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Full text of "A dictionary of medicine including general pathology, general therapeutics, hygiene, and the diseases peculiar to women and children"

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BICTIOI^AKY OF MMlClN^ 



nCCLUDINO 



GENERAL PATHOLOGY, GENERAL TMERAPS^^^^^* 
HYGIENB, AND THE DISEASES FECTJT^l^^ 
TO WOMEN AND CHILDREJJ" 



BY YARIOUS WRITERS 



EDITED BT 

EICHAED QUAIN, M.D., F.R.S, 

Aa9 i^TB ninoB omos or thi ^atu, oouioa of pamcuira; mucbkb < 
nn csiTKBiiTT or u»a>oir; laoaxiL. or thb ountAL couxou. or midioiax. i 
xn> SBomsAnoR; ooasuiTnia ra-nioiAH to tbi Hosrau, ros 
suxRnni .urn pnsASis or tbs om>i at BBOxnoH, no. 






NINTH EDITION. 



NEW YORK 
D. APPLBTON AND COMPANY 

1, 8 AHD e BOND BTBE£T 
1885 









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PEEFAGEI. 



Ths tast iruMBER of &cta and obeeiratiozis^ bj which the recent 
progress of scientific and piaotical medicine la^i,s been marked, is dif- 
fusely recorded in the Transactions of learned isocieties, in joumale, in 
monographs, and in systematic treatises. Witt*, progress so rapid, and 
information so diflfused, it is extremely diflScult a.Ixke for the practitioner, 
the teacher, and the student to keep pace. Iti -was the perception of 
this difficulty which induced the Editor, when iia.-v:ited to undertake the 
production of a new Medical Dictionary, to ezn^'^Lee in a task ■wtiich, 
he was fully conscious, must be one of great. Xaibour and of great 
responsibility. He felt, however, that he woxilcj^ be rendering Tisefnl 
service to his profession if he could bring togetli^^ i\^q latest and moet 
complete information in a form which would al-X<2^-m of ready and easy 
reference. Accordingly, he invited the co-oper-^-^jQn of certain of his 
colleagues and professional friends, both in th. j^^^ coiintry and abroad ; 
and evidence of the readiness with which thi.^ invitation has beeu 
accepted, is afforded by the list of contribut:-ca»::^-g. Each contributor 
volunteered or was invited to write on a subj ^^ . -xl wj^jfji, jje -was 
specially familiar. The present work, which i^^ fi,- „ i^ f t-li**® 
combined efforts, may therefore be regarded n^^^-. only as a dictioi^^^^^ ' 
but also as a treatise on systematic medicine, ixa^ -wh' h *h -1 ^& °^ 

the more imp<Htant subjects constitute ™o'*-Oj»7« l • , *:*'1.~>'^*' 
whilst definitions and descriptions of matters -»,„, . . . .__. to 

_x J J _. r.u ■ -bavwg less claH*>- 

extended notice are given as fully as is reqmreci^ fu ■^^'O^ 



has been made to supply, in a clear, condense<3^ __ , ,.. -:Vile 

'*°" readily aco&ts^^^ 
form, all the information that is at present a^ail^bje f <-»> -*^ tb^ 

practitioner of medicine. 

As indicated on the title-page, the work is primaril 
of Medicine, in which the several diseases are fiJlv w* '"^t^^^^^jarf 
alphabetical order. The description of each includes an ^^^^^<^ io 

"^^^ of its 



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ri FBEFACK 

eetiology and anatomical charactei^; its symptoms, course, duration, 
and terminations; its diagnosis, prognosis, and, lastly, its treatment. 
Greneral Pathology comprehends articles on the origin, characters, and 
nature of disease, and the many considerations which these topics 
suggest. General Therapeutics will be found to include articles on the 
several classes of remedies — medicinal or otherwise — which are avaU- 
able for the purpose of treatment ; on the modes of action of such 
remedies ; and on the methods of their use. The articles devoted to 
the subject of Hygiene will be found to treat of the causes of disease, of 
its prevention, of the agencies and laws aSecting public health, of the 
means of preserving the health of the individual, of the construction 
and management of hospitals, and of the nursing the sick. Lastly, 
the diseases peculiar to Women and Children are discussed under their 
respective headings, both in aggregate and in detail. 

It may be well to explain that, although it has been found neces- 
sary to include some notice of diseases which Ml more generally under 
the care of the surgeon, the work does not pretend to be a dictionary 
of Surgery ; and also that, although certain drugs are enumerated in 
discussing subjects of general therapeutics, and of poisons and their 
actions, there has been no intention to invade the domain of Materia 
M»lica. 

It is right to observe that all the articles have been edited and 
revised with great care, so as to ensure a completeness and unity in 
the work, which it is not always possible to obtain in books composed 
by a number of writers. 

The Editor desires also to state that, although the work has occu- 
pied several years in preparation, arrangements were made with the 
printers which have enabled him to revise every article which required 
revision, up to the time of going to press. Further, by the addition of 
an Appendix it has been possible to incorporate the latest contributions 
to medical knowledge. 

Having thus set forth the aims and objects of his undertaking, and 
how far they have been carried out, the Editor has the great satis- 
&ction of offering bis thanks to his friends and colleagues, for the 
valuable assistance which he has received from them. He is fully 
consdons of the trouble wiuch must ntiaH ^'® ^'^^^ necessary in order 



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PBEFACE. 

to condense extended knowledge of a fa.xxxiliu subject witlxixi. **^^ 
linuted space -which the nature of this work co^^ afford. 

The Editor has further the pleasing d«*y of offering hia »it>«<5i^^ 
thanks to Dr. Frederick T. Roberts and to !>«. J. Mitchell. :^:«.tjc;:^ 

who from the first have been his Assistant-editors and fellow-la.l>o-aztr-^^* 
Without the help which they have afforded brm, it would hav^ ^^^ * 
impossible for him to have fulfilled the duties which he undesiK-t,^ *^ 
He is well aware of the time and labour wbich their assistarxcs^ ^ *^« 
involved ; and he appreciates most fully the meurked ability by -wtiji^^ ^^ 
has been characterised. ( 

The Editor cannot conclude without a reference to some of *^-^ 
who were his friends and colleagues when this work was commen^ *^ 
but who have since been taken away by death. He would specjj^ ^, 
mention the names of Edmund Parses, Charles jV^itkchison, GEObT*^ 
Callender, Thomas Bbvill Peacock, John Bose Oo jaMACK, LockBa "^ 
Clarke, Tilbcrt Fox, Thomas Hayden, Harrv X,E-ACa, Alexaw 
Silver. The loss of these eminent men, many o£ them dear ^^ 
valued friends, and all of them ttdcen too soon from, tiejf ^^ . ^cj 
labours, is to him a source of personal sorrow. The ajrtielcg ^^ ^ 
them for these pages were in most instances their last cojitrit. . '^v 
medical literature, and wUl be valued accordingly. °^« (^ 



Lnmox; September 1882. 



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IjIst of illustratotoj^s. 



IB. r*am 

L OMtmoftMWM 71 

1. BWmma ^■1llll^^ll, male and female . 107 

t. BSkanialk mwtatoHa, OTom of, with 
CDntained emlnyo and ftee lanode- 
giannlcs 107 

4. Catdiognai 210 

5. Bcnal easts— Ucod 218 

C „ hyalim . . .' . 213 

T. , efntheUal . . . .213 

8. „ laStj 218 

9. ., gnnular .... 218 

10. „ eneknng crjrBtals, and a 

OBallereast ; also east of seminal tabnle 
wit^ apennatoaoa 218 

U. fUanasBJi^tiut-AoiBM. 2fi2 

U. Sid* -view of the left liamjsphera of the 
monkej, illostrating localiaation of 
tb« eereiinl oenties .... 297 

Uk Side Tieir of the leftbemispheie of man, 
ilfaatratiog localisation <^ the cerebral 
ccotres 297 

14. CftidTtrnM (<■<■) ttBvlitm, nmoTe4 fmn 

tks hnman ejre 823 

la. Qfttietrd in a portion of meaaled pork 828 

UL DUloma conjumctum 40'. 

17. J}rmametihu ■fifiamjii .... 408 

lA. Ftini 11 aamffinm*-h(fmumiM, anterior end of 

the matare 513 

19. niaria tarngximi^^iomiiiu, a portion of the 

maoue, shoiring nterine tnbulea, &e. . 612 

30. Filarim t amfm rn i p-iomhoM, ora and em- 

tarom of 518 

IL Fangotd fiUmenta and espsales flem 

fugiu disease of India . . 522 

g. Fstty dtgU M SsU on of the heart . 594 

Si. FattT growth in the rabstance of the 

ban £07 

2L Hjdatids of foar weelu" growth, showing 

cetocyst and endo(7St . . 664 

C Grosp of Echinoeoeci, with their hook- 

ennms inrerted 664 

2S The so-ealled ' Ecfainococcns head,' show- 
ing hooka, suckers, cilia, and corpuscles 664 



27. Mierooocci, dUU^Bresit tartat et . 

28. Bed bload.eorptis«sIee — homao . 

29. Scaly epithelial cel/s 

80. LeuoocTtes ; pas, m uooos, or irhit 

blood-corpusclea . . . 

81. Ciliated epithelial cells . 

82. Ck)tton fibres, showing ch«r«ct«r 

istio twist . . . 

88. Milk, showing colostram corpnjclM ' 
and oil-globules . . 

84. Particles of vomited matter 

86. Epithelium from urinary tracts 

36. Spermatozoa — ^humas . . 

17. Fragments of hair , , , 

88. Sardna ventrieuU ... . 

89. Hooklets of echinococcos , • 

40. From phthisical sputum, showini^ 

elastic fibres of lung-tiasue and- 
leucocytes .... 

41. Hemin ciystals from old blood-clo^ 

42. Cubes ofc^oride of aodium , 

43. Leucin 

44. Tyrosin ... 

45. Uric acid, Taiious forms . . 

46. Cholesterin plates . . 

47. Cystin 

48. Oxalate of lime: dumb-bells an <S. 

octabedra .... 

49. Triple phosphate of ammonia aaa<^ 

magnesia .... 

50. ToraJa cennmm : yeast fiuigas 

61. Sputum of early pnenmonia 

showing red blood-corpuscl^^^ 
andleneoeytaa . 

62. Shreds of elastic tissue in sputti(w^ 

of phthisis .... ^^^ 

58. OVUum albieaiu ; thrush. 
64. PtniciU\um glmnm . . 
56. Pulse-ttiofr— typical 
66. „ of high tension . 



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LIST OF ILLUSTHATIONS, 



no, PAOi 

67. Pulie-trace— of low tendon . . . 1296 

68. „ bard, frequent, sudden, and 

email pulae . . . 1297 

69. „ hard, alow, gridoal, and 

large pulse . . 1297 

60. „ hard, large, gradual pulae . 1298 

61. „ hard, audden, large, and 

vibratory pulae . 1298 

62. „ aoft, frequent pulse . . 1898 

68. „ aoft, fVeqaent, and large 

pulae .... 1298 

64. „ aoft, small, frequent, and 

sudden pulse . . 1298 

65. „ soft,ftequent,andsmalIpulge 1298 

66. The spleen in anthrax .... 1303 

67. The spleen in anthrax under a high power 1308 

68. Forms of 2><ie><bi« antkraeU . . . 1308 

69. From a cultivation of Bacilltu ttnthnuit, 

after forty-eight hours . . . 1801 

70. BaeUR ttom the fluid exuded fh>ra the 

lung in a case of internal anthrax . 1805 

71. Atcarit lumiricoidet ; male, withexsertcd 

spicules 1379 

72. Awaru mgttax, male and female . 1380 

73. Sderottoma duodaiaU, male and female . 1898 

74.'SphygmogTaphic tracing, shovring ob- 
structed peripheral circulation . . 1452 

75. Sphygmographic tracing, showing easy 

and quicic capillary circulation . . 1462 

76. Sphygmographic tracing, showing hyper- 

dicbrotism 1462 

77. Sphygmographic tracing, showing con- 

traction of muscular c<hU of artery . 1452 

78. Sphrgmographic tracing, showing ri- 

gidity of arterial walla . . . 1462 

79. Sphygmo^aphic tracing of right ladial 

artery m aneurism of the aorta . . 1458 

80. Sphygmographic tracing of left radial 

artery in aneurism of the aorta . . 1458 

81. Sphygmographic tracing in aortic regur- 

^tatiou 1458 

82. Sphygmographic tracing in aortio sten- 

osis 1468 

83. Sphygmographic tracing in mitral regur- 

gitation 1454 

64. Sphygmographic tracing in mitral sten- 

osu 1464 

85. Transverse sections of the normal spinal 

oord 1466 

86. Transverse sections of the spinal cord, 

showing areas of descending degene- 
ration 1461 

87. Transverse sections of the spinal cord, 

showing areas of ascending degene- 
ration 1461 

88. Spirilltm Oiermeieri, amrngst red bloocl- 

corpusdes 1608 

89. Tmxia tckinococetu . . . , . 1585 
90 rjmia neefwcme&to, nnanned head of . 1586 
». Tmma tolitm, timed bad ot , . ^ga* 



no. 

92. Tmnia nudlo e antllala, proglottia of. 

93. TVmia tolnim, proglottia of . . . 

94. Tmnia medhcaneUala, head and several 

segments of 

95. Oxjfurit permiculari; female . 

96. OxyttrU vermiadarit, eggs of. 

97. Tridana firalU, male and female 

98. TncAuio, a single capsuled, in a portion 

of human muscle .... 

99. Triehoctfikalut, male and female . 

100. Tubercle in a lymphatic gland 

101. Fibroma (nenroma) . . to fact 

102. Polypus of nose 

103. Myxoma 

104. Ossifying chondroma . 
106. Enehondroma (of jaw) . 

106. Enehondroma (of orbit) 

107. Myeloid of jaw 

108. Laige round-celled sarcoma 

109. Small round-celled sarcoma 

1 10. Oval-celled sarcoma 

111. Lymphoma . 

112. Small spindle-celled sarcoma 
118. Alveolar sarcoma , 

114. Mixed sarcoma 

115. Melanotic sarcoma 

116. I.arge spindle-celled sarcoma 

117. Papilloma of soft palate 

118. Epithelioma of lip 

119. Edge of rodent ulcer . 

120. Simple polypus of rectum 

121. Columnar epithelioma of intes- 

tine .... 

122. CoUold of breast . 

123. Cancer of liver (scirrho-eneepha- 

loid .... 

124. Encephaloid cancer 
126. Scirrhns infiltrating fat 

126. Cicatrizing cancer 

127. Scirrhua of mamma 

128. Adenoid of upper jaw (benign) . , 

129. Ulcerated adenoid of parotid 

(malignant) . . . , „ 

180. Adenradof breast (common type) . , 

181. Adenoid of breast (epithelial ele- 

ment in excess) . . . , 

182. Adenoid of breast (adeno-sar- 

coma) 

138. Urinary flocculi .... 

134. Vaginal spaenlnm — Cnsoo's bi-valve 

135. n Fergusson's . 

136. » the duck-bill . 
%87. Uterine sound .... 
^88. Uterine probes .... 



Piei 
1585 
1585 

1686 
1621 
1624 
1657 

1667 
165S 
1663 
1671 
1672 
1672 
1672 
1672 
1672 
1672 
1672 
1672 
1672 
1672 
1672 
1672 
1672 
1G72 
1672 
204 
204 
204 
204 

204 
204 

204 
204 
204 
204 
204 
204 

204 

204 

204 

204 
1710 
1777 
1777 
1777 
1778 
1781 



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TjIST of CONTRrBXJTOBS. 



ADAMS, vnUJAM, Soigeon to the Ore&t Morthern Hoapit^l. 

ATTKEIi, wn.T.TAM, MJ)^ FJLS., ProfeMor of Pathology xm the Am,- », 

Ketley. ^*^'»» School, 

ALLBUTT. T. CLIFFORD, ILA., M.D., F.B.a, Senior Pbymoan to tb r 

Tnfirmnry, and Leetarar on Ptactice of Physio, Leeds School of Medid^ ^'^eda O^nemi 

ALLCHIK, W. H., M.B., FJ1.8.E., Physician to, and Lecturer- on FbjsioloirF 

at, the Woetmisster Hospital ; Physician to Uie Victoria Hompital /or Cb^u"^ -^Atlaology 

AKDBEW, JAKES, MJ)., Physician to, and Joint Leetuer on Fbyma at, 8l Tt. 

Hospital; Coosolting Physician to the City of London Hospital fop n^^'^'*^^''^"^" 
Cbeet. •"'»••«•• of the 

BALFOTIR, GEOKQE W., MJ)., F.RS.E., Physician to the Boyal Inflm„„ ^ ^^„. 

■nlting Physician to the Boyal Hospital for Children, EdiubnrgL ^™^. «Ji<i Co» 

BANHAM, O. A^ lata Veterinary Assistant at the Brown Institntion. 

BASSTES. BOBEBT. MJ), Obstetric I>bysiciaii to, and Lecturer on Midwifery an<i "■-*- ^sa*^ 
of Women at. St. Gemge's Hospital t Consnlting Physician to the Roval iw^l— ^^^^^^ 
Charity. '^ .BKm.^m.:m^B>- 

BASHAK, JL CHAIiLTON, M.A, MJ)., FJI.S., Physician to, and Frofeasor c»*- «— litA**^ 
Mediane at, UniTeraity College Hospital ; Professor of Pathological Anatomy ^5" — -^^^"TJqT*^^ 
ColUge ; and Physician to the National Hospital for the Paralysed and EpilootS ^^^J" "^"^ 

BiDMLER, C. G. H., MJ)., Professor of CUuical Medicine, and Director of tla^ -^r^^ti^"^ 
CUnie, Uniyeraity of Fneibnrg in Baden. ^•^•n 

VSCSi, KABCVa, M.B., MA, Assistant Surgeon to, and Assistant Profeeaor «»:^- ^--linicai 

Sa^gery at, Uniyenity CoU««(e HospitaL -^^-.iw^— 

BEDDOE, JOHN, B. A., M. D., F. K. S., late Physidan to the Bristol Royal In«» -»-»-» ^g^-,-— 

SEUaAXY, EDWARD, Surgeon to, and Lecturer on Anatomy at, the f! V.^ , -, -= -»-»■. ru. 
EatptaL --^■'^ Uroas 

BESmET, J. HENBY, HJ> , late Physician-Acconeheur, Boyal Free HoepitaL. 

BENNETT, SIB J. BISDON, UJ)., UJ)., F.B.S., lata President of the Ro.;^^|> ^y_ 

at Pbysidans ; O o nsalt in g Physician to St l^omas's Hospital, and to the Cit;^^ T^^ -r ^%» 
Hospital for IXsaases of the Chest. "^ ^'^ -**'«(«)« 

BEVEBIDOE, BOBEBT, H3., Physician to, and Leetorer on Clinieal Ubdiei—- 

Ahndean Boyal Infirmary. ~-«« a<; fj^ 

BUZ. OABI« MJ)., Professor of Pharmacology in the Uniyenity of Buna. 



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«H UST OF CONTRIBUTORS. 

BIREETT, JOHN, Conralting Snrgeon to On/a Hospital. 

BISHOP, JOHN, H.D., C.H., Assistant Saignn to th« Boyal Inflrmaiy, Edinbaigfa. 

BLAHSFORD, O. F., U.D., Laetunr on Psychological Medicins at SL Oeoigs's Hospital. 

BOWLES, R L., ILP., Fhjrtician to St Andrair's Conralescent Hospital, Folkestone. 

BRI8T0WE, J. SITEB, MJ)., F.R.&, Phyncun to, and Jcnnt Lectnnr on Hedieine at, St, 
Thomas's Hospital. 

BROADBENT, W. H.. HJ)., Physician to, and Lectnrer on HediciiM at, St. Mary's Uflt* 

ptal ; Consulting ^ysician to the London Ferer HospitaL 

BROWN-S^UABD, a £., U.D., LLD., F.B.S., Professor of 3Iediciae, Collige de France. 

BRUCE; J. MITCHELL H.A., H.D., Phyrician to, and Lectnrer on Uateria Mediea and 
Therapeaties at, the Charing Cross Hospital ; Assistant Phyiician to tha Hospital for 
Consumption and Diseases of the Chest, Brompton. 

BRUCE, WILLlAlkl, IVLA., lU)., Physician to the Ross Hemorial Hospital, DingwaU. 

BRUNTON, T. LAUDER, UJ}., D.Sc., F.RJ3., Assistant Physician to, and Lectnrer on 
llataria Hedica and Thaiapentics at, St. Bartholomew's Hos^taL 

BUCHANAN, GEORGE, B.A., IkLD., FJLS., Hedieal Officer, HJH. Local Qoremment 
Board ; Consulting Physician to the London Ferer HospitaL 

BUTLIN, H. T., Assistant Surgeon to, and Demonstrator of Surgenr at, St. Bartholomea-'a 
Hospital; Soigeon to the Metropolitan Free Hospital. 

BUZZARD, THOMAS, MJ)., Physician to the National Hospital for the Paralysed and 
Ejpleptic. 

CADGE, WILLIAM, Surgeon to the Norfolk and Norwich Hospital. 

CALLENDER, The late G. W., FJI&, Soigeon- to, and Leetnzer on Sxagetj at, St Bar- 
tholomew's HospitaL 

CANTLIE, JAMES, MA., M3., CM., Senior Assistant Surgeon to, and Demonstrator of 
Anatomy at, the Charing Cross Hospital. 

CARPENTER, W. B, C3., M.0., LL.D., F.RA 

CARTER, R. BRUDENELL, Ophthalmic Surgeon to, and Lectoier on Ophthalmic Sngery 
at, St. George's HospitaL 

CATIiEY, WILLIAM, M.D., Physician to, and Lectnrer on Msdidns at, ths Middlesex 
Hospital ; Physician to the London Fever HospitaL 

nr.ATtTTR, The late J. LOCEHART, MJ>., F.R.S, Physician to the Hospital for Diseasat 
of the Nerroas System. 

CLARKE, W. FAIRLIE, MjL. MJ)., late Assistant Surgeon to the Charing Cross 
Hospital. 

CLOVER, The late J. T., Leetarar on Anststhelles at UnWeiaity College HospitaL 

COBBOLD, CHARLES a W, MJ)., Senior Assistant Medical OiBcer, Colney Hatch Asylum. 

COBBOLD, T. SPENCER, MJ)., F.R.S., Professor of Botany and Helminthology at the 
Royal Veterinary College. 

COLLIE, ALEXANDER, MJ)., Medical Officer, Ferer Hospital, Homenon. 



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UST OF CONTJEUBnTOBS. xffi 

OOOI'ER, AStETJBt M.B.C.a, late Hoos* BrngBon to the Ma-l ** I-5<* Hospital. 

COBMACK, The late SIR JOHN EOSE. K.B., M.D., FJIS-EI-, ^'hyeician to the Hertibid 
British Hospital, Pazia. 

CDKHINaHAM, D. DOtTGLAS, lU), Surgeon-M^or EM. ::B«D«al Anny. 

CnBIJKG. T. B, FJLS., Oonsalting Snigeon to the London ^ompitaL 

CUBHOW, JOHN, M.D^ Anistant Fhnieian to King's Colltfsgr" Eoapiul; Profe-__. j 
Anatomy at King's Ooaega ; Senior Visiting Physician to tiio Seamen a Hoipitaj,^"'* 

DALBT, W. K, BJL, M^ Annl Surgeon to, and Leetarar on AqikI Saw... ^ „ 
Geoige'sHo-Fital. ^*^ »*. »• 

DATIDSON, ALEXANDEE, M.A, M.D., Physician to the Ftoya.1 Inflnaarr T- 

and Leeturar on Pathology at the Liverpool Medical School. ''' -"^^Kpool. 

DB ZOUCHE; ISAUH, ILD., Honorary Physidau to the Dnoedixx 2Zo*pit^ jf^^ y. 

DOVK, J. LANGDON, UJ)., Phyaieian to, and Lecturer oa dixtieal VkK^-. 

Loodon Hospital. "^ano »t^ th. 

DUNCAN, J. MATTHEWS, M.A, M.D., LLD., F.KJS.K, Phywc»»a-Aoconch«ar fco^ uid 
Lietarer oa HidTifery at, SL BartholomeVa HotpitaL **** **" 

UCEHAM, AETHUE E., Sni^eon to, and Lecturer on Surgery at, Ony'a Boapital. 

BCHEVEKBLL, M. O., HLD^ late Physician-in-Chief to the Hospital /or Epileptics •"^^ 
Paralytics, and to the City Asylnm for the Insane, New York. 

BWABT, JOSEPH, MJ>^ Eetired Depnty SnTgeon-Oenoml, H.Bf. Bengal Annv' . \»*^ 
Piuftisor of Medicine, Principal, and Senior Physician. Oalentta Modieal OoUego. ' 

RWABT, VfTTiTJAM, KA., MJ}., Assistant Phyneian to St. Qeoigo's RospitAl ; lAt« ^ ■— i^tr""* 
Pkjaeian and Pathologist to the Hospital for Consomption and Hiiniiiia of tta.^ CIjbiB*^ 
Bionptoo. 

FAEQUEABSON, EOBEBT, MJ3., U.F., late Phyneian to the Belgra-va Hoa»^,v «-_i for 
Qiildran, and lata Assistant Physician to, and Lecturer on Materia He<li<sa at, f^^_ ^JraTy'* 
Hospital. 

FATEEE, SIB JOSEPH, K.C3.I., MJ), LLC, F.B.8, Honorary PIi:^m'caaQ 
the Qnaea, and to HJI.H. the Prince of Wales; President of the Medical 
Office ; Cnisnlting Physid&n to the Charing Cross Hospital. 

KESWICK. SAMUEL, MJ)., Physician to, and late Lecturer on Medicine at, tXx^ ZM" Aoa 
Hospital ; Assistant Physician to the City of London Hospital for Diseases of t.tx^ ^-^T"" 



FKBETER. DAVID, MJL, MJ), LL.D., F.E.8., Assistant Phymcian to Kin^s Ooli^— :»- w 
vial; Professor of Forensic Medicine at King's College; Physician to tlie ^^^^. "*" 
Hospital for the Paralysed and Epileptic ^tionai 

FIHHEr, J. M., BLA, MJ)., Physician to the City of Dublin Hospital; Kin^^^ 
at the Piaetice of Medicine at the School of Pbyiae in Ireland, and Proftasor < 
Medidne in Sir Patrick Don's HospitaL 

F08TEB, BALTHAZAE W, MJ>, Physician to the General Hospital, and 2*;ra,/- 
of the Piindplss and Practice of Physio at Queen's College, Birmingham. '^tstq. 

FOX, EL liONG, MJ)., ConsnlUog Physician to the Bristol Boyal InfinnaxT-, ^^n* 
Lsetmer on the Principles and Practice of Medidae at the Bristol School of ACedic^ ^'« 

tGX,t. OOLCOTT, BA., M.B., Physician to the St. George's and St. James's I>ia|nQQ 
*«^«»«-» Pbyndsn to the Victoria Hospital for Children. ^^'tt^ . 



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Br LMT OF CONTBIBUTORS. 

FOX, Tha late TILBURY, M.D., FhTaiciaa to the Skin department, Unirertity CoUege 
Hoapitsl. 

GALTON, CAPTAIN DOUGLAS, B^. (retired), O.B., D.Ci., F.E.S. 

GASCOTEN, The late OEOBOE O., Surgeon to tha Lock Hospital ; and Aimetant Snrgcoii 
tOk and Lecturer on Surgery at, St. Mary's Hoipital. 

QEB, SAMUEL, MJ)^ PbyBieian to St. BartholomeVa Hospital, and to the Hospital fat 
Sick Chilean ; Joint-Lecturer on Practice of Physic at St. Bartholomev's Hospital. 

GODLEE; HICKMAN J., B.A., M.B., M.S., Assistant Surgeon to Unirersity College Hos- 
pital ; Demonstrator of Anatomy at Unirersity College ; Assistant Surgeon to the North- 
East Hospital for Children. 

GODSON, CLEMENT, MJ)., Consulting Fhysidan to the City of London Lying-in Hospital ; 
Assistant Physician-Accoucheur to St. Bartholomew's Hospital. 

GOWEBS, W. R., M.D., Assistant Physician to, and Assistant Professor of Clinical Medicine 
at, UniTersity College Hospital ; Physician to the National Hospital for the Paralysed 
and Epileptic. 

GREEN, T. HENRY, M.D., Physician to, and Lecturer on Pathology at, the Charing Cioee 
Hospital ; Assistant Physician to the Hospital for Consumption and Diseases of the Chest, 
Brompton. 

GREENFIELD, W. S., M.D., Professor of General Pathology and Clinical Medicine in the 
Uoirersity of Edinburgh. 

GRQISEAW. T. W., M.A., M.D., Registrar-General for Ireland; Consulting Physician to 
the Fever Hospital, and to Steeven's Hospital, Dublin. 

HAWABD, J. WARRINGTON, Suigeon to St. George's Hos^tal; late AssisUnt Surgeon 
to the Hospital for Sick Children. 

HAYDEN, The late THOMAS, Physician to the Mater Misericordia Hospital, Dublin ; 
Professor of Anatomy and Physiology, Catholic University, Dublin. 

fTEBMAN, G. ERNEST, M.B., Assistant Obstetric Physician to the London Hospital; 
Physician to the Royal Maternity Charity. 

HICKS, J. BRAXTON, M.D., F.B.S., Physician-Accoucheur to, and Lecturer on Midwifaiy 
and Diseases of Women and Children at, Guy's Hospital. 

HILU BERKELEY, M.B., Surgeon to, and Professor of Clinical Surgery at. University 
College Hospital ; Teacher of Practical Surgery at Unireisity College ; Surgeon to the 
Lock HospitaL 

HOLMES, TIMOTHY, M.A., Surgeon to, and Lecturer on Surgery at, St Oeoige's Hospital. 

HORSLEY, V. A. H., B.S., M.B., Assistant to the Professor of Pathological Anatomy, 
Unirersity College ; Surgical Registrar, Unirersity College Hospital. 

HOWARD, BENJAMIN, M.D., late Professor of Medicine, and Leetnrer on Medicine, in 
Uie University of New York. 

HUTCHINSON, JONATHAN, F.Ril., Senior Surgeon to the London Hospital, and to thr 
Hospital for Diseases of the Skin ; Consulting Surgeon to the Royal London Ophthslmie 
Hospital. 



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LIST OF CONTRIBUTORS. »♦ 

TRVniK, The Ute J. PEAHSON, B.A., BJSc, M.D., AMistant Physician to, and lecturer 
OD Fonnne Kedidne at, the Charing Cioia BCoopital ; Fh^sieisn to the Victoria Hospital 
ferCtiildnn. 

JEIWKR, SIR WILLIAM, Bart., KC3.,M.D.. I>.C.I,..LLJ).,F.H.S..Physidan-in-Ordinai7 
toHJL tlia Qneen, and to H.R.H. the Prince of Wales ; President of the Royal Ccllf^e 
«l nijnciaiia; CoDanUting Physician to University College Hospital. 

]0NB3, JOSEPH, M.D., President Board of Health, State of Louisiana, New Orleans 

LATHAM, P. W, A.M., M.D., Physician to Addeubrookes Hospital; Downing ProfesEor 
of UediehM ia tba UnWeisty of Cambridga. 

LEACH, The late HARRY, Medical Officer of Health for the Port of London, and Phy- 
^—-1 to the Seamen's Hospital, Greenvicfau 



LBOa. J..W1CKHAM.M.D.. Assistant Physician to, and Lecturer on Pathological Anatomv 
St, St Baitholomew's Hospital. ^ =.ua.«)oiY 

LEWIS, TDIOTHY, M.D., Surgeon-lLyor, II.M. Army. 

UTTI^ JAMES. M.D.,Phpician to the Adelaide Hospital, DuWin ; Professor of PracUcc 

U^j.^^n^T'"' °''"''^^"" '- ^""''"^' '^•"'^^''« ^^^"-^ ^*" 

"^:^^o?r^n^atth^USl^^°^— °' "^^ ^ -. --^ I-t— ou 
"I^H-oi^'^^''' '^^■' ''•^- '"'^" "•• "^ ^'-»' «» ^'^olofSy «t. the 
'^SS^H^o^'''"^ ''^' ''^'^ «"^° '^ "^ ^-^ o» ««^ at. St. 

"^IS^^^ iu^^' ^' '-^f ^'^ *" ^ '^-''-^ ■>' Hedicin. in .h, 

KACKKKZIB, STEPHEN, MJ)., Physician to, and Lectnier on the Pri«-i-t a t._ 
of Kadicias at, the London Hospital. ™ ^*"'™"*» »• «aciple« and Practice 

MACLFJUf, W. O, C.B., M.D, Inspector-Oena^ of Hospital.. Pw«iv. < «. 
MedJdne in the Army Medical School, Netley. ""piwM, itofewoir of MiUuuy 

B[ACNAM.^RA, CHARLES, Surgeon to the Weatmin-t., Wn..^if.l 

Ophthaln.ic Hoepital; Joint-Lecturer on SurgS^^^Jr^'JP;^!;, «°^ ^^J^^i^U,^ 

MACPHERSON, JOHN, M.A., M.D.. Inspector-Q.„-_.i nt H«-.>!. i „ 

(>.tii«l}; Physician ti the slattish HospUeL ""^ "' Hospital,. H.M. Bengal Armj 

MADDEH, T. MORE. Obstetric Physician to the it^ Mi«,ricordi« Hospital. Dublin. 

XASaOV, PATRICK. HJ)., Amoy. 

M^BWM. W. A. M.B, CM.. Sn^n to th. Sann^ta. Pre. HospitM fbr W<«^ «, 

MEHT05. Th. lata EDWARD, MJ>, Phyrician to th. Hospital for Epilepsy and Paralysis. 

MUIRHEAD, CLAUD. MJ).. Phy«ician to, and Lecturer on n.„j- t « ... • 

Royal lafiimaiy, Edinburgh. °" Clinical Medidno at, the 

mTRCmsOX. The late CHARLES, M.D.. LLJ), p.Rjj Ph-.- • 

tmaar at CBaieal Medidne at, St. Thomas's Hospital : CteMnS ^'^'°'. ?°"* Special Pro- 
Fww Hospital. '-on.niung Phynaan to the London 



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«ri LIST OF COHTEIBUTOBS. 

UYEBS, A. B. B., Snigeon, Coldrtresm OuaTdi. 

KETTT.KamP, EDWARD, Ophthalmic Snneon to St. Thomas's HospiUO, and to tita 
{ Hospital for Sick Children ; Lecturer on O^thalmie Sorgexy at St. Thomas'i HospitsL 

I 

I HiaHTmaALE, Florence. 

OLIVER, OEOBOE, H.D., Eanogata. 

ORD, W. M., H.D., Physician to, and Lectnrer on Medicine at, St. Thomas's Hospital. 

PAGET, SIB JAMES, Bart., D.C.L., LL.D., FJR.S., Seigeant-Suigeon to H.M. the Qnean, 
Surgeon to H.R.H. the Prince of Wales; Consulting Snrgeon to St. BarthoIomsVs 
HoepitaL 

PAREES, The late EDMUND A., H.D., F.RJ3., Professor of Hygiene in the Army Hedkal 
School, Netley. 

PAVY, F. W., M.D., F.R.S., Physician to, and Leetmer on Medicine at, Ony's Hospital. 

PAYNE, J. FRANK, B.A., B.Se., M.D., Senior Assistant Physician to, and Lectnnr on 
General Pathology at, St Thomas's Hospital. 

PEACOCK, The late T. BEVILL, M.D., Honorary Consnlting Phjrsieian to St. Thomas's 
Hospital ; and Consulting Physician to the City of London Hospital for Diseases of the 
Chest. 

FLAYFAIR, W. 8., M.D., Fhysician-Acooocheur to HJ. and R.H. the Docheas of Edinburgh ; 
Physician for Diseases of Women and Children to King's College Hospital, and Con- 
salting Physician to the General Lying-in Hospital ; Professor of Obstetric Medicine 
at King's College. 

POORE, G. VIVIAN, M.D., Assistant Physician to Unirersity College Hospital ; Professor 
of Medical Jurisprudence, Unireisity College. 

POWELL, R. DOUGLAS, MJ>., Physician to the Middlesex Hospital, and to the Hospital 
for Consumption and Diseases of the Chest, Brompton. 

QUAIN, RICHARD, M.D., F.R.S., Consulting Physician to the Hoaiatal for Consnmpdon 
and Diseases of ib» Chest, Brompton. 

RADCIJFFE, J. NETTEN, Assistant Medical Offloer, Local Government Board. 

REDWOOD, THEOPHILUS, Ph.D^ Professor of Chemistry and Pharmacy, Pharmaceutical 
Society of Great Britain. 



ROBERTS, FREDERICK T., M.D., BSc, Physician to, and Professor of Clinical Medi- 
cine at. University College Hospital ; Professor of Materia Medica at University College 
Physician to the Hospital for Consumption and Diseases of the Chest, Brompton. 



ROBERTS, WILLIAM, B.A., M.D., F.R.S., Physician to the Manchester Royal Infirmary ; 
Professor of Clinical Medicine, Owens College School of Medicine. 

ROSE, WILLIAM, BS., M.B., Assistant Surgeon to King's College Hospital ; Surgeon to 
the Royal Free HospitaL 

ROY, C. 8., MJ}., Professor Superintendent of the Broirn Institntion, London. 

RUSSELL, JAMES A., K,A., M.B., C.U., Inspector of Anatomy for Scotland,- Lecturer on 
Sanitation, Watt's Institntion, Edinbuigh. 

SALTER, S. /, M3., F.BJ3, FXS^ Late 1) .. J Surgeon to Guy's Hospital. 
SAXaaTEB, ALFRED. B.A., MB.. Pbm^. Diseases of the Skin to, and Leetant on 



V 



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UST OP CONTEIBUXO^I*^ 

SADHDBY, K, MJ>^ AjMutant Phymdan to the Generai .^capital, Kmaaglum. 

8KAI0H. Th» late EDWABD C, MJ)^ Medical OfBeer, X-*»<»1 Gownment Board. 

8HAITKR, THOMAS. MJO., UuD^ Oon»nltiiig PhyTBi«s»»« *« the Dsron «"»^ 
HoiiritaL 

BJBBAXD, JOHN. JLD., F.E5.E., CommiMioner in Lnnacjr for Scotland. 

SILVER, The lata ALEXAHDEB, ILA., MJ), PhyridM to, *«1 I^ctawr on H»1e, 
at, the CharinK Cnm Hoipital. 

amOH. JOHN. <XB., D.Ci^ UJ)., FJU3., Coo»ulting aurgtton to St. nomaa'a tt. 
lata Medical Officer to Her M^'eaty's Privy Council, and to tbo local GoTemmon*. 

aiMP80K,AI.EXAKDER R, M.D., Phymcian to the UniTenritv- Clinical Waid for^>** ^_^ 
of Women. Boyal Inflrmaiy, Edinburgh ; Pwfeesor of MidwlfeiT »nd !>«•«»•«• <» ^^^**«k^ 
■ad OiildTen in the TTniTenity of Edinbnigh. ^^~ 

SMITH. EDBTAOE, MJ).. Physician to H Jt the King of the Belgian" ; Phyticiaa to . 
CSty of London Hoapital for Dinnaes of the Chest, and to the JEIajst Jbondon H(Mpit«| ^^ 
ChUdnm. ^^ 

SMITH, W. JOHNSON, Soigeon to the Seamen's Hospital, Oroenwicli. 




80UTHET, BOBKRT. M.D., Physician to, and Lecturer on Forensic JJifedicine and Hrffi 
at, St Bartholomeir's Hospital. *tt« 

SFABES, The late ESWAIU) I., M.A., M.B., Physician for Diseases of the gy- 

^''"""g CroM Hoapital, and Physician to the Boyal Infirmoiy fox- Womej, ^^ pP.,^ tj)^ 

SQUIBE; WZLLLOf, MJ)., Physician to the North London Hospital for 2); 



Oiest, and to St. Geoige'i Dispensary. ""^^es of ^ 

ETTEVEKSON, THOMAS, MJ)., Lecturer on Chemietiy and Medical Junern,^ . 

He^pital ; Analyst to SL Pancrsa, jus. ^"eilCe at Qq^ 

8IBWAST, T. 6BAINOER, MJ)., FJI.S.E.. Ordinary Physidan to Hjf ., 

Scotland; Professor of Praetioe of Physic in the Uniyenity of £dinbutfri,| Qoeen ■ 

8TBBATFEILD, J. P., Surgeon to the Boyal London Ophthalmic Hospit.) 

of <ninical Ophthalmic Snigeiy at, and Ophthalmic Soigeon to. Vaiv«i! ^^fesan 

TBIN, GEOBGE. MJ)., London. 

THOMPSON, E SYMEH. M.D., Physician to the Hospital for Consumption ..h 

of the Chest, Biompton. ^^ ^■eaaes 

THOMPSON, SIB HENBY, Soigeon Extraordinary to H.M. the King of the S.i ■ 
Con swh ingSnigson to Unirenity College Hospital ; Emeritus Professor of Olini<.^^'°' ; 
atVaiTsnityCollegeu ^"'*' Surgery 

THOBNTON, W. PUGIN, Surgeon to the St. Marylebone General Dispensary. 

THOBOWGOOD, J. C, MJ), Physician to the (Sty of London Hospital for Diseases of »», 
Cbes^ and to the West London Hospital ; Lectnier on Materia Medica at the HidmsM* 

TUKE, J. BATT7. M.D., F.B.S.E, formerly Lecturer on Mental Diseases at th. «_ . 
OoUsge of Surgeons, Edinburgh. ^ ^V*" 

W Al i K KK, T. J, M J), Smgeon to the Peterborough Infiimaiy and Dispensary. 




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sriU UBT Of CONTBIBITTOBS. 

WAKD, The late STEPHEN H^ M.I>., Consnltiog Fh:rRician to the Seamen's Uoepital, 
Oreenwich ; and Fhysieian to the City of London Hospital for Diseases of the Chest 

WASDELL, J. B., H.D., Consulting Physician to the Tanbridge Wells loflnnary. 

WATEBS, A. T. H„ M.D., Physician to the Royal Infirmary, Liverpool; Lectai«r on 
Principles and Practice of Medicine at the Liverpool School of Medicine. 

WEBER, HERMANK, M.D., Physician to the Oerman Hospital. 

WELLS, T. SPEKCER, President of the Royal College of Snrgeons ; Snigeon to the Qncwi's 
Household ; Consulting Surgeon to the Samaritan Hospital fct* Women and Children. 

WILLIAMS, C. THEODORE, M.A., M.D., Riysician to the Hoapitel for Consumption ami 
Diseases of the Chest, Brompton. 

WILSON, SIR ERASMUS, LL.D., F.R.S., late President of the Boyal College of Surgeons; 
Professor of Dermatology, Royal College of Snigeona. 

WILTSHIRE, ALFRED, M.D., Fhysicinn-Accouchenr to, and Joint Lecturer on Obstetrio 
Medicine at, SL Jtfiuy's Huopital ; Physician for Diseases of Women to tiie West Loudou 
HodiBtal, 

WOOD, JOHN, F. K. S., Surgeon to King's College Hospital, and Professor of Clinical Sur- 
gery at King's College. 



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A 



DICTION AEY OF 3VIEDI0INE. 



ABSOICnr, SlaaMM of th*. — Belbre 
npoD the gtaij of the peitieDUr 
I 'which an liable to be met vitb in oon- 

I with eadi of the prindpBl n^oni of the 

bodj. it ii expedient to ngard them tnm ft ge- 
nenl point of liev, aa inch a conne heipe mste- 
tiklly in clearing the iray for their clinical 
iiiwetigiitiiMi Thii general enrre; is paiticnlarly 
adTBBUgeoiu io the eaae of abdominal diaeaaes, 
erUdi aie neeeaarily veiy nsmeioos and Taried, 
holh aa regards the atroetnn affected and the na- 
tanofthanoibid change thejpreaent; they are 
eonaeqaantiy diiBenlt to reeogniie with certainty 
ia aiaiiy inatanrfa, and are oecaaionally inTolrad 
ia maeh obaeoiity. 

Eadading a few peculiar affection*, the dis- 
eaaea of t!>a abdomen may be arranged onder the 
foUoaing gnta^ : — 

L Diaeana cf the anterior abdominal walls. 

IL Diaeaaea of the peritoneum and its folds. 

Zn. Diaeaaes of the organs contained within 
the ahdnaiaal earity, muaely : — 1, Stomach and 
latertinaa; S, Hi{iatic organs, indndiDgtheliTer, 
gall-Uadder, and gall-dnets; S, Spleen; 4, Fan- 
enas; 5, San-rnal capmles ; 6, Urii^ry appa- 
rataa, riz^ the kidneys ud their dnets, and the 
Hadder; 7, Female gaoeiatire oi^gans, including 
the Btana and ita hmtd ligament, the Fallopian 
tabta, and the oraiiea ; 8, Abaorbsnt ^ands. 

IT. Diaeaaea of the abdominal ressels, espe- 
rially the aorta and the iliac aiterie*. 

T. Diaeaaes <rf the sympathetic or other nerrea 
contained within the abdinnen. 

TL DisfasBS orig|inatuig in cooaezion with the 
cellalai tiaaae, aueh aa in&mmation or absoaas. 

Tn. Di a e a a ea springing &om the posterior 
boaadaiyof thaabaomeD; from the pelris or the 
absetaica lining it; or from the diaphragm, 
aad inrading the abdominal cavity. 

Vm. DiiMsis aneroaehiog npon the abdomen 
i«lber partly eapeoally from the thorax. 

It Boat be borae in mind that the groups of 
issaaaa abo*»-mentiaoed may be preaented in Ta- 
nbinationa, two or more stmctores being 
V implicated at the aama time. 

The spec ia l nature and mode of origin of the 
I tea CBaiaMriaed will be discussed under 



■••• h««dii^ bnt a few gwoei^ 



their aj^nopi ___ 

of common oec^^^ y-odUtan* are ^ 
rery serioun SS^^^^f^ ^^'^ ^'^ ^ 
oonteined witS^'tgf^ ,S«>«" "^ «>• MgilJ 

natation,, tieShST^'.,. *• «" « to 
ac<imr«l; while"^ &."^'» «ng«d5i ~ 
Mat of «*f«««r'o,~7'!^ r^y h^Z 

DS KM « 



cbnically impartaat. 

Abdominal leaions are <v„ 
in their orifrin, !>„* ^ ^'3""'*IyiiBi«i» . 

local manifXtio^^V^r' '^ *^^^^l 
being MtheraaaociatedJSr «""«'^ «>Sf«£ti^" 

tationaIeaehez&. »»chvf!i^»"h«»ne ooaSi 
toma eonnacted with th? J^'' ^igain. ^^- 



tutionaleaehezLt. macb^'Z^'^'^* ooaSi 
toma eonnacted with th? J^'' ^igain. ^^- 
upon disease in sonao iWl^°"° ""V a2^a 
someof itsorgan. ^, C^f ^ «' th.'bodjT^ 
changes as » conaoqueocTrf ^? **" o^ n»orb3 
Btrocturea. For iDitin«%J^j»4»««e in ^„ 

aasociated with cerebral diioiA^"*,'" **~iaent]T 
of the heart ai. liable to W?'r^"'"**~««»' 
symptoma, aa well aa to aeW^ , ••«>i»l>lenon>« 
nezion with many of thT^ S ^«"»°n" in oqb- 
LasaT. a morbid conditS, „r^°='«'*l ^iMeia. 
the abdomen maybe the dir.^ °°* '"«*'» withia 
ing Hoondary mischief uToSe/SU^"!"' originat- 

nation of cases in which th. j;"*g"»cal ezami. 
the abdomen aa the eeat „7^?'°S" JP°*"* •• 
always be conducUd w^ ~ J!" , ** *onM 
thoroughness, as well aa in«^'*"^. «»« and 
othennse serious mistake- A!rt?*I"',^*"»M'. 
It ia ahK> yery deorable to T^J^J^^ ^ ""^ 
ilmu eooclualon as to the^at^f?!?*"* "f ?«■ 
haatUyor on insufficient ^tl k„/ ">? ~"pWnt 
and oLrre.the ^nrj. of':,*^i''»^~*« "^^t 
caae. lepeaUng the .»Te,tigatio.,''i;;,';S t^Tto 



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ASDOJtES, DISEASES OF THE. 



time, when any obscurity which mar exiit will 
otlen be cleared away. The past and family hii- 
toiy of the patient, with the course and progrees 
of the symptoms, are often of material assistance 
in diagnosis, and demand due attention in evenr 
instance. The chief clinical phenomena which 
may be associated with abdominal affections, and 
with reference to which it is requisite to inquire, 
may be thus indicated. First, there are usually 
symptoms directly connected with the strueture 
implicated, such as pain and other morbid «en- 
■abons, disorders of seeretoiT or other funcUons, 
or weited action. Seoondly, WTaral of the 
organs ninttiaUy afibct each othtr, eitlier fitom 
being anatomically or physiologically related, or 
from a morbid condition of one part causing 
pteonre upon or iiritation of some neighbouring 
Btracture. In this way numerous symptoms are 
liable to arise, sometimes in remote parts, and 
often of material significance. Thirdly, sympi- 
thetic or reflex phenomena in connexion with 
otgans in other regions ofthsbody are frequently 
excited by many abdominal disorders, such aa 
paljntation of the heart, convulsions, and other 
nerroaa diaturbances. Fourthly, the general 
ayatam often suffers seriously, and in Tariona 
ways. For instance, pyrexia may be exated ; the 
blood mar become impoverished or impregnated 
with noxious materials ; or mora or leas general 
wasting and dability may be induced. Where an 
abdominal diieaae is but a local manifestatioa of 
some constitution^ condition, it commonly ag- 
gravatea materially the general symptoma; wfaUe 
ID connexion with lesions of certain of the ab- 
dominal viscera theae general symptoms eonsti- 
thte in many eases the most prominent clinical 
featarea. FifUily, morbid conditions within the 
abdomen not an&eqnently interfere directly with 
the diaphragm and the thoracic organs; ocea- 
■ioDoUy also tbev invade upon the chest, or 
actually make their way into Uiis cavity through 
the diaphragm. In rare iastaaoes morbid pro- 
ducts, such as pus, may find their way to distant 
porta of the body. In these different wayi a 
variety of symptoms may be caused, sometimes 
of a carious natnre and difficult to explain. 
Lastly, abdominal diseases are frequently at- 
tended with abnormal physical or objective 
signs, which are revealed on physiool examina- 
tion, and these are of such importance that they 
demand separate oonsidaration. 

PlTsicua ExAmwATiDir. — The neglect of 
submitting patients to a satisfactory pbyrieal 
examination is a frequent source ot error in 
diagnosis in cases of abdominal disease, and 
there ought to be no hesitation or delay in 
resorting to this method of clinical investigation 
whenever it seems oalled for. The precise 
course to be punned must vary according to cir- 
cumstances, but the fbllowing outline will serve to 
indicate the plan of procedure ordinarily required. 

First, there are certain modes of examination 
which are allied to the abdomen eztainally, 
indnding Tn»ptetion; PalpaHom or JUSm^paio- 
Hon; Mtiuuratie* or iftt*mrtm*iU; Pavtution ; 
•nd AuieuUalum (tee FHrsicAi. EzaiairA- 
Tiok). Of theses inspection, palpation, and 
percussion are by tax the most important, and 
cave, in the large m^rity of oases, to be nlied 
■pon ton the infixnnstion required. In «(. 



eeptional instances Suecuuion or shaking )he 
patient proves serviceable, by bringing out cer- 
tain sensationa or sounds. In order to cany 
out these methods properiy, it is necessary to 
expose the abdomen sufficiently, due regaid 
being paid to decency in the examination of 
fem^ss ; to place the patient in a suitable posi> 
tion ; and to see that the muscles of the abdo- 
: minal walls are duly relaxed. The best posi- 
tion usually is for the patient to lie on the 
back, in a half-ieclining attitude, with the head 
and shoulders well raised, and the thighs and 
knees mora or less flexed. This posture serves 
to relax the abdominal musses, whidi nay be 
further aided by taking off the patientTs atten- 
tion by conversation or in other ways, as well as 
by directing him to breaths deeply. The posi- 
tioo, however, has often to be varied in the 
investigation of particular cases, and much 
information is frequently gained by noticing the 
effects of altering the posture. 

The objective conditions which may be revealed 
by the modes of examination thus far con- 
sidered are as follows: — I. The state of the 
snperfldal structures. 2. Th» sixe and shape of 
the abdomen, generally and locallv, as indi- 
cating an alteration in the volume of the oidinaiy 
contents of the abdomen, or the presence of 
some new or f^h element, sneh as dropsieal 
fluid or a tumour. 3. The ehoraeten « the 
abdominal respiratory movements ; and the pre- 
sence of any unusual sensations during the 
act of breathing, sneh as frkstion-fremitas. 4. 
The sensations experienced on palpatioa and 
perenasion over the abdomen, either as a whole, 
or in any particular part of it, such as its 
mobility, degree of resistance, regularity, con- 
sistence, &c. ; as well as the presence of cer- 
tain peculiar sensations, e^g., fluctuation, or 
hydatid-f^vmitns. 6. The presence and cha- 
racters of any pulsation. 6. The ooenrrenoe of 
abnomal movements within the abdomen, as 
those of a f<etU8. 7. The sounds elicited, gene- 
rally and locally, on pereusioa. 8. The pre- 
sence of certain soniMU within the abdomen, 
heard on auscultation, such as friction-sonnds ; 
mummra connected with aneurism or due to 
pressure on an artery ; or murmurs and sonnds 
asaodated with the pregnant ntamo. 

Secondly, it not uncommonly happens t^at 
special moles of examination have to be applied 
to particular organs within the abdomen, in 
order to arrive at a diagnosis with any cer- 
tainty. And here it may be remarked that it is 
highly important in all cases to see that no 
accumulation of fteces exists within the bowels, 
and that the bladder is properiy emptied, other- 
wise very serious mistakes are Uable to be mads. 
Purgatives and enemata an needed in order to 
remove any fiscal collection. The urine should 
also be piopeily tested in every instance ; and 
much information may often be gained in the in- 
vestigation of affections of the alimentary canal, 
ttom a fwrsonal inspection or more completa 
examination of faces or vomited matters. The 
abdominal otgans to which special mods* of 
examination an chiefly applicable are the 
female generativa organs, which ars invesdntad 
|)ervaginam(sesWoKB, Diseases of); the blidder, 
by means of the catheter, the soimd, and other 



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ABDOUEU, DISKA.S£S O^ THK. 
ar^iuboDtDti; the atomach. "by tbenaeof 
tba (toaadi-piua^ ptDbaog. &c. ; atnd the in- 
teatiiei, b^Biiusiiig'witJi Uia finger, hand, or 
nngial iutrmeDU per Fectam, ox* by injecting 
nteiHuithnugkthe anus into the boirel*. 
The oriioujuoiiM of examination already men- 
''^aadBujtlMuactaBoe ^rhen employed along 
with HMof tlwipaeial metboda jnst indicated. 
^ H itdl;, oearionaUy it is roqnisita to hare 
■"uwaueueptional modes of in-veetigtation, 
■"di u tie IH rf Um exploring trockar or upi- 
"■tor; tt to tiM adminiatra^on of chloroform. 
The Itttit ntj iSbrd direefc inlbrmaticm in 
«(taii ildaniul eonditiona, and it may alro 
^''"•Ujuiiit ia caizying crab otixar methodi 

"•iiiiiiiaoii. 

Tin ilmiBil oonditiona diaeoT<a«able by 
fih^iBal mmiintinp may involYV the eatii* 
"*»•■. giri^ iiM, for itaMtamee, to general 
??"f°SBM>t « ntrsiction^ om tbmy uay be 
^**^ •» "oe partieiilar xegion, «.^., enlirged 
^^^^>>Kni,orabaeeaaes. Xhia pait of the 
Shlj Im i^ Btifieially divided by anatomiati 
'y^^i^f"*! "i the aeat of auiy local morbid 
]S"™<" <u iJiu bs deSoed and deacribed. 
r~"''f""<pMliar to the ae-reral xegiona irill 
oacDiaiiJaijgij^^^;^ mijiuilian headinga. 

FumanmacK. T. Boanm. 

j*?'"'«nrAI. AirasmtlSlC include* 

^5^*rffh« lorta, and of any of ita branches 

^•wiirfoBen. 

(^^rf^af tha AbdoxnJzaail .A-orteii ewen- 

ed^''*iu>(/ middle ase. Of fifty-nine caaei 

'iZ*,^ Dr. Cxisp, tJiixty-throo were under 

<^ ;. "iatT. It m nsora caannM>n in the male 

> J' tt. /a 



''», 



"^g ut jMnaia aouc in. bhe proportion of 
'?*iL^i; and i» nsnally tzaceable to rtiain, or 
J^ 4* upon the abdomen or back. Theaneu- 
;i:V.^<Wfi«qaentJy locaatod in that portion 
"We! iaelnded betweca *!»« aortic open- 
(ie diaphiasm and the origin of the 
meKBfeiie artery. I» thia aituation the 



«»X^ ^^J aaated ; lia.i>loto tanoon from 
4^ V^ of ti/2Liph™«in ; and l.feely to in^olre 

\ of diafrooeia ; «»1 *^» freqnenqr of 
,~ vKpamin^tho borft firom eroeion of the 

H^^}^ of the at.««~" 
i;|L%?^Tariety ; and, »■ 
vVVitiileas o«bo«» » 

«J^1 



SB argent, 
uaual^ of 



^>. 



less 
rft£raGi-Si^,^^2^^^fcjt^, 

^aociated with axtensiTe 
_._ —-.J -erith fatty or other 



axe alao fever, 

S rfT*. *?* "MC^-STaro no*, howerer, neeei- 
V^taoViiida. %*f*^"ii«al form the pain of 
^««oat«d. I» ^j;^:S»UyiM«iialgiiTiti« 

^2*MlaaannaBa aa u^ , «idiatin»th«nirfi 

^Mttntaad 



_, — mdiatiiig throng^ 

__^ »nd beae of the thorax, 
Into eltber groin or testitaa. 
~ wanaUyattribatdae 



ABDOMIITAL ANEUBISM. * 

to aome definite eaase of nseoUurazeiteBMnt. Tha 
dozation extend) orar a period Taiying from «»• 
to three hoiuii, rarely longer; and thaceHation ia 
equally abmpt, leaving ^e patient in a atata of 
exhauatioD, but quite free from aetaal ■nffarin^ 
The aecond kind of pain referred to is contiaaoua 
and boring; fixed at a particular point of tb» 
vertebral column ; aggravated by presioreattltw 
point, by active movemeat or itampii^, and ^ 
gently turning the patient half loand apoa bis 
axia in the standing poeture ; bat xeliarad ^7 
anti-reeambancy or leanii^ forward. Fadn •» 
coaraeteriaed is pathognomonie of erosien of tlM 
^^i^brae. Pleasure c^ an anenriara Tas,y affect 
tlie functions of several organs Tithin the abdo- 
men. Thus jamdici may lewilt tam pi«aauM 
npon the hepatic or common Uliaiy daet :^ it is, 
however, mors ireqasntly dne to an anauriam of 
the hepatic or of Uie superior mesenteric w^rXmtf, 
Inter/erau* vith tMt vrimuy leontion, and the 
conaequences thereof, from pressure upon the 
renal vessels; dytpkagia from pressure upoo 
the oaaophagug; tonu<»^ from obstenction of the 
pylorus; displaoemmt of the livar forvarda, or 
of the heart upwards — though rare aymptoma 
— loay be likewise dne to the same caaae. Tha 
radial poise is not often afifected. Symptoma of 
"'"•^ituMmaJ irritation and impaired antrition 
*>]e rarely exhilnted, and appear only «t the tsr> 
uination of protracted and painful oasea, a«o> 
■*^ated with great snfferiae and want of sLeep. 

7he pkgtieal li^ are Uiose disoovaiable by 
Palpation, percussion, and auscoltatioo. Dta 
tunioar usually projects to the left of the aasial 
line, and tends to descend; it ia smooth and 
"^Aatie; communicating to the band alternate 
Biovemeots of lifting and expansion with inersas- 
}PK tension, and of subsidence with i«lsxatiaii. 
-the pulsation is all but invwiably sin^e, and 
■Yndoonoua with the radial pulse ; it kJuJ^ 
*^ t_ho tumour, and occasionally a«x»niBBaied^ ' 
thrill. Pressure upon the aorta below tlietumo 
■•ill increase the foroe of impB]se^ dimiiiS.fc "* 
»boli,h the thrill, and arrest ttreolliMri * 
*«'*■ recorded examples the tumour was hLi 5 
Pa^-ven on the sorbcc, and non-expans^ ^ 
^n * still smaller number no pulsation wL' 
'^•ptible, the aperture of commniucatiat ZJTi.'^ 
•*t«a7 having been block*!, or thev^* ^» 
J^eased on the pnizimal side by the «o«?"; 
J^« aneurism itself. Owing to the JS^ 'i 
\^ hoUow viscera in fr^ft. and tir^'"" "^ 
^»^b.rmnscles iKihind, the •videnc.^'^^ 
«o» IS less eondosivs U regard to ijb£^?^ 
«>«» thoncie aneurism. Shwever^?""^ 
^inal mi^cles be relkx^; ZdZ ^± 
^ bowels free from flatus^ absolutedMU "* 

SunS*'^'",''' the tumormay be defiS" !? 
•»und. single or double, as distinirtdrf^, ^ 

war's "•"?'' ^-^ i» fi«S? h^^„ ^ 

r,»th abdominal aneurism; whareiSf^?*""" 
tf sound without munwi and!!*r,**»'«"» 

cotrBBponding to the tumour i. .C^ •Women 
S!!L"»«ectel is of the u^ di± "'•• •»». 
f^MUt in the recnmber^B^^'^"'^'* 
•fc^itinfcout; it iSe bSS*^ ".»^7 



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fetwit points of the tumonr ; in m» iniitaDcs it 
WM of a buoing qnalit^. Shoald the anau- 
liim lure taken an rxcluuTely backward conne, 
which is the oxception, a single mnnnnr, not 
audible in front, may be heard in the back. In 
a fe\r recorded cases a donble murmur has been 
heard oyer the ansoriam in front. In the er«ct 
posture the murmur is usnally suspended ; but 
in a few published cases it was audible in both 
the erect and the recumbent posture, and in one 
atleastinthserectpostnreonly. These peculiari- 
ties depend upon the various conditions of the sac, 
its orifice, and its contents. A small anennsm 
engagine the posterior wall of the vessel only, 
and eroding the rertebne, nay be latent as lo 
physical sigtis, though attended with severe 
fixed pain in the back. 

DuoNosis. — ^Tbe diagnosis of abdominal anen- 
rimn has reference mainly to its physical signs. 
Strong pulsation of the aorta, slmalating tiiat 
of aneurism, may exist in connexion with hys- 
teria, uterine or intestinal irritation, dyspep- 
sia, or copious htemorrhage. But in all these 
cases, irrespeetivelT of the positive and specific 
evidence presented by each, throbbing exists 
thronghoat the aorta, and is propagated into the 
main artaries of the lower Irmbs, whereas it is 
localised in aneurism ; and a careful exploration 
ot tia aorta, if necessary nader the influence of 
ehlorofarm, will show that ita dimensiona are 
at all points normal. In these eases, too, 
although a murmnr may be produced by strong 
pressure with the stethoscope, it does not exist 
when pressure is withdrawn. A cancerous or 
other tumonr pressing npon the aorta may like- 
wise produce murmur, and may exhibit pulsation 
communicated from the aorta ; but in most cases 
both these phenomena are promptly arrested by 
placing the body in the prone position ; the 
tnmoar, in that position, ^vitating from the 
vessel. The fixed local pain in the back, aggra- 
vated by pressure and motion, may be simulated 
by Spinal rfaetunatism ; and the paroxysmal vis- 
ceral pain by biliaiy colic. The differential 
diagnosis must rest npon the spedfle evidence 
in each case, and npon the absence of the signs 
of aneurism. 

Aneurism of the Branobes of the Ab- 
dominal Aorta. — The branchra most liable 
to anenrism are the common iliacs and their 
divisions; the cceliac axis and its branches; 
the renal and the superior mesenteric. AneuHtm 
<lf tke lUao Arteriu belongs to the domain of sai^ 
gery, and will not be further referred to here. 
Amenrim of tie Caliae Axil and of its branches of 
division, and of the Snptrior Metenterio Artery, 
■re, in addition to the ordinary signs, equally 
ehaiaeteriied by mobility; and the first two 
varieties bj javndieet hsmatemests, and roelcena, 
fh>m pressure. Beoisl aneurism may cause ob- 
struction in the kidney or renal colic by pressore 
on the stmctures in the hilns. 

Ddsatidx and Tanmurroirs. — The duration 
of )iit> in esses of abdom/nal sDscrism has, jg 
the writer's axperieoee, rarrod from fifteen day^ to 
olevea years. De»th axitni '^ — ,f_yi\i — '^ 



elermmuni. Dettb ocean VaatUy (1) ^7 miT 
tnw o/tbe sac into (t) th^ MOO-peritot,^. 






ABDOMINAL AKEUBISM. 

pelvis of the kidney ; (A) the spinal canal ; oi 
(<) the ureter, biliary passages, or otsophagns ; 
and in the order of relative frequency just given ; 
or (2) by exhaustion or syncope. The duiatina 
of life after the rupture of the anenrism hai 
ranged from a few minutes to several weeks. A 
consecutive false anenrism of the retio-perito- 
neum is specially characterised by feeble pulsa- 
tion of the tumour, and diminiahed or arrested cir- 
culation in the femoral artery of one or both sidsa. 
TaaaTiaaiT. — The Ouraiive treatment of abdo- 
minal aneurism may be considered nnder three 
heads — Mfckeaiieal, Poftural and Bietetie, and 
Medicinal. Mechanical treatment consists ig 
pressure applied to the aorta on theproximal side 
of the sac, or simultaneonsly on its proximal and 
distal aidea, by means of tonmiqaets, so aa com- 
pletely to stop the circulation. The bowels should 
be fint well moved and fireed £ram flatus ; and 
during the coatinaaaca of pressure the patient 
should be kept nnder the influence of chlaroform 
or ether, five eases, if not more, in which a curs 
was efibcted by these means have been reported. 
The oly'ect sought to be attained being that of 
effecting rapid coagulation in the sac, the period 
during which preesum needs to be continued in 
these oases varies from three quarters of an hour 
to ten honia and a half. Where space for the 
application of proximal pressure does not exist, 
distal pressure aloue may be tried. Under all 
circumstances, pressure must be used with cir- 
cumspection, as inflammation of the peritoneum 
or of the bowels may result from it. 

Belhngham introduced the plan of treatment 
by posture and restricted diet. Under this plan 
perfect repose of mind and body is, as for aa 
practicable, to be maintained ; the bowels being 
kept modemtely free, and the dietary restricted 
to 10 OS. of solids and 6 oz. of liquids daily. 
According to the method of Mr. Tufnell, which 
is based upon the same principle, but is mora 
rigid, the patient is strictly confined to the 
horizontal posture for a period varying from 
eight to thirteen weeks, aa determined by the 
emxt upon the aneurism, morement in bed 
being efrected with caution ; whilst, by a special 
arrangement, the bowels and the bladder may 
be evacuated without disturbance of the body. 
For breakfast, 2 oz. of while bread and butter, 
with 3 oz, of cocoa or milk, are allowed; for 
dinner, 3 oz. of meat, with 3 oz. of potatoes 
or bread, and 4 oz. of water or claret ; and for 
rapper, 2 oz. of bread and butter, and 2 oc 
of milk or tea. The total amount in the twenty- 
four hours would be, solids 1 oz., liquids 8 oz. 
This system mig^t be in some degree relaxed 
if the patient prove restive. MUd laxatives 
and opiates aa required are the only medicines 
used. Ten caaea of the suoeessfbl treatment of 
aortic anenrism by this method have been re- 
ported by Mr. Tufhell. Abdominal aneurism 
«aa aolidified in two inatanoes, after treatment 
extending over thirtj-aeven and twenty-one daya 
,e»pectively. 

Of the varioua medicinal oganta naed with n 

•0iw to favouring or eflbcting a deposit of 

^ filiated fibrin in the aao, acetate of lead. 



ht ' / i^!jida of potassium, aeonite, and eigotia (hypo- 
"■- ' /3<^icsKy), stane dum attention. Iodide of 



'''•^^>; O) M y^^^ -»7 be given with advantsg. in doaea 



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ABDOJEdAX. Alf EIJBISH. 
■f 10 to 20 gn. tlinca dailr, vith a rieir to 
ndndiiK rueulu tcosioD, and tliaraby rolieTing 
pain md promotiiig deposition in the sac, wUl^ 
pcriact zest in tke reenmbeat poatnrs and a n- 
■Ineted dietaiy azs obaerred. The latter are, 
komrer, the more important facton in the 
tocatmenti. Dr. 6. W. Balfonr has reported 
metaX caaea aaeeeaafullj treated by means of 
iodids of potaasiiun ; and recently an example 
tt a dmiliBr kind has been published by Dr. 
Dyes DaekTorth. Dr. Grimahav hss lately 
^al an esample of enra mainly thrangb the use 
3f aeonita. At tha same time the alUnraoee of 
liquids mnst be zednced to the lowest possible 
Msndaid, whilst szeretion is promoted. Alco- 
holic stimnlants may be girea in small qnantit^ 
and at long intermls, if the pnlse exhibit 
dsUlity sad the patient complain of a sen- 
sstian of sinlting ; otherwise they should be 
{■Bhibited. 

The PaUiiiite treatment as applied to Ab- 
dnwrinsl Aneoriam will be fonnd described in 
the aitide Aoara, Diseases of [Atuaritm). The 
apflieation of a few leeches, followed by a 
warm poultices is TCiy sfficacions in reUering 
fiain. Tke h ypod a mu c ase of morphia is still 
BHtc rapidly effictive. Thomas Hatdbh. 

ABSOKUIAIi TYFSUa. — A. synonym 
for Trpjioid Ferer. See TrrKOiD Fbtkb. 

ABSOIOHAI. •VTAJAiB, Diseases ot. 
Bat little Bwre will be needed in this ar- 
ade tbaa to girs a brief ontline of the nature 
3f the affeetions to which the abdominal walls 
na liaUs, a* most of these are bnt local forms 
cf dinasss which am folly described in other 
BBZtsof tfaicwo^ The parietal peritoneum will 
00 errlndad from conaidstation, as its morbid 
eoaditiaBa are treated of separately. 

I. acmvEiAL AFFBcnoMa. — a. The skin 
(oraing the abdomen may bo the seat of Tarions 
trapdani. The rash of typhoid ferer is chiefly 
obserrcd orer this region, b. When the sbdo- 
Bsn is gmtiy anlaiged, its entanaons covering 
becomes stretched sad thinned, often presenting 
a sbiaing appeaiaoce : this may eren gire way, 
nthat it exhibits snpeiiJcial cracks or fissuies. 
If it has been disteaded for a eonsideraUe time 
or OB ssveral occasions, as after repeated preg- 
naacjaa, the skin becomes impaired in its structure, 
aad is oftea tlis seat of permanent white lines or 
fsituwa — Umb aMemtUi. In this oonnection al- 
losiaB may be made to the imbiliens, which, in 
(Cttain funis of disteasidi of the abdomen, may 
bteoaa poached oat, erarted, or actoallyobtitar- 
aled. e. TbeTetns of the akin frequently become 
caiaigcd and toctaons, when the retnm of the 
Uood which is wmaally conrsyed thnmgh them 
is in any way impeded. The particnlar vessels 
«Uck are distended will necessarily depend 
■pon the seat of the obstinetion. d. The eu- 
taaraas sensibility over ths abdomen is aome- 
tiaes materially altered. In certain narroas 
fiseosea it any become nune or less impaired 
er kat ; but the most important deTiation is a 
amrited increase of sensibility — hyfermtlumm— 
wUeh is oeeasionally observed in hysterical 
fawks, and wfaidi may simulats more sarieoa 
sfctioas, partieaUrly peritonitis, espscially if it 
ita eroan iai ii ed witb iTrnptous of much depiss- 



* «Waeeeris0d 



sion. This «:«:» »^*3it»oa „ eiur.,t^ . ^ 

abdomen, tha. "^J^^^f^ to^^h^^^^^T^^df ^ 
if the patien*^'^ •ttentiou MBfTT^J^' *"* 
and de.pV-«^:^^.eJ^^, 'S.„"i''t,^ 

prtteaee of 



tire of ^' J^''^ "' <«*««■ 

"*"f «y ssrw to di^Bguith 
omen of a aiarar nstuw. 



giarar nstuw. 
'«">i which IS sometija 



*/"? ibdomea nuv >l«> he af- 



sometuaes rery 



with little or 
aspect of the _ 
symptoms in<S S' 
sence of pyr«^cx^ 
this affection 
The sur&ce c 
fected withne- 
seTeie. 

2. 8cTicuTA»r^»t7« AcCTwiATjaHs. — «. The 
chief morbid c«>«3<*ifcioa coming under this bead is 
adena or dr^t-2Sf^^ o{ the subcutaneous tissue. 
This generally- :«<>Xlows anasarca of the less, and 
may be asaoci8a.<;^MJ -mritli ascitaa. The fluid Unds 
to collect fpecimlly io the lower part of ths ab- 
dominal walli lazaci towards the flanks. The akin 
often presents aa Twliite pasty aspect ; the abdo- 
men may be moro t>rlets enlarged ; the umbilicos 
appears depressocJ snd sanken, if the oedema ex- 
Uuds up to thia le-rel ; the siip«rf(eial stmctwts 
pit on pressaro, a-ad yitid the peculiar sansa. 
tion of dropaicaJ tissuea; and tlie percussion 
note is fcequonUjr znufH«d. b. The abdomim.! 
subcutaneous tissue is, la many parsons the 
of an abundant colloction of fat^ which ma^ 
important from ita ca.ximag geneisl i 
ment, and simtilafcin^ or obaeuni^ «»i, *'^" 
serious morbid eonctitious which^ "tasr uore 
abdomen. "■'Mge tha 

S. Arracnoiis or rrsrs Kvact^m ._, . 
BOSES.— a. The abdominal \raUm m. i? '^'^''W- 
of muscular rheumatism, vhi<>i, ^'^ °' 'lie as«t 
likely to follow nndns ^^^ndaii^ *'*'*'<*iarlT 
caosed by riolent coa^liijag orr^J^^^ »s that 
charactensodbypain, ■ometiaie,,,™"''^?. Jt is 
located in the muscular and tatnj/- •**• sWdsoti- 
accompanied with maeb soreueoa a* j* """ctoi^ 
The affected parUaro kept; oa Bipch,, '*"<'«n»e«. 
sibla, and any action wliicii distii,i_ ff *•»» as poe. 
allyaggraTOtasthepain. *. Aatjierl ,**>niatori. 
strain, the muscnUu or a.ptuioatotiei^''^ °f violent 
more or less torn or ruptured. ^. ^"Ues maybe 
a protrusion of some internal struetL'""'^'"'"'* 
place, forming a hernia, e. Tie aS"** ""*>" *»!'• 
des are liable to be the aeatof s^^"'*'"* >■>*»' 
tractions, cramp, or rigidity. 3v2f'*«<Jic oon- 
eommonly excited in sympathy with *** °°' ™"" 
turbance of the alimentary eanal &■ .^^v* ^**' 
In certain painful iotemal afiectioQ^ ^'^ cholera, 
the abdominal muscles are occaaitm^fi^ eome of 
state of mora or less rigid tensioii a^- ' kept in » 
invbltintarily contracted in order* to *' ^'^ey'*"'* 
diseased ports underneath from \ ^P*«tect tb> 
spasmodic eontraetions in totan-jx—*^^*?- '^^' 
quently cause great suffering over- » v ***** unfif*- 
d. On the other hand, the abdoia- *''<l°'°*°' 
areoccasionallyp8ralyBad,astfae ^^I,'?"'^ musdea 
nervous diaeasa, The movemen t a^i^*^ *' cantn« 
are then altered in character ; wlxil eVi,***'"*''"'* 
acts in which the abdominal n>»x«,ji * tixpulsive 
take]>art are much interfered wit;)^ •■ aatiusJiy 

4. Kblaxkd AsnoKiifAL W'.^i^l^ 
stmetuiss forming the walls of t-h^^vT*'^ '^ 
often in a relaxed and flabby a.tn.t^ •"""'^ "^ 



any pressure from within, eo tlia.t~Tj, ''"'^ ** 
becomes enlarged and piominexit ^^^ Ahdonieia 

• "■Peci«j;iy if^ 



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• ABDOMINAL VALL8L 

M b ftcqnsntljr the eaM, tUi eonditioo is ■»• 
•odatad with much flstulaneB. It mstarially 
wwkiM the set of defao t ioB, aaA promote! 
ooBttipation. 

6. hmtaotATiov txo KvcmM. — Local iDflam- 
matioa msj be set np in any of the abdominal 
■traelcn*, and thU may termiaata ia mppam- 
tion and the fonnstioD of an abKesi. Parolent 
•ecTUnvlBtiona from witiiia, aa in eases of pelvie 
abaeeai, al well as certain abscessM originating in 
dbaaaes of bones or joints, may likewise extend 
among the tissues of the abdominal walls, eansing 
thickening and induration, or may make their way 
OBtwards, directly or through a sinus. Subee- 
^[■snUy permanent sinuses or flstuls maybe left. 

9. The abdominal wall may be the seat of 
tx&aeatatiaii of Mood; and rarions kinds of 
tumour or n«t» growth may form in its stmoturas. 
FankBBiCK T. BoBam. 

ABSJEnA-TIOZT. — A diTergence or wander- 
ing from the nsnal course or condition ; applied 
in medicine chiefly to certain disorders of the 
mental facoltiea. Sea ImAMrrr. 

AJBOBTZOIT. — The act of ahortian signi- 
fles the expnlaion of the contents of the preg- 
nant uterus before the sorenth month of gesta- 
tion. An abortwn is a designation given to a 
fotns piematnzely expelled. Set Miscabbuob. 

ABBOaSS (oisoMfo, I depart). Snroit.: Fr. 
aboii; Qtt.EUtri$ut4;ClttdiigSr. 

DaninTiOH. — A collection of pumlent matter, 
one of the resnlta of inflammation. See Pvs 
and IXFumunoK. 

FATHObosT. — ^Iftltematarial'iriiichaoUaetsina 
tissue as the oonaequenee of inflammadon softens 
and beoomes Uquid (suppuiktion), it does so either 
rapidly or sloirly : if the former, the result ia an 
aeuie abscess ; if the latter, the absoess is termed 
ekrwtle or eold. If the material thns softened 
and farming pus, often mingled with fragments 
of dead tissue, is limited by condensation of the 
parts around, which are usually consolidated 
by &e products of inflammation, the abscess is 
said to be eireiaucriiod ; but if die surrounding 
parts in their turn soften, so aa practically te 
ofihr no barrier to the pus, then the abscess 
spreads and is said to be diffuud. In an aeuie 
eircuuueribed abseea the lymph which collects 
around it as the result of inflammation becomes 
organised and forms a sac (pyo^nio membrane) ; 
and this, with the compressed tissue about it, is 
the wall of the abseeas, consisting therefore 
of contents (pus), at a limiting sac, and of con- 
densed tisane around. The resiatanee oilierad to 
the aztaOBion ot the rappmation is greatest when 
the parts adjacent are dense and tongh, such as 
bone and Ihseia ; yet, as the pns in an abscess in- 
creases in quaati^, probably by breaking down 
of the pyogenic layer, sniBcient preasniiB is <x- 
•rted to cause the most dense structures to 
yield, and an abscess will thus make ita way 
•fm through osseous tissns. As might be ax- 
peeted, an abscess always advances in the direc* 
tfon ot least nsistanoe^ and this ezten«ioil is 
spoksa of as iUftMuy. Tbia pointing may b« 
towards the nmoeoftbe bodj, {mt an absceaa 
may direct itaelf toiranl>s«i«ro«iesnV> •'•ch a. 
liie paritcmeaa^ cr aloof ttrmok ofgOluJar tiut^ 



ABSCBSS. 

aa when pns beaaath thedaep eenieal fascia poiBis 
into the mediastinum. On the side at whidi the 
abscess is painting, its wall, as ths resistance 
lessens, p*ojeeta ; and by uleeratiTC absoiption the 
parte corrring it became qniddy thinner, until 
they and the abscess-wall give way and the pus 
escapes. In by fkr the greater number of caaaa 
this absorption of tissue before the pointing 
absceis ia towards the sui^ks, and it is by uloer- 
ation of the skin that the opening for Uie dis- 
charge of ths matter is effected. The wall of 
the afaaceea then contracts, pus eoaitinuing for a 
time to be discharged; and in the end, udedby 
the resilience of the tissues around, the sac of the 
abacees is obliterated, and the orifice through 
which its contents were diadiaiged heals by gra- 
nulation process. To ensure this result the walls 
must be left at net, or the giannlations which 
eorer them will fail to unite, uid the obliteration 
of the sac will not then take place, as happens 
for example in tha case of an absoess sitnated 
between the moraable rectum on the one side and 
the ischinra on the other, where the opposite 
abscess-walls are prcTsnted from joining by mna- 
enlar moTementa on the side of the bowei. and 
will only unite after such movements hare been 
stopped by catting across the mnscular fibres 
whidi occasion them. The track which resnlta 
from such failure of the healing of an abscess ia 
called a einut or fSttula. 

In a diffuted abscess the inflammation of the 
pSTts around does not limit the suppuration by 
organisation of the efinsed lymph, but such lymph, 
itsslf dsgenerating, forms mcsv pus, and so the 
abscess extends rapidly and widely, unless 
checked by some barrier of dense tissne. In 
this way matter often spreads along tracks oi 
cellular tissue, as abng the course of Teins, 
and in the snbcntansoaa structures. An abscess 
when farmed between bone and perioftetiii^ or 
otherwise hindered from reaching the surihce by 
pointing, also tends to diflhse itself by following 
the course of least renstance. In moat oi 
theae oases by dirsct pressure upon the resisting 
tissne or by cutting off the blood supply (ss <2 
ths skin when its subcntaneoos tissne is infil- 
tnted with pns), slonghing of the parts corering 
in the abscess ensues, oftmitimes to a consider- 
able extent, and so the pus eTcntoally makes 
its way to the suifacs. It ia these absccssss,^ 
spreading along tnicka of tissue before they can 
reach the sar&oe, which are apt, howeTn^ when 
iuTolTing ontain parts, snch as the coune of 
some of the lumbar nerree, to burst into a aaroaa 
carity with fatal consequences. 

A ekroitte abscess begins in some local inflam- 
mation withoot aetiTa symptoms, such as results 
in the deposit of aplastic lymph and subsequent 
nloeratire changes, aa caries uf bone, the irrita* 
tion leading to suppuration. The formatioB of 
matter proceeds in a languid manner, so that it 
is only by slow degrees that it collects in any 
considerable quantity, although erentoally these 
chronic abacesaes may acquire great sice. They 
dotrly point, and in their tardy adrance oeca- 
lly traretse eren serons caTities, which hara 
frat obliterated in the line of transit hiy ad- 



lotrlf point, ana in ueir laray aorance oeca- 
.^l^ly traretse eren serons caTities, which hara 
I '^'^ftrat obliterated in the line of transit hyad- 
y^Ly inflammation of thwr opposed surfiiaaa : ia 
\f0^f%j an abscess foimed in the liver (and thit 
hiA gfiiL also for these of a mere acute ebaiao- 



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M) m»j ftKni Utoaf^ th» Uyart of (lie parito- 
mmn,iad nay ftimt thsaagh the ■ntorior vsll 
if tks abdonan. 
Whaa an abacMs ^aebaifpt, ita eootenta m« 

MB to b* ettfacr a thick yellov ({ox^'') P°^ o' 
pwataiaad with bkiod, or othanrwecolonrid, inch 
nfahdc arUaiahFgiaeB;orth«piwmajrbe thin, 
■faaort VBter^ mu^ad with flakaa of Ijnmph; 
it naj faa inodoiwu or fotid, or irritating to 
lb* tMch (Ktormu). Abacaana may also eoD- 
tao doaghi of tiaaoe. or fonigB bodiea, or masaea 
tf ia^MBatad ina, as hardoeeaaooally as ealenli, 
ar&apnentaof dead bone, or ealenli of Tarioua 
kioda. SometiaieB a ehraoie abacass oeaaea to 
vlaiga aad if tha iiritation -wUcb oeearioaad it 
eoaaa to an aid. it may di»»niib by afaaorption 
of thefl^ part of ita oontants, the solid d^ng 
ap iato a ahrmkan Bottf-lika maaa. Itmayie- 
■aia ia thia atata -vuhont giTiog riae to tn>IlU^ 
or it my beeone again the seat of aappustioa 
by the fematiaa of 'what under awh ciicam- 
ba been termed by Sir Jamea Fagat a 



Tha fvmm of any abaeeaa is largely infla- 
by the atate of the general health. In 
peraona cCherwise mbost an abaceas commonly 
rans an acota eooree ; in those weakened by aente 
UfaMoa, SDch as seariM fever or typbns, they form 
tjfoAly, bat are slovly recovered &om, and 
aerarely tax by an exhausting discharge the 
poven of the patient Persons in feeble health, 
hciedicaiy or acquired, nsnally snf&r from the 
chronic and £ftued fsrina ; and chronic affections 
of iateraal organs, aa <tf tiia liver or kidneys, are 
not nnfteqaently aaaoeiatad irith the develop- 
BUDt of saeh ahaceases. 

£isou)oT. — The cause of an aei<<< abaceas may 
be an isjny, soeh as a blow or preasnre, as often 
)««yyn« in penoDs weakened by eontinned ferer ; 
sxpoaare-, or the irritation of a foreign body, or 
diat af a pniaBB iDtrodnead fiom withonL In the 
lart eaae the nhtrirm is often diffhsed. Abscess 
raaai^ an acnte eoarse may also be doe to a 
fioieigB bodv flor to an irritant from within, as 
when it fb&ovs neeroeis of a portion of bonp, 
ar the escape of nrine icts the tissnes of the 
It alao arises in oonnsction with 
sng, aa in vatioas fevers, and affec- 
' hed as sratie. The cause of a 
■nally found in changes which 
go Willi depoa ita of a tabercolons character ; or 
it is Stoad ia tha efaaacas iriiich slowly oocnr 
aaoaad aa irritating body, aneh a« a renal cal- 
calaa; or chr on i c inflanmatoty changes may 
calmiaste in one of these collections of matter. 
TImj any alao form ia parts which are long 
aaagsatad ia mnimction with obatncted vein cir- 
calatinn (eartx) ; and they may follow, or eon> 
ditiona el nss ly allied may fallow, theooelnsion of 
a main aztaiy and the eoaseiyiBnt ontting off of 
the anpply of blood to a particolar region. 

SnoTOKS. — Tha symptoms of an atmte abscess 
an thoaeef s ked hftunmation, with constitn- 
1 distafaaaea if the ahaeesa is of any size ; 
. by a acaas of add or aetaal shivering, 
witfc iaersaaa of pain aad swelling, tenderness, 
aad thnbUait Tha tandeiaaaa can be TBceg- 
■SBsdia tbaeaaa of Boatahaaeaaas; and, if pns 
ia ta ias d aaywlisn aaar the anrfcae, the 
fMaMMs «C tha Md ia datacted by ita flnetua- 




tion. Tha aavarity 
aaoed by the site of 
is held down and. 
dense straetares, sii< 
toms may also arise 
tion of the snppnra.t^< 
■ oanssd by the i>— 



the pain u much infl«. 



abscess deeply sea.t«.ci. «»t tiMTbas^'orfi™^ °' "• 
A dvfustd abscewa, i.:^ nh<M^° "** »°"««»^ 
nised by its rapiO. ■»:K*c«re»dimrTnd^ '•,»<»»• 
paeted if other ng^za^ -^a-wint to a^- ^ **• ■** 
of the abacass in -aarVa ^.^j-jj difliim„v'- ?" *^* ■''« 
for instance, by tiae* ^ide ofth "* ""* ™1». «». 
ischio-rectsl fossa. '"* Kctqia Ia the 

Of «*roa» absccMis «Ji«r, j, , , 
stage any evidena*. ^n,^ .-J^"""> » iu oariy 

thoaeoff.ilinghe*le.l«. -ad fJ^P*"^ ^ «ay, *ii 
by thoae of other a?Ia^ vaAea tmJT^J^ *>* ntarked 
u an ontoome. I'll wis in di^ ^"je'' the abacea* 
or of the spine, -«u:m 1 e^s aa^! l '''• '"'P Jo«at 
chances to attract ".tC-oiitioiL A i* "' ^rrluhj 
a rule suspected no. eiX it ImL h JJf*=««» ia oot^ 
first Umit^ and b«^ ''»^^°J^'<^b iJJ 
It is not worth wIb.21« to attem^^*'"»'>S aitT 
between ehToaioal>M<>0Mii«juinH.^ *° *«tinAaJ!i: 
as extravasated blood *»^1^ '^''^"e^n^ 
malignant tumoors i :«w i/ , d^h^ "P^cUllf 
arises, it can beat c»D«o«oIved bvM, •'" ^T ca*; 
of a grooved needle oar of » en/tZtl''^'^ncSy' 
iweUing. Thetraa pulsation j**^^ into 7?" 
sufficiently teUs ito xi»tn»a, and i.° "" "nenrf^* 
t^en for the impuxl^s ^metin,'!. '-"^'j^ 
abaoasahyanadgacaafc mrtary. "" 8iven to .t 

VAMmia.— TU ebitif 1^ ^ . "" 

soessea which ar» lively to jJ^"'** «' ab. 
madical practice ns^ "ht thi^ ""*' '""1» ia 

1, SnbcaUneous or taorw doeplj IL.*^?*"**! : 

in the limba, in eoanoctioa with i^^Tv "''•"'•ae. 
sipdaa, pywaia, &o. a. AbacaJI- "T"' **y- 
ongia in the wmU. of th« .bdo^ „'^ I°ea 
I. Abaeeaaea ongioatiog: in aaitni. 1 ^^♦'^••t. 
4. Certain sped J abaeeaaea •aaociat^'^^****^ 
eased bone, ejf., paoaa And ln»,K *'r* ^>»- 
6. Abscesses formed in the oeJIlalHrti^ ***"«*^ 
organs, «^., V^n-aeftaitSo. panJ^i"*^"^*^ 

gaM. the chief of which includa h^°° ^^ 
pyelibc jmlmonaiy, mamna«.»y. eerebnll ^,5^^*' 
nanci«it&. 7. Obscure ab«:ii«,7<Z^'^*P^««»J«^ 

dno.|«tal, m«d.a.ti™l. 8. GUx^Li^^^^^rJ^ 
wbd^ar. umuUy ch«,aic .a«d of . ..^^SSS 

T««*TMicT.-The treatttrat of an aomi^ ah. 
aeaaa oonaiali in reat, aoothiiMC loe&I i-ivJ^n 
tion^ and the use of reaedi^ tHlla?''^- 
aad oonstitutioaal distubsnce, if the Wf 
exists. As soon aa the preaence of nnm i« ^ 
cognised the abscess must b« opaaed if XKaasiU 
where the matter is most daneadgQ^ ; »^v! 
soon as itsMntents hare eaeapa^ ^ trtmWeaomi 
frmptomswillaaaaUydisanwar. The opoai^ 
18 needed to relieve pain, and to pnrr»nt iisoS 
eases diffusion, and sometimas to relieve mvant 
distress, as whea dyspnoa is c«iaa«a by tiiopnw 
sore of an abaceas upon tha '^^•■ptLBaugaa. It » 
also deeirable to open aa abaeeaa to avoid the 
considcraUe searwfaidi aniArseait jf tba matter 
is left to escspe by-nleeration aaj aianghiag^ 
the siqparfidal tissoea. If it W impectant feT 



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i ABSCESS. 

vraUi ths scar of u incised wnind, an abseeas 
may ba panctnred in (ereral place* irith a 
gnoT«d needle, vhen the jxuiettLres, if kept open, 
vill effectually drain oif the pni, and the marka 
left will in the end be acaredy ^aeernible. In 
most cases, however, it ia necessary to open an 
abscess by an incision: a narrow double-edged 
knife should be used ; and if the matter is deeply 
seated, the superfleial parts only need be cut, the 
deeper being torn through, as Hr. Hilton !•• 
commends, by dressing forceps: the risk of 
dividing important struetnres, as in the neck, 
is thns avoided. After the pus has escaped, 
the wound should be kept open by means of 
a drainage tnbe fnnless the abscess is of in- 
significant sin), which is eonreniently made by 
introducing a twisted slip of thin gutta-percha 
tissue or of oiled silk, and should be corered 
with carbolised oil on lint, or with a poultice 
of linseed and ferralum. Some surgeons pro- 
tect the wound whilst operating by meana of 
the carbolic spray or by a piece of linen steeped 
in carbolic lotion (1 in 20), or take other anti- 
septic precautions. The drainage tnbe should 
be withdrawn after the first day if the abscess 
is superficial, but if the pus has been deeply 
seated it should be only gradually withdrawn, 
portions being cut off as the abscess oontta«ts. 
If a foreign body has caused the formation of 
the abscess, it mast be sought far and removed 
before the suppuration can be expected to cease. 
Occasionally tns vascular wall of an abscess 
bleeds freely, or a vessel is opened in the pro- 
gress of the sffection : the hsmorrhage usually 
ceases on laying the abscess freely open ; but if 
this does not snfilce it may be permanently con- 
trolled by pressure, and the cases are rare in 
which ftirtber operative interference is called for. 
Inflammation of the ssc used not infrequently to 
follow the discharge of its eontents, but under 
ths treatment now emplK^ed such an occurrence 
is unknown. During the healing of any consi- 
derable abscess the general health should be 
attended to, and tonics and change of air may be 
useful to expedite recovery. 

Diffttted abscesses, whether sabeutaneoos or 
more deeply seated, require f^ incisions as 
soon as suppuration is even suspected, so as to 
avoid the damage which results from their 
spreading and from the sloughing of tissue, as 
of the skin, which will otherwise occur, especi- 
ally with those due to poison introduced into the 
system or those caused by inflltiation of urine. 
These abscesses sometimes lead to &tal results. 

A ckronie abseess may have its contents drawn 
off by the aspirator; or it may, when it has 
come near the surfiue, be opened, drsined, 
and dressed with earbolised oil on lint, without 
any risk of constitutional distarbanee, but its 
ultimate closing will depend upon the removal of 
the eaoM ; if, for example, it i« due to disease 
of a joint, it cannot b« cured until the disease 
in which it has originated has in some way 
•nded. 

Snnis. — ^An abscess after being opened may 
contract until it forma a narrow trade, swim or 
fUttUa, leading to the site of primary irritation. 
8«ch a tmek has a dense llbitMis wall ^miriiidi 
mueo-pnmlsnt fluid escapes : it may also conTsy 
MciatioDS, as from the livsr {kepatio JittuU) or 



ACABUa. 

stomach {ffiutriefiilula), or czcretioD, as from ths 
kidneys ; or it may simply cany out the pas 
which forms around some irritant at the deep 
extremity, such as a foreign body, a portion of 
carious or of necrosed bone. Some sudi flstale 
are due to the movements of a4jaoent muscles 
preventing union of the abseess walls. Unless 
the eanae of the sinns can be removed, as by ex- 
tracting necrosed bone, these fistulous tracks are 
diiBcuIt to mani^, requiring especial treatment 
aoeoiding to their situation. Other JSttuls are 
those forming oommunieations between mncons 
canals {neto-vnical, senoa • txi^tiud fistula), 
and these need special treatment, such a* 
plastic operations and operations diverting the 
oourse of excreta escaping through unnatunl 
channels. 

The tissue about healed abscesses, soar-tiasM 
generally, and tissue spoiled by inJBammation, 
are apt on slight provocation to infiame and 
suppurate, and to those collections of matter the 
tuTm'ruidual' has been applied. The treat- 
ment of such abscesses in no way difligrs from 
that of others, and they usually heal in the or- 
dinary manner. Q, W. CAixsmm. 

ABSIITTHISBI.— DxFuaTioN The eendi- 

Uon induced by the undue imbibition <^ »!>• 
sinthe. 

From the mode in which absinthe is taken, 
we should expect that the symptoms in- 
duced by its excessive consumption would be 
generally obscured by, and intermixed with 
those of alcohol (aee AIcoeousx). That it has 
a special effect on the oiganism, and that this 
may be diagnosed from alcoholism, has been 
pointed out by Hotet, Kagnan, and other French 
physicians ; and the writer last-mentioned has 
clearly exemplified its action by numerous ex- 
periments on dogs. In persistent absintbe- 
arinkers vertigo and epileptiform convulsions are 
marked symptoms, and come on much earlier 
than when alcohol in other forms is habitually 
drunk. Hallucinations occur also without any 
other symptom of delirium tremens ; and, when 
tremors coexist, these are limited more par- 
ticularly to the muscles of the arms, hands, 
and upper extremities. Absinthe acts chiefly on 
the cervical portion of the spinal cord, and this 
readily explain* ths special symptoms arising 
from Its regular use. Johh Cukhow. 

A3BOBBENT AaBITTB.— DiminTioir.— 
In Surfftry, absorbents are substances used to 
absorb fluids, as sponges, charpie, or tow: in 
ifedieint, drugs which neutralize excessive acidity 
in the stomach — a synonym for alkalis (m« Axi' 
xxLis). The term is sometimes also mads use of 
to designate remedies, such as the preparations 
of mercury and iodine, which are believed to pos- 
sess the property of promoting the absorption of 
morbid products. 

ABSOBBBITT VXBSIIZ.a and OIiAITOS, 

Ciaaases of. Set LmPHATia Sxstbk, Diseasss 
of; also 'BaottcsuL, and MassMTSBia Qi.un>a, 
Diseases of. 

AOABTT'S. — Atari or Afifes constitute an 
ordsr of the class AraeknUa, several species at 
which are parasitic. The Aoanu mbiei or 8ar- 
<n>pt«$ iommii, mi ths Jeanu folUtmlorum, at 



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I pnpaly the Stt a it ra ou falUeuhnm, aie 
tba ooljr hnnaa pMiuritM belonging to this 
faailj. 

DncBipnox. — 1. Th» Acuros scAinai ii k 
■■bU roondiah aninml, just rinble to tha naked 
•fe. KMMJTMri under the mietoeeope it ii leen to 
be flattaoed and to rteenUa a tortoiae in shape ; 
Thai folly dereloped it has eight legs, and on 
its aadar nt&ee are uattaTed filament! uid ihort 
apinca. -which are £ir tha moot part directed 
faackmazda. The female ia larger than the male, 
aad ia pcpvided vith terminal aoekan on the 
fear anterior Iega,vhile filamenta ooeapja rimilar 
poakiom ob the poetarior ones ; ia the male, hov- 
enr, the two extreme hind legs hare ancken 
hlca thoae on ita fore limbs. The joong Jeanu 
haa taif mx legs, the tvo hindmost ones, which 
an Hi at incr iTe of the sex, being vaoting; it 
aeqniRa these after riiedding its fint skin. Tha 
■ale Aeanu lires near tha sisilaee of the skin, 
while the female bnnows within the cuticle, and 
deposita from ten to fifteen ^gs in the euni- 
cana ozbanov; these egga hatch in abont a fort- 
■i^tt. The yatngJam escape from the bur- 
tow, but the parent does not leara it, and dies 
w4uo she haa iinished laying eggs. The AearuM 
teaUei is the eaose of the skin-affection termed 
Stabia or Itek (lea Scabibs). 

3. The Ac&sos ioixicnix>Buii is a reiy mi- 
nnte paiute commonly found in the sebaceous 
and hair foUidea of the face, but its presence 
esa liardly be regarded as indicating disease. 
Ia this animal the head is continuous with the 
thciaz, and to the latter are attached eight rery 
dtott legs, each armed with three strong claws. 
Ob eeeh side of the bead are short jointed palpi. 
The abdomen Tsries in length firom twice to 
three or fcnr times that of the thorax : it is 
posted at ita distal extremity. The presence of 
this pa»ate in the follicles of the i^n is quite 
unapartant. Hobbrt LiTEQra. 

AOCOKKODATIOir, Disorders ot.—8et 
Voarai^ Disonlers of. 

ACJEPHALOCTST (<i, pnV.; xt^aXl^, a 
head ; and tiims, a bladder). — A headless cyst or 
hydatid. — This term was formerly much sm- 
iled to distinguish the true hydatid from all 
thoae bladd«rworma that are furnished with a 
head Tisible to the naked eye. The expression 
is a misnomer and should be abandoned, since it 
is only bidy applicable to such hydatids as haTS 
failed to derelop the so-called heads internally. 
The Jetpialetjfttu endogena of John Hunter 
and the A. tmgtna ot Knhl are merely varieties 
of the tme hydatid (EeMnooooau veterinontm, 
or £ ioausu). See Hydatids, Ecsimocoocds, 
and Bladdbbwobiu. T. S. Cobbold. 

AOHOtJA (l,priT., and x<>*-hf Vile).— Absence 
or dafidcocy of bib. Sm Bilb, Morbid states of. 

▲OHOB. — ^A aiall £>Uie«Iar postola of tha 
t ip Willaa's definition is as follcnn : — 'A small 
seaminated pustule containing a stisw-«oIonied 
■alte^ wUdi haa the appeaiBDoe and nearly the 
coBBataaoB of strained bon^.aad is succeeded by 
a tliin brown or yellowish scab.' B<^ the poa- 
tde and the scab are ooostitusnts of the disease 
l^Kwigx The word has &Ilen into disuse, but 
ii IBaerred by Sebonlein in tbe name 'Acho- 



A-CEXX>XCV- I 

rion ' assigned by hina. ««» oM at the TukiU«t of 
parasitie cntaneooa 'f%>.-nai. 1^6 QTeett iroid 
ixi(> signifies scurf, <:»k- ^»A™ff i kx"(A» mean, 
ing chaff. Erashus 'Wuaojt 

ACHOBIOir(4.>cA-^. •"^rf)'»ti»enMaeri«» 
to one of the three i>irBn.<=ipal dennoD^^v^^ *^ . 

phytesoftheskin. Jit. is tte cousS ! ^ T' 

crusts of Favu.(ActA^:Br>. «ndbeW.\ ?>«* ^» 
of fungoid planU dera<ck:saa.S ^^^^Oidiumi ^°^ 
of spores, sporidia o:e- tubes fill ,wi'°°°"*t» 
and empty bnmcb»<a. t.-«a.-fc)ea or mv i*"^ "P"*"' 

Achoriun was th^ ■^%^-xr^x dii«>n ' '''• 
phytes of the skin, a.n«3. i xa comnl^*'*^ *^ "»« 'P'- 
eirly observers, Scla.S »» X e»xn >.». t "' ^ "d* otiu 
rion SchonianH. Ifc ia, snm^^" °*"'«'^''»- 
ofcontagioninFav-axaw - it h.V^ *? '** '**"*™' 

the loose cell-struct«^«r«. fc^effh^fT ^", '""n '" 

„i,._,...,i :. -.-— ^.— ^ooeath tbe nail in Onv- 

chogrjrphosis. £BA«.r5 WueoM."^ 

AOKBOUA (A, -^rir., aad xp»li». colour). 
Abeenoe of colour; «i.di *«<hrom»tons or oolonrlese 
statsof an usually coloured tieane, duetoabsenoe 
of pigment. In iwfejrionco to tbe akin Aohrom* 
is synonymous witJtx X^aetteoderma, Albiniam, and 
Alphods. Btt Pi0BcjBacx*.Aj(T SKUi-d'><u>i. 



colour; and i^, sightS. JHoro or less complete 

inability to distinorui^li coloura from each other 
See VisiOK, Disorders of. 



«iae 



AOIDITir.— Acids ai 
of the body by tha Ivrngm. 
neys. These acids, if ire eci 
introduced &om withoafc i 
of certain articles of foods 

body by the disintegiaUon- _.^ „ . , ....„,„ . , 
tissues and food. If tfa,« «Itfd.^**«t)oo^? "»• 
substances in the system -ww-^kts ZT " Of ^0 

products of their cambnstioxa ^ P'et* •l'^^Ixc 
acid, water, and urea ; bxxfc as ,?'<< u' ^® "ole 
never actnaUy complets^ ofcIa«, ^'» Oi,j'*'*>onio 
acid, ozalie acid, ttricacia, «t<.*"»<'licj,^"*«oo •" 
the increased or diiBiniati«d ft^J?'* ^W ** ^■eti. 
intermediary products mayr bo''<'ti^*^ !^!S 
measure of the completen«««w '^itl^'^al''^ *^^^ 
idation Pioeesses are beio^r p^^^'ohtt* tfeT 
body. The quantity of fuaT^^ni}^ ^^ o» 
through the blood on ita trm.y ,„*««te». J? *li» 
skin, and the kidneys is codVo^'^^ iun^^^^^g 



has been shown approximativelu ^ •"'." Bin 

man of eleven stoiio -noieht vr,:^' ""' a h '^ it 



ordi 



nary 






cnmstanoes, passes by the two fi 

avemge of 890 aranimes (about 2«"'"'"eiB 

carbonic acid daily, and that tl.« °"'>ecB-> 

by the kidneys in the same peri^4 'Xc^ot^ 

lent to two grammes (about 81 Sn^^-, '• •qwiwi. 

Used oxalic add; whilst the voU til * ^'y^*'"^- 

passingoflrwiththesweathavenotvBt w *'' **'»^e 

fcctorily calculated. It is evident tS^t ■ " •"•*•**- 

gular elimination of this acid, b»* ^* tl»» *»- 

channels, be interfered with, it w^l*?^ o« t*^«» 

camnlate in the system. Acidity o **^ 

acid in the body, therefore depends q^JL **°*'*'«««. 

— 1. ExoetriM/orvuUien, the result ^^^'^^ «^^" 



BO- 

of 



system. Acidity, tm- 
Bcid in the body, therefore depends on 
— 1. Exoemvi formation, the result of - 
oxidation of the elements of tie tij»i3***'°'*'i the 
fbod. 2. I)<!fioimt elimtnation of^^f* *^xaed 



Mther in normal or abnormal quMi^^^;'* *"'33oth 



these causes, however, are generally f *^'**i aet^DS 
in conjunction. Oxidation is imp^^^***,* per* 
formed, when an insnfflcient quaatS^^**^ «T8*» 



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10 achditt. 

is intioduced into iha body, mriiig to inniffl- 
«i«oejr of tbs nipirator^ Mt, th« rtntlt of 
dweaie or of ledenUrjr h»bita ; or whan the blood 
if poor ia red cor^nuelea, the earrien of oxygen, 
u m leneocytbsnua ; or from functional dersnge- 
meni of somt large gland, as the lirer, where 
oxidizing proeenea are extensively -wronght, 
Again, the materials submitted to the influence 
of die oxygen Trithin the body may be so in- 
ereaaed, as is the case in febnie conditions, or 
in general plethora induced by over-freding and 
insufficient exercise, that the snpply of oxygen 
may prove insufficient for their complete com- 
bustion. Defective elimination of the acids 
formed vithin the body is due either to dis- 
eased conditions which prevent, or to want of 
the physiological stimulus which excites, the 
longs, skin, and Iddneyi to exercise their re- 
•pectire fhnctions properly. It will be seen, 
therefore, that acidity may arise in consequence 
of the distnrbing influence of disease ; or may 
be acquired or inherited as the penalty of tiana- 
gnssion of certain laws of health — as the resnlt 
of unikvourablA hygienic conditions. In the 
former ease, acidity ia only seoondary, and ia 
generally subordinate to the disease producing it, 
and has rurely to be conssidered apart from it ; 
whilst in the latter instance acidity is usually at 
first the only trouble, leading, however, if dis- 
regarded to secondary mischiefs. 

EmcTS. — The mucous membranes and akin 
eiiisfly suffer in acidity. The former beeome 
subject to catarrh, produced, no doubt, by the 
irritating presence of the acid. Acidity msy 
Uins cause bronchitis, gaatxo-intestinal catarrh, 
and catarrh of the genito-nrinary tnet. Some- 
times the acid is poured out in such quanti- 
tiee from the mucous membrane of the stomach 
as to be ejected from the month. In these eases 
digestion is considerably interfered with by the 
too acid condition of the gastric juice. Bome- 
tisses, liowever, thia acidity of the stomach is 
produced by an opposite condition — the defi- 
ciency of the digestive fluid, and consequent 
acid fermentation of tiie food. Abnormal acidity 
of the urine prodnces not only catarrh of the 
urinary passages, but by decomposing the salts 
of (trie acid causes a deporit of insoluble nrio acid 
in the poasages, thus giving rise to attacks of 
gravel or leading to the formation of a calculus. 
Acidity manifests itself in the skin by attacks 
of etytiiema, herpes, eczema, and urticaria. Rheu- 
matism, too, may be considered as a disease 
resulting from the formation of acid, afleeting 
chiefly fibrous and serous membrane; no one 
can witness the enormous quantities of acid 
sweat poured out, and the highly acid urine, 
in the acuta form of this disease, without 
acknowledging that an increased formation of 
aeid is taking place somewhere in the body; 
though perhaps unwilling to commit himself to 
accept any of the views hitherto advanced as 
to the nature of the acid. 

SmKAnoK or Arm. — ^For clinical purposei 
an estimatioa of the acidity of tie nn'oe tar. 
niabes the physician with »n •matoximala clue 
as to the smoont of add fynaoa jg and peasinn 
out of the body. nUkdonm hfeolleetfag fk* 
urine *r tweoty^iiiiir bomi JjI^^l, tOO o c^ 
«. i. . isstor, sf «S« ^^.'XlB^^ 



▲ciDa 

ot sodiam hydrate, standardised so that 1 oa 
B -01 gramme of crystallised oxalic add, from a 
Hohr's burette, till the fluid is neutralised ; tho 
number of o.c.'s of the staadard solntioa requited 
to effect this is to be multiplied by '01, which 
gives the percentage acidity in terms of ozalie 
acid ; to aaoertaia fiom this the total amount of 
acid in tiie twenty-four henra' urine is only a 
matter of calcnbrtion. Too much dependence must 
not, however, be placed on the urine as a means of 
estimating excess or deflcienoy of acid in the sys- 
tem ; it sometimes happens that in highly aeid 
conditions the urine ia alkaline. Tiiis, as Dr. 
Bence Jones has shown, may occur when large 
quantities of acid fluid are poured out of the 
stomach ; and Prout long ago observed, that in the 
ectema of gouty persons the nrine, so long as the 
disease penisted, was either of low acidity or 
alkaline, bnt that the sobsidenoe of the aesema 
was frequently followed by an over-acid condition 
of the urine, aoeODspaaied with nennl and vesical 
catarrh. 

TajunoDrr. — The general indications for the 
treatment of acidity consist in the promotion of 
oxidation, and the eliminationofthe acids formed. 
Active habits, which promote the pnlmonaiy and 
cutaneous functions, should be encouraged. The 
diet should be just snlBcient to meet the physio- 
logical requirements of the body ; it should con- 
sist chiefly of flsh, fowl, game, and eggs ; sac- 
charine and farinaceous articles being exdvded. 
Sweet and cheap wines should be av(nded ; for 
those who cannot afford to purchase good wine, 
pure spirits and water is the best substitute. 
Carlsbad salts or Friedrichshall wnter may be 
given if there is much abdominal plethora,- the 
habit of taking mercurials as a relief for this 
condition is to be deprecated. AllcUine medi- 
cines are frequently administered with a view of 
neutralising the effects of acid; their employ- 
ment for this purpose seems, however, question- 
able. Dr. Parkes has stated that the adminis- 
tration of bicarbonate of potash (a favourite 
remedy in acid diseases), though rendering the 
urine alkaline, in reality increases very largely 
the excretion of the organic acids. This is not 
to be wondered at when we coa'dder that the 
bicarbonate, although alkaline in reaction, is in 
constitution an acid salt. The nitric and hydro- 
chloric acids, given in moderate doses about one 
hour bpfore meals, certainly have a powerful 
oxidising effect, and diminish the quantity of 
uric acid excreted in the urine. In cases where 
the acidity is manifestiy doe to defective ozida- 
tion consequent on poverty of blood fhim dimi- 
nution of the red corpuscles, iron and food must 
bo freely given. 

AOZDS. — DamnnoK. — Sabstancas which 
combine with alkalis, and destroy their power of 
turning red litmus paper blue. Most of the acids 
also redden Use litmus, and have a soar taste ; 
bnt loue. for example, carbolic add, possess 
Dsither of these properties. 

Einnonunotr. — ^Aeids may be divided Into 
Uiorganio or Mmeral, and Orgtmie. Ths mine- 
\^| scids used in medicine are Carbonic Hy- 
**-glil<*'*^ Hitrie, Sitrohvdrodilorie^ Fhos- 
(JP^C Solvlnmc and Sulphurous acids. Hm 
ItPZtJ^ aeias thus employed ineluds Aeslict 



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Acme. 

VtmBie, sod CarboUe, atiit, Oallie, Hydio- 
ennie, I^etao, SftUqrlu^ TBimie, TaitBrie, mod 
TaVmanir, 

Acna>. — ^Tbe stroogar acida — Solphwic, Ki- 
ttia, Hjdioehlorie, and Olacial Acetic adds — 
iaatioy aniiaal tiamMS, and act aa eaoatiea 
vbiaa applied to the nufaea. When aval- 
Waed, ti»7 prgdnea Uie STmptons of irritant 
faaoning. {See Poamn.) Aa antidato for thaw 
poiaaBa vludi ia almya at haod is carbonate 
•f lime, in the torn either of wUting or of 
pfautor chipped from the aeaiest wall. Othor 
autidotee are alkaline carbonataa and biearbo- 
^itai, milk, oili and aoap. Dilated aeidi, taken 
into the moath, inoeaae the MCiedon of aalira ; 
and lijdniehlorie acid forma an impoitant con- 
rtitoant of the gastrie jnice, tritboDt irhich 
digestion docs not go on. When abeorbed into 
the Uood, dilate aeida act on the heart gena- 
mllj, alowing its pulaatioBa and redoeing the 
taBpastare. Tbey are excreted in the uine 






Vma. — ^Nitric acid ia employed aa a canape 

appUeatioa to piles, to poisoned wonnds, and to 

stiiiBrdiiift or Bshaalthj sorea. Qlacial Acetic 

acid ia ased to destroy corns or varte, IHlated 

Aee<Je acid or riiMgar ia applied as a lotion to 

rslisvs hsadaebs ; to allsj the itching of prarigo, 

lidMa,aadpaoriaais; to check perspiration ; and 

srautiaM to hasten the appearance of eznn- 

theaaatoaa aivptioiia. Dilated acida, especially 

Gtric; Taltarie, and Hydrochloric, are adminia- 

t«ei ia fsTcrs sa refiigarants, becanae they 

rriisre the dryness of the month, and dimiiiiah 

the thirst by ineieasing the secretion of saliva, 

■a veil as lowar tha tsmperatore and pnlaa- 

iste. Undar the like circBmstaaeaa, the organic 

acids. Acetic, Citric, and Tattaric, vben com- 

biaed vith alkaline carbonates in a state of 

•Servcsccnea or othenrise, form agents vhieh 

act on tlw skin and kidneys. In febrile eon- 

ditiosii.aiirniia, and aome finms of dvapepsia, the 

paiopoitiaB of acid ia the gaatrio juice ia insofS- 

ciaat for the proper digestion of food, and the 

ardsuaiatntian ef dilute Hydraefaloric acid, imme- 

diately before or aitsr meals, is naeful both by 

aiding digestion and by prerenting the formation 

of batyrie and other acids, which gire rise to 

soar oroetatiooa. Nitro-hydrochloric acid, before 

meali. is likrwiae beneficial in prerenting acidity. 

It spppars to IiaTB some action on the liver, and 

is osmI both internally and externally aa a lotion 

ac footbath Sa janndice and biliouscess. It 

generally relirres the frontal headache common 

in yoai^ females, which ia felt jnet abore the 

e yslauwB . aai. not aosompanied by constipation. 

Dilota acids, aqtaeially Aromatic Salphnrie acid, 

are oaafal in eheddng diarrhesa, oolliquatiTe 

sweats. ha.Misilisg»s, and mnoons discharges. 

By liMiiiiiag tfa« alkalinity of the vrina, they 

taod to Tsvrent the fcrmation of phoaphatie eal- 

mU, phosphrrif and nitric aoids being most frs- 

•■satly caaployadfor tliis pnrposa. Carenmat 

M axs(«asad in their adnumstration to Boning 

ii<1m I a. aa thsy are excreted ia the milk, 

aad siwiiiliiiiis oaass griping snd dianhcea in 

nduta at tha braaat. Ssreral adda hare a 

•etiaa of their own, and are oonsi- 









laton ; but in coi 

place to V, and tl&e 

which the disease is a 

DBriKmoK. — An 



dawi mnAsr their raspsstiTS gionps, anch as 
ayJU a tj iiBJasciJ, wdiisli is s.aedalaTe; Carbolic, 



A 'ts rektiog 



an antiseptie; Salicsi^-I-*' 

Tannic, aatringea' 

AorimsiA(a. 

A synonym for pi 
partial or general. 

Greeka ahowed tbea- 

bid etatea of the **»*^*"«n»«nt'»!w "*„'*» Won.' 

disease iir/uJ. the ;fc»* "^^^©f tAe,^r'*i-"W »«• 

foUiclaa, or a foUicixJ»tMo/tj,g"^.»' «• Aa,-, 
with the deTelopmenC ox the p^Jr"^ '—'^ated 
the body at and after !>«» *ert^ ■ ft™","'"'' '"'' <>' 
aivo seat of manifes(t».e»on I,eiu„ , ""** Mela, 
anbmaatoid region c^* tfae i,f,X ? "<^. the 
region of the bmmnt, and ., ■ ^^b sternal 
shonldeis. "° ^xMsk and 

iBnoiooT and PAin«oiooT .» 

to other diseases of the skin, " 

more than a fiiUicQlitis ; , ^ 

ever engendeced, must «Iwsjj r,"]""^'''"'*' ioir 
pathological eonnsh Hence folj"*""* 'is Mae 
&oe, from whatarar oairse, ^ '•^"Jitis of the 
tended with papnlation and gi,i^"''Jy if ^ 
lar to the acne of pubortj-, hng^'^.^'ion simi. 
termed .^£m; anch ib tlie ^cn^ r^ ^^e^ft;^ beo» 
fiojaaas of adult lifo ; ajiti eu^ ,' *"^'*« or CftU^ 
(rf follicolitis produced by iodinf'l''" ^"netiM 
tar, whidi have been reapootiygi ' ""omine, and 
Iodine-, Bromine-, and Tttr'Aeoe ' *^'"*'«nated 

DsscBipnoN. — ^Tho pathologi^ 
Acne are: — a languid and torpi<j ^ •^•entials of 
to accumnlation of sebaeeons tnat> " ' * '""^ncr 
foUicles; congestion of the ooata of",?'*'''" *^« 
and immediately contignona strocturea ° i?***" 
ordinary manifestadons of inflammation SnSi*^ 
anpporation, infiltration, and aolidiacatio'n F™^ 
these wWch are the ordimiry «g„, of jnflk^ 
tioa of the follicles, jr. dmre the variousinb. 
jectivB designations of the disease: for ezamikla 
when aecmnnlation of aebaceona matter, show^ 
aa a black point with little or no inflammation u 
the leading featnrei the condilaon is termed Aetu 
punettUu ; whan congestion and inflltraUon force 
up the skin into a conical pimple. Mne coni- 
formit; when suppuration is present, Aetu put- 
tulosa; and when thickening and condensation 
display themselves Acne induraia. The whole 
senea, with the exception of Acne induraia 
which repreaents a chronic disposition, may b* 
called indiacriminately Jmt limplex or Jcnt 
mdgarit, there being obviooaly no regular 
atandard. 

DuoNOSia. — Acne ia a welMeflned emption, 
and not difficult of diagnosis, its most im- 
portant features being: — its limitation to 
the period of life corresponding to and soon 
after puberty; and its dejpendence on a phy- 
siological process at. that time taking place tn 
the economy. 

TsBATMSHT.— The treatment of Acne jnay 'b« 
summed up in a few words : — Kemove nv e^* 
citing cause that may exist ; improve tJi ^ntii- 
tive power of the indiridual and of »a* vin; 
stimulate, that is, give tMie and Tig^jC*^* thi 
part loeally. Onr beat general rain^^* ^^ ^ 



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a AOKE. 

tpai. iMiaiM, tuttrd atteotioa to diet and 
Dsbita of lib, ordiaujr toaici, and aspecially 
UMoie. Ths moat effleiant local a|^lication 
is aolplior, especially the compound bypocblorida 
of smphiu ointment, irhicli coosUta of a diaehm 
of hypocbloride of aulplinr vith ten graina of 
carbonate of potaah, to an ounce of benzoated 
laid. Aisenis ia beat adminiatand aa a com- 
tnnatloD of Vinnm Ferri and Liqnor Aneni- 
ealia (nU~>U) thne timea daily at the end of 



EBAaww VTrtsor. 
AOOVXTB, Foiaoninc by. — 8tt Foisoas, 

▲OQTTIBIID DISBABBB. — ^Diseaaea origi- 
nating independently of hereditary tianamiaiion. 
Sm Diuase, Cauiea of. 

AOBOOEOBDOV. — An outgrowth of the 
integoment in the form of a almder cylinder, 
whidi may be compared to the loose end of a 
piece of itring or oord — txpor lignifying a 
point or end and Xf^ a etring. Such ont- 
growtha are nanally met with in a feeble 
atate of the akin, and partieolarly in 
•Iderly peiaona, their common aeat being the 
neck or tmnk. They are at first seaaile, bnt 
become elongated ; and are aometimea bnlbona at 
the extremity, and more or leaa pednncnlatad. 
Pathologically an aerochordon is composed of 
loose areolar tiaras, firmer at the snr&ce than 
within, and of a fine artery and Tein, connected 
by a eapiliary loop or plexna, and sometimes a 
little ramified. It is popularly regarded aa a 
wart, and in medical works is termed termea 
acnehordon, bntitdifibrsfromawart ver^widely 
in atrocture. When aorochordones attain a size 
beyond that of a pea, they fall into the category of 
a soft tegnmentary tamonr or Ifollnscum. 

Tbbatkkxt Xliis consists in anipping them 

off with scissors, or tonching them with a strong 
sohitiott of potassa fiisa (equal parta). Whan 
numerous and minute, they admit of being shri- 
Telled np and removed by means of liqnor 
plnmbi, or a lotion of perchloride of meicnry, two 
grains to the ounce. The latter, by its stimu- 
lating property, also arrests their formation. 
EBASircs Wiuoir. 

AOBODTB'I JL {txfot, extreme, and 
iSirii, pain). A dermatitis afiTecting the handa 
and feet, particularly the palms and soles, 
accompanied with burning heat, stinging and 
smarting pains, and numbness. The pains some- 
times extend to the whole system, and there is 
more or less disorder of the aigestire and assimi- 
latire ftinctions. The redness is at first bright, 
then deeper tinted and brown, with considerable 
pigmentation of the retemuoosum. Occasionally 
there, are pimples, pustules, and blisters; the 
cuticle desquamates, and ia sometimes cast in a 
single piece; the disease ruaniog on for sereral 
weeks. 

TauTVEirr. — This should be directed to the 
regulation of the d^stiVe and assimilatire or- 
gans, and to (he relief of 7ocaI inflsmmatioo bv 
means of wateT-dnuiag fyjlowed by bandagiu 
with zinc ointment Emai^hp* Wttsott ^ 



HMtaent «»•«*• »''V<<P--i«»«J^^offoa«, ^^ 



?/ 



ADDISOire DISEASE, 
bnt little naed, ooosisting in the introduction d 
fins round needles thioou tha skin, to a TSiyiag 
depth. It is said to have been introduosd intotliii 
eoontiy £rom China ar Japan, about 200 years ago 
The naedles used are ab<mt two inches m length 
and are set in round handles, so that they cat 
be introduced with a gentle rotatory movement 
It is now employed solely in lumbago anc 
sciatica, in which affections it nndoubtedh 
grres relief. The operation is thus performed 
The patient being laid upon his face, tesdei 
spots are Bought for — in lumbago orer Ui< 
erector spins, and in sciatica along ths eooise o: 
the sciatic nerve. Ths needles are then pashe<! 
in vertically for a depth of from one and a-hali 
to two inches, and allowed to remain for fron 
half an hour to two hours. The number ol 
needles employed may vary fiivm one to six 
In sciatica it is recommended, if possible, tc 
midce the needle actually penetrate the nerve 
This is known b^ the patient complaining oi 
sudden pain shooting down the back of the leg 
The mode of action is nneertain, bnt in seiatiw 
it has been supposed that tbe puncture o! 
the nerve sheath allows the sscape of fluid 
Atfupoucture has also been employed in palnfta 
neuritis following injury, but without mud 
effect. In a modifloition invented by Bann 
Bchoidt, forty punctures, about half-an-inch ii 
depth, were made in an area of the size of i 
crown piece, by an instrnmsnt working by i 
spring. Oil of mnataid diluted with olive oi 
waa then painted on, which gave rise to ai 
eruption lifcs herpes. This was at one time ii 
great repute as a quack remedy for all ants o 
diseases. The term aeupunetun is also appliei 
by some to the introduction of needles into i 
cyst, in order to allow the fluid contenta ti 
escape, as in the treatment of ganglion, of hy 
droeele in iniants, or of hydatid cyst of tb 
liver. Puncture of the skin for the relief o 
cadema or subcutaneous smphysema is some 
times called by the same name. For this pni 
pose the ordinary three-cornered acupressui 
needle is more convenient than a round acv 
puncture needle, as the puncture resulting fro> 
it allows fluid to escape more readily. 

Uascus Bccx. 

AOTTTB.— This word, when associated wit 
a disease, signifies that such disease runs a moi 
or less rapid course, and is generally attendc 
with severe symptoms. It is also employed < 
express intensity of a particular symptom, as, f< 
example, pain. 

ADDISON'S SISBABll. Bnm.: Aforbi 
AdduoHtt; Bronud Bki» Biteue. Fr. Mi 
ladit itAddiion ; Oer. AMmueie Krankheit. 

Dhfihitiok. — In his original memoir on th 
sulgect. Dr. Addison wrote — * The leading ai 
characteristic features of the morbid state i 
which I would direct attention are ansemt 
general languor and debility, remarkable faebl 
ness of the heart's action, irritability of tl 
stomach, and a peculiar change of colour in t) 
skin occurring in connection with a diaeaM 
eondition of the supra-renal capsulea.' 

Jn reality, the general sjnmptoma of tl 
jj^esee, as given above, outweigh in impw 
dCe any pigmsntaiy ehanga wnatavar ; and 



/" 



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ADStSOira DISEASE. 



Il gnito poinbI« for tb« dismu to run iU 
■onna urithoat «dt vinianal deposit of pigment 
ia any poit of the body. 

AdAMn'a diiaan migfat, hoveirsr, be defined 
n *m osnatitatioDal nuladr ehsTaeterieed by 
(raat -maknaae Kod aiuemn, Trith depoeit of 
[ li gai e ut in the ikiii and eome otker puts of 
tta bailr, and aeeompanied hj or drpending om 
• epedne motbid change in the impn-nnal 
e^wnlea.* 

XnaioaY. — The eonititntiona] or geoeral 
nsnre of the maladj mnat erer be bone in 
sdnd, thoogfa lome of its fhcton are etiiclly 
local ; hat, though constitntional, it ia not tnna- 
ninble either (a) by contagion or infeetioB, 
or (A) bj inheritance. If, Imwerer, Addiaon'i 
diseaae itaelf ia nerer an inherited malady, it 
is in Teiy many eases associated irith a highly 
Weditcry eoDstitation, that of the tnbercalar 
«r aaofiuaiis type, and in snch indiriduaU ac- 
eidcDts like fidls or bknrs, which wonld fail to 
make an impression on stoonger men or vomen, 
may sufiee to set the morbid process in motion. 
In BO* a few instBDoea the bodies of the snb- 
ieeU «l this £ecaae hare been foond perfectly 
Bcatthy apart from the morbid change in the 
suprs-raml capsules ehaneteristie of the malady ; 
•ad, in a certain nomber of eases, local abscesses 
■eea to han been the starting-point of the 
^eeiOe changes in the eapenles themselres. 
Addison's disease is^ moreoTer, essentially one 
ef eai^ adnlt £fa, the great majoiitr of cases 
eeenmsg between fifteen and forty. It is mneh 
mn« freqoeot in men than in women, and seems, 
in a greet measore, to be confined to the working 



U 



OuuwMa, — ^It is not at all timet nov in all 
fastaaees an tm task to make oat a perfect 
cUneal hiabocy in a ease of Addison's disease. 
The satlier tj m pU m m are oftaa so indefinite 
aad so inndioas that it may not be mtil the 
disease is folly developed that the patient seeks 
■sdieal aid, and by that time the symptoms ate 
Bsnally nnmislakeable. It is diAtent when the 
malady appanntly originates in a ftll or a blow, 
bat aren saeh a statting-ptdnt as this may only 
bs aianhf for lata in tha histoiy of the disease. 

The misehiaf may be said to eommsnee in 
Meet esaes with a feeling of gential weakneee 
aad of being nnvell ; the diseoloaration of the 
akin ■ welly appssrs latar, bnt may be the first 
pcoamMot aymptam. In a small nnmber of 
aaav the aastt may be aeale, with loss of 
appetite, sickness, hasdadis, pain in the epi- 
also Tomiting and diar- 
When tha disease has attained its fnil 
Dt tha diaractaristica of the malady 
striking. Tbea tha downcast, monm- 
hl look, the drooping shonldsrs and stooping 
gait, the arsis hanging helplessly by the sides, 
and tha dow and listleas morements of the 
patisBt are strikingly impnasrre. If to this be 
added As darkaoing of the skin, the dear and 
psaiir eaajnaetira, and the braathlessneni on 
ezetooa, we have almost all that meets the 
eye when sod a patient presents himself. Bnt 
te thsae, on enqnuy, other important symptoms 
am saaly added. The fareathleasaess will be 
* to ba partly dna to auemia, partly to 
—^ ' — From the same eanasa 



in part, bnt not oottavely, yn And a miet, ' 
action of the hawrt^, veadQy giving place tonJ 
pitation. Witb t li a imp are nanally associated na^* 
*l»e apigastrinm and hf^ 



•With 
and tendeinesa iii 




ftom the anemia, «^ere ia a strong »!».j.r*"^ 
«iddinessand,yneoTpe. r^^UniuV^^J,!^, 
Sissase wears on, mnd. in mauT cu^J^- 1 
the patient whom xa.isiiig hims«ifTL^"'" ^ 
in bed for the pvurpoao of U>ia^toodTi^^ 
ing other necawsa^r-r ftmetion.7 ^J"^' 
inTariable mode txtdtmth, tor aerl™. " """ *** 
jnoh a. coma or oc«wiUsio.s. ^^TJ^ST??^ 
final scene, wlaexn tJie prastistion 



patient may ba «ot oome time befcre Satt an! 



parently nnconMnooai, bat this ia nn^tf^ *?" 

^wiUiibgneSB to make the riiJhf^'^'^^f "* 

owing to his protoixudw^n^'"'* ""lo". 

Throoghont th* -«riioIa disease th. >..wii ^ 

towards the dona ot the diaMaTtSSk^? *^ 
has been noted aa bigb as low'rh.^'^ " '* 

From the abowe alEatch it ia nlat- it. 

two most pfominant fetors in K rfsl??' ** 

preeented dnring Ufa, mi»— '"•eaao, as 

1st. Oeneral waakiiMB and anamis 

2nd. Abnomuil depoait of pi«n«„»*}„ __ . 

parU of the body. i"Pnent la mUt^ 

1. To the former of tbeae is to be r^t...^^ . 
fte lo«jof mnsonla, power, a. ^^^ ^ 
diminuhed ranscular eaargyand iar^x^-. °'' 
the rolnntary and inToluSkry i,^ ^th in 
heaH^s action is feaUo and imoerfli!* °^ *^» 
boweUareuraaUyoooflned. wCTtTT^'^^^ *!»• 
and aonseqnence of th« weakniM ° j * catiaa 
are loss of ajmetito, si Aim»« and Tomiting ^h^'? 
these, toOb depend in part on othelr'if **■?•» 
ebanges; whiht. hurtly C^impe.Jl^f'n^^*^'?^^ 
of the nervons system reimt,,'^S^,"'»^t.oii 
brain it«df, whence m^ri^, »„,;„ 3 ?.' »!>• 
dimn«s of sight, dsafnowi. tMa.onfL.S^*'?-^* 
The pain in the epigaatne .nd"'JJ^^i,"'J!i'-*''- 
regions is probably dna to JocU a«S^ °~*^" 



S. The deoosit of piinaent 
ehsnuMeristiZ^Itisn^^^lLl'i'T"'*'- ^^ 
and varies greaUy in tint. It^v «^i?^'''"''' 



to a light brown or smoky dis^L^^f ^ *mownt 
tain paKs, or it may "•»-ieI^eS^„'° «'- 
daric olire-green hue. appro^:'PPe«»nce of , 
some situK^spedal^*^;,"* ^^^J-kjJ 

thrback. of the hands, the'^i' ^ S>t 1^^ 
and along either side of the S!,^ ITha a 
strikingnecnli^tyis that the'^^^-^^ ^ 
clear Mi£i.early. and hat the aadT^e »ev« 
discoloured. On the other hand. th«re i» » «^ 
tendency to the deposit of Pigment -y^axca tba akin 
has been irritated or the epide^:, xemoTed, 
ss by a mnstard ponltiee « MU»., - tut tha 
skin u always mooth and snpj>I«7^in' sk tjpical 
ease under the writer's ••w.hUat^i had "»» 
apt)]ied to the chset for the nnea^^eel^DB *>- 
perienoed there, aad hare the pSjSneotaiy '"»* 
was deeper than in any other par^^f tba Iwdy, 
save the genitals. Cieatricesaff'ect.i^ tb* '^^'■w 



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dtpth 



AODiaOlTB mSBABB. 



of tha skill do not Man to be k pig- 
Tha mnson* meoibnna of tha month 
But nnfivqnenUT beooBsa tha lite of pigman- 
tatj dapoaits. Thaaa aie not difikaa^ but, iriMD 
tha lipa ua afSw t ad, thay nsnalljr take the ahspa 
et BDesn or Unas. On tha insidea of the chaaki 
blotches or irregnlarljr-definad spots are ntoat. 
oommon, u vail as on tha sidca and root of 
the tongue. The latter spots are oommonlj 
better cbtfined than are tha othara, and aoma> 
what raaemble the small iraU-maiked bLaek 
Sjpots oceasiooally obserTed in parts aliesidy 
pigmented. 

The site of this pigmentatj dmMsit is in (La 
gtimn^ lajrer of the epidenaia, the nsosl site of 
colour m all races of mankind, and 'which is 
vsnally known as the reU mueoMim; bnt oeea* 
aionally pigmentary grannies ate to be found 
deeper, in the cells of the tne skin. 

An interesting elinioal faet has been brought 
ont b; Dr. Oreenhow, which will, probably, be 
noted in a considerable proportion of eases. 
This is the mode in whieh the diaease pro* 
gieaaas. Often it pieaents periods of remission, 
only to be followed b^ a more marked ad- 
vsnce ; bnt, notwithstanding thaae remissions, the 
progrcBS is inrarisbly towards a fatal termina- 
tion. The time ooenpied in this p ro giw a s varies 
much ; it may be weeks or months, or it may be 
years, bnt in all well-dafliied cases the lesnlt is 
the same. 

Fatholoot. — ^From the earliest deaeiiption of 
the morbid state known aa Addison's disease, 
the malady baa bean aasociatad with disease of 
tha snpn-renal capsules. At flrst it waa sup- 
posed that any fonn of disease ai&eting these 
organs mast give rise to a similar train of 
■rmptoms, and some of the investigations eaiv 
lied on with a view to sustain thia position 
■oand absnrd anoogfa by the light of suiNnquant 
•xperienee. Omdnally it has been made clear 
that only one kind of lesion is acoompanied 
by the specific symptoms just detailed. Briefly, 
the morbid changes are as follows :— 

Normally, the suprs-renal eapsntes consist 
of two parts, a cortical and medullaty, differ- 
ing greatly in their structure. In Addison's 
disease both are superseded by a new stmctttre, 
whieh is to be seen in various sta^. In the 
earliest of these the capsules are invaded by 
a kind of translucent material, which is some- 
timea almost eartilaginoos in its hardness, and 
which, when examined under tlis miciosoops, 
resolves itself into a kind of vety finely fibril- 
lated or trabecular connective tissue, with cor- 
puscles like leucocytes £reely congregated in 
the interstices of the meshwork or between tha 
fibres. This matorial, when sera in bulk, is 
grey or greenish-grey, afterwards bacoming red 
on exposure. With it is mixed up an opaque 
yellow substance, varying in amonnt and appa- 
rently more abundant Ute more advanced tha 
disease. In the earlier stagea it presents the 
appearance of nodules embedded in the trans- 
lucent material, bnt later almost tha whole of 
this last may hare dimppe»Tai, sod the yellow 
opaqne matter become converted iaUt a thiek 
ereuay fluid, a pattf-Wu Bubmtiuee, or arat) «»! 
or more eretaeeoss aumm. TU' /uuuas. .^ _ /** 



iadioative of fatty degeneration, and closdy re- 
sembles in every respect what need to be koowi 
as yellow or crude tubercle. 

The exterior of the capsules presents certain 
important features. The oapsulsa thsmatlves 
may be large or small, according to the stage of 
the disease and the nature of their contents, but, 
area when they are small, it may be saflily ss- 
Mimed that at one time they were enlarged. 
In all cases they will be found eloaelj and 
strongly adherent to neighbouring itructnres. 
Soma of these atructures are of great importance : 
for example, the semi-lunar ganglia, and the rest 
plsxns of nerves associated therewith, in vhich 
important changee have been found. These pa- 
thologieal conditions have bean so often observed 
and so carefully noted, that Aej cannot be 
looked upon as aceidsntsi concomitants of the 
disea s ed process, but rather part «id parcel of 
it, and, in all probability, as giving a clue to 
some of the most marked phenomena of the 
malady. Braadljr it may be said that these 
changes consist in a great thickening of the 
connective tissue sorronndisg the nerve-fibres 
and the ganglion-cells, giving rise to something 
like oompreasion and ultimata deetmotion of 
the nerve cells and fibres. This occurs both 
in the cerebio-spinal nerve fibres and in those 
more intimately connected with the gangUonie 
■jatam. The nerve-cells, moNover, are not 
nnfireqnantly deeply pigmented. 

