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THE

LONDON

MEDICAL REPOSITORY

MONTHLY journal

AND

REVIEW.

EDITED BY

JAMES COPLAND, M.D.

Member of the Royal College of Physicians, and of the Medical and Chir urgical Society
of London; Consulting Physician to Queen Charlotte’s Lying-in Hos'pital; one
of the Physicians to the Royal Universal Dispensary for the Diseases
of Children, and late to the South London Dispensary ; and
Member of the Medical Society of London.

AND BY

ROBLEY DUNGLISON, Esq.

Member of the Royal College of Surgeons; Secretary for Foreign Correspondence to the
Medical, and Member of the Hunterian Society' yf London, Corresponding Member
of the Societe Linneenne and Societe de Pkarmacie of Paris, and of the
Socitte Royale des Sciences of Nancy, <|c. S;c.

Quserere Verum.

Horace.

VOL. XX.

FROM JULY TO DECEMBER, 1823.

LONDON:

PRINTED FOR THOMAS AND GEORGE UNDERWOOD,

32, FLEET STREET!

1823.

■

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. ,• • • ■'■'• *7 • ■ *

. •- >•-* - • •

LONDON:

' • / • •,*

PRINTED BY J. MOYES, GIIEVILLE STREET.

CONTENTS

VOLUME XX.

PART L

ORIGINAL COMMUNICATIONS.

PAGE

1. Historical Sketch of the Progress of Medicine, and of

the Sciences connected with it, in Great Britain and on
the Continent, during the first Six Months of the Year
1823 1

The same, concluded - - - - - 89

2. Observations on the Modifications and Treatment of Ma¬

rasmus. By a Physician to a Public Dispensary - 137

3. A Case of Venous Congestion of the Lungs. By C. T.

Haden, Esq. Surgeon, &c. - _ - - 144

4. On the Effects of Irritating Substances on the Intestines

when rubbed on the Spine. By J. King, Esq. Surgeon,

&c. - - - - - - 148

5. Cases of Rupture of the Liver. By a Friend of the Editors 149

6. Case of Chronic Diarrhoea successfully treated with the

Secale Cornutum. By A. Stout, M.D. &c. - - 151

7. A Case of Puerperal Convulsions successfully treated with

Ergot. Communicated in a Letter to W. Darrach,

M.D. by W. D. Brinckle, M.D. - - . I53

8. Observations on the Power of the Arteries in carrying on

the Circulation of the Blood, on the Nature of this
Power, and on the Manner of its Exertion. By William
Shearman, M.D. &c. - - - - 181

9. Case of Axillary Aneurism, in which the Subclavian Artery

was tied above the Clavicle, and the Patient recovered.

By Thomas Bullen, Esq. Surgeon, &c. - - 190

10. Case of Aneurism of the Aorta, in which the Application

of Cold proved very beneficial. By Joseph Ward,

Esq. Surgeon, &c. - _ - - _ 195

11. Case of Melanosis. Communicated, in a Letter to Dr.

Copland, by Sir Andrew Halliday, M.D. &c.
[With a Plate] - - - - -197

12. Case of extensive Abscess of the Brain, which partly dis¬

charged itself externally for some Time previous to the

CONTENTS.

PAGE

Death of the Patient. By William Pretty, Esq.
Surgeon, &c. > _ _ _ - 204

13. Case of Miliary Fever. By W. C. Dendy, Esq. Surgeon 207

14. Case of Scirrhous Thickening and Stricture of the Cardiac

Orifice of the Stomach. By A. R. - - - 210

15. Cases of Perforation of the Stomach, &c. occasioned by

the protracted Use of the Corrosive Preparations of
Mercury and of Spirituous Liquors. By U. Coste, M.D.
of the Faculty of Paris - - - 212

16. An Inquiry into certain Opinions which exist relative to

the Procreative Powers of Women who are Twins, the
Socius in Utero, or Co-twin, being a Male. By J. J.
CiiiBR, Esq. Surgeon, &c. - - - - 213

17. Case of Amaurosis produced by Enlargement of the Pitui¬

tary Gland. By Joseph Ward, Esq. Surgeon, &c. - 217

18. A few Observations upon the Nature of Fractures of the

Long Bones in general, and upon the Nature and Treat¬
ment of simple Fractures of the Humerus in particular ;
accompanied with a Description of a New Apparatus,
illustrated by Cases. By Joseph Amesbury, Esq.

Surgeon, &c. - - - - -219

19. Observations in Practical Pathology, No. TX. — Illustra¬

tions of Rupture in the Vena Cava, with Cases and dis-
quisitive Remarks. By James Kennedy, M. D. of
Glasgow 269

20. Case of Sloughing Phagedsena, with Remarks. By

Thomas Sutton, M.D. &c. - _ - 305

21. Contributions to Pathology. — No. 1. Case of Tumour

within the Trunk of the Vena Porta, completely obstruct¬
ing the Circulation through this Vessel, &c. &c. By
Joseph Ward, Esq. Surgeon _ _ _ 307

22. Remarks, by Henry Earle, Esq. &c. on Sir Astley

Cooper’s Reply to his Critical Observations on Fracture
of the Neck of the Femur, &c. &c. _ _ _ 309

23. Case of Anasarca successfully treated by Acupuncturation.

By John Tweedale, M.D. Lynn-Regis, Norfolk - 313

24. Case of Hydrocephalus Chronicus, in which Pressure

proved most beneficial. By J. F. Barnard, Esq.
Surgeon - - - - - -314

25. Cases in which Fumigation proved a successful Auxiliary

Remedy. By P. C. Blackett, Esq. Surgeon - 316

26. A Description of Trephining Instruments, upon Principles
entirely new, which are calculated to secure confidence
to the Operator, by removing all apprehension of injuring
the Brain, and are applicable to uneven Surfaces ; and
which are submitted to the attention of the Medical
Profession. By Frederick William Morris, of
Halifax, Nova Scotia, Student of Medicine at the Uni¬
versity of Edinburgh. [With a Plate] - - 318

CONTENTS.

PAGE

27. A singular Case of Umbilical Hernia, with Physiological

Remarks. By Thomas Sutton, M.D. Greenwich - 357

28. Case of Enlarged Spleen, combined with Disease of the

Serous Surfaces in both the large Cavities. By James
King, Esq. Surgeon, Hamilton, N. B. - - 360

29. Case of extensive Congenital Division of both the Hard

and Soft Palates, successfully treated by Mechanical
Means. By Mr. Snell, Dentist, &c. [With an En¬
graving] 365

30. Case of Vomiting of Blood, in which large Doses of the

Superacetate of Lead proved a powerful Auxiliary
Remedy. By J. Denton, Esq. Surgeon - - 367

31. Case of Purpura Hsemorrhagica. By Edward Thomp¬

son, Esq. Surgeon _ _ _ - - 368

32. Case of Acute Hydrocephalus, with Softening of the Brain.

By Thomas Rolph, Esq. Surgeon, &c. - - 372

33. A Case of Laceration of the Perinoeum, Urinary Bladder,

and Rectum; with Observations on the Use and Abuse
of the Vectis. By Wm. Gaitskell, sen. Esq. Surgeon 376

34. Contributions to Pathology. — No. H. Cases of Aneurism

of the Aorta. By Joseph Ward, Esq. Surgeon, &c. 382

35. A General Report of the Medical Diseases treated in the

Kent and Canterbury Hospital, from January 1st to
July 1st, 1823, with a particular Account of the more
important Cases. By Dr. H. W. Carter - - 386

The same, concluded _ > - - - 445

36. Case of Trismus, &c. approaching to Tetanus, supervening

to a lacerated Wound, successfully treated by Acupunc-
turation. By Frederick Finch, Esq. Surgeon - 403

37. Critical Remarks on the London Pharmacopoeia of 1809,
and the altered Edition of 1815; with Suggestions
intended to obviate the Objections made against attend¬
ing to the Directions contained in the “ Pharmacopoeia
Collegii Regalis Medicorum Londinensis submitted to
the consideration of that Learned Body, and the Medical
Profession in general. By J. H. Sprague, Esq. Sur¬

geon, &c. - - - - - - 404

The same, concluded ----- 479

38. On the Use of Digitalis Purpurea in Pulmonary Diseases,

with Cases and Observations. By T. W. Wansbpv,ough,

Esq. Surgeon ----- 457

39. Cases of Deafness and Dumbness. By John Harrison

Curtis, Esq. Surgeon, &c. - - - - 503

40. Some Account of the Life and Professional Character of

the late Matthew Baillie, M.D. F.R.S. L. & E. &c.

By Dr. Copland ----- 520

41. Some Account of the Life and Character of Andrew
■ Nicole, M. D. Deputy Inspector of Hospitals, &c.

By A. T, Thomson, Esq. F.L.S, &c, &c. - - 527

CONTENTS.

PART IL

ANALYTICAL REVIEW.

1. Dr. Pring's Exposition of the Principles of Pathology, and

of the Treatment of Diseases - - - -

2. - - — — - - - - (concluded)

3. Mr. Averin’s Treatise on Operative Surgery

4. Dr. Gregory’s Elements of the Theory and Practice of

Physic

5. Dr. Paris and Mr. Fonhlanque on Medical Jurisprudence

6. Mr. Bayjield on Practical Cupping _ . _

7. Medico-Chirurgical Transactions > . -

8. Mr. Haden’s Translation of Magendie' s Formulary

9. Ah. Guthrie on the Operative Surgery of the Eye

PART III.

ANALYSIS OF FOREIGN PUBLICATIONS.

1. Recherches Anatomico-Pathologiques sur la Medecine

Pratique. Par C. F. Tacheron, D.M. &c.

2. De rObliteration des Veines, et de son Influence sur la

Formation des Hydropisies Partielles, &c. Par M.
Bouillaud

3. Observations sur quelques Cas de Developpemens rapides

des Tissus Accidentels. Par M. Andral
Cases of Scirrhous, Encephaloid, and Tuberculous Tissues,
rapidly developed in the Abdominal Viscera
Cases of Tuberculous Disease Irapidly developed in the
Lungs

4. M. Rostan on Softening of the Brain - _ .

5. - - (concluded)

6. Dr. Casper on Injuries of the Spinal Marrow

PART IV.

MEDICAL AND PHYSICAL INTELLIGENCE,

BRITISH AND FOREIGN.

1. Destruction of a great Part of the Spinal Marrow, with

Contraction of the Arms, and perfect Motion of the
Inferior Members. A remarkable Case, communicated
by M. Rullier, D.M. &c. _ - _ -

2. Remarks, by M. Magendie, on the foregoing Case

PAGE

321

154

237

335

418

425

504

168

254

ib.

260

337

429

518

CONTENTS.

Vll

PAGE

3. On the Cure of Intermittents by Frictions with the Tar-

tarized Antimonial Ointment on the Epigastrium. By
Dr, Pommer - - - - - - 86

4. Experiment on the Effects of the Ergot of Rye. By M.

Cordier, D.M. - - - - - ib.

5. Use of Moxa in India - - - - - ib.

6. Army Medical Officers’ Funds for the Benefit of Widows,

&c. - - - - - - - 87

7. Alteration of the Anterior Part of the Spinal Marrow,

observed at the Hospital of Charenton. By M, Royer
Collard - - - - - -173

8. Emetics useful in counteracting the inordinate Effects of

Mercury ------ 174

9. A Solution of Opium in Nitric Acid beneficial in Hectic

Fever - - - - - -175

10. Shock of an Earthquake felt at Sea - - - ib.

11. Half-yearly MedicabReport of the Hospital for the Casual

Small-pox and Vaccination, at St. Pancras - - 176

12. Annual Report of the General Committee of the Asso¬

ciated Apothecaries and Surgeon- Apothecaries of Eng¬
land and Wales, &c. - - ■» - - ib.

13. On the Presence of the Hydro-Cyanate of Iron in Urine.

By Dr, Julia ----- 264

14. On the Efficacy of’ the Injection of the Volatile Alkali in

suppressed Menstruation. By Dr. Lamgna ']\m. - 265

15. Case in which Blue Urine was voided during Enteritis - ib.

16. On the Treatment of the Bite of the Viper - - ib.

17. Experiments on the Therapeutical Properties of Strych¬

nine. By M. Andral fils - - - - 346

18. The Manner of obtaining Brucine adopted by the French

Chemists - _ _ - - - 347

19. Experiments on the Medicinal Properties of Brucine. By

M. Andral fils ----- 348

20. Remarks on Poisoning by the White Oxyd of Arsenic

(Arsenious Acid). By Professor Orfila - - 349

21. Case of Fistulous Opening in the Left Side of the Thorax,

communicating with the Bronchise. By J. Lehidois,D.'^l, 351

22. On the Scorbutus which manifests itself in a local manner
during the Treatment of Fractures, and prevents their

Union. By M. Jules Cloquet . - - 352

23. Fatal Effects of Fear - - - - - ib.

24. Of the Chemical Composition of the Strychnos Pseudo¬

kina. By M. Vauquelin - - - - 353

25. Number of the Births, Marriages, and Deaths, in Paris,

during the Year 1822 - - - - ib.

26. Case of successful Operation for Salivary Fistula. By

Professor Bedard - - - - - 354

27. Improved Truss - - - - - ib.

VI 11

CONTENTS.

PAGE

28. The Report from the Select Committee on the State of the

Penitentiary at Milbank - - - . 438

29. On the Therapeutical Effects of Iodine. By Dr. Coster ib.

30. Vegetable Alkali from Rhubarb - - - 440

31. The^ Efficacy of Oil in Cases of Poisoning by Potass. By

M. A. Chereau - - - - - ib.

32. On the Use of Sugar in Cases of Poisoning by Lead. By

M, Reynard - - - - - 441

33. Clapham Retreat for the Medical Treatment and Care of

the Insane and Imbecile - - - ib.

34. Messrs. Voisin and Falret's Establishment for the Treat¬
ment of the Insane of both Sexes, at Vanvres, near Paris ib.

35. Society for the Cultivation of Meteorological Science - 442

36. Case in which a Tumour was found within the Vena Porta.

By M. Honore - - - - - 531

37. Case of Softening of , the Anterior Part of the Medulla

Oblongata and Spinal Marrow. By M. Royer Collard 532

38. Case of Chronic Hydrocephalus in an Adult Female - ib.

39. Case of Intus-Susception, followed by the Evacuation, per

anum, of about 30 inches of Small Intestine and a
Portion of Mesentery. By MM. Bouniol and Rigal fils 533

40. Efficacy of the Chloruret of Lime as a disinfecting Agent ib.

41. Vegetable Milk - - » - - ib.

42. On the Exhalation of Carbonic Acid during Respiration.

By Dr. Edwards - - - - - 534

43. On the Transmission of Contagious Principles from the

Lower Animals to the Human Species. By Rrofessor
Remery of Breslau - - - - - ib.

44. A new Remedy for excessive Salivation - _ ib.

45. Lectures on Medical Jurisprudence. Bn J. Gordon Smith.

M.D. . - ib.

Monthly Medical and Scientific Bibliography —

British
Foreign

Works received for Review
Literary Intelligence
Notice of Lectures
Quarterly Report of the Prices of
Pharmacy

Meteorological Journal for London
Notices to Correspondents

- 87, 178, 265, 442, 535

87, 179, 265, 354, 443, 535

179,266,443,535
87,179, 266, 355, 443, 535
179, 266, 443
Substances employed in

266

- 88, 180, 268, 356, 444, 536

88, 180, 268, 356, 444, 536

THE

, i

LONDON MEDICAL

REPOSITORY.

No. 115.

JULY 1, 1823. VoL. XX.

HISTORICAL SKETCH OF THE PROGRESS OF

MEDICINE,

AND OF THE SCIENCES CONNECTED WITH IT,

During the first Six Months of the Year 1823.

In the view, which we are now' about to take, of the pro¬
gress of medical science during the preceding half year, we
shall observe the following physiological arrangement: —

I. General Systems.

Nervous Systems. Cellular System.

1. Involuntary Nervous
System.

2. Voluntary Nervous
System.

Vascular Systems.

1. Arterial System.

2. Capillary System.

3. Venous System.
a. The Blood.

4. Absorbent System.

a. Lymphatic.

b. Lacteal.

11. Particular Textures.

Serous Texture. Fibrous Textures.

Glandular Texture. Osseous Textures.

Mucous Texture. ' Dermoid Textures,

VOL. XX. NO. 115. B

Muscular Systems.

1. Involuntary.

2. Voluntary.

2 Historical Sketch of the Progress of Medicine ,

III. Particular Organs.

5. Organs of Sense.

6. Organs of Voluntary

1. Digestive Organ.

2. Respiratory Organ,

3. Urinary Organs.

Motion, &c.

4. Generative Organs.

IV. Views which respect the relative condition of
THE Tissues and Organs, in their connected

STATE, AND WHICH REGARD THE WHOLE AnIMAL

Frame.

General Anatomy. — The most interesting observations
that have been made in this department of science relate
to the arrangement of the venous system in several classes
of animals. Dr. Jacobson,* of Copenhagen, who has
directed his attention to this subject, has shown that in
those animals the urinary secretion, as well as the biliary,
is derived from venous blood. In our last Historica 1 Sketch
W'e gave M. Mappes’s account of the intimate structure of
the liver, and of his conclusion, which is supported by
Eysenhardt’s investigations, that the organization of the
kidney is similar. May not this circumstance, as well as
the close analogy existing betw-een the structure and func¬
tions of tlie same organs thfonghout the various classes of
animals, so strongly and ablj" insisted on by Geopfroy-
Saint-Hilaire, be proofs that secretion does not lake
Jjlace in the kidney until the blood conveyed by the arteries
has passed into the venous capillaries, and acquired many
of the characteristics of venous blood t

It is well known that in mammiferous animals, the veins
which proceed from the inferior or posterior part of the body
meet in one common trunk, by which the vena cava inferior
is formed, and the blood conveyed straight to the heart.” Dr.
Jacobson goes on to state, that this arrangement of the
venous system, however, obtains in no other vertebral ani¬
mals ; and a new and peculiar system of the veins exists
which is not directly united with the other veins of the body.
By means of the veins which compose this system, the blood
which flows back from the middle or posterior part of the
body does not go directly to the vena cava inferior, and
afterwards to the heart, but is conveyed either to the kidneys,
* or to the kidneys and liver.

This system is observed in birds, reptiles, -and fishes;
and its primary form undergoes three degrees of modification.

The first modification j which is to be esteemed the pro-

* Isis ofDkfen for 18*2^; and Edinburgh Medical Journal for
January, 1823.

General 'Anatomy, %

totype of the rest, exhibits the following form. From the
skin and muscles of the middle part of the body branches
arise, which form several trunks, passing separately to the
kidneys, in the substance of which they again divide into
branches, and are there variously distributed.

^Mn the second modification^ the veins which return from
the posterior part of the body are received into this separate
system, of which we are treating. The caudal vein, which
brings back the blood from the skin and muscles of the
posterior part of the body, divides into two branches, which,
having received some veins returning from the middle part
of the body, flow to the kidneys of each side, and distribute
their branches in the parenchymatous substance of these glands.

In the third modification^ the veins of this system are
formed in the same manner as in the preceding, only that
the caudal, or other vein returning from the posterior parts,
gives off a branch to the vena portce. The blood returning
from the middle and posterior part of the body in the first
and second modification of this system, is conveyed only to
the kidneys; but, in the third, to the kidneys and liver.
The inferior vena cava of the common venous system, in the
second and third modification of this system, is composed of
the veins returning from the kidneys and testicles, or ovaries.
In the first modification, the caudal vein receives the veins
returning from the kidneys, is united with the veins of the
testicles or ovaries, and, in this manner, forms the inferior
vena cava.’’

No addition has been made to our knowledge of the con¬
formation of the other general systems of the body, within
the period to which we confine ourselves.

‘ Under the head of particular textures, we meet with little
of importance.

The intimate structure of tendons has engaged the attention
of Professor Isenflamm, of Erlangen.* This eminent Ana¬
tomist has ascertained that the constituent principles of this
substance are the same as those of muscles, with the dif¬
ference only, that tendons appear to contain no salts in their
composition. After careful maceration and dissection, he
found that they are formed — 1st, of cellular tissue disposed
in fine parallel fibres, with the addition of transverse fibres^
in .tendinous membranes; 2d, of animal gluten ^ Sd, of
albumen, which, jointly wdth the cellular fibres, gives them
their satiny appearance. Professor Isenflamm considers
that the existence of nerves in this texture is satisfactorily
proved by its sensibility in disease, and he very justly con-

Archives de Med. Jan. 1823;

Historical Sketch of the Progress of Medicine y S^c,

tends that no vital property can be generated^ but only
developed, either in this or in any other part, by a morbid
condition of structure.

Under that part of our physiological division which relates
to particular organs, the examination of the structure of the
lungs by Dr. Reisseisen ^ deserves particular notice. This
Anatomist has shown that the lobules of the lungs may be
considered as ramifications of the trachea, which lose their
cartilaginous portion as they divide, and w’hich ultimately ,
terminate in simple membranous cul-de-sacs, and not in
common cellular texture. Over each of these a vascular
plexus is spread, arising from the bronchial arteries, out
of which the pulmonary veins at once spring ; and, of course,
the arterial blood is mixed with the venous blood. The
bronchial veins, again, do not form a trunk, but open
separately into the pulmonary veins, which return the blood
to the heart.’' Dr. R. has demonstrated, in opposition to
Haller, that the lungs are well supplied with nerves, not
from the intercostal, but from the pneumo-gastric ; and he
has denied all anastomosis in the lungs with the eighth pair.
The state of collapse he has considered as the natural state
of this viscus.

' The structure and movements of the tongue have been
elucidated by M. Blandin f with greater accuracy than
heretofore ; and the general relations of the spine have been
satisfactorily viewed by Mr. Earle. J M. Geoffroy-
Saint-Hillaire II has entered into some details respecting
the intimate analogy which he considers to exist between
the structure of the skeleton of the articulated and vertebrated
animals, in reply to the observations of M. Meckel: these
possess much ingenuity, and evince an intimate acquaintance
with the organization of the lower animals, but furnish no addi¬
tional facts connected wdth the subject beyond what he had
adduced in his former memoirs, and in the first volume of
his Phiiosophie Anatomique. An interesting work on human
monstrosities § has also been published by this distinguished
Anatomist, which is destined to form a second volume of the
one just mentioned, as well as a separate production. It is
chiefly intended to illustrate his fundamental views, namely.

* Saltzburgher Zeitung Medizin, &c. ; and Jour, of For. Med.
April, 1823.

t Archives de Medecine, Avril, 1823.

X Philosophical Transactions, Part II. 1822.

II Archives de Medecine, Mars, 1823. . '

§ Phiiosophie Anatomique des Monstruosiles Humaines, etc. 8vo.
Paris, 1823. Accompagne d’un Atlas in'4to.

Physiology.

the theory of analogous organization, the principle of con¬
nexions, the affinity of organic elements, the mutual relation
or balancing of the organs ; and to apply them to the study
of human anatomy.

Dr. Duges* has entered with much research on the
examination into the causes of the difference of monstrosities
of the cranium and spine; and has, conformably to existing
opinions on the subject, referred such deviations of organiza¬
tion to chronic dropsy occurring, in these situations, at an
early period of foetal existence.

Physiology. — Proceeding according to the order already
pointed out, the views which relate to the nervous system first
claim our attention. Amongst these the researches of M.
Flourens, already noticed in a former Number of this
Journal, F ffi many respects deserve particular notice; but,
although very important, they appear not to be possessed of
so much originality as was at first supposed : indeed, they
can only be viewed as a repetition of the investigations of
Professor Rolando, of Turin, which were published in
1809. J The experiments of both these physiologists are
important, inasmuch as they disclose to us a more precise
knowledge of the functions of several parts of the cerebrum
and cerebellum than we formerly possessed. As the inves¬
tigations of M. Flourens belong to the period embraced by
this sketch, we shall notice the conclusions which have been
drawn from them by the reporters to the Institute; and we
are the more inclined to confide in them when we find that
they agree with the researches of M. Rolando, which were even
more varied and extended than those of the French phy¬
siologist, and that the principal experiments w^ere performed
by M. Flourens in the presence of MM. Portal, Berthollet,
Pinel, Dumeril, and Cuvier.

The questions proposed by M. F. and wffiich he has endea¬
voured to ascertain by experiment, are: — 1st, From what
points of the nervous system artificial irritation may set off
to arrive at a muscle. 2d, To what points of this system
an impression must be propagated to produce sensation.
3d, From what points voluntary irritation descends, and what
parts of this system must be infiuenced to produce it regu¬
larly. These questions he has only considered in relation to

Rev. Med. Avril, 1823.
t Repository for February, 1823.

I Saggio sulla vera Struttura del Cervello deirUomo e degli
Animali, e sopra le funzioni del Sistema Nervoso. Par L. Rolando.
Sapari, 1809 ; and Archives Gen. de Medecine, Mars, 1823.

6 Historical Sketch of the Progress of Medicine, S^c.

vertebrated aaimals, and to their nervous system of animal
life.

M. Flourens commenced with the nerves, and fully con¬
firmed the views usually entertained respecting their func¬
tions. He has shown, in a satisfactory manner, “ that, in
order to effect contraction, a free and continued communica¬
tion is requisite between the nerve and muscle; and that,
to produce sensation, a similar communication with the brain
is equally necessary. Hence he Concludes, that neither con¬
traction nor sensation belong to the nerve ; that these two
effects are distinct; that they may take place independent of
each other; and that these propositions hold good, at what¬
ever part, and in whatever branch, of a nerve the commu¬
nication is interrupted.

Employing the same method with regard to the spinal
marrow, he has arrived at similar conclusions. When it is
irritated in any given point, contractions are excited in all
the muscles which derive their nerves from below this point,
if the communication remains free ; but not if the commu¬
nication be intercepted. Exactly the reverse obtains with
regard to sensation ; and, as in the nerves the government of
the will requires the same freedom of communication as
sensation, the muscles beneath the intercepted part no longer
obey the animal, and he does not feel them : in fine, if the
spinal marrow be intercepted at two points, the muscles
which receive their nerves from this interval experience
contractions alone ; but the animal does not command them,
nor receive from them any sensation.^’ M. F. has farther
inferred, from his experiments respecting the functions of
the spinal marrow, that sensation and contraction belong no
more to it than to the nerves. He next directed his re¬
searches to the brain, in order to ascertain the point whence
irritation departed, and the point where sensation arrives,
and to determine their respective co-operation in acts of
volition.

Advancing from the medulla oblongata towards the he¬
mispheres, M. Flourens first examined how far it was
possible to go, and still produce sufficient irritation on the
muscular system, when he arrived at a point where these
irritations disappeared : then, taking the brain at the oppo¬
site part, he irritated it at points deeper and deeper, as long
as he did not act upon the muscles ; and, when he did begin
to act upon them, he found himself at the same point where
the action had ceased in ascending. This part is also that
where the sensation of irritation applied to the nervous
system likewise ceases : above this, punctures and wounds do
not excite pain. Thus M. Flourens pricked the jiemispheres

. Physiology.

, without producing contraction of the muscles, nor the ap¬
pearance of pain in the animal ; he removed them in succes¬
sive slices: he did the same with regard to the cerebellum;
he removed at once the hemispheres and cerebellum. The
j animal remained passive. The corpora striata and the optic
tbalami svere attacked, and removed without any other effect :
the iris was not contracted, nor even paralysed. But, when
he pricked the tubercula quadrigemina, trembling and con¬
vulsions began, and these increased in proportion as he pene¬
trated into the medulla oblongata. Pricking the tubercles,

I as well as the optic nerve, produced quick and continued
i contraction of the iris. These experiments agree with those
I of Lorry, published in the third volume of the ‘ Memoires
I des Savans etran^ers.’ ^ Neither the irritation of the brain
nor of the corpus callosum itself produce convulsions: it may
even be removed with impunity. The only part among those
contained in the brain which has appeared uniformly and
universally capable of exciting convulsions, is the medulla
oblongata : it is this part which produces them to the exclu¬
sion of every other.' They contradict the experiments of
Haller and Zinn with regard to the cerebellum; but, from
' what M. Flourens has seen and pointed out, it appears that
these physiologists had touched the medulla without being
aware of it. The author concludes that the medulla oblon¬
gata and the tubercles are (in his language) irritable ; which
in ours means that they are conductors of irritation, like the
^^pinal marrow and nerves, but that neither the cerebrum nor
cerebellum possess this property. The author hence con¬
cludes, likewise, that these tubercles form the continuation
and superior termination of the spinal cord and medulla
oblongata ; and this opinion is in conformity with their
situation and anatomical connexions."

Wounds of the brain and cerebellum do not excite pain
any more than convulsions. Hence M. Flourens infers that
to them the impression received by sensible organs must be
conveyed, in order that the animal may experience a sensa-*

■ tion. He appears to have established this proposition in a
satisfactory manner with regard to the senses of sight and hear¬
ing ; for when both lobes of the cerebrum are removed, the
animal becomes both blind and deaf. Instead of saying,
with the author, that the cerebral lobes are the only organs
of sensation, we w'ould restrict ourselves to ascertained facts,
xind content ourselves with saying that these lobes are the
sole receptacle where the senses of sight and hearing can
be perfected, and become perceptible to the animal. If we
wished to add to this, we would say that, they are likewise
those where all the sensations- take a distinct form, atid leave

Historical Sketch of the Progress of Medicine, S)C.

durable traces on the memory, — - that they serve, in a wordy
as the seat of memory ; a property, by means of which the}^
furnish the animal with materials for judgment. This con¬
clusion, thus reduced to proper terms, becomes the more
probable, in that, besides the verisimilitude which it receives
from the structure of these lobes and their connexion with
the rest of the system, comparative anatomy offers another
confirmation in the constant relation of the volume of these
lobes with the degree of intelligence of the animal/’

M. Flourens next examined the effects which follow the
extirpation of the tubercula quadrigemina. The removal
of one of them, after a convulsive movement, which soon
ceases, produces, as a permanent result, blindness of the
opposite eye and involuntary staggering ; that

of both tubercles renders the blindness complete, and the
staggering more violent and long-continued. The animal,
how^ever, retains all its faculties, and the iris continues con¬
tractile. The deep extirpation of the tubercle, or the section
of the optic nerve only, paralyzes the iris : from vyhich the
author infers, that the removal (ablation) of the tubercle only
acts as the division of the nerve would do; that this tubercle
is only a conductor with regard to vision ; and that the
cerebral lobe alone is the seat of the sensation, the point
where it is consummated, and passes into perception.”

M. F. next investigated the functions of the cerebellum,
and found that, during the removal (ablation) of the first
layers, there appeared only a slight weakness and want of
harmony among the movements. At the middle layers, a
disturbance nearly general was manifested. The animal, in
continuing to see and hear, only executed quick and irre¬
gular movements: the faculty of flying, walking, and keeping
itself standing, w'ere lost by degrees. When the brain was
cut off, this faculty of performing regulated motions had
entirely disappeared. Placed upon the back, he did not rise ;
but continued to see the blow which menaced him ; he heard
sounds, and endeavoured to shun the danger which was
threatened: in a word, feeling and volition were retained,
but the pow'er over the muscles was lost; scarcely could he
support himself with the assistance of the wings and tail.
In depriving the animal of the brain, it was thrown into a
state resembling sleep: in removing the cerebellum, it was
brought to a state resembling intoxication.”

The reporters to the Institute on the inquiries of M,
Flourens have drawn the following conclusions from a
rigorous examination of the facts which he has established.

The integrity of the cerebral lobes is necessary to the
exercise of sight and hearing : when they are removed, the

Physiology ,

will no longer manifests itself by voluntary acts. However,
when the animal is immediately excited, he performs regular
movements, as if endeavouring to avoid pain or inconve¬
nience ; but these movements do not effect his purpose, most
probably because the memory, w'hich has been removed along
with the lobes which constituted its seat, no longer affords
grounds or elements of judgment; these movements have no
consistency, for the same reason, that the impulse which
caused them neither leaves any remembrance nor permanent
volition. The integrity of the cerebellum is necessary to the
regularity of locomotion : let jhe brain remain, the animal
will see, hear, and have evident and powerful volition ; but, if
the cerebellum be removed, he will never find the balance
necessary to locomotion. As to the rest, irritability remains
in parts without the brain or cerebellum being necessary.
Every irritation of a nerve brings it into play, in muscles to
which it is distributed: every irritation of the spinal marrow
excites it in all the members beneath the point of its applica¬
tion. It is quite at the top of the medulla oblongata, at the
point where the tubercula quadrigemina join it, that this
faculty of receiving and propagating irritation on the one
hand, and pain on the other, ceases. It is this point at wdiich
sensation must arrive in order to be perceived : it is from
hence that the mandates of the will must emanate. Thus,
the continuity of the nervous organ from this point to the
parts is requisite for voluntary motion, and for the perception
of impressions, w'hether external or internal.”*

The functions of the vascular system have received no
inconsiderable share of attention. The very interesting
investigations of M. Fodera on absorption and exhalation
are calculated to enlighten our views, and to lead to still
farther inquiry : we refer our readers to the full account
which we gave of this physiologist’s memoir in a former
Number.T

While researches respecting absorption have been under¬
taken in France with becoming zeal, American Physicians
have not neglected to distinguish themselves in the same
path of inquiry; and, although they may appear the less
original, they certainly have not been less persevering and
successful in their investigations. The results of the experi¬
ments of Drs. Lawrence and Coates, on the absorbing
power of the veins and lymphatics, J were given in our

^ Journal de Physiologic, October, 1822; and Medical and Phy¬
sical Journal for June.

t Repository for May, 1823.

I Philadelphia Journal, No. X. These experiments, \yhich are

VOL. XX.— -NO. 115. c

10 Historical Sketch of the Progress of Medicine, S^c.

preceding Number. These experiments were extremely
numerous and judiciously varied ; and they altogether fur¬
nish vahaable materials for physiological inference, as well
as much requisite confirmation of many of the views of Ma-
GENDiE as to the functions of the venous capillaries.

The researches of Mr. Beodie on the effects produced by
the bile in the process of digestion have confirmed, in part,
the views usually entertained respecting the uses of this
secretion in the animal economy, and pointed out the part
which it chiefly and uniformly performs. Together with its
offices in changing the nutritious part of the chyme into
chyle, and in separating irom it the excremenlitious matter,
it was usually supposed that the more acrid and resinous
portion of the bile combined with the excrementitious por¬
tions of the chyme, and thus became a salutary tonic and
stimulant to the intestinal surfaces as it passed along them :
this opinion, although plausible, appears to rest upon insuf¬
ficient evidence, and is even contradicted by several of the
phenomena wdiich manifest themselves in the course of dis¬
eases affecting the digestive canal and biliary organs. For
the results of Mr. Brodie’s interesting investigations, w'e
refer our readers to a former Number.

We lately took occasion f to notice the experiments of
Dr. Edwakds, of Paris, on some important points connected
with i\\e function of respiration. We then mentioned that
the observations of this intelligent physiologist authorized the
conclusion that azote is both absorbed into, and discharged
from the circulating fluid, and that each of these operations
is regulated by the circumstances of the individual at the
time. Independently of the satisfactory nature of the expe¬
riments, whence Dr. Edwards has drawn his inferences, there
are many collateral proofs that may be brought to their
support, derived from the manifestations of the animal eco¬
nomy both in health and in disease ; and we have little
doubt that not only is azote, but that other gases are also
absorbed into, and discharged from the circulation, in a
greater or less quantity, according to the varying state of the
vital energies of the system. Even the formation of carbonic
acid gas in the lungs has been, in our opinion, explained too
exclusively after a single process. When the theory of the
absorption of oxygen w^as dismissed in favour of that which
contended for the discharge of carbon from the blood, either
in its pure state or in that of an hydrate, no participation in

fully detailed in this Number of Chapman’s Journal, amount to one
hundred and six.

* Repository for February, 1823.

t Ibid, for May, 1823.

Physiology.

the process, by which the carbonic acid was formed, was
allowed to the previously received opinion : however, it still
appears to us a matter of doubt how far either function
predominates ; for we are much inclined to think that both
operations go on simultaneously, and that while a portion of
the carbonic acid gas is given out, alreadj^ formed, from the
bloorl, it is accompanied with another portion of free carbon,
or an oxide of carbon, or even with an hydrate of the same
j substance, which combines with an additional quantity of
oxygen in the lungs, and thus forms the whole of the
carbonic acid in question ; and that, at the same time, a
portion of oxygen is absorbed, which combines with the
carbon in the blood, and there generates the carbonic gas
or oxide of carbon, which forms a part of the matters dis¬
charged from the blood in the lungs. These processes may
vary, and either may predominate according to the state of
the vital influence at the time, under whose control they are
immediately and completely placed.

Th e experiments of Dr. Carson have directed the atten¬
tion of physiologists in this country to the state of the lungs
themselves during respiration, and under the various influ¬
ences to w'hich they are usually subjected either by accident,
by operations, or by disease. “ Dr. Carson had inferred from
his experiments, that it is possible to collapse one of the
lungs, and to retain it in that state, ad libitum, by keeping
open the communication between the cavity of the chest and
the external air; and further, that upon allowing the opening
to close, the lung, in a given time, will recover its wmnted
function, thereby rendering it practicable, when conceived
necessary, to place the opposite lung under the like dis¬
cipline.’’ Dr. C. had very ingeniously proposed the applica¬
tion of his views to the cure of phthisis pulmonalis, so much
confidence did he place in the results of his experiments;
and has even, we believe, reduced his theory to practice, but
' with w'hat success we are not yet informed. In order to
I examine the stability of the hypothesis. Dr. David Wil-
I LIAMS, of Liverpool, instituted several experiments, in the
! presence of Dr. Trail and others, which contradict some of
! the chief positions held by Dr. Carson. After having detailed
his experiments. Dr. Williams has drawn the following in¬
ferences from them : — *

J. That a lung will not collapse from exposure to the
’ atmosphere as long as respiration is carried on by the
opposite one, and the auxiliary respiratory powers are not
restrained.

* Annals of Philosophy for June, 1823.

Historical Sketch of the Progress of Medicine^ ^c.

2. Tliat a lung possesses for a time, 'independently of
the influence of the diaphragm and intercostal muscles, if
respiration is carried on by the opposite lung, a peculiar mo¬
tive power, the source of which I do not pretend to explain.

3. That a sound lung soon regains its full power of
expansion, when the pressure of the exterior air is removed.

4. That air freely and uninterruptedly admitted into both
cavities of the chest simultaneously, through tubes of a cer¬
tain calibre, will not collapse the lungs, if the auxiliary
respiratory organs are unrestrained.

5. 'I hat air admitted into both the cavities of the chest
(^of a middle-sized dog) simultaneously, through apertures of
an inch and better in length in the intercostal spaces, will not
collapse the lungs, provided the animal is allowed unconfined
the use of his respiratory organs.

6. That a sound lung never fills the bag of the pleura.”

Dr. W. has very justly observed, “ that if the last phy¬
siological inference is correct, it is highly interesting in a
pathological point of view^ It enables us to explain how^
hydrops thoracis, or that species of it, hydrops pleurae, may
exist to a certain extent, without being attended with any
symptoms indicating the presence of the disease, as related
by numerous medical authors.” We can also more satis¬
factorily account how the lung so frequently escapes when
weapons penetrate the cavity of the thorax ; and how the
extravasation which follows, if not considerable, produces but
little derangement. It may also have a practical utility ; for
it informs the Surgeon that the lung descends to a certain
point only, so that he need not be afraid of wounding it,
should an operation be required below that position.”

The most interesting views connected w'ith tlte organs of
sense which we have to record are those entertained by
Mr. Cha RLEs Bell respecting some of the functions of the
eye.* This physiologist, in pursuance of his investigations
of the nervous system, has examined the motions of the eye,
in illustration of the uses of the muscles of the orbit; and
has shown, in the first place, that there are motions per¬
formed by this organ not hitherto noticed. Every time the
eyelids descend to cover the transparent part of the eye, the
eyeball ascends, or suffers a revolving motion. If this were
not the case, the surface of the eve would not be moistened,
nor freed from offensive particles. He has proved, in the
next place, that during sleep the eyeball is turned up, and
the cornea lodges secure and moistened by the tears, under
cover of the upper eyelid. He considers that these motions

^ Annals of Philosophy for May, 1823,

Physiology.

are rapid and insensible, and that they are provided for the
safe-guard of the eye. Tlie other motions are voluntary,
and for the purpose of directing the eye to objects.

Mr. Bell next examined the actions of the muscles of the
eyeball, and distinguished them, as usual, into the straight
and oblique muscles. It has been supposed, hitherto, that
both these classes of muscles were voluntary ; some de¬
scribing the oblique as coadjutors of the recti muscles, and
others as opponents to the recti; but Mr. Bell has viewed
the oblique as provided for the insensible motions of the
eyeball, and the recti for those motions which are directed by
the will, and of which we are conscious.

Mr. B. has also proceeded to show, that the consciousness
of the action of the recti muscles gives us the conception of
the place or relation of objects; and has endeavoured to
prove, by observation and experiment, that the actions of the
straight muscles are inseparably connected with the activity
of the retina; that is, with the enjoyment of vision: but that
the moment the vision is unexercised, the eyeball is given up
to the operation of the oblique muscles, and the pupil is
consequently drawn up under the eyelid. “ Hence the eyes
are elevated in sleep, in faintness, and on the approach of
death ; and that distortion which we compassionate as the
expression of agony, is the consequence merely of approach¬
ing insensibility.’’

The most important additions which we can refer to the
physiology of the generative functions, are the interesting
observations which have lately been made by Dr. Prout.
The conclusions which he has drawn from his interesting
experiments on the changes which take place in the fixed
principles of the egg during incubation, are already before
our readers.* The memoir of M. Pander, of Wurtzbourg,
on the changes which are observed in the egg during the
first five days of its incubation, which was published in
Germany in 1817, has been republished in France by M.
Breschet, t where it was previously but little known: we
believe that the observations of M. Pander have never
reached this countrv : we are induced to mention them at
present in order to turn that portion of scientific attention to
them which they fully merit. It is impossible for us to
convey any abstract of their very minute details which could
be satisfactory to our readers, even were they legitimately
before us, within the space to which we are necessarily
confined.

* Repository for February, 1823.

■f Archives Gen. de Med. Fev, ct Mars, 1823.

Historical Sketch of the Progress of Medicine y S^c,

Pathology. “ Coniniencing our view of the progress of
this department of medical science with the few additions
which have been made to the pathology of the nervous
system, we find these entirely confined to that part of it which
is immediately concerned in sensation and volition. Amongst
the various derangements of structure to which the brain is
subject, none appears more interesting than those which are
connected with the formation of this organ ; for not only are
they important in themselves — as species of organic lesions
requiring to be changed to that state which may be com¬
patible with the due exercise of the vital actions, but they
are likewise interesting as they furnish some of the strongest
proofs we are able to obtain respecting the extent of function
oi this organ, and the exact relations which it holds, both in
the successive stages of its production and during its perfec¬
tion, with the general systems and particular organs of the
animal body. In these points of view the case of congenital
hydrocephalus, recorded by Mr. Dendy in our preceding
Number, seems extremely interesting.

The effects of violent mental emotions in producing
structural derangement in the brain have been illustrated by
two cases: in the one recorded by M. Duparcque, a sin¬
gular tumour was found developed in one of the ventricles of
the brain, and complicated with effusion into these cavities;*
in the other, published by M. Gaste, this organ was greatly
softened, and contained an abundant serous effusion in its
ventricles.

M. Roche has recorded two instances of loss of sensation
in one half of the body, while voluntary motion was pre¬
served. On dissection of the one which terminated fatally,
in which there had been total want of sensibility on the left
side, the inferior portion of the middle lobe of the cerebrum,
on the right side, was softened in an unusual degree, and
presented, in its medullary substance, small black grains,
from the size of hemp-seed to that of millet-seed, apparently
the result of small effusions of blood into the cerebral tex¬
ture. The ventricle of this side contained a considerable
quantity of a reddish serosity. The left side of the brain
and its meninges were sound. Professor Lallemajmd has
recorded, in his second letter on the pathology of the brain,
three cases of inflammation of the same portion of the middle
lobe of this viscus, wherein paralysis was present, but not
accompanied with anaesthesia, which w'as so remarkable in
this instance. J

* Repository for June, 1823.
t Journ. Univcrs, November, 1822.

I Ibid. Nov. 1822.

Pathology. 15

A fourth part of Professor Lallemand^s interesting re¬
searches on the pathology of the encephalon^ which were
noticed in our former retrospect, has lately appeared. It
embraces the subject of encysted abscess of the brain,
occurring in an idiopathic form, in the course of, or as a
consequence of other diseases, and as an effect of external
injury. The particular point in the pathology of the ence¬
phalon which Professor Lallemand has illustrated in this
Number, and placed in a more satisfactory point of view
than any of his predecessors, is the frequent occurrence of
. encysted abscess, and, indeed, of other organic lesions of the
brain, as a consequence of inflammatory affections of the
ear. In this country, we regret to find that the connexion
of the disorders of this organ of sense with other affections,
especially those of the encephalon, is little understood, and
less attended to, by those who take the derangements of this
sense under their fostering care. Nor is such ignorance,
indeed, to be wondered at, when it is considered that, by
some singular fatality, the disorders of those very organs,
whose complex formation, and intimate connexions and
relations, with the most important part of our organization,
on the one hand, and with the mental manifestations of our
nature on the other — even those derangements which require
a more intimate acquaintance, than any other to which the
body is liable, with the operations of, and laws w^hich govern
the animal economy — with the very philosophy of our phy¬
sical and moral nature, — are generally committed to the care
of the most wretched empirics that ever disgraced a pro¬
fession.

Few diseases have been more investigated than epilepsy
during the present age; and within the period allotted to
this sketch it has received a due portion of attention ; we
wish we could add, that the success of those investigations
was commensurate with the ability with which they have
been prosecuted. The work of Dr. Cooke on this disease,
to which we now more particularly allude, 'has already come
before us. * The connexion of mental derangement with
epilepsy is too evident not to mention at this place the work
of Dr. Willis on the former subject. The observations of
this Physician possess some interest, chiefly, however, from
the circumstance of the actual propriety of some of his view's,

! and not from their novelty, nor from the manner in which he
has illustrated them. The current of opinion has lately set
j strongly in favour of the supposition — for it was no more
than supposition, — that, wherever symptoms appeared which

* Repository for March, IS‘23.

l6 Historical Sketch of the Progf'ess of Medicine ^ §c.

might be referred to cerebral excitement, there must conse¬
quently be inflammation, general plethora, or local determina¬
tion. That the last named state of the circulation may be
often present under, such circumstances, we will readily allow ;
but that either of the other two conditions should exist, or
be necessary to the production of the manifestations in ques¬
tion, is perfectly gratuitous, and what we positively deny.
In support of this we can refer to facts derived from expe¬
riment and observation. Bleed a man, or any other ani¬
mal, frequently, largely, but gradually, either when in good
health, or when suffering under some disorder not connected
with cerebral excitement: as a consequence of such con¬
duct, if the depletion be carried too far, we shall have
symptoms denoting determination to the brain; if farther
depletion be instituted, delirium will generally supervene;
and even if depletion be carried so far as to produce death,
the cerebral derangement will be manifest to the last moment
of existence: on dissection, while all the other textures shall
be found entirely deprived of blood, the brain will generally
evince more than natural vascularity, and always an infinitely
greater fulness of blood, relatively, than any other part of the
body. We wdll allow tiiat those effects are not observed if
very large quantities of blood are lost, so as to deprive the
animal of life in a very short space of time; but here the
reason is obvious — the animal dies before the vascular
system is accommodated to the mass of blood circulating in
it. Now, we assert that we have observed those phenomena
which we have described, and have seen those appearances in
individuals whose life we considered to have been lost by
ultra-depletion ; and w’e farther know that the same phe¬
nomena have been uniformly noticed in experiments on the
lower animals. But we shall be excused if we briefly illus¬
trate this important point by more familiar examples. How
often is it observed in profuse uterine heemorrhage, that when
the patient is but just saved from the immediate loss of
blood, great care is requisite to save her from the nervous
derangement which uniformly supervenes ! Irritative fever is
always the consequence, and is more immediately the conse¬
quence of the local determination and irritation to which the
brain is subjected, notwithstanding that the state of the parts
concerned in the process which she had previously expe¬
rienced might be supposed to divert irritation from that
organ. In such cases the arteries running to the head beat
violently ; sensation is quick and lively ; the least irritation of
the organs of sense, or excitement of the moral affections, is
apt to induce delirious manifestations ; the lower extremities
are pale, shrunk, and cold, while the head is hot and

Pathology.

painful, &c. Now, we all know the treatment which alone
succeeds in those cases, which treatment farther illustrates
that peculiar state of the vascular system, and of the blood
itself, in which the cerebral excitement originates. But not
only is local determination, and especially to the brain, the
consequence of depletion ; it still more familiarly supervenes
to a low state of the vital energies of the system : the
individual, in whom those energies are perfect, seldom is
subject to those disorders which depend upon local plethora
or excitement: it is principally those, in whom the vital or
nervous powers of the constitution are greatly weakened,
who experience local determinations, or those derangements
of the circulation in the brain w'hich are evinced by corporeal
and mental derangements. It is chiefly to those individuals
that the dictum, “ ubi irritatio ibi fluxus,” is strictly appli¬
cable ; and whether the irritation be of a physical or moral
nature, the effects will be apparent and commensurate with
its intensity, or with that disposition of the system to which
we have alluded. ■ ^

While we thus contend against certain doctrines which
have been lately carried to a hurtful and unscientific extent,
let us not fall into the opposite extreme, but let us seek after
an intimate acquaintance with the operations and laws of
nature, and make them our guide: under such direction we
shall shun the more prominent difficulties which surround
the exercise of our Profession, and in which we shall inevi¬
tably become entangled as soon as we lose sight of such
guidance, and generalize our pathology and practice beyond
the data which a sound observation and experience of the
manifestations of nature authorize.

' The connexion of apoplectic and paralytic seizures with
organic disease of the heart, the latter derangement predis¬
posing and inducing the former, has been contended for by
Dr. Craigie, in a continuation of his memoir on the patho¬
logy of the brain.* We were not a little surprised to find
Dr. C. assert, in this part of his paper, that it did not
appear that any pathologist has particularly examined those
effects to which the diseases of circulation give rise in the
cerebral organ.*’ JNow, unless Dr. C. should quibble about
the word 'particularly which he has used, he^ will find the
connexion for which he contends noticed by most of the
writers on apoplexy since the time of Baglivi: indeed, this
distinguished pathologist observed, in the dissection of the
celebrated Malpighi, who died apoplectic after the acces¬
sion of a paroxysm of palpitation of the heart, to which he

* Edinburgh Medical Journal for January, 1S23.

VOL. XX. — ^NO. 115. D

1 8 Historical Sketch of the Progress of Medicine, Si c.

had been subject, the left side of the heart greatly enlarged,
and copious extravasation of blood into the right ventricle of
the brain. But not only has the coexistence of these
lesions been frequently noticed, but the occurrence of
effusion of blood within the brain has been shown to be no
unusual consequence of hypertrophy of the left side of the
heart, as well as of ossifications or other lesions of its valves
or of its substance. M. Rich brand observed this con¬
nexion of disease in the great Caban is, whose case he
related to the Ecole de Medecine, and he afterwards asserted
the relation to be one of cause and effect which he had
verified by frequent observation. Portal and Testa sup¬
ported the same opinion, and M. Bricheteau has endea¬
voured to establish it still farther both by physiological
inference and the evidence of actual observation. But with¬
out leaving our own country. Dr. Craigie might have ob¬
served this connexion insisted on in the very Journal in
which he writes. The Jasiuary Number of that work for
1817.1S contains an article translated from the German of
K. Sprengel, in which reference is made to the account of
the case of the late Crown Prince of Sweden, in whom this
connexion of disease was observed on dissection. The
histor}^ of this case was published by Rossi in Horn’s
Archives for 1822; and Sprengel, at the place where he
referred to it, considered the position, that apoplexy often
arises from diseases of the heart, to be satisfactorily proved.
Dr. Abercrombie, whose originality has never been con¬
spicuous, has alluded to the same subject, in a subsequent
volume of the Edinburgh Journal; and Dr. Hutchinson
has adduced proofs in support of the same position in a
contemporary work. * Why, therefore, has Dr. Craigie
been ignorant of the very satisfactory illustrations which the
very topics on which he writes had received, before he turned
his attention to them ; and why does he profess to have been
the first to elucidate those interesting points in pathology,
w'ithout having ascertained what degree of notice they had
received from preceding inquirers, and whether they had not
been more fully and more satisfactorily explained by his
predecessors and contemporaries than his opportunities could
furnish him with the means of doing? But, although he
insists so strenuously, and as he says so originally, on the
dependence of apoplexy on disease of the heart — w'hich
dependence we will only allow to be occasional, and to be
neither absolute nor necessary — he has neglected to adduce
that species of structural derangement of this viscus, which,

* Medical and Physical Journal, Vol. XLIII.

Pathology. 19

in our opinion, is the most frequent antecedent of apoplectic
seizures, and has confined himself entirely to one class of
organic derangements of the heart, which seems to be less
frequently productive of apoplexy than those which he has
overlooked. From the very few instances adduced by him,
in which the connexion in question was observed, he has
drawn the following inferences: —

“ 1st, It is quite obvious, that several maladies of the
heart, such as ossification of the left side, or of the artery
connected with it ; ossification of the mitral valve ; of the
semilunar valves ; arctation of the apertures, either auriculo-
ventricular, or aortic, have a tendency to terminate in extra¬
vasation within the cranium, producing apoplexy, paralysis,
or a comatose state terminating in death.

3cl, It is by no means difficult to see how these effects
in the cerebral organ result from an irregular and disordered
action of the heart. The difficulty which the blood expe¬
riences in passing either, 1st, through the auriculo-ventricular
opening ; 2d, the aortic orifice ; 3d, along the aorta, neces¬
sarily produces a stagnation and congestion ; 1st, in the
pulmonary veins; 2d, in the pulmonary artery; 3d, in the
right side of the heart. The effect of this is to retard or
impede very remarkably the return of the blood from the
cerebral veins, and consecutively either to distend them, or,
unless they are exceedingly strong and resisting, to rupture
them, or to occasion an effusion of the serous part of the
blood, as We find in other examples of obstructed venous
circulation.’’

Connected with the pathology of the nerves themselves,
we have been furnished with little that appears to us to be
entitled to notice. A case of neuralgic affection of the face,
occasioned by the irritation of a fragment of china which had
been fourteen years imbedded in the substance of the cheek,
has been published by Mr. Jeffreys.* The removal of this
substance immediately relieved the painful affection, which
had several of the characteristic symptoms of idiopathic
neuralgia.

A very interesting case of that peculiar morbid state of
structure, which has lately been well described by Laennec,
Breschet, and other French pathologists, under the name
of melanosis, from the colour which it generally presents in
the various organs, has been communicated to the readers of
this Journal by Sir Andrew Halliday.F From the
manner in which this affection is disseminated throughout al

* Medical and Physical Journal for March, 1823.
t Repository for June, J823.

20 Historical Sketch of the Progress of Medicine, b)C.

parts of the body, and from the characters of its structure, it
seems to be clearly referrible to a diseased state of the cellular
texture, probably arising from some peculiar derangement of
the nutritious capillaries which supply that tissue, and which
derangement is not confined to the cellular substance form¬
ing the matrix of one particular organ, but is extended to
all parts of the system where this texture is most abundant,
and least interrupted by tissues of a denser or of a different
structure. Hence the more abundant development of these
morbid formations in the internal viscera, beneath the inte¬
guments, &c.

Under the pathology of the cellular tissue, the nature of
tuberculous derangements comes to be considered. M. Du-
PUY, who has paid very considerable attention to those
alterations of structure in the lower animals, and whose
excellent observations have been long since submitted to
pathologists, has continued his investigations, and, wfith the
assistance of M. Lassaigne, has submitted the concre¬
tions, into which they frequently degenerate, to chemical
analysis. For this purpose he took those found between
the laminse of the mesentery of a bull affected with
tubercular phthisis. I’hese concretions were small, white,
and hard grains united by a mucous envelope ; and consisted
chiefly of phosphate of lime, with carbonate of lime and
animal matter. M. Dulong, who has examined those
formed in the lungs of a cow that died of tuberculous
phthisis, found their composition to be similar to that given
by M. Dupuy. M. Lassaigne has informed us that these
pulmonary concretions, which have come under his observa¬
tion in the human subject, have the strictest analogy with
those which he has examined in the lower animals.* — The
ingenious opinions of Dr. Baron respecting the origin,
development, and relations of tuberculous formations, have
been submitted to our readers t in a former Number.

Proceeding next to view the progress of the pathology of
the vascular system, petechia^, htemorrhagicse first attracts our
attention. A case of this disorder has been recorded by
Mr. Pretty, which is, in some respects, calculated to
advance our knowdedge of the nature of this species of
vascular derangement, and to point to a rational mode of
cure.df Connected with these important topics, we refer our
readers to some observations which we made, in our former
Historical Sketch, and we now entreat them to compare
the- case to which we have just referred with those which

Rev. M4d. Janv. 1823. t Repository for March, 1823.

X Medical and Physical Journal for April, 1823.

Pathology. 21

gave an account of on that occasion, and with the infe¬
rences which we then drew from them. One of the most
important points connected with Mr. Pretty’s case was the
state of the blood, which seems to be characteristic of the
complaint. He has informed us that the blood first drawn
exhibited no serum for the space of about eight hours ; but
on the next day, after twenty hours standing, a small quan¬
tity appeared. One teacupful of the second bleeding showed
a coat of coagulable lymph half an inch thick, like very
soft jelly, and with the crassamentum ver}?^ loose, and so
tender as to be broken down very easily into a soft pulpy
mass. In this cup there was little or no serum. The other
portions of blood, which were not taken with an uninter¬
rupted stream, showed no huffy coat and very little serum :
it seemed as though the blood had become so dissolved or
altered as to be unable to separate in the usual way.”

On the subject of inflammation, an interesting memoir
has been published by M. Rayer. * This pathologist, how¬
ever, has chiefly confined his researches to that inflammatory
state of the capillaries which induces ossification of the
tissues which are the seat of such derangement, and has
viewed ossification as one of the terminations of phlegmasia.
M. Rayer has treated this subject in so full and instructive
a manner, and has imparted so much interest to it, by the
very comprehensive views which he has entertained respect¬
ing it, that it is impossible to convey any satisfactory account
of his investigations within the limits of this sketch. We
expect to have a future opportunity of placing an analysis of
this very excellent memoir before our readers.

The very interesting cases published by Dr. Bouillaud
are well calculated to elucidate the nature of many cases of
serous accumulations occurring either in the extremities or
in the cavities of the body, f They farther lead us to sup¬
pose, that many instances of those aflections which have been
usually referred to inflammation of the absorbents, have been
really inflammation of veins, producing effusion of coagulable
lymph from their internal membrane, and consequent ob¬
struction to the flow of blood along their canals, with all the
phenomena which may be supposed to result from such a
state, combined with the usual characteristics of inflamma¬
tory action occurring in serous textures. Against the opinion
that such affections are seated in some of the veins, and not
in the absorbents, it may be urged, that if the veins be the
parts affected, how is it that the inflammation does not more

* Archives Gen. cle Med. Mars ct Avril, 1823.

t Hepositoiiy for May, 1823.

Historical Sketch of the Progress of Medicine^ S^c,

frequently extend towards the large trunks until it reach the
heart ; but it should be recollected that it is characteristic of
inflammation, taking place in serous tissues and in a healthy
constitution, to throw out a copious deposit of coagulable
lymph ; which, while it completely obstructs the vessel,
serves at the same time to circumscribe the inflammatory
action by what has been usually called the adhesive process.
We have always observed in those cases of inflammation
of the serous coat of either the venous or arterial system,
which possess a tendency to spread, or which actually do
extend to the centre of the circulation itself, that there has
been some fault in the habit of the individual so affected,
that the inflammation has presented those appearances which
have been denominated erysipelatous, and that the effusion
from the internal surface of the vessels has not been suffi¬
ciently consistent to withstand the current of the blood, but
has been washed along with it, and has left the serous surface
exposed and inflamed ; whereas inflammation so situated, in
sound constitutions, has given rise to an effusion of lymph
possessing all the properties and appearances of that which
takes place in those textures during the most active inflam¬
matory action ; and while, in the former case, the effusion
has nearly resembled serum, in the latter it approached to
fibrin, and has presented similar characters as that which is
poured out in the adhesive inflammation. The actual nature
of venous or arterial inflammation is of the greatest moment
in practice ; for in those species of it which, owing to debi¬
lity or other faults of habit, are inclined to spread, it becomes
a rational indication to adopt such measures as may exalt
the vital energies, and thus enable the constitution to assume
that action which is requisite to the production of coagulable
lymph, and, consequently, of the adhesive process, as the
readiest and safest mode of arresting the progress of the
disorder.

After noticing those views which relate to the state of the
vessels, those which respect the condition of the fluid cir¬
culating in them come under consideration. Connected with
this subject — a subject of no mean importance, we have
had some excellent observations from Dr. Barlow, of Bath,*
who considers that a great proportion of the diseases of those
who enjoy good circumstances of life, arises from a state of
vascular plethora. If more food be assimilated,” he has
observed, than the usual waste of the bod}" requires for its
repair, a state of repletion must be the natural and inevitable

* Essay on the Medical Efficacy and Employment of the Bath
Waters, he. he. London, 1823;

Pathology, 23

consequence. But repletion may also take place under a
moderate, and even abstemious supply of food, when, from a
sedentary life, inactive habits, or any defect in the functions
of the several emunctories, the necessary excretions are ina¬
dequately performed.” This proposition he has made the
basis of his pathology ; and has illustrated it in an interesting
manner.

We refer our readers to the interesting experiments of
M. Magendie, detailed in a former Number,* on the effects
of putrid substances when injected into the circulation. The
inquiries of this physiologist have confirmed, in a satisfactory
manner, the experiments of M. Gaspard, and farther
evince the influence of the state of the circulating fluid in the
production of diseases, especially of those which affect the
w'hole frame.

Amongst those disorders that may, in the present state of
our knowledge, be referred chiefly to the ahsorhent system, or
to its functions, none possesses greater interest, or ought to
claim more attention from the pathologist, than that which
results from slight wounds received in dissection. The fre¬
quent occurrence of this dangerous accident, from the
greater and more widely diffused spirit of pathological re¬
search in the Profession, should bespeak from its members a
proportionate share of inquiry into the subject. At present,
it requires every elucidation, for nothing is known of the
nature of the derangement to which it gives rise, of the
textures or systems of the body which it chiefly affects, or of
the process which it observes, from the inoculation of injury
to the period of its fatal termination. The few instances of
post mortem inspection which have been recorded give us
very little information as to its pathology, and certainly not
any on which we can found rational opinions of its treatment.
In those cases in w^hich inspection has reall}^ been made, the
inquirer has most unaccountably been contented with looking
into one, or two, at the most, of the large cavities of the
body; as if any thing could be observed, in such situations,
beside the last consequences of the constitutional derange¬
ment. But has the internal coat of the veins been examined
from the point of injury along their trunks to the right side
of the heart? Has the heart itself, and the state of the
blood contained in it and in the large venous trunks, been
looked into ? Have the absorbents been inspected in their
course through the glands, until they reach the large veins ;
or has the internal tunic of the arteries been observed ? Has
the appearance of the nerves, from the part in which the

* Repository for April, 1823. f Ibid, for June, 1822.

§4 Historical Sketch of the Progress of' Medicine, S^c.

injury was received until they terminate in the spinal cord^
been noticed ? And finally, have the spinal cord itself, the
brain, and other parts of the nervous system, been satis¬
factorily viewed ? If, unfortunately, fatal instances of this
dreadful alfection shall continue to occur, the common in¬
terests of the Profession require that it should be more
narrowly looked into; and we would beg leave to suggest
that those points of inquiry be not neglected. The very
interesting case of Mr. Wan sbrough, * as well as the
history, of other cases of this description, which have been
circumstantially detailed, would lead us to suppose, that
inflammation of the veins formed, at least, a part of the
morbid actions induced in the system by this animal poison-—
if, indeed, it may be considered as such; and it also seems
not improbable that the nervous system, first, of the part
injured, and, consecutively, of the whole frame, is impressed
by the inoculated fluid in a marked and, perhaps, peculiar
manner. ‘I* The interesting cases lately published by Dr,

* Medical Repository for May, 1823.

t How far the vascular or the nervous systems suffer individually,
or how far either may be exclusively affected, in accidents of this
description, we have not data whereon to rest an opinion. If it be
contended that neither is deranged otherwise than consecutively,
where are we to seek the primary lesion ? The absorbents may be
disordered both in structure and in function by the local injury;
but even allowing the greatest extent of injury of this system, which,
indeed, the disorder does not present, still the cause is inadequate to
the production of the morbid phenomena observed in its course. But
the mass of fluids may be infected by the introduction of a morbid
poison; and here we arrive where we must all hesitate — at a point
of pathology, on which much confusion of opinion has existed, and
still continues to exist. Indeed, speculation is exactly in the same
state regarding it as it is respecting other animal poisons ; and
although we are far from denying it to be a poison, we cannot call
it a morbid one, inasmuch as it proceeds not from any morbid virus,
which we can point out as such and employ in that capacity, nor
from previous or specific disease, as is the case with rabies, small¬
pox, &c. But, since it acts as a poison, it matters the less whether
it be specific or not, the process by which it produces death, or the
succession of phenomena which it induces, may be either similar or
analogous to that which animal poisons observe. Here, therefore^ in
' tracing the process of derangement induced in the system by occur¬
rences of the kind under consideration, our knowledge is nearly of a
kind respecting them, as it is with regard to any inoculated virus.
But, viewing them as entirely similar as to their miode of operation,
the question still remains undecided, whether a specific virus, or any
other animal poison, produces its effects on the economy owing to its

Pathology. 25

Golles*, as well as that alluded to iu a contemporary
journal'!', seem to favour this conclusion.

The most important topic which has usually been con¬
nected with the pathology of the muscular system is that

influence on the blood, from its being received there unchanged, or
on the nervous system of the part, and especially on the nerves of
the vessels by which it is introduced into the circulation. That it
operates through the medium of the blood, presupposes that it is
carried into the blood unchanged, and that it is taken up immediately
by the veins ; for its absorption by the lymphatics would lead us to
suppose that it might experience a change, assimilating it with the
circulating fluid in the route through the absorbent apparatus.
Supposing it, therefore, to arrive in the blood, possessing all its pecu¬
liarities, in what manner can we conceive it to change the state of
this fluid ? Have we any proof of such change? But the bM'^ d may
be altered, and yet not sensibly so even by experiments, thof ^ ^ ?r-

fectly so by its effects in the animal economy : still, granting that it
is changed, (which cannot be allowed to its full extent in favour of
any morbid virus,) it cannot act upon the system otherwise than
through the medium of the vessels in which it circulates, which
vessels are only impressed by means of the nerves which supply
them. The introduction of any virus into an animal texture appears
not, however, to act primarily on the blood, from various cir¬
cumstances connected with the pathology of disorders which are
perpetuated in this manner, and chiefly from the following con¬
siderations; —

1st, The blood does not inoculate or transmit a disorder, though
the secretions do. 2d, A specific secretion can alone constitute a
specific virus, and propagate its kind by inoculation. 3d, The secre¬
tions that transmit the disorder, and the specific poisons generated in
the progress of certain diseases, do not exist in the blood previous to
their secretion, being only carried out of the circulation by the
secerning process ; otherwise they would be most abundantly voided
by the kidneys and other emunctories, and not generated in certain
tissues. 4th, It follows, therefore, and general experience and obser¬
vation confirm it, that morbid poisons are not generated in the blood
while it circulates through the system, but from the blood, in conse¬
quence of the altered function of the capillaries changing the nature
of the fluid passing through them, which alteration of function may
have been induced either in thenerves supplying the capillaries of a part,
as is the case in inoculation, ai)d thence propagated throughout the
system, or by an impression made simultaneously on a great portion
of this class of nerves, as in contagion or infection : in the latter case
the dilute secretion, on an extended surface, is equal in its effects to
the concentrated virus, applied to a limited point, as in the former.

* Dublin Hospital Reports, Vo!. III. p. 203.
t Medical and Physical Journal for February, 1823.
VOL. XX. - NO. 115. E

26 Historical Sketch of4he Progress of Medicine,

which relates to rheumatism. Respecting the intimate na¬
ture of this disorder we are still insufficiently enlightened, and
it appears to us even doubtful how' far the generally received
opinions with regard to it are correct: we, therefore, readily
attend to such facts as are calculated to advance our know¬
ledge on the subject. The translation of this affection to the
heart has become of so frequent occurrence, that it is no
longer looked on as an unusual circumstance. We are con¬
stantly hearing of instances in which it has proved fatal,
although it is not necessarily so; and, in a period compara¬
tively short, and in the course of opportunities by no means
very extensive, w’e have ourselves been consulted in three
cases w herein this supervention of disease had taken place, as

To these many other proofs may be added against the idea that
the blood undergoes the first change essential to the production of
disease and of a morbid virus; and in support of the opinion that a
morbid poison affects chiefly the nerves of the part to which it is
applied, and particularly those distributed on the blood-vessels, that
the blood, although it may be changed, especially in the course of dis¬
order, is not exclusively or even primarily altered ; and that, what¬
ever changes it may undergo result chiefly from the morbid influence
of the nervous system on the vessels in which it circulates, and on
the organs which remove the effete matters from the circulation.

Were we to state our belief respecting the species of disorder inocu¬
lated from another body which has ceased to live, and as to the
manner in which the inoculated fluid affects the system, from what
we have "heard of its effects, whether proceeding from the human
subject or from a lower animal, we should be induced to conclude
that it is produced from the animal textures before their vital pro¬
perties are extinct ; because putrid animal substances occasion different
and less dangerous effects in the system : that as all morbid poisons
possess certain properties bestowed on them by the vital or nervous
influence of the vessels and parts secreting them, in consequence of
previous disease either of these parts or of the general system, which
influence they preserve for a time, until the materials composing them
enter into different combinations and are consequently decomposed;
so may the capillaries, producing the usual secretions of the system,
occasionally experience, during the period in which the vital or
nervous energy gradually forsakes them, that particular condition
■which, with the state of the blood existing in them, may allow a fluid to
escape, which receives from the expiring influence certain properties,
thus giving it the qualities of an animal poison: that this fluid,
thus endowed, affects the nerves supplying the blood-vessels of the
part in which it is inserted: that, consequently, first the nerves and
vessels become deranged in their functions, and afterwards the whole
system is disordered; while,, with the general derangement, the nerves
,and vessels in the vicinity of the part inoculated still evince the
severest disturbance.

Pathology. 27

was proved by their termination and by post mortem inspec¬
tion*. Within the period to which we confine ourselves, a
case of this description has been recorded by Mr. A. Arm-
STRONGf. In this instance, and in all others that have
come to our knowledge, the muscular texture of the heart
presented fewer and less marked appearances of disease than its
serous envelopes: indeed, rheumatic metastasis does not
appear to attack the muscular parts of internal organs; the
serous membrane seems to be the obnoxious tissue ; and
although those surrounding the heart frequently experience
its invasions, no organ or viscus of the body, in which this
structure exists, appears to be entirely exempt from it.

The frequent translation, or rather conversion of this
disease to one of an internal texture, being so commonly’^
observed in modern practice, it becomes a matter of im¬
portance to speculate respecting its cause, and to inquire how
far the depleting and antiphlogistic plan of treatment, at
present so generally employed, may contribute to its occur¬
rence. This mode of practice in rheumatism has been en¬
tirely founded on generally received notions of its pathology,
which have not undergone that strict investigation w^hich
might have been expected from the inquiring spirit of the
age. It would be a subject of some interest to inquire how
far the conclusion, that rheumatism is inflammation of a par¬
ticular texture, is supported by pathological facts, or even by
analogy. There are none, in our opinion, which can be
adduced, except those which are derived from the appearance
of the tissue affected in the cases in which conversion of
disease has taken place, from the swelling and redness of the
surface sometimes observed in other instances, and from the
state of the fibrous and serous membranes, in protracted or
severe cases of the disorder. These are not, however, satis^-
factory proofs that this affection is inflammation of the tex¬
ture in which it is seated ; for, in transferred disease, the
subsequent ailment may be different, and it is so in many of
its characters, from that which previously existed; and w^e can
have no farther reason to conclude them both to be the same.

* On consulting our notes, we find that six cases have come under
our notice within the space of four years. Five of these were dis¬
tinctly of this description — one was doubtful. Of these two reco¬
vered, but presented, for a considerable time, slight symptoms refer-
rible to the heart. In these depletion had been employed, with the
exception of one, in which violent hypocatharsis was produced,
which immediately arrested the external disease, and as quickly in¬
duced the fatal disorder of the heart.

t Medical and Physical Journal for March, 1823. f

28 Historical Sketch of the Progress of Medicine, S^c.

because the former disappeared on the supervention of the
latter, than we have to infer that, because a blister removes a
pain distinctly nervous, or any other affection unconnected
with inflammation, therefore, this affection must have been
inflammatory, otherwise inflammation of another part could
not have removed it. The other proofs that have been
noticed are still more weak, for we well know that the inflam-
matory appearances that have been observed in external
parts or in joints, supervene only in the course of the dis¬
order, and are, we contend, the consequences of the disease —
are a morbid condition of the capillaries induced in them
consecutively, owing to the primary derangement of the
nerves of the part, and chiefly of these supplying those
vessels; which morbid condition, though approaching in many
of its characters to chronic or subacute inflammation, differs
essentially in its nature from the phenomena, which taking
place, in an idiopathic manner, in the capillaries of a part,
constitute inflammation of that part. We cannot, at present,
speculate farther on this subject, but leave it to the'consi-
deration of our readers, with the expectation of engaging in
it again on a more legitimate occasion.

Proceeding next to the second part of our physiological
arrangement, and viewing the particular textures in the order
there pointed out, the interesting case of chronic inflammation
of the peritoneum, published in this Journal by Mr. Waed,
first claims our notice*. The attention which has been paid
to pathological research in very recent times has shown that
this is a species of derangement of more frequent occurrence
than was formerly supposed ; and it is not too much to believe
that it was formerly confounded chiefly with colic, mesenteric
affections, tumours of the omentum, &c. Indeed, it appears to
us that the varieties of colic, which have been given in the
history of cases and in systematic detail by many of the older
pathologists, under the appellations of arthritica, rheumatica,
inetastica, inflammatoria, symptomatica, diuturna, chronica,
&c., were chronic inflammations of this membrane; and we
believe that the disease may supervene in the manner indi¬
cated by those specific names. Since we endeavoured to
draw attention to the frequency and importance of this dis¬
order, and to illustrate its pathology J*, several cases, more or
less marked, have come under our observation.

. The pathology of the fibrous textures has received very
considerable elucidation from the researches of M. Rayer,
in the excellent memoir to which we have before referred,

* Medical Repository for April, 1823.

t Ibid. Vol. XV. p. 372.

Pathology. 29

especially as respects the inflammatory condition of these
parts. Our limits, at present, prevent us from giving an
account of his researches*. We shall take a future oppor¬
tunity of submitting a review of them to our readers.

Adverting next to the osseous texture, the continuation of
Dr. K Nox’st memoir on the regeneration of bone, the
former part of which was referred to in our former sketch,
deserves notice. This pathologist has concluded from his
researches, that the manner in which new osseous matter
shoots from old bone appears to be as follows : — The vessels
supplying the remaining healthy old bone, whether proceed¬
ing to it from the periosteum, surrounding soft parts, or
otherwise, become increased in size, and perhaps in number;
granulations arise on the surface, which, by degrees becom¬
ing firm, are afterwards converted into bone. These are
found to shoot in various directions, but chiefly downwards
and upwards in long bones, often separating widely from
the surface of the dead bone, when not retained by careful
bandaging. They occasionally stretch across, forming arches,
and enclosing the dead portions of the original bone, — an
appearance of frequent occurrence in compound fractures,
% whatever cause occasioned. When arising from a fall or
blow, sufficient to break, but not destroy the vitality of the
bone, it is probable that compound fractures unite much in
the same manner as simple ones. For as bones are slow in
going through the various processes from health to disease,
so the lacerated soft parts may suppurate and heal by granu¬
lations, whilst the bone will unite chiefly by wFat must be
considered the first intention.”

The manner in which the new bone acquires a periosteum
is a matter of much interest and doubt. In the examination
of some specimens Dr. Knox has observed a thin membrane
covering the osseous granulations; but he knows of no facts
to decide whence this membrane proceeds. It is not un¬
likely that it is supplied by the cellular texture either of the
new' bone, or of the surrounding parts; and that in some
instances it may be merely a prolongation of the old. New
skin on ulcers does not always grow from the surrounding
healthy edges ; which fact may be applied to the formation
of new periosteum.”

But few objects of interest have lately presented themselves
connected with the pathology of glandular textures. The
frequent occurrence of disease in those internal viscera which
possess a glandular structure, as the liver, spleen, and pan-

* Archives Gen. de M6d. Mars et Avr. 1823.
t Edinburgh Medical Journal for April, 1823*

30 Historical Sketch of the Progress of Medicine,

creas, either after attacks of intermittent and remittent fevers^
or after the prevalence of certain epidemics^ has long been a
matter of notoriety amongst observing Practitioners. With¬
out instancing the more common cases and forms of these
occurrences which have been recorded, we refer to an account
given by Dr. Lucas, of Virginia, of the character of the
.diseases which were the sequel of the fever which prevailed
in that part of the United States during 1821 The account
also given by Dr. Agnew of the epidemic which prevailed
Jn some parts of Pennsylvania in 1819, 20, and 21T, still
farther illustrates the sources whence disorder of this structure
frequently originates. We refer, however, to the former of
;these articles, more on account of the facts which it contains,
than of the manner in which they are detailed and illustrated.
A review of the circumstances connected with the constitu¬
tional or local origin of diseases of the glandular texture fully
evinces how very much, and even how entirely, they depend
on the vital energies of the system and of the vessels of the part
affected ; whether the causes which produce them be pre¬
vious ailment, certain states of the atmosphere and of the
terrestrial exhalations, or the kind of ingesta.

The interesting case of organic disease of the liver ob¬
served by M, Nacquart J is already before the readers of
this Journal. Several cases have come to our knowledge in
which rupture of this viscus has occurred from external
violence, and yet the patients have lived for several days, and
betrayed no signs which were calculated to disclose the
nature of the injury. The particulars of some of those
occurrences we expect to detail in a future Number. Dr.
Heller has recorded a case in which the rupture of the
liver was complicated with laceration of the diaphragm and
dorsal muscles, yet the patient lived for some time after the
accident||.

The intimate relation between derangement of the mucous
tissues, particularly of the digestive canal, and those of the
meninges of the brain, was formerly shown b}^ numerous
facts recorded by Prost; and M. Broussais so confidently
regarded affections of the encephalon as a sympathetic effect
of primary irritation of the villous surface of the digestive tube,
that he made the connexion one of the fundamental principles of
his system, and resorted to it in order to explain the cerebral
symptoms and lesions, which were urged against his patho-

* American Medical Recorder, No. 21, p. 117".

t Ibid. p. 126.

X Repository for January, 1823.

jj Journal General, Mars 1823.

Fathology, 311

logy of fever. M. Scoutetten* has endeavoured to sup¬
port the opinions in favour of this sympathetic relation, and
has stated that the inspection of a great number of bodies has
confirmed his belief, that a connexion between the state of
the digestive canal and that of the arachnoid of the brain
exists, in so direct a manner, that when the former is irritated,
either in an acute or chronic manner, this membrane always
participates in the same degree of irritation. In order to
establish his opinion, M. S. commenced with ascertaining
the state of the arachnoid in health. Having satisfied him¬
self on this point, both by experiment and by observation;
and having always observed that this membrane is perfectly
transparent throughout its extent; that it presents no granu¬
lations, excepting on some parts of its surface; that it offers
no sanguineous injection in any of its capillary vessels; and,
finally, that no sanguineous exudation is found on its surface
in its natural condition ; he concludes that whenever it pre¬
sents appearances different from these, and is neither pale,
transparent, thin, nor without adhesions, it is then in a state
of. disease. He farther considers that it is only th^ mucous
tunic of the stomach and intestines which exercises so direct
a sympathetic irritation on the arachnoid.

M. Scoutetlen has gone on to remark, that when the
mucous membrane of the intestinal canal becomes inflamed
in an acute manner, the arachnoid membrane of the cerebrum
participates in the same degree of inflammation, and its
vessels are injected ; they form red patches on several points
of its superior surface, and sometimes sanguineous exuda¬
tions take place in a more or less abundant manner. All
these alterations are partial, and are chiefly observed on the
anterior lobes of the brain, and on the lateral parts of this
organ when the irritation is not very acute ; but when the
inflammation of the intestinal canal is violent, nearly all the
arachnoid is also inflamed, and presents a deep red colour,
and is dry and glistening. Sometimes an albuminous exuda¬
tion, which has a close resemblance to pus, forms between
the two laminae of this membrane. When the inflammation
is violent, adhesions frequently take place between the two
hemispheres ; the prolongations of this membrane, which
penetrate between the circumvolutions of the brain, are also
red, injected, and often adhere with considerable tenacity.

When, however, the digestive tube is affected with chronic
inflatiimation, the morbid appearances of the arachnoid are
different. It then becomes slightly opaque; an infiltration
of serosity takes place within its areolar tissue; its thickness
appears singularly augmented, and it assumes a gelatinous

Journal Universel, No. 84, p. 257 •

32 Historical Sketch of the Progress of Mediciney 3^c,

aspect. If a slight incision be made into it, the infiltrated
fluid escapes, and the two laminae collapse. In some cases
of the chronic irritation, so considerable an accumulation of
sero’sity takes place within the ventricles of the brain as to
" compress this organ against the bony parietes, and to arrest
the infiltration between the meshes of the interlaminar tissue
of the arachnoid. In this case the membrane appears dry,
but it is always thickened and opaque. When the intestines
present signs of chronic inflammation, which afterwards
assumes an acute character, corresponding lesions take place
in the arachnoid. This membrane is thickened, opaque,
frequently gelatinous ; moreover, it is red, its vessels are
injected, and sometimes it is covered with a sanguineous
exudation.

This remarkable coincidence of the existence of inflamma¬
tion in the gastro-intestinal mucous surface, and in the arach¬
noid, according to M. Scoutetten, satisfactorily explains
many important points of pathology hitherto obscure*, both
as respects diseases of the meninges of the brain, and those of
the brain itself, whether affecting the physical or mental
manifestations.

We cannot leave the consideration of the pathology of
the mucous surfaces without directing the attention of
our readers to the very interesting and remarkable case
of haemorrhage from the internal surface of the ilium,
detailed in our preceding Number by Mr. Lloyd, whose
laudable attention to morbid research will, we expect,
.be the means of rendering farther services to pathological
science.

The most interesting addition that has been made to the
observations we already possess on the nature of derange¬
ments seated in the dermoid structure, has been furnished by
Mr. E. Thompson. The case of pemphigus, which he has
published in our preceding Number, is well calculated to
advance our knowledge of the nature of this rare and imper¬
fectly understood disorder.

A singular species of cutaneous disease, which we had not
previously seen described by writers on this class of ailments,
came under our observation some time since through the
kindness of Mr. W, B. Painter, the very respectable Prac¬
titioner in Westminster. We took occasion soon afterwards
to detail the particulars connected with it to the Medical
Society. Since that time, this disease has been described by
Dr. Guersent, in the March Number of the Medical

* We can state that our experience fully confirms this connexion,
in those diseases of children which aifect the mucous surface of the
digestive organs.

Pathology. . ' 33

Archives for 1823, which has just reached us, under ihe name
of atonic furunculus, ^ — a name by no means appropriate,
according to the meaning attached to the word furunculus in
this country. As we intend to place before our readers the
particulars of the two cases which came under our notice, '
with the appearances observed on dissection in one of them,
we shall defer giving the accurate description of M. Guersent
until then.

Proceeding in the next place to exhibit a view of the addi¬
tions that have been made to our knowledge of the patholo¬
gical states particular organs^ we shall first direct our atten¬
tion to derangements of the digestive canal. Commencing
this part of our subject with the consideration of derange¬
ments, which may be considered as chiefly functional —
which present, at least, no very palpable lesion of structure —
diabetes, according to our ideas of its nature, first arrests our
attention. It may, perhaps, surprise our readers that we
should remove a disease, which has been usually considered
to have its seat in the kidneys, to the digestive organs. But
we are induced to take this view of its nature, 1st, because
the kidneys betray no signs of disorder on dissection that can,
in any measure, contribute towards the explanation of its
phenomena; and, 2dly, the various symptoms essential to
and accompanying the disease cannot be explained after
so confined a view of its pathology. Without, however,
stating any farther reasons against referring diabetes to the
kidneys, we may briefly stale our belief that further research
w'ill show that it is a disease principally of the stomach,
duodenum, and, perhaps, of the upper portion of the small
intestine; that it is not inflammation of these parts; that it
chiefly arises from increased activity of the capillary vessels
on their internal surface, secerning the fluids requisite to
digestion in greater quantity, and, perhaps, in an altered con¬
dition ; that the lymphatic absorbents running into venous
trunks, and the lacteal vessels, partake in this erythism ; that
these vessels experience this state from the greater activity
or influence of the nerves supplying them and the internal
surface of those particular viscera to which they are distri¬
buted ; that owing to the erythism of these vessels, the func¬
tions of digestion and absorption are craving, — hence the
desire of food and drink — and these operations are rapidly
performed on the substances submitted to them ; that, in con¬
sequence of this activity of function, — of the increased diges¬
tion and absorption which take place in the stomach, and of
an imperfect admixture of the biliary and pancreatic secre¬
tions, owing to the great disproportion existing between
them, and the increase of chyme furnished by the stomach,

VOL, XX. - NO. 115. F

Historical Sketch of the Progress of Medicine j S)C.

a larger quantity of fluids and of imperfect chyle is conveyed
into the circulation in an insufficiently, hastily, and morbidly
digested slate, which the energies of the other organs, from
the circumstance of the vital powers being chieffy deter¬
mined towards those of digestion, are incapable of assimi¬
lating in a complete and healthy manner; that owing to this
replete state of the circulating fluid the kidneys have a larger
quantity of those materials on which they are intended to act
conveyed to them, which stimulate them to increased action;
that the kidneys are no farther deranged, than that they have
their functions excited by the unusual quantity of the aque¬
ous, chylous, and insufficiently digested materials, which, cir¬
culating in the blood, are presented to them, and which,
owing to this state, cannot be assimilated with the textures
of the body, would be injurious to the system if they
remained in the blood, and are removed from it by those
organs whose uniform and natural function it is thus to
remove them ; and finally, that the materials conveyed so
superabundantly into the circulation, as we have stated, and
thus secreted from it by the natural action of the kidneys,
constitute diabetic urine ; and that the various phenomena,
essential to and concomitant on the disease, are best ex¬
plained by considering the digestive canal to be its chief seat,
according to the brief view we have just given.

In support of these positions, we may adduce the fulness
at the epigastrium, the sensation of internal heat and spas¬
modic constriction about the region of the stomach, and the
frequent sense of gnaw’ing felt in this viscus, &c. That the
saccharine quality of the urine results from the properties of
the chyle, and from the fluids so abundantly absorbed into
the circulation, is shown by the more saccharine state of the
urine discharged soon after a meal. Dr. Rollo* observed,
in a case related by him, that this secretion was insipid in
the morning, saccharine after dinner, and natural in the
evening, even after it was reduced to its natural quantity.

It may be contended against the pathology of this disease,
which we have now sketched, that morbid appearances have
not been observed in the stomach and intestines to account
for the disorder referred to it; but it should be considered
that organs which perform their functions merely in an
increased degree generally present but few lesions cognizable

* Since the above was written, we find, on referring again to Dr.
Rollo, that he entertained nearly similar opinions to ourselves re¬
specting the nature of this disease. His physiology, however, was
deficient, for he had not the advantage of the recent researches re¬
garding absorption, which tend, in an essential manner, to support
this view of the disease.

Pathology, 35

to the senses. Indeed, increase of secretion and absorption,
the natural functions of the part, do not necessarily produce
any derangements’ of structure ; nor should we expect to
observe any, but such as are the consequences of a continua¬
tion of this state ; and such are actually what have been ob¬
served in the very few instances in which the state of the
digestive organs has been noticed ; for so uniformly have the
kidneys been considered to have been the seat of the disease,
that the condition of any other part has been seldom inquired
into. Dr. Marsh, in his very excellent observations on
diabetes*, has informed us that, in looking over the notes of
cases of this disease treated by Dr. Crampton, he observed
that blood was vomited in one case, and that “ in almost all of
them there was fulness about the epigastrium and uneasiness
on pressure.” It is rather singular, though these and other
unequivocal symptoms pointed out the real seat of derange¬
ment, that the state of the digestive organs has been so
seldom an object of attention in post mortem examinations
of diabetic patients. M. Dufuytren observed, in the dis¬
section of a case which he has recorded, the stomach ex¬
tremely voluminous, and the vessels of this organ enlarged,
and forming, on its internal surface, a vascular net-work more
than usually developed. The duodenum, the commencement
of the jejunum, and the caecum, were also a little redder and
thicker than natural.

We refer our readers to the very instructive case of this
disease published by Dr. HEiNEKENf, which is well calcu¬
lated to elucidate its nature, and the treatment which ought
to be employed against it.

The importance of the memoir on spontaneous perfora¬
tions of the intestines published by Dr. Louis, and reviewed
in our preceding Number, will be apparent to every culti¬
vator of pathological inquiry. The case of stricture of
the colon recorded by Mr. SterryJ, will also be perused
with interest.

The epidemic cholera of India still continues to interest
the medical inquirer. Within the period allotted to this
sketch some observations on this devastating disorder have
been published by Dr. RankenH, who has considered that
two millions of British subjects in India have been destroyed
by it. This Physician has stated that the disease appeared,
in some instances, to follow the course of the wind, and to
originate in the heavy and continued falls of rain which had

* Dublin Hospital Reports, Vol. III. p. 454.
t Repository for April, 1823. t Ibid, for May, 1823.
II Edinburgh Medical Journal for January, 1823.

S6 Historical Sketch of the Progress of Mediciney S^c,

taken place, and which furnished materials for the deleterious
exhalations generated by the powerful sun of that climate.
Dr. R. has considered the unwholesome diet, arising from
bad rice, to have constituted a very general predisposing
cause. The phenomena and consequences of the disorder,
in his opinion, resembled the effect of poisons, in lowering,
and, in many cases, destroying the vital powers of the system.

Dysentery is a disorder w'hich presents so many pheno¬
mena that are intimately related to those of cholera, that we
readily turn from views connected with the latter to inquire
respecting the additions that have been made to our know¬
ledge of the former. Within the period to which we confine
ourselves. Dr. O’Brien has published observations on the
acute and chronic dysentery of Ireland, which, although they
may convey a satisfactory idea of the disease as it occurred
in that country, add nothing to our views respecting its
nature. The account by M. Lemercier, of the dysentery
which occurred in an epidemic form in France, in the depart¬
ment of the Marne evinces that he has by no means em¬
ployed to advantage the opportunities of observation which he
enjoyed. From the meagre detail w'hich he has furnished, we
are led to infer that the disease appeared in one of its severest
forms, and presented more of the characters which result
from a low condition of the vital energies of the system than
are usually observed in this country.

Several very interesting observations of spontaneous perfo¬
rations of the stomach have been detailed in contemporary
worksf published on the Continent; some of these cases
have also appeared in this Journal J. In one of the instances
which we took occasion to place before our readers, in addi¬
tion to the perforation from the interior of this organ into the
peritoneal cavity, a similar lesion was observed in the
oesophagus, which communicated with the cavity of the
chest ; effusion into the ventricle of the brain was also
present. The case published by Mr. Workman || furnishes
an interesting instance of perforation of this viscus as it
results from cancerous ulceration. Those recorded by
M.M. Bouillaud, Louis, and Gaste, which have been
just now' alluded to, are worthy of regard in several points of
view.

It is unnecessarv for us to do more than turn the attention
of our readers to the memoir of M. Andral^ on the patho-

* Journal Gen. de Med., Mars 1823.

J Journal de Phys. Jan. 1823 ; Journal Univers., Dec. 1822.

I Repository for March and June, 1823.

II Ibid, for March, 1823.

§ Ibid, for March, April, May, and June, 1823.

Pathology. 37

logy of the digestive canal, which we placed fully before
them in some of our preceding Numbers. It constitutes one
of the greatest acquisitions which has lately enriched this
branch of medical science. We recommend it to the
perusal of all who take an interest in pathological research, as
the result of extensive observation and acknowledged talent.

The illustrations of tuberculous diseases, especially as they
affect the respiratory organs, with which Dr. Baron has
furnished us, present several claims to particular notice.
Although we cannot agree with his views respecting the
nature of these derangements, still we approve of the ability
and assiduity which he has bestowed on the inquiry. And
even believing as we do that his explanation of the morbid
phenomena, which he has made the objects of his inquiry, is
not supported by sufficient evidence to ensure -adoption, yet
we conceive that pathological knowledge will be promoted
by the investigations to which they are calculated to lead.
The descriptions which Dr. Baron has given of the progress
of tuberculous formations in the lungs constitute a valuable
addition to what \vas previously known on the subject. Here
he has observed closely and described with considerable
accuracy' ; but when he enters upon an examination of the
manner in which these derangements come into existence,
many powerful objections present themselves to the conclu-^
sions at which he arrives on the subject. Having so lately
made Dr. Baron’s work the subject of review,* we refer
to the particular account there given of his opinions.

The work of Sir Alexander Crichton on consumption,
which received a full and critical analysis in a former Num¬
ber, f presents some claims to notice at this place ; and
although it is chiefly in a therapeutical point of view that his
observations and opinions deserve attentive consideration, and,
in many places, adoption, yet we recommend his observations
respecting the nature of scrofula to the perusal of our readers.

The very singular case of hydatids found within the pulmo¬
nary veins by Dr. Andral is calculated to interest, and^
indeed, to perplex pathologists. J

But few interesting observations have latel}' been made
respecting disorders affecting the organs of sense. Dr. An¬
drew Smith’s account of the cases treated at the Ophthalmic
H ospital, Chatham, and Dr. Evans’s case of iritis, || furnish
only some useful illustrations of acknowledged principles in
the pathology of the disorders which they respect. — The
diseases of the ear have received some elucidation in the

* Repository for March, 1823.

t Ibid, for May, 1823. f Ibid, for April, 1823.

4 Edinburgh Medical Journal for January, 1823.

38 Historical Sketch of the Progress of Medicine, S^c,

fourth part of Professor Lallemand’s * work ; those which
generally terminate in inflammation of the internal part of
this organ, and occasionally extend to the brain and its mem¬
brane^, have been the chief objects of his research.

But few additions have lately been made to our knowledge
of the pathology of the urinary and generative organs. The
works of Mr. Howship and Mr. Bingham on the diseases
of the urinary organs have been so fully reviewed in our
preceding Numbers, that we have only to assign them the
proper rank whi(^h they deserve to hold in the. pathological
history of the period under consideration. The production
of the former gentleman is undoubtedly the result of some
considerable extent of observation, although it would appear,
from the frequent reference made to the experience of Mr.
H EAVisiDE, that Mr. How^shipf has received no incon¬
siderable share of his materials from that experienced Sur¬
geon. For reasons that are obvious in the subjoined note,
we do not consider Mr. H.'s late work as so legitimately
falling within the intention of the present sketch, that it
requires any farther notice. Mr. Bingham’s volume on the
diseases of the bladder was sp fully analyzed on a former
occasion,! as to render it unnecessary to say more respecting
its merits than to repeat what we then said, that, although
it contains but few additions to our information on the sub¬
jects which it embraces, yet it forms a useful work to several
Practitioners, inasmuch as it lays before them in a single vo¬
lume what was previously scattered through the pages of many.

Particular and even solitary observations are frequently
calculated to promote our views respecting the disorders to

* Recherches Anatomico-Pathologiques sur rEncephale et ses
Bependances, &c. Paris, 1823.

-f There is one point which escaped our observation at the time
when vve reviewed this work, and respecting which, we conceive,
Mr. Howship has not acted with strict propriety. We refer to the
silence he has uniformly kept with regard to his former work, entitled
“ Practical Observations on the Diseases of the Urinary Organs, par¬
ticularly those of the Bladder, the Prostate Gland, and Urethra,
8vo. 1816,” and to the manner in which he has presented his present
W6rk, which is in many respects only a new and extended edition of
the former, to the Profession as an original production, under
the altered title of “ A Practical Treatise on the Symptoms, Causes,
Discrimination, and Treatment of some of the most important Com¬
plaints that atfect the Secretion and Excretion of the Urine, &c. &c.’'
We leave the Profession to judge how far they have been properly
treated in this matter : it is our duty to remark the circumstance,
and to inform our readers respecting it, since Mr. H. has failed iu
this part of his unquestionable duty.

I Repository for February, 1823.

Pathology,^ SQ

which they relate ; the interesting case of nephritis pub¬
lished by Dr. Brown* is of this description. In it little dr
no pain, fever, or other symptoms, except the appearance of
the blood drawn, were present, which could lead to the belief
that derangements so extensive as that which dissection de¬
tected, were present in the urinary organs during life. This
case was chiefly characterized by complete suppression of
urine, and subsequent coma. On dissection, very consi^
derable effusion was remarked on the surface of the brain,
and but little within the ventricles. The substance of the
kidneys was much inflamed and injected, their pelvic cavities
thickened and ulcerated, and a calculus about the size of, and
resembling, a small kidney bean, was impacted in each ureter 5
the ureters were not dilated above the part where the calculi
were lodged.

The pathology of the generative organs has presented us
with some remarkable facts. Respecting these, we have only
to refer to our preceding umber. The singularly compli¬
cated case of ovarian foetation there recorded by Mr. W. B.
Painter, and the full and perspicuous details with which he
has furnished us respecting it, cannot fail of interesting the
Profession, and, indeed, all who speculate on the operations
of the animal economy. The points of particular interest in
this remarkable case are, the morbid lesions which had evi¬
dently so long existed in the uterus, the situation of the
child within the covering of the ovarium, the impermeable
state of the Fallopian tubes, and the circumstances connected
with the previous history and last illness of the patient.
These facts would seem to prove that impregnation actually
does take place, although the route by which the seminal
fluid is commonly supposed to reach the ovum is completely
obstructed ; for even granting that the tubes were not
obstructed at the time of impregnation, still the membranes
of the ovarium were interposed, in this case, between the
ovum and whatever might be propagated to the ovarium
along these tubes. In order, therefore, to explain the phe¬
nomenon, we must have recourse to the opinion in support
of the transfer of the semen from the vagina directly to the
ovarium by means of lateral absorption. The facts which
this case also discloses respecting the effects of slow inflam¬
mation on the substance of the uterus likewise deserve atten¬
tion. The very singular case of fatal haemorrhage from the
Fallopian tube by M. GoDELLEf requires particular notice
at this place : to account for its occurrence is apparently
beyond the present state of our knowledge.

^ Edinburgh Medical Journal for April, 1823.

t Repository for June, 1823.

40 Historical Sketch of the Progress of Medicine, ^c.

Having sketched the additions which have been made to
the pathology of the general systems, and particular textures
and organs, we now proceed, in the same synthetical mode of
inquiry, to consider the views w'hich have been lately offered
respecting those derangements which appear to influence the
body in a general manner, and to disorder the functions of all
the grand systems and organs of which it is constituted,
although some particular textures may suffer in some of
them in an especial manner. Commencing, therefore, this
view with the opinions w'hich relate to the etiology and
pathology of idiopathic fever, one of the most interesting
works which have lately appeared on this subject, and, in¬
deed, the only one that has been published on it in this
country, is the account given by Dr. O’Halloran of the
epidemic which recently ravaged Barcelona. In addition to
the view which we gave in our former Number of his
opinions respecting the origin and nature of this fever, the
information which he has furnished respecting the state of
the weather, and of the diseases which prevailed previous to
the appearance of that destructive malady, deserves to be
recorded. Dr. O’Halloran has stated, that about the ter¬
mination of the foregoing month and beginning of May
sudden deaths were numerous : they were attributed to the
state of the weather. Comatose affections seized upon per¬
sons of all ages ; and, when life was not suddenly destroyed,
paralytic affections were invariably the consequences.

“ The heat was considerable in the month of June. Colics,
diarrhoeas, and dysenteries prevailed, and affected all classes,
but particularly the young. The bilious remittent, or gastric
fever, was common during this month, and ultimately pre¬
dominated in so high a degree, as in a manner to supersede
all other diseases.

During the month of July, the weather w^as very change¬
able. The mornings were cold, the evenings hot, oppressive,
cloudy, and damp. About the middle of July, several cases
of jaundice appeared among the people. The caterpillars,
which in other years strip the large trees which ornament the
square of the general hospital and public walk, were sud¬
denly killed, as if by lightning. In this month the ordinary
diseases of the season were rarely observed, viz. cholera and
inflammatory fever. The bilious remittent, with haemor¬
rhagic affection, was common and obstinate. It is worthy of
remark, that, during this month, the flies and musquetoes
were infinitely multiplied.

The occurrences which preceded the appearance of the
epidemic of Barcelona, in 18'21, correspond with the old and
recent observations on a similar subject in other countries; it

Pathology. 41

almost invariably happening, that the yellow fever of Spain
is preceded by unusual diseases of various form and force;
more particularly by bilious remittents, which are not unfre-
quently so aggravated and malignant, that Physicians them¬
selves do not venture to define the line of demarcation
between them and the avowed epidemic.’^

A letter which Dr. O’Halloran received from a Physician
to one of the hospitals in Barcelona, has furnished very strong
proof of the nature and non-eontagious property of this
epidemic, with the following account of the appearances on
dissection : — The liver,’^ that gentleman has informed us,
presented a saffron colour, sometimes with obscure stains
in its concave part, and almost always some gangrenous
stripes in the gall bladder, with some portion of black bile.
The mucous membrane of the stomach vvas inflamed, and
the bottom of it contained a great portion of black liquor.
Part of the intestines, and in particular the jejunum, con¬
tained the same humour; and there were bodies which con¬
tained more than three pounds of the same black liquor.

In the spleen and kidneys no particular alteration was
observable ; but the urine in almost all the cases was very
much of the colour of saffron. In many cases, adhesion of
the lungs to the pleura were met with. Nothing particular
vvas observed in the heart, nor in its large vessels: the liquor
pericardii was always of a straw colour.

Out of thirty persons of all descriptions, who were
destined to assist the sick, not one took the disorder. The
nurses continually communicated with the sick. When
delirious patients escaped from their beds, the assistants
had to take them on their shoulders, and replace them in
their respective quarters. On the opening of the bodies,
the anatomists, in my presence, involuntarily cut their
fingers and hands, and not one was inoculated with the
yellow fever. When the grave-diggers carried the dead bodies
to the churchyard, they had to handle them a great deal
before throwing them into the pit, and not one suffered
in his health. In short, not an individual employed in the
lazaretto either took the disorder, or was infected by those
who were sick of the yellow fever.’’

The circumstances contemporary with the epidemic of
Barcelona, the advantages which were taken of that destruc¬
tive malady by the French government, and the object of
the medical commission which proceeded to examine its
nature, have been long apparent. These commissioners
proceeded according to their instructions, and reported on the
disease accordingly. However, when their report was made,
and the political ends accomplished, to the effecting of which
VOL. XX. — NO. 115. G

42 Historical Sketch of the Progress of Medicine, S^c.

they were amongst the hired and humble instruments, we
should have supposed that there their vocation, as the
puppets of the minister, would Ijave ceased. And it did
cease on the part of some of them. Others considered that
it was requisite, on their parts, to preserve the appearance of
sincerity ; and altliough silence might have ensured them a
continuance of their yearly pension, yet they conceived that
their rew'ard would be less likely to be forfeited by per¬
severing in the cause which they had undertaken, and by
answering those who impugned the accuracy of their report —
we will not say of their opinions. Accdrdingly we have had
constant visitations from the abettors of opposite doctrines
respecting the origin of this fever, even within the period
W'hose medical history we are now sketching. Of these
M. Audouard has been one of the most voluminous'^' and
the most circumstantial in his details. He has reasoned in
behalf of the foreign origin of the disease, and of its conta¬
gious nature, in the usual wav : and he has given a novel but
fanciful explanation of the manner in wliich the contagious
principle is generated in its progress. He has not considered
the disorder to consist in inflammation of the internal gastro¬
intestinal surface, but in a particular derangement of its
vitality, w’hich he has not explained, allowdng a sanguineous
exhalation to escape into the cavity of the stomach. - This
exhalation he has view’ed as the proximate cause of the sub¬
sequent derangejnents that characterize the disorder, owing
to the changes which be lias conceived it to undergo after its
extravasation, and which may be compared to a species of
fermentation. In the opinion of M. A., an engorged and
congested state of the mucous membrane of the stomach and
intestines takes place on the invasion of yellow fever, which is
relieved by the effusion into the cavity of these viscera. This
effusion or exhalation, owing to its effects on the system,
produces the second stage; and the blood, tims extravasated,
undergoes certain changes, consisting of the separation of its
elastic or gaseous elements, which give rise to eructations,
and wdiich escape in this manner frotm the stomach, and
intestines. The volatile elements of the effused blood com¬
bine, according to M. Audouard, into a peculiar compound
of a gaseous form which constitutes the essential and repro¬
ductive cause of the disease — the contagious principle by
which it is propagated, and which can only produce the

* Relation Historique ct Medicale de la Fievre .laune qni a regn6
en 1821, a Barc^lone, par M. F. M. Audouard, D. M. M. envoye
a Barcelone par S. Ex. le Ministre de la Guerre, 8vo. pp. 540.
Paris, 1822.

Pathology.

malady in others by acting on the mucous surface of the
digestive canal. The black matter which is left behind in
th e stomach and intestines is a mere caput rnortnum, unen¬
dowed with any infectious property, and constituting the
matters which are ejected in the last stage of the malady.
Such is the nature and cause of yellow fever in the opinion
of this writer; how far it is well founded, it is neither
necessary nor convenient at present to inquire.

The inferences which MM. Bonneau and Sulpicy have
drawn from llieir lesearches on the contagion of vellow
fever have been shortly noticed in a former Number^; and
the arguments of Dr. Maclean in favour of the modern
origin of opinions respecting contagion are before our
readers T.

The effects of local or endemic causes in the production
of fever have been always recognized, although many parti¬
culars, connected both with the nature of those causes and
with the effects they produce on the animal economy, have
not received that elucidation which the state of our know¬
ledge on these topics requires ; indeed, the difficulties
attendant on this species of research are sufficiently evident,
whether we regard the nature of the products which emanate
from such sources, or the mode of operation they observe in
producing their effects on the animal system. Connected
with this subject, we have perused with satisfaction the
description which M. DupreJ has given of the sources of
the febrile disease which destroyed about a sixth part of
the inhabitants of the commune of Villechetive, in the de¬
partment of the Yonne. This commune is environed by the
forest of’ Othe, which furnishes abundant materials of humi¬
dity and of vegetable decomposition. The houses are generally
separated from each other by deep excavations into the soil,
which become the receptacles of rain-water, of vegetable
putrefaction, and of other putrid matters, arising from the
dwellings of the lower classes, and from the w^ashing of their
linen. In this commune also the dunghills are placed in the
midst of putrid water at the very doors of the houses; and
this state of humidity is preserved in order to promote the
decomposition of the straw mixed with the ordure of the
cattle. During the warm summer and autumn of 1822 those
reservoirs formed in the excavated soil were dried up, and
presented a thick covering of miry slime, which, when
warmed by the power of the sun at that season, gave out an

* Repository for May, 1823.
t Ibid, for February and March, 1823.
I Journal de Physioiogie, Janv. 1823.

44 Historical Sketch of the Progress of Medicine, Sfc.

odour which was insupportable, even at a considerable dis¬
tance from its source. Heavy rains fell during July, and the
inhabitants, who had been deprived of a requisite supply of
water for six weeks, now used that which had accumulated in
the excavations, although it was in small quantity, and pre¬
sented a greenish colour. This scanty supply of foetid and
putrid water, holding in solution the slimy and deleterious
matters accumulated in those pits, was their only supply
during July, August, and September.

Early in July the effects of those sources of disease, the
miasmal exhalations and the internal use of stagnant and foul
water, became evident. Young children were the first
victims. They were affected with a mucous flux, without
pain or abdominal tumefaction, and with an almost continued
sinking of the vital forces, interrupted only by occasional
evening exacerbations of fever. The pulse was uninterruptedly
quick from the commencement of ailment, but the other febrile
symptoms were slight. The stools became foetid, dark, and
sometimes nearly black. The tongue and teeth were covered
by a thick and dark coat ; and the perspiration was copious
and foetid. Most of the children affected by the disease
died on about the thirteenth or fourteenth day, in a state of
complete exhaustion, which frequently proceeded without
interruption from the commencement of indisposition.

It was not until the beginning of August that the disorder
was fully pronounced amongst adults; but in the space of
three weeks it existed in every family, and before the month
of December it had spared but a few of tfle inhabitants.
Disease commenced with several days of general ailment, to
which afterw^ards became added loss of appetite and frontal
cephalalgia. To this generally succeeded violent fever, with
a sense of w^eight at the epigastrium, a hard, full, but slow
pulse, and occasionally vomitings of a tenacious and greenish
matter. The tongue and mouth were foul and clammy.
This state continued for some days, with evening exacerba¬
tions, difficult respiration, and frequent cough with mucous
expectoration. To this supervened a copious mucous
diarrhoea, with colicky pains, and an abundant generation of
intestinal gas. Sometimes aphthae appeared in the mouth,
palate, and pharynx. The pulse became weak, perspiration
abundant and continued, and the thirst extreme. These
symptoms continued until the eighth or ninth day, when all
the evacuations assumed a foetid and putrid character :
about the eleventh day the prostration of the vital energies
was extreme; the evacuations were black, and often involun¬
tary ; the perspiration abundant, cold, and acrid ; and volun¬
tary motion nearly extinct. After this period the cough

Pathology. 45

ceased, the pulse became small and compressible, aplithaa in
the mouth appeared gangrenous, the perspiration was into¬
lerably foetid, the evacuations blacker and involuntary, &c.
Death generally occurred on the 17th or 21st day. When
recovery took place, the patient was frequently subject to
the return of obstinate diarrhoea or spasmodic vomiting.

The state of the seasons is always most intimately con¬
nected with the origin of febrile diseases. Relating to this
subject, Mr. H. Edmondston has given an account of the
weather, with reference to the diseases most prevalent in
Newcastle-upon-Tyne*. From Mr. E.’s observations it is
apparent, that fever possessing enteric and dysenteric cha¬
racters, as well as pure cholera and dysentery, were unusually
prevalent in that town, in consequence of the heavy falls of
rain which took place in August after two months of uncom¬
monly dry and warm weather.

That certain constitutions of the atmosphere give rise to
particular characters in the epidemics which result from them,
is a fact which has been frequently observed ; for it can be
only to that cause, in connexion with the terrestrial exhala¬
tions issuing from the seat of disease, that we can attribute an
effect of so general a nature as that which respects a parti¬
cular feature in a prevailing epidemic. The circumstances
of the patients may have some influence in its production;
but as the particular circumstances of individuals composing
a community must differ in many respects, so the resulting
effects cannot possess the uniformity which fevers often pre¬
sent. To such causes, therefore, as w^e can either manifestly
trace, or to those whose operations we may consider of the
most predominant and general kind, although we cannot
demonstrate their nature, we must refer the leading characters
of the various epidemics which have been observed in modern
times. The strict attention that is now paid to all disorders
which prevail in an unusually general manner, leave little
information to be desired respecting their nature ; and how¬
ever much we may be at a loss to recognize their causes, we
are generally made well acquainted with the phenomena they
present in their course. Within the period to which our
historical view' is limited several accounts have appeared,
describing fevers that have assumed more or less of an epi¬
demic character in various parts of France during the tw^o pre¬
ceding years. These have generally possessed peculiar
features; and the internal surface of the digestive canal,
the lungs, and the skin, have been more frequently the seat of
the greatest derangement.

- At the time when Barcelona was the prey of the malady

Edinburgh Medical Journal for April, 1823.

46 Historical Sketch of the Progress of Medicine^ ^c.

which destroyed nearly seven thousand of its inhabitants, the
departments of the Oise, and of the Seine and Oise, in
France, became the seat of a disease which occasioned some
anxiety in the neighbouring capital. This epidemic has been
described by MM. FRANgois* * * § and Dubun de - Peyro-
LONOUE, and more recently, and in a much fuller and abler
manner, by M. RAYER.-f* The last named of these authors
has entered minutely into the topographical description of
the districts which chiefly experienced the disease. From
the account which he has given, it appears that this part
of the country, formerly the province of Picardy, is moist,
marshy, unequal in its surface, plentifully watered, and thickly
wooded — circumstances which evince the abundant exist¬
ence of the sources of disease. M. Rayer has farther informed
us that epizootiesj have been frequent in this department,
and that epidemics have often manifested themselves, and
have presented characters similar to the one which he
observed.

The disorder generally commenced with symptoms of
general ailment, to which abundant sweats supervened, wRich
continued until the termination in convalescence, or in death.
Towards the third or fourth day an eruption generally ap¬
peared on the skin, which was developed more or less rapidly,
whether it was general or partial, discrete or confluent.
M. Rayer has distinguished three varieties of eruption which
it presented, and designated by the terms red, white, and
phlyctenous miliaria. This exantheme terminated in the
course of a few days by the eruption of the vesicles, or rather
by a desquamation of the cuticle. On dissection, the disease
presented more or less evident marks of inflammation of the
mucous surface of the stomach and intestines ; injection of
the brain, or of its membranes; effusions of serum into the
ventricles of the cerebrum ; and inflammatory appearances in
the lungs.

The history which M. Rayer has given of this epidemic is
one of the best specimens of this department of medical
literature which we have to record. The learning, research,
and scientific knowledge which he has evinced, will ensure for
him the esteem of his profession, and for his work an
honourable reference, whenever the nature of epidemic fever
is made the subject of inquiry. §

* Journ. Gen. de Med. vols. 77 ^ad 80.

t See Bibliography, Repository for April, 1823.

I The prevailing diseases of the lower animals form an excellent
illustration of the causes and nature of those of our own species —
an illustration too often neglected in descriptions of epidemic diseases.

§ With respect to the proximate cause of this fever, M. Rayer

Pathology. ' 47

i\n instructive memoir has been presented to the Medical
Society of Paris, and subsequently published by M. Henne-
guiN,* describing the fever which prevailed in the autumn
of 1822 in certain districts of the department of the Ardennes.
M. H. has given a brief but excellent description of the
disease, which he has attributed to the warmth of the summer
succeeding heavy falls of rain in the winter and spring. This
condition of the seasons, superadded to the natural humidity
of the country, gave rise to a more than usually moist, warm,
and close state of the atmosphere, which M. H. has con¬
sidered as the chief cause of the disease, acting in conjunction
with the particular circumstances of those affected.

After precursory symptoms of general ailment, which con¬
tinued for several davs, and which could not be assigned to
any particular organ or texture, thus furnishing a demon¬
strative argument against the opinion that all fevers arise
from a local affection, the more violent phenomena of the
disease generally presented themselves. These were ciiiefly
characterized by the adynamic state of the system generally,
the irregular and h)w state of vascular reaction, and the
atonic condition of the mucous surfaces. From the last named
characteristic of the disorder, M. Hennequin gave it the
name of muco-gastric fever. It presented no decided ap¬
pearances of a contagious nature. It never terminated before
the fourteenth day, and was sometimes prolonged to tlie fifth
or sixth week. In general, convalescence was tedious; and,
notwithstanding the severity of the symptoms and length of
the disorder, fatal instances seldom occurred: M. H. found
only one fatal case in about loO patients affected with the
disease in the village of Wasigny. its termination was fre¬
quently marked by spontaneous hgemorrhages from the nose
or anus, by copious vomiting, by a mucous diarrhoea, and by
sweats possessing an acid odour. It appeared to run into no
local affection of the internal organs.

We have been farther indebted to M. Hennequin F for a
good description of a fever which manifested itself at Leffin-
court, a village in the district of Vouziers, and in the depart¬
ment of the Ardennes. This disease appeared early in June;
and alihough the village contained only two hundred and
eighty inhabitanls, during the first days of that month forty-
six individuals were attacked, and seven fell victims to its
severity. Although the manner of its appearance evinced an

appears to have adopted an opinion similar to that which our readers
may observe to have been stated by ourselves, in the Number of the
IvEPOsiToiiY for May, 1822, at pp. 3/6 and 377-
Journ. Gen. de Med. Decembre, 1822.

t Ibid. p. 352.

48 Historical Sketch of the Progress of Medicine, ^c.

epidemic tendency, still there were circumstances connected
with its progress that might have led some to a belief in its
infectious properties. M. Hennequin, however, who was
commissioned by the Prefect to examine into its nature, has
decided that it was non-contagious, and considered it to have
possessed, for its predisposing causes, the particular circum¬
stances of the individual affected, combined with those deter¬
mining influences exerted by the great heat and moisture of
spring and summer. The principal characteristics of the
fever were those of a gastric and cerebral kind. Vascular
reaction was generally evident and well-marked, and the
animal heat greatly increased : remissions were evident in its
course. In several cases, however, the prostration of the
energies of the system was continued throughout the disease ;
and the vascular action was depressed, or irregularly and
imperfectly developed.

The general view which Professor FoDERk * has taken of
the causes of epidemic diseases, in the published volume of
the work which he is at present preparing on this class of
maladies, and on public health, is one of the most important
accessions which medical science has acquired, and is calcu¬
lated to enlighten both medical men and political economists
as to the origin and progress of this fertile source of human
misery. As we propose to analyze the work, as soon as it is
completed, we will not now take a view of the topics which
are discussed in the first volume.

Having now made as full a reference as our confined
limits will permit to the most interesting facts which have
lately come to our knowledge respecting the exciting causes
of, and the phenomena presented by endemic and epidemic
fevers, we should be more competent to enter on the delinea¬
tion of those opinions which have been advanced respecting
their intimate pathology or nature; because, viewing those
opinions in relation to, and, indeed, on the basis of the
observations regarding fever, which have been made, as we
have just seen, in diflerent climates, different situations, and
in different kinds of that disease, whether sporadic, endemic,
epidemic, or contagious, we have facts before us, whereby to
test their validity, and to lead to their adoption or rejection ;
but, although those inducements are sufficient to entice us
to inquire, after this manner, into the grounds of the opinions
which have been hazarded on the nature of fever, during the
period to which we confine our historical sketch, there are
many circumstances which oblige us to defer the inquiry,

* See Foreign Bibliography, in Repository for March, 1823.

Pathology.

and not the least urgent of these is the intention of entering
on the subject on a more appropriate occasion. It therefore
only remains for us briefly to introduce to the notice of our
readers those productions which have appeared on this topic.

One of the most voluminous writers whom we have to
notice, at this place, is M. Gendrin."^ This Physician has
gone back to many of the doctrines espoused by the older
pathologists, and has referred several of the manifestations of
particular organs, and of the system generally, to something
like a peculiar intelligence which is seated in the textures
and superintends their actions — an intelligent principle which
tends incessantly to restore the equilibrium of the functions.
Such was the opinion of Van-H elmont and Stahl, and of
others from their times, down to that of John Hunter and
his followers, who too frequently resorted to supposititious
intelligences and endowments, in order to explain those
operations of the animal economy which they could not
otherwise understand ; as if the feigning of properties, of
which they had neither knowledge, experience, nor proof,
could in anywise tend to satisfy inquirers, or advance the
state of science as to these matters.

M. Gendrin has divided fevers into two classes- — nervous
and vascular fevers. Under the former class he has arranged
intermittents, slow fevers, and nervous, phrenitic, adynamic,
and ataxic fevers. The latter embraces exanthematous,
inflammatory, hectic, haemorrhagic, bilious, gastric, mucous,
catarrhal, and putrid fevers. In his explanation of the nervous
class of fevers there is much obscurity; and here he has had
recourse to two principles, which he has introduced amongst
those usually attributed to the animal system, namely, spon¬
taneous exhaustion and spontaneous excitement; the altera¬
tion of which forces constitutes, in his opinion, intermittents :
and as he conceives that all the systems and textures of the
body are endowed with these two properties, so he imagines
that the various types that this kind of fever assumes, as w'eli
as those derangements to which particular organs and tissues
are liable, arise from the alteration of this property in such
structures. Thus, he considers that when the derangement
of properties takes place in a more particular manner in the
nervous or in the vascular system, intermittents are accord¬
ingly nervous or inflammatory ; if they act exclusively on one
of these systems, the phenomena are limited in like manner;
if on the excretory system, the intermittent presents a cha¬
racter according to the part of that system which is affected;

* Recherches sur la Nature, et les Causes Prochains de Fi^vres.
Par A. N. Gendrin, D.M. Deux volumes in 8vo. Paris, 1823.
VOL. XX. — NO. 115. H

50 Historical Sketch of the Progress of Medicine y S^c.

and if they be deranged in a single organ, congestions, irri¬
tations, &c. of an intermittent type, are the result. Our
readers may perceive in these principles a modification of the
doctrine of Brown — a dead and mangled member of that
system, without the genius that informed it.

The phenomena of some of the fevers which he attributes
to the vascular system are explained conformably to several
of the opinions entertained by the humoral pathologists. This
is, in some respects, the best part of his book, notwithstand¬
ing the confined views which he has adopted. Upon the
whole, this work has furnished us with a little that is good,
combined with much that is objectionable. It is deficient in
accurate opinions respecting the morbid derangements of
structure that supervene in the progress of disease, and it is
even apparent that he has not that predilection to this branch of
medical science which is requisite to its successful prosecution.

The work of M. Boisseau on the nature of fever ^
is founded on a principle which may be still more directly
imputed to the doctrine of Brown than that espoused by the
foregoing author. M. Boisseau has referred all the vital
properties to excitability, and, like the great originator of that
term, has allow^ed it no other variations than that of quantity.
This restriction was the great fault of that master, and it
appears, at the present day, still more glaring in the pupil.
M. B. has farther considered that the organs are merely more
or less excitable, but that no one is endowed with an excita¬
bility specifically different: he even will not permit this
property to be modified in kind by the causes of disease ; he
can perceive no other change than in degree.

Having thus contended for one vital property only always
identical with itself, he is equally consistent in his pathology,
and consistent, too, with the great pathologist from whom he
has borrowed the physiological basis of his views. He has
conceived that excitability can experience only two species
of change, viz. force and feebleness, irritation and abirritation
— lesions in the degree of excitability, and not in its kind.
Without entering into any criticism of this dogma, we may
remark, that as M. Boisseau has considered excitability as
the product of organization, the lesions of this property are
consistently with his own opinions merely lesions of organi¬
zation : but will it be believed that organization is capable of
two kinds of derangement only ?

M. B. has viewed irritation as presenting four degrees of
intensity; and abirritation, or asthenia, as being that of func¬
tion and of nutrition. Conformably with the physiology

^ See Foreign Bibliography, in Repository for June, 1823.

Pathology, 5 1

which he has adopted, he conceives that if the excitability of
one organ be irritated, thfat of other organs may be corre-
spondently depressed ; hence he imagines that the two oppo¬
site states of disease may exist togetlier in the same body, in
difterent viscera or textures, and succeed each other in the
same organ or part. He considers it impossible that irri¬
tation of the whole system can exist, and, therefore, concludes
that all fevers are local, but that such locality is various, and
is different in different kinds of fever, some consisting in irri¬
tation of the gastro-intestinal surfaces, others of the meninges
and substance of the brain, &c. As he does not allow the
kind of irritation to change under any circumstance, we are
therefore to look to its degree for specific differences; but
here his views are nearly equally confined. The degree of
irritation, which, in his opinion, produces fever, is one grade
less intense than that which constitutes local phlegmasia, and
this grade he considers the same in all fevers.

We cannot state more fully at present the views of M.
Boisseau, nor can we examine their stability; they are chiefly
a selection from former pathologists, and principally from
Brown, Broussais, &c. ; and, undoubtedly, if the selection
had been made in a more extended manner, and if he had
admitted more diversified changes in the vital conditions of
the organs, he might have reared, in this manner, a more
durable edifice; as it is, however, it presents much to admire;
but that admiration is entirely confined to the details of the
structure — to the workmanship bestowed on it: the design
and the materials are both defective.

The work of M. Duges * possesses greater merit, and that
of a different kind from what we have had to regard in the
foregoing authors. It presents more extended views of dis¬
ease than those embraced by M. Boisseau, and although the
illustrations which it contains of the particular species of
fever are less full and complete, still the principles which it
developes are much better founded, and lead to more just and
important conclusions, both in pathology and in therapeutics,
than those presented us in the w'ork of M. Boisseau. Our
limits now prevent us from recording the principles which
M. Duges has adopted. This, however, is of the less import¬
ance, as we intend to present them to our readers on a future
occasion. ' ■ i-

M. Gaultier de Claubry has reasoned with much
ability in favour of the local cause of fever, in a memoir pub-

* Essai Physiologico Pathologique sur la Nature de la Fievre, de
rinflammation, et des Principales Neuroses, &c. Meraoire couronne
par la Faculte de Mfedecine de Paris, 1821. Par Ant. Dug4s, D.M.
Deux volumes in 8vo. Paris, 1823.

52 Historical Sketch of the Progress of Medicine, S^c.

lished ill the work which he edites. * This cause, however,
he is not inclined to limit to one organ, but supposes it to be
different in different fevers and in different epidemics. He
considers the mucous surface of the stomach and intestines,
and the encephalon, to be its more frequent seat.

Our readers will perceive, from these productions which
have come before us during the preceding half-vear, the
laudable attention wdiich the French pathologists have be¬
stowed on the nature of fever. For this they are indebted,
in a great measure, to the writings of Broussais. The sub¬
ject of eruptive fever has been much less investigated by
them within the period referred to. We have, however,
received from them some interesting illustrations of the
appearances exhibited after death in cases of small-pox.
M. Dommanget, the author of an interesting article on
this subject, F found, in several dissections, the membranes of
the brain either inflamed, adhering, injected, or covered by
effusion : the brain either softened, or the vessels of its sub¬
stance injected : the lungs sometimes engorged, and occa¬
sionally hepatized : the pleurag adhering, inflamed, or en¬
closing an albuminous effusion: the internal surface of the
stomach and intestines more or less injected or inflamed, and
the muscular coat contracted. These observations agree
with those which have been made by Mr. Jackson, espe¬
cially as regards the appearances of the encephalon, in the
excellent article on small-pox and chicken-pox, published by
him in this Journal. We refer our readers to that article for
some interesting observations connected with the pathology
of both these disorders. J

Few subjects present greater interest than that which
relates to the comparative liability to disease at particular
periods of life. Connected with this topic, M. Bennoiston
DE Chateau-Neuf has published an interesting memoir,
which has received the approbation of the French Academy of
Sciences, || in which he endeavours to ascertain, from accre¬
dited sources which he has adduced/ whether the mortality of
females is greater at a critical period of their age than at any
other. M, B. has drawn the inference, that, from the 4Jd
degree of latitude to the 60th, in no period of female life
between thirty and sixty-six, has he been able to detect any
material increase of mortality beyond that which necessarily^
arises from increased age.

Between the age of forty and fifty% it would appear that

Journ. Gen. de M^d. Avr. 1823. f Ibid. Feb. 1823.

X Repository for May, 1823.

II Memoire sur la Mortality dcs Femmes de I’Age de quarante k
cinquante Ans. 8voi Paris, 1823.

Pathology. 53

more men die than women ; and during the same period, an
increase of mortality among females may be noticed in large
cities, while it appears even less amongst those who have led
a life of celibacy or of restraint ; but, although the increase
may not be very sensibly observed during this period, many
disorders may then form which produce their fatal conse¬
quences at a subsequent stage of life.

It now only remains for us to record those views which
relate to pathology in a general manner. Some of these
have been noticed in relation to fever, with which they are so
intimately connected.

The very important work of Dr. Pring* falls under con¬
sideration at this place; and although we have entered on an
analysis of it in another part of this Journal, w^e cannot feel
ourselves justified in entirely passing by the profound views
of this pathologist, on an occasion which would require a
more detailed account of them than our limits can permit.

Dr. Pring has very justly stated, that a certain con¬
dition, both of the life of structures, and of its alliances in the
mechanical, chemical, and hydraulic departments, is necessary
to health consequently, a deviation from this condition,
in the agents of either of these departments, may constitute
disease. But, as the properties of these departments are
intimately allied and related with each other, so a distinct or
exclusive modification of either is rarely displayed by symp¬
toms.” Dr. Pring has illustrated this view in a most lucid
and comprehensive manner. The life of a seat,” he has
very justly observed, in the state of disease, is changed;
in conformity with general principles, we may infer that this
change is produced by addition or subtraction of properties,
but we cannot say to what properties the change is to be
imputed, or in what the change consists. It has been at¬
tempted to limit the varieties of the condition of life to those
of degree, but it most commonly happens in disease, that
effects are produced, or symptoms exhibited, which cannot
be accounted for by any variety in the degree or force of
properties of life; on the contrary, such symptoms are gene¬
rally to be explained only by supposing the operation of new
or different properties, or of such as are preternatural, in the
seat of disease, rather than by any variety in the degree of
those which are natural.” Thus it appears, that disease of
the constitution of life ‘‘ consists of a change, the nature of
which cannot be defined, and, consequently, w^e are permitted
to reason upon it with a view of deducing its laws only, from
our experience of its effects or signs.”

See Bibliography, in Repository for May, 1823.

54 Historical Sketch of the Progress of Medicine, S^c,

Dr. Pring has considered that the condition of disease,
which respects the chemical alliances of life, may consist
either of a modification of the nature of chemical constitu¬
tions, which subserve the perfection of a living structure, or
in the formation of new or preternatural products;’’ and that
as the slate of health is maintained by the concurrence of a
precise chemical constitution, so one part of disease may be
a deviation from this precise state.

The condition of the disease,” he has gone on to state,

with respect to the textures, may be said to consist in a
modification of the natural organization which subserves
the purposes of life and health, or in the destruction of the
natural fabric, or in the formation of preternatural growths.
As the textures are governed by the life which is allied with
them, so their changes are secondary, and in the phenomena
w'liich they produce, in relation with life, they have only the
force of reagents.

‘‘ The condition of disease, in the hydraulic department, is
liable to varieties only of quantity and place: these varieties
may respect blood or the secerned fluids. There is excess of
fluids in those which are called the seats of determination,
and privation of them probably, in certain cases of paralysis;
and also in seats which suffer diminution of blood from their
relation with a seat of preternatural derivation of this fluid ;
as, perhaps, in the uterus, in consequence of the derivation
of blood to the head or chest, accompanying hysteria or
haemoptysis; in the feet, in ahnost every affection of the
head,” &c.

Having first illustrated these positions which relate to the
condition of disease. Dr. Pring has successively applied his
analysis in the most interesting and satisfactory manlier;
2dly, to the relation of agents which constitute its condition ;
3dly, to the relations of disease as a cause of more extensive
or of different diseases; 4thly, to the laws of its continuance
and varieties ; and, othly, to those of recovery or of death.

On the second of those inquiries he has remarked, that
‘"it very rarely happens that change in the condition of the
life of seats is not accompanied by a change in its material
alliance, which latter helps to constitute the condition of
disease. Among the most frequent deviations from the
natural mechanical state is that of increased vascular fulness.
In every state of disease, even if there should be no signs of
change in the material department, the concurrence of the
organization is necessary to its existence as it is to life itself.
Without deviation, then, from a healthy constitution, the
mechanical and hydraulic departments subserve the establish¬
ment and maintenance of disease : but if signs of disease are

Pathology, 65

also exhibited in these departments, one of two results may
be remarked; either, 1st, the phenomena of disease are
merel}^ multiplied by the influence of a changed condition of
the properties of life on their material alliances; or, ^d, the
phenomena of disease are multiplied, or its condition altered,
by the reaction of the effect produced on the organization by
the influence of a primary change in the condition of life.
We shall have occasion to notice that this reaction is almost
universal in disease, although it may not be attended by
disorganization.’^

With respect to the third subject of analysis. Dr. Pring,
after having considered the relations of disease as a cause of
farther disease, first, with reference to the properties of the
department in which it originates, has next viewed these
primary changes with regard to their vital and material con¬
nexions and agencies in the production of consecutive disease,
which consecutive derangement may in its turn influence the
primar}^ disease, and become a reagent of great power. We
cannot at present state the comprehensive analysis he has laid
down of the Various relations and reciprocal dependencies
subsisting between these properties of parts, nor can we
sketch the illustrations he has given of the circumstances
producing and influencing the continuance of disease, or of
those causing recovery or death; those particulars, and the
details connected with the foregoing principles, will be
brought before our readers on a future occasion.

We cannot, however, pass on without recording some of
Dr. Pring’s fundamental principles, illustrative of his opinions
respecting the continuance of disease. — Having laid it down
as a physiological principle, supported by the evidence fur¬
nished by the operations of the animal economy, that there
is no fixed or permanent sum of life, but that this principle is
perpetually dying or changing its form ; that each quantum
renews itself by the assimilation of its identity from blood,
or of a material which contains its elements, and then passes
away, and is succeeded by a new quantum of a similar prin¬
ciple, produced by itself from a material by the separation
and the union of its elements* — that “ life is, renews itself,
and dies,” Dr. Pring considers, conformably to this doctrine,
that if the natural state of life has undergone the change
in which disease consists, this change is only a modification

* Our readers will be so good us to recollect that we are stating
the views of this eminent pathologist as matters of history. They
will find the above particular tenet the subject of criticism when this
part of the work shall come under review. — J. C.

o6 Ili§t07'ical Sketch of the Pfogress of Medicine, S^c,

oF a principle, which is perpetuated by successive renova¬
tions. As the properties which constitute the change are
united wdth or make a part of this principle, the conditions
of the continuance of disease are either : first, that the state
of life under such change should be one capable of assimi¬
lation, by which the properties of disease, in common with
those others which belong to the natural state of life, are
produced or renewed from blood ; or, second, that the pro¬
perties of disease should be constantly supplied from a source
which is independent of a process of assimilation/’

Dr. Pring has given very particular and most satisfactory
illustrations of the agencies of the circulation in continuing
and extending disease. ‘‘ As primary disease,” he has ob¬
served, is a modified state of life, and as every state of this
principle is renewed from blood, so the supply of blood to
a seat of disease is necessary to its existence and conti¬
nuance. In this point of view', blood concurs only with the
structures to maintain properties of life, to w'hich these alli¬
ances are essential.

' The connexion, then, of disease With blood, and its de¬
pendences on this fluid, may be thus enumerated: — 1. Life
is maintained by assimilation from blood. — 2. Life is related
with the distribution of blood, and in its natural state pro¬
duces a natural circulation; or, under the modification of
disease, an increased, and probably sometimes a diminished
derivation of this fluid to its seat. — 31 Primary disease,
W'hich belongs to the department of life, and assimilates, is
maintained by the concurrence of blood, which furnishes the
material of its renovation. — 4. The increased derivation of
blood depends, both in its degree and its continuance, upon
the condition of life. — 5. The dependance of the conti¬
nuance of a disposition of life is upon assimilation.

6. A preternatural state of local circulation may have,
with life, the relation of a cause; and the influence of this
relation may be: first, to modify directly the condition of life,
and consequently its phenomena; second, to influence the
assimilation of life, and consequently the duration of disease,
if the change produced on life by an influence from the cir¬
culation is one which is capable of being in this way main¬
tained ; third, direct changes in the state of the structures
may be produced by a change of the local circulation, which
becomes thus mediately connected with subsequent pheno¬
mena, which are, according to the relation between life and
the changes in the condition of the structures.

7- These relations between the parts of the constitution
of disease obtain also in disease of primary and secondary

Tathology. 57

seats; and the modes of influence between such seats is only
a repetition of the order and dependence exemplified by the
constituents of disease in one seat.

: 8. As blood maintains disease by its concurrence, and

I as it is related with the state of disease in the department of
life also by aflfection, or is capable of influencing its con¬
dition ; so the state of disease, whether wdth respect to the
phenomena of affection or of assimilation, may be influenced
by means whose direct agency is upon the circulation.

9* It is also a common effect of local disease to extend
its influence directly by continuity of organic life, or through
the medium of the nerves, w'ith or without the participation
of their centres, to the heart, by which this organ is made to
concur in the supply of a preternatural quantity of blood to a
seat of disease: and in this point of view, the action of the
heart becomes very generally at otice an indication of the
degree and importance of local disease or irritation, and is
also auxiliary to the power of derivation in the seat of
disease, the energy of which is increased; and thus the
action of the heart concurs in all the relations, both me¬
chanical and vital, with the derivation of blood, and sub¬
serves to the increase, continuance, or modification of dis-
ease.^^

Dr. Pring has summed up his general principles of pa¬
thology in the following comprehensive paragraph: — ** It
appears from this view that primary disease consists of a
change in the condition of life; that secondary related dis¬
ease is an effect of this change ; that the continuance of
secondary disease is dependent upon the state which is assi¬
milated in the department of life; that in the reagency of
secondary disease, this state has the operation of a cause
which is related with primary disease, or may produce other
effects, in relation with the organization ; that the relation of
secondary disease, as a cause with primary disease, is to
modify its state, and consequently its phenomena ; that the
results of such modification of its state may be an affection
of life, while its assimilation is unchanged; or an affection of
life, which disposes it for the assimilation of another state : in
the former case, the same phenomena of disease are con¬
tinued, unless changes differently related are induced on the
structures; in the latter case, the assimilating state may be
changed by the influence of secondary disease, and the
results of this change may be progressive disease, or a suc¬
cession of assimilating states ; or the series may end in an
assimilating state, producing other phenomena of disease;
or it may terminate in death, or recovery. These events
depend upon relations between properties which are only

VOL. XX. — NO. 115. 1

58 Historical Sketch of the Progress of Medicine, S^c.

inferred ; and the events can only be anticipated, and that
without certainty, by an experience of their connexion with
the circumstances of the relation, which circumstances are
denoted by signs, or symptoms/’

Few works are better calculated to promote pathology
than those which contain a well digested, faithful, and
minute account of the progress, termination, and appearances
of individual cases of disease ; whether w e view’ those works
as furnishing materials whence w'e may deduce important
principles in pathology and therapeutics, or as tests by which
w^e may ascertain the validity of the doctrines more generally
adopted. It is chiefly on this account that the wmrks of Bonet,
Morgagni, Lieutaud, Bang, Stoll, Reill, the Franks,
Prost, Pin el, and several others, are esteemed. Within
the period embraced by this essay, the Parisian school has
furnished us with a work of this description, the materials
of which have been collected by M. Tacheron, with con¬
siderable care, from the records of the ditferent Parisian
hospitals. The very numerous observations which it con¬
tains, and their unquestionable authenticity and accuracy,
render it a production of great merit, as a work of reference.
Viewing it in this light, we have placed it on the same
shelf with the above-mentioned authors. *

The article enUt\ed deviation organique, by M. Breschet,T
will be read wdth interest, on account of the general views
entertained by the author respecting those derangements of
structure to which the foetus is liable in the womb.

Therapeutics. — Commencing, in conformity wdth our
arrangement, an account of the additional views entertained
respecting the treatment of disease with those which regard
the nervous system, the case of epilepsy connected wdth para¬
lysis, recorded by Dr. H. W. Carter, J deserves particular
notice. In this instance, the important therapeutical inten¬
tion of arresting an internal irritation by means of a pustular
eruption on the surface, was undertaken with advantage. —
The case of paralysis published by M. Nilo, || which was
successfully treated with nux vomica, furnishes a proof of
the propriety of employing active stimulants under certain

* Recherches Anatomico-Pathologiques sur la Medecine Pratique,
faites a I’Hospice Clinique Interne de la Faculte de Medecine de
Paris et dans les autres Hopitaux. Trois volumes in Svo. Paris,
1823.

t Dictionnaire de Mddecine, par MM. Adelon, Bedard, Biett, &c.
Vol. VI. p. 32b.

X Medical Repository for May, 1823.

II Joum. G4n. de Med. Novembre, 1822.

The^'apeutics.

circumstances of this disease, and of the efficacy of this
remedy when judiciously employed. — The propriety of em¬
ploying tonic remedies, conjbined with narcotics and seda¬
tives, in many cases of mental derangement, but too fre¬
quently treated on an opposite system, has been contended
for, as our readers are aware, by Dr. Willis. In that
species of derangement denominated by this writer the high
state with fever, the exhibition of small doses of the anti-
monium tartarizatnm, repeated frequently, and combined wdth
such narcotics as circumstances may indicate, is, according to
our observation, one of the best modes of practice that can
be adopted. The combination of these remedies with tonics
and aperients, according to the state of the patient, is also
frequently necessary in the state of high mental derange¬
ment to which Dr. Willis has particularly drawn attention,
especially under those circumstances to which we have
referred, when treating of the additions made to our know¬
ledge of the pathology of the brain. — The very instruc¬
tive case of mania recorded by Mr. P. C. Blackett,* in
which the treatment just mentioned was employed, fully
confirms those therapeutical views.

The discharge of serous infiltrations of the cellular texture
by external means is frequently a matter both of difficulty
and danger. We have, however, been indebted to Dr.
Sutton and Mr. Finch f for employing a method to which
neither of these exceptions can be taken, and which appears
to us to be a valuable addition to the means of cure usually
resorted to in derangements of this description. The method
to which we allude is the employment of acupuncturation
in removing serous accumulations in cellular structures.
This means may be adopted with advantage under circum¬
stances that might render the punctures by a lancet unavail¬
ing and dangerous, as the instructive case alluded to demon¬
strates ; and if we may be permitted to give an opinion on
the merits of this practice, as a matter of speculation, we
should be induced to conclude that it fully deserves to be
generally adopted, and to be extended to the treatment of
other disorders, in which it has not hitherto been employed.

The propriety of treating the more violent and more per¬
manent spasmodic affections of the muscular system by the
exhibition of the oil of turpentine, has been demonstrated by
the observations of Mr. B. Hutchinson and Mr. Toms.J
The cases which occurred in the practice of both these gen-

* Repository for June, 1823. t Ibid, for March, 1823.

X Medical and Physical Journal for Feb, and May, 1823.

6o Historical Sketch of the Progress of Medicine, S^c.

tlemen presented nearly similar characters, and very much
resembled tetanus. The disease disappeared in both in¬
stances after the exhibition of three or four doses of this
remedy, consisting of half an ounce in each dose, which was
given every two or three hours.

The advantages of treating derangements of the secerning
functions of glandular textures with large doses of tartarized
antimony have been satisfactorily shown by Dr. Fonta-
NEiLLEs.* The services that may be obtained from this
excellent remedy in disorders of the hepatic function, either
when given alone, or combined with other medicines of
an aperient, sudorific, antispasmodic, or tonic nature, have
been long and generally acknowledged. The chief circum¬
stance worthy of record in the practice of Dr. Fontaneilles, is
the exhibition of this remedy in large doses in cases of
icterus ; its employment in smaller quantities, combined with
aperients and deobstruents, has always been adopted in this
disease by judicious Practitioners since the introduction of
antimony into medical practice.

The removal of those glandular disorders that depend more
upon alteration of structure than of function, and which
►appear to consist of a changed condition of the assimilating
process going on in the capillaries of the part, has been
ranked amongst the acknowledged difficulties of our Profes¬
sion until very recent times. Some forcible evidence has
been adduced, in several of the former Numbers of this
Journal, in favour of the beneficial results of the preparations
of iodine, when employed either internally or externally in
the treatment of disorders of this nature. The employment
of these remedies in scrofulous derangements has been lately
adopted both in this country and on the continent. The
work of Dr. Baron, already referred to, has furnished some
excellent information respecting the use of this substance
with reference to the disorders more immediatelv under con-
sideration;F and Mr. J. B. Austin has published an inte¬
resting proof of the superior efficacy of this remedy to burnt
sponge in the treatment of bronchocele. J

Diseases of the mucous surfaces, from the frequency with
which they are presented to our notice, should always claim
attention, not only with respect to their pathology, but as to
the most efficacious means of removing them, without expe¬
riencing the risk of some other more serious derangement
supervening in their stead. Some interesting facts have

* Rev. Med. for Mars, 1823.

t Repository for March, 1823.

I Medical and Physical Journal, No, 284.

Therapeutics^ .61

come to our knowledge respecting the treatment of inflam¬
mation of the mucous surface of the digestive canal. A very
important communication relative to this subject, for which
the Profession is indebted to Dr. Whitlock Nicholl, *
has illustrated, in a very satisfactory manner, the beneficial
effects of the oleum terebinthinae in certain morbid states of
this surface ; and has corroborated the testimony we gave, on
another occasion, of the efficacy of this substance both in
diarrhoea and in chronic dysenteric affections. -t In a case of
dysentery supervening to strangulated hernia, recorded by
Mr. Robinson, J the same remedy was resorted to with
immediate advantage, at a time when the energies of the
system were greatly exhausted.

Some observations on “ diseased states of the mucous
membrane of the stomach and bowels” have been made by
Mr. Waller; II and nine cases, illustrative of the efficacy of
the soda lartarizata and potassse sulphas in the removal of
these derangements, have been adduced by him. Of the just¬
ness of these observations, we are fully convinced from ex¬
perience ; indeed, the use of both these substances in inflam¬
matory affections of this membrane must be familiar to many
Practitioners, although others may not employ them so fre¬
quently as other means. §

Proceeding next to notice the additions which have been

^ Repository for May, 1823.

f “ In the chronic diarrhea of children, in which there is every
reason to suspect slow inflammatory action to exist in the mucous
coat of the intestines, and in the follicular glands in that situation,
few remedies (if it is suitably combined, and given after a properly
digested plan, according to the circumstances of the case,) are likely
to be of more permanent service.

“ The plan I have generally pursued in those cases, has been to
prescribe a powder to be taken at bed-time, composed of the hydrarg.
subrnur. — pulv. ipecac, comp. — pulv. rhei, or the pulv. tragacanth.
comp, in proportions according to the circumstances and age of the
child; and a draught, in the morning, of the oleum terebinthinee en¬
veloped in mucilage, with the requisite corrigents. A medium dose
in this affection has been the quantity usually prescribed.'’ See also
our observations, at the same place, on the use of this remedy in
chronic dysentery. — Memoir on the Use of Terebinthinous Remedies
in Disease. Med. and Phys. Journ. for August, 1821.

I Repository for April, 1823.

II Medical and Physical Journal for February, 1823.

§ The late Dr. Saunders was very partial to the use of the
sulphate of potash in disorders of the mucous surface of the digestive
canal, from a well founded acquaintance with its efficacy in such
cases.

