHICH HAVE EXHIBITED AN INCREASED RATE of MoRTALITY.
Although the health of the metropolis has been generally satisfactory,
throughout the whole of last summer and autumn, as shown by the
statements just enunciated, several of the ordinary maladies have never-
theless manifested a different character.
Influenza has been rather more frequent during the last, than during
the previous season; 45 deaths by this malady having been reported,
instead of 25 in the corresponding two quarters of 1849.
732
1, 1 18 TiHE HEALTH OF LONDON.
... Cancer has proved fatal to 457 persons during the last six months,
instead of 397 during the second and third quarters of 1849.
Insanity has likewise been more fatal; 51 persons having died,
instead of 41 in the parallel period of 1849.
Inflammation of the Liver also exhibits a slight increase of mor-
tality; 107 deaths from hepatitis having been reported, instead of 96
in the previous period. &
Ovarian dropsy, moreover, has been more fatal in the recent period;
85 females having fallen victims to that complaint, from the 30th of last
March to the 28th of September; whereas, only 20 individuals are re-
ported to have died from a similar cause during the parallel two quarters
of 1849. In addition to the above important fact, it may be also instruc-
tive to mention, that of late years, this serious disease seems to have
proved more deadly than formerly. Thus, during three years ending the
31st of December, 1841, the total deaths in London by ovarian dropsy
were only 40; whereas, during the three years terminating the 31st
of December, 1848, they amounted to 142, or more than treble the
previous amount. These statements, indicating the recently aug-
mented mortality by the disease in question, I have been induced now
to mention, as they must be interesting to practical surgeons and patho-
logists. Does this increased fatality depend upon ovariotomy, and
diagnosis by exploratory incisions, being now in vogue 2
DISEASEs EXHIBITING AN UNIFORM RATE of MoRTALITY. Speaking
generally, although diseases affecting the Kidneys and Urinary System
have proved rather more fatal recently than in the previous season—
the total deaths by the above causes being 296 in 1850, and 279 last
year; still, some of the affections, in this division, have exhibited a
nearly uniform mortality. For instance, 13 persons died of Stone in
each half year; 67 died of Bright's disease during the last six months,
and 65 in 1849. Diabetes proved mortal to 18 persons in the six months
of 1850, in lieu of 20 carried off by the same malady during the parallel
two quarters of the previous year. This however is a complaint which
cannot be regarded as renal.
From Puerperal Diseases, during the six months just terminated,
200 fatal cases have been recorded, the number during the parallel six
months of 1849 having been 210; thus showing a slight recent dimi-
nution. Seeing the number of births during the last two quarters was
36,604, it becomes an interesting inquiry to ascertain the ratio of
deaths incident to females during, or immediately after, parturition.
From the data at present attainable, it is only an approximation to the
truth, that can be here enunciated; still, taking into calculation twin
and triplet births, which are much less common than many persons
may perhaps suppose, being in the proportion of about one twin birth
in every 113 cases, it follows, that nearly one female dies in every 180
parturitions. When puerperal fever prevails epidemically in lying-in
institutions, the mortality will be, in that case, augmented; but, looking
at last year's experience, the above calculation is very nearly correct."
As an illustration of the small proportion of twin births, it may be interesting
to mention, that in 1845, when 65,884 children were born in London, there were
not more than 580 cases of twins, and only two instances of triplets. Of the twin
3.
BY JOHN WEBSTER, M.D., F.R.S. 1 119
Considerable uniformity in the rate of mortality has been likewise
noticed in other diseases. Apoplexy proved mortal to 618 individuals in
the six months of 1850; the deaths being 612 in 1849. From Hernia
65 died in the six months of 1849, whilst the fatal cases, by the same
disease, were 62 during last season. Delirium tremens was the cause
of death during the past six months in 96 cases, whereas the number
was 94 in the previous year. Although this dangerous disease has
not varied much in respect to its mortality during the last and present
year, it should be noticed that, as compared with many former periods,
delirium tremens has recently greatly augmented, both in frequency
and fatality, in the metropolis, as shown by the following statement.
During the whole of the year 1841, 83 individuals died from this dis-
ease; in 1844, the deaths rose to 95 ; in 1847, they amounted to 156;
and in 1849, delirium tremens proved fatal in 164 cases; the mortality
being thus almost double of that in 1841. These are important facts,
and deserve serious attention from medical men, as well as from the advo-
cates of temperance. More human beings annually fall victims to this
complaint, which is really disgraceful to the individual, if one might
employ such an expression, than to syphilis, gout, insanity, and several
other maladies. Such a fact is not creditable to the present age, nor to
its much boasted civilization.
MoRTALITY AMONG CHILDREN. The large number of children who
annually fall victims to disease in London, exhibits a feature in the
mortuary reports of the metropolis, which ought to arrest the deepest
attention. If nature's laws were more frequently followed,—were the
properfeeding, and judicious clothing of young persons more in accordance
with common sense, and with their tender constitutions,—and farther,
if their physical education constituted a greater part of the duties of
parents and attendants, in addition to their moral culture, I feel assured
that so large a proportion as 45 per cent. of the total deaths would not
be met with among children. Of the 22,816 deaths recorded in London
from all causes, during the last six months, 10,242 of the individuals
who died had not yet passed their fifteenth year, many being even
infants or young children, whilst 7,787 were in the prime of life, viz,
from puberty to 60 years of age, and 4,657 were old people; thus
births, 183 mothers had two boys, 176 bore two girls, and 221, or two-fifths of all
the patients, had each a boy and a girl. It is also curious, that a large proportion
of the above 580 twins cases occurred in the out-parishes of the metropolis. Thus,
43 were reported from Lambeth ; 34 from St. Pancras; 34 from Kensington and
Chelsea; 27 from St. Marylebone; also 27 from Shoreditch; 26 from Stepney; and
22 from Islington ; whilst one of the triplet births occurred in Shoreditch, the other
in the London City District. The first case was the wife of a shoemaker, who had
two girls and one boy; the other was the wife of a tailor, and had three girls. . It
will also be interesting to state, in reference to triplet births, that in all the other
districts of England, out of 477,637 births in 1845, only seventeen instances of
females who had three children at a time are recorded; whilst not more than two
examples of quadruple births were met with in the same year throughout the whole
of England; one being the wife of a cowkeeper at Croydon, who had one boy and
three girls; the other case was the wife of a draper at Haslingden, in Lancashire,
who bore four boys at the same accouchement. It has been alleged (and I suspect
truly), that the proportion of plural births is much greater among the Irish than
the native English population.
1120 THE HEALTH OF LONDON.
leaving only 130 cases in which the age was not stated. These facts
incontrovertibly show that more children than adults die in this great
metropolis, notwithstanding the often dangerous and even insalubrious
character of the occupations in which the latter are engaged, and their
being further exposed to many causes of disease, to which children are
rarely subjected.
Several of the complaints which usually prove fatal to children, such as
scarlatina, measles, hooping cough, and convulsions, having been already
mentioned, it would be superfluous again to discuss these maladies. To
one cause of death, however, on which I offered some remarks in my last
report,' I would again specially call attention. I mean “the privation
of breast-milk”—the natural food of infants. From this cause, not
fewer than eighty-nine infants are reported to have died in London
during the last six months. And when it is remembered that, during
the parallel six months of 1849, the number of deaths from the same
cause, amounted to 111, it is at least somewhat consolatory, that the
number has thus recently decreased. Having specially adverted to the
great annual mortality amongst children, in my former report, I will
only now repeat, that the subject demands serious attention, as it shews
that there are sources of disease affecting this interesting class of the
community, which do not produce the same lethal effects upon indivi-
duals in more advanced life; notwithstanding the many influences
injurious to health to which the latter are constantly exposed.
WIOLENT DEATHs. The number of persons who every year lose their
lives in London by violence or accidents, is much greater than would
probably at first be imagined. During the last six months, 769 indi-
viduals are reported to have died violent deaths in the metropolis, which
makes one case in nearly every thirty of the whole mortality. Of the
above 769 violent deaths, 268 were produced by fractures and contusions;
155 were drowned; 89 died from burns and scalds; 51 by poison; and
37 by wounds; besides other casualties, which it would be superfluous
to particularise.
In reference to the subject of violent deaths, it may be interesting,
although rather a digression from the immediate subject of this paper,
to allude to the marked discrepancy usually noticed amongst two classes
of men, in regard to their comparative liability to accidental death; I
mean soldiers and sailors, not only in London, but throughout the whole
of England. As it is impossible, when discussing this point, to quote
recent occurrences, the peculiar facts, met with of late years, not having
yet been published, I must refer to a former period, viz. 1840; which
will however answer every purpose, and also sufficiently illustrate the
question.
Sailors are no doubt more numerous in London than soldiers, besides
being frequently changed, by arrivals and departures: yet it is curious,
that only four soldiers out of about 5,000 men, including Woolwich,
lost their lives by violence throughout the entire metropolitan districts,
during the year 1840: one being killed by a fall, and another by a
horse, whilst the causes of the remaining two deaths were not specified.
On the other hand, the number of sailors within the same category,
1 LONDON Journal OF MEDICINE, June 1850, p. 543.
BY JOHN WEBSTER, MI. D., F. R. S. 112 |
amounted to 64; of whom 37 lost their lives by drowning. The
difference is even more remarkable if the whole of England be taken
into account. Only eleven soldiers died by violent means beyond Lon-
don; whereas, the deaths from violence among sailors in the same
districts, amounted to 282; of whom 209 were drowned. The aggre-
gate number throughout the whole kingdom, was thus 15 soldiers and
346 sailors; of whom 226 were drowned—not at sea, it should be
remembered, but in the rivers and harbours of England and Wales.
Of the eleven cases of violent death among soldiers, six occurred in
the counties immediately round London, two in the eastern parts of
England, two in Cheshire and Lancashire, and one in Wales; the
immediate causes of death being drowning in six; injuries by horses in
three; falls in two; and poisoning by opium in one. The causes of the
remaining three are not specified. These statements are very singular,
and demonstrate the much greater safety of a soldier's life in England,
compared with that of the sailor. The facts also indicate the good con-
duct and discipline of the British army; and I will venture to affirm,
that in no other country have 30,000 military passed an entire year
with the loss of only fifteen men by violence ; not one of whom died
either by lead or steel. Viewed in every way, this statement, founded
on authentic documents, is highly gratifying; and it seems so different
from what most persons would expect, that it has appeared deserving of
being here recorded, and especially noticed.
MoRTALITY AMONG THE PAUPER PoPULATION. Amongst the 22,816
deaths registered during the six months embraced in the present narra-
tive, nearly one-sixth, or 3,549, took place in the prisons, hospitals,
workhouses, and other public eleemosynary institutions; thus shewing
that 15.61 per cent of the total mortality occurred among the pauper
population. It is also instructive to state, that the majority of the above
patients were men, the number being 2,099, and only 1,450 women;
which is more remarkable, as the lunatic asylums, comprised in this
category, contain more female than male inmates.
PRISONs. The prisons of London have lately exhibited a degree of
health much superior to their condition during the last century. Indeed,
few places appear to be more free from disease; and this doubtless
arises from the sufficient and wholesome dietary, and the discipline to
which the inmates are subjected, besides the diminished influence of
vice and intemperance. During the last six months, only forty-four
deaths have been reported from all the prisons of the metropolis; thirty-
five being men, and nine women. This constitutes a very small mor-
tality amongst so numerous a body as the London prisoners, the number
of whom, according to the most accurate accounts, recently amounted to
6,113; 5,483 being males, and only 630 females, the greatest propor-
tion of both sexes being criminals. The chief exceptions were inmates
of the Queen's Bench Prison, and the debtors of Whitecross-street, in
which two places, 384 prisoners were then confined. . From the above
data, it appears that one death occurred in every 1564 male prisoners,
and one in every 70 females. It should be also remembered, that the
inmates were often changed by the committal of new offenders, and the
release of those prisoners whose period of confinement had expired;
-
1122 THE HEALTH OF LONDON.
nevertheless, I believe, so low a rate of mortality will rarely be mét
with amongst any other class of persons. To shew the great salubrity
of the London prisons, it may be stated, that among 10,015 prisoners
committed to the House of Correction at Coldbath Fields, up to a
very recent date, there had only occurred six deaths; being not more
than one fatal case in every 1669 inmates.
One remarkable feature ought to be here especially mentioned, in
reference to the metropolitan prisons. However beneficial confinement
in such places may really prove to the bodily health of the inmates, it
sometimes appears to produce an opposite effect upon their mental con-
dition; particularly in those undergoing solitary or separate punishment.
This baneful influence is fully established by the fact, that from two
London prisons, viz., Pentonville and Millbank, where only convicted
criminals are confined, 61 prisoners were sent to Bethlehem Hospital
during the last ten years, who had become insane; 47 being men, and
14 women; besides four men who came from the hulks, but had pre-
viously resided in Pentonville prison. In addition to these sixty-five
individuals, several male and female prisoners have been also admitted
from other gaols as lunatics into Bethlehem Hospital, although to a
much smaller extent. The effect of confinement in prison upon the
mental faculties, is hence very decided; and it should be remembered,
that the above 65 cases of insanity sent from the metropolitan prisons,
and now reported, were not persons acquitted because they were insane,
but prisoners actually undergoing sentence for previous crimes and
misdemeanours.
LUNATIC ASYLUMs. During the last six months, the deaths in the
metropolitan asylums for the insane, whose average population is about
3,527, consisting of 1,573 male and 1,954 female lunatics, amounted to
171; 96 men and 75 women; being one death in nearly every 16 male,
and only one in every 26 female lunatics, during the last half year.
This seems a moderate rate of mortality, especially amongst the female
lunatics, who are also the most numerous. These facts are the more
interesting, as they prove the correctness of an observation which I have
elsewhere made, and which was based upon extensive data, that mania,
although more common among women, is in them more curable and less
fatal than among men. Female maniacs, moreover, are likely to attain
greater longevity than male lunatics.
LYING-IN HOSPITALs. At lying-in hospitals, which sometimes present
a very high degree of mortality, the number of deaths has been coin-
paratively small during the last six months; only 18 fatal cases of
child-birth having occurred in the four public establishments of that
kind in London, most of which happened during the first quarter of
º To the 18 deaths of mothers, must be added those of 12
children.
GENERAL HospitaLs. From the eleven General Hospitals of the
metropolis, there has been reported nearly one-third of the total num-
ber of deaths referred to in a previous paragraph, as forming the gross
mortality amongst the pauper population. The actual number of deaths
was 1,051, during the last six months. They may be thus classified,
to enable readers to form their own opinions.
BY JOHN WEBSTER, M.D., F.R.S. 1123
STATISTICAL TABLE OF DEATHS IN THE FLEVEN GENERAL HOSPITALS OF
LONDON DURING SIX MONTHS TERMINATING SEPTEMBER 28, 1850.
(COMPILED BY DR. webstER.)

Hospital. ...] ...|Rººm"
St. Bartholomew's................................. 580 180 || 1 to 34
Guy's ................................................ 580 164 || 1 to 3%
St. Thomas's ....................................... 487 115 1 to 44
London ............................................. 320 120 | 1 to 23. d
St. George's ....................................... 320 106 || 1 to 3
Middlesex .......................................... 285 86 || 1 to 3 1-5 |
Westminster ....................................... 175 78 || 1 to 2+
Free ................................................ I40 22 || 1 to 6,
King's College .................................... 120 66 || 1 to 18-16)
Charing Cross .................................... 110 36 || 1 to 3 1-18
University College................................. 106 78 || 1 to 1;
Totals ..................... 3223 1051 || 1 to 3 j-14T
According to the above statement, some very useful data, both in
reference to the mortality met with amongst a certain class of the com-
munity, and also to the amount of accommodation available in Public
General Hospitals for their treatment during sickness, may be now
brought under review. Few persons would perhaps believe, that in a
population of 2,300,000, there are at present only 3,223 beds for the
indigent sick in all the General Hospitals of London, exclusive of the
special institutions for particular diseases, such as fever, small-pox, and
consumption; but such is the fact. Many of the inmates of these chari-
table establishments are not always of the indigent classes, but persons
sometimes in easy circumstances, or domestic servants from the houses
of governors, and even of noblemen, and also petty shopkeepers; nay,
patients sent from the country, who thereby incur expense. Hence, it
appears, that the actual sick poor of London are not the exclusive par-
ticipants of the benefits of these institutions. Taking the matter
nevertheless as it exists, and looking only at the data contained in the
table now supplied, and which has been compiled with every desire to
ensure accuracy, the following inferences may be legitimately deduced:
1st. One death in every 21-75 of the total mortality throughout London, or
4:60 per cent, took place in the eleven general hospitals, during the last
six months. 2nd. One patient died for nearly every three beds, speaking
in the aggregate. 3rd. The highestrate of mortality generally occurred
in the smallest hospitals. 4th. With one exception, the lowest compa-
rative ratio of deaths was observed in the large or more populous insti
tutions. 5th. The fewest deaths, in reference to the published number
of beds, was reported from the Free Hospital; and 6th. The largest
comparative mortality, according to the same calculation, occurred at
University College Hospital.
On the other hand, when comparing one hospital with another, it is
curious to observe, that the mortality was nearly the same at St. Bartho-
lomew's and Guy's, the two largest institutions of the kind, and having
each the same number of beds, viz., 580. Again, at St. George's and
the London hospitals, each having 320 beds, one being situated at the
west end of London, the other at the east, where an immense number
of serious accidents constantly occur, and certainly very many more

l 124 THE HEALTH OF LONDON.
than in the neighbourhood of Piccadilly, there is not much differ-
ence in the rate of mortality. This is, however, in favour of the latter
hospital, although still inferior to the Middlesex, St. Bartholomew's, and
Guy's, but especially to St. Thomas's Hospital, where the ratio of mor-
tality was less than at any other similar institution, with the sole excep-
of the Free Hospital, as previously stated. I am fully aware that these
calculations must not be taken as absolutely free from all fallacy, since the
admissions of patients may be more numerous at one establishment
than at another. But I think that this argument, if it has any force,
would rather militate against the smaller and more modern hospitals, to
which letters of recommendation from a governor, unless for accidents,
are often required to ensure the reception of an in-patient; while
at the two ancient Royal Hospitals of the city, and at Guy's, where the
rate of mortality has been found to be lower, the facility of admission is
greater, and the applications, consequently, likely to be more numerous.
The subject here mooted, is both so important and instructive, that it
deserves further inquiry; indeed, it is solely with that object I have
now made these imperfect remarks, and based them upon the numbers
contained in the average table; which, I believe, is the first ever com-
piled in illustration of the results obtained at the eleven general hos-
pitals of London, viewed comparatively."
Before taking leave of the London Hospitals and their recent mortality,
I must remark, that few documents would prove more useful to the
medical profession, than a well-arranged yet succinct general statement
of all the facts and agenda noted in each separate institution, combined
and classified in an uniform, systematic, but not too complex a manner.
If from the country hospitals and infirmaries, as well as from the metro-
politan, similar statements were annually made, the accumulated facts
would materially tend to dissipate many erroneous opinions and specu-
lative doctrines, which could not then withstand the counteracting
influence of sound practical experience, supported by, and based upon,
numerous facts verified by repeated observation. General hospitals
ought to follow the excellent examples now set by many lunatic asy-
lums; the authorities of which annually publish a report of their pro-
ceedings, both lay and professional, accompanied by numerous, varied,
and often useful tables respecting the patients under treatment, the cha-
racter of their particular maladies, the results obtained, and often highly
important statistical data, besides other matters of much interest and
practical value. Every hospital and infirmary throughout the country
should do this; and if some master mind would take the whole facts
thus supplied, and arrange them in a lucid and instructive manner, the
great desideratum adverted to, would be effectually supplied. If docu-
ments of the kind described had been regularly issued by the authorities
of the different London hospitals, detailing the chief res gesta, when the
Potts, the Hunters, the Baillies, the Abernethys, and the Coopers were
attached to these institutions, the facts collected by such eminent men
would be invaluable to the modern practitioner. Nevertheless, were
* The basis upon which Dr. Webster's conclusions are founded, as to the mortality
of the different hospitals, is open to some objection ; but his remarks are likely
to be useful, by inducing the authorities to afford better data. In the mean time,
we refer to our report of the discussion at the Society where Dr. Webster's paper
was read. EDITORS.
BY JOHN WEBSTER, M.D., F.R.S. I 125
the plan carried out for the future, particularly whilst there are many
distinguished physicians and surgeons on the medical staff of those
establishments, great benefits would thus accrue, not only to all now in
practice, or entering the profession, but to posterity. Let us take, as
an illustration, hernia or fractures, about which considerable difference
of opinion sometimes prevails in reference to the treatment. Could the
surgeon easily refer to a large array of cases reported by the ablest
practitioners of ancient and recent times, much of the present discre-
pancy of opinion on such a subject must give way before the weight of
evidence derived from such sources. The treatment of medical diseases,
likewise the value of particular remedies, the symptoms characterizing
epidemics, the types of even ordinary maladies, the rate of mortality
observed, and many other interesting questions, would be all greatly
elucidated by the system here suggested. I therefore hope the parties,
who have the power, will take the subject and plan now suggested
into consideration, and by an united effort remove every difficulty
which might retard its realisation. It gives me pleasure here to state
that the authorities of some of the great metropolitan hospitals have
recently ordered, and secured for the future, faithful records of all the
cases admitted within their walls, which I hope will be published.
Edinburgh and Glasgow, however, deserve in this respect greater
honour, as from their very institution they set this noble example.
In the Edinburgh Infirmary, clinical reports are preserved from the
first opening of the hospital; and indeed it was from the clinical
teaching within the infirmary, that the Edinburgh School of Medi-
cine arose : that school so long pre-eminent and still illustrious in
Europe. The usefulness of a long series of such records is well
illustrated by Dr. James A. Lawrie's paper on the “Results of Ampw-
tations,” published in the London Medical Gazette for 1840, which
contains an analysis of all the amputations performed in the Glasgow
Infirmary from its institution in 1794 to 1839 : as well as by the truly
valuable and elaborate series of Essays entitled “Contributions to the
Statistics of Injuries of the Head” published by the same accomplished
surgeon, in conjunction with Dr. Alexander King, in the annual
volumes of the Edinburgh Monthly Journal for 1843 and 1844. These
Essays embrace an analysis of the nature and the treatment of all the
cases of injury of the head admitted into the Glasgow Infirmary from
1794 to 1841. The pathological and statistical records of the Edin-
burgh Infirmary, I would just add, were placed upon a nearly perfect
system by the late lamented Dr. John Reid; and the same afterwards
has been successively maintained by his industrious and talented suc-
cessors, Dr. T. B. Peacock, Dr. Hughes Bennett, and Dr. W. T.
Gairdner. If great scientific treasures have been accumulated by the
good order prevailing in two comparatively small and poor northern
hospitals, what are we not entitled to demand from the richly-endowed
and vast establishments of Guy, St. Thomas, and St. Bartholomew 21
ExcEss of BIRTHS over DEATHS. Similar to the facts stated in my
* I would here mention with pleasure, that good statistical and clinical registers
have been kept for several years past in the Hospitals of Nottingham and Oxford.
I have also reason to believe, that the same laudable system is followed in other
provincial hospitals.
l 126 THE HEALTH OF LONDON.
former report, a considerable excess of births over deaths, amounting to
13,542, has taken place during the last six months. The increase reported
in the first three months of the above period was 7,064; but in the quarter
ending the 28th of last September, it was only 6,478. This arose, both
from the mortality being then rather greater by 568 deaths than the pre-
ceding quarter, and also from the circumstance that more children were
born during the months of April, May, and June, than in the subsequent
season. This result is consistent with ordinary experience, as births
are always more numerous in London during the early months, and
spring of the year, than afterwards. The excess of births over deaths
in the metropolitan districts, referred to in my previous report, having
been 10,128 in the six months, it thus appears, that the total excess
has been 23,670 throughout London during the past year. This fur-
nishes one cause, amongst others, of the constant increase of the
enormous population now resident in the British metropolis.
ATMOSPHERIC INFLUENCE. During the whole six months embraced in
this report, the weather, although rather cold for the season, was seldom
marked, with only a few exceptions, by great fluctuations of tempera-
ture. The greatest variation was on the 1st of June, when the ther-
mometer indicated 78.1 as the highest degree of heat, and fell to 48.8
at night; thus making a difference of more than 34 degrees. The
above was, however, a rare instance, the variations throughout the entire
period being very moderate, or, to speak generally, 19 of the 26 weeks
now referred to, were characterized by an unusual equality of tempera-
ture, both by day and night; whilst only 7 weeks of the same period
indicated any considerable fluctuations, chiefly in the months of May
and June. The temperature was never very high at any period, having
only six times exceeded 80 degrees during the first three months; and
on only seven days during the last quarter. The highest noticed
throughout the whole period, was 87° on the 16th of July : during the
night of that day, however, it fell to 60°3.
The medium pressure of the atmosphere was somewhat low, during
the months of April and May, being frequently under 29} inches, but
on one occasion only, viz., the 4th of April, was it below 29 inches.
During the second quarter, the barometer ranged higher than in the
former period, having very seldom fallen under 29% inches. Indeed, it
was generally near, or even above, 30 inches, especially throughout the
last days of August and the greater part of September. Thus, during
twenty days continuously, ending the 17th of September, which, it
should be remembered, included the days parallel to those which I have
called the “black week” of 1849, the pressure of the atmosphere was
always high, never being under 30 inches, and sometimes above 30°25.
This makes the atmospheric pressure to range, on an average, about four-
tenths of an inch higher than in the similar weeks of 1849; the wind
being at the same time generally north-west or north-east, having also
considerable movements, whilst the temperature was low, but not
variable.
During this period likewise, the greatest difference betwixt the day
and night temperature was 27, although sometimes the alternation was
only 14:13, and occasionally only 8 degrees. Electricity seemed often
positive ; notwithstanding the weather continued dry, the sky was fre-

BY JOHN WEBSTER, M.D., F.R.S. 1127.
quently overcast. These particulars may be well contrasted with the
description of the atmospheric phenomena at the same period of 1849,
and given in my last year's report, when London almost resembled, as
it were, a pest-house.
At that period, the atmosphere produced an oppressive and ungenial
feeling upon the human frame; the sky was always hazy, and, at times,
appeared like a thick mist, the air being generally very dry; scarcely
any wind prevailed, and when it did, the direction was often south-west
or southerly, with diverging currents, while this year it was north-west
or north-east, blowing more freely, and without diverging currents.
Farther, the most remarkable feature observed in September 1849, in
reference to the atmosphere, was the frequent and daily very extensive
fluctuations exhibited by the thermometer, the alternations being some-
times so high as 30 degrees, between the warmth of the day and night-
time; whilst the lowest temperature, in the previous month of August,
was 42, the highest being 82, thus giving a difference of 40 degrees.
These are instructive phenomena, and may in part account for the great
discrepancy noticed in the two seasons; 8,844 persons having died in
London during the three weeks ending the 15th of September, 1849;
whereas, during the parallel three weeks, ending the 14th of September,
1850, only 2,710 deaths are recorded; thus making a diminution of
6,134 in the short space of twenty-one days, or to less than one-third of
the previous mortality, in favour of the recent season.
Besides the peculiar features just described, as characterizing the re-
cent healthy season, it should be likewise mentioned, that the sky lately
was seldom clear or cloudless, being frequently overcast; the wind was
generally west or westerly, north or north-easterly, but very rarely south-
erly. The weather was not dry, unless in the early part of September,
since frequent showers prevailed ; electricity was often positive; whilst
the summer and autumn of 1849, it should be always recollected, were
the driest known for upwards of thirty years. The more recent season
shewed, as already stated, greater equality in temperature, the move-
ment of the wind being quicker, and from a salubrious quarter; whilst
the amount of electricity seemed more apparent, and was oftener positive
than in the previous year. *
I am fully aware of the difficulty of making exact observations respect-
ing the influence of atmospheric phenomena, in the production and
modification of diseases, or in deducing therefrom correct conclusions;
but being anxious to bring this important subject before the profession,
in order to move other and more capable observers to pursue the inquiry,
I have here, as in previous reports, given the result of my own limited
experience. In this, as in every other scientific investigation, correct
knowledge can only be obtained by repeated and numerous observations,
carefully made by various individuals. As an illustration of the
influence which even changes of temperature frequently exert upon the
human frame, it is only necessary to observe, that a sudden fall of one
or two degrees of the thermometer, especially in the night-time, will
cause death in many patients, who otherwise might struggle on a little
longer, were the temperature less variable. Again, every person knows
the effect of the east wind in this country; the bis and mistral in the
south of France; the bitter piercing tramontano of Rome; the sirocco
of South Italy; the solano in Spain; besides the cold winds from Siberia;
II 28 THE HEAT TH OF LONDON.
the hot blasts from the sandy deserts of Africa; or the north-west winds
that blow from the marshy Pampas of South America, and which often
prove injurious to health, even in the much-lauded climate—as it is so
named—of Buenos Ayres. In London, the east and north-easterly
winds are dry and insalubrious; the south and south-westerly, humid
and unhealthy; the north is often followed by inflammatory diseases,
whereas the west and north-westerly breezes, although usually accom-
panied by dry and clear weather, are much more healthy and beneficial;
both to mind and body, than winds blowing from any other quarter of
the hemisphere.
LoNDON NOT INSALUBRIOUS As A PLACE OF RESIDENCE. Many persons
are in the habit of visiting Bath, Cheltenham, Brighton, Tonbridge,
and other places of repute in public estimation, under the notion that
London is less salubrious, as a residence, than these fashionable locali-
ties. Not intending to examine the comparative merits of the different
places now named, I shall confine my present remarks to the metropolis,
which appears, from the facts stated in previous pages, to have been
recently by no means insalubrious. Living in London is not per se
unhealthy; it is the manner of life followed by those who dwell in town
which so often proves inimical to the health of its inhabitants. If the
dictates of nature were more frequently followed, and if common sense,
aided by experience, were oftener made the rule of conduct proper to
be pursued by individuals, in regard to everything connected with
health and hygienic measures, much less sickness would prevail; whilst
the strength of our physical frame, and the condition of our intellectual
faculties, would be both greatly improved. More restless spirits or
novelty seekers, sometimes others as a mere pretext, go abroad in search
of health, or thus endeavour to avoid the variable climate of Eng-
land, which they, from sheer ignorance, call unhealthy. But there can
be no doubt as to the superiority of London as a healthy place of resi-
dence, when compared with almost any metropolis in Europe, or even
any large town on the continent. The superiority over other places, or
the reverse, in a different point of view, is not now the question; but
simply the proved salubrity of the capital of Britain as a residence.
Thus, in London, the annual ratio of deaths amongst the whole com-
munity, is one in every 42 inhabitants; in Manchester, one in 26-5 ; in
Edinburgh, one in 25.6; where, however, the deaths, in 1847, even
reached the frightful proportion of one fatal case in every 20:9 of the
population, being chiefly from the great fatality of typhus fever. In
Liverpool, the ratio is, on an average, one death in every 23:6 of the
inhabitants; whilst in Glasgow, the mortality is so high as one in 21:9
of the population, or double that of London. On the continent of
Europe, the difference is equally remarkable; seeing that in Berlin,
built in a sandy plain on the banks of the sluggish Spree, the annual
rate of mortality is one in every 34 inhabitants; in Dresden, one in
31-27; in Palermo, one in 31; in Paris, one in 30-50; in Naples, one
in 28; in Brussels, one in 26; in Rome—far famed as a refuge, but
often a grave for invalids, one in 25; in Amsterdam, which is constructed
on piles, and intersected by canals full of stagnant water, one in 24;
and in Vienna, it is one in 22 of the entire population; which, doubt-
less, is owing, as at Glasgow, in many respects, to the low and damp
BY JOHN WEBSTER, M.D., F.R.S. 1 29
situation of the city, from being near the banks of a large river like the
Danube; whilst there is often a burning Sun during summer, alternating
with storms; and in winter, frequently, cold winds that blow from the
neighbouring Carpathian mountains.
Besides the several capitals just named, I may also mention Constanti-
nople, so much lauded for its Golden Horn, splendid Bosphorus, and its
magnificent surrounding country, as by no means a salubrious residence.
This arises, in addition to local influences inimical to health, from the
great and sudden variations of temperature, even to the extent of 30
degrees, which often prevail between mid-day and sunset; being some-
times even greater at night. Besides this powerful cause of disease,
the Kara Yell, (or black wind,) that blows from the north or north-east,
and so sweeps down from the Balkan range, or from over the Black Sea,
having been previously rendered as cold as ice by passing over the
Caucasus mountains, produces severe effects upon the health of the
inhabitants of the Turkish metropolis, in which plague and pestilence
also prevail.
In North America, where the term of human life is shorter than in
Europe, and the “go-a-head” system applies to animal as well as commer-
cial existence, the diminished duration of life is even more obvious. In
New York, for example, where a person is almost roasted in summer
and frozen during winter, the ratio is, on an average, one death in every
23 inhabitants; whilst severe epidemics and even yellow fever are not
uncommon, when the mortality is much augmented. But, however un-
healthy New York may appear, it is almost an Elysium in comparison
with New Orleans, which seems the pest-house, or Sierra Leone of the
United States. In this city, situated on a lower level than one of the
largest rivers in the universe, the Mississippi, which is only kept from
submerging the whole district by immense dykes and artificial embank-
ments, the gross mortality in 1849 was one death in every 10-66 of the
inhabitants. Subtracting, however, the 3,548 fatal cases of Cholera
which occurred last year, the mortality from ordinary diseases still
reached one in 16-68; but as that epidemic malady always diminishes
the amount of deaths from other causes, it will be much nearer the
mark to reckon the mortality of New Orleans about one in 14 ; or treble
that of London. In fact, the former city may be almost likened to an
hospital for the sick; because, where so many individuals die annually,
those labouring under disease must be always very numerous; and it
thus appears probable, that the entire population are swept away and
replaced every fourteen or fifteen years. Such destruction of human
life is unheard of throughout Europe; whilst in England, the ordinary
results are very different, even in the most populous, worst drained,
or filthiest locality in any part of the whole empire.
Situated on rather elevated ground, upon a gravelly foundation, with
frequent declivities, London is by no means unfavourably placed in
respect of salubrity, especially on the north bank of the Thames, and
towards the west; the southern districts are, however, very different.
Although favoured by many natural advantages, the metropolis has
been, nevertheless, deteriorated in some respects as a healthy residence
by various objectionable proceedings, into which I will not now again
enter at any length, having alluded to the subject in former reports.
Still, when it is remembered that the river Thames, otherwise so im-
1130 , THE HEALTH OF LONDON.
portant, has become the “Cloãca Maxima” of London, and that it
carries off the exuviae of its immense population, it is marvellous
that matters are not much worse. The innumerable nuisances which
are so often created, prove also most injurious to the public health.
Some of these might be mentioned; as, for instance, the manufactory
of artificial manure close by the Spitalfields workhouse, containing 400
children and a few paupers. Here bullock's blood and night soil were re-
cently desiccated by the dry heat of a kiln, thereby causing a most power-
ful stench, which produced severe typhoid fever and other diseases of an
intractable form. Again, in the “Potteries” near Kensington, 3,000
pigs were kept ; and the process of fat boiling was also carried on so ex-
tensively, that the atmosphere became tainted for half a mile round ;
whilst the hovels for the inhabitants could scarcely have been surpassed
for filth and misery by anything known in Ireland. But even in aristo-
cratic neighbourhoods, the best means to improve the salubrity of a dis-
trict are not only neglected, but schemes are occasionally proposed which
would have an opposite and injurious tendency. The parks—justly called
the lungs of London,-St. James's and Kensington Gardens, for example,
are encumbered with trees, whilst further additions are sometimes made
injudiciously, so that free ventilation is interrupted, and damp engen-
dered in localities, where the light of the sun and the winds of heaven
ought more freely and constantly to penetrate." Besides neglecting
such matters, it was actually intended, in the summer of 1849, to spread
over the surface of Hyde Park the filthy contents of the great common
sewer which passes through its centre, in order, it was said, to have
more grass for the cows there grazing, the scheming projectors never
thinking of the lungs of those Londoners who might come here with
the intention of breathing the pure north-western breeze, but, in reality,
to sniff the mephitic exhalations produced by such contemplated irri-
gations. Fortunately, a strong representation in the proper quarter
prevented the proposed abomination, just when all the machinery was
completed, so that the absurd proposal was never carried forward;
although a memento still remains of the original idea, in the shape of
a huge iron pump with a large handle, which now points towards the
field of its projected, but hitherto abortive, operations.
I will now proceed to make a few observations on some circumstances,
the judicious or improper application of which materially influence the
health of individuals, and hence of communities. I allude to, 1. Food;
2. Clothing; 3. Habits or Customs; and 4, Bodily Exercise.