These, so &r as is known, constitute the main 
pathological elements of Addison's disease. It 
does not arise from mere destTsction of the 
supra-renal capstdes, for then it would be seen 
under other conditions, as when cancer of a 
neighbouring organ sxtends to and iavidvee the 
supra-renals ; but no Addison's disease follows 
this event. The exact mode in which these nerve 
lesions girei rise to the eharaeterietso symptomi 
of the disease are, as ye^ matters of specnlataon, 
and not of exact science; and it may bo said 
that our knowledge of the -whole of this snbjecl 
is yet in its in&ncy. 

Though those are tha insia £Mt* relating U 
the pathology of Addison's diaease, there an 
still others of some importaoee. Pigmentatiol 
faaa been suffioiently notiead, bnt its origin hai 
not been discovered Withont doubt t^ pig 
ment, like other animal pigments, ia denve< 
from the blood, and this haa been examinei 
witb a view to discover an^ change in it 
composition which would explain the darksnin; 
of tne skin, but withont rssult. 

In making the section of the body of on 
who has beui tha subjeetof Addison's diaeasi 
one cannot help being stmek with the amoui 
of snbentaneons fat, especially over the abd< 
man, as contrasted with the difficulties ( 
nutrition under whieh the patient anffeied ; y< 
a ooasidenkble quantity is almost alwaya foniu 
But more doeely connected with this malnati 
tion are certain changes ia the absorbent ayata; 
along the digestive tract. . Tbeae consist i 
enlargement of the sditaiy and agglocnarati 
_l^ds oonstituting Payer's patches, and of U 
^^gentsrie glands ; as well as of lymphoid d 
^^\tf in the mucous membrane of the stoauM 
Vl'iA KITS n» to little nrojeetlons, termed ma* 



rial, then, is imitiaij.bma. lunt^ *PP"ai^^ I }/^M^^' °° *^ ws^'of'Oiat organ, espMiai 






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wmt tha ]^<K«s. Snail ^wd^moMa are alio 
ant wawuHj tauni. in the nme situatian. Of 
ether ecgaoa it may be noted that the Uvar end 
qileen an aftsn enla]^ and hypamnio, and 
tba heert aaail and light. 

DuwBoeiB. — Then 'wmld hare been leei diffl- 
caitj or doabt in ttia diagnoeia of Addieon'e 
dJeeiee. had it been dearij enoaeiated ftam 
the ftret that a hnmiad skin did not almie con- 
■litate the malady. The diaeaae nsta on a 
thwefaldbaaia — genenUwiBJeiuit,ditiuidmpr»- 
rmul euftalm, uid inmaed «it», the laat being 
the laact impoitant of tiie three. Then may 
be darkitiBg of the dan &om a great variety 
of taniei, Tix. : (a) expoauek and attaefci of 
wnia (marbia Stmmm, QieeBhow ; Fajiairieii 
KramkieU, Vogt); (b) creating diaeane, ae 
cbnnie phthiaia; (e) nphilis; {d) malaria; 
(() linr diaeaae oc jaudiee if loB^^Mmtinned ; 
Ir. ; b«t in nana of than eaaea ihonld there be 
aay dilBenlty if the pieee^ng dictum ie home 
iamiad. 



I.— Xhie ia always nnfaTotuable, but 
it is UBpeenhle to aeaign any definite period for 
the termjaarinn of theffiaeaae, lince it often pct>- 
ftnewi incgalady, with periods of in^oora- 
iMBt followed by reUpee. 

TaaacMBiT. — Fran wiiat has jut been aaid 
it i* {ulain that sot mneh is to be efiected by 
tieatamit as legirds the cue of the dieeaset 
bat nueh may be done by canfiil manag»- 
ai«>t to letam its pngreis and eomfort the 
fotieat. Am aooa aa the diwaae is disaaTwed« 
the ssoBcr the patient mahea np hi* mind to 
an imafid li& the bettce. Beet and carefU 
dietisgase the baas of the tnatmenV Am t^ 
gards £tt, it may be briefly aaid that what 
the patient can take beet snits betU As the 
etnawrii ia ao irritaUe, anything likely to npset 
it ahoold be aroided. Hsnee, as a nilak it is 
better to fien egneentrated nooriehmeati as 
esaaoes of meat (not tie a&aei) or ebidun, 
or raw poonded maatt when other things eannot 
be tsksB. It is also important to bear in mind 
that the stnmarfi will often tdlerata food etdd 
«r af<n frooen, when hot snbstanees wonld be 
pseaoUjr rqe^ed. In certain atagas of thia 
nmlady it may wdl be said that the physidan'B 
ani-ww will depcod mora on his knowledge of 
the eookoy book than of the I^aimaoopceia — 
not, howerar, that oar phaimaceetioal gifts are 
to be deepiaed. For the profrand depression 
stimakaits will be useeasaiy, bat theae may 
take the ahaae of etlMr or spirits of obloiD- 
fiam^ aa well aa of wins or bnndy. For the 
initaUa atonueh, alkaliea^ with nox vcnica and 
ipeeaeoan, or catlnmba, are of creat sarriee. 
So, too, in another «sr> are liffA tonics and 
■eatnl oalta of iron; Imt the stomach should 
not be dogged with too modi medicinek The 
bowds ahoold not be mneh disturbed, bati 
if aa aperient be reqnind, a mild odsi aa a 
small doae of castor oQ, or the componnd 
linariee powder of the Proanan Phsimaoopaeia 
wfli soit, if the atomach does not rebel ; if so, 
a winnglasAI of Hunyadi Janos water the first 
^mg ia the mamiag, foUowed by_ a can of warm 
stt, Bi^ batter sgrae with the irritable organ ; 
vkaa 4acs is £aidi«a, a totally diftrent line 
af tagalBHot will ht naeeaaary. Bnt in all 



AX»HE8K»8. u 

things, and at oiU kiiaaa, th» grand nle i« t» 
•ave the patiant'a strength, to add to it if pa«. 
sible^ and to cenLst the inroads of the '^'Tanoc 
wlutever ahape t'We qa okay aoanme. 

Al)llHrAI.<iXA (Mil,, a gknd. and tXy,. 
pain).— Pain m» a gland. '^ ' 

ADBHITXa.-iiiUmmation of a gUad. 
&»theaeTer»i glanda. if^aa. 

ASBNOCXSXa (MV, a gland, and .ijx,. 
a tnmour). A. tnmonr connected with a glani ' 

AJ)BNOIX> (iSh", a«Iand,and d»e., foroV 
—Glandular : r«s»mM% the stroetare of • 
gland, whetlior •'CTetiogorlymphatie, 

ASBirOBCA (Uifr, a gtand, and t/ibt, lika). 

A morbid growth, the stmetare of whida is' «f 
glandular natitre. Set Tuitoons. 

AJDHBBIOWS. / —»»»«*»«• »~ ■'^d ta 1m 
adherent when thejr become^ abnormally UTxited 
tofrether, the morbid formations by -which this 
union ia efiected being' termed adhliioif. lY^^^^ 
are moat frequently melt 'with in cooneetaoia iviih 
aerons av&ees, being' nsmally the roaalt of ^, 
infiammatoiy pneesa, 'bob they may b« olia«rv«j 
in other atnictaraa. ^Rie adberioos wmxy ami* 
siderably ia eoctent, nimiber, nied* of acxasieal 
ment, firraneas, and ottiar chaiaetars ; thawaSr 
merely oonaiat of a fr«r loose, slendor, and daJ 
eats baada, or these bands may be thick illl^ 
stnmg, or the eontig'isaiis anifccea n^w iJ 
blended and matted taaatiMr to a trp*m*:J^^^ % 
extent, ao that they oannot be aep^nrtS^fi. ** 
tearing or eotting them aannder, thiaiW^ j?' 
tion oonstitoting agfUi/imaion. In^^Z *'*'•*• 
adhemons conaiat mainly of connactiv« j^^?^"'* 
tissn^ more or leaa ponfecOy dereloiM^ "Moiis 
few new Teaaels. P«"» -with a 

EmcTS.— Adhesions are often fonn^ 
mortem ezaminatioDS, which have !»« *' P**'* 
or no consequence dxning life^ a, ^P*** **^ "ttio 
many of thosewluch form in connB-«^ '"ff'c^ 
pleoral anrfeces. If, hower«., theT*;^ *?"■ "» 
and firm, or if they oocnpy oerti- ^..^"°*"^» 
the body, they may prore of^" T**™*" "f 
The priscipa •'ii-'Wch..reliabr'^'^<^ 
from adhesions may be thns indicated -— -i Tk 
often bind parts together, and interfer^ t5»7 
the moremenU of important orsuna. onch 
the longs, heart, stomMh, or intertinoa : in th!! 
way prerenUng the due performance «rf ti.1! 
functions. 2. When an organ i. displaced in 
any way, sa. for exmnple, the heart by plaoritie 
efliuaion, It may become fixed in iu new- po«tion 
by the formatioa of ndheaions. jta fnncUons 
bang thus disturbed. «. It is highly probable 
that aggludMfaon mar lead to hypSn^phy "f «» 
organ. «^., Ae liMrt, bjj embaniaainif tt* •»»■»•• 
ments, and hence aincting its •ctionf x. On the 
other head, atrophy or degvnaratioii nf .U^*"*^"** 
msrr enene, in consequence of the aAKjLio''* '*" 
tscfering with tbedoe supply of hlonA^-o***^^ 
vpon the vaaseUi so that the OtSSs 2»» "* ?-? 
tiisues becomes impaired. Ia **t^**\^ff' 



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ASHBCnOKS. 



Ik* d»T«topiMiit of •trnetnrM may be ehaekad. 
A. Adlianoni m»y iardT* important strnetiiiei, 
•adi •■ narre* or yemtlt, pnanng npon or de- 
■tioying them, Ihui giring riae to ■jisptom* of a 
tatiooa nature. 6. Tabes or canals for the pas- 
sage of secretions or other materials are some- 
times narrowed or obliterated bj adhesions. 7- 
When formed within the abdominal cavity, espe- 
dally when they tika the form of bands, adhe- 
sions may piore highly dangenms by oom- 
pressing, constricting, exerting traction upon, or 
strangulating some portion of the intestine, in 
either of these ways leading to intestinal ob- 
sttnetion. 

It is firequently difficult or impossible to deter- 
mine the existence of adhesions fay clinical inres- 
tigation daring life ; but the history of some past 
illness dnring 'which ther were likely to be 
formed, the results of physical examination, espe- 
eiaUy in connection wiUx the heart and Inogs, 
and the symptoms present, not unoommonly 
enable them to be disoorered, 

Fbxdbiucz T. Robbbts. 

ABIPOCBBH {adepi, fiit, and osro, wax). — 
Snroir. : Fr. M^foeirt; Qtt. Fettwaeki. 

DBmnnoir. — A substance fbnned by a nmn- 
taneous change in the dead tiasne* of animals. 

DBSCBipnoir. — As seen generally in a dried 
state in mnseums, adipceere somewhat rsssmbles 
spermaceti in consistonee, but it is less crystaUine 
in fhtctnre, and is of a dull white or buff colour, 
the sorbce being mnrked by the ontlinea of blood- 
▼eesels or other textures. Adipocere in the earlier 
stages of its formaUon, or when formed in a damp 
situation, is soft, and if rubbed between the Angers 
oommnnicates a greasy feeling. The odoor is 
. peoalinr and rather disagreeable. 

CHBincAL CoxposiTioir. — Adipocere diasolres 
in ether, leaving a delicate fllamentons web ; it 
bums with a blue 6ame, yielding a white ash. It 
is properly described as s soap eomposed of mar- 
garic and oleic adds in combination irith ammo- 
nia, the fixed alkalies, and alkaline earths; the 
nlatire proportion of the latter ingredients raiy- 
ing vith the age of the specimen (the ammonia 
disappearing), and with the composition of the 
fluids in contact with which the adipocere had 
been formed. It is said that oleic acid predo- 
minates in adipocere formed from dead fish. 

MiCBOsconc ApPKABAircss. — When the flesh of 
animals in which this transformation has recently 
commenced is examined with the microscope, it is 
fbund to be composed of broken-down or dis- 
integrated tissues, fatty granules or particles, 
together with a few acicnlar scales or eiystals. 
The gnnules may be seen in what was muscnlar 
tisane to assume somewhat the arrangement of 
the muacular filaments, thus preitenting an ap- 
pearance resembling an early stsge of &tty 
degeneration. In old and dry specimens of 
adipocere the crystalline scales form the great 
portion of the mass, and they may be obaerrcd 
preserving the outlines of the muscnlar fibres. 

OBionr. — Adipocere has long been known. It 
it formed readily flmm the ifesh of animals ex. 
posed to moistnre, or pltetd in running iratm 
in Tory dilate nitric $eid, or fg «)eoboI «„ .' 
water la tb» woportka of I t^g It ja {,* 1 
MS* with in iDaunaiut ^fcjj^^nee it, ^ 



AKPOCTKB. 

specimen jars of tbtf anatomist The bodist 
of men and other animals boned in peat moss 
have frequently been iband completely converted 
into adipocere. Lord Baeon mentions it in the 
Sylva SjflBarum, and so alao does Sir Tliomaa 
Kown in the BydriotapUa ; but attentioB iras es- 
pecially called to ita presence when a vast number 
of faodie* w«re removed (in 1786-87) from the 
Oifiutiir* da Innoemitt at Paris to the Osta- 
combs. FoureroT found many of thsse bodies 
nonverted into what be named edipceire, a name 
since retained. Oibbas (as did others) snggested 
the possibility of applying adipocere fiwrara from 
the waste flash of animals to soma oseAil pnr- 
poses, bat the tenacity of the disagreeable odour 
and the presence of other difBcnltiea have prevented 
these suggestions from being carried out. With re- 
spect to the immediate chaoges which give origin 
to adipocere chemists have differed in opinion. 
One dass believes with Oay-Lossse and Berzelina 
that the eompoond reaalts from the fiit originally 
present in the Uasaes^ and that the other eompo- 
nents are eompletelv destroyed by patrefiMtion. 
The other class, which inelades the names of 
Thomas Thomson and Brands, maintains 'that 
the fslty matter is an aetnal jnodoet of A* 
decay, and not merely an adact or tesidos.' 
These opinions may, the present writer thinks, 
be nooDciled by the bettm knowledge we now 
possess of the elementaiy composition of tissues. 
We know that the combination of fiit and albu- 
min oonstitnting one of the earliest steps in the 
process of nutrition is traceable in the farther de- 
velopment and formation of nearly everrteztaie. 
When that oombination is destroyed by a ces- 
sation of the process of life, the tissues are as it 
were resolved into their primary elements. We 
may thus have adipoeere derived not only from 
free ikt, but from the elements of &t existing in and 
obtained ttota the deoompoeiUon of other tissues. 
Adipocere may thus be described as both an 
educt and a product This opinion is confirmed 
by the researches of Bauer and Voit who showed 
that fcitty matter was derived from the meta- 
morphosis of albumin in starved animals^ to 
which phosphorus had been administered.' 

The interest concerning this substance is not 
confined to the chemist The medical jnristkis 
studied it with the view of determining the time 
and progrees of its formation, and of £hns ascer- 
taining the probable period at which death oc- 
curred. But hitherto no decided or satisfactory 
information has been obtained, owing to the 
varied circumstances which inflaenoe the prognss 
of the change, in connexion not only with the 
condition of the body itself, but also with the 
character of its mrroundings. He fbrmation 
of adipocere has a farther and a special interest 
for the pathologist It was the stndy of this 
process which led the present writer to point 
out the analogy which exists between it and fatty 
degeneration in the living body, and thus to es- 
tablish the pathological doctrine that fatty dege- 
nezation ia the result of a retrograde metamor- 

• The writer would deetra to refer bete to the analogy 

^)eh nnns to nrtal be t ween the ctange of aniinal 

TlJtter Into adlpoone, aodtkat which ooeiia In vegetable 

I '^tterl^ltaaoiiTailan Into pest and ooel. Thls,haw- 

fl'Zir <> oet the pleM in wliUsh to examine farther sauh 



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ADIPOCEBE. 

, due to defeetiTe nutriUon. {8m iltdical 
imd Ciirurgieal "Bnauaetiom, toL xzxiii.) 

BicHAss Qtunr, MJ). 

ASrPOSIB. — A term irhich properly Bigni- 
fca either general corpulency, or accnmalation 
of adipose tiasne in or upon an organ. Stt 
Fattt Gboitth ; and OmsiTT. 



and tirafui. 



ADYWAICCA \ ,. ., 

▲STBAKIO / ^*' P"^- 
povwX — Terma indicating aeriona dapnation of 
the Tita] powers, and employed aa aynon^rmooa 
vith the 'tgpioid eondUion.' Tbe alljectire ia 
api^ied to diaaaiifa in which the phenomena 
td tlua eoodition are prominent. Sie Ttthoio 
CaxBRXoa. 

.SOOFHOirS' (^, a goat, and ^tn>%, voice). 
— A pecnliar alteration of tbe leaonance of the 
Toioe, as heard on anscnltation of the cheat, 
compared to the bleating of a goat. See I^trsicu. 
EzumrATKnr. 

.BTIOIjOaT (oirto, caose, and \6rfos, word). 
— ^Tkkt famich rf pathological acienca which 
deals with the eaaaattoa of diaaaae. SraDuKAo, 



ATFIHinrS'.— Thia term ia the designation 
of a piopertj by which elementary and com- 
pound anbalancea unite with one another and 
farm new componnda. It ia, therefore, a pro- 
perty with which chemista are principally con- 
eeraed. Bat the ideas soggested to the chemiat 
by the term affinity are alao^ though leaa 
expUeitly, excited in the mind of the pnthologist 
and of the therspeoiist by certain claasea of &cta 
&eqaently ftlling nndei their obaerration. The 
ptfhologiat, for instance, knows that aalina or 
eeithy matter ia raj prone to accumulate in tbe 
midst of degenerated (iasne in the walla of an 
artery or of a cardiac ralre, so as to give rise to 
a patch of ' eald&ation ' ; he knows that in a 
KoatT patient mate of soda is most apt to accumn- 
Ute aod tarm 'chalk atones ' in the ti^anea around 
allected joints; he knowa that, however it may be 
adminiatered, arsenic in poiaonona doaes tends to 
podnee inflammation of the alimentary canal, 
that Btiychnia acts with preference upon the ner- 
TOBs STBtem, and that in ordinary cases of lead- 
poiaoning this metal interferes especially with 
tbe cntritioa of the extensor mnscles of the fore- 
arm. Applications of the same notion in tbe 
dejwrtracnt of thenpentica are equally familiar 
in respect to tbe action of many drags. It 
Bar be rrgaided as an ascertained fact that 
iodideafpotassiwn tends especially to influence 
the nntritioii of the llbroos stmctores in the 
body, and that bromide of potassinm has a no less 
ortaia aftion in modifying the nutrition of the 
acTToas eeotres in many nnhealthy states. Again, 
there is a whole class of snbstancea which when 
taken into the syatem hare, whaterer their 
atl»r actiooa may be, an nndonbted effect in 
■odifying the fanctional activity of the kidney. 
W'e hare in nitrite of amyl a remedy possrss- 
■eg a lenuukable influence orer the unatriped 
at— .J ar flbres of the arteries and bronchi, or 
elaa over the nerra-oentres by which they are 
•oelidled. We hare io woorara an agent which 
acta ■^aoaUy upon the motor side ol tbe ner- 

8 



aooek.aje»:eobia. j^ 

TODS system; and -^^"^ tare in digital!, «n im. 
portant remedy ■wl»5<2l»» amidst its other rffecta, 
■eems to have a det=i<3.^»«3. power of improriDir the 
nutrition of the catr-«iia»« ganglia. The r^t 
progress of thorap^-«mfci«^« encooragea m to hope 
that more and mo»r>^ o^ those specific efiocts of 
dm^ will bo accur»».t.^ly determined, so that tbe 
notion implied by -feb.^ term <fffnity taaj, miter n 
time, have a deeper' ax»«aning_ than at praeenf 
for the practition^^ar of medicine. Set AjriA 
oomsu. H. CoisLTON Bastuji, 

ATFlTSIOir. ^-A. 

consists in pouring sa. 
cold or warm, npoxm 
Therapeutics of; sekI. 

AFBIOA, BotL-feXa... - 

AOBTTSTIA (&. -jgt: 
Loss of taste. See T. 



« "thod of treatment w*/ch 
a -aid, usually water, either 
■t he patient. See Watkb, 

.U.ATHS. 

—See AmxTDix. 

iv,, and 7«B<rii, taste). — 
Disorders of. 



AaOSY (irjin^, m^X'ita or struggle). — AgonJ 
implies bodily pain oar mental sufEsring Bo in- 
tense that it cannot Z>^ eoduTed, but excites t 
struggle against it. £t imi salso applied to ihefiiai 
struggle that often pr^M^^rtles death. See ]>s*<iEt 
Modes of. 



AOOBAFHOBI.A. 

and ^iSot, fear). Sti«>2«'. 
— By these nameo a p>e< 
has been recognised, ch 
of alarm and terror, ac< 



li 



Lx nervooa cov.,Crr! 






fMuied iritK 
of nervous symptoms, -vr-Js a^fc — — - •* 
experience when they a 
The condition may be de 
dually, and the chief pli 
aa follows : — A sudden se 

as if the heart were heixM^p £fa '" ''^r^ 
organ palpitates violentlj^ s th *P^iJ f^^J-i 
flushed; the legs feel weaa-Jc. tr^ fi*<J/**'^ 
HS if they wouldgive way n. » - 

nuiy be sensations of itch! 
neas ; or profuse sweating wir» «»j>-^^ --<i>p 



in 

>fed 



"■°M,°>*y^ 



true vertigo ; the special 
and consciousneaa is sot 






"j". "i.'i* - "'^i 



cunons impression is iovaetimmt^ 'tifT'^^^ ''bn 
if space were elongnting itaolf ^'-^p^f^ifoJ'^te^ . 
Persons who are thus affecto<i skT*'' f ^^j^^" ^' 
of the foolishness of their *o,7* 9i,-''^6l7^'^5^' «, 



eru 



reasoned out of it. Buri 

feel a strong inclination to cry ~° af t'^^Ofl """■ 
do so. They think that thoi,j''t. 67'^V^l *< 
to others, and many of them enrf °"c/ ■' fon ^^ 
ceal their feeUngs, lest they shoujT^v^onJ* ioL!° 

'"■»"*• ^ Cor,^ eon 

The circumstances under whi^v '^^im 

jnst described may be 6xperienn«j*''8 ,- ^^ 
They may be felt, for instance • **» S^.*o»li« 
especially if the shops are shut"' ">e ^ ""s, 
bnildings, such as churches, coj^ ' 'o ^ ^^t, 
theatres; in omnibuses, caha, oj ^^^''^ot'^^''' 
ances ; on a hridge ; or in looking at *■ con"' °' 
faijnde or flying perspective. Siosj "^ ''*teiid''''" 
suffer thus in the street feel bette>^^'^°i8 ^^^ 
some one, or when near some objeot*'''"' tritj? 
carriage, or even when carrying in^ *™<:h j,^ 
a stick. Occasionally, however, thev'i!''^ oS 
people, especially acquaintances, *» oth^ 

But little is known as to the orleiB 
of agoraphobia. The complaint isw"^ "^'ora 



\ 



L 



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(Soogle 



IB 



AiJOBAPHOBlA. 



u idiopathic, bnt u aeqamtial to wme atba 
eondition. It oeenrs in mal« and females, and 
the indiridnali affected may be itioni; and in 
good bodily health, while they ire often intel- 
Ogent and trell-educated. A h'i<toty of heredi- 
tary nerroni disorder can be traced in some 
caaes, indicated by the oecnrrenee of inaaiuty 
or epilepsy in members of the family ; and the 
patients themselves may present indications of a 
nenroat temperament. Their emotions may be 
easily excited; and they may be subject to 
nerroaa symptoms, snch as headache, a feeling 
of heiat in tne top of the head, sparks before 
the eyes, occasional faintness, or motor disorders. 
Fbsdbiucic T. !Robbbts. 

AOBAPHIA. See AnusiA. 

AGBIA {iyput, wild). — This term signifies 
angry auU severe. Willan describes a Lichen 
agrin, vhich is likewise termed Agria ; it is a 
cirenmscribed inflammatory semimi sitoatad on 
the back of the hands. The qn&litiea implied 
iby agria are ezeessiTe pmritns, hnming pain, 
thickening, fission, and copious exudation. 

Ebaahvs WiLsoir. 

AOmL — A popular synonym for Intermittent 
Ferer. Bee hrtaatrmon Faras. 

AQTTE-CAKI!. — A form of enlargement of 
tRe spleen, resulting from the action of malaria 
on the system. iS^ Spuikh, Diseases of; and 

UUJLBIA. 

▲IB, JBtlologr o£ See Disuse, Causes of. 

AXB, Therapeutioa of.— Air is employed in 
the treatment of disease in many ways and 
for many purposes. It is used, first, as tie 
atmotpkere, a gaseous mixture of definite compo- 
sition and with a variable pressure. Secondly, 
advantAge is taken of air as a vehicle for other 
substances in the gaseous or finely divided 
state. And, thirdly, it is selected as a medium by 
which the temptrcUure of the body may be readily 
and effectively influenced. In the first of these 
relations only — as pure air — will its therapeutics 
require to be considered in this article. The 
application to the body generally of air that haa 
been warmed, or warmed and loaded with mois- 
toxe, will be found described in the article on 
Baths; while its administration to the respi- 
ratory orgms, either in this form or as a rehiele 
for such substances as creasote, carbolic acid, 
alkaloids, and solphorons acid, will be dis- 
cussed under iHRALATiom. 

Prihciflas. — The dual relationin which the air 
stands to the economy — as a definite compound of 
certain gases, and as an atmosphere with a certain 
pressure— is very frequently disturbed; and 
this disturlwnce accounts for some of the most 
familiar phenomena of disease. Alteration in 
the quality or quantity of the respired air, 
whether from the stato of the atmosphere itself 
or from derangement of the complex apparatus 
of respiration and circulation, is the cause of 
■ome of the mOst serious and distressing syinn, 
torn* attending diseases ot the cheat. It tQinfT 
be predicted by the pjiyu'olqgist tlwt under th 
eiicumstances relief wonid be aBbided, a^ j ^ 
to ^mptoms, by miitable aitention of t])^ ^^ 
ponlioa or rotame ot the ^t, Jb» mat], *H)k, 






Ant, TBBRAITEtmcS OF. 

treatment thus rationally indicated is ftartte 
readily practicable — the snpply of air is >■• 
limited ; its composition may be altered at plea- 
sure; its pressure may be increased or dimi- 
nished ; and such alteration will alter its chemical 
properties. We find accordingly that, ever since 
the discovery of the composition of the atmo- 
sphere, frequent trials have been made of its 
Tulue therapeutically. Oxygen was early recog- 
nised as its active constituent, and came to be 
administered, as it still is, in the form of 
inlialation. From time immemorial, indeed, 
advantage haa been taken of the purity and 
certain other unknown qualities of the sir 
for the prevention and treatment of disease; 
and the diameter of the atmosphere is natur- 
ally reckoned one of the most important ele- 
ments of climate («< Cukate). More recently 
use has been made of the powerful properties 
that air possesses when phyeicaUy changed. 
Within the last few years a remarkable advance 
has been made, on the one hand, in the physio- 
logy of respiration and the relation of the circula- 
tion to the atmospheric pressure, and, on the 
other, in the pathology of diseases of the chest 
Clearer views liare been reached on the signifl- 
cation of various symptoms, and especially of 
dprspnoea in its different forms. At the same 
time observations upon the effects of compressed 
and rarefied air have tieen becoming more exact. 
Forsuing the physiological track, modem the 
rapeatisto have availed themselves of this know- 
ledge, and revived the use of air physically 
altered in the treatment of diseases of the langs, 
heart, and other parts of the body. This ap- 
plication they are now able to make with accu- 
racy, and the success of the reformed system of 
aerotbenpeutics appears to be unquestionable. 
Although in England it is seldom hoard of 
beyond hydropathic establishments, the system 
is more extensively employed on the Continent. 
Its leading principles and some of its most 
important applications will be here briefly de- 
scribed. 

The physiological effects of compressed or of 
rarefied air will manifestly be different accord- 
ing as it is admitted to the body as a whole, or only 
to a part of it Familiar examples of the former 
condition are afforded by descent in the diving- 
bell, or ascent in the balloon ; and of the latteif 
by the action of the cupping-glass, and the effect 
of interrupted or frequently repeated respirations 
upon the pulse and system generally. Under 
the first circumstances the alteration of pressure 
is absolute; under the second it is relatire, 
and capable of producing most important 
disturbances in the distribution of the vital 
fluids. The two methods of application must 
accordingly be separately discussed. 

Gbxbral AiinoTHERAFRuncs. — The effects of 
compreeeed air on the body as a whole hmvo 
been studied in the air-bath, a simple mechanical 
arrangement in the form of an iron chamber, 
which can be filled with air at any prearare, 
whether above or bolow the normid, by means 
of steam-power. The principal physiological 
gfiects of air condensed bv three-serenths of 
-n atmosphere were ascertained by von Vivenot 
^ be:— pallor of the skin and mucous mam- 
^rsnet; a Mnntion of presmre in the oars; 



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■phen, immadUteljr 
inapiratory dyspncea : 



AIE. THEEAPEtJTICS Of, 

dbmdi^Hl tMapuaej of rsapirstion, the act be- 
eoBing; eaaHw; cnlugemeiit of the Inngt, and 
limmMi of the Tital capacity ; depreaeion of the 
— giti*!' f<»ce. and diminnti<m uf the size and 
■tnngtb of the pube ; rise of temperature ; in- 
creaaed rigour of moacalar actitm, aeeretion, and 
■atrilioa g«iarallT ; compreaaion of the gaaeoni 
T'm**fK» of the intesbnea ; and, perhapo, in- 
cnaaed abaorption of oxygen and excretion of 
earbooie acid. When the preaaure ia exeesaive, 
dugerons or eren fiUal ijmptonu may snper- 
TBoe. Freqoent azpoanie to condensed air vill 
■ndage eonsdcrable increase of the Titalcapncity ; 
and moat of the other eftcta, both physical and 
chemical, vill tend to persisL In a irord, it nuy 
probaUy La aaid that the air-bbth acts on the 
fyatem. Sat, tiy increasing the gaoenU me- 
A«"'~' preaaure; and secondly, by admittinft 
•a iaereased anxnut of oxygen. In employing 
dia air-bath, the patient is kept in it for a 
period of two boms, at first daily, but af(er 
aoma veeka leaa frequently. The preesnre, -which 
'.» employed in diflerent cases at one-fifth to 
3ne-haU o( an atoioBphare above the normal, 
■■St ha slovly raised on admiacion, and reduced 
oa renraial of the patient. 

Tha Bomber of dheaiu in vhich the air-bath 
nay be ^iren vith snooeas is limited : — (1.) In 
eeitain forms of dysfOKEa: — thas it gires great 
nliaf ia spaenodic aatfama, and ma^ alas afford 
lamponiy relief in emphysema, but its prolonged 
use appears to be po«itiTe!y bad, as it ia- 
uaau.1 the palmonary distension. (2.) In hy- 
|ienemia and catarrh of the air-pesaages, inclad- 
mg peztBSafia. (3.) In imperfect expansion or 
threatened retraction of the chest, as in the sub- 
jects of phihisiaaiid chronic plenrisy. Compressed 
air haa alao been extolled in some forms of car- 
£ae dinacc, and in general malnatrilion. 

Tberbeta o( rmrJSedair admitted to the body 
aa a vhole do act demand description in this 
plae^ either in their physiological or in their 
tbaapeatical aspect. Artificially nuefied nir is 
Barer empkryed in the form of the bath ; and the 
aaUiral npply in elerated regions, which has 
£>and so much Caroor as a means of treatment 
ia phthisis, ia a subject that belongs to Cuh^ts 
aadPwnasa. 

LocAi. AcaammBJLPBirncs. — When it is de- 
airad to bring eomptvssed or rarefied air into 
cOBtBct with the rapiralory snrfiice only, a 
£Sereiit appanitas moat be employed. Several 
farms bare been introduced, respecting which it 
will be safficieot to state that the air contained 
in a gaa-holder is compressed or rarefied by 
simple meebmnicsl means, and thereafter brought 
into relation with the air-passages by an arrange- 
■aat vt tabes and tbItvb. There are fonr pos- 
■Ua ■afhmli of ajqilication : — ( 1 ) Inspinition of 
eendaiiaetl air; (S) Expiration into condensed 
air ; (3) Ixnpiration of nreAed air ; and (4) Ex- 
laratioa into nreflrd air. The physiological 
efleela at the serenl methods hare been caro- 
islly iamtigatsd by Professor Waldenburg, of 
Barlia, vhoaa aeeount we shall fcdlow. 

bu f i r mtiut of tondeiued air. — Inspiration of 
wx that haa been eondeoaed by one-sixtieth 
ta •aa-foctieth of an atmoaphere produces 
• aaaaaiioo of extreme distimsion of the 
ebest, aeoeaipaiiied bj an actual sxpansioii 



-""^„--« 



l» 

"waiBssaj 






of the thomx 
admission of air, vc: 
present, ia relieved— 

thoracic eontenta tm.-*r^ _ ^^^Pffcivl .. ' ••■«' outm. 
vessel, fill, the »r*«.--"Vj«re,;^' «>• s^,^J 
jugulars become *■«»«>» «»**«i Th.^^^**"" *nd tfc. 
will be comparatir*-,!:^ -*•«„>. ^"^ «nd h^ 
tion of condensed •« xc- **** '"ooo-bh * "PP/ica 
vital capacity, the «i-=^, «' the cbl"^^. t6." 
epiratory force, miay ^1» , ^"er^zti ^"<^ tha f^ 
relief may be peina j» ks «d «y ^tb^^^l '"/ J»KfaJ 

ExpinUioH into ct^^^^^'^'^Ueii ^-^ ."^ '° Oympg^ 
of accoraplishmMit. «.»»<* *'"*«in,«L?"'^ *««;/ 
torytime. The effect *'« «ie p,v^'?"'? '» 'nspin,. 
differ essentially from t Im ./ustT'™"" does not 

liupitatioA ofTarc/S*f^ """•^In,"*" '^■ 



that has been rarefie<Z 1>J 

fortieth to one ono-Il «xid.„„.„^^, 

even, after a time, bjr 0"c-si";tt,Y,jj'''''fntfeth~( 



7 one t JP''*"> 0/ ai. 



' tijo 



-ot 



or 



"n atmo- 



_ . . tiio tliop^ .P"*nomena of 

congested, and hremoptji-s-is m.i 



•o- 



'•isccra are 



effect may be regard e<j Aa thg^"* Jl^'u/t, for jj,, 
the pulmonary Blreoli. Tbe " ""^ 

time becomes foil, and tii« 
Expiration into at'r 



lum.i. *t tbt ..».r 



'"*' i«« l'*J'«P»s. 
by one-sixtieth of an Htaioapkef^ been ran/lal 
a sense of eitrpme comprws^ioij -L* ''tended wi^ 
the same time there is actually .""e thcrax- t 
tion of the lungs, an increas, i„ ^<^rtiAl tttnr 
expired air, and a corroapojuj,- " 'ho roliaarf 
the amount of residual air io tiJi^i"o'nntion i 
tory dyspnoM, if present, ia relievei"*-^ ExpirJ? 
lungs thus dimmish m siw, tj,^ ™- Wbiie the 
viscera are dilated— the heart and th ' """"cie 
and other vessels within the chest £? ''"'"'"nary 
the expense of thoee external to it h"^ *"*** " 
and veins. If the expimtion intn L. °a ?'**riea 
frequently repeated, the circnmff^'^ t'' ''^ 
chStwillbefenished,whnrj£e"t,? °' ■'"' 
iriU be actually increased, along with incr^'Sp 
the inspiratory and expiratory force. 

AppUoaMons. — The method of »»*»*«•«/, 
txmdmKd air is obviously indicated in diseaai 
where inspinitory dyspnaa is an urgent syn^ 
torn. Spasmodic asthma, stenosis of the air- 
passages from anatomical causes, aente and 
chronic bronchitis, and atelectasis, have all been 
successfully treated by this method. In nom, 
where it is urgently indicated, it is most difflcSt 
or even impossihle to employ. In threatened 
phthisis it is used prophylactically ; and in chronic 
pleurisy it may prevent or remove the effects of 
collapse and retraction of the chest wall. Tha 
inhalHtioB of condensed air should also be of use 
in certain forms of cardiac dilatation, especially 
thatdneto mitral iuoompetence. Impim-ingas it 
does the general nutrition, it msy be combined 
with other remedies fbr ansmia. In the ndminis- 
trution of condensed air, a 'sitting' should 
last from ten to thirty minutes, once » 
day— seldom twice. — Expiration into eon- 
dmud air ia not used theraDeuticalW __/«- 
tpiraiitm of rarefied air may bo regnrd^~lB a 
means of exercising the inspiratory Z~ „i««. 
Like the atmosphere of great altitude. .?\n*y 
therefore be employed in persons with K ji de- 
veloped chests ; and even in phthisia 5.^^'? 
increasing the amonnt of blood 



>ui>.iuuro uD ou>{>iuj<u IB penons witu k ■-, de- 
veloped chests ; and even in phthisis 4 J^"'" \fm 
increasing the amonnt at Vilnnrf in .5 tna/' ^ 

t»<i itt«»5:; 



increasing lae amonnt oi blood m tv ""J' ^ 
prevent casestloa and promots absor^-'^^ ^^'Sm 



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10 AIB, THERAPEUTICS OF. 

BCodneU. Id dimna of the right lide of the 
beut, it irould aaost the flov of blood from the 
Taini into the Inngi, bnt it ia not likely to be 
employed for thii purpose. — Expiratiim into 
rartfiii airyiomiBet to bethemostsqccessfoland 
moet exteniirely emplond of all the methoda. In 
it, aoeording to Wnldenbiug, ve hare the phyn- 
eal antidote for emphyaema, and in hie handi the 
Bugority of ineh patientj hare been either cored 
or radically benefited. It haa also afforded great 
relief in aome cases of bronchitis, where it in- 
eraaaes azpectoiation. 

Other local applicationa of the phyaieal po- 
parties of the air, as seen in aapintioo, capping, 
Jnnod'a boot, and inflation, are deaeribea els«- 
irhaie in this rolume. J. Ilircaiax JBbucb. 

AIB mr am^LXUiAS. TissTnn. sm 

ElCFUTSSllA, SvBCtlTAKBOtJS. 

AZB ZH VXIIT8. &«VBin,Airia. 

ATB-FABBAaES, Dlaeaaes of. &» Sa- 
snaiTOBT Oboams, Diseavea of; alao Labyhx, 
Tbachsa, and BaoircHi, Diseaaea of. 

AIX.I.A-OHAFSIJ.B, "Waters of: Ther- 
mal snlphar watars. Set UnnMAi, Wanus. 

AIX-IiBS-BAIira, Waters of. Hot snl- 
phor waters. Stt MunoiAi. Watsbs. 

AXINXSZA, 8u Acimsu. 

AIiBimsX (albiu, white).— DanimnoK.— 
A state of wbitaneaa or absence of colour of the 
integument and certain other tiaauea, cunsrquent 
Odd defect of pigment-formation. The wont of 
colour may be eompkt* or ineomplete; partial 
vr uniimriai ; congenital or aoeidental. Partial 
albiniam may be limited to a spot of small 
dimensiona ; or there may be many anch apota 
of variable extent, dispersed over the surface of 
the body, and giving rise to the appearance 
which is denominated pied or piebald ; whereaa 
in universal albinism the defect of pigment is 
not restricted to the integument, but is especially 
remarkable in th^ iria and choroid membrane Of 
the eyeball. 

Obkcbal C&uucrmis. — ^Penons and nnimala 
aActed with albinism are called alUnoet. It 
woald ssem more correct to limit the term albino 
to those in wliom the absence or defect ct 
pigment is nniveraal, and demonstrable not 
oiuy in the integument bat likewise in the 
eyeball. In the true albino, therefore, the 
ddn is white and pink and mors or less 
transparent, and this both in the fairer and 
in the darker races of mankind ; but in certain 
of the latter, where the pigmentary function 
is simply defective and not totally wanting, the 
colour of the skin may be grey or tawny, and 
more or less variegated and fredtled. The hair, 
sometimes of a pore silvery or opaque white, may 
be diversely tinged with yellow or red ; occasion- 
ally it is flaxen or possesses a greyish hne ; and 
in some instances the whole body is covered 
with a white down. The iris is grey or ^nk in 
aeoordance with the density of its fibrous stmc- 
twe, and the ooineqsent facility of penetration 
of tlM colour of its vascular layer ; or, as geae- 
rally happens ia the n^grob it is blue. The papil 
ia eoBtiMlsd and brightly red from th* abttg^ 



ALBXJiHSOID DISEASE. 



of the screen of poteetion nsnally aflbided to 
the choroid memorane by its pigmentary layer; 
and for the same reason the nya of light pene- 
trating the aderotic and iria give a brilliancy of 
appearance to the Aindua of the eyeball. The 
abaence of fngment in the eyeball is productive 
of several pec^iarities of character in the albino. 
In the flrat phice the excees of luminoni rsys 
penetnting the coats of the eyeball interfares 
with the correctness of his vision ; bis ratine are 
intolerant of light ; he ttoope his head, or droops 
his eyelids, to shelter his eyes ; he sees with mora 
comfort in the dimness of evening than in the 
light of the sun ; he is near-sighted ; and there 
is in many cases an oscillation wT the eyeballs. 

.£tioloot. — Albiniam ia met with among all 
racea of mankind and in every country, btt ia 
moat common amonpat those who are subjected 
to insalubrious conditions of climate and hygiene. 
For these reasons it is not mwommon among the 
natives of the marshy coast of Africa; among 
negroes who are transferred to onhealthy districts 
in Sonth America and the West Indies; among 
the inhabitants of the western coast of South 
America and Mexico; in certain of the ialandi 
of the Indian Ocean ; and even in the northern 
regions of Europe. When albinism is congenital, 
it has been assumed to b« doe to an arrest of de- 
velopment; but when aoddental, ita existence 
must be refened to exhaustion of chromatogenoai 
or pigment-producing iHinction. Arrest of de- 
velopment haa been inferred from the occaaional 
peisiatence in albinoea of the membrana pnpil- 
una, and of the foetal down of the akin ; ftron 
the more frequent occurrence of the condition it 
female* than in males ; and tnm the obserra- 
ti<m that albinoea are aomettmes miaahapen an^ 
feeble inteltectoally as well aa physically. Oi 
the other hand it is well known that albinism ii 
often associated with perfect physical stn^ngt) 
and remarkable i ntellectual vigonr. Among othe 
causes to which it haa hetta assigned are heredity 
and debility, however induced. 

TnuTxmcT. — The treatment of congenita 
albiniam muat conaist in the application of thos 
agenciea which tend to atrengtben and improv 
the general health. With regard to the apecii 
inconvenience reaulting from the absecce of pig 
ment in the e^es, it has been observed that th 
difficulty felt in reading ia greatly lessened b 
uaing aereena or goggles made of some opaqig 
material, such as aluminium, each perforated b 
a small opening, admitting only the rays of ligl 
from the object looked at. The treatment of ace 
dental albinism will be considered under JPli 
KKMTABY SKnr-Siaaisn. Eblishvs Wiuom. 

AXBtnairon) hibsabxi. — stnoh. 

H<uy, Lardaoeou*, and Jatfloid Deqeneraiia 
Fr. Diginiration amyUndt. Oer. ^)ec'karti^ X) 
gtneraUim (Bokitaoaky) ; Jmj/kid» EnUtrtut 
(Viichow). 

DaFnimov.— A peculiar form of degeoeratio 
aibcting certain organs, and constituting in i 
effects a distinct and general disease. 

^noLOOx— In the m»ority of eases alb 
minoid diaeaaa is preceded by long-continn 
suppuration, most frequently in the fomi 
hone- «c joiat-diaease ; or else of destmcti 
pulmonary phthisis, empyema, pyelitis^ cyatlt 



Digitized by 



Goo gle 



iXBUIONOn} DISEASE. 

aad otber affietiona, vheia then has been a eon- 
ttut dn,ui of pniL In the absence of ofarioua 
■{ipnation, there is nnialhf pxeaent an exfaanst* 
ing diaeaie, as lyphilis, agne, or some more 
sbacnre cachexia. These anteradent eonditions 
niut be regarded as the cause of the malady, 
■Bil it is only in the rarest instaneea that nosncb 
aaie can be traced. It is not easy to recognise 
the eoBBeeUon, bat it may be pointed out that a 
drain of pos inrolTes not only a loss of highly 
eqpsised protoplaamie matoial, bnt also at 
potassinm alts, vhich are omtained in large 
prnioitioD in the aolid elements of pus, aud 
vbuh alts, as ve have seen, are deficient in the 
aSeetad tisanes. 

Ajutojocai. Chabactxbs. — The organs af- 
fected sie Bsnally mnch enlarged, bnt sometimes 
they ultimately decrease in size. They are pale, 
dene, dry, sometiinM hard, and either generally 
CK in certain spots tranalneent. In an adraneed 
Mage of tlw disease the parts appear as if soaked 
in vax, or other translucent material. If iodine, 
in aleoholie or aqneons aolntion, be applied to the 
afleoadpaita, they are stained yellov, orange, or 
• deep mBhcgany bovn, according to the degree 
of the morUd ckange. If the portions thns 
eoloored be further treated irith dilute sulphnrie 
seid. a parpiish Uack colour is produced. These 
:;bsiaetenB depend upon the presence in the tissne- 
akments of a peculiar substance, allied to the 
albaDdnates,aiid enntaining, -when approzimatoly 
pare, abont 15 pa cent, of nitrogen. It is so- 
nUa in sUcalia, not digested fay pepsins, and not 
nadSy altcmd by pntrefaction ; it gires urith 
iadiae theehazaeteiistic eolonr just noted, which 
|B¥B tiae to Virdiow's enoneons suppoeition of 
Jtm bamg allied to starch, whence the name— 
Am^oid. This Muminoid material being oon- 
tsiaed in the tissne-elements themsehres, and 
Bot inUtiBted between them, is probably not 
poored <iA by the Teasels as snch, bnt results 
fioBi a tiBBsibrmatieB of the materials of the 
tiasaas. (Asmieal analysis of the affected orgsna 
show* a ramarkable dtange in their mineral eon- 
ititiiealik tiw jwitasmnsB and phoephorie acid 
bdag Tory gnray dimiaiihed, as compared with 
haakliy crgans; while the sodium and chlorine 
twain nonsal, or are proportianatsly increased. 

AlbamJnnid disease afiiti^ moat frequently the 
liecr; spteen, and kidneys. Next in order of 
tatftaaej come the lymphatic glands, and the 
iatwtiBal Bncoiis Bismbrane, especially its rilli ; 
■ace XBicfy the aapsmrenal bodies, tfas pancreas, 
Um minaiy mneoas mamlKane, or the omentam 
are inrolrad ; aiid,qiiit8axeaptionally, other parts, 
sad OS the tlnroid body, the generative organs, 
the bsart, and the Inngs. In most organs the 
blood-reasels aad their appendagea, (glomeruli 
«f tiie kidneya, Ualpighian oorpoaeles of the 
qdeaa)ai«tlie seat of the morbid change; bnt in 
•ooe^ aadi as the kidney, secreting cells may 
also be aSaeted, and in the lirerthese stmctnres 
an due<Iy or solely inTolred. The dinased ele- 
■Mts an •Blaig«d,traashM«Bt, and stmctnreless. 

flisu - iiMM, lyuaaoau, tarn Fatxaosa. — The 
f m mal sjm^ i tiiins at albuminoid disease an 
•MBiDa, diebsH^, a eachectie appeannee, and 
aaastiaas eapillaiT faamiorrbage. The loeal 
mmfamaxn liaiAr important in the ease of 
«• fmr.ipUea, aad kidDsys, Unifoan smooth 



ALBCrafLI^S. 



tl 



*^» kidn''« 



'WheTO 



other kid^*^** U m 



enlargement <rf the I»x . 
be referred to no ottxei. 
the albuminoid change, 
affected, nlbnminuna, 
train of qrmptoms aniB 
whole, difini from those ocF other Wa*^" 
The dieufnnrii is greo.tJ^T' °°'»fi«m^'- - 
simultaneous oceurrszi<=>^» of diB-**^ ^ (iVTv* 
organs; (2) a hirtory «.* »oiw! .'» «ei^ 
some cachettio dis«Mu>«». •sdS; T**<onT^^ 
The prognoiU is ext«,«»»«»y^^ly ,' **.,.<>' 
when the disease is fiur ^L«3tTrai,<^''*0«lnH,|iP''>«». 
TBRiTiDnrr.— Thoo^** i.an ad^' " >« torLi*"*^ 
ment can avail bnt littl «», -«4e^Y*'cod <*8«»t **^ 
that wen the occnrron<::r ^ of ai * '"ensmTr "*"■* - 



or its presence earlier 

even cnn, might be p 

plaints as chronic joint — <3. 



L«ease 



pbiliticdiseaseofbone, oi- JProlon^'^o al^^"J°^- 



probsbili^ of this freq-i;ic 
be borne in mind, and gr-a 
able regimen. The di»it 



abundance of nitrogeno u 
well as the potassium 
tissnes lack. Tbese ar». 



rr'f'»houIcl 



^^:::j^^ 



'em 



rally nutritious, but shon. Id iaduJ""^ onJvY**"'*^"" 



th 



'Bat 



es), «.! 



in the juices of fresh na«.«.t, and Tl^^}y oonfV'*'^ 
parts of vegetables. Azuong J*° 'n tj,„ *'"»** 
tonics, of which iron ■.ud cod-JiV S's, ^ greerm 
type, most hold the firs* pJace ■ hut' o«i ""Wan » 
tration of potaasiom sa7t«, as ^ 1»o «?**. tJ*^ 
Dickinson, is also indicatad. Of<^^'°*9fl^^'''* — 
be induced, on i priori gxoands Tf"* ■*►« I Jt)r-- 
of which the local action is lai^ •«'ioe» *"''* 
which caose little vascular de&^.*io^.''>os^ 
the bicarbonate, or the citrate, o/^°*i, «Z^ aoci 
salts. The danger of • potaah poifc,!*.W ^1^ »«• 
nmote. J S.'"* ' ^^^°'«» 

AIiBUMIKS.— D«FiiaTToir._s,, **** 
substances closely resembling "'**»ine 
the chief constituent of white of ^'*'"*^l>nini'* 
men. To distinguish between the^?- ** ^b^ 
add its chief constituent, the form' *• °f ee» 
slbnmm and the Utter albumin ' " »p3t 
constitute a sub-division ef the cl ''^'"'niinc 
minous bodies, which inclndes all""" ,''' ''bn. 
having a general nsemblance to albm^" *"""*• 

Ekotobitjos.— The sulmlass tnot,!2f 
tains only two members, ^y-<iai,B,f^^^v con. 
alimmin ; but the name Bmct-Jo%e^, alSu *^"*" 
been given to an albuminous body di^^""" 
considerably in iu properties from the*ottI' 

CHAKAcrana.— Bgg^lbnmin and Berun»-ali,„ 
nun SM semi-transparent, yellowish, and wtZ 
tureless when dried. They an soluble in wS?. 
and this solution is ooagohited by boiUas ^Zl 
the same solution they an precipitated' hvl!!\ 
nitnc acid; (4) salts of the heavy metaik i^ 
example, copper^sulphate ; («) aostie acid ^^ 
potassiMu-ferrocyanide; (<*) bwMng with aeeS 
acid and a neutral salt, for example, potas^^ 
sulphate: W alcohol. , EgI^albJLin uSl 
gushed from serum-albumin by the coamdum 
which It forms with nitric acid being inwluble 
m excess, while that of serum-albumin is solnbl" 
Bence-Jones's albnmin gives no preeipit.tte with 
excess of nitnc acid nnleas left to stand, or an. 
leas heated and left to cool, when it fbrms a solid 



Digitized by 



€oDgfe 



M ALBwrxa. 

ooagtiMm, Thto eoagnlaiii radissolres on faMt- 
iog. Mid agUD formi on cooling;. It may be 
•tpanUd from oidiouy klbamin W adding 
nitric acid, boiling, and filtering irhen hot. The 
wdinaiy ijbamin will leaiaia on the filter irhile 
BeBoe-Jouet'a albaiain will pass through, and 
will coagnlate whan the filtrate cools. 

MooiFiCATioirs. — By the action of acids and 
alkalis albumin may be converted into aeid-eJbu- 
mi» and alimii-alhmin reepectiTsly, neither of 
which is oongnlated by boiling. 

jteid-aUmnuH nay be formed in two ways : — 
First, by dissolving solid albnmin in eoocentrated 
nitric or other mineral add with the aid of 
lieat. Secondly, by heating an aqneons solution 
ol albamin with one of these adds very mueh 
dilated (1 in MO). Although wlable in very 
GOBcentnted or very dilute acids, aeid-albnmia 
is imnlnble in moderately dilute acids. Ther»- 
fore, when the solution in concentrated nitric 
add is diluted with water, a predpitate is 
formed, which reditsolves when much water is 
added. And, conversely, when acid-albumin is 
made by boiling a solution of albnmin in water 
witJi vary dilute nitric add, the addition of more 
•ddwill throw down » preeipitate, which tedis- 
solves if a very large <ao«as of the concentrated 
•cid be added, and espedally if it be heated at 
the same time. On neutrelizing a solution of 
acid-albumin, a predpitate is thrown down, 
which dissolves in excess of alkali. 

AliaU-albumin, or AlJbali^iU>iimi»at« as it is 
also called, is formed by diseolvinp albnmin in 
caustic potash or soda ; or by adding either of 
these to its a<)neous solution and allowing this to 
stand, or heating it. This modification is not 
precipitated by heat, bat is precipitated by nen- 
tsaliatioo; the precipitate dissolving very readily 
in slight excess of acid. If alkaline phosphates 
•re prraent in the solution, as they are in urine, 
alkau-albumin requires a slight rxcess of acid 
to throw it down, and is not precipitated by exact 
neutralixation, as acid-albnmin would be under 
similar circumstances. T. LAtmBs BBUirroK. 

AZiBTTMUl UUIA. — ^DBFnrmoir. — A condi- 
tion characterised by the presence of albumin in 
the urine. Other albuminous bodies, not albu- 
mins, may be present in haematinnria, hama- 
taria, pyuria, and spermatoriiioBa. 

Stvvtoiib. — ^Albumin may occur in the urine 
without any ^mptoms whatever, but its con- 
tinaoas loss leads to anmiia and changes in the 
drcolation, which usually originata the following 
symptoms— a pallid pasty complexion, dry skin, 
and tendency to tsdema of the celhilar tissue 
noticeable on the eyelids and shins ; derange- 
ment of digestion, flatulence, occasional nausea, 
and irreguUrity of the bowels ; nervous disorder 
shown l^ muscular weakness, languor, lasdtnde, 
Tigne pains about the loins, and headache; 
calls to make water during the night ; palpi- 
tation, and ftequently aceentDOtion <S th« second 
Boond of the heart over the aortie oartiloga^ and 
redai^ieatinn of the first sonnd over the aeptam 
Tentnonlomm. 
TasTi roB Auranr.— The two teats ooaa]]- 



sn^yad to detect olbaoiin in the orin* 
Aist, boiling; and, teamdlr, the addition 



add; both tit wMeh pndao» acJood or 






^*«i, 



AUSUICINUSIA. 

tate. If the urine is turbid the albnminans 
cloud may not be noticed ; and therefore such 
urine ahould be filtered before the application 
of either test, unless the turbidity, beiqg depen- 
dent on the presence of urates, is removed fay 
heat. 

Mttltcd oftmflogina tha test by boiling. — 
With the object of saving time the urine i> often 
boiled at once, but the results thus obtained are 
liable to sevnal fellades, which will be subee- 
quentlydeacribed. InonlertoaToid snch fallacies 
the following method should be pursued ; — Ascer- 
tain the reaction of the urine ; and, if it be 
alkaline or very strongly acid, add acetic acid in 
the one case, or liquor potnssa in the other, 
until its reaction is only slightly add. Fill a 
teetrtabe to abont one-third of its eapadty with 
the urine, and hold it obliquely in the finme of a 
spirit lamp in such a manner ss to heat the upper 
part of the fluid only, until it boils. If it be 
turbid fioD nrates, it should be first warmed 
thronghont until it becomes clear, and then the 
upper part only should be boiled. Finally, add 
a dn^ or two of acetic or nitric acid. 

If albamin be present, it will form a cloud or a 
coagulnm, mora or less dense according to its 
amount. When there is much albumin, its quan- 
tity may be roughly estimated by allowing the 
unne to stand for a definite number of hoars, 
so that the coagulnm may subside, and then 
observing whether it forms a fonrth, a third, 
or a half of the whole length of urine in the test- 
tube. A small quantity causes a cloud, but no 
distinct coagulnm ; and, if merely a trace be pre- 
sent, a faint haze only will be observed, which ia 
best seen by looking through the test-tube at a 
dark object. The advantage of heating the 
npper part only of the urine is, that the lower 
portion, which remains cirar, affords a standard 
by comparison with which a faint cloud in tin 
heated part may be more readily detected. 

FaUaciet of ihi mt iff MUn^.— -The first 
ftdlacy is that albumin may be present, and ye< 
no cloud or cosgnlum be produced on boiling 
This may occur if the urine be alkaline or ver} 
strongly add, because alkali-albumin or add 
albumin, which are soluble in water, ma] 
be formed. It is to prevent the formation o 
Mali-alimmin that acetic or nitric acid shoul< 
be added to alkaline urine before boiling. Tht 
addition of acid also causes the coagulnm t 
separate more readily ; and it should therefore b 
made when the urine is ncatrsl. On the othe 
hand, urine rarely or never contains snfiSciei 
add to form aeid-tMiniti», unless the patiei 
has been taking mineral acids ; and therefore tb 
addition of liquor potaaate is not necessary axcej 
under these eireamstaacos. ^e sseond fallac 
of the test by boiling is, that a dond resemblin 
that of allnunin mav be produced, although th 
nrine is free team tnis substance. This oceni 
when the acidity of the urine is too slight I 
hold the earthy phosphates in solution, withon 
the aid of the eartionie add which it nsoall 
eontains. When such urine is boilsd, the cK 
bonic add is driven ofiT, and the phosphates w 
precipitated, forming a doud Hke that of al burnt 
|<be two douds or* madily diatinfuishod by tl 
^dition of a drop or two of nitrio or acet 
*^ whan if due to phcopliatta it will diwppei 



Digitized by 



Google 



fcf Mlvtioo ; bat if naaad hj ^bnmio it vUl 
MMin. If an ezcaasiTe qnantitj of nitric >ci<I 
b* aMed, aa tXhaaaamu elood ma.j alao oleur 
«p; foK •Ibnmiii eoagnlated by heat it aolnblA 
ia itiOBg aeid, though only to a alight axtoot. 

Afflieation of the nUrio-aeid tat. — Four 
ana orim into a tett-tnba, and then allow abont 
«o*-fo<uth of its bulk of strong oolonrless nitric 
add to trickle sloirlj down the side of the tvbr, so 
aa to form a layer b^ov the urine without mixing. 
Or the add may be pnt in the test-tube first, 
and the urine poured on it. Both processes 
nre the nme reanlt. If albomin be present, a 
haia or elood vill form doae to the line where 
Ills liquids meet. 

FaUaeiu «/ tie niirie-aeid tat. — 1. Albnnun 
nay be present and yet eacape detection, if the 
Bitiie acid is simply poured into the urine and 
mii«d with it, as is sometimes done. For if thrre 
be too much or too little acid, acid-albumin 
is fanned and diaaolTsd ; whereas, if the liquids 
fona two distinct layers, as in the process already 
daaenbed, the acid gradnally mixes with and 
shades oif into the urine, so that, at a ^ptater or 
leas distance from the line where thry join, it is 
certain to be of the proper strength to precipitate 
tha albvmin. 2. Albumin may be sappoeed to be 
p i eee n t when it is not, from ue formation of a 
eJoad by the precipitation of acid urates or uric 
add. This doad disappears on the applica- 
tion of haat : and another specimen of the urine 
tasted by bailing girea no clond. To aroid this 
fsUaey, it is common to employ the test by 
hailing, in addition to that by nitric ad(L 
3. The third &U«cy is not of common occur- 
naea. It is dne to the presence of fat or saponi- 
fied &ts ia the arine. Urine containing these 
when simply boiled girea no clond ; but if nitric 
add is abided to it in the cold, or acetic acid 
wbm it is hot, the fatty acids are precipitated 
and ionB a dood resembling albumin. This is 
diatingnished hj not being formed if along with 
dilata acetic add soma ether is added to the 
niaa heKsn boiling; the ether retaining the 
taXtj adds in sohition. If the precipitate pro- 
daead by aitrie acid be collected on a filter, and 
lisaleil with alfarr, it will be dissolyed. while an 
sibmuaoas precipitate will not. Copaiba, which 
oa he reeogaisea by its smell, sometimes eaasea 
SB cyahareaee in the urine, which is increased 
by aatrie add, bat ia remored by heat. 

JddHmmil tatM fur attanria.— When nrine 
eoatuas i w », which wosld render the presence 
of aa albaaunoos elood obaenre, a solution of 
faiULiaaide of potaosium fallowed by acetic add 
AbbM be added : this will produce a cloud if 
alliMiia be present, while it rather clears up a tor- 
tadi^dae toamens. A soiatioa of pjrrophosphste 
if aada alao predpitatas albomin. If a drop of 
■ Hi— iau na wins be poorad into a test-tabe 
aoatainiag one or two diachaia of a saturated 
■otatioD of pterie acid, a predpitate is formeJ, 
) teats ara somatimaa osefnl in determining 
I of albumin in the urine in doubtful 

QsunTriTrrB EsmuTioir op Autdkik. — There 
B* thm methods ia common nsa for this pnr- 
•oaib The lliat is easy bat iaexaet. It oonsista 
la beiliag the nrine with dilate acetic add in a 
•■Maba, sUawing th* eM^abun to subside for 




AiaVHIHUBIA. 

a deflnita nvm' 

the proportioa 

boiled, for exa. 

second is the 

It is like ths £B 

measured bef<c»«"^ 

eoogulnm is sa£^ 

weighed filter, -vv 

iog it. Tbettii 5 

exact A tuba 

nrine and plaeec 1 

the amount at 

undergoes in px 

amount of albt.'m : 

atsd. A fonrtf^ 

commended by 

diluting the ni-i *»-^ ^iii 

haze on the adci !«>»•« o/ n,(^. 

not become Ti»i t»I« nntii bet' 



• » fourth •^^''uUtv?**"* 
Jl.-,^"' U.e ' '• «roSS_5^e 



'^'-^l I^y^„"^» L-'^'Sv 

■h. 



."?«thoa 



^knoT '.'e««v;:'-?'0»ei 






[['on »hi 



•""ff ft,,^'"' 'bo ;^,"W 



««4 



'^QtD 



'^■^-•'^,:ii^ 



\v 



iioh 



three-quarters 
been added. Tlii 



nuDot, 
diiota 









t">tii 



»Jl 



°»>8- 



ich 



"«; 



'o„- 



*»• 



«>i 



ii« 



lid 



Ued 



oeen aaaea. ixj««» uuota Brii, ""'' tb '>«lf °*» 
per cent., or OO 1 -*-» «iain of^j.'^Dt^- '^id ?** 
ounce; and from t-Ao decree o/i ""iJi "• 0-n^'^ 
the amount contaaiaad ia (^ '^otiol '^^ ^'* 
calculated. ' t " 

Patholoot. — A.i2>amioi)r^ » 
occur in conseqnozjca of rarioog^ l>««i 
changes in the bicxod. chan^^es ia'^''^it'' ^ 
changes in the kidneiyB. Tin, "lo „• la - 
salt, or a diet of oggm nloae, i, ^^inl^^l^tj'^' 
albuminuria by altering tba e_ •*'<! , "co ^i^ 
blood ; and an altomtion in iJJ?*'tiit,o *»»^>SI^ 



to 






posed to be pwtly tha canse of »t fluid" -'*'' 
observed in high ferers, searl„f,r*o nJbn J? 
and osteo-malacia. The album-"*- diD^i" 
disease dep«ids on changes in n,"'''* of fc "^■« 
and that of nephritis on alteration. " '=''^uJ«S^' 
In order to distinguish more cl^? '"^^ho j^'^^ 
different kinds of albaminnrir^' '*"**««n "sl: 
them into— lat,<r«« albuminuria in JT*? "^'"i* 
albumin appears in the urine • 2ndl v 1?/ ■•nun,: 
minuria, in which some othe^ albnmiifr^*'^'^-- 
bnt not serum-albumin. U prewiu V ^^'' 
albuminuria there is always some chknor" f'i!** 
in the circulation through tha kidnev . ""•* 
structure of the kidney itself. In /«^e ail" i-* 
Buna the albuminous body passes out thr^iT 
the kidney, without there being any alte»d 
either in its circulation or atmctnre. ^™"0«» 

Thechief albuminous bodies occurring in fal 
albuminuria are haimoglobin, eggHiibumin »r« 
Bence-Jooea s albumin. Hmnoglobin ocdwJ;^ 
the nrine whenerer blood is present in itj ^** 
H«MATrBiA\ in which case it ia conUioei*** 
the oorpnscles ; or it may occur free {set nj^ >J^ 
TiiniBiA>, the blood-corpuscles, while atill ?*•*-! 
Inting in the rassels, having undergone »q1 *«U- 
This may result from the inhalation of ^^^on, 
ninrf-ttad hydrogen, or from the introA *■*»- 
of bilr-acids or of a large quantity of »r?^<SVion 
the reins. Haemoglobin is also fonn^ ?» inta 
urine in paroxysmal hnmatinuria, but tv ^"^ tlv* 
of the solution of blood-corpuscles in tK\ ^ oJafa 
is unknown. Egg^albumin is excret^-? ^\*'«I*» 
kidneys, and appears in the urine, whe^^ \v**A» 
iiu'ected directly into the drcniation oj. ^'V*^ ., ii. 
skin, or when it is absorbed unchang^^^^^ ** »!»• 
stomach or rectum. When taken 5^^ -is ^"■■' ^ 
mach 



undergoes 



ch or rectum. When taken i,.* "^^«* Tji* 
it is usually complftely digest^^l^'^ **tiB» "wj- 
goes absorption ; bnt when taVT; V.^^o i* 



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ALBtnONtJBIA. 



lugs qiuntitiea that tbe iHiole of it cannot be 
digested, part of it ii absorbed unchanged and is 
ezeretcd in the urine. Thus a diet consisting 
sotelnmrely of eggs, rspeeiHllywhen continued for 
■ereral days, produces &lse albnminnria, and 
Urge enemata of eggs hare a similar effect in 
animals and probably also in man. Bence-Jones's 
albumin is of rery rare oeenrrenee. It is (bond 
in oateo-malacia. Like egg-albumin, it is ex- 
creted by the kidneys when it is injected into 
the citeulation or in large quantities into the 
intestine. It is almost if not qui te- identical vitir 
the hemialbumose, which Kuhne finds to be one 
of the products of imperfect diacstion. It seems 
probeole that those cases of albuminuria which 
appear to depend on imperfect digestion are due 
to the passage into the systemic circulation of 
albuminous bodies, which hare not undergone 
the proper transformation in the alimentary 
camu or liver. 

In trtie albuminuria there must be some 
change, either in the drcnlation or structnre of 
the kidney, for serum-albumin differs from the 
other albuminous bodies just mentioned, in not 
being excreted by the healthy kidney. Some re- 
gard the alterations in circulation which produce 
•Ibaminnria as of two lands: — (a) increased pres- 
snie of blood in the renal arteries ; (b) incrwised 
pressure in the rennl reins. Increased pressure 
In the arteries may depend either on general high 
arterial tension, or upon an increased local supply 
of blood to the kidney, owing to dilatation of the 
renal arteries, such as follows division of their 
VBSO-motor nerves. Experiments seem to show, 
however, that increased tension in the renal 
arteries docs not produce albuminuria, and that 
the only change in circulation which will cause 
it is increased pressure in the renal reins. Con- 
oestion of the renal reins mny be produced by 
ugatnre of the renal arteries, ana when the 
flow of blood through the kidney is temporarily 
arrested by ligature of the artery, the urine 
Mcroted after the removal of the ligature is 
albuminous. Tenons congestion of the kidney 
also occurs whenever the onward flow of venous 
blood is obstructed, either by a ligature on the 
renal veins ; by the pressure of a tumour or of 
the pregnant uterus upon them or the vena cava ; 
faj disease of the liver obstmcting the vena cava; 
or by disease of the heart or Inngs, such as tricus- 
pid or mitrel regurgitation, or chronic bronchitis 
•md emphysema. The temporary albuminuria 
■ometimes observed after cold bathing may also 
be due to venous congestion ; and it is probable 
that albuminuria consequent upon lesions of the 
nervous system is due rather to the changes 
which these produce in the circulation than to 
any direct action of the nerves upon the tissues 
of the kidney itself. The albuminuria observed 
After varnishing the skin is probably due to the 
retention of some substance which acts as a 
poison. The structural changes in the Iddnoy 
which cause albuminuria are acute and chronic 
inflammation, waxy degenention, and cirrhosis. 
Bei Bbioht's DisKi.sB. 

TBBATMEirr. — In falte albuminuria where hje- 
BM^obin appears in the urine, tbe treatment iq. 
dieated is to connternet the solution of blood-eoi.. 
pnscles; and for this purpose quinine is y^ 
often waftiL Whan other idnds of albaaiiQ J7 



pear in the urine, and are piofaably dns to im* 
perfect digestion, the treatment is to give some 
artificial digestive fluid. Airnnie is also nsefliL 
Regarding those eases of aetao-malaeia inwliieh 
Bence-Jones's albumin oocnrs, we unfortnnately 
know very little. 

In true albuminuria, depending on venous 
congestion, the obstacle to free circulation 
should be removed, if possible; and conges- 
tion lessened, both by drawing the blood from 
the interior to the surface of the body, and by 
causing contraction of the renal vessels. The 
blood may be drawn from the interior to the 
surface by means of warm baths, but in some 
cases they prove ii^urions rather than useful, 
and ths employment of a wet pack, which has 
a similar effect on the distribution of blood 
without exciting the heart, is to be preferred. 
Cupping over the kidneys is serviceable : it pro- 
bably acts by causing refiex contraction of the renal 
vessels rather than by actually draining blood 
away from them. The tone of the renal vessels 
may be increased by the employment of digitalis 
{tee DiCRKTics) ; and this drug is useful even 
when no cardiac disease is present, although it* 
good effects are still more marked when the con- 
gestion is dependent on disease of the heart. The 
constant drain of albumin from the body occa- 
sions ansemia, which not only produces many 
nnpleasant symptoms, but tends to cause fktty 
degeneration of various organs, from which there 
is no reason to believe that the kidneys an 
exempt. The administration of iron, therefbrr, 
is the chief remedy in structural disease of the 
kidneys, and it is useflil by diminishing or re- 
moving the symptoms of anemia and the ten- 
dency to &tty degeneration consequent thereon, 
and also by increasing the tone of the vessels, 
thus diminishing the loss of albumin. 

T. L^uDXB BarirToir. 

AXiOOHOL. Stmov. : Eth/UAleoial ; Ftiaw 
MeoMol; £^n< 0/ Ifins (0,E.d).— Alcohol is the 
product of a process of fermentation induced bf 
the action of a microseopic fiingns, Yaatt, upon 
certain kinds of sugar, especially grape sugar, 
bnt also upon that derived £ram staich of 
any deaeription, and, in the soma manner, ttpon 
milk sugar. In this process a peculiar meta- 
moiphosis takes plaos, by which aloohol and car- 
bonic acid are prodneed in considerable amonnt, 
together with very minnte quantities of suoeinie 
acid, glycerine, and other faodiea. 

Alcohol may also be prodneed synthstieally 
bom its elements, carbon, hydrogen, and oxygen. 

As alcohol is very volatile, boiling at 173° 
Fahr. (78° C), it may readily be separated bjr 
distillation from the water with which it i* at 
first combined. Other means most be resorted 
to, however, in order to separate the very vlti- 
mate particles of this wster, as a strong attrao- 
tion exists between the two liquids. 

Alcohol, diluted with about 95 per cent, of 
water, and subjected to the action of another 
microscopic fungus, is oxidised into aldehyd and 
acetic acid. 

Fhtsioumical Effbcts. — Applied to the 
aUn, alcohol prodnees a sensation of ooolBeM, 
due to its rapid evaporation ; but, if the appli- 
0«tion be oontinaed foiBdeBtly long; trr USri t H* 



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AI/!OH0L. 



li adtad. Thia lattor cAeet anaoM knnM- 
distely if aloAol U broogtit into eontact with 
• mneoBs raemlvine. Iti strong attraction for 
«it«r seema to be the chief eauw of this action. 
Alcohol is a pow«rftil<ni(tw]>(w, probably firom 
the &et tlutt it ia capable, enn vhea dilated, 
ef pniTCBtiag the deirelopment of aeptie germi, 
neh aa vitarioa and baieteria, aa well aa of 
IwaljBng the aetiTity of thoae already formed. 
Xlttre is scareely any other tbenpeatical agent 
the iatevai action of whirh Tarifa ao mneh ac- 
ecBding to the doae girra. In itiuill quantity, 
(od eligfatly dilated with water, alcohol promotes 
the faaetjonal aetiri^ of the stomach, tlie heart, 
and tb» faimin ; whi^t a like quantity, larssly 
dilated, ezeRs bat a limited inflaence apon these 
ofgana : if, howerrr, the dose of aleohol be often 
cepeated,itiareadilyaBsimilated ; and, becoming 
difliised thraa^oat the aystera, andergoes com- 
bostion within the tiaanes of the body, iuiparta 
aaimth to them, and yields Tjtal force for the 
petftamuace of their Tarioua fonctiona. Simol- 
taneooaly wtth tins consumption of alcohol, the 
body of (heansamer ia often obaerred to gain in 
fist — a eirenmstanee due to aimpla accnmulstion, 
tbe &t foToisbed by the food remaining unbumed 
in the tiaraes, beonae the more oombostible 
aleoiui faraiafaea the warmth reqniicd, tearing 
no ntetmiitj tar the adipose hydrocarbon to be 
aaed for that purpose. A qnantity of 100 cubic 
eariimetrea of alcohol per diem (about three and 
a-balf Said ooneea) — eq[BiTalent to about one litre 
ef Rhine wins of nedinm strength — ia sufficient 
to sopi^y between ome-third andf one^qoarter the 
whole smoont of warmth requisite for the human 
body daring the twenty-fonr hours. The warmth 
so soppUcd tan not be nuBSured by a thermometer, 
h u w w e f, any bmi* than can that famished by 
the ioteraal combnstioa of other hydrocarbons, 
sodi aa the nib at sogais. The subjeetire im- 
pnsaioB of isereaaed warmth usually experienced 
after taking a dose of any alcoholic liquid is 
daee pti r e , aod is only due to an irritation of the 
Bcrres of tjie stomach, and to the increased cir- 
cnlatiaD of blood throngh the cutaneous Teasels, 
pafljeolarty those of the head. 

Zlaaa tomewkat Itirytr, bat still snfficiently 
moderate not to eaose intoxication, act, for the 
most part, ia the aame way ; but, aa an additional 
affect, they pi o duee a distinct decrease of tem- 
peiatui e in tbe blood, lasting balf-an-hour or 
B>or«. As ftraa the matter baa hitherto been ex- 
plained, this latter afTeet depends npon a directly 
dapn-aai ag inflaence exerted by alcohol npon the 
tiifcin g crils of the body, and npon a tempore^ 
paralysis of the Taao-motor nerres. The latter is 
followed, of eoaran, by dilatation of the super- 
fldal reasfls, paztiealariy those of the head, in 
•oaseqasnea of which a larger surface of blood 
is axpned, sod tfae loss of heat by irradiation 
into the air ia Increased, the temperature of the 
eireolating floid being thus lowerrd ; whilst, tbe 
eaaafa«atioD carried on by the cells being re- 
tarded, the gxceration of heat from this source 
is dinriicjysd. The quantity of carbonic acid 
cfiainatod ia thus diminished, as is also the 
t ef wrea escereted. After the organism has 
imowd to the action of alcohol, these 
eflhets «poa the temparatare of the blood are 
lass dJMnetly, or ao* at all, marfcad. 



«« 



-•nt at first osanaotl >»_ 

L*:nrd^:kn:^«^ 

osting long«t tli^ J2J 



prodne^fj 



KJcatlon f-.vj-moe^tj v. 
are sulBeiexi^iy -^7 
al condition «**■ _^ way 
hj thia 



The agreeable ezeitozn 
such doses of alcohol is a 
characterised by lassitia.* 
latter condition nsnal.I.3^ 
pierious one of exhilsrca.'C: 

The symptoms of iik^:.' 
large dotee of aloolioX 

known. When the >,hti<r^raacm.*i oonaition of ~ 
meat in the brain ixic3L'ca.'«~«d by thia «t.im^*i***' 
baa been kept up, alxnoj^r*^ witbont int«pn?^^***)t 
for a length of tims ; «»:Kr when it ia »^rt^?*'**>. 
withdrawn after th« «=»^r'giin haa •^ oii ^^'^T 

subjected to it ; the di^'fc.-^B_xt»nce Wo^»w? ^'*ng 
is so great and pernio O^nt aa to ^^ , ^bont 
oomplete orerthrow of 'K.lS'a reasi.)ni,jj^ ^^^^ »n 
and the condition knt:^ m m j-> aa efc<i,^~ "^^^ItaaiT 
ensnes. At the same -K-assae that thia**** ''"•sn^' 
influence is being exort ^ gj. apon th» ^*»>ic.7!!?* 
brain, fctiy accumaUt:.i«»»»ss may ^^""^^ Of??* 
other organs, particulai-l^^ in thelj-^^** Pla.«« • 
connective tissues; th^ ^**'od-Te_^'' '**«*** ** 

diseased ; and, in many «Dartanoe«^®^ bl^**'^ 
the liTer, kidneys, aiKi "Deainll* *>*»Krr?*«>»« 

appearance, as part eT eXie 8»no?«7 »n«.ir** Of 
nutrition. The ehrinti z>^ of co^* ^S^bT** iu 
characteristic of this La^«>— znent.- ''*'**?ti*r**<Je> «? 



tion, seems to depend apo 
caused by the presence o^ - 

Under ordinary cimxm 
consumption of modereLt^ 



tis 



--idlS- l^p)5^ 



»c«*. ^?^ •lj^i*«i 



lea. 



only alight tracfl of it ar^^^",^'i *A^'- 






unne, and none whaterer in th© . ^'oo*. - 
alcohol imparts no taint to »h«« ***'^r^^«t 
the body; the ethers an<» /njl,**^;^. '5«4« 
other hand, do so by ro^^on 0/1 *a».- -Hli,. 

less readily combustible. JTt f* O*" »*'•. ^<*«» «# 
alcohol is completely oaciclijpart***^ *»'***** tt 
acid and water during the pro^T i*,, ■^«, *fl/n 
Uon ; at least, no other 1Seco*»« ^ Z^^th.f 
resulting from its disintegi^ti^^a,,^ W'**^ 
been detected. •» i,^>" J****///" 

Thboipkcticax Appucatiok-s 
no doubt but that a healthy on»^~~'7Y| 
with sufficient food, is eapable of "'»»>>*'''' <•/>„ 
its regular fttnctions without J^'rn^''Pb/: ^% 



b^^*i^4, 



'»«'«^?S' 






e* 



•^« 



JUi 



'^■ft. 



specially oombostible material fof*^ 
at heat and the derelopment of w/^® gen "* "(1 * 
the case assumes a different ««„' ^or„r^tio-i» 

"Pact Jl®- .6, <^ 



'e- 






tlic 



ttlr- " 



,<i;> 



V-: 



sickness, it transpires thut, whil 

phoeia of tissae goes on with its 

or with increased eiicrg)', ns happ "*' 

diseases, ths stomach, refusinK to nvl"^ ift i^'''- v 

ordinary food, fails to supply n^^^ o, 5»*v; 

pensata for this waste. Here it ia u *«» **^ 

material which can be most readily »^« VkJ*"*^- 

by the system, and which, by its stl^i^**5^^ •■ 

bnstibilitT, spares the SRcriflce of anlj^**^*^^^ 

is especially called for; and such a -^^^^ ■k.**™^- 



hare in alcohol. Small but oft-:, 

of aleohol, largely diluted with wate^ 

nlly well tolerated by the weakest sf o^ ^*^ ^os«* 






thus given, the abeorptioB and oxidn.^'^^S^ ^*%. 
spirit goes on without difficulty or efti.**'** ' • v' 
part of the patient's system. ^'=*»>^ r>f »»• 

According to the experiments of ->-- ^»> * 

land and others, the burning of !•(> "^^"^ ^ 

alcohol yields sufflcint heat to raiJ^X^T I^'*^ 

Clure of seven litns of water l<»r^ 1^^^"•" 
ling of lOgiamme of ood-liveJ^- .^*« **^ 
for nine litres. Now, in taking ^ v**^* '"^^S 

^ki;^^*- staffl*** 



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ALCOHOL. 



tpoomtvU of the oil daily, ▼• yisld abont tba 
nine amoant of varmtii to the oody a* is given 
\ty foQi tabU-RpoonfuLi of abiolute alcohol — the 
quantity contained in a bottle of light claret or 
hock. The oil, howpver, i* digested and oxidiaed 
by the oignns of the body vith difficulty, while, 
for the auimilstion of the alcohol, icareely any 
exertion of the working cella is required. Thui, 
it can be demonstrated by calculation, aa above- 
mentioned, that heat-producing material, (uffi- 
eiant to supply nearly one-third the whole 
amount of warmth rvquired by the body within 
twenty-four hours, is offered in a quantity of 
100 gnunmes (about three and a-half fluid 
ounces) of nlcohol. In this sense alcohol is a 
food ; for we most regard aa food not only the 
building mslerial, but all substances which, by 
their combustion in its tissues, afford wann^ 
to the animal organism, and, by so doing, con- 
tribute towatds the production of vital force, and 
keep up the powers of endorance. Alcohol, 
thsrefoie^ diluted with at least 90 per cent, of 
water (in any convenient form of beverage), may 
be given with advantage, in small but oft-re- 
peated doses, in most of the acute and chronic 
diseases whore it is desired to sustain the 
stivngth of the patient, but where at the same 
time the digestive organs, from any cause, refuse 
to tolerate a more substantial form of noorish- 
ment, at least in qunntitics that would answer 
the necessities of the case. In such cases 
it is certainly not sufficient to call alcohol 
merely a itimilant. If alcohol served here only 
in the quality of a stimulant, its effect would 
soon pass away, leaving the patient more ex- 
hausted than ever ; for Uie human oiganism is 
•0 constituted that it cannot be driven to per- 
form its functions by the appilication of mea- 
awes that simply stimolate, without supplying 
some new force to take the place of that put 
forth by the organs of the body under the im- 
pvlse of excitemeoL To taka a fomiliar iUns- 
tzation, alcohol thus given stimulate* no more 
than does the eaaily burning coal which we pat 
in small quantities upon a languid fire, to pie- 
Tant its going entirely ont, 

Maiium doaei act powarftiUy npon the brain 
and heart, and are theref(xre serviceable as real 
stimulants in cases where it is desirable to excite 
the cerebral and eireulatory syatsms to greater 
actiTity. We most not forget, however, that, 
while exciting this increased activity, such doses 
do not elevate the temperature of the body ; on 
the contrary, where the effect can be measured, 
it is foand thnt they drpress it a little. By con- 
tinuing to exhibit such doses, we can sometimes 
(in erysipelas, pnerporal peritonitis, and similar 
diseases) lower felxrile heat by alcohol where even 

Sninino proves ineffectual. The consequences of 
liis decline of fever-heat are an immediate re- 
stocation to consciouaneaa, if delirium or stupor has 
been present ; and, in any case, a general improve- 
ment in the feelings of the patient. Todd and his 
school, before the application of the thermometer, 
called this tA* effect •/ ainaitmt, while in reality 
the improvement is due almost entirely to the 
witbdiaml or diminution of febrile disturbaoca. 
A« fbrer patients can tolsrate large qnantitie* of 
■leidiol withoat showing any aign of intoxica- 
tioa, it it allowaUsk ua sometime* even neces- 



sary, to risa in ths scale of doaas bejond ths 
limits ordinarily prescribed. 

Of late yearn alcohol has been given dnring 
the ni^ht to hectic phthisical patients as a 
preventive against copious and exhausting at- 
tacks of sweating, and with a gratifying amount 
of success. Such patients certainly tolerate ths 
remedy much better than has hitherto beea 
^eseruly supposed. It need hardly be said Uiat, 
in eases of caJnliae excitement, not resulting from 
fever, alcohol is at least to be used with caution. 

MoDB or AomxisTBATioK. — One of the moet 
important, b«t at the same time most difficult, 
points for decision is the exact nature and 
quality of the alcoholic drink to be prescribed or 
allowed to a patient, who may require alcohol 
in some form. For general MM, a pnrk Claret, 
Uock, 01 Mosel wine are the preparations most 
to be reeommended. Cognac, Champagne, old 
Gin or Whiaky, and the heavier Southern wines, 
may also be used according to cirromstancas. 
But whatever drink may be selected, it must at 
least be int from fusel oil to soch aa extent that 
a healthy man, even after imbibing a consider-- 
able quantity, will not feel any other effects than 
those of a pure stimulus; that is to say, aa 
agreoable exhilaration of spirits, neither accom- 
panied by a sense of weight in the head, nor 
followed by that persistent overfilling of the 
cerebral vessels and dulness of ideas charac- 
teristic of the physiological effects of fusel oil. 

The Futtl Oils (so-called from their oily quali- 
ties) consist chiefly of propyl, butyl, and amyl 
alcohol, of which the last-named forma the largest 
proportion. In ordtr to examine any specimen 
of alcohol with reference to its purity from 
these oI(jectionable constituents, it is only neces- 
sary to rub a few drops between the palms 
of the hands for half a minute, by which rapid 
evaporation is caused, and than to smell the 
moist spot left on either palm. If the alcohol 
be pure no odour whatever should remain, aa 
ethyl alcohol evaporates very quickly; amprl 
alcohol, on the contrary, is much less volatile, 
and, if present in the liquid, will not have 
evaporated, so that ita pe«aliar and unmistaks- 
able odour will remain to attest its presence as 
on impurity in the specimen examined. 

This test is not applicable to the more com- 
plicated liqueurs and wines, as these all contain 
certain odoriferona or^nio principles of their 
own that might disguise the smell of the fusel 
oil. The inoffenaiva quality of any given pira- 
paratioa, as a wine or spirit, can only be relied 
upon when one knows by experience that it i* 
pure ; and tiien it ahoald always be obtained, if 
possible, ftom the same source, so as to ensure 
aai$9rm purity. 

By far the most pernicious of all the ordinary 
drink* in use is the spirit obtained from potatoes, 
as this contains the largest proportion of fusel 
oil. Even after being redistilled, this liquor it still 
tainted with the poison to a fearful extent. Of 
course, wines mixed with such spirit possess the 
same objectionable qualities; whilst wines mads 
from must to which potato-sugar has b<^n added 
are likewise tainted, though to a less degree. It 
can easily be demonstrated by experiments upon 
animals, that amyl alcohol is the agent to tha 
presence of vuch tha axtrsmely prntonom 



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ALCOHOL 

«£lMB of Banj drinb upon onr ncrrw and othw 
ocguis ia due. All diitiUed drinks made flrom 
othar aoorces than &om grapes contain it to a 
(Rater or leas extent. 
To beilitate the proceai of eatimating the 

rDtitj of an J paiticolar berenge necessai^ to 
■dministered in order to prodooe a giTsn 
•&k% a table ia snbjoined anoiring the per- 
eantage of ahaolute alcohol contwned in aTcrage 
•psdmens of the diffisrent kinds of vine, beer, 
ie^ IB eoounoo use. 

AbtobtU AlaJul contmud in — 
Xaaim (a fBmntad Sqwr mada from vba;) to tram 

1 tOlToLllWIMBt. 

Qmmim Bacr ■ ia bom S to 6 toL per cent. 

HoA or Omt ia tiaa 8 to II toI. per cent. 

fifaampacne is fram 10 to IS toL per cent. 

BmRbon Tnaae (Pert, Bbany, Uaddra, Jm.) to from 

UtolTtsLperoantw 
la^7 aad tb« Btrooger Uqaenia to from 80 to 60 toL 

psmnt, 

For am/mretie jmrpota one vill need to give 
■B adnlt aulj not lasa than the eqniralent of 
tStj eabic eeatimetrea (abomt t'vo finid oonces) 
at abaolntc alcohol, in divided doses within an 
koDr or tva Taking this as a starting-point, 
the does soitahle tat each indiTidnal case can 
be estiBated accordingly. 

Tlie great qaantatj of carbonic add contained 
in eaitain ' sparkling ' vinea acU n^n the tem- 
pentore of a ferer patient nraeh in the same 
ttToamUe manner as the alcohol itsdf, and 
vfcan aleohcd ia to be taken as a food, it would 
•eea that the impregnation with carbonic acid 
&alitatcs ita abaoiptwii. 

AU that has been stated thus Jar with regard 
to the «ae of alcohol in sickness applies to 
chiUnn as ynil as to adults. Of course no 
Tesaanable person would aceuatom healthy chil- 
drea to the eas of alcoholic bererages ; but, in 
caaea of disfssa, really good and pure wine or 
laaady can be sdnatageonaly employed, even 
fer ia£iDts, eithsr as a ttiauUmt, an anUfyretie, 
tr ms m arttelt of food, according to ciienm- 



8«UiTided into thoi«B d«, ^^ . ^ ,^ ^bJ 

cironicalooholism. To the «Mi.Vorm. of alc^ 
holic poisoning belong t^, ^„j, ^^j^^,, ^f ^ti* 
ahmenlary maeou. mmgthnae, rapid coma. »aSP\ 
esses of delinum tr«n»,n,_ and certain ■poC**:', 
forms of aenteimiMuty ; ^jm.t t„ the chro^f^ 
class are referred t.H« prolonged oongBHtion.. 0»* 
fatty and connect! -wo-ti^rae degenerations or 0>* 
▼anow organs and. t-Uanea, most cases of ^^\- 

L'K;:?nd"-tr«*^asitThiii^^^^ 



iry shape, is 



» auffici. 



citing csBse of •u<:la 

a doabt ; moreov^ 

eentiated the foaraza 

more surely and xrapidlr »«".!,"' " "^ 

that, although aozn« W^S^l^J^^^c 

others, yet the nlti 



a «■*»*«« affection. isV^'*^ ««. 
V ^o find tiat th, ao^^OM 

-_ » ^^ W^^"^ ">duc«^ «,, 

liability to certain form, ^ i*'^" » Rar^ *«>d 
others, yet the ultimate tiMnLi^"*^ th^**^ 
byallarepractic^Jljr •inuSl'*"**' P^To^ *» to 



*tf 



dagenoatire ehara^:tex>, tl™"* "' ' oia»j»-«Z 
fluids will aUo induce M,. Po*** aJc^**> 
some of the pbenonaena ob **^ <ona* . ^O/if 
cases of aloohoUc poiaonim, ^ "^ "■ "»e *.^ *«t 
with some probabilit^y. to id ■ * '*"> r " ^"o*-- 



oU, essentisi oU of wiin'i,!i'°'""« »r«f*!?M 



and other snbstani 
ordinary alc^l 
Absihthisk. 



^^•i^i^^k 



itMoif. -■^"^nous eveiTth^ 



rot 
:oHoi, 



and 



For atanuU ttss, alcohol has been superseded 
by larioaa more modem agents, of which car- 
bolic sad salieylie acida may be mentioned as the 
Boat npoTtant, In thia cooneetion the author 
aaaot o«t to aotiea one method of applying 
alcohol, saggcsted by Dr. Richardson, namely, 
Um treatmFiit of diphtheria afleeting the throat, 
by neau of the inhaler, which projacta the al- 
eolwI-S|my with eonsidsrable force upon the 
Bnwons membtane, causing i( to pane- 
deeply than any other caostie would 
be Skaly to do. C. Bon (Bonn). 

AZiCOHOXJC nrsAiriTr. &4Au»hoi. 

mM, and Ixaajfirr. 

AX/JOHOZJBIL— Dsixinov.— This term 
is applied to the diverse pathological processes 
sad attendant symptoms canaed by the exeassiTS 
iigestiaa of aleoholie bereragaa. These are 
nrr diflerent if a large qtaotity is consumed al 
oaee or at ahoit Sntcrrala ; or if smaller quanti- 
liai na taksa halntaally: and iMncs they are 

'layci tmtr wfD contais a Itttle BMve, bnt tbe 
^ABSasBade aapatsgaal eranilnatlwi aato axaotir 



The j«»<ii^»«,y «„«^ ^ 
such as festive g»tlieiiW * ""^f <I«b«nch 
panions^ desire of reUeff;;S'»*J'»pIe of co^' 
cholv, &c., scarcely wqn^^"'*^ «>d meJan. 
alcoUiccom. b «»nein^due't°tH ^'^ 
eonsnmptionofalargeqnanut, K r^ "" ^^i 
it ia caused by ta£w a -1' 'i^' °"^°°^y 
the presence o/some TpecifT^ ?.'"*°'^'? » 
starvation, prolonged 1^^^°^°^^""^^ 
Wlitating disease. *P°«u» to cold, or 4*. 

Chronic habitnal drin'kin^ • :> . 

wutang ij undonbtedlw 

■«• ; not t*— •■ " — ~"j 

> dziuika 
natrwoua 



famUy is of unstabl^n^i^"^!?' ^^^'^^ ^^» 
that the neurotic taint wWhT^H""?/^-^ 
other members in «^ ^t^. '>">^' ^^f}^ ^* 
i.„^.„-. ;—»_•»_ . ^-** ■■Dactions as epxle-pew, 
hystena, msamty, u ma^ifeated in theJe cGJ; 
by an intense craving fo^: alcohol. Sometinie. 
ajernicons education, l^y ^^ baV.it,» of 
mdulgence m early V»>t^b,\^^'^,^b»^XL<,zA 
«c«s; »°dthepr««^bi^^«lw"^i^^ ixa. 
occasionally been prod^ieti^ * -Luai? kio^rm. 
In the ex^rionee of thV^rit" .Cl^-bitio- 
of huge dilses in fevera - -^T«t«r, the. e»~ - 



Lnd 



.ffoctioo 



s "bam 



never done this-indead i^*<^^'8 »1^-t taxicea. 
a gn«t dislike to "tinikl^t!'\*S fceexa V^. 
daced— but the custom o^^^* "^^dSg B^xiaM 
qwnUties to young p«oi>fr*'"?^oBa«'» f"- ' 
»«iedyinh,stiria.h,^o^\? *^ .^°^,xra.\e^ 
and allied isoi5«s. h^^V^^P^^A^ f»t.ig^«^ 
incident to their daily- li^"'I^„iofc 



stronglv protested againat. -;^ "^oct 
-'■- , J ^^ jTjie *", lit 



be 
'■«xs, p». 



■bo too 
tol\«="r^, as a 



jM/fon IS very marked. B;^ 

men, and others who tnt(] 

dass, very intemperate, «.»_ i** ^^^Zr^aetx- - 

oommerdal traveller. (rKJ^^ »<> C^*^ S^aont^ 

employments, being more ^nZ*^^™"/- ^. Jtr? _?!. 

ba^l than out^^ occS^**""" it*'**"* 



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^ 



38 



ALOOHOLIBIC 



drink more fraely than agrienltunl Ubouan ; 
vhilat night-Uboiuran, Cftbrnsn, uiion trltra on 
■bora, bnwen^ dnymen, navTie*, pitmen, ud 
pnddlan coniume lu anoimoiu Kmoant of aloo- 
lolie flnidi. Sorial infitienea, Eucii at domestic 
mihsppinets, rate of vagef, onbealtby dwellinKS, 
bad drinking miter, or an intermittent nippTy, 
are important faeton in tha eaoMtioa of drunken- 
nees. Under some einnmutaacea, aleoholio ez> 
eeseei do Ipm injnry than nsnal, for example^ 
in penODi vhoae employment lead* to copiooa 
nreating, or neeeasitatei abundant exercise in 
a keen air ; and some constitutions resist their 
baneAil inflnenee to a remarkable extents 

PaTHOtXMiT. — A large amooat of ardent siHrita 
acts on the nerve-oentres as a narootic poison, 
nnd canses rapid death by coma. Smaller quan- 
Uties produce intoxication, accompaiued vith or 
foUoved by an acute congestion and catarrh of 
the alimentary canal, especially of the stomach 
aad duodenum. Habitual dnun-drinking, by 
altering the chemical composition of the blood, 
and cMcking the normal changes of its eat- 
pnades, exerts an injurious influence on the 
nutrition of the tissues. This is increased by 
the leesened consumption of food, and by the 
alterations in the calibre of the blood-ressels; 
set np at first by a special action on their vaso- 
motor nerves, and afterwards Inaintained by de- 
generation of their coats, as well as frequently of 
uie hewt itself. Koreorer, alcohol probably in- 
terferes direetly with the nutrition of the call- 
elements of the Tariona oigaiis aa it circulates 
through them ; and it retards the elimination of 
sftte materials — carbonic acid, urieaeid,aBd vrea. 

AxATomcAL CiuaACTUs.— -(a) Aeutt jUcolkcl- 
iim. — Dr. Beaumont thus describes the appear- 
ances which he obaerred in the st<nnach of 
Alexis SL Martin, after an excess of alcoholic 
stimulants : — ' Inner membnine morbid ; con- 
siderable erythema, and some aphthous patches 
on the exposed snr&ee ; secretions ritiatad.' On 
another occasion, 'Small drops of gnunous 
Uood exnded from the sux&ce^ the mucous 
eorering was thicker than eommon, ami the 
gastric juices were mixed with a large propor- 
uon of thick ropy ranens and mneo-purnienC 
matter slightly tinged with blood.' The poit- 
mortem appearances in a case of rapid coma 
in a patient at King's College Hospital, after 
taking three pints of raw whiskey, ware : — in- 
tense injection of the ressels of the pyloric end 
of the stomach and duodenum, with a peculiar 
blanchir)g of the mueoaa Bsmbrana between 
them, giving rise to a Tivid searist arboreaeent 
appearance on a irhita ground ; two ounces 
of bloody serum in the pericardial sac, and 
about sixteen ounces in the right pleural carity 
(the left being obliterated by old adhesions) ; 
doable pneumonia of the lower lobss ; aztmne 
congestion of the kidneys ; and engorgement of 
the large veins orer the posterior part of the 
Inain. Contrary to the nsual statements, no 
alcoholic odour could be deteotad in the brain, 
and there was no increase of fluid in the ven- 
tiides. The heart, liver, and kidneys were fatty ; 
bnttbese changes were probably of older data. la 
rimilar cases Dereijie has noticed a bright rod 
oolouring of the pulmonary tissue ; whilst Tsc- 
dieo. found palmonary apoplexies in two 



and meaisgeal hamorrhages in tv» etlua. 
Death from aeuU delirium tremens leaves no 
marked characters ; meningitis and coarse brain- 
lesions are extremely rare, whilst pneumonia is 
much mora common. After repeated attacks, as 
well as in old drunkards, fatty dc^neration of the 
viscera, and Tarious other chronic changes are 
found. 

(&) Chnmie McoMwn. — The amount of fat 
in the blood is increased, or it becomes more 
visible. Chronic congeetion and catarrh of the 
stomach, leading to atrophy of the gland-eella 
and an increase in the submucous connective- 
tissue, is very omstant, but chronic ulcer is not 
frequent. The liver is at first enlarged from 
congestion, and may continue so from a sab- 
sequent intUtration with fat ; but more frequently 
it shrinks owing to cirrhosis, Iiobar emphysema, 
chronic bronchitis^ and hypostatic pneumonia 
are common. The heart is flabby, dilated, and 
presents &tty infiltration or even degeneration of 
Its mnsenlac tiasna ; but it may be hvpertrophied, 
probably as a result of coexistent disease of the 
kidneys. The arteries and endocardium are 
studded with atheromatous deposits ; the capil- 
laries are congested ; and the veins varicoas. 
The kidneys exhibit the Catty, or, more com- 
monly, the granular form of Bngbt's disease. The 
musdes are pale and flabbv, aad aven in the bones 
formation (^ £it takes place at the expense of 
the bony texture. The nervous centres are 
atrophica and tough; the coDTolutions are 
ihninken ; the nerve-cells and nerve-fibres are 
wasted; and an increased amount of serous 
fluid exists in the ventricles and sabarachooid 
space. The abnormal adhesion of the dura 
mater to the cranium, the Iwse faechioniaa 
bodies, the opaque arachnoid, and th« diidcaned 
pia mater, all testify to an exaggerated devdott- 
ment of fibrous tissue. Occasionally hsemor- 
rhaga into, or softening of, the brain, consequent 
en the diseased state of its blood-vessels, is met 
with. The increase of eonnective-tissne is es- 
pecially marked in tpiril-drinitn, and explains 
the emaciated appearance, prematurely aged 
look, sunken cheeks, and wrinkled countenance 
wfaieh they gmerally present. The &Mr- and wm- 
drinitn, on the eontniy, are loaded with fa^ not 
odI* in the risoeim, bntia the subcutaneous tissos 
and the omenta ; and hence these subjects ara 
aorpulent, with oily skins and prominent ab- 
domens, aven when the &ee and extremiUat 
are wasted. Qonty deposits are also firequent. 
These differsnees, however, are not nearly so 
absolute as is maintained by many writers. 
The presenee of a TariaUa amount of izofry, 
a congested pharynx, chronically-inflamed con- 
junctivK, turgid capillaries, and occasionally 
papules of acne rosacea on the fiiee, completo 
the morbid anatomy of the confirmed toper. 
The autopsy in aleoMie iiuanUf di s cl os es no 
sperifie duusetars. 

SmrtDHS. — 1. Jeuit Jnioxicaium. — In this 
state the suceessivs and varying mental pheno- 
mena, tbs diswdsrs of common and special sense, 
and of the moto* npaiatns, are well known. 
These ars foUowed.lqr maasy sensations aad 
tenderness in the epigaatrium, vomiting or 
retching, headache and vertigo, with diinnass 
and occasionally yelloiraats of viiSoa on itoopiiiff 



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and liaBg agun. Th* tongM b tami, tb* 
■fp^ta ia loat, and then U a eonatant feaUog 
tt thizaL Tha sriaa ii eopioaa and pale, but 
■ftcnrvda lieeomai scsaty and loadad with 
Th« coontananea ia aallmr, aod tlia 
laaattoda and depnaaion are Terj 
■uaAsd. 

a. AtaU AkcioUe Omm.— In tl«ht eaiaa 
of thiaeaaditiaapTolongaddiawsineia iathechiaf 
ajnptom: bat ia tha aota aarere foima the 
patient is quite iaaenaiUe ; tha povei of motion 
H ia eomplete abeyance; the breathing is iter- 
toraoa ; the &ce ii nsnaUy pale, the featnni N> 
Baimng eymmetrical; the pnpila are seneialtj 
tilatad, though they nay be eontncted or eren 
■aeqaal; the pnlaa u alow and laboured; the akin 
fWa cold and clammy ; and the tempentnre ia low 
—in ooe caae it fell to 93° Fahx. There may 
ka aUmninoris ; and oecaaianaUy the urine and 
Cmm aia paavd laTohutaiily. 

S. CJremie MeaJMnm . — ^Ihe earliest eymptoma 
«( thia tarn are mosealar tremors, especially on 
««iki9g;diat>ii)Md sleep; noises in the ears ; dull 
keadacha; oeeanonal rertigo; and disorders of 
'tinoo. If these be also a fool breath, slightly- 
jaoodieed caynnetine, wataiy eyts, and tiabij 
leatSRs, with or without papules of acne rosasea 
aromd the noaeandmonth, the eomlii nation isTary 
ehaiaeteristie. IztitatiTO dyspaptie aymptoma — 
tha tnatuM maOUanu at Hulehuia — and the 
signs of cammeneing or actual cirrbosia, of 
BdJi^s diriniei\ or of ttXtj heart, frequently eo- 
■ufc, Aa theaAetion adTaneee, the insomnia 
and tremoia increase ; the mental condition be- 
eosBsa impaired ; a atzikiog deficiency of will and 
SBfTiitsiiily of pvrpoae are noticeable ; the gait 
liwnaw ataxic ; and the patient has a constant 
feeUig of dread and anxiety. 

4. Dalirum 2>»»aM.— This form of aleo- 

bolisB oecadaoally anperranea on a single de- 

banch, b«t it midi more frequantly affects the 

ehranie diinkK. It ganarally comes on duriqg 

a driakn^faoQt, but this may have terminated 

befote the attack eommeccea. In some cases 

it is aadoabtedly determined by prolonged ab- 

stincnn firam food, mental distrees, tnrgical in- 

jny, or the onset of an acuta disease, along 

with tbe ingestion of alcohol ; but in others no 

cause but the last can be traced. The first 

stage is indicated by inability to take food ; 

■arkad anxiety and restlessness; tremor of the 

TOlantaTy mnselas ; furred and tremulous tongue; 

cool akin, winch ia frsqnantly bathed in perspira- 

tiaa; cold hands and feet; and a soft week pulse, 

Tkera is complete insomnia, or short periods 

sf simp are intamptad by terrifying dreams, 

aad tba patieoc's nights are tormented with 

neioDa of bonid insects, reptiles, and other ob- 

jscts piiraning him and eluding his attempts to 

Mcapa from them or to ssise them. Illusions 

«f hearing are not nneommoaily added ; but the 

saaa of smell ia amdb mora rarely involved. 

If there ia no i mpr o ve ment, these not only haunt 

Ua sighta, bat persist in the day-time; he 

ineoberant, his meotal alienation 

and attonpta at suicide are eom- 

naa. The pupils are now minutely contracted, 

lotthBa is no intolerance of light. The pulse 

T iift M i , aad is veij fiMble or even dicrotic ; 

nd tha gmcal syaptama becons mors marked 



ALCOHOIjaM. 

A prolonged sleep J 
the disease thus taxr: 
strength fails: th» 
and thready; the fc 
gets dr^ and bro' 



B,tf»j oaomr in this sta«w» •»*' 
c»^zate. If it eostinuast ths 
E»3jse becomes small, wsak^ 
^^kXiMO* increases ; the tongo* 

^ I in the centre ; persistant 

coma-Tigil and subswal t>iui teodinam come on ; the 
patient talks inrnm'sr'- "*'7i and picks at the bed- 
clothes ; and death. X0 usheied in by a delusive 
calm, or takes place x-U * psrazyam of violencs. 
The writer has kno-«rzs csssas in which the attack 
of dalitiura tremeos al-way* beg" ^J ••^•»' 
■eveie ej^lratie fits. 

6. AMMio bttiMaaity. — The fonns of insauty 
caused by aloohoUam mi« oaUtoumMiandiiMlan- 
ekalM, ekrmio <bmeM^*0« and einmiuuiia. In the 
first homicidal impoisea, and in the second strong 
suicidal tmdencies, dmt^ to aetiuX dAvaioM <a» 
ik4 to ntrt vauiv* t^^fort, are added to the 
other signs of deliiirsTs* tremens. Oinomania le 
a peculiar form of in«auxitjr, in which the pttient 
breaks out into paraacyvma of alcoholic excel** 
attended with violent, •txa.xige, or even .'"'^"ff^ 
acts, due to apparently xazusontroUabla ^'i'^*fzk 
Tbe auack Isau a few iiaya, and is •bo°^^. 
bv a long interval oX aoktnety and 'i>*^v2« 
Taese pstisnbi have geneMkUy some Iw*^^^^ 
taint ; and sot un£ceqsaojBtIy evidancas, thoii^|^ 
often slight, of a morbid nraantal state >'°'71 LA 
detected in the intervals, %£ 'very oarefnUy loo»^^ 
for. Sea iKaAHirr. 

CoMniCATioxa.— Hosfc ot these have l)"^ 
pointed out, but chroaio dx-uijEieT8 are espedt^'X 
liable to pnemnonia of a Xf>-f^ 't'jpe, and to npi^ 
phthisis. Delirium treuuBiaa is nsr^ rarAu ootti' 
pUcated with meninptis ; mftsxxXja alcoholic ff«.tiitf 
catarrh may be followed by jaiindice ■ ^§^^ 
bral hemorrhage may coxxi^ nm^ jq ^ .' ^^ CttV' 
Temporary albuminuria i» <x=a«sionon''''*^ ^'^ 
by the ingestion of large ^vm^uititi ^ <!&lUe4l 
and even of beer. *■ oif «oi«t^ 

DuoKosis.— Thedisgo«w=- - *«•"»# 




axamiuug its contents. _^ 

breath is quite &Uacious; and r-A^J^"*"* ^ *"«* 
but little importance to tha sfcate p ***■«!» '''• 
or to tbe general features of tiie oo^ '**• T>^**^"" 
sions sometimes usher in ta« ,^ C^^^ 
apoplexy may arise from the acmVi ''**«» . ""; 
of a blood-vessel whihit a p^i^'f *^1 '^up^ 
Opinm-poisoningcan only U la.tiKC^J^'*. , <irun!t 
nated by examining thecontenu oftJ^^ ^liwi 
Unemic poisoning may be diagnoa«^V*'*'"**«h.* 
the urine, though here an elenaoSi "***■'"* 
tainty is introduced by the occaaionai "uictaJ 

of albuminuria in alcoholic ca^.^ .***^^"*'*nce 



the 



l*e- 



sencs of hypertrophy of the he^i 
of casts in the urine, or other chan^^^ *V^PV, 
Sright's disease^ mustdeddB the Qiie^j„ *'**^ <>' 
lirium tremens is occasionally ■op«i«t^ '^•" 
difficulty from some forms of ineouitv n > ^^ 
by drink; but in these cases d«^«*i^ nT""*^ 
terrors or hallucinations^ are of prima" ■"'• 
portance. The delirium of »cuto feranT ^'''* 
Bumonia may be mistaken fg^ T^. .^hd 
mens ; but the pyrexia, history of tie '^"^ 
and physical condition of the patient trin ^'^ 
to a eorreet diagnosis if tha possibility of ^*^* 



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80 ALCOHOLISM. 

b ranembeKd. Ckrenia aleoholiim hu boaa 
mictakni for other ehronie nrrrous affactioiu, 
tneh na locomotor staxj, chronic loftaiiiiig and 
mnltiple scleronB of th« Berr*-<saotrM, pam- 
lysia agitnns, ehraoie tiomoi* from metallic 
poisons, senile dementia, and eommencing genaral 
pamlysis. In all these maladies, tpeeial symp- 
toms are present, besides those common to them 
and to ehronie alcoholism. 

FBoOMosts. — In the acute forms of alcoholism 
the prognosis is faronnble so far as the imme- 
diate attack is in question. In acute coma, the 
patient generally, but by no means invariably, 
ralUes from the state of insensibility ; bnt he may 
die firom the supervention of a very rapid pneu- 
monia. The prognosis in delirium tremens is 
favonrable in young subjects ; but its gravity 
increases with every attack, and with the co- 
existence of disease of the viseem, especially of 
the heart, liver, or kidneys. Patients with 
marked symptoms of fatty heart, or in -mium 
pneumonia sets in, bnt rarely recover. Chronic 
alcoholism may be temporarily arrested; but 
the nltimate issue is unfortunately as a ivle 
only too certain, for the habit is in most cases 
too strong to be broken off, or even to be 
checked for any lengthened period. Mental 
impairment, paraiatent tremors, ataxy, and signs 
of coarse brain-lesions, are especially significant 
of a speedy termination. 

Truthbmt. — The maii* gaitrie aatarrk is 
most rapidly subdued by washing oat the 
■tomoeh with copious draughts of tepid water, 
and then giving a saline purge. All forms of 
alcohol shon'd be rigidly abstained from; and 
the diet must be simple, and taken in a fluid 
form for a day or two. Bassivs exercise in the 
open air, or, if the patient be vigorous, a brisk 
nde on horseback, is very beneficial. 

In cases of acute ooma the stomach shonld be 
at once emptied by means of the stomach-pump. 
Cold aflhsion, followed by energ;etic friction and 
the application of bottles filled with warm water, 
so as to keep up the temperature, will generally 
rovive the patient. Galvanism, in the form of 
the interrupted current, may often be employed 
with advantage. If the patient be strong, a 
smart puif;e, or, if weak, a milder one, will be 
all the aftw-treatment that is necessary. 

Ddirium trtmena must be tieatsd dimrently 
in the young and in the old. In first atlaeki 
in young ntbjielt, complete abstention from al- 
aohol, light and easily assimilated food (milk diet), 
moderate purgation, and occasionally antimony in 
doses of one-eighth of a grain, earefblly watched, 
hare been most efficacious in the writer's hands. 
If the patient has two or three restless nights in 
succession, bromide of potassium (thirty grains), 
ordiloralhydrate(twenty grains), may be given 
at intervals of four hours, until sleep is pn>- 
eured; but as the disease is spontaneously 
curable, sedatives must not be pushed. An ex- 
periencpd attendant should be always present, 
but no form of mechanical restraint is permissible. 
In aUer catet, a mild purge should begin the 
treatment; and light but very nouriMig food 
•honld be adminirtered at short intervals, Htik, 
beef-tea, raw eggs beaten up with milk, strong 
•oops, and such article* are to be given freely; 
when, by careful BaaagsBMnt and good aaninf, 



ALEPPO EVIL. 

a very severe attack may be tided over, am 
natural aleep will retam in from three to fir 
days. The eariy administration of sedatives i 
to be deprecated, bat should the restleasnst 
persist, in spite of careful and assiduou feed 
ing, a full dose of laudanum (wi zxz.— xL) a 
bed-time is of great value. In the absence c 
albuninuria, lung-oomplieations, or any sig 
of failora of the heart's action, the writer piefei 
this drug to other sedatives. If the oplui 
alone fail, its combination with an alooooli 
stimulant (brandy, whisky, or ttoul) often sw 
eeeda. If then be any tendency to syncope, o 
if pneumonia shonld come on, as well as in case 
complicated with shock, a* in surgical injuries, 
fne use of stimulants is imperative. Hype 
dermic imeetioaa of morphia, and large dosi 
of digitalis, are recommended by many authc 
rities; bat the writer has seen great harm atten 
their free exhibition. The etuUiout inhalation < 
chloroform vapour has occasionally cut short a 
attack by icdndng sleep, bnt it much moi 
frequently fails. Meehamcal restraint ia seldon 
if ever, necessary, if the patient be proper! 
nursed and attended to. All methods of sel) 
destruction must be caiefUly guarded againsi 
and a padded room, when available, is of tt 
utmost MneflL 

The great desidatstum in ehronie aleokolitm 
to substitute an easily-digested and nourishin 
diet for the alcoholic stimulants, which can the 
be safely dinwnaed with altogether. The pra 
titioner's jnagmrot, and his knowledge of tl 
euubu, are very important in the managemei 
of these easesk Stiong meat-sonps and good spec 
mens of the concentrated preparations of me 
are of great valoe. The strictly medicin 
treatment will consist in the acuninistratit 
of bitter tonics, such as nux vomica, quinii 
in SBuU doses, calumba, or gentian ; with ca 
minativies, such aa spirit of chloroform, a 
moracia, and eapsicam. Alkalis, effervesce 
mixtnres, and hydrocyanic acid an peculiar 
nsefiLl if the stomach is irritable. The eon<i 
tian af the liver and bowels should bo careful 
regulated. Bromide of potassium is in genei 
the best sedative to employ against the insomni 
though chloral hydrate is more certain ; but t 
latter should oniy be given occasionally, lest t 
patient fall into the habit of frequently reso: 
ing to it. In long-standing eases, cod-liver o 
aisonic in small doses, and oxide of sine lia 
all dona good, bnt they require a long and pi 
tracted a&iinistration. FlxMphorus has been 
no use whatever in the cases in which t 
writer haa tried it; bnt small doses of t 
mora easily assimilable preparations of ii 
an occasionally well borne, and are then mc 
useful. The craving for drink, if ni;gent, mar 
cheeked by email doses of opium, but this di 
must be exhibited with extreme caution. ^ 
dicious supervisioD, and, in inveterate caaea 
residence in a proper asylum, are the only mei 
from which any permanent benefit can be < 
peeted. The treatment of insanity induced 
aleoholism will not differ from tlutt racommen< 
in ether forms, except in an eaforced absUna 
fimm its cause. John Cdsxow 

▲XtBPf O Will. 8m Psun Bon. 



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ALeU). 

UiQID {algidmt, cold). — A word impljing 
otRBM coUbeas of tlia body, naed only when it 
tfiwiin connection with sn intcnal morbid itste, 
■ack M dnlen, or > special form of malignant 
nnittent fever. 

AIjOISBS. — ^Warm vinter climate. Mean 
^intertempcratore 59° 7., liable to rapid ehangee. 
HesTj nioa not infrequent. 8te Cuxatb. 

AT.TIbkhT. — Fond or aliment fnmiaiua the 
tlament* icqmrad ftr the growth and main- 
teoaiKe of the organism ; an^, thiongh ita action 
vith toe 3thsr life factor — ur, 'forms the aonice 
of the power maoifeatad. 

The afinent of organisms belonging to the to- 
getaUe elaas ia deriTed fnim the ioorgnnic king- 
dom. Under the infhienca of the son's raja the 
iaorganie principles are applied to growth, and 
eomtractca into organic compounds. This con- 
•titntes the main operation of vegetable life, and 
in it we bare tbesomee of the aliment of animals, 
wlodi can only t^ppropriate organic componnds, 
and wbich »ther directly or indirectly derive 
tbeeeeonponids from the vegetable kingdom. As 
the solar force employed in the constmction of 
organic componnds, through the agency of the ve- 
getable osgaaism, becomes locked np in the com' 
poond Ifarmed, aiuh componnd represents matter 
combiiied wi& a definite amonnt of latent force. 
In the employment, therefore, of organic matter 
as aliraent by animals, we have to look npon it 
not only as yielding the material required for the 
eoastmetion and maintenance of the body, but as 
containing and supplying the force which is 
erotved mtder various forms by the operations 
if aaimal life. 

Aliment c uusUluti ng the source from which 
tlie several elements belonging to the body are 
dfxired, it follows that to satisfy the require- 
■enti of Ufa it most contain all the elements that 
•re encoamtned. It is not, however, with the 
daoMBts in a Kpatate state that we have to deal, 
bat with tlie piodncts of natnre in which they 
an vanoady combined. 

The elinentarf jndmctt as snppUed by ns- 
tore are resolvable by analysis into a variety of 
dfJm'te diemieal compounds. These eonstitnte 
the ttattniary frinc^iU*. Some are common 
to bolb animal and vegetable food, as for instance 
albmnea, easeine, fats, &c ; othen are peculiar to 
either the animal or ve^table kingdom. Starch, 
for ezasi^ is met with only in vegetable, and 
gelatine only in animal prodncts. 

With reference to the alimentary principtes, it 
Bust be andaistood that in no case do they exist 
in natural products in an isolated form, and no 
aiagle alimentary principle is capable of sup- 
pintiiig life. Althongb. however, it is with the 
alhnentary products as a whole that we are prae- 
tjeally eoote m ed, yet, regarded from a scientific 
point of view, a knowledge of these constituent 
prinaplM is required, to enable us to assign to 
them their proper value as alimentary articles ; 
and for the fmipo se of systematic consideration 
aoae kind of dassification is needed. 

CtAsnncATioir. — Front classified the consti- 
taest princiides of food into four gronps, which 
he aanad (1) the aqueau; (2) the tacoharina; 
(t) tha stea^nBims; and (4) the elSuminoiu. 
Tlib rianWnrtiaB is debetiTe^ inasmneh a* ft 



AixxcsaarF. 



i\ 






aT».«T\t\on 
Luct. 



y con. 



omits firom consideration 
equally as essential to 
part of an alimentary 
and oleaginous gronpa 
and independentdivisi^: 
they are related, and 3 
sidered under a combii 
Liebig p/opoeed a crl. 
siological principles; «m. 
only the organic concctra 
them under the heads o 
nutriiioH ; and (3) <iffm« 
plattie demaUt of nut-w^. 
genons principles ; and 
office of administering im« 
renovation of the tissue.^ 
tion of muscular and ii«».m.' •» on, "^^ to thj,' 
that the source of thea^ :K»«lrei!r***'- fi.'jj . 
oxidation of the respee«^x -^e-^ tigg^ '""Bed fiJ^?* 
the exercise of muaewwl j» j g^j ®^ ba i,!??' ™» 
created a corresponding d^m, 
alimentary matter, whi <? Is 
with an importance thsc^ 
affording a measure of Cls 
tary article. By reeenfc 
this view bac been found 



-»*CB.iin^; 



th. 



<^ni 



.PHs 



*S6 A'"^" 'he nitilr 

'"'8ot'fo*a,«rf 









■cUon 
— »»iuo of /^S'rded a m 



izistranx ^^ 



Th^ 



nervo-mnseular organs -.v/w j 

holding the position at iD«tmnie»i°**<l 

agency the force liberated by ciem -^ bv"**^ "^ 

made to manifest itself under cert«j» *^ * ««* • °"^ 



certaii, '~* «of, 
and what U wanted fop tie pnrpT <*i»o,. i'"" — 
oxidisable organic material, yehich^ i» P'uie ; 
rived from non-nitrogenons as ». i**^* V^P^y 
genons food. The Hmenia of Z^'^ a, **®. •lo- 
ss they wore afterwards more '^^''tii """*— 
the cttlorifttcient t>ri7,,-,\.^J'Pfor *^ 



'Pi-ii 



:«Pre, 



'«tel^ 



styled, the oalorifacimt jprineip/''i 
the organic non-nitrogenoos consfC'*' _„,. 
Their destination, according to Lie},- "'« ofr"^ 
prodnction. It is now maintained '^' ^*"»" v"^- 
stated above, that they play a part'" 



with nervo-muBcnlar action ; 



i>o;;:-4-t^ 



said that they are to some exfent J^^^ ^ al^ 
tissue-development. From the consi 1 '''^®'*«1^d 
forth, Liebig's classification loses th '*''°''"sot 
value it was at one time supposed to *^'®ntiae 

The following grouping of the ^f!*"®*"- 
principles based on chemistry fami«h "'*'>■ 

flcation which involves no theoretical' " '^■*»'- 
tion, and is practically convenient : P'opoei- 

Food is primarily divisible into /i.n«„_ • 
Organic principles. •'»e»y«mc and 

The Inorganie principles consist of wat«, o 
the various saline matters required bv th 

'J^"?v ^.Y *" " .°""^'' """^^ f"' the su'dS; 
of life as the organic portion of food. »'P°W 

The Oryontc principles are sub-divisible 5i.f» 
SUrogmoua and Non-nUrogetioiu ; and the 'W 
nitmgenous are again farther sub-divisible {« 
Bydrocarbmu and Carbo-hydratet. * 

The yitrogenoiu principles contribute to Hi« 
growth and nutrition of the various bodilv 
textures, and furnish the active agents of the s^ 
cretions. They also undergo resolution in the 
system into urea, which is excreted ; and a com 
plemenUry hydro-carbonaceous portion, whi-h 
IS susceptible of application to force-production 
They are thus capable of administering to all 
the purposes fiilflUed by the organic wrtion of 
an aliment. 
The Hydn-earboiu or Fatt are applied to tile 



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u 



ALOUSST. 



piodoetion of haat and othitt fomu of foica. 
Thaj Mem aljo to bo aaiantul to tiscue-ds- 
ralopraent generally, baeidee Tieldiog the boaii 
of the adipoae tiuue. 

The Carbo-kvdrattM (starch, ingar, gnm, &a.) 
eontiibata to the formation of fat, axid are alao 
applied indirectly if not diie^ to fbrea-produc- 
tion. 

There are a fev principlea, tneh aa alcohol, the 
Tegatabia acids, and pectin or regatable jeUy, 
which do not strictly fall within either of the 
preceding groups. Alcohol occupies a chemical 
position intermediate between the fats and carbo- 
hydrates; whilst the others mentioned are 
more highly oxidised componnda than the carbo- 
hydistes. 

All alimentary prodaetsin thefiorm snpplied 
b^ aatun contain o^anie and inorganic prin- 
ajdes, and the organic principles comprise more 
or less of the nitrogenoos uid non-niuogenous 
kinds; but the non-nitrogenous do not neces- 
sarily, and indeed do not generally, include both 
hydjTO-carbona and carbo-hydrates. In milk, 
however, which may be reguded, f^om the posi- 
tion it holds in nature, as fumiahing a ty{ii(sl 
representation of an alimentary article, principles 
emt belonging to each of the groups enumerated 
in the above classiflfation. iSm JDrar. 

AXIlOIXrTABT OAITAIi, DiMaaaa ot 
See SiSBSTm Oaatxl, Diseases of; and the 
seTeral organs. 

KJiJC A TiTglTT.— The reaction of human 
blood is always alkaline ; and, though the normal 
dtgttt of alkalescence has not yet been deter- 
mined, it is probable that, like the temperature 
of the body, it is tolerably constant. In dis- 
eaae considerable rariation, no doubt, occurs, 
but still the blood is always found alkaline. 
Pettenkofer and Voit found the serum of blood 
acid in a case of leukemia some few houn after 
death, but not during life ; and Dr. Garrod states 
that in chronic gout the semm may become some- 
what neutralixed, but never acio. F. HoBinan 
has also found Uiat the blood retains its alka- 
linity with great obstinacy ; he fed pigeons for a 
considerable length of time on food yielding 
only acid aah, but the animals suffered from 
blood-poisoning before the alkalinity of the 
•arum was neutralixed. The alkalinity of the 
Uood is maintained by tl;e constant passage into 
it cf the alkaline salts of the food, and of alkaliiia 
owbonates derived tram the oxidation of the 
lacUc, oxalic, and uric acids famished by the 
disintegration of the tissues. The blood is pro- 
bably prevented from becoming too alkaline by 
t^a wiuidrawal of ib> alkaline salts by the alka- 
line secretions, namely, the saliva, the bile, and 
the pancreatic fluid ; whilst the acid salts, which, 
if accumulated, would tend to depress its normal 
alkalinity, are removed by the acid secretions, 
namely, the sweat, the gastric juice, and the urine, 
and by the exhalation of carbonic acid from the 
lungs. It has been shown that the withdrawal of 
add by one secretion has a decided effect on tho 
reaction of other secretions; thus the saliva 
becomes more alkaline during digestion, when 
the stomach is pouring out the acid gastric 
joiee; and Dr. Benee Jones baa shown that | 



AIEAUa 
daring digestion the acidity of tha iuin« 
lessened. A sinular rdationahip is aJao ahow 
to exist between the sliminatiua of earbon 
acid by the lungs and the acidity of the oriD' 
the latter falling as the former is incivaaei 
and viee veriA. The importance of a propf 
degree of alkalescence for the blood is ol 
yions, when we consider that this oonditio 
increases the absorption-power of its semm fc 
gaaea, and is neoessary to maintain ita albs 
min in the liqnid state, whilst oxidation i 
alwajrs mora parfeotly pstformed in alkalin 
snlntinag. 

ATiTTATiTB. — DKrunrioit. — Inoiganic aub- 
stances, which turn syrup of violets green, and 
turmeric brown ; and restore the blue colour to 
litmiu which has been reddened by acids. They 
combine with acids to form salts, and their car- 
bonates are soluble in water. 

ExuKBaiTiox.— The only substances which 
ooirespond with ths above definition are — Potash, 
Soda, Lithia, and Ammonia. The alkaline earths 
—Iim», Magnesia, Baryta, and Strontia, and the 
organic aUcaloida, have a similar action on vege- 
table blues and yellows ; but the carbonates of 
the former group are almost insoluble in wsrter ; 
whilst the latter contain carbon, and are there- 
fore classed with organic substances. 

VaovMBToa. — Ammonia is distinguished from 
the other alkalis by its volatility. The non- 
volatile alkalis are readily recognised by their 
spectra ; and by tha colour they impart to tho 
blowpipe flame, potash giving it a violet, soda a 
yellow, and lithia a carmine colour. Potash 
and soda are present as constituents of the body 
in considerabfe quantities ; ammonia exists to a 
smaller amount ; and lithia probably in traces. 
Soda is found chiefly in the bU>od, potaah in tha 
muscles. 

Action. — When applied to the skin dilate 
alkalis and their carbonates act as rube&cients. 
Pure ammonia is a vesicant, and potash and soda 
have a canstic action. Both caustic potash and 
soda absorb water from the tissues, and form a 
corrosive fluid, which destroys the parts around, 
aa well as that to which the caustic has actually 
been applied. To prevent this effect they are 
sometimes mixed with lime, which absorbs the 
water. A mixture of potash and lime forms the 
Vienna Paste. When inhaled, ammonia causes 
irritation of the respiratory passages, and in- 
creased secretion of mucus. This irritation ex- 
cites reflex contraction of the blood-vessels and 
consequent rise of blood-pressure. When siral- 
lowed in quantity, the caustic alkalis and their 
carbonates produce symptoms of irritant poison- 
iog. In the case of ammonia these symptoms 
may be accompanied by those of inflammation of 
the air-passages, caused by the irritant vapour. 
The best anUdots is dilute acid, such as vinegar. 
In small quantities and diluted, alkalis increase 
the secretion of gastric juice. After absoiption 
into the blood thev render .this fluid more alka- 
line ; whilst potash appears especially to seeds- 
rate tissue-change, and is accordingly classed 
among the alterativeo. When injeeteo diiedly 
into the blood, potash acta specially on the mas- 
des, which it paralyses. Ammonia stimulstas tho 
motor centres in the biwn and spinal coid, tho 



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ALEAUS. 

ntfoatorj nntn in the mednlU oblongata, and 
tks aceeleratiBg nerrea of the heart. Whan 
iqaeted into the Tung it thenfora caitses con- 
nlaoBt Uks thoee of rtTTchnia, and qniciieniiig 
if tks rcapintioQ and polsa. Alkalis utr chiefly 
•nntal by the urine; and potaah, coda, and 
litbia leaaen it* aeidi^, or nnd«r it alkaline. 
Ammonia is partlj excreted unchanged, but a 
poitioB pasaes out in the ibrm of urra; and it 
dock not leader the urine alkaline like the others. 
Fmaah and lithia act a< diuretic* ; loda to a leet 
oleat ; uid ammonia least of alL The diuretic 
■etioa don not depend on an; change in the 
biood-pnssiize. Potash and ammonia are diapho- 
ntic Fotaah lessens the tenacitj of mneus. 

Usxs. — Dilate solntions of potash and soda 
reliere itciung in skin diseases. Caustic potash 
er soda is used to destroy -warts ; to cauterize 
p BJwned troonds and nleers; to open hydatid 
ejaCs in the lixer ; and to establish issnes. Am- 
nooia nsntraliaes the formic add which tenders 
veamnDas the stings of bees, ants, and moaquitoe, 
aadis tbeicforeap^ied to reliere the pain which 
tkmj caaaa. The inUsTanoos injection of am> 
Bumia has been recommended as an antidote in 
anake-poisomng; but the Talue of the remedy is 
not witaMished. Hized with oil, so as to form a 
Bnimwit, aaanomia is used as a mbefaeient in sore 
thnmtit bronchitis, rfaenmatic pains, and nen- 
latgia. It is inhaled to relieve headache ; as a 
MsUKstiTa in syncope and shock, when it raises 
the Uood-pnasore ; and to facilitate ezpectora- 
tioa in dironic brooehitia. Alkalis administered 
akar meab act as antacids, and reliere heartbnm. 
When given before meals thevincrease the aecre- 
1100 of gastric jmce, quicken digestion, and relieve 
weight at the epigBstriom, pain between the 
Aooldan, and flatnleoce. Bicarbonate of soda 
is uaaally given for this purpose, but when the 
shiiMh is very irritable liquor potassa ia pre- 
flBRed, as it ia coosiderad to have a sedative 
aetioo on the aracoas manbrans. Alkalis appear 
Id leano tlie taoifarmation of glycogen into 
ffftt, and they ars need on this account in dia- 
betes. UgaorpotMHe sometimes helps to reduce 
ebcaty. Alkalis an nsed in the treatment of 
snnftihi, rheomatiam, gont, and lithiasis ; but in 
the two last-mentioned lithia ia considued the 
■oat vahiable, whilst 'potash is preferred to aoda, 
as the urate ot lithia is most solnble, and the 
■rata of soda least co. Th» salts at certain 
organic sods, sach aa the acetate or citrate, 
■ay be employed as remote antacids to render 
th« anna alkalina, as they nndergo combnstion 
■ad ars eonroted into carbonates in the blood. 
AlkaUs are grren to lessen the acidity of the 
■tine in iBiamn>sti<m of the bladder or urethra, 
■ad potash is cai|>loyed as a diuretic in dropsies. 
Ob aeconnt of ita stimulating action on the 
beot aad lespiiation, ammonia is administered 
ia adyBamie eooditiou and in chronic bronchitis. 

T. LarsxB BBinrros. 

AT.yiT.O IPa and 0«lMr AOTZVS 
glUMCUflJtS. — Danxmoir. — An alloaloid is 
a sahstaaee farmed in the tissnes of a plant or of 
aa HJiil, having a definite oomposition as re- 
poibtha proportions of the chemical elements of 
which it is eompoaed, and capable ot combining, 
Bka ■■ aifcaB. with ■eids to form nlta. 

i 



Besides alkaloids tlaaz-^ .^-'^ otber activ 
eiples found in plants, -«w-i:ai<iVi have ailaQ * Prfn- 
fid influence on the n.xa.a.-aaal econom**,^***^ 
the cla.< 









. of . 



'loid. 



not possess all 
stated. 

CKKxnuL CoirFosn*z < 
These are briefly expretvi 
tion. Thus morphia, ^ 
opium, has always tix^ 
reprenented by the fo; 
may unite with acetto 
morphia, just as potash 
acid to produce acetato C3 
piricol formula CiiHiaf^ 
percentage composition « 
simplest numbers, and d^ 
atoms of the different « 
each other. For, just as 
composition CH'O, is l>^ J. 
from ita behaviour to 
contain a ' radicle,' or 

having certain chemical g-^^xipeft- — ««« ^j_ 
those of a base, such as «x»*^«a»;n J*^*ee«n,L,. "• 
a. this radicle, C^. kST^^^ «; .'^^"^ 
elemenU of water, so aw to , <»«• ^*''?*' 

{CH» + H'O = ^'^ O -H JS) ; ^ ^^^ *> »lca|.oi 

good reason for believingr tJxat aJkaJo" '*** 
the group known as an>an«« or />«...>'''* 



?*;^\«^coior'i',t»d.to 



u:wrdt 



oth, 






cbe 



J^^P««/er*°' 






'oja. 



to 



txao 



liare 



as amtrtaa or amid ~^ — «irw 
really ammonia, NH«, in ywhich ooT** *^bi^ ** 
the atoms of hydrogen axe replaced\°*' J»i« *" 
or radicles. It is impossible^ ioit -^ * *«? "' 
present state of knowledga. to reprJr"^®*-. '^^'e'* 
chemical composition of alkaloids 17?°"' it'** ^-^ 
Btitution of the radicles bein^ stjl'i ,?* **««c» **"• 
It is obvious that two or more ^t^^owa °°^ 
resemble each other in porcenta*8^^*''*><l« * 
and still be very diflerent, both io th'^^'^Posif^*-'' 
structure and, necessarily, in their j,T^ ^lien ■ 




less ; but they have different phvsf ,"• ""ore o, 
tions, showing that their chemical" "^"'^a' ac- 
which is not indicated in these for *''""cture. 
also be different. The physiological a .^• """t 
alkaloid may also be modified by en' i." " ' 
with another substance. Thus, as w • 



N 



out by Crom-Brown and Fniaer 



se, 
•^'on of an 
fWit 



pointed 



strychnia with methyl, ethyl, ajid'^S?*?'^ °' 
present the well -known physiological ait" ''°' 
that substance, but one analogous to^S**" °' 
woorara. 'HaX of 

EKtmmuTioif.-The alkaloids and other ., 
tive principles most familiar to the phvaim- 
i»B:-Moi^ia, Apomorphia, Narceia,*^ SdS^ 
Thebaia, Narcotin. Papaverin ; Atropia. Hw^ 
cyamia, Daturia ; Nicotin ; Conia; Physostieiu; 
Strychnia, Brucia ; Qninia, Cinchonia, Bsb^! 
Oaflein ; Aconitia, Veratria ; Digitalin ; Cui^ \ 
Mnscarin ; Santonin ; and Ergotin. ^^ ' 

8orBCM.-Th» nujiority of alkaloids an 
formed bv plants. The fanction which ther 
subserve In the economy of the plant is not 
known. Some plants prodace only one alkaloid, 
while in others two or more may be formed! 
A few of the alkaloids have been produced svn 
theticaUy by the chemist. f^^aa syn- 

PHTsrouwnuL AcnoH. — Alkaloids have 
nnons degrees of physiological activity iriieo 



Digitized by 



Gougf 



IT 



S4 



AIXAJX)TDB 



totrodneed into th* ammal body. Many are slow 
in thair action, and a large don ia reqnired to 
produce any obscrrable effect; irhile otnora act 
niof* rapidly, and am ao potent that even a minuta 
doM may deslroy life. Compare, for example, 
naieotin, one of the alkaloids of opium, vith 
nieotin, the alhiloid of tobacco. Tirenty to 
thirty grains of the former hare been taken by 
the hnisan subject without ptodneing any marked 
aymptoRis, while the twentieth part of a grain 
of the latter may induce symptoms ao aarere as 
to threaten death. It is also well known that 
alkaloids may have a diffei«nt kind of action on 
different animals. Thus one-fourth of a grain of 
atropia will produce serious symptoms of a com- 
plex ehamcter in a dog, while three or even fbnr 
grains may be given to a rabbit without causing 
any more marked effect than dilatation of the 
pnpiL In considering the physiological ac- 
tions of these substances the following geneml- 
izations may, in the present state of science, be 
made tentatively : — I . As a general rule, the 
mora complex the organic moleenle, and the 
greater the snm of the atomic weight, the more 
intense will be the action of the substance. This 
has been shown in experiments oa the action of 
the chiuoline and pyridine series of bases by 
HcKendrick and Dewar. 2. Substances which 
•plit up quickly into simpler bodies, produce 
rapid but transient pliysiolo^cal eStett, whersaa 
substnncea which resist decomposition in tha 
blood or tisanes may produce no appreciable 
results for a time, but when they do be^n to 
break up. the effects are sudden and yiolent, 
and usually last for a considerable time. 3. Al- 
kaloids have frequently a doable action on dif- 
ferrat parts of a great physiological system, and 
their action in a particular group of animals 
will depend on the relative degree of develop- 
nent of the parts of the system in that group. 
Thus most of the alkaloius of opium have such 
a double action — a convulsive action resembling 
that of stiyehnia, due to their influence on the 
spinal cord or on the motor centres in the brain ; 
and a nansotic or soporific action resembling that 
of ancsthetica, dne to their influence on sensory 
centres in the brain. Hence, in animals where 
the spinal system predomtnatae, as in frogs, 
theae alkaloids act as convuhnnts; while in the 
higher mammals their principal action ia ap- 
parently on the encephalic centres, which have 
now become largely developed. 

