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THE

LONDON

*

MEDICAL

MONTHLY JOURNAL,

AND

REVIEW.

EDITED BY

DAVID UWINS, M.D. SHIRLEY PALMER, M.D.

AND

SAMUEL FREDERICK GRAY, ESQ.

Quasrere Verum. Horace.

VOL. XIV.

FROM JULY TO DECEMBER, 1820.

LONDON :

* »•

PRINTED FOR THOMAS AND GEORGE UNDERWOOD,

32, FLEET STREET.

1820,

CONTENTS

or

VOLUME XIV.

PART L

COMMUNICATIONS.

PAGE

Tetanus, which terminated fatally ; with an Account of Appearances after Death. By Thomas Brayne, Surgeon, Banbury - - 1

2. Case of Injury of the Head from a Fall. By W. Sho¬

veller, Surgeon, R. N. - - - - 6

3. Remarks at the End of the Journal for the Sybille, 1818 —

1819. By the Same. - - - - 10

4. Case of Fractured Vertebrae. By John Hall - 15

5. On the Principles of Life and Mind. By J. Fosbrooke,

Surgeon - ----- - 17

6. On Colchicum. By Richard Battley, Chemist - 29

7. Observations, with Cases, illustrative of the Salutary Powers of the Colchicum Seed. By William Henry Williams, M.D. F.L.S., Ipswich, Fellow of the Royal

College of Physicians - - - - 89

8. On the Conduct of certain Lecturers. By Graius - 95

9. Case in which Electricity, combined with Oxygen Gas,

proved highly beneficial. By James Price, Henrietta Street, Covent Garden - - - - 101

10. Remarks on Mr. Davies’s Case of Labour prematurely

induced. By Edward Thompson, Whitehaven, Member of the College of Surgeons, London - - 102

11. Case of Laborious Parturition and Foetal Scrofula. By

Radcliffe Wood, Surgeon, &c., Oldham - - 103

12. Obstetrical Researches'. By Maurice Onslow, M.D.

(No. 1.) . 177

13. Two Cases of Puerperal Fever. By W. Gaitskell,

Rotherhithe - - - - - 180

CONTENTS.

PAGE

14. Case of Pulmonary Disease, in which Digitalis proved

decidedly successful. By W. H. Wansbrougii, Surgeon, Fulham - - - -182

15. Report of a Fever which prevailed at the Village of

Taplow, Bucks, in the Autumn and Winter of 1819-20.

With Remarks. By William RoAarts, Burnham, Bucks - - - - - - 186

16. Medical Sketches. By E. Sutleffe, Surgeon, Queen

Street ------ 190

17. Some Remarks on certain Modifications as well as Modes

of Treatment of Spinal Affections. By J. K. Walker, M.D., of Caius College, Cambridge, and Senior Phy¬ sician to the Huddersfield Dispensary - - 192

18. On the Existence of a Syphilitic Virus, over which Mercury

has been supposed to possess a specific Power. By J. Cole, M.D., Surgeon to the Forces - - 268

19. Case of Melancholia, cured by accidental Mercurial Saliva¬

tion ; with some Observations. By G. M. Burrows,

M.D. F.L.S., &c., Gowmr Street - - - 273

20. Case of Petechise. By Isaac Buxton, M.D., &c. &c.

New Broad Street - 279

21. Obstetrical Researches. By Maurice Onslow, M.D.

(No. 2.) - - - - - 283

22. Obstetrical Researches. By the Same. (Nos. 3 and 4.) 353

23. Cases of Diabetes ; with Remarks. By Isaac Buxton,

M.D., New Broad Street - 359

24. Case of Contracted Rectum. Communicated by Henry

Davis, Lecturer on Midwifery, Conduit Street. With Remarks, by Mr. D. - - - - 373

25. Case of a Wound in the Knee communicating with the

Cavity of the Joint. Ey W. Forts, Surgeon, Colchester 380

26. An Account of the Extirpation of a Female Breast, without

the Ligature of a single Artery being necessary. By — - - Kennedy, M.D. , of Dunning - - 381

27. Case of Perforation of the Stomach, Intestines, and

Bladder, by a Gunshot Wound. By Richard Bird,

Jun., Tamworth, Member of the Royal College of Sur¬ geons, London - - 383

28. Note on the Influence of Mercurial Salivation in the Cure

of Insanity. By Shirley Palmer, M.D., Editor of the Foreign Department of this Journal - - 386

CONTENTS.

V

PAGE

29. On Phagedsena Gangrsenosa. By J. Cole, M.D., Surgeon

to the Forces, Albany Hospital, Isle of Wight - 445

30. On the External Application of the Nitric Acid. By

R. Hull, Surgeon, Norwich - 450

31. Case of Hoemorrhoids. By P. C. Blackett, Surgeon

R.N. and M.R.C.S., Park Street - 454

32. Case of Apoplexy. By T. W. Wansbrough, Fulham - 455

33. Case of Concussion of the Brain. By the Same - 461

34. Note by George Parkman, M.D., V.S.A., of Boston, in

compliance with a Request from the Editor of the Repository, Vol. IX. page 353 - 464

35. Some Observations. By W. Philip, M.D. Suggested

by Dr. Scudamore’s Treatise on Mineral Waters - 465

DEPARTMENT OF NATURAL HISTORY, &c. Monthly Calendar of Flora and Fauna 31, 107, 200, 286, 388, 494

PART II.

ANALYTICAL REVIEW.

1. General Review of Medical Literature from

January to July, 1820 - - - - 35

2. Prichard on Epidemic Fever r - - - 36

3. Macleans Systematic Misrule •* - - 41

4. Cooke on Apoplexy - r -- ^ - 110

5. Powell on Ditto - - *• - -115

6. Harrison on Febrile Diseases - - - 119

7. Grattan on the Medical Profession - - - 125

8. Cross on the Variolous Epidemic, &c. - - 202

9. Bingham on Strictures of the Urethra - - - 219

10. Harrison on Chemistry - 229

11. A Toxicological Chart of Mineral, Vegetable, and Animal

Poisons 233

12. Bell on Diseases of the Urethra, &c. - 287

13. Hall on Puerperal Affections - - 299

14. Gregory s Theory and Practice of Physic - - 303

15. Hastings on Bronchitis - - - 312, 389

16. Howship on Intestinal Diseases - - 394, 479

17. Burrows on Insanity * 467

vi CONTENTS.

.PAGE

18. Hennen’s Principles of Military Surgery » - 473

19. Hutchinson on Tic Douloureux - 484

20. Vods on Blood-letting - 487

21. Hutchinson on Infanticide - - - - ib.

22. Carson on the Elasticity of the Lungs - - - 491

23. Macartney on Curvatures of the Spine - - 492

24. Pearson on Psycho-Physiology - - - 493

PART III.

SELECTIONS.

Alison on the Nerves • - - - 50, 150

Phillips on Electricity and Galvanism - 233

Braconnot on the Action of the Sulphuric Acid, &c. - - 319

Proposal of a Mode for passing Calculi from the Bladder, &c. - 398

The Name Calomel? ----- 400

Urea - - - - - - - 495

PART IV.

FOREIGN MEDICAL SCIENCE AND LITERATURE.

Spontaneous Perforation of the Stomach Case of Maxillo-Dentar Neuralgia Periodical Cough cured by Cinchona Case of Boulimia with Hsematemesis

55

56 ib.

57

Medical Topography of the Convent of Mount St. Bernard -

Coincidence of Earthquakes and Yellow Fever of the Antilles

On a Foreign Body introduced into the Intestinal Canal

Asphyxia in an Infant cured - -

Influence of Gravitation in the Animal Economy

Chomel on Idiopathic Fevers -

Le Sage on Ruptured Perineeum -

Researches on Fistula Ani -

Site and Course of Fistula -

Fischer on Lesion of the Heart - .

Croup, Syphilis, &c. -

Select Cases and Memoirs -

Pathology and Practice of Medicine -

Case of Rupture of the Uterus - - -

ib.

ib.

58

59 61

139

143

145

147

149

151

152 155 159

CONTENTS. Vli

PAGE,

Cases of Poisoning by Sulphuric Acid - - - 161

Meissner on Sebadilline - - - - -163

Hodgson's Treatise on Arteries and Veins - - - 165

Segalas' Case of Exhalation of Blood, &c. - - - 239

Georgct’s Case of Hydrocephalus - - - - 241

Cloquet's Case of Fracture of the Pelvis - 242

Larrey on Wounds of the Thorax - 245

Husson on a Caries of the Vertebrse, &c. - 247

Ticker on Tracheal and Bronchial Affections - - 248

Steinruk’s Case of a large Thoracic Aneurism - - 253

ANALYSIS OF JOURNALS.

New Medical Journal for April (French.) - 322

Ditto for May - - - - - - 401

Ditto for June - 496

Bulletins of the Faculty, &c. No. IV. (French.) - - 325

Ditto, No. V. _ 406

Ditto, No. VI. - 498

Hvfeland's Practical Journal for March (German.) - - 326

Ditto April and May - 408

Ditto for June - 500

SELECT CASES, MEMOIRS, &C.

Essay on the Veins of the Spine - 330

Discovery of Two New Vegetable Alkalis - 332

New Spanish Medical Journal - 333

Memoir on Ruptures of the Heart - - - ib.

New Process for detecting Mineral Poisons - - 336

Cases of Softening of the Brain - - - - 411

Memoir on Senile Rupture of the Heart - - - 412

Arteritis — Memoir by Dalbant — Case by Barde - - 417

Pericardiac Dropsy with Spinal Caries ... 420 Recto-Vesical Operation of Lithotomy - - -421

Extraction of Prostatic Calculi - 423

New Process for detecting Mineral Poisons - - ib.

Fatal Poisoning with Opium - 426

Examination of some of the Colchicese— new Alkali Veratrine 427 New Work on Surgical Anatomy - 428

Thesis on Dropsy of the Uterine Ligaments - - 503

New Remedy for Bronchocele (Iodine) - - - 506

New Process for detecting Mineral Poisons - - 509

Vlll

CONTENTS.

PART V.

MEDICAL AND PHYSICAL INTELLIGENCE,

PAGE

Royal Society, Proceedings of - - - 64

Royal Academy of Sciences at Paris, Proceedings of - 65

Linnaean Society, Proceedings of - - ~ 72

Associated Apothecaries, Annual Report from - - 1 67

Various Articles of Medical and Philosophical Intelligence - 73,

339, 429, 438, 511,520 Lying-in Charity, Report from - - - - 81

Literary Notices - - 83, 166, 257, 347, 439, 525

Meteorological Tables for London - 85, 173, 259, 349, 441, 527 Meteorological Tables for Richmond 84, 172, 258, 348, 440, 526 Monthly Register of Diseases, with Observations 86, 173, 260,

350, 442, 528

Monthly Catalogue of Books - 88, 176, 264, 352, 444, 531

Notices to Correspondents - 88, 176, 264, 352, 444, 532

Notices of Lectures - - 255, 347

Prices of Substances employed in Pharmacy - 262, 530

List of Licentiates of the Apothecaries’ Company, &c. - 544

Vaccine National Establishment, Report from - - 517

THE

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>** LONDON MEDICAL

REPOSITORY

No. 79. JULY 1, 1820. Vol. XIV.

PART I.

ORIGINAL COMMUNICATIONS.

Case of Tetanus which terminated fatally ; with an Account of

Appearances after Death. Accompanied by an Engraving .

By Thomas Brayne, Surgeon, Banbury.

The following case and dissection I am disposed to offer for insertion in the pages of the Repository, from the reflection that it is the duty of every member of our Profes¬ sion, who feels interested in its improvement, to contribute whatever he can in promotion of the increasing activity which has been lately manifested in the cultivation of morbid anatomy, the only rational means of deciding upon subjects still involved in obscurity and doubt. Of these, none can be of greater importance than that of tetanus.

Samuel Grigg, set. forty, was thrown, on the 20th of January last, from a restive horse, and dragged for some distance in the stirrup; the consequence of which was a lacerated wound, about the size of the palm of the hand, above the left elbow, just laying bare the tip of the internal condyle of the humerus, but not exposing the joint. He t received also several severe and extensive contusions on , both legs, and on the left hip and side, which bore the marks of most forcible friction along a rough road. There was not the slightest injury of the head, except a trifling ecchymosis under one eye, and a .scratch on the nose. He was perfectly sensible too, when first taken up. The accident happened , about noon, but it was quite evening before he could be vol. xiv. — no. 79. b

2

Original Communications .

made #£ t//i warm , notwithstanding all possible means were tried for that purpose. When the balance of the circulation was again restored, his arm, which had been excessively painful, became easier, and he slept for some hours. On the next day, he expressed himself very comfortable. There was but little febrile excitement, and every thing seemed to go on prosperously until the fifth day, when the wounded elbow was very painful, and the incipient suppuration was suspended. In the early part of the night, however, he obtained some sleep; but on awaking, and attempting to take some tea, he wTas found to swallow with great difficulty : before morning, the jaws were closed, the muscles of the neck had become rigid, and the head was occasionally retracted. Any efforts at deglutition now excited such violent contractions of the pharynx, as almost precluded the exhibition of any thing by the mouth. 1 regret that my notes were not copious enough to give a detailed account of his progress : suffice it to say, in conclusion, that the day was spent in reiterated trials to swallow, with very trifling success, and the wound discharged copiously a thin bloody serum. The pulse, which in the morning had been less than 100, rose to 110, small and quick ; the retractions of the head became more frequent, and the teeth more firmly closed. These symptoms during the next night gradually increased, until death put a period to his sufferings, about two P, M,, on the 27th, little more than seven days from the date of the accident, and about forty hours after the more obvious appearance of the tetanic symptoms. No paralysis or con¬ vulsive affection of the extremities preceded his death. He remained perfectly sensible during the whole course of the disease, and never once complained of the usual concomi¬ tant pain under the xiphoid cartilage.

The rapidity and violence of the symptoms seemed to defy the power of remedy ; and as the treatment affords no novelty, I shall not relate it. I must not, however, refrain from mentioning, that it was observed by the attendants on the third day after the accident, that while drinking he persisted that a hair was in his mouth, and it was long before he could be convinced of the contrary. Once also, on the next day, he was equally desirous of the abstraction of what he conceived to be a piece of string, one end of which, he said, stuck in his throat. It seems to me, that the cause of both these sensations was the commencing partial contrac¬ tions of the pharyngeal muscles ; and from his subsequent ability to swallow with ease, his friends did not report them, i would here take the liberty of suggesting the necessity of regular inquiry into the performance of the action of degiu-

Brayne’s Case of Tetanus . 5

tition, in cases likely to be followed by tetanus; and if any difficulty or irregularity therein be found to exist, we should immediately prepare to institute some active practice.

Twenty-two hours after death the vertebral canal was opened, in the usual manner, from the occiput to the first lumbar vertebra. A very turgid state of the venous system of the spine was observed throughout its whole extent. The spinal chord was removed, and exhibited the following appearances, which I have endeavoured to express in the accompanying drawing more accurately than a verbal description permits. The dura mater was of a deep red colour, in many parts approaching to purple. The pia mater in its whole length was much more vascular than usual, gradually increasing in redness from above down¬ wards; and two or three inches of the inferior dorsal portion were suffused by a continuous blush of inflammation. Tig. 1. represents this inferior half of the chord, and at A and B are seen three small, hard, white laminae, which appeared to be between the arachnoid membrane and pia mater. The part was preserved in spirit; and after it had beenfimmersed some days, a considerable quantity of air insinuated itself beneath the arachnoid coat, which raised the laminated depositions, and upon more minute inspection they seem to be contained in the substance of the arachnoid itself. It is right to observe, that this membrane was pellucid, as usual, and apparently healthy, nowhere thickened ; nor were any vessels to be discovered on its surface.

It is this morbid appearance to which I am particularly anxious to call the attention of my readers, having had occasion once before to notice a similar result in a case of tetanus after compound fracture, at St. Thomas’s Hospital, Southwark, under the care of Mr. Chandler, about two years ago. Several inches of the spinal chord were thickly studded with these laminated depositions, and all the vessels ol the pia mater very turgid and tortuous. Of this f made the drawing, fig. 2., which represents about the middle of the dorsal portion of the spinal marrow ; and I could not refuse myself the gratification of adding it to this paper, for the purpose of comparison with the present example, it did not occur to me, at that time, to examine in which mem¬ brane the laminae were actually formed ; and though every body who saw the preparation, so far as l remember, con¬ sidered them as the result of the inflammatory action of the pia mater, I make no doubt but that they belonged to the arachnoid. The cases are perfectly analogous, and differ only in the degree of this peculiar and uncommon

4

Original Communications •

change of structure, and in the vascularity of the dura mater, which somewhat exceeds in my case.

The specks are apparently of an ossific nature, which I would have ascertained by chemical examination, but I should thereby have spoiled the preparation; and the quantity of them is so small in this instance, that the result might have even then been doubtful. 1 judge them to be of this description from their structure, which, having now been some weeks in spirit, I can plainly discern to be fibrous.

Dr. Baillie, in his Morbid Anatomy, considers diseased appearances of the arachnoid membrane as extremely rare, and almost entirely overlooked by writers. A principal instance with which my limited investigations furnish me, is one mentioned by the celebrated Morgagni, which I will give in his own words. After quoting several authorities in support of the opinion, that certain hard depositions in the pleura and coats of vessels might be inferred to be ossifications from their fibrous structure, he goes on to observe: — -Quantum igitur ad hoc tempus observare potui, non licet mihi cum viris doctissimis facere qui vera ossa in arteriis, potius quam in meningibus, agnoscunt. In his autem non solum intra cranium, sed intra vertebrarum quoque tubum, ibique in ipsa arachnoide , quod nescio an aliis antea acciderit, si non os, at ossis, ut puto, inchoamentum con- spexi. Scilicet in eo sene, cujus pleurae, an membranae adnati pulmonis, quandam partem inveni osseam, ut alia epistola (xxi. n. 22.) ad te scripsi, cum medullas spinalis, in sua sede a tergo retectae integumenta studiosis anatomes demonstrarem, deductaque crassh meninge, tenuem inter et arachnoidem aerem immisissem ; in hac, se totani attolente, particulam auimadverti modici cucurbitae seminis forma et magnitudine, in transversum locatam, albidam, jam fermb opacam, et facie interiore subasperam, ac evidenter inaequalem. Haec lateri sinistro propior, undecimae respondebat thoracis vertebrae ; nec quidquam ejusmodi in caeteris meningibus apparebat. — Epist. xxv. art. 9.

I should not have introduced this long quotation, but for the purpose of showing that these depositions on the spinal membranes are not peculiar to tetanus ; Morgagni having informed us that this person died of a diarrhoea. The principal value of it is, that it corroborates the fact of this morbid state of the arachnoid, which we might, no doubt, more frequentty see, if we were more accustomed to examine the organ in which it occurs.

Histories of tetanus, in which inflammation in the spinal canal has been discovered, are by no means novel. In

Brayne’s Case of Tetanus . 5

an essay by Dr. Reid, in the Transactions of the King and Queen’s College of Physicians of Ireland, some cases are ac¬ companied by an engraving; from which, by means of the description, we may conclude, (for from the former alone it is certainly not very obvious,) that the appearances were very similar to those which are the subject of this paper. In that gentleman’s account it is said, that the white substance effused between the arachnoid coat and pia mater was like medullary matter, and so soft, that it could be wiped off, and not the slightest rupture of the pia mater, or any of its vessels, could be discovered ; thereby proving its inde¬ pendence of that membrane. Now, supposing that these laminated depositions on the arachnoid are the same, or different states of the same effusion ; and since they are found to occur unaccompanied by any tetanic affection, it may, perhaps, not be very unreasonable to conclude, if I may hazard conclusions from the few facts already before us : 1. That the remote cause of tetanus consists in the presence of this morbid state of the arachnoid, which future dissections will probably prove not to be unfrequent; and that those w'ho are so unfortunate as to be the subjects of it, are predisposed to this dreadful sequel of severe injuries. 2. That the proximate cause of tetanus consists in inflammation of the spinal chord and its appendages. 3. That the treatment which promises most success, because founded on more accurate pathology than any other, is the antiphlogistic, early employed, and consisting of copious, general, and local bleeding, blistering the whole length of the spinal column, and the exhibition of the most active purgatives.

Those few cases of tetanus which have recovered under treat¬ ment apparently the reverse of the above, militate nothing, in my opinion, against this theory of the disease; for in some of these it will be found, that purgatives and mercurials were conjoined; and these are among our most powerful remedies for inflammation.

Much laudable attention has been paid by our brethren on the Continent to the contents of the spine in different diseases. Some of their cases of tetanus, considered to depend on inflammation of the spine, are already before the public ; and their antiphlogistic treatment has more than once proved successful.

Here 1 might well terminate this imperfect sketch; but as I hold the foreknowledge of mischief more important than its cure, I shall subjoin another observation. It will be remem¬ bered, that, in the relation of my case, I have particularly noted the difficulty encountered in restoring the patient from the extreme coldness and collapse which immediately sue-

6 Original Communications.

ceeded to the accident. It seems to me not improbable, that the internal congestions, which must necessarily accompany such a state, laid the foundation of the spinal inflammation to which this individual, from the state of the arachnoid, was so particularly obnoxious, that the establishment of tetanus became inevitable. Such a circumstance, whether this ex¬ planation be correct or not, might always serve to excite our vigilance; and though I may be thought to have carried the doctrine of anticipation rather too far, yet I must contend, that there would be at least as much satisfaction in being able to say, that the worst of injuries under our care had never been followed by tetanus, as that, when formed, it had yielded to our efforts.

The liberal use of emetic tartar, as recommended by certain continental waiters, and particularly at the period when we have received a warning by attending to the action of deglutition, as before mentioned, seems to me well worthy of a trial ; and afterwards, the employment of the more powerful method of depletion, in proportion to the progress of the symptoms. In no case of the wffiole noso¬ logical catalogue is it of more consequence to bear in mind the salutary maxim of the poet,

a Principiis obsta, sero medicina paratur Cum mala per longas invaluere moras.7’

II.

Case of Injury of the Head from a Fall . By W. Shoveller,

Surgeon R. N., H. M. Ship Sybille, at Sea. January 7,

1818.

Charles Williams, seaman, aet. twenty-one, fell, between twelve and one o’clock last night, from the mizen-top, in his fall struck against the boat’s topping-lift, and dropt to the quarter deck. The noise made by the fall was so considerable, as to disturb the admiral and his family, who imagined that one of the ship’s guns had been fired. The captain also, and most of the gun-room officers, with myself, were awakened by it under a similar impression.

When brought below he was quite insensible, and groaned, as if suffering from extreme pain. Some contusions were discovc.ed on the right shoulder and thigh. On shaving the head, the integuments over the lower and anterior part of the right parietal bone were found discoloured aud slightly tumefied.

Twenty ounces of blood were detracted from the arm, and

I

Shoveller’s Case of Injury of the Head . 7

the pulse rising shortly afterwards, twelve ounces more were obtained from the temporal artery.

Habeat Bol. ex. Hydr. Subm. et Pulv. Jalap, et injiciat

Enema purgan. Appl. frigid, capiti.

Had a passage in the bowels at four this morning. Pulse was moderatelv full, and rather slow in its beat.

At eight A. M. — When roused, answers questions inco¬ herently. Pulse more natural; skin moist; pupils contract on exposure to light.

Rept. Bol. Cathart. et v. s. e brachio ad Ifoi.

Deliquium supervened.

At eleven A. M. — Bowels unmoved.

Habeat Sol. Magnes. Sulph. 4ta quaque hora.

At two P. M. - — No operation. Vomits after taking his medicine.

Omitt. Sol. Magnes. Sulph. et sumat Pilul. ex Hydr.

Subm. gr. ij. cum Extract. Colocynth. 3tia qu&que hori, donee

alvus seepe respond.

Six P. M. — Pyrexia, with increased stupor. An incision made through the contused integuments. No cranial injury discovered. About three ounces of blood were lost by dividing a branch of the temporal artery.

Eight P. M. — Stupor and drowsiness continue. Pulse 90, and firm.

Detrah. sanguin. ^xx. ex arteria temporali. Repetat. Enema

purgans.

A second incision made through the scalp, crossing the former, and the bone denuded. No marks of fracture or fissure.

The 8th, at eleven A. M. — Symptoms as last evening. No passage in the bowels since yesterday morning. Injec¬ tions continued, and a large blister laid over the occiput and nape of the neck.

At one P. M. — Pulse 100, and full; stomach irritable; general convulsive tremors.

Mitt, sanguin. h brach. ad R>i. et posted habeat Hydr.

Subm. gr. x. Gum. Gambog. gr. ij.

He sunk considerably after the bleeding. Pulse now (four P. M.) risen in strength and frequency, (120): lies in a comatose state ; eyes glassy ; face pallid ; lias passed a large quantity of faeces in his bed.

At eight in the evening. — Skin hot and constricted ; face a little flushed; pulse 94, and rather firm; the convulsive paroxysms more general, frequent, and severe, and similar to

8

Original Communications «

those of epilepsy, but the struggles less violent ; the frothing at the mouth considerable ; stomach more retentive,

Habeat Mist. Salin. cum iEther. Nitros. quaque bora, et, repet. v. s. ad ^xxiv.

The 9th, at six A. M. — Some mitigation of urgent symptoms after the detraction of blood last evening. The blister operated partially. The whole of the forehead ex¬ hibits a puffy, colourless swelling, extending from the wound.

Vespere. — Alvine discharges frequent and involuntary; soporific disposition continues ; pulse 100, and small ; sur¬ face somewhat below natural temperature ; extremities cold ; considerable thirst.

Ilabeat Mist. Camphorat. cum iEther, Vitriol, tertia quaque bora, et bibat pro potu ordin. Solutio. Potass. Supertart.

10th, mane. — Is rational at intervals. Involuntary ex¬ cretions continue. The organs of speech are paralyzed, but he makes signs to the nurse when in want of any thing. Ate some bread soaked in tea this morning. Pulse varies in strength and frequency, ranging from 90 to 100 in a minute. The tremors less frequent during the night, and he had some rest at intervals.

Con. Med. adde Tinct. Opii, gr. viij. sing, dos.

Vespere. — Has had several convulsive paroxysms since this morning's report. The spasmodic retractions of the lips, angles of the mouth, and alae nasi, are much ‘increased in strength and violence; when the eyes are fixed, the jaw agitated, he moans much, and foams at the mouth. These fits last for an hour or more each time, and on terminating, a copious salivary discharge takes place.

Ilab. Haust. Anodyn. h. s. et rep. p. r. n.

The 11th, mane. — The paroxysms recurred about mid¬ night; the spasms of the face and neck more especially became so violent, that his death was every moment ex¬ pected ; the surface was cold and damp ; and the pulse at the wrist hardly to be felt.

His medicine was repeated at short intervals, with large doses of the tinct. opi., which procured some natural sleep towards morning.

Vespere. — Pulse SO, and full; skin hot and dry; the blistered surface discharges freely, and the wound in the head healing rapidly; the muscles inserted in the lower jaw continue, at intervals, to be much affected with severe spasmodic twitches, in the absence of which he is more rational.

Omitt. Jalap. Camphorat. et sumat. Haust. Salin. cum Liquor.

Ant. d art. 4ta quaque hora.

9

Shoveller's Case of Injury of the Head.

12th. - — Slept well the early part of the night ; a recurrence of the spasms towards morning, but less violent and shorter in duration ; skin now of a natural temperature.

Con. Med.

13th. — Passed a restless night from frequent returns of spasm and general tremors. Has had several involuntary stools.

Resumantur Mist. Camph. ^Ether. Vit. et Opii.

14th, mane. — Has had a more tranquil night; intellect less disturbed; countenance more cheerful; uses the bed-pan. Con. Med.

He is supplied with nutritious soups, &c. from the5 admiral’s table.

lath, mane. — Had some sound sleep in the night. The spasms recurred early this morning with great violence. Was relieved by large and repeated doses of the tinct. opii. Appears rational this morning, and continues to make signs to denote his wants.

v

Repet. Mist. Camph. cum /Ether. Vitriol, et Tinct. Opii, p. r. n.

One P. M. — A severe paroxysm, lasting nearly an hour. He has never had the power of putting his tongue beyond his teeth since the accident. Bowels regular.

1 6th. — Frequent returns of spasm in the night. His anodyne draughts procured some rest towards morning; skin natural ; pulse 90.

17th. — Four fits during the night ; slept in the intervals. Has some appetite this morning.

Con. Med.

Vespere. — Several paroxysms during the day,

18th. — Four returns in the night. Slept towards morn¬ ing. The pulse is small and rapid during the spasmodic fits. His face of a purple colour; neck swollen; and the veins dark and turgid. He has made several attempts to speak this morning, in order to make known his wants, and describe his feelings, but without effect, not having the power to articulate his words. His manner and tone on these occasions is similar to that of a dumb person.

At one P. M. he surprised the nurse, by getting out of his hammock, and walking across his screened birth unassisted.

The 19th, mane. — Slept a great part of the night. Some return of spasm this morning, but less severe, and chiefly confined to the face and neck. Appetite improving.

Con. Med.

VOL. Xiv. — No. 79. C

10

Original Communications .

20th.- — lias had a good night. Last evening and this morning passed some purulent matter with his stools, un¬ attended with abdominal pain or uneasiness.

The 21st and 22d.- — A general improvement. Slight pains and spasms of the muscles of the face and lower jaw have recurred at long intervals. He can now articulate a few words, just sufficient to be understood, and put his tongue outside his mouth, when its motion is tremulous, and instantly returned, as if retracted by spasm.

23d. — Sound sleep during the night. No return of pain or spasm. Appetite for food voracious. A small quantity of matter is still discovered in his fecal discharges. His behaviour is marked with a degree of fatuity.

26th. — Great amendment, bodily and mentally. He appears to have no recollection of his sufferings. Bowels regular; the mixture of pus disappeared. His utterance more distinct.

February 7th. — The wound in the head not entirely closed ; in other respects he is perfectly recovered.

This patient was discharged into the admiral’s tender in the following month. I saw him six months afterwards in perfect health, when he had not experienced the slightest return of headach, vertigo, or spasm.

III.

Remarks at the End of the Journal for the Syhille , between 2Qih Oct. 1818, and 2c2d June 1819- By W. Shoveller, R.N.

- —4S*— - - -

Abstract , as follows :

Remitting Fevers » * • * • . • •

Fluxes . . ......

Ulcers »•••••••••»• .»o®.

Wounds and Accidents •• • • Rheumatism* ........ < . . *

Pulmonic Inflammation Intermittent Fever .......

Hepatitis ...... .........

Impaired Vision .... . . . » •

Other Complaints ........

On the line. Duty. Hospital.

® *302* • * *£)5. • • *198® • ®« 10®..® 9 » ® ° * o*.

• . 20® • * *20. • • ® 0** » • 0 * »

* * 2 • - • • 2 • • • • 0"® • • 13*®.° 9 ® • • • 2*®

a » 1 ® • » • !»»»• 0 ® ®

. « 2 ® * ® * 1 • * * • 0®*

.. 1 » • » » Q..o. 0®®

.. 8 ® ® ® • 8 ° • ® 0®®

Died. Invalid.

» . Q » « . . 0

. ®0 - 1

• . 0 .... 0

«o0. ...Q

..0....Q

• * 0 ® • • * 2 1 8 Q • 9 » e 0

• »0«. 9 8 |

• »0* a * • i »«0®.»*O

Total . . 369 1 55 200

Until the latter part of October, when this journal commences, our ship’s company had enjoyed almost an entire exemption from disease, saving on her first arrival in

11

Shoveller’s Remarks on Journal for the Syhille .

the country, in February 1818, when upwards of thirty men, who had been working in the naval yard, were attacked with fever: the whole, however, recovered at the hospital, then under my care.

It will be seen that some febrile cases occurred (one fatal) in the beginning of January last, during our passage from. Vera Cruz to Port Royal, and that the attacks were almost daily continued while we remained in port, twenty-seven cases having been sent to the hospital.

On sailing again for Vera Cruz, February 19th, twenty patients returned to the ship in a state of debility, for the purpose of accelerating their recovery. On the following day three men and two boys were attacked with fever, (not from the convalescents), and the month closed with the addition of nine more cases, and one of dysentery.

In March, fifty more with fever were added to the list, the seizures sparing us only nine days (between the 4th and 29th); and from the 1st of April to our return to Port Royal on the 19th, we were only exempted two days from fresh attacks, which had now in all amounted to 112 cases of fever, one of dysentery, and one of pneumonia.

Six of the convalescents received from the hospital re¬ lapsed, and six others had secondary attacks, all included in the above number.

The state of the sick list, on anchoring late in the afternoon, was eight with fever, fifteen under ptyalism and debility, and twenty-three convalescents. Those with fever and debility were sent immediately to the hospital : convalescents recovered on board.

Eight patients died on board of fever, between the IQth of February and the 19th of April following. The first lost case was a relapse, and terminated on the twelfth * day from attack; the others in the following order, — *3d, 5th, 4th, 6th, 4th, 5th, and 7th days. The disease, in the beginning of March, assumed a more aggravated form ; the prostration of strength became more considerable and sudden, the aching of the back, loins, and limbs more acute, and in some cases maniacal symptoms were exhibited ; in short, com¬ mencing and terminating with the whole train of symptoms described by medical authors as constituting the bilious remittent, or concentrated endemic, of this country.

In seeking for the rerpote cause of this fever, I am not aware that its rise and progress can be well accounted for, unless there was a hidden tendency to disease in many of the ship’s company, from some irregularity arpl intemperance committed by them a few weeks previous to Captain Popham’s taking the command of the Syhille, in the middle

1& Original Communications.

pf April, when twenty-four hours’ leave had been granted to certain numbers daily to visit the shore, where liquor can be procured at a small rate, and the consequent scenes of drunkenness and careless exposure ensued.

Yet it is to be observed, that no description of persons have been proof against the disease; the middle-aged and young, temperate and intemperate, the lean habit and the plethoric, those most exposed to the rays of the sun and the reverse of such exposure; all have been liable to its influence.

Up to the of June, when the fever had almost entirely disappeared, nearly the whole of the officers and men had felt its effects, the only exceptions being the captain, first lieutenant, and about ten or twelve men. Not more than two cases could be traced to the period of drunkenness t both proved fatal.

That no derangement of constitution could have arisen from a foul state of the ship’s hold, appears certain, from the examination which took place immediately on our going into port. A complete clearance was made down to the kelson, where not the least offensive matter was to be found, nor any vapours perceptibly mephitic. No complaints were made by the men thus employed.

Three seamen, and eleven marines, selected to act as nurses to the sick, were attacked with fever in succession : one of the latter died. By this time the patients wrere unavoidably crowded, notwithstanding the whole of the half¬ deck, and the main-deck under the gangways, was occupied by them; the fore part of the captain’s cabin also for the officers. Great pains were bestowed in cleanliness and ventilation.

Mr. M‘Lean, assistant Surgeon, and Messrs. Somerville and Clunes, supernumerary assistants, were also sufferers from their close attentions. The former gentleman had three attacks in quick succession, the last very severe, and sudden, whilst bleeding one of the patients. 'The icteritious colour of the skin continued on him when I left the country in the latter part of June. The disorder was actively increasing, and becoming more formidable, just before and at the time of our arrival at Port Royal ; but the subsequent seizures were generally of a milder form. There would seem, then, to have been a tendency to propagation within the range of the sick apartments, where the air was vitiated and offensive, in spite of every precaution to. render it otherwise. 1 had often experienced, after some length of confinement with the patients, a sudden dull sensation and giddiness in the head, accompanied with lassitude and weakness; but its duration was shortened by going into the open air. The assistant

Shoveller’s Remarks on Journal for the Sybille. 13

Surgeons were similarly affected. It was generally observed, that the odour from the bodies of the sick in a state of per¬ spiration was very unpleasant.

Fear in the nurses might have had some share in predis¬ posing to disease, as in the following instance : — Mr. C - ,

set. 22, had watched a part of the night at the bed-side of one of the young gentlemen, who afterwards died. The next morning he felt indisposed, and the impression on his mind was, that he had taken the disease from his young friend, whose fever had been ushered in with symptoms precisely similar to those he then complained of. He began imme¬ diately to despond, and died on the seventh day. This case, and similar ones occurring afterwards, seemed to mark the close connexion of the mind with the disease ; for, notwith¬ standing the form of fever had subsided after the early depletory measures pursued, so as to lead us to hope for a favourable issue, yet that constant nervous irritation produced by fear shortly destroyed those flattering expectations, by fulfilling the patient’s own dread and apprehension.

The Sybille lay at anchor three weeks near four miles from Vera Cruz, and at a short distance from the small island named Sacrificios, which is sandy and uninhabited. Here the sick were landed, and placed in tents erected for the purpose. Much benefit was derived from it; the increase of patients was for a few days suspended, the people expressed more comfortable feelings from the removal, and those on board were probably thereby freed from alarm.

A malignant fever at this time prevailed at Vera Cruz, which port was shut against us, so that we had no communi¬ cation with its inhabitants. The town is surrounded with a loose sandy soil, which extends from its shores to a consi¬ derable distance in the interior. Vegetable matter is scarce there.

The atmospherical changes in the course of the day were oftentimes very great, Fahrenheit’s thermometer ranging from 70° to 86° ; but we were not aware of its having had any perceptible influence on the disease, either in checking or extending it.

On returning to Port Royal, we found the garrison un¬ healthy ; some of the soldiers there had died of the bilious remittent, which had also visited the Serapis, convalescent ship, recently from England, and having but a small comple¬ ment of men; yet a large proportion of them, with two midshipmen, an assistant Surgeon, and two women, fell victims to the same disease: some of these cases terminated with the black vomit. It would appear, that this fever was connected with the climate, and the state of the season, at

14 Original Communications,

that time unusually dry, and the sea breezes constantly strong and fiery.

The other ships composing the admiral’s squadron were very healthy. From the judicious arrangements of Sir Home Popharn, the vessels were kept almost constantly at sea, not being permitted to remain in port a longer time than was necessary for refitting, receiving provisions, &c. The hospital was consequently thinly occupied with patients. When I was acting Surgeon thereto, it often happened that only two or three chronic cases were within its walls.

The caulkers from the naval yard employed on board the Sybille, eight in number, two of them Europeans, the others men of colour and negroes, were all more or less sufferers from fever. One of the former died. The new raised men also received from different merchant ships, and many of those lent to us from the Serapis, took the disease : some of them died at the hospital.

In my general treatment of fever I have nothing new to offer, having adopted the mode of others esteemed the most successful. Early depletion by the lancet, governed by effects produced, large enemata, cathartics, &c. &c., have been my constant practice, and on every occasion paying strict attention to the state of the egesta.

It has been a general observation, that few patients are lost in inflammatory diseases, where ptyalism has been clearly established. I have never witnessed one fatal termination, where it had been decided!}' raised, when the discharge of saliva was clear and somewhat copious.

In some who died, the gums and lips were covered with thickened saliva, at times oozing from the angles of the mouth ; but this seldom happened until the disease was far advanced, and fatal symptoms approaching.

The dissections show the rapid steps to disorganization, even under early and copious blood-letting, and that the liver in each case was more or less connected with the disorder. Under these impressions, 1 was led to the early use of mercurial frictions in every case of fever, after the first evacuations had been attended to, which in general effected a remission, an interval I was ever anxious to profit by, in throwing the mercury rapidly into the system; a dry hot surface being always unfavourable to its absorption. For this purpose, two men were employed to rub the ointment into a patient, one to each thigh, or other parts, if necessary. At the same time, the exhibition of calomel was not omitted ; but this medicine could not be always depended on, as gastric symptoms often rendered it unavailing. The same inefficacy was at other times occasioned by the irritable

Hall’s Case of Fractured Vertebra. 15

state of the bowels, every thing passing through directly it was taken.

Towards the close of the fatal cases, livid spots were exhi¬ bited, chiefly on the back of the neck and ears. The blistered surface also had a gangrenous appearance, discharging a deep yellow serum.

IV.

Case of Fractured Vertebra. By John Hall.

The following curious case was lately transmitted from the Cape of Good Hope, by Mr. Hal), a very intelligent naval Surgeon. We shall give it in his own words, and without comment.

March 18, 1818. — John Barnes, ret. forty, quarter-master, at six o’clock in the evening jumped from the top of the waist hammocks # into the sea, in order to bathe; a sail having been spread in the water, and on which many of the crew were swimming. Barnes threw himself downwards, head foremost, as others of the crew had done, and did not strike any thing in his descent. He was a middle-sized man, not corpulent, was in good health. He fell into the sail, and lay extended under the water, motionless; his companions seeing this, took hold of him, and conveyed him into the attending boat, at which time he was sensible, but motionless. I examined him, and found him in the following state: — A paralysis of the lower and upper extremities; perfect loss of sensation in the skin ; pain in the cervical vertebrae, especially on motion ; no difficulty or pain in the movements of the head or the neck ; the senses of seeing, hearing, smelling, taste, perfect; the pulse regular. I could not discover any marks of injury on the neck, nor on any other part. The patient could not tell how he came into this state. The pulse and the temperature of the skin were a little lower than natural, in consequence of the submersion; but, after the patient bad been put into bed, the natural condition of these returned; respiration was free, but no (or very little) motion of the ribs. No sensation was felt when the skin of any part of the body below the neck was pinched or pricked.

On the JQtb, in the morning, the skin was hot and dry ; the stomach irritable ; the pulse 88, firm and full; the abdomen tumid; thirst; inability to discharge flatus or urine; no sensation in the bladder on the introduction of a catheter; a

*

A height of six feet from the surface of the sea.

1 6 Original Communications,

cessation of the peristaltic action of the intestines. A slight motion had returned in the muscles of the right arm. During the day, the irritability of the stomach, thirst, and tumefaction of the abdomen, gradually increased, but the temperature of the skin, and vascular action, diminished to a natural state. During this night he slept at intervals, hut was much dis¬ turbed by the thirst, and a vomiting of the liquids taken to allay it.

On the morning of the 20th the urine was extracted ; the symptoms remained as on the day preceding, the thirst and vomiting constantly increasing, as well as the distention of the abdomen. No sooner was a small quantity of fluid swallowed than the stomach spouted it upwards and out of the mouth, by a single convulsive motion ; but so excessively urgent was the thirst, that the patient was continually drinking and spouting. Pressure on the stomach did not produce any sensation. The patient had a clean, moist tongue; a cool, but dry skin; a natural pulse; and no pain in any part except in the neck, and there only on motion. He had an appetite, and ate some sago for his dinner; he was cheerful, and sanguine of a recovery; a slight motion returned in the muscles of the left hand. During this day, more than two gallons of cold water (which he preferred to other fluids) was drunk by spoonsful at a time. In the evening of this day he suddenly became restless, and most importunate for drink ; the pulse began to vacillate, then gradually diminished; and, at the expiration of forty-eight hours from the commencement of this illness, the patient silently expired.

Dissection .- — Intestines much distended with flatus; several patches of inflammation on the cardiac extremity of the stomach, and numerous specks of coagula dispersed on its mucous coat. This organ was much contracted, and con¬ tained a small quantity of fluid like grounds of coflee, some of which had issued from the mouth and nostrils. The rest of the viscera, those of the thorax, and the brain, were all healthy, and no blood vessels were ruptured. On removing the mass of muscles from the posterior part of the cervical vertebrae, a looseness was felt in the bones, and blood was found effused. The vertebra between the second cervical and eighth dorsal were removed, and cleaned, when the following injuries were discovered in the cervical vertebrae : —

Anteriorly. — The body of the fifth separated into two portions horizontally, leaving a .space that admitted the extremity of my little finger between them; the lower portion split perpendicularly in its middle. The bodies of the fifth and fourth separated, and distant half an inch from each other. «

17

Fosbrooke on the Principles of Life and Mind.

Posteriorly. — The spinous process of the fourth forced down on that of the fifth; the oblique processes dislocated partially, and fractured. Fifth vertebra, oblique processes fractured and subluxated ; the left arch fractured in three places, and forced forwards (or inwards), compressing the medulla spinalis nearly flat, and breaking its structure ; the membranes were much thickened and inflamed ; blood was found effused on them. The sixth vertebra was fractured in its left arch.

Note . — If we conceive the head and neck to have been suddenly thrown backwards by the resistance of the water, or (what I think) by the sail, we shall be able to understand how the above-mentioned extraordinary fractures happened. The cerebral, and three pairs of cervical nerves alone pre¬ served from injury. How near was the mighty phrenic to destruction! Whence arose the gastritis ? This alone seemed to destroy life. What would Le Gallois, Brodie, Wilson Philip, and other experimental physiologists on animal heat, nervous influence, action of the heart, &c., say to this case?

V.

On the Principles of Life and Mind ; with an Exposition of the Physico-Theological Controversy . By J. Fosbrooke, Surgeon.

I observe that some opinions upon my former paper on Life and Mind are modestly offered in a recent Number of the Repository. The author seems principally impelled to repeat those dogmata which metaphysicians have thrown out as insurmountable by argument : added to this, a seeming difficulty in regarding purely mental principles, and the operations of reason, apart from instinctive and physical dictates, has placed him in perplexity and misconception between the two. A formal reply it is not my design to give, if it be expected ; but as I had something more to say on the subject when I wrote my first paper, there cannot be a better time than the present; and the matter of the writer’s re¬ flections, if due place is afforded, shall be reverted to where recollection serves. I have said, that there cannot be a better time than the present, for I should have waved the consi¬ deration of such topics altogether, after the decisions of so many great men, which have rested as yet without confutation, and have felt disposed to pass over the objections of mate¬ rialists with contumacy, was it not of late that these doctrines have gained ground by the respectability and arguments of VOL. xiv. — no. 79* d

18 Original Communications.

such as have supported them. As to the real amount ol scepticism which mere materialism would induce, even if it had passed into certainty, I am not so much disposed to see fit reason for apprehending, as many have seemed to do; but where moral principles have been endeavoured to be shown to be subordinate results of such materialism, too much in fair reasoning cannot be said to subvert doctrines thus far injurious. It is my sincere wish, that the unfair odium which has been attached to our Profession, through the manner in which these subtle and agitating questions, respecting the most untangible attributes of human nature, have been by gross perversions of physiology discussed, should be fairly compromised, by bringing the doctrines of parties and professions to just comparison. The zealous and ignorant hostility of many of another profession has of late fallen heavy on those who have professed to improve the capacity of medical science, and with the usual vices of dread and jealousy, without waiting to ascertain the premises, they "have misunderstood and misrepresented the conclusions: but of this, and other general matters, 1 shall introduce more in my section on mind, where the physico-theological con¬ troversy will receive some illustration through a correspond¬ ence which I have held on the subject with an enlightened divine, who has favoured me with the interchange of his opinions. There is one point for consideration before I enter on the subject farther; a third party seems to regard every attempt to make this branch of inquiry a point of discussion at all as wild and improper, and have a way of talking about its illegitimacy and presumption. Now this may be easily dismissed. Professor Stewart observes, that “ If we proceed no further than facts for which we have the evidence of our own consciousness, our conclusions will be no less certain than those in physics;” and he adds, “ There is indeed one view of the connexion between mind and matter which is perfectly agreeable to the just rules of philosophy. The object of this is to ascertain the laws which regulate their union.” Now nobody but materialists have pretended to explain simple principles or necessary causes; but, not to persevere within the bounds which we have quoted, would be a cowardice of human understanding, a prostration of its strength in regard to events of the most painful interest, which ought not to be obeyed. Sub spe et silentio is our motto without , and not within the confines of possibility.

Whatever has been considered by a Hunter, Blumenbach, Abernethy, Bichat, and other celebrated characters, fit matter for human speculation, is sufficient proof of its importance.

Fosbrooke on the Principles of Life and Mmd. 19

I am alluding more particularly to those who have spoken of life as an independent principle; for, as to writers on mind, they are too numerous and too illustrious to stand in need of being put forth.

Life I should define to be that regulating principle of animal matter, which was necessary to afford scope for a mul¬ tiplicity of active powers, and not only to sustain these in co-operation, but, where harmony of construction did not admit of the interposition of superadded contrivances, was capable of giving action as well as animation. That some¬ thing in its nature may be imparted by it to fluids or solids, which, by substituting particulars, may prevent the conflict of the general Jaw's of matter. Life in fact controls, by excep¬ tions and particular combinations, the invariable tendencies, chemical and mechanical, which influence matter without life, and is the guiding power of those active and superior principles which are circumscribed within every animate being. All this it works in phenomena, which I shall, in the course of this essay, endeavour to investigate. The vital powers, as Blumenbach w'ell observes, “ are not referable to any qualities merely physical, chemical, or mechanical From the operation of this definition to the full extent, those who have discovered most in practical physiology, have been quite unable to wave its particular and exclusive application to some of the more difficult actions of the human frame. The physiologist, in his scrutinies, not only detects it as a general element of being, and to be ascertained simply by general comparisons between vitality and wrant of vitality, but he also finds it to be an exclusive, active, and particular agency, in the production of certain phenomena. Mr. Hunter found that he could not account for the organization of blood, and its coagulation, by any other attribute but specific vitality. This encountered much con¬ troversy, but that served in the end to fix it the more Armfy ; and, as Mr. C. Bell has said, in contrariety to his brother, “ The doctrine of the life of the blood is the best established doctrine of modern physiology/’

The processes of secretion have again led to this inquiry, By what power does a gland form a fluid or a solid ? how separate the latter from the former? how, out of a supply invariably homogeneous, does each, as Berzelius proves, make something not existing in the materials which it lias to work with ? how does it happen, as an animated physiologist observes in his lectures, when it runs the hazard of forming

* See Blumenbach’s Physiology, by Elliotson, 2d edit. p. 16, pp. 42 to 44.

20 Original Communications'

an insoluble compound, that it adds a little more of an arid, and preserves the tutelary economy of nature? It is not merely the vascular, absorbent, and nervous energies, playing together in the system of an organ, that could effect all this, without some peculiar modification of a regulating principle. The same celebrated personage to whom 1 have just alluded, tells us how men sneered when Mr. Hunter talked of the perform¬ ance of secreting processes by the vital actions of arteries: yet Mr. Hunter is proved to be quite as correct as any body else in accounting for secretion; and thus what, at the birth of discovery, is presentiment only in great minds, is finally the only rational basis upon which all explanation and certainty must rest. For something, when a conjecture is accurate, still less evident than the laws of any preceding discovery, and still less within the range of simple perception, is gene¬ rally brought to light, and demonstrates the previous fact, and flashes it full on the conviction, in the arrangements and circumvolutions of parts within parts, we observe life to alter its form, to render minute structures as entire in regu¬ larity of formation as the larger and seemingly more com¬ plete. When a great physiologist informs us what is resulting from the force of life, he tells us merely what he knows cannot be otherwise explained. A superficial thinker smiles; such reasons he believes to be mere chimeras; a dernier resort to wrords to conceal blindness. But bv what

w'

process of induction is the conviction sought and acquired ? I would answer, by a severe train of reasoning, by long investigation of causes, by separating what is common from what is eccentric in the laws of vital phenomena. When Mr. Hunter told us that the power of secreting was a vital action of arteries, he told it as one who had sought every other means of explaining more agreeably to human com¬ prehension in vain. But if the same result had been obtained by one who, if any other cause had really existed, could never have found it out, we should be fully justified in deeming it to consist in the simple truisms of common reflection, and in making a hasty alternative of the easiest kind of generaliza¬ tion.

However physiologists may differ in applying terms to the principle of life, all mean to acknowledge the same thing in the elaboration of the vital secretions. The Bells say, “ Life resisting in a gland is an agent controlling its affinities ;w others call it the human eccentricity. Bichat comprehends it in his organic sensibility. Mr. John Bell says, “ An incomprehensible influence is exerted on the affinities and newr combinations which form the secretions of the human body, and the chemist can never so combine the fluids

Fosbrooke on the Principles of Life and Mind. Si

out of the body as to imitate the changes produced in the living system of fluids and vessels. Forgetting that anima¬ tion is the essential character of living bodies, that it in¬ fluences the chemical affinities, and varies the attractions of particles, physiologists have too much endeavoured to explain the phenomena of animated nature by demonstrations for¬ merly drawn from mechanics, hydraulics, and in the present day from chemistry.” The same writer admits that the principle of life, u as a power existing in an animal directing its actions, must be universally acquiesced in;’' and though he will not allow the vitality of the blood, yet “ it possesses pro¬ perties while circulating in the vessels distinct from those which it shows out of the body ; and these do not depend on the agitation and incessant motion, nor on the degree of heat, nor on any similar circumstance, but apparently on some secret influence which the vessels exert over it*.

This last hint, as to the vital influence of the vessel over the blood which it circulates, has been admirably illustrated by Dr. James Blundell, (the author of some essays on trans¬ fusion of blood, on generation, in the Medico-Chirurgical Transactions, and the successor of Dr. Haighton in the chair of physiology at Guy’s Hospital,) in his lectures, and is con¬ firmative of a particular influence of the principle of life, it is singular that these opinions should teach the vitality of the blood on a proposition diametrically opposite to Mr. Hunter’s ; that great man considering coagulation to be a proof of its vitality, and Dr. B. regarding the principle which prevents its coagulation in the living vessel as being the main proof. T he following is, perhaps, a fair statement or what I have heard in these valuable and more original prelections. The fibrine of vegetables becomes solid, so does blood, of which the principle is analogous : the coagula¬ tion is only alteration of cohesion modified. While the principle of life acts, it is preserved fluid ; this being diminished after extravasation, it coagulates. Another extrinsic power resisting coagulation is a vascular influence of the vessels themselves, originating in the principle of life ; for if blood, as tried by experiment, is passed through a portion of dead vein or artery communicating with the living, it will coagulate in the passages; and this cannot arise from cold, for increase of temperature accelerates coagulation., This is partly supported by the vasa vasorum. But though blood may cherish life, it is not itself the principle, neither does the nervous energy nor the mechanical properties of the vessels generate it ; for by experiment both blood vessels and nerves were insulated from the trunk of a vessel,

* Bell’s Anatomy, vol. iii. p. 236 —239.

22 Original Communications ,

yet its vascular life remained, and it was pervious to the passage of blood without coagulation. When you

destroy or impair the vitality of blood, you produce coagulation ; but it may be said, that there may be energies with which we are not acquainted which have power to resist the aggregative affinities of blood ; and we know this much, that that which resists aggregative affinities can certainly resist the affinities of homogeneous particles. Motion alone, or diffusion of blood through the lungs, (for in the foetus, being neither venous nor arterial, it is not exposed to atmospheric changes, and yet supports life,) does not enable it to resist putrefaction, nor to preserve vitality. It may be asked, How, if the blood cherishes life in the vessels, do the vessels communicate it to the blood ? but both together engender it, and resist the cohesive affinities. Perhaps the conjunction of both might be conjectured to produce something anew, which effects the principle. Blood becoming viscid and in a dying state, does not excite the heart; therefore vitality of the blood has something to do with the action of the heart. To these ingenious view's I might add some others from the same quarter, exceedingly apposite to the subject, viz. that the degrees of coagulability in the blood of different animals depend upon modifications of their vitality. By the experiment of injecting a little serum but a few hours before taken from one dog (and not at all putrid) into the veins of another, immediate death was produced. From this the physiologist concludes, that vitality implies a particular class of affinities set in play, and death the introduction and play of another class ; and that the latter renders the same substance which was before in assimilation extraneous to vital matter, and absolutely poisonous. Blood, when extravasated into cellular, wet, or any vital tissues, does not irritate as an extraneous sub¬ stance, because it is vital. 1 am of opinion, that blood is not only vital, but also the whole tribe of morbid poisons ; and that I shall hereafter be able to prove, that the encysted fluid of vaccination and small-pox can only preserve its power to infect after long periods by a property of this kind, and by a reciprocal action of its own latent vitality and that of the part in which it is inserted. Through this property the vaccine or variolous scab is long tenacious of its poison. Life is inherent in fluids; and it is necessary, because they form the solids, which seem to require it in a higher degree. As we trace the vital principle downwards to the lower orders of creation, we find it more imperfect, and the beings which it animates looser in their aggregation : thus some zoophites, especially of the polypus genus, are jelly-like in texture, but still having power to float themselves

2 3

Fosbrooke on the Principles of Life and Mind.

in given directions, and to exert irritability. Irritability, which is so necessary to muscular action, and is said to be retained by it after death, is, in my belief, a modification of vitality; but of this more hereafter.

Whether life has any resemblance to chemical laws, we can only judge by facts. What authenticates the experi¬ ment with the serum of a dog, is a phenomenon which I have been used to observe in dissecting-rooms. A student has pricked his finger with instruments used on a subject, extremely recently dead, and far from any process of decom¬ position, and the consequence has been, that instead of the effects of a common scratch, excessive irritable inflammation, propagated along the skin, and giving rise to inflamed absorbent vessels, and deep-seated suppurations have fol¬ lowed. The abstraction of life can be only given as a cause of this deleterious change. The change after death is un- doubtedly the strongest proof of a vital principle; but though no one ever denied its being as pure animation, yet few have ever considered it in the light of an active force. The action of the gastric fluid on its secreting organ, when the principle ceases to oppose resistance to injury, the transudation of blood through the muscular coats of the viscera, when this agency has ceased to communicate con¬ tractility, are all beautiful proofs of a vital principle. We will take another fact ; a glandular viscus, by some change of its economy, is subjected to the action of its absorbents. These hungry organs take away the parenchyma; but the main artery which pervades it, through its peculiar vitality, preserves even its cellular sheath untouched. The morsus of the absorbent is never imprinted on it. Even the previous power, by which a suppurative or alienative process surround¬ ing the vessel goes on without detriment to it, is a proof of particular and a self-appropriated life. That life and death are the play of two opposite classes of affinities is a brilliant conception ; but though it is frequently evinced according to the laws of chemical principles, yet it is not to be concluded that it is so, though it may be regulated by these or any other laws, agreeably to the form in which it is required. The secreting actions favour this hypothesis ; the secretions are alkaline, and the excretions acid, in as pure similitude to the products of the negative and positive extre¬ mity of Volta’s pile as can well be formed. I cannot suffer the law of secretion to be submitted to the principle of life without showing one objection, which must be foreseen ; that one uniform principle should actuate every organ alike : but it is not so ; every gland has its distinct products. The bile is unlike the urine, saliva differs from the gastric fluid ;

24

Original Communications .

so that we must look into the organ itself for a power not only of appropriating life, but adapting it to its secretory actions, and to the individuality of its economy. Even the blood which circulates through one structure, if conveyed through another that was superadded, and not of the same original conformation, would be subjected to the . life that was proper to its organization, and which actuates matter, but is not actuated by it. Thus when a shoot from one tree is engrafted on another, the secretion is altered into that peculiar to the shoot, and not to the tree, which furnishes the materials. Thus the wonderful phenomenon of two economies, quite homogeneous, and both supplied from the same fountain, being differently regulated by something not to be explained by any form of their peculiar mate¬ rialism, perceptibly different, is miraculous. Though the discovery of the intrinsic principle of secretion must have considerable relation to the mechanical actions of the secreting vessels ; for whatsoever increases the action of the vessels of an organ, is capable of exciting an increase, or diminution, or specific change of its secretions; yet still the appropriate principle remains in each gland, by which alone we can account for the influence of one stimulus more than another on it.

Having thus submitted such data as have been presented to my experience, l may be allowed to sooth the rigour of the labour which I have executed by making an excursion beyond the severe limits of this speculation. Every man is desirous of concluding his trials by settling on some real or imaginary results

It is not improbable that we may be, some time or other, better acquainted with the primary causes of life. Whether the vivifying principle be simply oxygen, or whether it bears any relation to heat, electricity, or galvanism, or whether all these are essential combinations of oxygen, are connexions which we have yet to learn ; and I do not despair of one day being taught. Oxygen, without the other constituents of atmosphere, is experimentally found to be destructive to life ; therefore oxygen alone is not life, as some chemists have seemed to think. Admitting it to possess the highest influence as a vitalizing principle, it could not be life; it could be merely an important agency ; for no fabrication of human invention could ever receive that extraordinary mo¬ dification through it which developes the functions of existence. Nor is the decomposition of atmosphere the only cause of life. Sub-marine existence proves it ; and we may refer to the class vermes for proof of the same positions. Neither is heat the sole principle that could generate anima-

25

Fosbrooke on the Principles of Life and Mind .

tion in matter undergoing decomposition ; all these prin ciples may be instrumental, but not principal. How it varies its form, deviates in particular emergencies, and yet preserves its being in the grain before it becomes the plant, and in the plant after it has been the grain; in the ovum of the May-fly, which sinks from the margin of the stream into the wave, and is preserved from destruction in a husky enclosure, which it afterwards floats to the surface, and by a self-parturition, disengages from it, and assumes a fresh element and new laws of existence. Nothing, indeed, can do more to convince us of the immateriality of life, than the striking opposition of states in which it is exerted; and we would ask, how can organs, in any shape, be rationally sup¬ posed to create that which is in them, indicated as something . superior to any power which they can, per se , consistently possess or direct ?

There is only one process by which man can be framed by man. Anatomy and chemistry have taught us to analyze the animal structure, i. e, to separate and classify its organs; but what we effect by analysis teaches us nothing of arranging or providing even the elementary parts by synthesis. Con¬ sequently, I consider the intentions of the only Architect of animate bodies to be in this instance more subtle than in most of his operations, and by the complexities and appa¬ rent incongruities of generation and growth, to have designed that the secret, which, if known, would produce strange disorder, should be superior to the comprehension of man ; and that he should form an animated being by a chain of causes and effects, seemingly without positive congruity, gradually, not all at once, as things mechanical, into the state of perfection permitted to him, and alike to* other animals in their scale. What an immensity of perplexing and seemingly incoherent orders of actions ensue in t lie formation of a little seminal fluid into a being, till the period of its highest lift in the scale of physical existence ! But though we may justly despair of ever strictly analyzing the simple principle, I do not hesitate to say, that it approaches very near to the eye of human perception ; that it works by such similitudes to physical laws, that more than is known of any first principles may be eventually known of this; and that we shall find fresh flows of delight and wonder in tracing it to operations more evident to human comprehension, more visible in its effects, though still dim in its nature as a cause.

My inferences then are, that life is a pervading principle. The experiments of Spallanzani show that matter under¬ going a change is always (particularly fluid) producing it. Heat appears to be principally potent in calling to

VOL. XIV.-— JS'O. 79* ' e

£f) Original Communications

existence the tribes of inferior and ephemeral creations; at least they are probably materially formed through the che¬ mical changes produced by heat ; but the animating prin¬ ciple is the same as gives vital action to higher orders. Geologists have found that there are certain incrustations of the globe which retain the exuviae or organic remains of unknown animals, some more gigantic than man, as the bones of the behermoth, the mammoth, and the mastodon ; of fish, as ammonites, proportionate in non-entity of magnitude. There are mountains, or rather tracts of primitive hills, which evidently existed before man, and on which man could have never existed. What are our inferences ? That the whole globe was once iuimensely larger, but the operation of an eternal and internal cause may have contracted its sphere ? At that period of its creation, animals larger and fewer might be suited to its economy ; but succeeding revolutions brought it down to the epoch at which the human race were called into being, by some universal principle of primitive creation ; for nothing in the construction of a man will lead us to believe that his remotest ancientry were mammoths, monkeys, or fish. If so, there is an economizing distribution, which neither species nor generation can prevent by propaga¬ tion. The race may futurally perish, from the decay or diminution of the worlds— at least such an hypothesis is not unphilosophical ; and be solely inhabited by a more suitable creation. But at last we arrive at this conclusion, that life is an universal operation upon organized beings; and all our knowledge of its conducing agents does not teach us its application or adaptation, so as to produce it by any but the given and instructively taught method of nature. Like the silkworm, we disgorge the silk; but we weave not the web, nor warp the woof. Other unknown looms model and work the texture of man, and communicate to it the materia diff usa vitae ; a phrase by the common acceptation of the first term here improperly implied. In the ratio of creation, such is the proportion, waste, and supply, that it may not interfere with these laws, its duration is limited by the fragility and conversions of matter ; therefore it pervades the universe, and, like light, occupies space and matter, without adding to bulk or gravity ; thus being, but so being as to be refined to immateriality. „

Let us inquire, what is vegetable life ? It is more simple than animal; it does not require a nervous system, to be actuated by mind. When mind is unnecessary, a nervous system would be superfluous; and where motion is so limited, a system analogous to the animal would have subverted the objects which the vegetable world seems

Fosbrooke on the Principles of Life and Mind. 27

designed to fulfil — growth and enlargement. A vegetable, possibly, is but semi-vital, compared with man; and so gradual in acquiring and diffusing it through its gross sub¬ stance, that it parts with it much more tardily. T he neces- sities of a plant are very limited, compared with those of the biped or quadruped. It sends forth its radicals in quest of moisture; and the elongation or multiplication of these constitutes its locomotion, or rather the purposes of loco¬ motion ; its leaves possess vessels which convey air, and with this the principle of life enters, and supports itself in every action of the vegetable, though the organs it has to propel functionize, and the secretions to which it must communicate vitality, are every way opposite in resemblance and in chemical character to those of the animal. Thus by the will of the Creator, its affinities are not arbitrarily confined to the election of certain fluids or material bodies. So Pro- teiform or comparative is it in its degree and universality, that I conceive nothing exempt from its influence. It may be deemed paradoxical to assert that there is no such thing as inanimate matter in the universe ; but why, I would ask, do two bodies move towards each other? Why do they beget reciprocal changes? They must inherit some prin¬ ciple, wdiich may be either passive or active, under certain laws, and is so assimilated to life, that it may be termed a modification. The principle of elective affinities in what is called inanimate matter, is as latent caloric to free in resemblance to life. I am far from maintaining that life and electricity coincide; but Sir Humphry Davy has shown, by passing an alkali unacted on through an acid, that both may be deprived of properties somewhat analogous to life, and without which they are as nothing. When we pause to remember the tendency of the blood to forcible coagulation, we see the genuine chemical property antagonized by that of life, as a more potent principle that holds it in subjection. It exists in matter in two different states, on which all its attractions are founded ; but when called into activity, and so disposed as to act on organized bodies, it certainly does not communicate life. For this reason, I deem it that modification which is fitted for certain material bodies; and I am not so sanguine as to think, as many would seem to do by their oxperiments, that when transfused it will ever restore vitality. It is true, that certain muscular actions ensue from its impulse on the nervous system ; but how would mortals ever be able to support this powerful transfusion, even if they succeeded in the first steps ? Perhaps, indeed, there is as wide a difference between the motory effects of galvanism and the efforts of a living body, as there

28 Original Communications .

is between the mechanical motions of an artificial skeleton and those of a living subject.

By the term matter, we too indiscriminately signify mineral and animal matter ; but it should be remembered, for the sake of confirming these latter observations which I have laid down, that these two varieties of matter are as dissimilar as matter and mind ; and the former, to perform the circum¬ scribed part which is appropriated to it, must be limited in its capability of receiving certain affections, in a manner which is evident. Indeed, who could meditate for a moment upon the elaborate frame of blood vessels, nerves, and lymphatics, and not deem that it was designed for much superior purposes, in the visible world, to the clod of the valley ? But it must be remembered, that for the fulfilment of every office in nature, each is equally inert, till the same principle which impregnates all with life, even the seed in the clods, calls the former into the actions of existence, and educes from man that eminent perfection of corporeal and mental characteristics, for which, if we were neutral beings, we should judge him, by the admirable refinements of his structure, and the secrets of his framing, to be beyond all other living things befitted. If we regard life as the mere effect of certain arrangements of organized bodies, as, in fact, a unity and accord of many functions, we must be mortified in seeing it in a thousand shapes between heaven and earth, in which these necessary connexions are entirely wanting to account for its presence : but if we look upon it as a simple attachment to all forms of matter, in every inferior or superior degree, as that which never ceases in its lambent play over the universe, as that which circulates through us and all things, a secret imparted by a com¬ munication we can, perhaps, never know', and makes its exit as well as entry, yet leaves us conscious that it is eternal still ; and mayhap bears away in its flight the sense it brought to us to gather into something anew the essence of our joys, and our sufferings, our sensibilities, and our sorrows; then is our notion somewhat more distinct, and we are perplexed no more by those inconsistencies of transformation, in which w?e discover it in most subterranean caverns, in the waters and under the waters, in the firmament, and on the surface of the mutable world, in the expansion of the flower, the ruptured chrysalis of the insect, and the beautiful evolutions of animal growth ; in this all motion, in that all passive, yet not exanimate ; sometimes like heat, some¬ times light, sometimes electricity, sometimes oxygen, some¬ times air, and yet none; but all these, with an incom¬ prehensible and unknown ingredient of all. Then we must

Battley on Colckicum. £g

confess that all that we know is, that there are states in which we are fitted to receive, and states in which we can no longer retain it. Nor is the idea of life being a bodiless perpetuation of the essence of our terrestrial being so wild or incoherent as many may suppose ; it is not the reverie of a sick metaphysician. If life quits the natural body, may it not convey away all that it rendered it susceptible of? If it brought to us the power of enjoying many things, of enduring- many things, may it not have the power to render these pecu¬ liar to itself, and undying hereafter?

To recapitulate principal points : animals being designed to embrace an immense concatenation of functions, and an accumulation of different classes of organs to perform them, the whole required a constitution differing from that which is commonly ordained to what is called inanimate matter, and to act as a governing and auxiliary principle with more energy than any principle or matter of another kind. Death is the separation of that principle and the interval between disorganization and reorganization. Reorganization may be an exchange for a modification of the same principle, in a different form of matter. Whatever, from the seed to the mineral, is not in the interval between these two changes, that is, the abstraction of the life of one kind of matter and the superaddition of the life of another, cannot be said to be truly dead; for it contains properties, which, though latent in one and passive in the other, are in both capable of effecting changes. The equilibrium of nature is adjusted by the power which enables matter to resist the encroachment of death, and gives death the power to undo that matter which is quitted by life, that it may be seized again by a modification of the same principle, and supply perpetuation. Such is the whole system of the universe, and, as Madame de Stael emphatically says, we may discover it in a flower. With the subject of mind, it is soon my intention to proceed.

VI.

On Colchicum. By Richard Battley, Chemist,

Fore Street.

The admitted value and importance of colchicum, and the want of professional agreement as to the medicinal powers of this root, induced the writer, some time since, to direct his attention to the investigation of its nature and pro¬ perties ; and agreeably to the intimation which appeared in the Repository, No, 75, he now proceeds to report the details and the result. —

In the spring (April,) the root does not materially vary in

i

30 Original Communications .

size and general appearance from that which is ordinarily met with. It is then of a full size, but irregularly or par¬ tially indented or hollow: at this time it is found with a small attached bulb, about the size of a bean. The growth of this small bulb proceeds from the latter end of April or beginning of May (according to the season) until the latter end of June, or beginning of July, at which time it attains its full growth. The parent root appears to yield as the new production advances, and when the latter attains its full size, is no longer to be found.

The new root is then plump, firm, and without any indenta¬ tion or hollow, and does not undergo any change of appear¬ ance from this period until the latter end of August, when in its turn it becomes old; for at this time it throws out a new bulb : from that new bulb the flower proceeds, and in the course of a very few days is fully displayed.

Between this latter period and the spring, very little apparent change takes place ; the root and offset are then found as first described. These changes are, of course, subject to some variation, from soil, climate, and season.

The state and condition of the root, if subjected to experi¬ ment, illustrate the process of nature in a striking and forcible manner.

A transverse section of a bulb, exposed to the temperature of 170;

If procured in the autumn, contracts, and when dried is shrivelled ;

If procured in the spring , the cuticle collapses, no other part of the then remaining substance being capable of en-» during the heat ;

If procured in the month of July or August , before the new bulb is projected, it remains quite solid and firm, and has a creamy appearance.

It may be inferred from these facts;

That, this root is deprived of its power, progressively, from the time of throwing out the newr bulb until its final disap¬ pearance; and that, although very little change of appear¬ ance occurs during the winter months, it really undergoes a decided change during that period.

That, August (before the new bulb is thrown out) is the proper season to procure the root.

And it may also be inferred,

That the various opinions as to the medicinal properties of colchicum have proceeded from the various states in which it has been brought into use.

The root, when removed from the ground, (in August, before the newr bulb appears,) should be immediately cut into transverse slices, equal in thickness to a half-crown ; to be

Battley on Colchicurn . oi

then exposed in wicker baskets, without placing the pieces in contact, to a temperature of 170 to 180, and so to remain until dried, which will require from two to three hours ; during this time it will lose in weight about two-thirds. This process should ensue without delay after the root is procured, other¬ wise the flowering will proceed, although out of the ground; and when the process is complete, these transverse cuts or pieces should be carefully preserved in small boxes, in a dry situation.

The root when taken from the ground at the time recom¬ mended, and cut transversely, exhibits a milky appearance on both surfaces. The exudation is not particularly pun¬ gent; it rather impresses the tongue with a cold but peculiar sensation, which remains unabated for some time. This sensation of cold is accompanied by a sense of peculiar excitement, which is conveyed to the fauces, and continues still longer than the first-mentioned sensation of cold. Under ordinary circumstances it does not inflame the skin.

In a recent case of decided gout, attacking the second joint of the great toe, twenty drops of vin. colchici* having been given, in about half an hour a slight nausea was expe¬ rienced, and upon awaking from the sound sleep which ensued, the pain had entirely ceased. The dose was repeated eight or ten hours afterwards. Two months have since elapsed, without any indication of a return of the complaint.

Specimens of this preparation are placed in the Museum of Materia Medica, St. Thomas’s Hospital ; and will be shown to the Profession by Mr. Whitfield.

DEPARTMENT OF NATURAL HISTORY,

Calendar of Flora and Fauna , kept at Hartfield , near Tunbridge Wells. By Dr. T. Forster. From the 9th to the 31 st of May , 1820.

May 9th. — As I returned from London, I observed all the way along that the Ranunculus bulbosus was become com-

* Two ounces of dried Colchicurn, of the description above men¬ tioned,

Two pints of Spanish White Wine,

Two ounces Alcohol,

The colchicurn slightly bruised, added to the wine, having been occasionally shaken up, this fluid was then passed through paper, and the alcohol added.

32 Original Communications .

mon, and spangled the meadows and fields with its rich yellow. Hesperis inodor ay Iris Germanica , and Tulipa Gesneriana , in bloom in the gardens. I saw here and there a very fine blow of Tulips about London. Near Eden bridge 1 observed the Yellow Asphodel ( Asphode/us luteus) just coining into flower. The weather is warmer after the showers of last night. At Clapton, Narcissus biflorus, N. poeticus, and N. angustifolius, in blow.

10th. — Papaver Cambricum and Peonia tenuifolia in flower at Withyham, in a garden, where I also saw to-day the vernal bastard flower of the Colchicum Autumnale , which is a curious phenomenon.

1 1th. — Dentaria bulbifera flowering at Withyham.

12th. — Scandix odorata in flower in a garden. The bulbous Crowfoot is abundant in the fields near Tunbridge Wells, and about London, and other places. The neigh¬ bourhood of Hartfield, however, is peculiarly destitute of this and other vernal flowers ; the fields here looking quite like winter. This backwardness of the Flora should be viewed in conjunction with the peculiarly great degree of cold which happened here almost locally in January last ; the thermometer here being many degrees lower than it appears to have been in any other part of the island. My thermometer, on the night of Jan. 14, descended so low as ten degrees below zero ; and at midnight I saw another thermometer so low as five degrees below zero. I forbear speculating on the cause of this circumstance; but the com¬ paratively late state of the vegetation here, and the de¬ struction produced in the plants, corroborate the fact, with¬ out explaining its cause.

13th. — Pyretdirum inodorum has one flower already.

14th. — Geranium molle and G. Robertianum now com¬ mon. Myositus scorpioides is also in blow, and the common TormentiUa , the Potenfilla , Wild Mustard, Charlock, and others.

16th. — Hieracium Pilosella in flower on a warm bank; but it is not generally in blow yet.

I Qth . — * Hieracium (novum) in flower under a steep bank between Cowden and the high road.

20th. — Sinapis arvensis begins to abound.

21st. — Hypochaeris radicata in flower. This fine warm weather has in two days produced more flowers than, in the last preceding week, the rain did. The Iris lurida is in flower in the garden. Nearly all the Ranunculi and Potentillce

* I know not to what species to refer the Hieracium alluded to. I believe it to be a new one.

S3

Calendar oj Natural History.

are in blow in the fields; and the rapid growth of the midsummer flowering plants is prodigious. The mea¬ dows have now assumed their rich yellow bespangled appearance ; while in other places they are beautifully blue with the flowers of the Harebell ( Scilla nutans); but still some few fields are almost flowerless, Ranunculus repens not being out yet.

24th. — Natalis Linn^ei. Tragopogon pratensis in flower at Hartfield. The weather extremely hot.

25th. — Tragopogon porrifolium in flower. In the gardens about London the Ljlium bulbiferum is already in blow. Papaver orientate is in flower at Clapton and elsewhere. Hy- pocharis radicata begins to abound.

26th. — Chrysanthemum Leucantkenlum in flower. I also saw the Papaver nudicaule in blow in abundance in a garden in Penshurst parish* *.

29th. — Sonchus oleraceus, Lychnis Flos Cuculi, Saxi- fraga granulata , Hemerocallis jlava the Yellow Day Lily, and Linum perenne in flower.

30th. — Aquilegia vulgaris m flower. This plant is found apparently wild hereabouts, though I have never yet found it greatly remote from the houses.

31st. — The different varieties of Azalea are in beautiful bloom. The weather is still very showery, and the tempera¬ ture low for the time of year. The rising of the barometer is unattended now by fair weather ; and the showers fall so rapidly, that one can scarcely get away from them. The Flora is very backward here. The meadows are hardly yellowed with Crowfoot in some places yet, particularly where the R. repens grows. Some garden flowers, how¬ ever, have been early this year, as Tulips and Crown Imperials.

[T-fo-s Journal is to be continued in the neighbourhood of Tunbridge

IV ells ; and will in future be 'published according to the calendar

months .]

k

* This is the Papaver erraticum nudicaule of Dillenius, in Hort. Eltham. It is about the size of P. Camhricum , but the flower is of a paler yellow, and approaches more to sulphur colour.

/

7

VOL. XIV.

NO. 79.

34

Analytical and General Review,

PART II.

ANALYTICAL AND GENERAL REVIEW

OF

MEDICAL LITERATURE, FROM JANUARY TO JULY, 1820.

Instrui ab evidentihus causis, obscuris omnibus ab arte rejectis. — -Celsus. Bonus theoreticus non potest etiamnon esse bonus practieus.— -Hoffm annus.

To deride theory, is to talk nonsense. No act, which is not purely organic or automatic, can possibly be performed without a previous process of thought or reflection ; and thinking, contemplating, theorizing, being synonymies in language, it follows, that the most routine practice that can be instituted or pursued is equally the result of theory with the wildest conceptions that have ever been brought into practical bearing. The question, then, Whether it be best to follow the guidance of principles, or act from simple experience ? is one founded altogether in misconception and mistake. “ To experience is to know, to know is to infer, to infer is to reason, and to reason is to systematize.” The old beldame of mere bed-room lore, who pertinaciously con¬ forms to the practices of her predecessors, is quite as theo¬ retical in her creed and conduct as was Brown in prescribing excitants under the supposition that stimuli were the sola remedia in nature. It does not, however, follow, because all acts are thus the results of reasoning, that all reasoning is therefore correct. Both the routine nurse and the specu¬ lative Brownists deduce or infer from fallacious premises ; and it is in this particular that especial care is requisite, namely, that our premises be such as to warrant our conclusions, and that phenomena be not viewed “ in the light we wish them to appear, rather than that in which Nature presents them.” The pathological philosopher, for instance, shall observe that certain deranged actions are con¬ nected with particular conditions of the first passages, or of the brain. He thinks that his predecessors in observation have not sufliciently taken cognizance of this connexion ; the detection, therefore, strikes upon his mind with the force of a discovery. He adopts this new view as a favourite principle. Having adopted it, he becomes blind to its deficiencies : from being thus a fostered and favoured

Medical Theories.

35

offspring, the tenet in question becomes an idol of the heart. It is raised up to the sight of beholders, and all lame and defective as it is, the world is commanded to admire and to obey ; and acquiescence and obedience, even in this age of boasted freedom from verba magistri authority, is by far too passive and too general. Hence the practices which at this moment appear to be founded upon the most unexception¬ able premises, will seem, perhaps, to our successors to be any thing but correct. Hence the temporary and successive reigns of blood-letting, and condemnation of blood-letting — » of opium and purgatives — of blue pill and antimony. Hence the cephalic, the gastric, the cardiac, the hepatic, and the mucous membrane views of disordered agency. These last we have especially indicated, since they appear to us to be now coming into vogue, to the exclusion of recent favourites ; so much so, that we think it behoves the deter¬ mined partisans of the cerebral and ventricular theories to look well to the legitimacy of these sovereigns, lest their throne be undermined, and their crowns declared vacant, as preliminary to the proclamation of the new potentate.

But “ to be serious in a serious cause.” While it is with the most heartfelt pleasure we contemplate the comparatively eclectic turn and tenor of the theory and practice of this our day, we hold it a duty to impugn the disposition which is still discernible, to take hold of particular and occasional facts, and to beat them out into large and universal bearing. The science and art of medicine is, from its very nature and objects, insusceptible of obedience to these sweeping laws : it is, and ever must be, a science founded, more or less, upon individual observation ; and that individual will ever prove the most legitimate theorist and the most efficient prescriber, who, while he thinks and acts with a respectful attention to the suggestion of his contemporaries, will at the same time close his eyes against the glare of imposing but fallacious generalities.

“ Sed hactenus hcec .” In looking back upon the several publications which have made their appearauce since our last semi-annual retrospect, we find it will be impossible to present distinct analyses of all of them in the space of the coming six months. We shall therefore pursue a principle, which we have already indeed in part adopted, of extending our retrospective review to some length, so as to furnish our readers with a something intermediate between a mere notice and minute analysis; reserving those treatises for separate articles of review, which, from their being of a more

36

Analytical and General Review.

important, practical, and detailed nature, will thus demand to be more amply discussed.

On the three subjects which it has hitherto been our plan to treat of separately, viz., fever, syphilis, and vaccination, we have not, in the present instance, much to say: the last will be discussed more at large in our next Number, under the form of a review of Mr, Cross’s History of a Variolous Epidemic*. The syphilitic combatants seem, like other belligerents, to be lying for a time spent and quiet; and it remains for us here to notice the only two productions which have appeared recently on the still disputed topic of contagion and fever. These productions are, Dr. Maclean’s qn Systematic Misrulef, and Dr. Prichard’s History of an Epidemic Fever which lately prevailed at Bristol J; the last of which is an interesting summary of the author’s practice in St. Peter’s Hospital and the Bristol Infirmary throughout the last year, ( 1 S 1 Q) . The proportion of mortality in the latter institution is reported to be eight in two hundred and ninety- one, or about one in thirty-seven, which is much belowr the usual average of fever hospitals. During 18 1 8 the average mortality, both of St. Peter’s Hospital and the Infirmary, was much greater than 1819*

This circumstance,” says Dr. P., u admits of the same explana¬ tion in both instances, from the greater number of distressed vagrants, who, during the former year, were wandering about in a diseased state, until they were brought into the hospitals in a state of extreme exhaustion. That the principal number of fatal cases in the infir¬ mary occurred among persons introduced in the last stage of disease, is evident, on comparing the dates of their admission with those of their death. It will be seen that most expired within two or three days from the time they were brought into the house.”

How strikingly illustrative is this fact of the good which may be accomplished by timely and judicious interference on the part of medicine, and is a sufficient reply to those allegations which go upon the supposition that nature, if left to its own operations, would operate the same number of cures as are effected by the assistance of art.

• A History of the Variolous Epidemic which occurred in Norwich in 1819, & c. &c. By John Cross , Surgeon.

t Specimens of Systematic Misrule; or immense Sums annually expended in upholding a single Imposture, &c. &c. By Charles Maclean , M.D.

I A History of the Epidemic Fever which prevailed in Bristol during the Years 1817? 1818, and 1819, &c, &c. By J. C. Prichard , M.D, '

Prichard on Epidemic Fever . 37

Dr. Prichard, in adverting to the pathology of the febrile state, thus expresses himself : —

That the derangement of the system of functions which con¬ stitutes fever, is very nearly allied in its nature to the disease which accompanies the inflammation of particular organs, is an opinion which is gaining ground every day among medical Practitioners. It

is, indeed, very remarkable, that they have been so long in arriving at

it, when we consider the striking analogy in the phenomena of these distempers.” — “ Fever,” Dr. P. says, in another page, “ is only dan¬ gerous when it gives rise to or displays the symptoms of visceral in¬ flammation/’

So many opportunities have been afforded us of stating our sentiments in respect of the reserve and qualification with which these inflammatory sentiments should be received, that we do not think it necessary here again to go over the ground of our objection to them, more especially as we wish to appear, in the present instance, rather in the light of analytical reviewers than critical commentators : and after all, successful treatment is the best commentary on theory.

Dr. P.’s practice is energetic. When patients were brought into the receiving houses, exhausted and nearly dead, “ they were stripped, and put into a warm-bath, their hair being at the same time cut off, and their heads shaved. While in the bath they were directed to be well rubbed, for the double purpose of cleansing the body and restoring the circulation of blood in the surface and extremities. After this process was completed, they were rubbed dry, and put into a dry and clean bed. A draught of some warm fluid was then given, which was generally thin gruel. In some instances, where the exhaustion was great, and the circulation not easily restored, a little wine was added to the gruel; but this was done only when extreme necessity demanded it, and with great caution and reluctance.” When the circumstances were not so extreme, a gentle emetic was administered to the patient after coming out of the bath. “ By these means the powers of life were generally roused, and the hot stage brought on, often in a mitigated form.” When the hot stage came on with a full bounding pulse, a hot dry skin, &c., from ten to fourteen or twenty ounces of blood were taken from the arm, more or less, so as to bring on “ a degree of relaxation approaching to syncope.” The use of the lancet was not, however, limited to the cases in which the pulse was full and strong. A feeble and oppressed pulse often rose considerably as the blood flowed. Sometimes the first drawn blood exhibited the buffy coat; at other times not. After a lapse of ten or twelve hours, the venesection was repeated, or, in very feeble subjects, leeches were applied

SB Analytical and General Review .

to the head ; and this last was often done with the more robust, individuals when topical affections seemed to call for it. In cases of very early application of remedial agents, it was, for the most part, only requisite to employ bleeding once. In more advanced, especially in cephalic cases, three or four bleedings were generally necessary. The head in these was always shaved, the body sponged with cold water, and the head kept covered with wet cloths. The medicines were chiefly calomel purges. In “ pneumonic cases” venesection was more urgently demanded than in the cephalic ones. In these the disorder was much more malig¬ nant and intractable. But the most difficult eases to manage were those “ in which the mucous coat of the intestines was the seat of morbid affection,” These cases were marked by tension of the epigastrium and vomitings. In these, how¬ ever, the inflammatory diathesis was more easily subdued than in the cephalic and pulmonic cases. One bleeding, followed by leeches, wann-bath, and fomentation, often proved enough. “ If pain seemed to take a permanent hold of one particular spot, leeches were applied.” Calomel and sulphate of magnesia were given. .The plan of bathing, shaving the head, and bleeding, was pursued “ when patients were brought into the hospital in a state of stupor or delirium, their eyes suffused, their tongues covered with a dry and dark brown crust, and their teeth with sordes ; their skin hot and parched, and beset with u petechia? and Dr. P. tells us, that the u benefit resulting from such evacuation often exceeded the most sanguine hopes. In the course of twenty-four hours the patient was sometimes found to have passed from a com¬ plete typhomania, and an almost total unconsciousness of ex¬ ternal impressions, to a tolerably perfect possession of his facul¬ ties.” The immediate effect of calomel upon the excretions was considered in these cases highly favourable ; and when this medicine produced “ a disposition to ptyalism, it was, in a majority of cases, found that a gradual remission of the more formidable symptoms had taken place;” and Dr. P., with others, at one time thought that patients were safe “ in whom mercury had produced the effect of ptyalism.” That opinion has now yielded to a contraiy experience. When the requisite doses of calomel proved too much for the bowels, Dr. P. combined it with Dover’s powder; an addition wrhich may be made with advantage when much irritability is pre¬ sent. W hen the above medicines were used in combination, it was generally in doses of five grains of calomel, with as many of Dover’s powder, every sixth hour. Otherwise, calomel was given with equal portions of anfimonial pow7der; hut of the use of this combination Dr. P. is doubtful, unless

39

Prichard on Epidemic Fever.

when opium is conjoined with the whole. The diet of patients consisted almost entirely of thin gruel and barley water. Wine, even in cases of exhaustion, was but very sparingly and fearfully employed.

We need not follow our author very closely through his sections oil the sources of epidemic fever, since his senti¬ ments are in entire accordance with those we ourselves have repeatedly had occasion to express. Dr. P. believes in the spontaneous origin of contagious fever; that is, that ordinary sources of derangement may produce such kind of disordered action, that the excretions or effluvia from the subject of it shall produce a specific effect upon another; a principle, to question which has always appeared to us to be dying in the face of fact. With respect to the distinction between conta¬ gion and infection, our author likewise well expresses himself, in the following words : —

“ It has frequently been remarked, that fever is a disease which becomes communicable to healthy persons only under certain con« ditions; and that these conditions are different from the circumstances under which the eruptive distempers propagate themselves. On this foundation, an attempt has been made to distinguish contagious and infectious maladies. Whether such a distinction in words is worthy of much attention 1 do not care to inquire; but the observation which suggested it is amply confirmed, by comparing the different phenomena displayed by this disease in St. Peter’s Hospital and the Bristol Infirmary. In the former house, the medical wards are very Small, having been originally destined, not for the accommodation of the sick, but for the abode of paupers ; and circumstances rendered it necessary to place the beds very near to each other, and to put too great a number of patients in a given space. Though the windows were generally kept open, and all the attention possible paid to cleanliness, yet offensive smells were often perceptible. It was under these circumstances that the disease was manifestly contagious. In the Bristol Infirmary the walls were very well ventilated ; they an; lofty and spacious, containing a great mass of air, which is continually? renewed. Here, also, the patients labouring under fever were dis¬ persed among individuals of almost every other description ; so that whatever effluvia emanated from infected bodies became immediately diluted in the mass of air free from such pollution. Here, accordingly, no instance occurred of the propagation of fever. None of the nurses were attacked; nor were the patients lying in the adjacent beds in any instance infected, though cases of the worst description, some of them exhibiting all the symptoms of typhus gravior, were placed promiscuously among the other patients, scarcely two feet of space intervening between the beds/’

With respect likewise to the cause, or combination of causes, which have produced the late epidemic, Dr. P.’s opinions are entirely such as we have ail along entertained

)

40

Analytical and General Review .

and expressed. The late fever occurred in a multiplied num¬ ber of instances where neither want of nutriment, nor filth, nor mental depression, could be assigned as its source; and it has always appeared to our judgment, as it does to the author of the pamphlet we are now reviewing, that u no other supposition can explain these phenomena, except the old-fashioned and almost exploded hypothesis of Sydenham, viz. the doctrine of a pestilential constitution of the air, or the notion that certain changes take place in the condition of the atmosphere, imperceptible to our senses, and eluding chemical tests, which predispose human bodies to febrile diseases in such a way, that circumstances, which in ordinary times would only give rise to a catarrh, an attack of rheuma¬ tism, or even occasion no indisposition at all, will now, in many individuals, become the exciting causes of continued fever.”

If it were only from the fact that epidemics originate, decline, and disappear, without the possibility of such dis¬ appearance being attributed to human interference, such as pest and fever houses, quarantine enactments, &c., the con¬ clusion would, in our minds, be abundantly substantiated by the premises, that there is an untangible, invisible something about and around us in cases of epidemic distempers, which only predisposes to disordered action in some persons, and in others proves equal to the actual production of disease. It is, as is well known to most of our readers, upon the ground of plague itself being a pestilence, and not a conta¬ gion, that the next writer we are to notice (Dr. Maclean) derides and decries altogether the communicable nature of its virus, and maintains the absolute inefficiency and absurdity of those measures which are had recourse to, in order to prevent the propagation of the disorder from individual to individual, and from country to country. We have read the volume now before us with much attention, but we still can only go those lengths with Dr. Maclean that we formerly did; viz. that for the extensive spread and long continuance of plague an infectious atmosphere is necessary; that many will fall ill from the per se operation of this atmosphere, but that others require the conjunctive use of the actual poison, engendered by the distemper; and that many would be affected to a certain extent by being exposed to this poison, even exclusively of the atmospheric influence. That qua¬ rantine might be abolished without fear, we are inclined to believe; but we Really cannot, with Dr. Maclean, pass con¬ demnation on the committee who were recently engaged in investigating this matter, for the practical decision to which they arrived ; since they appealed, as it seems to us, fairly,

4\

Chemical Retrospect.

to the only source to which they could appeal for information on the point — and decided accordingly.

Lord Grenville, it will be seen by the readers of Dr. Maclean’s very animated and ably written book, was in the first blush of the business very much inclined to favour our author’s views, in consequence of having read the former publications of the Doctor, and, in one of the most admirably penned epistles we ever recollect to have seen, candidly expressed his favourable feelings; leaving his mind open, however, to any change of sentiments that might result from a further investigation of the very interesting point at issue, fn the subsequent communications of that nobleman to Dr. Maclean, it is pretty evident that a change, the possibi¬ lity of which he anticipated, had taken place in his sentiments; and we think it must be likewise evident, even to Dr. Mac- lean himself, that, in this case at least, there was no bias either to one or the other side of the question, beyond what was fairly and legitimately produced by the force and weight of testimony ; and, whatever might be the private and poli¬ tical inducements of some few interested individuals to oppose the abolition of quarantine, it is to us clear, from Dr. Mac¬ lean’s own showing, that the question was agitated by the ruling powers concerned with every desire on their part to get at the truth of the case. We are extremely sorry, from our respect for the talents and perseverance of Dr. M., that we cannot be persuaded, by either his eloquence or arguments (although in neither is he deficient), to go to the extent that be requires us, either in opinion as to the absolutely non- contagious quality of the plague, or in respect to the motives which have actuated those individuals and bodies who have opposed the prosecution of his projected plan. Let every one, however, read and judge for himself, since the book now under review is insusceptible of analysis, unless we were to devote much more room to the discussion of the topic than would be consistent with the nature and objects of this retrospect.

We must here make room, as in our last general review, for the chemical retrospect; and in the next Number we shall prosecute the consideration of the miscellaneous matter before us.

The preceding half year has not been so fertile as usual of chemical discoveries and observations, nor of the other subjects connected with this part of our retrospective view of medical improvements. Most, indeed, of the facts we have to notice, hear but remotely on the immediate object of our VOL. XIV. - Nb. 79. G

42

Analytical and General Review.

work ; but, such is the multifarious nature of the medical art, such is its extent, and that of the sciences connected with it, that scarcely any the most insulated fact can be adduced, that may not at some period be brought to bear upon a medical subject.

Water. — - To pursue the memoria technica in which we are accustomed to arrange subjects in our mind, we begin with this fluid Crystals of ice, in form of triangular or hexaedral prisms, whose terminal surface was covered with striae parallel to the sides, the terminal edge having sometimes faces in lieu of edges, but none with terminal pyramids were found in a subterranean glacier at Fondeurle, in the south of France. (Journ. des Mines, xxxiii. 157). It is observed, in Edin. Ph. Journ., that octaedral crystals of ice have been observed by Rome de Lisle, and others, and that these crystals are strictly conformable to the optical structure of ice, as ascertained by Dr. Brewster. The thermal waters of Ischia deposit, on surfaces exposed to them, a substance having the resemblance of flesh, covered with skin, in one place forty-five feet long and twenty-four feet high, which on boiling yielded a gelatine or size. (Quar. Jour. viii. 376.) This has been considered as a production of animal muscle; but it may be doubted whether it be not in reality a vegetable, similar to nlva montana. The formation of gelatine by decoction in water, or of ammonia by distillation, is not so peculiar to animal substances as it was formerly considered. — I n the last winter it was observed that sweet wort does not freeze so soon as plain water, the saccharine matter of the malt preventing the action of cold. — The phenomenon of red snow has lately engaged much attention : that from the northern climes is said to owe its colour to a plant of the genus uredo : on the other band, that of the Alps, examined by Mr. Peschier, of Geneva, was found sometimes to depend upon a resinous principle,. of an orange red colour, probably arising from some cryptogamous plant, and at other times to an oxide of iron ; but this oxide may perhaps be only the ashes of some similar plant.

Earths. — The beating of glass in boiling water is not sufficient for annealing it.- — Several experiments have been made on bodies of this description; and it has been found that many stones are changed by exposure to beat under redness, in a crucible with sand. Yellow cornelian to a fire red; black rock-crystal quite colourless; amethyst colourless, and, by a stronger beat, white and opalescent, but is apt to crack ; beryl to light blue, and, by a strong heat, to resemble mother of pearl ‘ emerald the same pearly lustre; chrysoberyl -not altered ; flour spar from blue to red, or colourless.

Metallic S u bstan ccs .

43, *

Obsidian, with blue veins, discharged more air bubbles from the veins than from other parts. (Ed. Ph. Journ. ii. 194.)

Metals. — We have already adverted to the medical use of oxide of bismuth, in p. 249 of the preceding Vol. of our Repository. — Mr. Brandenburgh prefers the ferruretted prussiate of ammonia as a test for iron. This triple prussiate he prepares by digesting three ounces of ammonia upon half an ounce of Prussian blue, filtering and adding an ounce of water, to wash out all the salt from the then brown residuum. The liquor is of a beautiful vellow colour, has a particular odour, and lets fall an abundant white precipitate when mixed w ith nitrate of ammonia, but which becomes of a very beautiful red when an atom of copper is accidentally present.

— Messrs. Collin and Tail iefort have found that the blue and green carbonates of copper, heated to the temperature of 212°, become brown, and are good pigments. — The sul« phuret of arsenic dissolved in ammonia, has been applied by Mr. Braconnot to dyeing yellow colours in wool, silk, cotton, or flax. For this purpose he melts together one pound of sulphur, two of white arsenic, and five of potash, (more probably pearlash), then dissolves the mass in water, filters the solution, adds diluted sulphuric acid to precipitate fine yellow flakes, which being washed, are to be dissolved in ammonia, (probably aqua ammonias, or the alkaline spirit of sal ammoniac made with lime); and into this solution, diluted with water in earthen vessels, the articles are to be dipped, and then exposed to the open air until the yellow colour has been fully developed, as they appear colourless when first taken from the bath. This ammoniacal solution of sulphuret of arsenic may also be used in preparing coloured papers. 'The colour resists all agents except alkalies, and therefore does for those articles which do not require washing with soap or urine. — It has been long known that the magnet has no power of attraction or polarity when first extracted from the recesses of the earth, but acquires it by exposure to the air. It has lately been found (Silliman’s Journal) that a magnet exposed to the sun’s rays became much increased in vigour. — Pure nitrate of silver may he obtained from an alloy with copper, by keeping the salt in fusion, until it ceases to boil, by which the copper is converted into black oxide, and may be separated by solution in distilled water.

— The new metal cadmium has been found in many of our English ores of zinc.

Salts. — Boracic acid has been found in the crater of vol¬ canoes, on the most heated part of their surface, where vapours are continually rising in a white light state, some¬ times soiled with sulphur. The crusts are generally three

44

Analytical and General Review.

quarters of an inch thick, and sometimes more than a toot in extent. It is also met with in scales, and sometimes fibrous. The nature of these incrustations was ascertained by D. Gioacchino Arrosto, of Messina. This acid has been lately extracted also from the lakes of Italy by evaporation, and been introduced in large quantities into Paris, where no customer could be found for it. A similar circumstance seems to have taken place in London, since we observe the Custom House advertises a sale of thirty casks of six cwt, each, the importers having probably abandoned them rather than pay the duties. — Mr. J. F. W. Herschel has published (Edinb. Ph. Journ. ii. 154.) some observations of the hy^posulphurous acid, and its union with metallic oxides, as those of quick- silver and silver, which cannot be well abridged. — Numerous experiments on the Prussic acid, and the combinations it forms with other bodies, may be found in the Annals of Phi¬ losophy, which are not susceptible of abridgment into the compass allotted for our retrospect. — Dr. John, of Berlin, having made vinegar by fermenting bread, (query, rye?) two pounds ; honey, and fruit of the carob tree, ceratonia siliqua, ana one pound and a half ; vinegar, and spirit of wine, ana two pints ; with twenty-eight pints of water; saturated this acid with lime: and on distilling a mixture of twenty-4our ounces of this salt and one ounce of peroxide of manganese, with sixteen ounces of sulphuric acid, diluted with thirteen ounces of water, until no more acid came over, he obtained upon in creasing the heat two drachms of succinic acid. He repeated this process several times with success, and could not find any of that acid in the fruit itself. — In addition to the two new vegetable alkalies, vauqueline and strychnine, another has been discovered in the false angustura bark, or brucea antidysenterica. This alkali retains much water, which renders it bulky, but may be forced out by compression. It is deposited, from its solution in boiling water, in plates resembling those of boracic acid, and, from its solution in alkohol, frequently in the form of mushrooms. It is soluble jn 500 times its weight of boiling water, and in 850 of cold water; is bitter, acrid, and extremely active upon the human frame; it melts at a temperature a little above, that of boiling water, and assumes an appearance like wax ; at a higher temperature it is decomposed, yielding carbone, hydrogene, and oxygene, with scarcely anyr trace of azote. Notwithstand¬ ing the compound nature of this substance, it is considered as an alkali, because, like ammonia, it combines with the acids, and forms with them salts which crystallize with facility.

^ Combustibles. — Mr. Young, in a communication to the

Cultivation of Poppy, for Opium. 45

Society for the Encouragement of Arts, &c., with a view to obtain the premium offered by them to promote the culti¬ vation of the poppy in England for the purpose of procuring opium from it, has shown, that the quantity of opium con¬ sumed in the British Islands is 14,460 pounds annually, besides that imported and bonded for exportation, amounting, by the lowest computation, to 37,500 pounds more.

Mr. Y. found the most advantageous mode of cultivation was in double rows, eight inches apart, and two feet four inch intervals, in which asparagus is cultivated ; the white poppy plants being six inches apart in the rows. The opium is collected by double incisions, at first longitudinally, and afterwards obliquely upwards from the stalk, made by means of two dissecting knives tied together, whose blades are covered with sealing wax to within one sixteenth part of an inch of the edge, that they may not enter too deep. After these incisions are made, the stigma is cut off with another knife. The juice that flows from the wounds is collected by means of a painter’s brush, such as is used for painting the sashes of windows. When the brush is sufficiently charged with the juice, it is scraped off by rubbing it against a slip of tin, fixed in the mouth of a flask strapped across the breast of the gatherer.

Mr. Young estimates the produce of an acre at fifty-six pounds of opium, thirty-six bolls of potatoes, two thousand pounds of maw seed, producing two hundred and fifty pints of cold drawn oil, worth Is. 6d. per pint; one hundred and twenty-five pints of wrarm drawn oil, worth 6d. per pint; and five hundred oil cakes, selling at J 8s. per hundred, the charge for pressing the oil being IQs. per cwt. Poppy oil is at present used almost universally for sallads, being sold under the name of olive oil.

The Rev. Mr. Swayne has shown in detail (Quart.' Journ. viii. 234.) another method of collecting opium from the heads of poppies; and observes that, although collected drop by drop, a single individual, upwards of seventy years of age, collected no less than five ounces and a quarter of the fluid within five hours.

D. Taddei h as found that gluten of wheat is composed of two substances perfectly distinct, gloiodina and zimoma; the first is elastic, the second is fermentescible ; and, when mixed with resin of guaiacum, and kneaded with water in contact with air, becomes of a fine blue; so that the blue colour thus obtained will exhibit the quantity ol gluten in flour, and also the purity of gum guaiacum.

Dr. Maccullocli has given an account ol the growth of

46

Analytical and General Review.

peat from decayed vegetables deposited in peculiar situa¬ tions. He states a remarkable fact, that peat is occasionally luminous, as he has often observed in the bared bogs ol North and South Hist. The luminous matter is dispersed in small points over the brown surface ; and as these are very minute, while the colour of the light is also blue, they are scarcely visible at a small distance ; whence, probably, they have escaped notice. The stagnant water in peat bogs affords, on evaporation, a colouring matter equal to that ol sepia; and he has also shown that alcohol, ether, and the alkaline leys, extract from peat a brown matter, analogous to that capable of being dissolved in water. On evaporating the alcoholic and ethereal solutions, it is obtained in a solid form ; the alkaline solution forms a saponaceous compound, similar to that produced by dissolving bistre or wood tar in alkali.

Peat is a transition from fresh vegetable to bituminous matter.

Fresh vegetable matter, i. e, wood affords, bv distillation, acetic acid, volatile oil, and wood tar, with a variable propor¬ tion of ammonia, combined with the acetic acid ; and if the process is irregularly conducted, these new compounds are decomposed, and there is formed either hydrocarbonic gas, or that and carbonic acid.

The wood tar, by redistillation, affords acetic acid, volatile oil, and pitch. The pitch in a certain state of hardness is the bistre of artists.

The pitch, by continuing this process, becomes a brown or black friable mass, but still continues to give volatile inflam¬ mable matter and acid, until it is reduced to charcoal.

The charcoal gives only hydrogen, and acquires an extreme degree of hardness, becoming incapable of further change.

Wood tar is soluble in acetic acid, and is itself mixed with a proportion of it, which may be separated imperfectly by water, and perfectly by alkalies.

Naphtha, petrol, and asphalt, are analogous to the essential oil, tar, and pitch of wood ; and the phenomena of their distillation are similar.

The essential oil of wood does not mix with naphtha, and the vegetable tar and pitch are not soluble in it: at the boiling heat they are, indeed, taken up, but are deposited on cooling: on the other hand, asphalt urn is not soluble in oil of wood. Hence naphtha offers a test to show the progress of bituminizatiou, or change of vegetable matter in bitumen, of which jet mav, perhaps, be considered as the perfect state.

C o m bit si ible Substances.

47

Peat, submerged wood, bovey or brown coal, surturbrand, are all intermediate stages of vegetable passing into bitu¬ minous matter.

Coal has been supposed to be produced by beating vegetable matter in close vessels under great pressure ; but the produce in this case is neither coal, nor is it in the slightest degree bitumenized. It is only the pitch, (and bistre,) produced in the ordinary distillation of wood; nor could even that be pro¬ cured, unless by some careless mode of conducting the experiment, so as to suffer the more volatile products to escape.

Coal appears to be formed from peat by mere pressure ; for if heat bad been brought into action, the forms of vegetables would have been obliterated, and the coal itself charred, notwithstanding the pressure of the superincumbent strata, which are always porous enough to let the volatile matter escape, as we see whenever a trap vein traverses a bed of coal.

The independent formation of coal perfectly resembles the deposits of peat at the bottoms of lakes. There is, geo¬ logically speaking, no more difficulty in accounting for the deposition of peat under materials which have been converted into rocks, than in accounting for beds of shell limestone, or the accumulation of other organic remains which are found deeply buried beneath rocky strata of later origin.

It has been lately proposed to rectify spirits of wine by pour¬ ing it into a bladder, and after tying it up, to suspend the blad¬ der in a draught of air, or in a stove, the bladder transmitting

O 7 . . . O

water, but not alcohol. — Spirit of wine, sp. gr. 867, was thus rectified to sp. gr. 817 ; and on the bladder being then hung in a damp cellar, the spirit again returned to its original strength. In like manner, wine may be strengthened by tying a bladder over the mouth of the bottle, instead of using a cork.

Mr. Cl egg presented to Mr. Brande a specimen of a brilliant white crystalline substance, found in the con¬ densing vessel of the gas light and coke company’s ap¬ paratus, which was called benzoic 'acid — and which is one of the two substances produced in the first and second distilla¬ tion of coal tar, gradually precipitating from the tar, especially in cold weather, in the quantity of five pounds from one hundred gallons. When freed from empyreumatie oil, it has the following properties : It is inodorous, insipid, extremely volatile, fusible below the temperature of boiling water; rises in brilliant needles and hexaedral plates, often perfectly transparent; melted, it solidifies with much ex pan sion, in a soft fibrous mass, rather heavier than water; highly

48

Analytical and General Review,

inflammable, and, during combustion, smokes very much ; insoluble in water.

Alcohol, sp. gr. 8£0, readily dissolves it, becomes acrid and aromatic, and forms a milky mixture with water. If hot, the alcohol dissolves it in any quantity, and as the solution cools, it is deposited in crystalline flakes.

Sulphuric ether dissolves it at the ordinary temperature in large quantities, and by spontaneous evaporation fine crystals are obtained.

It melts in chlorine gas, and evolves fumes of muriatic acid ; the gas is absorbed, heat is evolved, and a substance is obtained apparently analogous to that from chlorine and olefiant gas; intensely heated in chlorine, it deposits charcoal, but does not burn.

Is much more soluble in hot acetic acid than in cold.

Scarcely soluble in muriatic acid.

Soluble abundantly in sulphuric acid* the solution deep violet, and hears diluting with water without decomposition. By long boiling in sulphuric acid, carbone is deposited, and the greater part volatilizes unaltered ; but the alkalies throw down white flakes, which, if the mixture is diluted, renders it curiously opalescent.

Repeatedly distilled with nitric acid, it suffers scarcely any change; part is retained in solution, which is precipitated by dilution, and part passes over unaltered.

Scarcely soluble in caustic or carbonated alkalies.

Suffers no change from repeated sublimations at tempera- lures above boiling water; and its vapour may even be passed through a red hot tube without decomposition ; if received in a cool glass tube, it crystallizes in white plates, as before.

Melted with potassium, it scarcely acts upon that metal ; and as the mixture cools, it oozes from it in brilliant globules.

Its general resemblance, to the fatty matter of biliary calculi is very strong, but it is less fusible and less volatile : on the whole, it approaches nearer to camphor than to any other body, yet it exhibits some peculiarities.

Contains no oxygen, bift seems composed of carbon and I, yd rogen.

/ Mr. Brande, in bis Bakerian Lecture, thinks that no other compound of carbon and hydrogen can be demonstrated than olefiant gas, ,of 1 hy. + 1 ox. That carburetted hydrogen is in fact a mixture of hydrogen and olefiant gases. Many products in distilling coals are secondary products, as by passing oleflant gas through red hot charcoal, a tar-like substance, possessing the properties of resin, is formed. Sul- plmret of carbon was formed by tiie mutual action of

49,

Vegetable's.

sulphuretted and carburetted hydrogen. The illuminating powers of olefiant, oil, and coal gases, are nearly as 3, 2, 1 ; their heating powers are nearly similar, coal gas being the greatest, and olefiant gas the least, illumination is much greater from several small jets in the burners, placed so near that the different flames can unite. Gas lights, although concentrated so as to produce a sensible degree of heat, do not affect the colour of muriate of silver, nor a mixture of chlorine and hydrogen gases. The concentrated brilliant light of charcoal submitted to galvanic action not only affects the muriate, but causes these gases to unite, sometimes with explosion. Concentrated moonlight did not affect either of those tests.

The singular phenomenon of the rotation of camphire on water is attributed, by Mr. Virey, to electricity, because it ceases on a conducting substance, as iron, being brought near it.— The elementary constitution of camphire has been found, by Dr. Thomson, (Ann. of Phil.,) to approach very nearly to seventeen atoms of carbone, twenty of hydrogen, and two of oxygen; and that of animal charcoal is stated, by Dobrenier, to be six atoms of carbon and one of azote .'—Dr. Thomson has also given an abstract of his researches on indigo, a singular substance, in a chemical point of view, as the addition of oxygen to it communicates alkaline properties to it, and the subtraction of oxygen gives it acid properties.

Vegetables, — Professor Amici imagines he has ascer¬ tained, by his microscopical discoveries, that the motion of the sap in chara is occasioned by a galvanic apparatus, forming regular parallel stripes, composed of small green globules.

Vancouver, Flinders, and Peroo, appear to have mistaken certain plants impregnated with calcareous earth, found in New South Wales, for corals, left by the recess of the sea;

Mr. Drummond has found the powder in the capsules of mosses to be real seeds, which germinate either on earth, or water, and to produce at first articulated filaments, which Hedwig regarded as cotyledons, and Sprengel as minute eon- fervee ; but which are neither, but only germinating expan¬ sions of the seed itself, somewhat analogous to what is called the spawn of mushrooms. Byssus velutma is nothing but polytrichum aloides in vegetation.

Sir G. S. Mackenzie adduces many trials to show the use of common fish oil rubbed on the bark of trees, so as just to give them a shining appearance, in destroying insects, and preventing their increase. Unfortunately, his gardener was not aware of its power in destroying the buds which were

VOL. xiv.— no. 79. h

Selections,

50

t

touched by the oil, and rubbed it over them also. The buds were destroyed, but new shoots sprung out in their places.

A great improvement is made in the culture oi onions by transplanting young plants in the beginning of spring : by this adoption of the Portuguese plan, they have been obtained equal to those imported, and to the size of one pound nine ounces a single bulb.

The growth of the fungus called the dry rot, that terror of house and ship owners, is said to be prevented, and ^the fungus itself, if it has already attacked the timber, destroyed, by colouring the cellars, &c. with whitening, to which so much green vitriol has been added as to give it a yellow hue.

The fruit of feuillea cordif’olia has been long esteemed an antidote to vegetable poisons, as hemlock, mix vomica, and rhus toxicodendron; and this fact is confirmed by the nume¬ rous experiments of Mr, Drapiez.

Animals. — An excellent paper of Dr. Henry, on urinary and other morbid concretions, is inserted in the Annals of Philosophy for February last, but which is not capable of being abridged. — A number of round bodies resembling pearls, about the size of mustard seed, which appear to be composed of lime, carbonic acid, and some animal matter, have been lately presented to the Hunterian Museum at Glasgow, having been sent from Canada, and taken, after death, from the urinary bladder of a dog.

PART III.

Observations on the Theory which ascribes Secretion to the Agency of Nerves. By YV. P. Alison, M.D., F.R.S.E., &c., Professor of Medical Jurisprudence and Medical Police in the University of Edinburgh.

[ From the Quarterly Journal of Science.']

[Continued from page 513, Vol. XIII.]

After having seen reason to think that muscular irri¬ tability, although often influenced through the medium of nerves, is in no case dependent upon any influence derived from the nervous system, 1 think we may go a step further, in laying down the fundamental principles of this kind of inquiry.

Alison on the Nerves .

51

Whatever other purposes the nervous system may be destined to serve in the animal economy, it seems obvious that it is intended to serve as a medium of communication between mind and body, and that all the changes in the bodily functions which are observed to follow mental acts, are produced through its intervention.

ft is generally agreed among physiologists, and I think it cannot be doubted, that som e physical change is produced in the nervous system by every mental act which, through its in¬ tervention, influences any bodily function. If this be so, it may naturally be expected that these changes in the nervous system may be readily imitated by the application of physical agents; which furnishes a ready explanation of the effect of such agents, applied to the nervous system, on the various functions ; and, therefore, when any effect is observed in any function, from the application of physical agents to the nervous system, analogous to the changes produced in the same function by mental acts or affections, instead of arguing from that fact, the necessary dependence of the function in question on any influence derived from the nervous system, it seems more reasonable merely to suspect that those physical agents must have wrought a change on the nervous system, somewhat analogous to that which these mental acts or affections had been wont to produce.

The opinion, that secretion is dependent on nervous in¬ fluence or energy, has been maintained by different authors; but the best arguments in favour of it are those which have been lately stated by Sir Everard Home Dr. Wollaston f, Mr. BrodieJ, and Dr. Wilson Philip |j.

Of these, the most important is derived from the observa¬ tions of the two last authors, on the effect of dividing the eighth pair of nerves on the secretions of the stomach. Dr. W ilson Philip found that no change takes place on food that has been recently taken into the stomachs of rabbits, on which this operation is performed, even when they live twenty-six hours after the operation, implying that the gastric juice had not been secreted. This is confirmed by the observation of older experimenters, that in animals killed by the division of the eighth pair of nerves, the contents of the stomach are found putrid; the effect, l presume, of their remaining some time at the temperature of the internal parts of the body, without being acted on by a chemical solvent. (See Haller ,

* Philosophical Transactions for ISOq. t Philosophical Magazine for I8O9.

X Philosophical Transactions for 1814, p. 102. || Expl. Inquiry, &c. p. llff, et seq.

Selections.

Experiences mr les Parties Sensibles et Irritables, No. 18-1 and i85.) And Mr. Brodie found that the ordinary effect of arsenic to produce an increase of the mucous and watery secretions of the stomach and intestines, is prevented from taking place, by dividing either those nerves in the neck, or the branches of them which supply the stomach, on the lower part of the oesophagus^. From these experiments these authors conclude, that the secretions of the stomach and other parts are dependent on an influence derived from their nerves.

According to the principle above laid down, the facts just mentioned, although obviously susceptible of explanation in this manner, are not sufficient to justify this conclusion. Without supposing the secretions of the stomach to depend upon any thing derived from the nervous system, we may suppose them liable to change, or even to total annihilation, from certain lesions of that system. And although the kind of lesion which produces this effect on these secreting organs be different from that which stops the movements of the heart, yet, as we are ignorant of the manner in which any lesion of the nervous system effects muscular action or secretion, we are not more entitled to conclude, that the secretions of the stomach depend on its nerves, from finding them stopped by the division of these nerves, than Le Galiois was to conclude, that the action of the heart depends on the spinal marrow, from finding it stopped, in his experiments, by crushing that organ.

If the conclusion in question does not necessarily follow from the experiments, we are justified in refusing our assent to it, without pointing out any other manner in which the results of these experiments may be explained. Different theories may perhaps be formed for this purpose; but there is one consideration that appears to me particularly deserving of notice. The eighth pair of nerves are generally regarded as those which are most concerned in the sensations of the stomach. Now it is pretty certain that different secretions are very dependent on certain sensations. No one can doubt of the effect of the sensation of grateful food in the mouth, upon the action of the salivary glands. I think it cannot be doubted, that dividing the nerves of the tongue and palates, and so paralyzing the organ of taste, would greatly diminish the flow of saliva during the mastication of

* He had previously found the secretion of urine to cease after the spinal chord is divided in the neck, or the head removed, both in rabbits and dogs ; notwithstanding that the circulation is kept up by artificial respiration.— See Philosophical Transactions for 1811.

Alison on the Nerves.

55

food; but we know that the salivary glands cannot derive any energy from these nerves, because they are supplied by other nerves. By dividing the eighth pair of nerves after an animal has taken food, the natural sensations which accom¬ pany and succeed the reception of food into the stomach are prevented from taking place; and the painful sensations of dyspnoea and nausea are produced : and may not this be sufficient to explain the failure of secretion in the stomach ? The same supposition, of diminution, or destruction of sensa¬ tion, and of the substitution of sensations of a different kind, may explain the want of any increased secretion from the action of the arsenic in Mr. Brodie’s experiments.

When, therefore, Mr. Brodie concludes from these expe¬ riments, that “ the suppression of the secretions was to be attributed to the division of the nerves;” and “ that the secretions of the stomach and intestines are very much under the control of the nervous system,” his inferences must command general assent; but when he hazards the farther conclusion, that “ the secretion was prevented in conse¬ quence of the nervous influence having been interrupted,” 1 would beg to ask, what is the precise meaning attached in this instance to the te*lm nervous influence ; and what proof there is of its having been interrupted ?

If it be meant merely, that the nerves are prevented from performing their accustomed actions, in regard to secretion, we may object to the expression, because it seems to imply that these actions are constant and essential to the effect; whereas, it is very possible that they may be only occasional, and may modify, without assisting, the secreting actions.

If it be meant, that some influence derived from the nervous system, really essential to secretion, is cut off’ by the operation, we may object to the conclusion, because the fact may be equally well explained by supposing the lesion of the nerves to communicate a noxious influence to the secreting organ, without intercepting a salutary one.

The other arguments in favour of the dependence of secre¬ tion on the nervous system, chiefly insisted on by the authors formerly mentioned, are these : —

1. Changes in the blood, somewhat similar to those pro¬ duced by secretion, particularly the coagulation of the albu¬ minous, and the separation of the saline part, may be pro¬ duced by galvanism.

2. Galvanism is excited by the contact of the nerve and muscle of an animal recently dead ; and a galvanic pile may be formed of alternate layers of nervous and muscular substance.

" 3. The action of nerves on muscles is similar to that which js exercised by galvanism on muscles.

54

Selections ,

From these facts it is concluded, that what has been called nervous influence, or energy, is, in all cases, galvanism ; and from them, taken in connexion with the facts just noticed, of the cessation of secretion on the division of the nerves sup¬ plying certain secreting organs, a strong presumption is thought to arise, that secretion is owing to a galvanic action propagated along the nerves, and is to be numbered with the other well-known chemical effects of galvanism.

In regard to secretion, a still stronger ’ argument in favour of this theory is adduced by Dr. Wilson Philip. He found that when the secretion in the stomachs, either of rabbits or dogs, is suspended by cutting the eighth pair of nerves, it may be restored by applying galvanism ; and the ordinary changes may be effected by the help of this agent, on the food previously taken into the stomach.

It is obvious, however, {taken for granted that all sources of fallacy in these experiments were avoided,) that even this fact admits very readily of a different explanation. It may be said, that the secretion in the stomach does not depend on its nerves, but is liable to be influenced through them ; that the shock of the division of the nerves acted as a powerful sedative, and suspended the secretion, but that the stimulus of the galvanism was sufficient to restore it.

It is obvious, also, that if this last explanation be admitted, these experiments of Dr. Philip must be regarded as furnish¬ ing a decisive argument against the dependence of secretion upon the nervous system. For here we have the nervous influence cut off, and yet secretion going on. On the suppo¬ sition that the nervous influence is really essential to secre¬ tion, this can only be explained by supposing the galvanic influence, which is substituted for it, to be really the same thing. 1

If, therefore, we can make it probable, that the changes which occur in the nervous system are not galvanic actions, we need go no farther, after these experiments, in order to show that the nervous system is not necessary to secretion.

But, on the other hand, even if we admit the galvanic nature of nervous actions*, it does not follow, from these ex¬ periments, that they are essential to secretion ; for the effect of the galvanism, applied in these experiments of Dr. Philip, may be merely to counteract a noxious influence resulting from the division of the nerves, not to restore a salutary one.

(To be continued,)

* In this paper I use the term “ nervous actions” as a short expres¬ sion for those unknown changes in the nervous system, which are pre-

sinned to take place on various occasions in the 1

i v ! n 2 boc

presuming to offer an opinion as to the nature of these changes

d y , witli out

Spontaneous Perforation of the Stomach.

PART IV.

FOREIGN MEDICAL SCIENCE AND

LITERATURE.

■' Him -■■- — ■■ — — "■- — pm-TTH

1

* *•' V

1. analysis of journals*. (French).

N»

New Journal of Medicine.

January 1 820. Vo l. V J I . — Case of spontaneous Per fol¬ iation oj the Stomach. 13y M. Segalas.— The following were the results of dissection in this case, which exhibits obvious and interesting relations with juridical medicine. The subject, a female child, aged between six and seven months. Abdomen. — Stomach natural in its site and connexions, but partly reduced to a soft greyish pulp, whereby its larger ex- Iremity, and about a third of its posterior and anterior surfaces, were destroyed; and an irregularly rounded orifice, with fringed borders, left; no trace of inflammation, external or internal ; mucous membrane deficient to a greater extent than the muscular, and the latter than the serous. Duode¬ num^ and commencement of jejunum containing a chymy matter; and the rest of the intestinal canal, a small quantity of liquid faeces. The whole of its mucous membrane dis¬ playing, without actual ulceration, variously sized and figured, but commonly rounded patches of a greenish, yellowish, or, for the most part, slightly reddish hue. Liver discoloured. Spleen unusually firm. Peritonaeum without effusion or morbid appearance. Cranium and vertebral canal. — Arachnoid highly vascular. Whole cerebral mass ex»

* The analysis of the foreign journals for 1819 was unexpectedly protracted to such a length, as to preclude all possibility of intro¬ ducing the general review of foreign medical literature, which we proposed and promised. Should our labours be continued for another year, we trust that we shall possess more leisure for, and be better prepared to execute the arduous task. In commencing the foreign department of another volume, we have, after much considera¬ tion, determined on so far modifying our plan, as to combine the advantages of an analysis of journals with a selection and record of the more interesting facts and opinions scattered in the vast field of foreign literature. The journals we propose to regularly analyze are the Nouveau Journal de Medecine, the Bulletins de la Faculte, and the Revue Medicate. — Hufeland’s Journal der Practischen Heilkunde, and the Italian Nuovi Commentari di Medicina et di Chirurgia, as soon as we receive it. — P.

56 For sign Medical Science and Literature.

tremely soft. Pia mater containing, in the ventricles and on the surface of the brain and spinal chord, two ounces of a limpid serum. Thorax sound.— The history oi this case is, unfortunately, very imperfect. Diarrhoea and vomiting, followed by great emaciation and debility, were the pro¬ minent symptoms. The former was ol six, the latter oi three weeks’ duration. Constant drowsiness ensued. Death occurred immediately after an unavailing effort to vomit. Remedies — baths, mucilages, stimulant liniments.

Case of M axilla- Dent ar 'Neuralgia , successfully treated by Division of the Nerve. By M. Bombard. — This appears to have been a well marked and severe case oi neuralgia, in a man of tall stature and nervous constitution, aged forty-eight, who had been much exposed to atmospheric vicissitudes. The attack occurred suddenly at night, in August 1819, at the point where the left inferior maxillary nerve emerges from the mental orifice; and radiated along its branches. The paroxysms were frequent, protracted, and horribly severe. During them, the saliva was abundantly poured out ; and the left side of the face was agitated by a tremulous and vibratory motion. The vision of the corresponding eye indistinct. For six weeks, the man scarcely slept. The moxa was applied to the lower jaw with good effect; but in October the pain recurred with violence. Speaking, mastication, or even opening the mouth, served to re-excite it when absent. For two months, all the usual remedies, local and general, were employed in vain ; and on the 7th of December, the nerve was divided at its exit upon the cheek, The pain instantly subsided. Half the lower lip became numbed, but recovered its sensibility in a few days.

Periodical Cough, transformed , by the Use of Belladonna , into Attacks of Hysteria , which were subsequently cured by Cinchona. By Dr. Chomel.— A lady, aged twenty-one, after having repeatedly sustained attacks of hysteria, was seized with periodical cough, commencing every afternoon about two o’clock, and continuing seven or eight hours with ex¬ traordinary violence. During the paroxysm, which was accom¬ panied by excessive perspiration, a small quantity of clear frothy liquid was expectorated. Great emaciation; appetite bad ; menstruation painful and irregular. The cough, at the period of its first invasion, did not continue more than an hour. The patient then suffered also from intermittent fever; the access of which was distinct from that of the cough, and cured by the cinchona, without any mitigation of the latter. An emetic previously administered, the extract of belladonna was employed, and had the effect of transforming the cough into real attacks of hysteria, which readily yielded to the

Case of Bon lit nia , fyc. Sc

57

cinchona. The patient not only recovered her health, but became remarkably stout. The “ Report of the preceding- case, by Portal and Dumeril, is merely an abstract of it, with allusi ons to other instances of disease of a nearly similar natn re.

Boulimia with Hcematemisis ; a case observed by MM. Bouresehe and Calmeil. — An instance of habitual voracity of appetite, complicated with frequent attacks of gastric hae¬ morrhage. The subject, an unfortunate girl, violated by her father at a very early age, and driven to prostitution in order to satisfy the cravings of her unnatural hunger; during which her intellect seemed to be deranged. Various remedies were employed without any decided benefit.

Sketch of the Medical Topography of the Convent of Mount St. Bernard , partly compiled from Notes of the Prior Bisela. By M. Hippol. Cloquet. — This institution is destined to afford shelter to travellers, from the storms and inclemency of the Alpine regions, upon one of the eminences of which it is situated. During eight months of the year it

• • • 'A' v t

is buried in snow. The atmosphere is exceedingly light, and pleasant of respiration to healthy subjects; but produces oppression and dyspnoea in asthmatics, and syncope in the delicate. Wounds require twice or thrice the time for their cicatrization here as in the plains, and medicines ope¬ rate with a greatly diminished energy. The appetite of those who respire the air of this mountain is commonly very keen, and digestion rapid ; but the situation is far from being healthy, or favourable to longevity. Bilious and inflamma¬ tory affections, apoplexy, cynanche, and rheumatism, are the prevailing diseases. Removal to a temperate and sheltered situation is the only efficacious remedy for the latter. The only pleasant months are July, August, and September. From July JS18 to June 1819, sixty fine days were expe¬ rienced. During every week in 1816, there was snow. Water, in this elevated situation, boils, at the mean height of the barometer (twenty inches, eleven lines), at about the temperature of 200° Fahrenheit ; and the hygrometer, not¬ withstanding the presence of eternal snow and fog, indicates uncommon dryness.

Note on the Coincidence of the Earthquakes and Yellow Fever of the Antilles . By M. Le Chevalier Moreau de Jonnes. — An opinion has prevailed in the West Indies, and on the continent of America, that the vapours exhaled from fissures of the earth, caused by the terrible convulsions to which these regions are exposed, constitute the source of yellow fever. Such a notion, the writer shows, is utterly unfounded. A recent earthquake at Martinique occurred

VOL. xiv. — no, 79. i

58

Foreign Medical Science and Literature.

during a violent storm of wind. M. Moreau de Jonnes asserts that this singular . coincidence between geological phenomena and those of the atmosphere has frequently been observed.

Bulletins of the Faculty of Medicine of Paris , 1820.

‘'No. I.

On a Foreign Body introduced into the Intestinal Canal. By Dr. Dubois. — A juggler, aged twenty-live, taken by? surprise while in the act of introducing a flexible metallic blade into the oesophagus, involuntarily relinquished his hold, and it immediately descended beyond his reach. Violent pains in the thorax, epigastric, and umbilical regions, were the immediate consequence of the accident. Fourteen days of constant suffering succeeded. The extremity of the instru¬ ment was felt projecting a little above the umbilicus. Broth formed the patient’s sole nourishment: bowels completely constipated. Night of the 14th, pains about the umbilical region intolerable : relieved next morning, and the blade had descended to the right side of the abdomen. An evacuation from the bowels now for the first time. Pains in the thorax and epigastrium subsided, and replaced by violent colic on going to the night-stool. After a lapse of two months, the man was able to traverse the country without inconvenience; but, six weeks subsequently, felt slight pain in the situation of the foreign body: here an abscess immediately began to form, and the man was admitted into th<g hospital of Lille. T he abscess, on incision, gave issue to a quantity of faecal matter; and, not completely cicatrizing, a stercoral fistula remained. Other two abscesses formed around the first; and, spontaneously bursting, became fistulous. Many fruit¬ less attempts were made to discover the blade; and repose and cleanliness were alone prescribed. Several months thus passed away ; and, one year after the accident, the patient presented himself to Professor Dubois in Paris. At that period, three fistulous openings existed in the right groin. Faecal matter issued from the largest; yet the bulk of the excrement was naturally expelled. The main aperture had an oblique direction backward and downward to the extent of four inches. A probe passed into it, on reaching the iliac fossa, communicated to the fingers the impression of a hard and rugous body. The two other orifices simply communi¬ cated, beneath the integuments, with the first. This having been for two days dilated by the introduction of bougies, the extraction of the foreign body was determined on, and executed by Professor Dubois. An incision having been made through the skin, muscles, peritonaeum, and the intes-

Asphyxia in an Infant Cured. 59

tine adherent to the latter, the metallic blade was with some difficulty extricated by the forceps. It measured ten inches and a half in length, one inch in breadth at its widest, and six lines at its narrowest part; rounded and smooth atone extremity, rough and angular at the other. The edges were smoother and thicker than the rest of the blade ; and exhi¬ bited here and there marks of corrosion. Simple dressings were applied to the wound, from which great quantities of blackish fluid escaped. No evacuation from the anus; absti¬ nence and injections prescribed. The greater part of the fluid of the latter issued from the wound. On the 8th day, the patient had a natural evacuation; the discharge from the opening was nearly suppressed; and from this moment its extent gradually diminished, and, in one month after the operation, was healed, with the exception of a very minute aperture, from which gas, and a very inconsiderable quantity of pus, continued to escape.

In most cases of introduction of a foreign body into the intestinal canal, observes the writer, where the subject reco¬ vers, the ingested substance, after traversing the whole extent of the bowels, is either arrested at the orifice, or evacuated from the rectum ; or, in some part of its course, gives rise to an abscess of the abdominal parietes, from which it is spon¬ taneously voided, or artificially withdrawn. But, reviewing the train of symptoms which in this case exhibited themselves, he thinks that the instrument, arrested in the stomach, and supported by ifs point on the fundus of the organ, had excited active inflammation, from which adhesion and ulceration between the stomach and transverse colon resulted. Through the aperture thus made, the instrument probably descended into the colon, and from thence into the ascending portion of the intestine and the caecum, from which it was at last extracted. A retrospect of all the phenomena displayed in the case, and reflection on the communications wdiich frequently are established between different portions of the intestinal canal, and on the transport of foreign bodies from this to the bladder, justify, in the author’s opinion, the infe¬ rences here drawm.

Asphyxia o f a new-horn Child , produced by Compression of the Umbilical Chord , and cured by Inflation. By Dr. Pernet.=— The lower extremities and trunk of the child had in this instance been protruded nearly four hours from the vagina, when the author was called. The patient in the eighth month of pregnancy. Delivery immediately terminated. The child exhibited appearances of complete asphyxia; pulsation of the heart imperceptible ; body almost cold; and limbs retaining any position in which they were placed. All the

L

fiQ Foreign Medical Science and Literature .

usual remedies fruitlessly employed by ihe assistants, the child was abandoned as dead. By means, however, of a quill, artificial respiration having been kept up for a consi¬ derable time, at intervals signs of animation were evinced ; and the child, by perseverance in this mean, and the employment of a warm bath, was eventually rescued from its almost hopeless situation. It was subsequently removed into a warm chamber, and enjoyed perfect health.

Funeral Oration on Professor JBourdier . By Professor Dumeril. — The subject of this mournful eulogy, Joseph- Francois Bourdier de la Mouliere, was born at Belley en Buge^y, department of the Ain, November 14th, 1757- He was descended from an ancient and respectable family. After having honourably distinguished himself in his studies, he graduated in October 1784. From being first Physician of a military hospital, he was, in 1794, recalled to Paris, and appointed to the chair of internal pathology, on the institu¬ tion of les Ecoles de Sante. He w>as subsequently appointed Physician to the Empress, and Physician to PHotel-Dieu ; and received, in ISIS, the decoration of the Legion of Honour. The time of his death is not precisely stated.

II. Select Cases and Memoirs,

Pathology and Practice of Medicine.

1. On the Influence of Gravitat ion on some of the Pheno¬ mena of Life*. — M. Isidore Bourdon f, an indefatigable student of PHopital St. Louis, has recently i?k?en employing himself on this interesting subject ; and published the result of his observations and inquiries. He commences the exposition of the facts, demonstrative of the influence in question, by that from w hich he derived the first idea of it. He one day accidentally remarked the impracticability of respiring by that orifice of the nose which corresponded to the side upon which he reclined. On turning to the opposite side, he found that the orifice, before obstructed, became gradually free; while the orifice, now dependent, was closed in its turn. In a supine position, both nostrils continued equally open. The experiment, frequently repeated, inva¬ riably afforded the same result. From this, and other analo-

* Essai sur 1’Influence dc la Pesanteur sur quelques Phenomenes de la Vie; presente a la Societe de la Medecine de Paris, le premier Juin, 1819. Par M. Isidore Bourdon.

t This is the young gentleman who so boldly, and, in our opinion, so successfully, entered the lists with Professor Magendie, on the interesting but controverted subject of the action of the stomach in vomiting. Sec Repository, Vol. XIL page 68.

Influence of Gravitation in the Animal Economy. 6 1

gous facts, M. Bourdon considers himself justified in assert¬ ing, that the transient obstruction of one of the nasal fossae depends on gravitation of the blood, and stagnation of an increased quantity of this fluid, in the tissue of the pituitary membrane, which is then loaded, and more or less thickened. Hence he concludes, that the influence of gravitation parti¬ cularly manifests itself in the relative phenomena of circula¬ tion ; and that such influence principally consists in rendering the circulation of venous blood more difficult on the side towards which the body is inclined. Considering afterwards that persons in general recline more frequently on one side than on the other, he asserts, that this continued situation must leave, even in perfect health, unequivocal traces of its influence on the venous and capillary circulation. Conse¬ quently, it is by no means to be wondered at that patients * have their faces flushed upon that side upon which they commonly recline Hence also it happens, that epistaxis most frequently takes place on the right side with persons confined to bed; except in peripneumony and effusion of the left side, and pleurisy of the right, from causes which are connected with the kind of decubitus imposed by these diseases.

The action which prolonged decubitus on one side of the bodv exercises upon the venous and capillary circulation, must at length affect the other organs, as it does the pituitary membrane; and this action is still more manifest in those which, like th# brain, possess, with numerous and delicate blood-vessels, considerable softness. Thus, in sanguineous apoplexy, the greater number of extravasations takes place on the right side. Out of eighteen cases of cerebral extrava- sation which the author observed in 1818, at la Charite, nine existed on the right side, four on the left, and five on both sides at once. Similar results have been obtained by most of those who investigate on the dead body the causes of disease. The author, after having combated the opinions of Morgagni and Portal respecting the great frequency of cerebral haemorrhages of the right side, doubts not that this difference is attributable to the influence of the gravitation of blood upon the brain. He afterwards remarks, that from the same ason paralysis, symptomatic of sanguineous effusion, is much more frequent in the left side than the

* This explains the principle upon which Galen, in the course of an acute affection, predicted the occurrence of epistaxis of the right side, in a subject who probably always lay on that side of the body; since his face, according to the report of Galen, had been for some time more flushed on the right than the left side.

6 ’2 Foreign Medical Science and Literature .

right; and, consequently, advances the assertion, that paralysis so frequently affects the left side of the body, only because most persons have contracted the habit of reclining on the right side. In sixty-three cases of hemiplegia, which occurred in eighteen months, at PHopitai St. Louis, thirty- six were of the left side, and twenty-seven only on the right. While, however, attributing to the influence of gravitation the frequency of sanguineous apoplexy on the right side, and of symptomatic paralysis on the left, the author is far from asserting that this is the only cause of such occur¬ rences.

Gravitation also exercises its influence on tissues of firmer consistence than the brain; for instance, on the cellular structure of the cheeks in young persons of lymphatic tem¬ perament, and on the conjunctiva in the subjects of chronic ophthalmy. In fact, says the author, it may be observed, that fluxions of the right cheek are much more frequent than of the left; and that, in persons suffering from chronic ophthalmy, the right eye is commonly the most swollen and diseased. To two patients who presented this latter disposi¬ tion, and who habitually reclined on the right side, M. Bourdon recommended that the}7 should for a time conquer the habit, and lie on the left. This change of position had nearly the result anticipated. The right conjunctiva was sensibly relieved; while the left became more red and thick. To this same influence the author ascribes that thickenin g of the integuments of the thorax, frequently very considerable, of that side upon which the patient has lain during a severe affection.

What the influence of decubitus determines with regard to the integuments, it produces also on the internal organs. Hence the reason, according to M. Bourdon, why inflamma¬ tion of the thorax most frequently takes place on the right side. Out of forty-four cases of adhesion of the lungs, wit¬ nessed by him in 1818 at la Charite, twenty-six were on the right side, and eighteen on the left; and, out of twenty-one cases of hepatization, thirteen belonged to the right lung, and eight to the left.

With regard to effusions, they are almost equally frequent on both sides of the thorax. Out of twenty-nine cases, twelve were on the right, thirteen on the left, and four on both sides at once.

The author has remarked, that pulmonary tubercles are commonly more numerous, or more advanced and softened, on the left side than the right; and that if there exist tuber¬ cles only in one lung, it is most frequently in the left. Bayle, PHerminier, Fouquier, and Chomei, it will be recollected,

6*3

Influence of Gravitation in the Animal Economy i

have observed, that tubercles occupy almost exclusively the summit of the lung, while hepatization is commonly seen at the base of the organ. Connecting these latter facts with those which he had previously observed, M. Bourdon consi¬ ders himself justified in drawing the following conclusions:

1. Tubercles occupy particularly the left lung, and more frequently" the summit than the base of these organs; while hepatization is most commonly found at their base, and especially in that of the right side. 2. The seat of the pulmonary tubercle thus differs from, and is indeed the inverse of that of hepatization and inflammation. Hence it seems reasonable to infer, that tubercles of the lungs are not invariably the product of pre-existing inflammation. 3. The left lung, which in most persons acts twenty-four hours, while the right acts only sixteen, is also that in which tubercles are the most frequent, numerous, and advanced. 4. There exist evident relations between this observation: tubercles at the summit of the lungs , hepatization at their base, and this other observation, tubercle of the left side , hepatization of the right. In fact, if, for the second case, gravitation exercise some influence on the inverse seat of the two diseases, by the more frequent decubitus on the right side, it must also possess an influence in the first case by the vertical posture, which is the most common of all.

From all the observations contained in the memoir of 1M. Bourdon it results,

1. That decubitus exerts great influence on some of the phenomena of life, even in persons who enjoy the most perfect health.

2. That the side of the body in which gravitation unites its action to that of the heart, is also the side wherein the most decided phenomena of circulation are produced.

3. That, th us combined with the action of the heart, the influence of gravitation gives rise to phenomena which, under some circumstances, it would be wrong to regard as critical efforts.

4. That to the influence of decubitus may be referred the frequency of real crises, haemorrhages, and inflammations on the right side, and paralysis on the left.

o. Finally, that this influence may be turned to a favourable accoiu in medicine, either for the cure or prevention of diseases or the diminution of their frequency on one side of the body.

M. Bourdon thinks, with reason, that long-continued reclination on the same side does not limit its influence to the phenomena of circulation, but extends to many others. He inquires, whether gravitation may not be the cause of the

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Medical and Physical Intelligence .

obliquity of tbe: uterus to the right, so frequently observed in pregnane}', as well as the first position of the foetus at the time of delivery? And he terminates the memoir by the exposition of some facts corroborative of his assertions, which he has himself observed, or borrowed from the works cf eminent pathological writers.

PART V ;

- - — — - -

MEDICAL AND PHYSICAL INTELLIGENCE.

ROYAL SOCIETY.

April 20. — A paper, by W. Kitchiner, M.D , was read, entitled, “ On an Improvement in the Eye Tubes of portable Achromatic Telescopes/' It has been long known, that by increasing the distance between the two glasses next the eye and the two next the object, the magnifying power of telescopes may be nearly doubled. After several attempts to improve this principle, the author stated that he has at length succeeded, and rendered it so complete, that vision throughout a great range of power is perfect even to the edges of the field. Applied to an object glass of 30 inches focus, and 2.7 inches aperture, he stated that bis improved eye tube produces in the most perfect manner any intermediate power between 70 and 270, and with an achromatic telescope of 44 inches fccus, any intermediate power between 90 and 360. The light by the use. of four glasses was admitted to be diminished, but the images of fixed stars were stated to be better defined and rendered more distinct than by the use of any other eye tube.

At this meeting also a paper was read, on the different Qualities of the Alburnum of Spring and Winter felled Timber, by T. A. Knight, Esq. It has been long supposed that oak timber felled in the winter is superior, to that felled in spring, but the cause of this difference has not been inquired into; and the felling of timber in the winter has been discontinued in consequence of the superior value of spring bark. The author proceeded to relate some experiments he had instituted on the subject. These were made on two similar oaks of about 100 years old, which grew near each other, and which were felled at the different seasons above mentioned. * The specific gravity of the alburnum of the spring felled oak was 0.666, while the speci#c gravity of that of the winter felled was 0.565. Two equal blocks were then cut out of the alburnum of each, which, being well dried, were suspended in a damp room for ten days : at the end of this time it was found that 1,000 grs. of the spring felled timber had gained 162 grs. while the same quantity of that felled in winter had gained only 145 grs. Hence there was found a striking difference between the properties of the two. Mr. Knight stated it to be his opinion, that oak timber would be much improved, if the tree, after being barked in the spring, was permitted to stand till the following winter. He concluded by stating, that although he had not made the experiment, he had little doubt that the same observations would apply to the heart wood as to the alburnum.

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Medical and Physical Intelligence.

At this meeting ‘also, a paper, by Assistant-Surgeon Hood, was begun on Diarrhoea Asthenica.

May 4. — The above paper was concluded. This disease is endemic annually among the indigent Hindus, on the Malabar and Coromandel coast, and usually appears about the commencement of the monsoons. The symptoms are diarrhoea with spasms of the bowels and flexer muscles ol the legs, sickness, &c. and the pulse is slow and feeble. To these succeed a shivering fit, and excessive thirst; and if proper treatment is not speedily adopted, the pulse becomes weaker, the features contracted and ghastly, the pain violent ; and death, preceded by coma, soon closes the scene. After discussing the various remedies which have been em¬ ployed in this disease, he proceeded to recommend that, on an attack, the patient should take two ounces of brandy and ten drops of sulphuric acid in half a pint of cold water, and that this dose should be repeated at proper intervals. He directed also that sinapisms should be applied to the region of the stomach and extremities to promote reaction. Bitters and astringents also were stated to be occasionally useful.

At this meeting a paper was also read, on the Mode of Formation of the Canal for containing the Spinal Marrow, and on the Form of the Fins, it they deserve that name, of the Proteosaurus, by Sir E. Home. The structure of the vertebrae of this animal was stated by Sir E. to be in¬ termediate between that of lizards and cartilaginous fishes ; and to bear so close a resemblance to those of the shark, as to have been often mistaken for them. They are composed of bone, and have a body, canal for the spinal marrow, and a process for the attachment of muscles ; but the body consists of one piece, while the spinous process and two lateral branches which adhere to it, constitute another; and between these two pieces there is no bony union, but a species of joint peculiar to themselves. Hence the foramen in the middle thus formed appears unusually small. In the specimen from which the above description is taken there is also a fore foot, paddle, or fin (for it is difficult, according to Sir E. Home, to say which it ought to be called), which, though not quite perfect, is much more so than any that has hitherto been found. This was stated to present nothing like the thumb or claw for laying hold, which dis¬ tinguishes the animals that occasionally inhabit the sea, and come to shore to lay eggs, or deposit young. If it be called a fin, it must be considered as made up of bony materials, the joints of which are very numerous, so that it may possibly perform such an office.

May 11. — A paper was read, entitled, “ On the Fungi which constitutes the colouring Matter of the Red Snow discovered in Baffin’s Say,” by F. Eauer, Esq. The author stated, that in the winter he put a small quantity of the red globules composing the substance in question into a phial filled with compressed snow, which was placed in the open air, in a north-west aspect. A thaw coming on, the snow was found melted, and the wrater being ‘poured off, more snow was added. In two days the mass of fungi was observed to be raised in little pyramids, which gradually increased in height, occupying the cells of the mass of ice. A thaw now continued for some time, and the fungi fell to the bottom of the water in the phial, where they occupied a space about double that ot their original bulk. These fungi also appeared to be capable of vegetating in water; but in this case they produced green, instead of red globules. By exposure to excessive cold, Mr. B. found that the original fungi were killed ; but that their seeds still retained vitality, and if immersed in snow, they regenerated new fungi, generally of a red colour. The author supposes that snow is the proper soil of these fungi. The paper was accompa¬ nied by beautiful drawings illustrating the different appearances described, i (See Retrospect, p. 42.)

VOL, XIV. — NO, 79.

K

©6 Medical and Physical Intelligence.

ROYAL ACADEMY OF SCIENCES AT PARIS.

Botany. — The first known and the most useful of the palms is undoubt¬ edly the date tree; it is one of the most valuable productions of Barhary and Egypt, and is also cultivated with advantage in several of the southern countries of Europe. M. Delisle, who carefully observed the cultivation or it, while he was attached to the expedition to Egypt, described it very fully in* a memoir which he presented to the Academy. This tree is cultivated from seeds, from suckers, and even from slips. The mode of treatment of the slip, which consists in replanting the top after having separated it from its trunk, had been already mentioned by Theophrastus and by Pliny; and M. Delisle was assured by the Arabs that it is still practised. It is well known that the date tree has the sexes separately on different, plants ; the suckers of each tree producing plants of the same sex. The inhabitants, in order to gain as much profit as possible from their land, take care to plant no more than the small number of males which are requisite for the artificial fecundation of the females ; and if, from any cause, the catkins of these male date trees should not be placed at a proper time in a situation to throw their fertilizing farina on the female flowers, the fruit will not ripen, and the crop is lost.

A species of palm, much less known than the date, is that of the nipa, which grows spontaneously in the Indian Archipelago, on the sea coast. Rumphius and Thunberg have given imperfect descriptions ofit; the young kernels of it are eaten when preserved. Its catkins, cut before it is fully expanded, produce a sweet liquor, which, by fermentation, becomes spiri¬ tuous and pleasant to drink. Baskets, mats, and other trifling articles, are made of the leaves.

M. Ho u ton Labillardiere observed, and carefully describes the fructifi¬ cation of it, and has in several instances rectified the opinions hitherto entertained of it. The female flower has three stigmas, and the young fruit three ovales ; the embryo is placed at the foot of the seed. In respect to its male catkins, with sessile flowers, its anthers borne on a single filament, which is not ramified, its female flowers without a calyx, and its aggregate fruits, it strikingly resembles the pandanus ; but its spathee, the calyx of the male flowers in six divisions, and the fan-like form of the leaves, produce a still nearer degree of affinity to the true palm trees.

The ancients make frequent mention of an Egyptian tree to which they give the name of Per sea ; it resembled a pear tree, but its leaves lasted during the whole year; its stone fruit was very sweet and wholesome, and the wood, which was black and hard, was extremely valuable. In the Arabian writers of the middle ages, we may still find descriptions of a tree which they called leback , and which offers all the characters attri¬ buted by the ancients to their persea ; but this tree has latterly become so rare, at least in Lower Egypt, that botanists have not been able to fix upon it with certainty: some of them, as Clusius, and Linnaeus upon his authority, have given the name of persea to a species of laurel; an opinion which is the less admissible, as this laurel comes from America. Others, as Screber, have fancied they found it in the sebestier (cordia mixa), whose viscous fruit is, however, quite different. M. Delisie was more fortunate, having observed in a garden in Cairo a specimen of the tree called by Linnaeus ximenia agypliaca , he perceived it possesed most of the characters of the persea; the height was from eighteen to twenty feet, the branches thorny, and the oval perennial leaves more from one inch to an inch and a half in length, which traits may have occasioned its comparison wuth the pear tree; its fruit is in the form of a date; is sweet when ripe, and contains a kernel which is rather ligneous. When M. Delisle arrived in Lpper Egypt he met with two others; and he learned from the inhabitants

Medical and Physical Intelligence.

ot the h:gher country, that it is common in Nubia and in Abyssinia, and much esteemed in Dafour. Nevertheless, he could not learn whether the inner part of the wood is black, as the ancients say is the case with respect to their persea.

The tree is now' called in Nubia eglig. M. Delisle remarked in it peculiarities sufficiently marked to separate it from the other ximenia, and he made it a genus, to which he gave the name of balanites.

Among the vegetables, which furnish a juice of a milky appearance, one of the most remarkable is that which the Spanish colonists have called the cow tree; because its milk, far from having, like that of the spurges and most other lastescent plants, acrid and pernicious qualities, yields, on the contrary, a wholesome and agreeable beverage. M. de Humboldt read to the Academy a description of this tree, and of the experiments made upon the juice which it supplies. This celebrated traveller, not having been able to see it in flow’er, has not settled its genus; but, to judge from its fruit, it seems to belong to the family of the sapotillae ; it is tall ; its leaves are eight or ten inches long, alternate, coriaceous, oblong, pointed, and marked with lateral and parallel ribs.

When incisions are made in it, a glutinous milk runs out, with a very pleasant balsamic smell, of which the negroes drink large quantities, dipping into it maize bread, or tapioca; and this food sensibly fattens them. When exposed to the air, some pellicles are formed on the surface, which acquire as they dry somewhat of the elasticity of the caoutchouc, and a curd is separated, which becomes sour in time, and to which the common people give the name of cheese.

M. de Humboldt takes this opportunity of making some general reflec¬ tions on the different vegetable milks, whose injurious qualities depend on certain poisonous principles, which exist in a sufficiently large quantity to produce sensible effects, such as the morphium in opium ; but in the most poisonous families there are some species of which the juice is not poisonous, as the euphorbia balsamifera of the Canaries, and the asclepias lactifera of Ceylon.

Messrs, de Humboldt and Bonpland are continuing the publication of their great botanical work : it is entitled, “ Nova Genera et Species Plantarurn Equinoctialium*.” The third volume, which will be finished in a few months, and the fourth, which is already printed, but not yet published, will complete the series of monopetalous plants. These four volumes contain more than 3000 new species, divided into 623 genera, of which nearly 100 are new. M. Kunth, who is ti correspondent of the Academy, and has undertaken the publication of this work, describes in the family of the composite plants nearly 600 species classed according to a method peculiar to, himself. Some notes, which M. Humboldt has added, give an account of the heights at which the plants of the cordilleras grow, and contain observations on the distribution of vegetables upon the surface of the earth.

Two volumes still remain to he published : they will be devoted to the polypetalous plants.

But as the plan adopted respecting the nova genera et species does not admit of giving figures of all the plants collected by these travellers, M. Kunth has begun to give, in a separate work, entitled, “ Mimoses et

* Nova genera et species plantarurn quas in peregrinatione ad plagarn aequinoctialem orbis novi collegerunt, descripserunt et adumbraverunt Am. Bonpland et Al. de Hfimboldt. Ex schedis autographis A» Bonplandii in ordinem digessit C. S. Kunth.

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Medical and Physical Intelligence .

autres Plantes du nouveau Continent de ia Farnille des Legumineuses/’ a selection of the most beautiful species. The plates, which are executed with all the splendour which the French engraving has attained, will be accompanied by a general work, on leguminous plants. The figures be¬ longing to the first number of this monography have been presented to the Academy.