62 Historical Sketch of the Progress of Medicine, S^c.

made to our views respecting the treatment of disorders of
particular fu7ictions, those of the digestive organs first claim
our attention. Considering diabetes as a disease chiefly of
this function, in conformity with the pathology already stated,
the interesting instance of this disease, recorded by Dr.
Heineken, of Madeira,"^" deserves particular mention at this
place. The very judicious indications of cure which this case
exemplifies, and the very decided and efficacious means em¬
ployed to fulfil these indications, will be consulted with ad¬
vantage by all who desire to obtain satisfactory information
with respect to this obscure and difficult disease. — The case
of diabetes published by Dr. Neuman, of Berlin, T which
supervened, as it not unfrequently does, to dropsy, was suc¬
cessfully treated by large doses of the carbonate of ammonia,
a remedy wtiich has been frequently employed in this country,
in combination with opium, although not to so great an
extent as it was by this Physician, in the case referred to.

Few derangements are of more frequent occurrence, or
deserve greater attention, than those which occasion, or
which result from, the generation of intestinal worms. This
subject has received a very interesting elucidation within the
period embraced by this essay, especially as regards the ex¬
pulsion of these animals from the body. The memoir of
Dr. Kennedy, J to whom we are indebted for this accession
to our information, will be perused with advantage by all
who wish to obtain the requisite information respecting the
treatment of verminous diseases. Nor is the importance of
Dr. Kennedy’s communication limited to an illustration of
the efficacy of tlie therapeutical agent which he employed: it
contains pathological views of importance, as well as some
interesting information regarding a species of vesicular worms,
which is but seldom the object of observation.

The treatment of obstinate constipation of the bowels has
been promoted by the case recorded by Mr. Dendy, || in
which the oil of croton tiglium proved immediately successful
after every other remedy had failed. This case is also
valuable, inasmuch as it shows that this remedy may be
’employed without risk, even when symptoms indicate consi¬
derable fever, and inflammatory action in the bowels.

Referring next to the practical views connected w'ith dysen¬
tery, the employment of the acetate of lead in that disease
has been lately a subject of attention with American Practi-

^ Repository for April, 1823.

t Hufelaiid’s Journal for 1823, and Repository for June, 1823.
X See Repository for February, 1823.

II Ibid, for April, 1823.

Therapeutics.

tioners. Some of them laud its efficacy, while others con¬
demn its use as not only inefficacious, but even hurtful. Dr.
R. Harlan,* of Philadelphia, has published seven cases of
dysentery which were successfully treated with this substance
in combination with opium; and an anonymous writer con¬
firms the same views. Idie doses of these remedies, and the
frequency of their exhibition, were modified according to the
circumstances of the case. It ought, however, to be re¬
marked that this is by no means a novel practice ; Dr.
Jackson, to whom medical science has been so greatly
indebted, and Dr. Mosely, have both employed the sugar of
lead in acute and chronic dysentery in the West Indies.
The Editors of the American Medical Recorder remark,
respecting the use of this preparation, that in one case out
of four or five in which they employed it, its effects were
unequivocally injurious: in that case the discharges were
speedily checked ; but the patient was incessantly tor¬
mented by a painful pressing down of the bowels,^’ and much
general distress. Professor Wendt, of Copenhagen, has
stated that he has found a decoction of the triumfelta
semitriloba of eminent service in this disease. It has been
long in use as a domestic remedy in the West Indies.

The diseases of the respiratory organs have lately received
considerable attention, with respect to their treatment. The
work of Sir Alexander Crichton, to which we have
before referred, will be consulted wdth advantage on several
disorders of these viscera; and the illustrations of tuber¬
culous diseases by Dr. Baron will furnish some interesting
information respecting the employment of the preparations
of iodine in derangements of this nature, seated in the lungs
or investing membranes.

The article on hooping-cough, by Dr. Guersent, in the
dictionary of medicine now publishing at Paris, J has fur¬
nished us with a full and satisfactory exposition of the patho-
logy and treatment of this disease. I’he therapeutical indi¬
cations and the remedial means in this disease have been
pointed out by this Physician wfith more discrimination thafi
in any other work which has come under our observation.

The very important case of empy^ema, with the -interesting
remarks respecting it, which was laid before our readers by Mr.
Betty,|| and which was so ably and successfully treated by
this judicious Practitioner, cannot fail of exciting the atten-

* American Medical Recorder, No. 20.

t Nye Hygea, Januar. 1823.

X Dictionnaire de Medecine, Vol. VI.

II Repository for March, 3 823.

64 Historical Sketch of the Progress of Medicine , 4c.

tion of the Profession to this species of lesion. A somewhat
similar instance of successful treatment in this almost hope¬
less derangement, has been published by M. Larrey,* and
exhibited by him with all that bustle and pretension which
mark the conduct of this bold and decided Surgeon, and
which arise more from a laudable zeal in his Profession,
joined with a want of tact in guiding his enthusiasm, than
Irom any sinister or selfish motive.

The case of cynanche laryngea recorded by Mr. Gaits-
KELL, t has furnished a useful instance of the efficacy of a
judiciously directed treatment in removing this dangerous
disorder. — The case, also, of pulmonary consumption, by
the same gentleman, has illustrated the propriety of pro¬
ducing artificial eruptions in the treatment of this malady. —
A communication, by Dr. John F]ume,J has conveyed
some important remarks in support of the tonic treatment of
phthisis pulmonalis, a method of cure long since recom¬
mended by Salvador!, May, Pears, and Murray; and even
as early as the times of Caelius Aurelianus. Dr. Hume,
however, has not, contended for the employment of the tonic
plan under all circumstances of the disease. i

“ Of all the modes, he has observed, of treating
phthisis, either incipient or confirmed, the tonic appears to
be decidedly the best. But to be successful, this treatment
must be commenced at a very early period. Then, pro¬
vided there are no inflammatory symptoms, frictions with
cold vinegar and water, twice a day, on the breast or the
whole body, till the skin is quite dry ; exercise in the open
air, on horse-back, in a carriage, on foot, or in a swung,
according to circumstances; nourishing, but plain food,
taken at such intervals as not to load the stomach, with the
occasional use of steel and bitters ; are the most proper
remedies. Pain in any part may be removed by the appli¬
cation of leeches, aromatic embrocations, blisters, or the
tartar emetic ointment.’^

No actual addition has been made to our therapeutical
views, in relation to the diseases of the urinary organs^ within
the period to which we confine this sketch ; for, although
we have had two works on these derangements, which have
been placed fully before our readers, they chiefly convey
useful illustrations of acknowledged principles of practice,
and of ascertained means of cure. — Under the head of the
generative organs we have only to notice a species of

* Revue Medicale, Mai, 1823.
t Repository for April and June, 1823.

J Quart. Journ. of For. Med. for Jan. 1822.

Therapeutics. 65

intermittent menorrhagia, which was successfully treated by
means of bark, by M. Deslandes.*

We now arrive at the last division of this subject, namely,
to record the observations which may be considered as addi¬
tions to our therapeutical views respecting those derangements
which influence the system in a general manner. Here we
find but little to arrest our attention. The treatment of
fevers contended for by the authors whose works have been
already alluded to, has been, in most instances, a judicious
application of well-known principles and remedies. The
works of MM. Boisseau and Hugies contain a most satisfac¬
tory exposition of the therapeutical intentions and means
which ought to be employed in the different species of fever:
indeed we know no works that can be consulted with greater
advantage on these topics than these, more particularly that
by the former author. — The different memoirs, whose
history we sketched under the head of Pathology, furnish
useful illustrations of the treatment of the particular endemic
and epidemic forms of this disease to which they relate. —
The account given by Mr. Jones of the yellow fever w^hich
appeared in an epidemic form in the island of Bermuda,f
while it shows the local origin of the disease, evinces the
propriety and success of a depletory plan of treatment in its
cure, which, although it was generally, appears not to
have been indiscriminately used. The treatment employed
in the fever lately prevalent at Nevvcastle, as described in
Mr. H. Edmonston’s paper relative to the subject, was

gently antiphlogistic, chiefly consisting of local blood¬
letting, purgatives, diaphoretics,^’ &c.

A memoir on the scarlet fever, which occurred in an epi¬
demic form in 1819;» at Beauvoir-sur-Mer, J by M. Ollivier-
Mairy, of Nantes, has evinced the propriety of attending to a
well established principle in the treatment of some forms of this
disease, which was very nearly overturned, for a time, in this
country, by the phlogistic diathesis so lately prevalent, in a
too general manner, amongst Practitioners. The principle
to which we allude is the treatment of those varieties of
scarlatina which present great depression of the vital energies
of the system, by tonics, astringents, stimulants, &c. M. O.
has also shown the propriety of employing evacuations in
those serous effusions which supervene to this disease. (j

* Journal Gen. de Med. Mars 1823.
t Repository for March, 1823.

X Nouveau Journ. de Med, Dec. 1823.

11 Evacuations to a greater or less extent are requisite in dropsies
occurring under these circumstances, whether the previous disease
VOL. XX. - NO. 115. K

_ 'i

Analytical Review,

The only general system of therapeutics which has come
before us within the by-gone half-year, is the very important
sketch which has been given by Dr. Pring. This author
has analyzed the generally received views on this subject, and
has stated his own — 1st, as they regard the speculative doc¬
trines of therapeutics ; 2d, as they respect the practical prin¬
ciples of this science. He has very justly remarked, in rela¬
tion to the former of these topics, that whatever doctrine of
disease has prevailed, the same remedies have been resorted
to : the means were the same ; the explanation connected
with them only different.” The speculative explanations con¬
nected with them, as well as the applications to practice of
the view's and principles which this eminent writer either
examines or advances, cannot be sketched within the limits
of an historical essay. They will be made the subjects of
analysis on a future occasion.*

J. C.

Jernayn Street, St. James’s, 26th June, 1823.

PART IT

ANALYTICAL REVIEW.

An Exposition of the Principles of Pathology, and of the Treat-
. merit of Diseases. By Daniel Pring, M.D. Member of
the Royal College of Surgeons. 8vo. Pp. 5 12. London,

This is a work calculated to introduce an important
reform into the medical literature of the age. Its author,

has been inflammatory or the contrary : for when the exhaustion has
been extreme, the loss of vital energies has been chiefly expressed,
owing to the eruptive nature of the disease, on the extreme capillary
vessels, which frequently do not acquire their tone before the in¬
creased action and energy of the heart and large vessels impel the
blood with a greater impulse than their ^xhalants and the tonicity of
their extremities can withstand. Hence the frequency of these eftu-
sions after a too stimulating treatment, and want of attention to the
natural evacuations, during recovery from scarlatina. — J. C.

* The historical view of the remaining branches of medical science
will be given in our next Number.

Dr. Pring’s Principles of Pathology and Therapeutics. 67

while lie appreciates fairly the value of correct investigations,
and intimate and profound views in pathology, exposes ably
and energetically the fundamental tenets of the existing
systems of medicine: and while he examines the principles
of our science, with great candour and judgment, and with
great force of reasoning and happy methods of illustration,
he separates, with acute powers of discrimination, the
valuable results of observation and experience, from the
numerous assumptions and conjectures which have often
served as the basis of vague hypothesis and speculation.
The very extended and comprehensive views, also, which
the author takes of the causes, relations, and phenomena of
disease, place liis ow'n conclusions on a firmer basis than that
possessed by any pathologist who has preceded him, in
advancing general principles of the nature and treatment of
disease. VVithout offering any preliminary observations, we
shall proceed to analyze his interesting production.

The work is divided into ten chapters : the 1st is an
examination of the humoral pathology; the £d of the doc-
trine of spasm; 3d, of the doctrine of Brown; 4th, of the
pathology of the determination of blood; oth, of the origin of
disease in the ahdommal viscera; 6th, of the origin of disease in
the nerves; 7th, of the relations of disease ; 8th, general prin¬
ciples of pathology ; 9th, speculative doctrines of therapeutics ;
10th, practical principles of therapeutics. Six of these chapters
are entirely critical ; but while the author examines, in a
profound manner, the principles which characterize the par¬
ticular systems which these chapters embrace, he discloses
views which are more fully developed in the subsequent parts
of the work. It will readily be seen that it will be out
of our power to analyze, in a suitable manner, and within
our limits, those parts of the volume which are themselves
essentially a review' : we shall only endeavour to convey an
idea of the manner in which Dr. Pring has executed this
part of his undertaking; nor shall we regret the way — so
unsatisfactory to ourselves — in which we are obliged to
perform our office; since we are confident that to all those
who esteem profound views in pathology, and a critical
deduction of sound principles, by which they may guide
their speculations and practice, an extended analysis of this
work will be almost superfluous, as they will be contented
only with a repeated perusal of the work itself; while to
those, if there be any such at the present day, who value
only empirical precepts in medical practice, and who con¬
temn pathological principles — the pliilosophy of our Pro¬
fession — any review of a book like the present will be
unacceptable.

68 Analytical Review.

Chapter I. Humoral pathology . — Dr. Pring justly remarks,
that although the humoral pathology has now given place
to other doctrines, yet the evidences in favour of it are quite
as conclusive as those for some of the opinions by which it
has been superseded ; yet, although it is not held,’^ he
observes, “ in much reverence by pathologists, it is still the
popular one : it appears more level to general apprehension
than any other ; and it is by no means uncommon for those
of the Profession to avail themselves of this popular appre¬
hension, and to account for many circumstances, which they
are called upon to explain, upon false or absurd principles,
rather than to risk the suspicion of not being able to explain
them at all. Thus they oftentimes gain credit for superior
knowledge : and those who can condescend to accept repu¬
tation upon such terms are seldom deficient in the informa¬
tion, that an appeal to the fallacies and prejudices of human
nature is generally more successful than an address to its
better understanding.”

After noticing the causation contended for bv the humoral
pathologists, and after pointing out their errors in regarding
matter as originating disease, and in resorting to mechanism
for the explanation of the animal phenomena. Dr, P. remarks,
that analysis has taught us to look to another set of powers,
— has taught us to regard these morbific matters not as the
causes, but as the effects or products of disease. ‘‘ In all
instances in which the order of occurrence is perceptible in
the generation of the morbid poisons, the disease precedes
the formation of the matter: thus the immense pustular
eruption in small-pox is the consequence of the fever inci¬
dent to this disease; and thus irritation, in all other instances,
precedes, and does not follow, the purulent or lyrnphatic
secretions.” This is unquestionably just both as it respects
the generation of morbid poisons strictly so called, and of
several other secretions. The change is first produced on
the vital properties of a part, or of the system generally,
before the morbific matter is formed ; and then such matter
is not formed in the mass of blood, hot from the blood, by
the previous change induced in the vital properties possessed
by the capillary vessels or texture of the part whence the
morbid matter is produced. Yet, although this appears to
be the succession of phenomena which an intimate view of
the matter w’ould lead us to adopt, there are other circum¬
stances of disease in which the causation is not so apparent,
and some in which the mass of fluids seems to be more
intimately and immediately concerned: but even in the ma¬
jority of these a strict analysis will convey us to a previous
cause ; and we shall frequently discover some defect in the

Dr. Pring’s Principles of Pathology and Therapeutics^ 69

vital functions or properties of an important organ or viscus.
Thus, as we have stated on a former occasion, the nature of a
climate or the state of the atmosphere shall impede or
diminish the functions of an important organ employed in
producing certain changes on the blood, or in eliminating
from it certain of its .elements, or the effete matters which it
may contain. The consequence is an excess of these ele¬
ments or materials, which, if not removed by the vicarious
office of another viscus, wdll be the cause of either a general
or local disease. In such cases, although previous disorder
may be inferred, but little sensible derangement can be
noticed until the circulating mass of fluids has become
changed in such a manner as to disorder the healthy rela¬
tions of the system. This point could be farther illustrated
by proofs derived from a strict investigation of those maladies
which result from the presence of a noxious cause inhaled
into the lungs, or received into the digestive canal, &c. We
believe, however, that a strict examination of the causation,
in these cases, will also furnish us with evidence equally
favourable to the opinion, that a portion, if not the whole^
of the noxious cause has been received into the circulation,
deteriorating or changing the vital properties of the system
by its presence there, as that which can be brought in
support of the opinion that the morbid impression has only
been made upon the vital relations of the part to which it
was immediately" applied, without at all affecting, ip a pri¬
mary manner, the state of the blood, or acting by its pre¬
sence within the blood-vessels. If vre were required to state
our belief upon this important and fundamental subject, we
might, from some attention long paid to the subject,^ illus¬
trate fully what we shall beg leave to say briefly, that such
causes appear to act in both these modes, in many instances,
and more or less in either, in other cases : that while some
of them, owing either to their own properties or to the state
of the recipient, affect the vital relations of the parts which
they invade, or which are most sensible to their impressions,
externally to the blood-vessels — - without being absorbed,
others are received into the circulation, are carried along
with it throughout the textures, and, from their presence
within the vessels, produce their effects on the system : and
that many of them seem to act in both the modes pointed
out; the one mode preponderating to a greater or less extent,
according to the nature, relations, and combinations of the
cause, and circumstances of those on whom it acts. — But to

* See a Letter to Dr. Hutchinson in Vol. XLIV. of the Medical
and Physical Journal.

70 Analytical Heviezt!.

return to our author, from whom our partialities to hu--
moralism could alone have drawn us —

Dr, Pring next discusses the properties of those morbid
poisons which affect the animal economy in a specific
manner; and considers that they have certain vital properties
or relations bestowed on them, at the period of their forma¬
tion, which are calculated to influence the system in such a
manner as to occasion the formation of a substance — a
matter — or morbid poison, similarly constituted to that
which produced it : but we will allow the author to speak
for himself on this interesting subject, and to state the lengths
to which he carries his opinions.

“ It is more agreeable with the results of analytical inquiry to
conclude, that the animal poisons contain latent properties of a vital
kind, which are related to those of the same kind in living bodies ;
that the phenomena of disease or death, which ensue from the opera¬
tion of the animal poisons on living bodies, are according to the
nature of the properties which are engaged in this relation. It seems
proper, in all questions which respect the nature of the properties to
which animal processes are to be assigned, to consider those agents as
belonging to the department of life whose operation cannot be ex¬
plained by any perceptible analogy to the agency of chemistry or of
mechanism.” “ It appears, then, that certain animal fluids are
endowed with the qualities of poisons, by latent vital properties which
are allied with the fluid material. This affinity between these subtile
properties and the grosser fluid prevents the dissipation of the former,
and preserves also the characteristics of the latter; it serves at once
to limit and to extend the relations of the poisonous qualities : by it
these qualities have a fixed place ; and by the medium with which
they inhere, they are capable of mingling with the fluids of animal
bodies, and of being, in this way, conveyed into the circulation. It
appears probable, that by the existence or absence of this affinity
between the active properties of the animal poisons and a fluid
medium, the distinction may be furnished between the contagious and
infectious diseases. According to the entire absence or the degree of
this affinity, we should find some diseases which are wholly infec¬
tious, others which are both infectious and contagious, and others
which are only contagious.” — Pp. 10, 11.

This is an ingenious explanation of a difficult subject;
and, although many powerful objections may be urged against
itj yet we think no better mode of accounting for the per¬
petuation of contagious disorders has been proposed, — and,
indeed, none so good. The concluding sentence of the quota¬
tion would have been more perspicuous, if the author had
informed us as to the exact meaning he attaches to the words
contagion and infection.

The next topic of importance which the author examines is
the opinion respecting an error loci. This term, and the

Dr. Pring’s Principles of Pathology and Therapeutics. 71

meanings attached to it, are noticed and compared with the
more usual terms at the present day, viz. congestion and
obstruction. With respect to the imputed obstruction of
secreting organs, the liver furnishes him with an appropriate
subject of examination, and, indeed, of illustration: and here
he justly observes, that allowing “ the secerning system of
the liver to be obstructed by the fluid which it separates, and
which is still contained in lubes subject to the impulse of the
circulation, the secretion has then only the force of a reagent
in disease, the primary cause of which is a disordered stale of
those powers of life which the separation of bile from
blood is accomplished.’’ This is exactly what we should
conceive; but we will even go farther than our author, and
contend, even if the flow of blood in the vessels be impeded
or obstructed, that this state of the blood, as w’ell as a similar
obstruction of the bile contained in the secerning system,
(which, however, we believe to be, in that situation, beyond
the impulse of the circulation,) are the result of the same
cause, namely, of those vital properties with which the vessels
of this organ are endowed ; because we conceive that the
circulation of the blood in the portal vessels of the liver, the
secretions from these vessels, the condition of these secre¬
tions, and the flow of the secreted fluid along the vessels
containing it, are ail the result of the properties — powers —
or influences with which these tubes are endow'ed, from a
source which it is unnecessary to inquire into at this place.
What has been now stated regarding the liver may be ex¬
tended to other secreting organs.

Dr. Pring offers a remark on the relation of the absorbent
system with this subject, which should be kept in mind.

Whether, supposing,” he observes, the secretion of bile or
of urine be healthy, the absorbent function of the structure in
which calculi are found may be supposed to have any agency,
as by a partial separation from bile, or urine, of some con¬
stituents, leaving a concreted residuum, is a conjecture, for
the decision of which we w^ant facts.” — From this topic
Dr. P. passes on to consider some facts connected with the
state of the blood which have been lately but too much
neglected; but which, we predict, without pretending to
more inspiration than was allowed by Pliny to the medicines
vateSy will receive a more general attention; since patholo¬
gists, instead of attaching themselves exclusively to one
particular creed or dogma, are taking more extended views of
the operations of the animal economy, and are attaching
themselves more to the simple results of observation, than
becoming partisans of a particular sect. These facts con¬
nected with the state of the blood relate chiefly to its colon*'

Analytiml Review,

its degree of thickness, the cohesion of its crassamentum ; the
relation which these states bear to the action of the heart and
of the arteries, and the effects which great losses of blood
produce upon both one and the other, and upon the nervous
system. And here we cannot deny ourselves the pleasure
of presenting our less experienced readers with the fol¬
lowing remarks on great losses of blood, which appear to
be the result of intimate observation, which entirely agree with
our own experience, and which, moreover, direct experiment
has entirely verified.

“ There is seldom a slow pulse in those who have lost much blood,
either by the lancet, by an accidental wound of an artery, or by
uterine haemorrhage. On the contrary, the pulse is apparently full,
bounding and ranging perhaps from po to 120; and if under the
latter rate, is easily raised up to it by the most trifling excitement.’'

. It is commonly, and in my own experience it has been

invariably, the case, that those who have sustained great losses of
blood, suffer more or less from what is called determination to the
head. The symptoms most commonly are intense pain and throbbing
in the forehead or back part of the head, with a pulse seldom under
PO. I have known these symptoms to proceed on, with a pulse from
120 to 140, to delirium, serous apoplexy, and death.” — Pp, 22, 23.

This is a subject of great importance in practice. After
great depletion, and especially when depletion has been^con-
Joined with active purgation, the state of the pulse ought not
to be trusted to. The nature of the pulsations of the heart,
the proportion of the crassamentum to the serum, the firmness
and appearance of the former, and the colour, &c. of the latter,
ought to be attended to. It is impossible to state a general
rule by which we ought to be guided on all occasions; but
for the benefit of the unexperienced we may mention, that
when this apparently vigorous circulation is present after
large depletion, — and the crassamentum of the blood last
abstracted is either not very firm, or not very much cupped,
but especially when it is small in proportion — the serum
being abundant and w^atery, — and when the feet have been at
any time cold, — no more blood ought to be taken away: the
experienced and discriminating Practitioner will be always
able to distinguish, by means of the concourse of phenomena
which his mind will grasp and duly weigh, that condition of
the blood and vascular system which is the result of great
depletion, from that which requires a repetition of depletory
measures. For other interesting particulars connected with
the consideration of the humoral pathology, we must refer
our readers to the work.

The great activity of the circulation and of the pulse, so
generally observed after large depletions, and which may

Dr. Pring’s Principles of Pathology and Therapeutics, 73

often be noticed, even when depletion has been carried nearly
to inanition, is in a great measure to be referred, in the
opinion of Dr. Pring, to the tenuity of the blood occasioned
thereby (as is evinced by the great proportion of serum in
the portions last abstracted and by other circumstances), sub¬
jecting it to a stronger impulse from the heart; and to the
diminished resistance of the fluid, to a more easy propagation
of this impulse throughout the circle of vessels, than obtains
when the blood contains more crassaraentum, and, possessing
greater gravity*, is consequently less susceptible, in remote
points of the circulation, of the impulse given by the heart.”
The increased proportion of serum in the circulating fluid he
is disposed to refer to the greater activity of absorption in the
cellular membrane, and diminution of exhalation and secre¬
tion, occasioned by the earlier evacuations of blood, and to
the effects of these evacuations on the properties of life.

Chapter II, Doctrine of spasm. — Dr. Pring commences
this subject with some remarks on the manner in which the
doctrine of spasm entirely superseded the humoral pathology;
and he afterwards observes, that granting, for the present,
that the extreme vessels are liable to this state of spasm, the
effects which are ascribed to it cannot take place without
recurring, at least in part, to the humoral pathology, which
this doctrine was designed to supersede.” He afterwards
notices the opinions respecting suppressed perspiration, which
form a part of the doctrine of spasm; for, as spasm of the
superficial vessels is supposed to prevent the discharge of the
fluids by the skin, and as the retention of them is considered
to be hurtful to the system, they can only produce such an
effect in one or both of two ways; “ first, either by the deter¬
mination of a larger quantity of fluids to the internal parts, in
consequence of their escape from the surface being pre¬
vented ; or, secondly, by the retention of fluids which possess
qualities of a noxious kind, and the evacuation of which by
the skin is therefore necessary to health. The first alter¬
native evidently proposes a mechanical explanation ; and the
second is nothing less than a recurrence to the doctrine of
peccant humours.” This is, we think, a strong objection,
although the followers of Cullen may contend, that the
changes induced in the vascular system by spasm of the
superficial vessels are not confined to the retention of the
cutaneous excretion, which may or may not be discharged
from the blood by the internal Surface of the digestive tube
and by the kidneys ; but that these changes are chiefly

* To which we may add, less tenuity.

VOL. XX, - NO. 1 1 O. L

74 . Analytical Review,

extended to the venous and arterial trunks and ramifications,
in internal and vital organs, or in the vicinity of the head,
the vital condition of which may be altered, independently of
the retention of fluids of a noxious kind.

Dr. Pring farther argues against the supposition of sup¬
pressed perspiration being the cause of many diseases, from
the circumstance that'several disorders which are more com¬
monly imputed to such a cause, run a protracted course,
while patients labouring under them have been frequently
and long bathed in sweat. He afterwards notices a third
mode in which spasm may act in producing disease, which we
have just stated, viz. internal plethora or altered relations of
the internal vessels ; but the supervention of such conditions
or relations of blood-vessels, he justly contends, may be im¬
puted to some predisposition in the seat of disease not
existing in other parts of the body, which predisposition
does not amount to actual disease, although nearly allied to
it, until exposure to cold or any other exciting cause produce
that state of the system usually attributed to spasm of the
superficial vessels. — The observations which the author makes
respecting the morbific qualities which have been ascribed to
the perspiration in relation to the doctrine of spasm are interest¬
ing : the same may be still more deservedly said of his exa¬
mination of this theory, as it has been employed to account
for inflammation. Here his remarks evince great powers of
discrimination, and convey illustrations derived from an
intimate view of the phenomena which take place in the
vascular system from the application of various agents.

Chapter III. Doctrine of Brown, — The doctrine of
John Browm,'’ Dr. Pring very happily observes, ‘‘ was a
production of genius ; an offspring of the imagination, but
little corrected by the understanding : it was an intellectual
meteor, the light qf which was brilliant, but deceitful and
evanescent. Such was its general character and destiny : a
few rays have, however, survived, and still rescue the doctrine
, from entire oblivion.’^ The fundamental principle of Brown,
that an animal was originally endowed with a fixed sum of
the principle of life, which was afterw^ards to undergo per¬
petual and rapid exhaustion to the time of its death, is con¬
trary to all analogy.” Yet upon such a basis was his doctrine
built. Dr. P. adduces very cogent arguments against this
postulatum, which most satisfactorily disprove both it and the
inferences deduced from it. We regret that our limits pre¬
vent us from giving an analysis of many excellent observa¬
tions which Dr. P. has introduced in the course of his reason¬
ings on ihe principles of this path()iogy ; we can merely briefly

Dr. Pring’s Principles of Pathology and Therapeutics, 75

notice the manner in which he examines its leading cha¬
racters, Having shown the unsoundness of the assumption,

I that animals are endowed with a certain sum of excitability
I at their birth, which forms the physiological basis of the
I doctrine, he next examines the pathological principles which
I have been built upon it, and which, although they must
\ necessarily fall wdth the assumption which served as their
! basis, yet deserve attention as they have received the
I sanction of many who never entertained the fundamental
j part of the creed. Diseases, according to this pathology,

1 are only of two kinds, one arising from excess, the other
from deficiency of vigour or excitement, which latter
term designates the state of life — all diseases being attri¬
buted by it to the state of the excitement. The author
goes on to argue against this arbitrary assignment of
some disorders to certain supposed degrees of excitement,
by adducing those instances where many of the phenomena
referrible to vigour or excessive excitement are present, while
others essential to the existence of this state are either entirely
I absent, or exist in a very inferior degree. He very justly
I remarks that there seems to be no degree of life, as far as
may be judged by the energy or debility with which any one
or more function is performed, w'hich does not obtain in
diseases different, perhaps opposite, in their general cha¬
racter ; and that as strength depends upon one state of the
related agents of life, so debility must always ensue from a
deviation from this state.

I Another source of error, and we think the principal one
in the pathology of Brown, is the manner in which it draws
I attention entirely to degrees of excitement in particular
j organs, or in the general system, instead of attributing any
[ share of the cause to some alteration in kind — to some
I change in the vital manifestations different from degree, im¬
pressed upon a part or the whole of the system by the cause
I of disease. The consequences of this error — the exclusive
I reference of disorders to sthenic or asthenic states of the
system, as they display conditions which he conceived to
be above or below that middle quantity which he attributed
to health, are not confined to and visible in his pathology
only, but are banefully extended to and particularly manifest
in the general and special indications founded on that basis;
and, whether intimate view's of the animal economy in health
or disease, or the effects of medicinal substances, be referred
to, the confined ideas w'hich the doctrine inculcates, not¬
withstanding the beauty of its simplicity, become equally
apparent.

We confess that our limits cannot allow us to enter fully

76 Analytical Revietc.

and adequately into the merits of the pathological dogmata
of the doctrine of Brown ; nor would we have occupied so
much space with its consideration, but that we know, that
several of its terms are still retained in medical reasonings,
and frequently employed without any definite meaning being
attached to them. With a similar impression to our own on
this subject. Dr. Pring enters upon an elaborate, but, we
think, not happy discussion of the question, as to the degree
of excitement or of power with which functions are exer¬
cised ; and, at this place, he examines very fully the distinc¬
tion between degree and quantity, a distinction which ought
not to be lost sight of in our speculations respe,cting the vital
operations. After stating and illustrating the distinction,
which will be obvious to most of our readers, he considers
the relations of each of these terms individually, and after¬
wards views them as they are related to each other. Here,
also, the author is always profound, but frequently obscure.
We refer our readers to his exposition of these topics ; they
do not admit of abridgment.

Dr. Pring proceeds next to examine, at considerable length,
the pathology of Brown with reference to its application to
the doctrine and treatment of fever. The views wdiich he
discloses, in the course of this inquiry, are clear, just, and
comprehensive : we recommend them to the attentive perusal
of our readers, on account of the very excellent and practical
principles which he has deduced from them, and which he
has illustrated, from his enlightened experience, in a manner
that will interest every Practitioner, whatever pathological
dogma or practical precept he may entertain.

Our limits cannot allow us to give such an account of Dr.
P.’s observations at this place as would convey a satisfactory
idea of tliem, and we are unwilling to compromise ourselves
or our author, in the opinion of our readers, by stating them
in an inadequate manner ; we, therefore, refer them to these
ample and practical remarks, to which we now allude, and
with which Dr. Pring has concluded his examination of the
doctrine of Brown.

[The other Chapters of this work will be analyzed in our next
Number.]

Mr. Averill on Operative Surgery,

.II.

A short Treatise on Operative Surgery, describing the principal
Operations as they are practised in England and France;
designed for the Use of Students in Operating on the Dead
Body, By Charles Averill, Cheltenham, Member of
the Royal College of Surgeons, London. 8vo. Pp. 172.
London, 1823.

Believing this to be an useful little work to the surgical
student, w’e consider it our duty to introduce it to their notice.
Its author justly remarks, in his introduction, that, in order to
perform surgical operations, when they are necessary, with
dexterity and safety, frequent practice in the dissecting room on
the dead subject is requisite, and ought to be more attended to
in a surgical education than it usually is in this country. The
methods of operating which he describes, are, he informs us,
the most approved, and such as are now generally pursued.
Mr. Averill has prefaced some of the operations by historical
remarks, which exemplify the improved state of surgery ; and
he has very properly arranged them in a manner consistent
with presenting the greatest number practicable on the dead
body. We concur with Mr. A. in considering this a desirable
object, “ and now rendered too imperative, by the impedi¬
ments so injuriously opposed to the supply of subjects.”

Mr. Averill commences his work with directions respecting
what may be considered the principles of operative surgery,
namely, the manner of making the different incisions, of
puncturing abscesses, dilating sinuses, tying arteries, &c.
He ne^'t proceeds to describe the various operations on
arteries, and afterw^ards gives directions for performing the
other surgical operations usually resorted to. It is evident
that a work of this description is incapable of satisfactory
analysis ; its merits may be inferred from the Ibllowing
case : —

“ Wry Neck. — The history of the following case may serve as a
guide in practising the operation, as well as one proof of its success: —
A little girl, about ten years of age, whose neck, or rather whose head,
had been awry for three years, owing to a permanent spasmodic con¬
traction of the sterno-mastoid muscle of the right side, was admitted
into the Hotel Dieu, Paris, early in January, 1822. On the ibth of
that month the operation was performed by M. Dupuytren as
follows: —

“ The patient reclining against an assistant, a puncture was made,
with a straight narrow bladed bistoury, through the integuments just'
on the inner border of the sternal extremity of the contracted muscle.
The blade of the bistoury, being flatly opposed to the muscle, was

78 Foreign Medical Science and Literature,

pushed cautiously behind it, the point being directed forwards and
outwards till it protruded just on the outer side of the clavicular
border. The edge of the bistoury was then turned towards the
muscle, and a sufficient quantity of its posterior fibres cut to allow of
the head being placed erect ; the instrument was then withdrawn.

“ In this way the integuments escaped being divided, and a future
scar was prevented ; a very desirable object, the patient being a
female.

‘‘ The cut edges of the muscle were kept asunder by depressing the
clavicle, and inclining the head to the left side. The former was
effected by binding the right hand firmly to the foot, the knee being
bent : thus the clavicular fibres of the deltoid drew the bone down¬
wards ; the latter by a roller passed round the head and under the
left axilla.

“ The patient was kept in bed ; and at the end of thirteen days the
punctures were healed, and she had free motion of the neck, though
from long continued habit she still turned her face to the left side.
The bandages were reapplied, and the same bodily position main¬
tained till the 21st of February, when they were finally taken away,
and the patient pronounced cured, the head being but very slightly
inclined to the right side, and having free motion in every direction.”

PART III.

ANALYSIS OF FOREIGN PUBLICATIONS

IN THE DIFFERENT BRANCHES OF MEDICAL AND
SURGICAL SCIENCE AND LITERATURE.

Fecherches Anatomico-P athologiques sur la Medecine Pratique^
ou Recueil Observations sur Maladies Aigues et Chroniques,
faites d r Hospice Clinique Interne de la Faculte de Medecine
de Paris, et dans les autres Hopitaux, sous les yeux. de MM.
les Professeurs Corvisart, Leroux, Boyer, Fouquier, Petit,
Fecamier, La'ennec, Jadelot, et autres Medecins recomman-
dahles. Par C. F. Tacheron, Docteur en Medecine de la
Faculte de Paris, Medecin Civil et Judiciaire du Qnzieme
Arrondissement, attache au Bureau de Charite, &ei,&c.
Trois volumes in 8vo. Pp. 462, 518, et 632. Paris, 1823,

The title of this interesting work shows the sources whence
it is derived. Its character has been already given in our
• historical sketch of the progress of pathology. We now
proceed to make our readers acquainted with its plan and
execution. And here we may at onc^ state, that its excel-

Dr. Tacheron’s Anatomico-Pathological Researches. 79

lencies are the result of the materials of which it is composed, ,
while its defects arise from the faulty pathological ar¬
rangement which its editor has adopted.

The classification of the numerous facts with which M.
Tacheron has presented us, by no means meets our appro¬
bation. He appears to have adopted too many of the crude
and confined opinions, and sweeping generalizations, at
present entertained by some of the French pathologists. The
following is the order which he has followed: — ist, cuta-.
neous phlegmasia; £d, the phlegmasia of mucous mem¬
branes ; 3d, phlegmasia of serous membranes ; 4th, the
phlegmasia of parenchymatous organs. Under the second of
these divisions he has arranged pertussis, convulsive asthma,
asphyxia, and as a consequence of inflammation of the
bronchial membrane, he has placed haemoptysis : he has
classed scirrhus and cancer of the stomach, and haematemesis,
after gastritis. According to him, gastro-intestinal phleg¬
masia embraces gastric derangement or ephemeral fever;
bilious fevers; mucous, adynamic and ataxic continued
fevers; and intermittents, remittents, and typhus. We find
diarrhoea and dysentery under enteritis, hydrocephalus
amongst the phlegmasia of the arachnoid, hydrothorax under
pleurisy, and ascites under peritonitis; and amongst the in¬
flammations of the brain we recognize apoplexy, palsy, con¬
vulsions, tetanus, hysteria, chorea, and hydrophobia. Now
respecting these, we remark, that the very facts which he has
so satisfactorily adduced do not warrant the situation in which
he has placed the different species of fevers; nor have we a
right to arrange pertussis, asphyxia, and nervous asthma,
under inflammation of the bronchial membrane, because they
occasionally evince, in their consequences, such derangement.
As little reason have we for considering cancer, and scirrhus
of the stomach, haematemesis, diarrhoea, and dysentery, as the
same derangements as gastritis and enteritis; and granting
them all to result from inflammatory action at their com¬
mencement, which would be too general a conclusion, the
particular seats of these disorders bespeak for them a less
general arrangement. Dropsical effusions, also, undoubtedly
are' the consequences, in a very great number of cases, of
inflammation, in all its grades, in the membranes containing
these effusions, of increased momentum or determination, 8cc.;
but these disorders also frequently result from interrupted
circulation in the veins, from the condition of the absorbent
system, and from a relaxed state of the capillary exhalants,
and of the serous tissues themselves- Without questioning
the co-existence of several of me nervous derangements with
inflammation of the brain, to which he has ascribed them.

Foreign Medical Scienee and Literature.

or even their frequent origin from such a cause, vve see no
good reason for placing hydrophobia amongst the number.*
The reader will, moreover, be struck when he finds a very
considerable proportion of the cases of fever minutely de¬
tailed, which evinced no symptoms during life of gastro¬
intestinal disorder, and which presented no lesion, after death,
in that situation.

The faults, therefore, of M. Tacheron’s classification are
those which result from too confined views respecting the
nature of fever; from too general an application of the more
frequent causes of disease in some instances ; and from assign¬
ing, in others, the consequences of the disorder, as its cause,
origin, and seat.

M. l^acheron introduces each of his different pathological
classes, orders, and genera, with preliminary remarks; and
he makes some interesting prefatory observations on the ^
nature and relations of each particular disorder; and after
detailing the history, symptoms, and treatment of the cases,
with the appearances on dissection, he closes those relating
to each disease with sensible reflections on the various in¬
teresting particulars which they present. Each case has the
name of the el^ve attached to it who reported and attended to-
it, under the superintendence of one of the Professors.

It is evident that the nature of the valuable materials* of
which this work is composed must prevent us from entering
on its analysis. We shall, however, take occasion to refer
frequently to it; and we may have some future opportunity of-
taking up some of its orders of disease, in connexion with
some other production, and of thus making our readers more
fully acquainted with its nature and merits. M. Tacheron
has promised us a fourth volume from the same sources,^
containing a continuation of the disorders of parenchymatous
textures, which he has only entered upon in his third volume.
We think so highly of those now before us, that we shall re¬
ceive with pleasure this continuation, or rather completion, of
the work.

* The three volumes that have appeared contain upwards of eight
hundred cases, with the appearances on dissection in most of them. -

Medieal and Physical Infelligence.

, PART IF.

MEDICAL AND PHYSICAL
INTELLIGENCE:

BRITISH AND FOREIGN.

I. Destruction of a great Part of the Spinal Marrow, with Contraction of

the Arms, and perfect Motion of the Inferior Members,* A remarkable

Case communicated by M. Rullier, D.M. &c.

M. L - , the subject of this case, was aged forty-four years. His size

was small, his body thin, and his temperament eminently nervous. His
faculties w’ere early developed, and his mind cultivated at an early period
of life. Being but young when left to his own discretion, he became
addicted to those irregularities which result from an indulgence of the
passions. At the age of thirty-four he first experienced pain when moving
his arm, attended with pain and uneasiness at the top of the vertebral
column. This indisposition, the first serious ailment which he had felt,
became suddenly aggravated after several remissions ; and in January, 1815,
he entirely lost the use of it. After this the dorsal part of the spine became
curved, and his shoulders, especially the right, became elevated.

M. L. consulted some of the most distinguished Physicians in Paris,
who employed cauteries, moxas, and vesicatories, with little advan¬
tage. On the fifth of October, 1822, M. Rullier was called to attend him.
He was then feeble and wasted. The size of his head formed a striking
contrast with his small and emaciated body. His neck and extremities
were long and thin. The vertebral column was sensibly curved. With
the exception of the superior extremities, all the parts of the body enjoyed
their voluntary motions. The patient walked about, and even shortly
before his death could take several turns on the outer boulevards without
fatigue. Borne up by his nervous activity, he assured M. R. that he felt
strong.

The arms of this patient were contracted in a permanent manner, some¬
times painful, and generally aching. The fore-arms were in a state of
forced pronation, and the fingers in that of flexion. During sleep, the
fingers were contracted so forcibly as to mark the skin in the palm of the
hand. Notwithstanding the affection of the arms, M. L. could still sign his
name in his official capacity, by a movement of the whole arm. The con¬
traction of his arms appeared to be chiefly owing to the pectoral muscles,
and the contracted parts preserved their sensibility. The hands were per¬
fectly sensible to every alteration of temperature and to the slightest touch ;
and pain was excited in the arms by forcible impressions by external
objects.

M. L. possessed his intellectual and moral faculties unimpaired. His
sleep, however, was disturbed and broken, by difficulty of respiration and
palpitation, occasioned by painful stitches darting through his chest. The

• M. Magendie justly remarks, that this is one of the most remarkable
facts which pathological anatomy has furnished. It shows how much we
have yet to learn respecting the functions of the nervous systenh

VOL. XX, — NO. 115. M

Medical and Physical Intelligence,

thorax appeared to preserve only a part of its motions : cough was frequent
and difficult, and the expectoration abundant and like cream. Hectic
fever, with increase of the frequency and strength of the pulse, supervened,
and was accompanied with an aggravation of the symptoms more imme¬
diately referrible to the chest and lungs ; the remissions of the fever were,
however, marked, and attended with comparative ease. The bowels were
obstinately constipated. Violent pains were felt in the lumbar region and
in the dorsal curvature, and the breathing became more oppressed with the
accession of the hectic paroxysm.

Erections continued, as they had been during his illness, and, indeed,
through life, frequent, and it was only shortly before his dissolution that
the patient had ceased to indulge in the reproductive act ; the desire of
which, with the requisite energy of the parts, continued almost until his
death.

The treatment which was employed before the attendance of M. Rullier
had checked a ga^tro-intestinal irritation which had affected the patient.
M. R. found him in a state of pulmonary consumption, supervening to the
affection of the bowels, which he could not retard. And on the 31st of
October, fifteen days after M. R. first saw him, he sunk under his compli¬
cated disease.

Dissection. — The body, opened thirty-six hours after death by MM.
Piedagnel and Leconteux, in the presence of M. Magendie, who was kind
enough to assist me at this operation, was not as yet visibly altered,
although it had remained in a warm place. Its emaciation evinced com¬
plete marasmus. The breast and superior members were on this account
particularly remarkable. These last were, if I may use such an expression,
glued to the body, and were contracted, as was the case before death.
The legs and the feet were slightly oedematous.

The vertebral column, the particular object of our examination, offered
in the upper half of the dorsal region a slight saliant curvature behind and
to the right, and which raised the corresponding shoulder. The rest of the
back was w'ell formed ; the breast, sufficiently straight, appeared to be still
more so, in consequence of the arms and the shoulders being raised and
broifght forward.

The adipose cellular tissue had entirely disappeared. All the muscles
were lank and thin r those in the lumbar region were softened and of a
deep red colour. The psoas muscles presented the same colour, and were
as if in a state of solution. They were not entirely suppurated nor in¬
flamed, and we considered to what point this alteration explained the severe
pains which the patient had suffered in the lumbar region, and principally
to the right.

The brain was firm, very sound, and contained a remarkabre quantity of
serum in the four ventricles, and this serum appeared to have the power of
following the erection of the body into the cavity of the spinal arachnoid ;
at least, we could not establish the existence of a cul-de-sac formed by this
membrane, and which closes on this side the fourth ventricle. Neither did
the valvule ofVieussens exist. Nothing that regarded the cerebellum ap¬
peared to be worthy of remark, nor any thing that could be united with the
prodigious generative activity that had distinguished the patient.

The arachnoid of the ventricles was clearly distinguished : it presented a
simple increase of thickness, which did not alter its transparency;

The fibrous canal of the spine was laid bare throughout its whole extent,
by removing the spinous apophyses and plates of the veriebra3 ; the marrow
suffered no sort of compression in its canal; only it contorted itself as the
spine did in the dorsal region. The cavity of the arachnoid contained
a remarkable quantity of serum ; beneath part of this membrane, united to
the marrow, we found the membrane belonging to the latter covered with a

Medical and Physical Intelligence, 83

great number of red vessels, arterial and venous, strongly injected wit1i
blood.

The vertebral marrow, examined with care, in its place and by its poste¬
rior face, appeared to us in its natural state, from its origin as far as the
fourth pair ot cervical nerves. The two inferior thirds of its dorsal part
were equally sound; but between these two parts, viz. for about six or
seven inches in length comprised between the two inferior thirds of the
cervical region and the upper third of the dorsal region inclusively, and
corresponding to the eighth or ninth pair of nerves, this part displayed the
most remarkable alteration : it was soft to such a degree of fluidity that the
canal formed by the dura mater appeared to be full of a real liquid,
which followed the direction of its gravity up or down according to the
position of the body; but this liquid, which thus doubly inflated the
covering of the marrow, stopped precisely at those parts of this organ which
remained in their natural state. A small opening being made in the dura
mater immediately let a quantity of this fluid run off: w'hen the membrane
had been cut through, the spinal marrow w^as seen covered with its proper
membrane ; it was of a reddish grey, and extremely soft ; it presented a
sensible fluctuation, * and the opening of its membrane allowed a liquid
mixed with small flakes of the medullary matter to run out. We after¬
wards made a large opening, and a longitudinal incision, in this part of
the marrow, which presented to our view an elongated cavity, filled with a
sort of greyish light red fluid, in which a great number of red and extremely
thin capillary vessels were dispersed, f The medullary bands connected with
the corresponding roots of the spinal nerves could scarcely be distinguished
on the anterior part of this altered portion. On the left side, the inter¬
rupted band was no longer marked, for about an inch and a half, except by
lenticular pieces of the medullary matter placed one after another in the
line of its direction : this disposition appeared to us to have entirely
resulted from the running out of the matter w'hich had existed in this
place, in consequence of a small accidental perforation made in the middle
part of the opening, or of the treatment the marrow had received. The
marrow, detached and taken from its canal, could be examined by its
anterior region. Here the alteration of which we have spoken w'as much
less sensible ; the difference was not superficial, w'as not to be remarked
from the exterior, and the discharge of the matter from the incision that had
been made had diminished the volume and removed the appearance of
fluctuation ; tlie medullary hands corresponding to the reticulation of the
origin of the anterior branches of the spinal nerves were apparent, and
offered no interruption throughout their whole length, with the exception of
the left, which, as we have already said, was altered ; they were traced
throughout the whole extent of the marrow as far as the medullary tissue,
whence they have their origin.

An attentive dissection showed us that the disposition and structure of
the origin of the marrow and its superior part, as far as the fourth pair ol
cerebral nerves, presented nothing particular. Behind, the inferior part of

* The appearance of this part of the marrow was such, that eacli of the
assistants exclaimed that there was a dropsy in the marrow itself ; in effect,
the natural colour of this part had disappeared, and was replaced by an almost
colourless liquid, in which some flakes of the medullary matter were float¬
ing. — M.

f For the first time, I have seen as distinctly as possible the internal
cellular tissue of the marrow ; it was swelled with the liquid of which my
companion M. Rullier speaks, but its plates and its cellules were no longer
evident : they are still more so on the piece which I preserved in spirits of
wine. — M.

Medkal mid Fh^ucal Intelligence,

the fourth ventricle and the posterior pyramids — before, tlie pyramidal anil
olivarian eminences, displayed their known configuration. On examining
carefully the origin of the first spinal nerve, we convinced ourselves that the
most inferior reticulations of its origin evidently corresponded to that por¬
tion of the marrow' which was destroyed.

. The structure of all the part situated above the fourth pair of cerebral
nerves was sound; the medullary substance had its ordinary whiteness and
consistency ; but below this point this consistency and this whiteness
suddenly changed. It appeared that the marrow was converted into a
cellular substance, distended with a pale rose-coloured serum, as far as the
sixth pair of cerebral nerves, a place in w'hich there no longer existed but a
broad cavity, of which the sides were only formed by the vascular
and serous membranes of the marrow and the remains of the medullary
matter. This disorganization was remarkable as far as the fourth pair of
dorsal nerves ; but this alteration penetrated like a cave into the midst of
the medullary substance, which appeared there with its natural properties.

The eight lower inches of the organ showed no alteration. Some nerves
were dissected and followed, those of the brachial plexus, in particular, as
corresponding to the disorganization ; they, as w'ell as their ganglions, were
found without any alteration. The lungs, apparently soft and crackling in
their anterior part, were not sound ; they adhered in their posterior part to
the costal pleura in too loose a manner. The left lung contained in its
superior lobe some thin and dispersed tubercles ; the posterior edge was
filled with blood. The right lung, more diseased, presented in the same
region the same aspect ; it had there the appearance of hepatization,
and presented many reunions of suppurated tubercles, of which some
swellings were ossified.

In the belly, the stomach, sufficiently dilated, was in a healthy state ;
50 also were the other viscera, w'lth the exception of some parts
of the intestines, of which the different membranes, being very much
injected, w'ere of rather a dark red and slightly livid. Some blackish spots,
externally visible, corresponded to some small denticular ulcers of the
corresponding mucous membrane.

The bladder was small and thick, but sound.

II. Remarks by M. Magendie on the foregoing Case.

To how' many reflections does the preceding fact give rise ! , A man
enjoying, almost to his last hour, great moral activity, powerful generative
faculties, a free movement of his inferior members, and sensibility in his
upper ones, had probably suffered for a long time the loss of above a third
of the nervous matter of his spinal marrow; the communication between
the cerebral and dorsal part of this marrow was, if such an expression may
be allowed, no longer maintained except by the membranes; for it has
been seen that there only remained a thin layer of white substance scarcely
two lines in breadth, and very probably altered in its structure. The cavity
from whence the medullary matter had disappeared was filled with serum.
There was, therefore, an almost complete isolation of the superior and
inferior parts of the marrow', and that for above six or seven inches in
length ; yet the will exercised its power over the inferior members; the
imagination stimulated the genital organs, and these transmitted to the
sensitive brain the lively emotions of pleasure.

These two parts of the marrow thus persisting in keeping up their com¬
munication is worthy of all our attention. Some motives for a curious ex¬
periment may be deduced from it. 1 he great sympathetic nerve was with¬
out doubt the medium of it; for all sections, or even all compressions of
the marrow, intercept the determination of the will relatively to the motions,
and render the parts which receive their nerves insensible from the point

Medical and PliT/sical Intelligence. 85

of the marrow which is below the part compressed. The thin layer of*
medullary substance, and the proper membranes of the marrow, therefore
remain. If it be imagined that it is the stratum of nervous matter, it must
be thought very extraordinary, that notwithstanding its small breadth and
thickness, it performs this function as well as the marrow in its sound
state, and that there has not been at least some diminution, either in the
rapidity, or, if I may thus speak, in the perfection of the transmission.

If, on the contrary, it be found that so narrow a medullary stratun:
cannot be sufficient to explain the phenomena, it must necessarily be
inquired if the vascular and serous membranes would not be proper for
the nervous transmission. Up to the present time, it is true, nothing has
afforded cause for suspicion, but on the other hand nothing formally
opposes it: here is a new and very important subject of inquiry. The con¬
jecture is here the more allowable, as in the case which fell under our
observation, tlie membranes of the marrow were perfectly sound.

With regard to the motion of ttie heart, the fact of M. Kullier is not less
curious ; for after the investigations of Le Galois, a considerable diminution
of the mass of the spinal marrow ought so to diminish the force of contraction
in the heart, that the blood would not be able to arrive continually at the
lower extremities ; and yet the circulation was perfectly maintained.

The contraction of the upper members, with a continuance of sensibility,
deserves also to be remarked ; for the posterior portions of the marrow,
where the sensibility particularly resides, had disappeared, from all the pairs of
nerves which supply the brachial plexus. Thus the sensibility of the arms could
not have its ordinary source, viz. that which is connected with the posterior
roots. Reasoning after my experiment, there remain, therefore, the ante¬
rior roots which give the entire movement, but which, as I have observed,
are not incapable of sensibility. Now these roots extended as far as the
medullary stratum of communication, and, in this point of view, there will
be no difficulty in explaining it, if it be supposed, which is not impossible,
that during life a thin layer existed to the left, as one existed to the right.
But a circumstance of greater interest is that the anterior roots, as I have
recently discovered in the piece preserved, had lost their medullary matter, and
were reduced to their neurilema, as is the case with the wasted optic nerve.
The posterior roots, on the contrary, had retained their nervous matter as
far as their junction with the membranes of the marrow. Every where
else, except in that part of the marrow which was altered, the anterior
and posterior roots alike presented the medullary matter.

This pathological disposition of the anterior roots of the brachial nerves is
w'ell connected with the complete immobility of the arms; but it wkh dif¬
ficulty allows a belief that they were the agents of the sensibility. Why,
on the contrary, should not the posterior roots w'hich, far from being wasted,
were in their ordinary state, and consequently w'ere filled with the medul¬
lary substance, be the organs through which the arms of the patient pre¬
served their sensibility, and occasionally even suffered an acute pain }

I'his again leads us to conjecture that the immediate envelopes of the
marrow might be the conductors of the sensibility, or be themselves sensitive
parts. It has been seen, in the experiments which I have before mentioned,
that a simple contact of the serous membrane of the marrow occasions an acute
pain, if the posterior part of the organ be touched. I, together with M.
Dupuy, have recently established this interesting fact by operating on a horse.

An anatomical disposition which is extremely visilile on the piece I have
preserved, is that the interior cellular tissue of the marrow, in the cellules
of which the medullary matter is probably deposed, established a solid con¬
nexion between the anterior and posterior part of the marrow : it was on
the layers of this tissue that the blood-vessels ramified.

To sum up every thing, we shall repeat that the observations of M.

Medical and Physical Intelligence*

Ruliier show that we have still much to learn with regard to the functions
of the spinal marrow. This should induce persons engaged in patho¬
logical anatomy to lose no opportunity of examining this part, and even of
preserving it, if it present any irregular formation. — Journal de PhysiologiCf
A’oril, 1823.

III. On the Cure of Intermittents hy Frictions with the tartar ized Anti-

rnonial Ointment on the Epigastrium.

During the winter of 1815, Dr. Poramer had occasion to treat numerous
cases of intermittents occurring in the army of Wurtemberg, cantoned at
that time on the Loire and Allier. He frequently found the cinchona to
fail in producing its usual effects, and observed that the fever generally
disappeared on the eruption of pimples or pustules on any part of the body.
Taking advantage of this observation, he was induced to try the effects of
artificial eruptions in its cure. With this intention he employed the
common tartar emetic ointment, and prescribed it to be rubbed upon the
abdomen and epigastric region. The first two individuals whom he sub¬
jected to this treatment recovered immediately upon the maturation of the
pustules which were thus produced. This induced him to use the same
means in a great number of cases then under treatment, and in those which
subsequently occurred, and in all the cases with similar success. Dr. P.
employed the same mode of cure in those varieties of agues which were
complicated with nervous symptoms with the same benefit.— Jowr/i. der
Practischen^ Heilk. 1823.

IV. Experiment on the Effects of the Ergot of Rye.

By M. CoRDiER, M. D.

M. Cordier, being desirous to ascertain the mode of action which this
substance exercises, swallowed, on the 16th of April, 1822, two drams of
it, at seven in the morning, wdien quite fasting. He found it to possess a
particular but obscure flavour, durable, and leaving an acrid and rather
nauseous sensation after it. He experienced no peculiar feeling until two
hours afterwards, when he felt a sense of weight in the stomach, attended
with a disposition to vomit. At ten o’clock an eructation brought up a
mouthful of limpid, very acid liquid, tasting strongly of the ergot. After
this was rejected, he was entirely freed from the disagreeable sensation felt
at his stomach, but its passage over the tongue excited a copious discharge
of saliva. At eleven o’clock he breakfasted, with little appetite, on bread
and milk.: soon afterwards he experienced a desire to vomit, and about
half an hour subsequently he rejected, without effort, and at once, all that
he had taken. At noon he vomited again, but with greater efforts, and
rejected some mouthfuls of tenacious mucus. He perceived no traces of the
ergot in the rejected matters. After midday he felt a little lassitude and
uneasiness ; the odour of the perspiration had become somewhat sour, and
he felt rather weaker than before the vomiting. He dined in the evening
in his usual manner, but was still annoyed by the flavour of the ergot.
The vomiting occasioned by this substance is not violent, and causes
but little uneasiness ; for he did not observe any change on the state of
the circulation, or of the breathing and other functions. — Journ. Gen.
Avril, 1823.

V, Use of Moxa in India.

In a letter which we have received from George Henry Davies, Esq.
Surgeon to one of the Native Corps in the Bombay Presidency, he states
that the moxa is a favourite native remedy, and that he has witnessed in
numerous instances its good effects in cases of rheumatism and paralysis ;
and he thinks it generally preferable to issues, setons, and perpetual blisters^
in cases where those curative means are usually prescribed.

Monthly Bibliography , S^c.

VI. Army Medical Officers' Funds for the Benefit of Widows, 8^c.

We have much pleasure in acquainting our readers with the flourishing
condition of these societies. It would appear from their report laid before
the eighth annual meeting held on the 16th of May, that the yearly revenue
of the Society for the Benefit of Widows of Medical Officers, amounted to up¬
wards of X 2800, and their accumulated fund to very nearly o£29,000 ; and
that the annual subscriptions, &c. to the Medical Officers' Benevolent Fund
was X637, and their invested fund about ^£2000. After these satisfactory
accounts were laid before the meeting, the members and their friends, to
the number of above 100, dined together at the Thatched-House Tavern,
Sir Everard Home, Bart, in the chair. Amongst those who were present
not belonging to this department of the army, — a department to which
the country generally, and the state of medical science in it, are indebted —
were Sir H. Halford, Dr. Baillie, Dr. Mason Good, the Master of the
Apothecaries' Company, Mr. Brodie, Mr. Chantry, Mr. Wilkie, and several
other eminent individuals.

BRITISH.

A Series of Elementary Lectures on the Veterinary Art, wherein
the Anatomy, Physiology, and Pathology of the Horse, are essayed
on the general Principles of Medical Science, By Veterinary Sur¬
geon Percival, of the Royal Regiment of Artillery. Svo. pp. xxxvi.
380. London, 1823.

3'he author of this work appears to be well Informed in the principles of
medical science. He has viewed, in a very satisfactory manner, the
physiology and pathology of the horse, in relation to the laws which re¬
gulate the human economy, and, indeed, animal bodies generally. As far
as these recommendations may entitle it to regard, and as far as we are
capable of judging of its merits generally, we consider it a work of consider¬
able excellence.

FOREIGN.

Anatomic du Cerveau, contenant THisloire de son D^veloppement
dans le Foetus, avec une Exposition Comparative de sa Structure
dans les Animaux. Par Frederic Tiedemann, Professeur h I’Uni-
versite de Heidelberg, Menibre des Academies des Sciences de Munich
et de Berlin, Associe etranger de I’lnstitut : traduite de I’AUcmand
avec un Discours Preliminaire, &c. par A. J. L. Jourdan, Docteur
en Medecine, &c. &c. Avec 14 planches. Svo. pp. 325. Paris, 1823.

We take the earliest opportunity of making our readers acquainted with
the publication of this translation of Tiedemann’s important work. The
references which have been so frequently made to it will have convinced
them of its excellence. The translation is well performed, and the preli¬
minary observations by M. Jourdan are judicious. The plates are en¬
graved on stone, and well executed.

LITERARY INTELLIGENCE.

Mr. Herbert Mayo has in the press a second number of his Anatomical
and Physiological Commentaries.

Mr. Bayfield, Cupper to Guy’s Hospital, will very shortly publish a
Treatise on Cupping, comprising its History, a Description of its various
Instruments, and Practical Directions for its Performance.

Shortly will be published, the New Mercantile Assistant and General
Cheque Book, containing Nine copious Sets of Tables relative to the
Funds, Life Annuities. &c. &c.

THE METEOROLOGICAL JOURNAL,

From the \^th of MAY^ to the 20th of JUNEf 1823,
By Messrs, HARRIS and Co.

Maihematical Instrument Makers, 50, High Holborn.

May.

Moon.

Rain Gauge.

Therm.

Barom.

1 De Luc’s
Hygrora

Winds.

Atmo. Variation

•

Max.

9 A.M.

lOP.M

Cfi

10 P. M.

•

10 P. M.

SSE

Sho.

Fine

SW vr.

S var.

Fine

,02

SSW V.

Sho,

Rain

Sho.

,01

I29

W var.

Sho.

Fine

SSW^

Clo.

Fine

i29

SSW

Clo.

Sho.

Fine

,03

.50,29

SSW

NNW

Fine

Sho.

Fine

5029

NNE

Fine

5029

Fine

50,29

ENE

Fine

Fair

Fine

30 01

Fine

SSW

Fine

6.5

wsw

Fine

Rain

3.5

SSW

Fine

,02

Fine

Sho.

Fine

Fair

Clo.

Fine

■ 7

SW ■

Fair

,04

SSW

wsw

Fine

Clo.

Rain

Fine

NNE

Fine

Clo.

Fair

NNE

Fine

NNE

Fine

80.

Clo.

ESE

Fine

10;

Fine

65 <

69]

NNE

Clo,

Clo.

Fair

65.

691

^NE

Clo.

Fine

Clo.

The quantity of Rain that fell in the month of May was 1 in. 7-lOOths.

NOTICE TO CORRESPONDENTS.

Communications have been received from Dr. Sutton, Mr. Haden,
Mr. King, Mr. Perry, Mr. Snell, and from a Physician, a friend of the
Editors.

Communications are requested to he addressed (post paid) to
Messrs. T. and G. UNDERWOOD, 32, Fleet Street,

THE

LONDON MEDICAL

REPOSITOKY.

No. 116. AUGUST 1, 1823. Vol. XX.

HISTORICAL SKETCH OF THE PROGRESS OF

MEDICINE,

AND OF THE SCIENCES CONNECTED WITH IT,

During the first Six Months of the Year 1823.

{Concluded from page 66.) * •

Materia Medica.— But few actual additions have been
made to this part of medical science within the period to
which this essay refers. We have^ however, several observa¬
tions presented us respecting those remedies which have been
recently introduced into practice, confirming former expe¬
rience as to their efficacy in those diseases against which
they were first employed, and evincing their beneficial effects
in disorders for which they had not been previously pre¬
scribed.

Iodine has obtained a considerable share of reputation since
we directed the attention of the Profession in this country to
its use in bronchocele. * Since we last had occasion to notice
its effects, Professor Brera, of Padua, has published the
results of his experience respecting its efficacy. t We are
indebted to Dr. Johnson J for the following abstract of the
Professor’s clinical observations respecting it, which we shall
place before our readers as an additional inducement for them

* Repository, Vol. XIV. passim.

t Saggio Clinico suU’Iodio, e sulle differenti sue Combinazioni e
Preparazioni, &c. &c. Padua, 1822.

X Medico-Chirurgical Review, March, 1823.

VOL. XX, — NO. 116. N

90 Historical Sketch of the Progress of Medicine, S^c.

to put this substance to the test of farther experience. Dr.
CoiNDET, to whom^ vve are indebted for introducing this
remedy into practice, had stated, that the ill effects which
occasionally followed its internal use were entirely obviated
by its external application. “ Professor Brera, how^ever,
informs us that it can be employed internally with equal
safety, and with greater effect, except in such cases as
require its topical agency. The following are the formulae
most recommended by Professor Brera : —

1. Tincture of iodine. — Made by dissolving 48 grs. of
pure iodine in an ounce of alcohol (at 35). This is the pre¬
paration most frequently used at first by Dr. Coindet, who,
as well as Brera, recommends it being used fresh^ as it is
liable to decomposition in a few days. The dose is from five
to twenty drops for adults, three times a day. Twenty drops
contain about one grain of iodine.

2. Pills of iodine, made by forming one grain of iodine
into two pills, with elder-rob and liquorice powder — one to
be taken morning and evening.

“ 3. Iodine ointment, made by rubbing up a dram of pure
iodine with an ounce of lard, or half a dram of hydriodate
of potass with an ounce and a half of lard ; the former in
the quantity of a scruple, the latter about the size of a filbert,
rubbed on the part.

4. Solution of hydriodate of potass. — This preparation is
stated to be preferable to any of the foregoing, producing
their good effects without their inconveniences. It is formed
by dissolving 36 grains of the hydriodate in an ounce of dis¬
tilled w'ater, and is given in the same dose as the tincture.

5. Solution of the ioduretted hydriodate of potass, formed
by dissolving 36 grains of the hydriodate and ten grains of
pure iodine in ten drams of water. This is said to be a still
more efficacious preparation than the preceding, and requires
to be given in small doses, viz, five or six drops, three times
a day, to begin with.

‘‘ The following precautions are to be attended to during
the administration of iodine : — not to combine it with sub¬
stances likely to decompose it, and not to give it when the
stomach is loaded, but in the morning, a couple of hours
before or after dinner, and in the evening. Our author
farther recommends the occasional suspension of the medi¬
cine, on account of the sometimes sudden supervention, of
unpleasant effects from it, and to give a dose of magnesia on
the day of its suspension, with the view of clearing the primas
vise. The liquid preparations may be given in any vehicle.
Coindet usually employed syrup and water.

When iodine is cautiously and gradually introduced into

Materia Medica.

tlie system, it affects it in a general manner, analogous to
that of mercury, but very different in the consequences.
The first, and what may be called the salutary effects of
iodine, are an increase of appetite and of the strength of the
pulse; whenever these are produced, we must watch with the
greatest care that these salutary limits are not exceeded, and
the pernicious consequences of an over-saturation of the
system induced. The complete impregnation of the system
is indicated by the change of the above-mentioned increased
action of the pulse into decided frequency and quickness —
by a sense of heat and irritation of the fauces pain of the
orbits or eye-balls, with obscured vision — pain of the
internal ears and gums (with occasional salivation), headach,
restlessness, loss of sleep, with swelling and pain of the
diseased organs (e. g. thyroid and other glands), and an in¬
crease of appetite sometimes to a degree of voracity. In
some persons the submaxillary • glands become painful and
swollen, and a similar state of the mammae, ivith eventual
diminution of their natural volume^ takes place in some
females. When'given from the first in an over-dose, iodine
produces a strong burning sensation in the fauces, which
frequently extends down the oesophagus to the stomach and
whole intestinal canal. In a still higher degree of saturation
(or iodization^ as the author calls it) of the system, to the
above-mentioned symptoms succeed very considerable ema¬
ciation even in the space of a few days, excruciating pains in
the orbits and eyes, with great defect of vision, and similar
pains in the diseased parts ; the strength vanishes ; neuralgic
pains are experienced in the stomach, chest, bowels, &c. the
sleep entirely fails, and there is obstinate palpitation of the
heart, with tremors, convulsions, or palsy of the extremities;
to the excessive appetite succeeds complete anorexia, and
the factitious disease finally terminates life, in a short time,
by universal inflammation of the nervous and vascular systems
(profonde angioitidi e neuriditi).

“ Upon the appearance of the milder, class of symptoms
above-mentioned, the immediate suspension of the medicine
(which ought always to be done) sometimes is found suffi¬
cient to put a stop to them in a few days. For allaying
these deleterious effects, rigorous regimen, copious mucilagi¬
nous drinks, and the tepid bath, are recommended ; and where
■the topical affection of the goitre, or other tumors, runs high,
fomentations, poultices, leeches, &c. are prescribed ; and
general bleeding is advised where there exists a high phlo¬
gistic state of the whole system.

** As these symptoms sometimes show themselves all at
once, we ought to be cautious in not too hastily increasing

92 Historical Sketch of the Progress of Medicine^ ^c.

the dose in cases wherein no obvious effects are produced.
After the bad symptoms are allayed, the medicine is to be
repeated with the same precautions as in the case of mercury
and arsenic.”

Dr. Coindet has given the following explanation of its
operation on the system : — ‘‘ Iodine is a stimulant ; it gives
tone to the stomach and excites appetite ; it neither acts
upon the bowels nor kidneys; produces no perspiration, but
exercises its action upon the generative system, especially the
uterus. If given in a certain dose, and continued for some
time, it is one of the most active emmenagogues with which I
am acquainted ; it is, perhaps, from this sympathetic action,
that it so frequently cures the goitre.” Again — ‘‘The
experience of two years upon more than two hundred pa¬
tients, has proved to me, that this remedy is one of the most
energetic stimulants we know of the lymphatic system ; and
the variety of diseases in which I have employed it (such as
goitre, scrofula, enlarged glands of the breast, certain affec¬
tions of the uterus, some cases of dropsy, &c.) is only appa¬
rent, since the whole of these diseases are only lesions of the
same system.” — (Dr. Coindet’s Memoir, as quoted by Dr.
Johnson.)

We refer our readers to the March Number of this Journal
for an account of the experience of Dr. Baron as to the
efficacy of iodine in tuberculous disorders and in pulmonary
consumption, as detailed in his recent illustrations of these
derangements.

The effect of nuoe vomica as an energetic stimulant of the
voluntary nervous system, and, consequently, as a remedy in
chronic paralysis, has been farther shown by M. Segalas,*
and by the experience of several Practitioners.

The efficacy of charcoal in obstinate constipation of the
bowels has been occasionally asserted by Physicians and
writers of eminence. Dr. Daniell, of the United States,
has lately published cases illustrative of its effects in this
species of disorder. •f* In the first case which occurred to
this Physician, “ having adopted the usual treatment of
bleeding, warm bath, and mercurial purges, aided by jalap,
castor-oil, with other active articles of this kind, blisters, &c.
without success,” he conceived that a favourable opportunity
had now offered of testing the efficacy of charcoal. “ I
gave,” he has informed us, “ a tablespoonful of it every half-
hour, and at the expiration of about seventeen hours, my

* Magendie's Journal for October, 1822; and Repository for
January, 1823.

t Philadelphia Journal, No. IX. p. 1 ip.

Materia Medica.

patients bowels were freely evacuated. The discharges,
which consisted chiefly of a thick mucus, were fcoloured by
the charcoal. This medicine was then discontinued, and
castor-oil substituted — the latter, however, evacuating but
partially, I had recourse again to the charcoal, which was
continued until the patient recovered. My observations
since have convinced me of the necessity of continuing the
charcoal until the discharges are no longer marked by the
presence of slime or mucus, which I have found to abound in
very considerable quantities, in all the cases of constipation
which have fallen under my care. And, I think, the exist¬
ence of this matter in the intestines may explain the cause of
failure, not only of powerful enemata, but of cathartics to
evacuate them. Lining, as it most probably does, the chief
or whole extent of the bow^els, it protects their surfaces from
the influence of the medicines. The charcoal probably exer¬
cises a chemical influence upon this matter. The evacua¬
tions produced by the charcoal appear to be composed chiefly
of this article, and the mucus or slime intimately blended.

Since this case, I have used the charcoal in fourteen or
fifteen other instances, and always with complete success.
In this disease, the sufferings of the patient are usually
extremely great, and I have occasionally, since adopting the
charcoal, attempted to relieve them by other cathartics which
operate more speedily, but I have invariably failed, and was
afterw'ards compelled to have recourse to that remedy —
sometimes, however, not until the third and fourth days of
the disease, and always with decided advantage. Further
experience has convinced me, that the most speedy, as well
as most certain relief, is to be obtained from the free use of
charcoal. If it does not wholly relieve, it always very much
mitigates the pain in six or eight hours from the period of its
first administration — and within my observation, the patient
has always been entirely composed before the operation of
the medicine upon the bowels.”

To many, the tardy operation of this medicine may
appear as a serious objection to its use. It was formerly so
to me, but since I have been convinced of its certain efficacy,
and that although it may not act upon the bowels in twenty-
four hours even after its first exhibition, yet that it will in
one-third of this time very much relieve, if not wholly
remove the pains, 8cc. This objection appears comparatively
unimportant — for what avail a few hours in the cure of a
disease, if we can control the sufferings of our patient, and
afterwards certainly relieve him?

“ In relation to the dose of this medicine, the rule which I
have pursued is to give it as freely and as frequently as the

94 Historical Sketch of the Progress of Medicine j S^c.

stomach will allow. The quantity required is considerable.
It has a happy influence in lulling the irritability of the
stomach, when nothing else which I have used would control
the nausea and vomiting of the patient; thus fulfilling the
double intention of first alleviating a very distressing symp¬
tom, and then removing the disease itself. 1 usually give
from one to three tablespoonsful of the charcoal every half-
hour or hour: whenever the stomach becomes overcharged
with the medicine, the excess is thrown off, and the stomach
is again quiet. I give it in lime water, milk, or water alone
— the vehicle having appeared to me unimportant.”

Mr. Blackett has directed the attention of his profes-
siopai brethren to the more frequent use of the belladonna \w
several disorders which are characterized by excitement of
the nervous system. The observations of this gentleman are
calculated to bring this active remedy into more general use,
and to lead to its adoption in the treatment of some ailments
in which it had previously received an insufficient and an ill-
conducted trial.*

The efficacy of samphire, crithmum maritimum^ as a vermi¬
fuge, has been contended for,t and its chemical constitution
investigated, by Dr, Lavini, of Turin. Dr. Brayer has
also given an account of a vegetable anthelmintic, which is
said to be employed with uniform success in Abyssinia for
tape-worm. J M. Brayer, who resided a considerable time
in Turkey, obtained this substance from an Armenian mer¬
chant, and prescribed it to a patient in Constantinople, who
had been tormented for many years with taenia. After
having macerated about five drams of this substance in twelve
ounces of water, and taken half of the infusion while fasting,
the patient experienced nausea, with a disagreeable flavour
of the remedy : about an hour afterwards he took the other
half of the infusion, and went to bed. He felt pains in his
bowels, and, after frequent evacuations, discharged the taenia
dead and entire. Its thickest extremity was the last part
which came away. Several mucous stools followed the dis¬
charge of the worm, after which the patient perfectly reco¬
vered. M. Brayer procured some of this substance, which he
gave to M. Kunth,|| a botanist intimately acquainted with
intertropical plants, who considered it to belong to a new
genus of the family of the rosaceccy nearly allied to the genus

* Repository for June, 1823.
t Archives, Mars, and Repository for May, 1823.

J Archives Gen. Mars, 1823.

II The celebrated describer of the new plants discovered by Hum¬
boldt in New Spain, &c.

Pharmacy. 95

agrimonia, to which he has applied the name brayera, and
that of anthelmintica to the particular species to which M.
Brayer’s observation relates.

j The classification of remedies has been made the subject of
inquiry by M. Cap, a scientific druggist at Lyon, in a memoir
which obtained the gold medal from the Medical Society of
i Paris.* M. C. has divided his treatise into three parts: in
I the first he investigates the causes which have retarded our
j knowledge of the operation of the articles of the materia
medica ; in the second part he maintains that the present
state of science does not authorize us to arrange medicines
according to what we as yet know respecting the rationale of
their action ; and in the third he endeavours to point out the
course that ought to be pursued in order to obtain the
materials for such a basis of classification. M. Cap has very
properly considered that the epoch has only just commenced
wherein the Physician endeavours to trace the effects of
j remedies on the animal economy in an enlightened and phi¬
losophic manner; and from a knowledge of those effects,
to apply them to the removal of disease. Formerly medi-
! cines, with a few exceptions, were generally employed in an
empirical manner, without a strict reference to the exact state
of derangement at the time of exhibition, and often with no
other evidence of utility than a loose analogy in their favour.
But the spirit of inquiry into this most interesting and
most important subject is now abroad amongst all classes
and members of the Profession ; his inspiration is not limited
to a single country, nor his voice confined to one language.

Pharmacy. — In this department of knowledge there are
sufficient materials before us, could our limits permit us to
bring them fully before our readers. The scientific con¬
tributors to the Journal de Pharmacie, published at Paris,
and the Transactions of the Society of Pharmacy of the same
city, have contributed materially to the advancement of this
very important branch of medicine. M. Gallard has
directed attention to the necessity of preparing the hydriodate
of potash with recent lard;f M. Caillot has given a new
process for the preparation of the same substance and
M. Baup has made some interesting observations on the
properties of, and on the mode of preparing the hydriodate

* M^moire sur cette Question : Determiner si, dans Tetat actuel
de nos connaissances, on peut etablir une classification r^guliere des
m^dicamens, fondle sur leurs proprietes medicales ? Lyon, 1823.
8vo.

t Journal de Pharmacie, Novembre, 1822.

I Ibid. Octobre, 1822.

96 Historical Sketch of the Progress of Medicine j S^c.

of potash, both simple and iodurated. M. Pessina, of
Milan, has published a new process for the preparation of
the hydro-cyanic acid, by which he professes to obtain this
substance in its most pure state. For an account of the
method which he adopts, and which is more economical than
those heretofore employed, we must refer our readers to the
January Number of the Journal de Pharmacie.

An excellent memoir on the preparation and classification
of extracts, by M. Recluz, has been published by the
Society of Pharmacy of Paris. F M. R. has given a new
arrangement of these preparations, founded on their active
principles. He has divided them into six classes: namely —
Ist, Alkaline extracts ; 2d, resinous extracts — a. the resinous
properly so called, and, h. those that are less decidedly so ;
3d, hitter extracts — a, bitter extracts that are strictly such,
h. cathartic bitters, c. tannine or astringent bitters ; 4th,
saccharine extracts ; 5th, extracts consisting chiefly of osma-
zome; and, 6th, extracts of a compound nature, whose imme¬
diate principles are so equally balanced that they evince no
one active property that can be distinguished above the
others. M. R. has appended an useful table to his essay,
exhibiting, in columns, the name of the various substances
thus prepared, the part of them used, either in a fresh or dry
state, in the preparation of extracts, the vehicle employed,
the means resorted to in obtaining each of them, the propor¬
tion of extract which each article yields, and the consistence
of the extract at the end of the process, and after having
been kept a twelvemonth.

M. CaventouJ has directed the attention of French
pharmaceutists to the application of steam to .this depart¬
ment of pharmacy.

A new method of obtaining the submuriate (proto-clorure )
of mercury^ in the state of an impalpable powder, has been
promulgated by M . Henry, jun. ; || and M. Duzoziez, jun.
has directed attention to a different and improved process of
procuring the nitric ether from that usually employed. We
refer those who are desirous to become acquainted with the
details of the modes of preparation to which we have referred
to the Numbers of the work already quoted : our limits and
our inclination prevent us from entering into particulars
\vhich, judging from the taste and pursuits of the majority of
the Profession, might but little interest them.

Surgery. — As many of the observations which we have
already adduced, connected with physiology and pathologyq

t Ibid. Fev. 1823.

11 Ibid. Dec, 1822.

* Journ. de Pharm. Janvier, 1823.
X Ibid. Decembre, 1822.

Surgery.

apply equally to chirurgical therapeutics ; and as we are not
aware of any important additions having been made to sur¬
gical pathology, within the period to which we limit this
sketcli, that are applicable to this art alone, we shall at once
proceed to take a cursory view of its practical improvements.

Commencing with the surgical treatment of aneurism^ the
ligature of the arteria innominata, by Dr. Mott, first attracts
our attention. The patient, a sailor, aged fifty-seven, was
admitted into the New York Hospital, with a catarrhal fever,
and a swelling of the left arm and shoulder. These affec¬
tions partly yielded to treatment, when he fell by accident
upon his arm and shoulder, in consequence of which a violent
pain and swelling in his right shoulder followed, and soon
after a slight pulsation was detected under the clavicle. On
the 3d of May, he felt a pain as if something had rent, and
the tumefaction immediately increased to a great size, and
the pulsations became more distinct, particularly on the
inferior side of the clavicle. He became very feeble, and had
a violent cough. On the 7th of Maj?^, Dr. Mott called in
Drs. Post, Kissam, and Stevens, and it was agreed to tie the
subclavian artery, and if it was found affected, to put a
ligature on the common trunk. On the 11th, the operation
w'as proceeded with, the patient having previously had
seventy drops of tinct. opii. Two incisions were made, one
in the direction of the clavicle, and the other along the
sterno-cleido-mastoideus. The carotid was laid bare, and
traced towards the subclavian, which was found so diseased
that they had no alternative but to tie the innominata. They
accordingly carried the incisions deeper, and separating the
recurrent and the phrenic nerves, they came to the division,
and passed the ligature with a curved needle, about half an
inch higher. The parts were then brought together by
suture, and the wound bandaged. There were only three
arteries divided — a branch of the internal mammary, and
two branches severally from the inferior and superior thyroid.
He lost only about three ounces of blood. The whole opera¬
tion was about an hour.

“ The patient immediately after felt quite well -—pulse 69
— temperature of the arm nearly the same as the other —
respiration unchanged. From this period to the twenty-
second day after the operation, he continued to improve, the
suppuration went on well, the ligatures came away without
accident, and the pulse, which had at one time risen to >120,
was reduced by venesection to its natural standard, the cough
was disappearing, cicatrization was going on properly, and
the swelling becoming gradually less. He w^as in high
spirits, and was so far recovered that he walked daily in the

VOL. XX. — NO. Il6. o

98 Historical Sketch of the Progress of Medicine, 3^c,

garden of the hospital. All on a sudden, however, on the
twenty-fourth day, a hemorrhage from the wound took place,
and though it was soon got under, and there was little loss of
blood, it recurred twice in the next two days, respiration
became painful, and the patient died on the twenty-sixth day.

Eighteen hours after death, the wound was black and
foetid-. There was no trace of inflammation in the arch of
the aorta, the origin of the arteria innominata^ or in the lungs.
The internal membrane of the innominata was smooth and
soft, and its parietes were so thick that there was only room
for a crow-quill to pass. The subclavian artery opened into
the tumour; the carotid was filled with coagulated blood.
The arteries of the arm were healthy. The clavicle was
carious, and almost separated in the middle. The death was
evidently caused by extensive suppuration.’’ ^

The same operation was performed by Professor Graeff:,
of Berlin, on the 5th of March, 1822, in a sailor, about thirty
years of age, for an aneurism in the right subclavian artery.
The following account of the operation is given in a con¬
temporary Journal : — “ During the operation, the patient

was put upon his back on a table, in such a manner that his
head was hanging down on one side of the table, and the
arteria innominata drawn up a little above the manubrium of
the sternum. The Professor then made a longitudinal inci- -
sion, near the anterior edge of the sterno-mastoid muscle,
down to the sternum, exposed the carotid artery, and followed
its course till wEere it unites with the subclavian artery to
form the trunk of the arteria innominata. This was effected
with very little difficulty, and the arteria innominata became
distinctly exposed to sight. By means of a needle, curved in
a particular manner for that purpose, a ligature was then
passed round the arteria innominata, and both ends of it tied
together.

No alarming symptom ensued, and the ligature, which
was considerably broad, came away about a fortnight after
the operation, carrying out just that portion of the artery
where the innominata is divided into tlie carotid and sub¬
clavian artery. Some time afterwards, however, a hemor¬
rhage suddenly arose, which, though considerable, w^as soon
stopped by the application of cold water and pressure. The
patient then complained of pains in the tumour formed by
the aneurism, in which fluctuation was distinctly to be felt ;
and this determined Dr. Gfaefe to make an incision into the
aneurismal sac. A considerable quantity of pus and grumous

* Langenbeck’s Ncue Bibliothek, and Journal of Foreign Medicine,
t Medical and Physical Journal for June, 1823.

Surgery. gg

blood was thus evacuated ; and matter continued to be dis¬
charged daily from this opening, whilst the other was filled
with granulations, and went on exceedingly well. The
patient, however, got into a state of fever, began to spit
blood, and to throw up matter; and so he died on the sixty-
eighth day after the operation had been performed.

On dissection, the lungs were found in a diseased state ;
and in the arteria innominata a clot had been formed, ex¬
tending from its origin to where the ligature had been
applied. By an injection made into the aorta, the arteries of
the right arm and right side of the head were entirely filled ;
the circulation in these parts having been fully re-established
bv anastomosing branches,”

Ligature of the subclavian artery has been twice performed
in this country within the period embraced by this essay;
but as the history of the cases, and the particulars connected
with the operation, have not yet been published by the able
Surgeons who performed it, we cannot at present take farther
notice of the circumstance.

An interesting case of fungus hamatodes of the eyeball has
been published by Mr. Wish art. * The disease originated
from a blow received on the eye^ and advanced steadily,
during several months, notwithstanding the antiphlogistic
and depletory treatment that was judiciously employed before
it had arrived at that state, in which the operation of extirpa¬
tion could not with propriety have been longer deferred.
The general inflammatory symptoms having greatly sub¬
sided, from the evacuations that had been prescribed with
that intention ; and the disease in the internal part of the
eye being still on the increase, the iris being now in close
contact with the cornea, and the pupil completely closed by
the opaque matter, it was resolved to extirpate the eyeball ;
and the operation was performed in the following manner.

The temporal angle of the eyelids was divided with a
scalpel, which was then passed round, first at the frontal
aspect of the eyeball, from the external to the interrial angle,
and the muscular and other attachments divided ; the lower
segment was divided in a similar manner ; and the fore-finger
of the left hand being passed from the nasal angle backwards,
the optic nerve was found to form the only remaining con¬
nexion ; it was readily divided with the same scalpel, and
the whole removed from the orbit. The lacrvmal gland was
dissected out ; the vessels were allowed to bleed for a few
minutes. The divided eyelid was then brought together by a
single small ligature ; and the clotted blood being removed,

Edinburgh Medical Journal for January, 1823.

100 Historical Sketch of the Progress of Medicine, S^c.

two small strips of dry caddis were pushed gently into the
orbit between the eyelids. Over this a pledget of simple
ointment, secured by a compress of caddis, and a few turns of
a double-handed roller, passed round the head. The little
patient was put to bed. He bore the operation uncommonly
well. It occupied only four minutes.’’

A twelvemonth after the extirpation the patient complained
of no local uneasiness^ nor of any affection of the head ; and
his general health was perfectly good.

Mr. Wishart has remarked respecting this case, that it
is the only instance of fungus haematodes of the eyeball
‘‘ that he has met with, in which the operation has been
attended with success and as so long a period as eighteen
months has elapsed since the operation was performed, he
trusts that there is no probability of the return of the disease.

In all the cases,” Mr. W. has gone on to observe, detailed
in Mr. Wardrop’s work, the result of the operation was unfa¬
vourable, except in one doubtful case. But he records only
one instance where the operation had been performed at a
very early period of the disease, and none where the optic
nerve was found in a healthy state. Although the operation,
therefore, holds out little prospect of ultimate cure, if the
disease is at all advanced, 1 was encouraged to try it in the
present case, from being assured that the disease was in an
early stage, being only of about four months standing when it
was ..performed ; and, though only a solitary instance of com¬
plete success, it ought to impress on the mind of every
Surgeon the necessity of attending minutely to the symptoms
of tliOi disease, and the importance of operating at an early
period. In this case, and in another of a child of tw^o years
old, I observed some puriform curdly matter floating at the
lower part of the anterior chamber, — a circumstance that I
am not aware has been noticed by any otlier writer on this
subject.”

Mr. Wishart found, on dividing the eyeball from the optic
nerve to the apex of the cornea, “ the appearances precisely
the same as those so accurately delineated by Mr. Wardrop
in the engraving of the drawing sent him by Sir Astley^
Cooper, and subsequently copied by Professor Scarpa into
the last edition of his work on the Diseases of the Eye. The
origin of the disease in the retina was finely and satisfactorily
illustrated. The optic nerve was quite healthy. The sclerotic
and-choroid coats were of natural texture. The cornea was a
little softer than natural, and not perfectly transparent. The
lens was pushed into contact witli it, and seemed smaller
than natural, and flattened. The diseased mass, into which
the retina had been converted, connected only to the optic

101

Surgery,

nerve, floated loosely in various folds, occupying both cham¬
bers of the eye. The eyeball did not appear to be at all
enlarged.’^

Adverting next to cancer^ a disease so nearly allied in its
characters to the foregoing, the fact detailed in our Number
for May * seems to point to an important circumstance in the
etiology of this and of some other malignant disorders. The
very interesting case, also, of cancer of the lip, f in which the
operation lately recommended by Richekand was per¬
formed by Dr. C. A. Bull, of Cork, in so satisfactory a
manner, cannot fail of attractinsr the serious attention of
Surgeons, both on account of the very important practical
principle which it conveys, and the pathological inferences
which it supports.

An interesting case of amputation of the lower jaw has
been detailed by Professor Lallemand, J of Montpellier.
The patient, a robust man, aged sixty-eight, was received
into the hospital St. Eloy on the 23d of May, 1822. Nearly
the whole of the inferior lip, from one commissure to the
other, extending downwards to the lower margin of the chin,
was in a state of cancerous ulceration, in which disease the
periosteum and bone itself appeared to participate. M.
Lalleinand commenced the operation, to which the patient
had consented, with two semi-elliptical incisions, commencing
in the superior lip, about five or six lines from the commis¬
sure, and terminating towards the middle of the thyroid carti¬
lage : the incisions were very convex above, and nearly
straight below the chin. Having found the periosteum and
bone afl’ected, the former being engorged, thickened, and
lardaceous, M. L. abandoned the idea of attempting to pre¬
serve the lower jaw. He dissected the cheek on each side to
the anterior margin of the inasseters. In this situation the
periosteum seemed perfectly sound; and here he sawed
through the jaw, commencing with the left side, a little
obliquely from without to within, and from behind forwards;
he then detached the muscles and soft parts on the internal
aspect of the jaw, and sawed through the right side in the
same direction. The labial, sub-maxillary, and ranine arteries
were successively tied, and some other branches that occa¬
sioned slight hsBinorrhage. He afterwards brought together
the inferior angle of the wound by means of three pins and
the twisted suture, and approximated the branches of the jaw,
with the soft parts covering them, by adhesive straps, after
having placed charpie in the interval which separated them.
■ - - - - - - - - - - - - - - — - -

* P. 436. t Published in the Repository for June, 1823.

I Journ. Univers. Decembre, 1822.

102 Historical Sketch of the Progress of Medicine, 3^c.

Tbe whole was secured by compresses and a few turns of a
bandage. After several untoward circumstances,* and fifty
days after the operation, tbe whole of the wound was per¬
fectly cicatrized. At that time an interval of nearly tw’o
inches existed between both ends of the jaw, allowing the
passage of the tongue, and causing a dribbling of the saliva ;
for this latter evil M. Lallemand contrived a silver chin,
holding a sponge on its concave surface, which could be
readily secured by straps passing back over the neck. By
aid of this sponge the saliva was absorbed and afterwards
pressed out by the tongue or by any other means, and articu¬
lation, which was before indistinct, was rendered more com¬
plete by this contrivance.

The case of ununited fracture of the lower jaw, which was
treated successfully by passing a seton through it, by Dr.
Physick, i- comes before us a requisite proof of the pro¬
priety of this method, after the numerous instances of its
failure in this country.

The case wherein bronchotomy was successfully per¬
formed by Dr. Jameson, J of Baltimore, for the purpose of
extracting a water-melon seed that had lodged in the trachea,
is important, inasmuch as, with those few instances wherein a
similar operation has been undertaken on account of a like
occurrence, it proves not only the propriety, but also the

* Haemorrhage from the surface of the wound occurred a short
time after the patient was put to bed, which occasioned pressure
upon the larynx and base of the tongue, owing to the sutures
and charpie having prevented its discharge. The patient had re¬
moved the bandages, and when M. Lallemand arrived, he found the
haemorrhage very considerable : it proceeded from no single vessel,
but was discharged from the whole divided surface. M. L. con¬
sidered pressure impossible, owing to the pain and difficulty of
respiration which it occasioned ; he therefore determined on the
actual cautery, which he applied freely both to the soft parts and to
the divided extremities of the bones, the spongy texture of which dis¬
charged a large quantity of blood. M. L. noticed during this process
a pathological fact which he had uniformly observed under similar
circumstances. On each application of the cautery, the heat pro¬
duced a species of erection of the vessels, and the blood was thrown
out with greater impetuosity, as if the arterial extremities were all at
once straightened and augmented in diameter.

In the progress of the treatment, the cauterized extremities of the
bone exfoliated, and farther delayed the recovery of the patient.

t Chapman’s Philadelphia Journal, No. 9.

X Published in the Repository for April, 1823, and in the Ame¬
rican Medical Recorder, No. 20.

103

necessity of resorting ta this means of remedying what cannot
be otherwise even alleviated, far less removed.

The operation for empyema has been successfully per¬
formed by Mr. Betty,* in the very important case already
alluded to under the head of pathology, and by M. ANGUET.'f
The latter instance occurred in a female, aged thirty, and
supervened in consequence of inflammation of the pleura on
the left side. M. Ariguet, in consultation with Dr. Merly,
made an opening between the third and fourth true ribs,
towards their anterior extremities, where' the signs of col¬
lected pus w^ere most evident. A branch of the anterior
mammary artery was divided, but the consequent haemor¬
rhage was readily suppressed by means of agaric. Five
pounds of purulent matter were discharged, and the patient
experienced immediate relief, which continued for several
days. However, as purulent matter continued to be evacu¬
ated through the opening, upon coughing and inclining for¬
wards at the same time, M. Anguet therefore supposed that
a considerable quantity of matter would continue to lodge in
the lower part of the thoracic cavity, which could not be
discharged by this aperture. On this account he determined
on making a second opening into the anterior part of the
same side of the thorax, between the last true rib and the
last but one. This operation gave issue to more than a
pound of a similar secretion to that formerly evacuated. The
two apertures continued to discharge some pus for a month,
during which time the health of the patient continued to
improve. Diet and regimen suitable to the disease and the
state of the patient’s constitution were administered, under
which the openings cicatrized and her health w^as perfectly
restored.

Connected with the surgery of the urinary organs f the
works of Mr. Bingham and Mr. Howship may be alluded
to at this place, although it is unnecessary to add more
respecting them than we have already done when they were
the subjects of review, and when they were noticed under the
head pathology. We shall, however, repeat the observations
which we made on a former occasion respecting the influence
of inpiries of the spine on the bladder, in order that their
validity may be subjected to examination, and the matters to
which they relate may be scrutinized more closely than our
opportunities in this department of medical inquiry allow us
to do. There are two topics,” we remarked, connected
w'ith retention of urine from injury to the spine, which hitherto

* Published in the Repository for March, 1823.
t Journ. Gen. Decembre, 1822.

104 Historical Sketch of the Progress of Medicine, S>fc.

have not been satisfactorily accounted for ; namely, the am-
nioniacal state of the urine in those cases, and the prone¬
ness of the bladder to an inflammation, which speedily termi¬
nates in gangrene, when the urine has been retained from this
cause.

In developing the pathology of the bladder and its
connexions, it has been generally overlooked that this viscus
is supplied with two sets of nerves, whose functions are
distinct, namely, the voluntary and involuntary : that the
former runs chiefly, but not entirely, to its neck and parts
adjoining ; that, in injury of the spine, the former only
suffers, while the functions of the latter are but little im¬
paired. Consequently, as all the sensations which depend
upon the voluntary set of nerves are lost, in proportion to the
extent of compression at their origins, the bladder becomes
over-distended without the sensations accompanying such a
state being conveyed to the brain. But, not only is sensation
not transmitted ; volition also cannot be conveyed by the
medium of the voluntary nerves of this viscus; and hence the
distention destroys the tone of its coats, which has been
already impaired by the loss of one-half of its nervous energy,
w'ithout any effort at evacuation being made by the pa¬
tient. To remove this distention, the catheter is the only
means ; but it cannot draw off the whole of the urine while
the bladder is entirely deficient in contractile energy ;
and even under the most favourable circumstances, it sel¬
dom can remove completely the contents of this viscus;
consequently, the portion left undergoes the change natural
to it when out of the body, which is heightened by the
high temperature to which it is subjected while it remains
within. The irritating qualities that are thus generated excite
the vessels on the villous surface to throw' out an additional
quantity of mucus: this, in a great measure, remains as a
sediment in the urine which the catheter does not remove, and
undergoes putridity, which, with the ammoniaeal properties
thus evolved, farther irritates the bladder, which irritation,
although not felt for the reasons just stated, runs on to inflam¬
mation, because inflammation and the other phenomena of the
vascular system depend upon the involuntary nerves which
are unimpaired, and are entirely independent of the voluntary,
which are the seat of injury. Inflammation supervening
under such circumstances soon terminates in a dissolution of
the textures, owing, in some measure, to that loss of energy
arising from over-distention, and to the defect of a portion of
the wonted nervous influence, as before stated. It may be
objected to this explanation that no urine is left by the
catheter. How can it be otherwise, when the catheter lies in
a loose and imcollapsing sac, as the bladder is in injuries

105

Surgery.

of the spine, and in the usual position of withdrawing the
urine on such occasions

A formidable operation, the extirpation of the womh from its
natural situation, has been lately attempted by Dr. Saute a,
at the urgent desire of the patient while suffering under a
cancerous affection of this organ. The patient was fifty
years of age; she had borne six children, and had ceased to
menstruate about four years. Having tried in vain to bring
down the uterus with the index-finger of the left hand, M.
Sauter introduced that and the middle-finger to the extremity
of the vagina, and, with a straight knife, he separated it from
the uterus, cutting the termination of the vagina little b}^
little between his tw'o fingers. In operating in this way, his
object was to draw the uterus downwards, to detach it after¬
wards from the cellular membrane surrounding it, either with
the handle of the knife or with the fore-finger of the right
hand. He found this could not be done in any way that he
I made the attempt ; but having advanced so far, it was neces¬
sary, he thought, to proceed, believing that the cancerous
ichor would infect the cut surfaces. Re-examining the parts,
he found the bladder had been wounded in separating it from
the uterus, and he therefore determined to extirpate this
viscus. He accordingly introduced two fingers of his left
hand into the wound, between the bladder and uterus, and,
cutting little by little between the fingers, he divided all the
adhesions, until, with the finger which followed the borders of
the uterus, he could penetrate into the cavity of the abdomen;
he then passed the fingers of his left hand as high as possible
to the lateral ligaments, seized and divided them as near as
he could to the womb; he then separated it from the ovaria,
from the Fallopian tubes, and the other ligaments. He then
I laid hold of the fundus with four fingers, and tried to invert it,
r but in vain, as the action of the abdominal pushed

j down the intestines. Having desired the patient to restrain
I this action, and the intestines being pressed upwards by an
I assistant, he inverted the womb, and drew it out between the
I labia; the excision was then easy. This horrible operation
I lasted three quarters of an hour : only one pound and a half
I of blood was lost ; the woman, however, fainted towards the
I termination. The intestines being put back into their place,
I the vagina was filled with charpie. We need not be sur-
I prised that this poor w'oman was troubled for several days
I with vomiting, and that her belly was painful; but in a short
I time all these symptoms disappeared, and, excepting that

^ Aniuili Univ. di Medic. 1823.
VOL. XX. - NO. I Iff.

J06 Historieai Sketch of the Progress of Medicine, S^c.

some urine escaped from the wound, her recovery went on
regularly. Suffice it here to say that, after a period of about
three months and a half, the patient quitted the hospital.
She, however, only remained at home seven 'days, and ex¬
pired about a fortnight after her re-admission. M. Sauter
describes this operation as not being either very painful or
accompanied by much hemorrhage ; but is of opinion that
wounding the bladder is inevitable.”^

Professor Paletta, of Milan, considered himself to be the
first Surgeon who extirpated the uterus from its natural
situation. ‘t* He performed the operation, on the 13th of
April, 1812, with the assistance of Monteggia, for ulcerated
sarcoma of the neck of the uterus. But, although no unto*»
ward occurrence took place at the time, the woman died on
the fourth day after its performance. Several cases have
been published in modern times, both in this country and on
the continent, wherein the uterus has been successfullv extir-
pated under certain circumstances of prolapsus.

For an account of the plan which M. Dupuytren has
adopted for curing we refer our readers to the

Number of the Repository for January.

The very interesting case of an extensive wound of the
genital organs, published in this Journal, J by Mr. Calla¬
way, although it terminated fatally, from circumstances con¬
nected with the moral and physical condition of the patient,
yet it illustrates, in a very satisfactory manner, an important
principle in surgical science, as well as the propriety of the
means adopted by this able Surgeon.

Dr. Murphy has published a case of chronic traumatic
tetanus, || w'hich was cured by means of very large doses of
laudanum and rum : six hundred drops of the former were
given in nearly a quart of the latter in the course of the
twenty-four hours; and afterwards fifty drops of laudanum
were directed to be taken in a glassful of rum, as often as the
patient could swallow' the dose. This latter prescription re¬
laxed the spasms, and the patient experienced a protracted
recovery. . '

How'ever much we may value the fact which Dr. Murphy
has recorded, we cannot sufficiently blame the style in which
it is written. He appears to-be a pupil of the school of
composition, of which his countryman Dr. Caldwell is the
master, if, indeed, the term master ought to be so applied, —
and W’hich is characterized by want of precision and pro-

* Medical and Physical Journal, No. 293.

t Rev. M6d. Janvier, 1823. | Repository for March, 1823.

II Philadelphia Journal, No. 9*

Surgery. 107

priety of language, and by an inflated and gasconading
style. *

The late Numbers of the Philadelphia Journal have con¬
tained some communications on the treatment fractures of
the thigh, by Professor Gibson, of Baltimore; but as the
plan which he recommends is the same with that long since

* We would recommend our American brethien to look to their
literary reputation, and not to compromise their medical character in
this particular. All men are more or less apt to judge of others
from appearances ; and although those of the same profession may
be the least apt so to do, yet even with them appearances have due
influence, for the traits of character cannot be otherwise seen, how¬
ever intuitive the perception may be ; and notwithstanding that the
difference in the opinions which are formed of individuals arises more
from the extent in which the observer is qualified to construe appear¬
ances than from the appearances themselves, still they are the requi¬
site bases of judgment, for even the imputed intuition into character
is nothing more than the result of the celerity and the correctness
with which appearances are interpreted. Upon these grounds, there¬
fore, we would recommend our American brethren to attend to their
literary appearance, as it is one of the few tests by which the public
are enabled to judge of professional character, and one too which has
most essentially tended to advance the reputation of European Physi¬
cians, especially the Physicians of this country, in the judgment of the
well-informed part of the community. The journalist himself, from the
nature and multiplicity of his engagements, as well as from the stated
periods at which he is obliged to come before the public, has it not
always in his power to exemplify the precept which he inculcates,
but surely those who are able to choose their own time of appearance
should at least endeavour to render it tolerably respectable.

Dr. Chapman has the following motto for his Journal (published
quarterly, each Number containing upwards of 220 pages), taken
from the Edinburgh Review : — “In the four quarters of the globe,
who reads an American book ? or goes to an American play ? or
looks at an American picture or statue ? li^/iat does the world yet
owe to American Physicians and Surgeons?'’ if Dr. Chapman wishes
to demonstrate the injustice of the last clause of the above quotation,
by the character of his work, we think that he has failed in the eyes
of his European readers ; that he has succeeded in his aim on the
other side of the Atlantic we as firmly believe. Our readers may
judge, in some measure, of Dr. C.’s success in repelling the charge,
as wc have presented them with every thing of interest in medicine
and surgery that has been published in this quarter during the two
bygone years. In a literary point of view, the “ American Medical
Recorder” deserves still greater censure than the work which is edited
by Dr. Chapman. We, however, express our acknowledgments to
our American brethren for their valuable researches on absorption,
an abstract of which was published in the Number of the Repo¬
sitory for .iune, 1 823.

108 Historical Sketch of the Progress of Medicine j ^c.

employed by a French Surgeon, we will not occupy our
limits by taking farther notice of it.

The subject of syphilis has been brought fully before our
readers in the Number of this Journal for April. Mr. CiESAR
Hawkins has also furnished some interesting observations,
in a contemporary' work, * on syphilitic ulcers in the larynx.

The case of scrofula published by Mr. L. Edmondston f
demonstrates the efficacy of local depletion under certain cir¬
cumstances of this obstinate disease.

The extending experience of the operation of acupunctura-
tion seems to lead to its more frequent adoption. The cases
lately published by Mr. Churchill, J in addition to those
recorded on the occasion of his introducing the operation to
the notice of Surgeons in this country, fully evince its efficacy
in painful disorders, especially in rheumatism : and the expe¬
rience of Dr. Sutton and Mr. Finch, as to its effects in
removing anasarcoiis swellings, shows that it ought to super¬
sede the use of scarification in these diseases.

The first volume of Delpech’s Clinical Surgery is the most
important work in this branch of knowledge which has lately
come before us. || From amongst the various important dis¬
sertations which it contains, we siiall only direct the attention
of our readers to one particular point connected with this
Surgeon’s observations on the treatment of club feet. With¬
out attempting to describe the various and well-contrived
apparatuses which he recommends for remedying this de- '
scription of congenital deformity, we may briefly notice the
opefation which he has adopted when the distortion arises
from a shortened conformation, or permanent contraction of
particular muscles or tendons. In these cases M. Delpech
has endeavoured to apply to practice the process which takes
place when tendinous structures are divided, and the divided
extremities kept in a state of jiixta-position. Taking advan¬
tage of the circumstance of an intermediate gelatinous sub¬
stance being produced from the divided ends of a tendon,
which, while it forms the means of reunion, tends to fill up
the interval between both the extremities when this is not
considerable ; and believing that this intermediate substance,
at an advanced stage of reunion, possesses a considerable
degree of tenacity and ductility, M. Delpech has proposed to
divide the tendon of a contracted muscle, when the deformity
can be assigned to that cause, or wdien the tendon itself is
shortened. Having proposed the division of the tendon, he
has next advised the divided ends to be kept in a state of

* Medical and Physical Journal for April, 1823.
t Medical Repository for May, 1823. I Ibid.

j| Sec Bibliography, in the Repository for May, 1823.

109

Surgejy.

approximation until the connecting medium, Vhich thus
forms, has obtained a considerable degree of solidity, when it
will bear a gentle degree of extension. For this purpose he
employs an apparatus so contrived that the extension may be
jiermanent, and ma}’ be increased according to the judgment
of the Practitioner, until it has reached the full extent to
which it may be proper to carry it, without risk of rupturing
the medium of union. M. Delpech has recorded a very
interesting case illustrating this particular treatment. A boy,
aged nine years, had a congenital deformity of his right foot,
arising from a permanent contraction or shortening of the
gastrocnemii muscles and tendon Achilles. The ancle-joint
was perfect, but the foot was so firmly extended and so com¬
pletely on the same axis with the leg, in consequence of the
congenital contraction, that motion at the ancle-joint was im¬
possible in this state. The points of the toes only could
touch the ground. Having ascertained the state of the parts,
and having adapted an apparatus to the foot and front of
the leg and knee, which was well calculated to keep the
divided ends of the tendon Achilles in a state of approxi¬
mation, and also to make extension, as soon as the connect¬
ing medium could bear it, by means of bringing and fixing
the foot in the direction of a right angle with the leg, M.
Delpech divided the tendon Achilles, and made the extre¬
mities approximate until the medium of union was fully
developed. On the twenty-eighth day after the section of the
tendon, M. D. commenced to make a gentle extension of the
connecting substance by bringing the foot towards a right
angle with the leg. Before entering on this process, he had
ascertained that the intermediate substance had attained a
degree of solidity which could warrant extension; that the
wound of the integuments, through which the division of the
tendon was made, had nearly cicatrized ; and that the tendon
had acquired a very few lines in length, owing to the forma¬
tion of the substance connecting its divided extremities.
From this period M. D. continued to increase daily the
extension of the tendon, or rather the flexion of the foot, by
the progressive turn of a few teeth of the wheel of his appa¬
ratus. At each time of making extension, which was gene¬
rally in the morning, the patient felt considerable pain in the
tendon, which always subsided in the course of two or three
hours.

A month after this process had been commenced, the sub¬
stance of reunion appeared to have reached the greatest
length of which it appeared susceptible : it w'as then tw'o
inches in length, and much less in diameter than the rest of
the tendon. The foot had reached a right angle with the leg.

110 Historical Sketch of the Progress of Medicine, 3^c.

and the patient could walk or run with but little lameness
some months after the operation, which was performed in
May, 1816.

The description of the principal operations in surgery, as
they are practised in England and France, contained in the
small w'ork of Mr. Averil, deserve to be noticed at this
place, especially as they embrace the methods of operating
recommended by Lisfranc (an eminent authority on these
subjects), which are not generally known amongst us. The
very excellent papers of M. Lisfranc, connected with opera¬
tive surgery, which have been published in the late Numbers
of the Archives Gemrales de Medecine, deserve the perusal of
Surgeons, not only on account of this Surgeon’s observations
on the methods of operating which he has introduced, but
also for his comments on those which are practised by other
Surgeons of celebrity.

Midwifery. — Commencing this department of our histo¬
rical sketch with an account of the more rare deviations from
the regular and usual process consequent on impregnation, the
first important occurrence which we have to record, according
to the natural arrangement of this subject as it is pointed out
by the generative process itself, is a case of snperfcctation which
has been lately published by Baron Percy. ^ A woman, re¬
siding in the vicinity of Lagny, became pregnant in July, 1820,
for the third time. She felt distinctly the movements of the
child about the fourth month, which gradually became more
feeble, and at last enlirelv ceased. In the course of seven
weeks from this period, she experienced all the symptoms of
a fresh pregnancy, and the nine months of this gestation
passed on without any remarkable occurrence. She was
attended by Dr. Cochard, of Lagny, and Dame Robert.
She had an easy and rapid labour, and was delivered of a
small but lively male child. Soon afterwards, when the mid¬
wife was about to leave her, fresh pains came on, during
which a number of black unorganized coagula escaped from
the uterus, and were succeeded by a black, flocculent, spongy
mass, in the middle of which was a female foetus, seemingly^
of the fourth month, and well preserved. The boy was nursed
by his mother, and throve w'ell.

J’he history of this interesting case would lead us to sup¬
pose that the first foetuS' — that which was discharged last, W'ith
the black-coloured coagula, died in utero at the time when its
movements were felt gradually to cease by the mother, and
that foetation again took place, soon after its death, and while
it was still retained in the womb.

* Journ. Univers. Mars, 1823.

Ill

Midwifery .

The very important case of ovarian fat atioriy recorded in
the June Number of this Journal, by Mr. W. B. Painter,
and already referred to under the head pathology,' is an
interesting addition to the history of extraordinary occur¬
rences connected with this brancli of medicine. The value,
however, of this and similar cases does not consist in their
novelty, but in the light they throw on some of the most
obscure, but most important operations of the animal eco¬
nomy.

A case of Fallopian conception, which came under the
observation of Dr. Roagna,^ furnishes an interesting in¬
stance of the operations of nature in remedying such an
occurrence. A healthy Spanish female became pregnant for
the third time. This state was evinced by the usual symp¬
toms. The abdominal tumour was directed towards the left
iliac region ; and the motions of the child were distinctly
felt at that situation, about the period of quickening. Soon
after this epoch she was seized with pains similar to those of
labour, which terminated in an evacuation from the uterus of

I ^ ^

j a fluid tinged with blood. Milk-fever supervened to this dis-
i charge, and the breasts became filled with milk. She men-
; struated regularly from the month of December to August of
; the following year, w'hen the catanienia ceased, and were
succeeded by a continual discharge of a yellowdsh white
matter, and by pain and various anomalous symptoms refer-
rible to the uterine tumour and pelvic region: she had also a
continual diarrhoea, accompanied with tenesmus. About the
commencement of the second year of her ailments, her suffer¬
ings increased, continued fever, with intervals of cold and of
burning heat, supervened, and the sense of heat and the
I pains wdiich were referred to the sacrum became more severe.

^ Soon after this period she evacuated by the rectum several
bones, wdthout cartilage or covering. The excretion of the
bones was accompanied with a discharge of purulent and
sanguineous matter. On carefully examining the parts, M.
Roagna discovered that these bones had passed from the left
Fallopian tube through an opening of about six lines in
extent that existed in the intestinum rectum, twenty-one
lines from the anus. This evacuation continued at intervals
up to the third year after the conception. Since that time
she has menstruated regularly, and enjoyed a return of her
usual good health.

Adverting next to those occurrences which have beeu
lately recorded, illustrating the nature and management of the
parturient process, and of the derangements which frequently

* Revue Meclicale, Janvier, 1823.

112

Historical Sketch of the Progress of Medicine^ &>jc.

complicate and render difficult or dangerous this important
operation, the facts connected with puerperal convulsions
deserve, from the importance of the subject, an attentive
consideration. An interesting case of this description has
been placed before our readers by JDr. Henry Davies,"^
wherein depletion, carried to a very great extent, proved
eminently successful. In this instance the placenta was
allow'ed to remain for a few hours, owing to particular cir¬
cumstances connected with the case. The total blindness
which characterized it, and, indeed, its subsequent history,
render this instance of the disease important in a patholo¬
gical point of view.

The employment of the ergot of rye in puerperal convul¬
sions has been successfully adopted by American Practi¬
tioners, f Dr. Waterhouse has detailed the case of a
female of a nervous temperament and delicate habit, who
was seized with this disorder at the commencement of labour,
and while the os uteri was in a very small degree dilated.
Every method had been adopted, which he considered ad¬
visable, without advantage, when the ergot presented itself to
his mind as the only remaining means which he could employ
with the hope of saving his patient. He mixed thirty grains
of this substance in a small quantity of warm water, and with
difficulty procured its deglutition. The effects, he has
informed us, were almost instantaneous. Her spasms gave
way, and she awoke, as she supposed, from a disturbed and
painful sleep.’’ J

For a full detail of the experience of Dr. Stearns, of
New York, respecting the exhibition of the ergot in parturi¬
tion, and for copious directions for its use, we must refer our
readers to a former Number. ||

Pupture of the uterus, one of the most dangerous accidents
that can attend on the process of parturition, has come before
us on two occasions within the period embraced by this
essay. Both these cases were most remarkable, and even
singular in their complication ; especially the one which is
recorded by Mr. Gaitskell. § It is unnecessary to make
farther reference to that interesting occurrence, as it is already
placed fully before our readers : w4 will, however, notice
some particulars connected with the other, which is published

* Repository for June, 1823.

t See a case of its beneficial effects in another part of this Number.

I American Medical Recorder, No. 20, and Medical Repo¬
sitory for April, 1823.

II Medical Repository for April, 1823, p. 279* * * §

§ Ibid, for March, 1823.

113

Midwifery.

b}^ Dr. Ch URCH HI an American work,* as it illustrates one
of’ the consequences of injury done to the bladder during
difficult cases of labour, in addition to the occurrence under
consideration, the cause of which admits of various interpre¬
tations. Dr. C. was called to this patient, aged thirty-six
years, while she was in labour with her fifth child, and
attended by a midwife. On examination, he found that the
head of the child had descended low, and was w'edged in the
pelvis. By passing his hand over the abdomen, he was sur¬
prised to find that it had, in a great measure, lost its globular
form — and that just above the pubes, on the right side, he
could distinctly feel through its parietes the child's elbow.
He therefore apprehended a rupture of the cervix uteri, and
inquired if she had experienced any feelings indicative of such
an occurrence; but none of the symptoms, which usually
evince its supervention, were remarked. The absence of the
ordinary signs of rupture led him to hope that the cervix
uteri 'had spasmodically contracted around the child's elbow,
and under this impression he took sixteen ounces of blood
from the arm, on which her pulse became soft." He afler-
w'ards gave the powdered ergot, and repeated it without any
effect on the uterine action. Her pulse becoming rather
weak, several unsuccessful attempts were made with the
forceps, lever, and blunt hook, to bring down the head, during
w'hich* the child, at once, receded wdth a hissing noise
through the rent into the cavity of the abdomen." The
symptoms usual to such a state then became manifest ; and
the woman died within a few hours undelivered. On dissec¬
tion, which took place some hours afterwards, every part of
the child was found to have escaped from the cavity of the
uterus. The placenta was not adhering to the uterus,
although remaining in its situation. The uterus," Dr.
Church has continued to inform us, presented a general
and extensive laceration from iho: fundus to its connexions
with the bladder and rectum. Its parietes were reduced from
the ordinary thickness to that of paper, and more particularly
so at the insertion of the Fallopian tubes, where it was quite
transparent, and of a frail cobweb-like texture. We then
sponged up about a pij}t of blood from among the intestines
and the cavity of the pelvis. The next organ examined was
the bladder. This exhibited a truly singular appearance. Its
Size w'as preternaturally large — white and shining in its
external coat — and of a texture as hard and firm as the
most indurated mammary glands we ever recollected to have
seen. An incision was made into the fundus, and extended

* Philadelphia Journal, No, 9.
VOL. XX. - NO. 116. O

1 1 4 Historical Sketch of the Progress of Medicine^ Sfc.

to within an inch and a half of the urethra. At the fundus,
its parietes were two inches and three-eighths of an inch thick ;
and at the lower extremity of the incision, at least tivo inches.
To form a more accurate idea of this scirrhous mass, its cir¬
cumference around the fundus was carefully measured, and
found to be sixteen and a half inches — its length from the
margin of the fundus to the insertion of the urethra, was
eleven inches and an eighth. The walls of the bladder had a
cartilaginous feel, and were of a whitish and striated colour.
The cavity presented a very irregular surface, and appeared as
if it had contained clots of grumous blood. Its dimensions
were so much reduced, that we are confident it could not
contain more than two ounces of fluid at any one time. No
calculi were contained in it.

** The ureters were preternaturally large, and, like the
bladder, had a white shining exterior, with a cartilaginous
feel and firmness. The ovaria next came under our notice —
and w'e discovered the right enlarged to the size of a walnut,
and in a scirrhous state. The left was natural. The broad
ligaments were covered with small tubercles, and were torn
in several places. The round ligaments were perfectly natural.
The rectum was free from disease. No laceration or rupture
of the vagina had happened.”*

* That rupture of the uterus had not taken place, in this interest¬
ing case, when Dr. Church felt the prominence above the pubes, is
evident from his own showing. The pulse before the bleeding “ was
full and tense, and the countenance perfectly natural,” &c. &c. It
is much more probable that the attempts to bring down the child’s
head, under the state of morbid structure observed in the uterus,
actually lacerated this viscus. The attempts at introducing the
forceps, or at bringing away the child by means of the lever, were
sufficient to produce this effect under the singular circumstances of
disease of the uterus, although such means were perfectly justified by
the state of the patient. That this was actually the case, is shown by
the symptoms of rupture which then became most evident, and not
until then. The deception, on the examination of the abdomen,
arose, perhaps, from the morbid condition of the bladder. Was Dr.
C. sure of the previous death of the foetus, that no attempt was made
to bring it away alive, when it was evident that the mother could not
be saved? It does not fully appear that he was by the manner in
which the case is related.

Dr. C. has given the following history of this case previous to the
occurrence already noticed, which appears to account, in part, for
the disease of the bladder; — “ In the month of February, 18l6,
Mrs. D. was, after a very difficult labour of five days and nights,
delivered by the natural powers of her first child. It was very large,
and to all appearance had been dead two or three days. A slight

Two cases of Ccesarean operation have been recorded by
Mr. J. U. Van Buren, of Tortola,* one of which proved
successful, notwithstanding the warmth of the climate in
which it was performed. This case, which occurred in a
slave, aged thirty-five, in her sixth pregnancy, took place in
April, J820. Dr. Doty, who attended this female, had
ascertained that labour was impeded by deformity of the
pelvis, which had evidently advanced to the state in which he
found it since her last delivery ; considering the Caesarian
operation indispensably necessary, he sent for Mr. Van Buren.

After having attentively examined,^’ this Surgeon has in¬
formed us, the state of the pelvis, and found the malforma¬
tion such as to render it impracticable to introduce any
instrument for the removal of the child, I did not hesitate in
coinciding with Dr. Doty in the necessity of the immediate
performance of the Caesarian section ; being of opinion that,
where the state of the pelvis is such as to prevent the possi-

attack of puerperal fever supervened, which in a few days yielded to
the usual remedies. But she also complained of a violent pain in
the region of the bladder, with inability to make water. Opium,
anodyne glysters, warm fomentations, and demulcent drinks, were
prescribed, w'hich mitigated the pain, though the inability to make
water still continued, and she had to be relieved every few hours by
the catheter. Early in March following, enuresis came on, of which,
by the aid of the usual remedies, she recovered in about three weeks.
The use of the catheter had to be continued till about the middle of
April, when, her health being apparently re-established, further medical
attendance became unnecessary. From P^ebruary, 18l6, until June
23d, 1822, she had one miscarriage, and was at different times de¬
livered of three children at the full period, one of whom was still¬
born. She always had severe and lingering labours.

“ I think it more than probable that the bladder was injured during
the first labour, owing to the chihfs head being wedged low down in
the pelvis, upwards of twenty-four hours previous to delivery. This
made it impracticable to introduce the catheter to evacuate its con¬
tents ; consequently distention took place, occasioning inflammation
and thickening of its muscular coat, and which eventuated (terminated)
in scirrhus ; and that it being so frequently exposed to injuries during
laborious parturition, kept up and increased its diseased condition,
which gradually extended to the uterus and the parts connected
therewith : and further, that the constant pressure which the uterus
sustained between the child and the firm and enlarged bladder, caused
absorption of the parietes of that organ — hence, rupture of that
viscus took place. I am, indeed, much astonished, considering its
diseased state, that it did not rupture much sooner. The state of the
bladder satisfactorily accounts for the unsuccessful attempts to deliver
by the forceps and lever.”

* Medical and Physical Journal for February, 1823.

116 Historical Sketch of the Progress of Medicine , ^c.

bility of the child’s passing, no time should be lost, from the
firmest persuasion that lives would be saved by the early
resort to the operation, instead of waiting (as is too frequently
the case) until the patient becomes exhausted by useless
efforts to expel the child. The patient, instruments, and
dressings, being ready, I operated in the following manner: —
Having placed the patient on her back on the table, with a
common scalpel I made an incision through the integuments,
from the umbilicus to the pubis, so as to expose the linea
alba. An opening was then made at the superior part of the
incision, through the aponeurosis of the linea alba, into the
cavity of the abdomen. Introducing tw'o fingers as a defence
against wounding any of the viscera, with a curved bistoury
the linea alba and peritoneum were divided, the full extent
of the first incision. The uterus immediately presented
itself; an inspection, to ascertain the situation of the pla¬
centa, being previously made with all possible despatch. An
incision was made into the superior part of the fundus uteri,
and extended about seven inches, when the foetus and pla¬
centa were extracted as speedily as [)ossible. In the instant
of removing the foetus, a prolapsus of the intestines took
place, but they were immediately returned, and kept in situ
by Dr. Doty. The lips of the external wound were brought
in contact by sutures and adhesive plaster, care being taken
not to include the peritoneum in the sutures. The eighteen-
tail bandage was used, the patient put to bed, and an anodyne
given.”

The patient did not lose more than eight ounces of
blood during the operation, which she bore wdth astonishing
firmness. Every precaution was taken to save the child,
which lived for several hours.^ The patient slept well during
the greater part of the night. Not having passed urine for
some time, she was relieved by the catheter. She was free
from pain, and had every appearance of doing well, until the
morning of the fourth day, when she complained of thirst,
had slight fever, but felt no pain or soreness of the abdomen.
At noon she complained of griping pain: an enema w^as
ordered, which procured two evacuations, and afforded her
relief. The rest of the day she continued free from pain.
Her diet consisted of salup, panada, and flour-pap. She
slept well this night, without an anodyne.

About two o’clock, P. M. of the following day (the fifth
after the operation), she became restless, and complained of
much pain in the lower part of the wound, attended with

^ The patient had been upw'ards of sixty hours in labour before
the operation.

117

nausea, inducing efforts to vomit. The pulse was contracted,
hard, and upwards of 100; tongue dry. Thirty ounces of
blood were taken from the arm, and the following anodyne
administered : —

R Tinct. Opii, tttxl.

Spt. iTth. Nit. 3ss.

Aq. Menth. Sat. 3x. M.

In about half an hour she found relief, and slept for several
hours. Her bowels were kept open by the use of glysters,
and the same diet was continued.

On the sixth day, she had no return of pain or nausea,
and her appetite was good, until a few hours after the first
dressing (which took place on this day), when she was
attacked with intense pain in the abdomen, attended with
vomiting. Her bowels were now perfectl3J^ free ; the pulse
upwards of 100, and, as before, hard and contracted. Six¬
teen ounces of blood were taken from the arm, and flannels
steeped in warm spirits applied to the abdomen. She had a
severe rigor. The patient attributed this relapse to the cir¬
cumstance of the door of her hut (which opened directly
opposite her bed) being incautiously left open for several
hours, during which time she was exposed to the draught of
a northerly wind. The first bleeding afforded no relief; and
no internal remedy could be resorted to, for the stomach
rejected every thing. In about three quarters of an hour,
twenty-four ounces of blood were taken from her. Shortly
after this bleeding she found relief, and fell into a sleep of
several hours’ duration. I’he w'ound retracted at the inferior
part of the incision, for about two inches : it, however, did
not assume an unhealthy appearance.

“ The following day she was much better, and continued
doing well until the eighth day, when, unfortunately, the bed¬
stead on which she lay fell down, and gave her a violent and
sudden shock. She soon after complained of having received
sensible injury from the fall. On the evening of the same
day she complained of violent pain in the neck and back, in
the course of the spine, with stiffness of the jaws, and diffi¬
culty of deglutition. I visited her about two hours after she
was seized. The jaws were much locked, and the spasms
increasing rapidly in violence. One dram of laudanum was
administered in a gill of white wine. The neck, back, and
throat, were rubbed with warm oil and laudanum. The
spasms not abating in half an hour, two drams of laudanum
were administered in burnt brandy. In about a quarter of an
hour after the last dose was given, the symptoms abated; but
at the expiration of the half-hour the dose was repeated, as
before, in burnt brandy, as the patient did not appear to be

1 1 8 Histoncal Sketch of the Progress of Medicine, S^c.

sufficiently under the influence of the medicine to produce
a complete remission of symptoms. Shortly after this she
fell into a profound sleep, and the tetanic symptoms did not
return. Her diet was now ordered to consist of animal food,
and Madeira wane, to the extent of three gills, per day.
The wound retracted a little more, assumed an unhealthy
appearance, and for several days the discharge was sanious
and fetid. Stimulant applications were made use of, and
in a few days healthy action was renewed. The wound was
dressed daily, from the sixth day, until cured.

From this time no material circumstance occurred. On
the nineteenth day from the operation she was able to walk
about the yard. An elastic roller was ordered to be applied
over the abdomen, and worn for some time. The patient
continues well to this day, and does field-work with the
rest of the negroes on the estate.’^*

On the 20th of May, 1822, Mr. Van Buren was called to
the second case, a negro woman, in labour with her first
child. On examination, he found an extensive warty ex¬
crescence uniting firmly the labia nearly their whole extent.
In consultation with Drs. Porter and Ross, it w'as decided
that, considering the indurated nature and situation of the
tumour connecting the labia, excessive haemorrhage would
attend the excision, and, in all probability, endanger the life
of the w'oman ; and that, therefore, the Caesarean section was
the only alternative.’’ f Accordingly the operation was per-

* The importance of this case, and the able manner in which it
was treated, must be our apology for the particular account which
we have given of it.

t Were the dangers to be apprehended from excision of this warty
tumour, and from attempting to procure delivery afterwards, vid
naturali, as great as those which we might expect from a division of
the abdominal and uterine parietes? We certainly would answer
this question in the negative. It does not appear that the vagina
was included in this state of disease, for we are informed that a
passage still existed into it — “ admitting the introduction of but one
finger into the vagina.’^ Those who had the opportunity of examin¬
ing the patient were certainly the best judges of the means to be
adopted for her relief; but we must be permitted to suggest, that the
case may not go down to posterity without dissent from the
principle which it appears to involve, and which it may become
a precedent for under some circumstances, that the excision of
the warty excrescences connecting the labia, and the acceleration of
the labour, which was at the time in progress, would not, under
proper management, have been attended with the excessive haemor¬
rhage which was dreaded. Indeed the passage of the child, and con¬
sequent pressure, would have arrested haemorrhage for a time, and

119

formed in the manner described in the former case, and a
living child removed, which has continued to thrive. The
patient was put to bed, and an anodyne given. She con¬
tinued free from pain, was cheerful, and sanguine as to the
event, for two days, when her bowels became obstinately
costive, and the abdomen very tense. A saline cathartic was
administered without effect. Injections were given every
two or three hours, which opened her bowels on the third
day. The fourth, she continued to do well. On the fifth,
her stools became frequent and watery : port wine and
Indian arrow-root, with anodyne injections, were ordered.
The discharge from the bow'els was arrested for a few hours;
but, owing to the want of attention in the regular adminis¬
tration of wine and nourishment during the night, the dis¬
charge from the bowels returned wdth increased violence,
under which she sunk, and died on the sixth day after the
operation.’’

The concluding part of our historical report of the progress
of the obstetric art would have related to those disorders
which supervene soon after, and as a consequence of the
parturient process, if any additions had been made to this
branch of the subject within the period to which we are
limited, or if any observations possessed of due interest had
come before us. A very long treatise, however, on uterine
hamorrhage, by Dr. Dewees,* * has reached us in part only;
but as we are yet strangers to the extent to which the Doctor
intends to prolong his discourse, we cannot at present make
farther reference to it.

The excellent articles connected with midwifery, con¬
tributed by Professor Desormeaux to the volumes of the
Dictionnaire de Medecine, which have already appeared,
will be read with advantage by those who devote their
attention to this branch of medical practice.

Botany. — We regret that our limits oblige us to give
rather the references to the observations connected with this
branch of science that have lately come before us, than a
detailed account of the observations themselves. The most
important work, which it is our duty at present to notice,
is the synoptical description, by Professor Kunth, of the

after delivery means might have been devised which would have
stopped it altogether, if it recurred. The only risk from this pro¬
cedure was the heemorrha^e: the risk in the Caesarean section was
double — the risk from haemorrhage was great, and that from peri-
1 toneal inflammation was still greater, which latter was not to be
dreaded from the excision in question.

* Philadelphia Journal, Nos. 6, 7? S, 9, lO.

1£0 Historical Sketch of the Progress of Medicine^ S^c.

plants collected by Humboldt and Bonpland during their
researches in South America,* the greater part of which s}'nopsis
has just appeared. Of four thousand five hundred plants
brought by these travellers from equinoctial Ylmerica, about
four thousand have been shown to be new species. The splen¬
did work which M. Kunth published, in six folio volumes,
under the title of Nova Genera ei Species Plantarum,^’
contained an admirable account of these extensive disco¬
veries. It may be proper to mention that, during the pub¬
lication of this work, M. Kunth availed himself of the
assistance of two distinguished individuals: M. Agardh,
Professor at Lund, described the Algai; and our eminent
countryman. Dr. Hooker, Professor of Botany at Glasgow,
arranged the orders, Musci, Jougermania, Lichenes, and
Fungi. The number and beauty of the plates, which accom¬
panied the descriptions in that splendid work, rendered it
too expensive for general circulation amongst botanists:
M. Kunth and his distinguished associates have, therefore,
considered it proper to publish a synopsis of their labours in
this department of knowledge, which may be accessible to
the learned and scientific of every country. M. Kunth has
follow'ed a natural arrangement in both the former and
present works. He has commenced with the order olg^e,
and has given not only the generic and specific characters
of each plant as he has proceeded, but he has also noticed
the various synonyms, the precise place where each vege¬
tates, the time at which it flowers, the colour and appearance
of the flowers, its use in medicine and in domestic economy,
and various other particulars possessed of interest to the
scientific or practical botanist.

, Professor Bertolini, of Bologna, has publishedf an
account of some plants but little known to botanists. Of
these two are indigenous, the polygonum flagellare, Bertol. ;
and the arnica floccosUy a new species : the others have been
brought from iniei tropical America, and are too numerous
to be particularized within our limits.

An interesting enumeration of plants collected on the
banks of the Black Sea and in the islands of the Grecian
Archipelago, has been lately published by M. Dumont

* Voyage de Humboldt and Bonpland, 6e. partie. Botanique. —
Synopsis Plantarum, quas, in Itinere ad Plagam TLquinoctialem Orbis
Novi, collegerunt Al. de Plumboldt et Am. Bonpland. Auctore
Carolo Sig. Kunth, Prof. Reg. Acad. Eerol., Inslitut. Gal. &c. &c.
Paris, 1823.

t Antonii Bertolinii, Med. Doct. &c. Lucubrationes de Re Her¬
baria, &c. Bononise, 1823.

121

D’Urville.* * * § This addition to botanical science is im¬
portant under two points of view, 1st, as a geographical
catalogue of plants from places but imperfectly known to
botanists. M. D’Urville has given an enumeration of 950
species, of which the majority is either new or never before
assigned to tlie countries where he found them ; or then
known only by means of the collections and manuscripts of
Tournefort. This catalogue, however, is not arranged
into natural families; and the circumstance is the more to
be regretted, as the natural classification is the only one
that can give an exact idea of the kind of vegetation of a
district or country. 2d, The botanical descriptions of the
plants discovered by M. D’Urville are given ’ivith much care.
They amount to about 60 species, chiefly belonging to the
families of the Graminea, Rubiacead, Caryophyllea^j XJmbellifer(Rf
habiatcE, Leguminosce, OrchidecE, and Alga. The last named
order has received, by the researches of this botanist, si.x
additional species and several varieties, which have been
determined and described by jVJ. Lamouroux.

Two new families of plants, the Balanapkorea and the
CydayithecEy have been lately established in France. The
former, which has been described by M. L. C. RicHARD,‘t
embraces four genera, of which two only have been known to
former botanists, the Cynomorium, and the Balanophora. M.
Richard has added the other two genera; one of which, the
Langsdorffia, was discovered by Martius in the Brazils ; and
the other, the HelosiSf is entirely new.

The latter natural family, the Cyclafithea^ which M. A.
PoiTEAU has proposed to establish, J contains only one
genus, Cyclanthm, a new and singularly organized genus.
This family is nearly allied to the Aroidea^ and especially to
the genus CarludovicGy the characters of which genus this
botanist has endeavoured to describe more accurately than
they have been heretofore. 1|

A very interesting and classical production, entitled the
Flora of Virgil, § has been published by M. F^:e, of Paris.
The importance of such a work to the cultivators of classical

* Enumeratio Plantarum, quas in insulis Archipelagi aut Litto-
ribus Ponti-Euxini, annis 1819 et 1820, collegit, atque detexit
J. Dumont D’Urville, Mem. de la Soc. Linn, de Paris, T. I. 1822.

f Memoires du Mus. d’Hist. Naturelle, Vol. VIII. p. 404.

X Mem. du Mus. d’Hist. Nat., Tom. IX. p. 34.

II Oper. cit. p. 25.

§ This work, which was lately published along with an edition of
the Latin classics, has appeared separately within the by-gone
month.

VOL. XX. — NO. 116. R

122 Historkal Sketch of the Progress of Medicine, S)C.

literature, as well as to botanists, will be most evident. The
learned papers also of the same author, in the late Number of
the Journal de Pharmacie, especially those on the Lotos
of the ancients, will be perused with much interest.

The first volume of the work of M. A. Richard,* on
Medical Botany, has appeared within the period to which
we limit this sketch. The author has given a full account
of the natural history of the ^medicines, poisons, and aliments
which are derived from the vegetable kingdom. This work
possesses the advantage of having the plants, wdiich are de¬
scribed in it, distributed according to the natural method of
Jussieu. This is a oreat recommendation to those who
study botany with a regard to the practice of medicine,
because the properties of plants of the same family are gene¬
rally analogous, and hence the Physician may generalize his
views respecting the properties of medicines contained under
the same family, and may have a more extended field before
him whence he may choose, or may vary, his remedies accord-
insj to circumstances.

JVJ. Richard has described the families, genera, and species
with great accuracy and precision, and has added interesting
observations on the use, properties, and chemical compo¬
sition of the particular species. He has, at the conclusion
of each family, recapitulated the general qualities and modes
of action on the animal economy of the plants which it
embraces. The natural history of the different species of
cinchona, which concludes this volume, is particularly in¬
teresting.

A very valuable exposition of a new method of classifica¬
tion, which has been adopted in arranging the plants at the
School of Pharmacy in Paris, has been published by M.
GuiART.f This plan appears more nearly allied to that of
Tournefort than to any other.

We regret that our limits prevent us from giving this very
able, although in some respects objectionable, arrangement
in the present sketch ; as, however, it has only recently come
before us, w^e will defer it until our next historical essay.
Another methodical exposition of the vegetable kingdom has
lately claimed our attention. The author of this ingenious
production, M. Caffin,J has supported bis views with great

'* Botanique Medicate, &c. Par A. Richard, M. D. Premiere
partie, 1 vol. in 8vo. Paris, 1823.
t Journal de Pharmacie, Mars 1823.

t Exposition M6thodique de R^gne Vegetal, dans laquelle les
Plantes sont classees d’apres les Differences qu’elles presentent dans
leur Organization et leurs Fonctions, &c. &c. Par F. I. Cafifin,

123

ability, and with a perfect knowledge of his subject. His
observations respecting the organization of fruits are par¬
ticularly interesting. With respect to his classification, many
objections may be urged against it. Indeed, it furnishes an
additional proof how very difficult, and even impossible, it is
to assign and to establish the natural relations of vegetables
by means of a single organ or part ; and it clearly points to
the propriety of consulting the general characters and con¬
ditions of all the organs, or the greatest number of general
similitudes, in order to bring together organized beings into
strictly natural families.

The most interesting works which we may notice, as being
in progress of publication in this country, are, the Anatomy
and Physiology of Plants, by Mr. A. T. Thomson; the
Flora Exotica, by Dr. Hooker; and the Scottish Crypto-
gamic Flora, by Mr. Greville. These works are becoming
well known to the cultivators of botanical science; and we
expect that they wall contribute materially to excite a
desire after this branch of knowledge, especially in the
medical profession, amongst all ranks of which it is very
improperly neglected.

No additional facts have come to our knowledge within
the last six months respecting the anatomy plants. M. T.
DE Saussure has, however, been engaged in some interest¬
ing observations w’hich elucidate their physiology . This phi¬
losopher has ascertained, as the results of his experiments,
that the flowers, even of aquatic plants, do not develope
themselves in media deprived of oxygen gas; and that they
require, for the support of their vegetation, a greater pro¬
portion of this gas than the rest of the plant. M^hen a flower
is placed under a receiver full of air, and shut by mercury,
it changes little or nothing the volume of the air, while
oxygen is present. It absorbs this gas, replacing it by
nearly an equal volume of carbonic acid. M. de Saussure
has not found any trace of hydrogen nor of azote in the air
in which flowers have vegetated. He found the quantity of
oxygen destroyed by the flowers to be greater in the sun
than in the shade : he observed also that a rise of tempe¬
rature also augmented this destruction. While the flowers
thus consume a much greater quantity of oxygen than the
rest of the plant, and soon perish when deprived of it ; the
leaves contain so much oxygen in their green parts that,
when deprived of it for a while, they form a proper atmo¬
sphere by means of the quantity which they give off'.

Medecin. 8va. Paris, 1823. — See Bibliography in Repository
for April, 1823.

1£4 Historical Sketch of the Progress of Medicine, S^c.

M. de Saussure also observed in his experiments that
simple flowers destroy more oxygen than double flowers of
the same volume and kind ; that the greatest quantity of
oxygen was consumed at the moment of foecundation ; and
that the stamina adhering at their base, and to the receptacle,
caused the disappearance of more of this gas than the other
parts of the flower.

Lamarck had discovered that the spathae of the genus
arum evolved heat, and Lennebier and Hubert con¬
firmed the observation. Saussure has observed this property
in some other plants, although it is most remarkable in the
species belonging to this genus, and he is inclined, partly, to
account for it by the rapid destruction of oxygen, or its
combination with the vegetable carbon, especially during the
time of foecundation. He found the heat of many flowers
to be in proportion to the quantity of gas destroyed. He,
however, considers the absorption of oxygen not to be the
only cause of heat ; for the bignonia radicaiiSy w hich is a
warm flower, consumes less oxygen than the passijiora
serratifolia, which is a cold flower. A fallacy is apt to arise
in estimating the heat of plants, owing to their evaporation,
and to the moisture adhering to the bulb of the thermoscope,
and thence evaporating.*

Chemistry. — Our limits prevent us from noticing the
greater part of the numerous researches into the constitution
of particular substances which have lately come before us,
and oblige us to confine our sketch to a few investigations
which have tended to render the present an important epoch
in the history of chemical science. The researches of Mr.
Faraday respecting the constitution of the gases appear
to us the most important amongst the latter number, and
indeed the greatest discovery which has been made for
several years in this department of science.t This enter¬
prising Chemist has ascertained that many of the gases may be
condensed into liquids, and that the liquids thus produced are
colourless, with the exception of euchlorine ; and all are per¬
fectly fluid, and highly volatile. As the communications,
which have been read before the Royal Society, describing
the means of obtaining these very important results; and
the papers of Sir Humphry Davy on the application of the
liquids thus produced, as mechanical agents, have not yet
been published, we cannot at present make farther reference
to the subject.

* Mem. Soc. Phys. et Hist. Nat. Geneva,
t Repository for May, 1823.

Chemistry, ' 125

The researches of Dr. Ure into the composition of vege¬
table and animal substances* form the greatest acquisition to
analytical chemistry which has come before us for some
time. The importance of the subject, when viewed in rela¬
tion to the materia medica and pharmacy, and, consequently,
to the practice of medicine, is most apparent. We con¬
sider, therefore, that no apology can be required from us,
for giving the results of the investigations of this very able
and industrious Chemist into this interesting subject —
a subject which, we are happy to perceive, has obtained
that degree of attention from Ur. Ure which its importance
(to medical science especially) demands. After describing
the apparatus and process which he employed in his ex¬
tensive analyses, Dr. Ure has given the results in the following
table, after which he has applied these results to the atomic
theory, and accompanied them with interesting remarks: —

TABLE OF ORGANIC ANALYSES.

1 , ,1 ,,,, ■! - - . .. —

Substance.

Carbon.

Hydrog.

Oxygen.

Azole.

Water.

Excess,

Sugar • • • • • • • • » • • . . , .

43-38

6-29

50-33

56-62

Oxyg.

Sugar of diabetes . .

39-52

5-57

54-91

51-13

10-35

Starch . - .

38-55

6-13

35-32

55-16

6-03

Gum arabic • • • ♦ • • • • • •

35-13

6-08

5579

34-72

7-15

Hydro,

Resin . . . . •

73-60

12-90

13-50

15-20

11-20

Copal . . . .

79-87

9-00

11-10

12-03

7-06

Shell lac .

64-67

8-22

27-11

30-51

4-82

Resin of suaiac • ' -• • • -•

67-88

7-05

25-07

28-00

3-93

Amber • • • . . , . . . . .

70-68

11-62

17-77

20-00

9-40

Yellow wax .

80-69

11-37

7-94

8-93

10-39

Caoutchouc . .

90-00

9-11

0-88

0-99

9-00

Splent coal .

70-90

4-30

24-80

27-90

1-20

Cannel coal . . . • • •

72-22

3-93

21-05

2-08

23-68

1-30

Indigo .

71-37

4-38

14-25

10-00

16-00

2-32

Camphor • . .

77-38

11*14

11-48

12-91

9-71

Naphthaline . .

91-06

7-07

0-70.?

0-79.?

Spermaceti oil .

78-91

10-97

10-12

11-34

9-71

Common oil of turpentine.

82-51

9-62

7-87

8-85

8-64

Purified oil of turpentine. *

84-09

11-05

3-06

4-00

11 01

Naphtha .

83-04

12-31

4*65

5-23

11-73

Asiatic castor oil

74-00

10-29

15-71

17-67

8-33

Alcohol, spec. grav. 0’812 .

47-83

12-24

39-91

44 09

7-25

Ether, spec. grav. O' 70 * *

59-60

13-03

27-01

30-03

9-09

Oxyg.

Bleached silk .

50-69

3-94

34-04

11-33

35-43

255

Cotton . • • • • . • • * • •

42-11

3-06

52-83

45-56

12-33

Flax, by Lee’s process * •

42-81

5-05

51-07

49-05

7-07

Common flax . . * » • •

40-74

3-37

52-79

0-09

30-16

8-02

Wool . - -

53-07

2-80

31-02

12-03

25-07

8-03

* Philos. Trans. Part II. for 1822,

'IS6 Histor ical Sketch of ' the Progress of Medicine , S^c,

Table of Organic Analyses — Continued.

Substance.

Carbon.

Hydrog.

Oxygen.

Azote.

Water.

Excess.

Cochineal . . •

5075

5 81

36*53

6*91

39 06

Hydro.

14*01

Cantharides .

48*64

5-99

36*29

9*08

40 83

14*53

Urea . . .

18*57

5-93

43-68

31-82

49-14

047

Benzoic acid • • • . . *

66-74

4*94

28*32

31-86

1*04

Citric acid .

33-00

4-63

62*37

41-67

Oxyg.

25*33

Tartaric acid . .

31-42

2*76

65*82

24*84

43*74

Oxalic acid . .

19-13

4*76

76*20

42-87

38*09

Ferroprussic acid . .

36-82

27*89 of iron.