Fassinff to the consideration of the action 
of the individual substances, we cannot do 
more than give, by way of example, a brief 
rfocmi of onr knowledge regarding a few of them. 

1. ICoTpUa— C„H,,NO,— an alkaloid of 
opium. In the fWig this substance has an action 
rrsembling that of strychnia. At first there is 
a state of agitation, followed by tetanic spasms : 
finally, all reflex actions, including thoae of the 
heart and of respiration, are paralysed. Pigeons 
have been found to possess a remarkable power 
of withstanding the influence of this drug — an 
ordinary-aiced bird requiring about two grains 
to kill it. Rabbits become partially somnolent, 
(how a tendency to reflex spasms, and tolerate a 
large dose— say about one-half to one grain per 
rowid weight of the animal. In tha dog the 
mtikvenoui iqjaetion of even one-tenth of a 



grun (fur a small animal) eauaea agitation fg|> 
lowed by sleep ; the poise and reepiratoty move- 
ments are slowed ; the smaller arteries become 
(at least during one stage) contracted, so as to 
cause an augmentation <^ general blood-preasnie; 
the pupil is contracted ; and, if the dose be huos, 
deatii may be preceded by convulsions. In UM 
higher mammals morphia acta chiefly oa the 
sensory apparattis, both peripheral and cantzai. 

2. Other alkaloids of opium have also been 
investigated. — (a.) Naroaia, CaH^NO,, is a 
pure hypnotic, causing profound sleep. Even 
in large doses it does not produce convulsions, 
(i.) Oodeia, C„H„NOy has an action like that 
of morphia, (f.) ThebaU, C„H„NO„ causes 
tetanic convulsions, thus resembling strychnia. 
(dL) ITarootln, C„H„NO,, is slightly narcotic, 
but strongly convulsant (e.) FapaTorin, 
C„H„NO„ causes a somniferous action like that 
of narceia. Apomorphla, C,,H„NO,, a deri- 
vative of morphia, has none of the characteristic 
actions of that substance, but acta chiefly as a vas- 
cular depressant and as an emetic. It is evident, 
therefore, that opium, which may contain more 
or lass of all of these substances, must have an 
action on the body of a vary complicated cha- 
racter. 

8. StrrohnU, C^iHaN.O,— the alkaloid of 
Stiychnoa nux vomica. In the frog very mi- 
nute doaes cause convulsions of all the volun- 
tary muscles, excited by peripheral irrita- 
tion. These convulsions ate dne to the action 
of the poison on the spinal cord, as they persist 
after decapitation. In warm-blooded animals 
the reflex character of the convulsions is less 
evident ; they have more of a tonic character, 
and chiefly aSect the extensors. The exact 
modut operandi of the poison on the cord is un- 
known, but in some way or othfr it heightens 
its reflex sensibility. Death is usually the result 
of asphyxia from arrest in spasm of the respira- 
tory mechanism, but it may result from exhaus- 
tion. Bruola, C^H^Vfl,, another substance 
found in nux vomica, appears to have an action 
like that of stiyehnia, but more feeble. 

4. Atropia, C„EgNO„ — the alkaloid of 
Atropa belladonna. In the tnjg it cauaes tetania 
reflex spasms. Herbivorous animals, as a rale, 
have a tolerance of this poison, so that its effect* 
are best studied in eamivora. Even in these the 
action is somewhat uncertain. Ilospiration may 
be paralysed without general convulsions: the 
pulse is quickened by paralysis of the inhibitory 
action of the pneumogastric nerve on the heart ; 
and the arterial pressure is increased. After vary 
large doaes the arterial pressure may be dimin- 
ished with paralysis of all parts containing in- 
voluntary muscular fibn. Secretion is dimin- 
ished. The pupil is dilated apparently by a 
direct influence of the poison on the centres or 
nervous airangemente in the iris itself as tha 
effect may be obaerved even in an eye removed 
from the head. Hyoaoyamla, the alkaloid of 
Hyoseyamns nigar, and Datorls, the alkaloid 
of Datura stxamoninra, have an action like that 
of atropia. 

6. D Wt a Uti , C„HuO,„— the active principle 
of Digitalis pnrpnrea. A Lnga dose causes slow- 
ing of the faeatt's action, and if the dose bo in- 
creased the heart will be amsted in diasUd^ 



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AJXALOWB. 

■id vin not napond to direct ezcit ation. With 
aMdivm do6es there is a period of acceleration of 
the heart's action, bat this period mnj mpidly 
psis into that of sloimrss just mentionea. 
This aetioD on the heart has not yet been 
dearij acooant<^ for, and it remains to be de- 
rided whether it be due to the inflaence of the 
dreg on the terminations of the pneumogaitric, or 
3f ^a sympathetic, or on the intracardiac ganglia 
tfaemsdrea. Coincident with the action on the 
heart, the smaller arteries are contracted and 
the arterial tension is increased. Digitalis would 
appnr to hare little effect on involuntary muscle, 
bot it exerts a potent action on voluntary muscle, 
vhidh, after sniall dos<«, Lecomea feeble in eon- 
tiaetila power, while large doses may abolish 
eootzaetility altogether. 

S. FhTBoattsmiA. C,,H,,y,0„ — the active 
sobstaace of Fhysoetigma Tenenosum, or Calabar 
bean. Aa has been pointed out by Professor 
Fraaer, this alkaloid baa an action antagonistic 
to that of atropia. Sensibility and conscious- 
aeas reatain until death ; the Toluntary muscles 
are paralysed ; involantary muscles are said to 
show tetanic contructiona ; respiration is at first 
accelnatrd, aad afterwards slowed ; the vessels 
become alternately dilated and contracted ; secre- 
tion, eapadally that from the lachrymal and sali- 
vary glands, is increased ; and the pupil is con- 
traced. It appears to paralyse the extremities 
of the motor nerves, in this respect resembling 



7. Onrare is a resinous substance, eontaining 
an alkaloid. Cumin, uf the composition C,^,,N, 
obtained from certain parts of South America, 
and used by the natives of these regions aa an 
airow-poiaoii. It is probably obtained from cer- 
tuB pnuts belonging to the genera Strychnos 
aad Faallisia. Its diatinctive physiological 
actioa ia abotitjon of the power of all Tolnotary 
movement, ia coaaeqnence of its action, as was 
proved by Claude Bernard, upon the peripheral 
tenninataaas ctf motor nnrea — the " terminal 
piates ' of masele. Beepiratory movements are 
arrested in consequence of paralysis of the 
masclas of icapiiation, but the heart may eon- 
tinae to beat for a eonsiderabls time. If arti- 
tcial respiration be established, the circulation 
■ay be Baintalned for several hows while the 
aainal ia eonpletely under the infinance of the 
safaatance. AU the secretions are increased, and 
the mean tempeistare fall*. 

8. Kuacarin, the alkaloid of Agarins moa- 
esiina, eaoses anrst of the heart's action in dia - 
atol^ an effect which may be removed by the 
inSaeaes at atropia, thus affording an instance 
tt pbysiolagieal antagonism. Ia warm-blooded 
-"—*'« nmacarin slows the heart's action ; the 
Uood-ptaasare &lla ; respiration is first embar- 
1 ssar d. and auy be completely arrested ; parts 
oataiaiiig inToInntary mnaele are in a stats of 
tctaaic spasm ; the pupil ia eoDtraeted ; and 



9. Buataaiii, C,^„0„th» alkaloid of Arte- 
Btoniea, may cause in nan nausea, 
^ hallaeinationa, rartigo, and a peculiar 
<d visaal aenaation — the field of vision 
■■■aUy appearing yellow, but sometimes violet. 
It ia said that the stage of vitdet rajridly passsa 
iKa thataf ydlow, and therefore it is probable 



d anim&l ■ 



that santonin may fl: 
sensitive to violet (acco: 
theory of eolour-perDepCS 
lyse them. In large d 
of consciousness, tetani< 

10. Xrgotin, the 
comutum, causes conl 
blood-vessels, contract:! 
slowing of the pulse ; tas 
consequence of arrest 

11. aulnia, C^,^T*r^* 
of Cinchona, in small dc»ee« 
action in the warm-bloc:»«5l 
doses it slows it ; and S an 
restit, and cause conrnl^ a 
shows that its action is ^»i 
trat nervoiM system. H fc ' 
animal organisms, ap^r^^a. i 
bacteria, and amcebse ; 1i>a 
out action on humble o-w^^ 
vegetable kingdom. E t:. 
of all kinds of protopi ^ 
the colonrless corpvscl^^ of^ 
fermenlive processes -wrtk. 5<3h 
sence of animal or veg-c 
does not interfere witta C:.Ia 
finids. 

12. Onohonla, C^H',.;i«'^0, i. 






VES. 

rsceite the retsnaa.! 

L»g to Thomas* Yo,„™, 

».),andafterwa.Tda ^^^ 

B«, santonin ©•n^^-^jfr^ 

jcs«nviilsions. aind deith 

m-»re principle of Se,.«i* 

^«^ion of the .^i?^' 

.«»« of the ixt.Br^^U"' 

a. theanimial d,^ "* .*«>d 

-K.Sie action of the K '" 

<=>^ one of tHe -ifc ^T^- 

accelerate, tK^T * °*^ 



IQ 



largo do«^ j^ 
>n 8 and de^^h 



»«»o«i 



*»««i»f, 






sntly 



•'*te 






tOcKj, 



»08e 



0/ 



action similar to quiiiia,~ K>a< niM..»i?**i 






Further researdi is see<Io<X 
AXiOFBOIA. 



Set B^x:.»„^ *^*«»rft 






<L 



AXFE08 and ALPS OacjS:^}^^ 
terms signifying white and 'v^ii- 

associated with the whitexa 

common Lepra : hence Lepw-a 
alfkndu. 8te "Lsnx. 

AI.FHOBIS (iX4>it, irbit«^ 
the process of turning white. ■^^^^J, 

AI.TBBA.TIV1I8.— D»«ici>r* -^ 
which gradually restore the n«at»j"»?*-~^ji«. 
to a he^tky condition, wtthoat pt^" tv" 
tions, OP immediately exerting _^*cff- - 
action upon the nervous ayateni. 






*4>C^W^ 






tions, OP immediately exerting'i!^*c&l.**e &JI2^ 

action upon the nervous ayateni. ' 'ei5^***c^2a>. 

ExuioExaTiox.— The pnncipsl ,if **'<*e^^ 

-Nitric and Nitro-hydraehlmin ^*ti»— 
_. J nkL^j... . t-j!_ "* aeiH. "a 



rine and Chlorides; Iodine '~«!?5'''» : T***^ 
Sulphur and Sulphides: Potash a^** iodS'i^ 
Mercury and its salts; Phosphol 't* i?>: 
phosphites ; Antimony ; Arsenic ; j* ■ H^^ ; 
SanapariUa ; Hemideamns and Ouai^^**,^^ 
sereon and Sulcamara. '**>v-^Jj' ; 

Acncm.— Healthy nutrition depend * " 
digestion of the food, iu aasimillti^* 'i'«\ 
tissues, the decomposition of the tis»^^** \w 
the exercise of their Ainctions, and tlj^* i^ ^* 
•f their waste products being peM> *'^>S^'*'\ 
a proper manner — in due proporti^jJ^^^j^**"''^ 
another. If the food is not properly <jj t^*^ » 

indyspepsia; or is not properly assimil ^^^^* I^ 
diabetes : if the tissues break np too i^?'"^*!^*^' ^ 
in fever ; 3r if the waste prodoets are tj^^l^^i ,"" 1« 
removed, as in some cases of kid»»r[^ '>:^-«!^ y* i« 
nutrition suffers. Digestion and ex<j^^^^J?P*'^ 
be improved by tonics, pni^tivea, mih^ V.-5i^'*"^*^ 
bnt alterativea seem to exert their ^ ^i ^" *?* . 
assimilation and tissue-change. The^^^^ ^^retic« t 
food is effected by means of '■»™»«»tij^^L"^f 



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te iXTKRATIVKB. 

thoae of tlw laliTuy glands, rtomaeli, pnncreM, 
■te. Soma aiao of the ehanget, raeh u tba eon- 
Tenion of gljeogen into sngsr, which the food 
nndeTgoM after abaorption in the lirer, and 
eran certain eo-ealled vital aetiona — sneh as 
the coagulation of the blood — are prodnced 
hy a limilar agency. It ia not improbable 
that the hiatolytic changea in the tiaanea an 
alao effected by fermaots. They do sot de- 
pend upon oxidation, for although dariag 
ncalth the producta of tissne-drcompoaition are 
oxidiaedaa fiiat aa they are formed, yet under cer- 
tain eircnmataneea the tiaaiiea are aplit np ao 
isradly that the producta which tbe^ yield are 
only psitisUy oxidized. This ia aaen in poiaoning 
by antimony, araenie, and atill more markedly 
hy phosphonu, where auch tiamiea aa the mnadea 
become decompoaed, yielding nitrogenona anb- 
ataaoes, auch as leucin, tyrosin, or urea, and fiit. 
The former are excreted in the urine ; while the 
laat, inatead of undergoing eomboation, accnmu- 
latea in the place formerly occupied by the moa- 
eolar tiasne, which ia accordingly aaid to be in a 
Btata of iktty degeneration. It la poasible then, 
although by do means certain, that alterativea 
influence nutrition, either by modifying the ac- 
tivity of ferments, or by altering the anaceptibility 
of the tiasuaa to their action. 

Hercnriala in purgative doeea.taraxacnm, nitric 
and nitro-hydrochlorio acids, probably act by 
modifying the digestion of the food in the upper 
part of the aniall intestine, or by affecting the 
changea which it nndergoea in the liver after ab- 
aorption. Potash has probably an action on the 
muscles. Antimony, arsenic, and phosphorus 
especially affect the nervous and cutaneous aya- 
tema. Hereury has a peculiar power of brpaking 
np newly-formed flbrinoua, and particularly 
qri^itic depoaita. Iodine, iodidea, and pro- 
Mibly chlorides, act upon the lymphatic system 
and promote abaorption. 

Uaxa. — Fusativa dosea of naicntiala, taraxa- 
cum, nitric ana nitro-hydrochlorie acid are useful 
in casea of firontal headache, general malaiae, and 
depreaaion of spirits, associated with aymptoma 
of ao-called bilionanasa, or with the appearance 
of niataa or of oxalates in the urine. Potash 
and colofaicom are employed in the treatment of 
gout. Fhoaphoraa anil araenie an need in caaea 
of narvona debility, aa well aa in narroua diaeaaea, 
■ocb aa nenralgia and choie*, in which antimony 
ia slao aerviceaUs. Aisenie >• alao given 
in diaeaaea of the akin; and antimony in 
inflammation of the mucona membrane of the 
bronchi. Hereury in alterative, that ia, in 
■mall doaea, which an abaorbed into the cir- 
eoladon without purging, ia need to break up 
aawly-depoaited fibrinooa masaea, aa in iritia, 
perintditia, etc., and to counteract the effect of 
^yphilitia vims upon the s(rft tisauea in the 
•aoondaiy stage of thia diaeaae. Iodine and 
iodidea act on the lymphatic syatem, and an 
■■afnl in removing glandular awallinga. By 
itimnlating the abaorbent ayatam they may alao 
aaaiat in the nmoval of the flbrinona depoaita 
Md ayphiiitie grtnrtha diaintegrated by the mer- 
eaiy. The iodidea an aometimea given in tha 
aeeondaiy, but an atill mora valiwble in the 
tmiai7 afeige of syphilia. 

T. LtvB^ BwnatOK. 



AKAUBOSU. 

▲IiVXOZiAB. — A word oaed in pathology u 
daacriptiva of any morbid growth which eontiita 
of amall eavitiea or apacea (oieaoji), nan&lly 
occupied by eontenta, and bounded by walU 
formed of sella or flbrea. Alveolar Cancer is 
the moat familiar application of the term, beings 
aynonym for Colloid Cancer. See CAMcnt. 

AlCAUBOBIS (i/iotipbi, dark^— Dxninnoir. 
— ^This term cannot be strictly defined. Liter- 
ally, it means an obieurity of vitian, a ststa 
of M m rfxM, in the popular sense of the term, 
whenbj nothing mon is learnt than that the 
patient cannot see well enough for practical pur- 
poses, and is thereby unfitted for the nansi oeen- 
pations of life. Besides this, it is always tacitly 
undentood that an external observation of the 
organ of vision, during the life of the patient, 
does not nveal any oatenaibla eauae of blindness. 
It ia further understood that the use of glassea 
ia no remedy in amauntio caaea. It is rather 
the kind, than the decree, of blindness that is 
called amaurotic ; but it must be observed that 
lesser degrees of blindness, of the amaurotic 
type, an genenlly, vaguely and indefinitely, 
ailei ambljfopus. To add to the obscurity of the 
subject, some writen call aome caaea of moderate 
blindness, of the amaurotic kind, amaurotia 
ta^i^/apia ; othen speak at partial or iaeompkte 
amaaront. We now estimate any defect of 
vision with mon accuracy, and reooni its area on 
a map, and its degree in figures, in comparison 
with a standard of ordinary normal vision. 

JBnoiaar. — The causes of amaurosis have 
been mon recently specifically attributed to 
morbid conditions of the peroipient nervona 
apparatus of the eye or of vision. All cases an 
esdndad in whidi, in the present state of 
science, and using the ophthalmoaeope, we can 
ass any morbid condition. Bnt very few casea 
an now, in the statistical tables of the diief 
eye-hoapitala, included under the head amau- 
rotit. Soma few caaea aeem likely, at least 
for aome time to come, to be called by thia 
term of npnach. The ophthalmoscope haa - 
enabled na mon accurately to classify a large 
minority of the caaea formeriy called amaurotic 
Many new namea an thus introduced to our 
systematic treatises on eyo diseases, whereby ws 
gain more definite information, if only, as in tonu 
of them, e.^. ' white atrophy,' we have anbetitnted 
the name of a particular ophthalmoaeopie aign 
for an indefinite symptom. At leaat we can 
speak man aecuratiBly of the part that ia or 
haa been diaaaaed — of the ntina, or of the ocular 
end of the optic nerve. And, indeed, befon ths 
invention of the ophthalmoaeope, the ancients, 
whilst pnfoasing to include only caaea of diaeaae 
of the percipient nervous apparatus of vision, 
inoladed all kinds of obacun visual disorders. 
Maekensie (1864) includes, beaidea ntinitis, etc., 
chotoiditia, and dialoeated lenaea I Of the first 
named he asays, ' It would ba auperflnoua to 
conaider theaa statea aeparately, becauaa we ara 
at pnaent ignorant of any diagnoatio aigna by 
which, during life, the one can oe diacriminsted 
from the other.' Evan now, whenever the term 
amaoion^ ia had recouraa to, it uipieaaua mora 
paitienlatly that of which wa an ignorant, and it 
■a; mean any OM of so many difibimt aUtas that 



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iUCAUBOSIS. 

toaaataaattl ehusetariitiei on be aadgned 
tait. 

In « Uige HMJority of Uia eaiea oommonly 
tkaed •■ thoae of Bnuaniais, it ii fonod 
aphthalmaKopieall J tl»t thsre is ' white atro- 
^t' of the optic nerrcs. The 'diika' are 
mmAj or qmta bloodlees; vhite, not pinkj- 
vhita ; and the nerre-fibcei going to the retina, 
being mote or leaa vuted, there is aome ezca- 
imtion of the diaka, perhaps so much that the 
lamina eribraes, in one or both, is ezpoeed to 
Tiev, while the retinal reasela are aomevhnt 
diminkhed in lize. The eanns of this condition 
are, nost eorainonlr, intracranial tumoors or 
other d imaa ee irhich induce pressara npon the 
optic serre, or lead to an exteaaion of inflam- 
iMtinn, followed by (edema or double optic 
■oritis (deaoending), these terminating in the 
atropbj and amanrosis. The nerve-disease is 
sftea dne to s;fphilis. But some cases of white 
sizopfay occar, in which there has been no pre- 
cedrat ncoriiia. Of such ' tobacco amanrosis ' is 
aa example, in which, nnless smoking be giren 
np, bj an idjosjnoasy of the patient, be soon 
beeomea blind. Bat nerre-atrophy or inflam- 
jnatioo sboold be no longer called amanrosis — 
they han oiitained a better nomenclature. The 
prwwiing stages of the diseases causing them, 
£C as is rarely the case, unaccompanied by any 
Jeftnite ophthalmoscopic signs, and yet producing 
a ooaaidnble amount of blindness, may, for 
rant at beuer kno-wledge, at present be called 
istoBrstic. Other soch cases are those reported 
IS snow-blindness ; or in which blindness has 
Deea produced by a lightning-flash near the eye ; 
a Uow on the eye without other mischief re- 
sakieg; dtsnae of an eye in children, at in 
tam» neglected aqnlnt cases ; irritation from some 
lennrhfs of the fifth nerre (dental caries, etc) ; 
siismii af^ iiirtssiTe losses of blood ; suppres- 
aioB of meaaea ; blood-poisoning by tobacco, lead, 
qminins ; onoaia; and aome cases of eerobral 
apoplexy. &nloIism of the central artery of the 
retina oemri, but it is easy of diagnosis with 
the ophtJialnaaBme, and therefore should not be 
calisa aaaunotic. The writer does not think there 
an any eases atUmg-tlttadimg blindness that show 
■o ophthalmnscnpie changes. 

Smnoxs and Diaoxosis. — There is one 
symptom of amanrotie blindness, affecting both 
ms, which is sotewoithy, as eonstitnting, jirimd 
fieit, a genenl distinction between it and 
the other eases of blindness not of nervous 
engin: the gait and ^neral aspect of the 
paticat is peenliar— he is hesitating and hope- 
less-looking. He no more triet to see objects. 
Ba bol^ ep his head ; the eyes are open 
asd twmcd apwards, as eyes not in use (in 
sleep} always are, or because tbe patient has felt 
the heat of tbe sna from orerbead, and has last 
aajoyed seasation of light, whence he knows it 
wius, ftom above. He feels his way with his 
leet, aad bis hands are extended before him. He 
4Des Bot look towards you, or at anything in 
fsrliealac. Bat amaurosis does not by rut 
■eaaa implj a similar stats of vision in botb 
v^a, Bor that the blindness is to be taken in the 
SBhtbslmrilngieal sense, tA wanting perception 
•■ fi^ It woold be well if any less degree 
' ' ol viaioo, withoat evident causes 



Alc: 

might be called 



KOPIA. 

'^yopie, bat tbe 



t*o Vfm 

tely. To diagnose tlie 

^ power ot perception ct 

.*3t prwenu tions most be 

patiunts who are abeo- 

Jare, and probably b^ 



Bee light, t.e. objecOve 



most be consideied 
absence or presenos «>:f 
light, certain impox-C: 
t^en, as almost atl. X 
lately blind will <3.4 

lieve, that they still <=j _ --j^^mtb 

lighL The patient ss>ao aid bo placed opposite to 
a bright light, sncli aa-ms ^ gaa-lamp, and ottr to it 
but not so near thal^ ]ie can feel the heat of it • 
tbe light is then tng-r xx ^ up and down, am} u ■ ' 
fully exposed and oV»«»«»xrod, and the patjant '* 
asked many times, ica «g|saick woceasion, ift- " 
light or not. Tho li^fit- should be left bim^* 
and exposed, or not, dms-z-ing several of th^^"^ 
cessive queries, so a^ ^o do away with an* a *^' 
The word of the pa«.i^nC untested is qnlL • **• 
missible. An^r ether bXii EB<dness than this nf "'*^' 
lute amaurosis, or o^z-s^^nating jg "'^bso. 
diseases than thoso <:>:f the percipig >"' ''Uttr 
apparatus of the eye. i^ never »o " "WTong 
prevent the perception 0/ light. Tf 1 ' «• to 



can see light from da.z-lc rs <^-ss, test 



II obje"c>l'";^'l.e 
I>rtS8e<I 1^.°' t!i9 Ju„j' 



patient 

Of .!;..•*«'' 



see shadows of somo ^zx:a<^&, 
or of one finger onl^r, 
the burning light, or ^ 
only. If he can sea t 
ness is insuJBcient to > rm 
amaurosis. Another p<^ 

amaurosis is that, oj^ i, t Ji,,; — «,^ . — m 
appearance of the fundtia of ^ "^opic^i *'• 0/ 
such as, independezxt of «* *J'o 1, /' Uje 

'"^ of Z?^^ 




«^*ot. 



or soca as, 

tion, we find in other cutset 

standard vision, or at leosC »-,»f°*P'«t;b), 

of useful vision. This wi 1 1 »a7;o»„,* 'aiV 






latitude, and will not incIutZe «nr°r'"*''«i*°'°'"'* 
nary hyperemia or anaaxnis of tl'*'"©!-;?^^* 
any physiological excavations oftu°l^ di£" 
congeniul opacities of tbe rwtia, .»>. * """ne, ^ 
of the affected eye is, if tlio otJiar'be^^''" POpiJ 
eluded from light or vision, nearly oi """"^'ly ex. 
to almost the greatest ext<>nt, thooTh" ^^^**T^ 
dilates it yet more fiiUy, and it ia I;-,f**°P'''» 
insensible to light 'Ute<l, being . 

Pbookobis.— After a due oonsid.^.- -* 
the cases thus classed together—and i.*" 
very unlike in fiict, and often rery ^b«ir*' *« 
may say generally, that if the blindnS^^ ot 
one eye only, sudden and recent, the t»^??_^\» 
hopeful ; but if both eyes are aflfecWl*'' A. ' 



disease, whatever it may be, is of 



and of long standing, it is veiv 



■ten;^^ 



»»" 



\)a" 



•S^*" 



.™ „. ™uB „.„^,.,B. ,v .. very «or\^^.. ^.^o^ 
cases of amaurosis are very rare in«a.e«i^^^ V*' L>a- 
vision is perfectly restored; most o^^\ ^^ ^* 
&tally to vision, or would so end. 'fava-^'^Yv*'' -v 
disease is sooner fatal to life. ^ A*'. 

TBKATKxirr. — This must neeessa-K-vl.^^^ j, ■»'^^\ 

according to the cause of the ama.'«:>.^^^? "^. <^ •0**\' 
tion. For instance, if there is i^^^^'^^.C** i^ < 
disease, treatment directed thereto ^ck^ ^*n*' \)* ^ "^ { 
lowed out; and should there be ix^^^^^^ '*'*'. '\0** ^^y 
syphilis, iodide of potassium and w»:»-^^^^"* "^^^''^iJ V* ** t» 



mercury mnst be given for sone t 
amaurosis depends on any injuriots.; 



Bs smoking, thin must be relinqu^ 
doses of strrehnine and iron are - 
TBneed white atrophy. J, F. 

AKBI.TOFIA (i/>/9Xte, bl 
sight). — Obscurity of visioB. fiss 




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3S AMBCLATOBY. 

AMBVJiA.'COSY (ambulart, to wallc^— A 
Urm applied to latant typhoid ferer, signifying 
that th« patient i« able to -vnlk about during 
th* attack. 8m Ttfhoid Fevkb. 

AUiKOBBHCBA (&, prir. ; /tV> a month ; 
and f4m, I flow). — ^Absence ol tha menstrual flow 
daring any portion of the period of life when it 
joi^t to be present. Su HursTBUATioN, Dis- 
orden of. 

AHSHOBBHCBAX. IKBAiriTT. See 
Insahitt. 

AMXITTIA (&, prir., and litres, the mind). 
— An obsolete term for Dementia. See Ds- 
UBirnA. 

AMinEBIA (i, prir., and lu^u, memoiy). 
iSM Apiubia. 

AUPHOBIO.— A peculiar hollow metallic 
kound, elicited occasionally by percussion, but 
more commonly beard in auscultation. Am- 
phoric breath-sound resembles that produced 
by blowing into a liirge empty glass or metallic 
ressel {amplUira). See Pkysicai. EzAKurATiOH. 

AM7aDAIiITIB {amy^dtUtt, the tonsils). 
— A synonym for inflammation of the tonsils. 
See TonsiLs, Diseases of. 

AjnrLOU) DIBBABB (SimXor, •tardh> 
— The name given by Virchow to Albuminoid 
Disease, from the belief that the material charac- 
teristic of this morbid condition is of tho nature 
(^ stuch or celluloiia. See Albiticikoid Dubasi. 

ASMltXJL (1, priT., and tlim, blood).— 
Sxxos. : Spanamia; tij/tbvama; Oli^mmia; A- 
fflobulitm. fr. Jnemie. Qer. jnSmte; BUUar- 
uuUk. 

DBPonnoir. — Deficiency of blood in quantity, 
either general or local ; also, deflciency of the 
most important constituents of blood, particu- 
lar albominoiu substances and red corpuscles. 

'uiis definition is purely pathological, and the 
condition thus expressed presents many varieties, 
Anaemia in the widest sense of the term including 
OligKmia, Oligocythemia, Hydremia, and Spans- 
mia, as wcU as Clilorosis. (See CHtoaosis, Htsbs- 
iiiA, SPAM.BIIIA, OuaocrniJtxiA, and Blood, 
Uorbid Conditions of.) From the dioical point of 
yiew. Anemia is a condition of system in which 
impoTerishment of the blood, whether &om want 
or from waste, is associated with symptoms of 
imperfect discharge of the vital fimctions. 

^TioLooT. — ^The causes of annmia are gene- 
rally multiple and complex. First, the euppljf 
of blood to the body may be insufficient, and that 
fitom a variety of causes, of which the chief are : 
— Hlerangemrnts of alimentation, includins in- 
sufficient food, and morbid states of the l^pnatia 
and blood-glands ; such defective hygienic con- 
ditions affecting the formation and nutrition of 
the blood as want of light, air, and moscolar 
exercise ; prolonged exposure to the infltteacg t>f 
certain poisons, as lead, mercury, <uid malapift ! 
and, lastly, interference with the free circa|n>-/<i} 
of the blood by cardiac or vascular (J;, ^ 




tion, catarrh, and albuminuria ; by rapid growth 
and development ; by fi'equent pregnancy and 
superlactation ; by excessive muscular exertion ; 
and by the presence of pyrexia,or of new growths, 
which rob the system of nutritive material. 
In a third group of cases of anemia both the 
supply and the consumption are at fault. Thus 
derangement of the organs and of the whole process 
of saoguiflcation is frequently associated with 
profuse discbarges from various parts ; and ia 
malignant diseases and the ' chronic constitu- 
tional diseases,' such as s^hilis, tuberculosis, 
Bright's disease, albuminoid disease, Addison'a 
disease, and others, the causa of the anemia 
is extremely complex. But the majority of the 
cases of anemia that are regarded and treated 
as such fall into the class to which the name of 
idiopathic has been applied. In such cases the 
anemic condition is due, not to any disease so- 
called, but to disturbance of nutrition generally, 
that is of the healthy relation between the 
demands of the system and the supply of nu- 
trient material. This condition occurs chiefly 
in children and young women, at the period 
of bodiljy growth and of the development and 
early activity of tha sexual ftmctions ; and when, 
as BO frequently and unfortunately happens, 
the air, light, food, occupation, and moral rela- 
tions of the individual are all mora or less un- 
healthy. 

AHATomcAi. Ckaractbbs. — The blood suffers 
three principal chanp;es in declared anemia, 
namely, (1) deflciency in amount (Oligemia) ; (2) 
deflciency in red eorpusclee or hemoglobin (Oli- 
gocythemia, Aglobuiism) ; and (3) deflciency in 
albuminous constituents (Hypalbuminosis). Of 
these Oligemia is the simpleet, and perhaps never 
occurs alone ; it is speedily complicated with 
Aglobuiism, which is a very early and common, as 
well as the most obstinate, change in the blood. 
Hypalbuminosis is the most advanced and perhaps 
the moat serious alteration of the three. {See 
BuiOD, Horbid Conditions of.) The blood is 
scanty and pale, and has a diminished specific 
gravity; and coagulates slowly and loosely, or in 
sggravated cases not at all, settling into three 
layers — consisting respectively of red corpuscles, 
white corpuscles, and plasma. Tha body pre- 
sents certain changes directly due to the state 
of the blood. Whether the anemia be local or 
general, the corresponding parts are blanched 
and ' bloodless.' The cells of the tissues become 
atrophied and degenerate, in consequence of, and 
In proportion t<i,tSB interference with their plastic 
and Ainctional activity respectively; and the 
so-called 'anemic' form of fatty heart, liver, 
kidneys, and other organs, is' the result. If death 
occur suddenly from acute anemia the heart is 
found empty and contracted. 

Fathoixxit. — When the volume of Wood in 
the body has been reduced by repeated small he- 
morrhages, the phenomena that supervene, while 
they express the want of blood as a whole, and 
of Its several constituents, are chiefly referable 
t6 the loss of two of these constituents— the 
albnminotis substances and the red eorpuselea or 
hemoglobin— that is, of the ozidisable and tha 
asidising materials. The pathology of hypolbn- 
jninosis and sglobnlism is fully discussed in the 
artida on diseases of tho blood, and need not t« 



\ 



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ASJKOIA. 



TUfmtrd here. Tlia nma eflbeU will }» pio- 
dased by a drain at the liquid part onlj of the 
bfand, or by porerty of the blood from any of 
the eavaea amimerMed abore, vhethor of the 
Baton of vaata or of vant ; inaBmneh as Ion of 
plaana speedily aSbeta the nntritioa of the red 
cocpaadea. Tliaae phenomena constitute the 
sjaptoms of the amemie oondition whatever may 
1>5 its cause ; their relatire prominence natotally 
tarying aeeordiDg to an immeniie nrnnbei of cir- 



Sncpma. — The snbjeets of anamia are vsoally 
giila aad yoong 'WomeB. Their general appear- 
•aer, which is striking, is one of pallor, debility, 
sod Tariable loos of feminine fUneas. The 
TisiUe parts of the surface are pallid, often 
with a tinge of dusky brown on the eyelids 
sad Uw backs of the hands ; the clearness of 
tka eonplazico Tarias with the normal pig- 
aentatioa of the body; the skin is soft, satmy, 
sal rather looae. The mncons surfaces also are 
blnehed ; tha aelerotie is pearly bine. The loss 
of fleskniay be moderate, or it may be considerable. 
Tha extMBUties are cold, and the legs and lower 
ej^da are often edematous. Bodily strength 
is led au aj ; mnseolar force is diminished, while 
myalgia is oommon ; an air of langnor and want of 
rigour perrades the whole demeanour ; and the 
padaot IS sleepy, dnll, and depressed. Tbemibject 
of anaemia generally eomplaios of weakness, Ta- 
rioDs pains aboat the body and head, and muked 
dantaees of breath on the least exertion. The 
last symptom is vnaeoompanied by other eri- 
dcaee of reaptiatory derangemeot ; in duuraeter 
tha breathing is regular, and short or eren pant^ 
iag. The symptoms referable to the circulation 
eoBsist chiefly of palpitation on exertion; a 
teadency to Hunt ; aod pain or eTan distress over 
the eaidiae region. The impulse is variable ; the 
first aoad is cothCT hollow or mnrmurish, or eoD- 
Tertedinto am-nrmurat the base, and fre<jasntly 
arran orer the whole praeeordinm ; the diastolic 
■oond is sharp generally. Over the manu- 
bnam aad in the eerrical Tsssels a murmur 
fiiUovad bf a sharp somid is commonly audible, 
aad tbaivwith a renoos hum. The cervical 
nastlj Boay throb ; the radial pulse is small, soft, 
waak, ajsd of variable but usually increased irs- 
|Ufrj and saddeoness. There is a tendency to 
haamiilisftra. eqieciaUy epistazis ; and petecbite 
axe oecaatoBally observed. The digestive system 
is markedly aStcted, as shown by loss or 
iMnmsi oB <rf ^ipetite ; an anasmie, i^en bare, 
Mt Tsriaida toogna; dyspepsia, nansea, and sick- 
Dsaa aikar meals or on rising; and constipation, 
whidi is present in the majority of cases and is 
freqasoUy prokmged aad severe. The menstrual 
lanetiaas ara abnoat always deranged ; amenor- 
ihoea is fowimnn in some form ; menorrhagia is 
nn (oseept as a eauae of anemia) ; dysmenor- 
itoa is freqaeottf asneiated ; aod lenconhoa is 
Iha rals. lliswiae is vsnally abundant and pale, 
bat lanes greatly. Headache and other cerebral 
miptasas are eoaunan. Blood drawn frsm the 
fagcrprssantsa^bolism. SeeHsukcmaaTRO. 

Tha Ifading phsaomsDa of aeiU* anamia are 
AasB tt syaeopa, or suspended animation bom 
AQan of the aMslation, and are described under 
tettitls. 

I tm TssmxAiioiis. — Ths cause of 



annmia in thia fopm is eaaentially slow and pro» 
gressivo, lulesa it is checked ; the duratton in 
perfectly indeflaite. The course of tha symp- 
tomatic form -jriH. naturally vary with its cauae. 
Idiopathic aniexsiia. rarely terminates fatally ; and, 
when It does ao. the event may be referred with 
few exceptioua to some compUcation. Oc»- 
sioD^y, howovear, it proceeds steadily to death 
(s«PBoaRaMnr« PimKunous An^tii; below). 
InUrcurreufc di,e»,es ma, be expected to bt 
vere in an «.^ ^,^ condition, irproportioa 



severe in 
to its degree, 

DuoKosis. -A^Tuemia 

with the grscktca^t 



'» Renarally recognised 

of diagnosi-s r«l«.tes "'us «t!f" i'fi^t ™i"„t 
to be determliio<a therefar?^^' v. fi™'.?""'^ 

uWnlo.is.ay^SXLr?."'*"'' ™'' *" 
other of the ^^^^ 31'""'^ ''"'""*•" ~°* 
of blood. Ha^i^^,K •,""!• °'P°T'"'T 

^TwMch it. ^' ""i" «<=l'«de two disease-. 
SorosT'l^l^^lc^m'^ \Z'^'<'^.'>d' ^-T^' 
plsnna is not onsidwed t?i"?"' '? ^^i'K^^ 

^edbythey«liow.i^'?' ?**^°'°?^' i 
It wasti4 «.^*f W°^*^'"' ^y theabsene 
features («. CaioB^f- r" ^'^^ " ^^ ° 
nised by exami^on rf\u^i*«""'* ," ^'^~ 
lymphatic glaad, T],. ^' ¥°°^' »P^«"°; 'T 
bl«Jd-chan^ i^%uj^; .'/.'^'^Voint of tls 
only be diijoverS fa. „ '^'°f«thic an«mi.». . 
aU the fscU of th^c«l """^"^ wvestigation 

PaooHosis. — The pix^n • 
favourable as reg-ards lift ""V" 

from loss of bloodf the Mt?;.* a^ 

speedy and complete ^'1."*"^ ^ ?^?"»f,^ 
anamia, howeverf this S*^- ^ id.opath. 
.h.n th. «n»- -.-- f"'™"^ can be given onl. 



of 



ansemui s 
simple anKmua 



when the cause can ^""1"^ •=*» ^ given onl.jr 

Under favourabla circnm.f '"°'^«^ °' »7°'^««*- 
. ; .."^^'tancesi .„H .r.niid treat:.— 



can be 

menfc, improvement will h^~^ 

atalv: and health .l,„..iJ,''*ff'»» almost immedi- 



ately; and health should bo 
weeks or months, 
Tkbathxitt. — The 



ces and sound treafc.- 
nza almost immedi- 
*"«Btiored after a fe-^ 



when it is symptoma'tio oV^!^'^"***"' °*" »»«e™»a« 



■oxne 



dition, such as Bright's dise^ 



more n-ave con- 



not require notice here. 



--. — or phthisis, does 
vneix blood has been 



lost in serious quantity witK *** blood h 
consequence, it will be ijatur«?i^' other iiyury or 
cient time but be given aad" ^'»'«red if sufB. 
wise avoided. Attention to ♦ i**'*^^'"^"^" other, 
health, abundance of food anrf ** .ordinary rules of 
exercise, will surely, if slowlv^"^*''' °'°'^ moderate 
without the administration of-'„ - ^® *^^* patient. 



in this case, however trea^^*"*^® '^'■"S- ^'">'' 
great service, by arresting, if nSe^""fl. ^^ °* 
of the anamia, such as menorx-hav^ ■ "*"■• 
and by assisting nature, if the iS"^°' *?'■**»» ; 
threaten at any time to become ^ '.'**° «l»o«ld 
own effecU. «--ome wtensifled by its 

But before the blood can 1>« „^ 
large and iU-deilned group of f^^'*^ '" 'ho 
idiopathic anamia, the unhealthvi'^ tooTm aa 
which the patient is placed, and tta iS"*"-'"*' *""**' 
other derangements, which are nsnall '*'°°**^ and 
for the imperfect sanguification •''"""ountabl* 
covered and corrected 'VVhoro'th'"'" • ^ *^''' 
complex, treatment must be eonall * *''°loKT *» 
the whole system of life wiU hav»^J iP"*™'' ""«' 
On the other hand, in the ranidL ^' '?>'"°"n«i 
"ipiojy growing chia 



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M 



A^SaOA. 



lad yoath, and still mora in girli at paberty, the 
great demand for mttritiye material miut be daij 
ooBsiderod and erery obitaele to ita rapply re- 
mored. When other than direct dischargee are 
draining the blood they most be cheeked. Lac- 
tation may hare to be forbidden ; and lanoorrhcea 
and spermatorrhcea will sometimes demand local 
tnatment. 

The removal of the cause being thus made the 
first element in treatment, means must nest be 
adopted for the restoration of the blood. Bnt 
before this can be accomplished, it will be neoes- 
■ary to bring the alimentary tract and the organs 
of sanguification into a healthy state. Dyspepsia 
and constipation rrquirs immediate treatment; 
and for this purpose simple alkaline and bitter 
stomachics with rhnbarb, and free purgation by 
ordinary mrans, followed by a coarse of aloes 
and iron pill at night, are the best. The food 
most be carefully ordered, so that it shall not only 
supply the albuminous elements that are specially 
d^eient in the blood, but be retained and ab- 
sorbed ; it must therefore be at once nourishing 
and digestible, and be taken in small quantities 
at frequent interrals. The patient must not be 
allowed to yield to the disgust that she may 
hare for meat. 

The process of sanguification may be success- 
fiiUy assisted by means of drugs. Iron is the 
soTereign remedy for aglobulism ; and, practically 
speaking, it spsedily becomes a queation in the 
treatment of a caee of aneemia in what form iron 
is to be given. The compound iron mixture of 
the phArmacopceia anrwers more frrauently than 
any other ; but, on the one hand, when there is 
much constipation, the protosulphate with pnr- 
gatire saline sulphates will be more suitable 
for a time ; and, on the other hand, when there 
is a tendency to discharges, the per-salts with 
bitters will better answer the purpose. The 
combinations of iron with qninia or strychnia, 
should be giren in cases where less marked 
ansemia occurs in older subjects with nerrous 
depression and general want of rigour. In 
special cases the ferrum redactum, saccharated 
carbonate, vinum ferri, or the French dragiaftr- 
nymevsM at meal timesmay beordered. Ood-liver 
oil may sometimes be prescribed with success. 
Other symptoms must be treated on ordinary 
principles. Uterine complaints demand special 
attention ; and bromides, ergot, opium, and other 
sedatires and astringents are indicated where 
•xcitement and ezeessiye discbarge are present. 
While these dietetic and mediciiuT measures are 
being carried out, it is impossible to insist too 
strongly upon aUention to bodily and mental 
hygiene. In a large number of eases chants 
of air Ailfils all the necessary conditions, and it 
is generally to be recommended. Above all, 
time is an essential element in the cure ; and 
rest is scarcely less so. A frequent change in 
the form of the medicinal remedies is also 
advisable. 

Frosresslva Psmloioiu Anssmia. — A 
peculiar form of anemia has long been knowiif 
bnt has lately attiaetsd special attention, 5pd 



is rarioasly des^^nated as pemieiotu, tfujia- 
naiU, UiepailUe, sod progmtive, on ^/^ •■ 
tt the inttBtity of U>o lymptoma, ^v^ 



mtHjotiUpMuJcg^, Ma4tb» ^^n^n. 



*e«OU>»* 



'>wr^ 



AKiBSTHETICS. 

which it advances to a btal termination. Tlui 
disease may occur in both sexes, but has been moat 
frequently observed in middl»«ged, pregnant wo- 
men ; it presents no fecial post-mortam appear- 
ances ; and it cannot be reforred to any reasonable 
cause. The tymptonu are those <^exeeadva an* 
mia, as described above ; bnt gastric distnifaaiies 
and general hamorrhagaa are ralativaly promi- 
nent, and, in some cases, irregular attacks of 
Syrezia occur. The blood during life is said to 
iSer from that found in ordinair anemia, fay eon- 
taining an unusual amount of iU-shapsd rsd ear- 
puseles and granular matter. Tha coirM of the 
disease issteadilytawardsdeatli,inwluchitgsn»- 
rally terminates. The valkolegg of progressive 
pernicious anamia is obacnre. It is believed 
D^ some to be but the advanced stage of or- 
dinary anemia, which attracts attention by 
its resistance to treatment, and its fatal tar- 
mination. The appearance of the blood w<mld 
seem to indicate excessive deetmction, nther than 
insufficient supply of the important elements, as 
the essential cause of the laorbid condition ; but 
then is probably derangement io both directions. 
The proffnom is as unfavourable as poosiUa. 
JYeatment must be ordered on general principles : 
transfusion has been frequently tried, but with- 
out success. J. HiTCBELL Batrca. 

JlSJBVUL I.TXFEATIOA.— a form of 
Anemia which is associated with a peculiar af- 
fection of the Lymphatic System. Set Hoso- 
kin's Ciseash. 

AITJBiSTHSBIA (1, piv., and iuvBinfua, I 
feel). — Anesthesia literally means absence or loss 
of sensation, which may be general or local. 
The word is, however, more especially employed 
to signify loss of tactile sensibility, as distin- 
guished from insensibility to pain or Analgtiia, 
It is further used to indicate the condition in- 
duced by the action of Anesthetics upon ths 
system. See Skwsatiox, Disorden of. 

AJf.SiSTHIITIOS. — Dbfikitioh. The name 
given to a series of agents which are employed 
for the prevention of pain, but more especially 
applied to those used in surgical proctiosi 

HisTOBV. — The idea of annulling pain in smv 
gical operations is a very old one. Compression 
of the nerves and blood-vessels, and the inhala- 
tion of the vapour of mixtures containing ear- 
bonie anhydride were practised at as early data. 
In the sixteenth century ether was probably tiM 
active ingredient of a volatile anesthetia de- 
scribed by Porta. The nse of aneathetics was, 
however, but little nndentood and nrely prac- 
tised. Even the suggestion of Sir Humphry 
Davy, that nitrons oxide should be used in minor 
operations not attended with loss of blood, waa of 
little practical value, on account of the inefieiaat 
apparatus then available. In ISMHoneeWeUa 
inhaled laughing gas so meeessfVtlly that he may 
be said to have introduced the practice ; but he 
appean to have so often foilea to produce tha 
desired effect that this agent fell into disnsa 
on the introduction of ether in 1844 by Morton, 
after some communication on its properties ftaaa 
a chemist named Jaduoa. In 1847 ehlorofonii 
was used by Simpson, and quickly supezaadad 
ether almost all over Eniop*, At the piasent 



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ANiBSTHETICS. 



tin* the ecmpuatiTe laftty of athar hu csviad 
this anaathatie again to ba prafaned by manj 
wigB o na in thia taaatTj. 

Sanmmax-noa. — ^The three aganta jnat man- 
tJOBcd, nanelj, nitrooi oxide, ethar, and ehloio- 
fatm, are thoae chiefly in nse, and thej hare each 
■lTanlageain|i«Tticiilarcaaea. Expcrimentamade 
•ith oihar agonta, each aa amylene, tetrachloride 
ef eaiton, ethidanedichloride, and bidiloride of 
■ethylaDC, hkT« not ahown that they poaaeaa 
BaffiaaBt adTantagea to coanterbalance the defect 
of nqoiriag apedal management in their ad- 
ffliiiiitiatku. Thia list of anoathetica might be 
itiU father inenaaed, for in order to fvodnce 
iaamaifaiUty it ia only neoesaaty to reduce the 
iap^y of artarialiaed blood to the nerroaa 
eantrea, or to introdnca into the blood a aub- 
Maaee vhich deprirea it of iti pover of oxygen- 
ataog the tiasnea. 

Ibiins OF Uaa. — Anaatheais may be produced 
far aaigical pnrpoaea: — 1. by bennmbing the 
nait to be operated on by meana of cold ; 2. by 
ntcRcptiiiig ita nerroaa communication ; 3. by 
anaadng the actirity of the nerroaa centiea 
«B nt « ii iii.l in aenatioa. Thna aneathetica may 
be laeai crfemml in their action. 

IkmbI 11 n— (liiiala may be indooed by cold. 
Tba mart eonrenient plan ia to blow a jet of 
anhydram ether ipray npmi the part, aa aug- 
nated by Dr. Bichaidaoa, and thua to fireeza it 
The aor&oe to be froaan ahould be dry, and hence 
IhedilBealty of fiveaing the gum of the lower jaw, 
ao aeeoant cf the aalira. A mixture of equal 
parte of ponnded ioe and common aait contained 
IB a bag of moalin ia eflectiTe, but leaa easily 
applied. Thia plan ia adapted for opening ab- 
aeaaaa and boila^ and for the extraction of a few 
teeth ; bnt the pnxeaa both of congelation and 
at thaw is painfal. Chloroform applied locally 
ia aud to eanae nnmbnaas, but it is reiT little 
■aad eaeept issida the mouth, and then it owea 
ita aoothing affects to the quantity of chloroform 
vaponr which is inhaled. Compreaaion of nerre 
trmokM for inducing anaatheaia ia never prac- 
tiaad at the pnaaat day. 

Oanaral ft nawtlinala is at present rarely 
-'*'"—^ in any other way than by inhalation, 
attboogfa luLLnauful attempts hare been made to 
the eoDdition by subcutaneous and in- 
I iigsetian of chloral or morphia. 
Ts roB AjuBSTmcncs. — We may say 
gaDerally that any peraon fit for a Bevera ope- 
xataoB iaaHtaubjactfor an anaeathatie, but no one 
ia ao fine hoot danger that care in watching ita 
aAeta can be dispensed with. The easea requiring 
tba gieattat rigilance are not the young and deli- 
cate, liar wfaoma small doaeanfficea, bat the strong, 
vfao iahala deeply aad straggle much. Ether is 
pBofaaUy better for those suspected of fiitty de- 
gaoantiaa of the heart, although aa a rule such 
caaea are eminently aatiafactory under chloro- 
fgnL Hany of the deatha under chloroform 
have ooam e d in interaparata drinken, and the 
paaaaee of aleolul in the aystam undoubtedly 
wtanaifaa ita effset. 

Paacaimoaa. — Before commendng inhalation 
iba Mloving psitieulaxa shoold be attended to. 
Aa patiaat moat not hAva ncentiy taken a ftdl 
■Mai ; be aixmld lie eominitably, in a horisontal 
I if poeiibla^ ■nlaaa whan gaa or ethar is 



41 
a^Mld 



given for B short opoir»-*io*','" and t|,^ 
not be tight. When «i»»^ ^''fun'etmtion i- k 
he should be encour«K«-cif<' hra^tha i-otmil^l^!^ 
freely. The pulse u ^n^^U -• tie r,^,^^^^^^ 
be witched. '^If the ^« po-r excit^iT^^" ^. 
lowing or con^ngr. »t. V? "I"*, P^**eoat tbau is 
requisite, and its mtr«aM^t^*bmild bo diminuihed. 
Most patienta are &t^ mr^ afeajd of bzw«,tIiiog, 
and some hold theriir bx^oath for half aa minnte.' 
The vapour ahoald xboI> be romowecl on this 
account, bnt care ahoaald be t&ken. bjr holding 
the inhaling appar a a f w Luther _ofi^ fco pr«vaat 
the vapour becomings t*>o strong in tJie interval. 
After volition has boon a-bolished, any !>»«■« in 
the breathing shonld bo noted, &nd xxxore q, i 
fresh air given. Fojrtfaer direction e wwill be gj^ 
in describing the anaesCJaetica specia-lly. "" 

SraciAL Ax Ms t axrz cm. — Pntoxidm o_f ^U-roa^ 
yUrout Oxide, or Lattffhittg Gaa. T\x\u a^J^V^' 
now prepared whcdesal*. sand sold ««»n<i«.ni^* '* 
a liquid in strong iron bottloa. T1m» »a«7wh !?** 
supplied thus or from sa fi5a«>met.er, aho ij ' 
inhaled from a bag tiaT^n^ Buotx «. JwT'**" b« 
mnnication with the face tbafc it 'vrilj^ ~** _ COn, 
supplied even in pantingr^ '^*^P*'*tioi>^'**^''y be 
tube, however large, is olijootJona.\jj • A. Iq. 
ia lees mobile than oommon ^^^r. ■ 1^ the 

The special aim in givxa^ fi>&« ^i^ ^ 

be to exclude air, and to axci^^^^^ tK^^^ a» 
within the ajy-passagea and Isa-t)^ ?** "^tin ^t 
mis. The patient should xaofc *>»• ^^ On *^ll9j» 

spirstion should not be jaz-JcJI^ ' **()(« ^^ J)n ''^ 






gas. 

breathe slowly and deeplyr, 

do so, about fifteen times i i 



l>ut 



tion should be complete. It a* ' **t>rt ^^ Ti^"^ 
of laughing gas that no hja.rocm o« ** «i^ ^h^ *• Jfl, 
ing too freely at first. OTIbo r*» fiJ'^Kiai^*Pi*^ 
kept filled either by preasixfo o^^-i, '**« of ■ ""^l 
or by turning the screw tap o*- ''j^^S" {/'"ba) 
This may be done by the bsn,]' t/,^ «ii«o *' iT 
or more conveniently with the f ^f ^h^ i"'"^!' 
nistrator, by means of a contriw^t J\^ i^,- '"e ' 
Hr.Sraine, in which thegaa-botM^t^o ■ 'Ae *?*ot' 
a and mo^i^ 'p^on^'^./: 



xontally upon roUera 
whilst the head of the 



writer'a plan is to fix the bot{j^'* 
turn the screw by pressing thg fo^^'^t/Q. 
iron plate with spikes on its unrvT*** «*- ■ 









a a^uore hole fitting the tap oo i^f ""fii^* ««> 
It IS imperative that the 'ace-piei'**»r aS*?*'* 
piece tiould fit ttceuraUly, and ti! *"• *o^i.*- 
almoat essential to effect this in » *''-pad •' 
—- It should be warmed if tho ^?' man * 



cases. 
isstiS 



After five or six good respi r, " ■'""■ubb, 



is no need of supplying fresh gas win, "» 'iier^ 
spiration. The expiring valve kii^nu *,"* >n^ 
cloeod,andlheinspiringvalveopem.,l p * kept 
alwaya bo taken that the supply of »~'*'® ""ust 
cient to replace any that is lost bv .K.'* '"ffl- 
into the blood or by leakage. This is to^''*H?«» 



»l>«orpti. 

effected if the ga8-{)ag is made of'thi^?^.*""'* 

as to distend easily and contrelj'^""'''' 

""^' I'»honWbe 



ber, so 

with the movement of breathing, 

anfiSciently filled, so that if the month ra.^ j - 

not fit, the gas would escape inateS^f ?* 

entering and becoming mixed with it *" 

Lividity of tho skin will not heln'us t^ i. 
when tha patient is fuUy under the infli^,?"* 
gas, neitber wiU insensitivenesa of the^!r- 1 
yet the stats of the pupils. Th. ikl??i^r». 



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■hoold become etertoiou* or interrnptcd, or the 
pnlM Tery feeble, or conTuliiTe twitching* should 
occur, before the fiioe-pieoe ii removed. A little air 
may be admitted b/ rsieiiig the face-piece, if the 
operation is not upon the face, and by doing so 
•rery fontth or fifth respiration anesthesia may 
be kept up for seTeial nuDates. The effect of a 
single All! inspiration may be to bringthe patient 
into a state of excitement, and the continuance 
of the gas teitiotU air brings on coDTuLsive more- 
ments, so that it is not well adapted for any 
operation lasting as mneh as firs minutes, and 
requiring steadiness^ 

Patients are sometimes so unsteady that it is 
found to be almost impossible to make the 
fiice-piece fit. In such cases the best plan is to 
coTer the patient's eyes and let him breathe air, 
merely prerenting him from rising from the chair 
or bed, and not speaking till ho is conscious, and 
as soon as he becomes so to recommence the 
inhaling as if nothing bad happened. A Tiolent 
patient oiten becomes perfectly rational in less 
than two minutes. 

Sickness and headache ought not to result 
from the inhalation of gas, but if the use of it is 
prolonged, or if the patient is kept for several 
minutes in a semi-consdons state, breathing a 
little air with the gaa, both these symptoms 
may occur. The recumbent poatntv, quiet, and 
warmth to the feet, constitute all that is likely 
to be required in the way of treatment. 

Ether, SHJplnirio Etitr, Etkj/Ue Elier, Vinic 
Ether, or Oxide »f Elkgl, was first used for anes- 
thetic purposes in 1816. Before its use was well 
understood in England chloroform was brought 
forward as a more convenient agent, and much 
less unpleasant to the patient. Ether is less 
liable to berama dangerous to life, as it does 
not under ordinary ciicnmstance* depress tli* 
action of the heart. 

If ether be given firom a towel or hollow sponge, 
the best kind is the Mther Punw of the Pharma- 
copoaia, of sp. gr. 720 ; but the ether of sp. gr. -786, 
which contains a little water, answers very well 
if the towel or napkin is arranged so as to form a 
large cone, thus lessening the access of fresh air. 
The disadvantage of using the latter kind is that 
the moisture of the patient's breath condenses 
upon the suiface maoe cold by the evaporating 
ether, and diminishes its volatility. When pure 
ether is used, a certain amount of condensed 
aqueous vapour is taken up before it reaches 
the density '735. 

In nil inhalers when an arrangement is made 
for preventing the ether from becoming too cold, 
the washed ether -735 may be used, and will be 
found cheaper. Kot only is it sold at a lower 
price, but it is much easier to keep from escaping 
through cork or stopper. 

Al£ough it is not difficult to destroy dogs sud- 
denly with ether, it is believed by many writers 
on the subject that in man it can only prove fatal 
by causing asphyxia, and that the signs of this 
condition are so easily seen and remedied that 
practically this aoSBSthetio is quite safe. ;i<fa0 
writer ;s not of this opinion, believing that some' 
times when narcosis M f»r advanced, the frlotutf 
will allow etha vaponr to pssa of auffi.. * 
sCieiigthtostoptfeeikesjt. Aiei cases, hoirey'''' 
reiXnraiodMd Stiue iM tti^aiTeiy ^^**\^rt 



tared by pouring an omnce at a time npoo a 
very large cup-shaped sponge, which, if cold 
from previons nee, is dipped into hot water and 
eqneexed as dry as possible. It is to be expected 
that the patient will resist breathing when this ia 
held over his face, but after a minute's struggling 
he becomes nocoDScioas, and easy to manage. 
Oompared with giving ether timidly, so as to 
let the patient remain delirious for several 
minutes, tliia may be a good plan ; but there is 
no necessity for giving the ether so strongly if 
tM dminuk the aeceu of frak air. The ad- 
ministration of nitrous oxide from which air is 
at first excluded, and afterwards admitted veo^ 
sparingly, has taught us how slight the after- 
effects are from the asphyxia so induced. Cone* of 
leather or pasteboard lined with felt, and having 
a small opening at the apex, are better than 
sponges ; but they should be larger. They may 
be made more effective and economical by placing 
a thin india-mbber bag over the apex of the con*, 
so that more of the expired atmospheie may be 
breathed again. 

Morgan's inhaler is very efficient. The ether 
is poured into a tin chambw as large a* a bat, con- 
taining sponge. This is covered by a sort of 
diaphragm, which rises and fMls with respiration 
as the patient breathes into and out of it by means 
of a tube and face-piece. There are no valvea. 
Anaesthesia results partly from asphyxia, and 
partly from the action of the ether. The amount 
breaued depends on its temperature, and on the 
freedom of respiration. If the respiratory 
movements are slight, as in young children, or 
in persona suffering from emphysema, the 
amount of ether supplied is apt to be too small. 
Ormsby's inhaler is an improvement upon it. 
The sponge for ether is contained in a cage near 
tlte fhce-piaoe. 

An excellent inhaler for hos^tal porpoaes and 
for prolonged operations is sold by Mr. Hawkee- 
ley. The ether-vessel is kept in a water-bath. 
There are valve* which allow air to pass over 
the ether, but prevent its return, and the ap- 
paratus has an arrangement for lessening the 
odour of ether in the room, consisting of a tube 
leading to the floor, which carries off the expired 
air and ether. 

With the view of regulating the strength d 
the ether vapour, the writer ha* contrivwl th* 
following apparatus, which is made by Mayer and 
Meltzer. It eonsista of an oval india-rubber bag 
fifteen inches long, at one end connected with the 
f<ice-pieee, at the other with the ether-vessel. 
Within the bogie a flexible tube alsolasding from 
the face-piece to the ether vessel. By turning a 
regulator the patient is made to breathe into the 
bag either directly or indirectly thnraeh the tube 
and ether vessel, or partly one way and partly the 
other. The mora the regulator ii turned toward* 
the letter E, th* more elhor vapoar he take*. By 
turning it badt again th* amount of vapour la 
diminidied. The ether-vessel contains a reeemnr 
of water, which prevents the ether becomim 
too cold from evaporation. It is filled witn 
ether up to a mark on the vessel. A thsnao- 
meter in connection shows the tempentvr* of 
the ether. The veesel should be just dij^ad 
into a basin of warm water and gently rotatad 
till th* tbermooMter reaob** from 6S° to IV*, 



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^•D and this reaael should bo Buspended by a 
■np from tb* neck of tha ndmJiiiBtiBtor. 

At fint the Kgvlator allows the passHge from 
tkc &ee-pieea into the bag to remain open, and 
•Ih bag ahonkl be filled hy pressing the face-piece 
Bonfiimljagainatthe faceduringexpirationthan 
iupiiation. B7 degrees the regulator is turned 
tomrdi letter K, Rod thus the im; to the ioner 
tabe ii opsned, and the air breathed through it 
■met ether rapoar from the vessel into the dis- 
tal eod of the Ing. "Wbea the regulator allows 
half the inspired air to pasa through the ether, 
Ibe Tapoar is strong enough to induce sleep ia 
two minutes, nsuaUj vitbout exciting cough. 
As the act of swallowing ia excited bj a smaller 
i)iiaiititj of ether than that of coughing, it should 
W -satebed for, and the regulator rery slightl; 
tamed beck sboold it ooeor. 

This same apparatoai may be used for giring 
Uogbisg-gas, aU. comznnnication with the etber- 
tcskI bnng cut c^ by taming a stopcock, 
sad by attaching the tube leading from the gas- 
bottle to a monnt near the bag. 

By tu the least unpleasant and the quickest 
way of fRpating a patien t for a snrgical operation 
is to «M gas and ether combined ; the change 
from gas to ether being made by turning the 
ngnlatar above described as soon as the patient is 
saiBdeBtlyimdeT the influence of gas todiaregnrd 
the ^TDur of ether. The supply of gas should 
be stopped aa soon aa the ether is introduced ; but 
if saLeeqoently the patient is allowed to become 
eoosdous, the gas may be given freely as at first, 
in order to make him sleep again. The writer 
finds leas sickness and more rapid recovery &om 
tha anpleasant taste of ether than when the latter 
ia g^Ten alona. The chief difficulty is to prevent 
the anstesdinees of the patient, resulting from 
tl»a panting character of the breathing. To lessen 
this the ether must be given aa strong as possible 
witlnat producing irritation of the throat, and 
the opsiauir sbcnld wait lutil the influence of 
the nbar has ioereased to the production of deep 
■tsstor. Air being then admitted with every 
fburth or fifth inqnration, the breathing soon be- 
eoases as regular as it is under ether when given 
ia any other way. 

On reeoveting from the inhalation of ether 
patisDta ai« often in a state of intoxication for a 
period eotT wpnndi ng to the time and extent of the 
sUteriiatioa. The eyes should be covered, but the 
■Miath and noae left tne ; and the room should 
be kept quiet, with a brisk fire, and the window 
more or Uss open. Set Afpekdix. 

OUon/arm was introduced by Simpson in 1847. 
It should not be made from methylated spirit, 
aad, when a drachm is poured upon blotting 
paper, it should evsporats without leaving an 
aaplcaaant odour. It is the most ooavenient 
•f all aoasthstics, and the most easy to admi- 
nister. UafartDnately, when given beyond a 
eettaia stnmgtli. it has a tendency to produce 
-"J"» ayneope, and it is not improbable that 
aoae pecsooa are particularly liable to be so 



authorities think it desirable to give 
■leaholic stimulants before administering chloro- 
fosm-, others partially naieotize the patient 
wkhBvphiacrchloraL Ko doubt these sgents 
■■Mt the actioD of the ehlotofanB, bat if from uy 



accident an excess of chloroform should be glvsai, 
they interfere with the means of recovery, ami 
for this reason are not to be recommended. 
There is lesa objection to the inhalation of a mix- 
ture of chloroform and ether, or of these agents 
with alcohol ; but such mixtures, if kept for some 
length of time, alter their relative proportions, 
owing to the escape of the more volatile in- 
gredients. Even the change from the adminis 
tration of chloroform to that of ether, if made 
suddenly, is not free from danger, for, when s 
person is partially under the influence of chloro- 
form, the glottis allows a high ^rcentago ot 
ether to pass ; and, if ths lung-circnlatjon t>* 
slow, as IS likely to be the cas^ the blowi insJ 
be so highly charged with ether as to depr^ 



lather than stimnliUe the heart. 



ado- 



Chloroform, therefore, should be P"" .f!f tUe 
aUy. The object should be to keep ^°^^ to 
proportion of chloroform-vapour rather y"~ fgf 
give abunaance of fresh air. In V'r''P^''^^x to 
an operation requiring perfect stillnesS' ^<.s». 
eight minutes should be allowed for the V and 
Sponges or lint saturated with cUlorofo^ ' ^^^ 
held close to the mouth, are dangerous, *'' ^^ tbo 
possibility of liquid chloroform faUioB t\co » 
lips or into the mouth. In midwifery ^\^ •wtlll 
piece of linen or blotting paper "P^^^ji ot «k 
chlorofonn and placed at tho botW^rj^tion, 
tumbler is a, convenient plan of adoi'»?'i gbloio- 
care bemg taken to prevent siny liqu}^ KeneiO 
form from settling at the bottom. ■*'\?*nia»/* 
surgery a handkerchief or towel may '^ -tr* 
into a sm&ll cone, open at the «?**',,.'** 
which not more than a drachm Bnould b^ 
poured at ftrst, and fifteen minims at a U(a^ 
afterwards. A better plan is to roll and ti^ 
a piece of Ijnt into a compress the size of ^ 
walnut. A drachm to a drachm and a-h«lf of chl-^ 
roform .ho^Ud be poured upon this, thfch "to i?^ 
held about smincTinlrontof the iaS,* n ^ 
lip, the hai,«i and compress being Jor«^ "''jP®-*' 
towel, which shonld gradually bf A^!!!°^ '"'b ^ 
patient.faoe. ThispUngivoa 000^0^^" "»* 
mand over th, „pp,^ of chlorofo^ '?''^» =01^ 
the chloroform, having cooled ^°^' «". »h^ 
given off too slowly, the vapour ^J^^^°o, i^ 
^y 7»™'"e the i>mpre»s in thl\^,""^'«««^ 
hand. When it is becoming drv ^"^ "^^ 

M "^if ?"* ^^'"« " ^^^ given kT*« t^ 
ch orofonn „ „^^_ jhis shSuId b^" ^-^J? 

should still be leftover the faceVf "h?'"»"'il 
'hi f" "^ ^P him breathing L^'.f^'jo^t 
chloroformed atmosphere. The 1„ot.» '^''"j' 
swallowing ahould be looked foJ. and^i '»' 
" •"<*'«"'« that the vapour is »t^lr^f^^^ 
necessary. If ,o„nd like hiccoolS in^". ^ 
laryngeal obstruction, the cblorofoTau. .'f^ 
^ould be removed, aid. if the son^ conth^"^ 
Uie chin ,ho«M be raised a. much as °s,"bU 
from the sternnn,. I^iyDge"! obstrnctior^^ 

" /"i^K^.I,"^ of the epiglottic The W, 
axcited by the pungency of the vapour, LdriiJ 

notably when » "P""» '"' tiRhtened upoTa 
pile. The epiglottS covers the Urvnx Vverj 
bme we swallow, but the muscles coming from 
ths ohm raise it again direeUy. In daay 



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nareoaii then mnacles ars ilusgiBb, and cannot 
let thiu if the position of the elun places them at 
a disadvantage. If raising; the chin fail to open 
the air-passage, the tongue must be csUed 
forward. In doing this the head sboiud be 
kept back. Depressing the chin renders a partial 
obscroeUon complete. A Luyngeal soand in- 
dieating obstruction is of little consequence if 
the poise is good, since, althongh the breathing 
be imperfect, sufScient fresh air continues to be 
breathed ; but if the pulse flags, or if it appears 
that the amount of chloroform in the air-paa- 
sagea is excessive, not a moment should be lost 
in seizing the tongue with forceps. 

When a patient is delirious and struggling, 
extra care must be taken that the chloroform be 
not too strong, beeaose he inhales deeply, carnr- 
ing the vapour almost to the air-cells of the 
lungs, and, when he next doses the glottis and 
■trains, the pressure of the air and vapour within 
the Inngs is increased, and the diloroform enters 
the Uood very quickly. The compress should 
be held at least two inches off the mouth, 
although the towel may still cover the &ce. 
Dinetly any stertorous noise is heard, a breath 
or two of fresh air should be allowed, and no 
mora chloroform given till the pulse beats well 
and the respiration is free. 

Skinner'sappanttas — a cap of 'domette' flannel 
stretched over a frame — ^is a much better appa- 
ratus than a towel ; but its virtue is simplicity, 
and it has little pretension to exactitude. Snow's 
apparatus is ver^ efficient, portable, and econo- 
mical. The addition of a water-jacket to equal- 
ize the temperature was a great improvement ; 
but it should be provided with a thermo- 
meter. 

The safest and least unpleasant mode of giving 
chloroform is by means of the apparatus fitted 
with a large bag of air containing not more 
than thirty-three minims of chloroform in a 
thousand inches of air. The apparatus is, how- 
ever, too complex to be generally adopted, and 
the writer hopes shortly to be able to introduce 
a modificHtion of it which will be more easily 
used. The advantage of more precise measure- 
ment of the strength of chloroform-vapour than 
is afforded by towels or napkins will appear 
when we consider the several circumstances 
that alter it when so given. 

The itrmglk of vapour ^ven off from a known 
quantity of chloroform is influenced by : — 

1. The extent of sur&oe of chloroform. 

2. The temperature of the chloroform, which 
it constantly changing. 

3. The temperature of the air of the room, of 
the patient's face, and of the administrator's hand. 

4. The distance at -which the chloroform is 
hold from the patient's face. 

6. The rapidity of the cnixent of air. 

6. The height of the baiomster. 

Horaover, when the ehloroform-niztur* is of 
jbiotcn strength, its effect is increased by high 
barometrical pressure; by low temperature of 
the blood; by deeper 9<i>ek respiration, and 
especially by muscular erorts when the glottic 
is eloaed; and bj ehw moraauDt of the Kl/>o<l 
tbioi^b the iunei. "iv^ 

On the other mni, it it letMssd b^ ]q^ , 
metrical preetttre; tjbigh tetapMStore Kif^^i^. 



bpr raperfldal or alow respintion ; and by rapid 
circulation through the lungs. 

Under ordinary eircunutances danger fipom 
these causes is easily averted with moderate 
care, for they do not often concur to produce 
the same effict ; but if a patient, &tignsd with 
straggling, takes a very deep breath just aa 
fresh chloroform has been poured upon the 
towel, and then cloees his glottis and makes 
another struggle — the barometer being high at 
the rime time— it is evident that blood nndnly 
aharged with chloroform will gain access into the 
coronary arteries, and depress the cardiac ganglia. 
Death has occurred so rapidly under these eir- 
comstances, that it has been thought to be the 
result of shock from the operation. 

CSiloroform lessens, if it does not entirely 
prevent, the shock of an operation, but it is to 
be feared that if chloroform be given freely for 
this purpose, a dangerous amount of it will be 
administered. 

If a severe operation is about to be performed, 
the chloroform should be given in the same 
gradual manner as in a slighter one, but con- 
tinued to the point of fixing the pupils and pro- 
ducing stertorous breathing ; and, when the mief 
shock is expected, two or three breaths of pure 
air should be admitted, so that, if the pulse fail, 
there may not be an excessive amount of chloro- 
form-vapour in the lungs. 

Compounds of Chloroform. — Under this head 
comes SicUoride of MetM/Uiu, which contains 
a variable quantity of chloroform. Its che- 
mical characters and physiological effects are very 
similar to those of a mixture of chloroform, ether, 
and alcohol. It narcotizes quickly, but notsafely; 
and, OS the amount of chloroform in it is not 
always uniform, it is better to mix, in small 
quantities at a time, one part of alcohol, two of 
diloroform, and three of ether, and to keep the 
bottle BO well corked that the ether is not UkNyto 
evaporate and leave chloroform in excess. The 
word ACE fixes the proportions in one's memory, 

A mixture of one part of ebloroform witii 
four of ether is convenient for a brief opeiotioo, 
as this produces much less excitement than ether 
alone. On the whole the writer objects to 
keeping mixtures of this kind ready-made ; and 
it is probable that the plan of giving at the out- 
set sufficient chloroform to abolish consdous- 
neas, and subsequently administering ether, will 
be found safer than mixing them together in thr 
liquid state. 

Eihidau, 4^ Ste Appbhsix. 

Aftxb-tbxuvbkt. — Quietude or oonversation 
of an anoouraging or soothing character is de- 
sirable during the half-minuta of recovery from 
gaa. The eyes should be covered, unless the 
view is tranquil as well as pleasant. If gas be 
given until there are intermissions in th* 
breathing, or its administration continued for 
several minutes with a small allowance of air, 
there may be headache and even vomiting : atill 
no other treatment than repose is needed. 

Aiter the inhalation of ether a taste will re- 
main, vairing with the strength of the vapour, 
and the duration of the administiation. Thia 
may be got rid of by washing oat the mouth, and 
gating with worm fluids ; while the Topour re- 
maining about jtb» patient and in the room n»j 



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laMBOTcd hj besting the rar&oe hy maBOi of 
kot bottles, and making a bright fire. 

Whan the sjatem faai bean long or pro- 

faandlj nndcr tha iaflnaDee of cfalorofann or 

■tliar, ninaiia and TomltiDg an likaly to anana. 

Tba writer has not ibana any ramediea mora 

t"i*«— 't ia ralieving these symptom* than 

VBiBih. freeh aii, and sbatinenee &om food. 

Hot tea and esffiee, taken from a feeder without 

taioag the head, and afterwards beef-tea and 

jelly, an safllaant tat tven^-fbnr bonra, nnlees 

the patient wishes for samething solid. The 

rala then shoald be to giTe as little as, or less 

than, is asked for. Ice has been raoommended, 

and, if it does nothing else, it relievos thint, 

and sems to postpone the necessity for giriog 

sriids whidi might prore hnztfnl. 

TBUimHT OP Dajcobbous Sntmnia. — An- 
■sthstifs in excess destroy life bjr stopping the 
aetioaof the heart, or the icepimiioo ; generally 
bodi an afliseted. When langhing-gas is giren to 
aaioiala till the breathing has oesaed, t3a> heart 
cootiBBea to beat long afterwards, and attiBcial 
l e eptia tiMi rapidly leatoree them. Ethsr-Tapour, 
giren almost pan throo^h a tncheal taba, will 
•mat thsaetiaa of a do^s heart in sixteen se- 
eoads ; bat if administered as rapidly as possible 
with a doth, withoot opening the trachea, the 
IsiMthiiig Cdl* beCora the heart, and the hema- 
dyimaw— ster shows adeqnata pt e iaui e in the 
TCsaeb wUbt the breath is gasping, and fbr 
sersral aeeonda after it has ceased. 

WiAcUosofona the hcmadynamometer indi- 
aatss dJMJiiMifd pnasnre dinotly the animal 
i ia s Mtesfc^ggle, and the heart sometimes stops 
betes the bnathing. In caaa alarming symptoms 
shoald asiae, the Snt afbrt shoald be directed 
tn lasaaaing the amount of the ansBsthetic in the 
laa^ fay peasing the trunk with both hands, 
aad s qima ing oat as nnidi air as possible with- 
oat caasfaig • shock. If, after this has been 
dsaa two or three timea, the air does not readily 
re e a f e r the chest, the obatmetion is to be orer- 
ccaae either by lifting the chin or drawing oat 
tha taBgn% and other artificial morements of 
the chest must be carried on. {Ste Annncui. 
BaanBATiaK.) If pallor be aotioed whilst 
IwssrtiiTig is going on, the recmnbeat postnre 
and eisntioa of the fset an immediately re- 
qoiied. (Set BasmoTATioK.) Ndaton's plan 
it inrerting the body hss often been followed 
by wju a mj i. bat, eoasidering the impediment to 
bam the weight of the abdominal 
, the writer is of opiniott that the pelria 
Derer be many inches higher than the 
head. Kitrita of amy! — by reason of its effect 
in diiatiBg tho Tt as fl s of the akin — lias been 
'; bntwithantcarefiil phynologiesl 
; and vpop tcit small eliniesl esperisoca. 
' sty mt^ be expeoted to mora the 
t to aasMt th» action of a feeble heart 
Ike vBtsi'a (sparinuotal obaeiration baa not 
bsaa fcsm omMe to its employment; and cer- 
Imaly aftildal xespiiatiaa sfaoiUd not be delayed 
i in order to apply electricity. 
I is not to Iw depended on. The 
iwmddbennlendwone by distending 
tke snisrti, which cannot always beprerentad 
hfyntmag the laiyox against the spina, 
r may be reqoired ia 



A17AFHBODISIAC8. ** 

spite of tbRvwiiig the bod badcwazd, »»& ^ 



j*|n»<v v« lasA^^waaiir ^uv Amu uui ■ w^»— » — - — 

moving the chin away from tha tUnma, air < 
not be made to enter the chest. 

Hot-water ii^eetiona may be of use, t»t ."'^1'^ 
ean be no aeoeaaity for brandy whilst artificial 
breathing is "being carried on. Afterwar^. » 
swallowing is difficnlt, brandy may be added t« 
the eneroa. 

Friction at the Umlia in the direction ofthe 
heanis nnaecseaaarr, provided the fcet are alignUy 
raised. Where there has been great loaa ot 
blood, the limbs shonld be bandaged HxvaXj tr^J"* 
the fingers and toes upward, aa in E««narch« 
plan for sariiw the blood of a limb about to »• 
amputated. In warm weather, or if tbe tx*^ *• 
warm, » towrel dipped in Cold water may l>e flap- 
ped against the chest, bnt harm -wonld ""?** 
from cooling the body grenerally. Bottle* of hot- 
water and hot blankets should bo applied »■ •^"^ 
as the breathiqg is rastOMd. sad » l>r»»^ "^ 
ahonid be kept «p, in order to ft.roat th e wn n- 
htion of the dumber. j, X< Cx^**' 

AHALGrasiA (i, prir., and «X-y»». W^*i>- 

Abaence of sensibility to painful iaapJ*"**"*. 
Bm SmraATiox, Disordaia of. 

AJTAFHBODISXA. (A, prfy »nd 'J^^P"'^'^'^^ 

Venus). — Absence of aextiil appetite- Som^^ 
times used to express ImpotenceT Se» Bmxv^^^ 
FtTMcnoHS, Disorders of. 

,. ■»J'-*^??ODISlA.OS. Dbfikixios.— at, 

dicines which diminish the eexual p«»ion- ^ 

EnnanunoK.-ai,o agent, employed aa an,,^ 
phrodwsai a»:-.lc, CoW. Baths—local a^^ 
oeneral; ftomide of Potaaeimn and Ammonln^^ 
Iodide ^Potassium; Cooiiun. Camphor; DL»S ^ 
talM; Pnrgatjves; Nanaeant,'. ^ ^leeding!^-^ 

Acnoi«.-aiie eraetion which occnra in th. 
genital owuis dnnng ftinctional actiwity » ^^ "^ 
to dilatat^n of the arteri„ in their 4iecS^^ 
*^1!t, 'A* '?8«l»ted by a nerrons ce^^-^ 
mtaited ,n the lumlwir portion of the spi^^>^ 
cord. From this centre raeo-inhibitorr B*^^ 
FM* to these artenea. and cause them to dST^^ 
whenever ,t,. caUod into action. It 2^^^ 
b, exoted either reflexly ^ stimnl«tL*'«^> 
the aen«..7 nerve, of the ^eniTal o>««>s wd ^ "^^ 

i^i^"? ^fu^5:,. ^??P»»«>di.iaca miy^T?^ 

main inaspuai com and K-I;. ."i." — .""*««». ' 
iodide of potassium and^ni^!?'^ «» bromi^, ^ 
the ci«nSSr.s di8itS"'™TWe''^i><?S 
jnvant messnres, of a hygienic and m^,!j* "S* 
tetv which greatly aaaiat and mar ««. **«»«« 
anaphrodisiae medieinea, ■.-h „. Z **Pl«e^ 
especially of a vegetable natwf 5,?***? *«t 
of stimulants, and the ^^H"" "r<*Iaa^ 



leiening the excitawj??, '^"i'*" ""^ «et ^i^ 
iodid.ofpotl.siam and^„|^^!!.^^'«J« a^J" 



mental and botfily exei«jae xv i. "tirs 
teg to stimulate the genitij SSZ,^* t«>d- 



mentai ana oooiiy ezeraae xv i. "uy. 
teg to stimulate the genitkl m^^^ **^- 
cnassthefiow of blood to tw2V^i.^ *<» in. 
portion of the spinsl coid, shooH hi !tS? l'»»»l>«» 
as warm and heavy dothil^^ $!3!*^'* •«? 
hips «r loina; and a W'^tto!^ fe* i>- 
«d in pUce o' »f-«w5ir*^'^> 
likdy to arose, the piSiM?iieh M^»t 



Digitized by 



G6ogIe 



M ANAPHBODiaiACS. 

dorala, piatnMi, thMtrical repnwntatioiu, && 
ifaould iiao be ihnnned. 

UsBi. — ADaphrodiiiaa are employed to lessen 
the sexual possiaiis irhen these are sbnonniilly 
azoitad in satyrians, ii}in|)hoaaoia, and allied 
conditions. As such ezeiteinenC may som«- 
timea depend on local irritation of the genitals, 
in eonseqncnce of pmrigo of the external organs, 
excoriations of the os nteri, or bolaniiis ; or on 
the presence of vorms in the rectum or vaguia ; 
these soarces of excitement should be lochad for, 
and, if present, should be subjected to appro- 
priate treatment. T. Laddbb Bscinoir. 

AJTASASOA (ivi, thron{;h, and nif4, the 
flesh). — An eSiision of serous fluid into the 
■abcntaneous connectiTe tissues, not limited to a 
particular locality, but becoming mors or less 
dlfiiued. Bee Bbopst. 

AirOHYLOSIS {ir/HiXos, crooked).— 
Harked stiffiiess or absolute flxaticn cf a joint, 
whicli may be due to rarioos morbid conditions 
of the structures entering into its formation. 
Set Joara, Diseases of. 

AJTOHYIiOSTOUA {leyieiKat, crooked, and 
tr6ita, a mouth), — ^A genus of nemstoid worms. 
See ScusosTOKA. 

AITETTBISM (iftufiim, I dilaU.) — Dm- 
xiTioN. — Aneurism is a local dilatation of an 
artery, leading to the formation of a tumour 
which contains blood, and the walls of which are 
composed either of the tissues of the vessel, or 
thoae which form its sheath or immediately sur- 
round it. Therefore every aneuism, properly so 
called, consists of two parts — a sac and its oon- 
tmU. 

Ct-usmcATioH. — ^Aneurisms are usaally divi- 
ded, according to the varying composition of the 
sac, into the following varieties : — 

1 . True aneurism, in which all the three coats 
of the artery form the sue or a portion of the aac 
This variety is rare : at least it is so rarely possible 
to tiaee all the coats of the artery over any part 
of the sao beyond its oriflca, that some patho- 
logists deny the existence of this so-called ' true ' 
form of anenrism, and moat admit ita existence 
in the aorta only . 

8. FaUe aneurism, in which the sac is formed 
by one only of the (oats of the artery. This is 
almost always the external coat; but a sub- 
variety baa been proved to exist as a consequence 
of wound of the outer part of the vessel, and is 
believed by some to take place spontaneously, in 
which the inner coat, or the inner and part of 
the middle coat, is dilated, pushed through the 
outer coat, and forms the sac This is called 
htnUalfalu auemitm. 

8, J)ifined or CStmswuMw anenrism. Here 
the sac is formed of the sheath, cellular tissue, 
or other structures around the artery, which are 
matted together into the form of a membrane. 
The name 'diffiiaed' is applied to this form of 
anenrism to expnm the fact that the blood is at 
flrst diffused amongst the tissues in consequence 
of the rapture or division, whether from injury 
or disease, of all the casta of tbe vemel, ^th«r 
In a part or the whole of ita etKumfereoog . t-t 
it is not a good teim, suioa, at soon oa tlie 1 
riimali»eiehrm»d,ti4bU>o4lfJje'u»ednn] '^e'*' 



AKKURISH. 

but, on tbe contrary, is encysted in the newly 
formed sac. So that the other term, ' consecutive,' 
seems a better one, expressing, as it does, the 
important &ct that the formation of such aneu- 
risms is always consecutive on a rupture, partial 
or entire, of the artery. 

4. Diuectina aneurism it seen only within 
the trunk of the body, imd alw^t involving the 
aorta — although it may spread &om the main 
artery down to its branches. In this form the 
internal and middle coatt have given way, or 
cracked ; and the blood has farced its way, usually 
into the substance of the middle coat, sometimes 
perhaps between the middle and outer coats, dis- 
tending the external portion of the vessel into a 
land of sneuriim. 

This is the nomenclature stiU in common use ; 
Int as the first and second varieties are pmcti- 
colly indistinguishable during life, and the first, 
though called the < true ' form of aneurism, is 
very rare, it would be better to include both 
nncier the common name'tme' anenrism, and 
apply the term ■ fklse ' to the third or ' consecu- 
tive ' form. 

6. Besides these, which are all forms of pure 
arterial aneurism, there are aneurisms in which 
the vein and artery are simultaneously involved, 
and which are therefore called jirterio-veni>ut, 
which will be afterwards spoken of; and tumours 
having a certain analogy to aneurism, which are 
formed of dilated and tortuoua arteries — Oinoid 
and Anatlomotic aneurism*. 

Other dassificatioos of great importance are, 
according to the cause of the disease, into 
AxnUsfKous and TVaumaiio; or, according to the 
shape of the tumour, into l^i^orm and Saeculattd. 
In funfom aneurism there is a dilated tract of 
artery, often of conaiderable length, firom either 
end of which springs the vessel of its natural 
calibre. Sacculated aneurism springs like a bud 
from one side of the vessel, and the artery is often 
buried for some distance in the wall of the aneu- 
rism ; but there are many sacculated aneurisms 
which approach in shape to the fusiform, the 
vessel being dilated for some part of its extent, 
so that its two openings 1 ie at different pait% and 
sometimes on different aspects of the sac. 

jEnoLOOT AXD Paihouxit. — The proximate 
cause of spontaneous anenrism appear* to be 
usually a loss of the elasticity of the wall of the 
artery, whereby it loses its power of resilienee 
after having been dilated by the force of the cir- 
culation. This loss of elasticity is commonly 
eaoaed by atheroma or else by partial calcifica- 
tion of the wall of the artery. In the latter eaas 
the blood often forces its way through the entire 
arterial wall, and an anenrism of the consecutive 
variety forms,' or the external part of the artery 
ia dissected off, and a dissecting aneurism results. 
Inflammatory softening of the artery, without the 
presence of any definite atiieromatons deposit it 
looked upon by many writers of credit, such aa 
Wilks and Hoxon, at a common cause of aneu- 
rism. Such low inflammation may have ita 
origin possibly in rheumatism — and, as a matter 
of fact aneurism is often preceded by acute 
rhenmatitm ; more etitaiidy in violtnt ttimin, or 

■ BomeMmas, hoverer, the tdeedias wttl ge on wttbool 
the (ormatkai a< an/ uanrimal wte, and lead to ths 
loa o( life or Umb. 



Digitized by 



Goog e 



AMEUBjaU. 



B iierhaiiinal -rtolenee. AnjtlaDg das vhieh 
wtakaem tha aiterial vail, luch sa the ezpoanra 
ef Um Xfmtl in an abaoeaa, ia looked on &s a 
eaasa of SDeariam. The yielding of a waukened 
aiterial vail ia doubtleaa accelerated by ine- 
galaritiaa ot the dicnlation. The inflnenee 
if afphilia and of intempennee in eaosing 
aneariam ia iridel/ beUereo, though periiapa 
aa yet neither &et ia abaolotely aatabliahed : tne 
latter, at anjr rate, ia rendwed Tery probable 
6«n the oonaidezation that chronic alcoholism 
teoda to impair the antrilion of all the tiaaaea, 
iadBding the azteriaa, and ia aocompnnied by a 
conataatly initaUe condition of the circalation. 
That syi^lia may eanae a fibroid degeneration 
at tha Tcaacli mnat alao be allowed to be at least 
poaaiUe, and that it doea ao ia the opinion of 
many eminent pathologiata. If ao, tha tmn- 
aition to aneariam ia natnral, if not ineTitable. 
Another pnnrad eanae of aneariam ia emboliem, 
or the obatinetion of a diaeaaed artery by a 
fibtinooa ping, -which haa been known to be 
loUmred 1^ the dilatation of the artery inunedi- 
Buly ahore tha {dng, jtut aa in Tery rare caaea 
the ligfatnre of a healthy Teasel haa given rise to 
the formatioa of Bneariam above the tied part.' 
Tiolanee ia a very freqnent eaaae of aneiuriam, 
even in caaea which are not technically denomi- 
aated 'tzamnatie.' The latter term is genenlly 
Ratricted to caaea in vhieh the veaael ia wounded 
by a cot, or ia known to be rajAured, and the 
amriaw makea its appearance at once ; and in 
these eases the aneariam ia of the ' diffiiaed ' or 
'eo na eentivB' varie^. Bnt there ate, no doubt, 
■any caaea in which the artery ia partially torn, 
and the walla, beiog thua weakened, afterwards 
alowly yieU at the injured apot. This fiwt is 
Dlaatiatad by tha veil-known experiment of 
Kcbetaod, designed to explain the frequency of 
poflitBal aneariam. The experiment consists in 
B3 ^)ere x tcaaiBB of the knee in the dead subject. 
If thia be carried on forcibly bll the ligaments 
•w heavd toeiaek, it vill nsnally be found that 
tfc» two inner eoata of the popliteal artery are 



4,t 
on Clxa preaence of loogh -protaettn—. 
from the vail or moulh of the aac. aid ot S- 
shape of tho a-neoium. When the latter ia 
purely cylindx-icail. much less ooagnlum. pomiblw 
none, will l>o found in it. When the tamow 
stands wall Away from the artery, so that th« 
force of the. circulation is much broken, tha 
formation of eoa^ula is greatly favoured Xbe 
deposition of traclx firm ooogula must be looked 
on as the coDasnoncement of spontaneoua eixr», 
and at any rate ^««nds the patient from the 

of tlae 



AS these eaoses of aneurism act much more 
powerfally in later Ufe than in childhood, and 
aaay asa nnknovn in eariy years. Aneariam, 
tl mafase , is very xar« in children. In eases 
vhevr tha arterial tystem is extensively affected 
vith stheniBia, a great number of aneurisms 
any be fnand in the same person, or another 
saay Cocm after the core of the first. To such 
caaea the term * aneurismal diathesis ' has been 
applied, nis fact riwvs the great importance, 
in all eaaea of apontaneoua aneurism, of examin- 
ing the vhela body to detect disease of the heart 
«r aary aseoad aneariam vhieh may exist. 

Alaoat all aaenrisms contain more or leas tdot, 
■Bd Biaefa of this dot is usually of the laminated 
enosisting almoat entirely of fibrine 

nee or leaa of the blood-corpuscles. 

ted eoagnla adhera very firmly to 
the intenar of the bk ; they are arranged eon* 
eenirically like the coats of an onion ; and usually 
km iheir eolonr in proportion to their remote- 
•eas bom the blood vhieh still drodates thioagfa 
dw aw. Tlidr dspodtion depends in a great 

• Vwoass el tUsDStaia sas 4>«» << Aitytrr, and 

tm n*.a.v^*n. 



risks of rnptttTO, or of renewed grovth 
tumour at the j>»ita which are so lined. 

^^^fVnptoms of arterial aneii- 
palasting 

— ^_... of one of 

and 



SmFToiis.- . ^ , 

rism are as foJlom: — There la a 
tumour, which i» aituated in the conrse of one 
the arteriea. and which cannot be drawn aw»/ 
from the reaael. _ The pulsation is equable and ex- 
pansile, that is, it. xotonlycauaeaannp-and-down 
movement of the tumour, for such a movement 
may be commnnscated to any tumour by a la«K« 
vessellyingin con tact with it, butalao expands the 
tumour laterally »nd in all otherdireetions. The 
pulsation ia in most cases accompanied by a ^Tf* 
or blowing sotxTid, heard on auscultation, which 
can be tolerably- -well imitated by the lip«« *°<* 
which is synchronous with the pulsation- ^^^ 
sure on the ai-t«ry above suspends both title 
pulsation and the bruit. Sometimes »t ™^ 
be noticed that th» rmlrt below is retaraetl., 
that is, that it reaches the finger 1»"' *5^ 
m the correeponding: vessel on the o*-**.*' . 2^ 
Beddes these, -which are the »»>»» "ff 1p^ 
aneurism, there are othei», -vhieh »^ imtwa^ 
coBsUnt occurrence op of subordio»** iJ^'V 
tanca. Thus, on compression of the ""^^^ con^ 
the tumour will empty itself more o* » ^^ ^ 
pletely, and the greater or less <**llst of t^ 
under these conditions is a. nsefttl ^ o. ^^ 
proportion of fluid and solid in ^^e e»c- oom, 



times pressure on the artery "tM-yonO- "^.'''""Oxv^ 
may cause an inereaae in its ei*e- .i,°* P'*!^^ 
below the tumour is often found to *°''' Btrj^*^ 

side. There u"^> 



ingiy f^m that on tha soizsacl 
many and various aymptozna d 
of the aneurism on neigh bo- 
bones, and viscera — sympeo 



ring reins, o^^'l^'^ 



which 



'3^^ 

^ 



subordinate importance in a. d iagnostic iwT ® ^a^ 
view in the casa of external ^aneurism, *^'''* ^ 



often of the greatest ralua in tbo^^^^ 1*^ 



«>*■ 



abdominal aneurisms. Thus <Jj-spntB8 ai!;'''* "tlid 

ing cou^h from pressure on die trachflg. . ** rina- 

paralysis of tha vocal oords ±rv>m prem^'i'^ta^ 



recunrent laryngeal nerve, pa.in iotb^ fw*"^ en thT 
pressure on the vertebrae, oar neu«S<=k fpo,^ 



from pressure on the nerves 



neck, are veU-knovm symptoms of .^P of «,. 
rism; and, simiUrlv, pain in thelegfZy^ «neo 
sure on the popliteal nerve, and «»deii, ****». Brea' 
presdon of the vein are frequent avtoT*** com." 
popliteal aneurism. -Pt^am, * 

Duairosis.— The affections -which a 
confbanded with aneurism are toinour«!!S. ■**»naU.» 
kinds lying ^PO?. V*"***. "1*c«mL *X,.^^ons 
cerous tomooia which nave latge vasiJuiT' ** *«n" 
in their interior, and therefore pnlaTn*' faeam 
tumonrs whidi rsesive pulsation from 34s 

against which they lie are of varion« ^^"es 
cysts and enlarged glands in the popljt.. .-*'o<^ . 
and enlargements of the thyroid bodr >^ *'"■«•.* 



Digitized by 



ANBUBI8M. 



ontiM eaiotid or iDaonuiuto Mtaij, arc Ui* moat 
ftmiliAr examplM. Ths disgnosii is nsnally 
•wjr- They have oommonly little or no bruit, 
thongh in lome cages a dull thud is produced by 
their pressure on the artery ; they nave not the 
•zpansile pulsation of aneurism; tLey present no 
dunge in size or form when the eiiGnktion is 
ttop^ ; and they can osoally be drawn away 
from the artery sufficiently far to lose their pnl- 
aation. An abscess has been often mistaken for 
aneurism, but the mistake has generally pro- 
ceeded from a neglect of anscultation.' There 
are a very few eases in which aneurisms hare lost 
their pulsation in consequence of the mptnre of 
tiie sac, and in which no bruit may be audible,' 
and sneh tumoon can hardly be diagnosed from 
abeoeas except by an ozploratory puncture, which 
under these circumstances is justiflnblo ; these 
cases are, however, extremely rare. The disease 
most commonly mistaken for aneurism is pul- 
sating cancer, and the resemblance has been 
sometimes so striking as to deceive tho best sur- 
geons, even after the fullest possible inresti- 
gation of the case. These pulsating cancers 
almost always grow from the bones ; ' and the 
neighbonring bone can generally be felt to be en- 
larged, which is rare in aneurism. They have not 
nsnally the well-marked bruit of an aneurism, 
not is the bruit nniversal; the pulsation also 
is more indistinct, and not so expansile as in 
aneurism; and the growth of the tumour is 
more rapid. 

CoDBSB um TiBinirATioKS. — Aneurism is 
generally a fatal disease if left to itself. The sac 
•nlaiges; parts of it give way, either by a pro- 
cess of inflammatory softening or by rapture ; or 
it j^^uces fatal pressure on the surrounding 
parts ; or the whole tumour suppurates, and the 
patient dies of fever, of pysmia, or of hemor- 
rhage. But to this general statement, inde- 
pendent altogether of what the effects of any 
special treatment may be^ there are numerous 
exceptions. In some cases, and especially in the 
fiisirorm kind of aneurism, the tumour, after hav- 
ing attainedacertain size, remains stationary, and 
this stationary condition is sometimes produced 
by a deposit of coagnlum lining the sac, and 
leaving a canal through which the blood-stream 
passes, as through the normal artery. In these 
cases, however, the symptoms persist, but there 
are others in which a complete spontaneous enre 
is obtained, and this may happen in rarioos ways. 

l^ntaneouM Cure.— rlhe first, aiMl probably 
the most usual method of spontaneous cure is by 
the gradual diminution of the circulation through 
the tnmour, and the gradual filling of the sao by 
successive layers of fibrinous ooagulunx. The 
second is by impaction of clot in the mouth of 
the aneurism, whereby in some eases possibly 
tho sac of the aneurism is cut off from tiu hlooa- 
■tream, and iti contents brought to coagulate. 
In other cases, where mors than one artery opens 
ont of the sac, the impaction of clot in one of the 
distal arteries leads to consolidation of «!] ^at 

' Sms paper br the mtbor in St. Oeuvet a ^^1 

'8e«><i*MniKl«'tlM«>martte«riter,npaM„ ^^ 

tmmti naner. n. laO. ^^^^Sn , tfi 



ssnie paper, p. 190. 
' In ona oan miliar tlu amre of tb» vif tar •>. 
■ DooriiiiMctaii wtOi tbt btmei, smfaActiM 7I9 



^^ 



part of the tnmour throagh which tba riMol^ 
Uon nsed to pass into ths obstructed ressd, and 
thus a practical cure is sometimes effected,' i.e. 
the symptoms are cured and the disease arrastsd, 
though the wh<de sac is not oonsolidated. The 
third method of spoataneons enre is by inSam- 
nation of the tumour. This is nsually accom- 
panied by suppuration of the sac and eraenation 
of all the contents of the aneurism, ths aaeom- 
panying inflammation closing the mouths of the 
arteries which open ont of it. If the arteries 
are not so close(t death from hnmorrhage will 
occur. It seems possible that inflammation of 
the sac and the eeUular membrane aroond it may 
sometimes produce coagulation within the anen- 
rism without any suppuration. A fourth way in 
which eoagnlalion of an anenrism has been 
known to be caused is by retardation of the 
circnlatton or impaction of dot, caused by another 
aneurism above; and there is an old idea, which 
can hardly yet be said to be exploded, that an 
aneurismal sac may by its growth compress the 
arteiy, and so lead to its own eoognlation. This, 
however, if it ever happens, is purely excep- 
tional. 

Supture. — The mptnre of an anenrism may 
take place either throagh the skin, in which case 
the hismorrhaga is nsoallv, but not always, fttal 
at once ;' or into one of the cavities of the body, 
whan death generally oecors immediately, if the 
mptnra is into a aarons cavity, and after one or 
two attacks of luemonfaage if a mncsna mam- 
brans has been involved; or lastly into ths 
cellular tissue of a part. This event is marked 
by the cessation of the pulsation ; tha sadden 
swelling, accompanied with eeehymosis if tha 
blood is eShsed subcataneonaly ; and the abrupt 
&U of temparatare below the anenrism. A 
sensation of pain, or of 'something giving 
wn^,' is often axperieocad. Stethoseopic as- 
amination will probably detect a bruit. 

TaBATKnrr. — a. MmncAL. — The methods of 
treatment of aneurism ars very numerous, and it 
would be impossible in a summary of this kind 
to discuss fully all the indications for each. In 
the flrst place, those aneurisms which are inaeces- 
sible to any local treatmont, or in which kwol 
treatment would involve great danger, aretieotad 
meJicaUy, that is by regimen, diet, and medians, 
by which it is hopsd that gradnal coagnlatian 
will be promoted in the contents of the tumour, 
and thus a complete or a partial enre will ba 
brought about, as in tha natural pmcass above 
spoken of. The method of Vakalva, of iriiieh 
ths main features weia starring and axeesmrs 
bleeding, and which therefbire produced consider- 
able and often dangerous inegularity of the 
heart's action, is now given ap in fsvonr of tha 
opposite plan introduced by Belling^iam and 
modified by Mr. Jolliffe Tnfiiell,' in which, by 
complete rest and reatiictsd bat untoitioM diet, 
ths absolute regularity of the heart's aetioa i> 
secured, and at a rats below that of health, both 

• Sp«>ouso( tnnnmlBa U ■nsnttan with reaarki la 
the Imml, June U, 1872, p. (18. 

• InitaooMof nooisstnl ll(stm«of the utery above 
after bkadlnf from mptured aneoiism are on noord. 
SeeacMe la the Itmit, 18*1, vol. U. p. 10, la which the 
(aoonl sttsry WM soeowAiUj tM attar the bnisilns of 
a femonl aneorkm thnqgh the ddn. 

• n« *MM«W nralmmu^rdmkrma AunHtm, ted 

siit.i8n. 



V 



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GoogI 



ANEUBISIL 

u to r^iidity^ and foree. Hr. Tn&eU ha« giren 
■one interating and e(BicliinTS examples ^ the 
eaajietje enre of abdominal aneniianu thus ac- 
complished. Tcrified bj dioeetion; and one, at 
lea*t, in Thich an anenrism of the arch of the 
loita was in all piobabilitj entirely consolidated, 
tboogh thia £tct «aa not verifiad by dinection. At 
any rau the patient vaa permanently restored 
to health. In this method of treatment dmgs are 
osly employed vhen necessary (as narcotics, 
lazatiTea,aiid tonics often are) to ensure the regu- 
,lari^ <tf the fonctiooa. to control irritability, or to 
■ Hi li urt the genesal health. The drags vhich hare 
been recommended aa producing a direct effect 
oa SDeBrisra by pnxnoting the coagulation of 
blood in the sac, such as acetate of lead and 
iodide of potaasinm, do not, in the -writer's 
qsnion, pmdnce any snch effect, nor in fact any 
ipeci6e rfict on the disease whateTer. He has 
liUa seen a certain amount of improvement nndrr 
the nae of these drugs, bnt not, he thinks^ more 
than tile icg^men and diet used at the same time 
voaU aeooant for. Other dmgs, ns aconite and 
£pta&a, an Teeommended in order to steady 
and ladacs the heart's action, and the latter 
eapeeiaUy is scBstnaea a usefol a^nrant, if 
employed vith caation, to the treatment by 
Rstrietad diet and rest. The rest is total, the 
pstj'ent narvr Icaring his bed, nor ever rising 
from it, or changing his position more than by 
oeeasiaaally taming on his side ; the bowels are 
so regulated aa to avoid both constipation and 
l oos wws s ; and the diet is restricted to about 10 
esL of solid food, of vhieh one half is meat or 
tak, aad 8 os. of fluid (comprising 3 or 8 oz. of 
l%;kt wine if neoessair), per diem. The period 
may be extended iodefinitaly, so long as improre- 
■ent eontinun ; but in all cases the patient and 
his fneeds should be prepared for a confinement 
of aot l«as than three months. See ABDOMiVAt. 
AxKcmsH ; aad Aokta, Diseases of (Atieuritm). 

b. ScaoKJX. — ^Moct aneurisms which occupy 
an external positioa, and are therefore amenable 
to sogical treatment, are curable, when the 
dagcnatation of the Tascnlar system is not too 
extmsiTs, by machanieal means. Uf these the 
dnef and by £u tbe most sncceesfol are either 
ths Bfftturt vf tit artery, whether in the sac, 
above it, or in some special cases below; or 
issyirsw'us, applied either to the artery abore 
tlie aaearism, or to the tnmonr itself, or 
•imoltaneoasly in both situations, and either 
t^ t]>e preesnre of ao instmment, of the fingers, 
sr of Esmaieh's bandage. Bat as these metnods 
of tisermtnt belong szclnsiTely to the prorince 
etwmgeij, it is thooriit better in a work of this 
Idnd merely to name Uiem, and to refer the reader 
to the standard wrirks on surgery for their de- 
Knptioo. 

Tbe other methods of surgical treatment are 
Cb kas secBtssfal than the iux>Te, and hare the 
great dxawbaek of being addressed exdusiTely to 
the eooteots at the sac ; while in the treatment 
by the ligstore and by compression the resilient 
power of the sac, and its eonsequeot reaction 
aa tin blood wliidi it contains, no doubt play a 
gnat fait in the eiUB. The methods now to be 
■MOMtd, SB the cu utrar y , as ftr as they act 
•« tks at at all, rather tend to contsss at to 
lit 

4 



Ga|iHni^no««r«._The first is galvMnopiiiie- 
ture, in which a. current of electricity of low tea- 
sion, long conciuued, is passed through the Uood 
in the sac, decomposing it, and causing iu coa- 
guktioo. NeoOles are plunged into the sac, and 
lire then eonnc^ed with the Uttcry. and Ui* 
action IS continued „n,ii ^^ reduction in the 
fi, r»,'"n^ *■> a-^^'ni-g of the tumour sh^ 
thHtt^ieUuod fciaa been pa?ay coattuCei An- 

only, the P<«.iti ^,Z» Wl^' negntire ppl. 
the neighboarxDg bU^,S^^"° conUvct witl^ 

coaguUtion *»^«Tl.cri!,T^"!. •»,<>»»* ;°* 
Clot tonod tbo wJi^r! ^S^^.**^ I"^"' ^^ 
firmer than tl.«.f^„L' g"'" ^'^ '"^^ l^*- 
ject of the op«:.r«tiri, to^?, "?»''"• ^^V^ 
possible T.-ith coBiM urn -i- ^' ^, " "^^i?^ 
harden, and •la.a.llltte^t 7''!'* .•»»»" g™«l'»l»3r 
The danger. ^:e thT^ '^ ^^^ T^""^^ 
inflammation cxT thelJT*^"^ "" .'^"^ **^ 
around it; of •unm^- ""^^i^ crUubir 1 
or of slo;ghirr^^TC''» '^thin th. tumo 
rhage: and It «^t beJ^^""***- •°t ^ 
of luvanopnnotu^'^ ^»«* '^'•'^"J^ 
to the amounfc and fl™?^ nncertain. both. 
produc«i. StiU there ii^frJi '*' ^^ 'l?*''"-^ 
benefit in many cW^,?^"«t»'7 "^/"""^ 
danger ofinflamin^'^?'??i»"i«»'»*- y, 
Ussues around nm/u^i?^ •"•'»« ^^^ "*1" *^ 
by coating the neidie. wiS*" Jnaseure obT" - 
mended by Dr. JoJw Dn^ T^J**"**- " ' -, 

TerycUarexpo.itionofjK!?"'*^™'*"^*^ ^^^^"" 
as Wl M f<r.tiSnM^''"***J«of *W- metho Nsa,. 

which has attend.sdelectw^J^*?*^''* the buocli ■ » 
is referred toaleetur8ljn^?"«*^*J'«rto. tlioroaa«^- 
in the BrUisA Ifedioal t ««»»tlein»n, reporl aii^ 
Th. writer think. htsflT^"'* ^^^ *<*■ J!?^^- 
that electrolyaU should K."*""*^'*"^ '° "^^^^B" 
of thoracie, snbclaTian, o^ - '«"tricted *° 




which cannot be cnrod^bvm^S^**™'"*' *" 
which mptnre seems to ][.•***<=«• moaiw, and ixm 
situation of the tntnoar ft.J?!*I^'''*°'' ■«"'»"i« tb». 
ofpieasuie. »ort.x<i. the applioatioa. 

OoagtOaUng b^jtetiont a 

producing coagulation of tha l*i** ' method of 
bythenseofcoagnlatinffiB?«-Jl-°*^'" the Bac i« 
hare been employed, but thV^***"*" °"'"*' """da 
usenowistheperehloridoof i-J^*^m°" '" S*""*! 
is to be suspended by pre«J«***" •^''" "^'"^n^tioa 
abore, before the iniection iM^^j"" *••• iwtonr 
time afterwards. The method*- * *"** '"°' ■"*• 
ons one for large anenrisma «1" * ^'^ dangear- 
risks of embolism, stomrhtm^ °" .•^^count of tho 
but it may be used wi^sucfiM "f '"*^a"*ioii. 
aad anastomotic aneurisms, emj , "?•'' cirsoid 
aneurism, ' "*> >n varicoae 

Introduetion of foreign hodit, m 
hare also been treated by the {,*""•'"'*"'•• 
foreign bodies into the sac. with ;?*^"ction ot 
ducing coagulation of the blood „•"**■ ot pny- 
sobstanee, such as fins wire e« ?^?. ^* ^xrelgn 
and horsehair ; but no ease of mi^i"^ ewtgot, 
been reported. ™° «« hitharto 

Nanifulatien. — finally, anen • 
treated by manipuUtion, ThT^iI?" '°*7' *• 
treatment is either to dst^sh a «L2 J*" °* *1"»« 

~ I^WtlOB ofcostfa. 



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50 ANKUBISlu 

lam from tha -wall of the ananrinn, fHAeh may 
be carried into the month of the lac or the distal 
nteiy, and lo afTect a cnie ai ia onr second 
mode of ipontaneoni enre, or at anj rate so 
to disturb and break op the clot, that its detached 
lamins may form nuclei for farther coagula- 
tion. With this Tiew the aneurismal tamonr is 
Rasped between the two hands to squeeze all the 
laid blood ontof it, and one wall rubbed against 
the other till ' a friction of surfaces is felt within 
the flattened mass.' ' The proceeding is obTiousl; 
a rery dangerons and nncfrtain one, but some 
indubitable cures hare been thus effected. 

Arterioranoaa Ananriams. — A few words 
mast be added with respect to tha rarer forms of 
aaettrism. Attsriorenous anenrisms are generally, 
bat not always, tiHumatic, and are divided into 
twochief forms:— 1. Fari<»»«o»i««ri»», in which 
(here is a small aneurismal tumour communiMt- 
ing both with iJie artery and with a vein which 
is always Taricoae ; and 2. Anmritmal varig, in 
which tha opening between the two Tassels is 
direct without any tumour interposed ; the rein 
jmlsates as well as being Tarioose, and the tempe- 
nture of the limb and nutrition of the skin 
and hair are increased. In all forms of arterio- 
reooufl aneurism the artezy after a time becomes 
thin and much dilated. Tha signs of arterio- 
renooa diflbr from those of arterial aneurism 
mainly in this — that besides the intermittent 
blowing muimnr caused by tha arterial current, 
there is h continuous purring or rasping bruit 
das to the renous current ; and that Msidea the 
intermittent pulsation there ia a continuous thrill. 
Varicose aneurism may be cured by digital pres- 
sure applied directly to tha venous orifice, and 
indiractfy to theortcTy above at the same time; 
or the old operation may be performed, the clots 
being turned out of the sac and the artery tied 
afaOT* and below, the vein being of course laid 
i^n and secured either by ligature or pressure ; 
or the artery may be tied above and below without 
opening the sac Electropuncture and coagulating 
iqjeetions have also been used with success. 
Aneurismal varix does not usually require or 
admit of surgical treatment If it discs, tha 
ligature of both parts of the artery is the only 
measure that can bo adopted, on the failure of 
compression. 

Cirsoid and Anaatomotio Anenriams. — 
Cirtoid aneuriam, or arieritU varix, is a tumour 
formed by the coils of a single dilated and elon- 
gated artery ; * while anturiim by at%attomont is 
a tumour formed by the coils of numerous di- 
lated and elongated arteries, with the dilated 
eapillarias and veins which communicate with 
those arteries. It is often difficult to distinguish 
these two forms of arterial disease from each 
othrr. Aneurism by anastomosis frequently origi- 
nates congenitally as one of the forms of navus. 
The usual situatioB of these tumour* is on the 
icalp. They have often a peculiar continuous 
buszing or rushing murmur, which is propagated 
over the whole head, and much disturbs the 
pationt's rest; while they are liable to ulcerate 
and to become the source of serious and even fats^ 
hagmorrhoge. Soma coses of spontaDeous C V 

• sir W. ynrnaon, JIM. Chlr: Tran*. xl. I, 

• Sm tl>« llfnni onp. ft*, vol U. ot tbe 
a»«i»Kta4«dMas. 



AVOIXa PECTOBia. 

are on record. Vary numerous methods of treat- 
ment have been employed, of which the writer can 
only mention those which are most generally use- 
ful. When feasible, the total removal of the tumour 
with the knife is certain to effect a radical cure, 
bat this oparatitm is often too dangerous to bo 
attempted. The entire removal by ligature is 
still more rarely practicable. The galvnnic 
cautery is often successful ; the incandescent 
wire being drawn through tha masa in rariooi 
directions divides it into portions, and obliterates 
the vessels by producing cicatrices at the parts 
cauterised. Setons hiive also been used with 
success, when combined with the ligature of the 
trunk-artery ; and the ligature of the artery 
alone has been said to be followed by success, 
but certainly is generally unsuccessfliL Finally, 
coagulating injections and galvanopunetore have 
bolS effected a certain number of cures. 

T. Houos. 



'W 



AnraSIBOTABIA (irK*'. * ▼owbI, and 
frroo-M, extension). — ^Extenrion or hypertrophy 
of the capillaries mid minnte vessels of the sur- 
faces of the body, especially the skin; heuca 
amgeieaUuia capUlaru, a term applicable to several 
forms of vascular nmvus. 

AirOBIOLBTTOITIS (An*"'. *■ vessel, 
and Xtmir, white). — Inflammation of lymphatic 
vessels. Su Lticfs^tio Stbtsk, Diseases of. 

AKOnrA (S7X"> I •eixe by the throat, 
strangle, or choke).--STiiOK, :— Fr. on^wM ; Ger. 
Mt Sriune, 

Tha term angina was originally applied I9 
Latin writers on Fbync, and is still mndi used oB 
the Continent, to indicate a condition in which dif- 
fieultvof breathing and of swallowing exist either 
together or sepaiatelv, caused by disease situ- 
ated between the mouth and the lungs, or between 
the mouth and the stomach. By a special affix to 
the original term, significadra of the seat or the 
nature of the disease, several varieties of morbid 
stetes are known and described, for example : — 
angina parotOea, or mumps ; angina tonnUant, 
or quinsy ; axgiita laryngea, or laryngitis ; an- 
gina ftetorii, or breast-pang ; angina maligna, ot 
malignant sore throat; oa^tna numbranou, ai 
croup. 

These and numerous other diseases, differing 
essentially in their nature and pathological rela- 
tions, and having nothing in common but certain 
difficulties in breathing or swallowing, are thus 
classed under the word angina. Such a classifi- 
cation is open to several objections, and has 
nothing to recommend it. . With tha exception, 
therefore, of angina peetorit, which has a special 
and familiar signification, the various diseases 
occasionally recognised by the term angina will be 
found described imder the names by which they 
are generally known in this country. Set also 
CruAKCKH. R. Qdaih, M.D. 

AJrO-IITA VKOTOBIU.— Small.: Svneop* 
Anginoaa ; Aogor Pectoris ; Suffiicative Breast- 
pong. Fr. jMffin* d* pcitrin*; Qar. Bnut- 
brSiait. 

DiFixrnox. — An affection of the chest, cha- 
racterised by severe pain, &intness, and anxiety, 
oceurriag in paroxysms : connected with disorders 
of the pneumogastric and sympathetic nervss osd 



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Aeir IsBiidms ; and frequatly saaodated witb 
' s dueaae ot the heart. 

urrunc. — ^An attadc of angina pectoris 
I raddeniy ▼ith pnin in the region of 
the h«ait, generally on a level vith the lower end 
«{ the rtrmam. The pain is serere, and of a 
gTuinDg, crashing, or stabbing character ; it 
uteadi sometimea across the cbest, but more 
faequeaUy baekararda to the senpnla, and np- 
vaida to the left shonlder and arm. The pain is 
iccompanied bj a distressing sense of sink- 
ing, of fkintneas, or of impending death. The 
aetioQ of the heart is generally irregular. The 
pain at the vrist corresponds ; bnt in some 
'adl-raarked eases it is regnlar, tense, and resist- 
iag. A ftar of aggravating the pain prevents the 
patient from breathing, tbongh the respiratory 
metian ma; not be r»Uy interfered with. The 
expreasiao is anxions, the face is pallid, and the 
hps are man or leas lirid. The whole surface 
«f the body is pale, cold, and rorered with a 
dammy sweat, flatnlence is often present ; nrine 
ia some eases is passed at short interrals, and 
geDcrally in abondance. The sense of Ikintness 
eanaea the patient to seek support, and he rests on 
any object by which this may be obtained. The 
attack baring lasted for a variable time — fh>m 
a few miantes to one or two boon — comes to 
an and, either by a sudden cessation of the 
■wra vigent symptoms, or by their gradnal 
diaappearaore. The pallor and coldness of the 
sar&ce are replaced by a tmi&rm glow — the face 
aiay even Ansa, the poise beoomiog soft and full, 
and Oitn is a general feeling of relief; a sense 
af nombacas or tingling along the course of the 
■■Ilia derived from the brachial and cervical 
pli I iii»ss of the affected side occasionally remains. 
An attack c^ angina Tpectoria frequently comes 
«n daring sleep; bat it may be indaeed by 
•OKitioB or by physical exertion, especially by 
wtalking ap an ascent, or by exposure to cold air 
«r wind. An attack of thu kind may occur but 
ance and end £itally ; or it mny recur after an 
JBtcrral of bocn, days, or weeks, and be thus 
eoctiaaed ; m there may be an interval even of 
yean. These and other modifications of the 
^■ase will b» agun referred to. 

PitxsouiGT. — The nature of the aggregate of 
the syssptunM or phenomena comprised under the 
aaae oMgina pectorU, cannot be understood with- 
•Bt a el«r apprehension of the relations of the 
■erre-denents of the organs and regions that 
•ccm to be isvolvcd in the affwtion. It will be 
well briefly to summarise them. 

Tba nerves chiefly involred are the pnenmo- 
gastrie aad the sympathetic, and their branches, 
which oema, it ahonld here be stated, are con- 
Mctsd with each other at their origin in the 
^«Aill« obkmgata, in their course, and in their 
distiibotioo to the ganglia and structures of the 
heart. Thcry also communicate with certain of 
the errebnl aerrea, and with the cervical and 
Icadiial plexaaaa, which supply part of the head 
■ad Bsek. the anna, the diaphragm, and the 
Awl waUa^ Their oooneetiona with the heart 
■as veiy SDrtensive. Thia organ is supplied by 
tka caraiae ganglia and ths branches derived 
Itom them, whxh an in relation with, and, 
ia fiKt, eonatitnte put ot the cardiac plexus 
iaoMd by the istanacameiit of branches from 



AMQIKA PECTORIS. 

the pneomogostrie and th^ 



The pneumogastrie snppli 
nerre and apparently the m 
(which, however, is dei-m^c 
accessory, and is merely 
pnenmogastric] ; the aywatm 
sererBl branches throngti 
Branches of both pneumo^^a 
nerves are distributed t<:> 
sages, the lungs, stomads . 
other abdominal viscera. 

The connection of tX%^ 
sympathetic nerves in tu2x^» 
allusion has been made, 
and raao-motor centres ; •«.xa. 
nerres, and ths heart (vr-da 
thus bruogbt into relatiowm 
nerves throaghont the 
systemic blood-vessels; t 
with the other important 
bonrhood; and with th» 
especially that part of -i^ 
amotions. 

Such being the distril>vai 
of the nerves connected 
rounding parts, we leara. 
fnnetions, that the movana^ 
maintained by its ganglica^ 
ments may be acceleratewl 
sympathetic, whilst they 
be even arrested by that 
branch trom the pnanmogssi 

The superior cardiac bi 
gastric has to do with th' 
conTpying impressions coca 
heart to the medulla, when, 



SS 

X»tb«t;« ni ■ I ■■_ 

-ft-bv mpnriop cazvljsae 

«Wnor ca^rdiAc n«n-w« 

Trom tlae aipuaal 

Sistribat«d ^rifth kb« 

•■■.til etie eozstnbat^ 

K«-ric and ■jmipiafc.b«^iQ 
-Cvtx4> respimCor-y 
tines, liwer. 



posaaaogMtnc ^ 

■anedolln. to ^^Kj"^ 
caT. a* ««. ^Cu^i*^ 
«soDaaq.«>«nt.ly t.W«^ 
1-a thoy awptolw-v*** 
-~^Sth the wm.^'' 



itrea in tj»^* 



.V% 






sbntia 



•t^ 









may be reflected through ^ j^ ^ 
nerve to the heart, eontr<K>MWi 
movements ; and also refleefto<3i 



9 m '-^ 



.'^^ 



<Vjy''<>^ 



'^ 



motorcentreandraso-motOF m 



'^W^*- '^»- ^«»»o> 

relation, relaxation of tho ^rf "-tt «/, '''o . *» 
those of the abdomen thr>oa]^|j ^*^« "■'• r^^n"^ 



'>'*>>l 



circulation. By means of tl>f« .^i^, 






'«/;w2'^ 



nerves is accomplished, and t2i« i.'^ 
of pressure. ^Oq 

With regard to other fhnctioD 
nerves, It is baiteved that sae{|" "^f 
bilify as the heart possesses ia *^'^'>j^° <•« 
connected with the superior eu,.^5>»'e J'" ee^ 
the pneumogastric Mumerons to"*° h^^'^'tl] 
exist between this nerve and th» „'**'?'<J(,i^''"^'i o. 
nerves; and it must also be re*^'^'"'<i-y "!""< 
reference to the sites of pain in '""".'"eijrf''*' 
nerves may be rendered •ensitiT«*^'n«7tkf'* 
which are not sensitive in health. ^ '"•e^ 

Lastly, it is to be noted that the bb ^^"^ 
trie and sympathetic nerves, aa •writ'"'*''8a«. 
heart and blood-vessels, whose funet; ** *'>e 
regulate, possess the extensireconQectio"* ^''*> 
mentioned with the abdominal and Ik"^^* 
viscera, and thus they not only infloeng. r°''<'>c 
influenced by the conditions of the In^ v "^ 






"", 



■<xi 



stomach, kidneys, and other oigans. 

Keeping in mind this distribution of n 
and their functions, we can recognise h l* 
movements of the heart may be affected »h*f k 
in the direction of acceleration, retardatio 
even arrest. We can further understand h ** 
painful impressions originating in ths caid"" 
narrea may be propagated to ■■ to be ref^JJS 



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to ths aamsiatad tUBaotj atnm and thrir 
bnoebM; and hoir nlatiou may be aitablUbed 
with tb* Taso-motor systsin and the circula- 
tioB guMraliy. Tbns the tmnIi thronghoat 
the body may be acted upon, producingf cold- 
neai and pallor of aarrace from the aboOTmal 
fiUiog of the abdominal at the expense of the 
■nperSdal reaaeU, a oondition which aeenu to 
be the eauM of the diminiahed arterial ten- 
sion noticed in these cases. We can also com- 
prehend horr morbid impreseions mods either 
on these oerres, in their distribution to the 
abdominal Tisotsa or the hearty or on the 
peripheral distribution of the Taso-motor nerves 
at the snrfiKs of the body, may, passing een- 
tripet^y, admit of reflex impressions and re- 
flflz actions, vhich in some cases may be pro- 
TocatiTs of the symptoms of this disease : also 
how direct impressioas made on the aetrea 
themselTea in their course, or at the Taso^notor 
eentie, or throngh the cerebral emotive centres, 
■117 sech give rise to the phenomena which 
represent the symptoms constituting angina peo- 
loiU. 

Aiticlogj^qf UnengfUetttdJngma BteterU. — 
That this disease is dependent on an aSbction 
of nerves may be held to be demonstrated 
by the paroxysmal character of the attack; by 
its sudden access and sudden departure; by 
the nature of the causes that promote it, whether 
they be mental emotion or direct or reflected 
irritation ; by the ponrse and character of the pain, 
and by the fact that in severe— even fatal — in- 
stancee of angina, there is often an absence of 
any tangible or evident oiganic local disease. 

The morbid state affecting the nerves may be 
situated in the medulla ; or it may be in the 
•oaiM of these nerves, or in their branches ; or 
in the csrdiao ganglia themselves. It may 
be the result of congestion or inflammation 
of the nervck sisch as occurs in ths lithic acid or 
govty diathesis ; or of other textural changes, 
such as connective-tissue growth, involving the 
nerve-fibres and gai^lia. It may be produced 
by emotions acting centrifugally ; or by irritation 
acting cantripetally, refleoEed, as we have just 
said, ftom imprassions made on the peripheral 
extremities 01 nerves. Thus acidity of the 
stomach distended by flatus, the result of indiges- 
tion, often gives rise to symptoms which very 
dosaly resemble, if they do not constitute, an 
attack of angina. The like effect has been pro- 
dneed by irriH^ion reflected from the fifth nerve, 
as; for example, in pivoting teeth ; by such irrita- 
tion of the surface of the skin as results from 
severe herpes ; by cold, or by exposure to wind. 
But the most frequent source of the symptoms 
of angina caused by reflex action is to be found 
in those organic sffectiona of the heart which 
will b« described in the next section. 

Whatever the nature of the irritation or of 
the exciting cause, the symptoms will, in some 
measure, b«ir a relation to the nerves affected. 
Thus, if the sensory branches connected with 
the spinal nerves suffer, we shall probably have 
pain more severe and more diflnsed : whereas 
if the branches more immediately supplying the 
hsort are affected, we shall have the action of 
that organ mora or less disturbed, accelerated or 
dapresMd. And so with the btaaches at other 



FECTOBIS. 

nerves, more especially of those connected vitk 
the vaso-motor system, or with the laqgi tai 
abdominal viscera, modifleations of symptoms an 
produced which it is needless to describe at 
this pmnt in detail. 

Patielcmf of Angina Peetorii complitaiti with 
Orffomie Duetut tjf iit Heart and Veudt.— 
The striking character of the symptoms of angina 
pectoris has led pathologists to connect the heut 
with the disease, and to investigate its condition 
accordingly. Such researches have established 
the fact already mentioned, that angina may eiist 
without any discoverable disease in the heart or 
its appendages. On the other hand, in the great 
mig'onty of cases various forms of structural 
disease of the heart and aorta have been ob- 
served ; for example atheromatous or calcareous 
dagenrration in the ooronar7arteries,in the Talvra, 
or in the aorta; dilatation of the cavities of the 
hsart, or of the aortn ; accmnnlation of fat in the 
cardiac walls ; and lastly, and probably the most 
important change of all, btty degeneration of ths 
muscular tissue. A kiwwledge of this lesion is 
of comparatively recent date ; it is constantly 
associated with the calcareous and athoromatcnu 
diseases described above, and which alone at- 
tracted the notice of older observers. Nay mora^ 
this lesion of the walls of the heart is in itself a 
i^equent and sufflciezit cause of one of the most 
pnaniaent a^rmptoms of angina pectoris — faint- 
ness. This condition has been elsewhere 
described by the present writer {Medical and 
Chirurgiaal Society 1 TrantactUma, vol. xzxiii.) 
under the name of Syncope, Leihalit or fatal- 
faintness — a deeignation analogous to that given 
by Fany to aqgina pectoris, which he railed 
Syncope Anginoia. 

£tioloot. — When treating of the pathology 
of angina pectoris we have already discussed 
the conditions under which it occurs. We have 
endeavoured to show that the disease consists 
in a lesion of certain nerves, associated with 
various morbid conditions. In seeking to in- 
dicate the prediipoang eauta of these condi- 
tions, we have to point out (1) the existence of 
a peculiar stats of the nervous system, which 
may be described as an undue susceptibility to 
impressions. What that state is we know not. 
It would seem to be oflen hereditary, and to ba 
found in those temperaments in which there ia 
a hi^h development of the nervous element, 
associated with certun habits of life, such as 
sedentaij emplo^ents, high living, and so on. 
Thus it is that this disease has been the cause of 
the death of many men who, by their intel- 
lectual parts, have left their mark on history. 
It is merely necessary to mention, as instances, 
Lord Clarendon, John Hunter, Dr. Arnold, 

is) The influence of age is conspicuous ; the 
iaeaso is rare before puberty ; and the writer's 
researches show that quite eighty per cent, ot 
cases occur after forty years of age. (3) Sex 
also displays a marked influence on the dis- 
ease ; it is comparatiTely rare amongst womeo, 
a statement by the lata Sir John Forbes shoir- 
ing that out of 49 fatal eases, only 2 occurred iu 
females ; and 4 out of 15 non-&tal eases — facta 
entirely corresponding with the writei's expe- 
rience. (4) The pecidiar diathesis which giraa 
rise to neuralgia of various parts, and thnt in 



"Tj i g i t iz eci -iy 



Goog le 



AiranrA FEcrroBia 



vtadi litliie aeid prcdomiastM in the tjttem, 
vodU aeem to Im in manj eaaai an efficient 
CBOse of the ■jrmptome of sngina. 

The excitimif eaasa of angina pectorii are (1) 
Those that affect the nerre-teztnresthemMlTee. 
(!) The condition to which ve hare leferrad, in 
^lUeh 0T]gBnie disease of the heart exists. (3) 
Mental emo'ion, especially anger or nervous 
rinck. (4) Irritation propagated ceotripetalljr 
Cram the surface, as bj the branches of tbe 
ifth nerre ; through the brachial plexns ; 
throogfa the sympadietie and pnenmo^tric 
aerres distribnted to the abdominal naeera. 
(i) Cold applied to the surface, and especially 
coidvinda. (6) Physical ezartion, or any other 
agenn by vhich the circulation is quickened. 
(7) Be^easing agents, such as ezcessire 
totaeeo-smoking, malaria, &c 

AxaToxiCAi. CHARiCRBs. — Beyond the con- 
ditions indieatod nnder the h<«d of Pathology, 
ihcTt is little to be said on the morbid anatomy 
af angina pectoris. These sereral conditions, 
and the symptoms of angina as above described 
bsve been foui to exist independently of each 
other. There most therefore be something in the 
state of the nerrons tisanes that acts as the pre- 
Jisposing or exciting caase of this aggregate of 
phmomfTM Inflammatory changes and tnmonrs, 
inrolTiBg tbe ragns or the cardiac plexus, baTe 
been obserred and described. With reference to 
tiie state of the heart itself, its caTities hare 
been fnmd dilated and containing blood ; or con- 
tncted and empty ; and theories hare been founded 
Jmeapaa, astoviietherdeath occurred fay spasm 
cr by paialysii. It is more than probable that 
either one or the other of these conditions may 
oeear in angina, and lead to fatal resnlts, aceord- 
iag to the particular nerves controlling the func- 
tions of the heart which are affected. SetPxxo- 
mootatac Vmscn, Disease of. 

CuxKU. VAsnmn. — All the phenomena of 
■a anginal seiinre as sbore described may be 
BH>rs <»' less modifled. The attack, though gene- 
lally indiieed by exertion, may come on when the 
aatieat is at rest, and not nn&equently it sets in 
ortag sleepi The pain may be comparatiTely 
Jjght. sad as such may recnr occasionally, it may 
be, for moaths or years. On the other hand, 
it may be so serere as to mark a 6rst, a single, 
and a fatal attack. In its character the pain 
■ay be stabbing or burning ; but it is more fre< 
^at utl y described as ^^asping, crushing, or op- 
preaarre. It may be limited ^most to the region 
of tba bent, or the lower part of the sternum ; 
it umj sxtead all over the cnect to both arms, or 
spread to the side of the head and neck and down 
•ae or both legs ; and it may in some casee 
a jujar ei ut ly iorolra the diaphragm. The action 
af the heart may be alow, weak, and fluttering ; 
•r excited and boanding — constituting palpita- 
tisa ; and it may be regular or irregular. The 
poiKU with the heart's action ; in the 
fwtagt <2r a genniiie attack itsometimea yields 
a sphygM OgrapMe tracing indicatirs of extremely 
bipi tmsion. The breaQiing is sometimes dis- 
iiiwiag; aad althongfa the patient can take a 
dosp biealh trbea adted to do so, he generally 
■tmHs this ttooaj^ fear af aggraTatmg the pmi. 
Iban asy be laryngeal spism. The mental 
I are gananl^ naaistarbed ; yet there 



is sometimes dis^*-^ 
passes off, and 



■■ ■■ inluiji^ aa 
eioosness ia 

^he senae of j " »<» kIT 
<='»»«oteristi« ***»«»w **• 






>a»i restios- i» -^"^^t^ 7*® 
oct to obtTf^ **»« i>*»« 
•toops, or le,^^ V***^^!?* 



»b 



occasionally obeerV' 

impending death 

of angina, and oi 

sensation ol gsspa 

in swallowing is 

position of the paokCs 

sitB, aometimes la^ ortands, 

on any eonrenietx^ oI:>jeet 

aometimes he sits s»-rafi 

As a rule the ottacsJc pasKs 

it commenced, lea^vixx^ the_ __^ 

discomfort; in otli.^:r <=■•«" its diaaj,, 

more slow. The vafc«-a«fc»«" >» the , 

angina pectoris are tlxxi* ■•«'» to ba 

numerous, eonstitiafcin^_ * fonq 

which may be corafH»Jr*^t,i'veij mil^ "^ j . 

duration, or one of isx *•*>•• •nfferin^**^ Ojp 

to a fatal terminatiozi-* ^*» ^**«» ^ 

Ooiin.iciTio]ra. — .A-moMigat tho j- ^^**»li, 
which angina pectoris **^^y. ^' sajH **' 
ciated, rather than comi>licated ^ 'o i — 



^fc^L*^*^'! 



^J***^ 
^^^ 



•y«tt^^::^«»*s^ 






*« 



of the liver and digo«tiwo ^"nctio^*** <i 



'^^^^ ^J 



iti, 



minuria, diabetes, tmd 



, , __ — ^ diB«r_**»«tf *^«*» 

nervous system, ladooa, •*"'>«ri!^*»«^ * *»Jbii 

connexion, that Trouaseaau '^"^t o * tJ> ^^ t^~ 

betwem epilepsy and axi^iia—, ^^ **«i*/*tfc^ 



.^h 



see m s to d«>end on the vosceptibji^:'* 
maladies which some indiwiduais " ^ 



to"** 



than on any special identie^ ^tit^*^tit 
diseases. More than one stiikitur . * ti, * 



*>e; 



''^, 



'OBa 



connexion has fallen undar the \Zt*Ai i>i, 
he might mention an instsnco rette^^s ' 



'•♦ 



in w£iieh this suaeeptibilitT was ^^^ **>ot 

USUI ■■ — ■ ■!■ in ■■■! M^ 1B.JZ.. ^ ft y _ 'QCn ^ -m 



«><*, 






oppressive meal of indigeotibJe food k — — ; n - 
a first and distressing an^'nai attack, f ^?°*** o5? 
others. In this case brain disaaaowitfc '*"d <>^ 
was subsequently developed on the di«aD,2*'^P«> 
<rf the angina. '*™'Ppearan<si 

PaooBBsa, DvsAtiox, amd TmaiaxA-^^ 
The progress and dnr-.s™ JT^TT*'"**- 



clurati( 



wiU depend wholly upon the natU of tt.'^^ 



Cases have been recorded in which U,f*«!^' 
attack provedfataL The writer hLs^uMtJ^- 
in three of these case, a pot-m^^T^^^ 
revealed the fact that there was slighTSStiai 
hemorrhage into the walU of the h4rt.*^iiV<*» 
had been the sMt of &tty degeneration. ot»- 
nected with calafieaUon of the coronary ^^ieriem- 
The symptoms m these eaaes perfecUy reseixibled. 
those of tbe most severe ezamplea of oa»K^°* 
pectoris. It is highly probable, thorefcw*, «!»"* 

I ' \fT '■" »!?»»"y ««»« niMlerthe wrleer*. xK»tiJ« 

in wblcta a gentleman acciutomed to nua ItthTa acid. 