FooD. Although many individuals in London may sometimes not
have sufficient food for proper nourishment to support their physical
frame, others exist who would enjoy often much better health, were they
more careful in regard to dietary. This truth particularly applies to
children and persons of sedentary habits. The quantity of animal food
which many of these parties consume, is far beyond the requirements
of nature; hence arise stomach complaints, visceral congestions, and, in
old people, apoplexies, paralysis, with other maladies occasioned by
1 A great improvement would be effected, if the high wall on the north side of
Kensington Gardens were replaced by an iron railing, so that the wind might blow
freely through the trees to dry the gravel walks and grass, the dampness of which
greatly diminishes the pleasantness and Salubrity of this promenade.
BY JOHN WEBSTER, M.D., F.R.S. 1131
their full habit of body, and from their blood being too much animalised.
Even when of good quality, and taken in proper quantity, food often
proves prejudicial to health by improper and imperfect cooking; acting
as a very common cause of dyspeptic complaints, which are so frequent
in this country. All kinds of provisions, but especially animal food,
are generally of much better quality in London than elsewhere; but,
being often injudiciously cooked and badly prepared for digestion. they
are not so beneficial as they would otherwise prove. Much attention is
given in England to the rearing of animals as food for the inhabitants;
and societies exist, by whom prizes are awarded to the producers of fat
pigs and overgrown oxen; but no rewards are ever given, or public
encouragement held out, to teach persons how to cook properly and
economically. This is a great desideratum. Were more attention
generally given to the manner of preparing even ordinary articles of
diet (especially for young and debilitated persons), better bodily health
and greater mental activity would be ensured.
The victuals and beverages best adapted for individuals, vary according
to their constitutions and occupations; but it may be stated as a general
rule, that the man who is much engaged with bodily labour in the open
air, requires more nutriment than an intellectual person of sedentary
habits. *
CLOTHING. Many persons, but especially children and females, suffer
in health from inattention to covering their bodies properly and equally.
Bare necks in females, uncovered arms, legs, and throats in children,
prove always most hazardous to health, and, along with other obvious
causes, materially contribute to the larger amount of sickness and death
which occurs amongst these two classes of persons than among adults.
The partial and improper mode of clothing the susceptible physical
frames of children, is sometimes attempted to be justified by the most
absurd of all reasons, that their constitutions will thereby be hardened.
Such a proceeding does certainly try the strength of their powers of
resisting disease; but, although some may escape unscathed, many fall
a sacrifice.
The system of tight lacing in females, which fashion sanctions,
although reason and experience strongly condemn, likewise proves fre-
quently detrimental to health, by impeding the free action of the lungs
and heart; whilst the equally important abdominal organs,—the liver,
stomach, and other viscera,_are thereby displaced, and even forced
down upon the pelvis. This is not an exaggerated, but a true picture.
Such distortions of the graceful forms of the fairest portion of creation,
must fill every admirer of the beautiful in symmetry with distress and
astonishment. If Cleomenes, the sculptor of the Venus de Medici,
if Pheidias, Praxiteles, or any of the great Grecian statuaries, whose
works of art have been the admiration of every succeeding age, were
to revisit the earth, and frequent the fashionable European world of
1850, with its boasted civilization, they would indeed be astounded !
UNHEALTHY HABITS AND CUSTOMS. The middle and upper classes in
Great Britain are decidedly much more temperate in their habits than
formerly; and instances of intoxication are now very rare exceptions.
But among the lower ranks, and even among the very poor, intemper-
WOL. II. ’74
1182 THE HEALTH OF LONDON.
ance is too often met with, as shewn by the number of well-frequented
gin-palaces. The fiery spirit there imbibed acts as a frequent and
powerful cause of disease in the physical frame, and also, too often
proves destructive to the mental faculties.
But although intemperance in spirituous liquors be almost unknown
in certain ranks, a vice appears to have taken its place, which I think
as great an abomination, and equally destructive to health, namely,
tobacco-smoking, especially amongst the younger portion of the male
population. Dyspepsia, nervousness, paralysis, and madness, may be
confidently enumerated as some of the evil consequences produced by
the use of this narcotic and poisonous weed. Many medical practi-
tioners in this country know well, that the health and constitution of
persons are frequently injured by smoking tobacco. In North America,
also, the subject has occupied the attention of several physicians, who
have written against this habit, as well as against the vice of intem-
perance by ardent spirits. Indeed, insanity has been so often traced
to the operation of tobacco, that it is now one of the recognized causes,
like opium and ardent spirits, of that severe malady; and it has been
prohibited in several American lunatic asylums. How men of intellect
and education should ever be induced to adopt this filthy, health-destroy-
ing, and vulgar custom, so common amongst cab-men and pot-house
frequenters, is to me astonishing. In this, however, as in other cases,
fashion and example prove, unfortunately, too powerful against reason
and experience.
Another injurious custom, which prevails chiefly among females and
children in the middle and upper ranks, deserves also some notice.
I allude to the greater consumption of tea at present, than formerly,
éspecially at unseasonable hours, and when the stomach is empty;
because an infusion of tea, and still more so if made with green, then
acts more powerfully upon the nervous system. The practice of
taking such a beverage, which acts upon the nervous and circulating
systems of individuals, an hour or two before dinner, and which has
recently become fashionable amongst ladies, is highly prejudicial to
health, however grateful it may be to the palate at the time. Like
tobacco-smoking amongst men, or opium inebriation, so common in
Turkey and China, the practice of drinking tea in the manner described
should never be sanctioned. At breakfast, when solid food is also taken,
the effect is different, as digestion is then promoted, and any deleterious
effect which tea might otherwise produce upon the nervous system is
materially counteracted. Nevertheless, as the physiological action of
this aromatic leaf is that of a nervous excitant and cordial, it hence
produces various forms of neuralgic pains, affections of the stomach,
with other disorders of the viscera, which often baffle all treatment,
unless the cause now adverted to be removed.
However injurious tea may thus sometimes prove to adult persons,
it becomes in a higher degree detrimental to children, and young
people, from exciting their more susceptible nervous and cerebral
systems. When taken habitually under such circumstances, it excites
and renders irritable their physical constitution, by unduly developing
the cerebral structure and its functions; hence, I consider, this beverage
should be put almost in the same category with tobacco, opium, ardent
BY JOHN WEBSTER, M.D., F.R.S. 1133
spirits, or wine, and ought never to be allowed to very young indivi-
duals, unless as a medicine.
ExERCISE. Many persons in London, as elsewhere, have plenty and
frequently more than sufficient muscular movement that might be
called exercise, in one sense of the expression; but unfortunately, being
often in confined or unhealthy localities, and sometimes when em-
ployed in deleterious trades or occupations, their exertions become toil
and exhausting labour. In the metropolis, although many individuals
are obliged to work to procure daily bread, others pass their physical
if not moral existence in indolence, which becomes doubly detrimental
to health, if accompanied by luxurious living and repletion. Similar
consequences also ensue where the mind is exhausted or long kept in a
state of tension, and especially if the party breathe an impure, confined
atmosphere. Indeed, numbers may be met with, whose general health
and mental vigour would be much improved, were they to take more
bodily exercise, and be oftener in the open air. Fewer dyspeptic and
bodily ailments would prevail, if the above useful precept were followed.
Allusion has been already made to the public parks of London, which
are denominated the lungs of the metropolis. The expression is correct,
although figurative ; but it is astonishing how very little practical ad-
vantage is taken of the privilege which they afford to the inhabitants of
breathing their pure breezes which, especially in the morning, are so
conducive to health, as the atmosphere is then untainted by dust or
smoke. A walk before breakfast in any of these promenades, will at once
establish the truth of this remark, and show the inactive habits of the
adjacent neighbourhood, especially of the younger and female part of
the population. This neglect conduces to the greater amount of sick-
ness and impaired health noticed amongst them, contrasted with that
of the male portion of the community. Undoubtedly, the human frame
may have both too little, as well as too much bodily exertion. In this,
as in diet, extremes should be always avoided, since to no point more
than to either of the above questions is the well-known and truly philo-
sophical axiom, “in medio tutissimus ibis”, in a higher degree appli-
cable. To this it may be also added, that as the physical constitution
of man often wastes from the want of sufficient muscular movement, so
will the nervous organization, on other occasions, become exhausted or
worn out by excessive toil, as well as from too great mental excitement.
24, Brook Street, Grosvenor Square, November 1850.
7.4 2
1184
ON THE EXISTING STATE OF OUR KNOWLEDGE OF
WACCINATION AND REVACCINATION, AS
PREVENTIVE OF SMALL-POX.
By ALEXANDER. KNOX, M.D., Physician to the Dispensary, Strangford,
County Down, Ireland.
(Concluded from page 1051.)
AN argument, derived from the alleged composition of the lymph,
might have been advanced, in confirmation of the identity of the Vaccine
and Variolous Diseases, but it has been designedly omitted as prema-
ture, until the existence of the phenomena, said to be revealed by the
microscope, shall have been confirmed by repeated and careful examina-
tion. This part of the subject would, however, be incomplete, without
a passing notice of the very interesting observations contributed by Mr.
E. Oke Spooner, to the July number (1850) of the Provincial Medical
and Surgical Journal, p. 867. The purport of that gentleman's views
will, however, be best explained in his own words.
“If we examine the Cow-pock and the Small-pox microscopically, as
I have done very carefully in every stage, we find that the essential
character consists of a number of minute cells, not exceeding the
10,000th part of an inch in diameter, being about one-fourth smaller
than the globules of the blood, containing within their circumference
many still more minute nuclei, and presenting beyond their circum-
ference bud-like cells, of the same size and character as those contained
in the circle.
They exactly resemble in everything, except the size,
the globules of the yeast plant, the Torula cerevisia.”
In conclusion, the leading phenomena of the three forms of Small-
pox may be thus grouped with reference to their identity.
NATURAL SMALL-POX.
General symptoms usually
SeVere.
Primary fever, may be
typhoid, more usually in-
flammatory, declining about
the fifth day.
Eruption of papulae on
the third day, completed on
the fourth ; papula gener-
ally numerous.
Papulae vesicular on the
fifth day, and containing
pellucid lymph.
Vesicles depressed in the
centre.
Redness around the are-
ola, the papulae assuming a
deeper hue, as the pustules
ripen.
Vesicles assume the form
of distinct opaque pustules,
either spherical or acumin-
INOCULATED SMALL-POX.
Usually mild.
No primary fever.
Minute papulae on the
third day—generally few
in number, and sometimes
confined to the puncture
or its locality.
Vesicular, with clear
lymph on the fourth day.
Vesicles depressed in the
centre.
Pain of axilla about the
sixth day; areola on the
ninth or tenth day. Fever,
Sometimes severe, about
the eighth day.
By the tenth day, the
primary pustule is full of
matter.
WACCINE SMALL-POX.
Almost invariably mild.
No primary fever.
Minute inflamed papula
on the fourth day; the
eruption, with rare ex-
ceptions, confined to the
point of operation.
Vesicle on the fifth day,
containing clear lymph.
Vesicle depressed in the
centre.
Pain of the arm, and
sometimes of the axilla,
about the eighth or ninth
day.
Areola on the eighth
or ninth day. Fever
slight, sometimes inap-
D.B. KNOX ON WACCINATION AS A PREVENTIVE OF SMALL-POX.
NATURAL SMALL-POX.
ated, about the eighth day,
and contain sero-purulent
matter, attaining the maxi-
mum size of a pea about the
eleventh day, when second-
ary fever occurs.
The pustules break and
scab about the twelfth day,
and the crusts fall off in a
few days more.
Pustules leave, when se-
vere, permanent scars.
INOCULATED SMALL-POX.
. No secondary fever.
The primary pustule
scabs about the fourteenth
day; and by the end of
the third week the disease
disappears.
Primary pustule, and the
secondary pustules, when
1135
WACCHNE, SMALL-POX.
preciable, about the
eighth or ninth day.
No secondary fever.
Scabbing takes place
about the twelfth or thir-
teenth day, and the crust
falls off about the end of
the third week.
Vesicle usually leaves
a permanent striated ci-
severe, leave permanent catrix.
cicatrices.
d. Evidence in favour of the protective influence of Vaccination. This
is almost universally prevalent, even up to the present day. The doc-
trines of Jenner have been advocated, to a greater or less extent, by
Baron, Thomson, Good, Gregory, Watson, Alison, and a host of other
writers of the first celebrity in these kingdoms, as well as, on the con-
tinents of Europe and America, by many of the most eminent medical
authorities, to whom we have not space even to allude. Amongst
others, Berthollet, Percy, and Hallé, have discussed the subject with
great force and precision, in an article published by the French Imperial
Institute. The united opinions of such men unquestionably offer the
strongest presumption in favour of Jenner's discovery; but the actual
extent to which protection is imparted by Cow-pock, is rather a question
of fact than of opinion, and is only to be determined, to the satisfaction
of the sceptical, by a rigid inquiry into the actual results, and the con-
clusions fairly deducible from them.
Evidence as to the actual results of Vaccination is the most satisfac-
tory and, after all, the only conclusive method of determining the true
value of Vaccination. The general testimony, in favour of the protective
influence, either absolute or partial, of Vaccine Inoculation, is still, as we
have seen, all but universal; for, even among the many observers who
now demur to the unqualified doctrines of Jenner, Baron, and others,
there are very few who do not admit, that immunity to a certain degree,
and for a limited period, is imparted by the operation. The proposi-
tion, however, that it confers absolute protection on all persons ever
after, is now admitted, on all hands, to be untenable ; but it is the belief
of a great many, that where the casual disease occurs after Small-pox,
it usually displays itself in a greatly ameliorated shape, which may
thus be briefly described. - -
Modified Small-poa. A secondary attack of Small-pox may occur
after Inoculation or Vaccination, or even after a primary attack of the
casual disease. The consecutive malady, in rare instances, runs through
its course with unabated severity, and may even prove fatal; but, in a
vast majority of cases, it exhibits itself in a very mild form. In some
peculiar constitutions also, this ameliorated type of the disorder occurs
primarily, although the system has not been protected by having
previously passed through the disease in any form. The preliminary
symptoms and primary fever of the modified disorder differ, however,
-
| 136 WACGINATION AS A PREVENTIVE OF SMALL-POX,
in no respect from the first stage of unmodified Small-pox, being equally
severe until the appearance of the eruption, when the ameliorating in-
fluence, especially of Vaccination, at once becomes evident. The con-
stitutional disturbance rapidly subsides, and the papula, usually, though
not invariably, limited both in point of number and extent, are confined
principally to the face and breast. The pocks, or a portion of them,
may, in some cases, pursue their ordinary course; but they more usually
moderate by the fifth or sixth day, and rapidly dry up, and many of them
die away, without coming to maturity at all, exhibiting neither the usual
central depression, nor the presence of purulent matter. Meanwhile,
the attendant indisposition is very slight, the appetite perhaps unim-
paired, and the patient free from that secondary fever, with all its
frightful consequences, which render the unmodified disease so terrible.
No permanent scar is usually left by the pocks, the site of which is,
however, marked by temporary brown discolorations of the skin. We
are, therefore, amply justified in stating, that if the only result of Wac-
cination had been to substitute this mild disease for natural Small-pox,
the value of Jenner's discovery could scarcely be over-rated, even if it
had failed to produce absolute protection in a single case. Small-pox in
the modified form was termed by the elder writers Varicella, and this
appellation, with the adjunct variolodes, to distinguish it from chicken-
pox, was retained by Dr. George Gregory; but its application to any form
of Small-pox may lead to confusion, and had better be abandoned by all
who do not look on the diseases mentioned as essentially the same.
This, however, is a long disputed point, not yet perhaps conclusively
determined, but which must be passed by for the present.
It is obvious, that in attempting to fix the true protective value of
Cow-pock according to existing information, the correctness of our con-
clusions must depend on the assumption, that the primary Vaccination
has not only apparently, but really, produced its full effect on the system.
The value of any inferences arising out of the extensive Revaccinations
in the Prussian army, and elsewhere, evidently hinges on this point, and
it therefore becomes a necessary preliminary to examine the various
alleged tests of effective Vaccination, which may be enumerated as fol-
low: Bryce's test; the cicatrix left by the Primary Vesicle; Variolous
Inoculation, and Revaccination.
Mr. Bryce's well known test of the disease having affected the system
was this: he performed a second Vaccination, at the end of the fifth or be-
ginning of the sixth day, from the date of the first operation. The vesicle,
º by the second Vaccination, was found to be not more than one-
ourth of the normal size, and the areola was equally diminished, being
also accelerated in its progress, so as to arrive at maturity, and again
to decline, at nearly the same period as the affection depending on the
primary operation. This test was not held to be of much consequence
by Jenner; and Gregory objects to it, that although it shows the con-
stitutional influence to have been excited, it does not determine whether
in a sufficient degree to secure the system, and he justly looks on it as
being absolutely nugatory, as a test of the stability of vaccine protection
in after-life.
By many practitioners, a perfect cicatrix left after the primary opera-
tion, has been considered as a certain test that the protective influence
BY ALEXANDER KNOX, M.D. 1137
has been duly imparted to the system. The proper characteristics of
this cicatrix are stated to be, permanency and a diameter of about rather
less than half an inch, its surface being striated, and marked with
six or eight slight indentations, corresponding to the cells of which the
vesicle was composed. ' As far, however, as the question is to be deter-
mined by the investigations of the Wirtemberg physicians, it does not
appear that the state of the cicatrix can be relied on to determine
whether, and how far, the system is protected, either by the primary
operation, or by Revaccination. Genuine pustules may leave no mark
at all, or an imperfect mark; and even a true cicatrix will only show,
that Vaccination has been duly performed, but not how far the pro-
tective influence still remains in the system, if we admit what their
statistics apparently show, that the protection may be diminished, or
entirely lost, at varying periods from the date of the operation. In proof
of this it is stated, that of 1055 cases of Small-pox, in which the marks
were visible, 914 had good, and only 141 imperfect marks, and 147 of
the above cases were of genuine Small-pox, although the marks were
normal. And of 27 18 revaccinations, one half had the cicatrices
from the previous operation regular; yet in this half, Revaccination
succeeded perfectly in 65 per cent.; in a modified manner in 26 per
cent. ; failing entirely in only 9 per cent. In further illustration of
this point, we are informed, that, out of 14,384 Revaccinations amongst
the military, in more than one half the marks were normal, yet of this
number the process went on regularly in 31 percent., and in a modified
manner in 31 per cent, whilst in 40 per cent. no effect whatever was
produced. Again, in the Prussian army, according to Lohmeyer, 42,041
soldiers were revaccinated; and of these 33,819 only had distinct, and
many no marks whatever; yet the secondary operation was regular
in 19,117, irregular in 8,672, and failed entirely in only 14,252 cases."
On the other hand, protection from the primary Vaccination may exist,
where no trace of a cicatrix remains, as illustrated by 2,030 cases, in
which Revaccination failed altogether in 47 per cent. ; had a modified
result in 19 per cent. ; and succeeded perfectly in only 34 per cent.
The testimony of Gregory? is to the same effect, severe forms of Small-
pox occurring where the cicatrices were normal, and very slight forms
where they were very imperfect. A better criterion, therefore, would
be satisfactory proof of the previous process having been complete; but,
as this can rarely be attained, we must depend chiefly on the character of
the operator as a guarantee for the regularity of the primary Vaccination.
Cazenave and Schedel consider the best test to belnoculation with vario-
lous matter, the usual effect of which, if the previous Vaccination have
been successful, is to produce a small local pustule, which dries up rapidly,
and is not accompanied, for the most part, with any constitutional symp-
toms, although it may be followed by a slight general eruption. They
admit, however, that this method is not without inconvenience. Inocula-
tion, although a good test in itself, is objectionable, as tending to diffuse
the contagion of a very terrible malady; for though the inoculated disease
* Medicinische Zeitung, in Brit. and For. Med. Rev., No. xv, p. 263.
* Med. Chir. Trans. vol. vi., second series.
1138 VACCINATION AS A PREVENTIVE OF SMALL-POX.
in any given case may be of the mildest form, it may convey, by infec-
tion, the most malignant type of the disease to others.
Another mode of testing the efficacy of Vaccination is by a
secondary operation, a Revaccination, after the lapse of varying periods
of time. The effects of this secondary operation are various, and have
been minutely described by Dr. Gregory. In some cases, certainly the
majority at least within five years, the puncture in the skin heals in
a few days without any subsequent results, or it may produce a degree
of common inflammation. In others, a greater effect is produced, and
in three or four days after insertion, a small vesicle, containing trans-
parent fluid, is produced, but it is acuminated, and dies away about
the eighth day. Or the vesicle may resemble the genuine one in other
particulars, but is flat, does not attain the usual size, and dries up with-
out leaving the characteristic mark; or it may be perfect in every
respect, except in the existence of the areola. These imperfect vesicles
may be destitute of any concomitant marks of inflammation, or they
may be affected with troublesome itching, surrounded by an areola,
irregular either as to size and colour, appearing sooner than the genuine
pock, about the seventh or eighth day. The glands in the axilla swell
very frequently; and a marked degree of redness and engorgement of
the arm, with occasional smart feverishness, may exist. These symptoms
are especially common in the female sex. The principal points, there-
fore, indicative of a spurious disease, are anticipation of the various
stages, the whole progress being too short, irregularity of the vesicle,
which may be too small, or acuminated, or pustular, instead of vesicular,
and absence of the regular cicatrix.
But, after all, the best and most certain test that Vaccination has
imparted its full influence to the system, is the regular progress of the
vesicle, with its attendant symptoms, through all its stages, which have
been minutely described in a former part of this paper.
In returning to the main question, it may be premised, that the pro-
tective influence of Cow-pock has been advocated on the following
grounds:— 1. The power which it confers of resisting the contagion of
the casual disease. 2. Of resisting the effects of Variolous Inoculation.
3. Of resisting the effects of Revaccination.
1. In proof of the first of the positions here stated, it was related by
Jenner himself, that 6000 persons had been vaccinated, who entirely
resisted the contagion of Small-pox, although exposed to it in almost
every way for the express purpose of determining the question. The
history of Vaccination in Denmark offers similar testimony; for in con-
sequence of rigidly enforcing the practice in the first instance, Small-
pox disappeared from that kingdom, but only to reappear and renew its
ravages, when supineness had grown out of continued immunity. So
also in Ceylon, as clearly shewn by Dr. Kennis, the extent and fatality
of the malady alluded to were regulated by the degree of attention paid
to Vaccination. When this was duly attended to, secondary Small-pox
was both unfrequent and mild : thus of 737 cases, 550 were without
satisfactory marks of Cow-pock, and of these last 198 died, or 10 in
every 28; whilst of the remaining 187, with satisfactory marks, the
deaths amounted only to 8, being in the proportion of 1 to 62. This
evidence to shew, that the vaccinated, when exposed to the contagion of
BY ALEXANDER KNOX, M.D. - 1139
natural Small-pox, escape the disease in a far greater proportion than
those who are unprotected by the operation, might be greatly enlarged.
For example; in the history of the epidemic which prevailed in
Copenhagen for three years, commencing in 1828, written by Wendt,
it appears that of 84 patients affected with true variola, and who had
not been previously vaccinated, 24, or 1 in 3}, died, whilst of 29 who
had been vaccinated, only 4, or 1 in 7, died. The results in 1832-4
were still more strongly illustrative of the same position. Of 147 persons,
not vaccinated, or on whom the operation had only been performed
eight days previously to the breaking out of the Small-pox, 34 died, i.e.
1 in 4; whilst, on the other hand, only 10, or 1 in 90, died out of
898 who had been vaccinated. Again, of 179 affected with the true
disease, 119 had not been vaccinated, and the mortality amounted to
34, or 1 in 3}; whilst of there maining 60, who had been vaccinated,
10 died, or 1 in 6; of 1043 vaccinated patients in Copenhagen, there
died of Small-pox 47; of 123 not vaccinated, partly because they had
had the Small-poa, 51 died; on the whole, of the vaccinated, there died
about 1 in 22; and of those not vaccinated, about one-third fell victims:
The most recent results, which have fallen in my way with reference
to this part of the subject, are contained in the last quarterly report of
the Registrar-General. They shew the obstinate prejudice which still
exists against Vaccination, especially amongst the lower classes, in many
parts of the country, and also the great amount of protective influence
conferred by the operation. Small-pox, it appears, prevailed epi-
demically at Lewisham in Kent, and, with the exception of five cases,
all the deaths occurred in the unprotected; in East Maidstone district,
in eleven fatal cases, eight had not been vaccinated; in Walcot dis-
trict, Bath, fourteen died, twelve of whom had never been vaccinated;
in Bath Eastern district, four individuals died, who had not been
submitted to the operation; in Nottingham, St. Ann's district, six
deaths occurred under the same circumstances; and in another district
at the same time, in eight fatal cases out of ten, vaccination had not
been practised.” -
It is not necessary, however, to adduce farther testimony on this
point, as enough appears to shew, that the immunity from casual
Small-pox is infinitely greater amongst the vaccinated, than the
unvaccinated portion of the community. And the same conclusion
is deducible from the comparative results of variolous inoculation,
accordingly as the recipients have, or have not, been previously vac-
cinated. ' - - - - . . . . . . .
2. With very few exceptions, all persons are susceptible of the contagion
of Small-pox, by inoculation; and the disease, when thus conveyed into
the system, may be more or less severe, but always passes through its
different stages, with due regularity, as described in a previous part of
this essay. But supposing the individual to havé been vaccinated, the
results, as far as they have been investigated, appear to be totally
different, in the vast majority of cases. The most usual effect of the
operation, according to Cazenave and Schedel, is to produce merely a
* British and Foreign Medical Review, No. ix. * *
* See LONDON Journal of MEDICINE, No. xxi, September 1850, p. 920,
1140 VACCINATION AS A PREVENTIVE OF SMALL-POX.
small local pustule, which rapidly dries up, and more rarely a slight
general eruption, for the most part unattended by any active constitu-
tional symptoms. On the other hand, as we are told by Gregory,
Vaccination, practised after variolous inoculation, is usually followed by
no effects whatever. In rare instances, a modified Cow-pock is pro-
duced, the lymph of which cannot be trusted (nor in common prudence
should it be), to reproduce the genuine disease.
But the effect of inoculation, at periods remote from the primary
Vaccination, are very little known, owing to the difficulties in the way
of instituting the inquiry. The experiments, as far as they have gone,
are presumably in favour of Vaccination; at least it was demonstrably
shewn by Woodville and Jenner, that for three years at least, after the
operation, the system appears to resist entirely the effects of variolous
inoculation, and analogy favours this view of the case.
3. The last point to which we shall refer, as demonstrative of the in-
fluence of Vaccination, is the observed results of Revaccination.
This part of the subject has attracted great attention of late years;
and the increasing anxiety in the public mind, as to the real protection
conferred by Cow-pock, is traceable in a great measure to the German
statistics on this head, coupled with the renewed prevalence of Small-
pox : yet both causes of anxiety have, as we think, been greatly overrated,
as we shall endeavour to shew in the sequel. It should be premised
that Schlesier, Heim, and some other writers, take for granted, that the
success of a second operation for Cow-pock, shews the constitution to be
equally liable to the casual contagion of Small-pox; and although the
identity of the diseases in question may be urged in favour of their views,
still it does not by any means necessarily follow, that a vaccinated
person, although again susceptible either of the vaccine or variolous
virus, when applied in a material form, should be equally liable to
contract the disease by atmospheric transmission. This is a point only
to be determined by very ample observation.
But assuming for the present, that the receptivity of one form of
disease, indicates in an equal degree the receptivity of the other forms,
what do the results of Revaccination shew 2 We shall first state the
facts, and then draw our conclusions. In the experience of Lohmeyer,
of 48,000 persons revaccinated, 37,000 presented evident traces of pre-
vious infection, yet 15,000 had the disease afresh, 12,000 took it im-
perfectly, and 21,000 not at all; and of this last number, one-third con-
tracted the disease on a second Revaccination, the remaining 3,000
escaping altogether. And of over 44,000 persons, revaccinated in
Wirtemberg, during five years, 20,000 were operated on with perfect,
and 9,000 with modified success, and in 15,000 the operation failed
altogether. Finally, in England, in 1837, forty-five persons in the
hundred are described as exhibiting true vesicles after Vaccination.
Now, looking at these details in the most unfavourable point of view,
they shew that in many thousands of cases taken indiscriminately, and re-
vaccinated at various periods from the date of the primary operation,
one-half, at least, were shielded entirely or partially from a second attack
of Cow-pock, and therefore, according to the views of the German phy-
sicians, from a consecutive attack of Small-pox. Neither, in aiming at a
fair conclusion, should it be left out of view, that many of the persons
BY ALEXANDER KNOX, M.D. - 1141
operated on may not have had the disease, in a genuine and regular
form, after the primary operation. This would be a very unfair way, no
doubt, of accounting for all the failures, but a certain proportion of them
may thus be reasonably disposed of. It may fairly be assumed also,
that amongst the large numbers experimented on, many would be
found, with that strong susceptibility of the contagion, which imposes
liability to a second attack, even after the patient has gone through a
regular irruption of the casual disease. But with all deductions, it
must be conceded, that a secondary Vaccination may unquestionably
succeed, in a certain proportion of cases. .. -
e. Causes of Failure of Vaccination. Admitting, as all authorities
to a greater or less extent do admit, the partial failure of Cow-pock,
it becomes important to examine the various causes to which this
has been attributed. Of these, some seem calculated rather to occasion
manifest imperfection of the vesicle during its progress, than to account
for failure of the protective influence, after the disease has apparently
gone through its regular course. -
A careless and inefficient manner of performing the operation, has
been strongly urged, in the report of the Vaccine section of the Provin-
cial Medical and Surgical Association, principally drawn up by its chair-
man, Dr. Baron, and this has been principally relied on by the followers
of Jenner, to account for the want of success. Without, however, going
the whole length with that able writer, we believe that the actual
number of failures has been exaggerated, and also that a certain propor-
tion of them, but by no means all, may be fairly attributed to the imper-
fection of the primary operation; as the secondary occurrence of the
disease, after the most careful Vaccination, has been placed beyond doubt.
Of the other assigned causes of failure, which appear worthy of being
examined in detail, perhaps the most important is the employment of
unsuitable virus. Thus if the lymph be taken from a spurious pock, or
from a genuine pock at too late a period, we shall in the latter case
possibly, and in the former certainly, fail to impart the true protective
influence by Vaccination. It has, therefore, always been considered a
matter of practical importance, to determine the most suitable period
and mode for selecting the lymph for the purpose of transmission. Vac-
cine matter taken before the eighth day has been objected to, but on no
good grounds, except that it is difficult to procure it in sufficient quan-
tity, and as interfering with a desirable uniformity of practice. The
period at which it is usually selected is the eighth day, in accordance
with the calculation of Mr. Jefferson, the President of the United States
of America, who determined, after the most careful investigation, “that
the point of time counting from Vaccination, when the matter is ge.
nuine, is, in all cases, eight times twenty-four hours.” And, for the
sake of uniformity, it appears desirable that this rule should be adhered
to. But if the progress of Vaccination have been at all retarded, the
lymph occurs in greater abundance, and is equally efficient, on the ninth
or tenth day. Its employment, after that period, is justly condemned
by most writers on the subject; for it will very often fail to commu-
nicate the disease. But at whatever stage the virus may be taken,
provided it succeed at all, the resulting vesicle will be the same both in
appearance and efficiency, as is clearly shewn by the successful effects of
I] 42 WACCINATION AS A PREVENTIVE OF SMALL-POX.
vaccinating with the dry crust. This view of the case is sanctioned by
the high authority of Dr. George Gregory," and it appears to be more
consonant with the fact than the assertion of Willan,” that Vaccination
may fail, from the employment of lymph selected on or after the tenth
day. In my own experience, I have almost invariably found the vaccine
matter, existing in sufficient quantity for transmission, and perfectly
emergetic, on the eighth day, at which period I have, therefore, made
it a rule of practice to operate.
The uncertainty of lymph, taken later, has been attributed to its
being diluted with the common product of inflammation; but the
experiments of Adams, and of M. Bousquet, conclusively shew, that
diluted lymph may be perfectly efficient.
Great objection is made by some parents, especially in the better classes
of Society, to allow the matter to be taken at all from the arms of their
children, but less so amongst the more ignorant, many of whom look on
the taking off the pock, as they term it, practised for the purpose of pro-
curing a supply of lymph, as a necessary part of the process. Good feeling
will induce us to comply on ordinary occasions with the first-mentioned
prejudice; but if every parent were selfishly to act on this principle,
the supply of matter could not be kept up, and Vaccination must in a
great measure cease altogether. If properly and gently done, no evil
can arise ; but it is a different question, whether all the vesicles may
be exhausted without prejudice to the individual, or to the protective
influence of the operation. Heim attributes great local irritation to the
exhaustion of all the vesicles. The lymph of a primary is said to be
more effectual than that of a secondary Vaccination, and it would
require much stronger evidence than that offered by Heim, to convince
us that it is desirable to employ the product of a revaccinated vesicle,
especially if taken from an adult, which last, he says, is more energetic.
In such cases, we should be sceptical both as to its purity and superior
efficacy; and his assertion that vaccine matter is scarcely susceptible of
mixing with any other virus, would, in no degree, lessen our fears of
transmitting by inoculation the poisons of syphilis, scabies, and perhaps of
other diseases. Consequently, nothing but the impossibility of obtaining
matter from any other source, when urgently required, would overcome
the objection just stated. Exhaustion of the entire lymph, in any given
case, either by accidental rupture, or for the purpose of transmission,
without leaving at least one vesicle entire, is another alleged cause of
abortive Vaccination. Heim, we have seen, attributes great local dis-
order to the practice of exhausting the lymph in all the vesicles, and he
mentions one case in which death from convulsions ensued three weeks
thereafter. Grave doubts may be entertained, however, whether the
convulsions were fairly attributable to the cause indicated; and the
inflammation and irritative fever, occasionally of a severe character,
which sometimes supervene, are attributable rather to the rough and
too often repeated application of the lancet, than to the exhaustion of
the lymph. We question farther whether any abatement of efficacy, in
Vaccinations otherwise perfect, is a result of the cause above mentioned.
Were the exhaustion of the virus to take place before the constitutional
* Med. Gaz., vol. xiii, p. 441. * On Vaccine Inoculation.
BY ALEXANDER KNOX, M.D. 1 148
effects of the operation have arisen, some weight might be attributed to
this alleged cause of failure; but at the period when the lymph is usually
removed, the disease has affected the system, and it may be presumed
therefore that its progress is no longer controllable by any local influ-
ence exerted on the part. Hence it may be questioned, whether, even
if the vesicle were extirpated, or the arm amputated above the point of
operation, the protective influence would be thereby affected. Still,
to obviate a possible source of error, it is desirable to leave at least one
vesicle unmolested. The question will thus be narrowed, and if failures
occur, they cannot, at all events, be attributed to this cause. At the
same time, a high degree of inflammation, however arising, may render
it prudent to repeat the operation; and the same may be said of a very
slight degree of local irritation, or of any deviation whatever from the
ordinary and regular phenomena of the process. With reference to
this point, it may be further observed, that Jenner directed the super-
ficial lymph, oozing from a slight puncture, to be employed, whereas
Dr. Walker detached the epidermis from the vesicle, and used in his
Vaccinations the virus which exuded from its floor; and we are told by
Dr. Gregory, that the result of one mode of procedure has stood the
test of time as well as the other.
Many German writers, and especially Heim, allege that the number
of punctures materially modifies the result, and that the production of
a single vesicle is not adequate to secure the system from a subse-
quent attack of Small-pox. They argue, moreover, that the protective
power is increased by creating an evident constitutional disturbance,
which they endeavour to excite by making a considerable number of
punctures, their custom being to revaccinate if one alone comes to
maturity. With this view, Camerer, Wanner, Eichorn, and at one time
Gregory, who subsequently abandoned the practice, advised the produc-
tion of twelve, fifteen, twenty, or even thirty pustules. The effect of
this must, no doubt, have been to raise a considerable degree of consti-
tutional excitement, but attributable rather to the local inflammation of
the numerous Sores than to any specific effect of the infection on the
system. On the contrary, the high degree of fever thus produced, would
seem calculated rather to check than to promote the regular progress of
the disease, not to mention, that severe inflammation, gangrene, con-
vulsions, and even death, have been the result of this plan of over-scarify-
ing; and on the whole, the practice may be regarded, not only as cruel
and useless, but even positively dangerous; and the supposed advantage
is too questionable to justify us in incurring such a risk. And there are
good grounds for believing that one genuine vesicle, passing regularly
through all its stages, is as effectual as a dozen; but it is convenient to
make three or four punctures, to multiply the chances of infection,
especially where dry lymph is employed, as well as to augment the
supply of matter. For these reasons, except at the express desire of
the parent, my invariable practice is to make three punctures on the
same arm (to inoculate both is inconvenient not only to the child but
the nurse), at such distances as may prevent confluence of the vesicles in
their maturative stage. -
Deterioration of lymph, arising from its transmission through a great
number of individuals, is alleged by Prinz, and many others, to affect
1144 VACCINATION AS A PREVENTIVE OF SMALL-POX.
the results of Vaccination, and it is admitted by a few, that such dete-
rioration may actually take place, but only through carelessness or want
of due skill. Dr. Baron, on the other hand, expresses his unabated
belief in the opinion, that the Cow-pock virus, after transmission through
many hundred persons, is now what it was in the beginning. The
same view is taken by a recent writer in the Medical Gazette, Mr. John
Patterson, who expressly affirms that deterioration of the vaccine virus
is never a cause of failure, which is attributable to operating with lymph
taken before the ninth day, when the pock is matured. The cases
which he brings forward, however, even as far as they go, would merely
show that the infection is more readily transferred at the later period;
but they prove nothing as to the relative degree of protection conferred
where the operation succeeds.
It is asserted by Dr. Gregory, that the number of punctures should
have reference to the energy of the matter, which, after being long
humanized, is alleged to be less active than that more recently de-
rived from the cow, one vesicle with the latter being equal, in his
opinion, to five or six made with the former. In these views we cannot
concur, as we think that they are neither supported by the analogy of
other diseases, nor demonstrated by sufficient experience. In fact, the
alleged deterioration of vaccine lymph, in its progress from one indivi-
dual to another, is a mere hypothesis, and therefore more importance
is safely to be attached to the genuine appearance of the vesicle, and
the regularity of its progress, than to any theoretical notion about the
quality of the lymph, or the source from which it has been derived. It
is further obvious, that the hypothesis, which we are discussing, would
fail to explain the failures which occurred in the earlier history of Wac-
cination, even in persons vaccinated by Jenner himself.
The employment of dry lymph cannot be set down as a source of
failure of the protective influence, although it may, and indeed is, a
frequent cause of failure of the operation. Where liquid matter can be
procured, it is always to be preferred; although a regular vesicle pro-
ceeding from dry lymph, or even from the scab, is equally efficacious.
As it is impossible, however, in any given place, to keep up constantly the
supply of fresh vaccine matter, it is of consequence to determine how it
may be best preserved and transmitted from one country to another. When
vaccine lymph is to be employed within a few days, it may be kept in
an effective fluid state, either in small capillary tubes, having a central
bulb, or in small bottles, with projecting ground stoppers, as pointed
out by Dr. Gregory;' but when thus preserved, it is alleged by some
authorities to produce an irritable vesicle. Where it is necessary to
keep the matter for several weeks, or months, this may be most effectually
done by preserving it between two portions of glass, or on ivory points,
repeatedly dipped in the lymph whilst liquid. In the Vaccine Estab-
lishment in Dublin, they employ the former, and in London the latter
method. The ivory points, gratuitously issued from the Royal Small-
pox Institution, I have been in the habit of using from time to time for
several years, and I have invariably found the lymph both genuine and
effective, and the same may be said of the supplies which I have pro-