35-29

Remarks on the preceding Analyses. — The sugar which
I employed/’ says Dr. Ure, had been purified by Mr.
Howard’s steam process, and was so well stove-dried, that it
lost no appreciable portion of its weight, when enclosed along
with sulphuric acid in vacuo. The diabetic sugar has a
manifest excess of ox3^gen, which I believe to be the case
with all weak sugars, as they are called by the sugar refiners.
I consider this excess of oxygen as the chief cause which
counteracts crystallization, and, therefore, the great obstacle
to the manufacturer. The smallest proportion of carbon,
which I have ever found in any cane sugar, was upwards of
41 per cent. The experiments on starch and gum were
among the earliest which I made, and the results differ so
much from those given by other experimenters, that I shall
repeat the analyses at the earliest opportunity. The con¬
stituents of the above three bodies, referred to the prime
equivalent scale, will be approximately as follows: — *

Sugar. Starch. Gum.

Carbon ... 5 atoms ... 5 atoms ... 4 atoms

Oxygen . . 4 ... .5 ... 5

Hydrogen .4 ... 4 ... 4

‘‘ Starch is liable to a similar deterioration wdth sugar ;
that is, some species of it make a much firmer coagulum with
hot water than others; a difference probably due to the pro¬
portion of oxygen. The starch here employed was that of
commerce, and was not chemically desiccated : hence, the
redundancy of water beyond the equivalent proportion. A
little hygrometric moisture was present also in the gum, as it
was not artificially dried. A note of interrogation is placed

* The following are the equivalent numbers employed by Dr. Ure
in this paper: — Oxygen, 1*0; hydrogen^ 0*125; carbon, 0*75;
azote, 1*75.

Chemistry.

after azole. That doubt will I trust be solved, when I com¬
plete my analysis of grains, roots, and leaves, with a view of
tracing the origin of azole in the bodies of graminivorous

animals . With regard to resin, I believe the quantity

of its carbon to be somewhat underrated in the table. Though
three experiments were made on it, I now perceive that I
had omitted to retriturate and reignite; and the carbon of
resin is very difficult of oxygenation. Its true composition is
probably, carbon, 8 atoms ; hydrogen, 8 ; oxygen, J. A still
more symmetric arrangement would be derived from carbon,
8 atoms; hydrogen, 9; oxygen^ •• This proportion cor¬
responds to 8 atoms of olefiant gas and 1 atom of water; and
I think it is very possibly the true constitution of resin. Had
the loss of weight suffered by the contents of the tube, during
their ignition, been a few hundredth parts of a grain more,
the experimental result would have coincided with this theo¬
retical view. Copal approaches to carbon, 10 atoms ; hydro¬
gen, 7 ; oxygen, 1. Lac may be nearly represented by car¬
bon, 6 atoms ; hydrogen, 4 ; oxygen, 2 ; or 2 atoms of olefiant

gas + 1 atom carbonic oxide . Resin of guaiac gives

carbon, 7 atoms; hydrogen, 4; oxygen, 2.”

Although the experiments on amber were conducted
carefully with retrituration and reignition, no good atomic
configuration of it has occurred to me. It approaches to
10 carbon + 10 hydrogen + 2 oxygen.”

Wax is apparently composed of carbon, 13 atoms ; hy¬
drogen, 11 ; oxygen, 1 ; or, in other words, of 11 atoms ole¬
fiant gas + 1 atom carbonic oxide -{- 1 atom carbon. Had
the experiment given a very little more hydrogen, we should
have had wax as consisting of 12 atoms olefiant gas + 1 atom
carbonic oxide. This is possibly the true constitution.’’

Caoutchouc seems to consist of carbon, 3 atoms ; hydro¬
gen, 2 ; or it is a sesqui-carburetted hydrogen. The oxygen
deduced from experiment is in such small quantity, as to leave
a doubt whether it be essential to this bodv, or imbibed in
minute quantity from the air during its consolidation.”

Splent or slate coal, specific gravity 1*266, abstracting its
incombustible ashes, approaches in constitution, to carbon,
7 atoms ; hydrogen, 3 ; oxygen, 2. Cannel coal from Wood-
hall, near Glasgow, specific gravity 1*228, resembles a com¬
pound of carbon, 9 atoms ; hydrogen, 3 ; oxygen, 2. In both
of these bodies, there is an excess of carbon beyond the 3
atoms of olefiant gas and 2 of carbonic oxide. The former
coal has 2 extra atoms of carbon, and the latter, 4 atoms.
Hence this coal is found at the Glasgow gas-works to yield a
very rich burning gas.”

The elements of indigo may be grouped as follows ; car-

128 Historical Sketch of the Progress of Medicine, Sfc.

bon, 16 atoms; hydrogen, 6; oxygen, 2; azote,. 1 ; or, in
other terms, we shall have 1 atom cyanogen, 6 atoms olefiant
gas, 2 atoms carbonic oxide, and 6 atoms of carbon in
excess.”

I had intended to pursue, at considerable detail, my
researches on this curious azotized product of vegetation, but
the subject having been lately taken up, and ingeniously pro*
secuted by niy pupil and friend, Mr. Walter Crum, I was
induced to leave it in his hands. He announced to me the
presence of hydrogen in indigo, before I had analyzed this
substance myself; and drew my attention particularly to the
fallacy occasioned by the hygrometric water of the peroxide
of copper. It is likely that some slight modification may
require to be made in my tabular proportion of the consti¬
tuents, for I did not resume the subject of indigo, after I had
become most familiar with the manipulations.”

Camphor is very nearly represented by carbon, lO atoms;
hydrogen, 9 ; oxygen, 1; or 9 atoms olefiant gas + 1 atom
carbonic oxide. Naphthaline is, in my opinion, a solid bicar-
buret of hydrogen, consisting of carbon, 2 atoms ; hydro¬
gen, 1 .”

It is very difficult, even by the best regulated ignition, to
resolve the whole carbon of this very volatile body into car¬
bonic acid ; hence, the carbon may come to be underrated in
the result.” Naphthaline is obtained during the rectification
of the petroleum of the coal gas-works. It is found encrust¬
ing the pipes in the form of a greyish crystalline mass; and
when purified by a second sublimation at the temperature of
about 220°, it forms beautiful thin plates, white and glisten¬
ing. It has a powerful petroleum odour. With brine of the
specific gravity 1*048, these plates, when once thoroughly
welted (which is difficult to effect), remain in equilibrium;
that is, float in, any part of the liquid. That number, there¬
fore, represents the specific gravity of naphthaline. It is
insoluble in water, but very soluble in ether, and moderately
so in alcohol. With iodine, it fuses at a gentle heat into a
brown liquid, forming as it cools a solid resembling plumbago,
which dissolves readily in alcohol, and is thrown down by
water. Naphthaline is soluble in oils. In water heated to
168° Fahr. it fuses, and remains like oil at the bottom of the
liquid ; but w hen stirred, it rises, and spreads on the top in
little oily patches. At 180° it rises spontaneously from the
bottom in oily globules, which, as the temperature is raised,
dissipate in the air, undergoing motions similar to those of
camphor floating on water.

“ Spermaceti oil is constituted apparently of carbon, 10
atoms ; hydrogen, Q ; oxygen, I ; or, in other w^ords, of 9

Chemistry. 1^

atoms olefiant gas + 1 atom carbonic oxide. The experi¬
mental proportion is, however, more nearly carbon, 10 atoms;
hydrogen, 8 ; oxygen, 1. There is here an atom of carbon in
excess.

Common oil of turpentine, specific gravity 0*888, comes
very closely to the following arrangement : carbon, 14 atoms ;
hydrogen, 10; oxygen, 1. Oil of turpentine, purified with
alcohol by Dr. Nimmo’s method, seems to approach to the
constitution of naphtha, or of a mere carburet of hydrogen.
Its specific gravity is 0*878. But as from the mode of pre¬
paring it, a minute portion of alcohol may remain in it, I do
not think it necessary to investigate its atomical structure.”

Naphtha, specific gravity 0*857, obtained by distillation
from petroleum, is very nearly represented by carbon, 22
atoms; hydrogen, 20; oxygen, 1. It, therefore, consists of
20 atoms olefiant gas, 1 atom carbonic oxide, and 1 atom of
carbon held in solution.”

Castor-oil is an interesting unctuous body, from its great
solubility in alcohol. It consists nearly of carbon, 7 atoms ;
hydrogen, 6; oxygen, 1. It is composed, therefore, of 6*
atoms olefiant gas + 1 atom carbonic oxide.”

A]coliol, specific gravity 0*812, is composed very nearly
of carbon, 3 atoms; hydrogen, 5 ; oxygen, 2; pr, of 3 atoms
olefiant gas zz 2*625, 2 water zz 2*25. And in volumes, 3
olefiant gas =: *9722 x 3 zz 2*9166; 4 aqueous yapour = ‘625
X 4 zz 2*500.

Thus alcohol of 0*812, by the above analysis, which I
believe merits confidence, from the care and consistency of
the experiments, differs from M. Gay-Lussac’s view of abso¬
lute alcohol, deduced from M. Th. de Saussure^s experiments,
in containing an additional volume of aqueous vapour. At
the specific gravity *814, alcohol would have exactly this
atomic constitution. If the condensation be equal to the
whole 3 volumes of olefiant gas; that is, if the 7 volumes of
constituent gases become 4 of alcohol vapo'ur, we shall have
■ its specific gravity at this strength zz 1*3722; the additional
volume of aqueous vapour producing necessarily this abate¬
ment in the density.”

Fibres of the bleached threads of the silk-worm were sub¬
jected to analysis. Their composition is apparently, carbon,
10 atoms ; hydrogen, 4 ; oxygen, 5 ; azote, 1 ; or, 4 of ole¬
fiant gas, 5 of carbonic oxide, and 1 of nitrous oxide ; or of
1 atom prussic acid, 3 atoms olefiant gas, and 5 atoms car¬
bonic oxide.”

* This is probably the truer view. The former would make it
coincide with camphor.”

VOL. XX. — NO. 116.

130 Historical Sketch of the Progress of Medicine, Sfc.

Cotton fibres, unbleached, seem to consist of carbon,
11 atoms; hydrogen, 8; oxygen, 10. Flax, by Lee’s patent
process, consists of carbon, 7 atoms ; hydrogen, 5 ; oxygen, 6.
It contains more carbon, and is therefore probably stronger
tham common flax, prepared by a putrefactive maceration.
This seems composed of carbon, 1 atom ; hydrogen, 1 ;
oxygen, 1. But this is the theoretical representation of sugar
by M. Gay-Lussac and Dr. Front ; and hence, these chemists
would readily explain, how linen rags may pass into the form
of sugar by the action of sulphuric acid. Wool approximates
to carbon, 10 atoms; hydrogen, 3; oxygen, 4; azote, 1.”

Cochineal seems to be made up of carbon, 15 atoms ;
hydrogen, 1 1 : oxygen, 8 ; azote, 1 . Cantharides approxi¬
mate to carbon, 11 atoms; hydrogen, 10; oxygen, 7;
azote, 1.”

My result with urea differs so considerably in the pro¬
portion of azote from that of Dr. Front and M. Berard, that

1 am disposed to doubt of the accuracy of my experiments,
though they were made v*^ith the utmost care, and were most
consistent in the repetition. I could perceive no smell what¬
ever of nitrous gas in the gaseous products, which were made
to traverse a column of copper filings three inches long, in a
state of ignition. I shall renew the inquiry on urea, and
employ the lowest temperature compatible with the formation
of carbonic acid.”

The prime equivalent of benzoic acid crystals, I find by
saturation with water of ammonia, to be 14*5 ; and it consists
apparently of carbon, 13 atoms; hydrogen, 6; oxygen, 4.
Of crystalline citric acid, the prime equivalent is 8*373 by my
experiments; and it consists probably of carbon, 4 atoms;
hydrogen, 3 ; oxygen, 5 ; or, of 4 atoms carbon, 3 water, and

2 oxygen. Two of these atoms of water are separated, when
citric acid is combined with oxide of lead in what is called
the dry citrate. Hence, the acid atom is in this case 6*125.
The prime equivalent of crystalline tartaric acid is 9*25 by
my results ; and it seems made up of carbon, 4 atoms; hy¬
drogen, 2; oxygen, 6; or of carbon, 4 atoms; oxygen, 4;
water, 2. From my experiments I have been led to conclude,
that into dry tartrate of lead these two atoms of water do
enter as a constituent; and hence, that the crystals of tartaric
acid are as dry as is compatible with its constitution. Oxalic
acid crystals have 7’875 for their prime equivalent, and are
composed of carbon, 2 atoms ; hydrogen, 3; oxygen, 6; or
of 2 atoms carbon, 3 oxygen, 3 water. Into the dry oxalate
of lead, these 3 atoms of v>^ater do not enter. Hence I find
the dry acid to be composed of carbon, 2 atoms ; oxygen, 3 ;
or, of 1 atom carbonic acid + 1 atom carbonic oxide, as was

Chemistry. 131

first suggested, I believe, bj Dobereiner. Crystallized oxalate
of ammonia consists of 1 atom acid, I atom ammonia, and
^ atoms water, == 8*875. By a gentle heat, 1 atom of water
may be separated ; and an oxalate of ammonia, as dry as is
compatible with its neutra]it3r, remains.”

Amongst the most interesting detached observations, in
this branch of science, which have lately come before us, we
may notice the discovery of a new acid, the pyro-citricj by
M. J. Lassaigne.* This acid is produced by the distilla¬
tion of citric acid ; it is white, inodorous, and of a strongly
acid taste, and generally occurs in a white mass, composed of
fine small needles. It melts on a hot body, and is converted
into very pungent w^hite vapours, leaving traces of carbon.
It is very soluble in water and in alcohol. At 50° of Fahren¬
heit, water dissolves one-third of the w^eight of it. It is com¬
posed of, carbon, 47*5 ; oxygen, 43*5 ; and hydrogen, 9*
With the oxides it forms salts, which differ in their properties
from the citrates; of these M. Lassaigne has examined the
pyro-citrates of potash, lime, barytes, and lead.

Another new acid, the hydro-carho-sulyhiiric acid, which
has the same relation to sulphuret of carbon that hydrocyanic
acid has to cyanogen, has also been discovered by l)r. Zeise,
of Copenhagen.*! The compounds of this acid have been
called hydro-carbo-sulphates. The acid itself may be pro¬
cured by pouring a mixture of four parts of sulphuric acid,
and three of water, on the salt of potash, and adding much
water in a few seconds. The acid collects at the bottom, in
a transparent slightly coloured oil, which must be freed from
sulphuric acid by washing. Its taste is acid and astringent.
It reddens litmus paper. It burns readily, giving out sul¬
phureous fumes. Its odour differs from that of sulphuret of
carbon, and it is decomposed by heat.

A new compound of iodine, hydrogen, carbon, has been
found, by M. Serullas, to result from the saturated solution
of iodine in alcohol of at least 39°. It consists of small
pearly scales, of a sulphur yellow colour. It is friable and
soft; it difiPu ses, when rubbed, an aromatic odour. It is
decomposed at a slight elevation of temperature. Water dis¬
solves a very little of it, while it is very soluble in alcohol. J

A new compound has also been found, by M. Vauquelin,
to arise from the combination of 100 parts of oil of turpen¬
tine, in volume, with 20 parts of alcohol. It does not become
turbid by water. ||

A new fluid of a singular nature has been discovered by

* Journal de Pharmacie, Oct. 1.822.
X Ann. de Chim. Vol. XX. p. 245.

t Ibid. Mars, 1823.

II Ibid. Vol. XIX, p. 279.

132 Historical Sketch of the Progress of Medicine,

Dr. Brewster in the cavities of minerals.* It possesses
the remarkable property of expanding about thirty times
more than water. It is also distinguished by its extreme
volubility, adhering very slightly to the sides of the cavities
which contain it, and is likewise remarkable for its optical
properties. It exists, however, in quantities too small to be
susceptible of chemical analysis.

Legal Medicine. — The chief performance which has
come before us, in this department of the present sketch, is
the work of Dr. Paris and Mr. Fonblanque on medical
jurisprudence.^ As a review of this w^ork will appear in our
next Number, we will not now occupy our confined limits
with any observations respecting it.

The experimental inquiry of Drs. Christison and
CoiNDET,j on poisoning by oxalic acid, is the most in¬
teresting and important of its kind which has appeared for
a considerable time. The effects of this poison on the
animal economy observed by these inquirers, especially its
action on the tissues of the stomach, may be stated, as pre¬
liminary to the means which ought to be adopted, in order to
detect its presence.

1. Concentrated oxalic acid renders the mucous epi¬
dermis brittle and less adherent. It dissolves the other coats ;
but during life, this action never extends beyond the surface
of the corion, and seldom so far; hence its action on tlie
living system is more like that of the pure irritants, pro¬
ducing extravasation of blood within the tissues, and into the
cavity of the stomach, and little chemical decomposition.

2. But its action on the dead stomach is so rapid, that,
if the examination of the body be dela3^ed a few minutes,
the w'hole corion, and even the other coats, will be found
dissolved ; and the diluted acid will also have the same effect,
though more slowly. Hence it is easy to explain why Mr.
Thomson, in his experiments, found so much apparent corro¬
sion. In fact, he always allowed an interval to elapse suffi¬
cient for the acid to act extensively on the dead tissues.

3. The chemical action of oxalic acid is not owing, as
Mr. Thomson conjectures, to mutual decomposition of the
acid and stomach : it is one of pure solution, in which
the acid and the animal principles of the tissues remain
unaltered.”

* Edinburgh Philosophical Journal, April, 1823.
t Medical Jurisprudence. By J. A. Paris, M. D. F. 11. S. F.L. S.
Fellow of the Roj^al College of Physicians; and J. S. M. Fon¬
blanque, Esq. Barrister at Law. In 3 vols. 8vo. London, 1823.

J Edinburgh Medical Journal for April, 1823.

133

Legal Medicme.

Additional experiments proved that dilution ncreased the
deleterious effects of this poison ; and that death followed
more speedily, and without leaving any cognizable trace of
organic change in the stomach, after its exhibition in this
state. With respect to the mode in which it operated its
fatal effects, Drs. Christison and Coindet are of opinion that
it organically deranged the stomach, and that the nervous and
vascular systems were soon afterwards sympathetically
affected. . When, however, no signs of lesion of the stomach
could be detected, they consider that it acted upon the other
parts by absorption, although they could not detect the acid
in any of the circulating fluids. Their experiments are, in
this particular point, at variance w’ith those of Mr. A. T.
Thomson * and Mr. Perey, who discovered the acid in the
blood.

Drs. Christison and Coindet further are of opinion, from
the evidence obtained from their experiments, that the spinal
cord and the brain were affected primarily, and that the heart
and lungs were deranged secondarily by this poison through
the effects produced by it on the nervous system, which
effects they consider to have been of a sedative nature.

With regard to the subject more immediately under con¬
sideration, namely, the means of detecting this acid, in cases
wherein there is reason to believe that it may have been
employed with a criminal intention, Drs. Christison and
Coindet have given the following directions: — ^

The stomach is to be washed with pure water, and if dis¬
organized, preserved for analysis. The washings, the con¬
tents of the stomach, the vomited matter, and the disorganized
tissues and suspected articles of food, are to be boiled sepa¬
rately, a little pure water being added if necessary. If chalk
or magnesia has been used as an antidote, what remains on
the filter (except that from the tissues) is to be preserved for
analysis. The filtered fluid is to be tried first with litmus
paper, and then by the three following tests — the hydro¬
chlorate of lime, the sulphate of copper, and the nitrate of
silver.

“ 1. Decolorize the fluid, if necessary, with chlorine. The
hydrochlorate of lime, dropped into a solution containing
oxalic acid, or an oxalate, especially the latter, throws down
an insoluble oxalate of lime. But it also precipitates with
the carbonates, sulphates, phosphates, tartrates, citrates, and
with all their acids but the carbonic. The following mode of
procedure will serve to distinguish it from these substances.
The nitric acid will not take up the sulphate of lime, but a

* Repository, Vol. Ill, p. 382.

i 54 Historical Sketch of the Progress of Medicine, S^c.

few drops of it dissolve the oxalate. The hydrochlorate acid
will not dissolve the oxalate, unless added in very large
quantity, while two or three drops will lake up the carbonate,
phosphate, tartrate, or citrate.

2. Decolorize a second portion of the fluid with chlorine.
The sulphate of copper precipitates oxalic acid bluish-white,
and the oxalates pale blue. This is a test sufficiently de¬
licate, especially if any free oxalic acid is previously neutra¬
lized with potass ; and it is also a very useful one, since the
sulphate of copper does not affect fluids that contain sul¬
phuric, hydrochloric, nitric, tartaric, citric acids, or their ordi¬
nary salts. But it precipitates the carbonates, and throws
dow'n phosphoric acid, whether free or combined. The oxa¬
late, however, is easily distinguished; for it is insoluble in
hydrochloric acid, while a few drops of that acid at once take
up the phosphate or carbonate.

‘‘ 3. The nitrate of silver produces a heavy white precipi¬
tate with oxalic acid, and still better with the oxalates ; and
this precipitate, when dried and heated over a candle, becomes
brown on the edge, then of a sudden fulminates faintly, and
is all dispersed in white fumes. When impure, it deflagrates
like gunpowder, and when in too small quantity to be col¬
lected, the filtering paper burns, as if steeped in nitrate of
potash. This is a very characteristic and delicate test. From
a quarter of a grain of oxalic acid dissolved in 4000 parts of
water, we have procured enough of the powder to show its
fulmination twice. The precipitation alone cannot be trusted
to ; for it may equally take place with hydrochloric, phos¬
phoric, citric, or tartaric acid, and likewise with the alkalis.
But when the test of fulmination is tried, there is no chance
of its being confounded with any of these, except, perhaps,
with the tartaric and citric acid. The compounds of these
acids with silver, we find, possess properties, that will render
the nitrate of silver one of the simplest and most correct tests
for distinguishing them from each other, and from oxalic acid.
The nitrate of silver becomes brown under exposure to heat,
froths up, then deflagrates slightly, with the discharge of
white fumes, and a large quantity of dull, ash-grey, crumbling
matter remains, of a very peculiar fibrous structure. The
tartrate of silver becomes brown, and froths up like the
citrate, white fumes are discharged without even deflagration,
and there is left an ash'coloured botryoidal mass, encrusted
outwardly with silver.

‘‘ If magnesia or chalk has been given as an antidote
during the patient’s life, the oxalate of magnesia or lime may
be mingled, in the form of powder, with the contents of the
stomach, or with the vomited matter. The powdery matter

135

Legal Medicine.

is then to be separated by eliitriation from what remains
upon the filter during the previous process. If magnesia has
! been the antidote employed, it is only requisite to boil the
powder in pure water for a few minutes, and then subject the
filtered fluid to the three tests described above. For the
oxalate of that earth is sufficiently soluble to furnish, even
with a single ounce of water, a solution in which all the fore¬
going characters may be observed. If the antidote employed
has been chalk, then the powder is to be boiled for fifteen
minutes, with half its weight of pure subcarbonate of potass,
dissolved in 20 or 30 parts of water. A mutual interchange
[ then takes place, and the solution contains oxalate and car¬
bonate of potass. In applying the tests to this solution, the
free alkali is to be previously neutralized with hydrochloric
acid, when hydrochlorate of lime or sulphate of copper is to
be used, and with nitric acid, before using the nitrate of
silver. In the last case, there ought to be as little excess of
acid as possible, because the oxalate of silver is soluble in
nitric acid.”

The examination of the body of a female who hanged
herself led M. Esquirol* to offer some important observa¬
tions respecting the fallacy of the formerly acknowledged
I signs of this act. In that instance the cord was removed
soon after the extinction of life ; its traces around the neck
I were then not deep, and the skin w^as not discoloured ; the
I body still preserved all the traits of life. Twenty-four hours
I after the act, there was no ecchymosis around the neck ; and
I the sugillation observed at the instant of death had disap-
I peared at the time of opening the body. The natural appear-
I ance of the countenance was at that time but little altered ;
I the skin, which had become smooth where the impression of
I the cord had been, was neither livid nor ecchymosed, but as
I if it were burnt. The meninges of the brain were very little
I injected, the brain not at all ; the lungs and heart were void
I of blood ; the right ovarium was alone gorged with black
I blood. From these appearances, it w'ould have been con^
I eluded by those who were guided by the diagnostics of some
I writers on medical jurisprudence, and who knew not the cir-
I cumstances of the case, that suspension had been committed
I after death. The reason of these erroneous diagnostics are,
I first, that it has been generally supposed that hanging and
I strangulation produce apoplexy ; and, secondly, that those
I bodies which have been suspended for a considerable time,
I and on which the cord has consequently remained until
I after the body has become cold, have only been examined.

^ Archives Gen. Jan. 1823.

1 36 Historical Sketch of the Progress of Medicine ,

M. Esquirol has therefore concluded : — 1st, That the diag¬
nostic signs laid down by writers on this subject, to distin¬
guish suspension before and after death, are by no means
sufficiently precise to be trusted. 2d, That ecchymosis
around the neck is but an equivocal sign of suspension before
death. 3d, That when a Practitioner is called to examine a*
body which has been found suspended, he ought to reckon
as nearly as possible from the hour of death, and the time
the cord has remained round the throat, as these two circum¬
stances must be the foundation of his judgment on the case.

For a full disquisition on that part of legal medicine which
relates to midwifery, we refer our readers to our Numbers for
January, February, and March. They will there find some
of the points most important to the medical Practitioner,
especially the subject of infanticide, brought before them in
such a manner as to supersede, in most instances, any farther
reference respecting it. — Several very interesting occurrences
have been also recorded, in some of the late Numbers of this
Journal, which are intimately related to forensic medicine.
Amongst these Mr. Ollier’s case of poisoning by means of
nux vomica is particularly important,* inasmuch as it illus¬
trates the effects of this substance on the animal economy,
and shows the very sudden and rapid manner in which it pro¬
duces its deleterious effects, after the deceitful calm which for
a time follows its exhibition. The particular condition
of the body for a considerable time after death, as well as
the symptoms which evince its action on the living body,
are sufficiently diagnostic of the ingestion of this substance.
We can only refer our readers to the case of M. Tacheron,T
wherein the nux vomica was taken in a much smaller quantity
than in the preceding case. J i

* Repository for June, 1823. t Ibid.

I We may remark that but little dependance can be placed on any
means which have been yet tried for the treatment of poisoning by
nUx vomica, unless the treatment be commenced before the tetanic
symptoms have been produced, or unless the dose of this poison has
been small. Some of the most active emetics have been found un¬
successful, and have even appeared to aggravate the symptoms,
while, on the other hand, the most gentle means, as in the case of
M. Tacheron, has produced copious vomiting. The only certain
method, therefore, of evacuating the remaining poison from the sto¬
mach, is the mechanical apparatus mentioned in a late Number of
the Repository (Vol. XVIII. p, 362).

Those remedies which have been supposed by some to be antidotes
to the deleterious action of nux vomica, or strychnine, without suffi¬
cient evidence derived from experience in such cases, have been found
either altogether inefficacious or in some degree hurtful, from the cir-

On the Modifications and Treatment of Marasmus. 137

We have so far exceeded our intended limits, that we can
only refer our readers to previous Numbers of the Reposi¬
tory for the very interesting cases of poisoning by arsenic* *
and by corrosive sublimate, f published by Mr. Buchanan.
The instances, also, of poisoning, by means of the digitalis
purpurea, J by the ccnanthe crocata, || and by the solanum dul~
camara,\ detailed in some of our late Numbers, will not be
found devoid of interest.

J. C.

Jermyn Street, St. Jameses, 5th July, 1823.

PART I.

ORIGINAL COMMUNICATIONS.

Observations on the Modifications and Treatment of Marasmus.
By a Physician to a Public Dispensary.

Though the diseases of children appear to have occupied
the attention of late medical writers more than formerly, and
though they are generally, doubtless, better acquainted with
them, yet too many instances of inefficient or injurious
practice must occur to every Physician to render fresh dis¬
sertations useless. Neither altogether are these to be blamed
if they contain nothing absolutely new nor unknown before;
for amidst the great mass of medical works that issue from
the press, a few only can meet the eye of each individual,
and it may happen that those which evade his attention may
have a powerful claim upon it, from their practical utility.
With this impression on my mind, it has not appeared
entirely without its use to make some observations upon
that disease of children which has been variously named

cumstance of their aggravating the effects of the substance against
which they were administered.

We stand in need of more facts on the subject before any opinion
can be offered with propriety as to what ought to be done, or not to
be done, in the treatment of cases of poisoning by this substance.

* Repository for April, 1823. t Ibid, for May, 1823.

X Ibid, for January, 1823. || Ibid, for April, 1823.

§ Ibid, for May, 1823.

VOL. XX. — NO. 1 16.

138 Original Communications.

marasmus, verminatio, febris infantum remittens, &c. Some
doubt, perhaps, may exist, whether the latter disease be the
same with the two former; but whoever will consider the
histories of the infantile remittent of children can scarcely
fail to perceive its coincidence with the disorder to which
Dr. Hamilton and Dr. Ayre have given the name of ma¬
rasmus.

The symptoms of marasmus differ in some way according
to the age of the child. In young infants, it will often chiefly
show itself by dulness and great unwillingness to be tossed
about. From being manageable and crying little, the patient
is perpetually whining, and it is impossible to engage its
attention for more than a few minutes. The face becomes
pallid and leucophlegmatic, occasionally, however, lighted
up with a hectic flush. The feet and hands burn, ai^d even
if the child sleeps, it is restless, tossing about in the bed and
moaning frequently. The appetite varies, being sometimes
even voracious, and at another loathing every kind of food.
The bowels are irregular, and the dejections unnatural, some¬
times greenish and what the nurses called griped ; at another,
when there is nothing improper in the colour of the faeces at
first sight, minuter examination shows it to be covered with a
semi-pellucid jelly-like matter, apparently being merely the
effects of an increased secretion from the internal surface of
the bowels; occasionally the faeces are very blacky but this
occurs more frequently after opening medicine than at any
other time, and it may perhaps be in some measure attributed
to the remedy. Whatever may be the appearance of the
faeces, they are always exceedingly offensive. The bowels
are not alw'ays much enlarged nor hard ; and, indeed, fre¬
quently it would be impossible to perceive any difference in
the feeling and appearance of the abdomen from its state in
perfect health. As this disease often occurs during the time
of dentition, it has not unfrequently been attributed to this
cause, and it is undoubtedly not seldom aggravated by it ; but,
upon the whole, I am much more inclined to refer the severity
of the symptoms which attend dentition to the previous bad
state of the health than the reverse. T he wasting of the
muscular flesh is not so marked in very young children as in
those of more advanced age, to whom the description of
Dr. Hamilton more particularly applies.

In children of four or five years of age, besides the above
symptoms, it is not unusual to observe a palsy of the lower
extremities supervene, when the disease has continued a con¬
siderable time, while no derangement can be observed in the
course of the spine. In the earlier stages of the disease,
however, older children have more distinctly the symptoms

On the Modifications and Treatment of Marasmus. 139

referrible to worms, such as cough, sometimes merely dry and
hacking ; at others, occurring in severe paroxysms, and
attended with expectoration, itching of the nose, and of the
fundament, dry and scaly, sometimes swelled lips, and pro¬
tuberant and hard abdomen. If the disease takes place in
children who are just beginning to walk, they are frequently
taken off their legs, and even those who may have walked
firmly for a month or two, will totter and require to be
carried. It would appear that the earth of bone is often
not sufficiently deposited, for it is during this state that I
have seen the bones of the legs most frequently curved.

The general cause of this disorder has undoubtedly its
place in the primae viae, through which, perhaps, tlie secre¬
tions of the liver may, as Dr. Ayre inculcates, become
vitiated, together with the other glands which contribute to
perfect digestion.

The treatment of this disease has varied very much; by
Dr. Hamilton purgatives almost entirely have been employed
and recommended. Dr. Ayre gives minute doses of calo¬
mel, and, as he states, with the greatest success. Those
who have been brought up in Mr. Abernethy’s school confine
themselves to hydrargyrum c. creta and jalap and calomel,
while the old nurses, to whom in this country most of such
cases are confided, give rhubarb in different forms. It seems
impossible that these plans could have been pursued or
recommended if success had not attended them ; and it
appears to me chiefly necessary to point out the different
states of the disorder to which the various remedies are
applicable.

In the very early stages of this disorder, a brisk purgative,
or a repetition of purgatives, every other day, will frequently
' remove it ; but when we speak of the early stages of this or
any other disorder, it must be referred rather to the order of
symptoms than to time: for it will often happen, that the
progress of the complaint wall be very various in equal spaces
' of time in different patients. In orte it will long be merely
observable in a want of animation and general sluggishness,
while the alvine evacuations are offensive and improperly
formed. In another case, and no longer time, it shall be
accompanied with cough, considerable emaciation, large
protuberant and bard abdomen, and great debility. The
enlarged abdomen, however, does not seem peculiar to the
latter stages of marasmus, in which it is frequently wanting,
until effusion or organic disease of the mesenteric glands has
taken place. But in this case, the tumour is either soft and
giving a sense of fluctuation to the touch, or irregular and
tuberculated — two states which cannot possibly be mistaken

140 ' ’ Original Communications.

for that kind of tumour which arises from constipated bowels.
When, from investigation, we find reason to believe that the
enlarged abdomen is accompanying the early stages of the
disease, and before there is any threatening either of hydro¬
cephalus or organic disorder of the abdominal cavity itself,
we may almost promise a speedy removal of the symptoms by
the use of purgatives. In prescribing these remedies for
children, it is essential to bear in mind that they will usually
bear and require proportionably larger doses than older
people, and that the first dose or two must be stronger than
what will afterwards be necessary, b'rom the nature of the
discharges after purgatives, it seems probable that this arises
from the bowels being lined by more mucus than natural,
and thus preventing the action of the medicine upon their
internal tunic.

Case — June, 1818. William Langford, aetatis six, the
only surviving child of a large family, who by report had died of
marasmus; affected with headach, slight hacking cough, dul-
ness, frequent hectic flushes, and great restlessness ; pallid
countenance; had fallen away within the last fortnight;
abdomen protuberant; bowels costive ; pulse weak. Purga¬
tives, wjth jalap and calomel, six grains of the former to two
of the latter, repeated on alternate days for a fortnight,
restored this patient to health ; but it has been necessary to
repeat them from lime to time, as symptoms have recurred.
1 saw him about a year ago, when he was strong and
healthy.

Case ^id. — October, 1822. Joseph Smith, aetatis eleven;
symptoms of marasmus, combined with an eruption of por-
rigo on the face ; tongue furred with elevated red papillse ;
pulse feeble and quick ; bowels protuberant, hard, and
generally costive. The mother had in this instance given
calomel and jalap occasionally ^ but without much relief.
Purging with jalap, gr. iv. — pulv. scamm. gr. iv. — hydrarg.
submur. gr. ii. — continued on alternate days for six weeks,
restored the health of this patient, and removed the porri-
ginous affection. The matter removed from the bowels in
the early part of the disease was slimy, green, and extremely
offensive; and for the first fortnight nothing like natural
laeces passed.

Case October, 1822. Bromfield Kerry, aetatis nine;

general symptoms of marasmus ; large abdomen ; bowels
alternately costive and relaxed ; appearance strumous ; had
been poorly for six weeks. Purgatives removed much offen¬
sive matter, and he was dismissed cured in the course of a
month.

Jn these cases the disease had been but of sliort duration ;

On the Mod^cations and Treatment of Marasmus. 141

and there seems little doubt, but that the first case would
quickly have terminated fatally, as the former instances had
done, if it had not been arrested in its early stages. The
second case shows the combination of marasmus with porrigo;
and I may strictly say, that I have never known a single
example of this eruption without affection of the general
health ; and, indeed, the directions which Dr. Bateman has
given for the treatment of the disorder seem to prove that
he had a similar opinion. Still, however, though not in the
case before us, local applications are, for the most part,
necessary, in addition to the general treatment.

There are, perhaps, very few instances of marasmus in
which it is not advisable to commence the treatment with
the exhibition of purgatives, though it may not always be
safe to rely upon them solely for a cure. And here great
caution is necessary not to be deceived by the report of the
parents with regard to the bowels ; it is no unusual thing to
be told that the child is extremely relaxed, and that the
bowels are moved seven or eight times in the course of
twenty-four hours, when stricter inquiry shows, that though
the child makes frequent attempts, little or nothing passes
away. Here it can scarcely be necessary to observe, that
purgatives must be absolutely required; and, indeed, no
other means, can be advantageously employed till the bowels
have been cleared out. Even, however, where diarrhoea
really exists, much matter will still remain upon the bowels;
and though the more powerful purgatives, as calomel and
scammony, might be injurious, it is quite essential to give
something wdiich may effectually dislodge the offending
matter. When this lies, as it generally does, in the lower
part of the alimentary canal, glysters, with oil of turpentine,
will be a powerful assistance, and will most completely
destroy any ascarides which may be present, and which so
usually accompany the disorder. As an aperient medicine,
under such circumstances, nothing can be found more bene¬
ficial than castor-oil; and disagreeable as this drug is to most
adult persons, it is not often refused by young children.
When diarrhoea attends marasmus, the dejections will for a
long period consist of nothing but a dark-coloured slimy and
offensive matter ; and if occasionally a more natural evacua¬
tion should appear, it is quickly superseded by these diseased
secretions. After the exhibition of castor-oil, a great quan¬
tity of small black pellets, resembling sheep dung, are usually
expelled, and it will require frequent repetition before they
entirely disappear. Sometimes when this is effected the dis¬
ease vanishes, but much more frequently considerable de¬
rangement of the animal functions continues ; the cough, bad

142

Original Communications.

appetite, furred tongue, and restlessness, remain, and demand
additional treatment. If, under these circumstances, purga¬
tives be persisted in, the disorder is only increased, the
debility and emaciation are augmented, and death speedily
closes the scene.

When diarrhoea continues, the hydrargyrum c. creth,, with
two or three grains of rhubarb, twice a day, is a very useful
medicine ; and I have found, the diarrhoea being previously
stopped, the infusions of camomile and rhubarb, given in
such proportion as to ensure a tonic effect, particularly ser¬
viceable, with one or two grains of calomel, at first every
day, and afterwards only every other day.

Case ^th. — November, 1822. Mary Ann Parkes, aetatis
ten, for three years had been observed at times to be
poorly, varying very much, with general bad appetite and
great restlessness at night ; she had lost much flesh, but more
especially within the last few weeks; countenance pale;
abdomen little if at all prominent; tongue furred; pulse
weak ; bowels alternately costive and relaxed. Purgatives
removed a great quantity of green slimy matter, but without
any corresponding relief to her general state.

R Hydrarg. Submur. gr. ii.

2nda qu^que node sumenda.

R Infushs Rhei, Infusdis Anthemidis, aa 5iv.
pro haustu ter die sumendo.

Under this treatment she quickly regained a good state of
health, and was dismissed cured at the end of a month.

This case is an evident proof that much general weakness
may remain after the original cause of the disorder has been
removed, and that a tonic treatment will be necessary to
ensure a complete restoration to health. With regard to the
choice of medicines, i cannot, I trust, be misunderstood as
to recommend those only which 1 have been accustomed to
prescribe myself, but merely to indicate the principle upon
which the curative plan is generally to be conducted. How
far Dr. Ayre’s mode of giving small doses of calomel alone
may succeed, 1 am unable to say, as I have never found it
necessary to recur to it.

There is still another modification of marasmus, which is
attended by worms, and more particularly the lumbrici.
When Dr. Bateman changed the term verrainatio in his
reports to that of marasmus, because the symptoms which
indicated the presence of worms were not peculiar to them,
he announced a fact of very great importance in a patho¬
logical point of view. But it is to be regretted that he did
not go farther ; for there seems to me little question, not only
that the symptoms are not peculiar to worms, but that these

On the Modifications and Treatment of Marasmus. 143

may be completely removed without the removal of the
diseased state. The truth is, that worms are never generated
in a healthy state of the body, and that they ought them¬
selves to be considered rather among a series of symptoms of
a peculiar disorder, than as the essential and sole cause.
And this view of the subject is highly important as it regards
practice ; for if when no more worms are expelled we con¬
sider every thing done, or if we persist in treating for the
worms because the symptoms which are supposed to indicate
them have not disappeared, we shall probably equally fail in
our purpose. Undoubtedly, as foreign and irritating bodies,
it is most necessary to remove these parasites, but it is not
less necessary afterwards to correct that state of the system
in which they were originally generated. This opinion of
the nature of the disease in which worms are found is not,

I believe, original, though it seems but rarely adverted to,
and I have seen somewhere (though i cannot now recover
it) a paper in which mercury was persevered in with success,
upon this principle.

Case 5th. — Aprils, 1822. William Haurey, aetatis five;
affected with symptoms of marasmus, cough, itching of the
nose and anus, protuberant abdomen, &c. often passes large
pieces of tape-worm.

R Hydrargyri Submur. gr. iv.

Pulv. Jalapse, gr. v.

pro pulvere 2nda quaque nocte sumendo.

R Olei Terebinth, ^iss.

Gum. Acac. q. s.

Aq. Purse, ^viss.

optime tere et misce ; sumat coch. ii.larga 2ndo quoque mane.

He continued this plan till the 26th, having passed several
yards of the worm at first, but none for the last w^eek. The
dejections were slimy, dark-coloured, and offensive, mixed
with a considerable quantity of a substance resembling the
white of egg. For the last two days, the faeces have been
more natural in appearance.

R Infushs Anthemidis, Infusfis Rhei, aa 3iv.

Potassse Subcarbon. gr. v.

pro haustu ter die sumendo.

He continued this for a fortnight or three weeks, and was
dismissed cured. I have heard of him within the last three
months, and he continued well. I ought to have observed,
that he remained very poorly and weak after there seemed
reason to believe that all the worms were expelled.

With respect to the morbid anatomy of marasmus, very
little information is to be acquired, since it seldom proves

144

Original Communuations,

fatal while in its simple form. The most usual organic
derangement appears in the mesenteric glands, which are
often enlarged and scirrhous, more or less, broken down, and
in every way having the appearance of scrofulous tubercles.
On one occasion, in which an opportunity was afforded of
examining a patient of four years old, no disease whatever of
the abdomen was discovered, except, perhaps, a very con¬
tracted state of the sigmoid flexure of the colon. The peri¬
cardium was firmly united to the heart in every part, but
there had been, I understood, no symptoms of disease of that
organ during life. The symptoms which distinguish maras¬
mus are not unfreqnently also the precursors of hydroce¬
phalus ; and if this disease ensues, of course the chief disease
will be found in the head, though, as is well known, the
abdominal viscera are also frequently found to have under¬
gone some change.

In the above observations on marasmus, 1 have not had
it in contemplation to give any thing like a complete essay
upon the complaint, but merely to point out some of those
circumstances which I have found useful in a considerable
experience of it. I might easily have extended the paper by
a greater enumeration of cases, but it appeared to me fully
sufficient to give such instances as would illustrate the points
I had in view : if what has been stated be correct, one case
will be sufficient to exemplify it; if incorrect, a hundred
cases could not make it true.

11.

A Case of what may he called Yenous Congestion of the Lungs,
Communicated by Charles T. Haden, of Sloane
Street, Surgeon to the Chelsea and Brompton Dispen¬
sary, &c.

We are still but imperfectly acquainted with the true
nature of those peculiar cases of disease which are so well
described in Dr. Armstrong’s works under the name of con¬
gestive fever. The almost paralysed state of the nervous
system, the cold and often blue state of the skin, the
oppressed breathing, the cold clammy perspiration, and the
great depression both of the pulse and of the general bodily
powers, form sufficiently remarkable characteristic symptoms
of this disease; but the peculiar organic lesion which pro¬
duces these symptoms, or by which they are at least alwaj^s
accompanied, has not been clearly pointed out.

It is well known, indeed, that this train of symptoms is
never present without being accompanied by some peculiar

Mr. Haden’s Case of Venous Congestion of the Lungs, 145

local affection ; and in a large majority of cases this local
affection appears in the form of a loaded or congested state
of the capillaries of some bodily organ; but it is not so.
certainly known, in all cases, wliether the congestion be in
the capillary arteries or in the capillaries of the veins. It
has been ascertained, too, that all these symptoms are not^
present in one and the same case, and that the grouping of
them 'depends on the peculiar organ which is congested.
Thus it is remarked, that when the disease is induced by a
blow on the head, as when it forms the state of concussion,
the symptoms are materially different from those which
characterize it when it is produced by any of the causes cf
fever : rigors, for instance, are present in the one case ; in
the other not. So also when, on the other hand, the lungs
are congested, the blue state of the skin, the affection of the
breathing, and the rapid destruction of the powers of life, and
often, indeed, of life itself, give the case a materially different'
aspect from what it assumes, either when it is clothed in the
symptoms which characterize so many forms of the late
epidemic cholera of India, or in cases where it produces
insensibility and convulsions, or when it is induced by the
stomach being oppressed by indigestible food.

The same enlightened and indefatigable observer of dis¬
ease, Dr. Armstrong, has pointed out many other peculiarities
which characterize the state called by him congestive fever,
and by which the local organic lesion with which it is con¬
nected may be determined. One of them, however, deserves
to be noticed particularly here, because it refers to the par¬
ticular subject of the present paper, and show$ that the causes
by w'hich the nervous energy, as it is called, is depressed in
cases of congestive fever, may be indirect as well as directs
Dr. A. has found, that in very many cases of the typhus
fever of London the bronchial lining becomes coated by a
species of tenacious varnish, which, by mechanically pre¬
venting the blood in the capillaries of the pulmonary artery’^
from being exposed to the action of the air in the bronchia,
interferes with the proper decarbonization or oxydalion of
the blood, whichever it may be. When this occurs, the
heart ceases to be supplied with arterial blood, and venous
blood circulates in its stead ; and late observers have abun¬
dantly proved that the bodily powers are immediately de¬
pressed, and life even rapidly lost in such cases.

It is this mechanical action of such causes as interfere
with the due purification of the blood in the lungs which
gives the peculiarity of the symptoms of bronchitis when
severe, or rather when extensive, and which cause the often
sudden death of patients while labouring under that disease.

VOL. XX. — NO. 116. u

146

Original Communications,

In ordinary cases, so small a part of the bronchial membrane
is inflamed or put hors de combat, that the changes in the
blood still go on in a sufficient degree; but if a large portion
of the whole membrane be inflamed, and especially if any
thing like the whole of it be inflamed, death certainly and
often very suddenly takes place. Thus an infant, who had
suffered for three days from mild bronchitis, along w’ith its
brothers and sisters, suddenly became worse, and died in a
few hours, iu spite of treatment, with a blue and cold skin,
with the bodily powers intensely depressed, and the breath¬
ing most laborious. Thus, too, a second infant, who almost
at once fell into this state from a state of health, was saved
by the warm bath and by emetics ; the blue state of the skin
and the other symptoms disappearing as the arterial action
was re-established by these remedies.

In like manner, if the capillaries of the bings be suddenly
overwhelmed with blood by any cause, so that the circulation,
through them be impeded, the same effects follow. Many
cases of sudden death are to be attributed to this state of
disease; and it is probable that a late celebrated Arlatomist
lost his life in this way. The following case also is one in
point, and it is valuable on account of the distinctness with
which the previous history of the case and the consecutive
syniptoms illustrate the seat and nature of the affection : —

Case. — June 1st, 18*23. A rather elderly woman was
found in the agonies of death. Her skin was blue and cold,
her eyes blanched and turned up, her pulse nearly imper¬
ceptible, and her respiration as if it were not drawn lower
than the top of the sternum. She was in the ninth month of
her fourth pregnancy. She had complained much latterly of
deranged health, especially as regarded her stomach, and she
had called up her midwife on the preceding night, on account
of intense abdominal pain. Her neighbours were now, how¬
ever, called into her room at four in the morning: bv her
sudden and violent screams. They found her lying on her
belly, and the child born dead. The medical Practitioner
saw her immediately after this; and whilst he could not but
remark the hideous appearance of her countenance, especi ally
as produced by the contrast as to colour between her eye and
skin, and felt some hesitation on account of the patient’s
apparently impending dissolution, he was surprised to feel
his arm pulled by the patient with considerable force, and to
hear her reproach him, in an almost inarticulate whisper, for
delaying to give her assistance.

He gave her frequent teaspoonsful of tinct. aloes c. (the
only cordial at hand), set open the window (the room being
very hot), and opened two or three veins. At first he could not

Mr. Haden’s Case of Venous Congestion of the Lungs. 147

obtain blood ; but by degrees be pumped out about twelve
ounces, and with much relief’, for the patient’s countenance
brightened and became less blue as the blood flowed.. The
pulse also was rendered more perceptible; it, indeed, became
labouring and even resisting.

Nine in the morning. — The patient saved from death, but
the congested state still continuing. V. S. in several places
by an assistant, but inefiectually.

Eleven at night. — Still the same state. V. S. ad ^xij.
with much difiiculty, though with great relief.

It should be stated, that soon after the attack commenced
the patient became so hoarse that tier voice was nearly lost;
she only spoke in a whisper.

' June 2d. — The patient was better in every respect ; but
she now complained of pain all over the chest, especially in
the left side low down, and towards the front. Gradually
cough came on, or rather that state in which the patient is
very desirous of coughing, but has scarcely the power to do
so. Her skin still, however, continued cold, and especially
her feet; but the colour of the skin was natural, and the
pulse under 80. Low diet was strictly enjoined.

4th. — Has continued to improve, so as to appear nearly
well ; except that her voice remains a whisper, and the pain,
cough, and difficult breathing, still continue nearly as before.
Her skin has never been hot, nor has her pulse risen. The
skin, indeed, has been throughout rather too cold.

The patient said that she remembers nothing after the
labour pains became very bad, except that she turned on her
knees as she had done in previous labours.*

She was now considered to be convalescent; but the pur¬
gative medicine which she had previously taken daily was
continued, and a continuance of the low diet strictly en¬
joined.

On further inquiry after this patient’s recovery, it appeared
that for some time before delivery she. had suffered from diffi¬
culty of breathing and other embarrassment of the chest, so
as especially to prevent her from going up stairs without
difficulty.

The hot-air bath would have been very advantageous in
the treatment of this case.

Derby, June 15, 1823.

148

Original Communications.

On the Effects of Irritating Substances on the Functions of the
Intestines, when rubbed along the lower Regions of the Spine.
By James King, Esq. Surgeon.

When perusing the 104ih Number of the Repository,
I was struck with the novelty of some opinions stated in a
very excellent paper on the “ nature and treatment of fever/’
by Dr. Wight. When speaking of the efficacy of purgatives
in fever, he says ‘‘ that it is a fact well established that a
sinapism or a blister applied to the dorsal region of the spine
will often excite the bowels to action, when the most power¬
ful cathartics fail to produce such effect. It is proved, too,
that cathartic substances, mixed with the common volatile
liniment, and rubbed along the spine three or four times
a day, will maintain a regular action of the bowels, after
a course of cathartics, most assiduously administered, prove
unsuccessful.” Were it satisfactorily proved that purgatives,
when prescribed in this way, were uniform in their opera¬
tion, the advantages to be derived, in particular cases, would
be great indeed, where, ‘from irritability of the stomach or
other circumstances, we were disappointed in obtaining bene¬
ficial effects from their internal exhibition.

The following effects produced by the external application
of tartar emetic, which to me at the time of their occurrence
appeared of considerable interest, go to corroborate Dr.
Wight’s opinion as quoted above.

- — ‘ — McGregor, a 3’oung man, aged twentj'-five, was
seized, during the month of April, 1821, after exposure to
cold, with a severe rheumatic affection of the dorsal portion
of the spine, for which bleeding and the other remedies
usually found of service in similar cases were resorted to
-without any benefit; by the advice of a medical friend, 1
was induced to rub tartar emetic ointment on tlie surface of
the part affected. Two days after the first application of
this ointment, he informed me that he had been troubled
during the night with a severe purging, which he attributed
to the rubbing. At the time, not being aware that tartar
emetic, when applied externally, would produce such effects,
I ridiculed the idea, and attributed it to some derangement
of the alimentary canal. I ordered the ointment to be con¬
tinued till next day, when I was informed the purging had
been still more severe than it was before last visit. I now
began to suspect that the emetic tartar might be received
into the system by means of the absorbents, or act through

149

Cases of Rupture of the Liter.

ihe medium of the nerves, so as to produce this effect; but
to obtain a more satisfactory proof, I ordered it to be discon¬
tinued for three days, during which time the bowels returned
to their natural action, as he had only one stool each day.
I again commenced the use of the ointment, and again it
exerted a similar influence over the alimentary canal, which
obliged me to give up its use entirely.

- Hamilton, a boy, aged thirteen, some time in the

month of September, i8‘21, felt, for the first time, pain and
weakness of the back and difficulty of walking, which, along
.with other symptoms, became more and more severe, and at
length terminated in a very bad case of diseased spine. He
was repeatedly blistered, and an issue kept open for six
months on each side of the diseased bone; which, though it
had produced little or no benefit, would have been allowed
to discharge a longer period had it not been for his friends,
who, by the advice of some ignorant person, would not allow
it to be kept open any longer. As soon as it was completely’’
cicatrized, I rubbed this ointment around the diseased part,
as often as I was able from the state of the pustular surface.
His bowels, previous to this, were always rather costive, and
occasional doses of laxative medicine were required to pro¬
duce regular evacuations; after the first rubbing their action
was considerably increased, as he had daily two stools, at
least, without the use of any opening medicine.

In the first case, the action of the medicine was very
severe, keeping up a continual diarrhoea; in the other, how¬
ever, its effects were more moderate, but sufficient to show
distinctly its operation on the alimentary canal. During the
external use of this medicine, neither sickness, nausea, nor
any other of the effects produced by its internal administra¬
tion, were observable : I have repeatedly rubbed it on other
parts of the body, such as the nape of the neck, breast, &c.
without observing any effect produced on the abdominal
viscera.

IV.

Cases of Rupture of the Liver. Communicated by a Friend of

the Editors.

A GENTLEMAN, aged fifty-five years, who had been in the
habit of drinking freely during the last thirty years of his life,
particularly of ardent spirits, on the 4th of March, 1822, fell,
while in a state of intoxication, when his right side struck a
hard and projecting substance. As no bruise nor ecchymosis
was observed in tlie part on w'hich he thus fell, but little

150 Original Communications,

notice was taken of the occurrence, until about four days
afterwards, when he began to complain of pain in his side,
which was attended with some ditficulty of breathing. His
medical attendant thought that he had suffered a relapse of
Hyd rothorax, under which he had been considered to have
laboured about six years previous to his present accident, by
a Physician of some eminence, under whose care he then
was.

The remedies usually employed for hydrothorax were
resorted to on this occasion, but without any appearance of
amendment. He constantly complained of soreness in the
right side, under the true ribs, which was so great that he
could not bear the waistband of his breeches to be buttoned.
Although no improvement took place, yet the medical gen¬
tleman in attendance did not apprehend any very immediate
danger until the day on which the patient died, and which
was the eleventh from the time of the accident. Nor was it
supposed, at the time of his death, that the fall was its cause,
but that he had died of hydrothorax. A gentleman who was
consulted having entertained a different opinion, permission
was obtained to open the body, when the following appear¬
ances were observed : —

On opening the abdomen, the peritoneal covering on the
right side was found inflamed. The omentum w'as tuber-
culated, and at least three-fourths of an inch in thickness.
On removing this viscus, about four pints of a pus-like fluid
was effused in both h3?pochondria, but chiefly in the right.
The right lobe of the liver was nearly divided into two parts,
which were held together on the lower or posterior part by
about a fourth of an inch of its own substance. The divided
surfaces were covered with a coat of perfectly transparent
lymph. The left lobe was of a clay colour, as was the right.
The other abdominal viscera were healthy. On dissecting,
in order to get into the cavity of the thorax, the cartilages of
the ribs were found perfectly ossified, so that a saw was used
to divide them. Tiiere was no fluid either in the left cavity
of the thorax or in the pericardium. The heart and lungs
were natural. The right cavitj^^ of the thorax contained about
a pint of serum ; and on the pleura covering the lower ribs a
deposit of recently formed lymph w'as noticed, evidently the
result of the blow received in the fall, and corresponding
to the inflamed peritoneum of the same side. There were
no adhesions in either cavity.

Might not the complaint, for which this gentleman was
treated, about six years previously, have be^n the ossification
of the cartilages of the ribs ; which ossification, during its
progress and completion, occasioned at first that derangement

151

Dr. Stout’s Case of Chronic Diarrhcca.

of the function of respiration, which led to the belief in the
existence of hydrothorax, and which was removed in conse¬
quence of the muscles concerned in respiration having
become accustomed to the chano-e ? And misiht not the same
circumstance, viz. this ossification, conjointly with the small
effusion into the right thoracic cavity, have occasioned the
symptoms which led the medical attendant to conceive that
hydrothorax existed after the patient had met with the
accident .f*

A very respectable and experienced Practitioner informed
the gentleman who favoured us with the above case, that
about nine years ago he met with one entirely similar to
it, as far as it related to the rupture of the liver. A
farmer’s wife fell from her market-cart, when her right
side struck the step of the cart. The symptoms of which
she afterwards complained were very indistinct, and did not
indicate that any important organ had suffered materially.
She survived the accident exactly as long as the gentleman
did, whose case has been just related, and sunk as unex¬
pectedly. On dissection, it w^as found that a rupture of the
liver had taken place, very similar in extent and situation to
that described above.

Case of Chronic Diarrhota successfully treated hy the Use of
Secale Cornutiim. Communicated by Aeraham Stout,
M.D. of Bethlehem, Pennsylvania.

S. L. a single woman, aged tw'enty-eight years, was from
her childhood very weaki}^ and subject to nervous affections.
About eight years ago, she was first afflicted with a diarrhoea,
which continued, without much alteration, for upwards of six
years. She became much emaciated, her legs w'ere often
oedematous, and occasionally a tumefaction of the abdomen,
attended with a distinct fluctuation, was observed. Her mind
became so much disordered that it was often with difficulty
her mother could get her to converse, and the sight of a
stranger excited fear to an extreme degree. She had no
appearance of the menses before she was in her twenty-fourth
year. I'he discharge was then natural, but it came on at
irregular periods, and did not appear to have the slightest
effect on the diarrhoea or mental disorder. In this deplorable
condition she was, in the summer of 1821, when I first saw
her. Previously to this time, she had been attended by
several country Practitioners. I put her on a course of
tonics and astringents. By pursuing this treatment for a

152 Original Communicatiom,

considerable length of time, she gained more strength, thougii
the various vegetable and mineral astringents, which 1 at
different times employed, together with opium, had little or
no effect in restraining the diarrhoea. They checked the dis¬
ease sometimes for a day or two, but, notwithstanding the
continuation of the treatment, the complaint wmuld return
with an apparent increased violence. The flores martialis
were given at one time, with a view of checking the diar¬
rhoea, on the authority of Dr. George Green. The effect
which this article produced for the first eight or ten days w'as
so striking, that little doubt remained in my mind of its
effecting a cure : but after the patient became habituated to
the medicine, the disease resumed its usual course, though
the dose was increased to as much as the stomach wmuld
bear. In the early part of last summer, the patient had a
suppression of the menses, which occasioned hysteria, head-
ach, and vertigo. iVfter using several emmenagogues with¬
out success, I was induced to give the secale cornutum a
trial, and commenced with the dose of six grains, three times
a day. The medicine produced an uneasiness in the uterine^
region, without restoring the menstrual discharge: on the
diarrhoea, however, it had a very salutary effect. By con¬
tinuing this article a few^ days, her bowels became so much
constipated, that it was necessary to omit it, and resort to
laxatives. I directed her to take one or more of the powders
of the secale cornutum, only when the complaint made its
appearance. She followed my advice, and it had the effect,
not only of checking, but of curing this very obstinate case of
chronic diarrheea. The menstrual discharge was restored, by
the use of the tincture of caniharides. Her health afterwards
improved rapidly, her mind became cheerful and happy, and,
during the course of last wdnter, she paid many visits to her
friends and relatives.

As far as my observations have extended, with respect to
the modus operandi of the secale cornutum, in curing the
above-mentioned disease, I have reason to believe, that it did
not produce this effect by any astringent quality which this
article may possess, nor from a direct action on the bowels.
It probably made an impression on the stomach, which by
sympathy excited a new action in the uterus, that counter¬
acted the morbid one in the intestines.*

* Philadelphia Journal for May, 1823.

Dr. Brinckle’s Case of t^ueiyeral Convulsions, 15.1

VI.

A Case of Puerperal Convulsions successfully treated with the
Ergot. Communicated in a Letter to William Darrach,
M.D. by W. D. Brinckle, M.D.

Mrs. R. aged thirty-five, was taken in labour with her
first child, about sunset on the 18th of May, 1821. Her
pains w^ere good, and a very flattering time was anticipated —
when suddenly, and without any premonition, she was at¬
tacked with convulsions. The midwife who officiated sent
immediately for me, and on my arrival, which was at ten
o’clock, P. M. gave me the preceding information. Since
her recovery, however, Mrs. R. has told me, that previously
to the occurrence of the convulsions she had a very severe
pain in the fore part of her head. At the commencement of
each fit, the arms and wrists became cold, although the hands
continued warm : the appearance of the convulsed counte¬
nance was horrific — with a pulse hardly perceptible and
frequent. When the froth began to issue from her mouth,
and the stertorous breathing, which was truly alarming, had
come on, the arms and wrists resumed their natural tempera¬
ture, a moisture made its appearance on the surface, the pulse
rose, and beat violently. These paroxysms succeeded one
another with very considerable regularity. The lancet, in
this case, was freely employed. I drew blood copiously at
three different times, and 1 would, unquestionably, have coti-
tinued the depletion, had the pulse permitted it. Ip additiqp
to venesection, I had recourse to camphor, aperient injec¬
tions, sinapisms, and blisters. I am sorry, however, to say,
that this course produced very little effect either as to the
frequency of the paroxysms, or the efficiency of the pains.
Her pulse was now evidently too much reduced to bear any
further depletion. Conceiving that the ergot might be em¬
ployed to advantage, although I had not heard of its having
been used in a similar case, 1 gave, at ten o’clock next morn¬
ing, ten grains of it, which was repeated in half an hour. In
twenty minutes after the first dose was given, both the force
and efficiency of the uterine action were increased, and at half¬
past eleven the child was born. She had no convulsions
after the ergot was administered. Although the advantage
derived from the secale corniitum, in this case, was so de¬
cided, I do not know' that I should resort to it in puerperal
convulsions, until the lancet had been actively employed. If
there exist much action, 1 have always found the ergot to
operate more promptly and powerfully when preceded by
VOL. XX. - NO. 1 16. X

154 Analytical Review.

venesection. Nor do I think it would be altogether proper
to prescribe it until labour is pretty considerably advanced,
and the os uteri dilated. Where convulsions supervene, in a
case of commencing parturition, we should ^endeavour to sus-
petid the action of the uterus, by boldly using the lancet as
far as may be expedient, and then resorting to opium and
camphor. This plan succeeded in a case which occurred
four days after that which has just now been related. 1 he
pains were completely arrested, and, with them, the convul¬
sions. In a week afterwards labour recommenced, and my
patient was delivered without the recurrence of the convul¬
sions, or the accession of any untoward circumstance.*

PART 11.

ANALYTICAL REVIEW.

Elements of the Theory and Practice of Physic. By George
Gregory, M .D. Licentiate of the Royal College of Phy¬
sicians in London, and Senior Physician to the St. George’s
and St. James’s Dispensary. Vol. II. London, 1823.

The learned and sententious Zacharias Silvius, of Rotter¬
dam, in his preface to a work of some repute on the art of
preserving health, published in the sixteenth century, and
entitled, “ Schola Salernitana,” has made no small waste of
the precious oil of the lamp — not in praises of the art — but
of that which it professes to preserve. But this is not ail —
the same Zacharias has there bestowed some notice upon the
early Professors of this art, of which, peradventure, he con¬
ceived himself no unworthy member. Speaking of it, in the
time of the Asclepiades, wdien those fields from which the
moderns have gathered so many harvests were fallow land
and waste, he utters a brief and sharp sarcasm against them
in these words, Turn temporis medicorum penuria.” Nor
is this all — in the next sentence he proceeds to tell us, in
Latin, assuredly none of the purest, that when the art was
communicated, and men sought to stimulate their appetites
rather than to gratify them, it was then that the luxuries and

* Philadelphia Journal for May, 1823.

Dr. Gregory on the Theory and Practice of Physic. 155

refinements of the table begat a strong necessity for leech-
craft, and gave rise to the multitude of its professors — hum
■ multiplicem medicorum numerum of which he complains.

If Zacharias were now' among us — totus teres atque rotun-^
dus — if the grey quill were now between liis fingers — if,
moreover, he had to unite a preface in our time, nay, we will
suppose a preface to this \e\y critique, what would he now
say of the rising generation of the Philistines, as we have
been called ? Would he not quote Ovidius Naso — as he is
previously addicted to quoting — and compare us, so quick in
growth, so formidable, and so many io number, to the
dragon’s teeth, which were no sooner sown than they sprung
up into armed men ? But — for we will speak only of men’s
works — if he were to cast his eyes about him on the
immense piles of medical writings that have accumulated of
late years, and which must, like poor Zacharias, be soon
gathered to the dust of their forefathers, what w'ould he then
say? Would the real motives which led to the existence of
many of them be quite apparent to him ? Would he not
rather laud our ingenuity and industry, our patience and philan¬
thropy, in collecting so large a mass of information for the as
yet unlearned in this most marvellous art of healing ? Would
he not do some honour to our zeal, that the lives of our fellow
beings should be carefully intrusted to skilful hands, and
heads, though not grey, yet full of the wisdom of years?
Would he not share — deeply share — in our anxiety to shake
off the obloquy that Pliny cast upon us in the olden time, and
whose truth he has with prepossessing frankness acknow¬
ledged ? Assuredly he would ; and w’e should take no small
pride to ourselves in committing to his hands some works
that might redeem us, at least, from a part of this reproach.
It should go hard with us but we would lay before him works
of our own country, in the various departments of medical
science, that should awake him for ever from his intellectual
slumbers — w'orks of unpretending merit-— works of deep
erudition, of a pure philosophic spirit, but what is better
than all, of high practical importance. In this our own day,
what w'orks could w'e deposit at his feet, and what names to
consecrate them ? — Jackson, Blane, Barclay, Cook, Prichard,
Pring, Good, Abernethy, Cooper, Armstrong, Johnson,
Baron, and others — many others ; nor should we fear to fling
down the work w'ith which we are now concerned. Then,
in truth, we might forgive his enthusiasm; and when he read
these names, he might indeed exclaim, without show of
affectation, Av^^^ttoi av^puTrm ^ai/xoviccl

It is indeed marvellous to consider what materials we have
for the propagation of medical science and the salvation of

156

Anaiytual Review. '

the species — materials most, or at least very many of iheni^
spread 'abroad in pamphlets, particular treatises and journals,
like orient pearls at random strung, and needing only the
labours of some fine Roman hand’’ to gather and collect
them together. These scattered and solitary lights that burn
dimly by themselves, and throw a diminished lustre over the
detached and miscellaneous pages of medical literature, may
be thus made to derive additional strength and brilliance from
concentration, as the hues that are broken in the prism, com¬
bined together, make all the glory of the rising or the setting
sun. I'he object, to which we advert, has been accordingly
attempted by a few pathological writers, but in no wise wilb
that success which we presage will, in the fulness of time,
crown their ulterior efforts. We have works both compiled
and eclectic, and these are precise!}^ the works wherein we
may be emboldened to seek that information en masse which
is conveyed in so many minor and subordinate vehicles, and to
which we may look as to a graduated scale for the progress
of our advancement in medical science. But what works of
reference have we of the kind alluded to? First, we have
Cullen’s Practice of Physic, Cullen Primus we should say ;
but strange rumours have gone abroad that his doctrines are
false, and his principles unsound — this, however, all are not
bound to believe; — then we have a large and a small hook,
daily resorted to like the oracles of yore, we mean Thomas’s
and Hooper’s Practice of Physic, by some, with unbecoming
irony, called Cullen Secundus and Cullen Junior, and by
others declared to bear a strong family likeness to the elder-
born, and above all to hear, with very few of the redeeming
qualities of their ancestor, all his faults and imperfections on
their heads — this, even, all are not hound to believe: — we
have also Dr. Good’s laborious and gigantic work,' the
^‘ Magnum Opus,” of so many sleepless nights and toilsome
days ; but his volumes, we have heard it said, to speak it not
profanely, would have been more acceptable to the moderns
if there had been less of the ancients therein, — this, too, all
are not hound to believe. Lastly, we may add, Dr. Gregory’s
Practice of Physic, and we pronounce it, upon the whole,
an useful addition to this particular class of works. It is
the simple and unambitious offering of a young Physician to
the junior members of the Profession, to whom it is chiefly
adapted. ' »

Most medical men have a strong predilection for one par¬
ticular work, w'hich acquires a certain degree of sanctity and
excellence with them by frequent reading, and to this the
mind secretly and unconsciously reverts in the soft un¬
bended intervals of ease,” and when occasion calls. This

Dr* Gregory on the Theory and Practice of Physic. 157

predilection was strongly characteristic of the ancients, and
we have a Latin proverb that has come down to us from
them, with a number of others in less repute — “ Cave ab
hornine unius libri.’’ It is in truth a very good proverb ; for the
perusal of one work of standard merit and usefulness is worth
the desultory reading of many, and alone it might make the
student not only master of his subject, but, as the proverb
imports, a formidable opponent too. Now, we should not
hesitate to recommend our young readers to an intimate
acquaintance with our author, for in him they will find in*-
struction conveyed in obvious and easy terms, and delivered
with earnestness, ingenuousness, and caution. It is not, we
confess, a profound work or one of research, and perhaps, for
lliis reason, we may promise it a longer reading; yet we
take shame to ourselves that it should be so, it is needless
to remind the reading part of the medical public that the
largest pearls are to be found in the deepest waters; for, alas!
the dust hangs thickest upon those writings which the learned
few' admire the most, as if in pure mockery of their lore and
science. But we must show what our author is before we
make further comment on his talents as an author; albeit,
after what we have said, further comment would be idle. It
may be already known what we think of him — celavasaris dire.
The first part of this elementary w'ork has been some time
before the public, and has passed muster in the reviews;* we
shall, therefore, confine ourselves to the second volume, of
which we think more highly than of its predecessor in regard
to style, composition, and subject matter. It is devoted to
the consideration of chronic diseases, (the acute are discussed
in the first part,) which are divided into five classes, j

Class 1. Chronic diseases of the encephalon; 2. of the
thorax; 3. of the chylopo’etic viscera; 4. of the urinary' and
uterine systems; 5. chronic constitutional diseases. We
shall select two chapters from these, and shall begin at
the beginning, as we prefer the first chapter in this class
to the others, containing particular accounts of diseases
of the brain, having analysed most of them in the pre¬
ceding Numbers. Dr. Gregory refers the symptoms that
mark their character to disordered states of the functions
of the nerves and brain; the chief of which are sensation,
voluntary motion, and manifestation of mind; and designates
these states as coma, convulsions, and mental aberration.
1. Coma, he tells us, consists in the loss of sensation,
thought, and voluntary motion ; in it the organs of involun¬
tary motion preserve their functions ; and as the pulse still

* See the review of the first volume, in the Medical Reposi¬
tory, Vol. XIV. p. 303.

158 Analytical Review.

continues to beat, and the lungs to breathe, it must not
confounded with syncope and asphyxia. We cannot^
however, make the like distinction between coma and two
states of the body perfectly compatible with health, namely,
that of sleep and intoxication. In the former case we caonol;
rouse our patient from what may be almost called the sleep
of death” by shaking,* noise, or otherwise; whereas, in the
latter, our own organs, and some little information to be
obtained from bystanders, will be sufficient to show that the
invisible spirit of wine has been busy in the brain. We say
nothing of the other signs that Pliny has enumerated, viz. the
pallor et gence pendiUa, oculorum ulcera, tremulcc manus^
furiales somni, mquies nocturna. Perfect coma is attended,
as in apoplexy, with abolition of sense and voluntary motion ;
but it is more or less partial in other disorders of the above
functions, and is variously modified in the different slates of
preternatural drow'siness or lethargy, paralysis of particular
muscles, indistinctness of vision, amaurosis. 2. Speaking of
convulsions, he objects to the common definition that recog¬
nizes only the excitement of the voluntaiy muscles into
action. It must be allowed, indeed, that sometimes the
involuntary muscles are alike affected as the respiratory
muscles, for instance, in asthma, or the muscular coat of the
stomach or intestines in colic. Besides the two kinds of
spasm, the tonic and clonic, which evidently depend on the
states of the nervous system and of muscular irritability, he
mentions a variety of partial convulsions symptomatic of dis¬
eased brain, as permanent contraction of the iris, irregular
contractions of the muscles of the eye, vulgarly called squint¬
ing, and the convulsions of the pterygoid muscles consti¬
tuting grinding of the teeth.”

3. Mental aberration is temporary or permanent, occurring
either in the form of delirium or mania; and general or
partial, the whole state of the mind being deteriorated to
the utter extinction of the powers of thought, as in idiocy,
or one or more faculties being disordered while others
are undisturbed, or more or less perfect. Sometimes the
imagination is alienated, as in cases of mania, while the
memory is uninjured ; and sometimes the memory fails,
while the brain preserves the powers of perception entire, of
which we have examples in injuries of the head and paralytic
seizures. There are different degrees and kinds of mental
aberration, depending, we may remark, upon the causes that
give rise to it, on previous habits, and above all, on the pecu¬
liarities of temperament. Sometimes it is attended with a
fierce, intractable, and turbulent spirit, breaking out into
paroxysms of ungovernable rage, strong enmities, and high
constitutional excitement. At other times it is accompanied

Dr, Gregory on the Theory and Practice of Physic. 159

with a deep and concentrated feeling of melancholy, and a
settled, sullen gloom of spirits. To modifications of this
state of mind the term hypochondriasis has been applied.

i\fter having discussed the nature of nervous diseases, the
author proceeds to inquire into those derangements of the
circulating system which involve their proximate cause : and
we give his own words : —

‘‘1. The first of these is chronic inflammation of the substance of
the brain or its meninges. That this is the true proximate cause of
many cases of chronic disease within the encephalon, is abundantly
proved by the appearances found on dissection, which are depositions
of coagulable lymph upon the surface of the brain, thickening of one
or more of the membranes, and suppuration. These unquestionable
marks of inflammatory action are, however, but rarely met with in
comparison with two others frequently adduced as evidences of the
same state of disease; I mean, increased vascularity within the
cranium, and serous effusion between the membranes, or within the
ventricles. These appearances are very common in diflerent diseases,
but in none are they so generally met with as in chronic affections of
the nervous system. There are few instances indeed of any morbid
change of structure in the brain existing without them. Pathologists
have differed however in their estimate of the importance to be
attached to them, especially that of serous effusion. The general
opinion appears to be, that though it cannot be assumed as a proof of
the existence of actual inflammation within the brain, it must yet be
allowed to denote a degree of morbid excitement of the vessels of the
brain not far removed from inflammatory action.

‘‘ 2. The second of the morbid conditions of the circulating system,
connected with nervous disease, is simple congestion of blood in the
blood vessels. This may arise either from an extraordinary flow of
blood into the arteries of the brain, or from the difficulty experienced
in the return of blood to the heart. The peculiar structure of the
large venous trunks of the brain is calculated to lead, under certain
circumstances, to stagnation, or, as it is now more commonly called,
venous congestion in the head. That such a state of the circulating
system in the encephalon does occasionally exist, there cannot,
1 presume, be a doubt; but it may be fairly questioned how far we
are able to judge of its. existence, with any degree of accuracy, by
examination made after death. It is, at least, sufficiently ascertained
that that fulness in the brain, so often found upon dissection, and
supposed to denote congestion, depends in a great degree on the
position in which the body had lain previous to examination.

“ 3. The third of those states of disease, to which our attention
must be paid in this inquiry, is hemorrhage. The rupture of a blood¬
vessel within the brain acknowledges many of the laws which affect
other hemorrhagies ; but the want of outlet for the effused fluid, the
peculiar delicacy of the structure of the brain, the importance of its
functions, and above all, the remarkable effects of pressure upon its
substance, give to the heemorrhagia cerebri an interest far superior to

l60 Analytical Review,

\ i» » •

what belongs to any other form of hsemorrhagic disea^^ The
symptoms produced by effusion of blood within the brain are, with
few exceptions, those of apoplexy, and the nature and varieties of
cerebral hemorrhage will accordingly constitute the most important
feature in the pathology of that disease.

“ 4. The fourth morbid condition of the circulating system, ob¬
served in certain diseases of the nervous kind, is an imperfect supply
of blood. The brain, like every other organ of the body, is dependent
for the due exercise of its functions on the circulation. It can
neither perform them properly when the supply of blood is either too
great nor when it is too defective. Syncope is the usual result of a
want of due supply of blood to the brain ; but convulsions occasionally
arise from the same cause, as is well exemplified in the instance of
puerperal hemorrhage. It is not often that we have to apply this
principle in the pathology of nervous diseases, but in a general view
of the subject, such as we are now taking, it v;ould have been im¬
proper to omit it.

5. In like manner it becomes necessary to notice a fifth state
of the circulating system which is occasionally present in nervous
diseases; I mean the supply of blood imperfectly oxygenated, and
therefore unfit for supporting the functions of the nervous system.
This principle, it is true, like the last, is very limited in its applica¬
tion ; but it enters into the pathology of apoplexy, and is the founda¬
tion of many of our reasonings concerning asphyxia.”

There are, however, two distinct morbid conditions of the
brain not depending, as we have good reason to believe, upon
any primary change in the vascular system. The one is
concussion of the brain, and simple compression produced by '
a coagulum of blood, a soft tumour, bony excrescence, de- j
pressed portion of the cranium, or some extraneous body ; the i
other is a specific affection of the brain and nervous system, ;
altogether independent of the causes above mentioned, and j
curiously, but strongly illustrated in the phenomena of narcotic
poisons, which act directly on the sentient extremities of the 9
nerves, occasioning coma and convulsions, and depriving the ^
nervous substance of its mobility, or of its powmr of receiving |
or communicating impressions. The former gives rise to 5
symptoms of a comatose or apoplectic character, and has 3/
been known to be followed by high nervous excitement, j
mania, and convulsions. The latter, it is supposed, may ^
account satisfactorily for the absence of those evidences of ijo
morbid derangement we expect to find post mortem in cases a
of long-standing disease of the brain. ,

The researches of morbid anatomy do indeed often perplex
us in the extreme, and too often show the hollow’iiess and
vanity of our pretensions to perfection in pathological know'- iw
ledge. When we look into the recesses of those organs fi
which w'C have assumed to be the seat of derangements that

Dr. Gregory on the Theory and Practice of Physic, I6l

belong to other systems, we cannot abstain from certain
reflections, not so much upon the imperfection of the art, as
the swelling and vainglorious spirit of those that profess
themselves to be perfect in it. The fallacy of judgment
which we now deplore, and whicli is unavowedly too often
chargeable upon us, has more frequently alliance with chronic
than acute diseases. In them we often find the fons et origo
mali where we least expected, after having pursued dis-
I ease in the living subject, after having tracked it through
! its various involutions, combinations, and movements from
one organ to another, and referred it to some part or
system of parts, discovered in the issue, as the French Physi¬
cians say, intact. Dr. Pring, in his excellent chapter on,
Determinations of Blood — which we have perused and re¬
perused with increasing satisfaction — has observed, that the
j proofs of a determination of blood (and on this cause most
j of the diseases of the encephalon depend) to parts during life,
which are obtained by their inspection after death, are some-’
times wanting, must be admitted by all who are familiar with
such examination. Amongst other cases in which this fact
is exemplified, he has related one of a boy who laboured
under tetanus, in consequence of a w'ound, involving the
pes anserinus of the face. No morbid appearances were
observable either in the nerve or in the brain, whose vessels,
Dr. P. remarks, were not more turgid than they may be
found in subjects who die of old age, or diseases the most
distantly connected with the brain. We were present a few
i weeks ago at the inspection of the body of a boy who died
! also of tetanus, produced by a simple contusion; but no signs
of lesion were to be perceived in any of the viscera, though
i one or two gentlemen present thought that the membranes,

^ surrounding the medulla spinalis, were more vascular in some
parts than they should be. We may infer, therefore, with
this eminent pathologist, that determination of blood is not
an universal accompaniment of disease; and if this conclusion
be established in certain cases, it will also appear that he who,
upon a mistaken principle, makes large and frequent abstrac¬
tions of blood in all instances of disordered brain, will not
only often fail of giving relief to his patient, but will aggravate
the disease. The student of medicine may here, in Dr.
Gregory’s own words, receive an important lesson. He may
learn from this that the causes of death are often as obscure
as the sources of life and health ; and that morbid anatomy,

' with all its acknowledged advantages, may, if pursued too
' exclusively, injure rather than forward the conclusions of the
pathologist. After having noticed the paradoxical analogies
f that occur between the chronic diseases of the encephalon,
VOL. XX. — NO. 1 16. Y

16£

Analytual Review,

and which are stated with admirable precision and perspb
cuity in Dr. Prichard’s work, in that part entitled Intimate
Connexion of Nervous Diseases,” he insists upon the efficacy
of the depleting and lowering system — adapted necessarily
to the particular circumstances of each patient, and the pecu¬
liarities of each disease. This is the great principle kept
in view,” he well remarks, whether we employ bleeding,
purging, leeches, cupping, local cold, blisters, issues and
setons, or content ourselves with remedial means of a less
formal, though not less useful character, such as a cooling
spare diet, regular exercise, or a course of aperient mineral
waters. By these means, early, steadily, and judiciously
applied, we may often do a great deal towards the relief or
permanent cure of the chronic diseases of the brain; while
without them, and depending upon stimulants and antispas-
modics, our expectations will be but too often baffled.”

Dr. Gregory, in this class, has omitted ■ — ■ and we are sorry
to find him guilty, throughout the w^ork, of too many omis¬
sions, both pathological and therapeutical — - to mention
nervous disorders of the head, and certain severe affections of
the head which are found sometimes to substitute disease of
the skin or scalp, and which are noticed by Dr. Pring in his
profound work on Pathology. The most common symptoms
of nervous disorder of the head, he tells us, are pain, throb¬
bing, sense of tightness across the forehead, rather white but
moist tongue, and the pulse, during an exacerbation, between
ninety and a hundred, at other times, perhaps, between j
seventy or eighty^ We have often been inclined ourselves to <
refer the pain, with Dr. P., to the scalp, for the reasons he
has assigned, namely, the tenderness of the part, and the :
relief obtained from pressure by a handkerchief, whereby the :
blood is intercepted from flowing to the scalp. There not
unfrequently exists a tendency to cutaneous diseases in alii- ^
ance with these disorders, particularly to boils ; and Dr. P.
thinks the form of cutaneous disease is most frequently that ;
of erysipelas. The best mode of treatment seems to be occa- -j
sional local bleedings and purgatives, alternating with a slight )(
mercurial course of blue pill, and a regimen by degrees in- o
creased to repletion. |

We have alluded to severe cephalic affections, substituting 'i
a diseased state of skin or of the scalp. In two cases of this ^
kind. Dr. Pring tried every sort of treatment in vain : bleed- b
ings from the arm, from the temporal artery, by cupping, by n
leeches; blisters on the back of the neck, between the shoul- L
ders, on the scalp behind the ears ; cold lotions; hot fomenta- i
lions; setons; pustular eruptions produced on the scalp by ^
emetic tartar ointments; the extraction of suspected teeth; d

Dr. Gregory on the Theory and Practice of Physic. 163

;

nauseating and emetic medicines ; a long course of purga¬
tives ; tonic remedies, as steel, bark, arsenic, ammonia, asa-
foetida, opium^ &c. ; vegetable diet, and starvation ; animal
diet, with ale and porter. In one case, the disease terminated
by metastasis to the liver; the other has continued with but
trifling mitigation more than ten years.

We shall next select a chapter from the next class ; and
perhaps one of the best is that upon chronic affections of the
heart, though he has given but an imperfect account of the
diseases affecting its cavities, valves, and great vessels, con¬
sidering the abundant resources that have been furnished by
pathologists on these important subjects. We do not con¬
ceive an inquiry into the several kinds of structural disease of
the heart and vessels to be one merely of curiosity, or, in
the author’s words, one of curiosity more than of practical
interest. A w'ork of this sort is in some measure bound to
present us with as full and comprehensive history of disease
as its limits allow; but assuredly its limits, in the space
afforded by two volumes of more than ordinary calibre, are
not so narrow as to justify undue curtailment of its fair pro¬
portions.

1. The simplest, and one of its most frequent structural
derangements,” he states, is dilatation, either general or
partial, of its cavities. It sometimes takes place without any
increase of substance in the heart ; at other times, the heart
is enlarged by an addition of solid substance, cellular and
muscular ; its cavities remaining very little, if at all more
capacious than usual.” In the latter case, the auricles are
rarely affected, but one or both ventricles may be diseased.
Simple dilatation of its cavities is attended with a sense of
oppression about the chest, a full, slow, soft, or sometimes
even an imperceptible pulse. Three distinct varieties of this
form of disease are recognized in Laennec’s excellent work —
a work which Dr. Gregory has entirely, and most unac¬
countably neglected to mention — namely, active aneurism
of the heart, without dilatation of its cavities (hypertrophia
simplex) ; 2d, dilatation of the ventricles of the heart, by
Corvisarl called passive aneurism ; and, 3d, dilatation of the
ventricles, with thickening of their parietes (by him also called
active aneurism). We refer our readers to Laennec’s work
for the symptoms, and to our review of that work."^

2. In cases of active aneurism, or where the heart has
undergone a thickening and augmentation of its muscular
structure, we are informed that the symptoms resemble those
attending chronic inflammation of the pericardium. There

* Repository, Vol. XVII. p. 209.

164 \ ^ . Analytical Review.

is a constant sense of struggling in tiie thorax, with inex¬
pressible anxiety referred to the heart. The pulse is quick,
hard, and jarring; and when the hand is applied to the chest,
the motion communicated to it resembles a thrilling. When
there is dilatation of the right ventricle, together with increase
of substance, there is increase of dyspnoea, haemoptysis, a
purplish hue of countenance, and coldness and discoloration
of the extremities. Laennec tells us, in this case, the stetho¬
scope, of which Dr. G. makes no mention, on being applied
to the chest, conveys a clear and distinct sound. In active
aneurism, w^e generally find a diseased state of the valves,
which oifers a mechanical impediment to the circulation of
the blood, and necessarily produces an increased, nay violent
action in the heart.

3. The author takes a short and cursory view of diseases of
the valves, and remarks : —

“ Much importance has always been attached by pathologists to
the changes of structure which the valves of the heart and large
arteries so frequently undergo, and to the symptoms thereby occa¬
sioned. That in many cases diseased valves are the direct cause of
various marks of obstructed circulation there can be no doubt ; but, it
is not to be forgotten that they are often found where no symptoms
had led to the suspicion of them. It is, I believe, quite impossible to
ascertain, with any degree of precision, during life, the existence of
diseased valves, as separate from every other variety of disorganiza¬
tion of the heart. Still more hopeless is any attempt to determine
what valve or set of valves are affected. The general symptoms of
obstructed circulation by which we are led to form a plausible con¬
jecture as to the existence of ossified valves are, according to Dr.
Baillie, frequent palpitations, a difficulty of breathing, a weak and
often irregular pulse, and in some cases a disposition to fainting. To
these symptoms, other authors have added, and I believe justly,
hemorrhage from the lungs and dropsy.”

The deposition of calcareous matter in the very citadel of
life is perhaps ona of the most extraordinary specimens of
disease that affect the human frame, and warn us, as it were,
of the slow and progressive resolution of its materials into
those of dust whereto Tis kin.” We do not, however, con¬
sider it as entirely the concomitant of a prolonged state of
existence, nor even its effect, as it has been known occa¬
sionally to occur in young subjects, and rarely in brutes, (as
Hodgson has remarked, in his work on Diseases of the
Arteries and Veins,”) many of whom, as the elephant, eagle,
&c. live to a very advanced period. In the coats of the
arteries it is frequently productive, as he has accurately
described it, of the most serious effects, either by destroying
the continuity of that portion of the vessel in which the depo-

Dr. Gregory on the Theory and Practice of Physic. 165

sition takes place, or by impeding the current of blood that is
destined to pass through the artery for the supply of other
parts. It is therefore the frequent cause of aneurisms and
passive hemorrhagies. Indeed, in many cases of apoplexy in
persons of advanced age, we find ossification and other disor¬
ganized states of the vessels of the brain.

Ossification of the aortal valves is often found to be the
cause of those diseases of the heart of which mention has
been made — in consequence of the violent action to which
this organ is subjected by its frequent attempts to rid itself of
the volume of fluid that stimulates its cavities, and which can
only flow through its constricted orifice. We have so good
an account of the symptoms produced by a morbid condition
of aortal valves in this same treatise, that we shall hazard no
apology for making a few hasty extracts from it. They con¬
sist in the violent action of the heart, and the feeble and con¬
tracted state of the pulse. The former arises from increase
of substance in the muscular structure of the ventricle, and,
consequently, increased force in its contraction. The latter is
produced by the diminished quantity of blood that is thrown
at one contraction into the arteries. But it is necessary to
combine the knowledge of symptoms of some other diseases,
superadded to those already mentioned, before we can attain
to a diagnosis sufflciently satisfactory. Contraction of the
left auriculo-ventricular opening he has, in several instances,
observed to be attended with a double pulse at the heart;
whereas, in simple obstruction of the orifice of the aorta, this
symptom is altogether absent. He accounts for the double
pulse in the following way: — There is one pulse produced
by the action of the auricle, which is increased in thickness,
and consequently in force ; by this the blood is propelled
towards the ventricle, but the opening being smaller than it is
in a healthy state, it is not poured at once into that cavity.
The auricular pulse resembles an irregular thrill or bruisse-
ment, as Corvisart terms it, rather than distinct pulsation.
There is also another pulse produced by the action of the
ventricle, which, though incompletely filled, forces the blood
into the aorta. The sensations which are produced by the
deposition of calcareous matter in the valves of the aorta,
attend most other organic diseases of the heart and great
blood-vessels. The patient complains of palpitation and irre¬
gularity in the action of the heart, producing occasional
syncope. There is an intense pain at the scrobiculus cordis
and underneath the sternum, generally extending down the
arms, and terminating in a sensation of numbness. The great
cavities and the extremities become dropsical, the respiration

166 Analytical Review*

is laborious, and there is often a violent pulsation in the
epigastrium/’*

The treatment of such disease can only be mitigative.
We must endeavour to diminish the constant irritation under
which the heart labours, by lessening the quantity of blood,
and preventing it from being increased. This indication is
best fulfilled by moderate but repeated depletion and absti¬
nence, to which must be added, the removal of such causes,
either physical or moral, as affect the heart.

4. Aneurism of the thoracic aorta. Dr. Gregory proceeds to
inform us, is a frequent and most distressing state of disease.
It is generally attended with more or less of pain in the aneu-
rismal tumour shooting to the arm of the same side, and in
proportion to the advances of the disease, the breathing
becomes disturbed. If this be intended for a pathological
draught of the disease, it is indeed but imperfectly executed,
and we fear few of our students would be enabled thereby to
trace out the original. In our friend Dr. Reeder’s Practical
Treatise, we have a long and elaborate delineation of symp¬
toms, occupying four ample pages. There truly we have a
picture — large as life — of the disease; and, indeed, to
speak of it, not as a picture, but as, what it is, a work, we
must say that he does not like Pistol’s maxim pocos palabras,
but has eked out his solid pages to French wire. Dr. G.
proposes, by way of treating this affection, repeated leeches
to the chest, and the application of cold to the tumour, when
it makes its appearance externally. He speaks favourably
of digitalis, and recommends a strict attention to diet and
regimen.

5. He concludes this chapter with an account of congenital
malformation of the heart and large blood-vessels, which are
of various kinds, and which have been ably described by
Dr. Farre : - —

‘‘ They all agree in one result — the intermixture of venous with
arterial blood throughout the body. It is certainly a curious fact
that life should be compatible with such a state of the circulating
system; yet it is so; and persons have been known to live for many
years with it, and even ultimately to die of a disease unconnected
with such a deviation from ordinary structure. The great source of
mischief and danger, as Dr. Farre has pointed out, is not the mere
mingling of black and red blood, but the difficult;^ with which the
circulation is generally carried on by a malformed heart. This is
connected, in many cases, with the comparatively small size of the
pulmonary artery, the consequence of which is, that the full propor-

* Hodgson on Diseases of the Arteries and Veins.

Dr. Gregory on the Theory and Practice of Physic. l67

tion of blood is not circulated through the lungs. The principal
symptom of malformed heart is a permanent blue colour of the skin,
from which circumstance the term blue disease has commonly been
applied to these cases. The other symptoms to which it gives rise
are, general weakness of the whole frame, permanent or spasmodic
dyspnoea, palpitation, an irregular, weak, or intermittent pulse, and
in some cases coldness of the skin and emaciation. Persons who
have malformed hearts are liable to hemorrhagies, dropsical effusions,
attacks of syncope or epilepsy, and occasionally to the unequivocal
symptoms of oppressed brain.”

We cannot afford room for further extracts, and we have
already, we trust, given enough of this work to show what it
is. We shall, therefore, be permitted to draw our review of
it to a close, and say a few words to the author at parting.

We regard his performance more as. an earnest and pledge
of something better, than as possessing that degree of excel¬
lence which we should be satisfied with ; and, therefore, we
would animate and exhort him to the prosecution and com¬
pletion of his task. He will find, and no doubt he has found,
that the wide field on which he toils abounds in produce, and
may be made to answer the expectations of those who labour
at its cultivation and improvement. It is, in truth, a rich and
practicable soil — the land has been well ploughed — the
seed already sown, and its growth rapid and luxuriant. We
have only to reap the harvest — to collect the grain, and
deposit it in that vast granary where so many stores are
already garnered — whence we may select at leisure, and ap¬
propriate them in time of need to the purposes of life and
health. We have said that we consider this work only as a
pledge. We would, therefore, remind our author that he has
acquired some degree of reputation by beginning as he has ;
but he has still much more to do before he reaches that
perfection which all medical authors should aspire to. We
would also remind him, and it is encouraging so to speak,
that the reputation of the Physician is not only productive of
an honourable emolument, but of the dignity and high con¬
sideration which confirms its stability. ‘‘ The feather,”
Junius has emphatically remarked, in one of the finest meta¬
phors of our language, “ the feather that adorns the royal bird,
supports its flight. Strip him of its plumage, and you fix
him to the earth.” And what is reputation to us but the
plumage to the bird? We rise and fail with it. With it we
are enabled to aspire to that “ pride of place” which the
royal bird, it is said, can only reach — to the highest honours
of our Profession; and without it, we sink grovelling to the
earth, and are scarcely numbered among living men. We
would, lastly, remind our author, that his responsibility is

168

Foreign Medical Science and literature.

marked upon the scale of his advancement; and that although,
according to the French proverb, the chief difficulty lies in
the first step, it is still difficult to retain one's footing on
a place even of moderate elevation. *

PART III. \

ANALYSIS OF FOREIGN PUBLICATIONS

IN THE DIFFERENT BRANCHES OF MEDICAL AND
SURGICAL SCIENCE AND LITERATURE.

De V Ohliteration des VeineSj et de son Influence sur la Fomation
des Hydropisies Partielles : Considerations sur les Hydropisies
Passives en gmeral. Par M. Bouillaud, Interne des H6-
pitaux Civils de Paris. J

In a late Number of this Journal || we gave a short extract
from a communication, by M. Bouillaud, contained in the
January Number of the Journal de Physiologie, in which he
stated that he had observed, in several cases of infiltration or
cedema of the lower extremities, that the venous trunks, after
entering the pelvis, were quite impermeable, and filled by a
concrete and organized coagulum. The communication be¬
fore us is a more extended inquiry into the same subject, and
consists of an attempt to confirm, by facts and observations,
that passive dropsies, or those which are not occasioned by
acute or chronic inflammation of the serous membranes, are
all produced by the influence of some obstacle to the venous
circulation ; and that, in a considerable number of cases, such
obstacle consists in an obliteration of the venous system of
the part which is the seat of the dropsical affection. By this
explanation, the author, of course, denies that they are occa-

* It would be well for the great men, or even for the moderately
great men of our Profession, to bear in mind the well-known lines of
Horace : —

“ Seepius vends agitatur pinus
Ingens, et celsse graviore casu
Decidunt turres, feriuntque summos

Fulmina monies.’'

t The length to which our “ Historical Sketch" has unexpectedly
extended, obliges us to defer the concluding part of the review of
Dr. Pring’s work on Pathology until our next Number.

I Archives Centrales de Medecine, Juin, 1823.

II Repository, Vol. XIX. p. 435.

M. Bouiilaud on Obliteration of the Veins, ^c. 169

sioned by a debility either of the general system or of the
lymphatic vessels.

M. Bouiilaud commences his observations by the detail of
seven cases, which serve as a basis to his new theory : of
these, two have already been referred to in this Journal; and
the following are abstracts of the others : — ■

Case — A female, aged fifty-five years, was admitted into
the Hospital Cochin, labouring under pulmonary tubercles
and chronic enteritis, accompanied with oedema of the lower
extremities : she died forty-five days after her admission. On
opening the body, a cancerous tumour was found, formed by
the rectum, uterus, cellular tissue, and surrounding ganglions.
The hypogastric and iliac veins, which traversed, as it were,
this enormous tumour, were obliterated by a fibrinous, red¬
dish, old, and apparently carnified coagulum : the oblitera¬
tion extended downwards the whole length of the crural
veins, and upvvards into the vena cava, as high as the right
kidney : towards this part the coagulum was of a lesser con¬
sistence, somewhat resembling the lees of wine.

Case 26? * has been already given in this Journal.

Case Sd, — A man, aged sixty years, was received into the
same hospital, labouring under chronic pleurisy and peri¬
tonitis. On his admission, his lower extremities alone were
cedematous; but on the following days the oecjema extended
to the scrotum, and soon afterwards even to the axillae : it
did not, however, affect the face or upper extremities. After
the expiration of some time, the dropsy of the cellular tissue
of the trunk and scrotum disappeared, and it was at the same
time observed that the veins of the abdominal parietes
i acquired a very considerable size, and became somewhat vari-
! cose. Seventy-five days after his admission he died, still
li labouring under the infiltration of his lower extremities. On
dissection, the right kidney was found to have degenerated
I into a cancerous, encepbaloid substance, forming a tumour
I equal in size to half the liver. This enormous tumour had
1 compressed and flattened the vena cava towards its division
into the iliacs : the canal of this vessel, which was wholly
impermeable, was distended and obliterated by a fibrinous,
friable, pultaceous matter, bearing some resemblance to the
: disorganized tissue of the kidney. The emulgent veins, the
i veins of the pelvis and of the lower extremities, were also
t obliterated by blood, which had been a very long time coa-
l i gulated. The veins of other parts contained liquid blood,
i Case Ath. — A female, aged twenty-one, died from the
1 i effects of typhus : on her admission into the hospital the left

* Repository, Vol. XIX, p. 435.

VOL. XX, — NO. 116. z

170

Foreign Medical Science and Literature-

lower extremity was oeclematous and painful. She died nine
days afterwards. On dissectioriy the veins of the affected limb
were found obliterated by a long, solid, reddish, fibrinous,
fleshy-lookiug coagulum, which extended as high as the
vena cava. The veins of the opposite limb contained liquid
blood. Their internal membrane was less red than that of
the obliterated veins. ^

Case 5th'^ has also been already given.

Case 6th. — A female, aged thirty years, three months after
delivery, was admitted into the Hospital Cochin, with symp¬
toms of most severe peritonitis, and wdth the left lower ex¬
tremity in an anasarcous state. Seven days after her admis¬
sion she died. On dissection, an enormous abscess was dis¬
covered in the pelvis, which appeared to have begun in the
left side of the cavity, in the anterior part of the psoas
muscle. The whole of the surrounding parts were in a
truly frightful state of disorganization. The left iliac and
hypogastric arteries and veins, which were situated in the
midst of the purulent mass, were thickened. The external
layers of their parietes were disorganized and of a lardaceous
appearance. The veins of the anasarcous limb, not except¬
ing the great saphena, were obliterated by a solid, fibrinous,
and friable coagulum. The other veins were pervious.

Case nth, — A female, aged seventy-five years, was ad¬
mitted into the hospital, labouring under chronic pleurisy
and pulmonary tubercles : the left lower limb was oedematous, ,
and the sub-cutaneous veins of the leg were varicose. Seven i
days after her entrance, this woman expired. On dissection, ,,
the sub-cutaneous veins of the leg, and the left crural and i
iliac veins, were found completely obliterated in the same ;
manner as in all the preceding cases. The other veins were,
in general, free, and contained black liquid blood.

The foregoing histories certainly go far to corroborate the o
theory laid down by M. Bouillaud : in addition to which it
may be well to observe, that Morgagni relates the history of k
a woman who died whilst affected with infiltration of one of !c
the limbs; and, on dissection, the femoral vein was found to lu
be filled by a sanguineous concretion ; the correspondent iliac :i.
vein was obliterated.

After referring to a case mentioned by Hodgson, and to )l
others cited by Breschet, in his treatise on Inflammation of )
the Veins, from Travers, Raikem, Bodson, &c. M. Bouillaud le
observes, that it is not uncommon to meet with infiltration of u
one or both of the lower limbs in women recently delivered. I ;
On the dissection of such instances, as in cases fifth and sixth i :

* Repository, Vol. XIX. p. 435.

171

M. Bouillaud on Obliteration of the Veins, ^c,

above detailed, he has met with obliterations of the crural
veins. For analogous examples, the works of Chaussier,
Meckel, and Travers, are referred to.

The author next proceeds to notice the opinion of
Hodgson, that dropsies are not, in general, the consequence
of the obliteration of a principal vein.

“ This assertion,” says he, “ which is founded on three or four
facts only, is in contradiction to the numerous observations which
have just been related. I am, however, very far from calling in
question the facts which are adduced as proofs that obliteration of
the veins is not, in general, followed by dropsy. I may merely,
observe, that this proposition is wanting in correctness. Mr. Hodgson
ought to have said that venous obliteration is not constantly accom¬
panied by dropsy. Besides, the negative facts of v^^hich he speaks are
simple exceptions to a general law. What do they prove .? That
this same nature which is so ingenious in re-establishing the arterial
circulation in a limb, the principal artery of which has been tied, is
equally possessed of means for keeping up the course of the venous
blood in a limb, the principal veins of which are obliterated. These
means consist in innumerable communications established between
every part of the venous system. It is proper, however, to remark,
that the collateral venous circulation is much less active than the
collateral arterial. Thus, in twenty cases, I have never observed the
venous circulation become re-established in those limbs, where it had
been interrupted.

“ If the course of the venous blood becomes restored with very
great difficulty in a limb, the principal veins of which are imper¬
meable, it is not the same when less important and, as it were, secon¬
dary veins are obliterated. This is the reason why, in cases of obli¬
teration of the sub-cutaneous veins of the fore-arm, as may occur in
consequence of inflammation of those vessels, after bleeding, the
venous circulation is scarcely disturbed. For the same reason, vari¬
cose veins of the lower limbs may be^ excised without running the
risk of producing serous infiltration. In these different circumstances,
the deep-seated veins of the limbs remaining free, the venous circula¬
tion goes on with the greatest facilit}^”

M. Bouillaud next proceeds to apply his principles to the
case of ascites, or rather, to that species which he has called
passive ascites ; and refers to three cases in which similar
phenomena were observed regarding that disease, as in the
case of infiltrations of the low'er extremities.

Case Is^. — In 1819, on the dissection of an individual who
succumbed under a tuberculous engorgement of the liver, the
author found the trunk of the vena portae obliterated by a
very old fibrinous coagulum. The peritoneum w’as healthy ;
its cavity contained much yellowish fluid.

Case 9.d. — A woman, aged thirty-eight years, had been
affected with jaundice for eight months, when she was ad-

17^ Foreign Medical Science and Literature,

niitted into the Hospital Cochin. Fluctuation was very mani¬
fest in the abdomen ; and through the parietes, in the right
side, an enormous tumour could be felt, the nature of which it
was difficult to ascertain. She died in a state of marasmus
twenty days after her admission. The limbs were never at
all cedematous. On dissectiouy a great quantity of yellowish
fluid was found in the peritoneal cavity ; the peritoneum w^as
healthy. The tumour which had been Felt through the abdo¬
minal parietes, was nothing more than the gall-bladder, so
much dilated as to equal, in size, the head of an infant : it
contained bile and a hundred biliary calculi. A considerable
tuberculous mass, occupying the inferior part of the liver and
a portion of the pancreas, compressed the ductus hepaticus,
cysticLiSj and choledochus, as well as the trunk of the vena
port£e. The first were impermeable. The vena portae was
obliterated bv a clot of blood similar to those before described.

Case 3d,^A patient, aged fifty, was admitted, labouring
under icterus and ascites. The upper and lower limbs pre¬
sented no infiltration. Three weeks after her admission she
died. On dissection^ the trunk of the vena portae was found
to be filled and obstructed by a fibrous, corrupted, pultaceous
matter, formed by blood which had been for a long time
coagulated. The inferior surface of the liver had become
degenerated into a tuberculous substance, in which, by the
most minute research, no vestige of the hepatic, cystic, and
choledochus ducts, could be discovered. The gall-bladder
was so much disorganized, that it could not be easily recog¬
nized. It contained a dirty, purulent liquid, in which several
biliary concretions were observable: it adhered to the arch of
the colon, and if the patient had lived longer, a communica¬
tion would have been established between the intestine and
the gall-bladder, so that the biliary calculi might have been
discharged per aniim.

Such are the principal facts and considerations adduced by
M. Bouillaud in the communication before us, in support of
the theory which he has embraced regarding the general
cause of serous infiltrations ; and although they may be con¬
sidered to, and assuredly do, require farther investigation, yet,
so far as they go, they throw considerable light on the patho¬
logy of hydropical affections : how far venous obstruction
may be considered a general cause of serous infiltrations,
remains to be proved by future observation. We have shown
above, that in M. Bouillaud’s opinion they are. With our
au thorns deductions from the facts and considerations of
which w'e have given a sketch, we shall conclude our analysis.

1st. ‘‘ Obliteration of the veins is a cause oi dropsy in the part
where such obliteration is situated ; as this obliteration never occu-

17S

Medical and Physical Intelligence.

pies the whole of the venous system, the dropsies, produced by it, are
partial: it has been an error to attribute these local dropsies to a
general debility, or to an atony of the lymphatic vessels : obliteration
of the veins coinciding with dropsy, is a pathological fact which con¬
firms the new doctrine of absorption.

2d. “ Passive general dropsies are owing to some obstacle to
venous circulation : these dropsies are only general by reason of the
seat of the obstacle which exists at the centre, and 'as it were at the
confluence of all the venous system.

3d. “ That it is highly necessary to avoid confounding the drop¬
sical affections, treated of in this work, with those which are the
result of a chronic inflammation of the serous membranes; they are
essentially different — the cause of the former is wholly mechanical ;
that of the latter entirely intal^

PART IV.

MEDICAL AND PHYSICAL
INTELLIGENCE:

BRITISFI AND FOREIGN.

I. Alteration of the Anterior Part of the Spinal Marrow, observed at the
Hospital of Charenton. By M. Royer Collard.

Sprevale, born at Salines, in Piedmont, April 18, 1760, on the half-pay
of the fifth demi-brigade of veterans, entered the hospital of Charenton
October 17, 1806, and died March 3, 1823.

No information can be obtained as to the situation of this man before
he entered the hospital : during the first ten years of his residence there he ,
remained silent, idle, liking nothing but his bed, scarcely answering the
questions that were asked him ; his walk was unsteady, his lower extre¬
mities were tottering, his upper ones were free, his pulse was feeble and slow.
His apathy sometimes left him, and he became peevish and mischievous,
endeavouring to strike all whom he met. The pelvian extremities becom¬
ing more and more feeble, he was at length unable to walk, and he re¬
mained about seven years with his thighs bent upon the pelvis, and the legs
upon the thighs, “ without ever moving these parts, which nevertheless
retained their sensibility.^’ He still understood what was said to him, but
his answers w'ere not articulate; his intellectual faculties were almost
annihilated, and he lived only to drink, eat, and occasionally fly into a
rage. His excretions were made involuntarily. Three weeks before his
death he w'as taken with a looseness, which became more and more
abundant; his pulse was almost insensible; his emaciation was extreme.
The trochanters and the perineum soon became excoriated.

Appearance after Heath. — The skull hard as ivory, and three times as
thick as when in a healthy state ; the cerebral and spinal dura mater is
thickened, but not injected ; the arachnoid is healthy throughout.

Tlie pia mater of the brain presents nothing remarkable ; that which

J74

Medical and Physical Intelligence,

covers the corpora olivaria and pyramidal eminences, as well as the
anterior faces of the spinal marrow, is very dense, of a bluish colour, and
marked with dots. This colouring is bounded on each side by the anterior
roots of the spinal nerves and the dentated ligament; above, it insensibly
diminishes on the developement of the cerebellum, on the upper edge of
which no trace of it is seen ; below, it finishes with the spinal marrow.
This membrane being taken away, the olivarian and pyramidal bodies are
found of a greyish colour, and as soft as bouillie ; the softness continues,
but gradually diminishes along the whole anterior part of the marrow,
and almost through the whole thickness of the bundles of fibres which form
it towards the encephalon it may be traced across the commissure of the
cerebellum into the crura of the brain, the optic thalami, the striated
bodies, and some of the cerebral convolutions, particularly towards the
middle part of the right side. The anterior roots of the spinal nerves can
also be distinguished on the fasciculi which give them origin, but they have
not their accustomed consistency.

All the other parts of the brain, besides those which we have mentioned,
are, as well as the cerebellum, in their natural state; but the commissure
of the latter is more firm than ordinary, and affords a striking contrast with
the softness of the neighbouring parts.

The posterior face of the spinal marrow, and the membrane which covers
it, are sound. There is nothing to be remarked in the breast; a little serum
is effused in the abdomen, and some light red spots exist on the peritoneum :
the internal membrane of the stomach is bluish, dotted almost throughout
its whole extension ; that of the intestines presents some red spots.

The pelvian members cannot be extended, (thirty hours after the patient’s
decease the thoracic members became flaccid); after cutting the muscles
which move them, they were rendered moveable. There is much synovia
in all their articulations.

M. Magendie inquires, is not this case calculated to enlighten our views
respecting the distinct properties of the anterior and posterior parts of the
spinal cord? However, it should be added, that the movements of the
arm in this case were partly preserved ; the writer of the case says they
were not, but M. Royer Coliard informed M. Magendie, verbally, that they
were. However, this last circumstance shows the necessity of a farther
examination of the anatomy of the spinal cord and of its vital phenomena.
This part of the nervous system is much more complicated at its superior region
than any where else, and we know nothing of the functions of the corpora
olivaria, of the anterior and posterior pyramids, &c. M. M. is at piesent
investigating these points. — Journ. de Fhys., Avril 1823.

II. Emetics useful in counteracting the inordinate Effects of M.ercury.

During the last autumn. Dr. Richard Field, of Petersburg, Virginia, in
treating one of his patients for a profuse hemorrhage of the bowels, brought
on by the inordinate action of calomel, with his favourite prescription, con¬
sisting of opium, ipecacuanha, and sugar of lead, gave the remedy in rather
large doses, and the stomach being extremely irritable, violent vomiting
was excited. The patient, at thte time, was labouring under a most
profuse salivation, amounting even to sloughing of the mouth and fauces.
The hemorrhage was soon suppressed, (an instance illustrative of the utility
of vomiting in hemorrhage,) and with an almost simultaneous arrestation of
the mercurial affection.

Having a mind always susceptible of improvement, and of unbounded
zeal in his profession. Dr. Field determined to profit by the hint thus given,
and was induced to make a farther trial of the remedy, in some other
violent cases of salivation then under his care, and which had resisted the
usual mode of treatment. The effects of the plan were mot less beneficial
than in the first instance.

175

Medical and Physical Intelligence.

Not long after this, I happened to be in Petersburg, and meeting with
Dr. Field, he informed me of the decided advantage which he had derived
from emetics, under such circumstances, and assured me that he had not
been disappointed in a solitary instance, referring me to several other
respectable practitioners of the town, who, he said, would bear ample
testimony to the efficacy of the practice. I was then requested to inform
my preceptor, who was once a pupil of Dr. Field, on my return to the
country, of the circumstance, and which I accordingly did. Confiding in
every thing coming from Dr. Field, my preceptor immediately made an
extensive trial of the remedy, and in a short time w'as enabled to corro¬
borate all which had been previously said in favour of it.

On the whole, from what I have myself seen of the utility of emetics
in arresting inordinate salivation, and the gangrene resulting from it, I
think I am warranted in pronouncing the practice a most important medical
improvement. — Extract from the Thesis of Dr. Haskins of Pennsylvania.

III. A Solution of Opium in Nitric Acid, beneficial in Hectic Fever.

We have employed, says Dr. Harrison, a distinguished Physician of
Louisville, Kentucky, opium dissolved in nitric acid, with effects decidedly
and eminently beneficial in hectic fever. One drachm of opium is dissolved
in one ounce of nitric acid, in an open vessel, to allow tfie nitrous fumes,
which are disengaged, to escape. According to the condition of the system,
we give twenty, thirty, or forty drops, three times a day.

When it manifests an action too predominantly narcotic, we diminish
the quantity of the opium. But a sufficient quantity of opium must be
dissolved, so as to calm the hectic irritation, at the same time the accom¬
panying acid imparts strength. We have witnessed one case of entire
recovery with this combination when nitric acid alone, mercury to a
ptyalism, opium, &c. were tried with little benefit. Even in cases, where
the prospect was clouded by the shadows of death, life w'as evidently pro¬
longed, and the passage to the grave rendered more smooth and gentle,
by its administration. — Philadelphia Journal, No. 11.

IV. Shock of an Earthquake felt at Sea.

The following account of a curious phenomenon was communicated to us
by our friend Mr. Parsson, who was at the time Surgeon of the ship in
question : —

On Sunday the 10th of February, 1823, at ten minutes past one P. M., the
Honourable East India Company’s ship Winchelsea, on her passage from
Bengal to England, when in lat. 52 min. N. long. 85. 33. E., experienced a
shock similar to that of an earthquake. Every individual on board was
alarmed by a tremulous motion of the vessel, which gave a sensation as
if she were passing over a coral rock; at the same time a loud rumbling
noise was heard, similar to that communicated by the rolling of a butt along
the deck. This agitation and noise continued at least for two or three
minutes. The captain, being at the time in the round-house, looked out
at the stern windows, but there was no appearance of any shoal ; this he
must have seen had any existed, as the water was remarkably clear and
smooth, and the ship not going more than two knots an hour ; indeed,
she was considered to be out of soundings at the time. One sin¬
gular circumstance to be mentioned is, that during the continuance of
this phenomenon, there was no perceptible commotion in the sea. The
Winchelsea was at this time some hundred miles from any land. This
remarkable phenomenon cannot be accounted for in any other manner than
by referring it to some volcanic eruption in one of the islands eastward
of the bay of Bengal.

176 Medical and ’Physical Intelligence,

V. Half-yearly Medical Report of the Hospital for the Casual Small-Pox

and VaccinatioUf at St. Pancras.

The proceedings of this establishment during the last six months have
not been marked by any circumstances of peculiar interest; yet they have,
nevertheless, been silently working a great deal of public benefit; and
while it must be satisfactory to the governors to know that their charity has
been effectively applied, it may not be unprofitable to the public in genaral
to have their attention re-awakened to the only form of human suffering
which mankind universally anticipates.

Eighty-four patients have been admitted into the Small-Pox Hospital,
between the 19th of December, 1822, and the present date; 49 havefhad
the disease in a severe and dangerous degree,^ and of them 23 have died.
Nine remain under treatment.

Among the 35 persons who passed through the complaint in a mild form,
24 had been previously vaccinated; and the influence of this process, in
stripping the small-pox of its most formidable features, was never more
strikingly manifest than in the period now under review. None of them
died. While the natural small-pox indeed was raging with a a degree of
violence which hardly admitted of control by medical aid, those who had
been vaccinated remained in comparative security, experiencing no other
inconveniences than what result from the visitation of casual disease.

^ Strongly impressed, by the result of another half-year’s experience, wdth a
sense of the benefits of vaccination, your Physician is gratified by having
to report that in the same period 1603 persons hare been vaccinated ; and
that with the full knowledge of the occasional failure of this protection, the
public voice is still decisively raised in its favour. Your Physician cannot,
in this place, avoid an allusion to the conduct of some persons, heretofore
strenuous advocates of vaccination, who have recently shown a disposition
to desert it, because it does not fulfil all the expectations which a bene¬
volent, but too sanguine feeling had once indulged. It behoves such
persons (before they recur to inoculation, which experience has proved to
be so pregnant with danger to the public welfare) seriously to consider,
whether the failures of vaccination may not, in some degree, be attributed
to causes under our control ; and whether the alternative proposed may
not, even as far as the individual himself is concerned, be as dangerous as
the evil to be avoided. Your Physician, judging from the experience
acquired in this establishraeut, is disposed to reply to both questions in a
manner favourable to the cause of vaccination. He is convinced that a
stricter attention than what once was bestowed on the process of vaccina¬
tion, will assist materially in reducing the number of failures; and he is
further of opinion, that the inoculated small-pox is equal in point of seve¬
rity to the same disease, as it occurs casually subsequent to vaccination.

Your Physician therefore, in conclusion, again presses on the attention of
the governors the importance of affording every encouragement to vac¬
cination. GEORGE GREGORY, M.D.

VI. Annual Report of the General Committee of the Associated Apothecaries
and Surgeon-Apothecaries of England and Wales, received and adopted
at the Annual General Meeting of the Association, held by Public
Advertisement at the Crown and Anchor Tavern, Strand, July 2, 1823.
Joseph Hayes, Esq. President.

Your committee, in compliance wfith annual custom, submit to the
Association the result of their proceedings since the last general meeting.

The meetings of the committee have been regularly held, although there

* Our correspondent would oblige us by informing us if any of these
49 severe cases had been previously vaccinated. — Editors.

177

Medical and Physical Intelligence.

has-been but little business to transact, and that little of no particular
interest or urgency.

The committee have not, however, been indifferent to the objects for
which the Association was formed; and in the first volume of Transactions,
now aearly completed, although necessarily partaking of the imperfections
incident to the commencement of a new undertaking, they trust will be
found an earnest of the zeal which they entertain for the welfare of the
Medical Profession, and of their sincere desire to render the exertions of
its members subservient to the public good and the best interests of
humanity.

Viewing, as they do, with satisfaction the success which has so far
attended the exertions of this Association in the improved state of medical
education, particularly in that of the general Practitioner, they still hope to
witness further benefits, which cannot ultimately be otherwise than reci¬
procal between the Profession and the public.

Well aware of the difficulties which attended the passing of the Apo¬
thecaries^ Act, and of the opposing obstacles which prevented the fulfil¬
ment of the laudable wishes of the Association with which it originated,
and of the Profession at large, in rendering it fully adequate to its pro¬
posed end, the committee still cherish the hope of obtaining further iiiiir
provements through the medium of the Legislature, which, whilst they may
-afford the necessary protection of the various members of the Profession,
shall be founded on a more dignified and extensive basis, — the public good.

They therefore abstain, in the present instance, from any other than
general allusion to the imperfections of the existing state of the Medical
Profession, and of the legislative provisions relative to it, or the means
required to effect the necessary meliorations. The work of improvement
is slow and laborious ; but when attempted with zeal, and carried on with
perseverance, and with a purity of motive, which the end desired must
show to be above suspicion, it cannot be otherwise than progressive.

They who now labour to place the practice of medicine upon a footing
more consistent with its real dignity and usefulness, can scarcely expect
personally to reap any benefit, unless the consciousness of having strenu¬
ously exerted themselves to effect the diminution of human suffering can be
supposed to bear such an interpretation.

As an accurate knowledge of the present state of the Medical Profession
can be the only ground-work of any rational attempt to effect improvement,
the committee beg leave to recommend to the Association that it be
therefore an instruction to the future committee : -

1. To ascertain, as far as may be practicable, the actual condition of
the Medical Profession, and the obstacles which have hitherto impeded
its advancement.

2. To examine and to arrange the imperfections to which its present
condition is liable, showing the particulars in which the public and
members of the Profession are injured or aggrieved;

3. To point out the remedies for the evils complained of.

4. To use such means, as may to them seem proper, to effect (whether
by application to the Legislature or by other legal means) the meliorations
to be desired.

5. To continue to collect and record the experience of the Profession
on subjects relating to medical science, and to publish the same in occa¬
sional or annual volumes, calculated to prove the just claims of the dif¬
ferent classes of the practitioners of the healing art to that confidence of
the public which they have so long enjoyed.

6. To give a brief account of the discoveries and improvements which
have been made in medicine, surgery, and the accessory sciences, within
the preceding year.

VOL. XX. — NO. 116.

178

Monthly Bibliography .

7. To offer such encouragements of honorary rewards as may to them
(the committee) seem proper, for the best practical essays on select subjects
relating to medicine and surgery, as may call forth the energies, particu¬
larly of the younger members of the Profession, and elicit improvements in
the healing art.

8. That the proftts arising from the publication of the Transactions of
this Association be devoted to the above-named laudable purpose.

Published by order of the Meeting,

1, Keppel Street. JOHN POWELL, Secretary.

MONTHLY MEDICAL BIBLIOGRAPHY.

BRITISH.

Practical Observations in Surgery. By Henry Earle, F. R. S. As¬
sistant Surgeon to St. Bartholomew’s Hospital, and Surgeon to the
Foundling. With plates. Svo. pp. 230. London, 1823.

A considerable part of this volume is occupied with observations on
fractures within the hip-joint and at the upper part of the thigh, with critical
remarks on that part of Sir A. Cooper’s work which treats of the same
subject. As we deferred reviewing Sir Astley’s w'ork longer than we in¬
tended, owing to the circumstance of learning that Mr. Earle’s work would
soon appear, in which a different view would be taken of fractures in the
vicinity of the hip-joint from that entertained by Sir Astley, and owing to a
wish of embracing both works in the same review, and thus of bringing the
subject fully before our readers, we now consider it still farther in¬
cumbent oiy us to defer our review still longer, as we find that a third
edition of Jjir Astley s excellent work will soon appear, in which the cri¬
ticisms of Mr. Earle are to be answered. By adopting this plan we shall
have the very difficult and perplexing subjects at issue fully brought before
us, and consequently be enabled to give a more satisfactory view of, and
opinion respecting them — ‘‘ Tros Tyriusve mihi nullo discrimine agetur.’’

The other topics which Mr. Earle’s work embraces are — Description of
a Bed for the relief of patients labouring under accidents and diseases re-
quiiing rest ; Observations on Fractures of the Olecranon, &c. ; with
ciitical remarks on the diagnosis of that accident; — On Injuries in
the vicinity of the Shoulder-joint j with a description of an Apparatus for the
moie effectually securing the upper extremity : — On the Re-establishment
of a Canal in the place of a portion of the Urethra which had been de¬
stroyed : And on the Mechanism of the Spine.- — We can, at present,

only add that these subjects are ably and ingeniously treated by Mr. Earle.

FOREIGN.

I. Phytographie Mffdicale, ornee de Figures coloriees de Grandeur
iiaturelle, ou i’on expose THistoire des Poisons tires du Regne
Vegetal, et les Moyens de remedier h leurs Effets deletaires, avec des
Observations sur les Proprietes et les Usages des Plantes Heroiques.
Far Joseph Roques, Chevalier de !a Legiim d’Honneur, Docteur en
ffJedccinc de la laculte de Alontpellier, ancien hledecin des Hopi-
taux Militaires, Membre de plusieiirs Academies et Societes savantes.
Chaque Livraison, deux ou trois feuilles de texte, ct cinq planches.
4to. 8 francs.

W^e have received 21 llwciisons of this excellent work, and can speak in
terms of the highest praise regarding its execution : the text is written by
a man well informed of the subject on which he treats, whilst the plates are
beautifully finished, and correct representations after nature. One livraison
appears regularly each month. It will consist of 36 in all, and when com¬
pleted will form a valuable addition to the library of the Physician or
Naturalist.

! MolUhly Bibliography j Works for Review, b^c. 179

I II. Dictionnaire de Medecine par MM. Adelon, Bedard, Biett,

; Breschet, Chomel, H. Cloquet, J. Cloquet, Coutanceau, Desormeaux,
Ferrus, Georget, Guersent, Lagneau, Landre-Beauvais, Marc, Mar-
jolin, Murat, Orfila, Pelletier, Raige-Delorme, Rayer, Richard,
Rochoux, Rostan, Roux, et Rullier. En 18 volumes. Tom. 7^ine.
DIG— ENC.

The seventh volume of this interesting work has just appeared, and is
not at all inferior in execution to its precursors. The principal articles
comprised in it are the following: — 'Dynamomttre, Effort, Encephale,
(physiol.), by Adelon — Egagropyle, by Breschet — Dysenteric, by Chomel —
Encephale (anat.) by H. Cloquet — Ectropion and Encanthis, by J. Clo¬
quet — Eclectique and Element, by Coutanceau — Dystocie, Eclampsie,
and Embryotomie, by Desormeaux — Douleur, Dyspepsie, and Encephale
(path.) by Georget — Diuretique, Eaux miner ales (ynevap.), Electuaire,
Elixir, Emeto-cathartique, Emm'enagogue, Emollient, and Empldtre, by
Guersent — Dyspermatisme and Ecoulement, by Lagneau- — Dilatation and
Ecchymose, by Maijolin — Elevatoire, Emhaumement and Emphyseme,hj
; Murat — (chimie), Eaux Minerales (chimie), and Empoisonnement,
by Orfila — Eaux distillees Aromatiques, Eaux spiritueuses, Elaine, and
j Emetine, by Pelletier — Dogmatique (ecole), Dysphagie, Empirique (ecole),
i Empirisme, by Raige-Delorme — Ebullition, Elephantiasis, Embarras gas-
1 trique et intestinal, by Rayer — Digitate, Ellebore, by Richard — Douche
I by Rochoux — Eau (hygiene), by Rostan — and finally. Digestion, by Rullier.

I WORKS RECEIVED FOR REVIEW.

I. Practical Observations in Surgery, By Henry Earle, F.R.S. Assistant
I Surgeon to St. Bartholomew’s Hospital, and Surgeon to the Foundling,
j With plates, 8vo. Underwoods. London, 1823.

] IT An Outline of Hints for the Political Organization and Moral Train-i
ing of the Human Race: submitted with deference to the consideration of
those who frame Laws for the Civil Government of Man, and more espe-
I cially for those who direct, or profess to direct Man to the true worship of
I the Deity. By Robert Jackson, M. D. 8vo. pp. 253. Baldwin" & Co. 1823.

I III. Prison Labour, &c. Correspondence and Communications addressed
to his Majesty’s Principal Secretary of State for the Home ' Department
concerning the Introduction of Tread-Mills into Prisons, with other Matters
connected with the Subject of Prison Discipline. By Sir John Cox Hip-
pesley, Bart. D. C. L. F. R. & A. S.S. a Bencher of the Inner Temple. 8vo.
pp. 228. Nicol and Rivington. 1823.

LITERARY INTELLIGENCE.

In the press, the third edition of Sir Astley Cooper’s Work on Dislocations
and Fractures of the Joints. An Appendix will contain a Refutation of
almost every Statement made in a late critical publication, on a subject
treated of in the former editions of the above work.

Mr. Plumbe has in the press, a Treatise on Diseases of the Skin, intended
to comprise the Substance of the Essay for which the College of Surgeons
have awarded to him the Jacksonian Prize, a reprint of his Essay on Ring¬
worms, &c. and copious Notices of such Improvements as have been made
in the Pathology and Treatment of Cutaneous Diseases generally since the
publication of Bateman’s Synopsis.

NOTICE OF LECTURES.

Mr. Greenitig, of Aldersgate Street, Consulting Accoucheur to the City
Lying-in Charity and the London Midwifery Establishment for delivering
\V omen at their own Habitations, will commence a Course of Lectures,
early in the month of October, on the Theory and Practice of Midwifery,
and on the Diseases of Women and Children.

180

THE METEOROLOGICAL JOURNAL,

From the \^th of JUNEf to the 20th of JULY, 1823,
By Messrs. HARRIS and Co.

Mathematical Instrument Makers^ 60, High Holborn,

June. j

1 Moon..

j Rain Gauge.

Therm.

Barom.

De Luc’s
Hygrom.

Winds.

Atmo. Variation 1

Max.

9 A.M.

lOP.M.

j 10 P. M.

•

10 P. M.

55 29 84

29 80

Fine

30,29 76

29 90

N ■

Ovc.

■Ovc

90 85

90 87

29 74

29 72

WNW

Clo.

Fine

29 70

Fine

29 64

29 30

Fine

Sho.

,03

29 44

29 34

Fine

Sho.

,05

29 20

29 11

SSW

Ovc.

t.& r.

Rain

,09

29 14

29 25

ssw

Ovc.

Rain

29 46

29 53

Clo.

t.&r.

Fine

,02

29 74

29 68

Fine

Clo.

Ovc.

29 71

29 80

NNE

SSE

Clo.

Rain

Clo.

20 80

29 83

SSW

Finp

29 84

29 90

NNE

NNE ,

Clo.

Fine

29 83

29 77

SSE

ssw

Rain

Clo.

90 76

90 70

SSW

ssw

1 u

29 70

f \J

29 54

ssw

oo vv

ssw^

r iijo

Clo.

29 50

wsw

Clo,

Rain

Clo.

,47

29 50

29 53

wsw

Clo.

Fine

29 73

29 80

wsw

Fine

29 86

29 73

wsw

SSE

Clo.

29 54

29 52

SSE

Fine

29 50

29 35

ssw

Clo.*

Clo.

29 58

29 54

SSW

Clo.

Rain

29 50

29 60

Fine

,15

,29

29 60

29 40

ssw

Rain

,21

29 41

29 40

ssw

^o.

Rain

,40

29 64

29 72

Fine

29 60

29 63

SSE

Rain

Clo.

Rain

29 75

29 7^

ssw

Clo.

Rain

Clo.l

The quantity of Rain that fell in the month of June was 0 in. 25-lOOths.

*Notice to Correspondents. — Communications have been received since
our last from Dr. Shearman, Dr. Kennedy, Mr. Callaway, Mr. Bullen, Mr.
Iliff, Mr. Cribb, Mr. Boyle, Mr. Barnard, Mr. Desormeaux, and Mr.
Amesbury.

In consequence of the copper-plate printers having provided an in¬
sufficient number of the Plate of Mr. Painter’s Case of Ovarian Foetation for
the preceding Number, those of our Subscribers who did not receive it may
obtain it by applying to their Booksellers.

Communications are requested to he addressed (post paid ) to
Messrs. T. and G. UNDERWOOD, 32, Fleet Street,

THE

LONDON MEDICAL

R E P O S I T O R Y.

No. 117. SEPTEMBER 1, 1823. Vol.XX.

PART 1.

ORIGINAL COMMUNICATIONS.

Observations on the Power of the Arteries in carrying on the
Circulation of the Blood, on the Nature of this Power, and on
the Alanner of its Exertioji. By William Shearman,
M.D. Member of the Royal College of Physicians, and
Physician to the London Dispensary.

The doctrine of the circulation of the blood being one of
the most important in physiology, it becomes desirable that
our notions of the powers producing and regulating the
course of that fluid through every part of the body should
be correct and well-founded. It has long been taught that
the circulation of the blood depends upon the contraction
of the heart, as the primum mobile or centre of action,

: assisted by that of the arteries, the structure of which vessels
^ is in some degree muscular, adapting them to this office.
The principles upon which this theory was established have
long been acquiesced in, and, indeed, they appear to be
] supported by demonstrable proof, the nature and extent of
which are too well known to require repetition here. But
we are now called upon by physiologists of no little authority
and reputation to discard our antiquated notions, and to
adopt opinions repugnant to all our former conclusions,
derived, as had been supposed, from actual observation and
VOL. XX. — NO. 117. ^ B

1812 Original Communications,

reasonings grounded upon evident facts; and this on penalty
of a stigma not a little appalling.* It is not my intention
to enter into a critical examination of the new doctrines
proposed to us, with a view either to support or refute their
pretensions ; but I hold it to be reasonable, that previously
to surrendering our former opinions, we should be allowed to
express such doubts as may occur to us, touching the validity
of the conclusions deduced from the reasonings and experi¬
ments of these distinguished philosophers.

It is not possible, within the compass of a single paper, to
advert to every point embraced in the various publications on
the physiology of the circulation ; I shall, therefore, confine
myself to a consideration of the share of power in carrying
on the circulation (if any) possessed by the arteries, and the
nature of this power, with the manner of its exertion.

The publications on this subject which have chiefly at¬
tracted my notice, are those of Dr. Lucas on the Principles
of Inflammation and Fever, and of Dr. Parry on the Nature^
Cause, and Variety of the Arterial Pulse, &c. ; and it is
remarkable that these tw’o authors are at direct variance on
one very material point — the power of the arteries in pro¬
moting the circulation ; the former attributing the propulsion
of the blood to the action of these vessels, the latter denying
them any share whatever in this effect. Dr. Lucas’s opinion
being in unison with that most usually hitherto entertained^
although probably incorrect as to the nature of the action of
the vessels, to which subject I shall hereafter revert, it is
only necessary to consider the proofs and arguments in favour
of the passive state of the arteries during the flow of blood
through them.

Various experiments were made by Dr. Parry to confirnr
his opinion, that arteries suffered no dilatation nor contrac¬
tion during the systole or diastole of the heart. We might
object in limine to all conclusions deduced from experiments
made under circumstances different from the natural and
ordinary state of the animal operated on, as all vivisections
must unavoidably in some measure be ; but granting that no
visible pulsation appears in a denuded artery, it is certain
that a pulsation may be felt on applying the finger over an
artery in its natural state ; and how is this to be explained?-
The blood in every part of the arterial system may be
considered as a set of continuous columns, possessing little
compressibility, and filling the tubes in which they are con-

* ** It is hardly credible that any man can continue to support
the old doctrine, who is at all opfen to the conviction of truth.” —
Medical and Chinirgical Review.

Dr. Shearman’s Observations on the Arterial Pulse, 183

tallied. When, by the contraction of the left ventricle, the
blood included in it is forcibly expelled into the aorta, all
these columns receive the shock of propulsion at the same
instant. But the velocity during this systole being greater -
than during the diastole, the momentum, and consequently
the impulse, in every direction is also greatest in the systole.
When, therefore, an artery is compressed with the fingers, in
the usual mode of feeling the pulse, the blood, in conse¬
quence of the systole rushing into the artery with an increase
of momentum, gives a stronger impulse of dilatation to the
fingers, than from the less momentum which exists during
the diastole, and thus produces the phenomenon of the
pulse.’’ — Parry.

On the other hand, I would contend, that the pulsation is
occasioned by an actual contraction of the vessel, restoring it
to its former diameter previous to the reception of the addi¬
tional quantity of blood thrown into the arteries during the
systole of the heart.

In proof of the former opinion, there appears to be nothing
but the naked experiment, demonstrating that, under the
circumstances of the experiment, no pulsation is visible. It
seems to be admitted by every one that there must be some,
however small, distention of the vessels during the systole of
the heart; consequently, there must be subsequent contrac¬
tion to a corresponding degree, at least ; and the question
seems to be, whether this contraction is at all appreciable by
the senses ? It is well known that many phenomena may
be detected by one sense, which are not cognizable by
another ; and it does not necessarily follow, that because
contraction of the vessel is not visible, it may not be felt by
the fingers. If it be admitted that any contraction at all takes
place in the artery to restore it to the diameter it possessed
during the diastole of the heart, there is no limiting the force
of that contraction ; it may not only be sufficient merely to
gradually restore the former diameter, but actually to con¬
tract forcibly upon the blood, and thus assist its propulsion;
and this is the point at issue.

No one denies the contractile power of the arteries, which
would seem to have been bestowed upon them in vain, if no
action or exertion of it was requisite in the business of circu¬
lation, if the whole propelling power resided in the heart
alone; but some experiments of Dr. Parry himself show,
that the larger arteries continuing to contract by their tonic
and elastic properties after the heart has ceased to supply
them with blood, necessarily propel all, or nearly all the blood
they contain, through the capillaries into the veins.” If the
pow'er of the arteries be sufficient to propel the blood for-

184

Original Commimicatiofis.

ward, independent of the heart’s action, in some circum¬
stances, is it unreasonable to expect that they also constantly
contribute some assistance to the propulsion of the blood,

• and to suppose that the pulsation is the measure of this
assistance ? ^

. One proof adduced in favour of the doctrine above men¬
tioned, is stated, by the able reviewer in the Medico-Chirur-
gical Review, to be, that the systole of the ventricle and
the pulsation of the arteries are precisely simultaneous in
every part of the system, and wherever we apply our finger,
that the pulsations are perfectly synchronous from the root of
the aorta to the minutest plantar twig/’ If this proof should
not be founded in fact, if it shall appear that different arteries
do sometimes pulsate variously and differently from the con¬
traction of the heartj an original power of contraction cannot
be denied them ; and possessing this, there can be no reason
why it should not constantly be called into action, as a part
of the circulating force, auxiliary to that of the heart, the
primum mobile.

That there are cases, and those very frequent, when the
pulsation of some of the arteries, at least, is not synchronous
with that of the heart, or even of other arteries, is evinced
in various inflammations. I shall, on this subject, quote the
words of an able author. ‘‘ In a state of inflammation, the
pulse of the inflamed part, in consequence of local excite¬
ment, is much more frequent than that of the heart or any
other organ. Thus in a whitlow, the radial artery may give
to the finger a hundred pulsations in a minute, while not
more than seventy strokes may be exhibited in any other
part of the system. The rapidity of the pulse is, in this case,
usually in proportion to the degree of the inflammatory action ;
and hence, if the system should labour at the same time under
ten different inflammations in different parts, or organs of a
different structure, as glands, muscles, and membranes, it is
possible that it may have so many different seats of pulsation
taking place at such different parts at one and the same time,
while all of them are at variance wdth the pulsation of the
heart.” ^ Here it is evident the pulsation is not occasioned
b}^ the sj'stole of the heart, but by the contraction of the
vessels themselves ; and if in this case, why not in every case
whenever pulsation is felt

Another proof adduced against the appreciable contraction
and dilatation of the arteries, is the small quantity of blood
thrown out of the „ ventricle at each systole, not exceeding
twelve drams ; indeed, the whole arterial system does not

Good’s Study of Medicine, Vol. II. p, lb.

Dr. Shearman’s Observations on the Jrterial Pulse. 185

contain, during the systole, an overplus of twelve drams,’ but
only of about eight drams.” ‘‘ We would be glad to ask,”
says the able reviewer before quoted, those physiologists
who argue for alternate dilatation and contraction of the
arteries, corresponding with the pulse, what perceptible or
tangible increase of diameter in the vessels of -the whole
arterial system can be expected from such a quantity?” The
fallacy of this reasoning consists in assuming, that the con¬
traction and dilatation of the vessels must be proportioned to
the force or momentum of the exciting cause; were the con¬
traction of the vessel performed by a mechanical power, this
would be true, for action and reaction must be equal; but
here the contraction is the result oi vital action, in which no
certain proportion obtains between the amount of action and
its exciting force. The functions of the heart and arteries
are similar; the forcible contraction of the ventricle is not
the result of the mechanical distention of that cavity’^ by^ the
blood poured into it, but a vital action to which the ventricle
is roused by the stimulus of that fluid ; the same thing is true
of the arterial system ; the stimulus of distention, even of the
minutest quantity, produces action, exceeding. in amount that
which would be caused by a very considerable external force;
the ordinary laws of mechanics and hydraulics have no place
here.

W^ere the heart the sole propelling power, the arteries
being passive or nearly passive tubes; w^ere there, in fact, no
contraction of these vessels, no pulsation of them but what
was created by external pressure interrupting the flow of
blood through them ; what information could we derive from
applying our fingers to the arterial tube, beyond that which
may be obtained by applying them over the heart itself? the
frequency of the contraction of the heart, or, perhaps, the
force with which ahe blood is propelled ? This last point,
however,' must be subject to much fallacy in feeling the
pulse ; the degree of momentum imparted to the finger must
be proportioned to the pressure applied, and the consequent
diminution of the arterial cavity. But there are certain
indications obtained by feeling the pulse, w'hich cannot be
derived from the most accurate attention to the action of the
heart alone, and which, therefore, seem to depend upon the
state or action of the vessels themselves. I shall only, in¬
stance the hard pulse and the redoubling or >\\ddmoxxho.^\c
pulse, neither of which can I reconcile with- the new theory.

I do not think the hard or contracted pulse depends upon
the momentum of blood in the vessel, from the quick and
strong contraction of the left ventricle (see Parry, p.T48); for
this, state of pulse,' indicating, I should say, strong action in

186 Original Communications,

the vessel itself, will frequently exist when the force of action
of the heart is very much diminished. Nor does the explana¬
tion of a double stroke of one particular artery offered by
Dr. Parry, p. 134 of his work, appear to be applicable to
that general state of the arterial pulse expressed by the term
redoubling, in which the force of action in the arteries exceeds
the degree which usually obtains in health.

I might cite, as additional difficulties to the belief of the
new doctrine, the frequent visible pulsation of the radial artery
under the integuments, even when the muscles and integu¬
ments themselves are in the utmost state of relaxation, exert¬
ing no evident pressure; and the facility with which pulsa¬
tion may always be felt with the slightest pressure of a single
finger, quite insufficient apparently to diminish the diameter
of the vessel the 100th part of an inch.

It appears to me that both Dr. Parry and Dr. Lucas are
incorrect in ascribing the contraction of the arteries to elasti¬
city; I believe, on the contrary, it will be found that their
contraction is performed by a power opposed to and constantly
counteracting elasticity.

From various preceding considerations, it is natural,
d priori, to conclude, that, wffien under the state not only of
the usual healthy dilatation of arteries, but of that increased
dilatation which often accompanies disease, the distending
cause, which is a certain quantity or momentum of blood, is
diminished, the elasticity will tend to contract them, so as
within certain limits to accommodate them to the quantity of
blood which they ought to convey.’^

The same idea of the contraction of the vessel being
effected by elasticity, is expressed in the following sentence :

During health, the larger arteries of a living animal, as well
under the diastole as systole of the left ventricle, are in a
state of distention, to which they are forcibly impelled by
their contained blood, against their mechanical power of
elasticity.” — P. 69.

To bring the elastic principle into action, for the support
of the circulation, with all the effect of which it is capable, it
is necessary that the arteries should be in a state of forced
distention, by which means a steady and permanent exertion
of the elastic force will be kept up for the propulsion of the
blood.” It must, indeed, be evident, that unless more or
less of forced distention of the vessels were present, the elastic
force could not be called into action at all for the propulsion
of the current.” — Lucas, pp. £3.

Elasticity is not a vital property — it is inherent in the dead
solid as well as in the living one; and the difference which
exists in the diameter of a vessel during its life and after its

Dr. Shearman^s Observations 07i the Arterial Pulse, 187

death, can only be effected by the power of this principle.
Whatever may be the diameter of any vessel during life,
there is always an increase of it after death ; and as this
increase cannot be effected by any vital power, it must be
occasioned by some property inherent in the dead solid, and
the only power the latter possesses capable of producing this
increase is elasticity.

It is stated by Dr. Lucas, and the experiments of Dr. Parry
are appealed to in confirmation of the fact, that the diameter
of the vessels is considerably reduced after death ; this may
be true at the instant of the death of the whole animal, but
the life of the different parts continues for a longer or shorter
period, after the death of the animal as a whole^ and this
reduced diameter is effected by the vital property of the
vessel endeavouring to contract upon its contents; some
hours after death, when the vital properties of every part are
extinct, the diameter of the vessels is always increased.

It is an important circumstance to ascertain whether, during
life, the diameter of the arteries ever equals that point of
dilatation to which elasticity brings them after death ; for
it is evident, that unless the diameter of the vessel ex¬
ceeded the point at which elasticity^ would preserve it,
this power can have no share in producing the contraction
of the artery. 1 have been taught, and am still of opinion,
that the arteries, at their utmost distention during life, are of
less diameter than they are after death, when acted upon by
elasticity alone. That in some of Dr. Parry’s experiments, ^
the diameter of the artery exceeded the point of elasticity,

I am aware ; but I am not satisfied that this increase is not to
be attributed to some extraordinary and unusual distention
arising out of the circumstances of the experiments; for in
other experiments we find the distention did not equal the
point of elasticity, as in Exper. 24, the left carotid, on ex¬
posure, measured fff of an inch, and the right whilst the
elasticity of the latter was fff ; consequently any contraction
during life could not have been effected by elasticity.

As tone or tonicity^ however, is influenced in its degree
, by the relative strength or weakness of the system, it may
happen that, in old age,* this principle may be so much
weakened as no longer to be able sufficiently to counteract
the elasticity, and to prevent the vessel from being distended
by a much slighter impulse than would formerly have been
adequate to the effect; but in young and strong animals, in
which the tone is in a vigorous state, the diameter of the

* The horses in which the diameter of the vessels exceeded the
point of elasticity appear to have been old ones.

188

Origin al Commu nictil ions,

vessel never reaches, that degree of dilatation to which the
elasticity, if not counteracted, would extend them ; and con¬
sequently, the elasticity can have no share in producing
whatever contraction takes place in them.

The action of every mechanical power must be uniform ;
the force exerted by it must always be equal under similar
circumstances; if the vessels were contracted by mechanical
elasticity in accommodating themselves to their contents, the
degree of contraction should be precisely equal under the loss
of equal quantities of blood; but this is not the case: in
Exp. <24, after the loss of the first fviij. the vessel con¬
tracted of an inch ; after the* second bleeding, it con¬
tracted only the diminution of the force counteracting
elasticity was in each case precisely equal, viz. the abstraction
of a;, volume of fviij. of blood, and if the contraction was
effected by mechanical elasticity, that also should have been
equal; but the contraction of tonicity varies according to the
relative degree of strength or weakness in the system, and is
not by any means uniform, vital properties not being governed
by mechanical laws.

The mode adopted by Dr. Parry in estimating the relative
force of elasticity and tonicity, in producing contraction of the
vessel, is by no means conclusive: elasticity, according to
him, has a tendency and exerts an effort to contract the
vessel, and tonicity has precisely the same tendency, and
exerts a like effort in the same direction ; but the. tonicity is
not exerted until the contraction has reached the point to
which elasticity will bring it, which in Exp. 24 was It

may be asked, was tonicity now first imparted to the vessel,
or did the vessel possess it previously to its contraction to
f ? If it did possess tonicity previously, and the tendency,
of this power was to act in the same direction w'ith elasticity,
viz. to contract the vessels, what proof have we that both
powers were not exerted at the same time 't or how can we
determine that if one of these powers only was exerted, the
tonicity was quiescent and elasticity alone acted, rather
than that the tonicity was acting and the elasticity quiescent?