•Me o( the d>en u low u the hJpodwnSlM iSs 

h<«t^(lep™«Joo, ud other ijinptoms, which? h^ tb« 
attuk oommenced on the left tide oC the eheiJ" ^ilSf 

rtctmd at internal tor soma iraeka ; theT^TiTtiSS? 
bcoyht on eren ^walking on a level «nrli«, ?~ ^Sz 
hnndredjarda. The moat oatefnl examlnalSon Slti!' 
^t anyevideDM ot organk) dlaaaa tntha oSS !S 
eirralatton or reqihmtloa. The paUent w»i reooSSSw 

In Swltaerhmd ; from whkfi he retn^ned gwatlytaSSS? 
and atanoatlnetrom pain. It ihoold bo meattmSrSSr 

Morlson in wUch diaean of the right dde of tbe^i^ 
waa aooompanied by ■ymptomi of angina affaotbiff tk. 
oo i wati eiM Ung alda of the cheat and ajmi, ^ 



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M ANGINA PECTORIS, 

■oma of the cmm proring fatal in a flnt attack 
of the diieaM an rather examples of partial 
raptvre of the heart than of what i» nnially 
eaUed aagnia. On the other hand, faMs of 
the disease majr oontinoe with interruptions 
for jean ; the differenr« being entirely due 
to the nature of the cause on -which the diveaae 
depends. Thns in many instances indiTidnals 
present all the symptoms of marked angina, 
accompanied by most of its distressing pheno- 
mena, and by the anxieties and fears that they 
beget ; yet these eases, having more a nenrotic or 
goncy origin, yield to treHtment, the snfierers 
oeiag restored to health, and continning for 
years to ei^oy comparatire comfort. (^ the 
contrary, in the cases in vhich angina is eon- 
nectad with organic disease of the heart or of the 
nerres intimately connected irith cardiac action, 
the symptomsprogress in frequency and seTerity; 
Bad the attacks tend, with more or less certainty, 
to a faial termination — it may be within a few 
day* or weeks, or it may be, in milder eases, 
not for yean. 

DuoKOSis.— A typical ease of angina pectoris, 
snch as has been described at the commencement 
of this article, csn hardly be mistaken. But 
when the sereral symptoms coBstitnting an attack 
are Tarioosly modifled, some being lessened in 
se>-erity and othera exaggerated ; or when these 
symptoms depend on, so to speak, remote and 
remoTable causes ; it is often difBcult to say how 
far the disease is what may be regarded as a 
passing nenialgia, or an attack of what is com- 
monly reeogniseid as angina pectoris. So also it 
may be difficult to say, in cases of angina, whether 
the seizure is dependent on organic lesions which 
admit of no improT«ment, or on some con- 
dition that is amenable to treatment. It is, 
llierefare, with this, as with most other aflbc- 
tions, more difficult to determine the catisa on 
which the symptoms depend, than to recognise 
the presence of the disease itself. With re- 
ference to the diagnosis of the organic dis- 
eases of the heart abore alluded to, it is un- 
neeessaiy to repeat hers what will be fonnd 
described nnder other heads. It rmains but to 
say that in erety casa the dosast somtiny must 
be made into the condition of the heart and 
groat blood-vessels, with a riew to determine 
the presence or absence of organic disease. The 
investigation must flirther extend to the other 
viscera, snch as the liver, stomach, and the diges- 
tive organs generally, as well as to the several 
other sources from which symptoms of angina may 
be exdted by reflected irritation. Certain symp- 
toms resulting from the presence of other diseases 
should not be coofonndad with angina — such, for 
example, as the pain and dyspnoea caused by 
pressure of aneurisms or of tnmoun within the 
chest ; by rheumatic or gouty neuralgia of the 
ehest-waUa; bypleurodynia, or acnts pleurisy ; or 
by indigestioiL Each and all of these conditions 
must M considered by way of exclusion in de- 
termining the nature and origin of the disease. 

I>Boairosi8.— In anticipating the future of an 
attack of angina pectoria, one most be guided 
chiefly by a knowledge of its eanae; in soma 
respect* also by iu severity; and fay tba 
fttrriaoM histoiy of th» case. Thus, if yre 
•as aaesttaia that (he attack haa bean brou b^ 



AKUINA PECTOBIS. 
on by soma elsarly established and reiMiT' 
able cause, a favourable prognosis may be 
''fairly entertained. On the other hand, if th* 
history of the casa tells that there have bees 
several previous attacks, increasing in severity 
and connected with heart-iiisease, one can seareely 
avoid being led to the conclusion that the distsaio 
will tend, with more or less rapidity, to a fatal 
termination. Between these two classes of cu« 
exist a large majority of the examples of the 
disease In which the symptoms of angins, of 
greater or less severity, dtpeod on nenrosia, on 
gouty diathesis, or on other sources of nsrvs 
disorder, amenable to treatment ; and in which, 
therefore, a favourable prognoeis may to aoms 
extant be given. But in all cases great caatioa 
should be exercised ; tor many instances oeoar in 
which, from slight and obscure beginnings, severe 
and even £ital examples of the disease have been 
developed. 

Tsxa-nuon. — The treatment of angina pec- 
toris must first have refereoce to relief of the 
attack itself; and, aecondly, during the inter- 
val to the removal of the causes on which the 
attacks may depend. 

Varing^ the attack, it is neecMary first, if ;«•■ 
sible^ to inspire eoD^denee, and remove appre- 
hension. The patient should be idlowed to retain 
the position in which he feels most comfort. 
Secondly, if the exciting cause is one that can 
be removed, thia should be done ; for example, 
if the stomach be full of undigested food, an 
emetic of mustard might be given with ad- 
vantage ; or if flatulence be present, peppermint, 
ether, and other anti-spasmodies will be nseftd. 
If cold havs produced the seizure, the feet and 
hands should be immersed in hot water, hot 
bottles applied to the surface of the body, and 
poulUcee of Unseed or mustard, or embrocations 
of chloroform or laudanum, should be pUced on 
the chest. The administration of chloroform 
internally had better beavoided. The nitrite of 
amyl, as recommended by Dr. Lauder Bruntoi^ 
has been fcnnd one of the most efficient remedies 
employed hitherto. Five or six minims of thia 
drug (preserved in a glass capsule) should be in- 
haled from a handkerchief, and, if noceasary, 
tha inhalation may be repeated. Nitm-glycerine 
is useful (^ of a minim dose), and hypodermic 
ii^ection of morphia may be tried with advan- 
tage. In eases where debility and exhaustion 
exist, the ordinary stimulants will be required ; 
and various antiapaamodics, such as ether, 
ammonia, &G., may be given with more or lea 
benefit. 

During th* btttraaU.— It is of ooune desi- 
rable to avoid all causes likely to bring on 
an attack of angina, such as mental excitement, 
bodily axertioD, axponire to cold, and iha naa of 
indigestible food or heavy meals. The leading 
principle in treatment shoiUd, however, b* to 
endeavour to determine and to remove, if pos- 
nble, the cause of the disease. 'Whether it de- 
pend on organic disease of the heart, whether 
on simple neuralgia, whether on gout or djna- 
prpsia, whether on debility, or on fulness of 
nabit — to each of such conditions must appropri^t* 
treatment be directed. A variety of speoifin 
rsmsdies have been rectwimmded : such aa 
axssaic, piwsphonis, steel, sine^ and tha di&Mnt 



-S.- 



Dinitizod by 



Goog le 



ASGISA. FECTOBia 

•ati-ipaaiBadies. OalTBnum, in the form of 
the cantinooiu eomot fiom thirty cells, has 
fcored succpsaful in some uncomplieated easea, 
llwpoBitire pole being pUced on the tternTim, and 
the n^Htire on the loirer crrrical vertebne. Kx- 
eeUeni, however, aa each of the remedies named 
■ay be under special and tnitable cirenm- 
■tance<, the resnit of treatment must entirely de- 
pend on the eaise of ihe disease, and hov far it 
u vithin reach of remedy. Some cases of ap- 
parently tcrere angina will be fomd to yield 
to treiitment ; whilst, as might be expected from 
the nature of the disease, others unhappily pro- 
ceed to a fat&l termination in spite of every 
e£>rt directed to their relief. 

B. QuAiir, U.D. 

ASIDBOSIS (i, prir., and Bpih, sweat). 
— A biaitu or want of penpiiatiim. Set Faun- 
TuaoK, Dia u i d et s ol 

AHZUnS POISOB'. — The aniline dyes, 
which are a modem discovery, present the most 
briUiant hues of yellow, blue, and red ; as such 
they have been used for dyeing stockings, gloves, 
&c Thne articles when worn are apt to pro- 
dnee an intense form of inflammation and vesi- 
cation of the skin, which is rebellious against 
treatment, and liable to relapse for many months 
after the original attach nas subsided. Set 

AHnCAXi FOIBON8. Set FoMOHS. 

ASODTHSS (It, prir., and Uini, pain). 
— D amiT ioy. — Medidnea which relieve pain 
by leasening the excitability of nerves or of 
Derve-c«itRS. 

EsmKKATiox. — Anodyne medicines include 
Opinm and its alkaloids— Morphia and Codeia : 
Braiurdc of Potassium ; Cannabis Indica ; Bells- 
doona and iu alkaloid — Atropia ; Eyoscyamns 
and UyxMcjamin ; Stramonium ; Aconite and 
AoonitJa ; \ cratnm and Veratria ; Coninm and 
Cooia; Lapolus and Lupulin ; Qelseminum; 
ChioiD&irm, £ther, and their allies ; Chloral- 
hydnte; Botyl-chlonl-hydrate ; and Camphor. 

Actios. — Pun is due to a violent stimulation 
of a snisoiy nerve beingconrey ed to some of the 
mceph^ic nerve-centn^ (probably the cerebral 
lleintfpheres), and perceived there. The impres- 
sion pnxhiced on all sensory nerves, except the 
cephalic nerves, is eonreytd fur a part of its course 
to tk* bead along the spinal cord. The primary 
impttanuo which is f<Ut as pain, is usually made 
mjfoa the peripheral ends of the sensory nerves ; 
bot it may also be made upon their trunks, 
•poo the spinal cord, or possibly upon the en- 
cpphalie centres directly, without any affection of 
Out nsrres themselves, as, fur example, in hysteria. 
^in may therefore be relieved, while the source 
•f irritation still remains, by lessening the cx- 
dtabili^r of the ends of the sensory nerves which 
tscaivr the painful impression ; of their trunks : of 
(he spinal enrd along which the impression travels; 
srt/the encephalic centre inwhich it is prceived. 
Opinm acta by les!>ening the excitability of the 
iSiMiij nerves, the spinal cord, and the encephalic 
(aaglia ; brom'ds of potassium is also believed to 
•el 01 ill three, although to a mach leps degree 
thaa efinm ; belladonna and atropia affect the 
server as probably does hyoscyamus; 



ANTACISB. 

stnmonium, aconita and aeoiutA»« "Wexstriik ^hl ^^^ 
and butyl-chloral, lupulus axul Inpulinr^ ^^^ 
m probably act oix th, •noeTrj*,*'***! 

As opium BndittOTrp\i\aact Qpoa _>■, 

nervous structures concerned. \tt the Vtotf *-^* 

of pain, they may be used tid TeAieire wSi^^^^^iofc 

ever iu cause. Cannabis »'a.A\caati4 V,»riw.^^Vfc^ 

potassium may be employed \ind«s tV/*^^^* ^1 

circumstances as opium, "t»ul I^q-v V * «._ ^T 

much less power. Chlor»«.X ^ewna \L > ^'^'^ft ^^**** 



gelseminum 
centres. 

USBS. 



opium 
Chlor»«.X 
only by inducing sleep, sekS. 
ansesthotic effect unless i^ S 
doses. Butyl-chloral also mac 
to have a special sednta '«-« 
nerve ; so likewise hits 
both these agents are 
facial neuralgia. As t1i» r 
exerted chiefly on the pox-j 
Bory nerves, this rema<3. 
directly to the painful pa. 
liniment, or ointment, 
opium are also used 
several forms, for the rel i e 
anodynes maybe admixii, 
mouth, but by other chanz: 
tion, by enema or snppo 



does 1 



v*V, 



■«=luce«»\(.. '^ ■ ^'^ 



i>.Cx,>'*o'S 



•"» th. 



^>^t.*'^?>« 






injection, or by endermic; 
Several therapeutic m 
Anodynes, such as the 
Moist Heat ; Cold ; Electi 



- >'\ ^'^J^/ W^^''»d 



torv 



M^Pl 



fjv . Ov . "J' It,. 



Vf, 



."^'>t;Z h 



■es 






Counter-Irritation ; 
■traction of Blood, 



Acup 



r-'^H^yj^-^^^ 



'"otjjo*.-, 



Of 






°<Ja 






AKOBSXIA 




^^ 



(*■ pri-w.. ,^«* fc^ **" 4^' 
tiU).— Want or deflciencjr of '>4 *"*»*>». 
companied with disgust for foo,^*Pp«.ti/]f"' "Pi 
Morbid conditions o£ ^^- -Sfe,^ Oot ' 

ANOSHIA (i, prir., and io- 
of the sense of smell. Set Sjt^ ' '""U). 

AJTTAOIDS.— DmnrrroH tlT'**^ ^ 

to counteract acidity of the lecJ"!- **''°'*» "" ^*'T^ 

E-XTOKBiTiow.— The anUdd.* •'°'',*- * "*x 

Sods, Lithia, Ammonia, Lime M *** ":** 
their carbonates; as well as the « 1"*°°^ V^^^V 
alkalis form with vegetable acid. 1 ."^V-^^* 
Ufes, Citratifl, and Tartrates. ** 

AcTiox.- Antacids are divided inf 
which act direelttf, lessening acid,? C 
stomach ; and (2) those which wt-*" 
diminishing acidity of the urine The » "* 
alkaline earths and their carbonates "* 
exception of ammonia, h»Te both a d£,^ 
remote influence ; for when swallowed tjL^ 
the stomach, and being absorbed from i^ 
tinsl canal, theyareeicretedby thekid»^ 
lessening the aciditprof the urine. Ama^ 
Its carbonate are direct but not remota^^ 
for, although they neutralize aciditc^ 
stomach, they are partly excreted in'^^ 
ofnrca, and do not diminish the HcidifcJ^ 
urine. The acetates, dtrates, and ta» 
the alkalis and alkaline earths, on t"* 
hand, have no antacid efl!ect in the stoi 
undergo combustion in the blood, being 
into carbonates, in which form theynr. 
in the urine, and diminish its acidity. " 

UsBS.— Excessive acidity of the ccv. 
the stomach gives rise to add eniovi.tj;*' 










'^^ ef 




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08 ANTACIDa 

iMUtbarn. It nay loniatimM depend on the 
Mcratioo of a too acid jnica t>T the etninach, 
Irat probaMr i> generalljr e«useu by the furma- 
tion of sciJ from the decomposition of foM 
when the proceei of digestion is slow and im- 
perfect. Antacids are girsn afirr meaU to 
teeaen aciditjr in the stomach, and afford imme- 
diate relief to its attendant symptoms. They 
Majr prove eren more efficacious by preventing 
acidity vhen given before meals (ms Alk^ilis). 
[f the action of the bowels be regular, soda is 
preferable ; but lime should be need if they are 
relaxed, and magnesia if there is a tendency to 
constipation. Remote antacids are giren to 
lessen the acidity and irritating qvdities of the 
nrine in cystitis and gonorrhoea ; and tt prevent 
the deposition of uric acid gravel or o.lculus 
in goaty persons. For this purpose potash and 
litbia are prrferable, as thnr urates are more 
■olnble than those of the other bases. 

X. Laudkb BsTmroir. 

AH'T AOOXriSK. —This term is employed to 
axpress the fact that the physiological action of 
certain substances may be affected, even to the 
extent of neutniliisation, by the presence in the 
tx>dy, at the same time, of other substances 
having an action of an opposite charucter. It 
is important to distingni-h between aiUidolal 
adim and phytMogkal ani(u/oni»m. By an 
antidote is meant a subntance which so aiiects 
the chemical or physical characters of a poinon, 
as to prevent its having any iiy'nrioas action on 
living animal tissues. Thus acids and alkalios 
neutralise each other, so as to furm innocuous 
■alts; tannin may render tiirtHr-emetie and 
many vegetable alkaloids insoluble; and the 
hydrated sesquioxide of iron mny be used to 
precipitate anenious acid. In thRse cases, the 
action is limited chieflyto the alimentary canal ; 
and the object of administering tlie antidote is 
to form insoluble salts, or compounds which 
will be physiologically inert. Bni the^^Aviio/a- 
gioal ttntagonisn of certain subetances is pre- 
sumed to take place in the blood or 'n the tissues. 
When such a substance as strychnia, for example, 
ii introduced into the alimentary canal, it is 
qnickly absorbed, and carried by the blood 
throughout the body. It does nut, so far as 
observation has discovered, influence all the tis- 
mes; but it so affects the spinal cord, and pos- 
nbly the brain, as to give nse to severe tetanic 
eonyulsions, chiefly of a reflex character. This 
ol&ct is, no doubt, due either to some interference 
in the nutritional changes between the blood 
and the tissues composing the nerve-centres ; or 
to tome specific action of the poiron on the 
nerve-centres themselves (see Apfiwitt). These 
changes, which are termed physiolcgicul, and on 
which the normal action of the nerve-centres 
depends, are probably of a molecular or chemical 
natoro ; and it is possibls to conceive that they 
■nay be modified in different ways by different 
•nbstances. Thus has arisen the idea of phy- 
siological antagonism ; and experiment haa 
•hciwn that, within certain limits, which will no 
4onbt rary in each case, such an antagonism is 
poanble. Antagonism maybe either local, affeet- 
iqg one oi^an, as is seen in the op|>osita eft^f 
apda the popiJ of apiam or jnoiphia Dpog ^h( 



ANTAGOKISU. 

one hand, and stramoninm, hyoacyamos, or bel- 
ladonna npon the other; or it may extend 
apparently to more important organs or gronpe 
of organs, as in the case of the antagonism 
between strychnia and the hydrate of chloral 
The most important investigations upon the 
subject of physiological antagonism are the fol- 
lowing : — 

(1) Phymat^ma and Atnpia, by Profesaor 
Eraser — an inquiry which showed that the 
fatal effeot of three and a half times the mini- 
mum fiital dose of physostigma may be prevented 
by atropia. (2) Atnpia and Pruuie Aeid, a 
research by Preyer of Jena — of a more doubtfol 
character as regards the point to be proved, bat 
still sufficient to show that, within certain limits 
not yet indicated, it is possible to prevent the 
fatal action ofprussiea'iid by atropia. (3)Mrvpia 
and Miuearia (the active principle of Agariaat 
mtuearitu) : — which were found bySchmiedebeig 
and Koppe to have entirely antagonistic actions 
ontheganglia of the heart — muscarinexcitingthe 
intra-cardiac inhibitory centres, and stopping the 
heart in diastole, while atropia has the contrary 
effect. (4) Chloral and Strt/eknia, — an anta- 
gonism first pointed out by Oscar Liebreich, who 
showed that minute doses of strychnia might so 
rouse an animal from the effects of an overdose 
of chloral as even to aare its life. And (5) 
Strychnia and Chloral — ^with respect to which 
Hughes Bennett demonstrated the converse of 
the last-mentioned observation, namely, that in 
the rabbit a &tal dose of strychnia might be 
so antagonised by a dose of chloral as to save 
life. 

Comxrsioxs. — It has nnfortunately to be 
admitted that the practical results of the |tre- 
cedinK researches have not been very encouraging. 
In all of these investigations it was qnite ap- 
parent that the limits of physiological antagonism 
were very narrow. Three elements affect the 
chances of success in the way of saving life: — 
( 1 ) the ago and strength of the animal ; (2) the 
amount of the doses of the two active snbstances 
—so that if cither the one or the other active 
substance be given slightly in excess, death will 
probably take place ; ahd (3) the time between 
the administration of the two active substances. 
If the stronger be introduced first, and be 
allowed to manifest distinctly its physiological 
action, it is almost impossible to counteract this 
by that of another substance ; but if the two 
substances be introduced simultaneously, or 
if the supposed antagonist to the more active 
substance be introduced first, the chances of 
success are much greater. It is appannt, theK- 
fore, that the fiocts relating to physiological anta- 
gonism at present known in science do not 
hold cut much hope of good results from their 
application in practice ; bat itill the physiolo- 
gical facts are so definite as to indicate a precise 
mode of treatment. For example, no one ao- 
quainted with the invesUgattons mentioned 
above would hesitate in attempting to relieve 
the tetanic spasms of a case of poisoning hy 
strychnia by repeated doses of hydrate of 
chloral, or hj the administration of chloroform. 
A practical resnlt of snch researches is that 
the principle of phyiiologieal antagonism may 
serve as • gnids to tas application of r» 



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AMTAOONISK. 

in diww. Thna excearive secrstion. 
mj bom mneoiu membraim or from sali- 
nij gUnia, may be modifled or armtad bj 
tha QM of anlphata of atropia, a itriking ex- 
perimeiital d«inaaatntion of vhich mar be Men 
IB the aatagooism between bromal hydrate and 
■alphale of atiopia in the rabbit. 

JORV O. HcKxHSRICK. 

AJTTXnJSXIOH. — ^A bending forward* of 
any organ. The term i< spedaUy und in rela- 
tion to the nterna, when this organ is bent for- 
wards at the Una of junction of ita body and 
&« VfouB, Diaaases od 



AJTTEVSBSION. — A displacement for- 
wards tt any organ. The term is particularly 
apfJifd to a chajoga of position of the nterus, 
in which this organ is bodily displaced in the 
pelTie carity, so that the Aindus is directed 
against the bladder, and the eerrix towards the 
See WovB, Diseases of. 



ASTHSUOHTIOS (Arrl, a^inst, and 
lA^iFs, a worm). — D a r twi i i ow. — Medicines which 
kill or axpd intastioal worms. 

Einnaaanox. — The principal anthelmintics 
an: — Oil of Mala Fern ; Kamala ; Konsso ; Oil 
afltopcntiae; Pomegranate Boot ; Worm-seed 
■ad ita aetira prineipls. Santonin ; Aieca ; Mn- 
cona ; Boe ; and drastic pnrgatiTes. As pnrga- 
tirea oniy expel the worms, they are termed 
Vermifi^a; while the other anthelmintics which 
kill the worms are called Vermieidee. 

AcnoaL — The oil at male fern, kamala, konsso, 
ail sf tarpeotine, and bark of pomegranate root, 
act aa poisoiM to t^ie-worms ; worm-seed and 
""r*""*^ kill romid-worms,and also thread-worms. 
Ostor oil, jalap, scammony, and other purgatives 
do not k^ the worms, but dislodge and expel 
tbam, by the increased peristaltic action which 



"^. 



JaasL — Drastic purgatirea may be nsed for 
wvmsof any sort; aiecafor both tape- and ronnd- 
worm* ; and tli* other agents for the worms on 
wUeh they aerRally act as poisons. Vermicides 
are geneisUy giTen after the patient has fasted 
tar seresal bous, in order that, the intestines 
faciaw empty, the drugs may act more readily 
est the wonns. A puigative is usually giTen 
hoars afterwards, in order to expel the 
wanna. Aa thread-worms chiefly inhabit 
the raetam, they an most effectually killed by 
SilfmBts, wUeh may eonaist of a strong infusion 
at qaaasia ; salt and water ; vinrgar and water ; 
aolntian of solphate, or of perchloride of iron ; 
ail of tarpeatine ; castor oil; decoction of aloes ; 
sir infiwimi of senna. As abnndanee of mucus in 
the inteetiw fonns a oouTement aides for the 
growth at wonu, anything that diminishes this 
lands to prsTent their ooenrrence; and for this 
patpu aa xnwpazatioca of iron and bitter tonica 
an a aif a l . T. IjainnB Bbumtoii. 

AJTHKAX (t*tfm(, a coal).— A nuonym 
for eaibonelek aad for malignant pustule. See 
Casaanscu; and Fcstulb, SLkuanAxr. 

ASTtVOnB (isrl, against, and Ut«/u, 
I pn.) — Dannnoa. — An antidote is any 
naaidywlDd, by its ptnraical or ita chamie^ 
■CMt apa a poiaaa, or la both ways, ia capaUa of 



AS'UPBXtl.OVl^' 

prerenting or countexrabe^ing 



effecU of that subatajaco. (?^. 
Sometimes, howeTcr, tta^ t;enB 
compnhensiTe sense, tt> aua to ir>. 



6T 
,,vsiol°B''*\ 



„gcJ ''l.o geo« 

compnnensiTe sense, to aua to •■, ^,y »■ >^ ^-^o " 
ral treatment of a persoxa aaf6ct««^itjrO« ,-bftftp8 
poison. Thus, in poiaoiaiaig bf ,er^^ J'f ^^ '^^' 
at the stomach-pump, erxforced ®. ,, ***' ^^, 

the limbs, and artifldaJ. r«m)pv»^^^.^t^^^ .-MoA 

eluded in the general a.xa'biclotitl tr -rt*-^^' „ inBo\- 



^th the ?v{-p-,^^j;« 



MoDKs or Acnoir, 
antidotal substances fox 
nble or innocuous eoTn pounds- 
tempting to give a comx>let:a ^"''"^ 
are examples of the iaoz-<^ com^° ^.y- ,^crrve»ia' 
their respective antidotes i— — <!) -^ Vit. *****? r»-cul 
hydrated peroxide of ir«>n. or V'S'^it.**^^*^ ,? 

(2) Ayrfnxyonicflc/Vf: ncs-wwl^y F^ <^\^ -. C^ >. "'"w 






and 
ncid ; 



of iron with an alkalio' 
add : chalk, common wh i t 
pended in water; (4) ^« 
catechu, or other vegetakvl 
taie of lead: sulphate oi 
phatea of soda and magn 



te 



omls 



dilute acftic acid, fixed. 
eomeive sublimate : albur 
or milk ; (8) mineral 
whiting, pla^i^r from tb< 
carbonate of magnesia; 
albumen, milk, or carbons^ 

Vegetable poisons canixoc:, 
acted. If they bare beezx 



i xag. or *^ ^ i/7 - t»iim\ti. 
'*'*' -^ots ; C5) ace. 



rbtitJf^ 



— . lemon juice ; (^v 

. white of eee. a^' 



. w^iH OP ceU^i^'^O'X 



X.I:x e 



of seeds, leaves, or rootsi. 
is to remOTS them from tfa.^ j 
as soon as possible by eia^£.Bc»._^ 
and at the same time to ^wx^ ■::_;, 
strength of the patient by «^ix«. 
of stimulants, (hi the othcar I.^ 



?OU 









^^ 



^w 



^«»^*! ^t 



^«f/, 



laid has been taken, it is ^t* ''^r»"0)." H •'rgj 
that emetics and purgatix-em ax-f, «>>.• it'^iJ''^f(inJ 
or may even be injurioaa. j- " ri^*^*! tK'^ftt; ^ 

BtancPB we must rely on tla« t, J- a i ^ a/i <> 
of the physiological anUgonJ^j ^> '^>*.*'o *o>A^^ 
(such as chloral hydrate in ttao <sfj ti *> ,^ '^ «,. ''(f 
poisoning), and on supportiziD. ^^q ■'* ^'/j "" ''"'■ 







zinc and stimulants; {?■') heittn/^f ^'>,'^'>tt,^ 
not: emetic of sulphate of ^5^*,^*«</^76- % 
stimulants, and after some time '*o ** <f "'o*'"' 
gatire; (3)digilalie: emetics, Btitt,^"? n,.,"."'^'''' oS 



Of 



maintenance of the recumbent 



POSJ.'I-'**') 






eyamtie leaves: emt tics and ttiTOuln.,, '"^<i; / ''"c^"' 
chlorate or meconate of morphia, *= (5\*-' /{j,'*' 
preparatiotu of opium: emetic of 'sai*'«j(,/ ''■S"f°*~ 
external stimulation by warmth, •^""'o n/ 'i~ 
camphor liniments, enforced eiertin''P'''itift '"c* 
respiration, and small repeated dose."' "'■tiff ""^ 
of atropia; {6) chloral-hydrate : tU °^ ^^lpi'"'l 
opium ; (7) strj/chnia or nui voiiii"" iis ?'* 
charcoal suspended in water, ren,.!?' ."nim^!' 
doses of chloral-hydrate, or chlo^r'^'^ 1^' 
Poisons. Joh» G. M'K»""'"'- &t 



ANTIUONT, Folaoninc by. 
EiOTic, Poisoning by. 



-'<Dr 



&.T. 



'Cic. 



AJTTIPBIillODIOS. - DuFiNmo!, 
oinea which prarcnt or nliere the i)a~^ '^'- 
of oettaia diaeaiei which exhibit a '^''^^'^> 
•bancter. l^''>(xlie 



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n ANTIPEBIODIOS. 

BmianATioir. — The chief antiperiodiei uo: 
— Cinehom-bBrlc and ita ftUcaloida — Quinine, 
Ciiiehonine, Quintdins, and Cinehonidine : Be- 
beam-bark and ita active prioriple, Bebeerin; 
ti«liein.S;Uic7lic Add and ita aalta ; £ucal;ptiia 
globnlns; and Araenic. 

AcnoK.— The mode of action of antiperiodica 
is at present onknown. 

Uses. — Cinchona, and still more qninine, is 
almost a specific in the treatment of intermit- 
teni ferera, periodic head-nchas, nenralgias, and 
other affections caused by mAUria. Though 
leas certain in ita action than in intermittent 
fevers, quinine is also the beat remedy in the 
remittoit ferers of the tropica, in whieli, however, 
it moat be given in very large doses. The other 
^kaloids of cinchona have a similar action to 
that of quinine, but they are not so powerful. 
Bebeerin is only about one-third as powerful, 
and is by no moans so certain ; and the same 
lemark applies to the other remediea enumemted. 
In some caaea of ague and other intermittent 
Sections arsenic proves aaceesafol when qni- 
nine £ula. Emetics and purgatives are useful 
auxiliaries to quinine in the treatment of ague, 
and are employed alone for the cure of this 
disease in some parts of the world where quinine 
is not available. 

T. Laudbb Bbuktoii. 

AlTTIPHIiOOtBTIC (irrl, against, and 
t^fyoi, I burn). — A term for any method of 
treatment that is intended to counteract inflam- 
mation and ita accompanying constitutional 
diaturbance. 

AirTIFTBBTIOB (irri, againat, and 
nprrii, a fever). — Dxramon, — Uedicinea 
which reduce the temperature in fever. 

Ekumedatiov. — The principal agents nsed as 
antipyretics are — Cold Baths, Cold Applications, 
Ice; Biaphoretics ; Alcohol; Chloral; Quinine; 
Salicylic Acid and its salts ; Eucalyptol ; Essen- 
tial Oils; Aconite; Digitalis; Veratria; Pur- 
gatives ; and Venesection. 

Acririx. — The temperature of the body may 
be reduced, either by increasing the abstisction 
of heat, or by lessening its production. The 
direct application of cold, by means of baths, 
afibsion, or sponging, or by enveloping the body 
in sheets wrung out of cold water, is the most 
powerful and rapid means of abstracting hrat. 
But the loss of heat which constantly occurs, 
even in health, by evapomtion of the sweat, and 
the radiation and conduction of heat from the 
skin, may be increased by the use of diapho- 
retics, such as salts of potaah, preparations of 
antimony, or ocptate of ammonia ; or by such 
medicines as dilate the cutaneous vessels, so as 
to allow the heated blood to circulate freely 
tbrongh them, and to become cooled by i be ex- 
ternal media surrounding the skin. Alcohol, in 
the form either of wine or spirits, and chloral, 
have an nct'on of this sort, though alcohol also 
inilnences the production of heat. Alcohol, 
qninine, salicylic acid and its salts, euealyptol, 
and essential oils lessen the production of heat 
within the body, probably by diminishing oxida- 
tion of the tissnes. (See Alcokol.) Aconite, 
d%italis, and rentria raduc* the temp«t»t)ixa> 



AMnSEFTICS. 

but their mode at action is not pneiael/ i 
tained. 

Usas. — Antipyretics act much more powerfully 
in reducing the temperature of the Ixxly in fever 
than they do in health. They may be nsed 
when the temperature has risen either from ex- 
posure to a high external temperature, as is 
thermal fever; in consequence of inflammation, 
as in pneumonia, or pericarditis ; or in specifie 
fsvera, as acute rheumatiam, typhus, and scarU- 
tina. The most r^id and powerful antipyretie 
remedies are cold baths; next probably corns 
largo doees of aalieylie odd and qninine. The 
latter seems to act very etBeiently in tlMrmie 
fever when iqject«d subcutsnoously. 

T. LiimiB BEUirroK. 

AKTISBFTIOS.— Antiputrasoenta (iM, 
against, and ini*Tut&t, putrefying). 

DxFiirmoir. — An antiseptic is a substance 
which prevents or retards jiutcefaetion, that 
is, the decomposition of animal or vosetable 
bodies accompanied by the evolution of oSenaiva 
gases. The putnfactive change occurs only in 
dead matter, and requires the preaenoe of water, 
heat, and a ferment. That there is no putreiiM- 
tion in the abeence of water is obvious, for bodies, 
such OS albumin and blood, which in the moist 
state are highly susceptible of putrefiietion, may 
be kept for an indeflnite time without change 
if they be perfectly dry. Heat also has on im- 
portant influence on pntre&etion. At very low 
temperatures the pntrefiM^ve change ceases, 
while elevated temperatures, such as prevail in 
tropical climates, are favourable to iL An addi- 
tional element besides heat and moisture is, how- 
ever, required, and the opinion generally aocepted 
at present is, that this consists of minute vital 
organisms, which in some way excite putiefao- 
tive decomposition. 

Modi of Actiox. — The substances nsed as 
antiseptics set either directly on the bodies in 
which putrefaction is occurring or might ooonr, 
forming with them eombinotions that are not 
anaoeptible of the decomposing action ot a fer- 
ment ; or they act indirectly, by destrcying the 
vitality or otherwise preventing the develop- 
ment and propagation of the organisms of which 
the ferment is composed. In this respect an<t- 
teptia are distinguished from dutnfeeUaUt, tho 
action of the latter being directed only towiudo 
the exciting causes and oSenaive or deleteriona 
products of a class of changes which are them- 
selves more comprehensive than those implied by 
the term pntivfaction. 

'BixmuMknait. — Them are nnmeroos chemical 
agents posarseing antiseptic propertiee, the chief 
of theae including Chlorine, Sulphnrooa Add, 
Nitric Oxide, and Peroxide of Nitngen, aa gaasa ; 
Carbolic Add, Crensote, Benzol, Sulphites ood 
Hyposulphites, and the Hypochlorites, which 
emit vapoum at common temperatures ; Chromic, 
Boric, Tannic, and Salicylic acid^ Permanganato 
of Potash, 8uIphocarboIat«o, Chlorate of Potash, 
Chloride of Zinc, and Charcoal, from which no 
Tapoor is emitted. 

Uasg. — 1. In therapeutic practice antiaaptica 
ore chiefly employed in the treatment of snrgical 
operations aadopen wonnda,to prevent the oei!ar> 
rBnssofputiefaetivedooompaitMiB.TlMa« aotiai^ 



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AnnsEFxica. 

lieBin Iwrt raited for this imrpose wUch, utiiig 
iSaaiitl^ am tha fermant, hare littls action, aad 
at iojiuiou efirct, oa the parts in which ths 
Inliiig praeess is going on. Gases, except ia 
nlitioo, esnaot be readily luod, as it vould be 
iseeauy to socloae the substance to be pn-served 
iiaa kir-tiglit TeaasI ooDtainiDg the gas. The 
mlatile mtiaspties vhich slowly emit a Tspoor 
ksTC been prefemd to those which emit do 
nponi; altiioqgh ajnong- the Litter salicjrlic and 
hne aoda, baiii^ dsrroid of any irritating pro- 
perties vheii sppbad to inflmned surfiices, iroald 
OB this aeooant present a marked adraotage. 

Cubolie acid has been used vith soccsss, a 

nliboD in ntar eontaining one part of the 

djitaUiaed acid in firom forty to one hnndred 

futi of water bmng appliod aa s lotion, and 

alio in the form of spray, diAtsed through ths 

atacKphere dnring a suigical operation or the 

dnaiag of a Toand. The carbolic add solutioD 

■ay aba be nsed on linfc or cotton-wool for 

eaiTKiiig the aSactcd part. Antiseptic gauze for 

a amlai farpne nay be xoade by adding one 

.fsrtet ojstaUiad cubolie acid to fire ports of 

eeamnn leein and seraa parts of paraffin melted 

together, and applying tae compound to ooarsa 

■nalin, n as to form a thin ooating of the 

plaster onr the gunafi which, when it has 

Baideoed, is sied for eoTering the parts to 

be pnite<ted. Profeasor Lister has also r»- 

riMBisiidid a bone acid dressing for rodent 

slsBi, wludi is ecmpoaed of boric acid and 

«Ula was, each one part, paraffin and almond 

oil sack two parts. The boric acid and oil 

aa added to the maUed wax and paraffin, and 

ths whsls stined in a mortar nntil it thickens, 

thoB set Slide to cool nod harden, after which it 

is ta be nibbed in the murtar until it acquires 

thsmasisranca ti an ointment. This is thinly 

^Rsd CD fine ag and applied to the wound. 

Tbt ol aepantoa. and ia abcorbed by lint or rag 

placed OTcr the dicaain^ while a firm plaster 

rfsins sttadied to ths skio, which is essily 

tiBorad whaa seeessary. Sslicylic acid may be 

sobatitBted ia this dieasiDg for the boric acid. 

In some fans jalicylic acid is applied alone, by 

mtatj «p'»m"e it in fine powder over the part 

~ d. Its Tczy slight solubility in water 

ts an obstacle to its nse in aolution, nn> 

thing be sdded to render it more sola- 

Us; aad btKUC. which is itself a good antiseptic, 

magr be nacd for that pnrpose. One disebm of 

sahgrlie acid, two drachms of borax, and lialf an 

•■aaa at glraerine, with three ounces of water, 

ioKm, it aiitd. with a little beat, a clear solution 

which may be nsed as an antiseptic lotion. 

X. Ia aMnHfal ncaetice antisepticssre also am- 
phjyod. ather aa kwal applications or as intemsl 
naeiiliia Thoas which are chiefly arailsble 
iaflila cmaota, carbolic acid, the solphocorbo- 
kles, salphaiDBS acid, the solphitss or bypo- 
' 'tsa, dikrina water, permanganate of 
I, bocaz or boric acid, cUotate of potash, 
al, salicylic acid, and thymol. They are 
(daopally ased iior tlia prerantiott and trsat- 
■ant of ingnrtinas ferara; and ia low ttawa of 
■Iwrotiim of the throat. 
%. Ia asiag antiaqiiics for the pieoerration at 
ieal spaeinwns, a wider range of chamical 
■ay ba tsiun, and a saLeetiga nude of 



ANTISEFTIO TBEATMENT. «» 

snbstanoei that would be inapplicable in th* 
treatment of the liTingsabject. Arsenions acM^* 
eoInlsiTesal>liauat^ orcblotideof sincin aolutioD 
are of ssrrica for this purpose, and chromic aeidv 
BTen when diluted with from fire hundred U> 
one thousand parts of water, poaseasea the pco- 
perty of pr<«erwing animal matter from d«»n>- 
position, as alao does a solution of one part ot 
borax in iorty patrU of water. 

Besides the nanre powerful antiaeptica noticed, 
others of a milder nature, such as common salt, 
nitre and TOKar. are used for piee^rring article* 
of food ; while alcohol and glycerine are employed, 
for the preeorration of animal and veiretabb eab- 
staoeee as specimens. x. BMoyiooo. 

AKTIBEPTIO THBATMIirrr i« Iroali- 
ment directed Mgninst putie&ction or rather, as 
now generally understood, against tba develop- 
ment of fennentatire orgnnijiis, 

1. Iw SuBOiBT, the employment of the anla- 
septic method is based upon the theory whieb attri- 
butes putrefaction and iUconeeqnencea t" minute 
ornnisms (bacteria, &c.) dsrii^ from without. 

The treatment yields the most satisfactory 5^ 
sulU when It is ao employed a. to prevent, r»tb^ 
than to attempt to correct pntref J^tion. ^°J^ 
tam Uiese results the snige,£„a«th,„ "O^'^* • 
|kin to oper«te upon, or the wound »>»**; ^d. 
been so recently inflicted that there baa »°* V*«» 
time or opportanity for the aeptic or«-^^b\«=*>- 
to get beyond the reach of the aSliUp«»*" » V^- 
he employs. Hence there must alwav* *'* tU*™^- 
cenuge of failures in the treatoAtof c^^^^*^ 
fractures and large lacerated and contue>eAJ*^i«* 
owing to the amount of septic air and d^.^tim,*. 
into the recesses of the rounds l>«twee*» t.Tw«*tZ 
of tbemjuiyand the commencoxnont. of '"^^nK i,* 
ment. In the event of putrefact^i*^ ^c**^ cc^i.^ 
such a case, antiseptic *es«int™ «K^^<1 ^^ ^^ 
tinned but the question of ope™t.rv« interfefeJlO^ 
must be determined according tc» she ordinary- 
principles of surgery. Putrid ^lc«.,^ancl 0upei^ 
flcal wonnds mv certainly l>o renS-red Mept/« 
by guitable means, and ao t>it»V.=,t.-i .*1 '** 

laid open during exds^a^r^il?' "J*:^ «•"''«• 
theattimpt to correct p^a^Uo^i'^!!!''"? '" ''"t 
such as those connected with eariea X^P*""«e^ 
U hopelew, though by appropriate^^ '^"rtebrn, 
pntnd emanations may be rendered i *■•*«• thm 
to the patient and those about him *** Hoxion- 

The antiseptics which have been * 
snitable are carbolic acid, "boric Z.O''^^ nogt 
of sine, and salicylic acid. ^'«. chJn J7^ 

Carbolic acid U the antiaoTjUc «,. ^"*"«J» 
u«>ful. A solution of one pm ^^' S^noft.,, 
water » emploved to pnrify t£e .lun l^ootjT^T 
to be operated upon, the anon^^" °' «>e 'JL*'* 
tec A»lutionVfonspa?^'^"i.'n«r^^^ 
for washing sponges during. .,, „ v ia „ *•» 
the hands of the snigeoo and «2^'"«''Ott i^ 
for the changing of dressings. Tfc *'*''*• * ' 
carbolic acid render* it invaiuable /"^t'lit?*'^ 
hollow wounds and abscesaes. Tf • '''ie^ 
constituent of the ordinary dreaei '* ''* *«t ** 
gsoze, which is applied in eiirht 'i*"~*"ti»a^* 
proportioned to the expected^oL^?:'*. o^?^ 
diatge, a piece of leliabCthia Si'^ ^ di? 
(hat lining) being interpoaed beD^Ji"!?*^ cloij 
Uyer of gauze; thia serves to pi«v^t tS **'H^ 



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AlinSEFTIO TREATMENT. 



thaiga from sonVing directly thronsli tht eentnl 
part of Uie drcHing, thoreby VMning out th« 
(tored np acid, and allowing the direct Boeem of 
pntrefaetiTe organiima to the a,ritj: Sisaetrons 
eonaeqnencei ^ra followed firam a defect in the 
mackictosh. A amall portion of gaoze wrong 
oat of the one-to-forty carbolic add lolmtion '■ 
applied over the wound before the ordinary 
nght-fold dressing, ao aa to prerent poasible 
inieehief from putnfiwtira oiganiims aecident- 
iJly adherent to the iiuer layer of the gauie, 
which might not otherwiae be destroyed, owing 
to the alight T<datility, at the ordinaiy tempera- 
tme of the atmosphere, of the add stored in the 
gauze. The gauze is ^so useful, on aoeonnt of 
its antiseptic properties, u a bandage in retrac- 
tion of the soft parts in stumps, and in any ease 
in which free discharge is expected. 

In addition to other meosnroa, there must be an 
antiseptic atmosphere provided, so that the air 
which gains access to the wound or abscess nuy 
be innocuous. Tliis is secured by means of a 
R)ny of one-to-forty carbolic add solution, for 
the production of which Lister's portable steam 
apparatus may be used. When the spray is 
suspended during an operation or the changing 
of a dressing, the wound is covered with a piece 
of sound calico moistened with the same solution. 
Of course superficial sores and woands ret^oire 
neither spray nor guard. 

Cicatrisation is promoted by interposing 
between the healing parts and the antiseptic 
agent an imperrions, unirritating protectire 
layer, composed of thin oil-silk Tarnished with 
«opal and then coated with a layer of dextrine, 
which allows the oil-silk to be uniformly wetted 
by the antiseptic solution into which it is dipped 
at the moment of application. The antiseptic 
dressing proper must extend a considerable dis- 
tance beyond the protective layer, so as to prerent 
the access of putrefactive organisms beneath it. 

Lint soaked in a one-to-ten solution of car- 
bolic acid in olivs oil is used aa a dressing for 
abacesses near the anus, and occasionally as a 
stoiBng for caTities. A one-to-twenty oily solu- 
tion is smeared npon orethral instrunents to pre- 
vent putridity of urine and its consequent evils.' 
Bm^ Mid is a powerful antiseptic, but its 
non-volatility prevents its being used for the 
dressing of hollow wounds and in the form of 
spray. It is bland and unirritating as compared 
with carbolic acid, and is therefore particularly 
serviceable as a dressing for superficial wounds 
and sores. It is employed in the form of a satu- 
rated watery solution; as an ointment, in the 
proportion of one to six ; and as boric lint, which 
contains about half its weight of the add. 

Chloride of rime has the remarkable property 
of producing such an effect upon the tissoes of a 
recent wound, that when applied once as a watery 
•olotion of about forty gnuns to the ounce, the 
cat surface, though not presenting any visible 
slough, is rendered incapabls of putrefaction for 
two or three days, even when ej^Kxed to the 

■ Cfitltli, thai oompUoted with ]nitTldlt7 ot the nrine, 
due to UfccUon by catheten, 111117 often be beoem.^ bT 
wuMng out Um talwldv with sclntloa er boSrM. 
This oonpUcation of conn* never •riMswhni til!, r *>nl 
BMBtshave been oarbollMd ftoai the aeauogn^'llft'T^ 



influence of septic material. The patient is thus 
tided over the dangerons period preceding stip- 
puration, dnrii^; which the divided tissues are 
moat prone to inflammation and the absorption 
of septic products. Hence this agent, thongh 
not aidapt«d for geneiml use, is of the highest 
value when it is impossible to exdude septic 
organisms in the after-treatment, as, U» ex- 
ample, after the removal of tumonra of the jaws, 
in operations about the anus, and in ampu- 
tations or exdnons in parts affected with pntrid 
sinuses, which should first be scraped out with 
the sharp spoon. 

Sometimes a peculiar, disagreeable odour is 
observed on removing an antiseptic ganxe dress- 
ing which has been applied for several days, 
esperially to regions which hare naturally a 
powerful odour, as the axilla or groin ; and oeea- 
sionally ths odorous material is so irritating M 
to produce actual eczema around the wound. 
This seems to depend upon a reaction between 
the discharge or excretion and some ingredient «f 
the poie. SaUet/lie odd has the power of pre- 
ventmg this leactKm, or, at any rate, of obviating 
nr remedying its bad effoets, if a little of tlu add 
is smeared upon the protective or upon the inner 
layerof gauze. Salicylic add has been introduced 
as an independent uesnng by Prof. Thiersch, 
but has been found by Prof. Lister to be inferior 
to carbolic acid for the destruction of bacteria, 
though very efficient in preventing fermentations. 
Chloral, thymol, and Eaealyptol are need as anti- 
septics. Hr. Lister recommends gauze containing 
oil of Eucalyptus when symptoms of poisoning 
follow the use of the ordinary gauze dressing. 

Prepared antiseptic catgut is employed for 
arresting arterial hamorrhage. 

Chassaignae's drainage-tubing is introduced to 
prevent tension after the opening of an abscess, 
or after the application of antiseptics to the raw 
surface of a hollow wound. 

Carbolised silk sutures are used, aa they are 
not liable to catch in the dresnngs. 

2. Ik MsDicnni, antiseptic treatment is based 
on the hypothesis that infectious and contagions 
diseases are caused by the presence and mnltipli- 
cation in the hnman organism of minute para- 
sites, termed microsymes, microphytes, miero- 
coed, Ace. On this assumption, spedal remedies 
are administered for the purpose of destroying 
these minute organisms, or of rendering the 
blood and other tissues incapable of sustaining 
them. The treatment Auther aims at preventing 
the spread of these diseases by the prophylactic 
administration of antiseptic remedies to persons 
who are compelled to ramain in infected places. 

At present a definite relation would seem to 
hare been made out between spedfio mierophytea 
and eow-pos, sheap-poz, splenic ferer, and re- 
lapsing fever re a pe rt iv a ly ; whilst a similar eon- 
nection has been so for supported by observationa 
in the case of measles, scarlatina, diphtheria, 
enteric fever, and erysipelas ; but much remaina 
to be done before the true relation between 
microphytes and infections diseases can be esta- 
blished. Sedng that antiseptic therapentica 
depends on an unestablished ctiolocy, it cannot 
ba expected to be in a very advanced condition ; 
accordingly there is at present but little that <• 
sitdedor satiafoctoijtobaaaid. Thai 



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ae Amrs, diseases of. 

Js to deetioy or remor« tha grovth by eanstici 
or ezeisioD. 

3. Irritable BpUnotar Ani. — In this eom- 
plaint the nnus is stroogly coatnicted and drawn 
in bjr the action of the sphincter. Any attempt to 
examine the part producei ipum, and the finger 
pasted through it is tightly gmsped as if girt by 
A cord. In eases of old standing the mnssle bfr- 
'samet hypertrophied, and forms a mass encircling 
the finger like a thick unyielding ring. This 
state is the source of serious trouble in defecation, 
owing to the expulriva power of tha bowel 
being insufficient to OTe?come the impediment 
caused by the muscle to the passage of the fteces. 
Irritability of the sphincter occurs generally 
{n hysterical females, and is reliered b^ mild 
laxatives, the local application of an opiata or 
belladonna ointment, and the occasional passage 
of a bougie coated with a Sf^latire ointmart. 

4. Irritabla xnoar. — This is a small super- 
ficial tore, situated just within the circle of tha 
sphincter, usually at the back part, comntonly 
known tafiasun, from its appearance in the con- 
tracted state of the part. The feces passing orer 
the sore excite spasm of the musde, and cause a 
sharp homing pain which lasts for two or three 
hoars. The distress often does not come on till 
•n interval of ten minutes or more has alapaad 
after defecation. The pain is sometimes so 
acute that patients resist an action of the bowels, 
and allow them to become eoslire. The irri- 
table ulcer occurs urually in middle life, and 
is more firequent in women than in men. It sel- 
dom gets well under the infinence of local appli- 
cations, but an incision through the centre of the 
•ore sets the muscle at rest, and allows the part 
to heaL Ths French surgeons use forcible dila- 
tation, so as to rupture the sphincter— a rough 
made of treatment not to be commended. 'When 
tha suffering is moderate, a coia may be at- 
tempted by giving a laxative to ensura soft 
evacuations ; by enjoining rest in the recumbent 
position ; and by the application of merenrial oint- 
ment with morphia, belladonna, or chloroform. 

6. Frolapsiis. Set RBcnrK, Diseases of. 

6, Fnirico. — Itching, though a common symp- 
tom in disorders of the lower bowel, may occur 
M a distinct affection, a neurosis liable to parox- 
ynna. It is caused by worms in tha rectum, and by 
eongestion of the hmnarrhoidal veins. Patients 
suffer more after taking stimulating drinks and 
when heated in bad. The itching is extremely 
teasing and annoying, especially at night, keep- 
ing the sufferer awake for hours. Friction sg- 
gravates the mischief, excoriates the skin at tha 
margin of the anus, and causes it to become dry, 
harw, and leathery. Am regards treatment, 
stimulants and condimanta ars to be avoided. 
Tha bowels should be regulated, and the part 
riiould be washed with sosp and water after 
each evacuation. Ercry effort shcald be made 
to avoid friction. A piece of cotton wool 
waked in oxide of zinc lotion should be kept 
•ppliad to the anus, or tha part may be 
cmaared with some merenrial ointment, such as 
tha dilate citrine^ or one containing the grey 
coida of mercury. Lotions of carbonate of bis- 
muth and glycerine, of borax and morphia, or of 
carbolic acid, are often efficacious. In ^reak 
psMOif f uinine oai we nic ksip the cbn, 



AORTA. DISEASES OF. 

7. Tomonrs and Bzareaomioes. — Beeidss 
the flape and folds of integument consequent oa 
external piles, tumours of a fibroti* textnrsaome< 
times form in tha sub-eutaneons areolar tissas, 
which as they increase baooma pedoneolated. 
They are usually small in sise, lobnlatad, and 
have a firm feel. These growths may be easily 
and safely removed by excision. Warta sra 
liable to be developed around tha anus, and 
sometimes grow so abundantly as to constitute a 
large canliflower-lookiog exereacenee. They than 
form projecting processes of various sizes, densely 
gron}Md together, with their summits isolated, 
expanded, and elevated on narrow pedundei. 
They give rise to a thin offensive discharge. 
They originate in want of eleanlinesa. In some 
persons there is so strong a disposition to the 
formation of warts that it is difficult to prevent 
their growth. If few in number and small in 
size, they may be destroyed with strong esehar- 
otics. They usually require, however, to be 
removed by excision, the quickest and moat 
effectual node of treatment Astringent lotions 
miut afterwards be used to prevent the reprodne- 
tion of the waits. Flatteiwd growths iiam the 
skin, commonly called muootu iuberolm, a secon- 
dary result of syphilis, are liable to occur around 
the anus. They yield readily to the local appli- 
cation of meteuy and specific general treatment. 
T. B. CuBuxo. 

AZrXIXTAS.— Anxiety or distress, whether 
subjectively felt, or expressed in the features, 
attitude, or general behaviour. The term is 
also specially associated with a peculiar sensa- 
tion experienced in the region of the heart Sm 
Fbjecoiudial Amxbtt. 

AOBTA, Diseaaea o£— The diseases to which 
the aorta is liable may be thus considered : — 
I. Aortitis, Acute and Chronic; 2. Atheroma; 
8. Primary Fatty Degeneration; 4. Primary 
Calcification ; S. Coarctation ; 6. Smple Dila- 
tation ; and 7. Aneurism. 

1. Aortitis. — Acvtt aertitii is exceedingly 
rare. It may result from the direct irritation of 
an atheromatous aorta by a thrombus or an 
embolus, in persons of gouty diathesis ; but 
has never been observed as an extension of acnte 
endocarditis. The morbid ehanget consist in 
hypemnia, with thickening and softening of the 
coats of the vessel, and deposit of fibrin upon 
its internal surface. The ascending portion of 
the arch is ths part most frequently affected. 
The lymptomi are acute mibsternal pnin with 
oppression, palpitation, quick and feeble pulse, 
and elevated temperature. With these symptoms 
may be associated a harsh systolic murmnr, 
originating at the seat of inflammation, and 
transmitted to a distant point of the aorta. 

Sub-acute and Chronic Aortiti». — These Br« 
the usual forms of inflammation of the aorta. The 
disease may be general, arising from a blood- 
dyscrasia such as gout, from pytemia, or frtm 
the various septic agents; tmt it is nsnally 
limited to a definite portion of the vascular aia^ 
fiice, being the result of local irritation. 

jGnoLoor. — Excessive and continued strain of 
the vascular walls is, according to its degree, th« 
most frequent cause of inb-acuta and chronic aor- 
titii. HJmee, the portipn of the arterial syrtom 



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■oM dinetly iSaeteA 'by the iropnlm of the left 

viBtride, Dunelj, theajrch of the aorte, is that in 

ibich isflamnatoiy iiritation is first, and often 

actasrclT, exhibited. labour of »ny kind jr»- 

^■mng great and Tepeated. miiaciilflr effort whilst 

die breath is held, mtist neeesaarilj subject the 

Kste to cxtmne tension, partly tbroogb the ob- 

■tnetion arising Crom the preaanre of the eon- 

tiaeiad mnieleB upon the anbjaeent ■rteries, and 

putlf inm the bnek-prcaaim of the distended 

Tnia Hence, sledgera, rammers, ship-porters, 

tt, ue those vho moat frequently snffer from 

the eSeets of aortitis. As s necessary result of 

■Kk effbtti the left rentricle soon becomes hj- 

jertit^ed. and the evils arisiDg- from vascular 

Kosioa are there'iiy pzoportionately increased. 

faOiaaen, the free nae of alcoholic stimtilants, 

m wbidi tnch labonrcra habitually indulge, con- 

tiiivtcs to the same resnlt by imparting irritant 

snpotiei to the blood. The British soldier has 

Dcea (sptdaUyUable to the erils aboTS sketched, 

miiLg to a tidoBS ^stem of forced drill with a 

bceaSnng'^tTaaty diminished by faulty con- 

ftnedoB tflua dnas and accoutrements.' 

Axaicoocai. CKiSACTKaa. — Sub-acnte aortitis 
oceua in disaeminated patdies, and inrolres all 
die costs of the Tcssel. These are inffltrated with 
exndatiaD-cells at an early period ; become soft and 
tnmid, aSBuming a bluish-white tint; and, owinf 
to loss of normal elasticity, project outwards, 
thai caasnguDsrenness or pittiiig of the internal 
sarfaee. 'Ui the aorta the inflammation ie 
asoally ^nimaiy; hut exceptionally it may be 
pndaeed by the mechanical irritation of an 
eobolns deriTcd from an inflamed focus. In- 
flsBmiaUary soflenin;; is a fret^ent cause of 
aacmism at all poiods of life ; and in the young 
it is the ordinary precursor of that disease. 

In ehiciuc aortitis, which is the most common 
form cf the dSsesae, the internal coat is alone in- 
Tolred. The outer portion of the intima exhibits 
the rcnit of irritation in the abundant production 
at new cplls. These cells occupy the Aisiform 
qaees between its lamellae, and, gradually distend- 
ing them, ultimately project the internal and nn- 
aftctad pottioo of the tunic into the lumen of 
the TcsaeL The prominence so caused is com- 
patatirdy solid, presents a &int bluish tiut, and 
coastitates the condition described as ' fibroid or 
seai-eaitilagiiioas thickening.' The inflamma- 
toy prodoet is prone to undogo fatty de- 
gennation, and the consacutiTe change called 
atheroma. 

3, JLthoroma. — ^This morbid condition is most 
coBBiBan in the first portion of the aorta. 

AiramincAi, Cbajuctxbs. — Atheroma eom- 
B iK ei with inilammatary oreigrowtfa by multi- 
iJifstimi of the cells of the outer portion of the 
isdaia, as described in a preceding paragraph. 
The Bct^Uata, tram their sitoation, readily nn- 
decgo iiitty ehan^ and caseation ; the septa of 
saaltered tissne interrening between them soon 
bee their Titality and are absorbed ; and the 
Cksss thu spreads; whilst it adTaneea throa|;h 
the same snoqr towards the internal sor&ce 
*t the TesseL Examined miercseopically, athe. 

■ Atm^Oitaiamtnbaea nd *xed peritlon In which 
ttewsBsef tte chat »• iilMsed vben tba ihooUen ire 
tamd kackmok, with tbs tIcw <i< pndndng the i^ 
pmtmict el aa «qaasd«l chestr-KD. 



lomatous matl^nr is fbnnd to eoosist t# 4WA 
granules, crystals of cholesterine, and fiiim^^ 
dibris. At an eairlj stage collections of tSfl 
matter may undcogo liquefaction, and. oraiL^^Z. 
into the ressel, cowered only by a thin Ik <p 

the unaltered intinm, constitute a ao-caIU>l ^^ ** 
matoM ttbtettt. Should this estabUA » ^"^ 
mnnication with the artery, an atkj,JZ^^^~ 
j^iUbethe ~.ult..na.«.n.ecu«j^2:;^ 

.■\llJ!^lZ^-rJ^^-^T^ ^ °' athoromatoi,. 
liquid conatituexat-, m.y..«d. tC^Ar. W fe 



sharp edges, 
aneurism may 



From 



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K, -m.h th»^Z^^'J" interslJtial thr«mbosi- 
by which the wesset nay be entirely blocked and 
gangrene of t^he •JJtremitie, p^„^ ""^"J^^ 
jequetice of the fbrejoing diang^Tthe re-i 
o«» tt. da.t,c,ty an3 become, j^ated; its in- 
ternrijurface 1. mottled with yellow or ^y^ 
coloured patches, of Tarfou. „V u;ng •!« 
ronA, spiculatod. and fissured- and thus th- 
wna.tjond«wibod by Vlr^how under the i»eS* 
of Sndarttritu Chronica ZVo^ffians is LwbW**"^- 
Theuric^d aiad ««.lic-lacid dtaJh^ «»'°^ 
these changes, not o«>Iyby,timnlat?Bft*etn»^^ 
arteries 1» contract, and «, raising thr^<^'f«^ 
sure .n the Urger Tessds, hot Tlk«^,e ^^^.w*. 
nishing material for cretifleation. ^b* •*S^*- 



- . . eretifleation. 

of constitutional srphilig »„ w^yy 

ateatomatons' (ntheroraatoua) 
intima. 



e tio' 



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ths 



ek«,x,ge« 

S. Primary rattjr l>e«enera*»-^_. ^WrCo^^ 

has described, under the name of /-^TT^ ero^f^'jt 
torn of fatty degeneration of t\^^^W» of tl^« 
internal coat, unpreceded by inftn.nr«.«,»tion, com- 
mencing on the free ■nrfsee, an<i ~^«dt»»Hy •*- 
tending ontw^rda. The internal m^Sice of th« 
ressel is marbled with minnte yellt>-ww dots, whiclx 
are groups of fatty cells; these andergo liqtl*- 
^'°''j, 11 ''""■'.^B^tion of the i„te5ial ciat 
foUowed by aneurism, 19 the tisna,l w^wT 

4. Primary Oaldfloatlon.—Ex^^' ' 11, : 
the distant portion, of the aort^^^^ """^•."» 
fibre-cell. o/the middle coat are lisTw, ^"T-^^ 
cation, as aremote result of endartm-jti ^''i''*- 
tothetransrerseairangementof the etd^n^^"^ 
fissurinc of the middle ooa.t under th *eU«, 

of the blood-corrent, and dissactinir nn ?**■*"*"« 
ordinary reanlts of this change. p*""""! »r» 
entire middle coat, and ewen all thrn"*"^' '*"• 
the artery, may be infiltrmted with r ****" °f 
as a primaT7 change. Xhia is most l**.""*'** 
due to precipitation of these salt. «Jf°°*l>Jy 
congested rasa vaaorum, in consequent ** «*• 

eaispe of their ordinary solvent, oarboBi **' W** 

8. Ooorotatlon or Btenosta Thi ""^d. 

may be either congenital or txcg^i,^ * '^'XlitioB 

Omgatiial stenosis of th e aorta im 
quently located at the point of innctio***** ***- 
duetta artmomt, and is of w<>ry iimitoS'* **' lia 
in many cases presentingr the aDnaanT '^'•■t; 
linear constriction, or of a PcribrateddiJlfif ** • 
In a few examples, the reseel, at th ""S**- 

contrnction, has been entirely closed ' ?*' *'' 
Terted into a ligamentous cord. On the *'*"'' 
dde of the constriction the aorta is dilatS'*^ 



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AOBTA. VISBASES OF. 



flftaa thickened and atharomatoai, vMUt on Um 
diatal «ide it ii ndneed in calibi* u far u the 
junction of the colUtenl renals. Congenital 
■tenon* of the aorta ii compatible vith life of 
modeiata duration. In tventy-fonr oat of thirtj- 
MSht eaaet analyted by Dr. Peacock the age at- 
tained varied fixnn tventy'«ne to flity yean. The 
diagnocii of the condition reite mainly on dispto- 
portionat* puliation of the arterial arising from 
the aorta on the cardiac, aH contrasted with thoae on 
the peripheral lida of the obetruction; and on the 
enlazftement of the etdlateral reeaeli, namely, the 
(lansrene cerrieal, internal mammary, and in- 
tereottala. The ordinary conaeqaencee are ex- 
hibited in dilated hypertrophy of the left rentricle, 
and inadeqnaey of the aortic valTea. Death naaally 
> ocean from progieeeiTa debility and failure ol 
the left rentricle; firom pulmonaiy eonpstion; 
or from dinecting aneuriam of the ascending por- 
tion of the arch. Congenital stenosis of the 
entire arch may result from imperfection of the 
inter-Tentricular septnm or patency of the fora- 
men OTals allowing the blood to take an ex- 
eeptional course. 

In the ac^ired form, stenosis of the aoita at 
any portion of its course may result from in- 
flammatory thickening or calcareous change of 
the coats OC the Teasel, followed by thrombosis ; or 
it may follow the natural curs of an aneurism. The 
aofta may be much reduced in calibre without 
being disproportionately narrowed. Such will 
be its condition in connection with mitral in- 
adequacy in early childhood, should the patient 
•vnTO a few years. In such cases the left 
Tentride will hare become dilated and byper- 
trophied, and a marked disproportion will be 
obserred between the force of cardiac and that 
of radial pulsation. This circumstance, taken in 
eoigunction with the age of the patient, the 
ezistenee of disease at the mitral orifice^ and 
hypertrophy of the left ventricle, would warrant 
the poaitire diagnosis of narrowing of the 
atota. 

6. Btmpla Dilatation of the aocta consists in 
a uniform enlargement of the Tessel or of a por- 
tion of it, from impairment or loss of its normal 
•lastieity ; and de^nds primarily upon arterial 
obetmction or resistance beyond its seat, and 
directly upon eonaecutire hypertrophy of the 
left Tantriele. The eontiaoea tension, to which 
the walls of the aorta are subjected between 
these two opposing forces, necessarily leads to 
progreasire impairment of nutrition and loss of 
slaMicity in its middle coat. The immediate 
oonseqoence of this change is exhibited in far- 
ther hypertrophy of the left Tentride; and its 
remote effects in still farther impairment of 
nutrition and dstericxation of tissue in the vas- 
cular tunics, throngh the increased tension to 
which they are now exposed. No elementary 
change of stmctuie is, howsrer, diseorerable. 
Simple dilatation of the aorta commences in the 
ascending inrtion of the arch, and to this it is 
nsnaUy Umited; but it occasionally extends into 
the tmurreiM portion. The other portions of 
tlie Teasel are ncTn dilated, except in association 
with atheromatona change. The condition under 
notice is manifestly in close relationship with 
iikflammatory irritation of the ressel. It has, 
howisrar, a distinct pathol<«gical ezistaac*^ •»•* 



logons to that at tfaeaarly stag* of Tsdenlar em. 
phyaema of the lung. 

No morbid results, with a single exception, are 
directly traceable to simple dilatation of the aorta. 
Bat, should the dilatation extsnd into the ttani- 
Tsrse portion of the arch, and engage especially 
its superior wall, the primaiy branches may 
become tortuous, and exhibit abnormal pulsation 
in the neck, simulating aneurism. In a note- 
worthy example obserred by the writer the 
existence of this pulsation on both sides of 
the neck, and the facility with which it was 
arrested by forcibly extending the neck and 
shoulden, and so unbending the Teasels, sufficed 
to establish the diagnoais. Tortuosity aC ths 
cervical arteries, dependsnt upon a local dilata- 
tion of the aorta, may be confined to one side of 
the neck. 

Simple dilatation of the aorta most frequently 
occurs in connection with the contracted or gran- 
nlar form of chronic renal disease. -It may, 
however, likewise arise from simple ftmctioul 
hypertrophy of the left Tentride dependent 
upon habitual Tascular sxritement ; or uom di- 
lated hy^rtrophy consecutive to inadequacy of 
the aortic valves. 

7. Aneurism. — JEnou>ar jmm Fatbot.oot. — 
Aneurism of the aorta is easenl iaily a disease of the 
middle period of life. Of ninety-two cases ob- 
served or analysed by the writer, sixty occnrred 
between ths ages of thirty and fifty years ; twelve 
over fifty ; and five under thirty years. Thus, 
whilst deterioration of the arterial coats as 
typified in atheroma is most common after the 
ago of sixty, one of its ordinary consequsnces, 
aneurism, belongs to an earlier period of life. 
Ths apparent discrepan^ may be explained by 
the more frequent employment of men under 
fifty in seven labour, and their greater capacity 
for extreme muscular effort then than later in 
life, the condition of the arterial wall wbioh fit- 
voun aneuriam having been already established. 
Aortic aneurism is mora common amongst males 
than females in the proportion of about 8 : 1 — a 
diffitnnce no doubt due to the more active and 
laborious habits of the male sex. Soldien, me- 
chanics, and porten suffer from it in larger 
proportion than thoae of other callings ; and in 
most instances the first symptoms of aneurism 
of the aorta may be traced to a great muscnlar 
effort involving Tascular stnin, or to a severe 
shock or blow, causing a direct contusion. 

Aneurism of the aorta is always consecutive 
to diseese of ita coats. Inflammatory softening, 
atheroma, and calcification an the usual ante- 
cedent conditions, and in exceptional instances 
primary fatty or calcific transfurmation of the 
internal and middle coats ; whilst a definite over- 
strain or a direct contusion of the vessel is fn- 
qnent^ the immediate cause of the disease. 

AxaTOMicu. Chabactebs. — Aortic aneurism 
may be presented under the following forma, 
Tiz^(a)inu; (b) faltt (circumtcribcd, aiA d{f- 
JuKd or conuoUivi); (e) duteling; and (<{) 
vttricoie. 

a. Tnu aaeurwn ot the aorta is ran; it 
may be either fusiform or saccular. It is ea- 
ssntially transitional, leading to the false variety 
of the disease ; and difTars from sirople dilatation 
of ths aorta only by its sharp limitation, and hy 



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AOBTA. DISEASES OF. 



tta taktaaee of iaflmnmutory pndneti in its 
walliL Tnie anemina never oonteiiu dots, bts 
Ij ineideiital thxoBiboaii ; md rsnly, as such^ 
MtuM dimeanooa eaimUe of prododog sztrinsie 
nBptoms or signs. It may, howerer, nnlika 
mmfia dilatatioii< ba the eaoae of TBlmlHr in- 
adeqaacy, and ao giTe tiae to a mTumnr of 
rAbx at the orifice oif the aorta. 

k Ftite antritm is either eircumairibed or 
iljyiiMrf. Ciramueriied /ttUe anturitm (or, aa 
it ia alio tannad, faUe ttneuriim) is the most 
U MU i mu iona of tbe disease in connection vith 
the aorta. It ia a ece ss tt rily confined to a portion 
of the eireamfenDoe of the vessel, the yidding 
of which TelieTCB the remainder from extra teo- 
■OBL Hence, it ia nsoally saccular in geneml 
onlliaa ; bat, oving to nneqnal resistance at dif- 
ftrant points of its anr&ce, it may, and commonly 
doaa, present one or more secondary prominences. 
The internal and middle coats are nsnally 
hnkan ; — the adrantitia sapplemanted by the 
>^^' *^**^'''C jt r m - tji riMi more or less condensed, 
foEBUBg tJbe sac 

Mantagiatioa of the inner coat, already in a 
■tat* aC axhauBBtoas change i^ mechanical 
atimia ec Tasealar tension, is ordinarily the im- 
madiata eaoae of Use anenriam. The irmption 
al aa ' KhcfOBstaaa abacau ' may also give rise 
to it ; so likavise may nlcerati(m of the intima 
&aB &tty erasian. Bnptnre of the oonts of 
tla Teaad by meehanioU strain is nsnally an- 
■oaaoad by definite symptoms of the utmost 
■|,iiilh si> II. Bamely, a &ding of something 
banag giica way within the chest or abdomen ; 
fidiowod by <untaeas ottat amuantiDg to syncope, 
dfsp'Ba.palpitBtiaa, and oocaaionally hsmopty- 
Bs. Thcae symptoms of shock nsnally subside 
witin a period of one to two hours, bat the 
patient ia theneaforward incapable of his ac- 
tuati— id eicitioa, being easily pat out of 
lifiath, and iVatiiastd by excitement or rapid 
Muiiimiiit, aapedaUy that of ascent; there is 
Hkewiae a fixed pain at some point of the chest, 
back, or atnioaiiii A fusiform false snearism 
■aj bramri 'inraginating ' by abruptly expand- 
iagaadenaheatiiingthe artery at its proximal 
m Uttal nda, or ia both these sitiiationB. 

Jjffmei fdbt a m e mrir m (or, as it is othefwiie 
aaUad, Hifmati aiieuritm,oTCo»ieeiUive aneurint) 
br eaeapa of blood from the artery, 
. ita diSaano to a greatrr or less extent 
> sanamdiiig stznetiires, aoeording to 
s eeaidition or anatomical anange- 
It may be the raanlt of maehaoical Tiolence 
I or ihoek to the artery in a prerionsly 
I ; or of porogressive aieiategra- 
laoaaf thaaaeof a dreomsBribed anenrism. In 
tha latter eaae the diiBision of the axtiaTaaatad 
aaoally limited by antecedent adhedve 
<tf the aaiRmnding parte, wharst 
oamaa portioa of the ardi of the 
aena, the poaitJwi at the aneoriea ia l^Teaiable 
ML A case of this dascription 
' nodar the writer's notice. Under 
difflised false aneorisra 
at the 'aoita caaoot oeeor within the pericar- 
j te ike iadation of that portion of 
i,aad the fingile itnietnre ef ita serous 
Haoce, a yleldinK of the sac proper 
<ioa is, ia moat inataaccs, IbUotred 




• heart In a a!I 
•^'nptureoftha. 



yT iiraptioa oqT 
tMsue, bet«»t9 
'••«>-colon OF tfc^ 
eoralope of tit* 
ffnnrabaek> 



by instant death from 
cardium and paralysis tr^T 
rsoorded cases, owing to p^ 
perieaidinm, the patients sai 
BBC in this sitoation for a^*^' 

Diffiised &lse anenriaaaa 
aorta is frequently fonaa> 
blood into the letro-perifco: 
the layers of the tmnsvezn 
mesentery, or into the flft>: 

psoas miucle. When the sa: _ _ -__ __ 

wards the sac is quickly erodod l'.7I('*>sareagainat 
the vertebra, the naked an <i ^arioua aurfaee of 
which theo forms ita posteri<»^ fconndory. Diflb- 
aion in snch cases rarely oe«ia ■ ^ auatil the TvctebrsB 
are entirely absorbed ; th« Ul^k^^u ""^y then eacap* 
into the stanal canal, canaixBflT _ Scleral paralysis 
and immediate death. I>ifR>iviox3 may also occur 
amongst the musdesaodareolsa^ t^'ssueof theloiaai, 
or behind the diaphragm into ^a teii ^rplearal earit^r, 
usually the left. Any portioa o^ die aorta ontsido 
the pericardinm may be the we a * of diSiised fala* 
aneurism, bat the tnasverse pcxrt^'on of the areb 
and the abdominal aorta airio t^he part* iiio«% 
frequently affected. 

CrasentdM fiiltt anenrisno, 4Sona!stingr in ^ 
primary bulging of all the eoatos of t.kie artary, tli^ 
internal and middle coats ha'visaf^ snbsfqmn'tly 
given way, eonstitntss the oyidigsary form axa 
which fiilse aneurism originaaC^^ = it thcafo'^ 
demands no fVirther notice hers. _ 

c. Diufoliitg atmiritm oonsiat^ s an n bro"^ 



a sobse?' 



itnenfc: 



--V^"^.^" 



i»/^V»lclm 



the internal and middle eoata, sai 

detachment of these fram the esc 4 _ 

the force of the blood-carrent, ^p '^ ■'■*****h« 

extent over the length and drciaaxa #«r«BC0 ^ \ 

ressel ; or in a splitting of the xiaac2«3 le coa^ ^^ ' 

same agency. This form of an^-tx^rasni is * 

kinds— that with a single aperture tij xroug^ ^^n^ 
the blood enters theabnormaleha.*aza^] iind**^^M>_ 
to the artery ; andtimtwhicheK^ii-^^^.^^ t*'" imci. 
ings, one by which the blood ran i> ■ n_j, f r****' »^ 
another through which it r6-eg»t> c jw a tbe -V**^*-— 
The fbrmer is the more usual vai-i^^^y. ^^^ ,^0«ee^^°§F 
aneurism; and it is ISkawias tla.^ :KxtJ^t» grtif^m 
because liable at any moment to t oa e Mx ^ in'^ c« f stttUy 
by raptore of the external coat. ^ 

Any portion of the aorta may t»^ ^j ^^ 

dissecting aneurism; the ascendi^^ .-_ "-^jo 
anh is most frequenUy affected, a.^^ I>«rt at u« 
order of fireqaency comes the abtJo:,— ^ ?»ext in tll« 
The primary lesion consists in ft tra.ai^^^**'*' *<'rtia. 
the internal and middle coats ; wh^i^ ■fc^L"^*.**"' **' 
to the heart, the outer or the antei-j^^^. _ ^ ** ia dct^ 
vessel is its nsnal site, and detaehm^,^ •i*' "^^ '*^0t» 
aics rarely extends beyond the asc«a^ j v>^^^* (■• 
of the arch, and seldom engages moi^ t.^^^ -'""t/oja 
ted area of its drrumference. In tbi^ '*^*tiittU 
too, aa aperture of re-entrance is TnL:ar^x^*^*>ott 
the disease usually terminating bjr r-Ktx»t^,^**^ed' 
external coat within the pericardruia, ^5*»of j^* 
the cootrary, the second curve of the n:^^?"'*, oo 
portion of the aorta beyond this poin^ la»i?'*''> 
of primary lesion, separation of the cosat:^ ja '*'*t 
fbund to extend along the Temaii)r|«^ "***% 
length of the veAel, and over the whole q^ ^L*^a 
part of its circumference, whilst the bloSrf** 
re-entered through aa opening in ©j,^ ^?\'''"* 



•ommon iliac arteriei. 
The establishment of a second a- 






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AORTA. DISEASES OF. 



aommnnication with tlie artery it an attempt at 
■natural cure;' and \rben this happens the 
{latiant may mmTa for tnany years. Amongst 
the eccentricities of dissecting aneurism may be 
mentioned detachment of the laminated dot from 
the -vails of the sac proper, and subsequent es- 
cape of blood by rupture of the latter ; and sepa- 
ration of the mucons from the muscular coat of 
the CMophagaa, with irruption of blood into the 
stomach. Dissecting and ordinary false aneu- 
rism may coexift, the former being usually a 
eossecntiTe lesion, and the immediate cansa of 
death. 

i. Varieote ot Jnaitomosing fouurum consists 
in a direct oommnnieation between an aneurism 
of the aorta and (a) one of the chambers of the 
heart ; (i) the pulmonary artery or one of its 
branches ; or (e) one of the Tena cam or innomi- 
nate reins. This form of the disease is necessarily 
consecutire, and nsnally late as to the period of 
i ts development. In the greet majority ofrecorded 
examples the primary aneurism was connected 
with the ascending portion of the arch, and in a 
large number it arose from one of the sinuses 
of Valsalra. The communication, with few ex- 
ceptions, is formed with one of the chambers of 
the heart, the pulmonary artery, or the descend- 
ing Tena cara. Of the oarities of ths heart, the 
right Tentride is most often implicated; next 
in order is ths right auricle; then ths left yen- 
tricla ; and lastly the left aoride. The pnlmonary 
artery and the descending cava hare been fre- 
quently inTolrad, at might have been inferred 
from their close relationship to the ascending 
aorta ; the innominate reins in fewer instances, 
and only when the aneurism engaged the upper 
portion of the arch. An aneurism of the ab- 
dominal aorta has communicated with the in- 
ferior Tena cava in a few cases. In the pro- 
cess of formation of a raricof e aneurism of the 
aorta, the apposed sur&ces are agglutinated by 
adheaire inflammation ; and the composite septum 
is subsequently eroded by progreBsire absorption, 
or suddenly rent by the force of the arterial cur- 
rent The immediate effects of communication are 
engorgement and i ncreased tension of the receiving 
chamber or vessel; diminished blood-current and 
vascular tension in the aorta and its branches : 
and admixture of arterial with venous blood 
when the right side of the heart or one of the 
great veins is the seat of discharge. The spedal 
symptoms and signs by which the disease is 
characterised have direct reference to these re- 
sults. Death has followed most rapidly in those 
eases in which the aneurism bad established a 
sommnnication with the pulmonary artery or the 
left amide. 

ISfeett upon tit Ltft Vemtruslt.—Bypeitioj^y 
of the left ventride cannot be regarded as a 
consequence of aueuriam of the aorta. The 
•isociation, when it exists, is accidental ; hyper- 
trophy depending upon antecedent or consecutive 
[lisnasn or inadequacy of the aortic or the mitral 
valves, chronic atheroma of the aoita, granular 
degeneration of the kidneys, or excessive fiinc- 
(iMial activity. 

SrMPToiu, — The symptoms of aortic aneu- 
rism may be discussed under the three heads 
}f (a) Bun; (i) Excuitria PNasnia; sad (e) 
Tnniow. 



Pain. — ^The pain of aneurism is of two Muds, 
iniriiuie and txtrinrie. The former is due to 
subacute inflammation and tension of the sac, 
and varies with intra-vascnlar pressure. It is 
dull, aching, and localised, and promptly allevi- 
ated by measures which depress the ciienlation 
or reduce local tension. Extrinsic pain nsnally 
arises from pressure upon sdjacent nerves, and 
may be direct or reflex. This kind of pain haa 
the characters of a difihsed and aggravated 
neuralgia, being paroxysmal, and wandering to 
a greater or less extent over the back, chest, 
shonlders, arms, abdomen, and thigha. In theab- 
domen, when due to pressure npon the splanchnic 
nerves or tension of the solar plexus, it is of the 
most ezcruciatingchaiacter. The extrinsic pain of 
aneurism may be fixed and boring. When of this 
character, it is usually located in the back, and 
arises firom progressive absorption of the ver- 
tebne. 

Excentrie Prtsture. — ^The parts affected by the 
pressure of an aneurism, and the symptoms 
thereby developed, va^ aeeor^ng to its situation 
and the direction of tts growth. Parts which 
are exposed to counter-pressure, or are other- 
wise fixed, suffer most ; whilst tiioae which are 
flexible or moveable are less injuriously affected. 
The symptoms have referenoe to the respeetire 
functions of the organs or structures pressed 
upon ; whilst their severity is in direct proportion 
to the importance of those functions, and the 
degree of pressure exercised. Structures sub- 
jected to the remittent pressure of an aneurism 
are slowly removed by absorption, but between 
the sac and the resisting surface union has been 
previously Established bj adhesive inflammation. 
Hence the sac itself is at the sametimeabsorbed, 
and escape of blood will inevitably occur where 
further resistance is not presented. When serous 
cavities are laid open ly this process, entrance is 
effected by a rant ; and if the cavity be laiga, 
e.g. the pleura or the peritoneum, death by 
hiemorrhage, almost instantaneous, is the result ; 
in case of irrnption into the pericardium or 
the spinal canal, death occurs with equal rapidity 
from compression and paralyais of the contained 
organ. Communication with a mucous eanal 
or with the cutaneous sur&ee is eflected by a pro- 
cess of sloughing, and bleeding occurs by ' leak- 
sge,' in variable quantity and at uncertain inter- 
vala, till the slough is finally detached, when 
death by copious hionorrhage immediately ensnea. 
The irruption of an aneurism into a gland-duct, 
such as the Ureter or one of the biliary passages, 
is fiital by obstruction and suspended secretion, 
the duct and its tributaries having been blocked 
by coagnlum. Communication with the thoracic 
duet proves slowly fatal by inanition'; and when 
an opening is e&cted into a vein, a varioosa 
aneurism, characterised by spedal symptoms and 
signs, and of greater or less gravity according 
to its situation, will be the reswt. 

The nrnptomi of nerve-pressure vary acooid* 
ing to the nerves affected. Thus, pressure upoa 
the roots or branches of sentient nerves is 
attended with nenialgic twinges or paroxysma 
referred to the seat of their peripheral diatribu- 
tion, and, when the pressure is extzema, with 
numbness in the same situation. Irritation of 
motor nerves is >n4icat«d by spasm or paraljm^ 



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AOBTA, DISEASES OF. 



ueatdiiig to the dagme of picanue, of tlie 
■nde* soi^ied hy them. Imtation of the eer- 
rial RTmpathede, or of ita dlio-motor roots, is 
nfcal^ hj dibitation of the popil on the eoms- 
I»odingskle:or, if the pmmre bs (neh as to cause 
pucaa, by cjoDtTKCtion of the papil vith ptoeis, 
Bjpenmiia, hypeneatbena, ana eleT&tion of tem- 
nratun in the eye and eormponding side of the 
fitML The efiecta of pramire npon the pulmonic 
aad cardiac plexoaes bare been less precisely 
ietcnniord, oving to the difficnlty of distingnish- 
iac the sTmptoma due to this caoae from tboae 
vuch anas firam direct pressare upon the 
tiadiea or bronchi, the great Teasels, or the 
heart, or bom atmetoml disease of the heart or 
IIm eomiary arteries : l>nt that the paroxysms of 
bnochial spasm and of angina, so often iritneseed 
in eonaectioG with anenrism cf the arch of the 
aorta, are in some degree drpendeot upon 
yttman on the pslmonary and cardiac nerres, and 
oceaaoBally are due to it exclasiTely, the irriter 
entertains no doabt. The symptoms arising from 
the pnanre of an aneurism npon the pneumo- 
gpslrie 01 laeamBt nerre of either side have 
raffciatce to the laiynz, and are eminently 
ehaiacteristie. They are of two kinds, according 
to the degree of ptessnre ; namely, those dne to 
qiasm, and those to paralysis, of the laryngeal 
BOseJrs oo one or both sides. They are presented 
•ader the sereral forms of dysphonia, aphonia, 
stridor, mefallk* eoogfa, and paroxysmal dyspnea. 
tba latter isfrc^oenU^ of the roost uigent charac- 
ter, and sometime* u the immediate cause of 



pnsrible. and uneven, l.^ ^^pomition of UminaUd 
flbrin within the sac. ■ . ■ e 

Phtsicjli, 8i0KS.-Th« I>*»^»"?J "^v° r °?5 
rism of the aorta are tho-« tmrhicb may be elicUod 
hj palpation, vfrcuuiom, m.x»d ^*f"', j"Tv '? 
supply the most raluablo, —-D**. indeed, the only 
positive evidence of the d i^t^»^>-*^' 

ThctiUngnt.— Tht tact.il ^ «»gn8 of *ne\m»m, 
impvlacfremUut, and r«OT«V^*r»«' <f»««>*. Me Con- 
tingent on perceptible tumo**^- Tno ^mpmlsetnai 
be single or double. It is ii»o»fc firoqnenUy »ing\i 
and is then always systolic i la x-hy thm, «o»na4Ju_ 
approzimately with the iErap"**!*® ot tjj^ \^^^ 
In character the systolic i «x» p»iaJU« i, W • 
and expansile i audit is cJi^flfViasetl, i^ j^^?S 
stances equally, over the oxati-*"^^ tniv. — ^r >•*- 
due to sodden expansion o^ cla^ 
influx of blood during ventra <rwi 1*».J 
in those portions of the acaarf;:^ "*'Hioh"--^' ''*?*^"» 
to the heart, it is s^-nchroxaowiu^ ^ith 



^/«»n actiw. 

are do 

the 



pulsation ; bat in the doscoxad asB^-ti, ~*. "Po^r 
abdominal aorta perceptibljy^ I'ost-_„r?*J? •*;** 
Ume. The force of systol i^i ™p J^-^'^"^^^^ 
expansion of the sac will bo d a z-<^tir as the oo«» — 
tractile power of the left veat^r-i'<=I m, and ia-rsxanl^ 
as the deposit of coagulum -wzCljin the we. -^ 
second and more feeble inif>mal«e of diaatol*^ 
rhrthm is occasionally, but mca«=la leas fre4™^°^^^ 
exhibited by an aortic anoiur>.^zia. Tb»* *? ^tr^ 
' back-stroke,' or ' impulse of arre**". ^a o^C 

antliors. It coincides with t.la^ «■— . ■o«r»*'^ ty* 
rentricnlar diastole and tfa 



Adjacent organs^ such as the haiurt, lungs, 
IiTcr, and kidn^s, are oeeasioQaUy displaced by 
an aw 11111111, the direction being determined bv 
that of the prcamre, and in part also by the dl- 
taetinn in which the atfui is moveable. Obstmc- 
tioa or ocelvsion of adjacent arteries, as indicated 
by dnsiaiahed or sappreased pulsation, may like- 
viae rcaalt fiom tlie pressare of an aneurism. 
FresBBre on a rein is eridencod by venous stasis 
£atal to the seat of obatrortion ; npon the pul- 
taooaiy artery, by engorgement of the ngbt 
daabas of the heart and general venous eon- 
l,iisciiin Obstnietioa aroedusion of either bron- 
ekaa <«' of one of ita primary branches is evi- 
diinfid by distress in breathing or shortness of 
hfcath; and by diminution or suppression of 
HHiisliiij aonnd in the corresponding portion 
•f tbe lang. Inasnneh as the symptoms of 
siusiliii {a us snte may be produced by a tumour 
at mxij kiad, they po sse s s , in regard to aneu- 
a Angnostic value only correlative to 
and mare poaitiva evidenes of that dis- 



'. — ^Tbe tamonr formed by an aneurism 
if the aorta is fizad. smooth, and eomprCMible. 
It is altsiMteiy tease and soft in nnifon with 
: pnlaatirn, and is especially characterised 
wot of general and equal expansion. 
I with the inptilsa of the heart. It 
r dSatingnisfaed by a remarkable Kabflity 
ta the rata and direction of its 
HjecaasioB at one point coinciding with 
'. at another ; a new set of symptoms 
' at th* same time developed by its en- 
baaot apon ikeah tenitoij. In the pro- 
I sf ears the tsBMor may baeana aolid, ioeoB- 




renoe than diastolic 
communicated from the heart, xac_ 
tive of anenrism. It aceompaai«>^ 
impulse, and is dus to the vibTa#-_z« 
sac firom an eddy in the current «>:f 
dared either by a spiculated eoo«^ 



the heart, and is duo to asyziclxx'oni*''*' I_— iVa** 
action between the aorta avad «-i»^ »** ^^j \t* 
of the latter being notably l^t«LZ-. o~«r^**^ ^<add>1^ 
defective elasticity. Theconseq-u^za^s^ ;» * ^^-frcrtO 
arrest to the recoil of the aa« t>^^r io^^* ^^'i 
the aorta. Diastolic impulso i^ «:,Xa.^»r®f*'^** ©mi* 
nently characteristic of aneuriaita. 

Fremitus or thrill is of more :^K-^»caTaaiit OCCn 

im^uls^ s,.„«^, ^h Sr 

Stf^O* ^h 

orifice, or by a pendent flake of fib.K-a sa **<» Pfo. 

Ptreuuum-tomid. — The intrinai^ i^^ ^f tj, 

sound of sortie aneurism !a abaoluc-^?^lv> ' 

the extent of the tumour. Po^t-^jjj^ »»**l*i 
dulness is not sufficiently distingu i^,j^Oj,5'li ».***• 
that of the vertebral eolnmn and *>?^7 "^ *^ "" 
be of positive diagnostic value; irbi j^*ti^ tk^* 
and in front, when the tomoor is iio^ * i^^'^^*^ 
contact with the walls of the tJ)o»i.x ^*» **<»*/ ^ 
men, it is modified or masked by th^ .1*. •oj?^ 
tion of the lung or the intestinal canai ^'>tn*^^ 
any circumstances, dulness per « cnotj fy**^^ 
positive evidence of anennsm, JnsamJ't ««?*'«»•* 
may_ be due to a tumour of any kintj^i ^'tf 
liquid, in the same situation ; but, the' *°^j5* '* 
of a tumour having been determined, th'^ti "*' 
ing of perenssioO'^nlness from one ^1 'bi&* 
another, or ita cessation where it had w"' ta 
vioDsly detected, would be in the higbeaj a ^*t~ 
suggestive of aneurism. "B^ 

Aamttie tignt. — These are Unu or •otnitf 
murmur. Sound without murmur is of frgJ "M 
occurrence in anenrisms of the arch, biitV''*^ 
pamtivaly laie in those of the deaeen^,^ 



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AOBTA, DISEASES OF. 



tliai«cie and abdominal aoita. It is araally 
donUe, eorraai<ODding in time to the aounds of 
the heart) bat exaggerated, the second anen- 
rismal sonnd being especially intaDsified. The 
first sound is occasioDally ' splashing,' and both 
are not nnfreqnently of a * booming' quality, 
— chamicters no doubt due io the density, 
rigidity, and grant capacity of the aac. 

The murmur of aneurism is most frequently 
single, systolic and blowing; it is occasionally 
double (systolie and diutolic) ; and still more 
Tanly single and diastolic. As to qu^ility, the 
syBt<uio murmnr may be accompanied by a 
musical note, 'cooing,' or shrill, and audible 
over the whole or only a portion of the tumour. 
Lastly, it may be, and tunally is, of a 'busing' 
character in cases of varicose aneurism. The 
essential cause of the mnrmur of aneurism 
consists in friction of the blood against the 
orifice, and the production uf an eddy or a ' fluid 
vein ' wiUiin the sac A certain force of ventri- 
cular contraction is, howevex, likewise necessary. 
Benea the not nnfkvquent ooincidence of cessa- 
tion of murmur with failure of the left ventricle 
for some time before death. A strongly con- 
tracting ventricle, a relatively small orifice, » 
capacious sac, and a liquid state of ita contents, 
supply the most favourable conditions for the 
proauction of murmur. The orifice of entrance 
need not be absolutely narrow ; a large fusiform 
aneurism, even of tne true kind, with rough 
walls, and contuning liquid blood, may jrield a 
loud systolic murmnr, as the writer haa fre- 
guently witnened. A murmur may be absent 
in an aneurism lined by thick lamina of fibria 
through which there is a smooth channrl, or in 
a lateral aneurism communicating by a small 
orifice witli the vessel. 

SiAOMOsis. — The positive diagnosis of sneu- 
rism of the aorta may be made from the exist- 
ence of a tamouT, forming a second centre of 
pulsation and of aound ; the putaation being 
systolic expansile, and equally aiSfased over the 
tumour, aecominnied by thrill, and foeeeeded by 
a minor polaation of diaatolie rhythm; whilst 
the sound, single or double, and accompanied or 
not by murmur, is always shan> and ringing, 
and occasionally of a ' booming quality. The 
foregoing signs are rarely all associated in the 
same case. Various other groupings of rational 
symptoms and signs would be scarcely leas con- 
clusive as to the existence of aneurism of the 
aorta. Qenml systolic expansion, thrill, dia- 
stolic impulse, and exaggsatad sound, at a ^nt 
mora or Mw distant from the heart; eonatitute 
the most positive aigna of the disease. 
. The exMtence of aneurism of the aorta may be 
inferred with greater or lasa confidence from 
•ertain symptoms and signs, according to their 
individual or correlative value. £v«a negative 
«ign% if associated with others in themselves 
of minor significance, may be scarcely less oon- 
olnsive thaji the most positive evideuee would 
be. Thus, for axampls, suppressed leepiration 
with percQsaon-iesonanee on the left ride of the 
chest, dyspnma, hemoptysis, fixed pais in the 
back, and left intercostal neuralgia — ^the entianoe 
ef a fiarMga body into the Ittt bronchns and the 
existence of cancer of the poetarior mediaitinum 
hariag beea aselodad— v«wU lia aU b«t can- 



elusive as to tke -existence of aneuiiim. A 
foreign body in the bronchus might be diag- 
nosed from the history of a missdventare ii 
swallowing, followed imxiediately by dyspnoa, 
hamoptysia, and the special signs of bronchial 
obstruction, which, in nine cases out of tan, 
would be on the right side: whilst thediagnosii 
of mediastinal caneer would reat upon evidence 
eminently suggestive^ namely, the presence of 
cancerous enlargements in the neck and axilla, 
and of extreme dulneas over the root of the 
lung, without corresponding pulsation or sound, 
finally, aneuriam of the aorta may be, though 
it very rarely is, strictly latent in regard to both 
symptoms and signs. 

Faoohosis, DcaATioir, Am TBHmHanons. — 
The prognosis of aottic aneurism is in the 
highest degree nnfuvourable. Becovery is, how- 
ever, under &vouakble circumstances and ap- 
propriate treatment, quite within the range of 
medicine. Numerous examples of cure of aortic 
aneurism, both thoracic and abdominal, have 
been lately recorded. 

The duration of life, in connection with aaen- 
Dsm of the aorta, haa varied, aoQarding to the 
•xperienee of the writer, from ten days to eleven 
yean ; but it may be much longer. The situa- 
tion Mid rsktions of the aneurism ; its complica- 
tions ; the constitution of the sae, and the state of 
its contents; the previous health and present 
habits of the patient; and the advantages emoyed 
in regard to rest and treatment — will all ma- 
terially influence the prognosis, vhether as to 
duration of life or prospect of recovery. 

Death in,fkneurism of the aorta may result from 
— (a}ruptursof the sao; (b) exhaustion fh>m pwn, 
loss of sleeps or leakage of blood; ((;) asphyxia; 
((i)Bynoope; («) inanition; or (/) intercurrent 
disease. The foregoing represents the order of 
relative frequency of the several causes men- 
tioned. Rupture of the sac is not, of necessity, 
immediately fatal. Hemorrhage may be stayed, 
and life thus protracted for soveral diays, by ob- 
struction from the eztravasated blood, itself ar- 
reated and ooagulated in the surrounding tissues, 
or by its pressure upon the aorta on the pioximsl 
side of the sao. Rupture into one of the cham- 
bers of the heart, the pulmonary artery, either 
vena cava or the innominate vein, the portal vein, 
gx the biliary passages, is usually fatal within a.' 
veny brief period ; whilst rupture into one of the 
senms cavities in the absence of previous adhe- 
aion, into the trachea or bronchi, or into the ali- 
mentary or the spinal canal, is instantsneonsly 
llttaL 

T««ATiaDrt. — The treatment of aneurism of 
the aorta is palliative and cvratire. Fain firaai 
aervo-preasure is moat effectually lelieTBd by 
hypodermic injections of morphia, one quarter to 
half a grain ia solution, repeated and increased 
in quantity aooording to necessity. The psin 
and oppression due to congestion of the sae and 
Ab surrounding stractores is best tneted by 
local or general abstTsetion of blood, combined 
with the use of cardiac and vascular depnssants. 
sspeeisUy iodide of potassium (SO to (0 grains 
every fovrth hour), obloral hy&ata (20 grains), 
and varatrum viride or aoonite(6 to 10 minims of 
the tincture every third hour). Mechanical support 
by means of a iraU-eoastmetsd shield is liks«ia% 



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AOBTA. SISEASEb OF. 

•meM lAea tb« tainaar project! axtemally. 
Find pain in the liaek, doe to erosion of the 
ratebnb is most effectually reliered by a letOD 
or iarae id the ridnity of its seat. The curative 
tieatment of anenrino of the aorta may be cUasi- 
led ander the heads of — (a) oompresaion of the 
litoj, pToximal or diatal; (i) distal ligature ; 
(c) afaoolote rest irith legolated diet; aad {d) 
tte n*e of medicinal ageota promotire of coagu- 
btion Tithin the sac For the details of these 
MTeial modes of treatment the reader is referred 
to the articles in this Tolnme respectively entitled 
^■■CBiss, ABiioMni.u. Akkdbism, and THOBAao 
AsBiTBUx. Tboius Hatdbm. 

AOBTIO VAI.VEB, Siaeases of. See 
Hbast, Valmlar Diseases of. 

AFEFSTA. (i, prir., and rirrm, I digest).— 
lodigestjon. &« DioBmaii, Disorders of. 

AFKBXEITTB {aperio, I open). — Kedicines 
vfaieh produce a gentle action of the bowels. 
Sat FcKk-nrsa. 

APHAQIA. (i. prir., and fdyv, I eat).— In- 
ability to swallow. See DaaurrrnoH, Disorders 
.f. 

APHASIA (i, prir., and ftiid or ^iv, I 
■pcakji — Srwm. : Apkewtia, Alalia ; Fr. Aphtuie. 

Daaaamcm. — Aphasia is the namegiren to a 
defect of ^leech from cerebral disease, to which 
modi attention has been paid daring the last 
few yean. When it exists the patient is foand 
U» be vsaUs to titter any proposition, thongh his 
ORanuoal distinct pronunciation of some one or 
two words shows that his speechlees'condition is 
net dae to a mrre difflenlty in the more mecha- 
nieal act of aitkolatioii. Uoreorer, the patient's 
intslUeFBt manner and gestures may plainly 
show that he nnderatands what is said, and 
ia capable of thinldog, eren though he is Oaite 
oaablr to gire expression to his thonghts. This 
kind of powerlessnea as regards speech is most 
inqneody cncmntered in persons saSering from 
Twiit hemiplegia, thongh it is occasionally met 
wHb ia tbosB who are paralyted on the left sid«, 
and at other times in persons who are not hemi- 
pUgicat alL 

The aphasic condition is not always, as it 
oa^t to be, clearly distinguished from another 
wUdi may be encoantered in association with 
hemiplegia on either side of the body, and to 
which the name Amnesia is given. The essence 
of this bitter defect lies in the fact that the 
patient Tery frequently sabstitotes wrong words 
or Basee in the place of those he wishes to em- 
|loy, em when speaking of his ' hat,' he calls it 
a 'brash ;' or when seeking a 'pen,' he a«ks for 
a 'kmfe.' In a bad case of this kind the patient 
■•y be quite nnable to arrange words into a 
sssitciKe capable of conreyiog a deflnite meaning, 
so that hi* speech is rendered nnintelligible. 
When this species of defect exists there seems to 
be SB iaco-ordinate action of those higher cere- 
Icil centres whose ftinction it is to translate 
(hm^ into the c ui ruspondiny motor acts of 
•peach, so that we get hesitation and delay in 
the Wnaoes Cft right w«rda, or, what is worse, 
tbt nhtititioa occasionally of entirely wrong 
■onb or cnn of » mesningleas set of sounds. 



APHASIA^ „ 

These amnesic or inco-oixJin^j^ ^^^^ ^^ ^^5" 
at first recognised as b«»ng dhtinct ia nature 
from those of an aphaatc typo, in which there is 
rather a lass than a miadiroction of power in 
some of the higher centroa, whence the incita- 
tion to the motor acta of speech prtjceod. The 
two kinds of defects, inde^ not nufrequently 
coexist to some extent in the same inUiyjl 
dual. 

When occurring \xi asaociation with hemi 
plegia, nphasia varies uwch in intowdty accord 
ing to the degree of neneral mental iniunir_,rrl 
with which .t ma.y >«> combined. Wrin^f?' 
first week or ton au.ys afUr the onset of «,-k 
att«ck the spocal delect may be kirJ,, ™ "* 
„i«.ble owng to tU« masking inC« T^' 
general mental intijaoirment. TheT?,^ **' '^« 
perhaps in a re»tf^ tnt othorwiw u^ "*?• 
sUte, biking no i»«>tice of »»,.»• ««argic 
around him, and not allowing »,• '* ®<»«rriiig 
be fixed even for a. moment -T fil' ""en^ion to 
each a time no r>o»itive erlnvJj ,*' "^ere is at 
that he or aho, -^riu ^^^ ^ot concluding 
aphasic i^ptom... Bttt^.^''«'"Ij' manifest 
general menti»lpo^,w.«rb.»ftero recovery of 
the patient takinj^- uofZ,,""''"' "t*-!^ <"»* 
atotind him, also «ften, " "/ what w passing 
questions, the flrKt wigi^rl" '" reply u> Bimpl" 
may reveal themael-res r,*" aphasio con<iiuo»» 
or ' no' to all questions !nJ-i.P^''biips nays 'JT'^y. 
words are nseS, it ia ,a '"'''^'''•'■'■tly or i' ^^^ 
this stage, howeror, tbeT,f^"'f"''<>itt\y. ^^f^^" 
in the initiation rather tl"'"^' "* 'i'^fecti^" ^^-o. «- 
many much simpler act. .^l '" '''« «»*5"««»«'*^^ 
Attention to tho nn»„ ™'' t^oto «>*,Io»^^' 



'«» 

Attention to tlio liTtnJ'"'' *'^°*^ "'a^^^^^^ 
power clearly sho^rs thaf if- **' "*'" ^\.o^^Z»-*'^ 

{^ralysis in_ tho ord&- °?^ °5r"vV>« ^^^^ 



Thus a patient in thivT^ ■?-"?* °lJ^^ vcA^^' 



aoie to procruae n,« tongne wbon lAittVV'cV*.. -;«••-;:, 
do so, tfiough n may c„ « ^ ^^^^ ,^01 «**t>*> ^^-tf^ 
nees when .1 swecimoat is apT>li«a. **> *-V^* ^- 

even when he is kbown rat^ox- ti-ia.t» , t***', 

we want him to do. n*tt»«»«- " «^ t. j,tal 

After a time, however, moli «». V^^^X ^^e^^ 



regain a considerable amount of isod'^-'^V^* Ae^*f 
power, though he may be left ^oi^ <?f ^^c te^d" 
plegic, and mapr also present tti« an,!** „*«**'- - 



to a marked .fegree. He r^«^ily oO*»^^I. , T^em 



everything that is said to r» im 
undcriitaud what he reiids. IBi^ti' 
as was ihe case with one cif Vrx:,- 









:•« 






though able f«nru.uX.^tIS^^^t"en 

rr st S Krp^i.ri^»>-s.?^^«^-„S 

or che.5 well, and by nWniT'^^J. I'^^ureS »"• 
pantomime can make ^s wan "- ^^ ^"^l af *'" 
wishM fairly well understoo.^ ft^^,^^ g^CCtlS- 
tomed to interpret them. Yet ^i^ cUoBO ^ ^ 
able to articulate some one ^ZL ^\^ »>«J' *^/ or 
else combinations of mere unJl, ♦wwo -vrora^, " 
such as 'poi, hoi, bah,' '*«po^ ^*^og t^nnoa, 
other sounds which, doing dut:v-* ^^foo, or momt 
constitute his only form of "it^" "" occfimioat, 
occasions, under the influenco *^^'^A. On rare 
tion, the patient may blurt <rt^ •tix>nj2- cmo. 
expletive or short phrase, sucj, „ ^^o^mimplt 
Sometim™ he can repeat a w-orrf ^t * °A dearf 
just hea.-d uttered though at ot^o^^^«=-fc ho hm, 
no such power, and may even be n^ v'^'^e. hi C^ 
when told to do sok on, of U,^ *^^«» ^ ^tt* 



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70 



AFHASIA. 



■oaiicb to wbieh he is aeautomMl to gir« att«r- 
anee. In a fe\r eases the patient has seemed 
unable to nnderstand what is said, as thongh 
from some difllraltf in realising the meaning of 
vonls. Words mny hare to be ottered vttj 
slowly and repeated several times to snch a 
patient, and even then they may fuil to convey 
their meaning. Yet the langnage of gesture, 
appealing as it don to the sense of sight, may be 
at once understood. 

The patient's power of writing is necessarily 
interfered with when aphasia, as is so often the 
ease, co-exists with right hemiplegia. Many 
each patients, however, learn to write with the 
left hand to a variable extent, though others 
continue powerless in this respect The varia- 
tions as regards the puwer of writing are, in 
fact, almost as marked as the variations in power 
of speaking, though these two classes of defects 
by no means run parallel with one another in 
the same individual. The writer has known a 
man who was quite unable to express himself in 
spoken words, write a fiiirly good letter with 
very few mistakes ; on the odicr hand, the per- 
formance of snch a patient, without a copy 
before bim, may be limited to writing his own 
name. At other times the patient is able to 
write only mere senseless combinations of letters; 
or writing some words correctly, ifae makes mis- 
takes and substitutions with others — in fact, 
shows an amnesic defect in writing, and writes 
much an an amnesic patient speaks. Still more 
rarely it is found that an apbasie patient is, 
though not from want of manui\l power, unable 
to write even a single letter— in attempting to 
do so he makes mere unmeaning strokes. 

Looking to the mode in which these symptoms 
moiit fluently group themselves, we find in 
one set of eases defects of an aphasic tj'pe only, 
as follows: — 1, Loss of power, both of speaking 
and of writing (Typical Aphasia). 2. Loss of 
power of speaking, but power of writing pre- 
served (Apiemia). S. Lens of power of writing, 
but powrr of speaking preserved (Agraphia). 
At other times aphasic and amnesic defects are 
combined in the same individual, and then we 
may have — 1. Loss of power of speaking, with an 
amnesic defect in writing. 6. Loes of power of 
writing, with an amnesic defect in speaking. Or, 
lastly, mere amnesic defects alone may exist in 
speech, in writing, or in both modes of expres- 
sion. 

PxTKOLOoT. — The recent concentration of 
attention upon these defect* of soeech was 
started by the enunciation of Broca's views as 
to the dependence of the aphasic defects upon 
lesions in or about the thira left frontal con- 
volution. Subsequent investigations have in 
the main tended to con6rm Broca's view as to 
the effects of injury to this convolution, thongh 
Meynert and others think that a lesion of the 
convolutions of the island of Beil on the same 
side is more frequently productive of aphasic 
symptoms. But all pathologists are now agreed 
as to the fact that lesions in or about the third 
left frontal convolution are much more prone to 
give rise to aphasic symptoms than are corre- 
sponding lesions on the right side of the brain. 
It I* commonly believed, however, that amnesia 
may h« induced by snpOTficial lesions on either 



side of the brain, and by lefions also which ruij 
much in their topograpbical distribution. 

Aphasia occasionally supervenes, independently 
of paralysis or convulsions, in individuals who 
have been subjected to great excitement or pro- 
longed overwork, when it may be due, perhaps, 
to mere functional derangements. In other 
cases it presents itself as a temporary condition, 
lasting only for a few hours or a few days, in 
a patient who has just had an attack of right- 
siaed unilateral convulsions ; or, lastly, as baa 
already been indicated, it occurs in conjunc- 
tion with a right-sided hemiplegia produced 
either by brain-softening or by cerebral hcmor- 
zfaage. Cases belonging to the latter category 
vary very much amongst themselves as regpudi 
the degree of co-existing hemiplegia. If the 
third left convolution alone is damaged by 
softening, the hemiplrgic condition may be 
transienc and incomplete — never, perhaps, affect- 
ing the leg appreciably. This condition is 
often inductil by a small haemorrhage, or by a 
patch of softening produced by an embolism 
of that branch of the middle cerebral artery 
which snpplie* the third frontiil convolution; 
but when the haemorrhage is larger, or whers 
the main trunk of the middle cerebral artery 
is obliterated, either by an embolon or a 
thrombus, the aphasia is combined with much 
graver and more persistent paralytic symp- 
toms. 

In some cases in which typical aphasia is 
met with, no actual lesion of the thinl frontal 
convolution is discovered after death. This is 
due to the fact that these symptoms may be 
occasioned by a lesion which, whilst not im- 
plicating the third frontal convolution itself, 
severs or interferes with the efferent fibres pro- 
ceeding from this convolution to the corpus 
striatum, the next lowest nerve-centre ; so that 
a lesion either of the part of the corpns 
striatum in reUtion with the third frontal con- 
volution, or of the white matter intervening 
between the two, should be, and is found to be, 
as capable of producing aphasia as a lesion of 
the convolution itself. 

The third left frontal convolution is not now 
supposed, as Broca put it, to be the seat of any 
' faculty of language,' though the anatomical in- 
vestigations of Meynert and of Broadbent have 
shown that its relations with other convolutions 
are exceptionally complex. Whether or not 
certain assumed higher centres for speech are 
sittuted in this part of the brain, it must at 
least be conceded that this convolution is in- 
timately concerned with the physical expres- 
sion given to thought in articulate speech and 
in written language; it contains, in fact, the 
sites (or nerve-centies) from which the volitional 
incitations to these muscular acts usually pass 
downwards to lower centres. 

We know that the left hemisphere is the one 
from which the volitional incitations proceed 
in the case of written language, and it is pre- 
sumed that the same half of the brain also takes 
the lead in the production of articulate speech. 
It is, therefore, a point of much interest when we 
find that, in some of the exceptional cases in 
which aphasia has occurred in association with 
lesions on the right side of the brain and left 



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APHASIA. 

fcenipkeia. the individual had been left- 
kanded daring life. Some of the other exee^ 
Unal eaaes, faowerer, hare not admitted of thu 
bterpratatiao, ao that Anther obaervations are 
leqnnvd. 

TiuuTKxjrr. — Where aphama oecon after ex- 
otement or overwork, viUioat parslysii, it i« a 
valuing of much importance, since it may be 
the precomr of much graver symptoma. Under 
■Bch circmnstancea the patient require* an abio- 
hte eeaaation from work for a time, and most 
eiKefal watching. Stiranlants may need to be di- 
niniahed, and bromide of potaasium, with rambal 
aad other aedatiTe remedies, ahoald be adminis- 
tend. Where sphaais is a temporary eonditiun 
in anociatian with right-sided eonruUiona, or 
vbere it is Imrfing and co-exists with right-sided 
paraljss, the treatment of the aphasic condition 
becomes merged in that of the associated convnl- 
sire tendene^r or paralytic condition, since, as a 
nle, an amelioration takes place in the patient's 
{lover of speakiDg etnncidentl^ with his improve- 
ment in other respects. This, however, is not 
atwaya the ease where aphasia has co-existed 
withapartialhemiplegicoondition; the paialyiiis 
may be recovered bom, whilst the aphasic defect 
Tcmaioa aoie or leaa as it was. Where this is 
the case, an attempt should be made to teach 
the patient to speak again. Such efibrts have 
eerasjooally been crowned with success (see 
TVaas: of Gin. Soe., vol. iii. p. 02}, bnt much 
judgment and nntiring patience have to be 
called into play in order to obtain satisfactory 
Tesalta. H. CHAm,T0if Bastia:(. 

APHXICU. (i, pnv., and ^wil, I ^eak). 
&s Anuau. 

AFHOHXA. (i, priv., and ^mrh, the voice). — 
Abaesse of voice, that is, of intonated utterance. 
Stt ToKx, Dtaotders of. 

AraHODiaiACS ('A<^p«*(n|, Veniis).— 
Daiuiiiiua. — Hedicinea which increase the sex- 
■ol qipadte and power. 

Bamtmwjenos. — ^The direct aphrodisiacs in- 
dade — Nnx Tomiea and Strychnia, PhosphonUf 
Outharide*; TTitieetiaB and Flagellation ; Oan- 
Babis ladica, Opiam, and Alcohol in small doses. 
Ina aod bitter tonics ; meat diet ; warm clothing, 
aspeenlly anrand the hips and loins ; and absti- 
•eoee from severe ment^ and bodily work act aa 
indirect aphrodisiaea. 

Acnnr. — Aphrodisiacs may act by ineressiDg 
tke excitability of the nerves passing to or from 
the genital organs, or of the genital centre in 
the (piaal cord (te* Axaphbodisucs), as, for ex- 
ample, atiychnia, nnx vomica, and probably 
phoaplioms; by causing irritation of the nerves 
et the genital or urinary organs or of adjoining 
parts, as eantharide* and nrtication ; or by sti- 
tilafing the brain, as Indian hemp or small 
4oess of o|riiim. Alcohol in large doses has a 
double aetioo, increasing the sexn^ desire by sti- 
malariog the brain, while lessening the power of 
snctioa, probably by weakening the nerves 
tkrangh whieii the spinal centre acts on the 
geaital organs, or depressing this centre itself. 
As the sanal passion becomes diminished when 



APHTTT ^f<- 



tiM asiiiMis system is weakened with the rest of 
tbs body, tad iscrpases with retoming strength. 



iron with bitter tonics, 
directly as aphrodisiacs. 

UsBSi — When the sexiia.1 ^ 
mally depressed, strychnaaa. a 
the most generally nse£%>JI. 
rodisiaes. Cantharides, 
valuable, must be emplo'' 

T_ 

APBTHiB— APHTS O ' 
to inflame). — Stmok. : ITjk 
BsscBiFnoH. — In som.o 
deranged digestion the toix 
other parts of the montlx, K 
small flakes, like morsolss* 
known as aphtha. Somet.i 
and coalesce, so as to form X 
soft tax. This condition i.^ 
manifest itself at the extre 
and old age — but it also 
of wasting or debilitating 
flakes can easily be detach 
they are soon reproduced, 
not to detach them, but to 
conditions which are 
If they are forcibly detachecl, 
the epithelium along with cix 
papiUn nw ; and these ret-mr 



axioroti.. 



diot 



tl 



*«^ 



actions 



\1»* 



»*• 



.1 -a=..}ioag^ 






tCS^-»^"^«- 






»th"«^„>»*x, 









c*i. 




ulcerate. ApUhmuuloen tta.-w^ ^'''' ^ *<* /" '"ca"''*- 






^^J-'^'f^ 



istac appearance. They are 
enlar or oval; ^nerally 






'V 






fo 



^.'^V 



'Ofj 

and, as it were, m suecessivs **Djjl''* '*''• •j,?*'^*' 
are soft and smooth, with ^ tbj' y^ ^t^t **" 
grevish slough; their margins n^>e7/ '"'^ia^' 
and surrounded by a bright iie<J ^^ "^oii"'"^^^ 
thickening or elevation. They "^^'n \f'"'''^ 



'if 



situated on the fore part of the lo**^ «>o.too "j"* 
Ups, where they are always aecom^I*".'' "><i tbZ 
creased hoet, and virid congestion ofib^ ''^ '»- 
membrane. At the same time there is 0^^!^^°*^ 




Fia. 1.— Oldlmn tiw~ii«, 

active gastric or intestinal irritation, as well aa 
fever of an atonic kind. 

It was not till 1842 that the precise nature ol 
these whits patches was aaoanabed. In that 



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fa AFBTOS. 

jnar it ma tkowu by Ornby that thoy depand 
npon the preaence of a mieroaeopie fdngus, to 
Wiieh he gare the name at apiuhaphyte, or eryp- 
ttgami dm mtgmt. Sabeeqnently this fnngna 
was Nfenred by Bobin to the geniu eiditun, and 
by Um called oidium albiauu. It u found 
growing npon the tongue in eloae association 
with the epiibelinm. It forms delicate, horizontal 
filaments, which are apparently homogeneous in 
■tnieture, and from which short articulated 
pedicels take their rise. The uppermost cells of 
these pedicels become expanded into oval bodies 
which fall off, germinate, and become new fila- 
ments. It is generally found growini; in tangled 
masses, like minute bunches of mistletoe, mixed 
with the (2eAH« of scattered spom. cells of the 
Uptothrix, and epithelial scales; but if separate 
filaments are followed out we may obtain such 
forms as those represented in Fig. 1. 

Many nlcers are called aphthous which are 
feally dyspeptic, and which owe their origin to 
Romatitis and irritation of the intestinal canal. 
The true aphthous ulcer, however, is always 
Meompanied by the growth of the parasitic 
fcngns that has been described above, and to such 
■tears the term ought to be confined. 

The trtainuiU of this afiection will be found 
described nnder Thbtsh, a popular term which 
includes both aphthts and the dyspeptic ulcers 
resembling them. 

Some writers speak of aphtlMut vleeniioit tif 
the txiffina, by which is meant a severe form of 
vaginitis attended by the formation of small 
ulcers resembling; the aphthous ulcers. The 
oidium altneant is £requently met with in the 
vaginal secretion. W. FuBLia CLaKXx. 

AFHTHOtXa— A term applied to diseases 
ia which aphthn aia present, 

▲FXiABTIO (i, priv.,and wXiavm, I mould). 
— Incapable of being organized or of forming 
tissues ; generally applied to inflammatory exu- 
dation. 

▲PITBIUICATOBIS (k, priv., and wnvfui, 
raspiistion). — A synonym for Atelectasis. See 
Atbuktasis. 

AFNCBA (i, priv. and nfm, I breathe), lite- 
rally signifjring breathleesness, is used by some 
medical writers as synonymous with asphyxia 
(m« Aspstzia), the condition which supervenes 
on snspeneion or obstruction of the lespiratoiy 
fiinetion. 

By physiologists, and with more justice, the 
term is employed to signify the cessation of 
respiratory movements which is brought about 
by nyperozygenation of the blood, as when an 
animal is made to hreathe oxygen, or to breathe 
more rapidly than the needs of the economy re- 
quire. 

▲POIaUITABIS, Wstan «t— Addnloua 
alkaline table-waters. Set MiKaau, Watbrs. 

AFOPLBXT. — Baninnoif. — The word 
apoplexy meanst by its etymology, a ttrikingfrom 
(a», from, and vX^fn, a striki ng), and was at first 
■ad is still chiefly used to signify sudden abolition 
3f consciousness and power of motion, which, ia 
flommon £nelisfa, i* also called a ttnke. C^ra- 
bml bMuomuigs hmg tlw most fteqaent ^mo 



APOIlJSZT, OEBEBBALb 

of this condition, ' luemoirhags into the bnuo' 
and 'apoplexy ' came to be used sa synonymoos 
expressions. Subsequently the ciilisioa of blood 
itself was spoken of as tkt QpupUty, th« wotd 
being used to designate the pathological eoodition 
causing the symptoms which itat fint epitomised. 
Ultimately it was applied to .a simibr patho- 
logical state elsewhere, and thus hamorrbages 
into the substance of the lung, the spleen, or 
the retina were, and still are termed respectively 
pulmonaiy, splenic, or retinal 'apoplexies.' 

The term etnbral apoplexy is sometimes need 
to particularise hnmorrnage into the btaia, but 
it IS mora commonly employed to daoota an 
apoplectic condition depending on any oerebnl 
lesion, and in that sense it will be here employed. 
W. R. Oowus. 

AFOFLEX7, CSBEBBAIi. — Sntoir. i 

A Stroke; Fr. Apoplcxie; Ger. Sehlag. 

DaFiHXTiox. — Loss of oonscionsness, of sen« 
sation, and of voluntary motion, coming on 
more or less suddenly, and due to a morbid state 
of the brain. 

This condition of coma is termed ' apoplectio 
when of sudden or rapid onset. Los^ of con- 
sciousness may be due to other causes acting 
directly on the bmin, such as defective or ezces- 
s'lre supply or altered condition of blood; but it 
is customary to include among the fbrms of 
apoplexy only that sudden loss of consciousness 
which is due to cerebral congestion, and to con- 
sider as apoplectic ttatee only those which result 
from distinct toxsemia. 

.£tioloot. — The apoplectic condition may be 
due (I) to the influence upon the brain of a 
poison circulating in the blood ; (2) to a sudden 
cerebral lesion, such as hemorrhage or vascular 
obstruction; or (11) to a siidden shock or other 
impression arresting the cerebral functions, but 
causing no visible alteration in the brain. 

1. The toxsmic states in which apoplectic 
symptoms occur are those of nnmia, drunken* 
ness, and poisoning by narcotics, as opium, See. 
These are described elscrwhere, and need be referred 
to in this article only in respect to the diagnosis. 

3. The great cause of apoplexy is a sudden cere- 
bral lesion, which may be tnumatio or may occur 
without external injury. Iqjuiy may lead t« 
apoplexy by simple concussion, by laceration of 
bnun, or by rupture of vessels and hmmorrhaga. 
Apoplexy, not due to injury, may be caused by 
congestion; by thrombosis or embolism; but 
especially by hemorrhage. The latter is its moat 
common and moat efficient causa. Profound ccmo- 
is rarely due to any other spontaneous cerebral 
lesion. A very small hemorrhage may caUM 
apoplexy. 

3. Lastly, apoplectic symptoms may ooenr with- 
out obvious lesion of the brain. The coma which 
resnlts from concussion, that which succeeds aa 
epileptic fit, and that which, in the absence of 
any recognisable cause, bas been called ' aimpla 
apoplexy,' furnish examples. 

PaTBouxiT. — In all these cases the apoplexy 
is in relation chiefly to the extent and snddonneaa 
of the lesion. Roughly speaking; its occurreuc* 
may be said to d^nd on the suddenness, ita 
degree on the extent of the cerebral misefaiaC 
Butthaoocunaneaofapoplazy depends sometimsa 



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APOPLEXY, 

* dw nzb ai UialMiaD,&sd the degree rariea not 
Mlydinetly with the extent of the miachiet but 
with the extent of Inun-tianie which is expoaedin- 
Crectlf to the irritative infiaence of the primiury 
lanoB. Heoee positioii of lenon has an important 
iafiaeaee in determiniogthe apoplectic iTOiptoma. 
Fcr these Mrreml reaaoos apoplexy is especially 
nofenni when the hemoirhage alFecu both 
oemistdieiea, either by nraaltaneoni exti»va- 
Mtioa on each side, or aa the reanlt of hemor- 
ibage into the lateral rentridea. 

The pieeiae condition on which tha apoplexy 
■ imaudiately dependent has been a matter of 
liqmta^ It was formerly ascribed to the prea- 
snre exerted by the dot on the net (tf the tnain, 
either inflneadng directly the cerebral tissue, or 
pnasisg on and emptying ita capiUariea (Niemeiy- 
a). That anch preaanre is exerted by a Uiga 
loniarrfaa^ is nnqnestionable. The couroln- 
tkms on the rade of the extraTsaation are flat- 
teaed, andthe&lx ia bulged to the oppoaite side 
(Hntdunskin, Jaeksoo). It cannot be doubted 
that the intansty of the apoplexy in these easea 
is dne in part to thia cause. But this will not 
explain the ocearreDce of the symptom in small 
faaemorrhagea, by which no genenl pressure is ex- 
erted, or not more than is at once reliered by the 
di^laeeneot of the mobile fluid which aur> 
muids the Teasels. It will not explain its ooeor- 
reme in laeention of the bisin, or the early loss 
of eooBcioiianeaB in sercre hemorrhage, in which, 
as Jaoeood insists, it shonld, if merely das to 
neaanie, be a late rather than an early symptom. 
Tliere can be little doubt from these consider*- 
tiooa, and &oin the eases in which there is no 
leco gn i sa bte l»ain-lesion, that shock ia an im- 
portant element in the causation of apoplexy. 
Tina ia eorefanl hsmonrfaage the apoplectic 
mnptoma are dne in part to the influence on the 
test of the hcain of the irritation of the nerre- 
elanaata hj laeantioii. We can thus understand 
wl|y taaeolaroeetaaion causes a fighter degree of 
apiMlaay, ataee ths immediate irritation of the 
loBU anraia is less than that of laeention ; and 
•bo VI7 laooos of the poos jnoducs as they do 
tuA dnpsnd loBg-continaed coma, since the 
iiiilstiil fibres sre connected with, and thus 
{■ftiTiirr iadireetly a large part of the oerebmm. 
Simp/e AfOfUx^ was a term giren by Aber- 
asaabu to toe eases, once thought to be fnxjnent, 
ia which apoplexy ocears without recognisable 
■lef or blood-poisoning. Some of 
-1 vara piobably instances of nrsmie 
sad others may have been dne, as 
Bastiaa suggests, to eapillair embolism, 
I are not infrequent to which neither of 
these exptanatjons applies, in which death occurs 
ia an spopleetifiirm attack, all orsans being 
femaA kealuiy, and the brain only exhibiting, in 
—■— rrrr with the other organs,' that passive con- 
gestioa which lesolts &am an asphyxial mode 
ef death. The Datare of these cases is still 
a^atarioas, bat they may be grouped with those 
ia which fstai coma fallows an epileptic attack, 
sad is vpgmB&j due to the bniin-shock pro- 




ftnsu JtfOfUxy is a term applied sometimes 
Ic eases ef &tal apoplexy in which no lesion 
is rtisiiaHislilu axeept azeess of serum on the 
t c< ths hnin. It is now understood that 



CEBBBBAL. *» 

•neh serous eAision is -met with eouatantly I* 
atrophy of the conwoLotiooa, rarely in Bright** 
disease, and nndor no other circunaBtanc««. 
There is no reason for aasoeiatiog ita praaenca 
with the apoplectic syiDptoms. Tho casea da- 
scribed under this tjerm were probably inataxkcaa 
ol nnemia, or of ' nmpla apo^xy ' in old paraooa 
with atrophied hrakixxa. 

SntPToxs.— riio pxonunentfeatureof spoplazy 
is loss of consciousxiees without obvioua Ciiltaza ^ 
the heart's action. The onset is ofiea inatsnta* 
neoos, so that tlko amSerer {alia to Lhe ground. 
Ths face may be flushed or pale — it is rarely 
very pale. Tba lx.eart and arteries beat, oit«(| 
witJi undue force aaxid leasened frequency. Ba. 
si>iration continia«e, ^^^'BlAbouredandatartoioiia 
with flapping eheelcs. The limbs are motioalc^ 
In severe cases xxo wwflex action can at first b« 
excited. The pxxpila may be dilated, contracted 
or unchanged; azi profound coma they »>r 
usually dilated ; .»«»<* they often -rary in ,\^ 
spontaneously, besiaar «lnggial, in their setjon f? 
bght Thsi»tie«it«aiin«q«u^,„j^o^ ^ti^^^ 
often with aifficultw-. Ti, sphiactexs permit thZ 
escape of unne sum! isMes^ or the nrina mKjhZ 
retained. In a oase at moderate aewerity tW 
reflmc aouon soon rtttuxtm, tha co^janctivw beoomZ 
sensiUvs, and the patient can be roused to exhiU^ 
some sign of conseioiisoen, shows letumin^ 
power of voluntary mtxioa, ©pons his eyes whs^ 
spoken to, and tries, irhea told to do ao, to n»C^ 
trude his tongue. On the other hand, the ap^^ 
plexy may continos or may deepen in intensftw" 
the patient 4ying at the end of a few bonis or 
few days. Death rarely ocems in a shorter tiii»^ 
than two or three hours. In wery rare instan^l!? 
an extensive hemorrhage into the pon. ^** 
medulla may stop the te^>ir»4Jon and kill |i?^ 
patient in a few minnteo. ^^* 



It 



IS not often, howevexv tAixX. there 



^t^U 



simple loss of cerebral fbnefcion, unifoj^, j^^^ 
tributed, and gradually deepening q, ^ ~*— 
away. Iluch moreoommonlv' t^esyQ)|v„'''''*">^f 
local cerebral lesion are aJ«ied to those"/* **^ ■•* 
plexy. Frequently sudi synptoms pneed »i! *P**— 
of consciousness— nnilatatal "^^^^OtsBH .^'^^^ 
of the month, eouTulsion. Tliev tony 'r^^Mios* 
nised during the attack: the •I'mbe'oB '*'!'^"~ 
exhibit more complete museoUar feUi",""' *'S^ 
those on the other ; they fall mart helni '\ I'" t^s-ra 
raised; or there is unilateral rigij/l ^'''v »4eia 
spasm, unvaried in iu sent ; or ;„ ^ "'' '^°oxo 
pupils is observed, or roudon of th*^)""'''' ***" 
coqjugsta deviation of the eyes. ,\g ?i "'' •»<! 
recovers, these local symptoms become tn ^*^*°* 
more distinct, the tongue deviatfs on dm* " i*"*^ 
speech and swallowing are difficult, or S"^"^™*' 
ma^ hare lost the use of language. 'Pstient 

In ingrateseent apoplexy the commeDr. 
of the cerebral mischief is marked by bttb^*"" 
of general dioek, without any, or withliB^ 
transient, loss of consdonsnees. There is eo ' 
monlj pain in the bead, and there may be oth"** 
localising symptoms. After aome honra, duns' 
which the patient may continue his oeoupatioi? 
coma gradually comes on and deepens intodeath' 
Thia form of apoplexy, first described by Aberl 
crombie, is usually due to a slowly incnoaua 
cerebral haemorrhage. ^* 

The temperature in ceiebral apo^e:^ jg at fli«a 



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74 



APOFI^XT, CEREBBAL. 



kiwajt I«wend, bat wnally the &U h imall, Mid 
it raeeeeded, aftar twalr* to tweatj-taaz boon, 
hj a rile. 

Suoxosis.— From ths nneoiueioufneia due to 
cardiac tyneopt, apoplexy if eauly diatingniahed. 
Id the former the haart'a action fiula, the pulae 
ia weak and impaicrptibla, the face is very pale, 
the napintion is righing and irregular, reflex 
action is rarely abolished, and the sphincters are 
seldom relaxed. 

FromtheaeTend fommof toxamia thediagnosia 
ia often easy, aometimes extremely difficult. It 
ia easy when, on the one hand, the symptoms 
of apo^exy are preceded or accompanied by 
those of a local cersbral lesion ; or when, on the 
other hand, the direct or circnmatantial eridence 
of poiaouing is clear, or the sjrmptoms of toxemia 
nnmiatakable. Where there are no local symp- 
toms, and where no guiding histoiy ia to be 
obtained, the diognoaia ia difficult, but a correct 
opinion may commonly be formed by an attentive 
comparison of the symptoms present. 

There may be, as just observed, indirect eri- 
denea of toxiemia: the breath may smell of 
opium or alcohol ; ths urine may contain albn- 
min. But albuminnria or a smell of spirita may 
mislead. Cerrbral hamorrhage often occnrs after 
drinking ; spirit ia constantly given to a person in 
a fit. A smell of spirit must therefore only be 
allowed weight in the absence of any evidence of 
eerabml mischief. So, too, albumin is always 
present in the urine in nmmis, but it is also very 
neqaently present in cases of cerebral hipmor- 
rhaige. Alone, this evidence of Bright's disease 
is of little value, except ther« be general oedema 
and the patient be young ; then unemis is more 
probable than vaaeulardegeneiation and cerebral 
namorrhage. But with othrr symptoma which 
indicate uremic poisoning, albuminuria is con- 
clusive. 

The age of the patient should be considered. 
Late life is in favour of bmin-diseaso. The 
history of a fall or Mow on the bead adds weight 
to other symptoms of cerebral mischief. 

The character of the eoma will sometimes 
guide. In ummia, and oommonlyin alcoholism, it 
is leas profound than in cerebral mischief. The 
patient can readily be rooaed. In apoplexy, 
in opinm-poiaoning, and in the most intense 
alcoholic poiaoning, the coma may be profound. 
On the other hand, in cerebral hamorrhnge the 
patirat, aa Dr. Hogblinga Jackson remarka. may 
aometimes be roused to answer questions. Violent 
straggling is strongly in favour of drink. 

The mode of onset of the coma is important. 
In apoplexy it is sudden ; in nramia slow. The 
uremic patient becomes first drowsy, then coma- 
tose. Bat with convulsions onemic coma may 
oome on suddenly. The onset of the eoma of 
opium- and alcohol-poiaoning is also alow. In- 
giaveacent apoplexy ia of deliberate onset, but 
a profound degree of coma is quickly reached. 

General convulsions at the onset exclude drunk- 
enness, and usually opinm-poisoning, while thry 
favour uremia. Cerebral mischief sometimes 
commences with a convulsion, but the convulsion 
is then commonly unilateral, and one-sided 
aymptoma are almoat alwaya afterwards to be 
recognised. Sigidity of limbs or local muscular 
twitebing duriog the coma is, if constant in seat, 



ia favour of cerebral miachief ; if variable it 
position, it ia in favour of uremia (Reynolda) 
Poat-opileptic coma is of course preceded by i 
convulsion, and should be borne in mind. 

The state of the pupils is alone of little im 
portance. Great contraction occnra in and 
fuggnts opium-poisoning, but it is present ia 
hemorrhage into the pons Varolii. The pupils 
may be normal or dilated in uremia, in alcohoUa 
or opiom-poisoaing, and in apoplexy. Inequality 
of pupils, an unilateral symptom, pointa to 
brain-miachief. The retina shonld be examined, 
since the presence of albuminuric retinitis points, 
in the abaenee of the signs of a localised cerebral 
lesion, stiongly to anemia, 

Lutly, the temperature should be noted. In 
uremia there is persistent uniform depression ; 
in cerebral leaions the initial depression is so^ 
ceeded by a rise to a point above the normal. 

The diagnoaia of the eatue of cerebral apoplexy 
will be described more folly under the heMS of 
cerebral consmtion, hemorrhage, and softaning. 
It may be nere pointed out that slight and 
transient apoplexy, without local symptoms, with 
flushed face, and coming on during efifort^ points 
to cerebral congestion ; slight and tnnaiont apo- 
plexy wit h marked local aymptoma pointa to soAao- 
ing ; early and profound loss of consciounnees to 
cerebral hemorrhage. Post-epileptic eoma may 
be distinguished by the history of epileptic 
attacks; or, if this be not forthcoming, it may 
be suspected if symptoma of local cerebral lesion 
or indications of toxemia are absent, if the 
patient be under 40, and exhibits indications of 
speedy recovery. ' Simple apoplexy ' cannot be 
diagnosed during life, since fivedom from the 
symptoms of a local lesion does not afibrd 
ground for inferring that there is no such lesion. 

FaooiioaiL — The prognoaia in cerebral apo- 
plexy depends in part npon the intensity of the 
attadc Aa long as unconsciousness is complete, 
and reflex action abolished, the patient is iadangor 
of speedy death. The longer uie apoplectic con- 
dition lasta without improvement, the less pro- 
spect is there of recovery. Persistent depression 
of temperature, or a rise of several degrees above 
the normal after an initial fall, are both of grave 
significance : such cases rarely rsoover (Chaioot, 
Boumevilli;). 