In order to assign to each genus its place in the natural order, M. Kunth was obliged to study particularly all the families of the plants, to examine the immense number of genera and species preserved in herbariums, and to consult all the authors who had already treated of the same sub¬ jects. In consequence of these researches, he has given in separate memoirs general remarks on thfe families of the gramineag of the cyperaceas, of the piperacese, of the aroidese ; and since that he has considered the family of the bignonacfiss. The object of these memoirs is either to point out the groupes or subdivisions which may be established m these families, or to fix the characters of their genera with more precision.

At the same time, Mr. Hooker, the learned author of the Monograph of the Juugerhiaimia, is continuing to publish m London the cryptogamous plants which M. Humboldt entrusted to his care. He has united these plants to those collected by M. Menzies. M. Hooker’s work bears the the title of u Musci Exotici.”

M. Beauvois continues with the same perseverance the publication of the plants he collected in his trav els ; and this year there has appeared the 17th number of his “ Fiore d’Oware et de Benin,” which wTe have already mentioned several times.

Zoology. — The Count de Lacepede, having had the use of some very highly finished paintings, brought from Japan by the late M. Titsing, representing many subjects of natural history, of which those which were known to us are given with great exactness, thought he might regard these paintings as documents sufficiently authentic to establish even the species which are not known in any other way. In consequence of this, he com¬ posed from them a description of several cetaceous species which have not yet been observed by European naturalists. These consist of two whales, properly so called ; that is to say, without a dorsal fin, four balcenoti, or whales, provided with such a fin, one physeter, or cachelot, with a dorsal fin, and one dolphin.

The author gives a detailed account of the distinctive characters of these eight animals, forming a considerable addition to the catalogue of known cetaceous animals, which, in the last work of M. de Lacepede on this class, did not exceed thirty-four.

M. Cuvier has presented the head of an ourang-outang, of middle age, sent from Calcutta by M. Wallrch, director of the garden of the Hon. East India Company. He remarks, that the heads of ourang-outangs hitherto described, were ail taken from very young subjects, which had not yet changed their first teeth; that which he placed before the Academy being of maturer age, has a more prominent snout, and more receding forehead ; some traces of temporal or occipital crests may he perceived in it, which occasion a resemblance to the head of the large monkey, known by the name of the pongo of Wurmb. The latter having, besides all the sutures, forms, proportions, foramina, and cavities, characteristic of the ourang- outang, it is not impossible that the large monkey of Wurmb may be nothing more than a common full-grown ourang-outang. At all events, it is certainly a species of orang ; although M. Cuvier himself has, from the comparative smallness of the skull, been led into the error of placing it among the mandrills, and other long snouted monkeys. The same member has exhibited the figure of a tapir, a native of Sumatra, and now alive in the the menagerie of the Governor-General of the English East Indies, the

f>9

Medical and Physical Intelligence.

I

Marquess, of Hastings : it differs from the American tapir in respect to the whitish colour of part of its back, while the rest of its body is of a very dark brown. It appears from a memoir which accompanied this drawing, and which was sent to M. Cuvier by M. Diard, a young naturalist in the East Indies, who is occupied in scientific researches, that this species of quadruped inhabits not only the island of Sumatra, but likewise a part of India beyond the Ganges. Hitherto the genus of the tapirs had been supposed peculiar to America.

M. Moreau de Jonneo, a correspondent of the Academy, who intends to describe particularly the different reptiles of the Antilles, and who began that work last year by a very detailed history of the famous yellow viper, or fer de lance of Martinique, presented this year to the Academy a memoir on the species of gecko, called in that island mabouia des murailles, and which is no other than the thorny-tailed gecko of Daudin. This animal, which has a hideous aspect, and talons which give him the faculty of fastening himself so as to walk along ceilings, inhabits the interior of houses, where it principally pursues the cockroaches.

The inhabitants have a great dread of it, attributing noxious qualities to it, and have given him the name of mabouia, because it is that by which the evil spirit is known among the Caribbees. It is the same animal of which Acrelius relates that it spits out a? black and venomous saliva, and it has been mentioned, but very ill described, by several naturalists, under the name of spectator. There is another species of gecko called in the Antilles mabouia of the Bananas ; it grows to a large size, and is the smooth gecko of Daudin; and its tail, after having been pulled off, fre¬ quently grows again larger than it was at first*.

These remarks are the more interesting as some naturalists had erro¬ neously given the name of mabouia to a species of scinque.

The same writer has given another memoir respecting the species of coluber, which, from its agility, has acquired the name of runner (coluber cursor gm). It is a timid innocent animal, destroying a great number of snails, and very carefully protected by the inhabitants, because they suppose it to be the bitter enemy of the fer de lance viper; but that is an error, owing, according to M. de Jonnes, to their having confounded it with a large species of boa, which no longer exists at Martinique.

The large works on zoology, published by the academicians, have been continued with zeal. There has appeared one volume of the Animals without Vertebrae, by M. Delamarck, and also some numbers of the “ Zoological Observations’' of M. Humboldt, and of the Insects of Africa; by M. de Beauvois.

Anatomy and Physiology. — We have already, in our analysis of last year, given a v«ry detailed account of the important researches, by means of which the Chevalier Geoffrey Saint Hilaire has endeavoured to form a comparison between the bony parts of the branchial apparatus in fish, and those which perform analogous functions in the skeleton of the three other classes of animals with vertebra. This learned naturalist has this year presented to the Academy several new memoirs on the same subject, and he has published the whole in one volume, under the title ot u Anatomical Philosophy, or on the Respiratory Organs, considered with Respect to the Determination and the Identity of their bony Parts,” with ten mezzotino plates.

The work of M. Geoffroy may be considered in three different points of view ; it embraces,

* The gecko with a thorny tail, the gecko porphyre, and the spectator, are, according to M. Moreau de Jonnes, the same animal ; they belong to the family of the hornidactvl geckos. The smooth gecko and the gecko with a swollen tail are also the same, and belong to the thecadactyls.

(i> f ' / - V x

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Medical and Physical Intelligence.

1. d be enumeration and description of all the hones composing each of tiie organs which contribute to respiration in fish, and of those of some of the other classes, whenever it was necessary to the plan of the author to describe them anew.

9. The resemblances admitted by the author between the bones, which had hitherto been supposed to belong exclusively to fish, and those which he considers as analogous to them in other animals with vertebras.

3. The conclusions which he is led to form from these newly discovered resemblances, as far as regards the nature and the destination of the organs to which these parts belong.

M. Geoffroy has thus carefully enumerated and described all the minute parts which enter into the large branchial apparatus ; those which form the honey arches on which the gills are suspended; those which support those arches; those annexed to them called the pharyngial bones; those which cover them, and bear the name of operculum, &c. He informs us of how many bones the sternum is composed in the different classes of animals with vertebra?, and how these parts are arranged in them. lie also gives new and curious details respecting the composition of the different os hyoides, and respecting the points of ossification, which are to he met with in the cartilages of the different larynges, and likewise on the resem¬ blance between the upper larynx of birds and that of the mammalia.

This part of his work, which consists of positive facts, most of them new, and all clearly described, will always remain a valuable acquisition to science.

The second part, which establishes the analogy of the bones of which we have just spoken with those of the superior classes, presents much greater difficulties, as may have been seen in our last analysis.

According to M. Geoffroy, the bones which form the gill covers, correspond with the frame of the tympanum and the small bones of the ear, the hones which bear the branchiostegal membrane, proceed from an intermixture or intercalation of the pieces of the sternum, between those of the os hyoides : from a change of position of this bone, whose thyroidean processes, which in the mammalia are directed backwards, and united with the thyroid cartilage, and here carried forward, and changed into a lingual bone ; and lastly, from a removal of the sternum, from the place it occupied in the first three classes behind the clavicles, or the os coracoides, to the front of these bones where it is placed under the throat. The lateral pieces which unite the arches of the gills to the ligament which carries them, correspond, according to M . Geoffroy, with the points of ossification of the thyroid cartilage, and with the arythenoid cartilages ; the lower pharyngean bones with those of the cricoid cartilage ; l he upper ones to a flat piece, which may have detached itself from the syhenoid bone, or with the cartilaginous part of the eustachian tubqj the branchial arches with those of the bronchiae, and the small bones which stand out from them to the rings of the trachea. We have already given an account of these resemblances m our preceding analysis, and we can now do no more than refer to the full explanation which M. Geoffroy gives of them; ail the reasons which induced him to give to each the degree of probability it is susceptible of are there detailed.

With respect to the third order of M. Geoffroy ’s ideas, those concerning the really essential functions of the organs, it may be asserted that they arise partly from the above-mentioned researches, and have partly beea formed in order to add weight to the results he draws from these researches.

Consequently M. Geoffroy, being firmly convinced that the perfectly developed bones which compose the gill covers of fish, and which in that class do not appear to serve for hearing, are nothing else than the malleus, the incus, and the other small hones of the ear of the mammalia on a

71

Medical and Physical Intelligence.

larger scale, must have been led to doubt whether these bones are the organs of hearing, even in the animals in which they have always been considered as such, and to regard them merely as a sort of superfluity which has remained incipient (these are his own terms) in the animals with lungs, and indicative of an organization which is vigorously necessary and amply developed in fishes.

In the same way, having supposed that he found in the bony apparatus of the gills, which produce no sound, all the bones of the larynx, he has been induced to believe that “ it is not upon true and solid foundations that the larynx has been represented as destined for the voice, as the principal organ of the voice,’7 and he prefers calling it “ the first ring of the windpipe, the station for the governors of the breathing organ, and the assemblage of its most zealous attendants.”

Nevertheless, it is our duty to observe, that on the latter subject M. Geoffroy is not so hostile to the received opinion as the efforts he makes to support his own might induce one to believe; for he does not dispute that in animals with lungs the larynx serves for the voice, and he even establishes a new theory to explain how that organ performs this function. This is also the case with respect to that part of his work in which M. Geoffroy combats* the existence of a lower larynx in birds ; not that he denies that they have at the bottom of their tracheae organic dispositions which produce sounds; he only means to say, that these dispositions do not cousist in parts similar to those of the upper larynx, which no person indeed had ever ventured to assert.

The theory peculiar to M. Geoffroy of the voice and of sound, is' not necessarily dependent on his anatomical researches ; it is the result of some ideas of general natural philosophy, which he long since formed, but which he has not, on the present occasion, developed sufficiently to allow of our giving an account of it. We shall merely say, he considers the thyroid cartilage as a sonorous body, which serves at a table of harmony to the vocal instrument, and attributes to the variation of the distance between this cartilage and the os hyoides the variations of tone.

This volume is terminated by a memoir on the bones of the shoulder. The author long ago made known the resemblances of these bones in fishes to analogous bones in birds, and he has indeed been led by this circum¬ stance, to make all those researches on comparative osteology, of which we have more than once spoken to our readers. He has resumed this subject in a more general point of view, and considers these bones as having attained in fish their maximum of developement and importance, by serving as a shield to the heart, a support to the diaphragm, and a stretcher to the gills.

To conclude, we shall here repeat the invitation we have already given to naturalists, to consult a work filled with new and interesting facts, and from which much may be learned even on those points, respecting which we may not be able to adopt all the opinions of the author.

M. Edwards has continued the curious experiments which he began last year on the respiration of frogs ; he had then convinced himself the presence of air is useful in prolonging the life of these animals, when circulation and pulmonary respiration have ceased ; that water causes them to perish more quickly than a solid covering, and the more quickly in proportion as it is less impregnated with air; and he has this year occupied himself more particularly about the influence of the air contained in water, and that of the temperature to which tms liquid is raised. He has proved that the deleterious effects of the water diminish with the temperature. Frogs have lived twice as long in water at 10° (50 Fahr.) as in water at 15° (59° Fahr.), and thrice as long in water at 0° (32° Fahr.). On the contrary, their life is shortened by nearly ojie half at 22° (72° Fahr.) by more than three quarters at 32° (90° Fahr.) and they perish instantaneously upon being plunged into water at 42”

lcl

Medical and Physical Intelligence.

(107° Fahr,). The coldness of the atmosphere before the operation, is also a circumstance favourable to the lengthening of their existence in cold water. The quantity of air contained in the water, the volume of* the water employed, and the frequent renewal of that water, are circumstances which likewise contribute to it, each in such proportions, and with such limitations, as M. Edwards has determined by numerous experiments, which were made with every precaution of the most accurate natural philosopher.

Frogs can live for several months between 0° (32° Fahr.) and 10° (50° Fahr.) in a quantity of ten quarts of aerated water, which is renewed once every day ; the action which the air of this water exercises on their skin is sufficient for their existence without their lungs being required to be brought into play; but at 10° and upwards, they can only live by rising to breathe the air on the surface. If they are confined under the water at 12° or 14° (53° or 57° Fahr.) for example, they perish, whatever care may be taken to renew it, in one or two days : a running stream will sometimes enable them to support a more elevated temperature under water; some of them support it as high as 22° (or 72° Fahr.)

These experiments, independently'' of their interest with respect to the general theory of the action of air on the blood, explain several singular traits on the economy of these animals, and particularly the extraordinary difference in their manner of living in winter and in summer.

LINNEAN SOCIETY.

May 2 — The following gentlemen were chosen to fill up six vacancies which had occurred among the foreign members : —

F. E. L. Fischer, M. D., Moscow; Gotthelf Fischer, M. D., Hist. Nat. Prof. Moscow; J. B. de Monnet de Lamarck, Zool. Prof. Inst. Sc. Paris. Soc.; Jos. Pavon, Acad. Reg. Med. Madr. Soc. ; K. Sprengel, M. D., Bot. Prof. Halle ; and C. J. Temminck, Soc. Sc. Harlem. Soc.

And on Wednesday, May 24, the anniversary of the Society was held at the Society’s house in Gerrard- street, Soho, for the election of a Council and Officers for the present year; when the following Members were declared to be of the Council, viz.

Sir Jas. Edward Smith, M.D.

Edward Barnard, Esq.

Samuel, Lord Bishop of Carlisle.

Henry Thomas Colebrook, Esq.

Edward Forster, Esq.

Sir Alexander Johnston, Knt.

Aylmer Bourke Lambert, Esq.

Win. Elford Leach, M. D.

And the following were declared to be the Officers for the present year, viz.

Sir James Edward Smith, M.D., President.

Samuel, Lord Bishop of Carlisle,

Aylmer Bourke Lambert, Esq.

Edward, Lord Stanley,

Wm. George Maton, M. D.

Edward Forster, Esq., Treasurer.

Alexander MacLeay, Esq. ) « .

Mr. Richard Taylor, ^Secretaries.

His Royal Highness Prince Leopold, Prince of Saxe Cobourg, was also elected an Honorary Member.

The Members of the Society afterwards dined together at the Freemasons’ Tavern, Great Queen Street, according to annual custom.

7

>Vice Presidents.

Alexander Mac Leay, Esq. Matthew Martin, Esq.

Wm. George Maton, M.D. George, Earl of Mountnorris. Joseph Sabine, Esq.

Thomas Smith, Esq.

Edward, Lord Stanley, M. P.

Medical and Physical Intelligence .

73

SCIENTIFIC INTELLIGENCE, AND NOTICES OF SUBJECTS CONNECTED WITH SCIENCE.

I. Population of Glasgow.

An actual survey to determine the population of Glasgow was terminated on Feb. 26, 1820. The following is an abstract of the information derived from tiiis survey : —

Population of the ten parishes within the Royalty •• • • 75,169

Barony Parish.

Anderston district* - • . . . . . . 7,113

St. Vincent Street and the Blythswood estate

district • . . . 7,941

Port Dundas district . • . 7,598

Calton and Mile End district . . 15,616

Bridgeton district . . • • . . . • 13,593

51,861

Gorbafs parish, including Hutchesontown, Lauries-

town, and Tradestown . . - . 21,768

148,798

As several thousand persons had left the population district for want of work, during the few months which preceded the enumeration, and as some of these persons may be expected to return, the population may be safely stated at 150,000.

II. Colouring Matter of a Lichen which grows on the Bark of the Brucea

Anti dysenterica.

This lichen had an intense yellow colour. It was subjected to a chemical examination by MM. Pelletier and Caventou. They first digested it in sulphuric ether, till every thing soluble in that principle was taken up. Nothing was dissolved by the ether but a solid oil, of a greenish-yellow colour, and a mild taste, and possessing the usual characters of the fatty matter of plants. The lichen was now digested in successive portions of hot alcohol, till that liquid refused to dissolve any thing more. The alcoholic solutions had a very intense colour. The alcohol was distilled off, and there remained a yellowish-red matter, which attracted humidity when exposed to the air. Water being poured upon it dissolved a yellow-colouring matter, and left a brick-red powder, which was destitute of taste and smell, and perfectly soluble in water. By boiling it repeatedly in water, it was freed from the remains of the soluble colouring matter which still might remain mixed with it.

This substance is a powder of a reddish-yellow colour, insoluble in cold water, and almost equally so in boiling water. It dissolves with facility in alcohol ; but is insoluble in sulphuric ether. When exposed to heat, it gives out the usual products of vegetable bodies, with some traces of ammonia, indicating the presence of azote as one of its constituents. When concentrated nitric acid comes in contact with it, it assumes a fine greert colour. This colour is removed by the fiction of water, and by most of the salifiable bases. It is owing to a combination of the colouring matter of the lichen with nitric acid.

Sulphutic and muriatic acid facilitate the solution of this colouring matter VOL. XIV. - NO. 79. L

74

Medical and Physical intelligence .

in water ; but they at the same time alter its nature ; for it is now very soluble, and is not rendered green by the action of nitric acid. This colour- ing matter is not acted upon by weak alkaline leys ; but the concentrated solutions of the alkalies decompose it. — ( Journ . de Fharm. v. 546 )

III. Curious Effect produced by kneading powdered Guuiacum and good

Wheat Flour.

M. Taddey observed, that when the powder of guaiacum and good wheat flour are kneaded together with the requisite quantity of water, in contact with atmospherical air, the mixture assumed a tine blue colour. M. Rudolphi, whom he employed to examine the action of these bodies on each other, made the following observations : — 1. When the powder of guaia¬ cum and pure stock are kneaded together, no blue colour is developed. 2. The powder of guaiacum scarcely becomes blue when kneaded with any meal or flour which contains but little gluten. 3. It does not acquire a blue colour when the wheat flour has undergone any great alteration in its qualities. 4. When gluten or zimome is kneaded with powdered guaiacum, a very fine blue colour is instantly developed.

From these observations, Rudolphi concludes that the powder of guaiacum is an excellent re-agent for determining whether wheat flour be of a good quality, and whether it has undergone any alteration. — ( Giornale di Fiscia, Chemlca , fyc. second bimestre, 1819.)

IV. Substances capable of developing a Blue Colour in the Alcoholic

Solution of Guaiacum.

From the experiments of M. Planche, it appears that the fresh roots of the following plants are capable of producing a blue colour, when introduced into an alcoholic solution of guaiacum :

Symphytum consolida, Leontodon taraxacum, Iris Germanica, Cichorium intybus, Eryngium campestre, Nymphsea alba, Solanum tuberosum, Bryonia dioica,

Inula helenium, Althaea officinalis, Daucus carota, Glycyrrhiza glabra,

IN apis sativa,

Arctium lappa, Colchicum autumnale, Saponaria officinalis, Fumaria officinalis, Cochiearea officinalis, Scrophularia officinalis, Rumex acetosa, Scorzonera Hispanica, Asparagus officinalis, Borago officinalis, Angelica archangelica. Allium esepe.

V. Substances z»hich do not strike a Blue Colour with the Alcoholic

Solution of Guaiacum .

M. Planche has found that the fresh roots of the following plants do mt affect the colour of the alcoholic solution of guaiacum : —

Rumex acutus.

Polypodium filex mas,

Fragaria vesca. — {Journ. de Pharm. vi. 18.)

VI. Morphia.

I find the easiest method of obtaining morphia in a state of purity is the following: — Into a strong infusion of opium pour caustic ammonia. Separate the brownish-white precipitate by the filter. Evaporate the in-

Medical and Physical Intelligence . 7&

fusion to about one-sixth of its volume, and mix the concentrated liquid with more ammonia. A new deposit of impure morphia is obtained. Let the whole of this deposit be collected on the filter, and washed with cold water. When well drained, pour a little alcohol on it, and let the alcoholic liquid pass through the filter. It will carry off a good deal of the colouring matter, and very little of the morphia. Dissolve the impure morphia thus obtained, in acetic acid, and mix the solution, which has a very deep brown colour, with a sufficient quantity of ivory black. This mixture is to he frequently agitated for twenty-four hours, and then thrown upon the filter. The liquid passes through quite colourless. If ammonia be now dropped into it, pure morphia falls in the state of a white powder. If we dissolve this precipitate in alcohol, and evaporate that liquid slowly, we obtain the morphia in pretty regular crystals, it is perfectly white, has a pearly lustre, is destitute of smell, but has an intensely bitter taste ; and the shape of the crystals, in all my trials, was a four-sided rectangular prism.

When one grain of pure morphia is passed slowly through red hot peroxide of copper, it is converted entirely into carbonic acid and water. The water obtained in four successive experiments was ahvays 0 5 gr. The carbonic acid gas amounted to 3 58 cubic inches, supposing the barometer to stand at 30 inches, and the thermometer at 60°.

Now 0-5 gr. water contains . 0‘0555 gr. hydrogen,

3-58 cubic inches of car. acid 04528 gr, carbon,

Total . =z 0-5083

There is wanting 0 49 17 gr. to make up the original weight of the morphia. This deficiency must be owing to the morphia containing a quantity of oxygen equal to it in weight.

It follows, from the preceding data, that the constituents of morphia are as follows : — -

Hydrogen . . • • • 00555

Carbon . 0*4528

Oxygen**** . 0'4917

1.0000

Now when these weights are changed into volumes, they amount very nearly to

18 volumes hydrogen,

24 volumes carbon,

10 volumes oxygen.

This is equivalent to

18 atoms hydrogen* . zz 2‘25 . 5' 59

24 atoms carbon . zz 18 00 . 44*72

20 atoms oxygen . — 20-00 . * 49‘69

4025 100-000

So that, if the preceding analysis be correct, the weight of an integrant par¬ ticle of morphia is 40’25.

The reader will easily perceive that we might consider this substance as a compound of only half the preceding number of atoms, or of

9 atoms hydrogen . * . . • ~ T125

12 atoms carbon * • • • . . ~ 9’000

10 atoms oxygen • . . . * ~ 10 000

20-125

Medical and Physical Intelligence’.

On that supposition the equivalent number for it would only be 20*125;- Perhaps this last estimate may be the most correct; but the analyses of the salts of morphia, published by Robiquet, and by Pelletier and Caventou, give an equivalent number for morphia not far short of 40. This is my rea¬ son for considering it as a compound of 62 atoms rather than of 31 ; either of which is equally indicated by the analysis.

Comparative Strength of Europeans and Savages.

M. Perqn, the naturalist, has had occasion to observe, that men in a savage state are inferior in strength to men civilized ; and has demon¬ strated, in an evident manner, that the improvement of social order does not, as some have pretended, diminish our physical powers. The following are the results of some experiments made with the dynamometer of M Regnier : —

Force with hands,

r Of Diemen s Land . . . 50.6

Savages »«<•—- New Holland . . 51.8

i. — - Timor •••••••• . . 58.7

( French* ••••••• . . 69.2 *

Europeans l~ . i”.!.. ™

with traces. . • • 0.0 •* 14.8 ■ 16.2 • •• 22.1 .. 23.8

State of the Population of Par is for 1818.

Births.

At home

At the hospitals

^ legitimate l iHeg itimate • • legitimate illegitimate • « Total of births • •

l bof . 1 14,499

( girls . 7,147 S 9

f b.°ys . — > 4201

i girls . * 2,043 S ’

2,158 *

• * e •

1 acknowledged

Natural Children <

boys ( girls > boys ( girls S boys l girls

£ boys ...... 1,069

C girls ...... 935

I abandoned . • . . i b.°f . JG66

v C girls . 3,019

479 3,888

’,315 123>067

8,089

Deaths.

At home . . . - j ™lef ••••••

C females 7,169

At the hospital French military Id prison

males . 3,738

females . 4,372

564 > 22,421

fl> e » p (?> © & d- • to

# 5 males *•■•••■•

C females ......

Deposited at the Morgue |

Marriages.

Bachelors and maids ............ 5,476 q

Bachelors and widows . 312

Widowers and maids . * . . . 625

Widowers and widows * * . . . •> » SOS

6,616

Medical and Physical Intelligence. 77

Deaths according to the ages.

Under 3	months	2,750	From 30	to	35 years	834
From 3 to 6 months	390	35	to	40	815
- 6 months to 1 year	793	40	to	45	798
1	to	2 years	1,634	45	to	50	847
- 2	to	3	903	50	to	55	873
3	to	4	526	- - /55	to	60	1,011
- - 4	to	5	325	- 60	to	65	1,234
- 5	to	6	278	- 65	to	70	1,186
6	to	7	244	- 70	to	75	1,119
7	to	8	144	- 75	to	80	921
* - 8	to	9	120	- 80	to	85	921
9	to	10	116	- 85	to	90	243
- 10	to	15	462	- 90	to	95	58
- 15	to	20	855	- 95	to	100	9
- 20	to	25	1,200	Above 100		3
- - 25	to	30	880	Morgue			246

Description of an "Urinary Calculus , composed of the Lithate or Urate of Ammonia. By William Prout, M.D., F.R.S.* * * §

M.Fourcroy had stated that the lithate of ammonia not only frequently enters into the composition of urinary calculi, but sometimes constitutes entire concretions f. Mr. Brande, some years afterwards, called this state¬ ment in question, and was induced to conclude from his experiments, “ that no substance which can be called urate of ammonia exists in calculi J.” In this latter opinion I believe most British chemists have acquiesced; and Dr. Marcet, in his recent work on this subject, observes, “ The presence of this substance (lithate of ammonia) in urinary calculi 1 still think very doubtful, especially because, since it is so easily discoverable in the excre¬ ments of the boa constrictor, it is not probable that the English chemists would have overlooked it so long in the human calculi, which they have so often and so successfully submitted to chemical examination |j.”

From these decided opinions of such eminent chemists, we must con¬ clude that this variety of calculus is extremely rare. To obviate, however, the belief that it does not exist at all, I have been induced to draw up the present account, the object of which is to describe a calculus composed almost entirely of the substance in question.

This calculus, for which I am indebted to my friend Dr. Elliotson, was extracted in April last, by Mr. Cline, jun. from a boy about two years of age, in St. Thomas’s Hospital. When entire, it weighed about fifty grains r its general shape was ovoid, a little flattened; its external surface was smooth, and of a greenish clay colour (corresponding nearly to the wax - yellow of Werner §). It was composed of thin concentric layers, easily separable from one another, and readily breaking into sharp angular pieces, with a compact earthy fracture. Its general colour internally differed, both in shade and intensity, from that of its external surface: it might be de-

* From the Medico-Chirurgical Transactions, vol. x. p. 389.

i Systeme des Connaissances C'himiques, tom. x. p. 224. t Phil. Trans, vol. xcviii. p. 231.

|j Essay on the Chemical History and Medical Treatment of Calculous Disorders, p. 140, first edition.

§ See Werner’s Nomenclature of Colours, by Patrick Syme.

<r

8 Medkal and Physical Int dhgence,

nominated a pale reddish clay colour (corresponding nearly to the wood- brown of Werner*), The different layers, however, differed somewhat in intensity, which caused the laminated structure to he visible to the eye. "Between some of the layers, also, there were minute depositions of the earthy phosphates, which render this structure still more sensible. The nucleus exhibited the same general appearance as the re3t of the calculus, except that it appeared to be made up of fine powder and a few larger grains, loosely agglutinated together.

It was sparingly soluble in cold water f, but it dissolved readily in boiling water (especially when in a state of line powder), requiring only about 300 times its weight for that purpose. On cooling, the calculous matter did not immediately separate, but after some days a great part of it was deposited.

It readily dissolved in solutions of the fixed alkalies, and at the same time a strong smell of ammonia was exhaled. When muriatic acid was added to this solution, lithic acid was precipitated.

In nitric acid it dissolved readily, especially with the assistance of heat,

Exposed to the action of heat by means of the blow-pipe, it decrepitated so strongly that it was difficult to ascertain the effects produced by this agent. When reduced to powder, and exposed to heat, it first appeared to give off ammonia, and afterwards to burn with the same phenomena as lithic acid. It left a minute residuum, which strongly reddened turmeric paper, and appeared to consist partly of lime (and alkali), and partly of the earthy phosphates.

From these properties it is evident that this calculus consisted principally of the lithale of ammonia*.

hibitmg the same phenomena as litmc acid when similarly treated. Muriatic acid, in which it had been digested, was found to be converted :o muriate of ammonia.

* See Werner’s Nomenclature of Colours, by Patrick Syme. t One part of the excrements of the boa constrictor (which is lithate of ammonia) at 60° required about 480 quarts of water to dissolve it ;

At 90° • . . . 300

At 212°* • * . . . 240.

But the calculus above described was found to be somewhat less soluble than this substance, probably on account of its compact state of aggregation.

| The following is Fourcroy’s description of this species of calculus, which does not differ much from the above. “ Les caleuls d’urate d’am- moniaque, bien characterises par leur dissolubilite dans les lessives d’alcalis fixes caustiques, mais avec un degagement abondant d!ammoniaque, sont ordinairement petits, d’une couleur pale de cafe au lait, ou d’un gris tirant sur cette nuance, formbs de couches fines qu’on detache facilement les unes des autres, et qui sont lisses par les surfaces qui se touchent; presque toujours contenant un noyau dont on separe aisement l’enveloppe. Leur forme la plus ordinaire est spheroidale, alongee, comprimee, quelquefois amygdaloide; leur surface est ordinairement lisse, jamais tuberculeuse, quelquefois brillante et crystalline; leur pesanteur specifique va de i*225 a, 1*720, 1’eau seule les dissout, surtout quand eile est chaude, et quand ils sont divis^s et en poussihre fine. Les acides, le muriatique surtout, leur enlevent Pammoniaque, et laissent seul l’acide urique, qui se dissout ensuite dans la potasse sans effervescence : ils se trouvent quelquefois reconverts d’acide urique pur : la couche exterieure de celui-ci est ordinairement pen 6paisse, et la plus grande quantite de calcul est de l’urate d’ammoniaque. Sur les 600 calculs examines la proportion du nomhre d’individus de cett© espece a line des plus foibles/’— Op. cit. p. 237.

79

Medical and Physical Intelligence.

The boy from whom this calculus was taken suffered extreme irritation, and his general health was much deranged. Two or three weeks before it was extracted, I had an opportunity of examining his urine; it was pale-coloured, and exhibited the appearance it usually assumes when a calculus is present in the bladder, or when the functions of the inner coat of that viscus are otherwise deranged. Its specific gravity was 1023.8, and it abounded in urea and the triple phosphate of magnesia and ammonia. It reddened turmeric paper; but as it had been kept for some days before I had an opportunity of examining it, this property might have been acquired after it was voided from the bladder.

1 possess a fragment of another small calculus, having precisely the same colour and properties as that above described. It was likewise taken from a boy under the age of puberty, and was accompanied by great irritation. This fragment, which is about one-tenth of an inch in thickness, -appears to have constituted a part of the outer crust. Its external surface is rough, and covered with mamillary protuberances. To a part of its internal surface there is adhering a portion of a common lithic acid calculus; probably, therefore, the whole of its centre was composed of that substance. This boy, as well as the former, recovered from the operation, and I believe neither has ever had any return of the complaint.

The characteristic properties of this species of calculus appear then to be the following: — 1. Their colour and general appearance, which are peculiar; 2. Their solubility in water; 3. Their yielding ammonia when treated with the fixed caustic alkalies. To which, perhaps, may be added, 4. Their property of decrepitating before the blow-pipe * *.

There are also strong reasons for concluding, from the smallness of their size, and other circumstances, that this species of calculus, in its pure state, is peculiar to children under puberty f, and that it is accompanied by great derangemeut of the general health, and the most distressing irritation.

With respect to the medical treatment of this variety of calculus, ifc ought probably to differ in no respect from that adopted in ordinary cases of the lithic acid calculus ; certainly not, at least, in a chemical point of view-.

In Doctor T. Forster’s paper on Periodical Affections of the Human Health, mention is made of the coincidence of the periods of irritability with the lunar periods. These periods do not correspond exactly with the new and full moon, though there is evidently some close connexion between the two phenomena. The author proposes to the medical public to examine the subject in the following manner : — Make an artificial division (in some regular journal of canes ) of the lunar month into four weeks, so that one of the four changes (as they are called) shall happen in the middle of each week; then, according to his observation, the periods of irritability will happen in those wmeks in the middle of which the new and full moon happen, and never in the weeks of the quadratures. — Hence they happen apparently within a given distance of time from the new or the full moon,

V * N

•*m ■ • ■■■ . n. , n - ■ „ . . - .

* I am awfare that decrepitating calculi are usually said to contain a little oxalate of lime, and this was perhaps the case in both the above instances. In these instances, however, the decrepitation appeared to me rather to depend on the escape of ammonia.

f The morbid urine of children generally contains an excess of the phosphates, but in some rare instances a peculiar clay-coloured deposition takes place after the urine has cooled, which, if I am nat mistaken, consists partly of lithate of ammonia.

SO Medical and Physical intelligence.

Burning Spring. — “ A phenomenon which has for several years excited the attention of travellers, under the name of a burning spring, exists in one of the principal forks of Lecking river, Kentucky. It is situated about three- fourths of a mile from the banks of the river, and about eighty miles above its junction with the Ohio, opposite Cincinnati. A spring here breaks out at the foot of a hill, forming a basin of water about six feet in diameter and two feet deep, at the bottom of which issues a stream of gas, which in volume and force is about equal to the blast forced from a common smith’s bellows ; but there is no cessation of its force, which is such as to create a violent ebullition in the water. Being heavier than common atmospheric air, the gas on passing up through the water constantly occupies the surface which is still the lower part of an indenture in the earth at that place. On presenting a taper this gas instantly takes fire, and burns with great brilliancy. There is no absorption of it by the water, which possesses the purity of common spring water, neither is any offensive odour thrown off. This spring has been known to dry up entirely in the summer, when the air rushes out with increased force, accompanied by a hissing noise. There is nothing like smoke emitted.” — Schoolcroft , Lead Mines of Missouri, p. 216.

Remedy for the Plague. — The use of olive oil has lately been recom¬ mended as a very effectual remedy for the plague. It was strongly praised some years ago by Mr. Baldwin, an English consul in the East; and in the month of June, last year, Mr. Graberg writes from Tangiers, that by drinking from four to eight oz. of it a number of patients have been saved from death. The remedy acts generally as a sudorific, an abundant sweat breaks out all over the body ; it sometimes proves vomitive and purgative, but the sweating is most salutary. Its use has been recommended for trial in disorders allied to the plague.

Meteorological Prize Question. — The following subject is to be rewarded by the Academy of Dijon, in 1823, by a gold medal of 300 francs value :

u How far, in the present state of natural philosophy, can a ous meteorological phenomena be explained The memoirs to be sent to the secretary of the academy, before March 1, 1821, accompanied by a closed billet, as usual.

On the Ligature of the Carotid Arteries as a Remedy for Deter » mination of Blood to the Head , By C. R. Young, M. D.

( From the Annals of Philosophy.)

The tying ol the carotid arteries in order to moderate a determination ot blood to the head seems at once so simple and obvious a remedy for this disorder, that I am inclined to think it must have suggested itself long ago to the I acuity, and that some weighty reasons can be opposed against the employment of it ; or that it has been already tried and rejected for special reasons. But as my reading and information are not sufficient to assure me of these facts, I venture to make the proposal with a due sense of my own ignorance and inexperience, and with every sentiment of respect and de¬ ference for the wisdom and knowledge of others.

There is, I believe, in all or most graminivorous animals, which are forced to procure their food by grazing with their heads much lower than the rest ot their bodies, a piece of structure in those arteries which corre¬ sponds to the carotids in the human species, by which the determination of the blood to the heads of these animals is prevented ; for considering the time which they employ in taking in their food, this affection could hardly fail to occur in them, were no such apparatus furnished by nature. This consists in a convolution of the arteries, by which the impetus of the blood coming from the heart must be much broken. Now is it not reasonable to

Medical and Physical Intelligence .

81

expect, that if by any means we could imitate this device of nature, in cases of determination of blood to the head in the human species, a beneficial result might be obtained ? Let us suppose that one of the carotid arteries were tied (for as in many cases there is evidence of a much stronger deter¬ mination to one hemisphere of the brain than to the other, it might be sufficient to tie the artery of the affected side only), and that the blood was forced into a longer and more circuitous course by the anastomosing branches ; the arteries and veins may have lost their natural tone and calibre, and eventually, no doubt, the anastomosing branches themselves would become expanded and enlarged so as to admit as much blood to the brain as formerly ; yet the tortuous course of the arteries would probably much diminish the vis a. tergo, and deaden the impulse of the blood coming from the heart ; so that a powerfully co-operating remedy might be obtained in addition to those generally used.

Of late, the operation of tying the carotids for aneurism has been success¬ fully employed. I have not the advantage myself of knowing what pheno¬ mena have resulted from the operation with respect to the circulation of the blood in the head. As I believe it is a rule not to perform the operation until the anastomosing branches are sufficiently expanded to carry on the circulation, after the main artery has been closed, the case will not he in point; but probably much might be learned from an attentive observance of such cases. It is very rash to form a priori conclusions upon the effects of operations which have never been performed, more especially where so delicate and mysterious an organ as the brain is concerned. It is likely, however, that if both carotids were tied, even where an inordinate distention of the blood-vessels of the brain had before occurred, that the flow of blood would at first be so much impeded that the patient might fall into the opposite extreme, and that fainting, or some affection arising from the presence of too small a quantity of blood in the head, would supervene. But this evil would only be temporary ; and there are fortunately plenty of remedies for it much more efficacious than those now in use for the opposite affection. As most nervous diseases are supposed either to he connected with, or produced or aggravated by, a determination of blood to the head, I hope we may at length be enabled to discover some ade¬ quate means of subduing and keeping down these obstinate and untractabie maladies.

In the City of London Lying-in Charity , for delivering poor married women at their own houses, conducted by Mr. Thomas Greening, of Aldersgate Street, the number of deliveries during the last three months, from the 1st of April to the end of June, was seventy-two; of these the natural labours were sixty-seven, instrumental three, premature one, and preternatural one.

Two of the instrumental cases were facilitated by the forceps, the pains having ceased. The third was that of a poor woman residing in Uoleman Street, low in stature, also lame, recommended by the Female Benevolent Society. About the end of the second day of labour I was sent for to give assistance. Upon my examination per vaginam, , there was found consider¬ able deformity in the pelvis, the deficiency being from sacrum to pubes, rendering it impossible for delivery to be accomplished without the inter¬ ference of ait The forceps were applied; their utility in this case was of little value in forwarding the labour: no untoward symptom had taken place, except considerable prostration of strength. Under these circum¬ stances it was considered right to open the head, to evacuate the brain, and to extract by means of the crotchet. These measures were not put into effect until we were convinced the child was dead. The delivery was easily completed : the woman had a good recovery.

VOL. XIV. — NO. 79- M

8$ Medical and Pki/skai J ule/iigeMe.

In the case of preternatural labour, where the arm of the child presented, all that was requisite, was to turn and deliver by the feet.

In that which occurred prematurely it was found necessary to extract the child with as little delay as possible. The woman had lost a considerable quantity of blood'; it was beginning to have an effect upon her pulse : the os uteri being pretty well opened, the two fingers were carried round the neck of the child, and it was extracted w ith great ease.

Peritonitis. — Mrs. H., ietat. twentv-one, was delivered on the 8th of April of a son. The labour w as natural, and every thing appeared to go on favourably until the third day after delivery : she sent for the gentleman who attended her in labour, and complained to him of pain in the abdomen, with a degree of fever, and symptoms somewhat wrong ; her pulse being 100 to 120 in a minute. Twenty ounces of blood were immediately taken from the arm, 'plena vivo, until she fainted; and an opening mixture was ordered to be taken, which operated in two hours after the bleeding. Inquiry being made what she had taken to produce so sudden a change, one of the attendants informed us the nurse had been administering a quantity of spirits to her the preceding day.

Thursday. — No better; pain in the abdomen still continues, with tenderness when pressed upon ; pulse 130 in a minute. Rep. venae sectio ad y xvj . Bowels relaxed ; calomel with opium and pulv, Jacobi were ordered to be taken every three or four hours, with a tablespoonful of a mixture of infus. rosee and magnes. sulphas. — Eight P. M. much the same; she was again bled, from which relief was obtained: fomentations were now ordered to be applied to the abdomen every two hours.

Friday. — 1 was requested to see her. Pain in the abdomen increased ; pulse 120.

Rep. medicinae ut ante ; rep. v. s. ad Jxij.

Saturday. — Considerable change; much worse; pain in the abdomen greatly increased ; the weight of the bedclothes now became a burden to her; pulse 130; the medicines taken yesterday procured, several alvine evacuations in the night ; at nine P. M. eighteen leeches were applied to the abdomen, which continued bleeding until four the following morning: the ol. terebinth, was ordered to be taken, in doses of half an ounce, with an ounce and a half pf piisturas amygdala : the abdomen was rubbed with the same.

Sunday. — Every symptom indicating ill.

Rep. 01. Terebinth, ut ante.

Monday. — Pulse feeble. No benefit was derived from the ol. terebinth. ; it rather aggravated the disease : to use her own words, it could be com¬ pared to nothing less than if two fires had met in contact. The fomentations were renewed, from which great -benefit was obtained pro tempore. Under every means which were adopted consistent with the patient’s life, still she died at six P. M., quite sensible to the last.

Sectio Cadaveris. — There was found a general inflammation over the whole of the peritonaeum ending in suppuration ; the peritoneal coat con¬ siderably thickened, arid very vascular, as if it had been injected; great adhesion to the abdominal muscles; the fluid contained in the abdomen measured two pints, in appearance it resembled a whey-like fluid; the internal part of the uterus presented nothing particular; it appeared not to have suffered that degree of inflammation which had spread its destructive ravages in the adjoining parts of the viscera; its fundus, where the placenta WaS attached, resembled, as Dr. Gooch accurately describes in his Midwifery Lectures — a cullender with a number of perforations or small holes.

A poor woman residing in White cross Street, Cripplcgatc, applied for-

83

Medical and Phi/ deal Intelligence .

a ticket two months previous to her confinement. She had a considerable discharge during the whole of her pregnancy. Upon examination per vagi- nam there was found a polypus of considerable size, protruding beyond the soft parts. Labour came on at the full period of utero-gestation : she was delivered without any untoward symptom. On the second day after delivery, convulsions supervened, from some unknown cause, when it was found necessary to bleed her to a considerable amount, and again to repeat it on the following day, aided by aperient medicines. At the end of six weeks after her lying-in, a ligature w'as passed round the root of the polypus, for extir¬ pation, and it was removed on the eighth day. She is now doing well.

Although the little knowledge I am possessed of in the obstetric art has not been obtained entirely by perusing the works of different authprs, who have written on this subject, so much as the Lying-in Roam, which charity frequently calls for my feeble aid, nothing yet will enable me to present any new subject on this point, when we look into the w'orks of Denman, Burns, &c., which afford us such good information: let us still bear in mind what an old philosopher frequently repeated, u Beat the bush wed, and the game will fly out.”

In the practice of midwifery, one of the most hazardous parts of the pro¬ fession, and perhaps in general more subject to censure than any other, it behoves us to be particularly circumspect; and though events are fre¬ quently beyond the power of human art to control, no man’s character can long be supported, if he be not determined to do w hat is right, to the best of his judgment and power, under every circumstance. Nature is not an unjust step-mother, but a most provident and beneficial patent. Cases are daily occurring where she is unable to finish the delivery herself; it then becomes the duty of the Accoucheur to assist her, and promptly, and not let her be worn out in useless conflict.

The number of children produced was 72 ; 32 males, 40 females.

LITERARY NOTICES.

Dr. Prout is preparing for the Press an Inquiry into the Nature and Medical Treatment of those Diseases connected with ,a deranged Action of the Urinary Organs, especially Gravel and Calculus. It is the author’s object to take a more comprehensive view of this important class of dis¬ orders than has hitherto been attempted.

Dr. Leach has nearly completed his Synopsis of British Moflusca, being an Arrangement of Bivalve and Univalve Shells, according to the Animals inhabiting them.

Dr. Thomson is printing a new edition of his System of Chemistry. Lie also announces his intention to prepare a work on the Practice of Che¬ mistry.

Dr. Harty, of Dublin, has nearly ready an Historic Sketch of the Causes, Progress, Extent,, and Mortality of the Contagious Fever, epidemic in Ire¬ land during the years 1817-18-19 ; with numerous Tables, and an Appendix, containing various Documents illustrative of its general History, and of the System of Management adopted for its Suppression.

In the Press, a Toxicological Chart, in which are exhibited at one view the Symptoms, Treatment, and Modes of detecting the various Poisons, Mineral, Vegetable, and Animal, according to the latest Experiments and Observations ; most respectfully dedicated to the Royal Humane Society. By a Member of the Royal College of Surgeons.

Just Published, a Treatise on Derangements of the Liver, Internal Organs, and Nervous System, Pathological and Therapeutical. By James Johnson, M.D., Author of the Influence of Tropical Climates on European Constitutions, &c. Third Edition, improved. One vol. 3vo. pp. 230, Price 8s. 6d. boards.

84

A METEOROLOGICAL TABLE, From 21 st of MAY to 20th of JUNE , 1820, KEPT AT RICHMOND, YORKSHIRE,

D	Raroi Max.	neter. Min.	The Max	irm . Min.	Ram Gauge.	Winds.	Weather.
21	29	85	29	77	63	52		SW..	13 Sun. 2 Cloud... 4 Moon.
22	29	77	>9	74	78	49		SW..S,.	1 Sun..
23	29	66	29	52	75	53		SE..	1 Sun...
24	29	40	29	33	76	43	40	Vbie.SW..	13S,. 2S..Th. Lt.R....4M...
25	29	30	19	29	60	46	29	SW.. „	1 liain... 3 Sun.. 4 Cloud..
26	29	37	29	30	64	44		SW..	13 Sun... 2 Show. 4 Moon..
27	29	24	29	17	66	46	03	SW.	1 Sun.. 4 Rain.
28	29	05	28	90	69	44	23	SW..	13 Cloud.. 2 S.. & Sh. 4R...
29	28	86	28	78	61	43		WSW..SW...	1 Sun..
30	28	81	28	87	59	41	09	w..	1 Sun..&. Show. 4 Starl...
31	28	94	28	93	61	43	05	wsw..	1 Sun,. 4 Rain.
1	29	04	29	03	58	46	01	SW...	1 Sun.. & Show.
2	29	27	29	24	64	46	09	N.NW..	1 Sun.. & Show. 2 Sun...
3	29	45	29	42	65	45	01	NW..WbN...	1 Sun.. 3 Rain. 4 Cloud..
4	29	57	29	50	60	45	08	WNW.	1 Show. 3 Sun.. 4. Cloud..
5	29	59	29	5?	69	47	59	SW.	1 Sun.. 3 Rain,...
6	29	75	29	60	59	42	12	N.	13 Rain.. 2 Sun. 4 Starl..
7	29	60	29	57	63	43		W..	1 Cloud.. 2 Sun..
8	29	4?	29	44	66	48	01	WbN..	1 Sun.. 3 Rain. 4 Cloud..
9	29	42	29	41	59	39	24	NW.NE.	1 Cloud... 2 Show.. & Sun..
10	.29	27	29	08	57	41	03	NW..W..	1 Sun... 2 Sh. & S. 4 Starl...
11	29	41	29	36	65	46	36	Vbie.	14 Cloud.. 2 Show.... & S..
12	29	55	29	54	61	47		NE.	1 Sun... 4 Cloud..
13	29	7 2	29	67	54	45	31	NNE. v	14 Cloud.. 2 Rain.... 3 S..
14	29	54	29	52	66	47	15	SW..W..	1 Sun.. 2 Rain.. 4 Starl..
15	29	63	29	61	62	44		NW..NE..	1 Cloud.. 2 Sun..
16	29	62	29	60	67	41		NW.ENE.	1 Sun.. 3 Cloud..
17	29	65	29	65	71	45		w..	1 Sun..
18	29	47	29	33	67 .	50	12	WNW.SW.	1 Sun... 3 Cloud... 4 Rain..
19	29	27	29	24	65	48	19	W.SW..	1 Sun.. 3 Show..
20	29	52	29	48	63	47	06	NW..NE..	1 Clou... 2 Show. & Sun..

The quantity of rain during the month of May was 4 inches.

Observations on Diseases at Richmond.

The disorders under treatment were, Abscessio, Aphtha Jactentium, Asthma, Colica, Cynanche tonsillaris, Cynanche trachealis, Diarrhoea, Dys¬ pepsia, Enteritis, Epistaxis, Febris coiitinua, Gastrodynia, Gonorrhoea, Hannatemesis, Haemorrhois, Ischuria, Lateris dolor, Lumbago, Menorrhagia, Obstipatio, Pneumonia, Podagra, Rheumatismus, Rubeola, Scarlatina an- *pnosa, Scrofula, Tussis, Vaccinia, Vermes, and Vertigo.

THE METEOROLOGICAL JOURNAL,

from the 20 th of MAY to the 1 9th of JUNE, 1820,

IJy Messrs. HARRIS and Co.

Mathematical Instrument Makers , 50, High Holhom.

D	Moon |	If	Therm.	Raroin.	Lie Luc’s Dry.	fly groin. Damp.	Winds.	Atmo. Variation.
20	D		00	64	51	oa	15	30	30		10	9	WSW	WSW	Fine	Clo.	Clo.
l i			02	66	53	30	33	30	29		8	8	wsw	SW	Fine
22			02	70	54	30	21	30	11		9	10	s	SE	Fine	-
23			02	73	5?	30	00	29	86		11	9	SSE	E	Fine
24			63	71	5 i	29	80	29	80		8	8	SE	S	Fine		Clo.
25		,50	55	59	49	29	79	29	74		9	9	SW	SW	Rain	Sho.	Clo.
20	0	,03	61	62	52	29	84	29	76		8	7	w	wsw	Clo.	Sho.	Clo.
27	,47	53	55	52	29	67	29	65		8	7	VVN W	wsw	Rain	Fine	Clo.
28		,03	58	62	50	29	60	29	50		6	8	w	w	Clo.	Rain	Sho.
29		,15	53	58	48	29	40	29	35		6	5	WNW	w	Clo.	Rain	Fine
30		,01	50	58	49	29	38	29	38		4	5	w	w	Fine	Rain	Sho.
31		,02	54	58	48	29	40	29	46		4	5	w	w	Clo.	Rain	Clo.
1		,01	54	56	50	29	51	29	57		45	44	w	w	Fine	Rain	Fine
2		.32	56	59	47	29	60	29	68		44	45	w	w	Clo.	Rain	Rain
3	d	,07	51	57	46	29	76	29	84		45	48	WNW	NW	Clo.	Rain	Clo.
J i		,01	50	52	46	29	91	29	91		47	48	WNW	WNW	Rain	Sho.	Clo.
5			52	60	50	30	00	29	91		48	48	WNW-	WNW	Clo.	Fine	Sho.
6		,25	53	56	48	29	95	30	08		48	47	WNW	NE	Sho.	Clo.	Fine
7			54	60	48	30 07	29	97		50	49	WNW	NT	Fine	Clo.	Clo.
8			55	62	54	29	97	29	90		49	51	WNW	NW	Clo.	Fine
9		,06	56	60	47	29	81	29	73		51	50	NW	NW	Clo.	Clo.	Rain
10	»j		52	60	47	29	76	29	70		50	51	NNW	NW	Clo.	Clo.	Fine
il		,02	53	57	50	29	59	29	61		50	52	W	SW	Clo.	Sho.	Sho.
12	|	,03	52	59	46	29	73	29	86		50	52	SSE	NE	Rain	Clo.	Fine
13		,63	56	60	48	29	90	29	91		53	53	NNW	ESE	Fine	HI. st	Rain
U			52	61	48	30	06	30	0:2		55	54	NE	WNW	Clo.		- . - -
15			52	59	49	29	84	29	92		55	54	WNW	NE	Clo.	Sho.	Clo.
16			55	62	54	29	96	29	93		54	54	NW	N	Clo.
17			>9	64	54	29	96	30	00		55	55	NW	WNW	Clo.	Clo.	Sho.
18	D	54	50	64	54	10	06	29	91		54	53	WNW	SW	Fine	Fine	Clo.
19|		09	58			29	73	29	73		57	51	NW	w	Clo.	Clo.	Clo.

The quantity of rain fallen in May is 2 inches and 63-lQ0ths.

86

A REGISTER OF DISEASES Between MAY 20 th and JUNE I gtA, 1820.

DISEASES.

Abortio .

Abscessio . .

Amenorrhoea . . • •

Anasarca • « « * . . • •

Aphtha anginosa .

Apoplexia . • • * •

Ascites . . .

Asthenia . .

Asthma .

Bronchitis acuta .

- chronica * • * •

Cancer • • • • . .

Carbunculus .

Carditis • • ............

Catarrhus .

Cephalalgia *

Cholera . .

Colica . .

— - Pictonum

f * • • •

Convulsio ..........

Coryza • * * .

Cynanche Tonsillaris

- - maligna * • <

— - Trachealis

- - Tarot idea* -

Diarrhoea .

Dysenteria .

Dyspepsia .

Dyspnoea .

Dysuria . * * *

Eczema .

Enteritis .

Entrodynia .

Epilepsia .

Erysipelas .

Erythema lave •••< • - nodosum

• • • •

catarrhalis • * * * Si/nochus • • « • Puerpera • • • * • Remit. Infant.

Fistula Furunculus • * * Gastrodynia * • • Gonorrhoea pura

Haemoptbe .

Ilaemorrhois « • • Hemiplegia • • • Hepatalgia • * * * •

•	•
<r£	cd -*->
O H
9
1
5
7	1
1
9
6	2
1
19	3
6
6
1
1
4
35
22
6
3
o
3	1
1
4	1
1
1
3
13
5	1
22
6
1
3	j
2
4	j
5
11	1
1
1
15
ia
15
a	1
8	2
2
2
D 6
4
6
3 3

DISEASES.

Hepatitis «•••••

Hernia ........

Herpes Zoster • • Hydrocephalus •• Hydrothorax Hysteria .......

Icterus .

Impetigo figu rata Ischuria .......

Leucorrhoea * • • *

Lumbago . . •

Mania .

Melancholia • • • • Menorrhagia • • » • Morbi Infantiles*

- Riliosi* * •

Nephralgia .

Nephritis .

Obstipatio • ♦*•

Odontalgia . *

Ophthalmia .

Otalgia

Palpitatio .

Paralysis * * .

Peripneumonia • • • *

Peritonitis .

Pertussis .

Phlogosis .

Phrenitis * .

Phthisis Puimonaiis

Pleiaritis * • * * .

Pneumonia .

Podagra .

Porrigo decalvans • *

Prolapsus .

Prurigo mitis • * * • « * Psoriasis guttata * • — - - inveterata

• e • »

Pyrosis .

Rheuma acutus — — — chronicus

Roseola .

Rubeola .......

Rupia . . * * •

Scabies .

Scarlatina simplex <

* • • • • 4

Scrofula * Spasm i • Strictura

anginosa

	cd
O H
14	l
3
2
7	2
3	2
6
3
1
1
6
2
6
2	1
3
33	1
13
1
1
5
8
18
4
2
	1
J 15	1
8
1
19	4
11
6	1
3	1
1
2
1
4
2
10
21
1
24
1
63
4
3
5
4
1

Observations on Prevailing Diseases . 87

DISEASES.

Syphilis • • • * .

Tabes Mesenterica Tympanites* • • •-• •

Vaccinia .

Varicella .

Variola .

Vermes .

Vertigo .

w

o

cC 1

ft

18 5 1

10 3 ! 19; 1

7

12

DISEASES.

U rticaria febrilis * - - tuber osa

Total of Cases • Total of Deaths

Total. !	«3 c t
2 1	87
872

* Morbi Infantites is meant to comprise those Disorders principally arising from tien- tilion or indigestion, and which may be too trivial to encer under any distinct head; Morbi Biliosi, such Complaints as are popularly termed bilious, but cannot be accurately classed.

Observations on Prevailing Diseases.

By some mistake, we have not received the whole number of our lists for the last month; to which circumstance is owing the unusually small number of cases which appear on the record.

No epidemic tendencies have been particularly conspicuous during the period which this report embraces, with the exception of those catarrhal and infantile ailments which are referrible, in a great measure, to the long continuance of a rainy, and consequently chilling season. The fevers also which have appeared, have, in many instances, still assumed more or less of an intermittent character.

The temperature for the last few days has been uncommonly high : this weather, so suddenly succeeding to the damp and cold days of the preceding month, has produced some slight cases of cholera, which is more usually the ailment of a later period.

True pulmonary consumption is most certainly on the decline in this country — a happy, but perhaps not easily explicable fact.

88

Notices to Correspondents .

MONTHLY CATALOGUE OF BOOKS.

Cases in Surgery. By II. Jeffrys. 8vo. Price 8s.

A Treatise on Inflammation of the Mucous Membrane of the Lungs. To which is prefixed, an Experimental Inquiry respecting the Contractile Power of the Blood Vessels, and the Nature of Inflammation. By Charles Hastings, M.D., &c. &c. 8vo.

Exposition of Elementary Principles specially concerned in the Pre¬ servation of Healthiness and Production of Distempers amongst Mariners, Travellers, and Adventives, in Tropical, Variable, and Unkindly Climates ; with Miscellaneous Illustrations of Prophylactical Administration. By Andrew Simpson. 8vo. Price 18s.

A History of the Variolous Epidemic which occurred in Norwich in 1819, and destroyed Five Hundred and Thirty Individuals, &c. &c. By John Cross. 8vo. Price 9s.

NOTICES TO CORRESPONDENTS.

Communications have been received this month from Mr. Thompson, Mr. Price, Graius, and a Correspondent from Oldham , whose name we must again request , as the letter which accompanied his paper has been mislaid.

Dr. Palmer’s Contributions to Morbid Anatomy ( continued. ), and Mr. Davies’s Case of Abscess of the Liver communicating with the Stomach , we have orders to announce as immediately forthcoming. Mr. Wansbrough likewise writes us zvord, that he purposes shortly to transmit a Case of Phthisis , in zchich Digitalis was administered with marked efficacy.

We have been obliged to defer Dr. Williams’s very interesting communi¬ cation on the Colchicum Seeds , on account of the coloured Engraving which is to accompany it not being ready. It shall certainly appear in the next Number.

**n; Communications are requested to be addressed, (post paid) to Messrs. T. and G. UNDERWOOD, 32, Fleet Street .

THE

LONDON MEDICAL

REPOSITORY.

No. 80. AUGUST 1, 1820. Vol. XIV.

PART I.

%

ORIGINAL COMMUNICATIONS.

I.

Observations , with Cases, illustrative of the salutary Powers of the Seed of the Colchicum Autumnale , or Meadow Saffron , in the Cure of Chronic Rheumatism. Bv William H enry Williams, M.D., F.L.S., Ipswich, Fellow of the Royal College of Physicians, London. (With an Engraving).

Daily observation evinces the fallacy of the hopes which are continually attached to the almost innumerable host of remedies, which different writers have recommended for the cure of that species of rheumatism usually termed chronic — a painful disease, attacking principally the muscles and larger points of the body, unaccompanied by fever or inflam¬ mation of the parts affected.

In all situations of life, from the mansion to the cottage, this complaint meets the medical Practitioner’s view, in every variety of suffering to which it is liable; but it is peculiarly prevalent among the lower classes of society, who, subject to violent exertion and exposure to the ex¬ tremes of heat and cold, and often destitute of proper clothing to check its rapid progress, linger through a pro¬ tracted existence, without a prospect of cure, or alleviation to their pains, and are thus frequently deprived, for many years, of the power to support their offspring by an honest and laborious occupation.

In reflecting upon this disease, we are reminded of the VOL. xiv. — no. 80. n

90 Original Communications .

sufferings of our medical oracle, the immortal' Boerhaave, whose comforts were abridged, and his valuable life short¬ ened, perhaps, by the violence of this cruel disorder; whilst the very garden in which he daily solaced himself after the fatigues attendant upon his profession, and in which his botanical researches were pursued with so much ardour, might have furnished the antidote to his sufferings, if the seeds of the colchicum, which possess all the virtues of the root, without its pernicious qualities, had been presented to his imagination 1

Of the properties of the colchicum root in gout and acute rheumatism, much has been said and written ; but I believe the salutary powers of the seeds of that plant are neither generally known, nor justly estimated, either in chronic rheumatism or any other disease.

In administering the vinum seminum colchici, or colchi¬ cum seed wine, to thirty-five patients, most of whom were severely afflicted with chronic rheumatism, the effects of this medicine have really astonished me, by the early removal of pain, the progressive restoration of the use of the limbs, and the return of that salutary sleep, the want of which destroys all comfort, and embitters every enjoyment of life.

A few instances will serve to illustrate the surprising powers of this medicine, as the similarity of circumstances, in regard to positive pain, more or less, usually attending each case, renders a numerous detail both tedious and un¬ necessary.

Case I.- — John Burbridge, aged thirty, of Upper Orwell Street, Ipswich, requested my advice early in the autumn of 1817, being afflicted with severe pains in his loins, shoulders, and arms. He was free from fever; bowels regular, and appetite good.

He followed the occupation of labourer and super¬ intendent in a very extensive malting, for which, as an athletic man, of industrious habits, he was well adapted.

Not aware of having taken cold at an early period of his disease, he attributed his sufferings to the sudden changes of heat and cold, as well as to the vapour arising from the wetted malt, to which he was necessarily exposed ; and his malady had been gradually increasing for three years, aug¬ mented by continually restless nights.

I prescribed various medicines for him, during twelve months, without any material benefit; among which, a course of mercury produced no relief. His spirits began to fail, and the future presented to him only the cheerless prospect of protracted disease, and the unavoidable necessity of relin-

Williams on Colchicum Seeds.

91

quishing a situation which afforded the chief means of support to himself and family. In this painful state it occurred to me early in December to advise a fluid dram, or a tea-spoonful of the vinum seminum colchici, in a little ginger tea, twice in the day. After six days’ trial of the medicine, he called upon me with the information that his pains had totally subsided ; and a gradual increase of the dose to two spoonsful for ten days longer, afforded me the satisfaction of finding him entirely free from disease. He continues in the same state to this period, following his usual occupation.

Case II. — George Western, aged sixty-five, resident in Cox Lane, Ipswich, has been the subject of severe rheuma¬ tism in his arms and feet for some years, and at the end of December, 1817, he was under the necessity of giving up his employment, being confined to his bed for some weeks, from agonizing pain, and total inability to use his limbs. At length he was enabled to walk, or rather crawl ; for he was so bowed down by his complaint, that he was altogether incapable of walking upright. In this state I met him, and having known him some years since, as coachman in a gentle¬ man’s family, I inquired what had reduced him to so forlorn a situation? Upon his replying that he was “ eat up with the rheumatism,” which for some weeks past had “ cruelly” kept him confined to his bed, and deprived him of sleep, I offered him the vin. sem. colch., to which he objected, that his- advanced period of life, and infirm state, gave him no hope of being better. Upon my assuring him that I considered the prospect of his relief from pain very promising, he thankfully accepted my offered service, and 1 prescribed for him as* I had done previously for Bitrbridge, and with the same happy effect ; for in three weeks he was entirely recovered, and able not only to walk, but to return to his daily occu^ pation.

In February 1810, I accidentally met George Western again, apparently a great sufferer from rheumatism. He complained that his ankles were so painful, and his heels “ so drawn up,” to use his own expression, that he never should be able to walk comfortably again. I offered him the same assistance which proved so beneficial to him upon a former occasion. In one month he was perfectly free from all pain and the sense of contraction in his heels, and continues so to this period.

Case III. — William Potter, biicklayer’s labourer, aged twenty-seven, living in Albion Street, in Ipswich, became

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incapableof following his daily occupation early in July, 18f9, from severe rheumatism in his feet and ankles, which ren¬ dered walking an exertion scarcely to be borne. About the middle of August he was admitted a patient of the dispensary, and continued there eight or nine weeks with little benefit, on which 1 advised him the use of the vin. sem. colch. in the quantity of one to two tea-spoonsful in mint water at bed-time, for three weeks, by which time he was perfectly recovered. He has since been free from that complaint, and able to follow his usual employment.

Case IV. — Mrs. Kedgley, aged fifty-five, residing in St. Clement’s Street, Ipswich, has been many years subject to rheumatism, more especially in her loins and left hip. On first visiting her, January 7, 1820, I found her in complete despair as to her recovery ; in bed, to which she had been confined three months, and unable to be removed from it without experiencing the greatest agony, to which she submitted every third day, for the purpose only of having her bed made. Her account to me was, that during the greater part of 1817, the severity of the complaint confined her to the house, and also during the last eighteen months ; that she was scarcely ever free from pains, which about four o’clock in the afternoon always became exceedingly severe, and continued till six o’clock, when they remitted, but returned at eight or nine in the evening, or about one o’clock in the morning, extending to the left shoulder and breast, continuing for several hours in so violent a degree as to be almost insupportable. Her bowels were slightly irre¬ gular, the excretions from them not unnatural • tongue coated with a brownish fur; little thirst, but no fever; appe¬ tite indifferent; skin neither hot nor dry; the body greatly emaciated. In this state she commenced with guaiacum and other anti-rheumatic remedies, and continued them for several weeks, taking, during a considerable part of that period, from one to two grains of opium every six or eight hours, carefully abstaining from all diet of a flatulent nature. This treatment was attended with little or no benefit; and the case being rather an extraordinary one, I wished to make fair trial of the usual remedies, in as powerful a degree as the comfort or safety of the patient would admit, before I ad¬ ministered the vin. sem. colch., of which, about the middle of March, I prescribed daily a fluid dram, in mint water, at three o’clock in the afternoon, and at seven or eight in the evening. She had not persevered a week in this medicine before she experienced material relief : her pains were lessened, her appetite and bodily strength were increased, and she began to

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enjoy a little sleep. The medicine having been gradually augmented to three fluid drams in a dose, at the end of three weeks she was exempt from the periodical returns of pain, and was nearly free from her former sufferings ; and at this period, the end of May, her health in general is renovated, her natural sleep nearly restored, and she is resuming the active duties of the mother of a considerable family, with no other symptom of the disease than occasionally a trifling pain in the hip*

Jt should be observed, that the distressing effects upon the stomach and bowels, too often produced by the concen¬ trated tincture or infusion of the colchicum root, (the sup¬ posed basis of most of the pretended specifics for gout,) never have occurred under my observation, in administering the seeds in wine*, which I attribute principally to the seeds being free from that acrid quality so evidently prevalent in the root.

Indeed, such is the uniform mildness with which the medicine acts, that it requires no particular care in the patient, nor anxiety on the part of the medical attendant ; and its effects have been always so pleasant, that the only sensible operation has arisen from its requisite action upon the bowels once or twice a day, and the comfortable support derived from it, which is so manifest to the patient, that an omission of one or two doses usually occasions a sensation of the absence of some invigorating power.

To ensure the full efficacy of the medicine, it is desirable that diet of a flatulent nature be avoided ; especially fish, broths, gruel, milk, puddings, and undressed vegetables: at the same time, a material diminution in the usual quantity of beer, tea, coffee, or chocolate, will prove highly advantageous to the patient, who, in yielding to these restrictions, may still enjoy the solid comforts of the table, with the conviction that he is thus diminishing pain, and promoting his recovery.

The vinum seminum colchici which I have been accus¬ tomed to use, is prepared as follows : —

R Sem. Colch. Autumn, siccat. ^ij.

Vini Hispanici (Sherry Ang. dicti), octar. j.

Digere per dies octo vel decern, subinde agitando, dein per

chartam colaf et in vasi probe clauso usui serva.

The quantity administered must be proportioned, of course,

* A preparation of the seeds in proof spirit is objectionable, being turbid, unpalatable, and disposed to precipitation.

t As the seeds contain a large quantity of mucilage, it is desirable to pass the preparation through Dutch blotting paper, before it is filtered in the usual manner.

94 Original Communications .

to the age and strength of the patient. With adults, I have usually commenced by giving one fluid dram in a table-spoon¬ ful or more of some aromatic water, once or twice in the day, according to the violence or continuance of the disease, gradually increasing the dose to three fluid drams, as circum¬ stances may require, beyond which I have never found occa¬ sion to extend it. it should be taken generally two or three hours after breakfast, and repeated at bed-time; but if the disease be mild, and of short duration, it may be requisite once only in the day, when the hour of going to bed seems to have a preference.

It may not be unnecessary to remark, in this place, that the acidum aceticum, and the spiritus ammonise aromaticus, im¬ bibe the powers of the seeds in the same proportion as sherry ; that an abundant aqueous extract may be obtained from the seeds, but no oil; and that water distilled from them appears totally inactive.

Having tried the extract, and a tincture prepared from the seeds and the aromatic spirit of ammonia, in the proportions just mentioned, each in two cases only, I am not competent to pronounce them efficacious to the extent my most sanguine hopes anticipate ; but I think I may venture to predict, that, these two preparations, and also the acetum sem. colchici, will be found very powerful remedies in subduing various convulsive, spasmodic, and other disorders, to which mankind are liable, without the dire consequences too frequently produced by our more potent remedies.

With respect, more especially, to the vinum seminum colchici, of the safety and efficacy of which I have expe¬ rienced such abundant proof, I cannot contemplate an ex¬ tensive use of it in many painful diseases, besides chronic rheumatism, without entertaining the hope and belief, that we have at length found the happy desideratum, a powerful yet mild medicine, capable of substituting calmness, tranquillity, and balmy sleep, in the place of pain, weariness, and restless nights — a renovation of long lost limbs and comparatively robust health, in lieu of feebleness and emaciation — in a word, affording to the poor, as well as to the rich, the cherish¬ ing prospect of prolonged life, and, during its continuance, an oblivion of many of its distressing pains.

In speaking thus favourably of the colchicum seeds, and recommending so earnestly their use to the Profession, I am not urging the administration of a rare and expensive medicine, nor one which is difficult of access. A bountiful Providence has diffused around us in abundance every blessing that tends to the enjoyment of life and the amelioration of its evils ;

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95

und the facility with which the colchicum plant may be pro¬ cured, evinces that the remedy is as widely dispersed as the disease. Medical men, therefore, in collecting and applying the seeds to the purposes for which they were evidently designed, will confer an essential benefit on mankind,- and gladden the hearts of thousands.

The colchicum autumnale abounds in several parts of Suffolk, and grows plentifully in the north and west of England.

The annexed Plate represents the seed vessel entire, and a transverse section of another, exhibiting the form in which the seeds are deposited. They should be gathered the end of June, or early in July, be carefully dried, and kept in a dry place.

If a supply of the seeds should be required in those counties where nature has denied its spontaneous growth, an application to Mr. Fitch, Chemist, Ipswich, will readily obtain the quantity desired.

ig

On the Conduct of certain Lecturers. By Graius.

In the philosophic and lenient pages of the Repository I should have been loath to have led the way in vituperation ; but as, some months since, Lucius was permitted to vent his philippics against certain deteriorators of the dignity and benefits of hospital appointments, I trust that I shall not be prohibited, who have a few remarks to advance upon another order of our professional brethren. They to whom I now refer, are lecturers in various branches of our common art; or science, if this title be demanded. The office of a lecturer is very imposing and very influential. He who fills it, is apt to create in the bosoms of his auditors, not merely a prepossession in favour of his scientific sentiments and dogmata, but likewise — I appeal to facts — a leaning towards his individual character and habits, and opinions, moral, political, and theological. He wields a weapon, which, though it be aimed at a straight forward object, is very capable of giving, as it is swmng, a most potential side-cut. It may be thought, perhaps, that I am about to reiterate the arguments that have been hurled from many a quarter, against a certain public medical advocate of the Lucretian doctrine. I am not upon that score; enough has been said, in my opinion, for refu¬ tation and a quietus. My quarry are men, who do not propose themselves as subtle philosophers, appealing to the in-

96

Original Communications.

genuity and ratiocination of their pupils; but a more pre- tensionless race, who make a direct overture to the fancy and the passions. The Editors of the Repository will consider my objurgations as restricted to that metropolis, wherein their beneficial and laudable operations for the medical world are instituted. There are then lecturers, who do not con¬ fine their discourse within the boundaries of their special and scientific subjects, but suffer it, when opportunity is presented, to range into obscenity, not simply of allusion, but even, impliedly, of exhortation. Bold as may appear a charge of this description, l do not hesitate to advance it, confidently relying on that experience of its truth, which many students of our profession must have had. So much for the fact : whereon 1 am anxious to make a few and obvious remarks.

The lecturers to whose conduct 1 now refer cannot be insensible to the charms and benefits of purity and virtue. If they concede not to integrity of morals that overwhelming importance which the Christian revelation attributes, they cannot deny the political, the social, the worldly good which it involves. They cannot affirm, that simply relative to the temporal prosperity and reputation and peace of any man, he can be too temperate, too conscientious, too severely virtu¬ ous. This postulatum being admitted, that acquaintance with the philosophy of the human mind, which their native sense and their peculiar studies impart, assures them, that no impressions are deeper than those made in the young and the susceptible, by men to whom, for any mental superiority, they look with deference and awe. They cannot but allow that, gain the implicit reverence of a youth for superiority of acquirement and judgment in any art or science, and you possess a strong hold upon his credence of your individual sentiments upon other subjects not allied to the immediate science you may teach. This truth I shall not endeavour to enforce, for its axiomatic character will be recognised and granted by every man of sense and sincerity.

Nor need l more than assert, that the vast majority of medical and chirurgical students in London is composed of the susceptible and the young — -of men at that precise period of their lives, which, in all human probability and calculation, is both the prophet and the cause of their future course and destinies.

To the interest, to the ticklish complexion of this era of their lives and studies, must be added another and most in¬ fluential circumstance, that of place. The fascinations of the metropolis, its great power of seduction from sobriety, and Steadiness, and virtue, will be conceded by men of the most

7'V 1

Graius on Lecturers ,

97

adamantine and habitual self-control. Born, bred, and edu¬ cated, most of these students, in the quietude, the simplicity, and the unvarnished integrity of country life and manners, the delights, the dissipations, the splendid and luscious vices of the city surprise them, unprepared by previous fore-know¬ ledge or even conception of their power.

Loosened from the restraints of apprenticeship or home, withdrawn from the eye of the parent, or guardian, or master, these young men, for the first time, behold all external impediments to pleasure and vice removed ; none remaining, save what they may create for themselves by voluntary firm¬ ness. How little of self-imposed restriction there is in the world, how little of goodness which does not result simply from foreign circumstances, or absence of temptation, or opportunity, it is not necessary I should calculate • no man will contend that there is much.

It is then exceedingly obvious, that at this particular period of the student’s life, the dangers of error, of fatal folly, and of irretrievable criminality, are of themselves, and of necessity, sufficiently numerous to justify the keenest solicitude — and that the corrupting influence of others, and those their supe¬ riors, at all times culpable, is now egregiously to be con¬ demned. To necessary and inevitable perils ought addition to be made by the discourse of a philosophic lecturer? If from such we do not expect the rant of fanaticism, nor even the professed inculcation of moral truth, neither do we look for indirect exhortations to impurity in conduct, any more than palpable incentives to scepticism in sentiment. But I have repeatedly, nay as regularly as particular lectures have been delivered in the order of the course, heard broached from, the chair language which is hostile to taste, decorum, and virtue ; language very likely to contaminate the moral sen¬ timents of the youthful auditory, and which, I have reason to believe, does produce the probable and lamentable result.

I trust that these inculpations will not be considered gene¬ ral ; involving all or many of our lecturers. There are men, to whose instructions the most solicitous parent may submit his son, fearless lest with the nutriment of science he imbibe the poison of sensuality ; men as amiable for their tenderness of conscience, and venerable for the sternness of their virtue, as they are admirable and inimitable for genius, and erudition, and skill. The practice of medicine brings us into contact with every variety of character — with integrity and innocence, with turpitude and folly : and it is on this very account, that more caution to avoid the snares of vice is demanded of the medical class of the community than of any other; for we all know, that human nature is more prone to the imitation of

VOL. xiv. — no. 80. o

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bad than of good example. The presentation to the view of the student of the most flagitious actions, is unavoidable by lecturers on medicine and surgery: and it is a fact, that the mere contemplation of viciousness, without eulogium or ac¬ quiescence, is of itself, in general, a sufficient cause of vice in the spectators. Man is, indeed, an imitative animal; and he not only copies the mechanical arts, and the indifferent habits of his fellows, but he quickly sympathizes with the moral behaviour and sentiments of those who surround him, whether they be laudable or worthy of detestation. It is on this fact that the success or failure of the education of the young depends — and its importance has not only been acknowledged in Holy Writ, but by the sagacious teachers of an admirable philosophy. I hope that this crimination of certain gentlemen, holding most efficient stations, will not be deemed irrelevant or unhandsome, since their professional talent and knowledge, great and masterly as it is, does not authorize them to exceed the bounds of science; since their very powers and celebrity render them truly formidable, if they embrace an occasion to propagate moral error; and since their auditors are disabled from that species of self-defence or reply, which in lesser assemblies, or social intercourse, is enjoined by an ancient moralist : — ‘£ Periculosum est etiam ad orationis obsccenitatem progredi. Cum igitur tale quip- piam incident: aut (si feret opportunitas) objurgabis eum, qui sermonem ilium injicerit : aut taciturnitate saltern, et rubore vultuque ostendes, earn orationein tibi displicuisse.” — Epictet. per Ber helium.

Will it be credited, that in the same discourse wherein voluptuous images and appeals to the violence of passion are introduced, a lecturer shall exhort to diligence in observa¬ tion and study ? Can he expect that his counsel will be obeyed, when within the same hour he has relaxed the sinews of mental energy, and proposed to the imaginations of his pupils, pleasures less dearly earned than those of professional fame and emolument and the comparatively frigid consola¬ tions of mere science ? Yet this flagrant absurdity is practised ; the learned teacher wonders that the benches of the lecture- room are vacated, when his own language has excited in the bosoms of his disciples a preference of the bagnio or the saloons of the theatres. He forgets the general laws of human character; that it is almost impossible to be, at one and the same time, a devotee of pleasure and a severe student of art or learning. There are, indeed, exceptions to this rule ; there are men, who, by a force of character rare and frightful, contrive to unite prodigious labours in science and literature with the most abject lawlessness of sinful pleasures. But

G ra i u s on Led urers .

99

these original monsters are not fit objects of imitation by common minds; to say nothing of the insuperable impe- diments to calm lucubration which, in such, an uneasy consci¬ ence will engender. Jt is not easy for them to alternate, with rapidity and ease, the abstraction of hard study with the relax¬ ing deliria of imagination and sense. I am surprised that the subject of these remarks has never yet extorted public ex¬ posure and public reproof ; that there has never been excited that general indignation which his behaviour merits, who travels out of his road to add incentives to the most important, most violent, and most influential of all human passions; that restricts himself not to the enforcement of scientific dogmata, but dales to cast his weight into the scale of im¬ morality and libertinism, and deigns to make himself a pander to vice.

Perhaps, on this important subject, enough has been said ; tlie truth of the case being too near the surface to require much labour to expose it to the view. I would, however, once more endeavour to impress upon the minds of those whose situations as lecturers enable them to exercise great sway over the minds of their disciples, to be upon their guard, lest, by impurity of discourse and inattention to rigid morality, they not only degrade and ruin those minds, for whose direction to nobler purposes they occupy the academic chair, but ultimately bring upon their own consciences deep guilt and terrible dismay. Betwixt immorality and scep¬ ticism there is, after all, a close relationship ; and jflie follow¬ ing quotation from a recent writer, will not be deemed mis¬ placed; — “ If there be a thought which, in the hour of im¬ pending dissolution, must agonize arid distract even the most hardened infidel, it is the remembrance of having been the instrument of perplexing the understandings, destroying the hopes, and corrupting the morals of the young men com¬ mitted to his charge. At that very age, when every motive which religion can supply is so imperiously called for, to check the rising passions, and to subdue them into a state of permanent and rational restraint, it is an offence no less against social than individual happiness, to inculcate those principles, which set all conscience and morality at defiance.’5 Rennell on Scepticism.

But the guilt in this business is not confined to the lecturer alone ; I should he sorry to foster the idea, that because he is culpable his contaminated auditors are void of blame. They are old enough to think on moral subjects for themselves ; and if they sufter their respected master to modify their senti¬ ments and practice in morals, with the same dominion as he exercises over their medical creeds, they are both pusillanj*

100

Original Communications.

mous and blameworthy. He is not clear of wickedness ; but they participate therein. And i beg leave here to hint, that even on medical particulars it is the part of a philosophic and a manly mind, not to pin an implicit faith on the sleeve of any teacher, however eminent — however sagacious — however eloquent. Every man, it is well known, rides his hobby- horse ; and a wise student will religiously guard himself from any prejudices which may induce him to ride with his master the full lengths. It is the want of this caution— it is the want of this vigorous independence of thought — this examination for himself into opinions — which makes so many a student carry devastation through the circle of his after labours. It is this which enables an observant spectator to declare from what hospital, from what school, a Practitioner has emerged, when he perceives him applying one set of remedies to univer¬ sal disease. One man drains the life-blood from all his patients; every pain is that of inflammation, and every debility results from congestion. Another beholds in mercury and its preparations a panacea whose value can never be suf¬ ficiently appreciated - — w7hose powers can never be too often applied. He makes a bold attack upon the vital principle, and he quenches it by scruples and semi-drams of calomel. With some, every malady must have an hepatic origin; with others, purgatives are both the preventive and the cure of all varieties of complaint.

Not that I would dictate an insolent contempt of the doctrines of older and wiser minds, or a rash presumption on individual sagacity. However paradoxical it may appear, it is no less true, that great independence of thought is quite consistent with great humility and self-distrust. The wisest have ever been the most diffident of men. Let a student dis¬ trust himself for the very same reason he would distrust another. Let him recollect, that in science, as well as in other affairs, all men have their prejudices- — their own narrowed and jaundiced perceptions. Let him remember, that all science is composed of facts and of inferences ; of the facts he must soberly ascertain the verity ; and the inferences must be cautiously estimated, by his own powers of balancing evidence, by his own skill in logical deduction.

I hope this letter will not, from its moral complexion, be alien from the design of the Repository : and if against the remarks on the lecturers it be objected, that after all 1 may be the dupe of hearsay, or a Methodist parson in a medical mask, I reply to the first suspicion, “ Quaeque ipse miserrima vidi;” and as it regards the lamentable results above deprecated, I confess with remorse, u quorum pars magna fui/' 1 .

Beneficial Effects of Electricity , fyc.

101

III.

Case in which Electricity , combined with Oxygen Gas, proved highly beneficial. By James Price, Electrical and Pneumatic Institution, Henrietta Street, Covent Garden.

Mr. - , a young gentleman, twenty-three years of age,

consulted me upon the propriety of his inhaling oxygen as the last resource, conceiving, that if he should not derive benefit from its use, in conjunction with the application of galvanism, nothing could be done for him, as he was tired of taking medicine, which he had persevered in for three years, agreeably to prescriptions he received from some of the most eminent Practitioners in the metropolis. He continued declining in health, and had become so emaciated that his Friends apprehended his being in a decline. He laboured under extreme nervous debility: the functions of the chylopoetic viscera were very much deranged ; bowels so constipated that ordinary purgatives had no effect; but by repetition of an increased quantity, an evacuation was occa¬ sionally effected by this means, but which left him in a weak state and his feelings so extremely affected, that at last it was deemed prudent by his medical advisers to have recourse to enemas to evacuate his bowels daily, which if he neglected the use of but for one day, it rendered him distressingly un¬ comfortable. He had tried the effects of a course of mer¬ curial pill, and had taken calomel ; neither of which had any effect in exciting a proper action of the bowels. He not only complained of general debility, but also of the usual symp¬ toms of a derangement in the digestive organs; aversion to motion; spirits very much depressed; sense of oppression and sinking ; sallow countenance; disturbed sleep, &c. As he proposed to try galvanism, I made no objection, con¬ ceiving it probable that that species of electricity, if judi¬ ciously applied, might rouse the nervous energy, and that the torpor in the secretory organs might be removed. However, after persevering in its use for some time, and finding no amendment, he was induced (by the suggestion of a relation, who had been informed, that the person who applied gal¬ vanism was not professionally educated, and, consequently, could not be a competent judge of the mode of applying so active an agent as electricity,) to consult me upon the pro¬ priety of electricity being applied to him in die manner w hich several of my patients (which he met when attending to inhale the gas) stated they had derived so much benefit from, under somewhat similar circumstances, though not so aggra-

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Original Communications.

vated, or of so long standing. I commenced the application of electricity about the middle of February last, and repeated it daily for three weeks (exhibiting also two gallons of oxygen gas); then every second day for three weeks; after this the application was less frequent, every third or fourth day, till the 22d of April, when it was discontinued, (the gas was inhaled for seven weeks), when his health was ma¬ terially restored, and his bowels evacuating more regular. (The enema was discontinued the first week of applying electricity.) He progressively improved in health, and recovered his flesh so rapidly, that each visit, latterly, it appeared the more evident. Those friends who had not seen him from the commencement of his attendance on me, ex¬ pressed their astonishment at the restoration to perfect health, when they rather anticipated hearing of his decease. He paid me a visit yesterday, and states that his alvine evacua¬ tions continue regularly every day.

Should any reader, from the perusal of the above, be disposed to investigate more particularly the circumstances of this case, the gentleman in question authorizes me to state, that he will be most happy in communicating them by appointment.

IV.

Remarks on Mr. Davies’ Case of Labour prematurely induced. By Edward Thompson, Whitehaven, Member of the College of Surgeons, London.

In the Repository for May there is a case related by- Mr. H. Davies, of labour prematurely induced, wherein it is stated, in a concise and clear manner, that the usual mode of operating was deviated from. The treatment of the case does the gentleman the highest honour, and displays particularly the resources which an active and intelligent mind has in reserve, when difficulties present themselves. Yet, although Mr, Davies deserves the greatest praise for the improvement he then made, (evidently without being aware of such an operation having been before recom¬ mended or practised,) 1 will, as briefly as possible, give an extract from the lectures of Dr. Hamilton, Professor of Midwifery, taken eight years ago, where the same practice is laid down which Mr. Davies pursued in the case of Mrs. H. Dr. Hamilton has frequently operated in this way with success, and speaks of it in his lectures in terms of high commendation. That it is more simple, less difficult,

103

Wood’s Case of Laborious Parturition , §c.

and equally as effective as the one usually recommended and commonly performed, admits of no doubt. The case alluded to stands as a proof; a stronger one need not be brought forward. The membranes were left whole; they descended, gradually dilating the os uteri, as in a natural labour; and the case ended with not one untoward symptom taking place. But to proceed in extracting a few words from the written lecture before mentioned. After having at large commented upon the states requiring such an interruption to the common course of nature, the lecture is continued thus: — u An operation to excite the uterus to action before the full period of gestation being admissible in certain cases, and the time when such an operation should be had recourse to, having been particularly men¬ tioned in a former part of the lecture, it only remains to describe the steps which should be followed to promote the end we have in view ; and which can readily be done, for the method is simply that of removing the decidua with the finger from the neck and os uteri.” Such has been the practice of Dr. Hamilton, which cannot be too much recommended. Nature is but little disturbed or interfered with, so much desired by all; — u servare modum, finemque tenere, naturamque sequi.” And though we may have to resort to means like this with regret that it should ever be necessary to do so, yet cases will be met with to which aid must be given; and surely the gentlest, if it is as effective, is the best. My object in transmitting the above extract will be seen; it is, that Practitioners may direct their atten¬ tion more particularly to a plan which, before the case of Mr. Davies appeared, I thought had been more generally practised.

V.

Case of Laborious Parturition and Foetal Scrofula. By Radcliffk Wood, Surgeon, &c. Oldham.

On the IQth instant, about 5 o’clock, A. M., a person came to desire that I would go to see N. Mellor, a poor woman, who had spoken to me a few weeks before to attend her accouchement, i was informed that she had suffered much during the last ttventy-four hours; but her previous labours (this being her twelfth) having generally been lingering, she was unwilling to give me any unnecessary trouble. She is in the forty-ffrst year of her age, and has led an active spirited life, till the completion of her eleventh pregnancy ; since which time her health has gradually declined : and

104

Original Communications.

on my arrival this morning, I was struck in seeing how milch she was wasted since the time she bespoke me; her sunken chest, raised shoulders, protuberant abdomen, and ghastly visage, gave her a very uncouth and frightful appearance. The pulse was rapid and stringy ; breath short and irregular; and her skin was hot and parched ; bowels are freely open ; and she has voided urine several times during the night: is certain she is at her full term of reckoning, and that the child was alive when her labour commenced, which was the preceding morning. She has a fistulous opening in the right hip, that takes a direction completely through the os ilium of the same side, and enters the cavity of the pelvis. This fistula and her recent ill health she attributes to having been hurried, as she terms it, at her last accouchement.

On examination, I found a portion of the membranes and liquor amnii protruded into the vagina conically, the base resting against the os externum, and the apex entering the os tincse, or rather lying in the cavity of the vagina, like a half filled bladder, which altered very little during her pains, although they were distressing, with short remissions, filer pelvis was well formed, and vagina large; the os tincse was dilated to near the circumference of half-a-crown, which was sufficient to allow me, without exciting any considerable degree of pain, to ascertain what part of the foetus presented ; being satisfied that the case was hitherto natural. I advised her to avoid struggling or exhausting herself as much as possible, and took occasion to relate a few successful cases, which 1 represented as having been similar to hers, and which exhilarated her spirits very materially. However, on finding there had been no alteration during my stay, which was upwards of an hour, 1 returned home, a distance of not more than a quarter of a mile, and ordered an anodyne draught to be given her immediately. About six hours after¬ wards, I was hastily told that the waters were just discharged, and her pains very violent ; and on repairing to my patient, I found her throes incessant and very agonizing, the opiate, as in similar cases, only having procured a slight temporary relief. The membranes were ruptured, and there was no fetor or discoloration of the liquor amnii any more than is usual ; no alteration had taken place in the os internum since my first visit. In the course of fifteen minutes her pains ceased, and she became quite easy for near half an hour, when they returned, and continued violent and incessant for fifteen or twenty minutes as before, and again ceased. She continued in this way upwards of three hours, during which time 1 assisted her by the most efficacious measures which the exigence, of the case and accruing circumstances

Wood’s Case of Laborious Parturition , fyc. 105

required ; but perceiving that her pulse became languid, with supervening cold sweats and subsultus tendinum, with other disagreeable symptoms, added to her hectic habit and previous weakened condition, 1 became convinced that nothing less than a prompt and determined, but cautious proceeding could save my patient. After having prevailed upon her to take a little light nourishment, 1 attempted cautiously and gradually, at short intervals, to dilate the os tincae, which gave less resistance than I had anticipated ; but which 1 suppose was caused by the soft and relaxed fibres of the uterus in consequence of her consumptive habit. However, notwithstanding that any resistance which the os uteri might have caused was now removed, the head still made no advancement. I therefore cautiously introduced my right hand, lubricated with bland oil, into the vagina, and gen lIy gliding my two first fingers round the cranium, which was riding loose over the superior strait of the pelvis, by this means I discovered the head to be uncommonly large, and the bones very considerably separated from their correspond¬ ing edges; and on applying a tolerable degree of pressure against the fons pulsatilis without perceiving the least evi¬ dence of life, I gently desisted from any further exami¬ nation; desired my patient to compose herself a little, if possible, and take a few draughts of negus, which she did. Shortly after, as I was devising the most likely mode of proceeding in order to effect a speedy delivery with safety to the mother, her pains began to assume a more natural appearance than they had hitherto done ; and I was no little surprised to find the head engaged in the superior strait, which, by encouraging her to hold her breath, and bear down during the pains, and avoid sobbing when they left, soon descended into the vaginal cavity. Thinking the greatest difficulty was now surmounted, I congratulated the sufferer on her success, assuring her she would presently be released ; but I soon found myself mistaken, for the preceding pains had not the least effect in advancing the head any further. I therefore, after waiting a short time, thought it prudent to apply the forceps, but they were not attended with their wonted success ; for it was a considerable time, and with great exertion, before I was capable of bringing the head beyond the labia pudendi. Having succeeded so far, and being more fully satisfied of the child’s death, 1 placed one hand under the chin and the other behind the head, and thus gradually increased my hold, at the same time moving the head up and down, and from side to side, till my whole strength was applied ; but to no effect whatever. I therefore VOL. xiv. — no. 80. v

106

Original Communications

passed my two first fingers into the arm-pits, which brought the arms and hands very easily forward ; but notwithstanding I was now in possession of such hold, and the pains sur» prisingly strong, i was under the necessity of gradually increasing an extractive force, till my utmost strength was ap¬ plied a very considerable length of time before 1 succeeded in bringing forward the body. However, after it was accom¬ plished, the placenta came easily away, and my patient was very comfortable, considering her situation and the severe and dangerous trial she had undergone, and is at present convalescent ; although, as 1 before mentioned, evidently af¬ fected with phthisis pulmonalis.

The child’s head, elbows, wrists, knees, and ankles, were unusually large; the forehead very protuberant; the limbs much emaciated and flaccid ; the abdomen was so enor¬ mously tumefied, that the circumference of the body in a direction across the umbilicus measured twenty-three inches. I conjectured from the appearance of the child that it might have been dead a few hours, as the colour was slightly changed, and the cuticle on some parts of the abdomen easily stripping off ; and from concurring circumstances I was fully satisfied, that this monster (for 1 cannot give it a more appro¬ priate term) was the consequence of an hereditary scrofulous taint and rapid progress of the disease in utero, and not in the least from the putrefactive process which occurred after its death.

Nineteen years ago last March, this poor woman’s afflicted husband had his left leg amputated a little below the knee joint, by Mr. Simmons, of the Manchester Infirmary ; and nearly six years since his right leg and thigh were amputated near the hip joint, by Mr. Kinder Wood, in consequence of scrofula. Though this child, as I before mentioned, is their twelfth, it is only the second that has been still-born. Eight of their children, that were born alive betwixt the first and second amputation, died before they w^ere a year old : their tenth and eleventh have been born since the latter amputation, and are yet living, and enjoy good health; but have evident scrofulous lineaments. Within the last year and a half the father’s elbows and wrists are become affected with enlargement and running sores, and the circumstances of the preceding case, in my opinion, are evident consequences of the parents’ constitutional malady.

Calendar of Natural History.

107

DEPARTMENT OF NATURAL HISTORY, &c.

Calendar of Flora , Fauna, and Pomona, kept at Hartfield, near Tunbridge Wells. By D r. T. Forster. From the ls£ to the 30th of June, 1820.

June 1st. — This month has set in with showery weather, which has continued for a long time past, while the tempera¬ ture remains low, and the wind south and westerly. There is nearly twenty degrees of difference between the maximum heat of this and that of last first of June. The vernal Flora is passing away, while the solstitial is backward in the gardens. The Purple as well as the Yellow Goat’s Beard is in full flower; but this weather seems to retard its meridian closure of the flowers, often for above twenty minutes.

2d. — Weather showery. There are still in flower, in the gardens, iris lurida , I. Germanica , I. Pseudacorus, Hemero- callis Jlava, Hesperis matronalis , Aquilegia vulgaris, Papaver Orientate , P. Cambricum, P. nudicaule , Asphodelus luteus, a few Roses, &c.

3d. — Weather calmer and warmer, but we had a few gentle showers*.

4th. — Clouded and calm, with gentle showers. Senecio squalidus still in full blow.

3th. — Cnicus pratensis in flower in my garden; it is not common yet in the fields. I hear that the Corn Rose (Papaver Rhceas) is in flower at Walthamstow to-day : those sown in my garden are not yet in bloom. Rhododendra, Azaleas, and other shrubs, in flower.

8th. — The common Peony in flower.

9th. — The weather is now warmer, without much rain; but the preponderance of clouded over clear skies still prevails, and is unusual at this time of year.

10th. — Lychnis dioica, L. flos cuculi, the several Gera¬ niums, the Ranunculi , &c. are now numerous every where. Tragopogon porrifolius and T. pratensis are numerously in blow; but in general the gardens are comparatively dull, the vernal Flora having subsided, while the solstitial plants, or those which come into flower about midsummer, are not yet out.

* This present showery weather, in this district at least, seems very wholesome ; we have rarely had a season of less sickness. Is this from the peculiar electric state of the rain and atmosphere generally } For some rainy seasons are as remarkably unwholesome as the present is healthy.

108

Original Commun icatiom .

1 Ith. — Papaver somniferum in flower in my garden, from seed which came up last autumn. (The petals are single, pale purple, and like those of the large white kind in shape #.)

12th. — Anagallis arvemis, the Wincopipe, in flower, but its petals are closed on account of the showery weather.

13th. — Papaver Rhceas in flower in my garden. This plant in general blooms very early in the morning. As far as I can observe, each morning supplies a fresh set of flowers, and they soon drop off, and the capsule ripens.

14th. — - Ophrys bifolia in flower in my field; likewise a variety of Carduus Marianas , without the milky streaks. Valeriana officinalis, Lysimachia nemo rum, and Dianthus barbatus, are also in flower to-day; the latter is, of course, in the garden. 1 hear that Papaver Rhaas is now very abun¬ dantly in flotver among the corn in Surry.

15th. — Digitalis purpurea in flower on most of the banks. This evening the stratus filled the valley of the Medway, and indicated a change to fine weather — a sign alluded to by Virgil : “ At nebulce magis ima petunt, campoque recumbuntR &c. — See Georg, lib. i.

3 7th. — — Fine morning. Dianthus barbatus , the Sweet William, Gladiolus communis, the Sword Flag, just coming into flower at Hartwell.

18th. — - Riding to Merstham, I observed Corn Poppies (P. Rhceas) to begin to be common at Bleachinglye, though they are not numerous in all the fields there. In some places only, the fields are already quite scarlet with them ; the soil being there a red sand, mixed with chalk ; but on the Sussex side of the town, and in all this tract, of dun-coloured clay and marie, about E. Grinstead, and as far as Tunbridge Wells, there is scarce a Poppy to be seen, except in gardens.

The Dychnis dioica is abundant by the road sides in Surry, and the Germander Speedwell every where blooms on the braes.

19th. — Carduus Marianas ( sine lacteis striis) and Hera- cleum sphondylium, now in full blow.

20th. — The Corn Flag ( Gladiolus communis ) in full flower.

21st. — Weather calm and fair. Dychnis Chalcedonica just coming into flower. Poppies begin to be common; though those sown in the spring are as yet small, and only just begin to rise up in the stalk. Sweet Williams and Pinks are also in bloom. The (Enanthe crocata in full flower by the road sides.

22d. — I procured and sowed some of the seeds of the Maw

* I shall notice the particular varieties from time to time, as 1 find old Gerard considered them to be permanent.

109

Calendar of Natural History.

Poppy, which are of a bluish-grey colour. I take this to be the wild P. somniferum.

23d. — I found Papaver Rhocas , P. dubium, P. Argemone, and P. hybridurn , all flowering near Brighton. I likewise saw the small variety of P. Argemone, which is by some per¬ sons mistaken for a new species, and called Papaver mariti- num. In riding through Chaley, from Brighton to Hartfield, I observed that no Poppies were found nearer than Newark, and there were only a few there, perhaps one or two by acci¬ dent. I should consider the tract of country devoid of Poppies (of which tract we may consider Crowbrough Bea¬ con as in the centre), as extending to within five miles of the sea. When one gets on the South Down hills again, they are seen among the corn and other sown fields, though by no means so numerously as in parts of Surry and Hampshire

26th. — Hot weather. Thermometer eighty-four degrees in the shade. The sky, though free from many definite clouds, is nevertheless misty, and of a whitish hazy blue. The gardens are much improved by the change of weather. Campanula Medium and Linum perenne in flower already, besides numerous Poppies, Pinks, Roses, Carnations, the Yellow Day Lily, Heartseases, See.

27th. — Apargia hispida in flower; also Rosa canina. The weather hot, but the horizon always thick and misty.

29th. — Lapsana communis, and Crepis tectorum, and the Stonecrops.

30th. — Crepis bcirbata , Convolvulus Nil., Cnicus palustris , C. lanceolatus, and C. arvensis, in flowrer. A few young plants of Leopard’s Bane are still flowering. The Yarrow and the Achill&a Ptarmica are coming out, and the Malva Moschata was out this evening.

The Poppies, which are now numerously in blow every where, appear to me to have produced the same varieties from the same coloured seeds as they did last year; that is, the seed of any particular variety produces the same variety again, perhaps out of a whole capsule of seeds, there being only one new variety, or lusus , which becomes a plant, the generality of whose seeds come up like the parent, that is, like the new lusus. i\nd this seems the manner in which varieties of plants in general are formed and per-

* A work exclusively on the Range and Distribution of the Habitats of Plants , made out to correspond with maps of the strata, would be very interesting ; and if such a work were in the contemplation of any able person, I should be happy to contribute several observations which I have made on this subject.

no

Analytical Review.

petuatecl. With regard to Papaver somniferum: 1. One va¬ riety has large round capsules, white petals, and white seeds. %. The next allied to this has a capsule not quite so large and round, pale lilac petals, deeper purple at the unguis, and bearing dingv yellowish seeds. 3. The Garden Poppy, with black seeds, has many varieties, both single and double, the seeds being greyer in proportion as the colour of the petals is lighter. The deep red kind, with blackish ungues to the red petals, produces black seed ; the lake-coloured sort, dark grey seed ; the double white, yellowish or pale seed ; the cream and rose coloured, deep yellow seed ; and so on. These seeds produce again the same varieties.

[This Journal is to be continued in the neighbourhood of Tunbridge Wells ; and will in future be published according to the calendar months. ]

PART II.

ANALYTICAL REVIEW.

RETROSPECT OF MEDICAL LITERATURE.

[Continued from page 50.]

In prosecuting our general review, it may be expected of us to advert, as we formerly did, to the lectures de¬ livered during the preceding season, at the Colleges of Physicians and Surgeons. Our account, however, of these readings must necessarily be cursory and imperfect, more especially as in the present instance they were so arranged as to fall, at the two Colleges, on some of the days, at the same time.

Dr, Cooke, Dr. Harrison, Dr. Powell, and Dr. Paris, were the lecturers at the College of Physicians ; Mr. Wilson and Mr. Brodie, at the College of Surgeons.

Dr. C. continued his dissertation on nervous diseases, from apoplexy to palsy ; adverted to the varied and frequently inexplicable phenomena characterizing this last species of morbid affection ; remarked on the retention and even in¬ creased acuteness of one faculty of the nerves, while another was suspended or abolished ; alluded to the question which has been agitated in the schools, whether these morbid states are to be considered as disorders of the same or different nervous fibrillse; and then more particularly called the at¬ tention of his hearers to the still unexplained circumstance, that injuries on one side of the brain affect for the most

Dr. Cooke on Apoplexy. 1 ] J

part, but by no means invariably, the opposite side of the body. On these particulars, however, we shall not now enlarge, as they, with others, will fall to be discussed when we shall be called upon to analyze the second volume of Dr. C., which is announced as forthcoming. We shall here take occasion, though a little out of order, to complete the ac¬ count of our author’s first volume, the review of which was left unfinished in the June Number, for want of room.

The sixth section of Dr. C/s published volume is on the treatment of apoplexy, in which we have, as in the former chapters, the several sentiments of both ancient and modern writers on this disease stated, and occasionally commented on. Our author first treats of the means to be employed when symptoms appear threatening an apoplectic attack ; secondly, on the mode of proceeding in the paroxysm of the disease; and lastly, on the remedies to be used after the recovery from the fit, with a view of preventing its return. The menacing symptoms of apoplexy indicate, we are told, for the most part, too great fulness of blood in the head; and blood-letting, purging, and revellents, should be had recourse to ; more especially the first, topical and general, according to the age and circumstances of the patient. In the actual fit, “ the patient should, if possible, be immediately carried into a spacious apartment, into which cool air may be freely admitted ; he should be placed in a posture which the least favours the determination of blood to the head. All ligatures, especially those about the neck, should be removed ; and the legs and feet should be placed in warm water, or rubbed with stimulating applications,”

The “ strong apoplexy” was thought by Hippocrates to be necessarily fatal ; and therefore he discouraged the use of potent measures, lest the remedies should be thought to have effected what was justly attributable to the force of the dis¬ ease. “ This dogma of Hippocrates,” Dr. Cooke says, “ has had a most mischievous influence both on ancient and modern practice ;” and he points out its inconsistency with the 51st of the sixth section of the aphorisms; in which it is stated, that persons who are seized with sudden pains in the head, who become speechless and stertorous, die in seven days, unless fever supervene*. Galen, iEtius, Caelius- Aurelianus, and Paulus-ZEgineta, all recommend blood¬ letting, as does Celsus, who however remarks, that in the strong disease this measure either kills or cures J. The

* ’Avrohhvvloci sv iitrcc v [xv •nvyvroc, i'n\'hot£>Y\.

| Si omnia membra vehementer rcsoluta sunt, sanguinis detractio vel occidit, vel liberal.

1 \cl Analytical Review.

moderns have, with few exceptions, followed the ancients, in recommending blood-letting, as a sme qua non in apoplexy. Fothergill and Heberden are those whom Dr. C. points out as the chief authorities opposed to this general principle and practice. Kirkland, Brown, and Darwin, are likewise objectors on the same grounds; viz. that apo¬ plexy is a disease of age and debility, and blood-letting is a weakening and exhausting measure. These objections, Dr. C. thinks, ought to be overruled by the consideration, that pressure on the brain is the source of the disease, and blood-letting the only means by which we can expect such pressure to be removed or relieved. The following sentence is quoted from Dr. Cheyne : “ Two pounds of blood ought to be removed as soon as possible after the attack; and if the first bleeding has not been of service, and the disease is unequivocally established, the chief question to be decided is the additional quantity of blood to be drawn. It ought to be known, that from six to eight pounds of blood have been taken from a person by no means robust, before the disease, which ended favourably, began to yield. The first and second blood-letting ought to be large, and a third ought to follow as soon as it is ascertained that this has been ineffectual in stopping the disease.” A ret ee us, Valsalva, and Morgagni, propose that blood should be taken from the sound side when a paralytic affection can be discerned. Baglivi recommends the evacuation from the affected side, being of opinion that the defective circulation cannot be relieved more speedily than by opening a vein in that part. Dr. Cullen adopts the former practice. Topical blood¬ lettings are advisable. Leeches, however, are “ too slow in their operation for the urgency of these cases.” Burserius recommends their application to the anus, in cases of apo¬ plectic attacks following supposed haemorrhoids or catamenia-. Dejean’s proposal of opening the superior longitudinal sinuses is referred to, which was formally objected against by Portal and Tenon, as offering no advantages over that of jugular venesection, and on account of the difficulty of stopping haemorrhage after the opening of sinuses. Although a friend to free blood-letting, Dr. C. thinks it may be and has been carried too far. Stimulants he objects to, even in what would be considered serous apoplexy. Drs. Cheyne and Cullen are at variance with respect to the propriety of blistering the head ; the former recommending cold applications in preference. Clysters as revellents are said to be occa¬ sionally very useful. Purging is always desirable. On the much agitated question respecting the propriety of giving emetics in apoplexy, Dr. Cooke thus expresses himself:

113

Cooke on Apoplexy.

“ Although we do not precisely know how the brain is affected during the act of vomiting, and although we are informed by Dr. Bryan Robertson and others, that emetics may be safely given in haemoptysis and other haemorrhages, I think that vomiting should not be excited in the strong apoplexy, till depletion had been tried in vain ; but if, after free and repeated evacuations of blood, both general and topical, and the administration of clysters and other revellents above mentioned, no signs of amendment should be perceptible, I would endeavour to excite the action of the vis medicatrix naturae, by the exhibition of an emetic of speedy operation, such as the white or blue vitriol/'

Our author next adverts to the circumstance of suspended animation from mephitic vapours, and objects to the as¬ sumption of Dr. Cullen, that the modus operandi of all such agents is the destruction of nervous mobility, and not the production of a compressed state of brain. Mephitic gases, Mr. Good more correctly conceives, produce apoplexy in some states of the constitution, and asphyxia in others; and the consequent conditions are to be treated accordingly.

When apoplexy arises from suppressed evacuations, the obvious indication is to aim at restoring them ; and when it is vicarious of other affections, the treatment must be adapted to the primary disorder.

Preventives of the disease are repeated blood-lettings ac¬ cording to circumstances, cathartics, issues, setons, with tem¬ perance in diet, and moderation in every thing. Individuals of an apoplectic tendency should also lie upon hard beds, with their heads elevated.

Of lethargy, coma, carus, cataphora, &c. u These soporose affections/' says Dr. C., “ as I have already stated, are very differently considered by different writers ; some receiving them as various degrees of apoplexy, others as entirely dis¬ tinct diseases.” When they7 partake obviously of an apo¬ plectic nature, they are to be treated accordingly ; but soporose affections, it is very properly remarked, sometimes depend upon a particular condition of the brain, exclusive of vascular torpor or fulness; an interesting illustration of which is detailed in a case that ended in insanity, after repeated depletions, as well as mercurial and other medi¬ cines. Neither the rationale nor treatment of catalepsy is very satisfactorily made out : this is a state of very rare occurrence ; and many of the recorded cases are attended with suspicious circumstances as to their reality.

Hydrocephalus, or apoplexia hydrocephalica. Although the ancients have not described this as a distinct disease, Hip¬ pocrates, in speaking of the complaints which arise from the head, (N ouaoi at omo KttpaXris yivofxevai), describes one which

VOL, xiv. — no. 80. o

114 Analytical Review,

in its symptoms a good deal resembles the acute or internal hydrocephalus. In his account of this disease, the ancient sage uses the expression ett) rco Evuetpahco, from which Dr. Whytt infers, that he means to designate the water as upon , rather than within the brain ; but Dr. C. very properly objects against this explanation, by stating that the preposition ett) is often employed in the latter signification. For the minute description, however, of this complaint, we are to look into the modern authors, particularly Whytt, Fothergiil, Cheyne, Smith, Yeats, and Coindet. Several authors, particularly Yeats, have regarded its origin as referible to the diges¬ tive organs, and have directed their preventive measures ac¬ cordingly. On this head our present author thus expresses himself : — -

“ The symptoms which Dr. Y. has mentioned as occurring before any alarm is taken, and which, in his opinion, often lead to hydroce¬ phalus, are, it must be confessed, equivocal : they may have no con¬ nexion with that disease, or they may be precursors of some other complaint of a very different nature ; but whatever they lead to, they require careful consideration, and he has very properly called our attention to them.”

Dr. Cooke, with others, speaks in favourable terms of the history of hydrocephalus given by Dr. Whytt, who divides the disorder into three stages : the first or pyrexial stage, in which marks of vascular irritation are present ; the second, in which the pulse is even slower than natural ; and the last, in which comatose symptoms supervene, with dilated pupils, rapid pulse, hurried breathing, and convulsions. These 1 symptoms do not, however, occur witli any thing like that regularity which the description of Whytt would lead the student to expect; and the duration of the malady is like¬ wise extremely uncertain. Coindet divides hydrocephalus into two kinds; the first marked by febrile and inflam¬ matory signs, the other without fever. In the idiopathic or inflammatory species, he contends that one of the most prominent characteristics is a remarkable resistance to the action of strong emetics.

The appearances on dissection after death from hydroce¬ phalus are various; but the most common is that of a fluid upon the surface or in the ventricles. Dr. Cheyne remarks, that “ The substance of the brain is generally soft and blanched, fimbriated and particularly soft where it forms the ventricles.” Many diseased indications are also found within the abdominal cavity. The hydrocephalic fluid has generally been attributed to inflammation. Respecting, how¬ ever, the degree and kind of this prior state, much con¬ troversy has taken place ; and Smvth even goes so far as

115

Powell on Apoplexy.

to say, that “ Neither the brain itself nor its membranes, in any case of genuine hydrocephalus that has ever yet been examined, showed any appearance of inflammation, or of the usual effects of this having taken place.” The fluid in hydrocephalus exhibits variable degrees of coagu¬ lating power. For the most accurate account of its ana¬ lysis, Dr. Cooke refers to Marcel’s paper in the 2d v.ol. of the Medico-Chirurgical Transactions. In regard to the exciting sources of this affection, some authors, as Wall and Rush, think that blows, falls, and the causes of in¬ flammation generally, are sufficient to produce it in an imr mediate way ; while others, as Cheyne, conceive, that when the malady is so induced, it occurs through the medium of a ■scrofulous diathesis thus brought into play.

As it relates to the curable nature of hydrocephalus, Dr. C. holds a sort of intermediate opinions; neither, with some, giving up the notion of its being altogether irremediable when confirmed ; nor, with others, fancying the disease will yield with facility to proper remedies. On the contested question of mercurial influence, our author thus expresses himself : —

4t The instances of recovering from this dangerous complaint, under the management of Dobson, Percival, and many others, as well as those which have fallen under my own observation, may, I think, be fairly adduced in support of the practice in question ; and I believe few Physicians of the present day would think themselves justified in omitting to employ mercury in attempting the cure of this complaint.”

The volume is concluded by a slight allusion to the hydro¬ cephalus exterior, described by some of the ancients, par¬ ticularly by Galen ; and by Sauvages, and other modern nosologists. The cure of this disease by puncture, as par¬ ticularly related in the 9th vol. of the Medico-Chirurgical Transactions, is referred to ; but Dr. Cooke declines entering at large into the consideration of this affection, as belonging rather to the department of surgery than medicine.

We. now revert to the college lectures ; and shall first speak of those delivered by Dr. Powell, since the topic on which they treated is nearly the same as that upon which we have just been animadverting. Dr. P., indeed, thought it right to commence his readings by an apology for continuing to discourse on apoplexy, after the lectures and publication of his colleague; but justified himself in so doing by professing to treat the subject of apoplexy in a manner somewhat different from that of Dr. C. The discourses of Dr. P. were principally confined to the astiology of the disease; and on this head he introduced some very

116 Analytical Review.

interesting facts and reasonings. He especially adverted to the apoplectic cyst, about which our readers have lately seen so much in ihe foreign department of this Journal. The lecturer showed a preparation illustrative of this par¬ ticular, and the subject of which had been a patient of his own, who perfectly recovered from an attack of hemi¬ plegia, after it had lasted ten days; but in two months after¬ wards she wras seized with apoplexy, which proved fatal; and upon examination the cyst in question w7as found.

Dr. P. dwelt particularly on the fact in apoplexy of occasional restoration of pow7er lesed by the disease, without the actual removal of the affection upon which the lesion had depended. This fact is one of the most extraordinary wdiich pathology presents, and is not limited to the particular malady under notice. It serves, we have often thought, to prove that much more than meets the eye is concerned in the production of many disordered conditions, which are erroneously deemed explicable by taking into the account of their origin the alteration merely of vascular and visible parts.

We were struck with the propriety of Dr. Powell’s objec¬ tions against the inferences of De Serres, who argues that apoplexy is not occasioned by pressure upon the brain, inasmuch as he artificially produced such pressure in animals, without the apoplectic symptoms being thereby occasioned. The cases, Dr. P. alleged, are not similar in their prior circumstances. Predisposition to be affected by pressure may exist as a preliminary to the actual development of the effect, and yet the effect itself be brought about through that medium. The lecturer, however, admitted, what some of our vascular pathologists will not hear of, the possibility and occasional occurrence of mere nervous apoplexy; by which is understood an apoplectic interruption of function, purely through the intervention of the organs of perception and motion, without a primary or necessary fault in the circulatory conditions. The remarks, too, of Dr. Powell, respecting the independence in one sense of, and the con¬ nexion in another between, the organic and animal system of nerves, were, in our judgment, exceedingly well con¬ ceived. We think, since the proposed division of Bichat especially, reasoners and experimenters on this subject have been, as is well pointed out by our correspondent Cuniculus#, too disposed to take partial and isolated views of nervous functions. “ There are classes of animals,” says this writer, (quoting from Charles Bell), u whose nervous system appears * . . . . . . . . . . . . . . . . . ■ — - •

** See Repository, Vol. XIII. page 46/.

117

Powell on Apoplexy.

dispersed, the several parts not being combined by nerves; but as we gradually ascend the scale, we have more distinct organs; then a more distinct brain; and, at the same time, nerves of combination.”

Pursuing the aetiology of the apoplectic state, Dr. P. ad¬ verted to the extreme and often unaccountable variety in several of its symptoms. Neither the number nor the kind of pulsations is to be trusted to as an unequivocal or regular sign of the precise nature or degree of the disorder. The respiration also is sometimes exceedingly hurried and inter¬ rupted; at others nearly natural, without any obvious reason why this discrepancy should exist. Serres mentions a case in which one side of the lungs was filled and emptied naturally, while the actions of the other were interrupted and laboured. This, we confess, reminded us of another continental nicety, which is rather too precise for the tact of British Practitioners, and which Dr. Spurzheim gravely relates, viz, of a man being mad on one side of the head and sane on the other.

In adverting to the circumstance of temperature as con¬ nected with apoplexy, Dr. P. expressed it as his opinion, that the difference consisted more in the varied degrees of power in regulating heat, than in any actual difference. It has been averred, that apoplectics retain their heat longer after the departure of the vital principle than is the case in deaths from other sources ; but this would appear (said our lecturer) to be rather referible to the suddenness of death than to any other peculiarity of the diseases.

Apoplexy appears, if accounts are to be relied on, rather on the increase in this country, in the ratio of from seven to sixteen in a thousand, without any satisfactorily made out cause. The want of precision, however, and defective science in those who make the returns upon which these comparisons are founded, ought to be recollected, as inter¬ fering very considerably with the accuracy of the accounts. It has been known occasionally to be epidemic. Too much stress. Dr. P. thinks, has been laid both on the age and make of individuals, as predisposing to it. it is most generally fatal when originating without any obvious excita¬ tion from without.

Active remedies are indispensable: the slower and more oppressed the pulsations may be, the greater is the necessity for copious detractions of blood. The jugular vein is the best outlet. Cupping is, for the most part, too tardy and ineffi¬ cient an operation ; the application of leeches is still more objectionable, on the same score. Cold applications to the head are not sufficiently appreciated in modern practice

1 18 Analytical ’Review*

Pressure on the carotids might, be, in some cases, made for a length of time with advantage. The shoulders should be raised as well as the head. Suppositories may be applied with advantage when purgatives are precluded, such as two or three grains of elaterium made into a pill with soap. Vomiting in haemorrhagia cerebri is objectionable — the prac* tice can only apply with propriety to nervous apoplexy. Dr. Po well once saw a distinct case of hemiplegia brought on by the violent action of an emetic. In thirty-three cases recorded by Series, the patients became worse after the exhibition of an emetic. Rousing and stimulants of all kinds are objectionable in the haemorrhagic apoplexy. Blisters are only benelicial in the ratio of the discharge which they occasion. Dr. P. concluded by informing his hearers, that he had tried the nux vomica for the paralysis left after apoplexy, in doses increased gradually up to ten grains, without any beneficial effect following. We were, we must confess, rather surprised at the tenor of Dr. P.’s remarks, in reference to this medicinal ; as it appeared to us that the lecturer regarded it as rather a negative and neutral than an actual and active substance. As far as our observa* tions have gone, the mix vomica is an agent of very con¬ siderable power; and when objectionable, is so upon the ground of its being too excitative of the capillary circulation, and therefore, without, much circumspection, inadmissible in cases where the nervous deterioration is connected with congestive or inflammatory states of the cerebral organs.

As derangements of the sensorial organs and functions have lately been investigated with a particular and lively interest, we have thus ventured the attempt of presenting to our readers, in faint outline, the general reviews and doctrines

j 7 7 O

of two Physicians of the highest respectability in reference to these points.

We hope that we have not mistaken the general character of that part of the reasonings of these gentlemen, the tenor of which we endeavoured to collect from oral communication, and that we have not unfairly dealt with matter which, although delivered publicly, was not precisely7 intended for the publication of the press. Were we to venture further our own estimate of the merits of these lectures, we should say7 that their main deficiency consisted in a deficient attention to the actual circumstances of the brainular mass and the encephalic vessels, as connected in the way both of cause and concomitant with the production of an apoplectic paroxysm. To these heads of inquiry Dr. Powell did indeed advert in the lectures of a preceding year, of which the present series constituted a continuation; but still we should have been

H arrison on Febrile Diseases.

119

gratified in having had more especially and minutely de¬ lineated, by these able artists, the difference between con¬ gestion, and inflammation, and haemorrhage ; the probable condition of the capillaries under the circumstances of apoplectic lesion of different kinds and degrees ; the state of the larger vessels relative to the capillaries during these several varieties ; and the analogical points of resemblance, or particulars of discrepancy, between apoplexy, phrenitis, fever, compression, and concussion — points which are ad¬ verted to and ably descanted on by Abercrombie* and Wilson Philip'f, but which still stand in need of a more ample and systematic discussion than they have hitherto received from any author with whom we are acquainted.

The lectures we have next to notice are those delivered by Dr. Harrison, on a very important question in pathology, viz. how far febrile diseases generally, and more especially those characterized by cutaneous eruptions, have their origin and essence in primary affection of the mucous membrane lining the first passages and the pulmonary organs. After a most interesting and ingenious survey of the dermoid and mucous textures, the lecturer ran over the usual characteristics of the eruptive fevers, remarking upon the primary, and secondary, and vicarious affections of the skin in these fevers, and dwell¬ ing upon the circumstance, that the indices of their force and danger are to be taken, not from the degree of cutaneous, but of ventricular, intestinal, or pulmonary derangement. He inferred, therefore, that to these facts is the patho¬ logist to look for an explication of their essence, and that curative indications are to be grounded on this particular alone. Dr. H. especially pointed out, in defence of his views, the fact which VVillan mentions, of rubeola si/ie catarrho not destroying the susceptibility of future attacks of measles, and that scarlatina may be so cut short by an emetic in an early stage, that the subject of this affection, thus treated, shall likewise not be made exempt from a future visitation, as would have been the case had the malady been suffered to run its course without interruption.

That a great deal of ingenuity and pathological acumen pervaded these readings of Dr. Harrison, no one who heard them will fora moment feel disposed to deny; but, for our own parts, we cannot help thinking that the whole presented rather a display of hypothetical ingenuity than a precise exposition of actual circumstances. That it is absolutely necessary to watch assiduously the attacks of inflammatory

* Papers on the Pathology of the Brain.

f On Vital Functions and Internal Diseases.

120 Analytical Review.

action upon mucous tissues, can never be made a question ; but that such irritations are so invariably, or essentially, or immediately allied to dermoid inflammations, is an assump¬ tion which fails of support from fact; and that much irrita¬ tion may exist in these parts without consecutive or vicarious disturbance of the skin, is at once evidenced in catarrh, hooping cough, dysentery, and a thousand other diseases. Again ; some of the eruptive affections, even of the more specific kind, commence, run their course, and decline, with¬ out implicating any portion of either the pulmonary or intestinal linings*. And as to fever generally, which, if we understood Dr. Harrison aright, he, with Jackson, and some of the tissue pathologists, (this word tissue has verily become a cant expression,) refers to a primary irritation of a mem¬ branous part, we have often endeavoured to prove that such theories, even allowing their correctness up to a certain point, leave out of their explicatory calculations those generally pervading derangements of the whole frame, which have never been explained by any congestive, or encephalic, or membranous views which have hitherto been offered. Indeed, we know not whether the capillary assumptions

* The determination of Dr. Harrison to strain every fact into actual adjustment with his theory, has, we perceive, been alluded to by Mr. Allcock, in a well written paper on the same subject with that of Dr. H., published in the two last numbers of the Medical Intelli¬ gencer. We may take occasion to extract a sentence from one of the numbers of that publication, which is very applicable to our present purpose: — “ VVe always,” says the Intelligencer, “ expect inaccuracy of observation, or of reasoning, where we find the word sympathy freely used by authors. Practical men have always observed a simultaneous action or reciprocity of action between certain distant parts in certain diseases. This action has been called a sympathetic action, and the evil of the word has generally been , that it has, in some odd way , been considered to be an explana¬ tion of the fact .”

We may take occasion to say, further, that this useful publication (the Intelligencer) is, in the general way, characterized as well by candour as intelligence ; but that, in one instance, the writers of it seem to have deviated from their usual course, and to have misrepre¬ sented the tenor of a paper on which they commented. Our able cor¬ respondent Dr. Gordon Smith did not, we conceive, transmit his communication to the Repository, respecting the deceit¬ fulness of symptoms in pulmonary disease, as a defence of either Cullen’s or any other system of nosology; but, on the contrary, the very purport of the paper was to prove the little dependence that can be placed on mere semiology as an unfailing index to diseased states.

Morbid Anatomy and Pathology . 121

of those pathologists, whose works are now so rapidly running out of credit, may not be quite as meaning, aye, and in some cases quite as practically good too, as some of those of more modern and membranous manufacture. Let us not be misunderstood. — - Minute and morbid anatomy we profess to hold in high estimation in its way ; and we likewise hold it to be of high moment to trace and pursue the lineaments and actions of disease through every kind of organic structure; but let us recollect, at the same time, the importance of pervading energies, and of vital as well as organic conditions. Let us not be exclusively occupied in breaking up particular tracts, and investigating the nature of this and that soil, till we have contemplated the whole bearing and character of the coujntry at large from some eminence which shall command a panoramic survey. Why has there always been a decision, a character, an energy, an effect in British practice, unknown to our ingenious Gallic or our laborious German brethren ? Is it not because they have been too much engaged in, and contented with particulars ; and have, in consequence, too much lost sight of general and leading laws? It has been the same with their medicine as with their painting; correctness, and accuracy, and minuteness, have characterized the productions both of the pathologist and the artist; but the je ne seals quoi of connecting medium — the commanding principle — the life and soul of the thing has been too much wanting. Let us then, while we follow’ our respected rivals in all that is worthy of imitation, be careful that we do not lose ourselves in the littlenesses of anatomical lore, and become mere post mortem Prac¬ titioners. That will always prove the most correct phi¬ losophy, and the most effective practice, which steers a midway course between the inapplicable abstractions of hypothetical generalization and the piece-meal instruction of the preparation museum — which recollects that primary impulses demand recognition, as well as the consecutive and subordinate condition of blood vessels that are spread over membranes; and which, in fine, refuses to be guided by mere verbal terminology, whether tissue or any other tech- nicalia be the order of the day. We hope to be pardoned for thus having insensibly been led into comment, when it was our design merely to notice; and we feel confident that the learned lecturer, whose ingenious speculations have elicited these reflections, should he chance to see our remarks, will receive them in good part, as, at any rate, well meant ; and though he may smile at these our objections to the mucous membrane mania, he will believe us sincere in our VOL. xiv. — no. 80. R

\%t Analytical Review’.

expressions of the highest respect for his talents and ac¬ quirements.

On college lectures we have very little more to remark. It was our misfortune to have been absent from two out of the four which Dr. Paris delivered on the philosophy of the inateria raedica; and recollection would scarcely serve to give even a satisfactory outline of those we did hear, which, it must suffice to say, were pregnant with scientific principia, and rich in learned allusion. The only marked feature in these lectures, whose delineation we can even attempt by the faintest sketch, was that of the necessity there is, in examining the medicinal properties of substances, to take into account their “ adjective'" as well as “ substantive” principles (we use the Doctor’s own expressions). Suppose, for instance, we analyze a plant, and find its absolute and positive virtues to reside in a particular poition, or to consist of a particular ingredient, we may be much at fault if we calculate upon the full effect of such ingredient byr consider¬ ing it abstractedly, or without reference to other principles in the vegetable, which, although per se they may be proved to be inert matter, may notwithstanding become powerfully ad¬ juvant to the main and leading virtue of the substance. Dr. Paris took occasion, while illustrating this position, to allude somewhat personally to the labours of an ingenious Chemist, who has recently paid much attention, as the pages of the this Journal have proved, to analytical and synthetical investigations of medicinal agency ; and the lecturer went so far as to infer, that a good deal of this labour was labour lost. If the individual thus charged and challenged should feel disposed to take up the gauntlet, we shall be exceedingly happy to give him Repository space for the contest, under the impression that truth is often most effectually elicited by contrariety of opinion. Our desire is, in all cases, to be rather seconds and assistants in the legitimate and laudable warfare of science, than to stand forward as umpires in any contested question.

Of the lectures delivered at the College of Surgeons we should have been exceedingly happy, but for the causes just specified, to have given an account as particular and as much in detail as the plan and limits of our present retrospect would admit. Sir. Wilson's, however, on the physiology and pathology of the bones, will, we hope, be published ; and in that form they will properly come before us for notice. From that portion of this course of lectures which we did hear, we received very considerable gratification; and were often much surprised at the power of the lecturer in

Medical Education and Rank.

ns

making elementary matter so exceedingly interesting. It afforded us much pleasure to hear him object to the general principle of instrumental aid in cases of spinal deformity from weakness, and urge the necessity of adopting such measures in these cases as should ensure a free and equal action of the dorsal and other muscles. But on these and other topics, we again express a hope the publication of the discourses will enable us, in no long time, to enlarge.

Mr. Brodie’s lectures were excursive in their nature, and happy in their selection of subject. Every one knows that Mr. B. is a man both of genius and science ; and in the introduction to his course these attributes were abundantly conspicuous. In his general survey of the economy of nature, he took occasion to express somewhat different sentiments from those of his able predecessor. He anti¬ cipated much improvement in medical philosophy, from the analytical methods now pursued in its cultivation ; and intimated that much more might be expected than had hitherto been done, in the way of detecting morbid causation, by more minutely investigating the chemical condition of the Hu ids. The lecturer concluded by an eulogistic notice of John Hunter: Why is it, he said, that the labours of this great man are daily more and more appreciated and admired, while the speculations of Cullen, of Darwin, and Brown, are in the same measure disesteemed and neglected ? Is it not because Hunter took nature for his map, and guide, and compass ; while the others vainly followed the false lights of an abstract philosophy ?

We have still much miscellaneous matter lying before us, prior to entering upon the subjects of medicine and surgery, more strictly so considered ; — and since wre purpose, in the notice of the three under-mentioned pamphlets*, to be strictly analytical, it may^ be expected that wre generally express our own opinion of the topic about which they treat, as preliminary to such analysis. We would say then, briefly, that the radical evils from which emanate the minor ramifications of grievances are resolvable into two particulars. In the first place, the system is highly objectionable which

* Remarks on the Importance of the Medical Profession, and on the present State of Medical Practice in Ireland. By Richard Grattan , M.D., &c. &c.

Review of the above pamphlet.

Letters to the President of the Associated Apothecaries and Sur¬ geon-Apothecaries of England and Wales, on the present State of the Practice of Physic and Surgery. — First Series.

124 Analytical Review*

makes professional remuneration to be formed out of the tare and tret profits of medicinal articles ; and, secondly^ Physicians, or referee Practitioners, are, under the present constitution of things, manufactured with too much facility. We believe it was the late Dr. Warren who used to say, that an Apothecary’s shop and a London hospital are by far the best schools for efficient medicine; and no one can or ought to question, that a youth well initiated, in the first instance, into the principles and practice of pharmacy7, and afterwards made systematically to pass through the great schools of anatomy, physiology, surgery, medicine, and midwifery, which are attached to the hospitals of this metropolis, together with the clinical instruction that these establishments afford, is, by such process, as com¬ pletely qualified for the practice of medicine as any education can make him. Now, let a sensible and conscientious mao, having thus been instructed, commence the exercise of bis art in all its branches, and we hesitate not to say, that such a man is as deserving and honourable a member of the corn- rnunity as any other individual can be, whatever may be his rank or profession ; and, moreover, has a right to demand a due appreciation of his important labours. But here begins the mischief. Constituted as things at present are, he finds himself treated rather as a tradesman than a gentleman ; and many of his neighbours shun his professional counsels under the notion— a notion that is by no means unfounded-— > that while the quantum of medicine is the quantum of payment, a temptation is opened for mercenary influence, which the most correct in principle and honourable in feeling is unable altogether to withstand. Application comes, there¬ fore, to be made, in the first instance , to those individuals whose interest, on the contrary, is obviously that of con¬ centrating and diminishing, rather than of expanding and increasing the quantity and number of drugs ; and thus does the Apothecary find himself forsaken for the Physician and mere compounder — and hence the multiplication of that order of Physicians, whose education, either in common science or professional learning, is very frequently not much above, and sometimes is even inferior to that of the general Practitioner — and hence the jealousy with which the latter beholds the countenance given to the former. The ob¬ vious remedy, then, for these evils, for evils they are, would be that of rewarding the scientific Surgeon-Apothecary for his time, and attention, and skill, and not for the number of his potions, and of making access more difficult to the higher honours of the Profession. The number of Physicians would then, indeed, be diminished, but their respectability would be

i

125

Grattan on the Medical Profession , #c.

increased; and the Apothecary would no longer either be ashamed of his bottles, or look upon the superior order of the Faculty as surreptitiously presuming in its assumptions, and unfriendly to his individual interest. In what way the reformation required would be best accomplished, we pre¬ sume not to say — the late act will unquestionably operate prospectively in favour of the respectable professor of general practice, by diminishing the number of unqualified prescribers ; but we think it will not be likely to accom¬ plish all that is aimed at, while the mode of remuneration for professional services continues on its present footing.

Now for an account of the pamphlets before us, “ with¬ out note or comment.”

Dr. Grattan tells his readers that —

“ He probably should not have engaged in the investigation, had not several Apothecaries, and others practising in the inferior departments of the Profession, lately applied to be admitted as licentiates of the King and Queen's College of Physicians. A measure/' says he, “ of this kind appeared to me so inconsistent with sound policy, and so decidedly opposed to existing regulations, that from the moment the question was submitted to our consideration I resisted it in every possible way."

Dr. Grattan proceeds, in the body of his pamphlet, to advocate the division of the healing art into the two separate branches of medicine and surgery, and to maintain the great importance of the former.

“ The great majority of the human race die," says our author, “ of medical diseases, which if nature were sufficient to cure, could never terminate fatally, and man would live for ever. But nature is constantly insufficient to preserve life, and as often equally incapable of restoring health, unless when assisted by the judicious efforts of the Physician."

He then proceeds to state the high qualifications which the name of Physician should imply, and observes —

u That admission into such a Profession ought not to be a mere matter of course ; nor should the high honours which it confers on those who have earned them, by devoting the principal part of their lives to a study so laborious, be easily attained by every person, who, neglecting such previous pursuits, shall think fit to aspire to them by shorter methods, and such as scarcely require any preparatory education

Literature is necessary to enlarge and liberalize the mind ; science, to preserve against blunders and errors. Chemistry it is absolutely requisite for the Physician to be familiar with, and pharmacy no less so; and his education ensures a know¬ ledge of these branches of the Profession, Botany, too, is

I £6 Analytical Review.

necessary, and anatomy, but not that minute anatomy which it is the particular province of the Surgeon to acquire.

i( Anatomy, ” says Dr. G., “ presents itself in a very different light, according as it is considered subordinate to the acquisition of medical or surgical knowledge — medical anatomy, if I may use the ex¬ pression, differing essentially from that which is truly surgical. An acquaintance with the different parts of the system, so as to explain their general character and mutual relation, is sufficient for the Physician ; and more than this is completely superfluous. Anatomy is only of use to the Physician so far as it contributes to promote the study of physiology, or the study of the actions which it is the pro¬ vince of each organ to perform. For instance, a moderate share of anatomical knowledge will enable us perfectly to comprehend the circulation of the blood, the discovery of which constitutes an epoch in medicine as important as that of gravity in natural philosophy. When once understood, no anatomical inquiry, however accurate, can elucidate it further. To the Physician, the conception and per¬ fect comprehension of the simple fact is of itself sufficient; and it matters not to him whether the arteries, capillaries, and veins, through which the blood flows, adopt the shortest, or pursue a more circuitous course, or whether their situation be different from that generally observed, or their branches more or less numerous than usual.”

Even the utility of morbid anatomy to the Physician, .Dr. G. thinks, has by some been greatly overrated ; and he takes occasion to point out the erroneous opinions which have been advanced on the ratio spmptomatum of fever from post mortem inspection of the brain and other organs. To the Physician then (says Dr. G.) belongs general science, and the acquisition of pathological and practical principles. To the Surgeon, minute anatomy and operative tact; and he quotes from Mr. Ahernethy’s Hunterian Oration for 1819? that —

“ Not to acquiesce in the division between medicine and surgery, would be to subvert the institution of societ}\ and throw the whole Profession into confusion — “ The sphere of the Apothecary,” con¬ tinues Dr. G., “ is well defined, and the distinction between him and the Physician is even more strongly marked than that which sepa¬ rates the Physician from the Surgeon.

“ In the earlier ages, indigenous herbs, and a few simple remedies assisted by regimen, constituted the greater part of the curative means then at the disposal of the Practitioner. It is, therefore, probable that the Physician at first prepared his own medicines, or gave the necessary directions to those in attendance on the patient. But when medicines imported from foreign countries, and particularly when those derived from the mineral kingdom were generally em¬ ployed ; there arose a class of persons, whose proper office it was to prepare and compound them.

Grattan on the Claims of Apothecaries, fyc* 127

“ The many tedious and operose processes to which, from their want of chemical knowledge, those who prepared medicines were then obliged to have recourse, so completely engaged their attention, that it never occurred to them to depart from their proper sphere, and undertake the treatment of medical or surgical diseases. Physicians, on the other hand, were equally careful not to trespass on the busi¬ ness of the Apothecary ; and, indeed, it was impossible for them to do so, from the time and labour which it would cost them to prepare and dispense their own medicines.

“ The Arabians, we are told, pursued the same track; and during the dark ages, medicine must have been reduced to what it was pre¬ viously to its having been cultivated as a distinct profession/’

But after the revival of learning the healing art once more resumed its proper rank, and medicine was again practised separately from surgery and pharmacy.

“ But innovations on the part of the Apothecary, at first scarcely perceptible, but steadily and perseveringly directed to the same object, have at length nearly affected [effected] a complete revolution in the state of medical practice. Instead of employing themselves over the alembic or crucible, they have become medical Practitioners. Instead of preparing, under their own inspection, medicines genuine and unsophisticated, and on the purity and activity of which the Physician may depend, in cases the most urgent and critical ; they have usurped his province, they pay their visits, and prescribe as regularly as he does.”

“ Is this,” continues our author, “ as it ought to be?” His reply is of course in the negative: and he goes on to state, as one of the evils resulting from the system, the absence of the Apothecary from his shop; and the important office of compounding medicines being intrusted to the young and in competent apprentice, within whose reach are placed the most active poisons, “ the tinctures of opium and digitalis, extracts of hemlock and henbane, the arsenical solution, the caustic alkalies, &c. &c. are all at his disposal.” The evil of a juvenile or incompetent prescriber is increased by the practice which has obtained among Physicians, to write their recipes with abbreviations and contractions; and we are here reminded in a note, that an act of the 1st of George III. sub¬ jects the Physician to a penalty of forty shillings, for every prescription in which any contraction is used, and in which the names of the medicines, and the quantities ordered, are not written in full length. But even allowing that the above objection might be done away with, Dr. Grattan maintains that the education of an Apothecary is inconsistent with his afterwards becoming a scientific or efficient prescriber.

4i He is certainly taught to spread plasters, to pound powders in a mortar, to weigh out scruples and grains, and to measure fluid ounces and drachms ; but medicine, as practised by the Physician, is

128 Analytical Review ,

as much connected with such operations, as the scientific discoveries of the astronomer are with the mechanical dexterity of the artist who polishes the speculum of the telescope which he uses. A knowledge of the practice of medicine is to be acquired neither in the shop of the Apothecary nor in the dissecting-room of the Surgeon, but by the bed-side of the patient.5"

But mere experience, he says, will prove worse than no¬ thing, unless regulated by enlightened views and philosophical habits. Dr. G. then goes on to recommend the College of Dublin to act in the same manner with respect to licen¬ tiates as does that of London, which last he designates “ the hist medical body in Europe and he contends that in no part of the world are medicine, surgery, and pharmacy, upon so good a footing as in London. Dr. G. concludes his pam¬ phlet with remarks respecting the impropriety of individuals at once prescribing medicine, and being interested in the quantity prescribed »

In the review of the pamphlet which we are now to notice, the writer first introduces a few sarcastic remarks on the pro¬ bable spirit and motive with which the strictures of Dr. G. were perused. He then goes on to state, that the chemical and other errors which are committed in prescriptions, are more likely to be detected and avoided by the Apothecary than even the Physician ; “ for errors are manifested to the sight of the compounder during the mixture of the ingredients, which might escape observation while the ingredient^ are only written on paper.” Chemistry, too, in theory makes a part of the qualified .Apothecary’s study : “ the present race of these individuals, therefore, may stand a comparison with the Phy¬ sicians in the theory of chemistry, and they exceed them in practice." “ Physicians, it is true, do construct the pharmacopoeia without the aid of the Apothecaries, and this is one of the causes of its numerous imperfections/ The reviewer proceeds to point out what he considers incon¬ sistencies in Dr. Grattan, in reference to the anatomical knowledge required by the Physician ; and is severe on the Doctor’s speculations with regard to the principle of life, the whole of which he says, resolves into this; that although animals can leap with great agility, stones cannot ; " and he (Dr. G.) concludes the investigation by confessing that he is incapable of understanding any thing on the subject. Well may the Physician boast of his peculiar province, and fool indeed must that man be who would encroach on it.”

“ It is impossible,” says the reviewer, “ to restrict the Apo¬ thecary to the manipulations of pharmacy ; for although the poor may, with a good deal of delay and trouble, procure

The Claims of Surgeon-Apothecaries. 129

the gratuitous and precarious attendance of a dispensary Physician, the class of people immediately above them are not at all times able to fee a Physician, were his demands but half or a quarter of what they are.”

Against the allegations of Dr. Grattan, that the mechanical occupations of the Apothecary have a tendency to contract the mental powers, the critic adduces the instance of Newton, and Franklin, and Davy, with several others, who have proved the compatibility of cultivating w'ith effect the higher branches of science, and engaging at the same time in opera¬ tive manipulations. “ Were not,” he further says, “ Monroe, Hunter, Cullen, and Smellie, Apothecaries? and have not some of the most celebrated Physicians now in actual prac¬ tice been formerly of this class— Sir W. Knighton, Sir M. Tierney, and Dr. Babington, for instance

Having gone some length in reply to the matter of Dr. Grattan, his reviewer proceeds to comment on the style of the pamphlet. “ Where the matter,” says the critic, “ is so bad, the manner can scarcely be better; and as the former is abusive and misrepresented, the latter is unpolished and sophisticated.”

The letter to the President of the Associated Apothecaries commences by saying, that before the passing of the late Act, a class of unauthorized and ignorant pretenders were suf¬ fered to practise, the mal-practices of whom were more dangerous than disease itself. This evil has been partially remedied by the Act in question; but still its provisions are inadequate to effect all the good that is desirable to obtain. “ The well-educated general Practitioner,” says the writer, “ should receive for his services the recompense which is due to professional skill. In return for his trusts and ability, for the wear and tear of his body and mind, he unquestionably does deserve a remuneration congenial with the character of his art. He should not be compelled to seek for payment out of the profits of a trade , wherein he is obliged to become a loathsome dealer , as the only 7nethod of establishing a charge T’ That part of the Act which requires competency in pharmacy on the part of the assistant as well as principal, receives the approval of the present writer. He then goes on to state what ought to be the education and acquirements of an Apothecary. “ From the academical Physician he should only* be distinguishable by the different mode of acquiring a thorough knovvledge of physic, and upon entering into practice by the different measure of his reward.”

Although the writer objects to the present mode of re¬ munerating the general Practitioner, he conceives it expedient

VOL. xiv. — no. 80. s

130

Selections .

that a well-educated and legally authorized person should be kept by him for the purpose of compounding medicines, which should he charged without profit” In the prosecution of his plan, the writer of these letters proceeds to the detail of such a medical education as ought to be undergone by the general Practitioner; and in conclusion, points out the actual advantages, in a practical point of view, which those enjoy, who from the very nature of their calling are unfettered by those nice distinctions between surgery and medicine, which professional etiquette demands from the graduated Physician. The duly qualified Surgeon-Apothecary has likewise an advan¬ tage in one sense over the Surgeon, “ since the latter gives in general a more exclusive attention to the operative depart¬ ment/* And

“ This exclusive attention given to operative surgery is sometimes prejudicial to the medical department of the art, which is liable from thence to become neglected. This is a consideration of the greatest importance; for the benefit mankind derives from the exercise of surgery, proceeds, perhaps, more frequently from comprehensive and enlightened views of the general laws of the animal economy, than from the most dexterous performance of formidable operations; the necessity for which a scientific Practitioner will sometimes be able to prevent. If in their initiation and subsequent examinations the Surgeon and general Practitioner possess the resemblance which is marked above, in their practice a considerable difference obtains. The Surgeon does not dispense his own medicines, but receives a Physician’s fee for his advice ; and if he practise medicine, or, in other words, advise in cases of general disease, he does so without having undergone the medical examination which the law requires.”

(To he continued,)

PART ILL

SELECTIONS.

Observations on the Theory which ascribes Secretion to the Agency of Nerves. By W. P. Alison, M.D., F.R.S.E., &c., Professor of Medical Jurisprudence and Medical Police in the University of Edinburgh.

[From the Quarterly Journal of Science. ]

[Continued from page 50. ]

I shall first state the considerations which seem to me to render it probable that the actions of nerves are not galvanic, and afterwards those which seem to me to show, that even if

.Alison on the Nerves. 131

nervous actions be galvanic, still they cannot be necessary to secretion.

i. It is not, of course, intended to deny, that a certain degree of galvanic action may be excited by the contact of nerve and muscle, or of nerve and gland ; that these sub¬ stances stand related to each other as the zinc and copper of a galvanic trough do. VVhat is doubted is, not the pre¬ sence of the cause assigned, but its adequacy, both in de¬ gree of intensity, and in kind of agency, to the explanation of the phenomena, and that for the following reasons: —

1. If the changes in the nerves, which precede the con¬ traction of muscles irritated through their nerves, be of the nature of galvanism, and if it be by galvanizing the muscles that all the stimuli applied to nerves excite these motions, we must suppose galvanism to be excited, from time to time, to an intense degree, in nerves and muscles, without the aid of any chemical agent, and without any change in the che¬ mical constitution of these parts taking place, either during or after the evolution of the galvanism. iNow it is quite clear, that in tracing the physical changes produced by mind on body upwards to their source, we must ultimately arrive at some physical change which is inexplicable; and this ulti¬ mate inexplicable change may just as well be of the nature of galvanism as of any other nature. I do not, therefore, urge it as an argument against nervous actions being galvanic, that we cannot understand how the mind should excite, under these circumstances, strong galvanic actions in the nerves. But the important fact is, that nervous actions may be very readily excited by various physical agents, which certainly have no effect whatever in exciting galvanism in any other apparatus. Farther, these actions may be excited in the nerves long after their communication with the brain (which is supposed on this theory to be the main source of galvanic energy) is cut off; muscles being excited to contraction by stimuli ap¬ plied to the nerves fifteen days at least, according to the observation of Haller, after the division of these nerves above the point irritated.

If, indeed, it were ascertained as matter of fact, that the irritation of muscles through their nerves is always attended with a notable evolution of galvanism, though it might be very difficult to explain the fact, it would be fair to argue, that the galvanism, known to be evolved, was the cause of the contraction; but in the present state of our knowledge on the subject, there being no proof whatever that more galvanism passes from nerve to muscle during the con¬ traction produced by irritation than at any other time, it seems to me fully as probable that muscles should be so

132

Selections ,

constituted as to contract in consequence of imperceptible changes, not galvanic, communicated to them by their nerves,, as that galvanism should be excited to a most intense degree in nerves, merely by bruising them with a probe, or pricking them with a pin, particularly after their communication with the source whence they are supposed to draw their galva¬ nism is cut off.

2. The effects which are produced upon muscles by changes in the nervous system, are much more various than those which have ever been observed to resuit from gal¬ vanism. Stimuli applied to the nerves supplying the volun¬ tary muscles, excite them very readily to contraction ; but I believe no physiologist has ever succeeded in exciting the involuntary muscles to contraction by applying stimuli to their nerves. Galvanism applied to either set of muscles directly excites them with nearly equai facility. Alcohol applied to the brain augments the irritability of the heart ; an infusion of tobacco applied to the brain diminishes it. We may admit that galvanism is a power capable of pro¬ ducing both these kinds of effect on muscular organs, ac¬ cording as it is applied in a greater or less degree of in¬ tensity ; but have we any reason to suppose, either that these two substances, acting on nervous matter, can excite gab vanism at all, or that they can excite it in so very various degrees of intensity ?

These considerations seem sufficient to show, that we cannot suppose the action of nerves on muscles to be of the nature of galvanism, without supposing a much greater variety in the modes of exciting galvanism, and in its effects on muscular organs, than any observations on this power entitle us to assume.

3. If we suppose, with the authors of the galvanic theory of nervous actions, that these actions are essentially concerned in secretion, a strong argument against their identity with galvanism arises from the fact that the various secreted fluids are so different from each other. This difficulty increases greatly when we take into account the nutrition of all the different textures in the body, a process which Haller has well characterized as “ omnium amplissima secretio.” If there be powers in the animal economy distinct from gal¬ vanism, which are sufficient for the formation of the solids of the animal body out of the blood, it is quite obvious that these powers must be amply sufficient for the formation of the secreted fluids out of the blood ; and it is therefore quite unnecessary to suppose galvanism concerned in this last pro¬ cess. But if we regard both secretion and nutrition as dependent on galvanism, transmitted through the nerves, and

Alison on the Nerves .

133

refer to this cause the formation of all animal substances, from bone to serum, out of the blood, then, I think, we must make one of two suppositions. Either we must suppose the galvanism transmitted by the nerves to the various parts of the body to be different in its nature in different places ; or we must suppose the blood to undergo very various preparation in the different parts of the body, before it is submitted to the action of the galvanism.

In the former case our explanation is contradicted by all that we know of galvanism, there being nothing to make us suppose that the blood can be differently affected by gal¬ vanism passing through tw'o different sets of nerves ; and certainly nothing that we know in the structure or com¬ position of the different nerves, induces us to suppose that the nature of the galvanism sent through them can be different.

In the latter case our explanation only begins where the real difficulty ends. If there be powers in the animal system sufficient to prepare the blood so variously, that one chemical agent, thereafter operating on it, shall form out of it bone, muscle, tendon, oil, and serum, those powers must surely be adequate to the formation of these different substances without farther help; or at least it is to those powers, and not to the agent subsequently applied, that by much the greater share of the phenomena of nutrition and secretion must be ascribed.

It may be said, that although we have no proof of gal¬ vanism being excited in nerves by the application of stimuli, to such a degree as can explain the irritation of muscles through nerves; and have no proof of galvanism being so different in different situations as to be capable of producing effects so different from each other as the formation of bone and of serum out of the same blood, — still all this may be true of galvanism ; and we know so little of that power, that we are not entitled to lay down the limits, either of its deve¬ lopment or its action. To this 1 would answer, .that it will be time enough to regard galvanism as identical with nervous actions, when it shall be proved, that it may be excited by as various means, and may produce as various effects.

To explain a set of phenomena in nature, is to establish their coincidence with another set of phenomena more general and better known. How then can we be said to ex¬ plain the phenomena of the nervous system by resolving them into the phenomena of galvanism, when it is only by a hypothetical extension of these last phenomena that they can be made to include the former, and when it is only in consequence of our ignorance of their real nature and limits, that we can venture upon this hypothetical extension?

Selections .

234

4. Another circumstance which seems to me very adverse to the supposition, that division ot the eighth pair of nerves, and division of any nerve supplying a voluntary muscle, act on the secretions of the stomach and the motions of the muscle equally, by cutting off a supply of galvanism, is this; that no secretion at all takes place after the former operation, whereas powerful muscular contractions may be excited by applying stimuli to the nerve below the point of division long after the latter. According to the galvanic theory, these con¬ tractions are excited by galvanism remaining in the nerve after its division^'. Why, then, does not galvanism enough remain in the nerves of the stomach after the division of the eighth pair, to carry on digestion for a certain length of time ?

These considerations seem to render it extremely doubtful whether the changes which take place in the nervous system, and affect the muscular or secreting organs, or the nervous actions, can be of the nature of galvanism; and if they be not galvanic, Dr. Wilson Philip's experiment, above referred to, becomes an Experimentum Crucis against their being essen¬ tial to secretion.

But, even if the actions of nerves be galvanic, there are very strong reasons for thinking that they cannot be essential to secretion and nutrition.

1. The secretion of the stomach was found to be sup¬ pressed, in Dr. W. Philip’s experiments, by other lesions of the netvous system besides cutting the eighth pair of nerves. It was suppressed in rabbits nearly or entirely by destroying the lower half, or even less than the lower half, of the spinal marrowr. (See Exp. 58, 59> 60, p. 171). In these cases the stomach must still have had the supply of galvanism which it receives through the eighth pair of nerves, and in fact all that it receives from the brain and upper half of the spinal marrow, a much greater supply than that, the interception of which in the former experiments was supposed to stop the secretion. Where we find so great an effect produced on the secretion of the stomach by a cause which, even on the supposition of its deriving galvanism th rough its nerves from the brain and spinal marrow, can only have intercepted a small portion of that galvanism, it is surely reasonable to suspect, that the effect is to be ex¬ plained on other principles than the interception of galvanism, or of any other influence essential to secretion derived from the nerves.

* See Haller, Mem. sur les Parties Sensibles ct Irritables, Exp. 201, 202, 214, 220—225, and p. 2 37.

Alison on the Nerves .

1 Si

It is likewise particularly worthy of notice, that the se¬ cretion of urine, although it was found to be destroyed, in Mr. Brodie’s experiments, by division of the spinal marrow at its upper part, was not affected, in these ex¬ periments of Dr. Philip, by the destruction of the lower half of that organ. I believe it will be allowed, that the kidneys have at least as much communication with the spinal marrow by their nerves as the stomach has ; and therefore, when we find the secretion of the stomach suppressed by an injury of that organ, which does not affect the secretion at the kidneys, it seems fair to presume, that it is not by intercepting an influence essential to secretion that the injury produces the former effect.