*
* Cyclop. Prac, Medicine.
* - BY ALEXANDER KNOx, M.D. I 145
cured from the sister metropolis. For transmission to warm countries,
the virus is found to preserve its virtues better in the form of crust than
by any other method, being simply diluted when it comes to be used.
An irregular vesicle, or modified Cow-pock as it has been termed,
should always be looked on with doubt, if not as demonstrative of the
non-effective nature of the operation. It may, and perhaps most usually
does, arise from some defect in the lymph; but the same result may
arise from the most genuine virus employed in a cachectic constitution.
No more conclusive proof can be given of this than the well-known fact,
which I have repeatedly observed, of the occurrence of the genuine and
spurious vesicle, in different individuals, infected with the same lymph.
But even when the vesicle in other respects follows its regular course,
it is the opinion of some writers, that the formation of purulent matter
after the ninth day, indicates a pock in which due confidence is not to
be placed, and especially if the consecutive crust is friable, and of less
than the usual dimensions. At all events, any vesicle not following the
normal course elsewhere described, especially if approaching the irregu-
larities of form, described under the appellation of degenerate pock by
Sir Gilbert Blane, cannot be depended on ; as where the vesicle is amor-
phous, or uncertain; the fluid straw-coloured, or purulent; the areola
either absent altogether, or confused with the vesicle, or where there
is premature formation of the scab. So also the operation is not to be
relied on, if, after extreme itching, or premature efflorescence, the vesicle
attain its height about the fifth day, or if it shall assume a conoidal
acuminated form, or display the characters of a common festering Sore.
It is equally objectionable when the pock becomes scaly, or the areola
is superseded by a species of psoriasis, or by erysipelas. In all such
cases, the undeviating practical rule should be to operate again and
again, until the disease goes through its regular form, or until we ascer-
tain, by repeated trials, that there is some insusceptibility of consti-
tution, which would probably protect the individual equally against
Small-pox. At any rate, the choice remains, in such cases, after a fair
trial of the operation at due intervals, between Variolous Inoculation, and
leaving the patient to take his chance. Should the failure depend on
some derangement of the health, we may succeed after removing this;
but in certain constitutions the insusceptibility is permanent. Mr.
Crosse calculates that l in 50 were thus insusceptible." * *
Age. Heim advises that no child should be Vaccinated before th
termination of the first year, from a theoretical belief that, during that
period of life, there exists in the constitution something resistive of the
protective influence. In this mode of accounting for failure of Vaccina-
tion, and more especially in the advice founded on it, it is impossible to
concur, as no sufficient or valid proof has been offered in its support,
and the reasons for an early operation are too cogent to be set aside on
any speculative grounds. Ryan advises the operation to be performed
after the sixth week, and Cazenave and Schedel not before that period,
without pressing indications. The opinion of Capuron, which I quote
from the Italian translation, having neither the original French, nor an
English translation at hand, is to the following effect. “L'esperienza
1 On Variolous Epidemic of Norwich, p. 32.
1146 WACCINATION AS A PREVENTiVE OF SMALL-POX.
attesta, che l'operazione riesce quasi egualmente benigna nel neonato
di venti quattrore, o di cinque O Sei giorni; Soltanto se osserva che la
Vaccina è più regolare, ed accompagnata da una febbre più mite dai due
ai sei mesis ecco perchè quest' epoca della vita è preferibile ad ogni
altra.”
In all cases where a child has been exposed to the contagion of the
casual Small-pox, we should perform the operation of Vaccination forth-
with, in the hope that the milder may anticipate the more malignant
malady. The results of our interference will, however, prove to be
various, according to the period at which it takes place. Where the
vaccine lymph is inserted during the incubative, but still latent, stage
of Small-pox, the effect, as stated by Gregory, is, that the latter disease
runs through its course unmodified, whether the Cow-pock, as is most
usual, either does not advance at all, or at least tardily and imperfectly;
or whether, as may more rarely be observed, it passes through its usual
process, at the same time as the casual disease. Cazenave and Schedel,
however, state, that in vaccinating an infant exposed to variolous con-
tagion, the Small-pox will sometimes adhere to its usual progress, but
more frequently assume a modified type; and that, occasionally, even a
confluent form of the disease will pursue its regular course, concurrently
with the Vaccine eruption. At any rate, the prudent course, in case of
exposure to variolous infection, is at once to vaccinate, in the hope that
the germ of the casual disease may not yet have been imbibed.
The following strong practical reasons for an early operation are
supplied by the Registrar-General in his First Report for the year 1839.
At Bath and Liverpool, 22 children died, between birth and the second
month, of Small-pox; 41 between the third and fifth months; 54 between
the sixth and eight months; and 59 between the ninth and eleventh
months, amounting in the whole to 176 deaths within the first year;
whilst 158 children perished from the same disease in the second, and
110 in the third year.” Mr. Farr therefore advises Vaccination to be
performed within the third month.
When Variolous Inoculation was generally practised, the fourth month
was the period selected for the operation, and the same period is well
adapted for Vaccination. In my own practice, I usually select any age
from the third to the fourth month, if no constitutional disease, or other
circumstance be present to contraindicate the operation; vaccinating,
however, at an earlier period, if there be any risk of contagion from the
prevalenge of casual Small-pox. The period advised by Gregory is be-
tween the third and fifth months, when the child has acquired plumpness,
and before dentition has commenced. Capuron considers the spring and
autumn to be the best seasons of the year for Vaccinating; but this is a
point of trivial importance, and at any rate, inconsistent with the rule of
practice laid down as to the infant's age, the observance of which will
of course impose on us the necessity of operating at all periods through-
out the year.
According to Heim and some other writers, the process of teething
does not interfere with the due results of Vaccination; but it appears to
1 CAPURON. Tratt. delle Bambini. Ed. Nap. p. 211, 1828.
* Brit. and For. Med. Rev., No. xviii, p. 353.
BY ALEXANDER. KNOX, M.D. I 147
us, and many of the best authorities might be cited in confirmation of
our opinion, that febrile excitement, from whatever extraneous causes it
may arise, seems certainly calculated to interfere with the regular
development of the disease; and dentition, if accompanied by fever, offers
no exception to the rule. &
In cases where the formation of the teeth is unattended by any very
evident constitutional disturbance, the Cow-pock may possibly pursue
its regular course; but, except for some urgent reason, Vaccination should
not be performed at all during the period of dentition.
It is further asserted by Heim, that inflammations, certain fevers, and
influenza, so far from interfering with, assist and hasten the effects of
Vaccination; whilst nervous fevers, as he alleges, as well as haemorrhages,
dysentery, and cholera, retard their progress. Jenner also expressly
states, and in this Gregory coincides with him, that the process of Wac-
cination will be delayed, perhaps for many days, where the infection of
measles or scarlatina has been imbibed before the operation."
Heim is again at issue with both Hering and Jenner, as to the influ-
ence not only of acute, but of chronic diseases of the skin, asserting,
that herpes and itch usually exert no essentially modifying influence on
the progress of the vesicle, whilst Hering positively affirms the modifying
power of the last mentioned complaint; and it is set down as a law by
Jenner, that the pre-occupation of the skin by any disease capable of
affording a humour, is “the grand impediment to the success of Vaccin-
ation.”
By Capuron, not only the process of dentition, but the periods of
puberty, pregnancy, child-birth, and menstruation, are enumerated as
unsuitable for the operation. Now it is quite possible, that the vaccine
process may at times appear to go through its various stages regularly,
under the circumstances described: but the more prudent course will
be, never to vaccinate, except under exposure to variolous contagion,
when the system is deranged from any cause whatever. By following
this plan, one source of error, in ultimately arriving at the exact value
of Vaccination, will be avoided; nor can the discovery of Jenner be
said to have a fair trial, if the regulations laid down by him be not
strictly attended to. *
Retardation of the infection is another assumed cause of failure of
the protective influence. It is well known, that a vesicle arising from
the most genuine lymph, may, from non-absorption, or some unknown
cause, be delayed in its progress, for a day or two, and occasionally for
so long a period as eight, ten, twenty, or even twenty-five days, and the
disease may afterwards pass through its various stages with perfect regu-
larity. In one individual in the Prussian armies, the pock did not
appear until six weeks after the operation; and in a child properly vac
cinated with dry lymph, in whom no effects were observable, a number
of fresh punctures, with liquid lymph, were made on the eighth day
thereafter, all of which succeeded, as well as two of the punctures, which
had been made in the first instance.” We have, in our own practice,
seen the effects delayed as late as the ninth day, owing, as we thought,
1 Jenner's Facts and Obs., pp. 137 and 170.
* Brit. and For. Med. Rev. No. xv, p. 262:
WOL. II.
7
5
1148 VACCINATION AS A PREVENTIVE OF SMALL-POX.
to some constitutional peculiarity; and Heim assigns the same cause. By
other German physicians, this retardation has been attributed to cold
weather. But however this may be, in some countries, and in certain
seasons, the difficulty of conveying Cow-pock by inoculation has been so
great, and so general, (at Turin, for instance, in 1829), that we must admit
with Griva, Howison," and others, the influence of a peculiar condi-
tion of the atmosphere. The effects of the Sirocco, and of other hot
winds, in interfering with the process, are well attested.
It appears, even from the statistics of the continental physicians,
which have been one principal cause of exciting distrust in the
public mind, as to the real efficacy of Cow-pock, that about one-half of
all the persons, who have been subjected to its influence, are proof
against the effects of Revaccination. Hence it might be reasonably in-
ferred, that the consecutive liability of the other half depends on some
irregularity in the primary operation; and without assigning this, in
accordance with Dr. Baron, as the sole cause of failure, no doubt
it is so in a very considerable number of instances. But it has
been well established, that, independently of any imperfection in the
lymph, or in the mode of applying it, a certain undetermined propor-
tion of the vaccinated again become susceptible of the variolous con-
tagion; and it is therefore a question of great importance, but of great
difficulty also, to determine on what this consecutive liability depends.
By some, it is explained as a mere exception to the general rule, and as
analogous to the secondary occurrence of Small-pox in individuals, who
have already passed through the disease in its matural form; and this,
no doubt, is the true explanation, to a certain extent. Another mode
of accounting for consecutive susceptibility of the contagion, is by sup-
posing, that the vaccine vesicle, whilst apparently passing with due
regularity through all its stages, fails, from some inappreciable causes,
in imparting its genuine influence to the system, which is therefore only
seemingly, but not, at any time, really protected.
A third explanation is, that the protection imparted by Vaccination,
even in the most perfect manner, wears out in process of time.”
Heim expressly asserts, as the result of his extended experience, that
the number of persons liable to secondary attacks of Small-pox is in-
creased in proportion to the lapse of time from the primary operation,
and endeavours to account for this renewed liability, by supposing, that
even after a perfect Vaccination, a portion of the susceptibility has
been left unextinguished, which is possibly beyond the reach of the
protecting powers of the lymph.” Wendt also observed, that cases of
secondary variola were milder, according as the patient was younger,
and therefore concluded, that the protective power was really diminished
after the expiry of many years.4 This opinion, however, is not, by any
means, confined solely to the physicians of Wirtemberg, and other
continental states; for Burns, many years before the observations of
Heim were published, had expressly stated, that the liability to a second
attack of Small-pox increases in proportion as we recede from the date
of the first Vaccination, and augment the activity of the infection; * and
* Med. Gaz., vol. viii. * Mr. Brown in Med.-Chir. Trans., Wol. xii, p. 336.
8 Brit. and For. Med. Rev., No. ix. * No. xiii.
* The Principles of Midwifery. Sixth Edition. London: 1824.
BY ALEXANDER KNOX, M.D. l 149
Spooner," very recently. has advocated the practice of Revaccination on
the same ground. Dr. Alison, also, whose caution and precision in
drawing his conclusions, render his opinions of the highest authority,
expresses his view of the subject in the following terms: -
“The most important question in regard to this mitigated form of
Small-pox is, whether it is more apt to occur, or approaches nearer to
the natural disease, in those vaccinated long previously: and the fairest
conclusion that can be drawn from the facts hitherto ascertained is, that,
if not occurring more frequently, it is oftener severe in those long pre-
viously vaccinated, than in others; whence it may be inferred, that
when the disease is prevalent, Revaccination may be an effectual pre-
wentive as to some who might otherwise be affected.”
Many accurate observers, on the other hand, are of opinion, that
distance of time impresses no modification on the anti-variolous power
of Cow-pock, which is alleged to resist the contagion equally at all
periods of after-life; and it is further urged, that if a secondary attack
of Small-pox actually becomes developed, the symptoms are alike modi-
fied, whether the primary operation has preceded its appearance by some
years, or only by a few days. And certainly this view of the case is more
in consonance with the law, which seems to regulate other diseases
occurring only once during life; for the protective effects of measles and
scarlatina are not known to suffer any diminution by lapse of time.
It is pretty evident, therefore, that renewed and extended observations
are necessary to determine, at all accurately, the proportion of secondary
attacks, which should be assigned to each of the alleged causes which
have been passed in review. But to whatever it may be attributed,
the fact cannot be disputed, that Small-pox unquestionably occurs after
Vaccination, and, as it is alleged, with increased frequency of late years.
The actual amount of such cases has, however, in our opinion, been
greatly exaggerated, and the fatality of the epidemic, even in the places
which it has most severely visited in these kingdoms, is in no degree to
be compared to that of the epidemics of an earlier date, before the intro-
duction of Cow-pock. And if from the entire number of deaths, which
have occurred, we deduct those fairly attributable to the total neglect,
or the imperfect performance of Vaccination, as well as those occurring
in constitutions absolutely insusceptible of protection, the remainder,
supervening after the perfect progress of Cow-pock through the system,
will, I apprehend, be found to be extremely small. Within my own
sphere of observation, the occurrence of Small-pox, especially in the
unmodified form, after genuine Vaccination, has been very rare; and
Baron, whose opinion on this subject is not lightly to be controverted,
alleges, that the cases of Small-pox occurring after Vaccination, are not
more numerous than those occurring after a previous attack of Small-pox,
and consequently, it may reasonably be presumed, after Variolous Inocu-
lation. On this point, we think, the practical question in a great measure
turns; for if it can be conclusively shewn, that Vaccination, confessedly
preferable, in point of mildness and safety, to either the casual or
inoculated disease, confers an equal degree of exemption from a se-
1 Prov. Med. and Surg. Journ., July 1850.
* Alison's Outlines of Pathology and Practice of Medicine. Part ii, pp. 475-6.
75 s
1150 VACCINATION AS A PREVENTIVE OF SMALL-POX.
condary attack, no farther room would remain for controversy. For it
is not reasonably to be expected, that Cow-pock, formerly believed, and
more recently proved, to be in itself only a modified form of Small-pox,
should impart any greater amount of protection than the more severe
forms of the malady.
The view of Baron, just alluded to, is, however, opposed by various
authorities," and it must be conceded, that data do not exist which enable
us to arrive at a definitive conclusion; but, reasoning from analogy, now
that the identity of the different forms of the disease has been esta-
blished, the fair inference appears to be, that the immunity afforded
should be in each case the same. But, even if we were to admit con-
secutive attacks of Small-pox to be more frequent after Vaccination, at
the present time, than after the casual disease, there are good grounds
for believing, that they could, at all events, be reduced within the same
limits, by the more perfect and careful performance of the operation.
For, without totally denying the influence of other agencies, I think
there is sufficient statistical information to shew, that by far the most
influential cause of the renewed frequency of Small-pox, is the total
neglect, or imperfect performance of Vaccination; a fact which, if fully
brought before the public, appears highly calculated to restore their
confidence in the preventive efficacy of Cow-pock.
But whatever may be the comparative frequency of secondary attacks,
after Vaccination and Small-pox, it is certain, that the mortality is much
less after the former than the latter, and infinitely below that occurring
in cases totally unprotected by the previous occurrence of the disease
in any form. To illustrate : of 556 cases of Small-pox which fell under
the observation of Dr. John Thomson,” in 205 the disease was primary,
and of these 50 died, or rather more than 1 in 4; 71 had previously
had natural Small-pox, and of these 3 died, or 1 in about 23. The
remaining 310 patients had been vaccinated, and only one case proved
fatal | Again, of 419 patients admitted in 1825 into the London
Small-pox Hospital, 263 were unprotected, and of these 107 died; of
two previously inoculated with Small-pox, one died; whilst of 147 who
had been previously vaccinated, death occurred in 12. Such a rate of
mortality as this last, although still very much in favour of the com-
parative safety of Vaccination, is higher than in any other recorded
instance. But it afterwards appeared, that only one of the twelve
patients alluded to, was proved to have been efficiently vaccinated ; and
therefore the unfavourable opinion, deducible from the original report,
must fall to the ground. .*
Out of a large mass of statistics illustrative of the same point, the
following facts, referred to in Dr. Watson's admirable Lectures on the
Principles and Practice of Physic,” appear conclusive. Of the popu-
lation of Marseilles in 1828, among the 30,000 vaccinated, about 2,000
were attacked with Small-pox, and 20 perished, or 1 in 100. Of
8,000 unprotected, 4,000 were attacked, and 1,000, or 1 in every 4, died.
And out of the 2,000 variolated, 20 took the disease a second time,
and 4 died, or 1 in 5. On reading these details, the immense value of
* British and Foreign Medical Review. No. xii, p. 494.
* On Varioloid Diseases. * Third Edition, p. 798.
BY ALEXANDER KNOX, M.D. | 1.5 L
Cow-pock in saving human life is irresistibly forced upon us. Yet a
charge of an opposite tendency has been made against the practice, to
which it is merely necessary to advert. Many years ago, it was appa-
rently demonstrated by Dr. Watt, of Glasgow,' that the effect of Wac-
cination was to increase the other diseases, and consequently the
mortality of infancy; but this view was subsequently shown, by the re-
searches of Roberton and Cowan, to be based on erroneous statistics, and
it has, we believe, been longentirely exploded. But we must now proceed
to examine the measures, which have been suggested, to remedy the
admitted failure of Vaccination to a certain extent.
III. REMEDIES WHICH HAVE BEEN SUGGESTED To obviaTE PARTIAL
FAILURE OF WACGINATION.—VARIOLOUS INOCULATION.—EMPLOYMENT OF
LYMPH TAKEN AFRESH FROM THE Cow INSTEAD OF THE STOCK IN GENERAL
USE—INCREASED NUMBER OF THE WESICLES—THE UNIVERSAL ADOPTION
AND MORE CAREFUL PERFORMANCE OF WAccINATION AND REVAccINATION
UNDER PECULIAR CIRCUMSTANCES, AND AT SUITABLE INTERVALS.
a. Return to Variolous Inoculation. A few writers recommend that
Vaccination should be relinquished for Variolous Inoculation, and others
have proposed that the latter should be performed in all cases after the
former, at once in proof and in aid of its efficiency. In point of mild-
ness and safety, as is universally known, no comparison can be instituted
between the two resulting forms of disease, and the subject for practical
consideration is, therefore, not only whether the protective influence of
inoculated Small-pox is greater than that of Cow-pock, but so much
greater, as to render it advisable, or even prudent to abandon Vaccina-
tion altogether, or at least to test or aid its effects, in every case, by
subsequently inserting the Small-pox virus.
Before adopting any change in our practice in this respect, it is in-
cumbent on those, who advise the alteration, to enforce their views, not
only by a general expression of their opinion, but reasonably to de-
monstrate by a reference to accredited facts—for no general expres-
sion of belief will suffice—not only, that the number of attacks,
but also the number of deaths, from Small-pox secondary to Vac-
cination, is greater, in any given number of cases, than in Small-
pox secondary to the variolous disease, whether casual or inocu-
lated. Neither will the statement of bare results be conclusive, unless
accompanied by reasonable proof that the primary Cow-pock was
perfectly efficient and regular; for it is obvious, that any inferences
unfavourable to Vaccination, as far as they are drawn from its imperfect
performance, are thereby vitiated, and useless in determining the true
value of the operation. It therefore becomes necessary to examine
somewhat closely the evidence on this head. From the almost general
abandonment of Variolous Inoculation in the present century, little
statistical information can be adduced in illustration of its comparative
efficacy; but there is quite enough to shew, that the assumption of com-
plete immunity being thereby afforded in after life, is totally opposed to
the facts of the case. It may also be reasonably presumed, that the
inoculated is, at the utmost, not a more powerful prophylactic than the
natural form of Small-pox. Yet it is now fully established, that
* Edin. Med. and Surg. Journ., vol. x; and Maunsell and Evanson on the Dis-
erºos of Children. first edition n. 440.
1 52 VAC CINATION AS A PREVENTIVE OF SMALL-POX.
the occurrence of a secondary attack, after the latter, is anything but an
unusual occurrence; and the researches of Thomson, Bryce, Mohl, and
others, may be adduced, as shewing that its modifying influence is actually
inferior to that of Vaccination.
We have already pointed out, that it is quite erroneous to suppose that
Variolous Inoculation confers any certain exemption from a consecutive
attack of the natural disease; and this is proved by facts of the following
kind. In the records of the London Small-pox Hospital, before referred
to, of two cases of Small-pox, known to have occurred after Inoculation,
one proved fatal; and at least one other person died of a secondary
attack in Norwich, in 1819, and many other instances of the same kind
might be adduced. Certain writers, moreover, affirm, that a subsequent
attack of Small-pox is much less frequent after the casual, than after
the inoculated disease. According to the conclusions drawn from the
London Bills of Mortality by Jurin, to which we have already alluded,
as quoted by Dr. Baron in his Life of Jenner, death occurred in the pro-
portion of one in every fifty of the Inoculated.
At the utmost, therefore, we think it questionable, whether the pro-
tection capable of being conferred by the practice of Inoculation, would
exceed that afforded by Vaccination, if universally carried out in the most
perfect form of which it is capable. And in estimating, generally, the
comparative advantages of the two plans, we must keep steadily in view
the greater severity of the symptoms, and the much higher ratio of
deaths, directly resulting from the operation, in the case of Inoculated
Small-pox, as well as its inevitable tendency to increase the absolute
mortality by the diffusion of contagion. This last consideration alone,
as affecting the general welfare, is worthy of the most mature consider-
ation; for, conceding that successful precautions might be taken to pre-
vent the spread of the disease, under particular circumstances, it is easy to
foresee, that the practice of general Inoculation, from a variety of causes,
would again be followed by a great increase of the natural disease, as in
former times, when the total mortality from this cause, as shown by
Heberden, was swelled from 7-4 to 9.5 per cent. It is also instructive
to contrast the diminished mortality, arising from Small pox, at the
present day, with that occurring before the discovery of Vaccination;
for it appears that, even after Variolous Inoculation was in general
operation, 1 in 14 of all persons born, died of Small-pox.
It has been a question, whether the entire prohibition of Variolous Ino-
culation by law is a desirable measure; but, strongly as we are opposed
to the resumption of the operation as a general practice, we agree with
several previous writers in the belief, that a positive enactment on this
head is neither desirable or necessary. Particular instances may occur,
as in the outbreak of Small-pox in a ship at sea, in which anticipation of
the natural disease, by the artificial method, would certainly be followed
by a great saving of human life; and we think that the circumstances
under which Inoculation may be beneficially resorted to, may be safely
left to the determination of the medical profession, who have already
decided against it as a general practice. But the total prohibition of
Inoculation by the hands of the ignorant and unqualified, is but a simple
act of justice to the general community; the more especially, as the
inoculated disease, even when occurring in its mildest shape, is capable of
BY ALEXANDER KNOX, M.D. 1153
diffusing the infection in the most severe and deadly forms. With such
facts as the following before them, capable of being swelled to a long
and sad catalogue, but which we have selected as the most recent, it is
surely time for the legislature and the executive to interpose in an
effectual manner. At St. Thomas's, East Budleigh, Devonshire, eleven
individuals died of Small-pox, which had been propagated by persons
opposed to Vaccination, and who had inoculated not only their own
families, but those of their neighbours." Facts like these fully justify
the strong condemnation of so barbarous and fatal a practice, contained
in the Report of the Vaccine Section of the Provincial Medical and Sur-
gical Association of 1839, and the recommendation that it should be
invariably superseded by Vaccination. $
b. Renewal of Lymph, by taking it afresh from the Cow, for the purpose
of Vaccination. It has been asserted, but by no means satisfactorily
demonstrated, that lymph, taken directly from the cow, is more effective
than the stock which has been so long in use, and which has been
alleged to become weakened by transmission through numerous subjects.
The testimony on this point is, however, discrepant. Many believe
that there is little or no difference between the effects of the old and
new virus; whilst in the hands of Mr. Estlin,” and some other English
practitioners, the results have been apparently favourable to the fresh
stock. That form of lymph, obtained by Mr. Ceely from direct inocu-
lation of the cow with the Small-pox, has been found to act successfully
and energetically in reproducing the vesicle in man; but whether it shall
be superior to that in general use, can only be decided by extended ex-
perience. That a deteriorated form of virus, yet capable of transmission,
may be produced by carelessness or want of skill, I think there is no
reason to doubt, even if it had not been proved by the researches and
experiments of the late Dr. John Thomson, of Edinburgh; but, pro-
vided all the directions of Jenner be adhered to, in which case only it
is fair to judge, I have seen no just grounds for concluding, that the
genuine vaccine vesicle, in appearance, progress, and effect, is not pre-
cisely the same that it was in his day. It appears, however, that more
severe constitutional symptoms are produced by lymph taken directly
from the cow; and those who hold that febrile irritation is a measure
of the due effect of the virus on the system, will, of course, give it
the preference. But many competent observers have adjudged the
superiority to the human lymph, as more mild, equally sure, and, at the
same time, entailing fewer accidents. Still, various circumstances may
render it necessary to draw a fresh supply of virus from the cow; but
in so doing, it is a matter of the first consequence, in order to ensure
protection to the vaccinated, that the most accurate distinction shall be
made between the genuine pock in that animal and the spurious forms
of the disease, which caused so much embarrassment to Jenner, and
which might still lead to a variety of false conclusions respecting
the real value of Vaccination. The best practical rule to guide the less
experienced in such matters, will be, to reject all forms of the pock
* Report of the Registrar-General.
* See a paper read before the Medical Section of the British Association, “On
the New Vaccine Virus”; and another “On the Cause of the Increase of Small-pox,
and the Origin of Variola Vaccina”, by Dr. Inglis, in 1839.
11 54 WACCINATION AS A PREVENTIVE OF SMALL-POX.
which appear the least doubtful, and extract the lymph only from
such as correspond closely with the symptoms of the genuine disease,
which, principally to this end, the reader will find minutely described
at a former page. The necessity for this precaution will appear, from
a statement made by Heim, that there are no less than eight forms of
Cow-pock. Of these, three, described as Viborg's wart or stone pock,
the white eruption of Thār, and the wind-pock, are incommunicable
to man. The five varieties capable of transmission to the human
system are, the amber-pock of Nissen, the black-pock of Nissen, the
bluish-pock, the white-pock, and the red-pock. Of the.spurious forms
of disease, the white-pock is perhaps the most common source of error;
as it sometimes exhibits a well defined vesicle, a pink areola, and
even the central depression ; but its true nature may be detected on
close examination, as it is destitute of two of the most striking cha-
racteristics of the genuine vesicle, namely, the presence of a fluid
lymph, and the cellular structure. The distinction will be more evi-
dent in other forms of the spurious disease, presenting the appearance
of reddish pustules, containing a yellow humour; mere vesicles con-
taining a viscid, or watery fluid; a miliary eruption, characterised by
the rapidity of its progress, and terminating variously in different
forms of corroding ulcer; or warty induration. The subject is rendered
still more embarrassing by the fact, that the true and false diseases
may be prevalent at the same time, and even co-exist in the same
animal. Jenner (by whom the bastard forms of pock were classed
together, under the appellation of spurious cow-pock) pointed out, as
broad distinguishing marks, their freedom from all bluish, or livid
tints, and their property of desiccating quickly, without producing any
constitutional disorder.
We have not space here to enter more fully into detail; but ample
information, on the disease in the cow, will be found in the works of
Jenner, Ceely, Heim, Hering, Prinz, Thiele, and other writers, who
have expressly investigated the subject." But from the great variety
of affections in the cow, and the rare opportunities afforded to most
physicians of acquiring an adequate practical knowledge of the subject,
the more prudent plan, supposing at any time we may deem it expe-
dient to renew our supply of lymph, will be to produce the disease in
that animal, for the express purpose, by Variolous Inoculation. And
in all cases, without exception, where the resulting phenomena, after
vaccinating directly from the cow, do not appear to be perfectly re-
gular, we should revaccinate the patients, and cease to employ the
lymph for the further transmission of the malady.
But neither the casual, nor the inoculated disease in the cow, is the
sole source of vaccine virus; for lymph may be procured, although
with some difficulty, by the practice of Retrovaccination, or the arti-
ficial communication of Cow-pock to that animal, from the human
subject. The experiments of M. Fiard, and the scepticism of Gregory
on this point, have already been glanced at ; but the conclusive and
beautiful experiments of Mr. Ceely have subsequently put the matter
* See also Brit. and For, Med. Rev., No. xiii, p. 190; and No. xvii, p. 95.
Trans. Brit, and For. Med. Ass., Wol. viii, 1840.
BY ALEXANDER KNUX, M D. 1155
beyond doubt, and farther shewn that the vaccine lymph, thus pro-
cured, may again be transmitted with success to the human system.
It is worthy of remark, however, that when thus employed, the re-
sulting vesicle is smaller than usual, and does not reach its acme till the
eleventh, twelfth, or thirteenth day ; recovering, however, after two
or three removes from the cow, its usual characteristics". It is con-
tended by Prinz, that this process of Retrovaccination has the effect
of renewing the efficiency of the lymph, supposed to be impaired by
repeated transmission through the human subject ; but, even if this
deterioration were admitted as a fact, it does not appear how the pro-
cess could restore its efficacy. Practically speaking, the only useful
object of Retrovaccination is to increase the supply of vaccine matter;
for though some have argued that its quality is improved, and others,
that it is deteriorated by this process, to us it appears that it would
just be possessed of the same qualities, and be neither better, nor
worse, for its retransmission through the cow.” Where it is desired
to experiment on the subject, genuine vaccine lymph, taken fresh from
the arm, should be freely applied to the teats and udder of a young
animal. The spring is said to be the best season for performing the
operation.
It may here be mentioned that, in describing certain peculiar-
ities of the disease in the cow, Ceely” details some very interesting
circumstances, which render it extremely probable that the Cow-pock,
in one instance, had its origin in several of those animals from vario-
lous effluvia.
c. Increased Number of Vesicles. We have already adverted to
this point, and shall here only point attention to the conclusions of
M. Delfraysse, contained in a note addressed to the Academy of Me-
dicine of Paris, as the most recent promulgation of opinion that has
fallen under our notice. The French writer expresses his conviction,
that Vaccination is an infallible preventive, where the vesicles are
sufficiently numerous to produce a degree of febrile reaction ; and
that its failure is attributable, as Heim has maintained before him, to
the absence, or insufficient development of this febrile affection. He
therefore recommends from twenty to thirty punctures, to be made in
each case, in different parts of the body.” M. Delfraysse, in proof of
his doctrine, alleges that all his patients, thus vaccinated, have resisted
the influence of variolous contagion. No doubt they have : and so
also have innumerable persons, protected only by two or three vesi-
cles. But we do not maintain that a large number of punctures are
ineffectual, but simply that they are cruel, inconvenient, and super-
fluous. We admit that thirty vesicles cannot be raised, on different
parts of the surface, in any case, without producing symptomatic
fever; but we question the advantage of the practice; and it evidently
leads to embarrassment, as it does not appear possible to distinguish
the constitutional disturbance, excited by so many wounds, from the
* See Brit. and For. Med. Rev.; and Dublin Med. Press, Aug. 1839.
* See Brit, and For. Med. Rev. No. xvii, p. 85.
* Mr. Ceely in Trans. of the Provincial Med. and Surg. Association, vol. x, p.
354; also, Brit. and For. Med. Rev., No. xxviii, p. 398.
* Dublin Medical Press, Nov. 6, 1850, p. 294.
| | 56 WACC INATION AS A PREVENTIVE OF SMAILL-FOX.
specific febrileirritation, resulting from the effects of the vaccine virus
on the constitution. And, further, if the doctrine of M. Delfraysse were
true, Revaccination should succeed not in one half, but in the entire
number of cases exposed to its operation. On the whole, we confess
our scepticism as to the plan being either judicious, or necessary.
d. Vaccination and Revaccination. Little importance can fairly be at-
tached to renewal of the lymph, or to the employment of a great number
of punctures, as means of increasing the defensive efficacy of Cow-
pock; and Variolous Inoculation has not only been shewn to be a
dangerous and ineligible substitute for Vaccination, but its actual
superiority, as a protective, may be fairly questioned. Cow-pock is
admitted, on all hands, to confer immunity from Small-pox, in the
vast majority of instances; and any additional security to be hoped
for will probably be found, if due means shall be taken to ensure the
universal and careful practice of Vaccination, aided by Revaccination,
under peculiar circumstances, and at suitable intervals.
How efficacious the measures advocated would prove, may be
clearly shewn, by contrasting the following table of results, occurring
amongst the British troops, where Vaccination is duly attended to, with
what is known to occur amongst the civil population, from the culpable
and reckless disregard of the means of safety too frequently exhibited.
TABLE, compiled from the official “Statistical Reports”, for twenty
years, commencing in 1817, and ending in 1836.
Aggregate Total Deaths from
Strength. Mortality. Small-pox.
Dragoon Regiments and Guards ............ 44,611 ... 627 ... 3
Troops at Gibraltar ........................... 60,269 ... 1,291 I
In West Indies, where Small-pox was se-
veral times epidemic ......ps is gº tº e s tº º e º ºr e º ºs | 86,661 ... 6,803 0
Black troops .................................... 40,934 ... 1,645 0
In Malta, for 19 years, where Small-pox
raged as an epidemic, and destroyed $ 40,826 ... 665 2
1,169 persons ..............................
In Ceylon, where above 3,000 of the na-
tives died of the epidemic in 1819, 1830, ——- ... 3,000 ... 4
1834, White troops ........................
Malay troops ........................ — ... 858 ... 9
Pioneer corps ........................ — ... 647 ... 1
Similar results were observed in India, and other British colonies;1
and I think it would be impossible to adduce any stronger, or more
convincing practical argument, in favour of the high degree of pro-
tective power exerted by Vaccination. After reading it, we may
truly adopt the conclusion of Dr. Watson, “Where Vaccination is,
the contagion of Small-pox need never come.”
The conditions of the lymph, and of the system, necessary to the
successful transmission of Cow-pock, have already been discussed at
full length ; but it remains to say a few words as to the most effective
manner of performing the operation. This, in itself, is by no means
difficult ; but considerable skill, and due attention, are necessary, not
only to determine the genuine characteristics of the vesicle, but to
decide, whether it shall have gone regularly through all its stages, and
* Watson's Lectures, third edition, vol. ii, p. 799.
BY ALEXANDER KNOX, M.D. 1157
imparted its full protective influence to the system. Hence, in Ger-
many, the physicians and surgeons are alone allowed to operate ; and
a similar regulation might be adopted in these countries with great
advantage. Few physicians think it necessary to employ any pre-
paratory treatment; but the use of a gentle aperient, as recommended
by Ryan, cannot, at all events, do any harm. The operation itself is
done variously. Some recommend a clean, and some a blunt lancet
to be used. One surgeon advises a single puncture to be made in
each arm, another three or four, and a third as many as thirty, whilst
a fourth prefers longitudinal scratches to punctures. Capuron says,
the less painful the puncture, the better characterised will the pock
be ; and Elliotson advises the lancet to be so held, that the matter
may gravitate into the wound. Cazenave and Schedel, on the con-
trary, direct the instrument to be introduced horizontally ; and they
object to incision as being less sure than puncture, by causing a flow
of blood, and thereby diluting the lymph. Now all this rather savours
of the foppery of science. Vaccination may be perfectly well per-
formed either by puncture or incision ; and he must be a very coarse
operator indeed, who shall wound the arm in such a manner as to pro-
duce any serious degree of irritation. This may, doubtless, arise in
peculiar constitutions, after any mode of operating; and it is very likely
to occur, when the cruel and unnecessary plan of creating a great
number of punctures is resorted to. The objection, founded on the
dilution of the lymph by the flow of blood, we hold to be purely the-
oretical, and not based on accurate observation. At one period, I
had considerable experience on this point, having vaccinated as many
as one hundred and eighty individuals in a single day, and most of
them successfully; but it never appeared, that the results were affected
by the degree of haemorrhage, which depends rather on the constitu-
tion of the child, than the want of dexterity of the operator. We
may naturally expect an infant of full habit to bleed freely; and
the actual state of the matter appears to be correctly expressed by
Dr. Gregory, when he says, that provided genuine lymph has come in
contact with the absorbing surface of the cutis vera, it is no matter
whether little or much blood flows.
The plan which I adopt in my own practice, is to render tense the skin
of the arm to be operated on, by gently grasping it in the left hand,
and then to carefully make a few slight scratches with the point of the
lancet, previously charged with fresh fluid lymph, on three different
points, at the distance of about an inch apart, so as to guard against
the possibility of the vesicles running into each other. The lancet
should be immersed anew in the lymph after making the scarifica-
tions, and gently drawn over the wounds, to transfer to them the
matter as completely as possible. The same manipulation should be
repeated at each point operated on. This mode I have rarely found
to fail, except where constitutional insusceptibility of the infection was
present.
For the convenience both of the child and nurse, the more conve-
nient plan is to vaccinate only one arm, as the vesicles can thus be
much better defended from accidental injury and irritation. The ob-
ject in making three punctures is two-fold ; first, to multiply the
1158 WACCINATION AS A PREVENTIVE OF SMALL-POX.
chances of success in the operation ; and in the second place, to pro-
vide a supply of lymph, for transmission, without disturbing all the
vesicles; and not from any belief that twenty punctures would more
certainly impart protection to the system than one. At any rate,
analogy is in favour of this view of the case ; for the casual small-pox
appears to protect equally, whether the pustules be many, or few.
Of course, where liquid virus cannot be procured, after making
the necessary scratches with the lancet, the dry lymph should be
effectually rubbed into them. The child's dress should be carefully
adjusted, so as to prevent contact with the arm until the wounds are
dry, and friction must be sedulously guarded against, as soon as the
vesicles begin to form. Examination of the patient, at due inter-
vals, afterwards, especially on the fifth, eighth, and tenth days, is
indispensable, to ascertain that the progress of the disease is per-
fectly regular.
The most eligible age for Vaccination has already been pointed
out ; but we should not delay to operate at any time, where the infant
is either likely to be exposed, or has already been exposed, to the
contagion of the natural disease, taking the chance that the milder
may anticipate, and possibly prevent, or at all events modify, the more
malignant malady. With reference to this part of the subject, we
shall introduce some of the results observed in such cases, as well as
certain experiments which have been instituted with the Small-pox
and vaccine lymphs.”
Where the variolous and Cow-pock virus are inserted on the same
day, each malady may pursue its course unaltered, with considerable
constitutional disturbance; or they may be mutually modified by their
influence on each other, the Small-pox being greatly mitigated, and
the eruption either proving abortive, or terminating in imperfect hard
shining pustules, called horn-pock, stone-pock, or swine-pock (variola,
verrucosa).
Where Vaccination precedes Inoculation by a period not exceeding
four days, the local diseases advance together, but the Small-pox may
or may not be accompanied by a general eruption, and the constitu-
tional symptoms may be very slight. In such cases, the vaccine
lymph retains its peculiar properties; but more frequently it is conta-
minated by the variolous virus, and consequently it should not be
used for the transmission of the disease.
Variolous matter will affect the system more or less severely, where
Inoculation is practised anterior to the seventh day from the period of
Vaccination, but subsequently it will produce no effect.
Inoculation with Vaccine and Small-pox matter mixed, is some-
times followed by Cow-pock, and sometimes by Small-pox; and if the
two forms of lymph be introduced at the same time, at separate
points, but near enongh to permit the vesicles to unite, the virus
thence taken shall in one case produce Cow-pock, and in another
Small-pox.
From observing some fatal cases, occurring in infants cotempora-
neously affected with Cow-pock and Small-pox at the Children's
1 Willan on Vaccine Inoculation. 1806.
BY ALEXANDER KNOX, M.D. 1159
Hospital of Paris, it was believed by MM. Rilliet, Barthez, and
Legendre, that Vaccination exerted an unfavourable effect; an opinion
controverted by M. Herard, who came to the conclusion, consonant
with general experience, that when the two eruptions are developed
together, the variola is advantageously modified, but less so in an
unhealthy than a healthy child. And he adds, very justly in our
opinion, that the danger in such cases arises from the Small-pox and
not from the Vaccination, which should, as at least innocent, be prac-
tised in all cases." This is judicious advice, at all events, although it
may frequently fail to produce the desired results; and it is scarcely
necessary to say, that the previous directions, regarding the mode and
period of selecting the lymph, and the health of the patient at the time
of operating, should be strictly attended to. In leaving this part of
the subject, we may be permitted to express our conviction, that Wac-
cination, if universally carried into effect, with all the precautions alluded
to, would be found at once the safest and most efficient means within
the reach of human power, to arrest the ravages of Small-pox. At any
rate, its superiority over Inoculation, in diminishing the absolute
mortality from that disease, is strongly illustrated by the following
results, deduced from the tables of Sir Gilbert Blane.
In the fifteen years immediately preceding the introduction of
variolous Inoculation, the mortality arising from Small-pox amounted
to 78 in every 1000 deaths from all causes; in the next thirty years,
when Inoculation was in use, the ratio was about 90 to 1000; and in
the following fifteen years, after the introduction of Vaccination, the
mortality was reduced to 53 in 1000.” Were it not superfluous, we
might farther refer to the vast saving of human life, consequent on the
introduction of Cow-pock into Sweden and Prussia.”
But admitting that the most perfect Vaccination does not render all
persons proof against the subsequent effects, either of the casual con-
tagion of Small-pox, or of variolous or vaccine Inoculation, we are
not thence to infer, that the practice is less efficacious now than it was
at the earlier period of its history ; but simply that Jenner overrated
its power, in alleging that it extended complete protection to all who
submitted to the operation; for it is now well known that, in many
constitutions, the susceptibility is so strong as to be absolutely beyond
the protective influence of the variolo-vaccine virus in any shape.
The class of persons alluded to we believe to be greatly more numerous
than has been commonly supposed, in proof of which it may be stated,
that in the experiments of Heim, Vaccination, practised after Small-
pox so severe as to leave the patients marked with scars, succeeded in
more than half the cases; a result nearly analogous to the effects of
Vaccination after Cow-pock.
With reference to Revaccination, the practical questions which we
are called on to decide are these : Is it necessary or desirable, for the
purpose of protecting the system from the contagion of Small-pox, to
revaccinate, where the primary operation has been effectively per-
* L'Union Médicale, and Med. Chir. Rev., 1849, quoted in Monthly Retrospect,
ann. eodem, p. 158.
* Med. Chir. Trans., vol. x. * Ed. Med. and Surg. Trans., vol. xxvi, p. 171.
| | 60 WACCINATION AS A PHEVENTIVE OF SMALL-POX.
formed ? and if so, how often and at what periods of time 2 For there
cannot of course be any doubt as to the propriety of a second Vaccina-
tion, where the process has either partially or completely failed, in the
first instance, either from imperfection in the lymph employed, or from
the existence of some cotemporaneous disease, or constitutional pecu-
liarity in the patient. It was announced by Jenner himself, that the
system, after a time, has its susceptibility of Cow-pock renewed, a
position subsequently demonstrated by the observations made in Wir-
temberg and elsewhere. Thus of 275 Revaccinations, in the Danish
army, recounted by Wendt, considerably more than one-half suc-
ceeded, and it were easy to adduce a mass of statistics of a similar
tenor. Indeed, the fact seems now incontrovertible; but, admitting it
to be so, the practical utility of Revaccination has been questioned, on
the grounds of want of proof, that revaccinated individuals are less
susceptible of Small-pox, than those who have only once undergone the
operation. And it is evident, that the argument for Revaccination, so
far as it relies on the statistics referred to, assumes that the receptivity
of the artificial, implies an equal receptivity of the natural disease, or
in other words, that all persons in whom the secondary operation suc-
ceeds, would be liable to an attack of Small-pox, if casually exposed
to the contagion. And it is expressly on this ground that the practice
of Revaccination has been advocated by Wendt, Heim, and several
other writers. But this assumption, although countenanced by the
identity of the different forms of the disease, has not been satisfactorily
demonstrated by a sufficient body of statistical data ; and ample proof
will be required to establish for it the character of a law in the disease.
One mode of accounting for consecutive susceptibility of Cow-
pock, rests on the assumption, that the effects of the primary operation
on the system wear out by lapse of time ; and the statistics of the
German physicians have been relied on, as the chief means of demon-
strating this point. But too much stress, in this respect, appears to
have been laid on the facts which they have brought forward; for, on
referring to the details, it will be found, that in one-half of all the
cases enumerated, the system was perfectly proof against the infection,
and Revaccination entirely failed. It is farther very material to observe,
that this resistance of the contagious lymph exhibited itself, not merely
amongst those who had recently undergone the primary Vaccination,
but indiscriminately amongst all the patients operated on, who had been
previously affected at any time by the Cow-pock virus. If, therefore, it
be an inherent tendency in the protection conferred by Vaccination to
wear out of the system by process of time, it may be fairly asked, why
one-half of all the individuals operated on, should be an exception to the
general rule. With reference to the question we are discussing, it is also
particularly worthy of remark, that as far as the observations both of
the Wirtemberg and Hanoverian physicians extended, the effects of
Revaccination very closely approached each other, whether practised
on those who had been previously vaccinated, or on those who had
suffered from a primary attack of Small-pox in the natural way. In
either case, about one-half resisted the influence of the vaccine virus
either partially, or altogether, whilst the other half displayed the usual
effects of the operation. Hence, it would appear, that if the protective
BY ALEXANDER KNOX, M.D. 116.1
influence of Cow-pock really becomes extinguished in process of time,
the immunity afforded by the casual, and a fortiori by the inoculated
Small-pox, is of an equally temporary nature, an inference closely
bearing on the comparative merits of Variolous Inoculation, and Vac-
cination. On the whole, however, the progressive extinction of the pro-
tective influence of Cow-pock may be gravely questioned, and a more
reasonable explanation of the success of the German Revaccinations,
may be founded on the two following considerations: 1st. That, in a
considerable number of the cases detailed, the primary operation, from
various causes, had not duly affected the system at all; and 2dly. That,
in a certain proportion of all individuals born, the most perfect impreg-
nation with the variolo-vaccine infection, of which the constitution is
susceptible, does not destroy the liability to be affected by the infec-
tion subsequently, more especially when directly introduced into the
system, in a material form, by inoculation.
But the success of Revaccination is not the only argument advanced
to show, that the effects of the primary operation gradually wear out
of the system. Mr. Spooner and others, in proof of the same doc-
trine, assert, that the number and severity of the cases of secondary
Small-pox, are increased in proportion to the length of time which has
elapsed from Vaccination: and, if their belief were confirmed by a suf-
ficient body of facts, the inference would be unquestionable ; but
there is no sufficient statistical information, relative to the recurrence
of Small-pox in the civil portion of the community of these kingdoms,
to determine the question; and the accurate military returns before
referred to, point to conclusions very different from those of Mr.
Spooner. So also do the reports of the Registrar-General; for in an
ably-written article, published by Dr. Stark in the Edinburgh Medical
and Surgical Journal," the fact, that four-fifths of all the deaths caused
by Small-pox in some of the largest cities and towns in Great Bri-
tain occur in the first five years of life, is shown from the most au-
thentic documents. This seems to militate strongly against the
belief, that the protecting effects of Cowpock wear out by lapse of
time; for the period mentioned is precisely that in which the influence
of Vaccination should be least impaired, and, consequently, in which
the mortality of consecutive Small-pox should be lowest. But it
has not only been alleged, that the protective influence wears out, but
fixed periods, at which this is supposed to take place, have been
defined.
According to Dr. Retzius of Stockholm, the protection remains un-
diminished from the close of the second to about the end of the thir-
teenth year, gradually losing its influence to the twenty-first year, after
which period, the original liability to Small-pox recurs, and continues
unimpaired to the age of forty years. Subsequently it approaches by
degrees the limit of its existence, which it generally attains about the
fiftieth year. Hence, his advice is to repeat the operation for Cow-
pock, in about thirteen years.”
Wendt's opinion is, that the protecting power of a good Vaccination
secures the system for a certain time, perhaps for six years, and he
1 Vol. lxiv. ° Med.-Chir. Rev., July 1844.
1162 v.AccINATION As A PREVENTIVE of SMALL-Pox.
admits also that a properly vaccinated person has always a milder form
of the disease. As might be expected, he strongly recommends Revac-
cination; but he adds, at the same time, that the precise period for this,
cannot be accurately determined, but must vary with the suscepti-
bility of each individual for the Small-pox. Heim goes still further,
asserting, that in very few instances was Revaccination entirely
without effect, when performed five or six years after the first opera-
tion; whilst Spooner enlarges the period for successful Revaccination
to fifteen or twenty years.
It is also a part of the evidence on this point, that where Revaccin-
ation does not produce any effect on the first trial, the operation
should be repeated, as it will often succeed on a second attempt,
although failing on the first. In proof of this, we may cite the state-
ment of Schlesier, from which it appears that in about 14,000 unsuc-
cessful cases, it succeeded in 1,569 on a second operation. According
to Heim, the protective power of Revaccination extends to an equal
time with the primary Vaccination, provided the success of the Revac-
cination be complete, and in no degree less perfect than the good
Cow-pock of children ; and that the vaccine virus be in sufficient
quantity to saturate the system. Hence, it would appear, that if we
were to adopt the views of Heim, the proper periods for Revaccination
would be about every sixth year, during the entire period of life.
Gregory assigns a longer period for the duration of the protective in-
fluence, extending, at least, to the tenth year.
But, whatever may be the true explanation, the secondary occur-
rence of Small-pox, in a certain number of cases, cannot be questioned
any more than the fact that Revaccination succeeds to a considerable
extent, and the practice may, therefore, be recommended on sound
principles. There is much evidence to show that, in point of safety,
the revaccinated are placed in the better position ; and whether we
subscribe to the theory of the progressive failure of the vaccine influ-
ence, or adopt the views, which in preference have just been advocated,
it is impossible to say with certainty, in any given case, whether the
system is truly protected or not. It may be added, that Revacci-
nation is perfectly innocuous, and very rarely indeed productive of
any serious results. In making this assertion, founded on the details
of my own experience, I am aware, that in one case, related by Dr.
Henry Kennedy, sloughing and alarming debility followed the opera-
tion ;' but such instances are too rare, in a proper condition of health, to
weigh at all against the practice, which at worst can only be useless,
and may be legitimately defended, if its only effect were to save a
single life, in thousands of cases. Influenced by these considerations,
I have for many years recommended, and frequently performed the
secondary operation as a measure at least prudent, if not absolutely
necessary, and as being in no degree incompatible with the doctrines
of Jenner. . - - - z
With reference to the periods at which Revaccination should be
performed, it appears that the opinions of different observers are too
discrepant, to enable us to deduce from them any general rule of prac-
1 Dublin Quarterly Journal, 1846.
BY ALEXANDER KNOX, M.D. 1163
tice. Five, seven, ten, fifteen and twenty years have been respec-
tively assigned as the limit of the protective influence ; but, even
granting that this limitation exists, it may reasonably be inferred,
that the period at which the immunity becomes extinguished, varies with
individual peculiarities of constitution. Were it, however, in the exist-
ing state of our information, considered eligible to revaccinate at
stated periods, the more prudent plan would clearly be to adopt the
shorter intervals. In my own practice, I have been guided rather by
the wishes of patients and their friends, and the imminence of con-
tagion, than by reference to the actual lapse of time. It is scarcely
necessary to observe, that all the precautions respecting the choice of
lymph, and the health of the patient, employed in the primary, are
equally applicable to any consecutive Vaccination. And it may be
further observed, that where Revaccination fails on a first attempt,
the operation should be repeated, as it is impossible to decide, by a
single trial, that the system is proof against the renewed application of
the infection, as has been fully illustrated by the experience of Schle-
sier, to which we have already referred.
Such are the views, which after the most deliberate inquiry, and a
reasonable share of practical acquaintance with the subject, I have
been led to entertain, and to which I have considered it a duty to
give currency ; being deeply impressed with the conviction, that the
efficient and general practice of Vaccination, aided by Revaccination,
under suitable circumstances, will be found an efficient safeguard against
the ravages of Small-poa, in all constitutions not absolutely beyond the
influence of any protecting agent whatever. And in this age of sani-
tary reform, it is a fact not very creditable to the good sense or
intelligence of mankind, that a large proportion of all the children
born, remain, in most countries, unvaccinated through the entire
period of their lives. It evidently, therefore, becomes the duty of
every member of society to contribute, as far as is in his power, to
remedy a state of things, alike dangerous to the individual and to the
community ; and each, in his degree, may contribute at least some-
thing to so desirable an end. As far as regards the legislature, it
may be respectfully suggested, that a law to enforce universally the
adoption of Vaccination might be justified on principles of the soundest
policy; but, even without any positive enactment on the subject, it is
within the power of all governments to extend the practice in a very
great degree. The bare knowledge of the fact, that the subject was
considered of importance by the various branches of the executive,
would do much ; and the object in view might be more fully accom-
plished, by bringing all the powers of both the common and statute
law to bear against the practice of indiscriminate Variolous Inocula-
tion, and by requiring proof of previous Vaccination, as a necessary
condition to holding any situation or appointment, whatever, remu-
nerated out of the public purse. Effectual means of enforcing the
necessary regulations are evidently within the power of the directors
of the army, navy, and East India Company, as well as the various
police forces. The same may be said of the Customs and the
Excise, and especially of the Poor Law Commissioners, and the
WOL. II. 76
1164 VACCINATION AS A PREVENTIVE OF SMALL-POX.
different boards of guardians throughout the realm, as the inmates of
the poor-houses are mainly furnished from that class of the population,
in which Vaccination is most likely to be performed carelessly, or
neglected altogether. In private life, a great deal might be done to
the same end, by the governors of hospitals and other charitable insti-
tutions, the masters of schools, the owners of merchant and emigrant
vessels, and the proprietors of the great mills and manufactories of
every description, throughout the country. The more intelligent
classes of Society, not content with having the operation performed in
their own families, might materially promote the practice, by endea-
vouring to enlighten the ignorance, and overcome the obstinacy, still
unhappily too prevalent amongst the uneducated, with reference to
the subject. The benevolent offices of the ministers of religion might
also be interposed with great effect ; and tracts, couched in plain and
forcible language, enforcing the practice of Vaccination as a Christian
duty both to ourselves and others, if issued by the various societies for
the promotion of knowledge, would, no doubt, be productive of the
best results. Various other measures might be suggested; but what is
especially required, is a full and universal recognition of the great prac-
tical importance of the subject; for if this be once attained, measures
will speedily be found to carry out to completion the discovery of
Jenner, which, even with the limitations imposed on it by our more
extended knowledge, must always be looked on as one of the greatest
blessings ever conferred on the human race.
RECAPITULATION. The most important practical deductions, sug-
gested by a careful reconsideration of the whole subject, may be briefly
embodied in the following recapitulation, which the writer begs leave
earnestly to commend, with all due respect, to the consideration of his
professional brethren. Should the views which he has advocated be
found to contribute, in the slightest degree, to reassure the public con-
fidence in the protective influence of Cow-pock, and to promote the
more general and careful practice of Vaccination, his object will have
been amply attained.
1. It appears to have been satisfactorily demonstrated, that secondary
Vaccinations have succeeded in a considerable proportion of the cases,
in which they have been resorted to.
2. It also appears, that Small-pox has prevailed of late years to an
increased extent.
3. The results in question have been attributed, partly to a diminu-
tion of energy in the vaccine infection, caused by repeated transmis-
sion through the human subject, and partly to the alleged tendency
of the immunity conferred by Cow-pock to wear out of the system,
after an uncertain period from the date of Vaccination.
4. Both the success of Revaccination, and the increased prevalence
of casual Small-pox, appear, however, to have been exaggerated in
the popular belief; and, at any rate, the facts seem explicable, in a great
measure, without resorting to the hypothesis just stated, by attributing
them in part to the imperfect performance, or the entire neglect of
Vaccination, in part to the temporary tendency to increased diffusion,
at distant and uncertain periods of time, which characterizes all epi-
BY ALLXANDER KNOX, M.D. 1 165
demic diseases, and, finally, to peculiarities of constitution, which render
many individuals absolutely insusceptible of being protected against
a secondary attack, either by Vaccination or by inoculated or natural
Small-pox.
5. It has been proposed to re-introduce Variolous Inoculation as a
certain remedy for the occasional failure of Vaccination, ; but the
Superior efficacy of the practice is not only questionable, but its indis-
criminate employment has been proved to be dangerous, and destructive
of human life, and is therefore highly to be deprecated.
6. Revaccination, however, may be prudently reeommended, not
only as innocuous in itself, but also, on various grounds, as positively
advantageous, even by those who question the gradual extinction of
the protective influence of Cow-pock.
7. It does not appear that genuine Vaccination has lost any of the
efficacy, which at any time really appertained to it; and it still remains
to be demonstrated that it is not capable of conferring, to the end of
life, complete immunity from the horrors of Small-pox, on a large
majority of all the individuals fully submitted to its influence.
8. Even where Vaccination fails to prevent a secondary attack, the
consecutive disease, in general, assumes a mild and modified form,
although, in some instances, it may be sufficiently severe to leave the
countenance marked with scars, and still more rarely to terminate in
death : but fatal cases from secondary Small-pox do not seem to be more
frequent after Vaccination, than after a primary attack of the natural
disease. -
9. On the whole, it is respectfully maintained, that Cow-pock, im-
parted in the most efficient manner of which it is capable, by Vaccina-
tion, and, under certain circumstances, by Revaccination, is the most
eligible safeguard, within our power, against Small-pox ; and that it
will prove effectual in most constitutions, not inherently insusceptible
of protection, by any means whatever.
Strangford, Ireland, October 1850.
P. S. Since the first part of this paper appeared in the November
number, I regret to learn, on the best authority, that I have uninten-
tionally fallen into an error regarding Dr. Gregory's views, in attri-
buting to that distinguished physician (p. 1051) any change of opinion
in consequence of the researches of Mr. Ceely. Dr. Gregory is still
a believer in the non-identity of Cow-pock and Small-pox ; and I
therefore take this, the earliest opportunity, of rectifying the mistake.
The reader is requested to correct the following
ERRATA.
Page 1042, lines 9 and 21, for British, read Provincial Medical and Surgical.
Page 1049, line 14, omit the word Retrovaccination.
Page 1050, line 5, for Cow-pock, read Small-pox.
7
{}
1 166
IBIBLIOGRAPHICAL RECORD.
CoRPULENCE ; or, ExCESs of FAT IN THE HUMAN Body ; its relations to
Chemistry and Pathology, its bearings on other Diseases and the value
of Human Life, and its Indications of Treatment. With an Appendix on
Emaciation. By THoMAs KING CHAMBERs, M.D., Fell. Roy. Coll. Phys,
and Gulstonian Lecturer for 1850. pp. 166. London : 1850.
WE have derived much pleasure from the perusal of this little work, which
is conceived and executed in a right philosophical spirit ; and though the
Lectures of which it consists have already appeared in the pages of the
Lancet, we conceive that it merits additional notice in this place.
Obesity, or polysarcia, is a true hypertrophy of the tela adiposa, an increased
growth, without change in chemical or anatomical characters. In this it is
in marked contrast with another condition, the fatty degeneration, which is
rather an atrophy than a hypertrophy, the tissues of the affected organs
being replaced by a substance lower in the scale of vitality, The microsco-
pical characters of the fat in these two cases clearly indicate the fundamental
distinctions. In obesity the fat is vesicular ; in the fatty degeneration it is
molecular. Each vesicle, in natural fat, is a perfect organ in itself, having a
distinct wall, and being supplied on its exterior by capillary blood-vessels. The
vesicles are round or oblong, but assume a polyhedral form from compression.
“Mr. Paget has pointed out an interesting peculiarity of the fat vesicles,
namely, that their contents, though fluid, do not pass by exosmosis through
the membranous walls. This he ingeniously explains, by noticing that the
membrane is moistened continually by the same fluid which all tissues im-
bibe from the blood-vessels—that is, water containing albumen and salts in
solution. With this the oil has no disposition to mix, and thus each drop is
imprisoned in a vesicle of impermeable tissue. During life, the oil-cells, by
the attraction of their walls, constantly imbibe this watery fluid from the
capillary vessels that surround them ; and after death, if fat be kept in or
near water, no oil transudes till the cells decompose. They retain their con-
tents, on the same principle that an oil-silk bag holds water ; the one is
rendered water-proof by oil, and the other oil-proof by water. The fluid thus
inclosed in an impermeable sac, being incompressible, is highly elastic, and
diffuses pressure equally in all directions. It is similar, in fact, in its con-
struction, to a water-pillow ; and is similar in its use too, for, distributed
about the sole of the foot and the nates, it enables us to stand or sit with
easy comfort, without the fear of squeezing out the oil from the tissue. The
membrane is supplied with this necessary watery fluid by the capillary blood-
vessels, which ramify in great abundance among the vesicles, forming loops
around each, and detaining the blood as long as possible in their vicinity.
When the vesicles increase in number, these blood-vessels increase in number
also, and appear capable of almost indefinite multiplication. How great must
be the effect of this upon the circulation . If, for instance, a man of five feet
two inches, whose healthy weight would be eight stones, increases to twenty-
eight, no less than twenty stones of additional fat have to be supplied with
capillaries, and those capillaries have to be supplied with blood by vessels
constructed to circulate but one-third of the quantity. How wonderful must
be the power of adaptation which can render such a change consistent with
life at all ! How little cause for surprise, if that life is short, and burdened
with innumerable ills 1” (p. 8.)
The uses of fat appear to be to act as padding, filling up angular cavities,
and facilitating motion, to defend from external cold, and to form a store-
house of carbon for the use of the lungs. It is derived directly from olea-
ginous articles of food, and indirectly from some other proximate principles,
as the saccharine. But, for its formation, it is necessary that the materials
be digested in a greator quantiiy than is sufficient to supply carbon to the
HIBLIOGRAPHICAL FºECORD. 1167
respiration. There has been much difference of opinion regarding the means
by which the oily matters are taken up by the lacteals; but experiments
performed by Dr. Chambers on rabbits seem to set the matter at rest, and
to show that the pancreatic juice is the agent.
The desire for oleaginous food is not equally strong at all periods of life;
children commonly dislike it; the taste appears to be acquired about the
time of puberty, and in a more marked degree in females.
A certain amount of fat is necessary for the perfect well-being of the indi-
vidual, while an excess is injurious. It is, therefore, of some moment to
determine the best way of ascertaining this point. Dr. Chambers believes
that the balance is the best test, seeing that its indications are chiefly modi-
fied by the quantity of fat, the bones and muscles having comparatively little
influence. This is illustrated by several examples, for which we must refer
to the original work, as well as for the tables showing the average weights
in healthy subjects, in obese persons, and in phthisical patients.
Corpulence is in a very marked degree hereditary. From the tables con-
structed by Dr. Chambers, it appears, that the tendency was referable to their
ancestors in twenty out of the thirty-eight cases quoted; in five more, it was
to be seen in their collateral relations; in six only was it absent, the rest being
doubtful or unknown. In insanity, 13 per cent. is the full proportion; in
consumption, according to the First Report of the Brompton Hospital, 24%
per cent. Of the exciting causes, an acute attack of illness appears to be the
most common. Accidental surgical injuries also frequently produce it ; and
so, too, good living, with moderate exercise and an easy mind.
“The most interesting way of illustrating the pathology of obesity, will be
to detail the causes of death in a considerable number of cases of this affec-
tion. I have put together sixty-nine, of which the post-mortem records are
thoroughly to be trusted, sixty-seven having been examined at St. George's
IIospital, and two by Dr. Shearman, of Rotherham, a gentleman of well-known
accuracy and research.
- - CAUSES OF DEATH IN SIXTY-NINE CORPULENT PERSONS.
Medical Cases.