The nature, extent, and position of the eera* 
bral lesion, when they can be inferred, furnish 
other prognostic indications. In hamorrhsge 
the prognosis is more serions than in softening. 
A sudden occurrence or increase of apoplaetie 
symptoms, a few houn or days after a sbgbter 
attack, is alwaya grave, indicating a freih «z- 
tnvaaation. If such apoplectic symptoms beeoma 
profound and uniform, the prognosis ia &tal, 
rapture into the rentridea or on the smflw* 
of the brain having probably occnrred. If tha 
localiring symptoms point to a lesion of tha 
medulla or pons, the prognoaia ia almost aa aa- 
fisvourabls. Early return of oonscioosness and 
slight alteration in temperature are favonrabl* 
signs. Pnvious oereluHl disease renders tha 
prognosis worse. Lastly, the prognosis must b* 
influenced unfavourably by any iii.painnent rf 
the organic fractions of einnilation aind nspic». 
tiori, iraetliMr iad e paa de iit of «t dM to tho Mn* 
bral lesion. 



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APOFLETE, CEBEBBAL. 

Imuxtaan. — Tba tnatment of ewebnl &{»- 
pigij mast be gaidad hj the indicaUona of ita 
mwii Where nooa can be obtained, it ihould 
ba treated aa e«cbial bcmoirhage. Still- 
Masia the moat impoitant condition. The patient 
■honld be moved aa little aa possible, but placed 
IB the recumbent postore vith the head (lightly 
laiaed. The necksbould be froed from constriction. 
If the estzcmi ties are cold, varmth nu; beapplied 
to them; and cold to the head if there is local 
beat or flnshiog. Sinapisms to the neck and ex- 
benities sometimes s<«m to hasten the return of 
eoasaonaiiesB. The administratioD of stimulants 
■hoold be r^nlated hj the state of the heart. In 
thrombosis or embolism the heart should be kept 
up td the normal bj very careful administration 
of akkhol, ether, or ammonia. In hRmorrhage 
it may be allowed to fell a little below the nor- 
mal, bat indicationa of £iiling power should be 
vBtcliad for mad counteracted. Where no cnusal 
indiratinn exiata, the Utter is the wiser plan. 
Veneaaetiioo and purgation are remedies of similar 
efiiect, bvt different in degree, and are indicated 
by high artoial trason and cephalic conges- 
tion, dMwn by incompreasibility of the pulse 
and flashing c^ the face. Venesection is useful 
where the heart acta atrongly, and the pnlsa is 
fhJl am well aa inoompreasible. Its effect is 
praportum^ to the rapidity vith which the 
blood is tak«n, rather than to the quantity 
reaored. PnrgatiTea remore serum from the 
Uood, and leaaen the amount of blood within the 
aknll by causing an afflux to the capacioiuintestinal 
naselsL The beat purgative is crotou oil. With 
a failing heart and pale surface they sboold be 
arradcd. Diuretics may then be used to relieve 
the Tsacalar tension. Aa the apoplny dears, 
the aatan of the ease becomes evident, and the 
Ucatmcnt of the several conditions is described 
alaswhete. (See Baux, Hnmorrfaage and Soften- 
ing at) Tor treatment of the other eausss of the 
apofdectic state, «« Alcoholisk, Poisons, and 

UUEXU. W. H. QOWBIU. 

APPBlTDrZ VBBUrFOBlUS, Inflam- 
wfl^r^, Uloeration, and Perforation o£ 

DsnxmoN. — Inflammation of the appendix 
vcDnifannia from lodgment of hardened fieeea 
sr a foreign body, leading to ulceration, frequently 
aading in perforation of the coats ; to inflammn- 
tion uid ani^Niration of adjacent tissues (peri- 
lypUitis) ; and to peritonitis, local or general. 

JBnovoat. — ^Tbe nsnal eanse of this affection 
is s Cmign body (c.^., fruit-pips or -stones, a 
saiaJl boor, Aot, pins, &e.) ; or a fiecal concretion 
imprtsoned within the cavity of the rerraiform 
appaodix. Perforation has been recorded in ty- 
phoid fever and tnbenmlous disease. 

AxaTDMicAi. CHAiutnsRS, — Before perfora- 
tica takes place the ap^ndix may be found 
diateaded with pus ; a foreign body or concretion 
lodged within it; and the mncons membrane 
•ItnrA'* The concretion or concretions vary 
ia Bsa from a amall pea to a bean ; are usually 
taswB and bxid ; and consist of layers of con- 
dsned facea, seeretiona, and phosphates, depo- 
■lai Broad a small nucleus, whtth may prove 
la faa asaed or otberibrgign body, or a piece of 
■aaaaally iaspisated fhcees. These concretions 
gnady Twaililo, and aia oftoo mistakan for, 








APPENDIX 

fruit-stones. Ulceration 
cur at any part of the app^: 
at the extremity or the lo'^W' 
be a circumscribed perit-oa 
perfomtad part of the ap[>«z 
herent to the sunoundisf j» 
cncum or the abdominal iv^kI 

Stkftoicb. — Pain, genor:^! X 
right iliac region, may be 
attract attention, and, as 
local peritonitis or peritypla J 
may suspect the nature d C' 
sence of premonitory sympC^o: 
istic tumour of typhbtia, mt.MM.<^ 
struction, excluding inflam awi 
Often, however, the course fV< 
and the mischief is suddenljr -B. «»5r«sa.) , 
ation into the peritoneuna, ^Sot2Jo«%>'^^^ 
and rapidly fatal peritoniti*. ~ 

in front of the slowly advan^v 
localise the consecutive inflatasaxKU^f ^^^ ^ 

The substance imprisoned nwi^iMMzt .*>, ^^ »^5 







of 



CilQ 



>1 









mN^N^ 



-u! 









♦>«-^Q 



'^K 



typhlitis, pericacal abscess); or (^) tt^ ju**, 



may be dislodged by (a) infl. 
puration of the tissues aronnd 
typhlitis, pericacal abscess) ; or C^^ ij 
at the point of perfontion, ha.yr£ag^ f^ 
rent to the cncnm, a cnmm n n i<-fT ftf-.^^.''* 
lished with this part. ^>r^i 

BiAoiroBU. — Inflammatoty afleot; 
ctecum and of the appendix can rar^^^^ 
distiDguished from each other. laffff-y 



--<^^ 






^-^^^^^^ 






the appendix is apt to peisiat, cooti***«fc^ «>/« 

' ■ — i-:i !•■!- •>l»j*C 



acute and severe; while cceitis Bia»*?**i^tf^^-{f- 
by free relief of the bowels. Csecit i,^ •Sli° ^ 
ration is apt to follow intestinal in' ^tb^"'^ 
the alarmingly acute and rapidly fatal**** •" **jv*" 
of inflammation with ulceration and nei?''*"'"'** 
of the appendix often arise during porSIt h***'"" 



Inflammation of the cellular tissue 



»««noojKBn 



the cscuro (perityphlitis) is more oommonlyth* 
result of ulcerative inflammation of the ciecn * 
than of the appendix. The complete investment 
of the appendix by peritoneum contributes to 
perforation and fatal general peritonitis. 

Pboohosu. — General peritonitis from sudden 
perforation into the cavity of the periioneum 
IS the great danger, recovery from which is 
extremely rare. Inasmuch as this may occur at 
any time during the course of ulcerative inflam- 
mation of the appendix, a guarded opiuion should 
always be given when there is suspicion of the 
existence of this affection. Continued uneasinesa 
in the right iliac region without indications of 
fecal accumulation, or of inflammation in or 
around the ciecum, should not be regarded 
lightly. Though this serious accident u less 
apt to occur after the formation of adhesions 
around the advancing ulceration, we must not 
forget that well-marked local inflammation of 
the peritoneum, or of the cellular tissue around 
the cecum, does not always prevent it, inaa- 
much as the adhesion which may thus form may 
not be sufficiently strong to withstand the pres- 
sure of pus in the appendix. 

TnaxTKBirr.— The patient mnst be kept at rest 
in bed, hot poultices applied,and an nairritating 
fluid diet allowed. Opiates, for the purpose of 
relieving pain and subduing the peristaltic con- 
traction of the intestines, should be freely and 
continuously administered ; and if imtabuity ot 



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f« AfFBMDIX VKKUIFOBHiaL 

the (tdmusb axut, tiiqr ihooU be intradnoed hj 
enetDB or bj lubentknaoo* iqjectioti. FeritomtU 
or othar eomplieatioDa moat be treated u they 
OsosoB Olitkb, 



APPBTtTB.— In diiesM tbb denfefor food 
maj be either leuened or inartastd ; or the appe- 
tit* maj be pervtrttd, and a longing for Tanuos 
aabataoeea nnlltted ibr or incapable of digeadon 
Bay be diaplayed. 

Lou tf appttitt — Anortxia aoeompaniei 
almoet all forma of aente or chronic gastritia; 
and a* theae affaetiona eonatantty eoeziat with 
other diatsaea, great variety aa regards the derire 
for food ia manifested in Tarions complaints. 
In acute gaatritia there ia often not merely a lose 
of deaiie for, bnt a poaitive areraion to food, 
and the patient roeolntely resiata any attempt 
at obliging him to take rithw solid or liquid 
nourishment. In the more diionie forms of gaa- 
tritia the distaste for food may be only sU^t; 
in some eases the appetite ia increased, but ia 
qoieUy satiafled as soon aa a small quantity of 
food is taken. In chronic ulcer of the stomach 
the appetite, as a role, remains good, and the 
patient ia only prerented £ram indulging it by 
the foar of the pain that will result from his so 
doing. Whenever the secreting structure of the 
organ is extensively diseased the appetite fails. 
Thus, in atmpby of the stomach the desire for 
food genemlly lessens alone with the diminish- 
ing strength of the invalid In cancer of the 
stomach tiiers is always an extensive destruction 
of the glandular structure, and loss of the appe- 
tite is a constant and prominent symptom. 
It must be remembered that a loss of appe- 
tite may be more apparent than real. The phy- 
sician is constantly consulted on account of this 
iymptom, when a little inquiry will show that 
Hie patient is really digesting as much as his 
qrslem rsquires, bnt that by s habit of eating 
withont allowing a proper interval between his 
meals, or by indulging in food of too nutritions 
a nature, or in an undue amount of alcoholic 
stimulants, the sensation of hunger is prevented. 

Inenaie of appetUt — Bulimia usually oeenrs 
where there is a neceaaity for an increased supply 
of food. Thus it is comnioa aftar all febrils 
diseases, where the stomach has been long inac- 
tive. Again, in diabetes, where a huge portion 
of the food ia paased off in the form of sugar 
instead of being convntsd into the matanal 
required to keep up the nutrition of the body, 
there is an nnnsually laiga appetite. A craving 
aensation is a common symptom in cbionie catar- 
rhal gastritis. It probably arises from the ir- 
ritation set up by the mucus and fermenting 
substances long retained in the stomach, and is 
temporarily relieved by eating. The bast tnat- 
ment for such eases is to give alkalis about half 
an hour before the eraving usoally occurs, at the 
same time that the aifoetion of the mucous mem- 
brane ia combated by appropriate diet and reme- 
dies. In some persons the sensation of extreme 
hunger appeara to arise from an irritable condi- 
tion of the stomach, by which the food is passed 
into the dnodennm before digestion is completed. 
The sensation is mostly complained of at night, 
and the writer has found it a good plan to let 
Ike patiaot have sani* hwf-t«« or mmk loasages. 



ABCUS BENILia 
for •xarapla, either just beforr retiring to nst or 
daring the night In children a eraving for food 
ia a frequent symptom, and aiiass either from tb* 
irritation of worms, or feom chronic catarrh of 
the mucous membrane of the small intestines. 

Ptrienion of appetite — Pico is most common is 
pregnant or hysterical females. Curious articles, 
such as chalk, cinders, and slate-pencil, are some- 
timea swallowed. In the insane and in idiots 
articles of an indigestible nature are not unfre- 
quently introduced into the stomach, such as 
string, paper, cocoa-nut fibro, &c. 

It is a matter of great importance that all 
persons, but especially dyspeptics, should ac- 
custom themselves to control their appetite. 
Whenever a larger amount of food is taken than 
the stomach is capable of digesting, the residae 
is apt to ferment and thereby to produce gastric 
catarrh. This is mora especially the case where 
the digestive powers have been enfeebled by 
previous attacks of gastric inflammation. 
8. Fkhwiol 

AFTBXTIOS. See AxnPTBmcs. 

AFTBXXIA. (ti, priv., and nvfUtu, I am 
feverish). — This word literally means aijsenee 
cX fever: it is also used to denote the interval 
between paroxysms of intermittent fever. 

ABA.OHS'ITIB. — Inflammation of the 
arachnoid memhnne. Bu Hawxxorns. 

ABOAOHON, Wast aoaat of FraaoeL— 
Summer and autumn resort. Sheltered by pine 
woods. Calm in winter. 8e$ Gtoura, Txmb' 
msnt of DisfiSB by. 

ABOU8 SBHIZjIB is a croscentie opacity of 
the cornea, within its margin, often seen in old 
people. Thearcus is usually first observed in the 
upper part, and soon afterwards a smaller cpsque 
crescent, opposite to this, appears below. In the 
course of years the two ereaeentie marks become 
slightly wider and more opaque, their point* 
having at the same time extended much more con- 
siderably in proportion, so that an oanvtm or ring 
is farmed. It probably is always widest and 
most opaque above, and wider and more opaque 
below Uian at the sides. An arcus is grey when it 
first appears, but it may attain at last to an 
ivory whiteness. It is especially noteworthy 
that arcus, besides being regular in shape, of an 
evenly-graduated degree of opacity, and well-de- 
fined at its inner margin, is never continuous with 
the opaque sclerotio external to it, but is always 
separated from this membrane by an extremely 
narrow line of demarcation of unaffected corneal 
tissue, which, as It is normally almost transparent 
bara at i ts margin, is the more conspiennns hj fores 
of contrast with the new opacity. At the same tim* 
it must be obnerved that the well-defined opaei^ 
is moat opaque in the centra or alightly external 
to the centre of its width, at any part ; so that, 
although it is everywhere well-defined, it is shaded 
off somewhat abruptly towards its outer ciicum- 
fennce, and more gradually at its inner maigiD. 
TIm kreos is much more prone to increase in opa- 
city tbui in width. It rarely attains a width, even 
at the upper part of thecomea, of more than iin. 
It is vsry conspicuous when backed by a dark 
iria. Tlie cornea within the rrgular bookdariaa 
of the arcus senilis remains peifcetly transparant, 
sadviiioiiisinaodagfMimpaiasdbyit. WimwU 



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cue 
the 0°** "tSrtenl. a«»^ 



HoMb 






to th« 

aepiwMiioB^ inteiMa 
epigastj-io -raoipn. 



in 

^ of 



' iad riA°'*Jv^«oit»a »»»««« are «att»«meiy 

' of ptolonwd "»"«'■ - *.— — ^..- 

-riti Wood. 






•w* »*-^"?!^^t»nt fetty ^^*^ But 



of piolonwi •JJ'^'^y -roBUtiDK la .pcMdaJj. 

'''^ OtbM P"""? . rJuT and «=old. csUwjmbj- 
^r The l»ti.«'»? r„T!.r^of coU^v-* ; b« 



I)uo«»«»^5^^t or by deco«»»P?"»*« food. 



;^; .T^ P^^^^n ordinary ^^"^J^Y^ 
I)uo«»«»^5^^t or by deco«»»P?"»*« food. 

-^ i ™o»*hl. «- — ' - ^l'^^W»"*'.t^^«*^'**J*^*** 

"J'^^Srt-AitsM •«''\"^L3tit»i»««*^\!Jf«itent cii««?-..»°\ "^ ,»an »a|>«w~iiiiar on 
^^"''fSUi»»P'rl!«^iW»' •• *^* t5&» '""'^"^oHtofwdrinfc of » ^, 

«*• ."".il^ttd ^A • «* ;'L- J-* *« I ^Jtond. ox P«« \J 'i/Sgw-W b^r the 

d^il»»ie di»rrli«»»4i,5rt,to.ixty minute. 



miDute* 

ua abaenca 

rfS;^foodordnDki»-^-;j-S;v^iy -o£ the dan ; 

^'^e.-*»t»r •»^l5„"otyi«li'"8 to treatment 

id by t»«.»yS;SSSg by «»«°K**T" """iS' 

lM»^«''°,!^«ro«r the .pigwt""?": th« 

«M&t«r tendetnee* ojo ^^mpanied with 

_!Lt«iie»nin»W*V° wo^v: and ncrvoTW 



^ter tendetnee* ojo ^^mpanied with 

g^iU U ^""^^C&ic di«Th<B. ; the 

!^ t«no»nin» t** V unndv: oo^ ncrvoTW 

"'*?- «• i»o» "*^'' ^^^. The dug. 



"*• 2!Sr*tateT«t be ^« ^J^ The n«>et 



""^.^i^ "^^ "Tiiied. Thedul^ 
,jm^M» ^ ojtan Terr " ^^^^ 

" w idea by » cl^»""^ronAhe «c«,U, 



;,jr from the »w™^ j I \n donbtful a»e«. . 

'^t»S-TT^Cto j^i» 'I'' ir- 

^y„'^^:;o^^ ... «i™nt^ •»4^'^.- 



T»»AT>^'-_f^te remedie.: ^'"VTS 



•■" K^L^Jt, of ««*" "^^ ^r<i Mienion»Mitt , i 



5'«tia<». •"f^.r "ireee ot Mi>eni»» 






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re ABSENIC, POISONINO BY. 



snee eomidieatcs > ebemieal analyrii. Uoie- 
srer, tartar emstie iireqawitly oontaioi tnees of 
kmnie, and, in the avent of an analnii being 
mads, an unfounded snapieion ma; be raised. 
No confidence can be placed in the lo-called 
antidotes, /«me tmdrate and magnesia, except 
where a aolntion of anenie ha( been taken. 

B. Ohronio Anenical FolaoninK. — Tbia 
fbm bf poiaoning ia not uncommon, and is, 
vnlike the acute form, generally accidental. 
The inhalation of arsenical raponrs in factories, 
or of arsenical dnst, as from green and other 
wall-papers, and in the process of mann&eturing 
artificial fiowen, is a oommon sonrce of chronic 
arsenical poisoning. 

Those who are diiefly exposed to this fbrm of 
poisoning are persons employed in the manufac- 
ture of pigments, especially green pigments ; 
paperhangers and decorators ; artificial-flower 
mannfiusturers ; milliaets; persons exposed to 
the femes of heated metals, partieulurly rino 
and bi-aaa ; manufacturers of dyes ; and leather- 
dressers. In the process of depilating sheep-skins, 
prsrious tA the tanning or the tawing process, 
a mixtoro of lime and OTpmvatiadfhide <(f 
anenie) is used ; and serious ulceration of the 
hands, scrotum, nose, and cheeks not infrequently 
Nsnlts. PMsons living in rooms the walls of 
which are covered with arsenical paper, especi- 
ally bright-green papers containing arsenite of 
eopper, are liable to snfier from chronic arseni- 
eat poisoning. It is uncertain whether this is 
•ntinly eanaed by the mechanical transfer of 
pigmentary dust to the air-passages, or is partly 
due to volatilisation of the arsenic, probably in 
the fimn of angimmtttdh/dngm. Many brown 
wsU-papers also contain arsenic, and arsenious 
acid IS sometimes added to the size ; such papers 
hare been known to piodooe the specific symp- 
toms of arsenical poisoning. 

That some persons can take anenious odd 
internally with impunity in relatively large doses 
{«rt»»ie-*ating) is now a well-estabbshed fact. 

SmTTOMS. — The first symptoms of chronic 
arsenical poisoning are usually loss of appetite, 
precordial pains, irritability of the bowels, and 
occasionally headache. 8nn\ision of the eyes, 
a peculiar and characteristic appearance of 
the ooigunetiva, often amounting to actual 
coignnctiTitia, and intolerance of light are early 
manifested. The muscular power of the limbs u 
impaired pretty constantly, and actual paralysis 
extending upwards troxa the lower extremities is 
oecasion^ly observed. A characteristic vesicular 
eruption on the skin {tesema arttnicaU) is fre- 
quent, as well as irritation of the skin, especially 
over the neck, scalp, hands, and armpits. Ifales 
who handle arseni^ preparations are liable to 
ulcerations of the seTotum and penis, obviously 
due to a mechanical transference of the poison to 
the genitals when these are touched. If the source 
of the disease be not removed, progressive emacia- 
tion, exfoliation of the cuticle, and nervous pros- 
tration supervene ; and convulsions may precede 
the fatal termination. The effects of green 
arsenical pigments are sometimes manifested by 
bleeding firom the nose. 

DuoHoais. — When a patient snflbn more or 
less from the symptoms above described, and is 
also Imown to be evposed to any of the louKet 



ARTEBIES, DISEASES OF. 

of danger from arsenical poisoning enumerated 
under the etiology, the diagnosis is not diffleulL 

Tbratiudtt. — The source of poisoning should 
invariably be removed. It is found that those who 
suffer from working in arsenic make no progress 
towards recovery until they are remo-red from 
contact with the poison. Wall-papers which 
contain arsenic, and are suspected to be the 
causa of symptoms, should be taken away. 
Quinine, or other tonics, iron, and attention t« 
the digestive organs will be needed. Kconoval 
to fresh country air is often productive of marked 
benefit. Soothinglotions to the skin, andeareAiI 
attention to eroding ulcers, especiallyof the cheok, 
may be necessary. Shampooing and warm baths 
form the best treatment for paralytic lesions. 

Morbid Affeadakcbs. — These are the same 
by whatever channel the poison has gained 
access to the system. As a rule there is marked 
infiammation of the stomach and duodenum, 
usually of the small and large intestines also ; 
but not uncommonly the infiammation is limited 
to the stomach, duodenum, and rectum, the 
intervening alimentary tract having escaped. If 
the poison has been administered in a solid form, 
white patches of the arsenical compound may be 
foandimbedded in thick bloody mucus andiuflam- 
matory exudation. Portions of the white arsenic 
are also sometimes converted by the sulphuretted 
hydrogen evolved during decomposition into the 
yellow sulphide. Ulceration of the stomach is 
rare, and perforation almost unknown. An ecchy- 
mosed condition of the heart is often observed; 
and fattv degeneration of the liver, as in poison- 
ing by phosphorus, has been described. 

T. Stkviksok. 



ABTIIBXBB, Siaaaaaa of.— It is important 
to keep in mind the following anatomical fiicts 
in studying ths morbid processes to which 
arteries are subject : — ^In immediate contact with 
the blood-straam in arteries lies the mdothdium 
—a layer of flattened cells ; ontaide this is the 
tumiM tnMiM, composed of elastic tissue in 
longitudinal arran^ment : together the endothe- 
lium and tunica intima constitute the internal 
ooat of the older writers. Still more external wa 
find the middle coat, made up of muscular fibra 
arranged transversely, in the larger arteries mixed 
with elastic tissue ; and, most external of all, the 
external eoat, consisting of longitudinally fibril- 
lated connective tissue. 

l._ Aouta Arteritla, aibeting a reir limited 
portion of a vessel, and leading to ulceration, 
occasionally occurs. In some cases this has 
arisen from the irritation caused by an emfados^ 
which, becoming detached from a cardiac valve, 
has blocked a distant artery; and Dr. Moxon has 
specially drawn attention to its occurrence in the 
aorta, when the ascendingportion of thevessel baa 
be<-n exposed to the i mpact of a hard, freely moving 
vegetation on one of the segmenLi of the aortic 
valvei _ Dr. Moxon has also described, under 
the dengnalion inflammaton/ molUties, the occur- 
rence of softening and swelling of the arterial 
tunics in circumscribed spots; which becom* 
flabby and inelastic, and ultimately bnlge out- 
wards and form aneurisms. He believes that this 
condition depends on a peculiar general stats, and 
is Um gnat cause of aneuriam in young, hard- 



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ASTBBIB3, DISEASES OF. 



MBUUua UK uiD mnanai uuiics to wntca uie 

agntioa aenta utaritU can be applied. Sac] 
daap has, indeed, been deacnbed, and 
iiitc haa eeen the linins membmna of 



totiig maa. Eseept ia thaaa drenmaeribed 
iiiimBtoiy laaioaa, we do not meet vith any 
eaaifiuoa of the arterial tunica to which the de- 

Sach a 
the 
lining membmna of the 
inadiiig and tranaTene pcrtiona of the aoita 
tf a biigfat Tennilion hne, strongly anggestire of 
iota inflimmatory change ; bat the beat ob- 
Btm are now agreed in believing that thia 
ipfaMinee ariaaa fiom ataicing by hcmatin. 

i. Cbramio Arlaritta haa been deacribed aa 
pnraiag a eonna diflarent from the ndarteriti* 
i ^i twm u , which will immediately be noticed ; 
■a) u caoaing thickening of the eoata of the 
I— li, narrowing of their calibre, and abaence 
of pslation during life. Aa sneh, ehronio ar- 
loitis apppara to be a diaanae of extreme ranty. 
Bit, oa the other hand, if it be conaidered aa 
the flnt stage of atheromatous diaeaae, it may 
ba mid to be of frequent occorrence. 

\. Fariartoritia ia the term applied by 
Chneot and Boochard to the morbid changiB 
■hiA, in their (^nnion, erentnatea in cerebnl 
ti Mauiih age. Aeovding to these physicians, 
forefccal faMuuiih age is not uanally due to 
-itberomatooa decay of the veaaela of the bnin ; 
Nit, in the Tast majority of eaaaa, to the mptore 
)f miliary aneoriama, which in their turn hare 
bean proanoed by a aiorbid proceas beginning in 
the periTaaailar aheath surrounding the cerebral 
raaaela; aod which, proceeding fromwitbont in- 
waida, nltimalaly inTolrea aU the eoata of the 
TtaarU (an Bauv, Hjemotrhage into). 

4. Atlteromatona Disease, the EndarUritit 
it fm aiiiai of Virchow, is the arterial disease 
waieh is naost freqnantly met with, and the one 
whose eaaseqoaaeea are moat ai^oaa. It preaenta 
tfana toVoafcly w«U-de6aed atagea. (a) In the 
fnt stags we Botica^iriien thereasel is alitopen, 
peyiah patches, by which the lining membrane ia 
ur^nlarly thi^aoed ; these patches aeem to lie on 
the wvAet ct the mambrane, but this appearance 
is deeeptiTs; the eodothelinm lies between them 
sad the blood-stream, and is, atleaat atthebegin- 
■iag of the moabid p roc es s , unaffected. The ma- 
taml of which the patches are formed is really 
•taated between the tunica intima and tunica 
media ; it is semi-cartilaginoas in consiateDoe, and 
is fanned by an abnormally rapid multiplication 
of the deepCT cells of the tunica intima, — the new 
growth ptasbing up this tunic with its saper-im- 
poead aododidnmi, and so cannng a bulging into 
the iatarior of the TeaaaL The process ia of the 
f of an inflammatoty change ; that is, it con- 
I in the proUfoation of esllolar alementa, in 
> of some inflaenos which has excited 
tfasiB to annatmal growth. (A) In the second 
stage the eellolar elements of which the new 
gmrth is eo m peee d andergo a process of fatty 
isfsBScatiaa ; asd in eonseqnaaee it becomes 
yallowish in eoloar aod pasty in conaiatence : it 
was the paale-Iika rapaaianee of the mass in this 
alaaa which originally sained for the proceas the 
daaigesCion ^<ieroaia (£hin»meal). It not nn- 
fi iijiisiiilT happens that the whole ot the internal 
•oak with its endothelium is iarolTed in the 
_, aad gma way ander the preasuie of 
hlooil, laaring an ezcaration, the floor of 
ia taaiail bj the middle and external 






eoata of the artery. (0) £ 

erer, the paaty maaa, inai 

away, becomes the seat ofT 

u the third stage in the p: 

of a Teasel in which sua 

reached thia ataga ia veiy 

preaent to the naked eye bb' 

not ahow the minute Bt2 

observed at interrala in %kM 

sel, and their sharp spiewi 

interior ; in the aorta it la — 

sach plates an inch long a. 

and in the smaller arteriai^ >"<> (W| 'Pqk *o ft*** 

sometimes forms a ring roaa.x»d t^^^Q^ ^^w"*' 



*»li« 



--;^ -^a> 






.^ts? 




the latter the calcareous p^fcr-«iaci«^ , _ ^. ^ 

deposited in the patch whxl^ »«• >« t'to^T**!^'*** 
that the second sti^e of the P'Tp'^Q^ ^*'^ll^ » -^Q 

AtheromatoQS disease toMXi^tSrK*.^^ .*« ^ ^l-iJ? ^ 
the aorta and the small woaw— fJ^*. K***"*^*^!^* •o 
m»y be extensively distnsstrf *»»d'** »?*• I'S'- 
arteries nnafiected; or, on tfa^ '-'tK tK ^«i ^4 

cerebral, temporal, and ooron^i':^ 'i^,***" »^ ***'t» 
theseat of calcific change whil«> *' *ti^-*»n ^ -•te.i. 
are healthy ; occasionally the di 
afewvessels. Nexttotheaorta, t£a« ^ ^ . . 

ary,asd aplenic vessels, and tha aar*^ "'"•Bji^ ^'>ti}T'*'U 
extremities, are prone to thia ioni) '^'•s o*^^. p^°^*o 

Effbcts.— The dangera to w-ij,-,.?*" fiD^ej°'^- 
motona atate of veaaela exposes .,' •etr*'''"'£;^*'* 
whom it exists are varied. Tho *t»ji* bL *'*<•«>. 
is retarded by the prcgection of tjj^'*<«»^i'°» /o 
into the vessel, and atiU more b^ m," ''•v ^^°ot/ 
of the elasticity of iU coats ; and i * *^«*tiS'*** 
failure in the nntritian of the org^n ** •aS^J"* 
penda for its anpplj of blood oq tl.***** def 
veasel : — thia is said to be a cauae 0/ '''■eaaad 
softening. When the paste-like maaa is'*"''"*' 
away it aometimea happena that the bl<S*^-"^ 
ainnaUa itaelf between the coats of the vbssST 
producing a dissecting aneurism; or the por^ 
of the vessel, which has been weakened by the 
removal of the internal coat, yields to the pressure 
of the current, and a sacculated aiioiiriam is 
originated; sometimes the diseased vessel bnrsts. 
Cerebral vessels, probably on account of the 
thinnaes of their walls, are specially liable to 
rupture when they are the seat of atheromatous 
change; and occasionally a diseased coronary 
artery has given way, filling the pericardium 
with blood. Arteries have been completely 
occluded by tha depoaltion of fibrin on the 
apiculated edgea of calcareous pUtes : thia ia 
one of the causes of senile gangrene ; and embolio 
plugging of distant vessels at times results from 
tlia dsfaachment of such fibrinous dots, and 
the washing away of atheromatous diabris. 
Bigidity of the larger arteries from atheromatous 
change is likewise one of the most frequent 
causes of hypertrophy of the left ventricle of 
the heart, on which incrcaaed work ia imposed 
in eonseqnenca of the deetructiou of the elasti- 
city of the vessels. Anasarca has not, so &r as 
tha writer is aware, been mentioned by any 
author among the conse^uenoaa of diseased ar- 
teries ; but some casea which have come under hia 
obacrvation have led him to the conduaion that 
peiaistent anasarca, especially of the lower ez- 
tremitiea in alderiy men, ia sometimes mainly 
due to a diseased condition of the arterial tunica. 
In the cases which he haa obscrrcd them irm 



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KfawiM pnMnt dilatation irith hTperbophj 
and commencing &tty change of the left rentri- 
do, itmlf a coueqnance ti the aitarial diBCOM ; 
bat thii eeemed insufficient to account for the 
peniitant cedema of the lower extremities. 

Xiraojnai. — The cause of endarteritis de- 
formans is now generallj admitted to be orer- 
stnin of the vessel. It was formerly thought that 
sjphilitie impregnation of the sjrstem irss a pover- 
ftu iiarcttring condition ; but this opinion rested 
chiefly on obserrations mads among soldien, who, 
in addition to the sjrphilitic taint, vara subject to 
other inflnrnces now known to be adequate in 
themselves to derelop the disease : and the writer 
has himself seen thr most extensive atheromatous 
diaeasein men in whom there was no trace of the 
syphilitic taint. Intemparata habits and gout 
appear to be powerfully predisposing causes ; thpy 
probably render the blood impure, and its pas- 
saga through ths eapillaiy vessels being thereby 
irUrded, the tension of the arterial system is 
ioereaaed. Baades violent exertion, which ira- 
pooea a strain on the entire arterial tree, there are 
other influenoea which act upon certain vessels. 
Thua the renal aitaries are kept oTer-fuU in the 
eirrhotie form of Bright's disease, owing to. the 
destnetion of the capillary tofts, and hence athe- 
roma of these yessels is almost constantly present 
ia that form of renal mischief. The writer baa ■_ 
on two occasions found extensiTe calcareous 
formations in the oersbial vesssls of persons ia 
whom enebral degensiation had followed ex- 
cessiTe anxiety and mental eSbrt. The pul- 
monary artery is very rarely invaded by atheroma ; 
and only in cases in which it has been kept in a 
state of tension by hypartrophy of the right 
Tentride or disease of the mitral oriflca. 

DiAOHOsis. — Ths diagnosis of athetomatons 
inflammation of the aorta will be discnsssd in a 
separate article. The existence of the disease in 
the aiteriea of partiealar organs can only be a 
matter of reasonable presumption when the patient 
ia past middle life ; when the ascertained causes 
of atheroma have been in operation ; i^en 
symptoms of impaired nutrition of the organ are 
present ; and when ths organ (the bisin or heart) 
IS one the arteries of which are known to be 
pfone to the disease. Calcification of ths snpar- 
fldal arteries renders theee vessels rigid and 
tortuous ; the temporals when so afiectea attract 
the eye by their prominenca, and may be felt 
hard and rigid beneath the flagar; the brachial 
nuT equally be made the subject of soomimition ; 
andf, although the presencs or abiance of athero- 
matous change in such superficial vessels does 
not necessarily prova that the other arteries of the 
body are in a similar eonditiim, itrendan it more 
than probable that they are. Those who are 
not fomiliar with the resisting feel of the radial 
artery, when it is ths seat of the change now 
under consideration, are liable to form a very 
erroneous eetimate of the airength of the poise : 
this atay eonvsy to the insxparienoed flngar an 
impression of a force which it does not possess. 
The error also is sometimes committed of inferring 
the axistenee of aortic regurgitation in tfaesa 
eases in oonsequeaoa of the tortooas eoorse and 
Tjaible polsation of the soparflmal vassals; bat 
tksy do not eollapsa aoddaoly under the finger, 
•• do tha vcMala daring the raaading wave in 



jIBTBBIES, BIBEABES OF. 

aortie pateney. The sphygmogisphic traetsgi 
moreover, is essenliaUydinbreBt: in atharomatoot 
disease of the artery the upstroke is vertical, sad 
the summit of the tracing extended. Ttis 
existence of such evidences <^ vaaculiur misehisf 
affords a foir subject for consideration to thoN 
who ant called upon to form an opinion as to ths 
sligibility of a life for assuianes. 

TBaiTKBHT. — The treatment of endarteritis 
deformans is mainly preventive. It consists in 
the aroidanee of all those influences to which 
we have adverted as oanaes of the disease, 
namely, indulgence inalcohol ; onisea originating 
a gouty stats nf the blood ; excessive muscular 
efforts, especially in constrained positions ; pes- 
tures which involve the loug-continued con- 
traction of muscles which surround arteriea; and, 
as far as the brain and heart are concerned, all 
those states which forour overftilnsss of tjisir 
respective arteries : — in the case of the biain, 
excessive meotal application, deficient deep, 
and, the writer believes, prolonged periods of 
sexual excitement; in the case of&ie heart, ta<<r 
alia, tHotXa which involve holding the hrsath, 
thus leading to distension of ita right cavities, 
and imposing an obatacls to the return of Uood 
from its walia. 

6. Vatty SagMiMFatioa, unconnected with 
the atheromatous process, is_ sometimee, though 
rarely, found to afibet arteries. Circumscribed 
opaque and velvety spots appear on ths surface 
of the intima, and eroaion ultimately occurs. 
Once this haa taken place, the muscular coat, 
unable to bear ths preasure of the blood-stream, 
fissures transversely ; and the blood either rup- 
tures the external coat, or, insinuating itaelf be- 
tween the middle and external coat, produces a 
dissecting ansurism. This change has been 
found in the arteries of persons who seemed 
otherwiss quite healthy ; it is * a morbid ehanga 
which is simply degenerative from the first, and 
of whose immediate cause we know nothing' 
(Bindfleisrh). Fatty degeneration of the external 
coat of the smallest arteries haa also ham. no- 
tieed : it appears to be a senile change^ and to 
piny a part in the production of cariiac and 
cerebral degeneration. 

6. Oalolfloation of the arterial tunics also 
occurs unconnected with endarteritis, but mora 
rarely than fatty degeneration. When this is 
ths caae, it is the middle coat of the amaller 
vessels that is the seat of the deposit, which 
(onsists of carbonate and phoaphata of lime and 
nmgneaia. The process is usually limited to tha 
vessels in whidb muscular fibre is abundant; 
but those it may affect extansiTely, the super- 
ficial vessels and the arteries of the brain an4 
of the extremities being the £ivourite arat : it ia 
emiaeatly a senile ehanga. 

7. QmnmattmaP la e— a cf the cerebral aiteriea 
in syphilitic patients has been described by Dr. 
Hu^lings Jackson, Dr. ^Iks, and others. Tha 
vessels present nodose swellings, and are thiok- 
ened sometimes to three times their normal aia* 
by gnmmatona material infiltrating the outor 
coat; the calibre of the vessels is theraby nar- 
rowed, the formation of thromln favoured, and 
cerebral softening piodnoed. 'A random soe- 
oession of nervous symptoms,' to nse the worda 
of Dr. Jackson, affoids stnag gronnds for aoa- 



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ABTERIES, DISEASES OF. 
pe^ag ij^Irilitie cHsene within ths crsniuin ; 
and the writer has himnlf saen three ensea in 
which inch ajmptonu disppmnd nnder the me 
of perdilaride of meiciiiy and iodide of potaasiain, 
aad in wUeh it aeemed to him that the mppoei- 
tka of arterial diaeaae was moefa more probable 
than that of any other form of intraennial 
■vphilia. 

g. AUnuniiiald P l aaa a a, when it attacks the 
•pleen or kidnejs, appears first in the walls of 
the small arteries of these organS) bat is not 
band is the larger arteries of the body. 

9. Oo n traetion and final imparmeabib'ty of 
SB artery £rom atheromatona calcification, from 
Iha aeeamnlation of flbrine in ita rough inner 
SBi&ca, from preanra, or ttam other caoses, 
oeesaooally ocean, leading to gangrene of the 
aitnou^ which it supplied. 

IDL Pilatiitinn of arteries is in the ma- 
joii^ of cmsaa d>e to prerioos disease of their 
coats ; bat sometimes io the aged the arteries are 
faaad dilated without any degeneration of their 
toniea being pccaent, — a state of afhiis which 
Biodfiaisdi soggests may depend on atony of 
the araaenlar coat, and in soma cases may pos- 
sibly be eouectad with deficient innerration. 

II. Aiwaiiam receiras full consideration in 
a aepBEsts artiele. Here it is merely necessary 
to pMnt oat the waya in which atheromatons 
infiammation and the other morbid processes 
which bare been described contribnte to the pro- 
daetioa of dilatation and aneori&m. In some 
eaam the cosne of ereots consists in the wasb- 
iag away of the diseased patch of the intJma ; 
«£n the middle ouat either dilates, or, by 
■faration of its mosenlar bundles, undergoes 
raptsrc, and the external coat yields before the 
preasoe of the blood-etteam. In other cases 
the dilatation oeenrs, not at the point where 
the eodartoitis has inraded the Tesael, but 
Baairr to the htert At the affected point there 
ia Baoowiog at the canal of the vessel, and loss 
of elasticity in its coats ; and as a cooseqneoce 
we kaTB slowing of the eiicnlntion and deficiency 
ia the tapfij of Uood beyond, and increased ar- 
terial tnaaina oa the proximal aide of the affected 
•pot. The effect of this tension is mote serious 
thaa woald at first sight appear ; in health the 
Uood, pcoraeUedby eadirentncnlar systole, enters 
eoatraded Tceaela, which, yielding before it, are 
aaiajvred by its sadden impact ; but a resael in 
a atata trf teuion is enwsed to the full riolenee 
of tha odamn of blood discharged by the heart, 
aad mast gradaally dilate before it 

13. ArteriMl IMaaaas In Inaanity Accord- 
ing to Dr. J. Bat^ Take, sod other phyncians 
who hava specialrr inreBtigated the morbid 
cfauiges in the brains of the insane, arterial dis- 
caas is alaaast invariably present. It consists 
ia aadh altorations as would result from obstruc- 
taoB in tha nitimate laicifications of the vessels ; 
— 'fc«»*-'-'"g of the proper coats of the arteries, 
aad of tha dieath of connective tissue which 
sanoBBik the cereloal vessels ; the deposition of 
Caa isolecalar matter and crystals of DKmatoidin 
ba t'j a i a the adrentitia and tha sheath; and ex- 
tiaae toitaosity of the vessels. 

IS. Axtorio-OairiUazT Tfbroaia is the term 
applied I7 Sir William Gull and Dr. Sutton to 
the hypeitiopby of the walla of th* small anerira 

« 



ASTinotAX, BBajK»Jr:rtAriojj^ 

fc«nd In the sabjeets of Aa«» — = ~i- 

Brlght'a disease. Itisodmif 
of repute that the walls of 



'"•hoti 
the kidney are greatly thiek»iB«<Li m tj^: ^"^i^^*-^ tif 



but it ia by no means so an 5 ■» ». **v 

that the Bmsll arteries th»o«3a^?-*>o'»*t 



.i^-- 



^f 



body are in all such cases bSws-* « 1«*-V.^*^V»^>^^^^' 

phied. That they are hyperti«>j:> 1^^ «i j _ J^^ V-'Mr -* 



proportion of the eases admits o^ >~*^ 

the nature of the thickening jr«^wr»*^j 

eided. Dr. Qeorge Johnson. -<«»^l»c» 

attention to this condition, ct>«»a»«*J *>.^-^^^ 



*C ^"^ 



•"•1? 



t.-t»«» 






to <rr** 






TV, 



ia present an hypertrophy of ftll 
small arteries, especially of th^ 
a consequence of tha obetmcfcio' 
blood invarmbly meets within tJ* 
William Oull and Dr. Sutton, orn 
assart that the thickening is d' 
growth, especially sested in tli« 4 
the vessel ; and they believe tlt»& 
disease of the kidney is not the 
arterial change, but that both rar-e 
general diseased process, JT^anr^ 

ABTBBias, Jmnmlnatlon oi^ 
sicAi. £sAiaifATioMj and PtTLoi. - '^^«i, 

ABTUHAXOIA {iftpor, a Joint ; 
p*in). — Pain in a joint. The term is "^ «» 
ticularly applied to articular pain in t]^°''« paj- ' 
of objective disease. ° "^^"ace 

ABTHBITia {iftftr, a joint) .. 

generically nsad to signify any disease wA,,**™ 
involving a joint, but more correctly confined''*' 
articular inflammation. It is also employed t° 
designate _ infiammation of all the strm-ture^ 
forming a joint, as distinguished fh«n mere syno- 
vitis. iSiMJoilTTs, Diseases of. 

ABTHBODTSXA (iplear, a joint; und 
Uini, pain). — Set AkTHBAioiA. 

ABTICtriiAB BHXUMATIBU.— Ilhoa. 
matism affecting joints. See BHStrUATisK. 

▲BTIVIOIAI. KI8FIBATZON, or the 
method of exciting and keeping up the move- 
ments of the chest, so as to supply uir to the 
lungs, is a subject of the highest imporlan:^, 
since the hopes of recovery depend on ita due 
performance in many eases of narcotic jioieoning;, 
m the apparently drowned or asphyxiated, 
and in the collapse of the advaneed stage of 
the condition induced by anesthetics. For its 
effective employment it is eesential to see that no 
foreign body obstructs the air-pasaagps. Children 
and old people are liable to swallow lar^e pieces 
of meat or crust, which become imported in the 
pharynx or aesophagus. These should, if pos- 
sible, be dragged away with the Ungcr or a 
spoon-handle, but they may require the use of a 
probang. Tracheotomy is rarely neccNsary. A 
knife-handle held between the molar teeth is a 
reedy and useful gag to keep the month open. 
A button-hook, in the absence of ph.iryngeal 
forceps, is sometimes vety serviceable. Vomited 
matter should be quickly removed with a sponge 
or cloth twisted round a piece of wood. In 
treating the half-drowned tbe body should be 
inverted for a few nitrates to fkvour the escape 
of water from the air-fasaages, hut artificial 



**1 






^i>ii'^i 



4 



.-''Q». ^a 






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aa ABTmouL Btttpnunoir. 

tmthiog shonld b* eommMo«d eraa wbilft tht 
tody is in this poiitioii. 

MaraoM. — lo mod aaaaa lbs bcit method of 
eoMiiieiieiiigartifici>lrHpintioni«tooomprMithe 
Aot aad abdomwi sinuilUnaouiIy, than icmora 
pMcnre n aa to aUoiraii to anter theeluat, and 
tgtin repeat the prainm arery tvo or three 
Meands. If the eoand indieatea that air ia paaaiog 
into and out of the lungs, thia method may tw 
cotiaaed for half a minute ; but if we aia not 
■ua that the air is exchanged, and in all eaaaa if 
tha patient's condition is not decidedly improred 
ia half a mianta, ira should resort to : — 

1. ^teitei'tnutkod. — ^Placs the patient on his 
back on the floor, with a block or pillow under 
his shoulders, and raise the arms upwards above 
hiahead, by grasping them abora the elbow, and 
pulling firmly •>« steadily as longaa thersis any 
■naBdorairenteringthachest. Some arrangement 
is Beaded to preveutthe body from being dragged 
towards the operator. For this purpose ths plan 
of raising the chest on a high cushion or box has 
been adopted, but as a condition of cardiac anmmiii 
is often present, this is objectionable. It is 
better to etket On obiect by plasiag a bo^ in 
fltont of the thigha while knsaliag at the head 
of the patiant. It may be needfol to draw forth 
the tongue, but generally if the head falls back 
orsr a cushion pueed behind the neck, thisia not 
required. An artery forceps, or a noose of string, 
or a handkerchief will enable an assistant to 
kaap the tongue wall forward. 

As soon aa ths sound produced by tba entraaee 
of air into the cheat ceases, the arms should be 
baougfat down a little towuds the firont of the 
chant, and pressed firmly and steadily against it 
foe about one aaoond after air ia beam escaping. 
In eases of drowning it is enough to repeat this 
operation every four seconds, but in the collapse 
reanlting ftom chloroform or other aoasthetics, 
the necessity for getting the raponr quickly out 
of the chest justifies a mora rapid performance 
of the movements during the first firs minutes. 
After this time the movements should be carried 
on more slowly, bat thay should be oantuniad 
for half an hour at least, and even longer if the 
warmth of the sur&ea and diminution of lividity 
girea any reason to hope that the heart has not 
antiralr eaaaed to act. 

S. liartkaU HaU$ nadg mrtiod is performed 
by placing the body on one side^ and ijtemately 
rolung it on its face to compress the cheat, 
and on ita back t* allow the elasticity of the 
ribs free movement to dnw air into the lunga. 
The plan ia not nearly so effective as Sylrestar'a, 
but if no aasistant ia at hand it is the best mode 
of artificial breathing that can be adopted. 

8. Hownrit mttiod. 8m RasnacriATioir. 

4. M<mtk-to-mo^k iiunfitUion is not to be 
depended upon, on account of the difficulty both 
U keeping the laivnz open, and also of prevent- 
iaig the air going down the gullet. 

Of thtintlrumentt introduced for the purpose 
«t carrying on artificial respiration, mention 
shonld be made of those invented by I>r. Haroet. 
and Dr. Richardson ; but except in the handa of 
the inventors or of those who had gained much 
azperianeeintheiruse bypraetisiBguponauimals, 
the writer thinks they would do aa much harm 
M good. Th« olgectiaa to tham »U is that tbaj 



ASOITEa. 

iatacfars with the prompt imitation of the mora 
ments of respiration just described. 

The administration of oxj/ifmi is indicated ia 
most cases of artificial raspiiation, but ths results 
of its use have not been satisfactory hitherto. 
Now that ths gas can be had in a compressed 
state, and can bs given by means of the laughing- 
^aM inhaler, it is worthy of a further trial ; bat 
It is certain that in all eases of impending asphyxia 
time is of BO much importaaca that anything 
which would delay the supply of ox^rgen would 
not be compenaated for by giving it pure, in- 
staad of in the form of oommon air. Tracheo- 
tomy is not to be thoaght of in the first instance 
in an^ casein which air can be made to pass, 
even in vny small qaaatity, through the tradiet. 

For Bupplamsntal and aftar-treatmant, «< 
RaauscrrATioir. J. T. Cu>vaB. 

ASOABISIiS (imapXt, a kind of worm! — 
This term, by long usage, is often employed to 
designate the very common intestinal parasitta 
poimlarly known as7Xra«{-tMfWM <a 8ett-w»rm$. 
Strictly speaking.thass do not bdoag to the ganna 
Jtearii, but to the genus Oxyurit. The fuller 
eonsidemtion, therefore, of their characters and 
clinical importance will be found under the 
Article THsnaD-woBiis. 

Although the term aa employed in the sense 
referred to is altogether erroneous, there are two 
true species of the genus Aiearis found infesting 
man. These arc^ respectively, the common round- 
worm or Lumbricns {Atearu lumbriooidet) ; and 
the moustached or margined round-worm(.<<4caru 
mytax). Full particulars respecting the fbcinar 
will be found under Rouiro-wtmiis, whilst the 
consideration of the latter need only occupy a 
few words in this place. 

Since the diacovery and description of the 
Aicarii myttax as a genuine human parasite by 
the writ«r in 1868, six instances of its oceorMoca 
have been noticed at home and abroad, and there 
can be little doubt that ths parasite is ranch 
more frequent in man, especially in children, 
than is commonly supposed. The writer lias 
alao shown that this parasite is identical with 
the Akotu mytax in the cat, which, according 
to most helminthologists, is only a Turiety of 
the J»earu marginata in Uie dog. The nudes 
are usually from' 3 to 2^ inchaa in length ; the fo- 
males sometimes aoquiring a length of 4 inches 
or more. 

TuBA-ncmrr. — Like its congener, the faltdy 
so-called Lnmbricua, the margined round-worm 
readily yields to treatment by santonina. Two 
or three grains of this drug, followed by castor 
oil or a saline puigative, should be administared 
twice or thrioe daily for a Inr daya in succeMsn. 

T. S. COBBOUO. 

ABOZTSS (incit, a leathern sac ; a largo 
bellv). — Srxoir. : Dropty of tka peritontam; 
Hyiropi peritonei vA abdominu; Hjfdrtptri' 
toneum. Fr. Jtciie ; Ger. Die Bawhwateenmekt. 

BBmnnoir. — An accumulation of fluid within 
the cavity of the peritoneum, more or less serova 
in chaturter, the accumulation bring of the 
nattira of a local dropsy, and not originating in 
inflammation. The amount of fluid varies much 
in ditbrent eases. 

^noLooy Axs FanioLooT.— The chief maltM 



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Asoms. 



m,». 



Um 



*to*' 



lOttid 



to poiat 

conditioss Xxy irhicti it may be 

aa it almoafc mlw&ys Xollows, and ia 

.gji^neBce of certain pne-«nstin^ oiganio 

f^ig^iA *l>i^ it becomos a^ moMr important 

m^m i"^. P^tliologieMl ptianoiD«aon. Tlie 

^ U, «hich_ it has l>e«n nttribntad may ba 

j^jmeJ^ gceocding to tlie follovring aiTaiig»- 

Wit— 
LTniKtmechaiucal obaitxxtctlon affecting the 
{tlUlenilition. 

\. OblUaetiaa of the tfctnlt of tbe portnl 
nu Won it enters tile liver, either from 
«Utml ;naatira or internal otwtrvetion. 
L Tioniia upon or obliteration of tlie 
tnadM d Um Teia ^rithin tfaie liver. 
V htsue Tvpon ^>e tranlc of the hepatic 
nil, 01 1^ the inferior vena eara after it 
neara thu Tno. 

n. Cudiu or palmonarx diaeaaea obatroeting 
JknunlTenaiu arcnlation. 
iu. Dvnue of the kidneya. 
IT. Xabii eanditAona of t.he peritoneom. 
y^KnlluMma. 

I. Aij died obstmction interfering nith 

tix P»^>1 dicnlation muat neceasnrily Irad to 

""(■■'■Kiuilorer-distenaion of ita tribntariea, 

.<"• of tile conaaqoencea of -which ia azcea- 

j"n buaaiuion of the fluid portion of the 

UooJiilotieperitooeal ctirrity, while abaorption 

I eaaelcd rha aecites ia, n"'^*"' sneh circnm- 

"■^ in ihort, merely n localiaed dropay, 

na/tiiy /^ mechanical congeation. The 

^p&auA may affect eitlier tbe portal tmnk 

'^^n it eiten the liver ; ita branchea in the 

MlMute 0/ this cnsan ; or tbe hepatic rein 

*l oMu rtoa, eara near ita tezmination, 

\. iJbe jxirtAl tmnlc may be preaaed upon a« 

a lies io ^e fiasora, by promlnanoea ftom the 

^nr itieix aOaigad abM>rbeot; glanda in iti 

nmit/, I uighbiniriiw tnmonr (aa cancer of the 

*•'"•• or a growtbin tbe axnall omentum), a 

ffp^tx aearian, or inflammatory thickening 

"»«%fc>mneri-hepatitia. The preasure may 

•WaJyrtee^ tbe -veaeel. but U morecom- 

■«!r«»MaJ^Bl dot. to form, »nd thua iU 

«™d i» Uodked np. -A- tbiombna u alio in 

•»"Pt»«] inatances produced jn oonneuon 

»itli t dixeaed craidition of the portal reii^ 

••iuiiiftunination or calcification ;obrtruction 

to4.eiR,Utioo witbin tbo liver; orfeebleneaa 

rf the dwbti^. with an abnormal und«>cy to 

"yl^ioo of the blood- •.,.*...^u„ „/ .1, 

i Aonre upon, or oblit«««Uon of the 

. awm u(>vu. . .,rithin the liver, can 

of soma morbid 



Aaoeia if the portal 
^Wm^^^hT^ctnal aub^nce of thia 
IS^ Th. h^c diaeaae which by &r moat 
e^nlT le^to tbi- r«"»l^ "^ '"j'-^^ ?• 

a. of ti. toL freqnan* ca»»e- of aacit... « 

fc«»d,^fcT»-of~2t^™«««^^ i»««u«l 
ISw. « tt ma, be •^"•"^^troction thua aet 

,^xy with that of the 
_j <»san. Oocaaionally a 

obatrocta a eoBa i da m ble 



The extent af 
i( viU Mcenazily ^^ 
*>^iAdengea in the 
BaaviOin the liver 



tiie praaanra of a growth oouaetad vith tW 
liver itaelf, or of aoma naighboBring tuiBovr. 
, II. Siaasaaa of , the liug* or hMxt vhieh 
impede tbe general Tenooa eircnlattoB mwt 
neoeeMTily eiarriae • aiieMly and diieot in. 
floeaoe upoD the hepatin cijKniUti(M,Mid may thw 
lead to aiGitea. Uraally, b»v«r«r, ia eaaw U 
thia kind the laga on (ha a«et«f eouidambU 
u>a«ar«a before peritoneai dconay ia obaacved. 
In couraa of time the oontinnid coMertion oii> 
Kioataa aariava oiganie changM in the Van. 
lU vaaaela baiof .rare or leaa obUtanited. aad 
oonaequently it la at thia period that a^tJ^ 
particularly liable to aet inT ""w M 

IlL iWitea nay OMistituU a pait of Ik. 
dropey whieh ao oftra awompaniea nala diaeJir 
It la. howerer, of eauparatiTely i»ft««ni 
occurrence to any gr«it •MUnt^^uT^ 
orcomataKea, the aaout of flaid beiagMt 
cooajderable aa a rule^ and the aaeite. beS S 

XV. Mm or leaa aenma •fiuioo into the 
peritoneal eanty le a prthohigical temUt ef 
pmtomtu i but, io aecoidsaoe with the daflai- 

il!?-.?^ '^l'?* «"'"" »'»▼•. thia doeaaoteom* 
*nctly within the preaent aitiel,. Ja .se^ 
uooai inataneea, howerer, troeaaeitea ia ofaaerrad 
^^JUT^^^ "^ pwitonilia. ia eonaaqnenoa <A 
th« laorbid coDditioBa whieh it learea behind, 
wronic petitoaiiis aay alao oeawiea a aimpie 
tocn dwyay ; but thia ia panieaiarly liable to ba 
tei up u connesioB with nwUd forBatiou 
in ttw perttoneum, aneh aa cancer or tubercle, 
M wttich the writer baa aaen atrikiiw axamdM. 
iiie imnwdiste canaea of aadbM aaaoewtad 
with diaeaaea of the peritoaanm aav be ■— aetin 
09.ngat.oa; implication of the 4pili»ri« " 

m to mechanioal eongeitioB ; obat„ctioB td 

V. Among the chief «"-~" — ,„. e_„.^ . 

tioned exporore to cold or wet; the iSri«^ 
preaaion of habiUi.1 diwshar^ "r^. JS 
cure of ca^niccntanaonMffiwSi?!^' ."***» 
"•".-and debility. ThaeliS^'^"*^^"; 
to ongiaa«e thi. ,>mntom eittoT t^ tS^^T* 
aeUve internal <»B»..trL. vj- ' 'ndneing 

rtateoftaXid^ri'T!^.'''"*'"^-! 
fill wh.the,«fc^/,'J!«': '"'t"i-»erydoSt. 
occaaion aaaST^li'^'" ~° T^^ "' 't*!* 
peritoneum aaTh. 2.*? '^.~"'^ ■»''«» the 
Whin thoVwliT'"'"'^. *?," "P"" °f • oyS 

due to a oomb?„^,"^?>;3?l/»>»t •«'»« ma^S; 
oMuea which haw w5i*?° <» m»K .<4 Hu, 

obatracUon «&-ti »"•»•»«>• *l>«a«» »ar be 
within the JivTtS*„ut^ P°rtal oitculitioa 
I •im«lt«,^.f5'*«" °*8«- »ay b. in. 



^BM^el the portal 



volvedaimultane.^i'y"'™" '»8«»« »ay _ 

np aitC^ 'thT'^??*"*' *»^« to ••» 
originate aacitea, »»> 
diapoaing caoae. it , 



»>wbid oonditioaa which 
<>• regwled aa a pre. 



1 oi*^?"^ TSThepatic vein or inferior aoa. but ia mdat eom^ ^ "** '"^ »* "V 



"Baah taoN fka^aanli j 



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ASCfTA 



■■iM tban ftmttoK An knamie eonditloB 
of the bload aol wIpmw of th* tiiraM pndis- 
poM'to pantoawldMpiy, •■ thay do to dropsy 
mothorputi. 

A>*.TOiacAi,CMA>*OTias. — Tha assential sna- 
touiMl ehaimeter of >wttM ia the ■ecnmnlatioB 
of • aafona fluid vithiii tha paritaoasl sac lU 
amaoot maj lang* ftora s fair ooocea to aoms 
caUaaa. Aa wigaida phyaieal ahaiaetora, the fluid 
» ganemlly tun, limpid, and wntary in eooaiat- 
onea ; eolonrleaa or alii^tly yellow ; dear and 
tnaapaiant; and of aliulina taaetion. In ez- 
oeptioBat inatanea a , however, it may be eoloond 
br blood or bile ; or moie or leaa tarbid and 
duty'looking'; or of thicker and aomevhat 
galstiaaas consiataBee. Soft flbrinooa maaaaa 
oeaaaioaaUy float in thaflnid, or theae may form 
fpootaoeonaly irfaea it ia allowed to atand. 
Vtrf rarely tha reaetioa ia Aenttal or acid. The 
apedfle gtaTity Tuiaa considerably. Chemieally 
the fluid oensista cf water holding in solution al- 
bominand theasnal aalts which are £»nd in drop- 
aiealflnids; but their proportion iamTrariaUe, 
thonRb tha albumin ia generally in good quantity, 
w)ii(£ ia eridenoed by the degree of coagulation 
whidi take* place when tin fluid is boiled. 
Oeeaaionallyit eontaina flbrin, choIesterine,bile- 
aleiMiita, or, in eases of renal dropsy, urea. 

Thfs eflbeta of the accomolation upon surround- 
ing ainetures are to distend and macerate them 
nom or less, or to oompreaa them. Of course 
along with the aadtaa there will be the signs of 
any morbid oondition upon which it depends; 
and there may alao be indicationa of anatomical 
ehaoges resateing tnm long<»minned pressure 
of the fluid upon certain atracturea. 

Smrroxa unt Sioirs. — ^Asdtea usually aata in 
raaygmdaally, being chronic in its progress, bat 
•dvaneiag stmdilT, Oocaabaally, boweTer, the 
fluid eoUects with considerable rapidity. The 
dinical phenomena aasoeiatad with tbia patholo- 
gical condition differ in different caaea, both in 
their exact natare and their degree, according 
to ita eauae, the amoont of tha fluid, and other 
eiioamstancas, but they may eonreniently be 
eensiderad under the following heads, namely : 
— V. Pifitai tignt. S. Miekanieal efftett of the 
dnpiieat eeeumiukiHem. 3. GtHtml »ymptomt. 

1. PAjwienJ fili^.->-Fhyaieal examination eon- 
atitatea a most important part of the clinical 
inraatigatioa of caaea of aacitaa, and it will be 
teqniaite to diaeuas the signa in aome detail. 

(4) If fluid collects in the peritoneum in any' 
quantity, the abdomen presents more or less 
^sMnit ailBrffim»mt. This is often the first 
change which attmeta the patient's attention, and 
it may also haTS been noticed that the increase 
in aise commenced below. The degree of en- 
laigemant depends tipon tha amonntof fluid, but 
it may beociae extreme, ao that the akin is 
tightly stretched and thin, preaenting a smooth 
Mid shining appea r an ce , or aometimaa white lines 
are visible, dw to laceration of ita deeper layers. 
The nmbilicus becomee affected in a character- 
istic manner, being more or less stretched and 
aTarted, and finally beoonang obliterated, or in 
some caaea mora or leaa pondiad out, and it may 
form a oonaiderable prominence. Should there 
happan to be a weak portion of the abdominal 
waJMiMAas a hsmial aac, thia will beuduly pro- 



truded. The important cfaaoaelen of abdominal 
enlargement due to uncomplicated ascites are 
that it ia of a roimded form, though tending to 
be more prominent or to bulge towards the lower 
part or in the fianks, acearaing to the postnie 
of the patient ; that it is quite symmetrical in 
shape, when the patient stands or lies on hia 
back, but that the form alters considenbly with 
a change of position, the abdomen becoming then 
more prominent in the dependent r»:ion, in con- 
sequence of the gravitation of the fluid in this 
direction, and it may actually be seen to more 
as the posture is changed. In contrast with ths 
enlarged abdomen, the chest often looks small 
and depressed, and the fluid may cause its 
maroon to become everted, or it may posh for- 
wards the xiphoid cartilage. 

(i) The abdomen feels perfectly imootk and 
even over its entire surface. It nsuallv gives a 
sensation of tentbmct the walls, without any 
hardness underneath. In some inatancea an 
obscure feeling of finctnation is experienced on 
palpation with the fingers. 

(c) The tendency of ascites is to interfere -with 
the abchminal retpimtory movevuntM, if it is at all 
conaideraUe^ by preventing the diaphragm from 
acting properly. At the same time the writer 
has not uncommonly observed that, even in caaaa 
where the aeenmnlation of fluid has been very 
conmdeiable, abdominal respiration did not aeen 
to be much diminished. 

{d) Ptreuuion affords some of the most im- 
portant signs of peritoneal dropsy ; and when 
the flnid is present only in small quantity, tUs 
is the onl^ mode of examination that can lead to 
its detection. In the first place marked dulntti 
is elicited over the seat of the fluid ; while a 
tympanitic aound, which ia often abncnnally 
dear and distinct, is heard over the intestines. 
When there is bat little fluid, it may be im- 
possible to detect any abnormal dulnass as the 
patient lies in the recumbent posture, but on 
placing him on his hands and knees, the fluid 
gravitates towards the tcont of the abdomen, 
and dulness may then be noticed in the um- 
bilical region. In most cases, however, there is 
no difficulty in makiDg out the dulness, rad this 
sign is observed in those regions towards which 
the fluid natnrally gravitates. Hence, when 
the patient lies on his back, the lower part and 
sides of the abdomen are dnll, while its upper 
and f^nt part is tympanitic As more and 
more fluid colleeta, so ue dulness increases in 
extent, gathering in, as it were, from below and 
from the sides, until finally tha entire abdomen 
may be dnll, except the umbilical region, which 
remains longest tympanitic. The boundary Una 
between the dulness and tympanitic sound ia 
usuallywell-dofined. As the posture is changed, so 
will the site of the dulness vary, the part which 
is undermost presenting this sign, while that 
which becomes highest is tympanitic ; and thus 
Qio relative situation of these two sounds, aa 
well aa the shape of the dulness, can be altered 
in a variety of ways. When the patient sits up, 
the prominence between the recti muscles girea 
a tympanitic sound on percussion. In exceptional 
instances a distended colon pves rise to a tym- 
panitic sound along each sSe of the abdomeo, 
even when thsM is abundant flnid praaaat. 



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ABOFTBa. 




^pMaMS u tlw wn^tinn rgtoMUj t«rm«d 

ffi ff^iam, wUeb ia t^ peealiar wars-like Bore- 

WitMb'dM i^apiig tlu fingan of oaaliaiid 

fnroMn)* of tlw abdoiaan, and fillipping or 

imii^lhBonxaiUad* with Uis fingenof tha 

^jS^laad. Iliia Hnaatioo ia vatj aaaily 

tn^tmt if than ia moeh fluid p raa en t, pn>- 

ndal it it iioe to more, and aometiaita tha 

BOtM ii MtuU/ Tiablak Chaoge of poature 

(ill Btdify the a«at over which flnctoatioa can 

btpadmd. 

(,) jbuedUtiaii yialda negatiTe raanlta in 
(MM ft aMttea, tfaeia baii^ no aoand of any 
kaj kMid 0T«r the abdonMn. 

(/) la the Urge ■^jorilj of eaaas aaeitaa ia 
datih Terralad ^ the phjraieal aigna ahead/ 
jambad. In aaea|ilkiaal inatancea, hoveTW, 
wka the diagaoaia la ofaacnr^ it ia raqniaita to 
nwrt le a Hgitul ezaminatioa thioogh the 
iMtaai, aad in MnaleB Ihnagh tha tn^tiM. Tha 
laid eoUeeta ia the reeto-Teaieal pondi, and on 
per netom, the flagn deteeta the 
I of thia laid thiDogh ita anterior waU. 
\ ia amally felt to be ahortened, while 
I ia paahed down ajid flexed. In ex- 
I of aaeitaa the poaterio wall of the 
, ev em the nteraa itael^ nuj protmde 
thioi^ the Tslra. 

(g) htm and then it ia reqniaite to make nae 
ct the ayi'i iiftir e« a aaiaU <raeiar, by the aid 
d whidi net onl^aan it be dctermiaed whether 
flaid ia praaent u the abdominal canty, but ita 
■atare «aa alao be aaiieitaiiied Thia method of 
•nauMtiaa ia foithar naeful when aaeitaa ia 
aaodated with agna other morbid ecndition 
withaa tlM abioi— n, which freqnentl^ cannot 
bo^i^ oata»laagaa the flvid reouuna in the 

It malt be ben* in mind that the oadiaarf 
phyiaaal ngas of aadtea will be materially modi> 
fled or olacKcd aadar certain eiieuutaneea. 
For egaM^ilav the qoantity of fluid may be ao 
I tiaU Boat ouwAd examination ia required 
to detect ita preaanoe; oa the other 
kaad, it xwy be ao abaadant that dolneea ia 
ahaamail orar the eotire abdomen, and flnetoar 
tioa may be raiy indiatinrt. The exiateoce of 
ptrifoMl adheaioaa— 4iir inatanwi, thoae which 
aaaj be temed aa tha raaolt of repeated pata- 
"■ alaa leaduia aoM* of the SMlt eharae- 
I aijgBa of aaeitea my iU-deflned. Again, 
' ' of peritoneal dnqay with aoma 
■1 anriiid oooditioo, aorh aa a new 
gi«*tk,aa«alKgad livsrwapleei^ or an orariaa 
, will all* modify the aigna elicited. The 
N7 BV ha ahaonnaUy abort, or the in- 
I nay be adhenat, tbna being pierented 
( fgraaadi^ ao that the aaaal Mlative 
dolneai and tympanitic aonad are 



X. Jttftaniml tfieU oftii dnpti eal at amm 
-Tha diaieal pheaoBwna reanltiag from 
' (flaeta of- aaeitaa are botitaa^ 
■f. The patiMit often expe- 
t afMiiag of awaaiinBa and diaoomfiirt in 
'oaia, aa wall aa mere or lea* tearioaand 
, if there ia mooh flaid pr eaa n t; while 
tkcn May be a aeoaa o< &tigBa aad aehing aboDt 
' i«r ahdoaaiaal waU*. ^ a tale ao 







n'^^'!'5r^:*^^>. 



BiX01lI(l«^> 

eC»r7 <^0«i 






particalar pain ia Itt^^ 

liable to occur from ta asa 

diateneioa of the atnicr 

minal wall may alao 

la exceptional inat; 

When the fluid is aba 

riaooaa ita weight wheo 1>^ 

act, he throwB the head mMMt 

aame time keeping tfaa 1 

connected with the alioa«a 

mon occurrence, bat thi 

extant due t« the 

the aaeitaa, though th* ^ 

tend to interfpie with * 

atomaehandioteatinea X^fa^ 

oooatipatad, but iu aom^ AXX' 

or dyaanterie aymptomat 

lenee ia Tety commonly 

a email amount of gaaoomi 

iataatinea beine felt oadxal,^* 

diaoomibrti and insrenning^ 

tha abdomen temporariiy. <I><:r<iq^'*»^^ 

ing oeeare,ia cooaequence of ijj. 'o^ *?»>;? ihJ^ 

theetomach. Whan «on8id«»i-^*.iJ*»>f '>Jj/»»^*'S6 

maiaed in the peritoneum f<:>4- fj '**"^r' KJr.y 

pnaiea upon the inferior Tea«a *°'^>w^(ta>l*^ ,°« w^ 

the return of blood through Cju^v ^ ^?* t. **im ^ 

thus lead to anaaarca of botb ^^^Wl^V^ kT^^ '^ 

with anlaigement of the imuM (jl*^ T**. /^'^•n '^ 

veine. £xoq)tionaUy the anaaMj-K^««j ^C^n^ ^T* 

tion at an early period. Tbm ^t^h^^Zy 

throa^h the renal Teina.may tt.lm^ ?*»*?*««•****«« 

indaong menhanioal cgo^aatioA tM-^ oL.*^ 6l^ 

with oonaaqueat dimiaation io r?^ H ^'*^*^^ 

urine and albaaunnria. Ia Mr« .* ^^^^^^^^ 

fluid haa beea kaown to aecaaaiLl,^ ''iaca^^^- or 

extent aa to mptare acnne paK of »? *o iTr? U« 

waUa. "^ "* «»• aid^, •• 




Aaeitaa alao fireqaently interfar*. 



iritb 



larnj 




ia e^nenced.^ eapedaUy ia the wcSblS 
poatare and after takiag food, the breajii 
ahartonexertian.aad the raraaatiooa are oft« 
hurried and shallow. The heart it likaT; 
liable to be diatorbed in iU aetioa, aa eridMold 
by palpitation, iiragnlarity, or a tendansv to 
iaiatoeaa. Thia eigaa but ako be diaaland. 
ao thatiUa«a.beatisiaiaedaad toofartowaida 
the left, and ia rare inaUneaa a baaio systolie 
ranrmar haa been originated aa a rasnlt of thia 
diaplaeemeat. 

S. ehmmU ^/mptemt.—Tb» general ayateat ia 
freqaeatly aeraosly ailBoted in eaaea ia wbieh 
aadtea ia a preniaent ayBqitom,bnt thia naaally 
dependa apoa the eaaaa or eaaaee which hare 
enginatad the dropay, thon^ it may itaalf in- 
dnee more or leaa debility, waatia^anmnia, aad 
other geaoal effeeta. The loaa of fluid in thia 
way ha» alao besn ann;«aed to lead todeflment 
penpiration, aad oonsequeat diyaea of the akia; 
aa wall aa to diminatioa in the quantity of aiine^ 

DiAOxosii. — The flrat awttar beanag qpon 
the diagaoaia of aaoitaaia to detenune whether 
thia morbid condition aetaally oxiata. Tha 
paaenee of fluid ia .the peritoDettm, aa weH aa 
tta amoont, can oidy be positiMly made oat by 
physical examin a tio n and ia tha great n^irai^ 
•f MtaeathaaigMtbaaaUBitedaraqBite r*^ ~ 



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(WiiCie. When the llnid n small in qnant'itf, 
ti wen as nnder other eircmnstaneM in irfaieh 
the phyiieal tigni are Miacnnd or raodifled, the 
diagnorii mj be difflenit and uaeertain, bat it 
majr then be aided ij a koovledge of the ex- 
istence of tome dieeiwe likelj to gire rise to 
ueitae. That the aceumnhilion of (laid is of a 
diopsical natare, and not dne to acuta or chronic 
pen'^onitis, is nsnalljr sofRciently obvious tiom 
the history of the e<se, and tiM oollaten! symp- 
toms, while the local signs are also of a diffbrent 
character (see V t t a r om v i t, InSamraation of). 
Hie remaining abdominal enlaigementa from 
which Bseites has to be most commonly distin- 
guished are those due to flabby relaxation of the 
walls of the abdomen, combined with flatnlence ; 
Mcnmnlation of fiit in the anbcDtaneons tissue 
•nd omentnm ; abnndaat subcntaneons cedrma, 
WUeh may be associated with and obscure 
aitettes ; an orarian tnmonr ; or a pregnant 
tttems. Among the rarer conditions with which 
ascites is liable to be confounded may be men- 
tioned colloid disease of tiie omentnm ; a greatly 
dilated stomach ; distension of the ntems with 
fluid ; great accumulation of urine in the blad- 
der ; a rery large hydatid tnmour, usually eon- 
aaeted'with the lirer; extreme cystic enlarge- 
ment of the kidney ; and the so-called * phantom 
tnmonr.' Hoet of these conditions an described 
in other parts of this work, and the limits of this 
article torlnd any disonsslon of tiieir sereral 
diagnostic chancters ; bnt a oonsideration of the 
histoid and existing symptoms of the ease, com- 
bined with the results of a proper physical exami- 
nation, constitute the data upon which the diag- 
■ocis is fbnnded. It nrast be remembered that 
•antes may coexist with other morbid con- 
ditioiiS in the abdomen, their physical signs being 
•ombined. Should there be an anlar^ organ 
or ether solid mass, it may often be leoognised 
Iff making sadden Arm pressure with the flngers 
orer the abdomen, when the fluid is pushed aside, 
and the nnderlying reaiatsnce can be Mt; or 
paracentesis may be performed, and Anther 
examination carried out after the eracnatioa ot 
the flnid. 

Another most important point in the diagnosis 
of ascites is to Moke ant its eautt. For this 
purpose all the fhcts bearing upon the case must 
Be- taken into account and carefkilly weighed, 
speelat attantioa being paid to the lirer and the 
stroetures in its ricinity, to the heart, and to the 
kidneys. The amount of the ascites, and its 
relatioB to other forms of diopey, aflbrd consider- 
able aid in the diagnosis. If it resolta from 
eaidiao or renal disease, asdtes always follows 
dropsy in other part* of the body, to which it is 
also ^nemily subordinate; when it is dne to 
hepauc or some neighbouring disease, the peri- 
toneal dromy appears flrst, and is throngbont 
most prominent, ^ould the Yena caTa Inferior 
b« obstructed at its upper part, anasarca of the 
legs will be observed simnltaneottsly with, or 
«Ten before the aseite*. 

' FMwifOSis. — ^The prognosis of ascites will 
■ainly depend upon its cause ; the amount of 
taid present; the rtate of the patient; the 
aondlaon of the main organs ; and thereanlts of 
HlWlMsnt. In sane eases this symptom is in it- 
Mlfattoadsd with iasnisdiau iiagat, on Moout 



of themechanical elftcts of thedrapilfltl ■ 
lation, especially upon the thontcie organs, aaJ 
still more if these organs an in a diseawd ooaiU' 
tioiL In other instaneea it aids in radnoing thl 
patient, and in thns bringing about a fatal ter 
mination. When ascites is due to local iatm- 
ferenee with the portal circulation, great nliaf 
cannnqneetionably be allbrded in a oonaidaraU* 
number of eases, and life may be prolonged liy 
appropriate treatment ; while, if the local eanss 
is not snch as in itself to lead to a iktal iesne, the 
asci tea may not infrequently be permanently enied. 
TBUTitBNT. — The principles of treatment ap- 
plicable to casesof ascites an (a), toattend toths 
oondiUon upon which the dropsy depends, and 
thus endeaTonr to get rid of its cause ; (il to 
promote the abaorption of the fluid ; (e) to ■■• 
prore the constitutional ecoditlon and the state 
of the blood, if n wc ssa r y ; (li) to remore the 
fluid by operation, if absorption cannot be ac- 
eompliMiea ; and (<) to treat any symptoms need- 
ing special attention. 

(a) Am an important part of the treatment 
directed to the oauss of ascites, particular atten* 
tion must be paid to those organ* which are 
most commonly accountable for this symptooi, 
though unfortunately in a large proportion of 
eases b«t little eifect can be produced upon the 
dropsy in this way. 

(o) Absorption of the fluid i* chiefly promoted 
by acting freely npon the bowels, akin, at kidney*. 
The class of remedies indicated will rary in 
diffennt ea***, and most be adapted to th* *tat* 
of the diiibrent organ*, bnt as a rule actiT* nnr- 
gativr* an most efltcient in reliering aacita*^ 
especially when dne to local eaoses, of which th* 
most useful are compound jalap powder, erenm 
of tartar, elaterium, ealomd, gamboge, pod»- 
phyllin, and ODton oil. These remedies mnst, 
howsrer be used with due caution. In som* 
in*tano** balaam or reain of copaiba ha* 
prored nseful in the treatment of peritoneal 
dropsy. Assistanes may be derived in certain 
forms of aseit** from acting upon the akin by 
mean* of rarions diaphoretic baths. Digital!* 
and squills may be of service as diuretics; or 
the application of poultices of digitalis leave* 
over the abdomen is oocasionally attandsd witk 
beneflt. The administration of iodide of potas- 
sium also seems to aid absorption in soma eases. 

(«) Treatment directed to the general oondition 
of the patient, and to the state of the blood, i* 
nndonbtedly valuable in many ea*e* of •*eite*. 
Tonio* an often of decided aervice, aati pnpain> 
tion* of iron are ipeeially indicated for im- 
proving the quality of the blood, if there i* any 
tendency to anamia. Not only do the*ei«n*dien 
anstain the patient, bnt they may also hare aa 
inflnmce in promoting the proeeas of abaorptioD. 
The diet mnst be adapted to the eireumstanosa 
of the case, but usually needs to be of a nutri- 
tions character. 

{d) In a considerable proportion of ease*, 
however, no eflTeet is produced upon the dropeieal 
acenmnlation by any of the measures thus tMe 
oonaidered. Then it becomes nsceeeary todn- 
termine whether it ia desinble to remove th* 
fluid by operation. The fluid may be taken 
away either by means of the aspirator, or hf 
the trocbnr snd CHinla. Th* ndviaabilitx A 



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ASCirES. 
l i M g iw>un> ts tbia pha of tntitmMt 
Jnfi-i «pon eiRamattneu. Tha anatM u fi«- 
mgnflj not rafBeimtly abmidaiit to jaitiQr 
IMaecBtMW, Bod vhan tlis condition ii of eaidiae 
m icDsl origin, th* opantioii can only affbrd 
nnponzy relief; ■> that tJwr* i» no o^act » 
nmtiiig to it nnlM* the maefasnical ei&eU of 
the aecomalation are radh as to eauaa tnmble- 
aoBM or dai^araaa aTrnptama, and it had batter 
ba delaytd as long a» poaible- When MOtea >• 
a local diopay, the (laid is often so aonaiderablo 
in aaooab aa to neeassitate its nmoral for tha 
rmn Dorpoas of einng nUef for tha time. In 
caaM of aaeitas aaaodatad vith malignant 
«naaa, for inatanea. this is all that can be 
^gud for, as tha Itaid iriU eeitainly eoUaet 
^m. When. howsTer, the condition is dne to 
aoBis local diseaaa vUeh is not in itself tatAU 
sal cspseiaUr to eiiriiaaaa of ths liTsr, the -writer 
bMftaoBdsignl bsoaflt remit fiom ths npeiKe^ 
mr fa nmamm s/ysraeasiaM, and has adrocatad 
tUs pUa of tnatment as a eanHv msasnre, so I 
fairaatbaaaatssisaoaeanied. Baidy does the 
opecatkn gire rise to any immadiato ill-€*B»ots, 
and it is fraqnsntly found that remedias vill act 
andi BBom cAeiendy after the remoTal of the 
ftiid than tiey did prwrioosly. In the -writor i 
anwrianee pancmtaaia repeated as often as the 
Aod le-aecBMilated has nHimately led to a 
(iiariBtff csra in mrtnX instances; in othays 
Iha care vas partial, a eartain qnantitr of flnid 
laiwiininr in ths peritonanm, limited bj ao- 
taaoaa; iriiile in others still, life has bem 
I mill f proioaged. and mneb comfort afi>rded. 
Tha repcstad acenaiaiation does aot seem to 
■Ket the ^stem materially by reason of the 
it, and fraqnently not at all. Of 
_ care mast he exeteised in the per- 
of the operation, and in ths anbssqnent 

„ t. In a fc» days after the remold of 

tha *AA, ths i^lieatioa of a bandage Armly 
lo^ the abdonmn, so as to exert erenpraMnre, 
^y psOTS of serries in aiding ths absorption rf 
whit xcamiv, and preventing the rsenrrenoe of 
t^ mcMm ; and this measara may alaobs nsafnl 
wbea a csctaia amoont of flnid oontinnes after 
tha*spsatsdper«iBnaneoofpB«osntMss. 

(e) Tba symptoms leaalting fcom ascites which 
s« Hfcsly to rtqnira attention ars tboss eoa- 
■actad whh ths alimcotaiy canal; dyspoflM; 
aad caifiae <listuribanca, or a syncopal tendeney. 
Thaaoshoaid be mated on ordinary prindplaa ; 
bat it mast be obsemd that mulnd dy^mos, 
ifaridwllydaatothaflnid,Uaa iodioation for 
tba m— *•"-** p e r l u rm m ee of paracentesis. 
■". IUmhbts. 



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ASIATIC CHOUEEIA. Bit Choujea, 
.40FHTXZA (4, prir., and rf^Ju, pnlss)j— 
8nm.: ApMaa; Vt. AtpigiU; Oer, «^ 

Dnminoir.— The tenn J*p^peia, thoogh lite- 
■By rian^ngfOmtminm, is geaoaUy undsr- 
slaad to mean the eonditicB that nrperrenes on 
iBiemptioarftbsftaaetionof zcsinration. The 
tmm iteaos. nafemd by many as a more ssaet 
aM,kia the fisadraatage of being emplc^ed by 
' ' asto in a totally different eeose, Tin. the 
_ of tho leepintoy morements eonse- 
itMcmlh yp f iu s yP — tioBoftbsMotd. 



ASPHYXIA. Mr 

■nan is thsreftire no adrantaga to b* gaiasd 
by Bubatitating the term apoou fS»r tbe wall- 
oadarstood and older one, aaphyzia. 

JEvtauoat. — Aaphjrxia may result from many 
caosaa -which obstmct or interrupt the reaping 
tion. They may be divided into two catagoriatf^ 
internal and external. i 

/sterna]. — Then iadnds paralysis nf ths M- 
spitatoiry narTSHseotres by disease or injury of tha 
msdolla oblongata; paralysis of the nerres ar 
mnselam of lespiration ; a rigid fixation of tha 
respintfeoiy muaclm; eollapae or disease i^ (ha 
luDga ; occlnsion of the air-paassges by wgaaie 
diseaaa or spasm of the glottis, pressure of 
tamanxw, and tbs like. 

E^eiamal. — To this groop belong ooelarioa of 
the air-jnasigea by foreiga bodiea; pressure od 
tbe ehsst not capable of oeing orercome by tlv* 
muscle* cf respiration ; closnie at, or axtamal 
preaaaz<e on, the sir-paaaages, aa in aoffocation, 
atrang-aalatioa, or hanging. These an all cases 
of oba^mction of the leapiratoiy morements in 
a msdina espabls of supporting life. To thssu 
extentasl causes ars to be added those conditionB 
in wbicli, though the raqiiratoiy movements an 
firee, tJie surrounding medium is incapaUs 
of oxygenating the bUwd, vis., snbmsnioa in a 
liquid li>aiUam(dRnruiDg); or being surroundad 
by a medium devoid of oxygen, such as ni- 
trogen or hydrogen. Thess gases have a puselv 
negativa affect ; but many other gaaee which are 
classsd aa s^hyxiants, such ss oarbonie oxide, 
salphnret^ed hydrogen, chloriae, chlorofbrm va- 
pour, etc, hare positive poisonous sffaets, and 
should tliarafoia be called by some spodal name, 
such as Uxcie atphyximU, to distinguish them 
fifom tfaosM which hsvs no such properties. 

FaiacmairA.— When an animal is plaesd ia 
an atmoaphets devoid of oxygsn, or not coatun- 
ing a anificlent quantity ot' tbis gas (under 10 
per een^) to maintain ths respiratory prseass, 
or if Um mechanism of respiration is aimidy 
obrtmeted, it begins to show signs of agitatuo 
ud to make powsrhl inspiratory and exniratort 
stforts, in which tba accessory mosclea of n- 
spiration an all hrougbt into action ; tUs artarial 
tension lacnases; and tha sunerficial reins ba. 
come distended and livid. 

After a Tarisble period these dyspnosic eilbrta 
pass irto gwieral convuUions, in which the moa- 
eles or expiratioa are more especially in actioh 
dunng which ths sphincton are foreedani 
ths ftxcretaona voided. On these thei« foUowa a 
cslm, dn»»ng which the animal lies insensihld. 
with dilated and immovable pupils, snd with 
refle« excitability abolished ^araUy. AU 
mnscolar morements csass except thoae of ij»- 
spnrtion, which are repeated at intarvato. Am 

iZL^^SS^ *^'. "•P'"*»y movemmrt. 
bMoma shallower and leas regaUiv and i 



ceeded Iw stiatdiing convnlaimis, dnrinir -whidx 
S'w*^ " •'~«»'*««J. tbs b«Ki i, throwia 

The hesrt Mill eontimus to beat after otksr 
mevsmsBts have csaaad. The be«rt nttimataiw' 
stops in the state of diastoU. Death is tb« 
eomplsto and final. 

CooBsa ATO Twira„TO)K.— The time neees- 
laiy to bnm? about a fatal termination rariee in 
dUfereol animals, and in ths sams animal nader 



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ASPHYXIA. 



difinnt eonditioai. It haa besn notad Uut the 
yanng of ■ome animals resiat aaphjxia longer 
than the adulta. Paul Bert haa abo«n that tbaaa 
dUEarencaa an all explicable in acconlance with 
the lav that the more actira the rital eombaa*ion, 
tha gr ea t er the gaseous interchange, and thenfiire 
the more rapidly £ital the obatroction of On re- 
■piiatory proeras. Ezelnding upecial oonaidara- 
tions of this kind it may be stated aa the reanit 
of tha exparimentsof the Medical and Cbintrgieal 
Committee oo Suspended Antmatioa {ltd.-CI>ir. 
Ttmu. Tol. xlr. 1862) that when tba raspimtion 
of a warm-blooded animal is totally obstmccfd, 
sU external movements erase in from three to five 
minutes, and the beart stopa within ten minutea. 
CSsrtain modifications occur according to the 
method in which asphyxia is produced (an 
Dsoiriniio). 

AxATOKicai. CuARA.cnta. — The blood is of a 
dark colour, owing to complete reduction of the 
hamoglobin, and the proportion of carbonie acid 
ia greatly increased. Owing to tha excess of 
carbonic acid, tha blood eoagnlataa alowly or 
imperfectly; hence it remaina long fluid, or 
taxaa few and soft coagnla. The tsdous side 
of the heart, tha great Tenooa trunka, and the pul- 
monary artery are distended with dark blood ; 
while tha left side Taries, being aometinea full, 
more often ^hapa either empty or containing a 
amall quantity of dark blood. 

The appearance of tha lungs is not ooostaat. 
These organs are by no meana always oongestad, as 
is Teiy generally stated, being more often pale and 
anemic. The poaterior and dependent parts b*- 
eoma kypostatically oongeated poet morttm. The 
abdomiul Tiseera are usually oongestad. The 
appearance of the brain Taries, tliia organ being 
either ansmic or more or less congested. Spe- 
cial signs characterise special modaa of eanaa- 
tion of asphyxia. 

P^TmoLooY. — Inasmuch as the cessation of re- 
spiration means botbozygen-starrstion aad accu- 
mulation of oarbooie aeid, theqorstion is whether 
tha phenomena of asphyxia depend oa the one or 
tlia other, or on both. Various opiniooa hara been 
anlartained on this subject, but the axperimeots 
of Boeentbal and Pfliiger would soem to show 
that the deprivation oif oxygen ia the chief 
Atcter. That the accumulation of carbonic arid 
has nofffectat all cannot, however, be maintained, 
for it ia demonstcaUe that carbonic acid has a 
distiact toxic aftct on living tiasaes. 

Thaeircnlationofiion-oxyganatcdUoodthKmgh 
tha longs and tha laspiisti^ centre in tha me- 
dulla oblongata is ua csnaa of the powerful 
taapimtory effiirta in the first stage— ^liivetly, 
Iqr itimalation of ths leapiratory necvs'^anlns; 
indirectly, by paripheral irritation of tha pnU 
moaaty btandiea of the Tsgi. The z«a|nntoi]r 
movements inereaae in force, and tha irritation 
imdiatea into the oentrea of othar movamenta 
bcaidaa thoae dirwtly eoneamed ia napiratioa, 
giving rise to the expiratory eonvalsioas which 
Bars bean ascribed by aoma to excitation of a 
^eeidl 'oooTulnon-eantra' {Krampfcemtrum). 

The ie»pii»ta(7 oentrea ultimately baooma 
panlysed, but subsequently to those of conations 
activity — tha brain ; aad of raflax action — tha 
spinal cord. 

Tba cireulatiMi of aon-ooiygMiatad blood lika- 



wise eansas cootnelioB of thaa(tariolesft«miRi> 
tatiouofthavaao-motoreaDtzsu Increaied reriot- 
aaca is thus offiircd to the heard aad this is inteo- 
aiAed by ths eonvulsiva moaealar effiuta, TIm 
oitarial tausion rises. The resistance to the 
flow through the eapUlarias by oontioctioa at the 
minute bkiod-vraaela oesara net only in the sya> 
temie, bat alao in the pulmonary eirealatiail. 
Henee thera ia rasistanca both to the arterial and 
vanooa ride of the heart. Tha vantriclfa beeoaM 
diatended, and tba heart'a action laboured. The 
heart beeomas enfeebled by tha circulatkm of 
non-oxygenated blood in its valla, the diastolic 
intsrvols beeoma longer, until the heart AmUj 
atopa in a state of diaatola, vith the ri^ aido 
full, while the left may fawra succeeded in ampt^ 
ing ilseU 

TauTMBHT, — Besttseitation from pureasphyzia 
ia pOBsibla ao long aa the heart oontinnaa to faoak 
After cessation of the heart's actioa treatment is 
unavailing, except in eases of cessa t i o n from 
mere over-distensioa, in which bleeding from tba 
extamal jugular vein may bo raaort^ to with 
aneceas. The chief indioatioa in tiM trsatmant 
of asphyxia is to efiTset oi^fgenation of tho blood 
by the utaodnctioa of ait into tha lunga. If tho 
medium by iHiich tha patient is sarroundad ia 
incapable of aupporting nspiiatioa, he muat 
be imntediately rsmovad, or tho atmoaphare 
chaaged. If tha aipfossago is obatraetad bf 
a foreign body, thiamustbeezlneted;if thisis 
impossible, orif tbeobstraetion reanltfromdiaeais, 
tracheotomy or laryngotomy must bo lesortad ta 
Means must be ndoptedof eiritingtbe >aapirat«7 
contraa or napiratory muscles to action ; or if 
thiaa aro paralytsd and non-exdtable, thenatniol 
moveaMBts of respiration must be imitated arti- 
ficially, or air introduesd by iosnfBation. 

The respiratory osatrrs, if notabaolately para- 
lysed, may be excited reflexly by stimulation of 
eutaaaons nerves, especially thove of the fiMe and 
thorax. Thia may bit atfeeted bythe stimulus of 
sudden cold, or bettor by alternate daahing of hot 
and cold water on the fiice and cheat, or bf flick- 
ing tha akin with a towel. These reflex stimali 
are oftan of themaolvee aufBciant to excite respi- 
ratory movemanta; if not, they ars poverful 
subsidiary aids to artificial laspiration. Tha 
diaphragm may be stimulated to oontiactiim by 
galvanisation of tha pbraoie nerve, one pole b»- 
ing placed on the serve aa iteroaars the sealanos 
anticns at the root of tha neck, tho other on the 
epigastrium. Chief ralianca, hovevar, is to bo 
placed on the mathoda of aH^ieial rtifiratioH, 
which, after all, are the most simple and tho most 
eSaetnal, and possessed of the pre-eminent ad- 
vantase of being always available. Sei Aaron 

CIAL BZSPIRXTIOX. 

Air may also be introduced into the lunga di- 
rectly by properly constructed tniufflation-appm- 
ralfu, either by the insertion of a tube within 
the larynx (an operation requiring dexterity, bat 
without danger if akiUiilly performed, though 
there ia always risk of ruptuieof iheoir-rasiclaa 
from over-diatMwion) ; or mora easily hj the ia- 
BsrtioB of tha tuba in one aoatril, tho othor 
Bostril aad tho mouth beii^ closed(^chardsoB'a 
apparatus). Uoutk-to-moutk-i»tufflationi»mimit' 
tunes of sdvantage, eapaeially in infants, - TiM 
oporator must «Imo tho aostnlo of tho p n t l i wt . 



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.^ iJiBOitiiBiwrtly to UMt of the 

ST'Tbtttoii^ to inltatioB of the »to- 
•"r^ ■■■— "« anU c a oU d by backward 

laprKATOa-SW"" Fp. Atpvalmr.— 

.^T-^o/iirioiii iflrtrnoMiiti had been need 
^J^um «t 'nction-troehai.,' but to 
^^ M dM the credit of fuUy anireciUuig 

i||.i> rait. 

n, Miwetor «»»««• rf »8l""^y™8^ !>»"»« 

tf ,u ld«rM<J t»o opram?! prondcd with stop- 

•jeij. When the piston is raised and the cocks 

u»cIo»i»nK:'i»""°^'**^''' thesjrringe. which 

oi l< nuiutiiB"! by 6xing the pist-m in tho 

witidrawB position- An india-rubber tube ia 

Ittd mto eMb nf the two openings, and these 

UMt be proTided with coils of wire inside to 

Ptarect tkn from coUapeing. At the end of 

su ttbe i« fi»«l » ^^ hollow needle. The 

gaadV sboold lure only one opening, at the point, 

udnt ajis oft^n seen, another at some dis- 

taott mm it. The iostrument is thus used : — 

A nruusa lurinf been created in tJio syringe 

by nuiiig tiu piston whilst both stop-cocks are 

cStmi, tbe seeale is introduced into the part to 

^g«..jtaj apcn. As soon as the opening of the 

asaoie is bentAtb the akin the stop-cock leading 

to it Bust be opened. The vacuum will then 

atcad to the point of the needle ; and coose- 

mgatJr, if it 1-? gentlj* pushed onwardii the mo- 

Bcoi II eneoonters fluid, this will jet up into the 

glue sjiinge. when it* nature may be ascertained. 

nis mode of openting with what Dieuliifoy calls 

the ' previous vacuum ' is the essential diffrrence 

| ) « t» ee u as[aratiou and suction. In aspiration 

it ia impomUc to pass the needle through a 

ealla<ti>:j>n of fioiJ without discovering it; whereas 

without tile 'pieriaus vacuum' in the needle this 

miigtil readilv m done. If the fluid is sufficient 

in aiiK>iuC to £11 the syringe, the stop-cock lead- 

iag to the aeedle is to be closed and the other 

lynad. by which the fluid may be discharged. 

n* raemun m^y tiien be re-established, and the 

opexaticn repeated as often as is necessary. By 

opaniBg both stop-cocks at once and allowing tlie 

Jwlian^i tube to hang down, the aspirator may 

ba amverted into a syphon. The action of the 

i— tiaiiiiat may also be reversed, and it may be 

aiii^iltyed ibr iryeetiog flaidi. Other rarieties of 

■■inntji' an in aaa besides the one above de- 

■cnbad. Ju Weil's the receiver is a glass bottle, 

tto^ vhifh the air is exhausted by means of a 

•B^asaXc esliausting syrioge. The objection to 

tkw is that if Um needle becomes choked, it can- 

BoA te deand by poshing down the piston and 

diiaiiigaoBie of tiio fluid back through it. Other 

Villi of aspirator cannot be eonrerted into 

■Jphoos, and tliese are objectionable. AVeiss's 

IsM the advantage of being less liable to get out 

of arder, as the fluid docs not touch the ex- 

WaKicg syringe. The needles employed vary 

ia ane. Dieulafoy ncommenda that they should 

bs alioat ^. g^, X. and ^ of an inch in cUameter, 

aad calls tiiem No*. 1, 2. 3, and i respectively. 

) aapintor nay alao be applied to trochart. 



A8ttBATOEB-> 

but thcB its distinetirs fea.'fc.'a^^ 
bn-omu!) bnt a 'suction trocfiia w^— 
The fdlowing nles must. ^a.1. ~^ 
in using the aspiiator. 1st. 
is pervious and dean and tJt>. 
before nsing iL It is advisi 
needle well in strong earbol ic 
The ceedle must l» pustiftd 
direction only. Its course x*y 
while the point is under tlxe 
is found, it may be withdx-a. 






it 









It most be held'os steady a« I*"*?!!^^ 
aspiration. 3rJ. If the fla.i<l. -«r-j| j W, 



« -i^-ui.. 5«t/i' 



'^'^'^^^ 



of 



Aat 



the force of the racuum, it ia of a*^^ ^'ifc ^Ij'^^S'*^ 
and pressing the part. Thi« cmJX ^^**«o ^°«»-^-^ 
4th. Aspiration must ccaso nX •tj^. **J>. ^"e^^** 

comes in any quantity, espoci»i/^ . ^,|, ** Aei^''^ 
6th. Keep up the vacuum dui-infftlj**! ^^?J>loo,i 
of the needle, lest some of tlie morftj^ ^^u!!^*"^ 
in iU track. 6th. If the need le boe^ ^UJ^ ^•»' 
force a little of the fluid back thror ^^*»— -'• •'' 
to clear it. 

Uses. — Aspiration is used fof 
diagnosis and treatment. Dieulafoy^^T'Q'ae 
wiih the No. 1 needle it is posslbJo to^^JJf'** '^■* 
fluid without danger, whatever may^ b, ite"*** *' 
its nature ; and experience has proved Sh^^ "' 
be practically true. In treatment it ligj hL5f 
employed in the following ftfTcctiona: "eon 

Abtcesfea. — In acute abscessos aspiration is 
usually uf little value, as the pus soon re-accumu- 
lates. In clironic abscess connected with diseased 
lione it usually fails; and often it is impossiblau 
from the amount of cheesy mutter in the pas. In 
chronic abscesses unconnected with bone it some- 
times effects a complete cure after three or four 
repetitions. It luts proved successful in curing 
perinephritic abscess in the writer's cxporienco. 
It is always well in chronic abscentcs of doubtful 
origin to give this mode of treatment a trial. It 
must bo remembered in treating large chronic 
abscesses that a dirty needle may lead to decom- 
position of their contents. DiKOfen of tie Livtr, 
— Hydatid cj'sts have been succcsslully treotod by 
aspiration. In many cases the fluid becomes 
purulent after one or two aspirations, and in 
some the cyst has opened externally. For pur- 
poses of diagnosis the small needles may always 
safely be thrust into the liver. Abscess o{^ the 
liver has been successfully treatedbytheiispirator. 
lUlenlion of Vrme may always be Hufely relieved 
by using No. 2 needle above the pul>es. Ovarian 
cytta may be diagnosed and treated in the same 
way. Hernia. — It has been asserted that stran- 
gulated hernia may be, in the great majurity of 
cases, relieved by the use of the aspirator. The 
finest needles only should be used. 1 hey removs 
first the fluid from the sac, after which some gas 
may be obtained from the strangulated gut, but 
faecal matter rarely fails to choke the tulie. In 
this country surgeons have not succeeded in 
sufficiently emptying the gut to allow of it* 
reduction. Experience has, however, shown thst 
if the needle bo kept steady, any number ol 
punctures may be safely made into the gut. 
Disease* of Joints. — Aspiration is occasionally 
useful in acute synovitis. Great care most M 
taken not to scratch the insiite of the joint 
with the needle, as this has been known to lead to 
acute arthritis and suppuration. No. 1 or 2 needls 



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PO 



ASnSATOIL 



riundd be nsed. BjfdnetpJtahu and Spbui Ufiia 
m»7 be aipirated with isiety wifh No. 1 needle. 
In hydioe^)h>lna it ii to be pused throngb the 
anterior footaoella. Ko taM hu hitherto been 
eored by tfaii treatmenL In Ptturity and AteiU; 
except fbr purpoees of diagnoeia, in the mitet'i 
opinion the aspirator preaente no adrantagea 
orer a tiochar properly eonatraeted ao aa to 
ezelode air (lee PAiucximais). Ptricardita. — 
TUm operation of nspiration hu frequentlr been 
(ueeenfolly peribrmed for periearaiiU emuioa. 
It ia thoa carried ont : — A ipot i* chosen S to 
ii in. (S or 6 centimetres) bcjrond the left edge 
of the Btemnm, in the 4th or fith interspnee. No. 
3 needle is then passed obliqaeljr npwaida and 
inirards, taking care to turn on the raenum aa 
soon as the aye is eovered. The moment the 
fluid jets into the syringe the needle mnst be held 
steadily till the flow eeaaea. If this be done 
then IS no danger of wounding the heart. If 
there is any doubt as to the existence of fluid, 
No. 1 needle must be employed, with which the 
heart may be ponetuied without great danger. 
Mjlscvb Bao. 

IsiCTino} (».priT^««lrtfr.»..tr«gth). 
— Terms signifying want of strength. Aa applied 
to the entire SjEtem, they indicate considerable 
general debility ; in connexion with particdar 
diseases, they imply that these are attended with 
marked weaknoss. 

ASTHSIf OPIA. (i, prir., rSirn, strength, 
and it^i, the eye).r— Weakness of aighu &• 
ViaioK, Diaoidois of. 

ASTHKA, BPAaUOma{iatiiM,tiomlm. 
I blow).-STxuic. : Bronchial Asthma. Fr. jUthn* ; 
Oer. Brcmekial-AMkna. 

Damnrio. — An aibetion charaetsriaed by 
•erere paroxysmal dyapnoaa, recurring at mora 
•r leaa well-marked perioda, generally in the 
night, the dyspnoM being dne to spasmodic con- 
traction of the bronchi, ptodneed by a Tariety of 



JRnouoar. — ^The eaaaea that indnea an attack 
of asthma are my rarious, and may be roughly 
classed according to their action, direct or ti>- 
dirtet, on the mpiratorr organs. In the former 
the exciting eauM immediately affects the mocona 
membrane ; in the Utter it does so in a more 
cireoitons manner, aa through the blood or the 
Berroos system generally : — 
rDuet. 
Vegetable irritants. 
Chemical raponrs. 
Animal emanations. 
Climatic influences. 
. Bronchial inflammation. 
Through the ner- /Centric. 
Tons system . \ Excito-motor. 

^S* '^' f&^lia. 

I Skin diseases. 
[ Heredity. (. Renal diseases. 

Dirtel eauta. — Common roadside dnst; flnflT 
from woollen clothing; tbednst of milla, threshing- 
loon, or bakehouses; and any mechanical parti- 
dea when inspired, will prodnee in some persona 
an aathmatie seizure, dnst of low specifle gnn ty 
bahv more apt to hara tliia aiftet than heary 



Dinct 



Indirect' 



ASTHMA, t^Asmmc. 

particles like coal, steel tlinga, etc, ttam vUdi 
arise lesions ia the Inng of a more paratanant 
and aerioaa character. 

The odour erolTed by eertain Tcgetables, raeb 
aa ipecacuanha; the poUeo of many giMssa 
and plants (tat HAT-raTBB); certain chemical 
vapours, aa that of pitch, snlphurons acid, and 
phosphorus Amies ; the peculiar smell of some 
animals, aa dogs, eat% horses, and barest may 
each proToke a spasm in indiridoal eaaea. 

A still more powarfnl canse is climatic !ii> 
flnence, the action of which on different patients 
cannot, vnfottonately, be reduced within tlia 
limits of law, bat depends mainly on the idio- 
syncrasy of the indivianaL Extremes of tempera- 
tare, or exessrire dryness or dampneaa, may pro- 
duce an aathmatie seiznre, bat in the laigest 
somber of easea one of two elements appears aa 
the chief factor. One large elaas of auArera 
trace the attack to danmntti, whether of soil or 
ot atmosphere, in combination with either heat 
or cold ; another to ciMmssf of atmoaphare and 
a want of proper cireolation of air, such as is 
found in deep Talleyaand thick foreata, and during 
thnnderr weather — tUs laat dass experiencing 
great relief when a breaie springs np. Malaria 
pUys an important part occasionally in the caoaa- 
tion of asthma. 

Far mors general and intelligible in its action 
is bronchial inflammation, which is the cause 
in 80 per cent, of aathmatie eases. It frequently 
happens that aftar whooping cough, meaalea, or 
tnmntilebrondiitia the tendency towaida asthma 
begins to m>pear. These diseaaea, implicating 
aa they do both bnmdual mnada and nerte sup- 
plying it, leaTs their marie behind, either in irri- 
tability of the mncous membrane ; in induration 
of some portion of the lung, generally at the 
not ; or in enlargement of the bronchi^ glanda, 
eansing preasare on the pneamogastrics, or on 
some of the branches of the pulmonary plaxoses 
{lee Bromchui. (Hajfss, Di s e a ses of) ; and thus we 
often And that the diaeases which implicate the 
bronchial tabes in childhood lay the fonndation 
of astlima in after-life. 

Indirect amma. — This class of causes indndea 
those acting throngh the general nerrooa system ; 
those acting throngh the blood ; as well' as the 
more or leaa atructnral one of heredity. 

The eadrie subdivision embracea attacks 
ariringftom emotion, anger, or fright ; as well aa 
the enrions altemationa of asthma, neoralgia, 
angina, and gastralgia dne to some centric irri- 
tation in the medulla, involving the origins of 
the flfth and eighth pairs of nerves, and mani- 
festing itsdf by aflecting first one bnoch and 
then another of theae nen-ea. 

Exeiio-motor causes may be illQstrated by indi- 
gestion or coati re bowels giving rise to a paroxysm 
of asthma. In the flrst case, irritation of the 
medulla is induced throngh the gastric branches 
of the pneumogHstric, and a motor effect is re- 
flected through the pnlmonaiy branches. Thesa 
peptic attacks, aa they are called, occur more 
ftvquently after suppers than dinners, probably 
because reflex irritaUU^ is always exalted by 
sleep, as we know to be the ease in ei^epsy 
and the teething convulsions of childhood. 

Oout, towBids old age, often takes the {Sana 
of asthmatic seisuica, which alternate with the 



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ASTHMA, SPAtMODIO, 
HtieaUr afbetiain. In Uk* mtnoa kttadt* ef 
the dinaas hav* been sttiilMtad to iTphilii. 

n* eoonrxion betveen aetliiBa and Tsriou 
tft ekia-diaMae ii intimate; the rtb- 
I of ecawna, of nitiearia, or of paoriaaie, 
hM often been aeeompanied by flu of tpaamodio 
tualhiiig, whidi bare cesard on the nappfamaee 
<f tlw eraptiona. Hera, agaiii, the itate of the 
bload is preaomed to be the <»giD of both 
■alailin. aa in dfaaaae of tbekidneTi, whieh vill 
beag^in lefened to. 

B m i i tj can be traced in about 40 per cent, of 
MthBaties. though the tendancj often do«a not 
Ao<r itaeif till Ut« in Hfe. The eharaeteriatie 
tarn ot cheat t* often tnuxmitted ttom parent* 
ts cliildien ; and erea when thia ia not to, a 
dh yiti uo towaids apaamodie tjmpUma ia 
cafamfaal attaeka ia often aean in the ehildrea 
«f ioiaa aathmatica. 

STMFnni*. — The patient ntiies to bed with 
fcw or no pcnoaitorr ajBptcoaa, and ileepa 
foe aaaa koora, bat is diatntbad in tiie late nigbt 
or eaii; vomiog — two a-m. is a eommoa time 
— bj a feeling of o pp n aa ion i^mMKhiag to 
aaflboatiaa, l afeted either to the throat, ater- 
Bam, arepi9utriaa,iriiieh oUi|^ him to ait np in 
osdar to bieathe. SoaiatiiaeatheODaetts more gr»- 
daal ; the patknt, haTingfUlen adeap in spite of 
neaay saiaatiana, beginsto wheendvriBg deep, 
Bad is oaly anand when the djapnoa becomes 
mmn. "At breathing ia aeeomranied by a hum- 
■iag soond, wfaieh (^mdnally oeretopas into a 
great raiictj of diaoaraant noise*. 
' la order to iacraase the eapeeily of hi* ehaat 
ta the ntnuat, the asthmatic patient sit* sp and 
txaa his sbmlders, either by pladng hi* hands 
no eitkar aids of Urn, or by anpportiog his 
elbows by his kaeas; or aomatimes he stands 
leaaiBg o*«r the back of a chair or odiar snpport. 
In SDe or other of thcas positions he remains im- 
■DTaUe, with chat, back, ahoalders, and bead 
Csad; nnaMe to speak or even to more hi* bead; 
the lips bcingpartad ; the face pale, anzions, and , if 
dM <^*^<Ba coatfinne, lirid; and the eyas pro- 
nineot aad watery. Ererymiiseleof respiratioB, 
evdinaiT and estmordinaiy, is broacnt into 
r e qaiaiti on; thoaa paaaing from the liead to 
the dMaldera, to toe daricles, and to the riba 
bacone ri|pd, emd, in plaee of moring the head 
and neck, act the rereise way, being uaed as 
•xed pointa to laiae and dilate the thorax. The 
tnpeaii aad UfTBtorea angnli aeapahe by thrir 
contiaetian derate the ahoalders, in oider that 
tfaa Braadcs ceonaeting these with the riba may 
act as deratoca to the latter. Kren the mosdes 
of the back are ynmnH iatq the serriee, and 
thay almoat cease to eappoit the back ; eonae- 
■aaotly the patient atoopa. At each inspimtion 
na atacBO^eido-nmatdda stand out like eorda, 
karing a deep boUow between their atemal at- 
l u l iaiii i it*: the diaphragm is contiaeted, and 
htaes the a*"*— ^, lirer, and heart are some- 
what dmplaeed. With all this diapUy of mus- 
eaUr Ibica, the chest mnains almost motionless, 
bdag expandrd to a Tsriable extent. 

Ia S[iiu of the great dyspnoea, respiration* are 
jMt paepertiaaatdy frequent, sddom exceeding 
^rtj, sad aometunea suHng to nine a minate. 
Tka cj^antioo ia prolonged, bang generally two 
■r thiae timas as bog a* the inspiratioB. .The 



pntle is Bsnany *1a>w and fS»»'X:»X 
rarely exceeds 99" Fhbr., 11.11 <-l 
Fahr. Analysis of the esc t^i 
oxygen to bo almost sntirel.y 
acid, which may incieas* tro 
mneh as 11 per cent., the ni r 
80 to 93 per eent. The ax- 
ptobably the cause of the 
acid, bnt the total diaappea xr 
is hardly to be explained, fij> 
the tissoas does not pp ceed, i • 
nrioe passed after the fit. 

PKTncAi, SioHS. — These r«3 -< 
be enwetad. The peicossi <» 
raiaea orer the whole chest, 
tenor ragiona, whnre a dram 
aionally prerail* : this hypox- — 



9^ 

of «>.'>>.i^^ ^ 



C-kxo 






.^-lat 



\t 



*t 



V'^^fes.u 



-* iJt 



•o'?'*^n 






^^i* 



ail* : trns hypc-z — .»-«r»«o~ %^^ f.'<«> 'ftK. 

bably ane to accumuUtiMi of ^m. -iV7*»'iK''»» ^h^ V?'»t 

atmc»«d expiration, nndiniue-i w^^i.'''tK;^^ M Ix^l 

off witlrthe attack. "^ ' o '^<v»»\ ^W^' 

Anaenltationahowsan eiit;isr«^ «i ^^ l k^^ 



normal breath-aonnds, and th. 
sibilant or sonoions rfaoncbi, n 
in tons according to tho call br- 
tabes; the smaller ones givin ^^ 




^^^J 






and the larger ones the dt 



M*^_C^. 



'V'C'-^^ 






V 



"S- 



sovnds eontimially change the i r^ X3r>''°e,J''*.»i**c»r-N-7^ 
ing no under the listening eax-. dT^'tT^^^ ^^^*# 
vanishiBg again to rire place to ^r^^ J^\ :^?t/'^ 

asthma, when once establitihed. Jjj. ^.^Q . '/cl*#•- 
aahonrto aereraldays,aBdgenemj/* r *>^''®«^ 
with expectoration — thin and tr»T3g '*" to*^*^**" ''*" 
adinrs be short; but abundant '"'^i '^ 
leas opaqae if the lit be prolong(><j, "^'^'i 
be ehronic. The urine ia li^j. ''''•"' 



Of ,v '»' 



ir 






«.« 



plentiM ; and flatus ia often ezp«i]] '°>>i>x^ '"<» 
txrwela. Little or no food is taken d^ '^iq ^ "^ 
tack, at the close of which the patient&u'^ *''* *^ 

The recurrence of the attada when on **'"*P^ 
hare been excited is geneially poriodif 'k^ 
mnch depends on the presence or abaonea^ tk^ 
exdting eanse. In many cases the patient * 
^ite free from wheedng and dyspnoa in tlu 
intwrals, and fcds and acts like other people^ 
bat when the attacks fbllow each other doeelv' 
a more or leas wheesy condition remains behind,' 
and a few signs of obstructed breathing ani 
generally to be detected in the inteiBcapolar 
regions. 

ComucAnoKS Am SxqtnnjB. — If the asth- 
matic attack* become habitual, their effects ai« 
leen on the fVame and on the organ* implicated. 
Theshoaldersbecomeraised,thehead being buried 
between them; the musdes of the back, owing to 
their being called oa to act as extnordinatr 
muscles of respiration, are dirertrd fiom their 
use as erectoiB of the apine, which, accordingly, 
yielda in the anterior direction, and the patient 
atoops. The fk«quent occurrence of apaamodie 
contraetioB of th* bioadit causes hyper^phy of 
thrir muscular coat ; and this, with or without the 
oongeftioB of the mucous membrane accompany- 
inglt, leads in time to thickening of the tube* 
and permanent narrowing of their calibre. Ths 
more common result of asthma is emphysema, 
aridng flrom the difficulty of expiration. Th* 
emphysema, at flnt temporary, becomes in 
chronic cases permanent, and gtres rise to di*> 
placement of the acyofauBg oigans (sssEiomr* 



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ABTHXA. aPAaif(H>ia 



t,), OuntactiDa of tka twooebik iMfalj 
lBfluaiK!Mtliepalinoiisr7raa*la,sndoouidaiiiUe 
obstraGtion of tlia polmopaiy eueolatioD is th* 
Twalt. Tlia tmmU htcaaa goigsd, and Mm*- 
timei the longi nimaatom. If Um aDph;iaia> 
be extensive, we may in tina expect diULition 
of the right aide of the heart and mariud pio- 
mineaea c^ the Taina of the breast and neck, and 
the effaeta may be carried so fiir as to eanaa 
ndenu of the lover eztiamitiea with albnminona 
arine, as the writer witnessed in a ease when 
the Utter symptoms disappeared on the sab- 
■idenee of the asthma. 

Fatholoot.— Patients mrelv, if erer, die of 
apaamodic aathma, thoogh daatA nu^ ansae froa 
some of its eomplioations and aeqneUe ; and the 
disease being a functional one^ cannot ba said 
to hare any morbid anatomy. The onset and 
departare of the attach and the ever-changing 
physical sigoB, led LaanDce to think that, ma(> 
ever obstnction in the bronehial t«bea eansed the 
phenomena must be ofaspasmodieandtraiuataiy 
nature. He therefore concluded that asthma waa 
due to a spaam of the bronchial mnsdes whieh 
hadbeendeacribedbyBaiiaNSsen. Ijtenaeealao 
diowed that an asthmatie aaffanr eould aame- 
timea, after holding his breath, aetoally bteathe 
Batorally for one or two respirations, thus clearly 
demonstrating that the apaam was ea|pabla it 
momestaiy relaxation. Other theories wen 
pat forward, and donbt was thrown on the exist- 
enca of moacnlac fibiea in the bronchi, ontil 
Dr. C. J. B. Williams prored their Muatasee by 
his experiments on the longs of oxen, dqga^ 
labbita, and other animals, when he eaasad eon- 
tnetion of the trachea and bMDchial tabes Vt 
the application of electrical, diemiaal, oad ■»- 
dHwieal stimali. The mnacolar eoat was 
•bown to be mora abondsnt in th* anaUer 
tabes than in the laigsr, the fonner eontraeting 
■offleiently to entirely obliterate thur passagea. 
In aathma, exeitatioa of the moaole pcobably 
takea place throngh the anterior and poeterior 

C' lonary plexA% which era made np of 
chee fiom the pneomogastriosi l a anreent 
laryngeals, the spinal nerrea, and the ganglia 
of the aympathetic, thns giving the branchial 
tabee a very wide area ot connections. The 
branchea of the palmonaiy plexiis form a net- 
work ronnd the oronchial tabe% and aontain 
some minute gangUa. tVheo the eanse is direct, 
aa dnst of any kind or climatic influence, the 
spiam may be induced by Mflez action through 
these email gaoglia, or tjuoogh the pulmonary 
plexAa, thon^ it soon extends deeper into the 
nerroas system, involving the pneomogastrica, 
and cansing a motor e&«t on thie thoiacie mne- 
elaa through the upper cervical, phrtoio, and 
dorsal nervee. Wbaie emolioD, fright, cc 
laughter startc the fit, the irritation is asntrie, 
and cauaes a motor effecton the pnlmonaiy plexAs 
through the pneamogaatrica. Wheist again, 
indigMtion exates it, the sensation passes 
tlirtragh the gastric branches of the pneomo- 
gastrie, and is reflected by the motor fiamenta 
of the pulmooaty plexAa. Lastly, whara gout, 
syphilid skin-disaaae, and heredity ore the axci- 
lanti, we may regard the blood itnlf aa oaasing 
the local imtatioo. Spasmodic asthma may, 
tborafoM^ be sonadand aa a aearoaia of th* pol- 



monaiy biaaabas of Aa plexAs of ibi 
similar to other neaioaea, aa hemicrsnia and 
aoiatioa, and giving riae through the motor 
nervee of the plesAa to spasm of the bionctual 
mnsde. 

DiAOiroau. — Aathma is distinguished tnm 
broaekiiii by th* fugitive phyaiMl signs ; by 
the apasmndie f haranter of the dyspnoaa; aadl^ 
the acant e^ieetaratioo. The breathing in bfoa- 
ehitis, if at all difficolt, is hurried ; in aathma 
it is slow, whseay, and prolonged ; this feators 
also eoBtOMting stiongly with the gasping, pant^ 
ing dyspnoaa generally aeaompanying pnenawwia, 
pleorisy, and some fonas of heart-diseasa. £!tam 
STMip it is Mcognised partly, but not eatinly, 
by the age of the patient; and partly by the 
ahaiaeter of the dyspraa, which in eroap is 
iiufiraiorj/, wfaersaa in astliaia it is mainly er- 
piratory. Thia characteristic also distingtusbei 
asthma from spasm <^<i<^i(i)Mi« and the varioos 
forms of l ary nfm l rfj q wuw . The diagnosis from 
tmpijfmma, which is so oftan mixed ap with 
spasmodic ssthma, is foonded chiefly on the 
paroxysmal character and violence of the aath> 
matic dyapooBa; aad on the complete freedom of 
the intervale, th* dysimaa of emphysema bang 
mora or leas psnnaaent. 

^asKrifst of tit mtrta and other ma rf i arti a sl 
tttmnm often give rise to symptons so exactly 
simalatiag spannodic aathma aa to make the 
diagnoaia diinealt, and this is to be aocoontad fof 
by theee taaoan pressing on the pnenmogastiie 
and its brandiss, ud thoaindndngaa aathmati* 
These e a a e s are, aa a role, however, 
by a certain omoant of stridor 
•rising from laryngeal spasm, not prese n t in 
aathma, aad thia qrmptom is often of grant 
diagaoatie valoa in eioaaara eaaea. As the 
taaaoar enlarges, it caoaes greater preasuiw eo 
the lungs, traehea, eronphagos, aympathatie 
ganglia, or other atnetniea, and prodnoes shrill 
coogh, ctyephagia, diffieolty of inspiration, paia 
in the cheet, iaqmlaa in tiie thoiacio wall, aad 
other noted anaorismal symptoms. Koreovar, 
eertain phyaiaal aifna beeome evident, s^. dnlneaa 
over the flrst pottioa of stonnm or to th* right 
ofitior betweeatbeseapnlB; tabular aonndt aad 
bro n chopho n y doee to the etemom, orabovamie 
or both aeapahe ; or eome form of bmitorarai^ 
muria the coarse of the aorta. Theee and «ther 
avmptama and signs eontract sufEieiently with 
thoaaof spasBiodie asthma, to make the diagnoaia 
fiom developed aoeorism eonparatively eaay. 

In aoma eaaes of r a w * / Ajsass a form «rf 
dyqasaa appears, whieh is occasionally marksd 
by paroxysmal featares, and haa been mistakan 
for spaaniodie aathaaa. Seaal dyspnoa diflanv 
howaver.aa a mle, in being moneontinuons; and 
in having for its origin osdema of the long rather 
than bronehial spaam. 

Faoiurosis. — The qaeation of raoorery in ease* 
of aathma dependa to a eertain extent, — 

Firstly, on the poasibility of the removal of 
the exciting cause ; 

Secondly, on the age of the patient; 

Thicdly, on whether the attacks ineteaa* or 
BOt infreqoeaiey; 

Foorthl^, on the eosdition of the longs and 
brsathing m the intervals. 

If the patient be yoont (sajy, ondsr fifteen), the 



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ASTHMA. SPASHODIO. 



chirtvaU-ianaad, tiM attacks toadii«todinimh 
ia bunt mut s y and inteoaity, and the longa&aa in 
the jntorrala, a nuMt Impefnl pmeiioau can ba 
tiiaii If, on the oikcr taad, tna patiant b* 
■dddla-agBd, tiie aUacka incnaaing in maaba 
tad aanaity, and the bnatk mora or leM thoit 
in ths intervala, ts bm/ eonelada that than 
•zirta a considarable amoosr of pamaoant am- 
ik^aoa, which lendsn the prognoais of an nn- 
tRonisfaie cfaaneter. In tyrj in itan e a tha 
dataetion and nmoral of the exciting causa or 
eauea, as tha ease may be, exercise a chief in- 
ftaeacaorer the pragnosis. 

TaMiTjaarr. — ^The ptineipal difBcnlty in the 
tnabnant of asUnaa lias in eleuly ascertaining 
the origin d tha irritation, and irnen this is dis- 
eonnd two gnat prindplas should gvida na, 
■siisij. ifast, to aToid or remote the exciting 
ana*; neoiidlj, to allaj and prerent the 

llaa; of the caaaa arising tarn direct causes, 
•a (bob dast, cbsmieal ▼apoan, lic^ are cored 
ty piaple aroidaoee of tha asoiting oansa, 
'Wkaa baoodiial inflsmmation indaees ths 
the ialsismition most be snbdned by 
and expestoiants, oombinsd with soma 
■ beUiidoana, hanbana, or 
In more chronic instaneesi where 
(■■IS thiekening of the walla of the larger bronchi 
and enlargsmeat of tha bronchial gliinds exist, 
iodiila of potaasinm in doaes of gra. iii. to z., 
laa been foond beneficial when perristad in fcr 
kagr parioda. Where tha attaidu depend on 
a Boshid state of blood, aa that associated with 
ent, syphilis, nnal disease, or eomsclsd with 
, treatBsat most be diraoted to the 
1 at this floid, which, if improred. will 
indaae facoaebial qiaasL Arsenic 
fo a aaaf signal suiiim in awuna eo-ax i a ti ng 
vith SI ■■IIS, iianrisBs, and other skin-affeotions. 
Whcse hendity is the predisposing cause, ths 
OBipa of the rtiseisn Ilea guanllT in daisctiTe 
daTalapawat d the frame or of the Inng-stmo- 
tataof the patisot: for soch persons gjmnaatie 
tmttnata, swinging an the trapess, and other 
Meaaa of saynding the upper part of the cheat 
aad eaiiaehiig the asthmsfif stoop are to be 
aseflnjsd, combined with cold sponging and as 
■adi onwlnor liis as possible, with walking and 
lidiag ia modsntion. The tendeney to catarrh 
is tbaa Isassnnri, and the fiame of the patient 
di>Tsl<nied and iiutifted. In a large number of 
instance, those arising from di- 
sea, we hare to treat a sin^^le nen- 
, aad to allay tha spasm either by climatic 
ar by mcdieiaal means, of which the former 
is oilaa ths ssois important, and, owing to 
tha leading past played by the idionnciai^ 
af the patient, geneially the most diffictit. 
Ia obatinsts eases the' doctrine of contissts 
HHsai s ths nnly enfn nmn Whn* the disease has 
beea contracted in a moist climate, a dry one 
■ast he tried ; if ia aa inland district, the seaside 
mast be resorted to ; bnt for by far the mi\jority 
«f ssthmaties the atmosphere of latge towns is 
— '*-W. aad the aaiakier the air and the eloear 
the stTMts tha moaa good do the snflfaren appear 
la aemra. Loodon, 61a^{ow, Birmin^iam, and 
BfisfiJ sre all faTOuaUe resorts fcr cases of 
aad the points of differsaee 



between their 
country consist, (1) in 
of ozy^n ; and (8) in 
and oarbon: aU of wUeh _ 
exercise a sedative efiect on tla 
whether of soil or atmoaphaar< 
to ba hnttfbl, and is ons of 
causes of asthma. 

Tha medicma most useAd i 
spasmodies, eidier stinnilaia'fc 
fbrmer, including alcohol 
ctharis, and nitrite of amyl. 
efllcacions where emphysema i^ 
comprise stramonium, balla(l.«>m: 
lobelia, tatula, tobacco, opi 
and many other drngs. Thea 
teniaUy in the form of ax 
or smoked in pipes or as cii_ 
as raponr diffused through t^2i 
papers or pastilles containing -k: 
and often reliable remedy isi -c^J 
from the combustion of nit:K-c 
sererest attacks the patient ^s«i 
nor swallow, and in this ^ 
trodncing medicines into his ^sj 
hypodaimio injection of atro2>s 
chloral provea effectual; bat^ £ 
present, or if the pulse be w< 
attempted. Chloroform oftei _ 
in the worst case, and after it» 



.V»%t 










a ■•H»7* «>> 






... .... «/i,Z''** >k ^'ot 177 

mmmia the patient^ will gaua ti, ** ^S '**»fm* 



"^^^^^^y^ V 



has bean denied to him for ho-aix-^ ^"ea^ '-« a 
but tie effect is generally traasiti^jf^e*-^ ^^hi^ 
of tha remedy not free from risk J?»«^'*<t it».*^J* 
but not so effectira. Chlora-I» -^dfl . •*" i^* »»^* 
of 15 to 20 grs., repeated -—-^^^ ' *— "^ 



left 



»r» 



S*'** 

.<*<>-• 



until the spasm subsides, has prv>daoeci*^ ^^^^ 

O07 



temporary, but even permanent ^ooil^ *'ot*^'?* 



number of asthnuitio eases, and Tt -w^^ « i ^'■'.f 
be persisted in for soma time. Xn u^^^ ^"^ 
hands it has proved tha moat tuccema^? ^^iu^ 



proved ua moat snccesaf,,. 
In tha use of snti-spasmodics -«re n, ^^ 
judging the efiecU of one from thn y*^ *'^S' 
another of the same class ; but in dim^'^drs ^ 
we mast try each in succeaaion — fop^* "aeea 
bsppaos that the successful remedy is On] "' o^q 
at siter repeated trials. ^^'rire^ 

Certain mineral waters, and cspeciHH 
of HontCoreaod the Pyienean sulphn, ^J"""* 
of Eaux Bonnes, Eaux Chaudes »nd Canf^"^ 
are reputed to exercise a beneficial ii^ "^ 
over asthma, but they have not b<>eD su """'" 
fol in tha writer's experience, and it ig ***•■■ 
probable that they relieve by r6dncin»'°u!* 
catarrhal symptoms than that they either »1^* 
the spasm or prevent its recurrence. ausy 

Compressed air baths at praasures Tarvim. 
from 3} to 7 inches of mercury, and lastingtwo 
hours, have afforded considerable relief, A. 
AiB, Therapeutics of. 

The dietetio treatment varies in individoal 
cases, but as a rule asthmatics should dine earlv 
and for the reat of the day limit themselves to 
liquid food, such as beef-tea, soups, and milk, 
combined with such an amonnt of stimulant aa 
may be necessary, thus avoiding any distension 
of the stomach and intestines before retiring to 
rcat. The diet should consist of brown brmd, 
toast, and biscuits— excess of starch in any form 
being studiously avoided— a fairsnpply of plainly 



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N ASTHMA, 8PASU0DIC. 

Mokad awtt, fiab ar wmltij, and a limited 
amoant of resatablM aad fruit, can baiog cdken 
to telMt only tbo aioatdigtstibla of evh olaw. 
C. THioDOBa WnxiAJu. 

▲STiaKATISK — ABTiaKIBlC (i, 
priv., and frhrf>> • "pot or point).— Want of 
irmmatry in the antenor refracting rarfaee* of 
toe eyeball, is oooMqtMnc* of wh ich raya of light 
proceeding from a point cannot be brongbt to • 
focni upon the retina a* a point, bat only a* a 
dJAued ipoU Ste Tuioh, Uieorderi c£ 

AMTKOraVSTB. — Dtrnmioti. — MetU- 
einet which wuee'the contraction of tissuei. 

EmjMBRATiOK.— The chief aitringente are Ni- 
trate of Silver; Sulphate of Copper; Sulphate of 
Zinc; Acetate of Lead; Ferchlorideof Iron ; Alum; 
Tannic and Gallic acids, and regetable sub- 
(tancei containing them, auch as Oak Baric, Galls, 
Kino, and Catechu; and Dilute Mineral Acids. 
Home authors also include in this dasa of 
remedial a^^nta snch articles as Ktgot of Rye, 
irbich contnicta the blood-Teasels and lesaena 
hcmorrhnge aftrr it has been absorbed into the 
blood, although it has no local astringent action. 
AcnoK. — With the exception of gallic acid, 
the snbstancea already mentioned coagnlate or 
precipitate albumin. ' Dilute mineral acids do 
not coagulate ' albumin, but precipitate many 
albaminou* bodies fmm the alkaline fluida by 
which they are held in solution. When ap- 
plied to a Burbce from which the epidermis 
has been remored, the other astringents combine 
with the albuminous juices which moisten this 
surface, as well as with the tissues themaelvee, 
and form a pellicle more or leas thick and denae, 
which in some measure protects the structures 
beneath it from external irritation, at the same 
time that they canse the structure* themselrea 
to become smaller and more denae. On a mucous 
membrane they hare a similar action, and they 
lessen ita aeeretion. It was formerly supposed 
that their action was partly due to their caus- 
ing the blood-vessels going to a part of the 
body to contract, thus lessening the supply of 
fluid to it ; as well as to their effect on tb* 
tissues themselves. But experiment has shown 
that, while nitrate of silver and acetate of lead 
possess this power, porchlorideof iron and alum 
do not, and that tannic and gallic acids actually 
dilate the vessels. The astringent action of these 
latter drugs most therefore M exerted spon the 
tissues. 

UsBS. — Astringents may be employed locally 
in Tarious forms. In the solid form, as a pow- 
der, or in Tariona preparations, snch as lotions, 
ointments, plasters, glycerines, &&, tliey are 
applied, especially the metallic astringenta, 
to wounda and ulcere for the purpose of 
(educing the aire and increaaing the flrmneaa 
of exuberant granulations, as well as of pro- 
tecting the surface by forming a pellicle over it. 
Hiey are used to leaaen congestion and diminish 
the secretion of the various mnoous membranes 
— as a lotion to the eye and mouth ; ns a gargle 
•r a spray to the throat ; in the form of an 
injection tu the nose, urethra, and vagina ; and 
aa a suppository t.o tiie rectum. Administtred 
istemally several astringents have a powerful 
affect in checking diarthoa, and certain of tiism 



ATHETOSIS, 

may hare a local action upon the stomach and 
inteattne*. 

The rttHoU action of aveh astringonta M 
aeetata of l«ad and gallic add, when abwirbed 
into the blood, in lessening hemorrhage, is made 
available in the treatment of haemoptysis, hKma- 
temecia, hmnatnria, and loss of blood team 
other parts of the body. 

T. LiiTrDBB BBmrrair. 

ABTtrRXAir BOSB.— The roae or ery- 
thema of the Aeturiaa ; one of the numerona 
synonyms of Pellagra— itfii/ it la rota ; Lepra 
AiturmmM; El^ianiiaiu Mturieiuu. Set 
Pbluuuu. 

ATAV^ISK {atamu, a grandfather) aignifies 
the inheritance of a diaease or conatituticmal 
peculiarity from a generation antecedent to that 
unmediately prece^ng, 

ATAXIA 1 ,. . , , 

ATAXIC S^*' P"^- *"* ''^"' O"^^)' — 
Tenna which originally meant any irremlaritf 
or disoidsr, bat are now apeeially appHed to fr^ 
regularity of associated or oo-ordinat^ museolar 
movementa. The noun is frequently used •• 
synonymous with the diaease known as LoeD> 
motor Ataxy, Bh Looohotob Ataxt. 

ATBIiBOTASIS {Itrthht, imperfect, and 
Itcrmra, expansion). — Absence or imprfection of 
the expansion of the pulmonary alveoli which 
normally take* place at birth, the lungs thus 
remaining more or leaa in their foetal condition. 
Set Lbmos, Collapse of. 

ATBWBOXA. Ste AsnuBa, Diaaasca at, 

_ ATHSTOBIB (U«rer, without fixed po< 
aition). — Dxnirmox. — A name given by Dr. 
Hammond of New York to a condition in which 
the hand and foot are in continual alow irregular 
movement, and cannot be retained in any position 
in which they may be placed. 

DncsiFTiosr. — The apecial character of tin 
movementa in athetoais ia that they are slow and 
deliberate. They usually alftct the arm and leg on 
one side only. Voluntary power ia retained, bntii 
intmfered with by the alow spasm. The finger* 
are irregularly flexed andextended : at one monrant 
they spread wide apart, the thumb being oTar> 
atretched ; thereafter firatone, then another iabent 
in to the palm, and again extended. The move- 
ment can be arrested for a moment in certain 
positions by the will, but is renewed with in* 
creased force. The foot is usually inverted ; th* 
toes being flexed or extended, but in lees constant 
movement. The spasm may canse rain. The 
mnade* sometimes become hypertrophied. The 
movements in some eases cease during aleep, in 
othera they do not. Senaation ia often, but not 
alwaya impaired. The onset of this condition 
ia uaually sadden, and in some caae* with a eon* 
Tulaion. The subjects hare been generally ia 
middle lifis. 

Athetosis differs f^m the spastic contrao^ 
tare so common after hemiplegia in childivn 
in the slowness and spontaneity of the move* 
menta ; but the two conditions are probably very 
closely allied. It cannot be regarded as • 
distinct disease. Typical athetosis nay woo- 
ceed hemiplegia. 

Fatholoot. — It if pwteUa that, at Drl 



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ATEETOSia. 

, tha mat ot tha miaehiaf in 

MlhUmii ia tha eorpoa rtriatimn or optic tliala- 
■a*. "Hm amMm on a et of tha Hi»wi«i», and the 
dsht aflaetioB of aamation, iqndar it pio- 
UUs that a laaion damaging, but not daatioy- 
ii^ » paatinii of one of thaaa nnelai, leadi to 
a pemrtad actioa of the nwe-aeUa, lo that 
■liwri aial BOtar impalaaa aie originatad, and 
thoaa tzaaamittad fiom above diatnrbad — ' irta- 
diatad ' (Nothiu«el). Charcot believea that all 
pait-hamipl>||ie choraa-.d moTementa depend 
OB ttie iippi "•«*»«»« of flbree ontaide the optia 
thnla^iia Inaeaasof simple ataqr after hemi- 
phgia — aa aaalagoaa epodition, — tha -writer 
hM fimoda dftricial aeletoaia axtanding icroaa 
the (ftie tJialamis and piobabljr left by a 
frtfh ef avOtnnng. 

R mu r uai a. — This ia nnfaTDorabla, bnt the 
iGgkter eaaM improra and may eTan appnxi- 
■afaly naorar. 