2. This suspicion must become much stronger when these cases of suppression of the secretion of the stomach, from the destruction of part of the spinal marrow, are contrasted with the cases, of which there are many on record, of destruction of large portions of the brain, which is supposed in this theory to be the main source of nervous influence, without any affection of the functions of secretion and nutrition. For an enumeration of cases of this kind I refer to the review of Sir Everard Home’s late paper on the functions of the brain in vol. xxiv. of the Edinburgh Review. When we find the secretions of the stomach nearly destroyed by sudden destruction of a part of the spinal marrow, and not at all affected by gradual destruction of nearly the whole brain, we surely cannot consider the former cause to operate merely by cutting off a supply of nervous influence coming from the brain and spinal marrow; but must regard it as more probably on the same footing, with regard to secretion, as the destruction of the spinal marrow in Le Gallois’s expe¬ riments, with regard to circulation, on which Dr. Philip himself has so j udiciously commented ; that is, as exemplify¬ ing, not a continual and essential agency of changes in the nervous system upon the function of secretion, but an oc¬ casional and controlling agency.

A. But what appears to me to remove all doubt upon the subject, is the class of facts (very candidly acknowledged, but I think not duly weighed, by Dr. Philip, — Experimental Inquiry , fyc. p. 240,) in regard to secretion and nutrition taking place where nervous influence cannot be supposed to operate; in the vegetables, in ihe animals in which no nervous system has been discovered, in the chick in ovo before any vestige of the brain and spinal marrow can be traced, in the early part of the existence of the human foetus, when the brain and nerves appear incapable of performing their

136

Selections .

functions, — but most of all, in the cases, which are reported on unquestionable authority, of foetuses born alive without either brain or spinal marrow.

Dr. Philip gets over this difficulty by supposing that there may be some other apparatus, in all these cases, by which galvanism may be applied to the blood, and which may, there¬ fore, supply the place of the nervous system. But this is ob¬ viously supporting one hypothesis by means of another and a much bolder one. That galvanism is at all concerned in secretion or nutrition, is a hypothesis which rests funda¬ mentally upon two suppositions; that galvanism is identical with nervous influence, and that nervous influence is essential to secretion. If we put nervous influence out of the ques-. tion, we have no better evidence of galvanism being at all concerned in secretion than merely this, that it produces chemical effects on the blood, and in particular coagulates its albumen ; effects which are equally produced by caloric and various other chemical agents, and which never can be considered as amounting to a proof of secretion depending upon galvanism. When, therefore, we adduce even a single instance of secretion taking place independently of any influence that can be derived from the nervous system, we cut away at once the very foundation of the hypothesis which attributes secretion to galvanism ; and although the hypothetical explanation of such instances, by galvanism supposed to be drawn from another source, given by Dr. Philip, may possibly, in the progress of knowledge, turn out to be correct, yet 1 think we may say, with confidence, that, in the present state of our knowledge, it is not philoso¬ phical. The proper conclusion from the examples of secre¬ tion and nutrition going on independently of nervous influ¬ ence should have been, not to suggest an additional hypothe¬ sis, that another influence equivalent to that of nerves may be applied, but to invalidate the hypothesis formerly entertained, that nervous influence is essential to secretion.

Abstracting from the rare occurrence of the foetus without either brain or spinal marrow, the foetus acephalus , of which many examples are recorded, appears a sufficient answer to the conclusion drawn from the experiments both of Dr. Philip and Mr. Brodie. In the child, of whom we have an account by Mr. Lawrence, in his paper in the Medico- Chirurgical Transactions, vol. v. p. 165, there was neither brain nor cerebellum. This child Jived four days ; and the secretions from its stomach, bowels, and kidneys, seem to have been quite natural. Surely this is sufficient to show, that the division of the eighth pair of nerves, and of the

137

Alison on the Nerves,

spinal marrow in the neck, which stopped the secretions of* gastric juice and of nrine in those experiments, could not have acted by cutting off an influence, essential to secretion, coming from the brain.

4. If any farther proof be required, that the conclusion drawn from the experiments of Mr. Brodie and Dr. Philip, of an influence derived from the nervous system being essential to secretion, is not warranted by the facts already known on the subject, 1 think it is afforded, as has been already stated, by Mr. Lawrence, in the paper above referred to, p. 223, by the experiments of these authors themselves, in animals, in which the eighth pair of nerves is divided, the bronchus and air-cells of the lungs are always found, as .Dr. Philip expresses it, “ clogged with a frothy mucus,” which prevents the lungs from collapsing when the thorax is opened after death, and which, by preventing the applica¬ tion of air to the blood in the lungs, appears, from the ob¬ servations of Dr. Philip, Le Gallois, and others, to be the immediate cause of the death that succeeds that operation.

Now this frothy mucus, found not only in the air-cells, but in the bronchia?, in a quantity so much greater than natural as to be the cause of death, — what is it but a secretion ? If it be denied that the fluid which is effused on the membrane lining the bronchia and air-cells be a secretion, it is not worth while to dispute about the word ; but it appears to me obvious, that it is a formation from the blood, so much akin to the formation of the stomachic juice, that the two must depend upon the same principles. And when we find, in the experiments in question, that the division of the eighth pair of nerves, which supply equally the lungs and the stomach, di¬ minishes or destroys the production of the one of these fluids, and increases that of the other, it is surely preposterous to conclude, that these experiments demonstrate the necessity of an influence derived from the nerves to secretion in general.

There is a series of experiments by Mr. Brodie, (Philoso¬ phical Transactions for 1812, p. 378,) intended to prove, that in an animal wdiich has been either killed by decapitation or stupified by poison, in such a manner as apparently to suspend all the functions of the nervous system, the evolution of carbon still goes on at the lungs, to an equal extent as in a healthy animal, when artificial respiration is employed. To this evolution of carbon Mr. Ellis has given the name of secretion; and, although I do not pretend to decide whether that name is applied with perfect propriety in this instance, I

VOL. xiv. — no. 80. t

188

Selections.

take leave to observe, that this process, thus proved to go on, notwithstanding the division or destruction of the functions of the nerves supplying the organs concerned in it, is con¬ sidered by that distinguished physiologist so nearly akin to secretion, as to deserve the same name. Its continuance, therefore, even independently of the increase of the formation of mucus, in these circumstances, must be regarded as a very strong argument against the dependence of secretion on ner¬ vous influence.

Having thus considered the different arguments in favour of the supposition of that dependence, I think we may fairly say, not only that there is no proof of it in the writings of phy¬ siologists, but that there is strong evidence against it. I need hardly add, that if we suppose the nervous system to be destined to exercise over secretion, as well as over muscular motion, not an uniform and essential , but an occasional and con¬ trolling influence , and that particularly when itself is affected by mental acts or emotions, we shall be at no loss in explain¬ ing the phenomena which have been thought to denote the dependence of secretion on the nervous system. The secre¬ tions of the stomach, in particular, are so notoriously under the control of various affections of the mind, (acting on them, in all probability, through the medium of its nerves,) that it cannot appear surprising that theyr should be very much deranged by division of these nerves.

Dr. VY. Philip’s opinion, in regard to the connexion of the nervous system in the living body with muscular action, which appears to me to be perfectly correct, may be thus stated : That when the nervous system is itself impressed by various agents, mental and physical, it is capable either of exciting or of variously modifying the actions of all the different moving solids of the body; but that, when not itself impressed by any of these agents, it appears, from all that we yet know on the subject, to be absolutely passive and inert, in regard to all these moving solids.

The considerations which I have now stated, appear to me sufficient to show, that the same conclusion may be extended to the connexion of the nervous system in the living body with secretion ; and in another paper I shall endeavour to show that we have good grounds for forming the same conclu¬ sion in regard to its connexion with animal heat.

Chomel on Idiopathic Fevers.

m

PART IV.

FOREIGN MEDICAL SCIENCE AND

LITERATURE.

1

I. ana ly s i s of journals. (French).

New Journal of Medicine.

February, 1820. On the Existence of Fevers. A memoir, by Dr. Chomel. — It is the object of this memoir to contro¬ vert the opinions so speciously and confidently advanced by the authors and disciples of the new doctrine in France, respecting the non-existence of idiopathic fever. Our readers

are probably aware that the partisans of the new system, at

the head of which is Broussais, ascribe the origin of every fever, continued, remittent, or intermittent, to phlegmasia of some internal organ, and particularly of the intestinal canal.

In the organs of those subjects who have exhibited all the phenomena of fever, exists there, after death, no appreciable alteration? or is the disorder of all the functions invariably owing to a local phlegmasia, the traces of which are evident on dissection ? Such is the question with which M. Chomel commences his memoir, and to which he proposes strictly to confine himself. After indicating the spirit and manner in which the inquiry should be conducted, and exposing the contradictions of the new sect in their admission of scorbutus as a disease of the whole system, the author proceeds to the proofs furnished by clinical observation, in favour of the existence of fevers. The phenomena of fever, he observes, come on rapidly; and having continued some days, subside either gradually or all at once. Here every thing tends to show that no organ has been particularly affected ; but as the patient survives, demonstration is impracticable. Yet the authors of the new doctrine pretend, that in all these cases local inflammation invariably exists, and is appreciable by signs which have escaped their predecessors : thus every slight, obscure, or transitoryI. * * * * * 7 symptom is magnified, and adduced by them as characteristic of a phlegmasia ; and gastritis and enteritis are made the source of all acute diseases. #

Clinical observation frequently presents another pheno¬ menon of some moment in the present discussion : in many patients, who for two, three, or four days have suffered

140

Foreign Medical Science and Literature .

all the symptoms of idiopathic fever; erysipelas, inflammation of the tonsil or other organ, supervenes, and the febrile commotion subsides.

The following are stated by Chomel, as the general results of the dissection of those who have died in fever; and such examinations may be considered as almost decisive of the question. 1. In some cases there is no appreciable altera¬ tion. 2. In others, only a slight, and often very limited, redness of the intestinal canal. 3. In nearly three-fourths, numerous ulcerations of the intestine about the ileo-ececal valve ; corresponding mesenteric glands red and tumefied ; spleen frequently enlarged, and converted into a blackish pulp. 4. In some subjects, merely traces of cicatrized ulcers.

Admitting that they who deny the existence of fevers had constantly descried traces of gastric or intestinal inflamma¬ tion in the bodies of those who have died from violent febrile diseases, it does not follow that such inflammation invariably exists. A thousand facts, favourable to their opinion, cannot destroy one solitary fact hostile to it. Chomel asserts that he has repeatedly examined subjects who have died from fever, in whom not the slightest perceptible alteration of struc¬ ture existed ; that in these cases the whole track of the intestinal canal, and the spinal marrow, were most scru¬ pulously inspected ; and that this was done public!}7, and in the presence of a crowd of students, many of whom were interested in discovering traces of phlegmasia. Similar results have been communicated by other eminent Practitioners. In opposition to these facts, it lias been argued that the red¬ ness and tumefaction might have disappeared after death ; or that life might have been extinguished by the pain before the alteration of structure existed. Such arguments Chomel rejects, as unworthy of serious refutation.

In other subjects, as has been observed, red spots really exist in the stomach and intestines. Yet this partial redness seems to be unimportant; since it is found in the bodies of those who have died from widely different affections, and even from external injury. Bedard has very commonly observed it on the dissection of criminals.

In the greater number of the victims of fever, redness, swelling, and ulceration, are discovered in some portion of the intestinal tube. Prost and Petit have particularly directed our attention to these very common lesions, but they are not constant; and if the symptoms of severe fever sometimes take place without them, we may conclude that such symptoms are independent of them. There, in fact, exists no accurate relation between the number and extent of the ulcers and

141

Chomel on Idiopathic Fevers.

the intensity of the febrile symptoms. And again, in some subjects the intestinal ulcers are all completely cicatrized, where the febrile phenomena have continued unabated to the last. Similar ulcerations exist in pulmonary phthisis and chronic dysentery, without producing any symptoms similar to those of fever.

Yet the frequency of intestinal ulceration in febrile diseases is remarkable, and indicates a close connexion between them. Probably, in most cases where diarrhoea has long preceded the invasion of the fatal malady, the progressive weakening of the system has given to the intestinal inflammation, at first sight, a malignant character. The ensuing are stated by the author as his reasons for considering such ulcerations as com¬ monly the effect, and not the cause, of the symptoms which characterize fever. 1. The signs which announce the forma¬ tion of the ulcers, as meteorism, excretion of sanies, sensi¬ bility of the abdomen, and especially of the right flank, in general occur only about the tenth day of the disease, at which period the diarrhoea in most cases commences. c2. The ulcers occupying that part of the intestine, where the faeces, having acquired irritant qualities, remain longest. They are found neither in the stomach nor duodenum, where the con¬ tents, although long retained, have suffered little alteration. They rarely occur in the jejunum ; become progressively more frequent, large, and deep, in the vicinity of the iliac valve; are very thick and extensive on the valve itself, in the coecum, and ascending colon; and again become rare in the rest of the large intestine, because the faeces, when they have once reached the transverse colon, are promptly expelled. 3. The site of these ulcers presents another circumstance favourable to the opinion just advanced. In the moveable portion of the intestine they in general occupy only the side opposite to the membranous band by which it is suspended, and consequently its most dependent part. In the coecum and ascending colon, whose position is vertical and fixed, the ulcers overspread nearly the whole internal surface. Some¬ times, however, the dorsal exhibits more of them than the an¬ terior portion; and this strengthens the conjecture before advanced as to their etiology. 4. Similar ulcerations form in different parts of the body, at an equally advanced period of the disease ; as in the interior of the mouth, on blistered surfaces, and particularly on the integuments of the sacrum and trochanters. The contact of faeces and urine certainly concurs with the weight of the body in the formation of them. Now, all these ulcerations being evidently secondary, and de¬ termined by causes at once both local and general, it is probable that internal ulcers form about the same period.

142 Foreign Medical Science and Literature.

•* ‘

and arise from a combination of the same or nearly the same

causes.

Hitherto our author has been speaking only of continued fever. T he variable and periodical phenomena of intermit- tents are, lie contends, still more inconsistent with the new theory. Nothing during life indicates that they have any particular seat ; and the absence of all lesion in those who die even with some signs of particular congestion, leaves us in great ignorance upon this important point of their history.

The fact, too, of intermittents being cured by large doses of cinchona, is considered by Chomel as decisive against the existence of gastritis as their cause. The action of large quantities of this drug, in immediate contact with an inflamed membrane, could not fail to aggravate the affection. .And as to the cure of one irritation by another, it is too much in opposition to the new theory and reason itself to merit a serious examination.

Note by M. Bourge, on an Erysipelas cured, by the appli¬ cation of Tonics.- — The affection succeeded the employment of a blister on the arm of an hemiplegic female, aged 55 ; and was speedily cured by the topical application ol camphorated spirit, at first largely diluted, and subsequently pure.

Note on a precocious Menstruation. By Dr. Descuret. — The subject of this note began to menstruate at the age of thirty months: and the flux has never failed to recur regularly and abundantly, except during and after pregnancy, till the pre¬ sent period, her 53d year; nor is there at present any sign of its cessation. At the age of eight she measured four feet four inches, and has not grown since. Her throat is sin¬ gularly developed. Married at 27 ; she lost her first child from laborious labour, succeeded by prolapsus uteri. She has since twice suffered abortion ; and borne eight children, two of which are twins. She is of a full habit, and in¬ variably healthy.

Case of a Foreign Body introduced into the Trachea , and ex¬ tracted by the Operation of Tracheo-Earyngotomy. By Dr. Troussel Dalvincourt. — A boy, aged nine, swallowed at play, about noon, January 23, a white kidney7 bean. Redness of the face, violent agitation, and paroxysms of coughing, instantly succeeded. At six P. M. Dr. Jadelot ascertained the presence of a foreign body in the trachea, and prescribed vomiting and sternutatories without success. At seven, respiration croupy; and the boy pointed to the summit of the sternum, and sometimes the middle of the throat, as the seat of pain. Vomiting again fruitlessly induced. Sound sleep from nine to eleven. Night good. Symptoms recurred with

Le Sage on ruptured Perinteum. 143

violence at four A. M., and again at frequent intervals, till the morning of the 25 th, when the operation was determined on. During incision of the trachea, in the centre of the throat, four veins veere successively tied. Air issued from the orifice; voice continued. The orifice proving too small, it was enlarged in direction of the larynx ; and the voice ceased. Air now passed freely to and fro; but the bean did not present. No attempt at extraction. The wound slightly covered. Patient pale and restless. Respiration relieved by the erect posture. Left to repose, but could not sleep; teased by thirst and cough. A noise heard at times, as if something ascended and descended in the trachea. At two P. M., during sleep, sneezing was excited by the application of snuff, and in the violent agitation and convulsive cough which ensued the bean was expelled. It was increased in bulk at least two-thirds, had a colour as though it had been immersed in boiling water, and a slightly fetid smell. The wound proceeded favourably under the or¬ dinary treatment; although granulations, arising princi¬ pally from the thyroid gland, required the repeated ap¬ plication of caustic. February 12th. — Completely cica¬ trized, without injury to the voice. Reflections. — In this case the whole of tfie cricoid cartilage and four rings of the trachea were divided. Hence it constitutes the mixed opera¬ tion of tracheo-laryngotomy ; and the present, according to the author, is the first instance of its successful performance. The case, he adds, is valuable, moreover, as proving that the centre of the thyroid gland may be cut with impunity.

Bulletins of the Faculty of Medicine of Paris , 1820. — No. IL

Description of a Congenital Malformation of all the Limbs. By M. Breschet. — An account, exceedingly elaborate and precise, of a boy, aged seven, who, instead of perfect anus, exhibits two short conical stumps, and whose inferior extremities are greatly distorted. The unfortunate child otherwise well formed, intelligent, and healthy. The descrip¬ tion illustrated by an engraving.

Case of ruptured Perinceum, inflicted by the Point of a Ploughshare. By M. Le Sage. — A boy, aged twelve, run over by a plough, received from the point of the share, newly sharpened, a deep wound of the perinaeum. Moderate haemorrhage ensued, and the boy walked home. Four days afterwards, the wound, on examination, was found situated on the left of the raphe, and extending from the tuber iscbii to the pubic arch. The lips ot it were hard and swollen ; sphincter ani untouched. Part of the faeces, and all the urine, with the exception of a little voided

I

144 Foreign Medical Science and Liter at are.

with great effort from the urethra, escaped through the wound. Hypogastric region tense and painful. Little fever. Laceration of rectum and urethra hence evident; but determination of the extent of the lesion impracticable from the existing irritation. Symptoms in six days greatly relieved, by blood-letting, abstinence, emollient injections, abdominal fomentations, and poultices to the perinaeum. Great difficulty was now experienced in introducing the catheter. That formed of elastic gum, being too flexible, slipped out of the bladder on every motion; and its point getting into the intestine, was, by the weight of faeces, thrust from the anus. It was at last advantageously replaced by a metallic catheter, curved like the Italic S. Tents smeared with digestive were introduced into the rectum ; the wound superficially dressed. Every thing went on favourably. The passage of a little urine between the urethra and catheter, which caused a slight induration of the borders of the wound, was effectually obviated by leaving the instrument unclosed ; and in seventy-two days the wound was completely cicatrized.

Report on a Memoir of M. C bom el upon the Existence of Fevers. By^ MM. Fouquier and Lerminier, — A long disser¬ tation on the memoir which we have just largely analyzed, and decidedly favourable to the author's views and opinions.

Medical Review.

This is the new Quarterly Journal ; the publication and plan of which we have recently mentioned and exposed*. If continued with the ability which signalizes its commence¬ ment, no eulogy of ours will be required to fix its station and character. The original articles which it comprehends will, of course, only be noticed by us.

First Year (1820). First Part. — Memoir on Fistula Lachry mails. By M. Nicod. — Two methods of treatment, observes the author, have alternately prevailed in fistula lacbrymalis. One of these has for its object the restoration of the natural course of the tears; the other, the creation of an artificial passage. Each consists of numerous processes, and has been advocated by eminent men. Both have fre¬ quently succeeded, and both, under certain circumstances, failed. His aim, therefore, is to ascertain the causes, in order to fix the principles of treatment applicable to each par¬ ticular species of fistula. The first method, comprehending compression, injection, and dilatation, is reviewed in the present article. The second is reserved for an ensuing

* See Repository, Vol. XIII. page 357-

Researches on Fistula Am.

145

Number of the work. We shall amply analyze the whole as soon as it is completed.

Researches on the Situation of the internal Orifice of the Fistula Ani, and on the Parts in the Substance of which these Ulcers are seated . By Dr. F. Ribes. — After some intro¬ ductory pages, wherein the opinions and practice of Sabatier in fistula, and the motives which led to the present investiga¬ tion, are fully detailed, the author proceeds briefly to exa¬ mine the disposition of the anus and its component parts.

This orifice is more or less deep, according to the sex. In woman it is nearly on a level with the widely separated and hut slightly prominent tubera ischii ; while in man it is more elevated — a disposition, doubtless, dependent on the greater projection and decreased distance of these bony prominences. 'The perinaeal skin is readily seen in the female, uniting with the internal membrane of the rectum, nearly on a level with the perinaeum; whereas in man the skin sinks deeply in to meet the intestinal membrane. From this disposition the operation for fistula is easiest in the former. The internal membrane of the rectum is much more extensive than the muscular, and their union is effected by a loose cellular struc¬ ture. Consequently, when the muscular contracts, the mucous membrane becomes puckered, and gives the interior of the rectum a wrinkled aspect. These wrinkles, which disappear on dilatation of the intestine, are transverse, and occupy three- fourths of its superior part, and are rarely seen below. Yet some have asserted that they constantly exist there, and are directed longitudinally. The semilunar folds, described as situated there, the author has in vain sought for*. The orifices of mucous ducts are visible over the whole internal surface of the intestine; but their precise direction it would be difficult to determine. Lacunae also, described as having their orifice turned upward and their fundus below, Dr. Ribes has never seen. Yet he has invariablv found, four or five lines above the margin of the anus, three and some¬ times four depressions, somewhat resembling those at the origin of the aorta and pulmonary artery with their valves removed, ^except that they are smaller. These, doubtless, have been taken for lacunae. They are, however, without any orifice, quite smooth, and directed somewhat upward.

The internal sphincter muscle and hccmorrhoidal plexus are situated at the lower part of the rectum, between

* Morgagni in two instances found real valves instead of these folds. In one they had a circular form, in the other they repre¬ sented a crescent. They were situated about a finger’s breadth above the anus.

VOL. XT V, - NO. 80. U

146 Foreign Medical Science and Literature .

tbe mucous membrane and longitudinal fleshy fibres. After dissecting the internal membrane of the rectum at its inferior part, the haemorrhoidal plexus is first observed. This con¬ tinues, and anastomoses above with the internal haemorrhoidal veins, below with the external, and in the centre with the middle. Internally, the plexus is applied to the internal membrane of the rectum; and when any branches of the plexus are dilated at this point, the membrane is pushed inward, extenuated, and assumes a bluish aspect; so that tbe tumours seem to project into tbe intestine without any inter¬ mediate membrane, apparently no longer existing. Yet, on cautious dissection of these tumours, the mucous membrane of the rectum may be separated, and the proper membrane of the haemorrhoid afterwards appears. Externally, tbe plexus is applied upon the internal sphincter muscle ; but it is important to observe, that large branches of the plexus traverse the muscle, and afterwards descend upon its external surface to its inferior border, and communicate anew with the inferior border of the plexus ; so that the internal sphincter muscle, in subjects suffering from piles, is traversed and sur¬ rounded by many large veins, which give it a cavernous aspect. This disposition is scarcely seen in persons who have never suffered from piles. It should be remarked, that the plexus and its veins are more or less dilated and varicose in the vicinity of the haemorrhoids. By inflation of air into the inferior mesenteric vein, the plexus is distended, and the cellular structure of the inferior part of the rectum becomes emphysimatous. Essence of turpentine also passes with facility.

The haemorrhoidal veins, distended by their contained blood, give rise to varices; but if from any cause the blood, instead of mounting into these veins, descends, and is extrava- sated at the inferior and internal part of the anus, in some of those cells of the cellular membrane with which the haemor¬ rhoidal veins communicate, this state constitutes an haemor¬ rhoid. If the inferior mesenteric vein of an haemorrhoidal subject be dissected, the ramifications of the vessel are seen terminating in these sanguineous cysts ; and on isolating or completely removing the whole, the haemorrhoids remain suspended to the branches of the haemorrhoidal vein, as grapes to the vine.

These small tumours are frequently the seat of a fluxionary state and of severe pain. If they open externally, the blood escapes, and the patient is for a while relieved; but if they are situated internally, and penetrate into the rectum, the blood issues from the anus. In this case, the stercoral moisture may insinuate itself by the ulcerated point into the

Site and Course of Fistula .

147

haemorrhoid, induce inflammation and small abscess, and thus give rise to fistula ani ; and out of one hundred fistulae in this region, ninety-nine are formed by this mechanism, and deter¬ mined by this cause.

In his dissections of fistulae, which have been very nil merous, Dr. Ribes has endeavoured, first, to ascertain the situation of the internal orifice; and, secondly, the course which the fistula commonly pursues, and the parts through which it penetrates.

The situation of the internal orifice is usually found imme¬ diately above the point where the internal membrane of the rectum unites with the skin, and sometimes a little, though never more than five or six lines higher ; in many cases scarcely three or four*. The orifice is as it were lacerated ; in most instances soft, in some hard and callous.

The course taken by the fistula is a little variable. In general, it descends from its origin in the rectum between the mucous membrane of the intestine and internal sphincter muscle. Arrived at the inferior part of the muscle, it turns, and, getting between the external sphincter and skin, opens in the vicinity of the margin of the anus ; but in some cases the fistula perforates the fibres of the internal sphincter, descends between this and the longitudinal fleshy fibres of the rectum to the superior surface of the external sphincter, traverses the fibres of this muscle, and ulcerates the skin near the inferior extremity of the rectum. In many subjects, however, the parts are so confounded or disorganized, that it is impossible to determine accurately the course of the fistula. The canal is, in all cases, invested by an adventitious membrane, thin, delicate, and apparently destitute of villi. From these researches the author is convinced that fistula is almost invariably formed in an haemorrhoid, and sometimes in the course of a vein of the haemorrhoidal plexus. He more¬ over affirms, from these data, that in most cases the internal orifice of the fistula is clearly visible. Upon a slight effort, like that of evacuating the faeces, being made by the patient, and the borders of the anus separated, the minute ulcer, indi¬ cating its site, will almost invariably be seen. If not, the probe, never failing in the hands of a skilful Surgeon, must be had recourse to. But, under the impression that the orifice is situated, and the intestine denuded high up, the instru¬ ment is very often erroneously directed; and the loose cellular structure yielding readily to the probe, the delusion is aided, and discovery of the orifice rendered merely fortuitous. On reviewing the common height of the internal orifice, and the

* T his observation is at least applicable to the seventy-five fistulous subjects.

148

Foreign Medical Science and Literature .

course taken by the fistula, as above described, it will appear obvious, that in directing the probe upwards when it has been introduced, its arrival in the rectum is impracticable, in order, therefore, to effect this, it is necessary to direct the probe horizontally and almost parallel to the perinseum in the female, but somewhat higher in the male, for the reasons before indicated. When passed into, the fistula, by sliding the probe head on the internal surface of the skin without quitting it, and directing the instrument towards the lower part of the rectum, the internal orifice, and the finger intro¬ duced into the rectum, will soon be met with. If, then, the patient be conveniently placed, and it be intended to operate by incision, the grooved director, introduced into the rectum, may be slightly curved, and its extremity brought out from the anus. After this, nothing remains but to divide the in¬ teguments from one end of the fistula to the other, with a bistoury point passed along the groove of the director, Larrey, it seems, has adopted this simple and advantageous method of operating, instead of the process of Desault, which he before employed.

Dr. Ribes concludes by asserting, that his description of the site of the internal orifice of fistula ani will be found invariably correct*; and that the operation ought never to be performed when the probe does not penetrate into the rectum by the internal orifice of the fistula. Denudation of the intestine, he adds, is never to be dreaded when both orifices of the fistula are comprised in the incision. In blind external fistula the denudation is never so extensive, nor the cellular texture so completely altered as to prevent re-union of the intestine with the adjacent parts ; and in this case, according to Sabatier, the intestine should on no account be divided. Fistula ani, then, is a disease commonly of little importance, and the operation employed for its cure, one of the most simple in surgery.

German.

Journal o f Practical Medicine and Surgery.

January, 181 9t . Volume X L V 1 1 1 J. — if i p pocrates

* Whatever be the number of external openings of a fistula, they make no change.

t In conformit}^ with our engagement, we have resolved on com¬ mencing our analysis of this excellent journal with the first Number of the preceding year. The same will be done with the Italian journal of which vve have repeatedly spoken, and which we hope shortly to receive. — Foreign Editor.

+ XLI. of the new series. See the account of this journal in our Number for last January, page 8f). The Editor of the Foreign Department takes this opportunity of informing the friends of tne

f

149

Fischer on Lesion of the Heart.

and Galen, Nature and School. By the Editor, (Professor Hufeland). — In this the author traces, at considerable length, a parallel between the two great Physicians of antiquity, and between clinical and scholastic medicine. More curious than useful.

History of the remarkable Disease of an illustrious Person , who died of a Lesion of the Heart ; with an Account of the Morbid Appearances , and Ref ections. By Dr. Fischer. — This case is detailed with such extreme minuteness as to occupy nearly fifty pages. Subject, a married lady, past the middle age. Symptoms principally, dyspnoea, haemoptysis, livid colour of the face, irregular pulsations of heart and arteries, and pain on pressure of the pubic region. Dis¬ section. — Externally. Great emaciation of the superior parts; oedema of the. whole lower extremities; gangrenous swelling beneath the right eye, with a large opening which led into a purulent cyst. Cranium. — Vessels of dura mater, and both hemispheres, particularly the left, much loaded. Targe quantity of water effused, between the cerebral convo¬ lutions, into the lateral ventricles, and on the basis cranii. Plexus choroides empty. Thorax. — Muscles wasted and without fat. Cartilages, costal and xyphoid, much ossified. Tight lung adherent; on the apex of this lobe, two hydatids as large as a goose egg ; the empty membranes of two equally large in the left cavity, which contained about two pounds of water, and the right three. Pericardium uni¬ versally rose-coloured, as it were injected, thickened, covered with fatty excrescences, and containing a little water. Sur¬ face of the heart, especially left ventricle, highly inflamed; in many places bluish, as it were gangrenous; in others, covered with a milk-white layer. Heart itself wrinkled and very soft. Much tdood, partly fluid and partly coagulated, in both ventricles and aorta, the internal surfaces of which exhibited marks of inflammation. Abdomen. — Liver appa¬ rently though not actually enlarged, and otherwise healthy. Stomach contracted, so as to resemble large intestine; mucous membrane highly inflamed. Pancreas firmer than natural. Transverse and descending portions of colon contracted to one inch in diameter ; their membranes thickened. All the

Repository, that he shall feel great pleasure in transmitting to any gentleman, desirous of obtaining it, either for literary or practical purposes, a more extended abstract than can usually be given; or, if it be required, a literal translation of either case or memoir contained in the various foreign journals from which he gleans. Applications of this nature, addressed, post paid, to the Editor, at Tamworth, will rneet with every attention. — S. P.

150

Foreign Medical Science and Literature .

abdominal veins loaded. Hsemorrhoidal tumours in the rectum. Small intestines inflamed, discoloured, and par¬ ticularly narrow. Four pounds of water in the peritonaeum. Quantity of blood in the whole body very small.

Case of Gun-shot Wound of the Heart . By J. H. Fuge, Esq. &c. From Edinburgh Med. and Surg. Journal*.

Some Observations on the Employment of Prussic Acid in Nervous Diseases. By Dr. Liidike. — The object of this me¬ moir is to detail some instances of the successful exhibition of prussic acid, or rather of the distilled laurel or bitter almond water, in spasmodic diseases, particularly when complicated with affections of the uterine system. In 1816, this remedy was given by the author to a patient during a violent pa¬ roxysm of listeria, very nearly bordering on epilepsy. The first dose, of fifteen drops, produced an almost immediate calm ; and by perseverance in its use, the succeeding pa- Toxyms were greatly mitigated. From this period, the patient continued to employ the medicine with decided benefit.

A young girl, in 1817, was attacked with violent hepatitis consequent on suppressed menstruation. The inflammatory symptoms had not completely subsided, when, on the 6th day, delirium and convulsions suddenly supervened. Twelve drops of the bitter almond water were immediately administered. The symptoms were sensibly relieved, and yielded completely to a second dose, given half an hour afterwards. In a few days the patient was quite restored.

In a girl, aged 18, whose mother had suffered from hys¬ teria, the precursory signs of this affection were for some time visible. Several symptoms resembling those of hy¬ drothorax also existed. The parents, apprized of it, neg¬ lected for half a year to consult their Physician, At this period, after taking with appetite a light supper, she suddenly complained of violent headach, and fell senseless, and with¬ out motion. The face red and turgid; pupils dilated; mo¬ tions of thorax difficult; respiration stertorous; extremities cold; insensibility to external impressions; all seemed to indicate an apoplectic seizure. After some minutes, warmth, motion, and sensibility returned ; and the patient, directing her hand to the left side of the thorax, screamed out inces¬ santly. The pulsations of the heart and arteries very irregular, tremulous, alternately strong and feeble. Powders of musk and camphor prescribed by the attendant Surgeon ; allowed by Dr. Liidike to be continued for a while. Symptoms re¬ lieved ; pulse more equal ; and speech distinct. Patient now complained of dreadful thoracic oppression, and piercing pain

* VoL xiv. p. 129*

Croup, Syphilis, Sc.

151

in the heart. As after 48 hours’ employment of the musk powders, injections, sinapisms, &c. no amendment was per¬ ceptible, the existence of carditis was apprehended, and Dr. Reiner called in consultation. This latter regarded the dis¬ ease as of a spasmodic nature; and directed eight drops of bitter almond water to be given, with kali tartaricum (tar- trite of potash), every two hours; ail other medicine dis¬ continued. Next night much more calm; cardiac pains re¬ lieved, and in a few days wholly disappeared, under the employment of the aqua amygd. amar. The nervous debility, yet continuing, was eventually removed by tonics and chaly- beates. On recurrence of the thoracic spasm after a period of perfect health, the prussic acid was invariably given with great effect. The patient, quite restored, has since become a mother.

The fourth case is that of a woman suffering from puer¬ peral mania, consequent on inflammation of the uterus, which came on after the birth of her third child. Twelve drops of the aqua amygd. amar. were given in distilled water, at first every hour, and afterwards every two or three hours, for two days. Gastric fever supervening, was combated by other remedies. Some slight irregularities of sensation and intellect were afterwards evinced; but the patient eventually recovered.

V(ews of Medicine at Paris. By Dr. Nacquart. — Trans¬ lated from a memoir in one of the Trench journals.

History of a Case of Croup , which occurred in a Child aged Seven Weeks, and was successfully treated. By Dr. Osann.— This is a somewhat interesting case, but too minutely de¬ scribed to allow of our tracing it through all its details. Vomits, mercury, and blood-letting, were the remedies to which the fortunate issue may be principally ascribed : and the inference drawn from it by the author is, that croup, treated at the onset with promptitude and energy, is sus¬ ceptible of cure in subjects of the most tender age.

Remarks on the new English Method of treating the Venereal Disease without Mercury. By the Editor. — The opinions and practice of Dr. Thomson, and many of our countrymen, with respect to the treatment of syphilis, are too well known to demand recital or exposure here. After detailing the experi¬ ments adduced by the Edinburgh Surgeon in support of his doctrine, Prof. Hufeland objects decidedly to the conclusions founded upon them. They, he contends, prove nothing further than that the symptoms of the venereal infection may be removed without mercury ; but respecting the complete extinction of the virus, and subsequent occurrence of consti¬ tutional syphilis, they leave us in uncertainty. The Professor

152

Foreign Medical Science and Literature .

has recently seen a patient, who, after continuing well two years from the superficial healing of a chancre, is at last suffering from an affection of the bones. He therefore entreats Dr. Thomson to await the lapse of one year, and then report whether all the patients, the result of whose cases he has brought forward, have, without being exposed to any fresh infection, remained perfectly free from syphilitic taint. This proved, the Professor will not hesitate to admit the high importance of Dr. Thomson’s discovery.

Short Notices and Extracts

2. SELECT CASES AND MEMOIRS.

Anatomy .

I. Essay on the Veins of the Spine f. — This essay, the pro¬ duction of Dr. Breschet, consists of nine sections. We shall analyze it as briefly as possible, consistently with its im¬ portance.

Section First . — No complete description of the spinal veins has hitherto appeared. Chaussier has first spoken of them. By Dupuytren, in his oral lectures on anatomy, they have been circumstantially delineated. The difficulty of their in¬ jection and preparation has probably given rise to this defect in the history of the venous system, which it is the object of Breschet to supply. Attentive study of the origin, course, connexions, and terminations of the spinal veins, will show that the analogy supposed to exist between them and those of the cranium is very slight ; and that the former con¬ stitute a distinct venous system, with dispositions worthy of the attention of the physiologist.

Section Second. Choice and Injection of Subjects. — In order to demonstrate the spinal veins, the body of an old and spare subject, possessing slender muscles and large veins, should be selected ; and with a view of facilitating the pro¬ cess of injection, it should be immersed for a considerable time in a warm bath. One tube is then to be adapted to the

* These notices and extracts, which invariably constitute a con¬ cluding article in the journal, seldom offer any thing very interesting. Whenever otherwise, we shall not fail to glean from them. In the present instance, they comprehend the transactions of the Medico- Chirurgical Society of Berlin, for 1818; notes on the plague, from the French ; and reports of the weather and diseases at Berlin, for the month of January.

f Essai sur les Veines du Rachis. From the work of Dr. Breschet, which lately gained for him the then vacant situation of chef des Ira - faux anatomiques to the Faculty of Medicine of Paris. The work itself we shortly propose to notice, together with those of the two less fortunate candidates.— -For. Edit.

lireschet on Vein?, of the Spine.

\f)5

point of the superior longitudinal sinus; another to the gluteal artery; a third to the superior vena cava; a fourth to the great prelombo-ihoracic (azygos) vein, near its en¬ trance into the cava ; and a fifth to the mouth of the inferior cava. Through these, common injection, coloured with Prussian blue, should be thrown in at the same instant ; so that the extremities and the centre, the essential parts and communications of the spinal veins, may be equally filled.

Section Third. — Of the Dorsi-spinal Veins, fn proceeding from the exterior and spinal surface of the vertebral column towards the interior of the canal, we discover these veins ; which, originating from the skin, cellular substance, and muscles of the spinal surface of the vertebral column, are both numerous and considerable, and, instead of uniting with any system of superficial veins, penetrate the substance of the muscles, and gain the intervals of the bodies of the vertebrae, or those of the transverse processes where they terminate. These veins form, at their origin, two planes dis¬ tinct in position and termination. One, situated near the spinous processes, traverses the internal part of the dorsal muscles, and gains the bodies of the vertebrae; insinuates itself by two or more branches into the intervening spaces; tra¬ verses sometimes the yellow ligaments ; and lastly, terminates in a venous net-work which envelopes the meningeal canal : the other, placed near the external border of the sacro-spinal muscle, accompanying the branches of the intercostal and lumbar arteries in the back and loins, gains the summit of the inter-transverse spaces, and unites either with the inter¬ costal veins, or with the trunks which extend from them to the great spinal veins. In the sacral region, the dorsi-spinal veins penetrate by the posterior orifices of conjugation into the vertebral canal.

Section Fourth. — -Of the Basi-vertebral Veins. These form part of the venous system peculiar to the bones, and dis¬ covered nearly at the same time by Dupuytren and Chaus- sier. They occupy those numerous, minute, and variously I' sized orifices, which may be seen upon attentive examination of the circumference of the bodies of the vertebrae, and which have hitherto been considered as transmitting the nutrient arteries of these bones. There is one of these orifices much larger than the rest, of an irregular figure, and situated pos-

teriorlv on the bodv of the vertebra. This is the commence- %> •/

ment of a double canal passing horizontally into the bone, and almost immediately dividing into two smaller ones, which I proceed anteriorly at a nearly equal distance from the I superior and inferior surfaces of the vertebra, and soon con- VOL. xi v. — no. 80. x

' L

154

M edical

Science and Literature .

verging, form by their union an arch from the convexity of which several branches go off in the manner of the pes anserinus. These again divide into smaller branches; which, diverging as the former, reach the front and sides of the circumference of the vertebra, and terminate either insensiblv sn the osseous structure, or in one of the veins of the orifices - on the surface of the bone. All these canals are situated at parallel heights in the substance of the vertebra. None of them, except perhaps some imperceptibly minute ramifica¬ tions, pursue a vertical direction. Hence they may readily be discovered and prepared by removing, layer after layer, from above downwards, the body of the bone. The scalpel, chisel, or file, may be employed for this operation.

1 he existence of veins in the canals just described is shown by ordinary injection; but if the injection be made with this view, and prove successful, the vessels may be readily traced either from the interior of the vertebral canal to¬ wards the body, and to the circumference of the bone, or from the veins resting on it, and from its circumference towards the canal, and particularly towards the great venous reservoirs behind the bodies of the vertebrae.

These veins have a double origin : the first borrowed from the numerous communications which they keep up with the veins covering the surface of the vertebra; the second, or real, from the cells of the spongy structure filling up the interior of the bone, I he veins peculiar to the vertebra proceed from its body and lateral masses.

1 he veins of the body of the vertebra, placed horizontally in the canals just described, unite at an acute angle, and become less numerous till they form but five or six branches. Arrived at the posterior part of the body of the bone, they implant themselves into the back of an arch resembling that formed by the mesenteric vessels. The two branches of this, directed backward, approach the posterior surface of the vertebra ; but each of them, before passing out, commonly receives two branches proceeding from the superior and inferior lateral masses of the corresponding side. They then issue from the body of the vertebra, by openings situated on its posterior surface; and, separating from each other, pro¬ ceed outwardly to join the great spinal veins, with which they communicate at a right angle. The disposition of these veins exhibits numerous varieties, not only in different sub¬ jects, but in different vertebrae of the same individual.

The analysis of the five remaining sections will be finished in our next Number.

155

('one ret ions in the interior of V eins»

PATHOLOGY (INCLUDING MORBID ANATOMY) AND PRACTICE OF MEDICINE.

II. On the Concretions which form in the Interior oj Veins*. Small calculi are sometimes discovered in the cavity of veins. They seem first to have been mentioned by Columbus *f\ BartbolineJ, Moeniken ||, Walter^, Soemmering ^f, John **, and LangstafffTj have subsequently recorded examples ol their occurrence.

Professor Meckel, author of the present memoir, has very frequently observed these conecretions, both in the male and female; only, however, in the veins of the bladder, uterus, vagina, and rectum. Most commonly they were met with in individuals at or past the middle age; and accom¬ panied by varicose dilatation of the vessels. Once only he found them in the vesical veins of a man aged twenty, destroyed by pulmonary phthisis. In children lie has never seen them. The following are their distinctive characters:- Volume. Variable from half a line to several lines in dia¬ meter. — Weight. Specific gravity nearly that of bone.— Ab¬ solute, varying from two-thirds of a grain to several grains : the largest in the professor’s collection weighs twelve and a half. — Colour. Externally, in general, yellowish white; some¬ times reddish, from colouring matter of the blood : internally, white as chalk. — Figure. Commonly round or oval, with smooth surface; rarely irregular or rough. — Number in the ^ same individual. Variable : in some rare instances only one, and that very small; usually from three to ten, or upwards. — Consist ence.Soh on their first extraction; when dry, very

* Journal Complementaire du Diclionnaire des Sciences Medi- cales, tom£ iii. p. 38.

t De Re Auatomica, lib. xv. Francof. 1593. 8vo. p. 491.

I Histor. Anat. Rarior. cent. 3, hist. 34, tom. ii. p. 7 I •

|| Obs. Med.-Chirurg. obs. 20, p. 73.

y In the veins of the bladder of a man aged forty, which contained four urinary calculi, of the volume of a nutmeg, he tound also lour hard concretions as large as a pea. Several were observed by him in the uterine, vaginal, and ovarian veins oi an apoplectic female; and three in* the vaginal veins ot a woman aged filty. Obsertat , A natomicce. Bcrol. 1 775. fol. p. 44-5 ; and Museum Anatomicum ,

torn. i. p. l6l, No. 325. t

5[ Notes to the German translation of Dr. Baillies Morbid Ana¬ tomy, p. 191, No. 5. , , . , ,

** Memoir inserted in Schiveiggers Journal fur Lhemie unci

Pbysik, tom. xii. p. 80.

It London Med.-Chir. Transactions, vol. viii. pait i. p. 2f2r »

156

Foreign Medical Science and Literature .

hard. The author has seen one so soft as to crumble readily between the fingers .—^-Interior Structure , Consisting of white and thin strata, concentrically disposed around a kind of nucleus, and united by very delicate membrane. — Chemical Analysis. Composed, according to Gmelin, of phosphate and carbonate of lime, and an animal matter. Traces also of the muriatic, sulphuric, and phosphoric acids, combined probably with soda; perhaps a little oxide of iron ; certainly no uric acid. — Mode of Formation. Hitherto unknown. Mr. Hodgson, who has cursorily spoken of these concre¬ tions without ever having seen them, thinks that they are formed in the circumjacent parts, and subsequently intro¬ duced, by absorption, in the veins*. Are they' then formed in the bladder? Certainly not: since they contain no uric acid. It has again been pretended, that they originate in the parietes of veins, in the same manner as the tophaceous concretions of arteries ; and that by the rupture of inter¬ nal membrane of the vessel, they get introduced into its cavity. But their circular figure opposes the admission of this hypothesis; and, as Langstaff correctly observes, rupture of the internal membrane of the veins containing calculi, has never vet been seen.

The following reasons induce Professor Tiedemann to con¬ clude, that these concretions are formed by the blood con¬ tained in the interior of varicose veins:— 1. They invariably exist in the centre of firm and black eoagula of blood. 2. The numerous strata surrounding their nucleus prove that they are gradually formed, and that they are produced by a fluid contained in a space sufficiently large to permit a sort of crystallization in a globular mass, or by strata deposited one upon the other. 3. The constituent earthy parts of these calculi are the same as those found in the blood.

The Pfofessof lastly explains their formation in this manner. When the circulation is retarded, or momentarily suspended in a varicose vein, the albumen separates from the mass of blood, and forms a nucleus, round which the con¬ stituent earthy parts of the fluid are deposited in concentric strata. I bis formation, he adds, is particularly frequent in ha3morrhoidal affections alternating with fits of gout. In the latter disease, the blood doubtless contains an excess of earthy substances. Concretions somewhat larger than grains of sand frequently formed, in the rectum of a man aged more

* We do not recollect to have seen any such opinion advanced in the work of Mr. Hodgson on the Diseases of the Arteries and Veins; nor can we discover, on hasty retrospect, the slightest trace of it. — For. Editor*

Case of (Edematous Angina of the Larynx. \57

than forty, who suffered alternately from gout and haemor¬ rhoids ; and were evacuated with the almost dried excre¬ ment *.

III. Case of (Edematous Angina of the Larynx , which tons complicated with Abscess in the Cricoid Cartilage, and ter - minated in Dcatlr\- — Dry, frequent cough, with pain about the larynx, hoarseness, tight respiration, and evening pyrexia, in an epileptic vagrant, aged twenty-one, during convales¬ cence from low fever, which had been followed by formation of abscesses in the leg, groin, and jaw, were the first symp¬ toms of the affection. — 10th day from their invasion, much pain in the throat; inspiration more difficult than expiration. - — l 1th. Sensation of a foreign body in cavity of the larynx. — 12th. No better; little sleep; respiration noisy ; constant pain about the larynx. On introduction of the finger, epi¬ glottis found distinctly raised, and orifice of the glottis con¬ tracted by two soft and cedematous lateral tumours. Re¬ spiration more embarrassed. Night restless. The patient, his intellect unimpaired, urgently entreated for relief by an operation. The small frequent pulse, hoarse and interrupted voice, difficult inspiration, and profuse sweats, were consi¬ dered as contra-indicating tracheotomy. Before an elastic gum tube could be introduced into the larynx, the man ex¬ pired. During the whole disease, the countenance had pie- served its natural paleness, and, notwithstanding the difficulty of respiration, was neither red nor swollen ; nor had the epileptic paroxysm, previously frequent, ever recurred. Repeated local blood-letting, counter-irritants, emetics, pur¬ gatives, pectorals, and topical application to the throat of sulphuret of potash in honey, constituted the treatment.

- — Dissection , forty-eight hours after death. Parts surrounding the larynx healthy. Membranous bands, extending from

* One of these venous concretions, we should mention, found by John in an uterine vessel, consisted of equal parts of phosphate of lime and a membranous substance, a little carbonate of lime, and some traces of other salts. It weighed two grains ; was of the volume of a pea; surrounded by a thin membrane; of a yellowish white colour externally ; internally, chalk-like; formed round; of a bony hardness; fracture shining ; composed of concentric layers, separated from each other by a yellowish white membrane.

t Bulletin de l’Athenee de Mhdecine de Pans. Seance du 18 Noveinbre, 1819- A description of this disease was first published in 1815, at Paris, by Dr. Thuilier, in a thesis entitled, Essai sur PAngine Laryngee (Edemateuse. An excellent memoir on the same subject, by Bayle, was also analyzed in the Repository, Vol. NI. p. 320.

158 Foreign Medical Science and Literature

epiglottis to the base of the arytenoid cartilages, whitish, soft, and tumefied by infiltration of serum in their cellular struc¬ ture. Superior aperture of larynx capable of admitting the little finger. A small abscess, with pus issuing from its orifice, situated at the inferior and posterior part of the cricoid cartilage, between the perichondrium and cartilage, which was consequently denuded, hut neither ossified nor otherwise changed. No trace of inflammation in the larynx or trachea. Lungs and abdominal organs sound, except some decided patches of redness here and there in the in¬ testines, and enlargement of some of the mesenteric glands’:

Dr. Patissier, author of this case, describes, as the charac¬ teristic symptoms of oedematous laryngeal angina, extreme difficulty of inspiration, expiration continuing free ; and the existence of a soft tumour, accessible to the finger, around the riina glottidis. Some Physicians have questioned the practicability of acquiring the latter sign, but incorrec tly, as the preceding history serves to show; for it should be re¬ collected, that in this disease the superior part of the larynx is, by its tumefaction, actually brought nearer to the mouth than in the natural state; and that in the act of vomiting, induced bv the introduction of the examinant’s finger into the throat, the pharynx, and consequently the larynx, with which it is united, are considerably elevated, and great facility thus given to the exploratory process.

In this instance, the angina appears to the author to have been consequent on the affection of the cricoid cartilage. An abscess, irom the same cause as that which produced the others in various parts, had probably been developed about this cartilage; and its presence induced an irritation about the glottis, from which exhalation of serum into its mem¬ branous folds had resulted.

After noticing the manner in which the difficulty of in¬ spiration attendant on laryngeal angina is produced, and the unobstructed state of the glottis in persons who have been destroyed by it, the author finally observes, “ Such is the astonishment of Bayle at this latter circumstance, that, in order to account for the fatal event, he gratuitously supposes that the lungs are stricken with a spasm, which prevents them from undergoing the necessary changes ; so that, al¬ though continuing to dilate and contract, their functions cease. This opinion, however, is destitute of proof, and of course hypothetical. And if, when the disease has attained a certain stage, the lungs be inadequate to the performance of their functions, of what utility can prove the operation of laryngotomy, so judiciously proposed by Bayle, with a view of obviating the consequences of an obliterated glottis A

Case of Rupture of the Uterus. \*,g

IV. Case of Rupture of the Hepatic Artery*. On the morning of April 29, 1819, Dr. Taxil, St. Vincent, was called to a criminal who had been found dead. Subject, a healthy but intemperate man, aged 50. No external appearance indicated the infliction of violence. Two inguinal hernise of long duration, were soft and reducible. — Dissection. Cranium. Extensive inflammation f between the arachnoid and pia mater of the base and external surface of the right cerebral hemisphere. Thoracic viscera sound; intestines healthy; but an enormous collection of blood, part coagulated and part fluid, extravasated deeply amid their central convolutions bel ow the lesser lobe of the liver and the stomach, and behind the vertebral border of the transverse mesocolon and mesentery. It was found to have issued from a recent rupture of the hepatic artery, in three different places, a little beyond the origin of the gastro-epiploica dextra. All the coats of the artery, otherwise apparently sound, were lacerated. On re¬ moval and dissection of some inches of the vessel, it was found, that besides the three ruptures before mentioned, which were regular, and of the diameter of about a dine, the internal and middle coats of the artery were in several places trans¬ versely and widely slit and cracked; the cellular (external) coat remaining unaltered.

It appeared that the man, a short time before death, in descending hastily from a high bed upon the floor, had fixed his arms to a solid body, and thrown himself forcibly back. To this violent and sudden extension of the trunk the fatal event could alone be attributed. There apparently existed no internal vice or morbid disposition which might favour such an accident. Ruptures of this description excite the more surprise, as they occur in the largest of the visceral cavities, and upon a short flexile artery placed amid soft and humid parts, and especially near the centre of the movements of the trunk.

MIDWIFERY.

V. Case of Rupture of the Uterus , terminating favourably — On the 1st of Sept., 1817, a delicate female, aged thirty- three, was attacked with labour pains of her fourth pregnancy. A slight obliquity of the head, at the superior aperture of the pelvis, offering some resistance; the uterus, probably injured by a fall which had been sustained a fortnight before, gave way transversely to the fundus; and the foetus, with its

* Journal Universal des Sciences M4dicales. Mai, 1820.

t This, we conceive, from the adjective, sanguine , appended to it, is a misprint for injiltration. — For. Editor.

I Journal Complementaire du Dictionnaire, &c. Decembre, 181.9.

160

Foreign Medical Science and Literature .

appendages, passed into the abdominal cavity. From the piercing shriek of the woman, the accoucheur (M. Bernard) suspected the accident, which was instantly recognizable by the vacuity of the uterus, the form of the abdomen, through the parietes of which the projection of the child’s body might be distinguished, and the cessation of the regular pains, suc¬ ceeded by others of a different description. Gastrotomy was determined on as the only resource. Twelve hours elapsed ere MM. Latouche and Josset, who were summoned in con¬ sultation, could arrive. The introduction of the hand now impeded by the contracted state of the uterus, indicated, in addition to the other signs, the existence and direction of the rupture. The operation was performed on the linea alba, between the umbilicus and pubis. The child was found dead; and there was considerable extravasation of blood, mixed with the fluid of the amnios. The intestines were inflamed, and some of them had a slate colour, consequent on long- pressure. The borders of the wound were retained in accurate contact by the twisted suture, lateral compresses, and body bandage. Antiseptics in potion and in injection, combined with camphorated spirit, as also in fomentation, were pre¬ scribed. After six weeks, tlie wounds were cicatrized ; but an inflammatory tumour below and on one side of the um¬ bilicus then supervened, and under the application of emol¬ lient cataplasms, suppurated. From that period the woman gradually improved, and a fortnight after was completely well.

MEDICAL JURISPRUDENCE.

VI. Cases of Poisoning by Sulphuric Acid*. — First Case. Jn May, 1819, Dr. Willudovius was called on to inspect juri¬ dically the body of a woman who had died under suspicious circumstances. She had long been in a dejected state; and on the day of her death, being missed from the house, was after long search found in an out-building. She was in a posture indicating spasm* concealed her sufferings; but at length confessed that she had pain in the abdomen. With some difficulty she was put to bed. Her limbs were cold, and countenance death pale. The case was treated by the Surgeon as colic, till the woman acknowledged that she had swallowed a large quantity of sulphuric acid. Milk was now with difficulty poured into the stomach, the mouth smeared with almond-oil, and tincture of valerian and castor ad¬ ministered; but in vain. The woman died two hours after she had been missed from the house. She was of the middle size, and aged about thirty. — Dissection,' on the following day.

* Journal der Practise hen Ileilkunde, September, ISlffi

161

Cases of Poisoning by Sulphuru Acid.

Exterior. Body without fcetor. Two scald-like streaks ex¬ tending from the angles of the mouth towards the chin. — Cranium. Integuments and membranes sound. Substance of brain firmer than natural, and cutting like coagulated albumen. Uery little fluid in the ventricles. Plexus eho- roides, and other blood-vessels, little distended. Internal surface of the cheeks, the gums, lips, and tongue, white; the epidermis shrivelled, and in some places abraded. — Thorax . Lungs sound, excepting adhesion of the right. Brown colour of their external surface extending two lines into their substance, and then gradually changing into a bright cinnaber-red, which continued throughout. The brown ex¬ terior cutting like leather: interior naturally, and little loaded with blood. Pericardium healthy. Both ventricles of the heart quite empty ; parietes of left unusually thin. The blood of the large thoracic vessels blackish and partly coagulated. The oesophagus, in its whole circumference and length, in¬ ternally whitish; and the shrivelled epidermis but loosely connected with the subjacent muscles. Diaphragm brownish, very soft, and in some places much corroded.— -Abdomen, Omentum nearly destroyed. The stomach of a dirty brown colour, tore on the slightest touch: contained fluid of a sourish and somewhat cadaverous smell, and brown colour, and mixed with white caseous matter, and blackish coagu¬ lated blood.

This fluid was passed through filtering paper, and then imparted a red colour to litmus paper. A solution of muriate of barytes dropped into another portion, produced a white precipitate, which was! wholly soluble in pure nitric acid; and hence sulphate of barytes. To a third portion was added a solution of nitrate of lead : from this immediately resulted a white precipitate, again soluble in the supernatant liquid. Consequently, as demonstrating sulphate of lead, it confirmed the evidence of the first experiment; and clearly proved the presence of sulphuric acid in the con¬ tents of the stomach.

The coats of the organ itself were scarcely recognizable ; in some places very thick, with coagulated blood extrava sated between them ; in others, dark brown much corroded, exhibiting, as it were, gangrenous spots; and their whole substance extremely soft and lacerable. The internal mem¬ brane of the small intestines shrivelled, and the valvulas conniventes projecting one on the other, so as to close the whole canal. The mucous coat of the large intestine also white and wrinkled up, but otherwise unaltered. Pancreas sound. Liver externally discoloured ; every where very firm and compact: its external surface cutting like leather to the

VO La XIV. — NO, 80. Y

162

Foreign Medical Science and Literature.

depth of some lines, and of a brown colour; internal structure bright red. Gall bladder, its membranes considerably thickened, containing a thin and almost colourless fluid*, and bright yellow bile strongly adherent to the blood-vessels, which projected on its internal surface. Spleen firmer than natural, and resembling, on incision, the liver. The kidneys, except that they presented a leather-like surface, unaltered. Urinary bladder empty. The unimpregnated uterus very Arm, and cut with difficulty.

The comments of the author on the preceding facts, more diffuse than interesting, our limits will not allow us to retrace.

Second Case.' — In August 1816, a calico printer, aged fifty-six, drank, by mistake for brandy, a considerable quan¬ tity of concentrated sulphuric acid. Every effort to relieve him was unavailing. He sunk exhausted, two months afterwards. The following: were the results of the dissection. October 4th. — Exterior. Body so emaciated, that the cellular membrane, in the intervals of the muscles, appeared quite empty, and the muscles themselves projected distinctly beneath the skin. The bones, with all their prominences, perfectly visible. The teeth firm ; gums of a pale blue colour; tongue yellowish-white; nostrils dry, and widely dilated. The belly so sunk in, that its parietes seemed completely drawn together, and the navel to rest upon the spine. Anus closed. Livid specks observed on the inguinal region only. No trace of external injury. — Abdo¬ men. Adipose substance completely absorbed. Omentum, merely a delicate transparent membrane, interwoven with vessels. Liver uncommonly small, of a dark brown-red colour. Gall-bladder distended with bile. Spleen of a bright blue or lead colour. Transverse colon low down ; and greatest portion of the small intestines deeper than usual in the pelvis. All the parts in the vicinity of the gall¬ bladder, the peritonaeum, and muscles, of a dark-brown colour. No traces of inflammation. The stomach was so contracted as to measure but five inches long and three deep. Its membranes everywhere, but especially in the vicinity of the cardia and pylorus, considerably thickened ; the orifice of the latter scarcely four lines wide, but its cir¬ cumference thickened, and of cartilaginous hardness. On the villous coat of the organ, and near the pylorus, several small, red, firm, granulated spots, with elevated margins, which had the aspect of incipient carcinoma, and evidently

* The author supposes the bile to have been precipitated from the fluid upon the parietes of the gall-bladder.

Meissner on S elm dil line .

163

indicated the operation of a corrosive fluid. In the pylorus itself, cardia, and great curvature of the stomach, similar spots; but those in the two latter situations smaller, and less red. One in the fundus of the organ, of a greenish-blue colour, and two inches in circumference, exhibiting several small vessels much gorged with blood. A bluish patch on the external surface corresponding to it. Ail the con¬ sequences of chronic inflammation. The duodenum in the same state as the stomach, but more strongly marked the nearer it approached that organ. The villous coat of the small intestines exhibiting very firm wrinkles, disposed in rows. Membranes of jejunum and inferior portion of ileum extenuated; their blood-vessels, as it were, injected, and villous coat much wrinkled. Large intestine displaying these changes in the slightest degree, and containing some bright-yellow excrement. Kidneys firm and small. Bladder empty and contracted. Gall-bladder affording a consider¬ able quantity of dark-green thick bile. — Thorax . Lungs collapsed, marbled with red and blue. Pericardium very firm, and containing a quantity of fluid. Heart large; little blood in the ventricles, especially the left. Auricles empty. (Esophagus thickened, but without inflammation or corrosion. — Cranium . Clear lymph beneath the dura mater, diffused over the whole brain. The same, coagulated, beneath the tunica arachnoidea, and all the cerebral vessels much gorged. Small quantity of fluid in the lateral ventricles. Basis of brain natural.

CHEMISTRY.

VII. On Sebadilline, a new ( vegetable ) Alkali #. — Dr. Meissner has obtained from cevadiila, or Indian caustic barley, (r eratrum sabbadilla ,) a new alkali, to which he has given the name of sebadillium ( sebadilline ). It is contained in the epidermis of the long blackish-coloured seed of the plant, and exists in the proportion of about half per cent, combined with an acid which bears a strong analogy to the malic.

Th is alkali is prepared by making, wdth moderately strong alcohol, a tincture of the seeds. On evaporation there remains a resinous matter, which is to be rubbed down with water. To this brown liquid, when filtered, sub-carbonate of potash is added, till there is no longer any precipitation. The precipitated matter is then washed in water till the fluid passes colourless, and is afterwards dried.

This substance is of a (somewhat dead) white colour,

* Journal de Pharmacie, Mai 1820.

?■

164 Foreign Medical Science and Literature .

inodorous, and has a very pungent taste. Introduced into the nostrils, it acts as a violent sternutory. It restores the blue colour of reddened litmus paper. It is a little soluble in water, but perfectly so in alcohol.

Thus there are now at least seven new alkalis : morphine, strychnine, delphine, atropine, daphnine, daturine, and sebadilline. It is probable that the list will still increase till Chemists have recognised, in these apparently different sub¬ stances, a common base.

BOTANY.

VIII. New Febrifuge Plant*.* — In the Madrid Gazette, under the date of June 25, 1819* is announced a new febrifuge plant, known to the Indians of Quito, by the name of chinininka (pronounced as chinininga). it is a shrub of a new genus. Dr. Joseph Pavon has named it unanuea febn- fuga , and presented it to the Academy of Sciences of Madrid. Some experiments have already been made upon it in inter¬ mittent fever; and several well-known Physicians have obtained great success from giving a scruple of the root, In powder, every three hours. The dose is afterwards raised to half a dram ; and by this mean, the febrile paroxysms, which had resisted even the cinchona, have been prevented.

FOREIGN REVIEW.

Joseph Hodgson, von den Krankheiten der Arterien mid Venenj mit Besonderer Rucksicht auf Entwicklung mid Behandlung der Anevrysmen mid Arterienwunden . Aus dem Englischen ubersetzt , und mit Dr. Kreysig's soicohl ah mit eigenen Anmerkungeny herausgegeben von Dr. Franz Adolph Koberwein, fyc. Mit drei Kupfertafeln . 8vo. pp. 609* Hannover, 1817.

Trait e des Maladies des ArUres et des Veines. Par Joseph H odgson, Membre du College Royal des Chirurgiens, et de la Societe Medico-Chirurgicale, de Londres ; Cor- respondant de la Societe de la Faculte de Medecine de Paris, de la Societe Medicate d’Emulation de la meme Vi lie. See. Traduit de l’Anglais et augmente d’un grand nombre des Notes. Par Gilbert Breschet, Docteur en Medecine, Prosecteur a la Facultd de Medecine de Paris, &c. Deux Volumes. 8vo. pp. 416 — 595. Paris, 1819.

* Journal Universe!, &c. Mai 1S20, — Journal de Pharmacies Fevrier 1820.

Hodgson’s Treatise on Arteries and Ferns. 3 05

A Treatise on Diseases of Arteries and Veins, fyc. % Joseph Hodgson. 8vo. London, 1815.

To d escribe the nature and constitution, or descant upon the value of Mr. Hodgson’s work, to the readers of this Journal, would surely be superfluous. Five years have now elapsed since its first publication ; and it would be a reflection on the professional character and understanding of an English Practitioner to suppose that he yet remains unacquainted with a production, wherein is concentrated the whole of the important knowledge then acquired on the pathology of the arterial and venous systems, which has found its way wherever the medical literature of Britain is known, and been eulogized, and quoted, or translated, in every country where there vvere men possessed of the intellect to ap¬ preciate, and the liberality to do justice to its valued.

The German translation of Mr. Hodgson's work, is the production of Dr. Koberwein. Some notes are added to it, both by himself and by Dr. Kreysig, the elaborate and voluminous monograph on diseases of the heart ; but they are neither numerous nor important. The translation is remarkably literal, and, with the exception of some verbal errors, evidently arising from defective acquaintance with the niceties of the English language, particularly in his epithets, tolerably correct. It is illustrated with copies of three of Mr. Hodgson’s engravings, (the first, fourth, and seventh). In beauty and expression, they are greatly inferior to the originals.

Dr. Bresehet, who, if we may be allowed to form an opinion from his character and productions, promises to be one of the best and most indefatigable writers on medicine that France at present boasts, is author of the second transla-

* A very young or obscure French writer, named Begin, (during a long and tolerably extensive acquaintance With foreign medicine, we scarcely recollect to have noticed such a man,) in concluding a review of Dr. Breschet’s theses, regrets that an author, so gifted, should prostitute his time and talents to the translation of English books. (Journal Universel des Sciences Medicales, tom. xvi. p. 1 QJi) Who this arrogant M. Begin maybe, we know not; but we think that he might spend his time far more creditably and advantageously in cultivating a knowledge of English literature, than in penning stupid criticisms, or sneering at the productions of a country with which his illiberal contempt sufficiently indicates that he is wholly unacquainted ; for ignorance is in general the associate of illiberality. When M. Begin shall have produced a work fit to occupy the same shelf with Mr. Hodgson’s, there are, we can assure him, many able writers among us who would not consider the labour of its translation a degradation or disgrace. — Rev.

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Medical and Physical Intelligence .

tion, announced at the head of this article. It is executed with great fidelity, ease, and spirit, and honourable alike to the zeal and attainments of Dr. Breschet., The notes with which it is accompanied are very numerous, and, in general, valuable.

The preceding slight notice, which we wish to be con- sidered, (and which in fact really is) rather a contribution to the literary history of a most interesting department of pathologi¬ cal anatomy, than a critical review of the foreign trans¬ lations in question, we possess not the leisure at present to extend farther. On some future occasion, we propose to condense into a second article all that is novel or im¬ portant in the notes of their respective authors. We shall probably have, at the same time, to include those of an Italian translation, which, if our information be correct, has actually made, or is about to make its appearance.

Respecting haemorrhoidal affections, some omission or defect has been adverted to by the reviewers of this Journal^, as existing in the work of Mr. Hodgson. We have no doubt that in a second edition the deficiency will be fully and ably supplied. The mode of formation of the hemor¬ rhoidal tumour has been hitherto very imperfectly under¬ stood ; nor have its connexion with the state of the internal organs, and the practical indications which it is frequently calculated to suggest, been explored or followed in a manner at all adequate to the importance of the subject. Some very clear views on the anatomy of the region occupied by haemor¬ rhoids, and of the process by which they are developed, will be found in the foreign department of our present Number; and on their pathology and treatment, the work of the lamented Montegref, an analysis of which we are engaged in preparing, will afford our readers all the information hitherto accumulated respecting them.

* Repository, Vol. V. p. 502.

+ Des Hemorrhoides, ou Traite Analytique de toutes les Affections Hemorrhoidales. Paris, 181 £>.

PART V ;

MEDICAL AND PHYSICAL INTE LLIGENC E.

I

LITERARY NOTICES.

Mr. Josh. Swan, Surgeon to the Lincoln County Hospital, has in the press, a Dissertation on the Treatment of Morbid Local Affections of Nerves, to which the Jacksonian Prize of the College of Surgeons was adjudged.

167

Medical and Physical Intelligence.

Shortly will be published, Outlines on Midwifery, developing its Prin¬ ciples and Practice. By J. T. Conquest, M.D., F.L.S.

A Translation of Duval on the Teeth, with Notes. By John Atkinson, Surgeon-Dentist. In the Press.

A Compendium of British Ornithology, with References to the Anatomy and Physiology of Birds. By John Atkinson, P.L.S., Surgeon. In the Press.

M. Rouzet, Editor of the Revue Medicale, desires us to announce, that such English authors as may wish to have their publications known in France, have only to send them to M. Rouzet, Editeur de la Revue Medicale, a Paris, under cover, to Mr. Cuthell, Bookseller, addressed to Theophibus Barrois, Bookseller, at Paris.

Annual Report of the Associated Apothecaries and Surgeon- Apothe¬ caries of England and Wales, held at the Crown and Anchor Tavern , Strand, London, June 21, 1820. James Parkinson, Esq. President.

* The Committee has the honour of laying its Annual Report before the General Meeting of the Association.

No particular circumstance has occurred during the past year, demanding immediate exertions, yet has your Committee not been inactive.

The great object which the Association hopes one day to see obtained, namely, a legal enactment, by which the health of the public will be guarded against the manifold evils w hich daily arise from the practice of uneducated, and therefore unqualified, persons, has been duly and con¬ stantly kept in view.

The Committee is much gratified in being able to state, that the code of rules and regulations, which was sanctioned by the last Anunal General Meeting, has been distributed throughout the country : and that district committees are forming in different parts, with the certainty of their being ultimately very advantageous. In Staffordshire, for instance, not only have the regulations, recommended for securing the necessary intercourse with the metropolitan committee, been carried into effect with zeal and promp¬ titude, but a most beneficial measure has resulted, a medical and surgical library has been established, for the use of the members of the Association who reside in that district, of' which Wolverhampton may be considered the centre. The Committee hopes to see this excellent mode of inducing medical men thus to associate with each other, acted upon in other districts, as it cannot fail to promote useful discussion, and extend professional knowledge.

The Committee must here express the satisfaction it feels at the great exertions which have been made by the Society of Apothecaries, in carrying into active operation the powers intrusted to them by the Legislature. In the before-mentioned county of Stafford a resolute stand has been made against empiricism; and the Committee learns with satisfaction, that there are other cases still pending, which will serve to show the energy evinced by the Society of Apothecaries, in protecting the just rights of the legalized medical Practitioner ; in a very short time these circumstances will become more manifest, as the many obstacles by which the operations of that act have been too frequently impeded and evaded, will be done away.

The rejection of the Surgeons’ act in the late session of parliament, at the same time that it must have disgusted the Royal College of Surgeons, by the very unfair, and even unjust manner, in which it w'as opposed and thrown out, has had the unhappy effect of showing more clearly to irregular

168

Medical and Physical Intelligence .

Practitioners, how little power the Royal C oiiege of Surgeons possesses over those who practise Surgery in this country.

Under these circumstances, although the practice has been hereby left in a much worse state than before, yet the Association cannot expect that the Royal College of Surgeons will apply to parliament again for some time to come ; and therefore, the Committee has most anxiously sought for some new channel, through which it may obtain, for society, a proper guarantee, that ignorant persons shall be prevented, by a positive law, from the practice of Surgery, and more especially of Midwifery ; but it has hitherto sought in vain. Indeed, as your Committee has been led to conclude, that the desired legal enactments have not been obtained, only because neither the public nor the houses of parliament are yet sufficiently aware of the necessity of the measure, it has of course, for the present, abandoned every idea ol recommending this Association to go before parliament with a bill for amending the practice of Surgery and Midwifery ; but has principally turned its thoughts towards the best mode of laying before the public such proots of the evils which necessarily result from the present system, as must render the necessity of parliamentary influence abundantly manifest.

It is with great pleasure the Committee learns, that “ A Series of Letters, addressed to the President of the Associated Apothecaries and Surgeon- Apothecaries of England and Wales, on the present state of the Practice of Physic and Surgery/’ 1ms been published. The hrst series is intended to give a comparative view of particular systems of medical education, to con¬ sider the separation of medicine from surgery, to estimate the claims of the general Practitioner, and to propose a more respectable mode of remune¬ rating his attendance. The Committee learns this with satisfaction, be¬ cause it is sure that good will result from laying the present state of medical practice before the public, for their consideration in every possible manner.

That the public are not fully sensible of the varied and precise knowledge which is required before any person can honourably, or even safely practise the art of Medicine, is perfectly clear ; but that the higher classes of society are even still more uninformed of the gross ignorance which pervades the mass of irregular Practitioners, has been forced upon the notice of the Committee by abundant evidence. This is not, however, unnatural; for the higher classes have but little intercourse with medical men, except with Physicians, or with those general Practitioners whose varied and extensive knowledge, and whose medical acquirements constitute them Physicians in every thing but the name.

Urged by these considerations, the Committee has therefore to recom¬ mend, that it be an instruction to future committees to bring the subject into ^general notice by all possible means; that the country members be urged to collect, through the medium of the district committees, such facts as may fairly display the mischief which results from uninformed Practi¬ tioners, and may supply a body of evidence ready to be adduced whenever the measure of petitioning is adopted ; and especially that, early in the next session, a petition be presented to each house of parliament, praying its interposition, and stating fully the grounds upon which the Association believes that some legislative enactment is absolutely necessary.

Upon the same principle also, of giving publicity to the claims and the present situation of the general Practitioner, the Committee further recom¬ mends the formation of some plan, by which the members of the Association shall have an opportunity of vindicating their own respectability, and of marking as perfectly as it may be done, the line between the scientific and the empirical Practitioner.

To do this the more perfectly, the Committee proposes, that an invitation be given to the members of the Association, and indeed to all other members of the medical Profession, to transmit to the Committee, for

Medical and Physical Intelligence .

169

publication, some portions of that knowledge which must have resulted from their extensive practice and abundant experience. In this way the Com¬ mittee hopes to be enabled to publish, at short intervals, volumes of medical and surgical transactions, which will demonstrate how well the general Practitioner deserves the legal sanction which he claims for himself and for the public ; and to stimulate him to improve himself further in the God-like art of relieving the countless miseries of a sick bed. The Com¬ mittee feels that these are only silent labours ; but it is at the same time convinced that the Association will gain its object as certainly and as quickly by such means, as if it endangered the existence of its small funds by taking more apparently active measures before the time arrives when such measures may be attended with success.

In conclusion, the Committee cheerfully commits itself to the kind con¬ sideration of the Association, regretting only, that its ability to protect the community at large, and to benefit its own respected Profession, is so dis¬ proportionate to its wishes and its zeal.

The state of the funds of the Association being reported by the Treasurers, (see page 171,)

The following Resolutions were then carried unanimously : —

1. Resolved, That the report now read be received and adopted.

2. Resolved, That a book be prepared and printed containing the present report, the rules of this Association, and a list of the members; which book may be obtained by any member who applies for it to the Secretary in any mode which will not subject the Association to expense.

3. Resolved, That the grateful acknowledgments of this Association be given to James Parkinson, Esq. for the great ability, the indefatigable attention, and unabated zeal, with which he has, during the last three years, conducted himself in the office of President, and that he be requested to continue in that situation.

This meeting having heard, with unfeigned regret, the intention of James Parkinson, Esq. not to accept the office of President of the Association for the ensuing year, after having filled it for three successive years in a manner wffiich has called for and obtained the thanks of this Association — -it was

4. Resolved, That Joseph Hayes, Esq. be elected to the office of President of this Association, vice James Parkinson, Esq. resigned.

5. Resolved, That Joseph Hayes, Esq. and Arthur Tegart, Esq. be requested to accept the best thanks of the Association, for their zealous services as Vice-Presidents during the last year.

b. Resolved, That the thanks of the Association be given to the Treasurers for their past services, and that their continuance in office be requested.

7. Resolved, That the thanks of this Association be given to the General Committee, for their very able report, and for their great attention to the concerns of the Association.

8. Resolved, That the best thanks of the Association be presented to the secretary, John Powell, Esq. for the readiness and ability with which he has fulfilled the greatly extended duties of his situation during the last year.

9. Resolved, That Arthur Tegart and C. T. Haden, Esqrs. be Vice- Presidents of this Association for the year ensuing.

No regular order having been observed in placing the names of the General Committee, but it being specified in Article 4. Section 5. that half of each class shall go out every year by rotation, such members nevertheless being eligible for re-election,” the Committee, to avoid the difficulty which now presents fitself, suggests that such gentlemen shall be fixed upon to go out as favoured the Committee with their attendance, during the last year, the least frequently. This proposal having met with the approbation of the meeting, it was

VOL. XIV.— NO. 80. Z

170

Medical and Physical Intelligence .

10. Resolved, That the arrangements of the General Committee re¬ specting the formation of Committees for the year ensuing, be adopted.

The members of the Apothecaries’ Society who have attended least frequently, being

R S. Wells, Esq. R. M. Kerrison, Esq.

M. Bowman, Esq. John Cates, Esq.

C. Shillito, Esq. T. Graham, Esq.

And the members who do not belong to the Apothecaries’ Society who have attended least frequently, being

R. Ogle, Esq. A. T. Thompson, Esq.

P. Fernandez, Esq. Lewis Leese, Esq.

R. James, Esq. T. Rodd, Esq.

C. T. Haden being elected Vice-President, it was

11. Resolved, That

R. S. Wells, Esq. Edward Brown, Esq.

Henry Field, Esq. Thomas Parrot, Esq.

Jos. Hurlock, Esq. Charles? Shillito, Esq.

belonging to the Apothecaries’ Society, and that

James Parkinson, Esq. Nodes Dickenson, Esq.

Thomas Alcock, Esq. Robert James, Esq.

George R. Rodd, Esq. Lewis Leese, Esq.

Thomas Morrah, Esq.

Non-members of the Apothecaries’ Society, be elected to fill the vacancies of the General Committee for the year ensuing.

12. Resolved, That the day of the annual meeting and anniversary dinner be changed to the first Wednesday in July; the hour of meeting to be three o’clock instead of two ; and that of the dinner to be six o’clock instead of five.

13. Resolved, That the General Meeting most earnestly recommend to the members of this Association who reside in the country, the imitation of the Staffordshire district committees, in the establishment of medical and surgical libraries, in such central situations as may appear most likely to be beneficial to the members resident in such districts.

14. Resolved, That the General Meeting feel themselves called upon to express very strongly the grateful sense they entertain of the benefits which have resulted to the public, and to the medical Profession, from the zealous and active exertions that have been made by the Society of Apothe¬ caries, in carrying the Apothecaries’ act into efficient operation.

15. Resolved, That the General Meeting do recommend to the General Committee, to take into their consideration, at a future meeting, the present mode employed by the chemists and druggists, of acting as apothecaries, and even visiting patients, under the supposed sanction of Clause 28, (vide Apothecaries’ act,) in opposition both to the spirit and principle of that act, passed in the year 1815, for the regulation of the practice of apothe¬ caries, &c. &'c.

1G. Resolved, That the attention of the Committee be directed to the propriety of presenting a petition to each house of parliament, to take into their most serious consideration the deplorable manner in which the health and lives of the community are hazarded, by the want of a proper legal control over illiterate and unqualified persons practising surgery and midwifery.

17. Resolved, That the members resident in the country be urged to collect, through the medium of district committees, such facts as may more fully display the mischiefs which result from the practice of uninformed and ignorant persons, and may supply a body of evidence, ready to he adduced whenever a new application shall be made to parliament.

18. Resolved, That the Committee he directed to take the necessary measures lor inviting the members of the Association, and all other

%

Medical and Physical Intelligence.

O

members of the medical- Profession, to transmit to them papers on medical and surgical subjects, for publication in occasional volumes, to be entitled u 1 transactions oi the Associated Apothecaries and Surgeon- Apothecaries of England and Wales or such other title as the Committee mav hereafter approve.

19. Resolved, That the Editors of the London Medical Repository, and London Medico-Ciiirurgical Review, be respectfully requested to insert the Report, &c. now adopted, in their respective valuable publications.

20. Resolved, That the General Committee be directed to lay the objects ol the Association before the public in all possible ways.

June 21, 1820.

JOSEPH HAYES, President

FUNDS.

Statement of Account from July 21, 1819, to June 21, 1820.

1819. Dr. £. s. d.

July 23. To Mr. Powell,

the Secretary, for sundries and sa¬ lary to June 24,

1819 . 37 6 0

Dec. 29. For advertise¬ ments . 16 19 6

Sundries to Mr. Parkinson, au¬ dited July 21,

1819, but not drawn . . ° 3 12 6

1820.

June 21. To Mr. Powell, for sundries and ad¬ vertisements to June 21, 1820 13 0 3

£10 18 3

1819.	Cr.	£•	s.	do
	By Balance in the
	bankers’ hands '124	6	d
1820.
Feb. 19.	Subscriptions
	through J. Up¬
	ton, Esq. • • • •	23	2	0
June 14.	One year’s divi¬
	dend of ^£’500
	3 per cents • • • •	15	0	0
June 21.	Subscriptions

through Mr.

Powell ••••••«• 8 7 0

170 15 0 70 18 3

Balance in bankers’ hands, £99 16 0

3 per Cents £500.

We have audited this account, and $ C. T. Haden,

find it correct, June 21, 1820. \ E. Leese.

Officers 6f the Associated Apothecaries and Surgeon- Apothecaries for

the Year 1820.

President. — Joseph Hayes, Esq.

Vice-Presidents. — Arthur Tegart, Esq. ; C. T. Haden, Esq. Treasurers. — James Parkinson, Esq.; James Upton, Esq.; John Hunter, Esq.

General Committee. — Members who belong to the Society of Apothe¬ caries : — James Upton, Esq.; John Hunter, Esq.; Janies Seaton, Esq.; Walter Drew, Esq.; Wentworth Malim, Esq.; William Hillman, Esq.; R. S. Wells, Esq.; Henry Field, Esq.; Edward Browne, Esq.; Joseph Huriock, Esq.; Charles Sliillito, Esq.; John Parrott, Esq.

Members who do not belong to the Society of Apothecaries : — ’William Acret, Esq. ; George Fin chain, Esq. ; Thomas Hurst, Esq.; Neville Wells, Esq. ; Edward Leese, Esq. ; Lewis Leese, FJsq. ; James Parkinson, Esq. ; Nodes Dickenson, Esq. ; Thomas Alcock, Esq.; George R. Rodd, Esq. ; R, James, Esq. ; Thomas Morrah, Esq.

Bankers. — Messrs. Gosling and Sharp, Fleet Street.

Secretary. — John Powell, 6.2, Newman Street.

173

A METEOROLOGICAL TABLE, From 21 st of JUNE to 20 th of JULY, 1820, KEPT AT RICHMOND, YORKSHIRE.

D.	Baron Max.	meter. Min.	The Max	rra, Min.	Rain Gauge.	Winds.	Weather.
21	29	66	29	64	70	48		NW.E.	13 Sun... 2 Rain. 4 Moon..
22	29	66	29	64	73	56	(	E.SW..	1 Cloud... 2 Sun..
23	29	81	29	81	67	45		SW..JE.SW.	1 Cloud.. 3 Sun.. 4Moon...
24	29	94	29	93	79	55		E.SW..	1 Sun....
23	30	03	30	02	84	53		sw.	1 Sun...,
26	30	09	30	06	83	62		WSW.WNW.	1 Sun....
27	30	06	30	01	84	56		WbN,	1 Sun....
28	29	99	29	88	78	59	02	NE.	13 Sun.... 2 Sun.. 4 Rain.
29	29	81	29	77	78	53	05	SE.NE.	1 Cloud... 4 Rain.
30	29	90	29	87	59	42	01	NE.	1 Rain. 2Cloud...4Starl....
1	29	90	29	76	69	47		NW.NE.	1 Sun... 4 Cloud..
2	29	67	29	04	70	48	41	W.WNW..	14 Rain ... 23 Sun...
3	29	66	29	64	67	46	11	N.	1 Cloud... 3 Rain..
4	29	79	29	77	61	42		NNW.NNE.	1 Sun.. 2 Cloud... 4 Starl...
5	29	84	29	83	69	50		NW..NE..	1 Sun..
6	29	86	29	86	72	51		NE.E.	1 Cloud... 2 Sun..
7	29	88	29	88	65	50		N.NNE.	1 Cloud...
8	29	88	29	88	67	49		N.NE.	1 Cloud...
9	29	88	29	83	75	44		NE.	1 Cloud... 2 Sun..
10	29	81	29	76	75	43		NW.SE.	1 Sun...
11	29	74	29	68	74	54		SW.E.	1 Sun... 4 Cloud...
12	29	65	29	63	77	51		E.NE.	1 Mist... 2 Sun.. 4 Cloud...
13	29	64	29	61	66	54		NE.	1 Cloud...
14	29	64	29	64	70	51		NE.	1 Cloud...
15	29	70	29	66	80	55		ENE.	1 Sun..
16	29	62	29	50	79	57		NE.SE.	1 Sun...
17	29	18	29	05	72	54	75	NE..	1 Sun.. 3 Cloud... 4 Rain....
18	29	16	29	14	75	48		Vble.	1 Sun.. 3 Thun.. & Light..
19	29	33	29	33	74	53		Vble.	1 Cloud... 2 Sun..
20	29	48	29	48	61	52	08	NE.	1 Mist... & Rain.

The quantity of rain during the month of June was 2 inches, 36-100ths.

Observations on Diseases at Richmond .

The disorders under treatment were, Abortio, Asthenia, Cephalalgia, Cynanche tonsillaris, Diarrhoea, Dyspepsia, Dysuria, Febris catarrhalis, Febris continua, Gonorrhoea, Hernia, Hydrocephalus, Lumbago, Odontalgia, Ophthalmia, Otalgia, Phthisis pulmonalis, Rubeola, Tussis, and Vertigo.

, i

A

1*7^

1 t O

T H E /M ETEOROLOGICA L JOURNAL,

i ^ Cj~

, ° Lpw 0e 20 th of JUNE to the 1 Qth of JULY , 1820,

• \v ^

By Messrs. HARRIS and Co.

Mathematical Instrument Makers t 50, High Holborn .

D	Moon	sa X' s*	Therm.	Barom.	De Luc’s Dry.	Hygrom. Damp.	Winds.
20			52	55	50	29	67	29	81		54	54	WNW	NNW
21		,08	57	58	51	29	88	29	96		54	54	WNW	N
22			66	70	48	30	06	30	08		52	55	WSW	WSW
23			63	71	60	30	15	30	16		55	56	w	w
24			66	75	64	30	21	30	25		55	52	w	E
25			70	78	66	30	30	30	34		52	52	E	SW
26			72	83	67	30	37	30	38		53	51	W	ESE
27	0		74	81	68	30	38	30	35		52	54	E	NE
28			76	81	60	30	29	30	20		51	53	W	SE
29			64	73	58	30	15	30	08		53	53	ESW	SE
30			64	68	54	29	94	30	05		54	52	ENE	ENE
1			60	63	55	30	19	30	23		52	53	NNE	NNE
2	D	,16	61	64	52	30	13	SO	02		54	54	W	NW
3		,12	58	62	53	29	93	29	90		54	53	NW	NW
4			59	62	54	29	96	30	04		52	52	NNE	NE
5			57	63	52	30	10	30	12		50	50	NE	ENE
6			58	62	54	30	14	30	14		-52	53	NNE	E
7			58	61	52	30	13	30	15		53	52	NNE	ENE
8			51	60	54	30	17	30	18		51	52	NE	NE
9			56	63	56	30	15	30	14		52	52	ENE	ESE
10			58	60	52	30	12	30	07		53	52	ESE	SE
11			60	65	53	30	04	30	01		51	53	SE	E
12			60	65	55	29	92	29	85		53	52	E	E
13			61	64	55	29	82	29	83		52	51	E	ENE
14			59	62	58	29	85	29	89		52	55	NE	ESE
15			61	70	57	29	94	29	98		59	55	ESE	SW
16			62	70	60	29	92	29	84		55	56	SE	ESE
17		,20	62	76	55	29	64	29	52		58	60	ESE	WSW
18	D	,43	58	64	55	29	46	29	44		60	59	S	WSW
19		,74	58	68	57	29	46	29	66		60	58	w	SSW

Atmo. Variation.

Rain

Fine

Fine

Fine

Fine

Fine

Fine

Fine

Fine

Fine

Clo.

Fine

Fine

Clo.

Fine

Fine

Clo.

Clo.

Clo.

Clo.

Clo.

Fine

Fine

Clo.

Clo.

Clo.

Fine

Sho.

Rain

Fine

Fine

Sho.

Sho.

Fine

Fine

Fine

Fine

Th.r.

Rain

Rain

Clo.

Rain

Clo.

Fine

Clo.

Clo.

Fine

Fine

Clo.

Clo.

The quantity of rain fallen in June is 2 inches and 8A00ths.

A REGISTER OF DISEASES Between JUNE 20 th and JULY I Qth, 1S20.

| DISEASES.	Total.
Abortio • • • . .	7
Abscessio .	15
Amenorrhoea .	3
Amentia .............	1
Anasarca* « • • * . » •	22
Aneurisma- ...........	1
Aphtha lactentium • • * •	12
Apoplexia . . . *	4
Ascites ...» .	12
Asthenia .	6
Asthma . . • * .	18
Atrophia ...» . •	4
Bronchitis chronica * ...	4
Bronchocele .	3
Calculus . . . •	2
Caligo . .	3
Cancer . . .	1
Carbun cuius • » • . . .	4
Cardialgia * .	6
Carditis .	4
Catarrh us .	26
Cephalalgia . .	34
Cephalaea ............	1
Chlorosis .	1
Chorea . Cholera . . •	5 22
	7
	8 4
J- Ci. LU tlU ill • 9 • • • • Convulsio «... . *
Cynanche Tonsillaris • ♦	15
- maligna .....	3
- - 2 rachealis • • ■ - - Tarot idea* • * •	1 1
Delirium Tremens * ...	1
Diarrhoea .	24
Dysenteria . . • •	17
Dyspepsia . .	21
Dyspnoea . . •	7
Dysphagia. • * .	1
Dysuria .............	2
Ecthyma .	2
Enteritis .	6
Entrodynia . .	1
Epilepsia ............	1
Epistaxis . .	6
Erysipelas .	4
Erythema lave • * .	2
- - - nodosum • • • •	2
Febris Intermittent • • • •	13
— - — catarrhal is . .	5

DISEASES.	O H	| Fatal.
Febris Synochus .	7
- Typhus mitior * • •	Q	1
• - Typhus grav. • • • •	1
	25
M y / l KJ C / * 11 O
- Tuerpera •••••*•	5	2
- Remit. Infant. ♦ •	10
Furuhculus . .	2
Gastrodynia ..........	Q
Gonorrhoea pura .	5
Hsematemesis .	o
Hsemoptoe* • • * . . .	7
Heemorrhois . .	9
Hemiplegia .	1
Hepatitis .	10
Hernia * . . * *	4
Herpes circinatus .	1
	2
Ill 1/ III Ho - praputialis ••••	2
Hydrocele .	2
Hydrocephalus .	6	3
Hydrothorax .	2	1
Hypochondriasis ......	1
Hysteria . . * •	9
Hysteritis . .	3
Icterus .	7
Impetigo sparsa . .	1
- - erysipel. ...»	1
	i
* 5 L l.l If l Cl II ****** Ischuria • * .	3
	s
-Ljepi d «••••»»»••»»»«•
Leucorrhoea • . .	12
Lichen simplex . * • •	2
Mania . * . .	4
Melancholia . . . .	1
Menorrhagia • . . .	19
Miliaria . .	4
Morbi Infantiles* .	44	2
	27
‘ ~ JJlllUol •••••• *
Nephritis . .	1
Obstipatio * ■•••••••••	8
Odontalgia .	11
Ophthalmia * * .	32
Otalgia . . .	4
Palpitatio * . . .	2
Paracusis . .	1
Paralysis .	8	1
Paronychia .	4
Peripneumonia .	6
Peritonitis . .	16	1
Pertussis . * .	24

Observations on Prevailing Diseases

175

DISEASES.

Phthisis Pulmonalis**

Plethora .

Pleuritis . .

Pleurodyne . ? • •

Pneumonia .

Podagra .

Porrigo favosa, .

Prolapsus • . .

Prurigo mitis • •••••••

senilis •

Psoriasis guttata

— mveterata

Purpura simplex • •

Pyrosis .

Rheuma ac.utus • • •

— - - chronic us

Rubeola .

Scabies .

Scarlatina simplex •

angmosa

w	X
O H	ce
24	5
2
16
8
26
S
3
3
2
4
2
1
1
o
28
25
26	l
69
M 8

DISEASES.

Scrofula .

Splenitis . ?••••

Strictura .

Strophulus intertinctus

Sycosis rnenti .

Syphilis .

Tabes Mesenterica • • •

Vaccinia • . . .

Varicella . ? • * •

Variola . .

Vermes .

Vertigo . .

Urticaria fehrilis .

- evanida .

- tuberosa .

Total of Cases

Total of Deaths

Q

5

2

2

2

1

15

5

29

5

14

18

14

3

1

1

1115

26

* Morbi Infantiles is meant to comprise those Disorders principally arising from den¬ tition or indigestion, and which may be too trivial to enter under any distinct head; Morbi Biliosi. such Complaints as are popularly termed bilious, but cannot be accurately classed. |

Observations on Prevailing Diseases.

One of our usual Reporters has again failed in his list, so that the number of diseases returned, being below the average, must not be con¬ sidered as a proof of the preceding months having been more than commonly healthy. It will, however, be remarked, that the proportion of fatal cases is under the ordinary ratio.

Rheumatism still continues very prevalent. When it assumes a chronic form, the Reporter has found much benefit attend the administration of half grain doses of the stramonium extract, with decoction of cinchona bark — a medicine which is too much losing ground in modern practice. The Reporter feels extremely anxious to press upon the attention of his readers the paper of Dr. Williams which appears in the present Number of the Repository ; and he will he greatly obliged by communica¬ tions respecting the effects of the col chi cum seeds , after their virtues shall have been tried.

In a private communication, hut this moment received from our Cor¬ respondent, Mr. Fosbrooke, it is stated that Dr. Baron has lately been very successful in the use of cubebs in inflammation of the villous membrane of the intestines. That remarkable fact, for fact it is, that certain inflammatory actions are more speedily subdued by the vi et armis measures of stimu¬ lating counteractives, than the more obvious and ordinary ones of depleting and sedative operation, is not perhaps duly appreciated in the pathology and therapeutics of the present day.

In thus laying before our readers the intimation contained in a private letter, we hope that we do not -offend against propriety. In the same com¬ munication it is stated that “ Dr. .Tenner, who has been some time trying ex¬ periments to remove affections of membranous surfaces by setting up coun¬ teractions on the skin, has had a remarkable case of paralytic seizure of the intestines in a gentleman, of Bristol, which dissolved like a charm, in con-

176

Notices to Correspondents ,

sequence of the infriction of tartarized antimony on the skin. He has reason to think that it has great power in modifying some of the neuroses. I am trying it now," continues Mr. Fosbrooke, “ in a case of gouty irri¬ tation of the serous membranes — a case of very extraordinary description.”

We were about to add, by way of comment on these statements, that mucous membranes are not the only ones which occasionally display a sympathetic connexion with the dermoid texture ; but our readers will be ready to say, that enough has already been advanced on this head in' the present Number of the Repository.

MONTHLY CATALOGUE OF BOOKS,

Lexicon Medicum ; or, Medical Dictionary : containing an Explanation of the Terms used in Anatomy, Physiology, Practice of Physic, Materia Medica, Chemistry, Pharmacy, Surgery, Midwifery, and the various Branches of Natural Philosophy connected with Medicine. Selected, arranged, and compiled, from the best Authors. The Fourth Edition. By Robert Hooper, M.D., &c. &c. 8vo. Price 18s.

A Dissertation on Infanticide, as it relates to Physiology and Juris¬ prudence. By William Hutchinson, M.D. 8vo, Price 5s.

A Treatise on the Derangement of the Liver, Internal Organs, and Nervous System. By James Johnson, M.D. Third Edition, revised and improved. 8vo. Price 8s. 6d.

Proposals for establishing in Edinburgh, and other Towns, a New Improved Apparatus for the Application of the Vapour of Water, Sulphur, and other Medicinal Substances, found so efficacious in the Cure of Rheu¬ matism and Diseases of the Skin. With a Paper upon the Subject, which has been submitted to the Perusal, and received the Approbation, of Dr. Hamilton, sen., Dr. Gregory, Dr. Barclay, Dr. Farquharson, and Mr. Bryce. 8vo. Price 2s.

Cases of a serious Morbid Affection, chiefly occurring after Delivery, Miscarriage, &c. By M. flail, M.D. 8vo. Price 4s.

Introductory Lecture to a Course of Botanical Lectures, Excursions, and Demonstrations, delivered in Edinburgh, by J. R. Scott, F.R.S., &c. 8vo. Price 2s.

NOTICES TO CORRESPONDENTS,

Communications have been received this month from Mr. Wansbrough, Dr. Onslow-, Mr. Sutleffe, Mr. Gaitskell, and Mr. Robarts.

We have been obliged to postpone our Rcviezc of Mr. Cross’s valuable Work on Vaccination, fyc. to the next Number , in which it will certainly appear, together with Mr. Bingham’s recently published Volume ; and , if possible, the Works of Dr. Hall and Dr. Hastings. The Retrospect will likewise be continued.

Our Correspondent who favoured us zoith the Essays on Medical Im¬ provement states his intention of speedily renewing the series.

%* Communications are requested to be addressed ( post paid) to Messrs. T. and G. UNDERWOOD, 32, Fleet Street .

t

t M

s i

THE

LONDON MEDICAL

PART I.

ORIGINAL

C O M MUNI CAT IONS.

I.-

Obstetrical Researches. By Maurice Onslow, M.D.

No. 1.

- - * —

Much uncertainty seems to prevail respecting the time at which midwifery began to be practised b}' men. It is very well known, indeed, that from the earliest periods the occasional aid of Physicians and Surgeons was required by Midwives in doubtful and dangerous cases ; but when was it that the race of Practitioners sprung up, now designated by the appellation of Men-Midwives or Accoucheurs1 i

I shall not now enter into any consideration of the question, Whether or not the Athenians decreed that no females should be permitted to practise midwifery? nor shall 1 again detail the so often related pretty story of Agnodice ; but advert more immediately to subsequent times, — more directly to what concerns ourselves.

By modern writers, the year 1663 is fixed upon as the period from which we are to date “ the first epocha of Sur¬ geons being employed on such occasions/’ it was on the 27th of December, in that year, that Madame de la Valiere, the mistress of Louis the Fourteenth, was delivered of her first child secretly, by the aid of Julian Clement, a Surgeon of reputation at Paris. The succeeding labours of this lady were not so secretly kept; but as they were all successfully terminated, u this brought Men-M idwives into repute, and put the Princesses into th e fancy of making use of Surgeons on this occasion; and as it soon became the fashion, the name VOL. xiv. — no. 81. 2 a

178

Origi nai Comm uni ca i ion $ .

o ¥ Accoucheur was invented to signify this class of Surgeons.” — Astrucs History of the Art of Midwifery .

When Philip Thicknesse began his abusive career against the Men-Midwives, it suited his purpose to make it appear, that the practice of being attended by men was of novel intro¬ duction ; that it was a fashion imported from France; and that it was first adopted by a kept woman. This statement of Astruc was therefore propagated by him as far as his means extended. The statement has since found its way into ency¬ clopaedias and books of reference, and is now generally believed.

A little inquiry would have proved to Astruc, tiiat the practice of employing men to attend women in their labour was established long before the period which he assigns. He indeed admits that f£ there were, especially in great cities, Surgeons who applied themselves to the art of midwifery, and made it their particular study, who were sent for in difficult cases, where the Midwives found their incapacity/’ But it is evident, from many passages in authors, that the Surgeons not only were prepared to give their assistance in difficult cases, but were in the habit of engaging to attend females without the intervention of a Midwife.

Louisa Bourgeois, Midwife to Mary of Medicis, queen of Henry the Fourth of France, began to practise midwifery in 1591, and in 1609 published her “ Observations Diverses,” and in i6l5 her Instructions a sa Fille,” in which she complains that women, discarding Mid wives, chose men to attend them even with their first children*. These instruc¬ tions of Madame Bourgeois to her daughter were translated into English in 1656 ; and the paragraph in question runs thus:— “ There is a great deal of artifice to be used in pleasing of our women, especially the young ones, who many times do make election of men to bring them to bed. I blush to speak of them ; for I take it to be a great piece of impu¬ dence to have any recourse to them, unless it be in a case of very great clanger.”

Guillemian, who died in 1609, published a treatise “ Be la Grossesse et Accouchement des Femmes,” in which there is a chapter specifically addressed to Surgeons, to direct them how to manage labour from its very commencement. Unless Surgeons were then in the habit of attending women in labour, when no Midwife was employed, there would have been no necessity for such counsel; for if the Surgeon was

‘£ Com me font nos jeunes femmes, qui des leur premier enfant font election d’une hornme pour ies accoucher.”

Onslow’s Obstetrical Researches. 17^

only to he called upon for assistance in difficult cases, he would not have required to be told what was to be done in the early part of the labour. This very treatise of Guillemian not only shows that he himself was in the habit of attending women in labour, as our Accoucheurs do now, but likewise that MM. Honore, Benet, Hubert, Marchand, and others, whose names he mentions, were in the same practice.

it is extraordinary, that Astruc did not advert to what Mauriceau, with whose works it is evident he was familiar, says upon this subject. In 1693, Mauriceau prepared for the press his volume of cases (Observations sur la Grossesse, &c.) ; and in the preface he tells his readers, that for more than thirty-five years he had made midwifery his particular prac¬ tice^. Of course he must have commenced practice prior to the year 1658, which is five years before the date fixed by Astruc ; and it is certain that Mauriceau was not the first professed Practitioner of midwifery: on the contrary, a very cursory perusal of his writings will demonstrate that there had existed many before his time. Of one of timse, whom he describes as the late M. Oelacuisse, he says, that he used to fall asleep while his patients were in labour, and never awoke till the child was in the passage, just ready to come into the world. This, 1 think, is sufficient to show, that in 1663 it was not a new thing for ladies to be attended in their labours by men ; but probably Astruc is correct in fixing this as the time at which the denomination Accoucheur was first adopted.

Respecting the introduction of men into this practice in England, we are told, that “ by degrees it reached this country/’ from the dissolute court of Louis the Fourteenth, after the year 1663. But that Men-M id wives, so known by name, were common in England before that period, may be proved by the following lines, intended for poetry, pre¬ fixed to “ Wolveridge’s Speculum Matricis,” published in 1669: —

“ So the production of thy brain shall make

Mid wives themselves produce, and for thy sake,

Sol teeming thus, mu?i~midzoivesf out a birth That is the product to the globe and earth.”

* “ Quoiqu’il y ait plus de trente-cinq ans que je fasse une pro¬ fession particuliere de Tart des accouchemens, avec une continuelle assiduite.”

f Robert Barret very indecorously uses a somewhat similar mode of expression, as applied to the Almighty, who, he says, “ midwifed man from the tomb of nothing into a state of existence.”- — Companion for Midwives, 1699'

180

Original Comm u n icat ion s .

If man-midwifery travelled only by degrees from France to England, such an expression as the above would hardly have been used in six years after the fashion was begun in France.

But there is more complete evidence that men practised midwifery in England before the period stated. u The Ex¬ pert Midwife” was published in London in 1637* It is addressed “ to all grave and modest matrons, especially to such as have to doe with women in that great danger of childbirth, as also to all young Practitioners in physick and chirurgery whom these matters may concerne;” in which the “ Men-Midwives ” are accused of having, a for private profit,” interfered with the practice of the Mid wives, or, in the words of the book, u too farre already encroached upon women’s weaknesses and want of knowledge in these their peculiar businesses.”

In Aikin’s Biographical Memoirs of Medicine, we have an account of a Practitioner of midwifery at a still earlier period, Dr. George Owen, who died in 1558, and is said to have attended the Queen of Flenry the Eighth, when she was delivered of her son, afterwards Edward the Sixth; and it seems probable, from the u Prologue” to the “ Byrth of Manky nde,” that the editor, “ Thomas Reynold, Phisition,” was an occasional Practitioner of midwifery. At all events, it is manifest that, during the reigns of Henry the Eighth, Elizabeth, Mary, and James, Men-Midwives were establish¬ ing themselves in practice. Dr. Hugh Chatnberlen, who is described by Mauriceau as being, in 1670, the most cele¬ brated Practitioner of midwifery in England, was the son of Dr. Paul Chamberlen, who had been many years in the prac¬ tice of midwifery.

It was not, then, in order to follow a fashion, that women first consented to be attended in their labours by men. It must have arisen from other causes sufficiently obvious; viz. the insufficiency of the Mid wives, and the great danger to which women were exposed in their labours, from the igno¬ rance and rashness of the female Practitioners.

II.

Tzeo Cases of Puerperal Fever. Byr W. Gaitskell,

Rotherhithe.

- - -

I mentioned, in a former monthly report, my regret at the prevalence and destructiveness of puerperal fever, and am therefore truly concerned to announce two more unfortunate cases.

Within the last six weeks I have been solicited to attend

181

GaitskelPs Cases of Puerperal Fever.

six cases of puerperal fever, all patients of the same female Accoucheur. Each of these had a safe and natural delivery, but passed through pregnancy with much pain and suffering. Four recovered, and two died.

The first fatal case w'as that of a woman, twenty-three years of age, of good constitution, and not addicted to in¬ temperance. The lochia flowed freely for the first day, and then became suddenly suppressed. On the third day she complained of pain in her loins and abdomen, accompanied with chilly fits, succeeded by fever; which were attempted to be removed by a dose or two of the oleum ricini. The bowels were slightly moved, but w'ithout relief; and the pain became greatly aggravated. At this time the milk was sparingly secreted. On the fifth day, and not earlier, I was desired to visit this patient. I found her with a pulse 140, hard and vibrating; skin hot and dry ; great thirst; the pain in the abdomen severe, particularly in the hypogastric and inguinal regions. To counteract this she was freely bled, both generally and locally, blistered, and the bowels relieved by repeated injections, and treated rigidly antiphlogistic, but without avail; for on the eighth day the pain suddenly subsided, with cold extremities, which was soon after fol¬ lowed by death. In the evening of the ensuing day the body was carefully inspected. The abdominal cavity showed marks of general and severe inflammation ; several folds of intestine were united by adhesion, and flakes of coagulable lymph were seen floating among the bowels. But the greatest mischief was perceptible in the vagina, the uterus, and its appendages. The wTole substance of the vagina was highly inflamed, and the posterior half in a state of gangrene. The uterus w7as equally injured ; the posterior half of its neck, fundus, and appendages, of a chocolate-brown colour; the omentum gangrenous; the mesentery morbidly vascular ; the stomach, liver, spleen, pancreas, and kidneys, were found to be free from disease.

The second case was that of a woman, thirty-five years of age, of a sanguineous temperament, the mother of six children, industrious, and regular in her habits. She was delivered of her seventh child on Saturday, July 1; and nothing occurred in her labour deserving of particular notice. On the day following the after pains were unusually severe, when, some coagula being discharged, temporary relief was afforded. The pains recurring with violence, were mitigated by Godfrey’s cordial. On the third day, some oleaginous laxative was administered, which acted on the bowels, but without any permanent benefit.

On Friday, the 7th, the symptoms being greatly increased,

182 Original Communications .

I was requested to visit this patient. 1 found her labouring under fever, with a rapid pulse, heating 130 in a minute, hot skin, incessant thirst, and abdominal pains, principally in the umbilical and epigastric regions. 1 hied her immediately to twenty ounces, applied leeches to the part in pain, ordered emollient injections, and purged her with salts and senna. Twelve hours after, the bleeding was repeated, ’ which so mitigated the symptoms, that hopes were entertained of her recovery ; but as the pulse was hard and frequent, without an approaching convalescence, the bleedings were three times more repeated, blisters applied to the abdomen, injections persevered in, and the bowels kept soluble, while the diet was strictly antiphlogistic. Notwithstanding the activity of this treatment, on the 16th she suddenly expired.

The body was inspected in the evening, and the following appearances presented : the stomach, liver, spleen, and pan¬ creas, healthy; the large and small intestines moderately distended with air, generally inflamed, but not adhering ; the mesenteric veins loaded with blood ; the uterus, vagina, and urinary bladder, without a vestige of inflammation; while the ligamenta lata, ovaria, fimbriae, and fallopian tubes, were in a gangrenous state. The lungs, heart, and pericardium, were examined, and found perfectly sound ; but more serum than usual in the pericardium.

In these two unfortunate cases, the most marked inflamma¬ tion was perceptible, which ultimately terminated in gangrene. In the first case, the uterus and vagina were disorganized ; in the second, the uterine appendages only. The development of such serious mischief by these dissections shows a necessity for the boldest practice. It also demonstrates, that in puer¬ peral fever the disease should be early recognised ; otherwise the best treatment will be unavailing. The practice should be unremittingly pursued till the symptoms give way to the remedy. Like the croup in children, or cynanche laryngea in the adult, it must be grappled with in the onset, or the best concerted plans will be thwarted.

III.

Case of Pulmonary Disease , in which Digitalis proved decidedly successful . By W. II. W an sb rough, Surgeon, &c.

Fulham.

- - ■— - - •-

The subject of the following case, Master Alfred Wallis, an interesting child, eight years old, has had from his birth an unusual prominence of the os froutis and occiput, clearly in¬ dicating a superabundance of cerebral substance. Ocea-

Wansbrough’s Case of Pulmonary Disease. J83

sional torpor and effusion of tears ; the latter consequent upon the slightest fatigue, attended by great debility. Hence his parents were led to suspect the existence of hydro¬ cephalus. A consultation with Mr. A. Cooper removed their apprehension; and the case was determined by that gentleman to be an “ unusual development of cerebral structure.” Nutritious diet, and attention to the bowels, with the occa¬ sional exhibition of tonics, proved effectual in obviating the previous symptoms; and the child continued free from any affection until the autumn of last year, when, from exposure to cold, lie contracted symptoms of pneumonia. These were palliated by the parents for a time, until his health visibly declined. The cough increased ; and in the month of January last l saw him for the first time.

As die object of this paper is merely to illustrate the virtues of digitalis, it will be unnecessary to enter into the minutim of the symptoms antecedent to the exhibition of the drug, beyond the statement that, after endeavouring by venesection to subdue the inflammatory diathesis, suppura¬ tion at length supervened, and the little patient gradually ex¬ pectorated from a table spoonful to four ounces daily ; this expectoration being occasionally streaked with purulent matter and blood. I endeavoured, but without effect, to reduce the pulse, which varied from 140 to 160, by bleeding, and enforcing the antiphlogistic regimen most strictly. I had also nearly exhausted the class of expectorants, sedatives, an- timonials, sudorifies, 8cc. &c., without much benefit, or once thinking of digitalis, which, by the way, I had long since held in no estimation beyond its effects as a diuretic : and I now' was about reluctantly to resign the child to the irresist¬ ible ravages of this consuming disease. On the 28th of February, then, the symptoms were as follow: cough exces¬ sively severe; pain in the head violent during each paroxysm of the cough ; breathing much oppressed, by the continual accumulation of matter in the bronehim and air-tubes of the lungs; expectoration about four ounces, in the twenty-four hours, of thick pus, sometimes greenish ; night perspirations profuse ; great reduction in flesh ; great prostration of strength; tongue furred; pulse J 40, small and regular; much general distress.

O

P< kactis A my gd.

Tinct. Digitalis, glt. v.

Statim sumend. et bus hods repetendus, cum digitalis incre- mento, glt. v. ad xx.

On the following day,

O */ '

2f)th, he had passed rather a better

184 Original Communications ,

night ; cough not quite so violent as the night before ; pulse ISO, small and regular* The child seems relieved ; expec¬ toration much about the same, with the addition of a small streak or two of florid blood.

Perstet in usu digitalis.

He had now taken twenty drops of the tincture; and during this and the following day, viz. the GQth'and March 1st, the dose was increased guttatim to forty drops, when the expectoration was suddenly reduced to about two or three efforts in the twenty-four hours, and these not followed by much distress. The pulse, however, now assumed a serious aspect. On the morning of the 1st of March 1 sat by my little patient nearly half an hour, endeavouring to obtain a correct number of vibrations during five and sometimes ten seconds. The pulse would amount to twenty, then cease during five seconds, and so on, varying every minute, from 60 to 70, 75, and 55. The nocturnal perspirations had com¬ pletely subsided, and the bowels were regular. I desisted from any further exhibition of the digitalis during the period between the 1st and 2d of March, watching the pulse atten¬ tively. The same suspension and irregularity continued until the 3d of March, when a more equable circulation appeared, with a mitigation of all the symptoms. The child scarcely coughed, and then without any effort --in short, on the 5th no one could have traced the former existence of phthisis in the case, save from the pallid look and emaciated appearance of the child, whom the ravages of the disease had left with very little cellular, and not much more muscular substance.

It may be asked, Were there vomicae in this case, as, in the opinion of some Practitioners, the existence of tubercles is necessary to constitute legitimate phthisis ? I will not enter into the question in this place, but simply state my firm con¬ viction, that had the case furnished me with a post mortem examination, at the time . 1 first exhibited the foxglove, I should have found a considerable formation of pus in the sub¬ stance of the lungs; and from the continual pouring forth of secretion from these viscera, occasionally streaked with purulent matter, the extreme debility, pallid hue, and wasting of the patient, there did not appear a chance of recovery. Added to this, the determination of blood to the head, which was the invariable concomitant of the severer paroxysms of coughing, led me to hope nothing, as, from the idiosyncrasy of the brain, I dreaded mischief there also, because every effort to expectorate left my patient completely exhausted and in severe pain in the head.

Wansbrough’s Case of Pulmonary Disease. 1S5

To resume: on the 6th of March I discontinued the digitalis in toto (the six last doses amounted to forty drops each); put my patient on a nutritious diet, with tent wine. Under this plan he progressively and rapidly recovered; and on the 30th of March, one month after the commencement of the digitalis, I pronounced him convalescent. Moderate and gradual exposure to the air was permitted ; but he soon threw off restraint, and, from a natural liveliness of disposition, he shortly lost the recollection of his illness, and resumed his wonted range.

The effect of digitalis in this (to me) most interesting case, appeared altogether unequivocal. 1 never witnessed such a decisive transition in any case by any remedy, save in the one of asthma, wherein the efficacy of tar vapour operated like magic, which I published in the Ninth Volume of the Re¬ pository.

Injustice and candour I cannot close this account without acknowledging myself indebted to the late Dr. J. Margennis, for the information which led me to make the trial of tinct. digitalis in this instance. In the Edinburgh Practice of Physic, under the head of phthisis pulmonalis, are several cases of this disease, related by that eminent Physician, successfully treated with foxglove, and where this medicine was pushed to an extent truly alarming to the young Prac¬ titioner. In one case, if my memory serves me correctly, the exhibition of the tincture was increased successfully, in an adult, from forty to two hundred and twenty drops! Had i not read these very interesting cases, and been stimulated but the day before my trial of that cure here related, to try the digitalis guttatim, I feel convinced my little patient would have fallen a victim to the disease. It is under the impres¬ sion, therefore, that by the publication of cases of this nature a stimulus may be afforded to the propagation of science, by the adoption of any new, or the revival of any old remedy, that 1 venture to offer the contents of this paper, as likety to prove not undeserving a place in the Repository.

I should state, that a copious secretion of urine attended the exhibition of the medicine; the bowels were kept in a com¬ fortable state by the effect which it produced on the system, rendering the administration of aperients unnecessary. The child has not experienced the slightest relapse; but is now, four months since his illness, in perfect health. The size of the head continues the same.

o

B

VOL. XIV. — WO. 81.

186

Original Communications .

IV,

Report of a Fever which prevailed at the tillage of Taplow, Bucks, in the Autumn and Winter of 1819-20; with Re¬ marks, By William Rob arts, Burnham, Bucks.

So much has been written on the subject of fever, that I am in doubt whether this paper will be worthy of attention ; but as it is chiefly from tlie observation and concurrent testimony of various Practitioners, who have had peculiar opportunities of witnessing the progress of particular dis¬ eases, that we can hope to obtain clear and successful ideas of the practice proper to be pursued, l have ventured to add to the general mass what occurred in my own experience.

It may be right to premise, that the village of Taplow is situated on the declivity of a hill bearing a southern aspect ; consequently exposed to a high degree of heat during the summer months. The fever of which 1 am treating was nearly confined to this district, although it had previously been prevalent in the parishes of Cockham and Bray, a short distance from Taplow, and separated therefrom by the Thames.

Within these limits the fever appeared in the month of August 1819, and continued to the latter end of March 1820, during which period about one hundred persons were affected, five of whom died. The first cases which pre¬ sented wrere marked with the usual characters of general fever, as described in the work of Dr. Bateman, pages 87, 38: but at this period the attack was of the more sudden kind ; those who were, in their own feelings, and to all appearance, in good health the previous day, becoming suddenly unnerved and debilitated. But the symptom most particularly striking wras pain and confusion in the head, sometimes described as darting violently, at others, fixed either to the fore or back part. In some of the cases the eyes looked glaring and much excited; in others, languid and suffused. In the treatment, the principal remedy depended upon was early and large bleedings, followed by active cathartics, sometimes exhibited in one dose, at other times repeated at intervals of six or eight hours, so as to keep up a continued action. The suc¬ cess of this plan was such, that for several wTeeks no cases passed beyond the character of pure inflammatory fever, excepting, indeed, a small number, where, as noticed by some other Practitioners, the character of fever changed in a few hours after the first copious bleeding, the tongue be-

Robarts on Fever.

187

coming covered with a dry brown fur, &c. ; but the recoverv was not retarded by the change. There was something pecu¬ liarly imposing in the general event of the cases during the continuance of warm weather. So effectual was the depletory system, that not one fatal case occurred in a considerable number. In some instances one large bleeding was found sufficient; in others, repeated bleedings were adopted, before the excitement and affection of the head could be removed ; yet this extensive evacuation seldom debilitated.

As soon, however, as the weather became cold, it was evident that the depletory system might be carried too far ; and in most instances where venesection was carried to any great extent, and in some where even only a second bleeding was instituted, the subsequent debility was such as to place the patient in great danger. The fever put on the typhous character, and ran out to a period of three, five, or six weeks. The type of the fever not only appeared to have changed, but in almost every case, a greater or less degree of irritation or inflammatory action of the lungs supervened ; thus much increasing the difficulty of managing the cases : for it will be observed, that the patients, being chiefly cottagers, were unable to guard against the severity of the season, either by keeping out the cold air or admitting warm, fewr of the rooms having the convenience of fire places. Ventilation, too, was rendered exceedingly difficult from the rooms, where from one to four or five persons were confined, being very small, and the admission of cool air in the most cautious way pro¬ ducing pulmonary irritation and cough. In proportion as the frost became more intense, so much more violent was the affection of the lungs, and also the disturbance and pain in the head. Ardent pyrexia attended, and all secretion from the general surface became suspended. I felt no difficulty in accounting, to my own satisfaction, for this oppressive or inflamed condition of the lungs, and for the excessively hot and acrid state of the skin. During the mild and temperate weeks the cutaneous vessels were unobstructed, and perspira¬ tion kept up more or less free and regular : consequently there was less determination to the head, and less duty was thrown upon the lungs. The air which supplied these organs was unirritating, so that, except in one or two subjects, where some pulmonary obstruction previously existed, no thoracic affection demanded attention. Under the application ofco/c/air, however, a very different set of symptoms arose, and 1 conceive altogether produced by the inhalation of a larger quantity of oxygen, acting, as I believe, on those organs in the same way, and upon the same principle, as frosty air is constantly ob¬ served to act upon our fires ; causing a more rapid combus-

188 Original Communications .

tion, and consequently increased heat. Not that there is a larger proportion of oxygen in cold air than in warm ; hut that the former, being in a very condensed state, of course contains, in the same bulk, a larger quantity of its constituent parts : hence every inspiration of frosty air conveys a higher degree of the oxygenating principle than equal inspirations of warm mild air; the former exciting the calorific power of the lungs, and causing the symptoms above particularized.

With extreme prostration of strength, low muttering deli¬ rium, quick and small pulse, and (hectic) flush in the face, it would have been highly dangerous to have abstracted more blood, with a view to relieve the lungs; the extremities would immediately have become cold ; a general collapse or relaxa¬ tion of the system, and colliquative sweats, would soon have proved fatal. These cases were the most distressing; and three out of the five which ended fatally were of this descrip¬ tion, or, as it has been termed, typhoid pneumonia. That large bleedings in the earliest stage would have prevented this pulmonary disease, [ cannot admit, as such were, in many cases, adopted; and I had reason to believe that every repeti¬ tion of bleeding after the first was succeeded by increased debility and more ardent fever#, rendering the recovery of the patient far more difficult.

That confidence with which I had so successfully pursued the bleeding system was now greatly shaken ; and although I still continued to institute one full bleeding in subsequent instances, I felt the strongest objection to venturing on a second ; and it was only in some few cases, where leeches to the temples did not remove pain in the head and every high excitement, that I ventured to abstract a further small quan¬ tity of blood from the arm. It is but right, however, to state, that in numerous instances where patients complained of pain and uneasiness in the head, they expressed great and often¬ times complete relief from local or general bleeding.

Perhaps stronger evidence than I have related of the danger of indiscrimate bleeding is seldom presented to one individual; and it is from conviction of the danger to be ap¬ prehended from the unreserved adoption of such a practice, that I obtrude this report. That the brain is the organ primarily and chiefly affected in fevers of this kind, I most unequivocally agree; and it is of the greatest importance that it should be relieved as speedily as possible, otherwise “ irremediable injury” may be produced, and a general affec¬ tion of the nervous system, constituting protracted fever of the typhous kind.

* Dr. Bateman, -page 131.

Robarts on Fever,

189

With regard to the question of contagion, I feel perfectly convinced that this fever was communicable, but that it required there should be a susceptibility in those exposed to its influence. I can in no other way account for the circum¬ stance of every individual in a family, excepting one or two, becoming infected, while living under the same circumstances, and constantly attending the sick ; nor for the longer period which one nurse continued unaffected than another. But that it did not depend on similarity of habits or constitution was evident, from persons coming from a different part of the country free from fever becoming affected during their attend¬ ance upon those who had it.

In some of the houses and rooms the nitrous fumigation was adopted ; but, beyond the little influence it appeared to have in overpowering any unpleasant effluvias, I had reason to believe it had none in preventing contagion.

Until the month of March fresh instances continued to occur; but the air then becoming mild, clear, and light, the fever gradually subsided, and contagion altogether ceased.

Several patients still complained of the head for a consider¬ able time after the termination of the active disease. Here an occasional emetic seemed to produce more benefit than bleed¬ ing, blistering, &c.

In the general treatment of the cases which could not be checked by active means in the earliest stage, it appeared to be chiefly necessary to balance the constitution against the fever. Under an antiphlogistic plan the patient sunk ; under a tonic, the febrile actions and brainular affection increased; while a combination of these appeared to be most useful. In the latter stages, the nitro-muriatic acid proved serviceable. The use of calomel and antimony evidently required much caution. Where the tongue and fauces were covered with a dark brown and dry secretion, these remedies were very useful; but if too frequently administered, or in too large doses, they caused a degree of excitement overbalancing the good effect of their specific action ; and I generally found it best in ex¬ hibiting calomel, to give it with some gentle aperient, merely as a chologogue.

Under the use of antimonials, I had opportunity of ob¬ serving that the skin became hotter ; and I conceive nothing more likely to break down the system than the absorption of calomel, which, when given with antimonials, is so likely to take place.

Opium is, doubtless, injurious, except after a protracted case, where, with much confusion pf the head and sleepless¬ ness, there exist constant tremor and subsultus tendinum; and here four or five grains of Dover’s powder has so Iran-

190

Original Communications .

quillized the system, that the patient has earnestly begged its repetition.

A remarkable change was observable in the state of the blood taken at the first and second bleeding, even under a very short interval ; the texture of the first being very firm, with strong marks of inflammatory action, and much cupped; and that of the second loose, soft, and covered with a thick coat of coagulated lymph, i regret exceedingly that I did not note the different degrees of heat in the blood by a thermometer. In an early bleeding it usually flowed with great force, and at a very high temperature ; so high, indeed, that it was not at all wonderful such a sudden enervation of mind and body and disorganization of the circulating fluid should have succeeded.

On closing this report, I may observe, that although the majority of subjects affected by this fever were paupers, suffer¬ ing under great privations, many others were of a different class, and could not be rendered obnoxious to its influence by want of cleanliness or necessary sustenance.

Y.

Medical Sketches . By E. Sutlepfe, Surgeon, &c.

Queen Street.

No. I. Two Cases of Peritonitis,

Mrs. L., of I - n, advanced in life, and exceedingly en¬

cumbered with obesity, solicited my attendance with her first-born a few months ago. The labour, though protracted, was effected as usual by the uterine efforts, and was precisely what Dr. John Clark, in 179 b used to denominate a case of impaction. Nothing particular occurred subsequent to this period, except the pulse, which was as rapid as 140. Two days after the patient was seized with rigour, fever, and ab¬ dominal pain. Upon my arrival I endeavoured to abstract blood from several orifices, but in vain ; no blood would flow. Thirty leeches were put upon the painful part, which gave immediate relief. Warm glysters I repeatedly introduced, and expended the whole day upon this individual patient. I was determined nothing should be left undone which could contribute towards her recovery. Calomel and pulv. ant. were freely given, and by the evening all painful symp¬ toms were so much reduced, that I turned my attention to other patients ; the pulse, however, continuing full and rapid as before, so that I could not pronounce her out of danger. In two days afterwards the abdominal pains re¬ turned with increased violence, which bade defiance to all

Sutleffe’s Medical Sketches. lgi

remedial measures; and on the sixth day from the delivery she expired.

A few weeks subsequent to this event, Mrs. G., of Goswell Street, a little delicate lady, with an early labour, was de¬ livered of her third child. Four days after, I was quickly summoned, and found the pulse full and bounding, fever, ab¬ dominal pain, &C. I immediately removed several ounces of blood, and ordered fomentations ; ext. colocynth. c. calomel, &c. The blood was buffed and cupped. Relief was appa¬ rently complete; but at the expiration of two days more, the same process of venesection, &c. was obliged to be resorted to, and finally with success. Such is the gratitude of Mrs. G., that she considers her protracted existence owing to the measures resorted to.

!STo. II. A Case exhibiting the ill Effects of an unnecessary Pro¬ portion of Mercury in Syphilis.

A porter of Mr. H., a large orange merchant in the city, contracted the lues. The subject required surgical attend¬ ance at his own apartment; but the master was too indignant to permit my daily attendance upon his servant under such circumstances, and imperiously insisted upon his removal to an hospital, by way of inflicting correction, no doubt urging the necessity of completely drenching him with mercury. Thence I lost sight of my patient, expecting to see him no more labouring under syphilis; but in about seven weeks after¬ wards, I had a hasty summons to visit him at Bartholomew’s, when it was expected he could not long survive. Upon my entering the foul ward, I could scarcely recognize the features of my quondam patient. I perceived that he had been over¬ dosed unnecessarily; and 1 promptly urged his removal, which was immediately effected. I withheld all mercurial remedies; and substituted the decoct, sarsoe alone, with which he rapidly recovered, and is now a lusty man : and my surgical powers are very far overrated by his rapid recovery.

No. III. On the Utility of the Gaseous Form of the Acetic Acid

in correcting Putrescency.

Having been in the private and public department of the medical routine for nearly thirty-four years, I take the liberty of suggesting the result of my individual experience, relative to the steam of vinegar; indeed, when 1 reflect upon the numerous accounts of the spread of contagion, until every in¬ dividual became infected by the atmospheric influence, I smite upon my breast, and cry, “ God be merciful,” for having withheld my preventive, quota so long from the .Profession.

m

Original Communications,

When I am called to a case of ardent fever, ushered in with rigour, &c. I pursue my usual course of emetic and purge, and the full use of antiphlogistic regimen; and, if the pulse require it, venesection ; if not, probably leeches and blistering topically; adding pretty copiously pulv. ant. and calomel, equal parts of which, I mostly find, reduce the febrile symptoms, and establish a new action of ptyalism, which immediately relieves the symptoms, though they be not of recent formation. But the principal motive of taking up my pen was to detail the virtues of the fumes of common vinegar, suffered to be emitted in the room of my patient, placed over a lamp kept constantly burning. Whether the pungency of typhus be an ammoniacal exhalation, of which the olfactory nerves will offer pretty strong proof, I am not prepared to determine; but I think 1 may say, without a fear of contradiction, that the acetic acid meets with an alkali and neutralizes it; relieves the patient, aids his recovery, and, above all, precludes the possibility of transmitting the in¬ fection. The sulphuric acid poured upon the muriate of soda, I consider a perfect bagatelle; and, at any rate, this I can affirm, that hitherto, in the whole course of my medical practice, I have never met with a second party susceptible of the typhus or scarlatina, (except in one doubtful instance,) after the gaseous fumes of acetic acid had been suffered to rise.

VI.

Some Remarks on certain Modifications as well as Modes of Treatment of Spinal Affections. By J. K. Walker, M J)., of Caius College, Cambridge, and Senior Physician to the Huddersfield Dispensary.

The recently awakened attention of the Profession to ’spinal pathology, and the enthusiasm with which this subject has been lately prosecuted, added to the mass of conflicting evidence relative to the diseases of this part, have induced me to seek every opportunity of drawing from that legitimate fountain of medical improvement, the morbid anatomy of its structure, such solid testimony as we usually give when ex¬ ploring the maladies of other parts, and w hich no other mode of investigation can so effectually supply. Pew of our country¬ men, who have lent themselves to this interesting department of medical science, have superadded to the fruit of their inquiries the corroborative evidence of post mortem examina¬ tions. To the credit of the continental writers be it spoken, they have applied themselves with assiduity to this source

193

Walker on Spinal Affections.

of information. Frank, Portal, Ludwig, and some others, have enriched our art with many important facts, solely from a more frequent inspection of the spine in its diseased state. Some of these physiologists, indeed, have carried their specu¬ lations so far as to ascribe a variety of spasmodic diseases solely to the morbid agency of this part, or of the nerves transmitted from the medulla spinalis to the seat of the disease. It is probable that the theory of these writers, which ascribes many of those painful affections of the back and loins which accompany haemorrhoids, menstrual, and other obscure affections of the thorax and abdomen, to a supposed irritation at the origin of the various spinal nerves, is not altogether groundless. They have made it very probable, from dissec¬ tions, that considerable turgid ity of the vessels of the spinal chord exists in many of these cases; and this local congestion they have termed “ plethora spinalis/' With regard to the ascription of chorea*, tetanus, epilepsy, coliea pietonum, &c. to a similar cause, (a position broached by many foreign Physicians,) so long as we meet with dissections of these cases without any such appearances in the spine, and others with evident marks of injury of the brain alone , it is illogical and absurd to draw such sweeping inferences, unless we are prepared to maintain, that the medulla spinalis has a more im¬ portant influence in the animal machine than the encephalon itself, or that when diseased it is more alarming in its con¬ sequences than even a similar malady of the brain. Indeed, such affections will often come to be synchronous ; so that it shall not always be easy to decide in which the affection first began ; but the keenest advocates of spinal influence will hardly assert such influence to be paramount even to the sen- sorium itself. Next to the reveries of a Gall and a Spurz- heim, this, indeed, would be the most preposterous.

I hope it will hereafter be in my power to furnish other dis¬ sections of this part of greater interest. The one I shall now

* We continue to receive strong evidence, from dissection, of the frequent connexion of this disease with medullary inflammation of the spine. I have perused few more striking exemplifications of this than in a case of tetanus, communicated to me by my friend, Dr. Freer, of Leicester, who, I trust, will be induced to give it that publicity which the interesting nature of the case, as well as its able treatment, deserves. It appeared, on examining the spinal chord, that the dura mater of the medulla spinalis had been affected with intense inflam¬ mation in its whole extent, it appearing of a chocolate colour, similar to contusion, but more especially so in the region of the upper cervical, of the fifth dorsal, and the lower lumbar vertebrae. 1 he pia mater was similarly affected ; but the distended vessels were more dis¬ tinct and tortuous.

— NO. 81.

VOL. XIV.

2 c

194 Original Communications.

relate is the appearance of the spine, on dissection, of a fatal case of lumbar abscess, which had been considered and treated in its incipient stage as a rocse case of lumbago, with the use of liniments alone, until the tumour in the thigh gave un¬ equivocal indications of the existence of psoas abscess, which was the period, indeed, when it first became an object of my treatment. The origin of the psoas muscles, from the sides of the upper vertebras lumborum, and from the roots of their transverse processes, would induce us, a priori, to suppose that any serious detriment in the spinal canal of that part might communicate itself to the contiguous muscles; but in the case here recorded, not only three of the lumbar vertebrm were partially carious, but traces of inflammation in the membranes of the chord itself, with a slight effusion, also were discernible. The history of this case would occupy more space than my readers might think warrantable ; but enough, 1 think, is here stated, to prove the necessity of attention to the early mani¬ festations of this disease. It is not contended, that the most energetic practice would ultimately have arrested this for¬ midable malady; but it is plain, that in a part so sensitive as the spine, a timid temporizing treatment is to the last de¬ gree pernicious. If, however, such an oversight occur occa¬ sionally, it is equally true, that a simple case of lumbago has been dignified in its turn into a spinal affection; and so preva¬ lent, indeed, is the spinomania (if I may so term it) in some places, that the slightest pain in the vicinity of the vertebrae is proof enough with many of disease in that part; and what was, in fact, no more than an ordinary case of chronic rheu¬ matism, has been met with all the active treatment of a genuine spinal disease, and perhaps incarceration in the recumbent posture for many months. One consequence of this indiscriminate and indiscreet practice is, that it has given birth to some curious empiricism; and it will hardly excite sur¬ prise, when the reader is told that other pseudo cases like these, readily removed by friction, have been quoted as instances of cures of diseased spine, without any of the ordinary resources, (such as leeches, blisters, caustics, or confinement,) and that a linament is all that is necessary for the removal of inflam¬ mation in the spine, which in less important and less sensible parts requires the aid of the most active remedies to remove. Do 1 contend, then, for the impropriety of such application in every stage of spinal disease ? Assuredly not ; no more than I should dispute the propriety of a liniment to a swelling of the knee joint, after every symptom of inflamma¬ tion was removed : but what should we think of the judgment of that Practitioner, who, with evidence of a deep-seated in¬ flammation in that part, should neglect the use of leeches, &c.

Walker on Spinal Affections. 195

for the sake of a favourite liniment? None but those who are aware of the insidious nature of spinal disease in its nascent state, and the subsequent ravages which often ensue on a neglect of its early manifestations, can properly appreciate the consequences of oversight in this particular. That Prac*- titioner will be deceived, who expects invariably to find altered structure of the spine as a necessary condition of a disease there. Tumours and effusions may exist so as to cause compression on the medulla spinalis, and yet no inequality or deviation be manifest to the eye or the touch. We have examples on record of idiopathic active inflamma¬ tion of the spinal chord (as appeared on dissection), without any disease of the brain, and without any distortion, where pain in the peccant part was almost the sole clue to the affec¬ tion. We have equally wrell attested instances of dissection, where the disease occurred under the form of chronic inflam* mation, of which three cases are related by Brera#. In the first of these the spinal marrow was soft and flaccid, and partially suppurated, and its investing membranes covered by a puriform fluid. In the second, the cord itself was sup- pu rated. Its investing membranes and the periosteum lining the vertebral canal were partially destroyed, but the vertehrce and their ligaments were sound. If the constitutional symp¬ toms w'hich accompany this affection of the medulla spinalis were more uniform, less danger might exist of its being over¬ looked ; but so mutable and uncertain are they, that there are scarcely two patients that present the same routine of symp toms; and if they come to be coternporaneous, and coiiit plicated with other affections, the difficulty of diagnosis is still greater. Wherever, therefore, the state of the pulse and pain in the spinal region create any suspicion of this latent malady, it has always been my practice to apply and repeat the leeches, until a mitigation takes place in those symptoms. But it is probable that the number of cases of spino- medullary inflammation is small, when compared with those where the inflammation involves the substance of the ver¬ tebrae, or their intermediate cartilages and ligaments. The nature of this affection is now so generally understood by the Profession, and the symptoms which are supposed to accom¬ pany it have occupied the pen of so many foreign as well a»

* The same author quotes instances of induration and of extrava- sated blood within the spinal chord, where the vertebrae were sound : and a case of paraplegia is related by Copeland, where, on dissection, no disease could be observed in the vertebrse; but within the lower dorsal and first lumbar, the spinal marrow was entirely wanting for more than two inches.

196

Original Communications.

writers of our own country, that the difficulty is to extract what is valuable, and, amidst so many glittering materials, to select the reai metal from the base. It appears, from the various dissections of several of those patients who died under this disease, whose spines were curved in various degrees, and whose limbs were paralytic, that in infants and children, and in those who had been afflicted but a short time, the ligaments connecting the vertebrae, which formed the curve, were slightly thickened, and the cartilages between the bodies of the vertebrae much compressed ; but in others, who had so long laboured under this disease as to have been destroyed by it, or by its consequences, the corpora vertebrarum were carious, the interjacent cartilages being totally destroyed. Whatever other symptoms accompany this morbid state of the vertebral column, ( and there is scarcely a viscus in the human body that has not been affected by it ,) the tendency to caries is evidently the first thing to be obviated— neglect this, and the effect will be distortion, or anchylosis, with the probable destruction of the general health of the patient for life. It will occasionally happen that the most skilful and energetic treatment is insufficient entirely to arrest this disorder, especially if it be combined with a scrofulous diathesis*; a combination, though not infrequent, yet not a necessary concomitant, as some have contended. Here the maxim (C principiis obsta” is peculiarly appropriate; and if there be any truth in the position, that the primary cause of the caries and all its attendant consequences resides in the spine itself, it will readily be conceded that early

* In many instances, it is true, strumous tubercles in the lungs, and a distempered state of some of the abdominal viscera, have been found to co-exist with spinal disease. Mr. J. Delpech (vide Precis Piemen- taire des Maladies Repartees Chirurgicales ,) thinks that those small spherical tubercles, which, when situated in the lungs, are one of the causes of consumption, may and do exist in the tissue of muscles, tendons, ligaments, and even in the substance of bones. lie supposes that on attentive examination these scrofulous tubercles will be de¬ tected on the surfaces of these bones, or in the very centre of the osseous substance. At different periods of the disease he has found tubercles situate at various depths, in the long tissue, and in the sur¬ rounding soft parts. He has observed them at different periods after their formation, and in different stages of the disease, the cavities in the diseased bones still containing the pulpy matter, into which the tubercles are converted when they change their form and consistence; but even on the supposition that the formation of tubercles takes place in scrofulous subjects, independent of original inflammation, yet, as foreign bodies , they are liable to produce inflammation of the parts in con¬ tact with them.

197

Walker on Spinal Affections.

topical applications, which may abate the tendency to inflam¬ mation, are indicated. I have had ample opportunities of witnessing the beneficial effect of this treatment, and the almost invariable relief from the application of leeches to the suspected part. It is much to be regretted that in all doubtful cases this expedient is not adopted, which in painful affections, whether of the spine or only of the con¬ tiguous muscles, is almost always productive of benefit, and may prevent a caries and probable disorganization of the vertebrae. The number of carious spines is not likely to be diminished while the contrary practice is followed ; and, as I have before observed, if the use of liniments, or any other inert practice, is allowed to supersede this timely vigour, many a credulous patient may live to rue, when it is too late, the loss of stature and of health. While, however, I have to lament that any delusion should have existed as to the real nature of the disease I am now discussing, I am gratified to find that almost every Practitioner of real merit has come to the same conclusion, as to the utility of issues, aided occa¬ sionally by the recumbent posture, which, of course, will vary in duration, in proportion to the extent of the affection. Steel stays, swings, screw chairs, &c. have all been tried ; but experience has now shown that much judgment is requisite in their employment, to prevent them from exasperating the affec¬ tion. Those who have acquired the greatest celebrity in the invention and employment of machinery to throw' the weight of the superincumbent column upon the pelvis, have found it necessary to premise in some instances active local ap¬ plication. Mr. Cheshire, of Hinkley, would never have gained the high reputation he now enjoys for the treatment of spinal cases, if he had blindly applied his excellent apparatus for the support of the spine, without ascertaining, in the first place, whether there was not some local inflamma¬ tion to be removed — some symptom which demanded active medical treatment. I should conceive, that where the inter¬ vertebral substance is destroyed, the anchylosing process would be retarded by a separation of the approximating surfaces of the adjacent bones. I have hitherto called the reader’s attention to those cases where more or less pain in the spinal column in¬ dicated the presence of active symptoms; and I trust l have shown the fallacy of that treatment, which, where inflamma¬ tion exists, is worse than frivolous — I mean the premature use of liniments. There is, however, a class of cases which may be materially benefited by them, and which, to an unprofes¬ sional examiner, or even to a prejudiced Practitioner, might pass for spinal diseases. I think i shall be borne out by the experience of those who have been much in the habit of

m

Original Communications.

examining the vertebral column, that there occasionally occurs in the dorsal portion a very discernible lateral inflexion, of which the convex portion inclines to the right, without the slightest pain on examination. This, however, 1 have observed oftenest in children, where there is unusual delicacy of habit; and 1 am confirmed in this opinion by a similar remark made by Professor Hufeland of Berlin, who states also, that he has recommended, with great success, the occasional bathing of the spine of children so affected with som,e spirituous lotiony or even common brandy. This constitutional debility, let it be remembered, may create a similar appearance in more advanced age, or it may be the consequence of some original malconformation. I am ready to admit, however, if there is any supervening declension of the genera! health, the vigilance of the Practitioner cannot be too soon directed to that part. Every one is aware, during the period of dentition, how many anomalous symptoms arise in children ; how very flexible is their spine, and how often does it assume an appearance of deformity, so as to excite an alarm, and even sometimes to deceive the Practitioner. Jn some perhaps, from bad nursing, a slight tendency to deviation may arise, so as to call for the greatest vigilance to establish the rectitude of the ver¬ tebral column, yet no tenderness may be present^. Those who reason on the omnipotence of the spine to produce dis¬ ease, seem to forget that there is also such a thing as mus¬ cular power concerned in maintaining the erect posture of the body, and that if any cause exists, which has impaired the integrity of such muscular power, the patient may not be always able to sustain the perpendicular position, and may ac¬ quire a habit of leaning in one direction, so as to give a fallacious appearance to a superficial examiner. Whenever, however, such a patient, on assuming the recumbent posture, becomes perfectly straight , and free from pain on pressure, it is absurd to designate such a case a spinal affection. Such a case might possibly be relieved by liniments, or by the use of the emplast. roborans; yet we should not be warranted in pretending that these remedies were a cure for diseased spine. Where, however, a tendency to become awry is observed, the avoidance of too long continuation in the erect attitude, and the adoption of the recumbent posture for an hour or two in the middle of the day, for several months, furnish the best

* If the cause which is ordinarily assigned for the more frequent prevalence of curvature to the right side is founded in truth, viz. the more frequent use that we are in the habit of making of the right arm, be not erroneous, the caution sometimes given to children to use their right hand rather than the left is evidently incorrect*

Walker on Spinal Affections. 199

mode of arresting any incipient deformity. It is well known,, that young persons are taller sometimes by half an inch in a morning than at night, which arises solely from a removal of pressure upon the spinal column; and by analogy, as well as by experience, we are sure that such an expedient will relieve, and frequently remove any tendency to deviation, especially in growing children, where the bones are softer than usual. Of course, if any one of the vertebrae protuberate*, and become tender, additional means will be required, such as [ have above alluded to. I have been induced to trans¬ mit these cursory remarks, because, obvious as they may appear, they cannot be superfluous, while such indefinite notions and such inconsistent practice are still persevered in. rl he history of medicine, unhappily, affords us too many in¬ stances where favourite medicines have been extolled as specifics in one generation, and shortly consigned to oblivion the next; not, indeed, because they were not useful reme¬ dies, but because they did not equal the splendid expecta¬ tions which their sanguine discoverers attached to them. Our age will have the credit of bringing to light many important facts relating to spinal pathology; but it depends upon our¬ selves to stamp perpetuity upon these discoveries. The over¬ weening fondness of a parent has destroyed many a child ; nor can the many valuable materials, elicited from this mine of medical knowledge, save us from the derision of posterity, if we content ourselves with the glittering materials which lie on the surface, too idle to explore the massy and more valuable materials that lie below. My concluding sentence I extract from Baglivi — u i\rs medicinae necessario conjec- luralis est ; non nihil autem hujus incertitudinis et incon- stantiae preposteris argumentandi speeulandique modis attribuendum est : nec mirum est, si, neglectfi, vera sede et veluti fomite morbi, falsas inde deducant conclusiones, et curationes talibus innixte conclusionibus ex voto non re- spondeant.”

[We shall he excused for soliciting the attention of our young readers especially to the intimations and cautions contained in this valuable paper. — Ed.]

* May not a protuberance of the spine arise occasionally from de¬ fective nutrition of the bones, or perhaps from a want of due secretion of phosphate of lime ? A medical friend of mine acquaints me, that he is in the habit of administering phosphate of lime internally in analo¬ gous cases, where he suspects osseous innutrition, not without seeming benefit. Whatever strengthens the constitution, is certainly of service; and particularly cold bathing, provided that, in adjusting the tempera¬ ture, due attention be paid to the season of the year, habits and strength of the patient, &c.

200

Original Communications .

DEPARTMENT OF NATURAL HISTORY, &c*

Calendar of Flora , Fauna , and Pomona , kept at Hartfield , near Tunbridge Wells. By Dr. T. Forster. From the ls£ to the 31s£ of July , 1820.

July 1st. — This month commenced with cool fair weather, after the storms of yesterday. Notwithstanding the season has been very different, the plants have flowered at nearly the same time as last year, and some on the same day. The Hypericum perforatum, V erbascum Lychnitis , and V. virgatum , flowered to-day. I likewise first saw the Garden Chrysanthe¬ mum and the Crepis barbata in flower. Roses, Sweet Williams, Pinks, Convolvuli, Corn Flags, Poppies, and other solstitial flowers, now ornament the garden in profu¬ sion. Papaver Rhocas and P. dubium are in flower nu¬ merously about Hartwell, from seeds sown by me in the autumn. Among the former 1 observe none of the variety with a dark spot at the base of the petals, so common in Surry.

2d. — Agrimonia Eupatoria and Senecio aquaticus in flower; they have the appearance of having been out a day or two. Weather showery again,

3d,- — (Enothera biennis , Ilemerocallis fulva , the greater and the lesser Garden Convolvulus, the Hawk’s Eye, and others. Achillea Mil l folium is abundant in the fields.

6th. — A white variety of the Foxglove in flower at Walthamstow; also Calendula officinalis , Tagetes Africana , &e. Stocks, and other later flowers, are now abundant. A Poppy is now flowering, with red petals except a perfectly white unguis.

7th. — A white variety of the Garden Poppy in flower; that is, with white petals, a glaucous leaf, small capsule, and many flowers on one plant. The Nasturtium flowered first to-day. There are still some flowers of the Great Leopard’s Bane yet remaining. By cutting down the old stalks as the blossoms fade, new ones will spring up, and then the plant will continue flowering all the early part of the summer.

8th. — Cool day and northerly wind. Perch, Trout, Chub, and Roach, caught in the streams of the Medway at Hartfield and Withy ham. Malva sylvestris , M . Moschata, and Convol¬ vulus arvensis , in blow.

10th. — The Garden Chrysanthemum (C. coronarium ), Lupines L. varius, and L . luieus, in blow abundantly in the garden. The grass began to be cut to-day.

201

Calendar of Natural History.

15th. — Sonchus arvensis in flower among the oats in a field beside the Withyham load.

J6th — Lilium candidum in flower in the gardens. L. bul- biferum has been in full blow some weeks.

20th. — Several Dahlias in flower in the garden. Weather fair, but with frequent thunder showers almost every day. A Boletus, with a fox-coloured pileus and yellow gills, is spring¬ ing up near Stoneland Park; perhaps B.edulis.

2.3d. — Papaver Argemone in flower in the garden, which is late for this species. Nasturtiums are nowin full flower.

26th. — * Althaea rosea, the Holyhock, came into flower in my garden to-day. Hieracium murorum and Doronicum Par- dalianches still in blow. The Purple Martagon Lily just in flo wer in my garden.

27th.— Riding to-day through Maresfield, Newark, Chailey, &c., to the sea side, I noticed a considerable advance in the solstitial Flora. Ly thrum Salicaria was in blow by the river sides. Sonchus arvensis very abundant every where among the oats, &c. ; and the JFleabane ( Inula dysenterica) was coming into flower. As I got into the chalky and sandy soils, I observed several plants in flower, which, not being common on our clay here, may have been out in blow some days with¬ out my noticing them, such as the Scabiosa arvensis , S. succisa, Centaurea nigra, C. Cyatius , Chrysanthemum sege- tum , Anthemis nobilis, and many others.

Walking by night on the high hills of the South Down, I noticed the most beautiful display of the cirrocumulus, dis¬ posed like fine wind rows of hay in lofty beds floating gently along in a serene welkin over the calm sea by moonlight.

28th.— Campanula Trachelium in blow. The White hedge Bindweed ( Convolvulus sepium) begins to be common, and to hang its white bells about every hedge. The small species, C. arvensis, is also common. I found to-day that Ked Poppies w'ere common all the way from Brighton to Chailey, where they became rare, and at length dis¬ appeared.

30th. — Lobelia urens in flower in the garden. Fungi begin to appear*. The Nasturtiums ( Trop&olum majus) now make a splendid figure, but begin to fade away.

* No part of the vegetable kingdom appears to have been more neglected than fungi. Mr. B. M. Forster, of Walthamstow, who has for many years closely applied his attention to them, is at length pre¬ paring some observations on the British species for publication, and VOL. XIV. - NO. 81. 2 d

202

Analytical Review.

31st . — Campanula rotundifolia flowering on a bank by the road side going towards Cowden, opposite to Perry Hill. The Senecio Jacobcca and S. aquations are now common every where, and gild the waste places by the road sides.

[This Journal is to he continued in the neighbourhood of Tunbridge Wells ; and will in f uture be published according to the calendar months .]

PA R T II.

ANALYTICAL REVIEW.

I.

A History of the Variolous Epidemic which occurred in Norwich in the Year 1819, and destroyed Five Hundred and Thirty Individuals ; with an Estimate of the Protection afforded by Vaccination , and a Review of past and present Opinions upon Chicken-Pox and Modified Small- Pox. By John Cross, Member of the Royal College of Surgeons in London; Corresponding Member of the Societe Medi- cale d’Emulation of Paris; late Demonstrator of Anatomy in the University of Dublin, Sic. London. Burgess and Hill. 1820. pp. 296.

This is a very valuable contribution to the stock of medical literature; and we think it calculated to do a great deal of good in this country. To many of our readers Mr. Cross must be known, as the author of the “ Sketches of the Medical Schools of Paris;’5 a work displaying, in a very eminent degree, the same good sense, extensive erudition, and habit of accurate observation, which are so conspicuous in the present volume, and which we rejoice to have this oppor¬ tunity of doing justice to. The work before us, however, has many strong claims upon our attention, independent of the character of its author. It details the history of the most remarkable epidemic which has occurred in this country for a long series of years ; and it lays before us a very clear and comprehensive view of those great questions, to which we

will thankfully receive the communications of such botanists as may be able to furnish him with any observations on them.

The species fungorum have been so confounded by authors, that I shall endeavour, in this Journal, to substitute a short description for the specific name.

203

Cross on the Variolous Epidemic, fyc,

have so frequently adverted in our late Numbers, as being among the most interesting which the present state of medical science offers to our consideration. In place of the chaos in which we formerly wandered, when analyzing a work very similar both in its object and title, we have now that lucidus or do, which we take to be as useful to the author as it is to the reader and reviewer; — -we have parts, chapters , sections, an ample table of contents, and marginal references, which make this a very pleasant book to read ; and the adoption of which we would strongly recommend to all authors, who wish to con¬ ciliate the favour of either of those classes of persons. W e like, indeed, almost every part of the book — except the title ; and as we intend to be somewhat more minute than usual in our criticisms, we shall begin by stating our objections to the first page.

t here is an unfortunate similarity between the title of this work and that of Dr. Thomson, (History of the Varioloid Epi¬ demic,) which, in the first place, we think the author might as well have avoided at any rate. But this became a matter of real necessity, when we were further to be informed that five hundred and thirty individuals were destroyed in the Norwich epidemic, knowing, as we all do, that the Edinburgh epidemic prevailed chiefly among those who had been vaccinated. We really believe that many persons have unguardedly been led to suppose, that a proportion, at least, of these five hundred and thirty individuals had previously undergone vaccination, and that this inadvertence has contributed to increase the distrust in which it is but too obvious that vaccination is now held by many individuals. If the author really thought it necessary to state the number of deaths in his title-page, we think he ought to have said, that, with only two exceptions, they occurred wholly among those who had never availed themselves of the protection which cow-pox affords. Feeling as the author does upon this important subject, and conscious, as we are sure he must be, of the present feeling of the country, with regard to the degree of protection afforded by vaccina¬ tion, we think that, instead of the studied obscurity in which this point is left in the title-page, it might have been as well to have blazoned forth there what is afterwards so strongly put in page f)5 — that ten thousand vaccinated individuals were living at Norwich in the midst of a contaminated atmo¬ sphere, while five hundred and thirty deaths occurred, in the course of twelve months, amongst little more than three thousand persons, who had neglected that beneficent provi¬ sion of Nature.