If the tone and contractility of the vessels acquired by life,
and the elasticity inherent in them, are employed conjointly
to< produce diminution of diameter, both acting in the same
direction, one of these powers would seem to have been
bestowed unnecessarily; if elasticity is sufficient to produce
the requisite contraction, of what use is the tonicity? There
appears to be some inconsistency in saying, that if the
elasticity should be inadequate to the requisite force or degree
of contraction, the tonicity, or vital power, may assume the
office of contraction lohere it was left by the elasticity j and

Dr. Shearman^s Observations on the Arterial Pulse, 189

carry it to the necessary extent.’’ The elasticity would not
become quiescent, it would now be counteracting the toni¬
city ; and if the former power was able to bring the vessel to
its mean point from a state of forced distention, why should
j it not also be able to bring it to the same mean point from a
state of forced contraction ?

I’he real fact appears to be, that the action of the heart
and that of the arteries are precisely similar in performing the
I function of circulation. The different compartments of the
heart,” says Dr. Parry, are so far from expanding in conse¬
quence of the blood which is driven into them, that, ivhen
altogether empty of bloody and even separated from the animal^
they expand in a greater degree than when in their natural
situation during Ife and healthy circulation. Hence Mr.
Hu nter himself, notwithstanding the view which he gives of
the action of the heart, acknowledges that this organ after
death has a larger volume than when the animal is living.” *
Th e same thing is true of the arteries ; they have an increased
diameter after death ; during life they contract themselves
upon the blood when it is thrown into them, and propel it
forward, not by their elastic action, but by a vital contrac¬
tility opposed to elasticity ; having done this, they expand or
are relaxed by the effect of the elastic principle, and again
easily admit the ingress of more blood, which again causes
them to contract, not by \is, forcible distention, ‘f* but by its
natural stimulus, and in this way they are capable of applj^-
ing an additional force to that of the heart, so as to pro¬
mote the circulation through the whole body. This appears
to me, at least, a more probable conjecture than that the
blood is circulated by the repeated shocks of propulsion
given to it as a solid column, by the forcible action of the
ventricle.

Whilst I am of opinion that Dr. Parry did himself great
credit by undertaking the experiments brought forward in his
work, and am fully disposed to allow the experiments them¬
selves all the w^eight they deserve, I still do not think them
conclusive ; and 1 must agree wdth the able reviewer before
. quoted, “ that it is exceedingly difficult, if not impossible, to
ascertain, by unequivocal experiments, the functions of the

* P. 121.

t Dr. Lucas, even on his own theory, is probably mistaken in ex¬
pecting any assistance from the elastic power of the blood-vessels,
because the heart or other propelling power vvould expend as much
force in distending the vessel and overcoming the elastic resist¬
ance, as would be derived from elasticity in the subsequent coiir
traction.

VOL. XX. - NO. 117. ^ c

1 90 Original Comrminicntions.

complicated machinery employed in the circulation of the
blood. We must, therefore, trust partly to reasoning and
reflection, and partly to observation.’^

Northampton Square, July 19, 1823.

II.

Case of Axillary Aneurisniy in which the Subclavian Artery
ivas tied above the Clavicle^ and the Patient recovered. By
Thomas Bullen, Esq. Surgeon to the Eynn Dispensary,
&c. &c.

Thomas Mitchell, sailor, sixty years of age, was ad¬
mitted a patient of the dispensary March 31st, 1823, having
a soft pulsating tumour, of an oval and conical form, situated
on the right side, and extending obliquely from the sternal
end of the third rib, to a little above, and wdthin one-fourth of
the humoral end of the clavicle. It could be partly emptied
of its contents by pressure, but would gradually return to its
former size on the pressure being removed ; and at the same
time, on applying the ear, a purring noise, at each systole of
the heart, was very distinctly heard. The right arm and hand
were frequently benumbed, and, at times, very painful and
slightly swollen. The pulsation of the brachial and radial
arteries was so feeble as scarcely to be felt.

About four months ago, a tar-barrel fell upon the shoulder,
but occasioned him, at the time, only temporary inconveni¬
ence. At a consultation, it was agreed that an operation
afforded him the best chance of recovery. To this he readily
consented; and it was performed on the 3d of April in the
following manner : —

The patient being placed on a chair, in a proper light, with
his head held backward and to the left side, and the right arm
brought forward, the integuments were drawn tightly down¬
wards, and divided from near the sternum, upon and along
the clavicle to the extent of four inches : a second incision
was then made from the centre of the first, in the direction of
the outer edge of the sterno-cleido mastoideus, by thrusting
a sharp-pointed bistoury underneath the skin, which was
pinched up between the finger and thumb. On turning back
the outer flap, the external jugular vein was exposed. A
needle, armed with a double ligature, was passed beneath the
vein, the two ends were tied about an inch apart, and the
vessel was divided between them. — Proceeding in the dis¬
section to the level of the axillary plexus, a momentary
interruption was occasioned bj' the posterior cervical artery,

Mr. Bulletins Case of Ligature of the Subclavian Artery, 19 1

which was greatly enlarged, running transversely from the
sternal end of the wound. Being desirous of not dividing
so large an anastomosing artery, after a little cautious dissect¬
ing, a blunt hook was passed underneath it, and it was
turned out of the way. Some small arteries were divided,
and immediately secured. Much inconvenience was expe¬
rienced, after exposing the axillary plexus, by an oozing of
blood from a division of the cephalic vein at the humoral end
of the wound ; it was, however, stopped by a pledget of lint.
— At this stage of the operation, the spatulas of sheet copper
recommended by Dr. Colies, of Dublin, and Mr. Liston,
were n)ade. trial of, but were found of little assistance. A
pulsation being distinctly felt at the bottom of the wound,
by cautious procedure, partly with the handle of a knife and
the finger nail, an artery, supposed to be the subclavian, was
exposed and detached ; a needle, made after the description
given by Mr. Liston, and armed with a ligature, was
passed underneath it without any difficulty. In doing this it
was observed that the coats appeared thin, somewhat resem¬
bling a vein. * On turning this aside by means of the liga¬
ture, which was kept loose round it, the subclavian artery
was seen and felt pulsating, a little cellular membrane merely
intervening; and it was then conjectured that a nerve had
been included in the ligature. The same method, in order to
secure the artery, as above noticed, was proceeded in ; but
here some difficulty was experienced until it was more fully
exposed by a partial division of the anterior scalenus muscle;
it was then accomplished by passing the needle from within
outward, and depressing the handle, when the point projected
on the opposite side of the artery, covered with some inter¬
vening substance, which was broken through with my nail.
The ligature was then laid hold of with a pair of forceps ;
and, on withdrawing the needle, a large stream of florid blood
gushed forth, per saltum, from the wound. My friend Dr.
Whiting, who stood near, plunged his finger into the wound
and pressed upon the artery, and while he thus suppressed
the bleeding, the ligature, which was supposed to be upon
j the subclavian, was tied. The finger being cautiously with¬
drawn, it was a source of the highest gratification to discover
I that no haemorrhage followed. All present were relieved
; from a degree of anxiety painful beyond description. The
: pulsation, however, of the artery, as it passes between the

* Here we ascertained, by pressure on the vessel, that it did not
command the pulsation of the tumour, and thence concluded that it
was not the subclavian. It was then turned aside, and the proper
trunk discovered.

192 Original Communications.

clavicle and the first rib, was not stopped, nor w'as it in the
aneurismal tumour. On attempting to move the first liga¬
ture, it was found fast ; and, by sponging away the blood
from the bottom of the wound, it became evident that this
had been, in the hurry and agitation of the appalling mo¬
ment, tied in place of that on the subclavian, and that the
knot had included one of the ends of the latter ligature. As
it was difficult to distinguish the included end from those
belonging to the ligature that had been tied, by the advice of
the gentlemen present, all the three ends were made fast, in
succession, to the one which remained detached on the other
side of the artery. The pulsation then ceased, and never
afterwards returned.

It was now evident that, in pressing up the end of the
needle * to clear the point of it, the coats of an anasto¬
mosing vessel, lying anterior to the subclavian, had been
penetrated, and under which the first ligature was passed.

I had provided myself with an instrument to enable me to
tighten the knot of the ligature which lay at so great a depth ;
but this w'as readily accomplished by my friend Dr. Whiting
placing his finger between the ends of the ligature and upon
the knot, while I tied it.

The edges of the wound were brought together by three
stitches and adhesive plaster. The patient bore the opera¬
tion, which occupied nearly an hour, with great fortitude.
Prom this time till the IQth, but little constitutional derange¬
ment followed. It was remarkable that the pulse in the
wrist of the same side, which, previous to the operation, was
scarcely perceptible, and which, directly after the artery w^as
tied, could not be felt, w'as, in the evening, as distinct and as
large as that in the other arm. The brachial artery also
could at this time be felt beating about two-thirds its length,
beginning near where the profunda major is usually given off.
The arm, for several daj^s after the operation, was gene¬
rally found in a state of perspiration. 'I’he heat was never
lessened.

The patient was placed on a very low diet, and kept quiet
in bed. He slept well during the night without an opiate,
and complained of no uneasiness. in the evening of the
second day, there were slight irregularity and intermission of
the pulse. Twelve ounces of blood were taken from the left
arm, after which the pulse improved ; and the following even-

* The needle, though considerably less pointed than that used by
Mr. Liston, is, I am satisfied, still too much so to be safe. One
more flattened, with a thin rounded end, may be handled with greater
freedom and security.

Mr. Bullen’s Case of Ligature of the Subclavian Artery. 193

ing the bleeding was repeated with the same effect. After
the eighth day, the pulse became quite regular, and varied
between 90 and 100. The tumour continued gradually to
lessen in size. The wound was dressed on the fourth day,
and was found partly adherent, with a discharge of healthy
pus from the openings through which the ligatures passed ;
and it continued to heal well.

Nothing of importance occurred after this time till the
19th, sixteen days after the operation. At four o’clock this
morning, I was sent for to the patient, on account of haemor¬
rhage from the wound, which had by this time nearly healed,
except where the ends of the ligatures hung out. When I
arrived, he had lost about three or four ounces of blood. I
took off the dressings, and found the bleeding had stopped.
The ligature on the main artery remained firmly attached.
Thinking the haemorrhage might have come from one end of
the jugular vein, which had been divided and tied during the
operation, and from the upper end of which the ligature had
not yet separated, I applied a compress of lint along that
vessel. At eight o’clock. Dr. Whiting saw him with me.
There had been no return of haemorrhage. On gently pulling
the ligature, however, with which the subclavian artery had
been tied, a slight oozing of blood, clearly arterial, came
along it. A thick compress of lint was applied, and adhesive
plaster tightly stretched over it. At seven o’clock in the
evening, I was again sent for on account of bleeding. When
I arrived, he lay almost covered with blood. I took off the
compress, and found the haemorrhage had stopped before my
arrival. On gently moving him, to take away the bloody
linen, he fainted. Another graduated compress, much larger
than the former, was applied. Directly after this bleeding,
the aneurismal tumour was found to have considerably sub¬
sided. The haemorrhage returned at one, and again at six
the following morning; but as he had not lost more than
Jss. of blood at each of these bleedings, I did not take off
the compress. There was no more bleeding till one o’clock
the next morning; and it stopped of itself as before.

On the £2d, as there was considerable foetor from the
dressings, the upper part of the compress was removed and
renewed. — £3d. The wound was dressed; no haemorrhage
occurred when the compress was removed ; and, on pressure,
a discharge of healthy pus appeared. — £4th. Dressed as
yesterday. The ligature, for several days, had been twisted
by means of a piece of w'ood put through its end, and fastened
down with adhesive plaster : this morning, it lay loose in the
wound. On examining the ligature, it was found that the
knot, iq)on the subclavian artery, had given way, on account
of its not having been tied double. A reference to the

194 Original Communications^

account of the period of the operation when the ligature was
tied will explain this circumstance. The silk was twisted to
the very extremity.

After the second bleeding, considerable constitutional irri¬
tation took place. The pulse was seldom lower than 112,
and usually between 120 and 130, very small and feeble;
sometimes it was scarcely to be felt. A troublesome cough
was also present, which was attended by a mucous expectora¬
tion, dry tongue, frequent hiccup, and a hot and dry skin.
The aneurismal tumour, on the 21st, began gradually to in¬
crease in size, without pulsation ; and on the 29lh, it became
so evident, that it was proposed to puncture it next morning.
In the evening, however, a violent cough came on, which
continued incessantly throughout the night. On visiting him
in the morning, I found he had brought up, by coughing,
six or eight ounces of bloody pus, very high coloured, and the
^ tumour had diminished during the night about one-half; but
as it evidently yet contained a considerable quantity of fluid,
and as he was exhausted by incessantly coughing, it was
determined to evacuate its contents by a small opening, at
the most depending part. About five ounces of the same
kind of matter as that which w^as coughed up escaped by this
outlet, which greatly relieved him. A cavity could now^ be
distinctly felt betw^een the first and second ribs, at their
sternal ends, through which the fluid had passed into the
lungs; and as there was now a free communication with the
lungs, the air passed freely into the sac w'henever he coughed,
distended it, and sometimes the air escaped by the external
opening. A compress and straps of adhesive plaster were
placed over the opening which formed the communication
betw'een the lungs and the sac, with a view of preventing the
matter from passing into the lungs. A plug of lint was put
into the outer opening, and occasionally withdrawn to let out
the matter. This plan had the eflect of preventing the cough
for several hours together. He continued, however, to cough
a good deal, and he expectorated pus, at intervals, for several
days, though of a much lighter colour. A free allowance of
wine and nutriment were allowed him ; and he continued
gradually to recover from his greatly emaciated and weakened
state.

The discharge from the outer opening and through the
lungs gradually lessened, and assumed a healthy appearance.
At the end of three w'eeks, nothing was discharged from the
outer opening, which was, therefore, allowed to close. The
cough, after expectorating for near a week a thin glairy
mucus, gradually left him.

After escaping from this dangerous situation, and when the
wound had nearly healed, an erysipelatous inflammation

Mr. Bullen’s Case of Ligature of the Subclavian Artery. 195

appeared on the left side of it, which was confined to the
inner triangular flap; and, notwithstanding the means which
were used, partial suppurations continued to form in different
parts of the flap till the middle of June.

On the morning of the I7th of June, seventy-five days
after the operation, there were two small openings, dis¬
charging a bloody pus, one about an inch above the other,
communicating by a sinus underneath the integuments, the
original wound having completely cicatrized. Supposing
that there was not a free exit for the matter, the space between
the openings was divided by a blunt-pointed bistoury. No
matter followed; and very little bleeding took place from the
edges, which had a glassy and spongy appearance. A piece
of lint was inserted between the edges, and lightly covered
with adhesive plaster. In the evening of this day, while
stooping to pull off his stockings, a large stream of blood
suddenly gushed from the wound, which he with difficulty
checked by pressure with his hand. I saw him a few minutes
after ; the haemorrhage had then stopped, and he very soon
fainted. The wound was dressed with a thick graduated
compress and long straps of adhesive plaster, as after the
former bleedings. On the third day after this, the dressings
were taken off; there had been no return of haemorrhage;
more healthy pus was discharged than for several weeks pre¬
viously ; and the erysipelatous appearance had subsided.

On the fourth day, the skin of the right side, in the
situation of the aneurismal tumour, became inflamed ; the
integuments very tumid and tense. He had passed a very
restless night, owing to pain in this situation, and to a
troublesome cough, which greatly aggravated the pain, and
which was attended with a mucous expectoration; his
breathing became hurried, and the pulse very quick and
feeble. His tongue was rather white and dry. A cold eva¬
porating lotion was ordered to the inflamed part, with direc¬
tions for leeches to be applied to it, if the pain should con¬
tinue. In the evening, it took on the erysipelatous cha¬
racter; but the pain was quite gone. The swelling continued
to subside, and after three or four days it had disappeared.
The wound went on healing, and, ninety-two
operation, was quite well.

The posterior cervical artery, w'hich was turned on one
side during the operation by a blunt hook, is now felt greatly
enlarged and tortuous, and running superficially across the
cicatrix. His health is fully re-established ; the hand, however,
is sometimes slightly benumbed, but he has had no pain in it
ever since the artery was tied. He can use both arms freely.

Lynn Regis, Norfolk, 26th July, 1823.

days after the

Original Communicalioris,

III.

Case of Aneurism of the Aorta, in which the Application of
Cold proved very beneficiaL By Joseph Ward, Esq.
Member of the Royal College of Surgeons, and Apothe¬
cary to the London Hospital.

Thomas Burgon, aetatis fifty-six, gardener, first applied
for relief April 9, 1822: he had been labouring under all the
usual symptoms of a thoracic aneurism, and at the time of his
application was found to have one of large magnitude on the
right side of the cavity of the chest, rather below the clavicle ;
it protruded very much above the surface, and to all appear¬
ance was in a very advanced stage; his breathing was short,
and he complained of excessive pain in the right arm, which
increased on his allov\ing it to hang by his side. He was put
under a palliative treatment for these symptoms during two
months, during all which time the tumour remained stationary,
when he went into the country.

Jn a short time afterwards, the tumour was observed to
increase in size, and the symptoms became more urgent; a
dark spot appeared in its centre, around the edges of which a
very small quantity of arterial blood oozed out. Attention
was paid to his bowels, and vinegar and water were ordered
to be applied assiduously, with a view to keep the part con¬
stantly cold; this gave him very severe pains in the head,
which were not relieved by the usual remedies, and annoyed
him much. After the cold application had been continued
some days, the tumour was observed to lessen, the dark cen¬
tral spot diminished in size, and at last a complete cicatrix
formed, the tumour totally disappearing; he was still, how¬
ever, troubled with pain in the chest and shortness of breath¬
ing, and the pain in his right arm continued : his situation,
notwithstanding, was very bearable, compared with what it
had been.

This state continued for about three months, when he
became worse ; the tumour was observed to increase very
gradually, and all the svmptoms became daily more urgent.
He was treated as before, but without relief; and on 24th
July, 1823, he died from external haemorrhage, the tumour
not having reached near the size it had on the former occasion.

On examination after death, nothing very particular pre¬
sented itself. A large aneurism existed at the arch of the
aorta, without ossific deposits; the other large vessels were
quite healthy, and the coagula in the aneurismal sac were
observed to be rather more firm than usual.

Case of Melanosis, communicated by Sir A, Hallida}'. 197

IV.

Case of Melanosis. Communicated, in a Letter to Dr. Cop¬
land, by Sir Andrew Halliday, Domestic Physician
to their Royal Highnesses the Duke and Duchess of
Clarence. *

[With a Plate,]

Hampton Court, 7th August, 1823.

Dear Sir, — When I transmitted to you the case of
melanosis which appeared in the Repository for June last,
I. stated that it had been sent to me by a young friend in
Edinburgh, who had copied it from his notes taken in the
Royal Infirmary, where the patient was treated. I further
observed, that as the disease was little known in this country,
and the case was of some interest, I thought it was worthy of
being recorded in the pages of your respectable Journi!!,
But you gave the case without printing my letter; it might
therefore appear to some that I had communicated it as one
which had occurred in my own practice, though, indeed, the
date of Edinburgh is pretty decisive of that point.

I have now the honour to enclose the notes of a still
more interesting case of the same disease, which, to prevent
all possibility of mistake, I beg to say have been furnished by
another friend from the same quarter. The patient w'as
treated in the clinical ward of the Royal Infirmary, by Pro¬
fessor Alison.

In my friend’s letter there is a remark which does not
occur in his notes of the case, namely, that this patient and
John Howston, the former case, were both inhabitants of the
same wynd or narrow lane in Edinburgh.

I expect portions of the morbid structure of the patient
whose case is enclosed, in which the distinctive marks of this
singular disease are very apparent. These I shall also transmit
to you, that you may, if you should think it of sufficient in¬
terest, give your readers a coloured drawing of the same.

I am, dear Sir, yours, &c.

To Dr. Copland.” “ Andrew Halliday.”

June 3d, 1823. — Rachael Bruce, aetatis forty-two, mar¬
ried, complains of severe pain shooting down from the loins

* We express our acknowledgments to Sir Andrew Halliday for
this, and the former case — the first, we believe, of the kind recorded
in this country. Our readers will perceive that we have attended to
VOL. XX. - NO. 117. ^ D

198

Original Communications,

to the inferior extremities, and around the abdomen, and
also of similar pains in the right shoulder and arm. The
pains are more severe in the night-time, are sometimes in¬
creased by motion, and when long continued, are followed
by incapacity of motion of the lower extremities. She has
become weak and emaciated since these complaints began,
and is occasionally liable to shivering, followed by flushing
and profuse sweats, which increase her debility, but do not
relieve her pains. She has some swelling, without distinct
fluctuation of the abdomen, which she thinks is more dis¬
tended at some times than at others. There is also pain over
the abdomen, not severe, and slightly relieved by evacuations.
She has also thirst, and her urine is scanty, high-coloured,
and not coagulable by heat. The integuments of the abdo¬
men are flaccid ; and there is an irregular induration,
moveable, and somewhat painful on pressure, in the hypo¬
gastric and both iliac regions. Has had ten children, the
last was weaned three months ago, since wdiich the menses
have not appeared. She is also liable to paroxysms of
dyspnoea, approaching in the night-time, chiefly after expo¬
sure to coldj which oblige her to sit up in bed, and which
vary in duration from twenty-four to seventy-two hours, and
are followed by copious expectoration. Her appetite is im¬
paired. She complains of bad taste in her mouth ; — tongue
white and dry- — bowels said to be regular — occasional sick¬
ness — pulse 108, small — sleep deficient.

Her complaints came on, five or six weeks ago, after
exposure to cold, with shivering pain and stiffness of the loins,
and of the hip and knee-joints of the left side. The pains
increased in severity for a week, but have continued nearly
the same since that time. The enlargement and induration
of the abdomen have only been noticed within the last fort¬
night, and began equally on both sides. Her asthmatic
paroxysms commenced five years ago, but she has been free
from them for the space of three months. ^Has lately used
purgative and diuretic medicines, and employed embrocations
to her loins and thigh. — Foveatur abdomen. Habeat, horfi.
somni, pulveiis antimonialis, gr. v. et haustum anodynum.

4ih. — Vomited her medicine last night — took five grains
of aniimonial powder this morning, which has been retained
— pains of abdomen and loins much complained of — pulse
112 — tongue white. — Habeat statim haust. ex oleo ricini.

Sir Andrew's suggestion of giving a coloured engraving of this species
of morbid structure : we are not aware that we have been anticipated
in this particular, even by our Parisian brethren, who have lately
paid some atlenlion to this interesting disease.

Case of Melanosis, communicated by Sir A. Halliday. 199

Applicentur hirudines viij. abdomini qu6 dolet. Habeat
balneum calidum vespere, et sumat postea pulveris ipecac, et
opii, gr. xij. Fricantur partes dolentes tinctura saponis et
opii.

5th. — Bowels were opened by the draught — the leeches
bled well — had, a better night after the bath — swelling of
abdomen and tenderness of lower part continue — pulse 1 12.

— Interinittantur hirudines. Repetatur haustus ex ol. ricini,
eras mane ut heri, et contin. alia.

6th. — Had a bad night from pain of thigh — oil has
operated — faeces pretty natural — abdomen rather easier —
pulse 114 — tongue whitish, with thirst. — Bibat potum aci-
dum vegetabile ad libitum. Sumat misturae diaph. salin. ^j.
3tia quaque hora. Rep. pulv, ipecac, et opii, hor^ somni,
et linimentum. Interm. alia.

7th. — A bad night from general pains, with some sweat¬
ing — bowels not opened today. — Sumat statim haustum ex
ol. ricini. Interm, mistura salina diaphoretica et pulv. ipecac,
et opii. Rep. bain, tepidum vesp. Injiciatur, hora somni,
enema anod.

R Submur. hydrarg. '

Opii, aa gr. xij.

Conservee Rosse, q. s.

ft. massa; divide in pilulas xij. sequales; sumat j. bis indies.

8th, — Had some sweating, after the bath, but not in the
pained limbs — bowels were opened by the castor-oil — the
anodyne enema not retained — had a bad night, chiefly from
pain of the back — tympanitic distention rather increased. —
In term. bain, et haustus ex ol. ricini. Contin. alia ut heri.

9th. — Had a better night, with sweating — pains are easier

— swelling of abdomen continues — pulse about 110 — urine
not increased — anodyne enema was partly retained — bowels
not opened today — mouth somewdiat sore. — Interm, pil,
cal. et opii. Sumat h. s. haust. cum liq. opii sedat. g‘*. xxx.
Contin. linim.# Rep. haust. ex ol. ricini c. m. Sumat pil.
scillilicae gr. x. bis die. Interm, enema anodyn.

10th. — A pretty good night, with sweating — draught has
operated — faeces partly scybalous — distention of abdomen
continues, but its tenderness rather diminished — pain of limbs
gone — pulse 108 — urine as before. — Rep. medicam. ut
heri. Sumat hor^ somni pil, hydrarg. ij.

1 1th. — Had a bad night — shifting pains in the side con¬
tinue — complains of globus — two rather scanty evacuations
since yesterday — pulse 114 — skin moist — mouth still sore

— abdominal distention as before, — Cont. medicam. et rep.
haust. hora somni, c. liq. op. sedat. g^b xxxv.

200 Original Communimtiom.

12th. — ‘Mouth very sore — had a bad night from pain of
the back — three pretty natural dejections from the castor-oil
this morning — hypogastrium still painful on pressure — no
dysuria — distention of abdomen not increased — pulse 100 —
still complains of globus. — Rep. bain, calid. vesp. Interm,
pil. hydr. et haust. ex ol. ricini. Cont. alia.

R Aq. Menth. ^viij.

Tincturae Valerianae Ammon, ^iv. M.

Sumat ^j. bis terve in die.

I3th. — Had a good night, with sweating after the bath —
pain much easier — the castor-oil draught, given by mistake
this morning, was vomited — globus relieved — tympanitis
as before. — Interm. bain, et h. ex ol. ricini. Cont. alia.

14th.' — Mouth less sore — three dejections, which were
pretty natural, and passed without pain — more pain of back
last night — pain of abdomen, flatulence, and globus, con¬
tinue — urine very scanty, — Interm, mist. c. tinct. Valerianae.

R Acetatis Potassse, ^ss.

Aquse Fontan. ^vij.

Spiritils Etheris Nitrosi, Jj.

Syrupi, Jss. M.

Sumat ter in die. — Cont. alia.

15th. — Had a good night, with sweating — two rather
scanty dejections today — less pain of back — distention of
abdomen somewhat less — tenderness at the lower part con¬
tinues — sore throat continues — some appearance of aphthae
in the fauces — pulse 108 — no increase of urine. — Contin,
med.

I6th. — Had a good night, with sweating — pains continue
easier — two dejections this morning — a castor-oil draught
was taken, but partly rejected — throat better. — Contin.
medicamenta.

17th. — An indifferent night, but without much pain —
bowels open, without the laxative — pulse about 100 — tongue
somewhat aphthous — distention of abdomen diminished. —
Contin. med. A bit of steak today.

18th. — Had a good night — rather less tenderness of
abdomen — complains chiefly of globus — relished the steak
— bowels open last night — tongue cleaner.

19th. — Complains still of globus, of tenderness of hypo¬
gastrium, and of some pain in the small of the back — a
pretty good night, with much sweating — two pretty natural
dejections — -appetite a little improved. — Contin. medicam.

'To have a bottle of small-beer dailv.

«/

20th. — Pain of abdomen as yesterday one pretty na¬
tural dejection this morning — pulse 198 — much sweating —

Case of Melanosis, communicated hy Sir A. Halliday. ‘iiOl

has taken a little wine — urine not increased. — Interm,
pilulae scilliticae.

R Decocti Cinchonee, Ibj.

Acidi Sulphurici Dil. 3iss. M.

Sumat ^ij. bis in die. — Contin. alia. — Hab. vini rubri, jiv.

21st, — Had a better night — much sweating — ‘One rather
scanty dejection — pulse 1 12 — distention of abdomen, with
pain at the lower part, continues. There are several small
tumours, slightly painful, immediately beneath the integuments of
the abdomen, which she says have appeared since her illness. —
Contin. medicamenta omnia.

22d. — Bowels not opened since yesterday — a blister,
which was applied to the lower part of the abdomen, not yet
removed — had a bad night — complains of confusion of head
after the draught — sweating continues — urine rather in¬
creased. — Interm, haustus, h. s. Sumat statim haustum ex
ol. ricini. Inj. h. s. enema anod. c. tinct. opii, 3ij.

23d. — Blister rose well — enema was not retained — five
grains of opium were introduced into the rectum — had an
easier night — urine considerably increased, and sometimes
passed involuntarily — no pain j ust now — bowels not opened

— has taken some more wine. — Rep. haust. ex ol. ricini c.
oleo, 3vj. Bibat infusum lini ad libitum. Rep. h. s. suppo-
sitorium ex opio, gr. v. Hab. vini rubri,

24th. — Pain has continued easier — has slept much, and
sweated — takes a little food — declined taking the draught,
but took two laxative pills, which have not operated — urine
still passed involuntarily — pulse 108. — Sumat statim pil.
laxantes, ij. Rep. alia ut heri. Interm, haust. ex ol. ricini.

25th. — Pain continues easier — has slept much — one
rather scanty dejection — urine not passed involuntarily to¬
day — distention of abdomen rather diminished — pulse 120

— tongue pretty clean. — Interm, mistura cinchonae. Cont,
alia ut heri.

26th. — Plad more pain of abdomen last night — three de¬
jections this morning of pretty natural appearance and solid,
since which the pain has abated — urine diminished — some
sweating — much debility — pulse 126 — complains of thirst.

— Contin. vinum, et suppositorium h. s. Interm. alia. To
have a bottle of small-beer, App. emplastrum adhesivum
sacro.

27th. — Had a wmrse night — pulse 120 — much complaint
of debility — less distention of abdomen — more swelling and
hardness at the lower part — bowels continue open — some
nausea. — Sumat haust. salin. efferv. urgente nauseh. Hab.
h. s. haust. c. liq. op. sedat. xl. Rep. suppositorium.
Poveatur abdomen decocto papaveris somniferi.

202 Original Commufiicathm.

28th. — Had a good night, and is free from pain — pulse
120 — bowels have been opened. — Contin. med. Sumat
piJ. lax. ij. eras primo mane, nisi prius solutus sit alvus.

29th. — “Had an easy night — no dejections since yester¬
day — no appetite. — Sumat pil. lax. ij. statim. Contin.
alia.

30th. — An easy night, without the draught — complains
of no pain — pulse as before — much debility — bowels con¬
fined. Sumat statim pil. lax. iij. Inj. enema domesticum,
et rep. si opus sit, A couple of oranges daily.

July ] St. — Had a worse night — some sickness and vomit¬
ing — no complaint of pain — one scanty dejection. — Rep.
statim pil. lax. Omit the oranges. To have a double allow¬
ance of fresh milk daily.

2d. — Complains somewhat of general uneasiness, but has
slept a good deal — pulse 124 — bowels opened by the pills,
— Contin.

3d. — Had an easy night — complains of smarting of the
sore over the sacrum — bowels not opened — tongue dry, with
thirst. — Sumat pil. laxantes, iij. App. catap. lini usitatiss.
dorso. Contin. alia.

4th. — Bowels have been loose since last night — poultice
gave uneasiness, and the adhesive plaster has been again
applied — tympanitic distention quite gone — no complaint
of pain — pulse quick and small- — much drow siness. — Interm,
pil. lax. Contin. alia.

5th. — Is nearly in the same state — less diarrhoea in the
night. — Rep. supposit, opii vesp. et haust. h. s. Contin.
vinum.

6th. — Some pain of left side — bowels still rather loose —
features much collapsed. — Sumat statim pil. opiatge ij.
Fricatur pars dolens tinctura saponis et opii. Rep. supposit.
ex opio.

7th. — Had some vomiting of dark-coloured matter at
twelve last night, and died soon after.

8th. — Sectio Cadaveris. The body was much emaciated,
and several small dark spots and tumours, visible during life,
were observed distributed over the body, chiefly on the
trunk. These tumours were largest and most numerous in
the mammae — they were imbedded in the cellular substance,
were encysted, and when cut into were found to contain a
dark brown substance, almost black, and of a soft pulpy con¬
sistence, which could be only partially removed, by washing,
from the cellular texture in which it was deposited.

Within the abdomen^ the cellular and adipose texture con¬
nected with the viscera had almost disappeared. The pen-
dojimm lining the parietes appeared of a blackish colopr, and

Case of Melanosis, communicated by Sir A. Halliday. 203

the black matter was irregularly deposited in stri® and spots
within this membrane, which had lost much of its shining and
transparent appearance.

The omentum was similarly altered, and several globular
shining tumours of a black colour were appended to it,
which, when cut into, poured out a dark homogeneous fluid.

Between the folds of the mesentery, and beneath the serous
membrane of the intestines, there were numerous black spots
and small tumours. There was some unusual vascularity,
and many small vessels containing red blood could be ob¬
served upon the portion of membranes which formed the
cysts of the black tubercles.

The ovaria were very considerably enlarged, and were
seated immediately in front of the uterus, occupying also the
iliac regions. Their external surface had a shining dark and
lobulated appearance, with numerous ramifications of vessels
on their peritoneal covering, beneath which black matter was
irregularly deposited in spots, giving a mottled appearance to
the whole. When cut into, their substance was uniformly
black. The cellular tissue still retained its consistence, and
vessels containing red coagulated blood could be traced
through it. Several distinct cysts or cavities were formed in
their substance, which poured out a black liquid when opened.

The kidneys, liver, spleen, and the mucous coats of the
stomach and intestines, appeared altogether free from black
matter, although it svas deposited in the cellular membrane
connected with these organs.

On removing the sternum and skull-cap, it was observed
that the whole texture of the sternum and the anterior por¬
tion of the ribs, and great part of the parietal and occipital
bones, were blackened, more brittle, and of a softer consist¬
ence than natural, but without enlargement or evident altera¬
tion, or thickening of the periosteum.

Beneath the pericranium, black matter was deposited in the
form of encysted tumours; but when these were raised from
the bone, the black matter was found to enter by fine projec¬
tions into foramina in the bone, without the intervention of
any cyst. The pericranium was easily separable from the
subjacent bands, but was otherwise natural. The whole inner
table of the skull, when removed from the dura mater, was of>
a darker hue than natural ; and, in some places where the
black matter appeared to proceed from the bone to the subr
jacent membrane, the latter had patches corresponding to
those on the inner table, and w hich could be partially removed
by scraping : at these points the bone was evidently darker
and more perforated than in other parts. The substance of the
brain was natural ; but several minute studs of dark matter

204

Grig inal Communica tio ns,

were deposited in the course of the ramifications of the small
vessels on the membranes covering the base of the brain and
of the choroid plexus. A large quantity of serum was effused
into the ventricles and under the arachnoid coat, which was
considerably elevated by it.

Within the thorax y a number of small black tubercles, of
similar structure with those in the integuments, were situated
within the pleura costalis ; and others, of a larger size, were
attached to the surface, of the lungs: all of them appeared
enveloped in a slender cyst.

The substance of the lungs was dark, and some minute
black tubercles were imbedded in it. Similar spots were
noticed within the pericardial covering of the heart, which
contained some coagulated blood in its cavities, and was
softer than natural.

Explanation of the Plate,

Fig. — The small tumours imbedded in the cellular texture
throughout the body. (See p. 202.)

. Fig. 2d. — A transverse portion of the sternum, sawn on both
sides, in order to show the black colour of the bone, and with the
periosteum, which is also considerably blackened, attached to both its
anterior and posterior aspects. At one corner of this portion of the
sternum the cartilaginous attachment of one of the ribs may be ob¬
served of nearly its natural colour. (See p. 203.)

Fig. 3d. — A small portion, we believe, of one of the thicker bones
of the cranium, showing the cancelli between the tables.

Case of extensive Abscess of the Brain, which partly discharged
itself externally for some time previous to the death of the
Patient. By William Pretty, Esq. Member of the
Royal College of Surgeons, London.

Frances Roberts, tw^elve years of age, w^as seized with
convulsions in the night of the 6th of July, when her parents
called me to attend her. I found her in a strong epileptic
convulsion ; and as I could then obtain but little knowledge
of her previous symptoms of illness, the girl appearing other¬
wise healthy, and the period of puberty having seemingly
arrived, from the enlarged state of the breasts, I felt disposed
to consider the affection as arising from sympathy with the
change wLich was taking place in the organs of generation.

The bowels having been freely relieved the day before, I
contented myself by abstracting eight or ten ounces of blood
from the arm, and desired that she might be taken such care

f <2^,

JJ3oorTey ■3i O.Sfy'cmydy.

2^or tht'y Zoridm^ yM~tdu>al Tf^epo^vtorj; J^or ifept^7S23.-^." Z(PA^

Mr. Prett}-'’s Case of extensive Suppuration of the Bram. 9,05

of as should prevent her from bruising herself. I saw her
again in a few hours. The bleeding had afforded no relief to
the convulsive paroxysm, for it continued three hours and a
half. The blood drawn was buffy, and the crassamentum
firmly contracted.

Upon seeing my patient the following day, she complained
of much pain in the head, with fever, and a pulse of 120.
She was now bled locally with leeches; and 1 ordered some
saline medicine, with digitalis, and directed her to continue
the use of a purgative mixture which her brother, a chemist,
had prescribed for her a week before.

I was now informed that she had suffered great pain from
the formation of an abscess in the left eyelid. Inflammation
had commenced a fortnight before the fit. Leeches and
poultices had been freely applied, after which the abscess had
burst. There had been a free discharge of pus, though it
was now very much diminished in quantity. The integuments
were recovering thefr usual healthy appearance ; and as no
particular complaint was now made of this part, it was
simply kept clean and poulticed. In a few days it healed
over. About this time she was so free from suffering,
although much reduced in strength from the plan which had
been adopted, that 1 left her for several days to recruit.
Calling afterwards, 1 was a little disappointed at finding her
ill in bed, with a return of fever, a slow, irregular, and inter¬
mitting pulse, some disposition to delirium and insensibility,
and with another attack of inflammation in the eyelid. She
was blistered upon the back of the neck ; had the head kept
cool by the constant application of cold vinegar and water;
a few more leeches were applied ; and the purgative medicine
again resorted to.

The symptoms, however, continued to increase : an abscess
formed again in the eyelid ; it burst, and discharged a little
every day. Delirium, tinnitus aurium, and restlessness, now
supervened, and were followed by stupor, insensibility, and
hemiplegia of the right side. The loss of motion and sensa¬
tion of that side Mas most complete ; but the mouth, instead
: of being drawn on one side, as is usual in paralytic seizures,
was so firmly closed as to allow the introduction of the point
1 of a spoon only between the teeth. The iris was perfectly
j inactive, and the sight of the right eye quite lost. There
I came on a very frequent tossing about of the left arm, and a
I drawing up and down of the left leg. At times a gleam of
^ consciousness appeared, as she swallowed some milk, when
roused to it by the solicitation of her friends, and resisted an
■ attempt to cut off her hair, but she was unable to speak.

I The breathing was quick, and sometimes stertorous. The
I VOL. XX. — NO. 117. 2e

206 Original Communications.

stale of stupor and paralysis continued for seven days, when
she died, exactly three weeks after the epileptic convulsion,
and five from the commencement of inflammation in the
eyelid.

Post-mortem Examination. — The upper part of the skull
was easily removed. The cerebral veins were very distinctly
seen through the dura mater, and when the latter was removed,
they appeared in a very turgid state. Upon slicing the brain,
blood oozed freely from the cut surfaces ; and when cut nearly
level with the corpus callosum, the right lateral ventricle was
opened, and was found as full of water as it was possible to
contain, in a folly ossified cranium. Plunging a knife in the
situation of the opposite ventricle, some ill-conditioned pus
escaped at the opening, which being enlarged in the direction
of the left orbit, the walls of an abscess of very considerable
extent w'ere exposed, containing not less than one ounce of
pus, some of which presented a dark hue, and some a healthy
appearance : a little extravasated blood was also discoverable.
I’he whole of the left hemisphere of the cerebrum was dis¬
eased : it was prelernaturally soft, and of a dirty yellow hue
when compared with the right, which possessed the natural
appearance. We could find no distinct left lateral ventricle,
so completely were its parietes broken down by the suppura¬
tion. The abscess took a pretty straight course through the
posterior, middle, and anterior lobes, till it reached the dura
mater, in contact with that portion of the os frontis which is
a little above a line drawn horizontally with the summit of
the crista galli, and about half an inch from it on the left
side ; here was a perforation in that membrane, large enough
to admit a crow-quill. A circular portion of the bone in con¬
tact with it was carious, the diameter of which was half an
inch. The caries had penetrated both tables of bone, and
very small perforations were discovered in it, externally above
the root of the nose, inclining towards the internal angle of
the orbit ; and thence the abscess must have made its way,
under the integuments of the forehead, to the eyelid, where
it discharged itself by ulcerative inflammation. The dura
mater, at its edges, surrounding the perforation in it, was but
very loosely attached to the inferior part of the os frontis, yet
no matter had escaped between the membrane and bone. A
thin layer of pus was seen upon the under surface of each
lobe of the cerebellum, and when removed left it a permanent
opaque spot in the arachnoid membrane; there was also
serous effusion between this membrane and the pia mater,
upon the superior surface of the brain, and likewise a good
deal in the theca vertebrarum. — This examination was made
sixteen hours after death.

207

Mr. Dendy’s Case of Miliary Fever.

Remarks. — The motlier of this girl informs me, that my
patient had experienced two attacks of chorea, each of about
five months’ duration ; one occurred in 1819, and the other
in 1820; and that she was well only six months between
them. For their cure she attended the Bloomsbury Dispen¬
sary ; and from the recommendatory letter, I perceive that
tonic medicines were prescribed, and that she was discharged
as cured of the last attack in October. She afterwards very
often complained of pain in the head, but looking well, little
notice was taken of it ; and even up to the time of the inflam¬
mation commencing in the eyelid, it was thought by the girl
and her friends that she had inflicted on herself some injury
•during her sleep. I therefore infer, that her disease assumed
an acute form onlj' a short time before the convulsion, but
that, in all probability, a chronic state of it had been going on
for several years preceding her death. During the convul¬
sion, it was remarked that the muscular contractions w'ere
much more pow'erful in the right arm and leg than in the
left ; the opposite side, it is well recollected, was more parti¬
cularly aflected during the continuance of chorea. Dr. J.
Johnson, Mr. Bagster, and Mr. Terry, assisted me in this
dissection.

Mabledon Place, 4tli August, 1823.

VI.

Case of Miliary Fever. By W. C. Den dy, Esq. Surgeon to
the Royal Universal Dispensary for Children.

Every derangement which occurs to females in the puer¬
peral condition, added to those peculiar changes which that
state must of necessity be in some degree attended by,
becomes, by the puerperal modification, additionally dan¬
gerous. The supervention of considerable pyrexia, com¬
bined with a diffused eruption of minute red spots, is not
a very unusual occurrence during the first week of parturi¬
tion, arising from exposure, injudicious administration of
stimulants, over-heated apartments, suppressed secretion, or
from some other cause — an affection which has been called
the rush. The disease, however, which may be considered
the true miliary fever, and which is marked by considerable
anxiety, fever of a high type, and more or less local disturb¬
ance, accompanied by the eruption of innumerable white,
vesicular spots, is one, 1 apprehend, of less frequent occur¬
rence. The instances of this description that have come
under my notice have been few ; the last was a case of such

^08 Original Communicalions.

severity, and yielded so speedily to a simple treatment,
although one that, a priori^ might have been deemed im¬
proper, that I trust a brief relation of it will not be considered
unworthy of the pages of the Repository.

The lady of a merchant in the city, on the third day after a
very short and easy labour of her seventh child, was attacked
by shivering, followed by anxiety, hot and dr}^ skin, arterial
throbbingj flushed countenance, and other marks of high vas¬
cular action. The lochia were by no means deficient ; but the
secretion of milk was diminished, though not in a sufficient
degree to account for the severity of the symptoms, which
might, perhaps, have arisen from exposure during the shift¬
ing of the patient, subsequent to delivery. Shortly after the
occurrence of these symptoms, a copious eruption of minute
wdiite vesicles appeared on the skin of the neck and arms,
wdth some alleviation of the febrile symptoms. The vascular
action, however, soon recurred with redoubled violence; the
eruption appeared universally ; an acid odour, similar to that
of rennet, was exhaled from the surface, and the patient
complained of a pricking sensation over the whole body.
Intolerance of light was now added to the symptoms, and the
mind became painfully sensible to the slightest motion or
noise. The abdominal pain, which had been but slight, now
became most acutely increased ; it was not, however, con¬
stant, but spasmodic, and was scarcely aggravated by firm
pressure.

Sixteen ounces of blood were taken from the arm, by
which the cerebral symptoms were materially relieved ; and a
blister was applied below the umbilicus. The next indica¬
tions were to evacuate the bowels, and restore the secretions
which had become in a great degree suspended. For this
purpose, laxatives, diuretics, and gentle saline diaphoretics,
were administered, which produced their full local effect. It
was, however, evident, that as the exudation through the
perspiratory pores increased, so likewise did the eruptive
vesicles, and the concomitant fever was proportionably aggra¬
vated. It, therefore, became my object to regulate, but not
to increase, the cuticular action, and the sudorifics were con¬
sequently omitted, and acescent liquids directed. Some de¬
gree of benefit was derived from this treatment; but still the
symptoms continued, with little abatement, until the fifth
day. On my visit that morning, I found the symptoms all
aggravated, with the exception of the abdominal pain, which
had nearly subsided. The perspiration, with its peculiar
odour, w’as most profuse; and the universal roughness of the
skin communicated to the touch the sensation which would
be produced by passing the finger over a coarse dull file.

209

Mr. Dendy’s Case of Miliary Fever.

Tlie fever was excessive, and the cerebral derangement
appeared rapidly increasing. 1 resolved to have recourse to
a directly repellent treatment. The clothes of the bed were
taken off, with the exception of a thin sheet; the curtains
widely undrawn ; and a regular current of air was obtained j
by opening the door and two windows. In a very short time,
my patient expressed herself much refreshed; and in the
afternoon, I was gratified to find the skin cool, and compara¬
tively dry, and withal every symptom of uneasiness vanished.
On the next day she was convalescent.

Remarks. — This case militates against the prevailing opi¬
nion, that the repulsion of all eruptions in the puerperal
patient is a very dangerous proceeding : but, although the
repulsion of many kinds of eruption' is undoubtedly dangerous,
this seems not to be the case with respect to miliary fever;
and I am confident that here the danger w'ould have been
continued, at least, by a perseverance in the plan first
adopted. — What was the cause of the great aggravation of
the eruptive fever by the perspiration — whether did this arise
from its quantity or its quality I certainly incline to the
latter alternative, from the peculiar acidity of the exhalation.
I am, at the same time, aware of the fact, that in some per¬
sons sweating is generally, nay always characterized by slight
eruption. The miliary form of disease, in this case, appeared
to arise from such an idiosyncrasy ; and it seems to me to be
a question whether the supervention of miliary fever during
the puerperal state does not depend more upon that pecu¬
liarity of constitution, than upon any fault of regimen. No
such fault had place in this instance, either as regarded the
ingesta, the temperature of the apartment, or the quantity of
bed-clothes. The peculiar odour of the perspiration in this
disease, and which was remarkable in this case beyond all
others which I have witnessed, points to two different
modes of explanation, viz. either that the functions of the
cutaneous capillaries are materially changed during the dis¬
order, or that the malady itself arises from certain impurities,
or from morbid states of the circulating fluid, which are eva¬
cuated from the cutaneous surface. If the latter were the
case, we might reasonably expect that the disease could only
terminate with such evacuation, or that any stop which should
be put to its excretion on this surface would be followed by a
metastasis of the disorder to another; but these occurrences
are not observed. The former explanation, which ascribes it
to a morbid action of the cutaneous capillaries, is more
plausible and more accordant with that idiosyncrasy to which
I have referred the predisposition to the disease, and, indeed,
with modern pathology ; and seems to support the treatment

1210 Original Communuations.

which was successful in this instance ; while the other doc¬
trine favours that which was employed at the commencement
of the disease, and which was found to add to its severity. —
I have been induced to publish this case, as, in my opinion,
illustrations of serious disorders which occur frequently are
more calculated to be useful, than notices of those that are
seldom met with in practice.

Great Eastcheap, 2d August, 1823.

VIL

Case of Scirrhous Thickening and Stricture of the Cardiac
Orifice of the Stomach. By A. R,

The following case is of too common a description to be
of any great importance. The records, however, of cases,
although familiar ones, by which a certain assemblage of
symptoms is shown to be connected with a certain state of
organic disease, are not altogether without their use: by a
comparison of such histories, diagnosis is rendered more pre¬
cise; and we are enabled to act upon our opinions, as well as
to express them, with the greater confidence.

A gentleman, between seventy and eighty years of age, for
many years felt an obscure, deep-seated sense of uneasiness
below the sternum ; it gave him but little trouble, and his
health did not suffer from it. About five months before his
death he had, at first, occasional vomiting after his meals :
this symptont gradually became regular; and for perhaps the
last two months of his life, every thing he swallowed was
rejected, either wholly or in part, sometimes immediately,
sometimes, though rarely, after an interval of one or two
hours. During this period, there was no remarkable disturb¬
ance of the circulation. He felt a sense of obstruction to
the passage even of fluids, which he described as being
situated below the sternum: the food which was swallowed
was rejected by an easy effort, scarcely to be called vomiting;
its appearance was but little changed, and it was never mixed
with food which had undergone a partial digestion. His
bow’els were kept open, with some difficulty, by an habitual
aperient : he refused to employ any other measures ; and my
attendance upon him, except tow'ards the termination of the
case, was only occasional, and at very distant intervals. I
was pressed very hard for my opinion of the nature of the
di sense ; and was not permitted to save myself by saying,
generally, that it was organic. It was inquired, in what did
this organic disease consist ? I said in a scirrhous thickening
of the cardiac or upper orifice of the stomach : and afterwards

Case of Scirrhous Thickening of the Cardia, S^c. 21 1

repented having committed myself by specifying a precise
state of disease, upon what will appear to those conversant
with the general uncertainty of diagnosis but slender pre¬
mises. During the last week of this gentleman’s life, there
was great difficulty in procuring evacuations from the bowels,
which were scanty and black. The croton-oil was given in
doses of one drop every three hours, with a greater degree of
success than had attended an}^ other measures. At the ter¬
mination of this case the subject was greatly emaciated, his
strength exhausted; and he died, apparently, from defective
nutrition.

On examination after death, the cardiac portion of the
stomach was found of cartilaginous hardness, and thickened
into a large bulb ; the passage through it, for the space of an
inch, was reduced to the size of a crow-quill : on slitting open
this portion, pus was found on the internal surface, some
superficial ulceration, and one deep circumscribed ulcer.
There was no very remarkable dilatation of the oesophagus
above the obstruction. The gall-bladder contained two large
calculi, one consisting of numerous small concretions cohering
together weakly ; the other was firm, white, and its surface
covered with minute crystals. The liver appeared less in
size, its colour lighter, and its firmness less than natural. This
gentleman’s habits had been remarkably temperate until he
began to suffer the symptoms of an established disease, when,
for the purpose of obtaining temporary relief, he drank wine
freely, and undiluted brandy; contrary, of course, to medical
direction, as well as to the wishes of his friends.

It will be remarked in this case, that the principal diag¬
nostic signs were — 1st, the sense of obstruction at the bottom
of the gullet, or commencement of the stomach ; 2d, the uni¬
form rejection of food ; 3d, the duration of the symptoms ;
4th, the return of food unmixed with the usual contents of the
; stomach. The two first circumstances indicated that the
disease consisted of obstruction to the passage of food ; the
j third, in connexion with his advanced age, indicated that this
' obstruction was organic ; and the fourth, in connexion with
\ the first, fixed its seat at or near the cardiac orifice of the
1 stomach.*

I July 31st, 1823.

* The Editors inform their readers that the eminent writer of the
j above case is known to them, and that its authenticity may be
I implicitly relied on.

Original Commurmations,

VIII.

Cases of Perforation oj^ the Stomach, S^c. occasioned hy the pro¬
tracted Use of the Corrosive Preparations of Mercury, and of
Spirituous Liquor's, By U. Coste,* M.D. of the Faculty
of Paris.

In December, 1821, a vsoldier of the twenty-second regi¬
ment died on the twelfth da}^ of his treatment, in the hospital
at Dunkirk, for sub-acute inflammation of the lungs, accom¬
panied with thirst, heat of skin, and some symptoms of gas¬
tritis. The gastric symptoms were, however, unattended
with acute pain, nor was the pain increased on pressure. The
pulse was quick; the patient complained much of thirst;
and the tongue was red only at its apex. The stomach
retained liquids ; and neither vomiting nor nausea were pre¬
sent. He could sit up until the seventh day of his treatment
in the hospital. — Leeches were applied on the first day to
the epigastric region, and the treatment throughout his ill¬
ness was antiphlogistic. This method of cure had no influ¬
ence on the state of the disease.

Upon inspection of the body, in the presence of the medi¬
cal officers of the hospital, considerable sanguineous conges¬
tion was remarked in the lungs; commencing hepatization
was noticed in a portion of the right lung ; and, in the left, a
few tubercles were found in a state of suppuration.

The stomach presented, at its anterior part, and near
the middle of the small curvature, an oblong opening,
about the size of a three franc piece, through which a
portion of the liquids taken by the patient had escaped.
A large and deep erosion, perforated at its centre to the
extent of half a line in diameter, existed near the pylorus.
The stomach, through the rest of its internal surface,
possessed marks of a chronic inflammation. No other per¬
forations were observed in the rest of the digestive canal,
but a number of spots of a dull red colour were situated in
the internal surface of the small intestines. The omentum
and peritoneum presented appearances of a recent inflamma¬
tion, wLich was more intense than was indicated by symptoms
during the life of the patient.

The state of this individual was nearly the same on the day
of his death, as it w'as on the day of his entrance into the
hospital. He complained only of general illness, and of
obtuse pains in his chest and abdomen, chiefly in the former.

* Communicated by the author.

Mr. Cribb on the Procreative Powers of Twin-Females, 213

He preserved his intellectual faculties, and up to the day of
his death referred his disease principally to his chest.

Case 2d. — In February, 1822, a soldier in the same regi¬
ment as the former case occurred in, died on the eighth day
after his entrance into the same hospital. He complained of
violent pain at the lower part of his throat. His voice was
not sensibly affected. I dreaded the presence of a foreign
body in the oesophagus, but he assured me that such w'as not
the case. Anxiety, pain, and difficulty of deglutition, with
dyspnoea, continued to increase, notwithstanding the local
bleedings, and the internal and external emollients which
were had recourse to. The pulse was small and contracted.

Upon opening the body, we found the oesophagus eroded,
both anteriorly and posteriorly, through the whole of its lower
third. Its lateral parts appeared like ligamentous bands.
The stomach vvas almost entirely deprived of its mucous
surface, and near its middle it had two perforations in
its tunics; one was as large as a half-crown piece, the other
was very small. Their margins were thin, and presented no
particular character. The right lung was filled wdth tubercles
in different stages of softening. The oesophagus and the
stomach in this and the former cases, are preserved.

Upon inquiry into the history of both these individuals,
before their reception into the hospital, it was ascertained that
the disorganization was the effect of an improper and pro¬
longed use of the muriate of mercury in small doses, with
which they had often treated themselves in order to avoid
entering the hospital ; and of the no less hurtful abuse of
Hollands, taken with a view to excite the stomach, and
repeated, both as regarded quantity and frequency, according
as they found the pain and difficulty of digestion to increase.

IX.

An Inquiry into certain Opinions which exist relative to the
Procreative Pozvers of Women who are Tivins, the Socius in
UterOj or Co-twin, being a Male. By J. J. Cm be. Esq.
Cambridge, Member of the Royal College of Surgeons,
London.

General conclusions,’^ says Locke, drawn from par¬
ticular facts, are the jewels of knowledge, comprehending
great store in a little room.” Whenever, therefore, in our
researches after knowledge, we are enabled, by careful and
correct observation, to detect an established error, or to
develope an additional fact, we deposit a jewel in the cabinet
of science. But the value of our discoveries must be deter-
VOL. XX. — NO. 117. ^ F

214 Original Communications.

mined by their tendency to promote the welfare and happi¬
ness of mankind, rather than by any extrinsic merit they ma}^
derive from the difficulty of their investigation, or the skill
and talent exercised in their development. As, then, the
inquiry here proposed affects the interests of a considerable
class of persons, it will not be regarded as altogether unim¬
portant.

My attention was first directed to the subject by some
remarks contained in a paper written by Sir Everard Home,
and published in the Philosophical Transactions for 1799?
entitled, An Account of the Dissection of a Hermaphrodite
Dog,’’ &c. in which paper Sir E. suggests some ingenious
hypotheses on the formation of the generative organs of the
foetus in utero, and takes notice of the following phenomenon
which is common among neat cattle.

When a cow brings forth twin calves, one a male and the
other apparently a female, the former always grows up to be a
perfect bull, but the latter appears destitute of all sexual
functions and propensities ; it never propagates, and is com¬
monly called a freemartin. Near the end of Sir E. Home’s
paper is the following paragraph : — It may also account
for twins being most commonly of the same sex ; and when
they are of different sexes, it leads us to inquire whether the
female, when grown up, has not less of the true female
character than other women, and is incapable of having
children It is curious, and in some measure to the purpose,
that in some countries nurses and midwives have a prejudice
that such twins seldom breed.”

From these remarks, together with the popular prejudice
alluded to, and which certainly more or less prevails, it
appears that some doubt does actually exist as to the pro-
creative powers of this description of females. As such twin
cases are by no means uncommon, it is obviously desirable to
remove this question from the obscurity of a vague and
remote analogy, and to place it in the clear light of fact
and experience.

With this view, I was naturally induced to apply for in¬
formation to Sir Everard Home ; feeling assured that a gen¬
tleman so ardently interested in promoting the advancement
of natural science as the learned Baronet, would not have
ventured a suggestion of so much practical importance with¬
out some strong reasons for believing it at least probable. In
his reply, how'ever, to a letter which I took the liberty of
addressing to him. Sir E. merely states, that the subject had
been long out of his mind, and that he had not been able to
ascertain any facts respecting it. Disappointed, therefore, in
not receiving the instruction I had hoped for from this

Mr. Cribb on the Procreative Powers of Twin-Females. Q.\5

quarter, I undertook to make inquiries respecting this de¬
scription of females who were married, and the following is
the information I have acquired : —

1. The widow Gillam, now’ living in the almshouses in
Jesus Lane, Cambridge, informed me, that she had twins, a
boy and girl, about forty-seven years ago; both are now
living, and have families: the daughter, wlio is now married,
and lives at Somers’ Town, has had thirteen children. 1 have
procured the baptismal register of these twins from the
church of St. Edward, Cambridge, which accords with Mrs.
G.’s account.

2. Mrs. Hall, of Chesterton, has had four children. I have
obtained her baptismal register, also, from the parish of
Cherry Hinton, with that of her brother, Richard Layton :
they are registered as twins.

3. Mrs. S. M. of IT, in Essex, has had ten children, and
is still young enough to have many more.

4. Mrs. G. bedmaker to Emmanuel College, has had two
children; one son living, and grown up.

5. Mrs. Pike, whose husband is employed in the University
printing-office, has had two children.

0. Mrs. Hardy, a poor woman living in Cambridge Place,
is a twdn of this kind, and has had several children.

7. Mrs. L. wdfe of a plasterer in Cambridge, has been mar¬
ried several years, but has not yet had any children; she is,
however, not more than thirty years of age.

These are all the instances I have ascertained of women,
born under the circumstances in question, having been mar¬
ried ; and six out of the seven have had children.

Of the truth of the above statements no reasonable doubt
can be entertained ; most of the individuals mentioned* I have
seen and conversed with on the subject. They could have no
motive for deception ; and the baptismal register, together
with the other concomitant evidence, as the testimony of
their neighbours and acquaintance, tend to corroborate the
general correctness of the accounts.

The notion of the sterility of females of this kind seems
to have originated in the peculiar sexual characters of the
freemartin ; which it was inferred analogically might belong
also to the human subject, when born under similar circum¬
stances.

A little more attentive observation, however, would have
discovered that this analogy will not bear the slightest
examination ; for when the external characters and the ana¬
tomical conformation of the freemartin and those of the
human female, are compared, it ceases altogether. For, in

216 Original Communications.

external appearance, the freemartin differs very consi¬
derably from the perfectly formed cow ; the head and neck^
in particular, bear a striking resemblance to those of the
bull.

The anatomy of the freemartin is sufficiently explained
for the present purpose by the following paragraph, which is
extracted from the same paper by Sir E. Home : — “ From
Mr. Hunter’s observations we learn, that in all the instances
of the freemartin which he examined, none had the complete
organs of the male and female, but partly the one and partl^r
the other, forming a mixture of both ; and what is deserving
of notice, the ovaria and testicles in all of them were too
imperfect to perform their functions.” The fact is, that the
freemartin is a kind of hermaphrodite, but without any com¬
plete set of organs of either sex.

The human female, on the other hand, so far as my obser¬
vations have extended, has nothing peculiar in her external
appearance ; and as so large a portion of those that are mar¬
ried have children, there could, of course, be no essential
imperfection in the structure of their genital organs.

Both experience and analogy, then, tend to establish the
fact, that women who are twins with male partners in birth
are as capable of having children as other women; and con¬
sequently, that the popular prejudice to the contrary, together
with the doubts and surmises of the learned Baronet, are
entirely without foundation. May we not, therefore, safely
conclude, that if, in such females, the catamenia and other
feminine characters are natural, the circumstance of gemi-
nous birth does not at all affect the probability of their
breeding ?

From the foregoing statement, it would appear that Sir
Everard Home has here thrown out suggestions, resting
merely on a popular prejudice, and an extremely remote and
limited analogy; suggestions calculated to excite painful
suspicion and anxiety in the minds of a considerable number
of individuals, and which that degree of investigation the
subject deserves, and that might so easily have been accom¬
plished, would have shown to be utterly destitute of founda¬
tion.

Cambridge, July 16tb, 1823.

Mr. Ward’s Case of Amaurosis,

217

Case of Amaurosis produced hy Enlargement of the Pituitary
Gland, By Joseph Ward, Esq. Member of the Royal
College of Surgeons, and Apothecary to the London
Hospital.

John Austin, baker, a strong muscular man of tem¬
perate habits, aged thirty-eight, for three years past has been
afflicted with dimness of vision, accompanied, at intervals,
with severe pains in the anterior part of the head, and with a
sense of burning and fulness in the orbits, which was at times
so distressing as to cause him to apply for advice. He had
leeches, blisters, and such medicines as were deemed most
proper, without receiving benefit; on the contrary, the appli¬
cation of leeches appeared to increase rather than diminish
his sufferings. Notwithstanding this, his strength and general
health continued very good, being up during the greater part
of the night, and frequently carrying very heavy loads during
the day. The digestive organs had been, for the most part,
regular in their functions, excepting at slight intervals, and
then only from such causes as might be considered wholly
independent of any existing local affection.

Sunday, May 25, 1823, he again applied for advice; and
complained that, during the last five or six weeks, the dimness
of vision had considerably increased ; that the pains had been
much more severe; that he had felt a strong inclination to
sleep, so much so that if, during the day, he sat down for a
few minutes to refresh himself, he fell asleep, being unable to
prevent it, and would continue so until disturbed ; and that for
the last two or three days he had been completely blind with
the right eye, and this morning found himself, for the first
time, totally blind with both : for the last week or ten days
he had been able to distinguish objects, but upon going to
bed last evening, the only object he could discern was the
candle, and that not distinctly. On examining the eyes, no
very apparent disease manifested itself; the pupils did not
contract on the application of a strong light; they appeared
rather small, but perfectly clear ; he complained of some loss
of appetite which had existed for a few' days only ; pulse 96,
and small ; natural secretions as usual. Supposing that some
of the more prominent symptoms depended on disordered
stale of the stomach, he was ordered an emetic, and after its
operation, five grains of calomel, to be succeeded on the
following morning by an opening draught.

Monday, on being seen at two o’clock, it was found that

21 S Original Communications.

the medicines had operated verj" well, having produced
• several bilious motions ; headach not so considerable, and in
a small degree had recovered his sight in the left eye; he
could see the window, and on placing the hand before his
eye, could distinguish something, although unable to tell
what it was. The whole of the above medicines were again
ordered to be repeated.

Tuesday, he complained of being much weaker, and, in
consequence, kept his bed, which he had not previously done ;
headach better ; vision as yesterday ; slept constantly, and
snored very loudly. Six leeches were ordered to the temples,
the calomel and opening medicine to be continued, and a
blister to be applied to the nape of the neck,

Wednesday, an eminent oculist being called in, he con¬
sidered the illness to arise from congestion in the cerebral
vessels, and ordered twenty ounces of blood to be taken from
the arm, with a saline draught every four hours; and con¬
cluding that it was a medical case, he declined his further
attendance; the patient fainted when he was bled.

Thursday, he was more inclined to sleep; was roused with
much difficulty, but when awake, spoke very sensibly, and
answered the various questions proposed to him ; since the
bleeding the pulse was weaker, and 120; debility greater.
This morning, a Physician being called in, he was ordered to
lose twenty-four ounces of blood from the arm, the saline
medicine to be continued, four grains of calomel to be taken
at bed-time, and an opening draught on the following
morning.

Friday, at half-past twelve, he died ; and on the following
day, when he was examined, the following appearances pre¬
sented themselves : — The membranes of the brain were quite
healthy; some degree of fulness of the vessels existed, but it
was only very trifling ; the fluid in the ventricles was about
the natural quantity ; on raising the anterior lobes of the
brain, a tumour was found arising from the situation of the i
pituitary gland, and pressing upon the optic nerves; it w'as
of considerable size, forming a nidus in the anterior lobes ; ;

the optic nerves were very beautifully expanded upon it;
the right diverging nerve was rather more expanded than the
left; the olfactory nerves w^ere likewise very much pressed i
upon.

London Hospital, 7th August, 1823.

Mr. Amesbury on Fractures.

219

A few Observations upon the Nature of Fractures of the Long
Bones in general^ and upon the Nature and Treatment of
simple Fractures of the Humerus in particular ; accompanied
with a Description of a New Apparatus illustrated by Cases,
ByJ osEPH Amesbury, Esq. Member of the Royal Col¬
lege of Surgeons, &c.

In the sketch, which I have ventured to publish, of the
treatment of simple fractures of the lower extremity, I have
enumerated some of the evils which attend the common
modes of treating fractures of the leg and thigh ; and have
endeavoured to point out some general principles of treat¬
ment, which, as far as 1 know, are altogether new.

Since I published this imperfect sketch, I have not seen the
least occasion to swerve from any one of the principles which
1 there endeavoured to establish. Indeed, I may say, tha
every case, which has since fallen under my observation, has
served to impress the importance of those principles more
strongly upon my mind; and, although much has been
written upon the treatment of fractures, by men no less dis¬
tinguished for their natural talents than for their surgical
acquirements, additional experience has convinced me, that
much still remains to be accomplished. Under this consi¬
deration, I again wash to draw the attention of my brethren to
the further investigation of this important subject.

In the various conversations which I have had with Sur¬
geons upon the nature, the degree of importance, and upon
the treatment of fractures, I have often been forcibly struck
with the different, and even opposite opinions which they
seem to entertain. How shall we account for such disparity
of opinion in cases where the nature of the injury is clear, and
w’here the effects of remedies allow of demonstration? Think¬
ing it may depend, in part, upon differences in the nature of
the accident, which have not been sufficiently attended to, I
shall make, first, some observations which may be regarded
as common to fractures of the long bones in general; and
shall then pass on to the consideration of simple fractures of
the humerus.

Fractures of the long bones may be either transverse,
oblique, or comminuted ; and they may be considered ac¬
cording to the degree of injury done to the bone, and accord¬
ing to the degree of injur}^ done to the soft parts; I shall
therefore view them as consisting of fractures of the bone

220 Original Commuidcations*

merely, or of fractures attended with much laceration of the
surrounding textures.

Among the injuries which are confined to fracture of the
bone merely, I believe one variety consists in a partial divi¬
sion or crack of the bone, which, for the sake of perspicuity,
may be termed an incomplete fracture. 1 have been led to
form this opinion from various experiments upon recent
bones while covered by the soft parts. Upon examining
these bones in a denuded state, I have found, that a fracture
may extend in a transverse or oblique direction through a
greater or less number of the fibres of a bone without passing
completely through it; and that if a fracture of this descrip¬
tion is attended with displacement, the displacement consists
in a bent state of the bone, wdth a portion of the edge of one
or more of the fractured surfaces projecting at the salient
angle formed at the fractured part.

I have been led to suspect the existence of such a fracture
in several patients, in consequence of my inability to produce
motion in the injured part in more than one direction ; from
my being unable to produce this motion in any other way
than by attempts to bend the bone; from the simultaneous
movements of the upper and lower portions when the lower
part was rolled ; from the power which the patient expe¬
rienced in the limb ; and from the rapidity with which a
perfect consolidation of the fracture was effected. I have
not, however, yet had an opportunity of examining the limb
of any patient who may have died with the existence of such
symptoms as 1 have mentioned : but even in the absence of
this proof, I think, the facility with which this kind of frac¬
ture may be produced in recently dead bones, is sufficient to
warrant the conclusion that such fractures do occasionally
occur in the living. ^

I can readily suppose the application of a force which
would be likely to produce a fracture of this description. A
person, while standing in the erect position, may receive a
blow upon the back of the leg; but the force acting upon
the limb may be only sufficiently powerful to break through a
portion of the diameter of the bone, which would give way
first at its anterior part. The same kind of fracture might
perhaps be sometimes occasioned by the passage of a heavy
body over the limb as it lies upon the ground. If the fracture

* Since I made these observations, 1 have discovered that Mr.
Colies mentions that he has seen and examined fractures in the neck
of the thigh-bone, which he believed to be of this description ; but as
some disease existed in the part, perhaps we are not justified in con¬
sidering these cases alone sufficient to substantiate the fact.

221

Mr. Ames bury 07i Fractures.

should extend nearly through the tibia, it would become evi¬
dent to the Surgeon in attempting to bend the bone, though
he would not be able to produce any rotatory motion in the
seat of fracture. Such a case would require but little surgical
assistance for its cure.

A second variety consists in a complete division of the
bone, unaccompanied by any material laceration of the peri¬
osteum. This variety, which I believe is very common, may
be called a complete fracture. It may be accompanied with
slight displacement in the angular or in the transverse direc¬
tion ; and if the fracture be oblique, it may be accompanied
with slight riding of the fragments. Oblique fractures of this
description overlap very little at first; but after the expira¬
tion of a few days, under common treatment, they sometimes
1 ride considerably. The increased displacement here alluded
to, I presume, takes place as soon as the projecting portions
of the fractured ends have made their way through the oppos-
! ing periosteum and other textures, against which they are
‘ forced by the constant action of the muscles. Fractures
I belonging to this variety are, very generally, easily discovered.

; The fractured surfaces, however, occasionally become so
locked together, that, in consequence of the simultaneous
movements of the upper and lower portions, a nice examina¬
tion is required in order to ascertain the exact nature of the

I Again ; a bone may be comminuted without any consi-
j derable laceration of the periosteum. Should the comminu¬
tion extend entirely through the bone, the fracture may allow

| ; of being as readily displaced as in fractures without commi-
li nution, when the periosteum is much torn, and may require

I I as much attention during the period necessary for its cure.

i I Besides the above varieties, other fractures occur with
great laceration of the soft parts, produced by the broken
ends of the bone. The laceration which accompanies this
variety of fracture is produced by the forcible separation of
the fragments. It may lake place at the moment of the
I injury, by a continuation of the force longer than is necessary
I to break the bone; or it may be produced after the accident,
i by the incautious movements of the patient. 1 do not mean
! to include under the head of laceration the contusion of the
muscles, nerves, &c. arising from the blow or other force
I i which may have occasioned the fracture, for this is common
to fractures and other injuries; but I wish to confine it to
the injury done to the periosteum and other textures, in con¬
sequence of the displacement of the broken portions of the
I bone.

j \ These fractures are usually so exceedingly evident, that the
I i VOL. XX. — NO. 117. 2 G

-2212

Original Communications ,

least motion of the limb informs the Surgeon of the nature of
the injury. They produce much pain to the patient, and
require a great share of the Surgeon’s attention during the
cure.

1 might, with great propriety, consider compound fractures
as belonging to the last variety, as the difference in these
cases consists only in the degree of laceration of the soft
parts. The injury done to the bone in compound fractures
does not differ from the injury which is observed in simple
fractures. The wound, however, which forms a communica¬
tion between the bone at the seat of injury and the external
air, places these cases under somewhat different circum¬
stances; and, as the treatment differs in some respects^ I
shall hereafter venture to speak of them as a distinct variety ;
and I hope I shall be able to show that these formidable in¬
juries are now robbed of many of their terrors.

Either of the above varieties of fracture may extend into a
joint. This circumstance modifies the fracture sufficiently to
authorize me to consider fractures extending iiito joints as a
distinct variety ; because they are often attended with high
inflammation of the joint; and frequently, unless well at¬
tended to, anchylosis is the consequence.

I have thought it right, on the present occasion, to make
these few general remarks upon the nature of fractures of the
long bones, in order that the observations, which I am about
to offer respecting the nature and treatment of fractures of the
humerus, may not be misconstrued.

Fractures of the humerus may take place at any part.
When they occur through the neck of the bone, it is some¬
times difficult to ascertain the precise nature of the injury.
The fracture sometimes extends through the bone at the part
where it gives attachment to the capsular ligament. In these
cases the ligament is occasionally so much torn as to allow of
the escape of the head of the bone from the glenoid cavity of
the scapula.

Through the politeness of Mr. Travers, I witnessed, a short
time ago, an inspection of the shoulder of a man who had the
neck of the humerus fractured by a fall ; and the parts pre¬
sented the following appearances: — The head of the bone
was broken off at that part which in anatomical language is
called the neck, forced from its natural situation, and was
found lying in the axilla. Both tubercles were broken from
the shaft of the bone, and were drawm in opposite directions.
The shaft of the bone was drawn up by the action of the
muscles, so that its upper end came in contact with the
acromion scapulae. Though two months had elapsed from
the time of the accident, there was not the least appearance

}

Mr. Amesbury o/i Fractures. 223

of an attempt at restoration. The man died from a rupture
of the heart, and the preparation of the shoulder is now in the
possession of Mr. Travers.

This man was a patient in St. Thomas’s Hospital, where I
had an opportunity of seeing him frequently during life, and
of observing the symptoms of his accident, which were these:
— The least attempt to raise the arm even passively gave him
great pain. The upper end of the shaft of the bone occu¬
pying the natural situation of the head prevented the deltoid
muscle from falling in, so as to present the usual appearances
of fracture of the neck when accompanied with much laceration
of the soft parts. This part of the bone could be distinctly-
felt th rough the muscles, moving when the arm was rotated,
and giving the same kind of sensation to the fingers as when
the head of the bone is made to roll under them. When the
bone was forced up against the acromion, and, at the same
time, rotated, the motion gave great pain, but was not accom¬
panied by crepitus. When the bone was drawn dowm gently,
and then rotated, a crepitus was discovered, which sometimes
gave that kind of sensation to the fingers which we should
expect to experience by rotating the head of the bone in a bed
of rough pebbles. A preternatural fulness w^as felt in the
axilla, which gave the sensation of crepitus wdien pressed
towards the humerus, at the time this bone was rotated.
Considerable tension continued round the joint to the period
of his dissolution.

The cases of this kind that have fallen under my observa¬
tion have occurred in old people.

Fractures often occur immediately below the tubercles.
Th ese, when complete, are usually easily discovered. When
t|ie fragments are brought in a line and the head of the bone
fixed, the lower portion should be gently raised, so as to
bring the ends in contact, and then by rotating the lower
fragment, crepitus may be felt.

1 have seen these cases in the young, the old, and in the
middle-aged.

But the most common situation of fracture of the humerus
is through the middle of the bone. When the upper portion
is fixed, crepitus may be felt in the same way as in fractures
through the bone just below the tubercles. A joint-like
motion may be perceived by moving the low'er portion in
different directions.

Fractures through the middle of the bone are common at
all ages.

Sometimes fractures happen immediately above the con-
.dyles. The appearances in these cases are the same as those
of dislocation of the ulna and radius backward, but often

224 Original Communications,

much less strongly marked. Extension removes the appear¬
ances of dislocation, but these appearances return as soon as
the extension is discontinued. Usually a crepitus may be felt
when the fore-arm is moved so as to produce a rotatory
motion between the upper and lower portions of the fracture.

This accidejit happens at all periods of life ; the state of
the bone, however, renders children much more liable to it
than persons more advanced in age.

Fractures frequently take place through the inner condyle.
The fracture usually extends in an oblique direction from the
trochlea of the os humeri to just above the inner condyle.
The symptoms of this accident are thus described by Sir
Astley Cooper : — “ The ulna projects backward from having
lost its support. If the fore-arm be extended, the hand
becomes twisted inward towards the side; but upon flexion
these appearances are removed.’’ These symptoms, with the
crepitus which, might be felt upon bending and extending
the arm,” are diagnostic of this injury.

Fractures of the outer condyle occasionally occur. The
fracture usually extends from the trochlea obliquely outward
to just above the outer condyle. Sometimes a small portion
of the condyle only is broken off. In these cases crepitus may
be felt by moving the fore-arm upon the humerus ; or by moving
the condyle wFile the body of the humerus remains fixed.

In taking a general survey of the diagnostic marks of frac¬
tures of the humerus, as they occur in different situations, I
have confined myself to the enumeration of such as may be
considered pathognomonic symptoms.

There are other symptoms usually laid down, in speaking of
fractures of this bone, such as tension and pain in the part,
and want of power in the limb ; but these I have refrained
from mentioning, because they may exist independent of a
fracture ; and when they occur after an accident, they merely
show that some violence has been sustained. The deformed
appearances of the limb, which are spoken of by authors, 1
have also purposely omitted in the above enumeration. I
have done so because I regard deformity as a collateral symp¬
tom, to be met with only in any considerable degree in frac¬
tures attended wdih much laceration of the surrounding tex¬
tures ; and as the indiscriminate mention of its appearances,
as a symptom alw^ays to be looked for, is, in my humble opi¬
nion, calculated to mislead the inexperienced Surgeon, the
observations I shall offer upon this symptom must be con¬
sidered as applicable only to fractures of this description.

Fractures of the humerus, accompanied with any consi¬
derable laceration of the soft parts, are usually attended with
iderangement of the fragments. ^

(

£25

Mr. -Ainesbui7 on Fractures.

When the fracture passes through the hone just helow the
tubercles, the deformity is produced by the action of the
pectoralis major, latissimus dorsi, and teres major; which
being attached to the lower portion, near its superior extre¬
mity, draw it first inward and then upward. In the last
direction it is powerfully forced by the action of the biceps,
coraco-brachialis, and long portion of the triceps. The supe¬
rior portion will be directed a little outward by the action
of the supra-spinatus, the infra-spinatus, and teres minor,
which make the head of the bone perform a rotatory motion
in the glenoid cavity of the scapula.

When the fracture occurs between the insertion of the
pectoralis major and tlie insertion of the deltoid muscle, the
inferior portion is first drawn outward, and then upward on
the external side of the superior. The cause of this position
of the fragments is evident. The adductors draw the upper
portion to the chest; and those muscles which arise above,
and are inserted below the fracture, draw up the lower por¬
tion on the outer side of the upper.

Fractures just below the insertion of the deltoid muscle are
often attended with great derangement of the fractured ends.
The deltoid muscle raises the upper portion; and the lower
is drawn up on its inner side. Sometimes the fractured sur¬
faces are separated considerably from each other. In a case
of oblique fracture that has lately come under my observa¬
tion, the distance between the fractured ends of the bone
allowed the finger, carrying the integuments and a portion of
muscular fibre before it, to lie between them, when the arm
hung steadily in the bent position by the side. •

Fractures near the lower end of the bone, when oblique,
are subject to great derangement of the lower portion; but
when transverse, the displacement is not so great as in other
situations — an effect which is to be attributed to the greater
size of the bone at this part, and to the retentive power of
the muscles arising from its surface.

In fractures of the inner condyle, extending through the
bone in an oblique direction, the position of the broken por¬
tions is influenced by the position of the ulna with respect to
the humerus. No displacement will appear when the arm is
bent, but in the extended position the displacement will be
evident.

When the fracture extends obliquely through the outer
condyle, the broken portion may be drawn a little backward
by the action of the anconeus.

Though 1 have here mentioned the more common varieties
of displacement in fractures of the humerus, it is not to be
considered that the fractured ends will aKvays be found

226 Original Communications,

deranged in the same direction even in fractures that may
seem to be similarly situated. It will immediately appear,,
that the direction in which the different portions become dis¬
placed, is greatly modified by the direction which the fracture
takes through the bone. The degree of laceration of the soft
parts will also contribute to influence the direction of the frag¬
ments in whatever situation the fracture may occur. Suppose,
for instance, that a fracture extends obliquely downward and
inward through the lower portion of the bone, what would be the
probable direction in which the lower fragment would become
displaced? Would it be drawn up on the inner side of the
upper portion? Certainly not; because the fractured surface
of the upper portion lying on its inner side would prevent the
muscles from drawing it up in that situation ; it would there¬
fore be drawn up on the outer side of the upper portion,
inclining a little forward or backward at the seat of injury,
according to the degree of flexion or extension of the fore¬
arm, and the degree of laceration of the soft parts.

In my observations upon simple fractures of the lower
extremity, I endeavoured to show, that a principal object, in
the treatment of these injuries, should be to fix the whole
limb by some unyielding substance, continued from one end
to the other. Let us now see how far the same principle
will apply in the treatment of fractures of the humerus.

Like the thigh-bone to the pelvis, the humerus is articu¬
lated to the scapula by a ball and socket-joint. The former
is connected to the tibia by a joint that has a hinge-like
motion ; and in this respect it does not differ from the kind
of joint that connects the humerus to the bones of the fore¬
arm. They are also both acted upon by powers which tend
to displace the fragments of a fracture in the transverse and
in the longitudinal direction. Now, as these two bones are
connected by the same kinds of joints to the bones above and
below them, and as they are both liable, from the action of
muscles attached to different parts of their surfaces, to be dis¬
placed in various directions when broken, we may ask what
makes the great difference in the treatment of a fractured
humerus and a fractured femur? The humerus, it will be
seen, is so situated, with regard to the other parts of the body,
that it may be allowed to hang by the side when fractured ;
and that, when placed in this position, the gravity of the parts
below the fracture serves materially to prevent displacement
in the longitudinal direction. In the arm, too, the muscles
are so thin that splints act more effectually in preventing
lateral derangement of the fragments. The thigh, on the
contrary, is so placed, that it cannot be kept in a depending
state during the cure of a fractured femur. Here we see that

Mr. Amesbury on Fractures.

the pendent position of the limb, in ibe treatment of a frac¬
tured humerus, is lost in the treatment of a fractured thigh.
Again ; the muscles surrounding the thigh-bone are so thick
and powerful, that transverse displacement is easily produced;
and, w'hen the fracture is attended with much laceration, this
cannot be prevented by any means which do not fix the
whole limb. Thus we see, that from the position of the arm
with respect to the trunk, and from the thinness of its muscles,
we derive advantages in the treatment of a fractured humerus,
from w'hich we should conclude, even without a knowledge of
the fact, that the treatment of fractures of this bone is far
more easy than the treatment of fractures of the thigh.

There is one point, in the consideration of these accidents,
which applies equally, or nearly so, to fractures of the humerus,
treated in the common way, and to fractures of the femur;
and this is the rotatory motion produced in the site of frac¬
ture, by powers usually independent of the muscles of the
limb. This our curative means should prevent, for it is a
matter of no trifling nature as it regards the ultimate result.
It is certainly more likely to take place in a fractured femur
than in a fractured humerus, from the greater weight and
greater length of the lower limb ; but still the causes which
produce it in the one will also tend to produce it in the other.
The short splints made use of in the treatment of fractures of
the humerus, and frequently in the treatment of fractures of the
thigh, have no power to prevent this motion from taking place.
This, I think, will appear from the first experiment related in
my paper on fractures of the lower extremities, if it needs
further confirmation, it may be shown by two circular rods of
any given length, with two of their ends brought into contact
and surrounded by a piece of tube just large enough to
admit them. If we take the projecting end of either of these
rods, placed as I have mentioned, we shall find that, by
i I carrying it out of a line with the tube, we shall move the rod
I which projects at the other end of the cylinder. But if we
place the whole upon a plain surface, and attempt to rotate
! ! both the 'rods by the motion given to one, we shall perceive
j that the rod to which an impetus is given rotates freely
i within the calibre of the tube, while the other remains at rest,
i Now', a fractured arm or a fractured thigh, put up with short
j splints, is placed under circumstances very similar, as far as
j it regards the rotatory motion of the rods mentioned in this
I I experiment. I'he only difference consists in the slight resist-
I I ance which the muscles give to the rolling of the fragments,
\ I in consequence of their being placed as a soft cushion between
j I the splints and the bone.

\ It will be observed that the rods thus situated cannot be

^£8 Original Communications,

moved in the lateral or longitudinal direction, and very little
jn the angular; and, supposing them to be prevented from
separating as they lie in a straight line, we can only produce a
rotatory motion between them. Here we see that the rods
can move in any considerable degree only in one direction ;
but the short splints surrounding a broken humerus not only
do not prevent the rotatory motion to which the rods are
subject, but they allow of displacement in three directions,
lateral or transverse, longitudinal, and angular : therefore, we
should infer that a broken humerus, put up with the common
splints, is far less secure from the eflects of passive motion
accidentally given to the limb, than two straight rods whose
approximated ends are placed within a portion of tube just
large enough to admit them easily.

Indeed, if we lay aside for a moment the slight effect
which the muscles have in preventing displacement, we may
consider a broken humerus, put up with common splints, to
be situated like two straight rods, with two of their ends
placed in contact within a portion of tube much larger than is
sufficient to admit them; and which therefore allows of con¬
siderable derangement of the approximated ends, as well as
rotatory motion between them.

From what I have stated, it will be seen, that the muscles
may oppose the derangement of the fragments of a fracture in
three ways: — 1st, By the attachment of their fibres round
.the fractured part. 2dly, By acting as a cushion between the
;Splints and the bone. 3diy, Those muscles which arise above
and are inserted below the fracture, tend, by their contraction,
to keep the fractured surfaces from separating from each
other, as long as the soft parts remain entire.

It has been said that, while the muscular fibres which sur¬
round the fracture preserve their attachment at the seat of
injury, they tend to prevent displacement of the fractured
ends; but suppose they are torn through, and the fracture is
quite loose, will the support which they and the other soft
parts give to the fracture, as a medium between the splints
and the bone, be sufficient to secure the fragments from lateral
derangement — especially if the fracture is oblique .f* Cer-
, tainly not. What, then, will become of the third retentive
power, derived from the contraction of the muscles, which
arise above and are inserted below the fractured part ^ This
power, as soon as transverse displacement is effected, instead
of retainins: the fractured ends in contact, causes them to
ride ; and if this is not prevented, deformity is the conse¬
quence.

But it is not the lateral displacement of the fractured ends,
and the consequent displacement in the longitudinal direction

Mn Amesbiiry on Fractures. 229

only, that demand oiir attention : we must guard against
angular displacement; by which 1 mean such a position of the
extreme ends of the fractured bone as causes an angle to be
formed at the seat of fracture: we must also guard against
rotatory motion, which may be occasioned by an impetus
given to the limb below the fractured part. Our business is
to prevent every kind of derangement, whether lateral, longi¬
tudinal, or angular, and thereby to prevent deformity; and
every kind of motion between the fractured surfaces, and thus
to ensure reunion. Are these indications answered by the
common sliort splints ?

In taking a general survey of what has been laid down
by some authors who have written upon this subject, we are
almost led to suppose that fractures of the humerus are unim¬
portant accidents ; that there is little to be done in the treat¬
ment ; and that the Surgeon may confidently expect a
favourable result. But I would ask the ingenuous and expe¬
rienced Surgeon the result of his observations in the treat-
ment of those cases which have come within his notice, and
which have been treated by the common means. Has he
not found it necessary to remove and repeatedly reapply his
splints during the cure? Has he not frequently, in doing
this, produced motion between the fractured surfaces of the
bone ? Has he not often found, on visiting his patient, that
his splints and bandages were loose aid disarranged? Has
he not often experienced great difficulty in keeping the frac¬
tured surfaces in apt and proper contact? Has he not occa¬
sionally found all his efforts ineffectual in preventing the
occurrence of deformity ? Has he not often noticed the cure
to be long and tedious ? Has he never met with cases in
which all his endeavours to produce a union of the bones
failed to be successful ? Then, who is there acquainted with
the treatment of fractures of the humerus, that would say
that the common means are sufficient for all the purposes
; required ? Is the prevention of deformity and non-union of
no importance to our patients? Is the frequency of their
s occurrence no stigma on our Profession ? It might be said
- that the short splints have been used, and fractures of this
« bone have generally united. So a few years ago, even in this
country, stumps were allowed to lieal by the granulating pro¬
cess ; many of them did well ; but who will deny the great
^ advantages arbing from the present plans of treatment? I
am aware that the best contrived means may be brought into
discredit by the mal-practices of the careless and unskilful ;
but the treatment of fractures of the humerus with the com¬
mon short splints cannot be supported upon principle ; nor
are they found sufficient to answ’er the indications which pre-
VOL. XX. — NO. 117. 2 H

230

Orminal Gommunications.

sent themselves, even in the hands of the most skilful Siir- ^
geons. Is it, then, enough because fractures of the simplest
kind unite without deformity — is it enough because non¬
union is met with comparatively seldom — that we should still
go on in the beaten path, and not try to avoid those modes of
practice, the results of which disgrace us daily ? I am dis¬
posed to believe, that my candid and scientific brethren will
agree with me in thinking, that here the treatment of frac¬
tures calls loudly for improvement. It is our business to
discover wherein the means we employ in the treatment of any
disease or accident fail to answer our intentions ; and to suffer
such as are discordant with the soundest principles to sink
into oblivion, and to adopt in their stead such as are more
safe and found to be more suitable.

In the treatment of fractures of the humerus, as in the
treatment of fractures of the thigh, our first object should be
to fix the whole limb so far as to prevent any motion given to
it from being felt in the situation of the fracture. In doing
this the hand should be guarded from accidental alterations in
position, though, from the great mobility of the wrist, I do
not think that slight and gentle passive motion would be at all
likely to affect a fracture of the humerus, even if it were of
the loosest kind. Flexion and extension of the fore-arm
should be prevented. The elbow-joint should be perfectly
fixed during the union of the bone.

It has been seen that the humerus is articulated to the
scapula and bones of the fore-arm by the same kinds of joints
that connect the femur to the pelvis and the tibia. Hence it
will appear, that the points of difference, in the treatment of
the fractures of these two bones, must be drawn from the dif¬
ference in their form, and from the difference in their situa¬
tion with respect to the trunk. If the inferior extremity were
attached to the scapula instead of to the pelvis, the treatment
of a fractured thigh w ould differ very little from the treatment
of a fractured liumerus.

In the treatment of a fractured humerus, the curative indi¬
cations which require to be answered by mechanical means,
are, in my humble opinion, two : — 1st, To fix the fore-arm
^and humerus at a right angle, so that any motion given to
them may have its centre in the slioulder-joint ; 2d, To pre¬
vent the fragments, when once placed right, from being de¬
ranged by the involuntary action of the muscles, or by any
accidental motion given to the limb below the frac¬

tured j^lttt. An apparatus, used for these purposes, should be
so contrived as to admit of being easily adjusted, and so as
to maintain the situation with respect to the limb in which
it is first applied, without producing more pain or incon-.

Mr. Amesbury on Fractures. ^31

venience to the patient than necessarily arises from the
proper confinement of the parts.

As no contrivance, hitherto published, that I am ac¬
quainted with, can be made to answ'er these indications, I
have invented an apparatus which appears to be calculated
to answer all the purposes for which an apparatus is required,
till th e process of union is completed.

The apparatus to wdiich I allude consists of three portions
of beech, two of which are fixed together at a right angle;
and the other is straight, and of the length of the humerus.
The two portions connected are long enough to reach from
the head of the humerus to the wnist. They are about two
inches wide, and are excavated to the depth of about a
quarter of an inch. That portion destined to lie upon the
upper arm has two straps attached to it transversely. Each
of these straps is armed with a buckle, and is long enough to
reach about three-fourths round the arm. One of the straps
is fixed to the splint close to the angle formed by the junction
of the two portions of beech ; and the other a little below
that part of the splint, which is made to lie by the side of the
tendon of the pectoralis major; and in such a way that the
buckles lie upon the splint. Another strap is fixed to that
part of the splint intended to lie upon the fore-arm, close to
the angle formed by the junction of the two pieces of beech.
Twt) studs are also placed upon this part of the splint, one in
the middle and the other near its end, for the reception of
straps destined to pass round the fore-arm. The other splint
is of the same width as tliat last described, and of a length to
reach from the head of the humerus to the lower end of the
bone. I’his splint has two leathern straps furnished with
buckles attached to it in a line transversely to the splint,
and opposite to the straps fixed upon that part of the angular
splint, which is destined to take the line of the humerus.
Each of these straps should be sufficiently long to reach about
three-fourths round the arm, and should be attached so as to
be received by the buckles placed upon the angular splint.
Th is splint is hollowed out about one-fourth of an inch at its
upper part ; and the depth of the excavation is gradually
diminished to within two inches of the low^er end, where the
splint is left quite flat.

What I have above described constitutes the whole of the
apparatus.* But, besides this apparatus, it is proper, in order
to add as much as possible to the comforts of the patient, and
to secure the fracture from every kind of derangement and

* The same apparatus admits of being applied to adult arms
of various lengths and sizes.

232

Original Communications,

motion, to make use of three other splints, which may be
made of split deal, in the common way. One of these should
be long enough to reach from the arm-pit to the inner con¬
dyle, another from the point of the shoulder to the outer
condyle, and the third from the elbow’ to the fingers.

Having now given a description of the apparatus, and
mentioned the length and number of common splints I use
with it, it remains Ibr me to show the manner in which it is to
be applied to the limb. This, in general, should not be done
till the high inflammation produced by the injury is consi¬
derably got under, which is usually in about three or four
da3fs, more or less, according to the degree of injury of the
soft parts ; but if the bones ride, or if the patient is restless,
it is proper to apply it lightly as soon as possible after the
accident.

The Surgeon should place the fore-arm so as to form a
right angle with the humerus, and then support the integu¬
ments, by means of a spiral bandage, as high as the fractured
part. This part, being nicely adjusted, should be surrounded
with strips of soap plaster, which should be drawn moderately
tight. The Surgeon having pads properly made for each
splint, should now commence the application of the appa¬
ratus, by placing the angular splint upon the fore-arm ; and
then the longest deal splint, wdth a tape extending along its
outer surface, in the ordinary way, should be placed beneath
the fore-arm and hand. This splint and the angular splint
should now be confined to the fore-arm by means of the
proper straps attached to the latter. This being done, the
fore-arm should be given to an assistant, who should keep it
at a right angle with the humerus ; and, if the fragments ride,
he should be directed to draw' down the fore-arm, w'hile the
Surgeon placed the upper part of the angular splint in a line
with the biceps muscle, and adjusts the fractured part. The
straight splint belonging to the apparatus being placed upon
the back of the arm in a line with the humerus, the assistant
should be directed to support this splint and the angular one
in their proper situation, with the fractured bone between
them. The Surgeon should then place a piece of common
splint on the inner side of the arm, so that it may extend’
from the axilla in a line W'ith the bone to the inner condyle;
and another on the outer side, extending from the point of
the shoulder to the outer condyle. The proper straps fixed
to ihe apparatus should then be carried over the splints and
buckled riioderately tight. It is advisable to place an addi¬
tional strap round the limb between these, as it assists in
keeping the splints steadily and firmly together. The arm
should now be placed in a sling extending from the elbow to

23S

Mr. Atiiesbiiry on Fractures.

the hand, and just short enough to steady the arrn comfortably
as it hangs by the side.

When the Surgeon wishes to examine the fracture, he may
do it without disturbing the fragments in the least, by^ re¬
moving the splint placed along the outer side of the arm,
while an assistant keeps the apparatus from shifting its situa¬
tion.

By this plan of treatment the parts are kept quiet in their
natural position; and thus deformity is prevented, and nature
is assisted in her efforts to consolidate the bone.

Here it might be asked, why are the splints not confined to
the scapula in the same wa}" as the apparatus for the lower
extremity is confined to the pelvis, in the treatment of fractures
of the thigh A little consideration, however, will make it
appear, that though the humerus is articulated to the, scapula
by the same kind of joint as that which connects the thighr
bone to the pelvis, it is by no means necessaij that the appa-»
ratus, described for fractures of the humerus, should be fixed
to the scapula in the treatment of a fractured arm. The
scapula is placed at a part of the body where it may be kept
at rest without any inconvenience to the patient. The situa^
lion of the scapula, therefore, may be regarded as even more
than sufficient to compensate for the loss of that support
which the thigh receives in consequence of connecting the
splints to the pelvis. Hence we may conclude, that any
connexion of the splints to the scapula may be regarded as
superfluous.

It now remains for me to substantiate the utility of the
apparatus which I have endeavoured to describe, by relating
cases, for the cure of which it has been employed. In doing
this I shall purposely refrain from mentioning any that have
, occurred in my private practice, as I have been kindly

favoured with more than sufficient for this purpose by the

Surgeons of the Borough hospitals.

? April l5th, ]82'2. — John Alefounder, setatis twenty-nine,
was admitted into Guy’s Hospital, under Sir Astley Cooper,
! for the cure of a fiactured humerus. The fracture was occa-
! sioned by a fall from a height of twenty-five feet. It was
I situated a little below the insertion of the deltoid muscle,

I and extended through the bone in a direction slightly

j oblique,

i I saw him the fourth day after the accident, and, at this
j time, the lower fragment was drawn up considerably, indi-
j eating the fracture to be of the loose kind. The fragments
I being placed in proper apposition, the apparatus was applied,
I and the man was directed to carry the arm in a sling. Three

234 Original Communicafions,

weeks after the accident the apparatus was taken off, and the
bone was found straight and firmly united.

During the cure, 1 frequently moved the limb to show the
pupils the power which the apparatus possesses in holding
the upper poition, so as to make it move simultaneously with
the lower, when llie limb is passively rolled upon the scapula.
Whenever the arm was moved, as here mentioned, the head
of the humerus could be as distinctly felt rolling upon the
scapula as if the bone were entire. The man never felt pain
in the fracture from the rotatory motion given to the limb,
nor was the process of union retarded. These circumstances
are sufficient to show, that the fractured surfaces remain at
rest when the limb is passively moved upon the scapula by
an impetus given to it below the situation of the injury.

Now,' if this be granted, it can be of little consequence
whether the impetus given to the limb be intentional or acci¬
dental, supposing it is passive, and not violently applied ; for
if the fractured surfaces are not disturbed in the one instance,
it is not to be expected that they will be in the other: there¬
fore we should infer, that the fracture is kept quiet at all
times, when the whole limb is being gently and passively
moved upon the scapula, provided that no resistance is made
to the motions of the limb by the voluntary action of its
muscles, and that the fracture is not so high up as to prevent
the splints from holding the upper fragment firmly. Hence
we should conclude, that the apparatus, b}^ keeping the frac¬
ture quiet, favours a speedy consolidation of the fragments :
and allowing this to be the case, the patient may reasonably
expect the powers of the limb will be restored to him propor-
tionably early ; and as the pain occasioned by the derange¬
ment of the broken portions is avoided, as well as that which
arises from repeated attempts to place them in their proper
situation, the cure will be effected with much less incon¬
venience than he would experience under treatment by the
common means. By this mode of treatment, too, the Sur¬
geon will be spared from that painful anxiety which arises
from the knowledge of the insecurity of the fracture, and from
the consideration that his reputation would suffer from what
it might not have been in his power to prevent — the occur¬
rence of deformity or non-union of the bone.

John Barret, setatis sixty-three, w^as admitted into St.
Thomas’s Hospital November 11th, 1822. A few hours
before his admission, he fell down four steps, and pitched
upon his elbow in the stone yard. The force of the fall pro¬
duced a fracture of the humerus, which commenced a little
above the condyles, and extended very obliquely through the

Mr. Amesbury on Fractures. Q,So

bone in a direction upward and outward. I saw him the
fourth day after the accident. Fie was then in bed, with his
limb lying upon a pillow. The lower fragment was drawn
up from two to three inches. The limb was much swollen,
and the man was suffering greatly. Short splints had been
applied, but were found ineffectual in supporting the parts in
their proper situation.

This man was under the care of Mr. Travers, who now
politely offered me the treatment of the case. Assisted by
his apprentice Mr. Dunkin, I applied the apparatus lightly,
but, at the same lime, sufficiently close to prevent the frac¬
tured ends from riding. Two days after the application of
the apparatus, the straps were tightened, and the man was
desired to leave his bed, and carry the arm in a sling.
February 2Blh, 1823, the apparatus was taken off, and the
bone vvas firmly united.

In this case, it will be observed that nearly three months •
had elapsed before the consolidation of the bone was com¬
pleted. I have selected it purposely to illustrate the effect
of motion between the fractured surfaces, in retarding the
progress of union, and to sliovv the necessity of guarding
against the voluntary action of the muscles.

This man was particularly dull of understanding, and could
not be prevailed upon to keep the limb quiet. He frequently
raised the arm by the action of the deltoid muscle, and thus
caused the fractured surfaces to rub upon each other. He
vvas frequently informed, that his omitting to comply with
directions, in this particular, would retard his cure; but it
was found he either did not comprehend or recollect the
caution. The straps were therefore drawn closer, even to a,
degree which was painful to him ; but crepitus was still pro¬
duced by the voluntary action of the muscles, though none
was felt when the limb was passively rolled upon the scapula.

1 felt convinced that union would not take place as long as
motion was continued in the fracture ; and, as reasoning was
lost upon him, 1 bound the arm to the side, so as to deprive
him of the possibility of raising it by the voluntary action
i of the muscles; and, at the same time, shortened the sling, so
I as to keep the fractured parts closely applied to each other.

I After persevering in this plan for three weeks, I w^as happy
i to find ilmt it had perfectly succeeded. The extreme points
j of the fractured ends could be felt when the fracture was
! united, and it was ascertained that the obliquity was. above
I one inch and three quarters.

I Sarah Cooke, setatis sixty-two, much troubled with rheu-
j matic gout, was admitted into St. Thomas’s Hospital February
! 11th, 1823, under the care of Mr. Green. She had a trans-

236 Of io'inal (lommunicatiom*

verse fracture of the humerus about mid-way between the
insertion of the deltoid and the head of the bone, and a
transverse fracture of the olecranooi Neither of the fractures
was attended with any considerable laceration of the soft
parts. The fracture of the humerus was easily discovered
bv rotating the lower portion, while the upper was fixed ;
and the fracture of the olecranon was equally distinct; but as
the periosteum was not torn, the fractured surfaces were not
separated from each other. Both the fractures were attended
with great tumefaction in the affected parts, which was re¬
moved by rest in the horizontal position, and cooling lotions
to the limb.

February 2ist, I saw' her, with Mr. Green, who kindly
offered me the superintendence of the case. The apparatus
was now applied, by his dresser Mr. Thomson, and she was
directed to leave her bed, and cany her arm in a sling.
March ££d, the apparatus was taken off, and the humerus
was found united, and also the olecranon, by the inter¬
position of bony matter. The callus which joined the ole¬
cranon could be distinctly felt through the integuments.

This case is interesting, inasmuch as it show's that her
habitual disease, which had greatly enlarged the joints of her
fingers, &,c. and limited their motion, did not interfere with
the process of union in the fracture ; and that the apparatus
is applicable in cases which are complicated with fracture of
the olecranon, when the periosteum remains untorn.

Several other cases of fracture of the humerus have been
treated with the apparatus above described, in Guy^s and
St. Thomas’s H ospitals, but the limits of this paper will not
allow of their insertion.

I have some observations to offer upon the effects of this
apparatus in the cure of fractures which have resisted the
common means, but these I must reserve till a future period.

From' the length of the present paper, I must also refrain
from entering into the treatment of that variety of anchylosis
which so frequently occurs after fractures extending into the
elbow-joint. But this, as I have above hinted, in conjunction
with the treatment of the same affection in the knee and
ancle-joints, is of sufficient importance to form the su
of a future communication.

Great Surrey Street, Blackfriars’ Road,

9th Aug, 1823.

Paris and Fonblanque on Medical Jurisprudence. 237

PART TI.

ANALYTICAL REVIEW.

MedicalJurisprudeuce. By J. A. Paris, M.D. F.R.S. F.L.S.
Fellow of’ the Royal College of Physicians; and J. S. M«
Fonbl ANQUE, Esq. Barrister at Law. In three volumes,
8vo. Pj7. I. 440, 472, 153, with S71 pages of Appendix.
London, 1823.

But a very few years since, the subject now before us was,
in this country, the most neglected of any connected with
medicine: it was an opprobrium to our medical literature.
But it was not the character of our literature alone which
suffered by the neglect : the Practitioner was without guides
whereby he might have been directed in a very necessary and
an important department of his duty. This duty was conse*
quently, and not un frequently, either altogether neglected, or
insufficiently and, in other respects, improperly performed.
The state of medical jurisprudence amongst us is now entirely
changed, and the works which have lately appeared may be
considered among the most classical and most interesting
connected with our Profession. So beneficial a change in the
literary study of the subject cannot fail to be followed by the
best results in the practical discharge of the duties which
relate to it; and, indeed, those results are already evident,
and they will become still more so as opportunities arise for
their appearance.

There is no department of medicine wherein works of an
approved character are so necessary as in that now before us:
being matter-of-fact productions — being founded on, and
even built of, materials derived from the direct evidence of
more than one of our senses ; furnishing "a collection of such
facts far greater than can fall to the share of individual expe¬
rience and investigation ; applying these facts, which are of
the most tangible description, to the various circumstances
and relations in which they may occur, and in which obser¬
vation has shown them to occur ; and, finally, presenting
them to our acquaintance and study, in a methodic manner,
and assisting, as occasion requires, our recollections of them
that might otherwise betray us into error and difficulty, owing

VOL. XX.— NO. 117. 2 I

^38 Analytical Review,

to the comparative infrequency of these facts as objects of
individual experience — in virtue of such qualities, works on
forensic medicine deserve a considerable portion of our regard ;
and there are few, in other branches of our science, for the
very reasons which we have now adduced, that will obtain a
more lasting reputation. But, although we put so high a^
value on works of this description, we do it with the proviso
of their possessing merits, at least, of a respectable order.

These which have lately engaged our attention have not
been deficient in the highest requisites of literary and prac¬
tical excellence ; it is for us at present to show'^ how far the
copious w'ork now before us possesses these qualities : here,
however, we must state, that our confined limits, owing to
the numerous and important papers which it w^as our duty to
insert in our Original department, and to the number of those
now before us, which it is incumbent on us to publish in our
next Number, oblige us to be succinct in our analysis of its
contents. We have also other, and equally cogent reasons,
for brevity in the present instance. The most important
topics which the present work embraces have been brought
before our readers, on various occasions, as fully and satisfac¬
torily as the limits even of the most extended reviews will
permit: we cannot, therefore, expect to excite their attention
by entering on the discussion of the same subjects, especially
as these do not admit of much difference of opinion, and as the
majority of them are founded on accredited evidence and
acknowledged principles of science. Those topics, indeed,
which do admit of the greatest contrariety of opinion — and
some of them are of the first importance in forensic medicine,
both as respects the individuals more immediately concerned
and the professional reputation of the medical witness, have
been fully examined by us, when reviewing the work of M.
Capuron on Law Medicine as it relates to Midwifery; and other
departments of the subject now before us have come under
consideration in preceding Volumes of the Repository, to
which we shall occasionally refer our readers.

After a well-written and an ingenious introduction, in which
the history of medieal jurisprudence is succinctly detailed,
and the plan of the work commented on, the authors enter
upon the Jirst part of the three into which it is divided : this
part comprehends an enumeration of the different medical
corporations, with an account of their charters, powers, and
privileges, together with the subjects of medical police. The
second part embraces all those subjects connected with medical
evidence, as applicable to civil and ecclesiastical suits : in
this part the order of the subject corresponds wdth that of the
progress of human life from infancy to old age. The third

Paris and Fonblanque on Medical Jurisprudence, 239

contains the inquiries which are necessary to medical evi¬
dence, as applicable to criminal cases. Thus the part
comprises the most material questions relating to Medical
Police ; the second and third those which belong to Forensic
Medicine.

Part I. Of the College of Physicians. — The authors
have devoted upwards of fifty closely printed pages to an
account of thi^ learned body, and of the policy which it has
thought proper to adopt towards its licentiates and others.
The attack which has been made at this place, by implica¬
tion, on the character of the licentiates collectively, we are^
from various considerations, by no means surprised at ob¬
serving; we even expect, nay hope to see it repeated, if not
from the same quarter, at least from some other which may
be as justly considered to be the organ of the College, as
the authors seem to be on this occasion. We consider it no
small evil, that individuals, whose terms and opportunities of
education have been as long, as legitimate, and as complete
in every point of view, whether a literary, a philosophical, or
a medical education, be contemplated, as any one of those
who consider themselves their superiors ; individuals who
have studied under the direction of the first masters of the
age in these departments of human science ; who have after¬
wards visited other countries, in order practically to extend
their views of science; and who, setting themselves down in
the metropolis in order to reap the fruits of their studies, are,
in the first instance, debarred from the immunities and
honours to which they are, from these attainments, entitled,
and are afterwards even subjected to the supercilious con¬
tumely of some who are their inferiors in literature and
science, merely because these attainments have not been
acquired at Oxford or Cambridge : — These are the grounds
on which we consider the present attack an evil, and we wish
it to be repeated, because we believe that, in this age and
country, the knowledge of, and repetition of, an evil, will lead
to its removal : — Ex vipera theriacum,’’ is a proverb of no
very limited application.

The College of Physicians confine admission to a fellowship
to graduates of Oxford and Cambridge, and the authors argue
in support of the justice of such a limitation, on the tacit as¬
sumption that these universities are the only sources of know¬
ledge, and all their inferences betray the sophistry arising from
this postulatum. The arguments which they have adduced,
when stript of their sophisms, amount to nothing more than
what any one will readily grant, who is possessed of requisite
information, namely, to the propriety, and even necessity of a
liberal education in the higher walks of physic. To this we
cordially concede, for we are so thoroughly convinced of the

240, Analytical Revieiv.

advantages of <a classical and philosophical course of study,
in an university of reputation, as the best introduction to the
study of medicine, and as the best guardian of the dignity and
public consideration of the medical character, that we con¬
sider the completion of a regular and satisfactory course of
literary and philosophical studies, before that of medicine be
commenced,' as an. indispensable requisite to medical honours.
But, is there any one who is acquainted with the state of know¬
ledge in the different universities of the united kingdom, or
\vho has had opportunities of viewing it in relation to the
condition of learning and science in other countries of Europe,
and who, at the same time, is unbiassed by the various
idolatries, from which the most cultivated and most enlarged
minds are alone free who will conclude, with our authors,
that Oxford and Cambridge are the only sources whence a due
knowledge of ancient and modern learning may be obtained ? *
According to the present policy of the College of Physi¬
cians, its licentiates are subjected to various indignities,

* For some very excellent reflexions, on the subject of the British
and foreign universities, we refer our readers to Gibbon^s Miscellane-
ous Works, volume first, from page 26 to page 41, orig. edit, and to
the works of Dr. Adarn Smith.

t As an instance of the unsuitableness of the bye-laws of the
College to the present stale of knowledge, we may mention that any
individual who, after having acquired the rudiments of education
necessary to an entrance at College, has devoted four years to the
study of literature and philosophy, in the University of Edinburgh,
and afterwards as many to that of medicine and of the sciences on
which it is founded, as well as of those with which it holds relation,
and who has there acquired a degree, after a residence of eight
years, after a most rigid examination, and after other trials on pre¬
scribed subjects ; during which eight years, his terms of study have
averaged eight months in every year; vvho afterwards has enlarged
his views of disease by observing the practice of the metropolis ; who
subsequently has visited foreign countries in order to extend his
knowledge ; and who, lastly, has determined on exercising his pro¬
fessional knowledge, thus legitimately acquired, in the metropolis, as
offering the best field for Exertion after so long and so expensive a
course of study, and, in pursuance of this determination, has applied
to be admitted a member of the College - — any individual thus
initiated in science, receives for answer, that he can only be allowed
the examination appointed for the admission of a licentiate; and
ahhough his education is more complete than can be obtained at
either Oxford or Cambridge, he is treated as an inferior after being
thus admitted, and finds the combined influence of the fellows of the
College directed against his endeavours to obtain celebrity in his Pro¬
fession by legitimate means : — “ Hie cum horainibus non cum diis
agitur,’^ is a fact which he is often obliged to acknowledge. Happily
such anindividual is consoled for the contuniely to which he is occu-

Paris and Fonblanque on Medical Jurisprudence. 241

howeyer great their opportunities of acquiring knowledge
may have been, or however much their acquirements may be
acknowledged. Some of these may be gathered from the
observations which the authors have thought it necessary to
make in the work before us, to which we refer our readers.
But, as we consider that both sides, of the question ought to
be heard, and as our limits prevent us from going into its
merits, we beg leave also to refer our readers to the well-
known letter of J3r. Wells, and to a paper on the same subject
published in the Edinburgh Medical Journal for October^
1820, to which latter we consider the observations of the
authors in the light of an official reply. If this surmise be
correct, we congratulate the author of that paper on the
superiority of his arguments ; for, although they may be con¬
sidered as having been replied to^ they have not been an¬
swered. And if they could not be answered by the authors,
notwithstanding the learning and science which characterize
them, we despair of others being more successful in the
attempt.

We have every reason to believe that, in consequence of
the licentiates looking on their privileges with indifference,
and even with spiritless apathy, the fellows of the College
have considered it proper to treat them in all things as if they
did not belong to the College at all.

in the work now before us, we find the authors asserting
and attempting to prove — with what success we cannot at
present show — that the licentiates are not members of the
College : indeed, they treat this unfortunate class of Physi¬
cians with much less ceremony than the Surgeons and Apo¬
thecaries. We thought that the Surgeons, at least, would not
have escaped so easily, for we believe that they practise more
as Physicians than as Surgeons : — we recommend them, how¬
ever, always to consult fellows of the College when they bring
themselves into difficulties, as a matter of sound policy; but

J still to go on and prosper; and thus the obnoxious licentiates
will be placed, as it were, between tw'o fires. Honesta
oratio est;’’* * and such the licentiates find it, to their cost.

' The authors tell us that we are not members of the College.

' We call ourselves a member, as may be seen on the cover of
this Journal, and we thought that it could not be disputed.

sionally subjected, by the following observation of Montaigne: —
; “ C’est le prix de I’espee que vous cherchez, non de la gaine. II le

I fault iuger par luy mesme, non par ses atours: et, comme diet tres-
plaisamment un ancien: ‘ S^avez vous pourquoy vous festimez
grand ? Vous y comptez la haulteur de ses patins/ La base n’est
pas de la statue.’* — f Mont. lib. i, cb. 42, p. 87* Desoer s Edit.)

* Simo in the Andria, Act I. sc. 1.

^ 1 I

<242 / Analytical Review.

until they told us the contrary : — they must excuse us for
thinking so still. For without referring to as long, and as
legitimate terms, and as extensive opportunities of education
as any fellow of the College can adduce — which, however,
goes for nothing in a licentiate — we are simple enough to
consider that admission according to prescribed forms and
examinations, and after payment of the usual fees, is sufficient
to constitute a member, although we have perfect knowledge
that all these do not make us a fellow. If the governing
part of the College do not consider its licentiates to be
members, why does it oblige members of the Surgeons* and
of the Apothecaries' Corporations to disfranchise themselves
from these before they undergo the forms of admission at the
College ? When we have been honoured with the forms of
admission into any corporate body, after observing the ap¬
pointed requisites to admission, we naturally consider our¬
selves members of that body ; and we even would think that
any person who should seriously assert, with an eye to our¬
selves individually, that we are not a member, notwithstand¬
ing these observances, intended little less than to insult us.
We do not say, or even think, that the authors, in the excess of
their zeal for the College, had any such intention : but let them
place themselves in our situation : — If they were, we are con¬
fident that they would repel, with becoming spirit — and be
the first, as well as the most able to do so — every encroach¬
ment on what they considered their rights, and every attack,
even by implication, made upon their professional character.

We spoke of encroachments ; — can the authors deny that
the licentiates have not suffered from them ? Was not the
College formerly in the habit of summoning the licentiates to
the comitia majora ? Were not the licentiates formerly
indulged with the show, although the substance was more or
less withheld, of constituting a part of the College ? Does
not the influence which the fellows exert, as a body, in order
to have one of themselves appointed to fill each vacancy in
an hospital as it occurs, as well as to exclude a licentiate
from every appointment of honour or emolument, real evils,
under which this class of Physicians labour? Are not these
evils greatly on the increase, as well as others which we think
unnecessary to mention ? Indeed, we should not be asto¬
nished were we to see, within a very short period from the
present, the licentiates entirely excluded, by the laws of the
public institutions themselves, from the possibility of admis¬
sion, even as candidates for the office of Physician to them.
These are the grounds on which we mention encroachments ;
and we should not have noticed them, did we not actually
believe what the authors have thought proper to state, as the
prelude to others of no small importance.

Paris and Ftmblanque on Medical Juruprudence, 243

We, however, console ourselves that under even the worst
System, the well-educated Physician, who is also prudent and
industrious in his profession, will attain considerable eminence;
although to do so will require extraordinary exertion: but as
difficulties present themselves, those manifestations of intellect
will be brought into exercise, which are the most necessary to
professional celebrity : and consequently, although these dif¬
ficulties may retard his advancement for a time, his elevation
wdll not be the less certain, nor the less secure. It therefore,
in our opinion, remains a question, AVhether as much good
does not resoilt to the individuals who are thus aggrieved,
from the very obstacles which are placed in their way to
eminence, as would follow from a more liberal policy ? In
the meanwhile, the man of learning can ill brook any sort
of indignity, whether it be real or constructive. His sen¬
sibility is seldom obtuse, unless it be from a repetition of this
species of suffering ; and, although he may repine but little
at the sacrifice of his prospects, as far as his professional
emoluments are concerned, still he feels not the less acutely
the contumely to which he is subjected : — Gravius contu-
meliam ferimus quam detrimentum.”

Thus far we have spoken with reference to the policy
which the College has thought proper to adopt. We have
done so, because we consider ourselves, although but humble
journalists, bound, by the duty which we owe the Profession
in that capacity, to speak our sentiments without reserve,
when matters of high import to the Profession and to the
community come legitimately before us, and when we con¬
sider that those sentiments tend to promote the interests of
both. As journalists, we by no means think lightly of our
influence, but we only wish to exert it in the cause of truth.
To the promotion of that end, it seems to us proper that we
should add a few words, with stricter reference to the licen¬
tiates themselves.

The College enacts that no one shall present himself in
order to become a licentiate unless he has obtained a degree,
after two years’ study at an university, and we believe that
any university will not answer the purpose. This is suffi¬
ciently easy, if nothing be looked to by the applicant but the
bare fulfilment of this injunction : and here we consider that
the College makes more than double amends, by the latitude
which it gives to the admission of licentiates, for the narrowed
grounds of admission to a fellowship. But even these qua¬
lifications — although one would suppose that no Physician
could be a Physician and be devoid of them — are not unfre-
quently disregarded ; and even this insufficient period of
study at an university, which period ought at least to be

244 Analytical Review,

twice as long, is not observed on the part of some
who obtain admission as licentiates. We verily believe
tliat the College is not aware, at the time, of the deceit
which is practised upon them, as their law is fulfilled
by the production of certificates of actual attendance. But
we have sufficient reason to know, that in several instances
such certificates are obtained after little more than forty-eight
hours having been passed at the places whence they are pro¬
cured. This cannot fail of coming to the knowledge of the
College, when it is too late to be remedied in respect to the
individual thus admitted; and it can as little fail of lowering
the respectability of these individuals, and of reflecting upon
the licentiates, as a body, in the eyes of the fellows whose
education has been regular and expensive. No one can have
any reason to censure the College for want of liberality in the
admission of licentiates, or for unfairness in the examinations
to which they are subjected. Were we disposed to find
fault, we would blame the College for not exacting from
them a longer and a more regular course cf study, at an
university of reputation; for the facile manner in which the
half-educated may become licentiates, with a little previous
preparation, is a cause, and, we think, an increasing cause, of
the very little consideration with which this class of Physi¬
cians is treated ; and, although those who thus obtain admis¬
sion are comparatively few, still the deception — for we
can call it no better — which is practised upon the College by
that few, becomes a serious evil to those amongst the licentiates
who, from the attention wffiich they have paid to their educa¬
tion, deserve equal consideration with the fellows themselves.

But this is not only the cause of the little regard which
the licentiates receive as a body; it is also the source of
disunion amongst themselves. Those amongst this respectable
class of Physicians who possess influence, do not exert it on
occasions when they legitimately ought, as when the influ¬
ence of the fellows of the College is combined against a
licentiate, in order to obtain the office of Physician to an
hospital for one of their own number. What is the reason
of this disunion? Do not many of the ' licentiates who
have attained eminence consider, owing to the causes just
pointed out, that the merely being a licentiate carries but
small recommendation with it? Are not others averse from
acting in any thing which, even by construction, should tend
to disoblige a fellow — expecting that, in the fulness of time,
they shall be elevated to the same rank in the College ? Do
they actually suppose that men of sense will be seduced, by
the spiritless meannesses of which they thereby become guilty,
to make them their associates? We leave those licentiates

Paris and Fonblanque o// Medical Jurisprudence. 245'

<vho thus act, or who, in any other respect, lower the dignity
of the medical character, to answer those questions from their
ow'u experience. They, doubtless, know the bliss of ‘‘ hope
deferred;’’ for notwithstanding its reputed misery, deferred
hope implies a desired object; and pleasure, they well know,
and no doubt feel, results from the zeal with which the object
of desire is prosecuted, even although it be prosecuted vvith
all obsequiousness and humility, and under all the contumel}’’
to which obsequiousness is deservedly subject — therefore
they, even in this way, may be happy. But their hope is
not merely deferred — ^it is seldom gratified, and if at all
gratified, it is only in such a manner as to lead them, who thus
aspire, to crawl more lowly for its attainment. The mind that
has onCe stooped below its proper dignity will stoop again
and again, and each time still lower — yet hoping that the

rewards of former servilities mav not be lost. Notwithstand-

•/

ing its delusiveness, the hope is, to minds thus constituted, a
pleasure, and even the last w'hich disappointment destroys —
excite but this desire, and, in spite of experience, its victims
hope on till death. There w^e leave them to that peace which
their aspiring submissiveness never endangered, and to that
oblivion which their nameless existence cannot arrest.

The Physician of sense, of education, and of sound medical
knowledge — whether a fellow or a licentiate of the College,
will sooner or later find out that, although he has many diffi¬
culties to contend with in the present state of medical prac¬
tice in the metropolis, these qualities are alone substantial —
that these alone will eventually carry him to eminence ; and
he will as certainly discover (what Montaigne has already
expressed with characteristic terseness), that, although colle¬
giate honours are the pedestal, they are not the statiie. — We
pass on to other topics — we have to thank our authors for
the one now dismissed. — That spirit is worse than poor
which will calmly submit even to a constructive indig-
nity.

Our authors next give an account of the other corporate
medical bodies, after which they notice the exemptions and
liabilities of medical Practitioners. With respect to actions
by Practitioners, although a Physician cannot maintain an
action for fees, yet pro consilio impenso et impendendo is a good
and valuable consideration for an annuity,’’ which was formerly
a very frequent mode of remuneration. If a bond, bill, or
note, be given for medical attendance, the consideration would
be good, though the original fees could not have been reco¬
vered.” If there be any promise, a Physician may receive a
quantum meruit. All Physicians may practise' surgery
(32 Hen. VIII.); though Surgeons may not ericroabh in

VOL. XX. — MO. 117. 2 k

£46 Analytical Review*

physic and a Physician, when practising surgery, may sue
and recover as a Surgeon.

Practitioners are liable to damages in an action of trespass
on the case, if they undertake the cure of any wound or dis¬
ease, and if, by neglect or ignorance, the party is not cured, or
suffers materially in his health. A Surgeon or Apothecary is
also responsible for the negligence and unskilfulness of his
apprentice or servant. Similar actions would be maintainable
against Physicians; ‘‘ but as internal injuries are less demon¬
strable than external, there might be some difficulty in ob¬
taining the necessar}?^ evidence.’’

On the subject of midwifery ^ the authors inform us, that
there is some probability that both the College of Physicians
and the College of Surgeons will decline all future inter¬
ference with this branch.” We are sorry to hear it; for if
the practice of this department be not interfered with by the
Legislature in an effective and enlightened manner, we shall
have a wider avenue opened to irregular practice, not only in
this branch of medicine, but in every other, than has yet
tended to seduce uneducated and self-sufficient charlatans to
invade the medical Profession. Females, even the well-
informed of them, are but little able to judge of the character
of Accoucheurs but from vulgar report or private recom¬
mendation ; and either the one or the other may be as effi¬
cient in the favour of the empiric as in that of the man of
science. The female, also, who would entrust the former in
so important a duty, will not hesitate to employ him in other
departments of practice, if he choose to desire it, and, whether
he desire it not, his opinion, in cases purely medical, will be
often requested. The ignorant are seldom devoid of pre¬
sumption; and the hopes of success and of emolument will
generally be found greatly to outweigh every alarm for the
fate of a patient, and every fear of exposure which such indi¬
viduals are capable of entertaining.

We now arrive at two very interesting chapters, namely,

of the preservation of public health,” including remarks on
the burial of the dead, and of quarantine, lazarettoes, and
other establishments of plague police” Of these we cannot
convey a satisfactory idea within our limits ; we therefore
refer our readers to this part of the w'ork, where they will
have reason to be satisfied with the authors’ learning and
abilities.

Under the latter of these heads they propose the following
questions : —

I. ‘‘Are all epidemic fevers contagious ?’' This question
seems to be answered by the authors, by allowing that epi¬
demics are frequently contagious, although not necessarily so.

Paris and FonbJanque on MedicalJurispnidence. 247

II. Does the matter of contagion require the aid of a
certain state of the air (^pestilential constitution of the
atmosphere’) to give effect to its powers and propagation;
and to what causes are the decline and cessation of a con¬
tagious pestilence to be attributed ?” This question is an¬
swered, after referring to the opinions and observations of
various writers, by considering the singular career which a
pestilential epidemic runs, having a beginning, height, and
decline,” to be explained only on the idea of the pestilential
constitution of the air undergoing corresponding changes;
and it is probable that the return of a plague is a revival of
infection that has been latent or dormant, until a particular
state of atmosphere rouses it to action.”

III. Can filth and animal putrefaction generate conta¬
gion ?” The authors do not state with sufficient precision
whether they conceive that these causes are alone productive
of contagion, or whether an additional cause, the pestilential
or epidemic constitution of the air, is also required to its
generation.

IV. Can a fever, produced by fatigue, unwholesome
food, &c. be rendered contagious in its career by animal filth,
impure air, &c. This is answered in the affirmative. While
we allow the justice of the answer, we may contend that,
although a fever thus produced may become contagious to a
lew, who, owing to particular states of predisposition, are
obnoxious to it, still the contagion will not extend far, unless
the state of the atmosphere be favourable to its propagation.

Some important observations and suggestions conclude
this part of the work, under the heads, medical police^ ^ and

hills of mortality

Part IL — Having considered the charters, statutes, laws,
and privileges, of the several medical bodies corporate, and
taken a view of the prominent subjects relating to public
heakli, the authors enter upon the second part of the work,

' which may be viewed as the first part relating to forensic
medicine^ according to the strict meaning of the term. In
this part they follow that arrangement “ which is afforded by
; a natural and immutable scale, — the life and propagation of
< the human species, from its commencement to its close.”

This part of the work is very appropriately prefaced with
remarks on medical evidence: these are judicious, and calcu¬
lated to be useful to all classes of Practitioners. Here we
shall detach a few passages from this important chapter : —

“ It has been supposed that medical Practitioners may avail them¬
selves of the privilege of legal advisers, and that they are not bound to
divulge the secrets of their patients, reposed in them in the course of
professional confidence ; undoubtedly this confidence ought not to be

248 Analytical Review.

violated on any ordinary occasion, but when the ends of justice abso- >
lately require the disclosure, there is no doubt that the medical wit^
ness is not only bound, but compellable to give evidence; ever bear¬
ing in mind that the examination should not be carried further than
may be relevant to the point in question ; of this the court will judge,
and protect the witness accordingly.” — I. p. l60.

As to the mode in which a medical witness should deliver his
evidence, very different advice appears to have been given by dif¬
ferent authorities ; while some, impatient of delay, and dreading the
arts of exaUiination, recommend their pupils or readers to open at
once all the stores of their reasoning and information ; others, fearing
the effect which cross-examination may have on nervous or embar¬
rassed witnesses, advise that no more shall be disclosed than categori¬
cally meets the question of the counsel ; and to this vve incline, with
this difference, that, as we should deem too costive a retention of truth
as blameable as the flow of garrulity with which we have sometimes
seen a court overwhelmed, we recommend the witness to steer a
middle course, first answering patiently, distinctly, and tersely, the
questions put by the counsel on both sides, the court, and the jury ;
and if none of these elicit the whole truth, and any material point
remains to be disclosed, the presiding judge will always admit and
gratefully receive the additions or explanations which may be neces¬
sary to the ends of justice.” . “ Notes, if taken upon the spot

or immediately after a transaction, may be used by a witness to
refresh his memory ; and as to dates, numbers, or quantities, it is
generally expedient to have them; the notes should be original, not
copies ; if there be any point in them which the witness does not
recollect, except that he finds it there, such point is not evidence, for
the notes are only to assist recollection, not convey information.”

“ The witness must relate only that which he himself has seen or
observed ; that which he has heard from others is not evidence as
coming from him ; except, indeed, where some expressions or de¬
clarations of the parties concerned have become a part of the res
gesta ; but the declarations of a dying man are evidence when related
by a third person on oath, though the party making them was not
sw'orn ; for the law presumes that the solemnity of the occasion may
dispense with the form, and that a man, trembling on the brink of
eternity, will never risk salvation by falsehood. To give this weight
to a declaration, it is necessary that the party should believe himself
to be dying; Mr. Justice Bailey is reported to have said that the
party must be satisfied that recovery was impossible: we think that
the reporter must have been mistaken ; for such a rule would exclude
all such declarations; hope is the latest faculty of the mind. ‘ I am
better,’ has not unfrequently been the last articulation of expiring
nature.” — I. pp. lb3 — 165.

The witness should bear in mind, under circumstances in
which he may be possibly placed, that he is not bound to
give any evidence by which he may render himself liable to
any criminal prosecution.

Paris and Foablanque on Medicdl Jnrisprudetice. 249

Marriage^ being a necessary preliminary to the propagation
of our species, according to, our civil and religious institutions,
is the next subject which is taken into consideration, as far
as it is connected with medical science. At this place the
authors chiefly confine themselves to the investigation of the
capacity of individuah to contract marriage in respect of age^
mental endoiomenty and corporeal fitness : the question of con-
sanguinity is also noticed. For the details respecting these
matters, as regards their legal bearings, we must refer our
readers to the work. After some observations on divorce^ or
nullity of marriage, the authors discuss various questions
connected with the foregoing subjects,” and elucidate them
by physiological researches.” At this place, agesj especially
that of puberty, are first considered, at great, and, we think,
unnecessary length. .Impotence and sterility are next exa¬
mined, as regards both sexes, under the separate heads of
organic, functional, and moral causes. These topics are fully
discussed, as respects their physiological and pathological
relations; but, although these relations are important and ne¬
cessary sources of information to the legal student, yet as they
contain merely a satisfactory digest of what is, or ought to
be, well known to our medical readers, we cannot devote
our pages to their consideration.

The next subjects at which we arrive, and which naturally
enough arise out of the foregoing, are, the legitimacy of
children, supposititious children, tenant to the courtesy^ of mon¬
sters and hermaphrodites. These topics are first individually
considered, in their legal relations; they afterwards become
the subjects of physiological illustrations ; and here the
authors commence with the history of conception and utero-
gestation. Of course, the phenomena characterizing and con¬
nected with these states, are familiar to our readers.

Parturition is the next matter of investigation ; and under
this head we have several questions of great import in law-
medicine proposed for our consideration. The first of these
is, Whether a woman can be delivered during a state of
insensibility, and remain unconscious of the event?” This
question is answered by admitting the possibility of the occur¬
rence, and by referring to two instances of the kind which
are on record. — The second question — How far the term
of utero-gestation can be shortened, to be compatible with
the life (viahilite) of the offspring?” and the following —
Whether to any, and to what probable extent, the natural
term of utero-gestation can be protracted?” — have been
answered in our review of Capuron ^ on Legal Medicine-, as

* London Medical Repository, Numbers for January, Fe¬
bruary and March, 1823. See the Number of January, p. 63.

250

Analytical Revieto,

it relates to Midwifery. The views which our authors take
of these subjects are similar to those which we have there
entertained.

The fourth question proposed is — What is the value of
those signs by which we seek to establish the fact of a recent
delivery Here we must refer our readers either to the
work, where they will find this topic satisfactorily discussed,
or to the review of Capuron"^ just noticed. We must also
refer to the same sources for answers to the following
queries: — ‘‘5. Are there any, and what diseases, wdiose
effects may be mistaken for the traces of a recent delivery
— 6. Can we determine by any signs whether a woman has

ever borne a child, although at a period remote from that of
the examination?’’ — ‘‘ 7* What are the earliest and latest
periods of life, at which women are capable of child-bear¬
ing ?” — ** 8. What is the possible number of children that
can be produced at one birth?” These questions will readily
be answered — as far as they can be answ'ered, by our readers.
The next, however, will not admit of so speed3^ a solution : —
Is superfcetation possible ; and under what circumstances, and
at what period of gestation, can a second conception take
place ?” The authors have bestowed considerable learning and
research upon this subject. In answer to this much controverted
point, they quote the opinion of Kannegeiser, with which they
coincide: — De superfcetationis existentia rationis quippe
principiis, atque infinitis hominum et brutorum exemplis
abunde comprobatu, medicis atque jurisconsultis mens vix
amplius haeret in ambiguo.” They next refer to the case re¬
corded by Dr. Maton in the fourth volume of the Transactions
of the College of Physicians. This case was related to Dr.
Maton by the husband of the lady, who may be considered to
be the next person to a medical man capable of forming a
correct opinion on the subject. In this instance, the one child
was born nearly eleven weeks before the other, and lived nine
days : now, although it was large and well formed, it may
have been a six months’ child ; and, consequently, the case
has only proved the coexistence of separate ova in the womb ;
unless, indeed, we believe the husband’s opinion, that both
foetuses were full grown.

We gave, in that part of our preceding historical sketch
which related to midwifery an account of a well-authenti¬
cated case, which may seem to some to support the affirma¬
tive of this much discussed question ; but it, like the majority
of instances of the same kind upon record, admits of more
than one explanation; and it is even doubtful how far the

* See Medical Repository for January 1823, p. 62.

t Ibid, for February 1823, p. 110.

Paris and Fonblanque on Medical Jurisprudence. 251

explanation which we gave in that case, and which appeared
to be the most obviously deducible from it, goes to support
the occurrences which are essential to constitute a case of
superfcetation in the opinion of the medical jurist. — We
should bear in mind, what several physiologists have con¬
tended for, in the consideration of this topic, that, as instances
of a double uterus are occasionally met with, so the pheno¬
menon may be referred to such a conformation.

The authors next propose the following questions, which
our readers will find no difficulty in answering: — What
are the causes of abortion.^ — Under what circumstances,
and by what means, is it morally, legally, and medically
proper, to induce premature labour? — What circumstances
will justify the Caesarian operation, and of what value is the^
section of the symphysis pubis, or Sigaultian operation ?’’

After some observations on extra-uterine conception^ and
respecting hermaphrodites , they next advance to the very
important part of their work which relates to mental aliena¬
tion.

The law of this country, as it respects idiots and lunatics,
is first discussed at this place, after which, the acts that regard
lunatic asylums are noticed. This latter subject is one which
suggests abundant materials for speculation. There is, how¬
ever, one consideration which is left us, namely, that it is
possible for these establishments to be placed under worse
superintendence than they are at present ; and we so far
coincide with the authors, as to consider the appointment of
a permanent officer, in order to execute the duties now per¬
formed by the commissioners chosen by the College of Phy¬
sicians, to be by no means a satisfactory provision ; and as;
little do we think it just, that, in this country, and in the
present advanced state of scientific knowledge, the choice of
commissioners should be confined to one particular class of
the Physicians of the metropolis.

Medical and Physiological Illustrations of Insanity’^
follow the legal consideration of this topic. After an account
of the different forms of insanity, the authors state the follow¬
ing questions, to which the attention of the medical witness
should be directed during his intercourse with an insane
patient : —

“ 1. Whether the person be actually insane? and what are the
proofs of his derangement?

“ 2. Whether the symptoms are of such a nature as to suffer the
individual, with propriety, to retain his liberty, and enjoy his pro¬
perty ?

3. Whether there has been any lucid interval, and of what dura¬
tion ?

25^ Analytical Review.

4. Whether there is a probable chance of recovery ; and in case
of convalescence, whether the cure is likely to be permanent?” —

I. p. 317.

It is obvious that we cannot, wdtbin our limits, enter into
the authors’ illustrations of these matters ; we must, there¬
fore, refer our readers to the work, or to former Volumes of
the Repository, where they will find them discussed under
reviews of the recent productions which treat of medical
jurisprudence as it relates to insanity.*

We next arrive at a very interesting chapter respecting
nuisances f legally, medically, and chemically considered.’' This
subject is treated of under four distinct heads : the first em¬
braces those nuisances, ‘‘ during whose operation gaseous
effluvia, the products of putrefaction, ox fermentation, escape
into the atmosphere, and are either noxious from their effects
Upon animals, or insufferable from the noisomeness of their
smell.” The second includes those, where, by the action of
fire, various principles are evolved, and diffused in the form of
vapour or gas ; the inhalation of which is not only disagree¬
able to the senses, but injurious to the health.” The third
relates to those which are capable of yielding waste liquids,
that poison the neighbouring springs and streams : dot fourth,
those trades, whose pursuit is necessarily accompanied with
great noises.

The authors devote a chapter to impositions, including
under this head feigned diseases and the adulteration of food.
On the former of these topics they observe, after stating the
several objects, for the accomplishment of which persons are
induced to simulate the existence of disease, that, whenever
suspicions are excited with respect to the sincerity of a
patient’s account, the Practitioner should always endeavour
to conceal them, and should become himself a dissembler ;

for while the impostor is persuaded that the medical at¬
tendant is his dupe, he wdll be the less on his guard; he
should then be desired to describe with minuteness every
symptom and circumstance of his malady.” Few impostors
will be able to withstand such interrogatories, if properly put,
without tripping. The authors illustrate this by a suitable
example. “ A girl of seventeen counterfeited epilepsy so

* See the reviews of Dr. Haslams work on Medical Jurisprudence,
as it relates to Insanity, in the London Medical Repository,
Vol. IX. p. 473; — of Dr. Malts work on Forensic Medicine, in
Repository, Vol. XII. pp. 415 and 503 ; — of Dr. Burrows’s work
on Insanity, in Vol. XIV. p. 467, of the Repository; — and of
Dr. Gordon Smith's System of Forensic Medicine, in Vol. XVI.
p. 211, of the Repository.

Paris and Fonblanque on Medical Jurisprudence, 253

well in the general hospital at Montpellier, as to elude
all siis[)icion ; until M. de Sauvages, being less credulous,
asked her whether she had not felt an air pass from the hand
to the shoulder, and from the shoulder to the thigh, when,
upon her replying in the affirmative, he ordered her to be
whipped, after which she never had any return of the dis¬
ease/’ The previous character, habits, constitution, and
former complaints of the suspected person, should be taken
into consideration; and the probable reasons which he may
have for practising the deception. The circumstance of his
taking the remedies ordered him with alacrity and regularity,
or that of his neglecting the medicines provided for him,
ought to have weight in the opinion which we may form.
If these modes of investigation fail, others of a severer kind
may be practised : such as, low diet, fasting, the affusions of
cold water, blistering, the actual cautery, and, above all, a
continued nausea from the administration of divided doses of
tartarized antimony.

Insanity, somnolency, syncope, epilepsy, hysteria, shaking
palsy, fever, dropsy, jaundice, haemopthysis, vomiting of
blood, bloody urine, incontinence of urine, gravel and stone,
alvine concretions, abstinence from food, deafness and dumb¬
ness, blindness, ophthalmia, ulcers, hernia, are enumerated as
the diseases more usually counterfeited, and they are indi¬
vidually considered in relation to the modes best calculated
for their detection.

The law of this country, as respects policies of insurance
on lives and survivorships, is clearly stated, at the conclusion
of this part of the work, which, upon the whole, contains a
very satisfactory view of the topics which it embraces; the
notes are copious, and the illustrations classical and interest¬
ing. The medical reader will, with sufficient reason,’ consider
some of the physiological illustrations unnecessary, and others
; too tedious ; but the authors have addressed themselves
j equally to readers of the legal profession ; and, therefore, they
seem to have considered that many topics connected with that
^ view of their subject ought, on this Account, to be more fully
i developed than otherwise was requisite. Whether a similar
1 idea will be entertained by readers belonging to this profes-
i sion, with respect to the numerous cases which are quoted or
,j referred to, we shall not pretend to say^ The authors have
j doubtless felt,, better than we can describe, the difficulties
attendant on an attempt to satisfy, in a single work, however
voluminous or well-executed, the wishes and expectations of
I the two learned bodies for which they have written — and,
I notwithstanding those difficulties, written so well : • illustra-
< tions which are useful, and even necessary, to one class of
: VOL. XX. - NO. 117. 2L

254 'Foreign Medical Science and FUerature*

readers, are disregarded and thought superfluous by the
other; and ihe very endeavours which are thus made to
attain excellence and to meet the wishes of all, place the
results beyond the reach of some, or render them unsuitable
to the exigencies of others. This is, however, more frequently
the fault of publishers than of authors; and in the present
instance we attribute it to the former entirely. But we
recommend the trade to remember the fable of the dog that
saw his shadow in crossing a brook, and not to forget the
moral — qubd cupidus magis damno aflicitur.”*

PART III.

— —

ANALYSIS OF FOREIGN PUBLICATIONS

IN THE DIFFERENT BRANCHES OF MEDICAL AND
SURGICAL SCIENCE AND LITERATURE.

Obsern)ations sur quelques Cas de Developpemens rapides des Tissus
Accidentels, Par M. Andral, l ils, Membre-Adjoint de I’Aca-
d^mie Royale de Medecine.

Observations on some Cases of rapid Development of the Adventitious
Tissues. By M. Andral, Jun. &c.t

Although the following cases are not of any interest in a thera¬
peutical point of view, yet as tending to improve our knowledge of
pathology, they are of very considerable importance. In general, the
different adventitious tissues are slowly developed and characterized
by symptoms of a chronic disease; occasionally, however, they spring
up and increase with astonishing rapidity, and occasion an acute
affection. The cases which we are about to relate were collected in
the clinical ward of M. Lerminier at La CharitCy by the same indefa¬
tigable observer whose excellent paper on the Pathological Anatomy
of the Digestive Tube we communicated at length in our last Volume.

Case Cancer of the {Stomach terminating fatally thirty -seven

days after the appearance of the first symptoms. — A man, aged forty
years, was admitted into the Hospital La CharitOy in the month of
January, 1822, labouring under acute rheumatism. Although he
had been subject for a long period to rheumatic pains, he enjoyed an
excellent state of health: his digestive functions had never been
deranged. Being convalescent at the end of a fortnight, he procured

* We are obliged to defer the review of the third part of this work,
and other reviews with which we are in arrear, to our next and future
Numbers. >

t Archives Centrales de Medecine, Juin 1823.

M. Andral on the Development of Jd'oenlitious Tissues. 255

iood beyond the quantity that was allowed him, which' occasioned
considerable dyspepsia. The following days the gastric symptoms
continued, and indicated the invasion of a more serious disease : he
vomited the emollient drinks and broths which were given to him ; he
complained of a pain at the epigastrium, which was so much exas¬
perated at intervals as to compel him to cry out. The remainder of
the abdomen was soft and indolent; the pulse accelerated; the skin
hot and dry ; the tongue of a natural appearance; the features of the
face were considerably altered. The epigastrium was covered with
leeches, and emollient and anodyne fomentations were applied. The
symptoms, however, continued ; and on the third day from their
invasion, the patient had already fallen into a state of marasmus : he
then began to experience frequent acid eructations. Towards the
twenty-fifth day he vomited, for the first time, a great quantity of
dark-coloured matter, similar to soot: this vomiting recurred on the
following days : the pain at the epigastrium became more and more
violent: the marasmus had soon reached its last stage : the pale face
assumed a cadaverous appearance: the pulse acquired more and
more frequency, and death took place on the thirty-seventh day.
Blisters, applied both to the epigastrium and the pelvic extremities,
were productive of no more advantage than the local blood-letting
practised at the commencement.

Dissection. — From the internal surface of the stomach near the
pylorus, a fungiform tumour projected of the size of an egg, present¬
ing all the characters of the enccphaloid tissue, in a soft state: at its
base, the tumour implicated the parietes of the stomach, which, to the
extent of five or six fingers’ breadth in every direction, had acquired
six or seven times their ordinary thickness. In certain parts these
parietes consisted only of a bluish white tissue, covered with an
infinite number of small cavities filled with a fluid of a gelatinous
appearance — (scirrhous tissue in a crude and softened state.) In
other })laces a dull white tissue was observable, furrowed by a multi¬
tude of reddish striae, and e.xcavated here and there by small san¬
guineous extravasations — (encephaloid tissue in a crude and softened
state.)

The remainder of the mucous coat of the stomach was not sensibly
altered. The other organs w'ere healthy.

This case furnishes a very striking example of a cancer of the
stomach, commencing, becoming developed, and terminating in death,
in less than five weeks. A simple deviation in regimen appears to
have been the occasional cause : the rapid increase of an adventitious
tissue, the severity of the pain, the complete want of alimentation,
sufficiently explain the intensity of the symptoms and the rapidity of
the death. It is worthy of remark, that in this case no symptoms of
typhoid fever were present. The tongue, in particular, was scarcely
changed from its natural condition : this depended on the mucous
membrane of the stomach being affected secondarily, the cancer
having been primitively developed in the subjacent cellular tissue.