UniiBiilhi iliiiffr iBiHiBtiiii..Oftl^ 
■BMie, and c< tfaa latter fadiaa ham^ dv 
(Dod ; facoBidcs sea alao Bsahl. Thaeontinnona 
cazicnt ia pciiia|ia tha agant-wliieh affinda most 
tSatinrtnlidL In me veil-marked case nndar tha 
writac'a can tha spontaneoaa moTe'nwnta ceaaad 
autii ei y after aome months' galTsniaation. 
Ibe pnatire pole may be placed on the Bpine 
or bnefaialjdcxiis, the ncgatJTe on the mnsclea 
iavDlTcd. Tna ae^m of the oondonoos cnrreDt ii 
probably ia part diieet, in part reflex, lenening by 
the p«ipliafal impreaaion the OTer-aetion of the 
caatrat aa ia some other peripheral impressions. 
Vf. R. Oowsas. 

iTOS?}(*' v^- •"* **^' **"•>- 

Teran int^yi^ -want of tone, pomr, or rigonr, 
and aaaociiHiii either vith such a con^Uon of the 
system gaaenny, or of particular organs, espe- 
cially thoae -wfaxfa are eontnctilsb 



L(l,priT., and rfrfiyu, I pierce). — 
AbsBDoe of a naeiial opening or pasasge, wheUier 
eoi^eaital or csoaed by disease. 

AVBOPHT. OKHBBAX..— Sncox. : Ha* 

OiBcnraar. — Atrophy means, etymologieally, 
simply -waaC of aaarishrasnt (1, prir., and rpoM, 
■oorahaent^ bat the term is commonhr ajq>lied 
to tha eondition resulting fraan -want of noorish- 
lamit. aaDwly, wastiiif ordimiantiOD in balk and 
sabataBee, area tfaoogh this may hare b«en pro- 
daeod by aome other caaar, and eren thoogh the 
aappl^ of BotritiTe material may have been 
ahaadaaL CcaersI alivpfy is need to denote 
aisling. ia vliidi the wmle body participates. 
iUl aeata diaeaaei^ if seraie, are aeoomptuiied by 
■■rialiiin. br at soeh times nntrition is tsm- 
ponzily interfered vith. The ase of the word 
'ataifmf' ia, honrarer, eonlioed, as a role, to 
taars wlieaa the iat aiiia e u ce with nntrition has 
hew gcadaal, aad the kai of flaah conseqaently 



-Atrophy is common raongh.at all 
Mriodaaf li&. In inihiitBaad children it is duo, 
m tka msjority of cssia, to ehronis fimetionai 
I wiiidi iatcifiBra with the digcatioQ 
I of food. licaa fieqiiently it ia a 



ATROPHY, 9KNSBAL. •« 

eoBseqaeneeofoigaaiediaiese. In adolta gaaaaaV 
atsophy seldom raralta tiom any other caoae tium 
oiganio dittitien. and fimotional diaordar aa • 
eaoae of serious wasting is the exception. Inol4 
age atrophy is a common oonsequeactt o{ th* 
dagenatations of tissue which acooaapany th« 
deelina of life. The iatsrierenca with motntioai 
may, howara^ be aggiaTated by the preaaaca ot 
disease. 

In infant* tatdnr iwilvi mtmiit old th«c« ua 
four pnneipal caoses to which chronic iraatiiia 
can nsoally be referred, namely, nnauitable food* 
dmmie Tomitin^ (gastric eatarrfa) ; ehionio 
diarriuBa (inteetinal catarrh); and inherited 
Vfphilis. Bad feeding, by setting up » chianje 
catarriial condition of the stomach and bowalaJa 
a fisqnsDt eaaae of both Tomitii^ and diairiuaa, 
but it may prodnee atrophy without eithor^ 
these synqitoma. When an infiuit ia fed, for 
instance, with large quantities of farinaceons 
natter— a form of food which ia alika indkis- 
tibU aad insatritioas— « Tory samU part only 
saasataaaa natrimant into tha syatam. Tb* 
laaiainder paana down Ihsaliaiialaij < anal, aod 
is ejected at rare interrals in an oftoaiva pntty- 
like mass or ia hard roundish Inmpa. The child, 
therefore, althongh orerioaded with food, ia laally 
irader-ooarished, and loaea flash as long as sneh 
a diet is persisted in. li^ as oftoa happens, 
diarrhcea or vomiting be set np by the irritation 
to whidi the digrstive oigass are subjected, 
wasting is more rapid and the danger of the case 
is increased. Any finm of bad feediqg, and not 
only exoeaa of ^inaoeoas mattrr, will piodnca 
this result. Wasting, indeed, will be found in 
eraiy case where the food selected ia unfitted for 
the child, aad tioM it is not unfieqnently seen ia 
iafonta who aia fad vpon milk and water alone. 
The casein of eoVs milk is diflienlt of digestion 
by many infoota on aooount of its tendency to 
coagulate into a large Arm clot like a lamp ot 
chMoe. In this respect it dilTera from tha curd 
of human milk, which forma li^t email flooca* 
lent coagnla, and is digested without diiBcnlty. 
Special preparation is therefore generally r^ 
quired to render cow's milk a suitable diet for a 
yonn^ child. 

It M not only, however, unsuitable food which 
is a cause of atrophy in infonts. Catarrh of tha 
stomarh and bowtJa may be present, although 
the feeding is ia all raepects satisfactory. In- 
fonts are exeessively sensitive to chills, and 
catairii of their delicate digestive organs ia 
easily excited. Now, catarrh of a mucous mem- 
bmne is always accompanied by an increased 
flow of muens, and thia alkaline secretion in 
excess acts as a ferment and sets up decoa'- 
position of food. A sub-acute gastnc catarrh 
from this oanse ia not rarely seen in new-bom 
infants, who thus are lendered for the time 
incapable of digeating even their mother'a milk. 
In such eases the foult is usnally attributed 
to the milk, which is said to be uasiiitad to the 
child ; and the mother ia compelled, much agaiaat 
her will, to wean her baby and feed it in a 
difoent way. So long as the eatarrii continnee, 
however, no food appears to agrees and the child 
often after a time diea exhaasted. 

Between ens and tirte yran atrophy is com- 
monly associated with rickets. In these i 



/ 



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96 ATBOPHT, QENBBAL. 

tk* waaHng ii noted eliisflj about th* ohait uid 
Umbi^ for the bell^ is laiga aad nn^ea £nnn 
iatnlent aeeaintilatioii. At tltii ag* dildnn an 
•dll liable to waate from caturh of tha atomaeh 
and bomU : indeed, riekots is itaelf often com- 
plicated by meh denngaments. Oancer of the 
utenal organs if alao lOBietimes found at tbia 
time of life, and it attended vith estreme 
emaciation. 

4/ttr ths agi of ikrM gtan caaeoBs enlaqte- 
ment of the messnterie glands beeomee a causa 
of wasting. 

Jfttr th4/ifikor tixtk ymr cfaionie polmonaiy 
piit£iaij begins to awean Oases of heait* 
diiaase as a reeolt of acnte rheomatism are 
also more freqnentlj seen. Diabetes, too, is 
sometimes met with. All these diseases may pro- 
dnoa mneh interference irith nutrition. 

Fiom the time that the child begins to taks 
other fbod than that furnished by his mother's 
breast, he is liable to 'worms in the aUmentaij 
canal. Tha presence of worms is frequently 
accompanied by loss of flesh, not, perhaps, so 
much on account of the parasites themselTea, aa 
on aeooant of the derangement of the digestive 
organs which ia aasociatsd with them. Kmacia- 
tioo due to thia cause may sometimea be extreme. 

/a iht edmU atrophy is rarely the reeult of 
mere functional derangement, but is almost in- 
rariably a sign of serious organic disease. All 
ehroaie ailments are not, howeTer, accompanied 
by marked wasting. Purely local diseases lead 
to little loss of fleah rmleas they affect soma part 
of the digeetive apparatus, or of the glandalar 
iystem which is coneemed in the elaboration 
dc natritlTe material ; or otherwise directly 
inflasBce the proo os se s of nutrition. Thus, 
euadation quickly results from gastric ulcer or 
ehioBie dysentery, but ehionie pneumonic 
phthisis may produce little diminution in 
weight if there is no vp!ezia, and if the case 
is not complicated by diarrhcea or profuse ex- 
pectoration. The most msrked atrophy is pro- 
aueed by tha so-called constitutional dissases, 
su<di as cancer and syphilis in the third stage ; 
by thoee which set up a persistent drain upon 
tha system, such as severe albuminuria, ehionie 
hamorrhages, and long-oontinued snppumtiona ; 
or by those which directly impede the passsga 
of nutritive material into the blood: and in 
the latter class of diseases, influences wbidi 
aet directly upon the thoracio duct, snch aa 
obstraetion to its passsga from pressure by 
aaeorism and other tumours, must not be over- 
looked. There is a form of atrophy sometimea 
sees in hysterical females, depending upon dis- 
ordered innerration, in which the most extreme 
emaciation may be reached. Such oasss are 
marked by a dislike to food iriiioh may amount 
to absolute loathing. 

SnaToxs. — The symptoms of general atrophy 
are lossof flmh, losa of colour, and loss of strength, 
comhilied with other speoial phenomena arising 
from the particular disorder to iriiich the impair- 
ment of nutrition is due. 

Akuowcai, CHavAcrxBs. — ^The moat marked 
post-mortem appearance in thia eondition is 
diminution or loss of &t, especially of the sub- 
cutaneous adipose tissue ; and this is aooom- 
paaiad'by wasting of the tissues and organa 



ATBOPHY, LOCAL. 

paoerally. The histological elanenta ars redaecd 
u sise without nodergoing, aa a rale, aetaal 
numerical diminution. With the atzophy is 
often a sso ei a t ed a certain amount of ^tty 
degeneration. 

Tuumairr. — The treatment of general atee- 
phy ooDSists in removing, if possible, the impedi- 
ment to effleient nutrition. In ,the case of a 
child the diet must be selected widi cava. Excess 
of farinaceous food is to be avoided, and cow's 
milk can be diluted, if necessary, by admiztars 
with thin barleywater. Anygastrieor inteatinal 
derangement must be at once remedied, plenty of 
fWsh air should bs obtained, and perfect cleanli- 
ness strietly eiyoinsd. In an adult tha diaease 
which is the cause of the malnutritioD must bs 
sought for and submitted to treatment. Eflborts 
should be made on the one hand to arrest anv 
drain upon the system ; and, on the other hand, 
by a judicious arrangement of the dietary, and 
by attaotion to the duiinatory organa, to lemoive 
all obstacles to the entiaoee of aoarishmant. 
Even in casss of organic and incurable disease 
much beaeflt may often be derived ftom das 
observance of physiological laws. 

EosTACB Sma. 

ATBOPHT, LOOAli.— This condition sig- 
nifies atrophy of ajMir( of the body, which may 
be apparently congenital, or may be jprodacea 
by various causes acting during bfe. It will be 
convenient to consider local atroplqr aoootding to 
the several forms which are met with. 

ConganUal Atrophy is that condition in 
which some part of the body never reaches its 
full standard of size. It is more correcUy deno 
minated <im((S(i^rpie<i or eongmitaX maUnau. 
When the whole of one side of the body is 
thus affected, a marked and permanent disOTO- 
portion between the two sides results. This 
hemiatropky is, in theory, difficult to distinguidi 
from hypertrophy of the opposite side, but 
moetly the paralytic or enfeelued state of the 
atrophic side shows it to be abnormal. The 
limbs are most strikingly implicated, while the 
corresponding side of the face and head is some- 
timea slmilariy, somstimes conversely aifeeted. 
In many cases atrophy of the opposite half of the 
eerebrom was found on poet-mortem examina- 
tion. The same condition may be partial — 
intiatropJuafartiaUt — and it then chiefly affects 
the &ce, or some part of tha territory of the 
flith cranial nerve. Theee conditions must be 
aaoribed to some perversion of innervation 
occurring daring development. Other congeni- 
tal atrophies, local but not iemi-atrophie, aiw 
more probably referred to obetruotion of blood- 
vessels during the same process. The defective 
development of the brain in cretinism haa been 
attributed to the pressure of an enlarged thyroid 
upon the carotid arteries. 

Phjrsiolosioal Atrophiea. — Thsse form a 
distinct dass, where atrophy of a part of tha 
body takes place in the ordinary oonrse at 
development Such are the wasting <df the thymus 
gland in early life, of the mamma and sexual 
organs after middle age. Most commonlw 
the atrophy is here closely connected either with 
the involution or perhaps the development of 
seme eonelated organ; but it is not posiibW 



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ATROPHY, LOCAL. 



to nj ■whax tba natan of this connection ii, 
vbatkor ooe of mtiitioB or of innemtion. 

Assailed Atvophloa. — Tbe oondition* thiu 
datiigiualMd pouea moat intereat for tha 
poetioal ph^rsician. Wastinf; of any part of 
ika body daring lifs, when not phyaiologicnl, 
■oally depends either upon some interference 
«ith the Uood-snppljTi or some distnrbanee of 
iuarimtioa ; bat to these most be added, in the 
case of a>sana 'which hare an active and con- 
tinTPnit function, disoae or OTer-stimulatioa. 
Dcfloant blood-snpplr, -which eausea atrophy. 
Bay be prodneed by the obatroction of a nutrient 
artary, especially if it be gradnal, since sudden 
hiockinjt iriJll pnidace more complicated pbano- 
■ma. Constant pteasnre is a cause of atrophy, 
hw— «a it interferes both with the blooj- 
•B|^y, mad with the vital actions of the tissue- 
llaiiMiits Intennittent pressure, on the other 
kaad, by eansing hypenemia, is more likely to 
kad to hypertraphy. Horeover, inadeqnata 
xoMwal of Uood, that is, filling of the Teasels, 
•Ten to excess, with Tenons blood, or Tenons en- 
got g ^ttent, thoogh at first it may cause enlarge- 
nen' mostly leads to atrophy in the end ; as is 
sees n the gnnolar indnimtion of lirer and kid- 
neys aosed by disease ofthehcsrt obstructing the 
eizealation. Ussy forms of atrophy in old age are 
dearly dependoit opon senile obstruction of the 
aiterui^ for ezanple, that of tha skin, spleen, and 
kidneys. The inataaces of atrophy ftom disturbed 
innarratiaa are lea easy to discriminate, except 
who* there is aetaal paralysis. In two distinct dis- 
Msns. koweTer, fragrettivtmuieuUtratropkyBJiA 
iafmaUAi or euaitial vartUgtu, loss of power in 
tlw Boadea is followed by a remarkable wasting, 
lar nan xa|>id than -that which results &om dis- 
■as aknc. IHTision of the nerre of a limb produces 
rsfid waatingflf the mnsclea no longer used, and 
this ia aeeompaaied in the end by some diminu- 
tioa in the siae of the bones and accessory parts. 
Local atrophy of tbe skin is sometimes seen is 
Mglioaa limited by the distribution of a nerre, 
asjiiirisTTj' innit liiiiii h of the fifth ; andmoreex- 
taaaire atrophy of one side of the &ce or head, 
aqnally marked out by nerrous distribution, and 
ceseiiiliHiig some eases of congenital atrophy, has 
also been, though Tery rarely, obserred. These 
£Kta zaise the interesting question whether there 
an ' trophic nerres.' Without discnisiDg this 
qaeaiioa, it may b« pointed out that the nerres 
whidi deUaeata an atrophic region jin always 
■otoT oc mixed branchea, nerer solely sensory. 

Disoss pndnces atrophy only in organs 
vboae fnnetiona are actire and constant, such as 
Bcrrea and mnscles. Nerrous tissue wastes 
CBoatantlj. and somrtimes rapidly when currents 
rsasii to tnroBe it^ This is seen not only in 
the nerres of paralyzed limbs, but eren in the 
■a in -egBtrea, where any interruption of the 
■crroos channels, either abore in tne cetebmm, 
<r beknr in the nerre-tmnks, is followed 
'by dtgnieration, eoding in atrophy, of the 
whda nerrona tract leading from the cerebral 
cottex to the peripheral termination — so called 
metmiarj deaauntiim of the cord. In muscu- 
lar tiasne the wasting is almost as constant, 
bat hyateiieal paralyses make an exception, the 
belpiwa liat» praaerring their nutrition in a 
•vpctsiag — "-'- In oigans vfaoaa functions 

7 



«0» 



are iatermitiant or periodle, *»»•• **•• ^ 
appear necessarily to prodwac« atxophy, •• >• •••^ 
in the OTsries, testicles, a.T:id. mammtt. 

That excessive stimiUa-ti on or over- work '"•7 
produce atrophy is seea i t» degenerstire diBe»»a» 
of the nerve-centres arising from undua xaenta^ 
aoiiivity ; and of the so3c:xa.sLX organs from exce*' 
sire indulgence. 

Unexplained Atro^^xlea. — Cases of loc^ 
atrophy occur of whicb it is impossible to kit« 
any sads&ctory explaix^tlon. Such are tHe cot\. 
di'tions known as lin©a.ir atrophy of the skin 
some remarkable c«»^»» of atrophy of \>c»t» ' 
•specially of the skull (yV-<^rt2i<(M ott»i'm\, 9ixt£iJ!^ 
some parts of the cer-«»t«-uin. We mny Vi--^^ *** 



attribute to ehang^ of time latter claaa jaa» 
tioned, certain periphex-u.1. atrophies, witHtv^T 



iXJg 



to 

able to account for the of a ginal lesion. "•n 

It is possible that de-ficiencrof spoo' 
of food may lead to at:f<oplx;7 of special A!wL ^»»d« 
thus deficiency of li mo Dm^y make the K^^^*-*** 
jmd deficiency of iron «^-«-«et the derel^i?^« ao^ 
blood-corpuscles; but ^won these f ^i'^^tot^ 
stances must be accept^K^ 'with a r/'i'**'^'i*»> • 
In the same way it is stx XI •Jonbt/ui v* v^Mn ***' 
special drugs, such as iodine. „ ***>«i^*^*' 
atrophy of special glandas. ^''> l>**Cj***.y 

Pathoxoot. — WastiD^- zsaay (vv. "^****0«>« 

as a consequence of ey»^.w»ge of]II''i.**»»»i 



*«»ce 



from the intmsion of soi 
words, there may be sm 



"ube 



.j^*-'^'^ 



from drgeneratioH, or a.tjcx>t)hv ^^°y. a^ ***l»e» 
The first is probably r^. ^ ***4»^?^*>ll» 
change of substance occtizs. 3Ti« ''**^llv '"^'••t 
degenerative process is *»ttr deKfo?""' '"^o^.***'*'* 
albuminous substance 'boiag cnn^*'*'-«o»» ***•>« 



replaced by fat, which, if 
leaves a Toid. Organs 



"V conre; 



;no^ 



^-^'^'r 






apparently enlarged; though tb~e orit? ^^,^1^' 
stance is wasted. Atrophy fW)m aubeV*'*-! Z °« 
seen when the connective tissue of an ^'**«o 
instance, increases, comppeaaing and rf***^o "<. *• 
the other tissne-elementa, and theaa ^"teyj*.'"* 



renewed when the newly-formed coDo^*?"' bf^** 
is absorbed, the whole oHran i«/j;_-.-_; T^v-^_» . "tg 






is absorbed, the whole organ is dinu 
This is seen in all the changes csaJIad"** ' 
or fibroid degeneration, as in cinh^:''^ 
liver and kiduoys. 

Tebatjiknt.— No general rule* can i. 
down&rtreatingallcasesoflocalatronir ^ J 
the blood-supply is dt-flcient, we have ^" ^ere 
means of supplementing it; where in^'-^*n* 
is at feult, it is seldom under onr con»^,'*''oa 

Jn 



!*id 



cootroj. 



general, harm rather than good results f ' 
attempt to attract blood by artificial irrSi"* '"f 
In the case, however, of atrophy from ^ **"• 
the nerro-muscular system, a line of treaT"* '* 
and more especially of prophylaxis, jg**""' 
clearly indicated ; that is, to keep the mn^?' 
in exercise by artificial means, particularirif 
electricity, or by tlie processes of friction .„? 
kneading, known as passive motion. In this w 
BO much of thn atrophy as is due simply ^ 
disuse may be checked for the future, and ev 
the past Ices reinstated. We shall, moreover 
never do harm by attempting to supply soma 
special kind of food which appears to be 
deficient, as iron for the blood andphosphorui for 
the bones or nerrous system, 

J. F. Pawb. 



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IS 



AODITOBT N£RTE. 



ATTSITOBT NXIBTll, DiMMM ot 8e* 
£as, Diwsiea of; knd Hsuhko, Diford«n of. 

AUBA (offpa, a brewe). — A peculiar wnM- 
tion, inbiectire io origia, immediately preceding 
an epileptic or hysterical cooTnlsioD, and samed 
respectirely Aura Ejrileptiea and ^itni Hyfterica. 
The word was originuljr adopted because the 
■ensation ia often described as that of the pas- 
sage of cold air or light rapoar from the trunk 
or extremities to the head ; but it has been ez- 
tendod so as to include any phenomenon, whether 
sensory or motor, that usners in a &t of epilepsy 
ur of hysteria. 

AUBAIiDIBIiABHB. &eEAB,I>iseasesol 

ATTSOITLTATIOS (awnifto, I listen).— A 
method of physical examination, which consists 
in listening orer various parts of the body, either 
by the direct application of the ear {immediate 
auMCuUatiott), or by the aid of special instru- 
ments {mediate aueeuUation), for the purpose of 
studying certjun sounds prodnced in health and 
disease. iSar Phtsicai. Exaximatiow. 



B4CTERIA 

ATTSOUIiTATOBT FUBOUBSIOIT.— A 
metho of physical ttuuniDstion in which the 
sounds elicited by pereossion are studied by 
means of anscoltation. Bee Fbtsicai, EzAjma. 
noM. 

AUSTBAUA. SeeAmKBix. 

ATTFOFHOiriA (ulnit, itself, and ^wij, 
the Toice). — A physical sign obtained by study- 
ing the modifications of the resonance of ue 
observer's own voice during auscultation. Bu 

PKTStCAL EXAMnrATIOK. 

AUTOPBT. See NncBorsT. 

AZOBSS, St. Klohaal'a.— Warm, veiy 
moist, equable climate. Hean winter t«mpera- 
ture 68° F. Prevailing winds K. and E. See 
CuxATB, Treatment of Disease by. 

AZOTTTBIA. — Jl condition of the urine in 
which there exists an absolute and relative ex. 
cess of urea, without aoonmpanying pyrexia. &• 
Usiini, Morbid Conditions of. 



B 



BAOnXtrB (from baeillum, a little staff) is 
the name now given to certain filiform Baetaria 
which hnre assumed much importance of late, 
principally because of tbeir conotant presence in 
the blood and tissues in splenic fever and malig- 
nant pystnle. S« Leftothrix, aud JUcTKRiA ; 
also PusTULB, Malioxavt; imd Baoilu in 
Afpehdiz. 

BACTBBIA (fiMTtifuv, t rod) IM some of 
the lowest known forms of life. They most fre- 
quently exist OS minute rod-like bodies, about 
1^^ inch in length, with a slight median con- 
stnetion. They mny be larger or smaller than 
this, and mny present minor variations in form. 
They swarm in all putrefying solutions and mix- 
tures of organic matter, and in many fermenting 
fluids in which the chemical changes are not ac- 
eompnnied b^ an emission of stinking gases. In 
fluids belonging to the latter category, uie typical 
Tnrvla or yeast-cell may be met with, as well as 
oiganie forms strictly intermediate between it 
and the typical Bacterium. From a chemical 
point of view, it is admitted that no absolnte 
line of demarcation can be drawn between the 
intimately related processes of puir^aciio% and 
femuntation ; whilst from a biological point of 
view we are similarly unable to erect any impass- 
able barriers between the organic forms which 
are found as part of the products of change in 
putrefying and fermenting fluids respectively. 
It is unquestionably true that typical Bacteria 
are most frequently met with in putrefying fluids; 
whilst, on the other hand, typical Xorula are 
only present in some fermenting fluids. But 
the rather long rod-like bodies, which have been 
hitherto named Yihrionee, and the stiil longer 
filaments mostly known as Leptotkrix (tet litt- 
tOTHiux), are unquestionably capable of being 
derived from ordinary Bacteria in rartain madia. 

In th* most highly putrescent fluids Bacteria 



are usually found to ba vety small, because, 
though the total bulk of liTin^ things rapidly 
augments in such fluids, the individual units 
(in consequence of the frequency with which a 
process of fission takes place) do not increase in 
size. In less putrescent fluids, however, where the 
chemical changes constituting the putrefactive 
process take place more slowly, the living forms 
also appear and grow with less rapidity ; and 
owing to the co-existence of a lower frequency 
of fission or spontaneous division amongst such 
individual living units, they often attain a laiger 
size. They then appear, according to their 
length, either as Vibriones or as Leptothrix flla* 
ments. These are plain, jointed, or monilated, 
according as' partial segmentation is absent, has 
taken place rarely, or has occurred so rapidly 
as to give what would have been a plain flli^ 
ment the appearance of a string of beada. 

Concerning the question of the precise i«]a- 
tion of organisms to the processes of putrefse> 
tion and fermentation, opposite opinions are at 
present held. Believers in Pasteur's germ-theory 
maintain that they are invariably the initiators 
of these chemical processes ; whilst those who 
reject this theory, as being too exclusive, con- 
tend that putrefaction and fermentation fR«y be 
initiated in the absence of Bacteria and their 
germs. Those holding the former view believe 
that Bacteria are only capable of being derived 
from pre-existing organisms of like kinds ; whilst 
those who reject it contend that particles of 
living matter, which develop into Bacteria, 
mny be generated from the organic compounds 
dissolved in fermentable fluids, and that such 
particles of living matter are, in fact, just em 
much products of the fermentative process and 
of the fluid in which it occurs, as are the gases 
simultaneously generated therefrom. Acccnding 
to this view, these lowest living units bridge 
the gap hitherto held to exist between livinK 



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BACTERIA. 

•od Bo-ealled dead matter, and sffbid an illns- 
mtkm of the natantl independent origin of 
demieal eompoonds lo complex and endoved 
■nh •neli attributes a* to win for them the 
nanu of 'rital' eompoands. (See Pmeeed- 
w^ of th* Bogal Soeutf, Vo. 172, 187S, pp- 
I49-MS.) 

Paatevra 'Tital theoi7' of fermentation u 
oae of gnat iatportanee both to ehemista and 
faioiog:i9ta, and it aba force* itaelf npon the 
attention of medical mea^ aa the parent of 
another doctrine vhich has at late annmad 
great prominence in relation to the adenee of 
nedioiw — the doctrine, namely, that loww or- 
gaaisma allied to tboee met with in pntreljing 
and fermenting media are camal]; related to cer- 
tain morbid procesees with which they either do, 
-van said to coexist. Bacteria and their alliea 
an as uniformly eoexirtent with a few general 
diseases and certain local morbid procenM aa 
they are with putrefiictions and fermentations, 
so that the same general question as to the 
praoae ngniCcanee vt this eoexistenee again 
pnssca for solntioD. Are the organic forms 
nt r"'-'*^ with snch morbid processes the sole 
fmiw or inciters of these proctasesf or are 
ther co n s eq u en ces {Le. concomitant products) of 
nauolagi^ fto am em which hare been initieUed 
in their afaseneer The former Tiew is warmly 
ni|i()Ottad by many who regard Bacteria and 
allied organsc forms as the contagions elements 
of Boch eooannnieaUe diseases; and many of 
then same pathotogisU, rating upon analogy, 
wish to extmd their theory, so as to r.ake it 
apriiesUe to many other communicable diseases 
with whidi organic forms hare not as yet been 
slwwn to be correlatiTa. 

ThM, jaat as certain chemists hold that Bac- 
teria anl slUed forms are the causes of all 
Irnientatiaas and putrefcctions, so certain 
pathologists either do actnally, or are inclined to 
muBtain that Bacteria and allied oiganisms of 
eonwma or of special kinds are the causes of all 
eommnnicable or contagions diBenaes. Accord- 
ing to saeh dwmists all femmtt are living 
oiganisDis ; and seeording to such pathologists 
an tcmXagia. am allied liring organisma _ 

The cocxistam of organisms is one which ob- 
tain for almost all fermentations, but only for 
a lew of the communicable diseases, so that any 
■iwmnent dedndbls from such mere ooexistenoe 
in fcroop of the carnal relaUooship of the or- 
gan i-— - . is mneh stronger in the cass of fer- 
,,,,1,11,1111 than SB regards diseases.^ Yet, in 
aoita of the almost nnirenal coexistence of 
iiilisiiisais with fermentations, it is still necessary 
tKimVo ask whether they appear as causes 
tt m cAew of these phenomena. From 
thia it may b* jvdgad how little the more 
fimitad *&cl> of coexistence' shonld be allowed 
to iitfoeaee oar opimon on the derirative qnes- 
tiaa of tha relatMO of the lower orgsjusms to 
djscHa. At least one of the reptited instances 
B wUdi this ooexist«nc8 of organisms has been 
dwsk apoQ, as showing that they are the caosss 
of tka sMrtnd phenomena with which they are 
„iiii,m bas of iate been dissipated, since in 
tba (H**f the snall-pox of sheep lyeaiola oviaa) 
the alltasd oiganisms are now admitted to 
havaao" Bdateaee-certaio appearances pro- 



BADEK. ^ 

dneed in the tissues by {»x-0a«rTativ8 mtH^ 
having been mistaken for orgw^MMimtat whicli ha!^^ 
been elaborately described and fig^nred. (S*ely<^ 
eeedinffto/lluSmttlSociety.'ISo. 1 72,IS70.p.l^Q.') 
But even if all the alleged csas«« of eoexial^i^ge 
of organisms with morbid paroceases 'Wttr« ¥«&! 
and if ftiture inrestigationa should ■ho'^r ^Vl 
such facts are more numeroixa t^hxui are ^^ *kw> 
sent imagined, still the muLfciplication ,;j^ ^>e. 
eridenoe to say extent will salver halb '^TT ^\v\b 
more than it has done in th« r sssss> of r«^!|j^ ^^<m 

tions) to soWe the real queat.ion '•^'•t^^'**!^*' 

morbid processes are only c^xLse<S U»^ ^^ Mtk* 
gated by oiganisms, or whofch »t- th«>. ^^^v^^ 
times come into existence iiidep^*^*^^<it.V^ ^^%^^('^- 
The vital or germ-theory o^ 's**?^ ^ %L 
would be broken down and 1>CM;ome ^* 



whenever it 



shown 




morbid processes in question coxxld •*) ^ "-f |Ij'^*« 
the absence of the living orsa.n ism, '^*"'i&-^ <i^ b«' 
sequently appear as part of the >^**"'iT'*»« th 
producU. The latter refdUt ion, iJo^'*tA^^ *« 
never be made directly, since ao 
could in any circumstance yriia.t.Mtoet-, 
— in an experimental sense — 1< 
possible roach of some of I he 



i/'^C'o. 



'e 



•^fc. 



possible roscn or some or \ he a7/6i» *>■ ■'-'■f^^'*^? 
germs. But inasmuch as th i a f>ro!jf ^ rt f''^ ^'^ 






Its very nature, one which docs n- 
experimental proof or disproof j^ ,. *<i»Z'. 'i^to' 
sense of the term, and because thia c, *S^'* "^ 
of disease is clearly a derivatii-e d?f'*>>-tj*'''*' 
the germ theory of fermentation, it^^'"® jS'^ 
or fall with the germ- theory of fe^""' "taorf 
which, fortunately, is capable of oxn^S*'"'""'. 
proof or disproof. The question of ■ s^oitSi""*' 
generation' comes, therefore, to be inextST?}'* 
mixed up with the question of the truth o " 
falnity of the germ-theory of disease, so that 
the stndy of tlie latter to the neglect of the 
former can only end in the propagation of 
vagueness and uncertainty. The real question 
is not as to the extent or frequengr of the oo- 
existence of organisms with local or general 
diseases, hut the much more important one as 
to the nature of their reUtion to such pro- 
cesses. If they act as invariable and sole causes, 
then their presence is a matter of the deepest 
intorest and importance. If, on the other 
hand, the organisms are not causes but ntther 
concomitant products, their present^ from a 
purely medical point of view is of trifling im- 
portance. The study of their growth and 
development would in that cass be important 
only as adding to our knowledge of the struc- 
tural changes pertaining to the diseases in ques- 
tion. 8ai Vransactiont tf tht Pathological Socitiji, 
vol. zxvi., and JourwU cf the lAnntan Socitiy, 
vol. ziv. Ste also the articles HiCBOceocii Pw- 
TULB, Mauoxakt; and Zyms. 

H. C1UBI.TOK Bianut. 

BAOSir-BADBir in Ctotmany. Thermal 
saline waters. Sa$ Himxbai. Waters. 

BASmr in Austria. Thermal .tidphai 
waters. &• Huibbal Watkbs. 



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100 BADEN. 

, 'BASail'lnBirltaeTluid. TIwRiuI ralphnr 

vmtem. Sm Uikiiul 'Watsbs. 

B ASEH W JBHiXIB In Oerouuijr. Simple 
thermal waters. 8m Miwbiul WitTBBS. 

BAaHBBXIS-DlC-BiaOBBB in rranoe. 
Simple thermal and earth; waters. See Hwsbai. 
Watsbs. 

BAON^IBBS-SB-It'D'OHOV in Vrano*. 

Thermal sulphur waters. See i/Lnaau. Watkbs. 

BAIiAlTZTIS — BAIiAirOPOBTHITia 
(jSiUarvi, an acorn, and wSaBii, the foreskin). — 
Sticoh.: Bastard Clap; Blennorrhagia Balani; 
Inflammataiy Fhimtios. 

DarixTTiov. — Inflammation of the opposing 
surfiices of the glans and prepuoo ; sometimes 
aeace — eren gangrenous, and sometimes chronic. 
A purely local affection; frequently, but not 
necessarily, of venereal origin. 

£noLooT, — Balanitis is mnch less common 
than urethritis, being met with at the Iiook Hos- 
pital in the proportion of one to twenty-four of 
(lu latter. It may be either primary ; or con- 
•eentire to chancres, syphilitic eruptions, warts, 
aeeomnlated smegma, rariolons pustules, or 
gonorrhoea. When primary, the common pre- 
Htpoemg cause is a long, narrow foreskin. Four- 
nisr attributes two- thirds of the cases of balanitis 
to a long prepnoe with insufficient cleansing; 
aboit one-thinl to irritation by chancres and 
gonorrbmal pus; and a very few to other causes. 

Smrroiis, — ^The symptoms of balanitis de- 
pend OB the intensity and extent of the inflam- 
mation. In the simplest form there is heat and 
itching of the furrow, slight redness of that 
part) with a milky or yellowish secretion. When 
the inflammation is mors severe and extended, 
swelling and pain are added, the other sym- 
ptoms are more marked, and characteristic 
excoriations appear. They ore irregular, shal- 
low, never extending more deeply than the 
epitlwliani, but often coalescing into large 
raw chaftngs. An abundant yellowish-green 
matter of offenuve odour bathes the surface. 
When the urine trickles over these excoriations 
there is severe smarting pain. If still further 
irritated, the foreskin swells enormously, is 
divided at the tte» border by deep creases, and 
can BO longer be tamed back. Aching, smart- 
ing, great tenderness, and painful erection, often 
aeeompanied bj constitutional disturbance and 
ferer, are present, 

CoicFUcaiTOMi.— The cellular tissue and the 
lymphatic ducts of the foreskin and sheath, or 
tbelrmphatic glands, may inflame to snppuratioo, 
to Bleeration, and, in persons enfeebled by any 
eaosa, even to gangrene. Sloughing begins on 
th* inner *<axBu» of the fore^cin at the npper 
put; seldom to miuh extent, though the wWe 
pmpace, except the finemtm, may be lost, and when 
cicatrisation set* in tlia organ appewrs drcum- 
eised. Paraphimosis is caused by imprudent 
retraction of a swollen fbteskin. Warts keep 
up dirobic posthitis of the fuiiow. Adhesions, 
uoally at the oorona and the ftirrow, may 
attach A* prepuce completely to the glans. 
Thidcening and phimoeis are not nooonunon 
altar repeated attacks. 

CoDJisa. — thfi duratioB irf balBBitia depends 



BALDITEaa. 

OD the anatomical condition of the parts. When 
remedies can be easily applied, it is not more than 
three or four days. With phimosis, the course is 
severe, and the duration is indeflnite ; even when 
limited to the furrow, poethitis is often obstinate 

Suomsis. — This is easy when the parts can be 
axpoeed. Herpet is distinguished froin bslaniUs 
by small groaped round ulcers, limited to ons or 
two points of the mnoous surface, without general 
congestion. SimpU cJutnere liaa well-defined 
undermined edges and a spongy surface. The 
tjfphiUlie mre has the indurated base and en- 
larged Ivmphatio glands. When there is phi- 
mosis, the discharge may come from the urethra 
or from a chancre. If from the urethra, it can 
bo usually seen escaping thence, and there is 
pain along the penis, with other signs of 
urethritis. A chancre under the foreskin is 
betrayed by a hard and tender point, and after a 
few days consecutive sores usually appear at the 
orifice of the prepuce. 

Pbookosu in the primair form is always good. 
If the complaint is secondaiy or symptomatic, 
gangrene may result. 

° TaaaTioDiT. — The chief indication is to keep 
the inflamed surfaces separata. After washing 
and thoroagbly drying, the excoriation* should 
be toBched with a lO-grain solution of nitrate of 
silver, and a bit of dry lint laid on the glans 
before the foreskin is drawn forward. If there is 
phimosis, frequent injections of tepid water, and 
twice daily of a 6-f^n solution of nitrate of 
silver must be thrown to tlie fiutbest part of the 
foreskin with a long-nosled syringe. Leeches 
to the groins, and opium internally, as well as 
in injections, relieve pain. Acupunctures give 
vent to simple oedema, but tend to accelerate 
gangrene wiUi brawny tension and erysipelatous 
rednees. Incisions, LT needed, should be free ; 
one on each side, carried quite back to the fur- 
row, Th* oppar half of the foreskin can then 
be easily turned back, and the subsequent de- 
formity is less than if the foreskin is divided at 
the dorsum. In paraphimosis, before replacing 
the swollen foreskin, the tension should be re- 
lieved by acupuncture and astringent lotions, or 
by incisions if needed. BrauutusT Hn.u 

BAIiDBIiBB.— Svwoir. : Alopecia. 

DnscRimoK. — Baldness or loss of hair pro- 
sents an extensive range of variation in degree, 
from moderate thinness of the hair, such as 
occurs in Difimivm capUlorum, to complete 
baldness — Alopeeia ealva or Calvitiee, the latter 
not limited to the scalp alone, but involving 
eyebrows, eyelashps, beard, and every hair of the 
body. Instead, however, of being genercd, bald- 
ness may be partial, affecting more or less of 
the sui&ce of the scalp for example, the svmmit 
and forehead in men, and the summit and occiput 
in women. One remarkable form of partial 
baldness has been denominated Alopecia areata, 
or simply Area, and as this was described by 
Celsus, it has likewise been called Area Crfst. 
Area occurs suddenly, and is a mere falling-off 
of the hair over a space at circular fignr* ; Uiere 
may be one or more of sach Are», and sometimes 
Area is only the beginning of Calvitie*. Area is 
likewise oocasionalfy met with in the whiikera 
and beard. 



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tiiiSiSSS. 

TitKUOJ- ''r^ ^, ihn. Kuraetimea 

f^-.] uMatm; «^ "'"•times limited 

".' ?^^ erHmt i. rhe Uiter form. 

^T1^^ h/ir, til. ii.tegiun.nt w pais and 
'Tl'^" SJ^.I,«lioiii.»l»t»n««*J"Mic. """l 
!^L^bZt« ti.» - th. rircumferene. ; 

Cnowor-Tie «use.of AWpeaaaro «- 

h^d oatriti" po»rr cf ll.e akin ; nerre 

„rrm.h.UKc.sc */Ar«, jvplu .. ; and lo«al 

man TieAlof**"*"' '■T'"'" foUowsthe jliin 

rfdiiilwtioiiof it»ei»iitbem. Partial Alopecia 

JUT '"«'' '""" ■ ^'''"' ' '""" *■''* "'^'^'''*'''"' 
tmrixaaof Bloeiofhiiir; from the sting of 

a hee- (nm Btrrom shock; or from other 



TMimsT.—Thn consists in the restoration 

•rf Mrr»-p<nrer and uulritire power; and in 

Jotal itiiBiiUtioii. The best applicationa for 

Hu latter nirpoM ara the stimulating liniments 

y iba Britiili Pharmacopeia ; ejj. liniment of 

vn^np^ eoBipoand Oimphor liniment, and the 

laioenl* of eUoroform and mustanl; or the 

lettam csatliaridif properly diluted for general 

^Jopeeia, orippliad vith a brush in its concen- 

listed form for Ana. In the treatment of tho 

*httv, azoBKaiia, tnipetitine, and the com(H>und 

tiactan of iodine are likewise useful ; while for 

ijj^dliue Alopecia the vhite precipitate ointment 

with eaaipbor ia the best local application, con- 

joiaed with an anti-syphilitic constitutional 

Erasmus Wilson. 



BAUraOIiOOT (0a\anTor, a bath, and 
.t^>«f, a void). A laentific exposition of all 
that idatca to batba and bathing. 8u Bami 
and HTSBoracaipxDTica, 

WAT.WnTinrRA I'miTinW (jSaXonltv, 

a hath, and tt fuM t t m, I heal). That department 

of tbanpeatiea which deala with the application 

af bmthi ia thr tzeatment of diieaae. Set Biraa 

•■d HnmarATwr. 

BARBASOE8 Ua. A tynoaym for Ele- 
jhanHaait. &« KixmAimAMU. 

BABBIXB8. A synonym for Beriberi. 
SmSmmamMi. 

BAStiOBS ia Vranoa. Thermal anlphnr 
watoa. Sei Kixkbai. Watcbs. 

BABBDOWS DISBASIB. A synonym 
for Exophthalmic Goitre. See ExoPHTHauiic 
GunsK, 

SJLTS in Bomaraatahire. Simple thsrmal 
■■d earth J watan. See Jlmnai. W atbbs. 

BA.TUS. — Batlu may be regarded as iiwgtU ; 
— d co Msym ifs. wtedieu t ei. at artjfmaL Theymay 
^ '■■ad ia dw fona of liquid, Tapsor, or air. 
W* aball eonaider them nader these heads in 
*h* CbUowing description : — 

A_ SarLa Batbs. — 1. Simple liiqnid Baths. 
I. Tk CM Batk.—Bj a cold bath is meant 
(1m i—uai oii of the body in wator beloir the 
of 70'. Anything lalow 40" is 
1 a Tery .vU bath. The first eilMt of 



BATHSw 

the ti«th ia a sensation of eol« 
to shivering, with slig^it { 







.'JS-fS'^ 



the lath is eontinned for m 
niinutiD, the temperature of 
nishui ; and if it is protna^ 
the subjacent tissnea lose & la 
does not generally occur tilL 
bath. If the cold is inte>: 
there is a certain degree o^ 
akin ; while the pulse baoona^ 
fall from ten to twenty l>e>,aB. 
After a short time (the col«J 
shorter;, reaction takes plac^, 
to the skin and inrraase o^ 
a certain amount of ezoit' 
bath be continued, the depi 
immediate action of the cold 
capillaries to contract and 
the surface, while by its ops: 
phrral extremities of the ill i « waa 
central nervous system. In i 
effects, the cold bath aoceierBtes C J 
of tissues, au^'nientin^' the •: 
acid and of urea from the syst^a 
sequence, increiising the appeti ^m 

The body is usually immeraod 
water, but the shock of this naaa_^ 
l)y first using tepid water, and 
adding cold to it. 

The effect of a cold bath del 
duration. Brief immersion, 
four minutes, makes both the deipiv* JI^^'oA 
exciting action less ; a longer dijC^^V* t? 
ten to fifteen minutes, inrrtiaaf ^?^^^ * 

bather is able to keep himself in bh^*****, if^- 
pecially if he swims. **"> and o^ 

2. 'J'he Warm Balk.—k warm t)«>i, 

to lO*" produces nosbock to the syaUm^;."' "*" 
a moderately increased flow of iba cirBj?*^^ 
fluids to the surface, augmentingthe fnonaii *"'5 
the pnlse; and scarcely affecta the nmiiB? 
Then is not the depression or the ezeitoment'mP 
a cold bath. It rather retards the transmutation 

of tissues. With a hot or rery hot faniii tnan 

104° to 114°, the eentnl oervouaand citeolatorr 
systems are more affected. The freqneoey of tha 
pul se increases greatly. The respiration beeomee 
anxions and quiekaned. The akin is in a 
hypersmle condition, and a free perspiration 
breaks out. 

3. The Tepid Ai<i.— Tepid batha of the 
temperature of 8S° to 95°, are intermediate be- 
tween cold and warm. Their effeeta seem to be 
confined to the peripheral extremitiea of the 
nerrea, and they do not excite the nerrons centres 
or the dreuktory system. Neither the poise nor 
the excretions and secretions are affected. As no 
heat is confined in the sjrstem or taken from it, 
there is no reaction, and the animal tempeiatsre 
is unaltered. 

It need scarcely be said that drying and rub- 
bing after a bath materially assist it* action on 
the skin ; or that, according to eirconwtaaeaa, it 
may be eonrenient to order a whole bath, a hip- 
baUi, or a slipper-bath. The fgot-bath is a rery 
•seiU and oonvenient one, sspeeially when soae 
stimulant substanoe is added to the siapla warn 






''>• 



but if the bath be very protracted, 2^ 
alwtraction of heat produces donJ*^ •son,"' 
Tho effects of a cold bath are leaa iB?^»oa ** 
.. i^ .1.1-. »-. 1,^ kl ^ic: **rr— 




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IM 



BATH& 



Wet packing and the rariona processes of h;dro- 
pMhr, and those powerful ageoU hot and cold 
affiinon, whether as shower-baths or as douches, 
are desoribedin tlie article oa Htdbopatht. 

The duraUoit of a bath must depend on a 
Tariety of cirenmstsnces, for instance, on the age 
and oonatitution of the patient, on the nature of 
hia malady, and on the temperature of the bath. 
It mny rar; from a few minutes to many hours. 
\ xarj hot or a very cold bath can be supported 
for a much shorter time than a tepid one. 

AcnoH AXD Usas. — Cold baths are indicated 
for the strong, for youth, and for manhood; warm 
baths for &a delicate, for women, for early 
childhood, and for old age. Tepid batlis are 
suitable for almost all oonstitutions, sexes, and 
nges. Cold baths may in a general way be 
considered tonic and bracing; thry are useful 
when judiciously employed in many nerrous 
affections, as in chorea and hysteria, and they 
are the best of all for general hygienic purposes. 
Of lata years they have been specially employed 
in the treatment of fever (see article Tmnu- 
tuhb). The great value of warm baths, besides 
their hygienic employment, as better detergents 
than oold ones, is in soothing and reducing 
excitement; in rdieving spasms, such as colic 
and retention of urine ; in the oonvulsinn^ of 
children, combined with the afiiuion of cold 
water on the head ; in cases of gout and rheuma- 
tism ; and generaUy when action on the skin is 
desired. Where prolonged immersion is wanted, 
tepid baths are indicated, as in calming many 
chronic nervous disturbances, and in many cnta- 
nsous affections. 

As to contra-indications, all baths, and es- 
peciallv prolonged and even tepid baths are 
not smted for the asthenic Both hot and cold 
baths are to be avoided where there is a weak, 
fatty heart, or any tendency to apoplexy. Ko 
one shoald ever enter a cold bath when ex- 
haustsd, and such baths are also contra-indicated 
wlieii there is a tendency to congestion of inter- 
nal organs. Under such drenmstances a warm 
both is usually both safer and more refreshing. 
The too long and too frequent use of hot baths 
is debilitating. 

11. 1h» Simple Vapour-Bath. — A vapour- 
both is one in which the skin is exposed to the 
action of hot water presented in the form of 
vapour. The vaponr-bath may be taken in a box 
with the head included or not ; or in the more 
common form of the Turkish or Russian baths, 
where a large room is filled with vapour, and 
where tlianfore the vapour is inhaled ; or by 
vapour obtained from a small and suitably 
aoBstmeted apparatus, which vapour may be 
diffiised over the whole body or directed to a 
particular part. A very simple apparatus for 
the vapour-bath may be prepared by placing 
under a chair a shallow earthenware or metallic 
pan, containing boiling water to the depth of three 
or four inches, and from which abundant vapour 
can be (d>taiaed by placing in it one or two red- 
hot bricks. The patient sitting on the chair, 
snnonndad by blankets and other suitable cover- 
ing, «iU reeairs the full benefit of a vapour-bath. 
Vapour-baths produce profiise perspiration, and 
•et io eisonsing the skin much as hot-water 
balks d», only more powsrfnlly. Vapoor being a 



slow conductor, does not act so fiut on the bo^)' 
as water. Vapour^baths can be borne hotter tliaA 
warm-water baths, but their use cannot be con- 
tinued so long, as vapour interferes with radiation 
of beat from the body. In such batlis a heat of 
more than 1 22° is not borne comfortably. The 
vspour-bath, though falling considerably short 
In temperature of the air-bath, raises tile lieat 
of the blood somewhat more. The great virtus 
of these baths is in their sweat-producing proper- 
ties. The average loss of perspiration by the 
use of a Russian bath hiis been set down at 
from § lb. to 3 lbs. In the Russian bath a slight 
degree of stimnlation of the skin is caused by 
switching it with twigs of birvh, iind tlie alter- 
nation of depression and excitement of the cold 
bath is obtained by placing the patient, when in 
a state of profuse penpiration, under a douche of 
cold water. 

III. The Simple Hot-Air Bath.-^Thereare 
two forms in which the hot-air bath is adminis- 
tered : according as the mtient does not or does 
brmtbe the heated air. The action of the ktter 
closely resembles tliat of a vapour-bath, but 
differs from it in not impeding the respiration, 
as the latter does by depositing nioistnra in the 
bronchial tubes. The lungs, instead of ntiuiring 
to heat up the inspired air, are subjected to a 
temperature above their own. Bot-oir Imths 
favour the highest degree of perspiration, while 
the moisture of vapour baths somewhat retards 
it. If they ara retj hot, they raise the tempe- 
rature of the body by several degrees. 

As tha anongements for vapour- and hot-oii 
baths are practically the same (except that in the 
latter it is attempted to exclude all vapour from 
the calidanum or iitdatorium, the hottest room), 
the following description of an ordinary bot-nir 
bath, the arrangements of which are closely 
copied from the Romans, will answer for both. 

The patient after unclothing first goes into 
the tepidarium, which has a temperature of 1 1 3° 
to 117°, in which he remains until the perspira- 
tion bunts forth, which happens in from twenty- 
five to forty minutes. He next proceeds to the 
hottest room or ealidarium (in which the air 
is heated by hot-air pipes which are inserted 
in the walls), of a temperature of 133° to 
140°, and nmaina then until tha penpiration 
runs down his skin, in twelve to eighteen 
minutes. An attendant then rubs off the per- 
spiration with a w(x>Uen glove, and kneads all 
the muscles for four or five minutes. The 
patient next betakes himself to the lavacrum, 
where he has water poured over him of the 
temperature of 81° to 86° ; next, the whole body 
is soaped over, the suds are rubbed off, and the 
patient goes to the .^ri^idariuni, where he laya 
himself on a couch and waits till his skin is 
completely dry. This may occupy twenty-five 
to thirty minutes, when the patient dresses and 
leaves ths bath grratly refreshed. 

Such is a brief aocount of these baths, the 
nvived use of whioh is at present so general. 
The arrangements vary in detail. For ordinary 
purposes it is easy to furnish either vapour- or 
hot-air baths. A great variety of apparatus 
have been invented for this purpose, which re- 
solve themselves into this, that the patient 
should lie in bed or on a seat, and havs the bed< 



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dotlM* or other eorering Mcnnd from eomtact 
with hijB bj tha emplojment of a, framework 
or endle. Banaath this hot air or vapour ia 
iotradnccd, nther directly or indirectly, from a 
nitaUe apparatna. 

Ti* Samd-Bati. — Wa mar here meotion bath* 
of sand, vhich ara a Taiy old remedy. Of lato 
jeais aetablishmenta for snpplnng them hare 
■prang up in Tarioos towni. They are a eon- 
Twiaat vay of applying dry heat either locally 
or generally, and are employed in chronic 
iheoatism. Bags filled with heated sand are 
nssfol in hospital aod ia domestic practice. 

IXso. — Both hot-air and rapour-batbs are 
indicatsd when increased action of the skia ia 
dcaied. They are nsed most for the cure of 
eatanha, of neuralgic and rheumatic pains, and 
sristitTi They hare also been moeh employed for 
tadneing obesity. They are oseful for general 
hysienic purposes, but an apt to be giren too 
iadiscriminately. Hot-aic and raponr-baths are 
aftsn locally applied with great adrantage to a 
hand, or leg, or aim, in rheumatism or thickened 
joints. 

B. CuKKiantx, Mudioltsd, ob Abtificial 

Batss. — A great rariety of substaoceg hare 

been nsed in baths at diflerent perioda We 

most eooflne outselres to such as are at present 

jo sae and appear to be of some real value, 

cautling ereo atma that ara employed, such 

as baths ct iodins, of iodide of potassium, of iron, 

of termented grapea, and of wbey. 

I. Compoaito laiquid Baths. 

1. Tkt Stm- Water JialA.—Tht average amount 

of aalta in sea-water may be set down at 3 

per cent. ; this may therefore be considered a 

eoitaUe strength for ordinary salt baths. The 

quantity cooimonly nsed in London hospitals is 

aboat 9 Ibe. of salt to 30 gallons of water. Some 

Bse lay salt, others Tidnun's. Owing to the high 

plica of sea.esU in inland continental places, 

Taricvs natsial salts, some of them containing 

a eoraparacively small amount of chloride of 

■odium, hare been suggested as substitutes ; 

and also, tor economy's sake, 22 to 26 gallons 

bars been set down as a minimum amount of 

water fca- tha bath of an adolt. The value of 

theae sabatitntea can ouly be determined by 

observing the degree in which they stimulate 

iha akia. Apparently it does uot matter much 

what pactiealar salt u employed to produce the 

■timniaticai. A salt-bath can of course be in- 

craasnil to any strength by the addition of salt, 

or at Lb* uMtner lye as it is termed. 

Tha chief uses of salt-water baths are as tonic 
iiiiiadiM especially for the young, when there 
is aay taodeoey to soofhla or ehloroais ; also in 
eoBvalaf enre frem many diseases. 

2. Mhlne Batlu. — Alkaline baths may be 
made hy addii^ 6 onnees of crystallised car- 
booataof sodA,or 3 ounces of carbonate of potash, 
to 2ft or SOgallooaof water. Alkaline baths are 
of aaa im s great Tarietyof cutaneous affections. 

a. Tkt Cornmm SuUimaie JSoM.— Baths of 
euiss a i ia atLblimats axe occasionally employed. 
Ihsf ara easnaxmly made by adding 3 drachms 
•f esBosiTa subliiiiata and 1 drachm of hydro- 
dUoric acid to 30 gallons of water. They are 
•■flayed ia aooia skio-aflectiona, and in secon- 



BATHS. *j 

4. Sulphunt of tcUM^^*mm Sati.-^^.^ 
sulphuret of potassium sa.K-« laode hy '"■^* ^- 
from 4 to 8 ounces of tlsskC:. salt io 2o U> ^" J -^ 
Ions of wafer. A liitlo <ii lute »«'i''"'['° * bee» 
sometimes added. Theise laths hare ^"J^ c«iw» 
extensively employed ira t;las ^■^'^^ fV.aX tltej 
of skin-disease iu whicla fclie sulphur to 

contain is indicated. — < a . Tlva 

6. Vu mro-Muriatitr Aeii ""'*■ 



Path- , 

nitric or rather the nitxx>— zauriatie f?" -^ra.*** 

made by adding nitru-rouxiatic aciu- to wra^w. 
The ordinary proportion ia one ounce ox ACia. \» 
one gallon of water. Tho discolouring ~rtlOtt oa 
clothing makes a full l>atli of this K-intl ineo«< 
veoient for domestic use, sajid. it ia t>f at to t^xVa 
it in a bathing estnblisIixEiaa^ Tot tVie OTxliiiKjY 
purposes of a foot-bath ttt. Jiomethe old. dir«ct.ioiia 
of I)r. Hslenna Scott, irko intxoductHl lH« Usn « 
the acid, are sufficient. T*lie "veaeelmuat oF «w^_ 

X>r. Scott " • - «?^«« 



be of wood or earthenwmz-e. -*-"• Scott atltj^j' J"" 
to six ounces of the add to tla r-ee gallons of*^ *o«r 
This made a rather strong iToot-bath T'V?''^***'' 
tient WHS to keep his fee-t; iixsniersecl' f ^* p». 
minutes: and the bath wa.9 to ^e ri-x>asi^ ''^''t.T 
other day for two or three -wwoeks. ^T^*^**^ ^Voj.. 
the groin, and the regioca of ih^ ,."* **-*-HlJ 
to be sponged with the acid, solution X?*" "•W^iT' 
causes slight tingling of tiao Klin anH "''^e kJ.l 
the mouth, and is belierod oocasio i ** **««tlr 
'"• bten ,.^ to 

of or.;. . It* 2j 



in 



eiy 



dace salivation. This bath 
extensively in India and i cs 
affectiona There is difference* ot „ - 
its value; many have great: oo Jj fid.,?"' *Ot>~' *""»J> 
8 Tk,BranBalh.-Th^ bx^n^f* in i *• «o 
by boiling four pounds of bran in ^ *« 
water, straining, and addii^^ the "i* «^*Jl ***«da 
quantity of water sufficient fox- »ba,.'9Uow *• o^ 
bath is userul in albiying tha irriti-: S '** « 
skin, and also in diminishiaf tJi. **' tv —"i^^A . 
effect of 01 her baths. ** ' "'^"t^?'^ tba 

7. The Fuau ioM.-This is ai«d **''* 
ing a decoction of sea-weed, or t/, ^'y- 
chopped up, to an ordinary bath ; it ^. •«*», **'<f. 
more or leas gelatinous if enough be^^''^ b^^®*rf 
baths go popukrly by the name of o. ®*i- «*"*• 
and they contain a certain amount of"^ *«<'5'"^ 

of sodium and a minute proportion ^^^oi^' 
They are nsefol in the same coses an . 'orf.v * 

8. Tie Mustard Baih.-Aa ex^^-'^tb^'' 
stimulating bath ia the weU-known '"eftif 
bath, which is made by adding a handf „?'"•'«*</ 
of mustard to the ordinaiy hot bath, -"rl °' '*o 
lurium is its most useful form. " • Pedi, 

9. Pi»» .Bo/As. — Batha of the bal 
pine-leaves may bs prepared extemJL""' ^>* 
making decoctions of the fresh leaflets ate ■•'' 
seasons ; but the usual way is to add about'**''* 
pound of the extract which ia prepared from t? * 
leaves, and is everywhere for sale — at Wt " * 
Oermany. The extract dissolves in the batK" 
which is then ready for use ; but of late it 1^ 
been usual to add a small amount of an Msen 
which is also prepared from the leaflets. Tt 
floats to the surface of the water, and attaches 
itself to the person on leaving the bath, and ita 
aroma is grateful. Of course the quantity o* 
the extract to be employed depends on it« 
strength. These baths are at present Isigel* 
employed. They are slightly stimulant, and a4 
much used in hysterical, rhiramotic, and goaty 



/ 



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104 



BATHS. 



Aflbetioni, and also u an a^janct to thu intenul 
UM of minenl vaten. 

10. Bathi of Coniim, Lavender, ^c. — Aro- 
laatio or sedati re battii are prepared bj adding a 
deeocUoD of larendar, hyisop, or coniTim to an 
ordinarf bath. 

It ia icarcelf neeeaaaiy to add that, ai a 
rule, all composite liquid bathe should be of a 
temperature a little above the tepid ; and that 
their strength, and the time that the patient is 
to rwnain in them, must be determined by the 
■pecial eiTGumstanees of the case. 

11. Oomposlt* Vapour- Baths. — Vapoor- 
baths impregnated with fir baUam are popular, 
and are considered to be more powerful in their 
operation than pine-baths. The rapour which 
rises in making the decoction of pine leaves is 
convpved to a box in which the patient is eo- 
eloeea. 

Aromatic vapour-baths may be giren by 
making the steam of hot water paas through 
bunches of fresh aromatics {conhim, lavender, 
Ice.) before reaching the box in which the patient 
is placed. Such baths may be useful in 
hysteria. 

III. Composite Alr-Batlu. 

1. Sulphurous Aeid Bath. — A raluabla mode 
of applying sulphur in the form of a bath is by 
using its fumes — in other words, sulphurous acid. 
The patient is seated on a cane-bottomed chair, 
and his body is encircled with a cradle, over 
which oil-cloth is thrown, the head remaining 
uncovered. Sulphur is placed on a metallic 
plate, to the lover surface of which the flame of 
s lamp is applied, when sulphurous acid is dis- 
engaged. This bath is less used in eutaneotis 
affections than formerly. 

2. Hie Mercurial Vapowr-Baih.—'VrTjnm\]AT 
is the mode of applying the fumes of mercury. 
Under the chair are placed a copper baih con- 
taining water, and a metallic plate on which 
are put from 60 to 180 grains of the bisulphuret 
or of the grey or red oxide of mercury. Spirit 
lamps are lighted under the bath and under the 
plate. The patient thus experiences the effects 
both of aqueous and of mercurial vapour. At 
the end of five or ten minutes perspiration 
commences which becomes excessive in ten 
minutes or a quarter of an hour. The lamps 
are then to be extinguished, and when the 
patient become* moderately cool, he is to be 
rubbed di^. He should then drink some warm 
liquid and remain quiet for a time. This has 
onan been a favourite mode of treating secondary 
syphilis with some practitioners. Calomel, in 
quantities of from 20 to 30 grains, is adminis- 
tered in a similar manner, under the name of 
the Calomd Balh. It may be given locally by a 
suitable apparatus. Jobx MACPHaitsox. 

BATHS, NaturaL Set Minioui. Warnts. 

BBD-SOBB. Set Ui«bk and UiiCBBATioif. 

BBLIi-SOmfD. A peculiar physical sign 
associated with pneumothorax. See ParsicAi. 
ExajuManoK. 

BBLL'S PABAIiTSIS. (Named after Sir 
Charles BelL) A synonym for paralysis of the 
facial nenre. Stt f acui. Pajultsis. 



BERIBERL 

BBBIBBBI. — STmnr.: Barbiers; and name* 
rous other local names. 

Dtranrtoti. — A disease ebaiseterised by 
anemia, anasarca, deganeiktioB of muscular 
tissue, effusion into the serous eavitiea, debility ; 
numbness, pain, and paralysis of the extremities, 
especially the lower ; precordial anxiety, pain, 
and dyspnoea ; acanty and high-coloured nnne ; 
and m some eases drowsinass or sleepiness. 
Beriberi occurs in a chronic and an acnte form ; 
in the latter often proving rapidly fiital fmm 
exhaustion, syncope, or the formation of cardiac 
or pulmonary eoognla. 

Etxiioloot. — The etymology of the word Beri- 
beri is obscure. Herklotts suggests the Hindi 
word, Bhiree — a sheep — from tOe fancied resem* 
blance of the gait of persons affected to that 
of sheep. Soond-bhirte comes from the words 
numbness and sheep. Soond-ka-baiet signifles 
numbness and rheumatism. BUr-bheri, a Hindi 
word, signifles a sore, a swelling. Hason Oood 
says that Boutins introduced the word Beriberia, 
and tells us that it is of Oriental origin. Carter 
suggests Bhari, sailor, from Bohr, the sea ; and 
Bhayr, shortness of breath. As the disease is seen 
among African and Arab sailors, this is probable. 
Some think it is derived from a Cingalese word 
meaning weakness, first applied to a variety of 
conditions, the result of scorbutic, malarious, 
rheumatic, and anemic eachezie, on the Malabar 
Coast. 

QaooiumcaL Dis iwu t i ow. — Beriberi pre- 
vails endemically in Ceylon ; and in India, on the 
Malabar Coast, and in the Northern Circars, 
between 13° and 20° N. latitude, extending in- 
land firom forty to sixty milee. It is known in 
other parts of India, probably occasionally nil 
over the peninsula ; in Burmah and the MaLsran 
peninsula ; amongst the'crews of ships trading 
to porta in the Fenian Oulf, Red Sea, coast of 
Africa, Bay of Bengal, Singapore, Siam, and the 
islands of the Indian Archipelago ; and in the 
Australian seas. On the West Coast and other 
parts of Africa beriberi also occurs, and is known 
as the tleepmg licknett. In Europe ncmieiowi 
ananua ia possibly the same disease. Beriberi is 
also met with in South America, and probably 
wherever certain conditions of food, water, soil, 
climate, and mode of life coexist. 

Mtioiaai. — All observation tends to show 
that beriberi occurs where causes of debility 
have for some time operated, especially in the eh- 
mates and localities previously mentioned, ineh 
as certain conditions of soil, air, and water; 
exposure to great alternations of temperature, 
especially when accompanied by wet, fatigue, 
mental and physical depresnon; fbod deficient 
in quantity and quality or variety; previous ex- 
hausting diseases ; malaria, and other undefined 
atmospheric and telluric influences — all, in fifiet, 
that tends to depress the vital energies, im- 
poverish the blood, and starve the nerve-centres. 
The symptoms, it is said, seldom begin to appear 
within ten months or a year after first exposure 
to these causes. Beriberi has been ascrioed by 
Banking to disease of the kidney, but there is ao 
evidence to prove that it is due to this cause, or 
bdesd to stmctnni changes of any of the vis- 
cera. Morehead refers it ratber to a scorbutic 
origin, and in some respects it does rssemble 



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BEBIBEBI. 

H may proliabl^, alao, be a eonMqnraea 
of ths mefaexia that so often nanlU from long 
nadonee in a malarioos climate, especially when 
ttat bai been aceanpanied ty ezposnre, ^si- 
and eseaariTV exhanatiou <^ the Titsl 
In aBch, the noet complete aniemta, 
vith debilitj, maj occur, independentljr of the 
•liitaDoe ti oigaaie riaeeral diaeaee, thongb 
■atoBUjr thej -will b* intaomtad where each 
diaaue is pie ee nt. 

Aw.T^*"^"- CRiBACiasa. — Setooi fluid ia 
iflauil gaoeEally — in the areolar tiaras, in the 
liBgi^ biaio, heart, and abdominal viioera. The 
cavitiea aia, like the tiisnas, loaked vith watery 
tOuBaa. The tisnea are aoft and degenerate. 
Matalar fibre ia &ttf, e^MciaUjr th^ of the 
heart, irfiicfa ia often enlarged and dilated. The 
kafaqra are enlarged, anaemic, and loftaned. 

PizaouMir. — Tb» recent diacoreiy by Mr. T. 
I^nria in India, of tbe embryo of a nematode worm 
i> tha blood of persons lofiering from ehyluria 
(m* CanxBu), lymphonfacea, and elephantiasis, 
of wfaidi iliiii iisia it appears to be to some extent 
tha caase, sajgasts inquiry whether a similar 
kBnataaaoa may not also be in some way oon- 
eecaed in indaang beriberL FoDsagrires and 
Loroy ds Meneooit describe beriberi as general 
dropsy with a npid coarse, do albnminnria, and 
and loas of sensibility in the lower 
Dtaptj commences as anasarca, and 
aitsods to the serxnu caritiea. Though hepatic 
iplaaie, or renal complications may exist, and 
iatansiff the eererity and hasten the progress 
of the general symptonis, they are not essen- 
tial eoBcomitants of the disease, but appear 
to ori^Bata in a spansmie state of the blood, 
^id to be kept np by its progressive imperfect 
daboration. The resulting partial starvation of 
tfaa t ai e hnx pinal nerre-eantrea, and the serous 
aAanm iaio and amongst them, sufficiently 
aceovnt te ths psralyais which, in severe cases, 
ehaocteriass thu disease. 

8mn u na. —Beriberi presents itself nnder a 
ainiBirand an aaU* aspect; rarely, it is said, 
aier arrwrring in either form, nntU after an az-. 
poaars of aoese months to the exciting causes. 
The gsnenl symptoms may be said to be those 
uf «»■— it> and aaaaaRs. CEdema pervades the 
limfaa aad body geaezaUy, accompanied with 
aambocas, pain, heafiaesa, and loss of power, 
amoaatingmsoase eases to paralysis. Along with 
these aymptoBia thara ocou: pneeordial anxiety, 
dyapasaa, izngolaritf and palpitation of the 
heart, paia at the ensiform eartikge, amemic 
I I ■!-■ ■_ dability, and a small qoidc pulse, wfaidi 
at tha oataet may be rather hard and full, ao- 
iiiMjisiiiwt by dryness and heat of skin. The 
sppeCita ia at first not impaired. Later there is 
iiililiirMiiif thn mtrnmitinn. torpor of the bowels ; 
scsa^. high-eohmnd urine, of sp. gr. 1U20 to 
WW, bat no albnminnria as a mle. According 
ts Hottaa aad othsca, excessive drowsiness and 
t stages of eertain eaaes of the 
also palsk flabby tongue and blanched 
aneaas nambnaes ; oceanonally hemorrhage 
Seam ths «*~»««* and bowels ; with petechia] 
Si ■stiuas ; an aoxiona look; a puify, swollen, 
tmi soMsCtmes lirid &ee; and a peculiar 
tcHtmag ^it. Death resnlts rapidly in some 
Ok ths acuta eases, with symptoms of effusion 



BEEIBKRZ. t*^^' 

into the thoraeie and abdonaixaa.1 caviti"*' ^^ ^'^^ 
in the skull, by exhaustion. syneopSi °\a '^ ^ 
mation of coagnla, either in t^be aT»t*?pn-«tgo.^>l 
the pulmonic circulation. ^3«-jribeTi ^?^^VcbA«I» 
assumes a slight and modiflAcl. tonOt ^gycfOLiA <|t 
by annmia, numbness, and ^ *'^'^°^^0n * ^\&> 
pain in the limbs ; an anxious «*ui**fL . ^ V^^ 
ordered bowels ; scanty urioe ; oolo. ^^^ wi^i*?*'*' 
fseble, and irregular pulse ; y a.ia.o otA^^'^ ^~**^, ^ 
noeasinus, with palpitation ; n^r-woua »*^***av^jj. , 
an unsteady, almost tottering epwifc ; oxtO- ^ "JrnW. 
&ee and neck. Dr. Paul saws = • I kia'o m«t: -^?*3 
a numerous class of caaes tfaxL-t^ ^ls:^ TkOt ao ^»^^^-\ 
(aa the acute) or so often livtiaaJ., -wwbcf^ t.\^^*^<i^ 
symptom com|dained of was bax-x-xoing Of '^|^ ^^\ 
Malcolnuon describes this r»saxsa.-r''kA\>\« c^^ ^^^t 
in connection with bsribeii. to -^ivlilch, lw**^it!f ^••' 
is allied— it is found to a.SSa<s*i. «b« i^ %»» ^^^ifc 
calves of the legs, the back. m.xad c^ocur; ^"^ <^^*» «! 
muscles of the legs.' It ooereai,-.. ^J^"**:*! * ^ ** 






*>«;i,^;^^: 



i^>> 




slight ezamidea of beriberi, an«3. 'w, 
in the troops afier the first Sas-rr 
times in men who had not h^^l. 
whole, MalcolmacHi thinks it 
tism nor beriberi, aad mar a 
other diseases, as an indica.^i 
bility. 

In the aeuU forms of berib <» j - £ 
are vary severe and often Ti».f»i^x 
tality would indicate it to b-^ ^i^^o '*-»»^ 
chdeim in fctality. The chiof „-y mT^Tf* T/>) . 
Bapid general anamia and droparj- ojs^^o ^ ^q**^0!i». 
scanty, almost rappressed nnoo - ,x 'A *>i4k ^t)i**io* 
weak, irre^r pulse; intense l>^j«J'ifc:^o 'iJ> ,*" 
hurried, irregular, and peinTui ^oJ*t/^t.,^®.-.J'' 
occasional vomiting — sometimes o/" 1 Jk^/*»^'»/ • ®« 
ing of the limbe, with numbD«««. ■'ti •^-' ' »- ^°« •' 






s« 



'4*'- 

"•"e//.' 
■?«</ 



paralysis, preceded by a feeble, to^' ]^ • '^' 
all the symptoms of pleuritic anc/ '*/?'*'" 
eflHision j failing heart ; and deatJi ^ej5?* os, 
syncope, or oerhaps almost sudderj;^*t/jo''^'V,i,/ 
holism — in tie most acute cases \i,-.-^ .^Oftj^oi 
days. In this acute form the affect '^ a /*'" 
fatal, but in the milder and more ch^*. *• rer^ 
recovery is frequent. Acute cases ofto^'° foi^ 
vene in those who have snflered from th "JP*r- 
disease, or in those who are exhausted ancf*^ ^^ 
mia from other causes. an«. 



TRBATmoiT. — Attention to diet, snitaKi 
clothing, and protection against vidasitodM 5 
temperature, wot, and cold, are the best o^ 
mntivt measures. Bad hygiene and exhan^^' 
habits of life tend to promote the development 
of the constitutional condition io which the 
disease commences. 

When beriberi is established these precautioQg 
are still necessary, and attention must be paid 
to the symptoms as they occur. Diuretics and 
diaphoretics relieve the ffidema and dropsical 
efiusions. Tonics and stimulants give ngour 
to the weakened mnscular fibre ; while appro- 
priate remedies and diet may improve the con- 
dition of the blood. 

Acetate of potash, digitalis, and squill, and 
occasionally c^omel, are said to favour the re- 
moval of the fluid. It is needless to say that 
the physiological action of mercury is to be 
avoided. Salines, hot-air baths, diaphoretics, 
and turpentine may at various stages be found 
nsefU. The object being to remove the fluid and 



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IM 



BERIBERI. 



Hn.TTAByi ^. 



■tnngthen muscular fibre, qiusioa, iron, iind 
other tonid are an important element in the 
treatment. No remedies, howerer, vill be of 
much avail nnless the patient be placed in 
&Toatable hvgienic conditions. Idalcolmson 
■peaks highly of two remedies — treak /areok, 
and oUum uiffrum, which are coasidered to be 
very effective in the treatment of the diaeaae, 
enpecially in relieving the dyspnoea and isdema, 
which proved very fatal imtil these drugs were 
introduced. The composition of the tr&ii; is appa- 
rently generally unknown — it soems to be diuretic 
and stimulating, and probably not aperient 
unless combined with rhubarb, m doses of four 
to fifteen grains. The Ueum itiomm is a stimu- 
lant and diaphoretic, given thrice daily, and 
baa been found by Indian physicians to be 
TUj beneOcial in some rases of beriberi. Dr. 
AitJcen says that turpentine is a Qsefnl remedy. 
Ergotin, iron, and belladonna with doc in the 
form of pill, accompanied with sea-bathing, were 
useful in this disease, as seen at Bahia. Kuz 
vomica has often been foand serviceable in cer- 
tain cases, as might be expected, and opium may 
be needed to allay pain and irritability. Hepatic 
and splenic com{dication8 need their appropriate 
remedies. Obviously the chief indications are to 
promote removal of the oedema ; to regulate the 
f^inctions of the abdominal viscera; to increase the 
action of the skin ; and to give tone and vigour to 
the muscular fibre. By such measures can we 
alone hope to deal successfully with this profound 
form of cachexia. Joseph Fatbbb. 

BTARRTTZ la Tranoe, on the Bay of 
Biscay. A fashionable sea-side resort. The 
climate is considered to be bracing. See Cukatb, 
Treatment of Disease by. 

BHiB, Disorders oC— Disorders of the bile 
held a large place in the medicine of antiquity, 
with the exception of the theories of Van Helmont 
and Baracelsus ; the latter looking upon the bile 
as the balsam of life, and therefore incapable of 
begetting disease; the former regarding it as a 
mere excrementitial fluid, and therefore equally 
incapable of begetting disease. Disorders of the 
bile have, nevertheless, held their own quite 
into our time. It is common enough to hear 
persons speak of a < bilious attack,' or ' being 
troubled with the bile,' expressions the surriviils 
of the humoral pathology. The liver was for- 
merly credited with most of the dyspeptic dis- 
orders of the stomach. As Sir Thomas Watson 
says, it is an organ often blamed most gratui- 
tously and unjustly, but no educated or scientific 
physician would now think of attributing a gas- 
tric catarrh, or constipation, to an ' attack of the 
bile,' or to a 'sluggish liver.' 

Physicians have arranged disorders afliecting 
the bile under threeheads — (1) diminished secre- 
tion of bile ; (2) increased secretion of bile ; and 
(3) secretion of morbid or altered bile. This divi- 
sion may very well be accepted as a convenient 
basis for the further discussion of biliary disor- 
ders, but it is nothing more than an hypothesis. 
It is likely enough that the bile, in certain dis- 
rnies, changes its character as regards both its 
amount ana constituent parts : but it cannot be 
denied that the means by which physicians are 
able to asceKaio these changes can scarcely be 



said to exist in ordinary oaaei, A common saying 
is that tlie patient must be making plenty (rf 
bile because the stools are high in colour. N» 
reasoning can be more fallacious. The colour o< 
the stools may be high if the fteees be quickly 
swept through the intestinal canal, because there 
has been no time for the bile-pigment to be 
absorbed into the blood. Or the fieces may be 
pale if they lie long in the bowel and the coloured 
matter absorbed. So that the colour of the 
stools is no sure sign of the poverty or abun- 
dance of the secretion of bile. In cases of pale- 
coloured fieces purgatives often do good, not 
because they have any special tendency to in- 
crease the ilow of bile, but because they I111117 
the fieces out of the intestine, and thus give no 
time for the absorption of the bile, which, if it 
lay long in the bowel, would be absorbed, earned 
to the liver, and again excreted into tiie gall- 
ducts — the vicious circle of Scbiff. 

Nor is the analysis of the bile found after death 
in the gall-bladder of much value. Freriebs 
annoanced the presence of albumen in the bile 
in cases of oongestion of the liver ; but it is now 
generally thought that this appearanca is dm 
solely to a post-mortgm transudation. Bitter 
also has described a colourless bile in which all 
the constituents of bile are present except the pig- 
ments. Host of his analyses were made on bile 
tsken from the gall-bladder after death ; but if 
the cystic dcctbe obstructed for any time, it ia 
well known that the bile containod in the gall- 
bladder may become colonrless without any real 
secretion of colonrless bile having taken place in 
the first instance. It is impossibis to bo certain 
that the changes, which are found in the bile 
taken from the gall-bladder after death, hav* 
taken place during life. 

The only source of what may be called know- 
ledge of the disorders of the bile is obeervation 
of men or animals in whom biliary fistula hara 
been formed either by disease or by art. Unfor- 
tunately, the minority of such observations have 
been physiological or pharmacological ; and but 
few are recorded of the changes which Uie bile 
undergoes in disease. Altogether contradictory 
experiments are recorded of the inflnence of the 
nerves and of the diabetic puncture of the fourth 
ventricle upon the secretion of bile. It is an 
admirable field for further research, but it will 
be seen that our present knowledge very closely 
approaches to complete ignorance. 

It is disputed still whrther the presence of bila 
in the stomach puts an end to the process of 
digestion. By many it is thonght that the bile- 
acida throw down the albumen of the food, and 
with the albuinen the pepsin. It is well known 
that in some disorders there is an inverted action 
of the duodenum, and bile is poured into the 
stomach, aa in long-continued vomiting, fii>r 
instance; thus the dispute has a practical bear- 
ing. The best treatment of this state would 
seem to be by saline purgatives. 

Bile may also be taken up into the blood, and 
when this occurs, jaundice results {m Junnnoi). 
J. WicKHAM Lugo. 

BHiHAJtZIA. — This name was given bj 
tbe writer to a genus of flukes discovered by Dr. 
Bilhars, of Ckiro, in the portal system of humaa 



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BIUTABZIA. 
blflod-TMHla, mnd th« warm ma oubtaqiisntl; 
fcod I17 lb vriur ia the portal rain of a monkajr. 
nainmatode hnaatoaoon vaa first deteri bed aa 
a Diitoaitt, bat thaapaeie* is now mora geoanlly 
kamni as the SUiarna hmwuUoUa. It wna ori- 
giiulljr fimnd in tho portal ajratem, and BUban, 
flr w a n^ w Jantaar^nd othars aftemmidaahowad 
tkat thia paiaaita alao infeata the Teini of the 
ntmaUry, bladder, and otlier parte, nrodaeiog a 
AnaidBble disease which ia endemic in £gypli at 
Aa Cv/t, at Natal, and pnobabljr in other parts of 
tke African eaDtinent,as wirliaain theliLuiritiua. 
The diaeoTtr^ that the endemic hsematuria of the 
C^ of Goad Hope ia oocasioiied bjr'the presence 
ii JiHsrri a, is doe to Dr. John Harley, who de- 
tMied the ora io the nrine of a patient who had 
pmoari^ resided in Soathem ilftiea. Dr. Har- 
\t't ioprasion that ha had to deal with a new 
^<s of Bilhanaa iiaa not gained general 
tanfiutt, bat he /umiabed proof of the wide 
m^piial diatiibation of this parasite, and 
m sin added Jsig^Ij to our knowledge of its 
migei. 

^i-euma.—Tius paraeiea, tinlika nearly all 
t^ otker kaon ipeeiaa of flake, haa the aezes 
■^'x'MiH ieaaJea beini^ compazatiTely slan> 
'* wnu^ nseaiiling Slarifarra nematoids. 
^^nafapaiifaea tha featmla ia lodged in a long 
iBt'Uki gram, or frntBCopfaoric canal, with 
*^ tie tbdoata of tha male >s Auniahed. 



BiLUBT wrrct*- 



tf 





hk t-BiOmnia hmattt- 
mit, male mat lanmim 
■oilT'oaBMaed. Ma«- 
■ital ASUt ILOciaesa- 



■pf^^ S. — OTum of Bil- 
iJitrxIa hcrmaUMa 
-^rt^ eositalJMd eoti. 
tiTTO and «rts smv. 
oode-snmalea ; x 2M 
AlaBMten. OrtglnaL 

11. psenbar. beug ?»»^«' '^^Sniapine, placed 
od, cr faaiahed ^^^ ^SluSdSr Vol' ^ This 
a.littl. di--»»^^ t^^^ ^ the epg 
EL^'jr-i-^^rf t:Br«»bryo to effect IS 
^^^S^to S- iSS-re-tedf in the organi- 
"^ , S^ ^ j!^JS^oBibryo«' and in the re- 
ansa or ^^«='^^*^„/Tho^larT« during their 
BrioOaa »>**^?"^L^£ti till find the «.bject 
mia^ atasM of ^?T*^Tor'. P<4>« 'On the 
{ri.,<fi«»».admtl2^-2^' tocher with 

enunac la a «»^ "^ d«>— ~ 

"'2Lll±±r'T»i writer baa pointed to the 
*~*^3Tl^Itl2^«««a of Bilharaia aa if they 
r^fSbUu> «Sina.7 halminthiaa.* It la 
, eusavaiaUa ^J.'^pioT actire draga fothe 



expnlsion of the parasite snd iM *ll T^",^^ 
bladder.nori, it prudent to •«'< dea'^ny 
Bent of vermicides with the Tie* ."' . ■o-.t.-^ 
tha worms. Aa in Trichioosia, iO wjf "J^";^ 
sia disease, it is esuential to suppo" "v- Vi^ 
tern. Thus tonics, cold bathing. •^ L ®^Jf 
nourishing diet, combined with the bie«'»"«''f°* 
potash and infusion of bucho, constitute our tn»v 
reaourcea when dealing with caaea of endeuao 
hsematuria. The pathological «»<*» cla^TV^ 
show that in order to effect a cute wa YKoa^ 
imitate natnre herself as closely as we CAa. "VT^ 
must seek to erect artificial, barcian. and ^Vvxx& 
check the luemorrhage aa miach aa posaible. f^w 
this porpoae the writer has found Oie ^trVt^^^^^ 
properties of Aretostaphylos n-vn nrsi attti^^^T^ 
serriceable; smaU quantities of hyoacyatn-m} vJ^- 7 
useful jr combined. Cr. Haz-Iey adriscs • i^ -^l!^*^^ 
rering use of belladonna and. henbane,' TlUcj****- 
impression that treatment -witli these dni~^* th^ 
retard the dflTelopment of t^ho paraait^^^ ' "Wijl 
they (Jo not effect its deatxna.ct!on.' fK* *^^H i* 
entirely disagrees in this vaewr of the * ^•it 



he alao objecta to the emplo'.yznent of «!***» ^ • 
injections. He thinks that tlio •"Mploym^ ^>C»» 
retics is likewise clearly oontna- i ndicat«ri**^ **frt^**' 
thing that will contribute fto-vwsrds all * ^«. ^' 

toe 



Tesieal irritation, is certain to 
process of cure ; and, in this w^cw, 



tration of bnchu-infunon, the 



tJi 



J>*tt 



liberal di«t, and the taking o^ S'eQti 



*'""°«^i*'^«^i'*^^ 



will be found amongst the most 



'*Po, 



«« 
.**< 



•*«/a. 
Of- 



tire aids. In bad cases a thorr>ntt^**%^J**teiag 
likely to be completed until after ii*"*^ - '^'I'a.' 
several years, rrophylactically ,•( ^» K '■ Hot 
to remoTe patients from the localjf ** e'aiP'* "' 
there is every reason to believe the*** •« "tf'"^ 
traeted the disease. In view, also, of have*" "'^ 
infection on the part of others, it ,- ^*^v«„^" 



coo. 
that the water employed for domeaiT ""^ea^^t^ 
throughout the infected districts, j^ ^^^P^2 
thoroughly pure by efficient ffltration S?""*^ 
thor particulars the reader ia recomni 3*^ ''"■■ 
oonsnlt the general works of KOche *? '" 
and Leuckart ; the writer's int«>dnctor»-'V^'*'*' 
on Entoxoa (p. 197 el ttj.) ; Dr. Harl^','!?'''*> 
separate memoirs (in the Trantactioiit r^i^ 
Royal Med. and Chir. Soc., I88t, Sec)- '^ 
also especially the recent memoir by Dr. Sonaf " 
entitled ' Hesearches concerning Buhania li/em^' 
tobia in relation to the endemic hsmaturiaof 
Egypt, with a note on a nematoid found in 
hnman blood ' {Send. deUa S. Aocad. dtlh Sciente 
fe., 1874). See alao ILbiutoioa. ' 

T. S. CoBBOLO. 

BrLZABT OALOXTLVB. See Quj^nwna, 
BIIiIAJtT FIBTTTIiA.— There are t»o 
kinds of biliary fistula -.—one, in which a eommu* 
nieation exists between the gall-bladder and tha 
surface of the body ; the other, in which there ia 
a eomrannication between tha oall-bladder and 
other internal organs. Neither kind is oommon 
but the first is less rare than the other. 

In the first variety a tumour forms, sometimes 
in the place of the gall-bladder, at other times near 
the nmbilicns, in tha lines alba or to the left of tiiia 
line, or in the groin. The tumour, if opened apon- 
taneoDslyoT by the surgeon, discharges a quantity 
of pas, bile, uid gall-stones. If the cjstio duct 



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108 



BILUBY FISTtlLA. 



be obi) tented, no bils need empe, A snppura- 
tion of the gall-bladder, esDBed by the preesnee 
of giiU-etoDse, is the common eanse of these 
fistuln. The prognosis is good. The diagnosis, 
before the tamonr opeon, is rmj difficnlU In a 
ease irhieh came nnder the writer's notioe, it was 
mistaken for an abscess of the liver. 

In the second kind of biiiai^ flstola, Ae gall- 
bladder mar oommonicate with the dnodenum 
or colon ; with aa abacas* of the liver ; with the 

Krtal or other abdominal rein, though it mnst 
owned that cases of this kind seem somewhat 
dabioos ; or with the nrinaiy bladder, or at least 
with some part of the nrinaiy tract. Qall-stonts 
aie in nearly eveiy ease the cause of the fistvloos 
opening. J. Wickhak Laoo. 

BZZiIOITB.— This term is used with much 
vagneness, and in popular language is often em- 
ployed very inoorractly, though the idea is to 
associate it with conditions in which an exceaiire 
formation of bile is supposed to occur.. The 
chief uses of the word are as foUown : — In the 
first place it is employed to designate a peculiar 
temperament — the biliout temperament. Again, 
individuals are often said to be biiioia when 
they present a sallow or more or Iras yellowish 
tint of akin, bnt especially if they are distinctly 
jaundiced. BUioai vomiting and dUirrhaa signify 
respectively the discharge of a quantity of bile, 
mixed witb vomited matters or with loose stools. 
Certain febrile diseases, attended with yellow- 
ness of the skin, are sometimes designated fttftbiw 
feeer, and nnder lilcs circumstances pneumonia 
has been described as bUioui ]fntimonia. Lastly, 
one of the most frequent applications of the 
term is to certain so-called bUiou* aitaeki or 
bUioumeu, which, however, are commonly merely 
attacks of acute dyspepsia or migraine. The 
most prominent symptoms of a supposed biliout 
attack are anorexia, furred tongue, a bitter 
taate, sickness, constipation, and headache, with 
a feeling of marked depression and general 
malaise. Such attacks are most effectually pre- 
vented by careful regulation of diet, and the 
avoidance of exposure to cold, fatigue, and undue 
mental exertion or anxiety ; when they come on, 
abstinence from food is desirable, with rest in 
the recumbent posture, and perfect quiet. Altera- 
tive aperients and saline effervescents may be 
given, alcoholic stimulants being avoided as far 
as possible. Fbkduucx T. Bobbbts. 

BHiIOUS •mHPBBAHXiirT. See Tbk- 

nsAiciaiT. 

BITTXB ATMOITDS, Poiwrning by. 
8m FsDsnc Acu>, Poisoning by. 

BI1A.OX TOUIT. — Vomited matters may 
'M more or leas black in ditEerent diseases, but 
she peculiar Uaek vomit is that which occurs in 
fellow fever (je« Ybuow Fevkb). — The rejected 
aiattars ai« acid in reaction, and a sediment 
is dapositad of coagulated albumen and dis- 
integrated blood-corpoBcles. Ammonia is also 
present The black colour at the vomit has been 
attributed by some writers to altered bile, bnt 
' there can be no doubt that it is due to its ad- 
mixture with blood which has undergone certain 
changes. 

BIlADDBB, DiMMM of.— The bladder may 



BLA.SDEB. DISEASES OF. 

be the seat of the following morUd condition*: — :- 
Inflammation, acute or ctuonie ; Abscess ; Nsn- 
ralgia; Atrophy or Eypertrophy; Mechanical 
Distension, with chronic engorgement and reten- 
tion of urine, commonly, bnt erroneously, termed 
■ Paralysis '; Soecnlation ; Displacements, such a* 
hernia in the male, or, very rarely, inversion and 
protrusion in the female ; Tumours or Orowth% 
including fibrous, vilioos, or Tasenlar growths ; 
2pithelioma and Carcinoma; Tubeicnlar Dis- 
ease ; Ulceration, either simple or malignant ; and 
Tesico-vaginal or Vesieo-intestinal fistula. The 
bladder may also be the subject of true paralysis, 
partial or complete, as the result of injury to the 
brain or spinal cond, or following disease of 
those organs. 

Only a brief statement respecting the moot im- 
portant of this class of affections need be pre- 
sented here, in ordertoCteilitataanacqnaintanaa 
with thnr diagnosis, since the treatment of almost 
all of them belongs to the province of the surgeon, 
and so fiu only as it consists of medicinal reme- 
dies will the subject be considered. 

1. Aoat* TTillrwnniatton — Aoata OrattUa. 
—The mnoons lining of the bladder is the part 
affected by inflammation — and although after 
long and severe attacks some morbid action oc- 
cur* by extension to the muscular coat, or even 
to the peritoneal onvering, these structure* are 
very rarely afiSteted. An acuta inflammation 
of a veiy severe kind occurs from iduries; 
from the presence of instrumenis, foreign bodies, 
or calculi ; and from unrelieved retention of 
urine. A less severe, somewhat e^'anescent, 
but very painful form of cystitis arises from 
irritants taken internally, as cantharides. A 
still less severe, but often troublesome form 
originates by extension from gonorrhiea. 

In the firet class of cases there are not only 
severe local symptoms referable to the bladder, 
but the general system may be gmvely affected. 

In the eeeond class, of which cantharides- 
poisoning is the type, the phenomena of voy 
frequent, painful, and spasmodic attempts to 
qect small quantities of urine which in irften 
bloody, occur within a very short time after 
absorption of the poison. A common blirter is 
said to produce the alKction in some person*. 
In two cases — the only two the writer has ssen 
— it has followed the application of a blister to 
a Burfiice already partially denuded of the scarf 
skin. In one of these a blister was applied 
to a knee which had been frequently painted 
with tincture of iodine, and was still slightly 
sore. In three hours after the application the 
patient was attacked with ezceedinftly paiaAil 
efforts to micturate, which were at times intense. 
The attack lasted six hours, gmdoally diminidi- 
ing in force, and leaving no ill-effects behind. 
In less than twenty- four hours no trace of the 
symptoms remained. 

In the third form of cystitis, which is the most 
common, and of which that arising by extension 
from gonorrhoea may be taken a* this type, the 
usual symptoms are undue frequency of micta- 
rition; a necessity to perform the act imme- 
diately the want has declared itself, a condition 
conveniently expressed by the single word 
'urgency; ' a desire to pass mora, aecompoaied 
by pain, when all the nriae ha* bees vmdsd ; aad 



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BLADDER, DISEASES OF. 



MB* dall aehmg ovsr tKa pnt^M ; togethar with 
a gcoaral febrils itete of the mytiUm, often rair 
d^fat, bat oocTespondioe for the moet part with 
the iegna of Jooal iDflammMion. The orine 
itactf ia eloodj, knd depooiu aome lignt mncai 
bol U Dot otherwiee Hpparently 
Under the mieroeeope abnnouiee of 
risible, •■ well a< (nme pii»-«eUf, 
ud if the afTeetion ia serere, a few blood-eor- 
{MKlas ai« alao present. It ma; be remarked 
han that the prut nee of a few piu-celU in ibe 
anaa^ a fact to which ao many practitioners 
Bttniwta oooaideiable impoitaDce, 0/ no means 
steisasrfly deaerres to be so regarded. The 
raj slightest attack either of this or of the pre- 
cadLag font of cjatilia is certain to be attended 
by the formatitMi of aome quantity, howarer 
saall. of fnlly-dereloped pns-eells. 

'Vtejtarelj t/mlte mem brane may be produced 
•a the i-r^*^ of the mncoos membrane of the 
bladder, asd Bay be thrown off almost entire, 
laadiac to the belief that the inner coat has itself 
baea axfoUated. In vomaa this membrane has 
been Toided par artthram in a condition for ez- 
"•— *^~' ; ia B«> this cannot occur, because 
tha Bretlna is too small to admit of it. Now 
aad then oamples of the former have been 
afaova at the Pstholagieal Society of London ; 
aod OBe of the latter may be seen, discovered by 
epeatka, ia the mnsevm of the Boyal College of 
8 urg eoaa of London. 

TsajknosT. — In the fint form of cystitis, 
tfas reawral of the exciting eaose, if possible, 
ia tka chief indication. 

The izaatBMnt of the ieeoad form should eonsist 
of Tarrhot bidets or hip-baths, the former being 
■aobaUy infatabie as capable of being used at 
Ugber teaipetstiirea than the latter ; together 
vHh large doaea of the tinetnre of henbane, sa^ 
a drsfhm, with 10 or 15 dropa of liquor opii 
ar aijt w u hoaia while pain is serere ; 20 miiJms 
of Uqaor pataanr may be giren either simultane- 
•■■Ij or altenattly, in water or in any bland 



Tb» tnatmant of a well-marked ease of the 
third lisssiianisti in afaaolute rest in tne recnm- 
bsBt paatnreh mild diet, abstinence from all al- 
coholie atimnli, gentle lazatira action of the 
bowda, aad the admioistratira of small doses o{ 
alkali. The writer prefera liquor potassn to all 
Hhns. &«q|neatly repeated ; ana this may be 
rwhianH with laanbaoe, or, if mietarition is very 
iutf t m A and paiafol, with opium or morphia, 
ar with cfakrodyBe in small dose*. Hot hip-baths 
« Tiiil<<a. followed by hot linseed-meal poultices 
ar Ibmntatioaa, giva great reliet The patient 
mtf diiaik freehr of decoction of triticum repens, 
based tta, faailay water, or similar demulcents. 
Bslief impidly fbllowa, but care is requisite to 
araid mlaiian. which easily occurs if exercise 
be tafcan too soon, if injections for the gonor- 
ihaa ha iiisiimnl too readily, or if aleoholjo 
I are freely taken. 

Oamaation — Obronio Oja- 
flanmatioB of the bladder is 
1 tram the acnte form by very distinct 
. Itia moatly the result of retained urine 
I or eolaiged prostate ; but it may 
Moea of calenli, or of growths 
ia tbaUadte; fraaa orer^isteoaioo, or atony of 




its coats ; from paralysis aflto 
affecting a nerroua centre; fr^i 
bouring oigans ; and somafci 
urine : it is also met with in 
the kidney. Sometimes this 
by the presence of a large qo^ 
mucus, often called ' eatarrli ' ; 
monly this symptom is absan Cv 






t>at 



contains merely ordinary nauxras* or jj^ - ti^^'u^ 



i'^c^^oo:: 



rendering the secretion more *>*" -**«• cIq^JIo-imi, 
Paihaps there are «ox»^<*se»7!r'' «nd 

of gout 



opaque. ,_ 

the inflammation ia mainly diss 



*«ti. 



'"^bT^ 



SmTTOits. — The symptnms of *^.''>Oie 
are increased frequency of micfcuntioi] ^-^'^itia 
but the latter is by no means aecoMtfjj "'* P»'a, 
The urine is always cloudy, and contai ^***"''*' 
pus-cells. There is ofUn, but not tlwa^ **"°* 
suprapubic uneasiness. The geoeial ienltA ^"^ 



not suffer unless the affection 



pus-cells. 

sr unless the affection is ptolon^^"^ 
serere. If important eanae% as the pr»aieiice of 
stricture, calculus, &c., occasion the chronic crstl- 
tis, their specific symptoms will predom inate. It is 
not common to find ckronic cystitis as an idiopa- 
thic disease, although undoubtedly it ooeasionainr 
is so ; so that the writer has always regarded ft 
aa a useful maziTn, 'Whsn chronic cystitis is 
declared to be idiopathic, we may be sure that 
ws bare only not yet discorered the real cause.' 
As a general mis we may be sure that there is 
inability to em^y the bhuder, or ealeolus, stric- 
ture, or organic dissass of some kind ia some 
part of the urinary tract, when the group of 
qrmptoms are present which ws denote by the 
term 'chronic cystitis.' Bespecting the well- 
known glaiiT mucus, which is deposited to 
abundantly nom the urine in some cases, in 
elderly people almost inrariably, it ahould be 
said that it appears only in those whose urine 
is abnormally retained, through atony of the 
vesical walls, or in consequence of enlarged pro- 
state, or as the result of sacculation of the blad- 
der, and that medicine has little or no effect 
upon it. 

Tbutkott. — Ths regular and habitual use of 
the catheter, and perha^ also injections into the 
bladder, form the essential mechanical treatment 
of chronic cystitis in the cases just mentioned. 
In the few cases in which chronic cystitis is pre- 
sent, and no organic causa, such as those named 
above, can be discorered — and olso as adjuncts 
to mechanical treatment when these causes de 
exist — certain mediimal agents are undoubtedly 
useful : these are bnchu, triticum repens, uva 
nrsi, alchemilla arrensis, pareira brava, and the 
alkalis potash and soda. Buchu is more usttb] 
in subacute and recent ehrooie cystitis than in 
eases already of low; duration. The patient 
shoidd take not less than ten ounces of the in- 
fnsiondaily. After this, in similar eases, the 
decoction of triticum repens, made by boiling two 
to four ounces of the prepared underground stem 
in a pint or a pint and a half of water, of which 
six ounces should be taken three or four times 
in the twenty-four hours, is highly nseftil. For 
more chronic cases, where the unne is alkaline 
and deposits modi mncos, and perhaps ths triple 
phoaphatss also, alchemilla, uva ursi, and pareir* 
bnva may be very valuable. The alchemilla 
is administaarsd ia inftaaion, one oonca of th6 



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110 BLADDEB, DISEASES OF. 

barb in ons pint of boiling wstar, of which the 
doM ia foar to lix ouncM three times dailj; 
the otben aoooi^ng to the diraetioni of the 
ph&nnacop<sia, Theae may be taken alone or 
«ombinedirith potash, irhien ra moderate quanti- 
t)«a diminishes the natural acidity of the urine 
before it enters the bladder; the mncons 
membrane of which, althongh accustomed to 
that condition in health, is pprhaps some- 
times, when inflamed, irritated by urine cf 
even the ordinary acidity. Whether tliis be so 
or not, there •t no donbt that allulis do fre- 
quently tranqnilUae an irritable bladder. They 
are often given in the form cf Vichy water, 
Tals water, or that of Erian, all strong solu- 
tions of soda; but on many grounds the salts of 
potash are prefBrable. On the other band, the 
mineral acias hare been largely administered 
in cases where the nrine is allcaline ; although 
there is no reason to believe that the acid has 
any direct action tlirough the Icidneys, or that 
it is eliminated by those organs. Alkalinity 
of the urine in chronic cystitis is almost always 
dna to inability of the bladder to empty itself, and 
the remedy wanted is not medicine but a cathe- 
ter, at all erents to ascertain whether this be the 
cause or not. A very small quantity of urine 
retained in the bladder, say ons or two ounces, 
after every act of micturition, snfflces in some 
cases to maintain an alkaline and otherwise nn- 
healtby state of the secretion: while itls equally 
true that some pitients may habitually, and 
during long periods of time do fail to empty 
the bladder, always leaving behind from half a 
pint to a pint, without losing the acidity of the 
urine. Of coarse other signs, and notably great 
Ct«qneney of micturition, are present when such 
is us case. 

S. Hauralsla. — It is impossible to deny that 
the bladder may be, like other parts of the 
body, subject to symptoms which are described 
as neuralgia, although the occurrence is an ex- 
tremely rare one. All the writer can say is, 
that he has occasionally met with cases in which 
he has not been able to account, by the existence 
of any lesion, for pain and frequency in micturi- 
tion, or for difficulty in performing that act, and 
where these symptoms have been more or less 
periodic in their appearance. In such instances 
he has given quinine, and has occasionally 
found great relief to follow a few doses : more 
frequently this has not been the case. B'jt now 
and then the value of the drug has been so 
marked as to corroborate a belief in the existence 
of vesical neuralgia. Itmnstbeiepeated, however, 
that examples of such phenomena are extremely 
rare. The writer has also employed arsenic 
on the same ground. It is invarialify necessary 
to inrestigiita the general health, as well as the 
habits and diet of the paUent. This, perhaps, 
may be the plnce for stating that in all chronic 
and slight, deviations from natural and healthy 
function in the urinary organs, it is essentially 
necessary to inquire into the state of the diges- 
tive organs, to correct by diet and by medicine 
when necessary any imperfect action on their 
part, if possible. Ckinstipation alone, when 
haUtual, may produce considerable irritability of 
the bladder, so also may the nnneceSsaiy use 
of purgatives. A gentle, easy, and daily actica of 



BLAODEB, DISEASES OF. 

the bowels, a healthy eondition of the primai7 
digestion, the absence of flatulenee and distension 
after food, should be ensured as fiir as possible in 
all patients complaining of frequent, difficult, or 
uneasy micturition ; and many such may be com- 
pletely cured of so-called urinary affections by 
strict attention to these matters. The writer's 
strong convictions relative to this fiict, grounded 
on innumerable experiences of its value as an aid 
<n practica, led him nearly twenty years ago to 
weertain the great Talue, for such patients, of 
Friedriehshall water, now so extensively need; 
and more than ever he insists on the use of a mild 
and laxative regimen and diet in their manage- 
ment. 

4. Where obstruction to the outflow of urine 
exists (stricture of the urethra, moat fbrma of 
enlarged prostate, other tamonrs, &c), the 
muscular walls of the bladder become the seat of 
H]rp«rtroph7, which is a condition of compen- 
sation, therefore^ and not of disease in or by 
itselt But such changes in the interlaeingmua- 
cuUr flbrea exieting, Booonlatlon readily occoia, 
by protrusion of the lining membrane between 
the bands so produced. On the other hand, moat 
commonly when the proatate is hypertrophied, 
the bUdder beoomea gradually distended, ila 
coats become expanded, thinned and weakened, 
and a certain degree of Atrophy takes plaee. 
The power of the organ to expel nrine is lost or 
diminished ; and micturition being a function of 
simply mechanical nature, the circumstances of 
the case demand only a mechanical remedy, viz. 
the catheter. Xo medicine can restore power and 
exercise of function under these circumstances. 
But atrophy and loss of power may occur ftom 
oomplete or partial loss of nervous iniluanca to 
the bladder, as in those who are the subjects of 
paralytic states commencing in the spinal cord or 
brain. When the paralytic state follows accident 
cansing injury to a nervous centre, the nature of 
the cose is obrioos enough. But sometimes the 
onaet and progress of chronic disease in theaa 
organs are very slow and insidious ; the urinary 
troubles, as manifested by slowness or difflcultr 
in passing urine, or by urine clouded throogn 
inability of the bladder to empty itself, may be 
the eariieat signs of the nervous lesion. On the 
other hand, impaired gait, and other eTidencee of 
central mischief, may be and mostly are earlier 
phenomena, the derangement in the urinarr 
function appearing at a later stage. For su^ 
patients, the habitual use of the catheter is often 
necessary [always of course when unable to 
empty the bladder by the natural efforts] : while 
such constitutional treatment as is indiotted by 
the cerebral or cerebro-spinal lesion present wiU 
comprehend that which the bladder demand*. 
It is therefore onneoeaaary to allude ftutitar to 
that subject in this article. The same remark 
also applies to those few examples of Tnbaronlar 
disease of the urinaiy organs, which is always a 
local expression of a general constitutional state 
sufficiently considered under its proper head in 
this work. All other treatment of this malady ia 
local and surgical. 

6. Relatire to Tmnonn, the rorieUes of which 
have already been enumerated, no medical treat- 
ment other than that of chrooie eystitia ia to fa* 
thought a£ 



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BLADDER. DISEASES OF. 

Vith almoct all aSectioiu of the bladder, 
■amle or malignaQt, ulearotire or uiociated 
witn fictnla, ejntitu to wma extent and in aome 
Com co-exista. It ia thia irhich gtrai rise to the 
jneaenee of an undue quantity of mticna in ths 
■rine ; it ia often the loaree o^ fWa, ■(Hnetimea of 
Uood in amall qnantitj. Thxu in all the abore- 
mentioned dtaeaaaa, acme degree of cjatitia ap- 
[ean aooner or later. Statct TKoimoir. 

BLASDKB-'WOBXa— Eobnoa haTJng 
the chaiaffrr of cyata or vakiclea, and being 
at tlw aame time aora or leaa tranqparent. This 
geoenl term embracea a vanity of paraaitic 
fetma, aoch as EcJkmocooci, Crnnuri, ana Cyiti- 
arti, all of which are the lama of diffurent 
■pedra of t^pevorm. Practically, it is impor- 
tant to knoT the origin of ereiy kind of human 
bladder-worm, ainee the adoption of appropriate 
hygienic meaanrea may prevent infection by each 
of the rariooa spedee. Set Echucocoocus, Cts- 
ncsBCca, Htuattds, TtfKtip.B, Tjnru, and 
TaimwoBiL T. B. Cobbold. 

BIiAIH. — A bliater, as in the case of chil- 
blain. According to Mason Good, blains are 
' orfcieal<ir rierations of the eaticla, eootaining 
ft watery fluid.' 

BIiSB. — ^A large vesiele or bulla, containing 
fiir the moat part a aerooa fluid, aa in pemphigna, 
•ryaipdaa, or buna aod scalds. S4t Blutbb. 

BUarORKHOI A , BIiBNOBBHAGIA 
(0»ifcM,^hlcni,aad^, Iflow: ^A^rw, phlegm, 
aad ^tn»>ii, I burst ont). These terms are most 
coDeetly aaed to e xp r aas execasiTe flow of mnena 
from any m bo os anr&ea. By msana of an afBx, 
the locality or natore of the discharge is ex- 
pcaaaed: *^^ i l im m ii mi oaUi, uatalu, untinUu. 
Maim eoBuioaly, faowaTar, and leaa accurately, 
biimii iliii s ia employed aa syaonymosa with 
gumiiiluf in the niale or female. 

BUiPEABITIB {0\ifapor, an eyelid). In- 
flammation cf the eyelida. Bee Era and its 
Appcadagea^ Disesseaof. 

BIAFOABOBFABIC (^/^ofwr, an ^e- 
Ed, and rnc^u, a spasm). Spasmodic more- 
nmt or eootractico of the eyelida. See Era and 
its Appendages, Diseases of. 

BUSSKXSS. — Loss of sight 8tt Akad- 
aaaa, ai^ VtsKn, Disorders of. 

BXJBTXB,— Snio>j Bleb; BoUa; Vi.BitlU; 
Omt.Slmm. 

Daauuma u — A Teside of the skin, eaased by 
the ■ayfirien of the horay eatide from the rate 
ana >Mam by the tcansodation of serous lymph 
b enaa t li tbsConaer. 

Xnotoar. — BBstsra may be idiopathic, aa in 
waijiiiigaa . or aymptooatic, as in erysipelaa. 
Xhsjr are mat with nader ths influence of any 
caaaa which dapreasea the Titality of the integn- 
meat, aa in aooie Corma of prurigo, in chilblain, 
aadiacarbaaela; in scalds and bums; andaa an 
ifci.1. of iweifu l irritants, such aa cantharidea 
or the aailiBO aalta. 

D sauufiM SS. — ^A blister lan^ in aixa from 
tbata(apeatoatiiik<7'segg; it ia mote or leaa 
•aarcs aeentding to the amoant of exudation ; 
wad rnsftsiai ia eoloor with that of ita contents, 
baiag iiMsllaiia yellow or amber-eoloucd and 
lihs sisiiin. sometimea (^alaaoent 



111 



BLOOD, ABSTRA.CrX"XO^ O^^ 

from the preaence of pus, atra <3. ^5™*''"'*** 
purple from admixture witla. l^Io****- _ 1^ 
a blister, generally limpid aa.zB'd ^Jroe, ja 
held in the meshea of a del i<s^a.c ^ "''^tjj.v*"^ 
ing ftam the stretching of tii^ ^'^?°*<t|j.'^ *'«^"' 
the rete mncosnm and homy ^^^'■"•'8»J^% *^i»^^^* 
peculiarly the caaa in blist«ar»_ ~**«lo>r 5?^ of 
the influence of acnteinflamiDca.'fcS. on, Utid^^ ^« if 
in Dermatitis anilina. Bli^t^»'» uj^* ^|i_*''»d«« 
perasd, or aggregated, or ewerx ^""^ Ogl^ *> 1h^^»Ol 
phigua or Pompholyz solitnn a s ^ — * ^ j^* ^'7 
I'BBATiacHT.— Blisters an t-;e5:^cnti *» ■b.'^'s- 

in their nature, and call for ear-^r-^-^Wif^^y 
tieal treatment. Locally thojr "bou^t (i^tfe 
tured so as to admit of the ^5"'^(J,, '<i J *"»W1?*"'<? 
their contents, and then du»t«»-«J Ov. 'i - * »«.*^0- 



«jji. 



Of 

BLIBTZBIira.— A th<;r.-^ fJeij,. 
which consists in the artiSt-i .^a.^ ^ 'c 



<^»- w?«0^^«* 



absorbent powder, such aaoxid ^» Of *" 'Vj.^'iij 
earth, or cinchona. Eie-^Sj|, *Ji, 'h r* 






ru,,°'»» 



of 



wnicn consins in toe arutiL-i jj-j », "^ •"^• 

blisters on the skin. iSee CooiTnrMe^,^^,^^9s„^ 

BLOOD, A.batraotUm of. SyJ*****!-^'"* "^ 

ing; Blood-letting. Fr. la Strdg^^^Jir. .- ^°' 



«y 



Adeiiau. — Daronnaii. — Th « 



J^tb, 



.Oei- 



'/••erf. 



Mood from the body, either («) t^^'^^''^ 
ral drculation, by artariotomy Of ^?,^* A«a^ 
or (6) locally, by leeohes, acariflcat^r* •'wonij.; 
cuppine. ^ <" Wet. 

It is to the first two of these atath^^ 
abstracting blood that the term • bl^* "f 
or 'blood-letting,' haa by eommoo naamTilf?!' 
restricted. ^^ "**" 

The topical abatroction of blood by means of 
leeches, acariflcationa, and cupping, though of^n 
raluabla, is of seeondary importance, 'rhe pre- 
sent artide will, therefore, chiefly be devoted to 
general bletiing. 

General Bleeding.— This art, practised for 
centuriea more or less nnirersally, has of late 
yeara in this country fallen into disfsTour. Mndi 
discussion has been raised aa to the grounds for 
so great a difference. It haa been attributed — 
(1) to the type of disesse having nndergone a 
change; (2) to mare fiiahioa or caprice; (3) to a 
better knowledge of the nature of disesse, teaeh> 
ing us that ita proesssea were of a lowering or 
depressing character, which were to be overcome, 
not by the abstraction of blood, bat rather by 
the use of stimulants and support. It is highly 
probable that several causes have contributed 
to ths undoubted change which has taken place. 
The year 1880 and snbseqnsnt years were 
marked by the epidemic visitation of cholera and 
of influensa. These diseases were characterised 
byextrerasdepreasion. If antiphlogistic measures 
were adopted, they proved failures, and taught the 
}^ysician that blood-letting waa not the univetial 
panacea it waa supposed to be. By degrees it 
ceased to be practised as it osed to be. A new 
generation which knew not the past has sprung 
up ; and, aa in all reactionary movementa, the 
practice haa become at len^h as limited as it for- 
merly was universal. It is almost certain that 
in either extreme there is an evil, and that we 
may have recourse in certain eaaes to abstraction 
of blood with some degree of that success which 
formerly led to its extensive tisa, if not ita abuse. 
It will be well to eonnder the sutrjeet st soms 
little length, and nnder ths following heads:— 



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lis 



BLOOD, ABSTRACTION OF. 



1. The atbet of modamto Iosm* of blood on 
the htaltby aoononiT. 

3. Tb« Tsloe of bla«diogM • nmedy in dis- 
togadier with the indicationa for iu employ- 
in T«rioii« affection*. 

9, The method of perfornung the opeiationa 
of opening an artery — «rteriotomy ; ana opening 
a vain — phlebotoniy. 

1. Effbcts. — We hare fliatt then, to eon- 
aider the effect of moderate loaaea of blood npon 
the healthy economy. Upon thia point ire hare 
abundant evidence, for the cnitom of Ngolarly 
bleeding healthy people had reached aoeh a 
point daring the earlier half of thia century that 
in eonntiy dietricta it became a practice for 
adolta to be bled aa regularly aa they vent to 
market. Nobettertaatimonyregaidingtheeffects 
nf thia practice could be adducwl than that of Sir 
Jame* Paget, who, when referring to theae 
cuatomaiy Tenearetiona, aaya : ' I can regard 
tboae aa a aeriea of Teneaectiona fairly performed 
for the determination of what ia the influence 
of the remoral of blood up to the point of 
ayocope npon a compdratively healthy peraon. 
I think I can aay aurely that not one of theae 
peraona anffeied harm.' To thia might be 
added other and abundant teatimony to the 
hatmleaaneaa of reneaaction on the healthy eco- 
nomy. 

3. IsDioATioira AHS Uau. — Coaeloding, than, 
that the abatraetion of a limited quantity of blood 
kaa no deletariona effect upon the healthy organ- 
iam, we will next act forth the general indica- 
tiona for the uae of bleeding in di a eaae, and 
briefly refer to the Tariooa afnctiona in which it 
mar moat eaitably be employed. 

Broadly atated it may be aaid that bleeding 
ia indicated when there ia eridence of marked 
ovar-diatanaion either of the artarial or of the 
Tenona ayatem. In either caae the reanlt will 
be cardiac diatanaion — in the former caae of the 
left, and in the latter of the right chambera 
of the heart In auch eonditiona ganocal bleed- 
ing reatoiea the loat equilibrium <n tha vaaeuUr 
ayatam, and relierea tha heart and the other 
parte coDcamed in the circulation of the blood. 
The arterial ayatam may be iu a atate of aug- 
mented tension from two eauaea: (1) contrac- 
tion of the arteriea (the amaller veaaels) them- 
adve* with a diminiahed amount of blood in the 
aitarial mtam; and (2) engoagement or dia- 
tanaion of the arteriea from apaam of the arte- 
riolea : both may be regarded aa Taao-eonatrictira 
nenroaca. In the firatcaaa there may be engorg». 
ment of the renona ayatam and embarraaament 
of the right heart, calling for abatraetion nf 
Uoad by venueetion ; orTiaceral fluxion, the ekin 
being piale : and In the aaoond, relative emptineaa 
of ue Teina with oreifolnesa of the larger 
arteriea, calling for blood-letting by arttriotomy. 
In the fanner condition there would be, m 
bed-aide language, a twuM hard or wiry pulae, 
and in the latter a /aU and hard or bounding 
poise. In the former the aurfoee of the body 
may pnaent one of the two following oon- 
ditioaa: eitber the akin ia injeotsdand, porhapa, 
doa^, and this appeara to be the caae ordinarily; 
or it ia pale and eool, the blood having receded 
inwaida, ehiefly to th* abdominal Tiaoara. The 
aaeond condition obtain* Mid ia mU laan ia 



of ursmio asthma, when the arterial sys- 
tem is turgid almoat to bursting, while the 
veins are comparatirelpr empty. ' Hardnea* ' of 
the pulse is usually said to be an indication tor 
bleeding, and in certain associations it is so; 
but it is necessary to discriminate carefully 
between the ' hardness ' due to ' tension' of tha 
sound artery ariaing from (a) exoaasire con- 
traction (the email, hard, wiry pulae), and (A) 
oveifulneaa (the full, bounding piUae) on the one 
hand ; and that due to arterial degeneration with 
more or less hard deposit in the walls of the 
vessels, on the other. In doubtful cases inquiry 
should be made into the state of the brachial 
artery at the bend of the elbow. This can readily 
be done b^ flexing the limb, when, if calcareoua 
degeneration have taken place, th<9 vessel will be 
thrown into serpentine folds, viaible, except in 
fat people, to the eye, and cord-like and rigid to 
the touch. The temporal artery is a less safe 
guide, but neither it nor an arcus senilis should 
be overlooked in this connexion. A visible and 
tortuous pulse in a young person may indicate 
aortic regurgitant diaeaae : the age of the patient 
muat therefore be taken into oonaideration. 

Dilatation of the arteriole* would permit of 
the rapid passage of arterial blood into the vrina : 
under such cirenmstancea, therefore, we should 
expect the blood isauing from a cut vein to pre- 
sent a more florid appearance than under ordinary 
condition*. Bleeding here should be undertakan 
with considenbla cirenmapection, and not be 
pushed very far, for collapse out of prt^ortioB 
to the amoBttt of blood abstracted might anme. 
On the other hand, when there ii ipasm of the 
arteriole*, and the abatraetion of blood ia deemed 
adviaabla, it would be well to reaort to aitario- 
tomy rather than veneaection. The best guide 
here would be the sphygmograph, but, a* faw 
persoiu are ^et aoeuatomed to use it, the fnll, 
hard, bot^ndicg pulse must be relied on when 
found in association with corroborative aymptomsh 
^ YThaterer leads to over-engorgement of eithot 
aide of the heart may render olMding neceaaary. 
If the left side of the heart be orer-'fall, arterio- 
tomy is indicated; if the right, venesection. 
The object of the withdrawal of blood from 
the general circulation is the direct relief of 
the overburdened heart. 'Whether the l^ht or 
left chambera be taxed the immediate ^eet ia 
the same ; they are orer-diatanded, and cannot 
get a grip npon their swollen currant*. It 
IS with the embarrassed heart a* with other 
hollow moscuUr organ* — the Uadderaad ntcrua. 
Over-distension paralyaea them by removing the 
'points d'appui essential for the initiation of 
mnacular contraction ; the energy may be there, 
butiteannot be exercised. It is obvious that the 
amount of blood which it is necaasary to with- 
draw, in order to free the embarrassed ornn, 
mnat vary considembly in different cases. But 
it may be safely laid down aa a rule that it need 
rarely exceed • few ouncesL Excess in this 
renpect is the evil which formerly existed. 

On tlus stttgectwe may refer to tha eminently 
practical rauiarka of Sr Thomas Wataon, who 
■ays : ' I hold it, then, to be certain, that for some 
•pedal morbid condition*, which iuflanunatiou 
mav or ma^ not accompa n y, geneial Uyood-Ietting; 
MM **paaaUy Taneaactioa, w a potent and life- 



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pmcrriwr zcnad^ ; that then are many exigen- 
cw ta wUeh it u not onlj aafe to employ, but 
•mfc and Bii{iardonable to withhold it. 
Ba also givaa tbs following jndicioni td- 



BLOOD, AB8TBACTI0N OF. 

the Tains, adaakjeauDtMK 
pulM, bleeding mnj moat 
to. in a word, altboouh bt' 
Bore the (fi^isad blood in 



' Alwaya it ia naeeaaaiy to conaider the age, 
the MK, the general tnnperunent and condition 
af the sick peraoD, when we are turning oTpr in 
ear mioda the ezpediaDc; of abvtmcting t>Iood. 
Tlw Tnj Toang, the old, the feeble, thaoichectic, 
do sot bear wdl the loea of mnch blood. Tbii 
eooiidentioa ia not to deter 70a from bleeding 
inch pensona topically when they are attacked 
Ij dangerosa inflaramation, but it eepnciallj 
eniorces, in regard to ihem, the golden rule that 
BO more blood ehonld be abntmctcd than aeema 
ahaolotelj lequieite to control the diaeaae.' 

Hm foUowiag an aomeof the affections under 
wluch blood-U^ng would seem to be more or 
lev indicated : — 

i^sfameaia. — Blood-letting in pneumonia, aa 
IB many other iDflamnuitiom, is moat useful in 
the auly atagea. It is indicated in healthy 
patients anSenng from uncomplicated acute 
cthenie laiwimonia, if they happen to be seen 
early raoagh. It relieres pain, abates fever, 
and if it does not arrest the diaeaae, it certainly 
■rapean to liwieii its dunttion. It may also be 
eafled for when there ia severe pain and eTideoee 
of eaniiae smbanaaamenL It did good, and will 
still do good, in eaaea of pneumonia, attended 
kj cmfaanaasBieDt of the dienlation, and that 
ia trath ia tha indication for bleeding in this 



JfofUrj. — The same may be said with le- 
tonea to ecnbral apoplexy. The old belief 
ia tha mpoetanoe of 'letting blood' ia easra 
of apoelfsy was, if possible, stronger than in 
Bmai» at paeaBoata. But here again mora accn- 
nta ^meal aad mora extended pathological 
koowladgi have taa^t as to look upon ' apoplexy ' 
Tcry difioaatly to our fore^hers. Recngnising 
the aaeaps cf Uoodfrom the bursting of a brittle 
arte^ aa a eonaoa cause of ' apoplectic fits,' we 
•ee the intilitf of reneseetion when the 'stroke' 
or '&' is dne to a lesion of this kind. Nor will 
hlradii^ ustop an artery when it is plugged by 
aa cabidna, or carry nutriment to the region 
tboa banft of rital fluid. On the other hand 
v* baT* l^uvt to leeognisa the value of 
Maading in anothar class of cases of s»<alled 
'afOfiBtj' — those wliieh are nnaeoompanied 
by cffassoD of blood or lesion of the aervons 
tMsna, bat depend on rspidly occurring e<nn- 
jaiasioii of tha nemnis centres from sudden 
cr ■aaqoal increase in the volume of any portion 
•f thaemaial eootcnts; or in certain eolamptio 
caset fma th« drenlatioo of blood poisoned by 
■BdiBunatfd oxiaaiT axereta. In caaee of this 
ieacriptien, whan the rig^t hrart and vanons 
tyatOB an eogoiged, phlebotomy acts well; the 
suttor will eeass, the purple face resumes its 
astaeal haai, tke ehwdsd intaUi^nee becomes 
dssc, and tha impendiog danger la for the time 
■MCtsd. Ibis has not cared tha patient, how- 
sner. it has only 'obviated tha tendency to 
deadi:' it haa saved tha patient's life, though 
be nay altimal-sly die of Um dissaae which 
'Whoa wa meet with evidence of 
leooBipaaiad l>y fhUissi ef 

8 









hiemorrhage, it may someC^ 
ployad 10 prevent fnrther 
Iimrt IS acting too forcibly ; 
fiirbidden when thnt organ s 
pulse nt both wriats si<ould ' 
aminail befora UeiKiiog, in 
hamorrhage, for aa a rule mti 
pamlyied than on the sound ■»!« »^ 

Rlamptia. — Indiscriniio^t^ ^»«rf' 
eclamptic spiiures would be *■ ^*v^^''9 ia 
It would not nlierr, but Rithe^ ^^tldo' *"■"■* 
intruify, convulsions of rsfiex '"^o, ai'^'***^ 
t'lin cases of puerperal conrulsiooa. Oat/ '"**'■ 
hund, ciuMM of puerperal coDvalsiOla aceoni'rL**'^^ 
by great turgescunce of tha x^tcuUp an^^ 
whether venous, (as is commonly the case) a! 
arterial, would be immensely benefited by tha 
withdrawal of blood from the gaoentl cuircnt, 
either by venesection or by arturiotooiy, aoconl- 
ing to the indioition. This treatment may sarva 
to stop the convulsions, and though that may ba 
far from curing the didease, it may, neveitha- 
leea, be of the ntipoat valos, for in the first 
place the fits thembelves may kill by their 
violence or frequent repetition ; whilst, secondly, 
time may be gaiced for the employment of othar 
measnies calculated to relieve the ororesssd 
system, as, for example, purging by hydragogaa 
cathartics, vapour baths, cupping the loins, dw. 
This gain may be immense ; for bleeding nay 
avert impending dissolution. Uoreover, per- 
manent good may ensue, inasmuch as bleeoing 
reduces temperature, aiid in the eclampsia <n 
pregnancy the temperatura is usually high. In 
this it contrasts with pare uramic eonvulsiooi^ 
in which thera is lowenng of temperature. 

Venotu Emgorg$mtid. — Engoigenwnt of tha 
venous system arising from ohronic disease, o^ 
pulmonary emphysema or heart-disease, does not 
call for bleeding, unless the condition be acntnly 
intensified by some inteiciimnt mischief, such 
as acuta broaehiUs ; for, as tha deraogemeot is 
slowly nrodnced, the organs and stnteturea In- 
volved learn to accommodate themselves mora or 
less to the altered conditions. It is only whan 
vascular engorgement suddenly ooenrs in appa- 
rently healthy snbjects, or, as stated above, thus 
ia aente iatensifleation of a chronic condition, 
that bleeding is required. Thus, in cases wheto 
me^astinal tumours impede the nt«m of blood 
from the head and upper portion of the bod*, 
the condition is ordinarily of such comparatively 
alow production, that bleeding is seldom urgently 
called for; and, morrover, it would be of bat 
small service, for the obstruction is immsdiabla 

The lividity of the &ce which accompanies aU 
fits should not be euifounded with the duskiness 
due to engorgement of the venous system gena- 
rally. 

Urmmia. — In para nrwnia bleeding is nsa- 
ful ; the kidneys being especially in de&alt. For 
venesection answers a double purpoee, by not 
only relieving the engofged right heart and 
Tanooa system, but remariag from ths body * 
osrtain amount ot poisdaed blood — blood that la 
ehaigadwith wiuMjaxctata. Soabtlss%itdoa« 



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in 



BLOOD, ABSTHACnOH OF. 



Mod tn both wmfs, bnt th« ibrmtr ]«, qmud Aa 
nti. the more impoitant bsesnw more imin«- 
dmta mode of it* eetion. The aeeond fffeet, thnt 
tt ridding the body of dsmagvd bidod; fa eb- 
Viooslj STiiilable to iu when va bare to deal 
trith unemis, oeeuning in tha nnD-pregnant ; 
•ad #heD coma is dampening, the hestt ubmiring, 
•nd the rKsenlar ayatem tnrgid, no leraedy is so 
■wift'and rare as the lancet. 

Plethora. — Blood-letting majr be called fsr in 
aaaea of general plethora, whether athenio or 
•athanie. In the former condition the Taacnlar 
■Tatete generally aeemi to be orerfttU, thongh 
the ezeeas ii moat mailed in the arterial aj'atera. 
Azteriotomy, hovever, ia seldom balled for, 
thongh it might at first sight seem indicated, 
nnee' reneaectioa nnallj answen ererjr pnr- 
poae* 

In aathenic pleUiora, on the other band, the 
tenods system only is orerfllled ; tha right side of 
tiie heart is diatemled and its action ia labonred. 
. Here Teneseetion is sometimes called for, but 
H ahonid be carefully employed. It is seldom 
oeeessaTy to irithdraw more than 8 to 1 onnees 
ef blood, and often a smaller quantity snfllces. 

Pirit»niHt.—1ht relief obtained by bleedmg in 
•rate peritonitiB rendered yeneaeetion a &moaa 
remedy in this afiSection in farmer times. And 
there can be no doubt abont its efficacy in reliering 
the pain of peritonitis, as of inflammation of other 
■eroas membianea. It nay be used when the 
patirat is yoong and strong, and in that stage 
of the disease which is aoeompanied by a small, 
hard, and wiry poise — tha pulse of a eontneted 
•rtety, of augmented teneion from contraction, 
not fh)m OTerfnlnesa. It is worse than nSeless 
in the later stages of the disease, when adynamia 
has set in. Bat Tslnable as bleeding may be in 
certain cases of peritonitis, it rarely happena 
that it is admissible, for in the great majority of 
taaea inflammation of the peritonevm is aeeond- 
ary to other diseases, and notably to disease of the 
kidneys. Where peritonitis arises after delivery 
it is commonly of septicBmic origin, and it ia 
•eldom indeed that bleeding is of any arail 
under these conditions. So that, piactieally, 
bleeding is not a remedy which we ean often 
ssBptoy in peritonitis. A very high temperatnre 
cannot alone be held to be iadicatire of its nse, 
for it so happens that sneh pyrexia is as a rale 
imeont only in septicemic eases. Some cases of 
peritonitis, even fatal ones, run their course 
without any marked eleratioa of temperatare : 
or indeed without ahowing any definite symp- 
toms. Probably Teneseetion ia most serriceable 
in tninmatie peritonitis, or it may be, when the 
inflammation is localised, thon^ in that case 
hwehea are more suitable. 

PUurisjf. — ^When pleurisy attacks a young and 
MkuM po'tient, and is aeeompanird by sorere pain, 
great relirf follows blood-letting. The blood 
■hould be taken firom a rein, and plmio rieo. 
But when, as so often happens, pleurisy is, 
Kke peritonitis, seeondaiy to damaged blood-con- 
diiions — f.ff. Bright's disease — blaeding is often 
inadmissible. 'When, as in plenro- pneumonic 
easea^ pipurisy oamplieates pnenmonin, bleeding 
nay possibly be called for, if there be great pain 
•naopprenion of the chest; btitjtahouldbemoet 
'ciKBitMpeetly asad. LMalbtood-iMttngiaaMah 



to be ■ptekarti if bleeding be thought neecMarr; 
flM: general bleeding is vsually' incompatiNe 
with the Btrength of the patient. 

Urmmit Aitima. — In the aflkction liniMrB aa 
nnemie asthma, in which there is spasm of the 
systemic arterioles, with intetue tsrgidity ef the 
arterial system and engorgement of t^e left 
heart, bleeding, in the form of arteriotomy, 
appears to be clearly indicated. 

apammiie BmtMal Anthma. — Purs asthma 
is doubtless often a nerrons malady, and bleeding 
is not a remedy which should ordinarily bo 
employed for its relief. It is only admisuble 
when spasm of the pulmonary Teasels, or 
obstruction to the flow of Uood through thetti 
from bronchiole-spasm, leads to rapid engorge- 
ment of the rij^t heart and Tenons system. 
Tliis is the exact co n Te w e of imemie asthma : 
but tha effect in both is impediment to the 
aeration of the blood. Hero the abstnetioa of 
a few ounees of blood tnm a yein may giys 
immense and retr prompt relieC 

EmvhvieTiia. — It is not so, however, in the 
•o-called ' asthmatic attacks,' which chronically 
emphyaematons people are so prone to. Hen 
Teneseetion may be impetstiT^y demanded when 
an aente attack of bronchitis has, by adding to 
the already difficult passage tt bloiad through 
the lungs, ezdted rapid engorgement of the 
dilated heart and previously tuigid Tenons 
system. 

Puerperal /Nsentx.— Formeriy bleeding waa 
much employed ia midwifery piaetice^ and espe- 
cially in inflammatory affections after delivery. 
We now reeogniae that for the most part post- 
partum affections arise from septic mischief 
and an of an adynamic type. It is bnt aeldom 
t^at we an called apon to bleed in these cases. 
NaTertheleas, now and again, Teneseetion may 
be called for. 

Oitordert ef Hfnafruiitvm. — Bleed! ng is a most 
valuable remedy in certain menstmal disorders, 
and eapecially in the pletJiora of women at the 
change of life. Many women snfftr distressinglT 
tram general Taseolar dittnrbanea at this period. 
The flushings, headaehae^ giddiness, feeUng of 
oppression and other Taso-motor phenomena 
which they mflbr from in association with the 
cessation of the eatamenial flow, are immensely 
relieved by an oeeaaiaaal venesection. No other 
measure will so quickly and so effectually relieve 
these symptoms. Some robnst, plethoric, ameoar- 
rixeicyouag women require periodical bleeding. 
The writer has known the abstnetion of a few 
onnees of blood to be speedily followed by the 
oecnmnee of the menses, in eases of what may 
be called eoBgestive araenorrfaeea of many months' 
or even years' duratioB. Itmaybewelltottate 
in this ooimexion that in certain pulmonary, intrs 
eraaial, and other viseeral lesions, danger nay 
arise trwa the augmented arterial tension which 
for a few days preredes the flow, and that tha 
abstraction of blood may avert htnnorrhige into 
the damaged organ*. 

Afier VfteroHitni. — Bleeding is less f^«qn«iitto 
called for in stagieal tliaa in mefieal practice, n 
is indicated mainly in the after-treatment of ouea 
which pres e nt engorgemsbt ef the rif^t hsart 
and venous system, as ia some eases of uvario* 
tcaqroad ouer opaittiogis inv^^'riBg A» O* 



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BMKUDk ABSTSACnOM OF. 

tban«i« c»Tit)a«. A. tnigid .rmaa» 
fpum. with a anajl hard pnlae,«ad,» Uboaiins 
iiwrt— > fondit.inn ^hieh ia oftwuMtm-iartid irixo 
»r«iirtTi«fi, «iiionoting almoat U> •appraM^ti, of 
«riB»— iadieate* blood-lsUinK «ft«z.op«ntioai of 
the kiad afaoT* xefenad to. 

S it ei . — ^la oanain eaies of thochtbe abatntc- 
tioa of a limited aniaiuit of blood maj be m^aind. 
Thiapoiotvill be ibaad disooaied elaewhaie («« 
tetCK). 

>VMr. — That bleeding •will lower the.triniiar.»- 
tanof Areradpatiaataluubeea known iroia the 
leriiiW tiiaea. It ai^ howaTei; not a ninety to 
be wawlwl to for that porpoee aleoe, foe, a< the 
Boat proaoniieed hypeipjrrezia oooan ebietty 
■ aancininn with wiaditwian leading to great 
itfttmtoa, Uopd-Utuiig ia ^lader aoch oiroun- 
itiBiwa aaaaaUaa aa.it iadangarooa. 

frr-^'*-"— — ^Tbaie az« few diaordera ia which 
hlDod-lettiait ia mora anocraafol, when hglitl; 
aoflond, than in auutzvke. It ia aeldoD 
BaetaMi; to take tDorr thaa a few ooaoea of 
blood; aad ejweaaabonld be particularly guarded 
*gpf***. {or bar of aobeeciaeat colUpae. - The 
iiiaamilile patieat with iorgid veina, a tight. 
fala% and lahoaring h<«ttt will ^n immriue 
. and pconpt relief from TeaanctUD. The a^- 
lieaie pnlasoaijr eeocealioa and orer-diateDsioo 
«if the njgfal haut ao oftao fboud pott mortem 
might pmbaUy be preTaoted hg, the tiau-ly 
abatiacuaa of a little blood bam the Teoooa 
Bleeding ia not to bathoqgbt of ia the 



I or SuamMo. — The following ■» 
the aathada ol per&raing the opera(iona of 
aiteriotoaij* and Mlebotomy. 

jtr<«rio(«ay. — -Thia opention ia best per- 
fcnned od the temporal nUmj. The reaael 
donld ha faztuUr euC tfarDt^h b^ a aimple 
tBuanaaa iriaioe, and iriiea a anffleieat qaan- 
tiljr of Uoed baa bean «*««jn«<< it u».y then be 
Mnplelalt aavacaS, ao that, reiractios of both 
takmg place, tho hiemoirfaaj^ may be 
A toanamaa of dry liat afaoold then 
ba mpftmi, aad a ii|^ foUar-bandage applied 
ewer it. 

Ftmintmn. — Tha median baailia r«a ia the 
ana awwllxaahirtad te theoparatioo on accoaat 
of ka beii^ oaott aadUy foaad. Tha brachiul 
aitaqr lica i — a d ii ta l j r ba^aath it, and care 
ba taken ta aToid wounding tha latter 
Tha aadian aapbalie rain ia preferable, 
otaaaaailTfiiaiid. ATeiaoa thedonnm 
of t^ fooc w «tW part of the body may be 



, bat, aa a fala^ it ia not desirable to opein 
tha jat^aiar Taia, aaptcially «b aooooat of the 
daiign of tha antiBaca of air, and other riska. 