We really cannot conceive any thing more decisive as to the merits of vaccination than is afforded us by the occurrence

£04 Analytical Review .

of this epidemic at Norwich. It is not that of those ten thou¬ sand vaccinated individuals none were affected — many were ; some severely; but it is that only two died. We may reason as much as we like about modified small-pox, and small-pox after cow-pox ; but when the comparison comes to be made between one death in six, and one in five thousand, the most determined enemy of vaccination must be silent. Yet this is the result of the epidemic at Norwich, in the year 1819; and well, therefore, may Mr. Cross advocate the cause of vac¬ cination, and regard it as the most powerful means of preventing misery, and of saving human life, which Provi¬ dence has vouchsafed to put into the hands of inan^.

But it is time that Mr. Cross should speak for himself; and having now stated how7 fully we consider him entitled to confidence, and how very important is the subject of his volume, we proceed to our analysis of it.

The work is divided into two parts ; the first containing fact, and the second theory. They are both subdivided nearly in the same way ; that is to say, into chapters and sections, in which the several subjects of genuine small-pox, cow-pox, chicken-pox, and modified small-pox, are re¬ spectively considered.

The volume commences with the history of the epidemic small-pox which prevailed at Norwich in 18 IQ- It appears that the seeds of this disease were sown so far back as June 1818; but it was comparatively dormant during the winter months of 1818-19, bursting out, when the season became milder, suddenly and unexpectedly, and continuing its work of devastation for three or four months, with undiminishing fury. The following list of burials, taken from the bills of mortality, will give a pretty good notion of the advance and decline of the disease : —

1 S 1 Q. Deaths from Deaths from

u ’ Small-Pox, other Diseases.

January, February, and March . . 5 200

April . . * . . 15 bl

May . * * . . 73 63

June . 15b 70

July . . • . - ............ 142 bl

August . 84 63

September • * . 42 pb

October . . 10 b3

November and December . . 3 145

530 822

The epidemic was so nearly extinct at the end of the year,

* Page 252.

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that Mr. Cross could not then find a variolous patient from whom ichor could be procured for the purpose of an import¬ ant experiment. The following table is given of the ages of those who fell a sacrifice to the disease : —

Under two years of age . . 2(j0

Between two and four years* •••••••• 132

Between four and ten . 128

Between ten and forty . 10

530

The average of deaths was about one in six ; and there¬ fore the author considers himself fully warranted in saying, that above three thousand individuals, or a thirteenth part of the whole population of Norwich, had the small-pox in the year 1819 — twenty7 years after the discovery of vaccination.

The author proceeds to inquire into the cause of this great mortality. lie tells us that “ the disease was often aggravated, and made to assume its worst characters, by the most injudicious practice. The old nurses tri¬ umphed not a little in having an opportunity of showing their skill, after it had been so long unexercised; nor was it easy, amongst the deluded persons in whose families this affliction occurred, to persuade them or compel them to adopt a different plan of treatment*.” But that there was a pecu¬ liar malignancy also in the contagion in this epidemic, seems probable to the author, and to ourselves also ; yet the state of the atmosphere in May7, June, and July, when the greatest mortality prevailed, “ wras mild, dry, and seasonable, without being marked by any obvious peculiarity^ .” No details are afforded us of the characters of the epidemic, further than this, that the petechial form of small- pox was very common during the summer months, and invariably fatal. Several cases occurred of secondary small-pox ; and one distinctly marked case is recorded J of small-pox recurring after inoculation .

The second chapter treats of vaccination, and particularly of the efforts which w7ere used to promote it during the existence of the epidemic, and of the success which attended them. During the height of the epidemic, viz. in the begin¬ ning of July, a public meeting was convened by the mayor, to consider of the best means to put a stop to its progress. A committee was formed, which in a few7 days obtained a census of the whole city, and found the number still liable to small¬ pox to exceed one thousand seven hundred. The Prac¬ titioners in the town wrere then summoned together, and were

* Page 12.

f Page 14.

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Analytical Review .

unanimous in recommending vaccination. In the course of a month, one half of those who by the census were found to require it had received the protection of cow-pox; but neither persuasions, nor gratuitous attendance, nor the picture given in printed addresses of the horrors of the small-pox, nor the powerful argument of half-a-crown in their pockets, could induce the other half to submit to it, who were left therefore to be the food of the disease. Nor did the disease spare them ; for towards the end of the year not a hundred individuals were to be found in the city, (save infants a few months old,) who would be affected by exposure to tb e contagion *.

Chapter fourth details the few eases that occurred of regular small-pox after cow-pox. They amount altogether to six, of which two proved fatal. In one of these, there is some suspicion of imperfect vaccination, from the mother’s reporting that u some small pimples appeared around the vaccine pocks, and a few broke out in other parts of the arms;” yet, upon the whole, it is better to acknowledge it at once as a case of small-pox after vaccination.

We are next presented with a very full account of the eruptive diseases which prevailed along with the genuine small-pox, and which Dr. Thomson would have called varioloid. One class of these occurred indiscriminately in those who had passed through small-pox or cowpox, and in those who had not had either of those disorders ; but such cases were not very frequent, and of no great importance. They were, in fact, cases of genuine varicella , spreading among children by contagion, and influencing neither sub¬ sequent vaccination, nor subsequent small-pox, (at least, so the author has reason to belie vet). Mr. Cross, therefore, very properly refuses to assign this disease to the variolous contagion. What will Dr. Thomson say of this conclusion, or rather of the facts ?

But the most interesting subject of inquiry is that of the eruptive diseases which occurred chiefly in the vaccinated. The author is very careful to inform us, in the outset of this section, that a few cases of the same kind occurred in those who had previously passed through regular small-pox. He then describes sixteen cases, comprising the principal varieties which be met with in the characters of the disease. These we need not stop to enumerate. Hie disease was the modified small-pox. It gave rise to no deformity or per™ inanent injury, (not even to any pitting of the slightest con¬ sequence). To the best of the author’s knowledge, it was

* Page 15.

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not attended in any case with a fatal result, although in a few instances danger was apprehended. In a large proportion of the cases, the pocks were indented in the centre; and this the author justly regards as the principal criterion of the disease. Wherever such indentation existed, the disease was communicable by inoculation, producing genuine small¬ pox in the unprotected, and in a small proportion of the vaccinated, an eruption similar to itself in mildness and duration. The author confidently announces his persuasion that they formed a series of the same complaint, and that they all proceeded from variolous contagion.

We h ave now given a rapid sketch of th e first part of this work, which occupies about one half of the volume. We come now to analyze the author’s pathological specu¬ lations concerning variola and varioloid diseases. The opinions of a man who has had such abundant opportunities of seeing these diseases, whose attention has been so forcibly directed to the subject, and who has so carefully read and collated whatever others have written concerning them, both of old and up to the moment when his book was in the press, (for we find, in page 19 1, an allusion to some of our own cases, published in the Repository of March last,) must be considered as valuable; and we shall attempt to do justice to them.

In the chapter on small-pox, the author directs his attention exclusively to the distinctive characters of the disease. Me comes to the conclusion f, that te amongst the numerous characters that have been regarded as distinctive of the small-pox, no one of them, taken singly, can be implicitly relied on ;” and that every Practitioner, in the course of an epidemic small-pox, meets with cases so imperfectly marked as to leave him doubtful of the exact nature of the disease. Of those that have been mentioned, Mr. Cross is inclined to lay the chief stress upon the anatomical structure of the pock; upon which subject he thus expresses himself, after premising, as a general principle in pathology, that the vesicular or pustular character of an eruption is affected, in a very remarkable manner, by the degree of inflammation of the cutis : —

“ If we attend to the growth of the variolous pock, in a regular and distinct case, we shall find it successively changing from a minute red spot to a pimple, a vesicle, a pustule, and at length ending in a scab. Each of these terms may therefore be applied to it, and almost any form attributed to it, if reference be not made to some particular period of its progress.

* Page 121.

| Page 133.

208 Analy tical Review .

“ The first indication of that change in the cutis which is followed by a distinct variolous pock, is the appearance of a small red spot, in the centre of which a firm knot is perceptible to the touch, although not so soon visible to the eye. In twenty-four hours a pimple is observed in the centre, which increases so as to present an acuminated vesicle: this gradually changes its form during its growth, so as to present, on the fourth day, a vesicle perfectly circular, somewhat flattened upon the top, and indented remarkably in the centre, as if the point of a pin had been pressed upon it, and the impression remained. At this time the vesicle is about one-eighth of an inch in diameter, and has often a reddish or bluish appearance, (from the inflamed and very vascular portion of the subjacent skin being seen through it,) being filled with a limpid fluid contained in different cells.

To a cellular structure of this sort the term pock should perhaps be strictly confined. The walls of the cells being perfectly trans¬ parent, the disposition of them during life is not easily ascertained ; but they are more readily examined in the dead subject; and the arrangement of the partitions, first described to me by Professor Macartney of Dublin, (whose researches in minute and comparative anatomy have been so justly appreciated,) I have found to answer to the axis, spokes, and circumference of a wheel. Besides the cutis, which is external, and the very vascular surface of the skin forming the basis of the pock, there is the cellular structure formed by the rete ?nucosu?n*i or by a freshly organized substance thrown out by the cutis itself, and excavated into cells for holding the fluid of the pock. The walls of these cells secrete the contained fluid ; and if this be partly let out by a puncture, the drying of the lymph closes the point opened, and the fluid is again secreted, distending the pock to its former shape. Inoculation is practised most successfully with the transparent lymph taken from a pock in this stage of the eruption.

“ The pock grows more in its circumference than in its elevation subsequent to the third or fourth day; and by the fifth or sixth, its size is one-fourth of an inch, the indentation is less observable, and the contents cease to be transparent. A red circle shows itself at the circumference, and becomes

* The vaccine pock bears a strong resemblance to the variolous; yet, from the foveolous appearance of the scar, it seems probable that the cells are differently arranged. Dr. Willan, ( On Vac. Inoc. p. £h) speaking of the cells of the vaccine pock, says, “ These are perhaps only a portion of the cellular membrane distended by the effusion of lymph.” This observation shows how little attention he gave at the time to the situation and structure of the vaccine pock, the cellular substance being deep and out of the way, with the dense and less vascular part of the skin between it and the basis of the pock. Cotunnius ( Dc Sede V ariolarum , p, 202,) came nearer the true situation of a pock, placing it neither in the cutis nor cuticle, but rather between the two.

J

y

209

Cross ow the Variolous Epidemic , #c.

wider as the pock increases, the circular shape of the latter being still retained. After this period the surface becomes convex, the point which was indented being now the highest part; the circular shape is lost, the pock changing to oval, oblong, or irregular ; the contained fluid, at first turbid, is afterwards purulent; and the cellular structure is altered, the walls or partitions being thinner, broken up, or partly absorbed, so that a great proportion of the, fluid will escape by a single puncture. These changes are effected by the eighth day, when incrustation commences, and proceeds in one of two different ways — either the pock bursts at its apex, allowing a part of the fluid to dry as it exudes, or the thinner parts evaporate without the pock bursting, while the denser parts form, with the cuticle, cells, and slough of the pock, a thick, convex, and nearly circular scab, one fourth of an inch in diameter.”

We have made this long extract, because we look upon this as the best description of the variolous jTock we have ever met with, and because we believe this cellular structure to be a great deal more important, with a view to pathology, than the loose circular slougli at the bottom of each pock, which Mr. John Hunter and Dr. Adams considered as so in¬ variably attendant on this disease, and which, we have reason to believe, is still much insisted on by many pathologists of our own times.

We cannot but feel considerable regret that the author has declined saying any thing about the treatment of small¬ pox. It appears* that he attended, and kept a register of, two hundred cases, of which forty-six died (being in the proportion of two in nine.) Now, it would have been interesting to know what practice was followed in these cases, and to what extent the author had reason to consider the disease to be under the influence of medical treatment. We cannot for a moment believe that he looked upon it as beyond the control of art; but we should have liked to see him raise his voice against that notion which is now beginning to prevail, (in London, at least,) regarding the treatment of small-pox. It was not, we confess, without some degree of surprise, that in a late number of a contem¬ porary journal f, we observed an author express an opinion, apparently intended fo be general, that the danger of small¬ pox is in the ratio of the bronchial inflammation ; that a depletory system of treatment, during the fever which precedes the eruption, will almost invariably prevent confluence; and that the new light in which he views the disease, prevents it from becoming, in his mind, that source of anxiety which it must be to others, who are accustomed to view it in the old light.

* Page 7. f Medical Intelligence, June, 1820.,

VOL, XIV. — NO. 81. 2 E

£10

Analytical Review.

Now, surely this author need not be told that bleeding in small-pox, which we suppose is what he means by a depletory system, so far from being a new practice, is at least as old as the time of Sydenham, who has often been blamed for carrying it too far; and, provided blood be drawn, it cannot, in our humble apprehension, be of much consequence whether we bleed to diminish bronchial in¬ flammation, or to check the ebullition and abate the heat of the blood. The fact appears to us to be, that this writer overlooks the character of the epidemic , over which he can have no possible control ; and we are much deceived if, with all the new lights of Dr. Armstrong’s pathology of fever, the mortality of the severe Norwich epidemic of 18 19 was, or could have been, much diminished. Small¬ pox in London, during the last eight or ten months, has been of a remarkably inflammatory character. It has borne bleeding well, and has certainly been less fatal than usual, all over the town. But let us see what bleeding will do for us, if we have ever the misfortune to witness here an epidemic of the same character with that which raged last year at Norwich ? We hope Mr. Cross may still be induced to communicate his observations on the treatment of small¬ pox; more particularly on that very formidable species of it, the petechial, of which we observe that five fell under his own observation.

We may here allude to an opinion which the author entertains regarding the occurrence of small- pox and cow- pox in the same individual. It is introduced, indeed, in the first part of his work; but we omitted the consideration of it under that head, because it did not at all bear upon the history of the variolous epidemic. Several cases are described of small-pox occurring on the tenth and eleventh days of vaccination, one of which proved fatal. The author then proceeds to state, that “ the existence of the two diseases together, so as to maintain their usual intensity, and take in all respects a regular course, seems to be in¬ compatible*.” We have many doubts on this point; having seen, a few years ago, a young woman at the Small-pox Hospital, in whom the cow-pox and the inoculated small-pox were each following their regular course, without in the smallest degree interfering with each other. If we remember rightly, the punctures were made at the same time.

After describing the distinctive characters of small-pox, the author gives a sketch ofth qu history of varicella;’' and certainly this is not one of the least interesting chapters in the book.

* Page 58.

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Cross on the Variolous Epidemic , fyc.

We strongly recommend its perusal as a good introduction — we had almost said a necessary introduction, to the study of the prevailing doctrines regarding varioloid diseases. It is divided into three periods; and the whole gives a good idea of the wavering nature of the opinions which have been entertained concerning varicella, from Rhazes, A. I). 900, down to Dr. 'Thomson, A.D. 1820. In the last and shortest period of the history, (viz. from 1798 to the present time,) the same contrariety of sentiment prevails as may be traced in the best authors of preceding years; and this alone, as Mr. Cross justly observes *, cannot fail to prove the difficulty of the questiou which the subject involves.

In the next chapter, the author enters the land dehateahle, and treats very fully “ of modified small-pox , and its clas¬ sification with variola and varicella After showing, in the most decisive manner, that this disease, so far from being confined to this country, as some have alleged, is spread over the whole continent of Europe, be gives a general description of the appearances which it exhibits; and then proceeds to notice in detail those circumstances connected with the consideration of modified small-pox which we formerly pressed upon the attention of our readers. Instead of a formal enumeration of these, however, we shall take the liberty of touching only upon such points as appear to us to be new, or particularly important.

Of these, we may first mention the effects of inoculating those who have undergone vaccination. It is, we suspect, a commonly received notion, that if a vaccinated child will not receive small-pox by inoculation, it is secure from the casual modified small-pox. Now we have many doubts on this point. Mr. Cross says, “ that in a small proportion of the vaccinated, inoculation will succeed in producing the modified disease.” We wish he had added what the pro¬ portion was; and whether he had himself observed this, or upon whose authority the statement was made. We suspect it to be very rare indeed; and venture, though certainly with some degree of hesitation, to express our belief, that vaccination may secure the constitution from the inoculated small-pox, and yet leave it liable to the attack of the casual modified small-pox , under certain circumstances of idiosyn¬ crasy, or of peculiar malignancy of contagion. Our object is to determine, how far subsequent inoculation is really that test of perfect vaccination which some have supposed it to be; and we shall feel, therefore, obliged to any of our correspondents, to communicate with us, it a case of

* Page 172.

f Page IpO.

1

212 Analytical Review »

modified smallpox may at any time fail under their notice, where such testing had been had recourse to.

With regard to the effects of inoculating with the matter of modified small-pox, our author observes, that every example of eruption where the pocks are indented may be regarded as capable, under proper regulations, of producing regular small-pox by inoculation A variety of works are quoted, in which the experiments are detailed which' lead • to such a conclusion. u They afford/’ adds the author, “ an ex¬ traordinary phenomenon, by the production of a disease so different in character and severity from the case whence it was derived. In making the experiment, however, upon those who have had neither cow-pox nor small-pox, it has been found that a vesicle on the arm, with a rash or a few pimples on the body only, will sometimes be produced, leaving the subject equally liable to small-pox on subsequent exposure, and furnishing a motive for discouraging such attempts, without having a sufficient object in view in undertaking themf.”

With no parts of the volume are we more satisfied than with those where the author treats of the degree of protection . afforded, during this destructive epidemic, by vaccination. We perfectly coincide with him in the general principle, that the mere collecting separate instances of failure or protection answers no useful purpose. “ It can show only/’ what has long since been acknowledged, u the possibility of the one or the other, without establishing which is the general rule and which the exception. No documents can at the present day possess much value, except they help to ascertain the proportion in which the vaccinated are likely to be affected by small-pox contagion J.”

With the view of contributing to the determination of this point, Mr. Cross, instead of attempting to estimate the numbers who were affected by small-pox after vaccina¬ tion through the whole town, gives us a very minute history of one hundred and twelve families, which he himself narrowly watched, and in which the genuine malignant small-pox was raging. These one hundred and twelve families comprised six hundred and three persons; of whom two hundred had small pox, and ninety-one had been vaccinated, either previous to or during the epidemic. These latter were continually in the same room, and often in the same bed, with the variolous patients. Two of them took modified small-pox, and one had chicken-pox : and these were the only instances of indisposition, or eruption, occurring to the vaccinated,

* Page lpl.

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(in these families,) during the whole course of the epidemic. The scars upon the arms of these two children were single, small, and foveolous ; but to show that much reliance is not to be placed on this circumstance, a table is given* of the state of the scars in fifty-seven of the vaccinated individuals, by which it appears that twenty-one, in whom there was a large foveolous scar, and six, in whom the scar was scarcely perceptible, were as safe as those in whom the scars were perfect. Of the two who took modified small-pox, one had been vaccinated nine years and the other five. From these data, the author is disposed to conclude, that not more than one in twenty of the vaccinated will be in any way affected by the most intimate exposure to small-pox, and that the true modified small-pox wall not occur to more than one in fifty T* hie acknowledges, indeed, with great modesty, that his experience is not sufficiently extensive to enable him to form a calculation which can be much relied on; but wre think this a very good beginning, which subsequent and more extended observation may either correct or verify.

In speaking of the causes of modified small-pox, Mr. Cross does little more than repeat the observations of former authors. He is as much at a loss, too, as ourselves on the question of the periods after vaccination at which mo¬ dified small-pox is likely to occur. On this point we find wre have incurred the censure of a late waiter J, ( Dr. Macleod, Physician of the Westminster General Dispensary,) who; to prove that the interval between vaccination and small-pox is more frequently under ten years than above it, quotes, from Dr. Thomson’s work on the varioloid epidemic of Scotland, Dr. Gibson’s table of the two hundred and fifty-one Lanark cases. Now we strongly suspect that Dr. Macleod is not fully aware of the nature of these cases, or he never would have referred to them as cases of small-pox after vaccination. The bringing forward this table is, in fact, begging the question. It is assuming that all the eruptions observed by Dr. Gibson as occurring after vaccination, proceeded from variolous contagion, which we most strenuously deny. All that we have since seen of modified small-pox confirms us more and more in our persuasion, that it is not so common an occurrence before, as after the tenth year ; but we have had no reason to conclude, that the severity of the disease w'as at all proportioned to the time which elapses from the

* Page 3 7- t Page 193.

| London Medical and Physical Journal, July, 1820.

214 Analytical Review.

y, ' •

period of vaccination. This seems to us to be determined altogether by peculiarity of individual constitution.

Mr. Cross does not like the term modified small-pox , and instead of it, he proposes to class all the varioloid diseases under the head of varicella, or small-pox diminished ; and to make two divisions of varicella, naming each according to the structure of the eruption. The first he distinguishes by the title of the varicella cellulosa, “ in which the fluid of the eruption is mostly contained in separate cells, the pocks are commonly depressed in the centre, and the scabs are flat and circular, and, on falling off, leave tubercular elevations, or convex surfaces of the cutis. This form of varicella arises from the variolous contagion, and occurs sometimes after natural and inoculated smail-pox, but more frequently after cow-pox*.

The second species of varicella he names hullosa, the fluid in which is contained in vesicles composed of one cavity. 4‘ It is doubtful,” adds the author, in his enumeration of the characters of this species of the disease, “ if this eruption pro¬ ceeds from the variolous contagion ; certain that it does not give rise to small-pox, and that it maintains the same cha¬ racter in all classes, whether occurring before or after cow- pox and small-pox; very contagious, and affecting a majority of people once during life; probably not communicable by contagion.”

After considering this arrangement of varioloid diseases, we confess we do not see what is gained by it. The only ques¬ tion which it is really of importance to determine (the exist¬ ence of a varicella independent of small-pox contagion) is still left open : and therefore we prefer, and shall continue to use our old phrase, modified small-pox ; and this the more willingly, as we are unable to see any force in those ob¬ jections which the authorf urges against it.

From the subject of modified small-pox, Mr. Cross, in chap. 4, part 2, turns to the consideration of variolous inocula¬ tion, and the means of discouraging it. We regret to think that such a chapter should have been necessary ; and confess we were wholly unprepared for the terrible disclosures which the appendix (containing the correspondence with country .Practitioners) makes,, and which, in our opinion, fully justifies the author in saying that further legislative interference is necessary, to prevent indiscriminate inocu¬ lation. Will it be credited, that in the counties of Norfolk and Suffolk, thirty-eight Surgeons have lately practised, and

* Page 20S.

t Page, 205.

t Page 21<k

21 5

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are, possibly, still practising, though few of them willingly, inoculation; and that live of them inoculated whole parishes , at the desire of the directors or overseers of the poor*? The results of this inoculation we shall give in Mr. Cross’s own words : —

“ The Practitioners who, from these various motives, practised variolous inoculation, report to me the deaths of twenty-one of their patients; one, who inoculated extensive parishes, states three persons to have died of the disease thus induced ; a second laments that he lostyfre; and a third lost no less than seven. This great mortality occurred to those who, against their own judgment, were called upon to inoculate immediately great numbers of the poor. Three are men¬ tioned by other Surgeons to have perished from measles being con¬ joined with the disease produced by inoculation.

“ Medical men, however, inoculated comparatively few during the year of the epidemic. The greatest inoculators were the parents of poor children, farriers, blacksmiths, tailors, shoemakers, and old women. All these descriptions of persons are represented as having practised the operation, some from affection and humanity, some from a spirit of opposition, many for gain, and a few from worse motives. The mortality attending the practice, under these circumstances, has, of course, been considerable: fifty-five deaths are reported by fourteen Surgeons to have been thus occasioned within their knowledge ; and five other Surgeons observe, that they have known several who fell a sacrifice to a practice conducted by such improper hands. One Sur¬ geon states, that he was, in the course of the year, called to many patients inoculated by some of the description of persons alluded to ; and that fixe whom he attended died. In Yarmouth, where the medical men were unanimous in discouraging inoculation, Mr. Preston informs me, that a woman was summoned before the mayor for inoculating, and dismissed with a reprimand. In the neighbour¬ hood of Diss, an uneducated man went from parish to parish inocu¬ lating; and Mr. Burt informs me, that no prosecution was carried on against this man, because the magistrates, on being applied to, said they could not prevent him.”

Besides this, nine Surgeons affirmf that the disease was introduced into parishes where it did not before exist, by' variolous inoculation. One gentleman expressly states, “ Whilst this is permitted, we shall seldom be free from small-po£.’?

Now, though we are far from saying that in this country variolous inoculation should be prohibited, still we think that these practices should be discouraged, and kept under due regulation ; and as the law on this subject appears to be very explicit, we think it may be of service to quote it here, for the benefit of those in Suffolk, Norfolk, or elsewhere, who may

* Appendix, page 2 71.

t Page 270.

£ 1 6 Analytical Review ,

be suffering under a neglect of its very useful provisions. We must premise, that we extract this copy of the laws regarding the practice of inoculation from a pamphlet on the vaccination question, by Mr. Hulbert of Melksbam, put into our hands just as we were entering on the discharge of our present duty. It seems that some persons about Melk- sham had been spreading the disease by inoculation. In¬ formation of this was sent up to the Vaccine Board, from whence, in a few days afterwards, the following answer was received : —

“ National Vaccine Establishment, “ Percy Street , July 14, 1820.

“ Sir, — The board have directed me to thank you for the honour of your communication.

“ The resolutions of the parish officers and inhabitants of Melk- sham, signed by yourself and Mr. King, are highly approved of by the board.

“ I shall enclose a printed copy of the law* upon this subject, which was drawn up by our solicitor.

* “The copy of the law enclosed in the above letter is as follows: —

“ NATIONAL VACCINE ESTABLISHMENT.

<c Several letters having been received by the board of the National Vaccine Establishment, relating to prosecutions instituted by their direction against medical Practitioners, and others, on the subject of spreading the small-pox; the solicitor employed to conduct such prosecutions, has, by desire of the board, stated the following remarks, for the general information of those in whose neighbourhood this injurious practice may occur.

“ The principle upon which those prosecutions were conducted, was, that to he the agent in endangering the safety of the public, by causing persons in a state capable of communicating an infectious disease, to be exposed and carried about, at the risk of infecting others, is a punishable misdemeanour.

“ On this ground, an Apothecary*, who inoculated many children, and directed and authorized the parents to take them to his house during the progress of the disease, along the public streets and high¬ ways, was indicted, and, being convicted, was sentenced to six months ’ imprisonment .

“ In a case of a different descriptionf, a woman who caused her child to he inoculated, and wilfully carried it along the streets, while labouring under the disorder, was, on an indictment against her, con¬ victed, and punished with six months’ imprisonment,

“ There is certainly no law at present, to prevent the mischievous

* The King against Burnet. — Maule and Selwyn’s Rep. vol. iv. page 292,

t The King against Vantandillo. — Maule and Selwyn , vol. iv. page 73.

21 7

Cross on the Variolous Epidemic, fyc.

“ It is certainly very desirable that offenders should be prosecuted ; and we shall be happy to hear that this has been done by your parish.

“ I have the honour to be, u See. &c. v

“ JAMES MOORE, Director.”

The last topic to which Mr. Cross directs the attention of his readers, is to the means of promoting vaccination. On the part of the Practitioner, he strongly inculcates the necessity of revaccinating under particular circumstances, of being cautions in obtaining good ichor, of keeping a register of the vaccinated, and of watching with accuracy the progress of the vesicle. On the part of the government of the country, he throws out the suggestion, that some provision should be made for vaccinating gratuitously those paupers in the country who are desirous of it; as he has known instances [p. 235] “ of their being refused on making application to a Surgeon, because they did not belong to the parish they resided in; and while means were taking to procure an order from the overseer, the small-pox has advanced, and made victims of those who were sensible of all its horrors, and willing to avoid them. The poor should therefore be vaccinated at the expense of the

practice of variolous inoculation : but where it is resorted to, both the operator and the patients also, if the latter be of mature age, or, if not, the parents or others who procure such inoculation, must be extremely careful that all communication with the public is avoided ; for if any exposure should take place, by the advice, or with the concurrence of the inoculators, or by the vvilfulness or carelessness of others, they are liable to prosecution, and punishable by line and imprisonment.

“ The two cases above mentioned, were argued before the judges of the Court of King’s Bench, and are since published in the Term- Reports. After this new promulgation of that which, indeed, was always an established rule of law, it is conceived that every magistrate is bound, on his own view, or on a complaint made against any per¬ sons who are found violating it, to interfere and take cognizance of the offence, as in other misdemeanours.

“ Parish officers, who have the management of the poor, ought to prevent the practice of indiscriminate inoculation, and the illegal and dangerous exposure of patients suffering under the small pox ; and whether they happen to be friendly to vaccination , or not, probably a sense of duty and motives of humanity may induce them, on such occasions, to assist in the laudable endeavour of any person to pro¬ secute the offenders to punishment.

“ {By order of the Board ,)

“ JAMES HERVEY, Registrar.” 2 F

VOL. xiv. -—no. 81.

218 Analytical Review.

parish in which they reside, and not of that to which they belong.” Some restrictions also, he thinks, should be put upon those who are attacked with small-pox; and magistrates and parish overseers should be enjoined to proclaim the appearance of the disease in any district, and announce the preparatory steps to a general vaccination.

After throwing out several other useful hints, and illus¬ trating their importance by the good effects which have followed from the adoption of such measures in other countries, he concludes with the strongest recommendations of vaccination, and with expressing the conviction of his own mind, that its real power over the small-pox “ has not been affected by any of the facts and arguments which have been brought forward ; and that the exceptions to the protection afforded by vaccination, so far from offering any discourage¬ ment to the practice, seem rather to furnish an additional motive to make it more general, that it may be conducted under fewer disadvantages, and all the beneficial effects derived from it, which it is capable of affording*.”

After what we have now said, wre think it cannot be ne¬ cessary to sum up our opinion of Mr. Cross’s work. Our readers must have observed one superiority at least which it has over many of the others which have treated of the same subject. Whatever the author describes, he describes from his own observation. He takes no second-hand reports ; and though he has very properly entered into correspondence with his fellow Practitioners, and heard what they have to say, still all that he reaps from them is thrown into an appendix, and the reasonings in the body of the work are founded upon the results of his own observation. He has no theory to support; he is swayed by no prejudice; he neither attempts to explain away that which is obvious, nor to mag¬ nify into importance that which is insignificant. We have little hesitation, therefore, in saying, that this is the best book on variola and varioloid diseases which has yet appeared ; and we hope that it will meet with the attention that it deserves : above all, that the additional proof of the efficacy of the cow- pox, which the occurrence of the Norwich epidemic of 18 J 9 has afforded, will be duly appreciated by those whose faith is wavering.

Cow-pox was never put to such a test before ; and it has stood that test perfectly. We trust, therefore, that every member of the Profession will feel it to be his duty to avow the conviction which the perusal of this book must bring with it; and following the example of the Practitioners of

* Pa"e 234.

219

Bingham on Strictures of the Urethra, fyc.

Norwich, to forget slight differences of opinion as to the exact degree of protection afforded by the cow-pox, and to unite in diffusing, with heart and hand, the inestimable blessings of vaccination.

II.

Practical Essays on Strictures of the Urethra and Diseases of the Testicles ; including Observations on Fistula in Perinceo and Hydrocele. Illustrated ujith numerous Cases and an Engi aving ; and prefaced with some Remarks on Life and Organization. By Robert Bingham, Fellow of the Royal College of Surgeons. London. Longman and Co. 1820. 8 vo. pp. 357.

The maladies to which the urinary and genital organs are subjected, rank among the most interesting and the most important. The most important — for life itself is directly menaced by not a few of those which attack the different parts of the urinary apparatus. The most interesting — for there is no class of disorders which preys more upon the spirits of the sufferers than that which includes the various affections of the genital system. Some of these, truly, display an immediate and real influence upon the health, and even upon the life ; but all of them, from the worst to the most trivial, make deplorable impressions on the imagina¬ tion, and not unfrequently conduct to self-destruction, lie, therefore, who contributes to the mitigation or the removal of any of these disorders, but particularly of any of the latter description, merits well of his fellows; and he will realize a still dearer reward than their approbation ; he will enjoy the consolatory consciousness of his own bosom, that he has not lived in vain. Whilst charlatans by profession, and professors of medicine, who are at heart charlatans, are crowding newspapers with advertisements, and the press with pamphlets and volumes, addressed to the piteous credulity of sufferers under particular complaints, it is delightful to find men of sense, of honour, and of education, bringing up their forces to combat with the direst of diseases. Whether the author under review deserves to be estimated as one of such ; whether into that treasury, which has been enriched by the gifts of Wiseman, and Pott, and Hunter, and Home, and Ramsden, he has thrown if it be but his mite, we leave our readers to collect from the brief extracts which it is in our power to lay before them. It is a trite subject whereon he writes; and we shall notice nothing further than what we deem to be original, or not the worse for repetition. It has

220 • Analytical Review.

always been our object, and we trust our readers will give os the due credit, in the critical department of the Repository to merge ourselves into the shade, solicitous only to do justice to those authors who are exposed to our criticism, and to give to our readers whatever information we may think them to require on subjects of novel investigation. We have never aimed as the sole object, at the reputation of good writing, nor sought to puff a friend into public notice, nor to mortify an enemy, if such we unluckily have, but sincerely to subserve the cause of humanity by the detection of error and of sophistry, and by the publication of facts and of truth.

This treatise is divided into fifteen sections — of which, thirteen are devoted to the consideration of strictures; the fourteenth contains observations on fistula in perinam; and the last includes remarks on false passages in the urethra, on diseases of the testicle, on suspensory bandges, and on hydrocele. The preface, which is short, contains, as the title-page indicates, some remarks on life and organization. These, in our opinion, are very ingenious, and very logical. The author seems to have thought it needful to introduce them. We do not quarrel with him; but we cannot ourselves see the necessity. We have not space to do them justice; and we are the less disposed to regret an omission, since the practice which our author would found upon the assumption of their truth, is a practice from which the organists them¬ selves would not dissent. “ The function,” says Bingham, ie of every part depends chiefly upon the supply of nervous influence. Hence we must conclude, that life produces all its partial or peculiar effects through the medium of the nerves, which induces a further conclusion, that all local disease commences in morbid nervous action.” Now the practice which he would base upon this doctrine, whether the doctrine be admitted or denied, is what has been followed from the earliest era of medical science, with more or less of regularity, with greater or less precision — to wit, the treat¬ ment of local diseases with constitutional remedies, and with counter irritants. Whether pneumonia, for instance, result from morbid nervous action, according to Bingham ; or from morbid vascular, according to others, the remedy by each would be similar; they would apply a blister to the surface. The fact, likewise, of the benefit which local disorders receive from systematic remedies is admitted on all hands, and the correspondent practice is pursued, whether or not the Phy¬ sician believes that life is distinct from organization.

O ur own opinion, as vitaiists and immaterialists, has been frequently developed; and we say what we do say to disarm of hostility to the practice of this gentleman, those whom we

Bingham on Strictures of the Urethra, fyc. 221

dare not hope to convince of the truth of his theoretical opinions. If, however, they he corrigible, they will find in our authors preface, argumentation which deserves the appellation of masterly; and we recommend them to a perusal.

In the first section we find “ a description of the various kinds of stricture met with in the urethra;’7 and in the second,

“ on the theory and causes of stricture,” we are informed that “ disorder of the digestive organs is a very common cause of stricture, does, in fact, either directly or indirectly, give rise to stricture in the urethra more frequently than any other cause; and more particularly those disorders of the stomach and bowels which are brought on by excessive drinking of wine or spirits,” The third section is limited to the “ symptoms of stricture and the variety of sensations which it occasions is a matter of practical interest. Besides the common symptoms, it may excite “ itching on the peringeum, scrotum, or penis; a fluttering or pulsating sensa¬ tion in the urethra; numbness in the thighs; a smarting or burning pain in the glans; darting pains in the perinmum, round about the anus, over the sacrum, and up into the loins ; pain in the hip, the thighs, the knees, and in the sole of the foot.” Priapism, or a state the reverse of that, may be symp¬ tomatic ; but whenever Mr. Bingham has noticed patients “ who could not comfortably cross their legs, there has been, beside the stricture, disease of the prostate gland, or inflam¬ mation in the perinaeum.”

The fourth section contains “ 'preliminary Observations on the Treatment of Strictures ,” and great stress is laid on attention to the state of the chylopoietic viscera, both to insure or expedite a cure, and to prevent relapse; but the intelligence of the reader obviates the necessity of detail.

The fifth section contains some sound remarks upon iC Bougies.” The author notices the good and the bad qualities of the four kinds in common use, and then goes on to praise w'hat he denominates the “ hollow or compound bougie , as it differs in no respect from the flexible gum catheter, but in having no eye or aperture near its point. The various kinds of stilets give us great power of regulating the fl exibility and strength of this instrument; and by with¬ drawing the stilet a little way, we shall obtain a flexible point, of as much firmness as is desired.” With such a bougie, stiffened with the stilet, he can avoid the mouths of fistulse or false passages ; and, withdrawing the stilet a little way, he can obtain a point flexible enough to mount over a diseased prostate gland.

The Mode of introducing Bougies ” is the subject to which

222 Analytical Review .

the next section is devoted, and we are told that 11 ihe course of the urethra differs with the state of the penis : if that organ be erect, the urethra makes only one bend throughout its whole length ; but when the penis is not erect, the urethra naturally makes two curvatures, and as the convexity of each is in a different direction, both together, viewed in profile, represent a waver-line, something like the letter S. The first, or smallest of these -curvatures, is produced by the penis in its flaccid state, falling down from the pubes ; it can therefore he removed, by gently ex¬ tending the penis and supporting it in nearly the same degree it would assume during an erection. From the omission of this , and from the frequent practice of introducing bougies at a right angle with the body , it happens, that false passages are so often formed by the instruments boring towards the dorsum penis. The second, or larger curvature, is formed by the urethra going round the pubes, and afterwards turning up to meet the bladder. This curvature remains unaltered, whether the penis be in a state of erection or otherwise, and will always exist in some degree, although it can be very considerably diminished. For the attachment which the penis has to the broad surface of the pubes is so loose, as to allow of that organ being brought into a straight line with that portion of the urethra which runs along the perinaeum. To effect this during an erection, only requires for the penis to he depressed towards the perinseum ; but if it is to be accomplished without an erection, a stiff instrument must be introduced along the urethra, till its point has passed beyond the arch of the pubes, and then the penis may be depressed as above mentioned.” Does Mr. Bingham intend to advocate the passing of bougies during erections?

The coating recommended for the lubri faction of the bougie, when one is about to be passed, “ is the ceratum eetacei, fresh and good ; oil and lard being liable to be pushed back by the lips of the external orifice:” such a bougie, as well as one introduced dry, will excite pain at the time, and ardor urinae afterwards. “ Bougies that are to be passed beyond the bulb, besides being bent up at the point, should also be drawn through the hand a few times, to warm and soften them. It is owing to the thought¬ less mode of introducing plaster bougies cold, stiff, and straight, that so many false passages have been made in the bulbous part of the urethra.” How a bougie should be passed on till it enters the bulb, the remarks above have indicated : when it has entered, the Surgeon should “ lower his hand, to give the point of the bougie an elevation towards

Bingham on Strictures of the Urethra , fyc. £03

the membranous part of the canal, and then steadily and gently pass it on quite into the bladder.” We have made from this section such long extracts, because we have been, at times, spectators of frightful and brutish violence practised with the bougie; and because we wish especially to impress upon students and hospital-dressers the necessity of leniency and skilful tact. We are grieved to say, that, particularly in provincial hospitals, the bougie is very commonly intrusted to young Surgeons, before they are acquainted with the course of the urethra, its texture, or its relative anatomy ; and had ive our professional career again to begin, how gladly would we avoid, in this particular practice, the sins of a most noxious ignorance! But we cannot well spare space to insert the copious directions of the author on this point, they are elegantly and intelligibly given ; and if the student is not already master of the subject, he had best procure the treatise, and study them with precision.

Section the seventh is entitled u On the Cure of Strictures by the simple Bougie and it contains a note of much im¬ portance in illustration of an assertion in the text, that “ numbers of cases have been aggravated by the too frequent introduction of the bougie.” “ The following case is related by Mr. Abernethy in his lectures. A gentleman had stric¬ tures in his urethra; for twenty years he had worn a bougie for a full hour every day, regularly, till at last he could neither introduce a bougie nor make water. ]n this state he came to Mr. Abernethy, who passed a small bougie and requested him to call and have the operation repeated in four days. The patient was very unwilling to omit the use of a bougie so long, under an idea that the passage would close. On the fourth day, the same bougie ran along the passage without the least difficulty. A larger one was then tried: at first it hesitated, but afterwards went into the bladder. Waiting four days more, the second bougie passed with the greatest readiness, and a third size was introduced. In short, in less time than three weeks, Mr. A. passed a larger bougie than the patient had been able to do for twenty-four years. Mr. A . then advised the patient to do nothing more, and he remained perfectly well.”

Section VIII. On the Cure of Strictures by Argentum Nitratum. Mr. Bingham would confine this remedy to the membranous stricture — his objections to the universality of its application have been often made, but the following we do not remember to have .encountered. “ Excepting there be a superfluity of surface, as may be the case in membranous stricture, I think we ought to be especially careful how we destroy any portion of the urethra; for,

224

Analytical Review .

as we perceive that there is in other parts of the body a constant endeavour to preserve a continuity of the original surface, so we may surely expect the same disposition to exist in the'urethra ; and, consequently, the more we destroy ? the greater will be the contraction that takes place when the parts cease to be dilated with a bougie.” All we choose to reply is, What is the state of facts ? and, Is Sir Everard Home a competent and a credible witness ? His book says nothing of contractions. If the argentum be used, we are recommended to use it in powder, or as an ointment. In powder, on the tip of a bougie; or as ointment, to be pushed out of the orifice of a eanula, or to be inserted into a groove in the side of a bougie, which is turned round upon its axis within the stricture.

Mr. Bingham has no great respect, for the kali purum, ; and he labours to convince us that, where it does good, it operates upon the same principle as would Windsor soap, forming, indeed, a soap with the mucous secretions of the canal ; and never, unless it fall out of its place in the bougie, operating as a direct caustic, and, in this case, of course, uncontrollable and pernicious.

Section X. On the Cure of Strictures by Potassa (Potassw) Subcarbonas . Strongly persuaded that the kali purum acted by allaying irritation, and exciting copious secretions, Mr. Bingham anticipated from the sub-carbonated potash a similar efficacy; and experience has confirmed his opinion. He thus applies it : he selects a bougie quite as large as will pass through the stricture, and in its point he makes a hole, rather larger than to contain the small portion of alkali. This is pressed into the hole, below its margin, and the rest of the cavity filled with lard. He passes the bougie down to the stricture, against which he presses the point, until a smarting pain is excited; and then, as the potash is beginning to act, he gently moves the bougie through the strictum backward and forward two or three times — or he pushes the alkali enveloped in lard from the orifice of a canola— or he passes an armed bougie through a eanula. — This chemical preparation our author praises highly; it is powerful, yet safe; and, in his experience, <l generally successful.” Time, and the trials of other prac¬ titioners, must, doubtless, establish, or destroy, or moderate its claims to approbation, and to their award we leave it.

The Cure of Strictures by the Natron Exsiccatum forms the contents of the eleventh section ; and we are informed, that the apparent effects of both the natron and the sub¬ carbonated potash are so very similar, that the author has not, as yet, been able to discover any remarkable difference.

225

Bingham on Strictures of the Urethra , fyc.

Next comes an eulogium of Unguentum Hy dr argyri fortius, which is prescribed to be smeared upon the bou gie. In ten cases it has been tried, and in all it has answered well. This is a medicine which the author uses with success in gleets and in phymosis. In one case of the former, attended with disease of the prostate, and an irritable system, it proved too excitatory ; and it was his success in cases of phymosis that indicated to Mr. Bingham its applicability to contractions of the urethra. That Mr. Bingham does not limit his practice to the adoption of a solitary remedy, the reader will have seen already. The lunar caustic he deems adapted to the membranous stricture; even of the kali purum he says, we are greatly indebted to Mr. Whately for first proposing it ; and the subcarbonated potash, the natron exsiccatum, blue ointment, and Windsor soap, he uses in their turns ; and, last of all, we find him admitting that there are “ some anomalous cases of stricture, in which something more than mechanical dilation is requisite; and yet it seems to matter very little what else we employ, for they appear to do equally well with any one of those remedies which have been recommended in this essay ; and I believe there are also some cases that may be most successfully treated by employing a variety of applications in rapid succession .” He advises cold bathing of the perinaeum in some unirritable systems; and its propriety and degree must be estimated by the relief observable in the intervals of bathing. Sir E. Home treats one stricture at a time; but in unirritable patients Mr. Bingham advises that all, if possible, be treated together: the sympathy which strictures manifest with each other ren¬ ders his reason obvious.

In the section on Fistula in Ferinceo, speaking of the division of the stricture, he says : “ In some cases, when one stricture is divided, others will be discovered; and sometimes there is a contraction of considerable length occupying a portion both of the membranous and prostatic parts of the urethra.” Such a case gave birth to the following admirable operation : — -

“ A journeyman carpenter, between forty and fifty years of age, had retention of urine, supposed to be occasioned by a stricture about six inches down the urethra. Suitable means were employed to get away the urine without etfect; so that the bladder became much distended, and the patient laboured under such extreme distress, that it was deemed absolutely necessary to take away the urine without further delay. It was thought, that if the urethra were opened behind the stricture, nothing more would be needful : a metallic catheter was therefore passed down to the stricture, a free incision was made in the perinseum, and the point of the instrument exposed; the incision was then extended, with a view

VOL, XIV.— NO. 81. 2g

226 Analytical Review .

to divide the stricture. This done, no urine appeared, which evinced some other impediment to exist. A probe was then passed towards the bladder; but it did not proceed more than half an inch before it was stopped by what was believed to be another stricture. Under an idea that if this were divided the urine would certainly come away, the scalpel was carried into this second contraction about the distance of half an inch, but still no urine flowed. It was then agreed, that as the wound reached so nearly into the bladder, it would be better to evacuate the urine, by extending the incision in the same direction far enough for that purpose. This being done, the patient experienced immediate relief; and the operation was finished by passing a catheter the whole length of the urethra. No un¬ favourable symptom occurred ; and in less than six weeks the wound healed, and the patient was considered well.”

But such an operation “ is inadmissible in some cases complicated with great disease of the prostate gland.” The number of orifices of perinaeal fistula is sometimes surprising : —

“ A. B, showed me his scrotum: there was no inflammation, but it was very much enlarged, thickened, and had a loose flabby feel. On the under side, and thence backwards along the perinseum to the anus, there was an immense number of very small fistulous openings, through which the urine constantly oozed." — “ Upon close inspection, several small vesicles, about the size of pins’ heads, or rather larger, were observable; and when these were broken, urine oozed out slowly.”

In this patient there existed but one stricture ; and the whole disease was cured, by the simple bougie and the flexible catheter, in somewhat more than7 three months.

False Passages. Where these “ are situated at either of the two curvatures of the urethra, they will generally be found on the convex side of it. Thus, if situated near the pubes, they take a direction towards the dorsum penis ; and if met with about the bulb, they almost always take a direction backwards towards the rectum.” “ Any instrument that is intended to be passed beyond a false passage, must possess a considerable degree of curvature; and whilst being intro¬ duced, the convexity of it must be towards the false passage, which will carry the point of the instrument against the opposite side of the canal. There will also be great advan¬ tage in using a large instrument,” exceeding that which made the passage : and if it be a plaster bougie, it should have been previously curved, and suffered to cool.

It is in his section on Swelled Testicles that the author’s theory of morbid nervous action receives the chief support from facts. It has been customary, when this enlargement is synchronous with a suppression of gonorrhoeal discharge, to consider a reproduction of that discharge desirable, if we would remove the tumefaction of the gland. This doctrine.

227

Bingham on Strictures of the Urethra , #c.

and its dependent practice, we are here assured, are always erroneous, and may be productive of mischief. There is no necessity to reproduce the discharge. The glandular swelling is a sympathetic, and not a metastatic affection ; and the method of cure adopted by this Surgeon is the introduction of the bougie into the urethra; by the irritating agency of which, he believes that he destroys another and a morbid irritation existent in the canal, and the cause by sympathy of the swell¬ ing of the testis. Be this as it may, the effects speak best for themselves. Five cases are given, of which two were those of strictured patients ; and the bougie, in their instances, seemed to benefit, by removing the irritation of the strictures. Hence we are counselled not to rest content, in cases of this description, with the idea that the gonorrhoea preceding will account for the swelling; but to suspect stricture, orvsome morbid irritation in the urethra, of which last disorder the three other cases were examples. Another case is given ; but in this there is some doubt whether an increase of the dis¬ order was owing to the bougie or the imprudence of the patiefit : it seemed most probably referrible to the latter cause. In all the cases, the very first introduction of the bougie was marked by a diminution of the size of the testicle — even in the doubtful case, this result occurred ; and it was not until after the third trial, that the patient experienced an increase of pain, and hardness, and tenderness. All this might be due to his having “ walked about more than y usual.” He had, however, another relapse; and that was placed, by Mr. Bingham, to the account of disorder of the digestive functions.

Mr. Ridgway, a friend of the author, cures this disease by an injection of lunar caustic. In his practice, too, the discharge is not sought to be produced. The injection varies in strength from ten grains to two scruples of the caustic, in an ounce of distilled water. It must be used with an ivory syringe. It should not be thrown further than four inches along the urethra; but repeatedly , at each operation, night and morning, till the membranous lining of the urethra appears white or sloughy. It excites a copious pouring out of mucus, which coagulates on meeting with the injection: all this must be pressed out, and the injection used again and again , till it produces no more coagulated mucus.

The author gives a case of sarcocele, treated with the bougie. Violent inflammation, excited either by the instru¬ ment or by intemperance in drinking, was succeeded by a removal of the swelling. Upon this result, the author hints at the possibility, in other cases of sarcocele, of effecting a cure by the irritation which bougies might produce in the urethra, being propagated into the diseased testicle.

Analytical Review .

He is candid enough to confess the chance of u irritating and inflaming the wrong testicle;’' hut himself has never known the bougie to act differently than by te affecting the enlarged testicle.”

A subdivision of the last section contains an eulogium of leather, as the material of a suspensory bandage ; and the best form of a leathern suspensory would be a pair of drawers, “ kept up by spring braces, and having the thighs cut off within one inch of the perinaeum, which would save expense, if it answered no other good purpose.”

For hydrocele , Mr. Bingham deprecates the radical opera¬ tion, when the collection of serum results from increased secretion, lest “ deposition might take place, producing sarcocele and he gives the case of a patient, set. sixty- three, from whose scrotum, as the palliative operation was refused, he effected an absorption of the fluid, which was very great in quantity, by an embrocation of spiritus cam¬ phors and aqua ammoniae purse. The cure was complete in about two months.

In this treatise of Mr. Bingham, whilst there is much to be praised, there are some things which we are compelled to blame. We have remarked faults of three kinds : a few that are practical, some that are literary, and many of the press. These last, perhaps, he will endeavour to cast from his own back ; but somebody has a heavy load of them to sustain, for his list of errata is very imperfect. His literary culpabilities are more to be deprecated, inasmuch as the influence of the Surgeon would probably be enhanced by that of the scholar ; and we should be sorry if a critical taste should avert from the practical solidities of this gentleman's book any reader who might light upon such words as “ potassa subcarbonas,” “ natnm supercarhonas,” “ dilation,” “ quaqu# nocte,” “ gripped,” “ bile” for boil, “ hernia humeral is.”

In the practical directions on the mode of introducing bougies, we find no account of the benefit which is pro¬ duced, in cases of spasmodic stricture, by an opiate, or the sitting over hot water, previously to the introduction of the instrument; circumstances appreciated by every ex¬ perienced Surgeon, but which should not have been forgotten, on account of the student : nor is mention made of the facility with which the point of a bougie may be guided round the os pubis by the finger in ano.

There is more information on strictures and their sequelae, than, we imagine, the private practice of one individual could furnish ; and yet there is no reference to authorities, and not enough of all that is known about these disorders brought forward to entitle it to the character of a perfect trea-

Harrington on Chemistry. Q2Q

tise. In short, vve wish Mr. Bingham had said more or said less — either limited his treatise to his own valuable and individual experience; or given us a work after the model of that admirable compendium oi' particular surgery, Mr. Lawrence’s Treatise on Hernia. From silence upon the point, we conclude that Mr. Bingham has made no trials of Mr. Arnett’s dilator.

The treatment which Mr. Bingham adapts to the swelled testicle is so ingenious, and, in his practice, so successful, that the Profession would be much indebted to him, had he published that alone ; but, in our opinion, the practical matter of the work, which claims the chief praise, and the strictest attention, is the influence which constitutional disease and constitutional remedies exert on the urethra#. An instance of his sagacity in diagnosis upon this point we find in the preface: —

“ A gentleman, who had suffered from gonorrhoea about a fortnight, called upon me one morning early. He was in extreme distress. The prepuce and glans penis were greatly inflamed and swollen ; the orifice of the urethra bulged; the discharge was profuse; and the dysury so great, that he was perfectly agitated at the mere idea of making water. I knew that these violent symptoms did not, in this instance, arise from the gonorrhoea, abstractedly considered; but they were produced by a disordered state of the stomach, and such a disorder as required a strong stimulus to rectify it. I bade him go home and drink three or four glasses full of Port wine, and take coffee for his breakfast. He did so, and from that time he felt no pain in making water ; and all the other symptoms rapidly subsided.”

We sometimes think that analyses of professional works in our periodical journals do harm, preventing the purchase of works which ought to be perused at length. We trust that what we have said of Mr. Bingham will operate to a con¬ trary result. We can assure the student of surgery, more especially, that it is not in so short a paper he can obtain the whole pith' of this production.

IlL

An Elucidation and Extension of the Harringtonian System of Chemistry, explaining all the Phenomena without one single Anomaly . By, Hubert Harrington, M.D., Author of “ Fhre and Planetary Life,” from which all the newest important Nautical Tables have been taken. London. 8vo. J819.

Premium. Anxious to promote discussion and examina¬ tion of my important system , I have lodged one hundred

* Vide Part II. of Cooper’s Surgical Essays,

230 Analytical Review .

pounds in the hands of Messrs. Stephenson* Rimington, and Co., Bankers , London ; as a 'premium for a complete, fair, and full ref utation of it.

The history of the revolutions of medical opinions having shown us how much easier it is to heat down the theory of another person than to establish one in its place, we sat down to the perusal of this book with ardour, and not without some eye, we confess, to the prize thus generously offered to his opponents; but the perusal of a couple of pages checked our ardour. Almost all boarding-school misses show how easy it is to chatter with fluency upon subjects concerning which they in reality know nothing, or next to nothing; but to refute an authors reasoning, it is first necessary to understand him, and here we were soon entirely at fault. At first we suspected that age had commenced its attacks upon our intellects; but upon reading some passages to our young friends, in order to ascertain this point, we quickly discovered that they found it equally impossible to understand the theory of the author, even in those passages that we had picked out as the clearest in the book, and in which we might expect some account of the theorv to be elucidated.

m/

Indeed, as to this theory, of which the author is so confident, we have only been able to divine two points : viz. 1. That Dr. R. Harrington esteems atmospheric air to he “ formed of the aerial acid, carbonic, as it is absurdly called, water, and the rays of the sun neutralizing the acid, and the water being the water of composition/’ p. 13. This sentence alone is a good specimen of the Doctor’s happy knack of elucidating a dark subject, by rendering it still darker, fi. That phlogiston is no element but fire, fixed and united to various chemical bodies.

To make up for the paucity of information respecting theory, in this publication of 170 pages, Dr. Harrington has supplied the public with an equivalent quantity of personal abuse; and as he still adheres to the exploded opinions of Priestley in chemistry, so he has imitated, with good success, the caustic and envenomed style of contro¬ versial writing used by Stubbes, who resembled Dr. Har¬ rington in the continual warfare he kept up with all his cotemporaries. Rut, to let the author speak for himself, we will exhibit some extracts, taken at random.

He thus commences his work : —

u It is some time since the world has seen any new philosophical writings of mine. But this wretched combinations conduct being so reprehensible that I can no longer sit quiet, therefore I shall exhibit

231

Harrington on Chemistry .

them, their conduct, their hypotheses, and their machinations again to the world. Like all associations founded on their principles, they cannot hang cordially together, but are constantly shouldering each other, showing the keen eye of jealousy and envy. Sir Humphrey Davy, or Hercules, as he styles himself, seated upon the shoulders of Sir Joseph Banks, commands both the Royal Society and the Royal Institution of Great Britain.” — p. 1.

Respecting these and similar societies he says—

il Swift’s flying island of Laputa is more than realized by our modern conjurers. They are an island, as they are insulated from common sense, from common integrity, and common justice. This English and French Laputa may be constantly seen with the naked eye, hovering over the royal societies of both England and France. The cognoscenti of this legerdemain may be found in the old council of the Royal Society, or in Berthollet’s packed society, in the neighbourhood of Paris.

“ I wish, Sir Joseph Banks, as you are one of the pillars of this island, you would direct them to the extracting the sun beams from the cucumber. And after they have accomplished this won¬ derful feat, if De la Place, and your wonderful philosopher, Fler- culean Davy, aided with Playfair’s idea of these gaseous conjurers’ azote, oxygen, &c. being the cause of earthquakes moving this immense planetary body. That by collecting a quantity of these gaseous bodies or elements, they may send this modern Laputa, or dying island, along with its wonderful members, to the moon, to instruct the lunarians in all their surprising discoveries. And as you. Sir Joseph, have been so greatly instrumental to them, not by your head, but by your purse, you may accompany them in this magnificent gift, far surpassing, as Bruce said of his present, any other that was ever offered by a subject to his sovereign. So this gift of our planet will be far surpassing any gift that was ever offered from one planet to another : far superior to the meteorological stones which the moon, according to the members of this flying island, are constantly sending to our planet. It ought to be so; for this is a gift from the planetary sovereign to its subject the moon. And a gift of that exalted nature being the essence of the brains of its philosophers, who have gone, ac¬ cording to them, to the utmost stretch of human powers/’ — p. 34.

Neither does Dr. Harrington confine his abuse to native chemists ; foreigners come in for their share, as may be seen in the following beautiful specimen of English com¬ position : —

“ The next of these Laputaian Chemists, in point of self import¬ ance, is Dr. Berzelius. Davy, in his absurdities of the alkalies, alkaline earths, &c. being metals, and their amalgamating, with metals. The Doctor made some absurd experiments, which he said proved that azote was a metal. Davy upon this, and his friends, puffed this spurious Chemist, that he thought himself next in con-

232 Analytical Revieiv.

sequence to him ; and had the audacity to contradict our Demi God! Our Hercules ! But this wretched combination all clamoured against Berzelius, as being a rebel against their champion*,” — p. 73.

Dr. Harrington lays claim to the priority of discovery of almost every thing that has been done in chemistry ; and threatens a similar publication to the present every four months. He allows that his former publications have not been sold or read ; laying the blame, not upon his own desultory abusive way of writing, but upon a combination of the booksellers, reviewers, and chemists, against him. Poor man ! we pity you.

—

A Toxicological Chart. , in which is \_are] exhibited , at one View , the Symptoms, Treatment , and Modes of detecting the various Poisons, Mineral, Vegetable , and Animal , according to the latest Experiments and Observations. By a Member of the Royal College of Surgeons in London.

- - -**28**— -

We have transcribed the title of this chart, not, of course, for the purpose of analyzing, but merely in order to recom¬ mend the production. We are informed that it was first em¬ ployed by its compiler, in a written form, suspended in his surgery; and that, having actually experienced the utility of the immediate reference it afforded, he was induced thus to print and present it to the public. So fully do we feel with the author, that it is our intention to place this chart upon the walls of our own studv, and we advise all medical Prac- litioners to do the same; for without that incessant attention to these subjects, which is entirely inconsistent with the duties of the Profession, it is impossible that the most retentive memories should be furnished with the means of promptly meeting exigencies which every one is liable to encounter, whose office it is to preserve and restore life and health.

We question, however, the propriety of denouncing oils and alkaline sulphurets in cases of poisoning from arsenic, as “ worse than useless/' whatever may be the authority for such denunciation, and although our readers will give us the credit of not being hyper-chemical in our own notions on medicinal agency.

“ * This combination is regularly organized with leaders, like to military discipline, or band of pirates : they must implicitly obey their leaders; viz. La Place, in planetary science; Davy and Berthollot, in chemistry ; Biot and Brewster, in optics, &c. &c. ; and all against my philosophy. But Berzelius' vanity would not act this subordinate part : he rebels, and published against the illustrious Davy."

233

RETROSPECT OF MEDICAL LITERATURE.

(Continued from page 130.)

Our space is so exceedingly limited, in consequence of the unexpected lengths that the preceding articles of analysis have run to, that we can do very little more than merely open I this department, in order to preserve that continuity in the retrospect which we purpose doing till the review be com¬ plete. We are anxious, likewise, early to correct a slight [misrepresentation, of which we were guilty in the notice of Dr. Powell’s lectures at the college. It ought more distinctly to have been stated, that the allusion of Dr. P. to [the case in which the apoplectic cyst was found, was prin- Icipally with a design of illustrating the fact in pathology, that restoration of power is consistent with lesed organization. The second attack to which the life of Dr. P.’s patient [became the victim, w7as totally distinct from the hemiplegic Idisorder in the first instance. Death was eventually produced [by a breaking down of the encephalic substance about the medulla oblongata ; but upon inspecting the other portions of die brain, a well-marked cyst was discoverable in one of the cerebral lobes, which was, of course, connected with the attack of hemiplegia ; and from which hemiplegia the patient mad completely recovered.

The amende honorable is also due to Dr. Harrison, for Ineglect in noticing that feature in his lectures which took particular cognizance of the sympathetic influences of the nervous system. We have been reminded of this omission, by observing that portion of the readings devoted to the development of this particular in the Medical and Physical lournal for the last month, in which paper a question is discussed, wdiich has been amply treated of in the foreign [department of this Journal, viz. Whether the act of vomiting s ascribable alone to the motions of the stomach? Dr. H. ufers intermediately on this point ; and he properly warns [ais readers against the danger attendant upon an indis¬ criminate employment of emetic substances.

(To be continued in our next Number.)

PART III.

SELECTIONS.

We have been requested to present the following essay of Sir Richard | Phillips to the readers of the Repository. It will be seen that in this, as in his former papers, Sir R. proposes a radical change in the mode ot VOL. XIV. - NO. 81. 2 H

234

Selections.

explaining the phenomena of nature. With regard to the merit of this new method of philosophizing, the reader must judge for himself: certain it is, however, that, as well in science as in the common affairs of life, the mind is too much addicted to receive passively what is proposed authoritatively; and if bold proposals for reformation do nothing else than excite to reflection and independent thinking, they may be considered as having achieved something. In the particular instance of electricity, we have often ourselves thought, that too much of merely gratuitous and sometimes inconsistent terminology has been suffered to mingle with our reasonings on its essence ; and the electric, like the nervous fluid, is most certainly, in the present state of our knowledge, a mere supposition.]

if

f

Dial

Electricity and Galvanism explained on the Mechanical Theory of Matter and Motion. By Sir Richard Phillips.

*

( From the Monthly Magazine.)

In no branch of philosophy have superstition and the love of the marvellous revelled in greater luxury of variety and absurdity, than in every existing disquisition, observation, and i theory of the classes of phenomena called electrical.

Theories, assuming miraculous principles which never had existence, and which are inconsistent with that supreme power, for whose support they were weakly invented, and then a course of reasoning by false analogies, have led to all

these absurdities. The philosophical Electrician talks flip-

fe

pantly of his fluids and his fires — -his negatives and his positives — his charges, surcharges, and discharges — his saturations and non-saturations — his attractions and repulsions and

t

other conjurations - — and believes that he can bottle up this

j

1

1

1

fluid, sui generis; that a cloud can be surcharged with it; that bodies contain more or less than their natural quantity ;| and a hundred other equal errors. It is therefore to be; feared, that he will be as much enraged at the writer of these essays, as the devotees of the gravitating effluvia and or the! eternal projectile force, on its being proved that there is, in truth, no such thing as an electrical fluid, and that all the ap¬ pearances are mere mechanical accidents of passive matter,; temporarily disturbed by the causes which generate electrical phenomena.

We shall not be long in arriving at this conclusion ; but. we must look to facts, and not to theories; and must avoid false analogies founded on erroneous theories.

Fact 1. Every exhibition of electrical phenomena takes W place in and within electrics only.

Fact 2. The condensation or accumulation of force takes;! place at the surface of any body, which bounds the electric. H

Fact 3., No force appears at one surface of an electric, ; - unless a similar force appears at the opposed surface.

235

Phillips on Electricity and Galvanism .

Fact 4. The force at one surface is of a contrary character to that at the opposed surface.

Fact 5. The force at one surface has an oxygenating or acid effect, and that at the opposed surface an azotic or alkaline effect.

Fact 6. In the galvanic excitement a palpable decomposi¬ tion takes place in the fluid lying between the plates, and the latent elements decomposed appear in the acid and alkali at the opposite ends of the series.

Fact 7. In the excitement of glass, and all other electric plates, one side of the plate becomes simultaneously in an opposite state to the other; and must therefore be of suitable thickness, and in circumstances permitting its corresponding change of state, and the opposed sides exhibit respectively the acid and alkaline properties.

Fact 8. It makes no difference whether the conducting surface, which bounds the electric, be thick or thin ; whether it be a solid metal, or gold leaf.

Fact 9* When the electric plate, as such, is destroyed by the interposition or continuity of any non-electric, or conductor, an equilibrium takes place within the disturbed electric, and the opposed surfaces of the electric cease to exhibit electrical ph enomena.

Fact 10. When the opposed surfaces are brought near to each other, an equilibrium takes place, by a spark which pro¬ ceeds from any projecting point of one of the surfaces; and heat and light are elicited.

Fact 11. Unless the parts of each opposed surface are united, or rendered continuous by a conductor, the phe¬ nomena are inconsiderable.

Fact 12. Some mechanical action, as friction, variation of volume, or different power of receiving or radiating heat, or atomic motion, is necessary to the production of electrical phenomena.

Fact 13. The power, when excited in any electric, is capable of being transferred to any other electric, provided the surfaces be coated with a conductor.

Fact 14. Bodies are conductors nearly in the same ratio as that in which they are conductors of heat or atomic motion; and they are electrics by a contrary law.

Fact 15. All electrical phenomena take place, and all suc¬ cessful experiments are made, within atmospheric air.

Deductions from these Facts .

Fact 8 Proves, that electricity7 does not permeate the sub¬ stance of conductors; for whether a conductor is hollow or

236

Selections.

solid, or of glass, or baked wood, covered with gold leaf, or of solid metal, the effect is equally powerful. It is, therefore, a gross error to speak of conducting bodies as charged or sur¬ charged, or as containing more or less than their natural quantity, &c.

Fact 1 Proves, that the electrical power resides within the adjoining electric; and this fact, and fact 8, prove that it does not reside within the body of the conductor; the best con¬ ductors having no conducting substance, but only a conduct¬ ing surface.

Fact 15 Proves, that air is the universal electric, and that, in all cases, a plate of air is the thing affected. But air is composed of twenty or twenty-one volumes of oxygen, and eighty or seventy-nine volumes of azote, being the very prin¬ ciples which, by facts 5, 6, and 7? are evolved, and extricated on the opposed sides of every electric plate.

It is inferred from facts 5, 6, and 7, that all cases of elec¬ trical excitement consist merely of. the decomposition or separation of the acid and alkaline principles natural to the substance and constitution of the body, or electric plate; and that the various phenomena attending the partial or general restoration constitute all the appearances called electric and galvanic.

Is the electric power, therefore, any thing more than a mechanical separation, or decomposition of the constituent, or gaseous portions of the electric ? .Are not the gaseous portions, by some peculiar motions, carried to the positive and negative sides of the plate ? Do not all the phenomena proceed, first, from the endeavour of the oxygen and azote to return to their fit combination in air; and, second, from this often taking place suddenly? Is electricity, in fine, any thing more than an accident of the constituent atoms of air, or the similar atoms of other electrics? Or, in other words, as all experiments and phenomena take place in air, are not the phenomena of all other electrics merely relative to the powers of air, and governed by the relative powers of each to the other, as partial conductors and partial electrics ?

These questions, and the consideration of all the facts, lead to the general conclusion,-— that there is no fluid, sui generis, producing electrical phenomena — nor any peculiar fluid, nor any fluid whatever, concerned in electrical phenomena — and that all this class of phenomena arises from the mechanical decomposition, or temporary separation* of the constituent elements of the atmospheric air, or electric medium or fluid, interposed between conducting surfaces, within which electrics all the phenomena take place, as well between

237

Phillips on Electricity and Galvanism.

them and conductors, as between them and other adjacent electrics, and between them and other electrics and con¬ ductors.

Electricity is, therefore, an accident of air, or of the atoms of air, just as wind is an accident of air in mass; and it would be as rational to refer a storm to a peculiar fluid, as it is to refer the phenomena called electrical to a peculiar fluid.

But at the time when the peculiar fluid was first invented, the constituent parts of air had not been discovered ; just as the twofold motions of the earth were not suspected when the fall of bodies was superstitiously ascribed to the earth’s attraction ; or just as the rotation of the earth round the ful¬ crum of the earth and moon was not suspected, when the tides were superstitiously ascribed to the attraction of the moon. But new facts and improved reasoning render it highly proper to get rid of all these properties, per se , fluids, sui generis , and attractions without mechanical cause ! Phi¬ losophy must be cleared of them, or the schools of phi¬ losophy will soon be as contemptible for their appeals to faith, as any of the temples of any superstition with which ignorant tribes are abused by a selfish priesthood, in any part of the world.

Behold how beautiful and simple electricity rises on the wreck of the superstitions with which it has hitherto been entangled !

The excitement, whatever it be, is mechanical; and it pro¬ duces the mechanical effect, of separating the constituent atoms of an affected or electrified plate of air or other electric.

If we excite glass, &c. we produce a preponderance of the acid or oxygen atoms on the proximate surface of air ; and the withdrawing of these necessarily occasions an appa¬ rent preponderance of alkaline or azotic atoms on the opposed surface, which it has hitherto been so difficult to understand.

If we coat the glass surface with a conductor, or congeries of atoms more capable than glass or air of conducting heat or atomic motion, we then unite or connect the points of the electric plate or plate of air.

If we present a similar coated surface in opposition to the first excited plate, we then produce a maximum of effect, i. e. two surfaces which unite all the points of the surfaces of the plate of air, one of which is oxygenated or positive, and the other azotic or negative, both exerting considerable force to co-mix in that state of fitness which rendered them atmo¬ spheric air*.

* Thirty-two years ago, the writer made his prime conductor of a board covered with tin-foil ; and adopting the principle that every con-

Selections .

23S

If, then, any light body, or body whose inertia is less than the force with which the atoms seem to reunite, be presented between the surfaces, or to one surface, (the other being sup¬ posed or understood, and existing in the hand, the operator, or the walls,) then the said body will be driven, or apparently attracted, and will assist in restoring the equilibrium of the affected electric plate.

If the surfaces be moved so near, that the excitement which separated the atoms is overcome by the aptitude of their forms to reunite, and if any small point project on either sur¬ face, carrying the surfaces nearer by the thickness of the said point, then the reunion of the entire surface takes place through that point, and the concentrated force of the simul¬ taneous rush of the oxygenous atoms in one direction, and the nitrogenous atoms in the opposite, produces the action called light ; and also mechanical effects on all bodies which contain either oxygen or nitrogen.

The restoration, the double current, the spark (the stream being an optical illusion), and most of the other wonders, vanish, therefore, when examined by a rational mechanical theory.

The great phenomena of nature, when a vast affected plate of the atmosphere is coated by clouds, are easily understood. Some exciting cause, generally the atomic motion of heat, has decomposed the air; but the effects are dissipated in space, till a cloud coats the upper surface, and connects all the points of the affected plate of the atmosphere. Under these circumstances, some cloud or point of a cloud, sinking below the general level of the surface, or some projecting point on the earth, narrows the plate in that place ; and a con¬ centrated restoration, or partial restoration, takes place at that point, exhibiting lightning, &c. in such imposing grandeur, that priestcraft, in all ages, has seized upon it as means of terrifying the ignorant and superstitious.

One might trace, examine, and easily explain, all the details of the phenomena on this simple and natural theory; but enough has been said to show that electricity is no

ductor is, in fact, but a coating to a plate of air, he arranged similar boards above and below, and thereby decomposed a double plate of air. Galvanism was then unknown ; but if he had heard of the Voltaic pile, he would certainly have imitated it in a common electrical circle. He conceives that the accelerated power gained in this way would be far more splendid than in the galvanic circle ; because, in electricit}', the power is expanded, and results from the energy of natural restoration ; but in galvanism, the exciting power is limited, and not restored, but dissipated.

239

Segalas’ Case of Exhalation of Bloody fyc.

exception to the mechanical principles of matter and motion ; — and in regard to the kindred phenomena of galvanism, 1 will content myself with observing, that it is merely accele¬ rated electricity, the interposing fluid being palpably decomposed, and evolving the electrical powers, each term in the series of plates being a new impulse or power added to the previous one, till the ultimate effect is accelerated, like that of a body falling by the continuous impulses of the earth’s motions, or like a nail, heated red hot by accelerations of atomic motion, produced by repeated percussions of a hammer.

PART IV.

FOREIGN MEDICAL SCIENCE AND

LITERATURE.*

J. analysis of journals. (French).

New Journal of Medicine.

M arch, 1820. — Case of Exhalation of Blood in the Struc¬ ture of the Skin, and on the Surface of the Mucous Membranes generally. By Professor Segalas. — -This fact was observed in a stout man, of sanguine temperament, aged twenty. Epistaxis, induced by brisk exercise in a cold evening, was followed by slight haemoptysis, without cough, and subsequently by haematuria. Third day : black vesicles on the tongue, body, and hands ; headach ; face and eyes in¬ jected ; pulse hard, full, regular ; gums loaded ; buccal, palatine, and pharyngeal membranes unusually red ; right lumbar region painful on pressure. The vesicles were he¬ mispherical, and evidently formed by blood extravasated beneath the epidermis : smaller and more spherical on the tongue than elsewhere. Blood also was copiously poured out by7 the intestinal mucous membrane. Repose, vegetable acids, and ice, were unavailingly prescribed. The haemor¬ rhage increased to a fearful extent; without, however, pro¬ ducing any marked effect upon the system for a time. The strength, at last, gradually declining, and large ecchymoses

* The following typographical errors in the foreign department of the last Number require correction: page 141, line 12, for sight read slight ; page 147, foot-note, add to fstulous patients , whom Dr. Ribes has inspected after death ; page l6l, line 32, for again soluble , read not again soluble; page l65, line 18, read Dr. Kreysig, author oj an elaborate and voluminous monograph, &c. — For. Editor.

240

Foreign Medical Science and Literature .

appealing, the decoction of cinchona, with lemonade, was added to the preceding plan ; and under this treatment the haemorrhage and vesicular eruption soon subsided. This haemorrhage the author considers to be remarkable in many points of view; and especially from the vesicular form which it assumed, the quantity of blood lost without any corresponding degree of debility, and the facility with which it yielded.

On Irritation. By Dr. Caffin. — The object of this paper, not very clear, is apparently to show that irritation differs from exhalation; and that, u according to the varied state of things/’ it may be treated either by tonics or by debi- litants ; since these, not acting against the disease itself, exert their effects only on the state of the forces of the organ affected.

Case of Spontaneous Separation of a great Number of Warty Excrescences. By Dr. Cheneau. — JNumerous excrescences of this description had long occupied the hands of an hysterical and highly susceptible lady, aged forty-four. On the night following the decease of her husband, by which she was deeply affected, all these excrescences separated, leaving the spot which they had occupied wrinkled, but without induration.

Paralysis of several Parts of the Fauces. By M. Delaye.- — An hemiplegic female, aged forty-seven, is the subject of this affection. The tongue, although embarrassed, is moveable with great facility. The velum palati is much relaxed ; the uvula pendent beyond the base of the tongue, without producing any effort of vomiting; speech inarticulate ; the voice resembling that of a person with the velum palati destroyed; deglutition, particularly of liquids, which are commonly ejected by the nasal fossae, very difficult. The fauces are insensible to irritants both mechanical and medicinal. The dysphagia daily increases ; but there is at present no loss of flesh. This complete paralysis of the velum palati ex¬ hibits the uses of the organ in the production of the voice and act of deglutition. The voice of the patient, as before remarked, resembles that of a person with the velum de¬ stroyed; for the organ, incapable of application to the posterior aperture of the nostrils, ceases to modify the sounds, as if it no longer existed : and the same defect of action allows liquids to return by the nasal fossae, which ought to be closed by the velum during deglutition. From the invariable excitement of cough in the attempt to swallow liquids, it is probable that the glottis is not accurately covered by the epiglottis, as it ought to be, during this process.

Georget’s Case of Hydrocephalus.

Case of Hydrocephalus , which necessitated Puncture of the Cranium, in order to admit of the Delivery of the Child. By Dr. Georget. — In this instance, which occurred in a woman, aged thirty, wdio had previously born four children without accident, the abdomen of the foetus was supposed by the midwife to present. But Dr. Georget, on exami¬ nation, distinguished several of the cranial bones widely se¬ parated, and found that the inter-parietal space constituted the presenting point. The excessive volurhe of the cranium rendering delivery wholly impracticable, it was at length punctured with a large trochar; and four pints of a clear yellowish fluid evacuated. Extraction by the feet was sub¬ sequently accomplished without any unfavourable occurrence ; and the woman did w?ell. A very accurate description of the external appearance of the fcetus and admeasurement of the cranium are subjoined. The following were the results of its anatomical inspection: — The cavity, empty in its four superior fifths, contained inferiorly the encephalon. The dura mater was intimately connected both with the bones and the intervening membrane. At first sight, it seemed that the serum had been furnished by the exterior arachnoid of the brain ; but, after having detached the organ, an entrance was readily made by its superior part into a large cavity, collapsed by evacuation of the fluid, and formed by an union of the three anterior ventricles. Its interior surface was smooth, without rupture, erosion, or external communication. Its superior and posterior pa- rietes were formed by a soft delicate membrane, evidently resulting, in the middle and anteriorly, from distention of the corpus callosum ; and laterally and posteriorly, from unfolding of the corresponding cerebral convolutions. The falx cerebri no longer existed. The septum lucidum and fornix were sound; the first directed anteriorly; the second upwards, toward the corpus callosum : so that the commu¬ nication between the different ventricles was established bv

«/

the natural openings. The inferior paries of the cavity exhibited, slightly flattened and anteriorly separated, but otherwise unaltered, the corpora striata and optic thalami. A large vein, proceeding from the plexus, passed over the thalamus, and sent off diverging branches in all directions. The inferior parts of the brain, cerebral nerves, cerebellum, and spinal marrow, were sound. The encephalon was sup¬ posed neither to have increased nor diminished in weight. The author, in his “ Reflections shows himself to be decidedly favourable to the physiological doctrines of Gall and Spurzheim. Monstrous, diseased, or malformed foetuses are, he lastly observes, in general, (as is the case in the VOL. XIV. - NO. 81. 2 I

24 2 Foreign Medical Science and Literature .

present instance,) of the female sex. Is it, he inquires, that this sex possesses less energy of organization than the male ? or that the generative power is stronger and more perfect for the latter than the former?

Case of Fracture of the „ Pelvis, accompanied with Rupture of the Bladder , and Effusion of Urine into the Cavity of the Peri¬ toneum. By M. Jules Cloquet. — An athletic carter, aged thirty-one, was precipitated from his vehicle upon the pave¬ ment, and stricken by tjie extremity of a heavy piece of timber, which fell at the same time, upon the lumbar region, in consequence of this, he was conveyed, December 29, 18 19, to I’Hopital St. Louis. The regions of the loins, pubes, and scrotum, were tumefied, and covered with large ecchymoses ; pulse strong, tense, and frequent. Abstinence, lemonade, and copious blood-letting. The patient had felt no inclination to void urine since the accident. A slight projection above the pubes being observed, a large-sized catheter was without diffi¬ culty introduced ; but a few drops of blood only were voided. Next day, December 80th, no fever; countenance unaltered; respiration free; inferior limbs enjoying their sensibility and power of motion. Urgent but unavailing desire, at intervals, to void urine ; severe pains in the pelvis on the slightest movement ; pubic region soft, and without the tumour before remarked. Professor Rieherand now passed, with facility, yet not without pain, a middle-sized catheter into the bladder ; but some drops of blood only were discharged. On the introduction of a larger, a little urine, mixed with blood, came away. It was ascertained, by the passage of a finger into the rectum, that the instrument was actually in the bladder. An attempt was then made, but without success, to absorb the obstructing mucus or coagula by the adaptation of a small syringe to the extremity of the catheter. On im¬ mersion in the warm bath for two hours, a small quantity of urine was repeatedly voided. Twenty-five leeches to the abdomen, and emollient injections prescribed. The abdo¬ minal tumefaction, at first slight, gradually increased ; and the whole region became very painful, and much distended. Pain aggravated on pressure ; sleeplessness ; constipation ; intense thirst; pulse small, wiry; urine scantily voided, with great difficulty. All the symptoms of acute peritonitis. These increasing, the night of the third day was dreadful. Vehement abdominal pains; profuse diarrhoea; respiration laborious; pulse thready; countenance pale and shrunk; pupils dilated; intellect unimpaired till death, which hap¬ pened on the morning of the fourth day .— Dissection, forty- eight hours aften death. Lumbar region covered with large black and violet patches, surrounded by reddish circles; sub-

243

Cloquet’s Case of Fracture of the Pelvis,

cutaneous cellular structure gorged with black blood, so as to exhibit a spongy and vascular appearance, like the spleen ; coagula of blood between the longissimus dorsi and sacro- lumbalis muscles; muscles themselves uninjured; pubic region, penis, scrotum, and perinaeum, greatly distended by black blood. On opening the abdomen, six pints of a turbid yellowish fluid, with the smell of urine, escaped. A yellow sediment, resembling that which forms at the bottom of a chamber pot, abundantly deposited in the pelvis. Peri¬ tonaeum inflamed, particularly in the vicinity of the small intestines. A large perforation, evidently the consequence of rupture, in the summit of the bladder, and extending on its posterior surtace. Peritonaeum, investing the organ, exhibited two large floating flaps, the ends of which were as even as though cut by a sharp instrument. Bladder collapsed; its parietes, four or five lines thick, ecchymosed and inflamed. Slight ecchymosis below the peritonaeum, which covers die rectum, immediately behind the perforation of the bladder probably resulting from the contact of the catheter, the extremity of which had passed into the peritonaea! cavity, and been thrust against the posterior paries of the pelvis. The ossa pubis were separated a'oout an inch asunder; the cartilage of the symphisis remaining wholly adherent to the left bone. Plorizontal ramus of right pubis, and ascending portion of the corresponding ischium, completely fractured, and their fragments displaced. Sacrum wholly luxated at its articulation with the left ilium, and driven into the pelvic cavity. Right sacro-iliac symphisis ruptured only anteriorly, and the bones preserving their natural relations. Much blood extravasated in the vicinity of the injured bones; and neigh¬ bouring muscles distended, and partly ruptured.—- Refections. Rupture of the bladder from external violence, without apparent lesion of the abdominal parietes, has rarely been observed. The mechanism of the injury is minutely ex¬ plained. The bladder, full of urine, would obviously, during the violent compression which it suffered at the moment of the injury, give way at the weakest part, and where it is least firmly supported : this part is the summit; for there, while the parietes of the organ are thin, they are merely in contact with the convolutions of the small intestine. It is probable that the frequent inclination to void urine, experienced by the patient, might be dependent on the irritation produced by rupture of the bladder : and the mode whereby it was after¬ wards, in small quantities, evacuated, may be thus conceived. The urine extravasated into the peri ton mum would naturally occupy the pelvic cavity. On the violent effort made by the patient to discharge it, the viscera were compressed by the

244

Foreign Medical Science and Literature .

simultaneous contraction of the diaphragm and abdominal muscles; and the urine, then repelled into the bladder through the rupture, passed through the neck of the organ, and escaped. The peritonaeum thus represented, as it were, a large bladder, of which the abdominal muscles constituted the highly contractile parietes. From the great injury sus¬ tained by the pelvic bones, M. Cloquet thinks it impossible that the patient could have walked nearly one hundred paces after the accident, as waS represented *.

Bulletins of the Faculty of Medicine of Paris, &c. 1820. — No. III.

Chemical Examination of the Piper Cubeba. By Professor Vauquelin. — From this analysis, which, considering the cele¬ brity of the operator, we hardly need observe, seems to have been executed with great care, it seems that the seeds of the plant in question contain: — J. An almost concrete vola¬ tile oil. 2. A resin resembling that of the balsam of copaiva. 3. A small portion of another coloured resin. 4. A coloured gummy substance. .5. An extractive principle, analogous to that found in leguminous plants. And, 6. Some saline sub¬ stances.

Case of Hernia of the Stomach through the Diaphragm. By Dr. Lerminier. — A man, aged fifty-two, who, while serving, ten years before, in the army, had sustained a slight lance wound on the thorax, and subsequently fallen from a very high scaffold, complained of languor, indigestion, vomiting, and thoracic pains. On his admission into la Charite, March 8, last, he presented the following symp¬ toms: — Severe pain in the left breast, aggravated by pressure and motion; dyspnoea; infrequent cough, without expecto¬ ration; cheeks flushed; tongue whitish, and moist; thirst urgent; pulse small; constipation. Left side sounding well, although very painful on percussion. The disease was re¬ garded as simple pleuritis. Blood-letting, mucilages, emollient injections, (flb, no better. Epigastric region painless. Blood without trace of inflammatory buff. Blisters to the legs; purgative injections. 10th. Symptoms aggra¬ vated. Blackish blood in the fluid vomited. Death. Dissection, forty-eight hours afterwards.— -Countenance yet wearing expression of pain. Left thoracic cavity filled with an elastic, blackish, elliptic mass- — the stomach and part

* There is, in addition to these articles, an extract of a memoir, by Baron Fourier, entitled “ Analyse du Mouvement de Population/'’ Being itself an analytical article, and consequently insusceptible of analysis, we shall not here notice it.— -For. Editor.

245

Larrey on Wounds of the Thorax.

of the great omentum. The oesophagus, having regularly traversed the diaphragm, turned horizontally to the left above the transverse colon ; and, after a course of about two inches, repassed the diaphragm by an accidental orifice, and pro¬ ceeded in an upward direction with the stomach, the four superior fifths of which were contained in the thorax. The remaining portion of the organ was situated anteriorly to the omentum, and a little to the left of the oesophagus. The stomach, distended by gas, wits placed almost vertically in the thorax, and reached to the level of the second rib. Its two orifices were considerably drawn together, and its curvatures consequently augmented. The thickened mem¬ branes showed the vestiges of vehement inflammation. The internal membrane, especially, was in a state of sanguineous congestion, and rendered four lines thick by the blackish fluid which it contained. The organ in the vicinity of the pylorus tore on the slightest touch; when an extrication of fetid gas and the escape of a bloody fluid ensued. The accidental aperture of the diaphragm, irregularly rounded, with soft, thick, and organized borders, and about fourteen lines in diameter, was distant two inches from the oeso¬ phageal orifice, and existed in the aponeurotic portion of the muscle, to the left of the tendinous centre. The heart was driven on the mesial line of the thorax; the left lung greatly compressed, but sound; the right of its ordinary volume. Large intestine filled with indurated faeces. The case is terminated by some reflections, altogether unim¬ portant, and by a reference to analogous facts. In one man, who, about a year since, was received into i’Hopital St. Louis, and appeared to have an hernia of the colon or omentum, through the diaphragm, there formed, under certain circum¬ stances, a small tumour at the lower part of the thorax, which invariably receded on pressure.

On penet rating Wounds of the Thorax : extract of a memoir by Baron Larrey. — This memoir, which was read by Larrey to the Medical Society, on the 3d and i (3th of March, has for object : —

1. The advantages resulting, in penetrating w'ounds of the thorax, with lesion of the contained organs and haemor¬ rhage, from the mode of dressing proposed by this Surgeon ; and in the discovery of which he claims, and clearly merits, the priority from his friend and fellow-student, M. A. Petit, who published an account of it in I80b#. M. Larrey records several recent instances of the success of this method.

* In a work entitled “ Sur la Medecine du Coeur.” Larrey had published a memoir on the same subject, three years before} in his “ Relation Chirurgicale de i’Armee d’Orient.”

I

246 Foreign Medical Science and Literature.

2. Cases wherein the operation of empyema is necessary to save iife, when, in consequence of a penetrating wound of the thorax, with lesion of vessels, the extravasation is so great as to exclude hope of resolution. Larrey indicates the signs by which the effusion may he distinguished; calls the attention of Practitioners to the phenomena which ac¬ company the operation, to the mode of operating for em¬ pyema, and the process employed by nature in the cure,, Finally, he records the cases wherein he has operated with success; and exhibits to the society the thorax of a soldier, who died from excessive drinking a considerable time after the operation for empyema. The history has been already transcribed by us#.

3. The cases in which, notwithstanding the unfavourable situation and severity of penetrating wounds of the thorax, resolution of the effused fluid may be expected; the signs which distinguish it; and the means whereby nature may be seconded in the process of absorption. Larrey confirms the principles of the memoir by several authentic facts ; and presents to the society the subject of the most remarkable. This is a young Swiss grenadier, the centre of whose left thoracic cavity had been completely traversed by a sword point, so that the intercostal artery was divided, and the middle pulmonary lobe, and probably also the pericardium, wounded. This presumption was apparently confirmed by the attendant phenomena. The pulsations of the heart con¬ tinued, at the date of this memoir, to be perceptible below the anterior cicatrix ; and, in its whole circumference, this side of the thorax is more depressed and contracted than the opposite, and the nipple lower down. The left arm is in a state of decided emaciation, and disposed to atrophy ; and the pulsation of its radial artery comparatively small and feeble.

In the subject of the last case of the memoir, a depressed cicatrix is situated on the cartilage of the third rib, some lines from the clavicle. It resulted from the wound of a sword, which had divided the soft parts and cartilage. The extremities of this, never reunited, continue moveable. Larrey has repeatedly observed that fractures or divisions of the costal cartilages never reunite; and promises to give, in a distinct memoir, an explanation of this phenomenon.

On White Ipecacuanha. By Dr. Merat. — 1'he principal, and, indeed, only important object of this note, is to show that the white ipecacuanha is not the product of a viola, as hitherto presumed, but is obtained from a plant of the family of the rubiacem. M. Gomes refers it to the genus

* Repository, Vol. XI. page 511.

247

II usson on a Caries of the Vertebrae, fyc.

Richard ia, and names this plant the Richardie Brasiliensis. It seems to he the same vegetable as was observed by Fiso two centuries ago, since it accurately corresponds with the description of a plant whose roots he has designated by the name of 66 Ipecacuanha blanca

On a Caries of the three first Cervical Vertebrae , consequent on Jlbscess of the Pharynx. Extracted from a notice by Dr. H usson. — The subject of this case, previously to her admission into lTIbtel Dieu, had suffered all the symptoms of inflammatory angina, consequent on abrupt suppression of the menses. This affection yielded to the appropriate treatment, but left a swelling at the superior part of the pharynx which slightly impeded deglutition. One day, in consequence of a violent paroxysm of coughing, a great quantity of pus had been discharged, and the dysphagia relieved. Some days afterwards, a small piece of dead bone was found in the spitting-pot. On examination of the interior of the throat, pus was seen to issue from the superior and posterior part of the pharynx. The head, inclined towards the right shoulder, could only be turned with difficulty. Suppuration of the pharynx copious, but unaccompanied with pieces of bone. On decline of this discharge, diarrhoea supervened, with hectic fever; and, after considerable haemor¬ rhage from the mouth, the woman died. — Dissection . An orifice, with round and cicatrized margin, at the left posterior and superior part of the pharynx, capable of admitting a little finger, and communicating with a cyst, the parietes of which were unequal, and exhibited, in several points, blackish fungi, fetid, and filled with a black matter containing several pieces of bone. This cyst, extending backwards, seemed to sur¬ round the superior part of the vertebral column. The inferior surface of the bram, the inferior and anterior part of the cerebellum, and anterior surface of the medulla oblongata, were brownish, and covered with a grey stratum of purulent matter, of the thickness of a sheet of paper. The structure of these organs w'as softened in the parts corresponding to this stratum. On looking into the foramen occipitale, the processus dentatus was seen projecting through an aperture of the dura mater with brownish and uneven borders. The anterior arch of the atlas was corroded ; its superior articular processes sound ; the right and left inferior totally destroyed; as was the middle and left posterior part of the arch for the space of six lines. The ligaments uniting this vertebra to the occipital bone were softened ; the anterior destroyed. The processus dentatus, body, and superior articular process of the second vertebra, were carious ; the left and transverse, of the same side, destroyed. The

248

I

Foreign Medical Science and Literature.

inferior articular processes of this vertebra, and the body and superior articular processes of the third, affected with caries. The odontoid ligaments, the occipito-atlantoid, and the transverse ligament, were destroyed; so that the processus dentatus projected naked into the vertebral canal. The liga¬ ments which unite the lateral masses of the first vertebra to the second, the first intervertebral, anterior, and left yellow ligaments, were also completely destroyed.

Journal of Practical Medicine and Surgery.

(German.)

February 1819* Observations and Reflections . By Dr. Ficker.- — Inflammation of the Air Passages, ( Tracheitis , Laryngitis, Bronchitis ). — The present is the continuation of a paper published in a preceding Number, it is very long; and we shall encounter some difficulty in giving a perspicuous view of its contents in the limits to which its analysis must necessarily be restricted.

The formidable disease in question, and its still more formidable consequences, have frequently been observed by the author. Hence, he considers himself capable of delivering an opinion on the state of our knowledge relative to its treatment. The different consequeuces resulting from in¬ flammation of the air passages, more alarming than the primary disease, and commonly fatal, are attributable to the difference of structure and sensibility of the parts affected. Although the writings of Badham, Albers, J urine, and Royer- Collard, have taught us to appreciate, more correctly than heretofore, the inflammation in question, and contributed frequently to obviate its consequences, by prompt resolution of the inflammatory state, we should do wrong to infer that early blood-letting and debilitants will alone suffice to operate this resolution. Every thing depends here, as in all other forms of disease, on regulation of the vital activity in general, and direction of the treatment in a manner conformable to the mode of life and functions of the organ affected. Very rarely has the author employed blood-letting in inflammation of the trachea, larynx, and bronchiae ; and whenever he has prescribed leeches, the indication was founded less on the name of the disease than on the sthenic state of the patient. In the commencement of his practice, he followed Lentin?s method in tracheal inflammation and the membranous angina consequent on it. This consists in application of leeches and blisters, mercurial frictions, emetics, ammonia, and the senega; but, either from some defect in it, or the advanced stage of the disease, not one of four children subjected to this treatment recovered. It is, moreover, not sufficiently

i

249

Picker on Tracheal and Bronchial Affections .

simple; and, even when at times successful, the mixed em¬ ployment of debilitants and excitants necessarily leaves doubt as to the means from which the fortunate issue has resulted.

In membranous angina, where the inflammation terminates by exudation of lymph, and where, consequently, traces of phlegmasia, slight, or at least little proportioned to the degree of exudation, are discovered, every effort of the Physician to resolve inflammation, which no longer exists, is evidently ill-timed. It is the product of the inflammation — the exuded lymph, which must be resolved and eliminated — and the tracheitis, resulting from the presence of such a concre¬ tion, which must he obviated. In most of his fortunate cases, the author has ascribed his success principally to the employment of emetics, calomel, and blisters. When these means have not sufficed, and particularly when the tracheitis is complicated with cutaneous diseases, he has given the mercurial alternately with a mixture composed of elder- flower-water, gum acacia, syrup of althea, carbonate of ammonia, and camphor. Several cases, illustrative of the application of these principles, are then detailed. In other instances he has successfully restricted himself to the employ¬ ment of calomel, emetics, and blisters. ’The first of these remedies he has always administered largely; unintimidated, when the strength of the patient has been unbroken, by the frequent evacuation of copious green or liquid feces. For instance, he has given to a child, aged three years, thirty-five grains of calomel in forty-eight hours. During the employ¬ ment of this remedy in a girl aged two and a half, the linen was observed to acquire a stain of blue from the urine. The vomits were administered when the cough grew less hoarse; and the sound resulting from respiration denoted the exist¬ ence, in the trachea, of loose mucus. Thus decided relief was frequently obtained from evacuation of fragments of membrane streaked with blood, or mixed with lymph and mucus. How the muscular efforts and shock produced by vomiting will more effectually than the cough expel the loose lymph obstructing the trachea, may readily be con¬ ceived ; but it is difficult to explain the operation of mercury and ammonia in resolving the thick and adherent lymph. They probably exert a specific action, whereby is reduced to its regular standard the serous exhalation which had gone on' to exudation; and the suspended mucous secretion is re¬ established. In this way the sulphuret of potash, so much extolled by Senff, apparently operates.

Tracheal inflammation may again prove fatal, without the occurrence of exudation, merely froth spasmodic constriction of the glottis and bronchiae. This is proved by the obser- vol. xiv, — no, 81. 2 k

£50

Foreign Medical Science and Literature .

vations of Remer on tracheitis sicca. In these cases, dis¬ section shows traces of inflammation much more distinct than when exudation has taken place. Sometimes death may ensue in croup from spasm, in consequence of the newly- formed membrane acting as a foreign body on the irritable organs of respiration. Dr. Ficker saw a child, one year and a half old, under circumstances which left no doubt of the existence of croup, die on the second day of the disease; and on dissection of the windpipe, was discovered, with slight traces of tracheal inflammation, a thin membrane, and at the same time, in the right sinus of the larynx, a kidney-bean, which had served more powerfully than the exudation to excite sympathetic spasm of the glottis.

In latter times, the existence of the spasmodic angina described by Miliar has been denied, and the affection said to be identical with tracheitis. This opinion Dr. Ficker cannotadmit; since he has repeatedly cured, by anthelmintics, purgatives, and antispasmodics, children who, with all the syonptoms of membranous angina, have suffered from time to time paroxysms of suffocation, and subsequently remained for several hours without any other sign of disease than pale sickly countenance and accelerated pulse. And no one surely will contend, that by such means tracheitis has been dissipated. The spasmodic angina just mentioned is a formidable disease, and should have its causes closely inves¬ tigated. In musk, recommended by VVichmann as a specific in the treatment of it, implicit confidence cannot be reposed. An interesting case of the failure of this remedy, in a child aged sixteen months, is here recorded. On dissection, the back, buttocks, and thighs exhibited several blue spots; no trace of inflammation or exudation discovered in the trachea or bronchiag ; pericardium contained more fluid than common ; aortic ventricle, and large vessels, full of black blood; small patches of black blood on the surface of the lungs, particularly the right lobe. 'This affection, then, is probably fatal from spasmodic obliteration of the glottis; and hence the author proposes to try, on the first occasion which presents, the introduction ofacanuia by tracheotomy, in addition to the means ordinarily employed in asphyxia from suffocation; and he thinks that success from such operation is much more probable in this case than in croup.

The latter, whatever may be the efficacy of mercurials, alkalis, blisters, and vomits, is one of the most dangerous diseases of infancy. Trachehis once developed, its progress should be instantly arrested. The inflammation is, however, sometimes so slight as to be dissipated without the inter¬ ference of art. Dr. Ficker has known several instances of

251

Fieker on Tracheal and Bronchial Affections.

spontaneous cure; but they are not sufficiently numerous to justify inert or temporizing practice. The constitution of the patient, and other circumstances indicating venesection, it should first of all be had recourse to, in tracheitis and bronchitis, as in other inflammations. But blood-letting is not always indispensable; for if the mucous secretion be promptly restored by other means, exudation will be pre¬ vented. On the former of these secretions, no medicine acts more effectually than muriate of ammonia; and by employ¬ ment of this, of blisters, and frictions with volatile cam¬ phorated liniment, the author has repeatedly succeeded in resolving tracheal and bronchial inflammations.

While it were wrong to consider tracheitis impending whenever a child becomes hoarse, this alteration of voice, if of long duration, and accompanied by dyspnoea, hard cough, and fever in children, or frequent tickling cough in adults, certainly merits serious attention. These symptoms, in fact, indicate an inflammatory state of the larynx or trachea, which may soon be converted either into augmented mucous secretion, exudation of lymph, or suppuration. Tracheitis or bronchitis, which in adults terminates in increased mucous secretion, will provoke in children exudation of lymph. If in adults the inflammation principally occupy the larynx, and do not speedily terminate in abundant mucous secretion, metamorphosis to the cartilages, ligaments, and glands, fre¬ quently supervenes. Every catarrhal affection and morbid irritation in remote organs is then communicated to these parts, altered in their constitution and excitability; and determine anew chronic inflammation, with exudation of lymph, or increased mucous secretion. This state may con¬ tinue for years, till suppuration takes place, which at once destroys the structure of the organs and the patient. Thus the author has often seen slowly arise this tracheal or laryngeal phthisis in spirit-drinkers, and hypochondriacs affected with piles. The disease began with dry, hollow, infrequent cough, accompanied by hoarseness. Gradually there came on scanty expectoration of an albuminous, or at the same time mucous matter. The patient complained of titillation in the larynx, which, on inspiration of cold air, speaking, or deglutition of a liquid, particularly when cold, was converted into cough, with the expectoration just men¬ tioned. Sometimes these phenomena disappeared, and the patient seemed to have regained health; but from exposure to cold, or dietetic error, the symptoms speedily recurred. After several such relapses, the patient experienced, instead of titillation, painful sense of tension, or dryness of the larynx, occasionally along the whole course of the trachea, and sometimes slight shooting pains in the thorax. He becomes

252 Foreign Medical Science and Literature,

morose; has frequent rigors, followed bv transient heat, with flushed face, and accelerated pulse. The febrile pheno¬ mena become gradually more continued, cough aggravated, expectoration purulent, deglutition difficult; frequently the patient chokes, and is then distressed with violent spasmodic cough ; the voice grows more hoarse ; the cough is increased during meals, or a kind of strangulation with vomiting super¬ venes ; sometimes the cervical glands swell, and faucial inflammation farther aggravates the dysphagia: lastly, speech becomes unintelligible; and continued fever, with night- sweats, emaciation, sometimes diarrhoea and urgent thirst, destroys the patient. The lungs and trachea generally, and invariably the larynx, are found ulcerated, on dissection of these cases. In one young man, who for years had suffered from a violent hypochondriacal oppression, palpitation, ver¬ tigo, flatulence, and abdominal distention, the mucous mem¬ brane of the larynx was loose, and partly ulcerated; both chordae vocales eroded, and the internal surface of the posterior part of the cricoid cartilage, as it were, fretted. In the right lung there were several purulent cysts; in the pericardium, an unusual quantity of water; and the transverse and descending portions of the colon were much contracted.

That laryngeal phthisis, when it has attained this stage, resists every remedy, is well known; yet even here great relief may be obtained from inhalation of the vapours of the chenopodium, ambrosoides, and belladonna, from gargles of acetate of lead, and frictions with volatile camphorated liniment. In the first period, the muriate of ammonia, and mercury, exercise as salutary an action as in tracheitis; in th e second, characterized by increased secretion of mucus, and albuminous exudation, suppuration may still be pre¬ vented, by a decoction of the poly gala amara with extracturn hyoscyami, and liquor ammoniacalis ; and at last, by cin¬ chona and lichen Islandicus. The three cases published by Thomann, and designated by the name of inflammation of the broncbiae, were apparently, in two instances, inflammation of the larynx and trachea. In the third, dissection certainly proved the existence of bronchitis; but, with respect to diagnosis, none of these cases is very conclusive, on account of their complication with induration, adhesion, and sup¬ puration of the lungs, or exudation in the cavities of the thorax and pericardium. The cases of Jurine, likewise* almost all pretent a complication of tracheitis and bronchitis. The asthenic bronchitis described by Badham was a paralytic state of the bronchise, with or without inflammation of the lungs or pleura,— -an affection equally common and dangerous in children and adults. 'Dae bronchia;, invested with the same mucous membrane, and exposed to the same noxious in-

Steinriik’s Case of Thoracic Aneurism. 2,53

fluences as the larynx and trachea, are as susceptible as they to inflammation. Very frequently all these parts suffer; and hence it is difficult to determine whether the trachea or its ramifications have been principally affected. When, however, the bronchiae are alone or principally inflamed, the respiration is from the onset much more disordered than in pure tracheitis ; inspiration is particularly difficult, and an accurate observer may, especially during the sleep of children, ascertain that the wheezing sound of inspiration proceeds not from the larynx or trachea, but from the bottom of the thorax. Pyrexia invariably exists in the commencement of this inflammation; but the cough is more infrequent than in laryngitis or tracheitis. It is also hoarse; in the latter stage, less shrill than in these diseases, but rattling. Sometimes there occurs, as in spasmodic angina, a decided remission of the dyspnoea ; yet in most cases this symptom is constant. At last the cough ceases, rattling respiration succeeds, and the patient dies. When the in¬ flammation is successfully combated, the cough becomes loose ; and if the patient possess sufficient strength, a large quantity of lymph, mixed with yellow mucus, is expectorated. This is followed by marked relief : while in pulmonary phthisis the strength fails in proportion as the expectorated matter becomes copious and liquid.

Inflammation of the bronchiae requires the same treatment as laryngitis and tracheitis. Muriate of ammonia, mercury, musk, and blisters, have frequently sufficed, in the hands of Dr. Picker, to dissipate it, without the aid of blood-letting. In fact, the dissections made by Frank, Jurine, and Badham, prove that the latter is by no means an infallible remedy.

Four cases are lastly detailed in illustration of the prin¬ ciples which Dr. F'icker advocates. These, with several others in the body of this interesting memoir, we regret that the length to which we have already extended our analysis will not allow us to notice.

New Experiments on the Employment of the Prussic Acid . By Dr. J. A. Manzoni.- — This memoir is the abstract of a work entitled “ De praecipuis Acidi Prussici et Aquae coho- batae Lauro-cerasi, Medicis Facultatibus, Clinicis Observa- tionibus comprobatis. Specimen J. A. Manzoni. Quarto. IBIS. Batavii.” This article, as an analysis of a distinct memoir, is excluded from our plan. We shall presently notice it elsewhere.

Remarkable Case of a large Thoracic Aneurism , By Dr. Steinriik. — Has been already translated in this Journal*.

* Repository, Vol. XII. page 177

2,54

Foreign Medical Science and Literature.

New Discussions, in England , on the Preservative Efficacy of Vaccination. — Literal translation of an article in the review department of the Edinburgh Medical and Surgical Jou rnal*.

Contributions to Juridical Medicine . By Dr. Hinze. — It is the object of the author, in this communication, to confirm some opinions recently advanced by Dr. Klein, of Stutgard, that the bodies of persons who have destroyed themselves by suspension do not exhibit the pathognomic phenomena indicated in medico-juridical writings, as characterizing asphyxia by strangulation, nor the same as are observed in persons destroyed by this kind of asphyxia without suicide. All such subjects are peculiarly worthy of attention. Under this impression, we shall, in our next Number, present a nearly literal transcript of the article to which we have now briefly adverted.

Miscellaneous Practical Observations. Bv Dr. F. W.

j

Wesener,— -1. Intermittent Fever.-— After having observed and treated numerous cases of an intermittent fever, which, in 1809 and 1810, prevailed epidemically in the neighbour¬ hood of Dulmen, the author is convinced that this fever may be communicated by immediate contact, and particularly by the perspiration of the patient. Large doses of cinchona he reprobates as unnecessary in the treatment of this fever; and asserts, that the object in view may be attained as cer¬ tainly, and with much less inconvenience and expense, by administration of the remedy in small doses. It is his practice to give ten grains of powdered cinchona, ten of cinnamon, and twenty of calamus aromaticus, every two hours, during the apyrexia : and this plan he has found to be almost invariably successful.

2. Earthed Intelligence of a Patient whose Case was commu¬ nicated in Hufeland’s Journal for August, 1810.— The man in question was apparently suffering from an organic affection of the pylorus. Numerous remedies had been employed in vain; when he was advised to drink, every morning, four ounces of a saturated solution of muriate of soda. By this means, the symptoms were signally mitigated. Dr. Wesener attributes its good effect to the relaxation produced by the muriate of soda on the orbicular muscle of the pyloric orifice.

3. Treatment of Inveterate Ulcers by the Circular (adhesive) Plaster. — To the efficacy of this method, the experience of ,Dr. Wesener is decidedly favourable.

4. Chemosis — Two cases of very severe cheniosis are here

* Number for Julv, 1 818.

«r '

Medical and Physical Intelligence. 255

detailed. One of them terminated in a carcinomatous affec¬ tion of the eye-ball, which was consequently extirpated. An enormous fungous excrescence sprung up, and the patient survived the operation scarcely one year.

PART V.

MEDICAL AND PHYSICAL INTELLIGENCE.

NOTICES OF LECTURES.

Dr. Uwins’s Lectures on the Theory and Practice of Medicine will commence on Tuesday, the 3d of October, at a quarter before Seven in the Evening.

Arrangement of Dr. Uwins’s Lectures on the Theory and Practice of Medicine : —

PART I.

General Physiology and Pathology. - — Anatomy, habits, and general disorders of the blood-vessels ; anatomy, habits, and general disorders of the lymphatic system ; anatomy, habits, and general disorders of the nerves.

PART IT.

Particular Affections of Parts or Organs . — 1st. Of the head. 2d. Of the tracheal and thoracic organs. 3d. Of the alimentary and intestinal canal. 4th. Of the abdominal viscera, including affections of the urinary and uterine organs. 5th. Cutaneous affections.

PART III.

Disorders not decidedly local or organic, although affecting some parts or textures more readily and generally than others. — Rheumatism, gout, fevers, both such as are decidedly of specific origin, and those the sources of which are less certain.

PART IV.

On diagnosis, prognosis, toxicology, and on restoring suspended ani¬ mation.

The whole to be comprised in about thirty-six readings, to be delivered on Tuesdays, Thursdays, and Saturdays, at a quarter before Seven in the Evening,

Dr. Uwins can accommodate one or two young Gentlemen who may like to reside with him during their attendance upon his and other Lectures, &c. They will have the advantage of being Pupils to the Medical Practice of the City Dispensary.

Mr. Gray’s Lectures on Materia Medica, Pharmaceutical Chemistry, and Botany, commence on Thursday, the 12th of October, at Five in the Afternoon.

Mr. Edward Grainger, Jun. will commence his Autumn Course of Lec¬ tures on Anatomy and Physiology, on Tuesday, the 3d of October, 1820, at Twelve o’clock, at his Rooms, 13, St. Saviour’s Churchyard, Southwark. The Lectures will afterwards be delivered daily, at Eleven o’clock. Terms : Lectures and Dissections, Single Course, 31. 3s.; Perpetual, 101. 10s. Three Courses are given in the year, beginning in October, January, and June. A few Gentlemen are received as House Pupils.

256 Medical and Physical Intelligence .

Dr, Conquest, F.L.S , and Physician Accoucheur to the City of London Lying-in Institution, will commence a Course of Lectures on the Principles and Practice of Midwifery, on the Diseases of Women and Children, and on some points of Medical Jurisprudence, on the first Monday in October, at his House, 4, Aldermanbury Postern, at a quarter past Five o’clock in the Evening.

Royal Dispensary for Diseases of the Ear, 10, Dean Street, (removed from Carlisle Street.) — Mr. Curtis will commence his next Course of Lectures on the Anatomy, Physiology, and Pathology of the Ear, and on the Medical Treatment of the Deaf and Dumb, on Monday, October 2d. For particulars apply to Mr. C. at his House, 2, Soho Square.

Dr. Cloves and Dr. Gregory will commence their Winter Course of Lectures on the Theory and Practice of Physic, and on Materia Medica, on Monday, October 9th, at Nine o’clock in the Morning, at No. 14, Old Burlington Street.

Medical School, St. Bartholomew’s Hospital.-— The following Courses of Lectures will be commenced at this Hospital, on Monday, October 2d, at Two o’clock :

On the Theory and Practice of Medicine, by Dr Hue.

On Anatomy and Physiology, by Mr. Abernethy.

On the Theory and Practice of Surgery, by Mr. Abernethy.

On Chemistry and Materia Medica, by Dr. Hue.

On Midwifery, by Dr. Gooch.

Practical Anatomy, with Demonstrations, by Mr. Stanley.

Further particulars may be obtained by applications to Mr. Wheeler, Apothecary to the Hospital; or Mr. Anderson, Medical Bookseller, 40, West Smithfield.

Theatre of Anatomy, 18, Berwick Street, Soho. — The Winter Course of Anatomical and Physiological Lectures, given by Mr. Herbert Mayo, will commence on Monday, the 1st of October, at Two o’clock. The corre¬ sponding course of Anatomical Demonstrations, and Instruction in Practical Anatomy, will be given by Mr. Herbert Mayo, and Mr. A. Wyatt, jointly.

Mr. Davies, Member of the Royal College of Surgeons, of the Medico- Chirurgical Society, Surgeon in the Army, Surgeon to the Household of his Royal Highness the Duke of Cumberland, Surgeon Man-Midwife to several Lying-in Charities, &c., will commence his Autumn Course of Lectures on the Theory and Practice of Midwifery, and on the Diseases of Women and Children, in the Waiting Room of the Royal Westminster Infirmary for Diseases of the Eye, Mary-le-bone Street, Piccadilly, on Tuesday, Oc¬ tober 3d, at a quarter past Ten o’clock in the Morning. To be continued as usual, and with occasional Examinations. Medical Officers of the Navy, Army, and the Ordnance, will be admitted to attend these Lectures, on presenting a Recommendation from the Heads of their respective Departments to Mr. Davies, at his House, No. 29, Conduit Street, on Monday, Wednesday, and Friday Mornings, before Eleven o’clock.

Medical Theatre, No. 42, Great Windmill Street. — Lectures on Physio¬ logy and the Practice of Physic, by Richard Harrison, M.D., Fellow of the Royal College of Physicians, F.L.S., &c. &c. ; will commence at Nine o’clock on Monday Morning, the 2d of October. On the Materia Medica, including the Doctrines of Pharmacy and Therapeutics, by John Ayrton Paris, M.D., F.L.S., Professor of the Materia Medica to the Royal College of Physicians; will commence at Ten o’clock, on Monday, the 2d of October. The Lectures will be continued every Monday, Wednesday, and Friday, at the above hours. Further particulars may be had by applying to Dr. Paris, No. 23, Dover Street; Dr. Harrison, No. 6, Argyll Street; or at the Medical Theatre, Great Windmill Street.

Medical and Physical Intelligence . 257

Forensic Medicine. By Dr. Smith, at the Royal Westminster Infirmary for Diseases ol the Eye. Course commences in January.

Dr. Clutterbuck will begin his Autumn Course of Lectures on the Theory and Practice of Physic, Materia Medica, and Chemistry, on Monday, the 2d ot Octooei, at len o Clock in the Miorning, at the Oeneral Dispensary, Aldersgate Street, where further particulars may be had.

LITERARY NOTICES.

Preparing for publication, a Concise System of Anatomy, for the Use of Medical Students. By Edward Grainger, Jun., Member of the Royal Col¬ lege ot Surgeons, and Lecturer on Anatomy and Physiology.

__ Poisons. — Shortly will be published, in a small neat pocket volume, a Concise Treatise on Mineral, Vegetable, a!id Animal Poisons ; in which are detailed the Symptoms, Mode of Treatment, and Tests of each particular Poison, with the general Morbid Appearances on Dissection. To which is added, an Account of those Means necessary to be employed in Cases of Suspended Animation, from Drowning and other Causes.

Preparing for publication, a Treatise on the Plague, designed to prove it contagious, from Facts founded on the Author’s Experience, during the Visitation of Malta, in 1813; with Observations on its Prevention, Cha¬ racter, and Treatment; with an Appendix, containing Minutes of the Author’s Evidence, given before the Contagion Committee of the House of Commons, accompanied by their Report. By Sir A. B. Faulkner, M.D., Fellow of the Royal College of Physicians, &c. &c.

On the 1st of October will be published, Outlines of Midwifery, developing its Principles and Practice; with Illustrative Lithographic. Engravings. 1 vol. 12mo. Principally designed for Students. By Dr. Conquest, M.D., F.L.S. &c.

In the Press, the Continuation of the Narrative of Miss Margaret M‘Avey’s Case ; with general Observations upon the Case itself, &c. ; and with additional Proofs of her Blindness : also Strictures upon Mr, Joseph Sanders’ Pamphlet, entitled, “ Flints to Credulity,’7 upon the Letters of Mr. Egerton Smith, the Editor of the Liverpool Mercury, and upon the general Conduct of her Opponents towards this suffering Female and her Supporters. To which will be added, an Account of the Dissection of her Body, and the Appearances thereon. By Robert Harrison, A.B., M.R.C.S.,

L. S.D., one of the Demonstrators of Anatomy, &c. to the School of Surgery of Dublin ; with Observations upon the same. By Thomas Renwick,

M. D., Physician to the Liverpool Infirmary.

Sure Methods of attaining a Long and Healthful Life ; with the Means of correcting a Bad Constitution. By Louis Cornaro. Thirty-third Edition. Translated from the Italian. With a Portrait of Cornaro, from a Painting by Titian. Royal 18mo. boards. Price 2s. 6d.

A Toxicological Chart ; in which are exhibited, at one View, the Symp¬ toms, Treatment, and Modes of Detecting the various Poisons, Mineral, Vegetable, and Animal, according to the latest Experiments and Observations, (most respectfully dedicated to the Royal Humane Society). By a Member of the Royal College of Surgeons in London. Price 2s. 6d.

A Catalogue of Books in Anatomy, Medicine, Surgery, Midwifery, Che¬ mistry, Botany, &,c. ; which, with Books in every other Department of Literature, are on Sale at John Anderson’s Medical Circulating Library, 40, West Smithfield.

Lectures on the Duties and Qualifications of a Physician ; more par¬ ticularly addressed to Students and Junior Practitioners. By the late John Gregory, M.D., F.R.S., &c. &c. 12mo. Price 4s.

VOL. XIV. - NO. SI.

Q.

L

258

A METEOROLOGICAL TABLE, From 21 st of JULY to 20 th of AUGUST \ 1820, KEPT AT RICHMOND, YORKSHIRE.

D.	Baroi Max.	neter. Min.	Th( Max	irm. Min.	Rain Gauge.	Winds.	Weather.
21	29	57	29	49	71	49	15	NE.W.	1 Mist... 2 S.. 3 R.. 4 M..
22	29	52	29	50	66	50	08	NW.	1 Sun. & Show.
23	29	62	29	59	71	50		W.	1 Sun.
24	29	51	29	49	75	51	01	W..	13 S.. 2 Cl... & Sh. 4 M...
25	29	57	29	51	66	51	02	w..	1 Sun.. & Show. 3 Sun...
26	29	62	29	58	72	57		wsw..	1 Sum. 3 Show. 4 Cloud..
27	29	63	29	58	70	56		sw...	1 Cloud.. 2 Sun. 3 Rain.
28	29	70	29	68	72	54		w..	1 Sun.
29	29	70	29	69	78	59		sw..	1 Sum.
30	29	66	29	51	81	57		SW.SE.	1 Cloud.. 2 Sun...
31	29	44	29	34	85	64		s.	1 Mist... 2 Sun.. 3 Show.
1	29	62	29	49	75	51		sw...	1 Cloud... 3 S.. & Sh. 4 St...
2	29	65	29	63	75	60	07	sw..	1 Sun.. 4 Rain.
3	29	38	29	28	79	62	06	ssw..	14 Show. 2 Sun..
4	29	38	29	38	74	52		sw..	1 Sun...
5	29	40	29	22	71	55	09	SW...S.	1 Show. & Sun...
6	29	24	29	14	68	55	61	SEi.SW..	1 Sh .&S ,2Th . Lt .&R . . . . 3S . . .
7	29	53	29	51	68	51		SW..	13 Sun... 2 Show. 4 Starl...
8	29	36	29	23	65	55	11	s.sw...	1 Sun. & Show..
9	29	83	29	66	72	52		sw....	1 Sun... 2 Cloud.. 4 Star!,...
10	29	87	29	83	70	55		sw...	1 Sun... 3 Cloud..
11	29	87	29	83	71	55		SW...	1 Sun..
12	29	79	29	75	71	51		w..	1 Sun.. 4 Cloud...
13	29	68	29	55	74	58		wsw..	1 Sun..
14	29	53	29	47	71	58	02	sw..	13 Sun. 2 Rain. 4 Starl..
15	29	31	29	29	76	58	11	s.sw...	14 Cloud... 23 Sun. & Sh..
16	29	39	29	30	70	55		sw..	1 Sum.
17	29	49	29	48	69	47	17	WbN..	1 Rain.. 2 Sun...
18	29	48	29	43	67	42	21	sw.	1 Sum&Sh...4M...rn.g. 21.
19	29	50	29	48	65	44	01	NW.	1 Sum. & Show.
20	29	63	29	63	61	47	06 NE.	1 Sun. & Show. 3 Cloud..

The quantity of rain during the month of July was 1 inch, 61-100ths.

Observations on Diseases at FJchmond.

The disorders under treatment were, Abortio, Catarrhus, Cholera morbus, Cynanche tonsillaris, Diarrhoea, Dyspepsia, Dyspnoea, Dysuria, Febris simplex, Gastrodynia, Obstipatio, Ophthalmia, Palpitatio, Rubeola, and Vertigo.

259

THE METEOROLOGICAL JOURNAL,

From the 20 th of JULY to the 1 Qth of AUGUST , 1820,

By Messrs. HARRIS and Co.

Mathematical Instrument Makers , 50, High Holborn.

D	Moon I - - . -	& &	Therm.		JBa	rom.	De Luc’s Hy groin.
20			60	72	58	29	62	29	82	59	59
21		,42	61	71	56	29	89	29	97	68	57
22			60	70	58	29	95	29	94	54	54
23			60	71	57	29	95	30	00	54	54
24			60	70	61	30	00	29	93	55	56
25	0		65	70	55	29	88	29	94	58	52
26		,03	61	69	61	30	03	30	07	53	55
27			65	73	59	30	07	30	03	57	54
28			65	72	63	30	04	30	06	57	53
29			65	73	62	30	09	30	09	54	55
30			67	77	60	30	08	29	91	54	56
31		,41	66	77	65	29	85	29	83	56	55
A 1	D		68	75	58	29	82	30	00	55	51
2			61	73	62	30	09	SO	11	53	52
3			65	75	70	30	00	29	84	56	57
4			68	76	58	29	76	29	83	59	55
5		,7	62	73	58	29	84	29	85	54	55
6		,11	62	68	55	29	70	29	64	59	55
7		,12	58	66	55	29	75	30	00	55	53
8			59	62	58	30	00	29	83	55	53
9			61	68	57	29	97	30	18	55	53
10			60	69	60	30	27	30	37	55	53
11			62	70	59	30	27	30	19	56	54
12			61	71	58	30	18	30	13	54	53
13			60	66	59	30	11	30	03	52	54
14			65	72	59	29	98	29	92	50	52
15		,02	61	70	62	29	90	29	81	52	56
16			65	73	65	29	81	29	88	58	57
17	<L		68	72	59	29	80	29	86	58	54
18			61	68	57	29	81	29	79	52	49
19			59	63	50|	29	73	29	82	52	53

Winds.

wsw

w

WNW

NW

W

WNW

NW

VV

w

NNE

SSE

■SE

WSW

wsw

sw

wsw

w

sw

WNW

WNW

WSW

NE

W

WNW

WNW

NW

WNW

NW

W

w

NNE

WSW

SSE

SW

WSW

SW

SW

wsw

sw

sw

w

wsw

WNW

wsw

w

NNE

ENE

WNW

WSW

WSW

NNW

WNW

WNW

Atmo. Variation.

Fine

Clo.

Fine

Clo.

Clo,

Fine

Fine

Clo.

Fine

Fine

fine

Fine

Clo.

Fine

Clo.

Rain

Fine

Rain

Fine

Fine

Fine

Fine

F'ine

Fine

Clo.

Fine

Fine

Clo.

Clo.

Clo.

Fine

Rain

Fine

Fine

Sho.

Sho.

Fine

Fine

Fine

Fine

Lt.r.

Rain

Fine

Clo.

Sho.

Sho.

Clo.

T.l.r.

Clo.

Clo.

Fine

The quantity of rain fallen in July is 2 inches and 51-lOOths.

260

A REGISTER OF DISEASES Between JULY 20th and AUGUST 19th, 1820.

DISEASES.

Aborti . . *

Abscessio .

Amenorrhoea . .

Anasarca . .

Albina Pectoris .

Anorexia .

Aphtha lactentium « • • «

• - - anginosa .

Apoplexia .

Ascites . * .

Asthenia . . .

Asthma .

Atrophia • • • . .

Bronchitis acuta .

- chronica • • • •

Bronchocele . . • •

Cancer . . .

Carbunculus .

Cardialgia • • .

Carditis . . .

Catarrh us . .

Cephalalgia .

Cephalaea . .

Chlorosis .

Chorea .

Cholera . . .

Colica .

- - Tictonum .

Convulsio .

Cynanche Tonsillaris • •

- Parotidea • • • •

- Laryngea • • • •

Diarrhoea • • • • . .

Dolor lateris . . . . . .

Dysenteria .

Dyspepsia .

Dyspnoea .

Dystocia . .

Dysuria .

Ecthvma • • • . . .

Eczema .

Empyema . .

Enteritis .

Entrodynia .

Epilepsia .

Epistaxis .

Erysipelas .

Erythema l<zve .

Febris Intermittent • • • * - catarrhalis .

4-»	3
o H
9
10	i
8
11	i
1
1
9
2
5	4
11	2
7
14
1
1
2
1
1
4	1
2
1
16
25
1
3
10
25	4
6
5
1
27
3
2
30
2
_ 7
40
9	1
1
1
3
1
2
5
2
3
4
8	1
2
5
9

DISEASES.

Febris Synochus .

- Typhus mitior • • •

- — Synochus ••••*•

- Remit. Infant . • •

Furunculus . .

Gastrodynia .

Gonorrhoea pura • = •••

Haematemesis . .

Hasmoptoe . .

Hasmorrhois . . * • •

Hemiplegia . .

Hepatalgia .

Hepatitis . . . .

Hernia .

Herpes Zoster « • . .

— - praputialis • • • •

Hydrocephalus ••••••••

Hydrothorax .

Flypochondriasis .

Hysteria .

Icterus . . *

Impetigo figura ta' • • • • •

- - rodens .

Ischuria .

Lepra .

Leucorrhoea • * . .

Lithiasis . *

Mania .

Melancholia . .

Menorrhagia • . .

Morbi Infantiles* .

- Biliosi* .

N ephritis .............

Obstipatio • .

Odontalgia .

Ophthalmia .

Otalgia * .

Palpitatio .

Paralysis .

Paronychia * . . .

Pericarditis .

Peripneumonia .

Peritonitis ............

Pertussis .

Phlegmasia dolens .

Phlogosis .

Phthisis Pulmonalis • • • •

Pleuritis . * .

Pleurodyne .

Pneumonia * • . . *

OO _ ^ _ _ Or j Fatal

261

X>| nervations on Prevailing Diseases .

>.■

DPSE/SES.

V T //

iag^ .

' Pojysarcia .

- dP&rigo larvalis ■

Prurigo wzRis .

Psoriasis guttata •

Pyrosis .

Rheuina acutus • • • — - chronicus

Iloseola .

Rubeola . -

Scabies . .

Scarlatina simplex -

Scrofula < Spas mi <

angmosa

1 Total. 1	Fatal.	DISEASES.	Total.
2		Splenitis .	2
1		Strictura .	2
2		Singultus . .	1
1		Syphilis .	24	1
3		Tabes Mesenterica • • • •	3
2		Tussis . .	2
16		Vaccinia • • . . . • • •	21
24		Varicella .	9
3		Variola .	48	4
23	1	Vermes .	15	2
67		Vertigo .	11
6		Urticaria evanida .	1
4
7		Total of Cases .	1066
2		Total of Deaths .		39

* Morbi Infantiles is meant to comprise those Disorders principally arising from den¬ tition or indigestion, and which may be too trivial to enter under any distinct head; Morbi Biliosi, such Complaints as are popularly termed bilious, but cannot be accurately classed.

Observations on Prevailing Diseases .

Although four fatal instances are recorded of cholera, the generality of cases have not hitherto been marked by much malignancy. One of our Reporters adds to the word cholera “ all mild cases ;ff and this report cor¬ responds with our own observation.

In dispensary attendance, two individuals (a mother and child at the breast) were found both affected with a kind of paralytic rheumatism. The walls of the room were fresh painted. Query. Were these cases of colica pictonum ? The intestinal functions and feelipgs were not much deranged in the parent, but considerably so in the child. Has white lead, used in paint, power to affect, in any other way than through the medium of the stomach, or by actual contact with the skin ? This query is put, inasmuch as the deleterious quality of paint is attributed by some entirely to the vehicle with which it is prepared ; but would turpentine, diffused in any way, affect the nerves or the general frame in the manner which we find often to be the case, when a person is exposed to the fumes of fresh paint ?

Mr. Furnivall’s Remarks, appended to his Report.

a Infantile disease has very much prevailed during this month; the Reporter having seen upwards of fifty cases ; the symptoms in all nearly similar ; and when the remedial measures were adopted early, they generally subsided — two cases only having proved fatal. The children were first attacked with continued vomiting, having a great desire to take food, and immediately afterwards ejecting it; a discharge of loose offensive evacua¬ tions from the bowels, which ihe mothers always considered the most dis¬ tressing complaint, as they only desired (to use their own phrase) something to settle the bowels. These produced, in a very few days, a rapid wasting

262

Prices of Substances employed in Pharmacy.

of the whole frame. The flesh became flabby to the touch, and much reduced in size; and the usual distress of countenance, that so perfectly marks infantile enteritic disease, came on: the legs were constantly drawn up to the belly. Jn this state, the successful plan of treatment was the warm bath twice a day, and powders every fourth hour, composed of hydrarg. c creta, calomel, and p. rhei, premising their exhibition with a brisk purgative. The second stage of the complaint in a very few days came on, if relief had not been sought for. It was evinced by the symptoms becoming most decidedly cerebral. The child got drowsy, and would always be asleep excepting when roused to be fed, or take the breast; which it soon after returned from the stomach, and then sunk into its lethargic state ; in which it was continually throwing its hands up to the head, tearing off the cap, or whatever else covered it. Convulsive starts of the body, and the eye-balls rolling upwards, with involuntary fits of crying, combined to show the nature of the malady less equivocal. From these symptoms relief was generally obtained by leeches to the temples, blisters to the crown of the head, and, afterwards, an evaporating lotion, with large doses / of calomel, antimonial powder, and compound powder of scammony — the warm bath being used three times a day. Many had proceeded thus far, and only two that were in the last stage of hydrocephalus interims termi¬ nated fatally. This detail may appear totally devoid of interest to the general readers of the Repository ; but the immense number that occurred in the private practice of the Reporter, in such a short period, induced him to publish it, to learn if such complaints have pre¬ vailed in any other district.’'

We wish especially and earnestly to solicit the attention of our readers to the review, in this number, of Mr. Cross’s very important treatise on vaccination, small-pox, &c, &c.

Quarterly Pieport of Prices of Substances employed in Pharmacy.

		s.	a.
Acacias Gumnii elect.	lb.	5	0
Acidum Citricum	-	21)	0
- - Benzoicum	unc.	5	0
- Sulphurieum	P. lb.	0	9
- Muriatieum	-	O	0
- N itricum	- _	4	0
- - Aceticum	cong.	4	6
Alcohol ...	M. lb.	5	6
/Ether sulphuricus	-	12	0
- rectificatus	-	14	0
Aloes spicatas extraetum	lb.	7	6
— vulgaris extraetum	-	6	0
Althaese Radix exot.	-	1	8
A lumen	-	0	6
Ammonias Murias	-	2	2
- - Subcarbonas	-	4	0
Amygdalae dulces		5	6
Ammoniacum (Gutt.)	-	9	0
- (Lump.)	-	5	e
Anthemidis Flores	-	1	10
Antimonii oxydum	-	7	0
- - sulphuretum	-	1	O
A ntimoni 11m Tar tanzatum	_	8	0
Arsenic! Oxydum	“	°2	6

Asafoetidae Gumnii resina - lb. 7 6

Aurantii Cortex - .40

Argenti Nitras • - unc. 6 ti

si. <1.

Balsamum Peruviamim	lb.	52	0
Balsamum Tolutanum		44	0
Benzoinum elect.	-	10	0
Calamina praeparata	-	0	6
Calumbas Radix elect.	-	4	0
Cambbgia	-	9	0
Camphora		6	6
Canellas Cortex elect.	-	4	0
Cardamomi Semina	- lb.	9	0
Cascarillas Cortex elect.	-	3	0
Castoreum	unc.	3	, 6
Castor Russ.	- ox.	20	0
Catechu Extraetum	lb.	4	0
Cetaceum		3	6
Cera alba	.	4	0
- flava	-	3	q
Cinchona3 cordifoliaj Cortex (yellow)	7	6
— — laneifolia? Cortex (quilled)	11	0
- oblongifolias Cortex (red)	10	0
Cmnamomi Cortex	.	16	0
Coccus (Coceinella)	unc.	2	9
Coloeynthidis Pulpa	lb.	18	0
Copaiba	.	6	0
Golchiei Radix		8	0
Croci stigmata	unc.	5	6
Cupri sulphas	lb.	1	4
Cuprum ammoniatum	-	10	0

Prices of Substances employed in Pharmacy. <2(53

Cuspari® Cortex Confect io aromatica

- Aurantiorum

- Opii

Confectio Ros® canin®

- Rosas gallicas

- Sennas

Emplastrum Lyttae

- Hydrargyn

Extractum Belladonnas

- Cinchonas

- - Cinchonae resinosum

- Colocynthidis

- Colocynthidis comp.

Conii Elaterii Gentian® Glycyrrhizas Haematoxyli Ilumuli Hyoscyami Jalap® - Is. Opii

Papaveris Rh®i

Sarsapariil® Taraxaci

unc.

lb.

unc.

unc. 6d. Res.

lb.

Ferri subcarbonas

— sulphas Ferrum ammoniatum

— tartarizatum Galbani Gummi-resina.

Gentian® Radix elect. ... Guaiaci resina - -

Hydrargyrum purification

- pr®cipitatum album

- cum creta

Hydrargyri Oxymurias - une.

- Submurias

- Nitrico-Oxydum

- Oxydum Cmereum

- Oxydum rubrum

- Sulphuretum nigrum

- - rubrum

Hellebori nigri Radix lb.

Ipecacuanh® Radix - -

- Pulvis -

Jalap® Radix -

- Pulvis - -

Kino ....

Liquor Plumbi subacetatis P. lb. — Ammoni® .... — Potass® - Linimentum Camphor® comp.

- saponis comp.

Lichen ... lb.

Lytt® _ .

Magnesia -

Magnesi®Carbonas -

- Sulphas

Manna

— communis

Moschus pod, (36s.) in gr. unc. Mastiche ... lb.

Myristic® Nuclei Myrrlia - - -

Olibanum - -

Opopanacis gummi resina Opium (Turkey)

Oleum iPtlierem n - oz.

— Amygdalarum - 1 b.

— Anisi ... unc.

— Anthemidis — Cassi®

— Caryophilli

— Cajuputi ... — Carui ...

— Juniperi Ang. - - -

— Lavandul®

— Lini - - cong.

— Menth® piperit® unc.

s.

3

9 3

5 2 2 2

6

3 1

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— Rosmarini — Suecim 2s. G<2. —

— Sulphuratum — Terebinthin®

— — rectification

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— Superacetas ... — Oxydum semi-vitreum Potassa Fusa ... unc.

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Potass® Nitras . - • lb.

— Acetas .... — Carhonas ... — Subcarbonas — Sulphas — Sulphuretum — Supersulphas — Tartras ... — Supertartras Pilul® Hydrargyri Pulvis Antimomalis

— Gontrayerv® comp.

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Resina Flava Rh®i Radix (Russia) ... Rh®i Radix (East India) opt. - Ros® petala - -

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Sarsapariil® Radix (Lisbon) Scammoni® Gummi- Resina - unc Scill® Radix siceat. opt. Ang. lb. Seneg® Radix - -

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Serpentari® Radix Simaroub® Cortex Sod® subboras - -

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Spongia usta - - - unc. -

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— - - aromaticus

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Tamarindi Pulpa opt.

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Prices of New Phials per Gross. - 8 oz. 705. — 6 oz. 58s. — 4 oz. 47s. — 3 oz. 435. — 2 oz. and

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264

Notices to Correspondents, MONTHLY CATALOGUE OF BOOKS.

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NOTICES TO CORRESPONDENTS.

Communications have been received this month from Dr. Cole, Mr. Wans™ brough, and Mr. Forts.

The Communication of Dr. Cole is a very interesting one , on the Syphilitic Controversy.

Mr. Wansbrough requests us to state , that he has had: a remarkable Case , zchich he purposes speedily to transmit , of the Efficacy of Tar Vapour .

ERRATA IN LAST NUMBER.

Page 89, line 6, for points, read joints.

- 91, - - 3, after Dec. add 1818.

- 91, - 35, for 1810, read 1820.

- 95, — — 16, — its, - — - their.

—

Communications are requested to be addressed (post paid) to M essrs. T. and G. UNDERWOOD, 32, Fleet Street,

THE

LONDON MEDICAL

REPOSITORY.

No. 82. OCTOBER 1, 1820. Vol. XIV.

PART I.

ORIGINAL COMMUNICATIONS.

I.

On the Existence of a Syphilitic Virusy over which Mercury has been supposed to possess a Specific Power. By J. Cole, M.D., Surgeon to the Forces.

In making the following observations, on a subject of vital importance to society, and which has agitated the medical world for some time past, I may truly say, in the language of Cabanis, “ Ce n’est pas pour soutenir des preventions favorites que j’entreprends cet exainen ; c’est pour chercher sincerement la verite indeed, I believe no one could have commenced the investigation “ regarding the existence of a venereal virus, requiring mercury for its destruction, more unbiassed than myself for if, on the one hand, I had every reason to be satisfied with the practice then generally adopted in the treatment of the venereal disease; so, on the other, I had strong grounds for believing that the necessity of mercury was extremely problematic, and its employment, in many cases, injurious.

In my report to the enlightened and indefatigable head of our department, dated June, 1817, I observed, that although I had not treated venereal complaints without mercury, with a view to the question in dispute ; yet I had so done, under imperious circumstances, and never found that secondary symptoms followed. 1 noticed, likewise, that during twelve years’ practice in the same regiment, I never found secondary symptoms to follow the moderate mercurial course, which was then deemed necessary for the cure of the venereal disease ; but that among recruits and volunteers, who occa- vol. xiv. — no. 82. 2 M

*

£66

Original Communications .

sionally joined the regiment, labouring under confirmed pox, I generally found that they had undergone repeated and severe salivations; the venereal virus (as I then reasoned) having escaped extinction, by the mercury expending itself uselessly on the salivary glands; and in adverting to the fact, that mercury had been often superseded, and as often replaced as the grand antisyphilitic, I persuaded myself that it really did possess specific power over the venereal virus; altogether forgetting the natural indolence of man, and the charms of a doctrine that spared him the trouble of investigating symptoms, and of applying the appro¬ priate remedies.

At that time (1817), 1 advocated the propriety of limiting the new or non-mercurial plan of treatment to a few well selected cases in each regimental hospital throughout the empire; feeling alive to the misery that might follow the general adoption of it throughout the British army. I have ever since had favourable opportunities of witnessing the progress of the experiment, particularly in the hospital of the staff corps of cavalry, under the direction of its able Surgeon, Dr. Browne, and in the general hospital at Cambrai when under the immediate control of my much lamented friend, Dr. Eyre. The garrison of Cambrai, and the regimental hospitals of the first division, (to which I was then attached as Staff-Surgeon,) afforded me also ample opportunities of investigating the subject; and the office of the inspector general, Sir James Grant, enabled me to arrive at the views and opinions of my colleagues throughout the army in France.

Fortunately, these great advantages were not rendered nugatory by the tenacity of preconceived opinions ; nor w'ere my means of judging lessened by the angry feelings of a partisan, anxious for the inquiry, and uncertain as to its issue. I observed, as it were, from neutral ground, the able manoeuvres and sharp contests of the combatants : at last I found the mercurialists intrenching themselves behind precedent, and the authority of great names, from which they were ultimately driven by the force of stubborn facts and un¬ answerable arguments.

When I saw, over and over again, that every venereal sore, whether primary or secondary, could be cured without mercury, I could no longer pause, but became a convert to the opinion, “ that there is not in nature a syphilitic virus requiring mercury for its destruction.”

It would be tedious to enumerate all the grounds of this belief; suffice it to say, it is the fruit of cautious observa¬ tion and legitimate deduction.

e67

Cole on the Syphilitic Controversy .

With these impressions, the surgical patients of this garrison were placed under my care, and the experience of another year has corroborated my opinion and established my creed. I am now fully persuaded of the inutility of mercury in any stage of the venereal disease, and 1 therefore deem it my duty to put a stop to the pernicious practice that has so long prevailed, of indiscriminately administering it, as far as is in my power. Every one who has had common oppor¬ tunities of witnessing the old treatment, must have en¬ countered many poor wretches, reduced to the extreme of misery by the abuse of this mineral. If they do not recollect them, the case of Daniel Nouland may serve to conjure up their shades. He was admitted into the hospital on the 26th of December, 1811, at the age of thirty, affected with syphilitic ulcers, and an enlargement of both testicles. He had recently been discharged the hospital, in which, during six months, he had suffered repeated salivations, for an ulcer on the penis, which entirely destroyed the part . He was, after all this, ordered to rub in half a dram of the oint¬ ment. The mercurial affection of the system increased to so alarming a height, that his face and entire head became swollen in an extraordinary degree; his tongue projected from his mouth, its edges ulcerated, and were of a white sloughing appearance. He lay in a state of insensibility, or coma; and his breathing was laborious, like a man affected with apoplexy.” — Vide Carmichael .

May every mercurialist contemplate the wretched situation of Daniel Noulan, before he enters the ward appropriated for the reception of venereal cases! Another unfortunate being appeared before me a few months since, when em¬ ployed in examining the out-pensioners, with a broken down frame, and particularly dejected countenance. On inquiry, 1 found that he had lost one testicle and the whole of the penis , in consequence (as he stated,) oj fve salivations in as many months. I have his name, but wretchedness like this demands concealment.

I need say no more on the occasional destructive effects of this baneful mineral, since that is allowed by its warmest advocates; nor is it necessary to expatiate on the origin of the imaginary virus, for the distinction of which so many constitutions have been destroyed. The contradictory opinions held by the believers in the existence of the syphilitic virus, regarding its origin, duration, and manifesta¬ tion, are in themselves sufficient to excite suspicion; for whilst many believe it was first let loose to scourge mankind at the siege of Naples, towards the close of the fifteenth

£68 Original Communications.

century; others, and, amongst the rest, Baron Larrey#, assert, that it was well known in the time of Moses; whilst others, more profane, trace it back to the father of mankind ; some vow that it was imported from the New World ; whilst others trace its ravages in the old, among the Egyptians, Greeks, and Romans, long before the immortal Columbus traversed the Atlantic.

Among the luminaries of the present day, how irrecon- cileable are the opinions respecting this ignis fatuus — how fallacious their diagnostic — -how erroneous their prognostic- how unsuccessful their treatment !

Mr. Carlisle, in default of every other species of evidence, finds ophthalmia affecting the iris, and causing an irregularity in the form of the pupil, as sufficiently characteristic of a syphilitic origin; whilst Mr. Pearson u believes that there are no specific characters by w hich diseases of the eye or eye¬ lids, produced by the action of the venereal virus, can be distinguished from those which are excited by other causes.” In this dilemma, we may be allowed, with John Hunter, to doubt the existence of syphilitic ophthalmia. As to the irregular contraction of the pupil, and the consequent destruction of the circular appearance; insisted on as an infallible criterion by Mr. Carlisle a of a syphilitic origin of the complaint,” it is only necessary to call to mind, that an inflammation of a portion of the iris terminating in the effusion of coagulable lymph or adhesion, must necessarily produce that effect; and that the loss of the circular form of the pupil and free action of the iris is likely to be per¬ manent, unless the adhesions be removed by the extra¬ ordinary power mercury possesses of increasing the action of the absorbents, and at the same time preparing the effused lymph for absorption : if, therefore, it be found that this mineral be useful in iritic inflammation, and that under its use, partial adhesion of the iris, and consequent loss of its circular form seldom occur, is it not much more reasonable to attribute it to the power it possesses “ of arresting, in a special manner, the disorganizing process of adhesive inflammation/’ than to call in a will o’ the wisp, an imaginary poison ; and then arm this subtile messenger with powers to terrify it? It would be as endless as it is ungracious to pursue this train of reasoning; for every writer, imbued with

* Les Egyptiens disent que de tout temps on a connu la verole ; en effet il parait certain, qu’il existait mime du temps du Moises; nous en avons un grand nombre de preuves, que je crois inutile de cifcer. — Larrey , tome ib p. 228.

26g

Cole on the Syphilitic Controversy .

the syphilitic theory and specific power of mercury, must necessarily, in the opinion of those who deny the existence of such a poison and such a power, be found replete with error : but as truth is my aim, and the benefit of mankind my object,

I cannot refrain from examining, with undazzled eyes, the opinions of some of those worthies who have most honoured our Profession; and in combating their creed, I trust I shall not forfeit their esteem.

Mr. Hey, whose name is associated with ingenuity, industry, and integrity, (beguiled by this non-entity) has laid down a rule, that a disease is syphilitic if it can be cured only by mercury, (if such a disease there be); because, forsooth, John Hunter had said, that a disease that could be cured without that mineral was not syphilitic. Thus, reasoning from false premises, and in a vicious circle, we arrive at con¬ clusions the most absurd. I will say, with my friend, Samuel Cooper, whose Surgical Dictionary is, or ought to be, in every one’s possession, “ Perhaps there is no greater source of error in the whole practice of surgery, than the supposition that a sore, when it yields to mercury, must be of a syphilitic nature.”

Mr. Hey also asserts, “ that a man may communicate the lues venerea after all symptoms of the disease have been removed, and he is judged to be in perfect health.” What an alarming doctrine! However, here again wre may go a step higher, and consult John Hunter, who confines the con¬ tagious principle to pus produced by a specific action. In adverting to this opinion, another of this celebrated man’s doctrines is brought to my recollection, wrhich seems a little paradoxical, i. e. when the system is affected with this said syphilitic virus to saturation, nay, even to the destruc¬ tion of the most solid parts of the human frame, the power of communicating is lost.

Whilst on this subject, I may be permitted to observe, that Mr. Carlisle has seen “ syphilitic pneumonia;” and I presume that the inference may be drawn, that he has no doubt of this self-same virus producing inflammatory action in any other viscus. I do not know what John Hunter would have thought of this doctrine, or how he would have applied for the removal of the malady, the mineral stimulant, “ which excites a peculiar irritation, productive of a peculiar action.” After the high action in pneumonia, or any other inflammatory affection, has been reduced by blood-letting , that mercury will be useful I most willingly confess, in the first place as an evacuant, and, secondly, to arrest the adhesive process; but that it ever could be brought forward as a specific for any kind of acute inflammation, is surprising.

270

Original Communications .

According to some writers, there is not a fibre in the human frame that has not thrilled with agony under this terrible virus ; and, in consequence, not the minutest fibrilla that has not been made to vibrate by mercury in responsive wretchedness; until at last, between the bane and antidote, both body and mind have been subdued ; and, in the opinions of the wretched sufferers, no torments could be more in¬ tolerable than those which they experienced.

I am told that the Hindoo specific for the venereal disease is arsenic ; and the Egyptian one, the warm-bath ; and we know, from the enlightened medical chief of the Portugueze army, that the syphilitic patients of it were cured without “ an adequate mercurial course,” and that in defiance of a general order. His philanthropic mind must have been gratified, when assured that no ill effect followed this breach of discipline : and when he found the devoted natives committed to his care, fit to rejoin their brethren in arms, and so fitted by topical remedies alone , his faith in mercury must have been shook ; and, but for preconceived opinions, that stick even to the most enlightened, he would have perceived and avowed the whole truth, instead of having recourse to the untenable doctrine, “ that the poison was become less virulent by propagation, and less active by its multiplication.” Do we find the poison of the viper less destructive in those islands in which they swarm ; or its bite less fatal now than formerly ? No; it is now7 as it has been for ages; and so, if there is a specific virus, under the denomination of syphilitic, it should be as unchangeable in its nature, and as uniform in its effects. That mercury is deleterious to many constitu¬ tions, is allowed and lamented by its warmest advocates ; and a discussion not unfrequently arises among them, as to the cause of its being generally less pernicious in cases of chronic hepatitis, than in those considered syphilitic. The mineral being the same, the difference in its effects must arise from a difference in the state of the constitution— in the first instance, mercury is appropriately applied, to increase the activity of the absorbents, and finds full employment for its peculiar power in removing the adhesions and restoring the dis¬ organized viscus to its healthy state; hence the constitution is benefited ; but, in the latter case, being let loose to oppose and destroy an imaginary enemy — an ignus fatuus — it necessarily, by the very powers it possesses to do good, becomes injurious; for, as it has no antagonist to wrestle with, no opposite principle with which to contend, and as it must produce a change, and that on the healthy state, the change must be for the worse; in the same ratio that an article of pharmacy is efficient when appropriately applied.

271

Cole on the Syphilitic Controversy .

it is pernicious when directed improperly. We have enough of remedies, did we know when to use them.

The sedative power of foxglove, when applied to retard the destructive rapidity of the circulation in an irritable habit, may be advantageous ; but who, therefore, would give it to arrest the action of a heart excited by the mazy dance, the heat of argument, or the shout of victory — so of mercury; if it be an active and valuable agent in the removal of congestion, in arresting the disorganizing process of adhesive inflamma¬ tion, (and this I believe no one denies); then it must be in a like degree pernicious when given in the healthy state; and hence the difference so often noticed in its, effects on the system in the liver diseases of India, and the venereal ones at home.

If a specific virus, requiring mercury for its destruction, was ever in existence, it puzzles me equally to account for its generation and its extinction ; for I firmly believe that now no such poison can be found. The numerous sores on the genitals, so frequently occurring, arise principally from filth. Their appearance varies, according to the part affected, the patient’s temperament and idiosyncrasy, and the means employed or neglected for their cure. It is very difficult to convey a correct idea of the character of ulcers by a verbal description. The practised eye readily notices the slightest change, and catches a shade of difference ; but words (even did precise meanings attend their use) are quite unequal to the task. In my view of these affections, it is of little consequence, since the treatment must be conducted on general principles ; but it is far otherwise with those who, with microscopic eye, see in u a hardened edge and base” the necessity to throw in the specific, and more so with those who believe, with Carmichael, that certain secondary symp¬ toms follow certain varieties of the primary ulcer. This garrison, numerous and ever varying, offers a fair scope for experiment, and an ample field for observation. The weekly inspection for the detection of disease never fails to afford proofs that the principal cause of those ulcers on the penis, so often termed syphilitic, have their origin in filth allowed to accumulate under the prepuce, producing a chain of symp¬ toms from simple irritation and increase of the natural secretions, to ulceration and a flow of pus. Any one accus¬ tomed to those hebdomadal expositions will bear me out in ascribing to filth the principal cause of those little ulcera¬ tions ; although, doubtless, there are others which contribute to the same effect, acting on parts so vascular, sensible, and susceptible.

Every regimental Surgeon must have observed the ulcer

272 Original Communications .

on the penis characterized by John Hunter as the truly syphilitic, in men who denied ever having had sexual inter¬ course ; and who, whilst denying it, knew that little or no credit would be attached to their declaration- — little or no blame to their avowal of an illicit connexion. Some Sur¬ geons go further, and will not permit an inguinal gland to inflame without the agency of this subtile poison ; for, should no chancre be found, the soldier is accused of having healed it, or the subtile friend is charged with having penetrated to the groin, without leaving the slightest indica¬ tion of the route : some, I know, attribute to a simple bubo a venereal origin, although unattended with ulceration, excoriation, or discharge of any kind, either from the glans, urethra, or body of the penis. I know' not why the almost equal number of indurated glans in the axilla, daily occurring, should not be assigned to the same cause.

Had there really existed so dreadful a scourge to lash mankind as the syphilitic virus is described to have been, ex¬ tending from the centre to the circumference, carrying de¬ struction in its progress under every guise, and contaminating under every form ; resisting every effort to arrest its career, and sweeping from the face of the earth, covered with loath¬ some sores, the choicest of her sons ; and had at last some one appeared with a remedy for this intolerable evil, an antidote for this bane, would he not have been placed among the demigods, and his memory cherished, and his name enrolled in the grateful recollection of succeeding ages ? I can imagine that he who could extinguish every kind of contagion, and render mild our most formidable diseases, might, in a few' ages, be forgotten ; but I cannot believe that the discoverer of a specific remedy for a loathsome disease, prevailing among all ranks , and occurring at all times , would ever have sunk into oblivion. However this may be, the fact is, that since my attention has been directed to this subject, I have pursued the inquiry with diligence, and have indus¬ triously availed myself of the opportunities offered me — with a mind unbiassed, and no other object than truth, I am now obliged to doubt the existence of this virus , and deny the spe¬ cific power of mercury. After discarding mercury, as a sine qua non , in the cure of the venereal disease, What pian of treat¬ ment, it may be asked, ought to be substituted ? After having so fully stated my creed, and the reasons for adopting it, no one will expect that I should lay dowrn a specific mode, since it must necessarily vary according to the character, constitution, and condition of the patient — poultices, tepid lotions, detergents, or escharotics, as they may be indicated, rest, aperients, sudorifics, and blood-letting, if demanded. As

273

Burrows’ Case of Melancholia.

indurations frequently follow the early and repeated applica¬ tion of the sulphate of copper, therefore I prefer bringing on a discharge by digestions, even at the risk of detaining my patient longer in the hospital.