Dropsy ... . ... ... ... 13 | Aneurism, l; malignant disease, 1 ;
Apoplectic Coma ... ... ... ... 11 fever, l; rupture of stomach, 1 ;
Pneumonia ... ... ... ... ... 5 polypus uteri, 1 ... ... ... 5
Pleurisy (acute, 2; chronic, 1) ... 3 Erysipelas of face ... ... ... 1
Fainting (fatty atrophy of heart) 1
Surgical Cases.
Peritonitis after hernia. ... ... 8 || Secondary abscess ... ... 3
Erysipelas after ulcers and slight Nephritis after lithotripsy ... I
wounds ... ... ... ... ... 3 | Diseased prostate... ... ... 1
Gangrena senilis ... ... ... ... 2 | Accidents ... ... ... ... ... 10
Diffuse cellular inflammation ... 2
“The heart was examined in fifty-seven of these patients. In seven it was
found healthy—viz., in four who died from accidents, in one case of rupture
of the stomach, one of hernia, and one of nephritis. In the latter case, the
principal local collection of fat was about the kidneys, where the amount
usually found was greatly augmented. In fifty of the fifty-seven cases where
the heart was examined, it was found diseased. Of the fifty diseased hearts,
5 were hypertrophied and not dilated; 26 dilated only ;
8 hypertrophied and dilated ; 11 atrophied.
In sixteen of these, there was an increased amount of vesicular fat about the
heart—viz., In 13 of those which were dilated ;
In 2 of those which were atrophied ;
In 1 of those hypertrophied and dilated.
“In fourteen instances, the kidneys were also affected with chronic degen-
eration, which, in all those, where an opportunity occurred of forming an
opinion, seemed to be consecutive on the cardiac disease.
I 168 BIBLIOGRAPH LCAL RECORD.
“A cursory glance over the facts recorded in these lists will be sufficient
to show what a great influence over life the disorders of the circulating system
have had. In the medical cases, the two classes which make up the bulk of
the whole, may be referred entirely to this source ; and in the surgical cases,
nearly all are of a nature to be much aggravated by an ill-balanced distribu-
tion of blood.
“The change which most commonly affects the heart is dilatation, pro-
bably dependent on the greatly increased quantity of capillaries distributed
throughout the body, and the consequent increase in the amount and pressure
of the circulating fluid upon the central organ. The hypertrophy, which
sometimes ensues, is not unlikely to be an effort of nature to supply force in
proportion to the increased demand.
“In eleven cases out of the forty-nine, atrophy of the heart was observed,
that is, diminution in the thickness of the walls, without any external aug-
mentation of size ; and in such of these cases as were submitted to the test
of microscopic examination, a deposition of molecular fat, destruction of the
nuclei, and other evidences of degenerated muscle, were found.
“We must be careful to distinguish this fatty atrophy, or degeneration,
from deposition of vesicular fat ; the first arises from deficient nutrition, the
second is due to excess. One is a retrogression from a more highly endowed
tissue to one less distinguished by its importance and offices ; the other is an
increased growth. It is true, they may be coincident, as in the instances
before us of atrophied hearts in obese people ; yea, they may exist together
in the same organ, as in two of these cases, where there was much fat at the
base of the great vessels and degenerated muscle at the same time. But still
they are contrasted conditions, hypertrophy and atrophy of different tissues.
“It still remains to be explained, why these two opposite states are so often
associated together ; why degenerated muscle is more common in fat than in
thin people, as would appear to be the case from a paper presented by Dr.
Quain, a short time back, to the Medico-Chirurgical Society.” (pp. 118-21.)
In regard to treatment, Dr. Chambers observes : “The first thing indicated
in all cases is to cut off, as far as possible, the supply of materials. Fat, oil,
butter, should be rigorously interdicted in the diet table. But all eatables
contain some portion of oleaginous matter, and especially those most conve-
nient to advise the use of for a lengthened period. And, as we observed at
the former part of our review of the light which chemistry has thrown on
the subject, almost all are capable of a transformation into fat, when a small
quantity of this substance is previously present. It is desirable, therefore,
that the mass of food should lie in the stomach as short a time as possible, in
order that at least a fatty fermentation may not be set up in it. Wery light
meals should be taken, at times most favorable to rapid digestion, and should
consist of substances easy of solution and assimilation. To this end, the
time of the meals should be fixed for an early hour in the day, before exer-
tion has rendered the power of the entrails languid and weak. Breakfast
should consist of dry toast, or, what is still better, sea biscuit, and if much
active exercise is intended, a small piece of lean meat. Dinner at one, on
meat with the fat cut off, stale bread or biscuit, and some plain boiled
macaroni, or biscuit pudding, by way of second course. . . . Liquids should
be taken, not at the meal, but half an hour after, so as not to impede the
action of the gastric juice upon the mass. Here should end the solid feeding
for the day; no second dinner or supper should follow, nor, indeed, any more
meals be taken sitting down. A piece of biscuit and a glass of water can be
taken standing up, if faintness is experienced; a cup of gruel, or a roast
apple, before going to bed. . . It is often advisable to add a small allowance
of malt liquor at dinner, as otherwise the craving of the appetite is less
easily appeased.” Among medicines, the liquor potassae stands preeminent.
It should be given freely in milk, beginning with half a drachm, and raising
the dose to a drachm or a drachm and a half, three times a day.

BIBLIOGRAPHICAI, RECORL). 1169
The DISEASEs of THE BREAST AND THEIR TREATMENT. By JoHN BIRKETT,
F.R.C.S., F.L.S., Assistant-Surgeon to Guy's Hospital. pp. 264. London:
1850.
There are few organs in the human body subject to a greater variety of
diseases, than the female Breast, nor one in which it is of greater importance
that a correct diagnosis should be made. Many, we fear, have been the cases
in which the frightful operation of amputation of the breast has been per-
formed, without the slightest real occasion ; and numerous the instances in
which mastodynia has been confounded with scirrhus, and the patients con-
demned for months to the mental agony of supposing they had the much
dreaded cancer, when in truth they were the subjects of a harmless, though
painful disease. . It is the duty of every medical man to guard against the
possibility of such an error ; and the treatise before us will be a useful guide.
The subject is considered under the following heads:
I. The Diseases before Puberty.
II. The Diseases during the establishment of Puberty.
III. The Diseases after the establishment of Puberty.
The following are some of the points which are deserving of notice.
INFLAMMATION OF THE BREAST, or MAzo[TIs, may be limited to the nipple
or areola, the cutaneous and subcutaneous tissues, the lobes individually or
collectively, and the uniting fibro-cellular tissue. It may be either intra-
lobular, or inter-lobular, or both combined. To prevent inflammation of
the nipple, it is recommended that, during pregnancy, as soon as it en-
larges, it should be exposed to \the air, washed with soap and water, and
occasionally wetted with an astringent lotion. After birth, it is of conse-
Quence that the nipple be properly cleansed after each application to the
infant's mouth. If fissures and abrasions take place, collodion is advised,
as preferable to other applications. -
In inflammation of the subcutaneous tissue of the nipple and areola, it is
recommended that, if the gland be in an active state—i.e. the woman suck-
ling—warmed, evaporating, or Saturnine lotions be used in preference to
cold, and the general health carefully attended to. If resolution do not
seem likely to take place, fomentations and soothing poultices must be
applied. If, in spite of these measures, pus should form, a free opening is
to be made. The direction of the incision is of importance: it should always
be made in the direction of radii passing from a centre which is formed by
the nipple, since, as the ducts converge to this centre, the incisions will then
be parallel to them, and there will be no risk of their division.
In true Mazoitis, the progress of the disease may often be arrested by
antimonials, when they can be borne. When suppuration has taken place,
a free opening should be made, but pressure on the part must be scrupulously
avoided. At that time, too, a good diet is proper.
Cysts occurring in the mamma are divided by Mr. BIRKETT into
1. Cysts depending upon dilatation and a morbid condition of the lacti-
ferous ducts or acini. -
2. Cysts produced by a peculiar action in the fibro-cellular envelope of the
gland tissue, and the consequence of a morbid state of the function of
nutrition.
Mr. Birkett, having very carefully investigated the subject of cysts, has
arrived at conclusions differing from those entertained by Sir B. Brodie. He
is of opinion, that the lactiferous ducts are liable to dilatations resembling
cysts; that this morbid condition simulates more important diseases, but that
there is no evidence to prove that the growth within the ducts has any cha-
racter in common with either the cysto-Sarcomatous or carcinomatous new
formations, and that this morbid condition belongs to the class of non-con-
taminating diseases. The whole of the observations on cysts are well worthy
of perusal. Af
| 170 BIBLIOGRAPHICAL RECORD.
That distressing affection, MAZODYNIA, is considered as it occurs without
induration and with induration. The former generally occurs before the
cessation of the catamenia, very often in early life, and is generally connected
with some menstrual derangements, and excitability of the nervous system.
The treatment ought to be directed first towards the alvine secretions, and
afterwards tonics must be given. In patients who will bear the loss of blood,
local depletion is of service : otherwise sedatives are indicated.
When accompanied with induration, Mazodynia is a more formidable dis-
ease, the pain being often very severe, and the breast exquisitely sensitive.
The suffering from this disease is indeed very remarkable, and has often sug-
gested to persons, not well acquainted with the pathology of the breast, the
existence of serious disease; indeed, recourse has been had to excision, and
to subcutaneous incisions throughout the gland ; though we imagine that
it would be very difficult to say why or wherefore, although a French surgeon
has recommended it. It reminds us of the very simple proceeding recom-
mended by another French surgeon for the cure of myopia—merely dividing
the four recti muscles of the eye which he moreover says he has done—
more's the pity! The remedial measures for the disease under consideration
are those which have been mentioned as applicable to the first form, together
with gentle pressure and sedatives. We have found great benefit from a
combination of the extracts of belladonna and opium in equal parts, rubbed
down with oil of almonds to the consistence of cream, and then applied under
oiled silk or gutta percha sheeting.

The opinions of Mr. Birkett regarding operative proceedings in CANGER are
judicious. During the first stage of development of a carcinomatous tumour,
he believes its removal to be justifiable ; but in the third and fourth stages,
he condemns operations as inadmissible. We are perfectly satisfied, that
when the disease is far advanced, it ought to be let alone, and merely soothed.
If cut away, the object of prolongation of life will be defeated in ninety-nine
cases out of a hundred.
In conclusion, we recommend Mr. Birkett's volume as a perspicuous and
useful contribution to medical literature.
CHOLERA : ITS CAUSEs, SYMPTOMs, AND TREATMENT, CoNSIDERED AND Ex-
PLAINED. By J. P. BATCHELDER, M.D., of New York City. Pamphlet,
pp. 45.
THE SYMPTOMATIC TREATMENT OF ASIATIC CHOLERA. By EWING WHITTLE,
M.D., Lond., M.R.C.S., Honorary Surgeon to the Liverpool South Dis-
pensary, and Surgeon to the Toxteth Park Cholera Hospital during the
Epidemic of 1849. Pamphlet, pp. 100. London: 1850.
THE REMEDY of EPIDEMIC CHOLERA, WTTH DIRECTIONS FOR USE, so SUCCESS-
FULLY ADMINISTERED IN GATESHEAD AND ITS WICINITY, PARTICULARLY
IN FEBRUARY LAST. By Joseph BELL. Pamphlet, pp. 12. Newcastle-
upon-Tyne: 1849.
In looking over the pamphlet of Dr. BATCHELDER, which is fairly enough
composed, we find nothing, some questionable physiological explanations
excepted, which has not been said over and over again ; although the author,
from the beginning to the end of his treatise, makes no reference to the works
of any other writer on Cholera. In a practical point of view, it is suggested
by Dr. Batchelder, that the treatment of malignant Cholera was too active; or,
as he not very elegantly expresses it, “many of the patients were doctored too
much ; whereas the most judicious course, in many cases, would have been to
stand still and let the patient get well if he could.” The concluding part of
this little brochure, written with considerable cogency, goes to prove that
Cholera is neither a contagious nor an infectious disease.
The Treatise of Dr. WILITTLE, on the contrary, advocates the very converse
BIBLIOGRAPHICAL RECORD. I l'î *
I
of the proposition just stated, on the subject of contagion. On the general
question, we shall not offer any opinion here; but we think that Dr. Whittle
entirely misses the mark, when he alleges that the dispute will be found to
be one rather about words than facts.
Nor do we suppose, that there is any well-informed practitioner, who is not
fully aware of the etymological distinction between contagion and infection ;
but the anti-contagionists, as they are termed, would equally object to Dr.
Whittle’s views, whether he should term Cholera an infectious or a con-
tagious disease. “His conclusions on the subject,” he informs us, “may
be embodied in the following law, -namely, that Cholera is not so generally
infectious as other epidemic fevers, but, when communicated by infection,
engenders a very deadly form of disease.” Dr. Whittle's law as to Cholera
being infectious in any degree, cannot, even yet, be looked on as more than a
questionable theory; whilst the allegation of its peculiar deadly nature when
derived from infection, will certainly be set down as a mere vague assertion.
A severe critic might, with some shew of reason, be disposed to question,
whether the author has made himself master of the information necessary
for reasoning on so abstruse a subject, when he finds him expressing the belief,
as he actually does, without any qualification, “that it is scarcely possible
for one, not previously infected, to be exposed to the infection of variola
and to escape the disease,” and “that there is no case on record of any one
being twice affected with Variola /?’ (p. 95). Now there is scarcely a writer on
the subject, who will not give Dr. Whittle more correct information on these
points than he seems to possess, and very few physicians of any claim to expe-
rience, we apprehend, will be found, who have not met with cases of secondary
small-pox. We are ourselves cognisant of more than one ; and Dr. Whittle
might, without any great research, have ascertained that Louis XV of France
died of a second attack of small-pox, and that Dr. Baron refers to more than a
hundred writers who have seen secondary small-pox. On examining the cases
brought forward by the author, in favour of contagion, or infection, call it
whatever he may, we find that they are perfectly explicable on other grounds;
and, even on the supposition that the doctrine in question be true, his cases will
add little to strengthen it. The experience of the writer, however, in the
Epidemic of 1849 was ample; and, having practically found the value of
blood-letting, his principal object in laying his views before the profession is,
we are informed, to advocate the superiority of that remedy over every other
mode of treatment, and to point out the true indications for its employment,
For these indications, and the cases brought forward in favour of venesection,
we must refer to the work itself, which is written in an agreeable style, and
will amply repay the perusal, as Dr. Whittle is evidently a reflective, discri-
minating, and judicious practitioner.
The insignificant Treatise of Joseph BELL, is only worthy of notice for the
purpose of denouncing it as a mere puff, equally redolent of ignorance and
effrontery, and evidently published for the sole purpose of promoting the sale
of the author's drugs. Whether this judgment be too severe, let the reader say,
after reading the following extracts from his pamphlet. We shall only premise,
that Colchicum is the remedy principally recommended,—and that we are
gravely informed, that “a remedy is a medicine that in general cures.”
“REASONS FOR PUBLISHING THIS REMEDY, ETC. Being in earnest in this
matter, and seeing that this dread pestilence was devastating the human
family; and being quite incapable of adequately, to the exigency of the occa-
sion, administering this medicine, from the range of the disease, the doubts
of the public, (seeing that remedy after remedy had failed, after being san-
guinarily announced for the cure of Cholera),—I made application to various
parties to obtain attention to this remedy in vain; and seeing that the disease
still prevails, and will prevail, and that in all probability it will break out from
time to time in paroxisms (sic) before it finally leaves this island and Europe;
and also thinking, if this treatment be a remedy for Cholera, it is too great a
thing to make a household god of—a thing that so mightily concerns the
II 72 BIBLIOGRAPHICAL BECORD.
public, that they should have it; and again, should it be no remedy, however
limited the range of its administration, the consequences are too serious to
allow of any trifling;-then, on those grounds, I publish this—(the pioneer
of a more laboured work). -
“The frame is paralized (sic) by the intensity of the cause of this disease,
I would therefore suggest STRYCHNIA in such cases (which is chiefly used in
paralysis) combined with colchicum. In the state of collapse it has been
advantageously given.
“It ought to be impressively remembered, colchicum, to have its virtues in
perfection, must be gathered at a certain season, which is mentioned in the
Pharmacopæ (sic) and must be properly preserved. Perhaps this objection
lies not against veratria, which combined with an unknown acid constitutes
the active principle of colchicum.
“Not that I presume it will raise the dead, which some at first may be con-
sidered as being, from the severity of the attack, some actually perishing as
if struck by lightening (sic)—all I mean is, amongst admitted remedies this
remedy will maintain its Stand.
“That consequently Epidemic Cholera is now a Curable Disease.
“The Press, I respectfully solicit to lend its aid in spreading this remedy;
which, to be done safely, should be done wholly, giving both the reason, Yº.
and result, as stated here. J. B.-June 7, 1849.”
Surely this is enough.