Xba atapa ■« tha oprsation on tha arm are aa 
fuUowa: — JPira^ tha limb ia to be firmly bound 
abanthraibsw by a broad tap or fillet. This 
ahoaid ba applied with aaffioent tightotaa to 
aompfaaa, ana prarant tha ratom of blood by, 
tha «aar bat aot ao aa to intercept the current 
m the aitasy, and eit i i^iah .the pulae. An 
aU%ie eiit ia to be m«de in tha reaael by 
Baaaaaf a aaaall lancet, care being taken not 
lacattaodeap^. -Iha apirtiqg blood ahould be 
■mthtiaa riiaial aad meaaorad. 

VhaaaaOdaat blood haa been withdcawn, the 
^Hwtiif aheald Srmtr ytota a.thnpb oc a tpgit 



.••thaapertan,aa4thaa,»B «^^>*/ *«1(a._l*' 
aion, place upon the wound ^ *^ j^ . '""oLTW'f^ 
antiaaptia diwniAg, •QT«»«'<»***'*^ii^ y''*fc.i?'.^ 
over rhicb a roUer-handeg* »^^^Kai *» t^'''^ 
iew timea like a figure of ». tt*^ ^^^^i/''^ * 
thewoand. ,. '"Sostf 

Irt»albleadiJi«.— The ol^oct J^^ tJa^. 
ia tha relief of coogeated TtameJ'r *** »ma^r"^ 
thoaa of ioiSamed parte. Arterie* «u»r«^*^**w 
bluod to, aad retaa cuoTay mora aW^ £tx>a^ 
ilaawd.parU^aothiit lusal bloeduig j^^^ 



grpat relief and ioitittta reKtlut><">i aia^ ^h^ 
aor{>tioa duea not fully coamaoce Wtii ittOMta- 
matiun haa ceaaad. 

Mbthods or Local Buipixo.— Blood aaar 
be abetntcted topieaI\y b>y leechoi, bjr acan* 
ficatioaa, or by wet-ouppiag. 

1. Lmching. An avenge laeeh will ahatrart 
nrarly half an oance of bfood. I,eechae are 
exiremely uaefid in a great rarietT of liffectipuk 
■incn a preliy defioite amount of blood do lie 
withdrawn from ttie affected or a4jacent parte, 
or from mere distant yaft% theough intimacy 
of the macular connexion, .aa in diaaaaee of the 
eye and ear, and i« hepatic diaeaaei^ accom.- 
pniiied by obetraetion to the flow of blood 
tbroogh the portal 9l)tem, when tha applicatioa 
of leet^ea to the anua ia moat vduable. 

Care ahenld be token not to apply loechea to 

r» orar which aafficient eoinpctaaioD cannot 
made to ooDtB>l the bleeding, ahould any 
difficulty ariae in arreatiog it otherwiaak Thna^ 
laechea kbonld not be applied oror the trachea, 
eapecially in children, lo whom the error of 
applying them orer the epiatamal noteh iaaoma* 
tioira made. Fur the aama leeaou the fonta- 
nellea ahould be aToidad, 

The akin of the part where leeehee are. to 
be applied ahould ftrat be waahed, and when 
they do not bite readily the part majr bo wetted 
by a little milk or sugar aad milk. A alight 
prick of a needle^ anffieient to draw f, apeck of 
blood, aill often ^cauaa them to bite when re- 
fractory. 

Shomd the bleeding continae too long ai\er 
the leechea fall off, ])reasnre or atyptica may be 
applied, U it is desired to encourage Ueeding, 
fomentaUoBS of hot water or linaeed poultice are 
serriceahle. . 

In applying leechea to the eerriz uteri the 
precaution of closing the os by a pluf of wool, 
ahould not be neglecMd. When applied wiUun 
the month a leem-glaaa ahould be used. 

2. Scarifuiag. — ScariScationa consist in small 
cuta of a depth not exceeding the eighth ot 
an inch or Usa into the tiaaue irbence it ia 
deaired to take blood. This mode of topical 
bleeding ia mainly applied to the cerrix uteri, to 
the tongue in acute glossitis, and to the palpebral 
coiunnctiTa in certain kinds of ooqjunctiTitia; 
in the laat case only slight inasiona are pennia- 
aible. Deeper pnactorea are made by some prao- 
titioners into the tisane of the con-ix uteri, 
but theae are puncturea and not mere acvifl- 
eatioos. 

8. CVfiptn;.— Cuppingoitdthanaaof thasoari- 
fleator eonatttutins wat^pping. is an importfint 
method of topical blood-abatraction ; and aa » 
aonsiderablaamoniit.ot blood qu thua be with 
.dcawih the gNtaaol, Antila^ W tharel^ ha 




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tU BLOOD, ABSTBACTIOH 07. 

■Acted. It U mdiiarUjr Mtplojed, how B Ywr, 
far its lo«l elTeeU, 

The method of it* perfonnaaee U mi followa: — 
Onpptng-gUnef being flnt pot on for » brief 
time, M for diy-enpplng («w Curraa—Jhy- 
Cupping), the operator appliee to the part 
•alaMed a epring aeariileator co a<^nsted ai to 
eat only to the reqaired depth — about an eighth 
e( aa ineh orleai. The onpoing'^iUaaes are then 
re-appiied, and the. deeirad nninber of onnoea 
of blood abetraeted. If the glaaaei be too tigfatlj 
ittHched the blood will not flow readily, and nn- 
ttcoeaaarr pain may be eauaed. Alter their re- 
moTal atlheeire plaster or dry lint and a bandage 
ahonld be applied to the part. 

Cnpping over the loing ie extremely naefnl in 
renal ischamia ; on ihe temple or brhindtheean 
in eeruin cerabral diaordan; down the epinal 
aolnmn in inflammation of the ipinal oora or 
ueniages ; and on the ehaet in certain polmooaiy 
affeetiona. Altbbd Wu.nauui. 

BZiOOD-DiaBABXI. — The term bhoi- 
dittfut wna need by the hnmonl patJxdogiste aa 
■ynonymoni with dyianuit or anonurfoui eront 
if the blood, and expreued the idea that the 
blood waa the seat ' almoet without exception ' 
of all general dissasea. And, fnither, since 
purely local disease waa considered to be ax- 
eeptionnl, the rast nuyority of disrases wars 
referred to dyseraaaa, and were classed aader 
the head of blood-di s ea s e s . 

The condition of the blood iras considered by 
the hnmoraliats to depend upon the cnuu, that 
is the mixtnre, of its constituents ; and promi- 
nent among its constituents were reckoned the 
bUutemala, or gemunal substances of the differ- 
ent ti'suee, which exuded through the capillary 
walls in the proeees of nntritioii. When the 
blood-erasis was dis or dsrsd or diseased, a dya- 
erasis was stud to exist, and dyscrases were held 
to be in the nuyori^ of cases primanr ; though 
it waa allowed that local anomaliea of nutrition 
might and did occasionally occur, and give rise 
to seoondaiT dyscrases. A blood-disease or 
dyscraais being established, all morbid changes 
turonghoBt the body were beliered to be but 
local manifestatioiu of the same. Foathe pur- 
pose, therefore, of a rational cliasiflcation of 
ditenaes, a previous classifl>ation had to be made 
of the dyscrases. The principal blood-crasea 
were said to be : — 

1. The /irtn-crasis ; including the nmpU 
flbrin-crasis, the eroupokt erasis, and the tvberclt- 
crasis aa rarieties. The local expression of the 
flbiin erases was inflammation in some form. 

5. The MfMiis CMsis, in which fibrin was 
daSdant. This included a rut number of 
special craaes, lying at the foundation of the 
most direrM diseasee t .g., plethora, heart- 
diseaaa, acuta exanthemata, rickety albuminous 
urine, cholera, acuta tuberculosis, lardaoeous 
disease, cancer, acute eouTulsiTa diseasee, me- 
tallic poisoning, &0. 

1. The serous oasis ; aaioeiatad with anemia. 
4. The putrid or tepHt eiaais. 

6. Anomalous erases; aoch aa those of 
■yphilis, gout, tea. 

Ilia theory of dysensea may be said to hare 
deoUned nnea tha appsHanea «f Vinhow's 



BLOOD, HOBBID CO:7DITIOM8 OF. 
aUmlar PtUkatogg. Virchow Aowri that the 
Uoad is in ereiy rdation a dependent and not 
an independent fluid, and that tne eources tram 
which It is sustained and reatond, and tha SK* 
citing cauars of the changes that it may saffer; 
lie without it and not within it Snbatanrea may 
enter the blood and affect tha corpnarlea in- 
juriously ; the bloud may act as a medium ia 
oonraying to the organs noxious snfaatances that 
have reached it frum varioua aources; or its 
elements may be imperfectly restored. But 
never is any affection of the blood itself— any 
■d^crasia'— penaanent, nnless new inflneaess 
arise and ael upon the blood tiuongh aooM 
dianoel or throagh sosne oigan. 

At tha present time, while it cannot ba aM 
thst humoimlism is professed by many pathcdo. 
gints, the notion ti blood-discaa^ aa generally 
entertained thirty yean ago, still clings to tha 
noraencUture, and prrradee some of our patho- 
logical doctrines. Ui s sa a e s that affect the whole 
economy— syphilis, tubereolosis, gout,and cancer 
—are frequently described aa 'constitutional,' 
or * Uood-diseaaea,' and that whether theix 
general manifestations are secondary to local 
diseaae, as in syphilis and eaaoer, or are nest- 
able to inheritance. While the vierbid ctnditiatu 
of the Uoad are real and numerous, 'blood, 
diseaeee,' so called, an but abataetioaa, and. Mi 
such, a fruitful source of confoaini and nsdess 
discussion. It is desirable that the tann tiood- 
iimoit should be abandoned, and that the ex- 
pression morbid eonditioiu of tit blood sbonld 
IM applied to the pathologieid states of the vital 
fluid, which can bs distinctly demonatrated by 
I^ysical, chemical, or htstologieal examinatioB. 
J. MiTCMBtx Bnucn. 

BLOOD, KorMd Condittona ofl — Tha 
characters, oompoaition, and functiona of the 
blood in health are sufficiently familiar, and do 
not require to be described here. But eottaia 
facts connected with the physiology of this flnid 
have a special bearing upon its pathology, and 
most be briefly considered befoce its morUd statM 
can be profitably discussed. 

A. Pbtsioloot or thi Bumd. — The Red Cor- 
putekt of the blood consist of two poitions — a 
colonrlees, sponge-like matrix ; and a coloured sub- 
stance of complex composition, which occupies tiM 
interstices of the former and aoeniately fills tfaeoL 
The matrix is regarded aa poeseasing chiefly 
physical propertiee ; iriiile its contents constitute 
the active part of the corpuscle, and consist of 
hemoglobin. The sMires of the red corpuscles is 
of the greatest pathological importance. In the 
embryo the blood and Uood-veesela are deveioped 
fh>m the same elements, and thus tha two stmo. 
tnres in thmrphyaologieal aspect are essentially 
inseparable. In AiUy'^ereloped blood the souree 
of the red eorpnsele is obacnra; but there can 
be no reaaonabla doubt that it originates ia 
the colourless corpuscle, and more remotely ia 
the Irinphatia ^aads^ the spleen, and tha 
medulla of bones; and that light ia of tha 
greatest importance in the formation of bemogio- 
Un. With reapeet to the pn^ierties utifanetiom 
ct the nd oorpasele, it is to ba noted that tha 
■Itiinata elements of hamoglobin ars carbon, 
nitrugau, hydrogen, uiygaa, sulphur, and xxoi^ 



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—4* htt at tlHM BBofaabljr bnn^ th« evxm 

«/ in nd eoloar. Hnnoglubin la aolublA in 

•■tor, fonainK s lake liquid from vbirb Ana 

ajMaU aiaj ba ofatainra, and which m»j be 

nrioatljr decompoard, giving riae to other ' blood 

iijiUli Moat important of all it* proportiea, 

hamnghiljia eombinea with certain giiaea to 

farm dafinite ebemieal compoands; — with to 

lata oxjbBnoglabin ; vith CO to form carbonic- 

anda-iaeiiiagk&n ; and with N H) to form nitrona- 

anda-bK^oglotiin. Thaae compoiuula, and ea- 

pacially the ozyhcmoglolun, aia exceedingly 

-—'■'"-. being radvced eren nndor very feeble 

iateaocca to hamofcloLin and their other con- 

adtneau raspeetirdij. Altcmat* oxidation of 

hamoglobia and deoxidation of ozThamoglobin 

aneoBsbuiilygDiqg on within the nd corpuaclea 

<t the cimilating blood ; and the two changea, 

aGCBiriBg in the poljDonary and ayatemic capil- 

laziea rcapeetirely, conatitnte the first great func- 

tiian of ihr blood — ita oxygenating or reapiratory 

{■aeuoa. "Out Tolame of oxygen in artenal blood 

ia l6-ft par eaut, and in renona blood 5'96 per 

oaaC It meat ha dearly nndeiatood that dia- 

oidera coaneeted with the zed corpuaclea or 

te^iiatacy demeata of the body, whether in 

aaioant, eomuoa iti on. or circolation, directly 

iJEmC tlw OTidation-pro eaiaai only. Beaidea ita 

oiigia and iti fonetion, thare ia a third relation 

of the red e un— li e to the organism — namely that 

if ita fmitteU. Theaa at* eliminated by the 

»diBai7d>aaada;_ the aalta, which are chiefly 

aalta of potaah, being excreted by the kidneya, 

aad thaoolomed matarial fomiahing the pigmenta 

«f tka bila and ariiML 

Tka WliU tr (kiomUn Carfmidu of the 

blood, alao oiled hneae^ta, are chiefly derived 

Tiiii the corpoaclea of the lymph, and the cells of 

th« lymphatie glanda and alued organs, which 

t^y doidy reaanhle. By aacaping Uiroogh the 

waUa of tha hlnod-Teaaela, they become identical 

with tha wandsring-edla of tiasuea and with 

py LuifiMsilsa, — ^fnai which they are indiatin- 

gaiaksbia ezeapt byloealiy. Sodi is the origin, 

aad aaefa an aoae of the ranetions of the white 

aoa yc l e, and ita oeeaaional doTalupment into 

the iad«a*paaclehaa beao already mentioned. It 

■igh llisaiiflaa. ha expected th^ morbid atatea 

cf the lamiwjlia wvold be aaaoeiated with dia- 

odarof the lynphatio atmctnrea and nonnee- 

tire tMaaaa, of tha zed oorposdea, and of the 

Uood-raaMli^ and thia will preaentl^ be shows to 

be the emtu The ]^n^)attioa of white oorposdea 

:■ tjM Uood ia snlgact to phyaiologied ineraaae, 

witiHK beeoauagaseaaaiTe, aa after maala, dar- 

itfpmiadM af growth and derdopment, and in 

■aMtiaatioa aad pngnaney, Thia atate ia 

i r^aielagiaU LtmioeflMU (Virchow), and 

I IjtiJimlawlnlar axaitemeot. 

M. — ua physiologiod rdations ot the 

t to (he ocgaaiam are extromdy complex ; 

aad di a tarlM ca of lliaes zalatioaa ftamiabes many 
af the mwKffUmm of diaonler of the blood. Ita 
t fmm gl^mvt aaaentially one of nutrition— 4t 
I tfao I Mill M with oudisable material for 
igKnrtJi, aapportiaeeretion, andthe 
I af rmio Hie aparte of the plasma ia 
aoaaOy ailwaiia It danrts ita principd oon- 

-2^ •- < — , tka alioaotazy eaaal threo^h the 

1 aad ttwar; while ether imp<»> 



VUWO, WSKSSSD OOITOinOKS OV. .g^. 

tont slbnmiooas aabstancat ^^"^^ _g0 ^d^ 




y*>» 



nf 



aupplicd from the titsuea g»i 

Ijmpliatic S7»Um. Lastly. t»a«- -m^ »^^-er^h t^ 



**far, 



plasma, such aa carbooio ae-*<M.^ 

nre diachnrged by the regnlaz- ^b3 

Thns the condition of the plaaa**^"^^** foi,''''''^^. 

most intimatdy associated ^rixJ* *■ JB ** o/"*'' '«> br 

gnxa nD'l tissues ganerully, ■wt»^*\ ft ^r" tig gp, 

its origin, ita mature ftinctionr ^^'^ inS^STdg 



and it will therefore be tJBoe*^ fy^9''''ctsj 
at diseaae of erery organ, wb^tb^f •Jito '*"'''•' 
sangnifiictent, or excretory, aotf **' •» ,?''**'7'> 
goes. '*'«»•««». 

Cooffylatimt of tkt Blood.' ^'iri'n p- . 

certain circumstances, eapeciall r after" remonj 
from the budy, the blood eoagnJarei^ sad Bbtin 
separates more or less completdy from the other 
constitneDta. This change is now beliered to be 
doe to the action of three bodies contained io the 
plaama — two Sbrin-gfneratora, named respee- 
tirely flbriaogen and fibriooplastic sabatance, 
albominouB in nalura; and the third a ferment. 
The onioaaC of fibrin produced variee not only 
with the amonnt of thipee bodies, but with the 
Amount of salts, with the degree of alkalinity 
and of heat, and wiih other influences; and these 
rariatioos are subject to no law at preaent 
known. The rapiditg of the procees depends 
upon (1) the amonnt of ferment; (2) its in- 
ereaaed aetirity by agitation <^ tha blood 
and by deration of tempetatore; and (3) tha 
increased number of points of contact (so- 
called 'eatalytie' action) by the presence of 
red corpnsdea, luemoglobin, charcoal, &c It 
thus appcara that the expressions 'amount of 
fibrin ' and ' rapidity of coagulation,' however 
important as &etf, do not sjBbtd any definite 
indieation of the state of the Uood, aa has been 
generally believed hitherto. Three essential 
factors, and a large number of accidental infla- 
enoes, sharein theprocses;theymaydosoinvez7 
Tariona proportiona and degreea ; they do not 
vary together; the amount of fibrin is not ia 
proportion to any one of them ; and after ooagur 
latioo is complete, portion* of dl tha factor* 
probably remain nneombined. The ^art played 
by the red corpnsdes in oosgnlation is a double 
one — (I) the oorposdss, as 'points of contact,' 
greatly increase the rapidity of coagulation ; and 
(2) they supply oxygen, which appears to be 
indispensable to the process. The lencoeytae 
probably |Woduce the ferment. 

B. Patholoot of tub Buiod. — The morbid 
state* of the blood will now be considered in the 
following order : — I. Changes in quantity, aad 
tha effect* of such changes upon the composition 
of the vitd fluid. 'I. Morbid conditions of the red 
eorpuaelsa. 8. Changes in edotir. ^. Melanamia. 
6. Morbid state* of the whit* corpoede*. 
6. The pathology of the blood-plasma ; and of 
the pzooes* of ea*^:nlation. 7. The presanc* 
of fordgn materials in the blood, indnding poi- 
sons and inreetive substances. 8. Organisms. 

I. Change* ia Quantity of tha Blood. — 
Alteration* in Ihe totd amount of blood in the 
body are ^hsp* never dmple, but dwayaa*- 
eodaied with alteration* in ondi^. 

a. PolyJumia, or erosss of blood in tha body 
pnardly, may be tha result either of exceaaiv* 
ingastioo of the aUmtat* of Uood ; of the acen> 



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hi BLOOD, VOKBID 

ftmhtToii of tit* Mm* hj tha tnpjirenion «f 
habitual luemorrhsgei at fluzet ; <^ the loas 
Or ob«olet(n«M of a part of the body, nch a« a 
limb or a lune ; or of intoAdsnt ezerciw. It 
cannot be mill, ho\rerer, that polyhnmia haa 
arer been demonstnted by exact inveatigution, 
inaamach aa the to>al amoant of blood in the 
body ia atill nnecrtnin, and the phyaiologieal 
Umtta id thia reapeet are rery wide. Folyhasmia 
ia briieted to be prasant in plethora, tlong irith 
lelatira exceaa of the aollda, and eapecially of 
the red eorpoaclea (tea PurrsOBA). 

b. Oligemia or deficitncy of the total amount of 
blood ia, on the contrary, an exceedingly fireqnent 
change^ and eonatitntea the aimplMt form of 
munaa. It la, howerer, probably nev'tr pure, 
inaamadl ai alterationa in quality appear to be 
inaeparably aaaoeiated irith it ; ana the terma 
kydramia and tpanamia hare accordingly been 
uied aa aynonymoua with- the pre^nding. ^e 
manner in vbich diminution in quantity girea 
riae to alteration in quality mnst be conaiuered 
here. 

When hemorrhage occura to any amount, and 
the irhole quantity of blood in the veaaela ia re* 
duced, the preaaure fiilla, and abaorption of the 
parenchymatona ploania rapidly ibUowa; by 
irbich, along with Vaao-motiir atimuUtion, the 
phyHical reutJona are reatored. If the loaa of 
blood haa been moderate, the only change in 
ita compoaition may be conaidered to be oligeey- 
tlUmia, or diminution of the red corpuaelea, 
which alone of all the conatitnenta of the Ucod 
cannot be rapidly reatored. If the hiemorrhnge 
haa been more aeriona, the fluid abaorbed into 
the circulation from the tiaauea, ftom the enp- 
preaaed aeerrtiona, and from the alimentary canal, 
eonaiataof wat«r in erer-increaaing exceaa, which 
suniei tHtb it an amoant of aalta equal to one* 
ninth the loa* in alborainoua anlutancea. The 
morUd state of the blood ia now))eyond oUgocy- 
thaemia; there ia deficiency of albuminooa con- 
atituenba, or ivpalbitiittnoiu, and the condition 
correctly called atMrniia ia the reault The total 
quantity of blood probably remaina foraome time 
Below the normal. A aimilar impalrmeilt of the 
quantity, and therewith of the quality of the 
blood, may be alowly dereloped 'by repeated amall 
faannorrhagea, or by any eanae whaterer that 
imporeriahea the blOod, whether of the nature 
M waate or of want. Tha'ComBtfon which reaults 
eloaely reaamblea that juat deacribed it the aent* 
form— oligemia with oligocythemia and hypal- 
tralsittoaia: the aame ia known dinieally aa 
atiamia (aea Airxau). 

A* a tlutapeutie vietuurt otimmis may be 
deairabte. It may be induced either (1) by 
direct afaatraetioa of Mood, or ^2) by gradoal 
impoTetlahment Of Qm blbod, and reduMion of 
the intra<TaaeaI*r preaaure. 

2: Horbid OondttiOM »f «h« BM ODTpna- 
daa. — The pathology of the red edrpnaelea it 
still imperfectly underatood. The follAwfaig 
edmpriae the moct {mportant elitongaa connected 
trith them so fiir as they are Icnown. 

B. iWyeytJUniite.— Itacreaae !n number of the 
red . eorpoaeles is nerer eoneidembtt, being 
itnenOlf transitory and withitt physiolegiM 
Gmits ; ror example, in the nnrty-bom, and after 
batls. It has already beMitteatloned as aasoehusd 



OOMDlTIOlTS Ot. 

irlth polyhtemia h plsthors. In thii al^ stam 

of cholera the nd corpuscles are relatirefy in 

exceaa 

b. tMgteytktemia. — Diminution in Tramberof 
the red corpuscles is, on the contrary, of Tvry 
fM^neut occurrence, and of the greatest patho- 
logical importance. Sfictoseopiailly the num- 
ber of ted corpuaelea in a giren riaibte area of 
blood ia (liminiahed ; and oiemically the amount 
of haraoglobin in a given rolume of blood may 
fall from \i even aa low aa 4 per cent. The 
jMincipal rlrcumatancra nnder *hich digocy* 
themia occurs are — (I)inanienna,ordiminntiaa 
in the amoant nf blood as a whole, flrom any 
cause, whether rapid or protracted, esteeislH M 
the result of ferer; the red corpuscles trnHr- 
ing early, seriously, and Jiersistently, as com-' 
pared with the other oonstitnents : (S) inr 
iencoeythemia — the derelopment of the red 
cor^aeles being intermpted : (S) In hypalbnmi- 
nosia, where the red corpuaelea ibce other elements 
anffer from want of aibnminons msteriat : and 
^^) in chlorosis. Set HjnucrresrKrkii. 

c. OUg o e hnm a ai bt. — Oeflcieticy of The ted cof 
puades in htanogldbio has been deacribH by this 
name, and is a morbid condition of the gmtest 
possible interest, inasmuch as it is One of the 
essential alterations of th* blood in cMoroaia. 
When the indrridnsl ted corpnade coatalrra leas 
hemoglobia than normal, it is said to present a 
pale appearance to the eye. A more trustworthy 
method of determining the richness of the red 
corpuscles in hemoglobin, ia by mesas tt the 
hemoglobinometer(siM KaMoaioauioinmB). Or 
we may compan the amonnt of hemoglobin in a 
given weight of blood with the number of red cor- 
pnaclea in a given microsoopiMl area. Whsn tlia 
former is small in proportion to the latter, ths 
defect mnst lie in the udiridnal eorpnsete'; and 
this may be so great that the proportion of he- 
moglobin (alls, aa b some eases or chlorosis to 
2i per cent, of th* normal. Su Cklobosis. 

<r. Aglobalitm. — The effMa of the two eon> 
ditiona of blood juat described, namely, oligoey* 
thanttia and olicochromemia, may bo - disesaaed 
together Under w head of a^efattlism, or defl- 
eieecyof the blood ia hemoglobin. Wabfef the 
ozyg«nating substance of the organism' givSs ria* 
to symptoms at onee eztrenMly ipaxioM,'snd ef 
the most serions irapoit. ErMjr yiul p it ' tm, 
whether developmental, plastic, se um wy , dyB»- 
inie, or tratritfre, is abaolately deprndentmi a 
flreeandimmediatesttpplyvfoxygsB. Allofthsss 
, therefore^ will samr la^ 



processes, therelbfe^ will samr la -aghibalisst. 
The FBspimtonr and eironkatory mormisMs an 
aeoelersted. The complex prooessss efaUtisn- 
tation and secretion are performed impeffMtly, 
and the icetlts are dyspepsia, eowtipation, 
and disordered ■angOiileatMa— wliiek iAtenaiiy 
the ahnwrnsl 'hlodd-atat*. linaenlar contraetion 
is feebl*, and cannot b* raatained< ■ Bay* 
ehieal Ibrce ia weiik; and dalB«as, sleapiness^ 
pains, and other s yuiptum s iadintoiaipnfeet 
oxidation within the nemin* system, Badiiy 
growth and dentlepnieat—M of tlie«ex«al«igaii% 
for example-^wmain iocitmplete.aad'pahartyia 
deftrred. Nutriticti ersn>whM« safliMSt th* IM- 
terial* being' insufieienTiy oztdissd; md- sab-> 
Manee* 'intemediate' to albamea on thv one 
hand, nfti oebenie. mUi «iUr, aad «*• oar 



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I famsd, wppckllj oiU. 
"Out tiw oipim Mid the connoctiTS tiaioe* 
Mane kmdtd with &t and anUrgsd, iDntgad 
■f aidieriag ati«|>h]% aa thaj da wben Um blood- 
I is defideata Fioall; th« szcntiona ue 
, and the snbjert of aglebnliam preunis 
i of tha ooloiinng nuttrn of lbs bile 
aod anuh which an danvad ftom bamoglobin. 

Bitlolegieal ekamgtM. — AltataUon* in the 

ikct amiUmr, and aa mt i t tn e e of the red c<»rp«Kle 

bar* boen freqnantlj raeoadad, but mchaeeoaDti 

am iaeoapieta, and no rafceaefui attempt bu 

jet bean made to cramect any of these cfaugee 

with ■wlid piucut a in the tiasaee. Ib aerere 

fann, nch aa typhiM, and io sumo lapid aialig- 

wat Hiiiaaee, tba nd eorfoaelea appear peen- 

liai^ eoft, their oatUne baog Um rsaiataBt and 

Aaiy, and the b od i e a ranniBg together into ir- 

■ g a l ar heapa, i a atea d of into nuUama with well- 

lietnrdliaeB of eontaet between the elementa. In 

Mother da» of casea tbe eorpuadea nffiear mall 

aadereaaied or like the ' thorn-npple.' Macroeu- 

liana and Micnaftli»mM hare aleo bean (»- 

aenoed aa tewpnriiy and rarioUe conditioiB, in 

which the red eaqmaelaa are abnormally large 

aad ahaatiaally aaaU iMpeetirely. Drauntional 

miU h e ft i f tile white and tbe red eorpnsola are 

oaaaaaliy auiaueua in aoBia oanea of leuluemia. 

& Ohraasoe ia Oolonr. — ^The colour of the 

blood is ehielly doe to the nd corpnaelee, and 

ahaTitinae fian the noraal in thi* direction 

will be bast eonaideced in tlu* place, although 

the white onyiiwiiia and the pUina may also 

afttt the coImit, aa will be preeently ahown. 

a. Theduaf detenaining caose of the coUmr 
af the bl«od is the chemical condition of the 
bamoflalun. When this is united with oxygen, in 
tbe axtacica, the blood is loariat ; as daozidation 
adnaces, this eoloar paaws into a purple, and 
Anally beeoneeiieoi: or Tenooe. Tbe dark colour 
is diseeUydor toabseaee of oigrgen. Tbe purest 
asaaipia at thie ehaage is seen in smhyxia, where 
aiLyn s B is ewladsd from the blood ; but it also 
•eeara as the ratalt of the action ef certain in- 
lapon thscorpnarle itself such 
or poianing by phoephorus, 
i'i, aad other toiio agents. If the 
shaaga ptoeeed an feithrr, the scarlet colour may 
BliU ba asststad by oxidatien. This blackness of 
tha faloed isgaaeaUy associated with imperfect 
nstala<i«« mt area a state c^ fluidity (jm 
#ar«t)L 

4w i Wrxre of tbe blood is observed in olign- 
■■• snilriiniiytliaiMS. and is due to dcflcisney 
mt ihs ts—S^lubia. 
e. Iha Uoad nay ba aot only pule, but ynsent 
~ I of a pmrifUrm chsraetrr, even aa it flows 
I the UTlftl^ ressels, as in leoco^hnmia. Tbe 
Uosd wiU aettle on standu^ iuto three 
. saperiorly, loosely .ccegulated 
saaot; of whits oasposclaa in the middle— a pus- 
ike layer ; and of nd Gosyescles at the bottom. 
i. Tha 1 9 1 n f aiyea ra nce of chylous blood will 
^dsaaihsd oader the head of BloutJ'lataia, 

s. XsAs UamtL The reaaifaiUe ehitngs in tha 
Uaediaaitic^ it beceaaes lake or trBnapnreDt. 
)• fc a y ietljr obeenrad as a further - sUge of 
t ds sai bsd abov*. but it ms^ ocimr 
hartiMaMataMasi ttuiii dooxidatna. and 
ia ot thasaqr jmssat- wtaiflainiiiK intiaiith as 



BLOOD, KOBHD CONDITIONS OF. n0 

it indicstea complete and Ix **i**?**"i '^••t'^ctioD o( 
the red oorpustlsa. Lalt» ^ "" Jon(,rer 

opaque, but tranapannt; *-^** j -^^^'*'/°'""n ha* 



«J£fl»oJTed 



'I the 



left the corpuscles and ^ ■" 

pl&sma. The change can bo ^fi«ctod experiment. 
ally by the addition to blooci *>' water, chIa»o- 
form, the bile-ocids, or othex* «»ol vonts ; «oj -^ . 
probable that some of tbe t5B.»»» of mpij d«»jji 
after enormonsdrnagbta of iw^*>«^» ■"" '''® deats^.—. 
tionof red oorpuaclea that i» bohevad to occ^ 
in janndiee, mny be aceouat^xl '^ 'u thi« •»»■»..» 
But tbe most importAnt c»x»«« ™ '"^lutioa* f 
tbe nd corpnacles la complete «3ooxidiitioa jjj .^ 
hamogloUo, which ia followo<i "by iu •^'flEuaiQ-/"^ 
tbe pUana. Thus drawn blocxi ia nnder^,^ j *« 
by toe addition of ralphide ot" aLxniDoniuixi^ bK ^^ 
pAogros, phssphtuno acid, or ir«>ii— filings ; a.jjA^'*** 
same effect is piodaced by t;txe ^"'^'^^^nio^, ^'^A 
jeetion of salts of the bile-aci<f «. 7hia b«:l!^ ^ta. 
It might be expected that bloc^l would a^^ «n 
the bike appearance when ascposed to t.K**^^>bj> 
longed actioa of the causes tlxaft x*eiKler it.^^ ^^n? 
and recsnt observations seem, to iodica^ ^'^c^T* 
soch ia the esas. In a number of ^"^'a«nZ^ t}> * 
on attended with the accnmiiJa.tioa q^* \^|. r^t 
able ssbstancea in tbe circulation, tha i^ *^^'54 
bean described as 'fluid,' 'claret-' o*. ,*H»rt^»«. 
coloured,' 'clear,' and 'stainix^^ *b^ *^i^ ^^ 
— but apparently without mor« ezac^ ^^«J?^'^>< 







perhaps other agents. The effect of '**tjJ***oj;^ 
these influanoea is obviously to prodnco ^b^ ""^ 
siva amount of oxidifsble material in •:?'' «** < 
while the otheramay lead to tha same r^K^^ b^^*** 
dudnglheozygenatiogcapacityofthaco'''' fcy^ 
Persona dying imder auch circum»tancoJ'^«»*c;^' 
great lividity, from tha black or venoua ac>''*'^'>t' 
of their blood; death occun with evjn^"^"" 
indiratire of want of oxygen, as if ao in ^^?'''* 
the bcmogloliin bad be*n diffused ^xaughth^ 
plasma ; and pott mortem the vesaela arl^oiu^ 
stained with the aolntion, tha liaauea are aot^^ 
with flaid Uiks blood, and deoompoaitioD is rarlr 
and rapid. The ' fluidity ' of, or abaenco of clot m 
s<irh blood will be presently accounted for under 
Fibrin. That a similar solution or destruction 
of the red corpuscle may occur in all rases of 
fsrsr. bat in a much leas degree, is aupportrd by 
aaveral fiiclc — (1) the increaard diaiharge of 
potoah-aalts in fever; (2> a similar iurjrase of 
the colouring matter of the urine ; and (8) the 
anaemia that is found at tbe termination of the 
process. 

/. Other alterationa iu colour may occur in the 
blood. The blood is light-red after poisoning by 
carbonic oxide and ramains so after exposure, 
It ia choniate colourtd after poisoning by the 
nitritea. anch as nitrite of amy! ; and other hnsa 
have hern rreordad. 

4. ICaloonmia. — In relation with tbs pig. 
maQt-l>enriog element of the blood may bf 
meutioned a morbid condition which has been 
described under the name of melanamia. In it 
there an found in tbe Uood black and brown piff« 
meBt-p>irtieles and flakes, free or contained m 
cells of various Khapea, Thia atate ia especiallv 
aaaociMtsd with two others, namely, malaria ana 
»B ealoiged dseply-pigmented oonditina of th* 



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no BLOOD, HonsiD 

■ple«n ; and it is hi'uhlj probnbla thnt the pinneiit- 
particles are produced by the ferer, and Hnd 
their way from the ipli^o into the Uund. Tbe,T 
•t« tiina depoiited in the Urer and other orpinH, 
•od gire riaa to eymptonu iif riseenil diaturlmiiee 
daring life, sod to the pentliar elary or grey die- 
colouration that ii fonnd poit mmtrm. It has 
Iweu raid that in melanntic rancer pigmented 
•alia hare hern fonnd in the living blipd. 

6. Morbid Oondltions of the Whit* Oor- 
pnaolee. — The white eorptiscle of the blood 
may undergo certain morbid change! both in 
anmbrr and appearance. 

a. The moet remarlcable of thrae Is tnerMsr in 
nnmbera, which may advance to such a degree 
that tbe white corpuscles become as numerons as 
the red. This condition is known as ImeoryikaiHia 
cr leukicmia (*» Lrdcoctthamia). Short of 
thia, however, the proportion of wliiie corpuscle* 
in the Llood may bi* appreciably increaned, and 
to this minor condition the rame of tmeoegtoii* 
has been applied. Leucocytosis, according to 
Virchow, accompanies, almost nnexceptionuUy, 
every case of lymphatic excitement, such as 
inflammation, and tuberrular. scrofulous, or 
eancpmus enlargement or swelling of the glands 
•ad allied rtructnres — Peyer's glands, the solitary 
follicles, the spleen, and the tonsils. I/iueury- 
tosis is distinguished from leucoeythiemia by its 
very moderate degree ; by its evanescent course ; 
t>ytJieabeenes of deficiency of the rrd corpuscles ; 
and by the accompanying symptoms. Leueoey- 
tnsis may be appreciated even by the nakrd eye 
in the dot of drawn blood, by (he presence of 
■a irregular 'lymphatic layrr' — erusta lym- 
pkttiea, consisting uf collections of white coi<> 
pnaeles between the red dot and tbe bufiy coat 
vhieb so frequently occurs along vith it. 
' b, A diminution in the number of white eor- 
rowlcs occurs in chlorosis ; and, it is said, in mn- 
Isria, especially during the paroxysm of fever. 

e. With regard to the itmctun of the indivi- 
dual white corpuscles, the proportion of nninu- 
clnr or young cells, and of multinuelenr or aged 
cells may be diatnriied both in lencocytosis and 
teneoeythamia ; while corpuscles may be found 
containing gmnulec of vanouB kinds, especially 
pigment-particles, bacteria, micrococci, and other 
■truetnres. 

6. Horbid Oondltions of the Blood-planna. 
.—{1) WjlTRr. — The limits of the physioloiricHl 
▼ariations in the amount of water in tbe blood 
ue Terr wide. 

a. Dtminntion of water in the blood is observed 
in various degrees. It is moderate and transitory 
as the result of stimulation of the kidneys, skin, 
or bowels, but the normal proportion is Kprodily 
restored by absorption. This condition is found 
after severe purgation, sweating, diarrhoea, or 
dysentery ; and its prodnrtion is the rationale of 
several of the methods adopted fur tlie relief of 
dropsy. If the drain of water continue, or if the 
•npply fail, the anhydric condition of blord in- 
creases, so that the fluid appears black, thick, and 
tarty. Such is the state of the blood in thn algid 
itMcof diolera; the spedfie gravity of the serum 
rifing as high as 1,080, acrumpanied by a com- 
fantive excess of salts, atlbumen, and urea. The 
silief symptoms t>t great deficiency of «8t»r in the 
Uood are intense tiiiist ; a •hhrelled ahnukMi 



CONDITIONS OF. 

acpect of the body geacmlly ; coldness and liridity 
of the extremities ; muscular pains ; and snpprcs- 
sion of the excretiooa — phenomxna directly n* 
femble to loss of water, retardation of the 
cireulhtion, and interference with the fuaetioa 
of tbe red eorposcles. 

b, Excet*. — /fjFdncmiii.— Reference has beta 
already made nnder the head of olignnis to the 
ancnia or hydnemia that follows it. TTrnnss 
0)' water in the blood is perhaps never abeolitta, 
and the change may therefore be regarded with 
equal accuracy and greater oonvaniene* ■• de- 
ficiency of solids. 

<2) A tnpMmopg CoOT niua i i i ». — OorcTinwinc 
what has already been said under the head a 
Coagulation and Fibrin, the reader will ohserr* 
that ' amount of fibrin,' and otherezpressionaMB* 
nected with tbe albuminous constituents, laut be 
rrgatvied at present as comparativrly meanings 
lee», In the light, of our knowledge of the u to e—s 
ofcoognlatioo. Inasmnch,thersfore,aalitueTal«* 
can n iw bo attnched to the analysee of fibrin that 
hare been mn<!e in dilFrtent diseases, it fellow* 
ihat the estimstea of the albuminous substane** 
left a'tor coagulation — that is. of the albnminsof 
tbe »ennn, must also be rejected. But tbe total 
amount of slliumins in th* blood may be Msily 
Hscertained; and this is snitjeet to axtonsive vari- 
ations. The balance between the albnmioon* 
substances, which enter the blood from the ali> 
mrntory tract and the lymphatic syiteBi, on th* 
one hand, and the product* of their transfonaa- 
tion by the tissues, on the othar, is represented 
by the albumins of the blood. These will in- 
crease accor !ini^ly when thrrapply is excessive, 
or the consumption small ; and will deereas* 
under oppo.sit<- citcumstanees. 

a. HypenUmminotit is the name given to 
e:teia of allinmii'S in the blood. The amount 
has been found notably increased when the 
actiritv of the tixsues is abnormally heightened, 
as for example in inflammatory disease* (aont* 
rbaumattem, t'lnsillitis, pneumonia, and pleatisr); 
and when filirinugen, which is the product of this 
increaned activity, is poured abundantly into 
the blood. The amount of albuminous fluid pro- 
duced in an inflamed part, whether it appear* 
as a catarrh, an infiltration, an exudation, or aa 
eflus'uii, is rery great, and may be anormons; 
Hnd, under fiiTourable circumstances, this and 
much that cannot, be so easily appreciated is 
carried into i ha blood, the lymphatic stractuiea 
swelling e* rontt. Hyperalbnminusis aa a result 
of diminished consumption probably does not 
exist; for the efl'ect of an in*u£Beient snpply of 
oxygen to the albumins —(want of exercise or 
orer-fueding) — ^is lOt the aocnmnlation of the** 
in the blood, Imt the formation of ' lower' pro- 
duets, sBch as uric acid and its alliee, and th* 
deposit of fet. Relative hyperalbnminosis is a 
necessary but tmnsient efl&ct of cholera and 
other aevere watery fluxes. 

b. HyiyalfHiminntif.oTd^fieitHeyottiham'mtiB 
ths blood, occurs uniler exactly oppokite circura- 
stances from the preeeding, — ^whether the in- 
gestion of albumins from the alimentary tract 
and the tissues be oomparatiTely small, or th* 
consnmprtnn excessive^ Inanition, therefore, oa 
th* one band, and iu mahitnd* of cause*, are 
a**eciat*d with tuck pomrty of blood; and ••, aa 



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BLOOD, UOBBID 
Oa ttktr hand, an low of Uood, proftm di*. 
rhiigm of altNminoat fluids, morind gnnrtlu^ 
lod odui aooiees of «aat*i m veil u cxeeniT* 
<mni<« of growth and dardofOMiit. Th* albn- 
■osoftha plaama may &U wider th«» eiream- 
■ from 80 toS7 paitain 1,000. finch hypal- 
ia, l aia oio i , nerar nniple : the blood 
be delleiaat i> albBininom aabitaiicM 
lad otlwnrias nonaal, for, a> w* hsTS alnady 
§>>■■, loM of aUnraaa U alwaya foUowad t^ 
•tmittiaa of water and aalta from the tiaaaaa 
hdaflaits {nopoMiooa, aad amemia ia the raaolt. 
fha nd eorpaaelaa sofbr at the aanie timev for 
tlair BBtriti-.a apaedily £ub in brpalbnminoaif, 
ad agiobaliaB m—ea . HTpalbiiminoaia is 
tea a aaciova dianaaa ti the Uood. Iha ra- 
tatiaaa of theaa eooditions to each otber and to 
ifipiwda axe area more eomplicstad clinically 
tkn they aie patbologieaUy : and in tbia rala- 
tiaB tha whole of tfaan axe moat eooTiniantly 
diaeaaaad aBder the eompraheaaire head of 
a—Ilia (aai Ajmppa). 

(>) Clot ; f mmc. However noeartain aa a 
■aaaafie of any partieolar cooatitusnt in the 
Uoad, the aaoaat of dot or flbiin damanda a 
laiaf Dotiee aa a Batter of fiut. 

a. AfaeaJaf dot haa been eoDsidered aa indicat- 
iagaa iiraaa of fibrin in the blood or Jtyptriuoiit, 
the frofMstioa being atated to rise ae high aa 
l-O ■— "— ^ of 0^ per cent. Acute rhaomaUsm, 
crlloHtia, pnaumoma, and plenxiajr are the dia- 
aaaaa in which hjperinoeu ia most marked; 
bat it alao oeeois in pregnancy. The two 
fciacipBl eonditiona of ita occnrrence appear 
to be— -(1) laenaaed actinty of the timiee — 
Bada&ig inflammation ; and (8) Free and abnn* 
dant comnnmieatian of theaa tisanes with the 
Uood thioegh the lymphatic ayatem. 

b. Defieumeg, Umneu, or abiaiee qfdot — ' Fluid 
ilooi! — A Bualllooae dot is frequently obaerred, 
aa for axampla ia typhooa atatas, or in chronic 
waadng d ia tas< s attended with loas of blood ; 
and faaa ben deaerifaed as indicating kj/p(no*u 
3r dtSdatcj of fibrin. When the emdition 
ia axti ma e , the dot may be absdntely wanting, 
aa in certain caasa of amnnia : the blood then 
aapnatas on ataading into three layen — an 
mxr, coDsiating of dwr liquid ; a middle, pnri- 
tarm, ot white eorpnaelea ; and a lower, red, of 
nd eorp o i cle a. In another and larger group of 
eaaca, non-wignlaring or fluid bkx>d ia at the 
aae tine of an intmaely darlc colour or eren 
lake, and is eomnnnlydeeeribedaa 'blade.' 'Vh9 
drcaaistaatca under which thia condition of blood 
oeeois, and the canae of the remarkable colour 
ha*e been almdy notircd; and it remaina to 
arrmH only for the fluidity. The profonod 
altaiatioa of the red eor(«adea, the want of nxy- 
gaa, the intar&ranee with the iirodnetioa of the 
fanuBit, and the ehai/^ ia the fibrinogen and 
flbsnoplaatie aafaataaee — one and all combine 
ta joreot eoagnlation. 

e. Bi^fif toot. Another phenomenon connected 
wiiheaagaiation, fkom wluch enoneovs and eren 
Jaayiuaa emidnaiaas bare been drawn, is the 
■o-aHed it^j eoat. The pi o eeaa of coagnlation 
ia gnmaHj aidBdeotly vtow to allow of the 

SritatioB at acme of the ted oorpnsdea from 
avGKe of the blood; and the corresponding 
pntoTtha dot igaeeordingly paler. "WiMnthe 






»cU, 



na 



ooMsrnoiis ot. 

pale layer ia nnoswilly 
bafly coat or erutla pUeg^f^^- 
in the blood in pn>g:naae;yv 
hydrmmia, and digoeyc'* — 
eases are analysed, it isfon 
farourable to the format io: 
probably all more or less oc 
oorpnsclea, namely— (l)inAj 
of the red corpiisdea, as i : 
hydnemia — allowing n 

interference with the _ „^ 

haemoglobin, wbieh is ao f3«> ^''Wfui ij, <j_^'*y ^^) 
lag the rapidity of ooagnl».t« <**» «a ig fo!r**«"»>,z''» 
digoeythwnia; and(8) w™^»* "^ •7»c«r'*% **»• 
spending to the amount ^a«i **'*'ioa * *«»**'*' 
hemoglobin, as in the samo <i J^^eases. o^ 0(f *"•*• 
of these atataa render the j>i«.»^9B*» of eo~? ^«j^ *4>e 
slow compared with the A a m e^ Bt of tb^j^*»l|Z*',^H 
pnadea; and the hnSj oosfe £• the r^.*^ic|^*On 
thna appears that the bu^ eoaC ia OoTr'^lt/ ^^^k 
whaterer of ezoaas of flbria-^<0aemtQi» ^'^'q^ It 
opposite; and that it is fouxsci "odar |.^ o«^<^ 
dirarae eonditiona of blood. ''** ^f* tti, 

(4) Sura.— Tbeamoantorpoaitira]^ ^*^t 

concerning morbid alterations of t/is tei^^I 
blood ia but email. It ia to be obserred '^ o#^^^ 
salts of the plasma hare chielijr aadigjJ: ^'l^f *^ 
baae, while potaaaium-salta mostir ra..^ *• ^l'^* 
oorpusdes. ' ^'^^o iiTi^ 

a. DimiHUiion. — In febrile diseaara th ^^ 
inereased discharge of eompoonda of |^^* >m «. 
bat at different perioda; thepotaaaiuin!!!'',*»«««^ 
pearisg in excess in the ezcratioffa tintil tkZ*' "P" 

tt past, and the sodinm<salts during defer^lf,^'^* 
At both periods, it may be coosidered tt?*'"'*" 
that the blood ia the chief source of tho aSu^'" 
ezeted; and that it is accordingly deflcisnt^ 
these constitnenta, 

b. Exe$u. — On the other hand, the salts of the 
plasma are relaiiraly in excess in hypalbnmi. 
nosis, replacing, in the proportion alrea<ly stated, 
the loat albumen. The effect on the aalta of the 
blood of such drains aa ooenr in cholera baa been 
rariousl^ stated ; some authorities declaring that 
it is an increaae, others a dimiontion. 

e. Btaetion — The alkalinity of the blood ia 
said to be diminished in gout, cholera, and oateo- 
malaehia. 

(6) Fats. — The normal increase of fiits in the 
plasma thatoeeara after meals may be exaggerated 
by a diet rich ia oil, and, it ia said, ia chronic 
dmnkards and in persona disposed to obesity. 
Whan this increase is so great that the serum 
preaenta a milky appearance the blood has been 
called ekyleui. A. cnam-like acum formo on 
the surface of the serum ; and the milkr appear- 
ance ia found mieroaeopically to be due to the 
preeenoe of fine grannlea and oil-glol>nlss. A 
marked inrrease of fstty matters in the blood 
haa been found in aome onaes of chylnrin. Fat 
may also appear in the blnod as a foniKu body, 
by the escape of marrow into the circulation m 
fracture of bones — and that in such quantity aa 
to cause frtal capillary embolism. 

(6) OABBOinc Acid, which exists in arterial 
blood in the proportion of 30 per cent, and in 
remms bbod (rf M per cent., by volume, may bccd- 
mtilate within the dreubition either by increased 
formation or by retentioa. Although associated 
with asphyxia, thia ineiaaaa of carbonic mU li 



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ttt BLOOD, MOBBIU CONSITIOin 01. 

ynbablj not th* cmue fithar vt tlu qrmptom* 
of Uutcoaditioa, cr of tba dack coloui. of tit* 
blood that aoeomiMiiies iL 

(7) Othkb Coit mwuK T i . — Amongit the moat 
hnptntant of tlia otber sonititnanta of t-ba blood, 
tha &Uoiring an to ba notiead : — 

a. Urea, which axiata in nonnal blood to tlia 
aiBonnt of 1-8 paita in 10,000, maj incMaaa ia 
WBMnia hf two or thne timea. Thata ia atill 
mnch SBcartaiuty, howarar, on this subjaet (jm 
Ubjuha). Cii-eaea of the uriDBiyotgana, which 
intatfatta wiih the eliniaationof nrea and allied 
pradaeta from tha blood, ii the asnal canae of 
wania ; bat exoaidTe tiamu-ohange, aa in ferar 
and inuvdinate mnacular ererciaa, baa alao tha 
aama affect. 

b. Urie acid, fooad ia normal' blood in minnta 
tiacea, ia iacreiwad (aa wata of aoda) in all caaea 
of goat, and may amonnt, araocding toDr.Oanod, 
aran ta 0-176 parta in 10,000. Ita pnaaaoa ia 
eaailir daaonatiated by tha timad-expariment 
(aai Goct). Uric acid ii alao ioareaaed in laoiba- 
mia and chlonwia — probably from tha imperfect 
asidatMa aasooiatad vith tha eonditioa of the 
red oorpuactea. 

c. Ltuem, tj/romi, lajp/fmric aeii, tateim, and 
other allied complex oompounda, hare been fra> 
qnantly found in the blood in email qnaatitiaa, 
and the aame may be said of omIm and laetio 
aeuk, and of aaetcma. 

J. Bile. — Certain of the conatitaantsof thebile 
mayooeurin tha plasma. Tfaeimaatobrionaoftfaeee 
ara the MU^pigmeatt — biiimbin and bilittnlm, 
which either by direct fotnation in the blood from 
the faiemoglobin, or more freqontly by afaeorptioa 
fiora the lirer, accamnlata within theeircalatioD, 
and bj their depoait gire rise to the oohnr of the 
tiuiaea in jnandice. The biU-ttcidi fflj/eoeioUa 
and taurmJu/ia aad» — ara also nnder caitain oir- 
camstaoeM absorbed into tl:a blood, where thay 
may be drteotsd with dilBeilty. They bare a 
destniotiTe effect apon the red carpnadcs, and ttX 
Aothar aa a powerAil poiaoo to tha tiaanea, cannng 
tha axeeaairely aoTere symptoms that may ooenr 
in hepatogenoDS jaandioa. OSMestewi is credited 
fay soma paiholugista with being the caose of tha 
aame symptoms, and it has been foand in the 
blood in increased proportion in some caaea of 
serere jaandice. 

*. Sii^ar.— The sugar of the Ueod is inenasad 
in diabetes, in some cases reaofaing 0-8 to 0*5 per 
cent. 

7. XbdranBooa Uattam in tba Blood.— Be- 
sidea its normal conatitnaDts and their ptigdBet% 
the blood may oecaaioaallyeontam certain mattart 
entirely foreign tu it snch aa the nttmeroos poiaoiw 
wfarieh act either dirsetly^ion the eorpuadea, or 
remotely npon the oigaoiam. These, entering 
the ciuaoLitioa'betaire thay exmt their apecifte 
eflect.are in BanyinstaBcea readily discoTegred 
\i} analysis. The arid compounda of hydrogen 
with anlphnr, phofiphoras, araMiie, and antimoay. 
reapaetively, act as blood-poisons by deprrring 
the oxyhamoRlobin of it» oxygen ; vUle earbonie 
osida and nitrous oxide nnita with the li»mo- 

flobin, and expel tba oxyi;en from tha blood, 
t ia a matter of speculation whether other ao- 
r a l la d poisons, tha natnre cf which b atiUobaenjw, 
do Mt enter tha Uood and tharo^ eaert their 
friwiiy aftMtr«Mh aa.tha ooat^ioa of aoata 



BOILS. 

ai^fle f«nn and othar iafactfou diaoida& 
Stmilar infeetiire JQattaia,|«idiwad ia (be tisanaa 
of the body itaejf, are believed to be altaorbad in 
aaptieamiavpyaaiia,aDd other allied diaeaaaa^aad 
nuoieiaua Miaervationa sappoit tha farther be- 
lief that the prraeoBe of haeleriA ia intimately 
associated therewith. A somewhat similar ia- 
fMtioa may oceor ia nwligaaat diaasaa^ tha 
jniaaa being mbed with the blood-plasnai, bat 
IB soma instaaoea the prooess may be riUhmal, 
namely by maana of cells. We cannot axpeefc-to 
detect theee cells in the blood ia iraante. Tha 
same remark applies to embola, of wfaatsrar 
nature, and to blood-crystals. 

8. Omniama.— The Uoad may contain • 
Tariety'Of liriog organisam, either foieigii or 
pecoliar to itself; the latter bsing called kmm 
t«toa. Sea HjsicaTaaoa, CKtunu, aad lta> 
upaiMO I'oTBtt; alao Biscnau, Fuabu 8ait« 
oviins-aoiiixu, Hjcbocooci, Spuiuuk, wad 
Znok J. Urcbsu. Bbucm. 

BIiOOI), Transfusion o£ Bu TaiKsrcsnnr. 

BZiOOB-WOBMS.— This tent it of mnanl 
appUcatioa. It re&ra to all kiada of Entaoon 
linng in the blood. jSm Hwaatoioa. 

BliXn SISEASB. A condition in which tba 
moat prominent symptom ia a peculiar disee* 
louration of the skin and mncoos membrane*, 
dnetothe eircniation of dark blood in the Teasels. 
&«CrAK0SU; and Ebabt, UaUbrmationB o£ 

BOHiS. — Sxvoit. : Fonmcles ; Fr. Furxmdt; 
Qer. Furunktl. 

DaruiiTiair. — Gangrenoni infiammntion of 
tbe akin, forming small painful swellings, and 
ending by expulsiun of the necrosed centre or ' 
' core. The infliunmation begins in the clandu- 
Ur stmcturea, hence involving not only the skin, 
but also the cellular tiaaoe iounediately beneath. 
The sebaceous glands are most commonly the 
seat of boils, bat occasionally the Ueibomiao 
glands (s<ya), the ceruminous glands, and the 
sweat-glsnda of the ancpit ; oi, more raiely still, 
the glanda of the lips, vvlra, or anus are affected. 

.XnouMY.—The frtdiipatiag eautea of boils 
are : — the male sex ; middle me ; a stout habit 
at body; seasons of spring and autumn ;. a diet 
too foil of flesh, or one suddenly cbaoged, such 
aa that adopted daring training ftir rowing, &c. 
To theae ma«t be added the vitiation of the 
blood daring exhausting fevers and in certain 
eases of saccharine nrine, or induced by inbnling 
disaerting-toom effiuvia; and dirty occu{»itioas, 
for axamplsb chimney-sweeping or rag-picking. 
I«atly, boila'are •ometimet endemic. 

JmooI eatua. — Tha parte <^ the skin roost ex- 
posed to dirt or chafing, the hands and face, the 
neck sad bask, the buttocks and knees, are favour- 
ite sites for boils ; but their mvrform on any part 
except the palms and soles. Blisters, poultices, 
and stimulating liniments occasionally cause them. 

To theae canaos is added b^ some authors the 
apeeiSo c oB t agi o B of a parasitic iungtud plaaV 
theariielinm of which, bydsvelopiug in a gland- 
call, thereby aansas limited necrosis (tbe slough) 
«f the tissue ia which it grow*. The truth of 
this view is not yet clearly established. 
- SmpTuMS.— Btnis appaar eitbex singly,, w 
osaaxeial at<nw»,.iorming thait an 



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BOILS. 



Umg; noB »>mMMi pfanpl* bcna, foBMtiBM 
lima ntii i niinuta A-aaHa, in tli» eottn of 
AA a kair nuy geopnlly i>8 cUtBctsd. Tfa« 
la^groTB largrr aad baniar, tfas lad ana ia- 
aw— and pr^iirs darker, ami pna bagiDi,rting> 
ilgatinttt):.n throbbing. In riieat BiM J« j r»th» 
■■■il bnaks, {msoaawteth, thepaiaabatii, 
■litha hariiw— diMiaiiihM A di7 ortwo liitar 
tb eoBik a ■hrad of aykaeaUtad callalar tisaaa, 
tmom. Tha bail than anfcaidpiv' aad. hmliag 
■fiofytakaaplaee; thaicaiiadaproaiad, andfor 
■■a time ct a Tialat eoionr. OcmainwtUy tha 
duafly the caUnior tiama 
I tha Am ; tfaaaaaa k tbia aoftar, more 
ad elaarly ri Kaaw e ri bad, sod Snauutea 
Ilka an alaeaaa — tUa variaty fotina in tha ani>. 
■it. Bamly, tka ecntraLaloai^ aztaod* npidly 
baMth tha aasfiHa, aad eoauumieatM vita the 
■■Ciee bj aaiiaal amall ap t rtt t a U < t r6m mi t ) . 
laalkaraaaa tbaawi^ng ia nun oiffasa; no 
aaaa awwia at tba aoriiea, bat a haid faty 
paiaM pi>()ta i> ihrnmit, vbicb is long in nb* 
aadiag (Aiiarf 6ti% Tha ft n raaeulag araption, 
aaontiagof gnapa of aaiall boila, foraia aao- 
caaiTv erapi^aaal tknathe diaeaaemay coitiBae a 
long tin*. BtaUangMHsaUyKmitadtoaaaaU 
, bat t!ti» ia not aivajr* the caaa ; and lla 
gKBatir part, aaaa the wfaoU^ of tha body la^ ba 




diatarbance ia nansUyaiZ 

: vhaa tiia boil ia dna to local inritatjon, 

I it mqf anflce to raider nerrooi, iitiCabUi 

unfit tat -vratk. When tha bcila aia 

I by athaaarimi, tha geDenU ayaip l ii Ma aia 

■al daaola gxaat depreariaa. Proatrntioo, 

■SitalbaB, ilnpar, l^ d«)iriani, dry bnvn tongAct 

, K iai iti a g, wad diatthcat' a«t in, and the 

da frtalhr; orneorery ie Tery ahnr, 

by aaA aoppniatioii. Saptie ab- 

iand fjaaia veiy raaiiy teke plaoa, 

■BtSlafitm Fact.— Then isaTsie 

teal fooa of boil, tha datenuning 

It is mat vith only 

iaaJBadt,aeCabIy aothelip. KUd 

' at fliit^ like aa oadioaiy boil, it 

ilij iiifcaiiaiiliiiil of the Teiaa or 




I poiaoinng of the blood, 
t fatal ebaiyiatiiaoeoar- 




tftbia 

■ inlaail aial repeated ahiren. The boil 

m ba«gy avdK^; of bUekish Tioiat 

; klia awiiUBialiag tiaaaae become hard 

' ham m uy f aa tipiu'atiua eeasea ; ' ahnghing 

• ; ah* coaipbKiaa grsvs earthy;' thafw> 

it «fa» bailie on thefcce, beemne evntsd : 

the eyoi ia aomo care* ia paAd 

a^aa wmaalrae prejeet flpaai tha 

aad laboaaed gasping brtalhing 

ia ; Mad ^Tioteat aonatfietini^ jmin in the 

bal^ia ftafointly experienced. 

asaallyaqperreae, but eome- 

■ aadtiRible snfiwing re- 

-Tbo datation from &» 6z»t 

mi JaabMit fcor dm. The vatM 

Taflaaa(8cd tha pUeUtiaeMaflds 

jf tha acfait to ttaaatuMM In the 

HI fha J tj Jaia (hr ^ laal ■ b arnani flinn (■ 
— - '— ■-— d. Our Bealagea,' ot the 
iH 'CnNSuv TiVMnk 
irdhtibgnkhailbytiie 











oaatnl cariCraiid _ 

it. The boil of the fitee «aeoiii_ 

bilaa turn been confounJod in tia 

the ' nmiignaaf puetals ' of OootiK 

The bnner is still s toil with 

The 'pmtult wtaiisnt' is said to 

a large Teside enrmonnting a t 

with a ring of snuillar resides Tt»** **^ 

one,— 4 condition nnyr met vitts » ** 

FaooKosis. — Whpn due to Xa c i *' <^ 
prognosis is always good, unlesss ^j** j^ •^, ^^ 
exhausted by old nge or fever; fxaa'^^ «»1''*""^ 
cnmetanoes thn extensire slougbio^ '^1^*"^ "''^ 
mtioD often lead to a filial iiwne. 'uppa- 

Tmunaurt.— GtHerat. — First i*"*©*.© t>n,j- 
posing cnoses, and inrigonte tha pitti^^i,'' 
change of air, outdoor exerciee, t^ip^^j, ^ 
Turkish baths. The diet shonld^ be oiodentt 
and mixed. Alebhcl, unless the patient /« gnattlr 
debilitated, should be giren in very moderate 
qmlntity, and thn form of fermented liquor moet 
habitual to the patient Is best ; mnch alcohol 
taken before the core has loosened increasos the 
pain and throbbing. Occasionally a saline 
poTge should be giren. Of empirical Temediee, 
yeast (a tnbleapoonfhl thrice daily) is siiid to pnt 
an end to the repetition of boils. Quinine and 
perchloride of iron are aho nsed. Quinine 
shonld be giren to an adult in flre-gmia doses 
erefry six hours, till singlngintheeanand head- 
ache begin ; it shonld then be gradnnlly lowered 
for three or four davs to three or fonr grainr 
per diem, and then left oK la obstinate eaaes 
the waters of Viehy, Barigea, or Harrogate are 
bMieved to rembre th* dispositioB te boils. In 
diabetes emrssion of sugar-forming food, and tha 
iVee administration of alkalis are the moat eflhe*' 
tanl remedies. For the exhausting boil of tha 
fitee, large doses of brandy, with quinine, are re- 
quired. 

Xeeot.— 'When rfgnalled by Itching, a boH may 
he stopped by plucking out the hair of the iii- 
flamed fclliele, and in' a long eneceaeion many 
boils may thus be ui ete a le d . When the areola has 
A>ftned, V the pain Da sligfata drop of emiBtic sohi- 
Hon applied tn the centM will sometimps check 
the progress ofthe holL A better plan at this stage 
ia to cover Ae boil with « galhnnnm and opinm 
eJBSter (Giasnitt* Wilson's) spread on leather. 
Under tiiia tMatment pain at once ceases, the 
InflMnmatleii gradaaliy' subsides, and' the sepa- 
mtion of the ewe proceeds painlessly ; when 
the boil disoharges, a h<de should be cut In the 
centPBof the plastflP, for the escape of the pro- 
dortSk Whvn the pain Is ttii^ng, and tlM 
areola wids, with restlessness an>l hea'^ache, 
•arm poulticea are most soothing — those of 
staieh eauseptistahtian'leas than linseed tneal 
pooMeel. ' losing lard with linseed ponlth:e,or 
sprinkling It with the dilate s6hi« inn Afacetatd 
of lead, hiu a eimitor effect. Ponltkes hasten 
the expulsion of the slough, but' should be dis> 
eontinaed as soon as the hardness chaSgeS 
to doogtifness. ' If the (ilODgb is larpe. the suT.< 
(Me may be dressed with lint sprssd with Psru' 
irisn batoatt, and the boll carefhlly protected b^ 
atMlM of po& and com pr esse s . 

Incisions arb noSr much less employed thaa 
ftMraMdy: They increase ratiier than lessen the 
Isaa wf tlMn m or£uaiy boila, and do act 



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lU BOIU. 

AoilMi til* ilontioD of tlw :ofl*aiinaUon. Thoj 
gir* raKef to piun, howwrar, nnd eheek this 
wnad of diffined boiI» When made, iadsions 
■boBld bo &«a, croeisl, «r oreo itsr-Iika, nod 
(•mod beyond the boil. In the rapidly axtead- 
lag Ml (^ tha Cue local tieatment ii of little 
arailt the free nee of the actual cantery may 
bo beneficial if employed at an early period. 
BuxBLir Hnx. 

BOND, DlaeaMt of.— Under this head are 
inelnded :— Acuta and Chronic Inflammation of 
bone and ita membraDei, with the conaequencee 
thmat, anch as Caries, Necrosis, and Abscess ; 
New Orovths which arise both within and upon 
the bone ; Malformations ; and certain Disorant 
of Nutrition, numely. Hypertrophy and Atrophy. 
Bone-tissae should be regarded as being simi- 
lar to other conneetire tissues, but some dis- 
eases affecting it ar« rendered obacnre, while 
others are miiterially modifiod, by reason of ita 
me^es being filled with lime-aalts. 

1. inilaaunatlon. — As a matter of dinioal 
eonrenieoce, it is usual to consider separately in- 
flammations of the periosteum, of the bone proper, 
and of the meduUa ; but it should not be fo^tten 
that thcae structures are throughout continnons 
and interdependent, and that disease is rarely 
ezdosiTely confined ta any one of them — it may 
originate or be chiefly dereloped in one, but 
it eannot long eust without ioTolving the others 
to a greater or less degree. 

A. Paricrtttla— /»|) fawmr »Bi» of fkt i»vut- 
i»ff mtmbmnt tf hom» (««* KnockttAaat). Bj 
perioetanm isnaually meant the thin flbioaa en- 
mlop* of the bone in which the veaaeU for the 
■apply at btood snbdiTide. But between it and 
tha bone is a layer of oateogaoetie oalls like the 
cambium-layer of a glowing plant, and immedi- 
ately eztemnl is a layer of cellular tissue, oob- 
linnoos with that of the adjacent parts; these 
ai« iotegpral portion* of the perioatoBm, aiid taka 
an actira abara in all ita diaaaaed pwciM ts . 
Farioatitis may be eithsr actUt or ekremc, 

(a) Aeutt ftriotHtit, otttopaiottiiU, aeattpt- 
natteal abtceu, or otv/a memU, — Thia i* a tat- 
miclabl^ but fortunately comparatively lara, 
diswisfi. at leMt in the adolt It attacks the long 
boDea almost axelnairely, asnally those of delicate 
ehildren or young adnlta, in whom active bone- 
Bf«wth ia atill going on, and the paiioatenm is 
hi^y vaaanlar. Aenteperioatitia probably never 
oeeoza without eoineidant inflammation erf! bona, 
and it ia by far tha moat common causa of ne- 
•toaia. It will be best to regard it aa an aenta 
oatitia and perioatitia eombioed, and to call it 
a4tamtrio$ttiu, just aa we call inflammation of 
the bone and of tba endoataum otteomgritti*. 
The extent to whieh the bone and tha parioa- 
team are in the first instance laspaotively in- 
volved ia always diSenlt, and aometimea im- 
poaaible, to determine — it may be inferred 
from the extent of the aecroaia. There an 
two ways in which the disease may begin — 
either ia tha flbrona inveating sheath of the bone 
aad the cpllular layecs bena^ and sopsdrfieial to 
it, from whence itspnads inwards to the cottieal 
booe-substance, or even to the medulla; or in 
Ihe bone-tisBus— the inflammation apreading 
•HtWBids to the pericataam. It ia impoasiU* 



BONE. DISEASES OF. 

ia tha living aabjeet to ^Ustinguish asute 
oataerayelitia and oKtaoperioatitia ariaing i^on 
idiopatnie eansea. Tha disraae ia usually at- 
tribnted to an injury, often alight, or to ez- 
poaure to eztremea of cold or heat. Frequently 
no cause is assignable. 

FATHaLoaT.--IUpid coradation takea pla« in 
the layersof the periosteum, and in the Havetaiaa 
apaoea and eanata of tha bone, to aueh an extent 
aa to obatruct tha eirenlatjon, and probably to 
cause by preeaure the aaven pain oomplaiaed of 
at the outaet. The exudation beneath the flbrona 
layer of perioetanm ia eoriona, and aoon beoomea 
pumbmt ; the peiioateum is detarhed ; the vascular 
supply «t the oone ia ent off ; and necrosis results. 
Tba extatt vt the neooria dejwuda upon tha 
extent to which the periosteum u engaged, while 
the thickneaa of the deed bone depends mainly 
on the depth to whieh the inflammation in the 
oaseona tiasne extends. I«rge aceumulstiona 
of pus are often rapidly fcimed in these eaaea^ 
tba pus csaaping throngti opening* in tbaflbroua 
euTuope into the eircuimaeent cellular tisau*. 
Tha souU of the tibia and femur are the part* 
most frequently affected; the di*e«*e ooenrs more 
rarely in the bonea of tha upper axtiamitie* and 
other parts of the skeleton. 

Stkroiu. — One of the earliest symptoma of 
aeuta perioatitis ia andden and aevera pidtt in 
the affected bone, which ia aoon followed by 
intenas fever. On the aeoond or third day 
daep-aeated swtUittg seta in, somewhat obscure 
at first. After an interval varying from flve 
to tan <bnrs, tha inflammatory signs approach 
the ' aurnee, the skin beeomea oadematona, 
pita on pressure, and finally reddens and 
laflama*. The length of inteiral dapenda on 
thethidueas of musdea and soft parts covering 
the affected bone. Other things being alike in 
reapeot of pain and amount of fever, the longer 
tha delay in the appearance of external awellii^ 
tha greater the probability that the bone is the 
fliataaddiieftiiane engaged, the inflommatioa 
having leachel the perioetnim secondarily, while 
the eailv appearance of awellin^ and fluctuation 
extemaUy anggest that the inflammation is 
chiefly perioataal. Blood-poisoning, either lap- 
tieamie or pymmie, ia a common eonseqnence of 
aeuta inflammation of bone and periosteum. 

DuaKosm. — Thia diaeaae may be obseurs at 
the eommeneement, and its nature overlooked ; 
it ha* often been mistaken for acute rheumatism 
on account of the swollen joints, for phleg- 
monous erysipelas, for acnte cdlulitis, or for 
typhoid fever. The only malady with which 
acuta perioetitis need be confounded is as 
idiopathic inflammation of tha deep-seatad 
eellular tiasue ia a limb. This disease is rara, 
IVhen w« observe the chain of symptoms abov* 
daacribed in a young person, we may safely 
aaanma the preaence of ao acute oateoperioatitia. 
Hie dlseaaa almost invariably terminates in 
suppumtion and necrosis; resolution happens 
niely, but nactoaa ia not inevitable, even after 
BuppniatioB. In a few caaaa, especially in young 
ehildien, if the matter be speaduy evacuated, the ■ 
abscss* eoiUpaesk tha periosteum raunitea with 
the bona, and no necrosis takes place. This 
result is uafortuDstaly quit* exceptional. 

Plioaaosis.— This must be founded on tba 



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BOK& DISBA8E8 07. 



(of Ik 



r*?' ■MMomw: vbaUMT UiocxI-iniMB- 

■■f «tibD|)lie*; and wbaCher tiis ^jasMit 

Jtnii.»;-jj. — -j'n'hn rliinaBn Camcwmat 

"*• I>Im util tb* dwd boDe is tsamt. off or 

•^IJ*/^ 'Jiii ii often loos <i«l»y«d. Th« 

"■^OMitfdiiib aay Im }pmrvam.amMXXy inipklrad 

7 '*• ;•*•«, or it may reqnira mmpntiktion, or 

"rPtt»M u; ion hia lif* »ltageUi*r. On th* 

■UB'Mtiu nn of tfae limb, and Um hMltb 

;;jj*JWieot, B.jr becoow oompletaly m- 

rfar"*""''"^"'^ and enexsotic trestinaDt ii 
"* gfiKt iapoirtMiea. as ic afEurda the Ixat 
Jzy** ^inRii^ t^ fliaiureEOiia oonseqneocM o< 
^r<P|y"*iuiltiBtia hflspital pnurbee the euM 
*L^^'*'"««e«»°t»y ••»*y- In the flnt 
Mj^r*'!*I> iiioald be elarmtcMl. amd ice mppliad ; 
Ci^.'i'luit with m, ations •olution «f iodine 
a^iT''* i$m>oa *m Ui« imU«ix-« of th« nOec- 
^lojfJf^inoMOO- do»n to the bone, lo 



pcn<js 



^^'^'iform^' a-l»«-y »^ie'»» P-i» /nd 



•S/, 



> 



grouly 



, ^";p«-mitJnK tli«.ta«D«ay ercHpeof pm 

-*«£«• £»xn. tli» m.»noi»Dt of penoe- 

and coi»««q«»««»«-*y ***" «»«=™'»> '• 

"^^^i thm more ixttpo«rti»iit. to owke an 

' X!^ >Ud. tJi«»er«i:^ b- aone »«» »",«"•• 

1^ CO its -valU being 

conK^va mejb^eoaie 

i.n«r«*e'^»8' *^' peiieu's 

■ - . .v,^ limb «»fcioiild be kept at 
^•* ^ii^o«- -- «»•* '""'^ 

, si unare renein, end 

(«e* Aeemaj). 

^^^»Sed in the diieue 

♦ »a2^ fks-rnr rune higher. 

yg *"^ '— I^Z^ aJ>d tbe degree of 

•• *'?"t^ — — -pvocerding in rx- 

' ■"**• *""T^"X^'iSflsinni»lion and 

to •«nPI»^*^, Jticm- The odemiiof 

a^iS^"*»*^ phbbiii., 

,01 n^. Under theee 
^yf cJia limb is often 

nKTri«w«»«*- * ?•_ »JC^i«»-de«»ur»ct'en. and 






mxxmt 



A-w» »»«>»»• 



_ pjanua; or 
pcurtimi of the 



"i^^^lT^**;;***,^ w»e«t«&>'»n»Ki'»'»{r ^ 






the 



^gd K""^ ■offirring 
to teniporiie. It 
'e%-er, where the 



up cs the epiph;- 
*^^l)d»fc tl»«. BP*~ "^^e^Lho da»d bone. Ti.e 

"Si 4*»«i«* »?* ,i^^r^" »* diridedwitha 

•2£^«.^»r«A^**;U^;^™o■r«d. It it difficult. 

«H«lM( a««s»oo. ^;^ ^el^e» »» diiWKiee the 
^ Vn the •»«*3^ ^^are the joinU both 
^^ti?lSSrt^ l«,olv-d, «.p«.lion i. 



iBTariablT rappoiating, 



neeroeia. ia Tery euatmoB id t.f»^ ■^r2?*«V^*'^ 

ohiefly affecU the uBgaal pla.e Jtf**"**^- ' ''■^ 
ie Tery gnat, bat nay be reM. ■ 
and tn» inciaioa down to tlis 



ana free incuion aown to ms ''•^''ZZ^wm^^^L.?^ Aki' 
tbeleM.doeanotuuaUyaTerC' *** ^'•ji^*. h**W/ 
or necroaie. i'^ ^ ^*ii.^«r' 

(i) CAnmio {MrtMtUit ia "^■■^^Vv^^tJ* ^^"o* 
diathetic caas<v bat mayraaial* It^ i V* 
from aome cootiniKiaa m iae ui ' W ^ fc ^ jwV«jJ?'*^* 
qaant on the aaperBeiHl parts 01* ^J"* *^r*^at^' or 
the tibia. elariele,eknU, and jrifc'^,*''»t^]^lf»t^ O^, 
any bone ; and it is often oba^r*"*** *t ^*> »5; ■• 
or inatrtion of miuelea. When tJ*» *'t%^'»« cul?*^ 
from a general eaoae, inch a« '■^hhi^^ *3S^ 
wutaof Uie skeletoo areaffiMtsd; V^'^ ^i*^ 
local ennee, nniaUy only one. *> -Aoj^ ^ 

STMrtDU Chronio periosri"* 

talcee the form of what ia emlte4 ^^^^^^alfy 
tender, more or leae painflU, zooadecj ??*^ — * 
n«Uing; at fint tonM ud l»rd^ */>e%^ 
ioitar, or cran nnctoating. The pmlaim 
mnch greater at the outaat. i^Hn tha taaaioa ot 
the porta inrolred, and ia generally vona at 
night. Sabooqaentiy tha awelling bacoaa* im- 
dolent. and pouleee. anleea preeeed npoa. Nodia 
an due to a localieed inflammation. The eambiaaa. 
layer of the perioatenm and ita estamal layer 
proliferate and become filled with leneocytee, 
thua forming a well-marked niDJection on tha 
bone, which may undergo reaolntiaa, sappoTHte, 
or oeafy, according to drcomalancca. 

Paooxoeia. — In chronio parioMitis tbie if naa> 
ally faTourable. Under tha infloenee of early and 
■uitable treatment, tha inflammatory prodocta 
are completely aboorbad, and tha bone reeuaea 
ita natwal ehapa. If the chronic inflammatioa 
of tha perioMeua ba pemitltd to proceed un- 
checked, a d<>poail of new oeaeona lanu-lla uaually 
takea place on the auiiee of the affectrd booe, 
giring riae to permanent thickeningi, or even to 
oeteophytie growtha. Theea are compceed of 
light poTOUi bone, «ith a roogh rarfaea. The 
kkeleton of a eyphUitie anbject will often preeeat 
numarona thickeninge of tlui nature. On making 
a eection of the boM, it ia eaiy to aee that tha 
new bone ia eaperimpoeed upon the old, and ia 
formed by the perioetaum. 

Tbbatiuiit.— When dua to a local eauae, tha 
iwelling will often ipontaneoualy aubeida with 
reet to the part, bat u obatinate caeca iodide of 
potaaainm internally, and iodine ointment or 
Lliataring externally, may ba reijnired. If the 
aubject ba unhealthy, or if the original iqjory ba 
conaiderable. anppantion may take pUce. whea 
the treatment will be that of an ii^/lamaialorf 
ahteeu. SypkUitif uoJu, which are a Tery 
common expreeaioB of chronic perioatitia, yield 
rapidly to the inflaenca of iodide of potaaaiam, 
which in aome caaec may naefnll^ be oomUned 
with a mercnrial ooorae. Bliatenng or fiictioa 
externally ia hurtful in anch eaaea. Syphilitic 
nodaa an not at flrat prone to aupporaiion, and 
eTrn when they become aoft and floctoating, and 
the akin reddena oTer them, they abould not be 
miataken for abareaaoe, aa they readily baooD* 
aUnrbad under aui'abla treatment 

(c) Ptriotlitii afUr tyf/tM fntr.—K peeuliar 
form of chronic perioetitu if oocoaionally obeanred 
•f a fequel to typhoid flarar. It oeeaa doriag 



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BONB, USKUES <m 



nkas ibe form of l>ot,.raiiiSii, »iid tandar aodaa^ 
friqneotly ajrmmatnnf, aad ofUo placaii on the 
tibu( (ha diuaaa ia sbm fsud oa the riba and 
4tkar famiaa. It may baaaaoaiated with ■eeKiai% 
hat if ao iha aooaatnf tha daad bone ia ataall in 
raoportioD to tbe iDflsmeil areit of perioataam. 
Uagmaml health ia ootaeriowlj Hlbetad, aad 
tha diaaaae ia rerf aaMiaUit* to trestmeat by 
iodide «fpetaMiiiia,ooalii]Md «!*li inlideof ison. 

B. Oetaltla ia mi ioflammarion chiefly afibet- 
iag tii« bona-anbatanea; thia fom may aja be 
amU* at akroitia. 

(a)Aemtt»$ititiii» noitbarolinically norpatho* 
logimUy to bo diatiiigaiahad frua aeata oatao* 
nyaUti* or andoatitaa (aM'OtMeatyttrf «). 

(i) CknmicosttUii iaa diaaiiaa Mgianingiii tha 
boM, ii> which tha ehief ehangea from fliat to iMt 
aeeor, the parioatanm being Beeoiid«rily engagad. 
Thia afiecUan may nault fniea h^my, or be ac- 
eitad by expoaam to gold ; but it often dependa 
•a aoDatitmionid pndiapaaitioa, aash aa the 
iyphilitio. the atimmoaa, tlia gdo^, or the rhea- 
■atie diatheaii, the flnt being the moatiWqaent 
canae. It mny ooeur in any part of the akrUton ; 
tfie diief oliangca, when produoad by ayphilii, 
oeanr ia the sbaftaof tha long bonaa. They emt- 
riat mninly of hypeitvophy, and the bone ia nlti'- 
nately ioc ri aaed in thieknoia, in length, and 
gaaemlly in deoaity : Ita incariov ia often timna- 
iimiied into deoae bone-tiaae, and the mednliaiy 
eaTity i* oblitented. Another ferm, aaaoeiatad 
with the atramona diatharia, is generally seated 
in the ioin<*ends of the long bones, ami in the 
•pongy Ixnae. It ia piaa* to end in sappnz»i 
tioa, Meorapanied by either earisi or neeroaia. 
The goviy and rheaoMtlc Ibmu ara aaanwated 
with eridenca of tha praaenoe of either of thMa 
diatbeeee. 

P4'nn>u>OT.— Increased rasenlarity iint tahaa 
plaee, the Harenian osnala enlarge, the eaaali* 
culi disappear, the eonoelli enlarge to con- 
tain the iDfUmmatioB-prodocts, and tha earthy 
natter diminiehea! hence the inflamed bone 
aofteas, and, if naeevoted at thia stage, will be 
found eompatatirely light aad pomns. When the 
inflammntion afibcts the aapeifleiiil lamina of 
the bone, the periosteam beeomea thick and 
Tasonlar ; if tha deeper parts are invoiced, simi- 
lar chooges will oceor in tha endoeteom. The 
porous condition of the bone may become 
pmnonent, when the condition is colled 
Mttapofvu, the result of so-coUad rarefying 
astitia; or the grannlotiooa bMoms traaafbraied 
into tiew bone, and the eanoollated straeture is 
Died with osaaoua deposits so that the whole of 
the inflamed area beeomea Tory dense, and is 
then said to be sclerosed ; or the inflammation- 
procees may terminate in snpparation, followed 
by cariea, necrosis, or aa abscess of the bone, 
which laat nay be either difltaaed or cireua- 
•arib«l. 

SniFTom.— Thsee are insidions, Teiy obscnre 
at tha outset, «d may be mistaken for those 
«f dironic rheumatism, or mne jMriostitis. They 
Motisl chiefly in aching, gnawing piun in the 
affected bone, with characteristic remissions and 
■octomiU exaoerbatiom. The bone is tender on 
nressare, and fMs increased in bulk at fltat,' 
iMn tha MltfotiM «f tha jnmadiot*^ m»- 



rsnading aoft tissaaa; aafaaaqaeDtiy tha 
itaelf enUrgee; Tker* ia often inereaae of haot 
JM the limb. The piogreas is Tery chronic, an^ 
if onoheeked by tmarmant may give rise to eoB' 
siderabia deformity. 

TBBATMiiirr.— Thia should b» directed to tha 
cause of the diaeosa, If this be ayphilia, aa 
antii^philitie treatment will be foUiiwed by 
good reaalta ; even in chronic bone-inflammation, 
not dependent oa ayphilia, iodide of petao- 
slum is often of great serrice, liocal ooonta» 
itrltation may alao be employrd. Often the 
eaase caaiiot be mode out, and if iodide of 
^vtaatinm fiul ia prodooiag aa ei^t, wa nsBt 
Ml back oa geaenU trsatmnit. In the aoxly 
anfaaciM stage, rcat, widi elefMion of the aAotad 
part, is vaiy dasinibla. Worm foiaeatetions, foV> 
uwtd byicsd compresses, retisTe the snfbiring. 
If then be mtieb pain and tansion, leeches shoaM 
be applied. Faneturing the tissues down to 
the mflamed bone with a tenotomy kaifs or fine 
bistoary, it-lierae the tsnsa periosteum, and 
allows eztraraisMian baaeath it to eaeape, a* 
that tie pain is promptly abated. 

(e) Ottettit itfurmmt.—'k. peculiar form of 
ehronio inflammaition of bone hoa bem daecribed 
tr Sir Jamea Fag?l under this title, f^<om the 
cMogaa it produces, both ia thi> form and densi^ 
of the afiaeted boneo. It is -a ehronie osteitia 
of the most extreme type. It begins in middla 
aM and nay eoatina< ibr an lodelinite tiaM 
witlMat influence apoa tile general beolrJi, 
whidi distingaishes it elinicaUy fmn other 
boBe-inflammstioos. It is namlly symmetrical, 
oud ofleots chiefly the long bones of the lower 
extremity and the sknIL At first the bonaa 
enlarge nnd soften, ftom excessive proda» 
tion ^ imperfectly drreloped strnctare aad in- 
creoMed bl<Md-aap|i4y, and, yielding to the wei^ 
of the body, become carved and minhapen, bat 
the limbs, although deformed, remnin strongonl 
fltted to support the body. In ita enrly period, 
and aometimes throughout itsconnie,the disease 
is attended with pains in tbe affected bcaes; 
which vary widely in severity, mid are not 
especially nocturnal or periodic. It is not at- 
tended by fever, nor associated with any eoosti* 
totional diseosa. It diffna from the chroaio 
osteitis dependeet oa airaple inflamoiatian of bona 
or that pruduced by (tout or syphilis, in afibeting 
the whole length tk the bone. HypMnostosis aaa 
ostsopottwis dependent oa these latter cansss 
rarely affeet the entire bone. No treatmeot 
appears to produce any effect upon this disease. 

C. Oatao>Bi7«litia is on iaflammatioa chiefly 
affecting the interior stroctan of the bone. Like 
the former, it may be amte or cAronte. 

(a) Anitt otttamklil^xit tHdnUtu ia a sup* 
punitive ioflommation of the medulla and boos, 
which very frequently ends in septic poisoniag 
and necrosis. It is nearW always nasociated with 
bone-tiguiy, and most neqveatly happeas after 
ampiitatioi^ or gunshot meturss, in which tha 
cancellated strneture is iigured ; a severs eoata* 
sion of the bone, an injury to the perioatcaai, 
or ezpoeure to sudden bxtremes of heat and cold 
is capable, under some ciKunstanoes, of prodae* 
ing the d is eaae.- 

SrifPTOMt. — ^The symptoma at* obacore, bmbo 
espaoiall^ if thaia k»w»tippotUtttjfti«i»miuvK 



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BONX; DI8XA8E3 Of. 



tMininatos ia joint-d'uNnguiintioii. It liM b«an 
oalled tubartiatlar eariei ; and is part of tliadii- 
oidar known u tumor albiu («M Joum^ Duaaxi 
oA. Tba Don-artiealjiT form of nmplM csriet oftoo 
onginatca in a, localiMd pariottiti% ud u gena> 
ral^ due either to i^hilia or (tmma — the Utter 
is Bioet frequent in yoong peieoni, the former in 
adults. 

Fathouxit. — ^In eariee the boos gradually die- 
integratea ae the reeultof aelironie infliunmation 
(tfitaeaneellatfdtiwne. ThetrsbeeaI«b«Bomein- 
(Utiated with leuoot^tM, and gntnulationa form, 
which proTa tba MnKa of purulent discbaiga^ 
jmtaain agnuulatiiiginrfiuseof tbaecAparu; 
but the ptocam it interfered with and deUjad 
lij the act of getting rid of the oaseona ttruc- 
tare, in the trabeeuUe of which the ealla ronuiin 
■hut up until the dead bone finally breaka 
down, and oomea awHjr in the diacharges, being 
oftan distin^ishad in the form of gritty pa^ 
tidaa. Until thia proceaa is oompletM the dead 
bona ia aoaksd in pna, which oftan bacomea 

EBtrid, and until it ia got rid of a healthy granu- 
ktion-anr&oe ia impossible. 
Stxftohs. — Cariea ia very chronic in its pro- 

Cia, and often cauaea extenaiTe loaa of bone, 
txuction of a joint, or loaa of a limb. It is 
almoat always aaaociated with an impaired con- 
dition of general health ; the a4iacent aoft parte 
are inrolred in the inflammation ; abecaaaea form 
in them, generally connected with the diseased 
bona ; theae burst or are opened, and siousea lined 
with gelatiniform granulations, and discharging 
a thin pus, paraiat for an indefluite time. On 
examination with the probe the surface of the 
bone is felt bare, rough, and much softened; 
and outside the area of carious bone periosteal 
depoaita of newly-formed oaaaona tiasue srs often 
found. The diagiiaaia and prognosis depend upon 
the age, constitutional condition, and history 
of the patient, as much aa on the local sign*. 

TaaaTKBrr. — This must be directed to relieve 
the aonatitutional taint, aa well aa the local 
diaaaaa. Merely to excise or deetroy the diseased 
portion of bone is not suiSctsnt to cure the 
patient. Local means prOTe efficient only whan 
the gaaeial aondition haa been auffieiently ama- 
lior^ad, especially in the unhealthy cbronie in- 
flammation of bone frequently called atrumons. 
Good air, good foqd, and toniea are, therefore, 
of great impoitanoa. If ayphilis be preaent, an 
aoti-ay^litio t r e atm ent most be pursued. The 
principle by which the local means act ia to 
£teilitata the formation of a healthy grannUting 
sniftca— to tianaform, in foct,an indulent into a 
healing ulcer. The disintegration of the dead 
and diaaasad trabeeubs must be assisted- For 
this purpose the application of ationg aniphurio 
add diluted b^ two or three parte m water, or 
aoma other mineral acid, ottea prorea uaaful. 
Btrtial gouging out of the dissased bone seldom 
aaeeeediv baouiae of the iqjury done by the in- 
strument to the adjacent Ixme, weakened aa it ia 
by inflammatory changes, and therefore prone to 
set up fresh disease. The complete iniitmmt 
of the bona, leaving nothing but its thin outer 
abell, ia more successful ; but when the disease 
begins to invade adjacent joinU, aa in the tarana, 
asdsion of the entire bone is beat ; or when 
aaraial bones ais involved, ampntatioa beeomea 



In children opeiations of this kind onr 
not ao often required ; general treatment usually 
provee sufficient. In the early stogas the actual 
cautery, applied over the most painful spot, ia a 
valuable counter-irritant. It is undeaiimbla to 
maka early incisions into strumous abace as ea in 
connection with diteaaed bone. It ia better to 
empt^ them by a email troehar, and to pieeerve 
the diaeaaed area aa long aa poaaible from atmo- 
apherio influence. When the cariona action ia 
arreated, the cavity flUa with healthy granulations^ 
the sinuHS dose, the jiarta cicatrise, and the gap 
in the oasaoua tiasue is filled by ftbroua, orsome- 
timea by oaaaoaa matariaL 

4. Vawoaia. — ^The complete arrest of nutri- 
tion in a portion of bone tram any canaa ia fol- 
lowed by the death or neeroeia of the bone, and 
by a aeriaa of inflammatory changes in ths ad- 
jacent parte, which reault in the complete aepaia- 
tion of the dead from the living tissue. 

JBnoLooT.— Neeroeia ia moat freqaentljr tho 
leaultof acuta bone^nfiammation or severe iqjuijr, 
as after amputation, fracture, or contusion. It ia 
eepedally prone to happen in the compact tiasue, 
but it alao occurs in the spongy structure, as the 
joint-ends of long bones, or the tarsus and ew- 
pus, where it is UMially aaaociated with mors 
chronic forma of inflammation, and ia mora 
limited. The peculiur natnraof the bluod-aupj^y 
to bona, and the fadlity with which it may be 
interfered with or arreated nndw the preeanra 
of inflammatory changea, go far to axjAain the 
frequency of neeroeia aa a raanlt of bone-influn- 
mation. Acuta BUH>nrative oeteoperioatitia or 
ostaomyalitis rarely termiDatas without necrosis. 
Whether the dead bone will be in the anperfinal 
or ths deep lamdia dependa on the seat M the in- 
flammation, and on the extent to which the perioa- 
tenm and endoateum are raapectively implicated. 
The long.oontinued action of phoepboraab w 
obeerved in matoh-makera, and alao of SMreuxy, 
may induce naerosia. Syphilia is a frequenteauae 
of neeroaia, through its tendency to produce 
chronic oateoperioetitis, the aderoaed bona thoa 
originated being aftarwada prone tn necraee. It 
is not an uncom m on aequel during convalaacenea 
frma aoma eruptive and continued fsrera. After 
aoarlatina, oateoperioetitia, followed b^ neeroaia^ 
ia by no meaaa rare, although affectioiis of tho 
joints are mora oommon. It is pr-jlMbU that 
many caaea of naerosia occurring in chi Idhood are 
oonnactad with an aoteoadaut attack of acarlet 
fever. The aaaal bonea may necraee aa the 
reault of aevere eorysa, the Tertabne after 
pharyngitis, or the petrous portion of the tam 
poral bone as a consetjuanee of otitia. Arterial 
thromboaia and amboliam are occadonnl aeqnelm 
of typhus, and may produce a local gangrene, 
not only of the aoft parte, but of bone. Thia 
ia, however, more frequent in cbnoection with 
^hoid fever. In eodocarditia the nutrient artery 
of a bone haa been obeerved to be obliterated 
by an embolus, thus prodndng necrosis. 

PaTHoLoox — After the d«ah of a portion of 
bone, the living tiaana, in immediate contact with 
the dead, becomes inJUitted. The Havaraiaa caaala 
and eanalicnli become diatanded with nigtata*/ 
cdla ; loopa of capillariea form from tlu pM- 
existing vessels ; a graauliiing aarfhee, in net, 
anrronada the dead boM U a manner pracjaaly 



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mkttwhitttlaifl''' ^ the aoft parta whan 

1 itaori « I*"? til"" °* ^''* P«^o«teum 

«Bni« fro" ™ '*"•• *»»»"«» ">'"* "<! 

noJir tM' ''" <>"*°°* rarfaea beneath is 

laoMh »«i *''''•' "^ in»cerat«l bom. In caan 

rfmkUtie wow* M weU aa in that rcsult- 

i«r foB piosilionu, the aup&ce la rough from 

i^est jwmJmI depoaiL How the oasraoa 

laiealm tn diaolred or diaintegrated over 

ti( labet <rf lepuatioa, ao aa to loosen the 

dt»d boiH, ■ w* wrt*'"- Probably the grann- 

Iilioii-tiasa tiat *"">■ *™™ ^' living bono 

~„aaei amaboid piopertiea, ami thus dispoaea 

rfene of tie bone-particlea. The pns that ia 

jonaed has ■ gMehanieal influence, while accord- 

iif to (io« thtarj lactic acid is produced, which 

aiaJona the isiolabia into solable ealta of 

bnt. While this looaening proceea ia going on 

itw bone, limed chiefly from the perioateam, ia 

faessdefaitsd, eaoatantly becoming thicker, and 

nth one or more (fienings in it for the eacape 

el pas, called cboce, ao that nantnully the dead 

piece beeoBM completely inTaginatad, and ia 

Mosd, bom iu position, a ttqitettrum. Thia 

seqoertmiaa of the daad bona ia not inrariable, 

as for iiMtson ia the spongy bonea, the bones of 

the afaill, soil the npper jaw, or where &om any 

(soe (he perioateam has been destroyed, no 

sheath of new bone will be formed. Necroais 

Tajiaicly takes placewithoDtaappnration; when 

this does happen the nature of the caae ia rsry 

ohaeuei Occasionally nearly the whole shaft of 

s isag bone has been found necrosed, and after 

as iMarral of nontha or eren years no snppu- 

ation Bay hare taken place. Such forms of 

III 1 1 [ ' i ekisaly simulate malignant disease, and 

^bea they cannot be reliered or even recognised 

saTe sftcT amputatiott. A chronic oatitia, fol- 

lowad by hypsrunphy and aderosia of tho bone, 

ia the noat eommoa antecedent condition of this 

tern of neciasia. 

TmMAtamn. — The duuiges already described, 

vUeh aepaiata the dead bone from the living, 

do not eaosa its sxpatsion from the body. On the 

eeatimtj, thaj shat it np, like a kernel within 

its abeli, and nothing so imperatively demands 

sugiral interfsRoee aa the presence of necrosed 

booa. It acta aa a foreign body, ia a constant 

auoRa of risk to the patient, and sbonld be re- 

BKnred aa soon as practicable. Its preaence ez- 

citaa tha perioateam to fiuther formation of bone, 

ao tJiat tbs inva^nating sheath becomes of great 

rtiii kiHiii ia oid-etsndiug eases. The period at 

wUeb an cpention is naoally nndaitaken is when 

tbs ■n(]iii atiiiiii has become looae, and the time 

iwqwizird /or thia porpoae variea with the extent 

aad ttii>*Tw«M ot the nemaed bone. In the 

aeSiTaly growing bonea of the yonng the process 

■f aepKiatieB is aeeamplished more qoiclcly than 

■ tbe adult, especially when the soqoestnun in- 

ralraa Uie epipfaysal jonction. Bonghly esti- 

■Miiil, a pariod of from thne to six months might 

^ aaatadaa tJiat within which looaening of the 

■aqaaatraai asoaUy ooeora. Beyond the latter 

ttmim •■ rfbit to SKtEaet the dead bone should 

ba delayed, trea it it cannot be felt to be 

sa. AauBg other risks involved in doing so 

ay ha tkat of amyloid degeneration of the 

seen, ptiaopally ths liver, kidneya, and spleen, 

nek an salject to this change as ths conse- 

9 



3neneeof long-eontiDned di 
isease. In order to remov 
director should first be itit: 
cloaca as a gnide, and the aot'^ 



BONE, DISEASES OF. ^^^ 

^ym^ »y. '^«t a 

divided. An adequately Urge OPf^Hif "^<^"'t/jr 
ba made in the encasing shcatb f' H^-^^ ^'"f oow 
the chisel, trephine, small n-vr.of ei|,,y '?** 
oepa, and the dead bona extract*", ^itber'f 
or several piecea, asmay be the toot^ cooroo/eut* 
The opomtion may prove difficult On a<r«>oot ot 
great thickness of the soft parta or of t be scones- 
tral envelope, or because the sequestrum ItMlfit 
extensive. After tlie removal of the dead boos 
the envity fills with gmnnlstiun.4, which subse- 
quently ossify, and the soft partacicatrise. Finally 
the s»^ne»tr(il enreiope of new bone is partly 
absorbed, partly consolidated, just as the redun- 
dant callus is after fracture, and the bone tends 
more or less to resume its normal sixe and shape. 
6. Taberola. — An examination of some cases 
of chionio bone-disease in sciofhlous subjects 
seems to prove their connection with the forma- 
tion of tubercle in the bone. The medullary tissue 
in the joint-ends of the long bones, and cancal- 
latsd bone generally, are ehiei9y affected. The ex- 
ternal appearancea are thoee of f ungating caries ; 
but microscopical examination discloses multi- 
tttdes of round cells like lymph-oorpusdes, with 

?rotoplasmie matter, filling up the interspaces, 
'he cellsare found sarronnding thesoft, gray, non- 
vascular patches, which are ottan seen on scetioo 
of an inflamed oaneellated bona in strumous indivi- 
duals, the central part of which may be ths snb- 
jeot of calcareoua, fatty, or suppurative cbangaa. 
The bone when so affected u never sderoMd ; 
henoe these are not simply cases of chronic inflam- 
mation. There is, however, some difference ol 
opinion as to whether, in strictness, they should 
be called tnberenlar in their nature, and the 
inference that they are so rests rather on the 
general condition of the patient than on any 
purely local chameteriatic. 

TumkTiaairt. — In caaesof this kind general tonio 
treatment becomes of the greatest importance. 
Rest must be given to the affected part, and exer- 
cise to the body generally, combined with fresh air 
both day and night, and simple nourishing food. 
Where the bone is extensively diseased, it must 
either be excised, or ths part amputated. The 
presence of the tubercular diatheais doea not 
forbid an opemtion, the local aource of irritation 
and drain upon the system being thus removed, 
and a healthy traumatie surface subotituted for 
one infiltrated with inflammation-products. The 
removal of the local disorder often proves a 
oomfbrt to the patient, and increases hu chance 
of regaining health and strength. 

6. New Orowtha.— The bones are liable to 
most of the new growths forming tumours found 
elsewhere in the body, such as cancerous, vas- 
cular, and other tumours. The most important 
are the following: — 

a. Some tumours are peculiar to bone, as, fjr 
instance, the ICroloid, so called from ths many 
nucleated corpuscles contained in it, analogous 
to those foond in fcetol marrow ; it ia of en- 
dosteal ori(tin, causing an expansion of the bone 
in which it grows. It is mos' common in ths 
maxillary bones, and near the epiphysal enda 
of the long boaaa. It is ganenlly obasrvsd io 



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BOmS, DISEASES OF. 



)nang paiaoni, icqnirM nmoral, and extir- 
pation, if complete, ii not, u a rale, followed bj 
a returc of the dieeaae. 

b. Ferioateal or Vaaaisiilaitad Sarcoma, 
■prioging from the periootenm of a long bone, 
Mch as the femur, w not oncommon. The ahuit 
of the bone may b« leen on aeetion paaging 
tbtoagh the centre of the tumonr, Numeiona 
bands of fibrous tissue, of^n ossified, radiate from 
the periosteum through the growth, like an out- 
spread fan. The best tnatment is amputation of 
the limb at the joint abore, which does not, how- 
•Tsr, ensure against recurrence of the disaasa. ' 

e. Bxostosia. — This is a bonj outgrowth de- 
Teloped on any part uf the skeleton. It is diffi- 
enlt to distinguish canilaginoua from osseous 
outgrowths. The two structures are often 
mixed, and a (amour originally cartilaginous is 
often tracsfrrmed into bone. Cartilsginons out- 
growths, called ■nohondroaet are met with on 
tbe costal curtilages of old persons, also on the 
intervertebral discs, near the synchondroses, 
and arise also from the articslar cartilages in 
rheumatic arthritis. Cartilaginous tumours, 
growing either from the periosteum or the 
medulLi, hare their faronnte seat upon the 
phalanfrps ; they are usually multiple, and from 
the deformity and incouTcnience they produce 
often demand either enucleation of the tumour 
or, in extreme cases, amputation of the finger. 
The more special forms of exostosis ore of two 
kinds, the »pongff and the itorj/'liltt. Spongy exot- 
toiit is often dereloped near tiio orticalar ends of 
the long bones, where it forms a nodulated out- 
growth of cancellated bone of Toriable size, en- 
enisted with a thin Isyer of cartilage, and baring 
generally a bursa superimposed. This kind of 
exostosis is often connected with the epiphysal 
aortilage, and ceases to grow when the bone is 
ftaUy developed. This fact, as well as the proz- 
hnity of the neighbouring joint, ronders sugieal 
Interference generally nnnecessaiy, and often 
faaandous. Another form of spongy exostosis, 
sometimes called otteophyt; depends on a local 
excessive periosteal growth of bone. At first 
this outgrowth is porous, and but slightly con- 
nected with the bone on which it is aeveloped. 
Afterwards it ma^ become dense and hard from 
interstitial deposit, or it may always remain 
spongy. Such exostoses often depend on some 
local exciting cause, such ss a blow ; or they 
may be found at the insertion or origin of a 
mnsele, as in the so-called rider's bone, at the 
origin of the addnetor longtis musclo, or the exos- 
tosis frequently found at the insertion of the 
addnetor mognu, or the ' ezerdse bone * of the 
German soldier, lliey may be regarded as morUd 
axaggeiBtions of the normal taberositiss of the 
skeleton, hory exottotu, so called itom its dense, 
ebnmated chnaeter, is mon rare. It rariea 
much in sise, and may be pedunculated or sessile. 
Hereditary influence appears to exist in some 
coses, in others a predisposition to chronic peri- 
ostitis, but there may be no apparent cause. The 
development is slow and painless. 

Tan^Tiunn'. — Interference is seldom required 
in the spongy exostoses, except on account of 
pain or loss of fiinction. Vfbva pednnculated 
they Clin be broken off or divided subcntitneonsly ; 
Uid although they may reunite, it will proliaUy 



be in a more convenient and painless relation to 
a^aoent parts. Otherwise they should be ex- 
cised. 

Except on account of deformity, or of pressing 
on important structures, an ivory exostosis need 
not be meddled with. It can often, however, 
when necessary, be enucleated; and where only 
a partial removal is possible, the low Titolity 
of the tumonr often causes necrosis and anb- 
sequent exfoliation of the remainder. Sponta- 
neous necrtisis also occasionally occurs. 

d. Osteo-anenrlsm. — Certain sarcomata and 
myeloid tumours, when veiy vascular, pulsate, and 
have been mistaken for aneurism. There are, 
howerer, tindonbted rases of anenrismsl tumomrs, 
dilating the bone, which have been enred by 
ligature of the main vessel of the limb. When 
the tumour is small it may be excised, or the 
actual eauteiy applied. Sometimes amputation 
is required. The causes and pnthology of the 
disease are obscure. It is probably in some 
cases of a nsevoid ehamcter. 

e. Bone-OTsts are tumours distending and 
thinning the bone, and filled with serum or 
bloody fluid. In some rare cases they contain 
hydatids. The origin of bone-cysts is obscure ; 
some originate in the dentigerous cavities of 
the maxillee, in which bone-cysts are most fn- 
qvent, but they are sometimes found elsewhere. 
Avery slow, painless increase in size takes place. 
The bone becomes gradually very thin, and often 
aflfords on precsuro a peculiar and characteristic 
parchment-like crackling. In obsciin cases an 
exploratory pnnctnn should be made. 

TiuuTiuurr consists in fhiely laying open 
the cyst-eaviiy, and providing for subsequent 
drainage. The cavity gradually contracts and 
becomes oblitenited. 

/. Hydotlda. — The formation of eehinocoe- 
cns-cysts in bone is exceedingly rare, compared 
with other parts of the body. The causes are 
unknown, and the symptoms very obeenre, re- 
sembling those of an ordinary cyst. A cavity is 
formed, usually in the spongy extremities of the 
long bones, to contain the mother cyst. But it 
is also found in the medullary canal. The af- 
fection is grave. Serioiu inflammation often 
follows interference with these entosoa. It is 
sometimes difficult to remove the whole disease ; 
and unless this be effectually done a relapse will 
occur ; while in such parts as the pelvis art is 
unavailing. The cavity should, if possible, bs 
freely laid open, and all the cysts carefully re- 
moved or destroyed. The actual canteiy may 
be sometimes employed with advantage, or the 
surfsce of the adjacent bone removed, as it may 
be invaded by the cysts. An exploratory punc- 
ture can alone resolve the diagnosis, by finding 
the hooks of the acephaloeyst in ihe fluid. 

7. ICalfonnations.— These consist in any 
departure from the normal type of the skeleton, 
bpr reason of excess, deficiency, or irregularity, 
enher congenital or acquired. It is not neeao* 
sary mora than to allnde to the ftct, that til* 
skeleton is oiten defective in parts ; that senile 
changes occur, especially in certain bones ; and 
that supplementary bones and procesoes an met 
with. Various drfurmities occur in bones from 
fractures, both intro-nterins and subsequent to 
birth, and from cnrvmturee due to tickets or 



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B0;7£; DISEASES O^. 

^°™'>|°S; Tratmant of corvnxara eonsista in gnr 
gpj ''"^''aiiog bj splints or oCh«r a,pparatui, 
,„,r?^'^« Nnishteningr nudor chlorofonn, 
j^^r~* *>idi, in the soft, growing bones of the 
■j^ PJ°^ •occflBsfal in sbmttng autny defor- 
jitU J P** nn-rmCarea of adnl^ bone* do not 
""•'of fc *^'" *'*'*"• there is lose or impnii^ 
U tifcl.^'?'''" fr<M»» deformity, fche bone may 
• «, a^*^'''''^ sabcutsneoosly -with the chisel 

•lUiiiL U* limb stziusfatened often -with 

*ad •oBeJi!^''^ ForeaWo frmetmo is a clnnuy 
Mpfand I^ dAiigeroaa metbod, as the force 

«. ajBZ^HJt be TeenlAted. 
^Wti|Z**'Vpb7 monnn an esceeasire growth 
^ tit j *- Apart fcoBo. inflammation thi* ii 
^t (^ " nitiseaais epecimena of ezeeaira 
aei^ - - - - 



a^^et witb. egpeeially of the 1»ne« of 



nnknown, 
1^, -™fc appeara applicable. 
rf^'Vu^oonaiata in s diminntionof thenwi 
t'S^of » bona. Xt nt»ay be the reenlt 
0*»7rV chaneaa. of aonile deg^ronitioii, 
"Hl^Jih » limb, or of a.n injnry, eueh m a 
''^ • by non-nxrion. The bone-tie- 
-^^ tbe cortical portion 
~ i-cbxnant-like \kytr of 



■toll. Xhe cnni 



"Um'iJ, 



ki%l 



m. Cbin -pa 



'VS;i*ia soft a.^dT»ll*. Thie ha. beea 
fvN % mtr^nf^- Tba external 



s^.<»V.it - - — 




remain nDchangad. 

'W^t. ""„ i_s. ««• a. lixnb, dueoaeofa 

Sftontmuotfrae- 

tnflinf; CKUKS, are 

lap^rn.'rastaiioes. The 

mj„» been applied to this 

1^, -svfixelK alao frequenUy 

^^l<^S'*??ir"^^SJSr^^K»ni; and Motu- 

t^jQ^VaOanrnn- ^^ ^-^^^ MacCobmac. 

*«Urf ««'«'*»"> I^y. on the Eiviera. 
1 ^8DlO-«*^^*^J£L«e fbir l»aticnt» lafieriDg 
J'>it»|)le rinta*- '^'^I^I^i-eaae. The climate 
S igoe form* of *^^f^Sw,¥«A«^ Treatment of 

..J \^ tba b»ai"7- ^^ poaseanon of tiro 
*J "♦'S*ct«r*-«^ by ^^ JSther «de of the 
'^"••S.ssaooa. <»2* *^c^inK «Ji«k» nmally 

W.^.y ^ ^ m n ia - T^^ •K>n« the guufrin 
r^:t^ »**»« I***^^ t^pSent. ofthe 
V«*j;rflad 3oio«- «» ,^S*ce along the 

^5^teW«*U.a b«»J^ ^, Greenland 

tt,Vn»ittr»«™ <^-X' -^»a «»a crerted tape- 

,,i,«»a«v»aX«.') ««:-«^ of -riew little need 

WM. \tm\ dinieal V^^:^ broad Upeworm 

Uatwroitg thsM- _ JV .„d then only, it 

bmkiaaoat of ^»"»SSr'lia.vo trnTefled on 

«>ddiia,« T««»»»_r^_rlmon in SwitMf 



y^ 



BBAUnSM. 

land and north-\r « tem Buasia; ^^*^-rtiP*a^_ 
occur in Pbland, Sweden, Uulland„ -*'^ '^~^ a/0f 
(outb-wecten) proTinees of Francs^^ J^^t/ *"' *** 
timee in IreUnd. In reference C:"^ ^^%> *">•»- 
the parasite readily yieldi to tbe ■»***?*li^*f«»e» 
ployed in ordinai; onaae of tapowar»»i» -•<» .g^ f»" 
practice we hare genemlly resorted ttr ^JotT^r*** 
bnt Dr. Arthur Leared has found knnf «/« 000^^ 
efflcacions. Sw TAra-woBM ; and X»J»l4/* ^"v 
T. S. Cbteo^„ 

BOT8. — A term amplo^red to desigiutte tb» 

Uttk of certain dipterons insects called esdilw*. 

They more rarely infest man than animaJs. ^te 
(EsTsrs. 

BOm>IICIA. See BcLntu. 

BOUBBONirX-UliS-BAIIS'S in Fraaoa. 
Common salt waters. See Mxnsbal Watbiu. 

BOTTBBO'DIiIiiliA.lnl'ranae. Therroalal- 
kalineandaiMoieal waters. &»llnisaAi.WAnBS, 

BOUUDJBICOU'X'U in Hampshire. Re- 
garded as a suitable winter residejice for patients 
suiiering from certain furms uf chest-disease. 
The clim»te is mild and slightly homid. 8e$ 
Cuiun, Treatment of Disease by, 

BOWXIiB, Siaeaaes of. Set Imumma, 
Diseases of. 

BBAIDIBIC. — Smow. : Hypnotism.— Braid- 
ism ie the name which, after its inventor, Jamea 
Braid, has been applied to a tharapentio method 
destined to utilise the undoubted powers of 
mind orer body for the core of Tarions diseasea. 
In essence it consists of a species of Hssaerism, 
the patient being reduced to a partial or com- 
plete trance-like condition, by being made to look 
fixedly for a few seconds at a bright objeet held 
by the opentor at ' about eight to flflean inches 
abore the eyes, at such a distance above the fore- 
head as may be neeeasary to produce the greattM 
possible strain npon the, eyes and eyelids^ and 
enable the patient to maintain a steady fixed 
stare at the object.' The patient must be made 
to nnderstand that he is to keep his eyes 
steadily fixed on thie object, and his mind 
riveted upon the image of it. After so short a 
time as ten or fifteen seconds some patients may 
be intensely affected, and if so, it wilt be fbund, ob 
gently elevatii^ the arms and legs, that the 
jiatieut has a disposition to retain them in the 
situation in which tbsy have been plaaed. ' If 
this is not the ease,' Mr. Braid writes, ' in a soft 
tone of voioe desire him to retain the limba in 
the extended position, and thus the pnlse will 
speedily become greatly accelerated, and his 
limbs in process of time will become quite riipd 
and involuntarily fixed.' By slightly prolonging 
this process a condition of prufbnnd 'nervons 
sleep may be induced, in which operations may 
be performed as easily and in as painless a 
manner as if the patient had been under the 
influence of chloroform. All this has been 
abundantly proved by Esdaile and otben who 
performed numerous operations upon Hindoos, 
with absence of all pain, whilst they ware in the 
hypnotic state. In his attempts to cure DKsbid 
eenditions, however. Braid only rarely pro- 
ceeded so fhr as to induce aetnal nneoiiseion» 
Bess. Whilst in a semi-cataleptic ooadition the 
patient's attention ia stioogly dirseted to tho 



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13S 



BBAIOmiL 



■ottnd put, and Mine Tei^marrelknuinitaiieM 
of mUsi US raeorded bj hun, said to bars been 
effeoted nsder the inflneoce of this facility only, 
vithout the aid of inu^pnation, since eome of 
the patisnta opented npon vere quite ineiedu- 
knu M to any good being likely to reiult. In 
a recent work on ' The Influence of the Body 
mpoa tbe Mind,' Cr. Daniel II. Tnke remarke: 
' Bnidiam paaaeues tkia gnat advantage, that 
vhile the Imagination, laith or Expectation 
of the pttient may be beneficially appealed 
to, this u not aaaential; the mere coneentn- 
tion of tbe attention having a remarkable 
influence, when ikilfully directed, in exciting 
the action of eome parta, and lowering that of 
othen. The short period of time required, also, 
oompares fiiTonmbly with that consumed in 
some other forms of mental thenpeutics. . . . 
The great principle which appean to be involTed 
in all is the remarkable influence which the 
mind exerts npon any organ or tissue to which 
the Attention is directed, to the exclusion of 
other ideas, the mind gradually passing into a 
ftate in which, at the desire of the operator, 
portions of the nerrous system can be exalted in 
a remarkable degree, and othera proportionately 
deprsMad ; and Oius tbe Tasenlant^, innerration. 
and Amotion of an organ or tissue can be 
regubited and modified according to the locality 
ai^ nature of the disorder.' Braidism certainly 
deearres more attention than it has recaiTea, 
tiioogh it is a method Teiy difficult of adoption 
in onUnaiT practice and which, howeTer legiti- 
mate nay be its foiudations, would, unless the 
grsateat care and rigilance were exercised, be 
apt to descend {wrilonsly near to the lerel of 
quackery. Still, if only naif the rasalts which 
hare been attributed to Braidism would foUow 
the mtematic adoption of this method for the 
alienation of many diseases, it is one which 
should commend itself tfi the eameat attention of 
future enquirart who may be able to place the 
practice upon a broader and firmer foundatiim 
than that on which it now rests. 8e* Mhimbisk. 

H. CHABI.T«»t BaSTUK. 

BBAZir, Sieeaae* ol— Oenaral Obaer- 

rationa. — The range of unnatural phenomena 
which manifest themselTcis as the result uf dia- 
tnrbed actions of tho brain, whether from func- 
tional perturbations or structural disease, is wide 
and varied. This result is due to tbe fact that the 
brain, though spoken of as a Single organ, is really 
a congeries of many distinct but functionally re- 
lated parta ; and Auther tothe&ct that this con- 
geriee o^ paita is eontinnous with the spinal cord 
and intimately related to a scattered network 
of ganglia — entering into the formation of the 
narvont system of organic life ; whilst these 
several centiea within and without the cranium 
are brought into connexion, through the interven- 
tion of nerves, with all other structures in the 
body, whether entering intothecompositionof the 
organs of relation, or into diat of the visceral 
eystem. 

The action of particular parta of the biMn 
nury be stimulated, depressed, or anpp r eesed, and 
eiiaer of such altered modes of activity may 
entail a atimulation, deprsesion, or anppressioii 
in the Auctions of me, two, or more distant 
inita of the nervous system. The first class of 



BRAIN. BISBASES OF. 
f ffiiets are apoken of aa iinet, and the seooad 
«a ituUnet symptoms. It is often extmnely 
diiBenlt, if not impossible, for us to say which of 
the symptoms presented by a patient safferiajp 
from organic disease of the brain should be 
ranged under the one head and which under the 
other. Our ability to make such distinctions is 
at prvsent hindered by our still incomplete know- 
ledge ooneeming the anatomical details of the 
brain, the proper fonctions of its several parts, 
and the precise modes in which they oo-operato 
with each other. 

The effticts of a shock, whether produced 
by injury or disease, falling on such an extensive 
assemblage of sensitive and mutually related 
organs are, as may be well imagined, subject 
to much variation; and as a matter uf &ct it 
happens that in difierent cases of structural 
brain disease, the symptoms produced are de- 
pendent upon three factors, vu., the tituatvM, 
the exttnt, and the mddmnen of the lesion. 
Except in so far as the nature of the lesion 
tends to entail variations in one or other of 
the above-mentioned respecta, it is not of much 
significance from a clinical point of view (iA 
it does not lead to much difference in the 
sets of symptoms produced) whether we have 
to do with a case of hemorrhage into, or with 
a case of softening of the brain. Thus the 
' locality ' and extent of the lesion in the case of 
a local disease of the brain has always to be 
enquired into aa a pfoblam altogether apart 
from that as to the more or less distinct nature 
of the pathological change in the part afiected. 
In other words, the probUm of diagnosis in brain 
disease is twofold ; it must have reference to 
the region affected (Re^onal Diagnosis) and to 
the pathological cause (Pathological Diagnoais). 
The causes interfering with the progrees of our 
knowledge in - the former direction are both 
numerous and baffling, ao that, aa yet, oompai»- 
tively little progress ^has been made. 

SnpTOHs,— The most frequent effects or 
symptoms of Ainetiooal or structural brain-dis- 
ease may be thus classified : — 

1. PanvzBTBD SKirsATioir axd PrjicnTioN. 
— The special senses of smell, sight, hearing, 
touch (fifth nerve), or taste may be interfered 
with by diseases of their respective nerves or 
primary ganglia within the omnium. Owing 
to the decussation of tbe optic nerves, disease (n 
the optic tract gives rise (most frequently) to 
an affection of the sight of the opposite eye. 
The sense of taste pertains to different nerves. 
Thus the gloaso-phaiyngeal has to do with this 
special sensation in ^e back part of the 
tongue, the palate and Ihucee ; whilst the taste- 
nerves for the front part of tjio tongue, though 
they pass from these parta with the lingual 
branch of the fifth, seem to leave it by the 
ehorda tympani and then proceed to the brain 
with the faoial or the fifth nerve. Diaease of 
the intracranial portion of the fifth nerve may 
not affect the sense of taate, though it impairs 
the common sensibility of the tongue. 

Diaease of the primary ganglia of theas nerves, 
whether thny are separate (first and fifth) or 
lodged in the brain-substance at ita point of 
connection with the nerve, will prodnoe decided 
iBjiainieBt of the eeveral special sensn. Bat 



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BBAIM, DXSKA8BS OF. 



dnraae of portioos of the bnin abore thcM 
Keioci on one cide only, even thongh very 
•xtmsire, often exists vithont disturbing the 
cxcrciie of the cpecial eenses on either side. 
Hera may, hovever, be Itliuioiu, Halluematioiu, 
or DdiuionM in nmnectica with either of these 
■eoan in many functional and itructoral dieeasee 
of the bnin, where the morbid condition ia eitua- 
tei in ports higher np than the primary gitnglia, 
vt There there ii a ftnctional exaltation of the 
ganglia themaelTes. This Utter ftmctional ex- 
altatioa aeema aomctimea to be faronrad by 
morbid atataa of aome of the riecets — rapecially 
of the atonmch, or of the ntems and orariea. 

I>isea>« in the brain may also impair the oom- 
noB leaaibility of the body, and in aome of the 
moat marked caaea, this impairment is strictly 
limiiad to one lateral half of the body (llemi- 
aacatham). It may be Tery marked and laat 
for a loag time ; or it may be slighter and present 
saly far a few days. There are several modea of 
impremfaility eomprisrd under the term ' com- 
ssOB saoaitaUtT.' The principal rarietiea are 
tactile impreaatoDS, impreasions prodncrd by 
difleteacea of pisaaui e and of temperature, ira- 
preaaioBS yieJdiag pain, and lastly those of the 
so-called ' araacBlar aanse.' There is, moreorer, 
maibility pertaining to the muscles 
jsiat-textmea, and the last may be pro- 
fouadly impaimd in aome cases. The writer be- 
lieTCs that what tlMie ia of conscious impression 
pntaiaiag to that endowment known aa the 
■ oraacalar seoae,' ia compounded of the ordinary 
II nil I of toorfa and pressure pertaining to the 
•kin, ploa aeoaationa in joints and muadss ac- 
eraintc fram the contnetioo of the latter. 

BeU'iea diminutiooa of sensibility, wa oiten 
*aaTa to do vith disagreeable sensations of numb- 
naaa tin^n)(, or actnal neuralgic paina in parts. 
The two ffinaer may be widely distributed, 
Iboogh nearalgia from braio.disoase ia prinei- 
laily limited to the territory of the fifth nerves. 
2. PKBTawran Eaonox ahd loiAnox. — 
IliaaB manifestatians Taiy, from the mere in- 
.avased tmJracy to emotional displays seen in 
a faysteneal penoo or in persons suffering from 
booipJe^ia, to tiiase more complex aberrations 
Bet with in the Tariooa forms of delirium and 
inaanity (aec iMsucmr). 

3. PcBTZBSioifa or Coxsaotrsmus. — Under 
this bend may be included the comparstiTely 
rare statea known as somnambulism, ecstasy, 
and eatalrpay ; aa well as the exceedingly common 
eooditiosa of drawaineaa, stupor, and coma. The 
tartatt may be aaid in almost all caaes to be 
aaaoriatel with functional rather than with 
■tiaetnrsl diaeaae of the brain ; at least, this is 
most in aeeacdanca with our present knowledge. 
Drawsioeas, stupor, and coma are, however, 
aaoo^st the commonest results of organic dis- 
•Ma of the brain (see Coxsciocsifsaa, Disorders 
»l), though tlwy are also common conditions in 
Uooi-pinaoning — whether arising from fevers, 
■raaua, or from poisonous doses of opium or 
«f other aareotie or narcotico-irritant poisons. 

t. PanvBaioiia or Hotiutt. — These maoi- 

iiest tlisiBsiliiii in many forms, which, however 

diariact thry may appear to be, are, neverthe- 

iaaa, eloscly linked to one another. 

Tnmn may ba general or local, and in th« 






^-r-^'S' 



.Of 



latter caae they may be most 
tongue and facial muscles — prir^ 
about (he comers of tlie mouth or ^J"* 
palpebmrum. General tremora nn 
debility, over-exertion, nervousne*"- -'.'''■ t^,_ 
may be due to alcoholic or ^a^^^^'^l .Poi^^ 
ing, or to degenerative disease abo*** '«• pf^j^ 
and medulla, as in Paralysis Agitso*- 

Twitckitigt may be cliuractcristic (Va ft'ghlr 
nervous habit of body, and are atp^uUly ^^ 
quent in some epileptics in the intervsb ''•■twaea 
their fits, either in some of the facial muscles or 
in those of the neck or limbs. They mar mlao 
occur in acute febrile affections, in which the 
functions of the cerebrum ate involved, as shown 
by coexisting delirium, &c., and also in the 
course of many organic disrasea of the brain. 
In chorea the irregular movements of different 
parts of the bndy are often of this nature ; they 
may affect both sides of the body, or only one 
(hemi chorea). 

Spajimjofa continuous or 'tonic' character are 
encountered in \'arions diseases of the nervous 
system, such as laiyngiamus stridalna, trismus, 
hydrophobia, tetanus, hysteria, and some forms 
of hemiplegia and paraplegia. Such tonic 
spasms produce muscular rigidity, which has to 
be distinguished from that due to chronic changes 
apt to recur in paralysed limb*. 

Clonic Spams or CoHVuUumi maybe eitha 
uniUteral or geneml, and may be induced by 
the most varied causes. When well-marked 
they are mostly attended by loss of conscious- 
ness, aa in epilepsy and the majority of epilepti- 
form attacks. 

Co-ordinattd 5^«m(, or movements of astrag- 
gling type, are met with in many epileptiform 
and hysterical paroxysms. Spasms oi this type 
may be alao limited to particular groups uf 
muscles, as in ths conju^ted deviatioD of the 
eyes and neck occurring in hemiplegia in wry- 
neck, inwriter's cramp, and other afli^affectioas. 

Para/ysit may be local and limited in seat to 
some of the ocular muscles, the muscles of mas- 
tication, the Aiclal muscles, tluwe of the tongue, 
or to parts supplied by the spinal aeceaaoryand 
pneumogastric nerve, in those case* in which 
there ia merely an implication of the intra- 
cranial portion of one or more of the motor- 
cranial nerves ; or it may take an incomplete oi 
a complete kemijiegio type, with lesions limited 
to one half of the encephalon; or it may be 
general, and involve both sides of the liody, 
if a large lesion exists in the pons Varolii, ot 
if the functions of both cerebral hemispherea 
or their peduncles are gravely interfered with. 
In some of the.-'e cases, and especially with 
right-sided paralysis, vsriuns difficulties exist 
in giving expreasion to thoughts by means of 
speech or writing (ms Afuasia). Uelicient 
action of the will (without obvious structural 
change of the cerebrum) may causa paralysis in 
hysteria and allied Htates. 

D^ectii'c Co-ordinatiom of muscular acta is met 
with, aa in stitmrnering and in some hemiplegia 
defects of speech ; also in the body generally in 
some cases of cerebellar disease, producing a 
peculiar and unsteady gait (titubationj cIomIj 
resembling that which may be met with in 
alcoholic intoxication. SimUaz motor disticb- 



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134 



BRAIN, DISEASES OF. 



I m&y be induced by vertigo of veU-m&rked 
•xteot. Vomiting, again, ia e reflex motor act due 
to impaired cOKii^ination, which oceun in many 
farms of bnin-diaease. More rarely tli* sphinc- 
ter sni and the sphincter veaioe tjeeome relaxed, 
or the bladder may be panilyied. Bat incvn- 
liaeDea of fecet or of urine, or inability to 
Toid the nrine, are comparatirely rareljr met 
with as a lesnlt of brain^isease, except in the 
cHnatoM state, or in patients who are more or 
leas demented. 

6. NnraiTiTs on Tbophic Chxhobs. — With 
lesions in the motor tract of the brain in or 
below the corpua striatum a band of degenera- 
tion is produced, occupying pert of the cms 
cerebri, toe pons, and the medulla on the same 
hide, and (below the decussaUon of the pyramids) 
the opposite lateral column of the spinal cord. 
This is one of the most important of the trophic 
changes ocensioned by brain-disease, because the 
degeneration in the lateral column of the ootd 
i* apt to spread to the contiguous grey matter, 
and thus to gire rise to some of the trophic 
ehanftes prone to ensue in paralysed limbs. 
' Tlt^hic chiinges in other organs occasioned by 
soma serere lesions in the brain appear as low 
inflammations and congestions of the lungs, or 
as hemorrhages into these organs ; also as 
hemorrhages beneath the pleura or endocardium, 
or even into the snbstance of the suprarenal 
capsules or kidneys. 

Again, we may hnre acuta sloughing of the 
integument in the gluteal region on tne parar 
Ined side, dropsy or paralysed limbs, inflamma- 
tions of joints and of the main nerres of 
paralysed limbs, and, thongh more rorelr, 
marked atrophy of paralysed muscles, Betard- 
ation or arrest of growth is also apt to occur 
in paralysed limbs, when we hare to do with 
infants or young children, suffering from serere 
organic brain-disease. 

Blanching of the hair, or altered pigmentation 
of the skin, also occurs not nnfrequently in con- 
nection with brnin-disease or violent mental 
emotions ; whilst in the insane the nutrition of 
the bones and of the pinna of the ear is api to 
be interftred with, 

6. PxBTicBTKD ViBCBBU, AcTioxs. — Exalted 
BOtirity of the uterus, bladder, intestine, stomach, 
or heart, may be oecnsionerl by functional brain- 
disturbance mure especially; whilst the same 
bnin-conditioDs may gire rise to depressed or 
exalted activity of the liver or kidneys. With 
other functionally disturbed or emotional brain- 
states there may be u lowered functional activity 
of the salivary glands, of the heart, of the respira- 
toiy organs, of the organs of deglutition, of the 
organs uf digestion, or of the sexuiil organi. 
These are only to be taken as mere indications 
of the kinds of modiHcation that may be pro- 
dneed in visceral activity by bniin-disenxe. Much 
doubtless remains to be learned in this direction. 

It seems fitting here also to mention those 
eontractions and dilatations of vessels which are 
apt to take place in different parts of the surface 
of the body, or in internal organs, from stimu- 
lation or contraction of vaso-motor nerves, oo- 
eosioned either by direct or indirect influence 
exerted upon the principal vaso-motor centres in 
the region of the pons Varolii. These oontrao- 



tions or dilatations produce correlated altontion* 
in the temperature, sensibility, and fanctionol 
activity of the parts or organs affected. The 
temperature of p<tnlyaed parts, as well as the 
general body temperature, in the apoplectic stats 
is subject to great variatioOH, and tbe«s ore new 
begiuning to be studied more attentively. They 
ore capable of yielding diagnostic indications of 
great value. 

BaxABKS. — Some general remarks on the 
subject of stmctmnd and functioiud disease* ai 
the nervous system, showing how intimately 
these two classes of disease are related to one 
another, will be found in the article MiiKvom 
Ststsii. Most of what is said there is applic- 
able to diseases of the brain in particular ; hare, 
however, it is necessary to call attention to cer- 
tain points specially related to brain-ili8ea8& 

When paralysis occurs fiom brain-disease ofisct- 
ing one cerebral hemisphere, in the grant rn^wity 
of cases it is situated on the opposite side of the 
body, owing to tbe fact that the fibres conveying 
the volitional impulses to the muscles decussate 
in the medulla oblongata. It is tme that many 
cases are on record in which the posalysis 
either has, or has been said to have existed on 
the same side as the brain-lesion. A certain 
number of these cases ars probobly due to emre 
either in the clinical or in the post-mortem 
records of the case. Others, however, etill 
remain unexplained. The characters of the 
various forms of paralysis due to brain-disesse 
are briefly set forUi in the article on PARA.i.Tsia. 

Lesions of the left hemisphere much more tn- 
qnently than those of the right, are associated 
with apbosic defects of speech ; whilst, accord- 
ing to Brown-Siqnard, lebions of the right hemi- 
sphere are more frequently and rapidly fatal 
than otherwise similar lesions of the left hemi- 
sphere. They are also more apt to be associated 
with acute sloughs of the skin on the paralysed 
side. Convulsions at the onset, and subsequent 
tonic spasms of the paralysed limbs, are also said 
to be more fluently associated with left- than 
with right-sided paralysis. 

Congenital atrophy of one hemisphere, or 
atrophy occurring in early infancy, is mostly 
associated with an arrest of growth and develop- 
ment in the limbs on the opposite or paralysed 
side of the body. 

Very little is positively known eoneeming the 
diseases of the cerebellum. Of its functional 
affections we may be said to know absolutely 
nothing. That is, of the various ftinctional dis- 
eases of the nervous system with whose clinical 
characters we are familiar we are unable to name 
even one which we can positively say is a func- 
tional disease of the cerebellum. Whatever the 
precise mode of activity of tbe cerebellnm may 
be, there is a general eunsensus of o^rinion that it 
is principally, if not exclusively, concerned with 
motility, and that it has more especially to do 
with the higher co-ordination of muscular acts. 
Atrophy of one hemisphere of the cerelmm is 
fallowed by atrophy of the opposite half of the 
cerebellum, so that there is a strong presumption 
that the functional relationship of either half 
is with muscles on the same side of the body. 
Clinically we know that disease of the eerebeil- 
lum is not unfirequently associated with more 



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BHAIN. DISEASES OF. 

or Um maiked piumljsU on the oppomte side of 
tiw body ; bot thiit effect is nov genenUl; 
altnbBted to the presanre which etmctural dis- 
matB of the cerebeUuiii are apt tu occaaion on 
the poos snd mednllii of the aame side. 

JBnoLOCx. — The principal modes of caiua- 
tioa of diaeaaes of ih» bnia may b« thus anm- 
■ariaed: — 

1. D^eciiae NitirUion operate* by modifying 
tlu pioper oonatitntion of nenre-tisaiiei as veU 
■a the eoDStitudoo of the blood, and thereby in- 
tarfBiing with ihe normal functional relations of 
the aereral parts of the brain. Anemia, chlorosis, 
sypliilia, ague, and all lowarad states of health, 
howsoener indnced, and vhether acquired or in- 
hnited. become predisposing or actual causes 
*f brain-diaenae. To these states, &Tourable 
to the manifstation of brain^diaease, should be 
added the rarioas acnts speci &c diseases, niamia, 
■ctallie poisaning, poisoning by the narootie sod 
aafeotiooHrtitaat poisons generally, and also by 
tks mrnrinurl qualities of certain articles of food, 
sadi as naekeral, mussels, mushrooms, &c. 

2. EMtalimai Skoekt cause cerebral disorder, 
especially iu childrvn, or prolonged orenrork in 
tfaose Tfao sxe older — porucnlarly when com- 
billed with wony snd anxiety, with sexual ex- 
cesses, or with protracted lactation. Beligions 
exeitosant, sgais, not unfrequently leads to in- 
saaity. 

3. Fkftiologiettl Criies, sach as the period of 
tlte fint dentition, the period of puberty, pirg- 
aaney, and the climacteric period, uU &TOur the 
isainfHtatioas of Tariooa nerron^ diaeases. 

4. VueertU Daeata or sur&ce-irritations 
(sspedally in ehiMien or in persons having a rery 
seBHtiT* and mobile Dsrroas system) may give 
rise to varied nemns diseases. Thus we msy 
kxre cosralsiaDs or delirium in children ftom 
tfaa pRseoc* <j(w(ams or other irritants in the 
intsstines, or cooTslsions in adults during the 
psi^age of a tesal calcnloa. Again we may hare 
the plmomeoa riswed as hysteria, or we may 
ban wfniphaiaania, in consequence of certain 
states of (he sexual organs. (Jases of paralysis 
are said also to hare a reflex origin occasionally, 
tfaoagh this most be a very rare erent. With 
■UKh greater frequency we find surrace-irrita- 
tioBS of -nuions kinds lending, as in Dr. Brown- 
geqoard's gninea-pigs, to epileptiform attacks. 

5. Bbrmctmrml Utioiu of the bmin itself gire 
rise to a Teiy large proportion of its disonses. 
The TBrioes kinds of change will be found enu- 
mnstad under another heading (<« Mbbtous 
Srsnof). HJ Mu or ih agg and softening are the 
moat coanoo and, therefore, the most im- 
pottsot of tbrse morbid conditions. 

6. Bnin-diseasa may be determined by the 
aetiaa of Heat {intolatto), especially when com- 
bined with fiitigne and deficient aeration of blood, 
A aooewhat similar brain^ffection, howerer, is 
secasiaiially dereloped in the course of rheu- 
■stie ferrr or in that of one of the specific fevers, 
ia whiefa the hody-temperatiire rapidly rises to a 
lethsl extant ( 109°-1 1 1° F-)- 

7. Chmeusrioms (whether £rom blows or fnUs) 
aMy girs rise to brsin-diaeese, eren where no 
tmnmatic injariea or lacerations of the brain 

are Bcndand. . , . ,. 