Case 2d. Cancerous tumour of the liver arising and termmating
fatally in three •weeks, — A foreign merchant, about forty-five years

256 Foreign Medical Science and literature.

of age, had several times been the subject of intermittent fever: he
had enjoyed, however, from the age of forty, a perfect state of health.
In the course of the month of April, 1820, he felt some slight pains
immediately beneath the cartilaginous edge of the right false ribs :
towards the end of this month symptoms of jaundice showed them-
selves : at this time he was admitted into La Charite. When we saw
him, he had no fever: his appetite was very good, and the digestive
functions appeared unatfected ; except that, as in the majority of
cases of jaundice, the stools were colourless, and the urine of an
orange red : the right hypochondrium was soft and indolent. He
was ordered whey, with acetate of potass, and calomel and soap in
the form of pill. On the 2d of May, the pain in the right hypo¬
chondrium recurred, and continued on the following days: fever
supervened, and the hypochondrium became tense, as if occupied by
a tumefied liver. Leeches were applied to the hypochondrium.

On the 9th of May, we began to feel, immediately beneath the
edge of the ribs, to the right of the epigastrium, a globular, im¬
moveable tumour, which was very painful when slightly pressed
upon. He was ordered a narcotic cataplasm.

From the 9th to the loth, this tumour had acquired a considerable
development : it became evident to the sight ; and by the side of it
several other small, unequal, and painful tumours soon manifested
themselves.

From the 15th to the 20th, these tumours extended behind the
cartilages of the ribs, which they forcibly raised up ; at the same
time, the patient began to vomit his drinks, three or four hours after
having taken them : the fever was continued, with a violent exacer¬
bation every evening, during which the pains in the hypochondrium
became lancinating: the disease now proceeded with a terrifying
rapidity : on the 20th he had reached the last stage of marasmus and
debility : on the 21st he died.

Dissection. — The liver, which was large, passed beyond the edge
of the ribs to the extent of four fingers’ breadth. On its convex sur¬
face several tumours, formed by a mixture of encephaloid, scir¬
rhous, and tuberculous tissues, still in a state of crudity, projected.
These tumours extended somewhat deeply into the interior of the
viscus : between them, the tissue of the liver was, however, perfectly
sound.

Some tumours of the same nature surrounded and compressed the
ductus hepaticLis and ductus choledochus, as w^ell as the pyloric
extremity of the stomach.

It is, doubtless, possible that the tumours of the liver and of the
gastro-hepalic omentum might have existed for many years. Obser¬
vation proves, that similar tumours, so long as they are small, not
numerous, and in a crude state, are not incompatible with the healthy
state; but what we wish at present especially to notice, is the ex¬
treme rapidity of their increase, and the promptly fatal accidents
resulting from them. The jaundice, in all probability, began to
manifest itself at the period when the cancerous tumours, in becoming
developed, compressed the biliary ducts ; the vomitings, which super-

M. Andral on the Developme7it of Adventitious Tissues. 257

vened in the latter periods, are also naturally explained by the multi¬
plication of these tumours around the pylorus. ^

I Case 3d. Cancerous tumour of the great epiploony developed and
1 proving fatal in the space of Jive weeks. — An old soldier, aged fifty-
one, entered into the Hospital La Charite in the course of the month
of September, 1820: he complained of having felt, for eight days,
somewhat severe pain around the umbilicus: there was some little
fever: the stools were natural: the appearance of the tongue as in
the ordinary state. The true nature of this pain it was difficult to
discover. He was ordered tisanes and emollient fomentations, with
low diet.

The ne.xt day, the 20th, the abdominal pain was more intense, and
augmented on slight pressure : the face was altered ; the pulse fre¬
quent and small. The inflammation of the peritoneum had become
more evident. Thirty leeches were ordered to the abdomen. On
the 21st, there was a sensible amelioration of the symptoms. On the
22d, tension of the abdomen, somewhat severe pain, obscure fluc¬
tuation. Thirty more leeches were applied.

On the following day, the abdominal pains had become moderated,
and the fever was slight; but the abdomen became much tumefied:
the fluctuation, however, was not manifest, and it was doubtful
whether this rapid tumefaction might not depend on peritoneal effu¬
sion: the dull sound which the abdomen gave on percussion did not
allow of its being referred to the develooment of flatus in the intes-
tines. From the 30th of September, an irregularly rounded, very
moveable tumour, was recognized, extending from the umbilicus to
near the pubes. In the first days of the month of October, this
tumour became more and more evident; and it could soon be traced
into the right iliac region and into the flank of the same side : at this
part it was extremely irregular on its surface, and was more painful
than around the umbilicus. From the 15th to the 20th of October,
the pain became violent : each morning we discovered the tumours
sensibly increased in size since the preceding evening; they extended
a little above the umbilicus and into the right flank. On the 20fh,
delirium and convulsions came on : he died in the course of the day.

Dissection. — The umbilical region, the two flanks, the hypogas-
' trium, and both iliac fossa?, were occupied by a tumour attached,
above, to the colic edge of the stomach, and concealed below by the
os pubis, beneath which bone it extended.

< Detached from the stomach, and turned downwards, the arch of
i the colon, to which it adhered; the small intestines, covered with
i membraniform exudations; the coecum ; and the two portions —

i ascending and descending- — of the colon, might be successively

: observed.

I The situation of this tumour, its direction, and its connexion, did
j not suffer us to doubt its belonging to the omentum. It was of a
j remarkable hardness, very thick, rugous, and knotty on its surface:

j when cut into, it presented to us, in many parts, a bluish white tissue,

\ semi-transparent and gristly (scirrhous tissue in a crude state): in

258 Foreign Medical Science and Literature.

other places there were small cavities, occasionally of a somewhat
rounded form, sometimes oblong, and more or less anfractuous, filled
with a gelatiniform liquid: the smallest of these cavities would have
contained a pea ; the largest a great almond (scirrhous tissue in a
state of softening). Mixed with the preceding tissue, another of an
opaque white colour was every where observable, in which blood¬
vessels ramified ; these, in intersecting each other, left between them
areolee more or less irregular (encephaloid tissue in a crude state): in
two or three points only, there existed a pultaceous, reddish sub¬
stance, somewhat resembling the matter of the brain when in a state
of incipient putrefaction, and stained with blood (encephaloid tissue
in a state of softening). Finally, in some places the white colour of
the preceding tissues was mixed with a tolerably deep brown tint,
which probably indicated a commencement of melanosis.

In the midst of these different tissues, there were discovered also,
in tolerably great number, the fatty substances which commonly
exist in the healthy epiploon.

There are, I believe, but few facts in the annals of science resem¬
bling the preceding. In the space of less than five weeks, and at the
end of a somewhat slight peritonitis, a cancerous tumour invaded the
epiploon; acquired, each day, an increase sensible to the eye and to
the touch; and at last finished by lining, in some measure, almost the
whole of the anterior paries of the abdomen.

How are we to arrive at the cause of such a rapid development ?
Who is there that can explain, why, on the contrary, in other indi¬
viduals, these same adventitious tissues form, in some years, a tumour
scarcely the size of a nut ?

In this individual, the intensity of the pain and of the fever, his
frightful falling away, were in a direct ratio with the rapidity of the
development of the adventitious tissues. In the following case, which
is an example of a tumour, the increase of which was still more
rapid, we observed, on the contrar}^, neither pain nor fever; the
strength also, it will be seen, kept up very well: in both, however, it
was in the epiploon, and after peritonitis, that the tumour developed
itself : this difference of the symptoms, however, may perhaps be
explained by the difference of the tissues produced. In the third
case it was a cancerous tissue ; in the subject of the fourth the
tumour was formed by the tuberculous tissue.

Case ^th. Tuberculous tumour of the epifoon developed and ar¬
riving at an enormous volume in fourteen days. — A taylor, aged
twenty years, of a lymphatic temperament, worked and slept,
during the months of January and February, 1822, on a very damp
ground-floor. Towards the rgiiddie of February, he perceived that his
belly acquired an unusual size ; he did not experience, however, any
abdominal pain : at the same time there was emaciation of the limbs
and face. Towards the commencement of the month of March, he
had a copious diarrhoea: abdominal pain increased on pressure; loss
of appetite ; and prostration of strength. During the month of
March, the diarrhoea appeared and disappeared several times; the

M. Andral on the Development of Adventitious Tissues. ^59

size df the abdomen augmented. In the commencement of the month
of April, he was admitted into La Charite, presenting the following
state : —

Face pale; emaciation of the limbs; abdomen large — painful
only on somewhat strong pressure ; evident fluctuation ; one liquid
stool only in the twenty-four hours for several days; apyrexia;
respiration free.

The ascites was regarded by M. Lerminier as the result of a latent
inflammation of the peritoneum. To remove the phlegmasia, and
endeavour, at the same time, to procure the absorption of the effused
fluid, were the indications to be fulfilled. From the 7th to the l6th
of April, 120 leeches were applied to the abdomen or to the anus ;
bleeding to two cups (^viij.) ; emollient fomentations; barley-water,
with nitre; Dover’s powder given as a diaphoretic, in the dose of
twenty-four grains in four powders, in the twenty-four hours; broth.

Under the influence of this treatment, the ascites diminished ; the
urine became more abundant and clear : the skin was only once in a
moist state.

On the 20th, no more fluctuation could be felt ; but on pressing
the abdomen, the convolutions of the small intestines, aggregated
together into one mass, could be easily recognized ; so that the diag¬
nosis had been correct. The patient, in other respects, felt himself
well; and notwithstanding the loss of blood which he had sustained,
he declared that he felt stronger and more active than at the time of
his admission.

Nothing particular occurred during the month of April. In the
commencement of May, he walked in the garden of the hospital.
The abdomen, when strongly pressed upon, was slightly painful.

On the 7th of May, the whole of the abdomen was covered with a
large mercurial plaster.

Until the 21st, the state of the patient seemed to remain stationary :
he did not complain of any unusual pain in the abdomen ; he con¬
tinued to get up and walk about; fever, however, did not occur.
What was our astonishment, when, on the 21st, fourteen days only
after the application of the plaster, we found, on raising it up, in the
situation of the intestinal convolutions, a bulky tumour, occupying
the umbilicus, the lower part of the epigastrium, the left flank, the
hypochondrium of the same side, and which seemed to extend behind
the left false ribs! This disposition gave to the tumour a considerable
analogy to enlarged spleen. There was no cause, however, which
could account for such a rapid development of the spleen ; on the
contrary, we knew that the great omentum may quickly acquire an
enormous bulk. We knew that, when unequally developed in its
different parts, it may form tumours which have often put on the
appearance of tumours of the liver, spleen, kidneys, and even of the
uterus. Finally, the absence of fever did not seem to invalidate our
diagnosis, as in this individual an extensive peritonitis had also deve¬
loped itself, without pain and without fever.

The patient, however, persuaded that he was convalescent, was
desirous of quitting the hospital on the 1st of June.

260 Foreign Medical Science and Literature.

On the 2d of August, he returned in the most deplorable con¬
dition : after his exit, symptoms of phthisis pulmonalis had declared
themselves. The abdominal tumour had considerably augmented ; it
was hard, and covered with a considerable number of lumps. He
died four days after his admission.

Dissection. — The great omentum had acquired eight or ten times
its ordinary thickness. This augmentation of thickness was owing to
large tuberculous massea developed between the laminm of the epi¬
ploon : several had begun to become softened. The major part of
the mesenteric ganglions were also tuberculous. Behind the epiploon,
the small intestines were united together by false membranes, in the
substance of which enormous tubercles were equally developed.
Large tuberculous excavations were found in both lungs ; the other
viscera were healthy.

Let us recapitulate, in a few words, the different stages or periods
of this interesting disease.

First period. — Development of peritonitis, without pain and with¬
out fever.

Second period. — Ascites, result of the peritonitis: disappearance
of the serous effusion under the influence of copious blood-letting.

Third period. — Organization of the albuminous flakes, which, not
being absorbed like the serum, became transformed into false mem¬
branes. Adhesion of the intestines, readily distinguishable through
the abdominal parietes.

Fourth period. — Very rapid formation (in fourteen days) of tho
tuberculous tumour of the epiploon, notwithstanding his excellent
general state of health, his feeling well, the restoration of the strength,
and the complete absence of fever! The patient left the hospital in
this state : he no longer observed any regimen ; and under the influ¬
ence of the irritating causes to which he was submitted, the process
of tuberculization in the peritoneum augmented; it extended to the
lungs *. hectic fever declared itself, and he was rapidly dragged to the
grave, ,

When this young man quitted the hospital, no symptom indicated
that the lungs were diseased; and yet, in less than two months, pul¬
monary tubercles broke out, became multiplied, softened, and formed
extensive excavations.

In the following histories, divers cases of pulmonary phthisis will
be observed, which had also a very acute progress.

Acute phthisis pulmonalis. — Acute phthisis pulmonalis has already
been described by several authors. Morton has spoken of it, and
Portal has cited, in his treatise on phthisis pulmonalis, the case of
a young girl of thirteen years of age, who died of a tuberculous con¬
sumption of the lungs in the space of thirty days.

These acute consumptions present, in their symptoms, great vari¬
eties, which are important to be known as regards the diagnosis.'

In several patients, the rapid development of pulmonary tuber¬
cles is not announced by any local symptom. The cough is slight;
the expectoration wanting or purely catarrhal ; the respiration does
not appear impeded : if the chest be struck, it will be discovered to be

M. Andralew IJeveiopnieut of Adventitmus Tissues, 261

every where very sonorous; if asuscultatiou be practised, the respi¬
ration is heard every where, as in* health. There exists, however,
a continued fever, with: abundant nocturnal’ sweats ; a rapid ema¬
ciation takes place, and the patients, arriving in* a very short space
of time at the last degree of marismus, frequently die without the
derangement of the lungs having been more equally manilfested.
Dissection shows a great number of small crude tubercfes developed
in the parenchyma: of the lungs. The very healthy state of this last
part explains why percussion and auscultation gave' no* signs of
disease. The rapid? multiplication of the tubercles sufficiently
accounts both for the fever, the wasting away, and' the speedy deatli.

In other patients,, acute phthisis is announced' by truly local' symp¬
toms ; but such symptoms are not those which commonly characterise
the presence of mhercles in the lungs. We have seen individuals
who, after having for a long; time experienced a very slight cough,
were suddenly seized with a violent shivering, followed' by very
severe continued fever, with oppression and sometimes* acute pain in
some part of the thorax, particularly beneath one of the clavicres.
These symptoms are, in fact, partly those of pneumonia or pleurisy.

Amongst the individuals who have been presented before us, some
have died in a very short time, when we have discovered, either
at the top of the lung, or at its centre, a large softened tuberculous
mass, not yet, however, communicating with the bronchiae. It is
probable that in these subjects the tuberculous mass had already
existed for a long time in a state of crudity. 0n its becoming soft
depended the acuteness of the symptoms. In other individuals, the
same accidents, after having at first appeared with equal intensity,
became mitigated, and the phthisis subsequently pursued its ordinary
course.

We have seen cases where the rapid development of the granular
phthisis of Bayle has been only announced by a suffocatmn, to a
greater or less extent, by a sort of acute asthma.

The following case, which was communicated to me by' Dr^
Thibert, is a case of this sort.

Case 5th. Acute granular phthisis^ terminating fatally in less than
thirty days. — A student of medicine, usually enjoying good health,
was attacked, towards the middle of the month of March, 1822', with
slight dyspnoea, and some symptoms of plethora. Soon after this^,
diarrhoea occurred, which ceased at the end of some days ; but there
was increase of the dyspnoea and fulness of pulse: he took violent
exercise, with the intent of diminishing the plethora, to which his
unpleasant feelings were referred.

On the 29th of March, and the following days, brnmoptysis : after¬
wards fever, cough, orthopnoea, by no' means in proportion to the
trifling degree of pulmonary catarrh : pulsation of the heart strong
and full : leeches were applied to the anus on the 3d of April:
cessation of haemoptysis on the 4th : increase of oppression : lips
violet-coloured. From the 4th to the 10th of April, the major
part of the patient’s symptoms were those of diseased heart : he died
in the state of suffocation which usually characterizes that species of

VOL. XX. - NO. 1 17. M

262 Foreign Medical Science and Literature.

affection. The numerous evacuations of blood, the depletions to
which we had recourse, only afforded momentary relief.

No other lesion was discoverable than some miliary granulations,
developed in an innumerable quantity, in both lungs, and surrounded
by a tissue perfectly crepitant. .

Thirty days did not intervene in this case between the time of
the manifestation of the first morbid symptoms and of death. It
seems that the extreme rapidity with, which the granulations became
developed, did not suffer the lung to become, in some measure,
habituated to their presence. Hence the dyspneea, the intensity of
which always increasing, finall}^ produced death by asphyxia* It is
on this account that there is a very great difference, as regards the
general and local symptoms, between a pleuritic effusion, the increase
of which has taken place slowly, and that which, although less
considerable, has been effected more rapidly. It is thus also that in
consumptive individuals, the greatest part of whose pulmonary tissue
has become impermeable to the air, the respiration is, notwith^
standing, much less troubled than in those who, attacked with
acute pneumonia, have but a small part of one or both lungs
hepatized.

Finally, in other cases, phthisis pulmonalis shows itself with its
accustomed symptoms; but those succeed each other with a frightful
rapidity.

Case Gtk, Acute tubercular phthisis, terminating fatally in three
weeks. — A young man was received into La Char it e with symptoms
of slight enteritis, which quickly yielded to regimen and the use
of diluents. Until that period he had presented no symptom which
could give any susj)icion of the existence of pulmonary tubercles.
When on the point of quitting the hospital, he took cold; at the end
of some days, fever, emaciation, and alteration of the features, super¬
vened. Three weeks after the appearance of the cough, he had
colliquative sweats ; the last stage of marasmus; purulent expectora¬
tion; evident disease of the lungs, as indicated by the stethoscope
below the right clavicle. He died in the fourth week. An enormous
excavation was found in the upper lobe of the right lung. -

Case "nth. Acute tabercular phthisis, terminating fatally at the
end of five weeks. — A jeweller, aged eighteen years, had enjoyed
good health until the commencement of the month of March, 1822.
Before this period he had never had either cough or spitting of
blood, or difficulty in breathing: sometimes, however, he had felt a
pain between the left clavicle and the breast of the same side.

Towards the 6th of March, he took cold; towards the i5th of the
same month, oppression; great diminution of strength; recurrence
of the pain beneath the left clavicle ; a great number of leeches were
applied over this part, and a blister to the arm. The state of the
patient, however, became each day aggravated ; he was admitted
into La Charite on the 1st of April. At this period hectic fever,
well characterized ; purulent sputa; very strong gurgling in all the
anterior part of the hdt side of the thorax ; diarrhoea for several
days: he was ordered mucilaginous remedies. On the 1 6th of A}>!il

M. Andral on the Development of Adventitiom Tissues. 263

he (lied, about five weeks after the appearance of cough. Numerous
tubercular excavations filled the left lung.

Case Sth, Pulmonary tubercles becoming softened^ and terminating
in death, in eleven days, after having only been attended for several
years by symptoms of the Jirst stage of phthisis. — A man, aged thirty
years, presented merely, at the time of his admission into the hos¬
pital, the symptoms of a somewhat intense pulmonary catarrh. From
the age of twenty-five years, however, he had experienced several
slight attacks of haemoptysis ; there was no fever, and he was in
tolerable health. Auscultation and percussion, during the first ten
days, afforded us no instruction j at the end of that period he expec¬
torated, for the first time, streaked sputa, which appeared to us
tormed by a mixture of tuberculous matter and mucus. By aus¬
cultation we discovered a strong gurgling under the right clavicle ;
so that since the previous day, a softened tubercle appeared to have
broken into the bronchiee. The next day the characteristic expec¬
toration was abundant ; and pectoriloquism, which had replaced the
gurgling, announced that the cavity was partly empty. During the
eight following days, w'e heard successively, in several parts, a sound,
and above the principal cavity, a gurgling, which pointed out to
us the softening of other tubercles, and their communication either
with the bronchial tubes, or with the first cavity. The patient,
however, who, until this time, had preserved his embonpoint, and
his strength, fell away with a frightful rapidity, and died eleven days
after the appearance of the streaked sputa. We discovered, at the
top of the left lung, a large cavity, into which a great number of
small anfractuous cavities had just opened. ^

To this picture of acute phthisis pulmonalis we might oppose that ?
of others, remarkable for the extreme slowness of their progress, and
the mildness of their symptoms.

Thus we have proved, by necroscopy, the existence of phthisis
pulmonalis in an old man of seventy*six, who, for many years, had
coughed and frequently spit blood.

In the individual who forms the subject of the following case,
there existed a striking want of agreement between the symptoms
and the intensity of the pulmonary lesion.

Case 9th. Cavity aiinonnced by auscultation in an individual who
seemed to be merely in the first stage of phthisis. — A locksmith,
aged forty years, presented, for nearly eighteen months, the following
symptoms: slight heemoptysis every now and then, cough somewhat
intense; breathing a little short; preservation of his healthy appear¬
ance ; absence of sweats. This man never left off his laborious
employment ; he even followed it until the evening before his admis¬
sion into the hospital. At that time he was attacked with fever.
When we saw him, we discovered, by auscultation, that there existed
beneath one of the clavicles a cavity ; in this part there was a well-
marked gurgling noise.

On the 12th day after his admission, we could only hear a very
slight gurgling beneath the clavicle : after that, we were no longer
able to distinguish it. But in this same part the very strong

264 Medkid a9%d P^sicai 'lutelligetice.

respiration .imitated the sound made by a pair of bellows. The
patient coughed much less, breathed freely, , and had no more fever.

It was not long before he was discharged.

lit is presumable that in this patient, a tuberculous mass, existing
at the top .of one of the lungs, had broken down and given place,
by its evacuation through the brancbise, to the characteristic expec¬
toration which we observed on the first day. It was during this
process of breaking down that fever supervened, and the cough
became more violent. It was at this time that wo heard the gurgling.
The noise iike that of the bellows, which was heard later on, indi-
^Cated the entrance of the air into an empty cavity.

The utility of auscultation in such a case cannot be denied. ,
Without it, could we have even suspected the existence of a cavity '
.in the lung of a man, who bad only given up his 'employment a few }
days before, and who, after a short stay in the hospital, felt himself 1
s-uiSciently strong to resume his trade of locksmith ?

The scirrhous, encep, haloid, and tuberculuous, are not the only v
tksues which we have seen take on an acute march in their deve- ^
dopment. We have observed also cartilaginous and osseous incrus- -
tations invade, with equal rapidity^ Jilie mitral and aortic valves : :
feence the symptoms of a truly acute aneurism of the heart.

in another article we shall communicate some cases of this kind. *

- , PART IF.

MEDICAL AND PHYSICAL
INTELLIGENCE:

BRITISH AND FOREIGN,

S' ■

L On the Presence of the Hydro-Cyanate of Iron in Urine. JBy fi

Dr. Julia.

A gentleman of the sanguine temperament, • aged eighty-two, was ip//
attacked with an acute disease of the urinary passages. He had pre- ;(iq
viously enjoyed perfect health. The urine which he evacuated on the tjfl
second day of his disease was of a deep blue colour ; it frothed on i)
agitation, was glutinous, and deposited filaments of the same blue colour, fo
Dr. Sernin, who attended this gentleman, being desirous to learn the tfj
cause of this colour, sent the urine which the patient evacuated on 4
waking in the morning to M. Julia, for the purpose of analysis. This ^1
chemist ascertained, Ist, that this urine contained very little urea; 2d,
that it was charged with albumen and gelatin; 3d, that the blue colour jjol
arose from the presence of the hydro-cyanate of iron, probably in the form ipo
of a triple salt with soda. It remains to discover the cause to which this dj
salt was indebted for its solubility in the urine. M. Julia does not pretend
to explain this phenomenon; he rests satisfied with stating the fact.—
Archives Grfni. Mai 1823. -i- !

Monthli/ Bibliography. Q65

n. On the Efficacy of the Injection of the Volatile Alkali in suppressed
Menstruation. By Dr. Lavagna, jun.

M. Lavagna has published fourteen cases of araenorrhoea, in which in¬
jections into the vagina, with ten or twelve drops of this alkali in two
-spoonfuls of warm milk, and repeated several times in the day, have
uniformly procured a return of the menstrual flux in the space of five or
■six days at the farthest, and sometimes at the end of twenty-four hours.
M. L. informs us that it uniformly caused all the concomitant symptoms in
the obstructed state to disappear, and was equally successful in every habit
of body, and in every temperament and constitution. He observes, that in
general this injection produced a more or less disagreeable, and sometimes
even a painful sensation in the vagina, according to the relation existing
* between the quantity of the alkali and the sensibility of the parts ; but in
no instance did he observe any unpleasant effects from its use. — Annali
Universali di Medicina, Milano^ 18^3.

III. Case in which blue Urine teas voided during Enteritis.

M. Jules Cloquet gave an account, at one of the late sittings of the Royal
Academy of Medicine at Paris,of.a child, thirteen years old, that discharged,
for three successive days, during the worst stage of enteritis, urine of a pure
blue colour, depositing a sediment of the same colour, and giving a fine
indigo colour to paper immersed in it. The urine was sent to M. Pelletan,
for the purpose of analysis. A member of the Academy saw a similar
appearance of the urine in a patient afflicted with the acute rheumatism. —
Rev. Med. Julpf 1823.,

IV. On the Treatment of the Bite of the Viper.

Professor Paletta, of Milan, in several cases of injury inflicted by the
coluber berus of Pleuk, wherein the patients were nearly moribund, from
sinking of the vital energy, employed external warmth, wine in small doses
and frequently repeated, a diaphoretic tisan with the volatile alkali, and
the external application of the same alkali to the bitten part, with complete
success in ^very instance, — Annali Universali di Med.

MONTHLY MEDICAL BIBLIOGRAPHY.

BRITISH.

Anatomical and Physiological Commentaries. By Herbert Mayo,
Surgeon and Lecturer in Anatomy. Number II. July 1823. Pp. 141,
with seven lithographic plates.

This and the former numbers 'Of Mr. Mayo’s commentaries contain a
condensed translation of Reil’s essays on the Stucture of the Brain. Mr. M.
has accompanied his translation with numerous engravings and references —
the whole cannot fail of being most acceptable to the anatomical student.
Mr. Mayo concludes this part -of his commentaries v\dth some interesting
remarks upon the spinal chord and the nervous system generally. The
other commentaries which this number contains, are — on the cerebral
nerves, with reference to sensation and voluntary motion ; on the structure
oS horn, hoof, and cuticle ; on local action ; remarks in defence of the
Hunterian theory of absorption ; and an examination of a body soon after
parturition ; these original articles will come under notice on a future occasioa.

FOREIGN.

Petit Manuel d’Anatomde Descriptive ; ou, Description Succincte
de Tous les Organes de THomme. Par A. L. J. Bayle, D. M. P,
Prix 5 fr. Paris, 1823. Gabon and Co.

This little manual is written with great care and method, and must be of
considerable use to the advanced student or practitioner, for the pur, pose of

26f) Literary Jntelligeme, 8)C.

recaHini^ to liis mind the important points of anatomical science wlhch mhy
have escaped his memory.

WORKS RECEIVED FOR REVIEW.

I. Lectures on the Operative Surgery of the Eye: being the Substance of
that part of the Author’s Course of Lectures on the Principles and Practice
of Surgery which relates to the Diseases of that Organ : published for the
purpose of assisting in bringing the Management of these Complaints within
the principles which regulate the Practice of Surgery in general. By G. J.
Guthrie, Deputy Inspector of Hospitals, Surgeon to the Royal Westminster
Infirmary for Diseases of the Eye, &c. &c. 8vo. with Plates. Pp. xxvii.
517. Burgess and Hill. London, 1823.

II. Anatomical and Physiological Commentaries. By Herbert Mayo,
Surgeon and Lecturer on Anatomy. No. 11. July 1823. With Plates, ovo.
Pp. 141. Underwoods. 1823.

IH. Anatomical Diagrams of Obstruse Parts of the Human Body. No. I.
Bv G. D. D.ermott, M.R.C.S. 4to. Burgess and Kill. London, 1823.

LITERARY INTELLIGENCE.

In the press, and speedily will be published, a Translation of “ Magendie’s
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mens,'’ with copious Notes, and an Introduction. By Mr. Haden, Surgeon
to the Chelsea and Brompton Dispensary.

Preparing for publication. Outlines of Midwifery ; developing its Principles
and Practice. By J. T. Conquest, M.D. F.L.S. Member of the Royal College
of Physicians, &:c. &g. The Third Edition, enlarged, &c. &c.

Dr. Powder has in great forwardness a Second Edition of his Treatise on
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368

THE METEOROLOGICAL JOURNAL^

From the \^th of JTIIjYy to tht. ^Oth of AUGUST) ^

^ - By Messrs^ HARRIS and Go.

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NOTICE TO CORRESPONDENTS.

Communications have been received from Mr. Ward, Mr. King, and
Mr. Blackett; these,, as well as others which have been acknowledged,
will be published in our earliest Numbers.

— - — -

Commiinicalions are requested to be addressed (post paid) to
Messrs. T. and G. UNDERWOOD,^32, Fleet Streets

THE

LONDON MEDICAL

No. 118. OCTOBER 1, 1823. Vol. XX.

PART I.

ORIGINAL COMMUNICATIONS.

Observations in Practical Pathology , No. IX. — Illustrations
of Rupture in the Vena Cava, with Cases and disquisitive
Remarks. By James Kennedy, M.D. of Glasgow.

Rupture^ of the vena cava is one of those fatal lesions
to which, from their ultimate effects being instantaneous,
their situation inaccessible, and their diagnostic symptoms
uncertain, the resources of therapeutic science will never be
successfully opposed. Nevertheless, as a contribution to the
anatomy of morbid structure, it may not be unprofitable to
detail the circumstances of’ two cases of this kind — one of
the thoracic and another of the abdominal vena cava — which
at different periods have come under my observation. At
the same time, and with the object of making the Re-
posiTORAT a repository of the principal facts which distin¬
guish this irremediable accident, it is proposed to collect, in
the form of analytical gleanings, such instances of its occur-

* Rupture. — This epithet, in defect of one more appropriate, is
employed throughout the present essay to denote any opening of the
vena cava which permits sudden extravasation of the sanguineous
fluid, whether the lesion be consummated by perforation, erosion, or
laceration of the vessels’ tubular coats. — K.

VOL. XX. — NO. 118. 2 N

£70 Original Communuations.

rence as are scattered over the pages oF pathological history.
My inducement to extend, in this manner, the object of the
present sketch beyond a detail of two particular cases, has
arisen out of the circumstance of rupture of the vena cava
having hitherto passed nearly unnoticed by the cultivators of
British medical science : — it has obtained no description in
Dr. Baillie’s excellent work ^ on Morbid Anatomy, and is
only cursorily noticed in Mr. Hodgson’s treatise ‘f on the
Diseases of the Heart and Vascular Svstems, where a con-”
densed review of one of Portal’s sketches stands alone (p. 520),,
in testimony of the author’s acquaintance with such injuries
of this important vein.

There might be advantage in distributing these observa¬
tions under a twofold classification — those which illustrate
rupture of the vena cava without complication, and those
wherein there had been rupture of that vessel accompanied
with other modifications of organic disease. As the essay,
however, is more distinguished by an historical than a prac¬
tical character, a chronological arrangement of the facts has
been preferred. This, therefore, gives occasion to begin
with the doctrines of Aretseus, whose heroic practice in acute
maladies was altogether original and excellent, and will bear,
without eclipse, a comparison with that inculcated by the
highest authority in modern times.

I. Aretaeus has particularized rupture of the vena cava J
as a fact familiar to his knowledge, and an object of his own
observation. He regards this and every other vein as being
susceptible of becoming the seat of all kinds of acute and
violent diseases. His symptomatology, indeed, and manage¬
ment of the phlebitic state, have not been improved by the
latest and best writers on venous inflammation. With
characteristic, but elegant conciseness, he describes certain
affections of the vein denominated kedmata,\\ in which san-

^ The Morbid Anatomy of some of the most important Parts of
the Human Body. By Matthew Baillie, M.D. F.R.S. L. & E. and
E.R.C.P.L. 8 VO. Third edition. London, 1807.

t A Treatise on the Diseases of Arteries and Veins ; containing the
Pathology and Treatment of Aneurisms and Wounded Arteries. By
Joseph Elodgson, F.R.C.L. 8vo, London, 1815.

J APETAIOT KAIiriAAOKOT Airiov >c.oc,i "Evijj^Btav xat

X^oviuu HocQcoi/, KE<I). V], nczr^ r^v KoiAjjy o^sivjq vovj-qv,

Cura Hermann! Boerhaave, M.D. Folio. Lugd. Bat. 1735. P. 20.

II Ks^[j(.izrcx, appears to me to be a term almost, if not altogether,
peculiar to Grecian pathology. Its etymology and determinate sig¬
nification are involved in much obscurity. On the former it is not
for me to speculate ; and I willingly resign it as an object of research
to others more conversant than myself with the niceties of Hellenic

271

Dr. Kennedy on Rapture of the Vena Cava.

guineous effusion, from rupture of the vessel, occasions
sudden death. When the rupture has place within the
th orax, the blood gets into the lungs, and is evacuated by
the wind-pipe and mouth : when it occurs in the abdomen,
and near the vessel’s origin (in primeval anatomy, fxzv

yap (pX£i^oi; f(^co(ng hvrap, the root of the vena cava is the
liver”), the extravasated fluid enters the alimentary canal and
fills its tube, without being seen.

Morgagni, who was more conversant with the intricacies
of anatomical research than with the subtleties of philology,
declines examining whether Aretaeus, by the term kedmata,
had reference to dilatation of the vein from obstruction of the
blood’s course, or to some other form of vascular disease.
He admits, however, that the Cappadocian Physician does
speak of the rupture of this vessel, but regards the statement
as a conjecture rather than an inductive doctrine. Now this
is not altogether fair ; for, when a reputable author pro¬
nounces any circumstance to be a fact, we ought surely to
allow' Jiim credit for having known it to be a fact, from what¬
ever source, or by whatever mode of investigation, that know¬
ledge may have been derived. The following is not the lan¬
guage of conjecture : — iars ^Y\yvufjL£VY\ ai/xoppayln umaTa kteivsi’’
— quando sanguinis, ex ejus ( vence cavce ) ruptione, prqfusio
citissimh mortem infert — hemorrhage from rupture of the
vena cava produces instant death.”

The illustrious Pavian anatomist also finds difficulty in
accounting for the blood, in case of the thoracic vena cava
being ruptured, escaping through the lungs, the trachea, and
the mouth. Non apparet maf he says,* quam ex ilia

literature. The latter promises more congenial matter for disquisi¬
tion ; but a foot-note is not the place for discussing subjects of
such intricacy. When Hippocrates employs the word, I understand
him as implying reference, generally^ to a strumous condition of the
joints and inguinal glands, particularly , to some modification of

the ischiadic disease. Aretseus extends its application : he describes,
with laconic preciseness, the ultimate effects of on vascular

structure. With each of these venerable personages, the kedmatous
state seems to be one of disorganization consecutive to a defluxion of
acrid humours on the part, exciting inflammation, with its natural
results — suppuration, ulceration, erosion. In the text, we find it
recognized as being precursory to disruption of a venous tube. The
reader will perhaps see testimony favourable to this understanding of
the word in Epist. LI 11. art. 37? of Morgagni’s unrivalled

work, and in the observations of Puerarius, Doleeus, Brown, Lancisi,
De Haen, Doubleday, and Portal, as they are exhibited in the present
essay.

* Epist. XXVI. art. 28.

27^ Original Communications,

disruptd sanguinem in pulmones asperamque, unde effluat, ar-
teriam deducat — it is not evident how the blood from that
disruptured vessel should find its way into the lungs and
trachea, out of which it flows. My own mind, at least, is
satisfied that Aretseus, on this occasion, is describing rupture
of the vena cava consequent to kedmata, or ulcerative erosion
of that vessel. Now, such erosion may either commence in
the vein itself or in the contiguous structures, and be com¬
pleted by the usual processes of textural disorganization.
There is not, indeed, a large space of the vein exposed to be
brought into this kind of morbid relation with the organs of
respiration ; but when we know that more than two inches of
the vena cava superior, and nearly an inch and a half of the
inferior, stand in near apposition to a corresponding portion
of the lung, we shall not find difficulty in admitting the
possihility of inflammation, adhesion, and ulceration, extend¬
ing their ravages from a small point of the vein or lung, so as
to implicate many of the surrounding parts. By this means,
whether the disease originates in the vascular or pulmonary
organ, erosion of either or of both may be effected ; and the
necessary result of such a lesion must be a rapid extra¬
vasation of blood into the air-cells of the lung, and its
ultimate effusion through the wind-pipe, determining the pa¬
tient’s death.

II. Jac. Sylvius* dissected a person who fell from a
height. On the abdomen being opened, a great quantity of
blood flowed out, which had been effused from a rupture of
the vena cava. The liver was large, pale, tender, and fragile,
like one that had been boiled.

III. Marcellus Donatus f quotes a case, from i\matus Lusi-
tanus, of a man who, “ ex frequenti uxoris super se in re
venerea decubitu, quae corpulenti et vasii corporis erat, in

* This case is quoted from Bonet (III. p. 731), who mentions it.
I have referred to the Basil edition of the works of Sylvius, but
I have not been able to find it by the assistance of its imperfect
index; and his works are too voluminous and too diffuse for a deli¬
berate research within the period to which my avocations con¬
fine me.

t This case is also quoted by Bonet (HI. p. 371). Morgagni
(Vol. II. p. 281), however, says he cannot find it in any of the works
of Amatus. 1 have examined the works of Amatus Lusitanus, and
am also unable to find it; but, on referring again to Donatus, from
whom the above case, wdth the cause of its supervention, is taken, it
seems evident that it is not quoted from any of the common editions
of his works, but from a contribution to some one of the academical
collection of papers which were published about the middle or con¬
clusion of the sixteenth century.

27S

Dr. Kennedy on Rupture of the Vena Cava.

venae cavae ruptiiram incidit, et derepente omni sanguine
extravenato, mortuus

Joannes Riolanus't presents us with the following remark,
which shows that rupture of this vessel had fallen under his
observation: — Aretaeus writes that the vena cava is sus¬
ceptible of inflammation, and by this cause of suffering dis¬
ruption. Tliis I have seen happen. The trunk of the vena
cava cannot sustain dilatation so long as the circulation of the
blood is unobstructed ; nor is it affected with varices, as is
often the case with the veins of the lower extremities.’’

IV. Exclusively of its importance as a pathological report,
the following case will obtain consideration from the circum¬
stance of Vesalius having been consulted on the treatment,
and pronounced an opinion on the nature of the disease,
which the dissection in all respects confirmed. Two histories
of it are on record — one by Adolphus Occo, J the patient’s
original attendant; the other by John Udalric Riimler, |[
whose co-operation W'as required. From the latter the symp¬
tomatology is taken : the former is preferred for its descrip¬
tion of the appearances after death. Achilles Gassar § made
the necrotomy.

Leonard Welser, a gentleman of Augsburgh, sustained a
violent concussion in managing a restive horse, and in conse¬
quence became ill of an obstinate malady, distinguished in
chief by excruciating pain in the dorsal region. On its
resisting all the medicines exhibited by his Physicians, the
advice of Vesalius, who then taught anatomy at Brussels, was
solicited. This illustrious man instantly recognised the ma¬
nifestations of aortal aneurism, and foretold its fatal issue.
Immediately on discovering a small tumour pulsating from
under the dorsal spine, he declared it to be an aneurism from
dilatation of the aortal artery ; and that being produced by
concussion, it was incurable. At the same time, he stated,
that he had seen such a disease in the neck, the chest, the
ham, and the arm — that it always occasions excruciating

■* Marcelli Donati Ilist. Med. Mirab, ; opus varia lectione re-
fectiini. 4to. Venetiis, 1597* Lib. IV. cap. ix. p. 125.

t Encheiridium Anatomicum et Pathologicum ^ Joanne Riolano,
Filio. 8vo. Lugd. Batav. 1649. Lib. II. cap. xxvii. p. 143.

X Adolphus Occo : Epistola Medica ; extat in Libro Consiliorum
Medicinaiium singulare quern edidit Laurentius Scholzius. Folio.
Francofurti, 1598.

11 Johannes Udalricus Rumlerus : Miscellanea, Observationes,
Consilia Medicinalia, et Epistolae. Obs. 81. 4to. Ulmee, 1676.

§ Achilles Pirminius Gassar: Collectanea Practica et Experimenta
Propria. 4to. Ulmse, l67fi.

274 Original Communicatiom.

distress, and, in the end, sideration^ — -that it is irremediable,
unless the part can he excised — that these aneurisms fre¬
quently contain a concrete fluid resembling ice or the crys¬
talline humour, sometimes coagulated blood, or (“ molam^') a
polypous substance — that, during life, the aneurismal blood
remains fluid ; after death, it is black and siderated — -that the
patients die, suffering exquisite pain — and that sometimes
vascular dilatations form spontaneously ; sometimes they are
determined by an exciting cause, as in the present instance.

Getting impatient under his distresses, which had resisted
all sorts of medicine during two years, the sufferer ultimately
threw himself into the hands of an empiric, who administered
certain internal remedies cata'potid’^ the use of which

was soon followed by sanguineous expectoration and an abrupt
decease.

Dissection, June 1557. — Most of the abdominal organs
were sound ; the liver greatly enlarged, but otherwise rtatural.
The spleen seemed remarkable for its shortness : it had be¬
come semiputrid ; on its external surface were several whitish
patches. The heart was large, but undiseased : its cavities
contained much blood. In the descending aorta was a dila¬
tation three inches in size; it adhered so intimatelv to the
ribs and dorsal vertebrae as to be inseparable without lacera¬
tion. On this cyst being torn, some thin arterial blood
escaped. It contained a concrete mass, sen carniformis
materia Jihris destituta/’ enclosed in a peculiar, whitish, com¬
pact substance about eight lines thick, and resembling pre¬
pared lard in colour and consistence. Altogether the aneu-
rismai tumour was as large as an ostrich-egg. The vena cava
had sustained extraordinary? dilatation : its tube was ruptured
at the place of its contact with the aneurism, over the centre
of which the ribs were carious, and one of them ‘‘ prorsus
rnpta et J'racta — torn from its connexions and fractured.’’
Where the dorsal vertebrae were pressed by the tumour
above the diaphragm, they had become spongy, and so cor¬
roded as to be easily penetrated by the finger. They emitted

* SiDERATiox. — In ancient pathology, acT-r^o/SoXtcr/Ao? and sideratio
were synonymously employed to express the particular manifestations
determined in a living organ by the influence of some malignant star.
Palsy, apoplexy, epilepsy, and similar afiections, came in this way to
be regarded as varieties of the morbid state which the mysterious
term sidtration designated. By closely viewing the description and
concomitant symptoms of this state, however, we shall be led to
regard the epithet as having been generally used to denote the sudden
development of carious or gangrenous disorganization, in the ultimate
stage of an acute disease.

275

Dr. Kennedy on Rupture of the Ve)ia Cciva.

an intolerabl}" foetid odour. Notwithstanding the patient
expectorated blood in profusion, and even appeared to be
suffocated by extravasation of that fluid into the lungs, these
organs retained no trace of disease. The cutaneous dorsal
integuments, under which the tumour pulsated distinctly
during life, were quite livid and ecchymosed like the back of
a person on whom the beastly punishment of flogging has
been inflicted.

V. Felix Plater* relates the following case, which is in
some respects remarkable: — By an abortion in the fourth or
fifth month, a male foetus was expelled from the womb of its
parent. It had already become the subject of universal
dropsy. The subcutaneous system, over its whole body, and
even under the hairy part of its head, was distended with a
lymphatic fluid. In the fundus of the bladder was a large
aperture resembling the urachus : it terminated in the vena
cava below the kidneys, and that vein itself was “ universam
seroso sanguine refertam,’^ gorged with serous blood.

There is great reason of regret that Plater had not been
more minute in his investigation, and more circumstantial in
his description of this singular aberration from natural struc¬
ture in these important parts. If a large opening, meatus
amplusP was continuous between the cavity of the urinary
bladder and the channel of the vena cava, as the words, “ e
msicce ipsius fundoy in venam cavam desinebat,^’ seem, though
doubtfully, to imply, the subsequent proposition will arise
for solution: — Admitting demonstration of the physiological
aphorism, that the sanguineous circulation, and consequently
the processes of secretion, commence with life and the first
development of the foetal germ, what was there, in this
instance, to prevent the circumfluent blood from penetrating
into the inmost recesses of the bladder and if the secretion
of urine was at the same time proportionately active, what
was there to prevent that fluid from being commingled with
the blood, and thus, by secret but certain progression, con¬
taminating the sources of life ^ Shall we then be authorized,
by this view of the subject, in regarding the sanguis serosus^^
noted by Plater, as having rather been blood containing an
excess of urine, determined by the perpetual oozing of that
secretion into the circulating stream ? Shall we also be war¬
ranted in retracing to this phenomenon the death of the
foetus, and its premature expulsion from the uterine state

* Felicis Plateri Observationum in Hominis AfFectibus plerisque,
Corpori et Animo, Fiinctionum Lsesione, Dolore, aliave Molestia et
Viiio infensis, Libri tres. Opera Felicis Plateri Nepotis. 8vo.
Basilese, l641. Lib. III. in Partium Excretione, p. 748.

276 Original Qommunicatiom,

Vr. Jacques Aubert* * * § published the subjoined history iu
1579: it obtained a place among the pathological observa¬
tions of Schenckef in i609> and, just one hundred years
from its first appearance, was consigned in an abridged form
to the pages of Bonet’s J meritorious collection. These
writers describe it as an instance of what thev call tabes
spinea:'’ it is introduced here as a complication of venous and
arterial rupture.

A citizen of Lyons had brought himself into bad health
by habits of gluttony and drunkenness. His disease was
characterized by excruciating pain in the ium.bar region,
attended with great loss of strength and emaciation. Dale-
champ || and two other eminent Physicians were unable by
any means to relieve his distress. Overwhelmed, therefore,
with disappointment and incessant suffering, he discontinued
taking medicine altogether, and abandoned himself, in de¬
spair, to his former intemperate practices. At last, exhausted
with anguish and wretchedness, he sunk down on the threshold
of his own door, and instantly expired.

Dissection. — Each of the kidneys exhibited traces of morbid
action in their textures; two of the lumbar vertebrae were
corroded, and over them were corresponding ruptures of the
vena cava and aorta, from both of which a great quantity of
blood had been effused. The vascular lesion, which proved
fatal to this man, seems to have resulted from the excitement
of carious action during the progress of its development in
the contiguous spinal bones.

VII. Laurens, § who was Physician to Henry IV. of
France, concludes his discussion of the question Is the

* Jacobus Aubertus: Progymnasmata in Johanni Fernelii Librum
de Abdilis Rerum Naturaliura Causis. 8vo. Basileae, 1579' L^-

ercitatio XLIV.

t Joannis Schenckios : IlAPATHPHSEliN, sive Observationum
Medicarum, Rararum, Novarum, Admirabilium, et Monstrosarum,
Volumen tomis septem de toto Horaine institutum. Folio. Franco-
furti, 1609. Pp. 456, 457.

X Theophilus Bonetus: Sepulchretum, sive Anatomia Practica, ex
Cadaveribus Morbo denatis, proponens Historias et Observationes
omnium Humani Corporis Affectuum, ipsorumque Causas reconditas
revelans, cum Commentariis J. J. Mangeti, M.D. Folio. Tomis
tribus. Lugduni, 17OO. Tom. II. p. 573.

’ll Dalechamp was highly distinguished among his cotemporaries as
a physician, a botanist, and a profound scholar. Plunder has paid
an elegant and deserved tribute to his name, by conferring it on one
( Dalechampia J of the euphorbiaceous family of plants.

§ Andreas Laurentius : Historia Anatomica Humani Corporis;
et singularum ejus Partium, multis Controversiis et Observationibus

277

Dr. Kennedy on Rupture jof the Vena Cava.

heart susceptible of becoming the seat of abscesses, of suffer¬
ing solution of continuity, of enduring desperate diseases?
with the following remarkable case : — “ When I was writing
these things,’^ says he, a rare and perhaps unheard-of instance
of sudden death occurred among us. As Guicciardini, am¬
bassador of the Grand Duke of Florence at the French court,
was walking, in perfect health, with some courtiers in the
hall of the palace, and conversing familiarly with them, he
fell suddenly to the ground, breathless, pulseless, lifeless.
Some of many persons who hastened to inform the king of
this alarming event, represented the nobleman as really dead,
others as apoplectic, others as epileptic; but several did not
altogether despair of his resuscitation. By the royal orders,
Laurens repaired immediately to the spot, and found the am¬
bassador absolutely exanimate; and while many said the
cause of his death must be in the head, he was struck, indeed,
with astonishment at the accident, and declared, in the presence
of numerous bystanders, its cause to be in the heart.

Dissection. — Next day the body was inspected, when the
heart was found so prodigiously enlarged as to occupy nearly
the whole of the thorax. On the ventricles being laid open,
a profusion of blood, amounting to three or four pounds,
issued through the incision. The vena cava, at its junction
with the auricle, (“ cavce quidem vencc ostium disruptiimj
omnesque Him membramdm tricuspides laceratm,^') was ruptured,
and the tricuspid valves lacerated. The aorta, at its origin,
was enlarged lit brachii mquaret amplitudinem’^) to the size
of a man’s arm. From relaxation of all the cardiac valves

laxatis itaque ostiolis omnibus velut habenis^’), so great an
accumulation of blood had taken place in each of its ven¬
tricles utrumque sinum”), that the heart’s contraction and
expansion were prevented, and the man instantly died. —
Such, concludes Laurens, was the source of this premature
and sudden death, connected wdth which this one thing is
wonderful, that, without any determining external cause,
such as a blow or a fall, vociferation or anger, the tube of so
large a vessel should have been ruptured.

Lancisi * * regards the preceding history as being very
similar in its circumstances tarn simile qudm ovum ot;o”) to
the one related by himself, but cannot join the FVench ana¬
tomist in considering it as remarkable that the vena cava
should have been ruptured without being subjected to the

Novis illustrata. Folio. Francofurti, l603. Lib. IX. quasst. xviii.
p. 368.

* Joannes Maria Lancisi : Opera (}U£e hactenus prodierunt omnia.
4 Tom. 4to. Roma?, 1745. d’om. 1. pp. 135, 136.

VOL. XX. — NO. 118. 2 o

2-78 Original Communicafions,

influence of an external cause, for the reason of its being
consistent, as he thinks, with daily observation, that internal
causes are quite capable of determining such a result.

A remark, by Morgagni,^' on this case, is expressed in a
very particular way : it is thrown into the same sentence
with a stricture on the description given by Puerarius of the
lesions observed in the body of a gentleman, whose sufferings
were terminated by a sudden death. It is this: — But
really, when Laurens says the effusion was profuse in the
ventricles only, and does not even allude to its being present
dn the pericardium, 1 doubt, though 1 am not sure, whether
the rupture of the vena cava could have happened solel}^ in
its inner face.”

When Moroaani could discover somethino; remarkable in
Laurens omitting to mention, or even to hint at, an accumula¬
tion of extravasated blood in the pericardium, when both the
ventricles were replete with that fluid, he w^ould have exer¬
cised but small courtesy to the learned Parisian, whose
elegant and perspicuous Latinity even the father of morbid
anatomy himself might have done well to imitate, had he
made some slight endeavour to account for this silence by a
pathological explanation, rather than to depreciate the case
by confining his notice of it to the expression of an oblique
demur. More causes than one, however, might conduce to
bring these organs into the state Laurens has described.
There may be profusion of extravasated blood in the ven¬
tricles, and none in the pericardium, when that membrane
adheres intimately and universally to the external surface of
the heart. Such a state of the heart and its capsule is well
known to anatomists, and Morgagni himself-f has related
nine valuable illustrations of it from his own experience.
From the enormous enlargement of the heart in this subject,
and dilatation of the aorta within the pericardium, maintain¬
ing constant pressure of that membrane against all the cir¬
cumjacent surfaces, it was scarcely possible that the heart
could escape being almost inseparablj^ united to its capsule
by morbid adhesion. Sucli being the case, there could not
be congestion of blood in the pericardium; and, of course,
that circumstance required not to be particularized.

Extravasated blood, moreover, might be deposited, to their
repletion, in the ventricles, while the pericardium was com-

* Joannes Baptista Morgagni : De Sedibus et Causis Morborum per
Anatoraen indagatis, 4to. 4 Tom. Lovanii. Tom. II. epist. xxvi.
art. 28, p. 281.

t Epist. IV. art. ip; V. ip; Vlll. 6; XXII. 4, 10; XXIV. 11;
XXX. 7; XXXV. 12; XLIX. 4.

270

Dr. Kennedy 07i Rupture of the Vena Cava.

pletely wanting. Such an aberration from natural structure
is indeed of rare occurrence; but it has been seen and de¬
scribed by various observers.* Although such examples of
it are admitted by Bonet and Lieutaud as interesting contri¬
butions to the science of preternatural organization, they
have been doubted or denied by authors whose sentiments
will ever be regarded with reverence by the cultivators of
anatomical philosophy. Nevertheless, we are led to feel and
to lament that perfection is not an attribute of our nature,
when we find illustrious men, in their management of this
question, endeavouring, with the weakest, as well as the worst
kind of ‘‘ medical logic,’’ to repress our credence in the exist¬
ence of an entit}^ by the shadowy testimony of an assump¬
tion : — because they never saw the pericardium wanting, there¬
fore the pericardium never was wanting. Merat, J a recent
pathologist, of some distinction, has chosen thus to express
himself: — C’est cette maniere d’etre du pericarde (I’ad-
herence du pericarde an coeur), vu sans reflexion, ou par des
personnes peu instruites en anatomic, qui a fait croire que
quelquefois la sereuse du cceur manquoit; lesion qui n’a
jamais ete rencontree, si ce n’est peut-etre dans quelques
fcetus point viables : Adhesion of the pericardium to the
heart, observed without reflection, or by persons unskilled in
anatomy, has led to the belief that the serous envelope of that
organ has sometimes been wanting; a lesion which /zeue/’ had
existence, except, perhaps, in some foetuses insusceptible of
life.” — M. Merat must really have entertained a sublime idea
of his own consequence, when he expected his mere dictum
would be admitted as sufficient reason for denouncing, as the
statements of rashness or ignorance, all those reports of in¬
stances wherein the heart was found absolutely destitute of
its capsular membrane. The fact, however, is indisputable :
the authority of Dr. Baillie, though it stood alone, would put
it altogether beyond being questioned.

With the modesty of exalted genius and the simplicity of
truth itself, our British pathologist concedes all due respect

* Columbus, Bartholinus, Littre, Vaubonnais, Duvernoi, Tulpius,
Hoyer, Schenckius, Canani, Harder, Vieussens, Larrey, and Strathius,
have recorded such cases. Vide Morgagni, Tom. II. pp. 208, 20Q ;
Portal, Tom. III. p. 2; Senac, Tom. II. pp. 338, 339; and Dr.
Baillie’s paper in Transactions of a Society for the Improvement of
Medical and Surgical Knowledge, Vol. I. p. pi*

t These are Pcyer, Stulpart, Van der Wiel, Friend, Lancisi, Kaaw
]5oerhaave, Morgagni, Haller, Scnac, and Portal, in each of whose
works the author’s objections are stated.

I Dictionnaire des Sciences Mcdicales, Tom, XL. p. 3()1.

(280

Origina I Communications.

to former historians of this malformation, as well as to the
disbelievers in its reality ; and then proceeds to delineate the
characteristic features of the phenomenon,^ which seems to
have filled bis own mind with wonder and delight.

Upon opening the chest of a man about forty years of
age, Dr. Baillie was exceedingly surprised to see the naked
heart lying on the left side, and could scarcely at hrst believe
what he saw; but the circumstances were too striking to
keep him long in doubt. The heart was as bare and distinct
as it commonly appears in opening the pericardium, and
every collateral circumstance confirmed the fact.

The mediastinum consisted, as in common cases, of two
lamina?, of pleura; but it was somewhat changed in its direc¬
tion, being inclined to the right side of the chest, and lying
upon the right of the heart. Both laminm were connected
together, through the extent of the mediastinum, by the inter¬
vention of the cellular membrane, and crossed over the vena
cava superior about an inch above its entrance into the
auricle. The heart lay loose in the left cavity of the chest,
unconnected in any way except by its vessels ; was of a large
size, elongated in its shape, and had its apex opposite to the
right rib. The right auricle was obviously in view in the
same manner as when the pericardium has been opened, and
the vena cava superior and inferior w^ere clearly observed
entering into it. The appendage of the left auricle was as
clearly in view ; and when the heart was inverted, so as to
have its apex turned upw'ards, the extent of its cavity was
seen, with the two pulmonary veins of the left side entering
behind the appendage. Both its ventricles were distinct, with
the coronary vessels running upon them; and the aorta and
pulmonary artery were seen clearly emerging from them.
The heart was involved in the reflection of the pleura belong¬
ing to the left side of the chest, v;hich became its immediate
covering; and upon making the slightest incision into the
substance of the heart, its muscular structure was laid bare,
as in any common heart deprived of its pericardium. There
was no connexion between the heart and the diaphragm, but
they were entirely separate '; and the diaphragm opposite to

* As this valuable case stands in a volume now rather difficult of
access, the chief circumstances, as they regard the anatomy of the
parts, are here introduced. Some general observations and remarks
on the use of the pericardium accompany the original, which is
illustrated by a distinct and beautiful engraving. It will be found in
the Transactions of a Society for the Improvement of Medical and
Surgical Knowledge. 8vo. London, 1793. Volume I. No. 6,
pp. 91 ~ 102.

Dr. Kennedy on Rupture of the Vena Cava.

the flattened part of the heart was covered only by a reflec¬
tion of the pleura. It is well known that, in ordinary cases,
a portion of the pericardium adheres firmly to the diaphragm,
which forms a medium of connexion between it and the heart.
In adhesions, too, of the pericardium to the heart, its attach¬
ment to the diaphragm is always the same as in the ordinary
healthy structure of these parts. The apex of the heart being
lower down than usual, there was a deficiency of the left lung
corresponding to this change of situation. The phrenic nerve
of the right side ran betw'een the tw'o laminj® of tlie medi¬
astinum, near that edge of it which was applied to the right
side of the heart. The left })hrenic nerve ran between the
same two laminae of the mediastinum, almost immediately
under the sternum. This is a great deviation from its natural
course, for it commonly passes on the outside of the peri¬
cardium, following the obliquity of the left edge of the hearts
All these circumstances were seen upon simply removing the
sternum with a small portion of the ribs, and therefore put
the want of pericardium^' in this subject beyond all doubt.,
“ Did the ascertaining of this singular lusus naturod require any
other evidence than the description which we have given,^’
says Dr. B. with his characteristic modesty, it would happen
to be supported by a very large testimony, for it has been
seen by many medical gentlemen in this metropolis, who are
eminently skilled in anatomy, and by a great number of stu¬
dents, w'ho are very capable of judging.”

Vi II. Taking the doctrine, without examination, from the
Greek, Roman, and Arabian Surgeons, Marianus Sanctus T
describes, as certainly mortal quce hominem ad AcJieronta
sine viatico emigrare cogunf^), all wounds of the heart, cerebral
substance, wind-pipe, lungs, liver, gall-bladder, diaphragm,
stomach, spleen, small intestines, kidneys, and bladder ok
urine. The “ lethality’' of wounds in these organs is ad¬
mitted, and perhaps for the same reasons, by Ambrose
Par6, J who superadds to the list those of large blood-vessels

* The distinctions between adhesion of the pericardium to the heart,
and the appearances when that organ is altogether destitute of its
capsule, are stated, with great perspicuity and conciseness, by Dr.
Baillie, in his Morbid Anatomy, pp. 13, 14. Third edition. London.
1807.

t Marianus Sanctus; Compendium Chirurgicum, et Libellus de
Modo examinandi Medicos et Chirurgicos. Extant apud Uffenbachii
Thesauri Chirurgiae. Folio. Francofurti, l6l0. Pp* 871, 932.

I Ambrosius Parseus : Operum quse Latinitate donata Jacobi
Guillemeau labore ac diligentia in liicem prodicrunt. Folio. Parisiib,
1593. Extant etiam apud Uffenbachii Thes. Chir. Pp. 231, 235, 654,

Original Communications.

and the introspinal brain. Extinction of life is invariably
consecutive to a wound of the vena cava or aorta, by reason/^
says he, of the great and rapid effusion of blood, witli dissipa¬
tion of the animal forces and spirits, from which results an
interception of the cardiac and pulmonary functions, deter¬
mining the sufferer’s inevitable death.” In the chirurgical
creed of John Brown,* a still higher degree of importance is
attached to lesions, whether organic or functional, of the
hollow vein.” The disease,” says he, (p. 68,) ‘‘ w^as an
episthotonal convulsion made by coagulation in the vena
cava, the which does abound ofttimes with thick and viscousT
humour^s “ The vena cava,” he adds, in another place,
by the ancients was called koimv (xzyixXrw, that is hollow and
large; this being the fountain of human nature and the flood¬
gate of our microcosm, and the common mother of the rest,
except the umbilical and port-vein. It is bred out of the
gibbous part of the liver ; it is seated according to the length
of the back, and runs directly through both venters, hereby
conveying of its blood to all parts 1’^ ‘ If it be wounded,
a flux of black blood succeeds ; if the wound happens in the
right side, the veins do speedily empty and flag, the face
looks pale, and the extreme parts do grow cold, the faculties
wax weak, and soon after these the patient’s life is taken
from him.”

Forest J expresses himself on the nature of this lesion with
a peremptoriness which would indicate his having observed
many instances of its occurrence. After his own manner,
too, he strengthens his aphorism of its “ lethality” by nega¬
tive and positive argument. Wounds of the vena cava,” says
he, are certainly fatal ; not because it is one of our noblest
organs, but on account of its use: for, since all the blood
passes through its channel, when the vessel is disruptured, all
the vital blood escapes. Besides, its substance is nervous, and,
consequently, cannot he regenerated. Moreover, its situation
is so profound that it cannot be reached by the hand : there¬
fore, wmunds of the vena cava are necessarily mortal, ‘ 7iisi
Dei munere sanentur F ”

* John Brown: A complete Discourse of Wounds both in general
and particular; whereunto are added, the several Fractures of the
Skull, with their Variety of Figures, and also a Treatise of Gun-shot
Wounds in general. 4to. London, l6'7S. Pp. 68, 277? 278.

t Shall we regard this sentiment as a modern illustration of the
kedmatous state of the vena cava to which Aretgeus so laconically
alludes?

I Petrus Forestus : Opera Omnia. 4 Tom. folio. Rothomagi,
1633. Tom. IV. Observat. Chirurg. lib. vi. obs. ii. p. 150.

283

Dr. Kennedy on Rupture of the Vena Cava.

IX. Fiildanus, in liis epistle to Dr. Weicke * * * § on the danger
of internal hemorrhage, communicates the case of a young
Savoyard, who was wounded in a combat by the sword of
his antagonist. The weapon pierced his body a little below"
the navel, and in a few hours the man expired. — His
abdomen was found replete with blood, which had flowed
from a punctured opening in the vena cava, near where that
vessel receives the emulgent veins.

X. Paaiis p gives the following brief account of a wound of
the cava : — In the year 1594, I dissected a man who took
away his own life by stabbing himself with a knife in the
right hypochondriac region, immediately below the ribs.
The vena cava w"as wounded, and a great quantity of blood
effused into the cavity of the abdomen.”

XI. TimaeusJ: has the following case : — A.F. was w'ounded
in the right side by a thrust with a sharp-pointed sword. He
lost a great deal of blood, and soon began to complain of a
pain ascending to his throat. Bilious vomiting supervened,
with sanguineous dejections, dimness of vision, faintings, and
death. — On the abdomen being laid open and the blood
removed, the liver and trunk of the vena cava w'ere discovered
to have been wounded, which wound was of itself pronounced
to be the cause of the man’s death.

XII. Bartholin, II assisted by Philip Hacquinet, inspected
the body of a man, in 1669) w'ho, during the labour of digging,
fell down lifeless. On dissection, he found the vena cava
inferior ruptured near the heart, and the viscera inundated
with blood.

XIII. Puerarius, in his edition of Burnet’s Thesaurus,
has inserted the following case, apparently from personal
observation. In the form, also, of an abridged transcript, it
stands among Bonei’s^ Illustrations of Cardiac and Pulmo-

* Giilielmus Fabricius Hildanus : Opera Observationiim et Cura-
tionum McdicO'Chirurgicarum quae extant omnia, .Folio. Franco-
furti, i682. Obs. Chirurg. Cent. III. obs. Ivii. p. 243.

t Petri Paaii Observat. Anatom. 4to. Lugd. Bat. lb lb.

I Bald. Timaeus, Responsa Medic. 20. 4to. Lipsiae, ibbS.

II This case is given thus briefly and without comment in a letter
from Thomas Bartholin to D. Sachsius, and published in the Ephe-
merides Natur. Curiosorum (Dec. I. ann. i, obs. ci. p. 204).

§ Daniel Puerarius : Thomae Burneti Thesaurum Medicinae Prac-
ticae ex praestantissimorum Medicorum Observationibus, Consulta-
tionibus, Consiliis, et Epistolis, summa diligentia coilectum, ordineque
alphabetico dispositum, et Observationibus selectissirais auctum.
12mo. Tom. II. Genevae, lb78. Lib. III. p. 345.

^ Theophilus Bonetus : Sepuichrcti, siiprh citali. Tom.I. pp. 83b
etSSl.

^84

Original Cornmunica i iom .

nary Lesions, and is again introduced into his section on the
Causes of Sudden Death, in terms which w'ould seem to imply’
his havinji witnessed the dissection, or obtained the notes from
an observer more partial to minute researches after death
than Puerarius appears to have been.

L. S. a Genevan counsellor, aged thirty years, had long
suffered from palpitation of the heart, asthmatic paroxysms,
and a dull pain in the head, accompanied with extreme’
prostration of strength. By this state of his health, he was
prevented from appearing often in public : be had been more
than two years married, but remained childless. On the
recurrence of his asthmatic seizures, he required to place
himself in the open air, for the purpose of avoiding suffoca¬
tion. In the end, August I67O, as he was reclining on a
couch at table, an accession of his cardiac and pulmonary
symptoms returned with extraordinary violence ; and in
hastening to the window, he sunk on the floor and died.

Dissection. — According to Bonet^s notes, coagulating blood
distended the pericardium. Near where the vena cava ap¬
proximates the right ventricle of the heart (“ in ventriculi
cordis dextri confinid^') was a large rupture of that vein. A
particular substance, partly membranous, partly sarcomatous,
arose from the cardiac auricles; its superior part nearly
equalled the heart in size ; it was oval, and formed a shell,
containing a mass of condensed fibrine. This morbid pro¬
duction was closely attached to the adjacent blood-vessels,
which had sustained enormous maxima ac enormis’^) dilata¬
tion. The lungs were much enlarged, and loaded with sanious
purulent matter. No trace of disease could be discovered in
the liver, but it had attained preternatural magnitude. The
spleen was also unusually large and indurated. Vascular
patches, the effects of inflammatory excitement, remained on
the internal surface of the stomach, the coats of which were
remarkably thin, and its volume small. Traces of the pre-ex¬
istent inflammation pregressi mtus et incendii notas’') were
found ill the intestines and mesentery: some parts of them
also had become sublivid. A profusion of serous fluid was
congested between the cerebral membranes.

The consummating cause of this gentleman’s death is
ascribed by Puerarius to rupture of the vena cava, with
effusion of blood into the pericardium and rigfit ventricle of
the heart, from which it was removed plenis manihus in
gnimos co?icretus”) in large clots. He describes the fleshy
membranous formation, superposited on the natural heart,’’
as resembling another heart in size and flgiire, and forming
as it were a cushion and prop (“ veluti tomentum et fulci-
mentumD to the varicose veins, wliicli it encompassed on all
sides. ‘‘ As the veins, therefore, were exceedinglv dilated, and

•w i'' f

285

Dr. Kennedy on Rupture of the Vena Cava.

as free expansion of the arteries must have been prevented by
that preternatural body, it is my opinion,’’ he adds, ‘‘ that an
inordinate flow of blood became the cause of the venous
dilatation, and that the blood {per diapedesin^ extillantem)
oozing from the morbid veins supplied matter for the deve¬
lopment of the sarcomatous substance.” This substance,
growing by degrees on these vessels, at last formed that mass
which, having ultimately contracted the rudiments putre-^
dims rudimenta^^) of erosive ulceration, wasted (“ affricuif^)y
at the same time, the structures of the vena cava and of the
heart itself. By this process the putrescent vein” came to
be easily disruptured; and to it can be retraced the cause of
the depression of his animal and vital functions, and the
patient’s sudden death.

As an illustration of pathological induction in the end of
the seventeenth century, the commentary on the venerable
Bonet’s report of this case may be exhibited. We have it
there stated, that the counsellor’s Physicians ascribed his
abrupt decease suffocato cordis calori nativo’^) to suflbcation
of the heart’s native heat by the rapid effusion of blood into
its capsule, and particularly into its right ventricle. These
gentlemen also considered the rupture of his vena caVa, as
well as the varicose constitution” of that vessel’s trunk, as
being consecutive to the operations of a primary and ultimate
cause — an exuberant quantity of blood, whose free passage
was obstructed by the extraneous morbid growth formed on
the cardiac auricles, and the adjoined C* vasis annexis^’^) vessels
which were compressed by it — and the corruption and
putridity” of the concave and interior part of the fleshy
excrescence itself, which being extended to the vena cava,
predisposed its tube to crepaturam^') bursting and disrup¬
tion. The heavy headach was, moreover, referred by
them to the extraordinary congestion of serous liquid between
the membranes of the brain. They also deduced the languor

* DiAPEDESiSjfrom ^ioc, and is a nosographical epithet con¬

structed by the Greek Physicians for the purpose of distinguishing
the phenomena of sanguineous exudation. With them its significa¬
tion was definite : it denoted the slow oozing of blood through the
pores of vascular tubes. In later times it has come to be applied to
all kinds of hemorrhage from the cutaneous blood-vessels. Puerarius
employs it in the former acceptation, while theorizing on the morbid
state of the vein ; and the state which he describes may be regarded
as the first stage of the kedmatous condition which Aretseus knew
apparently from actual observation. Considered as designatory of
hemorrhage from the cutaneous vessels, it constitutes a rare and
remarkable form of disease. Several instances of it are recorded in
the writings of pathological historians.

VOL. XX. - NO. 118, 2 P

286

Original Communications.

of the animal and vital faculties from “obstructed fluxion of
the blood and spirits,” produced b}^ compression of the large
blood-vessels by the morbid mass — from the putridity en¬
gendered in that mass — ^and from phlogosis of the viscera,
and the debility thereby induced.

Morgagni, amid the multitude of his necrotoraical re¬
searches, seems never himself to have inspected the body of a
subject whom rupture of the vena cava had destroyed. He
was not unacquainted, however, with the nature of this irre¬
parable lesion, and a due portion of his immortal work * is
occupied wdth remarks on such histories of it as had come
under his observation in the writings of earlier pathologists.
He omits all detail of the original circumstances, and, begin¬
ning with animadversion on the sentiments of Aretaeus, pro¬
ceeds with a concise review of the cases recorded by Amatus,
Donati, Laurens, Hacquinet, Puerarius, Lancisi, and Peterius,’
the outlines of which are now consigned to the pages of this
Journal. With reference to the case of Puerarius, and that
extracted from the Anatomy of Laurens (No. VI 1. of this
essay), a sentence L has been left by him, the meaning oi
which it is difficult to apprehend through the obscurity ot bis
diction. My readers will be pleased to accept the following
as the best interpretation I have been able to give of its
import : — “ For,” says he, “ I am not so well able to ascer¬
tain in what sense I should understand (Puerarius’s expression)
rupture of the vena cava .with effusion of blood into the
pericardium and right ventricle of the heart, as the words of
Laurens, who was ignorant of the sanguineous circulation,
when he says that from rupture of the auricular extremity of
the vena cava and laceration of all the tricuspid valves, a
mortal effusion of blood took place into the right ventricle of
the heart; but, really, when he (Laurens) mentions its (the
effusion’s) having been profuse in the ventricles only, and

* Epist. XXVI. art, 28,

t Me enim minus ibi assequi posse, fateor, qu§. ratione bcec
intelligam disnipta vena cava et effuso sanguine in pericardium^ et
cordis dextrum ventriculum, quam in observatione Laurentii, sanguinis
circumitionem ignorantis, ob venae cavee ostium disruptumy omnesque
illas memhranulas tricuspides lacerafasy lethalem in dexterum quoque
cordis sinum effusionem sanguinis factam esse : quam, ut verura loquar,
cbm in ventriculos dumlaxat, eamque ingentem, in pericardium
autem non modh nullam memoret, sed ne significetquidem ; suspicor,
nec tamen satis scio an venae cavae disruptio acciderit in facie tan-
tummodo interiorc. Sed nimirum cordis ventriculi fato (juodam ne-
gotium saspius facessunt in descriptis venae disruptionibus intclli-
gendis.” — Epist. XXVI. art. 28, Tom. 11. p, 281.

287

Dr. Kennedy on Ruptui'e of the Vena Cava.

does not even intimate its presence in the pericardium, I
doubt, though I am not certain, whether rupture of the vena
cava could have happened soleJy in its interior face. By
some fatality, however, the ventricles of the heart frequently
occasion difficulty in understanding descriptions of the rup¬
ture of that vein.’^

The difficulty which presented itself to the mind of Mor¬
gagni, with respect to the preceding case, as depicted b\''
Puerarius, seems to have arisen in a great measure from his
overlooking some of its characteristic circumstances in their
anatomical and pathological relations. In Bonet’s version of
the same history, an accumulation of blood in the right ven¬
tricle is not mentioned: Puerarius, however, states this fact
in explicit terms ; efuso sangnirief says he, in 'pericardium
et cordis dextrum voitriculam, inde plenis manibus in grumos
concretus educebahir but Morgagni cannot comprehend how
such a phenomenon could have been produced. Neverthe¬
less, on examining the original sketch, we shall find Puerarius
describing an organic lesion simultaneously determining its
ultimate effects on the vena cava and the heart. In theo¬
rizing, also, on the progressive development of this lesion, he
rt'gards that vein as having been the primary seat of the
disease, and the point on w'hich the sarcomatous excrescence
first began to vegetate. By degrees, this grow^th, as a morbid
centre,, imparted its degenerative influences to all the conti¬
guous veins, and in the end implicated the approximate sur¬
face of the right ventricle. By and by, the internal parts of
the tumour went into a state of ulceration, which ceased not
to extend its ravages till, by gradual action on the venous
and cardiac structures, it imperceptibly eroded them, so as to
facilitate their disruption and the consequent extravasation
of blood into the capsule and right ventricle of the heart.

Puerarius, then, as I conceive, has described a complicated
organic lesion, the nature and extent of which will be under¬
stood by a view of the parts in their anatomical relations.
The abdominal vena cava terminates in the right auricle, at a
point between the end of the thoracic vessel and the ven¬
tricle, from which, as it ascends, it is not half an inch
distant. A sarcomatous mass, large as the heart itself, and
having its origin in the auricle, communicated morbid asso¬
ciation to all the circumjacent parts, and particularly to the
wall of the right ventricle ; turn venee caveef says Puerarius,

turn ipsi cordis substantive affricuit.^’ When the coats of the
vein and the wall of the ventricle came, in this way, to be so
far injured by the disease (ulcerative erosion, the kedmata of
Aretaeus .^) as to render them incapable of longer resisting the
expansive force of the circulating blood, a rupture ph the

288 Original Communications,

weakened parts in both organs necessarily took place ; and
through the apertures thus produced, the blood returning
by the abdominal vena cava would continue to flow out of the
opening in that vessel, and enter into the ventricle by the
opening in its wall, so long as the sanguineous elements
preserved their susceptibility of impression from the forces by
which their circulatory movements are maintained.

XIV. Dolaeus * inspected the body of a Hanoverian maid¬
servant, aged eighteen years, hsemophthysical, and endowed
with a choleric temperament. This woman having risen early
and opened the window-shutters, ran to the kitchen, uttering
loud screams. Her cries awakened her master’s son, who,
with horror, found the unhappy girl stretched on the floor and
covered with blood. Dolaeus, being called, hastened to her
assistance, but found her lifeless.

Dissection, — All the abdominal viscera were perfectly
sound, only the gall-bladder was quite empty. One of the
ovaria contained a multitude of ova tenuissimis membranulis
prceditaJ^ On milk being injected through the Fallopian
tube, these ova disappeared : “ which circumstance,” says
Dolaeus, confirmed the view I had entertained of the pro¬
cess of conception.” The lungs were blackish ad nigre-
dinem mrgentei*') and inflamed. There was a ruptured open¬
ing (“ in iisdem venom cavam disruptam'^) in them and the
vena cava, which vessel contained much frothy blood. The
heart was pale ; some grumous blood remained in its ven¬
tricles and the aorta : there was scarcely an ounce of this
fluid in all the rest of the body. “ If, on considering all
these things,” says the author, with perfect exemption from
doubt of the induction, you refer the cause of this person’s
death to the bile being poured into the blood, and occasion¬
ing an excessive fermentation of it, you will perhaps hit
the mark.” Here is a fact demonstrating the pathological
accuracy of Aretaeus, and his doctrine, that hemorrhage
from the vena cava, through the lungs and mouth, produces
sudden death. In this instance the disease seems to have
originated in the respiratory organs, and to have been conse¬
cutively distinguished by inflammation, ulceration, and ex¬
pectoration of blood, together with adhesion of the pulmonary
to the contiguous surfaces and the vena cava, which, being
progressively eroded and lacerated in the part of its tube

* Johannes Doleeus: Opera Omnia. Folio. Francofurti, 1703.
Exenteratio Ancillae Heemoptysi subito extinctae : extat etiam in
Miscell. Curios. Med. Phys. Academ. Naturae Curiosorum; sive
Ephemer. Med. Phys. German. Curiosarum, Ann. IX. obs. cxxxv.
p. 369.

Dr. Kennedy on Rupture of the Vena Cam. 289

nearest the morbid lung, permitted an instantaneous gush of
blood into the air-cells of that viscus, and deprived the patient
of life. Another proof of the nature of this lesion may be
drawn from the state of the vein after death. It contained
frothy blood sanguis spw/nos?/s”) — blood with which at¬
mospheric air, introduced through the apertures in the lung
and the vessel, had been commingled.

XV. Poterius"^ relates, in very summary terms, the case of
a healthy peasant who ceased to live in a manner as unex¬
pected as the Hanoverian maid-servant. This man, having
taken a hearty supper, retired to sleep with his bedfellow, to
whom he spoke a few words, and — peipetuo somno se tra»
didW^ — died. He had no cough, we are told, nor difficulty
of breathing, previously to his decease.

In this person the omentum was lacerated, a portion of
the liver near the ribs suppurated, and the lungs ulcerated.
Many parts of his body w^re livid, especially those which its
own weight compressed. But hujus tanthm repentinae
mortis fuit causa disruptio vence in ventriculo cordis^’ — the
cause of this sudden death was rupture of a vein in the ven¬
tricle of the heart. ‘

Notwithstanding the laborious Hoffman designates its
author by the magnificent title of “ medicorum sui avi
princepsf the foregoing sketch must be regarded as defective
in the enumeration of characteristic circumstances, and inac¬
curate, if not really erroneous, in point of anatomical de¬
scription. We are left without a name to the vein, and have
not been told whether the lesioned vessel was in the right or
left ventricle of the heart. But it may be inquired, whether
a vein exists in either ventricle, from the rupture of whose
tube sudden death may ensue ? The case, indeed, is noticed
by a French writer f among ruptures of the vena cava, and
it is probable that Poterius did find a rupture of this vessel ;
but still it may be asked, when did the vena cava become a
vein in either cardiac ventricle? The defect, or inaccuracy,
or error of Poterius, moreover, did not escape the observant
eye of Morgagni, J who seems to have regarded his * ** obser¬
vation’^ as valueless, by dismissing it with the sarcastic re¬
mark, You see Poterius proposing, as the cause of a'sudden

* Petri Poterii Opera Omnia Practica et Chymica, cum Annota-
tionibus et Additamentis utilissimis pariter ac curiosissimis Fridericii
Hoffmanni filii : extant apud Hoffmanni Opera. Folio. Geiievse,
1749» Tom. IV. cent. iii. obs. lx. p. 1 18.

f Dictionnaire des Sciences Medicales, article Maladies des Veines
Caves, Tome LVII. p. 143.

^ De Causis et Sedibus Morborum, Tom. II. p. 281.

290

Original Communicatio7is,

death which he relates, the rupture of a vein in the ventricle
of the heart; but what vein, or where he designates a vein,
deseribe to me if you can.” Poterius, if he was a lover of
laconism, might have escaped this stricture, had he chosen to
name the vein, and describe its lesioned part, without incur¬
ring a great waste of words. *

XVI. Lancisi, who stands in the highest rank of patho¬
logical observers, regards, as one of the causes of sudden
death, such a diminution of the mass of the blood as, being
rapidly wuthdrawn from the heart and brain, annihilates the
alternate movements of these organs, and intercepts the cir¬
culation : hence, he says, an abrupt bursting of the sangui¬
neous stream from the vena cava, pulmonary vein, heart, or
principal arteries, to a certainty and instantly extinguishes
life. In illustration of this doctrine, the following, among
other important observations, is advanced.

Stefano Ascieri, a shoemaker, a sexagenarian, and corpu¬
lent, had sustained paroxysms of arthritic pain in his upper
and lower extremities during the long period of eight years.
These seizures were periodical, and occurred about the time
of the equinoctial returns. Nearly tw'o years before his de¬
cease, he began to be annoyed with cough and difficulty of
breathing. Subsequently palpitation of the heart supervened,
and was accompanied wuth a deep-seated, heavy, some¬
times acute pain occupying the parts- under the right side of
his sternum, and extending itself to the shoulder. He had
also a sense of confinement and of vascular pulsation in the
chest. Latterly he experienced frequent vertiginous sensa¬
tions, and had a feeling of unnatural heat within his head.
At the same time a rapid loss of strength disabled him from
working. On March 4, 1706, having taken some wfine after
dinner, he suddenly became speechless, and, with a painful
struggle, expired.

; Dissection. — All the abdominal viscera exhibited appear-

* Morgagni quotes a case of ruptured cava, by Philip Hacquinet,
from the-Ephemerides of Natural Curiosities; but upon referring to
it, I find that it is the same as that quoted from Bartholin, Hacquinet
having only assisted him in the dissection.

Salzmann, in Haller’s Disputationes Medicae (Tom. H. p. 389),
alludes to a case in the Ephemerides Germanise, &c. (Vol. I. obs.
142), contributed by Nebelius, as one of rupture of the thoracic
cava; but upon examining the original account in the Ephemerides,
I find that blood was found, on dissection, to be effused in the cavi¬
ties of the thorax ; but it does not appear that the blood issued from
a rupture of this vessel.

f Joannes Maria Lancisi : Opera quse hactenus prodieruiit omnia.
4 Tom. 4to. Romae, 1745. Tom, I, pp. 131 — 13b.

291

Dr. Kennedy on Rupture of the Vena Cava,

ances of perfect health : the gall-bladder contained a little
darkish bile. The right half of the sternum was higher than
the other, and the subjacent lung redder than the left. It
adhered intimately to the costal pleura, and was- remarkable
for its firmness and magnitude. Immediately above the cap¬
sule of the heart was an aortal aneurism, having an oval
bony layer on the external surface of the dilated artery, cor¬
responding to the sternum and ribs of the right side. Beneath
that layer and round the anterior internal surface of the aorta,
w'e found,’’ says Lancisi, a polypous substance resembling
lard, so neatly incrustated into the arch” of that artery,
that the like was never before detected in an aneurismal
cyst.” This substance, on being melted and quickly refri¬
gerated, appeared to be perfectly concrete, being inseparable
into layers. »

The consistence of this deposition is referred to the action
of the blood puldoni sanguinis’') in compressing it against
the external parts. On that point of the surface of the tumour
which rested in contact with the lungs was a smaller polypous
formation, covering and confining the aorta. The aneurismal
cavity could readily admit a man’s fist, and was so full of
grumous blood as to appear incapable of receiving any other
duid. No opening, however minute, could be detected in it,
although at the base of the heart, within its capsule, and
at the inferior side of the aneurism, were several black
streaks, the harbingers, perhaps, of larger apertures. The
tumour did not exceed in length the arch of the aorta, which,
beyond the aneurism as well as near the heart, preserved its
natural diameter, and the integrity of its fibres unimpaired.
The pericardium felt as if distended with a preternatural fluid,
but it was soft. Being opened, two pounds of extravasated
grumous blood were removed from its cavity. This blood
had been effused through an orifice, one inch in diameter,
in the vestibule of the vena cava, within the pericardium, and
near the right auricle of the heart.

That this aperture was made by a liquid corroding the
muscular texture of the vessel was plainly indicated, says
Lancisi, by its margins being, not jagged and uneven,. but
quite smooth. He concludes, also, that the blood was pre¬
vented from sooner escaping into the capsule of the heart by
the vein’s “ thin coat, which ends in the muscular,” remain¬
ing spread over the ulcerating structure, and thus protracting
the fatal effusion. This deduction presented itself to his
mind on observing the thin coat’s” attenuated fragments
still lianging over the edges of the ruptured orifice.

In removing the calvaria, the posterior sinus of the dura
mater was incidentally wounded, and black blood gushed

292 Original Communications.

profusely through the incision. The lateral sinuses were
gorged with blood of the same kind. Limpid serum dis¬
tended the ventricles, and was redundant at the origin of the
spinal brain.

Subjoined to this important case is a series of remarks by
Lancisi on the nature of aneurism and the philosophy of its
symptoms. This is his theory of Ascieri’s disease, deduced'
from consideration of his pathological history and the state of
his vital organs after death: — The man's body, assailed by
the podagral vice, superabounded with pungent ichorous
humours. These, about two years before he died, took a
determination on the praecordial parts, inducing cough, pain,
oppression, and breathlessness. By and by, they (the hu¬
mours) 2vere intercepted zoithin the tendinous substance of the
aorta and the muscular substance of the vena cavaf giving
origin to irritation, convulsive action, and palpitation of the
heart ; then to exesion of the affected vessels, and ultimately
to their diloricationem*^) bursting : in this, we are informed,
the true nature of aneurism consists.

It is also the opinion of Lancisi that the sutrine trunk’'
conduces to the formation of aneurism, and to the mora
pertinax salino-erodentium ichorum intra fihras eorundem cana-
LiumH^) the congestion of acrid humours in the textures of the
thoracic vessels. Rarely, he says, do those who lead a
sedentary “ incurvamque vitamf if they abound with vitiated
juices, grow old without experiencing some important lesion
of the lungs, large blood-vessels, or the heart. In agreement
with such physiological views, he conceives that the dark
streaks which marked the bottom of the aneurisroal cyst do
afford occasion for considering whether a subtle and pungent
sanies, which every aneurismatic follicle perpetually ef¬
fuses,” was not insensibly extilled upon the vena cava, so as
to accelerate at least its extensive erosion. Thus, in the
diseased condition resulting from Lancisi's ‘‘ mora pertinax
ichorum salino-erodentiumf we have a substitute for the ‘‘ ked-
mata!^ of Aretaeus, who generally states inductions in laconic
phrase, and resigns theory to the amusement of idler minds.

XVI r. Professor Salzmann relates the following case of
ruptured vena cava, in his dissertation * of Sudden Death

* Dissertatio Medica de Subitanea Morte k Sanguine in Pericar¬
dium effuso ; quam Prseside D. D. Joh. Salzmann, Anat. et Chir.
PP. et h. t. Decano examini subjicit, ad diem Aprilis J2m. 1731,
Johannes Goeritz, Ratisbonensis. 4to. Argentorati, 1731. — A
meagre analysis of this valuable essay is given in Commercium Lit-
terarium ad Rei Medicae et Scienliee Naturalis Incrementura, insti-
tutum, quo quicquid novissim^ observatum, agitatum, scriptum, vel

293

Dr. Kennedy on Rupture of the Vena Cava,

from Effusion of Blood into the Capsule of the Eleart. The
subject of it was a citizen of Strasbourg, in the prime of life,
a hair-dresser by trade, possessing a melancholy choleric tem¬
perament, and exceedingly irascible. For three years this
man was afflicted with a tensive and heavy pain under the
sternum : it experienced paroxysms of exacerbation, and was
ac(* *ompanied with a similar pain in the back between the
scapulary regions. He also had difficulty of breathing and a
sense of constriction in the chest on the least exertion. For
relieving his tedious and afflicting sufferings, he took an
active emetic, and was much exhausted by the severe efforts
in vomiting which it produced. At the same time a loud
hoarse cough (“ tum^ ferina'’) supervened. In a few days
afterwards, his strength being a little recovered, he left his
attendants after dinner, and went to the door in high spirits.
On stretching out his hands there in an easy manner, he sunk
to the ground, and instantly expired, without uttering either
word or groan.

Dissection. — Extravasated blood, still fluid, distended the
pericardium, from which it issued in profusion on that mem¬
brane being incised. The sac of the vena cava had acquired
preternatural magnitude, and was perforated, about a finger’s
breadth from the corresponding auricle, by a triangular orifice
capable of admitting a thick-barrelled quill. Through this
opening the blood had been effused into the capsule of the’
heart. This organ itself was large and flaccid ; its right ven¬
tricle altogether empty. Dr. Salzmann, and his colleague,
Piofessor Boeder, who assisted him in the dissection, were
prevented from a farther prosecution of their researches by
the importunities of the man’s relations.^

XV Ill. De Haen, F in his section “ De Colica Pictonum,”
details an interesting history, in which, among other extensive

peractum est, succincte dilucideque exponitur ; Anni MDCCXXXI
semestre posterius. 4to. Norimbergje, 1731. Tom. I. p. 375. —
The essay was reprinted by Haller in his Disputationes ad Morborum
IJistoriam et Curationem facientes. 4to. Lausannae, 1757* Tom.
II. No. Ixvii. p. 583.

* Joannes Fantonius is mentioned by Breschet in^ the Diet, des.
Sciences Med. Tom. VUI. p. 136, and also by Portal in his Ana¬
tomic Meciicale, Tom. III. p. 353 ; but I cannot discover to which of
his works they refer. 1 have glanced at his Observationes Ana-
tomico-Medicas, his Dissertationes Anatomicae, and his Opuscula
JMedica et Physiologica, and been unable to detect any observation
respecting rupture of the vena cava in any of these works.

t Antonius de Haen ; Ptatio Medendi in Nosocomio Practice Vin-
dobonensi. 3 Tom. 8vo. Lugd. Bat. 1768. Par. X. p. l6l.

VOL. XX. — NO. 118. 2 q

294

Original Communications*

visceral lesions, a large rupture of the vena cava was dis¬
covered to have been the immediate and unforeseen cause of
the patient’s death.

A middle-aged chemist and pharmacopolist had expe¬
rienced slight and transient paroxysms of colica pictonum
through the space of four years ; but, during the last half
of that period, they had become more frequent and more
intense, subjecting him to accessions of suffering for two or
three da^^s every alternate month. In April before his de¬
cease, he sustained an exquisite attack of the disease, which,
w'ith short and irregular intermissions, completed, in the sub¬
sequent August, its fatal course.

This person’s malady is regarded by De Haen as having
had for its causes occasional intemperance in the use of
Austrian wine, and the frequent and extensive preparation of
plasters, in which lead, ceruse, and minium, in single or com¬
pound mixture, were combined. Its chief symptoms were,
an excruciating pain in the umbilical region; excessive re¬
traction in the anterior abdominal wall ; obstinate torpitude
of the bowels, with constriction of the rectum, which rendered
the exhibition of a lavement exceedingl}^ difficult, the alvine
excretions resembling those of sheep ; together with paralytic
failures of the lower extremities.

This man had no ischury or vomiting, but w'as a.fflicted
with dysury. Medicine at first procured considerable miti¬
gation of his distress. In this improved state, however, he
was annoyed with flatulency, and endured piercing ac si
perforareritur’) pains in the dorsal, epigastric, and lumbar
regions. In a consultation, paregoric and camphorated emul¬
sions, frictions, and anodyne fomentations over the dorsal
spine, and daily oleaginous injections, were prescribed. Two
days after this, De Haen found him in circumstances every
way ameliorated. All his functions at last came to be so
well restored, that he was able to walk out with some friends.
At noon of the same day, he returned in good spirits and had
dinner. About tw'o o’clock, after conversing a long time on
his domestic affairs, he found himself unwell, and called for
some wine ; but while this was being brought, he died.

Dissection, — After an incision had been made in the inte¬
guments, from the sternal to the pubic bone, it was acci¬
dentally discovered that all the joints of the subject, although
forty-eight hours dead, remained flexible as during life, and
that the countenance was little paler or shrunk, but retained
much of its natural expression; and De Haen, with great
ingenuousness, describes his alarm lest he should have com¬
menced dissecting a living man. The eyes, however, were
turbid and ohfuscatis’*) dim ; therefore the body was

Dr. Kennedy on Rupture of the Vena Cava. Q,Q5

truly dead, and the anatomist proceeded with his investi¬
gation.

On being laid open, the abdomen appeared to be quite full
of extravasated blood, which was not removed till the viscera
had been examined in their situation. What of the omentum
remained scarcely equalled the breadth of two fingers in size :
it was much displaced by the colon and disfigured, parti¬
cularly its gastric portion. The coecum contained a saccu¬
lated expansion, into which a man’s hand could be intro¬
duced. Much irregularity prevailed in the local distribution
of the stomach and intestines: the colon* exhibited several
dilatations and six contractions, by some of which its tube
was narrowed to the diameter of a common quill : the capa¬
city of its descending portion was diminished to less than
one-third of its natural size.

After an intricate search for its source, the sanguineous
effusion into the abdomen was discovered to have proceeded
from a lacerated aperture in the vena cava, immediately
below the diaphragm. Out of this aperture, which was so
large as to admit the point of a finger introduced into the
vein from the right cardiac auricle, a little blood, on the
vessel being pressed, could still be made to exude. Exter¬
nally the heart itself retained no vestige of adipose structure :
all its cavities were quite empty. The lungs had no trace of
disease, only the left was attached to the dorsal pleura by a
slight adhesion.

‘‘ But how,” inquires the Professor, shall we account for
the laceration of this vein ? When we find,” he replies,

that it is intimately connected to the posterior surface of
the liver by means of its hepatic branches — that the liver
itself was greatly raised out of its natural situation by the
enlarged and displaced colon — and that the colon, from its
origin to its arch, would be distended with faecal accumula¬
tions and ammoniacal air — we shall easily understand how
the vena cava, adhering to an almost immoveable point,
would, by the continued and forcible protrusion of the liver
upwards, be insensibly outstretched, elongated, debilitated,
extenuated, and ultimately dilacerated, so as to permit com¬
plete extravasation (vitali cruore) the vital fluid.”

> XIX. By M. Bland f is related the case of Jacques

* These intestinal observations are beautifully represented in an
engraving which accompanies the Professor’s interesting and circum¬
stantial description of the parts. Vol. III. cap. vii. tab. 3.

t Observation de Dechirement de la Veine Cave Sup^rieure. Par
M. Bland, D.M. inseree dans la BibliothbqueMedicale. Tom. LVII.
p. 144.

290 Original Communications.

Barras, a peasant, aged thirty-seven years, well-made, and
vigorous in constitution, who, in the act of making an abrupt
and violent effort to raise a bundle of brushwood from the
ground, felt an acute pain within the right side of his breast,
which caused him to cry aloud and hastily raise his body into
the upright position. He referred this feeling to the lacera¬
tion of some internal part. Notwithstanding the pain, how¬
ever, he tried to resume his work, but was unable to proceed.
A state of intense distress now commenced : it made rapid
progress. The man’s countenance grew pale, shrunk, and ex¬
pressive of profound apprehension. He sustained returns of
a syncopal tendency, tottered in his gait, and could not sup¬
port himself. Being conveyed to bed, he suffered from a
diffused pain in the right half of his chest, and had difficulty
of breathing, which every instant increased. His anxiety
redoubled, and he expressed his anguish by incessant moan-
ings. His paleness augmented: his pulse, at every instant,
lost strength. Towards evening, his agitation gave place to
great feebleness and dejection, his extremities became cold,
and about midnight the vital forces were overpowered.

Dissection. — The superior vena cava was longitudinally
lacerated to the extent of two inches, without exhibiting any
other alteration of its texture. Dark blood filled, to reple¬
tion, the right thoracic cavity. The heart and large blood¬
vessels were quite empty. Ail the other organs remained
free from disease.

XX. Dr. I)oubleday, in 1748, published the case of a
dragoon, middle-aged and healthy, who was seized with giddi¬
ness, and fell from his horse insensible. This man’s arm was
punctured, but did not bleed. His senses and speech, how¬
ever, soon returned, but all his pulses were extinguished. At
the same time, his face, hands, and feet, grew deadly cold.
He had no pain ; and with exception of occasional ten¬
dencies to suffocation, his breathing was unimpaired. Being
put to bed, he got some volatile medicine, and was blistered.
Next day, eight ounces of blood w^ere taken from his arm,
and he had some loose stools. Still he was free from all pain,
but had no pulse. On the following morning, he left his bed
and seemed livelier ; pulsation in the arm also had re-ap¬
peared : he experienced some pain, however, in the throat.
While sitting by the fire, he called hastily for assistance,
stretched himself out, and immediately expired.

* Case of Sudden Death from a Rupture of the Vena Cava. By
N. Doubleday, M.D. of Hexham: in Medical Observations and
Inquiries, by a Society of Physicians in London. Svo. 177b.
Vol. V. p. 144,

297

Dr. Kennedy on Rupture oj the Vena Cava.

Dissection.^ AW the abdominal organs were sound. On
raising the sternum, the membrane lining its upper part was
in some places inflamed, in others almost black, and the
whole covered with little vesicles of air. Bloody pus, on
pressure, issued from the inflamed parts. One side of the
thorax contained a considerable quantity of water ; the lungs
adhered strongly to the costal pleura in the other. Coagu¬
lated blood filled the pericardium : the heart, though sound,
was shrivelled and collapsed. In the vena cava superior, just
where it enters the pericardium, was an opening fifteen lines
in length. The vessel, between this rupture and the clavicles,
was semiputrid, and could be torn like wet paper.

Dr. Doubleday points out as remarkable in this case —
1st, That so considerable a decay in a part so essential to
life as the vena cava should be attended with no complaint
till its rupture; 2d, That the person could live forty-eight
hours after such an accident. But it ought to be observed,
he concludes, that four years before the event, the man
narrowly escaped from a consumptive disorder in which he
had purulent expectoration.

XXr. Portal* seems to consider rupture of the vena cava
as quite a common circumstance. Combien d’exemples,’^
he exclaims, de ruptures de veines-caves et de leurs branches
ne pourroit-on pas citer qui ont ete mortelles!’^ Notwith¬
standing this intimation, however, our venerable instructor
has declined favouring us with references to other instances
of the lesion than to that of Fantoni, and those which Mor¬
gagni has done little more than name. It may be, therefore,
some proof of its being infrequent when we find Portal him¬
self, during his illustrious career of more than half a century,
having it in his power to record only tw'o cases of it from his
own observation. Although less valuable from being unac¬
companied with a history of the symptoms which preceded
death, they are introduced here as pathological facts.

1. In the body of a female subject which was dissected
for his anatomical demonstrations in the College of France,
the Professor found the capsule of the heart full of blood.
The structure of that portion of the vena cava which is com¬
prised within the pericardium and a little above it, was in
some places thickened, in others thinned, and had the ap¬
pearance of being ulcerated on its internal face. In the
vessel near the right auricle was an orifice, through which
the blood had been extravasated into the pericardium.

2. On inspecting the body of a young girl who died sud-

* Antoine Portal : Cours d’Anatomie Medicale. 5 Tomes, Svo.
A Paris, 1803. Tom. III. pp. 354, 355.

298

Original Communica lions,

denly in a cold bath, M. Portal discovered the vena cava
superior to have been ruptured near the right auricle, and
a great quantity of blood effused into the right cavity of the
chest.

Professor Richerand ^ has a notice of this kind in his
System of Chirurgical Nosography. “ Violent percussions of
the abdomen,’^ says he, “ may wound the viscera contained in
its cavity without inducing a solution of continuity in the
structures of its wall. Thus have I seen rupture of the
abdominal vena cava of a young person occasioned by the
wheel of a carriage passing over the belly.” i

M. Breschetjf' in 1814, informs us that Professor Boyer
states in his lectures several facts of the same kind which
occurred in his own practice.” This eminent Surgeon, how¬
ever, has not judged these facts of importance to merit inser¬
tion in the volume of his elaborate work J published in 1821,
where his description and modes of treating the surgical
diseases of the neck, the chest, and the abdomen, are com¬
prehensively detailed. With regard to the action “ des
instrumens contendans” on the outside of the thorax, he
observes, by such means, the lungs, heart, and large blood¬
vessels, are sometimes contused, or even lacerated, by percus¬
sion or violent pressure on the chest ; hence result mortal
effusions of blood, sanguineous expectoration, inflammation,
suppuration, and occasionally consecutive serous or purulent
congestions.” All the abdominal organs, he states in another
place, are obnoxious to wounds. The liver, stomach, and
intestines, are more exposed to such lesions than the mesen¬
tery, spleen, kidneys, bladder, pancreas, gall-bladder, blood¬
vessels, and the uterus in woman. As to wounds of the
pancreatic and thoracic ducts, they have been regarded as
possible ; but it is doubtful if ever they have been actually
seen, unless in large wounds, where these ducts had been
divided at the same time with many other important organs.
Wounds of the aorta, vena cava, portal vein, and large
arterial or venous branches, are commonly followed by the
symptoms peculiar to excessive hemorrhage, and sometimes
to instant death. When a person sustains a violent contusion
in the abdomen, he may be killed on the spot, or survive only

* Anthelme Richerand : Nosographie Chirurgicale. 4 Tomes, 8vo,
A Paris, 1808. Tom. III. p. 345.

t Dictionnaire des Sciences Medicales, A Paris, 1814. Tom.
VIII. p. 137.

J Traits des Maladies Chirurgicales et des Operations qui leur
conviennent. Par M. le Baron Boyer. 8vo. A Paris. Tomes
I* — VI. 1818, et Tome VII, 1821, pp. 419> 420, 42b, 484, 485.

299

Dr. Kennedy on Rupture of the Vena Cam,

a short time. In some of these cases, on the body being
inspected, the liver and spleen are found crushed or lacerated ;
in others, the stomach and intestines bruised or disruptured,
blood-vessels opened, the kidneys and bladder burst. Many
instances of such lesions, he concludes with saying, are
recorded by authors, and particularly in Morgagni’s immortal
work, which may be consulted with advantage.

XXIL Laurent Lovadina* described the case of a robust
man, aged forty-two years, who, during a meal, swallowed a
hard substance, which was supposed to be a bone, and which
stuck in the pharynx, whence it required considerable time
and repeated efforts to cause it to descend into the oeso¬
phagus. The irritation that was thus produced brought on a
violent angina, which propagated itself to the bronchias, and
became the source of a continual cough and of violent pains
of the chest at each respiration. This state continued ten
days, when the patient, getting up to pass his urine, was seized
suddenly with a vomiting of blood, wLich speedily terminated
in death.

Dissection. Having disarticulated the lower jaw, and
opened the trachea in its whole length, the internal membrane
of the larynx was found in a gangrenous state. The vocal
cords were almost entirely destroyed. The curtain of the
palate, and the posterior parietes of the pharynx, also pre¬
sented large gangrenous spots, which extended along two-
thirds of the oesophagus. A little above the lower orifice of
this canal a lacerated rupture was observed, which was con¬
sidered to have been produced by the sharp angles of the
bone. The lungs were collapsed and devoid of blood. The
descending vena cava presented, in its external and anterior
aspects, a rupture of an inch in length, situated at the dis¬
tance of an inch from the right auricle. Another rupture, of
less dimensions than the former, was observed in the anterior
aspect of the ascending vena cava before its entrance into the
pericardium.

Dr. Lovadina considers that the efforts that had been made
to expel the foreign body from the pharynx, and the unre¬
mitting cough which continued for several days, impeded the

* Memoire Scientifiche e Letterarie dell’ Ateneo di Treviso. Vol. I.
I have been unable to procure this work. The abstract which 1
have given of this case is a translation from the first volume of the
Journal Complementaire du Dictionnaire des Sciences Medicales.
Paris, 181S. P.93 — Into which work it has been translated from

the Memoirs of the Atheneum of Treviso. The same case has also
been cursorily mentioned in the eleventh volume of the Repository,
p. 512.

300 " Original Communications,

circulation through the lungs ; consequently the blood accu¬
mulated in the right cavities oF the heart, and at first dis¬
tended, and ultimately ruptured both the venae cavae. To
this cause he adds a morbid disposition in the central organs
of the circulation.

XXIIL Dr. Starcke published the case of a serjeant, over
whose abdomen the wheels of a waggon heavily laden had rolled.
This man was admitted into the field-hospital at Fairns, in a
state indicative of his having sustained some mental injury.
He was exceedingly pale, and his vital forces seemed to be
nearly overpowered. All his extremities were cold, his pulses
languid and evanescent, his respiration laborious and dis¬
tressing. He experienced frequent swoonings, had pain and
distension of the abdomen, and indeed tlie general symptoms
of internal hemorrhage.

His attendants were zealous and indefatigable in employing
their best resources for his relief; but these w^ere of no avail,
and on the second day after his admission into the hospital,
their patient expired.

Dissection.' — Extravasated blood filled the interspaces of
the abdomen, the principal organs of which retained marks
of having been severely contused. The peritoneal and visceral
surfaces exhibited traces of pre-existent inflammation. In
the vena cava inferior, opposite the eighth dorsal vertebra,
was a considerable rupture, through which the venous blood
had been effused.

XXIV . My ow n experience furnished me with this and the
subsequent observations.

September, 1815. — A. B. a peasant, aged thirty years,
sound in constitution, and vigorous in person, fell more than
twenty feet from the top of a ha3'-stack, and was carried
home in a state of insensibility. On being roused by the
application of analeptics and cold water, he did not at first
complain of any particular distress. He became more and
more agitated, however, and had a wildness of countenance,
which alarmed his relations and attendants. About an hour
after the accident, I found him in the following circum¬
stances ; —

Fie was pale, and could not speak without exciting intense
pain in the chest ; his under lip was tremulous ; the facial
muscles sustained irregular nervous movements ; his face,
head, and breast, were moistened with clammy sweat ; his
breathing was laborious and unequal ; the voice quavered

* Magazin Fiir die Gesammte Heilkunde, von Rust; fuenften
bandes; Zweites Heft. Berlin, 1818.

301

Dr. Kennedy on Rupture of the Vena Cava.

find graduall}^ failed ; his pulses were feeble and intermitting,
the action of his heart palpitant.

His back liad struck the ground, and he now described the
seat of his principal sufferings as being in the organs of
respiration, and a circumscribed spot between the shoulders.

Being laid in a procumbent posture, his second and third
vertebro-sternal ribs were found with the appearances of
being fractured near their vertebral extremities. Tliere was
considerable discoloration of the integuments, and the parts
were intolerant of the slightest pressure, by which reason
their exact conditions could not be ascertained.

While the dorsal and contiguous regions were being exa¬
mined, the man was seized with an oppressive attack of sick¬
ness, accompanied by a tendency to faint. This gave place
to a paroxysm of coughing, which threatened suffocation, and
terminated in the expectoration of nearly a pound of coagu¬
lating arterial blood. He now sunk into a state of profound
exhaustion, being speechless, motionless, and parting rapidly
with vital heat.

Sanguineous effusion in the lungs, with a complication of
costal fracture, w'as regarded by me, at the time, as the chief
cause of all these inauspicious symptoms ; but, by the suc¬
cessive extinction of his pulses and other mortal appear¬
ances, I w’as induced to pause before interfering in his behalf.
In 1 ess than forty minutes, and before I had left his bed-side,
ray unfortunate patient expired.

Dissection. — Ten hours after death, the morbid phenomena
found within the chest were few, but of an important nature.
A large mass of clotted purplish blood gorged the right
thoracic cavity. It had been effused through a ragged longi¬
tudinal orifice, measuring six lines, in the pleural side of the
vena cava superior, near the point where this vessel usually
receives the azygous vein before entering the capsule of the
heart. About an inch above its termination in the right
auricle and wdthin the pericardium, was a contraction of the
vena cava, with a thickening of its coats, by which it lost
more than one-third of its natural calibre.

The right lung at first felt as if distended by inflation of
an aeriform or other fluid, which could be partially displaced
by compression; but, on the organ being incised, it was dis¬
covered to contain more than a pound of florid, semifluid
blood, which had escaped from a minute fissure in one of the
bronchial arteries into the pulmonary cells.

Two ounces of pellucid lymph were taken from the peri¬
cardiac cyst. This membrane was thin and transparent. The
heart seemed much prder than is natural : its ventricles were

VOL. XX. - NO. 118. ‘2 R

30£

Orig:inal Communications,

empty and collapsed ; its septum unusually thin. Similar
delect of structure had place in the vena cava and all the
other large arteries and veins. In every other respect the
vascular system retained the characteristics of health.

Neither a vena azygos, nor other vessel adapted in any way
to execute its functions, could be detected in this subject,
after the most minute research.

All the abdominal viscera were preternaturally small : they
appeared to be quite exanguious, but unaltered in structure.

In the left ureter were three considerable enlargements of its
tube, bearing great resemblance to the aneurismal dilatations
of arteries. With this exception, which, perhaps, was rather
an anomaly than a disease, the urinary organs were in all
respects healthy.

Many places of the calvaria were transparent; the brain
singularly large, *and its convolutions prominent. About
three drams of limpid serum were removed from each of the
cerebral ventricles.

The second and third ribs had not been fractured : they
were dislocated inwards, their spinal attachments ruptured,
the transverse processes of their corresponding vertebrae
broken off; and the dorsal pleura, over an irregular space
fifteen lines in diameter, detached from the surface of the
spine, on which and the face of the separated membrane were
globules of watery blood, giving a faint tinge of redness to
the lesioned parts.

May we not, from fair induction, regard the want of an
azygous vein, the preternatural thinness of the vena cava, and
its intro-pericardiac contraction, as the circumstances which
principally conduced to render this vessel less able to sustain
the shock imparted to it and all the thoracic organs by the
man’s fall from so great a height

XXV. November, 1822. — C. D. an active female, thirty-
two years of age, possessing an unimpaired constitution and
a strongly-marked sanguineous temperament, had been six
days delivered of her third child, when she was seized with an ’
acute malady, exhibiting all the symptoms by which phleg¬
masia dolens implicating the left lower extremity is usu
characterized.

On former occasions this woman had passed through the
processes of utero-gestation, parturition, and lactation, in the
happiest manner; and her last labour was distinguished by
every circumstance from which a favourable recovery
be anticipated.

From the first accession of her disease, the patient con¬
stantly referred her chief sufferings' to an intense lancinating

.103

Dr. Kennedy on Rupture of the Vena Cava.

pain deep-seated in the abdomen, and shooting downwards
along the spine and course of the large crural vessels in the
affected thigh.

Repeated abstraction of venous blood,* free alvine evacua¬
tion, sedative diluents with mercurials, tepid ablutions of the
surface, internal refrigerants, assisted by tranquillity and
abstinence, were ineffectually opposed to the disease. About
noon of the fifteenth day of her illness, when attempting to
turn herself in bed, she uttered a faint cry, fell into a state of
convulsive panting, which gradually became more and more
feeble, and, in less than half an hour, was terminated by the
extinction of life.

Dissection. — Fourteen hours after the patient’s dissolution,
her abdomen was found in a state of extreme tumefaction, and
having its surface marked with several livid spots. The left
limb, which was greatly enlarged during life, had now shrunk
to nearly its natural dimensions. Its integuments seemed to
have lost all their fluid elements : the}’ were loose and
puckered.

Immediately on its parietal textures being divided, a gush
of impure serum issued from the abdomen, all the interstices
of which were filled with a thin sanguinolent fluid and coa¬
gulated blood. These, to the amount of many pounds,
together with the intestines and viscera, being carefully re¬
moved, a perpendicular rupture, with irregular edges, and
measuring six lines in length, was discovered in the abdominal
vena cava, betw’een the first and second joints of the lumbar
spine, near the origin of the chyliferous duct.

From their capillary vessels being exanguious and col¬
lapsed, all the abdominal, extra-peritoneal, and pelvic organs,
with their investing membrane, were pale, and some of them
white as tendinous structure. That portion of the peritoneum
which lines the lumbar region was remarkably thin, and easy
to be lacerated.

The internal surface of the vena cava, from its origin at
the conjunction of the iliacs to the point where it receives the
hepatic veins, was thickly coated, so as to lessen its dia¬
meter, with a straw-coloured, gelatinous deposition, through
which many dark brownish spots were interspersed. With
this inorganic substance, which could readily be scraped off
with the handle of a scalpel, the interior and fibrinous coats
of the vessel, especially in the vicinity of the laceration, were

* In this case it was observed that the wounds made in puncturing
the median vein did not heal by the first intention. Their lips thick¬
ened, became everted, and gave out an offensive sanious discharge. ;

304

Original Communimi lorn.

intimately blended. Its cellular tunic, over the same space^
was much thinned, and tore with facility.

Matter of the same kind was deposited, but in a layer of
less thickness, on the concave face of the left iliac and cor»
responding femoral veins, half-way down the thigh, beyond
which the dissection was not pursued. The uterine and
vaginal veins which terminate in the left internal iliac were
filled with it; but, on their being divided, the end of a smajl
probe could, without force, be inserted into their tubes.

The cellular texture of the left thigh was changed into a
substance bearing resemblance to the colour and consistence
of animal jelly.

' In the fundus of the uterus, which had not completed its
ultimate contractions, was a shallow ulcer, nearly circular,
and twelve lines in its longest axis. It contained a small
quantity of fetid puriform matter,’' some of which adhered to
different parts of the utero-vaginal lining. This membrane
had lost its natural tenacity, and could be peeled off with the
finger.

Immoderate vascularity, or other traces of recent inflamma¬
tion, could not be discovered on any of the visceral or peri¬
toneal surfaces : all their vessels, both venous and arterial,
were empty and collapsed. Notwithstanding the superficial
paleness of the liver, however, when an incision was made
into it, large drops of dark hepatic blood were emitted by its
dissevered vessels.

The mucous coat of the bladder was free from all traces
of a morbid state: its serous tissue had acquired the same
tinge, and gone into the same condition, as the lumbar peri¬
toneum, being apt to suffer laceration from the slightest
force.

With exception of several dark patches on the posterior
surface of the small intestines, the alvine canal was healthy,
though pale, thin, and in some places transparent. It was
inflated with ammoniacal air, which in like manner distended
the stomach.

All the thoracic organs appeared in a state of vigorous
health. Very little blood issued from the lungs, on their
being cut open. A small sanguineous clot remained in the
right ventricle : the left, with the aorta, large veins, and,
indeed, all the chief branches of the vascular system, were
empty, and flattened from collapsion. The encephalon w^as
not examined.

Such are the manifestations of rupture in the vena cava
which my limited acquaintance wdth medical literature and
experience in the investigation of disease enable me to place
before the readers of this Journal. They will, therefore, be

305

Dr. Sutton’s Case of Sloughing Fhagedcena.

pleased to regard the preceding sketch as a well-meant,
though necessarily imperfect essay, towards completing the
pathological history of an organ, on the integrity of whose
functions much of the process of vital action depends,

Glasgow, George’s Square, July 4th, 1823.

11.

Case of Sloughing Phagedd^nay with Remarks. By Thomas
Sutton, M.D. Member of the Royal College of Physi¬
cians, London.

Having very lately read an account of sloughing phage-
daena, by' Mr. Welbank, in the Medico-Chirurgical Transac¬
tions, 1 am willing to state a case of this kind, and its result,
which had gone to a most formidable length, with some
general observations on the cure of certain ulcers and ulcera¬
tions. This I do wilh much deference to Surgeons, as my
professional occupations are not directed, nor much called to
surgical cases. This case was one of those that had been
connected with syphilis, and was therefore of the precise kind
alluded to by Mr. Welbank. The party was a man of about
twenty-five years of age, who, at the time I saw him, was
reduced to apparently the last stage of emaciation. I was
sent for on account of a very considerable vomiting; and
when I had seen his reduced state, and the ulceration of
which I shall speak presently, the whole gave me very little
hope of keeping the patient alive for many days. He,
however, seemed more rallied on the following day than I
expected, his vomiting having ceased ; and as the friends of
the patient wished me to continue my visits, I entered fully
into all the circumstances of the case. I was informed that
the patient had been ill for upwards of two months. This
disease first began with buboes in each groin, which had
extended themselves into rapid and very enlarged ulcerations.
The progress of this disease was much such as Mr. Welbank
describes, and the ulcers had increased by gangrenous spots
coming on the edges, so as to form a continuous and meeting
mass of ulceration of very great extent. This patient had
been attended by a very assiduous burgeon, and had enjoyed
the advantage of the advice of an eminent Surgeon from
London. But no effort whatever had as yet been able to
place the ulcerations in a healing state, nor stop its progress.
If any thing appeared to be gained on one day, a gangrenous
appearance on the next was sure to destroy the hopes formed
on the former. There was, when I saw the ulceration, no

306 Original Commmiications,

slough of magnitude on its surface, but the edges displayed
in all directions irregular indentations, which parts had been
lately so formed by small gangrenes. On inquiry, I found
that a great number of means had been employed without
effect, and that nothing in the general treatment of such a
case remained to be done that had not been attempted, and
without success. The dressing, such as had been adopted,
had been carefully removed night and morning, owing to the
excess of discharge, and the parts carefully cleaned from all
irritating matter. Under these circumstances, I felt that there
could be no impropriety in proposing a plan of my own ; and
as the ulceration was very extensive, there W’as an opportunity
of trying it on a part only, which I proposed to be done.
My plan therefore was this, to place a piece of dry lint
doubled upon one half of the ulceration, fastened with
adhesive straps as well as could be, and not to remove this
for two days. In order to render the discharge as little irri¬
tating as possible, and to dilute it, tepid water was to be
very frequently applied by a sponge or on hair, and the lint
to be thus kept constantly wet ; when this could not be done
so regularly, poultices were to be applied, which was gene¬
rally the case at night. In this way the thing was managed,
and on taking off the lint in two days, we were gratified in
finding the parts looking healthy and in a state of healing,
w'hile the other part. of the ulceration, not treated in this
way, was in a state of irritation. Thus, then, as no doubt
could remain as to the preferable mode of proceeding, the
last plan was adopted upon the extent of the ulceration ; the
whole soon healed, and the patient recovered, considering his.
reduced state, in a rapid manner.

The medical treatment consisted in giving moderate doses
of opium ; and, after a time, a tonic bitter medicine was
directed, and the bowels, as occasion might require, acted
on. The diet allowed was such as was likely to support the
strength, and with which it was found the stomach could deal
the best.

It now will become a question with my readers, as this
plan has proved thus successful, on what principle I adopted
it, materially varying as this treatment does from the usual
practice ? I have been long impressed with the idea, and in
several instances acted upon it, that the practice of exposing
large ulcerations often to the air, as is very commonly done,
should, if possible, be avoided. In a certain way. Mr. Bajm-
torfs plan has shown this, as it consists in reducing the sur¬
face of the ulceration as much as possible; and for that pur¬
pose, to obtain an union of parts, he recommended the
adhesive straps to be removed very seldom. Mr. Alanson’s

Mr. Ward’s Case of Tumour in the Vena Porta. 307

method in amputations is also of the same kind, which, by
keeping the parts in contact to encourage adhesion, reduces
the ulceration, after the operation, to a mere nothing. Each
of these methods, however, having in view an union of parts,
necessarily induced another most useful consequence — the
external air was refused admission to the wounded and ulce¬
rated parts. In the operations of nature in cases of wounds,
or breaking of surface, at least in the human species, we
perceive an effort to cover the exposed living parts — if of
moderate size, by inducing a scab; but if this cannot be
accomplished, the death of the upper part of a wound or
ulceration is effected, and a slough produced, thereby pro¬
tecting the sensible parts underneath from the irritating
effects of the external air. It is for the same reason that
sloughs induced by art cause much good, as for some days
the living parts underneath are not exposed to the irritating
contact of the external air. I am well aw^are that Surgeons
have thoroughly understood that exposure is very irritating to
ulcers; but they may have too sedulously endeavoured to
keep the parts clean from irritating matter, at the expense of
other consequences.

The above case was treated by my advice upon the sole
principle of avoiding exposure to the external air, with a
happy result. With too little experience to decide so
weighty a point of practice, but with the little I have had in
this part of the healing art, I should recommend it to con¬
sideration, that all reasonable means should be resorted to to
hinder the contact of external air as much as possible to
ulcerations. I believe this to be often practicable to a con¬
siderable extent, by diluting the irritating matter secreted,
and rendering it innocuous, without frequently removing im^
mediate applications, and thus giving INature an opportunity
of commencing and continuing the healing process after her
own fashion.

Greenwich, September 12th, 1823.

III.

Contributions to Pathology, — No. I. Case of Tumour within
the Trunk of the Vena Porta, completely obstructing the Cir¬
culation through this Vessel, S^c. S^c. By Joseph Ward,
Esq. Member of the Royal College of Surgeons, and Apo¬
thecary to the London Hospital.

Andrew Rafferty, setatis thirty-five, first applied for
relief January 29ih, 18^2, staling, that about five months

308

' Original Communications.

previous to that period he had felt himself very sick, without
having used any exertion, and that he brought up, by vomit¬
ing, about a pint and a half of blood; since that period he
had spit blood occasionally, and during the last week, once
or twice; he had also passed small quantities of blood by
stool. His bow^els were upon the whole regular ; had some
degree of tenderness on pressure at the scrobiculus cordis;
pulse soft and slow. He w^as ordered calomel and jalap
every other morning, and a common saline mixture three
times a day. By paying attention to the state of his bow'els,
and by varying the treatment, according to circumstances, he
was discharged convalescent in the following March. A few
months afterwards, he again applied for relief, stating, that a
short time after his discharge he became worse. He now
complained of pain and swelling in the abdomen. His
food was constantly returned in about ten minutes after it
had been taken ; this was always succeeded, in about half
an hour, by very violent pain. He has frequent craving for
food; abdomen distended with fluid; legs occasionally much
sw'elled ; bowels costive; urine very high-coloured; skin has
been yellow ; pulse regular.

After his admission, he still complained of much pain at
the scrobiculus cordis. Blisters, leeches, and the usual me¬
dicines, were employed without affording any relief ; he
appeared to be gradually sinking ; large doses of opium
gave him some ease from pain : he died in October fol¬
lowing.

On examination after death, the stomach was found dis¬
tended with a large quantity of fluid. A yellowish tumour,
of a pulpy feel, and about the size of an orange, was dis¬
covered in the lesser curvature internally. The substance of
the stomach about the pylorus was thickened, and contained
tubercles or small tumours resembling the large one. ^The
pyloric orifice, in consequence of the thickening of the 'parts,
was nearly impervious. In the liver were situated similar
tubercles, pulpy, cream-coloured, and of a soft, caseous, or
curdy consistence. The trunk of the vena porta was filled
with a similar tumour, which completely prevented the
passage of any fluid through it. The gall-bladder was dis¬
tended wdth bile.

Mr. Earle’s Letts?' to the Editors.

309

IV.

Remarks y by Henry Earle, Esq. Sfc. on Sir Astley
Cooper’s Reply to his Critical Observations on Fracture of
the Neck of the Femur, <^c.

TO THE EDITORS OF THE LONDON MEDICAL REPOSITORY.

I BEG leave, through the Diedium of your highly respectable
Journal, to correct an inaccuracy in a critical work which I
lately published on Fractures of the Neck of the Femur.
At page 41, in alluding to a preparafion, contained in Mr.
Langstaff’s museum, of a case of double fracture within and
external to the capsule, I have stated that “ firm ligamento-
cartilaginous union had taken place.’’ Mr. Langstaflf has
obligingly corrected the error into which I had fallen, and,
with his usual liberality, has afforded me another opportunity
of examining the preparation alluded to, which 1 find to be
very accurately described by Sir Astley Cooper. On the
the former occasion when I visited this collection, I had not
the benefit of Mr. Langstaflf’s attendance to explain the indi¬
vidual specimens ; and from the short notes which I then
made, it is very clear that I must have mistaken the prepara¬
tion in question. 1 consider this declaration due to Sir Astley
and myself, and shall be much obliged by your giving early
publicity to it. At the same time, 1 beg to observe, that the
absence of union in this case does not in the slightest degree
invalidate the reasoning which I have employed, and that I
still consider that the fracture within the articulation would
prevent the motions of the pelvis from being communicated
to the fracture external to the capsule; and, consequently,
that no comparison can be drawn between the two fractures,
as the one within the articulation would be liable to partici¬
pate in every motion of the trunk and pelvis, while that
external to the capsule, from the very circumstance of the
double fracture, would be in great measure secured from any
such interruptions to bony union. Added to which, it is
right to observe, that the central portion between the two
fractures, being nearly insulated,' would be placed under much
less favourable circumstances for union than when connected
with the shaft of the bone. These two facts are fully suffi¬
cient to account for the want of those reparative effects
which commonly take place in simple cases of fracture within
the articulation.

I have the honour to be, Gentlemen,

Your most obedient Servant,

HENRY EARLE.

2 s

VOL. XX. - iNO. 1 18.

310

Original Communication,

P.S. Since the above letter was written, i have had an
opportunity of reading Sir Astley Cooper’s reply to my
observations in an Appendix to his third edition; and as that
work contains onany heavy charges against me, it is incum¬
bent on me to endeavour to repel them.

In the first place, I am charged with an attack on the
honour and credit of Guy’s Hospital. To this I offer my
most unqualified disavowal of any such intention, or of the
slightest inimical feeling towards any individual connected
with it. No impartial person can possibly draw such an
inference from any part of my work ; unless, indeed, Sir
A. C. has so entirely identified himself with that noble insti¬
tution, that to differ from him in opinion can be construed
into an attack upon the whole school. No petty motives of
rivalship influenced me in taking the steps which I have fol¬
lowed, but a conscientious feeling that an advocate for the
possibility of union within the articulation w^as imperiously
called for. If I had wished to have contrasted one school
with the other, I might have strengthened my cause by
stating, that the doctrines which I have inculcated are enter¬
tained by most of the able associates with whom 1 am con¬
nected, and are taught by the eloquent and highly gifted
Professor who has so long been an ornament and support to
St. Bartholomew’s,

I am next charged with misleading the rising generation
with incorrect surgical principles ; and Sir Astley is led to
exclaim, ‘‘Good God! is this written by an English Sur¬
geon r’ It is even so, and by one who hopes to have some
claim to that honourable title, should he succeed in restrain¬
ing the rough and useless freedom of examination which he
has too often w'itnessed in these cases, and in establishing in
its room a train of more rational and less injurious diagnostic
symptoms, sufficiently clear to direct the judgment of any one
competent to the practice of his profession.

To the charge of misrepresentation, at page <22, 1 distinctly
plead not guilty, and feel confident of a verdict in my favour
Sir A. C., at page 146 of his large w^ork, lays down certain
rules respecting fractures external to the capsule, to which he
admits that there are exceptions : then follow three cases in
proof of the positions laid down, but, unfortunately, so far
from illustrating, they are all in direct opposition to them.
When this inconsistency is pointed out. Sir A. C. charges
me with misrepresentation, and wishes the cases in question
to be considered as illustrative of the exceptions to his rules ;
and so, indeed, in the next edition, with some trifling altera¬
tions and additions, they may be made to appear; but as they
at present stand in the first and second editions, there cannot

Mr. Earle's Remarks in Answer to Sir A. Cooper. 311

be any reasonable doubt of their bearing the interpretation
which has been put upon them by many other persons as
well as myself. If Sir A. C. really intended them as excep¬
tions to his general rules, he should have stated so more
clearly and intelligibly ; but surely no critic can be fairly
chargeable with misrepresentation in consequence of the
author’s want of sufficient perspicuity. With much greater
justice 1 might complain of the allusion which has been made
to the case of fractured olecranon, at page 15, as unfairly and
partially quoted. In relating that case I openly and can¬
didly avowed the mistake under which I laboured, with a
view to caution others from falling into the same error, by
following too implicitly the doctrines of the schools ; and I
have clearly proved that in the case in question not one of the
symptoms existed, which are described by Sir A, C. and
other systematic writers. It is not my intention at present
to answer the various parts of this Appendix in detail; but
having rebutted the several charges which have been brought
against me, I shall beg leave to notice a few passages in the
Appendix which might lead to a misunderstanding of my
work. With respect .to the case of Spilling, mentioned at
page 14, I had nothing to do with the treatment of him, and
believe that but little was done to restore the limb, because
it was evident that the patient was dying of a disease in the
liver.

The preparation in the College museum, alluded to at page
SI, I value so little, that I have not even mentioned it in my
work. It was taken from a patient wdio was burnt to death ;
and I could learn nothing respecting it, but that she was sup¬
posed to have dislocated her thigh, which was never properly
restored. With respect to the case of shortening to the
extent of four inches, mentioned at page l6, I have only to
observe, that the question at issue is respecting the degree of
shortening immediately consecutive to the accident. I have
myself expressly stated, at page 43, that in old neglected
cases where no union has taken y)lace, there will often be
very considerable shortening in consequence of the absorp¬
tion of the neck within the articulation precisely such is
the case in the preparation in question ; but surely this cannot
be gravely brought forward in proof of the degree of short¬
ening immediately after the accident. Sir Astley has em¬
ployed the man’s high-heeled shoe as a gauge ; but this is very
fallacious, as the direction of the whole thigh would be
altered, and the knee would be slightly bent, which would
increase the apparent degree of shortening, even supposing
the actual shortening not to exceed two inches and a half;

SI 2 Original Communications,

not to mention that some allowance should be made for the
thickness of the other shoe.

At page 7, Sir Astley has said that “ no argument can
ever settle the question of the possibility of union, which can
only be decided by observation.” This is undoubtedly true;
but it is equally so that the question never can he decided in the
affirmative by following the doctrines which he has incidcated, as
the practice Sir A, recommends and follows renders union hy
hone a moral impossibility. By reasoning, however, I hope
that 1 have shown that there is no actual law in the animal
economy prohibiting such union. By reasoning, I have en¬
deavoured to explain the causes which have hitherto contri¬
buted to interrupt bony union ; and by reasoning, I hope to
induce my professional brethren not to abandon these cases^as
hopeless.

I am w’ell aware that my work is deficient in positive
evidence, but I trust that I have assigned satisfactory reasons
for the results having been hitherto so generally unsuccessful.
If there had existed more positive evidence on this disputed
question, the doubts at present entertained could not possibly
have been maintained by any person, and my humble pen
would not have been required in support of the possibility of
union. The present inquiry will, I hope, lead to the solution
of the difficulties which have hitherto involved this subject,
and to the elucidation of truth ■ — the great end and object of
my inquiry. When, however, I find it acknowledged by
Sir A. C. himself, that perpendicular fractures through the
head and neck of the femur, through the patella, and through
the olecranon, will unite by bone, I cannot admit that a
different law' influences transverse fractures of the same parts.
The difference consists in the more perfect adaptation of the
broken parts, and the more permanent state of rest, and not
in any deviation from the laws of the animal economy. Bet
us then direct our whole attention to this one object, and by
improved means endeavour to accomplish this desirable end.
Instead of indulging in angry discussions, and anxiously
seeking for additional proofs of non-union, let us steadily
exert ourselves in endeavouring to prevent deformity and
lameness, and to restore our patients to the perfect use of
their limbs. By having pursued this plan, I am happy to say
that I can produce several living instances of complete suc¬
cess ; and should my own life be sufficiently prolonged, and
the prejudices of the public against anatomical investigatioiKS
not prohibit, I shall hope some day to produce unequivocal
proofs in support of the possibility of bony union.

1 shall conclude for the present these observations, with

Dr. Tweedale’s Case of Anasarca. SIS

reiterated assurances that I entered on this inquiry as a
public duty with much repugnance, and that I feel truly
sorry that what I have stated should have created any angry
feeling in Sir Astley's mind. In animadverting on that gen¬
tleman’s work, I have only touched on those parts which
were of importance to the subject under discussion, and no
unfriendly or personal feeling for a moment influenced my
mind,

I sincerely feel, and hope always to feel sentiments of
respect and regard towards that gentleman, and of cordial
good will towards my professional brethren who are con¬
nected with the excellent school of which he is so distin¬
guished a member.

George Street, September 13, 1823.

Case of Anasarca successfully ti'eated by Acwpuncturation. By
John Tweedale, M.D. Lynn-Regis, Norfolk.

In the absence of the Physician who had been in attend-
ance for some months, I was requested, on the 1st of August

last, to visit Mrs. - , of this town. I found her labouring

under anasarca, in a- very advanced stage; the cellular mem¬
brane of the upper and lower extremities and trunk being
enormously distended with fluid, accompanied with cough
and most distressing dyspnoea.

Various diuretics and cathartics had been administered, but
without benefit.

I prescribed still more active bydragogues, a blister to the
chest, and saline pediluvia.

On the following day, the family Physician having re¬
turned from the country, I met him in consultation, when it
was determined to continue the plan recommended by me on
the preceding day.

Several days having elapsed under very active treatment
without any material relief to the patient, I was induced to
recommend a trial of acupuncture. That operation was
readily, submitted to, and was performed with a common
needle of middling size, guarded with a small piece of sealing-
wax at the eye, to prevent injury to the Surgeon’s finger, and
with a thread passed a few' times round the needle, at rallier
less than a quarter of an inch from the point, in order that
the punctures might not exceed the depth required. With a
needle thus guarded, about a dozen punctures were made in

314

Original Communications.

each leg, within a very few minutes, and with little or no
pain to the patient.

The result has been most satisfactory : the arms and trunk
were, in the course of a week, reduced to their natural size,
and nothing now^ remains but slight oedema of the ancles and
feet. As the punctures had closed, the operation was
repeated with a triangular-pointed (small glover’s) needle,
which enters the skin more readily, and leaves a more per¬
manent puncture than the round-pointed needle.

Scarifying and puncturing with the lancet are not only
more painful operations, but are not unfrequently followed by
unpleasant consequences. I am of opinion that the method
above described may, in almost every case of anasarca, be
resorted to with perfect safety, and with, at least, temporary
relief to the patient.

At the time this case occurred, I was not aware that
Dr. Sutton and Mr. Finch had tried acupuncturation in
anasarcous cases ; but I am happy in adding my testimony
to theirs, not doubting but that this simple operation will be
found a most valuable auxiliary in the treatment of anasarca.

Lynn-Regis, Norfolk, September 8th, 1823.

VI.

Case of Hydrocephalus Chrofiicus, in which Pressure proved
most beneficial. By J. F. Barnard, Esq. Bedford, Mem¬
ber of the Royal College of Surgeons, London.

From the fatality so commonly attending chronic hydro¬
cephalus, now so frequent among children, I have been in¬
duced to submit to the readers of the Repository the
following case : — ’ ,

A child, about a year and a half old, was born, to all
appearance, perfectly health}^, and continued so until six
months old, when the head was first observed to increase in
size. I did not see it until the disease was so far advanced
that I almost entirely despaired of its terminating favourably.
The head was exceedingly large, weighing, I should think,
nearly as much as two-thirds of the rest of the body. The
child lay in a state of stupor, and was unable in the least
degree to move its head. There were a slight strabismus
and roliingof the eye-bails, and almost constant startings of
the muscles of the wdiole body, but more particularly of the
face. The countenance had a cadaverous appearance, and
the skin was of a yellowfish colour. The eyes were sunk in
their sockets, and enclosed in a dark ring. The .flesh was

Mr. Barnard’s Case of Hydrocephalus treated by Pressure. 315

flabby, and seemingly hanging on the muscles. The evacua¬
tions from the bowels were particularly unhealthy ; sometimes
green, sometimes blackish, but never of a healthy colour ; nor
indeed had they been healthy since half a year after its birth.
The tongue was constantly covered with a thick white coat.
When its head was moved it screamed, and seemed sensible
of pain. I expected the child would survive but a few days.
[[ should say that it had been taking purgatives and mer¬
curials, without benefit, for some time before I saw it.] I
communicated my opinion to the parents, and told them the
only chance I saw of saving their child was a plan which I
shall describe, and which they readily assented to.

I had the head shaved perfectly clean: I then applied
broad strips of adhesive plaster completely round the head
from before backward, and cross strips from one side to the
other, so as effectually to support the parietes of the cranium.
I ordered the whole head to be kept constantly covered with
lineir dipped in cold water; and that the child should take no
other medicine than a little castor-oil, should the bowels
require it. Having thus decided on my practice, I patiently
waited the result. Its good effects were evident in less than
a week: the little patient could move its head much better;
the strabismus had disappeared ; the secretions from the
bowels were more healthy ; and the startings of the muscles
were less frequent. He had not screamed on rolling or moving
the head since the bandage was applied. In a fortnight the
size of the head had evidently lessened ; the child was more
lively, and began to take notice of the persons around it ; the
secretions from the bowels were perfectly healthy and eva¬
cuated regularly ; the tongue nearly clean, and the skin of a
natural colour ; and the countenance more composed and
animated. It is now two months since the bandage was first
applied ; and the child is in every respect healthy, except that
the head still contains water, and is larger thaji it ought to
be. The flesh is firm, and the skin of a healthy mottled hue.
The water, 1 have no doubt, will in time be absorbed, and he
will completely recover. I shall recommend the bandage
to be worn until the bones are fully united.

As this disease generally attacks more than one in a family,
1 have advised that the younger children should w’ear a small
roller bandage on the head to support it during the time the
bones are forming, and until they are perfectly united. If
this were done more generally, as it used to be, I have no
doubt it would prevent many of those dreadful cases of hydro¬
cephalus we find in the present day. It is allowed by medical
men that the disease is more frequent now than formerly; and
to what greater cause can we ascribe it, than to the omitting

316 Original Communications.

of the application of that kind of bandage which was usually
employed to protect the head of the infant from injury, and
to support its imperfectly ossified and yielding parietes.

That this child was greatly relieved by the manner of
bandaging which I employed, and that alone, I firmly believe.
In order to ascertain more accurately the efficacy of this
practice, I ordered that the child should take no medicine, —
not even the castor-oil, unless it was absolutely requisite. It
was necessary to. give it small doses of the oil, but not
oftener than once or twice a week, and that in the very
outset of the plan. Its principal food during the cure was
eggs and milk ; I also allow'ed it a very small quantity of
wine as a stimulant to the stomach.

Bedford, July 23d, 1823.

VIL

Cases in iMch Fumigation proved a successful' Auxiliary
Remedy, By Powell Charles Blackett, Esq. Mem¬
ber of the Royal College of Surgeons.

From the opinions of some medical friends agreeing with
my own on the efficacy of fumigation, I have been induced to
avail myself of the advantageous opportunity which has lately
offered itself to the Profession, of trying it with some of my
patients whose cases appeared likely to be benefited^ by the
remedy. I have reason to be much satisfied with the result ;
and am induced to give a short abstract of those cases in
which I have had an opportunity of employing it, as it may
be the means of directing the Profession to an auxiliary
remedy in those obstinate chronic cases which are occasionally
found to be not much under the control of the usual modes of
treatment: and as fumigations are not only safe ‘‘ when pro¬
perly administered,” but frequently efficacious when little
expected, I trust it will not be considered an act of temerity,
on my part, to draw the attention of the Profession more
particularly to this mode of practice.

Case Is^. — My friend and neighbour, a general medical
Practitioner, had been afflicted with sciatica nearly five years.
There was no wasting of the limb affected, and the pain
always was diminished on taking exercise; but when he
came to sit for half an hour after his usual rounds of the day,
stiffness and pain returned, and his nights were not uncom¬
monly passed in extreme torment, which could not be allayed
by opiates, frictions, warm bath, or any of the accustomed
remedies in such cases. He was induced to try the sul-

517

Mr. Bjackett o/i Fumigation,

pbureous baths, as administered by Mr. Green, of Berry
Street, St. James’s — he took but four of them. Six weeks
have elapsed, and he has had not the least return of pain, not¬
withstanding the variable stale of the weather, which always
aggravated his complaint.

Case ^d. — ■ Mr. M., a respectable tradesman, near Regent
Street, had for many years been afflicted with gout, of the
atonic kind, accompanied with ail the varying symptoms fre¬
quently attendant on this disease. He had been confined
from last December until May of the present year, almost
exclusively to his bed-room. Being a corpulent man, he
required considerable assistance to move himself, or his
swollen extremities, when in bed. When he was able to get
up, he required the aid of two persons to help him to liis
chair ; and he considered himself tolerably well if he could
reach the window by the assistance of crutches. It was
with difficulty he got into a coach to go to Berry Street and
try the sulphureous lumigations, as he had been recom¬
mended. He found himself better even after the first bath.
He took one every other day; and when he went to the
fourth, he walked with the aid of a stick onl}^ After taking
the seventh, his amendment was so considerable, and the
swelling of the legs so much diminished, that he was able to
wear boots. He look altogether eleven of the sulphureous
fumigating baths; and ten weeks have now elapsed without
any return of his malady. This patient took no other reme¬
dies than a common aperient during the use of the baths.

Case Sd. — A gentleman, seven months previous to the use
of the baths, had had a severe attack of hepatitis, which was
subdued by the usual means. In consequence of the attack,
there remained much torpor of the liver, with evident enlarge¬
ment : he was also much emaciated, and very w^eak. He
complained of constant lassitude, of headach, and of thirst.
His tongue was white and furred, and his pulse irregular.
His skin was dry and unperspirable ; indeed he had not per¬
spired since the commencement of fhe attack. He had little
or no appetite, and his complexion was sallow'. In addition
to the usual treatment in chronic hepatic disease, which was
continued for some time w'ith but little advantage, he was
advised to try the sulphureous fumigations, with a view of
restoring the functions of the skin. He found himself relieved
after the first bath, and he continued moderately to perspire
during the following night. After three or four applications
of this practice, his general appeafaJice was much improved.
He could with comfort lie on his right side, which he had
not been able to do from the commencement of his illness ;
in short, he was so much improved that it was considered

VOL. XX. — -NO. 118. 2 T

518 Original Communicatiom,

a visit to .Cheltenham was all that was necessary for his
recovery.

1 have employed this remedy in several other cases, appa¬
rently with equal success; but as sufficient time has not
yet elapsed to ascertain the permanency of its effects, 1 shall
defer any account of them until a future opportunity.

Park Street, 20th August, 1823.

VIII.

A Description of Trephining Instruments, upon principles en*
tirely new, which are calculated to secure confidence to the
Operator, hy removing all apprehension of injuring the Brain,
and are applicable to uneven Surfaces; and which are sub¬
mitted to the attention of the Medical Profession. By Fre¬
derick William Morris, of Halifax, Nova Scotia,
Student of Medicine at the University of Edinburgh.

[With a Plate.]

Having witnessed, upon a few occasions, some anxiety on
the part of the Surgeon engaged in the operation of trephine,
when approaching the dura mater, and sometimes a degree of
difficulty on the first application of the instrument, these
circumstances excited my attention and reflection, and the
result has been the construction of the instruments which I
am now about to describe and to recommend to the Profes¬
sion. Allow me, therefore, to solicit the attention of those
who are interested in the advancement of surgical science to
the examination and practical application of them. I need
scarcely observe, that no mind, possessing enlightened views,
will for a moment suppose an invention of this nature in any
way derogatory to professional attainment ; for it must be
allowed that, in operations on the cranium, although anato¬
mical knowledge and manual dexterity may do much, still
much may also be accomplished by w'ell-constructed instru¬
ments. As the various instruments hitherto invented for
operations of the nature in question are unknown to few, I
shall now lake the liberty of describing those in reference
to this notification ; and here 1 beg leave to return my sin¬
cere thanks to those gentlemen to whom I liad first the
honour of submitting the instruments for inspection, parti¬
cularly to Dr. Ballingal, Mr, Allan, and Mr. Lizars, of Edin¬
burgh, and Mr. Guthrie and Mr. Grainger, of London, whose
kindness and encouragement I so freely experienced.

Fig. 1st. The common, or Hey’s saw. A, The handle.
B, '1 lie shaft of the instrument, which is admitted by a screw
into the brass plate, C, embracing the saw, D, and which

J N' S ' r XTlsA^K T B for T HE P

X nyzre-T^yt'e^ cf fp^y

Eb.h:DER.XCK WlLiLIAMMoilItlS,

. r .-— r - r - r.+. - r - ■ - 1 _ J 3 It-?-'

Zy .A/,' CA'^hH^

w>yi‘ -I'cipPir- 6^ f f^fxJketr

Mr. Morris’s Description of his Trephines and Saws, S19

plate has an opening, E, admitting a spiral spring, F, to
supply an index, G, which (unless in operation upon a sur¬
face where there is no hole or opening) is kept in a project¬
ing state beyond the line of the cutting surfaces, DO, by the
above spring, F, which spring is concealed by closing the
slide, H, a corresponding slide being on the opposite side.
It is evident, then, that when the instrument is in operation
upon any surface vvliere the resistance is equal, the index G
^vill be upon a level with the cutting surfaces, DD, on each
side of the index, as it retires within the brass plate or box,
C, by the resistance offered; but the moment the cutting
surface of either side has perforated, and thereby removed
the resistance, the shoulder or oblique corner of the index
will project obliquely into the opening; and lest even this
inode of entering the opening should injure the membrane
beneath, the spring possesses strength sufficient only to keep
the index in a state of projection. It will be advisable for
the Surgeon to use the other side of the instrument until he
has made a line or groove, by which he will be enabled to
use the index side with greater facility. It may not perhaps
be unnecessary to add, that the smaller the extent of the cut¬
ting surface of the insirument,’the greater will be the delicacy
of the operation, as by diminishing such surface the Surgeon
may operate upon any space, however small. We have now’
to apply this principle to the circular saw, Fig, 2, with an
addition to admit of its operation upon unequal surfaces.