PRACTICAL SUGGESTIONS FoR THE PREVENTION of CoNSUMPTION. By G.
CALVERT Hol.IIAND, M.D., etc. pp. 143. London : 1850.
The mental condition of an allopathico-homoeopathico-globulist is a sub-
ject for the moralist and the psychologist, rather than for the medical
reviewer. To others, therefore, we must leave for the future, Dr. G. CALVERT
Holi,AND, lately physician to the Hospital of Sheffield, and now physician to
the Homoeopathic Hospital of London. We have already told our readers
what London globulism is, when (p. 849-50) we noticed two books by Dr.
Holland, on Consumption, one of which was dedicated to Dr. Frederick Foster
Quin. We now simply announce, that we have here before us a TIIIRD book
on Consumption, in which homoeopathy, globules, and Dr. Quin, are ignored,
and some of the rational methods of treatment recommended ; and that the
book is prefaced by a magniloquent dedication to Sir James Clark, who, we
hope, is sensible of the honour which has thus been conferred upon him.
This exhibition of hardihood and folly on the part of Dr. Holland, confirms
our former statement, that “homoeopathy, as a system of medical practice, is
almost extinct ; the name and the globules being retained, chiefly as topics of
discourse, and sectarian insignia—insignia of no mean value to those who can
adroitly display them.”
THE Accom MoDATION of THE EYE To DISTANCEs. By WM. CLAY WALLAGE,
M.D. pp. 36. New York: 1850.
DR. CLAY WALLACE was one of the first of the living anatomists who
adopted the view of Porterfield, and some of the older investigators, respect-
ing the muscularity of the Corpus Ciliare, and the effect produced thereby
on the Adaptation of the Eye to Distances. The pamphlet before us appears
to be a reprint of his former papers; but we are somewhat surprised that no
allusion is made to the investigations which have been made in this country
on the same subject. The absence of such information detracts from the
value of the pamphlet, for the views which it promulgates have been known
and recognized for three years at least. Dr. Wallace is, however, deserving of
approbation for the talent with which he pursued his inquiries on this in-
teresting subject.
1173
CKITICAL DIGEST OF THE BRITIs H AND FOREIGN MIELDICALs
- JOURNAL.S.
PRACTICE OF MEDICINE AND PATHOLOGY.
*===s===sº
REPORT OF THE CATHERINE HOSPITAL, AT STUTTGART, ON THE DISEASEs
OF CHILDREN.
The Journal fir Kinderkrankheiten, for July and August 1850, has the
following extracts from DR. EISAESSER's Report on the Diseases of New-
born Children in the Lying-in Department of the Catherine Hospital at
Stuttgart, from 1st July 1848, to 30th June 1849. This article may be con-
sidered as a continuation of the Report, of which we gave a translation at
p. 494 of this Journal for May 1850.
SCLERosis of THE SKIN. Several feeble premature children were affected
with this disease, and thereby entirely prevented from sucking. The failure
of the vital powers was accompanied by intestinal catarrh, and in one case by
pemphigus; the parts of the skin, not affected by Sclerosis, were yellow, and
cool; convulsions and syncope followed. The following were the post-mortem
appearances. The skin, which during life was red and hot, was very firm and
resistent, but still pitted on strong pressure; the depressions, however, gra-
dually disappeared. The cutis was of normal thickness and consistence, but
the deeper layers were somewhat injected ; and this appearance was some-
times more marked in the subcutaneous areolar tissue. The latter was in-
filtrated with a glutinous matter, partly sanguineo-serous, partly sero-albu-
minous, which flowed out on section. The subcutaneous fat appeared among
this infiltration, partly in the form of dark-yellow isolated grains of the size
of mustard-seeds, partly as yellowish granular streaks. The neighbouring
muscles were also pale, being infiltrated with serum. In one case, the venae
saphenae, lying in the infiltrated areolar tissue, had their walls thickened,
and contained a little fluid blood. In two cases, the brain, with its mem-
branes, sinuses, and plexuses, shewed traces of hyperaemia. In two others,
there was anaemia of the brain and its membranes; and, in one of these, the
cerebral substance was unusually firm, and the ventricles contained some
serous fluid. The lungs, in one case, were bloodless, and very emphyse-
matous ; in two, they were in a state of atelectasis. In another instance, the
lower border of the upper lobe of the left lung was adherent posteriorly to
the costal pleura, and contained an abscess as large as a hazel-nut, surrounded
by an area of inflammation ; there were also two other abscesses in the same
lobe. The upper lobe of the right lung was in a state of partial atelectasis,
and also contained abscesses. The heart, in several cases, was filled with
dark blood, and in one instance contained a fibrinous clot. The liver, and
large abdominal vessels, generally contained much blood; but in one case
the liver was anaemic. The spleen was large, dark-red, and friable; the in-
testinal mucous membrane, in two cases, had a catarrhal appearance, being
swollen, injected, and presenting slate-grey and brownish spots, with enlarge-
ment of Peyer's patches and of the follicles. The kidneys contained a deposit
of uric acid in two instances.
CoNGESTION OF THE BRAIN occurred in six cases. In one instance it fol-
lowed extraction by the forceps, and was accompanied by heat of the whole
body, and convulsions of the muscles of the face and limbs; there was also
a peculiar croupy cough, yet unattended by any obvious change in the organs
of respiration. The child recovered perfectly under the use of leeches, and
of calomel and magnesia.
1174 CRITICAL DIGEST OF THE JOURNALS,
wº
TRISMUs occurred in one case. A mature male child, who had been
healthy until the eighth day, was seized with slight ophthalmia, and acidity
of the stomach; but improved under the use of antacids. It was suddenly
attacked, after a change of nurse, with frequent paroxysms of Trismus; for
which baths and opium were used, but the child died on the following day.
The vertebral sinus was found remarkably vascular, especially in the cervical
and lumbar regions; there was some yellowish serous fluid between the spinal
dura mater and the periosteum. The spinal dura mater was remarkably
vascular, and somewhat dull; the pia mater was very hyperaemic, and the
cord rather soft. The skull, brain, and cerebral membranes, were strongly
injected; the plexuses moderately so; the thyroid body was large. The
right venticle of the heart contained a fibrinous coagulum, and the left a
dark one. The right lung was slightly foetal, and the left mostly so. The
liver and kidneys were hyperaemiated; the umbilical arteries were thickened,
and their cellular membrane injected.
CoNGENITAL HYDROCEPHALUs : ABSENGE of CRANIAL Bon Es. A male child
died half an hour after being extracted by the forceps. The head was double
the normal size, fluctuating, and without bony substance : the eyes were
staring ; the mouth wide. In the neck, there was a fold of skin like a double
chin ; the child was chicken-breasted ; the abdomen was large, and the tes-
ticles had not descended; the limbs were crooked; the anus open ; and the skin
leathery. The bony cranium was wanting: the dura mater lay immediately
beneath the skin. Only on the temples was there a thin osseous deposit:
the dura mater presented spots of ecchymosis: the cerebral membranes were
much hyperaemiated and softened, with some bloody serum between them.
The brain was of normal consistence, but vascular; the ventricles were much
distended with serum ; the plexuses were very vascular ; the base of the
skull was thinly ossified, but only as high as the external auditory meatus.
The spinal column was healthy; the canal contained some Sanguineous fluid;
the cord and its membranes were hyperaemiated, but not softened. Both
lungs were for the most part foetal ; the heart lay obliquely, and its right
ventricle was very broad. The liver was very large; the stomach lay per-
pendicularly. The right kidney contained four, and the left five calices.
The thigh and leg were ossified only in points: there were no connected
ossified masses in the right arm, nor any distinct formation of joints.
SANGUINEOUs APOPLExy. A mature female child enjoyed perfect health
for six days after birth. At the end of this time it had green stools, refused
the breast, cried much, and was drowsy. Antacids, baths, and clysters were
employed. Convulsions of the limbs and emaciation set in. Towards the
ninth day after birth, there was spasmodic breathing, frothing at the mouth,
etc. Stimulants produced some improvement: but leeches to the back of
the head were of still greater benefit. Tetanic contractions of the jaw and
limbs soon supervened ; and death occurred on the tenth day. On post-
nortem examination, the cerebral membranes were found to be very vascular; at
the base of the skull, on the dura mater, there was an extravasated mass of
the size of a bean. The brain was very vascular, with a tendency to capillary
apoplexy ; the plexus was much congested. The heart, especially the right
ventricle, was very full of blood. The membranes of the spinal cord were
somewhat hyperamic : and, at the lower part, there was a clot of the size of
a bean. The cord was moderately vascular.
A premature male child died half an hour after birth. Delivery had been
normal: but the mother was suffering from typhus fever. There was an
abundance of dark red matter extravasated on the dura mater of the brain,
as well as on the pia mater at the summit of the hemispheres, and in both
ventricles. The plexus was moderately red. There was also extravasation
at the base of the brain, especially at the optic commissure; the cerebral
substance was very vascular; the lungs were mostly foetal; and the kidneys
were lobed. - - -
CRITICAL DIGEST OF THE JOU 1. NALS I 75
SERous APOPLEXY. The subject was a healthy mature male child, who,
had been delivered by turning. On the second day, there was some shortness of
breathing, and mucous rattles. There were several paroxysms, with interval
of freedom; in one of the attacks the child became pale, and mucus flowed
from the nose. It died on the third day. The meninges, especially on the
cerebellum, were much injected ; there was no extravasation. The substance
of the cerebellum was more vascular than that of the cerebrum; the plexuses
and sinuses were congested. There was a yellow gelatinous matter effused
between the arachnoid and pia mater, especially on the upper surface of the
brain. The air-passages contained an abundance of mucus. The lungs were
permeated by air throughout : here and there, there were extravasations of
blood. The heart was small, and empty; the kidneys contained uric acid.
INFLAMMATION of THE EYE. Ophthalmia appeared in 29 males out of 162,
and in 40 females out of 168 ; the greatest number of cases was in July, the
least in April. In most cases, the disease appeared between the second and
fourth days after birth. It was congenital in four cases. The affection was
mild in 51 instances, but severe in 18 cases, of which three terminated in
blindness from perforation of the cornea and prolapse of the iris ; one in the
left eye, one in the right, and one in both eyes. The constitution of the
children exerted no marked influence on their liability to become attacked,
for thin and weakly children were seized as easily as the well-nourished and
strong : but the latter class shewed a somewhat greater tendency to this
affection. In a child born of a syphilitic mother, ophthalmia appeared in
only a moderate degree.
PNEUMONIA. A mature normally formed child had from birth mucous
rattling and some dyspnoea ; it had also hyperaemia of the brain, with drow-
siness, and want of appetite. On the third day, there was dull stroke-sound
and bronchial respiration, over a space two fingers broad, at the posterior and
inferior part of the right side of the chest ; the dyspnoea increased ; the
countenance was livid, then pale. Death occurred on the fifth day. At the
post-mortem examination, the skull was found very vascular ; the brain and its
membranes pale. On the left side of the cerebellum, between the membranes,
there was an extravasation. The bronchial tubes contained rusty mucus : but
their mucous membrane was healthy. There was a quantity of watery exu-
dation in the pericardium. The liver was hyperaemiated ; the large intestine
strongly contracted ; the urinary bladder was distended to the size of a hen’s
egg, without evident difficulty of evacuating the urine. The upper lobe of the
right lung was mostly condensed : the middle one was normal : and the lower
one was condensed for two-thirds of its extent. The upper lobe of the left
lung was healthy ; but the posterior part of the lower lobe was condensed.
The hepatisation of the right lung was lobular, of the left more lobular; on
the left side, blood escaped on pressure ; on the right, there were also grey
patches, from which a grey fluid escaped on pressure. The hepatisation in
the upper lobes was reddish grey.
SoFTENING of THE STOMACH occurred in a male and in a female child.
Both children at first sucked eagerly ; but, in consequence of the illness of
the mother, one had to be artificially fed, and was seized with aphtha,
vomiting, green stools, and drowsiness. The other child became ill without
any evident cause ; it had convulsions, bowing of the head backwards, scanty
green evacuations, and vomiting on the last day. In both there was
rapid emaciation, and collapse : death occurred on the tenth day. In the
female child, an extravasation was found between the skull and dura mater,
in the vicinity of the right temporal bone: the sinus was filled with blood
and coagulated fibrin. There was some blood extravasated in the arachnoid
on the left side of the cerebellum ; the substance of the latter was softened,
of a brownish-red colour; the base of the brain was vascular. The lungs
were rose-coloured, emphysematous, and very large. The right ventricle of
1176 CRITICAL DIGEST of THE JOURNALs.
the heart contained a large quantity of dark blood. The intestines, especially
the stomach, were much swollen ; and at the base of the latter there was a
portion so much softened, that it was easily torn : the mucous membrane
could be easily stripped off; the softened parts had a blue-red appearance.
The rest of the intestines were swollen, but healthy. In the male child, the
meninges, especially the arachnoid, and the cerebral substance, were very
vascular; the plexus was congested, of a dark-red colour. The heart con-
tained much blood, partly fluid, partly coagulated. There was uric acid in
the kidneys. The base of the stomach was lacerated on being taken hold of ;
it contained coagulated cheesy masses. The parts surrounding the softened
portions showed no trace of inflammatory reaction : the softened mucous
membrane was of a rusty-brown colour, and easily stripped off. The oesophagus
and duodenum were healthy. The lungs were anaemic, and studded with
spots of atelectasis.
DIARRHGEA AND Wom ITING occurred in one male and four female children;
four of the cases were fatal. Death took place in two on the 17th day, in
one on the 14th, and in the other on the 10th day. The preceding circum-
stances were, inflammation of the eyes in one case, artificial feeding in two,
congenital debility in one ; in the fifth, there was nothing remarkable. The
symptoms were those commonly observed ; but the prognosis was frequently
rendered more unfavourable by the refusal of the children to take food. The
evacuations were sometimes green, sometimes almost colourless, thin and
watery. In one case, the vomited matters had a faecal odour. The treat-
ment consisted at first in antacids; then in mistura oleosa with opium,
clysters of starch, friction of the abdomen with oil of henbane and of camo-
mile ; and lastly, musk was given as a remedy for impending collapse. On
post-mortem examination, the stomach and intestines were found healthy in
two cases; in one case, the mucous membrane of the stomach was easily re-
moved. In the fourth case, the stomach and intestines were much distended,
but the jejunum was thin, and vermiform ; from between it and the duo-
denum there arose a cellular band, which reached to the pelvis—a product
of intra-uterine peritonitis. In the remaining intestines, nothing remarkable
was observed. The liver was very vascular in two cases. In one case, the
right kidney contained more blood than the left ; in one, the bladder was
distended to the size of a walnut. The lungs were in two cases in a foetal
state, in one much congested ; one case presented interstitial emphysema of
the lungs, which were otherwise healthy. The heart was generally very full
of blood. In three cases, the brain and its membranes presented extreme
vascularity, almost amounting, in two instances, to capillary apoplexy.
DEBILITY. Under this head, twenty deaths are recorded, being not much
less than half the fatal cases among the new-born children. Although the
term “debility” (Lebensschwäche) is indefinite, yet it is characteristic ; for
no especial sign of disease can be observed beyond a general failure of the
vital powers. They were either apparently dead, or in a condition very simi-
lar. The symptoms worthy of especial note were the following. In one
case, there was stertor and short breathing, with some vomiting and convul-
sions. Another child was vigorous immediately after birth, and the symptoms
of vital debility first appeared at the end of six hours. In a third case there
were vomiting and petechiae; in a fourth, ophthalmia. Five other cases
presented peculiar symptoms. (a) A premature female child, which at
first sucked with vigour, and appeared to thrive excellently, was seized with
icterus and aphthae, suddenly refused the breast on the eleventh day, became
weak, wasted, and died on the twelfth day. (b) A prematurely born female
child, at first thriving, had aphtha, acidity of the stomach, and icterus, and
refused the breast. Artificial nourishment was employed: the child had
green evacuations, and died on the tenth day. , (c) A premature male child,
who shewed no symptom of disease until the ninth day, suddenly refused the
CRITICAL DIGEST OF THE JOURNALS. 1177
breast, cried much, had distortion of the eyes and convulsions, and died on
the tenth day. , (d) A premature male child was vigorous during the first
days, but was then attacked with aphtha, green evacuations, emaciation, and
drowsiness, and died on the thirteenth day. (e) A mature male child, with
intense icterus, cried much, had numerous green evacuations, became ema-
ciated, had aphthae, and died on the fifteenth day. -
The following is an abstract of the post-mortem appearances in twelve
cases. The brain, or its membranes, were vascular in six cases: in one, there
was also an extravasation between the skin of the skull and the pericranium,
and gelatinous exudation over the whole upper surface of the brain, with
oadema of that organ. In another of these cases, there was hyperaemia, with
extravasation in the pia mater and ventricles: there was farther observed to
be serum in the ventricles, and extravasations on the base of the skull. In
the other six cases, the brain had no abnormal appearance. In the whole
twelve cases, the lungs were more or less foetal. The heart, in six cases, con-
tained coagula ; here and there it was empty of blood. Nothing remarkable
was observable in the abdominal viscera. In all these cases, atelectasis of
the lungs was present ; and in half, there was hyperaemia of the cranial
viscera. From this, we may pretty surely infer the connexion of atelectasis
with the occurrence of the symptoms of vital debility soon after birth. On
the other hand, the hyperaemia of the brain appears to be neither a necessary
cause nor effect of the atelectasis. The effusion of serum in the ventricles,
with extravasation of blood, observed in some of these cases, might perhaps
have been adequate causes of the debility.
The following case presented some very interesting appearances. A mature
female child died half an hour after birth. The general integument was
soft and doughy ; the abdomen much distended, the neck swollen, the face
livid, the lips thick and blue, and froth issued from the mouth. Between the
skin of the head and the pericranium, there was a considerable effusion of
blood with serum. The pericranium on both temporal bones, as well as the
dura mater and arachnoid, were very strongly injected ; and there was a
sero-gelatinous exudation on the upper surface of the brain, between the
arachnoid and the pia mater. The brain was oedematous and soft ; the lateral
ventricles were distended with serum. The subcutaneous areolar tissue over
the whole body was infiltrated with serum ; the adipose corpuscles were re-
markably distinct and prominent, as in sclerosis. There was a quantity of
yellowish serum in the pleural and peritoneal cavities ; the lungs were small
and foetal, and weighed little more than four and a half drachms. The peri-
cardium contained a normal quantity of serum. The ductus arteriosus was
perfectly closed, as was also the foramen ovale. The ductus venosus was still
pervious. The liver and kidneys were hyperaemiated ; the spleen dark-red
and friable. It can scarcely be doubted, that the general dropsy, observed in
this case, was due to the closure of the foetal passages, and consequent change
in the course of the circulation, even during intra-uterine life.
Although, from what has been observed, atelectasis cannot be considered
as the cause of debility, it nevertheless is instrumental in producing death,
as the imperfectly oxygenised blood is unfit for life, especially for that of
the brain.
Of fifteen children who died of debility, two were delivered by the for-
ceps and by turning. In the remaining thirteen cases, the duration of labour
was from 11 to 14 hours in four ; from 2 to 6 hours in three ; from 24 to 72
hours in the other six. This seems to show, that a very rapid as well as a
tedious labour is unfavourable to the child. As to the condition of develop-
ment, it was observed, that in twenty-five deaths from debility, two only
occurred in mature children. This was between one-ninth and one-tenth of
the total number of deaths (19) in children born at the full period : while,
among the deaths in the prematurely born children, those from debility were
thirteen in twenty-four, or 54 per cent., being above one-half. The propor-
I 178 CHR ITICAL DIGEST OF THE JOURNAI.S.
tion to the number of births was as follows: deaths among the nature children,
l in 137; among the prematurely-born, 13 in 38; so that rather more than
one-third of all the prematurely-born children died of debility. Most died
from the first to the third day after birth ; and most in the winter months.
The following were the post-mortem appearances in five cases, which have
been above referred to as presenting symptoms not peculiar to debility.
(a) The lungs were very pale, grey-red, nowhere foetal, containing afrothy,
pale-red, sanguineo-serous fluid, Small extravasations of air, of the size of
peas, were scattered over their surface. Microscopic examination showed,
that these did not arise from rupture, but from resorption of the septa; the
cavities had portions of septa projecting in their interior.
(6) The umbilical arteries were thickened, and filled with pus. There
was some croupy exudation on the hard palate and tongue: the mucous
membrane of the stomach was reddened in spots: there was slight swelling
and hyperaemia of Peyer's glands. The liver was friable, and contained a
moderate quantity of blood. The lungs presented spots of atelectasis, and
were somewhat oedematous. The superficial veins of the spinal cord and
brain were full of blood. The abdominal and thoracic serous cavities con-
tained some sanguineo-serous fluid.
(c) The lungs were anaemic, dry, and contained air; the heart and liver
full of blood. The cranial contents were somewhat vascular.
(d) The brain was very dry; the mammary glands atrophied ; both lungs
contained air ; the intestines were contracted, but the transverse colon was
much distended.
(e) All the organs were yellow throughout. The liver was flabby, small,
and void of blood ; the spleen very large; the kidneys anaemic ; and the
mammary glands very small. The lungs were superficially hyperaemic ; and
presented small ecchymoses. The heart and large vessels were full of thin
fluid blood, which, under the microscope, appeared yellow at the edges and
violet-coloured at the centre, and exhibited numerous lymph-globules. The
cerebral vessels contained much biood. The lateral ventricles contained
coagula, surrounded by a yellow layer of exudation. The brain was very
soft, and had coagula on its surface : there was also blood effused from the
vascular membrane of the spinal cord. In this case, there was cholaemia from
impediment to the removal of the bile from the blood.
ATELECTAsis of THE LUNGs. From forty-three children who died, five are
to be deducted ; viz., four who were not examined after death ; and one who
died of pneumonia, and in whom it could not be distinguished whether the
lungs were foetal, or not. Thirty-eight cases then remain : in fifteen of these,
five premature, and ten mature children, the lungs were perfectly permeated
by air; and in twenty-three,_eight mature, and fifteen premature, they were
more or less foetal. Hence prematurely-born children have twice as much
disposition to Atelectasis as those which are born at the full term.
Death was directly caused by atelectasis, under symptoms of debility, in
two mature, and ten immature children, generally in the first half of the first
week. In eleven others, six mature, and five premature, Latelectasis seems
to have been only a predisposing cause of disease, and death was directly
produced by other diseases; viz., sclerosis, erysipelas, infantile cholera,
softening of the stomach, trismus, hydrocephalus, and apoplexy. With re-
gard to the extent of the atelectasis in twenty-three cases, the lungs were
perfectly foetal in two cases, so that the child could only have lived a short
time: in seven cases, there was partial atelectasis, footal spots being scat-
tered over a greater or less extent of the interior of the lungs. The surface
of the lungs contained more or less air in two cases. The anterior borders,
the apices, and the anterior and superior portions, contained air; while the
remaining parts were foetal in eleven cases. In one case, only a part of the
upper lobe was foetal. In four cases, the left lung was less foetal than the
right: and in one, the right lung presented less atelectasis than the left.
CRITICAL DIGEST OF THE JOURNALS. 1179
State of the Lungs. In the cases of Atelectasis, the lungs were several
times rather soft and oedematous, but more frequently anaemic, pale, flabby,
with an excess of blood in the large vessels, and here and there in a state of
putrefaction, with development of gases, but in other cases presenting em-
physema of the parts where respiration had taken place. In one case, there
were five abscesses in the two lungs: in another, the tissue had undergone
intra-uterine hepatisation. Of the fifteen cases in which the lungs had been
perfectly permeated by air, they were congested in two ; anaemic, pale, and
dry, in four; emphysematous, in parts much so, with extravasation of air, in
four cases. -
State of the Foetal Passages. (a) The ductus arteriosus was, in one case,
found morbidly closed immediately after birth. It was usually open (nine
cases) in the first week; but sometimes then contained a coagulum of fibrin.
The fibrinous coagulum generally appeared from the seventh to the four-
teenth day; the canal was then still partly opened, but narrowed; in four
cases, it was imperfectly obstructed by a membranous septum. In the third
week, it was much narrowed in three cases, and only permitted a fine sound
to pass : in one case, it was entirely closed. In one instance, it was found open
towards the end of the fourth week. (b) The foramen ovale was, in one
case, found closed immediately after birth. It was generally (in seven cases)
open during the first and second weeks: in three cases, it was entirely closed
towards the end of the second week: in one case, it was open at this period.
(c) The ductus venosus was open till towards the end of the second week, in
eight cases; closed, more or less firmly, at the fourteenth or sixteenth day,
in four cases; in one instance, it was firmly closed on the sixth day.]
REDTENBACHER ON THE URINE IN PNEUMONIA.
In the year 1846, DR. W. REDTENBACHER commenced a series of observa-
tions on the Urine, with the view of determining, 1. In what relation the
inorganic salts—chlorides, sulphates, and phosphates—stand with regard to
the specific gravity of the Urine and 2. Whether any intimate connexion
can be detected between the increase or decrease in the quantity of salts, and
the increase or diminution of certain diseases. The results of his observations
are published in the Zeitschrift der K. K. Gesellschaft der Aerzte zu Wien,
for August 1850.
1. The quantity of inorganic salts is not subject to great variations, so that
they do not exercise any great influence on the specific gravity of the urine ;
it is the organic constituents—urea and uric acid—which chiefly affect its
density. Urine of high specific gravity may contain a small quantity of in-
organic salts, while a tolerably large amount may existin urine of low specific
ravitv.
3. 2. Fie quantity of chlorides in the urine has a direct relation to the inten-
sity of the inflammation, in cases of pneumonia. When the urine of a
healthy person is treated with nitrate of silver, after being acidulated with
nitric acid, the copious precipitate of chloride of silver shews the presence of
a considerable quantity of chlorides. If the urine of a patient labouring
under pneumonia be examined, a normal quantity of chlorides will be found
at first : this gradually diminishes as the inflammation advances, until, when
hepatisation is perfect, the chlorides entirely disappear, so that nitrate of
silver does not even produce a cloudiness after long standing. When the
inflammation, or rather the hepatisation, again recedes, the chlorides re-appear,
and continue to increase as the disease advances towards cure. This diminu-
tion and re-appearance of the chlorides in pneumonia has been constantly
observed by Dr. Redtenbacher, in upwards of eighty cases; and further, the
smallest quantity of chlorides always accompanied the most intense inflam-
mation, and the rapidity or slowness of their decrease or increase was in
constant relation to the rapid or slow course of the disease. The re-appear-
WOL. II. . - 77
1 180 CRITICA], DIGEST OF THE JOURNALS.
ance of the chlorides constantly accompanied the retrogression of the inflam-
mation ; their presence in the urine, indeed, often preceded the signs fur-
nished by percussion in denoting incipient recovery.
It is true that, in typhus, acute rheumatism, and capillary bronchitis, the
chlorides are diminished in quantity: but this decrease is not constant, nor
does it appear at any certain period of the disease. In tuberculous infiltration,
the chlorides are present in normal quantity, but diminish for a short timé
under a fresh addition of infiltration.
It might be objected, that the chlorides in the urine are chiefly dependent
on the culinary salt taken with the food; but if this objection were of any
force, they would be diminished in all diseases in which less food is taken ;
which is not the case. Besides, one-half of the patients with pneumonia had,
throughout the whole course of the disease, drink acidulated with hydro-
chloric acid given to them : yet the same phenomena were manifested, and
there were no chlorides in the urine when the disease was at its height.
It must hence be concluded, that the removal of the chlorides from the
urine during the course of pneumonia belongs essentially to the disease, and
that they must be disposed of in some other manner.
ENEMATA OF ETHER IN REHEUMATISM AND NEURAT,GIA.
It has been ascertained by M. Pirogoff, that the injection of the vapour of
Ether into the rectum produces complete anaesthetic effects; and M. Marc
Dupuy has found, that the same is the case when fluid Ether is injected,
either pure, or mixed with an equal quantity of water. M. GAUSSAIL relates
two cases, which shew the beneficial results of this proceeding, when it is
desired merely to obtain the calmative and antispasmodic effects of the Ether.
CASE I. A lady, aged 45, subject to nervous and rheumatic affections, had
for some days suffered from temporal neuralgia, of a continuous remittent
type. A sedative epithem, and antispasmodic medicines, produced slight
ease. The neuralgia was soon replaced by violent and continued pains in the
sciatic nerve, which prevented the patient from walking or sitting. After
trying various remedies for two days without any result, M. Gaussail pre-
scribed an enema, containing four grammes of Etherin one hundredgrammes of
water. In the evening, the patient was perfectly free from pain; the absorp-
tion of the ether was manifested about half an hour after its administration,
by its peculiar colour, and by a kind of pleasant suppleness and heat in all
the limbs. The enema had been retained without producing any inconve-
nience; and a haemorrhoidal flux, to which the patient was subject, re-ap-
peared in a few hours. She passed a good night; on the following and
subsequent days, there was no return of pain in the thighs ; and, although
there were still wandering pains in other parts of the body, the patient
might be said to be cured of the neuralgia.
CASE II. A yound lady, of delicate constitution, had been affected for
some time with general rheumatism. M. Gaussail prescribed, for a very
severe pain in the praecordial region, an injection with six grammes of Ether.
This had not the effect of calming the pain.
REMARKs. It is chiefly in wandering neuralgic and rheumatic pains in hys-
terical females, that enemata of Ether, and still better of chloroform, are likely
to prove beneficial. In hysteria in particular, where it is often difficult to make
the patients swallow medicines, enemata of Ether or chloroform often remove
the most intense spasmodic symptoms, as if by enchantment. The propor-
tionally greater activity of chloroform renders more care necessary in its
administration : twenty or thirty drops in one hundred and twenty grammes
(thirty drachms) of fluid, generally produce the desired effect. [Abridged
from Bulletin Général de Thérapeutique, 1849, vol. xxxvii, p. 139; as quoted
from Journ. de Méd. de Toulouse, and Journ. des Conn. Méd.-Chir., July
1849.] :
CRITICAL DIGEST OF THE JOURNALS. IISI
TARTARIZED ANTIMONY IN INSANITY. -
In the Annales Médico-Psychologiques (July 1850), the following abstract
is given of Dr. Flemming's views, as contained in the Allgemeine Zeitschrift
für Psychiatrie. The author examines in this article the action of Tar-
tarized Antimony in the treatment of Mental Diseases. This action varies
as the medicine is administered in large or in fractional doses. In a large
dose, it has been seen to cut short instantaneously a fit of insanity; and the
patient, after a certain period of torpor, has almost lost the recollection of his
excitement. But, to produce this effect, the medicine ought not to produce
vomiting. When the emetic is given in fractional doses, it produces nausea,
and exercises a kind of indirect sedative effect, in consequence of the modifi-
cations which result from it in the functional condition of the digestive
organs. The editors of the Annales Médico-Psychologiques add to the
observations of Dr. Flemming, that the administration of the drug requires
certain precautions, which cannot be neglected without producing the most
serious results. There are, say they, patients who appear to bear the tartar-
ized antimony perfectly well, and there are some on whom the medicine
appears to have no effect ; the excitement continues, and there are neither
stools nor vomiting ; all of a sudden, the excitement is calmed, a colliquative
diarrhoea is established, and there is exhibited as severe a degree of poisoning,
as if there had been given at once the whole of the successive doses adminis-
tered on several days. This fact ought to attract the attention of practitioners,
because the same is the case with other medicines. This may be explained
in two modes ; either the medicine is accumulated in some degree in the
stomach, where it does not act till it reaches a certain dose, or its action is
latent, and the last dose is no longer tolerated like the preceding ones, by
reason of the modifications which have supervened in the sensibility of the
internal organs.
PARALYSIS OF THE FACIAL NERVE IN A CHIT,D.
In a clinical lecture on the case of a child, two and a half years old, ad-
mitted into the hospital at Berlin with Paralysis of the right Facial Nerve,
which had appeared six days previously, without any obvious cause, PRO-
FEssoR RoMBERG made the following remarks.
Paralysis of the Facial Nerve is not so readily detected in children as in
adults: in the latter, the want of symmetry in the two sides of the face is
very evident ; in the former, it is only shewn during crying, etc. The
smoothness of the forehead in children also tends to prevent the Paralysis
from being observed. On looking at the child when quiet, nothing remark-
able was seen : but when it was made to cry, the mouth was drawn to the
left side, and the right eye was not closed. According to the parents, this
eye was nearly closed in sleep. This shëwed that the Paralysis had not yet
become entire : in perfect Paralysis, the eye remains open even during sleep.
Professor Romberg called attention to the influence of sleep on convulsive
and paralytic affections. In patients, in whom contraction of the flexor
muscles accompanied paralysis of the extensors, the former had been observed
to be relaxed during sleep. In sleep, the brain exercises a different influence
over the various parts of the nervous system : hence arises the changed posi-
tion of the eye in sleep, and hence also occurs the closing of the eye, which,
when the person is awake, is kept open by the oculo-motor nerve, acting
through the levator palpebrae, while, during sleep, the latter is relaxed, and
the Facial Nerve only acts through the orbicularis palpebrarum. The col-
lapse of the ala nasi is not so evident in children as in grown persons; only
when they sneeze can it be observed, that the peculiar movement which ac-
companies this effort is wanting on the paralysed side.
In determining the seat of the Paralysis, the first thing to be considered
was the state of the temporal bone. There was nothing which denoted this
77 2 -
I 182 CRITICAL DIGEST OF THE JOURNALS.
to be the seat of the affection: the child heard equally well with both ears,
there had been no otorrhoea, and the uvula was perfectly normal. If the
cause of the Paralysis had been situated in the neighbourhood of the internal
auditory meatus, the auditory nerve could not have escaped. It is not easy
to ascertain whether hearing be impaired at this age; but the best informa-
tion is gained from holding a loudly ticking watch to the ear, while the
other is closed, and watching carefully the motions of the countenance. The
cause could scarcely have been an exudation, or tumour, causing compression
at the base of the brain ; for here some of the neighbouring nerves must
have been also affected; nor was it likely that there was local softening of
the paralysed nerve; nor could a purely central origin be reasonably assigned,
as this would be likely to affect only portions of the nerve. The only re-
maining seat of disease, then, was the face. Swelling of the glands, or com-
pression by cicatrices, at the stylo-mastoid foramen, were not present in this
case. The Paralysis appeared suddenly, when the child was lying on the
floor of a room, with its head on a pillow. Hence a mechanical cause was
very improbable; and it seemed most likely that this case had a rheumatic
Origin.
The short duration of the disease, and its peripheral nature, allowed of a
favourable prognosis; although it could not be certainly stated that the
child would soon recover. Professor Romberg had sometimes seen such
cases recover spontaneously, after he had left off giving medicine for some
weeks. As the other symptoms of rheumatism, swelling of the face, sweats,
fever, and urinary sediments, were absent, general antiphlogistic treatment
was not indicated, especially as the rheumatic nature of the affection could
not be asserted with absolute certainty. (Journal für Kinderkrankheiten,
July and August 1850; quoted from Deutsche Klinik, 22nd June 1850.)
M. MARTIN-SOLON ON THE PREPARATIONS OF MALE FERN, AS REMEDIES
FOR TAPE-WORM.
M. MARTIN-SoLoN, in a paper on the various remedies for Tape-Worm,
in the Bulletin Général de Thérapeutique, vol. xxxviii, p. 299, observes that,
if the high price and scarcity of kousso sometimes render recourse to the
Male Fern necessary, the powder of the rapidly dried fresh root should be
used. Forty or fifty grammes (3x to 3xiii) should be given during the
morning, in divided doses, and a purgative of castor-oil should be adminis-
tered directly after. The oil of Male Fern, if well prepared, and mixed in
quantities of two grammes, with enough powder of fern, or mucilage, to
make ten boluses, which are taken in the morning, at intervals of an hour
between each, is usually efficacious ; it kills the taenia, and often expels it
immediately. The same effects result from the extract prepared from the
tincture of the buds of the same plants, which is much used at Geneva, and
which M. Debout says that he has used with success. He prescribes six
grammes, to be taken in three doses, enveloped in unfermented bread, and
given at intervals of an hour. It is sometimes necessary to follow the ad-
ministration of these preparations by a dose of castor-oil in the afternoon.
In this respect, kousso has an advantage over the preparations of Male Fern.
COMBINATION OF AUSCULTATION WITH PERCUSSION.
DR. RogFR has called attention to a process, first pointed out by Laennec,
in which Percussion and Auscultation are combined. A solid cylinder of
cedar-wood is used for Auscultation, while a person well versed in Percussion
practises it round the stethoscope, and in the entire extent of the region to
be explored. In this manner, we can not only determine the limits of an
organ, as of the heart, liver, spleen, or veins, but also those of the cavity which
contains any of them. -
This process, though possessing incontestable advantages, is opposed by two
CRITICAL DIGEST OF THE JOURNALS. 1 183
serious inconveniences. The first is, the dexterity required to enable us to
appreciate the result. M. Roger was six weeks in acquiring this power.
The other objection is, the difficulty of introducing into private practice,
especially in the country, a process which requires the aid of a second per-
son. The method, however, would be valuable in cases of difficult diagnosis,
and in which great precision is required in determining the therapeutic indi-
cations. [Abridged from Bulletin de Thérapeutique, 1850, vol. xxxviii, p.475,
as quoted from Comptes-rendus de la Soc. Méd. des Hôpitaua, April 1850.
SURGERY.
sºmºsºsºme
POLYPOUS EXCRESCIENCES FROM UMIBILICU'S IN NEW-BORN CHILDREN.
To the extensive category of affections of the umbilicus, Dr. FARREGE
has added another, of comparatively small importance, but worthy of the
attention of practitioners, on account of the anxiety which it may cause to
the mothers. We refer to small polypous excrescences, developed between
the furrows of the umbilical fossa. The following case is an example.
In August 1848, a female child, three weeks old, was brought to Dr.
Farrége. The mother had observed a red body at the umbilicus, which she
attributed to misarrangement of the cord by the midwife. The latter
examined the child, but was unable to discover anything, because the body,
hidden among the folds of the fossa, only projected when the child cried.
On turning aside the edges of the umbilical fossa, M. Farrége discovered an
excrescence, of the size of a large pea, red and granulated, and bleeding
easily when touched. A ligature was passed round the base, which was
pedunculated, and the excrescence fell off on the third day. The wound was
touched with nitrate of silver, and the disease did not re-appear. In another
similar case, Dr. Farrége excised the pedicle of the tumour by means of
scissors curved on the flat surface, and cauterised the wound. To recognise
the existence of the disease at the commencement, it is requisite to make a
very close examination, taking care to separate the lips of the umbilical
fossa, which, in very young children, lie very close to each other. The treat-
ment is very simple, consisting in excision or ligature, followed by cauterisa-
tion. [Révue Méd.-Châr., as quoted in Bulletin Général de Thérapeutique,
1849, t. xxxvi, p. 42.]
RUPTUHE OF THE CRUCIAL LIGAMENT OF THE KNEE-JOINT.
DR. STARK relates, in the Edinburgh Medical and Surgical Journal for
October 1850, two instances of an injury, which he believes to have been
Rupture of the Crucial Ligament of the Knee-joint. The symptoms, nearly
identical in both cases, were the following. There was no dislocation either
of the ankle or of the knee-joint ; no displacement of the knee-pan ; no rup-
ture of the tendo Achillis, or of any of the tendons round the knee-joint.
The motions of the ankle, and, when the patient was sitting, of the knee-
joint, in so far as its ordinary motions were concerned, appeared perfect.
In one case, when the patient assumed the erect posture, the knee-joint was
found to be preternaturally moveable ; and, whenever any weight was endea—
voured to be thrown on the right leg, the knee fell against the left leg, and
bent with equal facility forwards or backwards. When the legs were extended,
the slightest pressure on the patella caused the foot to be thrown upwards,
and the leg could be bent forwards on the thigh to a certain extent. No pain
was complained of in the knee-joint, but only a sensation of weariness ; and
there was no redness, nor swelling, nor effusion of blood. - -
Dr. Stark made several trials on the first patient, to ascertain the accuracy
of the diagnosis. When the knee was bound tightly with a handkerchief,
and kept slightly bent, the patient could almost bear the weight of the body
on it ; but the moment he endeavoured to straighten the limb, the knee bent
1184 CEITICAL DIGEST OF THE JOURNALS.
backwards under him, and he fell to the ground unless supported. The
lateral motion of the tibia on the thigh-bone, though freer than usual, was
yet so very limited, that there was no reason to conclude that the lateral liga-
ments were injured.
The treatment consisted in fixing the limb in a nearly straight position,--
just so slightly bent as to allow the flexors of the leg to have a slight advan-
tage over the strong extensors attached to the patella. A strong flat steel
spring, fourteen inches long, with a slight curvature, was softly padded, and
bound to the back of the knee-joint, half of its length projecting down the
back of the leg, half extending along the back of the thigh. The foot and
leg, to above the knee, were them bandaged moderately tight. The injury
was ultimately recovered from in both cases; but the knees remained weak,
and the patients had to use support for a considerable period. In one case
it was five months, in the other three months and a week, before the use of
crutches could be dispensed with.
Dr. Stark thinks these cases interesting from their rarity, and from their
proving that the injury in question may be perfectly recovered from. He
infers, that cure must have been finally effected by a reunion taking place
between the ends of the ruptured crucial ligaments.
COTTON-WADDING AS AN APPLICATION TO BED-SORES AND WARICOSE ULCERS.
In the treatment of wounds and ulcers, one great indication is to protect
the parts from exposure to the air. Adhesive plasters, and especially col-
lodion, often serve this purpose, but are inapplicable where a large extent of
surface is exposed. In these cases, we believe the application of Cotton-
wadding to be an effectual means of fulfilling the indication. Mr. RoBERT
Jon Es, of Conway (Lancet, Sept. 27, 1850), relates the case of a girl, aged
16, who had been suffering from typhus fever, and who had an extensive
sloughing sore of the nates, with profuse and offensive discharge. Wine and
bark were prescribed, and broth and beef-tea were given. Mr. Jones applied
some Cotton-wadding to the part, with the view of giving her a soft cushion
to lie upon, as well as to absorb the abundant discharge. After the applica-
tion, she appeared much relieved. On examination, three days after, the
parts covering the spine and the crest of the ilium were granulating, the
slough covering them had partially separated, and the parts beneath were
looking very well. Mr. Jones has also treated successfully a few cases of
varicose ulcers of the lower extremities, by the application of Cotton-wadding.
The manner of applying it is simply to cover the ulcer, and to dress the
patient every second or third day, a roller being applied over the cotton.
Perfect quietness, and keeping the limb in the horizontal position, are
enjoined; and three weeks or a month are generally sufficient for a cure.
INJURY OF CRANIUM, AND WOUND OF THE BRAIN IN A NEW-BORN CHILD :
RECOVERY.
In July 1839, Dr. LAGAE was called to a woman, aged 34, who had been
in labour forty-eight hours. Unsuccessful attempts had already been made
to extract the child by the forceps, and subsequently by Smellie's perforator
and a blunt hook. Dr. Lagae found it necessary to perform the Caesarean
operation. The infant was very weak, and scarcely uttered a few moans.
It had a very extensive wound of the cranium, a little to the right of the
sagittal suture, and a few lines in front of the posterior fontanelle. The
brain was exposed, and seemed reduced to a state resembling soup mixed
with blood: a small quantity of cerebral substance had escaped through the
wound, and, for several days, portions continued to be removed by suppura-
tion, in a state of detritus. The treatment consisted in the application of
compresses dipped in cold water ; and the child recovered. The mother was
restored to health in a few weeks. -
CR1TICAL DIGEST OF THE JOURNALS. 1185
Nine months after, Dr. Lagae exhibited the child to the Medical Society
at Roulers. The deficiency in the cranium was then of the size of a two-
franc piece, or even less. Even remembering the tendency which the cra-
nium possesses in young children to repair losses of its substance, it must be
admitted, that the loss was much more considerable at the time of birth. It
is also worthy of remark, that the child appeared to be as intelligent as other
children of the same age. (Abridged from Bulletin Général de Thérapeutique,
1849, t. xxxv.11, p. 92.) - *-
}
CONGENITAL PROTRUSION OF THE INTESTINES : OPERATION.
Dr. W. M. FAIRBROTHER relates the following case in the Lancet for July
20th, 1850. Upon the birth of a child, on the 29th of last June, a large por-
tion of intestine, about twenty-eight inches in length, was found protruding
from the navel, dark and discoloured. It had evidently been out of place for
many days. On my next visit, the bowels had acted, but were more pro-
truded, with a considerable portion of the mesentery. Dr. Fairbrother made
a careful and limited incision downwards in the median line, and, with con-
siderable trouble, reduced the intestine, and applied sutures and a compress.
The child, however, died the same evening, with all the symptoms of stran-
gulated hernia.
DIAGNOSIS AND TREATMENT OF POLYPUS OF THE RECTUM IN CHILDREN.
In children, as in adults, Polypi are situated on a more or less elevated
part of the intestine. When they are near the anal orifice they are easily
detected, by becoming protruded at each stool ; and they may give rise to
the supposition that there is a prolapse of the gut. When more deeply seated,
a Polypus is less easily detected. M. GUERSANT insists on the importance,
as a sign diagnostic, of a furrow in the foecal matters evacuated. Its mecha-
nism is too simple to require explanation. -
In the treatment, the Polypus is drawn beyond the anus, by means of the
finger introduced into the rectum. When the pedicle is very narrow, the
tumour may be replaced, as it is not long in falling off; but when the pedicle
is larger, a ligature is applied to the base, and the tumour is excised, leaving
the ligatured portion. M. Guersaut has never seen troublesome haemorrhage;
but, if it should occur, it could be easily treated by plugging the rectum, or,
still better, by the introduction of small pieces of ice, if it can be procured.
(Bulletin Général de Thérapeutique, 1849, t. xxxvi, p. 230.)
OCCLUSION OF THE WAGINA, THE RESULT OF WAGINITIS FOLLOWING
MEASLES : OPERATION.
MR. FERGUsson recently had occasion to operate in a case of this kind.
(Lancet, 23 Nov. 1850, p. 578.) A similar accident might occur in Waginitis
following the other exanthemata (vide LoNDoN Journ AL of MEDIGINE, Sept.
1850, p. 869); but only, of course, when there has been extreme neglect.
1186
R E POR T S OF SOC I ETI E S.
ROYAL MEDICAL AND CHIRURGICAL SOCIETY.
SPECIAL MEETING, TUESDAY, OCTOBER 29, 1850.
DR. ADDISON, PRESIDENT, IN THE CHAIR.
The following resolutions were brought forward by the Council, and, after
discussion, unanimously adopted by the Society.
SocIETY PROPERTY. 1st. That the Trustees of the Society be authorised
and empowered to sell #2600 Stock, to meet the expenses consequent upon
the completion of the lease and the repairs of the premises, as authorised by
two General Meetings of the Society, held on May 1st, 1849, and July 11th,
1850. 2nd. That the front drawing-room be appropriated to the general
uses of the Society, and that the Evening Conversaziones and the Meetings
of the Council take place there. 3rd. That the Council be empowered to let
the stables, and such portion of the premises as may not be required for the
purposes of the Society.
REFEREEs. The following alteration in the bye-laws, chapter xiii, section
6, relating to the Council, was also recommended by the Council, and adopted
by the Society, “That the number of Referees be increased from twenty-four
to thirty-six.”
TUESDAY, November 12, 1850.
DR. ADDIson, PRESIDENT, IN THE CHAIR.
SUCCESSFUL CASE of OVARIoToMy. By W. E. DUFFIN, Esq.; WITH A
DESCRIPTION of THE SAC, BY ROBERT LEE, M.D., F.R.S. A woman, aged 38,
in good general health, with her abdomen enlarged to the size of the eighth
month of pregnancy, (this size having been attained in seven or eight
months), applied to Mr. Duffin for relief by operation. The rapid growth
of the tumour, which appeared to be connected with the left ovary, had
been accompanied by neuralgic pains in the right thigh, in consequence of
pressure on the sciatic nerve of that side. The tumour was very moveable,
indicating the absence of adhesions. The patient was very urgent in her
desire for the operation, which was performed, on the 27th August, by Mr.
Duffin, assisted by Professor Fergusson, and Messrs. Ure, and Henry Smith. The
incision, at first only sufficient to admit the fore-finger for exploration, after-
wards enlarged to three inches, was made in the linea alba, midway between
the umbilicus and the pubes. The absence of adhesions having been ascer-
tained, the sac was punctured by a trocar, and one hundred and thirty
ounces of a viscid, ropy fluid, of a light brown colour, were evacuated. The
collapsed cyst (containing a smaller cyst, of the size of an orange) was drawn
through the incision, and its pedicle secured by ligatures. The tumour was
then separated; and the pedicle and ligatures were prevented from receding
into the cavity of the abdomen, by other ligatures attaching them to the
wound. The ligatures came away on the fifteenth day. On the twenty-
second day, the wound had healed; and the abdomen had resumed its natural
shape and size. The patient was kept on a light diet; for six successive
nights, after the operation, she took opium ; and her bowels were opened by
enemata. Her recovery was complete; and she had resumed her occupation
of a dressmaker.
Dr. Lee found that the walls of the cyst contained all the elementary
structures which enter into the composition of the healthy human ovary;
peritoneum, stroma, Graafian vesicles, blood-vessels, and ganglionic nerves.
ROYAL MEDICAL AND CHIRURGICAL SOCIETY. 1187
ANALYSIS OF ONE HUNDRED AND EIGHT CASEs of OvaBIoToMy which HAVE
ocCURRED IN GREAT BRITAIN ; BEING ALL THE CASEs of which ſhe AUTHOR
goULD OBTAIN SUFFICIENTLY AMPLE DETAILs. By Robert LEE, M.D., F.R.S.
In thirty-seven cases, either no ovarian cyst, or tumour to remove, existed,
or there were present ovarian cysts and tumours, the removal of which was
found to be impracticable. Of these thirty-seven cases, fourteen were fatal.
Of the seventy-one cases, in which ovarian cysts and tumours were removed,
twenty-four proved fatal; in fourteen of which, the operation could not be
completed. It appeared, that of the one hundred and eight cases analysed
by Dr. Lee, forty-five were reported by Dr. Clay, and eleven by Mr. Lane.
MR. CAESAR HAWKINS complained that a gentleman present (Dr. Frederick
Bird) had not made his experience of Ovariotomy available to the profession.
DR. FREDERICK BIRD was surprised to find that his cases were not included
in Dr. Lee's analysis. He had certainly declined to give Dr. Lee the details
of his cases, as he was going to publish them himself: but he had furnished
Dr. Lee with the results; having, by letter, stated that he had extirpated
ovarian tumours twelve times; eight times successfully, and four times un-
successfully.
DR. LEE replied, that he could not, in consistency with the plan and object
of his paper, make any use of the bare facts intimated to him by Dr. F. Bird.
Not only were the details of the twelve cases withheld, but no information
was given of cases in which it was known that Dr. Bird, after making incisions
in the abdomen, had abandoned the operation.
DR. F. BIRD had made in very many cases—perhaps in forty or fifty cases
—small exploratory incisions. This was quite safe, and none of his patients
had died from this method of diagnosis having been resorted to.
DR. LEE. In one case so explored by Dr. Bird in the Free Hospital, he had
heard that death ensued.
DR. F. BIRD. In that case, Ovariotomy was never contemplated. A small
incision was made previous to tapping.
MR. B. PHILLIPs eloquently denounced the practice, now, he said, so
common, of surgeons publishing only their successful cases. No man is
bound to publish his experience; but if he publish his successful experience,
he cannot honestly keep back his unsuccessful cases. The truth means the
whole truth. Judged by the information brought forward in Dr. Lee's paper,
we find that the abdomen has been laid open many times, when there was no
tumour in it : that the operation has been performed in this country seventy-
one times, and that forty-seven patients have recovered. And from Dr.
F. Bird's statement it is made evident, that so difficult, so valueless is the
diagnosis, that he has commenced the operation, that is to say,+that he has
made an exploratory incision into the abdomen—forty or fifty times, without
being able to proceed with the operation."
MR. I. B. BRowN explained his operation. (Wide p. 1189.)
MR. LAWRENCE spoke at considerable length against Ovariotomy. He
was not more friendly to Mr. Brown's method of cure, which he had long
since seen tried with unfavourable results. How could it be otherwise 2
Ovariotomy, with all its dangers, has the merit of extirpating the disease ;
but the plan of making an excretory duct—an “oviduct” as the gentlemen
called it—proved hazardous by lighting up inflammation in the great