With respect to buboes, however desirable it maybe to dis¬ perse them, I never tremble at their coming forward. At this station they come to us in every stage, and in each 1 find that poultices of linseed meal, a little above the tem¬ perature of the body, and frequently changed, to be the most efficacious mode of expediting the termination, be it by resolution or suppuration — it is also the most grateful to the patient; whilst cold lotions, however assiduously applied, cause only a change of temperature — a constant alternation from heat to cold. I also doubt the propriety of compressing an inflamed or a suppurating bubo : in the first instance, the pain is increased as well as the probability of suppuration ; in the second, the foundation of troublesome sinuses is formed. Although this paper is extended already to an unreasonable length, yet before concluding it, I must notice that some of the advocates of the potential mineral having, against their will, been convinced that it possesses no specific power over venereal sores, yet continue its employment from the persua¬ sion, that if it be not the only mode of cure, it is at least the most expeditious. This opinion, I am well aware, on further experience, will turn out to be as fallacious as those that preceded it; and that, ere long, John Hunter’s chancre, or any other body’s chancre, will be cured not only safely and permanently without mercury, but also in a much less time than was deemed necessary (even under favourable circum¬ stances,) to keep the patient under its influence. I must now apologize for the desultory manner in which I have delivered my sentiments, and the unreasonable space I have occupied in tli is excellent and independent Journal; but I have been urged to the task by a report that army Surgeons were retracing the steps they have so nobly trodden, and were relinquishing a contest with precedents and authorities, on the very eve of obtaining a victory. It cannot be so; truth is too grand an object to be sacrificed to sordid views, and the improvement of our art too sacred a duty to admit of any compromise.

II.

A Case of Melancholia, cured by accidental Mercurial Saliva¬ tion; with some Observations. By G. M. Burrows, M.D., F.L.S., &c. Gower Street, Bedford Square.

-•a-

Miss C. was a very respectable woman, aged forty, of a leueo-pblegmatic temperament, grey eyes, dark-brown hair, VOL. xiv. — xo. 82. ~ N

274

Original Communications .

and very corpulent. Her disposition was equable, though rather melancholic. She had for several years conducted a prosperous business ; but her occupation was sedentary, and admitted of little variety.

In the spring of 1817 she became very dyspeptic, nervous, and fanciful. She was unhappy, without any real moral cause. But a short time before, a female acquaintance, in lifting a heavy basket, had experienced an umbilical hernia, for the cure of which she had submitted to an operation. This incident produced such a deep impression on Miss C/s mind, that she at length insisted she also was afflicted with hernia, and must undergo a similar operation. No reasoning could convince her that her apprehension was groundless. This hallucination obtained too firm a hold to be shaken off ; and it made her truly miserable. Although the predominant, yet this was not the only mental illusion. She grew generally gloomy and suspicious, and had a strong dread of approaching povert}7.

Early in June she was so low spirited and morose, that her friends were alarmed, and consulted her medical attendant, Mr. Hunter, senr, of Mincing Lane. That gentleman prescribed a most judicious plan to be pursued in respect to her ; but she was refractory, and rejected his advice ; and her friends, unfortunately, did not enforce it.

On the 11th she contrived to squeeze herself through a small stair-window, apparently of dimensions inadequate to admit her passing, and from which there was a perpendicular descent, of about thirty feet, to the pavement of a court behind her dwelling. Luckity, and unknown to Miss C., some empty beer barrels had been piled up immediately under this window; and upon these she fell. By the inter¬ position of these barrels, the height was reduced; and by the gravitation of so weighty a body, she happily came on her breech. By these means, the suicide she meditated was prevented.

She was taken up, apparently not much injured, and walked into her house. Messrs. Hunter, senr. and junr., came to her assistance. On examination, one of her legs was found to be considerably bruised. She complained of no other part.

She was copiously bled, purged, and received such medical attention as her case required, and was very prudently placed under the supervision of a nurse accustomed to insane persons.

Fever followed, without anv abatement of her mental disorder. It had been, in the interim, discovered that the right buttock had received a most severe contusion.

On the 17th I visited her. The countenance presented an extreme cast of despair and melancholy. There was con-

Burrows’ Case of Melancholia . 275

siderable pyrexia; pulse quick; tongue furred; bowels disposed to be inert ; catamenia regular. The whole of the injured buttock was an entire sphacelus, and, from the size of the part, it was of extraordinary diameter. The pro¬ pensity to suicide was still very active ; for although, from bodily inability, she could not move from her bed, yet, by various and unequivocal movements, she plainly indicated that was still her intention. All the features of the case at this stage were, indeed, very unpropitious.

Regardless of the mental affection, except as far as the ne¬ cessary precautions against her attempting any violence on herself, and the avoiding of every topic likely to encourage her despondency, my first object was to prescribe such means as might arrest the progress of the mortification. I had had the most decided proofs of the good effects of blood-letting in a very similar case, and was anxious to try it in this; but the opposition of this patient, and the difficulty of controlling her, frustrated the attempt. A dozen leeches were then ordered to be applied to her temples, the hair to be removed from the scalp, and the head to be sponged with a refri¬ gerating lotion, the bowels to be well evacuated, and an anti- monial saline draught to be given every four hours.

18th. — She was very composed; the fever had abated, and the mortification appeared stationary. The cinchona was prescribed, and a regimen which would support without stimulating.

20th. — There was a clear line of demarcation between the living and dead parts. She took the bark and nutriment very regularly.

23d. — The separation of the edges of the slough from the contiguous sound parts was complete, and a discharge of healthy pus commenced. There had been, however, consider¬ able mental irritation exhibited, and an almost total want of sleep during the preceding night. Opiates had hitherto been avoided; but the effect of a full dose of laudanum was tried : no advantage was obtained from it, and it was discontinued.

For about three weeks, every thing went on favourably ; and the same plan was continued, with the occasional appli¬ cation of leeches to the head, to relieve symptoms of cerebral congestion. There had been a prodigious discharge from the wound ; a great portion of the slough had been detached and removed, and healthy granulations were filling up the immense vacuum it left.

About this period Miss C. began to loathe both nutriment and medicine: consequently, symptoms of cachexy appeared : her strength declined ; all the secretions seemed to diminish, especially the quantity of urine; the legs were cedematou^;

27 6

Origi rial Comm u ideation s .

the discharge from the wound was thin, glary, and very fetid : in short, the healing process was suspended. The mental disorder was the same. But she yielded to persuasion, and resumed the bark, with the addition of diluted sulphuric acid, and a pill at bedtime, with submuriate of mercury and squills; friction was used to the legs, and the wound was washed with dilute nitric acid. She ate also more solid food, and drank porter. 1 likewise recommended her removal, as soon as possible, to a purer air; from which I hoped not only an improvement in her constitution, but that those depressing ideas, associated with everv thing around her, in the scene of her late desperate attempt, would be diverted; and thus that advantage be obtained which almost uniformly attends a change of situation in cases of melancholia. This step, how¬ ever, the condition of her wound had hitherto precluded us from suggesting.

In about a week there was a sensible amendment in her health, and, of course, in the appearance of the wound ; and at this juncture (July 26th) she was removed to a friend’s house near the Commercial Road. The situation was far from desirable. Her chamber was close and cheerless. Besides, her relations were about her— -an arrangement rarely conducive of good in the treatment of such cases. Still it was an entire change, and, at any rate, preferable to her remaining at home.

A lighter tonic was now substituted for the bark ; but as the kidneys were still indolent, and the legs cedematous, the calomel and squills were continued.

She now mended every day in health, and was very tractable; but all her pristine mental aberrations prevailed.

After persevering in this plan a fortnight, she caught cold by falling asleep with the window open; the consequence was, salivation, but not excessive. It was suffered to take its course.

Concurrent with this ptyalism, was an amelioration of the mental disorder. She grew more cheerful, and every aber¬ ration by degrees vanished. Three weeks from the appear¬ ance of the salivation she was so well that I took my leave.

Soon after, she was capable of going by water to Margate. There her constitution much improved. The wound, how¬ ever, was several months before it cicatrized ; and then the injury had been so extensive, that the muscular action of the limb was greatly obstructed; so that, to the present, she is lame.

To complete the history of this case, Miss C. afterwards married, became pregnant, endured a very tedious and difficult labour, and was delivered, by art, of a dead child.

277

Bur rows’ Case oj Melancholia .

But neither the joys, nor the hopes, nor the pains, nor the disappointments of the marriage state, have deranged the equanimity of her intellectual faculties.

Observations.

There are several peculiarities in the above case not unworthy of notice. But my principal motive in publishing it, is the fact, that sanity here supervened to accidental mercurial salivation. I saw a similar result in two other cases of insanity, which were nearly contemporaneous with this. One I attended with Mr. Upton, of Throgmorton Street; the other with Mr. Lincoln, of Hatton Garden. In both a perfect restoration of the intellects followed ; but from the neglect of proper precautions by the relations, the latter, an elderly lady, soon relapsed, and she died insane and paralytic, about a year afterwards.

An inference might be deduced, from the event of these cases, that the occurrence of salivation is a natural solution of insanity, and that we have only to superinduce it, to re-establish the integrity of the understanding. But such a conclusion would be attended with that disappointment which almost always ensues from generalizing on the cure of particular diseases on the authority of a few detached cases. Yet the facts dis¬ closed are indications of sufficient importance to lead to a serious consideration in what degree the exhibition of mercury in the treatment of insanity may be useful.

Were ptyalism a natural solution of mental derangement, recoveries would probably be much more frequent ; for no symptom is more common in maniacs, than a spontaneous and abundant flow of saliva. But l have never met with an instance where this has proved critical. Such cases, never¬ theless, are on record ; though none of them, I think, are detailed with sufficient clearness to decide, whether the recovery was really consequent on this phenomenon. In the case of melancholia alleged to have been determined by spontaneous salivation, of which an abstract is given in the Fifth Number of the Journal of Foreign Medicine and Surgery, a particular exudation from the mammae was observed, which might also be deemed a critical discharge ; and there were several pre¬ cursory signs of convalescence.

Every species of insanity, not arising from mal-formation or organic lesion, may be cured spontaneously. Such a ter¬ mination often happens, and surprises us. 1 will not assert, that the maniacal action never ceased in consequence of spontaneous salivation; but 1 am strongly inclined to suspect, that the cases reported to have recovered in this manner, arc

£78 Original Communications.

rather coincidences, and not the specific effect of the in¬ creased salivary secretion.

Hitherto I have viewed this efflux of saliva as purely symptomatic, and occasioned by irritation from iocal de¬ termination to the salivary glands, because local determina¬ tions, in maniacal persons, are usual ; and whenever an increased flow of saliva appears, it is rather on the access or during the paroxysm, than on the decline of it.

The physical phenomena exhibited in insanity indicate, generally, a marked derangement of the vascular as well as of the nervous system. There is the plainest evidence, some¬ times of increased, sometimes of decreased arterial action ; and when the equilibrium of the circulation is disturbed, the sensorium sympathizes, and the functions of the intellectual organs are ofteh implicated.

Mercury, by its acknowledged power of equalizing the circulation, may restore the balance between the vascular and nervous systems, and thereby remove that morbid con¬ dition of the brain, which, perhaps, originates intellectual derangement. The theory of the operation of mercury on the system, therefore, favours the presumption, that salivation induced by it, may terminate insanity, while no such expectation could be formed from spontaneous salivation.

Analogy, too, supports this inference. The excitement from mercurial action very closely resembles febrile excita¬ tion ; and those conversant with insanity know, that a smart attack of fever, from whatever cause, often effects a perfect cure of the mental disorder.

But let not the facts 1 have detailed, and still less the speculations in which 1 have indulged, sway any one rashly to employ mercury in the cure of insanity. I propose, by these observations, to draw a greater degree of attention

in a malady so obnoxious to medicine, not to urge the practice without more experience. The rage for prescribing this mineral, as a panacea in almost all diseases, has already tempted many to try it, and pretty indiscriminately, in maniacal cases. However, we may fairly infer, that the success of it has been equivocal ; otherwise we should have heard more respecting its virtues.

After the caution I have given, it will be but candid to state my own observations on the effects of mercury as a remedy in cases of insanity. I shall briefly remark, that 1 have repeatedly given it as an alterative, where the functions of the chylopoetic viscera were faulty, and, T conceive, with great advantage ; but then it was always in conjunction with

to the exhibition of a remedy

[

Buxton’s Case of Petechia. oyg

other pharmaceutical remedies, and it was impossible to decide to which to assign the benefit.

The result of the above detailed case, and the two others alluded to, had convinced me that there were certain maniacal conditions in which the efficacy of mercury was indisputable. I accordingly made trial of it in various forms of this malady; but I must confess my first essays quite disappointed me. Nevertheless, 1 persevered ; judging that my failure proceeded from want of due discrimination, and that the cases I had selected were not appropriate ones.

I soon found that where there was great excitement mani¬ fested, such as a white tongue, flushed face, writh prominent and vivid, or blood-shot eyes, and a hurried pulse, or much throbbing of the carotid or temporal arteries, in whatever quantity or whatever manner mercury was exhibited, I never succeeded in eliciting salivation; on the contrary, generally all the symptoms of excitement have been aggravated. The only instance I have seen where the system, under great ex¬ citement, was affected to ptyalism by mercury, was that of Mr. Upton’s patient; and the effect here was by a mode very unexpected, and, perhaps, unusual. She had received a casual cut on her lip. I prescribed some calomel in a pill : this she chewed and spit out. The calomel was then mixed with a little sugar. In pouring this powder into her mouth, some of it was sprinkled, inadvertently, upon the recent cut. The powder was followed by a common laxative draught, which operated well. Two days after, a copious salivation was established. Whenever I have succeeded in producing mercurial salivation, it has been in cases of me¬ lancholia, in which there has been no remission of the paroxysm, or, at least, at very distant periods. But, in¬ cluding the three cases referred to in this paper, sanity has fol¬ lowed four times only in nine cases where mercurial salivation has been accomplished. My experience, therefore, of artificial salivation in intellectual disorders is still much too limited to speak confidently of its success. Yet enough perhaps is ascertained to encourage a more extended trial of it ; and this I shall not omit when opportunity offers.

III.

Case of Petechia. By Isaac Buxton, M.D., &c. &c.

New Broad Street.

On the 7th of June, 18 16, Charles Crow, a seller of dog’s meat, aged fifty-two, called on me. He is rather short, of a spare habit, and dark complexion. During the last sixteen

280 Original Communications.

years he has been subject to a cough in the winter. This has not yet quitted him entirely, as it usually does when the summer advances. It does not, however, at present appear to be severe or troublesome. Six days ago, he began to spit blood by coughing, and an eruption made its appear¬ ance. The eruption has gradually increased since that time, and blood has occasional! v been discharged. He thinks that yesterday, and the preceding day, he brought up about a quarter of a pint of blood. Since this was discharged, the cough has not been so troublesome. The eruption is thinly scattered over various parts of his body. The tongue displays several distinct spots, about, the size of half a tare, elevated above the skin, and of a blue purple colour. Each of these appears to consist of extravasated blood, situated between the cutis and cuticle, exhibiting nearly the same appearance as a small pinch would do. Over the uvula and adjacent parts of the velum pendulum palati there is a broad patch, as if the spots were here confluent. The colour of this part is not of so blue a cast as on the tongue. The covering of the extravasated fluid also appears thinner, and more shining. The extravasation gives these parts a tumid appearance, and hinders the back of the throat from being seen. There are several spots on the fore-arms and legs, a few on the chin, and one on the under lip. These are of different sizes, from the diameter of a small pea, to that of a pin’s head. In colour, they are like those on the tongue, but are scarcely elevated above the skin. There is a spot on his chin, where he has received a slight cut with a razor. In this place the blood is more ex¬ tensively extravasated, and its colour is of a more blue purple than it would have been in another person. There is also a place in one of his hands, where he was slightly wounded by a hook, to which the same remark may be applied. His skin is neither hot nor dry ; appetite tolerably good; is very weak; pulse quick, soft, and small; tongue very little c6vered, and moist; bowels regular, once daily ; complexion dingy ; eyes not clear.

Cap. Mist. Acid. Sulphur.

Extr. Coloc. Comp. gr. v. O. M.

8th. — The velum pend, palati is, in a great measure, free from the peculiar appearance it yesterday possessed. Some of the spots on the tongue, instead of projecting as yesterday, appear rather like very shallow indentations, as if the cuticle bad come off, and left the cutis bare. The surfaces both of the velum palati and of these spots, has a raw look. I saw a few spots on his forehead, which, I believe,

281

Buxton’s Case of Petechia.

were not observable yesterday. Some of the places in the arms are fainter. He brought up this morning, what he described as the clot sticking to the upper part of his throat; but did not throw out so much blood as he had done before. Has had two or three stools, which he speaks of as being ex¬ tremely black.

Pergat.

10th. — The spots on the arms are now of a dull red, and seem to be dying away. A few additional spots have appeared. The uvula is still covered ; but its cover is different in appearance from what I before observed. It looks like a moist crust, or skin, of a dirty brown colour. The velum still looks rather raw, but not so much so as at the last visit. Had four stools yesterday : he said that these were dark, but not so dark as on the preceding day. I had an opportunity of seeing a motion passed this day. It was of a moderate consistence, and of a dark olive colour ; no blood was mixed with it. The patient said that this was not nearly so dark as what he had previously passed. He brought up a clot of blood yesterday, but none this day. Pulse rather quick, small, and soft; appetite good; tongue clean.

Pergat.

12th. — No eruption has broken out since the day before yesterday ; and all the places which had previously existed, seem to be dying away. The uvula, and all the other parts of the mouth, are entirely clear. The uvula and velum exhibit a number of spots, which look as if they had been moderately injected. I can now see to the back of the pharynx, which I have not previously viewed, and there observe the same appearance. No blood came up this morning ; and only a very little yesterday, intermixed with mucus, or saliva. Had four evacuations yesterday, which wrere said to be lighter than that which l saw. He feels very weak ; appetite extremely good. Pulse rather weak, but in quickness. His cough is increased in a trifling

Extr. Col. comp. gr. v. O. M.

Inf. Anthemidis e Acid. Sulph. ter die.

15th. — Many of the petechiae have entirely disappeared, and those which remain are much fainter : their colour is a red purple. The velum, uvula, and pharynx, have not yet a natural appearance, though much more so than at the last report. Has not expectorated any blood. Pie is rather / weaker. Had three motions yesterday, which he says are still lighter, but not so light as what he passes when in

vol, xiv. — no, 82. 2o

mod era degree.

282 Original Communications .

perfect health. Tongue clear and clean, but a little sore; appetite very good ; pulse moderate, and, I think, stronger.

Pergat.

2 1st. — The spots have almost entirely vanished. The appearance of the throat is almost natural, though still somewhat redder than usual. His strength is much as it was. Has had two evacuations daily, which are nearly of the appearance which they have when he is in perfect health. Pulse rather stronger ; cough as it was previously to the commencement of this complaint ; complexion and eyes have gradually become less dingy, and at the present moment are quite clear.

Extr. Col. comp. gr. v. O. M.

Pulv. Cinch. <?ss. ter die.

o'

The patient at this visit expressed himself as thinking the complaint completely subdued, and therefore did not after¬ wards call upon me. The existence of petechiae where there is neither very great debility, nor considerable febrile action, is not very common, in the present instance, though the patient said that he was weak; yet the debility either of the pulse or of the muscular power was by no means sufficient to account for the existence of the complaint. Nor was there any febrile action on which the formation of petechiae could depend ; the pulse, though quick, exhibiting no violence of action ; and the skin always feeling like that of a person in perfect health. It appears to me, that the complaint was intimately connected with, and probably dependent upon, derangement of the organs subservient to digestion. It i9 true, that the patient’s appetite was good, and his tongue, at the first, not much covered. But every Practitioner must have noticed various cases in which the tongue was clean, and the appetite good, whilst the organs in question were con¬ siderably deranged. In the present instance, the dingy appearance of the eyes and skin, together with the dark¬ ness of the stools, were evidences which seemed to me sufficiently conclusive. How derangement of the digestive organs could induce petechiae, I presume not to conjecture. Having taken up the opinion, that this connexion actually existed, my endeavours were directed to rectify the derange¬ ment in these organs by the continued use of a moderate pur¬ gative ; whilst their tone was supported by a gentle tonic, and by diet moderately good. The petechiae receded exactly as the colour of the eyes; the skin and the faeces were ameliorated.

it appears to me highly probable, that the blood which he coughed up was produced from the rupture of some of the

Onslow’s Obstetrical Researches .

283

petechiae. These certainly extended down the pharynx ; whether or not they proceeded along the air-tube, must be left to conjecture. I think if there had been any about the glottis, that symptoms of greater irritation, both local and general, would have been excited than were actually ex¬ hibited, It is also possible, that the same disposition of the extreme vessels, which, in parts where the cuticle was moderately thick, would lead to the formation of petechiae, would, in parts not so strongly defended, as in the oesophagus, or trachea, at once occasion haemorrhage, without the forma¬ tion of petechiae. At all events, when the spots disappeared, there did not seem to remain any disease in the lungs which did not before exist ; so that I had no apprehension of any bad consequences arising from this haemorrhage.

The patient described the stools which he had at first, as being so dark that I suspected there was blood in them. If there was, it might be produced in the same way as the blood brought up by coughing. The stool which I saw on the 10th, was not coloured by blood.

IV.

Obstetrical Researches. By Maurice Onslow, M.D.

No. 2.

In England we have no Midwife who has distinguished herself by any literary production. In France there is now living a lady, who has published several volumes on ob¬ stetrical subjects. This lady, Madame Boivin, super¬ intendent in chief of the “ Maison Royale de Sante,” besides her “ Memorial de i’Art des Accouchemens,” has obtained a prize from the “ Societe de Medecine de Paris,” for her Treatise on Uterine Haemorrhagies; and has translated from the English, the essay of Dr. Rigby, and the treatise of Dr. Stewart on that accident*.

To this translation, Madame Boivin has prefixed (( an Historical Account of the Treatment of Uterine Haemor¬ rhagies,” from the earliest period to the present day; on one or two parts of which i shall proceed to ofier a few comments.

Sue, in his “ Essais Historiques, &c. surl’Art des Accouche¬ mens,” vol . ii. p. 114, attributes to Louisa Bourgeois, the celebrated Midwife of Mary de Medicis, Queen of Henry the

* “ Nouveau Traite sur les Hemorrhagies de 1 Uterus, d Edouard Rigby, et de. Stewart Duncan [Duncan Stewart], traduit de 1 Anglais, accompagne de Notes.” Paris, 1818.

284

Original Communications.

Fourth, the important discovery of the practice of delivery by turning the child, in cases of profuse floodings; and he reproaches Portal for not having done due honour to Louisa Bourgeois, by acknowledging her to be the first person who devised this method.

Madame Boivin, trusting to Sue as her guide, falls into the same mistake ; and speaking of Louisa Bourgeois, says, “ this woman of experience and discernment was the first who promulgated the bold and distinct precept, that the uterus must be speedily emptied in order to put a stop to floodings in parturition ;” but not contented with this, she charges Guillemeau with disingenuousness for not mention¬ ing her name as the author, though he strongly recommends the practice. She says, “ In 1609 Guillemeau published his book, entitled, ‘ the Happy Delivery of Women/ in which he recommends, in cases of flooding, the method projected and adopted by Louisa Bourgeois. Though this circumstance could not be unknown to the Surgeon of Henry the Fourth, he, notwithstanding, makes no mention of the Midwife to the Queen of that great King.”

In these two extracts from Madame Boivin’s historical account, two great mistakes are to be found. 1. It is not true that she was the projector or author of this method of practice. 2. Guillemeau does make mention of Louisa Bourgeois ; and pretty plainly points out when and where she first got an intimation of this important discovery.

A perusal of the naive and amusing account which Louisa Bourgeois gives of herself, teaches that she was the wife of a military Surgeon, residing in comfort and happiness in the environs of Paris. When Henry the Fourth proceeded to besiege that capital, all the houses in the outskirts were demolished, and at one stroke the whole of her little property was annihilated, and she and her family reduced to great distress. What added to her affliction was, that her husband was absent with the army ; and all the various means which she attempted to support herself, failed of success; and her sufferings were evidently very great. At length, in 1594, Paris opened its gates to Henry, and a more favourable prospect was opened to her. She was now advised to qualify herself for practising midwifery. This advice she followed; and with some difficultv got herself admitted regularly as a Midwife. 4

From this it appears, that Louisa Bourgeois did not begin to practise midwifery till after the year 1594« Let us now see what Guillemeau says respecting turning in cases of haemorrhage.

“ In 1599, Mademoiselle Simon, daughter of M. Pare,

Onslow’s Obstetrical Researches.

28 5

being near her time, was attacked with profuse flooding. She was attended by Madame la Charonne, her Midwife, and was assisted likewise by MM. Hautin and Rigaud, Physicians at Paris, on account of the violent faintings which seized her every quarter of an hour. M. Marchand, my son-in-law, and myself, were also sent for, when seeing that she was almost without pulse, the voice feeble, and the lips pale, I informed her husband and her mother that her life was in extreme danger, and that there was but one means to save her, which was, to deliver her immediately. This I had seen practiced by M. Pare, her father, who had directed me to do it in the case of a young woman in the family of Madame de Senneterre.”

Now, as Ambrose Pare died in 1590, and Louisa Bourgeois did not begin to learn the practice of midwifery till after 1594, it is evident that she could not be the author of the operation in question.

But Madame Boivin says, that Guillemeau makes no men¬ tion of Louisa Bourgeois. Jtis a pity that writers do not sometimes read the books on which they offer comments. In the next page to that from which I have extracted the above case, Guillemeau relates another. It is this : “ In the year 1603, Mademoiselle Danze, or Chece, being in labour, was surprised with a similar attack of flooding, which lasted her from the morning till eight or nine o’clock in the evening. She was attended by Madame Boursier*, Midwife to the Queen, and Messrs. Le Fevre, Riolan, Le Moine, Doctors regent of the Faculty of Medecine at Paris, were called to her assistance ; and as she continued to lose much blood, they sent for M. Honore, Surgeon to the King; but as he would not attempt any thing without my advice, I was sent for, and immediately on my arrival my opinion was that of all present, that she should be delivered. This was effected by the said Honore, and the child was born alive.”

Now, if Louisa Bourgeois was the inventress of this practice, how came it that she did not employ her method in this case, when she had M. Le Fevre and M. Le Moine (in whose presence, on some other occasionf, she boasts of having performed this operation) to support and encourage

* She styles herself, in all her publications, “ Louyse Bourgeois, dite Boursier.”

t Observations Diverses, cap. v. ; in which, by the bye, there is not a single syllable advanced by Louisa Bourgeois which can prove her to be the inventress of this practice. She says that she had re¬ peatedly performed the operation ; but does not say that she is the author.

286 Original Communications.

her? Is it not more probable, that this was the first time an idea of such an operation was imparted to her, and that she afterwards adopted it in her own practice ?

Guillemeau does not appear to have been of a disingenuous character. In other parts of his writings he seems anxious to do justice to his contemporaries. Speaking, in another place, of this operation, he says, “ I learnt this mode of practice twenty-five years ago, from the late M. Pare and M. Hubert, to whom I am indebted for many other practical observations, and must confess that I received this from them/9

( Nos . 3 and 4 in our next.)

DEPARTMENT OF NATURAL HISTORY, &c.

Calendar of Flora , Fauna , and Pomona , kept at Hartfield , near Tunbridge Wells. By Dr. T. Forster. From the 1st to the 30th of August, 1820.

Aug. 1st. — The following plants remain in flower in the garden, Doronicum pardalianches, Chrysanthemum coronarium , Campanula Medium , C. speculum , Convolvuli purpurei , C. althccoides, Alth&a rosea, Papaver somniferum (many var.) P. Plums, (also var.) P. dubium, P. cambricum , Tropccolum majus , (called commonly Nasturtium,) Lychnis chalcedonica , Roses, Pinks, Carnations, &c.

4th. — -I observe that Hieracium sabaudum , II. Forsteri , II. umbellatum , and most of this genus, are already in flower on every bank.

9th. — Riding through Surry, towards Hampshire, I noticed again the difference immediately observable in the flora as one enters on the chalky soil.

10th. — At Upton Gray J found the flora rather more forward than at Hartwell. The China Aster ( A . Chinensis) and the Michaelmas Daisy ( A . tradescanti ) already out. Verbascum Thapsus and V. nigrum abundant by the hedgeways. In the gardens, Common, African, and French Marigolds are now numerous. The Fraxinella is gone out of blow.

18th. — About Odiham, the Valerian grows in flower in most luxurious abundance and size. Apargia autumn alis is now commonly in flower. Mushrooms (A. campestris ) now common.

19th. — Violent and destructive storms of hail, with thunder and lightning, occurred to-day, between one and three o’clock, almost simultaneously in different parts of the south of England, At Upton Gray it was very violent;

287

Bell on Diseases of the Urethra, fyc.

at Hartfield, in Sussex, still more so. What is remarkable, is the local and circumscribed range of the storms in the places where they fell; and at the same time the occurrence of similar storms in distant parts of England. At Hartfield the hail was tremendous, and the floods very destructive ; while at Cowden, only three miles off, there was very little rain.

25d. — Papaver hybridum flowered to-day in my garden, which is rather late; but as I scattered some seeds of it this spring as well as last autumn, it may have sprung from the former, and therefore have bloomed late. Fungi are as yet seen but very sparingly. The capsules of Papaver somniferum gathered in for drying.

25th. — China Asters ( Aster Chinensis) in blow in the garden at Hartwell. Oats and wheat carried.

30th. — African and French Marigolds, and Garden Crepis, still abundant.

[ This Journal is to be continued in the neighbourhood of Tunbridge Wells ; and will in future be published according to the calendar months.]

PART IL

ANALYTICAL REVIEW.

A Treatise on the Diseases of the Urethra , Vesica Urinaria , Prostate , and Rectum. By Charles Bell, &c. &c. A New Edition ; with Notes, containing the Criticisms of the Editors of the Foreign Editions, and the Opinions of Foreign Authors on these Diseases. By John Shaw, &c. &c. London. Longman and Co. 1820. pp. 416. 8vo.

In present times, when literature, and science, and erudi¬ tion, are considered by numbers as sheer marketable com¬ modities; when it is inquired by authors, and particularly by those great personages to whom authors are little more than vassals, we mean the booksellers, not what a work possesses intrinsically good, but what it will fetch from the pocket, it is pleasing to light upon a sterling production that is modestly prized. We recognise in its author a nobler motive than the mere love of pelf; the reputation and the merit which himself does not extravagantly or conceitedly rate, we value the more willingly — vve praise him not ior doing

288 Analytical Review .

what the ignorant does not know., and what the learned should know better than to do.

The name of Charles Bell would have obtained for this treatise, had its author been actuated by those motives which evidently influence most of his cotemporary writers, a price double its present. It is a name dear to the fellow-members of his Profession; cherished by the friends of science; aye, it is as great and as proud a name as that which has procured for a recent publication, in general literature, a sum four times as high as the price of this work of Mr. Bell. We allude to “ the History of Methodism,” by the Poet Laureate. We really think it a duty to protest against exorbitant prices for medical books, when the practical and philanthropic character of the art is considered, and how partially the reports of journals and reviews can convey the benefits of the matter contained in the originals. The author of that publication on disorders of the urinary and genital systems, which we criticised last month, is, in this respect, exceedingly culpable. We do not mean that he had information to convey so important, that he was bound to give it away ; but that, what he had of novel to tell the public, might have been comprised in a pamphlet, and not in a dense octavo. This treatise of Beil is just that sort of thing which we then said was wanted— a perfect treatise— with this exception, that it narrates not fully the practices and the opinions of others. Yet most persons will forego this for the possession of the complete doctrines and treatment pecu¬ liar to Mr. Bell.

The subject matter is of vast importance : it is just that sort of matter about which w'e are glad to find a great man employing his talents; about which common-place capacities will busy themselves in vain, as far, at least, as originality, worth having, and the conveyance of information to others, are concerned. For the treatment of the diseases of the urinary organs and their adjuncts requires anatomical know¬ ledge of the more precise kind — it requires discrimination, and comprehens ion, firmness, and yet despatch. Perhaps the disorders of these parts, and the cures of which they are susceptible, illustrate, as much as any other, the progression of the chirurgical art. If we retrospect to the sera of Celsus, this advance will be rendered very remarkable. The surgery of Celsus was indisputably excellent: much of it is practised at this day; and yet all that seems to have been known relative to those obstructions of the urethra, which require the hand or the knife, was contained in the twenty-sixth chapter of his seventh book, where he says : “ Res verb interdum cogit emoliri m.anu urinam, cum ilia non redditur, aut quid

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senectute iter ejus collapsum est, aut quia calculus, vel con- cretum aliquid ex sanguine intus se opposuit. Ac mediocris quoque inflammatio saepe earn reddi naturaliter prohibet.”

It may be said, that if these disorders were then less known, it was because they were less frequent, and especially because the syphilitic disease had not then commenced its havoc. In this assertion there may be much of truth ; but it exposes the errors of that etiology which was broached by the author of that publication which we reviewed in our last Number. In that work it is asserted, that disorder of the digestive organs is one of the commonest causes of stricture in the urethra. That such disorder may aggra¬ vate the symptoms of stricture, we are certain ; that it may excite sensation, and develope symptoms in an unstrictured canal, resembling those of a diseased, we are ready to admit; that it ever has generated a true, permanent, organic stricture, we doubt — we doubt, because it does not tally with our modes of thinking; but particularly because we are

assured of no satisfactory- facts.

%/

But this is digression. Let us plunge into Mr. Bell’s book ; for it is too valuable to justify our occupation, while that is before us, about matters of less interest and minor utility.

Prefixed to the practical matter of this treatise, as it is diffidently called, is a concise account of “ the anatomy of some parts of the urethra and neck of the bladder,” by Mr. Shaw.

(s The internal part of the urethra is formed by the continuation of the mucous membrane of the bladder, and the reticulated cellular texture, which separates the mucous from the muscular coat. It is surrounded by a set of vessels, the coats of which are so thin, that they are not visible, except when injected or filled with blood. These vessels, which are of a very peculiar structure, commence on the posterior part of the prostate, and are continued to the glans. They form that which has been described, in the second part of the tenth volume of the Medico-Chirurgical Transactions, as an internal spongy body. Throughout the whole extent of the urethra there is an intimate connexion by anastomosis of vessels, between the proper corpus-spongiosum and the internal spongy body; at the glans they become quite incorporated with each other.” — “ The appearance which has been described as muscular fibres, is caused by the small vessels running on the outside of the membrane.” — -u A stricture cannot properly be said to be a contraction of the membrane, (for it is always contracted, when not distended by urine,) but it is a loss of its power of dilatability.”

“ There is, in the posterior part of the canal, a lacuna, which is sufficiently large to receive the point of a bougie, the size of No. 5. It is the sinus pocularis, or foramen coecum, which is situated at the

VOL. XIV. — no, 82. 2 r

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beginning of the caput galinaginis (galli). This little sac is of a con¬ siderable size in the healthy urethra, but it generally becomes enlarged in a case of stricture.”

41 If we may be allowed to draw conclusions from dissection, and from the examination of preparations in different museums, it may be laid down as a principle, that whenever there has been irritation of any kind in the urethra, or bladder, the ducts of the prostate will be found enlarged ; some of them to such a degree as to admit the point of the largest bougie.”

So that, as is deduced from a preparation in the museum of Mr. Bell, u though the stricture may be overcome, still it ma}r be impossible to introduce an instrument into the bladder.” — Vide p. 394.

Chap. I. — At this time of day every Surgeon is informed of the proper sphincter of the bladder; (( it re¬ sembles the sphincters of the other hollow viscera: for example, those fibres which encircle the pyloric orifice of the stomach. Directly over the junction of the muscles of the ureters with this internal sphincter of the bladder, the internal coat of the bladder is found to be more vascular than at any other part. In the dissection of the recent parts there is generally seen a blush, as of inflammation, here. This is the spot of the bladder which is, beyond all comparison, the most sensitive. Here is the seat of that sensibility which governs the action of the muscles, ” associated in the act of passing the urine. As soon as the catheter rubs upon this spot, a patient feels the call to minge, u although there be not a drop of urine in the bladder.” When a stone rests here, the patient suffers a fit of the stone ; “ there is an unceasing nisus.” Sometimes inflammation, “ originally seated in the urethra, spreads backward to this spot, and then the call to make water is incessant.”

“ The irritation of the glottis does not more necessarily (by the consent established betwixt the eighth pair of nerves, and the other respiratory nerves) call into action all the muscles of expiration, than the sensible spot at the neck of the bladder does” the muscles of the perineeum. Hence we cannot be surprised that the flow of urine “ should be very frequently stopped by the mere derangement of their natural association.”

Incontinence of Urine.- — Some persons, children especially, pass urine in bed, and involuntarily. Much useless, perni¬ cious, and even cruel treatment, has been applied to this species of incontinence. What is the proper method of cure ? “ This occurrence never takes place but when the

boy is asleep upon his back; — he is to accustom himself to sleep upon his face or side ; the urine is not passed, nor is he

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excited to dream of making urine, while he keeps this posi¬ tion/’ in which the stimulus of the water is removed from the sensitive spot. Stillicidium nrinae , from want of action in the sphincter muscles, is generally owing to an increased sensibility of this spot. And abscesses about the prostate, and the vesicula, may be produced thereby; of the formation of which it behoves every Practitioner to discriminate the symptoms. They are apt to be mistaken for stone, or other disorders of these parts. For these abscesses, injection of the bladder, besides the usual treatment, is anxiously recom¬ mended ; the injected matter is nothing more than tepid water; and for stricture, and for stone, for inflammation, and the commencing uvula vesica, it is lauded as a most efficient remedy.

Cases requiring the Catheter. — Among these, paralysis demands minute attention. A man with a palsied bladder, perhaps from spinal concussion, may be ignorant of the dis¬ tention of his bladder, and it ma}^ burst, from non-detection of the mischief.

That retention, which is produced by the repression for a long time oj the desire to minge, requires the catheter.

But we will relate a case, wherein an enormous retention was removed by a different method. A naval officer W'as travelling by the Plymouth mail to join his ship; he expe¬ rienced an earnest desire to minge; but he was too modest to gratify it, as there was a young lady, a fellow-passenger, in the coach. When he reached Plymouth, to his great horror, he could not pass a drop of water. He called, in desperation, for a strong glass of brandy and water, and turned into bed. All he knew afterwards about the matter was this: he found himself, early in the morning, nearly afloat between the sheets; and was so ashamed, that he slunk away from the inn before any body w?as arisen.

Again : The urethra is so long obstructed, at times, by the head of the child, that the bladder of the mother, after delivery, requires to be emptied by the catheter.

Stillicidium sometimes produces a delay, in the use of instruments, which proves fatal. Sortie persons imagine there is no danger of distention, while there is stillicidium; they temporize; more urine is sent into the bladder than dribbles from it, and the patient dies.

Further: A bladder distended from an inflammatory attack, brought on by drinking, upon the urethra of a man not quite clear of gonorrhoea, requires the catheter. It is said, “ that we ought to bleed the patient, and apply leeches to the perinaeum, and fomentations, or put him into the warm bath.”

Analytical Review.

u But,” says Bell, u I must confess, when I have seen a man in indescribable agony, moving about my room, with his body bent to an angle ; and, when I have understood that before this attack his urethra was free, and that now the bladder can be distinguished above the pubes, I have followed the dictates of common sense, and common charity; I have done that which I knew would immediately relieve him, and with perfect safety — I have introduced the catheter/' — “ If the cause of the sudden retention is a stricture in the urethra, then, indeed, it becomes a most delicate matter to pass instruments into the passage; for, if the attempt does not succeed, the symptoms are certainly aggravated/'

Upon the associated actions of the perinaeal muscles and the bladder, it is the opinion of our author, that much of the pathology of the bladder and urethra, in order to be correct, must be founded. Upon the principle of association depends the practice of introducing a solid bougie, either into the bladder, if manageable, or into the grasp of a stricture. Introduce a small bougie, press gently until the bougie has moulded itself in the stricture; “ or, if it be of catgut or elastic gum, until it has entered and wedged itself into the stricture. Now press gently upon the belly ; make the patient exert himself to pass the urine; put his hands in cold water, or sprinkle cold water upon the thighs; slowly withdraw the bougie, and the urine will generally follow the instrument.”

Operation of the Catheter. — Just under the arch of the ossa pubis, “ where the canal is braced up by the ligament of the urethra, the point of the instrument is apt to catch up a fold of the membrane ; the instrument should be withdrawn a little , and the point carried onward on a higher level, or so as to make the point press along the upper part of the canal, and consequently avoid the natural obstructions, which are all on the lower part of the urethra/’ Let not the reader think such quotations as these trivial, or too elementary.

Diseased Prostate. — “ In the true disease of the prostate, it may be recollected, that, although the patient does not complain at the time we feel and press the gland in the examination, yet, some time after the operation, he does feel very distressingly ; the gland being, in its sensibility, like an internal part, where the pain of pressure arises some time after the finger is removed/' — “ The surrounding cellular membrane maybe inflamed and swollen; and this we are, if possible, to distinguish from the more formidable disease of the body of the gland/’ — “ Any thing lodging in the rectum, or great intestines, will closely1 mimic the symptoms of disordered bladder, and greatly aggravate the symptoms, when they really proceed from disease in the urinary passages. Therefore the bowels should be moved, and the faeces softened by a mild laxative ; and their regular

Bell on Diseases of the Urethra , fyc. 293

operation should be secured by a large clyster of tepid water every morning. This should be done, not only to procure full evacuations, but that the parts in the pelvis may not be teased for the rest of the day.”

The catheter must be employed upon the following prin¬ ciple : the sensibility which controls the bladder in its action, is seated in a particular spot, above described. “ It is the high excitement of this part which causes the swelling and protrusion of the middle part of the prostate gland into the cavity of the bladder ; certainly there is no rest to the part diseased, while this excitement continues. It must continue while the bladder is full of urine.” To introduce a catheter in case of morbid prostate, is as difficult as the violence wherewith it is commonly done is reprehensible. In this country, says Mr. Shaw, French “ authority has made the drawing of blood, by the introduction of the catheter, to be considered not only as a trifling accident, but even as beneficial. It ought to be a sufficient interdict to this practice to know, that the instrument must have passed into the spongy body.”

Chap. III. Sympathetic Irritation. — “ Those sympathetic pains, which seem to affect the urinary organs, and which have their real seat in irritation of the rectum, or the other intestines, bring full one half of those patients to the Surgeon, who are considered as labouring under stricture of the urethra.” — “ There is an old patient of mine, who, when distressed in this manner with pain in making water, can ascertain, by his finger in ano, that it proceeds from hardened faeces there ; and, by a clyster of warm water and soap, he removes the pain.”

Another patient of our author was, when his bowels had become torpid, attacked by lancinating pain in the urethra and glans. The sufferer himself reports —

“ Considering this as inflammation of the bladder, I abstained from wine, until one day, being in a large company, and suffering very severely, I in despair took several glasses of port wine, which not only soothed me at this time, but made me much better the next day. After this, I found myself always better on taking a few glasses. Purges increased the irritation. The medicine which has done me the most good, is the balsam of copaiba, which acts as a gentle laxative.”

Chap. IV. Symptoms of the Dilatable Stricture, and of the Spasmodic Stricture. — Of the nature of spasmodic stricture the reader knows, and, perhaps, participates the common conception ; but, “ it can be showrn that this spasm is not in the stricture itself, but that it is a spasmodic action of the muscles surrounding the urethra.” The perinaeal muscles

294 Analytical Review,

i( are all opponents to the muscular coat of the bladder, and are in sympathy with it; not that sympathy which combines in simultaneous action, but that connexion which exists betwixt flexor and extensor muscles, and which provides that the action of the one shall be attended with the relaxa¬ tion of the other.” With this doctrine u we can comprehend how a blister to the sacrum or pubes will sometimes produce strangury, sometimes incontinence of urine.” With this doctrine we can understand why, “ when the bladder is distended with urine, and the muscular coat has no disposi¬ tion to contract, the introduction of the bougie into the urethra,” even when it distends only the fore part of the ejaculator seminis, will cause the urine to flow.

“ If the term spasmodic stricture be used in the course of this book, it is to be taken as only implying that stricture which is attended with much inflammation, with high sensibility on its surface, or in the neighbourhood of the canal, and with a morbid irritability of the surrounding muscles.”

Dilatable stricture is the early stage of true stricture. Chronic inflammation is limited to a spot, by which the fine elasticity of the membrane is diminished. The remedy is, u removing the inflammation, allaying the irritation, and occasionally stretching the membrane, by the introduction of the simple bougie.”

“ But ” says Bell, “ I have accomplished the same purpose more rapidly, if not more effectually, by using the caustic.” — “The urethra probes enable us to touch the inflamed surface of the urethra in a manner much more exact than can be accomplished with the bougie. I have the ball of the urethra probe made with a small hole in it, and into that hole I put a minute portion of the caustic. Giving time for the minute portion of the caustic to dissolve, the ball is pushed through the stricture, and withdrawn, and thus alter¬ nately, until a gentle sensation of warmth is produced.”

Chap. V II. Formation of true Stricture . — Varieties and Conse¬ quences of Stricture. — “ So constantly is inflammation the forerunner of stricture, that it may be held a point, as well established by evi¬ dence, that the origin of all strictures in the urethra is in conse¬ quence of inflammation, as that adhesions of the pleura are produced by it.”

Of the varieties of stricture there is one in which, 11 on dissection, two or three inches of the canal may be found diminished in capacity, and rigid; and all around this part of the urethra the spongy body is so obliterated,” as from compression. “ A firm stricture may very frequently be seen, in the centre of which there is ulceration.” In such a case, is the stricture primary ? or is the stricture the result of the hardened sides and cicatrix of the ulcer?

Bell on Diseases of the Urethra, fyc. 095

A very obstinate stricture may form just within the lips of the urethra.

Consequences. — In the instance of a gentleman who resisted all means of cure, and who died of inflammation of the bladder, the eoagulable lymph formed a dense coat to the inside of the urethra, behind the stricture, so as to close the seminal ducts and mucous follicles, and produce distention of the vesiculse seminalcs.”

In cases of confirmed narrow stricture, the most frequent appearance relative to the prostate, is a number of cavities on each side of the verumontanum. These cavities are enlargements of the ducts of the gland; and our author, having observed that, in bad cases of fistula in perinaeo, the urine came from the neck of the bladder and prostate gland, suspects that these cavities sometimes ulcerate, and produce the worst kind of fistula, because they receive the urine direct from the bladder.

“ If, by accession of inflammation in stricture, absolute obstruction comes on suddenly, the bladder suffers an extraordinary degree of distention, until the urine at last escapes into the cavity of the abdomen. On examining the fundus of the bladder in such a case, dark spots may be observed upon it, and, in the centre of these dark spots, small ragged holes. This may be distinguished from a bladder burst by an accident; for, in such a case, the opening would appear rent.”

Sounding the Urethra. — “ We cannot examine the urethra properly with a conical bougie; it maybe wedged in the first stricture, which will feel like the opposition of a second.” We mentioned Mr. Bell’s urethra probes — most of our Profession have heard of them — they are silver probes, with circular knobs, varying from the full size of the urethra, to what will just pass the narrowest stricture The author boasts of their very superior qualities. “ By successively introducing smaller bails, I ascertain the degree of stricture by the ball, which passes easily; and I am secure of being in the passage, by passing the probe onward when it has got beyond the stricture.” The extent of urethral contraction, and whether the knob is in alaeuna, or in the proper canal, can be ascertained by sensations communicated by this instrument.

In the application of the bougie, we are not surprised to find in Mr. Bell an advocate of tenderness and delicacy of tact; the time it “ should remain in the passage, must be determined by the feelings of the patient; for it should never give pain, if possible.” When a soft wax bougie is used, the stricture is apt to sink so deeply into it, as to menace lace¬ ration of the urethra when the bougie is retracted. The

296 Analytical Review.

bougie must be shifted, so as to prevent an impression too deep. Of the kali pururn, Mr. Bell now forms no favourable sentiments; he believes it to facilitate the passage of a bougie by the formation of a soap, when mixed with the mucous secretions of the part; he strongly advocates the lunar caustic in one species of stricture; and he deprecates and avoids the common practice of keeping the caustic too long in the canal. A minute is more than enough.

Of forcing the Stricture. — Mr. Bell gives his readers two cases, wherein he practised this method of instantly relieving total obstruction. And these two cases have this in common — in each the stricture was nearly in its natural state; unmo¬ dified, unaugmented by the treatment of the Surgeon, especially with caustic ; a state which, perhaps, will alone justify this process of violence, notwithstanding French example.

Of puncturing the Bladder . — In our decision to perform this, we are warned against precipitation ; many persons, in the course, of the season, being “ brought into the hospital with the bladder risen above the pubes, and. relieved by bleeding, the warm bath and opiates, purges, and anodyne clysters.” We have not space to do justice to the interesting cases, and the masterly deductions therefrom, which compose this section of the book ; the information when we are to puncture, and in whom we may venture; but we will extract the direction where the trocar should enter: —

“ On dissecting the parts in the natural state, we must observe, that it can only be by a happy chance that the prostate, the vesiculee seminales, and vasa deferentia, escape in this operation; and, in fact, I possess a preparation, where the bladder was four times punctured, and each time some of these parts were wounded. A very little variation in the manner of operating, will avoid these dangers. When the finger is introduced in ano, and a proper distinction made betwixt the membranous part of the urethra, the prostate, and the body of the bladder, let the trocar be introduced, not exactly in the centre, and behind the prostate, but to one side of, and behind the prostate. Thus the vasa and vesiculee are both avoided; but, even if the latter were touched, it would be in an unimportant manner.”

Division of the vas deferens would be equal to castration.

Operation above the Pubes. — It is recommended, that, to prevent infiltration of urine into the cellular membrane, the canula be left, filling the opening made in the bladder; and that the flexible catheter be passed through it and retained.

Of piercing the Strictures of the Urethra , after puncturing the Bladder above the Pubes. — The dangerous symptoms removed, “ it is possible to introduce a catheter through the wound into the bladder, and then from the bladder into the

Bell on Diseases of the Urethra , fyc. 297

urethra.” Mr. Bell has never performed this. We need not describe the instruments this process would require.

On the bursting of the Urethra. — Of this terrible accident the symptoms are detailed in Mr. Bell’s impressive, and, we may say, fine style; and the description is illustrated by striking cases. Among the other inferences, from a full consideration of the matter, we learn, “ that punctures of the scrotum are insufficient even to empty the cellular texture of the extravasated urine, and quite unfit for preventing the urine taking the same course a second time.” Make a large opening in the skin, avoiding the substance of the penis, and the larger branches of arteries. That, “ for the most part, the urine bursts into the perinasum, and is carried by the fascia of the perinaeum forward.” Point the knife back¬ wards, so as to cut the fascia freely. That u the extravasa¬ tion takes place sometimes more anteriorly.” Ascertain, therefore, in all cases, by the bougie, and very gently, the seat of stricture; the rupture is always behind it, and cut accordingly.

Cases of Urinary Abscess. — This may arise, not only from a rupture of the urethra, but likewise from irritation in the canal, causing abscess external to it ; for, “ a very little pressure of a bougie more than is right into a narrow stric¬ ture, will bring on irritation in the canal;” and this will cause a suppuration on the outside of it. There is a similar abscess outside the lachrymal sac ; and this, being neglected, may become true fistula lachrymalis.

Operation for Fistula in Perinceo. — It is advised, that the patient’s bladder be full : if he can minge during the opera¬ tion, the posterior portion of urethra will be found more easily. Let the flexible catheter be passed through the wound, not through the penis, until a few days have elapsed. When granulations shall have covered the catheter, withdraw it, or it will stretch the parts, contract and harden the lips of the wound, and be lef t bare. From a case in which Mr. Bell, in performing the above operation, removed a portion of callous urethra, he drew this corollary : “ in no instance is it necessary or proper to cut the smallest portion out of the urethra or perinaeum, ” lest the breach of the canal be not closed. If this happen when the hole is reduced to the smallest dimensions, “ take a wire, and, heating it, lay it in different directions on the skin, pointing to the orifice by which the skin will be drawn, and pursed more and more into a contracted orifice ; and now, if the lips of the orifice be preserved raw, they will unite.” If the reader will turn to a review of Cooper’s Essays, in No. 70 of this Journal, he will

vol, xiv. — no. 82. 2 o

298 Analytical Review .

find, at page 323, other modes of most ingenious treatment for these obstinate apertures, recommended by Mr. Cooper.

This division of Mr. Bell’s book is closed with two interest¬ ing cases ; of which the first is a wounded perinseum, and in which a distended colon attached to the bladder, which was inflamed, assumed the deceptive appearance of a distended bladder. But the bladder could not be felt by the finger in ano ; and death removed all uncertainty about the swelling. The last is a case of fatal “ abscess of the perinaeum, from diastasis of the ossa pubis,” produced by wide striding, and an endeavour, in that attitude, to lift a heavy weight.

The Diseases of the Rectum occupy about fifty pages only ; but the same practical character belongs to these as to the contents of the former part of the work. Great stress is laid on the necessity of attention to the various causes of the various maladies of this part. Of these, some are simply functional, yet stimulating the symptoms of organic disorder. Here, too, in order to obtain a correct pathology, the actions and harmonies of the muscular apparatus must be taken into consideration. When a bougie is used for stricture in the rectum, it is advised not to distend the part too rapidly, lest even fatal consequences, from peritoneal inflammation, arise. One case is mentioned, where for years the bougie had been pushed against the fundus uteri, which had fallen into the sacral hollow. Some persons possess a stricture without consciousness that it exists ; and the author detected such, when about to puncture the bladder.

When a stricture is cut, the more innocent methods having failed, “ it is better to turn the knife flat upon the finger, and then to move both the finger and knife round to some other part of the edge of the stricture, which stands most distinct and prominent, and thus to notch the membrane in several places. This will be more effectual, and attended with less hazard than one deep cut.”

Prolapsus Ani , when chronic, presents two membranous flaps, hanging from each side. These may be removed. Their hase is included in a ligature passed through the centre with a needle, then divided, so as to make two. These being tied, one on each side of the flap, the projecting part is snipped off with the curved scissars. The ligature and remain¬ ing part of the flap are left to be withdrawn within the gut.

Let not the reader rush precipitately to excisions of por¬ tions of the anus. We saw the whole circumference of the gut in a chronic prolapse once removed ; the raw surface was retracted within the verge, and there it poured out blood; the tube was filled with it, and then it ejected it like a stool ;

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the sheet was deluged ; the patient fainted ; and, to all appear¬ ance, was in imminent peril of his life.

But here we must terminate our analysis of this excellent treatise. It would be unfair to its author, and inconvenient to ourselves, to prolong the subject. We have not done justice to it — we could not, in this way, do it justice; neither insert enough of facts, nor elucidate, as we could wish, the principles inculcated. This book may be held up as a model to be kept in view by all the writers of our Profession. Let them recollect the great and long experience upon which it is founded, and presented to the world ; the simplicity and phi¬ losophical character of its principles ; the number of its corro¬ borative facts ; the elegance and spirit of its classical style ; the modesty of its price .

—

Cases of a serious Morbid Affection , chiefly occurring after Delivery , Miscarriage , fyc.frorn various Causes of Irritation and Exhaustion; and of a similar Affection unconnected with the Puerperal State. By Marshall Hall, M.D., F.R.S.E., &c. &c.

The lancet has been called “ a minute instrument of mighty mischief;” and so, we are persuaded, it is, in the hands of those “ bold and decided” Practitioners, who never can look at disease but through the medium of inflam¬ mation, and imagine that every thing must be safe, while enough of depletion is secured to their patients.

It was with much interest we learnt that a formal denunciation of the inflammatory mania had been made by so able a Physician as the author, the title-page of whose present volume, or rather tract, we have just transcribed; and after an attentive perusal of the pamphlet ourselves, we can most conscientiously, and we do most earnestly recommend its contents to the consideration of our professional brethren. If there are still any among the number that think undoing and unloosing is all that medicine demands or will permit, to such we would be more urgent in the expression of our wishes, that they would take Dr. Hall as a guide and preceptor. We the other day heard an anecdote, which, if true, and we had it from good authority, may serve as a comment to the present essay. — Several women, we think the number was nine or eleven, were under treatment for puer¬ peral irritation at the same time, and in the same neighbourhood, and only one out of the whole number survived; this being one who protested against further bleeding, saying, u You may let me die if you please; but kill me you shall not.”

300 Analytical Review .

Reader, let us not be misunderstood. Quite sure are we, that the fear of the lancet has proved fatal to thousands, as well as its inordinate employment; and all we wish to inculcate is, that irritation of the highest degree may exist independent of inflammatory action ; and that, even under the actual existence of this last, the measure of the patient’s strength, as well as the measure of the ailment, should be taken, before remedial processes are commenced and pursued.

Dr. Hall treats of u a serious morbid affection occurring principally after delivery, miscarriage,” &c.; and he intro¬ duces his remarks by the following postulatum : —

“ That the morbid affection in question constitutes a great pro¬ portion among puerperal cases, and a great majority among the fatal ones ; and of these fatal cases, many are daily rendered so by a mistaken use of the lancet

The causes, course, and symptoms of this “ morbid affec¬ tion” are first detailed; we then have the diagnosis; and afterwards the treatment. In conclusion, the author treats of a similar disorder occurring independently of the puerperal state. We have a good deal to do in our present Number, and can only very briefly notice these several heads of investigation.

“ The principal source of the irritation in question is a disordered and loaded state of the alimentary canal ; the principal source of ex¬ haustion, uterine haemorrhage.”

“ It has given rise, in many instances, to sudden and unexpected dissolution after confinement. Is it not, in fact, by this complaint, that the nation has been bereaved of a princess, on whom every hope and heart was fixed ? ”

“ The symptoms vary in degree, form, and assemblage, in every case. They refer themselves to the head, heart, chest, stomach, bowels, uterus, the muscular system, and to different seats of pain.”

To those of the head belong severe pain, intolerance of light and sound, vertigo, feeling of sinking, Sec. Sec. with delirium. The heart affections are marked by great rapidity, and sometimes irregularity of pulse, palpitation, throbbing of the carotids, Sec. ; panting, sighing, and oppression about the chest, are the prominent symptoms of the respiratory ailment, with sometimes irritative cough, apparently re- fertible' to the larynx or trachea. In the stomach we meet with sickness, hiccough, and eructation; the bowels are either too loose or constipated ; there is pain in the region of the uterus, with tenderness over the whole abdomen, and different spasmodic affections in the muscular system. u In some instances, the patient has expressed the utmost dread of

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being bled, from the feeling of aggravation of her sufferings, or of dissolution induced by it.”

To assist in the diagnosis, when the mind is in doubt, it will be right in all cases, that “ the colon and rectum should be unloaded by enemata ;” a measure which we deem, in every point of view, of great moment ; and which, we are convinced, might often save the patient even from impending inflammation in these puerperal cases. The treatment must have for one of its essential indications, the removing of intestinal irritation “ by aperient medicines and by enemata.”

“ One point is of the greatest importance; it is the union with the purgative of a proper dose of opium, or a stimulant medicine; and a point of little inferior importance is the administration, before, during, and after the action of the purgative medicine, of proper nourishment.” We shall perhaps excite a smile on the part of some of our readers when we say, that life, in some such cases as these, has appeared to ns to have been preserved by the carbonate of ammonia and cordial confection, when the question has been between excitation and venesection; and when under the latter, we have no doubt, the individuals would have sunk exhausted. When exhaustion has been consequent upon uterine haemorrhage, Hr. Hall recommends a “ lotion prepared by dissolving from one to two drams and a half of sulphate of zinc in a pint of soft water,” and a scroll of linen imbued with it to be introduced into the vagina. For the local affections, leeches to the head and to the abdomen may be sometimes requisite and highly useful. An opiate, witli purgative enemata, is always desirable where there is much abdominal pain. Fomentations, too, and liniments, both to the part and feet, are often exceedingly serviceable. For the sickness, the effervescing mixture is useful. The apartment must be kept cool and quiet, and the patient soothed and exhilarated. “ If there be any agitation, from dreaming or otherwise, the patient should be gently and cautiously awakened, and soothed and calmed, if there should be alarm; and the best mode of awaking has appeared to me to be by offering a little nourishment — the mind by this means being immediately collected to understand the state of things.”

With respect to a similar morbid affection occurring inde¬ pendently of the puerperal state, Dr. Hall has the following- remark : —

“ A deranged state of the stomach and bowels, and intestinal irritation, are incident to all periods and circumstances of life. The chief sources of exhaustion which occur independently of confinement and miscarriage, are uterine discharges, hsemorrhagia, leucorrhcea, protracted lactation, diarrhoea, purging, blood-letting, various diseases, and other accessary causes.”

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The principles of treatment are, of course, generally the same as in the puerperal cases.

The following are Dr. Haii’s “ concluding observations

“ It has already been observed, that the effects of intestinal irrita¬ tion and of exhaustion are somewhat similar, and that the two causes frequently co-operate.

“ It is also of importance to observe, that each of these causes seems to induce greater effect when the other pre-exists than when operating alone. Thus exhaustion is particularly apt to occur as an effect of the loss of blood, in cases of intestinal irritation.

“ The symptoms detailed in the preceding pages, as effects of loss cf blood and of exhaustion, occur generally from a protracted or repeated operation cf the cause ; especially the throbbing of the head, the palpitation of the heart, &c. The effects of sudden and profuse hsemorrhagy are different, and do not need to be described. In the latter case, the proper remedies are applied without hesitation ; the former appears perhaps to arise spontaneously , and is not so mani¬ festly connected with its cause; but is often mistaken for local inflammation, and often mistreated by remedies which co-operate with the exhaustion, aggravate the disease, and endanger the patient.

“ It is also observable, that, in some instances, bleeding has been borne better than could have been expected, when its repetition has been hurtful, or even fatal. In some instances, the loss of a little blood has not appeared to do particular or immediate harm, but even to give relief; in others, it has exasperated the throbbing, palpi¬ tation, or pain ; and the Practitioner has been led, by the apparent benefit conferred, or by the apparent obstinacy of the affection, to a fatal repetition of the same measure/’

We can only make room for one of the cases out of the thirty-three with which Dr. Hall closes his tract. These several cases are registered under four different heads: 1st, those terminating favourably ; 2d, those terminating unfavour¬ ably; 3d, fatal effects of blood-letting; 4th, cases occurring independently of the puerperal state.

“ Mrs. W., aged thirty-three, weakly, was confined of her sixth child, after an easy labour, without flooding, at midnight, on the 20th of July, 1818. During the ensuing day all was well. The lochia were natural; there was no alvine evacuation, but the bowels had been open during pregnancy, and twice evacuated during labour.

“ On the morning of the 22d, Mrs. W. took half an ounce of the oleum ricini ; and at four in the afternoon this medicine was repeated, the first dose having produced no effect; this, however, induced violent purging, gave great fatigue, and caused the patient to com¬ plain much. At ten o’clock in the evening, Mrs. W. was seized with rigor, which was violent, and continued more than an hour; this was followed by great heat of skin, with wakefulness, restlessness, anxiety, sighing, and moaning.

“ At ten on the succeeding morning, there were great heat of skin

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and pain at the bottom of the back. Four teacupsful of blood were taken from the arm. The symptoms still continued, and at seven in the evening three teacupsful of blood, and at eleven three more, were taken from the arm, and twenty leeches were applied to the region of the uterus for the increased pain. The pain still continued to increase, with restlessness, sighing, faintishness ; constant necessity for the smelling bottle ; apprehension of impending dissolution.

“ Afterwards, the symptoms being unabated, a Physician was consulted. About three o’clock, three teacupsful of blood were again taken from the arm, and leeches again ordered to be applied; an enema was given, which evacuated a quantity of feces, quite unexpected. In a short time Mrs. W. became cold, and the surface clammy, with fainting, gasping breathing, &c., and all was done to restore warmth. After an interval of three hours, the pain was still great. Some opening- medicine was prescribed ; but the state of sinking continued ; the smelling bottle, the fan, and fresh air were urgently called for. All the symptoms, except the pain, were aggravated, — there were gasping, a slight convulsive struggle, — - another, — and the patient expired.”

Dr. Hall’s pamphlet, we think, would have been rendered still more valuable, had he prefixed to his remarks and recitals a preliminary dissertation on the difference between mere irritation and positive inflammation; on the occasional conjunction of these two states; and on the different circum¬ stances of the body generally, and organs implicated, under which these local affections make their appearance.

III.

Elements of the Theory and 'Practice of Physic, designed for the Use of Students. Part I. Including the Symptoms , Pathology , and Treatment of Acute Diseases. By G eorge Gregory, M.D., &c. &c.

The principia and the language of medicine have under¬ gone a very material alteration within the few past years. Since the lime of John Hunter, Bischat, &c.5 we have been disposed, more than formerly, to search for pathological truth upon anatomical ground ; and not to frame systems of medicine, like systems of metaphysics, in a sort of ideal and abstract way. Every one is, or ought to be, aware of the excellence of Dr. Cullen; but every one, at the same time, knows, that his first lines contain a good deal of that kind of matter which the present-day pathologist refuses to own as matter of any worth. With all our modern improvements, however, real and supposed, (for there is a good deal ol both, in the mode of conducting medical research,) nothing has yet appeared in the form of arrangement and description ol

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disease, which can at all vie, as to accuracy and utility, with the nosology of Cullen. In all nosological schemes, indeed, as we have frequently had occasion to say, there is necessarily a great deal that is arbitrary, and, if it may be so called, illegitimately supposititious, since the very notion of classifi¬ cation and nomenclature in disease, in the same way that objects in natural history are arranged and named, is funda¬ mentally erroneous. Still, if there must be a system, Cullen’s, we repeat, is the best ; and one of its beauties consists, in our mind, in a recognition of the three leading principles of the animal economy, viz. circulation, sensation, and assimilation.

It was with much pleasure that we found the author of the book which is now under review steer a midway course. We were, we say, while perusing the present volume, gratified in finding Dr. Gregory (a name dear to medicine as Bell is to surgery) a modern pathologist, without being extrava¬ gantly or exclusively so. We were rejoiced to find that inflammatory and membranous views had not so dazzled his mental vision as to blind him to the good of former princi¬ ples. “ Erysipelatous inflammation often successfully treated by bark and acids.” Surely, Dr. G., would some of our venesectors say, you have forgotten the doctrines which the new' vascular lights in medicine have made so manifest, and are thinking of what Cullen, and your own relations, con¬ ceived and taught some forty years ago. But our author would reply to these remarks, or, at least, we would for him, that there are impelling powers, as well as conveying chan¬ nels, in the animal economy ; and that to be pathologically correct, and practically safe, we must carry our regards a little higher than the mere condition of the blood-vessels. Or the reply might proceed more in this strain: “ I have witnessed the truth of what is alleged in favour of bark and acids under some circumstances, of blood-letting and reducing measures under others; nor shall either the mad precepts of Brunonian generalization on the one hand, nor the more specious calls of modern vascularism on the other, seduce me from the sober paths of observation and truth. 1 will equally resist the sanguiphobia and sanguimania influence.”

But enough of this. Dr. Gregory has, in plain truth, and without any reference to prevailing parties and opinions, effected a very desirable object, and that in a very masterly manner; and we recommend all who are about commencing their medical studies systematically, to possess themselves of his book, the reasoning of which is correct, the practice of which is good, and the language of which is clear, facile, and forcible.

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It is only on acute diseases that the author has treated; but we could have wished (reviewers must object to some¬ thing) that he had completed his intention of going through the whole catalogue of morbid affections, chronic as well as acute, before he had presented any part of the volumes to the world. We might, indeed, object to the division of morbid affections into acute and chronic ; but there is no classifica¬ tion of disease, as above intimated, to which objections do not apply ; and it is as well, perhaps, while we retain this truth in our minds, not to be too nice and critical on the score of method.

As an elementary treatise, Dr. G.’s is not susceptible of satisfactory analysis; we shall, therefore, merely run over its contents in a cursory manner, remarking here and there upon particular points. Fevers, generally, constitute the first class of the acute diseases treated of by our author; the second division comprises the exanthemata , or eruptive fevers; the third class includes the phlegmasia, or inflammatory diseases; and the fourth hemorrhages.

In treating of the general doctrine of fever, Dr. Gregory, after remarking that all the theories already proposed are open to many and strong objections, proceeds to observe, that —

“ To the diminished energy of the nervous system we ascribe the languor, lassitude, loss of appetite, general uneasiness, and pain of the back, which mark the invasion of fever. The functions of the brain not being yet thoroughly understood, it is doubtful whether or not we are authorized in attributing to the same source the diminished and depraved secretion which occurs in fever; but it is highly pro¬ bable that the phenomenon is in some measure connected with it. The same thing may be said of the increased heat which attends fever, the physiology of animal heat being, like that of secretion, involved in much obscurity. It would appear, however, that this is a mixed function, in which the brain and the heart are both essen¬ tially concerned. Febrile thirst is a symptom which has never been satisfactorily accounted for. The restlessness, headach, delirium, and other disturbances of the animal functions, are certainly attri¬ butable to an increased flow of blood upon the delicate structure of the brain. They neither depend upon inflammation, as some have contended; nor arc they necessarily connected with congestion within the brain ; nor are they referrible to sympathy of that organ with the chylopoietic viscera, as others have imagined.”

With respect to cutting short fever, we are told that the question is set at rest, as to the propriety of so doing, but “ the possibility of it is still very questionable;” and further, in reference to the subsequent management, it is very justly remarked, that, “ though the extravagancies of a medecine

vol. xiv. — mo. 82. 2 ii

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expectante are justly blameable, the spirit of the doctrine should never be lost sight of.” When treating of the causes of fever, Dr. G. expresses that opinion which we have ever advocated, that true typhus, although unquestionably a con¬ tagious disease, may and does originate independently of this source. On the cure, too, or more properly the treat¬ ment of fever, we find the sentiments of our author almost in entire accord with our own.

“ Common continued, and typhus fever (he says) do not necessa¬ rily require the adoption of blood-letting. A large proportion of cases, especially of the latter, would be hurt by it, and in many, to say the least, it is uncalled for. But, on the other hand, there are some, and those among the most formidable, which fall under our observation, which as imperiously require it.” — “ The legitimate object of blood-letting in these diseases, is the checking those dispo¬ sitions to inflammatory action which are so often met with in severe cases.” — “ It is frequently observed, that a judicious abstraction of blood in the early stages of fever, not only diminishes the headach, the great sensibility to light and sound, the delirium, or the cause, or the pain and fulness of the abdomen, but it apparently shortens the course of the disease, and, more obviously still, the period of convalescence.” — “ I have frequently had occasion to see affections of the head in fever yield speedily to the application of leeches, where general bleeding appeared only to weaken the body, without influencing the local affection.” — “ For the most part, it will be found preferable to employ local blood-letting , when the object in view is the relief of an urgent symptom.”

Plague, Dr. Gregory tells us, is to be viewed as a continued fever, allied to typhus, but differing from it in the important circumstance of having its origin in specific contagion. We question, however, the propriety of this assumption, conceiving, as we do, that plague, as well as typhus, although propagated by contagion, may originate spontaneously under circumstances of an epidemic state of the air highly conducive to its generation.

The disputes respecting the contagion or non-contagion of the yeliow fever, are, according to Dr. G.? attributable, in a great measure, to the controverlists not distinguishing between the endemic febrile diseases of hot climates, which always are connected with more or less yellowness of the skin, and the e< epidemic yellow fever, such as that which raged in the West India Islands, and at Philadelphia, in 1793; at Cadiz, in 1800; at Malaga, in 1803; at Gibraltar, in 1804 and 1813; and again at Cadiz, in 1819.” He allows, however, that, under peculiar circumstances, the genuine malignant yellow fever may be generated by a combination of endemic causes. It is most certainly contagious, we are

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Gregory's Theory and Practice of Plujsic,

taught, when once received into a town, and “ a most extensive experience has satisfactorily proved, that the im¬ munity from second attacks is nearly complete, and that it forms one of the most striking characteristics of this remark¬ able disease.”

In his chapter on the exanthemata, our author adverts to that connexion between dermoid and mucous membrane affections, which has recently been noticed by Dr. Harrison and Mr. Allcock. We will extract what is said on this head.

“ The pathology of the eruptive febrile diseases is confessedly as obscure as that of the simple fevers ; but latterly an attempt has been made to clear up some of the difficulties in which it is involved, by showing, that disease of the great mucous membranes of the body is implicated in them, as intimately and to almost as great an extent as the skin itself. The structure and functions of the skin and mucous membranes bear a close resemblance to each other, and many pathological considerations tend to prove, that there exists also a very close analogy in their diseases. It would be a rational conjecture, therefore, that in fevers where the skin is extensively concerned, the mucous membranes would participate, and observation favours the opinion. The principle appears to be of very general application, and is illustrated not merely by the symptoms which the different ex¬ anthemata present, in their different stages, but by the appearances also found after death. There is reason to suspect, that upon this intimate connexion between exanthematous fevers and disease of mucous mem¬ brane, depend several of the most important varieties and anomalies which have been observed ; such, for instance, as the recession of the eruptions, and the occasional occurrence of the disease a second time.’'’

Dr. Gregory is not a convert to the hypothesis of Thom¬ son, respecting the identity of variola and varicella, “ although many ingenious arguments have been brought forward, in a late essay, to establish that identity.” The principal charac- teristics of varicella, as distinct from small-pox, are, that it is vesicular, and has no central depression. (i If the eruption, instead of being vesicular, exhibits, in its earliest stages, the appearance of induration ; if the vesicles have a central de¬ pression ; if, after discharging their contents on the third day, a lirm tubercle be found below ; and if the crusts are com¬ pact, defined, of a clear horny smoothness, and elevated, it is probable that the disease was not varicella, but arose from the contagion of small-pox.” When small-pox occurs after vaccination, “ the pustules are often hard or horny , but scarcely ever fail to exhibit the diagnostic marks of variolous eruptions , depressed centres. They run through these stages with fapidity, maturating, for the most part, on the filth day.’

308 Analytical Review .

This eruption will produce genuine small-pox in the unpro¬ tected by vaccination. To that peculiarity oj constitution which favours secondary small-pox, we must probably be content to refer the occurrence of small-pox after vaccination.

“ No reasonable doubt can be entertained, from the facts now before the world, that the proportion of these occurrences is so very small as not to affect, in any sensible degree, the credit of vaccination, which must continue, therefore, to uphold the fame of Jenner, and the triumph of the medical art.”

W e all knowr, that one of the peculiarities of scarlatina is the dropsy, by which it is often succeeded, and which seems to take place without any reference to the kind or degree of preceding disorder. Until within a few past years, the effusion by which this sequela is characterized, was attributed to debility, and a tonic plan instituted for remedying it. Latehr, however, dropsy, in all its forms, has been attributed to an inflammatory action, and bleeding has been pronounced beneficial in this particular dropsy. Dr. G. has already given to the world an ingenious essay in support of this opinion ; and it therefore is particularly deserving of remark, as evidence of his determination to make preconceived sen¬ timent bow to observations, that he states, he “ has met with several cases which appeared to indicate the propriety of bleeding and purging, but which resisted both, and ulti¬ mately yielded to bark and aromatic confection/'

In discoursing on the general doctrines of inflam mation, we expected Dr. G. to state precisely what he considers the actual state of vessels which constitutes this condition of parts. He declines doing this under the impression that the subject is involved in “ almost impenetrable obscurity.” He makes, however, one remark in reference to this point, which we consider of importance, viz. that it may be deserving of inquiry, how far the nerves are concerned in inflammatory action. Several circumstances, he says, tend to the notion, that a huffy state of the blood (a phenomenon not hitherto satisfactorily accounted for,) is a phenomenon depending on nervous influence. There is another observa¬ tion of his in this part of the treatise with which our opinions do not so exactly coincide with those of the author.

“ A doubt/' he says, “ has been expressed, whether differences of anatomical structure are sufficient to explain all the diversities which we observe in inflammatory action. It has been suggested, that is to say, that there may be differences in the nature of inflammatory action. This refinement, however, appears to be unnecessary.''

Now, in our opinion, too much in the pathology of the present period hinges upon the texture or part inflamed, and

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too little upon the abstract difference of the disordered state. Does not, for example, common inflammation occasionally extend to, and fully implicate structure, which is the seat of rheumatism, without, therefore, having any thing of a rheu¬ matic character connected with it ?

Treatment of inflammation : —

“ To a certain degree the part inflamed affects the treatment. Inflammation of a serous membrane demands the copious and rapid abstraction of blood. That of mucous membranes does not bear the same extent of evacuation, nor does it so often require it. Erysipela¬ tous inflammation is often successfully treated by bark and acids. Rheumatic inflammation is under the control of certain drugs, which have no effect upon, or which prove absolutely prejudicial in, common inflammation — I mean, colchic-um and opium.”

If we were disposed to query any part of the above paragraph, it would be its last clause.

Chronic inflammation is a term which has been used, like many others, without much accuracy as to the precise cir¬ cumstances which it is meant to indicate. We believe that there is a good deal of foundation for the French doctrine, that it has its seat in two distinct orders of vessels, sanguife¬ rous, , and lymphatic capillaries ; and although we think that Dr. Baron has generalized a little too hastily, we are not sure whether we do not feel a little more partiality to his views respecting lymphatic irritation, than Dr. Gregory seems inclined to entertain.

In the chapter on phrenitis and hydrocephalus, we do not find any -thing to call for particular notice. From such an -accurate observer of symptoms as Dr. G. has shown himself, we should have expected an allusion to that kind of croupal breathing which so often marks the latter affection, and which is sometimes so prominent, as to lead the observer to conceive that the tracheal is the primary and only affection under which the child labours.

We do not think that “contagion” sufficiently explains the rapidity with which influenza travels from one region to another. The circumstances of this disease are surely attri¬ butable, in part at least, to a something in the “ constitution of the air.” That it is contagious, however, we believe; and so, indeed, does common catarrh often seem to be. One child of a family has very seldom what is called a severe cold, without the affection pervading the whole nursery.

“ An antiphlogistic system of treatment is required in cynanche tonsillaris; but venesection is seldom, if ever, necessary.”

On laryngeal and bronchial inflammation we meet with a good deal that is very admirable; but, as an able treatise

3i() Analytical Review.

exclusively on these affections, is immediate! to pass oar critical tribunal, it does not seem necessary to detain the reader on these topics. We shall confine ourselves to saying, that Dr. Gregory is not so partial to the calomel plan of treatment in croup, as our own experience inclines us to be.

When treating on thoracic inflammation, Dr. G. very justly remarks, that “ metastasis of acute rheumatism is by far the most common cause of inflammation of the heart.” The possibility of this ought always to be recollected by the young Practitioner, in cases of severe rheumatic attacks; otherwise he may be overtaken by a deadly disease, when he has no dread of any danger.

Hepatitis. — •“ It has long been observed, that the blood which is drawn in inflammation of the liver, exhibits the very remarkable appearance of greenish huff ; and different ideas, none of which, however, are very satisfactory, have been entertained, with regard to the cause of this phenomenon. The great danger of suppuration in the hepatitis of hot climates, makes it necessary to be prompt in the employment of venesection. This consideration, however, appears to operate differently on the minds of some, and to induce them to employ mercury on the first attack. The propriety of this practice in hot climates, cannot, indeed, be judged of by the experience acquired here; but theory and analogy seem equally opposed to it. When the febrile symptoms abate, however, recourse may be had to this remedy. It is seldom, perhaps, that it is absolutely requisite in the acute hepatitis of this country; but, under proper management, it may be resorted to even here, in the latter stages of the disease, with some prospect of shortening the convalescence.”

Of the section which treats of inflammation in the mucous membrane of the alimentary canal, the reader will find some remarks worthy attention. “ There appears to be a peculiar tenderness and susceptibility of inflammation in this mem¬ brane during the first years of life; and this points out the great importance of regulating the diet of children with the most scrupulous care.” — -“There is reason to believe that diarrhoea, with thrush, which is an inflammatory affection of this part, is always connected with an improper diet.” The tabes mesenterica, marasmus, and infantile remittent fever of children rather more advanced, our author considers likewise as properly diseases of the mucous membrane of the bowels; and he questions whether there is a disease of the mesenteric glands, primary and independent of disease in the intestines. On this point, perhaps, Dr. Gregory is a little too membranous and inflammatory in his pathological views. We feel fully convinced that there is very often to be found a true, strumous, lymphatic affection of the mesentery in young children, productive of marasmus; and even by sympathy or

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metastasis leading to hydrocephalus, without any original or inflammatory affection in any portion of the intestinal tube. Tabes mesenterica, and infantile remittent fever, are distinct diseases, although often, it is true, combined.

Of the precise seat of the inflammation in rheumatism, we are told, very little is known; while the capsular ligaments, tendinous sheaths, and aponeurotic expansions, appear to be mainly implicated in the generality of cases, the cellular membrane round the joints probably partakes of inflammation in the active form of the complaint. Whether the affection common to the synovial membranes of joints, is the same in nature, and merely differing in locality, has not been made quite evident. It has less tendency to shift its seat than genuine or ordinary rheumatism, and is more under the control of local remedies.

Treatment of Rheumatism. — “ If an opinion were formed from the various, and even opposite modes of treatment, which have been recommended in acute rheumatism, not upon theoretical grounds, but after ample and successful experience, it might rationally be supposed that the disease occurs in the most opposite states of the system ; but this opinion is not borne out by the observation of symptoms. 1 believe the better conclusion to be, that acute rheuma¬ tism is at all times a tedious, and rarely a dangerous disease; that a large proportion of cases would recover with very slight care; and that, in many, medical treatment is of little further service than as obviating the tendency to internal inflammation. It cannot, I think, be questioned, but that with regard to the power of cutting short the disease, a considerable difference exists between rheumatic and common inflammation.’7

Colchicum, Dr. G. thinks, displays its efficac}' more in the chronic than acute forms of rheumatism. To the calomel and opium system of treating acute rheumatism, lie evinces some partiality. Bark he thinks only useful in the later periods of the disease. “ Local applications to the affected joints are of little service ; or rather, in most cases, of no service at all.”

Of Gout. — The recent attempts to revive the opinion of a materies morhi in this disease have failed. There is, probably, a certain pathological connexion between gout and gravel, the precise nature of which lias not, however, been ascer¬ tained. Colchicum may be occasionally used with much advantage for moderating the violence of the paroxysms. “ With regard to local treatment, experience has fully proved that little is requisite. Cooling lotions are occasionally useful; but, in most instances, any application of cold to the affected joint increases pain, and is therefore unadvisable.,, Hurely there are stronger objections to cold applications, than

Analytical Review .

that they sometimes increase pain : indeed, it is where they do precisely the opposite, that we consider their employment to be the most unadvisable. We do not, however, in toto condemn the practice; it is only its incautious and indiscri¬ minate adoption that we should fear.

Erysipelas is occasionally both contagious and infectious ; sometimes neither. Cold spirituous lotions to an erysipela¬ tous service are sometimes useful ; but for the most part “ it will probably be advisable to refrain altogether from local applications.

The doctrine of haemorrhage is as obscure as that of inflammation. To account for local determinations and con¬ gestions, upon which these accidents in part depend, too much of hydraulic pathology is, even in the present day, mis¬ chievously prevalent. Dr. Gregory lauds the little book of Charles Bell, on the powers which circulate the blood, as being free from, and even opposed to those speculations on circulatory movements which are not applicable to the living machine. Both, however, on the subject of inflammation and haemorrhage we should have hoped to have found our author more particular and minute than he has been.

The last topic treated of in the present volume is consump¬ tion. But as there is nothing under this head which calls for particular notice, we shall here terminate our review of a book, with which, upon the whole, we have been amply gratified. Minor differences of opinion, both on speculative and practical points, must always be expected between those who compose, and those who supervise treatises on par¬ ticulars, which, from their very nature, must ever remain more or less suh-judice ; but we can conscientiously say, that in the event of illness occurring in our own persons and families, Dr. G regory is precisely the kind of Practitioner to whom we should wish to commit the issues of life and death.

As a writer, too, he is, we repeat, deserving of every praise. His style is fluent without carelessness, and attractive without any affectation of sentiment, or the smallest admixture of 1 n e r e t r i c i o u s o r n a m e rr t .

IV.

A Treatise on. Inflammation of the Mucous Membranes of the Lungs. To which is prefixed , a Preliminary Inquiry respect¬ ing the Contractile Power of the Blood-Vessels, and the .N at ure of Inflammation. By Charles Hastings, M.D., &c. &c.

Reviewing, like other things of life, basils advantages as well as disadvantages. If it be painful to condemn where

Hastings on Bronchitis. 3J3

demerit demands censure, it is pleasing to be able to praise where merit calls for the award of praise. Our duties of this month have really been grateful to our feelings. Three books have already passed our critical ordeal with high and deserved credit ; and we have now to notice a fourth, of which it may be said, with truth, and ought to be said in justice, that no collector of modern medical classics should pass it by unpurchased.

It will be in the recollection of our readers, that we have given a check to that disposition which is indi¬ cated by some ingenious pathologists to stretch out the mucous membrane to such an extent as to make it en¬ velope the whole of medical institutes; but we hope that our strictures in reference to this particular were not so far misconceived as to have conveyed the impression that we were at all insensible to the necessity of paying minute attention to those morbid states, which, in a special manner, implicate this important part of organization. If so, let our commendation of the treatise now under remark convince the reader that we have been misunderstood.

The first chapter of Hr. Hastings’ book is devoted to an investigation of the nature and peculiarities of inflammation, and it consists of a very masterly illustration and defence of that doctrine which assumes debility and dilatation of the capillary vessels as the essential circumstances of the inflamed state. That such dilatation does occur in inflamma¬ tion, either as cause or consequence, is, indeed, more than assumption, since Wilson Philip, our author, and others, have actually made it the subject of ocular demonstration. It ought to have been stated, that, as a preface to this pre¬ liminary discourse on the nature and essentials of inflamma¬ tion, Dr. Hastings presents his readers with a paper on the habits of the blood-vessels, in which he makes it evident, to our perception, that they possess a contractile irritability, like other muscular parts, and that those pathologists who have denied this endowment to the vascular tubes, have been in an error. Our limits, of course, will not allow of detailing the experiments upon which the greater irritability of the arteries, and minor one of the veins, is founded; and we must confine ourselves to a statement of the two leading deductions from the experiments.

“ 1. The blood-vessels, through every part of the system, possess a considerable share of irritability, by which they contract and propel forward their contents. Hence the blood, by the action of the vessels, receives a new impulse in the most minute tubes, and a well regulated momentum is preserved in every part of its course. Rut of all parts of the sanguiferous system, the capillaries seem most cmi-

yol. xiv. — no. 82. 2 s

314

Analytical Review .

nently endowed with this faculty, and are least indebted to the pre¬ siding influence of the heart. Yet, even in these vessels, we can, with the fullest confidence, maintain, that the action of the heart is of consequence to sustain the healthy circulation ; inasmuch as it gives the first impulse to the blood, and preserves the harmony of the san¬ guiferous powers.

“ 2. The vessels are endowed with this vital property, in order that each organ in the body may receive such a supply of blood as will enable it duly to exercise its functions. It must therefore be evident, that a healthy state of this property is absolutely necessary for the preservation of the animal functions ; for if the vital contrac¬ tion of the blood-vessels be either increased or diminished, irregular distribution of blood inevitably follows; and from this fruitful source numerous diseases arise ; none, certainly, more frequently than inflammation.’'

Now, if we are actually shown the dilated condition of the capillaries during the presence of inflammation, it follows that this dilatation results from debility in the parts thus affected. This debility is either direct or indirect; it has either been occasioned by an abstraction or exhaustion of power: in either case the dilatation occasions the reception of more blood than the vessel would transmit, were its con¬ tractility and calibre that of health ; and this congestion, with its consequent commotion, constitutes, we are told, inflammation : to the existence of which Dr. Hastings main¬ tains the formation of new vessels (as argued by some) is not necessary; and that this formation of vessels only takes place when some degree of disorganization occurs. Others, how¬ ever, would say, that it is rather congestion than inflamma¬ tion which the theory of debilitated and dilated capillaries explains; and that, in cases of true inflammation, there must be new secretions, and the formation of new tubes for conveying the blood. In either case, however, the treatment required in inflammation is beautifully elucidated by the principles of weakened capillaries ; and on this head Dr. Hastings makes use of Dr. Philip’s illustration, which is given in the following words of the latter: —

“ The means which promote the resolution of inflammation may be arranged under two heads.

u 1st. Those which lessen the volume of fluid, distending the debilitated vessels by directly abstracting part of it, by occasioning a discharge from, or an accumulation of blood in, some neighbouring part, or by diminishing the vis d ter go.

“ 2d. Those which stimulate the vessels of the inflamed part,

“ How well the operation of these means corresponds with the foregoing doctrine of inflammation, need not be pointed out. It is true, that, did inflammation depend on a morbidly increased action of the inflamed vessels, it would be relieved by removing part of the

S15

Hastings on Bronchitis.

fluid which supports this action. But how shall we, on this suppo¬ sition, explain the effects of astringents, and other stimuli, applied to the inflamed part? These, it has been said, exhaust the excitability of the inflamed vessels, and thus lessen their action. But it appears, from the foregoing experiments, that their effect is that of increasing the action of the inflamed vessels; and that it is only in proportion as they have this effect, that they relieve the inflammation.”

Are not, we would just stop to ask before we proceed, are not the above principles and postulata in harmony with all the phenomena; and do they not show that a due admixture of excitement, with abstraction of volume and action, con¬ stitutes the legitimate, and safe, and efficient method of combating inflammation ? and is not the stimulating, or exciting, or astringent ingredient in the process, call it by which name you will, too much overlooked by those patho¬ logists and Practitioners, who think that you have nothing to do but to unsheath your lancet, and inflammation, with all its consequences, will fly with the rapidity of a mouse from a cat ? We take courage from the occasion to express our often conceived notion, that effusion into cavities is almost as frequently the consequence of too much as it is of too little bleeding. But to proceed with our author and his work.

The second chapter comprises an abstract of the opinions of preceding writers respecting bronchial inflammation. Nothing is to be met with very precise and satisfactory on this disease in the writings of the ancients; and it will be found useless to go further back than the time of Bonetus for information on the subject, who, in the first section of the second hook of the Sepulchrum, relates several cases of inflamed mucous membrane. Sydenham accurately describes one variety of the affection, under the name of bastard perip- neumony (peripneumonia notha). Hoffman speaks of the disease, under the appellation of catarrhus suffocativus. Morgagni and Valsalva are both rather meagre in their accounts of chronic pulmonary affections. Lieutaud gives a remarkable case of the relation which the disorder sometimes lias to measles. He also speaks of the idiopathic disease, and complains of a want of precision and accuracy in the accounts which both Boerhaave and Sydenham give of it. Sauvage describes a rheuma catarrhal; Van Swieten copies Sydenham ; and Cullen, though he has given a very accurate accouift of peripneumonia notha, has not added much to that which had previously been done by Sydenham.

“ The work of Dr. Badham is the first treatise entirely devoted to inflammation of the mucous membrane of the bronchia.” — “This writer thinks that bronchitis acuta has not been before described.

Analytical Review.

31 6

Bronchitis asthenka answers to the peripneumonia notha of Syden¬ ham and others. And under bronchitis chronica, chronic coughs, catarrh us pituitosus, &c. are arranged.”

Dr. Cheyne, Dr. Duncan, Dr. Wilson Philip, and Dr. Armstrong, have subsequently treated on the same subject. The first in the fourth volume of the Edinburgh Medical and Surgical Journal, and in his “ Pathology of the Mem¬ brane of the Larynx and Bronchia.” The second in his work on Consumption; the third in the seventh volume of the Medico-Chirurgical Transactions; and the last in his Treatise on Scarlet Fever, Measles, Consumption, &c.

Dr. Hastings, in his third chapter, gives his own account of the disease under notice, which he divides into seven varieties, of which common catarrh is the first; which, when suffered to run on into a purulent stage, produces a species of consumption. In these cases, it is acknowledged that tubercles generally are found in the lungs, but in some instances the mischief is entirely confined to the mucous membrane. Catarrhus selines is the next variety, which often creeps on insensibly, and becomes chronic bronchitis. The third variety is the active bronchitis of the strong and plethoric , the progress of which is more rapid than in the preceding cases. Even in this, however, there is not the pleuritic or peri pneumonic pain which characterizes affections of the pleura or parenchyma of the lungs ; “ but a distressing sense of straitness is constantly felt. The breathing is hurried and laborious, the patient only experiencing tolerable ease in an erect posture.” The fourth species is the acute bronchitis of young children , which occurs most commonly in the spring of the year, commences as a catarrhal affection, and, in the more urgent cases, does not take up more than seventy-two hours. “ In this disease, the breathing for several hours occasionally appears so free and easy as to lead the Practi¬ tioner to expect that he has subdued the disease.” During the remissions the child often dozes, and is not much dis¬ tressed by cough. The pulse varies with the breathing. The eruptive bronchitis is the fifth variety, or that which occurs in connexion with or vicarious of cutaneous eruptions, as of erysipelas, but more especially of measles. The disease in this case is of a more obstinate nature than when it arises from cold. Complications of the bronchial affection with diseases oj the abdominal viscera, form the sixth variety of Dr. Hastings; gastritis and peritonaeal inflammation, but more usually hepatic diseases, being the accompaniment and source of the Variety in question. This hepatic disease is more acute or more chronic, sometimes insidious and ob¬ scurely marked, at other times easy of detection. Seventhly.

317

Hastings on Bronchitis.

On r author treats of bronchitis as rendered obscure bi / co¬ existing disease , and unattended with its usual symptoms. ' One of these co-existences is laryngeal inflammation. Tumours, likewise, pressing upon the trachea, often occasion bron¬ chitis.

“ Sometimes the bronchial disease is complicated with a multitude of other phenomena.” — “ Sometimes its abrupt attack, its rapid course, and its combination with inflammation of the lungs, pleura, pericardium, or heart, do not allow us, with any degree of certainty, to fix the character or seat of the affection.”

Dissection. — The lungs are usually quite sound, but evidences of inflammatory action are found in the bronchia;, which are, for the most part, plugged up by purulent matter, or tenacious mucus, or bloody serum. The continuation of the mucous membrane through the air-cells, generally denotes the existence of inflammation. The abdominal viscera are not unfrequently found diseased. Every part of the peritonaeum is now and then in a morbid state. The blood-vessels of the head are generally in a congested state.

Rationale of Symptoms. — Whence the wheezing of bron¬ chitis? Dr. Badham conceives this to arise rather from a constriction and rigidity of parts, than a redundant secretion of mucus. Dr. Hastings rejects the former, , and supports the latter notion. The forehead pain, so conspicuous in bronchitis, is referred by Dr. B. to an inflammatory state of that portion of the membrane which lines the frontal sinus. But, says Dr. H., were this really the case, we should occasionally meet here also with the consequences of inflam¬ mation. He admits, however, that the headach may have some connexion with congestion in the head, caused by the impediment to pulmonary circulation. The sudden and fatal sinking, so common in this disease, is manifestly owing to congestions of blood about the head and Jungs unduly decarbonized.

Distinctions. — Anxiety is a tnore prominent symptom than in pneumonia; the dyspnoea more distressing; the acute pain of pneumonia is wanting; there is a remarkable wheez - big; the pulse wants the hardness of pleuritic pain. From croup bronchitis is distinguished by the absence of the stri- dulous respiration; from hooping-cough bronchitis is distin¬ guishable by its greater degree of fever. The dyspnoea, too, is greater, and more continued. Both croup, however, and chin-cough, occasionally become bronchitis in their course.

Prognosis. — Coma and increased labour of breathing, the nails becoming livid, and the voice hoarse and indistinct, indicate a fatal termination. i£ When the anxiety and sense of oppression are very great, and the pulse weak, quick, and

318

Analytical Review,

fluttering, the fatal event will almost inevitably occur.”—' u In young children, the prognosis is more unfavourable than at any other age.” — “ Bronchitis arising from cutaneous disease is more dangerous than that proceeding from cold.”

Treatment of Acute Bronchitis.

The following is a concise view of the means to be had recourse to for removing these inflammatory affections : —

“ To moderate the excitement of the sanguiferous system, general blood-letting, acidulated and mucilaginous drinks, and absence from all stimulating food. To promote expectoration and perspiration, antimonial and saline medicines. To direct the fluids towards the surface, and relieve the congestion of the debilitated capillaries , local blood-letting, blisters, and rubefacients.”

The first variety of the disease, for the most part, does not require blood-letting. In the second, venesection is generally proper; but on account of the age and circum¬ stances of the individual, it must be used with caution. In the third, blood-letting is to be promptly and boldly em¬ ployed; and “ several blood-lettings are sometimes required.” In the acute bronchitis of young subjects, it is better to take blood from the jugular vein than from the arm. “ Cases of this description have occurred to the author, in children of about four years of age, in whom dyspnoea, threatening speedy suffocation, was completely recovered by the detrac¬ tion of six ounces of blood from the external jugular.” When bronchitis occurs, in conjunction with visceral affec¬ tions, the bleeding that is required should be conducted under a recollection of the debility of the subject, and com¬ plication of the ailment. When the disorder supervenes upon chronic affection of the trachea, venesection is rarely admissible. When tumors have occasioned the inflamma¬ tion, blood-letting is required; but it is not, of course, a radical remedy. Emetics are sometimes very useful in the second variety, and in the fourth : they may be repeated with advantage

u In every variety of acute bronchitis when there is much fever present : the greatest advantage is derived from the steady use of antimonials. They are, indeed, the most valuable of all medicines, for they not only, by exciting nausea and opening the pores ' of the skin, considerably lessen the febrile excitement, but by their action on the exhalant vessels of the lungs they promote expectoration, and thus lessen the inflammation of the mucous membrane. They may be given in combination with saline draughts and nitrate of potass, which should be always employed when there is much fever.”

Expectorants are to be employed with reserve in acute bronchitis. <( In the advanced stage, however, when the

Braconnot on the Action of Sulphuric Acid , fyc. 3J9

inflammation is nearly subdued, and the bronchia} are clogged, ipecacuanha, combined with squills, is often of great service.” Mucilaginous mixtures are always desirable. In the commencement of every variety of bronchitis an active purgative must be given, and the bowels should afterwards be kept free, without much purging. In the variety of the disease, where there is evident hepatic disorder, the free em¬ ployment of cathartics is of great importance. Here small continued doses of neutral salts are highly beneficial. In the sixth species, small doses of the blue pill mav be given, so that the gums may become tender. The local means of most importance are topical blood-letting and blisters. Blisters, however, must not be applied, until the excitement has been considerably got under by blood-letting.

Here we are reluctantly obliged to come to a pause. The critical department of our two concluding IN umbers for the year will consist of a continuation and conclusion of the retrospect, when we shall resume the consideration of Dr. Hastings’ treatise. In these Numbers we shall notice every book of consequence that has been published on medical topics from January to June ; so that the half-yearly review will be in this, as at all future times, a complete review of the medical literature of the preceding half year.

PART III.

— — —

SELECTIONS.

On the Action of Sulphuric Acid on Animal Substances,

[ From the Quarterly Journal of Science . ]

M. Braconnot has continued his researches on the action of sulphuric acid on organic substances, and has obtained some other interesting results, in addition to those already published. The following are the most important of them, very briefly stated.

Twelve parts of powdered glue were mixed with twenty- four of concentrated sulphuric acid. In twenty-four hours the liquor had not increased in colour; about thrice as much water was added, and the whole boiled for five hours, adding water at intervals. The solution was then saturated with chalk, filtered and evaporated spontaneously. In the course of a month it yielded crystals of a very sweet taste, which, when washed in weak alcohol, pressed in a cloth, re-dissolved and re-crystallized, were moderately pure.

320

Selections .

This sugar crystallizes much more readily than cane sugar. Its solution, evaporated by heat, forms crystals on the surface. When they are obtained by slow evaporation, they form flat prisms or tables grouped together, are hard, and break between the teeth like sugar-candy. They are equal in sweetness to grape sugar, and are not more soluble than the sugar of milk. Their solution does not ferment with yeast. Boiling alcohol does not dissolve them. They are less fusible than cane-sugar, and resist decomposition more strongly. When distilled, an ammoniacal product is obtained. Though it resembles sugar of milk in some points, it differs from it in others. By the action of sulphuric acid, sugar of milk is converted into a sugar very soluble in water, whereas this sugar is comparatively insoluble. This sugar also is con¬ verted by nitric acid, not into mucous acid, but into an acid of a particular kind.

Jf nitric acid he added to the sugar of gelatine, it does not at first appear to dissolve it; but, on heating carefully, a solution is obtained, without the liberation of any red vapours, and, on evaporation and cooling, a crystalline mass is obtained, which, when pressed in paper, re-dissolved and re-crystallized, is mtro-sacchariue acid, and far surpasses in weight the sugar used.

n o

This acid is very soluble. It crystallizes in beautiful colourless prisms, transparent, flat, and striated like Glauber’s salt. Its taste is acid, and slightly sweet, and resembles that of tartaric acid. When heated it swells, fuses in part, and emits a sharp vapour. It does not affect earthy or metallic solutions; it forms a neutral and a super-salt with potash, which crystallizes in needles: these thrown on coals, detonate like salt-petre. It dissolves carbonate of lime with efferves¬ cence, and yields needle-form crystals/ which are not deli¬ quescent, and not soluble in alcohol. Thrown on hot coals, these crystals fuse and detonate like nitre. Its salt with copper is crystallizable, and unchangeable in the air. Its magnesian salt is deliquescent and uncrystaliizable. With lead the salt is uncrystaliizable, unaltered by the air, and resembles gum: this salt, when thrown into the fire, pro¬ duces a kind of explosion. This acid dissolves iron and zinc, and disengages hydrogen gas. The salts are uncrystal¬ iizable.

The action of sulphuric acid on muscular fibre was next examined by M. Braconnot. A portion of beef in small particles was put into much water, and pressed several times to separate every thing soluble. Thirty parts of this fibre were mixed with as much sulphuric acid, the fibre softened and dissolved without the production of calour or the dis-

Braconnot on the Action of Sulphuric Acid, fyc. 321

engagement of sulphurous acid. It was slightly heated, and on cooling, a layer of fat separated from the surface. It was then diluted with water, and boiled for nine hours, saturated with chalk, filtered, and evaporated. The extract was not sweet, but had a decided taste of ozmazome. When mixed with potash, it liberated ammonia. Heated, it swelled and burnt, and left a charcoal difficult of incineration. Its solution did not putrefy, though retained in a warm place for some time. This extract was boiled several times with alcohol, of the specific gravity of .847* The alcohol being put together, deposited a particular white matter on cooling, which M. Braconnot has called leucine .

Leucine in this state was white and pulverulent. In order to separate a small portion of animal matter from it, which was precipitable by tannin, it was dissolved in water, and a small portion of tannin added ; after some hours, it was filtered, and evaporated until a pellicle formed. Then being left to stand for twenty-four hours, the bottom of the vessel was found covered with small mammilated crystals of a dull white colour, aud feeling brittle between the teeth. If ob¬ tained by spontaneous evaporation, the crystals form on the surface in circular masses. The taste of leucine is agreeable, and is that of the juice of meat. Leucine is lighter than water. When heated in a retort, it first melts, a part then sublimes, and forms white opaque crystals, and the fluid which distils over is empyreumatic, and restores the blue of reddened turnsole.

The action of nitric acid on leucine is exactly similar to its action on the sugar of gelatine, but the acid formed is per¬ fectly distinct from the nitro-saccharinc acid, and forms dis¬ tinct salts with saline bases.

The mass which remained, after the action of the alcohol had separated most of the leucine, was like an extract in appearance, of a brown yellovv colour, slightly deliquescent, and tasted of leucine.

Wool, acted on by nitric acid a little diluted, and heated, gave results which very much resembled those produced by the fibre of beef.

A summary of the whole is as follows : —

1. That animal substances can be converted into other sub¬ stances, containing much less azote, by sulphuric acid.

2. That this change is effected by the abstraction of hy¬ drogen and nitrogen, in the proportions fit to lorm ammonia, and probably by the absorption of oxygen by the sulphuric acid.

3. That gelatine may thus be changed into a very crystal- lizable sugar, which does not appear to exist naturally.

VOL. xi v. — no. 82. 2t

322 Foreign Medical Science and Literature.

4. That this sugar combines with mtric acid, without de¬ composition, and forms a peculiar crystallized acid.

5. That wool, and especially fibrine, with sulphuric acid, form a peculiar white matter, which may be called leucine.

6. That this substance combines with nitric acid, without decomposition, and produces a crystallizable nitro-leucic acid.

7. That other incrystallizable and sapid compounds analo¬ gous to certain vegetable principles, are produced by the action of sulphuric acid on animal substances.

Annales de Chimie , xiii, p. 113.

PART IV.

~ — — — —

FOREIGN MEDICAL SCIENCE AND

LITERATURE.

I. analysis of journals. (French).

New Journal of Medicine.

April, 1820.— Memoir on Ruptures of the Heart. By L. Rostan.*— • See the section of pathology of our present Department.

Memoir on the Treatment of Acute Diseases in Persons addicted to the Use of IVine and Spirituous Liquors. By Dr. Chomel. — An intemperate coachman, aged seventy, was admitted into la Charite , with peripneumony of twelve days’ duration. From the invasion of the disease he had drank, without apparent ill effect, a bottle and a half of pure wine daily. He was bled, and vomited ; and was very speedily convalescent.

The author was about the same time summoned to another stout, but intemperate man, aged fifty; and who, for two days, had been ill of peripneumony in a severe form. He was treated by blood-letting, diluents, blister, and expec¬ torants, and died on the tenth day.

In May, 1816, a large strong man, aged twenty-nine, belonging to la Charite , was seized with violent peripneu¬ mony. He had been an habitual drunkard. Venesection, antiphlogistics, and oxymels, were prescribed with temporary benefit. Relapse on the 7th, and death on the 9th day. On dissection, the left lung and pericardium were found inflamed.

These facts, with several others of a similar nature, served to show that the acute diseases of drunkards are commonly

323

Larrey’s Note on Ranula.

fatal, and incited the author to ascertain the causes, and means of diminution, of this fatality. It consequently appeared to him that sufficient attention is not usually paid to the danger of suddenly breaking in on the confirmed habits of these patients; and that, from allowance of a certain quantity of wine and alcohol in an appropriate form, a more fortunate result might be obtained in the treatment of their diseases.

Out of 134 individuals treated for acute peripneumony at la Charite in a few years, twelve are found to have belonged to the professions of wine-merchant, cooper, coachman, and carter, (all of which, it seems, are, in France, proverbially addicted to habits of intemperance), and J22 to have exercised various other callings. Among the former, the mortality w7as in the proportion of two-thirds (eight in the twelve); among the latter, less than one-fourth, or 28 in the 122. Hence the fatality of the acute diseases of drunkards treated by the ordinary method, no longer admitted of doubt ; and the author’s confidence in the proposed change of treatment was strengthened by the successful issue of the case of a man, who, having been previously addicted to an almost incredible excess in drinking, was allowed by Cullerier to take, every day during the inflammatory period of a venereal affection, three bottles of wine, and one of brandy. An opportunity of putting his opinions to the test of experiment soon presented itself in a strong, but intemperate coachman, aged fifty, who was admitted into la Charite , in July, 1817, with all the symptoms of severe peripneumony. He had been ill for more than a w7eek, and taken every day, in addition to broths, about two pints of wine. Bleeding to eight ounces, and wine in various forms, were prescribed with evident advantage. Local blood-letting, with perse¬ verance in the use of wine, brought the case to a successful issue.

If the employment of wine in phlegmasiae be denounced as prejudicial or dangerous, on account of the irritation which it may excite, Dr. Chomel replies, that to allow7 only one-tenth of the quantity ordinarily taken by persons habitu¬ ated to its excessive employment, will have an effect rather debilitating than excitant. Wine has a tonic and stimulant action; but this, like that of all other therapeutic means, is not absolute, but relative. He farther contends, that absti¬ nence from wine in the chronic diseases of drunkards, is attended w7ith great risk; and that moderate employment of it may be advantageously allowed.

Note on Ranula. By Baron Larrey. — The object of this is to expose a mode of treatment which the baron has found

3£4

Foreign Medical Science and Literature .

constantly successful in this simple, but troublesome affec¬ tion. After having stated his objections to the method of cure by puncture, incision, and by actual cautery, as com¬ monly employed, the author proceeds to detail the advan¬ tages of the last process, with certain modifications intro¬ duced into it by himself. The principal consists in traversing the tumour from side to side with a cauterizing instrument (cautere cultellaire) made for the purpose, and red-hot. The adjacent parts of the ranula and lips are protected by the hand of an assistant, with thin plates of wood, while the Surgeon penetrates at one stroke the whole substance of the tumour; and, directing the cautery forward, burns all the anterior paries of the cyst. By this process, the whole cavity is- exposed; its anterior paries destroyed; the remnant of membrane which has escaped the hot iron, inflames and separates ; the orifices of the excretory ducts retract and adhere strongly; and cicatrization is accomplished in a few days.

Singular Case of Venereal A ffection. By Dr. Ratier. — The fact here recorded, the subject of it a man, aged twenty- four, and addicted from boyhood to solitary indulgences, is intended to show that simple gonorrhoea, particularly when it has been suppressed by astringents, may, long after its disappearance, give rise to secondary symptoms. At the age of sixteen the young man contracted gonorrhoea, which was cured without leaving any trace behind. Four years afterwards he was afresh infected; and the disease, submitted to no treatment, became chronic. Cohabiting with a woman who had a discharge, supposed to be leucorrhcea, he felt no uneasiness respecting it. On the point of marriage at the end of another year, he took extract of rhatany to cure the discharge, with success. No other primary symptom of the affection had ever existed. In June, 18 IQ, in consequence of the pressure of a tight boot, a greyish spot, with severe pain, arose on the second toe of the left foot. A small eschar, surrounded by inflammation, ensued, and left, on separation, an ill-conditioned ulcer, with ichorous and fetid discharge. Under poultices, and inert treatment, it gradually enlarged. Adhesive straps produced only an aggravation of the pain. At this period, one of the fingers, scratched by a pin, came accidentally in contact with the ulcer of a toe ; and, soon afterwards suppurating, exhibited a small ulcer, pre¬ cisely resembling that. This circumstance led to inquiry, and elucidation of the case. In order to fix more certainly its diagnosis, the ulcer of the toe was now dressed with mercurial, and that of the finger with simple cerate. The consequence was, that the first soon began to amend, while

323

Case of Calculus, fyc.

die latter remained the same. An opposite application of the ointments produced a corresponding effect on the sores. The patient was finally cured by a full mercurial course. Neither his wife nor child has exhibited any symptoms of syphilis. Several such cases as this have occurred at I'Hopital des Veneriens. The author finally declaims against the inutility, and even danger, of the semi-treatment, fre¬ quently instituted in syphilitic diseases.

Note on the Origin of Kino, and of Spurious Angustura. By M. Guibourt. — Doubts, without any attempt to elucidate or remove them, are here thrown on the real origin of botli these substances.

Bulletins of the Faculty of Medicine of Paris, &c. 1820. — No. IV.

Report on the Park of Oysters at Havre . By Professors Vauquelin and Chaussier. — A very long article, comprehend¬ ing a minute and elaborate examination of the oyster esta¬ blishment at Havre; and tending completely to remove some unfavourable prejudices which had been in France excited against it. The park at Havre is pronounced to be “ the best possible.

Extract of a Report made in the Name of a Commission on the Employment of various Mechanical Contrivances, for Correction of the Deformity known by the Name of Club-foot. By Dr. Thillaye. — The object of this commission is an examination of the respective merits and advantages of the instruments employed by three French Practitioners, for the cure of the deformity in question. The nature of the defect, and principles of Its rectification, are very clearly detailed; and the process and establishment of M. dTvernois, of Paris, spoken of in the most favourable manner. There is no description of the instruments * invented or used by these three Professors of the science of orthopedia.

Sittings of the Society. April 27th. — Professor Dupuytren presented to the society two very large calculi, of a prismatic figure, weighing fourteen ounces and six drams, and ex¬ tracted from the bladder of a man, aged thirty-six, by the high operation. From his early years he had suffered intole¬ rable pain. The operation itself terminated successfully, and every thing went on well for a while, when the patient was destroyed by an attack of nephritis.- — Dissection. On opening the abdomen, the peritoneum was without redness, and not implicated in the operation; the right kidney, very large and uneven externally, had its infundibula considerably increased in size; and showed internally an irregular pouch, capable of serving as a reservoir for the urine. The ureter

326

Foreign Medical Science and Literature.

°

'

was so much dilated as to resemble, at first sight, small intestine; that part of the kidney which still retained its form and organization, contained several large concretions; forming a whole, separated by real articulations. They were united in a form, comparable to a ramification of coral ; they formed three considerable masses, touching each other by surfaces alternately concave and convex, and so smooth, that they seemed to be invested with articular cartilages: they weighed eleven drams. The left kidney was of common bulk; the ureter somewhat dilated at its junction with the bladder; it contained one calculus, of the size of the finger. The interior of the bladder exhibited some blackish points, apparently the places where the calculi had adhered.- — Weight of the concretions. Vesical calculi, fourteen ounces, six drams ; renal, eleven drams; ureteric, two drams and a half. — - Chemical composition. All of the ammoniaco-magnesian osphate. The nucleus of the lar of uric acid.

ger calculi only consisted

Journal of Practical Medicine. By Hufeland.

(German.)

March 18 IQ. — On the Mercurial Treatment by Inunction , without Salivation or extreme Abstinence. By Professor Hufeland. — The author first enters into some general con¬ siderations of the inconveniences resulting from the slight manner in which many Physicians at present treat the venereal disease; and of the disuse into which the treatment by frictions and abstinence has latterly fallen. The dangers consequent on the abuse of frictions detailed, and due circum¬ spection in their employment recommended, the principal object of the memoir is developed. This consists in calling the attention of Practitioners to the advantages of the treat¬ ment by mercurial inunction without salivation — - a method published, in 1780, by Dr. Cyrillo, of Naples*. The oint¬ ment employed by this author, is composed of oxy muriate of quicksilver, muriate of ammonia, each one dram, lard one ounce; the whole to be rubbed together for twenty-four hours. The ointment should be so prepared that, in rubbing a portion of it between the finger and thumb, not the slightest fragment of sublimate can be detected. If the mercurial salt be not thoroughly dissolved, it will not penetrate into the system, and will moreover produce inflam¬ mation of the part upon which it is employed. Prolonged trituration can alone accomplish the object in question. Of

* Aviso intorno alia Maniera tii adoperare BUngnento di Sub¬ limate Corrosivo nell'a Cura delle Malattie Venerie. Napoli, 1780,

327

Hufeland on the Mercurial Treatment, fyc.

this ointment, one dram is rubbed in every evening on the soles of the feet. Hufeland prescribes, in addition, the use of the warm bath every other day ; and one ounce of sar- saparilla to be taken in decoction in the twenty-four hours.

If the bones are affected, a portion of mezereon is added to it. The diet is principally vegetable; wine and stimulants are prohibited; and confinement to a warm room enjoined. This treatment should be continued for some time after every morbid symptom has disappeared, and may thus occupy a period of from two to six months. For thirty years, Hufeland has employed the preceding method without inducing salivation, in inveterate cases, which had resisted the ordinary mercurial treatment; and .obtained from it invariably the most decided success. Two cases in illustra¬ tion of the practice are here detailed ; one of them we shall cursorily retrace : A man, aged thirty, had, twelve years before, been infected with syphilis, which was removed by mercury. Pain of the head afterwards catne on, slight iri the day, but so violent at night as to destroy sleep. This state had now, with slight intervals, continued for ten years ; and during this period the man had taken a great variety of medicines; amongst others, mercury; but inefficiently: afterwards, the disease no longer being considered syphilitic, alteratives, anti-arthriticis, and narcotics, were had recourse to. They, however, procured only a transient respite from the pains which subsequently recurred with increased vio¬ lence. At the period of the patient’s application to the author, the pains in the cranial bones were so severe, as to render his nights sleepless, and overwhelm his mind with despondency. Several exostoses had appeared upon the cranium. His countenance was cachectic; skin leather-like; appetite impaired. He had diarrhoea, with considerable emaciation ; feeble and accelerated pulse ; and evening pyrexia. Strength so much broken as scarcely to bear the , erect posture. Friction of the soles of the feet with sublimate I ointment; a tepid aromatic bath; and decoction of sar- I saparilla and Colombo were, with a nutritious diet, prescribed.

I The irritable state of the intestinal canal precluded the employment of milk. After four weeks’ perseverance in this I plan, an evident mitigation of the pain, fever, and all the other symptoms, was perceptible. -The treatment was con¬ tinued with some modification, and more decided benefit. The cranial exostoses decreased; not a trace of salivation showed itself. The hectic fever disappeared ; and after five months’ treatment, during which twenty ounces of the sublimate ointment had been rubbed in, the patient was dis¬ charged perfectly well. In a journey, which he subsequently

328 Foreign Medical Science and Literature .

undertook into France and Switzerland, the man’s beaMi continued good; but in the following year, after exposure to severe cold, on Mount Blanc, he experienced a slight recur¬ rence of the cephalic pains. They were removed by a month’s employment of the sublimate ointment; and for the last ten years, the patient has enjoyed robust and uninter¬ rupted health.

The author closes his communication by a recital of the advantages which the plan, now recommended, possesses in preference to ail others. These advantages are the following : 1. The most penetrating and corrosive of the preparations of mercury is employed without injury to the system by this mean. 2.* The most inveterate syphilitic disease may be radically cured without the inconvenience of salivation.

3. it precludes the necessity of the treatment by abstinence.

4. It does not operate injuriously on nutrition, and hence produces no emaciation. 5. It does not affect the breast like salivation. 6. It may be employed, without danger, in cases wherein salivation is impracticable ; for instance, in aged, or very delicate subjects, in such as are suffering from haemop¬ tysis, or phthisis, or in whom emaciation, or disposition to hectic fever, exists.

The peculiar advantage of salivation consists in determining: a violent reaction of the lymphatic system, and in producing a critical movement, which may effect the cure, not only of inveterate syphilis, but of many other chronic, and even organic diseases. Hence it may be expedient to avail our¬ selves of the advantages of both methods; and to employ, first, in confinhed syphilis, the treatment by sublimate inunction; and afterwards, if this fail, and there exist no con¬ tradictory sign, the ordinary treatment by salivation*.

On the Mineral Springs of Qber-Salzbrunn in Silesia. By Dr. Ebers. — - A paper occupying seventy-two pages — alike insusceptible of analysis within any reasonable limits, and uninteresting, when analysed, to the British reader.

Voluntary Death by Abstinence , described by the Suicide himself. Communicated by the Editor. — A merchant, aged thirty-two, depressed by severe reverses of fortune, and, con¬ sequently, slighted by his relatives, formed the resolution of destroying himself by abstinence. With this view, he repaired, on the 15th of September, 1818, to an unfrequented wood, where lie constructed a hut of boughs, and remained, without food, till the 3d of October following. At this

* The employment of the sublimate ointment is stated by some Italian Physicians to induce chronic inflammation of the serous mem¬ branes.

Case of Voluntary Death by Abstinence. 329

period he was found by the landlord of a neighbouring pot-house, still alive, but very feeble, speechless, and insen¬ sible. He died immediately after having swallowed, with difficulty, the yolk of an egg in broth. A journal, written with pencil, was found on him; which, as singular in its kind, and very remarkable in a physical and psychological point of view, cannot fail, in Professor Hufeland’s opinion, to interest the feelings of the reader.

The whole of this curious and melancholy document, we lament that it is not now in our power to transcribe. Our regret, however, is tempered by the reflection, that some account of it has already appeared in a contemporary journal*. The extracts which we shall present from the commencement and close of this mournful narrative, will sufficiently indicate its character, and evince the desperate spirit by which its infatuated author was impelled.

It begins thus : —

“ The generous philanthropist who shall one day find me here after my death, is requested to inter me ; and in consi¬ deration of this service, to keep my clothes, purse, knife, and letter-case. 1 moreover observe, that I am no suicide, but have died of hunger, because, through wicked men, I have lost the whole of my very considerable property, and am un¬ willing to become a burthen to my friends.

“ I wish not (my body) to be examined ; since, as before said, I have died of hunger.

(Signed) “ ANONYMOUS.”

This, with much that follows in the same strain, is dated near Forst, September 16th, consequently one day after the unfortunate writer had commenced his system of starvation. The ensuing paragraph is dated on the 17th: —

“ I yet live ; but how have I been soaked during the night, and how cold has it been ! O God ! when will my sufferings terminate ! ! No human being has, for three days, been seen here; only some birds.”

The next extract, which, as well as the preceding, we, for obvious reasons, have translated as literally as possible, ter¬ minates the dismal journal of this remarkable suicide : —

“ And again, three days, and I have been so soaked during the night, that my clothes to-day are not yet dry. How hard this is, no one knows ; and my last hour must soon arrive. Doubtless, during the heavy rain, a little water has got into my throat ; but the thirst is not to be slaked with water; moreover, I have had none even of this for six days; since 1 am no longer able to move from the place.

* Journal of Foreign Medicine, &c. No. V. page 106.

VOL. XIV. — NO. 82. 2u

580

Foreign Medical Science and Literature .

“ Yesterday, for the first time during the eternity which, alas! I have already passed here, a man approached me within the distance of eight or ten paces. He was certainly a shepherd. I saluted him in silence; and he returned it in the same manner. Probably he will find me after my death !

“ Finally, I here protest, before the all-wise God, that, notwithstanding all the misfortunes which i have suffered from my youth,' I yet die very unwillingly; although necessity has imperiously driven me to it. Nevertheless I pray for it. Father, forgive him ; for he knows not what he does !

“ More can I not write, from faintness and spasms: and this will be the last.

“ Dated near Forst; by the side of the Goat public house, September 29th, 1818. “ T. F. N ”

Short Notices and Extracts. — 'The articles here compre¬ hended, are wholly taken from English journals.

IE S elect Cases and Memoirs.

ANATOMY.

I. Essay on the Ferns of the Spine #. — Section Fifth. Of the Medulla- Spinal Veins. — -These veins of the spinal marrow, the median-spinal of Chaussier, take their origin from the medulla oblongata, and the nerves which it sends off. Their parietes being very delicate, it is necessary to inject them with a strong solution of isinglass in water coloured with Prussian blue. The injection should be thrown into the veins near the extremity of the spinal chord. For this pur¬ pose, the posterior and inferior part of the vertebral canal should be opened at the height of the last lumbar vertebras, by removing the spinous processes of the latter. The meningeal canal is then to be slit up, and, in the interstices of the spinal nerves, some of the largest veins sought for; into which the injection must be very cautiously thrown. These veins traverse the whole length of the spinal marrow without sensibly increasing. At their superior part, they unite into two trunks posteriorly, and into one or more anteriorly, to enter the cranium. The posterior, for the most part, pene¬ trate into the superior petrous sinuses. There are other veins in the centre of the spinal marrow. An injection, driven into them with great care, will find its way into a very delicate vein which appears to issue from the point of the calamus script orius.

* From the Prize Theses of Dr. Breschet. Concluded from page 154 of our Number for August.

S3 1

Description of the Veins of the Spine.

Section Sixth. Of the Venous Plexus of the Spine. — This is a net-work of veins, more or less considerable, situated and spread over the whole length of the spinal surface of the vertebral canal, between it and the meningeal canal. The veins of this plexus are very tortuous; they pass through the holes of conjugation, and unite with the intercostal veins. Breschet thinks that this plexus is but a supplement to the great spinal veins; and that it is destined to supply the place of these, in the many instances wherein the varied move¬ ments of the spine impede the circulation and passage of the blood from these to the intercostal and other veins. This plexus, and that which surrounds the spinal nerves at their issue from the vertebral canal, are readily exposed by a sec¬ tion which removes the spinous processes, the substance of the vertebrae, and the external and posterior parts of the parietes of the orifices of conjugation.

Section Seventh. Of the great Meningo- Spinal Veins. — • Two large veins, situated in the interior of the spine, con¬ stitute the centre and point of re-union of all the preceding veins. They extend the whole length of the spinal canal, from the occipital foramen to the division and separation of the spinous processes of the last sacral vertebrae, which ter¬ minate the canal inferiorly. They occupy its lateral and anterior parts, and are closely applied upon the sides of the bodies of the vertebrae, between the orifices of conjugation and those which transmit the basi-vertebral veins. The best mode of exposing them is a section of the spine which passes through its axis, and divides it into two equal portions from before backwards.

Section Eighth. Communications of the Venous System of the Spine with the general Venous System. — -The veins which serve to establish these communications, are a net-work formed by re-union of the spinal veins of every kind, which issues from the canal by the orifices of conjugation, and gradually reduces its branches to one or two trunks. These, after a course of one or two lines, unite, by one or two branches, with different veins about to be indicated. In the pelvis, these veins pass through the orifices of the anterior surface of the sacrum, and unite, by medium of a plexus, situated anteriorly to this bone, with the internal iliac veins. In the back and loins, they communicate with the intercostal and lumbar veins ; and in the cervical region partly with the veins which traverse the vertebral canal in company with the posterior cervical arteries, and partly with a considerable venous plexus, situated anteriorly on the bodies of the cervical vertebrae. In the inferior part of

i

332 Foreign Medical Science and Literature .

the lumbar region, the spinal veins terminate in the ileo- lumbar, without any intermediate plexus.

Section Ninth. Of the Circulation of the Venous System of the Spine . — The circulation of the blood in these veins differs greatly from that in other parts of the venous system. The blood, proceeding from the mass of muscles, spine, and spinal marrow, is emptied into the great spinal veins, as into a reservoir; from whence it passes into the veins placed on the sides and anterior surface of the spine, and thence into the superior and inferior cavse.

By what power is the blood, which arrives in the two great spinal veins, driven from them ? Are these veins capable of dilating to receive, and of contracting to expel the blood ? Or are theyq in fact, passive canals, from which the blood escapes only when these canals are too full, and, as it were, by a kind of regurgitation? Upon this difficult question, Breschet presumes not to decide.

The spinal veins become greatly dilated in old age. These dilatations are such as to justify the supposition, that they must exert an influence on the functions of the spinal chord and nerves in aged subjects ; and, in some cases, be the cause or consequence of the affections to which these parts are so frequently subject irrthe decline of life.

CHEMISTRY.

II. Discovery of two new Vegetable Alkalis*. Professor Oerstaedt has just discovered in pepper an alkaline substance. He calls it piperine. To this is pepper indebted for its flavour. “ Piperine,” says the Professor, “ is scarcely soluble in cold, and very little in boiling water. Alcohol dissolves it. The solution is slightly yellow, bordering on green ; and is rendered perfectly green by nitric acid. Piperine possesses, in a very high degree, the acrimony of pepper. With the sulphuric and acetic acids, it forms almost insoluble salts. I have not yet determined the quantities of them which alcohol and water are capable of dissolving. With the examination of this object, and of the capacity of saturation of piperine, I am at present occupied. The observations w hich I have already made, prove that the capacity in this, as in other alkalis of the same class, is very small. To obtain the alkali, the resin contained in the pepper should be extracted by ajcohol; muriatic acid and water are then added; the resin is precipitated by the water; the muriate of piperine remains in solution; the alcohol is then to be evaporated; the filtered liquid contains the muriate of piperine. This may be de¬ composed by pure potash, which precipitates the piperine.

m Journal de Pharmacie, August, 1820.

Medical Literature of Spain. 333

“ One of my friends,” continues the Professor, “ has also discovered a new alkali, of great acrimony, in the fruit of the capsicum annuum. This alkali is but little soluble in water, and possesses a greater capacity of saturation than the other alkalis of the same class. Jt forms, with the protoxide of lead and muriatic acid, a triple salt, which retains all the acridity of the vegetable alkali.”

BIBLIOGRAPHY.

III. New Spanish Medical Journal. — From a French journal, which has just reached us, we are rejoiced to learn that a new quarterly journal, entitled, Periodico de la Sociedad Medico-Quirurgica de Cadiz , has made its appear¬ ance in Spain. The first number was to be published on the 1st of April of the present year. We have long been endea¬ vouring to acquire some light respecting the state of medical literature and practice of that interesting country, in whose bosom the persecuted sciences, during the intellectual dark¬ ness which for ages enveloped Europe, found a resting-place and a refuge; and, from whence disseminated, they have since arisen in such astonishing might and splendour. To all our anxious inquiries, however, respecting Spanish works on medicine, our booksellers’ answer has invariably been, that none were ever received, or heard of, in England. We shall not fail to apply immediately for this most welcome publica¬ tion, and present an analysis of it. This, with the French, German, and Italian journals already received or promised, will enable us to trace a more full and faithful portrait of the state of medical science on the continent, than has, perhaps, at present been exposed to the view of the English reader.

PATHOLOGY (INCLUDING MORBID ANATOMY) AND PRACTICE OF MEDICINE.

II. Memoir on Ruptures of the Heart*. — Of this interesting memoir, the production of Dr. Rostan, we proceed to give a brief yet correct analysis.

Complete rupture of the parietes of the cardiac ventricles is so rare an occurrence as never to have been observed by Corvisart, and many other experienced Practitioners. After taking an historical survey of the few instances of this terrible accident which have hitherto been recorded, the author states, that, within a few years, he has five times observed the rupture of the left ventricle of the heart. Three of these cases occurred in the winter of 1816. The whole five are very circumstantially detailed.

First Case. — Subject, a robust female, aged seventy,

* Nouveau Journal de Medecine, Avril, 1820.

334

Foreign Medical Science and Inter at are*

admitted into la Salpetrilre , in the winter of 1816. Symp¬ toms: cough, dyspnoea, bitterness of the mouth, epigastric pains. A vomit prescribed. Next day, suffocation, cough with ropy and frothy expectoration, palpitation, stagnation of blood in the capillaries of cheek, nose, and lips. Evening, died suddenly, in hastily quitting the night-chair to regain her bed. — Dissection , two days afterwards. Pericardium of a violet colour, and distended with a large quantity of coagulated blood ; heart presenting at its apex, and a little on its anterior surface, two irregular fissures, one an inch in length, the other three or four lines, and distant from each other about half an inch; the solution of continuity perfectly resembling the rent, produced in a piece of linen by over-distention ; the margins of the fissure still attached to each other by a few fibres. The rupture communicated with the left ventricle, the parietes of which, about this point, were only two lines in thickness, while above they measured more than an inch in diameter #. The ventriculo- aortic orifice obstructed by numerous rugged ossifications; structure of the heart otherwise perfectly sound. No morbid change in the abdominal viscera, except redness of the gastro-intestinal mucous membrane p.

Second Case . — Subject, a pale, thin, delicate woman, aged seventy-live, had suffered syncope. Respiration, circu¬ lation, digestion natural; thorax sonorous. Died suddenly. — Dissection. Pericardium distended by coagulated blood; an irregular orifice at the point of the left cardiac ventricle, and communicating with its cavity. The other alterations similar to those detailed in the preceding case.

Of the Third Case of rupture of the heart, which occurred in the same year, the author has preserved no memoranda. He is unwilling to give the description of it from memory. It presented a close analogy with those just narrated.

Fourth Case.- — A strong, healthy woman, of seventy-eight, had sustained a violent fall five months before, and from this period her health declined. On admission into the hospital, March 11th, 1820, her only symptoms were, slight cold, severe lumbar pains, and constipation. — 12th. Cough, and other symptoms relieved ; all the functions natural.— Morning of 13th, death. — Dissection , on 14th. Pericardium violet-coloured, and distended with coagulated blood ; two

* It is remarkable, that in hypertrophy of the left ventricle of the heart, its apex is invariably thinner than in the natural state.

t Morgagni considers obesity as a predisponent cause of rupture of the heart, in consequence of its impeding the exterior circulation, repelling the blood internally, and compressing the different viscera. This plausible reasoning is invalidated by the case here recorded.

335

Rostan’s Memoir on Ruptures of the Heart.

irregular fissures in the heart, on its anterior surface, near the point of the left ventricle ; one seven or eight lines in length, black, deep, and communicating with the cavity of the ventricle; the other longer, and more superficial. Pa- rietes of the ventricle thickened superiorly, extenuated towards its point; no other alteration of structure; current of blood appeared to have been obstructed by the ossifications of the aorta Lungs sound, and perfectly crepitous; a species of cicatrix exhibited towards their summit; alimentary canal red throughout; other viscera healthy.

The preceding cases, observes the author, incontestably prove the possibility of rupture of the heart without (previous) change of structure. In general, this lesion produces instan¬ taneous death; yet if the fissure be inconsiderable, and the margins not parallel, the fatal event may be for a while protracted. The author even goes so far as to assert, that such an accident is, to a certain point, susceptible of cure, or may, at least, admit of the patient living a long time. A coagnlum of blood may form in the interval of the rupture, become indurated, and adhere; adhesive inflammation may at the same time occur, between the ruptured part and corresponding pericardium; and the patient long survive this serious accident. This is not mere conjecture. The following case exhibits a striking illustration of the fact.

Fifth Case. — A widow, aged seventy-one, and mother of four children, had for fifteen years suffered most severe pain in the left thoracic region and epigastrium, extending deeply into the dorsal region, and recurring at intervals. Reclina- tion induced a suffocative feeling; frequent syncope, con¬ sequent on severe palpitations; starting from sleep; great appetite; extreme sensibility. Her sufferings were grea tly aggravated by the inclemency of last winter. Vomiting, and pain in epigastrium, induced by immoderate ingestion of potatoes. She entered the hospital on the 7th of February of the present year. Features at that time greatly altered; skin hot; pulse frequent, full, regular; bitter mouth, and epigastric pains; abdomen little sore on pressure; evacuations and respiration natural ; thorax every where sonorous. — 8th. Patient, from desire of eating, dissembled her pains. Skin hot, countenance bad; abstinence and diluents prescribed. Some days after, vomited a lumbricus. — 20th. increased epigastric pains. — 24th. All the symptoms much relieved.

* This heart was submitted to the inspection of the Society of the Faculty of Medicine of Paris, before which the present memoir was read, on the 30th of March last. The curious specimen of morbid alteration described in the fifth case was also presented to it.

336 Foreign Medical Science and Literature.

Died at night. — Dissection. Pericardium irregular on its surface, and adherent to the heart, not immediately, but by means of several albuminous layers of different density, occupying the anterior surface of the heart. On detaching this concretion, blood was found effused in the posterior part of the cavity; and an irregular rupture, an inch and a half long, in the substance of the heart. It was evidently of recent date; but on its left side, to the exlent of five or six lines in every direction, the structure of the heart was destroyed, and replaced by a fibrinous concretion precisely resembling that observed in the aneurismal sac of the large vessels, it appeared to be confounded with the structure of the heart. The ventricle was extenuated in this part, but every where else thickened. It is remarkable, that the rupture took place, not in the point of the old lesion, but in its vicinity. The density of the fibrinous deposit must have been great, and its adhesion solid ; the intestinal tube was inflamed throughout, and contained several lumbrici. The other organs quite sound.

From the aspect of the local lesion, and the symptoms exhibited for fifteen years, there exists no doubt but that the loss of substance of the heart was of very old date ; and that the patient owed the protraction of her life to the plug of fi brine developed in the orifice, and adhesion of the part to the corresponding portion of external pericardium. This example, if it do not demonstrate the possibility of cure of rupture or ulceration of the heart, proves that the subjects of such lesion may survive its occurrence for a considerable time.

It has been theoretically asserted, that the right ventricle of the heart is more liable to rupture than the left. This speculative opinion is controverted by the five cases here detailed, and by reference to other writers on the subject. Why the thickest and strongest portion of the heart should most readily give way, is difficult of explanation; especially as the subjects of these cases were affected with hypertrophy of the left ventricle, and, consequently, increased thickness and consistence of its parietes. It may be observed, how¬ ever, that in proportion as the walls of the ventricle were more thick, the apex was thinner, and that the rupture always took place towards the point and anterior part of the cavity. But whence originates this disproportion, the author does not profess satisfactorily to decide.

MEDICAL JURISPRUDENCE.

I II. Memoir on a New Process whereby most of the Mineral Poisons } in their Admixture with Coloured. Liquids , may be

337

On detecting Poisons.

O

detected *. — -This memoir is the production of the celebrated Orfija — a circumstance sufficient of itself to attract the public attention ; especially when the high importance of the subject, in its relations with medicine and jurisprudence, is duly contemplated.

The Professor, in his classical work on toxicology, has particularly insisted on the difficulty frequently encountered in detecting the poisonous productions of the mineral king¬ dom, in their admixture with coloured fluids, sucli as red wine and coffee. The re-agents proper to detect a mineral poison dissolved in water, almost invariably operate in such a manner as to prevent its discovery, when combined with highly-coloured liquids. Under some circumstances, the precipitates resulting from these re-agents, are even of such a colour, that, far from furnishing any indication of the nature of the poison, they may induce a belief that none exists in the deleterious mixture under examination. This assertion is too obvious to require exemplification ; and it is clear that the Practitioner, charged with the investigation of a case of poisoning, should be correctly acquainted with the means of detecting poisonous substances in their combi¬ nation with coloured fluids ; since, in most cases, they are purposely or accidentally mixed with such fluids, commonly employed in domestic economy ; that the processes hitherto known for demonstrating the existence of mineral poisons in such mixtures, differ considerably for each poison ; and that the chemical operations composing them are generally complicated, and often inadequate to the end proposed. Minute portions of arsenic, sublimate, or other metallic salt, cannot in fact be readily detected on evaporation of a large quantity of fluid, and subsequent calcination of the product with potash and charcoal. Hence Orfila has been induced to publish the results of numerous inquiries calculated to simplify the solution of the problem in question. The fol¬ lowing is the reasoning by which he was led to the discovery of the process about to be exposed.

The mineral poisons, in admixture with highly coloured liquids, operate with their respective re-agents otherwise than if dissolved in water. This phenomenon depends wholly on the presence of the colouring matter of the fluid mixed with the poison. On destroying this colouring matter, the poison will then operate on the re-agents as though it were alone; provided the agent employed to destroy the colour of the mixture, do not decompose the poisonous

substonte. Now, chlorine dissolved in water (liquid oxy- — l.li . - - - - - - -

, - $ -w

* Nouveau Journal de Medecine, &c., Juillet, 1S20.

vol. xiv. — no. 82. 2 x

338

Foreign Medical Science and Literature ,

muriatic acid) has the property of removing the colour of wine decoction of coffee, tobacco, &c., and decomposes but few of the mineral poisons; consequently it may be employed with advantage. Experiment has justified the conclusion, that most of the poisonous substances may be detected by this mean.

White Oxide of Arsenic.— Upon a mixture of this dissolved in water, and of red wine, as much liquid and concentrated chlorine should be poured, as will communicate to it a yellow colour. A reddish-yellow precipitate will be formed, con¬ sisting of chlorine and the vegeto-animal matter of the wine. The liquid, then filtered, will yield a white precipitate with lime-water; green, with ammoniaret of copper; and yellow, with hydro-sulphuric acid : hence demonstrating the presence of the arsenical oxide. It may sometimes happen, that no precipitate ensues on bringing these re-agents in contact with the filtered liquid; either because the quantity of oxide of arsenic contained in the mixture is too minute, or the chlorine has been too largely diluted with water. These two circumstances render the arsenical solution too weak to operate sensibly on the re-agents. In this case, the liquid should be concentrated by evaporation; and constantly, when reduced to the third of its volume, it has furnished the various precipitates above mentioned. Hence it becomes important to employ, in researches of this nature, concentrated and recently prepared chlorine. Similar experiments have been made with white oxide of arsenic dissolved in water, and mixed with various quantities of decoction of coffee. The action of chlorine and the re-agents has been the same.

Arsenic Acid. — Erom a mixture of wine and this acid, rendered colourless by concentrated chlorine, a yellow pre¬ cipitate takes place ; the liquid, when filtered, reddens tincture of litmus; is precipitated of a w7hite colour by lime- vrater; light blue by acetate of copper, especially if a few drops of chlorine be poured into the mixture; and rose colour by slightly acid muriate of cobalt. Hence the arsenic acid may be detected by re-agents, as though it were simply dissolved in wmter. The same phenomena occur when coffee is substituted for the wine.

* In announcing that chlorine operates thus on wine and coffee, it is not meant that these liquids are thereby rendered colourless, but merely that their red or brown colour is destroyed. In fact, the mixture becomes of a yellow colour; but this is of little consequence; since such a shade does not prevent the principal re-agents from operating on the mineral poisons as though they were simply dissolved in water.

Medical and Physical Intelligence . 339

Acid Arseniate of Potash. — The mixture of this with wine or coffee may readily be rendered colouiless by chlorine. On filtering it, after the precipitate has been deposited, the liquid, then of a yellow colour, is precipitated white by lime- water; light blue by acetate of copper*; and of a rose colour by muriate of cobalt, if by chance the latter re-agent produce no precipitate, the excess of its acid must be saturated by ammonia, and the mixture will soon become turbid. Hence it follows that chlorine may serve to detect the existence of arsenic acid, and the soluble arseniates, in red wine and coffee.

( This Memoir will be concluded next Month.)

* Sometimes the precipitate, instead of being of a very light blue colour, is deep blue, or blue bordering on green. This happens when an insufficient quantity of chlorine has been employed. In this case, the precipitate will acquire a light blue colour, on addition of a few drops of chlorine. This phenomenon is observed in most of the mixtures of poisons and coloured liquids, which constitute the subject of this memoir; so that it may be established, that it will in general suffice to add a few drops of chlorine to the different preci¬ pitates which are obtained with the re-agents, in order to commu¬ nicate to them their proper shade — that which they present when resulting from the operation of the re-agent upon the poison simply dissolved jn water.

PART V, ;

MEDICAL AND PHYSICAL INTELLIGENCE.

{[The following Communication came too late for insertion in its proper place ; but, as the writer has expressed a wish that it should appear in this Number, and as the matter it contains is of immediate interest, we proper to insert it in this place, rather than wait another

have thought month ]

An Account of some Experiments to prove the Advantage of Employing the Alcoholic Solution of Guaiac , as a Test of the Goodness of the dried Bulb of Colchicum Autumnale ; with some Remarks on the best Period for taking up the Bulb , and the Method of drying it so as to preserve its Medicinal Properties unaltered . By Anthony Todd Thomson? F.L.S., &c. &c. &c.

There is a fashion in medicine, which has occasionally expelled from practice some of the best articles of the materia medica, and held them in disrepute, until accident has again restored them to favour. Such has been

340

Medical and Physical Intelligence .

the fate of the meadow saffron, colchicum autumnale ; a very ancient, and one of the most manageable and efficacious remedies, in many painful and inflammatory affections, when it. is good its kind, and properly prescribed; and soph is likely again to be its lot, if some means be not devised to enable (Practitioners readily to discover when it is in a condition fit to be employed; for the state in which it is now kept in the majority ol the shops of the London druggists, and even at Apothecaries'' Hall, can only produce disappointment to the Physician, who may prescribe it in cases which require the full extent of its powers. That the reliance of many Practi¬ tioners upon it has already been weakened by these circumstances, I have had several opportunities of knowing; and the wish to restore that faith in its virtues which the remedy truly deserves, has suggested the propriety of laying the observations and experiments about to be detailed before the Profession.

Whilst lately repeating the experiments of M. Taddei on gluten, I was astonished to find how readily that principle is destroyed, in many plants which contain it, by the action of heat; and reflecting on the changes which necessarily take place in all the components of a vegetable body, when one of them is destroyed, I w?as naturally led to infer, that those specimens of any medicinal plants in which the components can be preserved in a state the nearest to that which they hold before it is dried, must be the most efficacious and certain in their remedial properties. I had ascertained the correctness of M. Planche’s assertion, that gluten is one of the constituents of the recent bulb of meadow saffron ; and discovered that its presence can easily be detected in the dried bulb ; and, as I had found that those specimens of it, in w hich this principle can be demonstrated, are the most powerful in their effects, 1 inferred that those only should be regarded as properly dried, and fit to he medicinally employed, in which it is found; provided they bear marks of having been dug up at a proper season : and, therefore, that the agent by which gluten is detected in the dried bulb of colchicum, must be regarded as a proper test of its goodness. But, before making experiments to prove this opinion, it was necessary to fix the exact period at which the bulb should be dug up ; and that this is towards the end of July, some observations I had been making on the physiology of bulbs had already enabled me to determine. The bulb of the last year is, then, completely decayed ; and its progeny, the bulbs of the present year, are at their full size, and in their most perfect condition. When dug up, each bulb is found covered with a smooth, shining, thick, mahogany brown coat : it is plump, solid, and in shape somewhat resembling a roundish pear, the withered remains of the foliage answering to the stem, with a sharp ridge partially surrounding the base, and terminating in a short appendix. On removing this coat, and a spongy one wffiich is interior to it, a small white oval body, about a line in breadth, one-third of an inch in length, and slightly elevated, is seen seated in a depression near the point of this appendix on one side ; and another of the same description, a little higher up, in another slight depression, on the opposite side of the bulb. These are the rudiments of the expected flowers and leaves, and when the sheath by which they are covered has attained an inch in length, the bulb has already begun to lose its medicinal qualities. If it be taken up in July, and sliced transversely, each slice has a nearly circular figure, slightly approximating to the oval, but perfectly free from any indentation on either side ; and this form is retained in the dried slice : whereas, when the flowers appear, every slice is panduriform, or an oblong oval with a deep semi¬ circular notch or depression on each side; and every approach to this figure implies that the bulb has been dug up too late in the season. These indentatious arise from the sheaths of the flowers as they enlarge pressing upon the sides of the bulb, which how readily yield, owing to the absorption

Medical and Physical /Intelligence. 341

of its contents for the support of the growing flowers, first taking place in the part immediately under that on which the sheat'h presses. At that part the exhausting process is immediately recognised by the spongy appearance which is seen surrounding each indentation, when the bulb is transversely divided.

Having made these preliminary inquiries, I obtained nine specimens of dried colchicum for my experiments.

Experiment 1.

Ten grains of the bulb of colchicum, which was dug up on the 25th of July, and dried, in transverse slices less than •§ of an inch in thickness, without heaty were rubbed in a mortar with sixteen minims of distilled vinegar; and, immediately afterwards, with sixteen minims of an alcoholic solution of guiaic ; a most beautiful coerulean blue was almost directly evolved, and remained permanent until the following day, when the mortar was cleaned.

The specimen subjected to this experiment was dug up by myself, and in drying it the slices were simpiy spread out, each slice separate from another, on a sheet of clean white paper, placed in an airy situation excluded from the sun. The dried slices were very little shrunk, of a cream white colour, opaque and somewhat granular on both surfaces; perfectly friable, devoid of odour, and bitter to the taste, without the least trace of sweetness. Three grains of the powder produced some degree of nausea, purged moderately, and diminished both the quickness and strength of the pulse. It was therefore marked No. I. and regarded as the criterion for determining the quality of the other specimens.

I ought to mention, that in all the experiments with the dried bulb, the powder was first rubbed with distilled vinegar; because I had ascertained that in dry amylaceous powders containing gluten, this principle is in a state which prevents it from being readily acted on by the guiaic, unless it be previously dissolved ; and as acetic acid is the best solvent of gluten, distilled vinegar was employed for that purpose. Distilled vinegar, when added alone to the alcoholic solution of guaiac, merely precipitates the gnaiac unaltered ; consequently the change of colour cannot in any degree be ascribed to that agent; and the same colour is evolved, if the powder of colchicum be wrell rubbed with the solution alone, although it is by no means so quickly produced.

Experiment 2.

Ten grains of dried colchicum, obtained at Apothecaries’ Hall, were rubbed with sixteen minims of distilled vinegar, and immediately afterwards with sixteen minims of the alcoholic solution of guiaic, but no blue colour was evolved. The friction was continued, and a few drops more of the vinegar and the alcoholic solution were added ; but at the end of twenty minutes, no blue colour was perceptible.

In this experiment, (No. 2.) the bqlbs, with the exception of four slices in one ounce, the quantity purchased at Apothecaries’ Hall, were entire, shrivelled, and deeply marked with the indentations which indicate that the bulb has been in flower, or just about to flower, at the time it is taken up; while several of the bases of the flowering sheaths, in an apparently charred state, were also present. The bulbs, when sliced, instead of being white, were of a light brown, or rather fawn-colour, tough, with a peculiar odour, not unlike that of charred malt, and both bitter and sweet to the taste ; Indeed, in some of them the sweetness predominated ; and the odour was much increased in the powder. Eight or ten grains taken into the stomach did not nauseate, scarcely purged in some cases, and in others not at all, and did not produce any very sensible effect on the pulse.

Although I have no means of knowing the fact, yet I am inclined to iina-

342 Medical and Physical Intelligence.

gine that the people employed to collect the bulbs for the Apothecaries’* Company, being ignorant where to find them until the flowers show them¬ selves above ground, wait until that period for taking them up ; and that they are farther deteriorated, by being dried in a stove, at a temperature suffi¬ cient to destroy the gluten, and, consequently, to change the other compo¬ nents of the bulb so much, as to diminish, in a very considerable degree, its medicinal properties. The method of preventing the drying from injuring the bulbs, has been already mentioned; and I would suggest their cultiva¬ tion, which I know, from experience, does not diminish their medicinal pro¬ perties, as the best mode of obviating the disadvantage which results from not being able to collect them in their wild state, until the flowers appear.

Experiment 3.

Ten grains of a specimen of dried colchicum, procured at the shop of Messrs. Watts and Co. Strand*, being treated exactly in the same manner as No. 1, almost instantaneously evolved a deep blue colour ; but, however, in three minutes it changed to a glaucous green, and after some time became considerably darker, or sea green.

In this specimen, (No. 3.) the bulbs, although in a better state than those of No. 2,, yet bore evident marks of having been taken up when the flower was advanced. They were rather small, split longitudinally in halves, and had been apparently dried without heat, firm in their substance, friable, inodorous, and much more bitter, with scarcely any of the sweetness perceptible in those of No. 2. The powder was of a very light fawn hue; but, although the bulb was in a condition to produce its effects in an increased dose, yet it wms evident that it had been collected in too advanced a state.

Experiment 4.

Ten grains of a specimen, procured from the shop of a highly respectable Druggist at the west end of the townf, and treated in the same manner as No. 1,, produced no change of colour, after twenty minutes7 rubbing.

This specimen (No. 4.) was in a worse state than that of No. 2.; some of the bulbs being quite black.

Experiment 5.

Ten grains of a specimen, procured from another highly respectable Drug¬ gist, in the city, and treated as No. 1., evolved, after three minutes’ rubbing, a glaucous green, which, after some time, became paler, and passed almost into a grey.

In this specimen, (No. 5.) the bulbs were also split longitudinally. Some of the pieces were firm and internally white and good ; but others were quite spongy, and displayed, when broken, the vessels of the bulb, in a ligneous state, which occurs only after the flower has decayed, and the leaves are appearing in early spring. They had little odour, and the taste was bitter, devoid of any sweetness, which led me to think no artificial heat had been employed in drying them ; but the pieces appeared as if they had been kept for several years. The powder was of a light fawn colour.

Experiment 6.

Ten grains of a specimen, obtained from another respectable Druggist in the city, and treated as No. 1., evolved, immediately, a very deep bluish- green, which, however, very soon faded.

* It is necessary to mention, that, with the exception of Mr. Battley, I am not acquainted with any of the Druggists from whom the specimens sub¬ mitted to experiment were purchased.

f As it is not my wish to injure the reputation of any one, I forbear from mentioning the names of those Druggists from whom the bad specimens were procured.

343

Medical and Physical Intelligence.

In this specimen, (No. 6.) the bulbs were also split longitudinally, and many of the pieces were in the same state as the best of those in No. 5.; but the others were spongy. One of them, indeed, was not a colchicum bull), but that of crocus autumnalis. The powder of this specimen was a very pale fawn-colour, nearly white : it had no odour, and scarcely any sweetness; but neither was the bitter was perceptible.

Experiment 7.

Ten grains of a specimen, procured at Butler’s, in Covent Garden, and treated as No. 1., produced, almost immediately, a greenish-blue colour; but certainly with less of the green tint than displayed by Nos. 4, 5, and G. It became paler after a short time.

In this specimen, (No. 7.) the bulbs were sliced transversely; but the slices were too thick, and, consequently, tough, instead of being friable ; and a few of them were spongy. The taste was bitter without any sweetness ; and the specimen bore the appearance of having been dried without artificial heat. Indeed, with the exception of the marks of having been taken up at too advanced a season, it was a good sample of the drug.

Experiment 8.

Ten grains of a specimen, from the shop of Messrs. Herring and Co., treated as No. 1., afforded, almost immediately, a light blue, without any tint of green ; and the colour did not much fade when left for some hours.

In this specimen, (No. 8.) the bulbs were split longitudinally; but they were firm, friable, internally white, inodorous, and impressed the proper bitter taste of the bulb, without any sweetness. They were, however, too deeply notched ; but in other respects, the specimen was an excellent sample of the drug; and had been apparently dried without artificial heat, or at a very low temperature.

Experiment 9.

Ten grains of a specimen, procured from Mr. Battley, of Fore Street, Cripplegate, treated in the kame manner as No. 1., after two minutes’ hard rubbing, afforded a pale blue, without the smallest tint of green, and became darker, when left in the mortar for some hours.

This specimen was in transverse slices, about the thickness of the tenth of an inch, of a cream-white colour, opaque, and friable, with the granular sur¬ face, mentioned in No. 1, but notched ; some of the slices being of a kidney shape, and others panduriform. It was free from odour; the bitter not strong; and, although it was devoid also of sweetness, yet it had something of the flavour of the sweet almond. As Mr. Battley has published his mode of drying the bulb, I am of opinion, that the temperature of one hundred and seventy to one hundred and eighty degrees, to which he exposes it, is even too high; and that, although the gluten be not entirely destroyed, yet it is partially so, which accounts for the blue colour being longer of appear¬ ing, and for the almond taste it impresses when chewed; and, if my inference be correct, that all the components should be in a state nearly the same as before the bulb is dried, to secure the full medicinal qualities of the drug, it is evident that, as even so low a temperature as one hundred and seventy degrees, is, in some degree, destructive of the balance of the components which is maintained in the recent colchicum, it should not be employed. In every other respect, this specimen was excellent, and approached nearer to the quality of No. 1. than any of the others.