Fig. 2d, A. 'I’he common trepan handle, shown by
Fig. 3, whi ch is admitted on to the shoulder, upon the shaft
B of Fig, 2, and secured by the screw' previously removed.
B. The shaft screwed into C, a box formed of two brass
semicircles, and connected by partitions of the same metal, to
allow tlie saws, DD, to slide in ; which saws are of a convex
shape, lest too great a perforation should be made before the
index could perform its office or arrive at the opening. E. A
semicircle (fastened to a sliding circle upon the shaft B) cor¬
responding to the box, C, which is of this form, and per¬
forated at three points, by the pillars, FFF, which are secured
by means of the moveable female screws, GGG, above, and
to the saws, DD, by means of the bridge and pins, HH.
Those portions of the pillars between the semicircle, E, and
the bridge, and attached to the saws and index, I, are con¬
cealed by spiral springs, KKK, viz. three within one another
on each of those supplying the saws, and one on the pillar
which supplies the index. The reason of this will appear
obvious, for by such an arrangement we have the elasticity of
three different springs over the cutting surface, by means of
which the saws will rise and fall with more regularity and

320 Original Communications.

certainty over inequalities ; whereas one is only requisite to
keep the index in its proper state of projection. In the
middle of the circle (embracing tlie shaft to which the semi¬
circle, E, is attached) is a male screw serving to fix the circle
upon any part of the shaft, B, increasing or diminishing the
power of the springs, according to the distance which is
allowed between the semicircle and saws, or, in other words,
by pushing the circle towards the saws, and fixing it by means
of the above-mentioned male screw^ ; the springs are thereby
contracted and increased in power, and by the reverse are
lengthened and suffer a diminution of power. It will also
appear evident that, by screwing down the nuts, GGG, either
the index or saws may be withdrawn, according to the wish
of the operator. L is a screw attached to the centre-pin, M,
as in all other instruments, but is not allowed to extend more
than to within about the eighth of an inch from the cutting
surface. To operate with this instrument (which resembles
the common trephine divided longitudinally), in the first
place, loosen the screw', E, and slide the circle towards the
handle of the instrument, by which means the shoulders of
the saws are brought close up to the box, C; thereby allow¬
ing the centre-pin, K, to project, with which, by two or three
turns of the handle, a hole is made sufficient to regulate the
motion of the instrument upon the part; return the circle
again to its former place, wliich will enable you to use the
saws; by now pressing until the point comes in contact with
the skull, the saws will be found to have adapted themselves
to the part, and at every turn this will be more complete;
they will now be seen rising or falling according to the pro¬
minences or depressions in the part. When the Surgeon
finds himself checked by the index, he must remove the saw
from that part, and continue the operation on the part di¬
rectly opposite, by a semi-rotatory motion of the handle,
which will be found perfectly easy ; and, of course, at every
succeeding perforation, the motion w'ili become more limited.

Fig. 4th only differs from the other instruments in being a
perfect circle, and having the index supplied by means of
the brass bridge. A, which gives off the small spring for that
.purpose from its centre; each end of the bridge being fastened
to the saws, as in the other instruments.

These principles, when applied to the straight saw for dis¬
playing the brain, by embracing a great extent of surface,
give a decided advantage, and form a beautiful and perfect
instrument, which I shall introduce at a future period. The
index is applicable to all forms of instrument for sawing.
The semicircular instrument, or Fig. Q, I think preferable to
the circular one, as being a more simple and convenient one,

Dr. Pring’s Principles of Pathology and Therapeutics. 321

rendering unnecessai^y the trouble of withdrawing any of- the
saws. A better proof of the delicacy of Fig. 1 cannot be
given than my having exposed half an inch of the Schnei¬
derian membrane in the frontal sinus of a sheep’s skull, with¬
out rupturing it at a single point, which many young ^men
witnessed.

PART TL

ANALYTICAL REVIEW.

An Exposition of the Principles of Pathology, and of the Treat.-
ment ^'Diseases. By Daniel Pring, M.D. Member of
the Royal College of Surgeons. 8vo* Pp. 512. London,
1823.

- - -

In our former article * on this work we analysed its three
first chapters — we now proceed to review Chapter IV. in
which Dr. Pring examines the pathology of the determina¬
tion of blood.” After a minute analysis of the phenomena
of the circulation, he concludes that these phenomena cannot
be explained by referring them to the functions of the heart
exclusively; but either, 1st, that the vital properties of the
vessels, by an immediate influence upon the blood contained
in them, assist in the transmission of this fluid throughout
their respective systems ; or, 2d, that this end is promoted by
a function of the capillaries. Under the former of these
heads we find some very conclusive arguments in favour of
the position, that whatever properties are presented by the
blood, and which fit it for the purposes of the circulation, and
are essential to this purpose, are derived from the vessels
within which it circulates — a position which we have uni¬
formly maintained ; and, moreover, we have maintained that
such properties emanate from that class of nerves w hich are dis¬
tributed to the blood-vessels, and which, through the medium
of the vessels, influence the fluids which flow in their channels.
Dr. Pring’s arguments respecting the various functions attri¬
buted to the arteries admit not of abridgment : we recom¬
mend them to the attention and examination of our readers.

• London Medical Repository for July 1823, p. 66 of this
Volume.

322 • ■ V ' • Analytical Review,

He next examines the different morbid j:)henomenai on which
the doctrine of determination of blood is founded, and very
properly disapproves of the manner in wdiich general inferences
have been unwarrantably deduced from them. 1 his part ol the
author's remarks is illustrated by some interesting cases.
Here again we are happy to find him corroborate the opinion
vrhich we have always espoused. ** Thus it appears/' he ob¬
serves, “agreeably with the strongest and most unexceptionable
testimony, that the determination of blood to a part is a con-
seque7ice of the assumption of a state of disease; that it is a
part of a diseased state, which it helps to establish; and that
it can be at most but auxiliary to the other causes involved
in the condition of disease, in deciding its varieties and dura¬
tion." Tfhe follow'ing paragraphs enunciate still more clearly
a proposition, which every one must admit who looks closely
into the nature of disease : —

“ In a state of perfect health, there is an equal distribution of
blood to the different structures, which distribution agrees with their
vascularity, and corresponds with their organization and functions.
Now, as the blood is passive, it is obvious that the equal distribution
of it depends upon a healthy state of the powers by which it is moved,
and on which its distribution depends. If this is granted (and I pre¬
sume it will not be denied), it follows that an unequal distribution is
the result of an unhealthy or disordered state of the organs upon
which its distribution depends. If, then, a part obtain an undue
quantity of blood, this excess of blood cannot be the cause of the
disease, because disease itself must precede its occurrence. Thus
the presence of an increased quantity of blood must be dismissed as
the cause, since it is proved to be the effect of disease.’' — P. 152.

“ If the state of disease acknowledged only one cause, the condi¬
tion of disease would be the same under the existence of the same
cause; and if disease show any varieties in its course, they must
originate in a different state or degree of this cause, and should be, in
their series, expressive only of its varieties. But the state of disease
is not, in fact, so simple : it must acknowledge a complication equal
to that of the properties which concur to produce the structures, to
support their life, and to maintain their health. This complication is
shown by every diversity which is observable, whether by a gross and
general view, or by the minutest scrutiny with which the subject can
be regarded. The properties which produced, support, and renew the
brain, are different from those which perform the same offices in
regard to the structure of the eye: the same is to be said on a com¬
parison of all the textures, the muscles, the bones, the arteries, the
veins, the lymphatics, the nerves, the membranes, glands, viscera,

&c . Every different arrangement in the constitution of an

organ, the constituents themselves of organs, their products, the fluids
compared with each other, all furnish proofs of the operation of a
diversity of properties" from which immense concurrence results the
harmony of a system in this particular example; as by a similar

Dr. Fl ing’s Principles of Pathology and Therapeutics, 323

co-operation of endless constituents, the general harmony of nature
is preserved. Now, if the causes on which health depends are so
numerous, shall it be said that disease, which is a deviation from
health, and in which all these properties are liable to be interested,
acknowledges only one cause ; or that out of our endless variety of
causes which concur to an effect, one only shall have the privilege of
suffeiitiQ a change. ”-pp. 155, 156.

We cannot follow our author through his very interesting
illustrations of the fundamental principles which these posi¬
tions involve. Nor can we regret the omission, since we
are conscious that every one who is desirous to look closely
into the phenomena, which it is the business of our lives to
comprehend and to combat, will peruse, and wdll be interested
by, the speculations which the critical, and other chapters of
this work contain.

We shall now give the conclusions which the author has
arrived at in his examination of the fundamental principles
of the doctrine of the determination of blood.

1. That a part cannot obtain a preternatural quantity of blood
by the exertion of any power which belongs naturally to the
arteries.

2. That the ascertained powers of the arteries, viz. their tonic
and elastic powers of construction, may be overcome by the causes
which produce determination of blood.

“ 3. That a preternatural determination of blood, although a
general accompaniment, is not found to be an invariable one of
disease, in seats where the evidence of such determination has been
looked for.

“ 4. That a determination of blood is occasioned by a local state
of the structure, and cannot be produced by any action of the heart,
which must be equally relative to the whole vascular system, or by
any condition of this organ, except such as presents mechanical
obstruction to the passage of the blood through its cavities.

5. That the determination of blood does not commence disease,
or is not the antecedent of this condition.

“ 6. That determination of blood is preceded by the assumption of
a state of disease, which is denoted by symptoms; which state of
antecedent disease, merely as it requires some term, may be expressed
by the words, irritation or excitement.

7. That as the recognised powers of the circulation are inade¬
quate to account for this phenomenon, the concurrence of a function
of the secerning system has been supposed necessary to this end.

“ 8. That the secerning system consists of the terminations of
arteries, which separate fluids from the blood, by an affinity with
these fluids, which is an exertion of the properties of life.

“ 9. That this function constitutes a power of attraction at the
extremity of the arteries, which helps to carry the blood through its
course, and is at once auxiliary to the heart in the circulation of the
blood, and a centre of the power which makes nutrient fluids pervade

T ■_

324 Analytical' Review,

the molecules of the structures, and is also capable of compelling their
return through the absorbents into the s^^stem of the blood-vessels ;
although it is probable that the absorbent orifices have a similar
function, which gives additional strength to the vis a tergo, by which
fluids might be otherwise conveyed through them.” — Pp. l63 — 5.

Having drawn these inferences from an examination of
the physiological principles of this doctrine, Dr. Pring next
analyses in detail its application to the explanation of the
phenomena characterizing various diseases. At this place
our readers will find acute and profound disquisition, fre¬
quently interwoven with most excellent practical observa¬
tions; and here we may remark, that the practical precepts
and deductions of so close a thinker as our author, come
before us with more than ordinary recommendations, and
are quite of a different character from the vaunted experi¬
ence of many — the carelessly observed — the loosely and
vaguely related, factSj as their authors are pleased to call
them, but which are only empirical notions improperly dig¬
nified with the name of experience.

Before passing on to the analysis of the explanations of
disease furnished by this doctrine. Dr. Pring illustrates, at
some length, his opinions respecting increase of the function
of the secerning system, which he supposes to precede the
more prominent phenomena characterizing local determina¬
tion of blood. He considers this increased function of the
secerning system to give rise to a greater derivation of the
fluids which permeate it, and consequently to occasion an
augmented flow through the arteries which supply it. The
vessels which subserve the secerning function are not, in his
opinion, necessarily those which open, on the surface, but
those which pour their fluids into the interstices; the
minutest molecules of which they permeate, and after hav¬
ing accomplished their share in the business of nutrition,
renovation, &c. are forced by a vis a tergo, or drawn by
another action of the affinity of life, into the system of the
absorbents. Having thus stated his fundamental proposition,
Dr. Pring next applies it to the explanation of some of the
phenomena characterizing the early stages of disease, &c.

“ Those properties of the structure which are most under preter¬
natural affection, or in the highest degree of excitement, will derive
and consume the largest proportion of the materials which are sup¬
plied to them, by the increased energy of the function by which they
are separated from the blood ; and an order of vessels, opening super¬
ficially, whose business it is to effuse fluids on the surface, and to
derive from those which supply the components of the textures, will
be deprived of fluids so long as the excitement of other properties
shall preponderate, and will relieve the internal structure, or diminish

Dr, Pring’s Principles of Pathology and Therapeutics* 325

tiie fluids which permeate them, when their function is either addi¬
tionally excited, or when the excitement of other properties is dimi¬
nished.’’ — P. 174<,

“ Thus, in inflammation of the liver or of the kidneys, the excre¬
tory function of these organs is diminished ; the balance of excite¬
ment being not in favour of that order of vessels whose business it is
to excrete, but of those which are to feed the diseased condition, the
properties of which have their seat in those structures whose demand
is for the materials of nutrition. But the secerning function of the
vessels of excretion of a structure are sometimes the seat of irritation
or preternatural excitement, and we find diseased states accompanied
by determinations expressed by an increase of the secretions proper
to glands or membranes, as those of the liver, kidneys, peritoneum, or
internal coat of the intestines.” — P. 175.

Dr. Pring considers that preternatural excitement of the
capillary distribution of one considerable artery, deriving
blood to this scat in considerable quantity, if exclusive and
not counteracted by a general diathesis, will deprive, in a
proportionate manner, the contiguous vessels of their usual
proportion of this fluid. He very justly supposes that the
increased derivation of blood by the extreme vessels is not the
only way in which the state of irritation secures to itself a
supply of this fluid, and induces subsequent disease. In most
local diseases the action of the heart is quickened, and thus
the supply of arterial blood rendered more rapid. Although,
in many cases, the accelerated action of the heart frequently
appears synchronous with the determination of blood in local
diseases, he considers that, if the succession of phenomena be
scrutinized, it will most commonly be found that the state of
irritation in the seat of local disease precedes the accelerated
action of the heart, and that the cause of this action is a
sympathetic extension of the state of irritation from its seat
to this organ. Pie, however, by no means intends to pre¬
clude the heart itself from the ability of originating disease.

It frequently happens,” Dr. Pring observes, “ in acute inflamma¬
tory disease, as of the lungs, liver, &c. that, as the rapidity of the
pulse abates, the superficial secretions commence or are increased.
The diminished action of the heart in such cases proves a diminished
energy or excitement in the seat of the local disease, which we have
supposed to be in those minute spheres of the structures which are
supplied by the nutrient secerning system, an abatement in the energy
of which admits an exertion of the function of the excretory vessels,
which were before deprived of their fluids by the preponderating
energy of those belonging to a connected system. I am not aware of
any other way in which the facts just adverted to can be connected
with any physiological distinctions, than by supposing that the excess
of excitement preponderates in one order of vessels, and that the
function of another order of vessels comes to be exerted, when this

VOL. xx.^ — NO. 118. 2 u

326 . Arial^tical Review. , . ’

excess is moderated, and the energy or excitement of the two systems
rendered more equal.’^ — P. 183.

We must refer our readers to the work for a full illustra^
tion of the view which these paragraphs involve, and pass on
to notice some practical observations which the author has
adduced under that part of the chapter wherein he examines
the comparative merits of the treatment which the pathology
of determination of blood suggests. This examination is
conducted with great ability, and with a strict reference to
the aulhor^s enlightened experience.

Our author considers that we have been apt to confide too
much and too exclusively in the effects of blood-letting in
inflammatory diseases, and to neglect other means. In pneu¬
monia he has commonly found that two bleedings, of twenty
ounces each, within the first thirty hours, with perhaps a
bleeding of eight ounces on the third da}", and two or three
smaller ones, of five or six ounces, in the course of the disease,
has done all that was to be expected from blood-letting. He
has had reason to think that repeated copious bleeding has
kept up or increased the accelerated action of the heart; and
the fatal cases which have come to his knowledge have been
chiefly those in which blood-letting had been solely confided
in,^ and therefore carried to a greater extent, without being
aided by means which are certainly equally powerful in sub¬
verting inflammatory action, such as nauseating, emetic, and
purgative remedies, together with doses of nitre from a
scruple to half a dram.

Of mercury, to the extent of salivation, in consumption not
arising from tubercular formations, Dr. Pring is disposed to
speak favourably. He does not approve of bleeding in this
disease, and he is not much inclined to recommend setons,
issues, and perpetual blisters. He next adverts to the fatal
consequences which sometimes result from too large evacua^
lions of blood in rheumatism.

f '

“ I have heard,” he remarks, “ of cases in which death was sup¬
posed to have happened from effusion into the pericardium, in which
this practice had been pursued unsparingly. I never myself met with
a fatal case of rheumatism, although I have met with many severe
ones. In some instances I have taken very little blood, perhaps not
twenty ounces in the course of the disease, from observing that the
symptoms were much more decidedly influenced by purgatives with
calomel, elaterium, aloes, salts, senna, squills, &c. together with full
nauseating doses of emetic tartar and ipecacuanha, which sometimes

produced vomiting, &c . The benefits of purging have appeared

to me more decided than those of blood-letting, more particularly in
the middle or chronic stages of the disease.”-^?. 214.

Dr. Pring relates some very interesting cases illustrating

Dr. Pfiog^s Frinciples of Pathology and Therapeutics, ^917

the practical precepts which he here inculcates. He men¬
tions having found chronic rheumatism of considerable dura¬
tion yield, after bleedings had been premised, to alterative
doses of calomel with sarsaparilla. He also remarks that it
is possible to produce syncope, in many inflammatory dis¬
eases, only by the use of combined purgatives and emetic
tartar; and that the reduced action thus produced is more
permanent than that which succeeds syncope produced by
blood-letting. Here, how^ever. Dr. Pring wishes it to be
understood that his objections are not offered to a proper and
a judicious use of blood-letting, but to an entire confidence
in it, together with a neglect of other means.

In peritonitis, also, he has trusted much more to purgatives
than to bleeding, and he has never had reason to regret this
confidence; for out of many cases he never met with one
that terminated otherwise than favourably. He considers it
the first object in inflammation of the bowels, whichever coat
may be the seat of it, to overcome the constipation with
which such inflammatory disease is commonly or frequently
attended. The secretions which purgatives excite through¬
out the intestinal canal have, he justly supposes, a beneficial
influence over the disease. Dr. Pring reasons wdth much
force against the idea that purgatives are hurtful in enteritis,
because they act by stimulation. “It does not follow,’’ he
observes, “ that an agent which is related with a secreting
function, so as to increase it, should also be so related with
inflammation (w'hich frequently suspends secretion) as to aug¬
ment its intensit}’. On the contrary, it w'ould appear that if
secretion is suspended by inflammation, that which restores
secretion must diminish inflammation.” Setting reasoning
aside, and reverting to experience, he suspects that in the
cases in which purgatives have been supposed to increase
intestinal inflammation, it is because these means were inade¬
quately employed. Notwithstanding the vomiting attendant
on enteritis, and although he has generally bled in the begin¬
ning of the treatment, he has never rested until he has opened
the bowels; and he has given the most active purgatives
again and again, after their repeated rejection by vomiting,
with the auxiliary of soap and other enemas, until an effect
upon the bowels has been produced. After this has been
obtained, he has never found bleeding necessary afterwards.
A little blue pill and aloes at bed-time, with a draught of
senna, salts, &c. in the morning, will, he believes, prevent in¬
flammation in the progress of the case, and dispose the
bowels to recover their healthy action.

Dr. Pring has found puerperal peritonitis generally do well
under adequate purging. He has premised bleeding, but

3^8 Analytical Review.

never carried it to a great extent. AH the fatal cases of this
disorder which have come to his knowledge have been those
in which the treatment has been rested on bleeding, .to the
neglect of other remedies. Leeches and blisters are useful
auxiliaries. What he knows of oil of turpentine in this dis¬
ease is favourable to the adoption of it. In cases of intes¬
tinal inflammation, after the failure of other means, he has
given ten grains of calomel every six or eight hours ; a saliva¬
tion has followed this dernihre ressourcey with copious stools ;
and a favourable corivalescence has afterwards been main¬
tained by purgatives of the w'eaker sort. When peritonitis
is attended with diarrhcsa, he considers the purgative practice
not the less essential — the means, however, should be less
violent than in its costive form.

In phrenitis, from local injury of the head, Dr. P. views
blood-letting as having a more decided control over the
symptoms than any other measure. Purgatives and nauseat¬
ing doses of emetic tartar are very important auxiliaries : cold
applications to the head are also requisite.

On the subject of apoplexy we meet with many very judi¬
cious observations, for which w'^e must refer our readers to the
volume. We may, how^ever, remark, that Dr. Pring con¬
siders that blood-letting, as a remedy for this disease, is in
some, though not in all cases, overrated. In illustration of
the operation of this remedy he cites several very important
cases.

“ Blood-letting,” he observes, “ in apoplexy, as a means of cure, is
indicated both by principle and experience to a certain extent; but
it is suggested by many results, that although bleeding to a certain
extent may relieve the vessels, and tend to produce a more equal
circulation, an excessive loss of blood is commonly itself productive
of an irregular circulation, and will therefore tend to increase it
where it exists, and perhaps will also concur with the tendency of the
disease to a rupture of vessels, by diminishing the power which these
structures possess of resisting the impulse of the blood.” — P. 237.

Dr. Pring very^ justly considers that epilepsy may be often
prevented by occasional bleeding and great temperance in
diet; but if the disposition to epilepsy is accompanied by
chronic symptoms of affection of the head, these symptoms
are not mitigated, but frequently increased, by a course of
depletion, which might be instituted for their cure. For
some good remarks on some chronic and nervous diseases of
the head, we must refer our readers to the work.

Blood-letting in heemorrhage from the lungs may, if employed
with discretion, be highly beneficial; but, as in affections of the head,
if carried to a great extent, it is likely to increase, rather than dimi¬
nish, the unequal distribution of blood, -and the seat of preternatural

Br. Fringes Principles of Pathology and Therapeutics* 329

• • IT '•X

determination in this, as in other instances, suffers additionally from

this effect.” . “I have reason to think saline purgatives, with

sometimes calomel, nitre, tartar emetic, ipecacuanha, &c. more
effectual in heemopiysis than repeated blood-letting.” — P. 254.

Nauseating doses of emetic tartar he considers as service¬
able ; but vomiting he views as a hazardous practice." It
should be recollected that, when the blood taken in haemop¬
tysis is buffed, our practice should be energetic, as tlte dis¬
ease then evidently tends to rapid disorganization. Bleed¬
ings of sixteen or twenty ounces, calomel, active saline "pur¬
gatives, full doses of nitre, squill, ipecacuanha, emetic tartar,
&c. should be employed in the beginning, together with per¬
fect repose.’’ This part of the work contains many judicious
observations on the treatment of this disease, to which our
limits prevent us from referring. The same may be said
respecting Dr. P.’s remarks on disorders of the heart.

“ Hydrothorax and effusion into the pericardium are less success¬
fully treated by bleeding than by purgatives ; of course, I speak only
of what has happened in my own experience. The effects of purga¬
tives in relieving patients from the pressure of fluid on the heart,
lungs, and diaphragm, are almost magical.” — P. 268.

“ Idiopathic dropsy, or that supposed to arise merely from preter¬
natural fulness of the vessels of the peritoneum, commonly yields to
purgatives, as of calomel, elaterium, caraboge, with perhaps large
doses of squill, and small ones of digitalis.” — P. 270. “ I believe

mercury will very frequently cure the disease (dropsy), if this remedy
is carried to a great extent. But it is often difficult in this, and other
local diseases of a fixed character, to make mercury produce its usual
effects ; and upon its producing salivation, I have reason to think its
curative operation depends. Not that the mere salivation is of any
use ; but it is an index of a more general affection.” — P. 27 !•

This part contains some excellent illustrations of the treat¬
ment of dropsy, especially a most instructive and ably ma¬
naged case, which our limits cannot admit. Our author’s
explanation of the operation of mercury on the function of the
liver is the most satisfactory which has been offered: our
readers w'ill find it at page 277.

Chapter V, Origin of disease in the abdominal 'viscera. — •
Dr. Pring admits that, although the universal origin of disease
in the digestive organs, as a pathological doctrine is false,
still the digestive organs are often primarily affected in dis¬
ease. The affection, however, of these organs, he considers
to be generally that of relation. From this consideration, he
classes disorders of the digestive organs — I. into those which
are exclusive — II. into those that are related.

The first class neither requires nor admits of subdivisions.
Dr. P. considers that exclusive disorder of these organs is

,330 Analytical Remew. ’ ’

,not very common. He cannot remember to have met with
more than three or four cases in which disorder in these seals
appeared totally unconnected with other disease. The sub¬
divisions of the second class, which Dr. P. has assigned,
are —

1. Disorder originating in the digestive organs, and pro¬
ducing disease elsewhere, by simple extension. To this
class belong some forms of chronic fever, occasional erysi¬
pelas, some kinds of ulcers, &c.

2. Disorder originating in the digestive organs, and ceas-
ing by the occurrence of disease elsewhere. Cases ol this
kind are not very common. Dr. P. has known consumption
preceded by severe chronic dyspepsia (which he considers is
more infrequent than is generally supposed), the symptoms
of which have ceased in the course of the secondary dis¬
ease. He has also known chronic dyspepsia, which appeared
exclusive for years, cease under a cutaneous eruption.

“ 3. Disorders of the digestive organs, originating elsewhere, and
exemplifying simple extension of disease, form a very numerous
class. — 4. Disorder of the digestive organs, originating elsewhere,
and holding a curative relation with respect to its primary seat. —
5. Disorder of the digestive organs, of synchronous origin with dis¬
order elsewhere; at least disorder of these and other seats, where the
succession cannot be defined. b. Disorder originating in the diges¬
tive organs, and producing disease elsewhere, which is neither of
simple extension nor curative, but in which the secondary reacts,
and increases the primary disorder. — 7* Disorder of the digestive
organs, originating elsewhere, which is neither one of simple extension
nor curative, but in which the primary disease is exacerbated by that
of the digestive organs. — 8, Disorder of primary or secondary seats,
including the digestive organs, with or W'ithout curative relation, ex¬
tended to other seats, also with or without curative relation.’' —
P. 294.

We cannot follow our author in his illustrations of these
classes ; nor can we give a satisfactory account, within our
limits, of his observations on the pathology and treatment of
disorders of the digestive canal. We may, however, observe,
that he considers the blue pill, in doses of one or two grains
every night, sometimes of service, when continued for a con¬
siderable time.

“ Mercury in all its forms,” he remarks, “ is generally prejudicial
in the dyspepsia, accompanied by excessive nervous irritability, with¬
out evidence of disordered biliary secretion : but even in such cases,
an improved state of health, at a more or less distant interval, will
generally succeed to its discontinuance, provided it has not been car¬
ried to an injurious excess.” . “A combination of sulphate of

zinc, in doses of a grain, twice or three times a day, with rhubarb
and extract of , gentian, is sometimes useful in dyspepsia. I have

Dr. Fl ing’s Principles qJ Pathology and Therapeutics. 331

known an obstinate spasmodic asthma, which appeared to be inti*
mately connected with disorder of the stomach, cured by a perse¬
verance in this medicine for some months.” — P. 307*

“ Purgative medicines are not, in general, successful in mere dis¬
order of the stomach, accompanied only with nervous irritability, and
perhaps headaches ; but they are eminently successful if the disorder
of the stomach is accompanied with disordered function of the liver,

or chronic pain in the side and stomach.” . “ As a treatment

for affections of this kind, I have found a pill, containing a grain and
a half of aloes, one grain of blue pill, and one of ipecacuanha, taken
three times a day, a good combination.’' — P. 309.

Dr. Pring considers, when purgatives, employed for the
cure of any form of chronic disease, whether in the digestive
organs or m distant seats, increase the symptoms in the early
periods of their use, as tliey frequently do, that such increase
of symptoms is rather an argument for the continuance or
even increase of the remedy than for its suspension or dimi¬
nution, since it shows that the remedy has a relation with
the disease. The following paragraph contains some of
Dr. Pring’s remarks respecting diseases of the skin, which
entirely coincide with those we have offered on various occa¬
sions : —

The connexion between dyspepsia and diseases of the skin has
been before remarked. Those who have written on diseases of the
skin, with a great appearance of learning and connoisseurship, have
done little more than multiply unnecessary and trivial distinctions',
and propose a jargon of barbarous terms, which none but persons of
very corrupt taste will take the trouble to remember. I do not, in
the works alluded to, remember to have met with any thing like a
principle of the pathology and treatment of these diseases. In this
place it is necessary only to remark, that, as we have seen, in our
analysis of the relations of disorders of the digestive organs, diseases of
the skin are variously connected with such disorder; so a long-con¬
tinued treatment, by small doses of blue pill, perhaps with colocynth
or aloes and ipecacuanha, will cure many of them, without recurring
to the more powerful agency of calomel, corrosive sublimate, or
arsenic ; and as a local application, hartshorn and water, in the pro¬
portion of a dram of the former to an ounce of the latter, is almost
a specific in many chronic diseases of the skin, attended either with
lymphatic or pustular eruptions, whether confined to one spot or
extending over a whole limb. The effect of this stimulus is to
exchange a peculiar for a common inflammation ; and I presume,
by the same mode^ liquor ammoniee, liquor potassse, and turpentine,
will cure tinea capitis: the proportion of hartshorn is to be regulated
by the irritability of the surface, and either applied constantly or
occasionally, according to circumstances. 1 his remedy has long
been employed in erysipelas, and I have used it with great success
in almost every case of disease of the skin described above, which

33^ - Analytical Review,

has fallen under this treatment: if continued after the specific
character of the disease seems to be subdued, it appears to irritate
and produce troublesome exfoliations of the cuticle.’^ — Pp. 311
— 313.

“ 1. The most effectual of the external applications are sulphur,
tar, the different forms of mercurial ointment, hartshorn, zinc,
acetate of lead, spirit of turpentine employed with oil as a liniment,
which I have found successful in some inveterate diseases of the
scalp, &c. All these remedies tend obviously to produce what is
called a new action. 2. The internal ones, which act chiefly on the
skin, are sulphur, arsenic, ammonia ; these produce heat of skin,
temporary fever, and thus substitute an artificial for a natural
diseased action. 3. The remedies which cure diseases of the skin
by their action upon related seats, and may be regarded as means
of revulsion, are purgatives, emetic tartar, calomel, corrosive subli¬
mate, nitre, &c.” — P. 313.

Chapter VI, Origin of disease in the nerves. — This is a
doctrine which has been adopted since the days of Willis.
The arguments which Dr. Pring has adduced with much
cogency against the system, are applicable only to those
views of disease which have for their fundamental proposi¬
tions, that all those tissues, to which the name nervous has
been applied, are sent off from, and form part of, those textures
of which the brain and spinal cord are the origin and centre.
They by no means affect the opinions which are brought
forward* respecting those textures which have been usually
called ganglionic nerves, and which are as different from the
nervous texture of animal life as they are from the muscular
or any other substance. Considering, therefore, that Dr.
Pring’s arguments justly apply, and are directed to those
doctrines of disease which refer all - derangements to the
nervous system — the authors of which doctrines having in
every case viewed the nervous system as identical in organi¬
zation and function throughout — we concur in all, his
reasoning. With respect to the extent of the nervous func¬
tions, the following is the opinion of our author: —

“ The evidence which we at present possess with respect to the
function of the nerves amounts to no more than this: — 1st, That an
unimpaired connexion should subsist between those of a seat and their
centre or origin, in order that such seat should be capable of sensation
or voluntary motion. 2d, That nerves themselves have no relative
function with the structures with which they are allied, independent
of the influence which they convey from their centres. 3d, That
although the processes of organic life are continued independently of
the nerves, yet the privation of accustomed nervous influence, as a
cause of excitement, which to some extent may be substituted by

Medical Repository for May, 1822*

Br. Fringes PririQiples of Pathology and Therapeutics^ 5Si5

other stimuli, is attended by a diminished energy of some or all of the
functions of organic life. 4th, That although organic life, consisting
of a maintenance of the living principle, assimilation, and absorption
of organic particles, may be continued without nervous influence, yet
this influence, in some instances, may be necessary to the functions of
organs ; which functions are powers superadded to the general cha¬
racteristics of organic life. Thus the influence from a centre of
nerves may be necessary to digestion, perhaps also to some glandular
secretions, &c.”i — P. 325.

Now this we consider perfectly just with respect to the
functions of voluntary nerves, or the nervous system strictly
so called; but we conceive, from the most convincing consi¬
derations, that the operations of the ganglial or organic class
of nerves are of as different a kind as their texture, distribu¬
tions, &,c. are different. We find these nerves chiefly sup¬
plying very distinct and dissimilar organs and textures from
those which receive the voluntary nerves. We find that
secretory organs and textures, and the whole vascular system,
obtain their nerves exclusively from the ganglial class of
nerves ; and we have good reasons for concluding that assi¬
milation and secretion, all the phenomena which the blood
and vascular system display, the generation of animal heat,
&c. — in short, that all the processes essentially vital, are the
functions of this class of nerves ; and, moreover, that all the
derangements of these functions have their origin in this
class, and in the relations which it holds with the other
systems and textures of the body, either in the seat of dis¬
ease, or more or less generally throughout the animal frame.

Dr. Pring draws the following conclusions respecting the
share which the nervous system appears to him to have in
disease. Restricting the term nervous system to the nerves
of sensation and voluntary motion, in connexion with their
centres, we are not disposed to dispute his inferences : —

1. That disease, originating either spontaneously or from ex¬
ternal causes, may concern principally those properties of a structure
which belong to and maintain its organic life.

** 2. That the function of the nerves of such part may participate
in a disease which engages probably, more or less, all the properties
of the textures.

“ 3. That the disease may be increased or modified by the parti¬
cipation in it of the function of the nerves.

“ 4. That the centres of the nerves, by nervous connexion, may
become disordered by a disease originating independently of the func¬
tion of the nerves ; and that the disorder of a centre of nerves so
produced may react upon the original disease, or extend the pheno¬
mena of the disease to other seats.

“ 3. That disease may originate in the branches of nerves, and
from a disordered state of properties may produce the phenomena

VOL. XX. — NO. 118. 2x

334 Analytical Review,

dependent upon an increase or diminution of their function, or may
influence the structures with which they are allied by properties
arising out of their assumed condition ; and that in either M'ay, they
may direct or modify the processes of disease, according to their rela¬
tion with other properties which may also have digressed from the
state of health.

“ 6. That disorder may originate in the brain and other centre of
nerves.

“ 7. That this origin of disorder may concern only the function of
the organ, and be expressed in remote seats by a modification of the
natural influence of such function, which will consist principally in
variety of degree.

“ 8. That phenomena of disease of the kind just described may
also originate in the brain or other nervous centre, by secondary dis¬
ease in the same seat; that is, a process of disease which commences
in the organic life of a nervous centre may disturb the functions
which belong to animal life; and this effect may be expressed else¬
where in the other systems, exclusively by phenomena dependent
upon the animal functions, over which such nervous centre presides.

“'9* That disorder of the brain or other nervous centre, originating
in either of the two last modes, may extend disorder to distant seats,
either by exciting a predisposition in such seats, if the functions of the
nervous centre are merely increased or diminished, or by producing
disease in such scats, by sympathetic relations of preternatural pro¬
perties, dependent upon the condition of disease which has been
assumed by the centre of nerves." — Pp. 345, 346.

Chapter VII, is on the relations of disease, — We regret
that our limits prevent us from exhibiting the opinions of this
able pathologist respecting the interesting topics which this
chapter embraces : we recommend them to the attentive
perusal of our readers.

We gave as full an account of the other chapters of this
important work as we could, consistently with our plan, at
the time when we were recording the advancement of medical
science.-— We must now take leave of Dr. P.’s very excellent
work for the present. Our opinion of its merits has been
fully given. We may, how^ever, now add, that the opinion
which we formed after a first reading of the work has been
fully confirmed by a second perusal of it. It is not a reading-
made-easy book — one which will be valued by the idle, the
ignorant, or the empirical Practitioner ; such a reader will
find a difficulty in comprehending some parts of it, and his
untutored mind will even be unable to follow Dr. Pring in
many of his profound analyses, and in the intimate views
which he takes of morbid phenomena. It is chiefly in this de¬
partment, and indeed in other departments, of our Profession,
that many who practise it ought to regret — were, they capable
.of comprehending the real cause of a portion of their defi-

S35

Mr. Bayfield ow Practical Cupping,

ciencies — the want of that kind of education in early life —
namely, well-conducted and full courses of mathematical,
logical, and metaphysical studies — which is the best suited
to form the mind to habits of calm reflection, and to direct
it to objects of profound research. For this reason, there¬
fore, the present work will be most valued by those in the
Profession whose opinions are most valuable; and we are
happy to find, that these are so numerous amongst us, since
we understand that it has already been more read, and more
generally approved of, than any other work on the abstract
part of medicine has been in so very short a time as has yet
elapsed since its publication.

11.

A Treatise on Practical Cuppings comprising an Historical
Relation of the Operation, through Ancient and Modern
Times; ivith a copious and minute Description of the several
Methods of performing it ; intended for the instruction of
the Medical Student, and of Practitioners in general. By
Samuel Bayfield. With Plates, l^rno. London,
1823. Pp. 175.

Mr. Bayfield, in his introduction to this useful little
work, offers some remarks on the importance of a knowledge
of the operation of cupping, and of dextei;ity in performing
it, to Surgeons and general Practitioners, especially to those
who practise in the country, and to the medical officers of
the navy and army. Mr. B. adduces several instances
corroborative of the justness of these opinions, and after¬
wards 5/ives an historical account of this manner of detractins:
blood, which betrays considerable information. He very
judiciously confirles himself to a description of the manual
operation of cupping, and leaves the account of its therapeu¬
tical powers in various diseases to other ‘writers.

The description of the instruments and of the manner
of operating with them is full and perspicuous. Mr. Bay-
field recommends the approved scarificator, and offers some
judicious remarks respecting the cucurbitulse, for which we
refer to the volume. The following are excerpts from this
part of the work. In addition to these and the torch, or
exhausting lamp, the operator should have in readiness, ‘‘ a
washing-hand basin ; a piece of fine sponge; a small bottle
of rectified spirit of wine; a lighted taper; a jug of w'arm
water; some folds of lint; a piece of adhesive plaster, or
black court plaster ; a box of cerate, either of wax, or

336

Analytical Review.

spermaceti; two or three napkins; a graduated measure/^
Instead of the last article, one of the glasses may be
used.

Mr. Bayfield next describes the operation, and gives
perspicuous directions, suitable to the varying circumstances
in which cupping may be required.

2. For general purposes, let the scarificator be set so that the
points of the lancets project from the face of the box to the distance
of one quarter of an inch.

There are particular exceptions' to this rule ; when the operation
is to be performed behind the ears, the depth of the lancets should
be one-seventh of an inch ; for the temple one-eighth, and for the
scalp one-sixth of an inch.

^ “ 3. The next step is to select a spot (on the part chosen for the
operation) where each glass is to be affixed. It should be free from the
projection of any process of bone, and yet not be overloaded with fat.

“ 4. The part therefore should be carefully examined with the
fingers ; and an eligible spot being found, the glass should be placed
upon it, for the purpose of adjusting its exact situation, and to serve
as a guide to the eye in its subsequent application.

“ The number of glasses which should be used must be deter¬
mined according as the part is adapted to receive them, and to the
quantity of blood necessary to be drawn. About one glass to every
four ounces required is the usual ratio ; so that if it be wished to
take away eighteen or twenty ounces, and the part w'ill allow of
their application, four or five glasses may be put on ; as the abdo¬
men, the back, &:c. : but there are few parts where more than four can
be applied conveniently, and often not more than two or three ; as on
the upper part of the neck, for instance; and sometimes but one, as on
the temple, &c. Three cups usually extract from five to seven ounces
of blood at each application.

“ 5. Some hot water is now to be put into a basin, and the cups
are to be immersed in it till they become warm. The part itself
should be fomented with hot water ; and the operator having poured
two or three drams of the spirit into a cup or glass, takes the torch
in his right hand, and a cupping glass in the left, and places the lower
edge of the glass in contact with the skin, (in the exact spot where it
is to be affixed) elevating the edge at the opposite side of the glass about
an inch and a half from the skin ; the wick of the torch is now to be
dipped into the spirit, lighted at the taper, and carried under the glass
to its centre, where it is suffered to remain about tw’o seconds ; it is
then to be withdrawn quickly, and if it has been properly performed,
the operator will feel the glass sink from his fingers, and fix itself to the
part; the skin rising slowly into the glass, until it occupies nearly
one-third of the space within it.

6. The glass having remained affixed about a minute (during
which time the top of the scarificator-box should be warmed on the
palm of the hand), the operator holding the scarificator in his right
hand, takes hold of the gla^s with his left, and insinuating one of the

M. Rostan on Softening of the Brain.

537

finger-nails of his right hand beneath the glass, the air rushes into it.
He instantly removes the glass, and before the tumefaction has sub¬
sided, springs the lancets through the integuments. The glass is then
immediately exhausted, and applied as before, when the blood will be
observed to flow copiously.”

We must refer to the original for directions for the manner
of removing the glasses, which ought to be with the assist¬
ance of a sponge.

We recommend this work as the best account of the opera¬
tion of cupping, and as containing the best and most perspicu¬
ous description of the manner of performing it, that has come
before us.

PART III.

- -

ANALYSIS OF FOREIGN PUBLICATIONS

IN THE DIFFERENT BRANCHES OF MEDICAL AND
SURGICAL SCIENCE AND LITERATURE.

Recherches sur le Ramollissement du Cerveau : ouvrage dans
lequel on s'ejforce de distinguer les diverses Affections de ce
Viscere par des Signes caracteristiques. Par Leon Rostan,
Medecin de I’Hospice de la Vieihesse — Femmes (Salpe-
trihe.') Professeur de Medecine Clinique. Seconde edi¬
tion. Paris, 1823. 8vo. Pp. 503.

Researches on Softening of the Brain: a work in which the
various Affections of that Viscus are attempted to be distin¬
guished by characteristic Symptoms. By Leon Rostan,
Physician to the Hospital for Aged Females (SalpUrilre.)
Professor of Clinical Medicine. Second edition. Paris,
1823. 8vo. pp. 503.

Although many isolated examples of the disease to which
the term Softening of the BrairT has been applied by the
French writers, have been given in the w'orks of various
authors, particularly in those of Morgagni, Rochoux,
Abercrombie, Bricheteau, Moulin, &c. the author
before us is entitled to the credit of having first treated ex
professo of the subject. A detail of the pathological and
therapeutical views of this gentleman will be the object of
the present analysis.

Symptoms. — Softening of the brain is said to present two
distinct periods.

3S8 Foreign Medical Science and Literature.

First period. — The symptoms which show themselves in
the first period are uncertain, fugitive, and common to many
diseases, especially to those which have a somewhat intimate
connexion with the encephalon. Taken by themselves, they
are consequently of but little importance ; but on the super¬
vention of the signs which mark the second period, they
become of so much value, that if they had not been present,
the existence of softening of the brain could not be affirmed.
One or two of these phenomena are sufficient to indicate
the disease. They are local or general, and belong to the
encephalon or to the other viscera. The principal amongst
them are a fixed, obstinate, intolerable pain of the head,
continuing for several days or months : this pain is not con¬
stant. Vertigo — diminution of the intellectual faculties:
the perception, judgment, memory, and imagination, are more
or less vveakened : slowness in answering — -embarrassment
in speech — occasionally abruptness of speech — sadness —
hypochondriasis or indifference — tendency to sleep — formi-
catio — numbness in one of the limbs, commonly towards
their extremities — difficulty in laying hold of objects — -
rigidity and contraction of the limbs : the sensibility of the
diseased limbs is generally more diminished than their con¬
tractility : sometimes the sensibility increases so much that
the least touch coiupels the patient to cry out : these pains
may be distinguished from those of rheumatism, by their
being always unattended with redness, heat, or tumefaction :
the intellectual faculties are occasionally depraved, and some¬
times improved : there is delirium, with extreme agitation
and febrile symptoms : finally, mental alienation and dotage
frequently precede softening of the brain.

Difficulty in supporting a strong light, as well as strabis¬
mus, is rarely present; frequently, however, diminution and
perversion of the sight, or complete blindness, tinnitus
aurium, difficulty in bearing the least noise, and more fre¬
quently a diniinished state of hearing, occur.

The smell and taste seldom present any alteration suffi¬
ciently sensible to cause the patient to complain. The
major part of the symptoms above described are so slight,
that the [latients rarely apply for medical assistance, and
frequently do not even mention them to those around them.
It will be seen, under the head of diagnosis, that these pheno¬
mena are not the precursory signs of apoplexy.

During this period the organic functions also frequently
present derangements. 'I’he appetite is diminished there
is much thirst — the digestion is impaired — the mouth
clammy, and the tongue white : nausea exists, and even
vomiting of a bilious, green, and porraceous matter : the

339

-M. Rostan on Softening of the Brain.

epigastrium is tender on pressure, as well as the rest of the
abdomen : in some cases diarrhoea manifests itself; but con¬
stipation, or railier torpor of the rectum, is more common :
it rarely happens that during this period the stools are passed
involuntarily : it is not the same, however, with respect to
the urine, which, for the greatest part of the time, is retained
with difficulty : the quantity of this evacuation is, however,
less tlian ordinary. The respiration is sometimes affected;
but it is more frequently rendered slower than quicker. The
pulse is very variable, rarely increased in frequency : occa¬
sionally it is more full, whilst in other cases it is smaller and
slower than natural. It is by no means uncommon for some
severe thoracic or abdominal inflammation to precede the
softening of the brain, M. Rostan has sometimes ob¬
served it preceded by a general inflammatory diatliesis.

Second period. — After having laboured under some of the
symptoms above described, the use of some of the members,
or even of half of the body, is suddenly or gradually lost,
and in a more or less rapid manner. During the greater
part of the time the understanding remains perfect : some¬
times, however, the patient has extreme difficulty in answer¬
ing the questions which may be addressed to him ; and it is
only by signs that he shows his comprehension of them.
In certain cases there exists a complete comatose state. If
the coma and paralysis have suddenly supervened, the patient
commonly regains his intellect on the day after the super¬
vention of these symptoms; fresh symptoms, however, come
on, and become aggravated ; the senses are entirely lost ;
the patient falls into a slate of perfect coma: at the expira¬
tion of some days, commonly from the fourth to the fifteenth,
the limbs become immoveable, and he dies, presenting, in the
greatest number of cases, the symptoms of typhus fever.

Diminution or abolition of the muscular contractility, or
paralysis, most frequently takes place. Tliere exist also
numbness, great sense of weight, formicatio, pricking, lanci¬
nating, and intolerable pains in the limbs — especially
increased when the limbs are touched. It is not uncom¬
mon to observe great rigidity, and an inseparable contraction
of the diseased side. Convulsions rarely occur.

The face may be either pale or much flushed : the pain
in the head, which existed prior to the appearance of the
symptoms of the second period, becomes increased in
severity: at this stage it supervenes, even when the patient
has not previously experienced it. [f he be asked* to
point out the part where he experiences the pain, after
the first, but frequently not until after the second or third
question, he places the unaffected hand on some part of the

S40

Foreign Medical Science and Literature,

head, which is almost always the seat of the disease, and
on the side opposite to that affected with paralysis. When
delirium exists, it continues after the manifestation of the
paralysis; but the patient is more taciturn.

Delirium is not common : a more or less considerable
diminution of the intellects a comatose slate, more or less
profound, are more usual. The senses partake of this con¬
dition — they become much less sensible to their excitants,
and cease to be at all affected by them towards the last
moments of the disease. Sometimes one of the pupils is
more dilated than the other, and is even wholly immoveable.
The eyes are frequently fixed, and directed upwards : the head
commonly inclined backwards. The hearing generally becomes
hard. M. Rostan does not think that he has seen either
it or the sight become more acute in the second period.
As for the taste and smell, they almost always show a dimi¬
nution of their sensibility when any stimulants are applied
to them. The mouth is rarely distorted at this period : later
on, however, it becomes so : the sense of touch probably
suffers the same derangement; but it is difficult to arrive at
any positive knowledge on this subject: picking of the bed¬
clothes is frequently a concomitant.

The thirst is commonly augmented : the appetite dull :
the lips and teeth are dry : the tongue rugous and cracked,
at first red, but soon brownish, and even blackish. Degluti¬
tion is often difficult, and sometimes impracticable : the
patient makes considerable efforts at swallowing, and some¬
times experiences convulsions during the attempts. In some
cases copious vomiting, at first of food, and afterwards of
bile, is observed. The abdomen sometimes gives signs
of high sensibility : occasionally there are involuntary alvine
evacuations, but more frequently constipation is present.
The urine most commonly'^ passes unknown to the patient,
as has been pointed out under the first period : the respira¬
tion is affected in the generality of cases: the pulse, in some
cases, is more frequent and strong than usual.

Progress of the disease. — This state remains stationary
for a longer or shorter time, after which the disease proceeds
more or less rapidly to its fatal termination. At other times
its progress is evident in the first days, and it alw^ays goes on
increasing until its termination : it is very rare to see the
symptoms of coma and paralysis diminish at a somewhat
advanced period of this affection. The progress of the
disease is essentially continual, and always increasing. The
patient almost constantly lies on the back or the paralysed
side during the whole course of the disease. This affection
not only pursues an acute and chronic inarch, but also all the

34?

M. Rostan 07i Softening of' the Brain.

intermediate shades. The acute slate may be distinguished,
and a more speedy termination be predicted, when the symp*-
loms proceed with intensity and rapidity. If they are slow
and stationary, the fatal period will be more remote.

This affection does not constantly proceed with such regu¬
larity, but presents various anomalies higlily necessary to be
known. These anomalies spread much uncertainty on the
diagnosis of the disease, and may even render it perfectly
impossible. There are cases of softening whicti present no
symptom, others which proceed entirely contrary to the
regular march, -and others which present an insufficient
number of symptoms to characterize the disease. There are
cases, for example, in which the precursory symptoms are
entirely wanting : such cases M. Rostan thinks, however, to
be much more rare than they may appear to be to the major
part of those who have seen but little of softening of the
encephalon ; but he is of opinion that cases may happen in
which they do not exist.

Complication of the disease. — The affections which most
■frequently exist in concurrence with softening of the brain,
are sanguineous apoplexy — the most common complication:
inflammation of the membranes of the brain : cancers of the
brain : fungous tumours, exostoses, tubercles, and hydatids.
Phle2:masi83 of all the other viscera mav also be co-existent
with softening of the brain. In order to show the particular
appearance impressed upon the disease of which we are now
treating by the different affections above-mentioned, M,
Rostan has adduced several examples in the course of his
treatise.

Duration of the disease. — This is a subject on which it is
difficult to arrive at any satisfactory knowledge, in conse¬
quence of our not being able to lix the date of the first
symptoms: the precursory symptoms, or first period, accord¬
ing to M. Rostan, may vary in duration from some days only
to months and even years. In the second stage a variable
period may elapse between the moment at which paralysis
supervenes and death. T his period varies from two or three
days to two or three months. The duration of the affection
is -also influenced by the more or less intense action of the
exciting causes — the constitution and state of health of the
individual ; but especially l)y the extent, depth, and seat of
the lesion, and by the more or less rational mode of treatment
which may have been pursued.

Frequency of the disease. — M. Rostan considers that the
■disease is far Irom being infrequent ; osi the contrary, he
thinks that it is the most common cerebral lesion, not except¬
ing sanguineous apoplexy.

VOL. XX. - NO, J 1 S. 2y

342 Foreign Medical Science and Literature*

Pathological alterations* — The softening varies according
to the degree of consistence of the cerebral substance — its
colour, seat, extent, and number of alterations. The mem¬
branes are very frequently infiltrated by serum, presenting a
gelatinous appearance : this does not, however, always exist,
although there are but few cases in which it is not met with.
In these very rare cases the membranes are dry, and without
a manifest change of colour; occasionally they are red and
injected, but seldom affected with suppuration: sometimes
the membranes adhere to the softened part of the brain.
The morbid consistence of the brain varies from that of the
thinnest houillie to a firmness approaching that which is
natural to the organ. The middle state between these two
extremes is the most frequent. When the softening is by
no means considerable, it is difficult to appreciate it, unless
there be at the same time change of colour, which frequently
happens. *

The colour of the softened portion may be yellowish,
greenish, rose-coloured, red, chesnut, like lees of wine, or of
a dull white. These shades maj' be met wfith in a larger or
smaller number at the same time in the same individual.
The greenish yellow is commonly found in cases where the
softening has been subsequent to an old attack of apoplexy :
at such times the centre of the softened part presents this
colour. The rose-coloured shade, more or less red, is dis¬
covered in cases where the disease has been primary : it
shows itself more particularly towards the circumference, and
especially on the convolutions. The colour of lees of wine is
not uncommon : it gives to the softened part the appearance
of a scorbutic spot of an ecchymosis-. M. Rostan considers
that this last appearance is in all probability owing to a frus¬
trated hemorrhagic effort (un effort hemorrhagique avorte) :
he has never seen an example where there was one spot only :
in general they are numerous. The softened portion is often
of a dull white colour like milk ; tlie wffiiteness of the
medullary substance seeming heightened by the contrast :
this case is not uncommon. These are the colours which
M. Rostan has most frequently observed; but it will be readily
conceived that the intermediate or other shades may like¬
wise exist.

The softening may be superficial or profound. If the
lesion be superficial, the convolutions are found disfigured
and tumefied, either in a circumscribed part, or in the whole
of the hemisphere, rarely in both, but always in a more or
Jess uneven manner. At other times the change in consist¬
ence is indicated by the change of colour in the cortical sub¬
stance; this latter, in place of being of a yellowish grey, is

343

M. Rostan on Softening of the Brain.

rose-coloured in some parts, and almost always only half
through its substance. When these parts are touched, they
are found manifestly softer than those which have preserved
their primitive form and colour. If they be cut with a
scalpel, the edges which form the segments are obtuse,
rounded, and uneven : when the back or the handle of a
scalpel, or any blunt body, is passed over the altered part,
a portion of this substance is commonly removed by it,
which does not occur when its consistence is natural. This
superficial lesion may be of a greenish yellow colour, and
may" be met with at the same time as the other, and in parts
which are more softened. It follows the convolutions, dip¬
ping with them into all their windings. It cannot extend
beyond the cortical substance, or the superficies of the
medullary matter. Its most common extent of surface is
two or three inches in circumference : it may, how^ever,
occupy half or even the whole of a hemisphere.

The alteration is sometimes, however, seated more deeply :
all the parts of this viscus are exposed to this disorganiza¬
tion : the corpora striata and lhalami optici are most fre¬
quently affected with it : after them the central part of the
hemispheres — the middle lobe is its most common seat.
M. Rostan has not often observed it in the falx cerebri.
The cerebellum and cerebral prolongations are not exempt
from it. M. Scipio Pinel is said to have frequently wit¬
nessed this species of lesion in the spinal marrow. At these
different depths the softening may" be more or less extensive :
it may be of the size of a haricot-bean, or it may occupy a
great part of one lobe of the brain. It is difficult to fix the
limits of the softening in a precise manner; the centre being
always more softened than the circumference, and the latter
resuming its natural consistence in an irregular, indeter¬
minate, and gradual manner. There is commonly but one
lesion : it is rare that both hemispheres are affected : at such
times the one is always more affected than, and seems to
have preceded, the other. The same hemisphere may be
softened in different degrees in several parts : in short, it
may contain a multitude of ecchymoses, of a violet or lees of
wine colour, resembling scorbutic patches, w'hich are scattered
at different depths over the cerebral substance. The soften¬
ing may be joined with effusion of blood ; to which, in many
cases, it forms an envelope, and sometimes, indeed by no
means uncommonly, it exists in a distant part. It also accom¬
panies cancer of the brain, and every organic derangement of
that viscus.

The ventricles frequently contain a considerable quantity
of serum, which, according to M. Rostan, has frequently

344

Foreign Medical Science and Literature,

distractecl the attention of observers, and led them to ta^e
this disease for liydrocephalus or serous apoplexy. Tlie
arteries of the brain are commonly ossified when this organ
is softened.

Nature of the disease. — The following are M. Rostand
ideas on this subject :

“ I am of opinion that softening of the brain is often an inflam¬
matory affection — that it is frequently the result of encephalitis. The
rose colour, which is sometimes observed, can only be the effect of
an inflammatory process; the fixed pain of the head announces a
process of the same kind, although all pains are not inflammatory :
the convolutious are often thickened and tumefied ; the strength, the
frequency of the pulse, the heat of the skin, the redness of the face,,
the dryness of the tongue, the thirst which is observed in certain cases^
are signs of reaction, which commonly accompany the phlegmasise :
the softening, manifesting itself occasionally around a sanguineous
effusion, a cancer or tubercle, may be at such times assimilated to the
inflammation which nature produces around organic lesions of all
kinds at a certain epoch.

“ But if the softening sometimes presents these characters, it more
commonly offers some entirely opposite : errors in reasoning should
be avoided : because a thing frequently happens in one manner, it
does not follow that it should always happen in the same way. Thus
the symptoms of an opposite nature to those which we have just
shown to point out inflammation, are frequently present, viz. dimi¬
nution of contractility and sensibility, paralysis, stupor, dulness of
intellect, paleness, cold, smallness of pulse, absence of headache..
The colour of the brain in the majority of cases is unchanged : occa¬
sionally it is red, like the lees of wine — of a scorbutic appearance.
There is neither blood nor pus effused into the cerebral substance..
Softening of the brain may be the senile destruction of this organ :
it may be a sort of scorbutic hemorrhage: in short, it may be of an
unknown nature. It is, therefore, sometimes inflammatory and some¬
times not.”

Termination and prognosis. — The resolution of softening
of the brain, when arrived at its second period, appears to
M. Rostan a problem yet to solve : he has adopted every
mode of treatment without having obtained it. It is not so,
however, with the first period, which is susceptible of cure.
Some organic lesions met with after death, and not at all
resembling the marks left by apoplexy, might lead to the
belief that they had been produced by softening of the brain,
and that consequently it had been cured ; but this can only
be conjecture. The brain is sometimes hardened in a par¬
ticular manner : this lesion has been considered by manv as
the sign of an old softening of the brain. Cancer of the
brain M. Rostan considers to be no more the constant
sequel of inflammation than other cancers ; and he thinks

343

M. Rostan on Softening of the Bram.

that softening of the brain following cancer is a ranch more
frequent occurrence. There are some individuals who con¬
sider that softening is only a gangrenous state of the
encephalon.

Causes of the Jzscasc. We are, at the present time, igno¬
rant of the predisposing causes or predispositions of soften¬
ing of the brain. Old age, however, appears to be a predisposi¬
tion ; and M. Rostan considers that women are more subject
to it than men, if the registers kept at the hospitals be taken
as a criterion.

T he exciting causes are esteemed to be those of all diseases,
but more especially such as act directly on the encephalon :
the action of a scorcliing sun, or of intense cold; the appli¬
cation of ice upon the liead, or of any substance endowed
with active properties : a violent percussion : a fall upon the
head : intense thought : long watching : violent passions,
especially chagrin : the abuse of alimentary or medical
substances, which act strongly on the encephalon, such as
wine, spirituous liquors, coffee, narcotics, &c.

Softening of the spinal marrow. — The smallness of the
diameter of the spinal marrow, and the narrowness of the
vertebral canal, do not permit the thought that the disease
can only occupy the half of that organ, and consequently
do not allow us to think that the signs which announce that
lesion can be for a long time confined to one half of the
body. Thus the symptoms occasioned by the alteration of
this organ soon strike both sides of the body, when it has
nevertheless (which is rare) commenced with one: according
to the nature of the derangement there will be augmentation,
perversion, diminution, or even abolition, of sensation and
of motion in the parts situated beneath the alteration. If
the disease be inflammatory, there will be convulsions of the
limbs and trunk, with symptoms of reaction. If the soften¬
ing be atonic, there will be diminution, and afterwards com¬
plete loss of sensibility and mobility. If the softening occupy
the dorsal and lumbar region, the trunk, the rectum, the
bladder, the genital organs, and the lower extremities, will
be the seat of the lesion : if it occupy the cervical region,
especially the most elevated part, paralysis, convulsions, &c.
of the thoracic members, will be joined to the symptoms
just described. The functions of the senses and of the
understanding are more or less disturbed in this disease, as
well as the respiratory, circulatory, and digestive functions,
which are under the more or less immediate influence of the
spinal marrow.

(To he concluded in our next Nwnher.)

346

Medical and Physical Intelligence.

PART IV.

MEDICAL AND PHYSICAL
INTELLIGENCE:

BRITISH AND FOREIGN.

. r _

I. Experiments on the Therapeutical Properties of Strychnine.

By M. Andral, fils.*

The strychnine which M. Andral exhibited in the following cases was a&
pure as could be obtained, and was entirely deprived of brucine (see the
subsequent experiments with this substance), to which it remained united
in the preparations which M. Pelletier first made of it. It was given in the
form of pills, some containing the twelfth part of a grain, others the sixth of
a grain.

Case \st. — A house-painter, after having been several times affected with
colic, was attacked with that variety of paralysis to which this class of
mechanics are subject, and which consists in a great weakness of the
extensor muscles of the hand. The paralysis had been ineffectually treated
by stimulating frictions on the fore-arm. This individual took on the first
day a pill, night and morning, each containing half a grain of this
alkali. He experienced a painful trembling in the extensor muscles. On
the three following days the same dose was attended with like effects.
Four pills of the same strength were given on the fifth, sixth, and seventh
days, two night and morning. The effects were slight shaking of the limbs,
spasmodic contraction of the extensors of the fingers, and a diminution of
the paralysis. Pills of one-sixth of a grain each were then given, com¬
mencing with one, and afterwards increasing them to four at the end of
eight days. During this time he experienced violent shocks. He soon left
the hospital (La Charite), retaining only a slight weakness in his hands.

Case Zd. — A compounder of colours was affected with a similar form and
degree of disease to the preceding. A single pill, containing one-twelfth of
a grain, occasioned slight trismus, and incipient tetanic stiffness in the
muscles of the neck, the abdomen, and the limbs. The next day he took
another pill, and experienced only some spasmodic contractions in the
limbs. At the end of six pills, a pill was prescribed for him, night and
morning : violent contractions of both arms took place. The strychnine ,
was continued at this dose for fifteen days ; at the end of this time the
paralysis had disappeared.

Case 3d. — A German, of a strong constitution, who had long laboured
under paralysis of the extensors of both hands, from the eft'ects of the
preparations of lead, took a pill of one-twelfth of a grain, without feeling
any effects from it. At the dose of one-third of a grain, he began to
experience some shocks. He took ^omewhat too speedily a little more
than a grain of this alkali : at this dose he experienced such forcible
contractions, that it was necessary to reduce it to a grain. This man was
not benefited by it. This case, compared with the preceding, shows how

* The following experiments were made at La Charite, in the wards of
M. Lerminier.

Medical and Phi/sical Intelligence. 347

much the action of strychnine may vary according to the susceptibility of
the subject.

Case 4:ih. — A man accustomed to work in white lead had the same sort
of paralysis as the preceding. A pill containing one-twelfth of a grain of
strychnine produced in him violent trismus ; the next day he took a like
quantity, and this time felt no effect. Two pills produced strong shocks in
the limbs. In a short time the dose was increased to two-thirds of a grain :
this quantity could not be exceeded, owing to the supervention of tetanic
symptoms. This patient was relieved.

Case 5th. — In a potter, paralysed as the former, the dose of strychnine
was raised, in twelve days, to one grain. He experienced weak contrac¬
tions only. When this dose was exceeded, locking of the jaws, and throw¬
ing of the head backwards, supervened. Terrified by these unpleasant
symptoms, the patient would take no more pills, and left the hospital
without being relieved.

Case 6th. — A man was admitted into the hospital with incomplete
paralysis, which had been ineffectually treated by blisters, moxas, and
cauteries, applied on the lumbar region : there was no deviation of the
spine. A pill, consisting of one-twelfth of a grain, did not produce any
effect ; two pills occasioned slight convulsions of the inferior limbs : they
were carried to the extent of four a day (a third of a grain). This dose
gave rise to somewhat acute pain in the lumbar region, and at the same
time to stiffness in the inferior limbs only, and to notable augmentation of
the paraplegia. The strychnine was discontinued.

M. Andral considers the paraplegia in this individual as probably the
result of a lesion of the spinal chord, which the strychnine seemed to
aggravate.

Case 7th. — An old man, who had been long affected with complete
paraplegia, took three pills of one-twelfth of a grain each, without feeling
any effect. Four pills (a third of a grain) caused slight contractions in all
the limbs. It was then laid aside.

Case 6th.- — A man had remained hemiplegic after an old attack of
apoplexy. In him a pill, consisting of one-twelfth of a grain, was sufficient
to occasion a strong tetanic stiffness of the paralysed limbs. On the subse¬
quent days this man experienced, although the strychnine was discontinued,
violent pains in the head on the side opposite to the hemiplegia. His
intellects became confused, and the hemiplegia was increased ; in short,
he presented several symptoms which characterize softening of the brain.
M. Andral asks, “ Did the strychnine in this case produce an attack of
inflammation around the old apoplectic cyst or cavity ?” — Journal de Phy¬
siologies Juillet, 1823.

II. The manner of obtaining Brucine adopted by the French Chemists.

Brucine is an organic salifiable base, lately discovered by MM. Pelletier
and Caventou, in the bark commonly known by the name of the spurious
Angustura; {Brucea Antidysenterica, according to some: others consider
it the Strychnos Colubrinum.) Brucine is white, regularly crystallized in
oblique prisms, with a parallelogrammatic base. Its savour is very bitter,
slightly acrid, and styptic. It is soluble in five hundred parts of boiling,
and in eight hundred parts of cold water : it is very soluble in alcohol;
It forms with acids salts possessing different characters from those pre¬
sented by strychnine. Brucine is obtained by preparing an alcoholic
extract of the .spurious Angustura bark ; and by dissolving this extract
in a quantity of very cold water, and filtering it, in order to separate the
fatty matter. The colouring matter is precipitated by the acetate of lead —
the excess of lead, by sulphuretted hydrogen — and, lastly, the brucine, by
an alkaline base. For this purpose magnesia is advantageously employed.
The magnesia precipitate, slightly washed and dried, is treated by alcohol.

34S

Medical and Physical Intelligence.

which dissolves the brucine, which is afterwards obtained by evaporation*
As the brucine is but little soluble, the magnesia should not be too much
w-ashed. M. Pelletier considers that ten grains of brucine is equal, in its
action on the animal economy, to one grain of strychnine ; and M. Andral
considers that six grains of the former are required to produce the effects of
one grain of the latter, if impure, and of a quarter of a grain, if pure.-=—
Dictionnaire de Medecine, vols. 2d and 3d; Articles Angusture, Brucine :
and Journ. de Physiologic, Juillet, 1823.

III. Bxperiments on the Medicinal Properties of Brucine.

By M. Andral, fls.*

The pills of brucine which M. Andral administered to the subjects of the
following cases contained each half a grain of this alkali. From experiments
which he had made on animals, he was satisfied that no unpleasant effects
could result from this dose.

Case 1st. — A mixer of colours laboured for two months under a paralysis
of the hands. He took one pill without feeling any effect from it : two
pills produced slight shocks in the arms ; four pills caused tolerably
strong contractions. He was discharged, cured.

Case 2d.- — A compounder of colours, affected with a similar paralysis,
took as many as four grains (gr. 3.281 Troy) of brucine without any sensible
effect. At the dose of four grains and a half he felt a sort of unpleasant
creeping sensation in the arms; and in the dose of five grains (gr. 4.1. Troy)
he experienced somewhat strong shocks, without any serious symptom.
The paralysis was remarkably diminished.

Case 3d. — A house-painter, paralysed in both hands, did not begin to
experience any shocks until the dose of two grains of the brucine. Three
grains caused somewhat strong trismus. The patient was only relieved.

Case 4th. — A worker in lead, and paralysed like the preceding, expe¬
rienced a tetanic stiffness of all his limbs, after having taken three grains
and a half of brucine. He was not relieved.

Case 5th. — A paraplegic subject, after having taken only two grains of
brucine, felt a violent pain in the soles of his feet; his lower limbs were
the seat of violent contractions, tiis condition was not improved.

Conclusions drawn from the preceding Experiments with the Strychnine
and Brucine. — M. Andral deduces the following corollaries from the com¬
parative trials which he has made with these substances : —

1st. Pure strychnine acts upon man like the extract of nux vomica, but
with much greater intensity.

2dly. The action of strychnine is so energetic, that it ought to be used
with the greatest precaution. Its effects, moreover, vary in a remarkable
manner, according to the susceptibility of the individual.

3dly. The brucine acts upon man as upon animals, although much less
energetically than strychnine. It may be advantageously substituted, as a
medicine, for the alkali of the nux vomica.

4thly. Considered as regards their therapeutical properties, strychnine
and brucine are more or less efficacious, according to the kind of paralysis
which we may endeavour to combat with them. When employed in
those cases wherein paralysis is connected with an inflammatory state of the
brain or marrow, they may, very probably, augneent the symptoms. In those
subjects who are hemiplegic after cerebral Ijernorrhage, these alkalies are
most commonly useless ; and it is even to be feared that they may occasion
inflammation of the cerebral substance around the apoplectic _/bj/er. But
there are cases in which, as if by a sort of habit, the paralysis would seem
still to remain after the absorption of the extravasation; such cases may

* These experiments were likewise made at La Charite, in M. Lcrminier’s
wards.

349

Medical and Physical Litelligence,

yield to the strychnine or brucine. Lastly, these alkalies seem to be
especially efficacious against paralysis, the cause of which cannot be
referred to a lesion of the nervous centres ; such as, more particularly,
the species of paralysis to which individuals are subject who handle the
preparations of lead. The preceding cases attest the efficacy of strychnine
and brucine in this species of palsy. Of nine cases, six have been cured, or
at least relieved. 1 could also adduce other cases of paralysis of the same
kind, which have yielded to the alcoholic extract of nux vomica. — Journal
de Physiologic, Juillet, 18^3.

IV. Remarks on Poisoning by the White Oxide of Arsenic ( Arsenious

Acid). By Paor'EssoR Orfila.

M. Orfila commences this article with noticing, that Mr. Brodie, in an
article on the effects of the white oxide of arsenic, in the Philosophical
Transactions for the year 1812, had overlooked the effects of this substance
in producing an alteration in the appearance and tissue of the heart. From
experiments, M. O. states, since made by M. Smith and himself, they have
been induced to conclude, that this substance, introduced into the stomach
of dogs, injected into the veins, or applied to their cellular texture, acts
especially upon the heart, the contractility of which it destroys, and fre¬
quently inflames its tissue; in fact, they observed the heart of a deeper red
than usually with vermilion, or black and broad maculte in the left ventricle,
some of which extended a line into the fleshy structure of the heart ; some
also occupied the base of the largest of the columns carneae, and the mitral
and tricuspid valves.

Physiologists accustomed to compare the effects produced by poisons on
dogs and man, have no hesitation in believing, that the white oxide of
arsenic should occasion similar effects on one and the other. The following
observation is well calculated to confirm this conclusion. The particulars
of this case were collected by Dr. Jacquemin, Ucve interne at the Hotel
Dieu. — “ The body was opened in the presence of the Procureur du Roi,
MM. Dupuytren, Petit, and myself : we then remarked alterations of the
Jieart similar to those which are observed in dogs which have been poisoned
by the same substance. We regret not being able to give also the details
of another case of poisoning by the oxide of arsenic, observed at Brest by
M. Mollet, who has informed us, that he likewise observed similar lesions
in the tissue of the heart.'' ,

Mace and Goval, puolic writers, living together on the fruits of their
labour, found in their apartments three sausages and a piece of bread,
wrapped up in paper. On Sunday evening, the 29th July, having nothing
for supper, they ate the piece of bread and a sausage each, and commenced
with the third. Two or three hours afterwards they began to feel severe
colicky pains, with inclination to vomit. During the whole night the pains
increased, and vomiting took place. An apothecary, whom they consulted,
advised them to drink a quantity of milk ; this they did, but the pain and
vomiting did not cease. At ten o’clock, on Monday, they came to the public
consultation at Hotel Dieu.

Goval appeared to suffer but little ; his countenance and voice were
not altered ; he said that he had vomited much, and had had copious evacua¬
tions.

Mace walked with difficulty — the body was curved — the countenance
pale, and expressive of the most profound pain. He was received into the
hospital : he had several evacuations during the day, and frequent vomitings
of yellowish liquid matters, which were collected. The epigastrium was
very painful on pressure ; the face was contracted. The patient was in a
state of agitation and continual contraction. He could only answer the
questions put to him in monosyllables. He was made to drink copiously of
decoction of linseed and marshmallows. The same state of suffering was

VOL, XX. — NO. 118. 2Z

350

Medical and Physical Intelligence,

present in the evening. The pulse was accelerated. He was ordered an
anodyne draught and several injections, with eight or ten drops of lauda¬
num in each. On Tuesday the vomiting had ceased; the stools contained
a bloody mucus ; delirium supervened ; the extremities became cold.
He died at ten o’clock in the evening, forty-eight hours after having taken
the suspected sausages.

Goval did not enter into the Hotel Dieu until the evening of Monday;
he complained of colic, but he had no vomiting or alvine evacuations after
his admission. Could he, as he said, have rejected all the poison in the
copious vomitings which he experienced before his admission into the hos¬
pital The thing is possible ; but from the evidence adduced before the
judicial authorities, it is doubtful whether he really had been poisoned.

Dissection, thirty hours after death. — The body was in a state of
general stiffness ; the fingers and toes were strongly retracted. Head, — At
the convex surface of the brain a slight reddish layer of matter was
remarked. A little blood was effused into the right temporo-occipital
fossa. These lesions were regarded as the effect of a fall which he had
experienced a few hours before death. Abdomen. — Nothing particular was
noticed in the stomach externally ; in the interior, about eight ounces of
a yellowish liquid. On sponging off this liquid, a great number of small
white hard grains, of different sizes and shapes, were discoverable. The
internal surface of this viscus was of a deep red colour, which was not
removed either by washing, friction with a cloth, or by the blade of a
scalpel. Towards the duodenal orifice, there existed several maculae of an
irregularly rounded form, and of a size varying from that of a shilling to
that of a crown-piece, and of a brown colour. It, is difficult to say whether
these maculae were a species of eccyhomisis, or whether or not they were
true eschars. In the situation of these patches the membranes appeared
swollen; but they were not more easily lacerated than other parts of the
stomach. The serous coat was not altered. The (esophagus was healthy.
The duodenum and the commencement of the small intestine were of a
deep red colour; but no maculae were observed in them, as in the stomach.
In the remainder of the digestive canal there existed a strong vascular
injection, In the whole extent of the intestinal canal small white bodies
were observable, similar to those which were in the stomach.

Chest. — The lungs presented nothing reinarkable. The pericardium con¬
tained about an ounce of colourless serum. The heart. — Nothing particu¬
lar externally. A remarkable alteration was remarkable internally. The
left cavities were of a red marbled appearance. In the ventricle of this side,
and principally on the columnae carneae., small maculae, of a crimson red
colour, were remarked. On cutting into the parts where these existed,
they appeared not confined to the surface, but penetrated into the fleshy
substance of the heart. The right cavities presented a red colour, much
more red, and almost black. On the columnae carneae of the ventricle,
some maculae were also visible ; but they were less numerous and less
marked than in the left ventricle. The aorta, the pulmonary artery, and
veins, presented no appearance of change.

The sausage which had been left at the supper was examined: the
flesh was of a grey colour, and stuffed with a multitude of small white
hard shining bodies — some in a state of powder, others of the size of
millet and hemp-seed. A quantity of these white bodies, found in the
sausage^ was collected from the vomited matters, and from the liquids
contained in the digestive canal : these were fully proved, by chemical
reagents and by the garlic smell, &c. to have been coarsely pulverized frag¬
ments of arsenious acid.

Lesions of the heart, similar to those described in the present case, are
only manifested when the subjects, whether men or dogs, have not died

351

Medical and Physical Intelligence,

until several hours after the administration of the poison ; and even in this
case it may happen, for reasons with which we are unacquainted, to be
impossible to discover them. It is known, indeed, that corrosive poisons
sometimes produce death, witliout inflaming the tissues to w'hich they have
been applied; with still greater reason, therefore, may they not be expected
to alter those organs which are situated at a distance from the parts with
which they are placed in contact? — Archives Gen. de Med. Vol. I.
p. 147.

V. Case of Fistulous Opening in the left side of the Thorax, communicating
with the Bronchia. By J. Lebidois, D. M.

A female, aged forty-three years, mother of several children, was received
into the Hotel Dieu at Caen, for a progressive deterioration of health,
from neglected catarrhs, irregular menstruation, &c. During her first
residence in the hospital, a period of nine months, there formed in the
left side of the thorax, in the region of the tenth rib, immediately before
the external edge of the lumbo-humeralis muscle, a tumour, as large as a
small pullet’s egg, soft, somewhat painful, and without discoloration of the
skin. The tumour was punctured, and a discharge of bloody pus took
place from it, and afterwards a few splinters of dead bone. She con¬
tinued subject to violent catarrh during the whole winter, w'hich was
ameliorated in the summer, and recurred with greater intensity the
succeeding winter. She again returned to the hospital. On the cicatrix
on the left side of the thorax tiiere was then a small painful pimple, which
broke in a few days, and discharged a small quantity of pus, and a few
splinters of bone. The aft'ections of the chest were now aggravated :
to the cough, expectoration, and emaciation, were added alteration of tlie
voice and hectic fever. The opening in the thorax furnished a reddish,
and sometimes a puriform discharge.

During a violent fit of coughing, air was distinctly heard to pass out of
the thorax, to the great surprise of the patient and attendants. The cough
became milder — the noise ceased; but the ear applied to the diseased
part could easily distinguish a murmur at each expiration. The flame of a
candle applied to the opening was frequently extinguished. These symp¬
toms ceased at the end of six days, and frequently recurred at different
intervals. She went out of the hospital.

This w'oman was admitted into the Hotel Dieu, for the third time, on the
28th of November, 1822. She had then hectic fever, oppression, pain
between the shoulders, frequent cough, with clotted, greenish yellow
sputa. The left side was depressed beneath the mammae and the cicatrix,
not allowing the escape of air. She was put upon the use of demulcent
drinks, tinctures, weak soups, and mild pottage ; she was allowed choco¬
late, and wine and water.

Several days after her admission, the religieuse placed near her was
astonished to hear distinctly the air pass from her side. The pulmonary
fistula had reopened, and at the following visit the noise was distinctly
audible to the medical attendants. It was very sensible during expiration ;
and in the fits of coughing, or during efforts to blow the nose, the noise
resembled the sound produced by blowing into a hollow key, so as not to
make it whistle. She died twenty days after her last admission into the
hospital.

Dissection. — This took place next day. The external cicatrix on the
left side was deep and red. Its centre w'as pierced by a small aperture,
through which the blunt end of a probe could reach the denuded surface
of the tenth rib. The superior edge of this rib was hollowed by caries.
Thoracic cavity. — All the external surface ot the lelt lung adhered to the
parietes of the thorax. The ribs, detached and removed with precaution,
showed a canal, one line in diameter, which passed from the carious notch

Medical and Physical Intelligence.

in the tenth rib, horizontally (the body being in an erect posture), from the
dorsal towards the sternal surface of the body, and, after a passage of three
inches in length, became considerably narrower, bent to a right angle, and
proceeding directly upwards, and a little backwards, penetrated into the
substance of the lung at the base of this viscus- V\ hen arrived towards
the centre of the lung, it terminated immediately into a bronchial division,
as large as a goose-quill. The internal surface of this canal was smooth,
and perfectly continuous with that of the bronchial division, but much nar¬
rower. A puriform mucus covered it, and a reddish membrane, very diffi¬
cult to be separated, seemed to line it : its external surface in the lung was
adherent, and confounded with the parenchyma. Its external extremity
passed in the midst of the adhesions of the lung to the thorax, already men¬
tioned.

The pleura, all around the canal, for the extent of several inches, was
opaque, whitish, coriaceous, and at least two lines thicker. The adhesions
were thick and reddish. The top of the lung was occupied with a large
irregular cavity, half filled with purulent matter, of a greenish yellow
colour : the base of this lung was simply engorged : every where else the
parenchyma w'as dense, of a greenish colour, and covered with softened
tubercles. Sanguineous engorgement and hepatization were remarked in
the right lung. The heart presented a small whitish patch at its apex, and
was somewhat voluminous. Abdomen. — The peritoneum was natural.
The liver was very large, and irregular in its surface : its parenchyma was
yellowish. I he other abdominal viscera presented nothing remarkable.

VJ, On the Scorbutus which manifests itself in a local manner during

the treatment of Fractures, and prevents their union. — By M. Jules

Cloquet.

Occasionally during the treatment of fractures, all the symptoms which
characterize the last stage of scurvy develop themselves in the fractured
limb, and arrest for a long time, or even entirely prevent, the effusion of
the fracture. This troublesome complication is sometimes an entirely
local affection; at other times it first manifests itself in the fractured limb,
and afterwards extends to the other organs of the body. This species of
local traumatic scorbutus would appear to be produced by debilitating
causes, acting directly on the fractured limb, or even in a general manner
on the system. M. Cloquet, in order to prevent this affection, considers it
necessary, in fractures complicated with inflammation, to be very cautious
regarding general blood-letting ; nor does he advise emollient applications
to he continued longer than is absolutely necessary for allaying the inflam¬
mation ; and after this period he recommends the patient to be dressed
with linen, very dry and moderately tight. When the symptoms of local
scorbutus have manifested themselves, the attention must be redoubled,
tonics and stimulants must be given, and all the means proper in scurvy
should be employed. It is also necessary, at each dressing, to leave the
limb for some time exposed to the air, and especially to the rays of the
sun. — Archiv. Gen. de Med, Avril, 1823.

VII. Fatal Effects of Fear.

A man of colour, of middle age, rather above the common stature,
robust, and apparently in good health, was received into the London Hos¬
pital, labouring under a moderate-sized aneurism of the femoral artery : an
operation was proposed to him, to which he readily assented : on entering
the theatre, however, he fainted : some wine and water w'as given to him,
which he distinctly swallowed, and the operation was proceeded in, the
artery exposed, and the ligature applied, but not tightened. During the
operation it was observed that no pulsation could be felt in the tumour,
but this was accounted for by the fainting : before tightening the ligature,

Medical and Physical Intelligence, S55

it was suggested by the operator to wait until the pulsation was re-esta¬
blished ; some increased attention was then paid to arouse the dormant
energies of the patient, and it was remarked that the syncope had con¬
tinued an usual time : after the attempts had been some time persevered in,
a more attentive observation proved that he was quite dead. All the usual
resuscitative means were tried, but without effect. On dissection^ both
sides of the heart were found empty, and the lungs turgid with blood ; no
other particular appearance was observable.

VII [. Of the Chemical Composition of the Strychnos Pseudo-kina.

By M. Vauquelin.

On his return from Brazil, M. Saint-Hilaire sent M. Vauquelin the bark
of a plant, which that enlightened traveller has named strychnos pseudo¬
kina, with the intention of determining whether it contained any of the
principles of cinchona, whose properties it appears to possess, or of strychnos,
with which it is allied by its botanical characters. The following is the
result of M. Vauquelin’s analysis : —

1. A bitter matter, which constitutes the chief part of its soluble consti¬
tuents, and w'hich possesses the febrifuge properties of the plant.

2. A resinous substance of a particular nature, very soluble in alcohol of
36®, and but little soluble in pure alcohol.

3. A coloured gummy substance, united to an anirnalized principle, which
modifies its physical properties.

4. A peculiar acid, which, like the infusion of gall-nuts, precipitates the
sulphate of iron and gelatin, but with such modifications as to prevent its
being confounded with gallic acid.

This analysis is remarkable, as it shows the absence of strychnine and of
quinine from the bark of a plant which belongs to the genus strychnos, and
possesses the properties of cinchona.

IX. Number of the Births, Marriages, and Deaths, in Paris during

the Year 1822.

The following extract from the official returns to the Minister of the
Interior, conveys a view of the births and deaths in Paris during the
year 1822.

BIRTHS.

Males.

Females. Total.

Legitimate children .

Illegitimate children \ * V *

® ( Not owned • •

8,671 •• 8,438 .. 17,129

1,126 •• 1,144 •• 2,270

3,765 •• 3,716 •• 7,481

13,562 •• 13,318 •• 26,880

MARRIAGES.

Bachelors and spinsters . 5,933

Bachelors and widows . . * 329

Widowers and spinsters . . • • • 685

Widowers and widows . .

DEATHS.

Men.

W OMEN.

Bachelors • • • •

Married .

Widowers • • • •

Suicides * • •-

• • • • 203

Unmarried

Married • • • •

Widows ••••

.Suicides ••••

11,830

11,419

7,157

554

Monthly Bibliography.

X. Case of successful Operation for Salivary Fistula.

By Professor Beclard.

At a late meeting of the Acadtmie Koyale de Medecine, M. Bedard
mentioned a case of salivary fistula cured by forming an internal fistula,
which latter was made by passing into the internal part of the substance of
the cheek a leaden style, so as to reach the excretory duct at the part where
it was interrupted. The external fistula was united by the twisted suture,
after having been rendered raw by excision. In this case, as well as in the
former, which M. Bedard communicated to theAcademie two years before,
the cure took place without any other deformity than a small vertical and
linear cicatrix. — Arch. Gen. de Med. Juin, 1823.

XI. Improved Truss.

An ingeniously contrived truss has been submitted to our inspection,
which appears well calculated to answer every expectation of such an
apparatus. The chief difference between this and the common truss
consists in two spiral springs being introduced between the truss and the
pad, which, whilst it thereby admits of a self-adjusting movement, fur¬
nishes a sufficient degree of yielding pressure. We are acquainted with
several cases in which these trusses are now' made use of, and the principle
appears to us sufficiently novel and ingenious to induce us to draw the
attention of Surgeons to its merits. The following certificate of its prac¬
tical utility justifies us in our desire, that ingenious and useful inventions
connected with our Profession should, at least, obtain the reward which
publicity is calculated to obtain for them.

“ I hereby certify, that Mr. Coles, of London Bridge, has perfectly
succeeded in keeping up a very difficult and complicated rupture, on
which I operated some years since ; in which case many of the best
truss-makers in London had failed to effect any relief. When I placed
this patient under his care, I promised, should he succeed, to give him a
certificate of my approbation ; and in conformity with that, I now state my
firm conviction, that his truss will be found more efficacious than any
at present employed in similar cases. I have since tried his trusses in
other cases, and have been much pleased with the ingenuity he has dis¬
played in adopting his means to the circumstances of each case.

George Street, Hanover Square, - HENRY EARLE.

July 23, 1823.

MONTHLY MEDICAL BIBLIOGRAPHY.

FOREIGN.

1. Recherches Historiques, Chimiques, et Medicales, sur TAir Mare-
cageux. Ouvrage couronne par TAcademie Royale des Sciences de
Lyon. Par J. S. E, Julia, Professeur de Chimie Medicale, See.
Paris, 1823. 8vo. Pp. 135.

The researches of M. Julia, unfortunately, leave our knowledge of marsh
miasma in as much obscurity as before they were undertaken. The con¬
clusions to which he has arrived, from several experiments performed by
himself, and from the observations of various authors, are —

“ 1st, That the nature of the noxious gas is unknown to us, and that
there is every reason to think its deleterious effects are owing to a portion
of animal or vegetable substance, in a state of putrefaction, combined with
it; or rather to a solution of these substances in the air, and perhaps in
the gases, which are the product of putrefaction, and which are supposed to
exist in atmospheric air.

“ 2dly, That no experiment has been able to demonstrate, in marsh

355

hit er ary Intelligence.

miasma, any of the gases which are engendered by putrefaction ; and that
all my eudiometrical essays, and those of MM. Berard, Cavendish, &c.
have given the same constituent principles in this air, and the same quan¬
tities of these principles, as in common air.

“ 3dly, That if the gases which have been supposed to be contained in
the air of marshes are really contained in it, it is in so small a quantity,
that they escape all the researches and all the analyses of the most learned
chemists.

4thly, That those authors who have attributed the diseases produced
by marshes to the predominance of azote, carbonated hydrogen, ammoniacal
gas, &c. are strangely deceived, since these gases have never been met with
in the air ; and, moreover, as, both alone and united with atmospheric air,
they have been respired by several learned observers without their having
experienced any unpleasant effects.

5thly, That had we even a conviction of their presence in the air, it
would be in so small a quantity, that they could not exercise any action on
the animal economy ; as, when in a state of purity, they produce only
momentary accidents, if not breathed long enough to cause death.”

II. Formulaire de Montpellier, ou Recueil des Principales For-
mnles Magistrales et Officinales, tiroes des differens Ouvrages et de la
Pratique des Medecins, Chirurgiens, et Pharmaciens, de Montpellier:
contenant le Mode d’Administration de plusieurs nouveaux Medi-
camens, et precede d’un Tableau de Matiere Medicale. Par P.
Bories, Ex-Pharmacien-Major des Armees, &c. &c. Montpellier,
1822. Pp. 356.

The most rational formulae contained in this work are those of M. Ma-
gendie, although M. Bories, by not quoting them from the Formulaire of
that excellent physiologist, would seem to be desirous that they should '
belong to the school of Montpellier, Several of the formulae are excessively
absurd : thus, M. Bories gives one for a cephalic powder “ proper for caus¬
ing the waters which produce hydrocephalus to run off by the nose and
several others, equally ridiculous, might be referred to.

LITERARY INTELLIGENCE.

Just published, on the Use of the Moxa as a Therapeutical Agent, by
Baron D. J. Larrey. Translated from the French, with Notes, and an In¬
troduction containing a copious History of the Substance. By Robley
Dunglison, Member of the Royal College of Surgeons, and one of the
Editors of the Medical Repository, London. T. N G. Underwood. 8vo.
Pp. Ixxvi. and 148.

Dr. Shearman has in the press. Observations on Debility; exhibiting a
concise View of the History and Treatment of that Affection, when occur¬
ring: under a chronic form.

Nearly ready for publication, the Principles of Forensic Medicine, &c.
by J. G. Smith, M.D. in 1 vol. 8vo. This edition will contain much new
matter and various improvements.

The First Number of a Zoological Journal, to be continued quarterly,
and edited by Thomas Bell, Esq. F. L. S., John George Children, Esq.
F.R. & L.S., James de Carle Sowerby, Esq. F.L.S., and G. B. Sowerby,
F.L.S., will appear on the 1st of January next.

Mr. Samuel Plumbe has in the press, a Systematic Treatise on the
Diseases of the Skin, with coloured Plates.

In the press, the Sixth Edition, in 8vo. of Dr. Denman’s Midwifery, by
D r. Blundell, &c.

THE METEOROLOGICAL JOURNAL,
Vromthe igthof AUGUST, to the mh of SEPTEMBER, 1823,

By Messrs. HARRIS and Co.

Mo I hematical Instrument Makers, 50, High Holborn.

Moon.

[ Rain Gauge.

Therm.

Barom

De Luc’s
Hygrom.

Max.

9 A

lOP.M.

! 10 P. M.

,03

,32

,33

,12

59,29

5430

5629

,04

,06

Winds.

SSE

SSW

SSE

SSW

wsw

WNW

NNE

NNE'

SSW

NNW

SSW

ssw

wsw

SSW

ssw

WSW

wsw

NNE

SSE

ssw

SSW

NNW

Atmo. Variation

Fine

Rain

Clo.

Fog.

Sho.

Clo.

Fine

Clo.

Fine

Fog.

Fine

Rain

Fine

Rain

Fine

Rain

Fine

Rain

Fine

Rain

Fine

Rain

Fine

The quantity of Rain fallen in the month of August was 1 in. 77-lOOths.

NOTICE TO CORRESPONDENTS.

Mr. N. H.’s Letter shall be attended to.

Mr. Sprague will shortly publish, in the Uefository, Observations on many of the
Preparations ordered in the London I'harmacopoeia, with Suggestions.

We return our thanks to Mr. C. Belt for his valuable Papers, lately read before the Royal
Society. Also to Dr. Mackintyre for the Account of the Experiments lately made at Paris, on
the Functions of the iHerves. — These, respectively, will receive our earliest attention.

Communication^ are requested to he addressed (post paid) to
Messrs. T. and G. UNDERWOOD, 32, Fleet StreeL

THE

LONDON MEDICAL

REPOSITORY.

No. 119. NOVEMBER 1, 1823. Vol. XX.

PART lo

ORIGINAL COMMUNICATIONS.

A singular Case of XJmhilical Hernia, with Physiological Re¬
marks. By Thomas Sutton, M.D. Greenwich, Member
of the Royal College of Physicians, London.

Some time ago, I was desired to visit/ on Woolwich
Common, with Mr. Fitzpatrick, a patient, who had an
obstruction of the bowels, with incessant vomiting. It was
pointed out to me that this patient for many years had
laboured under a very considerable umbiKcal rupture, for the
support of which he had contrived a Convenient apparatus.
I begged' to see the state of this rupture, and found it sup¬
ported by a tin case lined internally with wadding, and
covered with' soft leather, with which it was also' covered
externally. This apparatus was adapted to the form of the
whole fore-part of the abdomen.

On its being removed I perceived the surface of the
abdomen to be irregular, and adapted to the convolutions
of the intestines. The abdominal muscles were completely
removed ; the umbilicus was actually thrust down into the
groin of, I believe, the left side. * •

This had been the state of the parts for many years, during'
which this gentleman had enjoyed good health, taken a
proper proportion of exercise, and had never been troubled
VOL. XX. — NO. 119. 3 a

358 Original Communications >

with any material complaint either in respiration or in the
discharges of urine or faeces, nor had been otherwise incon¬
venienced than from the weakness and the vreight of the
parts, which he had remedied by his own contrivance, with,
of course, the loss of the power of activity and flexibility of
the trunk of the body.

The vomiting in this attack had been so incessant that
for many hours every thing taken into the stomach, both
food and medicine, was rejected. Clysters had been em¬
ployed, but without producing the desired effect.

The first impression that this hernia would make upon the
mind is its enormous size and extent; the abdominal muscles
having been entirely removed from their position. The con¬
sideration that must next engage the attention, is the effects
this morbid displacement had produced ; and, lastly, the influ¬
ence these might have upon the present diseased state of the
patient. In a physiological point of view, we have been
long taught that the abdominal muscles performed most im¬
portant parts in the functions of respiration, digestion, assi¬
milation of food, expulsion of urine and faeces, &c., in con¬
junction with, or in counteraction of, the action of the dia¬
phragm. One wmnld scarcely, indeed, think it possible, on
reading some authors, that respiration could be performed
without their necessary concurrence, and that otherwise many
important functions must be at a stand. But in this case not
only respiration has been performed with perfect convenience,
but all the functions of the abdominal and pelvic cavities have
gone on in a suitable and healthy manner, by the sole aid of
a contrivance whose whole object was that of maintaining a
support of the bowels, and in which there was no substitute
for those supposed contractions and resistances to the action
of the diaphragm upon the contents of the abdomen, which
have been represented by authors as so necessary to the
proper performance of many important functions.

I now hasten to say, that this state of things did not form
any impediment to the recovery of the patient, who in the
course of some hours was completely relieved, and soon
arrived at his former state of health. We may hence con¬
clude, that the importance of the abdominal muscles to
animal life and health has been much overrated ; and that they
seem more adapted to support the contents of the cavity, than
to perform any signal and active part in the various functions
to which they have been hypothetically reported to have given
essential aid. I may also be allowed to conclude, that this
is almost their only necessary and most important office,
when we perceive all the processes of chylification, assimila¬
tion, and healthy action, performed, while a machine, as a

Dr. Sutton’s Case of Umbilical Hernia, with Remarks. 359

substitute for the loss of their aid, was employed, and especially
as the gentleman, the subject of this case, was inclined to be
stout, and was of healthy appearance, with good appetite,
although he must have arrived to at least the age of sixty.
We cannot, indeed, expect an apparatus to perform every part
assigned to the abdominal muscles, as it is certainly quite
destitute of that pliable support of the parts which allows
great activity, and variety of position and form. Yet this
case shows, abating these advantages, that the functions of
the abdominal viscera can be performed healthily by the aid
of a plain mechanical contrivance, in the absence of the
action of the abdominal muscles, and that such loss did not
retard recovery from a most formidable disease. When T
state the absence of their action in this case, I mean only to
convey the idea that they were completely removed from the
front surface of the abdomen, and could neither perform the
functions of support nor of contraction. It is most probable
that they did not exist in their usual form or shape, but had
undergone absorption and various changes, as the conse¬
quence of their inactivity and displacement.

I am willing to believe that the same conclusions to which
this case has led me, might have been justly attained by a
careful view of the state of the abdominal muscles in various
diseases, in which they have been so distended as to render
them incapable of affording assistance to those various func¬
tions alluded to : such as, for instance, in great distentions
of the abdomen by dropsical effusions and various tumours ;
or in cases of pendulous abdomen from repeated child-bear¬
ing, wherein these muscles have lost their power of contrac¬
tion. In the former of which particularly, the muscles,
through their great distention and attenuation, and weakness
after tapping, must have been frequently perceived to retain
very little power of counteraction. Yet in these cases, several,
or occasionally all the functions of respiration, secretion, and
expulsion of the contents of the abdomen, hav^e gone forward
without any essential aid from them. But such observations
are not likely to be made or urged successfully in the face of
a generally received and favourite hypothesis.

But this case certainly shows, more fully than these, that
all the functions of the abdominal viscera had been well
carried on without the aid of its muscles, and therefore
refutes much of those theoretical uses already alluded to.
One of the actions, among others, in which the agency of
their contraction and resistance has been considered to be
most necessary to its performance, is that of vomiting. The
case related, however, proves incontestably that this action
may be sustained without the active agency of these muscles,

360 ■ Original €wg^^:nwaiiom,

as the ypnaiting was forcible^ copious, and lasting, and the
tnachine, as a substitute for them, which was always worn^
could only afford support and resistance to over-distention.
In fact, the stomach can, when under irritation for that
purpqse, expel its contents by vomiting, without any auxiliary
aid, rather rendering all other concurring actions subordinate
to its purpose than assisting. And why not ? Is this half so
wonderful as the action of the intestines which compels the
food through their canals, frequently against the force of
gravity, by their innate power of fabric, and in some dis¬
orders giyes their contents a retrograde motion; in both
which operations the action of the diaphragm or abdominal
muscles can, upon no principle, be considered to be materially
assisting ? But complicated explanations of functions are
often taken as marks of ingenuity, while the real and evident
causes are placed in the back ground, or little dwelt upon,
until they are nearly lost in an hypothetical mass of intricate,
unfounded, and therefore unnatural suppositions.

Greenwich, September, 1823.

II.

Case of Enlarged Spleen, combined with Disease of the Serous

Su faces in both the large Cavities. By James King, Esq.

Surgeon, Hamilton, N. B.

‘ J. R. a tall young man, aged twenty, applied to me for
advice on the 5th of November, 1821, in consequence of
severe attacks of epistaxis, which had repeatedly troubled him
since the middle of the preceding month. He was evidently
of a scrofulous constitution, and the formation of his chest
and general appearance distinctly marked a predisposition to
phthisis, which appeared to be hereditary in his family. CJp
to the period above-mentioned he had enjoyed uninterrupted
good health. He stated, that before every attack of the
bleeding he was well aware of its approach, from a severe
pain and swimming in his forehead, a sense of burning heat
in his face, and throbbing of his temples, accompanied with
a peculiar smell, which he was unable to describe. He had
no other complaints, and during the intervals between the
attacks his strength and appetite were unabated. His pulse
was full, hard, and beating 90 in a minute; tongue furred;
stools watery and frequent. I took from the arm twelve
ounces of blood, and ordered a calomel purge, to be fre¬
quently repeated, in order to correct the state of his bowels.
He was bled again on the 8th to the same extent, in conse-

361

Mr. King’s Case of Enlarged Spleen.

quence of a severe return of his complaint; and as the state
of his bowels was much the same, the medicine was ordered
to be continued. After this bleeding he had but two attacks
of his complaint during two months, and these vyere so very
trifling as to require no attention. In other respects, how¬
ever, he was far from being well ; he had taken repeated
doses of calomel and jalap, and other cathartics, which had
operated severely, but still his tongue continued dry and foul,
and his stools frequent, watery, and of a yellow colour; his
urine was high-coloured and rather scanty ; pulse 90, and
vibrating to the touch; countenance pale and sallow. The
following medicine was prescribed, and continued till the
26th, when his complaints were so far removed as to enable
him to return to his employment : —

R Mass. Pil. Hydrarg. 3j.

- Aloes. 3ss* M. b*

Et in pil. xxiv seq. divid. Un. omn. noct. sumend.

R Sulph. Magnes. 3iss.

Supertart. Potas. ^ss.

Aq. Fontan. Ibiss*

Ft. mistura, cujus capiat coch. iij. magna omne mane sequent.

He called on me again for advice in the beginning of
January, 1823, when he informed me that he had had many
returns of the epistaxis, but the quantity lost was so very
trifling that he did not consider it in any way hurtful to his
health. For a few days previous to this he had been troubled
with a short dry cough, and a return of his boweP complaint,
which he attributed to exposure to cold. There was now a
great difference in his appearance; his face was pale, and his
colour bad, and from being of a full habit of body, he was
now much emaciated ; his breathing was hurried ; skin hot;
tongue foul; pulse quick and full. Upon taking a full
inspiration he felt no pain in his chest, nor did the cough
produce any uneasiness. Considering his complaint to be
phthisis in its incipient stage, I again bled him, applied a
blister to the chest, and began the use of the prussic acid by
giving a drop three times a day in a little syrup of ginger.
He was frequently bled, and the blister occasionally repeated,
during the two months I made use of this medicine, but still
with little advantage, as his cough continued much the same,
and the attacks of the epistaxis frequent, though never to any
extent. His diet was strictly antiphlogistic, and consisted
principally of milk. The prussic acid was gradually increased
in quantity till he took doses of nine drops three times daily,
without producing any visible effect on the constitution.
About the beginning of March he felt, for the first time, a

S62

Orisinat Communications.

dull, deep-seated pain in the hypochondriac regions; but on
examining the abdomen carefully, no hardness or swelling
could be felt, nor did severe pressure produce any uneasiness.
His bowel complaint still continued, and he was becoming
more and more emaciated.

A respectable Physician belonging to this place was con¬
sulted, who, supposing some hepatic derangement might
exist, recommended alterative doses of mercury till the con¬
stitution became sufficiently affected. The medicines were
instantly commenced by giving grain doses of calomel night
and morning ; in about three weeks the system became
affected, and then it was only given in such quantity as was
found necessary to keep up the action for six weeks longer,
when it was entirely given up, as we conceived it had had a
sufficient trial without producing any benefit. As soon as he
was quite free of the influence of the medicine (about the
end of May), w^e recommended him to go into the country,
and try what change of air and exercise on horseback might
do in alleviating his complaints.

I heard no more of my patient for six weeks, when he
again called on me for further advice : he told me that he
had, in compliance with my request, been in the country
ever since I last saw him, and had daily, when the weather
would permit, taken gentle exercise on horseback, and
adhered strictly to the regimen 1 recommended. At first he
thought he was benefited by the change, but for some time
before his return he found himself getting daily worse : his
cough and hurried respiration w'ere not more urgent, but his
appetite and strength, which, up to that time (July 10th), had
been but little deranged, began daily to be impaired ; and
the dull pain which he felt in the hypochondriac regions,
though not more severe, was now confined entirely to the left
side, and when the abdominal muscles were relaxed, by care¬
fully examining the part, 1 could feel a considerable, deep-
seated, hard swelling. On examining the region of the liver,
it appeared swelled, but no hardness could be felt, and severe
pressure produced no uneasiness. His breathing still con¬
tinued hurried — particularly so after taking any exercise;
but he felt no pain in the chest even on taking a full
inspiration. Next day 1 visited him along with two medical
gentlemen ; and after a careful examination, it was our opi¬
nion that the swelling of the left side was an enlargement of
the spleen ; and from the swelling of the right side, we like¬
wise considered the liver to be the seat of considerable dis¬
ease, and that the deranged state of the alimentary discharge
might be owing to the vitiated secretion of that organ. The
cough and anxious breathing, which had so long troubled

363

Mr. King’s Case of Enlarged Spleen,

him, though certainly symptomatic of pulmonic disease, were
attributed to the derangement supposed to exist in the abdo¬
minal cavity.

We again agreed to prescribe calomel, with mercurial
friction on the parts affected, and to keep the system under
the influence of that medicine for a time. We commenced
by giving him pills containing one and a half grains of
calomel night and morning, combined with opium, to prevent
it from passing off by stool, and by rubbing in half a dram of
strong mercurial ointment daily. On the tenth day his
mouth was sufficiently affected, and afterwards the medicine
was only prescribed in such quantity as was found necessary
to keep up the effect. In this state he was kept for six
weeks, and his strength supported by suitable nourishment.
Under this treatment he daily became worse: he had repeated
attacks of epistaxis, which were more severe than at any
former period; these weakened him very much; his pulse
became intermittent, and ranging from 1 10 to 130 in a minute ;
the swelling of the left side became more prominent and more
tender to the touch ; his cough and anxiety of breathing con¬
tinued much in the same way ; his extremities became ana-
sarcous, and water began to collect in the abdomen.

About the beginning of August he was first troubled with
involuntary motions of the muscles of the lower jaw, and an
inability to keep his mouth shut. These attacks troubled
him frequently every day during the rest of his life, and
continued about ten minutes each time. He w^as now more
than ever troubled with diarrhoea, and the other symptoms
of his complaint were so urgent that we had not the most
distant hopes of his recovery. At this time, without any
cause being known, he was attacked with severe rigors, soon
followed by vomiting and great pain of the abdomen, much
increased by the most gentle pressure. Leeches, repeated
small blisters, and warm fomentations, were applied to the
abdomen, and laxative and anodyne medicines given inter¬
nally to alleviate his sufferings, but without producing any
benefit : he died in a few^ days.

Sectio Cadaveris. — After removing the integuments of the
abdomen, our attention was first directed to the peritoneum,
which w'e found very much inflamed, thicker than natural,
and quite opaque ; its adhesion to the abdominal muscles
was nearly destroyed by the intervention of a quantity of
purulent matter ; but to the omentum and abdominal viscera,
with which it is in contact, it had formed many strong con¬
nexions, which it required considerable force to destroy.
After removing these connexions, a quantity of a high-

564 Original Communications,

coloured liquid (about one gallon and a half) was removed
from the abdomen before proceeding farther with the dissec¬
tion. On examining the stomach and alimentary tube, they
were found much inflamed, and covered with a network of
small vessels carrying red blood. Turning aside the intes¬
tines, so as to expose the tumour in the left side, we found
that it was, as had been supposed, an enlargement of the
spleen, which was found firmly adhering to the large end of
the stomach, and to part of the transverse arch of the colon,
by a tense, white, transparent membrane. We next removed
this viscus from the abdomen, and found it very much
enlarged indeed, not being less than seven or eight times its
natural size ; its coats had been chiefly affected with the
inflammatory action, which had evidently extended to the
intestinal tube: on cutting into its substance, a quantity of
whitish fluid could be pressed out, but in colour, consistence,
and other respects, it was quite natural. On examining the
liver, it was found unaltered in structure, but considerably
increased in size; the gall-bladder was nearly twice its natural
size, and completely distended with bile of a brownish yellow
colour. All the rest of the abdominal viscera were perfectly
healthy. In the thorax the following were the morbid
appearances : —The left lung was found healthy in every
respect ; but on examining the right cavity of the thorax, con¬
siderable disease was brought into view : it contained about
half a gallon of a greenish watery fluid, which being removed,
the lung of that side was found greatly diminished in size,
and much firmer in texture than natural — so much so, that
it could be of very little use as a respiratory organ ; in many
parts it was adhering firmly by short -ligamentous bands to
the pleura costalis. About five tablespoonsful of fluid were
found in the pericardium, but the heart was found to be
healthy.

Remarks, — It might be asked, after a careful review of the
symptoms of this case, and the appearances seen on dissec¬
tion, which was the primary complaint — the pulmonic com¬
plaint, or the enlargement of the spleen ? or did they exist
independent of each other, or originate from one and the
same cause I These are questions which may perhaps admit
of dispute; but it is my opinion that the disease in the chest
was the primary complaint, and the exciting cause of all the
organic derangement seen on dissection. It is also my
opinion that the diseased structure of the right lung was the
work of previous inflammatory action ; but as he never felt
any pain in the chest during his indisposition, that action
could not have been severe. As soon as derangement existed to

Mr. Snell’s Case of Division of the Palate. 365

II any considerable extent in the lungs, their functions were of
course much impaired; hence the pulmonic circulation must
have been less perfect. To this I attribute the enlargement
of the spleen, and partial increase in the size of the liver, as
also the epistaxis ; hou' far I am right, I leave it to others to
judge. The appearances denoting more recent inflammatory
action of the peritoneal surfaces I attribute either to pres¬
sure occasioned by the enlargement of the spleen, and the
fluid acting as extraneous bodies; or to the inflammatory
action having extended along continuous and similar tissues
from the surface of the spleen : if the latter alternative be
adopted, the effusion must be considered as the consequence
of the previous inflammatory action, which effusion pro¬
moted a return of, or kept up, the already excited inflammation
of the peritoneum. The effusion in the chest may be con¬
sidered as having supervened to the old adhesions found in
that situation ; and may be viewed either as the consequence
of the inflammation which gave rise to these adhesions, or
as the effect of a subsequent relaxation of the capillaries in the
pleura. Finally, the anasarca, at the close of the disease,
was only the common result of debility.

Hamilton, July 14th, 1823.

III.

Case of extensive Congenital Division of both the Hard and
Soft Palates, successfully treated by Mechanical Means. By
James Snell, Dentist, Member of the Royal College of
Surgeons in London.

[With an Engraving.]

The extreme importance of any successful contrivance, in
so distressing a defect as that of a fissured palate, will render
unnecessary any apology for introducing the following case to
the Profession.

An interesting young lady, now about sixteen years of
I' age, has laboured under this distressful malformation from
her birth. When an infant, it deprived her of the support
of the breast, — the milk, when any could be drawn, being
invariably ejected through the nose ; and her articulation,
from a later period to the time of my seeing her, was so
defective as not to be understood but by those who were
^constantly about her. On her application to me about three
limonths ago, the appearances were as follow : — The fissure,
lias may be seen by reference to the plate, commenced imme-
VOL. XX. — NO. IIQ. 3 B

366

Original Communieatiom,

diately behind the two anterior ineisores, extending back¬
ward through the palatal portion of the maxillary bone, and
through the os palati, velum pendulum palati, dividing the Ji
uvula, and giving rise to an unlimited comniUnicatiofi between
the nose and mouth.

When the case first came under my care, 1 was desirous of
making the attempt to unite the edges of the soft palate,
according to the suggestion of M. Roux;"^ but this mode of
proceeding being altogether objected to by the parents, I was
induced to try how far success might be attained by mecha¬
nical means. With this view, I obtained a correct model of
the deficiency, from which a gold plate was first fitted to the
roof of the mouth, as far back as could be worn by the :
patient, to the posterior part of which two pieces or flaps of o
Indian rubber were attached, thus filling up the deficiency t
of the soft palate. A small moveable piece Oi the same :
material was also attached, by means of a gold hinge, to d
the centre of the lower piece> to imitate as near as possible
the natural uvula. A piece of ivory was next fitted to the j:
, upper or back part of the gold plate, and carried upwards ®
until it came in contact with the remaining portion ofd
the septum narium : this was, of course, firmly attached.
The whole was held up in its situation by means of two gold
springs soldered to the plate, which attached themselves |
round one of the molares on either side. It may readily be^
conceived that the introduction of such an apparatus must, in i
the first instance, cause great inconvenience. This was, ii
however, overcome by perseverance on the part of the pa- 1
tient, who was soon convinced of a most material improve- j
ment in her speech, as well as of great increase of comfort*
while taking her meals ; and to crown the whole, the parents;
were most agreeably surprised to find her voice possessed of
considerable musical power, a qualification which none could
have presumed to hope for. As the apparatus requires to be
frequently removed that it may be cleansed, she is provided
with two, in figure the exact counterpart of each other.

EXPLANATION OF THE PLATE.

FIGURE 1.

The natural State of the Mouth.

a a The upper and lower Lips.
h The Teeth in outline.
c c The divided Uvula.

d d The Amygdalse. i

e The Tongue pressed down, |
F The Fissure.

* Medical Intelligencer, Vol. I. p. 98*

367

Mr. Denton^s Case of Hamatemesis,

a The Gold Plate.
b The lower Flap of Indian
Rubber,

c The upper Flap.

FIGURE 2.

The Artificial Palate. *

d The Ivory Piece,
e The Artificial Uvula.
f The Gold Spring.

FIGURE 3.

The Appearance o f the Mouth with the Apparatus affixed.

a The Gold Plate. — h The lower Flap of Indian Rubber,
c The Artificial Uvula.

IV.

Case of F omiting of Blood fin ivhich large Doses of the Supera^
cetate of Lead proved d powerful Auxiliary Remedy. By
J. Denton, Esq. Surgeon, &c.

I PROCEED to state briefly the chief particulars of the
following case, concerning which it appears to me unne¬
cessary to make any remarks. The practical inference which
it conveys, although by no means novel, should, however, be
kept closer in view^ than I believe it generally to be : with
that object I beg leave to submit the outline of the case to
the readers of the Repository.

In May last, Mr. S. of Castle Street East, Oxford Street,
of a spare habit, was seized with vomiting, without previous
illness, and ejected nearly two quarts of blood. I saw him
soon after his seizure, and was induced by the state of his
pulse to take fbss. of blood from the arm, ordering, at the
same time, an acid drink with the acid, sulph. aromat. and
water, and a strong cathartic of the neutral salts with digi¬
talis. 1 saw him again in tw'o hours, and found the sickness
had returned. The orifice of the vein from which he had
been blooded was therefore opened, and Ibss. of blood was
again abstracted, after which three grains of the plumbi
superacetas, with five grains of the extractum conii, were
prescribed, which dose was given every two hours : the third
put a stop to the vomiting. The pills were now discon¬
tinued, and a mixture of neutral salts and infusion of roses
with digitalis was substituted : a dose of this mixture was
given every four hours, in order to prevent any deleterious

* Any medical gentleman feeling interested in this case may
have an opportunity of seeing a model of the artificial palate at the
author’s, 21, Chapel Street, Edge ware Road.

368 Original Communications.

effect from the superacetate of lead which he had taken.
This mixture was continued for three or four days, at the
expiration of which time the patient was perfectly recovered,
and he is now in good health.

Castle Street, September 16th, 1823.

Case of Purpura Hcemorrhagica. By Edward Thompson,
Esq. Whitehaven, Member of the Royal College of Sur¬
geons, London.

“ De philosophorum hypothesibus parum solliciti, ea duntaxat quae
exhibet experientia adducemus.^^ — Lieutaud.

The following case of purpura hasmorrhagica perhaps
may not be found uninteresting. The disease is one upon
which medical men have displayed, at different times, their
learning and ingenuity, with, it must be regretted, but com¬
paratively little success. Although we have many theories,
Practitioners find it difficult to fix upon one leading to
successful practice : emetics and bleeding, purges and tonics,
have severally been recommended by those who have either
viewed the complaint as bilious or inflammatory, congestive,
or one of debility. As cases of failure might be adduced
where each of these plans had been strictly pursued, it
follows that none of them deserve our particular confidence,
as they are all liable to aggravate some states of the disease,
though they may assist in others. To set up the method
pursued in the case of Nail as superior, is not, however, the
object of this paper : it is only to give another instance of its
effect in a case the most dangerous that commonly appears.

On the morning of Eriday, June 21st, John Nail, a boy,
aetatis five, was observed to be covered over the body and
limbs with purple spots of various sizes, accompanied by
effusion of blood from different parts. He had for a day or
two before been very feverish ; and the da}^ before the erup¬
tion showed itself his whole skin w'as of a brightened colour,
and extremely hot. On the 24th 1 visited him ; he was then
complaining of great pain in his bowels, of some headach and
giddiness, and of excessive thirst; pulse 120; skin not hot,
but completely covered, except on a small part of the face,
which was deadly pale, with spots of a deep black colour.
The back, belly, and limbs, were so studded, that the true
colour of the skin could with difficulty be distinguished.
They had burst in places weakly supported, and he WRS then
bleeding from his eyes, mouth, nose, and slightly from his

Mr. Thompson’s Case of Purpura Hczmorrhagica. 369

ears. What was evacuated from the bowels was of the
same colour as that effused from the eyes and other parts^
except what was coughed up from the lungs; this was a
little lighter in hue. I could not observe in the evacuations
any appearance of feculent matter : they were much like
what is passed in melaena. He had made his urine in the
same vessel, and therefore I could not judge of the colour of
it; the mother told me it was of a deep brown cast. The
quantity of blood lost was described as being great previous
to the visit; he was in consequence very weak. He ex¬
pressed dissatisfaction on being raised up, as he turned very
faint. The tongue was white and without fur, appearing as
if destitute of blood ; it was entirely free of petechiae, giving
it a singular look when compared with the surrounding
parts, which were closely beset with them.

I had attended this boy about four months prior to this
attack ; he was afflicted at that time with three large collections
of matter, all of which were opened and injected ; they com¬
menced within a week of each other. From the great drain of
pus and irritative fever, he was reduced to the last state of
debility, and was not expected to live; he, however, sur¬
mounted all danger, and grew strong and lusty.

7’he following mixture was now ordered him : —

R Ol. Terebinthin. 3iv.

Vitelli Ovis, q. s,

Sacch. Alb. 3vj.

Ol. Menth. gtt. iv.

Aq. Purse, Jv. M.

Cap. cochlear, j. largum tertia quaque hora.

25th. — Pulse 112; thirst great ; tongue white, but moist ;
bowels not open ; oozing from nose and mouth ; eyelids
better; complains of pain in belly when moved or pressed
upon ; no appetite. The urine passed since the night of the
23d strongly tinged with blood.

R Ol. Castor. 3ij.

Ol. Terebinth. 3ij. M.

Cap. statini. Contin. Mist. Terebinth, ut heri.

<26th. — Rather better; pulse 100; thirst not so great;
bowels opened twice since last visit ; fasces black, but not so
fluid as hitherto; tongue clean and moist; blood flow's occa¬
sionally from nose and eyes ; expectoration tinged with
blood ; petechiae very thick on the body — on the legs and
arms they are more distinct, and they are somewhat raised
about the middle of the back, shoulders, and neck; urine
made freely, very deep in colour, but without blood; no
griping in the belly; debility very great.

370 Original Communications,

ft Mist, cum Ol. Terebinth. 3vj.

Ad Aq. Menth. Jv. M,

Sumantur cochlear, duo ampla quater indies.

Vin. Rub. ^iv.

27th. — Improving; petechiae less black; hemorrhage
from bowels, &c. not so great ; faeces as yesterday ; thirst
less ; no appetite ; slept awhile in the night ; pulse 100.

Pergat.

28tli, — In a state of improvement. — Pergat.

29th. — Symptoms as before. • — Contin. ol. terebinth, et
vin.

SOth. — Symptoms all relieved ; bowels regular, and faeces
assuming a more natural appearance ; bleeding continues
from nose and gums occasionally; coughs up bloody mucus,
but not frequently ; able to take broths and arrow-root.

Contin. med.

July 2d. — [On the 1st I was not at liberty to see him.
The report stated him to be improving.] Spots gradually dis¬
appearing ; hemorrhage from mucous surfaces much abated ;
bowels freely opened three or four times a day, and natural.

Sd. — Much better; petechiae gradually becoming ab¬
sorbed ; appetite good ; clots of blood occasionally coughed
up from the lungs, and slight oozing from the nose and
gums; the spots on the conjunctiva nearly gone; stools
frequent, but of a natural colour ; is now sitting up and feels
stronger, yet not able to walk without support ; complains a
little of pain in the head and giddiness,'

R Tinct. Calumb. 5j.

Acid. Sulph. Dil. 3ij. M.

Cap. cochlear, j. minimum quartis horis. ~Cont. Vin. Rub.

Rep. Mist. Terebinth, de quo sumatur cochlear, j. nocte
maneque.

4th. — Petechiae disappearing very fast, and in every
respect better; pulse regular; bowels open; urine rather
deep in colour; slept well in the night; thirst gone. — Con-
tin. medicamenta.

There was no report taken after this. I saw him at
intervals for a short time, and by the 12th ceased attending
him altogether. He has had no return of the complaint, and
remains in perfect health.

The above case is, I think, a decided proof of the powerful
action of the remedy employed. That other means might
have been equally so, is at best problematical. Bleeding is
a means very doubtful in its effects ; and although we have
the cases of Drs. Parry and Combe to direct us, w^e have others
decidedly against it. It was a remedy much recommended

Mr. Thompson's Case of Purpura Hemorrhagica, 371

by the old Physicians, but it was seldom successful^ in the
disease designated by them the bloody small-pox. From the
description given by Dr. Fuller and many others, there is
reason to believe that purpura occasionally received that
title. Thus we have an affection, receiving the name of
small-pox, beginning with a quick pulse, soon succeeded by
a general redness of the skin; this being soon follow'ed by red
spots, which turned purple, — then black, scarcely if at all
elevated above the surface; and attended by hemorrhage from
the bowels, &c. The practice pursued in cases like this, and in
real small-pox, with petechiae and hemorrhage, was precisely
the same as that recommended by Dr. Parry.

Praise is due to Dr. Whitlock Nichol for having first
exhibited oleum terebinth, in affections of this nature, and
the success that has hitherto attended it speaks highly in its
favour. In melaena I have seen the most decidedly good effects
produced by it in several instances, and this is a disease not
tar removed from purpura. Morgagni found, in a person
who died of melsena, several parts ot the abdominal viscera
studded with black spots, of which he says, doubtingly,
Macula haec gangrsenosa fortasse fuit.’’ The inside of the
stomach and duodenum was of the colour of the fluid vomited.
Ihis agrees in part with the appearances presented on dis¬
section of those cases of purpura at present before the Pro¬
fession. If this does not establish the identity of the two
diseases, it goes some way to prove that there is some rela¬
tionship. The blood-vesels in both cases are not able to
retain their contents, either from a loss in their contractile
power, or actual tenderness in the coats themselves. It has
been observed likewise, that obstruction, from enlarged liver
or spleen, has led to the appearance of both diseases : 1
speak of the melaena cruenta according to Dr. Good,

The urine in Naifs case was not examined, for which
omission I am sorry: it might have been done after it
assumed its natural appearance; before that, serum would
have undoubtedly been found, as blood formed a great part of
what was evacuated. That much dependence ought to be
placed on the circumstance of serum being always present in
urine when an inflammatory diathesis exists, remains yet to
be established. I lately saw a case of dropsy in which it
was discovered, although the disease succeeded excessive
hemorrhage, and was certainly caused by it, the health being
good previous to the injury. In Dr. Combe’s case the urine
deposited serum ; and from this he was induced to view
purpura as bearing, “in one respect at least, a striking resem¬
blance to inflammatory dropsies.” Facts are wanting to
strengthen this opinion. If ever depletion be required, it

37^ Original Communicatiom,

must be in plethoric subjects, and merely to diminish
momentum; if not employed early, in the very onset, in bad
cases, it will hasten the fatal event.

There may be in some a predisposition to purpura, or a
peculiar conformation in the vascular system, approaching
to the hemorrhagic diathesis. I attended, about three years
since, a singular case. It occurred in a boy about six years
old ; he was several times attacked with bleeding at the nose.
Before this took place he was generally feverish a day or
two ; on its subsiding, more or fewer petechial spots made
their appearance. He was at length carried off by hemor¬
rhage from the nose in a single night. His mother told me
he was seldom free from black spots, as the slightest knock
produced one. The formation of the vessels in this case was
such, and their structure so fragile, that it w’ould appear the
least increase in the impetus of the blood produced dilatation
and rupture; constituting part of the third and fourth causes
of Dr. Duncan’s arrangement.

It will be observed that the turpentine was given with a
view to its being absorbed or taken into the system. Some¬
thing more than its mere purgative effect is to be looked for ;
and although this may be a concern of moment, still it is
not the only one.

Whitehaven, October 11th, 1823.

VI.

Case of Acute Hydrocephalus, with Softening of the Brain.
ByT HOMAS Rolph, Esq. Surgeon, &c.

- -

James Hall, aetatis five, had been unwell some time w'ith
occasional headach and costiveness. September .5th, the day
I first saw him, he appeared but slightly indisposed. He
complained of pain in his head; the pulse was accelerated;
the tongue slightly furred ; the bow'els hard, swollen, tense,
and very constipated ; urine high-coloured ; his appetite bad;
and he appeared rather irritable. I gave him the following
powders and mixture : —

R Pulv, Jalapse, gr. vj.

Hyd. Subinuriat. gr. ij. hi.

Divide in pulv. ij. hac nocte et eras mane sumatur unus.

R Acid. Sulph. Dilut, xij.

Syr. Rhoead. 3ij.

Aq. Puroe, ^iij. M.

Ft. mist. coch. j. larg. 4tis. hor. sumendum.

" On the morning of the 6th he appeared much amended ;

373

Mr. Rolph^s Case of Acute Hydrocephalus.

the bowels had been opened twice, the stools were highly
offensive, of a very dark colour, and loose. I ordered the
powders and mixture to be repeated. In the evening he was
attacked with a convulsive fit; and on being sent for, I found
him quite insensible, with a rapid strong pulse, very florid
countenance, and cold extremities. I took ten ounces of
blood from his arm in a full stream, from which there was
evident syncope. I administered three grains of calomel
immediately, and ordered it to be repeated in four hours,
also a mixture with tiiv. of tinct. digitalis, to be taken every
four hours, a cold lotion to be applied constantly to the
head, and the feet to be immersed in warm water. He
passed a quiet night.

On the 7th, although he w^as sensible, the bowels had not
been acted on. I gave him three grains of scammony every
two hours.

8th. — The bowels were still confined. With every powder
he now took two grains of calomel, which brought away several
very offensive, loose motions, of a dark muddy colour ; his
pulse was tranquil, his head seemed better, and there was
moisture on the skin.

9th. — • He was so much better, that his mother gave him
the mixture he had at first: on this day, however, he had no
motion. The bowels towards evening became hard and
swollen, and the pulse more rapid. I then gave him a mix¬
ture, containing 5SS. ol. ricini in each dose, with two grains
of calomel, every four hours. He took four doses, without
the bowels being at all affected.

On the morning of the 11th he was violently sick, and the
contents of the stomach resembled the evacuations from the
bowels. I gave him the following powders : —

Hyd. c. Greta, gr. xvj.

Pulv. Jalapee, gr. xij. M.

Divide in pulv. iv. ; sumat unum 4t^ quaque hor^.

Neither of these powders remained on the stomach. At
this time the symptoms assumed the strong and evident
characters of hydrocephalus ; the pupils were dilated, and the
child was much disturbed at light and noise.

As the stomach was irritable, and rejected every thing, I
gave him, on the 12th : —

Magnes. Sulph. 3iij.

Infus. Rosse, ^vj. M.

Ft. mist. — coch. j. larg. 2nda quaque hor^ sumendum.

This mixture allayed the vomiting, but the bowels remained
still confined.

ISth. — The above mixture w^as repeated, and three grains

VOL. XX. — NO. 119. 3 c

374 Original Communications,

of calomel were given with each dose. The sickness re¬
turned, and the bowels still continued to be confined.

14th. — The same mixture was repeated, without the
powders. This day and during the night he had several very
loose, offensive stools, of considerable quantity, and of a very
dark colour.

15th. — He seemed extremely dejected, he sighed con¬
tinually, his pupils were very dilated, and strabismus was
observed for the first time. There was great prostration of
strength; he was perfectly sensible, and his pulse was very.
small and feeble. I gave him the following mixture: —

R Ammon. Carbonat. 9j.

Pulv. Rhcei, 3ss.

Aq. Menth. Pip. Jiv. M.

Ft. mist. Sumat coch. j. larg. 3tiis horis.

I6th. — Five stools of the same character as yesterday
were passed, but they were more offensive. The mixture was
repeated.

R Ung. Hyd. Fort. 3iij.

Sp. Ammon. Comp. 3ij.

Ol. Amygdalae, 3vj. M.

Ft. embrocatio region! abdominal! nocte maneque applicanda.

17th. — No stool this day. He sighed perpetually, and
the inspirations seemed so long and deep as to attract par¬
ticular attention. He was much worse ; for although he had
not been insensible since the convulsion fit, he appeared more
irritable this day, and took less notice of objects than usual.
The mixture was continued.

18th. — No evacuation.

R Hyd. Submuriat. gr. xvj.

Pulv. Jalapm, 5ss. M.

Divide in pulv. iv. ; sumat unum 4ta quaque bora.

^'Celling, — No motion.

R Mannse, 3iij.

Infus. Sennee, 5iv. M.

Ft. mist. Sumat coch. j. larg. Sndis horis.

19th. — He had two copious stools, which w^ere highly
offensive, but not so dark-coloured as before. The mixture
W'as repeated.

20th. — Fie had three stOols, tinged with mucus and
blood ; he was this day quite insensible, and the pupils were
imraoveably fixed. The mixture was continued, and a large
blister applied to the nape of the neck.

21st. — The bowels were still open, but nothing but a
dark fluid, like muddy water, came away.

375

Mr. Rolph’s Case of Acute Hydrocephalus,

— He was totally insensible to every thing.

23d. — He died.

On ex animation , we found considerable effusion between
the tunica arachnoidea and the pia mater; the vessels of the
dura mater were very turgid, the convolutions of the brain
extremely indistinct, the substance of the brain was very soft,
and the ventricles were filled with serous fluid. The optic
nerves, at their origins, were nearly disorganized.

The thoracic cavity was filled with a very dark sangui¬
neous fluid. The pleura was healthy. The left lung was
highly |inflamed, and both lungs were covered with tu¬
bercles.

The stomach, liver, and pancreas, were healthy. The
spleen w^as completely covered with tubercles. The kidneys
were healthy. The inner coat of the large intestines was
more vascular than common.

In this case there were several remarkable phenomena :
the liver, stomach, and pancreas, were quite healthy, whilst
the evacuations were of the most foetid and unhealthy
character. The lungs were loaded with tubercles, and the
left lung highly inflamed ; yet there was no cough nor
difflcnlty of breathing. Although I saw this child every day
from September 5th till the day he died, I did not observe
one symptom of active inflammation all that time, except the
evening: on which he had the convulsion fit.*

Crutched Friars, October 2d, 1823.

* We have been induced to publish this case on account of the
morbid appearances which it exhibited. In addition to the usual
phenomena of acute hydrocephalus, softening of the brain — a
structural derangement to which M. Rostan has particularly called
the attention of the Profession — formed its prominent feature. Such
cases are important, inasmuch as they draw our attention to the
actual derangement going on in the system at the period of observa¬
tion ; as they enable us to mark the outward signs of disease with
greater fidelity; and as they lead us to connect our therapeutical
indications, in a more rational manner, with the nature and seat of
disorder inferred at the time of observation, and to employ our
remedies more correctly and more decidedly, as physical agents in
the removal of morbid functions and structures. — Editors.

376

Orimna I Communications .

VII.

A Case of Laceration of the Ferinccum, Urinary Bladder ^ and
Rectum; ivith Observations on the Use and Abuse of the
Vectis. By William Gaitskell, sen. Esq. Member of
the Royal College of Surgeons, London.

May the 28th, 1822, I was requested to visit Mrs. A. a
healthy woman, thirty-one years of age, who had been deli¬
vered a fortnight before by an obstetrical Practitioner in her
neighbourhood. Mrs. A. informed me that she had sustained
a very serious injury in her labour, and wished me to inquire
into her situation and to render her my professional services :
on soliciting the particulars of her case, she furnished me the
following narrative : —

On the 12th of May, 1822, about seven in the morning,
she felt symptoms of labour, and desired her Accoucheur to
be sent for. He very soon attended, and assured her that the
labour was a fair one, requiring no immediate assistance.
He then left her, and called about ten, when she informed
him that the pains were slight, but, if any thing, rather
worse. He visited her again about one, when he examined
into the progress of her labour, and assured her that every
thing was doing well, and he hoped to deliver her about
three. Between one and half-past two the pains slackened,
when he requested her to lie on the bed in order that he
might assist her, and assured her that five or six pains would
deliver her. At this examination he put her to exquisite
torture, and subjected her to a very different examination
from those she had experienced in her former labours. *
Finding the pains lingering, and having limited his time of
delivery, he had recourse to such strong mechanical power for
the extraction of the child, as to require her being firmly
held on the bed, and this he continued for the space of three
hours, with only short intervals of rest : she often called out
for time and patience, declaring to him, from her feelings,
that the pains were not natural, but artificial ; and stating
that she had a frequent and strong desire to make water.
But without attending to her entreaties or complying with
her wishes, he still persisted in pulling ; when, about six in
the evening, the head of the child was extracted. F

* Mrs. A. had borne two living children at the full period of
gestation, and was each time attended by a female midwife; from
both which confinements she recovered and did well.

t The foetus had several cuts on the face, marking the application

Mr. Gaitskell’s Case of Lateration of the Per inceum, 8^c. 377

He now found a difficulty with the shoulders : to remedy
this he asked for a roller, which he tied round the neck of the
child, and pulled with such violence, that the shoulders, body
of the child, and placenta, all came away together. He now
desired her to be quiet for an hour; but she flooded so pro¬
fusely that she grew faint, and was cautiously drawn up the
bed to be placed more easy and comfortable. When the
child was extracted, a sudden gush of urine took place, *
occasioned by the rupture of the bladder; that viscus not
having been emptied from four in the morning till six in the
evening — a space of fourteen hours.

The next day Mrs. A. was pretty easy, and made a little
water, but with great pain. On the third day the urine and
faeces passed involuntarily, for she had no retentive power.
This was mentioned to her Accoucheur, but he observed that
it was of no consequence, as time would rectify every thing.
However, instead of things improving, they grew worse ; and
although the urine continually drained into the lacerated
parts, and produced the most severe torture, he never sug¬
gested a remedy for her sufferings, nor inquired into the
nature of her injury.

After enduring for a fortsiight the severest torments, occa¬
sioned by the constant draining of the urine from the torn
bladder into an extensive sore, I was called upon to visit her.
On examination, I found the perinseum lacerated quite into
the rectum, so that the strong sphincter muscle of that part
was completely divided in front; consequently, the internal
surface of the vagina, mouth of the womb, internal mem¬
brane of the rectum, and raw surface of the torn perinaeiun,
were constantly washed with urine. From the same cause,
the thighs and nates were excoriated and acutely painful.
I proposed the best relief in my power, but assured her re¬
latives that a perfect cure was impossible.

To give the bladder (which was torn in its cervix) a chance
of healing, I passed an elastic gum catheter into that viscus,
through the urethra, leaving the external end to terminate in
a quart wdne-bottle, while the other remained constantly in
the bladder. By this expedient the bottle received the urine,
and prevented the bed being wetted, or the urinous smell
becoming offensive.

This plan afforded her great comfort, and in six weeks
allowed the bladder to assume a healing process. At the end

of the instrument, and the violent manner in which it had been
employed.

^ This was proved to be urine by the odour, the amniotic waters
having been discharged three hours before, when the vectis was
introduced for the extraction of the child.

^378 Original Communications,

of three months the whole secreted urine passed through the
natural passage. *

The external sore was washed with some cooling lotion,
and emollient poultices w^ere repeatedly applied.

About six days after the adoption of the above plan, I
requested the opinion of my friend Dr. Blundell, who very
readily gave his gratuitous attendance. He examined the in¬
jury with the greatest* attention, and fully approved of my
remedial means.

I’welve months after this extensive injury, she informed
me that she was totally deprived of sexual sensation, that the
prolapsus of the uterus and vesica urinaria was increased and
attended with pain and sense of weakness in her loins, and
that she had no retentive power in the rectum.

The perusal of this unfortunate case will, I hope, induce
the 3^oung or inexperienced Practitioner to weigh well in his
mind all the minute circumstances of his patient’s situation,
and to be well convinced of the necessity of such interference,
before he dares to hazard the awful responsibility of intro¬
ducing an instrument into the womb of a parturient woman,
and of forcibly extracting the child. That the life of a
female, at this interesting period of her existence, should be
put in jeopardy, or that she should be condemned to years
of misery, from impatience of temper in the Practitioner, or
from gross ignorance of his professional duty, is a subject of
moment to every mind which is interested in the credit and
respectability of this department of medical practice.

The instrument made use of in this case was the vectis or
lever, than which 1 know of no instrument in the practice of
midwifer}^ so useful, and none so dangerous when injudi¬
ciously employed. With me it supersedes every other as a
simple mechanical power. After a practice of thirty-nine
years, I have never had occasion to use the forceps but
twice, and they not answering my wishes, 1 finished the
labour with the vectis. When the head of the foetus is
opened, and the brain disorganized with the crotchet, the
judicious use of this powerful instrument will so compress
the bones of the cranium, as to empty its cavity, and deliver

^ The healing of a ruptured urinary bladder is of such rare occur¬
rence, that if Dr. Blundell and myself had not satisfied ourselves of
the tact of previous rupture by passing a female catheter through
the opening into the vagina — [the rupture was so extensive,
that Dr. B. passed two fingers from the vagina into the urinary blad¬
der], — it might have been disputed by the Profession.

When the bladder sloughs, the opening remains for ever after
unhealed, and a perpetual fistula is the consequence. There are only
two instances on record of the bladder healing after throwing off a
slough, as was mentioned to me by Dr. Blundell.

Mr. Gaitskell’s Observations on the Use of the Vectis, <^c. 379

the woman with safety. In the present case, the extensive
injury sustained by the mother, and the marks of violence on
the face of the child, are so many proofs of the abuse of a
valuable instrument, and tell nothing against its superiority.
These inj uries were evidently the result of too much mecha¬
nical violence, of a neglect of the axis of the pelvis, of the
absence of natural pains to co-operate with the artificial
power, and of a loaded urinary bladder.*

A few cursory Observations on the Use of the Vectis, and the
best Mode of applying the Instrument.

The vectis should be thirteen inches in length, one half to
form the handle, the other the curve. The handle should be
made of hard wood, rendered rough for the purpose of
obtaining a firmer hold, and made to screw on and off.
When the instrument is made with a hinge handle, it is very
inconvenient to introduce ; therefore this construction of the
instrument should never be adopted.

First, The os externum and internum should be perfectly
dilated and relaxed, the amnion waters discharged, and nature
allowed to exert her own power before art steps into her aid.

Secondly, The urinary bladder and rectum should be both
emptied, either by nature or art, before the introduction of the
instrument, for the purpose of removing the obstruction which
a full bladder occasions, as well as of protecting adjoining
viscera from mechanical injury.

Thirdly, The patient should be placed in a proper posi¬
tion : on the left side is the best, with the breech close to
the edge of the bed, and the knees drawn up to the
abdomen.

Fourthly, The position of the foetal head should be exactly
ascertained, that the long axis of the head may be adapted to
that of the pelvis. It should also be borne in mind, that the
long axis of the upper brim of the pelvis crosses the lower on's
at right angles ; when, therefore, the woman is on her side,
the long axis of the upper brim is vertical, and the long axis
of the lower horizontal.

By discovering the anterior fontanel, it will not be difficult
to make out where the forehead of the foetus is placed, and
by this may be marked all the other relations of the different
axes of the head, and their correspondence with those of the
pelvis.

Fifthly, The instrument should be well greased with soft
pomatum or lard, the w’oman placed in a proper position,
the foetal head correctly made out, and the urgency of the

* The bladder had not discharged its contents for fifteen hours.

380 Original Communications,

case such as to justify the employment of an artificial power.
The preliminaries being settled, the next thing is the safe
introduction of the instrument. To do this with facility and
safety, the Accoucheur should kneel on a pillow by the side
of the bed, and introduce all the fingers into the vagina as far
as the brim of the pelvis at the side of the sacral promontory
(either right or left, according to the situation of the occiput).
As he passes up the instrument, the fingers should be gra¬
dually withdrawn. The instrument is now to be pressed up into
the cavity of the uterus, being careful that it is in the inside,
and not on the outside, gliding it over the parietal bone till
the screw part of the handle presses on the fourchette of the
os externum. This attained, the handle should now be held
firmly with the right hand, while the index and middle finger
of the left, fixed about two inches from the screw part within
the vagina, become a fulcrum. On this fulcrum, or point of
support, the instrument is made to move from the sacro-iliac
symphisis, toward the hollow of the ilium, hy the action of
the right hand on the handle. In this way it describeis the
section of a circle, and glides on to the occiput. Should the
occiput point to the right ilium, the left hand must be em¬
ployed ; if to the left ilium, the right hand must be used.

When a labour pain takes place, the Accoucheur should
gently aid it by drawing down in the line of the axis of the
pelvis, i. e. in an imaginary line directed from the umbilicus
through the centre of the axis of the pelvis. In this way the
occiput is depressed while the chin approaches the child’s
breast, and its head is reduced to the smallest compass, and
is thus enabled to pass through the cavity of the pelvis. As
soon as the occiput is brought so low as to press on the
perinseum, the instrument should be withdrawn, and reintro¬
duced with the usual precautions. «

The object now in view is to place the instrument over the
face of the child. To effect this, the hand must be passed
up, as at first directed, to the right or left sacro-sciatic
symphisis, according to the situation of the face. When the
instrument gets above the brim of the pelvis, a finger or two
must be inserted by the side of the instrument, and pressed
on it till it passes over the forehead on to the face, so as to
embrace the chin. An imaginary line drawn through the
centre of the child’s mouth, ear, and occiput, is the present
situation of the instrument, and quite the reverse of wdiat it
was before. The Practitioner has nothing now to do but to
draw down during the time of pain, increasing his power
according to the degree of resistance. The mechanical turn
of the head, viz. the face of the child to the hollow of the
sacrum, and the occiput to the arch of the pelvis, generally

Mr. Gaitskell’s Observations on the Use of the Vectis, 381

takes place spontaneously during the descent of the head,
though sometimes, but not one in a hundred, this mechanical
turn of the head wants watching; the face should turn for¬
ward, and’the occiput backward.

Having concluded my observations on the use of the
vectis, I shall now enumerate the various .ways in which
this most valuable instrument may be abused,

Firstj An attempt to introduce the vectis before the ex¬
ternal parts are properly relaxed, and the os uteri fully
dilated, or the amniotic fluid discharged.

Second^ An incautious mode of passing the instrument, so
as by the violence and wrong direction to rupture the parietes
of the uterus.'

Third, The employment of an extracting power, w'ithout
bearing in mind the different axes of the pelvis, and position
of the foetal head in relation to those axes.

Fourth, The passing the instrument on the outside of the
uterus instead of within its cavity.

Fifth, The use of power without waiting for natural pain,
so as to make a labour completely artificial.

Sixth, The keeping a constant pressure on the foetal head
in the interval of the labour pains, which endangers the life
of the child, by compressing the funis, and stopping the
circulation of the blood. In this way, I firmly believe, the
destruction of many children during parturition is accom¬
plished by the vectis. When the waters are discharged and
the cavity of the uterus lessened, the funis falls on the face
like a coiled rope, and is exposed to the hazard of mechanical
compression. To prevent this accident, I never use the
instrument but during a pain ; and when the pain ceases, I
raise the instrument about half an inch from the face to pre¬
vent the destruction of the child.

From these observations, it therefore follows that the vectis
is an instrument in surgery — of which midwifery is a branch
— which is dangerous or useful according to the hand that
uses it, and the head that directs it; and it may be said of
it, as of every other instrument and of every other remedial
agent employed in the various departments of medical science,
that it is neither a safe nor a beneficial means of aid, unless
it becomes such in consequence of its judicious and discri¬
minating employment. The excellent observation of Boer-
haave, “ Nullum ego cognosco remedium nisi quod tempes-
tivo usu fiat tale,” is as applicable to the use of obstetrical
instruments as to any substance employed in the practice of
physic.

Rotherhithe, Sept. 1823.

YOL. XX. - NO. 119. 3 D

382

Original Communications .

VIIL

Contributions to Pathology. — No. II. Cases of Aneurism of
the Aorta. By Joseph Ward, Esq. Member of the
Royal College of Surgeons, and Apothecary to the London
Hospital.

The three following cases of aneurism of the aorta
occurred within a very short period; they evinced many of
the symptoms of cynanche laryngea when it assumes a
chronic form, and sufficiently proved the difficulty of diagnosis
between these two disorders. As every circumstance that
can throw light on so interesting a subject as aneurism of
the aorta most assuredly is, must be acceptable to the patho-
log ist, I am induced to place the particulars of these cases
before the Profession.

.. Case I. ^

Mary Jones, getatis twenty-three, applied for relief Decem¬
ber 11th, 1822. She had been ill four months; her com¬
plaints commencing with cough and expectoration, which
were worse at night, being unable to lie down for some
hours. At this date she perspired very freely, which she
attributed to the exertion of coughing, and complained of pain
in the trachea just above the sternum, which was greatly
increased by deglutition, solid substances always being re¬
turned : fluids were swallowed easily. Her face was sometimes
flushed. Pul se 96; bowels costive; urine plentiful, high-
coloured, and depositing a lateritious sediment ; feet very
cold.

She received constant medical attendance till her death :
her symptoms, notwithstanding, remained for the most part
unrelieved. She was purged ; leeches were frequently applied
to the throat; blisters were employed; and the ung. antim.
tart, was resorted to till it produced a pustular eruption,
which afforded her some little benefit. In the course of her
illness, she had three or four sudden attacks of dyspnoea,
which threatened her life; they appeared to be produced by
a large collection of mucus in the bronchial tubes: w'hen in
this state, she always experienced much relief from emetics.

June 4th. — Complained of pain and fulness above the
right clavicle, but no pulsation was felt there : these sensa¬
tions were relieved, and appeared to subside, in consequence
of the application of a few' leeches.

July 2d. — From irritation produced by a blister, inflam¬
mation came on under the left breast, which terminated in

383

Mr. Ward^s Cases of Aneurism of the Aorta.

suppuration, during which time, until the abscess healed,
there w'as a complete cessation of all the bad symptoms; —
her breathing was very comfortable ; she could lie down at
night; and the mucous expectoration was much diminished.
As she now' felt herself much better, she very incautiously
over-exerted herself, when all the symptoms became aggra¬
vated : respiration was now' performed with difficulty; her
lips and countenance were of a pallid hue; the mucus in the
trachea became increased in quantity, and was expectorated
with difficulty, and cold sweats supervened. This state con¬
tinued for a few day^s : she sank under it on the 6th August,
18'23.

Dissection. — On examination of the body, the following
appearances presented themselves: — No disease w'as ob¬
served in the larynx. The trachea, just above the bronchiae,
was so completely compressed by an aneurism, as to bring its
anterior and posterior sides nearly into a state of approxima¬
tion. The lining membrane of the trachea presented a red
blush, without any evidence of suppuration.

The aneurism was of considerable magnitude, and arose
from the arch of the aorta, having a sulcus in its centre filled
by the trachea. There w'as another aneurism in the aorta,
where it passes between the crura of the diaphragm, which
had produced much absorption in the bodies of three of the
vertebrae.

Case IL

John Berry, aetatis thirty-four, has been ill twelve months.
He was taken at first with cough and shortness of breathing.
The cough was very troublesome, and without expectoration.

August 5th. — At this time he had very considerable
wheezing during inspiration, which was occasionally accom¬
plished with much difficulty. He also complained of some
pain in his chest; of. very difficult deglutition, being alto¬
gether unable to swallow solid food ; and even fluids were
taken with much uneasiness. He had been unable, for the
last six weeks, even to sit up, being obliged to bring his head
forwards, resting it nearly’ on his knees : raising himself into
the erect posture only for a few seconds caused him the
greatest distress. His voice was scarcely altered. — Ten
leeches were ordered to his throat, and the pulv. ipecac,
comp, was given with hydr. subm. in small doses every six
hours.