1 In the Lancet of the 23rd November 1850, p. 592, Dr. Bird has modified his
statement by reference to his notes. He says—“I have extirpated large ovarian
tumours in thirteen cases, of which number nine were successful, four unsuccessful:
in one case the tumour could not be extirpated, and the patient sank. In eighteen
other cases, I have made small incisions, as a means of diagnosis or relief, and in
no case did a bad result ensue from such incisions, leaving a total of thirty-two
cases, in the treatment or investigation of which the abdominal cavity had been
incised”. •
1 I 88 REPORTS OF SOCIETIES.
mass, covered by peritoneum, and in immediate contact with the abdominal
viscera."
MEDICAL SOCIETY OF LONDON.
NovKMBER 2, 1850.
J. RISDON BENNETT, M.D., PRESIDENT, IN THE CHAIR.
ON THE HEALTH of LoNDoN, DURING THE PERIOD FROM 30TH MARCH To
28TH SEPTEMBER 1850. By JoHN WEBSTER, M.D., F.R.S. [This paper is
published as an original article at page 1115, in the present number.] The
discussion was adjourned.
NovKMBER 9, 1850.
J. RISDON BENNETT, M.D., PRESIDENT, IN THE CHAIR.
ADJOURNED DISGUSSION ON DR. WEBSTER’s PAPER. DR. C. J. HARE was
desirous of correcting some statements made by Dr. Webster, with reference
to the MoRTALITY IN THE METRoPolitAN HospitaLs. Dr. Webster had stated
that the beds in University College Hospital amounted to only 106, whereas
the real number was 122. Besides, the number of beds in a hospital was no
criterion of the number occupied. On March 31, 1850, the Royal Free
Hospital, which was reported as containing 140 beds, had only 52 in-
patients; King's College Hospital, stated to have 120 beds, had 96 in-
patients; and University College Hospital, said to have 106 beds, had 113
in-patients. At a later period, the latter institution had contained 122
inmates. Even supposing that the number of beds, or even of admissions,
had been correctly given, no inferences could be drawn therefrom as to
the relative mortality; and some very different results from those in Dr.
Webster's table might be obtained, by comparing the number of deaths with
the average number of patients in each hospital.
DR. SIBSON remarked, that the previous condition of the patients, the
nature of their diseases, the situation of the hospital, and other circum-
* There can be no doubt of the general truth of Mr. Lawrence's remarks; but it
has yet to be seen that they apply so forcibly, as he supposes, to Mr. Brown's opera-
tion. One of that gentleman's casesundoubtedly recovered from the operation, without
having had dangerous intra-abdominal inflammation : and we cannot help thinking
that, by farther experience, the operation may be so modified as to prove a valuable
practical improvement. We must say, however, that we fear ovarian tumours are
far too often interfered with : and that, upon the whole, the greater prevalence of
operative interference with them in later years has increased their mortality. The
analysis of cases by Dr. Lee is an important contribution to science; and confirms
the conclusions of a reviewer in the Edinburgh Monthly Journal for January 1844
and May 1845. When a case is reported as “cured” by Ovariotomy, a long period
must have elapsed before we can declare the result to be really successful. On this
point, a speaker at the Edinburgh Medico-Chirurgical Society (17 Dec. 1845) made
the following remarks: “For a special reason which does not apply to other ope-
rations, the statistics of Ovariotomy are comparatively valueless. In such an
operation as Ovariotomy, the very reparative process becomes an imminent and in-
evitable source of peril, and had, he believed, in cases the latter history of which
was known only by rumour, been the ultimate cause of death. To repair the ex-
tensive cutting of the ovariotomist, nature must pour forth in abundance coagulable
lymph; and every one knows that in all situations in which lymph is thrown out,
it exerts an inherent tendency to the most powerful contraction”. Referring to
eighty-nine cases then before the profession, the same speaker concluded by stating
three objections to Ovariotomy. 1. The difficulty of diagnosis. 2. The non-fatal
character of ovarian tumours. 3. The immense and inevitable dangers of the re-
parative process. Edinburgh Monthly Journal, January 1846, p. 53–67. The
report of this discussion on Ovariotomy embraces an elaborate speech by Dr.
Simpson, which, as well as the remarks of other speakers, will well repay perusal.
EDITORS. &
MEDICAL SOCIETY OF LONDON. I 189
stances, were necessary to be known, before a right conclusion as to the
relative mortality of a hospital could be arrived at.
DR. WEBSTER had used every means to make his statistics accurate, but
should be happy to have any of them corrected. He had obtained the
number of beds at University College, and several other hospitals, from the
medical officer of those institutions. The discussion clearly indicated the
advantage of having regular statements from all the metropolitan hospitals.
DISLoCATION of THE DISTAL ExtremTTY of THE GREAT ToB. MR. Coulson
exhibited two specimens of this dislocation, in different degrees of intensity.
The internal lateral ligaments in both cases were thin, and spread out over
the projecting coridyles. In the joints, the cartilages were beginning to be
absorbed on the part of the metatarsal bone, from which the phalanx had
been dislocated. Mr. Coulson believed that the wearing of shoes had nothing
to do with this deformity. The cause was to be found in the muscular and
ligamentous apparatus connected with the sole of the foot, for the purpose of
strengthening the anterior part of the metatarsal region. The muscular
forces acting on the great toe, and on its metatarsal bone, are not the same.
The long tendons have a tendency to carry the toes outwards; but the
oblique abductor and the transversus pedis, and even the flexor brevis pol-
licis, seem to draw the metatarsal bone outward, especially at its distal
extremity. When, from various causes, the transverse and oblique muscles
lose their energy, the distal extremity of the metatarsal bone of the great toe
is no longer held in proximity to the others; the foot spreads; the inner
condyle projects inwards; and the phalanges of the great toe, being acted on
by the long flexor and extensors, are carried outwards.
ON THE TREATMENT OF Ov ARIAN DRoPsy BY THE ForMATION of AN ARTI-
FICIAL OvIDUCT. By MR. I. B. BROWN. Mr. Brown brought before the notice
of the Society his lateral operation for Ovarian Dropsy, of which an account
was given at p. 202 of the LoNDON Journal of MEDIGINE for February 1850.
Instead of making two incisions, at right angles to each other, he now found
one sufficient. He related three cases on which he had operated. The first
patient died a month after the operation, chiefly from disease of the heart ;
which had been diagnosed during life. The second patient apparently re-
covered, and was able to attend to her household duties, and to walk out ;
but was attacked, in four months, with vomiting, paralysis, and coma, appa-
rently from renal disease, and died. In the third case, that of a multilocular
cyst, the patient died a month after the operation. In the second and third
cases, purulent matter was found in the ovaries, or cysts, on post-mortem
examination.
At the conclusion of his paper, Mr. Brown gave the following practical
deductions:—
I. Pressure was applicable as a remedy in certain cases of Ovarian Dropsy;
for example, where the disease was unilocular, without adhesions, and the
fluid contents of the cyst were clear and not albuminous, and when time and
the general condition of the patient, did not contra-indicate this proceeding.
2. Pressure would relieve and retard ovarian disease, even when it was
multilocular, and adhesions exist.
3. Where pressure had failed, or was contra-indicated, and the cyst, or
cysts, were without adhesions, extirpation was a remedy which might be
adopted; but, before doing so, except in rare cases, pressure should have a
trial.
4. Where the extent and character of the adhesions forbad extirpation,
and pressure had failed, or was inapplicable, the lateral operation afforded a
ready and promising means of cure.
5. This mode of operating was attended with but slight danger, besides
being easy of execution. In support of his position, that the danger was
1 190 REPORTS OF SOCIETIES.
small, Mr. Brown stated, that, in the many operations in which he had had
occasion to cut through the peritoneum, no untoward result had followed.
MR. HIRD and DR. TILT opposed the practice advocated by Mr. Brown.
DR. PETTIGREw and MR. NUNN spoke in favour of the operation.
DR. MURPHY complained of the unsatisfactory nature of the statistics of
ovarian operations. What was the principle on which Mr. Brown's operation
was founded ? He would, if interference were demanded, give the preference
to pressure, over ovariotomy.
Now EMBER 16, 1850.
J. RISDON BENNETT, PRESIDENT, M.D. IN THE CHAIR.
MERCURIAL TREATMENT of SYPHILITIC ERUPTIONs. By MR. Hunt. The
following were the propositions which Mr. Hunt supported:—1. Mercury is
capable of curing, or aggravating, Syphilitic Eruptions, according to the
mode in which it is administered. 2. Syphilitic Eruptions do not get per-
manently well without Mercury.
NovKMBER 23, 1850.
J. RISDON BENNETT, M.D., PRESIDENT, IN THE CHAIR.
ON SUBCUTANEous BURSAE. By MR. Coulson. After making some pre-
liminary remarks, and detailing the situations in which Subcutaneous Bursae
are found, Mr. Coulson made some observations on the enlargement to which
they are subject. The treatment which he recommended, in preference to
all other methods, was puncture with a grooved needle, followed by pressure.
This plan he considered generally applicable, and very successful. There
was, indeed, a tendency to accumulation in some cases; but this could be
overcome by perseverance. [This paper will appear as an original article in
our January number.]
SURGICAL SOCIETY OF IRELAND.
APRIL 28, 1850.
ANDREW ELLIS, Esq., IN THE CHAIR.
ANEURISM of THE HEART. By J. TUFNELL, Esq. CASE. The patient
was a fine young man, aged 21, who had enjoyed uninterrupted good health
until three years since. He had afterwards, in succession, chancres, suppu-
rative bubo, acute pneumonia, hepatitis, and subsequently severe rheuma-
tism, the serous coverings of the organs being considerably affected. The
rheumatic attack took place in the autumn of 1848, and was followed by a
relapse in two months, the pericardium being each time engaged. Calomel
and opium were resorted to upon both occasions, the lancet not being used.
He was apparently in perfect health in February of the present year.
Towards the latter end of this month, Mr. Tufnell saw him in consultation,
for a painful affection of the lower end of the right femur, consequent upon a
process of bone which interfered with the use of the joint. The integuments
on the outer side of the lower third of the thigh were swollen and tender, and
were protruded directly outwards by a hard pointed tumour, evidently a process
of bone, which stood out from the condyloid ridge between the vastus ex-
ternus and biceps muscles, so as materially to interfere with the action of
the hamstring tendon. It was resolved to remove the growth ; but, the in-
teguments over the tumour being much thickened and inflamed, it was
deemed desirable that the patient should rest for some days; and as he could
not then do so, the operation was deferred.
He remained in apparent health until the middle of March, when, about
seven o’clock one morning, whilst dressing, he said that he felt indescribably
weak, so much so that he was certain he was going to die. Subsequently,
however, he ate his breakfast, and seemed to forget his forebodings; but at
half-past nine, he fainted and fell to the ground. He was insensible when
taken to bed, the hands and extremities cold, the face deadly pale. This
SURGICAL SOCIETY OF IREI,ANT). 1.191
state continued for some time; but by means of external warmth and am-
monia, heat was gradually restored, reaction ensued, and he seemed consi–
derably revived. Soon, however, the dyspnoea became excessive, the patient
calling continually for air, and begging to have the weight removed off his
heart. He died at half-past 4 P.M. -
Post-MoRTEM ExAMINATION 30 Hours AFTER DEATH. The body pre-
sented the appearance of a very finely made muscular man, the skin of a
natural colour, neither livid nor unusually pale : no trace of oedema in the
lower extremities. The contents of the cranium were healthy, and the brain
showing an ordinary number of vessels upon its substance being cut across.
The pericardium was enormously distended with black venous blood, which
was found partly coagulated, and partly fluid. Through the midst, projected
an aneurismal tumour, its apex pointing obliquely outwards to the left side ;
and, upon removing the contents of the pericardium by a stream of water
from a syringe, the aneurism was seen to arise from the left side of the an-
terior surface of the base of the left ventricle. Proceeding a short distance
vertically upwards, it assumed a semicircular form, passing obliquely back-
wards, overlapping to a certain degree the auricle of that side, and com-
pressing the auricular appendage, which lay beneath it shrivelled and curled
up. From the anterior surface of this sac, projected an additional pouch,
its cavity appearing capable of holding a marble, whilst the larger one
would easily contain an egg. The sac was densely firm and entire through-
out, not exhibiting the minutest opening for the escape of the blood. Round
the circumference of the tumour ran the coronary vein, modulated and en-
larged, presenting the appearance of a succession of pile-like tumours. At
this point the coagula were intimately attached, and here there was a dis-
coloured spot, where the vein must have burst. The heart was enlarged,
and more than ordinarily covered with fat. The visceral pericardium, at
its apex, was united by strong bands to the reflected portion; both ap-
peared to have been the subjects of inflammatory action. On removing the
heart, the lining membrane, and the whole of the valves on the right side,
were natural in every respect. On the left side, the endocardium was
healthy, as well as the mitral and aortic valves; but, opposite to the opening
of the aorta in the ventricle, above and in front of the right segment of the
mitral valve (but not in any way interfering with its action), was the mouth
of the Aneurism, perfectly circular in form, and capable of admitting the point
of the forefinger, and surrounded by a fibrous ring, apparently developed
from the endocardium alone. The sac itself appeared to be formed of this
membrane and the pericardium, the muscular structure being almost altoge-
ther absorbed. On the superior surface of the sac, the reflected pericardium
was adherent, giving it additional support. The aorta was of natural size
and thickness, but studded with minute points of atheromatous deposit.
The other viscera presented no remarkable appearance.
REMARKs. This case tended to establish the correctness of the observations
of Dr. Thurnam, in his paperon Aneurism of the Heart, published in the Medico-
Chirurgical Transactions for 1838. Dr. Thurnam had remarked, “that
in one case only of all that he adduced, did rupture of the sac occur when
there was adhesion between the pericardium and the aneurismal portion of
the heart.” In this case, the sac was entire, the point opposite to the influx
of blood having the pericardium adhering to it. Indirectly, however, Mr. Tuf-
nell regarded this circumstance as being the immediate cause of death, for the
pericardium, being attached below to the apex of the heart, and united to the
tumour above, prevented further dilatation of the sac, held it firmly down
upon the coronary vein, and, by the compression thus induced, led to rupture
of this vessel. This probably took place when the patient complained of
weakness, at 7 in the morning. 2. Dr. Thurnam had called attention to the
portion of the organ in which this lesion was universally developed ; viz., the
systemic side. He accounted for this in a two-fold manner; firstly, because
I 192 REPORTS OF SOCIETIES.
regurgitation of superabundant blood into the auricle, did not occur in the
left or systemic heart; and secondly, he referred its occurrence to the physical
condition of this part, the vital endowment of its blood, and the assimilation
of its diseases to those affecting its arterial continuation. Herewe found the syst-
emic side to have been the seat of disease. 3. He regarded Aneurism of the Heart,
as par excellence the disease of adult, as that of the arteries is of middle life.
He considered the lesion to arise from rheumatic inflammation, which rendered
the heart less able to bear the distending force of the ventricular systole,
and to be thus connected with the young, from their predisposition to acute
rheumatic disease. In the present case, the patient had suffered from rheu-
matic attacks, and his age was but 21. 4. Dr. Thurnam had shewn that the
seat of true Aneurism of the Heart was either at the apex or highest portion
of the base, those being the thinnest portions of the organ and the least
able to withstand distending force. The base was that affected here.
ANEURISM of THE APEx of THE LEFT WENTRICLE, Follow ED BY PERICAR-
DITIS. By O’B. BELLINGHAM, M.D. CASE. J. N., a servant, aged 50, was ad-
mitted into St. Vincent's Hospital, August 11, 1849. Three weeks ago, he
complained of debility and oppression of breathing, which was relieved by
treatment. Two days ago, hemiplegia of the right side with total loss of
speech set in, the mouth being drawn to the right side. On admission, the
countenance was pale and haggard, he was unable to speak, but was con-
scious and put out his tongue when desired, which was deeply coated with
white fur, and drawn towards the affected side. The paralysis of the face
had disappeared, and the hemiplegia had diminished. Since the attack, he
had been unable to lie down from dyspnoea. On examination of the chest,
signs of congestive bronchitis upon both sides were evident. The heart's
action was strong : no valvular murmur was heard, but the sibilant and
sonorous ràles were sufficiently loud to mask it, even if it had been present.
Radial pulse visible, locomotive, and intermittent. The patient died on
August 15th.
Post-mortem. Eacamination. On removing the calvarium, a considerable
amount of fluid blood escaped. The veins of the brain were much congested,
but there was no evidence of the rupture of any vessel, either upon the sur-
face or in the substance of the organ. The ventricles contained the average
amount of liquid. The brain was healthy. The anterior surface of the
heart was coated with a thin layer of recent lymph ; posteriorly, the opposed
surfaces of the pericardium were connected by recent and friable adhesions.
The heart was much enlarged, weighing 20% ounces; the left ventricle pre-
dominated much over the right. Near its apex, the left ventricle presented
a rounded prominence upon both surfaces. The parietes at this part were
thinner and of darker colour than elsewhere. The ventricle was dilated at
its apex into a rounded cavity, about the size of a small hen's egg, which
was nearly filled with layers of fibrine, coloured with the red particles of the
blood. The parietes of the pouch were thinned, in one place exceedingly
so, and very friable, so as to be readily torn with the finger. The upper
part of the cavity presented nothing abnormal. The walls of the sac were
formed by the muscular fibres of the ventricle, and by the endocardium and
pericardium. The sac did not open into the ventricle by a narrow mouth ;
it appeared to have been formed in a great measure by the yielding or partial
dilatation of the walls of the ventricle. The mitral and aortic valves were
healthy ; the lining membrane of the aorta, near its origin, presented some
patches of adventitious deposit. This case was interesting as an example of
the manner in which nature strengthens the parietes in such cases, and post-
pones the fatal result. Pericarditis had been set up, and a layer of lymph
had been effused, which, if the patient had lived, would have ended in ad-
hesions between the opposed surfaces of the pericardium, and would thus
have strengthened the parietes of the heart at the weakest point.
SURGICAL SOCIETY OF IRELAND. 1 193
SuccessFUL Excision of THE ELBow. By H. THoMPson, M.D. J. McG.
aetat. 13, of healthy appearance, was admitted into the Tyrone Infirmary, on
the 19th of December, 1849, labouring under disease of the left elbow. The
left arm was fixed in a very nearly straight position, the elbow-joint admit-
ting of scarcely any motion, and any attempt to move it producing severe
pain. The flexure in front was filled up, and all the bony prominences ob-
scured by a swelling, which extended from the middle of the arm to the
lower margin of the upper third of the forearm, increasing the circumference
three inches beyond that of the opposite side. The integuments were ad-
herent, rather pale, with blue veins ramifying over them, and the surface
was smooth and uniform, except in the situation of the outer condyle, where
a prominent deep red and soft elevation indicated the pointing of an abscess.
From this, and from the site of a fistulous opening, which existed about two
inches above the inner condyle, a gradually diminishing shade of redness
diffused itself over the neighbouring parts. A fungoid granulation projected
from the fistulous opening, which yielded a small quantity of thin discharge ;
and a probe, passed downwards and outwards towards the centre of the arti-
culation, encountered a piece of bare and roughened bone. He suffered
little pain when he kept the arm steady, but at night it frequently prevented
sleep. The sensibility and mobility of the hand and fingers were perfect.
His general health was pretty good, but his pulse was small and 120; and he
never slept without perspiring slightly about the head.
Ten weeks before admission, he had fallen off a ditch; the arm bent under
him with a cracking noise, and he suffered so much pain as to be disabled
for that day. On the next, however, he was so far recovered as to be able
to use the limb. In the evening, pain set in ; and next morning the joint
was swollen. From this, the disease went on ; but nothing was done for it
until about a month ago, when an abscess was opened, which pointed above
the inner condyle of the humerus, and a small quantity of sero-purulent
fluid was discharged without relief.
Operation. This was performed on December 28th. The boy was placed
on his right side on a table. Chloroform was administered until he was per-
fectly under its influence, and the brachial artery compressed by a finger.
Along the radial side of a line following the course of the ulnar nerve, Dr.
Thompson made an incision four inches long, the centre corresponding to the
articulation. From the middle of this, anotherincision was carried transversely
outwards to the extent of three inches, traversing the abscess, which con-
tained a straw-coloured sero-purulent fluid, and laying thus open the cavity
of the joint. The two triangular flaps thus formed were then dissected off the
bones, and the soft parts cleared away from the olecranon, which was cut off
at its base by means of bone-forceps. About half an inch more of the ulna,
which was in a carious state, was then removed, together with the head of
the radius, the cartilage of which was beginning to ulcerate. The arm now
admitted of flexion, and, by bending it up, the end of the humerus was thrown
out of the wound. This was examined, and the trochlea found completely
destroyed, an abscess occupying the cancellar structure of the bone, which
contained a loose piece of dead bone, and communicated by a large opening
with the cavity of the joint. The cartilage covering the capitulum was
healthy; and posteriorly a carious spot, about the size of a shilling, was
found in the fossa which lodges the olecranon. The bone was divided above
this carious spot, by means of a narrow saw passed in front and worked back-
wards. This completed the operation, which occupied about fifteen minutes,
during the whole of which time the boy was kept under the influence of
chloroform. No vessel was required to be tied. The arm was placed in the
flexed position on a bent tin splint ; and subsequently, when suppuration had
take place, and the swelling and inflammation was beginning to subside, a
gutta percha case was adapted to the front of the limb, so as to keep it flexed
to about half a right angle, and admit of the wound being dressed without
1194 REPORTS OF SOCIETIES.
removal. The wound healed by granulation, and a firm and healthy cicatrix
was the result. He had, on April 19, 1850, perfectly regained the power of
flexion of the limb, and could perform pronation and supination to a suffi-
cient extent for any useful purpose. The unnatural effects which had
resulted were, a degree of over-extension, or backward bend, to the extent of
about the eighth of a right angle, and a degree of abduction of the fore-
arm occurring during flexion, and produced by the action of the Supinator
longus, to the extent of about an angle of 45. The bones appeared to be con-
nected by a condensed fibrous tissue, about half an inch in extent. The limb
was three-quarters of an inch shorter, and the circumference at the elbow half
an inch greater than the opposite: the muscles of the arm were smaller than
those of the other, but there was no difference in those of the fore-arm.
APRIL 28, 1850.
ANDREW ELLIS, Esq., IN THE CHAIR.
PECULIAR AccIDENT of SHOULDER-JoſNT. D.R. JAcoB directed the attention
of the Society to a case, reported in the Medical Gazette of the 6th of April,
in which the scapula seemed to be thrown out from the ribs, so as to project
from the patient's back. Mr. Adams, of the London Hospital, regarded it as
a dislocation of the scapula, in consequence of its escaping from beneath the
edge of the latissimus dorsi. It appeared to be a rare accident ; and Dr.
Jacob's object was to suggest what was the real nature of the injury, which
was, in his opinion, so very manifest, that he was at a loss to conceive how
it could have been mistaken. The same journal, for 20th April, contained an
account of an analogous case by Mr. Rose, of Swaffham.
The above writers seemed to consider this remarkable displacement as no-
thing more or less than a dislocation of the inferior angle of the scapula from
beneath the latissimus dorsi—a notion which was erroneous, because no such
use could be assigned to the soft structure of such a muscle as the latissimus
dorsi, as that of keeping the scapula in situ. Were this the case, very slight
efforts would be sufficient to dislocate the bone, and no muscle would be
capable of withstanding the stretching and pressure made upon it, nor would
the pain be tolerable. Many years ago, a case came under his observation,
on a careful examination of which, the real nature of this accident struck
him with much force. A man, who was carrying a heavy board upon his
shoulder, suddenly slipped and fell down. He complained of his shoulder,
but the lower extremity of the scapula was elevated from the ribs, drawn
towards the spine, and depressed. The moment, however, the scapula was
pressed up into its proper situation, the coracoid process, previously lowered,
went into its usual place ; and he had therefore no doubt, that the coraco-
clavicular ligament had given way, and that the scapula, and along with it
the arm, went down under the weight of the limb.

After an address from the President, the Society closed its meetings for
the Session.
1195.
INDEX TO THE VOLUME FOR 1850.
ABDoMEN, catalogue of papers'on diseases of,767
ABERGROM BIE, Dr., case of disease of spinal
cord, 13
Abortion, inflammation of cervix uteri a cause
of, 153; chloroform in, 305
Abscess in neck after scarlatina, Dr. R. J. Hale's
case of, 720
AcTON, Mr., on venereal ulcers, 206; on M.
Ricord's treatment of venereal diseases, 605
ADAMS, Dr. James, on fever in hospitals and out
of them, 880
Africa, Eastern, M. de Froberville on Ostro-
negroes in, 48; Western Coast of, Dr. W. F.
Daniell on Diseases of, rev., 492
Age, influence of on phthisis, 37; on the fre-
quency of the pulse, 1064
Air, effect of injection of into an artery, 239; Dr.
Cormack on entrance of into uterine veins,
589, 928; case by Dr. Bessems, 942; by M.
Lionet, 944; by Dr. Wintrich, 946; by Dr.
Simpson, 946; cases of entrance by veins in
neck, 929, 933; by subclavian vein, 936
Air-passages, catalogue of papers on surgical
diseases of 767
Albumen, Dr. Haas on increase and diminution
of, 648
Albuminuria, Dr. S. Alison on tannic acid in, 4;
M. Landouzy on connexion of with amaurosis,
186; case of, simulating cerebral disease, 451;
Dr. C. J. B. Williams on treatment of in heart-
disease, 469; transient, M. Bouchat on, 500;
pathology of, Drs. G. Johnson and C. J. B.
Williams on, 502; Dr. G. O. Rees on Nature
and Treatment of, rev., 565; Dr. Bence Jones
on, 963; relation of to puerperal convulsions,
Dr. Blot on, 1082; Dr. Cormack on, ibid.
Alcoholic liquors, Dr. Haas on effect of, 646;
Drs. W. B. Carpenter and S. Thomson on the
use of, rev., 1058; poisoning by, Dr. James Bird
on, 4.19; diagnosis from poisoning with stramo-
nium, 426
Alimentary canal, catalogue of papers on diseases
and injuries of, 76
ALIson, Dr. Scott, on tannic acid in disease, I
Alkalies in phthisis, Dr. Turnbull on, 119
Almond-oil a substitute for cod-liver oil, 398
Alum in croup, 186
Amaurosis, M. Landouzy on connexion of with
albuminuria, 186: granular corpusclesin optic
commissure in, 570
American reprinting, remarks on, 275
Amphibia, Dr. Haas on summer-sleep of, 644
Anaemia, Dr. C. J. B. Williams on treatment of,
in connexion with heart-disease, 466; Mr. Syme
on connexion of with goitre, 1098
Anaesthesia in midwifery, Dr. Waller on, 77; Drs.
R. Barnes and Sachs on, 1076. See Chloroform
Anaesthetic substances, Mr. Nunneley on, 63;
chemical nature of, 63; effects of, with experi-
ments, 64; effect of injection into veins, 69; of
administration by alimentary canal, 69; of
prolonged inhalation, 69; local action of 70;
questions relating to, 71; treatment of poison-
ing by, 73
Anasarea, Dr. A. Kilgour on treatment of 991
Anatomy and Physiology, Mr. Goodsir's Annals
of, rev., 380; catalogue of papers on, 971
ANDERson, Mr. W. C., on Eccentric Nervous
Affections, rev., 755
WOL. II.
ANDREws, Dr., case of injury of pelvis during
pregnancy, 1093
Aneuralgicom, Dr. Downing on the, rev., 46
Aneurism of anterior palatine artery, 806; of left
posterior communicating artery, 824; of supe-
riormesenteric artery, 1094; of popliteal artery,
- fººd by compression, 1101; of heart, 1190,
Aneurismal varix, Mr. Cadge's case of, 126
Angina membranacea, Dr. R. Bennett on, 1089
Annals of Anatomy and Physiology, Mr. Good-
sir's, rev., 380
Anterior palatine artery, cases of aneurism of,806
Antimony, tartarised, in insanity, 1181.
Antiseptic, tannin as an, 1070
Antispasmodics in heart-disease, Dr. C. J. B.
Williams on, 462
Apoplexy, Dr. Thomas Smith on turpentine in,
345; cerebral, in children, Dr. Elsåsser's cases
of, 496, 1174
Apothecaries, review of former and present posi-
tion of, 553
Apothecaries' Society, Regulations of for 1850,
ºrev., 479,487; Regulations for various years,
rev.,651 : influence exerted by on medical edu-
cation, 651
Apothecary, W. Bullein on the duties of an, 555
Appointments, 104, 216, 310, 406, 506, 610, 809,
921, 1017, 1114 .
Apprenticeship, Mr. Skey's remarks on, rev.,
481 ; advantages of, 555
Arachnoid membrane, adventitious deposit on,
448; hydatids beneath, 453; haemorrhagic
membrane in, 1096
Arcus senilis, Mr. Canton on, 90
Arm, anomalies in muscles of, 690
Arsenic in unfermented bread, Dr. Henry on,
191; in skin-diseases, Mr. Hunt on, 855; post-
mortem appearances after poisoning by, 1097;
report of committee on sale of, 912
Arteries, Dr. Flood's Surgical Anatomy of, rev.,
142; diseases of, in connexion with heart-
disease, Dr. C. J. B. Williams on treatment of,
471; of brain, Dr. Cormack's case of disease
of, 599
Artery, posterior communicating, aneurism of 824
Artificial anus, Mr. Field's case of, 195; Mr.
Clarkson's case, 196; Mr. Hilton on, 197; Mr.
Coulson on, 198; Mr. Hodgson on, 198; Dr.
Pennell's case of, 905
— pupil, in conical cornea, Mr. White
Cooper on, 526
Asphyxia from entrance of air into veins, Dr.
Cormack on, 933
Asthma, chloroform in, 987
Astringent, tannic acid as an, Dr. S. Alison on, 3;
Dr Cummings on, 1069; oil of turpentine as
an, 328,330
Astringents in conical cornea, Mr. White Cooper
on, 535
Atelectasis pulmonum, Dr. Elsåsser on, 497, 1178
Atmosphere, Dr. Webster on, as influencing
health, 546, 1126
Atrophy of bone, Mr. Stanley on, 489
Atropine prepared by means of chloroform, 1086
Aºry nerve, Mr. H. Gray on development of,
98
Aurora Borealis, Baron von Reichenbach on, 838
Auscultation combined with percussion, 1182
*
78
1 96
INDEX
Racon, inunction with in searlatina, 865
BAGot, Dr., on cod liver oil, 1103 º tº
BALLEy, Mr. Gordon, case of synovitis during
identition, 585
BALY, Dr, on typhus and typhoid fevers, 80;
on the cause of cholera, 295; chloroform in
cholera, 987
BArcLAY, Dr., Ön typhus and typhoid fevers, 80
33ARLow, Mr. W. F., on the relation of epilepsy
to puerperal convulsions, 88; on the causes of
cholera, 295; on phenomena observed after
death from cholera, 889 º º
BARNEs, Dr. Robert, on scarlatinal vaginitis,
... 869; on anaesthesia in midwifery, 1076
Barometer, Dr. Webster on variations in, as
influencing health, 547, 1126
BARRow, Mr. C. B., on chloroform in facial
neuralgia, 990
BashAM, Dr. on the blood in cholera, 296; case
of stricture of oesophagus, 501
BATCHELpe R, Dr., on Cholera, rev., 1170
Bath, new medical members of order of, 918
BATTERsby, Dr. F., on chronic hydrocephalus,
with cases in which the head was punctured,
782; case of milk in breasts of a male infant,
l?06; congenital hypertrophy of toes, 1109
BATTYE, Mr. R. F., case of cranial tumour in an
infant, 987
BEARDsALL, Mr., on chloroform in asthma, 987
Brºck, Dr. Snow, on erectile tissue in cervix
uteri, 588; on pain in disease of cervix, 588
Bed-sores, cotton-wadding as an application to,
| 184
BEGBIE, Dr., on erythema nodosum and its con-
x mexion with the rheumatic diathesis, 774
BEI.L., Dr. Charles, cases of trismus and hemi-
plegia after delivery, 1099; case of twins, 1099
Mr. Joseph, on Cholera, rev., 1170
I3elladonna in nervous affections, 386
BELLINGHAM, Dr. O'Brien, on mortification of
feet from cold, 1105; case of wry-neck cured by
division of the sterno-mastoid, 1108; on early
operation in hare-lip, 1109; case of aneurism
of heart, 1192
B E NNE r, Dr. Henry, on the relation between
uterine irritation and epilepsy, 89; on Inflam-
mation of the Uterus and its Appendages, rev.,
146; on acute metritis, 146; chronic metritis,
147; uterine catarrh, 147; inflammation of
lateral ligaments, 151; inflammation of neck of
uterus, i52, 164; uterine polypi with inflām-
mation, 158; syphilitic ulcerations of neck of
uterus, 161 ; cancer of uterus, 162; uterine
, speculum, 172; on chloroform in midwifery,
and as a sedative of uterine pain, 265; on
ulceration of cervix uteri, 578; on relation
between uterine and ovarian disease, 588
BENNETT, Dr. J. Hughes, on Skin-Diseases,
rev., 848 -
r— T)r. J. Risdon, Introductory. Address
at opening of Medical Society, 1089; on angina
membranacea, 1089
BENsox, Dr., on cod liver oil as a cause of pul-
monary congestion, 1101; case of retention of
urine, 1103
B Ess EMs, Dr., ease of entrance of air into uterine
veins, 942 -
IBethlem Hospital, instruction at, 919
#; Dr. on goitre in new-born children, 1072
l
Bicêtre, statistics of for 1849, 505
BIG F. Low, Dr. H. J., case of recovery from iron
... rod driven through head, 893
Biographies of living medical men in Lancet,1017
BIRD, Dr. James, on intestimal ulcers in diarrhoea
and dysentery, 86; on delirium tremens, epi-
lepsy, and puerperal convulsions, 95 ; on the
types of delirium tremens, 419 r
B1RKETT, Mr. John, on Diseases of the Breast,
zev., 1169 . . . -
Bladder, Dr. Lankester's case of malignant disease
of, 298; Mr. Coulson on diagnosis of disease
of, 300; M. Malgaigne's case of extraordinary
distention of after delivery,395; Dr. Wardell's
case of death from ha-morrhage into, 586;
paralysis of, treated by strychnine, 882; ex-
tension of gonorrhoeal inflammation to, 895;
case of perforation of, 1013
BLAKE, Dr. James, on the quantity of blood in
the body, 50 +.
BLANCARD, M. on preservation of pills of iodide
of iron, 1087
BLANCHET, M., on chloroform in lead colic, 285
Blisters produced by burning, Dr. Wright on,754
Blood, Dr. J. Blake's method of determining the
quantity of, 50; effects of pus and other foreign
substances on coagulation of,217, 231, 614; in
cholera, Dr. R. D. Thomson on, 294; in heart-
disease, Dr. C. J. B. Williams on, 317,465 ; in
albuminuria, Dr. G. O. Rees on, 566; in chlo-
rosis and pregnancy, M. Cazeaux on, 576;
detection of uric acid in, Dr. Garrod on, 584;
Dr. Bence Jones on, 959; Dr. Snow on detec-
tion of chloroform im, 602; Dr. Panum on
casein in, 685; Dr. Parkes on excess of white
corpuscles in, 691; Dr. Haas on means of
altering quantity of, 716
Blood-letting in heart-disease, Dr. C. J. B. Wil-
liams on, 461
BLOT, Dr. H., on albuminuria and puerperal
convulsions, 1082
Bofareira. See Castor-oil plant.
Bone, Mr. H. Lee on absorption of matters from
into veins, 226; Mr. J. Goodsir on seat of mor-
bid action in diseases of, 277; morbid changes
in essential elements of,278; in accessory parts
of, 279; Mr. Stanley on Diseases of, rev., 489;
hypertrophy and atrophy, 489; neuralgia, 489;
inflammation, 489; suppuration, 490; caries,
490; ulceration, 490; necrosis, 491 ; tumours,
492; scrofula, 492; catalogue of papers on
diseases and injuries of, 762; of skull, Dr.
º case of epilepsy with hypertrophy
of, 452 -
Bouch AT, M., on transient albuminuria, 500
Bow MAN, Mr. John E., Handbook of Medical
Chemistry, rev., 665 . .
Mr. W., case of haematocele, 904
Brain, M. Duplay's case of induration of, 281 ;
osteophytes on surface of, 298; granular cor-
puscles in, in hemiplegia, 387; Dr. Semple's
illustrations of diseases of, 448; tuberculosis
of in a child, 498; softening of in children,
499; disease of, simulated by foreign body in
oºsophagus, 582; disease of arteries of, Dr.
Cormack's case of,599; morbid appearances in
after purulent infection, 621; Mr. Poyser's case
of disease of 731 ; Dr. Semple's cases of soften-
ing of, 811; iron rod driven through, 893;
softening of from plug in carotid, 893; fungus
of, l011; Mr. W. Cooke on Irritation and In-
flammation of, rev., 1067; wound of in a child,
1184
BRAINARD, Dr., on chloroform in neuralgia, 990
Brassica napus, case of poisoning by, 192
Bread, unfermented, Dr. Henry on arsenic in,
191; instructions for making, rev., 380
Breast, catalogue of papers on diseases of, 767;
milkin, in infants,1106; Mr. Birkett on Diseases
of, rev., 1169 -
Breath-sounds in chest-disease, Dr. H. Kennedy
on, 1107 - - . . . .
BRIGHT, Dr. James, on Diseases of the Chest,
rev., 970 .
BRi NDLEY, Mr., case of softening of brain from
plug in carotid, 893 -
BRodi E, Sir B.C., address at the Western Medi-
cal Society, 608; case of entrance 6f air into a
vein, 929 . . . . . . . . . . .
BRow N, Mr. I. B., on diagnosis of ovarian
dropsy, 81 ; new operation for ovarian dropsy,
202, 1188; on inflammation of the breast, 303;
case of chloroform in abortion, 305. . . . . . . . . . .
Mr. W., on Qualifications of a [edical
Missionary, rev., 31
INDEX.
1197
BROWNE, Dr. W. A. F., evidence in a case of
lunacy, 1 &
BRoxholm E, Mr. on chloroform in hemicrania,
989
BUDD, Dr. W., on turpentine in purpura, 998
BULLEIN, W., on the duties of apothecaries, 555
Burial-clubs, new Act concerning, l l 13
Burning, Dr. S.Wright's Pathological Researches
on, rev., 753
Burns and Scalds, Dr. Thomas Smith on turpen-
time in, 345
BUSH, Dr. William, presentation of testimonial
to, 405
BUSHNAN, Dr., on Cholera, rev.,966
BUYs, M., on acetate of lead in granular ophthal-
mia, 190 -
CADGE, Mr. W., case of aneurismal varix in a
stump, 128
Caesarean section, cases of, 1084, 1099
Calculi, salivary and urinary, 1200
Calculus removed through umbilicus, 1011
Calomel in croup, 187; effect of in purulent
phlebitis, 628. -
CAMBRIDGE, the late Duke of, proposed monu.
ment to,921 - -
Camphine bath, Dr. Thomas Smith on, 329
Cancer of uterus, Dr. H. Bennet on; 162; of pos-
terior mediastinum, 996; of lungs, 996
Cantharidal ether, M. Oettinger on, 1087
CANTon, Mr. E., on the arcus senilis, 90; on
hysterical ptosis, 199
Caoutchouc, Vulcanized, in surgery, 60
CAPE, 1)n, on the relation of epilepsy to puerpe-
ral convulsions, 88 -
Carbuncle, Mr. Vincent-on treatment of, 378;
case of, by Mr. Poyser, 378
Cardiac dropsy, Dr. A. Kilgour on treatment of,
99i -
Caries, Mr. Goodsir on pathological changes in,
278; of head of femur, specimens ot, 296, 301;
Mr. Stanley on, 490
Carotid artery, case of ligature of, 81; plug in,
causing softeniug of brain, 893 -
CARPENTER, Dr. W. B., on Alcoholic Liquors,
rev., 1058 -
Cartilage, articular, Dr. Redfern on Anormal
Nutrition in, rev., 568 - -
Casein in blood, Dr. Panum on, 685
CASTLE, Dr., case of aneurism of anterior palatine
artery, 806 -
Castor-oil plant, galactagogue and emmenagogue
effects of leaves of, Dr. Tyler Smith on, 951;
I}rs. Mº William and Cormack on, 1085
Catamenia, Dr. Routh on the periods of appear-
ance and cessation of, 243 • 3
Cataract, M. Kerst on seat of behind lens, 573;
black, M. Pétrequin on, 799; medical versus
surgical treatment of 802
Catarrh, bronchial, Dr. S. Alison on tannic acid
in, 3; suffocative, in young children, 284
Cauliflower excresence of uterus, Mr. Tufnell's
case of, 208; Dr. Johns on, 212; Dr. Montgo-
mery on, 213
Cau'erization with solidified nitric acid, 74; of
cervix uteri, Dr. H. Berinet on, 167
Cautery, actual, application of to cervix uteri, 170
CAVENTOU, M., on mineral springs eontaining
manganese,399; on a cheap substitute for qui-
nine, 400
CAzEAux, M., on the abdominai murmur in preg.
nancy, 576 * -:
Caz ENTRE, M., on therapeutic properties of
cedron, 1085 . .
Cedron, therapeutic properties of, 1085
CEE ly, Mr., on cow-pock, l J45 .
.Cellular tissue, effects of purulent infection on,
631. .
cerebellum, Mr. Battye on functions of, 987
Cerebrum. See Brain.
CHAMBERs, Dr. T. K., on Corpulence, rev., 1166
Chancre, M. Ricord's treatment of, 605
Charenton Asylum, statisties of for h949, 505.
Chemistry, Annual Report of, rev., 28; Dr.
Fownes. Manual of, rev, 665; Mr. J. E. Bow-
man's Handbook of Medical, rev., ib.; Animal,
Dr. Bence Jones on, rev., 957 . . .
Chest, Dr. Sibson on falling in of during, inspi-
ration, 83: Dr. R. Quain's new instrument for
measuring,923; Dr. James Brighton Diseases
of, rev, 970; Dr. H. Kennedy on amount of
respiration in diseases of, l 117. See Lungs.
Children, Dr. F. Churchill on Diseases of, reë.,
178; M. Trousseau on diarrhoea and cholera
in, 187; M. Van Hengel on real and apparent
death in, 193; M. Duclos on mucous pneumo-
nia of,284; diseases of, at the Stuttgart Hospital,
Dr. Elsásser's Reports on, 494, 1173; diseases
of eyes in, 494, 1175; vital debility in, 494,
1176; pneumonia and pleuropneumonia, 494,
ll 75; peritonitis, 496; erysipelas, 496; cerebral
apoplexy,496, l 174; convulsions, 497; atelecta-
sis pulmonum,497,1178; Gedema of lungs, 498;
tuberculosis of brain, 498; tetanus, 498, 1176 ;
softening of brain, 499; coryza,499; umbilical
hernia,499; sclerosis, 1173; congestion of brain,
1173; congenital hydrocephalus, l 174; soften-
ing of stomach, 1175; diarrhoea and vomiting,
1176; mortality among in London, Dr. Webster
on; 543, 1119 : opium in strangulated hermia of,
894; Dr. Fröbelius' repºrt on ophthalmia in,
999; Dr. Betz on goitre in, 1072; milk in
breasts of, 1106; facial paralysis in, 1181;
polypus excrescences from umbilicus in, l 183;
Pºposal to establish a hospital for diseases of,