From these experiments, and the prefatory observations, we are fully au¬ thorized in concluding : —

1. That the diversity of opinions held by Practitioners, at the present time, regarding the medicinal powers of the bulb of colchicum autumnale, proceed from the different conditions in which it is found in the shops, and in which it is consequently administered.

344 Medical and Physical Intelligence.

2. That the month of July is the best period for taking up the plant, as the bulb has then attained its full growth and perfection; whilst the vegetation of the gems or lateral progeny, tor the support of which the bulb is intended, has scarcely commenced.

3. That the bulb, when taken up, should, as soon as possible, be cut, as Mr. Battley directs, u into transverse slices, equal in thickness to half a crown*; and these being spread out upon clean white paper, should be dried without artificial heat, in an airy situation, screened from sunshine.

4. That the slices, when dried, should be nearly oval, but not notched nor panduriform, friable, of a white or cream-colour, somewhat granular on both surfaces, inodorous, bitter to the taste, and altogether free from sweet¬ ness, and should afford a fine coerulean blue colour, when rubbed with a few drops of vinegar and the alcoholic solution of guaiac,

5. That Practitioners, who compound their own prescriptions, should purchase the drug in the sliced state, and test it in the manner above described, before employing it.

6. That a Physician, in prescribing the remedy, should endeavour to ascertain in what condition it is kept in the shop of the Druggist who is to compound his prescription ; and that the Royal College of Physicians should notify to the Apothecaries’ Company, that, owing to the condition in which the dried colchicum is jiow sold in their Hall, it is not capable of effecting the object for which it is prescribed.

September 2<2d, 1820.

Researches on the Gluten of Wheat. By Dr. G. Taddei. — t( Whilst occupied in examining the flour of wheat, and investigating the cause of its difference from the flour of other grains, I happened to observe, that when the gluten of this wheat was placed in rectified alcohol, it softened, became less coherent, and filamentous like dense mucus ; finally, it became tena- ceous, hard, and less in hulk, having lost a principle which had been dissolved out by the alcohol.

Process to obtain the Gloiodine. — Procure gluten from wheat in the ordinary way, place it immediately in alcohol of 35° (s. g., 842,) or 40° (s. g. 817), and work it about with a spatula ; repeat this washing as long as the alcohol on trial becomes turbid on the addition of water. The different portions of alcohol, thus put together, are to be set aside in a close vessel. It will gradually deposit a small portion of gluten on the glass, and become transparent and slightly yellow. The clear solution, when slowly evaporated, yields the gloiodine having the appearance of honey. It is still contaminated with a small portion of a resinous substance which may be removed by sulphuric ether.

Gloiodine may also be obtained from gluten, which has been rapidly dried, and afterwards treated with hot alcohol; or it may be procured by digesting bruised seeds or wheaten flour in alcohol in the heat of a stove; but the first process is by much the best when the substance is required pure.

Properties of Gloiodine. — When dry it is of a straw yellow colour, and when in thin pieces somewhat transparent ; it is brittle, has a smell some¬ what like a honey-comb, and when slightly heated, the odour of apples. It becomes adhesive in the mouth, and has a balsamic taste. It is con¬ siderably soluble in boiling alcohol, but is deposited as the temperature diminishes. It forms a kind of varnish on bodies to which it is applied. It softens in cold water, but does not dissolve ; when the water is boiled the gloiodine forms a scum on it, and the water becomes turbid. It is heavier

* Vide London Medical Repository, Voh XIV. p. 29.

345

Medical and Physical Intelligence.

than water. The alcoholic solution of gloiodine is rendered milky by water, and is precipitated by alkaline carbonates in white flocculi. it is scarcely rendered turbid by the vegetable and mineral acids. Dry gloiodine dissolves in the caustic alkalies and in the acids. When heated, it smells and burns like animal substance with a lively brilliant flame, and leaves a light spongy coal, difficult to incinerate ; gloiodine, which appears in some points to resemble resinous bodies, differs from them in others. It is insoluble in ether; is extremely sensible to the action of galls ; is susceptible of a slow fermentation when alone, and occasions it when mixed with saccharine substances.

On Zimoma. — Gluten, when treated with alcohol as described, is gene¬ rally reduced about one-third in weight, in consequence of the abstraction of the gloiodine and water. What remains is zimoma, which may be rendered pure by boiling it in alcohol, or by continuing to wash it with cold alcohol until the last portions of gloiodine are removed. The zimoma then appears in small globules, or in an unformed mass, hard, tenacious, of a greyish yellow colour, and unadhesive. When washed in water it again becomes somewhat viscid, and when exposed to the air changes its appear¬ ance, and becomes obscured. It is heavier than water; it does not ferment like gluten, but exhales the odour of putrid urine. It dissolves completely in vinegar, and by boiling in the mineral acids; when acted on by caustic potash ; it forms a soapy compound in the alkaline carbonates, and in lime-water it shrinks, wrinkles, becomes harder, and is altered in texture, without being dissolved. When burnt, it exhales the smell of skin and horn, and emits flame.

Zimoma is abundantly dispersed in many parts of vegetables, and is the cause of various fermentations, according to the nature of the substance with which it is combined. The term gluten now belongs only to the chemical compound of gloiodine and zimoma. — Giornale di Fisica, 2. p. 360.

Gluten an Antidote for Corrosive Sublimate. — During the researches undertaken by Dr. Taddei on gluten and on wheaten flour, he discovered that gluten had the property of acting on the red oxide of mercury and on corrosive sublimate. If it be mixed with either of these substances, it immediately loses its viscidity, becomes hard, and is not at all liable to putrefaction. Further, if flour be made into a paste, with solution of corrosive sublimate, it is impossible to separate the gluten and starch in the usual way. This effect induced Dr. Taddei to suppose, that in cases of poisoning by corrosive sublimate, wheaten flour and gluten would prove excellent antidotes to the poison. It was found by experiment, that wheaten flour and gluten reduced corrosive sublimate to the state of calomel ; and also that considerable quantities of a mixture of flour or gluten with corrosive sublimate might be eaten by animais without pro¬ ducing injury; thus fourteen grains of sublimate have been given in less than twelve hours to rabbits and poultry without injury, whereas a single grain was sufficient to produce death when administered alone. A grain of the sublimate required from twenty to twenty-five grains of fresh gluten to become innocuous ; when dry gluten was used, half this quantity was sufficient; but when wheaten flour was taken, from fifteen to eighteen danari (500 or 600 gr. ) were required. Dr. Taddei recommends that dried gluten be kept in the apothecaries’ shops, and that it be administered when required, mixed with a little water. — Giornale di Fisica, 2. p. 375.

Water not a non-elastic Fluid. — Mr. Perkins, the inventor of the curious and useful art of siderography, or of multiplying engravings, (by executing them on soft steel plates, which when hardened are employed to transfer the lines in relief to steel rollers, which rollers are again used to impress other steel or copper-plates with all the lines of the first engraving,) has ascertained

VOL. XIV. - NO. 82. 2

346 Medical and Physical Intelligence .

and proved by actual experiment, that water subjected to a pressure of 326 atmospheres is diminished about l-29th in bulk, or 3-| per cent.

Boracic Acid. — By experiments made by Dr, Pleischl, of Prague, on crystallized boracic acid, it appears to be a compound of pure anhydrous acid 54, water 45 zz 99. Experiments made by this chemist on anhydrous boracic acid confirm those of Gay Lussac and Thenard. It is not able to decompose fused chloride of barium — no decomposition or chemical com¬ bination was obtained.

Vegetable Alkalies. — The number of these is daily increasing, and chiefly by the labours of the German chemists, Delphia, Daturia , Hyoscyama, and Atropia, were discovered by Dr. Brandes.

Atropia is the ingredient which gives to the Atropa belladonna its peculiar properties. It crystallizes in long needles, is a brilliant white, tasteless, and little soluble in water and in alcohol; withstands a moderate heat ; and forms regular salts with acids, neutralizing a considerable portion of acid. Sulphate of atropia contains sulphuric acid 36’52, atropia 3893, water 24'55 zz 100. Atropia mixed with potash, and exposed to a red heat, yields ashes, which when mixed with muriate of iron strike a lively red colour.

Hyoscyama (the alkali extracted from the Hyoscyamus niger ) is not easily altered by heat, even when brought to redness with charcoal. It crystallizes in long prisms; and gives, with sulphuric or with nitric acid, very characteristic salts.

Great care and circumspection should be employed in examining the alkaline constituents of narcotic plants ; for in them are concentrated the whole poisonous properties of the plants. The vapour is highly prejudicial to the eyes ; and the smallest portion put on the tongue is very dangerous.

Antidote for Vegetable Poisons. — It results from a number of experiments made by M. Drapiez, that the fruit of the plant Feuillea cordifolia is a powerful antidote against vegetable poisons. He poisoned dogs with, the rhus toxicodendron , hemlock, and nux vomica. Such of them as were left to the effects of the poison all died ; but those to which the above fruit was given recovered completely after a short illness. With two arrows dipped in the juice of manchineai he slightly wounded two cats : to the one he applied a poultice of the same fruit, and it soon recovered : to the other nothing was done, and it fell in a short time into convulsions, and died. In the countries which produce this plant, its virtues have long been highly esteemed ; and from these experiments it would appear, not without good reason.

Succedaneum for Peruvian Bark,— M. Re, Professor of the Materia Medica at the Veterinary School of Turin, has announced that the Bycopus Furopceus of Linnteus, called by the peasants of Piedmont, where it is found in great abundance, principally in the marshy places, where of course it is most needed, the Herb of China, is a complete succedaneum for Peruvian bark.

Arakatscha. — If we may credit what is stated respecting this root, which grows in Santa Fe de Bagota, we may expect before many years to see it brought to Europe, and cultivated as extensively as the potatoe. It is said to be as prolific, and more nourishing, and resembles the Spanish chesnut in taste and firmness. It is indigenous to the Cordilleros, a climate as temperate as Europe, and may be cultivated with the same facility as the potatoe.

Cure for the Hydrophobia. — Dr. Lyman Spalding, one of the most eminent Physicians of New York, announces, in a small pamphlet, that for above these fifty years the Scutellaria lateriflora, L. has proved to be an infallible means for the prevention and cure of the hydrophobia, after the bite of mad animals. It is better applied as a dry powder than fresh.

Medical and Physical Intelligence. 347

I

According to the testimonies of several American Physicians, this plant, not yet received as a remedy in any European Materia Medica, afforded a perfect relief in above a thousand cases, as well in the human species as the brute creation (dogs, swine, and oxen). The first discoverer of the remedy as not known : Drs. Derveer (father and son) first brought it into general use.

Gastronomy. — M. Lemare, director of the Athensum of Languages, has invented a utensil which he calls autoclave. M. Lemare engages to dress his dinner in less than half an hour; and lately made the experiment, with complete success, before a numerous company. He had put into the vessel a piece of meat, vegetables, and as much water as is necessary for a dish for five persons. The vessel was placed over a fire, which was kept up with some pieces of charcoal. In thirty-six minutes the vessel was taken oft, and left a few minutes to cool; and the reporter affirms, that the broth was excellent, and the meat thoroughly done. It is not necessary to open the pot to skim it so much as once during the boiling; for at the end of the operation the scum is found at the bottom of the vessel, and does not mix with the broth. The advantages of this autoclavian cookery are : 1st. That the soup is excellent, which is very natural, because the apparatus is hermetically closed, and nothing therefore is lost. 2d. That the produce is much increased by the quantity of jelly yielded by the bones. 3d. That the cookery is far more expeditious than in the ordinary kettles, &c. This mode of cookery will be highly advantageous to the poor in particular. We leave the detailed description of the autoclave to those journals which are especially devoted to such subjects. If satisfactory and repeated trials confirm the utility of the invention, it will become highly important in its results, as it will then be evident that cooking may be performed in much less than the usual time, and with one-tenth part of the fuel now employed. M. Lemare’s process is a very simple, and, for that reason, very ingenious improvement of Papin’s digester. It speaks much in favour of the in¬ vention, that, as appears from a letter of the Minister of the Interior, the autoclave has been in use above a month in the School for the Blind at Paris. Should it come into general use, M. Lemare will doubtless derive more profit from the sale of this apparatus than from all his discoveries in etymology, and his excellent precepts on orthography ; and this is in the nature of things. In this enlightened age, we undoubtedly set a high value on correctness of language, but a well-dressed dinner is far more valuable. —

( Foreign Journal.)

LITERARY NOTICE.

Morgagni on the Seats and Causes of Diseases.

Shortly will be published, an Abridgment ot the above valuable Work, in 2 vols. large octavo. By William Cooke, Surgeon, Great Prescot Street, London.

NOTICES or LECTURES.

Dr. Davis will commence his first winter Course of Lectures on the Theory and Practice of Midwifery, and on the Diseases of Women and Children, on Monday, the 9th of October.

These Lectures are delivered at Dr. Davis’s House, No. 29, George Street, Hanover Square.

London Hospital — Medical School. — The Winter Courses o( Lec¬ tures will commence on Monday, Oct. 2. Anatomy, Physiology, and Surgery, by Mr. Headington, Theory and Practice of Medicine, by Dr. Hob in son. Midwifery, and Diseases of Women and Children, by Dr. Ramsbotham. Materia Medica, by Dr. Billing. Chemistry, by Mr. Richard Phillips. Practical Anatomy and Demonstrations, by Mr. W. B. II ark NESS.

$48

A METEOROLOGICAL TABLE,

From 21 st of AUGUST to 20 th of SEPTEMBER 1820, KEPT AT RICHMOND, YORKSHIRE.

D.	Baron Max.	neter, Min.	The Max	rm. Min.	Rain Gauge.	Winds.	Weather.
21	29	69	29	69	64	42		NE.	1 Cloud.. 3 Sun.. 4 Moon....
22	29	78	29	75	63	42		NNE	1 Sun.. & Show. 2 Sun...
23	29	80	29	73	69	40		NW.SW.	13 Sun.. 2 Cloud . 4 Moon..
24	29	62	29	34	70	56	03	SW.,	1 Rain. 2 Sun..
25	29	23	29	14	69	51	03	SSW.SW...	1 Rain. 2 Sun..
26	29	22	29	18	64	47	09	SW..,	1 Show. & Sun..
27	29	27	29	07	63	45	02	wsw..	1 Show. & Sun..
28	29	14	29	11	61	47	09	w.wsw..	1 Rain. 2 Sun., and Show.
29	29	50	29	39	66	48	04	w..	1 Sun.. & Show.
30	29	72	29	69	66	39	> 10	NW.NE.	1 Show.. &Sun.. 4 Moon...
31	29	78	29	76	66	42		Vble.	1 Sun ..
1	29	83	29	82	66	44		Vble..	1 Sun...
2	29	84	29-	82	66	46		NW.NE.	1 Sun..
3	29	86	29	83	67	41		NW.NE.	1 Cloud.. 2 Sun..
4	29	83	29	77	66	44		NW.NE.SE.	lSun... 2Cloud.. 3Sun. 4St..
5	29	76	29	74	72	40		SW.SE.	1 Cloud . 2 Sun..
6	29	78	29	74	62	46		SW.SE.	1 Sun....
7	€9	80	29	77	67	49		S.	1 Sun.. 3 Cloud.. 4 Starl. ..
8	29	97	29	94	67	45		WSW.	1 Sun...
9	29	90	29	83	71	56		SSW.	1 Sun...
10	29	93	29	92	68	49		SW...	1 Cloud., 2 Rain. 3 Sun..
11	29	92	29	87	75	54		SW.SE.	13 Sun.... 2 Sun.. 4 Starl....
12	29	86	29	82	71	53		SE.	1 Mist... 2 Sun...
13	29	74	29	54	71	55		SE..	1 Mist.. 2 Sun...
14	29	35	29	16	72	54	14	SE..SW..	13 Cloud . 2 Sun. 4 Rain..
15	29	43	29	30	62	48	02	SW...	13 Show. 2 Sun... 4 Moon..
16	29,	58	29	55	63	45		SW..	1 Sun..
17	29	53	29	36	61	41		wsw.	1 Cloud.. 2 Sun..
18	29	49	29	43	59	37	04	NW..N..	1 Cloud.. 2 Sun.. 3 Show.
19	29	64	29	42	53	31		NW..	1 Sun...
20	29	12	29		56	34	10	SW...WNW..	13 Sun.. 2 Rain.. 4 Moon...

The quantity of rain during the month of August was 1 inch, 92-100ths.

Observations on Diseases at Richmond.

The disorders under treatment were, Amentia, Asthenia, Catarrhus, Cephalalgia, Colica, Diarrhoea, Dyspepsia, Enteritis, Febris simplex, Hae- moptoe, Obstipatio, Odontalgia, Paralysis, Podagra, Phthisis pulmonalis, Rheumatismus, Rubeola, and Syncope.

349

THE METEOROLOGICAL JOURNAL,

From the 20 th of AUGUST to the 1 pth of SEPTEMBER,

By Messrs. HARRIS and Co.

Mathematical Instrument Makers, 50, High llulborn.

820,

D.	Moon	Rain.	Therm.	Larom.	De Luc’s Hygrora.	i Winds.
20		,21	55	64	52	29	87	29	88	54	48	NW	E
21		,34	54	57	49	29	83	29	79	57	55	ENE	NNE
22		,19	54	56	48	29	82	29	92	57	57	NE va	NNE
23			55	60	53	30	10	29	17	54	55	N £	NE
24	©		56	63	52	30	14	30	08	53	53	SW	SW
25		,12	60	64	53	29	88	29	72	57	62	SW	WSW
26		,08	62	66	50	29	67	29	66	59	58	wsw	wsw
27		,08	56	64	53	29	74	29	65	55	55	NW	SW
28		,02	58	62	50	29	53	29	81	54	53	N W va	wsw
29			57	64	50	29	70	29	00	55	53	WNW	WNW
30	D		56	60	50	29	93	30	01	53	54	W	NW
31			56	60	48	30	06	30	11	54	54	ENE	NE
1			55	61	49	30	08	30	06	52	55	NE	NE
2			56	62	53	30	06	30	09	54	53	NNE	NNE
3			58	63	49	30	14 30	19	55	53	NNE	N
4		-	53	60	49	30	16	30	15	54	53	NE	ESE
5			54	61	49	30	16	30	07	54	53	SSE	ESE
6			55	63	48	30	07	30	11	52	53	SE	E
7			57	64	53	30	11	30	16	53	54	E	SW
8			60	66	50	30	23	30	35	53	52	NNW	E
9			57	68	51	30	36	39	32	53	52	ssw	wsw
10			59	66	53	30	30	30	28	54	54	w	wsw
11			64	72	57	30	26	30	24	56	55	ESE	ESE
12			66	75	54	30	23	30	21	56	56	SE	SE
13			63	70	57	30	18	30	11	56	54	ESE	ESE
14			65	73	58	29	91	29	83	57	56	S	WSW
15	d		64	67	51	29	71	29	94	57	52	WSW	w
16			57	66	53	29	99	30	03	54	54	w	w
17		,65	59	65	50	29	97	29	86	53	55	WSW	wsw
18		,81	53	61	40	29	57	29	78	55	53	NW va	WNW
19			46	57	45	29	95	30	05	52	52	INW	IWNW

Atmo. Variation,

i.am

tie

Fine

Fine

Fine

Fine

Fine

Fine

Fine

Fog

Cio.

Fine

Fine

Fine

Clo.

Fine

Fine

Fine

Fine

Clo.

Rain

Fine

Clo.

Rain

Sho.

Clo

Cio.

Fine

Fine

Fine

Finel

Sho.

Fine

Rain

Clo.

Rain

Fine

Clo.

Fine

Fine

Clo.

Fine

Clo.

Rain

The quantity of rain fallen in August is 1 inch and 36-100ths.

\

350

A REGISTER OF DISEASES Between AUGUST 20 th and SEPTEMBER lQt/t, 1820.

DISEASES.	n o H
Abortio .	12
Abscessio .	11
	1
iALlltJ •••••• ••••••••* Amenorrhoea .	9
Anasarca .	13
Aphtha lactentium • • • •	10
	1
Apoplexia .	8
	4
Asthenia • . .	13
Asthma . . .	12
Bronchitis acuta . .	3
- chronica ••••	4
Cancer . . .	1
Carbunculus • • * .	1
Cardialgia .	7
Carditis . . . • •	2
Catarrhus . . ♦	27
Cephalalgia . .	17
Cephalsea . .	1
Chorea .	3
Cholera . . . <• •	48
	Q
-■ - Pictonum .	4
Convulsio .	4
Cynanche Tonsillaris • •	18
- - Trachealis • •	5
■ - Parotidea * • • •	1
Diarrhoea .	44
Dysenteria . .	10
Dyspepsia .	19
Dyspnoea .	5
Dysphagia* . .	1
Dystocia .	1
Enteritis . . .	6
Entrodynia .	1
Epilepsia .	4
Epistaxis .	4
Erysipelas . .	7
Erythema Iwve ........	1
Erythismus Merc. ....	1
Febris Intermittent • • • .	8
cn.t/t vr*h.nh q • • • . . .	10
	13
1 ' ID U / LUxjULL *****-••
— - — Typhus mitior * • *	4
- - - Typhus grav. «...	7
	16
kjU flULIlllo
— — Remit. Infant . * *	10
Fistula .	2
Furunculus .	2

DISEASES.	1 O H	Fatal.
Gastritis .	2
Gastrodvnia .	12
Gonorrhoea pura .	12
Hsematemesis	6
Haemoptbe . •••»•■■	10	1
Hsemorrhois .	7
Hemiplegia * .	4
Hepatalgia . .	1
Hepatitis .	10
Hernia .	2
Herpes labialis .	1
- - prwputialis * * * *	2
Hydrocephalus . .	4	1
Hydrothorax • • » • . .	2	1
Hypochondriasis ......	4
Hysteria . .	6
Icterus . o..	4
Ischuria . . .	5
Leucorrhoea ...... ....	6
Melancholia .	1
Menorrhagia • • »-* .	15
Miliaria .	4
Morbi Infantiles* .	38	3
- - Biliosi* * .	23
Nephritis. . . *	1
Obstipatio • .	2
Odontalgia .	12
Ophthalmia • • * .	16
Otalgia .	2
Paralysis • * * * * .	2
Paronychia .	2
Peripneumonia ........	9
Peritonitis . .	17	1
Pertussis .	15
Phlogosis . .	1
Phthisis Pulmonalis «...	17	8
Plethora * . * .	1
Pleuritis .	10
Pleurodyne * * .	7
Pneumonia * * - .	10	1
Podagra • * • • * .	1
Porrigo larval is ........	3
O b IAj (/ tv v lv V U' **'***	I
	J.
Prolapsus ............	3
Prurigo senilis * • . .	1
Psoriasis guttata .	2
Pyrosis ..............	3
Rheuma acutus • .......	18
— - - chronicus .	30

I

Observations on Prevailing Diseases .

35

DISEASES.

Roseola .

Rubeola . . . . . .

Scabies . .

Scarlatina simplex .

- anginosa • • • •

Scrofula* • . . .

Spasmi .

Strictura . *• .

Syphilis .

Tabes Mesenterica • • • •

Tympanites* * * * .

Tussis •••••♦• .

Total.	Fatal.	DISEASES.	Total.	Fatal.
1		Vaccinia . .	17
25		Varicella . - .	T
54			11
6		Vermes . .	17
3		Vertigo .	15
5		Vomitus .	1
3		XJ rticznafebrilis .	3
1			1 % 1
17	1	tuber osa *•*•<-.
5	1
1		Total of Cases	985
1		Total of Deaths .	31

tition or indigestion, and which may be too trivial to enter under any distinct head; Morbi Biliosi, such Complaints as are popularly termed bilious, but cannot be accurately classed.

Observations on Prevailing Diseases.

Cholera has neither been so severe, nor have the cases been so nume¬ rous, as is usual at this season. No particular epidemic has, indeed, been prevalent. The list of diseases is unusually slender.

The following remarks we are favoured with by Mr. Parkinson : — - u The Reporters think it necessary to remark, that the cases of fever of the sub-inflammatory kind occurred in the early part of the time included in this Report, and were generally accompanied with disorder of the intes¬ tinal canal, chiefly in the form of diarrhoea, or of mild dysentery ; that the cases assuming more of the typhoidal type, occurred in the latter part of the time ; and that four out of the seven cases were accompanied with inflamma¬ tory affection of the chest requiring the free use of the lancet.

“ The fatal case was that of a young woman who had been previously in a bad state of health, and who died with symptoms of great congestion of the chest, which had been very gradually coming on during the course of fever, which, at its commencement, was not marked by any evident local affection. Her powers were too much exhausted to allow of the abstraction of much blood.”

Notices to Correspondents .

MONTHLY CATALOGUE. OF BOOKS.

Wilson’s Lectures on the Structure and Physiology of the 'Parts com¬ posing the Skeleton, and the Diseases of the Burns in Joints. 8vo. Price 12s.

Medico-Chirurgical Transactions. Vol 2. Part 1. 8vo. Price 9s.

Hooper’s Examinations in Anatomy, &c. New Edition. 12mo.

A Synopsis of the various Kinds of Difficult Parturition ; with Practical Remarks on the Management of Labours. Third Edition, with con¬ siderable Additions, and an Appendix of Illustrative Cases and Tables. By Samuel Merriman, M.D. 8vo. Price 12s.

Atkinson’s Compendium of British Ornithology. 8vo. Price 8s.

Elliotson on Prussic Acid. Illustrated with numerous Cases. 8vo. Price 5s. 6d.

NOTICES TO CORRESPONDENTS.

Communications have been received this month from Dr. Onslow, Dr. Buxton, ( through Dr. Johnson,) and Mr. Davies.

We hope next month to lay before our readers a Case of Tetanus, with the Dissection , in which the Appearances on Dissection were similar to those described by Mr. Brayne.

• 1

Communications are requested to be addressed (post paid) to Messrs. T. and G. UNDERWOOD, 32, Fleet Street .

THE

LONDON MEDICAL

REPOSITORY.

No. 83. NOVEMBER 1, 1820. Vol. XIV.

PART I.

ORIGINAL COMMUNICATIONS.

I.

Obstetrical Researches. By Maurice Onslow, M.D.

Hive Cottage, Chelsea.

No. 3.

[Continued from page 286.]

The following case is somewhat abridged from Dionis* Traite des Accouchemens, ( 1 7 J 8), p. 273.

“ A young lady of quality, pregnant of her first child, sent for Mauriceau as soon as she felt the pains of labour. The pains having continued till the next day, the waters broke, and it was now expected that the head would speedily follow, but it remained stationary, without making the least progress. The mother was made to walk about. She was bled ; stimulating clysters were thrown up, with the view of exciting such strainings as should force her to bear down ; but nothing could produce any advancement. The second day having elapsed, Dionis the younger was called in. The two Accoucheurs were spectators, during the whole third day, of the pains, which she bore without any advantage. At length, on the fourth day, the pulse becoming bad, her strength being diminished, and the pains no longer sufficient, fearing she W'ould die with the child within her, they resolved, in consulta¬ tion with other Surgeons and Physicians, to deliver her by force ; this being the only chance of preserving her life.

“ The patient being placed in a convenient posture, they began by baptizing the child, sous condition #, by conveying

* In Roman Catholic countries, Practitioners of Midwifery are required to baptize children as soon as they are born, if they appear to

VOL. xiv. — no. 83. 2 z

354

Original Communications.

water in a small spoon to that part of the head which could be touched. Mauriceau, being the elder Accoucheur, under¬ took the delivery ; but having applied his crotchet to the crown of the head, and the scalp having torn, he tried to fix it to one of the parietal bones, as he directs in his book ; but not being able to succeed, after many useless efforts, he gave the instrument to Dionis, saying to him, 4 You are young and strong ; you will succeed better than 1/

“ Dionis took his place, and began the operation. While he was endeavouring to find the best place for fixing his crotchet, Mauriceau, in a dictatorial manner, (en prenant un ton de maitre,) gave him directions ; but the father of the young lady, who was holding one of her hands, silenced him, telling him to let Dionis alone, who appeared to be doing every thing with the greatest possible caution. In fact, he managed so well, that having fixed the crotchet in the nape of the neck, near the base of the occipital bone, and finding that he had a firm hold, he drew with all his force, and finding that the head advanced a little, he brought it forth in a very short space of time ; then extracting the shoulders, he finished the delivery.

“ This delivery did great honour to Dionis, since all the ladies of the court interested themselves about it. The recovery went on without any accident, and the lady after¬ wards was delivered twice by Dionis, in very favourable labours.

de in imminent danger of death. And before any operation is under¬ taken, which may cause their death, the Practitioners are required to baptize them, in utero, ( sous condition ), that is to say, such a form of words as this must be used, 4 If thou art alive, I baptize thee in the name of the Father, the Son, and the Holy Ghost/ as was done in the above case. The following process relative to that custom is entered in the consistorial acts of the diocese of Rochester. — See Gentlemans Magazine for 1785, p. 939 : 44 1523, Oct. 14. — Eliz. Gaynsford, obstetrix, examinat, dicit in vim juramenti sui sub hac forma verborum. — I, the aforesaid Elizabeth, seeing the childe of Tho. Every, late born in jeapardy of life, by the authorite of my office, then beyng Midwyfe, dyd christen the same childe under this maner. In the name of the Fader, the Son, and the Holy Ghost, I christen thee Denys, iffundend meiam aquam super caput infantul. — • Interrogata erat, whether the childe was bom and delivered from the wyfe of the said Thomas; whereto she answereth and saith, that the childe was not born, for she saw nothyng of the childe but the hedde, and for perelle the childe was in, and in that tyme of nede she christened as is aforesaid, and cast water with her hand on the child’s hede. After which so done, the childe was born, and was had to the churche, where the priest gave to it that chrsytynden that takkyd, and the child is yet alyf/’

Onslow’s Obstetrical Researches .

355

u While Dionis was happy at having succeeded so well, Mauriceau was no less mortified ; first, at being obliged to give up the operation, after having undertaken it; secondly, by finding that Dionis was able to fix the instrument at the base of the os occipilis, he (Mauriceau) having declared in his book, that this was impossible, because the os pubis could prevent it ; and, thirdly, by finding that the child was not dead, he having declared, in his writings, that the child could not be alive after a continuance of four days in such a situation.”

What was the crotchet employed in this case, which was applied apparently in the manner of the modern lever, and brought a living child into the world ? _

In Mauriceau’s work, three crotchets are delineated ; two are sharp and pointed, and are said to be proper for bringing a dead child into the world ; the other is the crotchet-mousse , the blunt crotchet, “ proper for extracting the head of the child wdien separated and left in the womb ; the head being held by one hand, and embraced by the crotchet in the other.”

This crotchet is directed to be made full ten inches long, and its shape very much resembles that of the modern lever.

The context certainly does not warrant us in believing that this was the instrument used ; we must infer, therefore, that in this case of Dionis, the child, though born alive, w-as mutilated ; but was not this instrument the origin of the lever ?

It seems extraordinary, while the sharp hooked crotchets are recommended for bringing the heads of dead children undiminished into the world, that the above very powerful instrument should have been confined to the solitary case of extracting the head left in the womb. One can hardly believe that such an instrument, which seems to have been very generally known, as it is likewise engraved in an edition of Guillemeau, in my possession, dated 1642: one can hardly believe, 1 say, that some Practitioner would not have attempted to effect delivery with this, especially in those critical cases, where doubts were entertained of the reality of the child’s death.

Dr. Bland, in his “ Account of the Invention and Use

356 Original Communications.

of the Lever*,” seems to think it proved, that the origin of the lever was the accidental discovery of the practicability of delivering with a single blade of the forceps ; but the fact that a lever was discovered among the instruments of Chamberlemf, overturns this hypothesis, and rather coun¬ tenances the supposition, that the origin of the forceps was the putting together two levers, than that the lever originated from separating the forceps.

No. 4.

John Maubray, M.D., was one of the first English writers, who published an original work on midwifery ; those who preceded him being rather compilers than original authors. Of his history little was known, till he published his “ Female Physician,” in 1724. He then, and for some time afterwards, wrote his name as above ; but, for what reason I know not, changed it to Mowbray; and, in 1730, cancelled the title-page for the purpose of making this alteration, though he preserves the name of Maubray to the dedication.

Maubray wras apparently a native of North Britain ; he had travelled over a large part of the Continent, and was evidently a man of great book learning. He died October 27, 1732, and his death is thus announced in the Gentleman’s Maga¬ zine: “John Mowbray, M.D., late chairman of the com¬ mittee of the charitable corporation; justly esteemed an honest public spirited man.”

Maubray’s works are a strange compound of weakness and pedantry.

He gives advice to pregnant women how to conduct them¬ selves ; and some of his rules are ludicrous enough ; for instance, the third : — “ She must not desire rashly to walk abroad in moonshine, nor to wash her head in sunshine.” And the fourth: — “ She ought not to frequent gardens; and that for the following tw;ofold reasons : first, lest perchance she happen to sit or tread upon some herb of a pernicious quality, as divers are, in provoking abortion ; secondly, lest she covet some fruit or herbs, which may be of damage or in- conveniency if allowed, and the same if denied her.” In one

* Medical Communications, vol. ii.

t Few of my readers will require to be informed that Mr. Cansar- dine became possessed, a few years ago, of the obstetrical instruments of Chamberlen, and presented them to the Medical and Chirurgical Society, in Lincoln’s Inn Fields, — See the ninth volume of their Transactions, p. 181.

Onslow’s Obstetrical Researches. 357

of these rules, she is directed u not to lift her arms above her head ; and in another, is very sagely advised “ not to be sur¬ prised at any thing she hears or sees/’ — “ Lastly/’ to make well for trade, “ let her state of health be never so good, she ought to take proper medicines to strengthen the womb as well as the foetus, in order to prevent accidents, which may happen to the strongest woman."

Maubray believes that women may carry their children within them eleven solar months. One instance of which he relates which happened within his “ own proper experience, during his itinerant practice in the city of Prague.” — “ I hap¬ pened once to be called [by an eminent Physician] to a lady in labour, whom I had the good fortune to deliver im¬ mediately, of a fine lively and lusty girl. After which, I had the honour to attend her in childbed: — Upon this she was pleased to tell me, out of her own mouth, that before the day of her delivery, her husband (who was a colonel in the imperial service,) had been gone to the army, then in Sicily, ten months and two days ; so that this proculean child was born, at soonest, the third day of the eleventh month. And in this case, I dare say, I was nowise mistaken or im¬ posed upon ; that lady being endued with no less true honour and strict virtue than she was otherwise deservedly esteemed of a singular good character, and great distinction in that place.”

Another evidence of Maubray’s weakness, or rather of what more deeply implicates his character, is to be found in his opinions respecting the generation of monsters; respecting which, he has related an unpardonable falsehood, in the account he gives of the suyger, “ a monstrous little animal, the likest of any thing in shape and size to a moodiwarp ; having a hooked snout, fiery sparkling eyes, a long round neck, and an acuminated sharp tail, of an extraordinary agility of feet. At first sight of the world’s light it commonly yells and shrieks fearfully ; and, seeking for a lurking hole, runs up and down like a little daemon, which, indeed, I took it for, the first time I saw it, and that for none of the better sort.” — page 375.

Of this suyger he declares, that it is generated in the womb, and precedes the birth of the child ; and further says, “ I had occasion to talk with some of the learned men of the several famous universities in these provinces [Holland] upon this head, who ingenuously told me, that it was so common a thing, among the sea-faring and meaner sort of people, that scarce one of these women in three escaped this kind oj strange birth ; which my own small practice among them afterwards also confirmed ; insomuch, that I always as much expected the thing, de suyger, as the child itself. They properly call

358

Original Communicat ions.

it de sui/ger , which is (in our language) the sucker 3 because, like a leech, it sucks up the infant’s blood and aliment.”

Maubray having, by this atrocious falsehood, laid himself open to contempt and ridicule, was lashed by the wits of the day with deserved severity.

It is probable that this ridiculous tale of Maubray sug¬ gested to the contrivers of Mary Tofts’ imposition the idea of pretending that she was delivered of rabbits. By this trick, Maubray seems to have been easily cajoled ; and accordingly he cuts a conspicuous figure in some of the caricatures which that beastly story gave birth to. In the fabricated, u full, and impartial confession from her own mouth, and under her own hand, of the whole affair from the beginning to the end,” (1727), Mary Tofts is made to say of Dr. Maubray, “ As for the squab man that cried out a sooterkin, a sooterkin, I dont lik him at all; for it seems lie wonted to mak a devil’s damm of me ; and peept, and peept, the devil peep his eyes out, in hops to see a dansing devil cut a capor out of my belli, but he was disapinted.”

To Maubray, however, it is but justice to attribute a suggestion, which has done more than any thing else in promoting the improvement of midwifery ; this was, to in¬ stitute a lying-in hospital in London, similar to the Hotel- Bieu at Paris, where students might have opportunities of learning the art. On this subject he says, in his intro¬ ductory lecture, 172.5 : “ ’Tis true, we have hospitals for all other sorts of indigent people, and those, indeed, most superb and magnificent, and in every respect superior to others ; only in this point of provision for poor miserable women, in the time of their natural affliction, when they are in no case or condition, either in one regard or other, to help themselves, we have been hitherto, and still are deficient, notwithstanding the excellent good precedents set before our eyes in foreign countries. Surely if such a thing was once begun here, many good people would cheerfully contribute to it, and 1 dare say that no necessary encouragement would be long wanting, if once undertaken, for promoting of such a truly Christian work ; a work that would transcend and exceed all other acts of charity, in that it would extend itself to no less than two lives in every one person admitted to the benefit of it.”

The idea thus thrown out by Maubray was afterwards acted upon by Sir Richard Manningham, who, in the preface to his Artis Obstetricarice Compendium (1739), states, that an hospitiolum for poor pregnant women had been founded, where pupils were taught by him, and had opportunities

Buxton’s Cases of Diabetes . 359

of seeing and attending real labours. This was the first institution of the kind in the British dominions; hut from this sprung up afterwards the Middlesex Hospital in 1745, which, at first, was fixed in Windmill Street, Tottenham Court Road. It consisted of two adjoining houses, capable of containing thirty patients, one of which was appropriated to lying-in women. Mr., afterwards Dr., Layard was the Man-Midwife, and Dr. Sandys was to be called in consulta¬ tion in dangerous cases.

After this, the British Lying-in Hospital, and others, were founded, and from these sources so many opportunities of carefully studying midwifery and improving the practice were afforded as have established it upon the very firm footing which it has now acquired.

II.

Cases of Diabetes; with Remarks . By Isaac Buxton,

M.D. New Broad Street.

Our knowledge of diabetes mellitus is still so extremely confined, that the relation even of individual instances is by no means a superfluous task. A collection of cases, accom¬ panied by a few remarks, will, therefore, possibly not be un¬ acceptable. The particular symptoms of the disease have been so frequently and so accurately stated, that I have thought it unnecessary, in the following pages, to mention them, as they presented nothing peculiar, and as such a statement would have added much to the bulk of the paper, without producing any adequate advantage.

Case 1. — Mr. M., tavern-keeper, about thirty-five years of age, of moderate size, of dark, pale complexion, and of habits rather irregular, was attended by Mr. Hugh, of Gracechurch Street.

Before I saw this patient, in June 1810, Rollo’s plan had been partially pursued with him, but had not produced any good effect. As he was not very considerably emaciated or debilitated, I determined to employ the treatment recom¬ mended by Watt ; and accordingly had him bled five times within seven days. He derived no benefit from this mode of procedure. He was much weakened by the loss of blood ; the countenance became more pallid ; the appearance of the superficial veins was rendered smaller; and none of the blood drawn exhibited the smallest trace of being cupped or buffy. As far as I observed the blood, which was saved, it passed through the ordinary changes. I then felt myself compelled to desist. Shortly afterwards my patient went into

360

Original Communications,

the country. I heard nothing of him subsequently, excepting that he died at no very great distance of time ; but how long after I saw him, I cannot say.

Case 2. — G. B., aged thirty-five, unmarried, a nursery maid, of fresh complexion, moderately tall stature, applied to me on the 4th of November, 1812.

About two years previously had had severe flooding during three weeks, which she attributed to a strain. Had, before 1 saw her, been poorly six months. Made about six or eight pints of water in twenty-four hours. This was pale, glutinous, and decided!}7 sweet. She was thin and weak ; and her legs rather inclined to swell at night. She used the following remedies in succession : eolocynth pills, to regulate the action of the bowels : these, or some other purgative, she was obliged to employ throughout, as her bowels were confined ; nitric acid ; uva ursi ; an open blister to the loins ; arsenical solution ; liquor ant. tartar, with a blister to the chest, on account of a cold ; a grain of opium each night; tra ferri muriatis ; uva ursi, combined with powdered bark, lime water, carbonate of iron, nitric acid, (a second time,) liquor potassae ; a meat diet. Each of these articles was employed for a sufficient space of time, as it was the 9th of October, 1813, when she began the meat diet. No decided benefit appeared to be derived from any of these remedies, excepting the purgatives and the meat diet. The former were abso¬ lutely necessary to her health and comfort; though when used alone, and afterwards in conjunction with other remedies, they did not seem to materially affect the diabetic urine. The meat diet appeared to render the patient plumper, decidedly stronger, and to diminish the quantity of water, which, soon after this plan was commenced, might be averaged at from three to four pints daily ; though what I saw never entirely lost its diabetic character. It may be worth while noticing, that, when under my care, she caught cold two or three times, once rather smartly, and that the urine appeared to be somewhat influenced by these disorders, being at those times reduced to three pints, whereas at other times the quantity was never so small. At one period she had an attack on one side of the jaw-bone, resembling the mumps, from which she recovered without any remarkable occurrence. She observed, that during the period of menstrua- tion she felt low and weak ; but that, when it wras over, she usually became stronger and better. Whilst under my care she went into the country twice. The first time, she imme¬ diately became worse; the second time, she felt rather better than when in town.

As G. B. was in the country when she died, I give a sum-

Buxton’s Cases of Diabetes. 361

*nary of the particulars of that event* which I received from her mistress, who paid her the kindest attention to the last. Several weeks previous to her death she declined very much in strength, and during a week she was carried up to bed. Her thirst became intense. Her bowels, which all along had been rather inert, latterly became Yiuch confined, and "could not be opened without a large quantity of cathartic medi¬ cines ; and when they were opened, the operation seemed entirely to exhaust her. The urine continued nearly as usual to the last. For twenty-four hours previous to her death, she was only known to be alive from her breathing. The breath was drawn extremely quick for the last few hours. She finally went off without a struggle, 29th of November, 1815. Some time before her death she had “ disliked, almost to dis¬ gust, her meat diet, and had relaxed in her use of it.”

Case 3. — Miss Y. Z., an unmarried lady, forty-two years of age, of dark complexion, rather fresh colour, and spare habit of body, had for many years been subject to occasional attacks of an anomalous cutaneous disease, which bore a nearer resemblance to erysipelas than to any other which I have seen. It was accompanied by fever, and that sometimes in a high degree. She had likewise been exposed to mental anxiety of considerable duration. Her habits of life were, for a female, rather active.

When she first applied to me, in summer, 1813, she was incapable of mentioning when the complaint had commenced ; but I conjectured that it had existed about six months. At this time she was excessively emaciated, very feeble, so that she could not walk above a mile and a half, and was obliged to make water extremely often. The urine was decidedly diabetic, and amounted to about double what she usually made; but the exact quantity I could not learn. Impressed with the complete failure of bleeding in the case of Mr. M., (1,) and considering the emaciated and feeble frame of my patient, I proposed that vegetables, bread, sugar, and beer, should be entirely avoided, and that meat alone, of every description, should be eaten, accompanied by a beverage of broth, beef tea, common tea, water, and brandy and water. As the bowels were rather confined, it was proposed that cathartics should occasionally be taken, to regulate the intes¬ tinal action, but that no other medicine should be employed.

After Miss Y. Z. had pursued this plan with a tolerable degree of steadiness two months, she could sleep the whole night undisturbed, and could comfortably pass lour or five hours in the day without making water, the quantity of which was now diminished to nearly or quite its natural standard. She had, though still thin, recovered much of her flesh and

VOL. xiv. — no. 83. 3 a

Original Communications .

strength, so that she could walk five or six miles at once, without experiencing material fatigue. Her resolution of adhering to the proposed plan of diet now failed her in some degree; and she occasionally would indulge herselt with bread and other articles of vegetable food. It appeared to me and to her mother (with whom she resided), that in proportion to her adherence to or deviation from the plan, was the disorder diminished or increased. In October, 1814, she had an attack of the cutaneous disorder before spoken of, accom¬ panied by a considerable degree of fever. Whilst this con¬ tinued, the diabetic symptoms totally disappeared ; but on its cessation they returned ; so that in a month after the com¬ mencement of the cutaneous disease Miss Y.Z. was nearly in the same state as previous to this attack, viz. not so well as when she left off a rigid adherence to the plan, though infinitely better than when I first saw her. She continued in this state till the 13th of January, 1815, when she complained of a sensation of coldness, and of a general feeling of being unwell. Her bowels at this time (as, indeed, was generally the case, unless when affected by purgatives,) were confined. The day before they had been open twice ; and she had been as well as usual. She took a cathartic, which did not produce any effect. The next day, January 14th, I saw' her. She had slight pain at the pit of the stomach ; skin wras tem¬ perate ; bowels confined; breathing excessively short ; pulse about 140, rather small, and hard. In the evening of this day she had a small unnatural stool. About twelve at night she began to be insensible, and at one the next day expired. The bowels wTere not again opened ; and no remedy appeared to produce the smallest beneficial effect. During her illness she made water apparently as usual. No cause could be assigned for this attack. The body was opened on the 17th, two days after this lady’s death, by Mr. Bean, of Camberwell, Mr. Brown, jun., and Mr. Awyan, Mr. Bean’s assistant, who concurred in the following report, which was given me, I believe, the same evening: —

u The only peculiarities observable on examining the contents of the abdomen were as follow : a very slight efflorescence on the. surface of the smaller intestines ; the kidneys a little inflamed ; the pancreas smaller than usual ; the bowels generally distended with wind ; the rectum alone containing some feculent matter. The other viscera all looked very healthy. Of the thoracic viscera, the lower portion of the left lobe of the lungs wras a little inflamed ; otherwise they all bore their usual appearance. The vessels of the head, on removing the cranium, w'ere discovered rather turgid ; and some water generally diffused between the tunica

365

Buxton’s Cases of Diabetes.

arachnoides and pia mater. In every other respect, the con¬ tents of the cranium had undergone no alteration. We believe this to be a correct statement of appearances; in which, if we may venture an opinion, there was no sufficient cause discovered to account for the death of the patient.”

Case 4. — William Sawkins, aged thirty-seven, farmer’s labourer, of moderate stature and ruddy complexion, came into the London Hospital May 16, 1815. He had been ill five months, and had had a pleurisy immediately before his illness. He was thin and weak, but by no means in an extreme degree. At the visit on the 18th, he was reported (and I have no doubt accurately reported) in twenty-four hours to have made eight pints of water, and to have drunk five pints of fluid. The urine was decidedly diabetic. Nearly an ounce of very dry residuum was obtained from a pint of water. He related, that early in the complaint he had been bled once a week. This, he said, “ made him very weak and low, and did him no good.”

Nauseating doses of tartarized antimony and ipecacuanha were given him three times daily, and an emetic about every second day. This plan was followed till the 8th of June. During this treatment his gums became spongy; and he did not appear to be relieved in any respect, excepting that the urine was reduced to six pints in twenty-four hours. He drank about the same quantity as formerly, viz. five pints. Three drains of dry residuum were obtained from eight ounces of urine.

He was now ordered daily twelve ounces of dressed meat, a quart of milk, and a glass of rum. Bread and vegetables were to be entirely omitted. 1 think it probable that these were not taken to any considerable extent, as he appeared to be a man of steady resolution, and affirmed that he ab¬ stained from them. Under this plan he acquired flesh and strength, the thirst diminished, and he made less water: this was not so sweet, audits appearance not so diabetic; but, by some unaccountable omission, it was not evaporated immediately before his dismission from the hospital. On the 14th of June he made four pints of urine, and drank three pints and a half of fluid. These quantities were subsequently diminished each about half a pint. At the end of June his weight was ascertained to be one hundred and thirty-three pounds and a half. At this time he was evidently heavier than he had been. On the 10th of August he weighed one hundred and thirty-eight pounds and a half. About the 14tn of August he had lost three pounds of his weight, inconse¬ quence of a diarrhoea, which continued some days ; but the diarrhoea having been stopped, he recovered from its effects.

364

Original Communications .

Before and after he began the plan of meat diet, his bowels were generally regular; and he, consequently, had scarcely ever occasion to take a cathartic. After he commenced this plan, he took no other medicine than what was necessary to stop the accidental occurrence of diarrhoea, in the middle of August. About the 24th of July, he complained of pain in the loins and knees, on account of which he was ordered the warm bath three times a week. These pains soon became better. The warm bath did not appear to have any particular effect on his disorder. At the time he quitted the hospital, August 22d, he was fatter, and much stronger than he had been. He drank about three pints of fluid each day, and made about the same quantity of water; which, however, did not appear to have entirely lost its diabetic properties.

On leaving the hospital, this patient: went into the country, and I have since heard nothing of him.

Case 5. — Mr. Bl— — , a jeweller, aged thirty-four, of rather dark complexion, pale, of moderate stature, active, temperate, applied to me on the 13th of May, 1819. He said he had been ill five weeks ; but I suspected that he had not noticed his first deviation from health. Till then he had usually been healthy, and had met with no occurrence by which he could account for the disease. Mr. Cockel, of Hackney Road, attended with me. Mr. Bl — was reduced to the extreme of weakness and emaciation, so that he walked with difficulty. Indeed, the disease appeared to be hurrying him with dreadful rapidity to the grave. He made about eight pints of water daily, and drank about twelve pints of fluid. The urine was decidedly diabetic, and varied much in quantity, as did also the liquid he drank. The liquid drunk was always more than the urine. As his bowels were confined, a cathartic was directed to be used daily ; and he w^as ordered a diet to consist of meat exclusively ; his drink to be broths of different kinds, tea without sugar, milk, brandy, water. I attended Mr. Bl — — - about six weeks. He had gradually recovered his size and strength, so as to be nearly as fleshy and as strong as usual. He now drank about eight pints of fluid daily, and made about four pints of urine. This water had nearly or quite the common appearance. He was advised to continue his meat diet, and to keep his bowels regular by cathartics.

The plan thus laid down he pursued with a moderate degree of regularity, and with such success, that he was enabled to exert himself as usual, and to carry on his business with ease. Yet the disorder, though kept in check, was not subdued. It was remarked by himself and his wife, that he appeared better or worse in proportion as he adhered to or

365

Buxton’s Cases of Diabetes.

deviated from the meat diet. The quantity of water was little, if at all, greater than it had been previous to the com¬ mencement of the disease, and its appearance was nearly the same ; but it varied with the diet.

On the 31st of July, 1820, I was requested to see

Mr. B1 - . He had recently been much troubled with

the toothach, on account of which he had had two teeth drawn, and had applied some articles to his face, one of which appeared to be of a highly stimulating character, I

found Mr. B1 - complaining of excruciating pain in the

right side of the face and back part of the head. There was very considerable swelling and some redness of the whole lower jaw, extending upwards to the orbit, and downwards to the neck. On examining this with the finger, a large and hard gumbile was found at the root of the first bicuspis; the swelling proceeded back, though not with an equal degree of hardness, quite to the angle of the jaw. The tongue was somewhat covered ; the pulse a little quickened, and rather fuller and stronger than usual ; the skin was of higher temperature than it naturally should be ; but all the constitutional appearances w’ere so little different from the healthy state, that I considered the disorder to be merely a severe gumbile. Cathartics w^ere therefore ordered, together with (1 believe) ten leeches, and fomentations to the face.

The next day I found that Mr, Bl— - had had only one

scanty stool; that the night had been passed in much pain, and without sleep ; and that the symptoms continued nearly as the day before, excepting that the strength and fulness of the pulse were somewhat reduced.

The following day (the third of my attendance) 1 was told, that on the preceding afternoon and evening the pain had gradually quitted the jaw, and that the chest had been affected by some degree of pain, with great quickness of breathing. It was about one when I called. The patient was then lying on his back ; his breathing extremely rapid ; his pulse small, and very much hurried. He appeared to take no notice of any thing around, and could only be induced to speak by being strongly roused. He had had no motion ; the redness of the jaw was gone, and the swelling reduced to a moderate sized gumbile, scarcely, if at all, visible externally. The shortness of breath and insensibility increased, and he died about seven the same evening.

He made water in the night before his death; and had done so during the attack nearly as he had passed it previously.

Case 6.— Mr. L. M., aged about fifty, rather fair and pale, of moderate height, of regular and tolerably active

366

Original Communications .

habits, (according to his own relation,) called on me the I£th of June. About twelve months before he had had three attacks, two of which he denominated bilious, the other an inflammation of the liver; and six months afterwards an inflammation in the bowels. The length of time his present disease had existed I could not ascertain ; but I conjectured about six months. The patient was excessively emaciated, and very weak ; but the weakness did not appear to equal the emaciation. H e said that he made about two quarts of water daily. This was evidently diabetic. The bowels being rather confined, he was ordered a warm cathartic daily, A meat diet was also directed. He subsequently called on me, on the 39th of June, 3d and 31st of July, Each time he brought some water with him. He increased in flesh and strength. The urine, he said, at the last visit, was about three pints in twenty-four hours. It did not exhibit any diabetic properties.

Case 7. — Mr. O. P., aged sixty-two, consulted me on the 27th of July. He appears to have been rather fat. About twelve months ago, had a stoppage in his water; subse¬ quently to which, blood came from him in large quantity. About three months ago, his legs began to swell ; and they are now of considerable size. Lately his hands have swelled, but not his body, which is considerably emaciated. He is excessively weak; has had a hacking cough during a few days; bowels are open about twice daily ; makes about four pints of water during the night; to void which, he is obliged to rise every two hours. The urine is perfectly diabetic in its character. This patient has not called on me again ; I therefore can say nothing further respecting him.

Case 8. — The following instance occurred to me about seven or eight years ago. As I do not recollect the time or the par¬ ticulars accurately, (having, unfortunately, taken no notes of the case,) I place it last on the list, and merely mention a few circumstances, which I believe to be strictly correct.

Mrs. E. F., about fifty-five years old, of a florid com¬ plexion, and, before this disorder, rather fat. I do not recollect the quantity" of water she made, or the length of time she had been ill. The water was diabetic; and she had become very thin and weak. When i first saw her, she had diarrhoea; on account of which, I gave her chalk mixture with opium. She died in a very short space of time after I was called to her. Her death appeared to me to occur from exhaustion, and not to have any of the peculiar features spoken of in some of the preceding instances.

The above eight cases of diabetes are, I believe, all that I have had of this disease since the year 1810. Some months.

367

Buxton’s Cases of Diabetes.

ago I was called to a dying person, said to have had this disorder. 1 have seen some examples of diabetes insipidus; but as this appears to me to be a distinct complaint, 1 have not brought forward those instances. The paucity of the cases is an evidence of the rarity of the disease. 1 will suppose that I attend thiee thousand patients in a year, and i believe that in this reckoning I am considerably within the real number. If, then, l have had eight patients with diabetes mellitus since 1810, the result will be about one in four thousand patients.

It has not been in my power to discover any circumstance in my patients which disposed them to this disease. Indeed, the only thing in which they agreed was, that they all had passed the youthful period of life, the youngest, Mr. B1 -

(6) , being thirty-four; and the oldest, Mrs. E. F. (8), perhaps fifty-five. With respect to the sexes, five were males, and three females. It is rather singular that all the males, ex¬ cepting one, Sawkins (4), w'ere pale; but all the femal es were florid. I hey were all of spare habit, excepting Mr. O. P.

(7) and Mrs. E. F. (8). In their stature they had nothing, remarkable, being neither particularly short nor tall. Two of the three females were unmarried. The mode of life of the patients was various; but generally healthy. Mr. M. (1)

and Mr. Bl- - (5) resided in town; William Sawkins (4)

in the country; Miss Y. Z. (3), Mrs. E. F. (8), and Mr. L. M. (6), in the outskirts of London, Mr. L. M. coming to town during the day. G. B. (2) resided sometimes in London, sometimes in the country, but principally in London. Where Mr. O. P. (7) lived, I know not. With the kind of life led by Mr. O. P. (7) and Mrs. E. F. (8) I am unacquainted; but none of the others were sedentary in their habits; though Mr. M. (1), G. B. (2), and Mr. B1 — — (5), were not much in the open air. Mr. M. (1) was intemperate. 1 ain not sufficiently acquainted with the mode of life of Mr. O. P. (7) and Mrs. E. F. (8), to say whether or not they were temperate ; all the others, 1 believe, were so. Miss Y. Z. (3) had been subject, during several years, to con¬ siderable anxiety of mind ; hut 1 am not aware that either of the other patients had suffered in this way. The disorder could not, in any instance, be traced to what is usually termed catching cold ; nor, indeed, to any other exciting cause ; the patients, without a single exception, not being able to speak with precision of the time when their disorder commenced. G. B. (2) had had a haemorrhage eighteen months before the alleged period of the commencement of the diabetes. Mr. L. M. (6), six months before the supposed commence¬ ment of the complaint, had had inflammation of the liver; and immediately before its supposed commencement, an inflam-

368

Original Communications .

mation of the bowels. William Sawkins (4) had a pleurisy immediately preceding the diabetes. Mr. O. P. (7) had a haemorrhage not long before the disease in question com¬ menced. G. B.’s (2) haemorrhage occurred at a period so distant from that to which the diabetes could be traced, that it is not probable there was any connexion between them. But it is possible, that the acute disease in the other three instances just mentioned might in some way tend to excite the disorder.

When the disease was actually formed, its progress appears to have been very different in different patients. In Mr.

B1 - * (5) it proceeded with greater rapidity than in either

of the other cases. As the plan of procedure was not instantly adopted to the extent I desired, I had an opportunity of seeing in him an amazing change for the worse in a very short space; so that I believe he would not have lived above two weeks from the time I first saw him, had not some plan been devised to stop the progress of the disease. In G. B. (2) it proceeded with great slowness ; and in the other patients with various degrees of velocity between its progress in these two, who, I think, might be considered the extreme.

The quantity of water made in different cases was by no means the same. In only three instances was it accurately ascertained. William Sawkins (4) passed eight pints of urine in twenty-four hours, and Mr. B1 — — (5) about eight pints; G. B. (2) made six or eight pints; Miss Y. Z. (3) perhaps about five or six pints; Mr. L. M. (6) about four pints; Mr. O. P. (7) about four pints in the night, or about eight pints in twenty-four hours. Even in the same person the quantity of water sometimes varied considerably, without any adequate cause, and while the patient was not mending. Thus William Sawkins (4) one day made only four pints and a half; G. B. (2) varied from eight to four pints; both before they began to mend.

The quantity of residuum to be obtained by evaporating the urine was only tried in one case, William Sawkins (4). When he first was under treatment, and made eight pints of water daily, nearly an ounce of very dry residuum was obtained from a pint of urine. Three weeks afterwards, when he made six pints of water daily, but in other respects was worse, three drams of very dry residuum were obtained from eight ounces of urine.

The rapidity with which the disease proceeded did not appear exactly to accord with the quantity of urine. Thus Mr. B1 — — (5), whose complaint was the most rapid, made eight pints daily ; Miss Y. Z. (3), who was proceeding also quickly, but not quite so rapidly as Mr. BI — — , made perhaps

369

Buxton’s Cases of Diabetes,

five pints in twenty-four hours ; while G. B. (2) and William Saw kins (4), both proceeding slowly, made, the former from six to eight, the latter eight pints of urine. I observed that the debility was much increased in G. B., when she made eight pints of urine daily ; whilst it diminished as materially when she made only four pints. William Saw kins (4), in whom the quantity of water did not vary so much as it did m G. B. ((2), did not appear to be stronger when he made only five pints and a half, than when he made eight pints, in each case I am speaking of the period before the patient began decidedly to amend.

1 am inclined to think that the changes of weather pro¬ duced little effect on the quantity of urine, or on the disorder in general. But I decide on this point with diffidence, as m v observations on the disease were not sufficiently correct to enable me to speak otherwise.

'] he warm bath, which was administered three times in a week to Sawkins (4), while he was becoming better on meat diet, and which caused him to perspire, did not occasion any alteration in the quantity of urine.

-AH the patients were permitted to drink as much as they desired. The quantity varied at different times in the same patient, as well as in different patients; but in general it seemed to me to bear some proportion to the quantity of water which w'as made. In those cases where a tolerably accurate account was kept, it was found that in general the quantity of the urine passed exceeded that of the liquids drank, or even of all the nourishment taken in. Thus Sawkins (4), on the 12th of June, three days after he began his meat diet, made five pints and a half of urine, drank three pints and a half of fluid, and ate twelve ounces of meat, making an excess of urine above the fluid of two pints, and one pint and a quarter above the whole ingesta. G. B. (2) made, on the 9th of November, 18 !2, six pints of urine, and drank five pints of fluid. On the following 2d of January, she made four pints of urine, and drank three pints of fluid. Yet some patients with diabetes drink more fluid than they pass. This appears to have been throughout remarkably the

case with Mr. Bl- - (5). After the urine has much

diminished, in consequence of a meat diet, the nourishment taken exceeds the quantity of urine. I think this was observable in every case where the quantities were noticed.

T he remedies employed were various ; and, though some of them produced benefit, on the whole I have no great reason to boast of my success. Nauseating medicines were used fully and freely, with occasional emetics during a month, in the case of Sawkins, (4). This man having been situated

vol. xiv. — no. 83. 3 b

370

Original Communications.

in the London Hospital, I was confident that what I ordered was taken. From this treatment he appeared to me to receive no benefit. In the case of G. B. (2) various articles were given. G. B= was a steady attentive woman, and lived in a most respectable family in the city, by whom she was much esteemed, i have, therefore, the fullest confidence in her attention to what was directed. It is needless here to mention the medicines, as they are enumerated in her case. ISTo one remedy was, in my opinion, of any material use to her, excepting the cathartics and the meat diet, respecting each of which I shall speak presently.

Blood-letting was employed by myself only in one instance, that of Mr. M. (1). In this case it was fairly tried; and certainly was hurtful, as it did not in any respect diminish the disease, whilst it debilitated the patient considerably. Sawkins (4) said, that early in his complaint he had been bled once a week, and that “ it did him no good, but made him low and weak.7’ G. B. (2) remarked, that she always felt low while menstruating, but was stronger and better afterwards.

Purgatives have always appeared to me useful when the bowels were constipated; but of themselves totally insuffi- cient to effect a cure, or even materially to diminish the complaint. Patients labouring under diabetes generally have the bowels confined, and the disposition to constipation is usually increased by a meat diet. This rule, however, does not invariably hold good. Sawkins (4) scarcely ever required cathartics, even after he had adopted the animal food'; and Mrs. E. F. (8) had diarrhoea; but the bowels of all the other patients were more or less confined. G. B. (2) remarked, that she always was least thirsty when her bowels wrere open ; and I could not avoid noticing that the patients appeared best when about two evacuations each day w7ere procured. G, B. for a time had no other than cathartic medicines.

Febrile complaints diminish or suspend the disease for a time; but it afterwards returns with just the same degree of violence as before. When G. B. (2) had a cold, as long as this continued, the diabetes abated. While Miss Y. Z, (3) bad a more severe febrile disease, the diabetic symptoms totally subsided. When, however, the feverish symptoms declined, those of diabetes were renewed.

Meat Diet. — Rofio’s plan, which consists essentially in a meat diet, was said to have been tried with Mr. M. (1), and to have produced no benefit. I have ordered it in the five instances just given ; and have found a rapid, a decided, and a beneficial effect in all. But I have not known it to cure in any one example. 1 here would observe, that 1 permit the

571

Buxton’s Canes of Diabetes.

patient to take the meat in any way which he prefers. Of course, roast and boiled mutton and beef are principally employed. Patients, I believe, could scarcely be prevailed upon to live upon meats rancid and putrid. Indeed I never made the trial ; as I found by experience, that even when they were permitted to take the meat in such variety and manner as they pleased, not one would entirely refrain from vegetables, although convinced that they were hurtful. All the patients who employed a meat diet soon became fatter and stronger; and made less water materially, and that of a less diabetic quality than before. The amendment appeared the most conspicuously in the worst cases. Miss Y. Z. (3) was so much reduced, and the disease appeared to be making such rapid progress, that I believe she could not have lived above a month or six weeks longer, had the complaint been

left to itself. Mr. B1 - (o) was still worse, and I have no

doubt would have died within a fortnight. Yet after this M iss Y. Z. (3) recovered so far that she could continue in bed through the whole night frequently, without rising to make water, and could walk tive or six miles at once without ma¬ terial fatigue; and Mr. B1 - (5), who had been a remarkably

active man in business, amended to such a degree, that he carried on his business with the same activity as before his illness. Amendment, though not to the same extent, was equally perceptible in the other patients who employed a meat diet. Yet that it had not effected a cure was evident from this circumstance, that whenever they deviated materially from the meat diet, the diabetic symptoms were induced. This was particularly remarked respecting Miss Y. Z. (3) and Mr. B1 - (5).

Of the above eight patients, I am aware that five died. Respecting the time and circumstances attending the death of Mr. M. (1) I know nothing. Neither do I know the length of the period which occurred between the commence¬ ment of the disease and its conclusion in Mrs. £. F. (8). In G. B. (2) the diabetes continued three years ; nearly eighteen months before and eighteen months after the meat diet was begun. Miss Y. Z. (3) appears to have been ill two years, during; eighteen months of which she took meat diet. On

this diet Mr. B1 - - (3) lived above fifteen months. The

disease was supposed in him to continue sixteen months; but I am convinced that several more might be added to that time. Indeed, the complaint seems to commence so very gradually, that the patient does not observe when this occurs. Hence the duration of the disorder is, in a great measure, matter of conjecture ; and must be considered as such in ail the above cases. But what we have here seen is sufficient to

572 Original Communications -

show that its continuance is materially different in different instances.

The death of G. B. (2) and of Mrs. E. F. (8) appears to have occurred from complete exhaustion, each having gradually sunk into the grave. How far the death of G. B. was accelerated by her neglect of animal food, I am incapable of saying, as I did not see her at the time. Judging, how¬ ever, from her previous situation, and from what I observed in other instances, 1 think it probable that this circumstance did really hasten her death ; but life would not, I imagine, have been much prolonged by a rigid adherence to the meat diet.

The circumstances which occurred in the last illness and

death of Miss Y. Z. (3) and of Mr. B1 - (3) present many

points of resemblance. They did not sink gradually into the grave, like the two preceding cases, but were attacked sud¬ denly, wFile possessing moderately good health; Miss Y. Z. (3) having been as cheerful and well as usual three days

before her death, and Mr. Bl - (5) having been engaged in

his usual business till the pain in the face became severe. The manner in which the attack commenced was different in each ; Miss Y, Z. experiencing chilliness and a general feeling of uneasiness, without any previous disorder; Mr. Bl— - — , on the contrary, having had an inflammation of the jaw, which seemed to retrocede. The subsequent symptoms were almost precisely alike in each; some degree of pain in the chest and stomach, great quickness of pulse and breathing, constipation of the bowels, insensibility gradually increasing. Water was made by each till within a few hours of death. It may be here worth while noticing, that G. B. (2) had at a certain period, when I attended her, a swelling of the jawT on one side exactly like the mumps, but that it went away as usual, without being followed by any unpleasant con¬ sequences. What could have brought on the final attack in

Miss Y. Z. (3), or the conversion of disease in Mr. Bl -

(5), I am utterly at a loss to conjecture. This is the more remarkable in each, because the urine appeared to be con¬ tinued nearly as before the attack. That the suddenness of the final seizure, and the above symptoms preceding dissolu- tion, are not universal in diabetes, we may conclude from the cases of G. B. (2), and of Mrs. E. F. (8), both of whom appeared to die from exhaustion. That they do not depend merely on meat diet, or on meat diet given in this disease, seems likewise probable, from the instance of G. B. (2) ; but that they stood in some relation to the diabetes as conjoined with meat diet, I think is rendered highly probable, by the circumstance that where this food had been employed in

Davies’s Case of Contracted Rectum.

/ J

three instances, two of the patients died in this very unusual manner. That the death of Miss Y. Z. (3) did not take place in consequence of the inflammation of any viscus, was evidenced by the post mortem examination. Indeed, l per¬ fectly agree with Messrs. Bean, Brown, and Morgan, that the examination did not lead to any satisfactory conjecture respecting the attack ; nor were the symptoms during life such, in either of these cases, as to induce the suspicion that any individual organ was inflamed.

Conceiving that this paper would be extended to a length almost too great for permitting its insertion in a Journal, [ have carefully avoided noticing the cases or opinions of other Practitioners, as an allusion to them would have magnified this fault. I fear that my observations will not tend to increase the hopes of cure in diabetes mellitus ; but they may contribute in some degree to a more due apprecia¬ tion of the effect to be expected from remedies employed in this disease, and particularly from a meat diet. They may also direct the attention of Practitioners to the circumstances attending the death of those who sink under diabetes — cir¬ cumstances which hitherto, I believe, have scarcely been sufficiently discriminated.

III.

Case of Contracted Rectum. Communicated, by letter, to Henry Davies, Lecturer on Midwifery, Conduit Street. With Remarks by Mr. Davies.

The following case of simple contraction of the rectum, which I now submit to your inspection, (and which you are at liberty to make what use you may think proper of,) wras accompanied throughout by the most deplorable sufferings; such as 1 am persuaded few professional men, if any, would be inclined {a priori) to attribute to such a disease. I shall either intersperse a few remarks as I proceed, or keep them in reserve for a second communication. Being in the public service, (the army,) I was, in May 1812, ordered, with my regiment, to embark for the West Indies, at which station we arrived, and formed part of the garrison of Barbadoes till January 1813; during which time 1 was in perfect health, never having been confined a day. At the latter period I wras ordered to join another regiment, at Sta. Croix, one of the most beautiful of the Leeward Islands, indeed so much so, as to be called the garden of these islands. About three weeks after my arrival at this latter station, 1 was overtaken, rather late in the evening, by one^of those peculiarly heavy

374

Original Communications.

showers of rain; and neglecting, on my gaining home, the necessary precautions in these climates, 1 was confined by an indisposition of some days to my quarters. During my convalescence, and before I was enabled to resume my pro¬ fessional duties, I went to inspect the bodies of two men who had died from the yellow fever. Having- finished my inspec¬ tion of the one, I made the necessary incision through the abdominal parietes of the other, when I instantly inhaled a gas, evolved (from the body) through the artificial opening I had made, that almost suffocated me. Being fully aware of the effects likely to occur from such a cause, and perhaps the susceptibility of the body being increased by the depressing powers of the mind, foreboding ill, 1 directly resigned my scalpel, returned to my room, and was visited indeed by a very severe attack of this endemic, which, though fatal to very many, I had the good fortune to recover from. It was during this attack that the Surgeon of the regiment pre¬ scribed repeated doses of powerful cathartics; and it was only on the remission of more urgent symptoms that I first felt pain and uneasiness about the top of the sacrum, with a sense of weight and bearing down on the lower intestines, accom¬ panied also by a difficulty in expelling any faeces. These increasing, I was obliged to sit over the steam of hot water, and, by repeated strong inspirations, to depress the viscera. At those periods, the pain was so excruciating, that I frequently called out loud enough to be heard some distance, which at times brought some of my brother officers about me. After thus straining over the relaxing power of the steam a longer or shorter time, I succeeded in the expulsion of small quantities of a worm-hke form; and on rising from the night chair, (ever with the sensation of remaining faeces,) piles of extraordinary size were observed, which, being considered the cause of my sufferings, were occasionally lanced. So much did I dread the necessity of faecal expulsions, on the account of the attempts overwhelming me with pain, that I endeavoured to delay them as long as possible. Whenever I held my breath a little I could feel an unnatural resistance, and even in attempting the erect position. The posture of all others (and you may be assured I tried every varying movement) which gave me any ease, or rather respite, from continual pain, was the one on my elbows and knees, on which I used to crawl about night and day for weeks. I found, when I was so situated, the uncomfortable sense of bearing down, 8tc. left me ; but if I attempted the erect position, or to place the pelvis lower than my shoulders, the sense of weight, &c. on the sacrum immediately returned. No sleep,

3 75

Davies’s Case of Contracted Rectum.

however short, was ever obtained, but by opium ; and when I could get at it myself, [ used to take large quantities. The sense of resistance on holding the breath was felt only about the top of the sacrum, where the rectum is fastened down ; and there, on going to the night chair, was the whole of my excessive suffering referable, increased, as it was, by the necessity of straining to such a degree as 1 was always obliged, even to obtain the smallest evacuation. Strange, though i had every professional assistance, or rather attention, and was visited by many, I may say most in the island, never the most distant hint of a diseased rectum was either given by them, or thought of by myself. The piles were occasionally lanced ; and I v/as latterly advised to use sedative enemas, composed of the tinct. opii, ^i. et mucil. amyli, 5 v. vel 5vi. pro re nath. From this 1 found temporary relief; and after thus enduring for upwards of six weeks, 1 obtained leave to return to England. The vessel had (fortunately) good accommoda¬ tion ; and I only moved out of my birth from necessity, now and then lancing the piles, still believed to be the cause of my iilness, and continuing myr enemas, from which latter I found signal benefit, and always resorted thereto on any increase of irritability. I landed at Southampton, where I was com¬ pelled to send for professional aid, which only added saline aperients to my medical list. 1 was also attended by a nurse. After remaining about ten days there, I thought myself able to resume my journey to Devon; and just before entering the coach, I took a large quantum of tinct. opii in enema, and had a few half-grain pills of the opium purificat. if I should require them. The first dose kept me easy till I reached Exeter; on leaving which, finding myself getting worse, I halted at Chudleigh, where, the next day, my relatives met me. On my leave of absence expiring, (after having fruitlessly consulted other professional aid,) finding I could not possibly return to the West Indies, 1 was, by the great kindness of the late director general of our department, (J. Weir, Esq.) ordered to Guernsey, where, after a time, 1 arrived, still accompanied by my inveterate foe; and con¬ tinued the course of palliative means as before. Being confined to my bed still, 1 used, when a respite from pain allowed, to endeavour to withdraw the mind from its constant reverie, and wish to be released from such a suffering body, by looking over the newspapers ; and it was alter finishing the more important parts of one, that I cast my eye over the page of advertisements, when, among others, 1 found one noticing a publication (I think by Copeland) on stricture of the rectum. It Hashed like lightning on my mind, that I had now unmasked my terrible enemy ; and 1 directly

376

Original Communications .

decided on sounding the rectum, by the introduction of a bougie ; but after many attempts I failed, from the increased irritation not being bearable. However, on reflection, I had, the next day, a still smaller one, which, after a while, was passed through the contraction ; and the relief i immediately felt was such, that 1 slept (with the bougie remaining introduced), for the first time, without opium. On the with¬ drawing the bougie, a quantity of blood followed, accom¬ panied by such of the aivine accumulations as could pass through the opening made. The bougie W'as gradually increased, and on each successive withdrawing was followed by immense discharges, that had accumulated not only naturally, but by the various aperients l had been recom¬ mended, every one of which had only been adding to the disease, which most assuredly I should have died by, or rather from, a rupture of the intestines, from excessive distention, produced by an accumulated mass, unable to pass the con¬ tracted part.

By the use of the bougie, and attention to the disease, I gradually improved in health; and 1 at this present time only occasionally introduce the rectum bougie, or take aperients, thereby preventing constipation on the one hand, and accumu¬ lation on the other.

This case of mine I conceive to be one of simple contraction of the gut, arising from the effect of powerful purgatives. My not feeling the symptoms until more urgent ones had sub¬ sided, prevents my knowledge of its earlier indications of approach. The sensations of having more faecal matter to expel on rising from the night chair, as also the relief from the irritation of such feelings as 1 invariably experienced on placing myself on my knees and elbows, so as to keep the pelvis higher than the rest of my body, I attribute to the having forced down the higher part of the gut into the lower and larger, and which of itself gradually, as the power by straining was taken oif, relieved itself. I conceive tiie inner coat of the rectum to have been greatly relaxed by die united force of straining and the steam of hot water, which 1 was always necessitated to have recourse to— and this possibly might have occasioned those external tumours, so frequently lanced.

It is almost inexplicable, when the symptoms were so well marked, and so steadily enforced on the attention of every medical gentleman who visited me, that the most distant hint of the real malady was never offered ; yet 1 ought to be the last to be surprised, as it was never suspected by myself, though, in addition to symptoms offered to the attention only of others, they were presented to myself by two such as one would think enough to fix the exertion of the mind for

377

Davies ’s Case of Contracted Rectum.

their removal, namely, pain and suffering. On the passage, I used sedative enemas. At Southampton, the professional advice was aperients, from a Physician and Surgeon. At Plymouth, though examined by a professional friend, by the linger in ano, yet it was reported as not diseased, and aperients again recommended.

At Guernsey, by accident, (as stated) I first suspected the disease, and sounded the rectum with an urethra bougie of the largest diameter: this failed: the next day I used a small size, and succeeded. The quantity evacuated was immense. Indeed, I have often wondered at the capacity the gut must have attained. Relative to bougies, I always used the plaister, till I obtained some of the elastic; which latter, although in appearance they have every advantage, yet in their actual use 1 could not continue ; as 1 found on introducing them and leaving them even for a short time in the gut, they were not only extremely difficult, but very painful in their extraction ; they felt as if I was drawing out the gut itself, so closely did the temperature of the part make them adhere : I was obliged to keep turning them round in the action of with¬ drawing them; and on inspection they appear sticky, and exactly as if they had been held over the steam of boiling water ; though I oiled them, &c. prior to in¬ troduction. I could introduce them and withdraw them instantly, but no more; I therefore disapprove of them, and never recommend them to others. I should not speak so decidedly of their inferiority, but from having given them a fair trial on my own person, in this most painful complaint, and which 1 have had from March 1813, (being then twenty- four years of age). I think if gentlemen, on introducing an elastic and a plaister bougie, at different times, on the same patient, leaving it a quarter of an hour or more in the canal, and on withdrawing them, make the inquiry, the latter will most likely be preferred. 1 have found the plaister bougies, when made in a rough manner, also painful in the introduc¬ tion. Many who make articles such as these without any conception of their use, or such conception or knowledge only as merely relates to the part they are intended for, think any thing* however rough, or however made, will do very well, and keep them accordingly. I had occasion to send from the country to London for four plaister bougies for the rec¬ tum, for my personal use, and received four such as I could by no means use. They were partially covered, and no more; so that the cloth came in rags on their tops. This to me in the country was a source of vexation only', as I would not attempt their use. But, on the contrary, a completely covered, and well-finished plaister bougie, l found

VOL. xiv. — no. 83. 3 c

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Original Communications .

I could introduce easily, and keep it in the passage as long as I wished, as the longer I left it, it became the more easily retained by taking the form of the gut; and on its being withdrawn, (perhaps owing to the heat of the part in some measure acting on the plaister,) it gave me not the slightest pain, or that feeling of drawing the gut itself with it, which the elastic invariably did. Being quite satisfied of the utility of the plaister bougies, when well finished, I have tried none other, but as above.

The plan of treatment most beneficial is, in the morning to inject an enema of cold water; then, after emptying the rectum by the above, to inject an enema of tr. opii and mucilag. amyli, which is retained. In the evening the same. The bougie and aperients occasionally.

Remarks. — The foregoing case was transmitted to me by the gentleman who was the subject of it, on my mentioning the various train of symptoms and sympathetic affections that were produced from habitual costiveness and loaded rectum ; and that in females more particularly the constrictive power of these parts was further increased from education and habit.

In these cases drastic purgatives, so far from affording relief, are extremely prejudicial, by adding to the quantity of faeces already accumulated.

I believe that patients are often deceived, and very often deceive their medical advisers, by informing them that their bowels are open, when the rectum is blocked up with faeces : this, from the irritation it produces, causes an increased mucous secretion in the lowrer part of the canal, which is evacuated three or four times a day with a little faeces : — this removes or diminishes the temporary distention, and causes them to believe that their bowels are relaxed ; on more par¬ ticular inquiry, it will be found that these patients rarely void a natural stool. I may mention a case or two as illustrative of this.

. - i

A. D. complained of a bearing down of the womb; from which she said she had suffered two or three years past, and for which she had used various remedies without benefit; said that her bowels were loose, her catamenia regular, she felt a something falling through her; and that she suffered much uneasiness both generally and locally; her countenance was anxious and hollow.

On examination, per vaginam, the uterus was found in its natural situation ; the vagina was blocked up apparently by a tumour projecting from behind forwards, w7hich appeared to be from distended rectum encroaching into that canal ; the

Davies’s Case of Contracted Rectum.

379

feces were evacuated by aid of enemas; oily purgatives were exhibited; a bougie was passed into the rectum daily; and the tepid salt water hip-bath was used to allay irritation. After a few weeks the uneasiness and bearing down sensations went off. The rectum got a habit of evacuating its contents, by the occasional aid of oily purgatives and the use of the bougie; (she uses a common wax candle). Six months after the commencement of this treatment, she said that she had not enjoyed such good health for some years past, and in which latter state her health has remained now upwards of two vears.

I was requested by a medical friend to see a lady, for a disease of these parts, attended with a violent leucorrhcea.

On examination, the vagina was felt relaxed and flabby; the rectum, on its posterior surface, like a hardened cord. On introducing the finger per amtm, it passed with difficulty, and was girt at its extremity, causing the patient a good deal of pain, and she exclained, “ that is the seat of my malady !”

A full-sized urethra bougie was introduced the next day. The day following reports, that she has been much easier than usual, and that she had not passed so natural a stool for many months.

This case is still under treatment. An enema is ad¬ ministered daily, through a full-sized pipe, and thrown slowly up into the intestine. A bougie is used on the alternate days, gradually increasing the size.

With regard to the difference between the elastic gum and plaister bougie, a case occurred to me, which in some mea¬ sure confirms Mr. - ’s observation.

Some years since, during the treatment of a stricture of the urethra, which was destroyed by caustic, the patient from some circumstances not being able to attend regularly, had an elastic gum bougie to pass. He passed it in the morning, while in bed, after retaining it in the urethra for half an hour. He was unable to withdraw it. By using some exertion, the bougie broke, leaving the broken portion within the urethra. This caused him a good deal of alarm, (fortunately he pos¬ sessed the least irritable urethra 1 ever saw)* On immersing the penis in warm water, he was enabled to expel the bougie with the stream of urine. I attributed this occurrence, at the time, to some fault in the manufacture of the instrument, though I was not able to discover any. Might it not then be retained, as the foregoing case suggests, from losing its mois¬ ture while in the urethra ?

380

Original Communications.

IV.

Case of a Wound in the Knee communicating with the Cavity of the Joint. By W. Forts, Surgeon, Colchester.

William Sales, aged fifty-three years, a brewer’s servant, of a good general constitution, plethoric habit, came under my care on Thursday evening, in consequence of a wound he had received from a fall. His knee came in contact with a pointed stone, and a wound was made of a "> figure, which communicated with the cavity of the joint. The opening in the capsular ligament would have readily admitted my finger. A very small quantity of blood, mixed with a much greater of synovia, escaped from the wound. The external condyle of the os femoris was seen upon turning back the flap. It appeared that the point of the stone first came upon the patella, but it being convex, it slipped from the pressure inwards, while ’he flap thus formed was torn outwards by the stone. Thus I think the shape of the wound is easily accounted for.

I brought the lips of the wound together by means of four sutures, and then applied a dossil of lint over it, (as recom¬ mended by Mr. A. Cooper in his lectures,) a splint was then applied under the bend of the knee, which extended from about the middle of the thigh to the middle of the leg. 1 applied a roller to its full extent moderately tight, so as to prevent any movement in the joint by the action of rpuscles. An aperient and milk diet were ordered. Pulse 70, pretty lull.

Friday A. M. — Had little rest during the night ; no pain in the limb, but a great deal of snatching, as he termed it ; pulse 83, full, and labouring ; had four stools ; little in¬ creased heat in the affected limb; spirituous lotion applied around, hut not over the patella.

P. M.— -No rest; free from pain.

Opii, Pul v. gr. i. h. s. cap.

Saturday, A. M. — -Rested very well last night; bowels free; pulse less, but rather irregular; no increased heat in the limb.

P. M. — - Some twitching in the affected limb.

Rept. Haustus Cath. statim.

Sunday, A. M.— Bowels quite free; pulse small, 74; fest good; limb quite easy.

On the Saturday following I removed the dressings; the

Kennedy on Extirpation of the Female Breast, fyc. 381

edges of the wound were united, and it was quite cicatrized, except where the sutures had been thrown off. No purulent discharge had taken place. A small piece of simple dressing completed the cure. The limb was rather stiff', as it remained when I last saw him ; but he continued daily to get more power in it by use.

— - —

An Account of the Extirpation of a Female Breast, without the Ligature of a single Artery being necessary. By Dr. Kennedy, of Dunning.

[Communicated by Dr. Johnson.]

Pathological phenomena sometimes come under obser¬ vation of the practical Surgeon, which, though possessing no higher claim to attention than the circumstance of their exemplifying deviations from the natural tenor of things, are, nevertheless, worthy of being commemorated in the repo¬ sitories of chirurgical philosophy. Such may be the cha¬ racter, if I judge aright, of the subsequent history, the par¬ ticulars of which 1 now propose to give. “ Novitates autem,” said the sage of Arpinum, “ si spent afferunt, non sunt il las quidem repudiandae.”

July 20, 1819. — With the assistance of my friend, Mr. James Roy, I extirpated the left mamma of Mrs. Cunningham, residing in this village, who had been afflicted during more than twenty months with a carcinomatous tumour in that organ. The disease was consecutive of a bruise sustained by the breast while the woman attended her husband in fever, from a severe form of which she herself afterwards with difficulty recovered. She is stout and muscular, in her fifty- third year, has been long married, and is the mother of four children, for whose nutrition she always had a profusion of milk. Three abortions, one of which was accompanied with excessive flooding, did not materially injure her health ; they might, however, increase her susceptibility of mammary disease. In 1814 she ceased to menstruate.

The action of this person’s circulating system is naturally languid. Her pulse at the wrist is small and soft, and on an average vibrates not more than sixty times in a minute. Her sound breast is large and pendulous, measuring seventeen inches in circumference. That which has been removed did not differ much from the other, either in size or form. It weighed thirty-six ounces after all its blood had escaped. The axillary glands exhibited no appearance of enlargement or induration ; neither was the morbid tumour affixed to the subjacent ribs.

382 Original Communications.

With an intrepidity altogether extraordinary, this woman prepared herself for the operation, during which she uttered neither cry nor groan. Her breast was amputated in the usual manner. Having made the semicircular incisions and prepared the flaps, we proceeded, by dissecting downwards, to extirpate the isolated mass. Our plan was to take up the blood-vessels successively as they should be divided. When, however, we found our progress uninterrupted by effusion from the external mammary artery, we felt surprised. When the organ was dissevered from all its attachments, without the process being marked by the jettings of a single artery , we could not resist an expression of astonishment. From the surface of the immense gash not one ounce of blood was effused. After waiting more than five minutes in observation of this very singular phenomenon, we applied the ordinary dressings to the wound, when our patient retired, nearly unassisted, to another apartment, and with great composure placed herself in bed.

Immediately before reposing herself to rest, forty drops of laudanum were given to her, and quiet and silence strictly enjoined. At the end of an hour she felt easy, but indisposed to sleep. An equal proportion of the same medicine was again administered ; but after the lapse of a similar space it produced no effect. A narcotic pill, containing two grains and a half of solid opium, was then exhibited, and instruc¬ tions left to repeat the dose every hour till sleep should be induced. Conformably to this prescription, three additional pills, each containing two grains and a half of good opium, were used before midnight, when the patient sunk into a profound slumber, out of which she awoke at seven o’clock in the morning, greatly refreshed. About nine, on taking some food, she became sick, and was seized with vomiting ; this, however, was instantly allayed by an effervescing draught, and never afterwards recurred.

From this time forward, my patient’s convalescence was most favourable ; her appetite good; her sleep tranquil and refreshing. On no occasion did she experience symptoms of febrile excitement; her pulse generally beat from 60 to (i6 times in a minute ; her skin never lost its natural mellow¬ ness and temperature; her bowels required to be assisted only twice with a mild laxative draught. On the fourth day after the operation, she got out of bed, and remained more than an hour in conversation w'ith her friends. On the seventh, she walked in the garden without attendance. On the fourteenth, her wound was completely cicatrized.

Three remarkable circumstances form the character of this interesting case: — 1. A very large female breast was

Bird’s Case of Perforation of the Stomachy fyc. 383

extirpated, without the ligature of a single artery being re¬ quired. Can this peculiarity be otherwise accounted for, than by reference to excessive ramification of the vascular system ? The patient manifested no tendency to fainting or sickness, nor had she any symptom indicatory of the heart’s action being oppressed or suspended. Secondary haemorrhages, moreover, never threatened to arise. 2. Opium was administered in exorbitant quantity before the patient became somnolent, while the sleep produced by it lasted only a few hours, and was not followed by any bad effects. 3. The total absence of inflammatory excitement in con¬ sequence of the operation, together with the rapid progress of the granulations, which regenerated such portions of the wound as did not originally adhere.

VI.

Case of P erf oration of the Stomach , Intestines , and Bladder, by a Gunshot Wound. By Richard Bird, Jun., Surgeon, of Tam worth, and Member of the Royal College of Surgeons, London.

On the 2d of May, 1819, a boy, about sixteen years of age, residing at Wilnecote, near this place, while in the act of assisting to extract the ramrod from a loaded musket, with his body half bent on the pelvis, and the muzzle of the piece opposite to his abdomen, received the whole of its contents. They appeared to have entered the abdomen at two points; one immediately below the cartilage of the third short rib of the left side; the other about two inches above the navel in the centre of the abdomen. Both substances, one the ramrod, the other probably a stone, traversed the abdo¬ men and pelvis, and passed out on the inside of the left buttock, about one inch and a half from the anus, and the same distance from each other. One of his companions asserted that he had drawn out “ the stick” from the back part of the wounded boy.

The poor boy himself walked home, about a distance of six hundred yards, and complained of great faintness. He had passed a stool immediately after the accident occurred. About half an hour elapsed before I saw him. He then appeared to be very faint; yet uttered little complaint. His pulse was very small, eighty in a minute. Blood Lad escaped from the wound to the amount of about four ounces. The abdomen was full and tense. In the course of half an hour after, he was sick, and threw up all his dinner; after which he felt better. His hands and feet had been cold until the sick-

384

Or iginal Communications ,

ness came on ; afterwards, they became warmer, and the boy appeared to be somewhat drowsy. His pulse declined during the three hours that I remained with him. A poultice was applied to the abdomen, and renewed every two hours ; and fomentations constantly during the night. Calomel with opium was prescribed internally, and a mixture of magnesias sulphas. To slake the urgent thirst, tea or milk and water were allowed.

At twelve o’clock, an injection of warm water was ad¬ ministered ; and at four o’clock another, without operating or even returning. The boy slept comfortably, at intervals, until three, when he had a call to void urine. After this he had no rest. His respiration w'as very quick and hurried ; and he experienced great pain? particularly in the lower part of the belly.

May 3d. — At nine o’clock, A. M. his countenance was oppressed, pale, and languid; pulse 88, and very feeble; re¬ spiration quick and laborious. The urinary discharge was very largely mixed with blood. No evacuation from the bowels. There had been sickness about every half hour during the night ; and it still continued while I was with him. He was extremely faint and restless. When I left him, about eleven o’clock, his strength was gradually de¬ clining. During an effort to pass urine in my presence, a few drops of dark-coloured blood only were evacuated. The fluid vomited up had very much the appearance of what he had taken. This indeed had been the case from the first, with every thing which his stomach had rejected. The abdomen was very tense and painful on pressure. The whole physiognomy of the boy bespoke great internal injury; and it was evident, from the symptoms which 1 have enume¬ rated, that either the kidney or bladder, as well as the intes¬ tines, had been wounded.

In the evening, twenty-four hours after the accident, I again visited the boy. His pulse was then 100, and very small; breathing quick; painless; half a pint of bloody urine had been evacuated ; no relief from the bowels ; abdomen extremely tense, and sounding, on percussion, as though distended with air; excessive thirst, and constant sickness. During the day, several pints of fluid had been taken, and invariably, in a short time, rejected. Hands very cold ; feet not quite so much so. At the pressing request of the bojq I allowed him a draught of small beer; but, in five minutes after, this was in a great measure returned. The act of vomiting was performed with very little exertion, and less fatigue than might have been expected. He still continued faint.

385

Bird’s Case of Perforation of the Stomach, fyc.

At midnight, about thirty hours after the infliction of the injury, the boy died. From the period of my last visit he had continued very sick. There had been a marked increase of pain and restlessness. His intellect had remained unim¬ paired till the moment of dissolution.

Dissection . — May 5th. Ten o’clock, A. M. — External Appearances. — The abdomen was much distended; and, on pressure, some bloody fluid oozed from the orifice of the urethra. A slight contusion in the region of the liver, near the ensiform cartilage.

On opening the abdomen, evident traces of the passage of two substances were discernible. The wound of the left side traversed the coats of the stomach about the centre, some¬ what nearer, however, to its oesophageal than its duodenal extremity, and passed out at the point where this organ is connected with the duodenum. The duodenum was per¬ forated both by this and by the wound which the other substance had inflicted. Several convolutions of the in¬ testines had been traversed by them in the direction of the bladder through which they had both passed, missing all the important blood-vessels and the margins of the pelvis. There were about two ounces of a bloody fluid in the cavity of the peritonzeum ; but, notwithstanding the wound of the stomach and of the intestinal canal in several parts, and the great quantity of fluid taken by the boy, not a particle of the contents of these organs appeared to have escaped into the abdomen.

The wound of the stomach was surrounded by a slight dusky inflammation and some appearance of ecchymosis. The different wounds of the bowels and bladder exhibited also somewhat of the same aspect. Below the pylorus was lodged some portion of the food taken previously to the accident. The gall-bladder was distended with healthy bile. Kone had ever been thrown up by vomiting.

In the site of the contusion of the right hypochondrium, blood to the amount of a tea-spoonful was extravasated, between the substance of the liver and its investing mem¬ brane.

In those points where the wounded portions ol intestine were resting in contact, slight adhesions were beginning to form, or had actually taken place.

From the symptoms exhibited in this case, I certainly should not have supposed that the stomach had sustained any wound : for, from the period of the accident until death, not a particle of blood was thrown up with the contents of the organ. 1 wras present when the rejection of the food, taken at dinner, first took place ; and no trace of blood,

vol. xiv. — no. 83. 3d

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Original Communications .

I repeat, was discoverable in it. Perhaps, from the extreme oppression, and evident want of reaction of the system, one might have inferred that some organ of more direct import¬ ance to life than the bladder or intestinal canal had been implicated in the injury.

VII.

Note on the Influence o f Mercurial Salivation in the Cure of Insanity . By Shirley Palmer, M. D., Editor of the Foreign Department of this Journal.

The perusal of an interesting case of melancholia by Dr. Burrows, in the last Number of the Repository, has strongly recalled to my recollection a circumstance which, about three years since, fell under my observation. Of the suspicion with which insulated facts in the science of medi¬ cine should be viewed, and of the extreme caution with which they should be admitted in evidence of any particular doctrine or theory, no one can be more deeply sensible than myself. On the present occasion, however, i have neither favourite opinion nor theory to support. My object is merely to communicate a fact, and leave others to reason, and decide for themselves, on its practical inferences and application. From the corroborative testimony of my highly respected and enlightened predecessor, it has certainly re¬ quired in my own estimation a value to which, in solitary existence, it did not previously appear to be entitled.

On Wednesday, the 1st of April, 1812, a spare middle- aged man, of intemperate habits, and sallow and melancholy countenance, cut his throat in a fit of despondency. The wound was dreadful, and the situation of the man for awhile almost desperate; but he eventually recovered*.

* The wound had been inflicted in the interval which separates the os lyoides and thyroid cartilage, and was very extensive. Conse¬ quently the bag of the pharynx was wholly exposed; and the rima glottidis, alternately closing and dilating, might be distinctly seen and touched by the finger at the lower margin of the gaping wound. 1 shall never while 1 live forget the horrible and ghastly spectacle which the poor fellow exhibited, as I sat opposite to him, watching the curious action of the laryngeal orifice, and meditating on the means of conveying a supply of food into his almost exhausted system. Every particle of food, the introduction of which had been attempted, bad evidently escaped through the wound, after inducing great irritation at the top of the larynx, and a convulsive and suf¬ focating cough. Piactising then as a Surgeon, 1 was summoned to Jfis assistance, and leached his distant residence about seventy hours

387

Palmer on Mercurial Salivation in Insanity.

Returning to his unfortunate habits of excessive drinking, he alter an interval of nearly four years again became seriously indisposed. Consulted in the summer of 1816, [ found him labouring under all the symptoms of inflammation of the membrane of the liver, with high constitutional irrita¬ tion, and great depression of spirits. Leeching, blisters, the warm bath, a mild mercurial course, saline purgatives, and abstinence, were prescribed with the most prompt and de¬ cided benefit; and the health of the patient was again com¬ pletely restored.

On a journey to the vicinity of this man’s residence in the autumn of 1817, I was once more requested to visit him. For some time, he had betrayed unequivocal symptoms of a recurrence of his mental malady : and from the opinion, I believe, that the intellectual disorder was connected with a morbid state of the liver, mercury had been very freely administered by the Surgeon in attendance : and no sooner had the medicine evinced its operation on the salivary system, than the whole train of morbid phenomena had instantly disappeared. From exposure to cold or neglect, the mercurial influence was suddenly suspended; and the intellectual aberration immediately recurred. Upon my visit, I found that the mercurial plan had been for some days resumed, and the patient was then lying in a complete state of salivation ; but he was perfectly calm and rational ; and

after the occurrence of the injury. As the man was evidently sinking from inanition, introduction of food into the stomach was evidently the most pressing indication. With a view of effecting this, I passed an unusually long elastic gum catheter, made for the purpose, through the right nostril into the oesophagus; but, on the attempt to inject a little warm milk, the fluid, from an irreparable injury which the instrument had sustained in carriage, was com¬ pletely obstructed. The ordinary sized catheter was too short to reach the oesophagus : its point when passed through the nostril, scarcely reached the inferior margin of the wound. Consequently, I was under the necessity of introducing the tube through the wound into the oesophagus. By fluids thus injected, the patient was ex¬ clusively supported for sixteen weeks and two days, until the wound was sufficiently healed to admit of his taking food by the natural process. Persons correctly acquainted with the surgical anatomy of the neck, will be aware, that in this case the trachea was not divided. I have had some difficulty in convincing gentlemen, who have not thought sufficiently on the subject, of this important fact. During my five years’ practice as a Surgeon, 1 have seen five cases of attempted suicide by cutting the throat; and in every instance, the wound, as far as I can recollect, was inflicted between the os hyoides and thyroid cartilage.

388 Original Communications.

from the moment that the mercurial action had been restored, every trace of the mental affection had vanished. Confinement to a warm atmosphere, saline purgatives, and temperance, constituted the leading features of my prescription : and, although unable to speak decidedly on the subject, 1 have every reason to believe that the man has never experienced any recurrence of this dreadful malady.

A young gentleman suffering from a degree of mental depression bordering on insanity has recently derived, under my direction, considerable benefit from the employment of mercurial ointment, carried so far as to produce a sensible effect on the salivary system, in combination with aperients and the cinchona. And an instance not long since occurred within my knowledge, although not under my own obser¬ vation, wherein slight mental derangement was completely and permanently removed by a course of mercurial inunction, instituted with views and for a purpose utterly distinct from those of the existence or cure of the intellectual malady.

DEPARTMENT OF NATURAL HISTORY, &c.

Calendar of Fauna, Flora, and Pomona, kept at Hartfield, near

Tunbridge Wells. By Dr. T. Forster. From the 1st to

the 30th of September, 1 820.

- - -

September 1st. — This month set in with fair weather, a steady barometer, and clear nights, with stratus.

2d. — Falling stars observed to-night. The Moorhen ( Fulica chlorossus) noticed in the ponds.

4th. — A falling star was described to me by a person this evening as descending and running along the ground : it was probably an ignis fatuus.

7th. — During the Eclipse the thermometer fell from ninety-three degrees (in the sun) to seventy degrees.

18th. — I found Agaricus muscarius , a beautiful crimson fungus with white spots, in abundance, growing on the grass in Stoneland Park. Boletus edulis is also common.

19th. — The Autumnal Crocus, or Saffron, in blow.

21st.- — Sweet Peas, African Marigolds, Dahlias, and China Asters, are still in blow in the gardens ; and here and there a few Poppies. The Monarda didyma flowers at Hartwell Fartn#.

2§th. — The following plants still flower, though sparingly, and are much injured by the cold nights, and by the hard

* This plant is here called the Balm of Gilead.

Hastings on Bronchitis

(J> i '

* 'J C

\()

rains occasionally: Calendula officinalis , Tagetes pa tula , T. Africana , Dahlia superflua, Chrysanthemum coronarium , Papaver Rhocas, P. dubium, P. somniferum , and jP. Cambri- cum. Apargia autumnalis still abounds in the fields.

Swallows and Martins congregate and prepare for de¬ parture.

30th. — Agaricus floccosus and A.fascicularis springing up, though neither have been of any considerable magnitude yet. Fungi are certainly scarce this year. Swallows and Martins begin to assemble in flocks. Large flights of Starlings are also numerous already.

[This Journal is to be continued in the neighbourhood of

T un b riage IV ells h\

PART II.

ANALYTICAL REVIEW.

I.

A Treatise on Inflammation of the Mucous Membrane of the Lungs, By Charles Hastings.

[Continued from page 319.]

In a former Number it has been intimated that we consider our reviewing duties of one half year to consist in a retrospect of the whole medical literature of the preceding ; and that, according to the magnitude and importance oi the several works which fall to be noticed, we for the future purpose either to devote a separate article to a detailed consideration of their contents, or include them under one leading division. By this proceeding, it is hardly necessary to say, we shall avoid the necessary repetition involved in the plan of separating the general retrospect from the particular reviews; and shall find ourselves able to expand and enlarge where minute detail is required. Pursuing, then, this principle, we shall now resume the thread of our analytical disquisition from the part in which it was broken in the last Number, and shall go on to consider the remaining topics in the very interesting volume of Dr. Hastings on bronchitis. It will be recollected that our analysis of this treatise was not pursued in our last Number beyond the treatment ol acute bronchitis. It is in the fourth chapter that Dr. H. goes into the con¬ sideration of those chronic affections ot the -bronchial mem¬ brane which constitute chronic bronchitis, which, as in the

390 Analytical Review.

case of the more acute disorder, he divides into several varieties. The chronic cough of old people may be regarded, we are told, as the first variety, which attacks the patient at the commencement of cold weather, and continues through the winter months.. There is a peculiar wheezing, and the cough is more urgent in the morning. There is not much pain in the chest. The tongue is white, and the appetite defective. Pulse a little increased in celerity, but never hard. The urine is often high-coloured and scanty. The bowels are irregular. The warm weather generally sets every thing to rights; but sometimes hydrothorax is the consequence of the disorder’s continuance.

In the second variety, the symptoms more nearly resemble pulmonary consumption. The sputa is copious, and various in appearance, and is occasionally streaked with blood. The breathing is much affected. There is often tightness across the chest. The pulse is increased in frequency by the patient assuming the erect posture. The skin in the day time is dry; in the night hectic perspirations break out. Emaciation is perceptible. The expectoration, if the disease be not checked, greatly increases in quantity, and is changed in appearance ; more blood is mixed with it. The pulse becomes quicker, the tongue cleaner; a diarrhoea at length appears, and the patient is carried to his grave with all the appearances of tubercular phthisis.

The third variety is that which follows catarrh, carried up in intensity and duration to the point of acute bronchitis. Blood is sometimes in these cases mixed with the sputa; and night perspirations, with hectic tinge on the cheek, make their appearance ; but still there is no particular pain upon inspiration, nor are there any shoots of pain in the breast, as in real tubercular phthisis. Dropsical symptoms often super¬ vene before the fatal termination.

It occasionally happens, that chronic bronchitis follows the disappearance of a cutaneous eruption ; and thus is the fourth variety of the complaint formed. This kind of bronchial affection is generally very obstinate; and it often resists all remedies until the cutaneous affection returns.

The fifth variety is occasioned by mechanical irritation directly applied to the bronchial lining, as in the case of stone-cutters, and other occupations which render the inspired air either chemically or mechanically irritating. Haemoptysis often follows these exposures, which is usually the forerunner of very untoward symptoms. At other times, the expectora¬ tion is merely streaked with blood, and becomes gradually purulent. “ In by far the greater proportion of these, if the occupation be relinquished, these symptoms, by an appro-

Hastings on Bronchitis. 391

priate treatment, disappear, and the patient is restored to health.”

The last variety of the chronic disorder is that connected with disease of the abdominal viscera; and the viscus most commonly affected is the liver. In this case, beside the com¬ mon characteristics of hepatic affection and bronchial irrita¬ tion, marks of an irregular hectic make their appearance, “ which differ considerably from the completely formed hectic of tubercular phthisis.” Dropsical symptoms in this variety are exceedingly common before the termination of the complaint.

t( Ulceration of the stomach occasionally occurs in con¬ nexion with chronic bronchitis ; but the disease in these cases differs considerably from that which takes place in combina¬ tion with hepatic affection ; for subjects thus affected are generally much emaciated before any marks of pulmonic inflammation come on.” Antecedently to the pulmonic disease, which in this last case creeps on very insidiously, in¬ dications of gastric irritation are for a long time present.

“ Pectoral attacks, in their symptoms very much resem¬ bling tubercular phthisis, have been long known occasionally to supervene on protracted disease of the mesenteric glands, and to chronic disease of the peritonaeum.” In these cases, which have been too indiscriminately placed to the account of phthisis, “ it will, perhaps, on further investigation, appear that the disease is sometimes confined to the mucous mem¬ brane lining the bronchia and air-cells.”

Appearances on Dissection. — The lungs do not collapse. The bronchial membrane is usually thickened, and the capil¬ laries of it more or less dilated. Ulcerations are often found on the membrane. The bronchia and air-cells are almost always filled. The substance of the lung is sometimes thickened, and often hepatized. The tubercles that are often found, are mostly in an incipient state. Adhesions and tubercular deposits are found in the pleura. The blood¬ vessels of the lungs are loaded. The auricles of the heart are dilated. The right side of this organ contains more blood than common. A thickness is perceived often in the auriculo- ventricular valves. The liver is often diseased, as is also the stomach and abdominal peritonaeum. Indeed, the intestines _ are often closely united from peritonseal disease, in the way “ described so faithfully by Dr. Baron, in his work on Tuberculated Accretions of Serous Membranes.” Frequently the glands of the mesentery are much enlarged.

Ratio Symptomatum . — The falling off in flesh and strength is occasioned by the quantity of discharge from the mucous membrane ; the occasional haemoptysis by erosion of small

392

Analytical Review .

blood-vessels. Dyspnoea arises from the distention and en¬ largement of the pulmonary vessels and cavities of the heart.

Diagnosis. — From true tubercular phthisis, bronchitis chronica is distinguished by the absence of pain during inspiration, by the power of lying on either side when there is no abdominal disease, by the wheezing in respiration, leaden colour of the lips, pallidity of countenance, and the mucous appearance of the sputa. The cough is not short and tickling, but deep and sonorous. From asthma, chronic bronchitis is distinguished by the absence of the periodical suspensions and recurrence of the complaint.

Prognosis. — “The more purulent the expectoration, the greater the danger.” When the affection is complicated with abdominal disease, the prospect is unfavourable. If the latter, however, be cured, the bronchial disorder most com¬ monly subsides. In proportion to the insidiousness and less marked character of the malady in the first instance, is often the degree of danger.

Treatment. — Blood-letting, even when required, is often forbidden by the prevailing 'debility. Local is, for the most part, more advisable than general bleeding. Sometimes, however, where there are marks of much congestion and obstruction, one large bleeding proves of great service. Blisters, after blood-letting, are often highly useful. Emetics are occasionally of service in tiissis senilis, but they are not radical in their operation. When the disease seems to assume a dropsical tendency, digitalis, cautiously employed, is an efficacious remedy. Squill, in combination with am- moniacum, constitutes a good medicine. The colchicum tincture, in doses of twenty drops, three times a dajq from that to thirty, Dr. H. has found an excellent remedy. Copaiba his experience does not lead him to praise quite so highly as does his friend, Dr. Armstrong. A combination of hemlock and ipecacuanha, four grains of the extract of the former, with one of the powder of the latter, in a pill, taken three times a day, “ often allays cough, and produces a more healthy expectoration.” Cinchona and sulphuric acid may be occasionally employed. W hen the disorder is combined with hepatic disease, small doses of mercury, in conjunction with large ones of dandelion, are of service. Opium must not be used when it is found to prevent expectoration. The vapour of tar inhaled, sometimes seems to assist other remedies : this more especially applies when the habit of the body is not very irritable, nor the complaint at all active.

In the early stages of the disease, “ milk and vegetable diet must be adopted.3’ Afterwards, the support requires to be more nutritious; but cordial and stimulating drinks are

393

Hastings on Bronchitis.

always improper. The sea air, in the summer months, “ sometimes invigorates the constitution, and restores the tone of the vessels on the bronchial surface.” The skin must be kept equally warm, the bowels preserved moderately open, and that exercise adopted which is most congenial to the patient’s feelings.

Or. Hastings concludes by a very interesting section on the pathology of those dropsical affections which frequently prove sequelm to bronchial disorders. He assumes, that the pulmonary and cardiac derangements, by occasioning dilatations and congestions, produce an impediment to the motion of the venous blood ; and that hence is occasioned that increased exhalation which constitutes the actual state of dropsy. This view of the source of dropsy has always been considered by us as more in accordance with nature and truth than the modern theory, which refers every case of dropsical accumulation to arterial excitation. When blood-letting is used under these circumstances, its good effects are rather attributable to the principle of unloading vessels, than of reducing action. In the use of the meadow saffron for the pulmonary and other dropsies following bronchitis, Dr. Hastings adopts Dr. Crampton’s inferences, that “ the bulbs which are taken early in the spring possess striking medical powers; whereas those taken in the autumn are almost inert.” Our readers will see, by turning to a paper on this subject in the last Number of the Repository, that, according to Mr. Thomson, “ July is the best period for taking up the plant but wTe cannot prosecute here this inquiry. Mr. Battley has just apprized us, that he is preparing a paper on the subject for the present Number, to which we, of course, refer our readers. At the moment we are writing, it may be necessary to say, that we are not, in the smallest degree, aware of the nature and object of the promised communication from Mr. B. We, nevertheless, accede willingly to his, as we are ready to do to all other proposals of d iscussing con¬ troverted points with freedom.

I n concluding our review of the present treatise, we need not say any thing further in its commendation, to induce our readers to pay attention to its instructions. Dr. Hastings has proved himself, by this performance, an acute pathologist, a judicious Practitioner, and an able writer. We have given as faithful an analysis of the book as we have been permitted to do by our limits; and although the young Physician must not look to detect in practice all the varieties of disorder marked out with the precision of Dr. H.’s nosology and nomenclature, he will, we can assure him, find more of truth than of system in every page of this valuable work.

VOL. xiv. — no. 83. 3 E

394

Analytical Review.

II.

Practical Observations on the Symptoms , Discrimination, and Treatment of some of the most common Diseases of the Lower Intestines and Anus , fyc. Illustrated by Cases. To which are added, some Suggestions upon a new and successful Mode of correcting Habitual Confinement in the Bowels. By John Hgwshtp, Member of the Royal College of Sur¬ geons, &c.. &c. Longman, pp. 176.

In a large and luxurious metropolis, the division of medi¬ cine from surgery is perhaps proper and necessary ; but of this we feel convinced, that the student of medicine ought to combine with his other pursuits an attention to the science, at least, of surgery. It is, we believe, too common a feeling among young men who are destined for the practice of physic merely, to consider that time misspent which should be devoted to those anatomical and pathological researches that have an especial bearing upon the Surgeon’s more immediate calling; and although we are not among the number of those who consider minute anatomy to be every thing to the Physician, we do profess ourselves most strongly inimical to that indolent and mischievous assumption which contends, that while it is the duty of surgery to dive into particulars, it is enough for medicine to deal in generals.

In the present Number of our Journal, under the head of Original Correspondence, will be found a case which powerfully evinces the importance, in every instance of intestinal irritation, of inquiring whether some local or surgical complaint may not be the origin of the systematic disturb¬ ance; and fully persuaded we are, from what we have both seen and heard, that many individuals have run from one Physician to another, crying out Help, where no help was to be found merely in drugs, and whose malady has at length been ascertained to consist of what for a long time no suspicion had been conceived; viz. a disordered, constricted state of the rectum .

Diseases, then, “ of the lower intestines and anus,” we imagine to be, both in frequency and moment, among those which call for especial investigation on the part of the medical Practitioner, whether his duties be those of a Surgeon or Physician ; and a treatise on these particulars from an individual of established reputation, must be regarded with considerable interest.

“ Almost every deviation from health,” says our present author, “ either in the functions or the structure of the bowels, may be consi-

395

Howship on Intestinal- Diseases, fyc.

I tiered as connected with one of two states, for almost every case will manifest either excess or deficiency in tone or power of action; the

rst state favouring the production of inflammation, contraction or stricture, ulceration, abscess, and fistulae; the second, including ntemoi 1 hoidal tumours, haemorrhages, and prolapsus.

Jn no department of surgery is the safety of the patient more immediately concerned, or the discernment of the Practitioner more promptly lequired, than in ascertaining the early approach of some of these complaints ; and no adequate series of observations having yet appeared, the opinions ot several of my professional friends have operated as an inducement in bringing forward some of the results or my own experience.”

IMi. Howship first treats of “ contraction, or stricture in the rectum;” secondly, “on ulceration of the internal sur- face of the intestine;” thirdly, “ of the growth of tumours within the bowel;” fourthly, « of prolapsus ani, or the descent of the bowel;” fifthly, “of hemorrhoidal tumours, Qi piles ;” sixthly, “of fistula in ano ;” and seventhly, “of hemorrhoidal excrescence.” It is for us to present an out¬ line of these important delineations.

Stricture in the Rectum. — This may result from acrimo¬ nious matter in the system, or arise from extraneous causes; sometimes repulsion of eruptive complaints gives rise to it. It is simple or schirrous. Sometimes it is constituted by a mere excess in the action of the sphincter-ani muscle. A sensation of heat of a peculiar kind is one of the prominent symptoms of diseased rectum. When the mucous membrane is much inflamed, there is constant uneasiness, great pain, and a discharge of purulent matter. If an extraneous body is low down in the rectum, “ the patient is generally sensible of a sharp prickling pain in the part previous to formation of matter, aggravated during the passage of a motion.” As the complaint of contracted rectum increases, “ a progressive and evident change in the form of every figured stool” may be observed. The thickening of the gut from inflammation may be perceived by examination with a consequent dimi¬ nished aperture ; and the coagulable lymph, whether divided into bands spreading across the canal, or attached to one part only, “ may be pulled off, and separated by the end of the finger.”

The diagnostic marks between schirrous stricture and con¬ traction from other sources, are the peculiar sharp pain darting through the seat of the disease , or a more constant sense of glowing warmth in the part observable in the former. Mechanical pressure too, while it relieves other strictures, cannot be endured in the schirrous contraction. Strictures, it must be recollected, although most common in the lower bowel,

596 Analytical Review «

may and do take place higher up, where no actual exami¬ nation can obtain, or operation avail. The commencement of the schirrous stricture, Mr, H. conceives, is in the cellular membrane. The secreting lining of the intestine is more especially implicated in the common inflammatory stricture.

Treatment. — Anti-inflammatory measures are to be had recourse to in the first instance — mucilaginous diluent drinks, with repeated injections of warm water, aperients, and saline medicinals, are indicated; and blood jetting, if the pulse be hard and the inflammation high. When adventitious ad¬ hesions have taken place, the finger must be introduced into the rectum to separate them ; if force is required, the probe- pointed bistoury or scissars must be employed. A degree of spasm will occasionally produce appearances and symptoms so closely resembling those of inflammatory action, that the distinction is almost impossible ; and in these cases the fumes of tobacco have been found to succeed, “ injected cautiously by the proper apparatus into the bowels.” When the con¬ tracted part of the rectum admits the finger to pass up without giving any distinct impression of coagulable lymph, or of ulceration in the membrane, ic the common wax bougie, or perhaps, in preference, one of elastic gum, may be introduced through the stricture.” This may be required every day, and the diameter of the instrument increased according to circumstances. Dessault’s method of intro¬ ducing lint upon a probe, and suffering it to remain, is inferior to the bougie plan of treatment. Schirrous strictures will not admit of these applications, and the treatment in such cases must be merely palliative. Suppositories made of the extract of opium, of conium, or hyoscyamus, simply or combined, may be used in schirrus. Opium dissolved in a warm injection will sometimes operate much more beneficially.

Ulceration of the Internal Surface of the Intestine. — This sometimes, Mr. H. thinks, and thinks justly, exists inde¬ pendently of true inflammatory action. When inflammation has produced the disordered state, it has most commonly operated in conjunction with irritation from the presence of acrimonious matter in the bowels. In endeavouring to detect this disease in any portion of the intestinal canal, the common marks of inflammation and ulceration must be care¬ fully sought for. The appearance of blood in the stools Mr. H. does not admit to be a criterion of ulceration in the bowels, nor do the motions being free from blood prove that the bowels are free from ulceration. Bleeding to a con¬ siderable extent sometimes takes place when the blood poured out is derived merely from the exhalant and capillary

397

Howship on Intestinal Diseases , fyc.

arteries on the surface of the great intestine, and no inflam¬ mation has been present, I his we think a very important fact in pathology and practice to attend to: we imagine that, under the reigning feeling, that all disordered action is inflammatory, the effect in question has been met with different weapons from those which are the most successful in combating it. Sulphuric acid and syrup of poppies may often usefully supersede the lancet, and even, in some cases, purgatives.

Treatment oj Ulcerated BoweL — -Small divided doses of aperients, saline diaphoretics, “ a large and gently laxative enema, carefully and slowly injected,” the lancet, and the warm bath, must, according to circumstances, be employed in the first instance. When ulceration has actually7 taken place, “ a principal object will be to prevent the formation of any acrimonious matter in the bowels, taking care to preserve an easy and regular transmission of their contents.” We must observe with attention, through the pulse and tongue, the ever varying state of the system, and either raise it carefully when prone to depression, or cautiously moderate any tendency to excess of tone, thus endeavouring to maintain that quietude of balance most conducive to eventual recovery. Light tonics are to be had recourse to, combined either with aromatics or opiates; the effect of these means being oc¬ casionally regulated either by castor oil, or some other aperient. May we add, from our own experience, that the opiate confection is a remedy under these circumstances of admirable powers? Much reliance is not to be placed upon the injection of astringent matters, even when the ulceration is low down in the intestine. In one instance Mr. H. found the application of argenti nitras dissolved, advantageous : in this case the ulceration was confined to the sphincter of the anus. Attention to ensure an equably warm surface by clothing is always expedient.

Of Tumours within the BoweL — These are not of very frequent occurrence. They often proceed without any marked symptoms of pain and irritation. “ In the progress of the complaint, symptoms become more distinct, and, provided the disease is situated between the coats of the intestine, and has consequently an intimate connexion with the sur¬ rounding structure, there will, in some cases, be constant uneasiness, or sense of weight, or occasional paroxysms of pain about the sacrum. When, on the other hand, the patient is only incommoded by occasional obstruction of the passage of the faeces, the tumour will generally be found to be so attached as to admit of removal by operation.

These tumours occasionally produce large haemorrhagic discharges. Sympathetic irritations at length take place

398

Selections,

in the stomach or elsewhere, and diarrhoea supervenes. The tumour is sometimes of a schirrous nature, but the “ real schirrous tumour seated in the coats of the intestine, and projecting into the cavity,55 Mr. II. believes to be extremely rare. “ The soft tumour, (he says,) L have found in con¬ nexion with similar disease, either in the bladder in the male, or the uterus in the female.5'

Treatment.-— Benefit may be obtained, when the tumour is small in size, by pressure with a bougie. When it is of a schirrous or fungous nature, this plan is of course inad¬ missible. When much haemorrhage takes place, an astrin¬ gent injection may be thrown up, “ This may, according to circumstances, be an infusion of roses, decoction of oak-bark, of the rind of the pomegranate, or strong infusion of galls: any of these may be rendered more powerful by the addition of a concentrated aluminous solution.55 Constitutional reme¬ dies must be thought of. Should the tumour be such as to admit of removal by operation, the ligature may be recom¬ mended, which should be “ a simple ligature of sufficient strength, with a receiving noose at one end ; this adjusted round the basis of the tumour, the loop is tightened by an instrument with a small ring that runs freely over the line? pushing the knot before it, and consequently diminishing the noose, or tightening the ligature to the degree required. In some circumstances, perhaps, the ligature may be better applied by a canula.55

Mr. H. objects to Dessaulfs recommendation, that when the tumour is within view, the ligature should be first secured, and the tumour then cut off. It is better to wait the event of that process by which the ligature is thrown off.

The remaining topics discussed in this interesting volume we are compelled, by the quantity of other matter that has closed in upon us, to defer to the next Number; when we must finish our account of all the works which passed the press between January and July.

FART III. SELECTIONS.

A Mode suggested for passing Calculi from the Bladder by the

Aid of Atmospheric Pressure .

[From Thomsons Annals of Philosophy. ]

The writer of this has lately seen in one of the public journals the description of a new instrument, called, by its

Selections *

399

inventor*, a Dilator, by which any part of the urethra may be dilated without affecting other parts of it, by means of an elastic substance charged with air, for the removal of stricture, and to facilitate the passage of calculi from the bladder. JNow, whatever may be the merit, of the instrument itself, or whatever chance there may be, (and of this there is reasonable hope), of its leading to new and useful expedients, the inventor has at least the merit of directing the public attention to mechanic remedy in this class of complaints. Chemistry has done much, of late, towards pointing out the true principle on which alone medical treatment can be of any use. Let mechanic science also, by the invention of new, or by the improvement of old instruments, assist the progress of relief. The object of this paper is to suggest the plan of another instrument for the removal of the calculus, after the dilator has prepared a passage for it, of sufficient power, it is presumed, to draw away any calculi which the dilated calibre of the urethra may allow to pass, and which are not impeded by adhesion. I propose to effect this by means of a tube, or canula, so constructed as to allow an exhausted receiver of a portable size to be fixed to it, having its stop¬ cock to regulate the pressure : through this canula the cal¬ culus may be searched for, and when in contact with it, and the power of the vacuum applied to it, the powerful suction so excited would, it is presumed, be sufficient to draw the attached calculus forward as far as the previous enlargement would allow ; and, according to the size of the stone, either draw it quite out, or at least so far on in the passage as to be within the reach of a simple operation^. As the end of the proposed instrument must accommodate itself to all surfaces, rough as well as smooth, the having it so formed as best to answer the purpose will be a great desideratum : the body of the canula ought probably to be metallic, but its end or lower termination may be formed of the elastic gum, or some substance of that nature, and in shape and structure perhaps imitative of some processes to be found in the animal kingdom where suction is produced by muscular action.

A Surgeon of eminence in London some time since suc-

* Mr. Arnott, of Bedford Square, London.

+ It seems possible, and with much advantage, if it could be done, to join together the two instruments; in that case, when in use, the attached calculus would follow so .closely in the wake of the bulb of the dilator as to pass before the dilated parts could close upon it, and a less force be sufficient to move it along.

400

Selections.

ceeded in removing a small calculus, (said to be of the size of a small walnut), from the bladder of a gentleman, by the following method : he made an opening from the perinmum into the membranous part of the urethra, and after enlarging the passage with the dilator, he reached and extracted the stone with the common stone forceps. The wound soon healed, nor did the dilation occasion much pain or other inconvenience. Besides the case of regularly formed calculi, might not the instrument now proposed be used also in removing loose granular concretions lodged in the bladder? In some cases, might it not with advantage be substituted for the forceps, especially when they are to act through a long and narrow passage? Might not an instrument formed on this principle be used for drawing away aqueous fluid, or pus, situated in parts remote from the surface?

Calomel.

Corrosive sublimate was known to the Arabians, and is distinctly enough described by Avicenna, and, according to Bergman, by Abubeker-al-Rhasi, who preceded Avicenna by at least a century; but we have no evidence that calomel, or mercurius diflcis, as it was formerly called, was known to the alchymists. Crollius, in his Basilica Chymica, pub¬ lished in 1608, hints at it as a most valuable preparation of mercury, but without giving the least information about the method of preparing it. The same year, Joannes Beguin published a book in Paris, entitled “ Tyrocinium Chemicum,” in which he described the whole process of making calomel, and he distinguished the preparation by the name of Draco mitigatus. This mercurial preparation very speedily acquired great celebrity, and came to be distinguished by the name of panchymagogus quercitanus , in honour of Joseph Du Ch esne Domini de la Violette, a very famous French chemist of those days, who published, in l6lo, a work, entitled “ Phar- maeopcea Dogmatieorum Restituta.” During the eighteenth century, the term mercurius dulcis came into general use to denote this preparation of mercury, or sometimes it was called mercurius subhmatus dulcis; but this mode of naming was blamed by Meiiman, because it was apt to occasion corrosive sublimate and mercurius dulcis to be confounded together. The term calomelas , (which signifies beautiful black), was introduced by the French chemists, and applied to mercurius dulcis, when several times sublimed, which, in their opinion, added greatly to its virtue. 1 do not know who the person was who first applied this term ; but I think it must have been between the years 1730 and 1766. I cannot find the term

Pascal on Asthma.

401

hi any French book older than 1730; and Spielmann, whose Institutiones Chemise were published in the year 1766, gives us the term calomelas as new, and as not generally received by chemists. Bergman, whose paper on the Combinations ot Muriatic Acid and Mercury was first given to the world in 1769, speaks of the term calomel precisely in the same manner as Spielmann. What was the reason of applying so odd a name as calomclas to this preparation, and how came the term to acquire such universal currency in Great Britain ? I should suppose that it would be easy for some of the editors of the Journal de Pharmacie to discover the history of this term, which originated in France. If they can throw any light on the subject, I should take it as a favour if they would publish the results of their inquiries ; for I myself have not been so fortunate, during the course of my reading, as to meet with any satisfactory account of this word*.

PART IV.

FOREIGN MEDICAL SCIENCE AND

LITERATURE.

I. analysis of journals. (French).

Neiv Journal of Medicine.

May, 1820. — • letter on Asthma to Dr. Rostan. By Dr. Felix Pascal. — About eighteen months ago, the transla¬ tion of a valuable memoir on asthma, by Rostan, was pub¬ lished in this Journal f\ The object of it was to prove that the asthma of aged persons is invariably the symptom of an organic affection. Several able writers have since risen up to controvert this doctrine; while others, on the contrary, have borne evidence to its correctness. Among the latter is the author of the present communication. Of the four cases which it contains, the following is a brief extract : —

A man, aged forty-nine, subject for ten years to dyspnoea, sensibly aggravated by cold and damp, terminated in real asthma; its paroxysms at first infrequent, but finally recurring almost every evening. Day commonly tranquil. Dyspnoea induced by unwonted exertion, particularly in walking. — February, 1820. Cough, with thick and tenacious expectora¬ tion ; yellow tongue ; pulse regular, small, frequent ; oedema of lower limbs extending in a week to the whole system. Died in a fit of asthma. — Dissection. General effusion into

* See Dr. Paris's application of this word, t Repository, Vol. XI. page 145.

VOL. xiv. — no. 83. 3 f

402

Foreign Medical Science and Literature .

the cellular membrane; some old pleuritic adhesions; bron~ chia filled with mucus ; right ventricle of the heart enlarged ; much serum in the pericardium. Aneurismal dilatation of aorta, as large as a goose egg at its origin : abdomen sound.

A stout intemperate man, aged forty-one, for six years had suffered vertigo. He had habitual dyspnoea, frequently relieved by epistaxis, and, for a while, dissipated by blood¬ letting; succeeded, after the lapse of a year, by violent pal¬ pitations, dry cough, and haemoptysis. On admission into l’Hotel-Dieu, October, 1819, pale countenance; reclination easy in every posture; dry skin; respiration disordered on climbing stairs, with increased action of the heart, and sense of suffocation ; pulse small, concentrated, 102, regular, and perfectly synchronous with the stroke of the heart, which communicated to the hand a peculiar sensation, resembling the murmur of a spring falling on gravel. Thorax sounding obscurely. Severe paroxysm of asthma every evening, with violent pulsations in the left thoracic region and epigastrium, and subsiding towards morning ; apparently influenced, not by diet, but by atmospheric vicissitudes ; sufferings during winter greatly aggravated. Digitalis and blood-letting pro¬ ductive occasionally of relief. CEdema of the feet in January; died in the middle of February, during a night- paroxysm, not unusually violent. — Dissection. Lungs sound, except slight adhesion of the right; left thrust upwards. Great enlargement of the right cardiac cavities. Aneurismal dilatation of the aorta at its origin. Sac entire, and filled with tough coagula.

Third case, in a female, aged seventy, not so conclusive, as she was still living. Asthma periodical, and of many years’ duration. Symptoms nearly the same as in the preceding cases. Relieved by digitalis, leeches, and particularly vene¬ section during the paroxysm.

A woman, aged forty-eight, presented, in 1809, all the symptoms of cardiac aneurism palpitations ; dyspnoea; impracticability of lying on the back ; strong irregular pulse ; tumid face ; livid lips ; starting from sleep. After a year, recovered apparent health, with exception of habitual dyspnoea, palpitations, and dry cough. Symptoms, after three years’ suspension, recurred ; and speedily fatal, — Dissection. Great aneurismal dilatation of right cardiac ventricle.

Probably the habitual dyspnoea, which occurs at irregular periods in organic affections of the heart and large vessels, frequently depends on atmospheric influence, as on every agent capable of accelerating the circulation. A case, elucidated by dissection, is lastly detailed, to show that pleu-

Robert on the Anemone Pratensis.

403

ntic adhesions, unconnected with lesion of the heart or large vessels, may induce constant dyspnoea, aggravated by exercise and vicissitudes of temperature; but the genuine form of the asthmatic paroxysm is never, in this instance, assumed.

Case of Abscess of the Liver. By M. Depons. — Subject, male, aged twenty. Obstinate meteorism, with hectic fever, debility, and emaciation. Case abandoned as desperate. Obst ruction of the liver suspected by M. Depons. Leeches to the anus, with a view of unloading the vena portarum ; emollient fomentations and cataplasms; frequent injections. Alter a brisk purgative, discharged successively, in one day, three cysts filled with a fetid and pultaceous matter. The abdomen subsiding, allowed the discovery of an abscess in the convex portion of the liver. On incision, a large quantity of pus escaped. The wound was kept open for two months, and the patient recovered.

Case of Passive Epistaxis . By Dr. Felix Pascal. — A delicate woman, aged twenty-eight, and pregnant, after a fortnight's slight indisposition, was attacked, during sleep, with nasal haemorrhage, which resisted the employment of all the usual general and topical remedies, finally the cinchona and tonics, and terminated fatally on the thirteenth day. Large ecchymoses had appeared on various parts of the body on the eleventh and twelfth. — Dissection. Habit pale. Violet-red ecchymosis occupying the whole of the back. Several smaller, deep-blue, on front of the trunk and extre¬ mities. Wound made in venesection not cicatrized; brain healthy; right lung adherent; heart flaccid, little blood in its cavities; uterus containing a five months’ foetus ; abdominal viscera natural.

Program of a Prize proposed by the Academy of Berlin, on the external Employment of Cold Water in the Treatment of Fever. From Hufeland’s Journal. — Prize fifty ducats. Memoirs to be sent in by July 1st, 1821.

Extract of Observations on the Anemone Pratensis. By Mr. Robert. — from eight ounces of the flowers of this plant, and two pints of water, were drawn, by distillation, eight ounces* of a slightly milky fluid with acrid taste and pungent odour. From this, after six months, a quantity of w hite crystals w^as deposited : figure obscure ; at first tasteless, afterwards ex¬ citing a sense of acridity : neither acid nor alkaline. Placed on a heated knife blade, they fused, and emitted a vapour wdiich strongly affected the eyes and nostrils ; and in this

* From the remainder of this fluid, during evaporation to tiie con¬ sistence of extract, no acrid vapour was disengaged

404 Foreign Medical Science and Literature . ,

state operated like a caustic on the tongue. Vauquelin, on examination, confirmed these results. He describes the figure of the crystal as that of a six-sided prism, terminated by elongated hexaedral pyramids. Heated in a glass tube, it melts; in part volatilizes; and assumes, on condensing, the aspect of concrete oil. Another minute portion remains under the form of a brown resin. It for the most part dis¬ solves by ebullition in water, and imparts its acrimony to the fluid. A portion of it again crystallizes on cooling. With alcohol, it acts in the same manner. Vauquelin regards this substance as of a peculiar nature, differing from camphor and all other known bodies. It should be classed with the concrete oily substances, and probably exists in the clemates and ranunculi, which are very acrid, and of the same natural family as the genus anemone.

Experiments made with a Root named at Java Treba Yapan, a new Remedy against Herpetic Eruptions. By Hufeland. — This communication is translated from the German. Its object, to display the efficacy of a new remedy introduced into Europe from Java, against herpes. It is applied externally to the diseased surface twice a day, in a sort of jelly formed by trituration of the powdered root with vinegar. Three cases of its successful application in herpetic, psoric, and syphilitic eruptions, are detailed. The root in question is inodorous ; of hot and acrid taste. The family of the plant, to which it belongs is yet unknown.

Remarkable Case of supposed Ankylosis of the Lower Jaw . By M. Bardin. — This affection had existed from infancy in a woman aged 73, and prohibited all motion of the jaw, particularly on the right side. The corresponding cheek was sunk in, and appeared to be much less nourished than the left. The two condyles were in their respective cavities; the symphisis perfectly on the mesial line, and alveolar borders in accurate relation. The teeth were gone ; the woman contrived to introduce small pieces of solid aliment, and grind them between the alveolar processes of the left side. Hence the augmented bulk of this cheek, from the constant action of the buccinator, and the wasting of the opposite side from repose. 'The woman articulated well, but spoke very low. She died in 1819, from gastric cancer. On examination of the jaw, the fibres of the left buccinator were very red, and strongly marked ; those of the right scarcely visible. Left salivary glands greatly developed. No anky¬ losis of the jaw. A very strong intermaxillary ligament on the right side, fixed to the internal alveolar borders of the two jaws, and occupying the extent of an inch and a half, beginning from the last grinder. The jaws on this side so

Ouvrard on Ligature of the Posterior Tibial Artery. 405

closely bound by it, that the last molar tooth of upper (alone remaining) passed in front of the lower. The body of this where the ligament existed, very large, probably in con¬ sequence of the molar teeth never having emerged from their sockets.

Letter of M. Duchateau to the Editors. — Claiming the priority of the operation of laryngo-tracheotomy from M. Boyer, of whose successful execution of it we lately gave an account*. From the following narration of a

Case of Laryngo-tracheotomy practised with Success. Bv M. Duchateau. — ft appears that the claimant had absolutely precedence of Boyer by some years, as his operation took place in 1815, and that by the former in the commencement of the present year. From the close resemblance of this to the preceding case, a slight sketch will suffice. The subject, a girl, aged six, accidentally swallowed, one evening, a plum- stone. All the symptoms of introduction of a foreign body into the larynx ensued : and at each expiration, the shock of the stone against the glottis was distinctly heard. Pain principally felt at the superior and lateral part of the thorax. Vomiting induced in vain. Child slept profoundly till morning. Then violent agitation; convulsions; speechless¬ ness; insensibility; countenance pale; eyes closed; pulse small ; respiration difficult and slow. At seven, the operation performed, in which the crico-thyroid ligament, cricoid carti¬ lage, and three rings of the trachea, were divided. No artery sprang. The stone presented at the orifice, but every effort to extract it abortive. The child seemed dying from suffoca¬ tion, when, during a strong expiration induced by irritating the nostrils, the stone was expelled from the wound with such force as to strike the ceiling. It was nine lines long, four and a half broad, and two and a half thick. Wound healed in a fortnight. The voice unchanged.

Ligature of the Posterior Tibial Artery. By M. Ouvrard. January, 1818. This vessel was divided an inch and a half above the ankle by a knife? in a boy aged 17 • The haemor¬ rhage was arrested by compress and bandage* Burst out again at four next morning, and checked by compression. Pyrexia; foot numbed. Compress removed without recur¬ rence of bleeding. Simple bandage, abstinence, repose. Fourteenth day, haemorrhage returned on the attempt to walk; and again yielded to methodical compression. Ano¬ ther fortnight passed, during which the cellular structure about the wound was gorged with blood, and a large eschar had formed; the haemorrhage was renewed, and a ligature

* Repository for August last, page 142.

406

Foreign Medical Science and Literature .

consequently passed through the flesh, with design but without the certainty of including the wounded vessel. Three days afterwards, fresh haemorrhage. The author, now first called, exposed the artery by an incision, two inches and a half long, on the internal border of the tibia, implicating integuments;, tibia! aponeurosis, and inferior attachment of the internal edge of the soleus. By passing the left indicator beneath the common mass of the gastrocnemius and soleus, the artery was seized, brought forward, and included with some fibres of the flexor communis digitorum and tibia! nerve, (mighty blundering surgery by the bye), in a double ligature. No haemorrhage recurring, the ligature was not tightened. The wound healed rapidly ; and at the close of the yearl the boy walked with facility. His foot yet con¬ tinued numbed.

Bulletins of the Faculty of Medicine of Paris,

1820. No. V.

On the Organization of the Heart, By M. Gerdy. — This article being itself a mere abstract of M. Gerdy ?s memoir, and having minute descriptive anatomy for its subject, will evidently not admit of farther condensation. The memoir is well spoken of by Beclard, author of the present analysis.

Facts demonstrating the Efficacy of Moxa in the Treatment of Chronic Fhlegmasm of the Respiratory Organs. By Pro¬ fessor Vaidy. —After attentive examination of the real nature of phthisis, the Professor avows his conviction that this dis¬ ease is in its origin simple chronic pneumonia. The lym¬ phatic tubercles frequently observed in it, constitute, he asserts, only adventitious complication, which does not alter its essential character. Observation has also convinced him that hydrothorax is almost invariably the symptom of chronic pleurisy. From this simple and substantial theory, two grand indications, in his opinion, result- — local blood-letting at the commencement, or. febrile period; and in a more advanced stage, the most powerful exutories. Amid this last order of remedies the moxa stands pre-eminent ; and in illustration of its efficacy, seven cases are cursorily related. The first case is one of acute, degenerating into chronic pneumonia, in a soldier, aged 24. Second and third, phthisis pulmonalis, in soldiers, respectively aged 25 and 35. Fourth, haemoptysis with fever, in a Spanish lady, aged 22. Fifth, chronic pleuro-pneumony, in a soldier of 30. Sixth , chronic pleurisy, with hydrothorax, in a lady of 40: and seventh , laryngeal phthisis, in a soldier, aged 36. In all these instances of strongly-marked disease, the application of moxa appears to have been signally and permanently beneficial. The

407

Moreau’s Case of Difficult Labour, tyc.

Professor candidly acknowledges, however, that he has not found it invariably successful, but attributes the failure to the hopelessness of the case. He has not found its employment objected to in private practice; considers it far superior in efficacy and convenience to ammoniacal liniment, blister, cautery, or seton ; and adds that, if required, the sore resulting from its application may be transformed into a permanent drain by the introduction of a pea.

Case of difficult Labour from the Presence of a Tumour in the Pelvic Cavity. By Dr. Moreau. — A woman, aged 36, in the eighth month of her fifth pregnancy, was attacked with profuse haemorrhage, which recurred several times, and in¬ duced great debility. It arose from separation of the pla¬ centa on the left side of the uterus. But the principal and most important feature of the case was the existence of a firm and slightly moveable tumour, occupying at least two thirds of the pelvic cavity, at its posterior and superior part, apparently situated between the rectum, vagina, uterus, and right side of the pelvis, and extending so as to fill the whole right iliac fossa. The turning of the child was no sooner determined on, than executed. On the passage of the head through the superior pelvic aperture, the tumour, which had been elevated, redescended and opposed its descent. The operator, by re-introduction of his hand, thrust up the tumour again towards the iliac fossa, and extracted the child alive. It survived but four days. The mother speedily recovered. The tumour preserved, after delivery, its original volume and relations. It was apparently formed by the right ovary. The uterus was situated in the left iliac fossa. Six weeks afterwards, this organ had resumed its natural site and dimensions. The tumour retained its former position, den¬ sity, and volume.

The “ report” of M. Bedard on the preceding case con¬ sists in a brief review of the leading facts which it presents, and an historical notice of twenty similar cases : in seven of which it appears the women perfectly recovered ; in three, imperfectly; and in the other ten, died. Four of the children were born alive, but one of them not viable ; the remaining sixteen dead. The reporter concludes with drawing from the facts thus accumulated the following inferences :• — That the tumours in question claim, from the obscurity of their diagnosis, the attention of Practitioners ; that when the tumour occupies greater part of the pelvis, neither turning nor cephalotomy will avail; that the elevation of the tumour, when moveable, should always be practised, two of the women and children, in the cases noticed, having apparently been preserved by this practice; that the opening of the

408

Foreign Medical Science and Literature .

tumour is of great importance, five of the nine recovered women, and two of the four children born alive, having been saved by this measure : and lastly, that in some cases, those wherein the tumour, occupying the whole pelvis, is not diminished by incision, the Cesarean section may constitute the only resource.

Journal of Practice, of Medicine. By Hufkland.

(German).

April 1819* Sporadic and Epidemic Diseases which have prevailed in and around Ratisbon , during the year 1818. Observed by Dr. Jacob Schaeffer. — Of all the numerous and interesting facts consigned in this long paper, it will, we fear, be impossible to render a satisfactory analysis here. We intend, therefore, shortly to present a nearly literal transcript of it in another department of our Journal.

Ideas , Remarks , and Observations , on the Effects of Chaly¬ beate Baths, and particularly with respect to those of the Baths of Alexis, on the Human Organism. By Dr, Curtze.— A long, and, to the English reader, by no means important communi¬ cation. The general ideas entertained by ihe author respect¬ ing the operation of iron upon our organism, are more speculative than practical. The conclusion which he draws is, that when the irritability has been reduced in the system either primarily or secondarily, and the reduction is such as to require the administration of chalybeate remedies, their external use in the form of baths is preferable to their internal employment.

The most recent Proceedings in England , on the Preservative Efficacy of Vaccination. Translated from the Edinburgh Journal — By Dr. Hecker.

Short Notices and Extracts. — The first of these is a Notice of several new Dispositions of the Baths at Eger: interesting only to the continental invalid. The second, A Translation of Dr. Abercrombie’s Observations on the Utility of Blood-letting in certain Forms of Dropsy J*. I he third, A Confirmation of the Efficacy of the Internal Employment of Carbonate of Potash in Croup. By Dr. Hell wag. —No facts are detailed. The note is rather a defence of the author’s practice and opinions against the attacks of Dr. Fischer. Two of the author’s professional friends are said to have employed the carbonate of potash in croup with great success. Fourth, Literary Notices.

May.— A very uncommon Case of total Deficiency of the

* July 1818.

t Edinburgh Journal, April 1818.

409

Menstruation without Uterus, fyc.

Uterus , observed in the Operation undertaken to remedy a supposed Contraction , and published as a Caution in similar Trials. By Professor Stein. — The title of this paper so far indicates its nature and import, as to preclude the necessity of following the author through the long details into which he has entered. The subject of it, a lady aged 24, and five years married, had never menstruated, although the supposed symptoms of the impending evacuation had occasionally been felt. Her health, good at the time of marriage, speedily afterwards declined. Frequent syncope, and thoracic op¬ pression on climbing any ascent. Medicine tried in vain. On examination, the vagina was pronounnced to be obliterated by a strong hymen. Dr. Stein, consequently consulted, found that the patient exhibited all the moral and physical characters of the female sex in an eminent degree ; and that obliteration actually existed. An attempt to remove it by incision failed. This led to more minute investigation ; reiterated efforts terminating in disappointment, and dis¬ covery of the fact announced in the title. A soft and nearly insensible substance, possessing the consistence of liver, appeared to occupy the situation of the uterus. The in¬ cision speedily healed; and the subsequent amelioration of the patient’s health was attributed to the haemorrhage which i had taken place in one of the operations.

After the quotation of some analogous cases from the writings of Engel, Schmucker, and Theden, Dr. Stein ter¬ minates his communication by establishing the following inferences: — 1. Obscure and periodical efforts of menstrua¬ tion constitute no proof of the existence of an uterus. 2. The method proposed by Engel, of ascertaining the existence of this organ by introduction of a finger into the rectum and ja catheter into the bladder, and the inference consequently drawn from the space which separates them, is by no means decisive; since the uterus, as in the case just recorded, may be j replaced by a fleshy mass, which would render completely delusive such an investigation. 3. The degree of develop¬ ment in the external (genital) parts, forms no certain ground of diagnosis in these cases. 4. 1 he less resemblance the | part closing the vagina bears to the hymen, and the more it assumes the form of a sac, and particularly if tne sac I be directed from behind forwards, the more strongly is any attempt at an operation contradicted.

Epidemic and Sporadic Diseases , fyc. By Dr. Schaeffer.— The conclusion of the memoir commenced in the last Number; and comprehending a report of the diseases in and about Ratisbon, during the last three months of 1818.

History oj an Operation wherein the Ribs and Pleura were VOL. xiv. — NO. 83. 3 6

410

Foreign Medical Science and Literature.

removed , and the Heart laid bare , fyc.—An account of the celebrated operation of Richerand. From the French.

Remarkable History of a Disease induced by the Intro¬ duction into the Lungs of an Ear of Rye, which was afterwards fortunately expelled by Suppuration . By Dr. Marikowszky. — A girl, aged nearly four, swallowed, at play, May 18, 1818, an ear of rye. Violent cough and retching succeeded. Evening, rigors alternating with heat; cough. Cinchona and valerian, administered under the suspicion that the symptoms arose from worms, produced the expulsion of one next day, without any diminution of the cough or fever. An emetic productive of transient relief. Expectoration of florid blood; pain in the right side; dyspnoea ; heat and thirst; suffocation impending. 15th. The author, first summoned, found the child in the following state: — Face and eyes red; tongue white, dry; appetite gone; urgent thirst; dyspnoea; pain in right side; violent cough with haemoptysis; pulse rapid, small, hard ; skin moist and warm ; urine red ; faeces natural. The child could lie on the right side only, and for a short time. RecJination on the back easiest. Leeches, emollient fomentations, and antiphlogistic plan, prescribed. These symptoms continued with little variation, (saving the accession of a puriform expectoration, and great debility, to combat which, cinchona was directed), till the 28th. On that day, a swelling of the volume of a pigeon’s egg was dis¬ covered, inflamed and painful, between the sixth and seventh right ribs. Under the application of emollient poultices, it broke, on the 2d of June, and gave issue to a considerable quantity of pus. A foreign body presenting at the orifice, was extracted, and proved to be an ear of rye, one inch and a half long. From this moment, the symptoms gradually declined ; wound healed on the eighth day ; and the child perfectly recovered.

Review of the most important Chemical Discoveries relative to Medicine , Pharmacy , and the Arts, which have been made during 181 8.— — ' Translated from the French*.

Short Notices and Extracts comprehend an account of the Celebration of a Fete in honour of J earner, at Berlin, May 14, 1819.— From the statement then delivered, it appears that during the year 1817, the number of vaccinations amounted to 307,596 in the Prussian dominions. From Dusseldorf and several other places, however, no report had, at the date of this annunciation, been received. Dr. Ure’s Experiments on the Glasgow Criminal ; and two other articles, of English origin.

* Journal General de Medecine, Decembre 1818.

A visard’s Cases of Softening of the Brain. 41 1

II. Select Cases, Memoirs, &c.

PATHOLOGY (INCLUDING MORBID ANATOMY) AND PRACTICE OF MEDICINE

I. Cases of Cerebral Fever , or Softening of the Brain*. — A French journal, just received, contains the following cases by Dr. Avisard : —

First Case. — Subject, a tailor, long subject to haematuria, recurring at intervals. January, 1818, the haemorrhage returned, but immediately ceased. Urine turbid for several days. Soon afterwards, memory impaired ; deep-seated pain of the forehead; appetite good. On admission into PHotel- Dieu, face pale ; left angle of the mouth drawn back ; tongue straight; speech free ; replies correct, but slow; recollection contused; sensibility blunted; movement difficult; pulse small, firm; sleep good; memory gradually lost; cheeks flushed at night, without pyrexia. Died suddenly, February 27th. Treatment, leeches to the anus, blister on the nucha. — Dissection. — Cranium. Membranous, adherent to anterior and external part of left hemisphere. Left anterior lobe yellowish, softened, cream-like; but cortical substance presenting scirrhous induration, and remarkably dense at the point of adhesion to the membranes. The middle and posterior lobes and whole right hemisphere minutely injected. Little serum in the ventricles.- — Abdomen. Parietes of bladder thickened, and exhibiting numerous fleshy bundles. Mucous membrane streaked with red. Veins unusually numerous and dilated. Other organs sound.

Second Case. — A woman, aged seventy, brought senseless to FHotel-Dieu, January, 1818. Face pale; right extremities completely insensible; left nearly so; pulse scarcely per¬ ceptible ; whole body quite cold. Died during night. Had been ill a week, and taken repeated emetics. — Dissection.

■ — Cranium. Jelly-like softening of whole left hemisphere, with exception of extremities of the anterior and posterior lobes ? and circumscribed by a pale red line; parts beyond this presenting numerous red points. Right hemisphere sound. Ventricles and occipital fossae containing much limpid reddish serum. — Abdomen. Stomach much con¬ tracted ; its mucous membrane, and that of duodenum, streaked and patched with red.

Third Case.— A woman, aged eighty, brought to lTIotel- Dieu, in December, 1818, with loss, for the last fortnight, of intellect and motion; sensibility impaired; conjunctive in¬ jected; pupils contracted; cheeks flushed; skin warm;

* Bulletin de l’Athenee de Medecine de Paris, Mai 1820.

412

Foreign Medical Science and Literature.

pulse frequent, firm ; fore-arm contracted on the arm. Emetic tartar had been repeatedly given without effect. Leeches to the neck. Fifth day, dyspnoea; epigastrium painful on pressure; abdomen tumefied. Death next day. — Dissection. — Cranium. Arachnoid and pia mater minutely injected, and ecchymosed in several points, and adherent to the brain and dura mater. Whole right hemisphere reduced to a pulp of such fluidity as to escape on division of the cortical substance. Opposite hemisphere sound. Ven¬ tricles and occipital fossae containing much reddish and puriform fluid . — Abdomen. Stomach and small intestines distended with gas; their mucous membrane exhibiting large red patches. Other abdominal and thoracic viscera sound.

Dr. Avisard, reverting to the redness exhibited by the gastro-intestinal membrane in the two latter of the preceding cases, in both of which emetics had been repeatedly ad¬ ministered, attributes it to the operation of this remedy, and takes occasion to denounce its indiscriminate employment. He considers the morbid alteration here described as a consequence of the process of inflammation; and intimates that the term cephalitis might be more correctly applicable to it than either of those which he has prefixed. The u Report v of M. Vallerand de la Fosse contains little more than a recapitulation of the facts just detailed.

II. Memoir on Senile Rupture of the Heart . — To the interesting cases of ruptured heart presented in our last Number*, the following memoir, by Dr. Bland, will form

* Page 333. Another writer. Dr. Taxil St. Vincent, has also just published, “ Cases of Complete and Spontaneous Rupture of the left Ventricle of the Heart; with Reflections on its Causes.” The two facts contained in the paper, and alone worthy of being placed on record, we shall briefly transcribe : —

First Case.— June 180b. A lunatic, aged sixty, of robust constitu¬ tion and impetuous character, died suddenly in perfect health. — Dis¬ section. Brain and lungs sound. Pericardium distended with semi- coagulated blood. An oblique rupture of the floor of the aortic ventricle, implicating its whole substance, patent, and extending interiorly, in a transverse direction, the length of ten lines ; structure otherwise unaltered. Aorta and its valves natural ; heart empty. Abdomen sound.

Second Case. — April 1820. A robust, corpulent, healthy man, aged seventy-one, died suddenly in a swoon. — Dissection. Enormous quantity of semi-coagulated blood in the pericardium. Rupture of the right or anterior border of the heart; internally transverse, irregular, eight lines long, arid two wide, commencing at the inferior paries, and near the base of the aortic ventricle, taking an oblique

413

Bland on Senile Rupture of the Heart.

no inappropriate addition*. We shall trace it with all possible brevity.

Man, in the decline of life, is subject to a kind of rupture of the heart, dependant on a peculiar cause. Hence it is denominated senile rupture. The author, in his memoir, proposes, first, to demonstrate by facts the existence of this organic lesion ; secondly, to indicate its causes and me¬ chanism ; thirdly, to expose its signs and diagnosis ; fourthly, to establish its prognosis; and, fifthly, to inquire the prophy¬ lactic or curative means best calculated to prevent its occur¬ rence, or arrest its progress.

Article First. — Cases demonstrating the Existence of Senile Rupture of the Heart.

First Case. — March 21. 1805, a healthy man, aged eighty- six, felt, at night, severe pain, heat, and weight in the cardiac region ; inexpressible anxiety, oppression, debility ; sudden paleness; death. — Dissection , twenty-four hours after. Surface discoloured ; lips whitish violet. Brain and lungs sound. Pericardium distended with blood; left cardiac ventricle obliquely ruptured in its anterior region for about an inch ; this extent diminishing as it approached the interior of the ventricles, the irregular and fringed aperture into which barely admitted the little finger. Structure of the heart, and principally its left ventricle, soft, flaccid, greyish, converted into a peculiar gelatiniform mass, wherein the figure and direction of the muscular fibres were no longer distinguish¬ able; no extenuation. Arterial system empty; right cardiac cavities, and venous system, containing a little blackish semi-coagulated blood.