TMMtJMmrT. Tlie tieatmeot of brain.disease 



BBADI. ABSCESS ^J jj/> 

will be discussed under th» ^i^,«ft-j ^lts^„,r^ 

the several .ped.J disease, ^t**^ ^H ^'*» ^ 
described in iJpbabotinil ordei^- .. -,.- ^ " "^^ 

BBATN, Abaoess ofc-Thi» rfT*^ /, **»• 
able whenever a circumscribed *'^'li'*''oo 2f^^"^ 
is formed in any part of the eorw*'J*' ""Ms^ ■''"' 

£tiologt akd Patholoot- "'"Ogmt 

most freqnentcnuses of cerebral »»*^****»«reM *'" 
injuries to the skull, disease of the '^'"pom'Vy" 
in connection with the enr, ligatu" or obeb^"* 
tion of a main artery, and pyemi*. I7nci«y iaT 
three first-named conditions the abscess is tmuaUv 
solitary, but from pyaemia multiple abscessea 
often result. For pmctical purposes we tnny per- 
haps conveniently discard the latter — since the 
symptrjms will usually be those of geneml ence- 
phalitis — and confine ou'selves to those cases in 
which single large- sized collections of pus are met 
with. With this limitation, abscess in the brain 
is by no means of frH]nent occurrence. 

The best marked, and also the more common 
examples of large brain-abscess are met with in 
connexion with compound fractures of the skull, 
and by far the most definite symptom which de- 
notes them is the formation of a fungus cerebri. 
Unless in a compound fracture the bruin be 
directly injured and the dura mater torn, it is 
very rare indeed for any suppumtion in its sob- 
stance to occur. It is not to be denied, howerer, 
that now and then, after severe conctission or 
laceration without external wound, abscers may 
follow. Ill such cases we may conjecture that 
usually some slight laceration or extmvHsation 
occurted in the first instance, which constituted a 
focUB for the infiamniation. Abscess after simple 
concussion without lesion is probably a most 
nra event. 

In the article Bbaih, Inflammation of, we 
shall have to define Encephalitis as a diSuse 
change of a large part of the cerebral mass, per- 
haps of a whole hemisphere, attended by the 
infiltration of cells and fluid. It is obvious that 
the term abscess in the brain is applicable to 
one of the results of encephalitis, but it seems 
clinically probable that the two classes of cases 
are for the most part distinct, and that difiiise 
encephalitis has but little tendency to result in 
abscess, and that abscess is rarely preceded by a 
stage of encephalitis. Both are usually the con- 
sequences of local injury to the brain, or of ex- 
tension from local disease of its coverings ; but 
whilst encephalitis probably resembles the ery- 
sipelatous type of infiammatory action, in loca- 
lised abscess this tendency is not present. 
Having distinguished brain-abscess from ence- 
phalitis, we must next say a word as to the risk 
of confusing it with intra-cranial but extra- 
cerebral collections of pus. Encysted collections 
of matter may be met with either between the 
dura mater and bone ; or within the arachnoid 
cavity; and perhaps it ought to be added, though 
with some hesitation, beneath the amehnoid, in 
the pia mnter. Not unfreqnently inflamnution 
of the membranes precedes and attends the foT> 
mation of an intra-eerebral abscess, and in these 
cases the symptoms will, be mixed. In dealing 
with published cases it is also necessary to be 
on our goaid as to certain errors which have tangl 



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186 BBAIK, ABSCESS OF. 

in — MM* of mamDgeal abtccas being spoken of 
M brain-abwen. Mr. Frescott Hoirsu has ez- 
prassed his opinion that the celebrated case of 
be U Fey romp's vas hu example only of extia- 
cerebral abscess. It is absolutely necessary to 
make these restrictions if we would judge cor- 
rectly as to the symptoms which attend local 
r/jllectious of matter ID the brain and the usual 
terminations of such cases. 

SmPTOiu. — The symptoms of local suppnra- 
tioo in the brain will vtaj with the stage, the sixa 
of the collection, its precise situation, and, abore 
all, with the presence or otherwise of a fistula of 
relief. In many of the cases which come under 
•ot^^cal care a fistula exists from a veiy early 
period, though not unfrequently it is liable to 
occlusion. Under the latter conditions the symp- 
toms of a closed and an open cerebral abscess may 
be altemntely studied in the same case. It 
will usually be observed tliat when the exit is 
dosed and the abscess fills, the patient complains 
more or less of headache, becomes heav^ and 
drowsy, experiences twitchings or spasms in the 
opposite side of the face and limbs, with some ten- 
dency to hemiplegia. Of this group the tendency 
to spasms is probably by far the most significant. 
The headache may be but trifling, and the pa- 
tient may eren be well enough to Uare his brd, 
when the occurrence of spasm followed by pare- 
sis alone gives warning of what is going on. 
The cases now alluded to ai-e chiefly those in 
which abscess results from compound fracture 
of the skull with laceration of the brain-snb- 
■tanca. In these the abscess often gives way 
■pontaneoosly, and a fistula forms, around the 
orifice of which a mass of pouting brain-granu- 
lations, known as fungus cerebri, usually forms. 
In these cases the canal of communication may 
be very tortuous, and the liability to blocking 
considerable. Now and then the same result 
may be met with after syphilitic disease of the 
skiill and meninges. The writer had some year* 
ago a man under bis care in whom he had opened 
a cerebral abacen beneath a hole in one parietal 
bone. The patient was able to walk about, and 
ailed but little so long as the fistula w&s freely 
open; but spasms of the face, or even convulsions 
of the limbs (on the opposite side) always fol- 
lowed its ocelosion. The softening gradually 
extended, and he at length died in consequence, 
perhaps, of the impossibility of making a counter- 
opening in a depending situation. Unless the 
abscess be in the anterior lobe, there will almost 
invariably be present some degree of hemiplegia, 
but this will of course vaij with the size of the 
collection and the extent of destruction of tissue. 
The formation of an abscess after injury is some- 
times very insidious, the symptoms being very 
•light. The cases in which violent headache 
and pain, vomiting, delirium, and dry tongue, 
are said to have been present in the early stages 
are, tlie writer suspects, usually instances of 
suppuration between the bone and dura mater. 
These symptoms occur especially when brain- 
abscess follows disease of the internal ear, and 
in these there nearly always is the complication 
of inflammation around the petrous bono. Such 
symptoms are very rarely present in traumatic 
abscesses, which often develop very quietly 
jutil they attain a considerable size. It i* pro- 



BBAIN, ASXIOA. OF. 

bable that some degree of rigor, attended by 
rise of temperature, usually occurs in the begin* 
ning of cerebral abscess, but no Tery precis* 
data are extant on these points. 

The contents of a braio-absceas umally oon* 
sist to some extent of bruken-up cerebral tjsros, 
and in some cases there are but very few pa*. 
cells. Eapecially is this likely to occur i^en 
the so-called abscess follows on ligature of the 
carotid or occlnsion of a cerebral artery. In these 
cases, it is in the first instance at least the 
result of a process of softening rather than of 
true suppuration. 

If a laise abscess be permitted to develop 
without relief, the qrmptoms of compression 
will in time ensue : first *pasm, then hemiplegia, 
then hebetude and ooma, preceded possibly by 
violent convulsions. 

DuQHosis. — The diagnosis between cerebral 
abscess and meningealabsceas is exceedingly difil- 
cult, and often a guess is all that can M mado. 
The almost invariaUe occurrence of spasm or con- 
vulsions in the former, and their frequent ab- 
sence, with the greater degree of pain and head- 
ache in I ho latter, are the most reliable sign*. 
Sometimes— as, for instance, when trephining 
has been practised, and no inflammatory products 
are found between the bone and dura mater or 
under the latter— the diagnosis may be helped by 
this negative knowledge. In such cases, if hemi- 
plegia, preceded by spasm, have been gradually 
developed, the soigeon will be well justified in 
multing an incision or puncture into the hemi- 
sphere. Optic neuritis may equally be present 
in both, and its presence or absence will scarcely 
heU> the diagnosis. 

Fkookosis. — In addition to the danger of 
death by compression, there is the risk that ths 
abscess may break into the ventricle* or into the 
subarachnoid space. Some cases are on record in 
which spontaneous openings into the nose or into 
the eOr occurred, and profuse discharge followed, 
the patient in the end reoovering. It may be 
doubted whether these were not instances of 
meningeal abscess. 

TaaiTiuarr. — It is needless to say that if ab- 
scess be diagnosed with aqy degree of confidence 
an opening is essential. There is little or no 
room for medical treatment For the prevention 
of abscess, in all coses in which ii^juries likely to 
produce it have occurred, the utmost precautions 
should be enforced. Mercury in small doses, fre- 
qently repeated, should be given from the first ; 
tile iiuured region should be covered wi th lint 
soaked in a strong spirit-of-wine lotion, frequently 
re-wetted; purgatives should be administered; 
and the patient should be kept very quiet until 
long after the healing of the wound. 

Jo:(ATBAl( HUTCHUCSOV. 

BBAIIT, ATijBTTiii^ of. — Dbukition. — A con- 
dition in whidi the blood contuued within the 
capillaries of the brain i* deficient in quantity, 
or defective in quality. 

The blood within the braio is contained in 
arteries, capillaries, and vein*. The functional 
condition of tlie brain depends on the quantity 
and quality of the blood circulating in its capil- 
laries, and it is to these that the special symptoms 
are related. Deficiency in the quality of the 



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BKAIK, AK£MU OF. 



I»T 



Uood mpplied to the brain is always of gndoiil 
oeciiR«ae8,aodaffeeta the whole brain : deliciency 
ja qoutitj of blood may affect the whole brain 
or put onljr, and it may be sudden or gradual in 
iti {sodvcuon. 

J^ioLoex. — Gttteral etrAni ananiaa may be 
due to the following eaniee: — (1) It may be a 
part of systemic amemia — defect in quantity or 
qvtlity of the whole blood, and due to ciuscs 
i^eh are considered ebewbere. This is often 
seen in eases of hsmonhage, of exhausting 
disehuges, or of defective blood-nntrition, as 
in chlorosis. (2) The supply of blood to the 
brain may be deficient, the quantity of blood in 
the body being normal. This may be due to 
cudiae weakness, or to causes acting througb 
the DOTOQa ^stem oo the heart, as in swooning. 
In systemic aosmia, the lessened cardiac power 
inn I asm the eerebral deficiency. Whatever 
IcsscBB the amcnot of blood diseharaed from the 
heart at cadi systole, such as aortic or mitral 
diaeaae, may be a cause of errebral ansmia. 
Freaesie on the Tassels conveying the blood to 
the head, as fay an aoitic aneurism, has a similar 
effect. Uneqoal distribution of the systemic 
blood is another cause. The intestinal vessels, 
if dilated, sre easable of oontaining a large part 
of the Uood of the body, and the effect of their 
e u g ui gemrnt is often seen after paracentesis 
ahdomims. One theory of shock ascribes its 
laechacism to vaso-motor diUtation of these 
vessels, and cooseqnent amemia of the rest of 
the system. The effect of each cause is increased 
by tbe action of gravitation in the erect posture. 
Suae causes act only in that position. (3) The 
capacity of the cerebral vessels may be diminished 
by -pTcsBore on the brain, exerted by effusions 
of fluid (hydrocephalus), of blood (in cerebral 
aad meningeal bamorfaage), or by growths within 
theskalL 

Vartial erreiral namia is due to some ob- 
stroctian to the pa mage of the blood through 
the veasela. To be permanently efficient such 
obatrartion most be situated beyond the circle of 
Willis. ligature cf one carotid causes immediate 
symptoms of cerebral anemia, but permanent 
symptoms are not frequent. Pressure on, or 
i^isBSsa of one carotid, for the same rrason rarely 
gives rise to symptoms. Obstruction in cprtniu 
uterics of the brain may cause local amemia, 
sadden or gradual, temporary or permanent, 
acsording to its cause. Snch obstruction may be 
doe to nanowing of the calibre of the vessel by 
atheromatous changes in its wnll, or by rpasm 
of its mnscolar ooat, or may be due to actual 
ocdosion by oabolism or thrombosis. The 
praBnu«.eflaets of an intnding substance within 
tbesfcoll (tomour, or clot) act most intensely in, 
aad may iaflTwnee only one region of the brain. 

It is obrioos that of these causes some act 
Biddeniy, otiien gradually, and the symptoms 
pndand will differ accordingly. 

AxAToiocax. CBaBAcnna. — The principal ana- 
ttwcal character of cerebral ansemia is pallor 
of the hcsin, o b i u i a ble chiefly in the paler tint 
•f the entieal rabstanee, and the diminirhed 
nomfacr of red spots in the white centre. The 
nalior may be partial or general. The mem- 
onuMa are asaally pale, bnt in some cases of 
paxtial -■——?- tbey are hyperEmic. Effusion 



of semm in the meahe* of the pia miter aad 
between the convolutions, may be found in 
general anaemia. 

Stkptoiis. — The symptoms of this eondition. 
vary aocording as the anaemia is suddenly or 
slowly produced, and as it is general or partiaL 

(1) In mOm general anaemia of the brain the 
sufferer feels drowsy; the special senses are 
dnlled; noises in the ears and vertigo are oom- 
plained of ; the pupils are at first contracted ; 
sight may &il ; rouwular power is waaksnad ; 
respiration is sighing; the skin is pale, cold, and 
moist; nausea is common ; and headache is rare. 
If the anaemia is more intense, consciousness is 
lost ; there is nniversal paralysis ; and general 
conrulsions may occur, epileptiform in character, 
these being especially frequent in sudden exten- 
sive losses of blood in strong subjects. The pupils 
dilate, and the ooma may deepen to death. Tbe 
loss of sight in cases which recover may persint ss 
permanent amaurosis. 

(2) When general aiueroia of the brain is 
tUruly produced, tbe state of the cerebral func- 
tions IS usually that of 'irritable weakness.' 
Their action is imperfect in degree, and ezcitsd 
with undue facility. There is mental dulness 
and drowsiness; sometimes, however, insomnia 
is troublesome. Delirium is common in severe 
cases, and is conspicuous in some forms of im- 
perfect blood-nutrition, as in the so-called 
' inanition delirium.' Headache, usually general, 
is a common symptom. Sensory hyperssthesiae, 
tinnitus, muecae volitnntes, and vertigo are it*- 
quent. Convulsions are rare, but muscular power 
is generally deficient. All these phenomena are 
more marked in tbe erect than in the recumbent 
posture; especially when the erect posture is 
suddenly assumed. It has been remarked that 
some amemic persons can think well only whan 
lying down. In young children, after exhausting 
dischargpB, as diarrhoea, symptoms referable to 
cerebral anaemia are common, namely, somnolence 
and pallor, wiih depressed fontanelle and con- 
tracted pupils. The somnolence may deepen to 
coma with insensitive conjunctiva, and thecoma 
increase to death. Snch symptoms have been 
called hydroeephaUa, from some resemblance to 
those of acute hydrocephalus. 

(3) Partial cerebral anaemia causes, if complete, 
loss of function in the affected area ; and if it be 
permanent, as in obstruction of n vessel beyond 
the circle of Willis, necrosis of the cerebral tissue 
results (tet Bbaiv, Softening of). If incomplete and 
sudden, there is temporary arrest of function. 
Ligature of one carotid, for instance, causes 
transient weaknesii and numbness in the opposite 
half of the body. There may be at first an over- 
action of grey matter, causing, in certain regions, 
unilateral convulsions. If slowly developed, as 
in atheroma of arteries, pain and vertigo are 
common, with recurring local symptoms, snch as 
numbness, tingling, and weakness. 

In all cases of longK^ontinned cerebral anaemia, 
permanent damage to the nutrition of the brsin 
may rrsult. In the child the development of the 
brain may be arrested; in the adult, loss of 
memory and of general mental power indicate 
the deterioration of structure. 

Fatholoot. — Tbe symptoms are, as already 
stated, dependent mainly on the defective quantity 



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IS8 BKAIK, ASXtOA. OF. 

uid qnnlity of the blood ciicnUting in the bmin. 
Soma inflnenee may probably be ascribed to the 
diminntioD in the blood- preeeura to whirh the 
narre-elementi are iirdinanly exposed (Burowb). 
Nothnagel has pointed out that the lymptomi 
indicate an early affection of the respiratory 
eantie in the medulla, and of the corticiil Krey 
matter. Kuumanl and Tenner ascribe the ron- 
Tolakma in acnte nnsmia to the irritation of the 
madtiUa ; Nothnaoel, to that of the pons Varolii. 

DiteiKMin.— The diagnoaie is not difBcult. It 
nat* on the reoof^ition, in a giren rase, of the 
causes of eerebnil anemia ; and on the ezelnsion 
of gmrer maladies, as organic eerebnil disease, 
^th the latter, it should be remembered, amemia 
of the brain, local or general, often oo-exists. 
Soma symptoms of hy penemia of the brain closely 
fMambIa those of anemia. A common patho- 
logical state of imperfect blood-ienewal probably 
ezista in both conditions. 

Fboomosis. — The extent to which the canae 
of the annmia is amenable to treatment, and is of 
tnnsient ebanuster, mnst influence the prognosis. 
Asamie this is farourable when there is no or- 
ganic disease of heart, Teasels, or brain. lathe 
so-called 'pernicious aoBmia,' the prognosis is. of 
oonrse, nnftToniable. Hydrocephaloid symptoms 
ia inliants, if met by prompt and suitable treat- 
ment, are nsnally recorerNl tram, 

TvMintsirr. — The treatment necessarily varies 
ia the several forms of the affection, bnt it ia in 
the main causal. The beneficial effect of the 
rseambent poeture in afford-ng immediate relief 
to the aymptoms, and obviating permanent 
damage to the cerebral nutrition, mnst be always 
famsmbared. In acnte anemia firom losa of 
blood, the head mnst be kept continuously low, 
atimnlaDts freely administered, and as a pennlti- 
mata reaort bandages applird to the limbs from 
below upwards may increase the proportionate 
anj^ly of blood to the brain. If this &ils trans- 
ftasion mnst be had reoonne to. In chronic 
anemia sudden change of postnrs should be 
carefully avoided, and fermginons tonics are 
needed. In spasm of the eerebnil vessels, bro- 
mides are useful. In the cerebral anemia of 
syncope, the recumbent posture, stimulants to 
the son, cold water, faradisation, sinapisms, and 
ammonia to the nasal mucous membrane, assist 
the recovrry of cardiac action and the return of 
oonsciunsncss. In all coses, carefully regulated 
food and ttimulants are needed ; beef-tea should 
be given in small quantities, at frequent inter- 
vals. Tho group of symptoms called hydrocepha- 
loid require similar treatment 

W. B.OowBBa. 

BBAH)', Ananriam ot Su Biuur, Vessels 
ot, Diseases of. 

BBAIN, AtrophroC— Atrophy of the brain 
may be congenital, due to arrest of development 
in very early fetal life ; or the constituents 
of the brain may have been perfectly developed, 
and may subsequently disappear from one of 
several canses. This morbid state is regarded as 
primary when there has been no pre-exii>ting 
diaeaae of the brain or its membranes ; lecondary, 
either when there has been such prr-exJRting 
disease, and the atrophy has occurred from 
absorption of the part broken down by in- 
flammation, softening, hemorrhage, &c. ; when 



BRAIN. ATBOPET OF. 

atrophy of some special earabral organ foUowt 
upon deatmction of the particular nerve thai 
arise* from it; or when localised atrophy hat 
taken place in a very gradual manner from pna- 
snre of a tumour, of ventricular efiWon, JCCL 
To take these forms in order : — 

1. CougeuUal atrophy. — This is usually asso- 
ciated with weakness of intellect, even to tha 
extant of idiocy : there is atrophy of the body op- 
posite to the side of the cerebral lesion, and thia 
atrophy iuvolves all structures, even the bones. 
Paralyses of various intensity superrene, of lea 
with oontrartion of tlie paralysed parts ; there 
being no particular sousitiveness of the special 
senses, possiUy because of the mental hebetuda, 
Epileiitie attadu are common; vilaliiy is low; 
and the patient easily succumbs to other diseases, 

2. Primary atrophy. — In this variety there ia 
general diminution both of volume and of 
weight, afTecting moat nsually the cerebral 
hemispheres, and that ia pretty equal degree. 
It is most common as a condition of old age — 
tenilt manumut, atrophia cerebri teniltM. It some- 
times in earlier life follows exhausting diseases ; 
and may also be caused by deficient or impure 
hloud-supply to the brain. In don connexion 
with this mode of causation it is seen after i«- 
peiited attacks of intoxication, especially after 
delirium tremens. In this last condition tha 
cerebral atrophy may be acute and rapid. 

3. Seooudary atrophy. — This may be getieral 
or partial. When genmil, the convolutions have 
a shrunken sppearanca, and there is always an 
increaseof the subarachnoid fluid. This condition 
follows various lesions of the brain, especially of 
the convex surface, such as hemorrhage of the 
convexity, encephalitis, or more accurately that 
form of encephalitis that attacks only the grey 
matter or perhaps only one layer of the grey 
matter, as in some mental diseases. When the 
atrophy is^r^io^ there are found depressions in 
an otherwise normiU hemisphere, at which point 
a localised hemorrhage or patch of softening, 
inflammatory or depending on tlirombosis or 
embolism of vessels, has been absorbed, loaviiu 
only a cavity of greater or less extent, filled with 
fluid and sometimes lined with a thin membrane. 
A certain portion also of the brain may becoma 
atrophied by the gradual pressure of a tnmour 
or any foreign body. Even the little sieve-like 
depressions seen in varions situations after con- 
stantly repeated congestion of vessels may be 
the result of atrophy from compreraion by tlie 
distended vessels. Functional inactivity and 
atrophy of the optic nerves has leii to a similar 
abnormality of the corpora quadrigemina. 

AKATOKicat. Chabactbks. — The atrophied 
brain or portion of brain will vary in appear- 
ance on minute examination, according as tha 
lesion has or has not been preceded by inflam 
mation. When the atrophy is primary and dna 
to gradual interference with blood-snpply, then 
is seen a shrunken condition of the nerve-tissue, 
especially of the calibre of the nerve-tubas. Tho 
cells are smaller than usual and pigmented, tho 
arteries being decrused in size or themselrn 
diseased. If the lesion has had an inflammatory 
origin, tha process in order of sequence is, ttO, 
inflammation, then softening with fatty dagana* 
ration then partial absorption, and so ati^J\y j 



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BKAm. ATBOFHT OF. 
Ibe «ppmuieea diflbring aeeoidiDg to the itags 
•f the Imioo. Xneas of 6My dagBnetatioa of 
•U th* tiimes, — ramtit, ncrre-tnbei, mmI cell*, 
— Bay b* fband, vHh tbe nenroglui eithw mot- 
iar or adcroacd. 

I>r. RadoI|>h Amdt haM lately thtown doubt 
«B the poasibilitj of detarminiog straphj of the 
gugUooie bodiee or nerre-tnba by their sixe. 
'Ae ■» of tfa«aa bodiee varias n gnatlj, within 
the Umita of health, that be eoDiiders this teat a 
Toy ancertaia aim. AlmoEt the ooW tnutwotth j 
■ign at atmphj, in his opinion, is the appeaianeo 
is die snbiteiice of the ganglionic bodiee and in 
Ibe aiedallary sheath of nerre-bnndlea, of black 
riumag gloliBleB, aome^ut bt^looking. In 
jmoess of tame these globniea intrease in number, 
aad at last the vfaole of the bodies appear per- 
■■twl fay them. These globules are not fatty, 
tbey ais erttainiy more or leas pigmental. 
Exactly similar bodies appear, at post-mortem 
examiBatioBa, aad are a sign of simple decom- 
poBtJoa Tbii duration of this condition, irre- 
spectiTB of {s»«iiat>ng lesions, is protracted. 

S iMW ian. — ^The sTmptoma of atrophy of the 
brain nacemarily Taty aeeordiog to the seat, ex- 
tent, and ctiokigj of the lesion. Primarr atrophy 
•f the cerebial hemispheres and the nrst form 
of seeaadaiy atrophy -will most usually induce 
inbarilitT, or soma Isaser degree of mental in- 
saSriesey, loss of memory, slowness of thought, 
sad other mental diseases. Heedache,'giddinen, 
dalirium, and atopor are seldom met irith. Tn- 
t e rf er e u te -with ap«ech is more conunon. Affec- 
tfoos ef sight, sad of the motor condition of 
Iha eye. do not depend on general atrophy oi 
Ae bnin ; they own a more local cause, 

Coemlaocs, paralysis, stiffness of muscles, or 
•oatraeboos sre attea met Tith in connexion 
with tlasgeasral lesion, as -veil as rarious irregii> 
laiitici of kxanatiao : but it most be remembered 
that geeieril stro|iiy cf bnin is not seldom ss- 
eocisted with stmphie or sclerotic lesions of the 
•piaal cnad. and erea where this is not so, 
aeeend of the morbid phenomens, and partien- 
Jartr eoaTuIsaao aad paralysis, may derive their 
arjgia, aot from the atrophy, but m>m the cnn- 
diljaa pra-existent to the atrophy, such as 
kestHsraage of tha eonvsxity, meningitis, or 
peri-«geephalitis. 

la SM oadaiy atrspby of a more limited extent, 
Iks symptoma sre apt to be more strictly local- 
ind, audi as partial loss of power in a single 
Kmb, slight imperfections of speech, or strabis- 
■as; bat hen sgsin the positiTe diagnosis of 
s lw u ity IB hiadered by the complication of pre- 
*-****—* itiwiiisii. the local eongastions, luemor- 
thagsa, softeoiags. tamoois, or other eondiliocs 
€t wfaick the atrophy is only the sequence. Btill 
lam darsrtaiistie sie the phenomena attending 
fmsnl or partial atrophy of the cerebellum, the 
poaa, aad toe medulla oUongata. 

TaasTiaarT. — Treatment is useless as to the 
stnpky of the braia : it must be directed to 
ttffuttiog the poweis of the patient. 

£. Loxo Fox, 



BBAIV, Oaroinoma oC 
of 



Sit Bbaik, Tu- 



BBAIV, O uiuiw aasJon ot. — The bmin is 
eBrntprfrd in tbe p^wlogical seose whensTer j ts 



BRAIN. COMPRESSIO.P' ^j^ //0 
■trocture is so squensed that it» ^*'*gf^Jj**l»il 
any degree interiered with. Tbi.* '^^If^M'^'O*/ 
be effected either by the effusiou <*' ^^ . 'fkUa 
tbe sicull, thegrowth of a tumour, *~i^i, ***'lfii^ 
tioa of pus orsemm, or lastly by th^ - ,'*'*'oitt^ 
some laiga portion of the bony p*'**'** yi^ 
general belief that depresssd tnketur^ «j^ ^^ 
qusntly the cause of eompreesion ia prf*"'>''ly qolfg 
a mistake. In such eases the frngine0t.<'i>|ija«ed 
is rarely of suiBeient size to cause aenoaa ooa- 
preasion of the contents of the BkM an<j u,^ 
symptoms nsuilly sni^iased to indicate (bit state 
are really due in most eases to lacerstion and 
contusion, or to subsequent inflammation. This 
point is of great importaaee in pnctics, for upon 
UK reeognition depends much of tbe validity of 
the reawming by which the operation of primary 
trephining iu compound fnctures is defended or 
condemned. It also oSbrs a most serious fnllscy 
as regards tbe interpretation of the symptoms 
due to compression. 

By far the brat examples of uncomplicated 
compression of bniin are supplied to us by tbe 
not very infrequent cases in which a middle 
meningeal artery is injured, and a laige blood- 
dot is efTused between tbe dura mater and bmie. 
It is from observaiion of cases of this kind that 
the assertion is justified, that a vei^ considerable 
intrwion into the skull is permitted without 
the production of any symptoms. No doubt tbe 
sndaenness or otherwise has much to do with 
the results, but there seems good reason to believe 
that, as a rule, the brain will easily accommodate 
itself to quantities not exceeding an ounce or 
two, and that usually so laige a quantity as four 
or five ounces is required to cause death. It is 
very rarely indeed that a depression of bono in the 
least approaches such an extent of intrusion as 
this, and the majority of such cases are, as reeards 
the amount of possible squeezing, quite trivial. 
The manner in which the accommodation is 
effected is by the removal of the fluid contents 
of the skull, first the subarachnoid fluid, and 
secondly the blood. Of the blnod-vessels the 
veins and venous sinuses are probably emptied 
first, and lastly the arteries and cspilLiiries. A 
brain in a state of strong compression is an ex- 
sangniut-d brain. In this respect, tbe brain in 
the last stage of compression differs veiymudt 
from that in cases of insensibility from con- 
cussion or contusion. It by no means follows 
that because the brain is pale, the face should be 
pale also ; but it is perhaps usually the case 
that extreme compression ro much enfeebles 
the heart's action that the pulse is weak or 
flickering, the respimtion ehallow and irregular, 
and the skin pale and cold. That stertorous 
breathing, a laboured pulse, and a suffused and 
dusky countenance, are (as according to the clas- 
sical description) symptoms of compression, is 
probably for tbe majority of cases a mistake. 
Such a group much more ftrnjuently denotes 
laceration, contusion, or centml extravasation. 
Kor is it true that hemiplegia, except irg of the 
most transitory k'nd, is often due to compression. 
A clot of blood poured out over one bomisphera 
may, if rapidly efiused, produce for a while 
weakness of tbe opposite limbs, but the btnin 
mass is soft enough to allow of coni-idoiable 
yielding, and in the oonise of a few hours tha 



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140 



BBAIN, COMPRESSION OF. 



rfToeU cf til* diiplaeament will have beooma 
genanl. and not local. In a cbm ncoided hj 
the TTitflr ia which a poat-mortem, some ureelu 
lata, proTed the praaence of a large blcod.clot, 
tfaare had been partial hemiplegia without nn- 
eanioionsneaa at first, bat on the next day all 
liaea of it had diaappeared, and it never re- 
turned. In many of the eaaei <.f bleeding be- 
tween the dnra mater and bone, from the men- 
ingeal artrry, the hemorrhage takea place on 
aeveral different occaaJone, with, it may be,inter- 
Tsla of a day or two, mach aa ia often oboenred 
{n woDoda of arteriea, aneh aa the palmar arch. 
Thna the observer is able to appreciate the 
aymptonu otuied by different degrees of eom- 
piesaion, and further proof is affurded that, if 
the intruded quantity be but moderate, the 
brain bears it without obvious inconvenience. 
Often at the autopsy it ia quite ettsy to die- 
tinguiah clots of very different dates, and to feel 
sure that the origiaal one waa of considerable 
rise. It ia dear then that in apeakiog of the 
symptoms of compresaion we must aUow for 
diffarencea in amount of the compreaaing sub- 
stance, and also for differences in the npidity or 
suddenness of its application. 

When compresaion la produced instantaneously, 
as by a large fracment of bone driven down, the 
ease ia almost invariably complicated by con- 
tuaion. If paralysis or even insensibility be 

f>reaent. it ia usually impoaaiblo to say to which 
eaion they are reall^r due. We may, however, 
hold it almost certain, from what we know of 
other eases, that the effects in such would be a 
temporary hemiplegia, with symptoms of shock 
if the depression were but moderate ; and insen- 
sibility, probably soon followed by death, if the 
depression wore very great. The cases in which 
depression of bone has alone been sufficient to 
produce long-continnad compresaion with insensi- 
bility are possibly somewhat apocryphaL It is 
possible that compreesion under such circum- 
stances might be attended by stertor and la- 
boured pulse, but it ia possible also that the pulae 
might be extremely feeble, the countenance pale, 
and inspimtory efrarts weak and irregular. 

The deprension of bone ia perhaps the only 
condition which can be supposed mpable of 
producing compression suddenly. When blood 
IS poured out from a ruptured artery, the symp- 
toms come on rather gradually. The patient 
eomplnins perhaps of headache, and then be- 
comes more or less conAued in manner, his gnit 
is unsteady, and the limbs on the side opposite 
to the injury ahow special weakneaa. Vomit- 
ing may occur and the weakened limba may twitch, 
and unlesa, as ia often the case, the intmcninial 
bleeding stops, these symptoms are soon lost in 
a state of complete insensibility, with pale face, 
feeble pulse, and symptoms oF shock. Convul- 
sions may now occur, and death often supervenes 
very quickly. In such a case the whole course 
of the symptoms may occupy less than an hour. 
The surgeon oaght, of course, to trephine and 
let out the blood, and he must be prompt, or hia 
patient may die during his preparations. More 
commonly this rapid termination occurs unex- 
pectedly after one or more previous attacks of 
temporary head-symptoms^ and the patient may 
hsvtt apfMsied quiM wtU ia the intervals. In 



in which the aytnptoms pro gi e a a without 
interruption, their rapidity, no doubt, depends 
upon the size of the vessel npturod. Certain 
special aymptonu will alao depend upon the pra- 
cise position taken up by the clot which may 
chance to presa upon apecial nerve-tmoka as 
wall aa upon tha bniin-niasa. In ordinary caaea 
the clot la beneath the aqunmoua bone and the 
lower port of the parietal, and posaea duwnwaids 
into the sphenoidal fosaa. In the latter region 
it may preas upon the nervea going to tha 
sphenoidal fissure ; and it ia of importaoea for 
the surgeon to know that dilatation of tha pnpil 
on the affected side ia often produced. Thia 
important symptom ia piolably due to preaauia 
upon the third nerve. 

There it vet another daaa of compresaion- 
cases in whicn that condition is produced by the 
slow ar«ummuUtion of tha products of inflam- 
mation within tha skull. Uuch will depend, 
as regards apecial aymptoms, upon the position 
of thfl abscess, either within or without the braiu. 
If in the substance of the brain, it must more or 
less diaorganiae its atructure, and tbua cause 
s^ptoms due to laceration aa well as compres- 
sion. Under such conditiona some degree of 
hemiplegia, with, probably, preceding apaama of 
limba, can acarcely fail to be present Siow and 
then caaea occur in which an irregular ainua 
leads into an abaoesa-eavity in the brain, and 
this sinns'being sometimes free and sometimes 
blocked, the surgeon has repeated opportunity 
of estimating tha offecta of filling of the cavity. 
In such coses, headache, stupor, unilatenl twitch- 
ing of limbs, partial hemiplegia, with, perhaps, 
vomiting, and, it may be, general convulaiona, 
are the symptoms to be expected. The position 
of the abscess as regards different re^ons of the 
brain is alao of much importance, but its diacua- 
aion cannot be entered upon in any detail hais, 
and it obviously concerns rather disorgaaiaation 
of structure than simple compraaaion. 

When a large accumulation of pua takea place 
between tha bane and dura mater, the symp- 
toms produced are much the same as thoaa 
cauaed by blood-dot. We must make, however, 
much allowance for the fact that theae cases an 
almost always attended by meningitia, and thna 
the symptoms of compresaion are masked by 
those due to inflanmation. Chronie absoMa 
under tha bone without nrachnitia may occur 
now and then in syphilitic and other disease of 
the skull-bones, but such coses are very rare. 
Such cases will differ from thoaa of hsmorrhaga 
in that the symptoma are alwaya produced very 
alowly. The writer once had the opportnni^ 
of watching such a case, in which the patient 
died of compression, yei^ gradually produced, 
and without any complication. The chief symp- 
tom was constant wearing headache, which pie- 
vented sleep. The man was pale and feeble, 
but not paralysed in any part, excepting that 
both eyelids drooped. He waa rational, but spoko 
slo«ly, as if in a state of partial atupor. During 
the lost two or three days of life he had convul- 
sions, and finally, for twenty-four houra, he waa 
in a state of increaiting insensibility. 

DuQNOsis.— It will be seen from what haa 
been said above that the diaguomH of compresaion 
by symptoma ia exceedingly difficult, and that 



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BRAIN. GOKFBBSaiaN COf. 

th* Maoat OM moat in each «m be mmdt of the 
hisuoyof thermM. Intixiaeof blood-eompreanon 
after injaiy to a meniiieeBl aitety, there i» slmoet 
alaaje the fact that the patient betmen the 
dste of the injiuy and the mperrentioo of eymp- 
taoe had ao internal dnring vhich there ap- 
nared to be Kttle or nothing the matter. Thu 
betcvj is, if the ijBiptxnus hare developed 
rapidly and vithont the eigne of inflammation, 
b; itoetf eonelanTe fmt diagz^aia. Under rach 
eoaditiona trephining oogfat to be at oneereaorted 
ta, or poadbly it m^t be jet better practice to 
bit lie the carotid arteiy. 

The diagnosis of abwees in the brsin-aub- 
■taaee has alreadj been diaouscd, and that of 
iadammatoiT collections from meningitie will 
be examined in ita proper place (u« MsmmiBS, 
Diseases of). 

TsaATKKirr. — The treatment of eompreaaion 
of the brain ia almost wholly surgical, and con- 
urta ia the ass of the trephine and knife to 
derate depreaaed bone, or eracnate eoUectiona cf 
blood or poa. Johathah HxracEimoir. 

BBAIH, OooooaBlon of. — ^We class mder 
the head 'Oaoeaaaiaa of Brain' all aymptoma 
which reaaltaia{djfinim the shaking, moreorlraa 
Tiolently. of the eontenta of the skull. It will be 
obrioaSiharwcrer, that most easeatrfaerere riiaks 
of the braia are likely to be complicated by -riaible 
lestoBa. The akoll may be broVen and the brain 
■ay be contused, laeemted, or ecehymoeed. It is 
U^y prababls. howerer, that well-maiked and 
snn serioBS symptoms mny be produced by 
riiaking only, and without the existence of any 
leaian diacomable either by the maided eye or 
the mieraseope. We must Airther clearly under- 
stand that this dementof eonenaBion ({.«. the re- 
salts of ehaks independent of lesion) enters into 
almoBtereiycaset^injniytotheheBd. Whatever 
be theetherlcrioBa.itisas'nally tbefiict that the 
brain baa hem mote or less sererely shaken. 
Tkns it may eanly happen in ea ses in which 
eoBSpiraoas ieaioBs an present, such as fractore 
at tie base or local eontnakm, that still the results 
of the shake are the most important. It might be 
e uu Te ui ent if we were in the habit of apeaking of 
most eases of aerere injury to the head aa Coneiu- 
aom flat other Urkmt, with the endearonr to 
assign to sadi added complication ita proper 
ikare in the general result. These explanations 
am necessary befoca we put the quesbon — Can 
eonc Bssi on alone eaase death? Althongh it ia 
UgUy probable that we ought to reply with a 
Toy confident aiBrmation, and to aasert that it is 
Toy eommon for concussion to be the chief cause 
ef the fittal erent, yet it ia Tery difBcolt to prove 
it, since the eases are extremely rare !n which 
senre e uu e uasi on ia produced without some 
attcnfix^ lesion. The symptoms caused by con- 
eaaioa ^ the brain may be studied in Tery nu- 
aaeraas cases of rery varioas degrees of sereritv, 
wUeh yet rteorer perfectly. From what is 
ot su t e d is these, 've may infer aa to the part 
wiit^ eoBeajsioB takes in complicated cases many 
at which jrare fatal. 

The malts al cooenaaion may be divided into 
tfarea st^ea— the first stage ia that of eoUapte; 
the seeond, thtt at rtaetion, or of vaao-motor 
r, if named from its most pramment 



BBAnr. coNonssioN of. 



1«1 



symptom, the tltipy stage ; the third is that of 
eontaltaeenee, or recovery. The symptoms of 
the flnt stage, or stage of collapse, vary with 
the severity of the ease, but if at all well- 
marked consist in feebleness of pnlse, pallor of 
skin, coldneas of extremities, and dilatation of 
pupils. They may approach a condition which 
threatens immediate death. There is no stertor, 
for the respiration is too feebly performed. Al- 
though the collapse may be very great, the in- 
sensibilityis mrelyqnite complete. Itis of great 
importance in this stage to establish the negative 
as regnids all forms of paralysis. If any non- 
symmetiieal symptoms are present, the ease is 
more than mere cnncuaaion. During this stags 
nothing should be done, except placing the 
patient in a condition of comfort, and preventing 
the cooling of the body. Stimulants, onleas the 
collapse is extreme, should be avoided. Aitar 
the colLipse has lasted some little time (half-an- 
hour to two, three, or more hours), it begins to 
pass off. The patient moans, manifests discom- 
fort, turns OB his side, and draws his knees up. 
Very often at this period sioknese oeeara, and it is 
almost invariable if the patient'a atomach waa 
full at the time of the acoident, Conacionsneas 
is now nsually restored, and, by rousing, the 
patient may be induced to speak, and will tell 
his name, &e. Oradnally, during a period o< 
some hours, the case slides on into the sleepy 
stage. The pnlse is now relaxed and full, the 
skin is warm or even hot, the face may he some- 
what flushed, and the pupila are contracted. The 
patient is overpowered with sleepiness, and can 
only be awakened with difflcnlty. It is, however, 
always within possibility to airaken him, and he 
asually rouses himself to the calls of nature. 
Very commonly the pulse ia irregular, especially 
if the patient be young. At this stage again care 
must be taken to ascertain whether there are any 
non-symmetrical aymptoms, any weakneaa of a 
limb, of one side of the face, or of any single eye- 
muaela If the patient pasaes his urine or fteoes 
in bed, or if there is long-continued retention of 
nrinei it is very probable that there is more than 
mere concussion — namely, laceration or contu- 
sion. The sleepy stage may Inst for a day or for 
a week, and it is in severe esses so well-marked 
that the patient's eyelids may be held open, and 
the pnpils examined, withont awaking him. 

I)unDg this stage the meaanres of treatment 
called fur are spare diet, pnrgation, cold to the 
hend, and quiet. When the sleepy stage passes 
off, the patient is left weary, torpid, unflt 
for mental effort, and often with distressing 
headache. These are the symptoms of the con- 
valescent stage, and they may last more or lees 
for a considerable time. The patient should still 
be kept carefully quiet, no stimulants should be 
allowed, and purgatives should occasionally be 
used. Some of the symptoms present during the 
stage of convalesence may persist so long that 
they may rank rather aa sequela. Thus there 
may be for ^ears nervousness, inaptitude for 
business, liability to headache, and peculiar sus- 
ceptibility to the inflnence of stimuUnts. As a 
rule, however, even after very severe concussions, 
no such ill-results are left, but the patient re- 
gains after a time perfect cerebral health. This 
remark must, howerer, not be held to ap{dy to 



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MS BRAIN, OONC0SSIOK OF. 

aanamioB vhkn nesired in tailway aeddanU; 
for in theM cues thers ii a pvosptetof peenniuy 
eompenaation, and tbs ■•qnebe or* olten WToia, 
prolonged, and reiy pecnluu'. 

JoHATiULN HuTcuixnir. 
BKAIH, OongMtion of. Set Bbadt, 
HypenemU of. 

BBAIN, Haaiorrhac* into. — Stxdk. : 
Oenbral ApopUxy; Fr. Htmorrkagie ciribraU 
tKtenlilitlU; Qsr. Hinueluaa. 

DBnirrnoir. — Eieapaof blood, byrvptnreof 
m tssmI, into the anbetanee or eavitiea of tho 
brain. Hemorrhage into the mMungea ia 
separataly deaeribed. 

Cerebral hsmorrhage ia commonly dns to the 
mptitre of an artery, very rarely to that of a 
Teio. Oooanlonally, mioate eztravasationa are 
caused by mptare of capillaries. Hemorrhage 
ftom arteries or veins may also be due to their 
laoeraUon by injury. 

JErtoufXiTi. — Arterial hemorrhage is nscally 
due to the coincidence of weakened vascular wall 
and increased pressure within the vesseL The 
eaoaes of these states may be regarded as the 
eonditions pndupoiuty to cerebral hemorrhage. 
Hereditary inflnenee is sometimes distinctly 
seen, as a tendency to vascular degeneration, or 
to eonditions which, as renal dixease, prodaoe 
such degeneration. Similarity of vascular 
distribution may also be inherited, and may de- 
termine the locality of strain, and, tber^ore, 
first of degeneration, and ultimately of rupture. 
Cerebral hemorrhage is most frequent after fifty 
years of age, but occurs st any age, though rare 
during the first half of life. It is nearly twioa 
as common in men as in women. It is said to 
be more frequent in temperate than in tropical 
elimatea, in winter than in summer, and at nigh 
tiban at low elevations. Certain acquired con- 
ditions act as predisposing causes. Chronic 
Bright's disease leads to sarly and extreme de- 
generation of vess e ls, as well as directly to 
nypertiophy of the heart and increased blood- 
pressare: hence it predisposes powerfully to 
oerebrul hemorrhage. In purpua and scurry, 
cerebral hnmorrhnge occasionally cccurs — it is 
said in consequence of acute vascular degenera- 
tion and increased blood-tension. The state of 
vascular repletion known as plethora was for- 
merly thought to be a frequent cause of cerebral 
hemorrhage. It probably does aid other causes, 
but rarely oo-exists with the most efficient, 
and so takes a vei^sabordinate position. Chronic 
alcoholism and opium-eating are said to promote 
TasenUr degeneration. 

The jmaiauU* eansas of earelnsl hemorrhage 
an the weakened state of the wall of the vessel, 
and eommonly some increase of Uood-prsssnre. 
The Teasel-wall is weakened by degeneration, 
■ad ia olton imperfectly supported in an atrophied 
brain. The increas e of presaare within the ves- 
sels may be pemansnt, as in peripheral obstruc- 
tion, with or without hypeitrophy of the heart ; 
or temporary, as in excited acUon of heart, or 
impeded circulation dnringetRut. These cnnses 
•re conMderod mote fiuly in the article on 
Buxm, Vessels of. D i se a se s of. 

Hemorrhage from a vain is tare, except as ths 
Nsalt of laceration by direct iiuaiy, or of nlcera- 
tios invadiag tha vein seooodaruy. Varioose 



BRAIN, lUBMOSBHAGE INTO. 

veins in tha pia nator may sometimea xaptoM 
(Aadral). 

Capillaiy hemorrhage is usually due to venous 
obstmetion, especially to thromUwis in a rein. 

AjcATUKKJiLArpiUBAxcBS. — In intra-ceiebrat 
hemorrhage, the bkwd is extravasated into tha 
substanca or into the ventricles of the brain — 
into the latter osnally by rupture of a previous 
extravasation within the cerebral substaince. In 
the Utter situation the blood occupiee a cavity 
farmed by laceration of the biain-tissue ; lareW, 
when very minute and 'capillary,' by msiMy 
separating the fibres. In size an extravasation 
varisa from that of a pea or even smaller, nn 
to that of the fist. Ths blood is clotted, and 
reddish-black in colour; and fragments of 
brain-tissne are mingled with it. The cavity 
containing it is often very irregular ia shape; 
iu walls are uneven, present projecting shreds 
3f lacerated brain-substance, and are blood- 
stained and softened — at first by imbibition of 
serum, and later by inflammatiun. Many small 
extrarasAtions are oiten seen in ths neighbour- 
hood of a larger dot. Usually there is only 
one large extravasation: sometimes, however, 
there are two or threcu The extravasated blood 
exercises pressure ; the convolutions are fiattened ; 
the falx IS bulged to the opposite side (Hugh- 
lings Jackson, Hutchinson) ; and the rest of the 
hemisphere is anemic. The efiused blood may 
tear its wqr into the lateral ventricle ; it then 
speedily distends both lateral ventricles and tha 
third and funrth ventricles, and escapes i^ the 
openings at the lower extremity of the fourth 
ventride, central and lateral, into the subartich- 
noid space. Or tha blood may escape to the 
surface, infiltrate the pia mater, and tear its way 
into the subarachnoid onvity, oi).en by a veiy 
small openins. It is rarely that tha artery bam 
which the blood has escaped can be detected. 
Occasionally the axtravasaticn can bs traced 
to the rupture of an aneurism of soms size. In 
other cases miliary aneurisms may ba lunud oa 
many vaasels. The larger arteries ecmmonly 
present atheromatous changes. 

After a time the extiavaaated blood under- 
goes changea. Tha dot ahriuka and gradually 
beoomes, first chocolate, than brown, and ulti- 
mately a reddish-yellow ; and it then contains 
chiefly fat-globules, pigment and other granules, 
and hematoidin crystals. The rapidity with 
which it undergoes this change is doubt^, and 
certainly varies. It ia siiid that ths distinctivs 
blood- colour has disappeared as early as the 
twentieth day. Meanwhile the walls of the 
cavity undergo changes. The inflsmmalion, in 
rare cases exeessiTe and purulent, is usually 
conssrvative, and leads to the formation of con- 
nective tissue. A firm wall is thus developed, 
the iimar surface of which becomes smooth by 
the softening and removal of the loose fragments 
of brain-substance; by this means a cyst ia 
fbrmsd. It is said that connective- tissue may 
extend across its earity, and that in rare cases, 
the fluid being absorbed, the cyst walls msy 
niiite, and a cicatrix result. Such cicatrices are, 
however, much mors frequently due to softening 
than to hemorrhage. It is asserted that a cyst 
may be developed in thirty or forty days nadoi 
favouabla eonaitionik 



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fianoRlugs TBAj occur in any part of tha 
bisin, bfit u more freqrieiit in aome ntaatioos 
than in others. The most frequent seat is the 
eorpss (triatnin and the region just outside it : 
nearlj half the intracerebral hiemorrhagea are 
in this aitwuion. Other primary seats, in tha 
oadcr of freqoenej, are the pons and pednndes, 
the cerebellnm, the cortex, the optic thalamus 
(often affected by an extension of the hemor- 
itdgcfrom theeorpn8atriatum),thapostariorpoF- 
tioa. and the anterior ponioo of the hemisphere. 
The frequent extraTasation into and outside the 
SDtpos atria'om, is explained by the Tascnlar 
npply. ( See BoAnt, Veaaels of, Diseaaea of.) 

Tiaomatic hemorrhage occurs !nto and from 
a lacerated portion oi brain, and ia moat fre- 
^ently fbond <m the aorlace, occupying mainly 
the muidle of the eonrex portion of each eonvo- 
luttoo, and same other regions much exposed to 
injury, as th« surface of the temporOHsphenoidal 
lobe, ma\ the under surface of the frontal lobe. 
Ventricular haemorrhage sometimes results bum 
trauBEilie Tvpture of a small Tein on the surface 
of the e m p us striatum (Preseott Howett). 

Soft tumuurs (especially glioma) are some- 
times the arat of haemorrhage. The distinc- 
tion froa simple haemorrhage (aometimea diffl- 
eaUt) rests oa their position brinff commonly one 
in which rerebral haemorrhage is rare ; and on 
aome ^latinous-lnoking tumour-substance being 
found, into vfaich hemorrhage haa not ocenrred, 
and vhicfa haa characteristic miciosoopic features. 

Other organs may be healthy, or present the 
duagca vhich hare been mentioned as prcdia- 
posinK causes ; the lungs are usually aecondorily 
eoBge^tad, often intensely. 

Stkptomb. — The occurrence of cerebral 
haemonluge is indicated by cerebral eymptoma 
of tVD elaiirrai, tha one general and more or leas 
tranaeot. tha other local and more or leas 
permaBent. In addition to these there ore 
KBnetiiaes prcaaanitoiy aymptoma ; and commonly 
geu e i al aymptoans maaifeated by pulse, tempe- 
ra^ira, &«., -^lieh an secondaiy to tha bnm- 
leaKM. 

PrtmomHerg symptoms, aomeirhat nre, are 
those of altexad cerebral function due to local 
Taaealar disease, h e adache, Tcrtiginons feelings, 
local woaknees or numbness, alight mental 
efaaages, and dight affection of speech ((M 
Baaci, Vcaaeb of. Diseases of, and Bbaix, 
Aaamia afV They are less frequent than in 
eacas of aoftening, and more commonly precede 
ma till! a l hscBiorThage in the old than in the young 
■ad naWUle-aged. 

Tlia ematt of haemorrhage ia usually aceom- 
paaiad with apoplexy, Lt. loas of oonseioasneas and 
of power of motaon and of aanaation, often with 
lion of the sphinctera and loaa of reflex 
(sea AroruxT, Caaamai.). Theae aymp- 
ow profound and lasting according to the 
siaeaf the faaenurrfaageand its position ; being es- 
pedally marked in large and double eflhsiona, in 
iliaiaaliii iilai liwiiiii 1 1111(1,11 riiifl in htemorrhage 
iBtotkapaaa. In a ease of moderate aeverity they 
laa* oaly a fcv houra, and gtadnally pan away. 
In aei ei q cases they may deepen until death 
•eean fnm fblsra of raspiratory power. 
]>aath is raidy Tety apsady, hfa being usually 
At soom hoars aren in the most 



BRADf. ttiEMOBEHAGK INTO. ^ 

rapidly &tal easea. In Tmx-» iatititmi^ <• 

hemorrhage into the mednllMv ^tSaJto if 
meningeal hemorrhage, deat ti li«« ooearred >' 
Are mioutea, probably in «a«;lx c^ms irom t^ 
rapid interference with the respJ'^torv' eeotn- 

The temperature is at Srat 'ow-sretf ca» "^ 
two degrees, the puke beconaes iaas freqo^^ 
and the respiration slow. The Cbejae^'^^r 
respiratory rhythm often precedes death- ^ig^ 
a few hours the temperature rises to l/ia "O^^e* 
and in mild cases stops thsre, but in graver "^ (.c^\ 
it rises aboTB the normal two or thjeo ()^^ e*^iiV 



In some Teiy grave cases the initial full '^* ■^■^ ^e 
sequent rise may be extreme and go <"V ^ 'v*'"'' 
death occurs, sometimes reaching BO-" in *■ v^ c*^ 
oase,andl07''orl08''intheother(l!ouro« t,V^ '<^^ 
In alight caaes of cerebral hemorrUasf V^^*** ■> 
may be no loss of oooscionsnaaa. V om>^^ ^^ ^ 
auch cases is not unfreqoent. In otVi^ t> ^^ 



'^e^' 
-'*« 



eases of large hemorrhage, especially ^^^ f^et 
the external capsule of the corpus at.x^a.\,i> -t C^ Ji. 
the ialand of Beil (Broadbent), the !«>»« ^ A*^ 

acioumeas eomaa on gradually, a 
aymptoma, as of shock, for example, : 
for an hour or two. These cases 
termed ingrmuctut. 
Local symptoms, often permaneat, 

o# longer duration than the loss of < 

ate present in all cases of eireuma^i 

bral hemorrhage, except in the rac _ 

in which, by its oantnl position i »-^ 

and medulla, it causes directly hila.*^^. 

only, which are added to and intenaitf^B- 

ral symptoms caused indinctly. In .^ -^^^ . w-x»- 

cerebral leaion, the direct symptom^ ^^"[""'^^•^ \»i- 

toral loss of power of Tolnntary mo-^-^^.—^* ■»*" ' , 

often of senaation, accompanied som^^ -i^fe'"*" ^- ? 

cooTuIaion or rigulity. These local ^, ^.t** "'"■"•H* 

may commence a few minutee or ln»^>^ ^^'**i*^5 ****** 

the loss of eonsciotuness. They cor> - **^f!c 

the apoplectic condition, and maw 
reeognis«l, eren during coma, by the 






tbo 






*he^^ 









of the paralysed limbs, which fall more lacij^? 
than those of the opposite side; by i*ac*«v* ^'■'^i«~- 
of the mouth and of the pupils ; by «=«>^^''^^?'%> 
deTiation of the head and eyes towards ("-Za ^^ft^'<i^ 
of the brain injured ; by conTulsive "nov-^aj.^^ %^*» 
and, as the apoplexy clears, by the det.^^j£s^*i*^9 
unilateral defect of sensibility. Theeonut kim ^'b ^.* 



away, these signs become more distinct, abT^^ 
the symptoms of hemiplegia remain, raayiZ^ '' , 
intensity and extent according to the pu^it^^' ^^ 
the lesion. The apoplectic state may rerar ^^a 
its disappearance— a grave symptom, VMoal^^t^f 
dicating that a fireah hcmorrhnge has occn'*^-'V>, 
in the snme or the other aide of the braii^*^ 
more fret^nently that the blood has escapedj °' 
the ventndea. In the former case the unllat."''' 
aymptoma, ooigugats deviation of the head g^ 
eyes, &c., are increased on the same, or tr^?^ 
ferred to the opposite side; in the Utter the unjl 
lateral symptoms disappear, and general powerl 
lessness and deep coma supervene, with stertor 
relaxat ion of the sphinctera, lowered temperatnra! 
and impeded reapiratioo. Death always ansqear' 
Convulsion may be a oonapieBOus symptom 
at the onset er subsequently. It ia uauall* 
unilateral in its course or commencement, be- 
ginung on the side nualyied, rarely affectina 
only the noD-paralyasd aide. Where eoovulaion la 



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IM 



BKAIN, ILSKOBBHAOE INTO. 



cot met iritli, mnscnlar twitching or rigidity 
may occar. Oenenl or videly-spraad rigiditr 
or twitching points to a bilateiral iMion; if with 
eoma, to rentrienUr haemorrhage. 

After a day or two symptoms of irritation 
about the cerebral lesion come on, snch ss head- 
ache, delirium, and rigidity in the paralysed limbs. 
Soring this period the temperature rises abore 
the normal, and the pnlae becomes quick. On 
their subsidence, these ^mptoms, if the lesion 
is slight, may be scarcsly recognisable, and a 
stationary period ensues, at the end of which 
recovery of power over the paralysed limbs 
begins. In tli^t cases power may be recoTered 
T«ry speedily. Its return depends upon the 
straetnml reooTeiy of slightly damaged tissae, 
and on other parts taking on an increased Amo- 
tion in compeDsation for that which is destroyed. 
The electric irritability of the muscles exhibits 
little change. Sometimes, howeyer, when there 
is gr«at irritation at the lesion propagated 
downwards to the cord, a marked initial incrense 
in irritability may precede a considerable de- 
pression, coincident with rapid wasting. Be- 
eoreiy of power is rarely complete except in 
those cases in which the area of damage is Tery 
small ; and when the damage is large and affects 
an important motor region, thrre may be n» 
recoreiy, loss of power persisting, commonly 
with more or less ' late rigidity ' in 5ie paralysed 
limbs. Slight permanent mental change often re- 
mains, and as the motor power is recoTered, ataxic 
and other disorders of moTsment may superrene 
in the limbs which were paralysed, although 
much less commonly than after softening. 

SiAoirosis. — The diagnosis of cerebral hemor- 
rhage rests on the symptoms of a localised cere- 
bral lesion, occurring suddenly. The conditions 
from which it has most commonly to be distin- 
guished are— congestion of the brain ; softening 
of the brain, embolic and thrombic ; and, some- 
times, tnmou. For the distinction ftora it of 
other eanses of apoplectic loss of oonseionsness, 
uremia, post-epileptic coma, &e. tet Afoplbzt, 
Gaaxuxu From congutitm the cliief dis- 
tinction of eerebml hiemorrhage lies in the 
transient nature of the loss of consciousness ; 
•nd in the slightness and gsneial character of 
the symptoms which characterise the former. 
OongMtion generally, hamorrhage only some- 
timea, comes on daring eilbrt : and the absence 
of history of effort is in fhyonr of the latter. 
Similariy, the premonitory symptoms which are 
usually present in congestion, are generally 
absent In luemorrhsge. Tbe loss of motor power, 
and the symptoms of cerebral shock, are much 
greater in hemorrhage than in congestion. It 
must be remembered that the two states fre- 
quently ooexist. From tnfiming ccmssquent on 
embolitm cerebral hemorrhage hna also to be 
distingaished. The subjects of the latter are 
usually of aa earlier age than those of hemor- 
rhage ; their ressels are healthy, but they hare 
organic heart-disease, which is often grave. 
There may be evidence of embolism elsewhere, 
in q>leen, kidney, or retina. Loss of eonscious- 
aess may be absent in embolism, and the para- 
lysis often comes on delibemt<>ly. An axten- 
■iva capillary embolism, causing deep coma, 
osnnot be distii^nishsd from hemorrhage. From 



trflaang dne to tkromhotii the distinction b 
often difficult. Age, and the state of the vessels, 
no longer serve as guides. The presence of cbronie 
Bright's disease is in favour of hemorrhage. 
The occurrence of previous bemiplegic attacks 
points to softening. In the attack, loss of con- 
sciousness is much more considerable, in pro- 
portion to the subsequent paralysis, in liemor- 
rhage than in softening. But the distinction on 
this ground is often very difficult, since loss of 
consciousness may be absent in slight hDemO^ 
rhage, and considerable in an extensive softening. 
A deliberate onset is in favour of softening, and 
so are much mental change and early rigidity. 
Paralysis of sudden onset, in cases of tumtmr, 
may be ascribed to hemorrhage, to which it is 
indeed sometimes, but not always, due. Usually, 
enquiry elicits a bistoiy of gradual, Jong-con- 
tinued t^mptoms ; intense headache and optic 
neuritis are strongly suggestive of tumonr. 

Haemorrhage into the substance of the brain 
is distinguished from meningeal henuorrluigt by 
the pain and mental excitement being less con- 
spicuous, convulsion rarsr, and by the presence 
of symptoms of a local lesion. Htemorrkagt 
into the ventricle; which resembles meningeal 
hemorrhage in the generality of its symptoms, is 
usually distinguished by succeeding the symp- 
toms of a circnmscribed lesion. 

Fbooxosis. — During the attack itself the 
prognosis in hemorrhage into the brain mxu)t 
be guided by the intensity of the symptoms, 
and by the place of the lesion, as far as that can 
be ascertained. Death is probable if the coma 
is profound or long-continued, and if the early 
depression, or the subsequent rise of tem- 
peratureand poise-rate is great. When the symp- 
toms i ndicate ventricular hemorrhage, or hemo^ 
rhage into the pons, the patient will certainly die. 
Consciousness being recovered, and the danger 
of immediate death over, the Areedom from 
much secondary pyrexia, from Inng-congesiion, 
and ttnm bedsores, are favourable indications. 
The dmnce of recovery from the paralj-sis is es- 
timated by evidence of position of the lesion, 
and by any indications of improvement. Early 
contraction of the flexors is un&yoarable. The 
danger of recurrence is in proportion to the ex- 
tent of vascular disease, and the existence of 
irremovable causes of increased aiterial tension. 
Hence the prognosis is rendered unbvuniable 
by advanced age, or chronio renal diseaaa, and 
by the evidence ol general premature decay. 

TBaaTMBKT. — During the attack. Beet is the 
most important. The patient should remain, 
as far as possible, where he is seised ; stilhuss 
must be secured : and all effort is to be avoided. 
The posture should be recnmbent, with the head 
raised. Any cause of passive cerebral congestion, 
such as a tight collar, most be looked for and re- 
moved. Veneeection was formerly almost always 
employed in snch cases— certainly too oniveraally ; 
but it is now quite discarded — perhaps too abao- 
Intely. Loss of blood lessens the force of the 
heart and vsscnlar tension ; it thus hastens thi* 
cvssstion of external bleeding. Doubtless it acta 
in the mme way in iiitenml hemorrhage. It may 
be used with probable advantage if tbe arterisl 
tension is great (that is if the palse is incompres- 
sible), the heart acting strongly, and there in 



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BBAI5, H£MOBRHAOE IKTO. 

mm la bdim that the intn-cnnial bamor- 
lliip if iirnaniig. A nnall qtiantity of blnod 
■koiild b* lakao la^idly. In TgDiriemlar hBiDor- 
ihigit r wi m eti oa la probably powtrlea for good. 
U itaoBld Bot bo employed vhera rbera is anj 
•TJdmes of &iluf hasrt-powar. its indicstiona 
us dnn as bocb ftton the stata of tbe patisnt 
isfroBlhsftct flf hamorrbaga. Bright'e disaasa 
is M eoDti»4ndioatioa. 

If blaading ia Bot employad, the objects to be 

aiaied at by othrr nMaaarea most ba to direit 

cka blood aa iar aa poaaibia from tbe brain, hj 

sdaziagtbesTBtaBue TBsaels, vhUe endaaTOurii^ 

Is obtaia eoatiaetioa of tbe eerabnl reesals. 

i^SfBtb awy ba appliad to the limbs^ aided bj 

naipiwas Dij-eapfimg tu tbe aorfaea, aod 

fOj^na, aa ctotoo oil, will dirert thaiblood to 

tbe sufaee, or to iba eapadons imeatinal Teasels. 

Sngt vbidi voold canae eootnetioa of tbe 

Taseela ara to ba aroidad, since tb«ir inflaance 

baiag oa tba amslleat raaaals sad onireraal, their 

laBhacj ia to iacraaaa arterial tenaioD and 

luuaut ihsge. CoDtraetion of encephalic reaaela 

■aybef ui l b aia d byeoldtotheheador sinapisms 

to tba Deck, acewding as the head is hotter or 

eoldar than noraal. The heart shoold be allowed 

to till a little below tba normal in force, but 

Culara of power mnat ba warded off by stiiBn- 

Isnts girsD with fi aa t eate. CanTnlsioa is more 

alTiii f aally ehaekad bj cold than by bromidea ; 

the latter may be giren if the eonmlsion recnrs. 

jf^icr tit mttatk. — Daring the stage of iirita- 

tita, nat Bust ba maiatuned, and all aoarcea <rf 

ssaiijinrr ontat be aroidad. The bowels should 

ba kept gaatly apaa bj lazatires or by ii^jao- 

tnw. ^i—T"'""*- most be aroided. and the diet 

(hooUL b* IJgfat. Fkia suj be rsliered by cold 

lo tka faaad, a blister to the neeJ^ or by Indiaa 

heap a* bj baonida of potaaaiom. 

DwziBK iwpaiaiioB tha diet moat be nntritiov^ 
bat earo£aUy rsgolated; and constipatioo of 
the fcoweia a s i t ba aioiided. Eubbiog of the 
Jiab^ aad their gntla exercise, will aid their 
iBuu ia s/, and after tha aymptoma of irritation 
hara ysaanrf. fiuadiaatioo will improre nraacslar 
jmtrittam, mad iseapeeiallyiiidiartted where rapid 
loaa odT irritability indicates probable waeting, 
iea ara asaftal ; none mora so thaa a 
I of bypophoaphite of soda and tino- 

»«if Baxwomiaa. Ia anemia the symp-of 

tha pho^hata <tf ima U good. Warmth, change 
at matmm, aad iliasifal mental snrroiudings ara 
^■fcl iVjiiai ta. espadally in the later stagea of 

W. B. GOWKBS. 



BBAXV, HTparamla o£ — Stkox.: Con- 
ytinn of tba bnin. 

SaDTjnnm. — ^Inereaaa in tbe qoantity of blood 
witjun tlic eapillaiiea of tbe biain. 

Sue* ■either tha arteries nor the reins of the 
laaia aii^w*r'*~' can be orei^istended with 
Hood -vitbont capillary b^peramia, and since 
it ia to eapfllaiy hrpeiaemu that the fonetional 
distacrbaaca of tha brain is related, this may be 
jiitlj taken aa the essential pat hologioil element 
Ib csjslaa l eosKestioo. Tbe congestion may be 
when the capillaries contain, ia conse- 
I of sitarial distanrion or dilatation, oxy- 
1 Uood paasing rapiJly through them ; or 
mj ba fumm, when, from Tenons obstruo- 

10 



BRAIN, HYPEILKJk*^^^-^ o~. 
tion. the capillaries eoDtain •l«>'^'^^v»/^Oi. . ' //^ 
becoming, and in great part a.lr^f^'^^'m iT'^^l/oott 
XxviLooj. — (A) Jctite congee* fc ' "■** 0|^ "■"ciug, ^ 
may be grueral at parlUU. Of t;i» *^^e»._'^'' *'»"' 
the remott causes are as fallows 






-■^^J'^'^'fAm 



to be more liable to it than wc»iW*<J. ?^ ""^ 
creases its freqnrncy (but this im '*ioi^ , ** *" 
the paaaiTS form) ; yet chUdiF*. frotn tbaTn^ 
tivenens of their Taau-motur system, '^ccusiunMt 
suffer from actiTeearebnil coni^cstion. ilenditr 
has only an iodiract inllnenco. Tlie pU-thorie 
ooodition is a powerfnl prcdisponent. Th* im- 
mtdiaU caosea of oxeesnire flow tliroo^'h tb» 
arteries of the brain may Iw thus statod — (I) in- 
crease in the Uood-preseu.-e— cither gcncml, from 
ezceesire action of the heart (as iu fxtrcme 
hypertrophy or fnnctiobal overaction); or partial, 
from an obstmction alse» here, throwiag an un- 
dne proportion of the pressure upon t lie cerebral 
Teasels. This is seen in contraction of the aorta 
beyond the origin of tbe vessels to the head, and 
in sudden contraction of a large uumler of the 
systemic arteriolea, aa tliose of tbe snrface, in 
ex^nre to cold and in ague. (2) Active ar- 
terial dilatation of Taso-inotor origin may resnlt 
from prolonged mental work, severe moral 
emotion, insolatioB, digestive distarbanccs, or 
from the presence in the bloo<l of various poisons, 
such as alcohol and ainyl-uitr!te. ]u these 
cases the raso-motor ditturlunce may precede 
and cause, or may fciieoee<l and result Vrum the 
oTeraetion of the brain-tissue, which is inteosiSed 
by it. In acute alcoholic poisoning the cerebral 
congestion is, as Niemeyer suggests, probably 
secondary to the diaturbance of braiii-tissuo ; 
in chronic alcoholism it uiuy po^silily be pri- 
mary. In pyrexia the hoadaclio and delirium 
have been thought to be due to congestion, but 
this is ni.t certain. (3) Increased utmospheria 
pressure may canae con;;ostion of tlie braio. 
(4) And, lastly, graTitaiioo in the recumbent 
poeture may alone catue cerebral hyperemia, 
or may powerfully aid other causes in produc- 
JBgit. 

tartial ^tire congestion of brain-tissue oeenrs 
chiefly along with duease of the arteries, which 
perverts blood-pressure; in organic brain-dis- 
eases, as tomonr, hemorrhage, &c.; and after 
blows on the head. 

(B) Powi'm congestion of the bmin, when 
gentrai, is the result of impeded return of blood 
from the head. It may be due to pressure on the 
Teins in the neck, aa by tumours or t ight collars ; 
prasanre on the innominate veins hy tnmours or 
aneurism; or obstruction to the circulation from 
Tiolent respiratory efforts, as cough or bloving 
wind-instmments. It may be caused by impedi- 
ments within the circulation, such as tricuspid 
insufficiency and its causes in the lungs, or dis- 
ease on the left side of the heart. The recum- 
bent poeture assists all these influences. In 
arterial obetructionfh>m diseased vessels, a weak 
heart, Insufficient to overcome the obstruction, 
mav permit venous stasis, but the capillary con- 
dition is one of anamia. 

Partial i>assiTe congestion may occur from 
thrombosis in a cerebral vein, or from pressnr* 
by a growth on one of the cerebral sinuses. 

AifATOHiciX AmUBAJfCES. — The cnpillaries 
are not visible to the naked eye eveu when over 



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146 



BBAUr, HYPEILSHIA OF. 



diitended, but nHth the mieroscopa they are seen 
to be dilated, often to twice their normal calibre. 
Tlieir diatension is indicated by a deeper tint of 
the grey latMtanee ; and the fnUnen of the finall 
aiteriei and reini ahovf itself in an inereasr, 
>ften very groat, in the mnmber and site of the 
■ad points risible on section of the white matter. 
In aetire congestion the arteries are said to be 
distinctly larger than normal, and their periras- 
enlar spaces lessened in sizn ; the minnte ressels 
of the meninges at* distended. In passirs con- 
leation the reins and sinnsea are gorged with 
blood. It must be remembered, howerar, that 
•och engorgement of the reins occurs in all 
easea of death Aram interference with respln- 
tion, and that the ressels of the most dependent 
portion are always Aillest. The state of the 
cefebml reins must therefore be careftiUy com- 
pared with that of the reins of other organs. 
Aetire congestion may sometimes leare do risible 
traces. After a time blood-pigment collectsoot- 
side the ressels (Bastian), and serous eStasion 
Into the pia mater may be fbnnd ; and after long^ 
continued congestion, the ressels ma^ be perma- 
nently distended ; the spaces in which they mn 
are increased in size. Such increase is common 
apart from pathological congestion, but it is so 
great in some cases of long-continued congestion 
thatthis effect cannot (irith Uoxon) be altogether 
denied. 

SntFTOXS. — It is probable that many symptoms 
bare been erroneously ascribed to cerebral con- 

gistion, some because hypenemia, due to the 
ode of death, was found jxtt mortem, others 
because an assumed congestion was the readiest 
mode of explanation. Moxon has indeed main- 
tained that cerebral hyperemia nerer causes 
qrmptoms except perhaps in death fh>m strangu- 
ktioD. It is doubtful whether our knowledge of 
the conditions of the cerebral circulation is sof- 
ficiently exact to justify this conclusion, which is 
difficult to reconcile with clinical facts. 

The symptoms commonly referred to cerebral 
congestion may be gronped in two classes — those 
of exci tement, and Uiose of depression. Either of 
these mar exist aloue ; those of excitement may 
precede those of depression ; or they may partially 
co-exist. They may be slight or serere ; acute 
or chronic. In all cases they are inereasod by 
the retumbent posture or ^ depressing the 
bead, by expiration, and by effort; and they are 
nsnally aggmrated by constipation, and by in- 
dulgence m alcohol. 

In general cerebral hypenemia, among the 
symptoms of excitement may be mentioned 
mental irritability ; headache— slight or riolent, 
with feelings of Alness or throbbing in the head, 
and rertiginous or other unpleasant sensations ; 
increased or perrerted functions of the organs 
of special sense, such as flashes of light and 
noises in the ears; contraction of the pupils; 
•leeplessneas, restlessness, startings, twitehings 
or slight actual eonrulsions ; and mental excite- 
ment The pulse is quick. There may be 
romiting. The face ranes, ^rticipating in the 
eongestions of circulatory origin, and in some of 
raso-motsr disturbance, such as that which may 
occur during digestion. In other forms of sup- 
posed oongMtion of raso-motor mechanism, as in 
Uioae whiSi result 'from sxcessiye biainwork, the 



face may be pale, but the nature of these 
is donbtf^L 

Among symptoms of dapresaed brain-ftmetion, 
are dullness of the special senses ; motor aisiliiisss ; 
mental indifference and slowness; somnolenetk 
npecially after meals ; dilatation of the pupils ; 
and infk^uency of the heart's action. Oonsoow* 
neas may be lost suddenly, and the lots, it is eon- 
monly beliered, may deepen into coma. As • 
rule there is no ferer, bat in children the tent 
peratnra may be raised a degree or so. 

In the ekrtmio forms of cerelmil congestion, 
these symptoms, rarionalr gronped and moderate 
in degne, eontinne for days, weeks, or months. 
Their eourse is marked hj great rariabilitj. 
Durand-Fardel has pointed out that in than 
eases then is often much riscid secretion of the 
oomanetira. 

In the mora OMtefbrms of cerebral congestion, 
the i^mptoms of mnseolarspasm, of mental di»> 
tnrbanee, or of loss of consciousness, may be so 
predominant at to girs a special character to 
the attack:— 

In the eoitnUivi form pain or uneasiness in 
the head eommonlr precedes the musenlar 
spasm. The latter is usually slight. Oonaei* 
ousnass may or may not be lost 

The deliriout form is seen under two aspects— 
(1} in old age, after •motiooal ezdtament; in 
this the wandering is slight, and oftan related 
distinctly to the recumbent posture ; (2) a much 
more riolent delirium, which is apparently re- 
lated to cerebral oongesUoo, and is seen some- 
times after mental work or emotional excite- 
ment, or after aleobolie poisoning. Occasionally 
death results. 

The a^opUetie form it marked by sudden loss 
of consciousness, occurring commonly daring 
effort The unoonsoiousneES nsnally lasts only 
a few minutes, and incomplete general weakness 
remains for a day or two. In rare cases the loss 
of conseionaneaa deepens into coma, with ster- 
torous breathing and relaxed sphinetan, and 
death may occur from the extension of the 
cerebral depression to the respiratory centres. 
Vertiginoui sensations sometimes gire a cha- 
racter to an attack. 

In children congestion of the brain is a rar* 
but occasional cause of eonmlsion or delirium. 
Headache and contracted pupils make up a groap 
of symptoms resembling meningitis, but ferer 
is rwely present and if it exists it is slight, and 
the symptoms usually come on suddenly and pass 
away in a day or two. 

Jirtial hyperamia leads to localised symptoms 
of excitement or depression. Local conrulsion or 
paralysis mar result Headache is often intensa 
and localised. If nothing more than congestion 
is present, the symptoms usually soon pass ofC 

Fatholoot. — The pathology of cerebral con- 
gestion is still obscure, since we know little of 
the relatire part played by the blood-reasel* 
and the nerre-elements in determining the symp- 
toms and their form. An excessire snpply of 
arterial blood is, in all organs, attended with 
functional actirity, and it is easy to under- 
stand that aetire congestion should result in 
sjrmptoms of esdtement Subsequent deprea- 
sion of function has been accounted for br 
inferring compression of brain-tiane by ^Raea 



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BRXa, HYFEK£MIA OF. 



The raetioa of axliaiution may eoiH 
triiista. Id pusire eongntioa the nerre-tissne 
it iaperfeetl7 '^fV^inA vith ozTgensted blood, 
and compraMcd bj distended reeeels, and iU 
tectioa are impaned by the presence of eHeta 
penlnets. Hanee the predonuBance of sTmptonis 
•f dcpreasioii oner thooa of initatioo. 

SuaaDRS. — The diagnosis rests on the dii- 

cnVBij of eireolatorfand other canaas of cerebral 

eo ug e ali on ; on the eiremnstanees ot poatore, 

efint, tx^ wider which the symptoiDS came on ; 

OS tlM ezisteoes of eoneomitant ooogestion in 

•tker puts supped bj the carotids, as the £>ce 

(bf BO miiaiie inrariable); on the difiiuion of 

the Bjmptoms ; on their speedy disappearance ; 

and OB tJie abaeoee. in the adnlt at any rate, of 

daratioa of tanperatnreL The diagnoeia of the 

special forms ot cerebral eongeetion from the 

rtiwaaaa vhich they most reeemble is considered 

juder the head of thoee diseases. 

Fboqbosis. — The prognosis is geoeially imme- 
fiatrly &n«rahle, bnt from a serere attack 
death nay probably oocnr. The apoplectic form 
ia iBOBt deageroBs, the eonmlsire least so. De- 
g«.iM l u tui weabaed reasels render the imme- 
sUata ti fugmi ais less laTonnble. After many 
mttaekm, penaaDent notritiTS ehangee in the 



TaKancnT. — The most important elements 
la tha tuatiawiit of cerebral congestion are poa- 
tmrwi, ranoral of blood, porgation, cold to the 
hnft. aad warm and stimnlating applications to 
tha aanCaea. Whaterer be the cause, it is im- 
portaaft to raise the patient's head, so that gra- 
Htatiom nay impede the flov and aid the retoni 
o( the blood. By this meaoi alone insomnia 
boat I tjimiu na may often be prerented. The 
of Uood is nsefnl in extreme forms of 
, ei'iher aetire or passive, especially in 
I vi aetire congestion in which the face*. 
partieipaiaa. Veaeseetion or leeching may be 
easploTad aecording to the eeverity of the attack ; 
IB aetire >'<aigw»fi»ifi the blood which is taken 
aboold be l a mui e d qaickly. The relief which in 
—I fi c a — a IbOoas an epistaxis illostiatee the 
Taloa of this method of treatment. It is not 
aiTiiaaMo in th(«e esses in which, from orerac- 
tiom of bnnB-tiaaoa, or from cold to the snrfsce, 
I of the cerebral yeasels resnlts, while 
|iale. In all forms of con- 
I u vsefol. It remoTee from 
I blood ■orme of its semm, and it affords im- 
ta relief to the cerebral drcnlation, by 
" [ of blood to the capacioos in- 
In plethoric states dinresis 
Baa»t aaefhl, ud has saeeeeded where 
purgation failed (Reynolds). 
Gold to tha bead is of most Talne in reflex or 
' dSatatioo of the cerebral reasels, as 
I -aorlc insolation, fatigue, and some 
tie states. In the same class of cases, sti- 

I of the peripheral nerves b^ sinapisms, 

^ pTiaiju , irr . mmti»a to the neck, will, by reflex 
tnAaeaee. easisi in obtaining arterial contraction. 
Hot a^flieations to the limbe act in part in a 
^i^mi\Mr aaaBer, in part by eanring local afflux of 
hlrmit aad thas lessening tha tendency to en- 
ee]ibaSe cs g uig e iii ent. They are most oseAil in 
■etira c oa g est iuu . Alcohol and opium must be 
waa deJ ia all flanas ol aetira eongesUoD, but 




BRACT, htpebtroph:*?^ ' 

in passire eongeetion they may '^^A ^^ H^ 
Bromide of potassium ia useAtJ *■" ^ /^ ''**»-, 
in which the congestion is prodaatf^'^ ^ <% ' 
motor mechanism, excited eithsx* ^^ «e • *'« 



Uon of brain-tissue or of dist&nC -C^^'^O^ 
passiTs cocgestioD from heartHlis«a«0 ^^»t 
ment is that of the cardiac ooDditioxL 41/ *^ 
sons liable to congestion of the brain -t •''•J- 
lire regulariy, avoid hot rooms, and attend """ 
fuUy to the stomach and bowela, reiierfng-^ll^ 
latter by frequent moderate pnigation. ^^ 
W. R. GoiTBaa. 

BSAZV, Hypertrophy ot—EypertrophT of 
brain is a misnomer. True hypertrophy would 
consist of increase in number or in size of the 
nerve-eella, nerve-tubes, connective stroma, and 
supplying vessels : and there might be expected, 
as a result of this condition, some manifestation 
of a higher intellectual development. Such a 
condition is never found. A so-called hyportro- 
phied brain is one that is larger and heavier 
■ than normal. On removing the skull-cap, die 
encephalon seems to expand so as to render it 
difficult to affix the bone-covering in its place ; 
the membranes are dry, the sulci h.ive nearly 
Reappeared, and the whole organ appears pale 
and bloodless. On section there is a sensation 
of toughness, though less in degree than in a 
case of general sclerosis. There ig no sign of 
pressure upon the orbital plates, such ss is 
met with in chronic hydrocephalus. The lesion 
affects only the cerebral hemiBpherea, espe- 
cially on tJie convex sur&ce, and perhape the 
posterior lobes in particular. The base of the 
brain and the cerebellum are unaffected except 
by pressure. 

On minute examination, the nerve-<^eUs and 
nerve-fibres, far from being found augmented in 
number or in size, may even be compressed and 
diminished ; and there is often also some inter- 
ference with the normal calibre of the vessels. 
Gintrac, however, records a case in which the 
calibre of the nerve-tubes was almost double 
that of the normal. What increase there is affects 
the white matter of the bruin, and this stroctura 
is very pale and of an elastic consistence. The 
real and sole lesion ia hyperplasia of the connec- 
tive tissue. It differs from scleroeii in affecting 
the cerebral hemispheres more univenally than is 
the case with sclerosis ; and also that in sclerocia 
there is not only increase of the connective tis- 
ane, but subsequent retiacUon, and, as a fre- 
quent conaequeoce of this, an absolute destruction 
more or less of the nerve-elements of the organ. 
When the disease is far advanced it may poe- 
sibly cause absorption of the inner table of the 
sknll, and thus produce a roughness or thinning 
of the bone, or, in extreme cases, even perforation. 
The sinuses are generally distended with blood. 
Hypertrophy of imaller portions of the brain is 
rare : still various cases are on record in which, 
under the name of neuromata of the nervous 
centres, white or grey matter has been found in 
certain parts of the brain over and above the 
normal constituents of this organ. Hypeiplatia 
of tha pineal gland is dosely allied to gUoma. 
It should be distinguished fhnn encysted dropsy 
of that organ, 

iEnouxiT.— Eypartiophy of the brain has \mm 



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m BBAIN. HTPCKntOFHT OW. 
Mid to b« MmattBiM MModujr, ud OBOMd bj dw 
mitetion of noiMd giawtiba. Thb, hmnvar, ii 
tut. ItwgmaMlljrinteny.MidiiMybasdii- 
MM of iatn-atonia lif« ; Vnt it kgwanU; da- 
Tcloped after bitth, Mpeeially in tiowty ebildsM. 
Sana fimm ef marohsloeeis, vithoM b;diaM- 
phalus, iMm to b* doe to- tlia growtk of eom- 
°pMt mMM* of -oeMbnl nibitaiic* in ozeaM of 
'Wtet is nonaal. Tho conditioBi for the pndao- 
tion of thia noiMd ateta an in&iegr ; bad diet ; 
repeated eoagaatien of the ceiebBal reaaeli, 
eneh aa might be indaoed b; frequent eoogb ; 
and, perhapi, lead-praaoning. 

Sthftoks. — The a;mptomB of ao-aned geneni 
hjpertrophy vary acconling aa the inturea are 
efoaed or not. If, from insufficient ocdiuion of the 
antnrea, the head expands in proportion to the 
inereaae in size of the enceplialon, the symptoma 
mar be rery alieht. Childnn thua aflMted Aom 
no intelleetnal hebetude. In them, as long aa the 
abnormality is unoomplicatad irith local inflam- 
mation of membranea or irith bttmorrhages, 
there may be no headache, no aflettion of sight, 
no sensory or motor paralysis, and no oonmlsions. 
Convulsions, horreTer, are common in cases in 
vhich the occlusion of the sutures has prevented 
expansion of the head proportionate to the in- 
ternal increase of tissue. In such cases also 
there is generally more or less tbotor paralysis, 
often some anesthesia of the limbs, headache, 
vomiting, and mental hebetude — symptoms, in 
&et, either of marked interference \rith the 
intra-cranial circulation, or of irritation from 
inflammatory complications. The prognosis is 
al-ways bad, but in rachitic eases the course may 
be chronic. 

TBianmrr. — All tnatment leens to be inef- 
ftotiva in diminishing cerebral hypertrophy. 
E! Loira fox. 

BBAnr, InWammattoit of.— SAnnr.: En- 
eephalitia. — ^Encephalitia ia • term wUch ooght 
perhapa to be atrictly limited to inflammatory 
changea in the brain-aabatance itaelf, to the 
exdnsion of all forms of meningitis. It may be 
either diffuse or leeo', but for oar preaent pur- 
pose we hare chiefly to do with the difiase form. 
Local encephalitis will geDnally result in ab- 
aeeaa (ses Bkaik, Abacees of) and will usually 
be met with, if we fint aside the teanlta of inju- 
ries, in aasoeiation either with disease of the ear, 
with tnberenlu grovtha, or with pynmic depoaits. 
It may periiapa be doobted whetlier the oe- 
eorranee ot diflhse. inflammation of the brain- 
sabatunce aa an acuta diaeaae haa as yet been 
proved, excepting as a reaolt of woanda. Evan 
aa a traumatic leaion, ita apeeial fisatnras have by 
no means been aoenrately studied. It is, how- 
aver, highly probable that after penetrating 
wounds of the brain, its snbatanee may inflame, 
joal aa the oellalar tissue of a limb may, the 
mflamraatoiy ptoeeaaaa beginning at the site of 
the wound and rapidly aprsadlng through a 
large port of the hemisphere. It is probably in 
the pwivaseular spaces that the proceaa chiefly 
^raa da , and it ia in these that the microacope 
will detect the moat abundant reaulta. Snoh a 
•ondition of difRue encephalitia may exist with- 
out there being any visible changea in the bnun. 
It may perhapa be a little aoftoned or a little 



nUIir, LACBBATION OF. 

aongested, but -reiy prabaUy ' theM b notUag 
aboat which the moat •apariaaoad pathologiat 
oonld feel certain until tha'aucroaeopo ia sa- 
aortedto. 

S t Mi n Mia .— It is not poasible, in the preaaat 
state of our knowledge, to apeak with any ea^- 
tainty of the aymptoms of diftiaa aneeplmlitia. 
They will wiy, of conae, with the re(^B affaoted ; 
and diaturhaoce of ftnictian, loUowad by mora or 
leaa eompleto loaa, will be th« moat freqaaat oo- 



TBunDBRT.— When the symptoms of enes- 
phaHtia are onea recognised, it will usually ba 
too late for tnatment, and measures of prevea- 
tion are those of chief importance. The early 
use of mereoiy, beginning in anticipation of, 
rather than waiting for symptoms, is probably 
the most important; and nest to it come cold to 
the head, purgatives, and counter-irritation. 
JoKATEAR HuTcaotsoir. 



BSAZfr, Xiaee*»tloa of.— In the 
strict sense of the word, the brain is but littia 
liable to laceration firom iiyury. Yet, in eomea- 
tion with injuries, such aa panettatiag woanda 
of the skull, fraetnrea with great deprea s ion of 
bane, and even with riolant ooneoasions, the 
bimin-sufastance is not anfrequently, to soiaa 
extent, torn. In ao aoft a atmetnra^ however, 
and under the inflaonoe of nmdea of violanaa 
which are nsnally rather of the nature of blows 
than of anything likriy to cauae atretching, 
we rarely meet with leaulta comparablo to 
laoeratioB of any of the flrmer tvstsraa of 
the body. Whenever the brain ia 'laearated' 
it is aiao eoatuaed, and the contusion often ex- 
tends widely aroniid the rant, and ia by far dia 
more important lesion. In the peripheral parts 
of the bnin-mass thia is espeeiaUy true, and it 
is of little practical use to apeak of laearatioos 
excepting aa eonplieationa (rf veryaevere eoa- 
tnaiona. In tho eential paita, the crura eapo- 
cially, we meet now and tnea with a laearation 
properly ao called, and it ia not very infrequsait 
ro find the tmnka <tf aingle nerrca torn acroaa. 
The oonaidaration of thoaa fbnna of laoeiatian 
which are produced by the afihsion of blood from 
ruptured veasels of siae sufBeieut to supply a 
stream forcible eoongfa to bmk op the sue- 
rounding aabstance^ will be faand in the aiti- 
clea Apobuxt, CaBWwtr. ; and BaaiH, Hisaiai^ 
ifaage inta 

la the eaae of iqjniiea to the head from fall* 
or blowB without perforatiaB, oectain definite 
parte are prone to saffer from contusion and 
Uosration. Usually some slight evidence of 
iigury is found immediately beneath the part af 
the skull upon which the blow was received, but 
byfar the chief bmiaing will b« at tho <q>paaito 
points If the occiput be etruc^ thaantariorlobaa 
will be oontuaed ; and if oaa parietal eminenoa, 
the ofipcaila apbenoidal lobe. Thia law, how- 
ever, ia greatly nodifled by the difl°ering cob- 
ditiona under which different parte of the bnia- 
maas are placed aa regards their surroundings. 
In the poaterior half o2 the dtnll the braia-maaa 
ia bulky, and batwaan iu Under lobeaand theeam- 
bellnm is a atrong flexible membrane, well cales- 
lated to break vibiationa gtadnally, and thua to 
pravsnt eoBtasioa, Mor •(• thaca in thasa TUfinM 



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BBAIK. I.ACERATION OF. 




wmr ttnm^y natkad h(mf aigta againat whitb 
tha bcais mig^ ka daalud. Theaa eraditiona 
an u laiaaj as lagasla the antanor lobea nod 
Um atiddla lobca, and the eonseqaaiiee ia that 
«hilit acTci* cartnaiona axe often aaaa in the 
latter, thaj are moGii aian lare in the eerebe]^ 
]mm and paatarior tvo-ihuda of the brain* 
■aaa. In eaaea<ifeaBponndCnetara,vith tearing 
ut the dnn mater, aod deep depreniim ot boot, 
tha UiiJM aiiTiafaian ma^. of ooona, be iqjared 
at aay part ; boL ersn in reepeet to thia kuid o( 
liolenee tha hinder ngiioaa of the skoll are 
ifHiMj p ao toet ad. 

guu -T um . — WaknoT enough of mrfkea-laoeia* 

tioBi of tbafaEaiBiapaztaatharthaathaaaleriac 

■daiddlaIofaea,to be able to aaaert that, nnlau 

the kaion cstand Tei7 widely or dee]^7, it doea not 

iwwmX itaaif bj any facial aynploina. If rery 

ataaMTa^ ve^oiaaa it the opposite limbs and 

■iaof theJacBisaaaally obaerrad. Injury to tha 

r lobaa, ml nan axteaaiTe, eaanot be diag- 

liot it Bay be gseand at in a lev caaca 

■aa of ameU ia loat in one or both 

; ior it ia Tary eomnuw for the olfiutory 

hmlbm to be iiaMg»i at tha aaaM time. If tha 

lobea aat aaaorely laoeratad, the symp- 

viU be those of toj ssren eoncaanoD, 

with tha diJ a t a Ma that the insenability is more 

asarljr eoaplala^ and that it incseana instead of 

di M Jii ia l ifag as the days paas nn. When a sph» 

ossdal lob* ia tuatusad thsre ia nsnally, aooord- 

ding to the vritoi'a obawialiisi, ineamplate hemi- 

' lof tha<^poat»aida,inTolTiBga<naationai 

, and tha &es aa Tell aa the llmbsL 

^Bptons the paticDt may, in the 

I of — ~^*— . vhoU^ neoTer, It is aso^ly 

eC tha aphoBoulal lobe iriiieh is lace- 

C H tha loBOD aztenda higheiv and if it 

■ am tha laft ada, aphasia may be preaent. 

Ib iii M iai iim vith reeent disooTeries (Dr. 

Bael>U>8* Jai^aon, Dr. Fsrrier, and ethiBn) 

^ ta iaeaiiaad faitiiias, ao doubt ws shall be 

dale Luftaa loog to £a|paaa more acearatdy as 

t^tlie vaeiaaxi^gioaaiigniad. Itvoiikl,hoveTer, 

^ nt B0 ptanaass to attempt to do so. 

fmmM:iMmtw, and PBoaaoao. — In the treat- 
mtat sad | « <niMiai a of lawnations and contn- 
^gai of «!■• ■ aifa es of tha i»ain, much depends 
r or Dot tha ease is complicated by 
I ftaetars and the admiasica of air. It 
I admittad thate ia Bah of menin- 
smi aplisliria, deootsd in either ease, by 
a, vithin a' fev days of the iqjiny, 
k ofthaoppoaitasida. To prerent 
;b»tkaoiiiaet of treatment The scalp 

d.ttavoondeloacd'withsatnres 

^ ^^ ^ Mailiialiln. and lint wetted in a spirit- 
«*.|a«i dion iiMl 





afiM 



shwiH be laid orer tha part and 

s ilri" x ' it.ii — ^u— If theease 

ll^tgaaAad te bawitaiitmay be well, in addition 

^fhia, «• vaA the woaad with the lotion before 

it, ar t» drass with Lister's antiseptio 

!■ eaaas at laesiatian witlwnt ac- 

nay sasne feom ilHlWsii softening 

If thia happeaa tha case wiU 

f aait withia a week or tan days. It ia 

f caaaa cf&aetBiad base with 

rliliaaliuii af baam rsoorer ; 

la-aMBawilhpsaaaaeat paialyaia, bat ia otlms 

<«iKboiat< il mast be added that many of tha easea 




BBAIK, HALFORMATIO^a^^ Oj;. 
in which dautb occuib withia a fe«r '''**^«^ * 

or two after fraeture of the base »r» •ttejftS^ 
lacemtion. In these the qrmptosns uJ^Ttt^ 
difficult tediatinguikh from those ot OoiaZT°^ 
Piofonnd insensibilitT.a bloated CaM«, 'tartavm 
breathing, and a full pulse, are aftan p^^g^^ 
but they may be aubstitutad by pallor «iMf^ ieaui 
palse in oonneetion with grrat depnaaioo ot th» 
heart's action. If any dsTuition from tjioawttf ■ 
as regards the paralysis of the limba can be 
prored, it is in fATonr of laceration aod aoajnst 
compnssioa, but the difleiential diagnosis is a 
matter of extreme difficulty. 

Zaaoaration of Oraolal Kerrea.— Lacenu 
tions of single nerres withia tha cranial cavity 
are not by any means aooommen. This occor- 
renee is to be suspected whenever the parts sup- 
plied by a cranial narre ace oompletely paralysed, 
without accoanpanying symptoms indicatiTe of 
sereia tesioa of the uain-mass. Oases of lace- 
latioo of the brain itself may be eomplieated by 
laceration of nenre-tninks, and thus thasymptoms 
may become difficult to interpret with ooafldaace. 

Of single cranial nerree the olfwtoiy bulbs are 
the most liable to sufier from eontosioo ; and the 
third, fourth, and sixth nerre-trunks are those 
most frequently ten through. 

JoHATHAjf HuicEacaoK. 

BBAIK, KaUomatloaa o£— The malfor- 
mations of the eranioB and its contents may be 
dirided into two series : — A. Those which are 
scarcely compatible with life ; and B. Those in 
which life is possible, although the inteUectnal 
power may be vxm or less modified from a. 
nealtby condiTion. 

A. The >!rs< aeriee will inehide at least sevan 
forms, ia all of which life is so rare that it is 
impoasiUe ta q^eak of more than the pathological 
aaaUmy. 

1. Diotphalia — in which two heeds are found 
upon a aiBgla body, or upon two bodies preUy 
extensiTely eonnefted. lo the firat rariaty, one 
bead may be attached to the rault of the palate 
of the other, er may be united to the convexity 
of the skull. Ia the seeond variety the heads 
ma^ somstimes spring from a single neck. 
This dieephalous condition is frequenUy accom- 
panied by malformation afbcting the spinal 
column and spinal nsrrea, as wcH as by soma 
incompleteness in the development of the brain. 

2. Mottoetphalia — the nnion of two heads into 
one, on two separate bodies^ The two cranial 
cavities are united into one. Dissection of the 
dura mater points to ^s membrane having 
been farmed out of two, and ia like manner the 
cranial ooatents are either double, or appear to 
be ain^s ftftm the union of double organs. 

3. AtepluMa — the complete abeence of head. 
An aceplialoiu monster u usually a twia; aal 
when this is not the ease, it is asaneiated with 
the morind condition of the uterus of the 
mother known by the name of uterine hydatids. 

4. ParaetjiliaUa — tha head not ezitirely want- 
ing, but deprived of moat of the cranium and of 
the {see. A monster of this kind is generally 
a twin. 

&. AtmitefkaUa. — The absolute meaning of 
this term would be the absence of all oiBBial 
contents, bntit i* jggada to include certain vario- 



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BSAnr, UALFORUATIOKS OF. 



(te, diflbtiof Meordiag to the ftmoont of the 
•neaphaloo dereloped. The aipect of the head, 
MMmbling that of a £n>g, the eonrnderable pro- 
jection of the eyes, the flattening of the forehead, 
and the abeence of the cranial ranlt, are the chief 
eharacteriitics of thie abnormality. 

In the first degree, there is abunee of cere- 

bmm, cerebellum, mesocephale, and spinal cord. 

' In cases of this kind the eranial vanlt is generallv 

absent) and the bones at the bass of the skuU 

coavex and thickened. 

In the second degree, the cerebmm, eeiebel- 
Iwn, and mesocephale are absent, bat a portion of 
the spinal cord is found. This portion of eord 
M most usually the lower part. 

In the third degree, the spinal emd is pretty 
complete, but there is still an absence of the 
eerebnun, cerebellum, and mesocephale. 

A few cases have been recorded of the fourth 
degree, in which no cerebrum or cerebellum are 
found, but a normal spinal cord, and a pretty 
oompleto mesocephale. 

In the flfth degree,the cerebrum alone is entirely 
or almost entirely absent, whilst the rest of the 
nerrons eentree are present, though not always 
in a perfectly complete condition. The seat of 
the absent cerebrum is often filled by fluid. 

Lastly, one case has been recorded in which 
the cerebrum was present, whilst the cerebellum, 
mesocephale, and spinal cord were wanting. 

Anencephalia, like the other previously men- 
tioned malformations, is due to arrest of develop- 
ment, such arreet depending either on ph^cal 
injuries to the nterua at a very early period of 
pregnancy, or to some mental shock experienced 
by the mother during the first two months after 
conception. It differs from scephalia, not only 
by the partial formation of the head, but by the 
mesence of the heart, and other thoracic organs. 
The ganglia of the sympathetic are usually well- 
derslope^ 

6. PteHdencepialia. In this malformation 
there is anencephalia pliu a rery considerable 
thickening of the meninges, which take the 
place and often imitate the aspect of the brain. 
Its varieties exactly correspond to those ofaaen- 
oephalia. The tumour formed by the derelop- 
ment of the membranes is of variable sise and 
position. It may be frontal, fronto-parietal, or 
occipital. The real seat of the lesion is the pia 
mater. The abnormality consists in extreme 
hypertrophy of this structure, with complete 
arrest in the development of the encephalon, or 
of some portion of it. Several observers hare 
recognised certun vesicles in the interior of the 
membranous tumour, and these have been sup- 
posed to be cerebral cells in process of develop- 
ment. It is more in accordance with observation 
to believe with Ointrac that they are connected 
with the development of the choroid plexus. 

7. Cj/tloetpkaUtt. In this monstrosity there 
is an approximation or actual ibsion of two eyes 
in a common orbit. It is connected with certain 
abnormalities in the brain, that militate against 
viabiliU, or at least prolongation of life. The 
brain itself is generally more or less deficient, 
•specially in its snterior and central portions, 
WU in some cases the nose and moiath are very 
Ul-4mrelopML 

B. The tea-nd writ* of cases owe thair ab- I 



Boraial eonditiaas to iiyiiiy ariaJag in the conns 
of foetal life ; and some forms at lout may be 
due to lesion oonnning at a later period this ia 
the first series. 

8. AttlmieepliaUa — ^incompleteness of briin or 
of membranes — is the chief of these forms. This 
incompleteness manifeats itself in seven varieties 
aocorung to the part of the eneejphelon iqored 
by the lesion. 

In the first variety, the dura mater is soms> 
whatdefieient, being altogether abamt ia esctsia 
•itnalioas at the base of the brain. The falx 
cerebri may be wanting, or from incomplete 
development it may seem perforated viUi holes ; 
or the tentorium eerebelli may be absent. There 
are no symptoms which allow a positive diagnosis 
of any ot these lesions during life. 

In the second variety, there is general inoom- . 
pleteness of the brain, or imperfection of several 
portions of it at one uid the same time. Vndlst 
the eiamal vault is thrown back, and the lower 
jaw is short, the base of the skull is )Mtg», the 
cerebral eonvolntions almost absent, and the 
eerebellnm large. The head is almost always 
•mall, and it may present rarioos imgnlar 
forma. This coincides with certain internal 
lesions, partial or general atiopl^ vith eooae- 
quent serons effusion nnder the mambiaMi^ in- 
iiammatoiy conditions, or thickening of the 
crsnial bones and of the meninges. Toe inoom- 
pleteneis of the brain varies exceedingly, from a 
condition in vhioh the whole biain is atrophied, 
to mots of defioiency, such as the absence of a 
sing^ eonrolutiott, of Uie septom, or ctf the pineal 
ghud. The qrmploms will neeestariljr vary mnch 
according to the amount of cerebral incompleta- 
nesa. Where this is general, affecting in soiBa 
degree all the convolutions, the intellectual 
powers, as in the microcephaloaa Axtacs, wU 
Im veiy slightly developed, and their langnag* 
of the very simplest foim. With the brain stiU 
more imperfect, there is generally complete 
idiocy or a condition closely allied to it, llie 
spedal senses are dulled, particalarly sight and 
hearing. Speech is in abeyance, or is limited to 
monosyllables. There are various motar pheno- 
mena, snch as mnscnlar debility, hemiplegia, 
parajjegia, contraetion, oonTu]sion,Ioasof powar 
over sphincters, dysphagia, vomiting, or feeble- 
ness of respiration. 

The thira variety includes inoompleteness of 
the central parts of the brain. The corpus eal- 
losum, the septom, the fornix, the corpora striat*, 
and tlia oomua ammonia may be imperfectly 
developed. The cerebral hemispheres may thna 
be in some sort itaaed together, and the shape 
of the ventridca altered. The symphNBS dinar 
fimn those of the piaceding variety, ia that tha 
spedal senses ara seldom involved; and that, 
although complete liioej may accompany theaa 
lesions, it is more usnal for the biainto b«|i>oiid 
eapabls of soma dight intelligence, thongh va- 
eqnal'to the coneeptioo of abitesct ideaa. 

In tha fourth variety, the lateral poxtiaaa of 
the brain are ineonpleta. This lesion gemaially 
oecnpiea one aide of tha brain, leaTiag tha other 
hemisphere intact Seratal points in the hemi- 
sphen may be aflkcted, «r the whole of a siiigltt 
lobe. Host usually there is a depmsaion occopj- 
iag the ssat of oas or mace coavolatioaa. Snela 



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BBAIN, MALFOBMATIONS OF. 

m Imub oeemw«wlly aftaAi Um vbal« faomi- 
■pbac giringit thsappnnuieaof Blnrpepooeli 
Wad with llud. SoiMtimeialao Uie neigbtwor- 
iag TCOtticle eoBunimieatM vith it ; or then maj 
be math rentricniar efituioii. irith imper&et do- 
« t 't""'"^ of the eorpoa sbriatom, the optic 
n..Ui»n. the comua «iiimntii»^ the nuunillary 
tabncle, the eras cerebri, and the optic and 
aUactcny oerTea of one side. In a eonaidor- 
aUa proportioB of patienta so affected, the 
haiao ia accompanied hj idiocy, and poaaibl^ 
the inability to speak is eonnwtcd with thu 
Minnl eondition. Some fev patients, how- 
•nr, poaaeaaad with some intelligence, hare yet 
baaa wiable to speak ; this has been the case 
•*EB vben the lenon has existed on the right 
I>aafiMaB is rare ; feebleness of sight, 
fbnna of stiaUsmns, and nystagmua 

. Very fivqaently there ia hemi{uegis 

•f tba n4e oppoaita to the lesion, and certain 
othar ailMtiansaf tha limbs, — amsciatioa, inoom- 
ylflta dareloianeot, contraction, Tsrioos deformi- 
tiaa of the bands, &e. Sensation rren in the 
paialyaed limbs is normal ; conTnUions are not 

In the fifth variety, there is incompleteness of 
til* "«*'"^™- portion of the brain. Here both the 
anSBziar lobes are affected together. This con- 
ditioa may be aaaodated -with some deficiency of 
tba eorpam caUoaam. fornix, and corpora striata. 
Idioey ia not Baoommon ; mutism is the nls, bnt 
in KMEae patients not i^otic a few vords hare 
iMeo poaaible. Other phenomena — amaaioiiiB, 
■tzsbisania, and yariooa motor abnormalitiea— 
I^n« oeenrrad so imgnlarly in these patients 
that it ia probable they ▼an symptoms not so 
■raeh of this Icaioo as of certain farther compli- 



•| B^»i«n p |^»»»jf of the eerabellnm fuims the 
^sxb Tariety. This is sometimes associated 
■^rith n aimilnr eondilion of one side of the bruin. 
XTsaallTOBe lateral lobe only is affected. Oene- 
xal bytbocephaJns is an occasional complication, 
f-nA n f^i.^inn of Said nnder the tentorium 
x br'*' is Ttaj eommon. The symptoms an 
-veryacgatire. In genend terms it may be said 
t}tmt. tlsre is no loss of moaeular co-ordination, 
-~l BO loss of saxnal paver. 

In tfae asrontb Tarietf.then is incompleteness 
0t the aaesocsdiale and medulla oblongHta. This 
is not csTTiea rery far. Certain modifications 
in farm and Tcdnms are alone compatiblo vith 
tbe uttm I laliisi of life. It. is not a common 
1 ^^— nad has generally been associated irilh 

9. Cempt^iial Itgdroetphalut. One rariety of 

tf.;j f»»ig«miml effiision (^ flnid is rare, vix., vhen 

«.|^ 0nid is oatside the dura mater, between this 

iMiinlii III'" ui^ ^^ perieraninm, and the cranial 

liastr* are Cannd floating in the midst of the fluid. 

•[1,0 ^>eoDd rariety is that in vhich the fluid 

ba fiotaide the Inain. The writer believes that 

^tgaim eSoaioa ia this position is not the cause 

of tha atrophy, flattening, or induration of the 

aabweent eezelanal oivans, but the effect ; that 

-vhen ftbd is fband in this situation it is only 

%\tm eosaeqaeoce of some one of the lesions al- 

Yendy iiaMtiniiKl. notably atrophy of brain from 

toTcr esase, and of ateleneephalia. This 

r is, bovsrer, opposed to that of some anthots. 



BRAIN. (EDEUA. O^. ... 

The third Tariety is oongsnitol byarocepbMlim 
of ths rentrieles. In some mucn cnaea tie »• 
crease in ths size of ths head occara before birtb ; 
in others, not until after. The head incitatea 
rapidly in size in the flnt four weeJcs after 
birth. The sutures an widely separated, ths 
cranial bones rery thin, the integuments of ths 
head in^jected, and the hair deficient. Themnselo* 
an badly dereloped, locomotion is imperfect, thf 
intellect is generally obtuse, hot the special ' 
senses an not particularly affected, unless it be 
that sight is deficient. _ 

1 0. Syneneeplulia is inerely a matter of patho- 
logical intensU The head Ot the foetus is some- 
times found adhennt to ths membranes or to ths 
placenta, as a oonsequence of intn-uterine infianv- 
matiou. At the point of adhesion the place of ths 
cranial bone is token by a thin Tasculor mem- 
brane. This condition is sometimes acoompanied 
by, and indeed perhaps causes, encephaloeele. 

11. Exenetpkaiia. — Hen a large portion of 
the brain ia situated outside the cavity of the cra- 
nium. Practically it includes oil the other mal- 
formations of the brain that an ^et to be spoken 
of. Thus, if only a limited portion of the brain 
finds it! way outside the skull by an abnormal 
opening, the displacement is known by the name 
(rf enapiaioeek, or ktrttia cerebri ; if this hernia 
coincide with a hydrocephalic condition of the 
ventricles, it is aUoHtfdraioep/ialoctle ; and if 
the heniia is composed not of the bmin, but of 
the membranes, distended with fluid it may bo, 
the lesion is called TnattttgoeeU or kydromcningo- 
Celt. Exencephalia proper may be subdivided 
m^ frontal, sincipital, and oocipUal, according to 
the dinction taken by the extruded brain. 

In encephaloeele only a portion of the brain 
mon or less limited is found outside the skulL 
The exit takes place most frequently at the occi- 
pital, and next in the frontal ngion ; but the 
temporal and parietal ngions are occasionally 
the seat of this lesion. The symptoms may be 
very negative. Encephaloeele unless pressed 
upon externally is not often attended by convul- 
sion or paralysis, by intellectual feebleness, or by 
difficulty of speech. This latter symptom is some- 
times found when the heniia includes the cere- 
bellum. Neither is this lesion iocompitible with 
the prolongation of life. The chief diagnostic 
difficulty is the possibility of the tumour being 
cephalhamatoma. but this is iVequpntly situated 
over the parietal bones, an unusual position for 
encephaloeele : and external pressure of the 
former tumour causes none of the cerebral phe- 
nomena — stupor, dilatation of pupils, peralysis, 
convulsion, so constantly seen from compression 
of an encephaloeele, E. LoMa Fox. 

BILAIK, Malignant Diaaases of. iSm 

BxAiif, Tumours and New Growths of. 

BBAIIf, Uembrsnes or Maningss ot — 
See Mexinoes, Disesses of. 

BSAJir, Morbid Orowths of. Set Biuix, 
Tumours and New Qrowths o£ 

BBAUr, ODdema of. — DnranTioir. — In- 
flltntion of the brain and pia mater with samn. 

.SnotooT iJTO PATHOLOor. — In chronic ma- 
ladies attended with general cademo, especially 
Bright's disease, flnid is sSbsed aroxmd ths 



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BSAtlT, <EDGtfi. OP. 



brain, into th« msslias of the pta mater and 
between tlie eonvelntioos. Occasionally the 
cerebral enbstancs is infiltrated, but diis is 
Itncomman. The pertrascalar eanaU afford a 
resdr means of escape for effiised serum, and in 
BriKht's disease, at least, the substance of the 
bram often contrasts, by its firmness, irith the 
condition of other organs. In senile atrophj of 
the brain the space between the shranken cod- 
Tolntions is occupied by serum, and the Ten- 
trieles contain an excess of fluid. The biain- 
tissue may appear to contain more fluid than 
J usual in consequence of the distension by serum 
of the enlarged pertTuscular canals. In h^- 
penemia, especially passiTe, such as occnrs in 
neartrdisease, serum is commonly effiised from 
the engorged ressels. Such effusion is also eom- 
mon in insanity, especially in acute dementia. 
The serum may infiltrate the pia mater, distend 
the periTBScnlar canals, and eren infiltrate the 
braiu'tissue. 

The eShsion of fluid in these cases is usually 
slight. Occasionally it is more considerable, and 
the cerebral substance may be enlarged, the 
conToIutions being flattened, and the tissue 
much lessened in consistence. The same soften- 
ing is seen in the neighbourhood of eflusions 
of fluid into the yentricTes ; the Brain-tissue for 
a depth of some lines from the ependyma being 
softened to a pulpy consistence. The post- 
mortem imbibition ijways increases the appa- 
rent amount of the oidema. 

SmproKs.— Little is known of the symptoms 
of oedema of the brain. The cedema is usually 
seeondaiy to some other condition, the symptoms 
of which mask those of the oedema. Oeneral 
oedema seems attended by slowdiminution of men- 
tal power and motor force. The eSusion of serum 
in cases of congestion, and consequent pressure 
on the nerre-olemonts, has been considered as 
the cause of the symptoms of depression common 
in that condition. Cases occasionally occur in 
which efflision of serum into the ventricles and 
the pia mater is the only post-mortem condition 
to be found after an apoplectiform seizure, and 
such cases are often spoken of as instances of 
aerout apopUsy. In so &r as the eflhsion of 
aenim is related to the apoplectic attack, it is 
probably inerely as the consequence of a 
cerebral congest.on which has left no recognis- 
able post-mortem hypenemia. 

TmuTHEXT. — The treatment of cerebral 
cedema is usually secondary to the condition. 
Commonly conspicuous enough, which is its 
cause, — Bright's disease, pass! re cerebral con- 
gestion, &c. If oedema be suspected where 
no causal indication for treatment exists, pnrga- 
iires and diuretics, with iron if there be debility, 
are the remedies most likely to be of serriee. 

The effusion of fluid into the Tentricles is 
described under HTDBOCEFaAi.tis. 

W. -E. GOWBBS. 

BR&.IN', Scleroali of. See SnxAi. Cobs, 
Diceases of. 

B B ATWr , Boftasins of.— DsviKiTioir.— A 
pathological state of brain-tissue, depending 
aommonly oo vascular obstruction ; attended b^ 
dimiiushMt consistence, usually local ; and indi- 
sated, during life, by mental, motor, and wtaaatj 



SBAIN. 80FTENIKO OF. 

srmptans, which varf aacordhig to the seat «f 
Uis lesioB. 

MnauMT. — Local softening of the biain, 
oeeurring during life, is due to one of two anattt, 
inflnmrnntion or Txacnlar ofaatruetion. Host 
cases were formerly thought to be doe to inflno:- 
mation ; but it is now known that very few are. 
The vascular obstmetion, which is the Vfaal 
cause of softening, may be arterial or, rarely, 
eapillaty ; it may be due to a eoagulum furmal 
in tUu (thrombosis), or to a ping of fibria eon- 
veyed into the vessels by the blood (embolism). 
The predisposing and exciting causes of these 
conditions will therefbre be those of softening 
of the brain (ses Bbaix, Vessels of, Dissaaes 
of). The chief concomitant conditions are — 
in thrombosis, vascular degeneration; in em- 
bolism, valvular disease of the heart : and as 
predisposing conditions we usually find, in eases 
of thrombosis, advanced age, Bright's disease, 
chronic alcoholism, or syphilis ; in eases of 
embolism, acute rheumatism, chorea, or searlet 
fever. Senile vascular degeneration is the miMt 
common cause of all of softening of the brain, 
and hence the disease is met with most fire- 
quently in the old, especially in its recurrent and 
chronic form. Embolism, due to valvular disease 
of the heart, and thromboris due to syphilitia 
disease, arc the most fi^Bquent causes of acute 
local softening in the young and middle-eged. 

Akatokical Chabacteus The diaraeteristio 

feature of cerebral softening is diminished con- 
sistence. Tlus may, however, arise fh>m ante- 
mortem or post-mortem changes. In each ease 
the diminished consistence depends on the 
breaking-up of the myelin, of wlueh the nsrve- 
flbres are composed, into globules and granules, 
and the separation of these by an increased 
quantity of fluid. Thus the continuous struc- 
tures of which the brain consists are broken 
up into disconnected fragments, and the con- 
sistence of the tissue is accordingly dimin- 
ished. In po$t-mortem softening there is 
nothing more. The globules of myelin are 
often large, and the separating fluid abundant. 
The softened tissue has the tint of the normal 
cerebral substance. The process is the result 
of the imbibition of fluid fW>m some eolleetioa 
of serum, in the Tentricles or elsewhere, and 
occurs in the greater degree in the immediate 
vicinity of this. In ante-mortem softening 
there are, in addition, certain changes in the . 
tissue-elements. The process of segmentation 
of myelin result* in the fbrmation of finer 
granules. These are in part aggregated into 
'granule corpuscles,' round or oval masses of 
globules ana granules, sometimes contained 
within a distinct cell-wall. Some of these 
bodies may arise by simple aggregation, many 
certainly by the degeneration and distensioD 
of connective-tissue cells, and some by the de- 
generation of nerve cells. The walls ot vessels 
in the softened area also present fatty degene- 
ration. The specific graTitr of the tissue is 
diminished (Bastian), No further change may 
exist, and the area affected may present simply 
a diminution of consistence, its colour remainizur 
unchanged. It is then called vkitt or gny 
toftatinff. Very frequently, however, in tha 
part thus diseased, distensioD of capillarie* with 



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BBJOS, SOFTEHINO OF. 



bli)ad(icain,BoAe(»mdeiB]Me in t^he poripkaiy, 
ladbkxid isutSkUy eS^isad, duefly by raptara 
rf oiiQuni, in put peitiapa 'by mignttcm of 
ap«l«>. In pcoportrioa to tJbe amoant of 
Uood exttiTMitad, ths eoloitr ia dukagad, and 
tka nj iflmlag is prodnoed. Aitai a tima, 
the (Steed bknd dageneratea, ita tint beoomn 
itteiMto^dlovorofraage. and. y«<{<NB •o^raai^ 
■ {ndml mtimately. it ia aaid, th« eoktar. 
It aifintnodente, may be retnoved, and irliito 
MAuing nnlt. 

iU w/ttaua is ftnnd ebietty in tbe gray ■■!>- 

•bin, ■Aen thatwanln are nmneirNU,eai>aeiaU]r 

n tho ooitaz ud central ganglia. Th« tint 

niia; the nd eolcrar is nsoaliy panetiform, or 

na^el Titli jeUow >md "wliite. If the axtra- 

nBtiou in Vuga amd nnmeioas, 'eapillary 

■fopLexT' naoUi. The diminution of eonnstcnc* 

n taaUr modei&ta. Aoeor^ng to the amount 

of tftmoD of mrmiand blood there ia avelling, 

ud iha diwaiul aiea may project abore the eat 

nifaca. InCaiBmaUny Aanges reanlt from tha 

Taaeilsi dsAoBan, and in proportion to theae, 

iaocaae in tha nodei of the neuroglia ia foand. 

From tkiieauc and firom the migratioB of white 

eoTpnrtea, na-i^ eeUa appear. The reaaeLs are 

dilated, ud nsj pteaent a moniUforra appear- 



Thor pariTaacobtr sheatha are often dia- 
teaded 'nth Uood. CemmeneiDg degeneration 
af the efiiiiad Uood may eanse a brown tint. 

TeBow mfttimg reaalta from red atrfteDing, 
bj degcnezatiTe ebanges in the blood eflbaed. 
It has a aimlar aeat, being fraqnently met 
with in the eonrolntians, -where it eonstitntes 
ffafaat Jama of the French. Its consistence is 
■snHf slight, ita aspect granaliur. The colour 
depeada on tha presence cd minnte pigment 
gr m i ul es. diflWsed cohnning matter, and htema- 
toidia crjitala. 

Wtilt t^ftaa»g has Uia tint of the normal 

eerefaral sahsisnee. In consistence it varies ; it 

may be oidy a little below that of the cerebral 

aabstaoce, or it any be difflnent Ita aspect is 

ozufom, or white llakea are scattered through it. 

The limits are aaoallj gradual. Under tha 

BKroaoope it pceaents the detritus of nerre-ele- 

wmta, a few noelri irom the connective tissue, 

lea, and, ultimately, corpora amy- 

Vhita aoftening ia chiefly found in the 

wliita aabatanee of the hemispberas. It oeca- 

akoally haa a gangrenous odour, and then may 

be fband ia the white or in the grey substance, 

probably rcsniting from the obstruction of ca- 

pallanes by aeptie material. 

UUimwtr okaMcs. — White and yellow aoften- 
iag may rraainfcryeara unchanged. Sometimes 
the dhMg^s in the elements of tho neuroglia and 
the extrarasated white corpuscles result in the 
I of a eonsidatable quantity of connee- 
tiasae, eonsisting of One flhre-cells and fibres, 
; abundant in the margins of the softened 
, vUch becoBie firm and dense, while trabe- 
c a ha of epnaaetiTe tisane eroas the cavity. After a 
tima dhe fluid may be absorbed, the fat removed, 
aad a awt of eieatriz result. In other casea the 
vaQa aloae are thus altered, the solid particles 
are rsaaorad from tha softened tissue, and a cyst 
iafiamed. The onter portion of the cyst or cSca- 
triz >Bxy be limited by a lone of dilated bhiod- 



&B<t</«0/tomf.— There £js no j)i^ 
brain in which softening haa Tarr^r beea ^ ' 
itsmoat fraqDaat aaalaaratli'S ^s^ 
stiiatam, and the optic thalamaa^s. 
bellnm,pons Varaliuand ~ ' ■■■■ — 
qaently found. Ita 



<V 



4<» 






«^ 



.*jI.*v^ 



ihamtaii depend on the dlsO^ bntiQ^'*^, 
raaaek. The small artarias of KJie oow^ Ctf "**■ 
torn aad optio thalamns are • ««aeniiQ^^*»« atJH' 
having onlyaapiUaryeoBiniBnic ■»*'<><» ^..-.^^^aw*^*- 






The aitariaa to the anx-Aca of '^.^ 



are usually for the most part texmiinal 
times possaas artenole-anaatoEaa<iaa« 



"•tea' 



tnanehea. Hanoa obatractioia in (l '^ otl> — 
utariea leads invariably to aofb^aiii^. * '^^Mte^ 
tionin the superficial arteries al *c ''*Qali ^''nck 
sofkeaing, whidi involves the grty a^iT^ "^oaeg 
the oonTohitioiis and aoma of t4« ^'^'^'M cf 



white aantre toiHiieh the reaaela paat*^^^f*^'at 



occasionally, the anastomosaa o£ thal^^' ''■' 
Teasels aieao free thatsaftamnar doas ooif^^T^ 
An obatmction of a main tiawk {aa tlt^S^^ 
cerebral) may lead to aoftaaiag of the c^ST 
ngioa (corpus striatum^ while the conrolutfo!^ 
eeeapa; bat osaally both suffer. 

Stvtdiu.— The pmumtiory symptoma of 
softening depend apoo ita cause. Ia embolism 
other symptoms thaji those of the cardiao tioa- 
ble are nsoally abseaC Oeossionally a slight 
attack of loss of eeNbial fbnctioa, das to a 
slight embolism, msy precede a graver attack. 
In softening dae to arterial disaaae, prsmonitoiy 
symptoma of local cerebral aatamia are fre> 
qaently present. There is defective natrition 
of many parts of the laain, revealing itself by 
sjmptoms of wide range — mental deterioiation, 
numbness, pains in the limbs, pain in the head, 
or slight local weakness. These symptoms an of 
especial significance when asaoaatrd with evi> 
denes of arterial degeneiatioo elsewhere; with 
the conditions — as ehronie Bright'i diseaae, aleo- 
holism, and seaility—in which atheroma of the 
cerebnl arteries is common; or with aoattitO' 
tional sjrphilis. 

The symptoma of actual softeaiBg are those 
of loaa of AuKtion in the damaged portion of the 
brain. The onset of the fynptoma may be 
sudden, as in embolism, and somstimes in throm- 
biosis ; or it may be giadsal, as occasionally 
in thrombosis. In the former ease the symptoms 
of initial shock are added to those poper to the 
locality. The latter are fully considared in the 
articlea on Localisation. Hemiplegio sjrmptoma 
and mental alteiatioa are the most common. 
Hemiplegia especially oocurain embolism, on ao- 
count of the fke^fuaney with which the middle 
cerebral artery is obatrueted, and of the iai- 
portant motor regions (corpus striatum and 
motor part* of the eoavtuntions) to which that 
artery is distiibnted. From the distribution of 
the artery to the lower frontal oonrolutions and 
adjacent region, aphasia is frequently present 
when the obatmction is on the leA side. 

When the symptoms come on anddenly, they 
often follow some exertion, or occur during ez- 
hanstioo. If the area damaged be extensive, 
there is loaa ef eonacicnsaeast and there may be 
all the symptoms- of an apoplectie seianre. The 
loss of ooaacionaaeaa is rarely profoand, aad the 
symptoms of apoplesy soon pa^ioS IntlMBoat 



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154 



BRAIir. 80FTBMIM0 OF. 



WTsre cases, howerer, tbqr may dcrpan to fatal 
soma. STmptoms of irritation commonly aucoMd 
thoM of apoplexy aa the eollatcml bypersmia 
■eU in, or they may be marked at the onset. 
ConTolsions, often unilateral, may ocenr and be 
repeated for days. The patient may pass from 
the apoplectic condition into one of delirium. 
In the old, delirlnm may be the eUef symptom 
of the onset Aeoording oa thess symptoms are 
chiefly marlced at the onset three rarietiea have 
bern described, tlie apopketie, oonvultivt, or dt- 
ItrtoM forms. 

Boeovery from the special symptoms of the 
attack is often incomplete ; permanent weakness 
may remain, aa hemiplegia, and mental power is 
weakened, the patient passing into the chronic 
state about to be described. The posistent 
hemiplegia is often accompanied by rigidity, or 
by motile spasm, such as, in its most marked 
mm, has been described as atietorit. Whether 
reeOTery is complete or incomplete, retnrn or 
relapse is common, and is almost invariable 
where the arterial disease, to which the soften- 
ing is due, is widely spread. 

CkroHic mflening is a term applied to a (proup 
of symptoms, of wide range, indicatira of fiiilare 
of brain-power. These may snperrene on more 
acute symptoms of softening, or may be gradual 
in their onset. There is mental dulness, defeC' 
tire perception, drowsiness, loss of memory 
(especially for recent events), often slight wan- 
dering ; emotional manifestations are easily 
excited. The patient complains of headache, 
pains in the limbs, and feelings of ' numbness,' 
which may or may not be associated with octnal 
loss of sensibility. Physical power is defective, 
usually geaemlly, sometimes locally. The more 
delicate motor actions are imperfectly Bt^jnsted : 
articulation becomes confluent, and the hand- 
writing indistinct or illegible. These symptoms 
may progress into actual imbecility, or maybe cat 
short by some more profound cerebral seizure, or 
by some intaienrrent pulmonary aflTection, ren- 
dered grave by the deficient miiscnlai respiratory 
power. They depend upon de^jeneration of 
brain, commonly one to arterial disease. Spots 
of softening, often widely spread, may be aaso- 
eiotad with this condition, and may be, indeed, 
the cause of the symptoms. But tJie state may 
come on without any local softening; and 
atrophy of brain, with or even without degene- 
rated vessels, may be the only anatomical con- 
dition. It often follows any grave local lesion — 
softening, hssmorrhags, or tnmonr — and then 
depends on a direct prejudicial infinence on 
the cerebral nutrition, or on a secondary effect 
through the perturbed vascular OTstem. 

DuoHOsn. — The aeut* form of softening baa 
to be distinguished trtsm acute congesUve npo- 
ploxy and from cerebral hemorrhage. It is 
distinguished from the former by the persistence 
of the symptoms indicative of local mischief, and 
by the absence of evidence of cephalic hypenemia. 
From hemorrhage the diagnosis is often difficult. 
In softening from thrombosis, the initial apoplec- 
tic sjrmptoms may be absent, or, if present, are 
slight and brief. They are more often preceded 
by symptoms of local cerebral aoemia, due to the 
vascular disease, than is the onset of cerebral 
hamorrhage. Improvement occnn earlier than 



in cerebral hisniorriiage. The tampemtare lisai 
soon after the attack, but fiiUs in a day or two ; 
in hamorrhage the rise occurs lut«r(Bourneville), 
There is more marked mental change than in 
hamorrhage, shown ut first in excitement, sub- 
sequently by depression and deterioration of 
power. In the cases in which the onset is 
sudden and the apoplexy profound, a diagnosis 
from hiemorrhage is often imposxible. In soften- 
ing from embolism the patient is nauttlly below 
middle age, heartnliaeatie is present, and evi- 
deuce of arterial disease is absent. The onset o( 
the attack is commonly sudden, but the loss of 
consciousness is less profound than in hsmor- 
rhit^e. In capillary embolium, if pxtensire, a 
distinction from hemorrhage often cannot be 
mads : the loss of consciousooss is profound and 
lasting. 

Softening may be distinguished f^m local 
cerebral aiuemia, which often precedes it, by the 
definitenoss and persistence of local symptoms ; 
but a small area of softening ma^ produce symp- 
tom* identical with those resulting from a large 
area of anemia. Softening is distinguished 
from tumour and chronic meningitis by the 
•light pain and the absence of optic neuritis. 
From simple atrophy of the brain, chronic soften- 
ing differs by its less nniform course, and by the 
sudden occurrence and persistence of ^mptoms 
indicative of local lesions. 

Psooxosis. — The immediate and ultimata 
prognosis in an attack of softening of the biain 
depends on its severity in degree and extent, as 
indicating the extent of the lesion, and on the 
region of the brain damaged. Both the im- 
mediate and the ultimate prognosis is much 
graver in damage to the medulla and pons 
Varolii than when the corpus striatum or cere- 
bral hemispheres are affected. Youth and 
general health favour the rapidity and the 
degree of recovery. Where actual softening has 
occurred, the damaged tissue probably never 
regains its functionid power. The congested 
periphery recovers in proportion to the inherent 
vitality of the tissues, ana to the freedom of th« 
vessels from disease. The chances of a recur- 
rence of softening in another situation depend 
on the extant to which its causal condition is 
widely spread or can be removed. In vascular 
degeneration recurrence is almost certain. In 
embolic softening there is usually organic 
valvular disease in the heart, and emlwlism re- 
curs in a considerable proportion of the casea, 
though less frequently than senile thrombosis. 
The prognosis in syphilitic disease of the vessels 
depends upon the recognition and treatment of 
the syphilitic influence, 

TaMtxtcan. — During an acute attack the 
patient must be kept at perfect rest, with ths 
head moderately raised, in a uniform tempera- 
ture. During the initial stage of shock, warmth, 
by hot-water bottles, &c., should be applied to 
the surface, to equalize the circulation. Tho 
bowels, if confined, should be made to act gently ; 
bnt, unless the evidences of encephalic oongestioQ 
are early and conspicuous, purgation should be 
avoided. Should stimalants be administered? 
It has been proposed by stimulation of the heart 
to aid the establishment of the collateral circula- 
tion. But it must b« remsmbsred that the imper. 



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BBAIN, SOFTERIKO 07. 

ftet eoDsUtml flow arins from Ui* minota liie 
of the aitariml amutomoaaa. Tha obctraetion or 
oasiaaal ahg»y» in CT e m M tha liymeeat prM ii i re 
to aaeh an extant aa to dUtand tha TMaaU to 
thm* ntBoat stivngth, and any flnthar inoeaaa 
vodd. bj i^ttming them, impada rathar than 
Aothar tha objact in Tiaw. it, tharafore, tha 
kaut ia acting feebly, atimvlata it by amall 
f aantitiae i>f alcohol to the normal fane, bot 
■otbajoad. If tha diwtnoaia from hcnKorhifie 
ba ia any degree doobtftil, great eantioa ahonld 
be obaarnd in atimnlation. After the ataga (rf 
haa paaaed, the iiritation dna to 
hypeTmnua, and indicated by ele- 
Tstion of tenperataie, may be reliered by 
pngMi^**! drj-eappiofi, aad aTen, in aoma 
eaaai, by the application of leaehea, thoogh the 
latiar an oaily naeeaaaiy vhao tha eridenea of 
geaecal raacolar irritation ia great. When con- 
TahaoD ia an eariy and reemrent aymptom, 
maatsd plaaten to the neck and axtiemitiea, 
aad braauda of potaaainm in laige doaea, an 
asML 

After tha attadc haa paaaed, reeoreiy mnat be 
aided by maiaCainiag tim aenaial health in tha 
beet pneeibie enaditOTi, "tht aeerationa ahonld 
be kept free, thad ig ea li teoiganeingood radar, 
the habata itrietly regolatad, aad nervine tonica, 
eod-IiTcr oil, hypophonhite of aoda, atiychnine, 
qainiae^ and inm, may be ^ran vith adTantage. 
Iha ^nptaeaa of dirome aoftening, vhethar 
aeearring after an acote attack or coming on 
gmlaally, ehomld ba tiuatad in a aimilar manner. 
Hiaal can durald ba taken that tha peripheral 
ahatractiaa to the cirealation, indicated by ang- 
melnil aitenal tanaioB, (ineoopnaaibility of 
pdaa\ ia kept at ita mininram by the aToidanca 
of aaeeaa ia &t, aad by_ jvooipt purgation vhen 
anr inrraeee in tcaaioB is obsturrai. 

W. B. Gk> 



BBLAOr. BypMlltloPlaa a aa ofl /SmBbaw, 
I and Hew Oioaths oC 



BBAZV. Tnbante o£ &• Bsaoi, Td- 
■ona aad Xav Qrowtha of. 

BXAXV, Tonoara and. Vaw Orowtha of. 

-The intimate erainerrion of tha biain with ita 

I it impoaaibU, azeept in tha 

I terma, to dnw any marked diatino- 

L tamooia of tha eeiebisl anbatanoa, 

aad tnawnf aiiaing from ita anrelopaa. A 

J ininidi from a mambiana must 

lapoo biain-tieena : a growth originatiiSg 

I mnat ia many aitnationa inTolra 



AxasomcAi. ratatrraaa. — Thatiaanaa from 
wkiah t aa ao ar a hare their origin aeem to pte- 
aaatthabeatgioandfiira asiaatifio elaeei6cation 
«f theae limrmi : and it ia not daroid of intereat 
ta aaA that the ahaolnte narra-elementa of tha 
kaaia an narer pcimaiily tha aooroa of a morbid 
gnwih. 

Cawhtal UuMWua , then, may be ronghly aepa- 
ntad iaao three aeaea :— 

i, Tboae whoa* eentn of origin is aome one 
■r athar at tha nambimnes, eztemal to the 
hi MB or Sffii^ into the Tantriclaa. 
S, noaa wfaiah apring from the blood-Taaala. 



BBAIK, TUMOUBS OF. US 

S. Thoae vhieh own the aaongUa aa thai» 
atarting-point. 

Taking this anbdiriaion, which ia Itindflaiaeh'a, 
tha tnmoura which are plaeed in each aeriea di&t 
aomawhat from hie smngament. 

In the first aeriee fiTe kinda of tumour are fonnd, ' 
ariaing front tha mambninea or from the froa 
•nrfaca of the Tentrielea. Theae me Paaehi» 
nian grannlationa ; apindle^eUed ■arooma ; myx- 
oma of the membraaea ; paammoma ; and lipoma. 

Tha aeooad aeriea will melnde, firat, ananrisma^ 
depending npoD disean of one or mora of the 
arterial coats ; and, secondly, snch tomonrs as 
bare their origin in the sheaths of the ressals, 
comprising carcinoma eenbri simplex ; ftingaa 
of tba dora mater; eholeataoma; epithelioma 
myxomatodaa peanunoanm ; papilloma of the pia- 
mater and Teaabls; papilloma myxomatodaa; 
and tnberde. 

In the third aeriea may be ooonted glioma ; 
myxoma of -the narre-aufastanoe ; ayphilitia 
gamma ; aad fibroma. 

Inolodad under none of than haadiaga, aehi 
Boeocei and eyatioerei eeUnloaa mnat be men- 
tioned, aa they allkot the brain. 

£sch of the growtha annmeratad will now be 
briefly deeeribad, 

1. PaeekiimUm ffratMil<Uiomt. Theae an graao- 
lationa of tha araehnoid, aomatimea met with 
in childhood, rery conatantly frcnn middle aoa 
onwards, aad scarcely recognised aa moitid 
leaiona. Their Ktiology ia unknown. They do not 
g^Te riee to any aymptoma. They on chisfiy 
aitaated along the auparior longitudinal ainna, 
which in ran caaea is perfonted by them. They 
form gioupc of papilla, consisting of striped 
eonneetire tisane, poor ia cells, and proceadlLig 
directly from a thin but a continually nnewea 
layer ^subepithelial garmioal tissue. 

3. Sareowu. This sometimes has its origin in 
the nerroos tisane itself, but more frequently 
arises from the dura mater, especially at the ban 
of the skulL From their sitnation sarcomata an 
especially apt to interfen with one or man of 
the cenbrol nerrea. They may attain the «i»T 
of a pigeon'o, or araa of a hen's egg. 

When sarmma attocka the duia mater it ori- 
ginatea from its internal aide. The moat nanal 
aitoation ia tba mambraoa about tha aella tur- 
cica and the pan pctroaa. It forms a depras- 
aioD in the bnio, while tha bone becomea atx«K 
phiad behind it. The growth is compoasd of 
nuiform cells, with toUrably numerous, and 
sometimes dilated vessels. Saraomatous growths 
an not freely dcTslopad above the surface, but 
rather in the depths of the tissue; they distend 
tha eenbial convolutions, form deep Uepressionr 
oo tha surface, and even penetrate fiur into the 
brain. They occur under two forms— /tcrj jer- 
eoma with compact flbrona fundamental tissue 
and small cells, often called fibrous tumour ; and 
mft tarcoma, with a loose scanty intercellular 
substance, and numerous cells of comparatively 
laigosizs. The cells an mostly fusiform, but 
sometimes round and multinnclear, and the two 
latter may be surrounded by the former. Sar- 
coma in this situation is generally single. It 
may attain the lixa of a nut or even of an apple ; 
and is frequently hnmorrbagic. 

In the cenbrol tiasua itself tha hard ••^"rm^ 



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IM BBAIN, TTWOUltS AND NEW GROWTHS Of. 



■ttaivagnatdsgnoof danmty: it 
fibsrai, at other times eartilaginoni, of • deoM 
boBOKMMoni ■tmetan, whidili or blnUh'white, 
with a yellow ting* bar* aad there, and iritb 
rvTf few reiwli. It U diKJngu