CHILDS, Mr. G. B., case of plum-stone passed
through umbilicus, 301
Chloride of carbon, as an anaesthetic,.68 -
Chloroform, Mr. Nunneley on, 64; Dr. Snow on
detection of in blood, 602; preparation of atro-
pine by means of, 1087; attempted robbery by
means of, 1113; in lead colic, 285; in asthma,
987; in cholera, 987; in cynanche, 988; in de-
lirium tremens, 988; in hydrophobia, 988;
in laryngismus stridulus, 989; in nephritic
colic,989; in neuralgia,989; in odontalgia and
otalgia,990; in tetanus, 991; in strangulated
..hernia in infants, 834; in midwifery, eatalogue
of papers on, 859; Dr. Waller on, 77; insanity
from, 90; Dr. Henry Pennet on, 265; in natu-
ral labour, 266; in operative midwifery, 267;
in uterine examinations, 269; in uterine pain,
270; in abortion, 305; in puerperal convul-
sions, 988; Drs. R. Barnes and Sachs on,
1077; effect of on uterine contraction, 1079; on
laceration of the perinaeum, 1079; in producing
fºulsions, 1080; effect of on physical shock,
8 -
Chlorosis, Dr. C. J. B. Williams on treatment of,
in connection with heart-disease, 466; Dr.
Cazeaux on analogy of blood in, and in preg-
nancy, 576; connexion of digiti semi-mortui
with, 698 ..
Cholera, catalogue of papers on, 670; Dr. R. D.
Thomson on pathology and causes of,294; Dr.
Baly and Mr Barlow on, 295; Drs. Basham
and Copland on, 296; Dr. Lorie on sulphurin,
500; Mr. Barlow on post-mortem phenomena
of, 889; Dr. Bushnan on, rev.,966; chloroform
in, 987; accompanying diseases, sequelae, and
metastases of,997; comparative mortality from
in London, 510, 1116; Dr. Batchelder on, rev.,
1170; Dr. E. Whittle on, rev., ibid.; Mr.
Joseph Bell on, rev., ibid.; infantile, M. Trous-
seau on, 187, 189
Chorea, prussiate of iron in, 54; Dr. W. H.
Madden on humoral origin of, 519; Mr. Pilcher
o some cases simulating, 1090 -
CHRistison, Dr. on the treatment and fatal dose
in poisoming with hydrocyanie acid, 397
|*| 98
INDEX.
CHURCHILL, Dr. F., on Diseases of Children,
orev., 178; Selections of Essays on Puerperal
Fever and other Diseases of Women, rev., 381
Chylous urine, Dr. Bence Jones on, 964, 1012
Cinchona, new organic base in, 29
Cinnabar fumigations, Mr. Acton on, 605
Circulation, organs of, catalogue of papers on
diseases of, 674; of papers on anatomy and
physiology of, 972 - *
Citrate of iron and magnesia, 399 -
CLARKE, Dr. E. H., on ehloroform in tetanus, 991
CLARKson, Mr. case of artificial anus, 195
Classified catalogues of papers in British and
American journals, 666, 758,856, 971
Climate, influence of on health, Dr. Webster on,
549; of Madrid, Dr. Cormack on, 550; of Lom-
don, Dr. Webster on salubrity of, 1128
Clothing, Dr. Webster on, 113t -
Coagulation of blood, effects of pus and foreign
matters on, 217, 614 -
Coagulum, indications for preservation of in
purulent phlebitis, 625
goal-gas, Mr. Nunneley on, as an anaesthetic, 68
Cod-liver oil in phthisis, Report of Cousumption
Hospital on, 44; effect of in increasing weight,
45; in phthisis, Dr. Turnbull on, 1.19; almond
oil as a substitute for,398; congestion of lungs
caused by, 1101; Dr. Bagot on adulteration of,
and substitutes for, 1103
Colchicum in rheumatic disease of the ear, 56;
in enlarged tonsil, Mr. Harvey on, 3
Coldstream, Dr., on cretinism, 108
Colic, lead, chloroform in, 285; of prostitutes,
T}r. Hassing on, rev., 756; nephritic, chloro-
form in, 989 - *
College of Surgeons of England, proposed new
eharter of, 103; financial state of, 307, l l l l ;
Regulations of, rev., 651
—— of Edinburgh, proposed new
charter of,307; diploma of fraudently obtained,
40
CoLI,Es, Mr. W., on extension of gonorrhoea to
bladder, 895
CoMBE, the late Dr. Andrew, on the Physiology
of Digestion, rev.,493 - -
Congenital malformations, catalogue of papers
on. 666
Congestion of lungs caused by cod-liver oil, 1101
CoNoLLY,Dr. John, proposed testimonial to, 1016
Constantinople, Dr. Webster on climate of, 1129 |C
Consumption, Dr. John Gardner on, rev.,664; Dr.
C. Holland on, rev., 849, 1172. See Phthisis.
Convulsions, puerperal, relation to epilepsy, Dr.
Tyler Smith on,87,96; Mr. Druitt on,88; Dr.
Murphy on, 88; Dr. Cape on, 88; Mr. W. F.
Bariow on, 88; Dr. R. Lee on, 89; Dr. Henry
Bennet on, 89; Dr. Cormack on, 91; Mr.
Streeter on, 93; Mr. Wing on, 94; Dr. James
Bird on, 95; Dr. Snow on, 96; Dr. Routh on,
96; intra-cranial osteophytes a cause of, 92;
renal disease a cause of,96; Dr. Thomas Smith
on turpentine in, 344; chloroform in,988; Dr.
Barnes on chloroform as a cause of, 1080; re-
lation of to albuminuria, 1082; case of, with
loss of speech, 1083 - -
—— in children, Dr. Elsåsser's cases of,
497; salaam, Dr. Faber's cases of, 569; Dr.
Willshire on, 590 - - w
CookE, Mr. Weeden, on Hydrocephalus, rev., 1067
Cooper, the late Mr. Samuel, bust of, 401
— Mr. W. White, fatal case of gastro-intest-
mal haemorrhage, 19; on conical cornea, 407,523
Cop LAND, Dr., on cholera, 296
CoRMAck, Dr. John Rose, on chloroform during
labour,90; case of eggs united by a band,90;
on the relations and differences between epi-
lepsy and puerperal convulsions, 91; on intra-
erartial osteophytes, 92; case of premature
labour, with symptoms resembling irritant
poisoning,203 ; on the climate of Madrid,550;
on entrance of air by uterine veins, 589, 928;
case of death from air entering anterior jugu-
*
lar vein. 933; case of disease of arteries of
brain, 599; on iodide of potassium in syphilis,
697; on searlatinal vaginitis, 871 ; on provident
... dispensaries, 907; on cause of convulsions in
pºpura, 1082; effects of leaves of ricinus,
Cornea, conical, Mr. White Cooper on, 407, 523;
Mr. J. Dixon on, 521; history of, 407, 524;
appearances and frequency, 408; symptoms,
411; causes, 413, 525; pathology, 417; treat-
ment, 526; artificial pupil, 525; removal of
lens, 530; removal of segments of cornea, 532;
puncturing the cornea, 533; pressure, 533;
emeto-purgative treatment, 526, 535; local ap-
plications, 535; optical apparatus, 537
Corneitis, a cause of comical cornea, 415
Corpulence, Dr. T. K. Chambers on, rev., 11 66
Corpuscles, white, excess of in blood, 691
Coryza in children, Dr. Elsåsser on, 499
CoTTINGHAM, Mr., case of tumour of labium
treated by seton, 896 -
CoTTON, Dr. C., excision of head of femur, 58.
Dr. R. P., Clinical Lectures on Phthisis,
rev., 46
Cotton-wadding as an application to ulcers, 1184
Coulson, Mr., on the operation for artificial
anus, 198; on malignant disease of bladder,
300; on inflammation of mammae, 304; cases
of fracture of neck of femur, 1089; on disloca-
tion of the great toe, 1189; on subcutaneous
bursae, 11.90 -
Countenance, after death
Barlow on, 892
Counter-irritant, oil of turpentine as a, 326
Cow-pock, Dr. A. Knox on, 1037, 1134. See Vac-
cination.
Cox, Mr. W. J., on chloroform in laryngismus
stridulus, 989
CRAIG, Mr., tumour of supra-renal capsule, 1096
Cranium, hypertrophy of bones of, with epilepsy,
452; tumour of, in an infant, 987
CRAwFoRD, Dr.M., on typhus and typhoid fevers,
80
from cholera, Mr. W. F.
Cretinism, meeting in Edinburgh eoncerning,609;
, Drs. Coldstream and Guggenbühl on, 1098
Croup, alum in, 187; calomel in, 187
Crucial ligament of knee-joint, rupture of, l 183
CRU ver1.H.I.E.R., M., on absorption of pus and
foreign matters, 222 et seq.
Xryptogamic vegetations in favus, M. Wedlon, 283
Crystalline lens, Mr. White Cooper on removal of
in conical cornea, 530; M. Kerst on cataract
behind, 573
Crystals, Baron von Reichenbach on a peculiar
effect of,836 -
CUMMINGs, Dr. A.J., on astringent properties of
tannin, 1069 |
Curability of phthisis, Dr. Turnbull on, 105,
CURLING, Mr. T. B., on operations for strañgu-
lated hernia in old people, 507; case of haemato-
cele,904; absence of thyroid gland in idiots,1012
Cymanche, chloroform in, 988
Cyst of cervix uteri, explosion of under cauter-
ization, 581 ; of labium, application of caustic
to interior of, 1007; of mammary gland, Mr.
Birkett on, 1169 - .
DALRYMPLE, Mr., Pathology of the Human Eye,
rev., 274, 1068
DANIELL, Dr. W. F., on the Medical Topography
and Native Diseases of the Gulf of Guinea,
rev., 492
Dr., ligature of common carotid, 81
Dartmoor, climate of, in consumption, 1072
DARTNELL, Mr. G. R., Description of an Im-
proved Truss, rev., 563 -
DAvey, Dr. J. G., Contributions to Mental Pa-
thology, rev.,274; case of uterine hydatids, 392
DAvres, Dr. John, on chloroform in cholera, 987
Deafness, Mr. Harvey on excision of tonsils im,
850; Mr. Yearsley on, rev, 1067
INDEX.
1199
Death, diagnosis between
new-born children, 193
Debility, vital, in children, in Stuttgart hospital,
Dr. Elsåsser on, 494, 1176 - -
DEBREYNE, M., on belladonna in nervous and
spasmodic affections, 386
DE FROBERVILLE, M., on the Ostro-Negroes of
Eastern Africa, 48 - -
Delirium Tremens, relation of, to epilepsy and
puerperal convulsions, 95; Dr. James Bird on
types of, 419; modified forms of, 421; causes
of, 434; differential diagnosis of,426; patho-
logy of,420; treatment of, 431 ; table of cases
of, 434; chloroform in, 988
ID i. Mºaas, Mr. C., on section of tendo Achil-
is, 7 •-
Dentition, Dr. Fliess on the paralysis attending,
51; case of synovitis in an infant during, 585.
D'EsNANs, M. F., on prussiate of iron in chorea
and epilepsy, 54
Dew, Melloni on the formation of, 28
Diabetes, spurious, from disease of spinal cord,
real and apparent in
10; Dr. Macintyre on lesions of the stomachin,
353: Dr. Bence Jones on, 964
Diagnosis of disease, Mr. Poyser on difficulties
of, 730 - - -
Diarrhoea, chronic, Dr. S. Alison on tannic acid
im, 3; tropical, Dr. James Bird on intestinal
ulcers in, 86; infantile, M. Trousseau on, 187;
Dr. Elsåsser on, l l 76
Diet, Dr. C. J. B.Williams on, in heart-disease,471
Digestion, Dr. A. Combe on the Physiology of,
rev., 493; Dr. Bence Jones on, 958; catalogue
of papers on diseases of organs of, 677; on
anatomy and physiology of, 972. -
Digiti semi-mortui, M. Gillet de Grandmont on,
698; connexion of with chlorosis, 698; with
disease of the nervous centres, 699
Diphtheritis, M. Miguel on calomel and alum in,
186; Dr. Risdon Bennett on, 1089
Directory, London & Provincial Medical, rev., 179
Disjunction of epiphysis of humerus, Dr. R. W.
Smith ſºn, 389
Dislocations, Mr. Vincent on, 376
Dispensing of medicines, not a mark of degrada:
tion, 483,558; opinions of old authors on, 558
Diuretic, oil of tiltpentine as a, 327; Dr. Easton
on acetate of potash as a, 875
T) ixon, Mr. James, on conical cornea, 523.
Doug LAs, Dr. H., on the Influence of Hyper-
trophy and Dilatation on Diseases of the
Heart, rev., 756
Dow NING, Dr. T., on Tic Doloreux and the
Aneuralgicon, rev., 46 -
Dropsy, cardiac, Dr. C. J. B. Williams on treat-
ment of, 469; Dr. A. Kilgour on, 991; renal,
Dr. G. Johnson on proximate cause of, 502
DRUITT, Mr., case of ovarian dropsy mistaken
for pregnancy, 82; on puerperal convulsions
and epilepsy, 88 - -
Dublin, complications of fever in, 1102
DUclos, M., on suffocative catarrh in young
children, 284 -
Duffin, Mr. E. W., successful case of ovariotomy,
1186
DU.NCAN, Dr. P. M., on almond oil as
tute for cod liver oil, 398
DUNN, Mr., case of hemiplegia with loss of
speech, 1012 - , -
DUPARQUE, M., case of ovaritis by, 350
DUPLAY, M., case of induration of cerebrum, 281
Dutch liquid, as an anaesthetic, 67
Dysentery, tropical, Dr. J. Bird on intestinal
ulcers in, 86; Dr. Polak on relation of to cho-
lera, 997; Dr. Cummings on tannin in, 1069
Dyspepsia, tannic ac,d in, 5; in connexiom with
disease of pancreas, 1052
a substi-
Ear, Mr. W. Harvey on rheumatic disease of, 55;
Mr. Toynbee on the otoscope in diseases of,
501; Mr. H. Gray on development of, 984
EAston, Dr., Introductory Lecture on Clinical
Medicine, rev., 144; on acetate of potash in
diseases of the skin, 872
Eclampsia nutans, Dr. Faber's cases of, 569; Dr. "
Willshire's cases of, 590 : - -
Eczema, acetate of potash in, 873 - . "
Edinburgh, School of Medicine of, 102; Report
of Royal Infirmary at, 214; Report of Mater-
nity Hospital at, 307 -- :
Education of medical practitioners, neglect of
*College of Surgeons, 481; observations on,
Effusion into abdominal cavity, after muco-enteri-
tis and peritomitis, Dr. A. Knox's case of,473
Elaterium in cardiac dropsy, 991 . . . .
Elbow-joint, case of excision of, 1193 .
Electricity in air, influence of, in the production
of delirium tremens, 424 . . . ... :
ElsAEsse R, Dr., his reports on the diseases of
children in the Stuttgart hospital, 494,1173
Fº ‘purgative treatmentin conical cornea, 526,
535
Emmenagogue effects of leaves of castor-oil plant,
951, 1085 *
Emphysema of lungs antagonistic to phthisis, 113
Empyema, case of chronic, terminating favour-
ably, 887 . ." r
Entropium, Mr. H. Walton on treatment of, 601
Epidemiological Society, first meeting of 906;
Epilepsy, prussiate of iron in, 54; relation of to
puerperal convulsions, Dr. Tyler Smith on, 87,
96; Mr. Druitt, Dr. Murphy, Dr. Cape, and
Mr. Barlow on,88; Drs. Robert Lee and Henry
Bennet on, 89; Dr. Cormack on, 91 ; Mr.
Streeter on, 93; Mr. Wing on, 94; Dr. James
Bird on, 95; Drs. Snow and Routh on, 96;
influence of gestation on, 87, et seq.; Dr. Thos.
Smith on turpentine in, 345; M. Debreyne on
belladonna in, 386; M. Gamberini's case of,
with exostosis of parietal bone, 389; case of,
with hypertrophy of cranial bones, 452; Dr.
Madden on humoral origin of,520 -
Epiphysis of humerus, Dr. R. W. Smith on dis-
junction of, 389
Epistaxis, Dr. Thomas Smith on turpentime in,
334; Dr. Cummings on tannin im, 1070; -
Erectile tissue in cervix uteri, Drs. E. Forget and
Tilt on, 350; Dr. Snow Beck on, 588 -
ERICHs EN, Mr., on section of the tendo Achillis,
79; cases of hermia by, 100 -
Eruptions on cervix uteri, 1097
Erysipelas, nitrate of silver in, 57, 58, 191 ; tinc-
ture of iodine in, 57; in children at the Stutt-
gart hospital, 496 -
Erythemanodosum, connexion of with rheumatic
diathesis, 774 --
Ether, chloric, as an anaesthetic, 6
sulphuric, Mr. Nunneley on anaesthetic
effects of, 67; in midwifery, Dr. Waller on, 77;
enemata of, in rheumatism and neuralgia, l l 80
Excision of head of femur, Dr. C. Cotton's case,
58; of bones, catalogue of papers on, 765; of
tonsils, Mr. Harvey on, 880; Mr. Syme on,
1006; of elbow-joint, 1193
Exercise, Dr. C. J. B. Williams on, in diseases of
the heart, 472; effect of on the pulse, 1065;
Dr Webster on, 1132 -
Exhalations, poisonous, from an apparently
healthy man, 798
Bºwry murmur, prolonged, asign of phthisis,
l{} -
Extravasation of urine, case of, 199
Eye, Mr. Dalrymple on Pathology of, rev., 274,
068; Dr. Jacob on Inflammation of, rev., 274;
M. Debreyne on belladonna in affections of,
387; diseases of among children in Stuttgart
hospital, 494, ll 75: Mr. Gray on development
of, 980; Dr. Fröbelius on inflammation of in
children, 999; Mr. H. Howard on Anatomy,
Physiology, and Pathology of, riv., 1066; Dr.
Jacob on tumours of, 110] ; Dr. C. Wallace on
Adjustment of to Distances, rev., 1172
1200
INDEX.
FABER, Dr., cases of eclampsia mutans by, 569,
FAIRB Roth ER, Dr. W. M., on chloroform in
cholera, 987; case of congenital protrusion of
intestines, 1185 . .
FARADAY, Dr., his experiment of freezing mer-
cury in a hot vessel, 28
FARREGE, D., on polypous excrescences from
umbilicus in children, 1183
Fat in urine, Dr. Bence Jones on,964; excess of,
Dr. Chambers on, 1166 .
Fatty degeneration of heart, Dr. R. Quain on, 705
-—— tumours, Mr. Syme on, 1098
Fatuity, brieve of, 1088
Favus, Dr. Wedl on cryptogamic vegetations in
hairin, 283; Dr. Hughes Bennetton, 849
Fecundity, Dr. Routh on, 245
Feet, mortification of from exposure to cold, 1105
Femur, Dr. Cotton's case of excision of head of,
Mr. Coulson's cases of, 1089 *.
FERGUsson, Mr., cases of urethrotomy by, 61
Fern, M. Martin Solon on, in taenia, 1182
Fevers, catalogue of papers on, 668; Dr. Adams
on influence of hospitals on, 880; Mr. Taylor
on Cutaneous Inunction in, rev., 970; compli-
cations of in Dublin, 1012 -
– intermittent, Dr. Polak on relations of to
cholera, 997; cedron in, 1085
infantile remittent, analogy of with typhoid
fever, 80 -
low continued, tannin in, 1069
- typhoid, Dr. W. Jenner on, 79; Drs.
Barclay, Baly, West and Crawford on, 90; Dr.
A. T. Thomson on mosological arrangement
of, 846 -
puerperal, Dr. F. Churchill's Collection
of Essays on, rev., 381 ; Dr. Skoda on causes
of, 700; Dr. Semmelweis' experiments to de-
termine cause of, 701 .
Fibrin, causes influencing quantity of, 648
Fibro-cystic tumour of uterus, Mr. P. Hewett's
case of, 611 -
FIELD, Mr., operation for artificial anus, 195
I’ish-oils as substitutes for cod-liver oil, 1103
Fistula in Perinaeo, Mr. Syme on, rev., 35; Mr.
Vincent on, 379 -
Flame of candle, Volger on structure of, 29
Flatulent distension of abdomen, Dr. Thom
Smith on turpentine in, 343 .
FLEMING, Dr. C., on a peculiar form of glossitis, i.
882; on a tubercular affection of the tongue,883
FLEMMING, Dr., on tartarized antimony in in-
sanity, 1181
FLETCHER, Mr. T. S.,
to, 506 -
FLIEss, Dr., on paralysis from dentition, 51
Flood, Dr. W., Surgical Anatomy of the Arteries,
edited by Dr. Power, rev., 142
Foetus, catalogue of papers on diseases of, 857
Food, Dr. Bence Jones on, 957; Dr. Webster on
influence of in health, 1130 -
Forensic medicine, catalogue of paperson, 975
FoEGET, Dr. E., erectile tissue in cervix uteri, 350
Fownes, Dr., Elementary Chemistry, rev., 665
Fractures, Mr. Vincent on, 377 -
Fragilitas ossium, with much animal matter in
urine, 904. -
Fraudulent diploma of College of Surgeons of
Edinburgh,403 -----
FRoebe LIUs, Dr., report on ophthalmia of new-
born children, 999
Fulcrum, Mr Gilbert's, Mr. Robins on employ-
ment of, 574; account of, rev., 757
Fungus of brain, Mr. Lowe's case of, 1011
GABB, Mr. A. W., case of retention of
nine days, 2011 |
testimonial presen ted
GAIRDNER, Dr. W. T., case of aneurism of supe-
rior mesenteric artery, 1094; haemorrhagic
membrane within arachnoid, 1096; cicatrices
in lungs, 1097; case of atrophied panereas, 1400.
Galactagogue effects of castor-oil plant, 951, 1085
Gallic acid, effects of on chylous urine, 1012
GAMBERINI, M., case of epilepsy, with exostosis
of parietal bone, 389 -
Gangrene of lungs, Dr. Stokes on, 886; of feet
from exposure to cold, 1105
GARD NER, Dr. John, on Consumption, rev., 664
GARIEL, M., on vulcanized India-rubber in sur-
gery, 60 -
GARROD, Dr., on the connexion between gout and
rheumatism, 583; method of detecting uric
acid in blood, 584
GASPARD, M., experiments on purulent infection
by, 234, et seq. - -
Gastric fluid, Dr. Macintyre on the influence of,
in producing diabetes; 355; Dr. Bence Jones
on, 958

–- 2 GAUSSAIL, M., on enemata of ether, 1180
58; caries of head of, specimens of, 296, 301; G
fracture of neck of, Mr. John Lizars on, 893;
AY, Mr., on the operation for hernia, 101 ; on
inflammation of the mammary gland,303; case
of air entering a vein, 930 - ,-
General Practitioners, proposed College of, Mr.
Syme on, 26; Mr. Skey's remarks on, rev. 983;
examination of condition of, 555
GEOGHE GAN, Dr., on milk in breasts of young
children, 1107
Ghosts, Baron von Reichenbach on, 837 -
GILBERT, Mr., Mr. Robins' case of employment
of his fulcrum,574; on the Extraction of Teeth,
arev., 757 -
GILLET DE GRAND MONT, M., on digiti semi-
mortui, 698
GIRAUD, Dr. H., on poisoning with stramo-
mium, 427
Glasgow, Dr. Eastom on medical education in, 144
Glossitis, Dr. C. Fleming on a peculiar form of,
Glottis, influence of pneumogastric nerve on
movements of, 183 - -
GoDDARD, Dr. Jonatham, on the Practice of Phy-
sick, rev., 553; on the dispensing of medicine
by physicians, 559
GoITRE, Mr. Syme on connexion of with anaemia,
1098; in new-born children, 1072
Gonorrhoea, tannic acid lotions in, 4; Mr. Colles
on extension of to bladder, 895
GooDSIR, Mr. John, on diseases of bone, 277;
Annals of Anatomy and Physiology, rev., 380
Gout, Dr. Garrod on connexion of with rheumat-
ism, 583; Dr. Toulºnin on Treatment of, rev.,
853
Granular corpuscles in brain and spinal cord in
hemiplegia, 387; in optic chiasma in amauro-
sis, 570
GRAY, Mr. H., on the development of the retina,
280; of the membrana Jacobi, 983; of the
fibrous lamina, 983; of the auditory nerve,
984; of the membranous lining of the semicir.
cular canals, 985 . . .
Gº”. Dr. G. T., on nux vomica in hay asthma,
9
GREENHILL, Dr. W. A., reports on the public
health of Oxford, 1015
GREGoRY, Dr. Wm., his Translation of Reichen.
bach, rev., 833
GRIsol, LE, M., on the reciprocal influence of
pregnancy and phthisis, 382
GUE RIN, M. Jules, on Orthopaedic Operations,
rev., 1068 - - - -
Gºast, M., on polypus of rectum in children,
'85
GuggenBUEHL, Dr., on cretinism. 1098
Guinea, Gulf of, Dr. W. F. Daniell on Medical
Topography and Diseases oſ, rev.,492
Gºiº. W.A. on the pulse, rev., ſoč
urine for || -
HAAs, Dr. Rudolf, on the mechanism of nutrition,
642, 715 - -
Habits, unhealthy, Dr. Webster on, 1131 - -
HADDock, Mr. J. N., on Sommolism and Psyche-
ism, rev., 34 . . . . " . . . . . .
Haematemesis, tarpentine in, 330
INDEX.
1201.
Haematoeele of spermatic cord, 904; of tunica
vaginalis, 904; pathology of, 904; treatment
of, 905
Haematuria, case of, from malignant disease of
bladder, 298; Dr. Thomas Smith on turpentine
in, 335 : -
Haemoptysis, relative frequency of in phthisis.
41; Dr. Thomas Smith on turpentine in, 338
Haemorrhage, fatal gastro-intestimal, Mr. White
Cooper's case of, 19; after extracting teeth,
mode of arresting, 143; Dr. Thomas Smith on
turpentine in, 330; capillary, turpentine in,
336; in connexion with cholera, 996; Dr.
Cummings on tannin in, 1070
Haemorrhagic membrane in arachnoid, 1096
Haemorrhoids, Dr. S. Alison on tannic acid in, 4;
Mr. Vincent on treatment of, 379
Hair, Dr. Wedl on cryptogamic vegetations in,
in favus, 283
Hair-pin extracted from urethra, 293
HALE, Dr. R. J., case of fatal haemorrhage from
ulceration of veins of neck in scarlatina, 720
HALL, Dr. J. C., on nitrate of silver in erysipelas,
19 l
Dr. Marshall, table of paroxysmal sei-
zures, 1070
HAM Lton, Mr., on Syphilitic Sarcocele, rev., 36
HAN.cock, Mr., on the Operation for Strangulated
Hernia, rev., 141; case of stricture, with extra-
vasation of urine, 199; on treatment of inflam-
mation of mammae, 304
HARE, Dr. C.J., case of paralysis of motor oculi
from aneurism of posterior communicating ar-
tery, 824; on the mortality in hospitals, 1188
Hare-lip, Dr. O'B. Bellingham on early opera-
tion for, 1109 -
HARLEY, Mr. G., Caesarean operation by, 1099
HARRIson, Mr. J. B., case of monstrosity by, 79
Harveian Oration for 1850, 733
HARVEY, Mr. W., on rheumatic disease of the ear,
55; on Excision of Enlarged Tonsils, rev., 850
HAssal, L, Dr., on the Water supplied to London,
rev., 493
HAssing, Dr., on Colica Scortorum, rev., 756
Hastings as a Resort for Invalids, Dr. Mackness
on, rev., 381
Haversian canals, Mr. Goodsir on effects of dis-
ease in, 279
HAwkINs, Mr. Charles, on section of the tendo
Achillis, 78
Hay asthma, nux vomica in, 699
Hays, Dr. Isaac, on chloroform in neuralgia, 990
Head, catalogue of papers on diseases and inju-
ries of,765; case of iron rod driven through,893
Health of London, Dr. Webster on, 540, 1115
Heart, Dr. C. J. B. Williams on organic dis-
eases of, 311, 460; circumstances in heart
influencing prognosis, 312; state of blood in-
fluencing prognosis, 317; table of secondary
effects of diseases of,320; treatment of organic
diseases of, 460; case of valvular malformation
of in a small-pox patient,598; Dr. R. Quain on
fatty degeneration of, 705; Dr. H. Douglas on
Diseases of, rev., 756; Dr. A. Kilgour on treat-
ment of dropsy from disease of,991; Dr. Semple
on valvular disease of, 1019, 1090; cases of
aneurism of, - -
Heat of body, rise of after death from cholera, 890
Heathen priestº!octors, tactics of, 31 -
Hemicrania, chloroform in,989
Hemiplegia, granular corpuscles in brain and
spinal chord in, 387; Mr. Dunn's case of with
loss of speech, 1012 . . . . .
Hen eggs united by a band, 90 . -
HENRy, Dr., on arsemicin unfermented bread,191
— Dr. A., classified catalogues of papers in
British and American Journals, 666, 758,856,
971
Mr. Mitchell, case of abscess of vesi-
culae seminales, 1013 - * *
HENson, Mr. S., case of loss of speech during
pregnancy, 1083 " . .
Hepatic compression rhonchus, Dr. Wajshe on,797
HERAPATH, Dr. W. B., aneurism of anterior
palatine artery, 806 - .
Hereditary predisposition, influence of in phthi-
S1s, - . -
Hernia, catalogue of papers on,768; cases of, by
Mr. Érichsei, iod;’s rangulated, Mr. Hancºck
on, rev., 141; strangulated, Mr. T. B. Curling
on successful operations for, in ord people, 507;
strangulated, in infants, 894; strangulated,
with ileus, 1013; strangulated within abdomen,
remedied by operation, 1092; strangulated,
simulating hydrocele, 1103; umbilical, in chil-
drem, 499 -- . . . .
HEwett, Mr. P., case of fibro cystic tumour of
uterus, 611; case shewing organization of ef-
fused blood, 641
HILLMAN, Mr. W. A., case of vascular tumour of
urethra, 86 t -
HILTon, Mr., on artificial anus, 197 ,
HIPPocBATE's on the dispensing of medicines,558
Histogenetic, Dr. S. Alison on tannic acid as a, 5
Hopgson, Mr., on artificial anus, 198
Hollan D, Dr.G. C., on the Cure of Consumption,
rev., 849, 1172 *. . .
Homoeopathist, legal action for defamation of
character brought by a, 402; correspondence
between Dr. C. J. B. Williams and a, 403
Homoeopathy in the House of Commons, 916;
remarks on, 849, 1172 -
HoRN, M., on the termination in loops of the
olfactory nerve, 986 -
Hospital for Consumption, First Annual Report
of, rev., 37; hygienic conditions of, 43 .
Hospitals, effect of on the mortality from fever,
880; in London, mortality in, Dr. Webster on,
1122; Dr. Hare on, 1188
House of Commons, homoeopathyin,916; libel on
medical profession published by order of, 1010
Howard, Mr. H., on the Eye, rev., 1066,
ºire, M., on inhalation of hydro-iodic ether,
HULL, Dr., on Consumption, rev., 139
Humerus, Dr. R. W. Smith on disjunction of
epiphysis of, 389 - -
Humoral theory of nervous affections, Dr. Mad-
den on, 520
HUNT, Mr., on Diseases of the Skin, rev., 855;
on the mercurial treatment of syphilitic erup-
tions, 11.90 -
HUNTER, Mr. John, on the effects of pus and
foreign matter on the blood, 217, et seq. -
Hunterian Oration, Mr. Skey's, rev., 479
HUTcHINson, Mr. J., on chloroform in brow-
ague, 989