Second Case. — A male subject, aged fifty-eight, addicted to venery, and suffering from obstructed respiration con¬ sequent on nasal polypus. Symptoms, November, 1812:

direction, and terminating on the right, at the border adjacent to the base of the heart ; completely plugged by an unadherent fibrinous concretion. Substance of the heart, without any distinct organic alteration, flaccid, pale, readily lacerable, as in most aged subjects; but not thinner than usual. Aorta and its valves unchanged. Organs of the cranium and abdomen quite sound.

No sensible phenomenon, the author adds, had occurred during life, or previously to anatomical inspection, which could afford the slightest suspicion respecting the formation of the rupture in these cases. Both subjects had died suddenly, without any previous moral agitation, without complaint, without convulsion, and even without struggle. There is nothing novel or satisfactory in the author’s attempted explanation of the causes of cardiac rupture, or the mechanism by which it is effected. — See Journal Universel des Sciences Medicates, Septembre 1820.

* Bulletin de l’Athen6e de M6decine de Paris, Mars, 1820.

414 Foreign Medical Science and Literature.

painful constriction of the cardiac region recurring irregu¬ larly ; internal presentiment of death ; anxiety ; died, after violent efforts to vomit, on the tenth day. — Dissection, thirty hours after. Pericardium filled with blackish and partly coagulated blood. Right cardiac ventricle ruptured at its point and anteriorly about an inch, in direction of its fibres; a similar lesion at the anterior, middle, and inferior part of left ventricle. Two other incomplete ruptures of the left, and one of the right ventricle, situated near the former, and parallel in direction to the muscular fibres. Structure of heart naturally thick, but pale red, soft, flaccid, readily lacerable. Form and direction of fibres yet visible, and steeped in a sere-gelatinous fluid. Cavities and large blood¬ vessels empty. Brain, lungs, &c. sound.

Third Case. — -Subject, a male, aged eighty-four, spare and healthy, with exception of chronic pulmonary catarrh. Seized suddenly, while walking, April, 1814, with great weakness ; exclaimed that he was dying ; placed his hand on the cardiac region, and instantly expired. — Dissection , thirty hours after. Some blackish concretions in the cerebral sinuses. Lungs adherent. Pericardium distended with blackish semi-coagulated blood. Left cardiac ventricle rup¬ tured transversely, for about an inch, in the centre of its anterior region: parietes naturally thick, but soft, flaccid, reddish ash-coloured, breaking down under the finger with extreme facility. Muscular fibres less apparent than in the preceding cases. Cavities, as well as larger arteries and veins, empty.

Fourth Case.— -A man, aged seventy-six, long subject to chronic pulmonary catarrh, July, 1819? suddenly seized, after having made his bed, with sense of weight and heat about the heart; relieved byr rest. Soon afterwards, while stooping, swooned, fell, and instantly expired. The dis¬ coloured countenance, white lips, and cold extremities, indicated rupture of the heart. — Dissection, thirty-eight hours after. State of the brain same as m last case. Lungs crepitous, loaded with mucus. Pericardium dis¬ tended with black fluid blood and coagula; right cardiac ventricle extenuated, dilated, and ruptured transversely, for one inch and a half, in its posterior region; borders of rupture irregular and fringed. Cavities empty; whole structure pale red, soft, and similar to that in the former cases. The father of this subject died suddenly, at the same age, and probably from the same organic lesion.

Article Second.— Of the Causes and Mechanism of Senile Rupture , fyc. — The essential cause of this accident is the gelatiniform degeneration of the structure of the heart, in¬ variably recognized in the cases just detailed, which disables

415

Bland on Senile Rupt ure of the Heart.

this organ from re-acting efficiently on the blood, and allows its over-distention by the fluid. This is not a real morbid affection, but is directly and inevitably dependent on the nature of the functions of the heart, and hence an almost invariable concomitant of old age. It is developed with the more promptitude in proportion as the heart’s contrac¬ tions are more violently and frequently super-excited ; and consequently may be determined, or accelerated, by a number of secondary causes, capable of augmenting these con¬ tractions. 1 he principal of such secondary causes are, 1. Individual constitution, considered either in its effects on the motions or on the organization of the heart. 2. Sti¬ mulant food; abuse of spirits; every kind of intemperance. 3. Laborious occupations and professions. 4. Tumultuous passions; exercise of the dramatic art; excess in venery. 5. All diseases, such as nasal polypi and chronic pulmonary catarrh, which, by habitually impeding respiration, and accelerating its mechanical movements, unduly excite the contractions of the heart. This degeneration once esta¬ blished, the consequent rupture may either be spontaneous, or determined by some efficient cause, as a fit of passion or coughing, vomiting, or other effort, in which respiration is for a while suspended. When spontaneous, the fibres of the heart, at the point of rupture, yield simply, from atony, to the natural efforts of the blood distending them beyond the sphere of their molecular attraction ; but when dependent on any of the efficient causes just exposed to the efforts of the blood on the heart’s parietes, must be added those of the excess of this fluid, which accumulates in it by the mechanism of the action of the same causes — a new power generally render¬ ing the rupture more prompt and considerable. Whether spon¬ taneous or accidental, the rupture may be complete or incom¬ plete, prompt or progressively effected. Numerous varieties, in this respect, may arise from the individual constitution, the degree of softening of the organ, and activity of the efficient cause. However this be, the rupture invariably commences in the exterior fibres, as may be seen by its decreasing extent in proportion as it approaches the cavities of the heart. It may occur transversely, obliquely, or in the direction of the muscular fibres. The two first forms take place only when the degeneration is complete, and then the rupture is com¬ monly sudden. The third is rather a separation of the fibres than real rupture; and is the effect of constant impulse of the blood on the weakened parietes of the heart. Vertical fissures form on its external surface, and become gradually deeper till they penetrate into its cavities. Extravasation into the pericardium and death rapidly ensue.

416

Foreign Medical Science and Literature .

Article Third . — On the Signs and Diagnosis of Senile Rup¬ ture, fyc. — The precursory signs of this lesion are, weak, small, frequent pulse ; habitual cough and oppression, and loaded state of the venous facial capillaries; and admit of ready explanation. Those which occur at the moment of rupture, sudden sense of burning heat, pain, constriction, and weight about the heart, with extreme anxiety and weakness, paleness and change of countenance ; frequent and small pulse, soon becoming extinct. Sometimes these symptoms subside, and the patient experiences a transient relief. In this case, the rupture, from resistance of some of the muscular fibres, remains incomplete; but the lesion soon resumes its fatal progress ; and death ensues. In other instances, the rupture is suddenly effected ; and the blood extravasated with ex¬ treme rapidity. The body, in either case, becomes dis¬ coloured; face pale; lips violet-coloured or whitish; ex¬ tremities instantly cold ; and the body transformed at once into a real corpse. On dissection, the morbid appearances described in the preceding cases are discovered*. The volume of the heart and thickness of its ventricular parietes are commonly unchanged. Sometimes these parietes, and particularly those of the right ventricle, are extenuated and dilated.

The diseases with which this lesion may be confounded are apoplexy, paralysis of the heart, and nervous and asthenic syncope. From the first it may be distinguished by the immediate cessation of pulse, and sudden loss of colour of the face, and of heat in the extremities; from the second , by the non-occurrence of feeble pulse and frequent lipothymia long before, and by the sense of heat and local pain immediately preceding the syncope; and from the third, which, moreover, commonly soon yield to appropriate treat¬ ment, by the invariable presence of the two latter symptoms (pain and heat) in the cardiac region.

Article Fourth . — On the Prognosis of Senile Rupture , <5fc.— Generally unfavourable. When, however, the rupture is incomplete, the patient may survive for a while, according to the direction and extent of the rupture and the energy of the causes capable of accelerating its progress. If the rupture, for instance, have taken place in the direction of the muscular fibres, they will resist, to a certain point, the impulse of the blood, and the patient may live for a considerable time,

* The muscular fibres, their form and direction most frequently distinguishable, are softened, loaded with a gelatinous serum, and converted into a greyish semi-transparent substance, resembling that of atonic ulcers.

Bland on Senile Rupture of the Heart. 417

particularly if the rupture be slight, and its progress slow^. But if it be transverse, it announces utter degeneration of the structure of the heart, and will commonly prove at once fatal. Death will obviously be prompt if the rupture be considerable; and slow, if it be small. It is even possible, that, in the latter case, the breach may be obstructed by a coagulum, and form a real cicatrix. Lastly, in incomplete rupture, the prognosis will be the more unfavourable in proportion as the patient is exposed to the influence of all the physical and moral causes which affect the functions of the heart.

Article Fifth . — Of the Means best calculated to prevent the Occurrence, or arrest the Progress , of Senile Rupture , Sc. — The prophylactic means are those which may obviate or retard the atonic softening of the heart, and those capable of opposing its inordinate contractions when such softening already exists. Both consist in avoiding, or removing, all causes that may unduly accelerate the action of its fibres. When the rupture has actually taken place, we should distinguish whether it be complete or incomplete. In the first case, immediate death is inevitable, unless the breach be so small as to admit of obliteration by a coagulum ; in the latter, life may be for awhile prolonged: and if the rent be slight, and the fibres sufficiently strong and numerous to resist the impulse of the blood, it is possible that, under the influence of perfect repose abstinence, and exemption from all causes of excitement, the rupture may be arrested, and the divided parts completely cicatrize.

III. Inflammation of Arteries. — This affection has not hitherto been sufficiently observed to allow of our tracing its general history with correctness. Most of the insulated facts, found in the writings of authors, contain little or nothing respecting the symptoms which existed during life. .Franck is the first who has referred to this cause the

* The second case offers an example of these two circumstances. The five ruptures on the ventricles were certainly interior to the moment of death, which only took place when they became complete. That this was but slowly effected, is proved by the interval between the development of the first symptoms and the extinction of life.

t In the fourth case, reclination, by favouring the entrance of the blood into the pulmonary artery and aorta, and thus relieving the heart, produced an amendment which announced suspension of the rupture: and the lesion was only reproduced during a situation of the body whereby blood was accumulated in the ventricles. The rupture, which, in the second case, had commenced some days, was only completely effected after a violent effort of vomiting.

VOL. XIV. — NO. 83. 3 H

418

Foreign Medical Science and Literature .

development of a peculiar kind of inflammatory fever # ; and Portal records an instance of inflammation of the internal aortic membrane, consequent on sudden retrocession of measles in a young man, who died, in a few days, with symptoms of suffocation, and violent palpitation of the heart. The vessel was throughout extremely red ; its parietes tumefied and soft, particularly in the thoracic region, where it was covered with varicose vessels. The same writer adds, that he has ec several times found the aorta inflamed in subjects, the history of whose disease was wholly unknown to him T.

In July, 1819, M. Dalbant, of Grenoble, presented to the Faculty of Medicine, of Paris, a Thesis on Arteritis j, con¬ taining flve cases of inflammation of the arterial coats. By Mr. Hodgson one case of this nature is described, and three others are cursorily adverted to |j . M. Vaidy has recently consigned, in one of the French journals, an interest¬ ing example of it, which we have already noticed §. But the history which we are about to transcribe is, perhaps, the most complete that has hitherto appeared. The author of it is M. Bard e IT-

The subject of it, after long exposure to fatigue and atmospheric vicissitudes, in the army, w?as attacked, at the age of twentyr-seven, with acute rheumatism of the lower extremities, which gave way to local blood-letting and cataplasms. Seven months afterwards, March, 1816, pains in the epigastrium and between the shoulders, with frequent dry cough. July, symptoms aggravated; violent palpitations of the heart. March, 1817, symptoms exacerbated: pal¬ pitation increased on the slightest exercise ; cough more frequent; irregular rigors, followed by heat; constriction of the epigastrium. After some days, intense headach ; continued fever ; pulse, full, strong, frequent, and in the superficial arteries visible; internal sense of heat; surface natural; countenance pale; appetite for cold food and acids unimpaired. Some relief obtained from repeated application of leeches to the anus, and abstinence. Still the oppression was reproduced, and pains and palpitations aggravated, by

* Corvisart, Essai sur les Maladies du Cceur, p. 351.

t Cours d’Anatomie Medicale, tom. iii. pp. 127, 128. t Quelques Observations pour servir h ITIistoire de fArterite, on Inflammation des Arteres. These presentee, &c. le 2 9 Juillet, ISlfl.

j| Treatise on Diseases, &c. pp. 5, 6.

§ Repository, Vol. XIII. p. 517* * * § — From Journal Complement air e, Aoftt, 18ip.

IT Revue Medicale, Historique, et Philosophique. Mai, 1820.

419

Barde’s Case of Arteries.

slightest exertion. Counter-irritants on the chest, and per¬ manent blister on the left arm, again mitigated the dyspnoea and palpitations. In the summer of 1818, the disease assumed a more alarming aspect. Thoracic oppression very severe; cough frequent., rending, and recurring in paroxysms; reclination only practicable in a state of semi-flexion; pulsa¬ tions of external carotid and all the superficial arteries visible at a distance ; those of the heart extensive, and elevating, at each stroke, the epigastric parietes. Things continued in this way, with the addition of emaciation, general oedema, syncope, and all the signs of thoracic effusion, till May, 1819, when the skin, in different parts, exhibited a whealed appearance. Death on the sixth.- — Venesection had been repeatedly employed, with benefit, during the progress of the disease. The blood on one occasion showed, immediately after its emission, a very thick white inflammatory crust. Dissection. — -A considerable quantity of serum in the pleura, pericardium, and peritonaeum. Some suppurating tubercles in the lungs. Heart unnaturally large ; all its cavities dilated ; their investing membrane brownish, smeared with brownish mucus, and exhibiting deep red patches. Internal membrane, on detaching the mucus, found destroyed in the situation of these patches; but elsewhere sensibly thickened, and inseparably adherent to the muscular substance. The valves, particularly those of the right ventricle, filled with a reddish mucus. The ascend¬ ing aorta, carotids, and their facial and cerebral branches, subclavian, brachial, and digital arteries, bad their internal membrane thickened, indurated, of deep red colour, and covered with a whitish pus. A stratum of yellow and tolerably consistent serous matter (serosite) between the fibrous and internal coats. Same morbid changes in the pulmonary arteries and veins. Decided traces of inflam¬ mation, thickening, and redness, in the internal membrane of the abdominal aorta and its divisions, as far as the hypogastric and crural arteries, where they insensibly de¬ creased. The trunks of the venae cavce, from the subclavian vein above to the diaphragm below, highly inflamed: their internal membrane and valves thickened, red, and rupturing with facility. Mucous membrane of pharynx and oesophagus covered with a layer of viscid mucus resembling wine lees, and readily detached ; membrane below loaded with purulent serum. Gastric and intestinal mucous membrane reddish, tender; its vessels minutely injected. Liver very large; spleen small. Large omentum red ; its vessels dilated, and internally inflamed^ Small omentum of a deep brown red

420 Foreign Medical Science and Literature.

colour, readily lacerable ; its vessels loaded and unusually res is tent.

Arteritis, as seen in Dalbant5 s three first cases, is sometimes consequent on great surgical operations. At other times it is spontaneously, and without evident cause, developed, as in the two last cases detailed by Dalbant, and those by Vaidy and Barde. But one remarkable circumstance is the difference of symptoms observed in this affection. Thus, in the cases recorded by Dalbant and Vaidy the pulse was small and irregular ; while in the preceding instance it was invariably hard, full, and frequent. According to Franck, arteritis always gives rise to symptoms of inflammatory fever. Dalbant, on the contrary, remarks the prostration of strength and signs of asthenic fever attendant on it. But the latter, it should be observed, has seen inflammation of the arteries ensue from a surgical operation, or induce itself a new disease, calculated rapidly to exhaust the system. This particularly occurred in the fifth case; the subject of which is gangrene of the right abdominal extremity, in consequence of inflammation of the crural artery and vein, with formation of a false membrane in the interior of the artery*.

SURGERY.

IV. Pericardiac Dropsy cured by Introduction of a Scion in the Region of the Heart, and succeeded by fatal Caries of the first Cervical Vertebrae V- By Dr. Patissier. — A delicate man, aged twenty-two, had his thorax and left leg crushed by the passage of the wheels of a chariot over them, in November,

* Dalbant regards the redness of the internal membrane of arteries as invariably indicating the existence of inflammation ; and adds that, out of eighty-one subjects, who, during the first half-year of 1818, died at l’Hotel-Dieu, twenty-eight presented this appearance in different degrees. If this character were alone sufficient to establish the existence of inflammation, arteritis would not be so rare a disease as is at present imagined. Mr. Hodgson, however, throws great doubt on this opinion; and assigns very satisfactory reasons for such dissent, (see his Treatise, p. 8 ;) and Laennec, whose work has appeared subsequently to the Thesis of Dalbant, perfectly concurs with Mr. Hodgson. It is somewhat curious that Dalbant, in his fourth case, which he acknowledges that he examined in M. Laennec’s ward, at lTIopital-Necker, describes the internal membrane of the vessel as irregularly thickened: while Laennec himself, who attends at all the dissections made in his hospital, expressly asserts, that he has never observed redness with thickening of the internal arterial membrane.

f Journal Complementaire du Dictionnaire, &c. Janvier, 1820.

Sanson’s Recto-Vesical Operation of Lithotomy . 421

1815. Entero-mesenteric fever, with feeble, quick, irregular pulse, and diarrhoea, ensued in December, and was removed by tonics and external excitants. Afterwards, all the symp¬ toms of pericardiac effusion were progressively developed. Extensive blistering and diuretics were unavailing. A scton was then introduced ; and a week had -scarcely elapsed when the respiration was relieved, the action of the heart again sensible, and almost the whole of the region occupied by it perfectly sonorous. A tumour which had formed in the left leg suppurated; and in May, 1816, all the symptoms of pericardiac dropsy had disappeared. Another abscess, formed on the left leg and opened by incision, had nearly cicatrized, when pains in the nucha were complained oh They had previously occurred and been relieved by blistering. Daily increasing, they rendered difficult the action of the jaw and deglutition, and impeded respiration and the motions of the neck. A tumour was found in the mouth, thrusting forwards the pharynx, and approaching the posterior nasal orifices. Caries of the cervical vertebrae was suspected; and a seton introduced, but in vain. Suffocation impending, a bistoury was plunged into the firm and hard tumour; a few drops of blood only escaped. Extreme debility; dys¬ phagia. Death in September. — Dissection. Great emacia¬ tion. Body of atlas, advanced before that of the dentata, elevating the posterior part of pharynx, and forming the tumour in question. Condyles of the occipital bone and first cervical vertebrae carious. Cellular membrane between these vertebrae and pharynx tumefied and filled with pus. Left pleura adherent. Pericardium united to the heart, in some points closely, in others by tender filaments. A yellowish plastery substance on the anterior surface of tue heart. Intestines rather contracted. Some of the mesen¬ teric glands enlarged ; colour red brown, and structure dense. Periosteum of the tibia thickened ; colour of the bone tarnished.

V. The Recto-vesical Operation of Lithotomy. — On the advantages of this process. Dr. Sanson published, about three years since, an interesting work ^ : and it has once been practised on a young subject, by Professor Dupuytren, witn complete success. Notwithstanding all these claims, the subject appears not to have attracted that degree oi public attention to which it is entitled. Hence we consider it our duty to communicate the result of an operation oi this nature recently undertaken by the Italian Surgeon, D i.

* DesMoyens de parvenir a laVessie par le Rectum, &c Observations. Par L. J. Sanson, D.M.P. 4to. Paris,

. Avec des

18 If.

422, Foreign Medical Science and Literature.

Barbantini, and recorded in a pamphlet^, which he has expressly written for the purpose.

A peasant, aged 50, had long suffered from vesical cal¬ culus, which by its weight and volume had depressed the lower part of the bladder, projected into the rectum, and extended from one ischium to the other. This disposition induced the author to prefer the recto-vesical to the lateral operation. With this view, he procured a long grooved staff, and pair of lithotomy-forceps with the blades broader than common. Every thing ready, and the patient conveniently ’ placed, the operator introduced into the bladder a catheter, which he confided to, an assistant: then with his left hand elevating the scrotum, and stretching the peri nasal integuments with his fore-finger and thumb, he cut the sphincter with Cheselden’s knife, the point of which had been plunged in about half an inch from the anus; and terminated the incision, particularly that of the elevated part, where the parietes of the intestine yielded a little, by depressing the edge of the instrument on a gorget of wood, introduced into the rectum, in order to protect the portion corresponding to the coccyx. Afterwards insinuating the left indicator into the wound, and employing it to direct the knife on the groove of the catheter, he made in the bladder, beyond the prostate, an incision of small extent, because the point of the instru¬ ment was stopped by the calculus, which was very large and low down. The operator then introduced his fore-finger to the stone, and conducted upon it, to a proper depth, the long grooved staff. Withdrawing the catheter, he next passed up the knife upon the groove of the staff, and gave to the incision of the bladder an extent necessary for the passage of the stone, which he fastened by its shortest diameter, with lucre Gome’s forceps, but could not extract. The calculus thus being engaged in the wound of the bladder, the operator introduced separately the blades of his other forceps T, and em¬ it r aced the concretion as high as possible with them. The extraction was at last effected, with uncommon efforts. Warm water was afterwards injected into the bladder; and some bits of charpie insinuated between the lips of the wound, in order to prevent their premature re-union. The calculus weighed nine ounces and a half. No unfavourable symptom subsequently appeared. Great care was taken to

* Di un Voluminoso Calcolo della Vesica Orinaria, operato col Taglio Retto-veseicale, &c* 8vo. pp. 26. Lucques, 1819- With an engraving.

o o

f The forceps, it seems, were made with separate blades for this purpose.

On Corrosive Sublimate .

423

obviate the too prompt cicatrization of the sphincter ani, in order to leave a free course to the faeces, and prevent their introduction into the bladder. The urine escaped from the anus for the eighteen first days, except a few drops which issued from the urethra. On the introduction of the finger at this period, the parietes of the bladder were found hard and swollen ; and some days after, small calculous concretions adherent to the internal surface of the intestine. These were all detached, with a portion of the false membrane on which they were scattered, by the finger, introduced three or four days in succession. A gum catheter, now passed into the urethra, carried off the whole of the urine, which was no longer discharged from the wound, except when mucus obstructed the instrument; and injections by it and by the wound were then employed with success. Eighty days after the operation, the patient had perfect command over his urine ; and did not perceive that any passed through the small wound, which yet remained, although the catheter had been withdrawn.

VI. Extraction of Calculi from the Prostate Gland. The following case has recently occurred to Professor Dupuytren*. A man, aged 41, after having been admitted into several hospitals, applied to 1’Hotel-Dieu, on account of divers fistulae in perinaeo, of long duration. Dupuytren, on intro¬ duction of a probe, discovered several foreign bodies, which he recognised as calculi. The patient was then sounded, and the concretions again felt, not in the bladder, but in the substance of the prostate. Incisions being made on this part in different directions, twelve articulated calculi were ex¬ tracted. No accident supervened; and the patient was perfectly cured. The concretions, analyzed by Thenard, were found to consist of 86 parts of phosphate of lime, 13 of animal matter, and some traces of carbonate of lime.

MEDICAL JURISPRUDENCE.

VII. Memoir on a new Process whereby most of the Mineral Poisons , in their Admixture with Coloured Liquids , may be detected. — (Continued from our last Number 4).

Corrosive Sublimate. — The mixture of this and wine, when its colour has been destroyed by concentrated and recently prepared chlorine, and it has been filtered, after having throwm down a sediment of chlorine and vegeto-ammal matter, is precipitated yellow by potash, white by ammonia.

* Journal Universel des Sciences Medicates, Aouf, 1820. f Repository, page 339,. From Nouveau Journal de Medecine,

Juillet. 1820.

424

Foreign Medical Science and Literature .

and black by the hydro-sulphates, just like an aqueous solution of the salt. The same phenomena occur with a mixture of sublimate and coffee similarly treated. Both mixtures, ren¬ dered colourless by chlorine, act on a bright plate of copper completely like the aqueous sublimate solution. To this, however, the following process is perhaps preferable: — A mixture of sublimate with wine or coffee is introduced into a flask, and two or three drachms of sulphuric ether poured upon it. The flask is then stopped, and slowly agitated * for about ten minutes, so as to bring the ether repeatedly in con¬ tact with all parts of the liquid. The ether takes from the wine or coffee greater part of the sublimate; and on ceasing to agitate it, the fluid divides into two strata. By pouring the whole into a funnel, the inferior stratum is then suffered to escape ; and the higher, or ethereal stratum, preserved, and evaporated in a small capsule, when the solid sublimate will be obtained. This, again dissolved in distilled water, will yield with its respective tests the ordinary precipitates. The same process may be successfully employed, when the sub¬ limate has been dissolved in alcohol, or in such a large quantity of water as to render its presence inappreciable by the usual tests. By this mean, one grain of sublimate in 1000 of distilled water may be detected. It has long been, known that sublimate is much more soluble in ether than in alcohol or water. Chaussier, in 1811 ff, announced this fact; but the process for separating sublimate from coloured fluids by ether has never before been communicated.

Acetate and Sulphate of Copper . Artificial Verdegris dis¬ solved in Water. — To mixtures of red wine and variable quantities of these salts, fluid and concentrated chlorine is added, till the whole assumes a yellow7 or greenish yellow colour: a precipitate of chlorine and vegeto-animal matter is deposited. The liquid, when filtered, is precipitated chesnut- brown by prussiate of potash, green by arsenite of potash, and black by the hydro-sulphates or hydro-sulphuric acid— characters peculiar to aqueous solutions of the salts of copper. Ammonia and potash act upon the mixture of wine and sulphate of copper, rendered colourless by chlorine, in the same way as on aqueous solution of the sulphate. Not

*' If the agitation of the two liquids were violent or long continued, or the ether in insufficient quantity, the experiment w'ould fail; for the ether would be wholly dissolved by the water, or by the coloured liquid mingled with the poison ; and consequently, the two strata of different specific gravity, on which all the success of the operation rests, would not be obtained.

f Consultations Medico-Legales.

On Tobacco .

425

so, however, with the mixture of wine and acetate of copper similarly treated. But this is of little consequence, since the re-union of the brown, green, and black precipitates, resulting from the tests above mentioned, suffices to prove the presence of a salt of copper. Sometimes the mixture of wine and cuprous salt, rendered colourless by chlorine, contains so minute a portion of the poison as not to be detected by the tests. Under such circumstances, it must be concentrated by evaporation. Coffee rapidly decomposes the salts of copper, and produces a precipitate so copious, that it is impossible to suppose the existence of such a mixture in the liquid state.

Acid Tartrate of Potash and Antimony. — Emetic tartar being decomposed and precipitated by chlorine, must be ranged among the small number of poisons which do not remain in solution after being mixed with wine or coffee and treated with chlorine. Hence the process in question is inapplicable to it.

Compounds oj Lead. — If the soluble salts of lead are not miscible with red wine or coffee, from their being decomposed by these fluids, yet as, under certain circumstances, acid wine resting on litharge, or tobacco packed in leaden boxes, may combine with a sufficiently strong dose of a compound of lead to produce deleterious effects on the human organs, it is important to indicate the method of detecting the saturnine preparation.

Red Wine. — Acid wines, which have been for some time in contact with powdered litharge, may retain their red colour, and acquire a slightly sweet astringent taste. When rendered colourless by concentrated chlorine, and filtered after the deposit of chlorine and animal matter, they scarcely afford, with the proper re-agents, any sensible precipitates. This depends on the small portion of salt of lead contained in the wines. But when the fluid has been reduced by evaporation to one- third of its volume, it is invariably precipitated white by sulphate of potash, black by the hydro-sulphates, and canary- yellow by chromate of potash. Hence the process here recommended is preferable to every other for demonstrating the presence of lead in wines*.

Tobacco. — If this have been packed in lead, and contain oxyde or subcarbonate of the metal, it should be boiled for ten minutes, with equal parts of distilled water and vinegar, in order to transform the compound into a soluble acetic, and filtered. The fluid will be so brown as -to render demonstra-

* The process recommended by authors,— and elsewhere indicated by Ortila, is very conclusive. It consists in separating the metallic lead by calcination ; but is much more tedious and difficult.

VOL. XIV. - NO. 83. 3 I

426

Foreign Medical Science and Literature .

lion of the presence of the metal by the tests before men¬ tioned impracticable ; but it may easily be effected by rendering the fluid colourless with chlorine, and treating it in the manner described for lithargized wine*.

VII h Fatal Case of Poisoning with Opium f. — June 15, 1820, a soldier swallowed two drachms of crude opium, and died in six hours and a half after. The symptoms in fifteen minutes after the accident: violent pains; sullen coun¬ tenance, with furious and menacing look ; pupil dilated ; jaw strongly set; horrible convulsions; pulse slow and strong; subsequently dyspnoea ; all the symptoms of apoplexy, ter¬ minating in fatal insensibility and drowsiness.— Treatment. Antimonial emetic, without effect; acid lemonade; irritant injections; warm effusions on the lower limbs; dry frictions; blisters on the legs ; ammoniacal liniment on the thighs. — Next day. Body stiff; red brown patches on the arms, shoulders, and nucha; face pale; mouth filled with froth, j Dissection, — Sinuses of the brain loaded with black fluid blood. Dura mater injected in several points, particularly on the right side. Cerebral arteries containing black blood. Capillaries so much developed as to yield, on incision, minute drops of black blood. Chloroid plexus varicose. Same alterations in the medulla oblongata. Heart filled with black fluid blood ; cavities and large vessels natural. Lungs loaded with blood; bronchia reddish. All the hollow7 organs of the abdomen swollen, and externally rose coloured. Stomach with red brown patches at its fundus. Cardiac orifice exhibiting black parallel lines, covered with a thin layer of whitish, granulated, concrete matter. About two pints of offensive yellowish brown fluid, of an oily appearance, without a fragment of opium, in the stomach. Intestinal mucous membrane minutely and uniformly7 injected; — the effect of congestion, not of inflammation. Some red brown patches in the rectum. Liver and spleen gorged with blood. Both omenta thin, and of an uniform rose-colour. All the larger arteries and veins filled with black blood. Kidneys and bladder sound. The author thinks that the affection of the brain, in poisoning by opium, although secondary, enjoys a principal rank in the train of morbid phenomena ; and that large blood-letting, with a view of reducing the sanguineous turgescence in these cases, is too much neglected. Several instances of its beneficial employment are briefly referred to.

* We find it impossible to terminate, consistently with our arrange¬ ments, this article in the present Number : it will be certainly com* pleted next month. — Foreign Editor.

t Journal Universel des Sciences Medicales, Septembre, 1820,

Analysis of Cevadilla. 407

Attempts to expel the poison by vomiting, after the cerebral symptoms are developed, will serve only to aggravate the con¬ gestion already existing.

ClI EMISTRY.

IX. Chemical Examination of several Vegetables of the Family of the Colchicum , and of the active Principle which they contain*. — Messrs. Pelletier and Caventou, zealously prosecuting the analysis of different medicinal substances drawn from the vegetable kingdom, have recently examined the cevadilla, veratrum album, and colchicum, with a view of separating their active principle. The results of this experi¬ ment, communicated to the Royal Academy of Sciences, we are about to transcribe.

Analysis of Cevadilla , ( Veratrum Sahadillaf.) — The seeds of this plant, treated with sulphuric ether, cold and warm, yielded a yellowish tincture, from which, on distillation, was obtained a fat yellow substance, insoluble in water, soluble in alcohol, imparting a red colour to tincture of litmus, and pos¬ sessing a strong and peculiar odour. This substance is a com¬ pound ol fat and of a new and peculiar acid, to which the authors have given the name of cevadic acid. The characters of it are, chrystalline needles, or concretions of a very tine white colour, soluble in water, with a smell nearly resembling that of butiric acid, melting at 20° + 0, sub¬ liming at a more elevated temperature, soluble in alcohol and ether, combining and forming, with salifiable bases, salts somewhat odorous.

Treated afterwards with boiling alcohol, they yield suc¬ cessively, wax, a little fat matter, a colouring principle, and a new alkaline substance, which has received the name of veratrine. This is white, pulverulent, inodorous, and excites, even in minute doses, copious vomiting. From the experi¬ ments instituted on animals, it appears that a few grains of this substance will destroy life. Nearly insoluble in cold

* Annales de Chimie et de Physique, Mai, 1820. t Jn a late Number of the Repository we have given an account of a new vegetable alkali obtained bv Dr. Meissner from cevadilla,

‘ZJ *J

(H epository for August, page ld3). In a letter addressed by Pelletier to Cadet, the former Chemist expresses his astonishment that a discovery, made more than a year since, by himself and Caventou, should thus have been publicly announced by the learned German as bis own. The sebadilline of Meissner thus turns out to be the veratrine of the French Chemists ; and exists in at least two other plants of the same family. Pelletier also claims, in behalf of MM. Lassaigne and Fenculle, the discovery of delphine, at present attributed to Brande. — Journal de Pharmacie , Mai, 1 820.

428 Foreign Medical Scmice and Literature .

and warm water; it is very soluble in alcohol and ether ; and melts at the temperature of 50° 4- 0, It restores the blue colour of litmus paper, reddened by an acid. In the cevadilia, treated with water, gum and ligneous matter are afterwards found. The following, then, are the results of the analysis of cevadilia: — A fatty matter, composed of elaine, stearine, and cevadic acid; wax; acid gallate of veratrine; yellow colouring matter; gum; and woody matter. The ashes are composed of subcarbonate of potash, subcarbonate of lime, phosphate of lime, muriate of potash, and silex.

Analysis of the Root of T eratrum Album. — ■ Subjected to a similar process, this root was found to consist of fatty matter, composed of elaine, stearine, and volatile acid ; acid gallate of veratrine; yellow colouring matter; starch; ligneous sub¬ stance; and gum. The ashes, subcarbonate of lime, phos¬ phate of lime, subcarbonate of potash, silex, and sulphate of lime.

Analysis of the Bulbs of Colchicum Autumnale . — The results of the analysis of this root are, fatty matter, composed of elaine, stearine, volatile acid ; acid gallate of veratrine ; yellow colouring matter; gum; starch; inuiine* in abun¬ dance; woody substance. The ashes are in too minute a quantity to merit attention.

From this examination, it appears that the cedavilla, veratrum album, and colchicum, owe their properties, in great part, to a new alkali, called veratrine.

BIBLIOGRAPHY.

X. New Work on Surgical Anatomy^. — Professor Remur, after many trials to demonstrate, in a correct manner, the relative situations of the various organs and their containing cavities, has conceived, and executed with success, the process of freezing dead bodies; and has just published, under the title of Exposition of the exact Situation of the Internal Parts of the Human Body, a series of coloured engravings, executed with great care, and accompanied with proper explanations. This work presents obvious advantages with respect to the practice of surgical operations.

* The inuline appears to exist in the root of colchicum in in¬ separable combination with starch.

f Nouveau Journal de Medecine, Mai, 1820.

Medical and Physical Intelligence.

429

PART V.

MEDICAL AND PHYSICAL INTELLIGENCE.

TO THE EDITORS OF THE LONDON MEDICAL REPOSITORY.

Gentlemen, — My attention has been drawn, in a particular manner, to the paper on colchicum, by Mr. Thomson, which appeared in your last Number; not only on account of the interest which I have taken in the in¬ vestigation of this root, but because a feeling of personal satisfaction arises from the consideration, that Mr. Thomson’s useful inquiry may have been prompted by a communication which I had the pleasure to make to him on this subject, in conversation, at some time during the last year.

I perfectly agree with Mr. Thomson in the position, “ that those specimens of any medicinal plants, in which the components can be preserved in a state the nearest to that which they hold before dried, must be the most effi¬ cacious and certain in their remedial properties but I am of opinion that the method of drying colchicum used by me, is better calculated to produce the desired end, in respect of this root, than the method which is recom¬ mended by Mr. Thomson.

Mr. Thomson recommends that the transverse slices, into which the fresh bulb is proposed to be cut, be dried in the atmospheric air.

I recommend that the temperature of one hundred and seventy degrees, or thereabouts, be adopted for that purpose.

Mr. Thomson expresses the persuasion that the gluten of the root is diminished by the action of heat in the temperature which I recommend.

I am of opinion that the components are at least as well preserved by the quick drying effected in that temperature ; and this process presents the great advantage of drying a large quantity in a short time.

I am confirmed in my preference of the drying room to the atmospheric air, by the following experiments : —

Experiment T.

Of the fresh root of colchicum, a compact bulb was taken, the offset and stem of which were about half an inch in length. Two scruples were placed in a mortar and triturated, forming a pulp of a rather dirty white colour. The first taste was somewhat bitter and cold, resembling that of a fresh horse bean, or lupine, and was almost immediately followed by a pungent bitter. Very shortly after, the tongue and fauces became sensibly heated and uncomfortable. Thirty minims of tinct. guaiac. were gradually dropped in, the paste being rubbed in the meantime. A greenish colour wras almost immediately produced, which gradually deepened, and soon formed a perfectly green mass, which was taken out of the mortar, and placed on a slab. It then became variegated by streaks of a darker green. In a few minutes the colours deepened. Five hours, colours still deeper, but not so bright. Tw’enty-four hours, the surface partly dark green, and partly dusky brown. Internally, partly dark green, and partly of a dusky brownish stone-colour. Forty-eight hours, no change. 1 he mass tough, and not easily pulverized.

Experiment 2.

From the same bulb the cutis was carefully separated, and two scruples

430

Medical and Physical Intelligence .

of the inner part were triturated, forming a moderately adhesive paste. The taste of this paste was not quite free from bitter, making a slight impression on the tongue and fauces. Thirty minims tinct. guaiac. were dropped in, the paste at the same time being rubbed, which immediately produced a fawm-colour, and within the minute a green, similar to No. 1. When placed on the slab, it became of a brownish-green, with patches of a deeper green. In about ten minutes, it assumed a dirty brown hue, with a shade of green. In half an hour the dirty brown appearance^ had increased considerably, without any tint of green. Five hours, singularly variegated with patches of a light grass green. Twenty-four hours, the surface remained variegated with bright green and brown. Internally of a pale stone-colour, with a narrow border of green round the edge. Forty-eight hours, the appearance the same. The mass dry and firm, but not easily pulverized.

Experiment 3.

Slices from compact bulbs resembling No. 1., of the thickness of a half crown, were dried in the shade. When friable, one scruple was rubbed to powder, and in that state resembled wheat flour. Twenty-six minims of distilled water were added, and, being, rubbed, formed a moderately adhesive paste, of a dusky white colour, resembling No. 1. The taste also was similar to that of No. 1. Thirty minims of tinct. guaiac. were dropped in, and on being rubbed, a fine deep green was immediately produced. Being placed on the slab, it was of a fine deep grass green, much more brilliant than No. 1., and had patches of a still deeper shade of green. Five hours, colour darker, but less brilliant, and of uniform appearance. Twenty-four hours, colour uniform, but more pale, with a tint of blue. The interior of a pale greenish grey. Forty-eight hours, not any change ; the mass easily pulverized.

Experiment 4.

From sections similar to those described in No. 3., the cutis was very carefully removed, and a scruple of the inner part was pulverized. A clear white powder was formed, resembling fine arrow root. By trituration with twenty-six minims of distilled w ater, a moderately adhesive paste was formed, resembling No. 2., which it also resembled in taste. Thirty minims of tinct. guaiac. were dropped in, the rubbing being continued, which produced first the fawn tinge, and shortly after, a green of a pale tint: when put on the slab, had the appearance nearly of No. 3., but was not quite so deep, nor quite so bright. Five hours, colour duller and darker. Twenty-four hours, colour faded, and rather paler. The internal part chiefly grey, but a thin stratum of stone-colour m contact with the slab. Forty-eight hours, the appearances precisely the same. Perfectly friable.

Experiment 5.

Of the root, dried in a temperature from one hundred and twelve to one hundred and twenty degrees, one scruple w'as rubbed to a powder, which precisely resembled No. 3. Thirty minims of distilled water were tritur¬ ated with it, forming a moderately adhesive paste, closely resembling No. 3.; in taste and pungency, did not differ from No. 3. Thirty minims of tinct. guaiac. were dropped in, and, after a little friction, produced a brownish green, wfith streaks of a deeper shade ; in a few minutes it became brown, but shortly after became of a deep green. Five hours, colour duller, and of a darker green. Twenty-four hours, colour less deep, and tinged with a greyish hue ; the interior of the same colour, rather brighter. Forty-eight hours, no change. Perfectly friable.

Experiment 6.

From several of the same sections, the cutis was carefully separated, and one scruple of the inner part was rubbed to powder; it was of a clear white,

Medical and Physical Intelligence. 431

similar to No. 4., which it also ' resembled in taste. Thirty minims of* distilled water produced a clear white paste, resembling -No. 4. Thirty minims tiuct. guaiac. were dropped in, the paste being well rubbed, and produced, at first, a fawn colour, then a bright green, darker even than the last. When placed on a slab, it gradually assumed a brown hue, fainter in colour than No. o. Five hours, colour more dull. 1 vventy-four hours, colour still more dull, approaching to a bluish green ; the colour less striking than No. 5. The interior of a light colour, approaching to a greenish grey.

Experiment 7.

One scruple of the root, which had been dried the end of July, at a tem¬ perature of one hundred and seventy degrees, was rubbed in a mortar, and had the appearance of wheat flour. It was triturated with thirty minims of water, by which means, a moderately adhesive paste was formed, resembling No. 1. and No. 5. in appearance, colour, and consistence, with the same bitterness and pungency on the tongue and fauces. Thirty minims of tinct. guaiac. gradually dropped in, whilst the friction was continued, first rendered it brown, or fawn-colour. After continuing the friction a little longer, it became of a deep bright green, with streaks of a deeper shade, very much resembling No. 3. Five hours, very little altered ; colour rather deeper, but less vivid. Twenty-four hours, colour not quite so deep, and of a grey or blue tint; the interior presented the same appearance. Forty-eight hours, of all the specimens, this was by far the best and most striking. Next to this specimen may be placed Nos. 3 and 5., between which, there is little choice. Fifty-six hours, little change. A week after, remains unchanged.

Experiment 8.

One scruple of the root, dried at the same time as No. 7., the cutis from which had been most carefully separated, was pulverized. The colour of the powder pure white, resembling the finest arrow root. Thirty minims of distilled water being added, formed, after a little rubbing, a beautiful white paste, similar to No. 6. The taste free from bitterness and pungency, the tongue and fauces only slightly affected. Thirty minims tinct. guaiac. were dropped in, which being triturated with the paste, produced a brown colour, and, after considerable friction, a pale bluish-green streaked with brown. Five hours, not so bright, but not much altered. Twenty-four hours, considerably paler than No. 7. The shade of green very slight. Interior the same.

Experiment 9.

The whole cutis of a fresh compact bulb, the offset and stem of which were about half an inch in length, was pared off, and weighed thirty-three grains. The taste exceedingly hitter, conveying a pungent sensation over the tongue, fauces and throat, whh h continued about twenty minutes. It was rubbed to a pulp, of a dirty white colour. Thirty minims tinct. guaiac. dropped in, instantly rendered it of a deep green ; and when placed on the slab, it was of an uniform deep brilliant grass green. Five hours, deepened in colour to the darkest green. Twenty-four hours, externally of a very dark chocolate-brown; internally of a dark stone-colour, turning green on exposure to the light. Forty-eight hours, little, it any variation. The mass horny, not readily pulverized between the fingers.

Experiment 10.

An equal weight of the denuded fresh bulb, free from the smallest portion of cutis, was rubbed down ; the paste ol a beautiful white colour. Thirty minims tinct. guaiac. were dropped in, the trituration being continued, which first produced a fawn-colour, and after some rubbing, a pale green ; being placed on the slab, became brown, and in a few minutes a deeper brown.

432

Medical and Physical Intelligence .

Five hotirs, highly variegated with shades of green, the rest brown. Twenty-four hours, externally of a pale greyish-green, in the centre a large patch of brown, covering half the surface ; internally green beneath the green surface ; stone-colour beneath the brown surface. Remained un¬ changed at the end of the week.

Experiment 11.

A sound compact bulb, offset and sheath about three fourths of an inch in length, was cut through the centre ; both surfaces were applied to the tongue, and moved backwards and forwards ; the impressions were slightly bitter, succeeded by some warmth, which remained a minute or two after the surfaces were removed from the tongue. These impressions were followed by heat of the tongue and fauces, with a slight sense of rough¬ ness and want of comfort, which insensibly went off. A portion of the bulb was cut off, and on the surface was poured some tinct. guaiac. which instantly produced a light green colour. This was repeated many times, with similar results.

Experiment 12.

Sections of the root, dried in the shade, at a temperature of one hundred and twenty and of one hundred and seventy degrees, the surfaces of which were covered with tinct. guaiac. presented an uniform appearance, viz. the surfaces became of a fawn or brown colour, excepting where the bulbs had been injured, either in the substance of the section or in the cutis, and on these places a green appearance was invariably produced, which extended to the parts immediately adjacent.

Experiment 13.

The entire cutis of a fine fresh bulb was carefully separated, and covered with tinct. guaiac. A deep grass green immediately ensued, and the fluid which exuded became of the deepest green.

Experiment 14.

The cutis was separated from several sections dried in the shade, and at the temperatures of one hundred and twenty and one hundred and seventy degrees, and treated in the same manner. The first change wras to a deep brown, which in a minute or two was superseded by a green, but not so deep as No. 13.

Experiment 15.

Four sections dried last year, at a temperature of one hundred and seventy degrees, were rubbed to powder, without the addition of water. Thirty minims tinct. guaiac. were dropped in. On rubbing, a fawn-colour was produced. Twenty minutes after, being placed on the slab, the surface was greenish. Half an hour after, brown, with a few greenish patches. Inter¬ nally, dirty brown, turning green on exposure to the light. Two hours, of a holly green colour outside, green inside, appearance velvety. Two hours and a half, no change. Three hours, externally rather more dusky; inter¬ nally the same.

Experiment 16.

Four sections dried this year, at a temperature of one hundred and seventy degrees, were pulverized, and thirty minims tinct. guaiac. were dropped in, producing a fawn-colour, which remained several minutes. Ten minutes after, being on the slab, of a brownish green. In twenty minutes, of a fine deep dark rich green, much superior to the following (No. 17.) ; the interior green, looking like velvet. One hour and a half, the outside dark bottle green; inside, very deep green, still resembling velvet. Two hours and a half, little change ; if any thing, a little dingy on the outside, more of a bottle green.

433

Medical and Physical Intelligence .

Experiment 17.

Four sections dried in the shade, without artificial heat, were pulverized. Thirty minims tinct. guaiac, were added. An olive brown was almost im¬ mediately produced ; and, on further friction, a bright green. Ten minutes after, being on the slab, had assumed a fawn-hue. Internally, of a pale dirty brown, gradually assuming a shade of green on exposure to the light. Two hours, colour almost gone, irregularly streaked with fawn-colour and pale pea green. Two hours and a half, much trie same. Three hours, very much paler.

Experiments IB and 19.

Several sections of colchicum, dried at one hundred and seventy degrees, were immersed in water , which occasioned the appearance of a small quantity ot wheat flour in the water. Two of these seccions were taken out of the water one minute afterwards, and the moisture removed from the surfaces by a soft cloth. The surfaces were then covered with tinct. guaiac., and a fawn-colour was immediately produced. Shortly after, dots of green appeared on the surface, and hitermediate spots of a brighter Tawn-colpur. The fawn-coloured dots being intermixed with the green, on examination hy a glass of considerable power, the appearance was singularly pleasing ; the eye observing green and fawn-colour, beautifully intermingled with dots of a deeper green.

Experiment 20.

A third of these sections was taken from the water, having been immersed about five minutes. It remained on the slab until the moisture had drained off. The surface appeared, on examination, to be irregular and indented, like the surface of a fresh section. In this state it was covered with tinct. guaiac., and, within the minute, green streaks appeared over the whole sur¬ face, with patches of deeper green, and shortly after the green streaks became more frequent, with light fawn-coloured dots interposed.

Experiment 21.

A fourth of these sections was taken from the water, after having been im¬ mersed fifteen minutes. This section was very soft : whilst the moisture was yet on the surface, it was covered with tinct. guaiac., and, within a minute, the whole surface was covered with green, with patches of a deeper colour, more particularly a spot or- two which were slightly decayed.

Experiment 22.

The fifth of these sections remained in the water about an hour and a quarter; it was then placed on the slab, and immediately covered with tinct. guaiac ; green streaks very shortly appeared. In about fifteen minutes, the fawn-colour dots were numerous on a ground of green, far exceeding in brilliancy the appearance in any of the other four sections.

Other sections were tried, and produced similar results.

Experiment 23.

The sixth section remained in the water twelve hours. It became tulJ, plump, and soft. The surface became dry when placed on the slab ; it was then covered with tinct. guaiac., immediately became of a fawn-colour, and in a short time, green. Four hours, the whole surface of a deep green, equal, in point of colour, to the sections from the fresh root. A few fawn- coloured dots appeared, but very few. Six hours, remained of the same colour ; and all the sections that had been immersed in water, and covered with the tinct. guaiac., were improved in colour. Forty-eight hours, still more improved in colour.

Experiment 24.

Four sections, dried at the temperature of one hundred and seventy VOL. XIV. - NO. 83. 3 K

434

Medical and Physical Intelligence .

degrees, were immersed in distilled vinegar for six hours, when the whole were taken out. They became full, plump, and soft. One section was slightly discoloured, as if not perfectly sound ; and two others were slightly so at the edge. Before immersion in the vinegar, they appeared to be per¬ fectly sound. One section, somewhat discoloured in the centre, was placed on the slab, and remained one hour. The surface was then dry. It was covered with tinct. guaiac. The unsound part immediately became green, with a tinge of blue. The sound part remained of the colour of the tincture. In two minutes, the sound part was dotted with green. It was nowhere particularly deep tinged. The deepest colour was at the unsound part. Not any of the fawn appearance. Five minutes, rather darker, with a blue tinge ; the sound part only dotted. At this time, a little more tincture was added ; the colour, then in patches, became of bluish green, the green some¬ what deepened. The sound part was of a fawn-colour. One hour, the whole more dull, or more inclined to fawn. An hour and a half, nearly faded, except at the diseased part, which retained its colour. Four hours, not any appearance of green, except at the injured part, and there only slight.

The rest produced similar results.

Two bulbs, of firm texture, (Nos. 25 and 26,) the offset and sheath about half an inch in length, were each cut into six sections, about the thickness of a half crown. On the surface of a section from each bulb tinct. guaiac. was poured, which almost immediately produced a similar tinge of green on each. Five sections of one bulb were immersed in distilled water, and the five remaining sections of the other bulb in pure distilled vinegar.

Experiment 25.

The distilled water, with the sections immersed, was exposed to the tem¬ perature of one hundred and ninety degrees half an hour. The fluid bitter, but not intensely so, pungent, similar to a weak infusion of horseradish, and appeared as if gum tragacanth had been dissolved in the water. Thirteen hours after immersion, these sections were placed on a slab, and the moisture softly sponged up from the surface of three of them. Tinct. guaiac. was poured on the surface of all. The three which had been sponged became of a bluish green, in streaks, almost immediately. Two minutes, the blue still continued with slight dots of a brownish fawn-colour. Six minutes, if any thing, a little more green. A quarter of an hour, rather faded. Twenty minutes, as brilliant as at first. Eight hours, had lost the blue tinge, and were more green. Next day, colour continued.

The two sections not sponged, upon the application of the guaiac. became dotted with fawn, on a green ground. Two minutes, a milky fluid covered the green ground. Six minutes, nearly the same ; the milky fluid continued. Ten minutes, slight variation; the milky appearance continuing. Colour beautiful. Through the glass, the green ground, varied by spots of deeper green, and in beautiful arrangement with the fawn dots ; the milky appear¬ ance still continuing. Half an hour, no change. Eight hours, the appear¬ ance much the same. Next day, the colours remained unchanged,

. Experiment 26.

The vinegar, with the immersed sections, was exposed to the same temperature, during the same time. The taste became very bitter and pungent, as No. 25. On the addition of guaiac. in the same manner as No. 25, having sponged three of the sections, they acquired a brown colour, without the slightest approach to green; the two sections which were not sponged, much the same. Five minutes, not the slightest approach to green. Continued the same three hours, when the brown matter was scraped off; were then punctured in several places, and a fresh quantity of tinct. guaiac. added, but without producing any approach to

Mediccd and Physical Intelligence. 4S5

green. Eight hours, not the least change of appearance. Next day no change. ’

Experiment 27.

Se\eial sections, dried at a temperature of one hundred and seventy decrees, were immersed in distilled water, and exposed to a temperature of one hundred and ninety degrees, half an hour. These sections sunk on being first immersed in the water, but after having been exposed to the heat about twenty minutes, rose to the surface. Upon adding the tinct. guaiac. on the slab, became slightly fawn-coloured, with a little green matter upon them. The appearance five minutes after, milky, without the slightest shade of green : remained in this state three hours, when the surface was scraped and punctured in several places, and a fresh quantity of guaiac. added ; green streaks immediately appeared, two in particular gradually became deeper, till the whole surface became green. Eight hours, twm of these sections very green, the rest green, but rather dull. The green of the two was the most beautiful of any on the slab. Next morning, one of the two was of a deeper' green even than the sections of the fresh bulb; two others a very good green, a fourth green, with a fawn-coloured tinge round the edge.

Experiment 28.

Several sections, dried at a temperature of one hundred and seventy degrees, were immersed in distilled vinegar, and then exposed to a temperature of one hundred and ninety degrees half an hour. The sections, which sunk on being first immersed in the vinegar, after being exposed to the heat twenty minutes, rose to the surface. The fluid bitter, but not intensely so; and warm, as if a small quantity of horseradish had been infused. Upon adding the tinct. guaiac. to the surface of these sections, when on the slab, they became brown, and remained so three hours, without undergoing any change of colour. The surface was then scraped, and punctures made in several places. Tinct. guaiac. being added did not produce the least green hue. Eight hours, not any change. Next morning, no change.

Mucilage was more strongly indicated in the water in which the sections of the fresh bulb were immersed, than in that in which the sections of the dried bulb were immersed ; and more in the water than in the vinegar. The sediment from the water which contained the dried sections, upon the application of guaiac. became of a fawn colour, with spots of brown; but w ithout any appearance of green. Twenty minutes, it continued the same. The sediment from the water which contained the sections of the fresh bulb, upon the application of the guaiac. became of a dark creamy colour, with a considerable separation of dark brown matter; but no appearance of green. In a few minutes, spots of deep green; and the fluid became dark green, so as to dye the vessel which contained it in various places. In a few minutes more, the whole very green. Half an hour, intensely green. Two hours and a half, colour unchanged. Some hours after, had acquired an uniform dark grass green, and was drying in that state. Eight hours after, still intensely green. That from the dried sections remained several, hours without change. In about six hours it began to exhibit the green appearance at the edges, and became generally of a green hue. Next morning, the fresh without change; the dried, of a somewhat deeper green.

The vinegar, in which the sections had been immersed, was poured ofl from the sediment. It appeared ropy, particularly that in which the sections of the fresh bulb had been immersed. The tinct. guaiac. was added to each of these sediments, which gave to the sediment trom the dried sections a light brown colour; and that from the fresh a deeper brown, without the least appearance of green in either, in ten minutes, not the least change. In twenty minutes, no change. Eight hours after, no change, iwenty- four hours, no change.

456 Medical and Physical Intelligence .

It is unquestionable that the fresh bulb is the best.

How then are the medicinal properties to he most effectually held in preservation for use, when the bulb cannot be obtained fresh and in a mature state ?

It appears, upon the comparison of No. 3, Mr. Thomson's method of drying, and No. 7, my method of drying, that if the green colour be the test of excellence, as appears to be presumed by Mr. Thomson, my method is at least equal to his. r5 he permanent colour is distinctly superior. Not any other method of drying, detailed in the first series of experiments, No. 3 to 8, produces a permanent colour equal to No. 7. Nos. 3 and 5 produce the nearest approach to it.

Nos. 9 and 10 show7 that the colouring matter and the bitter reside in the largest proportion in the cutis.

Nos. 11 and 13 show, that neither trituration, nor the addition of water, is necessary to the production of a green colour, on the addition of guaiacum to the fresh bulb, or to the cutis. The water or moisture of the root, or the cutis of the root, appears to be sufficient to this purpose, without auxiliary aid.

No. 12 shows, that whether dried in the atmospheric air (if well dried) in the temperature of one hundred and twenty degrees, or of one hundred and seventy degrees, the guaiac. applied to the surfaces of sections of dried colchicum does not produce the change to green ; but Nos. 15, 16, and 17, show, that when triturated, even without the addition of water, the guaiac. produces the change to green.

No. 14 shows, that the matter which disposes to *he green colour is sufficient in the dried cutis to produce the change to green, on the mere application of the guaiac. to the surface, without rubbing down.

No. 15, compared with No. 17, shows, that even when kept more than a year, colchicum dried in the temperature of one hundred and seventy degrees, is equal, if not superior, if the green colour be the test of quality, to the fresh colchicum dried in the atmospheric air.

No. 16, compared with these specimens, shows, that the fresh colchicum dried at one hundred and seventy degrees is decidedly superior to either.

Nos. 18 to 23 show, that the dried sections of the bulb, immersed in water, change to green on the application of the guaiac. provided the immersion be continued a sufficient length of time, and that twelve hours’ immersion is not too long. The sediment which was deposited in the water wherein the sections were immersed was rather considerable, and on application of the guaiac. became of a deeper green than has been seen in any of the specimens.

No. 24 shows, that the dried sections, after immersion in vinegar, upon the application of guaiac. do not become green, or only partially become so; and that if even partially changed to green, that colour is quickly followed and superseded by the fawn or brown colour.

No. 25 shows, that the fresh bulb, immersed in distilled water, at a temperature of one hundred and ninety degrees, (exceeding the drying temperature recommended), does not reduce the property in colchicum of changing to green on the application of guaiac.

No. 26 shows, that a similar process in vinegar suspends or destroys this property.

No. 27 shows, that the dried bulb, exposed to a process similar to that pursued in No. 25, only required to be punctured, in order to the pro¬ duction of an effect similar to No. 25.

No. 28 shows, that the dried bulb, exposed to the same process in vinegar, did not produce any such effect. The colour became brown, and so contitaued.

The sediment of the water , upon the addition of guaiac. became intensely green. The sediment of the vinegar became of a brown colour.

Medical and Physical Intelligence. 437

It does not appear, upon a review of these experiments, that any advantage is gained by drying colchicum in the atmospheric air, as compared with the drying process recommended by me, in the temperature of one hundred and seventy degrees, or thereabouts; and I am further supported in the conclusion on which I rest in this respect, by having observed that the root does not cease to grow after being exposed for some time to a temperature of twTo hundred degrees. The advantage of my method will be seen, if it be considered that the bulbs should be divided into sections immediately on being taken out of the ground (to prevent exhaustion, by the continued effort towards germination), and that to supply any general demand, a large quantity must be secured at the critical moment of the annual perfection of the bulb.

Mr. Thomson observes as follows : — “ But, before making experiments to prove this opinion, it was necessary to fix the exact period at w’hich the bulb should be dug up; and that this is towards the end of July, some observations I had been making on the physiology of bulbs had already enabled me to determine. The bulb of the last year is then completely decayed ; and its progeny, the bulbs of the present year, are at their full size, and in their most perfect condition. When dug up, each bulb is found covered with a smooth, shining, thick, mahogany brown coat; it is plump, solid, and in shape somewhat resembling a roundish pear, the withered remains of the foliage answering to the stem, with a sharp ridge partially surrounding the base, and terminating in a short appendix. On removing this coat, and a spongy one which is interior to it, a small white oval body, about a line in breadth, one-third of an inch in length, and slightly elevated, is seen seated in a depression near the point of this appendix on one side ; and another of the same description, a little higher up, in another slight depression on the opposite side of the bulb. These are the rudiments of the expected flowers and leaves, and when the sheath by which they are covered has attained an inch in length, the bulb has already begun to lose its medicinal qualities. If it be taken up in July, and sliced transversely, each slice has a nearly circular figure, slightly approximating to the oval, but perfectly free from any indentation on either side ; and this form is retained in the dried slice : whereas, when the flowers appear, every slice is pauduriform, or an oblong oval with a deep semicircular notch or depression on each side ; and every approach to this figure implies that the bulb has been dug up too late in the season. These indentations arise from the sheaths of the flowers as they enlarge pressing upon the sides of the bulb, which now readily yield, owing to the absorption of its contents for the support of the growing flowers, first taking place in the part imme¬ diately under that on which the sheath presses. At that part the exhausting process is immediately recognized by the spongy appearance which is seen surrounding each indentation when the bulb is transversely divided.”

1 am obliged, however reluctantly, to affirm, that this statement is incorrect. Early in the month of June last, 1 ordered a considerable quantity of the bulb of Mr. Gririiiey and of Mr. Butler, both of Covent Garden market. I directed that the bulbs should be delivered at my laboratory, on or a few days before the first of August With then- accustomed punctuality, fifty-six pounds weight were delivered by Mr. Grimley on the 25th July, and one hundred weight by Mr. Butler on the 2d of August; which, having been brought from Gloucestershire, must have been dug up several days before. When received, with very few exceptions, the offsets or succeeding bulbs had not appeared ; but the grooves, for the reception of the new bulb and sheath proceeding from it, were well defined. Reserving a few pounds for observation, the remainder were immediately sliced and dried; but I find the indented or kidney-bean shape prevail generally, as must necessarily happen from the state in which the bulbs were received. The groove cannot be occasioned

438

Medical and Physical Intelligence.

by the pressure of the sheath proceeding from the new bulb, as represented by Mr. Thomson, since, before its appearance the groove is formed; and Mr. Thomson’s reasoning upon the absorption of the contents of the parent bulb, and its consequent yielding to the pressure of the sheath as the causes of the groove, is therefore erroneous. The groove is formed previously , and the notch tpill be found in the slices , although the bulb be procured at the time recommended by Mr. Thomson.

Having placed some of the bulbs, with their offsets of the present year, in various situations favourable to the accurate observation of their progress in growth, I reserve the more ample explanation of my objections to Mr. Thomson’s statement, and of my own view of the natural history of colchicum, until the following spring.

Mr. Thomson’s strictures on the u majority of London druggists,” in respect of the quality of the colchicum vended by them, is perhaps some¬ what harsh, since the attention of the Profession has only of late been drawn to the preparation of this medicine * ; but the Profession and the public might have expected more discrimination and attention at Apothe¬ caries’ Hall, (see Mr. Thomson’s report of colchicum supplied by the Apothecaries’ Company, Repository, No. 82, p. 339,) since the Company of Apothecaries, in addition to many other advantages, and under high pretensions, and the exercise of great power and authority, have the advantage of an extensive botanic garden f .

I remain, Gentlemen,

Your obedient servant,

R. Battley.

P. S. I shall have occasion to trespass on your indulgence, by a communication on senna, which I hope to be able to complete for your next Number.

Preparation of English Opium. — The papaver somniferum has been cultivated by Mr. J. Cowley and Mr. W. Staines, Surgeons at Winslow, Bucks, from which opium of great purity has been obtained to a considerable amount; and, in ’consequence of various improvements they have introduced, important advantages may be expected to accrue to the medical Prac¬ titioner.

testimonial im its favour.

An Account of the Effects of British Opium , exhibited to an Habitual

Opium-taker. By John Cowley, Member of the Royal College of

Surgeons.

Sarah Wing, aged about fifty, applied to me this morning (Sept. 4th, 1820) for half a drachm of opium, which she observed was her regular dose, having taken that quantity daily during the last seven years.

The wretchedness depicted on her countenance led me to suspect that she meditated suicide. She was labouring under violent trembling, and complained of a distressing flutter in her chest; subsuitus tendinum was observable at the wrist, and the extremities were cold and clammy, with remitting pains. The pulse was so feeble, tremulous, and irregular, that I could not count it. These symptoms she declared were owing to the want of her usual dose of opium.

Being satisfied, on the arrival of her husband, that her assertions were correct, 1 gave her half a drachm of crude British opium, in the presence of three medical friends: it was then thirty-five minutes past nine o’clock. A. M.

* See London Medical Repository for July, No. 79 , p. 29. f At Chelsea.

Medical and Physical Intelligence. 439

Ten o’clock, the tremor and aching of the limbs much relieved. Pulse one hundred and twenty, irregular.

Twenty minutes past ten, says she feels very comfortable. Pulse one hundred and twenty, more regular. Extremities warmer, and less clammy.

Thirty-five minutes past ten, pulse one hundred and twenty, regular; extremities warm : countenance animated and happy. Says she feels well.

Half-past eleven, pulse one hundred and four, not quite regular.

Three P. M., pulse eighty-six, feels well.

Sept. 5th, half-past eight A. M., pulse 96, has had a very comfortable night, slept from eleven till five. She now' repeated her dose of opium, and pursued her journey, after expressing her conviction that the opium she had yesterday was superior to any she had previously used.

THE DECLARATION OF SARAH WING, BEFORE THE REV. J. PREEDY, VICAR

OF WINSLOW.

“ I do hereby declare, that for seventeen years past I have been in the daily practice of taking opium; and that during the last seven years, my custom has been to take half a drachm every morning; which dose 1 have not once omitted during the last-mentioned period. I have been in the frequent habit of travelling, and have seldom been enabled to purchase more than one dose, never more than three, from the same shop. I have consequently had frequent opportunities of comparing the effects of opium purchased from various shops ; and I firmly believe that the dose of opium which I took yesterday morning in Mr. Cowley’s surgery was superior to any I had before used ; because I have not for many years enjoyed so much rest as I had last night, and because the trembling of my limbs, and the fluttering in mv chest, were more speedily and more effectually removed.

her

“ Winslow, Sept. 5, 1820. “ Sarah + Wing.”

mark.

“ The above declaration was made in my presence.

“James Preedy, Vicar of Winslow'.”

“ Witness, W. Staines, Surgeon.” 0

LITERARY NOTICES.

Outlines of Midwifery, developing its Principles and Practice ; w'ith Twelve Lithographic Engravings. By J. T. Conquest, M.D., F.L.S., &c. &c. 12mo. 7s. 6d.

A Toxicological Chart, in which may be seen at one view' the Symptoms, Treatment, and Mode of Detecting the various Poisons, Mineral, Vegetable, and Animal, according to the latest Experiments and Observations; (re¬ spectfully dedicated to the Royal Humane Society). By William Stowe, Member of the London Royal College of Surgeons. The Second Edition, w'ith Additions and Improvements, on twm large sheets, broad folio, Is. 6d., or neatly mounted on a board, 2s. 6d.

The "Quarterly Journal of Foreign Medicine and Surgery, and of the Sciences connected with them. No. VIII., 3s. 6d.

A new Edition of Dr. Thomson’s Chemistry is nearly ready for Pub¬ lication.

Mr. Price, Surgeon and Electrician, has in the Press, and nearly ready for Publication, an Essay on the Medical Application of Electricity and Galvanism.

Preparing for Publication. An Appendix to the Midland Flora ; comprising also Corrections and Additions, referring to the Two former Volumes; and occasional Observations, tending to elucidate the Study of the British Fungi: concluding with a generic and specific Index to the whole Work, and a general Index of Synonyms. By T. Purton, Surgeon, Alcester. Embellished with numerous coloured Engravings, by James Sowf.rby,F.L.S.

/

440

A METEOROLOGICAL TABLE,

From 21 st of SEPTEMBER to 20 th of OCTOBER, 1820, KEPT AT RICHMOND, YORKSHIRE.

Id	Baro Max.	meter. Min.	Th< Max	erm. Min	Rain Gauge	Winds.	Weather.
21	29	24	29	10	57	40		wsw..	1 Sun..
22	29	48	29	43	57	48		WNW..	1 Sun...
23	29	42	29	24	63	48	27	sw....	1 Sun.. 2 Rain...
24	29	29	29	18	53	43	20	NW..	14 Rain... 2 Cloud.. 3 Sun..
25	29	49	29	34	56	40	11	W..NW..	1 Sun... 3 Show.. 4 Moon..
2j6	29	73	29	66	51	36	03	NW..	1 Sun.. 4 Moon... & Show.
27	29	70	29	62	51	40		NE.NW.	1 Rain. 2 Sun.. 34 Cloud...
28	29	59	29	55	58	42	09	Vble.SW.	1 Rain. 2 Cl.. 3 S. 4 Starl...
29	29	82	29	77	56	33		NW..	1 Sun....
30	29	64	29	54	59	40	05	SE..SW...	1 Sun.. 4 Rain.
								NW..SW..	1 Sun...
	29	87	29	78	55	42		WbN..
2	30	18	30	08	55	43			L Sun.,
3	30	25	30	23	56	36		WbN.NhE.	1 Sun...
4	30	23	30	19	55	35		Calm E.	1 Sun...
5	30	15	30	08	56	46		NE.	1 Sun. 3 Cloud...
6	30	05	30	02	56	46		NE.	134 Cloud... 2 Sun..
7	29	98	29'	97	54	46		N E.	L Cloud....
8	30	01	29	99	54	43	01	NE	12 Sun. 3 Cloud... 4 Rain.
9	29	98	29	92	51	41		N.NE	1 Cloud...
10	29	85	29	75	47	41	«	NW.N.	1 Cloud. ..
11	29	75	29	75	52	32		NW.	13 Cloud... 2 S.. 4 Starl....
12	29	73	29	70	51	36	04	WbN.	1 Sun... 4 Rain.
13	29	60	29	42	49	40		NW.E.	134 Cloud... 2 Sun..
14	28	94	28	60	54	41	16	SE.	13 Cloud.. 2 Sun. 4 Rain..
15	28	64	28	48	58	38	26	SE.SW...	1 Rain... 3 Sun.. 4 Moon...
16	28	49	28	28	49	39	33	SSE...SE..	1 Sun.., 3 Cloud.. 4 Rain....
17,	28	47	28	40	51	40		SSE.W..	1 Cloud.. 2 Sun..
18	28	86	28	80	51	37	15	NW..	1 Sun.. 2 Rain.. 4 Moon...
19	28	56	28	34	48	40	10 NW..SW,.	1 Sun.. 4 Rain..
20	28	87	28	67	51	35	14W.NW..	1 Sun.. 3 Rain.. 4 Moon..

The quantity of rain during the month of September was 1 inch, 05-lQQths.

Observations on Diseases at Richmond.

The disorders under treatment were, Abortio, Asthenia, Catarrhus, Cephalcea, Cynanche tonsillaris, Diarrhoea, Dysuria, Erysipelas, Febris con- tinua, Gastrodynia, Leucorrhoea, Obstipatio, Ophthalmia, Paralysis, Podagra, Procidentia Ani, Scabies, Scrofula, Urticaria, and Vertigo.

441

THE METEOROLOGICAL JOURNAL,

From the 20th of SEPTEMBER to the 19th of OCTOBER, 1820,

By Messrs. HARRIS and Co.

Mathematical Instrument Makers, 50, High Holborn.

D	£ O o 3	I ts I-	Therm.		Barom	.	De Luc’s tlygrom	Winds.	jAtmo. Variation.
20		,36	51	57	43	29	92 29	54	52	5c	>SW	w	Fine	Rain
23		,11	50	60	48	29	45 29	51	52	5S	W	NW	Fine	Rain	Fine
22	Wi	56	64	53	30	00 30	Oi	55	56	NW	w	Fine
23	1 1	60	66	57	30	00 29	96	60	61	wsw	sw	Fine
24		,10	59	65	50	29	75 29	81	62	55	wsw	wsw	Rain	Sho.	Fine
25			54	60	43	29	69 29	76	54	53	w	NW
26			48	55	38	29	89 30	06	53	55	N	NW	(Fine		j
27		,08	44	53	50	30	12 30	10	54	53	w	WNW	Clo.	Rain	Fine
28			54	59	53	30	09 30	06	55	60	wsw	SW	Fine	Clo.	Sho. !
29	D	,03	54	62	44	30	00 30	22	61	59	NNE	NE	Fain	Fine	_ 1
30		,01	50	59	46	30	12 30	03	60	62	E	ssw	Fog	Sho.	Fine
1			50	60	48	30	19 30	32	59	57	wsw	w	Fine		- -
2			51	59	47	30	41 30	50	56	54	NNW	WNW	Fine
3			5 1	60	42	30	53 30	57	56	•55	NNE	NE	Fine
4		,02	45	56	49	30	53 30	42	54	59	NNE	NE	Fine		Sho.
5			55	59	49	30	33 30	30	58	60	ENE	NE	Fine		|
6			53	59	47	30	27 30	22	58	59	NE	NNE	Fine		—■ t
7			51	57	47	30	03 30	oc	58	60	ENF *	NF
8			50	55	45	30	26 30	-C kJ 23	59	59	E	NE	Fine		|
9			49	53	44	30	23 30	19	57	55	ENE	NE	Clo
10			47	53	45	30	15 30	09	54	55	NE	NE	Clo
3 1			47	51	43	30	07 30	09	54	55	NE	NE	Clo
12			45	50	38	30	08 30	04	54	53	N	NNW	Fine
13			43	48	39	30	02 29	95	55	56	NW	SSE	Fog	Fine	—
14		,05	43	47	45	29	71 29	46	56	66	S	SSE	Clo.		Cl
15	d	,20	51	59	44	29	07 29	20	64	61	s	WSW	Fain		Fine ■
16		,25	16	49	40	29	21 29	19	62	56	wsw	SW'	Fain	—	St. j
17		.09	13	48	39	.19	11 29	01	57	59	sw	SW	Fine	Clo.	Fine
18		,03	13	49	37	29	19 29	26	61	60	wsw	WNW	Fine	Sho.	. . 1
19	i 1	,09	13	48	38	29	15 29	05	60	60	wsw	SW	nne		Rain

The quantity of rain fallen in September is 2 inches and 42-100tbs.

3 L

VOL. XIV. — NO. 83.

442

A REGISTER OF DISEASES Between SEPTEMBER 20th and OCTOBER i 9th, 1820.

DISEASES.

Abortio .

Abscessio .

Acne . ....

Amaurosis .

Amenorrhcea .

Anasarca • . .

Aphtha lactentium anginosa •

Apoplexia

Ascites .

Asthenia . . •

Asthma .

Bronchitis acutci • • - chronica

Cancer .

Cardialgia . . * * •

Carditis .

Catarrh us .

Cephalalgia .

Cessatio Mens.* • • • • •

Cholera • • * * .

Colica • . .

Convulsio .

Cynanche Tonsillaris

— - maligna • • «

— - - Trachealis

- - — Parotidea • *

Pharyngea> Tremens • •

Delirium

Diarrhoea • • <

Dolor lateris <

Dysenteria • ■

Dyspepsia * * -

Dyspnoea • •

Dysphagia • • «

Dystocia * • •

Dysuria • • • <

Ecthyma • • •

Enteritis • •

Entrodynia •

Epilepsia * * ■

Erysipelas .

Erythema lave .

Ervthismus Merc. • •/

Febris Intermittent •

- Bilios* ......

- catarrhalis * * *

- - Typhus mitior

— — Typhus grav.* - - Synochus * • •

• • • <» • *

Total.	I
8
5
1
2
6
8	1
2
2
5	2
5	1
2
21	4
4	1
1
1	1
5
3	1
32
10
1
16
10
1	1
14
1
3	1
5
1
1	1
32
1
7	1
19
4
1
2
3
1
3
1
1
9
2
1
7
2
5
4
1	1
20

DISEASES.

Febris Puerpera • • • • — — Remit. Infant.

Gastrodynia .

Gonorrhoea pur a * • • Haematemesis .....

Haemoptbe . . .

Haemorrhois . • *

Hemiplegia * * .

Hepatitis . * • • •

Hernia .

Herpes Zoster .

- circinatus * * •

Hydrocephalus .

Hydrothorax .

Hypochondriasis * * *

Hysteria .

Hysteritis .

Icterus . .

Impetigo jigurata' • •

Ischias . .

Lepra .

Leucorrhoea .

Menorrhagia . * •

Miliaria • • * .

Morbi Infantiles* * * * - Biliosi* .

Nephritis .

Obstipatio * .

Odontalgia .

Ophthalmia .......

Otalgia .

Palpitatio * * * .

Paralysis .

Peripneumonia • • • * Peritonitis ........

Pertussis ........

Phthisis Pulmonalis

Plethora .

Pleuritis .

PI eurodyne .

Pneumonia .

Podagra* .

Porrigo larvalis * * • » , — - — - scutulata • •

Prurigo miiis .

- senilis ....

Pyrosis . *

Kheuma acutus • * *

- clironicus

llubeola .......

"c3	"eS
o H
i
7	1
4
3
1
5
2
1
7
2
5
1
3	2
1	1
1
3
2
5
1
1
3
A I
8
1
41	1
17
1
3
8
16
2
4
3
4
11
9
19	9
3
9 0
5	1
2
3
1
1
1
1
12
14
11

Observations on Prevailing Diseases . 443

DISEASES.

Scabies .

Scarlatina simplex • •

- anginosa

Scrofula .

Spasmi .

Splenitis .

Strictura . .

Syphilis .

: Tabes Mesenterica Tic Douloureux • ■ Tussis . .

Total.	Fatal.	DISEASES.	Total.	Fatal .
54		Tympanites .	1	i
i 11		Vaccinia .	16
7		Varicella .	7
4		Variola .	14	2
1		Vermes tania .	11	i
2		Vertigo .	9	1
4		I J rticaria febrilis .	1
18
4		Total of Cases . . •	735
1		d otal of Deaths .		35
1				‘

i * Morbi Infant lies is meant to comprise those Disorders principally arising from den¬ tition or indigestion, and which may be too trivial to enter under any distinct head; Morbi Biliosi, such Complaints as are popularly termed bilious, but cannot be accurately classed.

Observations on Prevailing Diseases,

Infantile diseases of the asthenic kind; and especially implicating the mesenteric functions, have been exceedingly prevalent during the pre-i ceding month. In some of these cases, small doses of foxglove, gradually increased, have exhibited a decided efficacy. Two cases of chorea, suc¬ ceeding to scarlatina, have been manifestly cured by this medicine.

An old rheumatic subject has just presented himself before the Reporter, full of gratitude for the good he has received from the vin. sera, colchitd, prepared according to Dr. Williams’s prescription. It is intended to institute a series of trials respecting the varieties of this medicinal, and to report thereon.

Our list is unusually slender this month, owing to the failure of two of our accustomed Reporters.

Extract from the Path and Cheltenham Gazette of this dap, Sept. .13, 1820. *£ A young woman, of the name of Harold, in the village of Soutbstoke,

)

near this city, who formerly had the small-pox from inoculation, is now afflicted a second time with that dreadful malady, and with aggravated symptoms.”

444

Notices to Correspondents.

MONTHLY CATALOGUE OF BOOKS.

Underwood’s Catalogue for 1820-21. — A Catalogue of Boots in Anatomy, Medicine, Surgery, Midwifery, Chemistry, Botany, &c. &c. ; containing a Complete List of the Lectures delivered in London, with their Terms, Hours of Attendance, &c. Tables of the Pay of the Medical Department of the Army, Navy, and East India Company’s Service.

A Chemical and Medical Report of the Properties of the Mineral Water of Buxton, Matlock, Tunbridge Wells, Harrowgate, Bath, Cheltenham, Leamington, &c. &c. By C. Scudamore, M.D. 8vo. Price 10s.

A Treatise on Dyspepsia, or Indigestion. By W. Woodforde, M.D. 8vo, Price 2s. 6d.

An Essay on Animal, Mineral, and Vegetable Poisons, &c. 18mo.

Price 3s. 6d.

Dr. Conquest’s Outlines of Midwifery ; with Lithographic Engravings. 12mo. Price 7s. 6d.

An Historic Sketch of the Causes, Progress, Extent, and Mortality of the Epidemic in Ireland, in 1817, 1818, and 1819. By W. Harty, M.B. 8vo. Price 16s.

A Treatise on the Plague; designed to prove it Contagious, from Facts collected during the Author’s Residence in Malta, when visited by that Malady, ' in 1813; with Observations on its Prevention, Character, and Treatment. By Sir Arthur Brooke Faulkner, M.D. 8vo. Price 12s.

A Practical Treatise on those Nervous Diseases which are denominated Hypochondriasis, or Low Spirits, and Dyspepsia, or Indigestion, &c. &c. By G. R. Rowe, Fellow of the Coliege of Surgeons. 8vo. Price 6s.

Views of the Muscles of the Human Body; drawn from Nature, and engraved by G. Lewis, accompanied by suitable Explanatory References; designed as a Guide to the Student in Anatomy, and a Book of Reference for the Medical Practitioner. 4to. Price 11. 5s.

NOTICES TO CORRESPONDENTS.

Communications for the Original Department have been received this month from Dr. Cole, Mr. Mansford, and Dr. Palmer.

We have to apologize to Mr. Greening, of Aldersgate Street, for omitting the Quarterly Statement of the Obstetric Institution, the manuscript of fvhich has been unaccountably mislaid.

Erratum in Mr. Sutleffe’s paper , in the September Number, page 190, third line from the bottom ; for “ full and rapid,” read u fully as rapid.”

Communications are requested to be addressed ( post paid) to Messrs. T. and G. UNDERWOOD, 32, Fleet Street .

THE

LONDON MEDICAL

• » 4 • . .

? r

REPOSITORY

No. 84. DECEMBER 1, 1820. Vol. XIV.

PART I.

ORIGINAL COMMUNICATIONS.

I. • - •

On Phagedena Gangrenosa. By J. Cole, M.D., Surgeon to the Forces, Albany Hospital, Isle of Wight.

' * * * * • ' - ; ' * . ‘ ' . I t

- - —

Very much has been written, and to very little purpose, on this terrific disease; since we are left in doubt as to its causes, modes of propagation, and plan of treatment. Under these circumstances, I should not have ventured to submit for publication the following observations, did I not feel per¬ suaded that they contain the germ of the true theory of the disease, and that they will lead to a less exclusive and more correct mode of treatment.

I should premise, before entering more immediately on the subject of this paper, that the substance of it was originally penned in reply to a series of questions proposed to some of the medical staff by Sir James iVPGrigor, very soon after his labours in Holland, Egypt, Portugal, Spain, France, “ and either Ind,” had put him in possession of the director- general’s chair. These queries 1, of course, have no right to lay before the public ; although I am persuaded the same ardent love of the Profession that dictated them would, with a view to general utility, grant the permission : but let us hope for some communication from that quarter, containing not *only the essence of the various opinions and modes of treat¬ ment, but also concomitant remarks, the fruits of such long experience in so extensive a field. I beg leave to transmit the following letter in its original form, that my opinion prior to my perusal (and, I believe, to the publication) of either Dr. Hennen’s or Mr. Blackadder’s works tilay

VOL. xiv, — no. 84. 3 M

446

Original Communications.

he known ; and the subjoined notes, exactly as I penned them after having read the works of those gentlemen, that the effects of their doctrines on my mind at the time may he seen.

1 need scarcely add, that neither this, nor any of my former papers, that have been thought worthy a place in the Repository, were drawn up with a view to pub¬ lication ; or that in sending them to the press I have any other object but the desire of being useful to those who may hereafter be called upon to labour in the same field. If the few things I have had time to note down tend to show that I have not been altogether an inattentive spectator of what has been passing under my eyes, well and good ; and if they at all contribute to bring me to the recollection of many old and tried friends, that time and distance have nearly estranged, so much the better.

Antwerp , September 22 d. 1815.

Sir*, — In replying to the queries lately circulated on hospital gangrene, you will permit me to premise, that that disease, interesting and important as it avowedly is, has never in a particular manner occupied my attention, either by its prevalence or its obstinacy; nevertheless, as it is your wish, I will briefly state my ideas concerning it. We have long known that a number of persons collected together, under certain circumstances, vitiate the atmosphere, and generate a febrile disease, commonly of the low continued form, the type, however, influenced by the power of the individual and the intensity of the exciting cause. If those persons thus assembled are suffering from wounds, or have ulcers from any other cause, a deterioration will take place in those secreting surfaces soon after the constitutional derange¬ ment has declared itself. If this morbid action be allowed to go on, it will be found capable of generating, secreting, or producing a poison, sui generis , which being communicated

* This gentleman, with whom I served in the Peninsula, in Belgium, and in France, to whose counsels and example I owe much, and of whose friendship I may justly boast, is now retired from the service, and enjoying well-merited “ otiuni cum dignitate” in his native country. In the language of Mr. Blackadder, “ He was admirably fitted for the duties assigned him : by a system of un¬ remitted activity, close attention, and rigid impartiality, united to all that constitutes the gentleman and the officer, he not only exhibited an excellent pattern for imitation to the junior officers, but excited a general interest, and diffused a spirit of emulation in the discharge of their several duties, not less conducive to the good of the service than to the immediate and future interest of individuals.”

447

Cole on Phagedena Gangrenosa.

to a healthy person by inoculation, (or in any other way applied to the ulcers of persons not under the influence of the cause that originally produced the malady), will excite a similar disease. This morbid state at first may be con¬ sidered local, and therefore to be arrested by local means : however, if not arrested, the constitution will sympathize, and general disease declare itself in a febrile form, the type of which will be governed by the predisposition of the indi¬ vidual, and the peculiarity of the circumstances under which he is placed.

Thus far advanced, instead of replying to the queries in succession, [ find myself obliged to continue a narrative of my own opinions; and afterwards I will try how they can be brought to bear on them. In the first place, however, it is necessary to define the meaning of certain words that frequently occur, or otherwise we shall get into the labyrinth that writers of our Profession are so often bewildered in.

By 'phagedenic ulceration , therefore, I would understand, a wound from gun-shot, or any other cause, suddenly putting on an unhealthy appearance; principally characterized by ex¬ quisite pain, tumid everted edges, a purplish areola, a dis¬ position to enlarge, and a tendency to assume the circular form. By gangrene, 1 mean the loss of vitality occasioned by the previous excessive and destructive action in the diseased part : by sloughing , the act of its separating from the subjacent living part; or, as we familiarly say, the throwing off. Hence it may be observed that I consider ulceration, gangrene, and sloughing, as different stages of the same disease, and by no means distinct species or even varieties : therefore I cannot say, that they are convertible, as a tertian into a quotidian, or a quotidian to a tertian, or either of these to a lever of a continued form ; but that they are successive and distinct states, following each other as regularly as the hot fit of an intermittent does the cold. We may fear “ the specific hospital idceratiori’ when the edges of the wound swell, become exceedingly painful, and are sur¬ rounded by an areola of a deep red or purplish hue ; if the granulations become prominent, and as it were isolated, on a depressed ground-work of a pale colour, the slightest touch causing both those and the edges to bleed ; if the pus be lessened in quantity, become thin and acrimonious : this may serve for the present to indicate the general character of the first or ulcerative stage. If the granulations lose their prominence and rosy hue; if the surface becomes glossy, and the pain ceases, the second or gangrenous stage has com¬ menced, which is farther marked by the want of action and irritability, but more particularly by the sore giving out a peculiarly offensive odour, which having once reached the

448 Original Communications.

olfactories, can never afterwards be mistaken ; layers coming away, (under which are seen florid and elevated granulations), constitute the third or sloughing stage. The newly exposed surface puts on a healthy or diseased appearance according to the state of the constitution, depending on its labouring, or not, under a. peculiar febrile action. Sloughing in thick layers being particularly mentioned, I must believe that this substance is the product of the dead animal fibre, and by no means a new secretion.

Reasoning from analogy, I cannot infer that any variety in the appearance or intensity of the disease would arise from a difference in the quantity of the morbid poison applied. Thus, as far as is in my power, I have replied to the three leading queries. To proceed : general remedies alone should never be trusted for the removal of the disease. Topical ones may be relied on, before the constitution is secondarily affected. The first symptoms of general derangement entirely depend upon the constitution and situation of the individual.

A man with two ulcers, exposed to the causes which first generate the malady, will have the specific morbid action (constituting this disease) commencing both at the same time ; but if not exposed to those causes, and the specific poison be topically applied to one ulcer only, that one only at first will suffer : but if this morbid action be allowed to go on until the general system be deranged, then, indeed, the second ulcer will be subsequently affected. It will be perceived that those ulcers will be in different stages of the disease at the same moment. Regarding the illness of the servants, my experience affords nothing satisfactory ; barring accidental inoculation, I should imagine that they would not suffer more than those attending fevers of the same type, unaccompanied by ulceration. With respect to the last question, I believe the constitutional affection is never found to be of the pure inflammatory form, very generally that of synochus, and, if the causes producing the malady are con¬ tinued to be applied, typhus.

It has been observed that some understand a subject because they have written on it ; and that others write on it because they understand it. I fear you will not include me in either of those classes; but you will, I am sure, give me credit for saying with frankness what I believe to be the truth, and will bear testimony to the regret I feel, that I know so little on the subject worthy of being said.

I have the honour to be,

Sir,

Your obedient servant,

J, COLE-

January , 1818.

Cole on Phagedena Gangrenosa.

449

How very difficult it is to arrive at truth, even when pursued with honesty and zeal, may be inferred from the difference of opinion that still exists on the subject of this and almost every other disease; but the marked discrepancy of opinion in two military Surgeons, whose works have lately issued from the press almost at the same moment, and whose deductions were drawn at the same time, in the same country, and on the same class of subjects, will render my saying a few words on it excusable. Whether the reasoning on the nature of this disease that I have ventured on, may not contribute to show that both these gentlemen are right, and both are wrong, is not for me to determine : be it as it may, Dr. Hennen directs that the principal attention should be to the removal of constitutional derangement by general remedies, be they bark or bleeding, sedatives or stimulants. Mr. Blackadder, on the contrary ; is not less strenuous in insisting on the necessity of destroying the local morbid action with arsenic or arterial cautery, and thinks, if that be done, little else is required. With Dr. Hennen, nothing less will do than evacuating the building. He calls, with reason, for pure air, and plenty of it; whilst Mr. B. considers it much more important to prevent the communication of the morbid poison, through the medium of sponges, fingers, or instruments. These may be considered fundamental differences, which cannot but influence in a very considerable degree the treat¬ ment, should either of them be exclusively adopted. In points of rather less importance these gentlemen are also much at variance.

Mr. Blackadder considers, that an ulcer exposed to the con¬ tagion does not begin to put on the characteristic appearance in less than sixty hours ; whilst Dr. Hennen says, that “ a soldier of the waggon train, just landed from England, admitted into the hospital with a venereal bubo, died in forty- eight hours. The gangrene, having seized on the bubo, eroded the great vessels, and extended its ravages even to the parietes of the abdomen.” 1 will not prosecute this subject further than by noticing Dr. Hennen’s observation, that among servants and washerwomen febrile symptoms occur without any local affection, “ which could be clearly traced to the washing of bandages and dressings/' Might not those febrile symptoms be more plausibly attiibuted to the vitiated atmo¬ sphere, and the absence of the peculiar local affection explained, by there being no solution of continuity on the surface of their

bodies ? . _ , . .

Before I take leave of this subject, I may be permitted to

add, that in the Minimes General Hospital at Antwerp,

which was under my direction, and after the battle of

450 Original Communications .

Waterloo for some months seldom contained less than five hundred wounded, nothing that deserved the name of pba- gedaena gangraenosa appeared ; nor did it in any great degree at any of the other hospitals at that station, if we except the Augustines, under the direction of Staff-Surgeon O’Connell; and there I believe it originated from the building being damp and ill ventilated, and his patients for several days being without bedsteads. The foul ulcers that occasionally did appear in the wards of the Minimes were readily cleaned under the old treatment of fomenting and carrot poultices, and lotions, charcoal powder, &c. An arsenical solution was occasionally used; and I willingly bear testimony to its good effects, as an efficient and powerful escharotic.

Enough, I trust, has been said to guard the young Prac¬ titioner from taking too narrow a view of this dreadful scourge, and from adopting an exclusive practice, however ingeniously inculcated. Under circumstances likely to generate the disease, let his attention be directed to the local as well as the general affection, and to the general as well as the local ; by which means, if I mistake not, the well¬ doing of those intrusted to his care will prove the propriety of the plan, and recompense him for his labours.

II.

On the External Application of the Nitric Acid . By Robert Hull, Surgeon, Norwich.

In that number of the Edinburgh Medical and Surgical Journal which is last published, is a communication on the subject of this paper. The author of the communication is Mr. Assistant-Surgeon Killet, of the Indian army ; and the value thereof will, I hope, justify the introduction into the Repository of a few remarks on its contents ; since this publication may be well supposed to obtain circulation among some Practitioners, especially in South Britain, whom the respectable journal noticed above never reaches. It seems that one of our Surgeons in the East has been employing the nitric acid as a counter-irritant in cholera morbus, in that aggravated form of this disease which has recently been developed in Hindostan. The reason for which this gen¬ tleman applied the acid is very cogent, and instantly to be apprehended by those who have been spectators of the effects of the cholera in Indian climates. 1 refer to the rapidity wherewith it rushes to a fatal close, and the necessity which exists, if it is at all to be arrested, to administer remedies without any, the least delay. The time which must elapse

451

Hull on the External Application of Nitric Acid.

before the Spanish fly commences its irritation permits the disease to acquire invincible strength; and an article which shall perform instantaneously what the lytta requires hours to effect, must obviously boast of great value. Nor is it only in the cholera morbus that such a remedy would be exceedingly precious in hot climates. The velocity observed by fever, characterized by symptoms of internal congestion, and hurrying its victim to the grave before a northern Practitioner would deem there had been time for the formation of the complete excitement, presents another motive to rejoice in such a counter-irritant. In such a case there shall be intense abdominal pain, defying purgatives and venesection ; the patient shall be dead in eight and forty hours; and yet, upon inspection of the seat of pain, there shall be found no adequate inflammatory appearances — no effusion to denote the previous existence or degree of inflam¬ mation. In such a case, where it is so very likely that the local irritation is chiefly connected with the nervous system, and where the counter-excitement of the lytta might be raised with a fatal tardiness, it does appear to me that the nitric acid holds out flattering hopes of success.

But the rapid maladies of a hot climate are not the only subjects adapted to the use of an instantaneous counter- irritant. In temperate latitudes, numerous disorders require the application of remedies which may operate with the least possible delay. Among the phlegmasias let me notice, in illustration, phrenitis, croup , gastritis, enteritis, metastatic rheumatism, and metastatic gout. Of the doiorosi, * the painful affections, unaccompanied by pyrexia, I will say, that the major portion seems to me susceptible of relief from the nitric acid; and I will now detail a case of gastrodynia, excessively severe, in which prompt deliverance from agony was attributable to this powerful article.

The wife of a petty tradesman, resident in this city, has been subject, upwards of thirty years, to attacks of gas¬ trodynia. Six months have been the longest interval of freedom ; and during the last year she has had four or five paroxysms. She is sallow, spare, of an anxious look, expressive of habitual suffering, or constant dread of suffering, and aged upwards of fifty,. She has been treated by various Physicians, has been suspected to have gall-stones; but has never received relief from their prescriptions, nor per¬ ceived any confirmation of their suspicions. She has never been blooded nor blistered for this disorder. Her general state is characterized by anorexia and nausea; and it her common laxative, the aloetic pill, fails to obviate constipation, she expects an attack of gastrodynia.

4 52 Original Communications ♦

About two P. M. of the 14th of October, 1820, she suf¬ fered one such. The pain, with intermissions, lasted through¬ out that day and the night succeeding; and about ten P.M. of the 15th I was summoned to visit her. I found her in a chair, curved forward, writhing in agony, contorting every member and every muscle, and presently rolling on the floor, in spite of the restraints of assistants. She had swallowed ether, was fomented ; but obtained not relief. I gave her half a dram of the ammoniated tincture of opium in spiritus Mindereri, which procured ease for about twenty minutes ; after which the pain returned, with intervals of freedom lasting only five minutes, until two P.M., when L was again called to her. Her pain was intense; the pulse quick; and the tongue foul and whitish ; and every now and then there were succussions of the whole frame, or contortions from agony. She had drank, just before I saw7 her, a dram of the ammoniated laudanum ; and I now drew from her arm twelve ounces of blood, an evacuation which did not relieve her. In a short time she vomited a fluid, which seemed coloured with bile. The vomiting was promoted by draughts of warm water; and she experienced temporary ease. But the pain returning with its previous ferocity, I brushed nitric acid with a feather over the epigastrium, over a space of two palms ; when the patient exclaimed, “ You are burning me!” but almost in the same breath, “ I am in heaven !” The relief might strictly be designated instantaneous and it was complete; delivering me, certainly, from a fear of her dissolu¬ tion, which I deemed a very likely result of agony so exquisite.

The acid excites a sudden and intense inflammation, but it does not corrode; the cutis is untouched, and

the epidermis is not detached immediately ; is not ve¬ sicated as by the lytta, but remains adherent and yel¬ lowed. After a longer or shorter period, perhaps some

days, the scarf skin is thrown off in patches; the healing process is attended by much more irritation than that from a common blistering plaster; cerates seem too annoying ; and the part is eased by the application of a poultice. The healing process is likewise more tedious. In a case I am about to notice, the acid was applied twenty days ago; yet the parts are still sore. I have applied the acid,

in metastasis of rheumatism to the brain. The patient was comatose ; her pupils moveable, but very contracted ; a candle flame held to the cornea produced no closure of the palpabrse ; her feet cold; her pulse intermittent, very w?eak, and evanescent; her eyes at times half closed, at times lifted upward and fixed, giving the expression, so com¬ monly represented by painters, of extreme anguish. She was

Hull on the External Application of Nitric Acid. 453

perpetually moving the left hand up and down plaintively. The conjunctivas were much injected, and the face as dark red as in erysipelas. Seeing the necessity of counter-irritation to be immediate, [ applied the acid to the dorsum of the right foot, by which no sensation was excited. I then applied it freely over nearly the whole of the flexor surface of the Jett fore-arm ; and yet the patient remained unconscious of any pain it might produce. I now gave her some weak spirits and water. The shoulder-joint of the right arm had suffered much from rheumatic inflammation, and the ointment of tartarized antimony had ulcerated the surface; and as I was laying hold of this arm, she became sensible of pain in its shoulder-joint. I proceeded to apply the nitric acid to the right for e-arm ; but she soon relapsed into coma : yet her pulse became regular and more forcible; and the application of heat to the feet and of cold to the head, sedulously main¬ tained, ultimately delivered her from her perilous state.

Whether or not, in this case, the nitric acid was the restorer of sensibility ; whether it roused from the coma, and brought the system into a condition to be affected by the other remedies, I cannot say ; nor do I care to decide. It was efficient in the case of gastrodynia, if it failed in this : and I think that its success in the first-mentioned disorder was sufficiently striking to justify publication; and that the nature of this disorder, and the principle upon which it was removed, are of a character so general and so obvious, that, especially when the Indian treatment is taken into considera¬ tion, I shall not be accused of wishing to draw a general inference, rashly and unphilosophically, from a solitary fact. The acid used by me was of the specific gravity of 1*370: and I have forwarded these loose remarks, unhesitatingly, to the Repository, because I think the remedy here advocated may not only mitigate pain, but preserve life; because, at any rate, it demands an extensive and impartial trial, to which I would exhort the readers of the Repository indi¬ vidually; and because I think the aqua fortis a less terrific application than boiling water, (which, although it has been employed, is very unmanageable,) and less barbarous and more extensively useful than the red hot irons, which are so much in vogue in France.

The great irritation which this remedy produces and pro¬ tracts through the healing process, and the longer period which this process requires, will prevent the employment of nitric acid in common cases ; and will necessitate great cau¬ tion in deciding, in some constitutions, whether to apply it, that is, whether urgency really exists; because, in this case, hesitation would cease.

VOL. xiv,— no. 84. 3 N

454

Original Communications.

P. S. Perhaps the violence of operation of the acid depends upon more circumstances than its specific strength, or the quantity wherein it is used. The Surgeon who has employed it so efficiently in the cholera of Hindostan, neutralizes the acid by an alkaline preparation applied directly after the former.

In the case of gastrodynia above detailed, as soon as I had brushed the aqua fortis over the integuments, I dabbed them with a rag soaked in cold water, that I might dilute whatever portion of acid might remain, after it had effected its imme¬ diate irritation. In this patient, although the sore from the detached cuticle irritated more and remained longer than a sore from lytta, still it was healed, I may say, in a few days. But in the rheumatic patient I did not dilute — -in her case the sores have been exceedingly annoying, depriving even of rest by night ; whilst an application of the acid to three different parts of her body has developed a difference in its degree of action, independent of quality or quantity. It is remarkable that in this person the sloughs did not begin to be de¬ tached for a fortnight after they were made; during which period she experienced no sensation of pain in the parts, which presented the appearance of buff leather, surrounded by a narrow rim of inflammation resembling a riband, from the cauterized spot on the foot the whole slough is not yet detached ; it has involved substance deeper than the cutis —it has left, in short, an ulcer — whilst the sores on' the fore-arms, although vastly more painful, present the aspect of those made by the emplastrum lyttae. The acid was swept with equal freedom over the foot and over the fore-arms. — Whence, then, the difference in its violence of action ? I think, from the relative distance of the different members from the centre of circulation. The inferences deducible from this history, in cases where the surface to be cauterized is large, as in enteritis, are obvious and important. If nothing, in such an instance, further than counter-irritation should be desired, all the superfluous acid should be immediately neutralized or diluted.

III.

Cases of Haemorrhoids. By Powell Charles Blackett, Surgeon R. N. and M.R.C.S., Park Street, Grosvenor Square.

The rapid increase of treatises on the various diseases of the rectum leaves us, in these days, hardly a corner for improvement; but having practised a mode of treatment which has succeeded in some few cases, I beg the indulgence

Wansbrough’s Case of Apoplexy. 455

of the London Medical Repository, by inserting the following : —

April 15, 1817, — G. M., aged about forty-five, a man accustomed to live free, Sec., complained that he had been afflicted with haemorrhoids for these six or seven years ; and that the first attack of them was preceded by a pain in the back and loins, headach, and severe griping pains in the abdomen ; the bowels at the same time being obstinately constipated, which has continued, more or less, ever since. Frequently, he says, there is a very great discharge of serum; and about thirteen or fourteen times since the first attack, there has been an excessive discharge of blood, which always appeared to relieve him much ; but in the course of a week the symptoms returned with increased vigour. He has now the serous discharge; bowels very much confined; and rectum full of tumours, as well as five externally. I ordered him the following remedies: —

R Potassse Sulphatis, 3j.

Sulph. Prsecipitat. gss.

Aq. Cinnam. f Sjiss.

Fiat haustus, ter in die sumendus.

R Pulv. Potassse Nitrat. 5].

Aq. Purse, f §viij.

Fiat injectio, ter in die utenda.

The above injection was thrown into the rectum by means of a uterine or female syringe, and to be retained there as long as possible.

The reason why I advised the female syringe was, that the fluid should be immediately applied to the diseased part and that only, which would not be the case if the common svringe was used. My patient continued this plan for five days ; when I found it necessary to omit the draughts, but to continue the injections, which i found was alone sufficient to keep the bowels perfectly relaxed ; and in the course of two weeks more he was perfectly cured, and his bowels remain open regularly twice a day ; since which time he has been quite tree from this troublesome complaint.

This, in general, has been my plan for these four or five years, which l have found very successful ; having, during that period, cured between thirty and forty patients ; and where there was great haemorrhage, i added to the injection one dram of the tincture of galls.

__ xy. ~~ ”

Case of Apoplexy. By T. W. Wansbrough, of Fulham.

Mrs. George Wallis, aged thirty-nine, of middle stature, regular habits, and a fresh healthy countenance, was attacked

456 Original Communications.

\

by apoplexy, on the night of Tuesday, the 20th of June, whilst going up stairs to her bed-room, between eleven and twelve o’clock. She wms discovered clinging to the banister. I saw her immediately after. I found her sup¬ ported in an upright posture on a chair, totally insensible to surrounding objects, and vomiting violently. Portions of undigested food were thrown up, the constituents of her dinner that day. Pulse 120, full, strong, and vibratory. She was immediately put to bed, the pediluvium applied, and twenty-four ounces of blood taken from the arm at the same time, pleno rivo. Upon examination of the right arm, I found it motionless ; the right thigh and leg were equally paralyzed ; the right side of the face did not participate in the paralysis. Hemiplegia then was conspicuous. The pupils of both eyes were forcibly contracted to a speck; or, to speak anatomically, the irises of both eyes were dilated to their utmost. The breathing short, quick, and laborious, but without the least stertor ; neither did I perceive any foam about the mouth. The superior palpebrse were half closed, and deglutition difficult: in short, every symptom denoted extensive organic lesion of the brain. After the bleeding, the pulse was reduced to 100, but it still indicated great strength of arterial action. I succeeded in exhibiting half a dram of pulv. jalapse, with half a scruple of hydr. sub., and applied a large blister to the nucha, down between the shoulders. A purgative enema was also administered.

21st, nine A.M. — -No abatement of s}miptoms. Pulse 120, full and strong. She has continued nearly in statu quo during the night. She moved the right with the left arm, and placed it in various positions several times, as if conscious of the absence of locomotion in the member. The draught and enema have operated most copiously.

V. S. & brachio ad Jxxiv. et hirudines xij. temporibus ap« plicentur.

R Magnes. Sulph. ^ij.

Solv. in Infuso Rosarum, jx.

Fiat haustus, 4tis horis adhibendus.

The fetor of the alvine deiections during the night was intolerable.

Sensibility to local stimuli eminently conspicuous, and has been so since the commencement of the attack ; as upon pinching either the left arm or leg she flinched, and groaned resistance, (if I may be allowed the term,) when the lancet entered the arm in bleeding her.

Capili eraso lotio frigida e liquore aramon. acetat. et camphora ssepissime applicanda.

457

Wansbrough’s Case of Apoplexy.

Seven P.M. — The blisters have risen well?; some gruel was got down in the day ; she turned herself completely over from her back on her right side ; the pupils continue immoveably fixed ; slight but transient symptoms of con¬ sciousness have appeared since the morning. Blisters were now ordered to the thighs, sinapisms to the feet, and blisters also to the calves of the legs were applied. The medicines have acted copiously. Pulse 100, smaller and weaker than in

the mornino-.

©

22d, nine o’clock A. M. — Deep and laborious breathing, but no stertor. About twelve, and from that period till three o’clock, she became and continued quiet; and her friends and those about her were much flattered in their hopes by a degree of consciousness that seemed to increase, as she handled with the left hand some flowers which were placed upon her for the experiment, gazed at them, and smelt them. The pupils were unaltered — therefore she could not have beheld the object before her; the pulse gradually increased in the course ol the afternoon from 100 to 144; and at seven o’clock, whilst I was present, it suddenly rose to 176, very small, irregular, and intermitting, vibrating beneath the Anger like the tense string of an instrument. The impression on my mind at the moment was, that a rush of blood to the brain had happened ; in fact, a second At. I, in consequence, opened the left jugular vein ; but the attempt to empty the vessels through that channel proved fruitless, a very small quantity only of blood issuing from the oriAce. Foiled in this, I immediately opened the median basilic vein of the left arm, and a free stream flowed, until about four ounces were taken, when she appeared to be in articulo mortis; and at eleven o’clock she expired without a struggle. During the whole of the last day some little hopes were entertained that the symptoms had in some measure subsided, especially after the experiment of the flowers; but at seven o’clock the sudden change totally extinguished them. Permission to examine the state of the brain being readily obtained, I proceeded, on the following morning, at twelve o’clock, seventeen hours after death, to open the head.

I found the substance of the brain very dense and firm ; the hemispheres unusually large ; the falx uncommonly broad, dipping down deep between the lateral lobes that form the firm texture ot the cerebral substance and the depth of the fissure; and from the force that was neces¬ sary in separating the anterior lobes with the Angers, [ could not readily perceive the corpus callosum, a very gentle pressure only being requisite to accomplish this in the generality of cases. The vessels of the dura and pia mater

458 Original Communications .

were of a natural appearance. Proceeding cautiously to the centrum ovale, removing the cerebral substance in thin striae, to detect the existence of an apoplectic cell, the knife glided over the left ventricle, and left a translucent portion, which appeared elevated and distended, from, I suppose, being relieved of the portion of brain above it. Upon penetrating this ceiling of the cavity, I was surprised at the contents. It confined at least an ounce of fluid blood, which ran luke¬ warm out of the ventricle, and discovered a solid coagulum, weighing an ounce and a half, unbroken, lying upon the site of the corpus striatum; this broad cineritious convexity being almost wholly absorbed, and the coagulum occupying its place. The thalamus also was nearly destroyed ; thus representing an apoplectic ceil of much magnitude, and situated among parts which rendered its existence singularly fatal to the patient.

The right ventricle contained about two ounces of opaque fluid, slightly tinged with blood ; the foramen of Monro was dilated to the extent of a quarter of an inch, yet affording a passage reciprocally to the blood and water in the ven¬ tricles. I was struck with the fact, that the blood did not fill the right ventricle from the left through this foramen ; yet when it is recollected that the right ventricle was distended to its utmost, the reason is clear why this did not happen. From the homogeneous mass of devastation which the left ventricle presented, and the disorganized state of the medul¬ lary matter surrounding the collection in it, yielding readily to the pressure of the effused blood, l am clearly of opinion that a cyst existed prior to the fatal attack; and in this hy¬ pothesis I am supported by the fact, that about a monili previously the patient suddenly became insensible, and fell down, apparently dead; she recovered in half an hour; and from that period she complained, more or less, of almost constant headach, with dimness of sight. The absorption then of brain, going on gradually, afforded a lodgment for the subsequent coagulum ; the recent blood distended the cavity of the left ventricle to bursting; but supported, as it was, by the heavy lateral lobe above, the thickness of the brain on the left side, bounded by the cranium, and the already dis¬ tended ventricle to the right, it made its way downwards and forwards, by the natural gravitation of fluids. The thalamus nervi optici becoming the object of its greatest fury, the gravitating absorption of the ventricle found less resistance- in fact, scarcely any — between the floor or base of that cavity and the sella turcica, compared to the opposition offered superiorly and laterally. The contraction of the pupil, or, as it appears to be, the dilatation of the iris, was caused,

459

Wansbrough’s Case of Apoplexy.

doubtless, by the destruction of its origin ; as in compression vve have a dilatation of the pupil, therefore a contraction of the iris, from the stimulus, generally, of the whole sensorium to reaction, produced by the oppression. The right thalamus was not destroyed, yet the iris of that eye was dilated ; and the mention of this circumstance brings to my recollection a fact which l observed in the commencement of my attendance, that the right pupil did not contract so powerfully as the left, and exhibited the very slight impression from the light of the candle. Now comes the grand question upon this point of sympathy, How can the facts here stated be reconciled upon any other ground? Perhaps it will be said, that the pressure produced upon the right thalamus by the aqueous contents of the ventricle, and the increased pressure from the distending left ventricle, produced a paralysis of that convexity, thus destroying the power of vision equally, or nearly so, in both eyes, I have started this hypothesis in opposition, and shall be happy to see it answered. Why not the iris be simultaneously affected by the cause being- applied to the origin of the optic nerve of one eye, as we know the fact to be with the muscles of the eye, which, (except with those who practise it, and gain a command over certain muscles of the eye, as in squinting,) act simulta¬ neously? At all events, the appearances of the brain in this case, as here set forth, appear, to my humble capacity, to be of high pathological importance; and were such inves¬ tigations pursued, I am convinced some good might be at¬ tained ; indeed, not in this case alone, but in every case, and in every opinion advanced.

Again : the observations post mortem in this case furnish a striking example of the amazing rapidity with which me¬ dullary matter is absorbed. In the short space of seventy- two hours was nearly the whole character of the left ventricle destroyed; the small remains of the thalamus, corpus striatum, and the inferior horn, only being apparent. That all this mischief took place in the period I have stated, is proved by the fact, that the patient was in perfect possession of every faculty but ten minutes or a quarter of an hour before the attack; nay, she spoke to the cook just before she went up stairs, respecting some arrangements for the following day. I myself saw her nine hours before the fit: she was then as w'ell as ever I saw her, save a little stiffness of the muscles of the neck, and headach, which she attributed to cold. It would be absurd even to presume that any destruction of the parts here mentioned could have existed previously to the attack, and the faculties remain entire.

Note. Twelve months ago, I bled this patient to the amount

460 Original Communications ,

of twenty-four ounces, in consequence of continued pain in the head, chiefly confined to the osfrontis. After the arm was tied up, tiie blood issued through the pledget, or perhaps from under it, and saturated the bandage : 1 opened the binding, and in a full stream took twelve ounces more. The reaction here was conspicuous; she was not in the smallest degree inconvenienced by the depletion; she lost her headach immediately, and experienced no return of it until about a month previously to the attack, when it came on violently. I bled her then with equal success; and the day before, she was compelled to seek ease in bed, and, unfortunately, resisted all importunities to be bled, it is worthy of remark, in this case, that the greatest injury the brain sustained was on the left side; the right side was paralyzed. What explanation can the disciples of Bichat give of this phe¬ nomenon, in support of their hypothesis ?

Y.

Case of Compression of the Brain . By the Same.

— — —

William Parish, aged eight years, fell from a tree at a height of twenty feet, upon the turf of Parson’s Green, at eight o’clock A.M , July i. The direction of his body in the fall was oblique; he struck his head on the occiput, and glided forcibly on the spine: lie was taken up totally insensible. I saw him half an hour after the accident, lying stretched on his back, breathing deeply and regularly. The pupils were alternately contracted and dilated, but strongly susceptible to light, contracting immediately upon the window curtain being withdrawn. He had thrown up a quantity of foam, mixed with blood, and was vomiting the same matter when I saw him : the effort seemed to distress him exceedingly. Susceptibility^ of local stimuli was here conspicuously present; for upon being pinched he hallooed loudly, but did not utter a word: upon being roused, he cried out lustily, and turned himself away from his disturber — then sunk into his former lethargy. He swallowed with little difficulty. From the symptoms detailed, I could not doubt that the case was one of concussion. The pulse strong and full, yet soft, breathing regularly at 75-6. I directed him to be kept quiet, and all light excluded. In the course of the day I saw him four times. Twenty grains of pulv. jalap, and six grains of calomel were given to him in gruel, with great difficulty. On the following day, second, he continued nearly in the same state. The powder had been repeated three times without any effect. An attempt to administer an enema

Wans trough's Case of Compression of the Brain. 46 1

was rendered unavailing, by the resistance he offered. In this state things were, until six o’clock, when he became restless, the pulse rose in number to 100, and assumed the inflammatory character. His head incessantly moved on the pillow, and the least admission of light was sensibly felt by the iris and retina: here then was reaction. Phrenitis was making its approach with hasty strides. I immediately opened a vein in the arm, and took away twenty-four ounces of blood; the pulse sunk to 70, but deliquum did not supervene. The vomiting, which had ceased six hours after tiie accident, now returned, but very little froth was ejected. The head was shaved, and a cold lotion kept constantly applied. Nine o’clock, pulse 96. I opened the temporal artery, whence I obtained about six ounces of blood : he became tranquil, and the pulse again sunk to 80. The irri¬ tability of stomach rendered the attempt to administer any medicine useless, as he threw out his gruel, which till this period he had readily swallowed without difficulty. Half¬ past eleven P.M., I was sent for, as his parents thought him dying: he certainly appeared to justify their fears, for he tossed about the bed in restless agony, and was in high delirium. Twelve leeches were immediately applied to the temples, and a large blister ordered between the shoulders, high up. I left him at twelve o’clock with a quick, small pulse, and in a state threatening a fatal ter¬ mination ere my morning visit. I was agreeably surprised, however, to find him alive, and better: the medicine had operated most copiously; the leeches bled freely until three o’clock, at which time he had the first motion, a black foetid mass.

Third, nine o’clock A.M. — Urgent symptoms much abated ; the boyr now answers incoherently, yes and no; when questioned, complains of his head, and puts his hand to the occiput, as the seat of his pain: pulse 80, fuller and regular, but not soft. As he has had four copious motions, i directed a free supply of gruel to assist the operation of the medicines. This morning the pupils contract and dilate freely, and in unison. Twelve o’clock, repeated the powder ; the blister ordered last night could not be applied, in consequence of his resistance and screams: I directed the attempt to be repeated at nine o’clock, and I learn that it was again frustrated. Supposing a disposition existed in the mother and attendants not to apply it, I endeavoured to place it between the shoulders; but, although a child, three of us could not get him in a position to accomplish it; he writhed about, determined not to have it on; indeed, had it been applied, he would soon have rubbed it off. Ibis

VOL. xiv. — no. 84. 3 o

462

Original Communications .

attempt gave me an opportunity of observing that it wad not altogether disease, but a great deal of temper that ap¬ peared in his resistance. I have often experienced the dis¬ advantage of such a circumstance, when, in defiance of threats or entreaty, children of this description have borne out their resistance to the exhibition of a medicine the most essential to their recovery? ; and, if coercive measures be adopted, the resistance they put in force, combined with temper, if obstinate, produces sometimes a fit: thus, I never advise parents to force their children to take medicine. I trust this will not be considered a. digression, because it is not irrelevant to the case in point : among the poor, espe¬ cially, this fact is conspicuous; and in the instance here stated I felt its force severely. The boy, who is the subject of this case, is of poor parents, and like the “ wild ass’s colt,” was unmanageable; for, whilst he was insensible, the powders were fortunately got into the stomach, but after, he became conscious of surrounding objects, neither the threats of his father, nor the entreaties of his mother, could prevail on him to swallow another mouthful, even of gruel, fearful lest it might be “ physic/’ I had, therefore, no other dependence for success, than the lancet and the powders he had taken, which, fortunately, proved efficacious, for he gradually recovered, and at the end of five days from the occurrence of the accident he called for more food than his parents could supply him with : at the end of a fortnight he became convalescent, and in three days after, that is, on the 18th of July, he was out of doors. I have seen him since, and there appears a degree of idiocy about him, which I understand has been noticed by others : whether he will recover this, remains to be proved.

It appears from this circumstance, that the brain sustained a severe shock, and that, had not the approach of inflam¬ matory symptoms been detected, and their progress arrested, the boy would have been lost.

Upon comparing this case with the preceding one of apoplexy, and with the diagnosis laid down, by which authors have taught us to distinguish concussion from compression, it appears to me impossible to draw a correct inference in even the generality of encephalic affections. In concussion, say the schools of Surgery, you have vomiting, dilated pupil, and sensibility to local stimuli ; in compression there exists vomiting, but this is not always a concomitant symptom; dilated pupil, and insensibility to local stimuli : whereas, in the case of Mrs. Wallis, which was, demonstrably7, com¬ pression, there existed vomiting, immoveably contracted pupils, with strong susceptibility of local stimuli. In the

Wansbrough’s Case of Compression of the Brain. 463

case of the boy, William Parish, the pupil was decidedly not dilated, and the susceptibility to local stimuli was highly conspicuous; so that it appears we are not warranted, in encephalic affections, to adopt decisive diagnoses from any particular symptom or set of symptoms, as they may, and do exist, in each particular disease reciprocally, where there is no visible injury of the head : we should, therefore, collect, arrange, and compare the appearances and symptoms as they arise, at the bedside of the patient, to assist our judg¬ ment in forming a prognosis. To quote the words of a very able writer, in support of my position, he says:- —

“ To distinguish between a commotion and an extrava¬ sation (of the brain) by the symptoms only, is frequently a very difficult matter, sometimes an impossible one; the similarity of the effects in some cases, and the very small space of time which may intervene between the going off of the one and the accession of the other, render this a very nice exercise of the judgment. The first stunning or deprivation of sense, whether total or partial, may be either, and no man can tell from which ; but when these first symptoms have been removed, or have spontaneously disappeared, if such patient is again oppressed with drowsi¬ ness, or stupidity, or total or partial loss of sense, it becomes most probable that the first symptoms were from commotion, and the latter from extravasation ; and the greater the distance of time between the two, the greater is the probability, not only that an extravasation is the cause, but that the extra¬ vasation is of the limpid kind, made gradating and' within the brain. Whoever seriously reflects on the nature of these two causes of evil within the cranium, and considers them as liable to frequent combination in the same subject, and at the same time considers, that in many instances no degree of information can be obtained from the only person capable of giving it, (the patient,) he will immediately be sensible how very difficult a part a Practitioner has to act in many of those cases, and how very unjust it must be to call that ignorance which js only a proper diffidence arising from the obscurity of the subject, and the impossibility of attaining materials to form a clear judgment.” Hence, how invaluable are the opportunities of post mortem examinations ? and how culpable the negligence of that Practitioner, not only to himself, but the community at large, who neglects to seize them when offered, nay, to ask it as a favour, wherever there may be the slightest shadow of evidence wanting in the general symptoms to warrant any important conclusion ? Let us, in this important point of our professional career, viz. the searching out for facts to guide our judgment imitate

464

Original Communications ,

the great John Hunter; not, indeed, in transgressing the laws of propriety but let us imitate him in that ardour which he evinced for inquiry, that thirst after knowledge which led him to seek for pathological truth where alone it is to be acquired, viz. on the ground of morbid anatomy.

VI.

Note. By George Paekman, M. D., of Boston, V.S.A. in compliance with a request from the Editor of the Repository, Vol. IX. page 353.

- - — has had three children : lives in a dark damp

cellar facing the north. For a month before her third delivery she had piles; for the first time, also, pain in her left side.

Sept. 17, 1820. Nine A.M. she seemed in labour so urgent I hardly left her till two, when she was delivered and had a stool ; she had had one twelve hours before. Sept. 18, noon: abdominal pains and soreness begin. Six P. M. I am told, that she has had no stool since birth, and that her lochia had lessened. (I had fruitlessly re¬ quested that she should have a laxative eighteen hours after delivery, if no stool should intervene ; and that I should have immediate notice of the occurrence of abdominal pains and soreness.) She takes sulphate of soda, two ounces, (a pint glyster of water, saturated with sulphate of soda, was prescribed, but neglected,) and at half-past seven, two ounces more. Eight P.M. pulse rather quick and hard: obliged to leave her for the night, I bled her in an erect posture, from a large opening, till the pain subsided ; twenty-four ounces are drawn: on lying down the pain returned; on swallowing sp. of turpentine, two ounces, she has a full stool and immediate ease; and many stools till Sept. 19, nine, P.M. - — Sept. 20, three, P.M. pain and soreness are felt; she takes

* John Hunter, upon requesting permission to examine the body of a nobleman’s child, who had died of a disease in which there appeared ambiguous symptoms, met with a denial from the father, which operated so strongly upon his scientific ardour, that he vented his chagrin and disappointment by addressing the father in these words : “ You will not permit me to open this child? No; was the firm reply. “ Then, Sir,5’ said John Hunter, <c 1 wish that you and all your children may die of the same disease !!!”-— Vide Abernethy’s Hunterian Oration, 1819* I do not know if this anecdote be inserted, but it was delivered by the orator, as illustrative of the irritability of temper, combined with a “ good heart,” so well known to every one who was honoured by the notice of that great man, John Hunter.

4 65

Philip’s Observations on Mineral Waters.

sulphate of soda, two ounces: five P.M., sp. turp., two ounces and a half: seven P.M., she has a full stool and relief. Sept. 21, secretion of milk is established : P. M. she returns to her domestic duties. During the whole time of her confinement her husband was in her bed, under typhus fever.

The disease seemed to depend on inactivity of the bowels, and to be relieved by emptying them. 1 do not know that in such cases any one quick purgative is much preferable to another.

VII.

Some Observations by Dr, W. Philip; suggested by Dr. Scudamore’s Treatise on Mineral Waters .

Dr. Scudamore, in his late Treatise on Mineral Waters, in alluding to my Analysis of the Malvern Waters, says, that he could detect no iron in them, and found the water of the Holy W ell and that of St. Ann’s “ precisely similar.” Dr. Scudamore gives no detailed account of the experiments by which he arrives at these results.

The reader will find in my Analysis, that the difference in the quantity of the ingredients which these waters contain was ascertained by repeated distillations of a gallon of each of the waters in closed glass vessels, and without allowing the water to boil ; for 1 had found, from several trials, that such a proportion of the solid contents as considerably influences the result, where the whole quantity is so small as in the Malvern waters, passes over when the distillation is performed by boiling. (Analysis, pages 19, 20, &c.) Each distillation lasted between three and five days. I need hardly observe, that it was impossible for me, on com¬ paring two powders, to mistake a whole for a half; for the solid residuum of St. Ann’s water was never more than about one half of that of the Holy Well water.

The experiments detailed in the above Analysis, made at the springs with the lime, strontian, and barytic waters, (pages 3, 4, 43, 44,) are alone sufficient to point out an essential difference between these waters. The same may be said of the difference of the effect on adding to the two waters infusion of litmus, reddened by an acid, (page 45); also of the different degrees in which it was necessary to concentrate the two waters, in order that they might produce the same effect on paper stained with turmeric, (pages 33, 52); of the difference in the quantity of the precipitates obtained from them, under the same circum-

466 Original Communications.

stances, by sulphuric acid, (pages 35, 53, 54*) ; of the precipitates obtained from them, under the same circum¬ stances, by carbonate of soda, (pages 37, 54, 55) ; of the precipitates obtained from them, under the same circum¬ stances, by prussiate of potash, (pages SB, 55) ; of the pre¬ cipitates obtained from them, under the same circumstances, by acetate of barytes, (pages 40, 41, 56, 57) ; and of those obtained from them, under the same circumstances, by acetate of silver, (pages 41, 57.)

I cannot help suspecting that the portions of water on which Dr. Scudamore experimented, were sent from the same well. It is often difficult, as I have repeatedly ex¬ perienced, even for those on the spot to be assured that the more distant water is brought to them.

With regard to the existence of iron in the Malvern waters, the means which I used to ascertain its presence are not liable to any of the objections stated by Dr. Scudamore. I did not use the muriatic acid of commerce; but that acid prepared by myself, and distilled in glass vessels from a mixture of muriate of soda and sulphuric acid, and with which I found that neither tincture of galls nor prussiate of potash gave the slightest indication of iron. If the reader will take the trouble to consult the fourteenth and fifteenth pages of my Analysis, he will find, that this acid, when it had been allowed to act on the powder deposited from the Malvern waters, gave a deep purple with tincture of galls, as well as a copious blue precipitate with prussiate of potash. In pages 39 and 55 he will find additional proof of the iron being derived from the Malvern waters; because, when they were used after having been kept some time, the quantity of iron obtained was too small to be appreciated.

While I most willingly admit the general candour and libe¬ rality of Dr. Scudamore, and chiefly ascribe what appear to me errors in his conclusions to the difficulty of drawing correct inferences from experiments made on small quantities of such waters conve3Ted to so great a distance, he must allow me to say, that the whole of his investigation seems to have been conducted with less attention than the subject deserves; particularly as he calls in question the accuracy of an analysis, all the steps of which had been minutely detailed, and laid before the public, and which, whatever be its merits, was conducted with no small degree of care and labour.

In the seventh line of this page there is a typographical error ; 2'55 ought, as appears from the following paragraph, to have been 0*55.

467

Burrows on Insanity.

The quotation which Dr. Scudamore gives as an account of one ot my experiments, is an account of an experiment of Di . W all, quoted by me, (Analysis, page ]). in my repe¬ tition of this experiment, equal quantities of lime-water and the Malvern waters were used. When the Holy Well water was used, the transparency was not disturbed till a short time had elapsed after the waters were mixed, (page 3). When that of St. Ann’s was used, it was not disturbed at all ; “ nor did 1 perceive any of the flocculi observed when the Holy WTeIl water was mixed with lime-water,” (Analysis, page 43.)

PART II.

ANALYTICAL REVIEW.

I.

An Inquiry into certain Errors relative to Insanity ; and their Consequences , Physical , Moral , and Civil. By George Man Burrows, M.D., F.L.S.; Fellow of the Phys. Med. Soc. of the University of Erlangen; Member of the Royal Medical Society of Edinburgh ; of the Atheneum of Medicine of Paris; of the Mineralogical Society of Jena, &c. 8vo. pp. 320. Underwood. London.

— — «a^p- -

Although the work before us more correctly belongs to medical statistics and police, than to medical science ; yet, as it presents some veryT important information, elucidatory of the success hitherto attending the treatment of insane persons, and an exposition of many errors which obtain, and impede the application of still more effectual remedial plans for their recovery; we think we shall be rendering an acceptable service by a brief analysis of its contents. This book has also some further claims on our notice ; for the author has attempted, and in a manner somewhat novel, to explain how far abstract religion may be considered a cause, and how far an effect, of a disordered mind — a point much disputed, and from misapprehension is, we fear, too fre¬ quently a source of irremediable mischief.

Dr. Burrows prefixes an advertisement, which exhibits the very extensive and authentic sources whence he has derived much that he communicates.

We collect that the object of his inquiry is the refutation of conclusions founded on premises which he conceives

468

Analytical Review.

are erroneous ; and which, he feels confident, still operate and by their continuance are likely to mislead the Legislator’

thUeLfi|l!:ftthVinsaneC.,an’ or P'escribmg for

Our author divides his treatise into eleven sections : —

• * . s tnsamt} curable- and in what proportion ? £ fs

insanity as susceptible of cure as other maVdie V 3 is

mXdlvy?aVnHeaSiDS mS,1y? 4‘ ]S insan’f3' * prevalent malady r o. Has insanity decreased? 6. Conseouenres of

7" OnThe fofT °f 'TTJ,’ reference to lunatic asylums. 7. Un the influence which the localities oflunatic institutions

have on then- results. 8. Remarks on the condition of the

epileptic, fatuous and idiotic. 9. Is religion a c use or an

tion of lunatics 1 1' i efficacy ot religious tnstruc- unatics. 11. Suggestions respecting leo-ishfiv^

regulation of lunatic asylums, &c. “ 8 tlVe

someacurfoutl,r-,1eCl‘<rnS ^ illastrated by tab!es, exhibiting

bracine such’nnblfo d IOnS’ and 3 COPious Appendix, eni- uidcing suen public documents as were necessary tn cr,no

,l,e *8„i„„, ,„d

,hf pZ u*D,,*Rep“"Cy rhicl' P™" public opinion on } P°lnls nr- Burrows has selected for investigation and Rom the necessity that the truth should iL known this

that “man? “OSt,0PPortunely undertaken : and he has proved

- r - wwtau? a, r 't,

only - »' ««»..» “

Giving our author that credit for Vprr.;t„ o a which is his due, till either the one or Z PL we may congratulate the friends of humanity and 'theT*3 ’ fessors of the healing art, on results which e ^tce how tfX

■ 7hdy ““7 «*e alleviatin' “£

with medical skill ^ ' JU j-c|ous union of moral management

that in selected and recent cases the ..A- , 100 ; and

in inn r . i eLUU tascs> tile ratio ascends even to S6

“b ;v; rss t £ .rf"— r%

b SIDgU ar and Unaccoumabie, that while the registers of

l

F

or

aci

li

469

Burrows on Insanity.

foreign hospitals exhibit a progressive increase in the number of lunatics cured , those of our two great national establish¬ ments, Bethlem and St. Luke, should exhibit a retrograde scale; yet so it appears, according to Dr. . Burrows’s table, tracing back from the present year to the foundation of each of them. We are inclined, and sincerely wish, to believe, that the inaccurate manner in which the registers of those hospitals have been kept, may partly explain the difference. Still the fact appears to us to require a minute examination. It ought, however, in candour to be noted, that the ratio of cures in Bethlem is again progressing.

Not less singular is it, in a country like England, famed through all nations for pre-eminent skill in the treat¬ ment of the insane, and abounding in private receptacles under the superintendence of able Physicians, that no one has ever published an account of his own particular ex¬ perience ; nor are we in possession of one scientifically arranged register kept in any public asylum. Glasgow forms the only exception.

Commenting on this egregious and little to be expected omission in the English system of conducting such places, Dr. Burrows observes, that it “ almost justifies the reproach of foreigners — that the many learned English writers who have published on mental affections, have displayed greater fondness for speculative disquisition than practical induction.”

The author has given, in the subjoined table, a summary of the results of the cases of insanity which have come under his own care : — -

Aggregate of Cases.	Aggregate of Cures.	Recent Cases.	Old Cases.	Died.	1 Remain.	Event unknown.
Cases. | Cures.	Cases. | Cures.
296	240	242 | 221	54 | 19	22	2 6	8

“ Th is offers a proportion of cures on the aggregate of all cases, of 81 in 100; on recent cases, of 91 in 100 ; and on old cases, of 35 in 100.”

Some of these cases appear to have been treated in Dr. Burrows’s particular Establishment ; but the majority in private practice ; and many were in a state of fatuity, idiocy, or epilepsy, complicated with mania, or in the last stages of acute disorders, “ where the mental derangement was sympto¬ matic delirium, the precursor of death.”

Whatever superiority of success has attended his efforts, our author candidly attributes it to having had an unusual propor-

VOLo xiv. — no. 84. 3p

470 Analytical Review .

tion of recent cases, which always afford the fairest prospect of a happy event. And to show that there is nothing very extraordinary in this high proportion, he refers to the cele¬ brated evidence which the late Dr. Willis gave, thirty years ago, and nearly to the same effect ; and to the ratio in the comparative table alluded to, of cures which have been performed in various institutions.

In allusion to the obstacles to improving the treatment of the insane, Dr. Burrows remarks: —

“ It is obvious that the study of mental derangement partakes of all the incidences attaching to the treatment of a disease little known; therefore any conjecture on the extent of improvement which may be attained, would be presumptuous. However, we certainly have not arrived at the maximum. The obstacles to that consummation are, indeed, numerous. Nevertheless, they are not to be imputed to a defect in knowledge or enterprise in the Faculty ; for although possessing every physical qualification, and evincing the most ardent zeal, yet it is almost impossible for a Physician to com¬ mand the means, either moral or medical, necessary for treating insanity with full effect. The outfit of such an establishment as a philosophic mind would plan and like to conduct, is beyond the ordinary resources of professional men. Besides, success much depends on unconstrained volition in directing the means: this being denied, few persons of liberal education, or honourable feelings, have been found to make this branch of therapeutics their study ; and still fewer to enter upon the practice of it. These also have been- causes obnoxious to the improving of the medical treatment of insanity, but not of other diseases.”

Our limits will not permit us to pursue our author in his inquiries, whether insanity is an increasing, or a prevalent [comparatively], or a decreasing malady. Suffice it, that he enters into a very elaborate discussion, and adduces a great variety of authentic testimonies, controverting the first and second propositions, and argues with considerable force and effect to establish the third. They are questions in the truth of which the interests of humanity are deeply involved: and we confess we have derived great consolation from the perusal of the proofs and reasoning he has advanced ; for if he do not completely establish his positions, he at least removes many prejudices which have obtained on these several points, and thereby clears the way for those who choose to follow the same course of investigation.

The intervening sections, although abounding with obser¬ vations of infinite consequence to legislators, country magis¬ trates, and persons concerned in the economy of public lunatic establishments, it would be irrelevant here to descant on.

The eighth section, however, contains matter which cannot

471

Burrows on Insanity.

be indifferent, either in a medical or philanthropic view of human afflictions. Dr. Burrows takes this occasion emphatically to remark on the condition of the epileptic, fatuous, and idiotic, who, it must be confessed, have been strangely neglected in this land of charity : —

“ In this branch of morals,” says our author, “ England is decidedly inferior to her continental neighbours. Almost all the public asylums in Europe receive the epileptic, fatuous, and idiotic. But in those which deserve the character of being the best regulated, they form a distinct part of the establishment. They are treated medically; the results are carefully registered; annually published ; and they are classed so judiciously, that one class interferes not with another. Each patient also has an occupation suitable to his abilities.” — “ From 1804 to 1813, three hundred and ninety-four cases of epilepsy were admitted into the Ric&tre at Paris; of which one hundred and forty-four were cured. In la Charite, at Berlin, from 1806 to 1818, four hundred and twenty-six epileptics were ad¬ mitted ; of whom one hundred and ninety-five were discharged wel]/’

Dr. B. appeals to the benevolent and affluent, to found distinct institutions for the reception and treatment of these the most abject of our fellow-creatures — a hint which, in our judgment, well deserves serious attention.

Idle subject which our author next proceeds to discuss, is, indeed, one so difficult and delicate, that most have shrunk appalled from the attempt — we mean, whether insanity is a cause or an effect of religious impressions.

Intensely interesting as the elucidation of this question is (and surely there are few more so to the happiness of mankind), we will not assert that it is one fairly coming within our province to dilate upon. Yet as our readers, whether in the exercise of their social or of their professional duties, may be inclined to learn the sentiments of a practical observer, like our author, on this point, we will impart them by making one extract, which condenses within a moderate compass the essence of his opinions. In truth, we are the more disposed to this concession, because Dr. Burrows has had the happy fortune to have his opinions on a subject so open to controversy treated by contemporaneous reviewers, professing very opposite religious tenets, with so much deference as to seal them with an authority ol a very unusual character.

Continuing his train of argument, Dr. B. thus speaks :

“ Hence I conclude, that there is a preparatory and essential condition of the mind, to which it must be brought, before religion can originate insanity ; and that condition is that of doubt as to the orthodoxy of the doctrine professed.

“ Were the remote cause of insanity, whether marked by religious exaltation or despondency, to be traced, I verily believe that almost

472 Analytical Review .

all such lunatics would he found converts from their original to a new faith; and that the aberration was usually developed during the transition.

“ Every writer, in expatiating on the exciting causes of insanity, lias ascribed a large and direct influence to religion. But they generally impute it, first, to the mysticism of the tenets inculcated ; secondly, to the intenseness with which abstract theology has been studied or followed ; and, thirdly, from religion being over ardently impressed on minds too tender or narrow to comprehend it. But none seem to advert to that particular state to which the perceptive and reasoning powers are brought, before religion ever induces derangement. It has been justly remarked, that when once the medium through which we have been accustomed to view the Deity is impaired, in the endeavour to approach Him through a new one, the mind is bewildered; we know not where to rest; and, ever dissatisfied, no clear conception is obtained of the real presence of Him whom we seek. This state is the most dangerous to the human mind ; and there is no marvel, if, at such a crisis, the intellects fall into disorder/’

Several striking examples, mostly of females, illustrative of mental alienation, proceeding from this condition of the intel¬ lectual faculties, are detailed from the author’s own obser¬ vations.

The efficacy7 of religious instruction of the insane is a subject which could not fail to attract the attention and

animadversion of one who has so zealouslv devoted himself to

«/ s

the study and treatment of mental derangement. Accordingly, Hr. Burrows offers many observations worthy the regard of those who are anxious to acquire a knowledge of the most judicious application of such a powerful engine on the human mind. We must, however, refer to his book for what he says under this head.

Relative to our author’s suggestions on legislative regula¬ tions of lunatic asylums, we shall say little ; because we could not, within the space allotted us, adequately explain the nature and extent of them. Thus much, however, we may observe : Dr. Burrows condemns all enactments imposing excessive fines, and such restrictions as would make it derogatory from persons of education, character, and property, to become proprietors and superintendents of lunatic asylums. He maintains, as an axiom, that “ severity never yet improved any system of morals and as a sound system of management must depend on the moral qualifica¬ tions of all classes engaged in this occupation, he insists, that by substituting a system of encouragement for one of coercion and punishment, men of talent and respectability will be induced to accept the charge of the insane, who otherwise will contemn and shun it.

473

Hennen’s Principles of Military Surgery , fyc.

The fundamental principles on which Dr. Burrows alleges the amelioration of the present condition of lunatics, and every improvement of which it is susceptible, depend, he in conclusion thus recapitulates : —

“ 1. Let none but properly qualified persons act as superintendents. 2. Establish an efficient, but neither a tyrannical nor a capricious supervision or inspection. 3. Make suitable provision for faithful, superannuated, or disabled keepers or attendants. 4. Ascertain that the site of every new asylum is proper, and its accommodations competent. 5. Suffer no private asylum without a license; and confer power to refuse, suspend, or annul licenses. 6’. Enjoin an effectual system, both in respect to certificates, and the registry of admissions, cures, discharges, deaths, &c, 7* Have the returns

perspicuously, uniformly, and regularly made; and the annual report, especially to parliament, drawn up so as to exhibit a clear comparative statement of the results of every asylum in the kingdom. 8. And, finally, abolish excessive pecuniary obligations; apportion penalties according to offences; and ordain that the accused shall have equal means of obtaining justice with the accuser/'

If.

Principles of Military Surgery , Sfc. By John Hennen, M.D.,

F. R.S.E. Second Edition, with numerous Additions.

pp. 580.

We, for the most part, consider it proper to abstain from noticing second editions of works; but we depart in this instance from our general principle, on account of the volume before us containing a disquisition, of an especial kind, upon the two momentous and still disputed points — the pre¬ ventive efficacy of vaccination, and the eligibility of treating the syphilitic disease without mercury.

Since, from such an author as Dr. Hennen, any thing involving controversial matter must come with much autho-

o

rity, we judge it expedient to present the reader with an abstract of his views, both on the vaccine and the syphilitic questions. With respect to the former, however, it is only necessary to announce his general sentiments, since the matter has been so amply treated in our reviews of Dr. Thomson and Mr. Cross. Dr. H. commences his paper on vaccination in the following terms: —

“ To enlarge upon the advantages of vaccination to mankind, would be quite superfluous; to deny that, like all other human inventions, it is not infallible, would be both absurd and injudicious. Vaccination possesses too many real merits to require false or exaggerated praise. From causes which it may, perhaps, never be permitted us to penetrate, that terrible scourge, the ravages of which

474

Analytical Review.

are so pre-eminently neutralized by the happy discovery of Jenner, attacks the unprotected with redoubled violence during certain epidemic visitations ; and even those who have undergone the cow- pox in an unequivocal manner, bear a share in the suffering, though rarely in the mortality.”

After giving an account of some of those affections which a little time ago excited so much attention, and about which there was such a difference of opinion as to their real nature. Dr. H. goes on to say —

“ After the most mature consideration, I must explicitly avow, that nothing has occurred in the cases I have related, which has, in the smallest degree, shaken ray opinion of the great and pre-emi¬ nent importance of the practice of vaccination, whether we view it as a preventive of small-pox in a vast majority of cases, or as a most effectual neutralizer of its malignity, in the comparatively few instances in which, from some peculiarity of constitution, or some anomaly in the process hitherto not fully developed, it has failed to afford this permanent security. If the more anomalous among these cases are considered as merely aggravated instances of varicella, the nature of the Jennerian practice is in no shape affected by them, except, indeed, that it is clearly shown, that the 'practice renders not only variola , hut varicella also , more mild. If, on the other hand, they are considered as the horn-pock, or the stien-pock, that disease, as I understand from the first medical authorities, was well known in this country before the introduction of vaccination, and frequently occurred in persons who had previously gone through the genuine small¬ pox y although never noticed of later years as an objection to variolous inoculation. In this case also, vaccination will be found to have manifested its neutralizing powers. But I have witnessed it still more remarkably among the children of the lower class, in the neigh¬ bourhood of Edinburgh Castle; where, while unmitigated small-pox has raged violently among the non-vaccinated children, many in¬ stances have occurred of those who have gone through that process, having the complaint in the mildest possible form, and many of them escaping it altogether; a fact exhibiting the results of a more rigid ordeal of the preventive powers of vaccination, than can be imagined by those who have not witnessed the incredibly crowded and confined apartments in which these compact masses of human beings gasp for air; while, from the mutual friction of their bodies under the same scanty covering, the most intimate contact takes place between the sound and the diseased, and, in many instances, effects a complete and constantly renewed inoculation.”

Dr. H. then proceeds to remark, that, allowing the disease in the adults alluded to to be small-pox, of which there can be no doubt, they afford so many additional proofs of the disease occurring a second time. He expresses his opinion, that the unbounded confidence which, prior to the practice of vaccination, was placed in the universality of the law, that

Hennen’s Principles of Military Surgery, fyc, 475

small-pox can be taken but once, induced observers to set instances of second small-pox down as cases of varicella; and, at the very least, our author conceives the position to have been fully made out, that if vaccination does not prove an infallible preventive of small-pox, neither does that disease itself, with absolute certainty, prove preventive of its future recurrence. A law here is alluded to, which we think, both as to the particular point in agitation and as to its bearing upon the doctrine of diseased communicability in general, has not been sufficiently recognised ; viz. that a certain degree of affection may, in some cases, be the result of exposure to contagious miasmata, without the positive induction of the actual disorder from which such measure of illness had arisen: a susceptibility thus to be affected with small-pox Dr. Jenner conceives may remain through life; and the remark might apply to all other morbid poisons to which the human frame is obnoxious. It is possible, indeed, that the varieties of disease which the records of different periods display are entirely referrible to this principle; and that what the ancients described under one name may be mere modifications of what we now are disposed to receive as disorders essentially different. The influences of climate and medical treatment, in thus modifying susceptibility, ought to be, perhaps, appre¬ ciated more highly than they are ; and it is certainly a very possible case, that, as it regards the disorder to which we are immediately to advert, these extraneously operating circum¬ stances have so altered its character and requirements, that what w?as, in the first instance, mere genital disease, without specific character, might, in the course of time, come to assume such character; and that this peculiarity and distinct essence may again, in a great measure, have been lost by vigorous treatment, and the more gradual and less imme¬ diately observable operations of time, place, and circum¬ stance.

Dr. H., in his paper on vaccination, details the circum¬ stances of a case of small-pox occurring after natural vacci¬ nation ; or, in other words, in a subject who had received the disease directly from the cow’s udders, “ and which were at the time said, by a doctor who w-as consulted in the neigh¬ bourhood, to be what is called cow-pox.” This fact is curious ; as it has been maintained that although artificial vac¬ cination may fail, the natural disease never does. It wrould, however, have been more satisfactory, that the testimonial of the woman’s having had the genuine cow-pox should have been rnade out in less vague terms, than that it was said to be so at the time by a doctor who was consulted.

476

Analytical Review.

The paper is concluded by the following remarks on the treatment of small-pox : —

“ In the unmodified disease, where it occurs in adult subjects, our most powerful remedies are called for; and among them venesection is often necessary and markedly beneficial. I had an opportunity of seeing this very clearly illustrated some time ago. Four adults, recruits, were seized with variola at Portsmouth ; the determination to the head and lungs was violent to a degree, and copious venesection was had recourse to in three of the individuals. These three reco¬ vered, while the fourth, in whom venesection was not performed, after having passed through the violence of the disease, sunk under extensive formations of pus, which appeared in the form of abscesses, dispersed almost all over his body, and affording a most disgusting spectacle.”

The object of Dr. Henneiq in his paper on syphilis, is to defend the army Surgeons against the allegations of temerity, in their late suggestions respecting the possibility and pro¬ priety of excluding mercury in their management of syphilitic affections; and to prove that u all kinds of sores , or primary symptoms of syphilis, may be cured (as far as a period of nearly two years will warrant the conclusion) without mer¬ cury and that secondary symptoms do not follow the non¬ mercurial treatment with any thing like the frequency that has been maintained.

Dr. H. thus candidly expresses himself on this most inte¬ resting question, w'hich now agitates the medical world : —

“ I would by no means be understood to assert, that many cases of syphilis have not yielded to mercury which had previously resisted every other medicine; but its indiscriminate employment in every case, whether old or recent, suspicious or confirmed, and without any view to the patient’s diet, or his general health, has produced the most dreadful consequences. To reduce its employment within the limits where it can be salutary only, without creating or evolving other diseases, is the best means of supporting the reputation of the medicine. Where Hunter and Abernethy, Pearson and Carmichael, have hesitated, we surely may be permitted to pause. These eminent men greatly contributed to the elucidation of the circumstances under which mercury was improper; their precepts and example have reduced the quantity formerly given to comparatively moderate bounds ; but it remained for the inquiry which is at present prose¬ cuting in the military hospitals to show that even these hounds are too extensive ; and that the Practitioner has, in a vast number of instances, the option whether to defer its use, to limit it, or to omit it altogether. Settled, as it now is, beyond a doubt, that syphilis does not run on uninterruptedly to a fatal event, if not checked by mercury, the Practitioner cannot be admitted to do full justice to his patient, who

Hennen's Principles of Military Surgery, Sc. 477

does not avail himself of the fact: — to his own judgment must be left the extent to which he may be pleased to do so.”

We are told further by Dr. Hennen, that the distinction between a chancre or true venereal ulcer, in which mercury is alleged to be indispensable, and one of a different nature, is not by any means a matter of such facility as the remarks of some would lead us to infer. It would be by no means difficult, he says, to show, that the scooped or excavated sore, the preceding pimple, the loss of substance, the hardened base and edge, whether circumscribed or diffused, and the tenaciously adhesive discharge of a very fetid odour, are all observable in certain states and varieties of sores unconnected with a venereal origin. The hardened edge and base, parti¬ cularly, can be produced artificially, by the application of escharotics to the glands or penis of a sound person ; and if any ulceration or warty excrescence previously exists on these parts, this effect is still more easily produced.

u What, then, (says Dr. H.), it may be asked, would I recommend as the proper treatment of the diseases produced by sexual intercourse?” The following are the different items of his reply to this most momentous question: —

“ 1st. In every primary ulcer I would give up the idea of using mercury at first, treating it as if it were a simple ulceration, by cleanliness, rest, and abstinence, and applying to it the most simple and mildest dressings *. if the sore did not put on a healing appear¬ ance in a reasonable time, the extent of which must depend on the circumstances of the patient, I should make use of more active dressings; but if, beyond all calculation, it remained open, I should certainly not sacrifice every consideration to a dislike of mercury, knowing how many persons have been seriously benefited by a judicious and mild administration of that remedy. 2d. The same principles which guide me in the primary ulcers, would have the same, if not greater force, in the case of buboes. In their irritable state, I consider mercury as altogether inadmissible. Moderate pressure, and cold applications, will often disperse them in their commencement, aided by Girtanner’s plan of frictions of volatile liniment on the thigh of the affected side. If they suppurate, opening with the kali purum is by far the best plan ; they then heal from the bottom. 3d. The cutaneous eruptions I would treat at first on the same general principle; but I should not very long postpone the employment of the mildest mercurial alteratives, aided by warm bathing and sudorifics. 4th. In the affections of the throat I would be more guarded than in any others in the employment of mercury, until all inflammatory disposition was removed; after that, I have seen them yield, as if by magic, so soon as the local effects of the

* A very early application of lunar caustic will often supersede all other remedies.

VOL. XIV. - NO. 84. S Q

478 Analytical Review .

mercury on the parts within the mouth became obvious ; but, before the inflammatory symptoms were subdued, I have seen a vast number of instances where irremediable mischief has been done. 5th. In the bone cases during the stage of periostitis, or any approach towards it, local bleeding, blistering, warm-bathing, and abstinence, are the proper remedies, to the entire exclusion of mercury. When inflam¬ mation is subdued, that remedy may be tried in moderation ; but, if caries exists, I hold it to be highly improper under any form.”

We are told, further, that so far from delay in the com¬ mencement of the mercurial plan having been attended with untoward consequences, the contrary is actually the case ; and that when it is necessary to use mercury, its efficacy is best insured by the previous preparations of rest, purgatives, &c.

The following we give as a summary of the author’s opinions and experience in reference to the points under discussion ; and we have only room further to say, that his opinions have been apparently formed with the utmost caution and candour; that the results of the extensive trials made by himself, and under his direction and superintendence, at the several mili¬ tary hospitals in Scotland, seem fully to warrant the inference which he deduces: at any rate, it will behove oppugners of his principles and positions, to establish the validity of their objections to the army faith, by a body of evidence of equal or greater weight than that which has been put into the anti- mercurial scale by the present author and those who have contended under the same banners,

“ Every thing I have seen of the practice confirms me in the pos¬ sibility of healing primary sores on the genitals, of whatever descrip¬ tion they may be, without the employment of mercury; and I have met with nothing to make me question the propriety of making the trial. Of some hundred cases, none have hitherto resisted ; in some of these, it is true, I should never have thought of using mercury; but far the greater number were of that description, that not only I myself, but Practitioners of much greater experience, would not formerly have thought of deferring it for a single day. I may, to a certain extent, apply the same observation to the secondary symptoms that have succeeded the non-mercurial treatment. I have now seen a great variety of them, but I have not yet studied and compared a sufficient number of cases to enable me to offer such positive testimony to the expediency of abstaining from mercury altogether in this class, as in the former. The facts at present ascertained are these: second¬ ary symptoms occur more frequently, and appear at an earlier and more determinate period, than when mercury had been used; but they in many cases have gone off as soon, never, as has been supposed, proceeding from bad to worse, or from one succession of parts to another in unabated violence; on the contrary, they by no means exhibit the same violent and unrelenting symptoms, which we have observed in many instances where mercury has been used; the

\

Howship on Intestinal Diseases, fa. 479

eruptions have not run into ulceration; they have not formed into large scales, or extensive blotches; nor have the bones of the nose or of other parts, been in any instance affected with caries. I cannot take upon me to assert, that these events will not occasionally take place; but, in the numerous cases which I have watched with the utmost anxiety, I can aver that they have not."

Dr. H., we shall just further say, concludes his paper by remarking on Dr. Hamilton’s recent objections to the non¬ mercurial plan of treating syphilis, founded on the notion that the venereal taint, unchecked by the mineral, may come to affect infants unborn, through the uterine or genital systems of the parent;. .and thus the disorder may bet in an indirect way, preserved and propagated. Dr. H. contends that the communicability of syphilis in this manner is not cleaily made out; and that, although there are many children u b°rn with a disease capable of infecting others/’ it does not follow that such infection is really and truly syphilitic.

“ The presumption (he adds) is not certainly in favour of the deadly effects on the rising generation which Dr. Hamilton has assumed ; or, in that case, the population of Italy* formerly, and that of Portugal at the present day, must have been most seriously dimi¬ nished : indeed, the inhabitants of the latter country, especially about Lisbon, and other great towns, should by this time have been almost extinct.”

III.

Howship on Diseases of the Lower Intestines and Anus.

[Continued from p. 398.]

Prolapsus Ani . — Any circumstances which favour the relaxation of the sphincter-ani muscle may prove sources of prolapsus. Disordered states of the bowels, such as pro¬ tracted diarrhoea, the irritation from worms, and even strong anthelmintics, will occasionally cause prolapsus ani. It will sometimes be induced by the same causes which give rise to colica pictonum. Habitual costiveness will at times favour its production; pressure from the gravid uterus, and even severe labour pains have been known to occasion it. The disorder is either sudden or slow in its formation. In adults the protrusion is, for the most part, a gradual process; in young children it is often made at once.

(i The tumour, at first only a production of the inner membrane, subsequently consists of a portion of the entire bowel, protruded completely beyond the verge of the anus. The degree of protrusion

* The Italian Physicians, about a century ago, were in the uni¬ versal practice of treating syphilis without mercury.