August 6th. — - Remained nearly as yesterday. Towards the
evening, the dyspnoea being much increased, it was thought
he might receive some benefit from the operation of tracheo¬
tomy, which was accordingly performed. At the time ot the

.'•384 Original Communimtiom.

operation, he lost a considerable quantity of blood suddenly
from some varicose veins, and he was somewhat relieved.
This relief continued, however, but a short time, as all the evil
symptoms gradually increased. He was unable to keep a
canula in the opening, it being constantly forced out.

August 7th. — Much worse; dyspnoea greater. He was
unable to swallow any thing. His pulse, which formerly was
rather full and not much accelerated, now faltered, and on
the following morning he died.

Dissection. — On examination, an aneurism was found in
the arch of the aorta, occasioning much pressure on the
trachea immediately above the bronchise. The aorta was
much enlarged throughout its whole length. The lining
membrane of the trachea was discoloured and covered with
mucus. Somewhat extensive inflammation was present in
the cellular substance of the muscles of the neck, on the right
side, which was attended with a large deposition of coaguiabie
lymph.

Case HI.

August 5th. — William Friar, setatis thirty-one, had been
ill about six weeks. He was first affected with pain in the
left side of his chest, which came on, as he supposes^ in con¬
sequence of a severe cold. He afterwards felt a general
soreness in his chest, with a sense of suffocation. His
breathing became difficult, and inspiration very stridulous.
His speech has been impaired about three weeks. He was,
at this time, unable to speak above a whisper; had no pain
in the larynx itself, but considerable pain lower down,
about the centre of the chest ; was unable to swallow solids,
and fluids passed with difficulty. Cough was troublesome;
expectoration much, and at times with difficulty; tongue
slightly coated ; bowels open; sleep disturbed by distress in
breathing. The pulse in the right arm was scarcely to be felt ;
in the left arm it was nearly natural.

He was bled to the extent of sixteen ounces; a blister
was applied to the throat, and calomel and Dover’s powder
w'ere given every six hours.

August 6th and 7th, — Tw^elve leeches were applied each
day, and a blister between the shoulders. He remained
unrelieved.

8th. — He fell down dead in the act of walking.

Dissection. — The first remarkable circumstance which pre¬
sented itself on examination, was the right carotid artery
crossing the trachea immediately below the cricoid cartilage,
it being thrust into that situation by an aneurism from the
arch of the aorta. The aneurism pressed on the two bronchiae,

385

Mr. Ward’s Cases of Aneurism of the Aorta.

and upon the CEsophagus, into which it had ulcerated and
burst; and about two pounds of coagulated blood were found
in the stomach. The ulceration in the oesophagus was to a
very considerable extent. The larynx was healthy.

Hemarks. — From these three cases, it appears that an
aneurism in the aorta may produce, from its mechanical
pressure, a train of symptoms which bear a very close
analogy to cynanche laryngea. In the first case, the con¬
tinual existence of the exciting cause induced that state of
inflammation of the membrane, which we should naturally
expect to find in this latter disease. When we observe that
the application of a few leeches was sufficient to relieve the
urgency of these symptoms, we should hardly have been
inclined to think beforehand that there existed any arterial
tumour, upon which this small bleeding could have had such
an effect. The relief too which was experienced by the
counter-irritation in the breast would have tended, in a great
measure, to confirm the opinion that it did not depend on
any mechanical cause which was constantly present, but upon
an inflammatory action originally existing in the membrane
itself.

The second case, however, does not bear so great a simi¬
larity to cynanche laryngea. There were symptoms which
might perhaps have led us to a different diagnosis : the
difficulty of keeping the head erect, and the unimpaired
power of the voice, are not symptoms which we are accus¬
tomed to find present in cynanche laryngea, but w^hich were
satisfactorily explained by the examination of the body.

The third case more nearly resembles cynanche laryngea
than either of the others ; the stridulous inspiration was
better marked, as well as the loss of voice and the difficulty
of deglutition. In this case there existed a circumstance
which, perhaps, may not be altogether undeserving of remark.
The operation of tracheotomy was directed to be performed,
if this man had suffered a sudden attack of excessive dyspnoea.
His sudden death, however, prevented the operation. It was
mentioned, when detailing the appearances on dissection,
that the right carotid artery was found crossing the trachea
obliquely, and immediately below the cricoid cartilage: if,
therefore, the operation had been performed, it is not impro¬
bable that this artery would have been opened into, more
particularly when w^e consider that the violent action of the
trachea w'ould render it difficult to have observed the pulsa¬
tion of the artery in this unnatural situation.

London Hospital, 12th October, 1823.

386

Original Communications.

IX.

A General Report of the Medical Diseases treated in the Kent
and Canterbury Hospital, from January Isif to July \st,
1823, with a particular Account of the more important
Cases, ByH AllRY WiLLIAlVI (-/ARTERj iVI.D. F'.H.S. -Ed.
Senior Physician to that Institution, &c. Sic.

The practice of an hospital affords many advantages, —
many facilities for observation and experiment, which private
practice, however extensive it may be, cannot supply. Ac¬
cordingly, we find that well-digested hospital reports are
among our most valuable records in medicine and surgery —
witness those which have latterly appeared in the Dublin
Transactions. My own experience in this department of
practice is indeed very limited, when compared with that of
the distinguished individuals whose names are prefixed to the
Dublin Reports ; yet I am anxious to contribute my mite to
the mass of valuable information which the medical world
ow'es to them. I would tread in their steps, and, to the best
of my ability, render the advantages 1 enjoys in the prosecu¬
tion of my profession useful to others, as well as to myself.

It is therefore my intention to offer, from time to time, a
catalogue of the diseases which it may fall to my lot to treat
at the Kent and Canterbury Hospital, * subjoining a brief
notice of such cases as may seem to merit more particular
attention. With this, my first essay, I have taken some
pains; but as I am by no means satisfied with it myself, I can
scarcely expect my readers not to find it very open to objec¬
tions. I trust, however, that, as I become more conversant
wdth my employment, 1 may succeed better, and I hope I
shall be allowed to profit by the suggestions of some of those

* The Kent and Canterbury Hospital is situated in a pleasant and
airy spot, within the precinct of the once magnificent monastery of
St. Augustine, in the eastern suburb of the city. The first stone of
the building was laid June pth, 1791? and the hospital was opened
in part for the reception of patients April 26th, 1793. When the
late William Carter, M.D. first proposed the erection of an hospital
for Kent, and submitted his proposal to the leading people of the
county, there was a prevalent opinion among them that it would not
succeed. My father, however, persevered, and the event fully
answered his expectations. The difficulty now is to find room for
the numerous applicants. The daily average of in-patients last year
was 59, and that of out-patients 318. Vaccination is performed
gratis once every week.

Dr. Carter’s Medical Report of the Canterbury Hospital. 387

who may honour these pages with a perusal. The friendly
counsel of my professional brethren I shall be forward to
acknowledge with gratitude ; and their hints I shall, wherever
it is possible to do so, embrace. To some, perhaps, my
record of cases may seem jejune, and the cases themselves
uninteresting ; but it is not to be expected that the wards of
a provincial hospital should afford many cases worth parti¬
cular mention, or very interesting, according to the usual
acceptation of the term. The Physician’s patients consist of
persons from the country, and of inhabitants of the city and
its vicinity, who, for the most part, do not apply to the
hospital for relief till their complaints have subsisted for a
long period, and they have gone through the common routine
of treatment at their own habitations. Persons, again, are not
unfrequently admitted in a state which must preclude all
hope of their receiving benefit ; for although it be contrary
to a standing rule to admit those who are in a hopeless or
dying condition, and although the introduction of such
patients frequently shuts the door against others who might
derive benefit from the institution, yet common humanity
forbids our sending them back, many miles perhaps into the
country. I have often urged upon the weekly board of
governors the expediency of cautioning the country sub¬
scribers, and parish officers in particular, against sending
patients merely upon their own judgment. They ought first
to consult some respectable Practitioner in their neighbour¬
hood as to the probability of the patient’s receiving benefit at
the hospital. Cases of very ancient date, and hopeless cases,
excepting those w'here the bodies are examined after death,
it were useless to give in detail. The same may be said of
others, which, though they might with propriety be referred
to the poor-house, we can scarcely exclude, because we are
well aw^are how much may be done for them by the quiet and
the nourishment of the hospital, as well as by tonic and cor¬
dial medicines. These cases of general debility from poor
living, hard labour, 8cc. (and they are numerous), offer
nothing of interest. Hence the paucity of cases which I have
recorded. *

I shall conclude this preface with a word or two respecting
out-patients. This is a class which constitutes the great
burden of every hospital. The Physician is, by the rules,
required to see them but once a week. If he have much
private practice, he can scarcely see them more frequently,
however desirous he may be of doing so; and even were he to
offer to see them, they would hardly attend, for many of them

* Contagious diseases, of whatever description, are excluded.

S88 Original Communimtions.

find once a week too often. Between each visit a thousand
things occur to counteract the effects of the remedies pre¬
scribed. Hard labour, scanty and improper food, deficiency
of fuel and of clothing, bad lodging, exposure to wet and
cold in their daily occupations — intemperance in some
instances : all these causes conspire to render our attempts
to relieve the out-patients too often nugatory. My report, as
far as relates to them, is to me far from satisfactory ; yet I
hope to be enabled to record a few cases not totally devoid of
interest from among their number.

I now proceed to give, in the first place, a statement of
patients under my care from January 1st to July 1st, 1823 : — ■

In-Patients,

Males - - - - 60\

Females - - - 54 j

- Total 1 1 4;

Males.

Females.

Cured - .

- 15

Received benefit -----

- 14

Received no benefit - - - -

Made out-patients - - - -

- 19

Referred to the Surgeon - - -

Discharged for irregularity - -

Died . -

Under treatment -----

- 4

Out-Patients.

Males - - - 63 ■)
Females - - - 124 3

Total 187.

'Males.

Females.

Cured - -- -- -- -

- 16

Received benefit -----

- .5

Received no benefit - - - -

- 2

Discharged for non-attendance -

- 2

Referred to the Surgeon - - -

- 2

Died .

- 2

Under treatment .

- 30

119

Total 178.

Of the out-patients nine are unaccounted for. No tidings
respecting them could be collected. ^ It is to be observed,
that those out-patients who were afterwards admitted into the
hospital are not included in the preceding list.

* They may be added to those discharged for non-attendance.

Dr. Carter’s Medical Report of the Canterbury Hospital, 389

STATEMENT OF

DISEASES OF IN-PATIENTS.

Apoplexy - .

Brought forward

Amenorrhoea -----

Hysteria -----

Breast, tumour of - - -

Icterus -----

Bronchocele -----

Liver, abscess of - - -

Chorea - - - - - -

Menorrhagia -----

Debility, general - - -

Marasmus - - - -

Diarrhoea ------

Obstipatio -----

Digestive organs, chronic af-

(Esophagus, stricture of

faction of -----

Paralysis -----

Dropsy - .

Peritonitis, chronic - -

Dysmenorrhoea - - - -

Phthisis - . - - -

Epilepsy ------

Psoas abscess - - -

Fever, intermittent - - -

Pylorus, stricture of

- continued - - -

Rheumatism, acute - -

Head, affection of - - -

- chronic -

Hsemoptoe - - - - -

Scorbutus - - - -

Heart, organic affection of

Scrofula - . - - -

Hepatitis ------

Thorax, chronic affection

Hydrothorax - - - -

Uterus, disease of - -

Hypochondriasis - - -

Worms -----

6o 114

STATEMENT OF DISEASES OF OUT-PATIENTS.

Anasarca ------ 2

Amenorrhoea . 1

Asthma . 2

Breast, scrofulous enlarge¬
ment of----- - I

Bladder, disease of - - - 1

Calculus . - 2

Chorea ------ 2

Diarrhoea . 2

Dysentery ----- 2

Debility, general - - - il

Digestive organs, chronic
disease of---- - 17

Epilepsy ------ 1

Eruptions ----- 9

Eneuresis . 1

Febris, intermittent - - - 2

- continued - - - 1

Head, pain of - - - - 6

Haemoptoe ----- 1

Hepatitis, chronic - - - 6

Brought forward - - 70

Hooping-cough - - - - 1

Hydrothorax ----- 5

Hysteria - .- -- -19

Leucorrhcea ----- 1

Melancholia ----- 3

Menorrhagia ----- 6

Mesenteric disease - - - 6

Neuralgia faciei - - - - 2

Obstipatio ----- 1

Ophthalmia ----- 1

Ovarial dropsy - - - - 1

Peritonitis, chronic - - - 1

Paralysis ------ 4

Phthisis, confirmed - - - 1 1

- incipiens - - - 7

Psora - -- -- -- 1

' Purpura ------ i

Pylorus, stricture of - - 1

Pyrosis ------ 2

Rheumatism, chronic - - 7

70 Carry forward
3 E

VOL. XX. — ^NO. 119.

151

390

Original Qommunications,

STATEMENT OF DISEASES OF OUT-PATIENTS — Continued

Brought forward - - 151

Ringworm of scalp - - ~ j

Scarlatina - - - . . 2

Scrofula . 3

Splenitis ------ 2

Scorbutus - . 2

158

Brought forward - -

158

Suppressio mensium - -

Thorax, chronic affection of

Tympanitis .

Uterus, disease of - - -

Worms ------

17^

ABSTRACT OF CASES SELECTED FROM THE PRECEDING LIST.

No. I. — Case of Diabetes Mellitus.

George Smith statis thirty-three, day-labourer, was ad¬
mitted into the hospital January 3d, ] 823, labouring under
diabetes. This man had formerly been under my care for
chrome laryngitis, which terminated in thickening of the
membrane lining the larynx, causing, of course, permanent
hoarseness. He was decidedly of that temperament of which
diabetic patients usually are, viz. the strumous. The disease
was well-marked; for although the quantity of urine was
much less than often occurs in diabetes, its quality was dis¬
tinctly saccharine, and in appearance it resembled capillaire
and water. The patient had remarked the increase and the
almred quality of the urine for about six weeks. He com-

dyspeptic symptoms, cardialgia,
V g appetite, distressing thirst. His bowels were inclined
to be costive, and whenever he neglected them, the secretion
o urine was greater. His tongue was covered by a siimv
mucus, beneath which a morbid redness was perceptible

and feeble; his surface hot, and
Without the slightest perspiration. Anaphrodisia. * He

Tss nrfnT Tr"" ‘he incessant calls to

p urine. The quantity of urine was directed to be accu¬
rately measured.

4th. — Rather more than eight pints of limpid water had

'’o hT. f “ i", »»"•

n«i u ir • < ’ acvcu iu lue morn-

Only half a pint of beer drank. Under the impression

* Does not this symptom generally occur where the kidneys have
been stimulated to secrete inordinately, and the stimulus ha^s been
kept up for some time? Drinking soda-water in large quantities has
I believe, been found to produce anaphrodisia. The water of the
Seme possesses, as every one knows, rather a laxative quality, and is
so very diuretic, I know of one instance where its exclusive use
greatly impaired the sexual feeling for the time.

Dr. Carter’s Report of Cases treated at the Kent Hospital. 391

that the disease depended upon derangement of the digestive
organs, I prescribed as follows : —

R Infusi Caryophyll.; — Infusi Quassise, aa3v. ; — Magnes. 3j. ; —
Tinct. Humuli, 3j. — Misce, ft. haustus, omni nocte sumend.

^ Ferri Subcarb. Bss. ; Sodce Exsiccat. gr. vj.; Rhei Pulv. gr. iij.;
Misce, fiat pulvis, ter die sumend.

Toast and water in moderation. No vegetables. Little bread.
Plain roast or boiled meat.

5th. — Eight pints of urine during the day; a quantity
exceeding the liquid taken by one quart. Four pints of urine
in the night. Half a pint of fluid taken. — Pergat.

6th. Urine in 24 hours, 8 pints. Fluid taken, 4 pints.

7th. - '~9 - — - - 5 -

8th. - .8 - - — 5 -

He was directed to continue the powders, and, as he still
complained of troublesome cardialgia, to lake the night
draught as before with twelve grains of potass, subcarb.
instead of the magnesia, and five grains of blue pill every
night.

11th. — The alkaline subcarbonate had certainly increased
the discharge by the kidneys, without at all seeming to dimi¬
nish the acidity of stomach. The urine continued very sweet.
Appetite was more natural. He complained of what he
termed a drawing sensation from the kidneys^along the course
of the ureters to the bladder. I scarcely comprehend what
he meant; perhaps it was forcing.

11th. Urine in 24 hours, 6 pints. Fluid taken, 3 pints.

12th. — - 6 - - - 4 -

The alkali having been discontinued on the 11th, the
quantity of urine became unimportant, but its quality con¬
tinued as before. I prescribed at night a grain and a half of
opium.

On the I4th and 15th the patient was very ill. The
opium had disagreed, exciting great heat and uneasiness,
while it had completely failed in procuring perspiration, or in
checking the secretion of urine in any way. A saline mix¬
ture was now ordered, and 9ss. of Dover’s powder at bed¬
time.

l6th. — The patient had perspired profusely in the nighty
and the perspiration had a peculiar faint saccharine smell,
similar to that of the urine. The bowels were considerably
relaxed. Pulse frequent. Tongue brown, in consequence of
the opiate, but moist. Appetite little. Only one pint of
urine has been passed in the twenty four hours. Observe the
effect of the diaphoresis.

17th. — Urine in twenty-four hours, six pints. Pulse 78.

392

Original Commmiications,

Tongue foul. Has rested ill. Perspiration had ceased entirely »
Augeatur pulv. ipec. c. ad gr. xv.

From the 20th to the 25th, owing to some mistake, the
patient took no medicine. The urine was now increased
to thirteen pints. He was feeble, and emaciated rapidly.
A mixture with decoct, cinch., tinct. ferri muriat., * pulv.
myrrhae, and sp. lavand. c., was ordered : a dose to be taken
every four hours. Blue pill with opium at night. Hard
eggs as the chief article of food, f

February Jst. — The diet w'hich had been prescribed did
not agree. It oppressed his stomach. On this day, influ¬
enced, I confess, rather by authority than led by experience,
I directed that the patient should be blooded to Jxvj. The
blood was neither cupped nor bufly, nor firm, and the deple¬
tion did rather harm than good. The relative quantities of
urine and of fluid taken in were at this time as follows : —

February.

4ith. ..•••«
5th. ••••••

6th. .

7th. .

8th. .

9th, .

]0tb. .

11th. .

12th. .

13th. .

14th. .

Urine in 24 hours.

’ * * • 7 pints. • • '

'^2

Fluid taken.
• 5 pints.

• • • • « •

*^2

5
4

About this time he began taking the prussic acid, and it
was continued till March 21st. His general health seemed
to improve under its use. His dyspeptic symptoms seemed
to be relieved, but the disease was not diminished. At length
his sight began to suffer from the medicine, and I was
obliged to discontinue it. During this period his bowels
were costive, and he took occasionally a pill, containing half
a minim of croton oil, w'hich operated extremely well.

I should have mentioned that he was made out-patient,
February 21st, at his own desire.

^ I shall perhaps be told that the preparations of iron are incom¬
patible with cinchona. I know, however, from experience, that the
combination is a useful one, and I therefore continue to prescribe it.

t This direction as to diet may seem whimsical enough, but I
was led to it by having heard long ago of a case of diabetes which
was supposed to have been cured by this kind of food, and in a
disease so generally fatal, I was inclined to make trial of every thing
that had been recommended.

Dr. Carter’s Report of Cases treated at the Kent Hospital. 393

About the middle of March he caught cold, and the
quantity of urine was again greatly increased.

On the 4th of April the diabetes suddenly ceased, without
any assignable cause, and distressing strangury ensued.
This soon yielded to tinct. ferri muriatis, and an opium pill
at night, and the urine became again sweet and too copious.

About this time the third volume of the Dublin Hospital
Reports fell into my hands, and Dr. Marsh’s paper on
diabetes of course attracted my attention forcibly. His
recommendation of opium is not new : * it was his statement
respecting the warm bath, and the exciting of profuse per¬
spiration by hard labour, that attracted me. I determined to
give both a trial in the present case. The warm bath, both
simply and with tinct. opii, caused excessive sickness and
languor, and the patient could not be persuaded to continue
it. Hard work, aided by warm clolhing, and a scruple of
Dover’s powder at night, entirely removed the disease.

At the beginning of June he was quite well, and left off
medicine, and on the 13th he was discharged.

I feel perfectly satisfied that Smith was free from diabetes
when he left the hospital, and I cannot but ascribe the
removal of the complaint to the profuse perspiration induced
chief! 3^ by hard labour and warm clothing.

Since his dismissal the disease has, I understand, returned,
owing, I dare say, to irregular living ; but the man has not
applied to me. This does no discredit to the treatment
which succeeded while he was under my observation, and
should by no means shake our confidence in the plan pro¬
posed in Dr. Marsh’s excellent paper.

No. II. Case of Chronic Encephalitis, with Congestion, and
perhaps incipient Effusion of Aqueous Fluid.

Joseph Hawker, setatis nine, was admitted March 14th.
This was really an interesting case. The boy complained of
great pain of the head, and his countenance evidenced that he
was suffering much. He was unable to raise his eyelids.
The eyes themselves were void of lustre, and the pupils
exceedingly dilated. He was drowsy, and averse from all
exertion. His pulse was slow, and I think it occasionally
intermitted. Tongue foul. His bowels were in a torpid
state. Urine natural. Suspecting that worms might be the
cause of all these unpleasant symptoms, I prescribed olei
terebinth. 3vj., syr. rosae to be taken immediately, and

* See cases recorded in Vol. IV. of the Medical Transactions of
the London College of Physicians, by Dr. Warren.

394 Original Communications^

to be repeated in four hours if the first dose should not
operate.

I3th. — The first dose produced little effect, and no worms
appeared. The second dose had not been given. — Repet.
oleum terebinth, cum olei crotonis r^ss.

This draught operated briskly, but there were no worms,
nor were the motions at all slimy. Symptoms continued
exactly the same. It could not then be doubted that the head
was primarily affected, and that if the disease were not
speedily arrested, effusion would take place.

Utatur capiti raso Unguento Antim. Tartar, ter die.

Sumat Hydrarg. Submur. gr. ij. ; .lalap. Pulv.gr. vij. Pro re nata.

— Full diet. *

The ointment was not begun till the 24th. It was dili¬
gently used; and in a few days, when the discharge from the
pustules had become very profuse, there was marked relief of
all the symptoms. The smarting of the scalp w'as trouble¬
some, and fomentations and poultices were ordered. Purga¬
tive to be repeated.

April 5th. — The boy continued much better. Pupils
contracted freely to light, but the pain of his head was not
entirely gone. The discharge from the pustules was still pro¬
fuse. — Admov. utrisq. temp, hirudines iij.

Qth. — Leeches have been of service. Discharge conti¬
nues, but in a less degree. Pain of the head is nearly gone.
Pupils contract freely to the light. Eyelids no longer drop.
Countenance cheerful, and torpor quite removed. Pulse
natural. Tongue clean. Bowels regular, and motions of
healthy appearance. — Repet. hirudines.

19th. — He was discharged cured.

The good effects of the tartar emetic ointment in this case
were unequivocal. The alteration in his appearance, as soon
as it took effect, was most striking.

No. III. Case of severe Pain of the Head, much resembling

Neuralgia Faciei.

- Jeffery, setatis thirty-three, married woman, was

made out-patient August 9th, J822. She complained of ex-

* In cases like the one above recorded, where there is great general
debility, and at the same time local congestion, the most rational
indications would appear to be, first, to relieve the oppressed organ,
and then, secondly, to support the system, that the recurrence of
congestion may be prevented. In no cases, perhaps, is this plan of
treatment more called for than in those where the congestion exists
in the brain, especially when the subjects are young and of feeble
constitution.

Dr. Carter’s Report of Cases treated at the Kent Hospital, 395

cessive pain of the left side of lierhead, which had tormented
her at intervals for some wrecks. I discovered, upon further
inquiry, that there was an abscess of the left ear, which
doubtless aggravated the disorder, but which did not seem to
be the sole cause of it; for although, whenever the abscess
burst, and discharged its contents, which it frequently did,
there was a mitigation of suffering, still the pain did not cease
at these times, but recurred in paroxysms, darting and shoot¬
ing, and almost depriving the poor woman of her senses at
the moment. There was great nervous debility about the
patient: she was feeble, with a w^eak pulse, and complained
of sinking at stomach. Her tongue was coated. Bowels
were regular. 1 first of all prescribed bark with myrrh, and
equal parts of pil. aloes c. and pil. gall. c. pro re nat^, also
an opium pill to be taken when the pain should be violent.

After continuing this plan for some time, without any
advantage, the subcarb. ferri was tried, but with no better
success. A seton was afterw^ards made in her neck, and kept
discharging for upwards of two months. It \vas then taken
out, having done no good.

January 3d. — The bark was resumed ; leeches were applied
to the left temple; and the following pills were ordered every
eight hours : —

R Extract. Strani. gr. ss. ; Opii, gr. ss. ; Hyoscy. gr. iij.; Hu-
muli, gr. V. ; Pulv. Jacobi (veri), gr. iij.; Pulv. Myrrhse, q. s.
ut ft. pil. iij. vel iv.

I7tb. — I did not perceive that any improvement had
taken place in the patient. I now^ determined to give the
iron a farther trial, and accordingly prescribed as follows: —

R Ferri Garb. 3ss.; Pulv. Calumb. gr. v. ; Misce, fiat pulvis, ter
die sumend. — Sumat Mist. Camph. 3j. cum Liq. Ammon.
Acet. 3iij. ; Tinct. Opii, tllxv.; Syr. s. 3j. Omni nocte.

March 7th. — Her general health was improved. The
powders had agreed, but they now rather oppressed the
stomach. They were, however, continued till the 28th, w^hen
ihey were changed for the following : —

R Ferri Subcarb. 3iss.; Pulv. Rhei, 3ss.; OleiMenth. Pip. g“. viij.;
Confect. Rosae Can. q. s. ut fiant pil. xxx. quarum sumat
iij. bis die, cum parte sexta misturae sequentis.

R Decoct. Cinch, ^viss. ; Tinct. ejusd. c. Jss. ; Confect. Aro-
mat. 3ss. ; Sp. Lav. c. 3vj. Fiat mistura.

This plan was steadily pursued for full two months. The
patient gradually improved in health, and lost the pain. On
the 13th June she was discharged as cured, and I have not
heard of her to this date, August 20th.

That this poor woman will not be visited by the same

3y6 Original Communications,

complaint again, I feel by no means disposed to say. From
what I have remarked, indeed, in similar cases, I should
think it more than probable that it will recur. Still the sub^
carbonate of iron has removed it for the present ; and this
case may fairly be added to many more of a like description,
in which that substance has been of undoubted efficacy.

No. IV. Case of General Dropsy, arising from extensive Ossi¬
fication in the Heart, and Adhesion of the Pericardium to this

Viscus.

Upon the death of my late colleague. Dr. Packe, which
took place in March, the care of his patients in the hospital
devolved upon me, until the election of a Physician to supply
his place. Among other cases, I found one of general
dropsy. The individual, whose name was Austen Upton,
setatis thirty-seven, was moribund when 1 saw him first,
viz. March 14th, and he died two days after.

I obtained the following statement of symptoms from one
of the pupils: — The man was admitted with general
dropsy. He complained of difficulty of breathing, accom¬
panied by a sense of weight and oppression at the chest,
inability to rest on either side, or indeed in any position,
unless his head and shoulders were considerably raised. His
countenance was much tinged with bile, and expressive of
anxiety. His pulse was weak and irregular. Tongue was
loaded with a brown fur. Bowels confined, and what faeces
were passed were not natural. His skin was dry. Little
urine secreted, and that little was of a deep orange colour.
On the 12th March his legs were scarified, and a great
quantity of fluid escaped, 'fwo days after, the punctures
assumed an unhealthy appearance; the legs became much
inflamed, particularly the right one, which sphacelated.^’

Dissection, — The body was examined on the 18th, and the
appearances were as follow: — Upon opening the thorax,
which contained a large quantity of yellow^ fluid, the lungs,
particularly on the left side, were found adhering, by strong
filamentous bands, to the pleura costalis, and they exhibited
a slight blush of inflammation. The heart was inseparably
attached throughout the whole of its surface to the peri¬
cardium. The semilunar, mitral, and tricuspid valves were
ossified, as were also the coronarv arteries, Coasfula of
blood were found in the ventricles, and in various parts of the
substance of the heart marks of incipient ossification were
discernible.

In the abdomen, the liver was rather larger, and more
hard than natural. The villous coat of the duodenum was

Dr. Carter’s Report of Cases treated at the Kent Hospital. 3Q7

very vascular. There seemed to be some obstruction of the
gall ducts. No other morbid appearance was detected.

The brain was free from disease.

It is rarely, I think, that adhesions so strong and so com¬
plete are found between the pleura v/hich covers the lungs
and that which lines the ribs, or between the pericardium
and heart. Still more rarely do sve meet with ossification of
the heart to so great an extent as had taken place in the
instance before us. Dr. Baillie, in his well>-known work,
informs us, that “ a portion of the heart has been observed
to be converted into bone, and that earthy matter has also
been found deposited in the muscular substance of the
heart;” but he adds, that neither of these appearances
have come under his own observation, and that they are to
be looked upon as very uncommon.”* Morgagni notices
a case from Platerus, of a merchant in whom “ the right
ventricle was internally so hard, every where rough, and in
some measure scaly, that the hand being thrust into it, was
hurt by the roughness of the scales.”‘|' He then proceeds
to relate a dissection which he made in 1745, where bony
matter was found in the heart. Baron Corvisart mentions
one case of this kind, which had fallen under his own
observation, and which it would seem was the only one
he had met with. The case he certainly deemed an extraor¬
dinary one, for he brings forward two others in support
of it : the one by Haller, the other by M. Renauldin.J

Upon the whole, the foregoing case of Upton must be
looked upon as one of no common interest.

in the short history of the above case, furnished by Mr.
Peter, one of the pupils of the hospital, it is mentioned,
that towards the close of the disease the lower extremities
were punctured, and that the punctured places assumed,
in tw'o days, an unheaitljy appearance, became much in¬
flamed, and that ultimately the right leg became gan¬
grenous. Here is one instance, among many which have
fallen under my observation, of irremediable mischief aris-
in<r iVom scarifications of the lower extremities in cases of
I'dropsy. All that 1 liave ever witnessed of this practice,
from the time that 1 first became a student in physic, has
tended to impress more and more upon my mind the
l*conviction that it is always hazardous practice ; and I con-
lisider it to be more especially dangerous, where the dropsical

* Baillie, Morbid Anatomy, page 45.
t Morgagni. Ep. XXVII. Art. l6.

X Corvisart. Treatise on the Diseases and Organic Lesions of
|Uie Heart, &c. — Chap. IV. sect. 2.

VOL, XX. - NO, 119. '5 F

S9S

Original Communications.

affection is thought to depend upon some disease of the
heart; for in these cases lam inclined to think,, though a
writer of high authority seems to question the fact,* that
the extremities are peculiarly liable to mortification. For
my own part, whenever 1 wush to evacuate the fluid from
dropsical limbs, I shall employ acapunctura, wFich I have
found in several instances safe and effectual. The punc¬
tures made by the needles are so small, that there is little
danger of their running into erysipelatous inflammation, |
while they are quite sufficient to allow of the escape of
the effused fluid. Several needles may be passed into each
leg, and the result will doubtless be satisfactory. As much
relief will be afforded as by scarification, and the risk
attending the latter operation will be avoided.

No. V. Case of Chronic Hheumatism , follozced hy an Epileptic
Seizure, which terminated fatally.

Sarah Hall, setatis 37, was admitted into the hospital, I
February 14th, with chronic rheumatism. No other disease
was hinted at by the patient or her friends, and no other
was apparent to me. For several days she seemed to be
improving, under the use of the warm bath, bark and ;
colchiciim^-and Dover’s powder at bed-time. On the 19th, ;
however, Tn the afternoon, she fell down in a fit, from which r)
she could not be recovered.

It has since been discovered that the poor woman was d
subject to epilepsy.T I

Dissection. — The body was examined about sixteen hours i|
after death, it was still somewhat warm, notwitljstanding i
the length of time which had elapsed since the patient expired. I
Externally it had several patches of a purple hue, and upon [j:
being cut into, the cellular substance was found to contain | '
a considerable quantity of a peculiar fluid resembling oil. fp
The omentum, mesentery, intestines, were loaded with fat. j
The liver and spleen were enlarged, and in their texture |
soft and pulpy. The bladder was full of urine, but it was !
not diseased. The uterus and its appendages were healthy, d
The heart was pale and flaccid. Lungs free from disease. ^
On removing the calvarium, which was unusually thick, |

* Corvisart, chap. IV. sect. 3, ad fincm. “ We may conclude,
from these cases, that sphacelus of the extremities is not a frequent!
consequence of diseases of the heart or great Vessels.” !

t In this case, as has happened in many others, the want of pro-[
fessional information as to the patient’s state, previously to her being!
sent to the hospital, was to be regretted. 1

Dr. Gai ter’s Report of Cases treated in the Kent Hospital. 399

there was observed a peculiar groove or depression, extend¬
ing throughout the whole length of the coronal suture. The
furrows produced hy the arteries were very conspicuous: the
dura mater seemed rather more vascular than usual ; and
when it was removed, the vessels of the pia mater, towards
the anterior portion, as far back as the situation of the
coronal suture, were of a livid hue, while those of the pos¬
terior part of that membrane were of a purple colour.
Upon cutting down to the lateral ventricles, a consider¬
ably larger quantity of fluid than they naturally contain
escaped. The substance of tlie brain appeared to be per¬
fectly healthy.

No. VI. Case of Hydrothorax.

John Maxted, aetatis 39, was admitted May 23d, labouring
under symptoms of hydrothorax. He stated that he first
felt himself decidedly ill soon after Michaelmas, J822 —
that he became a patient of the hospital, January lOlh, and
after remaining there a month, was discharged, much re¬
lieved. He, however, got wet in returning home, and all
the symptoms quick!}^ returned. The symptoms upon his
second admission w'ere — much cough and expectoration of
viscid mucus. The cough created pain at the scrobiculus
cordis. He was unable to lie down in bed, or to use any
exertion without great distress. His pulse was extremely
feeble, irregular, and intermitting. Tongue moist, but
covered with fur. Much thirst. Little appetite. His
urine was scanty and high coloured, and occasionally
turbid. No perspiration. Bowels relaxed, and motions of
natural colour. Lower extremities considerably swelled.
Countenance livid. Sleep much disturbed by frightful
dreams.

R Pulv. Scillse gr. ij. ; Pulv. Digit, gr, ss.; Pil. Hydrarg. gr. j. ;
Confect. Rosae gr. j. ut ft. Pil. ter die sumend. cum parte
sexla mist, sequent.

R Sup. Armorac. c. ^v. ; Sp. flEth. Nitr. Sss. ; Vini Colch. 3ij. ;
Sp. Junip. c. Jij. F. M.

Utatur pectori unguent. Ant. Tartar.

In this manner he proceeded till June 3d, when, in addi¬
tion to the above medicines, a drachm ol the stronger
mercurial ointment was directed to be rubbed in on the
right side every night. The ungt. ant. tart, was discon¬
tinued.

, June 8th. — Pulse regular and not intermitting. Tongue
cleaner. Swelling of legs diminished. His bowels are

400 Original Communications.

very much relaxed. — Sumat pil. bis die, cum coch. ij.
misturae.

R Mist. Camph. ft. ^xj. ; Extract. Hyoscy. gr. jv. ; Tinct.

Camph. c. f. 3j. Misce, ft. haustus, omni node siimend.

16th. — By this time all the symptoms were materially
relieved. The cough and expectoration were less; the
respiration was more free. He could lie down in bed witli-
out difficulty, and his rest was less disturbed than it had
formerly been. His pulse, about 80 in the minute, w^as
not intermitting, though still somewhat irregular. His
tongue was clean. Bowels relaxed. Urine clear and in-
creased in quantity. The swelling of legs was almost
entirely gone.

24th. — He continued much in the same state, except¬
ing that he complained of a degree of faintness and of
nausea. The digitalis was, therefore, discontinued for a
few days. The patient remained in the hospital until
July 8th, when he was discharged, as having received great
benefit.

There is nothing singular or extraordinary in the above
case. It is one, I may say, of almost every-day occurrence.
I have, however, recorded it, because the plan of treatment
seemed decidedly successful; and I wish to recommend it
as one which 1 have found equally so in several cases similar
to that before us.

In dropsy of the chest it is considered that diuretic
medicines are more useful than they are in any other species
of dropsy. When exhibited by themselves, however, I have
seldom, if ever, seen much advantage from them ; nor is
this to be wondered at, since hydrothorax and hydro-pericar¬
dium are but symptoms of disease of thoracic or abdominal
viscera. Generally, where there exist symptoms which lead
us to infer that there is water in the chest, we recognise
also some disease of liver, or spleen, or both, which demands
the appropriate remedies. Generally too w^e meet with
extreme debility of stomach, and such an universal failure
of the powers of life, when the disease has subsisted for
some time, that stimulants cannot be dispensed with. To
meet then every indication, a combination of various remedies
is needed, and a combination, either the same as that which
was adopted in the present instance, or similar to it, I have
found eminently useful. I have lying before me several
cases, in which marked relief was obtained. Of one of
tltese I shall offer an abstract, as I consider it, on several
accounts, an interesting one.

Dr. Carter^s Report of Cases treated m the Kent Hospital. 40i

No. VIL Case of Hydrothorax .

John Lewin, gardener, was admitted into the hospital;,
April 2^id, 1821, with the following symptoms: — Great
tremor and debility. Pulse feeble, and intermitting, and
irregular. Respiration extremely anxious, especially upon
the least exertion. Cough. Violent palpitation of heart.-
Tongue foul and dry. Urine high-coloured, but in sufficient
quantity. Bow^cls regular, but evacuations clay-coloured.
Cannot lie down in bed, and his sleep is much disturbed.
Lower extremities anasarcous. It appears that the patient
has lived rather freely. For a week he took inf. armorac. c.
with vinum colch., and a blister was applied to his chest; but he
he did not improve. On the 29th he w as admitted into the house.

R Pulv. Scillse gr. iij.; Hydrarg. Submur. gr. j. ; Pulv. Digi¬
tal. gr. ss. ; Confect. Rosse Can. q. s. ut fiat pil. ter die
sumend. Superbibendo misturse sequentis coch. iij. larg.

R Inf. Armorac. c. Jv. ; Sp. jEth. Nitr. ^vj.; Vini Colch.
3ss.; Sp. Junip, c. 5jss. F. M.

Alay 2d. — Much relieved. Breathing easy. S weeding of
legs gone. Pulse much less irregular. Tongue clearer.
Urine and alvine discharge as before. Little sleep.

7th. — Respiration much improved. No cough. He is
now able to walk quick, or to ascend a hill without much
difficulty. Pulse still irregular and weak. Bowels as be¬
fore. Appetite very good. He feels so much better that
he wishes to be made out-patient. He left the hospital
accordingly on the 1 1th.

18th. — Much the same in every respect. Complained of
want of rest, and was therefore ordered acid, prussici ttlij.
ex aq. rosse 3X. omni nocte, hor^ somni, et repet. horis
quatuor interpositis, si opus fuerit.

June 1st. — Going on as well as I could expect.

July. — A strong pulsation, just below the scrobiculus
cordis, which had been remarked when the man first applied
for admission into the hospital, has now become more
violent. The pills with digitalis have been relinquished for
between a fortnight and three weeks, and he has been taking
infus. rosse with tinct. digital.

July 13th. — He returned to the pills, and discontinued all
other medicine. He was soon after discharged, as having
received benefit. He was, however, allowed to have pills
from the hospital.

Sept. 9th. — Continues pretty well, and able to follow his
occupation.

March, 1822. — As before. He still takes a grain or a
grain and a half of digitalis occasionally, and with great

402

Original Communications.

relief to his chest. A short time ago he coQiplained of
numbness and coldness of hands, which I was inclined to
ascribe to the medicine. These threalenings of paralysis
soon, however, went off.

This man continued in tolerable health, and constantly at
work, till June, 1823, when I was requested to visit him at
his own habitation, as he had fallen down in a 6t. I sus¬
pected he had been making too free with his favourite
medicine, and such I found to be the fact. He had not,
however, had a fit; but feeling giddy, and unable to continue
his work, he had lain down upon the grass, and when
spoken to by those who passed by, he gave strange answers,
and seemed like one intoxicated. I found him perfectly
collected, and free from all pain; but he had so completely
forgotten words that he could give no account of himself.
I gave him a slate, and he attempted to write, but soon laid
down the pencil, intimating, by his gestures, that he could
not recollect words to express what had happened. When
I asked him, whether he attributed his loss of memory to the
pills, he said — Yes, yes.” 1 ordered him a warm purga¬
tive, to be repeated in two or three hours, if necessary, and
applied a blister to his chest. He slept from ten A. m.
till two very soundly. His bowels w^ere then very copiously
relieved. The evacuations were charged wdth bile, and
extremely offensive. He had, by four o’clock, recovered
himself so far as to be able to give some account of the
manner in which he was attacked, and on the following day,
he was nearly as well as usual. It appeared that he had
taken a pill, containing a grain of digitalis, in the evening,
and had repeated it the next morning, though he found the
previous dose had caused considerable giddiness and con¬
fusion of head. He now relinquished the digitalis alto¬
gether; and as he complained of great oppression and pain
at the pit of the stomach, a drachm of strong mercurial oint¬
ment was rubbed in every night, and he returned to the
mixture originally prescribed, taking every night and morn¬
ing the following pills:

Be Pil. Hydrarg. g. iij.; Pulv. Scillae gr. ij. ; Extract Hyoscy,
gr. ij. M. ft, pil. ij.

At present. Sept. 3d, he is very well. He continues the
pills only.

Canterbury, 13th October, 1823.

[We much regret that our limits, and the late period at which we
received this interesting report, oblige us to defer the greater
number of the valuable cases which it contains until our next
Number.]

Mr. Finch’s Case of Trismus cured by Acupuncturation. 403

Case of Trismus, S^c, approaching to Tetanus, supervening to a
lacerated Wound, successfully treated by Acupuncturation,
By Frederick Finch, Esq. Greenwich, Member of the
Royal College of Surgeons, London.

[In a Letter to Dr. Copland.]

In a paper on the Efficacy of Acupuncturation in Ana¬
sarca, which you did me the favour to insert in your valuable
publication a few months since, 1 ventured to suggest the
probability of that operation being attended with advantage
if resorted to in other diseases.

The frequent opportunities I have had of witnessing the
manifest benefit it has afforded in rheumatic patients, by
producing almost instantaneous relief, particularly in those
cases where there was rigidity of the muscles, induced me to
entertain an opinion that acupuncturation might be effica¬
cious in the alleviation of tetanus, and 1 determined to avail
myself of the first opportunity to make trial of it in that
disease.

In the course of the last month, a highly respectable neigh¬
bouring Practitioner (Mr. Bromley, of Deptibrd,) informed
me that he was attending a patient who had fallen from a
considerable height, and had received several extensive lace¬
rated wounds on various parts of the body and scalp, and
that he despaired of his recovery, in consequence of trismus,
&c. having taken place, and destroyed all power of degluti¬
tion. I intimated to Mr. Bromley that, if the case were
mine, I should try the effect of acupuncturation, and was
permitted to accompany him to the patient’s house. The
patient was in a most distressing situation, with a pulse of
130; the jaw completely locked; and, from the extreme
rigidity of the muscles about the throat, he was incapable of
swallowing the smallest quantity of fluid.

Having obtained permission to employ the needles, I intro¬
duced one into the masseter muscle of the right side, and
was much gratified to find that muscle, as well as the sterno-
cleido-mastoideus, platysma myoides, and all the muscles of
the neck and throat of. that side, instantaneously relieved from
their spasmodic contraction. Another needle was then intro¬
duced into the left masseter, and relief (though not to the
same extent) was immediately afforded. Such was the effect
of the operation, that before we left the room the patient
look a large dose of tinct. opii and a cup of chocolate,

404 Original Communications,

although he had beeu unable to swallow any thing for some
considerable time before. He is now perfectly recovered.

It would be too much to assert that the same means
would in every case be attended with the same fortunate
effects; but in such a dangerous and fatal malady, even a
distant approach to a successful remedy may lead to im¬
portant discoveries, which may be promoted by inserting this
case in the pages of the Repository.

Greenwich, 14th October, 1823.

Critical Remarks on the London Pharmacopoeia of 1809, and
the altered Edition of 1815; with Suggestions intended to
obviate the Objections made against attending to the Direc¬
tions contained in the Pharmacopoeia Collegii Regalis
Medicorum Londinensis submitted to the consideration of
that Learned Body, and the Medical Profession in general.
By J. H. Sprague, Esq. Member of the Royal College
of Surgeons, London, and of the Medico-Anatomical
Society of Bristol, &c.

Without a formal introduction, I shall proceed to call the
attention of the readers of the Medical Repository to the
following observations on the several imperfections and errors
which must be acknowledged as appertaining to the present
Pharmocopoeia of the Royal College of Physicians of London.
I do this with much less hesitation than I otherwise should,
as my remarks are not founded on my own experience and
opinion only, but on the experience and opinions also of
some of the most enlightened contemporary writers in thera¬
peutics and pharmacology. Many of these errors and omis¬
sions have been acknowledged by some of the fellows of the
College, wdio, 1 understand, form a part of the committee
engaged in revising the present Pharmacopoeia, as prelimi¬
nary lo the publication of a new edition of that work. Now',
after the very just criticism v\hich has been bestow^ed upon
the subject by many competent judges, whose opinions are
well known to the Profession as deserving the strictest atten-
tion, it would be highly discreditable to the College again to
issue a work of so jnuch importance to the community under
their sanction, without having profited by every suggestion,
of how'ever humble a nature it may be, that has a tendency to
correct the errors and omissions in question. My endeavours,
in the present instance, in whatever manner they may be

Mr. Sprague’s Pharmacological Remarks attd Suggestions. 405

viewed, are to be useful — this obtained, I am indifferent to
the rest.

In the first place, I would briefl}^ call the attention of the
reader to the propriety there would be in the College taking
into their consideration the observations made by Mr. Gray,
in his “ Elements of Pharmacy,” on the present weights used
by the Apothecary, &c. He remarks, When the London
College of Physicians published, in 16I8, their first Pharma¬
copoeia, Sir Theodore Turquet de la Mayerne, who compiled
the w'ork, being a French Physician, unacquainted, as it
should seem, with the usage of England, and not aware or
regardless of the practical inconvenience of Apothecaries
buying and selling by one weight, and making up their
articles by another, ordered them to dispense their medicines
by the troy weight, instead of the avoirdupois, by which they
buy and sell, and which had been previously used in dis¬
pensing. In order to avoid the expense of both piles, or the
trouble of calculating how many oz. of one pile are equal to
so many of the other, a strange mixture of tlie two are used.
When medicines are ordered in quantities less than a quarter
of an ounce, it is presumed that they are powerful in their
action, and they weigh them by the troy weight ; but those
ordered in a large proportion, being thought to be weak, or
intended to be divided into numerous doses, the Apothecaries
presume that the difference between the two weights will not
be of any consequence, and weigh them by the avoirdupois,
which they are obliged to keep for their retail business as low
as the qr. oz. Thus a trade in which the utmost precision
in weights is usually expected, is actually that which is the
most inaccurate in that respect ; but the patients have no
means of checking errors in dispensing. Some few Apothe¬
caries and other dispensers have troy weights as far as four or
eight oz., but scarce any have them heavier. The Physicians
who, front want of an academical education, or any other
cause, practise their profession under the mask of being
Apothecaries, that is to say, mere sellers of medicine, are at
least as inaccurate ; and many of them exhibit their medi¬
cines by the eye alone, without weighing. Dr. Powell, in his
translation of the last Pharmacopoeia, has desired, in a half¬
official manner, that no avoirdupois weights should be kept
in an Apothecary’s shop ; but that, like the gold and silver
smiths, they should buy and sell, as well as dispense, by the
troy weight. He does not consider that gold and silver are
articles bought and sold by that weight, whatever may be the
quantity ; whereas the medicines of the Apothecary are, in
general, only a specific appropriation of articles far more
commonly used for other purposes : hence he must buy them
voL. XX. — NO. 119. ^ ®

406 Original Communications,

by the usual commercial weight; and to forbid him the keep¬
ing of that pile in his shop, would deprive him of the power
of checking the weight of the drugs sent in by his druggist,
who, in the event of any dispute, would not rely on the
reduction that might be made by the Apothecary of one
weight into another. On the other hand, to oblige him to
sell by a weight the ounce of which is much heavier than the
common, would necessitate the asking of a higher price by
ten per cent, than the druggist, or a diminution of the profit
to the same amount. All this confusion and inaccuracy has
arisen from the national vanity of Sir Theodore Mayerne,
which led him to suppose that the weight of Troyes in
Champagne must be superior to that of the harhares of
England ; and his ignorance, that those English weights
that he despised, were the very weights used by the Greeks
and Romans in composing those prescriptions that he
selected. The only method to get rid of this confusion
would be for the College to disclaim this absurd introduction
of the French weight, to return to the national weight, and
thus restore the use of its small divisions.’^

At ail events, nothing should be regulated by the troy
weight beyond two drams, which is always included in the
small box of weights sold to Apothecaries ; and all above
that quantity may, with much propriety and convenience, be
directed to be weighed by avoirdupois. This would at once
do away with the perplexity now experienced in the calcula¬
tion and subdivision of the weights, and prevent the inaccu¬
racies which are continually occurring by men who are dis¬
posed to attend to their own interest, and disregard every
thing that they deem calculated to give them unnecessary
trouble. — For further interesting particulars respecting
weights, I would beg leave to refer to Gray’s Elements of
Pharmacy, pp. 3 — 16.

I shall now proceed to refer to some of the various articles
and preparations of the London Pharmacopoeia, in the order
in winch they are placed before us in the work itself ; oflfering
such humble suggestions respecting them, and such additions,,
as, I trust, will be found calculated to be applied to a prac¬
tical and beneficial purpose.

Following the course thus laid down, some of the articles
of the materia medica will now very briefly engage my
attention.

It must be allowed that every article introduced into the
materia medica is supposed to be of some utility in the
practice of medicine, and, therefore, should have an officinal
preparation assigned it: with this view, I would refer to a
few established formulae, which, whether the College conde-

}

i Mr. Sprague’s Pharmacological Kemarks and Suggestions. 407

scend to avail themselves of them or not, will be of essential
service to junior Practitioners to become acquainted with, as
several of- them are known to be efficient remedies, and are
combined according to the most scientific rules of pharma¬
ceutical composition.

The principal articles above alluded to, included <11 present
in the materia inedica of the London Pharmacopoeia, requir¬
ing officinal formulae, are the following:

MATERIA MEDICA.

Mat. Med.
Althaeae Radix
Ammonise Murias
Asari Folia

AssafcEtidse Gummi Resina

Balsamum Peruvianum
Balsamum Tolutanum

Belladonnse Folia

Calami Radix
Cardamom! Semina’^
Castoreum

Catechu Extractiim

Centaurii Cacumina
Cinchonse Cortex
Colchici Radix

Conii Folia

Contrajervge Radix
Copaiba

Coriandri Semina
Creta

Elaterii Poma
Ferrum

Gallae

Glycyrrhizje Radix
Granati Cortex

Guaiaci Resina et Lignum

Prceparat.

Decoctum Althsese.

Emplastrum Ammonioe.

Pulv. Asari Compositus.

Pil. Assafoetidas cum Cinchona.
Enema Assafoetidae.

Mistura Balsam! Peruvian!.
Mistura Balsam! Tolutani.
Tinctura Belladonnae.
Unguentum Belladonnae.
Infusus Calami. Tinctura Calami.

Tinctura Castorei Animoniata.
Pulv. Kino Compositus.

Troch. Catechu Extract!.
Tinctura Centaurii Cacuminum.
Sulphas Quininae.f
Vinum Colchici. (Dr. Marcet’s.)

^ Tinctura Conii ; et Mistura Co-
i nii Compos.

Infusus Serpentariae Compositus.
Mistura Copaibae.

Infusus Sennae.

Pulv. Cretaceus.

Mass. Pil. Elaterii.

^ Solulio Ferri Oxygenata. Dr.
t Beddoes’s.

Decoctum Gallae; Tinctura Gal-
lae; et Unguentum Gallae Opia-
C turn.

Decoctum Glycyrrhizae.

Decoctum Granati.

^ Decoctum Guaiaci. Mistura
( Guaiaci Ammoniata.

* Matonia Cardamomum.

t A paper of Dr. Elliottson’s on' its properties, just published in
tlie “ Medico-Chrirurgical Transactions,” Vol. XIL p. 343, will be
referred to, when we come to speak of its virtues in the proper
place.

408

Oriamal Communications.

Mat. Med.
Hydrargyrum
Jalapse Radix

Ipecacauanhae Radix

Juniperi Baccse

Kino^ - - -

Marrubium

Mentha Viridis

Menyanthes

Myrrha - -

Olibanum

Opium - _ -

Ova _ - -

Potassm Nitras
Pyrethri Radix
Rhei Radix

Scammoneae Gummi Resina -

Sarsaparilla Radix

Serpentariae Radix

Spartii Gacuraina
Spigellse Radix

Spongia _ - -

Tabaci Folia
Taraxici Radix
Tormentillm Radix
Valerianae Radix
Uvse Ursi Folia

Zincum - " "

Zingiberis Radix

Prcepardt.

Hydrargyri Cyanit.

Plydrargyri Phosphas.

Pulv. Jalapae Compositus.

Tinctura Ipecacuanhae. Pulv.
Ipecac, cum Antimonio ; et
Troch. Ipecac.

Infusus Juniperi.

Infusus Marrubii.

^ Infusus Menthse Compositus ;
1 Confectio Menthse Viridis.
Infusus Menyauthis.

Mistura Myrrhae.

Mistura Olibani.

Acetas Morphias.

Mistura Vinosa.

Troch. Potass. Nitrat.

Tinctura Pyrethri.

Mistura Rhei Composita,

^ Pulv. Scammonem cum Calome-
^ lane, vel Basilicus.

Infusus Sarsaparillae.f-
lafusus Serpentariae Compo-
( aitus.

Decoctum Spartii Cacuminum.
Infusus Spigelim.

Truch. Spongiee.

Tinctura Tabaci (Noble’s).
Decoctum Taraxici.

Decoctum Tormentillse.

Oleum Valerianm Essentiale.
Infusus Uvae Ursi.

^ Soluiio Zinci Acetatis. Troch.
^ Zinci Sulphatis.
infUsus Zingiberis.

.4/Pterocarpus Eritiacea.

*)■ An excellent paper on the different kinds of Sarsaparilla, by
Mr. John Pope, will be found in the “ Medico-Chirurgical Transac¬
tions,” Vol. XII. p. 344, which will hereafter be more particularly
referred to.

Mr. Sprague’s P harmcicological Remarks and Suggestions. 409

APPENDIX TO THE MATERIA MEDICA :

Consisting of medical substances not yet admitted into the London
Pharmacopceia, but which are certainly entitled to a place in
the next Edition, as there is sufficiently respectable testimony upon
record to lead us to believe that they have been administered by
different Practitioners with the most beneficial effects.

Artemisia Santonica, Worm-seed. — A strong decoction of worm-
seed as an enema is particularly recommended by Mr* C. M. Clark,
in his first volume on female diseases, as one of the best remedies
that can be employed to destroy ascarides. I have frequently tried
it myself, and can bear ample testimony to the correctness of Mr.
Clark’s opinion. The peasantry of South Wales give the worm-seed
coarsely bruised, and mixed with honey, in the form of an elec¬
tuary, as a common domestic medicine against worms, which is said
to prove the most effectual remedy. Vide Decoctum Santonici./*-/?^^*
Berberis Cortex^ Inner Bark of the Barberry. — Dr, William
Hutchinson (late editor of the Medical and Physical Journal) informed
me, that he had found an infusion of this bark particularly serviceable
as an aperient in jaundice; and since his recommendation, I have
also experienced from its use the most decided advantage in icterus,
and other disordered states of the chylopoietic viscera, attended with
a paucity of bile in the intestinal canal. Vide Infusum Berberis.

Cubeboe, Cubebs, or Jam Pepper. — Mr. Jeffreys has lately written
“ Practical Observations on the Use of Cubebs in the Cure of Gonor¬
rhoea.” Many other Practitioners maintain a favourable opinion of
its influence in the same disease. Dr. Macleod and Mr. Bacot (the
present editors of the London Medical and Physcial Journal)
speak of it as “ a very valuable medicine,” and give the result of a
correspondent’s experience at Wolverhampton, which is altogether
highly in favour of the remedy. It is observed, that the pepper is
rendered nearly inert, by remaining long in a powdered state, pro¬
bably by the evaporation of its volatile oil. Vide London Medical
and Physical Journal for October, 1822, p. 357. This remark may
account for its failure in some cases, and would seem to indicate the
propriety of always giving it in the form of a tincture, which contains
all its active qualities unimpaired by keeping. I have generally
found cubebs speedily efficacious in gonorrhoea, when it was given
early in the disease, and before the use of other remedies. It has
also been found efficacious in leucorrhoea and in diarrhoea. Does it
not, therefore, deserve to be restored to the list of the Materia Medica?
— for it once had a place there. Vide Tincturam Cubeboe.

Daturce Stramonii, Thorn Apple. ^ — Dr^ Paris observes, in the Phar-
macologia, Vol. II. p. 174,“ It is narcotic, and has been regarded
by many authors as eminently antispasmodic. Dr. Barton, an
American physician, made very extensive trials of its efficacy, the
result of which is highly favourable to its use; and I have been
recently informed, by Sir Henry Halford, that he has found a tinc¬
ture made of the seeds a very efficient and unobjectionable prepara¬
tion.” Surely, after such assertions, it must gain admission into the

410 Original Communications.

next edition of the Pharmacopoeia. — Vide Tincturam Stramonii
and Extractum Stramonii.

lodina, Iodine. — Iodine is a simple body, discovered in 1813, by
M. Courtois, in the mother waters of soda, as it is obtained from the
sea-weed. The name of iodine is derived from the Greek word
on account of the blue colour of its vapour. Dr. Elliotson
remarks, “ Of the powers of iodine in bronchocele we have abundant
testimony ; I have seen sufficient to satisfy myself ; and they would
seem equally great in other structural diseases.’’ Dr. Baron’s expe¬
rience of its efficacy is equally encouraging. — Vide Tincturam lodinae.

Iridis Flor. Radix, Orris Root. — Every person who is practically
acquainted with the pharmaceutical composition of pill masses, will,
I doubt not, agree with me, that orris root ought to have a place in
the Pharmacopoeia, for the very great use of its powder in rendering
various pill masses, into which soft extracts enter, of a proper con¬
sistence, and retaining them so. It is also one of the best substances
for involving pills of calomel and other mercurial preparations.
Liquorice, nor any other powder, will answer the purpose so well, as
a trial will prove the correctness of.

Lactuca Satim, Cos Lettuce, Inspissated Juice. — Dr. Paris, in
Pharmacologia, Vol. II. p. 209, remarks, This preparation has not
yet found its way into the London Pharmacopoeia ; but as consider¬
able interest has been excited with regard to its sedative properties, by
the testimony of Dr. Duncan and others, I may be allowed to intro¬
duce it in the present work.” This remark, I should suppose, may be
considered as precursory to its appearance in the next edition of the
London Pharmacopoeia. Prepared according to Mr. Probart’s method,
see Extractum Lactucae Concentratum. (Probart’s) Tinctura
Lactucse, and Troch. Lactucse.

Rhodium Lignum, Rose Wood. — See Dr. Mason Good’s observa¬
tions on its virtues, in his Study of Medicine, Vol. I. p. J36, where he
speaks of it as a valuable remedy in flatulency, not only affording
benefit for the time, but, by its tonic virtue, having a tendency to
correct the disorder radically, which certainly renders it deserving of
a place in the New London Pharmacopoeia. For further remarks on
its use, see Tinctura Rhodii.

Tiglium Croton (Oleum ^ Seminibus expressum). — For its
history and effects as a cathartic, I must beg leave to refer the reader
to Dr. Paris’s remarks, which he will find in the Pharmacologia,
vol. 11. pp. 418 — 423, and to various papers in the Medical
Repository.

Having flow comprised all the articles and preparations
of the Materia Medica, to which I wish to call the attention
of the Profession, 1 shall next endeavour to obviate any
unfounded objection that may be made against multiplying
our officinal formulae.

In my humble opinion, a Pharmacopoeia inclusive of the
Materia Medica ought to constitute a standard work of
reference, giving precise and scientific directions for the

Mr. Sprague^s Pharmacological Remarks and Suggestions. 411

accurate composition of every chemical preparation, and
of those more particularly denominated pharmaceutical. It
also should comprise the recipes for other approved medi¬
cines, under the classification of extemporaneous formulae. By
such an arrangement, all the preparations would, with much
propriety, be comprised under two principal divisions, viz.
officinal preparations and extemporaneous formulae. The
first should always be kept prepared in the shop of the Apo¬
thecary, for the purpose of forming the latter. The admis¬
sion of extemporaneous compositions into the Pharmacopoeia
has been already anticipated ; for the decoctions, infusions,
mixtures — several of the liniments, mucilages — some of the
ointments, pills, plasters, &c. must be regarded as extem¬
poraneous.

When it is considered how many are incompetent to pre¬
scribe with elegance and effect, surely the Pharmacopoeia
should be referred to as a guide to direct the Practitioner to
the most efficient extemporaneous formulae or compositions.
This would much abridge the labour of the Physician in
prescribing, as the work would contain some of the best
remedies against disease, in the most useful state of combina¬
tion. Keeping these principles in view, the extemporaneous
formulae of the College, I think, may be augmented with
much usefulness and propriety.

The Officinal Preparations and Compositions come first in
order. Thep are as follows : —

Acidum Aceticum.

On account of the diluted state of the acid, this prepara¬
tion should be named acidum aceticum dilutum, to correspond
with the nomenclature of acidum nitricum dilutum and
acidum sulphuricum dilutum. Nothing can be more im¬
proper than the name given to it by the London College,
as vinegar varies so much in strength. The College would
act very judiciously in directing it to be prepared with the
concentrated acetic acid, similar to a preparation manufac¬
tured by Beaufoy and Co., so much praised by Dr. Paris ;
and which is ordered by the makers to be diluted with
distilled water, as in the subjoined formula. I have not an
acetometer at hand to ascertain the relative strength of the
acid, and therefore can only allude to the proportions directed
by those persons, who at present exclusively monopolize by
secrecy the manufacture of the article.

Acidum Aceticum Dilutum.

R Acicli Acetici Concentrat. Oj.

Aquae Distiliatae, Ovij. Miscc.

412 Original Communications.

The above proportion of acid to the water makes diluted
acetic acid of the same standard strength as the distilled
vinegar of the London Pharmacopoeia, and forms an unique
preparation, answering all the purposes for which it is re¬
quired.

I shall treat of several other acids and other preparations,
which are deserving a place in the Pharmacopoeia, in an
i\ppendix to those sanctioned by the College.

Alkalies and Neutral Salts.

The title of this section in the London Pharmacopoeia is
Alkalies and their Salts; but as these salts cannot be termed
salts of alkalies in strict language, it would be preferable to
translate the phrase neutral salts.”

Liquor Ammonia. — The preferable process of procuring
the liquor ammonias is that recommended by Mr. Phillips,
and is as follows: — To §viij. of muriate of ammonia, and
an equal quantity of newly-burnt lime, add four pints of
boiling water ; allow the mixture to cool in a well-closed
vessel, and from the strained and clear solution distil off
ounces of the liquor ammonias.

Liquor Ammonia Acetatis.

R Ammonias Subcarbonatis,

Acidi Acetici Diluti, Oij. vel q. s. ad Ammoniam accu¬
rate saturandam.

Misce secundcim artem.

Thus prepared, the liquor of the acetate of ammonias forms
a very superior article to wdiat is commonly found in the
shops.

Earths and their Salts.

Calcis Murias. — That eminent Professor of Chemistry to
the University of Oxford, the late Dr. Thomas Beddoes, of
Clifton, was very dissatisfied with the preparation of the
muriate of lime ordered by the London College ; and there¬
fore, for many years before his decease, he directed it to be
prepared in his own practice according to the following
simple and excellent method, which completely supersedes
the complicated formula of the present Pharmacopoeias —

Liquor Calcis Muriatis. — (Dr. Beddoes’s.)

R Acidi Muriatici,

Aquae Distillatae, aa Jiv. ^

Marmoris Albi Pulv. q. s. ad saturandum.^"^^

Many doubts have been expressed respecting the use of
this medicine in scrofula, but I have witnessed the adminis¬
tration of it by Dr. B, in such cases with evident advantage.
That excellent Surgeon, the late Mr. Baynton, of Bristol,

Mr. Sprague^s Pharmacological Remarks, and Suggestions, 413

also corroborates this statement in his work on Diseases of
the Spine. I can also attest, from my own experience, that
it deserves not to be disregarded. The solution should be
kept closely confined in bottles with glass stoppers, and given
in doses of from xxx. drops to one fluid dram, in distilled
water.

Liquor Calcis, — In consequence of Mr. Dalton’s dis¬
covery, and Mr. Phillips’s confirmation of its correctness, I
have no doubt the London College will direct the liquor
calcis to be made with cold, instead of boiling water, in the
next Pharmacopoeia ; reasons for which will be found in
Dr. Paris’s Pharmacologia, Vol. II. p. 275, in a foot-note.

Magnesite Carbonas. — According to correct nomenclature,
this preparation should be named magnesiae subcarbonas ;
satisfactory reasons for which the reader will find in Mr.
A. T. Thomson’s Dispensatory, third edition, p. 631, in a
foot-note.

Remark. — If distilled water be employed, the magnesia
will be lighter, and of a whiter colour.

Preparatioiss of Antimony.

Liquor Antimonii Tartarizati. — It will be perceived by
the fifth edition of Dr. Paris’s Pharmacologia, Vol. II. p.274,
that the College has at length determined to substitute a
weak spirit for the wine at present used in this preparation,
which, if done, ought to be rendered palatable as a medicine
for children, by the addition of raisins or some syrup; other¬
wise druggists will not be able to vend it as a subst’^ute for
the old antimohial wine, which is often done. If this
remark is not attended to by the College, the former objec¬
tionable preparation will still be sold, the necessity for which
may be removed by a little attention. I would therefore beg
leave to suggest the following method of making the anti-
tnonial solution, instead of the present injudicious formula : —

R Antimonii Tartarizati, gr. xxxij. . .

Aquae Distillatae, ^^iv.

Spiritfis Rectificat. 5ij.

Uvarum passarum, demptis acinis, unc. ij. , . ,

Macera per hehdomadam, et cola.

If it be considered preferable, the raisins may be first
digested in the weak spirit for a week ; the tincture thus pro¬
cured may be strained off, and filtered through paper, in
which should be dissolved the tartarized antimony, and the
whole made up to sixteen ounces by measure, by the addi¬
tion of water or a little more spirit. A similar preparation
may be made by dissolving the antimony in twelve ounces of
water, and by adding to the solution rectified spirits of wine,

VOL. XX. — NO, 119. 3 H

414

Origmal Communications,

and syrup of lemons, of each two fluid ounces : this, I
believe, will be found to be an elegant and durable prepara¬
tion. Both these contain precisely the same proportion
of tartarized antimony as the present liquor antimonii tar-
larizati, viz. one grain in four fluid drams.

Pulvis Antimonialis. — I am anxious not to allow the pre¬
sent opportunity to escape, of directing the attention of the
Profession to an excellent paper on the Analysis of James’s
Powder, by R. Phillips, F.R.S. Lond. & Ed. contained in
the Annals of Philosophy for September, 1823. In the con¬
cluding observations respecting antimonial powder, Mr.
Phillips observes : For additional evidence as to the nature
of this preparation, I beg to refer Dr. Paris to a statement
respecting it, which has been made by Mr. Brande, and
which, if I had remembered, would have saved me the
trouble of an analysis. ‘ In examining,’ says Mr. Brande,

‘ the antimonial powder from various sources, prepared
according to the directions of the Pharmacopoeia, I have
found it of very variable composition : sometimes it contains
the peroxide of antimony only, sometimes there is a propor¬
tion of protoxide, and in some few cases the powder has
consisted chiefly of bone earth. These differences are referrible
to the mode of preparing it: but in almost every case a very
large proportion of the protoxide is lost during the process ;
and I have found it a matter of great difficulty so to conduct
it as to obtain, upon the large scale, an uniform product.
For medical use 1 should consider emetic tartar as the only
certain and necessary preparation of antimony.”’^

It will be observed, that without recollecting Mr. Brande/s
recommendation of emetic tartar to the exclusion of all other
antimonials, I ventured to give similar advice ; and I would
conclude with remarking, that if it be possible to urge satis¬
factory reasons against a preparation, such reasons are con¬
tained in the passage I have quoted from Mr. Brande. It
shows that pulvis antimonialis may consist almost entirely of
phosphate of lime, or that it may be a mixture of phosphate
of lime and peroxide or protoxide of antimony ; and it is a
perfectly well-established fact, that fifty times as much
peroxide of antimony may be given as of the protoxide ;
that the large dose is inert, the smaller one may be dangerous ;
and yet to this uncertainty is the Physician exposed, although
he may not be persuaded that ' he can never have derived
any benefit from the exhibition of antimonial powder.’”

Liquor Arsenicalis. — This appellation is certainly very
objectionable; it should have been liquor arsenialis potassse.

* Manual of Chemistry, Vol. II. p, 180.

Mr. Sprague’s Pharmacological Remarks and Suggestions, 415

or more properly, as named by the Dublin College, Jiq,
arseniatis potassae. Why not give a more ready and scientific
formula with the superarseniate of potash, in lieu of sublimed
oxyd of arsenic, and of subcarbonate of potass? — the most
proper directions for preparing which will be found in the
Dublin Pharmacopoeia, or that of St. Bartholomew’s Hos¬
pital.”

Preparations of Iron.

Ferrum Tartarizatum. — Mr. Thomson observes, in the
third edition of his Dispensatory, “ It is remarkable that
both the London and Dublin Colleges should err in giving a
name to this triple salt ; whereas much of the iron employed
in the London and the Edinburgh process remains unaltered,
or at least only in the form of a simple oxyd.”

Liquor Ferri Alkalini. — Dr. Paris and Mr. Thomson have
stated this to be a most injudicious preparation ; for they
remark, that it cannot be exhibited in anv form whatever
without decomposition.”^ As there are such insuperable
objections to the liquor ferri alkalini, and I believe it is but
seldom prescribed, surely it is desirable that it should no
longer be retained in the London Pharmacopoeia. I would,
therefore, with due submission, recommend as a substitute
the following elegant chalybeate, the Liquor Ferri Oxygenati
(so denominated by the late Dr. Bed^es) :

R Ferri Sulphatis, Sss.

A/*ifli Nitrftfti fnrtitsimi (per^otid.), Jss.

Tere prob^ simul in mortario vitreo, donee effervescentia peracla,
dein adde gradatim Aquae Distillatae, Sjss.

Afterwards filter the liquor through white paper, placed in
a glass funnel. The dose is from four to ten drops, three or
four times a day, in an infusion of ginger, or infusion of
quassia and cloves. It is an elegant and valuable chalybeate.
When given in an infusion of quassia, after free evacuations
of the bowels, it may be considered almost infallible as a
vermifuge ; and it is also one of the most powerful styptics
for suppressing bleeding from the alveolar processes, after the
extraction of teeth, and in other cases of hasmorrhage from
the smaller vessels.

Vinum Ferri, — Respecting this preparation I would beg
leave to refer the reader to Dr. Paris’s observations, in the
fifth edition of the Pharmacologia, Vol. II. p. 449* Mr.
Thomson remarks, that it is to be regretted that the College

* Vide Dr. Paris’s Pharmacol. Vol. II. p. 5277? and Mr. Thom¬
son’s judicious observations on this article, in his Dispensatory, third
edition, p. 664.

415 Original Communications,

did not follow the same plan it adopted for the solution of
ammoniated copper, and employ a given portion ot the
ferrum tartarizaliim, which readily dissolves in sherry wine,
and forms a permanent solution/’ In lieu of the vinum ferri
of the present Pharmacopoeia, I would offer for consideration
the following formula : —

R Tart. Potassse et Ferri,* Jjss.

Vini (Sherry), Oj. Solve.

The London College has again an opportunity of con¬
sidering the best method of preparing the wine of iron : I
should hope they will wisely decide, and benefit the Profes¬
sion by their decision.

Preparations of Quicksilver.

Hydrargyrum Purificatum, — As purified quicksilver is the
basis of aU the other mercurial preparations, should it not be
placed first in the list of preparations of mercury in the next
London Pharmacopoeia, instead of the hydrargyri nitrico-
oxydum, as in the one of 1815?

Hydrargyri Oxymurias. — The name oxymuriate appears
to be improper. Perhaps the name deuto-muriate — or deuto-
chloride of mercury which most judiciously designates its
chemical character, would be less exceptionable than lany
other of the three formulae of the British Colleges. A prepara¬
tion similar to that of the Dublin is to be preferred ; reasons
for which will be found in Thomson’s Dispensatory, third
edition, pp. 676, 677.

Hydrargyri Submurias, — ■ Dr. Paris has stated (in his
Phfirmacol. Vol. I. p. 71) this to be '^' the most objectionable
name of any.” For the reasons he has assigned, ought not
the old name, calomel, to be restored in preference to every
other, as it is less liable to be affected by the continual change
of chemical nomenclature ? It is at present directed to be
brought into a very fine powder, in the same manner as pre¬
pared chalk ; but by the method of triturating calomel
between two stones, termed levigation, it is reduced to as fine
a powder without loss. The test of the Dublin Pharma¬
copoeia ought alwa3^s to be had recourse to, for ascertaining
the complete separation of any corrosive muriate that may
have been formed, and which should be ordered by the
London College to be attended to in making this pre¬
paration. f/

Many serious erfors have occurred in dispensing medicines,
by the similarity of the names hydrargyri oxymurias and

/ As prepared by the Dublin College,

Mr. Sprague’s Pharmacological Remarks aad Suggestions. 417

hjdrargyri submurias, which can only be prevented in future
by changing the present name.

Liquor Hydrargyri Oxymuriatis. — A discerning critic has
very properly remarked, Whether this solution be intended
for external or internal use, the College have not condescended
to inform us.” There can be no excuse for not giving such
information, and therefore this suggestion should be attended
to in the next translation of the Pharmacopoeia sanctioned
by the College. It is very desirable that the particular
reasons for the introduction, and the uses, of every preparation
and compound, should be fully explained by the translator. It
is a duty which he owes the public.

I must beg leave to refer to the reasons for objecting to
the present preparation, which will be found in Dr. Paris’s
Pharmacol. Vol. 11. p. 277. I hope such authority will
induce the College to expunge it, and introduce a more
scientific solution.

I believe the following formula is entirely unexcep¬
tionable : —

Liquor Hydrargyri Oxymuriatis.

R Hydrargyri Oxymuriatis, gr. iv.

Acidi Muriatici, Wl^j.

Aquae Distillatae, f. 3j.

Spirit. Tenuioris, 3vj.

Tincturse Croci, 3ij.

Tere prob^ simul in mortario vitreo ut fiat solutio ; incip.
sumendo lllxx. nocte maneque ex haustu Infusfis Lini, vel
Decocti Glycyrrhizse ; posteaque pro re nata augeatur.

I prescribe this solution according to the following very
agreeable formula : —

R Decocti Glycyrrhizas, Jv.

Aquse Cinnamomi, Jij.

Liquoris Hydrargyri Oxymuriatis (pr^ep. ut supra),
Syrupi Aurantii, aa 3ss. Misce.

Ft. mistura, cujus sumat coch. ampl. ij. vel iij. statim post
cibum, bis tervo in die.

(To be concluded in our next.)

418

Analytical Review.

PART 11.

ANALYTICAL REVIEW.

Medico-Chirurgical Transactions. Published by the Medical
and Chirurgical Society of London. Volume the Twelfth
(Part II.) With coloured Engravings. 8vo. Pp. 597.
London, 1823.

A LARGE proportion of the articles forming the Part now
before us of the Transactions of this useful and eminent
Society, will, we are of opinion, materially tend to advance
its reputation.

Without alluding, at present, to any exceptions from this
proposition, we proceed to place before our readers the sub¬
stance of the papers in the order in which they stand in the
volume.

XXI. An Account of two Cases of Biliary Calculi of extra--
ordinary Dimensions. By T. Brayne, Esq. of Banbury.
Case Is^. — A female, fifty-five years of age, of a thin habit
and melancholic temperament, had been afflicted, during the
last twelve months, with uncommon languor and prostration
of strength. She had experienced paroxysms of pain in the
epigastrium, which generally commenced towards night, and
continued for several hours. I’hese attacks returned every
two or three weeks, for five or six successive times, and were,
for the most part, but not always, succeeded by slight jaun¬
dice, which soon disappeared. About a month after the last
attack of pain, she became the subject of continued fever,
characterized by constipated bowels, scanty secretion of high-
coloured urine, and great mental irritability, almost amount¬
ing to alienation. She suffered no local pain. After con¬
tinuing for a long time in this state, she was suddenly seized
with severe pain in the left iliac region, accompanied with
tenderness on pressure, “ This urgent symptom continued
unmitigated for sixteen or eighteen hours, after which she
became suddenly better, and soon passed a natural alvine
evacuation, which contained a calculus of extraordinary size.
This was followed in a short time by an abatement of the
febrile symptoms ; but she remained in a state of low mut¬
tering melancholy for some months, from which she did at

419

Medico-Chirurgical Transactions.

length recover, under the gentle and long-continued influence
of mercury on the system/’

The long diameter of this calculus was 1§ inches, its short
diameter 1^ of an inch, and its circumference at the widest
part 3§ inches. It did not possess a concentric laminated
arrangement, but was radiated from the circumference
towards the centre ; having here and there interposed between
the radii, particularly towards the middle of the calculus,
minute portions of a brown friable matter. The surface was
rough and tuberculated. The chemical analysis of this cal¬
culus, as detailed by Mr. Brayne, sufficiently proves its biliary
origin. The subsequent history of the patient, how^ever, puts
its nature beyond doubt.

About a year after the patient had passed this very large
calculus she died of hydrothorax, Mr. Brayne found, on
dissection, the liver of its usual size and colour, but more
solid and close in its texture. The cystic and hepatic ducts
were of the usual dimensions, but the gall-bladder itself was
smaller and very much thickened, containing only a little
pale unhealthy bile. It had contracted a strong adhesion,
about the size of a shilling, to the duodenum, close to the
pylorus. There was no uncommon appearance of vascu¬
larity. On removing these parts from the body, a commu¬
nicating aperture, large enough to admit a crow-quill, was
discovered in the centre of the adhesion. One kidney was
studded with numerous flat tubercles in its cortical part.”
There was no other morbid appearance of consequence, except
an accumulation of serum in the right cavity of the pleura,
amounting to about ^xxiv. — This dissection illustrates, in a
very satisfactory manner, the formation and the passage of
the calculus into the intestines.

Case %d. — Mr. Brayne was called, in the evening of the
24th February, 1822, to a married woman, aged sixty-five,
labouring under an obstruction of the bowels. He found her
lying on her back with her knees raised, the abdomen pro¬
digiously inflated, with frequent gripings, incessant vomiting,
the extremities cold and damp, and the pulse scarcely per¬
ceptible at the wrist. Although her articulation was indis¬
tinct, she was nevertheless sensible, and her countenance did
not evince the Hippocratic expression of a dying person.
She had rejected every thing from her stomach since the
IQth, when the sickness had suddenly invaded her without
any apparent cause. Various measures had been resorted to
by the medical attendant without success.

Mr. Brayne ordered her to have three drops of croton oil
in tw'O pills, of which she was to take one directly, and repeat
it in four hours if necessary ; he also directed warm applica-

420 Analytical Review.

tions to the extremities, hot fomentations to the abdomen,
and, in an hour or two, a little wine/’ The second croton
pill was taken. On the following morning the bowels had
not been relieved, bat the stomach was more quiet than it had
been. Some castor oil w^as next given, and, at intervals, a
colocynth pill with minute doses of opium. In the evening
some thin offensive dark-coloured stools had been procured.
Various purgatives and injections were persisted in ; and after
two or three days, evacuations more natural in colour and
smell were freely passed. From this time she rapidly im¬
proved. A few days afterwards (March 11th) she passed a
biliary calculus, in figure and size resembling half a large
pigeon’s egg.

On the 17th March the same train of symptoms recurred
in a slighter degree, and in a few hours she passed another
calculus, of larger dimensions, and of a flat square shape.
On applying the flattened extremity of the former and
smaller calculus to the greater side of the other, (which side
was concave, as if compressed when soft by some convex
body,) a correspondence was observed which gave the idea
of intimate juxta-position.

For some months previous to the severe symptoms, for
which Mr. Brayne’s attendance was first requested, this patient
had been frequently affected with a dull pain in the epigas¬
trium, with a sense of weight and oppression in that situa¬
tion. These attacks commonly occurred towards bed-time,
and varied in their continuance from half an hour to two or
three hours. They were not accompanied with sickness, nor
followed by jaundice. After the passage of these calculi the
pain and load at the epigastrium entirely subsided. June the
4th, she complained of symptoms distinctly marking the
supervention of hydrothorax, as in the former case : she is
still, however, under the author’s observation. Mr. Brayne
was averse from destroying the integrity of the calculi in this
case for the purposes of analysis. The plate which accom¬
panies these very interesting cases is beautifully executed.

XXII. On the Influence of Local Irritation in the Production

of Diseases resembling Cancer and other Morbid Alterations

of Structure. By Henry Earle, Esq. F.R.S. &c. &c.

This is a paper of considerable merit. Its author wishes
to call attention to those cases which, from their progress
and character, bear a close resemblance to those malignant
affections, which experience shows to be too deeply rooted
in the constitution to be eradicated by any local operation.
Mr. Earle considers those cases to originate from some local
irritation, and to be subsequently maintained by local circum-

421

Medico- Cliirurgical Transactiom.

stances. In some of them the constitution may be pre¬
viously disposed to disease, l)ut in many it is only affected
by the continual pain and excitement produced by the local
affection. “ From the experience,” ‘Mr. E. observes, “ I
have already had, I feel convinced that, by early directing our
views to counteract tlie influence of local irritation, we may
often succeed in restoring healthy action ; whilst, in more
advanced stages of disease, we may be induced to resort to
operations with far greater confidence of success than the
appearance and progress of the complaint would warrant,
independently of any such exciting causes.”

On Diseases of the Lips, — The author considers that any
ulcerations about the mouth will often be extremely difficult
to cure, and, if neglected, will often assume, from the con¬
tinual irritation to which the parts are subjected in the
diurnal performance of their functions, the induration and
other characteristics of carcinoma. The irritation arising
from the introduction of food, the effort of speaking, and the
constant flow of saliva, are sufficient to keep up the morbid
disposition.” After a time the neighbouring glands will
often become enlarged, and the Surgeon be thus misled
respecting the nature of the affection. In every instance that
Mr. Earle has w^itnessed, “ the disease has occurred either at
the angle of the mouth or the lower lip, which, from its
situation and greater mobilit}^, is much more liable to be
irritated in every action in which the mouth is concerned ; it
is much more readily drawn within the teeth, and when
ulceration has taken place, it is exposed to the constant flow
of the saliva, which, particularly in cold weather, causes
excoriation and thickening in the surrounding integument.”

Mr. Earle subjoins a very interesting case in illustration of
this affection of the mouth which was cured by excision.
To this case we cannot more particularly advert. Mr. E.
alludes to other instances of this disease; and he is led to
infer, from the. result in all but one case, that it is not
carcinomatous, or dependent on any constitutional disease,
but arising from the continual local irritation above alluded to.
From his own experience, and from witnessing the success
of others, he considers that few cases afford greater promise
of success than those corroding ulcers, with scirrhous edges,
which occur about the lip. The operation,” he states, is so
simple, and the woujid so constantly unites by the first inten¬
tion, that in cases that do hot readily yield to local and con¬
stitutional treatment, it is far better to resort to it, and often
the deformity will be less than when the ulceration heals
without any operation.”

Mr. Earle next enumerates similar occurrences of disease

VOL. XX. — NO. 119. I

422 Analytical Reviezo,

in the integuments of the nose and facef arising from, and
aggravated by catarrhal affection, the habitual use of'snuff,
the irritation of shaving, &c. When the disease remains
stationary, or is inclined to spread, he recommends the morbid
portion to be removed, either with the scalpel, the potassa
fusa, or the arsenical paste, as may appear best adapted to
the individual case.

On Diseases of the Tongue. — Mr. Earle very justly observes,
that when any morbid action is set up in this part, many
things contribute to maintain it. The extreme mobility of
that organ, the almost continual use of it in eating, drinking,
and speaking, the contact of the teeth which are often irre¬
gular or decayed, are quite sufficient to interrupt any efforts
to restore a healthy action. The continued operation of
these causes soon induces a disease which puts on all the
alarming characters of carcinoma. The period of life, how¬
ever, at which many of these cases occur, and the frequent
success which follow operations on them, are alone sufficient
to create doubts of their being carcinomatous. Respecting
the management of these affections Mr. Earle gives the
following directions: —

“ Under the head of local treatment I would place in the first
rank, the removal, as much as possible, of all local stimuli, such as
the taking away any decayed or projecting tooth, the shielding the
tongue from pressure by covering the teeth with wax or soft lint, the
complete privation of the faculty of speech., the frequent cleansing of
the mouth with a stream- of water, any medicated liquor from an
elastic gum bottle, instead of gargling or washing the mouth by any
muscular effort, the employment of the most mild unirritating food,
and, in bad cases, the prohibition from the use of solid food, substi¬
tuting in its room milk and strong broths, &c.’’ .... “ When there

is any enlargement of the glands, it will be right to combine with this
the repeated application of leeches under the chin. As local appli¬
cations to the ulcerated surface, few are more efficacious than a solu¬
tion of nitrate of silver, or very diluted nitric acid, in the proportion
of three or four drops to the ounce. Occasionally a solution of
arsenic is very useful. Any of these may be thrown upon the ulcer
with a syringe, which will be found better practice than keeping lint
moistened with any lotion constantly applied to the part.

“ In two instances of apparently very malignant diseases of the
tongue, I have succeeded in obtaining perfect cures by the plan laid
down. A similar practice was pursued in the case of a boy at the
Foundling, in whom the disease was of a very peculiar kind. Clusters
of very minute semitransparent vesicles pervaded the whole thickness
of the tongue, occupying nearly one-half, and projecting considerably
both above and below that organ. The slightest injury caused them
to bleed most profusely, and in some places the clusters were sepa¬
rated by deep clefts, which discharged a fetid irritating sanies. This

423

M edico- ChirurgicaL I ranmctions.

disease, which had resisted various plans of treatment, both local and
constitutional, gradually yielded to a strict attention to perfect quiet
and cleanliness, combined with large doses of hyosciamus, which was
increased to the extent of ^j. of the extract daily. I have employed
the same remedy in many cases of ragged irritable ulcers in the
tongue, and have been surprised at the influence which it seemed to
exert over these affections. In some cases no other remedy has been
employed, and its effect has been most marked and unequivocal. I
have employed other medicines of the same class, but without any
similarly beneficial result. Mercury, in all these cases, if admi¬
nistered in any quantity, seldom fails to aggravate the disease.’'

Pp. 284—286.

On Diseases of the Prepuce. — Mr. Earle observes, that

there is, perhaps, no instance which affords a better illus¬
tration of the deleterious influence of the constant application
of local stimulants, than the peculiar affection which occurs
in the prepuce of old people.” He gives the following history
and progress of this affection, which has been generally
considered as cancer of the penis : ” —

“ It invariably occurs, as far as my observation goes, in persons
with elongated foreskins. A want of proper attention to cleanliness
in removing the secretion from behind the corona glandis, will often
lay the foundation of this complaint. I'he jjrepuce, from the confine¬
ment of this irritating matter, is excoriated, and what at an early
period of life would be called gonorrhoea preeputii is the consequence,
the part becomes oedematous, the frsenum thickened, and it is soon
impracticable to withdraw the foreskin. Phymosis being thus esta¬
blished, the frequent passage of the urine over the inflamed skin
causes it to ulcerate, and the continual application of so stimulating
a fluid produces much surrounding swelling and induration. Not
unfrequently the natural opening in the prepuce becomes nearly
obliterated, and the urine dribbles away through several ulcerated
apertures. An intractable disease is thus established, from which,
when it has attained this height, the knife is the only remedy.” —
Pp. 287, 288.

Treatment. — If taken at an early period, the disease is perfectly
remediable by removing the exciting causes. I’he greatest attention
to cleanliness is the first requisite, and for this purpose, an elastic
gum syringe, with a blunted pipe, should be frequently employed to
wash away the secretion from behind the corona glandis, and to
convey any medicated lotions to correct the morbid action which has
been excited. Where phymosis is quite established, an elastic gum
catheter should be introduced; and if no disease in the urethra or
prostate gland prohibit the practice, it should be retained in the
bladder. The irritation from the constant flow of the urine will be
thus effectually prevented ; and, generally speaking, the swelling and
hardness will subside sufficiently to enable the patient to withdraw
the skin to admit of the exit of the urine without passing over the
prepuce. The introduction of a small portion of sponge will often

4Q4

Analytical Review.

assist much in dilating the contracted orifice; but when these means
do not succeed, it will be right, in some cases, to divide the prepuce
and expose the glans penis. I have known this operation succeed
perfectly in a case which had been condemned to amputation.” . . . .
“ For the reasons, then, above stated, amputation of the body of the
penis should not, on light grounds, be undertaken ; and only in cases
where the induration has extended itself to the corpora cavernosa or
glans penis, or where the state of the patient’s constitution renders it
advisable. With the views 1 have been led to entertain of the nature
and origin of these affections, I should, with great confidence, rely on
the removal of the diseased integument in those cases which did not
subside by the plan of treatment already laid down. Even when the
inguinal glands were enlarged, I should not be disposed to abandon
the case as hopeless, as they will often subside on removing the
exciting cause.” — Pp. 289 — 292.

Mr. Earle next notices the effect of local irritation in the
production of “ new growths.” We must refer our readers to
the original paper for his observations on this subject.

XXI n. On Chhmiey Sweepers^ Cancer. By H. Earle, Esq.
E.R.S. &c. — 1 his disease, which is invariably produced by
the irritation of soot applied to the rugae of the skin, is well
described by Mr. Earle in this paper. From its rare occur¬
rence, and its appearance at an advanced period of life, he
considers that a constitutional predisposition is necessary to
its existence. This opinion is confirmed by the liability of
the same family to become affected with it. With respect
to its treatment, Mr. E, observes : —

“ As far as my observation goes, no topical applications or internal
remedies have the slightest influence over the disease. The scalpel is
the only resource, and that may be resorted to with the most confi¬
dent expectations of success, provided the whole of the diseased mass
can be removed. Even where the inguinal glands are enlarged, this
ought to be attempted ; as I have before stated, that the disease
commonly spreads to parts immediately contiguous, and the enlarged
glands will often subside. When the testicle is affected, provided the
spermatic chord has not participated, it will be right to give the
patient the chance of recovery, rather than abandon him to a
miserable and painful death. ” - Pp- 301.

Mr. Earle coacludes his remarks with exhorting the Sur¬
geon to lose no lime in the useless exhibition of remedies,
but to proceed at once to the extirpation of the diseased
parts. Two cases are subjoined to tliis article.

XX iV. On the Destruction of the Foetal Dram. By Mr.
Hammond. — Mr. Hatmnond details a case in which embryo¬
tomy was performed, yet the child lived forty-six hours after¬
wards. He observes, that “ this case may be useful in a
practical point of view, as it lends to show that the removal

Mr. Haden's Translation q/’Magendie’s Formulary, 425

of a part, and the destruction of the whole cerebrum, does
not insure death to the foetus; and in such cases, w^here the
head must be opened, it would be better to divide the
medulla oblongata or the spinal cord ; for the mother, who is
generally prepared for the operation by the assurance that
her child is already dead, suffers considerable pain on finding
it born with life, but without brains.’’

XXV. A Case of Bronchocele. By Henry S. Roots, M.D.
&c. &c. — This case show's the good effects of iodine in a
case of bronchocele occurring in a lady nineteen years of
age. Dr. Roots prescribed this substance according to the
following formula: — ‘‘ Potassae hydriodat. gr. xxxiv.; cerae
albm, 5ij. ; adipis suillse, f iss. M. The size of a garden
bean to be rubbed into the tumour night and morning for ten
minutes at each time.” I'he proportion of iodine in the oint¬
ment was afterwards increased until it reached fifty-six
grains ; and ‘during the latter part of the treatment, the
internal use of the remedy was also adopted, twenty drops of
the tincture of iodine having been prescribed three times
a day. Two doses of the tincture every day were only taken,
in consequence of its having produced sickness and pain in
the stomach and intestines. The tumour entirely disap-

Roots had, at the period of his writing this case, a
patient under his care suffering from a very considerable
bronchocele, which has very materially diminished under the
use of iodine.

(To he continued.)

II-

Formulary for the Preparation and Mode of Employing several
Nezc Remedies ; namely, the Nux Vomica, Morphine, Prussic
ylcid. Strychnine, Veratrine, the Active Principles of the
Cinchonas, Emetine, Iodine, <5fc. ; with an Introduction and
copious ISotes. By Charles Thomas Haden, Surgeon
to the Chelsea and Brompton Dispensary, &c. T’ranslated
from the “ Formulaire pour la Preparation et I’Emploi de
plusieurs Nouveaux Medicamens, tels que le Noix Vomique,
&c. Par F. Mag EN DIE, Membre de ITnstitut de France,
&c. Troisieme Edition. 182*2.” 12mo. Pp. xxiv. 110.

London, 1823.

VVe are much indebted to Mr. Haden for this excellent
translation of a work w'hich, in our opinion, ought to be in
the possession of every Practitioner who wishes to keep pace
with the progress of science — to do all in his power for his

peared

Dr.

4Q{) Analytical Reviete.

patients, and thus advance his own reputation. The notes,
which Mr. Haden has subjoined, add considerably to the
usefulness of the original ; and his introduction contains
some very powerful arguments in behalf of the propriety of
rendering science and philosophical observation more sub¬
servient to the practice of medicine than it is at present
amongst too many in the Profession.

When showing the futility of the objections commonly
urged against the use of new remedies, Mr. Haden offers the
following very just observations : —

The translator, however, cannot refrain from mentioning one
species of objection to the adoption of such new forms of remedy,
because he considers it to be a superficial one ; and an injurious one
too, for it is subversive of one of our best means of improving the
therapeutical branch of our Profession. He is almost angry when he
sees the popular authors of the day sneering at the introduction of
new remedies, and saying, with what he considers to be an ignorant
self-conceit, ‘ Ay, here they come one after another vaunted to the
skies for properties which sober investigation shows not to belong to
them; we shall soon see them laid on the shelf, until they are again
held up to the world as prodigies by some future enthusiastic
searchers after novelty.’ How humiliating such remarks are to the
person who makes them ! for it is easy to prove that in the great
majority of cases the sneer is applicable not to the remedy, but to
persons who are too ignorant or too indolent to investigate its pro¬
perties so thoroughly as to use it with success. Men who really
think for themselves, and are not content with conclusions unless
they are drawn from an accurate and philosophical consideration of
all the circumstances of each individual case, know full well that the
trials of new remedies which are made by the Profession at large are
so superficial and inconclusive as to be a disgrace to themselves, and
not worthy the slightest attention when the value of such remedies is
under discussion.” — Pp. xvii. xviii.

All are not equally qualified, either by education or by
original talents, to observe accurately, and to deduce conclu¬
sive and useful inferences from their observations' ; but it is in
the power of many to perform these requisites of their pro¬
fessional duties in a much more creditable manner than they
are too frequently executed. If, however, such a duty be too
serious an undertaking, and be thus incompatible with the
indolence of some — with the knowledge of others — or w'ith
the comforts of a few ; if, moreover, some may suppose that
the time and trouble, w'hich thus would be directed to science
and observation, might be more lucratively, although much
less beneficially employed, let them learn not to depreciate
those who consider the crafts of trade beneath the dignity of
their profession, and who wish to contribute towards the
advancement of the science w hich they profess.

Mr. Haden’s Translation of Mageftdie’s Formulary. 427

It would neither be conformable to our limits nor to our
intentions to give a review of the individual substances so
ably and minutely treated of in this work. As a specimen,
however, of the manner in which both M. Magendie and the
translator have executed their undertakings, we shall first
briefly direct our attention to Morphine.

M. Magendie first offers some general remarks on morphine
and its salts: he next describes “the manner of preparing
morphine.” Here Mr. Haden has appended some judicious
notes respecting the modes adopted by our own and the
French chemists to procure this alkali from opium. M. Ma¬
gendie afterwards notices “ the action of this substance on
man and on animals.” The “ preparation of the acetate of
morphine'^ next engages his attention ; he also gives the mode
of preparing the sulphate of morphine^ and concludes the con¬
sideration of this subject with stating, in detail, the different
“ modes of prescribing the salts of morphine.” For the
formulae here recommended we must refer our readers to th6
translation. M. Magendie prescribes both the acetate and
sulphate of morphine, alternately, in the form of a syrup;
‘‘ for,” he observes, “ by varying the salts of alkaline medi*
cines, their action on the animal economy may be kept up for
a very long time, and without increasing the dose too much.”

Veratrine is the next substance which we shall particu¬
larly notice. This new alkali w^as obtained by MM. Pelletier
and Caventou from the seeds of the veratrum sahadillay and
from the roots of the colchicum autumnale and the veratrum
commune. After describing the mode of preparing the vera¬
trine, M. Magendie details its chemical properties and its
action on animals : he next examines the action of this alkali
on man in a state of health and disease, and concludes the
consideration of it with remarks on the “ cases proper for its
exhibition.” As veratrine constitutes the active constituent
of colchicum, Mr. Haden introduces the following interesting
case in his notes, at the place where M. M. treats of the
action of veratrine on animals : —

“ Colchicum certainly induces inflammation of the mucous mem¬
brane of the bowels whenever it is given in too large a dose; the
translator, from a large experience, thinks in all cases : but it never,
probably, produces tetanic convulsions, nor any thing resembling
them. The translator thinks it right to give the following fatal case
of gout, from an over-dose of the tincture of colchicum bulb, in eluci¬
dation of this opinion. He has also heard of other corroborative
cases, where death followed a large dose of other preparations of
colchicum, especially one where a female took a teaspoonful of the
seeds. The note of the case of gout, made at the lime, has been
kindly furnished by the attending Practitioner.

“ IVIrs. - , aged forty, after frequently suffering from gout,

428

Analytical Revieiv,

requested her medical man to give her the colchicum in a very severe
fit. She took siiss. of a tincture made by infusing ^iv. of the root in
Jviij. of proof spirit for three days, the mixture being kept at nearly
100° of temperature. This was given in the morning of December
5th. In the evening it had produced no effect, except slight qualm¬
ishness. Calomel, gr. iij. opii gr. j. was ordered at bed-time, and a
purging draught for the morning. However, in the night, vomiting
and purging commenced, and continued all the next day, in spite of
effervescing volatile saline draughts with opium; so that in the
evening of the 6th, opii gr. j. camphor, gr. iij. were given and
repeated in two hours.

“ On the 7th, from accident, she was not seen till three P. M.
when she was found in the collapse preceding death. The gout had
previously gradually subsided. It was stated that she became faint
at two o’clock P. M. and not till then were her friends alarmed. By
opium and spirits warmth was reinduced upon the extremities, and a
feeling of greater comfort produced ; but the pulse never completely
recovered, although the sickness was completely subdued ; so that at
ten P. M. she fell into an apoplectic kind of sleep, which terminated
in death before morning.

“ It is peculiar, in this case, that Mrs. — — was delicate, and some
years before had nearly suffered death from incessant vomiting
attended by cold extremities ; it was relieved by inducing gout on
the swelled knee by mustard cataplasms. In the fatal attack the
sinapism was applied, with the effect of producing great pain, but
without inflammation or heat of skin.

“ It should be mentioned also, that this female’s mother is exceed¬
ingly susceptible of the action of colchicum, in even very small doses.
The attendant Practitioner begged also to add, that he only prescribed
so large a dose as 3iiss. because the tincture had only been made
three days, and the formula directed it should be infused a fortnight.”
Pp. 6l, 63.

On Iodine M, Magendie treats very fully and satisfac¬
torily. For a full account of the various preparations of this
substance, we must refer our readers to the work before us,
or to the Number of the Repository for August, 1823,
where they will also find copious directions for its use. Mr,
Haden has given the following observations in a note : —

Besides using the tincture of iodine successfully in a few cases of
scrofula, the translator once saw it signally beneficial in a case pro¬
bably of pulmonary tubercles, in which he prescribed it according to
the suggestion of Dr. Baron in his last work on Tubercles. A thin
youth passed the winter and early part of the spring of 1823 in
suffering from an almost unremitted succession of attacks of pulmo¬
nary excitement. His pulse rose during these exacerbations, his skin
became hot, cough came on, and frequently the attack did not termi¬
nate without the expectoration of purulent matter and the occurrence
of hectic fever and of night sweats ; generally, however, these exacer¬
bations were speedily and perfectly dissipated by the moderate use of
colchicum, so that the pulse fell to 72 beats in the minute, and ail

429

M. Rostan on Softening of the Brain,

the other symptoms subsided. Still, early in May, the patient was
thin, pale, and in other respects having the appearance of a person
labouring under incipient phthisis. Under these circumstances he
took ten drops of the tincture three times a day. He almost imme¬
diately said, he had not received so much benefit from any former
medicine ; and after continuing its use for a month, he was discharged
apparently well, not having had one feverish attack, and being fat and
with the countenance of health.

“ In a case, too, of intermittent fever (a girl eight years old), in
which the fever had repeatedly recurred after being suspended by
cinchona, the tincture of iodine was prescribed in a small dose three
times a day, and the fever did not again recur.” — Pp. 96, 97*

The other substances, whose pharmaceutical and medicinal pro¬
perties are minutely examined into by M. Magendieare — resin of
nux vomica, strychnine, narcotine or the matter of Derosnes,
emetincj pure emetine, alkalies extracted from the different
species of cinchona, prussic acid, solanine, delphine, gen-
lianin, extract of opium deprived of morphine, extract of
opium deprived of the matter of Derosnes, lupuline, and
brucine. — We express our thanks to Mr. Haden for his
faithful translation of M. Magendie’s Formulary, and for
the excellent introduction and notes with which he has
enriched it.

PART III.

ANALYSIS OF FOREIGN PUBLICATIONS

IN THE DIFFERENT BRANCHES OF MEDICAL AND
SURGICAL SCIENCE AND LITERATURE.

Recherches sur ie Ramollissement du Cerveau : oiwrage dans
lequel on s^efforce de distinguer les diverses Affections de ce
Yisclre par des Signes caracteristiques. Par Leon Rostan,
Medecin de ITIospice de la Vieillesse — Femmes (Salp^-
triere.) Professeur de Medecine Clinique. Seconde edi¬
tion. Paris, 1823. 8vo. Pp. 503.

Researches on Softening of the Brain: a work in which the
various Affections of that Viscus are attempted to be distin¬
guished by characteristic Symptoms. By Leon Rostan,
Physician to the Hospital for Aged Females (Salpetriere.)
Professor of Clinical Medicine. Second edition. Paris,
1823. 8vo. Pp. 503.

{Concluded from page 34:5.)

Diagnosis. Symptoms of the first period. — The fixed and
VOL. XX. — ^ NO. 119. 3 k

430 Foreign Medical Science and Literatiire.

obstinate headach which is observed at this period, M. Rostan
considers to be a symptom of high interest; alone it is of
little value; but when accompanied with numbness, formication,
sense of weight, contraction, pain, and convulsions in the limbs
of the side opposite to the pain, if the understanding and
senses become weakened, softening of the brain is to be feared.
The fixed headach announces a local action to be going on in
the brain.

Vertigo is common to many diseases. This symptom indi¬
cates a congestion towards the encephalon.

The diminution of the intellect, although it may depend upon
a local lesion, does not in any manner indicate it. All that
ought to be deduced from it is, that the organ of thought is
primitively or secondarily affected ; for if it were not diseased,
the function would not be injured. This diminution of the
understanding may depend on many causes : — 1st, On a
general congestion; 2d, on a serous or purulent effusion into
the ventricles or bet^veen the meninges; 3d, on inflammation
of the superficies of the brain ; 4th, on a central affection ;
5th, on apoplexy ; ()th, on softening of the brain ; and, lastly,
on all lesions of the brain which have their seat in the think¬
ing part, or which react upon it, and even on diseases of
distant organs which are connected in some manner with it.

The tendency to sleep, also, merely indicates a general lesion
of the encephalon.

The delirium, which cannot happen without the thinking
part being altered, either primarily or secondarily, is, like the
diminution of the understanding, a sign of affection of the
brain; but it does not unequivocally point out a local affec¬
tion, although it may depend upon a local lesion of the ence¬
phalon.

The same reflections are applicable to mental alienation,
which sometimes precedes the softening, and which may also
be dependent upon it.

The numbness, formication, pricking pain, sense of weight,
convulsions, contraction, and incipient paralysis of the limbs of
one side only, are more precise signs than those first pointed
out: they indicate, in an unequivocal manner, a local action
confined within the encephalon or its dependencies. Some
of them induce a presumption of an inflammatory process
going on, especially when they are accompanied by general
symptoms of reaction, such as pain, convulsions, and con¬
tractions; others characterize an alteration of a different
nature, such as sense of weight, numbness, incipient para¬
lysis, &c. : the last are more frequent than others. These
symptoms are sometimes the result of a simple, partial con¬
gestion : they are commonly^, at such times,* removed with

M. Rostan ow Softening of the Brain, 45 1

much facility, or else rapidly augment, and speedily induce
death. They must persist and gradually augment in intensity
to acquire any value.

These symptoms, as well as the preceding, still only indi¬
cate a local lesion of the encephalon; they are not pathogno¬
monic of softening of the brain. Every alteration which
compresses or gradually destroys the encephalon may produce
them.

The symptoms furnished by the senses, if they manifest
themselves on both sides, can only indicate a general lesion ;
when on one side only, they may serve to locate the affection.
Their augmentation ought to accompany inflammatory soft¬
ening (encephalitis) ; their diminution atonic softening.

'^I'he symptoms which the organic functions present are
valuable as therapeutical indications ; but they teach us
nothing in the way of diagnosis : these M. Rostan therefore
passes over in silence.

Symptoms of the second period. — When the symptoms
which we have just been mentioning augment more or less
suddenly in intensity, after having remained some time sta¬
tionary, it is the commencement of the second period. At
such times these first symptoms acquire much value ; they
characterize softening : without them it is impossible to
know whether the disease be not a cerebral hemorrhage, &c.
They announce a process of long duration, a lesion which has
not suddenly supervened.

The most constant and characteristic symptom of this
period is the paralysis of the limbs : this occurs either sud¬
denly or gradually, but in a more or less rapid manner, and
is the least equivocal symptom of some local lesion of the
encephalon in the lobe opposite to the paralysed side. This
paralysis may depend on diverse circumscribed lesions ; but
M. Rostan considers that the way in w'hich it shows itself is
sufficient to distinguish it. When the paralysis is general,
the lesion is general or central ; or else, if local, the sound
hemisphere is compressed. The diagnosis of such cases is
most obscure : they are, however, rare. The paralysis most
frequently begins with the arms ; but occasionally it has
commenced with the leg, although the alteration was in the
brain : this is accounted for, if it be admitted that it is not
the same portion which influences these two organs. When
the paralysis attacks the leg of one side, and the arm of
another, it indicates an alteration in each hemisphere in a
different region. Paralysis of the tongue does not serve
much to locate the affection. Paraplegia depends on a lesion
of the spinal marrow.

Paralysis of a limb may depend on the want of circulation

432

Foreign Medieal Science and Literature,

in that limb, owing to obliteration of the principal artery.
This paral3?sis may be recognized by the absence of other
cerebral symptoms, by the lividity, coldness of the limb, and
especially by the absence of circulation. Paraplegia may
be the result of obliteration of the aorta : it is speedily fatal.

A tumour developed on the course of a nerve, or in such a
situation as to press upon the nerve, may occasion paralysis
of a limb : this must be borne in mind, and error avoided by
attentive examination.

The diseases of the heart frequently terminate in general
paralysis or hemiplegia, which may impose on those who are
inexperienced. A knowledge of these diseases should make
us doubtful regarding the value of paralysis as a diagnostic in
softening of the brain : it is the same with respect to the
paralysis which supervenes in some acute diseases : like deli¬
rium, it is purely symptomatic.

Some narcotic substances produce paralysis, which it is
very difficult to account for: metallic vapours, especially
those of lead, act in the same manner : but in these cases the
particularity of the cause cannot be overlooked, and all error
is impossible. These paralyses may, however, depend upon
some particular modification of the encephalon.

The pains of the limbs of one side of the body are an
important diagnostic symptom, when conjoined, at the same
time, with other signs of cerebral affection. These pains
sometimes indicate an inflammatory action going on in the
lobe of the brain opposite to the pained limb.

Contraction of the limbs is a sign of an equal value with the
preceding. The same may be said of the convulsions.

The headach which commonly persists at this period, and of
which the patient only complains by putting his free hand
slowly upon the painful part, announces a local action to be
going on in the brain.

The diminished understanding, which is much more frequent
in this period than in the first, commonly indicates compres¬
sion of the brain, or lesion of the part appropriated to
thought. As it is not an index of any local affection, it
cannot be a pathognomonic symptom of softening of the
brain, although the symptom may depend, as has been before
observed, on a local lesion.

The coma and carus which occur at the end of the disease^
announce its progress, and the successive invasion of all the
encephalon, by some compression made upon it.

Softening of the brain frequently occasions a particular
redness of the face ; and although redness is a symptom com¬
mon to many diseases, it offers in this case a particular
character. The whole of the face is red, and in an uniform

M. Rostan on Softening of the Brain, 43#

manner : in this redness the neck participates, and it ends at
the chest either abruptly or in an insensible manner, in pro¬
portion to its distance from the superior extremities : this
phenomenon indicates a congestion towards the head. The
complaints, the cries, the agitation of the patient, cannot be
considered as characteristic phenomena ; but they ought
not to be neglected.

Local diagnosis, — According to the researches of MM.
Delage, Foville, and Pinel-Grandchamp, the grey substance
of the brain having been found alone altered when the move¬
ments had experienced no modification — having been found
deranged, conjointly with the white substance, when the
movements had been injured at the same time as the under¬
standing — and the white substance being found alone altered
when the movements only had been affected, the understand¬
ing remaining unaffected — it is to be concluded that the
cortical substance presides over the understanding, and the
white substance over the movements.

The corpus striatum having been found alone altered,
whenever the inferior extremity had alone been paralysed,
the thalamus opticus being found diseased when the move¬
ments of the arm had been disordered ; finally, these two
parts having been found disorganized when the hemiplegia
was complete, it may be concluded that the corpus striatum
is connected with the movements of the lower extremity, and
the thalamus opticus with those of the arm.

Should experience confirm these data, we ina}^ then be
able to recognise, d priori, which of these parts is altered,
according as the understanding or movements of the arm or
leg may be the isolated or simultaneous seat of the morbid
symptoms.

Progress of the disease, — As regards the diagnosis, the
progress of the disease is of the highest interest, as it is
almost sufficient of itself to characterize it. Jt is essentially
progressive. At first there are slight symptoms of conges¬
tion ; then formication, numbness, sense of weight, stiffness of
the limbs of one side, and obstinate cephalalgia ; soon after¬
wards complete paralysis, immobility, insensibility, pains,
contraction, convulsions in the limbs, weakness of the intel¬
lectual faculties, disorder of the senses; finally, coma, com¬
plete paralysis, and death. By this march M. Rostan con¬
ceives it is difficult not to distinguish the disease of which
we are treating from all other cerebral affections.

Softening of the brain may be confounded with sangui¬
neous or serous congestion, inflammation of the meninges,
apoplexy, hemorrhage between the dura mater and iXiefeuiUet
of the arachnoid which covers it, cancer of the brain, fungous

434

Foreign Medical Science and Literature,

tumours of the dura mater, tubercles, hydatids, bony tumours
of the internal parietes of the cranium, some neuroses, &c.

1. Sanguineous congestion. — By the general symptoms, the
sudden invasion, and its speedy termination, whether favour¬
ably or unfavourably, it is impossible not to distinguish this
disease from softening.

Serous congestion. — Symptoms, general and gradual.
This disease is most commonly the consequence of another
cerebral affection, which it is almost always easy to recognise.

3. Arachnitis. — Symptoms, general ; febrile symptoms
strongly marked ; absence of precursory phenomena, or
rather, these phenomena are not the same as those of soften¬
ing ; shivering, heat, insensibility. Delirium is not a neces¬
sary symptom of arachnitis ; it can only exist when the think¬
ing part of the encephalon is primarily or secondarily injured :
for if it were in a perfectly healthy state, there could not be
delirium. In some extremely rare cases, arachnitis occasions
local phenomena ; this happens when the inflammation is
more pronounced on one side than on the other. The diag¬
nosis of such cases is very obscure.

4. Apoplexy. — By apoplexy M. Rostan means extravasa¬
tion of blood in the brain. This disease considerably resem¬
bles softening, both by its symptoms and frequency. In
order to facilitate the diagnosis, M. Rostan divides apoplexy
into three varieties, viz. into severe, moderate, and mild apo-
plexy.

If it be severe, carus takes place immediately^ with any
previous symptoms of the disease; the paralyis is general;
the stools are passed involuntarily; paralysis of the senses
occurs, and stertorous breathing; the pulse is oppressed, and
the patient dies in a few hours, or in two or three days at the
most. Softening of tlie brain never pursues this course, nor
has so short a duration.

Moderate apoplexy, which is the most difficult to distin¬
guish, happens suddenly : the symptoms are immediately car¬
ried to the highest degree of intensity, and on the following
days diminish, when the disease terminates by resolution.
When it terminates fatally, the symptoms commonly go on
increasing ; but under such circumstances, at the end of
some days, a degree of softening is formed around the extra¬
vasation, which is an extraneous body. Coma is the last
symptom of softening, but the first in apoplexy ; in the latter
the unpleasant symptoms diminish, whilst in the former they
go on augmenting : when they go on augmenting in apoplexy,
there is softening, and, moreover, almost always absence of
precursory signs. When precursory phenomena have been
present, the softening has existed before the apoplexy. AH

435

M. Rostan on Softening of the Brain,

these symptoms unequivocally announce sonie tliseased pro¬
cess going on in the brain.

If the apoplexy be mild, it will be very easy to distinguish
it from softening; paralysis of the limb, embarrassment of
speech, &c. are present. Resolution, however, takes place
speedily ; the symptoms gradually diminish, and convalescence
is established : the progress of softening is inverse.

5. M. Rostan is not aware of any sign which can indicate
the apoplexy or hemorrhage which is situated between the
external surface of ihefeuillet of the arachnoid and the cor¬
responding surface of th^ dura mater: the disease is, how¬
ever, extremely rare.

6. Cancer of the brain begins by laminating pains in the
head, which at first return in paroxysms, but afterwards be¬
come incessant; at a later period paralysis, convulsions, epi¬
lepsy, idiotcy, mania, declare themselves; the limbs are the
seat of lancinating pains ; the skin is of a straw colour. The
progress of the disease is essentially chronic, and sometimes
continues for several years. This complaint cannot be con¬
founded with softening of the brain.

7. The progress of fungous tumours of the dura mater is
slow, and they do not give rise to any peculiar symptoms.

8. Hydatids in the brain are extremely rare: M. Rostan
has seen but one instance of them : their progress is slow and
chronic.

9. Tubercles in the brain do not give rise to local para¬
lytic symptoms, as might be believed. In the cases hitherto
published, a very violent headach, and especially intense
vomiting, and some general symptoms, such as vertigo,
debility, and impossibility of holding himself upright, have
occurred. This disease does not, in M. Rostands opinion,
resemble in any thing softening of the brain.

10. Bony tumours of the internal parietes of the cranium.
The progress of these tumours is much slower than that of
softening. M. Rostan considers that they are owing to old
venereal affections : the external parietes of the cranium are
covered with exostoses, as well as the long bones; pains in
the bones are also felt.

1 ]. Syncope is characterized by loss of knowledge, paleness
of the face, slowness of the circulation and respiration, with
loss of power of the limbs. It continues but for a short
time, and leaves no trace behind. The symptoms are general.

J2. In asphyxia there is a purple injection of the face,
suspension of respiration and circulation, coldness of the skin,
loss of power in the limbs: there are alwa}?s general symp¬
toms, which have always a special cause, easily distin¬
guishable.

436

Foreign Medical Scmice and Literature.

13. Lethargy is only a profound carus : it is a symptom of
different cerebral affections.

14. In epilepsy there are violent convulsions, commonly
of short duration, to which succeed stertorous sleep; these
are general symptoms : nearly the same may be_ said of
hysteria.

15. In catalepsy, if the patient’s limbs be put in one posi¬
tion, they remain in it; the pulse and respiration are slow;
the symptoms are general, and of a perfectly peculiar character.

Treatment. — There cannot be, according to M. Rostan,
any preservation against this disease, as we are as yet unac¬
quainted with the predisposing causes of softening of the
brain ; but when the symptoms which characterize the first
period have manifested themselves, such as headach, vertigo,
somnolency, loss of memory, numbness, sense of weight, for¬
mication, stiffness, pains in some limb, diminution, exaltation,
perversion of the intellectual powders, they must be imme¬
diately combated.

Hygiene. — Those alimentary and medicinal substances
which exert a strong and speedy action on the encephalon,
should be strictly avoided. Wine, spirits, coffee, and spices,
are, according to M. Rostan, of this number. Excess at
table is dangerous. The regimen should be mild and mo¬
derate, and the diet easy of digestion, but not too nutritious.

The impression of cold air on the head may be favourable ;
sudden passage into a heated place must be avoided : the
patient should inhabit a. cool situation.

All those things which,' by compressing the limbs or the
organs contained in cavities, may favour cerebral congestion,
should be rigidly proscribed. Warm as w^ell as cold bathing
should be interdicted: tepid bathing alone may be permitted,
although with much caution. Cold lotions to the head may
be advantageous, provided we do not permit reaction to be
established : at the same time pediluvia containing mustard
may be prescribed. The ordinary excretions may be kept up
with advantage; but coitus M. Rostan recommends to be
carefully avoided. Too violent exercise should be avoided
with the same care ; violent emotions, long study, and watch¬
ing, may be still more fatal. The age, strength, constitution,
habits, and stale of the patient, must modify these precepts.

Pharmaceutical means. — The pharmaceutical means to be
employed in the first period are indicated according to the
general rules of therapeutics. A suppressed eruption, he¬
morrhage, or habitual evacuation, may be advantageously
restored : general and local blood-letting, evacuations, and
revulsives, are recommended, according to circumstances, for
fulfilling these indications.

437

M. Rostaii on Softening of the Brain.

In the second period the same means are also required ;
but the severity of the symptoms demands that they should
be more energetic. If the disease appear to be of an inflam¬
matory nature, after having combated the supposed cause,
recalled a hemorrhage, discharge, eruption, &c. which may
have been suppressed, the antiphlogistic treatment becomes
indispensable.

General and local blood-letting, diluents, gentle laxatives,
demulcents, and strict diet, should be ordered.

When the disease does not present an inflammatory cha¬
racter, it becomes necessary not only to enjoin abstinence
from debilitating means, but from the commencement to
apply rubefacients, to throw irritants into the great intestines,
and to have even recourse to tonics, aromatics, internal ex¬
citants, &c. Each of the complications which have been
mentioned, according to M. Rostan, will cause a variation in
the mode of treatment.

Such is an analysis of the opinions of M. Rostan on the
disease termed softening of the hrain-^2in alteration of the
encephalon to which he ascribes greater importance than has
liitherto been done by pathologists : like that of many other
lesions, however, the knowledge of this only assists us in our
diagnosis, withoutadding mucli to our therapeutics, the improve¬
ment of which is, and very properly ought to be, our great
end and aim. The work of M. Rostan is not, however, strictly
confined to a detail of cases or observations on the disease in
question, but contains a great variety of cases of different
derangements of the encephalon, with remarks upon those
derangements, which will be found of considerable interest to
the pathologist. Into an analysis of these investigations our
limits prevent us from at present entering; and more espe¬
cially as the object w'ith which we set out was to place
before our readers some account of the disease termed softening
of the brainy of which hitherto but a very imperfect account
has appeared in the pages of this miscellany. *

We may be allowed, in conclusion, to express our feeling
that in M. Rostan’s volume much valuable information will
be found, conveyed in a manner which is highly creditable
not only to the pathological but literary qualifications of .the
author.

See Repository, Vol. XV. p. 26, 112.

3 I.

VOL. XX. - NO. 1 IQ.

438

Medical and Physical Intelligence,

PART IF,

MEDICAL AND PHYSICAL
INTELLIGENCE:

BRITISH AND FOREIGN.

I. The Heport from the Select Committee on the State of the Penitentiar;y

at Milbank.

We have just now received this Report, with the minutes of evidence
given before the Committee of the House of Commons, and at present we
would merely direct attention to the various points of interest which it pre¬
sents. The first object which will engage the attention of the medical
reader, is the nature of the disease which appeared amongst the prisoners
confined in that place. Whatever difference of opinion existed amongst
those whose evidence appears in the report, we think that there cannot
be much amongst those who will take a comprehensive and an un¬
prejudiced view of the subject. We only regret that the opposing
opinions of men of eminence in the Profession should go abroad in the
community in a manner which cannot tend to elevate the medical character,
or to impress the public generally with any favourable idea of our science
or of our professional ethics. We shall defer our remarks on the disease in
question, and on some collateral topics, until a future opportunity ; but, as
to the medical ethics which the decision of that question - — or rather the
attempt at a decision — in the committee, has unhappily (for all concerned)
involved, we shall now only remark, that we are sorry to see the opinions
and statements of men who deserve respect on many considerations treated
so unceremoniously as they are in the evidence given, by some of the same
Profession, before the Committee of the House of Commons. We are sorry
also that a most able and deserving individual, who has served his country, for
many years, in one of the most responsible offices attached to his Profession,
and who, moreover, has had extensive experience in the disease which
prevailed in the Penitentiary, should have been deprived, from the com¬
mencement of its prevalence, of any management of the disorder, and sub¬
sequently of his office, particularly as the treatment v;hich he recommended
appears, from the evidence of the most experienced witnesses, to have been
the best which could have been adopted in the disease. We cannot,
indeed, refrain from concluding, from the evidence contained in the report,
that Mr. Hutchison has been very, and most undeservedly, ill-treated by
the leading members of the committee of the Penitentiary. He has not,
and, indeed, cannot, as far as this business is concerned, be injured in the
eyes of the Profession : on the contrary, we think that, as an eminent and
deserving brother, who has unjustly suffered, he will find protection there.

II, , On the Therapeutical Effects of Iodine. — By Dr. Coster.

When reviewing, in the Archives Generales de Medecine, an Essay ,on
Iodine, by Brera, entitled “ Saggio Clineo sulP lodio,’^ Dr. Coster has
offered some remarks on the successful employment of this substance, in
some cases which he observed in the practice of Dr. Coindet, of Geneva.

Particular circumstances,^' says Dr. Coster, “ having led me to remain
for eight months at Geneva, with this distinguished Practitioner, (Dr.

439

Medical and Physical Intelligence.

Coiiidet,) I was enabled to observe accurately the good effects of iodine in
enlargements of the thyroid gland, and in scrofulous tumours. M.
Coindet first of all employed this medicine under the form of alcoholic
tincture, and obtained very surprising effects from its administration in
goitre. It was not long before it was perceived that iodine did not act
solely on the thyroid gland, but that it diminished the form and size
of the mammas. In some imprudent patients, who, under the idea that
their cure would be hastened by it, secretly exceeded the dose pre¬
scribed by the Physician, it produced a degree of irritation which induced
marasmus.

M. Coindet next tried the employment of iodine in friction on the
tumour itself; and the success from the application was so great, that of
nearly one hundred individuals affected with goitre, whose cases I have col¬
lected, I may affirm that more than two-thirds were completely cured by it.
The hydriodate of potass incorporated with lard was the form under which
the iodine was first administered in frictions.

“ Soon after these successful results, the iodine was employed in scro¬
fula, in the same manner, viz. sometimes internally, and sometimes in the
form of friction. I shall not affirm that the success was as constantly
favourable in this latter disease as in the former, but it is certain that scro¬
fulous tumours yield sooner to the action of iodine than to that of any
other remedy at present known. When the tumours, whether of the thyroid
gland, or of the lymphatic glands, are hard, and renitent, experience proves
that the effects of iodine are much more prompt, when the frictions are
preceded by the application of leeches, and by submitting the patient to a
demulcent regimen. Notwithstanding these precautions, however, it occa¬
sionally happens that the tumour remains stationary, although it may not be
of the nature of those which are acknowledged to be incurable. A case of
this kind having occurred to me, I tried the following experiment, which I
merely relate here for the purpose of inducing Practitioners to repeat it.

“ A young man was affected with a goitre, the size of which was, at least,
equal to that of three pullets^ eggs : it had been unsuccessfully treated, in
the first instance by iodine in frictions, afterwards internally by the same
substance, and finally by leeches, followed by fresh frictions. Some one
gave me the idea of combining the action of the voltaic pile with that of the
iodine, and it is known that the positive pole of the pile exercises an attrac¬
tive action on iodine. From these data, I conceived that by making use of
frictions with pure iodine on one side of the tumour, and applying the pole
on the opposite side, the absorption would be more speedy, and the effects
of the iodine on the tumour more sensible. In order, however, not to attri¬
bute to the iodine those effects which might be believed to be those of the
electric action, I began by subjecting the patient, for eight successive days,
sometimes to the stream of the pile, and at others to the action of sparks ;
but it was all in vain. I then began with the experiment. The tumour of
the thyroid gland was placed twice a day, for the space of ten or twelve
minutes, under the influence of the positive pole of the pile, taking care to
change sides each time of using it; so that in the morning I made use ot
friction on the right side, and the action of the pile on the left ; whilst in
the evening I chose the opposite sides. At the end ol four days, the size of
the goitre had diminished about four lines. On the 10th day it was reduced
to one-third, and at the end of twenty days there did not remain the least
trace of it.

‘‘ The quantity of iodine which I employed, was two grains to a scruple
of lard. Daring the whole of this treatment no unpleasant symptom
occurred ; the skin had, however, a violet tint, but this disappeared in four
or five days. I regret not having been able to repeat the same experiment,
as no isolated observation is sufficient to establish a fixed rule. ’

440

Medical and Phi/sical hUelligence.

M. Coster considers that this plan might possibly be successfully em¬
ployed in scrofulous cases; but he agrees with M. Coindet, that if the
lymphatic irritation become raised to the inflammatory state, which is
marked by heat and redness in the tumefied glands, the iodine quickly occa¬
sions suppuration, which in scrofulous cases it is essential to avoid, from the
cicatrix whiiih is always produced by it. Under such circumstances, he
considers it prudent to abstain from the use of iodine. — Archives Gin'trales
de MedecinCf Juillet, 1823.

III. Vegetable Alkali from Rhubarb.

M. Nani, of Milan, states that he has discovered a new vegetable alkali
in rhubarb ; but he has not said much of its properties, and except its solu¬
bility in w’eak sulphuric acid, and precipitation by lime, no evidence of its
alkaline nature is offered. Six ounces of rhubarb in powder were boiled
for two hours in eight pints of common water, with four drachms of
sulphuric acid; this was filtered, pressed, and the residuum reboiled with
six ounces of water and two drachms of sulphuric acid; the fluid being again
separated, the residuum weighed but two ounces. The united infusions
were mixed by degrees with three ounces of quicklime, and from being
yellow they became of a blood-red colour ; after standing for a day the pre¬
cipitate was filtered out, dried in the sun, and weighed six ounces. I t was
then digested at a high heat, with four pounds of alcohol S.G. .837 for two
hours, filtered, and again digested with two pounds more of alcohol, which,
when separated by a second filtration, was added to the first. Being put
into a retort, five pounds of the alcohol were distilled off, and the rest of
the liquor carefully evaporated to dryness. The residuuhi weighed two
drachms, w^as of a red brown colour, with brilliant points throughout it.
Its taste was sharp and styptic. It was soluble in water, and its odour like
that of rhubarb. This preparation is recommended in pharmacy as being of
constant quality, of convenient solubility in water, and deprived of its
inert and ligneous matter ; one or two grains are said to be sufficient for
a dose. — Bib. UniVs xxii. p. 232, and Journal of Sciences, No. 31.

IV. Vhe Efficacy of Oil in Cases of Poisoning by Potass.

By M. A. CiiEREAU.

Case Isf. — The grand-daughter of a copper-founder, when very thirsty,
drank a glassful of a solution of potass, used for scouring metals. The
proportion of this alkaline solution was about sixteen ounces of red Ameri¬
can potass to a little more than two pints of water. The liquid was of a
reddish colour, w’hich at first induced a belief that it was a mixture of wine
and water, which the workmen were using; she drank it with avidity, but
soon experienced great heat in the throat, with violent pains in the stomach
and abdomen. M. Chereau being called in, made her take at once 10 oz.
of syrup of gum, and 4 lbs. of oil of sweet almonds. Vomiting super¬
vened ; and when it seemed to stop, the mixture was repeated : the vomiting
after this was renewed, and the patient felt herself relieved. Emollient
drinks and oleaginous potions, administered by spoonsful, subsequently re¬
moved all the alarming symptoms.

Case 2d. — The child of a wine merchant had drank by mistake some of
the aqua secunda of painters (a solution of potass in water.) Nearly 3 lbs.
of oil of sweet almonds were administered at two different times, and re¬
lieved the unpleasant symptoms. Vomiting occurred, as in the first instance.
It was remarked in this case, that the rejected liquid was of a whitish
colour, with some density, and of a saponaceous appearance. It would
seem that the oil does not only act in provoking vomiting, by the nausea
which it occasions, but also that it combines with potass in the stomach.
— Bulletin des Travaux de la Societe de Pharmacie de Paris. Juillet,
1823.

Medical and Physical IntelUgmce. 441

V. On the Use of Sugar in Cases of Poisoning by Lead. By M. Reynard.

The following fact has been lately addressed by M. Reynard to the
Societe des Sciences of Lisle. During the campaign of Russia several
loaves of sugar had been enclosed in a chest containing some flasks of
extract of lead. One of these flasks having been broken, the liquid
escaped, and the sugar became impregnated with it. During the distresses
of the campaign, it was necessary to have recourse to this sugar; but far
from producing the fatal accidents which were expected, the sugar formed
a salutary article of nourishment to those who made use of it, and gave
them a degree of vigour and activity which was of the greatest service in
enabling them to support the fatigues of marching. Might not,'’ says
M. Reynard, very properly, the employment of sugar be adopted for com¬
bating the effects of the sub-acetate of lead, instead of the other soluble
salts recommended by M. Orfila, (the sulphate of soda or of magnesia,)
wliich are not always ready at hand.” — Journal d' Agriculture et Sciences
accessoires. Par M. Limousin-Lamothe. Tom i. No. 4, page 94,
1823.

VI. Clapham Retreat for the Medical Treatment and Carff of the Insane

and Imbecile.

Dr. Burrows has lately fitted up, at very considerable expense, an exten-
tensive establishment for the insane at Clapham Rise, Surrey, into which
persons of either sex are admitted ; the house is placed on a gentle emi¬
nence, in the centre of a paddock of tw enty-two acres ; and it is extremely
commodious and well furnished. Every resource that appears calculated
to divert the morbid associations of the mind, and to conduce to health, is
provided : such as books, music, bowds, billiards, carriages, &c. whilst to
those who are capable of attending to more serious duties, every source
of consolation will be afforded. Besides the regular visits of Dr. Burrows,
the Physician to the establishment, a medical Practitioner resides in the
house; but every patient, should it be preferred, will be placed under the
treatment of his own medical attendant.

The view's from the house, in every direction, are rich and interesting.

We had an opportunity of inspecting this establishment prior to its
opening, and were highly gratified with the various arrangements. Of Dr.
Burrows’s qualifications, it is unnecessary for us to say much; he has already
been for a considerable period Physician to an extensive private establish¬
ment, and is well known to the Profession by several interesting essays
relating to insanity.

VH. Messrs. Voisin and FalreCs Establishment for the Treatment of the
Insane of both Sexes, at Vanvres, near Paris.

We have also had an opportunity, within the last few months,

through the kindness of Messrs. Voisin and Falret, of visiting their

private establishment, lately fitted up at an expense of o£’10,000,

on the model of the beautiful establishment of M. Esquirol, at

V^anvres, near Paris. The house is amazingly large and commodious,
and every thing that could give the appearance of restraint, both in
the house and grounds, carefully avoided : the gardens are laid out in the
English style, and are inclosed with strong trellis-work, so concealed by
shrubs, that no appearance of objects of constraint is perceptible : attached
to the garden is an extensive inclosure, where the convalescents may indulge
in the pleasures of agriculture and exercise. Every thing around the
afflicted objects is contrived so as to induce tranquillity of mind. Messrs.
Voisin and Falret are pupils of M. Esquirol, and have published several
important essays on mental alienation. We trust they may meet with that
encouragement from their countrymen to which their mental qualities so
richly entitle them.

442

Morithl^ Bibliography , S^c.

VIII. Society for the Cultivation of Meteorological Science.

On the 15th inst. a Meeting was held at the London Coffee-house,
Ludgate Hill, to take into consideration the propriety of forming a Meteo¬
rological Society. Among the gentlemen present were Drs. Clutterbuck,
Shearman, Armstrong, Copland, Roberts, T. Forster, Mr. Luke Howard,
&c. &c. : at eight o^clock the chair was taken by Dr. Birkbeck, when the
following resolutions were agreed to : —

1. Resolved, That the formation of a Society to promote the advance¬
ment of Meteorology huve the cordial approbation of this Meeting.

2. Resolved, That a Society be formed to be called “ The Meteorological
Society of London.’’

3. Resolved, That the business of this Society shall be conducted by a
President, Vice-Presidents, Treasurer, Secretary, and Council; and that the
number of Vice-Presidents and Members of the Council be determined at a
subsequent Meeting.

4. Resolved, That Mr. Thomas Wilford be requested to officiate as
Secretary to this Society {pro tempore), and that he be authorised to send a
printed summons to attend the next Meeting to each person who shall
become a Subscriber.

5. Resolved, That an Annual Subscription of Two Guineas be paid in
advance by every Member of this Society.

6. Resolved, That those gentlemen present who are inclined to become
Members of this Society, do now send their names to the Secretary to be
enrolled.

7. Resolved, That a Committee of three Members be appointed, in con¬
junction with the Secretary, to draw up an account of the Society’s pro¬
ceedings this evening.

8. Resolved, That scientific men throughout the United Kingdom be
solicited to co-operate with this Society, and to transmit communications to
it ; and that this Society will always be ready to receive meteorological
observations from the cultivators of science throughout the various quarters
of the globe.

9. Resolved, That no other qualification be required to constitute eligi¬
bility to this Society, than a desire to promote the science of Meteorology.

10. Resolved, That after the next Meeting the election be by ballot upon
the proposition of three, and that a majorit}' of Members decide.

11. Resolved, That this Meeting do adjourn to the 12th of November
next, to meet at the same place and hour.

MONTOIy MEDICAL BIBUO'GHAPHY.

BRITISH.

A System of Anatomical Plates; accompanied with Descrip¬
tions and Physiological and Pathological Observations. By John
Lizars, F.R.S. Fellow of the Royal College of Surgeons, and Lec¬
turer on Anatomy and Physiology, Edinburgh. Part I. The
llones ; and Part II. The Blood-vessels and Nerves. Folio and
octavo. Edinburgh and London, 1823.

This is a very splendid and an uncommonly cheap work. The plates are
in folio, and each part is accompanied with a copious and minute descrip¬
tion, in octavo letter-press, with physiological and pathological observations.
The First Part contains all the bones, and the Second exhibits the Blood¬
vessels and Nerves chiefly of the Head, Neck, and Thorax. The engravings,
which are very ably executed, are apparently after original drawings. The
objects are represented with an accuracy and distinctness which must
recommend the work to the student, as well as to the experienced anatomist
and pathologist.

Monthly Bibliography , Works for Review, S^c, 443

FOREIGN.

Clinique Medicale, ou Choix d’Observations recueillies a la Cli¬
nique de M. Lerminier, Medecin de I’Hopital de la Charity, &c. &c.
et publiees sous ses Yeux, Par G. Andral, fils, D.M. de la Faculte
de Paris, Mernbre adjoint de TAcademie Royale de M^decine, &c.
&c. Premiere Partie, Fievres. 8vo. pp. 536. Paris, 1823.

M. Andral is already well known to our readers as an able pathologist.
The present work contains about 120 cases of continued fever, with a
detailed account of the appearances observed on dissection of those which
proved fatal. M. Andral has also noticed upwards of fifty cases which were
treated by M. Lerminier. After detailing, very circumstantially, the history
of those cases, he takes a very interesting review of the particular phenomena
which they presented, and arranges their characteristic features under
separate heads. This work will excite the interest of those who study the
nature and treatment of fever; and who, that wishes to attain real profes¬
sional eminence, would not direct a very large portion of his attention to
this subject?

AVORKS RECEIVED FOR REVIEW.

I. Transactions of the Associated Apothecaries and Surgeon-Apothe¬
caries of England and Wales. Vol. I. 8vo. Pp. clxx, 424, with Plates.
Burgess and Hill. London, 1823.

II. A Practical Treatise on Tropical Dysentery, more particularly as it
occurs in the East Indies; illustrated by Cases and Appearances on Dissec¬
tion : to which are added. Practical Treatises on Scorbutic Dysentery, on
the Morbus Chylopoieticus and Gastrodynia ^ k'ame; with some Facts and
Observations relative to Scurvy in general, and a short Account of the
Scorbutic Disease that appeared at the Penitentiary, Milbank, Westminster.
By R. W. Barnpfield, Esq. Surgeon, one of the Surgeons to the Royal Metro¬
politan Infirmary for Diseases of Children, &c. &c. 8vo. Pp. .344.
Longman and Co. London, 1823.

III. A Course of Lectures on Chemical Science, as delivered at the
Surrey Institution. By Goldsworthy Gurney. 8vo. Pp. 310, with Plates.
Whittakers. London, 1823.

IV. A Treatise on Midwifery ; developing New Principles, which tend
materially to lessen the Sufferings of the Patient, and shorten the Duration
of Labour. The Second Edition, considerably improved, and illustrated
with numerous Cases ; comprising, also, additional Observations on Prema¬
ture Expulsion of the Ovum, and Retention of the Placenta. By John
Power, M.D. Physician-Accoucheur to the New Westminster Ljdng-in
Charity, &c. &c. and Lecturer on Midwifery and the Diseases of Women
and Children, &c. 8vo. Pp. 240. Simpkin and Marshall. London, 1823.

NOTICE OF LECTURES.

Dr. Gordon Smith will commence, early in January, a Course of Lectures
on Medical Jurisprudence, See. For particulars apply at the Publisher8^

LITERARY INTELLIGENCE.

Preparing for publication, a Treatise on Organic Chemistry ; containing
the Analyses of Animal and Vegetable Substances, founded on the Work of
Professor Gmelin on the same subject. By Mr. Dunglison, Member of
several Learned Societies Foreign and Domestic, and one of the Editors of
the Medical Repository.

Dr. Henderson’s History of Ancient and Modern Wines will shortly
appear in an elegant 4to volume, embellished with decorative Wood-cutSi

Dr. Prout is preparing a volume of “ Observations on the Functions of
tlie Digestive Organs, especially those of the Stomach and Liver.’^

444

THE METEOROLOGICAL JOURNAL^

From the l^thof SEPTEMBER to the 20th of OCTOBER^ 1823.

By Messrs. HARRIS and Co.

Mathematical Instrument Makers, 50, High Holborn.

Sept.

Moon.

1 Rain Gauge.

Therm.

Barom

•

De Luc’s
Hygrom.

Winds.

9 A. M.

Max.

9 A.M.

lOP.M.

! 10 P. M.

•

- — . . — 1

10 P. M.

ssw

WNW

,52

SSW

ssw

ENE

ssw

wsw

,27

SSE

WSW

wsw

WNW

SE'

SSW^

WSW

ssw

SW'

,15

SSW

SSE

ESE

WSW

SSW

SSE

,15

ENE

Atmo. Variation

Fine

Clo.

Fine

Rain

Clo.

Fine

Fog.

Fine

Rain

Fine

Clo.

Fine

Rain

Fine

Sto.

Rain

Fair

Fog.

Fine

Rain

Fine

Rain

Sho.

Fine

Rain

Fine

Rain

Fine

Sho.

Fine

Rain

Sho.

Fine

Rain

Fine

Rain

Fine

Clo.

Fine

Rain

Fine

Fog.

Cll

Clo.

Fine

Clo.

Fine

Clo.

Fine

Clo.

The quantity of Rain fallen in the month of September was 62-lOOths.

NOTICE TO CORRESPONDENTS.

, Mr. Ridge’s Case of Somnambulism is received through Dr. James
Johnson.

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

THE

LONDON xMEDICAL

REPOSITORY.

No. 120. DECEMBER 1, 1823. Vot. XX.

PART 1.

ORIGINAL COMMUNICATIONS.

General Report of the Medical Diseases treated in the Kent
and Canterbury Hospital ^ from January \st to July \st,
18*23, with a particular Account of the more important
Cases. By Harry William Carter, M.D. F.R.S. Ed.
Senior Physician to that Institution, &c. &c.

( Concluded from page 402.J

No. VIII. Case of Menorrhagia alternating with Leucorrhaea*

Mary Cheesman, aged twenty-four, single, was admitted,
April 2.5th, with menorrhagia. She had been ill nine months,
and had been under the care of a very judicious Practitioner
in this neighbourhood, who had examined the patient, and
found no disease of the uterus. She was first blooded to the
amount of twelve ounces, and took inf. rosae with tinct. digi¬
talis. The blood exhibited no marks whatever of inflamma¬
tory action going on. She afterwards took astringents and
tonics without the least advantage. The complaint had
seldom left her for the nine months, and whenever it had
ceased for a moment, profuse leucorrhoea had taken its place*
May 5th, she began the cubebs, a scruple three times a day
in mist, camph., and was allowed three glasses of port wine
daily. On the 10th, as she complained of pain of the hypo-
VOL. XX. — NO. 120. 3 M

446 Original Communications,

gastric region, six leeches were applied, which afforded
marked relief ; she also took a purgative draught. The
menorrhagia did not return, and the leucorrhoea gradually
subsided. Leeches, to the number of eight, were again
applied on the 18th, and from that date till the day she was
discharged, viz. June l6th, she continued free, or very nearly
free, from complaint. I flattered myself that the local bleed¬
ing and the cubebs had effected a cure; but,

‘‘ O curas honiinum ! O quantum est in rebus inane!’"

almost as soon as she reached home, the complaint returned
as bad as ever. It would appear, then, that the exemption
from it which she enjoyed in the hospital was owing to rest
and good nourishment chiefly. The medicine, perhaps, was
of some avail ; and had the patient been in affluent circum¬
stances, it might have had the exclusive credit of the cure,
since, after discontinuing its use, she might still have remained
quiet, might have lived generously, and thus have escaped a
recurrence of the disease.

The event of the case disappointed me not a little, though
experience has, by this time, taught me not to be very
sanguine in my hopes of removing affections of this nature
after they have subsisted for months. They generally depend
upon some organic disease of the uterus, although, as was the
case in the present instance, no disease can be detected by
examination.

No. IX. Case of Chronic , perhaps Organic j Disorder of

the Stomach,

Among the cases of chronic affection of the digestive
organs, the following seems not destitute of interest. Sarah
Swan, setatis eighteen, single, was admitted into the hospital
November l6tb, 1822. The medical gentleman, under whose
care she had previously been, suspected scirrhus of the
pylorus.

The patient was a very slight delicate person. Her pulse
was extremely feeble and small. The colour of her skin
indicated extraordinary languor of circulation. She was not,
by any means, pale, but her complexion was purple. Her
extremities were always cold. Her tongue was much furred.
Appetite bad, and every kind of animal food was rejected
soon after being taken. There was also incessant spitting,
and a frothy darkish-coloured mucus was thrown up in con¬
siderable quantities. She complained of great pain at the
scrobiculus cordis, shooting to the back, and there was
decided tenderness upon pressure of the epigastrium. Her
respiration w'as short, especially after taking food, which

Dr. Carter's Report of Cases treated at the Kent Hospital. 447

always lay as a load upon the stomach. Catamenia sup¬
pressed for several months. Various remedies were tried.
Among the rest, bleeding by leeches, tartar emetic ointment,
mercurial ointment, blue pill, wdth extract, conii, &c. &c. ;
and, in some respects, the patient certainly improved. The
spitting ceased, and the local pain was relieved. Still, how¬
ever, food continued to be rejected, the menses were not
restored, and great general debility remained. She was made
an out-patient, and returned to her situation as servant to
Lady Harris. From lime to lime I heard of her, but the
reports were never favourable. At length (it was, 1 think,
about the end of June), I prescribed five grains of the oxyd
of bismuth with a third of a grain of opium, and fifteen
grains of compound tragacanth powder, thrice a day.

I saw her July loth, and she was then, though not
recovered, considerably better. The symptoms of organic
disease of the stomach had become less urgent ; the menses had
returned, and her general appearance was more favourable.
I cannot say but I still apprehend organic lesion of this viscus,
for animal food is still rejected, and there exists some
pain. It seems evident, however, that the oxyd of bis¬
muth and opium have done good. The disease appears
to have been checked in this instance, and I think I have
found it useful in other cases, where I have had strong
grounds for suspecting more than functional derangement of
the stomach.

Nos. X. and XI. Cases of Pyrosis.

In the tw'o following cases the good effects of the oxyd of
bismuth were conspicuous.

No. X. — Mary Nichols, setatis fifty-three, was made out¬
patient January 17th. She stated that she had suffered for
several years from water-brash, for wFich she had taken, at
different times, a variety of remedies, without much relief.
The fluid rejected was limpid, and nearly colourless r its
taste somewhat acid. The pyrosis was her chief complaint,
but she had many distressing dyspeptic symptoms besides,
such as occasional severe gastrodjnia, &c. Her pulse was
feeble ; tongue foul ; bowels disposed to be costive. 1 pre¬
scribed oxydi bismuthi, gr. v., pulv. tragacanth. c. gr. xv.
ter die.