sº-º-º-º-º-º-mº Dr. John, on the diagnosis of
pulmonary consumption, 1075 -
Hybernation, Dr. Haas' explanation of, 645
Hydatids of uterus, Dr. J. G. Davey's case of,
392; beneath arachnoid membrane, 453; in
liver, suppurating through lung,903.
HYDE, Mr. G., on chloroform in delirium tre.
mens, 988 .
Hydrocele, Mr. Lloyd on treatment of, 190;
strangulated hernia resemblin# | 103 --
Hydrocephalus, turpentine in, 345; chronic, Dr.
Battersby on,782; Mr. Weeden Cooke on, rev.;
1067; congenital, case of, by Dr. Elsåsser, 1174
Hydrocyanic acid, Dr. Christison on treatment
and fatal dose in poisoning by, 397 -
Hydro-iodic ether, M. Huette on inhalation of,
Hydrophobia, Dr. Webster on causes of fre-
quency and diminution of,541; chloroform in,
988; seeds of cedron a remedy for, 1085
Hygienics, catalogue of papers on, 975 . . . .
Hypertrophy of cervix uteri, Dr. H. Benneton,
171; of bone, Mr. Stanley on,489; of toes, Dr.
F. Bättersby on, 1109 . . . . . . . . .
| Hypochondrium, case of tumour in, simulating
hepatic disease, 522
Hysteria, M. Debreyne on belladonna in, 386
I 202
INDEX.
Ice applied to head in scarlet fever, 867
Idiots, absence of thyroid gland in, 1012
Ileus & strangulated hernia in same person, 1013
Infant, case of synovitis in an, 585; opium in
strangulated hermia in,894; milk in breasts of,
1 106; wound of brain in an, l 184; congenital
protrusion of intestines in an, 1185
Inflammation, Dr. A. Wood on, 272
Inoculation, variolous, Dr. A. Knox on, 1039;
effect of vaccination on results of 1139
Insane, Parisian hospitals for, statistics of, 505
Insanity from chloroform during parturition, 90;
tartar emetic in, 1181
Intestinal obstruction simulating diseased liver,
Dr. A. Knox's case of, 522; case of by Mr.
Sharp, 1093; Mr. Field's and Mr. Clarkson's
cases of, 195; Dr. A. Knox's case of, simulating
labour, 823; from peritoneal bands, 993
Intestines, Dr. James Bird on ulcers in, in tro-
pical diarrhoea and dysentery, 86; changes
produced in by purulent infection, 621 ; pro-
trusion of in an intant, 1185
Inunction in scarlet fever, Dr. Schneemann on,
865; in fevers, Mr. Taylor on, 970
Iodide of iron, preservation of pills of, 1087; of
potassium in syphilis, Mr. Acton on, 606; Mr.
B. Travers and Dr. Cormack on, 607
Iodine, compound tincture of, in erysipelas, 57;
in phthisis, Dr. Turnbull on, 118
Iron in phthisis, 44; in heart-disease, 466; in
conical cornea, 537; in albuminuria, 567;
prussiate of, in chorea and epilepsy, 54; with
magnesia, citrate of 399; iodide of, means of
preserving pills made of, 1087; rod of, driven
through head, 893
Irritant poisoning, Dr. Cormack's case of prema-
ture labour with symptoms resembling, 203
Italy, Dr. Webster on, as a resort for invalids, 551
JAcoB, Dr., on Inflammation of the Eye-ball,
rev., 274; tumours of eye and orbit, l 101 ; cod-
liver oil, 1103; early operation in congenital
cataract, 1110; on a peculiar accident of shoul-
derjoint, 1194
J*os, Dr. S., on chloroform in hydrophobia,
98
Jacksönian prizes for 1850, 505
JAEGER, Dr., on conical cornea, 415
JANzER, Dr., on the state of the ovaries and
uterus after menstruation, 396
JENNER, Dr. Edward, monument to, 103 ... •
Dr. William, on typhus, typhoid, and
relapsing fever, 79
Johns, Dr., on cauliflower excrescence of uterus,
212
Johnson, Dr. George, on the pathology of the
kidney in Bright's disease, 502
Joints, catalogue of papers on diseases and inju-
ries of, 763
Jon Es, Dr. Bence, on Animal Chemistry, rev.,
957; on food, 957; digestion, 958; blood, 959;
urine, 960; chylous urine, 964, 1012; diabetes,
964
Mr. R., on cotton-wadding as an applica-
cation to bed-sores, 1174
Journals, medical, circulation of in Spain, 11.12;
Jugular vein, internal, fatal ulceration of in scar-
latina, 720
RENNEDY, Dr. H., on complications of fever in
Dublin, 1102; on cod-liver oil, 1103; on amount
of respiration in chest-diseases, 1107; on early
of eration in hare-lip, 1110
RERST, M., on cataract behind the lens, 573
Rhaya Senegalensis, alkali obtained from, a sub-
stitute for quinine, 400
Ridney, disease of, a cause of puerperal convul.
sions, 96; in scarlatina. Dr. James Miller on,
rev, 276; disease of, simulating cerebral dis-
ease, 451; Dr. C. J. B. Williams on treatment
of diseases of in connexion with heart-disease,
George Johnson and C. J. B. Williams qm,
502; Dr. G. Owen Rees on, rev., 565; effects
produced in by purulent infection, 619; cata-
logue of papers on diseases of, 680
KILGOUR, Dr. A., on the treatment of cardiac
dropsy, 991
— Dr. J., case of abscess of pancreas, 1052
RING, Dr. Alexander, case of abscess in neck
following scarlatina, 724 *.
Riss, Baron von Reichenbach's explanation of,
Knee-joint, synovitis of, in an infant during den-
tition, 585; rupture of crucial ligament in, 1183
KNox, Dr. Alexander, case of muco-enteritis, with
peritomitis and effusion into abdominal cavity,
473; cases simulating disease of liver, 522;
intestinal obstruction simulating labour, 823;
on vaccination and revaccination, 1037, 1134;
history of small-pox, 1037; variolous inocula-
tion, 1039; history and effects of vaccination,
1041 ; on revaccination, 1137, 1440, il 59;
causes of failure of vaccination, 1141; means
of obviating failure, 1157
Kousso, Dr. Pereira on,896; history,896: phar-
macography,889; adulteration,899; chemistry,
899; medicinal properties, 900; administra-
tion, 902
Labium, removal of immense tumour of 894;
encysted tumour of, treated by seton, 896; by
applying nitrate of silver to interior of cyst, 1007
Labour, chloroform in, Dr. H. Bennet on, 265;
premature, with symptoms resembling irritant
poisoning, 203; simulated by intestimal ob-
struction, 823
LAENNec, M., on recovery from phthisis, 107
LAGAE, M., wound of brain in an infant, 1184
LA MoTTE, M., case of epilepsy partially relieved
during pregnancy,88; Dr. Cormack's explana-
tion of, 92 -
LANDouzy, M., on the coincidence of albuminu-
ria and amaurosis, 186
LANE, Dr. Butler, on purging flax, 1010
LANGENBEck, Professor, on ligature of uterine
pºpi 704; operation for pharyngeal polypi,
LAN KESTER, Dr., case of malignant disease of
bladder, 298
LARREY, Baron, statue of, 1017
LARSEN, Professor, case of cancer of posterior
mediastinum, 996
Laryngismus stridulus, chloroform in, 989
Larynx, method of applying nitrate of silver to,
1075; Dr. John Scott on affections of, 1099
LAVENDER, Dr., case of poisomous exhalations
from an apparently healthy man, 798
LAWRENCE, Mr., on ovariotomy, 1187
Lead, acetate of in granular ophthalmia, 190
Lead-colic, chloroform in, 285
LFC LUYSE, M., on strychnine in paralysis of the
bladder, 882 ".
Lécture, Introductory to a course of Clinical
Medicine, by Dr. J. A. Easton, rev., 144
LEE, Mr. Henry, on inflammation of the veins,
and the introduction of foreign matters into
the blood, 217,613 .
— Dr. Robert, on epilepsy and puerperal con-
vulsions, 89; on the use and abuse of the
speculum, 905; examination of an ovarian tu-
mour, l l 86; analysis of 108 cases of ovario-
tomy, 1187
Leeches, Dr. H. Bennet on, in inflammation of
cervix uteri, 165 -
LEGENDRE, M., on of tape-worm, 1073
LENTE, Dr., case of anomalies in muscles of
arm, 690 . -
Lepra vulgaris, treated by acetate of potash, 874
LETALNET, M., case of acute ovaritis with me.
tritis, 35 l
LETHEBY, Dr., case of poisoning with chloride
469; pathology of in Bright's disease, Drs.
of zinc, 1011
INDEX.
1203
Lettsomian lecturers in Medical Society of Lon-
don, 1015, 1089,1112 . . . . .
Leucorrhoea, Dr. S. Alison on tannic acid in, 4
LEVER, Dr., ease of laceration of vagina and
uterus, 131; on mania co-existing with uterine
disease, 581; cases of death from entrance of
air into uterine veins, 941 - -
Ligature, Langenbeck on danger arising from in
uterine polypi, 704; means of applying to
pharyngeal polypi, 804 - .
LINDSLY, Dr., on cutaneous inunction in scarla-
tina, 868 -
Linum catharticum, Dr. Butler Lane on, I010
LIONET, M., case of entrance of air into uterine
veins, 944 -
Liston testimonial, 401 ..
Lithotomy, M.M. Pamard's cases of, 286
Lithotrity, M.M. Pamard's cases of, 286
Liver, Professor Retzius on the structure of, 47;
Dr. C. J. B. Williams on the treatment of dis-
ease of, in connexion with heart-disease, 469;
cases simulating disease of, by Dr. A. Knox,
522; changes produced in by purulent infec-
tion, 619; obscure case of disease of, by Mr.
Poyser, 730; enlarged, auscultatory sign of,
797; Dr. Peacock's case of hydatids of,903.
LIZARs, Mr. John, on diagnosis of fracture of
neck of femur, 893
LLOYD, Mr. E. A., on the treatment of hydrocele,
190; removal of large cellular tumour of la-
bium, 894 - . - -
LocKE and SYDENHAM, rev., 180
London, Dr. Hassall on Water supplied to, rev.,
493; Dr. Webster on health of, 540, 1115 ;
salubrity of as a place of residence, 1128
LoNGET, M., on the pneumogastric nerve, 181;
his neglect of Dr. John Reed, 186
LORIE, Dr., on sulphur in cholera, 500
LoRINSER, M., on maxillary necrosis in lucifer-
match makers, 1008 - .
Louis, M., on recovery from phthisis, 108
Lowe, Mr. G., cases of fungus cerebri, 1011 -
Lower jaw, Mr. Stanley on morbid growths from,
492; Dr. Lorinser on necrosis of, 1008
Lucifer-match makers, Dr. Lorinser on maxillary
necrosis of 1008
Lunacy, case of at Dumfries, 1088 -
Lunatic asylums, Dr. Webster on mortality in,
122
Lungs, capacity of in phthisis, 39; Dr. C. J. B.
Williams on the treatment of affections of, in
connexion with heart-disease, 470; inflamma-
tion of, in children, Dr. Elsåsser on, 494,
1175; atelectasis of, Dr. Elsåsser on,497, 1178;
oadema of, in a child, 498; changes produced
in by purulent infection, 618: gangrene of,
Dr. Stokes on, 886; case of cavity in, 1096;
cicatrices in, 1097; congestion of, caused by
cod-liver oil, 1101. -
Lupus, the late Dr. A. T. Thomson's treatment
of 847
Lying-in hospitals, Dr. Webster on mortality in,
1122 --
McDonnell, Dr. R., on application of nitrate
of silver to interior of encysted tumours of
labium, 1007 - -
—— Dr., case of strangulated hernia
resembling hydrocele, 1103 º
McGRIGoR, Sir James, retirement of, 1112
MACINTYRE, Dr., on lesions of the stomach in
diabetes, 353;
ossium, 904 § . . . . ;
MacKNEss, Dr., on Hastings as a Resort for
Invalids, rev.,381
MAcLAch.DAN, Dr., case of scrofulous abscess of
anterior mediastinum, 903 -
MAGIAGAN, Dr. Douglas, on poisoning by arse-
case of mollities and fragilitas
nic, 1097 -
McWILLIAM, Dr., on the galactagogue and em-
‘ menagogue effects of the leaves of the Bofareira,
951, 1085 -
WOL. II.
MADDEN, Mr. John, case of popliteal aneurism
treated by compression, 1101 *~ -
— Dr. W. H., cases of ramollissement of
medulla spinalis, 10, 516 : -
Madrid, Drs. Cormack and Webster on climate
_of, 549; medical faculty of, 1112
Magnesia and iron, citrate of, 399 . . . . . .
Magnet, Baron von Reichenbach on effects of,833.
Magnetism, Baron von Reichenbach on, rev., 833
Male fern in taenia, 1182 . . . .
MALGAIGN.E., M., case of extraordinary disten-
sign of bladder after parturition, 395. . . .
Malignant disease of ovaries and rectum,297;
of bladder, 298 . . . . . . . .
Mammary gland, Mr. Nunn on inflammation of,
302; Mr. Birkett on Diseases of, rev., I 169.
Manganese, mineral springs containing,399.
M.gºexisting with uterime disease, Dr. Lever
On, - - - - - - - ' ' . . . . .
MANSON, Dr., on inflammation of breast, 304
MARSON, Mr. J. F., valvular malformation of
heart, 598; disease of spinal cord, 602 #
MARTIN-SoLoN, M., on male fern in taenia, 1182
Materia Medica, catalogue of papers on, 974
Maxillary necrosis of lucifer-match makers, 1008
MAYNE, Dr. R. G., on medical observation, 725 °
MAYNWARING, Dr.E., on the Ancient and Moderm
Practice of Medicine, rev.,553; on the dispens-
ing of medicines, 559
Mazodynia, Mr. Birkett on, 1170
Mazoitis, Mr. Birkett on, 1169
Measles, without eruption, 572; in connexion
with cholera,997; vaginitis after, 1185
Mediastinum, anterior, scrofulous abscess of,
903; posterior, cancer in, 996
Medical Reform, Professor Syme's Letter to Lord
Advocate on, rev., 26; meeting of conference
respecting, 308; progress of 807 -
Medicine, Sacredness of, Dr. G. Wilson on, rev.,
33; Rational, Dr. A. Wood's, rev., 272; Dr. G.
. Wood's Treatise on Practice of, rev., 275; Pro-
fession of, Mr. Skey's Remarks on, rev., 479
Mºochirurgical Transactions, vol. xxxii, rev.,
Medullary sarcoma of brain, case of, 815
MEIGS, Dr., on the expulsion of air from the
uterus, 940 . .
MELIER, Dr., on the transmission of diseas
from the uterus to the ovaries, 348; case of ex-
plosion of uterine cyst under cauterization, 581
MELLON1, M., on the formation of dew, 28
Mºna Jacobi, Mr. H. Gray on development
of, 983 - -
Mºna tympani, Mr. Toynbee on structure
O 2
Membrane, adventitious, on arachnoid, 448
Membranous labyrinth, Mr. H. Gray on deve-
lopment of,984 . - - -
Meningitis, case of acute, without symptoms, 449
Memorrhagia, tannic acid in, 4
Menstrual fluid, retained, simulating ovarian
dropsy, 82 .
Menstruation, Dr. Routh on periods of com-
mencement and cessation of, 243; condition
of uterus and appendages in a woman assassi-
nated soon after, 396; Dr. Tilt on Diseases
; gº." 839; catalogue of papers on diseases
Of, - ** .
Mental Pathology, Dr. J. G. Davey's Contribu-
tions to, rev., 274 -
Mºjº, vapour-baths in syphilis, Mr. L. Parker
on, 6
Mercury, effects of introduction of into a bone,
226; into an artery, 237; in phthisis; Dr.
Turnbull on, 118; injurious effects of in puru-
lent infection, 628; acid nitrate of, in diseases
of cervix uteri, 167; nitric oxide of, in hydro-
cele, 190; chloride of See Calomel.
MERRETT, Dr. C., on Fräuds and Abuses com-
mitted by Apothecaries, rev., 553
Mesmerism, Mr. J. N. Haddock on, rev., 34
Meteorites, Baron von Reichenbach's explana-
| tion of, 838 _. - . . . .
79
1204
INDEX.
Metritis, acute, Dr. H. Bennet on, 146; chronic,
147; internal, 147; Dr. Tilt on connexiom of
with ovaritis, 347
Metropolitan police, medical expenses of 505
Midwifery, chloroform in, Dr. Waller on,77; Dr.
H Bennet on, 265; Dr. R. Barnes on, 1076
MIGUEL, M., on calomel and alum in croup, 186
Milk, privation of, a cause of mortality among
children, 543, 1120; effect of leaves of castor-oil
plant on secretion of,951, 1085; in breasts of a
male infant, 1106
MILLER, Professor, Introductory Lecture on
Medical Missions, rev., 30; Principles of Sur-
gery, rev, 852; case of suicide by puncture of
an inguinal aneurism, 1097
Dr. James, on the Kidney in Scarlatina,
rev., 276
Mineral springs containing manganese, 399
Missionary, medical, Dr. W. Brown on qualifi-
cations of a, 31
Missions, Medical, Lectures on, rev., 30; success
of, 30; importance of, 31
Mollities ossium, case of, with much animal
matter in urine, 904
Monstrosity, case of, by Mr. J. B. Harrison, 79
Montgometry, Dr., on excision and ligature in
uterine tumours, 213
MoREAU, M., on osteophytes in pregnant women,
93
MoREHEAD, Dr., on delirium tremens, 424
Mortality in London, Dr. Webster on, 540, 1115
Motor oculi, Dr. C. J. Hare's case of paralysis
of, from aneurism of posterior communicating
artery, 824
Muco-enteritis, with perforation and effusion,
Dr. A. Knox's case of, 473
Murderous attack on a physician, 1113
Murmur, placental, M. Cazeaux on, 576; pro-
longed expiratory, a sign of incipient phthisis,
1013
MURPHY, Dr, on the diagnosis of ovarian
dropsy, 82; on inflammation of mammary
gland, 304
MURRAY, Sir James, on the organic electric
action of the spleen, 1104 *
Muscle, changes produced in by purulent infec-
tion, 621; of arm, case of anomalies in, 690
Muscular contractions after death from cholera,
Mr. W. F. Barlow on, 889
Naphtha in phthisis, 44
Narcotics, poisoning by, contrasted with alcoholic
poisoning, 426
Nasal fossa, peculiar disease of, 1097
Natis, flattening of, diagnostic of fracture of neck
of femur, 893
Nature, Dr. Radcliffe on the Unity of, rev., 752
Neck, ulceration of veins in, after scarlatina,720;
symmetrical fatty swellings of, in idiots, I012
Necrosis, Mr. Stanley on, 491; maxillary, Dr.
Lorinser on, 1008
NELson, Dr. David, Principles of Health and
Disease, rev. 568
Nephritic colic, chloroform in, 989
Nerves, fifth pair of, congestive disease of,455
Nervine, Dr. S. Alison on tannic acid as a, 8
Nervous Affections, Eccentric, Mr. Anderson on,
nev., 755
Nervous system, diseases of, Dr. Madden's illus-
trations of, 10, 516; Dr. Semple's, 448, 811;
catalogue of papers on, 680; relation of digiti
semi-mortuito, 698; Mr. Pilcher on affections
of, simulating chorea, 1090
Neuralgia, Dr. Downing on, rev., 46; M. De-
breyne on belladonna in, 386; of bone, Mr.
Stanley on, 489; case of obscure, with disease
of brain and liver, 731; chloroform in, 989;
enemata of ether in, 1180
New Orleans, Dr. Webster on insalubrity of 1129
Nicotime, its presence in snuff, 29
NIMMo, Dr., case of Caesarean section, 1099
Nitric acid, solidified, cauterization with, 74
NUNN, Mr. R. S., on almond oil as a substitute
for cod-liver oil, 398
r. T. W., case of malignant disease of
ovaries and rectum, 297; on inflammation of
the mamma, 302
NUNNELEY, Mr., on anaesthetic substances, 63
Nutrition, Dr. Haas on the mechanism of,642,715
Nux vomica in hay asthma, 700
Obesity, Dr. T. K. Chambers on, rev., 1166
Obituary, 104, 216, 310, 406, 506, 610, 714, 809,
922, 1018, 1114
Observation, medical, Dr. Mayne on, 725
Obstetrics, catalogue of papers on, 857
Odontalgia, chloroform in, 991
Odyle, Baron von Reichenbach on, 833
CE dema of lungs in a child, 498
CEsophagus, stricture of, 501; foreign body im,
simulating cerebral disease, 582
Oettinger, M., on cantharidal ether and other
preparations of cantharides, 1087
Oil, effects of injection of into an artery, 238
Old persons, operations for hermia in, 507
OLDHAM, Dr., on the undersized womb, 75; on
tubercular disease of uterus, 76
OLLIVIER, M., case of disease of spinal cord, 13
Qpium in the strangulated hernia of infants,894
Ophthalmia, granular, powdered acetate of lead
in, 190; strumous, Mr. Vincent's treatment of,
379; in new-born children, Dr. Fröbelius on,
999; Dr. Elsasser on, 1176
Optic nerves, Mr. H. Gray on the development
of, 980; commissure of, granular corpuscles
in, in amaurosis, 570
Oratio Harveiana, 733
Orbit, Dr. Jacob on tumours of, 1101
ORR, Mr., Principles of Surgery, rev., 969
Orthopaedic operations, Report on M. Jules
Guerin's, rev., 1068
Os calcis, Mr. W. B. Page on excision of, 905
Osteophytes, intra-cranial, Dr. Cormack on re-
lation of to epilepsy and puerperal convul-
sions, 92; Professor Rokitansky on, 92; M.
Moreau on,93; in longitudinal sinus of a sup-
posed epileptic, 298
Ostro-negroes, M. de Froberville on, 48
Otalgia, chloroform in,990
Otoscope, description of Mr. Toynbee's, 501
Ovarian dropsy, Mr. I. B. Brown on diagnosis
of, 81; Mr. B. Travers, Mr. Druitt, and Dr.
Murphy on, 82; Drs. Tilt and Sibson on, 83;
Mr. I. B. Brown's new operation for, 202, 189
Ovarian and uterine disease, Dr. Tilt on con-
nexion of, 347
Ovaries, case of malignant disease of 297; con-
dition of soon after menstruation, 396; cata-
logue of papers on diseases of, 861
Ovariotomy, Mr. Duffin's case of, 1186 ; Dr. R.
Lee on, 1187; Mr. B. Phillips on, 1187; Mr.
Lawrence on, 1187
Ovaritis an effect of metritis, 348; inducing me-
tritis, 349; Dr. Tilt on, rev., 839
Oxalate of lime in urine, Dr. Bence Jones on,961
Oxford, sanitary reports in, 1013
PAGE, Mr. W. B., on excision of the os calcis, 905
PAGET, Mr. Thomas, case of open urachus, and
extraction of calculus through umbilicus, 1011
*::: RD, M.M., cases of lithotomy and lithotrity,
6
Pancreas, Dr. J. Kilgour's, case of abscess of,
I § ; Dr. W. T. Gairdner's case of atrophy of,
1100
PANUM, Dr., on casein in blood, 685
Paracentesis of cranium, Dr. F. Battersby on,
782; of chest, chronic empyema cured by, 887
Paralysis attending dentition, Dr. Fliess on, 51;
of facial nerves in children, 1181
INDEX.
tº 1205
Parasitic animals, Dr. Thomas Smith on Tur-
pentine as a remedy for, 342 -
Parietal bone, epilepsy coincident with exostosis
of, 389
Parisian hospitals for the insane, statistics of,
for 1849, 505
PARKER, Mr. Langston, on the Treatment of
Syphilis, rev., 663 - -
PARKEs, Dr. E. A., case of enlargement of spleen,
with unusual number of white corpuscles in
blood, 691; his edition of Dr. A. T. Thomson's
work on the Skin, rev., 842
Pºmas, Dr., on chloroform in hydrophobia,
98.
Paroxysmal seizures, Dr. M. Hall's table of, JO70
PATE Rson, Dr. G., dinner to, 214
Pauper population of London, Dr. Webster on
mortality among, 544, 1121
PEAcock, Dr., case of idiopathic tetanus success-
fully treated, 16; cases of hydatids of liver,903
PEDDIE, Dr., case of chronic empyema cured by
paracentesis, 887
Pelvis, case of deformed, 1084; injury of during
pregnancy, 1093 -
PENNELI, Dr. C., case of artificial anus, 905
Peptic, Dr. S. Alison on tannic acid as a, 5
Percussion combined with auscultation, 1182
PEREIRA, Dr., on kousso, 896
Perforation of stomachin diabetes, Dr. Macintyre
on, 353; case of, with disease of arteries and
kidneys, 597 -
Perimeal incision, Mr. Syme on, rev., 35 ; Mr.
Henry Smith on, 304; Mr. Syme on, 573
Perineum, influence of chloroform on laceration
of, 1079; case of abscess of 1106
Peritoneal bands, a cause of intestinal obstruc-
tion, 993
Peritomitis, with muco-enteritis and perforation
of intestine, Dr. A. Knox's case of, 473; cases
of, in children in the hospital at Stuttgart,496;
puerperal, turpentine in, 344
Pertussis, Dr. Thomas Smith on turpentine in,
346; M. Debreyne on belladonna in, 386
PETREQUIN, M., on black cataract, 799
Pharyngeal polypi, M. Langenbeck's operation
for, 804
PHILLIPs, Mr. B., on ovariotomy, 1187
Phlebitis, Mr. Henry Lee on the causes, conse.
quences, and treatment of, 217, 613; case of,
with cancer of mediastinum, 996
Phosphates in urine, Dr. Bence Jones on, 962
Phthisis, Dr. S. Alison on tannic acid in, 3, 4, 6;
Report of Hospital for, rev., 37; influence of
sex on, 37; of age, 37; of social condition, 37;
of trade and occupation, 37; of hereditary pre-
disposition, 37; capacity of lungs in, 39;
haemoptysis in, 41 ; duration of 42 ; results of
treatment of, 42; treatment of, 43; naphtha
in, 44; iron in, 44; cod-liver oil in, 44, 119;
gallic acid in, 45; Report by Dr. Walshe on,
rev., 46; Dr. Cotton's Clinical Lectures on,
rev., 46; Dr. Turnbull on curability of, 105;
pathology of, 105; evidences of curability of,
107, 121 ; symptoms of, l l l ; emphysema anta-
gonistic to, 113; treatment of,116; mercury in,
118; iodine in, 118; alkalies in, 1.19; Dr. Hull
on, rev., 139; Dr. Thomas Smith on turpentine
in, 338; Dr. Gardner on, rev., 664; Dr. C.
Holland on Cure of, rev.,849,1171; prolonged
expiratory murmur a sign of, 1013; tannin in,
Dr. Cummings on, 1069; climate of Dartmoor
in, 1072; Dr. Hutchinson on diagnosis of,
1075; and pregnancy, M. Grisolle on mutual
influence of, 382
Physic, old writings on the Practice of, rev., 553
Physicians in England, sources of diplomas of,
309; and apothecaries, relative position of, 553;
dispensing of drugs by, 558
PILCHF. R, Mr. G., on affections simulating cho-
rea, 1090 -
Placental murmur, Dr. Cazeaux on the cause
of, 576
Plagiarisms, foreign, 405
Plethora, in connexion with heart-disease, Dr,
C. J. B. Williams on, 317,465 +-
Pºpneumonia in children, Dr. Elsåsser on
Plum-stone passed through umbilicus, 301
Pneumogastric nerve, M. Longeton, 181
Pneumonia, mucous, of young children, M.
Duclos on, 284; as a complication of fever,
| 102; Dr. Kennedy on amount of respiration
in, 1107; in children, 1175; Dr. Redtenbacher
on urine in, 1179 -
Pneumothorax, Dr. Robertson's case of, 1095
Po LAK, Dr., on complication, sequelae, and me.
tastases of cholera, 997 -
Polypus, uterine, Dr. H. Bennet on inflammation
of cervix accompanying, 158; Langenbeck
on ligature of, 704; Dr. Simpson on treatment
of, 707; pharyngeal, Langenbeck's operation
for removal of,804; of rectum in children, l l 85
Pº, Dr. J., on poisoning by brassica napus
Posterior communicating artery, Dr. Hare's case
of aneurism of, 824
Posture, effect of on the pulse, 1064
Potash, liquor of, effect of on acidity of urine,
960; tartrate of, effect on acidity of urine, ibid.;
acetate of, in diseases of the skin, 872; effect
of on urine, 875
Pº fusa, Dr. H. Bennet on, 168; cum calce,
Żë)20.
Powe R, Dr. J. H., his edition of Flood on the
Arteries, rev., 142
PoysER, Mr., case of carbuncle by, 378; on dif-
ficulties of diagnosis, 730
Pregnancy, influence of on epilepsy, 87; antago-
mism of to phthisis, Dr. Turnbull on, 115; M.
Grisolle on, 382; Dr. Bennet on inflammation
and ulceration of cervix uteri during, 153;
Dr. Cazeaux on murmur heard during, 576
catalogue of papers on diseases of, 857
Pressure in conical cornea, Mr. White Cooper
on, 533; in hydrocephalus, 785
Principles of Surgery, Professor Miller's, rev.,
852; Mr. Orr's, rev., 969 -
Prisons, Dr. Webster on mortality in, l l 21
Procreative power, Dr. Routh on, 240
Prolapsus ani, tannic acid in, 4
Prostate, carcinoma of detected by the micro-
scope, 300
Prostitutes, Dr. Hassing on Colic of, rev., 756
Provident Dispensaries, Mr. H. L. Smith on,
368; first meeting of society for establishment
of, 808
Provincial Medical and Surgical Association,
anniversary meeting of, 909
Pºsis, tannic acid in, 5; acetate of potash in,
7
Psychology, catalogue of papers on, 978
Ptosis, hysterical, Mr Canton's case of, 199
Pulse, Dr. Guy on, rev., 1063; effect of age on fre-
quency of, 1064; of sex, 1064; of posture, 1064;
of exercise, 1065; of the time of day, 1065; of
rest, 1065; of sleep, food, and temperature,
1065; intermission of, 1065
Purgative, oil of turpentine as a, 327
Purging flax, Dr. Butler Lane on, 1010
Purpura haemorrhagica, turpentine in, Dr. Thos.
Smith on, 337; Dr. W. Budd on, 998
Purulent infection, Mr. Henry Lee on, 217,613;
Dr. Skoda on, as a cause of puerperal fever,
700; Langenbeck on production of after liga-
ture of polypi, 704
Pus, effects of on the coagulation of blood, and
when introduced into veins, 217, et seq.; 613,
et seq.; in urine, Mr. Colles on, 895
Quack pill-makers not protected by law, 404
QUAIN, Mr., case of urethrotomy by, 62
Dr. Hichard, on fatty disease of the heart,
705; on the stethometer, 923
1206
INDEX.
Quinidine, Winckler on, 29
Quinine, alkali from Kliaya Senegalensis a sub-
stitute for, 400
IABOURDIN, M., on preparation of atropine by
chloroform, 1086
RADc LIFFE, Dr. C. B., on the Unity of Nature,
rev, 752
RADLEY, Dr., on Dartmoor as a residence for
consumptive patients, 1072
Rational Medicine, Dr. A. Wood on, rev., 272
RAU, Dr.W., on medical treatment of cataract,802
REcAMIER, M., case of ovaritis with erectile en-
gorgement of cervix uteri, 350
Rectum, malignant disease of, 297 ; stricture of,
905; polypus of, in children, 1.185
RED FERN, Dr., on Anormal Nutrition in Articu-
lar Cartilage, rev., 568
Redness of skin in entrance of air into veins, 947
REDT 1 NBACHER, Dr., on the urine in prleumo-
nia, 1179
REEs, Dr. G. Owen, on Diseases of the Kidney
connected with Albuminous Urine, rev., 565;
appointed Lettsomian Lecturer to the Medical
Society of London, 1089
Regulations of Examining Bodies in London,
rev., 651 -
REICHENBAcH, Baron von,on Magnetism, rev.,833
REID, Dr. Joseph, on opium in strangulated
hermia of infants, 894
Remuneration of medical witnesses at quarter-
sessions, 404
Reproductive function, catalogue of papers on
diseases of, 856; on physiology of, 973
Reptiles, cedron a remedy for bites of, 1085
Respiration, catalogue of papers on diseases of
organs of, 675 ; papers on anatomy and physi-
ology of, 972
Retention of urine, case of by Dr. Benson, 1103
Retina, Mr. H. Gray on development of, 980
RETZIUs, Professor, on the structure of the liver,
47
Revaccination, Dr. A. Knox on, 1137, 1140, 1159
Rheumatic disease of ear, 55
Rheumatism, Dr. Garrod on connexion of with
gout,583; Dr. Begbie on connexion of erythema
nodosum with, 774 ; ether enemata in, 1180
Ricinus communis, galactagogue and emmena-
gogue properties of leaves of, 951, 1085
Rickets, Dr. S. Alison on tannic acid in, 5;
TIcord, M., his treatment of chancres, 605; of
vesical catarrh, 606; of stricture, 606
Rigor mortis, long delay of after death from
cholera, 891
RIVALLIER, M., on cauterization with solidified
nitric acid, 74
Rob ERTson, Dr. W., case of pneumothorax, 1095
IROBINs, Mr., extraction of a tooth with Mr.
Gilbert's fulcrum, 574
Bog EE, M., on transformation of tubercle, 109
Rog ER, M., on combination of auscultation with
percussion, 1182
RoKITANsky, Professor, on intra-cranial osteo-
phytes during pregnancy, 92
Romih ERG, Professor, on facial paralysis in chil-
dren, 1181
Rose, Professor H., on the oxidation of organic
bodies, 966
RouTH, Dr., on renal disease as a cause of puer-
peral convulsions, 96; on procreative power,
240; case of foreign body in obsophagus simu-
lating cerebral disease, 582
RUMLEY, Mr., case of abscess in perineum, 1106
SACH's, Dr., on chloroform in midwifery, 1071
Sailors, Dr. Webster on mortality among, 1120
Salaam convulsions, Dr. Faber's case of, 569;
Dr. Willshire on, 590
Saline treatment of cholera, Dr. Bushman on, 966
Salivary calculus, case of, 1100
Salpêtrière, statistics of the, for 1849, 505
SANNEMANN, Mr., case of Caesarean section, 1084
SARTI, Signor, death of, l l 13
Scarlatina, Dr. James Miller on Pathology of the
Kidney in, rev., 276; Dr Hale's case of ulcera-
tion of cervical veins after, 720; Dr. Schnee-
mann on cutaneous inunction in, 865; Drs.
Barnes and Cormack on vaginitis in, 869
SCHNEEMANN, Dr., on the treatment of scarlet
fever by cutaneous inunction, 865
Sclerosis of skin in children, 1173
SC HUH, Professor, case of entrance of air into
a vein, 936 -
Scott, Dr. John, on affections of the larynx, 1099
Scrofula in bone, Mr. Stanley on, 492
SEATON, Dr. E. C., case of softening of spinal
cord, 1030
Secretions, how affected by pressure of blood,
644; catalogue of diseases of, 666
Sedatives in heart-disease, Dr. C. J. B. Williams
on, 462
SEDILLOT, M., his plagiarism of Mr. Fergusson's
operation for staphyloraphy, 405
Seizures, paroxysmal, Dr. M. Hall's table of 1070
SEI, KIRK, Dr., on chloroform in delirium tre-
mens, 988; in traumatic tetanus, 991
Sermicircular canals, development of membranous
lining of, 985 -
SEMMELWEIs, Dr., experiments on the cause of
puerperal fever, 700
SEMPLE, Dr., on diseases of the mervous system,
448, 811 ; on valvular diseases of the heart,
1019, 1090
Serous membranes, how affected by purulent in-
fection, 621
Sex, influence of on phthisis, 37; on pulse, 1064
SHARP, Mr., case of intestinal concretions, 1093
Shoulder joint, peculiar injury of, 1194
SIBson, Dr., on the detection of adhesions in
ovarian dropsy,83; on the falling in of the chest
during inspiration, 83
Silver, nitrate of, in erysipelas, 57, 58, 191; in
inflammation of cervix uteri, 167; as a local
application in conical cornea, 536; in encysted
tumour of labium, 1007; method of applying
to larynx, 1075
— oxyde of, in tape-worm, 880
SIMPson, Dr. J.Y., on ligature of uterine polypi,
707; case of entrance of air into uterine veins,
946; on scarlatinoid rash after entrance of air
into veins, 947; case of tubercle of uterus, 1094;
on eruptions of cervix uteri, 1097
Sinus, longitudinal, osteophytes in, 298
SK KY, Mr., his Hunterian Oration, rev., 479
Skin, tannic acid in diseases of, 5; affected by
purulent infection, 620; cases of mortification
of, 63 l ; catalogue of papers on diseases of,668;
Dr. A. T. Thomson on Diseases of, rev., 872;
Mr. Hunt on Diseases of, rev., 855; Dr Easton
on acetate of potash in diseases of, 872; sclero-
sis of, in children, 1173
SKopa, Dr., on the causes of puerperal fever, 700
SLoMAN, Mr. S. G., on chloroform in tetanus, 991
Small-pox, valvular malformation of heart in a
man dying of, 598; Dr. A. Knox on vaccination
as a preventive of, 1037, 1134; history of, 1037;
inoculated form of, 1039; modified, 1135. See
Vaccination.
SMITH, Dr. G., on chloroform in hydrophobia,989
Mr. Henry, case of caries of head of
femur, 296; on the perineal incision, 304
— Mr. H.L., on Provident Dispensaries, 368
Dr. R. W., on disjunction of the epiphy-
sis of humerus, 389; on early operation for
hare-lip, 1110
Dr. Thomas, on the therapeutical uses
of terebinthinate medicines, 321
Dr. Tyler, case of long umbilical cord,
199; on stimulant enemata in abortion, 305;
on ulceration of cervix uteri, 592; on the galac-
tagogue and emmenagogue effects of the leaves
of the castor.oil plant, 951
INDEX.
1207
S.Now, Dr., method of detecting chloroform in
blood, 602
Social condition, influence of on phthisis, 37
Society, Royal Medical and Chirurgical, reports
of 78, 195, 294, 501, 705, 903, 1011, 1186 ; anni-
versary meeting of, 503; new bye-laws of, 504;
office-bearers, 505; Transactions of, rev., 24;
Charter, Bye-laws, and Catálogue, rev., 177;
remarks on election of office-bearers at, 306;
pºsed change in the Berners-street house,
01
Westminster Medical, reports of,81, 199,
296, 582; union of with London Medical So-
ciety, 214, 1014; election of officers at, 306,
697; termination of, 608
— Medical of London, approaching session
of, 1014, l l l l ; reports of, 1089, 1188
Western Medical and Surgical, anni-
versary meeting of, 608
Tºgog Epidemiological, first public meeting of,
for the formation of Provident Dispen-
saries, first public meeting of, 907
— Medico-Chirurgical of Edinburgh, re-
ports of, 707, 1092
— Surgical of Ireland, reports of, 208.
1101, 1190
Softening of brain in children, in the Stuttgart
hospital, 494; Dr. Semple's case of, 81 l ; of
spinal cord, Dr. Madden's case of, 516; Dr.
Semple's case of, 819; Dr. Seaton's case of,
1030; of stomach in children, 11.75
Soldiers, Dr. Webster on mortality among, 1120
Sol LY, Mr., case of ileus and strangulated hernia
in same individual, 1013
SouL.E., M., case of hair-pin in urethra, 293
Spain, medical profession in, 11.12; low circula-
tion of medical journals, 1112
Speculum, Mr. Coxeter's modification of, de-
scribed, 172; Dr. Lee on use of, 905
Speech, loss of, during pregnancy, 1012; in a
case of hemiplegia, 1083
Spermatic cord, haematocele of, 904
Spinal cord, cases of softening of, 10, 13,518,819,
1030; case of disease of, 602
Spirometer, results of observations with, at the
Hospital for consumption, 39
SPIttal, Dr., case of cavity in a lung, 1096
Spleen, changes produced in by purulent infec-
tion, 619; Dr. Parkes on idiopathic enlarge-
ment of, with increase of white corpuscles in
blood, 691; Sir J. Murray on organic electric
action of 1104
Sponge-tents, Dr. J. Y. Simpson on, 707
Spoon ER, Mr. E. O., on vaccine matter, 1134
SPURG IN, Mr. B., on the Provident Dispensary
at Northampton, 374
STANLEY, Mr., on Diseases of the Bones, rev.,489
Staphyloraphy, M. Sédillot's plagiarism of Mr.
Fergusson's operation for, 405
STAPLEton, Dr., on cod-liver oil, 1103
STARK, Dr.. on rupture of crucial ligaments, 11.83
Sterility, Dr. Tilt on, 839; Japanese remedy for,
1083
Sterno-mastoid, case of division of, for wry neck,
1108 *
Sternum, case of absence of, 601
Stethometer, Dr. Richard Quain on, 923
STEwART, Dr. A. P., on Sanitary Economics,
rev., 173
STILLE, Dr, on chloroform in nephritic colic, 989
Stimulants in heart-disease, Dr. C. J. B. Williams
on, 463; cautions regarding use of, 464
Stokes, Dr., on gangrene of the lungs, 886
Stomach, Dr. Macintyre on lesions of, in connec-
tion with diabetes, 353; Dr. Taylor's case of
perforating ulcer of, 597; softening of, in
children, ll 75 wº
Stramonium, symptoms of poisoning by, as dis-
tinguished from alcoholic poisoning, Drs. J.
Bird and H. Giraud on, 426
STREETER, Mr., on epilepsy and puerperal con-
vulsions, 93
Stricture of Urethra, Mr. Syme on, rev,35; Mr.
H. Smith on perineal incision for, 304; with
extravasation of urine, 199; Mr Syme's chal-
lenge concerning perineal incision in, 573; M.
Ricord's treatment of, 606
sº ophthalmia, Mr. Vincent's treatment
OI,
Strychnine in paralysis of bladder, 882
Styptic, Dr. W. Budd on turpentine as a, 998
Subclavian vein, fatal ulceration of branch of, in
scarlatina, 720
Suffocation, Dr. S. Wright on Death from, rev.,753
Sugar in urine, Dr. Bence Jones on, 964
Suicide by puncture of inguinal aneurism, 1097
Sulphates in urine, Dr. Bence Jones on, 961
Sulphur in cholera, Dr. Lorie on, 500
Sulphuric acid, effect of on acidity of urine, 960
Summer-sleep of amphibia, Dr. Haas on, 644
Superior mesenteric artery, aneurism of, 1094
Suppuration of bone, Mr. Stanley on, 490
Supra-renal capsule, tumour of, 1096
Surgery, classified catalogue of papers on, in
British and American journals, 758
Surgical Practice, Mr. Vincent's Observations
on, rev., 376
Swan, Rev. W., on Importance of Medical Mis-
sions, rev., 31
SYME, Professor, letter to the Lord Advocate on
Medical Reform, rev., 26; on Stricture of
Urethra and Fistula in Perinaeo, rev., 35; his
challenge concerning perineal incision, 573;
on excision of tonsils, 1006 ; on intra-abdomi-
mal hermia, 1092; on non-malignant recurrent
tumours, 1094; on anaemia and goitre, 1098;
fatty tumours, ibid.; evulsion of tendons, 1100;
urinary and salivary calculi, ibid.
Synovitis of knee-joint in an infant during denti-
tion, 585
Syphilis, secondary, Mr. L. Parker on Treatment
of, rev., 663
Syphilitic Sarcocele, Mr. Hamilton on, rev., 36;
ulceration of cervix uteri, Dr. H. Bennet on,
161; eruptions, Mr. Hunt on, 11.90
Tannic acid, Dr. Scott Alison on the use and
administration of, in disease, 1 ; Dr. A. J. Cum-
mings on, 1069; history and properties of, 1 ;
physiological and therapeutical effects of, 3; as
an astringent, 3, 1069; a peptic, 4; a histoge-
netic,5; a remedy for heterologous formations,
6; a nervine,8; mode of administration, 8
Tape-worm, Dr. Thomas Smith on turpentine
im, 343; Mr. Whittell on oxide of silver in,
880; Dr. Pereira on kousso in, 896: Dr. Le-
gendre on diagnosis of, 1073; Dr. Wawruch
#% ; M. Martin-Solon on male fern in,
82
Tartar emetic in delirium tremens, Dr. James
Bird on, 433
Tartaric acid, effect of, on acidity of urine, 960
TAYLok, Dr., case of perforating ulcer)of stomach,
Mr. W., on Cutaneous Inunction in
Febrile and other Diseases, rev., 970
Teeth, Mr. Gilbert on the Extraction of, rev.,757
Tendo-Achillis, Mr. De Morgan on section of in
fractures of leg, 78; Mr. Charles Hawkins on,
78; Mr. Erichsen on, 79; Mr. Shaw on, 79
Tetanus, idiopathic, Dr. Peacock's case of, 16;
case of, in an infant, 498; chloroform in, 991
Thermaclin, Dr. A. Toulmin on the, 853
THOMAs, Dr. J. C., on applying nitrate of silver
to the larynx, 1075
Thomson, Dr. A. T., on Diseases of the Skin,
rev., 842; life of,842; his classification of skin-
diseases,845; on constitutional treatment,846;
on treatment of lupus, 847
1208
INHD.EX.
THOMSON, Dr. R. D., on the nature and cause of
cholera, 294
Dr. Spencer, on Temperance and Total
Abstinence, rev., 1058
THQM PSON, Mr. C. R., on obstruction of intesti-
mal canal from peritoneal bands, 993
—— Dr. H., case of successful excision of
elbow joint, 1193
—— Dr. Theophilus, on prolonged expir-
atory murmur as a sign of phthisis, 1013; on
choreic affections, 1092
Throat, scarlatinal affection of, Dr. Schneemann
on treatment of, 867
Thrombus of vulva, case of rupture of,395
THURNAM, Dr., on aneurism of heart, 1.191
Thyroid body, cases of absence of in idiots, 1011
TILT, Dr., on the diagnosis of ovarian dropsy,
83; of the connexion of ovarian and uterine
disease, 347; on Diseases of Menstruation and
Ovarian Inflammation, rev.,839
Toes, case of congenital hypertrophy of, 1109
Tongue, Dr. C. Fleming on a peculiar form of
ºnanon of,882; on a tubercular affection
of, 883
Tonics, Dr. C. J. B. Williams on, in heart-dis-
eases, 453
Tonsil, case of ulceration of,81; excision of, Mr.
Harvey on, rev., 850; Mr. Syme on, 1006
ToULMIN, Dr. A., on Gout, rev., 853
Toxaemia, renal, a cause of puerperal convul-
Sions, Dr. Routh on, 96
Toxicology, catalogue of papers on, 975
TOYNB EE, Mr , his otoscope described, 501; on
the memblana tympani, 773
Trades and pations, influence of, on phthisis,
37
TRAILL, Dr John, case of salivary calculus, l 100
TRAVERs, Mr. B., jun., case of retained menstrual
fluid simulating ovarian dropsy, 82; on vene-
real ulcers not curable by mercury, 200, 207
Trismus in children, Dr. Elsåsser on, 11 74
TROUSSEAU, M, on alum in croup, 187; on in-
fantile diarrhoea and cholera, 187
Truss, Description of Mr. G. R. Dartmell's im-
proved, rev., 563
Tubercle, Dr S. Alison on tannic acid as a
remedy for, 6; pathology of, Dr. Turnbull on,
105; transformation of, 107; Laemmec on, 107;
Louis on, 108; Rogée on, 108; Rokitansky on,
109; Dr. C. J. B. Williams on, 109, l l l ; in-
flºes of pregnancy on, 382; in uterus, 76,
1094
Tubercular affection of tongue, Dr. C. Fleming
OIn
Tuberculosis of brain in a child, case of, 498
TUERCK, Dr. L., on granular corpuscles in the
brain and spinal cord in hemiplegia, 387; in
the optic commissure in amaurosis, 570
TUFNELL, Mr. J., case of cauliflower excrescence
of uterus, 208; of aneurism of heart, 1190
Tumour, vascular, of urethra, 86; fibro-cystic of
uterus, Mr. P. Hewett's case of, 611; non-
malignant recurrent, Mr. Syme on, 1094; of
eye and orbit, Dr. Jacob on, 1101
Tunica vaginalis, case of hydrocele of,904
TURNBULL, Dr. James, on the curability of pul-
monary consumption, 105
TURNER, Mr., on chloroform in puerperal con-
vulsions, 988
Turpentine, oil of, Dr. Thomas Smith on thera-
peutical uses of, 321 ; history of, 322; physical
and chemical properties, and mode of prepara
tion, 323; physiological effects, 324; thera.
peutical effects, 325; as a counter-irritant, 326;
a vermifuge, 326; a purgative, 327; a diuretic,
527; an astringent,328; external use of,329; in
haematemesis, 330; in epistaxis, 334; in haema-
turia, 335; in capillary hamorrhage, 336; in
purpura haemorrhagica,337; Dr. W. Budd on,
998; in haemoptysis, Dr. Smith on, 338; for
parasitic worms, 342; in chronic rheumatism,
343; in flatulent distension of abdomen, 343;

in puerperal convulsions and peritomitis, 344;
in diseases of nervous system, 345; in burns
and sealds, 345; in pertussis, 346
Ulcer, perforating, of stomach, case of, 597
Ulceration of intestines, Dr. James Bird on, 86;
of bone, Mr. Stanley on, 490, of cervix uteri,
relative frequency of, Dr. H. Bennet on, 578;
Dr. Tyler Smith on, 592; Dr. Robert Lee on,905
Umbilical cord, extraordinary º, of an, 1.99
Umbilicus, plum-stone evacuated through an
opening at, 301; case of abscess at, 473; case
of extraction of calculus through, l011; poly.
pous excrescences from in children, 1183
tººkwood's Medical Appointment Book, rev.,
Unity of Nature, Dr. Radcliffe on, rev., 752
University of London, Regulations of, rev., 651
Urachus, open, case of, l011
Urate of animonia in urine, Dr. Bence Jones on,
Urethra, case of vascular tumour of, 86; case of
hair-pin in, 293.; stricture of, Mr. H. Smith
on perimeal incision in, 304; Mr. Syme on, 35,
573; M. Ricord's treatment of, 606; grubs in,
removed by turpentine, 343; peculiar conform.
ation of in a female, 395
Urethrotomy, Mr. Syme on, rev., 35; cases of,
by Mr. Fergusson, 61; by Mr. Quain,62; Mr.
H. Smith on, 304; Mr. Syme's challenge con-
cerning, 573
Uric acid in blood, Dr. Garrod on detection of,
584; Dr. Bence Jones on, 959; in urine, 960
Urimary organs, Mr. Vincent on diseases of,379;
catalogue of papers on diseases of, 769
Urine, case of extravasation of, from stricture,
199; M. Malgaigne's case of retention of after
delivery, 395; albumen in, Dr. Owen Rees on,
5ö5; Dr. B. Jones on, 963; Dr. Easton on
ac.ion of ace ate of potash on, 875; Mr. Colies
on pus in, 895; Dr. Bence Jones on quantity
and acidity of, 960; on oxalate of lime and
sulphates in, 961; on phosphates in, 962;
alkalescence of, 963; 1 elation of to food and
system, 965; retention of 1011, 1103; case of
so-called chylous, 1012; in pneumonia, l 179
Uterus, undersized, Dr. Oldham on, 75; tuber-
cular disease of, 76, 1094; Dr. Lever's case, of
laceration of, 131; Inflammation of, Dr. Henry
Bennet on, rev., 146; inflammation of body of,
151; inflammation and ulceration of neck of,
152, 576, 592; occurring during pregnancy,
153; accompanying polypi, 158; syphilitic
ulceration of neck of, 161; cancer of, I62;
treatment of inflammation of neck, 164; vagi-
mal injections, 164; leeches, 165; Gauterization,
167; cauliflower excrescence of, Mr. Tufnell's
case of, 208; Dr. Johns on 212; Dr. Montgo-
mery on, 213; Dr. Henry Bennet on chloro-
form in painful disease of, 270; Dr. Tilt on
pathological connexion of ovaries with, 347,
839; state of, soon after menstruation, 396;
explosion of cyst of, under cauterization, 581;
mania co-existent with disease of 581 ; en-
trance of air into veins of, Dr. Cormack on,
589 928; case of fibro-cystic tumour of, 611;
vitiated fluids observed in, after child-birth,
638; polypus of, Langenbeck on removal of,
704; Dr. Simpson on, 707; catalogue of papers
on diseases of, 861; gravid, anteversion and
prolapse of, 1084
Vaccination, Dr. Alexander Knox on our know-
ledge concerning, 1037,1134; history of, 1041;
effects of, 1042; evidence in favour of protec-
tive influence of, 1044; tests of efficient per-
formance of, 1 136; proofs of efficacy of, 1138;
causes of failure of 1141; means of obviating
failure of, 115 l; proper mode of performing,
1156; simultaneous with variolous infection,
INDEX.
1209
effects of, 1158; success of repetition of, 1159;
means recommended for promotion of, 1163;
conclusions respecting, ll 64
Vaccine pustule in cow, description of, 1045; in
human subject, 1047
Vagina, adhesions of, after measles, 1.185
Vaginal injections, Dr. Henry Bennet on, 164
Wagin; scarlatinal, Drs. Barnes and Cormack
On,
Valvular disease of heart. See Heart.
WAN DER Con PuT, M., on citrate of iron and
magnesia, 400
WAN HENGEL., M., on real and apparent death
in new-born children, 193
Variola. See Small-pox.
vaccinia. See Cow-pock.
Varix, aneurismal, Mr. Cadge's case of, 126
Weins, Mr. H. Lee on inflammation of, 217,613;
coagulation of blood in, 218; effect of pus on
coagulation in, 218; changes in from presence
of foreign matters, 224; experiments on intro-
duction of pus and other foreign matters into,
231; constitutional symptoms produced by,
617; treatment of, 625; cases of, 63 l ; uterine,
Dr. Cormack on the introduction of air into,
589, 928; of neck, case of fatal ulceration of,
after scarlatina, 720 *
Venereal diseases, Mr. Acton on M. Ricord's
treatment of, 605; ulcers, Mr. B. Travers on,
200, 207; Mr. Acton on, 206 gº
Vermifuge, Dr. Thomas Smith, on turpentine as
a, 326,342; Dr. Pereira on kousso, as a, 896
Vesical catarrh, M. Ricords treatment of, 606,
Vesiculae seminales, case of abstess of, opening
into abdominal cavity, 1013
Veterinary surgeons, education of, 921
VINCENT, Mr., Observations on some parts of
Surgical Practice, rev., 376
Violent deaths, Dr. Webster on, 1120
Volger, M., on structure of flame of candle, 29
Voltaic battery for medical use, Dr. Thomas
Wright on a, 1094 * &
Vomiting, a symptom of purulent infection,618;
in pancreatic disease, 1052
Vulva, M. Wyffel's case of rupture of thrombus
of, during parturition, 395
WALKER, Mr. G.A., proposed testimonial to, 1016
WALLACE, Dr. Clay, on the Adjustment of the
Eye to Distances, rev., 1172 & &
WALLER, Dr., on ether and chloroform in mid-
wifery, 77 tº sº.
WALSHE, Dr., his Reporton Pulmonary Phthisis,
rev., 46; on an auscultatory sign of enlarged
liver, 797 *
WALTon, Mr. Haynes, case of caries of head of
femur, 301; on entropium, 601
WARDELL, Dr., case of death from haemorrhage
into bladder, 586 e g
Warmth, influence of on animal life, 647
Water supplied to London, Dr. A. Hassall's Mi-
croscopic Examination of, rev,493
wºuch, Dr., on the diagnosis of tape-worm,
WEBSTER, Dr., insanity from chloroform durin
labour, 90; on the health of London, 540,111
WED1, ijr. on cryptogamic vegetations in the
hair in favus, 283
Weight, effect of cod-liver oil in increasing, 45,
WEST, Dr., on typhus, typhoid, and infantile re-
mittent fever, 80
Wet blanket, Dr. Peacock's case of successful use
of in tetanus, 16 º
Wet-nurses, Dr. Webster on employment of, 543
WHITE MAN, Mr. R. H., presentation of testimo-
nial to, 309
WHITTELL, Mr. H. T., on oxide of silver in
tape-worm, 880
WHITTLE, Dr. Ewing, on Cholera, rev., 1170
WHITwo RTH, Mr. H. B., on the Provident Dis-
pensary at Northampton, 374
WILLIAMs, Dr. C. J. B., on the prognosis and
treatment of organic diseases of the heart, 31 1,
460; correspondence with a homoeopathist,403;
on the pathology of Bright's disease, 502; on
hydatids in liver, 903
— Dr. E., on a Japanese remedy for
sterility, 1083
WILLSHIRE, Dr., on eclampsia mutans, 590
WILson, Dr. George, on the Sacredness of Medi-
cine, rev., 33
— Dr. J. A., Oratio Harveiana, 733
WIN.cKLER, M., quinidine discovered by, 29
WING, Mr., on epilepsy and puerperal convul-
sions, 94
WINTRICH, Dr., case of entrance of air into ute-
rine veins, 94b
WooD, Dr. A., Rational Medicine, rev., 272
Dr. G., Treatise on the Practice of Medi-
cine, rev., 275
WooDFALL, Dr., case of osteophytes in longitu-
dinal sinus, 298
WoRMs, parasitic, Dr. Thomas Smith on turpen-
time as a remedy for, 326, 342
WRIGHT, Dr. Samuel, on Death from Suffoca-
tion and Syncope, and on Vital and Post-
mortem Burning, rev., 753
— Dr. Thomas, on a voltaic battery for
medical use, 1094
Wry-neck, division of sterno-mastoid muscle in
a case of, li O8
WYFFELs, M., case of rupture of a thrombus of
the vulva during parturition, 395
YEARsley, Mr., on Deafness, rev., 1067
Zinc, acetate of, as an application in conical
cornea, 537; chloride of, case of poisoning by,
1011
1210
ILLUSTRATIONS.
Mr. I. B. Brown's New Operation for Ovarian Dropsy - - - - - - 203
Conical Cornea. Figs. 1, 2, 3, 4. In Mr. White Cooper's paper - - - - - 410-11
Halo surrounding a Parlour-lamp. Ditto - - - - - - - 412
Rings surrounding Luminous Bodies. Two Figs. Ditto - - - - - - 413
Muscae Wolitantes. Two Figs. Ditto - - - - - - 414
Lower Jaw, and Tooth with Curved Fangs - - - - - - - - - - 575
Appearances produced by Stagnation of Vitiated Blood in Lungs. Coloured Lithograph.
In Mr. H. Lee's paper - - - - - - - - - - - - - 624
The Stethometer. Figs. 1, 2, 3, 4. In Dr. R. Quain's paper - - - - - - - 924-26
2%

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