480 Analytical Review .

may be sometimes such as to show, that although the bowel is con¬ nected by its peritonseal covering, as well as by its blood-vessels, to the spine, these parts are occasionally capable of great relaxation, where the complaint is gradually formed.”

The bowel will protrude in children to the extent of four or five inches, and the volume of the protrusion in the adult occasionally exceeds the size of a large orange. Delpech talks of several feet of intestine being protruded ; but u this must be regarded as, at least, a very unusual occurrence.”

The prolapsus, although often dependent upon a relaxed sphincter, is not seldom the consequence of a relaxed state of the bowel itself; the projecting portion occasionally becomes thicker and harder than natural by exposure.

The Surgeon must be careful not to mistake a case of intus¬ susception for one of simple protrusion. In the former case, viz. that of the membrane of another portion of the intestinal canal protruding through the rectum, a probe may be passed up freely between the sphincter-ani and internal surface of the rectum and the supposed surface of the inverted colon, and carried round the whole circle of the sphincter, which of course could not be done in cases of mere prolapsus recti.

Treatment . — When the prolapse is occasioned by mere relaxation, bark, steel, cold bathing, and nutritious food, are palled for. A constant regularity in the intestinal functions is of course necessary. When connected with any other diseased condition of the bowels, it is hardly necessary to say, that such disease must be subdued.

“ In reducing a prolapsus ani, the application of gentle pressure, the fingers being previously moistened with oil, is usually all that is necessary. It frequently happens, that if the patient reclines on a sofa or bed for half an hour, this alone will enable the parts to recover themselves; or, should the prolapsus not return spontaneously, it may then be reduced in the manner above mentioned.’'*

When the protrusion has become considerable, more care is often required on the part of the Operator, in this case, the return of that part first which was last pushed down must be attempted, one of the fingers being gently insinuated into the cavity of the protruded bowel. In cases of strangu¬ lation, active measures are called for; such as the warm bath, leeches, and the cupping glasses to the vicinity of the parts. Mr. H. is not partial to tonic and astringent applica¬ tions or injections after the reduction. (( Instruments for keeping up the parts are almost entirely useless.”

In cases of obstinate and long continued prolapsus, Mr. Howsbip recommends the operation of passing a ligature round the protruded portion of the gut, which plan he prefers to

Howship on Intestinal Diseases , fyc, 481

excision, having witnessed the failure of the latter, but never of the former. Previous to operating, the bowels should be emptied by some cooling aperient. Provided, in the operation, any small projection or fold of integuments is found at the verge of the anus, it may be taken up, and will generally answer the purpose ; if, on the contrary, the parts around the sphincter are in a perfectly natural state, the tenaculum may be passed through a small extent of the fine integument, at the verge of the anus, carefully avoiding the muscular fibres of the sphincter. The part raised is then to be encircled with a ligature, which, being tightened, completes the operation. “ Where haemorrhoidal tumours exist, in conjunction with prolapsus ani, the opera¬ tion that cures the one, if properly performed, removes the other also.”

Intus-susception, Mr.H.says,is always tobe suspected, when in early youth the bowels have remained obstinately confined for some days, in spite of proper medicines. "The object of treatment in cases of intus-susception is, in the first place, to remove or diminish the constriction which exists at the part where the inversion of the bowel commences. The warm bath must be tried, and warm water injected, and the belly gently but diligently rubbed. These means must be persevered in till the intruded bowel can no longer be felt by the finger in the rectum, or a large-sized elastic catheter carefully passed ; “ and, in short, till castor oil, or some other aperient, has produced a clear passage through the intestinal canal.” If these means fail, the tobacco fume injection is to be tried.

Of Hcemorrhoidal Tumours. A deposit of fluids in the cellular membrane of the integument immediately encircling the verge of the anus; this deposit, being either blood, or serum, or both, constitutes, in Mr. Howship’s opinion, the haemorrhoidal tumour, which most commonly depends upon some obstruction in the circulation through the huemor- rhoidai veins. It is of consequence to distinguish the san¬ guineous from the serous kind: the former is of a com¬ paratively dark colour, and is longer in its formation than the latter: it occurs likewise in the strong, and is more generally than the other produced by deficient regularity in the actions of the bowels. Haemorrhage from the parts, and contraction of the sphincter, are common to these affections ; for the most part, the blood comes from within the anus, though it may occasionally proceed from some portion of the external tumour. The sanguineous haemorrhoid is the direct con¬ sequence of extravasation. The serous is oedema horn, irritation or inflammation.

48 '2 Analytical Review .

In the serous hssmorrhoidal tumour, u absolute rest for a few days, attention to the bowels, and in some cases fomen¬ tations, in others, cooling lotions ‘to the parts, will generally be all that is necessary/*’ In the sanguineous kind, leeches and cupping are often required to abate the irritation ; the latter is best when it is necessary, from the degree of irritation, to take blood speedily. Sometimes it is ex¬ pedient to defer purging till the inflammation is a little got under. Warm and anodyne fomentations, with occasionally gentle and steady pressure upon the tumefied parts, will be of service in . the painful spasm of the sphincter. For the removal of the tumours, the ligature is preferable to the knife: when there are many, it is not necessary to take up each of them ; the tying of two or three of the largest will generally excite such inflammation as will produce a change in the texture of the remaining* parts sufficiently complete to insure the patient from any future returns of the disease. After the removal of the tumours, it will still be necessary to attend carefully to the general health.

Of Fistula. — “The cellular and adipose substance surround¬ ing the verge of the anus, in common with the same texture elsewhere, is subject to inflammation and abscess. This may arise here from any of those causes known to produce these changes in other parts of the body ; any external violence; any irritation within or near the extremity of the rectum ; and particularly that excitement sometimes consequent to fever. A severe cold sometimes operates as a cause; excessive fatigue also has, in some instances, apparently- been the means of inducing inflammation and abscess near the anus.’’

The existence of a sinus does not necessarily denote a depraved habit. Whenever abscess forms in the cellular membrane, it is disposed to extend its limits in whatever direction the membrane is most relaxed. The sinus com¬ municates or not with the cavity of the intestine, as may happen. “ The most common state presents a single external opening, near the anus generally, with a sinus passing up the side of the bowel.”

When the disorder is phlegmonous and active, blood¬ letting is sometimes required; when it is more erysipelatous and passive, bleeding is seldom admissible, and even other evacuants must be employed with caution. The assiduous use of fomentations is to he directed till the abscess is formed and discharges itself. When the tumour points, and the external skin is thin, it is to be opened with4* a lancet; a few threads of lint are to be inserted, and the fomentation con¬ tinued, till all the inflammation and most of the surrounding hardness have subsided. If the abscess does not readily heal, a probe must be introduced, to ascertain the direction

483

I low ship on Intestinal Diseases , $c.

I * . .

of the sinus. XS hen the inflammation has a gangrenous tendency, the parts assuming a livid and dusky colour, with a full, hard pulse, and great restlessness, hot spirituous fomen¬ tations must be applied, free incisions made, and bark and opium administered. When a sympathetic irritation takes place at the neck of the bladder, opiates, and a free use of mucilaginous drinks are desirable; if the urine is retained, it will be necessary to unload the bowels, throw up an emollient anodyne glyster, and occasionally take blood. The rectum, must always be preserved free from hardened irritating faeces. When a sinus is found to exist after the discharge of the abscess, “ the sooner the division is made the better/’ First a probe is to be passed into it ; then the fore-tinger, oiled, of the other hand is to be passed through the sphincter, so as distinctly to feel the point of the probe ; this being withdrawn, the bistoury is to be lightly and gently introduced into its place. “ In this stage of the operation, should no direct opening be found from the sinus to the bowel, the least additional pressure of the point of the bistoury against the finger may be made to bring them into actual contact. The point of the finger now becoming a guide to the bistoury, presses the instrument on before it; so that while the finger is gradually withdrawn, the bistoury is made to cut its way out, and the operation is finished/’ Lint must be care¬ fully now introduced along the course of the sinus; when, after the sinus or sinuses have thus been laid open, should there be a disposition to heal, recourse must be had to tonic medicine and change of air. If the habit is previously much reduced, it is sometimes necessary to improve it before the operation, be undertaken.

Of the Hcemorrhoidal Excrescence.- — This is a small, soft, fungous growth, situated at or near the verge of the anus. It is very different in its structure from the hsemorrhoidal tumour. It is generally, though not always, venereal in its origin; and when it is so, Mr. Howship conceives that it is mostly connected with gonorrhoea, u from the purulent matter, by means of the linen, coming in contact with the verge of the anus/’ These excrescences are rarely single — generally numerous. They arise from the inner membrane of the sphincter. Mr. B. Bell supposes them to be productions of the cuticle; but Mr. Howship is of opinion that the cutis is their seat and source.

When these excrescences are numerous, they may be snipped off with a pair of sharp scissars, or the scalpel, where the basis is broad. If the excrescence be single, a single ligature may be applied round the base; “ or if the base is broad, a double ligature upon a curved needle, passed through the centre, may be tied on each side.’ After

484

Analytical Review .

excision, a little lint, constantly wetted with some cold lotion, may be laid upon the parts for a few days. When the ligature is used, anodyne fomentations must be applied, should much pain follow the operation. Astringent solutions are useful when the excrescence is connected with cracks and fissures in the skin. Sometimes alterative medicines are required ; but it is seldom that the full mercurial plan is advisable.

Mr. Howship’s treatise is terminated by a dissertation on the means best calculated to obviate costiveness. He argues that the restoration of tone, under the circumstances of constipation, ought to be the principal object of the medical Practitioner, and that Peruvian bark proves often the best purgative. He advises the use of the decoction at first, with infusion of senna, which latter medicine may be gra¬ dually left out of the draught, as the bowel shows a tendency to resume its wonted regularity.

We think, with our author, that the actual condition of the membranes and muscular fibre of the bowels is, for the most part, too little recognised by those “ digestive organs’" Doctors, who think that purgatives are to do every thing in the way of counteracting disordered states and tendencies. Tonics were at one time too highly prized ; they are now not duly appreciated.

IV.

RETROSPECT OF MEDICAL LITERATURE.

(Concluded from page 398.)

The books which remain for notice, as having been pub¬ lished before the 1st of July of the present year, are : — -

Cases of Tic Douloureux. By Benjamin Hutchinson.

An Introductory Essay to a Series on the Use and Abuse of Blood-letting in Fevers , Inflammations , Sc. By Adam Dods, M.D.

A Dissertation on Infanticide , in its Relations to Physiology and Jurisprudence. By W i lli a m Hutchinson, M.D. F.L.S.

On the Elasticity of the Lungs. By James Carson, M.D.

Observations on the Curvature of the Spine. By James Ma¬ cartney, M.D. ; and

General Principles of Psycho-Physiology. By Edward Smith Pearson.

Of the first of these tracts we have only to say, that its detail of cases is calculated to make an impression on the mind in favour of the medicine recommended ; but that so much want of success has ever been found to attend general

485

Hutchinson’s Cases of Tic, Douloureux,

trials of drugs recommended by particular authority, that some degree of scepticism on the part of readers is always excusable.

'bhe fact is, that diseases bearing the same stamp of nomen¬ clature are often widely different in their actual essence and remedial demands; and that to talk about curing tic doulou¬ reux, or any other malady, is to talk a language that truth will never sanction. We have just heard of one of the most remarkable cures of the complaint in question that has ever come under our cognizance. A person in the neighbourhood of London, after having tried many Physicians and remedies, was persuaded to have the advice of Mr. Abernethy, who ordered him to reduce his food to twelve ounces in the day, and to drink only at certain distances of time after eating. Some little medicinal accompanied these dietetic directions merely as a placebo ; and the patient, from being the subject of the most excruciating torments, became, in a day or two, better, and is now (about three or four weeks from Mr. A/s visit) almost entirely free from his complaint. Query. Is the effect here to be attributed to the con¬ fidence of the patient in the superior skill of the pre- scriber — to the very small quantity of alterative medicine, which, as just stated, was ordered merely for form’s sake — or to the reduction in quantity, and regularity in times of taking food ? To the first of these causes we feel inclined to attribute the cure ; but at any rate we feel convinced that the same disorder would not invariably yield to the same cir¬ cumstances of remedial treatment, in like manner, giving full credit, as we do, to Mr. Hutchinson’s statement of the beneficial effects of the carbonate of iron, we must, at the same time, be allowed to doubt, whether all disorders apparently of the like kind would yield to the same treatment.

. The following is the first of the six cases that Mr. Hutchinson presents as instances of the good effects of the carbonate. It is proper to say, that he occasionally tried the remedy in smaller doses than a dram, but found it necessary always to increase it to that amount before the advantages of its administration became conspicuous : —

« Case 1. — The first case, I shall lay before my readers in the words of the very intelligent and well-informed patient hersell, whose obstinate complaint was situate in the nerves over the os mala?, just below the orbit; the gums, teeth, upper lip, and ala nasi : it proceeded, therefore, from the second branch of the fifth pair of nerves, the superior maxillary nerve.

“ Remedies usually resorted to on these occasions had been judiciously but unsuccessfully administered. The benefit resulting VOL. XIV. - NO. 84. 3 it

486 Analytical Review.

from the use of the carbonate of iron will be fully demonstrated by the complete cure of this case.

u Alder car Park , July 20, 1814.

“ Sir, — - Permit me to offer you my aknowledgments for your kind inquiries after my health ; in reply to which I have the satisfac¬ tion to acquaint you, that I am almost entirely free from the dreadful disorder in my face, which for many years embittered my life. I was, when first attacked by it, in my twenty-seventh year, and for the next twenty years and upwards, had very little respite from its tortures. Moved by what you heard and witnessed of my sufferings, you had the goodness to prescribe for me*. I followed exactly your advice ; and from that time ray pains disappeared ; and I have, of late years, only the most trifling remains of them, and these are so instantaneous, that they raise in me no alarm. I continue to take a course of the powder you recommended every month, and intend to persevere in this practice.

“ I am, Sir, &c. &c.

“ JANE SMITH."

(i Alder car Park , November 8, 1819.

fi Sir, — I think it a duty, which I perform with unfeigned satis¬ faction, to acquaint you, that since my last communication on the subject of tic douloureux, I have been entirely exempt from that ex¬ cruciating complaint. I, however, persisted in the use of your prescription, at the intervals I then mentioned, till the beginning of last year; when, experiencing no recurrence of pain, I ventured to leave it off totally, and remain perfectly free from any symptom of the disorder.

“ I am, Sir. & c. &c.

« JANE SMITH."

“ Aldercar Park , December 8, 1819.

“ Dear Sir, — If the foregoing statements can contribute to your purpose, I shall be sincerely happy. When I began to be afflicted with the tic douloureux, I have mentioned. As to the progress of the disease, I know not how to speak of it; for it was, from the first to the last, an extreme of pain that mocks description ; in short, it was the complete tic douloureux from the beginning. It was the right side of my head and face only that was affected : the other side had neither pain nor soreness. When the spasms came on, which they did a hundred times a day, they were like lightning for suddenness; and when they individually ceased, it was as suddenly and as completely as if they had never been. My health was in every respect good, excepting those consequences of the horrid disorder that arose from its preventing me eating due sustenance, (and even speak¬ ing,) and taking rest. I suppose every person who is so wretched as to be visited with this scourge, has had similar feelings to mine;

* R Ferri carbonatis, 5b Fiat pulvis, bis die sumendus, ex melle vel iheriaca.

487

Hutchinson on Infanticide , fyc.

but I am quite incapable of giving that history of my sufferings, which, I am persuaded, the importance of the subject requires. This, and my former letters, will, however, at least point out from what means much benefit, most probably a cure, might be obtained by those labouring under the dire disease in question.

“ I am, dear Sir, &c. &c.”

“ JANE SMITH.”

The object of Dr. Dods’s pamphlet is to prove-— what every one, by the way, must be convinced of— that blood¬ letting is either a poison or a remedy, accordingly as it is had recourse to, with or without discernment and judgment. “ There is great reason,” he says, “ to fear, that many are spurred on to death, under the vague notion of malignancy and putrescency, or the erroneous doctrine of attributing the proximate cause of putrid fevers to a diminu¬ tion of the vital powers; while, on the other hand, I am well assured, that unseasonably bold bleedings have exhausted, and even killed the patient, at the very moment the disorder has been subdued. It is in this, and every such case, that the lancet, in the hands of ‘ bold Practitioners/ as the Sangrado and present sanguinary phrase now is, proves, indeed, in the language of the Brunonians, a 4 minute instrument of mighty mischief/” The cause of these fatal mistakes, Dr. Dods tells us, he shall afterwards endeavour “ fully to explain, and apply a remedy.” We must, therefore, await the appearance of the promised dissertation, to which the pamphlet now before us is but a prelude.

The Dissertation on Infanticide comes from a masterly hand; but it would have appeared to us better for Dr. Hutchinson to have incorporated the information it contains in his projected work on Medical Jurisprudence; — a subject which has hitherto been considerably neglected in this country, but which is now likely to become a very important feature in its medical literature; since two men of unquestion¬ able talents and extensive erudition have promised speedily to give to the world the results of their researches, directed especially to the elucidation of the momentous particulars the subject in question involves. The individuals to whom we allude, are our present author, and our able correspondent, Dr. Gordon Smith.

Dr. Hutchinson’s pamphlet does not, of course, admit of analysis ; but we shall select from it, for the satisfaction of our readers, some of its leading instructions : —

“ Whenever sensible proofs of absolute death (in an infant) are not present, the body should be subjected to the means best calculated

488 Analytical Review.

to excite it to vigorous life : these are, external warmth, and gentle friction over the surface of the body, especially about the chest and arm-pits; whipping the soles of the feet, with small rods; the applica¬ tion of alcohol, or some other analogous stimulating substance, to the nostrils; the injection of a small quantity of such substances into the rectum ; electricity or galvanism ; and especially inflation of the lungs with air/'

Might not the external application of the nitric acid by a feather, in the way recommended by Mr. Hull, in the present Number of the R epository*, be at times advisable, for the purpose of recalling suspended animation?

Inquiries relative to infanticide involve the following particulars : —

u 1. Whether the infant was born dead or living? 2. If it was born dead; whether it died some time before, or during parturition ? 3. If it is proved to have lived after its birth ; whether or not its death should have been imputed to natural and unavoidable causes, wilful destructive violence, or omission of proper care? 4. In case of its death having arisen from want of due care ; whether or not cri¬ minal negligence was the cause of it, especially on the part of the mother, in the case of giving birth to the child whilst alone ? 5. The

degree of probability, that any woman, supposed to be the mother of the child, really bears such a relation to it.”

Having noticed the necessity, in the anatomical investiga¬ tions, to ascertain, first, whether any natural objects to the vitality)' of the subject appear to have existed, such as want of head, brain, heart, lungs, and alimentary canal; and, secondly, the apparent term of its foetal or intra-uterine life; Dr. Hutchinson is led into a very interesting inquiry respecting the progress and development of foetal vitality, for which we must, of course, refer to the book itself.

From Lecieux, of the Hospice de la Maternite at Paris, he gives the following account of the external appearances of a foetus that has been retained in the uterus after death : — -

<£ The ordinary period which it remains in the uterus is from five to twenty days; and, according to the greater or less length of it, the body will have lost more or less of its consistence and firmness ; the limbs become lax, and the muscles readily torn; the epidermis may be removed by the slightest friction ; the skin assumes a purplish or brownish red colour; there is often some bloody serum effused in the cellular tissue just beneath the skin, especially about the cranium ; there is sometimes a similar effusion in the cavities of the chest and abdomen, and the viscera in these cavities are of a deepish reddish hue; the interior of the vessels presents the same colour; the um¬ bilical chord is large in circumference, soft, infiltrated wfith serum, and is very easily torn; the thorax is flattened; the head falls

* See page 450.

489

Hutchinson on Infanticide , fyc.

into different shapes, and becomes flattened from its own weight; the membranes uniting the several bones of the cranium are much relaxed, sometimes the bones are disunited; the brain is almost in a fluid state, and emits a fetid odour.”

Contusions made after death are of a deep or purplish brown colour, and are not attended with diffused infiltration of blood in the cellular tissue surrounding the spot precisely injured. '

Our author is, as might be expected, very full on the point of the pulmonary states, as indicating the marks of natural or artificial death. The objects of examining the lungs are ; 1, to ascertain whether or not respiration had been effected ; 2, whether or not the child had breathed after it zvas completely born; 3, whether or not it had died from drowning ; or, 4, from respiration of certain deleterious gases ; and, 5 , whether or not it had died from suffocation, effected otherwise than by the two last classes of measures.

“ When the lungs are small, dense, compact, of a deep red colour, and the bronchial tubes and air-cells are devoid of air throughout the whole extent of both lungs, it may be concluded positively, that respiration has not been performed.

“ When those organs are of a yielding elastic texture, of a pale bright red colour, and when they crepitate on pressure by the fingers, and contain air diffused to a greater or less extent throughout the bronchial tubes and air-cells of one or more of their lobules ; and when they wholly, or the portions of them distended with air, as just described, float in fresh water, after having been compressed for about a minute in a folded cloth, with all the force a man of moderate strength can exert with his bare hands, it may be concluded positively, that respiration has been performed.”

Before the lungs would float in water from putrefaction,

, the child must have been dead in the womb for so Ions:

©

a time that other marks of putrefaction would render the trial unnecessary.

il I have found/’ says Chaussier, “ that in those who have died before birth, the head may be so far decomposed by putrefaction, that the slightest force was sufficient to detach the bones of it from each other, as well as those of the arms and legs, before the lungs , which now began to participate in the putrefaction, would float in water.”

When the infant has died from drowning, the cavities of the right side of the heart, and the large vessels which arise from them, are distended with a large quantity of black blood ; the left cavities usually contain a much less quantity of similar fluid, and are sometimes entirely empty; the pul¬ monary veins and arteries are filled with dark-coloured blood ;

490 Analytical Review .

and the bronchial tubes generally contain a certain quantity of frothy aqueous fluid. The diaphragm is thrust far into the abdominal cavity. The tongue often projects between the lips. The stomach most ordinarily contains some water. The blood is always fluid. The surface of the brain is of a dull red colour; bat its vessels are not in general gorged with blood, neither is there here extravasation of this fluid. The pupils are in general widely dilated. The surface of the body is commonly pale, but sometimes remains of a purplish hue. The presence, however, of water in the bron¬ chial tubes is the most decisive mark of death from drowning; and when it exists in lungs that evince signs of respiration having been established, and the body shows no sensible marks of putrefaction, it may be considered almost conclusive. The fluidity of the blood is of importance to attend to ; but this, it is well known, is found in cases of death from other causes, especially from lightning, some narcotic poisons, and respiration of deleterious gases.

When death has been produced by the vapours from burning charcoal, the body preserves its heat for a long time; black and very fluid blood is accumulated in the veins, and very little in the arteries ; the vessels of the lungs and brain are especially gorged with this fluid. Chaussier says, that the appearances after death caused by the gas of privies are the following —

“ The nasal cavities and the bronchial tubes are lined with a brownish viscid mucus; the blood is black and thick; the lungs , liver, spleen, brain, and all the organs, in general, that are abundantly supplied with blood vessels, are of a dark brown or black colour ; the muscles are also blackish and lax, and all the soft parts are very easily torn, and pass readily into putrefaction/’

It ought always to be recollected, in inquiries relative to infanticide, that new-born infants may expire at times merely from want of those aids which are necessary imme¬ diately upon their expulsion from the womb. These are : —

“ 1. The removal of them from the state of supination in which they generally lie. 2. The preservation about them of a degree of heat nearly equal to that of the medium they have just quitted. 3. A supply of proper food. 4. The division of the navel string, and the application of a ligature to it.”

Here, however, we must terminate our extracts from the interesting pamphlet of Hr, Hutchinson, a more lengthened account of which than we had at first intended we have been insensibly led into. We repeat that much is to be expected from those gentlemen who have pledged themselves to collect, into a general body of fact and doctrine, the several

491

Carson on the Elasticity of the Lungs .

particulars implied in the comprehensive term “ Medical Jurisprudence;” and that two able and learned men are engaged in the undertaking, may be considered as a favour¬ able circumstance for the medical public, since what is done in a properly tempered spirit of rivalry is almost sure to be well done.

The Essay of Dr. Carson on the Elasticity of the Lungs is a reprint from the Philosophical Transactions ; its object is to explain the modus operandi of the respiratory process, the rationale of which is given in the following terms: —

t( While the chest is in a sound state, a balance of atmospherical pressure ponderates against the external surface of its walls; or these are pressed inwards more than they are pressed outwards by a given weight. The shell of the chest possesses sufficient stability to resist this pressure without changing in any considerable degree its form and capacity at all parts, except at the base, or diaphragm ; which being muscular, pliant, and of a more extensive area than that of the transverse section of the chest, is, in consequence of the greater weight sustained by its outward or inferior surface, necessarily pressed, or, in popular language, sucked upwards in the form of a cone. The extent of this cone will be necessarily regulated by the extent of the area of the diaphragm, compared with that of the area of the transverse section of the chest. But the con¬ traction of the muscular fibres of the diaphragm diminishes its area, and reduces it to a nearer equality with the area of the transverse section of the chest, and thus diminishes the magnitude of the diaphragmatic cone, and in an inverse proportion enlarges the boundaries of the chest. But the diaphragm, at the succeeding relaxation of its fibres, is restored to its former dimensions; becomes capable of being swelled into a larger cone: and, by this encroach¬ ment, reduces the boundaries of the chest to their former limits.

Two powers are therefore concerned in regulating the movements and in varying the dimensions and form of the diaphragm ; the elasticity of the lungs, and the contractile power of the muscular fibres of the diaphragm. Of these powers the one is permanent and equable, the other variable, and exerted at intervals. The con¬ tractile power of the diaphragm, when fully exerted, is evidently much stronger than its antagonist, the resilience of the lungs; but the latter not being subject to exhaustion, takes advantage of the necessary relaxations of the former, and rebounding, like the stone of Sisyphus, recovers its lost ground, and renews the toil of its more powerful opponent.

“ Breathing is in a great measure the effect of this interminable contest between the elasticity of the lungs and the irritability of the diaphragm.

“ The cause of the successive contractions of the diaphragm, in those cases at least in which the will is not concerned, seems to admit of the following explanation. A permanent and invariable

i

492 Analytical Review.

load is sustained by its lower surface. By this load the relaxed muscular fibres become stretched to a degree which at length becomes painful and stimulating. To relieve itself from this irksome burden, the diaphragm is roused to contraction ; but this contractile power, agreeably to the laws of muscularity, is soon exhausted, and falling into a quiescent state, allows the painful and stimulating distention of the relaxed fibres of the diaphragm to be again renewed. From the irksomeness of this condition it relieves itself by a fresh contraction. Thus, by the alternated superiority of two powers, on the balancing of which life itself depends, the chest is successively enlarged and diminished, and air aTernately expelled and inhaled.”

Th is principle of elasticity in the lungs has been ingeniously made use of by Dr. Carson, to explain the movements of the heart, and the circulation of the blood : the circumstance, too, of the arteries being found, for the most part, empty after death, while the veins are full, is traceable, our author thinks, to the same source. But as these view’s are more fully developed in a paper published in the last volume of the Medico-Chirurgical Transactions, we shall defer the more particular account of them to the time when that volume shall fall before us for analysis.

Dr. Macartney's Observations on Curvatures of the Spine, which, although bearing the date of 1817, were only trans¬ mitted for review some months ago, are likewise reprinted from another work — the Transactions of the Irish Academy. They are conceived in the same spirit, and have the same general bearing, with those made by Mr. Wilson, in his able lecture before the College of Surgeons, proscribing the use of instruments in those cases of vertebral deformity which depend upon deficient or erroneous muscular action, and urging the necessity of those movements, for the purpose of counteracting these deformities, which call into equable action the muscles of the spine, the back, the shoulders, and the chest.

In the next semi-annual review, Mr. Wilson’s lectures will come properly to be noticed, when we shall return to this subject, and observe upon it a little more largely. It may here suffice to say, that too much care cannot be taken to ascertain the actual state of bones, with their appendages and muscles, in cases of spinal derangements, before any correct institutions can he set on foot to remedy them. Let it he recollected, that “ distortion of the spinal column may arise from three causes: — The first is that peculiar disease, which, terminating in the ulceration of the bodies of the vertebrae, necessarily induces an abrupt and very evident curvature. The second is that state of the bones

493

Pearson on Psycho-Physiology.

in which, from a deficiency of earthy matter in their com¬ position, they are incapable of preserving their natural form.

1 he third is, the feebleness of those muscles which are em¬ ployed in maintaining the erect position of the body.”

The last tract we are to notice is one of considerable ingenuity. Mr. Pearson, in his General Principles of Psycho-Physiology, has proved himself possessed of a very acute and metaphysical mind. We are, however, not quite sure, whether, in opposing the organic physiology which argues lor life being rather a result than a precise impulse, he does not assume a something beyond the warranty of his own data.

“ There is every reason to believe (says Mr. P.), that the ultimate material particles of organized bodies are, individually, insensible, since these particles, in ordinary circumstances, never manifest sensibility.

“ Now, since a whole is nothing but all its parts taken together, it is absurd to suppose that the whole of an organized body can possess feeling, if all the parts which constitute it be insensible/’

w e must, however, be permitted to say, that the inference does not here — as, to be legitimate, it ought to do — necessarily follow from the premises. When the organist tells us, that life may result from a certain mode , in which are put together abstractedly dead particles, although we have no proof that his position is a correct one, neither can we, on the other hand, prove that it is not. Even as far as the analogy of other than living matter goes, the facts may be deemed in opposition to those who maintain the necessity of a super- added principle in order to constitute life. In the case of a neutral result from the admixture of an acid and an alkali, the prior circumstances of the two bodies, which in their union constitute this tertium quid , lead not, in any way, to the supposition that such would be the consequence of their amalgamation. Indeed, all reasoning which involves the question of the abstract nature of life must ever be circular. It is only then that we proceed in philosophy, when we argue upon points that are susceptible of proof.

Mr. Pearson, however, we repeat, has evinced much power of mind in the little tract now before us; and his speculations are in nowise tinctured with a dogmatic or uncandid spirit. The following is the mode in which he expresses himself on the subject of those speculations which have recently been advocated by one party, and censured by another, with such undue and unnecessary severity:- —

“ Partial diseases of the brain show that particular parts of it excite peculiar sensations, and transmit peculiar motions to the

VOL. xiv. — no. 84. 3 s

494

Calendar of Natural History.

nerves. Hence, peculiar dispositions of mind are found connected with development of peculiar portions of the brain. Little satisfac¬ tory knowledge of this kind has been acquired, but much may reasonably be expected from accurate pathology and comparative anatomy.

“ The observations of Gall and Spurzheim, if substantiated by further experience, will be exceedingly important in this point of view. The mode in which this kind of information, when fully obtained, is applicable to the discovery of the peculiar states of mind to which individuals are subject, by examination of the skull, is sufficiently obvious. At present, however, this practice seems too difficult to be depended upon.”

We must be allowed to repeat here, in order to obviate any misunderstanding, that we conceive free-will and moral responsibility by no means implicated in the organic question of vitality ; the fault of theorists on either side is that of attempting to make those facts which only belong to ethical and moral, applicable to natural and physical science. Hozv the faculty of volition is appended to the organized frame we can never know ; but that there is a power to choose or refuse is equally clear to our conception as that the eye sees, and the ear hears.

DEPARTMENT OF NATURAL HISTORY*, &e.

Calendar of Fauna, Flora, and Pomona, kept at Hartfield, near Tunbridge Wells. By Dr. T. Forster. From the ls£ to the S\st of October, 1820.

October 1st. — This month set in with fair autumnal weather, but rather cool for the time of year. Many plants remain in flower in the gardens ; among others, Papaver Phceas, P . Cambricum , Chrysanthemum coronarium , Althcea rosea , Calendula officinalis, some late blowing Roses, African and French Marigolds, and others.

2d. ■ — Swallows and Martins congregating to depart; a vast number were missed to-day, which had probably left us with the north wind yesterday. Varieties of the China Aster ( Aster Chinensis) still in bloom.

3d.— There are now various appearances of autumn. Starlings assemble in immense flocks, and accompany the flights of Rooks and Daws ; and Sparrows, Larks, and other small birds, fly about in large flocks.

4th. — Nearly all the Swallows and Martins are gone ; the wind being northerly.

14th.— The Aster tardiflorm in full flower. A. Tradescantij

Selections.

49 5

which flowered three weeks ago in warm situations at Cowden, is now in flower here in my garden.

3 1st. — The Apargia autumnalis is still in bloom: the Great Perri winkle, the Corn Poppy, Garden Stock, the several Marigolds, Althaea rosea , &c. still flower.

The Jgaricus sordidus is springing up in the garden in a bed which was recently man tired.

Fungi in general have certainly not been at all plen¬ tiful this season. In the year J S 1 S they were particularly abundant; and, in general, they flourish most when a dry summer is followed by autumnal rains.

[This Journal is to be continued in the neighbourhood of

Tunbridge Wells.]

PART IIP

j . . 4 • J i •

. - i .

SELECTIONS.

III. Urea.

The well known substance in urine to which the name of urea was given by Fourcroy, seems to have been originally noticed by Rouelle. Fourcroy, in deference chiefly to the opinion of Dr. Pearson, gave the name of uric acid to that peculiar substance, which was first detected by Scheele in urine, and which he found to constitute the essential consti¬ tuent of those urinary calculi which he examined. M. Guyton de Morveau had previously distinguished this substance by the name of lithic acid, in consequence of this change, there are two very distinct substances in urine, distinguished by nearly the same name; viz.

Frea,

Uric acid.

The consequence which one would at first be disposed to draw from this is, that urea constitutes the base of uric acid , and that the two substances are intimately related in their properties and composition. This is a conclusion which, I have little doubt, has been drawn by young Chemists. On that account it is of importance to prevent it as much as possible. Dr. Marcet, in his Treatise on Urinary Calculi, has alluded to this defect in the present nomenclature ; and has endeavoured to correct it, by resuming the old name lithic acid , instead of the newer term uric acid , which has now got into general use.

This undoubtedly gets rid of the ambiguity of names; but I do not think that it entirely cures the defect of nomen¬ clature. When the chemical nomenclature was contrived by

496 Foreign Medical Science and Literature .

Lavoisier, Berthollet, Morveau, and Fourcroy, in 1787, they laid it down as a law, that all vegetable and animal principles were to be denoted (as far as possible) by names ending in in; as, for example, gelatin, fibrin, asparagin, ulmin. 1 have sometimes thought that this law might be followed, and yet vegetable substances distinguished from animal, by making the former terminate in in, and the latter in ine; but I have not uniformly adhered to this distinction. It is curious that Fourcroy, one of the contrivers of the new nomenclature, should have deviated so much from laws of his own making, as to give the term uree , urea , to an animal principle which exists in urine. Perhaps this deviation may enable us to form a pretty shrewd guess at those Chemists who had the chief share in the actual formation of the nomenclature; or perhaps, Fourcroy found it difficult to contrive a term from urine which should agree with the laws of the nomenclature; for urin, or urine, would neither have suited the French nor the English language. Be that as it may, I think that the manifest impropriety of the term urea , and its inconsistency with the laws of the chemical nomenclature, ought to be considered as a sufficient reason for discarding it altogether, and introducing a new one. I am induced, in consequence, to propose the term nephrin, as a very suitable appellation for the substance which has been hitherto distinguished by the name of urea. This name, as the reader will perceive, is de¬ rived from the kidneys, the organs which secrete the peculiar substance in question. The two bodies hitherto called urea and uric acid, may be henceforth called nephrin and uric acid. The term nephrin is systematic, and it has the advantage over urea of neither being ambiguous nor offensive.

( From the Annals of Philosophy.)

PART TV.

FOREIGN MEDICAL SCIENCE AND

LITERATURE.

J. analysis of journals. (French).

New Journal of Medicine.

June, 1820. — Supplementary Note to the Memoir on Osteosis or Ossification. By M. Beclard.— interesting, and, in fact, intelligible to those only who have read the memoir in question.

Report made to the Royal Academy of Sciences , by MM. Cuvier and Uumeril, on a Memoir of Dr. J. Cloquet, relative to the Existence and Disposition of the Lachrymal Ducts

497

Solon’s Case of Chronic Pleurisy , fyc.

in Serpents. — Cloquet has lately published a memoir, wherein he establishes, from anatomical observation, the existence, in serpents, of an apparatus of organs for the secretion of tears, and their conduct either into the cavity of the nostrils or of the mouth. The reporters charged with the examination of the work here render an account of it to the academy. The curious facts by which the opinions of preceding Anatomists on this subject seem wholly subverted, are too briefly detailed to admit of a luminous and satisfactory exposure here.

Considerations on the Diseases called Essential Fevers. A

Memoir read to the Medical Society, Sc. By - Pinel,

Jun. M.D. — This is a controversial paper. The sum and sub¬ stance of it are a warm defence of the celebrated Nosographie Philosophique of Professor Pinel, and a vindication of the opinions which that work contains on the disputed subject of fevers. There these affections are described as having for their cause a general lesion either of the sanguineous system, of the digestive apparatus, mucous membranes, or of the muscles, nerves, and glands ; and this, in fact, constitutes the basis of their distribution by Professor Pinel. The only import¬ ant practical remark which strikes us in this communication, is the asserted inutility of topical blood-letting from the parietes of the thorax and abdomen, in morbid affections of their contained organs; and its exclusive applicability to those cases wherein the serous membranes lining these cavities are inflamed. A review of the very slight and indirect communication which exists between the blood vessels of the lungs, or intestines, and those of their containing parietes, will at once expose the grounds of this reasoning. “ When it is considered that the digestive system has its own particular circulation, and especially that most of its vessels terminate in the haemorrhoidal vessels, one may readily perceive that application of leeches to the anus will exert a more prompt and direct influence on the stomach and bowels than their employment to the abdominal parietes.” We give this extract, as containing a practical lesson, the importance of which is not duly appreciated in this country.

Case of Chronic Pleurisy , with Pneumo-Thorax of the Fight side, and Chronic Pleurisy. By M. Solon. — Subject, a male, aged twenty-six, admitted into I’Hotel-Dieu April 1 6th. Symptoms: pain in the left side, removed by leeching and blister, succeeded by rigors, cough, dys¬ pnoea; violet Lcolour of the face, afterwards disappearing; purulent expectoration ; extreme anxiety. Right side sound¬ ing well anteriorly and laterally, but behind, obscurely ; pulse small, rapid; extremities cold; death. — Dissection. Issue of a column of air, on opening the right side of

498

Foreign Medical Science and Literature.

the thorax. Right lung greatly diminished ; and two-thirds of it impenetrable to air, and sinking in water. Correspond¬ ing pleura covered with false membrane and albuminous flocculi, especially towards the diaphragm. Left lung com¬ pletely hepatized in its superior lobe, and containing, in its centre, several collections of pus. Many suppurating tubercles in this, and in the inferior lobe, which was gene¬ rally crepitous. Left ventricle of the heart slightly enlarged. The author supposes that in this case serous effusion into the right thoracic cavity had taken place; and that, from the decomposition of this fluid, previously to its re-absorption, the gas, which, issuing from the cavity on dissection, con¬ stituted the pneumo-thorax, had been extricated.

Extract of a Memoir entitled Historical Researches on the Eruptions of the Yellow Fever , during the Fifteenth, Sixteenth , Seventeenth, and Eighteenth Centuries , fyc. By M. Moreau de Jonnes.- — The object of this work is to present an assemblage of decisive and authentic historical facts relative to the yellow fever; comprehending a space of three hundred leagues, and an interval of three centuries. With this view, the author has consulted the various Spanish, English, French, and Italian travellers and historians, who have traversed the new world, or collected its annals from the period of its discovery. From their testimony, and his own observations during nine eruptions, he demonstrates, 1, the American endemicity of the disease; % its peculiar nature; 3, its transmissibility by infection and by contagion : and he indicates, 4, the conditions necessary for its development; and, 5, the chances of its introduction into the different countries of Europe, besides the Spanish Peninsula. We have not ourselves seen this memoir, which is said, by the author of the extract, to contain numerous facts at present but little known, and highly deserving of attention, as subver¬ sive of the errors that prevail on this subject.

Case of a False Germ. By Dr. d’Astros, &c. — * In this narrative we absolutely And nothing worthy of notice, except a warning to ladies not to lace their stays too tightly during pregnancy. To such imprudent constriction, in the present instance, is attributed the destruction of the embryo, its conversion into what is called a “ false germ,” and premature expulsion.

Bulletins of the Faculty of Medicine of Paris, &c.

1820. IS 6. Vi.

Report on a Piece of Mechanism destined to facilitate the Practice of Midwifery. By Professor Chaussier and Dr. Thillaye.— • This consists of the description of an apparatus

Robouam’s Case of Chronic Peritonitis , fyc. 4gg

lately contrived by M. Vefdier, for the use and instruction of students in midwifery. A well-formed female pelvis con¬ stitutes its fiame. i he parts corresponding to the abdominal muscles, peririaeurn, and vulva, are formed of elastic materials. The child is represented by the skeleton of a full-crrown loetus, covered with leather, and having the cranial sutures and fontanelles correctly marked. On the whole, this

mannequin” appears to us to be better constructed than any thing of the kind which we have hitherto seen in England.

Report on Dr. Spalding’s Memoir relative to the Anti- Hydrophobic Virtues of the Scutellaria Lateriflora. By M. Merat. — As the reporter professes to know nothing experimentally of the effects of this plant in hydrophobia, we shall not waste time in reviewing his opinions. We, however, think with him, that the evidence adduced in its favour by Dr. Spalding should be viewed with a very suspicious eye.

Report on a Memoir of Dr. Gamard relative to a Magnetic Treatment. By M. Louyer Villermay. — Showing the utter inefficacy of magnetism in an encysted dropsy of the abdomen, and the want of confidence in its powers which its employers sometimes evince. Dr. Gamard associated with it powerful pharmaceutical agents ; and to these alone the slight advantages obtained over the fatal malady, appear to be attributable.

Case of Chronic Peritonitis, with Perforation of the Bladder and of the Sigmoid Flexure of the Colon. By M. Robouam. — The subject of this case, a once healthy and still corpulent young woman, entered I’Hotel-Dieu April 26. Had, a week before, been attacked with lumbar pains, colic, vomiting, anxiety, inappetence, and headach, consequent on suppression of the menses, previously regular. The effort to restore them, by leeching of the vulva and irritant injections, failed ; and, at the next menstrual period, the symptoms recurred with aggravated violence: abdomen tu¬ mefied and painful, particularly on the left ; nausea ; vomit¬ ing ; hiccup; constipation; hot skin; frequent and small pulse. Two hundred leeches applied, within five days, to the vulva and abdomen; baths, emollient fomentations, and injections. By these means, and blistering of the thighs, the symptoms somewhat moderated. — 15th day. Abdominal pain and tumefaction nearly gone ; vomiting relieved ; consti¬ pation, succeeded by diarrhoea ; marked evening pyrexia. Vomiting and pain soothed by anodynes and leeches for awhile ; subsequently aggravated. Debility ; extreme ema¬ ciation. Urine, the day before death, turbid, and containing inodorous purulent matter. On dissection, the peritonaeum

500

Foreign Medical Science and Literature .

was found thickened; large omentum diseased, and adherent to the abdominal parietes and intestines ; these latter ad¬ herent to each other. A large opening, with thin and black¬ ish margins, in the posterior and superior part of the bladder; a similar erosion in the inferior part of the sigmoid flexure of the colon. Several cysts in the abdomen, formed by adhesion, and containing a greyish watery fluid with albu¬ minous flocculi, suspended in it. One of these cysts, between the bladder and uterus, enclosed a quantity of yellow fecal fluid. The termination of the ileum was so much contracted as to admit with difficulty a common probe. The superior part of the left psoas muscle was reduced to a blackish putrid pulp; its attachments to the lumbar and last dorsal vertebrae nearly destroyed. A very large collection of black¬ ish purulent matter in its vicinity.

Journal of Practical Medicine. By Hufeland.

(German).

J un e, 1 8 1 9- — Eighth and Ni)ith Annual Report of the Royal Polyclinic Institution of the University of Berlin, for the Years 1817 and 1818. By the Editor. — in the years 1817 and 1818, two thousand, nine hundred and seven patients were treated in this institution. Of these, one thousand nine hundred and seventy-two were cured ; twenty-six died ; five hundred and thirty-seven were unrelieved, or sent to other hospitals; one hundred and eighty-six remained under treat¬ ment. In this number there were seven hundred and twelve children under twelve years of age ; and among these, two hundred and ninety from one to two; which merits particular remark: since, on one hand, it shows how much more successfully children of this tender age are treated in the Polyclinic Institution than in the hospitals; and, on the other, the utility of this establishment for the study of the diseases of infancy, in the prosecution of which the same facility does not exist in the hospitals. The author, after various details as to the funds and administration of the institution, presents a statement of the different diseases treated during the two years.

One hundred and fifty-six patients were treated for acute fevers. Of these, ninety-one recovered, and three died. They were, for the most part, rheumatic, gastric; very few nervous. The rare occurrence of intermittents during these years, is remarkable : eleven cases only were observed.

Seventy cases of pneumonia and pleurisy were treated : fifty-nine cured. I

Of one hundred and five patients suffering from phthisis pulmonalis , twenty-five were discharged as cured, ( als

Report of the Polyclinic Institution y 501

geheilt) ; which, indeed, is not always, in this disease, to be considered as a radical cure. There were, however, in the number of the convalescent, several cases of mucous phthisis which may be regarded as completely cured. In these, the Iceland moss with dulcamara, pearl barley in milk, acetate of lead, and artificial drains, were chiefly productive of benefit. In tubercular and catarrho-rheumatic phthisis, the excellent effects of dulcamara in strong decoc¬ tion (half an ounce daily, boiled from sixteen ounces of water to eight,) combined either with the sem. phellandrii aquatici, or polygala senega, or lichen Islandicus, were very apparent.

With rheumatism and gout, there were one hundred and eighteen patients. Of these, seventy-seven were cured. Besides the ordinary remedies, the great utility of repeated blistering and cupping was in several cases remarked.

Out of ninety patients suffering from nervous diseases, forty-nine were cured. In epilepsy and chorea , zinc was invariably found most serviceable; but it is administered in gradually increasing doses as far as half a scruple; and when the patient had become habituated to its employment, the sulphate of zinc was substituted for it (the oxide ?).

Seventy-one individuals, mostly females, were admitted with spasms of the stomach; and fifty-three cured. A chronic cold, employment in damp situations, and hysteria, were its principal causes. Bismuth, hyoscyamus, magnesia, cortex winter., cajiput oil, tonic and sedative plasters on the stomach, and blisters, when the disease was of rheumatic origin, constituted the chief remedies. In some cases, where gastric induration was clearly indicated, the most con¬ spicuous benefit was derived from the internal employment of laurel water, cicuta, and mercury conjoined with mer¬ curial frictions.

One hundred and seventy-three individuals were affected with chronic diseases of the skin. Of these, one hundred and fifteen recovered. In obstinate herpes, the graphite, (carburet of iron,) given daily, to the amount of a dram, was sometimes successful. Crude antimony also, given front two to three drams a day, had considerable efficacy. In young children, magnesia and chalk with rhubarb were often quite adequate to the cure ; hence proving the presence of acidity in the primae vise. The important influence exercised by the digestive system in the cure of cutaneous diseases, was evinced in a case of erysipelatous ulceration of the foot, which, in three days, was cured by emetics and the mere external application of wax-plaster.

* The infusion is represented as useless.

vol, xiv. — no. 84. St

502

Foreign Medical Science and Literature.

The extent of the city, and number of sick which it supplies, give the opportunity of observing many rare cases. Thus there were seven cases of diabetes, of which the urine w7as analysed by Mr. Hermbstaedt ; six of organic diseases of the heart; nine of hydrocephalus; two of pe¬ ricardiac dropsy; and several remarkable ones of organic lesion.

Professor Plufeland terminates this report by a detailed history of several of the most interesting cases observed by the Physicians of the Polyclinic Institution. In this, our limits will not allow us to follow him to an extent which would render the transcription useful or entertaining.

An Attempt at Explanation of the Cause which, in some rare Cases, prevents the Natural Small-pox operating as a Preservative from a Second Variolous Infection ; zvith some Re¬ marks on the State of Vaccine Inoculation. By Dr. Kausch. — The author of this communication establishes it as a truth, founded on the observations of eminent Physicians, and especially on those which have been made in England, Germany, and Holland, that there may supervene, in subjects who have been vaccinated, a modification of the variolous affection which ought not to be considered as varicella. Hodepjd, in his relation of the variolous epidemic which prevailed at Rotterdam in 1817, has particularly demon¬ strated the insufficiency of this explanation, and exposed several cases of modified small-pox, without the slightest appearance of varicella. He has moreover proved, on thou¬ sands of individuals, the preservative effects of vaccination ; and has found that the few exceptions occurred in individuals in whom the vaccine disease, although pursuing its regular march, had lost part of its valuable property, from the effect of some morbid state in the individual, cutaneous affections, or fistula. But even in these cases vaccination preserves the subject from a fatal, and, yet more, from a very severe attack : for although at Rotterdam variolous pustules have occurred in vaccinated patients, and threatened to assume a confluent form, they have, nevertheless, not proved so ; and the disease, always slight and transient, was unattended with secondary fever or suppuration. On a retrospect of these facts, we shall, the author thinks, be less astonished at seeing the natural small-pox, in some rare cases, and under certain circumstances, lose its property of preventing a second infection. This is particularly the object of Dr. Kausch’s researches. Into the explanations given by him it is un¬ necessary to enter. It is merely essential to establish that small-pox may occur a second time ; and only from correctly observed facts is it possible to demonstrate the reality of

503

De Fremery on Uterine Dropsy.

this position. from the evidence already adduced on the subject, this reality is scarcely to be questioned.

i he memoir of Dr. Kausch is terminated by statistical considerations on the progress of vaccination ; from which it appears that the number of annual vaccinations is not so considerable as to afford the state all the advantages of which this important discovery might be productive. TheP russian dominions contained, in 1817, 10,588,157 souls; and the number of vaccinated in one year has never ex¬ ceeded 350,000.

Observations on the Employment. ofEhatany. By Dr. Rath. — - Confirmatory of the excellent effects of this root in several atonic affections. Seven cases, in illustration, are recorded. The subject *of the first is a woman, aged twenty-five, in whom uterine haemorrhage of a chronic and passive nature was cured by the rhatany ; the second also is a case of uterine haemorrhage, in a subject aged forty-six ; the third, painful menstruation in a female of twenty-eight; the fourth, fiuor albus in a girl of sixteen ; the fifth, gout and fiuor albus in one of eighteen; the sixth, fiuor albus in a subject of thirty-eight ; and the seventh, excessive seminal discharges from improper indulgence, in a young man aged eighteen. In all these cases, cinchona and the ordinary remedies having failed, the decoction of rhatany was ad¬ ministered with success. In the colliquative sweats and diarrhoea of phthisis, the author has derived no benefit from its employment.

Sketch of the Medical Topography of the Canton of Bens- bergj Sc. By Dr. J. J. Gunther, &c. — This is a very long, and apparently well written article; but the subject is not sufficiently interesting to repay ourselves for the labour of writing, or our readers for that of perusing a detailed analysis of it.

Short Notices and Extracts comprehend only English articles, taken from the Repository and from the Edinburgh Journal.

II. Select Cases, Memoirs, &c.

pathology (including morbid anatomy) and

PRACTICE OF MEDICINE.

1. Dropsy of the Ligaments of the Uterus*. A thesis on this interesting and novel subject has lately been sustained by a graduate, M. de Fremery, at Utrecht; and, although the

* Specimen Medicum Inaugurale de HydropeLigamentorum Uteri, quod, favente Deo, & c«, in Academia Reno-trajectina, publico atque solenni examini sumittit P. J. T. de Fremery.

504

Foreign Medical Science and Literature.

correctness ofhis opinion, that the disease which has hitherto been taken for ovarian dropsy is, in fact, nothing but dropsy of the folds of the peritonaeum, improperly named ligaments of the uterus, is by no means, at present, clearly demon¬ strated ; we yet consider the work, both from the novelty and talent which it displays, entitled to attention ; and shall, consequently, present an analysis of the facts contained in it.

In his preface, the author states that two reasons have influenced him in taking dropsy of the ligaments of the uterus for the subject of his thesis : the first is, that the seat of the disease has hitherto been mistaken ; and the second, that the diagnosis of ascites from encysted dropsy has fre¬ quently appeared to him very difficult, and has been the source of many errors, even in the most enlightened Prac¬ titioners. Thus Wolterbeck inferred the existence of ascites in a woman who had a tumour beneath the right false ribs; and was only undeceived by the results of dissection. Dr. Bleuland, professor of midwifery in the faculty of Utrecht, was not more fortunate in two cases recorded by the author; from which he concludes that the difficulty of diagnosis is very great. However it be, the distinction of these two diseases is certainly not always easy; and every effort of the Physician to elucidate their diagnosis merits encouragement. The difficulty of this diagnosis is greater, in the author’s opinion, when the dropsy takes place in the ligamentum latum, as this membranous sac is susceptible of enormous development.

The First Part of the thesis comprehends the cases which have led M. de Fremery to his present views of the subject. The three first were previously unpublished : the others are cited from the works of various ancient and modern writers. The following is the substance of these cases : — -

The first is that of a woman who had a tumour in the right part of the epigastric region, and was affected with dropsy. Hence it was considered to be ascites, consequent, as frequently happens, on an affection of the liver; but, upon dissection, was found an enormous tumour of the right ovary, with considerable accumulation of serum in the corresponding ligamentum latum.

The subject of the second case is a lady aged fifty-six, who bad repeatedly submitted to paracentesis; and had a tumour, of the volume of a fist, in the abdomen. From 1802 to 1811, the operation of tapping had been nine times performed, with variable benefit. After the ninth, her debility was such that she survived it but three weeks. On dissection there was found, beneath the common integuments, a mem¬ branous sac, still containing a quantity of bloody serum,

505

De Fremery on Uterine Dropsy.

although the trochar had penetrated into its cavity. Between the sac and peritonaeum there was no fluid. Attentive dissection showed that this tumour was formed by the ligamentum latum of the uterus, in which was enclosed the diseased ovarium, enlarged to the bulk of a fist. The uterus itself was carcinomatous, and weighed five pounds. The left ovary also in a morbid state.

The third case, contributed by Dr. Bleuland, is that of a lady, aged fifty-four, and mother of two children. For ten years she had been much out of health ; but menstruation, more copious than heretofore, had never been permanently suppressed. Among other symptoms, there came on oedema of the feet, and tumefaction of the abdomen, with pain in the right side. In addition to these, increasing debility, scanty and turbid urine, constipation: fluctuation, at first scarcely perceptible, soon became more evident; but the patient refused to submit to the operation, until the abdomen had acquired a considerable volume, and she herself could feel the fluctuation. Notwithstanding the extreme weakness of the patient, and the faint hope of success from it, Dr. Bleuland, in the hope of relieving the patient’s oppression, decided upon and performed the operation of paracentesis. The abdomen, somewhat reduced, was still distended by hard and unequal tumours ; and death soon afterwards occurred. On dissection, a large quantity of coffee-coloured serum was found in the abdomen. ‘There existed in the left hypochon- tirium a voluminous body, containing a great number of cells, and compressing all the other viscera. This tumour, which adhered only to the great curvature of the stomach, was ascertained to be the omentum, and weighed eleven pounds. The uterus was degenerated ; the left ovary, much enlarged, presented the same morbid change as the omentum. The ligamentum latum of the uterus was converted into avast sac, which contained a black and turbid fluid.

M. de Fremery afterwards seeks to substantiate his doc¬ trine by facts quoted from ancient authors. Morgagni, Bonetus, and Zwinger, furnish him with some examples of ovary contained in the sac of dropsy. A great many others, extracted both from ancient and modern authors, are adduced in favour of this doctrine; and indicate, at least, the industry of M. Fremery. In all these cases he thinks himself justified in concluding, that the dropsy was not encysted in the ovary, but had its seat in the ligamentum latum : whence it results, in his opinion, that the real seat of the affection has been most commonly mistaken. How far the evidence of eminent men, who have devoted themselves to the prosecution of pathological anatomy, and given frequent descriptions of

506

Foreign Medical Science and Literature.

cysts in the ovary filled with serum, is to be controverted by the assertions and inferences of M. Fremery, we leave it to our readers to determine.

In the Second Part, the author deduces corollaries from the preceding cases, on the diagnosis, causes, nature, and treatment of this disease. Among the causes which give rise to dropsy of the uterine ligaments, he assigns the first rank to antecedent inflammation. From this theory it might be imagined that the antiphlogistic plan, general and topical blood-letting, would naturally be recommended. The author, however, asserts that there is hut little hope of recovery. In addition to the evacuation of the water, from which slight advantages only are anticipated, he recommends, like other writers, the employment of diuretics, purgatives, and diaphoretics.

II. New Remedy for Bronchocele*. iodine, a simple combustible body, discovered by Courtois, in 1813, and since examined in all its relations by various celebrated Chemists, had never been employed in medicine, till Dr. Coindet sug¬ gested its application to the treatment of bronchocele. His attention was first directed to this new and powerful agent by accidentally discovering that Russel had recommended sea-weed ( fucus vesiculosus), under the name of vegetable ethiops, against bronchocele. At that time he knew not what relation might exist between this plant and sponge; but he suspected, from analogy, that iodine might constitute the active principle of both these marine productions. The idea was followed up, and the success of the experiment so great as to encourage a prosecution of his inquiries. Should the observations of this Physician be ultimately confirmed, he may be considered as having rendered a signal service to humanity.

We pass over much interesting discussion on the nature and morbid affections of the thyroid gland, (or thyroid body. as Dr. Coindet, sceptical with regard to the reality of its glandular character, in preference denominates it,) in order to arrive at that part of the communication which is more directly interesting to the Practitioner.

After showing the existence of iodine as the active principle of sponge, and stating that the quantity of it in this substance is so minute as to render impracticable the determination of its relative proportion, Dr. Coindet pro¬ ceeds to describe the properties and method of administration of iodine.

* Annales dc Chimie, Septembrc, — Journal de Pharmacie, Qctobre, 1820.

507

Mezv Remedy for Bronchocele.

One piopeity of this new substance is that of forming an acid, in combination either with oxygen or hydrogen. The salts which result from the first combination being but slightly so. able in water, the author has preferred those which the hydrogen supplies. Iodine evinces a very strong affinity for hydrogen; and the acid which results from this combina¬ tion is known by the name of hydriodic acid. It saturates all the bases, and forms with them neutral salts; among which Or. Coindet has selected, for medicinal employment, the hydi 10 date of potash. That of soda may be used with equal benefit. 4 he hydriodate of potash is a deliquescent salt, of yvhich 4b grains (two French scruples), in one ounce of distilled water, represent, in an approximative manner,

grains of iodine. This preparation is one of those most frequently employed by Or. Coindet.

i he solution of this salt in a sufficient quantity of water may dissolve more iodine, and form an ioduretted hydriod - ate of potash; a property which may be taken advantage of to ineiease the power of the remedy in those cases where the bronchocele, unusually hard, large, or old, resists the action of the simple saline solution; and in this way the most extraordinary effects have frequently been obtained. The iodine dissolves, in a certain proportion, in ether and in alcohol. Gay-Lussac found that water dissolves but of its weight.

One ounce of spirit of wine at 35° dissolves at the temperature of 15° Reaumur*, and under the ordinary pressure, 60 grains of iodine, or about one-ninth of its weight; at 40° of concentration, and under the same conditions, it dissolves 84 grains, or about one-sixth : whence it results, that alcohol dissolves more or less, according to the degree of rectification.

In order to avoid all error in the dose in this third prepa¬ ration, employed under the name of tincture of iodine , 48 grains of iodine are dissolved in one ounce of alcohol at 35°. This formula Dr. Coindet has used more than the preceding, and, perhaps, with greater success; because, being- more easy of preparation in the smaller towns, where there are not always Apothecaries sufficiently expert to obtain the saline hydriodates pure, he has made it a principal object of his researches to ascertain the effect of a remedy which may come into general use.

This tincture ought not to be prepared too long before it is used ; for it will not keep any length of time, without de-

* Nearly 66° Fahrenheit.

508

Foreign Medical Science and Literature.

positing crystals of iodine; and the great quantity of hydrogen which the alcohol contains, and the extreme affinity of this substance for iodine, cause the tincture to be speedily con¬ verted into ioduretted hydriodic acid— -a remedy, doubtless, of high activity; but as there exist in some cases grounds of preference for one of the three preparations above indicated, each of them ought obviously to be such as the Physician wfishes, that he may with greater certainty direct the treat¬ ment, and draw from it unerring consequences.

Ten drops of either of the three preparations, in half a glass of syrup of capillaire and water, are prescribed for an adult, three times a day ; in a morning before breakfast, at ten o’clock, and at bed-time. After the first week, the dose is increased to fifteen drops; and if the iodine produce no sensible effect on the tumours, afterwards to twenty drops ; rarely farther. This contains about one grain of iodine; and seldom fails to dissipate the largest bronchocele, when con¬ sisting merely in excessive development of the thyroid body , without other organic lesion.

In about eight days the tumour begins to soften, and then to diminish. Even in these cases, where an operation is indispensable, the iodine, by diminishing the volume of the bronchocele, and consequently permitting the dilated blood¬ vessels to contract, will considerably lessen its difficulty and danger. Some tumours, apparently of the nature of bron¬ chocele, resist, however, the operation of iodine, long and variously employed. But Dr. Coindet suspects that the tumour in these cases differs materially from bronchocele ; or that almost the whole of it has undergone an organic alteration. He never employs any topical remedy in combi¬ nation with the iodine. In most cases the tumour has been wholly, in some, imperfectly dissipated. There are other instances wherein the cellular substance which surrounded the tumour remains tumefied, and communicates to the finger the sensation of an empty cyst.

iodine, moreover, is a stimulant; giving tone to the stomach, and exciting appetite. It operates neither on the bowels, kidneys, nor skin; but exerts a direct action upon the reproductive system and uterus. Administered for a con¬ siderable time, it is one of the most active emmenagogues ; and to this sympathetic alliance its effect in the cure of bronchocele may, perhaps, in many cases be attributed. It has also been successfully employed in chlorosis : and, on the whole, promises to prove one of the most powerful remedies with which modern chemistry has enriched the materia medica.

Mode of detecting Mineral Poisons.

$09

MEDICAL JURISPRUDENCE.

III. Memoir on a new Process whereby most of the Mineral Poisons , in their Admixture with coloured Liquids , may be detected. (Concluded from our last Number*).

Acid Nitrate of Bismuth may be combined with such a quantity of wine as not to destroy its transparency or red colour. On addition of a sufficient portion of concentrated chlorine the mixture is rendered colourless, and at the same time a yellowish white precipitate is thrown downf. A few drops of muriatic acid suffice to dissipate this deposit, and the liquid exhibits a yellow colour: it is then precipitated white by water and by potash, (the precipitate formed by the alkali becomes black on desiccation); and black, by the hydro-sulphates. Hence it operates on the re-agents as if there were no wine. Mixed with coffee, the nitrate acts as with the wine, on the addition of chlorine. Yet the pro¬ portion of coffee mixed with the salt should not be very considerable, or an abundant grumous precipitate will be deposited.

Sulphate of Zinc . — On a mixture of this in water with red wine, enough concentrated chlorine to destroy the colour should be poured ; and after the formation of the precipitate of chlorine and vegeto-animal matter, the whole should be filtered. This fluid, of a yellow' colour, will be precipitated white by potash, and slightly yellowish white by the hydro¬ sulphates, as though there were only sulphate of zinc. Its mixture with coffee, having been treated with chlorine and filtered, is precipitated of a slight yellowish white by the hydro-sulphates, white by muriate of barytes, and brown by potash. The latter becomes white on being in contact with a few drops of chlorine.

Muriate of Gold. — The mixture of this andred wine, treated with chlorine and filtered, is precipitated deep purple by mu¬ riate of tin, deep yellow by ammonia, and brownish black by sulphate of iron: hence acting as though it were simple aqueous solution of muriate of goid. 1 he fluid lesulting from its solution in coffee, decoloured by chlorine and filtered, yields the same precipitates, with the respective re-agents, as the vinous solution. Ilut ihe yellow precipitate icsulting from the ammonia becomes canary-yellow, with an excess of

ammonia, and a few drops of chlorine.

Nitrate of Silver being suddenly decomposed by chlorine,

* Repository, page 42 6. From Nouveau Journal, &c. Juillet,

1820, ... ,.

t Chlorine precipitates the acid nitrate of bismuth, white.

vol. xiv. — no. 84. S u

510 Foreign Medical Science and Literature .

cannot be detected in admixture with coifee or wine by the process here described.

Muriate of Tin mixed with red wine, decoloured by chlorine and filtered, yields a yellow liquid, which is precipitated white by potash, and yellow by the hydro-sulphates; just like the aqueous solution. Its mixture with coffee affords similar results.

Muriate of Barytes.— If a mixture of this with red wine or coffee be treated with chlorine, filtered after depositing the usual sediment, and heated so as to disengage the excess of chlorine, the fluid yields with nitrate of silver a white curdled precipitate, insoluble in water and in nitric acid; and with sulphate of soda, a white precipitate, insoluble in the same menstrua : hence exhibiting the same phenomena as the muriate in simple solution.

Composition Blue (mixture of concentrated sulphuric acid and indigo). — The extrication of sulphureous acid gas, on ebullition of this mixture with metallic mercury, proves the existence of sulphuric acid ■ which, however, cannot be detected by litmus or the salts of barytes. But it is instantly decoloured by chlorine in sufficient quantity ; and the yellow fluid resulting reddens litmus paper, and furnishes with nitrate of barytes a white precipitate, insoluble in water and nitric acid. Thus it acts as if there were no indigo in the mixture,

Alummixed with Wine.— Alum, it is notorious, is sometimes added to red wine with a view of improving its flavour and colour; and from this mixture serious mischief may accrue. Many means have been proposed for detection of the fraud ; but none of them appears so proper to demon¬ strate the presence of alum as the fallowing: — The wine should be decoloured with concentrated chlorine, and the mixture evaporated to about one fourth of its volume. The liquid when filtered, if it contain alum, exhibits the following properties : — 1. It has a sweetish astringent taste : 2. yields, with nitrate of barytes, a white precipitate, insoluble in water and nitric acid : 3. with potash, a yellowish white precipitate, soluble in excess of potash : 4. with subcarbonate of soda, a yellowish white precipitate (subcarbonate of alum), decom¬ posable by fire into carbonic acid gas, and alum readily recog¬ nised by its known characters,,

Medical and Physical Intelligence.

511

PART V ;

MEDICAL AND PHYSICAL INTELLIGENCE.

TO THE EDITOR OF THE LONDON MEDICAL REPOSITORY.

Sir, — In the year 1816, I supplied the late Mr. Mathias, of Tonbridge Place, New Road, with powder of rhubarb and confectio aromatica, both of which, upon inspection by the censors of the Company of Apothe¬ caries, were objected to, upon the ground, as was represented to me, of a difference in appearance, particularly as to colour, from preparations made by the Company.

Having been circumspect, and as I conceived, successful in these preparations, I stated the circumstance personally to the Company, when the samples which I produced (similar in quality to the preparations delivered to Mr. Mathias,) were admitted to be of a superior description: the names of the censors who had visited Mr. Mathias were ascertained, and I was informed that these gentlemen would be dismissed from their office if I should think proper to express a desire to that effect.

Satisfied with this explanation, I declined urging the matter further against the censors and retired, under the persuasion that similar cause of complaint was not likely to recur.

In the month of October, 1818, I received notice from Mr. M‘Cann, of Parliament Street, that the censors of the Company of Apothecaries had objected to some confectio aromatica with which I had supplied him; some explanations between Mr. M‘Cann and myself occurred, which led to a correspondence with the company, which was terminated by the following letters.

From the Master and Wardens of the Apothecaries’ Company

to Mr. M‘Cann.

Apothecaries’ Hall, Nov. 3, 1818.

The master and wardens of the Society of Apothecaries beg to inform Mr. M‘Cann, that they have returned herewith his specimen of conf. aromat., and have likewise sent him a specimen of that prepared at their hall.

By a comparison of the two articles, it must decidedly appear, from the external appearance, that they cannot both have been prepared from similar ingredients.

M‘Ca.nn, Esq. Parliament Street.

From Mr. Simons to Mr. Battley.

Sir, — The master and wardens, to whom your specimens of rhubarb and conf. arom. were referred, have ordered a specimen of conf. arom., as prepared at the hall, to be sent to Mr. McCann, in Parliament Street, in whose shop the investigation took place.

I am, Sir,

Your very humble servant,

(Signed) W. SIMONS.

\pothecaries' Hall , Nov. 3, 1818,

512 Medical and Physical Intelligence.

From Mr. Battley to the Master and Wardens of the

Apothecaries'* Company.

Gentlemen, — I have had the honour to receive from Mr. Simons a letter of yesterday’s date, in which he acquaints me that you have ordered a specimen of conf. aromat., as prepared at the hall, to be sent to Mr. M'Cann of Parliament Street.

I respectfuliy beg leave to inquire, whether I am to understand from this communication, that Mr, M‘Cann, being under the authority of your jurisdiction, is interdicted from using conf. aromat. and powd. rhubarb, of the quality of the several parcels which gentlemen, acting from you, have condemned in the shop of Mr. M‘Cann and others. I trust you will favour me with an early and explicit reply on this subject, which is of the greatest consequence to me, for my government.

I remain, Gentlemen,

With great consideration,

Your most obedient and very humble servant,

(Signed) RICHARD BATTLEY.

Fore Street , Nov. 4, 1818.

Not having received any answer, on the 13th Nov., I reminded the company of my expectation of hearing from them. On the 17th Nov. I received the following : —

From Mr. Bacot to Mr. Battley.

Apothecaries ’ Hall, Nov. 17, 1818.

Sir, — I am directed by the master and wardens of the Society of Apothecaries, to say, in answer to your letter of the 4th inst., that neither Mr. M‘Cann, nor any other person, is interdicted by their authority from using medicines of any quality they choose, although they always re¬ commend to every person, to use only medicines of the most superior kind.

They further desire me to say, that the persons who visited Mr. McCann’s shop expressed their opinion of the different articles which were shown them most fully to him ; and having said thus much, I have only to add, that they consider this correspondence as being terminated on their part.

I anq Sir,

Your obedient servant, (Signed) EDMUND BACOT.

From Mr. Battley to Mr. Bacot.

London , Cripple gate , Nov. 21, 1818.

Sir, — In a matter which essentially involves the question of my character and conduct in the business, on the success of which I depend, I cannot deem your letter of the 17th instant, in reply to mine of the 4th instant, a proper or satisfactory termination of our correspondence. I have therefore to request you to have the goodness to make known to the master and wardens of the Apothecaries’ Company my respectful determination to seek redress in such manner as I may be advised.

I remain, Sir,

Your very obedient servant,

To Mr. Edmund Bacot, Apothecaries’ Hall. (Signed) R. BATTLEY.

Medical ami Physical Intelligence. 5 13

From Mr. M‘Cann’s Assistant , Mr. J. M‘Cann, to Mr. Battley.

SrR,- — I must apologize for deferring so long to answer your note respecting the complaints of the censors belonging to the Apothecaries’ Company, who visited Mr. M‘Cann’s shop; on seeing the aromatic confection, they said the smell was pretty good, but the colour was very bad, that it did not appear to be coloured with saffron, but dragon’s blood, desiring that 1 would tell Mr. M‘Cann so.

Ihe following week, two gentlemen likewise called, having Mr. McCann on their list, who found fault with it also before Mr. M£Cann ; and on being informed you were going to write to them respecting it, they said you had better not, as it evidently was not good, nor was it the first time that it was found fault with, but if you pleased, you could serve as good as any other person. I am, Sir,

Your obedient servant,

Parliament Street , Nov. 30, 1818, (Signed) J. M‘CANN.

Notwithstanding the intimation with which my letter of the 21st Nov. concludes, I did not proceed further on the subject. Mr. M£Cann declared that he was perfectly satisfied with this and other preparations with which f had supplied him; and requested that I would suffer the matter to rest: and there it would have rested, if I had not had further experience of the misdirected activity of the company.

My friends, Messrs. Scott, Taynton and Scott, of Bromley, inform me, that about three weeks since, the censors objected to the confectio aromatica with which I had supplied them, upon the ground of the colour being dissimilar to that which was prepared by the company, and upon other grounds not quite distinctly stated, but having regard to its sensible properties.

I acknowledge that I was much hurt on receiving this communication, particularly as my dealings are very considerable with these gentlemen, who, in the most honourable and unqualified manner, desire me not to regard price, but to send them only the very best preparations. I consider that, in this respect, they place their character in my hands.

In all these instances the colour has been pointedly objected to. The censors, as I understand, have objected that the colour was such as could not be produced at Apothecaries' Hall; and have held out, as a logical consequence, that my preparation could not, therefore , be as good as the company’s, and was consequently exceptionable. It appears by the letter of Mr. J. M£Cann, Mr. M/Cann’s assistant, that the brilliancy of colour exhibited by my preparation was, by the censors, ascribed to the use of dragon’s blood, a substance not soluble in water, and, of course, obvious to detection.

I refrain from further comment, and proceed to show the method which I use in this preparation, in comparison with the method directed by the London Pharmacopoeia. A specimen of my preparation was delivered at the Royal College of Physicians, on the 3d December, 1818; and my method was explained personally to the President and some of the Fellows of that learned body, when they honoured me with a visit to inspect my museum and laboratory, in the month of June, 1819.

Confectio aromatica, as directed by the Royal College of Physicians.

Take of cinnamon bark,

Nutmegs, of each, half an ounce. ,

Cloves, an ounce.

Cardamom seeds, half an ounce.

Salfron dried, two ounces.

Prepared shells, sixteen ounces.

Refined sugar, two pounds.

Water, a pint.

514

Medical and Physical Intelligence.

Reduce the dry substances, mixed together, to a very fine powder; then add the water, gradually, and mix the whole until it is incorporated.

Confectio aromatica, as prepared by me ; the ingredients and the quantities being the same as directed by the Royal College, with the addition of gum arabic.

The cinnamon and the cardamom seeds are pulverized, and passed through a fine sieve: the prepared shells are dried perfectly; the nutmegs and cloves bruised in a mortar. The prepared shells are then immediately added in small and successive portions, by which means, friction being continued , the absorption of the aroma of the cloves and nutmegs is effected. These combined ingredients are then passed through a very fine sieve. Half the dried saffron is pulverized, and also passed through a fine sieve. The remainder of the saffron is infused in water below the boiling point, and so kept two or three hours, water being added to supply the waste by evaporation and by the absorption of the saffron. The liquor is then pressed from the saffron, and the sugar dissolved in it over a water bath. The powdered saffron is then added to this liquor, after which the prepared shells, impregnated, as already described, with the aroma of the nutmegs and cloves, the cardamom seeds, and cinnamon, with about two ounces^ of powdered gum arabic, are carefully and attentively admixed so as to produce the confection.

This preparation is highly aromatic, of a brilliant saffron colour, and of a consistence which experience shows to be superior. The high aromatic quality may be ascribed to the absorption by the prepared shells, the colour to the process used in respect of the saffron, and the consistence to the gum arabic.

I remain, Gentlemen,

Your obedient servant,

Nov. 25, 1820. RICHARD BATTLEY.

P. S. I have not had sufficient time to complete the series of experiments in which I am engaged upon senna, for insertion in the present Number of the Repository ; I hope to be able to make the intended commu¬ nication in your next Number.

A Inst of Persons who have obtained Certificates of their Fitness and Qualifications to practise as Apothecaries, from Avgust 1, 1819, to July 31, 1820.

Those who are marked thus *, are authorized to practise in London and ten Miles round. Those who are marked thus +, are Members of the Worshipful Societ)' of Apothecaries.

Adams, William

Adcock, John Fleming, Walsingham Adye, Arthur, Bradford, Wilts Allen, William, Cartmel, Lancashire Amesbury, Joseph Anderson, Francis Bine Ansel], Thomas

Armistead, John, Settle, Yorkshire Ashford, Seaman, Kenton, Suffolk Aspray, Thomas, Gluey, Bucks Astin, James, Huddersfield Atkinson, Robert, Hunslet, near Leeds

Atkinson, John, Kendall, Westmore¬ land

Balderston, William, Oundle, Nor¬ thamptonshire Baker, James Baker, Robert

Barrett, John Sessions, Appleton, Bucks.

Barnes, Joseph Steppen Beacall, Andrew Beard, Joseph

Beaufoy, Benjamin, Meriden, War¬ wickshire Beck, Henry

Bennion, Thomas, Oswestry, Salop Berrow, William, Hereford Blackwell, Montague Watts

51 5

Medical and Physical Intelligence .

Blathewick, John, Fareham, Hants Bleeck, Alfred, Bristol Blundstone, William, Manchester Bolton, Andrew, North Shields Bond, Edward Thornley Bowen, Frederic Perry fBowman, David, Harley-street Boyes, John Howes Brady, John, Bristol Brooke, John, Stockport, Cheshire Browne, Robert Cave •Browne, John, London Browse, George Bullock, Joseph, Congleton Bunny, Joseph, Newbery, Berks Bernard, Richard Nossiter •Burnett, John, London

Cantrell, Josh. Ashby de la Zouch Ceely, Robert

Chadwick, Benjamin, Bennington Chambers, Archimedes George Chandler, Ashby Chapman, John Strange Charlton, John Headlam Cliffe, John, Preston, Lancashire Close, James Collier, Frederick Corsellis, Nicholas Caesar Cottingham, Charles Crewe, William Pocle Cumpstone, John, Howden, York¬ shire

Cutler, Edward Davey, Robert

Davey, Henry William Robert Davis, William Sagittary Davis, John, Bedwelty, Monmouth¬ shire

Davies, George, Hull, Yorkshire Davies, David, Ruabon, Denbigh¬ shire

Daw, Richard

Dawson, George

Dawson, AVilliam

Dean, Thomas

Dean, Charles Henry

Dee, Thomas, Amport, near Andover

Denton, Samuel Best, Wethunwick

Dewey, William

•Dewsnap, Mark, Hammersmith

Dickenson, Thomas

Doble, Richard

Dobson, John Harrison, Lancaster Dobson, Frank, Market Weighton, Yorkshire

•Docker, William, London Dodd, David, Portsea, Hants Donaldson, John

Downing, Benjamin Bissell, Coleshill Dugdale, Thomas Dumbling, Joseph

Eborall, Henry Eiger, Isaac Elliott, Adam Empson, Edwin Eskrigge, Richard Bagally Evans, John

Flint, John Foden, Edward Fi -ance, Edward, Sheffield Freeborn, John James Simms, Ben¬ son, Oxford Furness, Martin Fm se, Robert

Garton, William, St. Helen’s, Lan¬ cashire

George, Richard Francis

Gill bee, Thomas

•Glen, George, London

•Gore, Henry John, Spital-square

Gore, Richard Thomas

Goss, John

Green, Josephus Septimus Greening, John ^Gregory, Joseph, Leicester ^•Griffith, Samuel Clewin, London Gurney, Burne, Lifton Gwillim, William

Hall, Joseph, Sheffield •Hall, Frederick, Southampton-row, Russel-square

Hall, William Chesterfield, Derby¬ shire

Hammond, Thomas James Hancorne, Robert Hands, Benjamin

Hawthorn, Charles, Rugely, Staf¬ fordshire Haxworth, John

Hempson, Philip, Ramsey, Essex Herron, Arthur Hicks, Edmund

Hillier, Henry .Bentinck Curry Holbrey, William Hood, Joseph Hooper, Thomas

Horton, Richard, Sutton Coldfield Hunt, George Hunter, William Hutchins, Henry

Ingram, Samuel Isbell, Charles, Plymouth

James, Hugh Thomas Jeaffreson, William Johnson, John Gladwin, Norwich Jones, Robert

Jones, George, Alcester, Warwick¬ shire

Jukes. Frederick, Birmingham

516

Medical and Physical Intelligence.

Keeble, Henry Kelsall, Henry

* Kendall, Henry, Rawstone-street, Brompton

Kennedy, Charles Storr, Ulverstone King, George

King, George, Sherborne, Dorset King, Thomas Hutchinson *Kirton, William, London Knowles, Charles

Lamb, William Davis, Worcester Langley, John, Boovey Tracey, near Chudleigh

Langworth v, William Frowde ♦Lavies, John, Charles-street, West¬ minster

Lawrence, John Ledger, John Ledlie, Thomas Leggett, William, Ipswich Lewis, James John, Haverfordwest Longton, James, Southport, near Ormskirk

Lutener, William, Bridgenorth Lyddon, William

Mallabar, Edward Lowndes Manley, John

Martin, William, Macclesfield *May, Edward Curtis, London Miskin, "William Mitchell, Thomas Moon, Charles Moyses, John

Mutlow, Edwin, Gloucester

Nathan, Lewis Henry, Manchester

Newman, John

Nichol, John, Torres, N. B.

Nind, Isaac Scott

Nnnnington, William, Chester le Street, Durham

Ollard, William Ortt, Edmund Owen, Edward

Parker, Christopher

Parker, Henry John Neil

Parsons, Thomas

Patch, John

Passingcombe, James

^Pearson, Edward Smith, London

Pearse, Wiiliam, Tavistock, Devon

Peat, David Brookwell

Pedder, George, Ryde, Isle of Weight

Percivall, William

Perry, Thomas, Woodstock, Qxon

Peter, Thomas

Peter, Deeble

Piercy, William Rrasier

Pollock, Timothy, North Shields

Potts, John, Altrencham, Cheshire

Price, John

Probart, Frederick L’Oste Puckett, Adarn Stapleton

Randolph, John

Rayner, Thomas Ingram

Roberts, John

Robins, James, Rugby

Roe, Thomas Edward, Bath

Rolston, George, Plymouth Dock

Rose, Frederick Wells

Rowling, Joseph, Leeds

Russell, George Ireland, Porchester

Rutter, Robert Champley

Sam well, Francis Peter Bellara Sankey, Edward Scarborough, James $Seddon, jordiua Sharpe, George Horatio Shearman, Edward James Shearwood, Win. Hiram, Barrow, Lincolnshire

^Simpson, William, London Smedley, Charles, Liverpool Smith, George Thomas, Meridan, Warwickshire

Smith, Richard Thomas, Exeter Smith, Edward

*3oley, Thomas Appreece, Vernon- place, London Sommers, Jolm

Spark, James, Newcastle-under- Lyne

Staples, William Stapleton Street, William Sterndaie, John Stanley Stevens, Edwin, Potrinth, Cornwall Stevenson, William, Berwick-upon- Tweed

Stone, William, Mayfield, Sussex Sumner, George

Sutton, Charles Frederick, Wragley, Lincolnshire

Sweeting, Robert Hallett Sylvester, Thomas

Tabberer, Frederick Tabois, James Alfred Thompson, Joseph, Pontefract jTborn, Richard Lawrence Tlnvaites, George Tice, John Angus, Ware Tickell, Trehane Symons, Ever- creach, Somerset Tomlinson, William Tomkins, William, Frome, Somerset¬ shire

Trollope, Thomas

Trout, Samuel, Louth, Lincolnshire Tucker, John, Bridport, Dorset Tunnicliff, William

Medical and Physical Intelligence .

517

Twynan, John

Wade, Robert Wales, Robert James Wall, William

Waller, Charles, Guildford, Surrey Walker, Thomas $*Ward, Joseph, London Waterworth, Charles, Newport, Isle of Wight

Watkinson, George Webster, Thomas Whitaker, Stephen White, John

Winter, Thomas Bradbury Woodward, George Workman, Thomas Skcete

COPY OF THE REPORT

TO TIIE SECRETARY OF STATE FOR THE HOME DEPARTMENT, FROM THE NATIONAL VACCINE ESTABLISHMENT, DATED 18lII MAY, 1820.

TO THE RIGHT HONOURABLE

LORD VISCOUNT SIDMOUTH,

Principal Secretary of State for the Home Department , fyc. fyc. Src.

MY LORD,

NATIONAL VACCINE ESTABLISHMENT, Percy Street, 18 th May, 1820.

The Hoard of the National Vaccine Establishment have the honour to report to your Lordship, that the number of persons vaccinated during the last year, in London and its vicinity, exceeds the number of any former year; it amounts to 8,957. Within the same year, 51,005 charges of vaccine lymph have been distributed to the public.

An abundant, an unceasing supply, which could only be afforded by such an institution as that which the Hoard have the honour to direct, has enabled us to answer the earnest demands for vaccine lymph, from various parts of Great Britain and Ireland, — from Jamaica, St. Vincent’s, Dominica, Tortola, Grenada, Nevis, Montserrat, Antigua, St. Christopher’s, Demerara, Hayti, and the Cape of Good Hope.

Lymph has also been occasionally requested from the continent of Europe, and charges were lately transmitted to Hamburgh and Hanover.

Our correspondents in Great Britain and Ireland have reported to this Board, that the number of persons vaccinated by them, during the year 1819, amounts to 74,940; forming, with the number vaccinated in London and its vicinity, a total of 83,897 persons in one year; yet many send no returns, or the number would be considerably greater.

From these facts, the Board think themselves entitled to conclude, that the practice of vaccination in his Majesty’s dominions continues to advance ; and, therefore, that the confidence of medical Practitioners, and the con¬ fidence of the public in that practice, remain unshaken; notwithstanding many unfavourable occurrences, with which it will be our duty to acquaint your Lordship.

The reports transmitted to this Board likewise warrant the conclusion, that wherever small-pox inoculation is abandoned, and vaccination exclu¬ sively favoured or commanded, the most striking illustrations of the value of the Jennerian discovery are uniformly afforded; for, in addition to those places mentioned in former reports, in which small-pox is now unknown, the Board have received information, that no case of that disease has occurred since the year 1804, at Shottisham, in Norfolk; nor since the

vol. xiv.- — is o. 84. 3 x

518

Medical and Physical Intelligence .

year 18 IT in the city of Gloucester. The boroughs of Clonmell and Newton Limavady, in Ireland, and Mothvey, in Carmarthenshire, with the whole country for twenty miles around it, are reported to have completely suc¬ ceeded in the extirpation of the small-pox; and, in the Island of Guernsey, only one solitary case of that fatal distemper is known to have occurred during the last year.

The career of vaccination appears, however, to have been less brilliant in its native country than in some parts of the continent of Europe, where the practice of it is enforced by legal enactments, and inoculation for small¬ pox is prohibited by severe penalties. Under such regulations, it is affirmed that the small-pox has ceased to exist in Denmark for the last eight years; and that the knowledge of this fact has now induced his Danish Majesty to proclaim the same decrees in his West India Colonies.

The Board are also informed, by a most interesting communication from Doctor De Carro of Vienna, that similar decrees have been published in the Austrian dominions ; and that small-pox is now confined to that portion of the poor, who by concealment contrive to evade the imperial ordinances. He announces, that since the year 1799, when he gave the first example to the continent of Europe, by vaccinating his two elder sons, he has never seen a single ca.se to weaken his confidence in the efficacy of that practice.

An important letter, together with a treatise on this subject, has also been transmitted to the Board from Dr. Krauss, an intelligent Physician, who is charged with the superintendence of vaccination in the circle of Iiezat in Bavaria. He affirms, that in that circle, containing half a million of people, small-pox has never occurred since the year 1807.

If these facts be correctly reported to us, they would appear to afford convincing proof, that the extinction of small-pox is entirely within our own power.

The testimonies of some of our correspondents in this country are by no means so favourable. They concur in showing, that great numbers of persons who had been vaccinated, have been subsequently seized with a disease, presenting all the essential characters of small-pox; but that, in the great majority of such cases, the disease has been of comparatively short duration, unattended by symptoms of danger. In several of these cases, however, the malady has been prolonged to its ordinary period; and ill eight reported cases it has proved fatal.

It appears to us to be fairly established, that the disposition in the Vaccinated to be thus affected by the contagion of small-pox, does not depend on the time that has elapsed after vaccination : since some persons have been so affected who had recently been vaccinated ; whilst others, who had been vaccinated eighteen and twenty years, have been inoculated, and fairly exposed to the same contagion, with impunity.

Nor is it undeserving of remark, that whilst cases of small-pox in the vaccinated have frequently been reported to us from some parts of the kingdom remote from the metropolis, no cases of a similar nature are know'll to have happened in other districts equally populous. Very intel¬ ligent Surgeons in the different counties of Norfolk, Devonshire, Middlesex, Cheshire, and Staffordshire, who together have vaccinated more than 30,000 persons, assert that they never saw or heard of small-pox in any one of their vaccinated patients.

But no assertions of individuals, however respectable, are so well calculated to direct the judgment of your Lordship, as the registers of public charities.

The practice of vaccination was begun in. the Small-Pox Hospital of London in the year 1799, soon after the promulgation of Dr. Jenner s

Medical and Physical Intelligence,

519

discovery, and has been continued to die present day. In the last annual report it is stated by Dr. Ashhurner, “ That the benefit of vaccination has been extended within the year to 3,297 persons ; that one only of the 46,662 cases mentioned in former reports, has been since affected with the varioloid eruption occurring after vaccination/’

At the Foundling Hospital vaccination was introduced nineteen years ago ; and we are informed by Dr. Stanger, that only two cases of disease, bearing any resemblance to small-pox, have hitherto occurred in the vaccinated of that institution.

Mr. Mac Gregor assures us, thut in the great assemblage of the sons and daughters of soldiers who are brought up at the Royal Military Asylum, no case, even of the mildest small-pox, has ever occurred after vaccination.

Under the immediate direction of the National Vaccine Establishment, more than 60,000 persons have now been vaccinated in London and its vicinity; and of this large number only five are reported to have been subsequently affected with smaii-pox, although positive orders are given at every station, to report all such cases as are even suspected.

This success in London, where the vaccinated are continually exposed to the contagion of small-pox, is strong evidence in favour of the practice adopted and inculcated by this Board ; and induces us to believe, that a departure from that practice is one source of the evil which has prevailed in different parts of the kingdom.

The great principle of that practice is to affect the constitution of each individual very completely with the vaccine disease; and the Board have thought it right to direct, that lymph should never be employed from any vesicle in which the slightest irregularity or imperfection can be observed; nor even from a perfect vesicle after the ariola is formed ; that two punctures be made in each arm, in order to secure at least three perfect vesicles ; that one vesicle on each arm should be left unopened, and the lymph be suffered to be absorbed or desiccate; that if the vesicles be accid itaily broken, or much injured, or if they present any irregularity, the patient should be carefully revaccinated as at first.

From extensive experience, and numerous reports, the Board have become most earnestly desirous that more rather than fewer vesicles should be produced. We think it especially wrong to confide in one vesicle, and highly imprudent to open all; but no treatment will be effective in certain constitutions; for twenty-one cases of small-pox occurring after small-pox have been reported to us within the last twelve months, three of which were fatal.

We have regarded it, my Lord, as one of our first duties, to consider attentively the different cases of small-pox after vaccination, as they have been transmitted to us. We have endeavoured to investigate them, free from the influence of theory, and solely intent on the discovery of truth : and, when we take into our view the immense number of the vaccinated, when compared with the reported failures; — when we reflect on certain peculiarities of constitution, that will exempt some individuals from all common laws; — when we think on the ignorance and catelessuess which the Vaccinator has but too often betrayed; — when we recollect the mild form which small-pox is reported to have generally, though not univer¬ sally, assumed in the vaccinated; — we cannot hesitate . to assert, that our conviction in favour of the experiment of universal vaccination is

unshaken.

It is a painful duty for us to state to your Lordship, that 712 persons are reported, by the bills of mortality of London, to have died of small-pox within the last year; and that the ravages committed by this disease in many other cities, and in many parts of the country, have also been

I

520

Medical and Physical Intelligence .

great; yet we believe them to be fairly attributable to the neglect of universal vaccination, and the partial but too frequent practice of small-pox inoculation.

J. LATHAM, M. D., President. ARTHUR DANIEL STONE, -v

ROBERT BREE, (Censors of the Royal Col-

EDWARD THOMAS MUNRO, | lege of Physicians. GEO. L. TUTIIILL, J

DAVID DUNDAS, Master of the Royal College of Surgeons.

THOMPSON FORSTER,

EVERARD HOME,

By order of the Board,

JAMES IIERVEY, M. D., Registrar.

Governors.

“Remarkable Instance of Spontaneous Combustion .■ — It is the custom with many of the merchants and manufacturers of Glasgow to spend several of the summer months at sea-bathing quarters, leaving the care of their town houses to a single servant, or sometimes shutting them up altogether. A gen¬ tleman, a neighbour of mine, removed with his family to Largs, in May last, carried with him all his servants, and shut up his house. It was opened for the first time about the end of August. The house stands on the side of a pretty steep declivity, so that the kitchen, which is in the back part of the house, though sunk considerably below’ the level of the street, is entirely above ground. It is remarkably well lighted and ventilated. I was in it on the day that the house was opened without perceiving any unusual appear¬ ance of dampness. In an opening of the wall near the kitchen fire, originally intended, I believe, for an oven, there was placed a wooden barrel, bound with iron hoops, and filled with oatmeal. This meal hac! heated of itself during the absence of the family, had at last caught fire, and was totally consumed, together with the barrel which contained it, nothing remaining but the iron hoops, and a few pieces of charcoal. I presume that the meal had been somewhat moist, and that it had heated precisely in the same way as hay does when stacked moist. The great avidity which oatmeal has for moisture, and the heat generated by its absorption of it, must be familiar to every one who has been in the habit of seeing oatmeal. Indeed, Mr. Leslie found that its avidity for moisture was so great, that it could be substituted for sulphuric acid in his well known method of freezing water by confining it over sulphuric acid, under the exhausted receiver of an air-pump.

Laccin. — I have given this name to a peculiar substance described, some years ago, by Dr. John, as -one of the constituents of stick lac , though I am not aware that any account of it has hitherto appeared in the English language. It is obtained by digesting stick lac repeatedly in alcohol and water till nothing further can be removed. The residual matter is laccin. It possesses the following properties :

It is hard and brittle, has a yellow colour, and a certain degree of trans¬ parency. It is insoluble in cold water; but in hot water, though it does not dissolve, it becomes soft. In cold alcohol, it softens, increases in bulk, and acquires a slippery feel. Even hot alcohol is unable to dissolve it. In ether and essential oils, it swells a little, and becomes quite transparent, but does not dissolve. It dissolves very readily in potash ley, and the solution has a light brown colour. Muriatic acid renders the solution milky, and the laccin slowly precipitates. Concentrated sulphuric acid dissolves it very rapidly; the solution has an amethyst colour, and becomes muddy when mixed with water. When long boiled with water containing Rom fgth to |th of its weight of sulphuric acid, only a small portion

521

Medical and Physical Intelligence.

of it is dissolved. This portion is obtained in the state of a yellowish gum, when the acid is separated by means of lime, and the solution evaporated. This property distinguishes laccin readily from cerasin. Concentrated nitric acid dissolves it slowly when assisted by heat. The solution is clear, and has a yellow colour, without any bitter taste. It gradually deposits some crystals of oxalic acid. Diluted nitric acid has no effect on it either cold or hot,

Laccin, when heated, gives out an aromatic odour, and becomes soft. It does not melt, but is gradually charred. When distilled, it gives out water, an acid which, when saturated with soda, throws down muriate ol iron white, and a yellow and brown oil. No ammonia can be detected in the products of the distillation. — {John's Chemise he Untersuchun- gen , iv. 12.)

Cantharcidin . — It appears, from a set of experiments made by Dr. J. Freeman Dana, of winch he gives an account in Silliman’s American Journal of Science and the Arts, vol. ii. p. 137, that the lytta vittata , or common potatoe fly, ol North America, contains a quantity of can- tharadin as well as the meloe vesicatoria. The lytta of America, Dr. Dana informs us, possesses vesicating powers in a higher degree than the Spanish fly. The experiments were made on rather a small scale, in consequence of the difficulty of procuring the fly in sufficient quantity; but a sensible por¬ tion of cantharadin seems to have been obtained.

(From the Annals of Philosophy.)

Remedy for Bronchocele. — The Bibliotheque Universelle, for July, 1820, contains a paper by Dr. Coindet, on a new remedy for the goitre , which, from his experience, appears to be very effectual. From the cir¬ cumstance that burnt sponge formed the basis of all successful remedies as yet used for this disease, Dr. Coindet considered that iodine might, be the particular substance that was useful; and, in consequence, applied it in different forms. One preparation was a solution of forty-eight grains of hydriodate of potassa, equivalent to thirty-six grains of iodine, in an ounce of water.

Sometimes iodine is dissolved i.n this solution, to increase the force of the remedy in very difficult cases.

Another preparation, called tincture of iodine, was made by dissolving forty-eight grains of iodine in an ounce of alcohol of 35 (S. G. 842).

The quantity for an adult was ten drops of one of these preparations, in half a glass of syrup of capillaire and water, taken early in the morning, fasting; a second dose was given at ten o’clock ; and a third in the evening, or at bed-time. At the end of the first week, fifteen drops were given in place of ten, three times a day; and, in a few days after, when the effect seemed evident on the tumours, it was increased to twenty drops. This quantity has rarely been increased, and was generally sufficient to dissipate the largest goitres.

After about eight days’ treatment the skin becomes less tense, and ap¬ parently thicker. The tumour softens, as becomes evident to the touch ; the goitreous tumours, if there are several, become more distinct and separate; they soften, and gradually dissolve. In many cases the nucleus, or part which is organically deranged, becomes harder, diminished in size, and isolated; sometimes they become moveable; a circumstance of great advantage in those cases where an operation is necessary.

In some cases the cellular structure, which pervaded the tumour, remains swelled, and feels to the touch like an empty cyst. Frequently also the goitre disappears only partially, but to an extent sufficient to be neither inconvenient nor a deformity. In many cases it is dissolved, destroyed,

52' 2 Medical and Physical Intelligence.

and dissipated in from six to ten weeks, so as to leave no traces of its previous existence.

That the effect of the remedy might be obtained free from any other effect, all local applications were avoided, which either by compression, or from the saline substances they contained, could produce any interfering result.

Vegetable Antidotes to Poison .- — Dr. Chisholm, in a paper read to the Society at Geneva, states, that the juice of the sugar-cane is the best antidote known for arsenic. It has been tried upon various animals in the West Indies with complete success, and always succeeds. Its power in the island of Nevis is generally known.

Dr. Chisholm also mentions the singular powers of a plant, well known to the Indians, as a remedy for the ophthalmia; it is called akouserounie and warannie' by them, and eye-root by the white people. It grows in la Guy ane , in the neighbourhood of Demerara, in a sandy soil, and is a species of bignonia, which Dr. C. has since called ophthalmica. An Indian prepares the remedy from the root of the plants, by first stripping off the brown epidermis, ar.d then separating a fibrous pulpy part immediately beneath; this he presses on cotton so as to collect the juice, and then by means of a paper funnel conveys a drop or two of it into the eye. This is repeated once a day for three or four days, in which time the cure is generally completed. Dr. Chisholm had occasion in his own practice to apply this remedy in three cases; and having only the dry root, he rasped off the outside, and then made a strong infusion of the part beneath. Six drops of this infusion were introduced into each eye once a day, and in six days’ treatment they were perfectly cured, though they had suffered for many weeks previously.

On the Poison of the Viper. — M. Configliacchi has been engaged on experiments with this poison. It was obtained by pressing the vesicles behind the canine teeth into a watch-glass, and applied by means of a needle.

He established, in the most positive manner, that this poison had no effect, except when introduced into the blood-vessels; flour-pills were dipped into the poison, and swallowed by birds, without producing any injury to them.

One object was to ascertain the effect of Voltaic electricity on birds poisoned by this venom. Some birds dead, but still warm, were subjected, with others killed, either by breaking the neck, suffocation, or decapitation, to the powers of a pile of twenty-four pair of plates, excited by a solution of sulphate of alumine, one pole being connected with the spinal marrow, and the other with a muscle of the knee. The result was, that the irritability of the muscles was considerably diminished in those animals killed by the poison, its duration not being more than one-fourth of that of the other animals, or even one-sixth of that of the decapitated birds. It was also so weak, that four times the quantity of plates did not produce an equal effect in them.

Another result was, that when poisoned birds, not vet dead, were sub¬ mitted to voltaic action, their death was hastened. The mean of three experiments gave six minutes as the difference between the death of poisoned birds electrified and not electrified.

it was also ascertained, that birds poisoned by prussic acid, more or less strong, as laurel-water, concentrated to various degrees, gave the same results, except that the duration either of the pain or of the irritability of the muscles was much shorter than with the viper poison.

Substitute for Peruvian Bark. — M. Re, professor of Materia Medica at the Veterinary School at Turin, has announced that the Lycopus Europeans of Lin warns is a complete succedaneum for Peruvian bark. It is

Medical and Phy sical Intelligence. 523

called by the peasants of Piedmont, where it is found in great abundance in marshy places, the Herb of China.

Plantain Root a Febrifuge. — Switzerland. — Dr. Perrin has lately read to the Society of Natural Sciences, of which he is a member, observa¬ tions made on the febrifugal virtues of the roots of the plantain, (plantaso major minor ct laiifolia , Linn.) lie is of opinion that it may he employed with advantage in intermittents. The question may easily be decided, as the plant is common every where.

. Medical Prize Question. — A satisfactory answer not having been given to the question, “ Can the existence of idiopathic fever be doubted ? ,} proposed last year by the Societe de Medecine of Paris, it is reproposed, the gieatest latitude being given to candidates in the choice and develop¬ ment ol their opinions.

lhe piize will be a gold medal, of three hundred francs value ; but, as a further stimulus, the st ciety will, if there be opportunity, award gold medals, of one hundred francs value, to the memoires which may most nearly obtain the prize, and silver medals ol emulation,

lhe concourse will close on the 30th September, 1821. The memoires, written in I' tench or Latin, to be sent, carnage free, before then, to the Secietane General de la Societe de Medecine, Rue St. Avoie, No. 39.

Prize Question. — The Academy of Sciences of Paris, propose the following I o follow the development of the triton, or aquatic sala¬ mander, in its different degrees from the egg to the perfect animal, and to describe the change which it undergoes interiorly, principally in respect to its osteology, and the distribution of its vessels.”

lhe prize, of the value of three hundred francs, will be adjudged in the public sitting of 1822. The utmost term for the transmission of me¬ moires is January 1, 1822.

Prize Question. — The Society of Sciences at Copenhagen, have proposed the following : —

“ Quibus naturae legibus regitur primaria evolutio corporum animalium, et formam sive regularum, nonnalem, sive abnormem adsciscant?”

I he author of the best answer to this question will receive a gold medal, of the value of fifty ducats. The memoirs should be addressed, with the usual forms, before the end of December, 1820, to the secretary of the society. Professor Oersted, at Copenhagen.

(From the Quarterly Journal of Science and Arts.)

Muriate of Potash in Rock Salt. — Dr. Wollaston’s discovery of the existence of muriate of potash in sea water, induced M. Vogel to examine whether this salt might not be detected in common salt obtained from springs, or dug solid out of salt mines. He subjected salt from Hallein and from Berchtesgaden to experiment. Nitromuriale of platinum produced no precipitate in the simple solutions ; but when they were concentrated till a large portion of the common salt was extracted, they gave a yellow pre¬ cipitate with this nitromuriate, indicating the presence of potash. Brine from Rosenheim treated in the same manner gave a similar result. — - Gilbert's Annalen.

Analysis of the Piper Cubeba. — The seeds of this plant, according to a late analysis by M. Vauquelin, contain : 1. A volatile oil, almost concrete. — 2. A resin resembling that of the balsam copaiva. — 3. Another resin, but in small quantity, and coloured. — 4. Extractive principle similar to that found in leguminous plants. — 6. Saline substances.

Spontaneous Separation of Warts. — In the New (French) Journal of Medicine, Dr. Cheneau relates the following singular case: —

u Numerous warty excrescences had long occupied the hands of a hyste¬ rical, highly susceptible lady, aged forty-four. On the night following the

524

Medical and Physical Intelligence.

decease of her husband, an event by which she was deeply affected, they all separated, leaving the spots which they had occupied wrinkled, but without in duration/’

This fact reminds me of a case that came to my own knowledge many years ago in Scotland. Some silver spoons having been mislaid, were supposed to have been stolen, and some expression fell from one of the family, which was either meant, or was so understood by a young lady who acted" as governess to the female children, that she had taken them. When the young lady got up next morning, her hair, which before was dark, was found to have changed to a pure white during the night. — The spoons were found afterwards where the mistress of the family had herself deposited them. — A. T.

Wodan Pyrites. — Some time ago it was announced that M. Lampadius, of Freiberg, had discovered 20 per cent of a new metal in this ore, differing as much from nickel as tellurium from antimony, and to which he had given the name of zvodantum.

The same mineral has since been analysed by M. Stromeyer, but without detecting in it any new metal. 100 parts contain

Nickel . . ..••••16-2390

Cobalt, with a little manganese •••••• 4‘255?

Iron . * . •••••• . 11-1238

Copper . . 0’7375

Lead . . . . Q"52 67

Antimony — a trace of.

Arsenic* * . . • . . 58-2015

Sulphur . * • * * . . • • 1Q’7 137

99-7979

Leslies Hygrometer employed to ascertain the Strength of Spirits . — Mr. W, Ritchie, of Perth, has proved by some late experiments, that there exists a uniform ratio between the cold induced by evaporation (from the bulb of Leslie’s hygrometer) and the strength of the evaporating spirits.

The bulbs of three very delicate hygrometers were moistened — one with strong whisky, another with a mixture of the same whisky and water in equal quantities, and the third with water. The lowest degree of cold induced by evaporation was carefully watched ; that of the water was 40, that of the dilute spirits 61, and of the strong 88.

“ Hence the following proportion : 24 : 48 : : strength of the dilute : strength of the strong spirit.”

Tliis he tried with different proportions of spirits and, water, in different states of the atmosphere, and found the same property uniformly obtain. — 1 'hum son's Annals.

Voltaic Electricity. — The most important of the facts just discovered by M. Ampere are tiie attraction and repulsion of two conductors, or of two portions of the same conductor, joining the two extremities of a Voltaic pile, and placed in a direction parallel to each other : there is attraction or repulsion according to the respective directions of the electric streams, which, in these conductors, are supposed flowing from tiie extremity which disengages oxygen in the decomposition of water, to that which developes hydrogen. Attraction, when the tvvo currents move parallel in the same direction. Repulsion, when they flow in contrary directions. These attractions, and repulsions, are totally and absolutely different from those which take place between electrized bodies in the ordinary way.

First. Because they take place only when the Voltaic circuit 1 est fermef that is, when the two ends touch.

Secondly. It is when the extremities, of the same nature, are the nearest to each other, that there is attraction, and there is repulsion when they arg

525

Medical and Physical Intelligence.

turther removed ; while, on the contrary, electricity of the same nature repels, and of opposite natures attracts.

Thirdly. These attractions, and repulsions, take place in vacuo as well as in air.

Fourthly. When there is attraction, and it is sufficiently strong to make the two conductors approach each other so as to touch (the wires which formed these conductors were nearly of the diameter of knitting needles), they remain adhering to each other like two magnets', instead of separating instantly, as would two conducting bodies electrified in the ordinary way.

M. Ampere showed that the actions between one Voltaic conductor and a magnet, as well as those between two magnets, are the same as those he has discovered between two electric currents, if it be admitted that a magnet is an assemblage of electric currents which are produced by an action of the particles of steel upon each other, analogous to those of the elements of a Voltaic pile, and that they move in planes perpendicular to the line which joins the poles of the magnet.

This part ol his theory he demonstrates, by showing that a magnet may be substituted for the electrical conductor, and then two magnets instead of the two conductors, without any different result, except in the intensity of the effects, which depend on the force of the magnets in all the cases where two currents act one upon the other in attracting and repelling, or in mutually making each other change directions, by virtue of the attractions and repulsions which exist between them, and which vary in proportion to the cosine of the angle of their directions ; so that the attraction of each is changed to repulsion, when this angle becomes obtuse, because the cosines become negative when the angle becomes obtuse.

Benzoic Acid. — This acid (which has hitherto been found only in benzoin, storax, balsam of Peru and Tolu, vanilla, cinnamon, and the urine of several graminivorous animals, as cows, horses, camels, rhinoceros) has lately been found, by M. Vogel, crystallized in the Tonquin bean (employed to give an agreeable flavour to snuff) between the skin and the kernel. These crystals melt at a moderate heat into a transparent liquid, which suddenly shoots out into stars on cooling, and then becomes a crystallized mass. In a higher temperature it sublimes, and deposits itself in fine brilliant needles, which have a smell similar to that of the bean. A concentrated solution of these needles in alcohol reddens litmus paper, and becomes milky when mixed with water. These needles when saturated with ammonia form a salt which precipitates iron with a brown colour. In a word, they possess all the characters of benzoic acid.

M. Vogel has also found benzoic acid in the trifolium melilotus officinalis by digesting them in alcohol raised to the boiling temperature. On cooling, it precipitated a fatty substance, and in a few days long crystals of benzoic acid appeared in the liquid. To get rid of the fatty matter, the whole was digested in boiling water, and then filtered. The liquid with the acicFpassed the filter, and, on being slightly evaporated, yielded the acid in crystals. According to M. Vogel, the quantity of benzoic acid in these flowers is so abundant, that it may be extracted from them with profit for sale. — Gilbert's Annalen.

(From the Philosophical Journal.)

LITERARY NOTICE.

In the Press, and speedily will be published, in octavo, volume first of the Principles of Medicine, written entirely on the plan of the Baconian Philosophy, to prove that the only rational Method of curing Disease is to induce by Medicine an opposite or counteracting Action, sufficiently powerful to expel the Disorder. By R. D. Hamilton, Medical Practi¬ tioner.

VOL. XIV. - NO. 84. 3 Y

5c2f)

A METEOROLOGICAL TABLE,

From 21 st of OCTOBER to 20 th of NOVEMBER, 1820, KEPT AT RICHMOND, YORKSHIRE.

D.	Baror Max.	neter. Min.	The Max	;rm. Min.	Rain Gauge.	Winds.	Weather.
21	29	05	28	43	47	36		WbN.	1 Sun...
22	28	57	28	32	50	37	44	SE..SW..	13 Rain.... 2 Sun.. 4 Moon..
23	28	63	28	42	51	39	02	WNW. SW..	1 Sun. 3 Rain. 4 Moon.
24	28	57	28	45	50	38		WNW.	1 Sun..
25	28	89	28	87	47	37		WbN..	1 Sun...
26	28	54	28	54	45	38	12	S.SE.	1 Sun. 2 Rain..
27	29	12	28	90	49	40	09	SW.NW..	1 Cloud.. 2 Rain. 4 Moon..
28	29	23	29	09	48	32		WbN..	1 Sun...
29	29		28	92	42	33	45	S.SE.	1 Cloud... 2 Rain....
30	29	21	29	16	47	31	01	SW..	lSun... 2 Sh. & Sun.. 4 St..
31	29	12	29	05	42	37	02	SSE.	1 Mist... & Rain.
1	29	22	29	14	48	32		N.WbN.	1 Cloud... 2 Sun..
2	29	40	29	35	45	28		W.	1 Sun...
3	29	49	29	48	44	30		SW..	1 Sun....
4	29	58	29	49	42	28		SSW.	1 Cloud.. 2 Sun...
5	29	27	29	27	44	29	26	SE.	1 Sun. 2 Rain...
6	29	39	29	34	49	43	03	SW.	13 Cloud.. 2 Sun. 4 Rain.
7	29	52	29	43	49	43		s.	1 Mist,.
8	29	60	29	56	51	42		SSE.	1 Mist...
9	29	75	29	75	49	36		EbN.	1 Cloud.. 2 Sun..
10	29	83	29	75	48	37		NbW.	1 Cloud..
11	29	88	29	66	44	28		NbW.NE.	1 Sun..
12	29	51	29	38	43	32	32	W.NW.	1 Rain.... 4 Star!..
13	29	60	29	53	39	33	17	NW..NE..	1 Sh of Snow.. Rain.. & S..
14	29	68	29	65	41	31	03	N.NW.	1 Sun. 2 Cloud... 4 Rain.
15	29	68	29	63	41	25		NW.	1 Sun..
16	29	46	29	20	35	28		Vble.	1 Sun..,
17	29	40	29	25	41	28	14	SSE.SW.	1 Sn.. & Rain.. 2 S.. 4 M....
18	29	52	29	52	40	28		SW.	1 Sun...
19	29	54	29	46	41	30		S.	1 Mist....
20	29	39	29	37	51	39	10	SE.	1 Cloud... 2 Rain..

The quantity of rain during the month of October was 2 inches, 33-10Gths.

Observations on Diseases at Richmond.

The disorders under treatment were, Amenorrhoea, Anasarca, Asthenia, Catarrhus, Cynanche tonsillaris, Diarrhoea, Dyspepsia, Dysuria, Febris con- tinua, Gastrodynia, Impetigo, Menorrhagia, Obstipatio, Odontalgia, Oph¬ thalmia, Pernio, Pyrosis, Scabies, Urticaria, Vaccinia, Vermes, and Vertigo.

5'27

THE METEOROLOGICAL JOURNAL,

From the 20 th of OCTOBER to the 1 Qth of NOVEMBER, 1820,

By Messrs. HARRIS and Co.

Mathematical Instrument Makers, 50, High Holborn.

D.	Moon-	Rain.' J	Therm.	Barom.	De Luc’s Hygrom.	Winds.	Atmo. Variation.!
20			45	50	38	29	17	29	33	55	58	W	NW	Fine
21	0		43	49	39	29	45	29	57	58	60	WNW	WSW	Fine
22		,28	45	52	41	29	92	29	85	62	60	wsw	wsw	Rain		Clo.
23		A1	45	50	40	29	21	29	05	59	59	sw	s	Clo. .
24		,23	43	53	42	28	97	28	84	60	62	sw	wsw	Clo.	Rain	Clo.
25		,19	47	52	40	28	67	28	90	61	60	wsw	sw	Rain		Clo.
26		,07	45	54	43	29	34	29	03	59	66	ssw	sw	Fog	Sho.	Clo.
27		,08	50	56	37	29	07	29	46	60	57	sw	NW	Clo.	Rain	Clo.
28	d		42	57	39	29	60	29	75	57	55	WNW	w	Fine
29		,10	43	56	38	29	47	29	33	60	57	s	w	Sho.	Rain	Fine
30			41	51	36	29	57	29	68	57	58	WSW	ssw	Fine
31		,02	43	50	44	29	50	29	46	58	60	SE	w	Fog	Clo.
1		,03	48	51	36	29	41	29	63	60	60	NW	WNW	Clo,	Rain	Clo.
2			39	47	34	29	79	29	84	60	57	W	w	Fine		- - -
3			37	43	31	29	88	29	91	56	58	w	w	Fog
4			35	46	30	29	90	29	96	57	59	E	NE	Clo.
5		,09	36	50	47	29	95	29	70	57	62	NNE	SW	Fog	Clo.	Rain
6		,H	50	53	45	29	78	29	80	65	62	w	w	Rain	Clo.
7			54	57	50	29	78	29	86	65	65	wsw	SSE	Clo.
8			54	57	49	29	86	29	91	66	61	E	E	Clo.
9			55	59	45	29	94	29	98	60	56	ENE	ENE	Clo.
10			50	53	39	30	01	30	06	58	59	NE	NNE	Fine	Fine	Clo.
11			43	50	48	30	00	29	91	55	57	NE	E	Fine
12		,1?	48	51	46	29	83	29	77	56	59	w	WSW	Clo.	Clo.	Rain
13	D	,17	38	47	33	29	59	29	67	61	61	E	ENE	Rain		Clo.
14		,H	38	44	31	29	81	29	82	59	58	NE	NE	Clo.		Rain
15			34	41	31	29	90	30	00	57	57	NE	NNE	Fine	—
16			35	40	31	29	93	29	85	57	55	N	N	Fine
17		,18	34	41	35	29	61	29	57	58	62	SW	WSW	Clo.	Rain
18			38	45	33	29	86	29	81	60	60	WNW	w	Fog	- -
19		,01	36	47	39	29	92	30	00	61	60	WNW	w	Fog		Fine

The quantity of rain fallen in October is 1 inch and 81-100ths.

528

A REGISTER OF DISEASES Between OCTOBER 20 tk and NOVEMBER 1 9th, 1820,

DISEASES.

Abortio .

Abscessio .

Amaurosis .

Amenorrhoea ••*•••

Anasarca .

Aphtha lactentium

Apopiexia .

Ascites • * . . •

Asthenia • . .

Asthma .

Bronchitis acuta * •

- chronica

Bronchocele ••••••

Cancer .

Carbunculus .

Cardialgia .

Catarrhus .

Cephalalgia .

Cephalaea . • .

Chorea .

Cholera ..........

Colica .

- Pictonum • «

Convulsio .

Cynanche Tonsillaris

- maligna

- - - Trachealis

- * Rarotidea •

• © •

Diarrhoea .

Dysenteria .

Dyspepsia .

Dyspnoea .

Dysuria .

Ecthyma .

Eczema . .

Enteritis .

Entrodynia . •

Epilepsia •

Epistaxis .

Erysipelas . .

Erythema lave .

Febris Intermittent * •

- catarrhalis • • • •

- Synocha . .

- Typhus mitior •

— — • Typhus grav. « •

- - Synochus « • • •

Remit. Infant.

Fistula Furunculus

	15	W
	o H	K
	8
	5 o
	z 8
	17	2
• ,	7
	6	1
	10	3
	14
	32	3
	10	2
<»	8
	1
	1
	2
	10
	49
	23
	2
e	2
	6
	5
	7
	3	1
•	24	1
	2
•	2
•	1
	31
	10
	18
	2
	8
	1
	1
	3	1
	3
■r*	3	1
	4
•	18	2
	1
•	9
	33
	3	1
•	20	2
	3
	26
♦ •	12	2
	4
	3

DISEASES.

Gastrodynia .

i/

Gonorrhoea pura • • Haematemesis « • • •

Hsemoptoe .

Hsemorrhois ......

Hemiplegia .

Hepatitis .

Hernia ..........

Herpes Zoster * • * • *

- circinatus • ■

— - - labialis • • • •

praputialis

Hydrocephalus Hydrothorax .....

Hj^steria .

Icterus .........

Ileus * .

Ischias * * * .

Ischuria ........

Lateris dolor .

Lepra • • • .

Leueorrhoea .

Lichen simplex • * * Mania .........

Menorrhagia .

Morbi Infantiles* *

- — — Biliosi* • • •

Nephritis* .......

Obstipatio .

Odontalgia .

Ophthalmia .

Otalgia .........

Palpitatio .

Paracusis .......

Paralysis . . .

Paronychia .....

Pemphigus ......

Pericarditis Peripneumonia • •

Peritonitis . *

Pernio ..........

Pertussis . . • •

Phlegmasia dolens *

Phrenitis * .

Phthisis Pulmonalis

Plethora .

Pleuritis * .

Pleurodyne ......

Pneumonia Podagra • * •

• » • • « ♦

• • © -o • • •-

	■a I*	s
	H	•H
	11
	14
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	10
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•	6
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♦	39	2
	16
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	3

Observations on Prevailing Diseases . 529

DISEASES.

Porrigo larvalis • •

- scutulata

■favosa • • •

Prolapsus Prurigo mitis • • • • Rheuma acutus • • • - chronicus

Rubeola .

Scabies .

Scarlatina simplex • •

- anginosa

maligna

Scrofula -

eS	"S
O H	CC
1
1	1
1
3
1
21
24
24
54
18
6	1
3	1
9

DISEASES.

Spasmi . -

Strictura .

Syphilis .

Tabes Mesenterica

Vaccinia .

Varicella •••••••

Variola .

Vermes .

Vertigo .

Urticaria febrilis • •

Total of Cases • Total of Deaths

o

H

2

1

19

i!

23:

13

13

14 13

3

1109

48

* Morbi Infuntiles is meant to comprise those Disorders principally arising from den¬ tition or indigestion, and which may be too trivial to enter under any distinct head ; Morbi Biliosi, such Complaints as are popularly termed bilious, but cannot be accurately classed.

Observations on Prevailing Diseases .

Prom Mr. Gaits-kell.

“1‘One of the cases of anasarca occurred in a delicate infant, about three months old, and was so universal that the whole cellular membrane became affected. Fortunately it did not go deep, or affect any of the internal cavities. By the pressure of the hand the water could be made to fluctuate from one part of the body to the other. This disease seemed to be the produce of great debility, the sequel of an attack of aphtha lactentium, which injured its appetite, and lessened the quantity of ingesta. This infant was of premature birth, being at six months and a fortnight expelled by an unexpected uterine haemorrhage. By wrapping it up in carded wool, to preserve its animal heat, supplying it with breast-milk in tea-spoons, till it had power to take the breast, its strength improved ; and throve well till the attack of thrush commenced. As the integumental absorbents were diminished in action, while the exhalant arteries were increasing their effusion, and the red veins returned their column of blood with difficulty, I ordered gentle and uniform friction of the whole body with a spirituous embrocation, and the tone of the digestive organs invigorated by four grains of carbonate of iron ter de die; the diet was also improved by giving thin chicken broth, sucked through an artificial nipple, made of sponge sewed in vellum. The advantage of suction to an infant, instead of drinking, is this, that the motion of the jaws throws out the saliva, and incorporates it with the food, which greatly assists its assimilation. By a continuance of this plan for three weeks, the effused fluid was gradually absorbed, and a balance established between the interstitial disposition and vascular absorption. The mother of the child having suddenly lost her milk from anxiety of mind, the infant was sup¬ ported by goat’s milk and chicken tea, alternately sucked through the artificial nipple. It sleeps well ; has two natural stools daily ; makes water freely, and of proper quality; the skin of proper temperature; and, in fact, is now in perfect health.”

530 Prices of Substances employed in Pharmacy .

Quarterly Report of Prices of Substances employed in Pharmacy*

lb.

unc. P. lb.

M. lb.

lb.

lb.

unc.

lb.

lb.

unc.

oz.

lb.

Acacise Gum mi elect.

Acidum Citricum

- Benzoieum

— - Sulphuricum — - Muriaticum

- Nitricum

- Acetieum

Alcohol - iEther sulphuricus

- recti 11 catus

Aloes spicatse extractum — vulgaris extractum Althsese Radix exot.

A lumen

Ammoniac Murias

- Subcarbonas

Amygdalae dulces Ammoniacum (Gutt.)

- (Lump.)

Anthemidis Flores Antimonii oxydum -

- sulphuretum

Antimonium Tartarizatum Arsenici Oxydum - Asafcetidae Gummi-resina Aurantii Cortex Argenti Nitras Balsamum Peruvianum Balsamum Tolutanum Benzoinum elect.

Calamina pragparata Calumbae Radix elect.

Cambogia Camphora

Canellas Cortex elect.

Cardamomi Semina Cascarillae Cortex elect.

Castoreum Castor Russ.

Catechu Extractum Cetaceum Cera alba - - flava -

Cinchonas cordifolise Cortex (yellow)

- lancifolise Cortex (quilled)

- oblongifolise Cortex (red)

Cinnamomi Cortex Coccus (Coccinella)

Colocynthidis Pulpa Copaiba

Colchici Radix (sic.)

Croci stigmata Cupri sulphas Cuprum ammoniatum Cuspariae Cortex Confectio aromatica

i. - Aurantiorum

- Opii

Confectio Rosae caninae — Rosas gallicae

- Sennae

Emplastrum Lyttas

- Hydrargyn

Extractum Belladonnae

- - Cinchonas

- Cinchonas resinosum

■ — - Colocynthidis

- Colocynthidis comp.

- - Conii

- Elaterii

— - Gentianas

- - Glycyrrhizas

— - Hasmatoxyli

- — Humuli

- * Hyoscyami

- - Jalapae

- Opii

— - — Papaveris

- Rhaei

- Sarsaparillae

- Taraxaci

unc.

lb.

unc.

lb.

unc.

lb.

unc.

unc. If. 6d. Res.

s.

5

26

5

0

£

4

4

5 12 14

7

G

1

0

2

4

3 9

5 1

7

1

8 2

7

4

6 28 50 10

0

5 9

6 4 9 3

3 20

4

3

4 3 6

11

16

16

2

16

6

8

5 1

10

3

9

3

5 2 2 2

6 3 1

3 6

4 1 0

30

0

6

0

0

1

3

5 12

2

2

e

o

o

0

9

0

0

6

6

0

0

6

0

8

6

2

0

6

0

6

10

0

3 0 6 6 0 6 0 0 0 6 6 0 6 0 0 0 6 0 0 6 0

9

9

0

0

0

9

0

0

0

6

4 0 6 0 6 0 0 3 0 0 6 6 6 6 0 6 6 0 6 0 6 8 6 0 0 0 0 0 9

Ferri subcarbonas - - lb.

_ sulphas

Ferrum ammoniatum * tartarizatum Galbani Gummi-resina.

Gentianas Radix elect. ... Guaiaci resina - - -

Hydrargyrum purificatum

— - prascipitatum album

- cum creta

Hydrargyri Oxy murias - unc.

- " Submurias

- Nitrico-Oxydum

- Oxydum Cinereum

- - Oxydum rubrum

— “=* Sulphuretum nigrum

- - rubrum

Hellebori nigri Radix lb. 5

Ipecacuanhse Radix -

- Pulvis -

Jalapas Radix -

- Pulvis - -

Kino -

Liquor Plumbi subacetatis P. lb.

— Ammonias - - -

— Potassas - Linimentum Camphorae comp.

■ - sapoms comp.

Lichen lb.

Lyttas - -

Magnesia - Magnesiae C arbonas

- Sulphas

Manna -

<?• d.

1 4

— communis

Moschus pod, (36s.) in gr. unc. Mastiche ... lb.

Myristicas Nuclei Myrrha ... Olibanum - *

Opopanacis gummi resina Opium (Turkey)

Oleum jpthereum - oz.

— Amygdalarum - lb.

— Anisi - unc.

— Anthemidis

— Cassiae

— Caryophilli

— Cajuputi

— Carui - - -

— Juniperi Ang. -

— Lavandulae

— * Lini

— Menthae piperitse

— Menthae viridis Ang.

— • Pimentae

— Ricini optim.

Rosmarini

— Succini 2s. Cd. —

— Sulphuratum

— Terebinthinae

— — rectificatum

Oliva: Oleum Olivas Oleum secundum Papaveris Capsulas - (per 100) Plumbi subcarbonas - - lb.

— - Superacetas - — Oxydum semi-vitreum Potassa Fusa ... unc.

— cum Calce - Potassa; Nitras . - lb.

— Acetas - - -

— C arbonas ... — Subcarbonas — Sulphas — Sulphuretum — Supersulphas

Tartras ... — Supertartras

Pilulse Hydrargyri - - unc.

cong.

unc.

unc.

unc. ■ rect. P. lb.

cong.

1

5

4 10

1

7

5 9

5 0 0 0 1

6 0 0 3

18

20

5

6 9 1

3 1

5

4 1

13

10

3 0

6

4 48

6

12

7

3

24

52

2

3 2 6

8

5 5 1

4

5

6

4

5

6 6 1 5 1 1 2

16

12

3 0 2 0 0 0 1

10

4 1 1 4 0 3 1 0

6

6

0

0

4

4

0

0

8

9

8

4

0

4

8

0

0

0

6

6

0

6

8

8

6

0

6

0

8

6

6

0

0

0

0

0

9

0

0

0

0

6

0

6

6

0

6

6

0

0

0

6

0

0

9

0

0

6

0

0

0

0

o

s

6

9

8

6

2

0

0

2

3

8

0

9

6

6

Monthly Catalogue of Books.

53 1

j. d.

Pulvis Antimonialis - - 0 9

— Contrayervse comp. » - 0 4

— Tragacanthze comp. - 0 4

Resina Flava - lb. 0 4

Rhaei Radix (Russia) - - - 32 0

Rhaei Radix (East India) opt- - - 12 0

Rosa? petala - - - 14 0

Sapo (Spanish) - 2 8

Sarsaparilla? Radix (Lisbon) - 5 4

Scammonia? Gummi-Resina - une . 3 0

Scilla? Radix siccat. opt. Ang. lb. 5 0

Senega; Radix - - 4 0

Sennae Folia - - -66

Serpen tar ia? Radix - -76

Simaroubae Cortex - -36

Soda? subboras - - 4 6

— Sulphas - - 0 6

— Carbonas - - 6 0

— Subcar bonas - - 16

— — exsiccata - - 5 4

Soda tartarizata - 2 0

Spongia usta ... unc. - 24 0 Spiritus Ammonia? - M. lb. 4 6

— aromaticus 5 0

— - fcetidus - - 6 0

— succinatus 5 6

— Cinnamomi - -36

— Lavandula? - -50

Spiritus Myristicae -

— Pimenta?

— • Rosmarini

— /Ether is Aromaticus

— — > Nitrici

— — • Sulphurici -

— — Compositus

— Vini rectificatus - cong. Syrupus Papaveris - - lb.

Sulphur Sublimatum — Lotum - — Pra?cipitatum Tamarindi Pulpa opt.

Terebinthina Vulgaris

- Canadensis

- Chia - i

Tinct. Ferri muriatis Tragacantha Gummi Valeriana? Radix Veratri Radix

Unguentum Hydrargyri fortius Nitratis

Uvse Ursi Folia Zinci Oxydum — Sulphas purif. Zingiberis Radix opt,

Nitrico-oxydi

s.

3

3

4

7

5

6

7

32

2

1

1

2

5

d.

6

0

0

6

6

0

0

0

0

2

6

6

0

0 10 6 0

10

5

6 2 2 4 4 3 3 7

3

4

0

8

0

0

8

6

0

0

6

0

6

0

Prices of New Phials per Gross. - 8 oz. 70s — 6 oz. 58s.— 4 oz. 47s.— 3 oz. 43s.— 2 oz. and

1 £ oz. 36s. — 1 oz. 50s. — half oz. 24s.

Prices o second-hand Phials cleaned, and sorted. - 8 oz. 46s _ 6oz. 44s.— 4. oz. 53s.

3 oz. 50s. — 2 oz. and all below this size, 25 s.

MONTHLY CATALOGUE OF BOOKS.

A Statement of Facts tending to Establish an estimate of the true Value and present State of Vaccination. By Sir Gilbert Blane, Bart., F.R.S., Phy¬ sician in Ordinary to the King. 8vo. Price Is.

Hall on Disorders of the Digestive Organs and General Health. Second Edition. 8vo. Price 7s.

An Essay on Mercury. By David Davis, M.D. 8vo. Price 2s. 6d.

A Sketch of the History and Cure of Febrile Diseases, more particularly as they appear in the West Indies, among the Soldiers of the British Army. By Robert Jackson, M.D. Second Edition, with Additions. 2 vols. 8vo. Price 11. 4s.

Mops on Mineralogy. 8vo. Price 6s. 6d.

Thoughts and Suggestions relative to the Cause, Nature, and Treatment of Intestinal Inflammation, including a Disease to which Lying-in Women are subject. 8vo.

Illustrations of Phrenology. By Sir George S. Mackenzie, F.R.S., &c. With Sixteen Engravings. 8vo.

A Practical Treatise on the Treatment and Cure of Consumption, and other Diseases of the Chest, by Means of a new and powerful Medicine, the Prussic Acid. Second Edition. By A. B. Granville, M.D., &c. 8vo. Price 9s.

532 Notices to Correspondents.

A Treatise on the Art of Brewing ; exhibiting the London Practice of Brewing Porter, Stout, &c. By F. Accum.

A Practical Treatise on Diseases of the Eye. By John Vetch. 8vo. Price 10s. 6d.

An Introductory Lecture. By B. C. Brodie. 8vo.

Illustrations of the Capital Operations of Surgery. By Charles Bell, F.R.S. Part I. Folio.

NOTICES TO CORRESPONDENTS.

Communications have been received this month from Mr. Mansford, Mr. Sutleffb, Dr. M‘Carthy, ( through Dr. Johnson), Mr. H. Wilkinson, Mr. Collingwood, Mr. Edward Thompson, Mr. W. Jackson, J. H., Dr. H. Robertson, and Dr. Conquest. A paper has likezcise been received from Dr. Williams, on the great Efficacy of the Vin. Sem. Colchici in the cure of Venereal Rheumatism , unaccompanied by Nodes , which shall appear in our next Number.

Communications for the Original Department , which are of such a nature as to require insertion immediately , must come to hand before the fifteenth of the month , as on that day , at latest , it is necessary to close the first division of the Repository.

*** Communications are requested to be addressed ( post paid ) to Messrs. T. and G. UNDERWOOD, 32, Fleet Street.

THE END OF THE FOURTEENTH VOLUME.

J. MOYES, GREVILLE STREET, LONDON.

1 N D E X

TO

THE FOURTEENTH VOLUME.

* . _ _

I Abernethy, his case of tic dou¬ loureux, alluded to 483

Abstinence, singular case of death from - - 323

Academy, royal, of sciences at Paris, proceedings of - 64

Acid, nitric, its use in gastro- dynia, &c. - . 450

Alison on the nerves - 50, 130

Alkalies, vegetable, discovery , I ot two new ones - - 332

Alum in wine, how best tested 510 Anasarca, G aitskell's case of - 529 Anchylosis of the lower jaw, case supposed to be - 404

Aneurism, thoracic, Steinruk's case of - - 253

Anemone pratensis, observa¬ tions on - - 403

Angina of the larynx, case of - 157 Animal matter, how altered by sulphuric acid - - 321

Antiphlogistic treatment re¬ quired in tetanus - - 5

Anus, diseases of, Howship on, reviewed - - 394, 479

Apothecaries, associated, an¬ nual report from - - 65

— ’company, licentiates of, list of 544 Arachnoid membrane of the spinal chord, ossific deposi¬ tions on, in a case of tetanus 5 Argenti nitras, on its use in the cure of strictures - - 223

Army Surgeons defended against the charge of temerity - 478

Artery, posterior, tibial ligature on the - 405

Arteries and veins, diseases of, translation of Hodgson on, reviewed - 165

Arteritis, memoir on, and case [ of - - 417

Asphyxia in an infant cured - 59

Asthma, is it always an organic affection ? - - - 401

VOL. XIV.— NO. 84.

Asylums, lunatic, Burrows on - 473 A visard's case of softening of

the brain - - - 411

Bark, Peruvian, substitute for - 523 Barde's case of arteritis - 417 Baths, chalybeate, on - - 408

Battley on colchieum - 29

— on the best mode of drying the plant for use - - 429

Begin, a French writer, cen¬ sured - 165

Belladonna, case ofhysteria oc¬ casioned by its use - - 56

Berlin, notice of the polyclinic institution of that university 501 Benzoic acid, Vogel on , - 525

Bernard, St., medical topogra¬ phy of the convent of - 57

Bird's case of perforation of the stomach - 383

Bismuth, how to detect its ex¬ istence when mixed with wine 509 Bladder, mode suggested for extracting calculi from the - 398 Blackett's case of hremorrhoids 454 Bland on senile rupture of the heart - - - 412

Blood, exhalation of, Segalla's case of - - 239

Boivin, Madame, allusion to her work - 283

Books, medical, monthly cata¬

logue of 88, 176, 264, 352, 444,

531

— , review of, Prichard on epi¬ demic fever, 36. — Maclean's specimens of systematic mis¬ rule, 40. — Cooke on apo¬ plexy, 110 • — Grattan on the medical profession, 125. • — • Review of l)r. G.'s pam¬ phlet, 128. — Letter to the president of the associated apothecaries, 129. — Cross on the variolous epidemic of 3 Z

534

INDEX.

Norwich, 202. — Bingham on strictures of the urethra, 219. * — Harrington on chemistry, 229. — A toxicological chart of poisons, 232. — Bell on diseases of the urethra, 287. — • Hall on puerperal affections, 299. — Gregory's theory and practice of physic, 303. — Hastings on bronchitis, 312, 389. — How ship on intestinal diseases, 394,479.' — Burrows on insanity, 467. — Henneri's principles of military surgery, 473. — Hutchinson's cases of tic douloureux, 484. — Hods on blood-letting, 487. — Hutchinson, on infanticide, 487. — Carson on the elasticity of the lungs, 491. — Macart¬ ney on the curvature of the spine, 492. — Pearson's prin¬ ciples of psycho-physiology, 493.

Bougie, tenderness and tact re¬

quired in its use - - 295

- — , Bingham on the - - 221

Bourdier, funeral oration on - 60

Bourgeois , Louisa, history of - 283 Bowel, tumour in the, symp¬ toms of - 397

Braconnot on sulphuric acid - 319 Brain, softening of, case of - 411 - — , injury of, from a fall, case of - - 6

Brayne's case of tetanus - 1

Breast, extirpation of, Kennedy' s case of - 381

British medicine contrasted with that of the continent - 121

Brodie, his introductory lecture noticed - 123

Bronchial and tracheal affec¬ tions, Fischer on - - 248

Bronchocele cured by iodine - 506 Bronchitis, Hastings on, review of - - 312, 389

Bulimia with hasmatemisis, case of - - 57

Burning spring, account of - 80

Burrows's case of melancholia, in which mercury proved useful ~ - - 273

Buxton's cases of diabetes - 359

CalendarofFlora andFauna31, 107, 200, 286, 388, 494 Calomel, why so named - 400

Calculi, prostatic, extraction of - 423

Capillaries, their condition un¬ der inflammation - - 314

Caries of the spine, with pericar¬ diac dropsy, account of - 420 Carotids, on ligature on the - 80

Catalogue of medical books,

monthly, 88, 176, 264, 352, 444,

531

Catheter, when required in dis¬

eases of the urinary organs - 291 Cathartics, their great utility in puerperal affections - 300

Charity, lying-in, report from - 81

Chemistry, semi-annual retro¬ spect of - - 41

Chomel on idiopathic fevers - 139 — • on acute diseases in persons addicted to the use of spirits,

&c. - 323

Cloquet's case of fracture of the pelvis - 242

Coindet on iodine in broncho¬ cele - 506

Colchicum, Buttley on - 29

— , his mode of preparing - 429 — , Williams on the seeds of - 89

Cole on mercury in syphilis - 265 — , on phagedaena gangrasnosa - 445 College of Physicians, lectures at, noticed - - 110

Colour, blue, produced by sub¬ stances treated with an alko- holic solution of guaiacum - 74

Combustion, spontaneous, re¬ markable case of - 520

Composition, medicinal, Paris on - - - 122

Contagion, how different from infection - - 39

Concussion and compression of the brain, diagnosis of difficult 462 Contracted rectum, case of - 373 Contractility in arteries argued for *- - 313

Concretions in the veins, Michel on - - 155

Confection, aromatic, Battley on 511 Copper, sulphate and acetate of, in wine, &c., how best tested 424 Correspondents, notices to 88, 176, 264, 352,444, 532 Costiveness, habitual, how best obviated - 484

Cough, periodical, cured by cinchona - - - 56

Croup, case of cure of - 151

INDEX.

Cubebs, its use in inflammation of the villous coat of the bowels - 175

Cullen , his system in some mea¬ sure exploded - - 303

Curvature of the spine, Macart¬ ney on - _ 4,92

Dalbant on arteritis - - 417

Death occasioned sometimes in infants tor want ot necessary aids - 490

Derangement, mental, not upon the increase - - 470

Diabetes, Buxton's cases of - 359

Diaphragm, its motion, how re¬ gulated - - - 491

Diet, animal, its use in diabetes 370 Diseases, Monthly Report of, with observations on pre¬

vailing affections 86, 174, 259,

350, 442, 528

Dropsy of the pericardium, with spinal caries, account of - 420 D rowning, its effects upon the appearance of the lungs - 489 Dupuytren s case of calculi - 325

Earthquakes, coincidence of with the yellow fever of the Antellis - - - 57

Efficacy in medicine, proof of - 36

Electricity, Price on the bene¬ ficial effects of - - 101

— and galvanism, Phillips on 234 Embrocations, their indiscrimi¬ nate use in spinal disorders condemned - - 197

Emetic tartar, its use in tetanus 6 Emetics in apoplexy ? - 113

— , Powell on - - 116

Epileptic subjects not suffi¬ ciently attended to in England 47 1 Epidemic disorders not solely referrible to contagion - 40

Epistaxis, case of - 403

Exanthemata, the connexion of this class of diseases with dermoid affections - - 307

— , Harrison on - - 119

Experience, misconceptions re¬ specting the true meaning of the word - - 34

Europeans and savages, their strength compared - - 76

Faith, change of, a source of in¬ sanity - - - 471

r o DOJ

Fevers, idiopathic, C home l on - 139 — , remarks on the theories of - 305 — , on blood-letting in - - 307

— • only communicable under certain circumstances - 39 Foetus, its appearance when it has been retained some time in the uterus after death - 488 Fischer on tracheal and bron¬ chial affections - - 248

Fischer on lesion of the heart - 149 Fistula, site and course of - 147 ■ — • lachrymalis, memoir on - 144

Forster's calendar of Flora and

Fauna 3 1, 107, 200, 286, 338,

494

Forts 's case of wound in the knee-joint - - 380

Fosbrooke on life and mind - 17

Fremery on dropsy of the ute¬ rine ligaments - - 503

Gangrene distinguished from sloughing, and from phage¬ denic ulceration - - 447

Gastrodynia cured by the exter¬ nal application of nitric acid 450 Gear get's case of hydrocephalus 241 Gland, prostate, extract of cal¬

culi from - - 423

Gold, muriate of, how to detect it in wine - 509

Gout, Gregory's remarks on - 311 Graius on lecturers - - 95

Gravitation, influence of in the animal economy - - 61

Guaiacum, mixed with flour, curious effect from - 74

Gun-shot wound, case of - 383

Hall's case of fractured verte¬ brae - - - 15

Hemorrhoidal excrescences, Howship on 483

Haemorrhoids, Blackett's case of - 454

Hsematemisis, case of, accom¬ panied with bulimia - 57

Head, injury of, Shoveller's case of 6

— , Wansbrough's case of - 460 Heart, Fischer's case of lesion of - 149

— , memoir on rupture of the - 333 — , Bland on 412

Hepatitis, Gregory's remarks on 310

Herpetic eruptions, a new re¬ medy for - 404

536

I N D E X.

Henry on urinary and other morbid concretions, alluded to 50 History, natural, Forster's ca¬ lendar of SI, 107,500, 286, 388,

494

Hodgson's treatise on diseases of arteries and veins, French translation of, reviewed - 165 Hufeland on mercurial treat¬ ment Without salivation - 326 Hull on the external application of nitric acid - - 450

Hulbert on vaccination, no¬ ticed - 216

Hydrocephalus, Georget's case of - - - 241

— •, Cooke on - - 1 13

Hysteria, case of, produced by belladonna, and cured by cin¬ chona - - “56

Idiopathic fever, does such a disease exist ? - - 139

Infantile asphyxia cured - 59

Infanticide, Hutchinson on, re¬ viewed - - - 488

Inflammation, Gregory on - 308 — , visceral, the source of dan¬ ger in fever - - 37

— • of the spine, common in tetanus - - 4.

Inoculation, deaths from, ac¬ count of - - - 215

Insanity, Palmer's case of, in which mercury proved bene¬ ficial - - - - 386

— , table of proportions of cures of - 469

Instrument proposed in mid* wifery - - - 499

Xntus-susception, How ship on - 481 Intestinal canal, foreign body introduced into the - 58

Intelligence, medical and philo¬ sophical, various articles of 339,

429, 438, 511, 521 Iodine, a new remedy for bron- chocele - 506

— , in what does it consist ? - 314

Iron, carbonate of, in tic dou¬ loureux - 485

Iris, how affected in cases of constipated pupil - - 458

Irritation, sympathetic, in uri¬ nary disorders - - - 293

Jaw, lower, case of supposed anchylosis of -* - 404

Journals of foreign medicine, analysis of, 55, 322, 325, 326,401,

406, 4C8, 496, 498, 500

Kausch on small-pox and vacci¬ nation - 502

Kennedy's case of extirpation of the female breast - - 381

Knee-joint, wound of, case of - 380

Labour, premature, Thompson on - 102

Laccin, account of - - 520

Lachrymalis, fistula, memoir on - 144

Lancet too indiscriminately em¬ ployed - 299

Larrey on wounds of the thorax 245 Laryngo-tracheotomy, case of, practised with success . - 405

Lead, compound of, how' best detected when mixed with wines, &c. - - 425

Lecturers, Grams on - - 95

Life and mind, Fosbrooke on - 77

Ligaments of the uterus, dropsy of - - - 503

Liniments, their premature and indiscriminate employment censured - - - 197

Literary notices 83, 166, 257, 347,

439, 525

Lithate of ammonia calculus, Front on - - - 77

Lithotomy, recto-vesical opera¬ tion of - - - 421

Liver, case of abscess of the 403

London, reports of diseases in - 86,

173, 260, 350, 442, 528 Lungs, elasticity of, Carson on 491 — • of infants, appearances of, in

cases of infanticide - 489

• — , mucous membrane of, Has- tings on, reviewed - 312,389 Lying-in charity, report from - 81

Maclean's specimens of syste¬ matic misrule, review of - 40 Meat diet, its use in diabetes - 3.70 Medicine efficacious in mental maladies - 469

Medical Profession, Grattan on, reviewed - -125

Meissenger on sebadilline - 163 Melancholia, Burrows's case of, in which mercury proved useful - - -278

— , Palmer's case of •» - 386

I N D E X.

537

\

Membrane, arachnoid, of the spinal chord, how affected in

tetanus - - 5

Menstruation, precocious, case of - - -14 2

— without uterus, case of - 409 Mercury, its indiscriminate em¬ ployment in syphilis con¬ demned - 191, 476

Metals, account of - - 48

Meteorological Journal for London, monthly, 85, 173, 258,

349, 441, 527 «— for Richmond, in Yorkshire, 84, 172, 257, 341, 440, 526 Mind and life, Fosbrooke on - 17

Morgagni on ossific deposits on the arachnoid membrane, re¬ ferred to - - 4

Morphia, account of - - 74

Mucous membrane of the lungs, Hastings on, review of 312, 389

Natural history, Forster's ca¬ lendar of 31, 107, 200, 286, 388,

494

Nervous influence, how con¬ nected with secretion - 51

Neuralgia, case of - - 56

Nicod on fistula lachrvmalis - 144'

• i/

Nitric acid, its external applica¬ tion in gastrodynia, &c., Hull on - - • 450

Norwich, Cross's account of the variolous epidemic of that city, reviewed - - 202

Nosology, how deceitful - 485 Notices to Correspondents, 88, 176, 264, 352, 444, 532 — of lectures - 255, 437

, literary 83, 166, 257, 347, 439,

525

Onslon^s obstetrical researches 177,

283, 353

Opium, case of poisoning by - 426 — , Cowley on English - 438

Oration, Hunterian, quotation from - - - 126

Organology, Pearson s opinion on - 493

Ossifications of the'spinal chord, in what way probably con¬ nected with tetanus - 3

Palmer on mercurial salivation in insanity - - 386

Paris, proceedings of the Royal Academy of Sciences at - 65

Parkman on purgatives in puer¬ peral affections - - 464

Parturition, laborious, Wood's case of - 103

Palmier on cedematous angina of the larynx - - 137

Pelvis, fracture of, Cloquet's case of - - 242

— , tumour in the cavity of,

case of - - 407

%

Pearson's principles of psycho¬ physiology, reviewed - 493

Pericardial dropsy with spinal caries, account of - - 420

Periodical affections, whether connected with lunar changes 79 Perinseum, case of rupture of the - 143

Perinaeum, fistula in, operation for - - - 297

Peritonitis, Sutlejfe's cases of - 190 — , case of - - 82

Phagedsena gangraenosa, Cole on - 445

Pharmacy, prices of substances employed in - - 262, 436

Philips's reply to Scudamore on mineral waters - 465

Philip , Wilson, Alison's obser¬ vations on his doctrines - 50

Phthisis, disorders which simu¬ late this affection - - 390

Physicians too numerous, and too easily made - - 124

Pipeline, account of 333

Piper cubeba, analysis of - 523 Plague, remedy for - ' - 89

Poisons, mineral, new process for detecting - 336, 423, 509 Poppy, proposal for English cultivation of „ - - 43

— , Cowley's account of the pre¬ paration of British opium from - - - 438

Position of the body, of import¬ ance in reference to disor¬ dered states - - 61

Potass, subcarbonate of, its use in strictures - - 224

Pozvel on apoplexy - - 115

Price on the effects of elec¬ tricity - - - 101

Prichard on fever, review of - 26

Principles in medicine too hastily acted on

34

538

I N D E X.

Profession, medical, Grattan on - - -125

Prolapsus ani, Howship on - 479 — , Bell on - - 298

Prostatic calculi, extraction of 423 Proui on a lithate of ammonia calculus - - - 77

Puerperal fever, Gaitskell's case of - - - 180

Pulmonary disease, Wans- brough's case of - - 182

Puncture in the bladder - ,206 Pupil, contraction of, theory of, in apoplectic affections - 459

Ranula, Larrey on - - 323

Katan’s case of venereal affec¬ tion - 324

Rectum, case of contraction of 373 — , diseases of, review of How- ship on - - 394

Religion, is it a cause of in¬ sanity ? - - - 47 1

Remunerating medical Practi¬ tioners, objection to the mode of - - - 129

Report of diseases, monthly 86, 173, 260, 350, 442, 528 Respiratory organs, efficacy of moxa in chronic phlegmasia of the - 406

Respiration, rationale of -491 Rhatany root, Hath on - 533

Rheumatism, on the treatment of - - - 311

Ribes's researches on the situa- j. tion of the internal orifice of fistula in ano - - 145

Richmond, in Yorkshire, me¬ teorological tables for - 84,172, 258, 348, 440, 526 Robouams case of chronic peri¬ tonitis, &c* - - 499

Royal Society, proceedings of - 84

Rupture of the uterus, case of - - - 151

Rye, ear of, introduced into the lungs, case of - - 410

Sage, Le, on ruptured peri- naeum - 143

Salts, account of - - 43

Savages and Europeans, their strength compared - 76

Scudamore , strictures on, by W.

Philip - 465

Sebadilline, Meissner on - 163

Secretion, is it dependent upon nervous influence ? - 51

Seeds of colchicum, Williams on - - - 89

Segala's case of exhalation of blood - 239

Senile rupture of the heart, cases of, &c. - - 412

Serpents, Cloquet on the lachry¬ mal organ of - - 496

Seton successfully applied in a ca^e of pericardiac dropsy - 420 Shop, an Apothecary’s, a good school of medicine - 124

Shoveller's case of injury of the head - - - 6

Society of associated Apotheca¬ ries, annual report from - 4

— , Royal, proceedings of - 65

— , Linnean, officers of - 72

Sores, syphilitic, not always dis¬ tinguishable from others - 477 Solon on chronic pleurisy - 497 Sounding of the urethra - 295

Spasmodic stricture of the urethra, what part does it

implicate ? - 293

Spine, caries ofv with pericar¬ diac dropsy - - 420

• — -, essay on the veins of - 330

— , condition of, in a case of tetanus - - 3

— , Vi a Ik er on affections of the 192 Stillicidium urinie, remarks on 291 Stewart , Professor, his opinions alluded to - - 18

Stomach, perforation of, Bird's case of - - 383

— , case of spontaneous perfora¬ tion of - - - 55

Stricture in the rectum, symp¬ toms of - - 395

Sublimate, corrosive, mode of detecting its admixture with other materials - - 424

Sugar-cane, juice of, an antidote for arsenic - - 522

Suicide, curious case of - 328 Sulphuric acid, cases of poison¬ ing bv - - - 161

Surgical anatomy, new work on - 428

Suigery, principles of, necessary for a Physician - - 394

Sutleffe's medical sketches - 190

Sybilie, the journal for - 10

Sympathy, objection to the term 120

INDEX.

539

Syphilis, on treating it without mercury, Cole on 265

— , Hennen on - - 476

— ? Huf eland on - - 151

Tetanus, Brayne on - 1

Theories, remarks on - 34

Thomson on colchicum - 339

Thompson on premature labour 102 Thorax, wounds of, Larrey on - 245 Thoracic aneurism, Steinruk's case of - - 253

Tibial artery, posterior, ligature of - - - 405

Tobacco, the best mode of de¬ tecting its admixture with lead - 425

Trachea, wound of, case of - 386 Tracheal and bronchial affec¬ tions, Fischer on - - 218

Tubercles, do they not exist oc¬ casionally in muscular and tendinous .tissue - - 196

Turpentine, oil of, its use in

puerperal affections - 464-

Ulceration of the internal sur¬ faces of the intestines - 396 Umbilical chord, case of as¬

phyxia caused by compression of - - - 59

Urea, on - 495

Urethra, Bell on diseases of, re¬ viewed - - - 287

— , Bingham on strictures of, reviewed - - - 219

— , anatomy of 289

— , of the bursting of - 297

Uterus, rupture of, case of - 159 — , ligaments of, thesis on dropsy of - 503

— , deficiency of, case of - 408

Vaccine establishment, national report from - - 517

Vaccination, Hennen' s estimate of its merits - - 473

Variolous eruptions, their ana¬ tomical structure of import¬ ance to attend to - - 207

Vegetables, account of - 49

Venereal disease, treating it without mercury, Cole on - 265 — Hennen on - - 476

Veins and arteries, Hodgson on, reviewed - - 165

— of the spine, how communi¬ cating with others - 330

Veratrine, new alkali, discovery of - 427

Verdigris, artificial mode of de¬ tecting its admixture with other substances - - 424

Vertebrae, fracture of the, Hall's case of - - - 15

— , caries of, Hasson on - 247

Viper, on the poison of the - 522 Vitality, cause of, inscrutable - 493 Voltaic electricity, Ampere on - 524

Walker on spinal affection - 192 Wansbrough's case of pulmo¬ nary disease - - 182

— case of apoplexy - - 455

— case of concussion of the

brain - 460

W arts, case of spontaneous se¬ paration -of - - 523

Water, its habits, &c. - 42

— , Malvern, Philip on the ana¬ lysis of - - 465

Wheezing in bronchitis, how produced - 317

Wine, how to detect adultera¬ tions in - - 423, 509

Young on ligatures of the ca¬ rotids - - - 80

Youth, importance of instruct- ing properly at the time of - 95

Zinc, sulphate of, how to detect its presence in wine - 509

J. MOVES, OREViLLF STRICT, LONDON

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