= 24th. — Pyrosis much less. — Pergat.

February 7th. — Only one return of vomiting since the last
report, and that return was this morning. She ascribed it to
fatigue in waiting at the hospital, Augeatur oxyd. bismuth,
ad gr. viij. As she complained of severe heart-buin at

448

Original Communications.

times, I ordered the following draught to be taken pro re
iiata : —

R Magnes. ^ss, ; Tinct. Opii, tlljv. ; Aq. Piment. ; Aquse Puree,
aa ^iij. Misce, fiat haustu^*

£lst. — Much improved. Complains only of costiveness.

Hydrarg. Submur. gr. ij. ; Pulv. Antim. gr. iij. ; Extract.
Hyoscy. gr. iij. Misce, ft. pil. ij. hac nocte sumend. et haust,
laxativ. eras mane.

On the 7th March she reported herself still greatly better
of the pyrosis, and her general health w^as materially im¬
proved. Still, however, there was a tendency to costiveness,
w'hich the draught with tinct, opii seemed to increasej and I
was compelled again to order the calomel, &c.

April J 5th. — Pyrosis entirely gone. She now took the
laxative pills twice a week, and continued the oxyd of
bismuth.

May l6th. — No return of pyrosis. Discharged.

No. XL — Susanna Carey, set, fifty-seven, admitted March
£5th. This woman had, for a very long period, been suffer¬
ing from pyrosis. She took the oxyd of bismuth thrice a day,
and the following powder every day at noon : —

R Pulv, . Rbei, gr. v. ; Sodee Subcarb. Exsiccat. 9ss. ; Pulv.
Cinnam. c. gr. iij. Misce, ft. pulvis, exquovis vehiculo idoneo
sumendus.

The patient quickly became so much better, that she
ceased to attend, and I sent for her to learn what had been
the effect of the remedy. She reported herself, June 13th,
nearly free from her complaint.

No. XII. Case of Scrofulous Enlargement of the Mamma.

Susan Mutton, setatis twenty-three. This poor girl has
long been a patient of the hospital for a complication of
disorders, some of which have, from time to time, been
relieved, but they have generally either returned or been
succeeded by fresh ailments. She is of decidedly strumous
temperament, and her mother, I believe, died of scrofula in
the hospital some years ago, I scarcely know what remedies
have not been exhibited in the present case. The great con¬
stitutional debility under which the patient labours has
rendered every modification of tonic medicine, and every sort
of diet, of little avail. One of her chief diseases is general
enlargement of both mammae, and it is on account of that
enlargement that her case is noticed here. This great
increase of volume of the breasts, rendering them quite a
burden to the female in whom it occurs, 1 have hitherto

Dr. Carter’s Report of Cases treated at the Kent Hospital. 449

found to bid defiance to every mode of treatment. Conversing
one day with a very intelligent Practitioner of this neigh¬
bourhood on the effects of iodine on the lymphatic system, I
was asked by that gentleman whether I had noticed a some¬
what unpleasant circumstance respecting it, viz. that while it
absorbed the morbid growth, bronchocele for instance, for
which its emplo3mient had ceen directed, it also absorbed the
mammae of the patient.^ This effect I certainly had not
remarked, nor was I at the time aware that Professor Brera
had noticed it.* Whether my friend had met with M. Brera’s
essay, or had read the abstract of his clinical observations
respecting it, contained in the Medico-Chirurgical Review
for March last, I cannot say ; but the question be put to me
led me to imagine that iodine might be usefully applied in
cases such as that of Susan Mutton, f

At first I prescribed it externally alone. This was about
the beginning of July, and I thought that, after the lapse of
a fortnight, the left mamma, to which only the ointment had
been applied, was somewhat diminished in volume. Not
long after this I ordered ten drops of the tincture thrice
a day, but soon discontinued its use, for it caused severe pain
of the stomach and bowels. The patient still perseveres with
the ointment to both breasts (August SQth). I certainly
think it has reduced their enormous size, but as yet it has not
had a fair trial. I shall give the sequel of the case in my
next report.

No. XIII. Case of Amenorrhcea.

Elizabeth Attwood, aetatis twenty, was made out-patient

* Professor Brera says, in some persons the submaxillary glands
become painful and swollen, and a similar state of the mammae, mth
eventual diminution of their natural volume, lakes place in some
females.” 1 quote from Dr. Johnson’s abstract, for I have not the
original essay before me.

t Dr. Coindet, to be sure, has exhibited iodine in cases of enlarged
glands of the breast; and Dr. Baron (in his ‘‘Illustrations of the
Inquiry respecting Tuberculous Diseases,” chap. vi. entitled, “ Re¬
marks upon the Treatment of Tuberculous Diseases,” p. 223), when
closing the sketch of a case, which he denominates physconia hyda-
tidosa, and which was much benefitted by the iodine, has the follow¬
ing words: — “A small tumour has recently appeared in the left
mamma;” and he adds, in a note, “ It is of importance to observe,
that this tumour has, by the continued use of the remedy, been nearly
absorbed.” But these tumours are very different from that general
augmentation of volume of the mammse at present under considera¬
tion.

450

Original Communications,

April 25th. She had symptoms of incipient phthisis, and f
was very apprehensive that she would become decidedly con¬
sumptive. The catamenia had been suppressed for several
months. There was this hope, viz. that the cough, &c,
might be symptomatic, instead of the suppression being so.
The patient was first bled to f. : the blood was cupped
and buffy. She was ordered inf. rosse, with a small addition
of acid, and tinct. card c. every four hours; a demulcent
saline draught, with tinct. of digitalis, it^vj. at bed-time ;
and, as the bowels were rather torpid, an ounce and a half of
decoct, aloes c. every, or every other morning. In three
weeks the more threatening symptoms of disease of the lungs
had subsided, and the case was proved to be one of sup¬
pressed catamenia only. She was now directed to continue
her night medicine, and the decoct, aloes e., and to take
gr. viij. of the pil. galban. c. thrice a day.

On the ^Oth of May she continued nearly as before. The
compound galbanum pills were changed for gr. x. of pil. ferri
cum myrrha. In about a week the menstrual discharge was
restored, and it returned at the proper time in July. On the
11th of that month she was discharged cured.

I have given the above brief history because it affords a
good example how intimately suppression of menses some¬
times resembles phthisis. It often, indeed, seems to lay the
foundation for that fatal malady. The suppression having
continued for a long period, the general health suffers ma¬
terially, and ultimately the lungs become diseased, and the
patient dies consumptive. Such, perhaps, would have been
the event of the case before us, had not the patient applied
for relief before her constitution had begun to give way, and
had not the means resorted to for restoring the menstrual
discharge fortunately proved successful.

No. XIV. Case of Hheumatismy

The second case of which 1 have given an abstract in this
report affords an example of the good effects of the tartar
emetic ointment in an affection of the head. The benefit,
however, which resulted from its use in that case, though it
was, I think, very evident, was by no means so decisive as in
the following instance, where it was applied for an extremely
painful and obstinate affection of the hand and arm.

Rebecca Tompset, aetatis nineteen, was admitted into the
hospital October 25th, 1822, affected by swelling, inflamma¬
tion, excessive pain, and tenderness of the right hand and
arm. Her general health seemed to be little affected. I at
first suspected, from the appearance of the affected limb.

Dr. Carter’s Report of Cases treated at the Kent Hospital. 451

that it had sustained some mechanical injury, or that it had
been sprained ; but the patient assured me that such was not
the case. I therefore treated the disease as rheumatism, but
to no purpose : it remained obstinately fixed to the old spot,
and became even more severe. Then, deeming it a scrofu¬
lous affection, I directed my views principally to the im¬
provement of the general health, using, at the same time,
various local remedies — but all failed in toto. Decoct,
sarsae. c. pil. hydrarg. and extract, conii, laxatives, and many
more general remedies, leeches, blisters, lotions, ung. hydrarg.
were equally of no avail. At one time so much symptomatic
fever was excited by the excessive pain, that I was obliged
to bleed to the amount of sixteen ounces. After three
months the patient was not at all better, and I kept her in
the hospital rather out of charit}'^, for she was destitute of a
home and miserably poor, than because I entertained hopes of
removing her complaint. At last, however, I determined
upon making trial of the tartar emetic ointment, and in this
determination I was influenced by my friend Mr. Hutchinson,
of Hythe, who one day happened to go round the hospital
with me. It may seem rather extraordinary that I should not
have thought of using this remedy before. In fact, it had
occurred to me, but 1 felt reluctant to employ it on account
of the inflammation always present, and because 1 feared
lest, in such a temperament, the sores should prove trouble¬
some and difficult to heal. The ointment was commenced
about the beginning of February. It was diligently em¬
ployed, and so as to produce its full effects. The pustules
were numerous, and assumed their usual malignant character.
The event was most satisfactory, and the patient left the
hospital with the hand and arm free from pain, or inflamma¬
tion, or swelling, and nearly as serviceable as the other. She
was discharged in February, and since that period I have
heard nothing of her; so that it may be concluded that she
continues free from complaint.

No. XV. Case of Organic Disease of the Heart.

In the following case again the tartar emetic ointment
seemed, in conjunction with other remedies, to be very
useful.

Samuel Hubbard, getatis forty-five, labourer, was admitted
into the hospital, April Soth, with the following symptoms : —
Violent and constant palpitation of the heart, perceptible to
the eye, with pain, referred chiefly to the scrobiculus cordis,
but extending also over the chest generally, and affecting the
left arm. Respiration always hurried, and excessively so

452 Origmal Conmmiications.

upon the least exertion. Dry, hard, deep, and incessant
cough, which was rendered more urgent and distressing by
exposure to cool air, on which account the patient generally
held a handkerchief to his mouth. Pulse rather hard, but
not full or strong, nor do I recollect that it intermitted.
Sleep disturbed. There were no syniptoms of dropsical effu¬
sion. The patient had for a long time laboured under what
evidently appeared to be disease of the heart, and he had
once before been in the hospital, but not under my care. He
stated that he was then relieved by bleeding. All that could
be hoped for in such a case was that symptoms might be
palliated. The pain and distress in breathing were so urgent,
when I saw him on the day after his admission, that I thought
it right to order bleeding to the extent of twenty ounces,
and I prescribed the following powders to be taken thrice
a day : —

R Pulv. Digital, gr. ss. ; Antim. Tart. gr. Pulv. Colchici, gr. v*
Misce, hat pulvis.

28th. — The first portion of blood, sixteen ounces, was
somewhat cupped and very firm, but it exhibited no buffy
coat. The remaining four ounces, which were in a separate
vessel, were buffy. This I have frequently observed. Little
or no relief followed the bleeding. All the symptoms con¬
tinued nearly the same. His bowels being confined, I ordered
a powder, composed of five grains of calomel and fifteen of
jalap; and directed the tartar emetic ointment to be rubbed
in on the left side twice a day.

May 5th. — There was little alteration ; the pain and
harassing cough continued. The ointment had not as yet
produced much effect. On the 12th, however, there was a
very copious eruption, extending far beyond the space over
which the ointment had been used, and the discharge from
the pustules was considerable. The powders of digitalis, &c.
had now affected his bowels, and they were very much
relaxed. All the symptoms were materially relieved. The
powders were continued twice a day. The irritation caused
by the eruption w'as soothed by fomentations and poultices,
and the discharge was maintained by the occasional applica¬
tion of the ointment spread on linen.

By the 26th the patient was much improved —much better,
indeed, than 1 ever supposed he could be. He was able to
move about without distress, and to assist, with other con¬
valescents, in the work of the house. He was made out¬
patient, and was strictly enjoined not to engage in hard
work. The discharge he was directed to keep up by the

Dj'. Cartei-^s Heport of Cases treated in the Kent Hospital. 453

aniimonial ointment,^ or by ung. lyttae, with a sQiall addi¬
tion of tartarized antimony, and the powders were still to be
taken twice a day.

1 have not seen the patient since he left the hospital.

No. XVI. Case of Abscess of the Livery u-ith Tubercles

in the Lungs.

James Miles, aetatis twenty-four, was admitted, April 11th,
with symptoms of phthisis pulmonalis and of hepatitis. He
had severe cough with purulent expectoration ; night per¬
spirations; frequent and very feeble pulse; pain of chest;
great difficulty of breathing. There were excessive pain, and
tenderness, ’and fulness, about the region of the liver, — pain
also of ‘the right shoulder and arm. His lower extremities
W'ere anasarcous ; his debility was remarkable. The pain
and tenderness of the right side were such, that I should
certainly have bled him from the arm could he have borne it.
As it was, I applied ten leeches to the side, and afterwards a
blister. On the IQth the leeches w^re repeated; and again
on the 22d, the pain and difficulty of breathing, &,c. still
subsisting, eight more leeches were applied and a second
blister. May 1st, a third blister was laid on the affected
part. The cough and other symptoms of disease of the lungs
continued so urgent as to require demulcents with opiates
to keep them in check. I tried also the prussic acid, but it
did no good. The anasarca of the legs, which added greatly
to his distress, was relieved several times by acupuncturation.
He was for a long time affected by obstinate diarrhoea, and
some apparently purulent matter was passed by stool. This
diarrhoea reduced the patient to such a degree, that, not¬
withstanding the inflammatory symptoms still present, I was
fain to employ astringents with opium, and to order port
wine and generous diet. Towards the end of June the
diarrhoea had ceased in a great measure. The pectoral
symptoms were nearly the same, but the state of the liver
still attracted our chief attention. Blue pill with opium
every night, and mercurial ointment, seemed, for a little
while, to arrest the progress of the disease ; but their good
effects were transient, and towards the end of June the

* The formula I generally adopt is that recommended by the late
Dr. Jenner, viz. : —

R Antim. Tart. (Subtil. Pulv.) 3ij.

Ung. Cetacei, 3jx.

Sacch. Albi, 9ij.

Hydrarg. Sulphuret. Rubri, gr. v. M. ft. Ung,

— • NO. 120. 3 N

VOL. XX.

454

Original Communicaiiom,

patient became much worse : the diarrhoea recurred, and
defied every effort to suppress it : general dropsy came on,
and, after lingering till July 8th, he died.

Examination of the body. — As the principal disease seemed
to have existed in the liver, that viscus was first examined.
It was enlarged to at least three times its natural size, and
extended quite across the epigastric region to the left hypo-
chondrium. Its left lobe exhibited marks of inflammation,
but was not disorganized. Its right lobe was, as it were,
converted into tw^o sacs containing pus. J he larger sac held
between three and four pints. The other abdominal viscera
were generall}' healthy, but their position was considerably
deranged by the enlarged liver. In the thorax the lungs
were compressed by the same, and the right lung was exten¬
sively diseased. It w’as tuberculated throughout, and several
of the tubercles had advanced to a state of suppuration.

This may be regarded as rather an uncommon case.
Abscesses of the liver are not often met with in this country,
and more especially are they rare in {)ersons who have never
been out of England. With the history of the case pre¬
viously, to the patient’s being admitted into the hospital, I
am but .slightly acquainted. He had, however, been long in
a baa state of health, often unable to do his work, though
very willing to exert himself. When he first came under my
observation, disease had committed such ravages upon his
constitution, that scarcely any prospect remained of his being
relieved by medicine.

No. XVII. Case of Haemoptysis.

Sarah Harrison, setatis fourteen, was made out-patient May
22d, 1822. She had been in the hospital at the beginning of
the year, with what I at first considered haematemesis. It
was soon, however, ascertained that the blood came from the
chest, and the girl was at that time relieved by blisters and
leeches, &c. Soon after she was discharged, the complaint
returned, and she was made an out-patient under my late
colleague. Dr. Packe. She again got better, and again
relapsed. Upon her readmission, 1 found that she was exces¬
sively annoyed by ascarides, which were got rid of by muriate
of soda taken internally, and aloetic suppositories. Still the
haemoptoe continued. Her health did not materially suffer,
yet she appeared generally weak. I prescribed mist, ferri
c. f j. ter die, and the tartar emetic ointment to the chest.
As her bowels were slow, an ounce of the compound decoc¬
tion of aloes was ordered to be taken every other morning ;
and twice a week she had a grain of calomel, with five grains
of rhubarb, and a little compound cinnamon powder. The

Dr. Carter^s Report of Cases treated in the Kent Hospital, 455

antimonial ointment, however, was not effectually employed
till some weeks after it was first directed to be used. The
patient lived at a distance from Canterbury, and I seldom
saw her. The bleeding continued, and it was not until the
middle of February that I ascertained the ointment had been
only occasionally used, and had been laid aside as soon as
the eruption had begun to appear. The mother was now
strictly enjoined to employ the remedy regularly, so as to
maintain a constant discharge. The mist, ferri c. was also
continued.

Mrs. Harrison attended to the directions that had been
given her, and by the beginning of March the haemopioe
had subsided. A discharge was kept up for about three
months, and the disease did not return. For several weeks
previous to the girl’s being discharged, the ointment was
omitted, and, June ISth, she was dismissed as cured. It is to
be observed that the catamenia had not appeared. Does not
the event of this case afford an additional proof of the efficacy
of tartar emetic as an external application ?

No. XVI 1 1. On Acupunctura.

In my abstract of the case No. V. it was mentioned how
efficacious and how safe I had found acupuncture in instances
of anasarca. I may now add, that I have known it also
useful in some cases of chronic rheumatic affection. Isaac
Terry, who was troubled with sciatica, underwent this opera¬
tion, and the relief which it afforded him, though unfortu¬
nately not permanent, was striking. The needles were
passed May 9th — the pain was almost immediately removed,
and stiffness only of the affected part remained. The patient
walked four miles with ease. The pain, however, returned on
the loth. The operation was repeated once and again, and
both times with marked relief. The relief, however, as I
have before stated, was not permanent; perhaps owing to the
man’s living exposed to cold and wet, and being obliged to
work very hard. He afterwards, however, got nearly well
by means of the warm bath and colchicum.

Another patient, Mary Pattison, a middle-aged woman,
had been long suffering from rheumatic pain of the arm and
hand. A variety of remedies had been tried, but to no pur¬
pose. Acupuncture was here of decided efficacy. It cer¬
tainly removed the pains from the part to which it was first
applied ; and the patient, at her own earnest request, had
the needles passed into the hand and fingers several times,
and, if her statement is to be credited, the operation put the
disease to flight. She was discharged some time back, and I
have not heard of her since.

456 Original Communications,

f have employed acupuncture in several other cases :
sometimes with considerable success, but, I must confess,
more often without benefit to the patient. Upon the whole,
however, I am inclined to look upon it as a remedy worthy
attention. Discrimination, as Mr. Churchill has said, is
necessary in employing it, and it may be that I have occa^
sionally resorted to it in cases to which it was not exactly
adapted. When a novel remedy is brought forward, how
prone we are to exhibit it without due discrimination!

No. XIX. On the Balsam of Peru.

The cases of chronic affection of the digestive organs, and
those to which I could assign no other title than that of
general debility, were of course extremely numerous. In
every hospital they constitute a great [)roportion of the
diseases we have to treat; and how obstinate they prove
every hospital Physiciati must be well aw'are. Generally
speaking, tlie patients quit the hospital with some relief, but
hard work, bad living, or irregular living, soon bring them
back again. Medicine does soinething, but the circum¬
stances and habits of the patients quickly overturn the little it
has done. It may, however, be worth while to mention,
that, among other remedies which have been found useful in
dyspepsia and general debility, the balsam of Peru is entitled
to some consideration. Every one know-s that this medicine
once enjoyed no small share of reputation ; but, like many
articles besides of the materia medica, whose virtues have
been overrated, or which have been injudiciously employed,
it seems, of late years, to have fallen into unmerited neglect.
In phthisis, I have no doubt, it often did harm, and the ill
success attending its exhibition in that disease probably
threw discredit upon it altogether. It ought, how'ever, to be
remembered, that, as Dr. Paris observes in his Pharma-
cologia, it is stimulant and tonic.” Tiiat excellent writer
adds, that therefore, in certain chronic affections of the
lungs, it lias been found a serviceable expectorant;” but I
contend that it is serviceable not only in certain chronic
affections of the lungs, but in many other cases of chronic
affection. Lemery says that the balsam of Peru is good to
strengthen the nerves.” Lewis, in his justly celebrated Dis¬
pensatory, mentions that its principal effects are to warm
the habit, and to strengthen the nervous system, and attenuate
viscid humours. Hence its use in some kinds of asthmas,
gonorrhceas, dysenteries, suppressions of the uterine dis-
chai ge, and other disorders proceeding from a debility of the
solids, or a sluggishness and inactivity of the juices!^

1 have frequently had recourse to the balsam of Peru

Mr. Wansbrough on Digitalis in Pulmonary Disease, 457

(especially where the patients complained of sinking at the
stomach, faintness, sensation of emptiness, and craving with¬
out appetite, and other symptoms indicative of a broken-
down constitution) after various other tonic and cordial
medicines had been made trial of in vain, or with very little
advantage ; and, febrile excitement being absent, and there
existing no signs of inflammation or congestion in any
quarter, I scarcely know of a remedy which I have found
more efficacious. In the cases to which 1 allude, it is sin¬
gularly grateful to the stomach. As Lewis has said, it
warms the liabit’’ — it imparts to the enfeebled frame a
vigour which other remedies are unable to supply. In a
word, the Peruvian balsam appears to me to merit more
attention than is commonly bestowed upon it at the present
day. I would strongly recommend it in dyspepsia and
general debility, and particularly would I recommend it in
cases of females whose constitutions have been broken down
by frequent child-bearing and hard labour, and in the uni¬
versal w'eakness which is the lot of advanced age.

I have usually exhibited the balsam of Peru made into
pills with powder of myrrh, giving from six to eight grains
of the mass thrice a day. Sometimes I have prescribed it
in tincture, according to the old Edinburgh formula for the
tinctura balsamica, combined with other tonic and cordial
medicines.

I here close this very imperfect report. That for the
remainder of the present year I mean to take in hand imme¬
diately. How soon I may be able to bring it to a conclusion
my various other occupations render it impossible for me to
say, and whether I shall claim for it the indulgence of the
public, must, of course, depend upon the judgment which
may be pronounced upon the essay which now appears before
its tribunal.

Canterbury, October 15th, 1823.

II.

On the Use of Digitalis Purpurea in Pulmonary Disease, with
Cases and Observations. By T. W. Wansbrough, Esq.
Fulham, Member of the Royal College of Surgeons.

I DO not presume to flatter myself that the medicinal
vegetable, on which I am about to treat, will receive a more
permanent rank than it formerly enjoyed as an important
remedy in phthisis pulnionalis through the humble instru-
mentafity of my individual observations or suggestions, yet I
shall be flattered by the event, should Practitioners arrive at

458

Original Communications.

any of my conclusions by the evidence of practical observa¬
tion ; and I cherish the hope that, viewing it as a medicine in
disorders of the lungs, its operation will eventually be rescued
from the obscurity and scepticism in which it is at present
involved.

The cases which I am about to adduce are intended to
convey a clear and circumstantial view of the modus exhi-
bendi et operandi of the digitalis purpurea, both in the
form of tincture and infusion, in pulmonic disease. I would
wish to show, by the regular and precise manner in which
the cases are detailed, that, in all affections of the lungs or
their investing membranes of an inflammatory nature, the
digitalis is a very valuable — indeed, an inestimable remedy.
I mean to say 1 have found it so ; yet it has failed in my
hands, in the earlier instances of my practice, when, from
enthusiasm, I saw not the difficulties which attended the
perfect development of its operation ; but subsequent obser¬
vation and experience have enabled me to perceive those
obstacles to success which are evinced by symptoms, and to
remedy the defect by removing the barriers that obstructed
my progress. The result of my experience I offer to the
indulgence of the Profession, in the expectation that the
remedy in question may receive that attention which it
deserves, and- be prescribed to an extent that may ensure
its appropriate operation on the system. j

The action of the digitalis on the circulation I have already
explained, as I conceive it to be, in tlfe l6ih Volume of the
Repository, page 23, as also its effects in diminishing the
morbidly-increased action in the extremities of the pulmonic
vessels, thereby cutting off the sole source and cause of
secretion, wliich, when once effected, the disease ceases to
exist. The action of digitalis can be said to have this effect
only in cases of incipient vomicae and tubercular disorders,
before that extensive destruction of the substance of the lungs
takes place, from the peculiar idiosyncrasy of the parts, the
predisposing cause being constitutional or hereditary, and from
the union ot several vomicae, which places the patient beyond
the power of human art. In those melancholy cases of far-
advanced disease, digitalis can be of no service ; yet having
arrested the progress of incipient ulceration of the lungs by
its means, I feel bold to say, that its exhibition requires but
promptness and vigour on the part of the Practitioner to
ensure success from it in the earlier stages of the disease.

Of the various divisions of pneumonia, I would humbly
submit, for the better elucidation of my views, the adoption
of two species only of the genus, viz. pleuritis and peri¬
pneumonia. By the former 1 would imlicate inflammation of

Mr. Wansbrough on Digitalis in Pulmonary Disease. 459

the pleuriB, and by the latter of the substance of the lungs : as,
ho vvever, in every case of inflamraation of > investing tissues,
the included organ is always sympathetically affected, and if
the acute symptoms be not speedily removed, the inflammation
extends to the structure of the organ iisell from its investing
membrane, so I consider that both forms of pneumonia may
be coexistent. In inflammation of the pleurae coslalis and'
pulmonalis extending to the substance of the lungs, the
aflection thus becomes compound; but in both cases the
treatment is the same during the acute stage : in fact, it
matters not whether the disease be peripneumonia, or simply
pleuritis, or both conjoined. The primary indications of cure
are the same, and the treatment must be similar in many
cases during the active stages of the disease at least.

The terminations of inflammation occurring in the struc¬
ture of the lungs, and in the pleura, should be always kept in
mind, and should influence our practice, especially in the
progress of the disease. We know that inflammation of the
structure of the lungs more readily ends in suppuration and
eft’usion, than inflammatory action of the pleura ; in the
former, also, we have sanguineous effusion as a frequent
consequence.

It is not always in the power of the medical Practitioner
to procure a fortunate termination of the inflammatory action
of the pulmonary structures by the lancet and antiphlogistic
regimen : the morbid action frequently continues, and runs
on into its next stage before he can arrest diseased impetus
of the circulation in the capillaries of the organ, or avert the
consequences of such morbid action, which is organic lesion.
Indeed, the more frequent terminations of inflammation in
the structure of the lungs, viz. effusion and suppuration, are
occasionally liastened, in some constitutions, by blood-letting
being carried too far, or relied on alone, to the neglect of
other means. It is in this stage of the disease that 1 would
call the attention of Practitioners to the efficacy of digitalis.
It is here, after having arrested the action* of the heart and
arteries, that a remedy is required to prevent the recurrence
of these symptoms, and to act specifically and permanently
on the capillary system of vessels : it is here that I have
experienced the decided efficacy of digitalis in subduing
inflammatory action, and in preventing its recurrence. By
thus keeping down the symptoms to the point obtained by
the lancet, I have gained upon the disease, and ultimately put
a stop to its devastating influence, without the consequences
to which it otherwise would have inevitably led. It is only,
however, by a prompt and vigorous exhibition of the digitalis,
that this desirable end can be attained ; and it is in all such

460

Original Communications,

cases, when thus adtniriistered, that digitalis has proved to be
an inestimable auxiliary to depletion; and in such it cannot
be too earnestly recommended.

In cases of liigh excitement during the attack of pneu¬
monia, after unloading the vessels, I have been in the habit
of giving both the tincture and the infusion; but where the
case is critical, from the urgency of symptoms, I prefer the
latter. To children from ten to fifteen years of age I give
half an ounce of this every six hours ; and by watching the
case closely and attentively, the result will soon appear —
either the pulse will rise, showing the medicine of no effect,
or it will remain stationary, although it preserve its inflam¬
matory character. It has happened in my practice that the
tincture and the infusion have both failed ; but even their failure
is only a certain criterion of severe inflammatory action, and
not of the medicine’s inefficacy. Whenever the symptoms
have increased whilst exhibiting digitalis, subsequent to
blood-letting, I have found it an invariable indication that the
sthenic diathesis still existed, rendering the remedy useless ;
and upon farther reduction of the inflammatory action by the
lancet, the subsequent administration of the digitalis has
proved decidedly successful ; and in no one instance has it
failed to answer my expectations whenever the pulse inter¬
mitted, as in the case of Master Morice. In that instance
recovery was conspicuously rapid after I had produced an
intermittent pulse by the action of digitalis. There appears
to me, then, to be in this vegetable some peculiar property,
which can be exerted only during certain states of the san¬
guiferous system, and where these states do not exist, its
virtue is unavailing ; yet that they are to be detected, I am
convinced by the result of my experience : but this can be
done only by a close and attentive observation of symptoms,
and by administering the digitalis after each bleeding, and
continuing or increasing the dose, as circumstances may
require.

Where inflammation of the structure of the lungs, of
already formed tubercles, of the mucous surfaces, or of the
serous coverings, either of an acute or chronic character, has
gone on to suppuration or ulceration, the use of digitalis is of
great service; the necessity of its prompt exhibition having,
however, ceased in the subsidence of the primary and urgent
symptoms. When a small portion only of the lungs is
involved in the disease, the powers of the constitution are
occasionally sufficient to restore the parts, by ridding them
of the morbid secretion; but this must not be trusted to.
The digitalis should be employed, for it arrests the morbid
■action of the vessels whence the secretion is derived, and,

Mr. Wansbrough on Digitalis in Pulmonary Disease. 461

consequently, diminishes the quantity of matter. It some¬
times happens, when the formation of matter is commencing,
that digitalis has no effect on the symptoms, the disease goes
on uninterruptedly, and the patient expectorates pus, which
increases^ in quantity. In those cases there is corresponding
inflammatory action of the vessels themselves, which must be
reduced by blood-letting, until the intermittent pulse be pro¬
duced by the digitalis on its subsequent exhibition. It is
plain, therefore, that the digitalis is to be given where
inflammatory action is going on, after blood-letting has been
properly employed, and either before or subsequent to the
existence of suppuration ; and that the propriety of further
depletion is, in a great measure, indicated by the failure of
the remedy to produce its specific eflect upon the system,
in the first or second instance of employing it after the lancet
has been used.

The action of digitalis on the system appears to me to be
twofold : it restrains the action of the heart after vascular
depletion has been employed, the intermittent pulse which it
produces being an index of this mode of operation; and it
diminishes, or entirely extinguishes, morbidly increased action
in the extreme vessels of the part diseased, especially of the
pulmonic system of vessels, thereby cutting off the chief
source and cause of diseased secretion, which being effected,
the local disease ceases to exist. ^

It will be recollected that I am speaking chiefly with
reference to the species of pneumonia, and to incipient
phthisis arising either as a consequence of pneumonia, or of
bronchial inflammation. It may be proper to observe that I
have not drawn the inferences here laid down from isolated
cases; I have selected the most interesting and conclusive
for the present paper ; the whole details would far exceed the
limits of a journal.

The case of Miss Moat {case IsO elucidates the action of
digitalis on phthisis in the incipient stage, supervening to
haemoptoe, and accompanied with slight inflammatory action.

* As respects the doses of the tincture of digitalis which I am
usually in the habit of adopting, and which were always resorted to
in the following cases, unless otherwise specified, it may be proper to
keep in recollection, that I give ten drops the first dose, twenty the
second, thirty the third, and so on, increasing ten drops every dose
until I arrive at the quantity which produces either the intermittent
pulse, vertigo, or nausea; then, in either case, I return to the dose
with which I commenced, or to half the quantity of the last dose,
according as I suppose that the sanguiferous system may be reduced
still farther without disordering the stomach.

VOL. XX.— NO. 120. 3 o

462 Original Communications, / . .

The disease was subdued by the digitalis^ aided by one
bleeding. The progress of the case was clearly demon-
strative of the influence of the remedy over the disease.
The delicate structure of this patient had borne up beyond
my expectations during the haemopto'e and subsequent expec¬
toration, by means of the treatment with foxglove, to nearly a
perfect recovery, when exposure to cold induced peripneu-
mony, which the powers of the constitution and treatment
were unable to withstand. This case had all the appearance
of the last stage of consumption when the course of digitalis
was entered on. Her subsequent attack precluded hope.

Mrs. H.’s case (2d) bears a close analogy to the primary
symptoms of that of Miss Moat. The effect of the treatment
was decisive, and, had not very extensive disorganization
existed in the liver, I have no doubt that the termination
would have been favourable.

The case of Master Morecock {case 6th) exhibits the
influence of digitalis on the arterial system. Its termination
was unfortunate, but the symptoms clearly marked the degree
and extent of mischief proceeding in the substance of the
lungs, and I was not permitted to use the lancet a second
time in the last attack.

Mrs. C. (case 4th) evidently owes her life to the effect of
digitalis in checking the progress of suppuration before and
after the bleeding, until the powers of the constitution
rallied. Had she not taken the foxglove, I am satisfied that
repeated bleedings would have been necessary to subdue the
inflammation, and her delicate frame probably might have
sunk under the rigorous discipline which the nature of the
case demanded.

The case of Miss Clarke {case $d) is illustrative of the
efficacy of digitalis where suppuration had supervened, from
neglect of depletion, during the acute stage of pneumonia.
In this case the digitalis acted conspicuously, by producing
an intermittent pulse. I have not the least doubt (such was
the violence of the symptoms) that, had I not administered
the foxglove in this case, the number and extent of the
bleedings must have been increased to the hazard of the
patient, either by failing to subdue the inflammatory action,
or, had I succeeded in so doing, by inducing effusion. The
patient has recovered the perfect use of both lobes of the
lungs, and exhibits not a vestige of pectoral disease.

In the case of Master Alfred Wallis^ the efficacy of
digitalis was equally conspicuous after suppuration had taken
place. The intermittent pulse was produced in that case,

* Repository, Vol. XIV. p. 182.

Mr. Wansbrough on Digitalis in Pulmona7y Disease, 463

and the child recovered from that moment, although incipient
hydrocephalus existed at the same time. In Mason’s case,*
the medicine was beneficial after copious suppuration had
supervened. In the case of Mr. Barker f the digitalis had
no effect, although given to the extent of 300 drops in a
dose. That gentleman was in the last stage of phthisis. He
died in ten days after my first visit. There the foxglove
failed, from the great extent of organic lesion; yet I was
willing to witness whether any effect would be produced by
it in so advanced a stage of the disease.

The case of Mr. E. Colman (case Hth) shows the influence
of the remedy in arresting and keeping down the morbid
excitement. In this case the digitalis reduced the pulse
decidedly, and I was thereby enabled, by gaining time, to
combat the symptoms more e^fectuall3^

Master Morice’s case (3th) portrays the efficacy of the
digitalis in a very striking manner: as soon as the inter¬
mittent pulse was developed, the effect was decisive, as from
that time the patient recovered.

Case I.

Miss Moat, aged twenty-one, of tall slight figure and delicate
habit, was attacked with pertussis, whilst a resident in England, at
the age of sixteen ; a chronic cough succeeded, and continued for
two years. Her parents, in the hope that a residence at Madeira
would re-establish her health, sent her to that island, where she
experienced an attack of haemoptysis ; inflammation supervened,
which speedily terminated in suppuration; and the quantity of
expectorated matter soon became so abundant, that, after a three
months’ stay, it became necessary that she should return to England.

I was requested by her parents to see her, at Richmond, about a
fortnight after her return. Miss M. was at this time expectorating
nearly sixteen ounces in the tv;enty-four hours. She had been six
weeks on the passage from Madeira ; and it was a period of five
months from the original heemorrhage. She was removed from
Richmond to Fulham in a close carriage, at a walking pace, in order
that she might be under my more immediate observation. Notwith¬
standing the gentle conveyance that was observed, it was as much as
her debilitated frame could support.

On the following day, June 1st, the symptoms were as follow: —
Pulse lOO) hard and small; tongue moist and nearly natural;
bowels regular ; cough frequent, occurring about every half hour
or twenty minutes ; slight headach ; expectoration nearly sixteen
ounces (purulent matter, with mucus) in twenty-four hours; coun¬
tenance pale; cheeks slightly flushed; eyes clear; skin dry, but not
hot. The catamenia had been suspended six months. At twelve

Repository, Vol. XVI. p. 20.

t Ibid. Vol. XVI. p. 24.

46 i Original Communications.

o’clock I gave her five drops of the saturated tincture (as mentioned
in a former communication*) of digitalis. The menstruum was 3x.
of infusum roste.

2d, twelve, Noon. — The dose of digitalis has been increased five
drops every six hours. The last dose was twenty-four drops.

3d, six, P. M. — One hundred and fifty drops have been taken
(in toto). The last dose was forty-five drops. She has passed two
better nights.

4th, two, P. M. Complains of pain in the right hypochon-
drium, increased on respiration. V. S. ad jvj. The pain ceased
after the bleeding. At eight o’clock in the evening the pulse is at
88, softer and fuller; skin moist for the first time; pain quite
removed. The digitalis was increased in the same ratio until half-past
one, A. M. June 5th, when sickness and retching supervened, during
which she expectorated about four ounces, with about one part puru¬
lent matter. She has now taken two hundred and thirty drops of
the tincture in eighteen hours ; the last dose, at eight o’clock yester-
da}^ evening, was sixty-five drops. After the vomiting, she recom¬
menced, at two, P. M. with forty drops, 6tis horis. The bowels have
been acted on five times. She vomited again at half-past two.

At six o’clock this evening, June 5th, I find her pulse 100; nausea.
Nine o’clock, pulse the same ; nausea increased.

6th, noon. — Has not expectorated during the night ; very
sick; vomited a little matter this morning; pulse 100, full. —
Two o’clock, nausea, headach, and pain in the hepatic region. She
took senna and salts this morning, which have operated, but produced
griping and vomiting. — Eight o’clock, considerably better; nausea
totally ceased ; pulse 96 ; skin moist. The purgative has operated
twice. There having been no expectoration during these two nights,
and a gradual decrease during the day, I suspended the digitalis,
which had been continued up to this period, making a total of three
hundred drops in twenty-six hours. The appearance and uniform
shape of the expectorations led me to infer that the matter proceeded
but from one vomica, or ulcerating cavity. Under this conviction, I
persevered in my mode of treatment, in the hope of producing a
health}^ action of that part of the substance of the lung affected, and
of the system generally.

7th. — She continues better ; pulse 88. - — Twelve o’clock, she took
3viij. inf. gent. co. — Eight o’clock, pulse 96. Tinct. digitalis,
g“. XX. The pulse fell to 88 in a few minutes after taking this
draught.

8th. — Pulse 86. Tinct. digital, g^q x. sextis horis.

9th.- — The pulse is 92, full and soft; expectoration much less;
appetite good, and strength increasing. Tinct. digitalis, g“. x, 6tis
horis, cum inf. rosse, 3x. ; syr. tolu. 3j.

13th. — Has continued improving. — Nine, P. M. pulse 88; has
taken forty-five drops of the tincture this day. The last draught

* See Repository, Vol. XVI. p. 24.

Mr. Wansbrough on Digitalis in Pulmonary Disease. 46.7

contained fifteen drops. The stomach now retains this dose without
inconvenience. She appears comparative!}^ well.

14th, eleven o’clock. — She complains of headach, pain at the
chest, and slight difficulty in breathing. She stood, last night, in a
cold room for some time, and afterwards felt much chilled, and
passed a restless night. Pulse 96, sharp, and vibratory. V'. S. Jiv.
She was much relieved after the bleeding. Sulph. magnes, 3iij. in
inf. rosce, 3x. ; also tinct. digitalis, g^*. x. 6'tis horis.

15th. — She is much better: the symptoms are nearly all re¬
moved; pulse 86, soft; blood slightly buffed.

17th. — She continues better to*day. The catamenia have ap¬
peared. — Cont. digitalis.

18th, 19th, and 20th. — Still better; pulse 82, soft and regular.
She walked a mile on the 20th, without fatigue. Her spirits are
excellent. The digitalis had been omitted these last three days. It was
again resumed, and sixty drops were taken on the 22d, and the same
quantity on the 23d. Ten drops were given on the morning of the
24th. Slight nausea had supervened the preceding evening. The
pulse remaining at 82, I discontinued the digitalis on the 24th, and
continued the infus. rosar. until June 30th, when she left Fulham and
returned to Richmond, so far recovered that she walked up the hill
without difficulty. Her appetite was good, and the expectoration
reduced to a mere trifle, from which she felt no annoyance.

In this state I left her at Richmond; but, unluckily, in the confi¬
dence of strength, she imprudently resisted the earnest representations
of her parents, and sat near a window six hours, pursuing her favourite
amusement, drawing, exposed to a current of damp air from the
North. The consequence was, that I was summoned to her the next
day, when, to my disappointment, I found her in a state of con¬
siderable distress, with great difficulty of breathing, a pulse of 120,
thirst, fever, and, in short, all the signs of most active inflammation
in the chest. I succeeded in reducing the urgent symptoms by
bleeding, and the tinct. digitalis, g*h xx. thrice daily; but, at the end
of a week, an abundant expectoration of pus supervened, her strength
sunk rapidly, and, about two months from this attack, she expired.

I have no doubt, could Miss M. have remained longer at
Fulham, that she would have completely and permanently
recovered ; but the air of Richmond was too bleak for the
delicate state of her lungs, and being left there too much to
her own guidance, she exerted herself beyond her strength,
and, by her imprudence, paved the way for her premature
dissolution. I could not examine the body.

Case H.

Mr. D. H. short and stout, short neck, full habit, and highly
plethoric, was attended by me, seven years ago, in a severe attack of
acute hepatitis, which terminated in the chronic stage. The violence
of the attack, ^nd the rigorous depletions he underwent, but just
saved his life, and he did not regain his health for six months. Three
months after the commencement of roy attendance, he complained of

466

Original Communieaiions.

a fixed, deep-seated, pain, exactly in that part of the liver immediately
under the scrobiculus cordis. Suspecting the existence of incipient
tubercles, I employed counter-irritation by blisters and tartar emetic
ointment successively, and he took five grains of blue pill on alternate
nights, for two months, when, finding himself considerably better, he
discontinued all medicine and resumed his avocations, occasionally
complaining of pain in the liver. Having been a sailor in his youth,
he was very fond of “ grog.’’ In this favourite beverage he indulged
most freely, and I was frequently called upon to remove the effects of
this “ powerful stimulus.” The powers of the stomach were totally
destroyed, he lost all disposition for food of every description, and,
from the debilitated state to which he had reduced this organ, an
attack of retching assailed him every morning, and to remove it he
had always recourse to the brandy bottle. In this course he con¬
tinued, drinking indiscriminately gin, brandy, porter, wine, and
cordials. He could not bear pressure on the region of the liver,
where he said the old pain” remained. During this state of system
he caught cold ; inflammation succeeded, which he nursed with his
favourite recipe, until his respiration became much oppressed, and a
violent cough supervened.

In the month of March last he suffered an attack of haemoptoe,
which was induced by a paroxysm of coughing. The hsemorrhage at
the time was profuse ; he, however, withstood it, and w'ent on for a
fortnight after spitting mouthfuls of blood, still continuing his
spirituous potations, till the 14th April, when, alarmed at the con¬
tinuance of the hsemoptoe, he yielded to the entreaty of his wife and
friends, and submitted to have advice.

On the evening of the 14th April I found him with a pulse at
120, full and bounding ; tongue furred: eyes languid; countenance
distressed ; respiration exceedingly oppressed. He had taken no
nourishment for some days, but he had not refrained from spirits.

I took sixteen ounces of blood in a full stream from a large orifice,
and ordered a brisk purgative. He fainted after the bleeding, and
the pulse was reduced in calibre, but not in quickness.

15th, ten, A. M. — Has passed a quiet night, but has not slept;
pulse 100, full and bounding as yesterday. Considering this a good
opportunity to give the digitalis a fair trial, I ordered the dose to be
increased ten drops every six hours. I had strictly urged the necessity
of absolute quietude and rest, but he would get up, dress himself, and,
in his boots, come down stairs. This exertion increased the haemor¬
rhage, and, at six o’clock in the evening, the symptoms being nearly as
urgent as on the preceding day, I determined on repeating the bleed¬
ing to the same extent as before ; and as syncope did not supervene,

I took twenty-four ounces, which he bore very well. Immediately
after my departure, I was summoned to him in great haste. In a
violent paroxysm of coughing, the hsemorrhage from the lungs had
returned, and, on my arrival, he was bleeding profusely. The pulse
was lowered considerably in volume, but retained its velocity. I
directed one grain ceruss. acet. and twenty drops of laudanum to be
given, with thirty drops of digitalis, every four hours.

Mr. Wansbrough on Digitalis in Pulmonary Disease. 467

l6th. — Haemorrhage decreased; pulse 100, fuller; respiration
freer ; the bowels have been opened three times ; cough urgent. He
complains of a fixed irritation in the trachea ; thirst excessive ; skin
hot and dry; tongue furred. — Tinct. digitalis, g^h xxx. 6tis horis ;
cum liq. amm. acet. Jss, ; syr. tolut. 3j.; et aq. purse, Jss. A blister
to the chest.

17th. — Symptoms abated; less fever; pulse QO, soft, hut full; no
sleep. — Extr. papav. alb. gr. x. h, s. sum.

18th. — 1 found him down stairs and dressed, though with much
difficulty, and obliged to be assisted ! I remonstrated with him upon
thus rushing into destruction ; but he expressed his determination
that “ he would never say die whilst there was a shot in the locker f'
In this unfortunate dilemma, struggling against wind and tide, I
resisted the progress of the hsemorrhage by a regular exhibition of
the digitalis until the 12th of May, having discontinued the acet.
plumbi after the first dose, when an accession of inflammatory
symptoms compelled me to have recourse again to the lancet, ta
which, with difficulty, 1 gained his consent. For some days pre¬
viously to this bleeding I frequently observed an increase of pulse, for
which I could account on no other principle than that he had taken
his favourite remedy. I ascertained this actually to be the fact ; his
wife confessed that she could not keep him from it. After having
bled him to the amount of sixteen ounces, the pulse sunk to pb, and
I continued twenty drops of the digitalis every six hours.

On the Ipth, he was considerably better, and, in the grateful
impulse of the moment, I obtained a promise from him to abstain-
from brandy, provided that I allowed him a little wine and water j
but the mischief was done. The dormant disease of the liver now
began to develope itself. He could scarcely bear the pressure of the
bedclothes on the praecordia. The cough had now decreased, and I
observed pus mixed with the bloody sputum. I applied a blister to
the region of the liver, which relieved him very much, and persevered
with the digitalis regularly. The haemorrhage gradually subsided,
and, on the 20th of May, pus appeared in the expectoration.

21st. — In the course of the twenty-four hours he has expectorated
about four or five ounces of purulent mucus, without the appear¬
ance of blood; pulse 86, somewhat hard. Suppuration having now
commenced in the diseased part of the lungs, I continued the fox¬
glove, and increased the dose ten drops every six hours.

22d. — He has taken one hundred and twenty drops of the tincture
since last visit. Pulse 46, intermittent, for the first time, full, and
soft. The expectoration is diminished one-third. He is considerably
easier, and the pulmonary symptoms are subsiding ; but the hepatic
derangement is increasing, and the enlargement of the liver begins to
impede the action of the diaphragm. He has had tolerably good
nights lately, his appetite has improved, and he has overcome his
propensity fbr spirituous liquors for the last week. — Contin. g“. xv,
digitalis, 6tis horis.

23d. — Expectoration decreased to less than one-third ; no incon¬
venience now but debility and the uneasiness at the prrecordia.

468

Original Communications,

which is relieved by lying on the right side ; pulse 60, regular and
soft; takes nourishment; and, but for the state of liver, I could say
going on favourably.

24th. — Expectoration of pus has quite ceased ; a little mucus
only is now brought up. The region of the liver is very much
distended, and that organ is distinctly felt, very much enlarged, but
not so painful as before. The expectoration of mucus is very much
diminished.

25th. — The digitalis was discontinued, all pulmonary disease
having ceased. The state of the liver evinces that suppuration is
going on in it, probably in the seat of the former attack. A blister
was applied to the epigastric region, and, after the part was healed,
the unguent, antimon. tartarizat. was employed ; and although an
almost confluent crop of pustules followed the use of it, no effect was
produced on the state of the diseased viscus.

In this state things continued till the 30th of June, when a sudden
change appeared. The patient described a sensation being produced
in the part affected, as if something had given way.” In four-and-
twenty hours a conspicuous alteration appeared ; and on the 2d
July I found him very low and weak ; pulse smaller and quicker.
On the 3d he became delirious ; the pulse rose, and assumed an
irregular action ; the countenance became pallid ; sordes collected on
the lips and teeth. I had ordered port wine and brandy on the
previous day; of the former he took nearly a pint, and of the latter
two tablespoonsful ; I also prescribed decoct, cinchonee, but without
any expectation that he could be benefitted by medicine. Typhoid
symptoms increased, and he continued in a state of wandering
delirium, which frequently assumed the appearance of delirium
tremens, until the 26th, when he expired. The body became putrid
in a few hours, and, being not in the best health at the time, I was
unable to perform the dissection.

In this case there was neither nausea, headach, nor
vertigo, produced by the digitalis. The intermittent pulse
succeeded the employment of the medicine; and I have
little doubt of the patient’s recovery from the pulmonary
affection, had there not existed extensive hepatic disease ; I
might almost say he drank himself to death.

Case III.

Miss Clarke, aged nine, delicate from her birth, and frequently
subject to slight attacks of inflammation of the pleura and lungs,
from idiosyncrasy of system, which was always removed by leeches
and blisters, was attacked with pertussis in the beginning of April
last. The disease was suffered to run on till it produced inflamma¬
tion and expectoration. The urgency of the symptoms at last
alarmed the mother, and, on the 22d, I found the child labouring
under violent and frequent cough ; laborious inspiration ; a lanci¬
nating pain in the left hypochondrium ; a quick, vibrating pulse, at
JOO; a tongue coated with a white fur; eyes suffused, from the

Mr. Wansbrough on Uigitalis in Pulmonary Disease, 469

efforts in coughing; and headach. The expectorated matter was
about four ounces in the twenty-four hours. The expectoration
commenced about a fortnight ago, and has gradually increased to the
present quantity. V. S. ad 3vj. et haust. purgans instanter. Syncope
followed the bleeding, and the pulse sunk to 9^^* evening

the pulse rose again, the bowels having been well acted on by the
aperient. The blood was buffed and cupped. — R Inf. digi¬
talis, ^ss. ; mist, amygd.; liq. amm. acet. aa 3ij. M. Fiat haustus
btis horis sumendus.

23d, eleven, A. M. — She has vomited and expectorated to the
extent of four ounces during the night. The pulse is sunk to 80;
respiration much freer. To have barley-water only. — Cont. haust.
cum inf. digit, 3iij. 6tis horis.

24th. — Bowels have not acted since yesterday morning. Enema
purgans. — Nine o’clock, P. M. The enema has produced two eva¬
cuations, but without fsetor, and coloured green by the infusion.
The pulse has risen to 120, and is full and hard. — V. S. ad Jviij. in
three vessels. Cont. inf. digitalis, 3vj. 6tis horis.

25th. — Pulse 86 and softer ; expectoration lessened ; the blood
is highly buffed, and cupped in the two first vessels, but less in the
third. — Pergat.

26th. — Symptoms abated; expectorates more freely; pain con¬
tinues in the chest.

27th. — The pulse has risen beyond its former standard, being
120. The pain in the chest is increased, and attended with dyspnoea.
— V. S. Jviij. Emp. lyttre sterno. Haust. salinus cum tinct. digi¬
talis, g“. XX. XXX. et xl. 4tis horis.

28th. — lias passed a much better night; the pulse is sunk to 50,
and is intermittent and soft ; has taken ninety drops of tinct. digi¬
talis. The skin is covered with profuse perspiration. The expectora¬
tion is much decreased since last night; slight nausea; vertigo.
Upon strict inquiry, I learn from the mother that she has by no
means attended to the rules for regimen and diet which I laid down
to her. This accounts for the return of the inflammatory symptoms.
The blood drawn last evening is again buffed and cupped. I was
strongly disposed to bleed again, but my faith in the foxglove pre¬
vailed, and I resolved to continue it. The grand criterion of its
influence on the sanguiferous system being conspicuous in the inter¬
mittent pulse, I therefore continued the tincture, in doses of twenty
drops every six hours, in infus. rosae. — Nine o’clock, P. M. Pulse
full, soft, and regular, at 60, The expectoration has decreased to
less than one-half. Every symptom is favourable.

29th. — Continues to improve : allowed chicken-tea.

30th, May 1st and 2d. — During these days the recovery has been
astonishingly rapid. The expectoration has decreased daily, and the
pulse continued regular at 60, soft, and yielding to the pressure of
the finger. The tinct. digitalis has been continued every six hours,
in doses of twenty drops. ^Neither nausea, vertigo, or headach,
occurred after the exhibition of the first ninety drops, which pro¬
duced the intermittent pulse. 1 left her going on extremely well this

VOL. XX. — NO. 120. 3 P

470 Original Communications.

morning (ihe 2d May). I had desired the mother to withhold every*
other kind of food, save the chicken-broth, as ordered. In the evening
I found the child considerably worse than when I saw her in the
morning: my visit was accidental, as being in the neighbourhood,
and doubting the mother’s compliance with my strict injunctions, I
was induced to w'atch the case more rigidly. The pulse is again at
96; dyspnoea returned; cough and expectoration increased: the
digitalis has evidently failed. Convinced that some artificial stimulus
had been applied, I questioned the mother, threatening to leave the
case unless informed of the true cause of all the mischief. I learnt
that, finding the child so much better, and earnestly entreating to be
dressed, she complied with her wish, and allowed her to expose
herself to the damp and cold air ; and that she, moreover, had
crammed her with stimulating articles of food, &c. Conceiving that
the child could not recover this third attack, I resolved to act
decidedly, 1 took twelve ounces of blood from the arm, ordered an
aperient, and sixty drops of tinct. digitalis every four hours during
the night.

On the following morning, I was most agreeably surprised to find
the little sufferer better. The blood drawn last evening is buffed and
cupped in all the three vessels. She is much reduced, and has
vomited once durins: the nisht.

3d. — She has taken one hundred and twenty drops of the tincture
since my last visit; pulse 40, full, soft, and intermittent; profuse
diaphoresis. — Tinct. digitalis, xx. drops 6tis horis, in inf. rosse, 3x.

4th. — Better. 5th, 6'th, and 7th, improving rapidly; the inflam¬
matory symptoms have completely subsided ; the pulse has continued
at 65 since the 5th ; expectoration rapidly decreasing.

Not to tire the reader Avith the period of a month’s convalescence,
suffice it to say, that my little patient improved daily in a regular
and steady manner, continuing the infus. rosse, 3x. with tinct. digi¬
talis, g“. X. every six hours, from the 7th to the 10th, when she left
off medicine.

, The expectoration totally ceased on the 10th, when I allowed her
to take mutton broth, which gave place to mutton, beef, &c. ; and On
the 10th June her mother took her into the country, whence she has
returned hale and hearty, the lungs performing their function without
the slightest difficulty.

The quantity of digitalis taken by this child, from the 27th April
to the 10th of May, is as follows : —

April 27th, 9 drops ; 28th, 9O; 29th, SO; 30th, SO; May 1st, 80;
3d, 120; 4th, 80; 5tb, 80; 6'th, 80; 7th, 40; 8th, 40; 9th, 40;
being altogether QOO drops in twelve days. She had taken the
infusion in the early part of her illness.

Adverting to the increase of symptoms after a full meal, I
beg to observe, that observation has frequently shown me the
impropriety of permitting patients, in a convalescent state, to
eat heartily of any favourite food, especially of a nutritious or
stimulating quality. Nothing is more common than violent

Mr. VV'ansbroiigh on Digitalis in Pulnionarij Disease. 471

determination to the head or lungs by sudden repletion after
a copious loss of blood, vvlieiher from accidental hasmorrhage
or by the frequent use of the lancet. In this opinion I per¬
ceive that I am borne out by Dr. Piing, in his Principles of
Pathology. I cannot, therefore, too earnestly urge the
strenuous prohibition, by the Practitioner, of any approach
to a full meal” in such cases.

Case IV".

Mrs. C. a lady of delicate habit, who generally possessed good
health, was attacked with symptoms of peripneumonia on the 3d of
March in the present year. She refused to be bled or blistered ; I
could, therefore, only assuage the symptoms b)’ purgatives, salines,
expectorants, and the antiphlogistic regimen. In the course of six
days expectoration commenced; and on the morning of the 9th of
March I commenced the exhibition of the tincture of digitalis every
six hours, beginning with five drops, and increasing five each dose.

10th. — Pulse 9d, small and vibratory. Cough is increased. She
expectorates about an ounce in the twenty-four hours, and complains
of nausea. In the evening she vomited, and about the same time
brought up from the chest about 3iij. of mucus with pus. Pulse
reduced to 7-5, full ; skin covered with perspiration. She is obliged
to go to bed, for the first time, having kept up against the disease
since its commencement.

11th. — Has passed an unquiet night from the cough; has satu¬
rated two handkerchiefs during the night with the expectoration,
consisting of viscid mucus with pus. Pulse 90? vibratory and small.

1 again urged the propriety of bleeding, which she decidedly refused.

- — Cont. tinct. digitalis, g“. x. 6tis horis, in haustu salino.

12th. — Much the same as yesterday.

13th, 14th, and 15th. — In the same state. The expectoration is
rather on the decline, and the strength increased, although the pulse
is at 90, and full.

l6th. — Better. As the digitalis has not affected the stomach, it
is to be continued at present, i. e. g‘h x. 6tis horis, in inf. rosar. ^x.
The appetite is improved, and the patient sits up.

18th, 19th, 20th, and 22d. — During these days a gradual im¬
provement has been perceptible. I allowed her to eat fish and light
pudding, and ordered strict confinement within doors in a tempera¬
ture at about OO, the respiration appearing freer in that medium’.
Expectoration to-day, 22d, about ^j. in the twenty-four hours.

23d. — She caught cold yesterday by accidental exposure in a
state of perspiration. The symptoms this morning are considerably
aggravated: pulse 96, full and vibrating; skin hot; tongue furred ;
lancinating pain in the left hypochondriura ; expectoration much
increased since yesterday ; has passed a sleepless night.

Through the persuasions of an eminent medical character, who
was summoned on this emergency, the patient submitted to be
bled. Ten ounces were abstracted, when the pulse sunk to 7O;
deliquium supervened when the arm was bandaged. On recovery the

47S Original Communications.

pulse rose to 75, but it had lost its vibratory character. My able
coadjutor, agreeing with me in my warm recommendation of the fox¬
glove, permitted me to continue it in doses of ten drops every six hours.

24th. — Pulse bo, soft and full; skin moist; has passed a quiet
night from the cough ; the expectoration about Jij. The pain in the
side continuing last evening, although much abated, a‘ blister was
applied. — Pergat.

31st. — During the last seven days a conspicuous amendment has
gradually appeared : the expectoration is decreased to less than an
ounce in the twenty-four hours. I have had several opportunities of
judging, in this case, of the size of the vomica, or inflamed portion of
lung, by the form of the expectoration, which has gradually dimi¬
nished, as in the former cases, down to the size of a small bean, being
one-fourth its original size. The pulse has continued steadily at 6'0,
full and soft. A gradual accession of strength enables the patient
now to leave her bed. I allowed her to take fish and light pudding,
and to drink soda water and milk.

April bth. — The expectoration has totally ceased this day. —
Omittatur digitalis, et cont. inf. rosar. ^iss. ter in die. She was
allowed to take a glass of claret.

13th. — Continued well all this week. She was directed to wear
flannel next the skin. The medicine was continued till the 17th,
when a journey was proposed to Cheltenham. A month’s residence
there has perfectly re-established her health, and she has returned
quite well, *

, Case V.

On the 25th October, 1822, I was summoned to attend Master
Morice, aged ten years. The symptoms were tension and pain at the
chest ; difficulty of breathing ; cough and expectoration of mucus ;
pulse vibratory ; skin hot and dry. There w'as an

unnatural fulness of the eye, and prominence of the frontal and
parietal bones, which indicated the existence of a disposition to
chronic cerebral disease. The mother informed me that from his
infancy there had been such a conspicuous listlessness about the
child, that her medical attendant feared the brain was under the
influence of incipient disease. This conclusion, it appeared, arose
out of an attack of fever with cerebral congestion, from which the
child was, with difficulty, restored, f With these data before me, my
primary object was to prevent the contents of the "cranium from
participating in the present disease. As a primary indication, there¬
fore, 1 detracted blood from the temples by leeches, and from the arm
by the lancet ; thus endeavouring to secure the sensorium locally,
and the system generally. — Haust. aperiens statim.

* The subject of this case continues perfectly well up to the date
of this paper.

f It is very probable that aqueous effusion, had taken place into
the ventricles during the advanced stage of the fever, which effusion
had remained unabsorbed, and given rise to the phenomena mentioned
by Mr. Wansbrough. — Editors.

Mr. Wansbrough on Digitalis in Fulmonary Disease. 475

October 2bth. — The symptoms are unabated ; the blood drawn
from the arm is buffed and cupped. — Tinct. digitalis, g*h v. 4tis
horis. Repetatur haust. aperiens.

27th. — Difficulty of breathing slightly relieved; pulse 86 and
vibrating. — V. S. ad Jvj. Cont. tinct. digitalis, g‘h x. 6tis horis.
Emplast. lyttse sterno admoveatur.

2Sth. — Better ; cough increased; expectoration freer ; pulse 80;
has not lost the vibratory character; a little pain in the left side.

2pih. — In the same state. — Emp. lyttee lateri dolenti.

30th. — There has taken place an accession of symptoms during
the night. This morning the pulse is Q6, hard and tense ; dyspnoea
increased; pain, which is very circumscribed, is transferred to the
left side, immediately under the fourth rib. The head aches this
morning, and the eyes are glassy and suffused with tears. Blister has
risen well. V. S. ad Jiij.

Evening. — The breathing is much relieved after the bleeding ;
pain in the side abated ; headach gone; pulse reduced to 80, and
softer, but still quick. — Tinct. digitalis, g‘h xx. btis horis.

31st. — Symptoms but slightly abated; expectorated during the
night about Jj. of mucus; pain in the side continues nearly the
same; the skin moist ; the bowels have been acted on twice during
the night by an aperient taken last evening ; the fseces were darker
than before, and very offensive. The antiphlogistic regimen has been
strictly enforced, yet the symptoms have resisted the treatment,

November 1st. — The pain in the side is increased with the
cough ; has expectorated during the night ; as before, the difficulty
ot breathing increased by the pain attendant on inspiration ; pulse 9b,
full, tense, and vibrating; bowels open; skin hot. V. S. ad Jvj.
When the pain ceased, syncope supervened, and the patient became
exhausted. The case thus going apparently from pleuritis to peri¬
pneumonia, I began to apprehend a termination in suppuration.
Under these circumstances I became more anxious to give the digi¬
talis a decisive trial, as in the former cases ; accordingly, as the
patient was taking twenty drops, btis horis, I ordered, in addition,
progressive doses of five drops.

2d, nine, A. M. — My little patient is much relieved since yester¬
day ; the pain in the side has nearly left him ; the pulse is at 70,
regular and steady ; but there still exists the inflammatory vibration,
though not sufficient to warrant vensesection. I suspended the lancet
this morning, in the hope that the progress of the mischief is arrested.
The last dose of digitalis was forty drops. — Pergat.

3d. — I am much disappointed this morning to find my patient
worse than when I left him last evening. The pain in the side is
increased, and with it the dyspnoea; the pulse has risen to 80; and
the system is distressed. Nothing appears now likely to arrest a
termination by suppuration, and I accused myself of suspending the
use of the lancet yesterday ; nevertheless it is clearly indicated this
morning. I therefore took from the arm six ounces, which reduced
the pulse immediately to 65 ; and rny patient experienced an almost
total remission of symptoms : the pain, however, returned in half an

474

Original Com munication ? .

hour after, but considerably abated. J resolved still to administer
the digitalis ; and as it had not as yet offended the stomach, I
continued the doses of the tincture as before.

4th. — The pain in the side continues, and extends to the sternum.
J applied a large blister to the chest, extending two inches below the
sternum. The pulse continues steadily at 6*5 since yesterday, and is
softer; the vibratory tense feel still remains in some degree, showing
that the acute symptoms have not yet subsided. I feel disposed to
give the foxglove in the form of tincture and infusion ; accordingly I
have ordered twenty drops to be taken every six hours, in 3ss. of the
infusion of the recent leaves gathered this autumn. The blister, I
expect, will operate as an excellent auxiliary in counteracting the
disposition to organic lesion in the lungs, while I gain upon the
sanguiferous system by the foxglove.

Vespere. — On entering the room this evening at eight o’clock^
just eleven hours after my last visit, the child appeared unusually
quiet. His eyes were half closed ; his face covered with gentle per¬
spiration ; the respiration was regular, and performed with much less
difficulty than I had previously noticed it. Fully expecting to find
the pulse much less, from the quantity of digitalis taken, which was
two doses since it was prescribed in the morning, viz, forty drops
of the tincture, and of the infusion, and from the large doses taken
on the preceding days, I was but little surprised to find the contrac¬
tions of the heart reduced to forty in a minute, and taking place at
such irregular periods that a second or two occasionally elapsed
between the beats. The blister has not risen, but the skin is
inflamed. I now felt so confident in the efficacy of the treatment,
that I hesitated not to give a decided prognostic of a favourable
termination, which the following morning verified. The digitalis was
omitted this night.

5th, Mane. — My patient appears cheerful. The symptoms are
entirely removed. The cough scarcely troubled him all night. Pulse
50, regular, soft, and yielding. I allowed him light nutritious diet.
To avoid unnecessary detail, I will only state that the digitalis was
now given in doses of five drops twice daily. The pulse remained
steadily at 50 for three weeks ; at the end of that time the patient
was considered perfectly well.

There does not appear at the present time (twelve months from the
attack) the slightest injury of the lungs from adhesion. The little
fellow has continued quite well ever since.

I cannot help thinking that I owed my failure, in the first
instance of the exhibition of the digitalis, to the age of the
tincture, it being made two years ; at all events, I am very
much inclined to doubt its effects in another case, unassisted
by the infusion. This latter I would always recommend when
the inflammatory action does not readily yield to the lancet.
In the first cases of pulmonary disease,* I found the

* Vide Repository, Vol. XVI.

Mr, Wansbrough on Digitalis in Pulmonary Disease. 475

tincture alone sufficient to affect the pulse ; the preparation
was then about a month old.

It is proper to observe here, that the case terminated
without any expectoration of pus whatever. — [N. B. The
appearance of cerebral affection, noticed in the commence¬
ment of this relation, has not been observable since his
recovery.]

Case VI.

On the 14th May, 1820, I was requested to see Master Morecock,
aged twelve years. He had taken cold, and was labouring under
difficult respiration and slight cough, with pain referred to the left
side. From the youth’s general appearance, I had not any reason to
apprehend any thing like a phthisical predisposition, being in pretty
good general health, save the pulmonary affection for which he was
to be treated. I took from the arm ^x. of blood in a full stream,
opened the bowels by an aperient draught, and prescribed anti-
monials and salines for ten days, the symptoms yielding daily;
but on the eleventh day cerebral congestion and headach rendered
cupping necessary. The operation was efficacious, and all the pre¬
vious symptoms yielded to the removal of the secondary disorder. I
could only trace, in this attack, inflammation of the pleura costalis
and pulmonalis.

The depletory treatment, with abstinence, was found sufficient to
the restoration of the patient, and therefore digitalis was not used.
The lad was removed to Highgate, where he was placed at school
during the succeeding spring and summer, and returned to this
place apparently well in the autumn. He continued in good health
until the following summer, when, on the 8th of June, 1822, he was
attacked with decided symptoms of peripneumonia. The pain, which
was deep-seated, was now referred to the chest; pulse 100 and
sharp; respiration checked ere the lungs were inflated to half their
area. I bled him in the arm, and ordered twenty drops of tinctura
digitalis 6tis horis. The bowels were acted on at the same time by
a brisk cathartic.

9th. — Breathing freer; pain less; blood highly buffed and
cupped ; has had six motions ; pulse regular and softer ; slight
headach. — Pergat in usu digitalis, g‘k xv. 6tis horis.

10th. — No headach; pain nearly gone ; breathing freer.

11th and 12th. — Better; no pain; pulse 70, soft; bowels
regular; breathing free.

13th. — Convalescent. Medicine was left off, and light diet ordered*

On the 4th of November I saw him again, after he had come
home, in consequence of a return of his former complaints. His
pulse was 120, quick and vibrating. The difficulty of breathing
was greater than ever, and the pain of the left side more violent
than before. Bleeding was proposed, but rejected ; and, in the hope
of reducing the action of the heart, I gave him the tincture of
digitalis in doses of fifteen drops, 6tis horis, for nine days, occasionally
evacuating the bowels, and enforcing the antiphlogistic regimen

476 Original Communications.

during' that period. The symptoms, however, gained gr6und, and,
on the 9th November, he consented to be bled. I took from his arm
twelve ounces in a full stream. He was sensibly relieved by the deple¬
tion, and I followed up the exhibition of the foxglove with the infusion
in the dose of ^ss. with fifteen drops of the tincture, every six hours.

10th. -—The symptoms are much abated; slight cough to-day;
expectorated a little mucus. The pain in the left side now extends
to the sternum. — Emp. lyttse sterno applicetur. Cont. digitalis in
haustu salino, 6lis horis. The pulse to-day is 100. The tongue,
which has been covered with a white fur, is now becoming red at the
point and edges.

11th. — The blister has risen well; the pain in the chest is
abated, but still remains in the side; pulse 9^) still vibrating. I
wished to bleed again, as it is evident the inflammatory action is
beyond the reach of the digitalis, having now taken two hundred and
forty drops of digitalis, and ^vj. of the infusion. My proposition
was rejected, and 1 declared that phthisis would inevitably supervene.

12th, 13th, and 14th. — The difficulty of breathing and cough have
increased with the pain in the chest these three last days. The
patient is evidently much distressed. The pulse is now 96, hard,
tense, and vibrating. I requested that the opinion of some respectable
Physician should be taken relative to the propriety of bleeding, which
is so much objected to.

On the 15th he showed no symptom of amendment. He had
taken, during this attack, with scarcely any effect, save as a diuretic,
four hundred and eighty drops of the tincture of digitalis, and fourteen
ounces of the infusion. In the full conviction that the efficacy of the
remedy was suspended by the inflammatory action going on unin¬
terruptedly in the lungs, I again urged the necessity of a bleeding.
He was taken to London without my knowledge; and, thus uncivilly
treated, I saw no more of him until early in the month of May last,
when I was again requested to attend him. I found him with a
pulse at 130, small and vibrating, with great oppression at the
praecordia, cough, attended with difficult expectoration of a little
viscid mucus and some pus. I suggested bleeding again, as a
forlorn hope, which was again resisted, but was allowed to try the
foxglove. Willing to ascertain how much the stomach would bear, I
commenced with twenty drops, and increased five every six hours.
In the course of forty-eight hours he had taken three hundred and
fifty drops, the last dose being eighty. Slight nausea and vertigo
were produced, but the pulse continued nearly the same, with the
exception of being a little fuller. . . .

Once more, and for the last time, I wished to bleed him, but was
finally, prevented ; and the next day the patient was taken to another
Practitioner in London, who pronounced his lungs sound, and
declared the case to be mesenteric glandular disease ; of course pro¬
hibiting bleeding. This was on the 13th May. Here again I was
foiled. . This Practitioner recommended Margate for change of air,
whence he was soon compelled to return, owing to an attack of acute
diarrhoea.. A neighbouring Apothecary was now called in; but the

Mr. Wansbrough on Digitalis in Pulmonary Disease, 477

case becoming hopeless, opiates were given to relieve pain and procure
rest. I saw him during the last fortnight of his life. His extremities
were then oedematous, and the air passages were obstructed with
mucus. He died on the 13th of September.

Dissection. — I examined the body with the gentleman who
attended him during the latter part of his illness. The colon exhibited
the appearances of recent inflammation to the extent of twelve inches
of its ascending and transverse arch ; about the same extent of the
ileum presented a similar appearance. The mesenteric glands were
enlarged, particularly the clustre in the centre of the mesentery, and
near the vertebi^j. The substance of these glands was of a steatoma-
tous character, in an incipient stale. There was not any appear¬
ance of inflammation either within or external to them. The liver
was particularly healthy. The perfect state of this viscus warranted
the conclusion that the enlargement of the mesenteric glands' was not
of long continuance. The left pleurse costalis and pulmonalis adhered
so closely, that it was impossible to separate them without the use of
the knife, which accidentally wounded the lung, when there issued a
stream of matter, which flowed into the cavity of the chest. On
examining the substance of the lung, a large cavity was laid open to
view, whence the matter had flowed. We could not discover any
communication with the bronchise, the abscess being walled in by
the cellular substance of the lung in an indurated stale, to the extent
of a line in thickness. The contents of the abscess might have been,
as near as we could form an idea, about four ounces. The right
lung was perfectly sound.

I beg to be understood, in my explanation of the action of
the foxglove in inflammation, that, beyond a certain inflam¬
matory excitement of the sanguiferous system, it possesses
no influence; but reduce the arterial action by blood-letting,
and then exhibit the remedy, it will often arrest the further
progress of inflammation and consequent suppuration. The
dissection of this case shows how far I was right in urging, to
my ow'n injury, at the time, the treatment which I did.

Case VII.

Mr. E. C. aged twenty-one, six feet high, of delicate frame and
nervous temperament, was attacked with symptoms of decided peri¬
pneumonia. A slight cough, without expectoration, which had con¬
tinued for nearly a fortnight, first alarmed him, and loss of strength
and appetite followed. His pulse was full and bounding, at 100;
the pain in the side, of which he had at first complained, now
affected his respiration ; and his rest was so much disturbed by the
cough, as to keep him awake nearly the whole night. I bled him to
the amount of twelve ounces, which produced syncope, ordered a
brisk aperient, applied a blister to the chest, and consigned him to
the effect of digitalis, forty drops 6’tis horis. As his residence was at
a distance, I did not see him until the third day, when all the
symptoms were completely removed, and the pulse had become

VOL. XX. — JsO. 120. 3 Q

478

Origina I Communicatmis.

steady at 80. His appetite and strength returned in the course of a
week) and he resumed his avocations. Conceiving himself completely
recovered, he unfortunately became careless of a proper degree of
caution in guarding his delicate frame from the impression of cold :
a recurrence of symptoms consequently compelled him to summon
me to his residence. The necessity for depletion being conspicuously
urgent, I bled him to the extent of twelve ounces. He became,
faint, but remained sensible. As the bowels were regular, I began
with the mistura amygd. and forty drops of the tincture of digitalis
(recent) every six hours. The following day I found him very low ;
the symptoms had abated, but the inflammatory character of the
pulse remained as on the previous day. He had become exceedingly
faint after my departure, and continued very ill till four o’clock in
the morning. The blood drawn, in three separate vessels, exhibited
the inflammatory coat. As the foxglove had evidently not affected
the circulation, 1 wished to bleed again; but, as he was averse from
depletion, I therefore doubled the dose of the digitalis. The general
appearance of symptoms this morning, and the characteristic heredi¬
tary predisposition to pulmonary disease in the system, induced me
to give but a very unsatisfactory prognostic to his parents. The
succeeding day, however, I found my young friend in good spirits.
He had passed a better night, and had had some sound and refreshing
sleep. The pulse was now reduced to 60, soft, yielding, and regular:
though the intermittent character was absent, the general abatement
of urgent symptoms during the last twenty-four hours inspired me
with such sanguine hope, that I gave the friends of the patient a
more favourable prognosis, ^ss. of sulphate of magnesia was now
added to the mixture to keep the bowels soluble, the quantity of the
tincture was reduced to forty drops daily, and a small blister applied
to the chest as a counter-irritant, to check the progress of further
mischief. Thus, on the third day, 1 had the pleasure to pronounce
my patient decidedly better from the efficacy of foxglove.

On the fourth day Mr. C. had no complaint save debility, the
pulse sunk to 50, and the powers of the stomach were returning. In
the course of ten days, that is, a fortnight after the attack, he rode
out in his carriage, clothed in flannel, which he had never before
worn. He is now perfectly well. I commenced my second attendance
on him upon the 27th September, the day on which he was blooded,
and my last visit was on the 2d of October. The progress of the
symptoms was so continuous, and the period of the attack so short,
that I have avoided the form of dates, keeping the reader’s mind on the
diurnal routine, which of itself is in this case sufficiently explanatory.

I have published the above cases from amongst a number,
in which I have employed the digitalis, because they illustrate
its efficacy and the causes of its failure, better than many
others in which, from the symptoms being less urgent, or
from the cases themselves being more recent, the operation
of the remedy might have appeared to many to have been
more equivocal than in these, ft will be observed that, in the

Mr. Sprague^s Pharmacological Remarks and Suggestions, 479

cases which I have just related, I have exhibited the digitalis
in larger and more frequent doses than usual ; but I have no
doubt' that it may be giveii^ in pulmonary disease even to a
greater extent than I have yet ventured to prescribe it, pro¬
vided the patient be closely watched.

1 have called attention to this remedy not from any idea
of novelty being connected with its use in diseases of the
lungs. We all know the encomiums which it has received,
in such cases, from Dr. Ferriar, Dr. Fowler, Dr. Beddoes,
and from Dr. Drake. I, however, think, that since the
period at which the praises of those Physicians brought it
into repute, it has fallen into very general and very unmerited
neglect. My object in the present paper, as I have before
stated, is to direct a greater share of attention to it in
pulmonary diseases than it has for some time past received,
and to show that it may be advantageously carried to a
greater extent in those maladies than it has hitherto been;
and hence to infer that the chief reasons of the discredit
into which it has fallen in the present era of medical science
are, the inefficient doses in which former trials of it were
made, the inattentive manner in vvhich its operation was
watched, and the neglect of depletion before its exhibition, as
well as a neglect of the repetition of depletion as indicated
by the effects of its exhibition.

Fulham, 30th September, 1823.

III.

Critical Remarks on the London Pharmacopoeia of 1809, and
the altered Edition of 1815; with Suggestions intended to
obviate the Objections made against attending to the Direc¬
tions contained in the Pharmacopoeia Collegii Regalis
Medicorum Londinensis submitted to the consideration of
that Learned Body^ and the Medical Prof ession in general.
By J. H. Sprague, Esq. Member of the Royal College
of Surgeons, London, and of the Medico-Anatomical
Society of Bristol, &c.

( Concluded from page 4 1 J,)

Preparations of Lead.

Liquor Plumbi Subacetatis, — Mr. A. T. Thomson ob¬
serves, that the London and Dublin Colleges err in naming
this preparation a subacetate, and that Berzilius is in the
same manner mistaken.’’ ** The acetic acid which the dis¬
tilled vinegar contains, in a highly diluted state, attracts a
portion of the oxyd of lead, and forms an acetate, which

480

Orieiual Comniumcatious. .

remains dissolved, Oiher chemists have also noticed this
preparation as incorrectly named, as it gives no indications oi
being a subsalt,’* Mr. Thomson also remarks, that the
proportion of litharge ordered in both formulae is too large ;
a gallon of distilled vinegar, of the specific gravity 1*007,
being capable of dissolving ten owices only of the oxyd. The
Dublin College orders but one pound of litharge to a gallon
of distilled vinegar, and it seems, from v^hat is above quoted^
that it should not exceed that quantity.

Medical uses, — The common use of the liquor plumbi
acetatis dilutus is too well known to need any description ;
but I believe it is not so generally known that the undiluted
liquor plumbi acetatis is a remedy of great value as an appli¬
cation to warts on the glans penis or prepuce, and in many
other anomalous excrescences. Mr. Brodie showed me some
time since a case in St. George’s Hospital, where a trouble¬
some excrescence on the nose was rapidly disappearing by
the application of this remedy. Dr. Vetch, in his valuable
work on Diseases of the Eye, observes, “ the liquor plumbi
acetatis, in its undiluted state, is the application which I can
recommend as the most efficacious in every stage of purulent
ophthalmia.” *

Liquor Plumbi Acetatis Dilutus (Formul, Extempor,) —
Dr. Paris remarks, in the fifth edition of the Pharmacologia,
‘‘ that the quantity of spirit ordered by the College is far too
small.’^ I believe the annexed formula will be found to be
in every respect preferable : —

R Liquor Plumbi Acetatis, f. 3j. ad 3ij.

Acidi Acetici Diluti, 3iij.

Spirit Rectificati, ^iss.

Aquse Distillatse, ^xiv. Misce, '

N.B.^ — The addition of ^dilute acetic acid holds the lead more
completely in solution than it otherwise would be.

Preparations of Zinc.

Zinci Sulphas, The white vitriol of commerce ought
never to be employed in medicine, as observed by Dr. Paris,
without previous purification. This ought to be attended to
in the next Pharmacopoeia.

Preparations of Sulphur.

Potassa Sulphuretum, — Mr. Thomson has very justly re¬
marked, that this sulphuret cannot be found in the manner
ordered by the College. For to render the combination
complete, it is necessary to expose the subcarbonate of potass

* Vide Vetch on Diseases of the Eye, pp. 205 and 212. London,
1820. .

Mr. Sprague’s Pharmacological Remarks and Suggestions. 48 1

in a crucible to a red heat previously to its being rubbed
with the sulphur: the water of the subcarbonate is thus dissi¬
pated, and at the same time a portion of the carbonic acid is
expelled, both of which, when not driven off, alter the pro¬
duct. When the fusion is effected, the mixture is to be
poured upon a marble slab, and, as soon as it concretes, the
mass must be broken in pieces, and preserved in a closely-
stopped bottle.”

Distilled W^ater.

It has been observed by Mr. Thomson, that many of the
distilled waters, when long kept, undergo a species of decom¬
position, become sour, and a ropy viscid matter forms on
them. In order to prevent this, he recommends their redis¬
tillation in preference to the addition of the spirit ordered by
the College. In this recommendation I entirely concur,
because, in this way, the waters are obtained impregnated
chiefly with the essential oil of the plants, and with their
aromatic properties, without any of the feculent or saccharine
constituents, to which the decomposition in question is, in
my opinion, chiefly owing.

Infusions. — ( Formula Exterripor.)

Infusus Quassia, — Dr. Paris remarks, that the propor¬
tion of quassia directed for half a pint of water by the
London College is much too small ; for in order to obtain a
saturated infusion tw^o drams are required for that quantity of
water.”*

Infusus Rhei. — The above observations on the infusion of
quassia will equally apply to this infusion. There is too
small a quantity of the substance for the vehicle in which it
is infused ; a formula similar to that of the Edinburgh Col¬
lege would be preferable, or the following neat and efficacious
infusion, varied a little from the Geneva Pharmacopoeia: —

R Rhei Radicis concisse, Jss.

Aquae Ferventis, Oss.

Macera Radicem per horas duas in vase leviter clause, et cola ;
dein adde,

Sacchari Albissimi, 3ij.

Olei Menthse Viridis, g“. viij, solutas in

Spiritu Menthae Piperitse, 3j. Tunc misceantur.

Irfusus Rosa. — As none of the infusions can be kept any
length of time, without undergoing decomposition, the quan¬
tity of this infusion, ordered to be made at once by all the

* Vide Pharniacologia, Vol. II. p. 225.

482 Original Communications.

British Colleges, is much too large. The following propor¬
tions would be more uniform and less wasteful : —

R Rosse Gallicae Petalorum exsiccatorum, 3ij,

Aquae Ferventis, Oj.

Acidi Sulphuric! Diluti, 3ij.

Sacchari Purificati, 3vj.

N. B. — Pour the water on the rose petals in a covered earthen or
glass vessel, stirring them well under : after infusing for ten minutes,'
add the dilute sulphuric acid, then macerate again for twenty minutes
longer. Finally, strain the liquor, and add the sugar to it. If the
acid be added to the petals at first, as ordered by the London College,
they will be constringed, and not yield that beautiful colour for
which this infusion is so much admired : this may be satisfactorily
ascertained by experiment. As its virtues chiefly depend on the
acid, the proportion may be increased with much propriety.

Injusus Senna. — Dr. Paris justly observes, that thereTs
an unnecessary waste of senna in the London process. The
quantity of infusion directed to be made at one time is also
injudicious,’^ &c, * The subjoined is a very excellent and
agreeable formula

R Sennse Foliorum, Jss,

Coriandri Seminum Contus. 3j,

Extract! Glycyrrhizse, 3ij.

Aquae Ferventis, Oss.

Macera per horam in vase levit^r clause, et liquorem cola.

Dr. Cullen says, that coriander seeds infused with senna
more powerfully correct the odour and taste of the medicine
than any other aromatic, and are equally successful in obvi¬
ating costiveness, which senna is very apt to induce. The
correctness of this statement I have often proved in practice :
I have, however, added the ginger with advantage, as
directed by the College (using also the coriander seeds), to
the above formula, in flatulent colic, in phlegmatic and hypo¬
chondriacal temperaments, and when no inflammatory action
w’as going on.

Mucilages.

Mucilago Acacia. — The name of the species whence the
gum is obtained ought to be added to the appellation, and
specific directions given to strain the mucilage through linen,
as this gum is often mixed with impurities.

Decoctions.

Decoctum Cydonia requires the adjunct seminum to the
appellation.

* Pharmacologia, Vol. II. pp. 257, 258.

Mr. Sprague's Pharmacological Remarks and Suggestions. 483

Decoctum Lichenis. — The impropriety of using only the
generic name of the plant is here very obvious ; particularly
as another species of this extensive family, the lichen rocellaj
is now introduced into the Dublin Pharmacopoeia.

Decoctum Malvce Compositum. — The best method of
making this decoction is first to boil the dry mallows in
the water for a quarter of an hour, and infuse the chamomile
in it vi'hile hot ; as by boiling the essential oil of the flowers
is completely dissipated.

Decoctum Papaveris. — In preparing this decoction, the
seeds should be bruised with the capsules and retained, as
they yield a quantity of bland oil, which increases the emol¬
lient quality of the decoction. *

Decoctum Sarsaparilloe Compositum. — It should be parti¬
cularly^ noticed (if the present method for preparing this
decoction is retained by the College), that, by boiling the
sassafras with the other ingredients, its essential oil, in which
its virtues (if any) reside, is dissipated. A preferable metho^
would be to infuse it in the boiling decoction (after taking it
off the fire) until cold. Mr. Thomson judiciously observes,
“ As the whole of the active matter of the sarsaparilla root
resides in the cortical part, and can be extracted from this by
infimouy as w^ell as by decoction, there is no necessity for the
various macerations and boilings ordered by the Colleges,
which, in fact, injure the remedy.” This remark demands
attentive consideration. The subjoined formulae are pharma¬
ceutically correct; they contain all the qualities that the
sarsaparilla can impart to an aqueous menstruum, and are
prescribed by Mr. Brodie in preference to the decoction.

R Sarsaparillse Radicis concisaj et contusae, Siss.

Glycyrrhizae Radicis contusas, ^ss.

Coriandri Seminum contusse, 3ij.

Liquoris Potassse, 3j. (vel sine).

Aquae Ferventis, Oj.

Macera per horas xxiv. in vase leviter clauso, ct cola ; liquoris
colati sumat partem 3tiam ter quotidie.

VEL

Injusus Sarsaparilla Alkalinus.

R Sarsaparillce Radicis concisse et contusae, ^iv.

Glycyrrhizse Radicis contusae, ^j.

Liquoris Calcis, Oiv.

Macera per horas xxiv. in vase leviter clauso, saepe agitand.
et cola.

The above-named eminent Surgeon orders a pint of this

See Pharmacologia, Vol. II, p. 177*

484 Original Communications,

infusion to be taken daily, in divided doses, and he assures
me it is much more beneficial than any collegiate pre¬
paration.

As I shall not have another opportunity of directing the reader^s
attention to an excellent paper on “ the Comparative Virtues of dif¬
ferent Kinds of Sarsaparilla,” by Mr. J. Pope, alluded to at p. 408
of my former communication, 1 shall proceed to fulfil my promise,
by making some important extracts from it. That gentleman ob¬
serves, “ The varied success attendant on the use of sarsaparilla has
been owing, no doubt, to the various qualities of the root itself, and
the mode adopted for extracting its virtues ; and as long as medical
men are in theory divided as to what constitute the active properties
of this medicine, and the best methods of obtaining them, so long will
its efficacy be partial and unsatisfactory. A desire to rectify some
prevalent errors respecting sarsaparilla, and to establish the relative
value of the different kinds, has induced me to devote considerable
attention to the subject. The sarsaparilla imported into the London
market is generally distinguished as Lisbon, Honduras, and Vera
Cruz ; those being the ports from which it has usually been shipped.
Within the last three or four years, sarsaparilla has been brought
from Jamaica, and is generally supposed to be the produce of that
island. It differs much from the other kinds in appearance, and still
more in the extract it yields. It has a peculiar deep red external
coat, is of somewhat close texture, and, when cut longitudinally, that
part next the outer coat (which we designate as pith in the other
kinds) is found, more less, to be of a deep red colour. It was,
some time since, strongly recommended to the medical world by
Mr. Richard Battley, whose reputation as a pharmaceutical chemist
is well known, and who, by a number of very conclusive experi¬
ments, satisfactorily established its superiority. He has very
obligingly favoured me with the results of his experiments, which,
for the most part, fully confirm my own observations. He considers
it the growth of Jamaica, and has distinguished it by the term red
rete mucosum sarsaparillae, on account of its deep red colour, more
particularly of the inner bark. From a careful and minute exa¬
mination of all the kinds of sarsaparilla, it is satisfactorily proved,

“ That the whole medical efficacy of the plant resides in the bark,
and consists of pure extractive matter, of which the best of each kind
yields the largest quantity.

“ That the root, deprived of its cortical part, contains only pith
and tasteless woody fibre j yielding nothing but insoluble mucus,
and a very small proportion of extract, either by cold or hot infusion.

“ That the cortical part of sarsaparilla gives out nearly the whole
of its virtues by cold infusion in distilled water — very readily to
lime-water ^ or water slightly impregnated with caustic alkali (as in
the first formula), and that boiling distilled water extracts all its
virtues.

“ That by submitting the root, cut transversely, to the action of
steam or of distilled water, at a temperature somewhat below boiling.

Mr. Sprague^s Pharmacological Remarks and Suggestions. 485

an elegant soluble extract may be obtained, containing all the virtues
of the plant, not liable to, decomposition, and applicable to the various
purposes of extemporaneous prescription.

From what has been thus briefly stated, it is evident that by the
usual mode of treating sarsaparilla, is chiefly obtained a large pro¬
portion of insoluble, inefficacious matter ; that the kinds of root
usually selected contain only a small proportion of the active pro¬
perties of the plant, compared with the red, lately brought from
Jamaica, and which is decidedly the best we are at present acquainted,
with.” If what has been said will not induce the London College to
substitute the infusion of sarsaparilla for the present injudicious
decoction, I know nothing that will,

Decoctum Seriekce. — The addition of half an ounce of
liquorice root to this decoction covers the disagreeable pun¬
gency of the seneka, and renders it a more grateful medicine.

Decoctum. Quercus. — There appears to be a complete
oversight by the London College in regard to this decoction.
The oak-bark should have been ordered to be bruised, as,
without this is attended to, the water cannot sufficiently
penetrate the bark, so as fully to extract i|g qualities.

Extracts.

From what Dr. Paris has said, the extracts, as made bv
Mr. Barry, by evaporating in vacuo, deserve the attention of
the London College, as he remarks, principle is, with¬

out doubt, calculated to secure the active qualities of the
plant from those changes to which U is constantly liable
during the ordinary operation of inspissation. The extracts
thus prepared are certainly more powerful in their effects, and
some few of them appear also to possess properties which are
not to be distinguished in the extracts of commerce.’^ Surely,
after saying so much in favour of extracts so prepared, the
London College will give directions for conducting a process
similar to Mr. Barry’s. For additional information, see
Pharmacologia, Vol. II. p.

Extractum Cinchona, — The judicious observations of Dr.
Paris respecting this preparation will, it is to be hoped, be
attended to in the next edition of the Pharmacopoeia.

Extractum Colocynthidis Compositum, — For the sake of
brevity, I beg leave to refer the reader to the remarks of
Dr. Paris, on this extract, in the Pharmacologia, Yoi. I.
pp. 100, 101. He will there find sufficient reasons to induce
the College to restore the soap as in the preparation of a
former Pharmacopoeia. If this extract is still to be retained,
a process similar to that of the Dublin College is one of the
most unexceptionable. However, 1 am of opinion that a
preparation containing all the qualities of this extract in

VOL. XX, - iNO. 120. 3 R

486 Original Communicatians,

greater perfection, without being deteriorated by the more
complicated processes of the Colleges, is contained in the
. following pill mass, and it has the additional recommendation
of being made with much less trouble and expense, and I am
sure no person can presume to say that it does not contain
all the active qualities of the former.

Massa Pilulcd Colocynthidis Composita.

R Colocynthidis Pulpee, jss.

Aloes Spicatoe extract! Deri*

Scammonise Gummi-resin®, aa
Saponis Duri, 3ij.

Olei Caryophilli, 3j.

Aloe, scammonia, et colocynthis, pulpa in piilverem redigantur;
turn cum sapone atque oleo conterantur ; denique cum muci-
lagine acacim subigantur in massam.

Extractum Conii. — Dr. Paris speaks in the most favourable
terms of this extract as prepared by Mr. Barry ; and Dr.
Maton has found that the virtues of it are much increased by
including the seeds in its preparation.

Extractum Elaterii. — I’he improved process recommended
by Dr. Clutterbuck for producing the extract of elaterium,
as prepared by Messrs. Allen & Co. Plough Court, Lombard
Street, is deserving the adoption of the College.*

Extractum Humuii. — It has been remarked that, during
the evaporation of the decoction of the hops, the essential
oil is entirely dissipated, and the extract thereby deprived of
the most active property of the drug. As the virtue of the
extract is very doubtful, perhaps the London College will
think proper to reject it from the Pharmacopoeia, or order a
process that will secure, with more certainty, the essential
qualities of the hop.

Extractum Opii. — By the College process, the anodyne
property of the opium is so much diminished, that tioo grains
of the extract are only equal to one of the unpurified opium.
Being a superfluous preparation, it ought to be expunged
from the Pharmacopoeia. Genuine powder of crude opium
should always be kept in the shop; and if extemporaneously
formed into pills, with conserve of hips, is more to be
depended on than such an uncertain preparation as the
extract.

* See “ Observations on the Nature and Preparation of the
Elaterium,’^ published in the Repository, Vol. XII. No. 67; and
for further particulars concerning this substance, consult the Phar-
macologia, Vol. 11, pp. 201 — 208.

Mr. Sprague’s Pharmacological Remarks and Suggestions, 487

Mixtures. — ( Formula, Extempor.)

Mistura Camphora, — This mixture, as at present pre¬
pared, must be considered as water merely impregnated with
the taste and smell of the camphor; but the substance is not
sufficiently diffused through this menstruum to impart to it
any of its medical qualities. I would beg leave to suggest
the following method of preparing it : —

R Camphorse, 3j.

Spirit. Rectificati, ttlxx.

Magnesise Subcarbonatis, 9ij.

Sacchari Purificati, 3ij.

Aquse Distillatse Ferventis, Oj. M, ft. mistura.

The camphor is to be rubbed into a fine powder by means of the
spirit, then with the purified sugar and subcarbonate of magnesia, and
afterwards the boiling water is to be* added very gradually. The
mixture should be poured into a vessel, kept closely covered for two
hours, and strained several times through a piece of fine lint, placed
-in a funnel.

Remark, — By the subcarbonate of magnesia, the camphor
is rendered more divisible, and I think the water holds a
greater quantity of it in solution than by any other process.
At all events, the College formula is ver^^ objectionable, if
we expect to derive from it any of the medicinal effects of
the camphor ; and if not, wherefore is it ordered ?

Mistura Greta. — A much more convenient and expe¬
ditious method of preparing this mixture would be by the
College ordering a pow'der to be kept in the Shops for that
purpose, named pulvis cretateus, which will be placed among
the additional powders. The' mixture is to be made as
follows : —

Mistura Greta.

R Pulveris Cretacei, 3xj.

Aquee Distillatae, t

- Cinnamomi, aa Oss. Misce.

Ft. mistura cretae, cujus dentur fluidunc. ij. post singulas sedes
liquidas : urgentibus alvi dejectionibus sit pro potu communi.

The cinnamon water renders the mixture more grateful,
and takes off the disagreeable earthy taste of the chalk.

Mistura Guaiaci. — A general objection to a mixture of
guaiacum gum by patients is, that it produces a very
unpleasant burning sensation on the palate and in the oeso¬
phagus. Why then order cinnamon water, which increases
this effect, without in any respect promoting the efficacy of
the medicine? The subjoined is an agreeable and efficacious
formula.

488 Original Commurtications, - -

Mistura Gnaiaei Ammoniata,

R Guaiaci Gumrai resinae,

Pulveris Acaciae, aa 5ij.

Decocti Glycyrrhizae, Oss.

Liquoris xAmmonise Subcarbonatis, 3ijss.

Tere Guaiacum ct Pulv. Acaciae cum Liquore Amraoniae, el
gradatim adde Dccoctum.

Spirits.

Alcohol. — I agree with Mr. A. T. Thomson, who observes,
that the process of the Dublin College for obtaining alcohol
is to be preferred. For some valuable observations on the
subject, the reader is referred to the London Dispensatory,,
third edition, p. 778.

Ti NCTUKES.

Tinctura Aloes Composita. — The College having declared
that saffron possesses no medicinal virtues, and that it is only
employed for its colouring matter, why order so great a
quantity of this expensive article in a tincture which does not
require a colouring ingredient? By the addition of the
saffron, the expense of making a pint of this tincture is
increased homfour to ten shillings !

Tinctura Camphorce Composita. — A gentleman who, from
much experience, is acquainted with the public disapproba¬
tion expressed by the alteration made in this tincture^ ob¬
serves, ‘‘ The oil of anise-seed is said to have been omitted
on account of its disagreeable flavour^but to most persons it
is quite the reverse. There are Practitioners who believe
that they have administered the oil of anise-seed in cases of
asthma and chronic cough with advantage, and are inclined
to attribute much of the benefit produced by the paregoric
elixir of the former Pharmacopoeia, in such affections, to it.
By selling the compound tincture of camphor without the oil
of anise-seed, many retail chemists have very undeservedly
been censured for vending an inferior article ; and others
have been accused of not compounding old family recipes
correctly in consequence of the medicine not having the
usual flavour. As this tincture derives its virtues chiefly
from the opium, is not the old name tinctura opii camphorata
more proper than tinctura camphorae composita ? The colour,
taste, and smell, are quite sufficient to distinguish it from the
tincture of opium, which is the reason assigned by the College
for changing the name. The following pristine method of
making the paregoric elixir renders it a very agreeable
tincture, and I know it would be approved of in lieu of the
present tinctura camphoras composita.

Mr. Sprague’s Pharmacological Remarks and Suggestions, 489

Tinctura Opii Camphor at a, — (Sive Elixir Paregoricum

Pharma copccicd Pristin.)

R Camphorae, 9ij.

Opii Crud. in Pulv., Acidi Benzoici, aa

Olei Anisi, 3ss. Potass. Subcarbon. 3j.

Omnia in mortario simul optim^ terentur ; paulatim affunde
Spiritus Tenuioris, Oij. ; stent in digestione per dies septem,
vas subinde agitans ; turn adde Radix Glycyrrhizas incisae, ^iv*;
digere iterum per dies septem, et cola.

Tinctura Cinchonce Ammoniata. — There is reason to
believe that the cinchona is decomposed by the ammonia,
which renders it an incompatible combination;* and if the
ammonia is not incompatible, the tincture contains so small a
portion of the cinchona in solution, that it would be more
judicious to add an adequate dose of spirit, ammonia aromat,
to a decoction of cinchona and its compound or simple tinc¬
ture, in extemporaneous prescription. As a superfluous pre¬
paration, seldom prescribed, it may with propriety be ex¬
punged from the Pharmacopoeia.

Tinctura Cinchonce Composita, — Query. If the only use
of the saflfron and cochineal is to heighten or give colour to
medicinal preparations, why order such expensive articles in a
tincture in which their colouring matter is nearly, if not
entirely, lost V’ Beside, it is of great importance to hospitals
and other charitable institutions that the officinal formulae
of the College should be rendered as economical as possible.

Tinctura Humuli. — The whole of the menstruum will be
so completely absorbed by the dried hops, that it will require
a strong press to obtain two ounces of the tincture. By
employing the seeds of the hop, in the proportion of an ounce
to a pint of proof spirit, a tincture may be obtained strongly
impregnated with its medicinal virtues.’’

Tinctura Jalapw, — If the jalap be powdered as ordered
in the present formula, the tincture will be so thick that one-
half of the spirit will be lost by evaporation during the time
it will require to filter. The spirit w'ill not take up the active
matter of the quantity of jalap ordered in this tincture ; hence
there is an unnecessary waste in the London process.” The
following is a preferable method of making it : —

Tinctura Jalapcc,

R Jalapae Radices incisx^ ^vj.

Spiritus Tenuioris, Oij.

Macera per dies quatuordecim leni calore, et per chart, cola.

N. B. — Particular attention should be observed in ordering the
jalap root to be thinly sliced, not powdered.

* See Pharmacologia, Vol. II. p. 147.

490

Original Communications,

Wines.

Vinum Aloes, — This preparation may be very properly
superseded by the subjoined excellent combination, which
should be named vinum aloes alkalinum. Mr. Thomson ob¬
serves, Aloes are advantageously combined with alkalies ;
and in this state I have long been in the habit of employing
a wine, containing aloes and myrrh, in dyspepsia and chlo¬
rosis, and also in that affection of the mesenteric glands
of children which produces a tumid and tense abdomen.’’
The following is the formula I employ, which was copied,
with some modification, from a very old Pharmacopoeia, that
accidentally fell into my hands, but of the date of which I
have unfortunately preserved wo memorandum -

R Sodas Subcarbonatis, jiij.

Ammonias Carbonatis, 3ivss.

Myrrhee, 3vj.

Aloes extracti, 3vj.

Vini Albi {Sherry^ Anglice), f. Jxxiv.

Macera per dies septem et cola.

The dose is from one fluid dram to half a fluid ounce.

Vinum FeraM*.*— This preparation has fallen into disuse,
and should be removed to make room for the vinum colchici ;
the best method of preparing which is the following, which is
the formula introduced into Guy’s Hospital by the late Dr.
Marcet. The London College would be manifesting a
respect to the memory of one of the most eminent of their
members, by introducing it into the London Pharmacopoeia.

Vinum Colchici,

Take of the recent bulb of the Colchicum (raised in July or
August), sliced and bruised, twenty-six ounces.

Sherry Wine, twenty-four ounces.

Rectified Spirit, two ounces (fluid). Agitate the mixture twice
a-day for seven days, and then filter through paper for use.

N.B. — I have given an accurate translation of the prescription,
that no mistake may occur in making the above preparation, which I
consider of great importance to avoid.

Syrups.

Syrupus Althcecz, — This syrup very soon suffers sponta¬
neous decomposition, and what other medicinal purpose can
it answer than simple syrup \

Syrupus Aurantiorum, — This syrup contains the pleasant
flavour of the orange peel. Mr. Thomson says, “ A syrup
equally agreeable and efficacious may be made by adding
one ounce of tincture of orange peel to a pint of simple
syrup.”

Mr. Sprague’s Pharmacological Remarlcs and Suggestions, 491

Syrupus JAmonum et S, Mori are agreeable syrups for
acidulating decoction of barley and other drinks in febrile
diseases, and the latter also has the advantage of its colour.

Syrupus Papaveris, — It is much to be censured that in
making this preparation, the directions of the College are
seldom attended to, as, when properly prepared, this syrup
is a very useful anodyne ; but in consequence of the trouble
required in making it, it is seldom found genuine in the
shops. The subjoined is a formula employed by a very
respectable druggist; and if particular care is taken to obtain
the extract of poppies genuine, he assures me it answers
every purpose of the former, and does not so quickly run into
a state of fermentation.

R Extracti Papaveris veri (in vacuo prsep.), Jj.

Aquae Distillatse Ferventis, Oj.

Sacchari Purificati, Ibijss.

Dissolve the extract of poppies in the boiling distilled water, and
let it stand by for twelve hours, that the feculencies may subside;
then pour off the clear liquor, and add the sugar in the manner
directed for simple syrup.

Syrupus Senna, • — This syrup appears to be intended for
children ; but the simple infusion of senna, sweetened with
sugar and with the addition of a little milk, given in the
form of tea, is more willingly taken by them, and operates
with greater certainty.

Syrupus Tolutani. — This syrup imparts an agreeable
flavour to some medicines ; but an intelligent commentator
on the London Pharmacopoeia asks, If this quality is owing
to the benzoic acid of the balsam, why not direct it to be
made with a proportion of benzoic acid, instead of boiling an
ounce of balsam of Tolu in water, which will only impart to
it a few grains ?” Many druggists are in the habit of making
this syrup according to the subjoined formula : —

R Syrupi Simplicis, Oj.

Tincturse Balsami Tolutani,

The simple syrup is to be heated, and before it becomes quite cold,
the tincture is to be very gradually added, frequently stirring it.

It was for the purpose of making this syrup that I pro¬
posed an officinal formula for the tinctura balsami tolutani.

Syrupus Zingiheris is an useful adjunct to carminative
mixtures. *

Confections.

Confectio Rosa Canina. — The name given to this confec-

* Vide Mistura Rhodii in the Appendix.

492 ' "Original Comm'unkatioiis/ ' , ,,

tion is incorrect, as it is not a confection of the dog-rose, but
of the recent fruit called hips. It should therefore be altered
to confectio fructm rosae caninae, or, according to the
London Pharmacopoeia Londinensis 1745, confectio fructus
cynosbati.

Confectio Rutcd, — As this confection is so very seldom
prescribed, it is scarcely to be found in the shops. The
intention of the College in introducing it not being generally
known, it would be very desirable to have more explicit
directions for using it, or have it expunged from the Phar-
inacopoeia.

‘ Powders.

As these preparations are generally affected by the air and
light, all powders should be ordered by the College to be
kept in opaque or green glass bottles, and the directions of
the Dublin College strictly attended to.

Ptilvis Aloes Compositus. — Both the active substances in
this powder are ill adapted for such a form of preparation,
which is seldom ordered by judicious prescribers; and being
a very inelegant and nauseous medicine (for which we have
many convenient substitutes), it should be expunged from
the Pharmacopoeia.

Pulvis IpecacuanhcB Compositus ('Syn. Pulvis Doveri). —
The ipecacuan and opium are rendered a much more effica¬
cious medicine by the addition of nitrate of potass, than by
the combination of sulphate of potass, as ordered by the
London College. The following formula will be found, on
trial, deserving preference to any other : —

R Ipecacuanhae Radicis contritse, 3j.

Opii Crudi contriti, gr. xlv.

Potassse Nitratis, Sviij. et gr. xv.

Tere simiil, et fiat pulvis.

A scruple of this powder contains one grain and a half of opium,
two grains of ipecacuan, and sixteen grains and a half of nitrate of
potass.

Mr. A. T. Thomson writes in favour of such a composi¬
tion, a formula for which he has given in his Dispensatory,
third edition, p. 911, Appendix. Dr. Paris has also intro¬
duced a similar prescription in the Pharmacologia, Vol. I.
p. 595, formula 150. He intimates that the powder is most
powerfully diaphoretic on account of the nitre; and beside, by
making this alteration, it is rendered more analogous to the
original Dover’s powder. *

Pulvis Kino Compositus. — If the reader can make it con-

* Vide Pharmacologia, Vol. II. p. 359.

M r. Sprague’s Pharmacological Remarks and Suggestions. 493

venient to turn to the Pharmacologia, he will find it stated in
several places that catechu, as an astringent, is to be pre¬
ferred to kino, and to which opinion I can fully subscribe.
Why not then substitute the former for the latter?

Pills.

It has often been inquired, the composition as directed
under this head being kept in the mass, would not the addi¬
tion of the word massa be more appropriate than pilulse alone ?
viz. massa pilularum aloes compositarum, massa pilularuni
aloes cum myrrha, &c. “ In dividing pill-masses, it is'usual to
to add to them, and envelope them in, magnesia; where
calomel is present, a muriate of magnesia is formed, and it is
owing to this partial decomposition that the surface of the
pill exhibits a greenish hue : orris-root ought invariably to
be preferred to every other envelope, whenever mercurial
and other metallic preparations enter into the composition.”

Pilulac Hydrargyri, — If orris-root pow’der be substituted
for the liquorice in this preparation, the mass will be of a
smoother and better consistence, and not so liable to become
soft in damp weather, which is an objection that requires to
be obviated.

Pilulcc Hydrargyri Submuriatis Compo$itcB (Syn. Pilulcc
Pliimmeri). — The College formula is Jjable to the well-
founded objection mentioned in the Pharmacologia, Vol. L
p. 336; besides, on being kept for some time, it becomes of
so hard a consistence as to render it unfit for the formation
of pills. The following, varied from the Pharm. Gen. Dispens.
is in every respect preferable; —

R Hydrargyri Submuriatis, 3ss.

Antimonii Sulphured praecipitati, 3j.

Guaiaci Gummi Resinae contritae, 3ij.

Saponis, 3ss.

Olei Juniperi, gt*. xxx.

Theriac. Purificati* q. s. ut fiat massa, in pilulas sexa-
ginta dividenda.

Every ingredient in this mass is judiciously proportioned.
Each pill contains half a grain calomel, which is as much

* Molasses, or treacle, is peculiarly useful in the formation of
pill -masses for its preservative qualities. Dr. Paris informs us, that
treacle is the best constituent that can be selected for the purpose of
forming vegetable powders into pills, for it undergoes no decomposi¬
tion by time, but maintains a proper consistency, and preserves the
sensible qualities of the plant quite unimpaired for many years. He
says, ** From exp'eriments, which I have repeated with some care,
I am enabled to state, that the peculiar flavour of this liquid is
entirely removed by a simple process, which consists in diluting it

VOL. XX. — NO. 120. 3 s

494 Original Communimtions,

as many systems will be able to bear without irritating the
bowels — an effect that ought to be avoided when we wish
lo produce the appropriate influence of the pill on the
system.

Filulct Saponis cum Opio. — The mass prepared according
to the College formula is liable to the objection of crumbling
to pieces on being rolled out. The following coincides with
the intention of such a pill, and I think cannot but be pre¬
ferred on an unprejudiced comparison. I would suggest the
propriety of naming it

Massa Pilularum Anodynarum,

R Opii crudi in pulv. subtiliss. 3ss.

Extract! Hyosciami, 3jjss.

Saponis Duri,

Iridis Flor. pulv. aa 3j.

Contunde, ut fiat massa, in pilulas sexaginta sequales distribuenda.

N.B. — Ten grains of the mass contain one grain of opium andy?t;e
of the extract of henbane. The orris powder is added for the reasons
stated under the head pilulse hydrargyri and orris-root, in the
Appendix to the Materia Medica. The name mass. pil. anodyn.
will exclude the appearance of opium in the prescription, which,
from the aversion of some patients to it, should be attended to.

PiluleB Scilla Compositce. — -The ammoniacum which is
admitted into the College formula cannot be supposed to be
of the least use, as only two grains are contained in ten the
mass, more of which is seldom given for a dose. I therefore
consider that the following is more to be depended on, as
every ingredient acts in unison with the intention for which the
medicine is usually prescribed, and it makes an excellent mass.

R Scillee Radicis pnlveris,

Zingiberis Radicis pulveris, aa 3j.

Ipecacuanhse Radicis pulv. 3ss.

Saponis Duri, 3jss.

Olei Juniperi, g“. xxx.

Contunde, ut fiat massa, in pilulas sexaginta dividenda.

Animal Preparations.

Cornu Ustum, — Testae Praeparatae. — Vide observations on
these preparations in Thomson’s Dispensatory, third edition,
pp. 554, 555. For the judicious reasons there given, both these
might well be spared from the list of officinal preparations.

with an equal weight of water, and then boiling it with one-eighth
part of powdered charcoal for half an hour, when the liquor is to be
strained and reduced by gentle evaporation to a proper consistence.
This is what 1 mean by purified treacle, which should be kept in
every dispensary for the formation of pill-masses and electuaries.”

Mr. Sprague’s Pharmacological Remarks and Suggestiom. 495

Cerates.

In making cerates and ointments some precaution is neces¬
sary. Books commonly direct most of the ingredients to be
melted together at the same time; this, however, is a very
improper direction. That ingredient which melts with most
difficulty should first be melted alone, then the next most
difficult should be added, and so on, and lastly the oil. Thus,
in making the ceratum resinm, the resin is first to be melted,
then the wax, and, lastly, the oil is to be added. So also,
in the unguenttim picis liquidae, the mutton suet should first
be melted ; and when the tar is added, no more heat should
be used than is just sufficient to melt the tar.

Ceratum Plumbi Compositum. — The College cerate cannot
be made of a good colour, nor the liquor plumbi acetatis
combine well with the wax ; it might therefore be usefully
superseded by the following, which, of course, should be
placed in the list of ointments, and named . . j ,

Unguentum Plumbi Acetatis.

R Emplastri Plumbi, Jvj. ' *

Liquoris Plumbi Acetatis, f. JJss. '

Olei Olivae, f. ^ij.

Adipis, Jvj.

Liqua simul emplastrum et adipem, dein sensim adde liquorem
et oleum, lit fiat unguentum.

This is a neat and valuable preparation of lead, and renders
every other form of the kind quite superfluous. The College
would act judiciously in substituting it for the former inele¬
gant cerate and the ceratum plumbi superacetatis. •

Oi NTMENTS.

The pharmaceutical remarks under the head cerates wdll
equally apply to these preparations.

Unguentum Hydrargyri Nitratis (vel Unguentum Citrinum).
— It has been very correctly observed that this compound,
made according to the College formula, is much too hard to
be termed an ointment, or for the uses for .which it is em¬
ployed in surgery. There have been a great variety of
methods proposed by different persons for making this oint¬
ment ; but after a careful trial and comparison, I think the
following formula deserving the preference, if carefully pre¬
pared according to the directions : —

R Hydrargyri Purificati, Jj. ^

Acidi Nitrici, 5j- jpowdl.)

Adipis, ^iij. - '

Olei Olivae, f. Jvij. . • ■

Camphorse (Sp.-Rect.) pulv. 3jj.

496 Original Communications^

First, dissolve the quicksilver in the acid, dissolve likewise the
camphor in the olive-oil, and whilst the former is yet hot, mix both
of them with the prepared lard, previously melted, but beginning to
concrete by being exposed to the air.

Remark, — The addition of the metallic solution to the
melted lard should be gradual, and made in a broad flat
vessel, such as a basin, so as to expose a large surface to the
action of a current of air, while the stirring should be per¬
formed with an ivory spatula, and continued until the oint¬
ment be perfectly cold. When prepared in the above
manner, this ointment has a beautiful golden colour, and is
of the consistence of butter, which it retains if preserved in
closely-covered pots ; but when made without the camphor,
it becomes hard, brittle, and of a pale dirty yellow hue, and
marbled wdth green blotches.

Unguentum Sambuci. — The ointment kept in the shops
under this name is made by boiling bruised elder leaves in
lard until they are crisp, and is of a dark green colour. The
wordjlorum should not, therefore, have been omitted by the
College ; for if a Physician adopts the collegiate name, it is
very probable that the ointment of the leaves will be used in
the compounding of the prescription.’^

Unguentum Sulphuris et Unguentum Sulphuris Compositum,
— These ointments are generally objected to on account of
their disagreeable smell. It is therefore very desirable that
they should be cancelled, and the following more agreeable
and cleanly combination substituted in their stead. The
formula is taken from Dr. Bateman’s Treatise on Cutaneous
Diseases. It may very properly be denominated unguentum
anti'Scabies, which would be the means of preventing the
unpleasant name of sulphur appearing in a prescription : this
certainly, on many occasions, we find it requisite to avoid.

R Potassse Subcarbonatis, 3ss.

Aquse Rosee, f, 5j.

Hydrargyri Sulphured rubri, Sj.

Olei Bergamoti essentialis, Jss.

Sulphuris Sublimati,

Adipis Prseparati, aa ^xj.

Misce secundum artem et fiat Unguentum.

Liniments.

Ijinimentum Mruginis — This preparation is certainly most
improperly placed among the liniments, as its chemical com¬
position shows that it belongs to the acetic preparations ; it
should be placed amongst them in the next Pharmacopoeia,
and named oxymel cupri subaeetatis ; directions should also

Mr. Sprague^s Phatmiacological Remarks and Suggestions. 497

be given for preparing the subacetate of copper for medicinal
puiposes.

Jjinimentum Saponis Compositum. — It has been correctly
noticed, that “ if the solution of the soap be hastened by
maceration in a sand-bath, as at present ordered, the liniment
will coagulate on cooling, and will be too thick to keep in a
bottle with a narrow mouth : retail chemists do not therefore
employ heat in making this liniment.’’ The following is a
much preferable and an economical formula ; the latter con¬
sideration alone ought to induce the College to adopt it, or
one of a similar kind, for the benefit of public hospitals and
dispensaries, in which institutions economy in the making of
various preparations is of great importance. See the remarks
already made under tinctura aloes comp, et tinct. cinchon.
comp., which, if rendered less expensive, by rejecting all
superfluous ingredients, will receive universal approbation.

JLinimentum Saponis Compositum.

R Saponis Mollis, Jxij.

Camphorse in pulv. 5Jv.

Olei Origani (vel Rorismarini), f. Jj.

Spiritfls Tenuioris, Ojv.

Camphoram et oleum solve in spiritu, dein saponem adjice, et
leni calore digere donee liquetur.

ADDITIONAL REMARKS.

MATERIA MEDICA.

Bismuth, — The nitric acid dissolves bismuth with the greatest
rapidity and violence; at the same time that much heat is extricated,
and a large quantity of nitric oxyd escapes. The nitric solution of
bismuth, when diluted with water, renders that fluid of a milky white,
most of the metal falling down in the form of a white oxyd^ called
magistery of bismuth. This precipitation of the nitric solution, by
the addition of water, is the criterion by which bismuth is distin¬
guished from most other metals. For its valuable medicinal qualities,
vide Bismuthi Oxydum.

Rhatanice Radix (Syn. Ratanguiaf Rattaiiia, Krameria triandria).
— This is the root of the Krameria triandria^ a plant which is placed
by some Botanists in the natural order Leguminosse, and by others
in the Polygalese. It has been lately analysed by some chemists in
Germany, where it enjoys a very considerable reputation.

According to Trommsdorfl who analysed this plant in 1820, the
root consists of tannin, 42*5 ; gum, 17*5; matter analogous to
ulmine, * and which may be extracted by means of potash, 25;

* Ulmine is a vegetable principle lately recognised by the Conti¬
nental chemists as a constituent of some kinds of soil, of turf and

498 Original Communhations.

ligneous fibre, 15. The analysis of Vogel gave tannin, 40;
gum, 1.5; fecula, 0*5; ligneous fibre, 48; water and loss, 10.
Lastly, this astringent root was more recently examined by C. G,
Gmelin, who found it to contain, tannin, 38*3 ; saccharine matter,
6*7 ; mucilage deprived of azote, and which may be extracted by
warm water, 8*3; mucilage charged with azote, extracted by cold
water, 2*5 ; ligneous fibre, with carbonate and sulphate of lime, with
silica, &:c. 43*3 ; loss, 0*9.

It has been said by the Practitioner to whom the Profession is
principally indebted for making it known in this country, that this
root is known in Peru, from which it is imported, under the names of
rhatania and rhatanguia. “ It seems evidently the root of a shrub,
and, in external appearance, resembles the rubia tinctorum more
nearly than any other substance with which we are acquainted.
Though introduced but a few years in this country, it has been for
many years collected in the district of Lima for the use of Portuguese
merchants, and employed by them for the purposes of improving the
colour, astringency, and richness of red wine. The part in which the
medical qualities reside is of the size of a goose’s quill, which ramify
in the same manner as the madder root; the cortical part, in which
its sensible qualities predominate, is very thick, breaks short, and is
resinous. The ligneous part is tough and fibrous, and somewhat
mucilaginous. Sensible qualities, — On being slightly masticated,
the root discovers a very grateful astringency, which leaves a lasting
impression oii the palate, and is slightly aromatic and bitter, and
very productive of extractive matter. These qualities are imparted,
as well as its colouring matter, both to cold and boiling water, and to
proof spirit. From the sensible qualities of this root, and its consti¬
tuent principles, discovered by chemical investigation, its power as a
tonic medicine, independent of any other proof, will stand evinced to
every discerning Practitioner.” And I am desirous of stating, that
that celebrated teacher of medicine in Guy’s Hospital, the late Dr.
James Curry, informed me that he found its tincture exceedingly
efficacious in diarrhoea, and preferred it to catechu, as being a more
agreeable astringent than any contained in the London Pharma¬
copoeia. He also considered it very efficacious as a tonic : but, like
many other valuable medicines, its virtues have not met with that
discriminative attention it deserves. See infus. rhatanise, tinctura
rhatanise, tinctura rhatanise aromatica.

Officinal Preparations.

Acidum Aceticum. — In allusion to this article, I consider it of
importance to make this additional remark, that there would be much
propriety in the London College giving a formula for preparing con-

decayed vegetable substances, of bituminous wood, and of the bark of
many trees. It appears to form during vegetable putrefaction, and
from the action of alkalies on the ligneous fibre: in this case it must
be considered more as a product of the analysis than a constituent of
the vegetable.

Mr. Sprague’s Pharmacological Remarks and Suggestions. 499

centrated acetic acid, not merely as the basis of the acidum aceticum
dilutum, but also for its other valuable medical properties and uses.
Mr. A. T. Thomson observes, “ Acetic acid is stimulant and rube¬
facient. It is principally employed as a refreshing scent in syncope,
asphyxia, and nervous headachs ; and for obviating the unpleasant
smell of the confined air of crowded assemblies and of the sick-room.
It is also an excellent application to warts and corns, which it
seldom fails to remove; but in applying iiL care mm^be taken to
avoid eroding the surrounding skin/’

Alkalies and Neutral Salts.

Liquor Ammonix. — The process inserted in the first part of this
paper is nearly similar to that mentioned by Mr. Phillips in his
criticism on the London Pharmacopceia of 1809* The following
error, however, occurred in transcribing the MS. for the printer:
instead of “ distil off eight ounces,” read distil off fifteen ounces.”
Mr. Phillips, in his remarks on the editio altera of the Pharma¬
copoeia, gives another formula for the process of obtaining the liquor
ammonise, which is, in my opinion, preferable to the former, and to
that ordered in the present edition of the Pharmacopoeia. He recom¬
mends twelve oz. of muriate of ammonia, nine oz. of lime, and four
pints of water, to be used, which will give twenty fluid ounces of
liquor ammonise of a specific gravity of *954.

Preparations of Quicksilver,

Hydrargyri Submurias. — In addition to what I have before
observed respecting this preparation, I would remark, that if the
College is still determined to adhere to a chemical nomenclature, the
composition of calomel appears now to be, according to Dr. Ure, a
protochloride of mercury, instead of a submuriate. He says, that
“ the following is the process used at Apothecaries’ Hall, London :
50 lbs. of mercury are boiled with 70 lbs. of sulphuric acid to
dryness in a cast-iron vessel ; 62 lbs. of the dry salt are triturated
with 40j lbs. of mercury until the globules disappear, and 34 lbs. of
common salt are then added. This mixture is submitted to heat in
earthen vessels, and from 9^ to 100 lbs. of calomel are the result. It
is washed in large quantities of distilled water, after having been
ground to a fine and impalpable powder.”

Liquor Hydrargyri Oxymuriatis. — As there is no formula given
by the London College for tinctura croci, which, indeed, may be
considered as altogether superfluous, but as it imparts a beautiful
colour, I would advise that xv. gr. of saffron be infused in f. of
proof spirit for a week, which being filtered, is to be added to the
deuto-chloride of mercury, previously dissolved in the muriatic acid
and distilled water.

Infusions.

Infusus Quassice. — Infusion of quassia is a deadly poison to flies
and other small insects, and I have reason to believe is equally
destructive to the w'orms which infest the human intestines: I have

oOO

.Original Communications, . ....

successfully prescribed it with that intention, combined with muriatic
acid, and have found it to prevent the generation of these animals
more than any other medicine. I commence by giving an active
purgative,' such as,

R Calomelanos, gr. v, . ,

Extract! Jalapee Resin, contriti, ,

Pulv. Radicis Rhei, aa gr. x. M.

^ Ft. pul^is, prima aurora in liquido spisso deglutienduf».

R Qu assise ligni rasi, 3ij.

Caryophiilorum contusorum, 9ij. ' -

Aquae tFerventis, Oss. . ' . ‘ ^ .

Macera per horas duas in vase levithn clause, et cola, *

R Infusus Supraprsescript. Jvij. ,

Acidi Muriatici, g“. xl. ad ’3j.

Tincturae Aurantii, M.

Ft. mistura, cujus sumat partem 4tam nocte maneque jejuno
ventriculo.

This medicine is very beneficial when given alternately with the
liquor, ferri oxygenata, as recommended under that preparation.

Cataplasms. ^

Cataplasma Fermenti, — In making this cataplasm, oatmeal is
to be preferred to wheat flour, the latter being too adhesive. Some
very useful additional cataplasms might be introduced into the Phar¬
macopoeia. This must be left to the wisdom and discretion of the
College, ‘ '

I have now concluded my remarks on the London Phar¬
macopoeia, and have endeavoured to condense and bring
together many valuable opinions respecting the errors and
omissions undeniably appertaining to it, and which surely
demand that attention which their respective merits entitle
them to. I can take on myself to vouch for ihe practicability
and economy of every process that has been recommended,
and for their great practical utility. On a subject of so great
universal importance, 1 have been particularly anxious to be
guided by the sentiments of a venerable author, who says,
“We ought not, like the spider, to spin a flimsy web wholly
from our own materials; but, like the bee, visit every store,
and cull the most useful and the best.’’ As far as I have
done this, I hope my observations will meet with a liberal
reception ; and to those to whom the revision of the Phar¬
macopoeia appertains, I would most respectfully say,

“ Seize upon truth where’er ’lis found.

Among your friends, among your foes.”

The improvement of the Pharmacopoeia must be acknow^^

Mr. Sprague’s Pharmacological llemarks arid Suggestions, 501

iedged to be of great importance, both as respects the repu¬
tation of the fellows of the College for scientific and medical
attainments, and as the work is constituted by high authority
the standard by which Druggists, Apothecaries, and others,
in this part of the kingdom, are guided in the exercise of
their branches of the Profession : consequently the London
College should consider it a duty incumbent on them —
a duty which is delegated to them by the Administration of
the country, and which the Profession expects to see well
performed — to bring out an improved edition of their Phar-
macopceia, as the progress of science shall require. There¬
fore, in order to direct attention to the propriety of such a
measure, and to the necessity of improvement in this depart¬
ment of our science, I strenuously contend for the absolute
necessity there was of concentrating and rendering conspi¬
cuous the valuable labours of those scientific men, who
have done so much in endeavouring to rectify its existing
errors. Some persons, from a want of proper refieclion, may
say that the sentiments of those authors are already suffi¬
ciently known. This assertion I totally deny as to its
general applicability. There certainly are some studious
reading men in the Profession who are acquainted with what
Dr. Paris, Mr, Thomson, and others, have written; but I
am bold in maintaining that a majority, from want of inclina¬
tion, sufficient leisure, or from their local situation, are totally
unacquainted with what has been these eminent

individuals for the improvement of pharmacology and thera¬
peutics.

It was therefore indispensable tlsat their opinions sliould
be collected and placed in the most prominent ligiu, so that
no excuse might be made for not attending to the remarks
and suggestions of an humble individual, unsupported by
such high and undoubted authorities. For the reasons I
have slated, 1 cannot but consider that the value of my
communication will in a great measure depend on the quo¬
tations I have made from those valuable works, -which,
although otherwise well known, their contents, in reference
to the imperfections of the Pharmacopoeia;, have not been
sufficiently attended to: and as there is now an opportunity
of that being done, i would aspire to no greater utility than
to that of havintr direWed the attention of the Profession to
what might otherwise have been lost in forgetfulness, or
entirely overlooked. /

An Appendix to this paper will be given in the Number
for January, 1824; which, in addition to those prepara-
YOL. XX,- — NO. 12Q. 3 T

502 Original Communications,

tions already mentioned under the Materia Medica,

will contain the following preparations' and compositions.

Acids. Ointments.

Acidum Hydro-cyanicum.

- Nitro-muriaticum.

- - - dilutum.

— - Sulphuricum Aromati-

cum.

Infusions.

Infusus Conii.

■ — - Valerianae.

Mucilages.

Mucilago Tragacanthas.

Mixtures.

Mistura Acidi Nitrici.

■ - Muriatici.

- - — Salina.

^Ethers.

Spiritus ^ther. Muriat. Olim
- - - — Febrifug. Cluttoni.

Confections.

Confectio Sennse Composita.

Powders.

Pulvis Infantilis.

Pill-Masses.

Massa Pil. Aloes cum Ferro.

• - Capsici cum Rheo.

- Colocynthidis cum

Hydrargyro.

— — Elaterii.

— Pil. Guaiaci Composita.

- Sodae Carbonatis cum Hy-

osciam.

- Pil. Hydrarg. NitriciOxydi,

tmlgo Pilula Rubra.

— — Flydrarg. Oxymuriatis.

- Pil. Plumb. Superacet.

- — - Stramonii.

- Tonicae.

Plasters.

Emplastrum iEruginis.

- - - Thuris. P. L. 1787.

Unguentum Antimonii Tartariz.

- Cersecum Hydrargyro.

- ad Porrig. Galeat. (Ban-

• yer’s). ’ •

- — ad Porrig. Galeat. (Dr.

Chapman’s).

■ - - jEruginis.

Liniments.

Liniment. Ammonise cum Oleo
Terebinthinae.

- - Calcis.

- - — Terebinthinse Compo-

situm.

Enemas.

Enema Catharticum.

- Colocynthidis Composi-

tum.

- Foetidum.

- Opiatum.

- Terebinthinae.

Lotions.

Lotio Acidi Hydro-cyanic.

• - Ammoniae Aceiatis.

- Muriatis.

- - -

Aceto.

— — Cupri Acetatis.

- Hydrargyri Cinerei.

- Hydrargyri Flava.

- Hydrargyri Oxymuriatis.

- Opii.

- Picis.

- Plumbi Acetatis.

- Potassm Sulphured.

Linctuses.

Linctus Acidi Muriatici.

— - - Oleosus.

- - Opiatus.

- - - cum Scilla.

— — Potass£e Nitratis.

503

Mr. Curtis’s Cases of Deafness and Dumbness.

Errata.

Materia Medica. — For mistura balsami tolutani, read tinctura bal-
sami tolutani.

Liquor Calcis Muriatis. — The liquor after saturation ought to be
filtered through colourless unsized blotting paper. A glass-ribbed
funnel is the best that can be used for this purpose. The portion of
liquid that passes through first must be refiltered, as it is seldom clear.
These directions for filtration ought to be always attended

Liquor Ferri Oxygenati. — :For acidi nitrosi fortissimi, read acidi
nitrici (per pond.) ^ss.

Cases of Deafness and Dumbness. By John Harrison
Curtis, Esq. Surgeon to the Royal Dispensary for Dis¬
eases of the Ear, &c.

I HAVE repeatedly observed the advantages that result
from a professional character limiting his practice to one class
of diseases chiefly; and daily experience convinces me more
and more of the nice discrimination he thus acquires in the
distinction of them, provided that his views be founded on a
knowledge of the operations which take place in the animal
economy, and that he take into consideration the nature of
the various derangements in which these particular diseases
originate, and with which they^ are frequently associated.

By Surgeons in general, no cases are more frequently given
up in despair than those of deafness and dumbness. They
are, generally, congenital, or the effect of acute disease, oc¬
curring at an early period of life. This latter cause of their
origin should lead us more frequently to attempt the removal
of them than is usually done, and should, at the same time,
give us greater hopes of success from our attempts, than if
the defect were one resulting from organic malformation ; a
cause which is much more unfrequent than is commonly sup¬
posed. Amongst the more recent cases which have come
under my care, the following may be found interesting. '

Case Is^. — George Hemmings, aged eighteen y^ears, was
admitted a patient at the Royal Dispensary for Diseases’ of
the Ear, on the 2d of May last. This young man lost his
hearing and speech at five years of age, in consequence of an
attack of inflammatory fever. On examination, I did not
perceive any organic defect, but, from the importunities of
his friends, I was induced to give his case a fair trial. 1 be¬
gan by dissolving the secretion, afterwards having the ears well
syringed, — circumstances which, although apparently simple,
are of more importance than is frequently supposed ; 1 then
had recourse to blisters behind the ears, which were kept
ooen two months. In addition to these local means, a slight

Amlytkal Review,

course of alteratives was adrninistered, to rectify some consti¬
tutional derangement, as indicated by the tongue and state
of the primae vise. As there appeared a defect in the natural
secretion, I introduced stimulant applications into the meatus
externus, from which I found a visible alteration in the ap¬
pearance of the secretion ; and soon after, this was followed
by his being sensible of the appulses of sound ; and I am happy
to state, that, after being deaf and dumb thirteen years^
he is now able to hear and speak. The first word he uttered
since his illness was ‘ mother,' which took place on the 21st of
last April.

Case 2d. — Mary Ann Hague, aged four years and a half,
lost her hearing and speech at tw'o years old, from an inflam¬
matory affection of the brain. By persevering in the treatment
detailed in the preceding case for upwards of twelve months,
she has also obtained hearing and speech.

Case Sd. — William Smith, a very interesting child, four
3’ears old, born deaf and dumb, was admitted a patient at the
Dispensary May 22d, 1821, By pursuing the same treatment
since his admission, as employed in the foregoing cases, he is
now able to hear, and speak many words.

These cases will show that, however forlorn matters may
appear, they should not be regarded as irremediable, under
such circumstances, as is the usual practice.

Sobo Square, 27th October, 1823.

PART IL

ANALYTICAL REVIEW.

Lectures on the Operative Surgery of the Epe ; being the sub¬
stance of that Part of the Author’s Course of Lectures on the
Principles and Practice of Surgery which relates to the Dis¬
eases of that Organ: published for the purpose of assisting
in bringing the Management of these Complaints within the
Principles which regulate the Practice of Surgery in general.
By G. J. Guthrie, Deputy-Inspector of Hospitals during
the Peninsular War, Surgeon to the Royal Westminster
Infirmary for Diseases of the Eye, Consulting Surgeon to
the Western Dispensary for the Diseases of Women and
Children, Assistant-Surgeon to the Westminster Hospital^
Lecturer on Surgery, &c. &c. &c. London, 1823. 8vo.
pp. xxvii. 623.

V-

This work treats of those diseases of fhe eye and its ap*
pendages which require for their relief Surgical operations,.

505

Mr. Guthrie on the Operative Surgery of the Eije.

It therefore includes most of those affections which have
been heretofore so tamely yielded by the Profession to the do¬
minion of oculists, but which, it seems probable, will, ere
long, be entirely restored to the management of men who
have at least received a regular Surgical education. Three-
fifths of the volume are devoted to the consideration of ca¬
taract, and the formation of artificial pupil : * as w^e do not
purpose entering at this time upon either of tliese subjects,
our labour in making known to our readers the character of
the work will be much abridged.

Inversion of the Eyelids is the disease with which our au¬
thor commences, and, after an examination of the merits and
demerits of the several operations proposed for its relief by
the older Surgeons, and those suggested and practised by
Crampton, Saunders, and more recently by Jaeger f of Vienna,
he proceeds to recommend one of his own contrivance,
w'hich seems to be more complete and effectual than any of
them. It is an improvement upon the operation of Crampton.

As to the nature of the disease, Mr Guthrie conceives,

“ 1. That the derangement of the eyelashes, constituting trichiasis,
is frequently the consequence of disease, but seldom or never arises
from unnatural formation, or from an accidental or too luxuriant
growth of the cilia.

“ 52. The relaxation of the integuments, ora partial paralysis of the
levator palpebrae, in a natural or otherwise healthy state of the eye
and eyelids, are not primarily concerned in the formation of entropium,
and never alone give rise to it : although, if other derangement take

* The former of these subjects came fully before us on a former
occasion. See the review of M. de la Garde on Cataract, in the Re-
' POSITORY, Vol. XVIII. p. fid.

! t We are surprised that Mr. Guthrie does not perceive any differ¬
ence in the operation of Dr. Jaeger from that of Mr. Saunders, whilst
I in the descriptions and cases of its employment quoted by Mr. G. from

! a pamphlet of Dr. Hosp, which we have not seen, no distinct mention

1 is made of removing the cartilage, but the operation is spoken of and

I described as an excision of the cilia, including their roots. To us it

! appears that Dr. Jaeger leaves the cartilage entire. Mr. Saunders re-

j moved it, on account of a vicious bending from its natural direction,

! to which he attributed much of the inconvenience occasioned liy the

1 disease. Whether, when the cilia have been excised, a bent condition

of the cartilage would produce material inconvenience, it is not easyj
without having had opportunities of seeing the effects of such an ope^
ration, to say; but as Mr. Saunders’s operation was imperfect in its ef¬
fects, so may we expect the more partial removal of the diseased parts
to be insufficient. In Dr. J.’s method, indeed, the eye may be better
protected by the lid after the operation, and this advantage may coun¬
terbalance the effect of the cartilage being bent*

506

Analytical Review.

place, they may (by removing some power of resistance to it) assist in
its more complete formation.

3. That, in a general or complete inversion of the edge of the tar¬
sus of the upper eyelid, the swelling of the external parts, and the
spasmodic action of the orbicularis palpebrarum, first tend to the for¬
mation of the disease, and which is completely established by the
contraction of the angles of the lids, and the accidental inversion of
such hairs as become stiff and matted by the vitiated discharge from
the meibomian glands and conjunctiva,

“ 4. That the change in the curvature of the lid takes place prin¬
cipally from the contraction of the angles, whilst under the influence
of the orbicularis, and not from the contraction of the conjunctiva,
corresponding to the superior broad ligament which supports the tar¬
sus, and maintains the shape of the upper lid.

“ These conclusions do not, of course, apply to such partial cases
of trichiasis as result from the formation of a cicatrix, tumour, or
other direct and obvious cause to which Mr. G. elsewhere al¬
ludes.

Without our undertaking to name the varieties and degrees
in which this disease presents itself to the observation of the
Surgeon, our readers will naturally conclude that the operation
about to be described is intended for the relief of the more
severe, cases ; whilst we may as well observe, that, amongst
the remedies recommended by Mr. Guthrie for the more slight
affections, are, first, the keeping plucked, as advised by Mr.
Travers, any one or two hairs that may, independently of ad¬
ditional disease, irritate the globe of the eyes by growing in
an irregular direction ; and, in case of their tendency inward
being too obstinate to be so overcome, the use of a pencil of
caustic to the hair gland to effect its destruction : secondly,
the application of strong sulphuric acid to a portion of the
skin, “ from three to four lines in width,” near where the
hairs are turned in, which is to be carefully^ wiped off after re¬
maining ten seconds on the part, and the operation repeated
at intervals, till the contracting effect of the cicatrizing process
shall have changed the direction of the cilia, as first advised
by Helling of Berlin, and now successfully practised and
strongly recommended by Dr. Quadri of Naples. This latter
application Mr. G. considers to be the most effectual substi¬
tute for the knife, when patients refuse to submit to the fol¬
lowing operation, the account of which Mr. G. shall himself
furnish.

Ttie operation I recommend as equal to the cure of the worst cases,
is to be performed in the following manner: The head being properly
supported, the eyelids are to be gently separated ; the patient is to be
desired to refrain from making any effort whatsoever,, and the Surgeon
is to wait until he sees that the lids are perfectly quiescent. A small
narrow knife, or one blade of a blunt-pointed scissors, is then to be in-

Mr. Guthrie on the Operative Surgery of the Eye. 507

troduced close to the external angle, and a perpendicular incision
made, of from a quarter to half an inch in extent, or of a sufficient
length to render the eyelid quite free; the quiescent state of the lids,
and especially of the orbicularis muscle, enabling the Surgeon to cut
closer to the angle than he otherwise could do, and thus to divide the
ligament, or at least the extremity of the cartilage. Another incision
is to be made, in a similar way, at the inner angle; but this should
not include the punctum lachrymale, as 1 have never found it neces¬
sary to do so; and, although the tears may continue to pass through
the lateral canal into the sac, when the punctum has been included
in the incision, they do not do so with equal freedom, and there is
some observable deformity. The length to which the perpendicular
incisions at both angles ought to extend, must now be decided upon
by the appearance of the part ; they must be continued, if necessary,
by repeated touches with the scissors, until that part of the eyelid con¬
taining the tarsal cartilage is perfectly free, and is evidently not acted
upon by the fibres of the orbicularis muscle which lie upon it. This
frequently causes the incisions, and especially the internal one, to be
longer than is usually supposed to be necessary. The part included
in the incisions is now to be completely everted, and retained by the
forefinger of the operator's left hand against the brow of the patient ;
when, if any lateral attachment be observed, acting upon, and draw¬
ing, or confining the lid, it is to be divided, which is, in fact, still
elongating the incision. On letting the eyelid fall on the eye, the edge
of the tarsus and the hairs will frequently appear in the natural situa¬
tion, in consequence of the relaxation of the angles which bound them
down; but, if the tarsal carlilage has become altered in its curvature,
this will be immediately perceived; it will turn inwards at its ciliary
edge, and be completely bent at its extremities, more especially at the
inner one, where it is more powerfully acted upon by the musculus
ciliaris. On desiring the patient to raise the lid, he readily attempts
it, but the action of the levator, in such cases of vicious curvature,
causes the cartilage partly to resume its situation : and, on examina¬
tion, the curve will be observed to be so permanently vicious for
about an eighth of an inch at each extremity, and especially at the
inner, that it cannot be induced to resume its actual situation. When
this is the case, the cartilage is to be divided exactly at the place
where it is bent, in its length, and in a direction at a right angle with
the perpendicular incision.^'

This enables the Surgeon to remove the altered curvature
of the part. The sub-section of the conjunctiva to unite the
perpendicular incisions, proposed by Mr. Crampton, is useless,
and even injurious, according to Mr. Guthrie, who proceeds
in his operation to cut away a fold of skin from that part of
the eyelid included between the incisions. Three or four
ligatures,” he directs, “ are then to be introduced, and the
divided parts from which the fold has been removed, are to
be neatly brought together by the ligatures, each of which

508 Analytical Review,

ought to be twisted, and then fastened to the forehead by se¬
veral short slips of sticking plaster/’

The fold of skin should be taken as close as possible to the
margin of the eyelids. Beer’s forceps, to which the spring
used by Gibson for his artificial pupil forceps has been
adapted, may be employed to include the fold which a knife
or scissors may cut away.

The ligatures,” Mr. G. goes on to state, should be in¬
serted, first, at each angle ; and when the vicious curvature is
considerable, I not only pass it through the skin, but take care
that the internal one shall include, at its lower part, the outer
edge of the margin of the eyelid,” which, retaining that liga¬
ture longer than those held by skin only, tends to prevent a
relapse. The eyelid having been completely everted^ is to be
retained in that state by the means already named. Union,
otherwise than by granulation, is to be carefully prevented by
the use of cupri sulphas, and every necessary attention to be
paid in the dressings. It is not always necessary to cut away
a fold of skin.

“ The operation on the under eyelid is analogous to that on the up¬
per, but is less severe, as the parts are more simple. It consists, in
inveterate cases, of a perpendicular incision made with the scissors at
the outer angle, and carried downwards to such extent as will perfectly
relieve the inversion. This incision, by dividing the fibres of the
orbicularis at that part as well as the conjunctiva, renders the mus¬
cular fibres powerless; and when it is properly made, the patient is
incapable of moving the lid. One ligature is now to be inserted at
the margin of ihe lid, and the threads fastened below the jaw by stick¬
ing plaster, so as to keep the eyelid everted,”

This operation appears to be effectual in relieving very dis¬
tressing instances of the disease, and its effects seem to be
permanent.

We pass over the remarks on relaxation of the upper eyelid,
in order to consider, in connexion with the disease already
noticed, the opposite affection of the same parts, viz. eversion
of the eyelids, a very unsightly disease, and productive of suf¬
ficient inconvenience to the patient, but one of far less severe
effects than the disorder just considered. Mr. Guthrie speaks
of four species, as distinguished by their causes.

“ I. As depending on chronic inflammation, accompanied by con¬
traction of the skin, and of the integuments of the lid, but without
any marked cicatrix.

“ 2. As depending on acute inflammation, or immediately follow¬
ing it, with relaxation, or swelling of the conjunctiva.

“ 3. As depending on the contraction occasioned by a cicatrix on
the healing of a wound on, or in, the immediate vicinity of the eyelid,
4. On paralysis.”

Mr. Guthrie on the Operative Siirgerj/ of the Ei/e. 509

The treatment of the disease depends upon the knowledge
of its cause. In chronic inflammation of the edges of the
eyelid^ commencing in the meihomean glands, by degrees tlie
skin becomes thickened, hardened, and contracted, the edge
of the eyelid turns out, the conjunctiva is irritated, inflames,
and swells, becomes thickened, but not granulated,’’ in¬
creasing and establishing the eversion. For this form of the
disease, Mr. G. employs the following means of cure : — - “

In order to lessen the contraction of the skin, and reduce
its thickness, he has the part regularly cleansed with warm
water, wiped perfectly dry, and anointed with the unguentum
zinci. The skin being contracted from irritation, and that
produced chiefly by its being moistened with a discharge
which sometimes encrusts upon the skin, at others produces
chopping by evaporation, it is of the first importance to
clean off the discharge which may lie upon the part, and
then to protect the skin from the irritation of what may af¬
terwards flow over it by a greasy application, which also con¬
tains the materials for healing any excoriation already occa¬
sioned. The outer skin being softened and relaxed by the na¬
tural subsidence of inflammation, on the removal of its cause,
the next object to be effected is that of reducing the thicken¬
ed conjunctiva, and inducing some contraction in that mem¬
brane, which will favour the restoration of the lid to its pro¬
per direction. For this purpose, the sulphuric acid is found
by Mr. Guthrie to be a most effectual application, indeed so
eft’ectual, that in its use caution is necessary, lest, by con¬
tinuing its application, the reverse of this affection, inversion,
should be produced — an effect which has been occasioned*
The acid is to be applied as follows.

“ The lid having been previously cleansed, so as to prevent its
slipping, the conjunctiva is to be gently wiped dry, and everted as
much as possible, so as to show the part where it begins to be reflect-,
ed over the eyeball. The upper eyelid ought to be a little raised by^
the finger of an assistant, and the patient should be desired to look up¬
wards, The blunt end of a common silver probe is then to be dipped
into some sulphuric acid, and rubbed with its side flat upon the con¬
junctiva, so that every part may be tg^ bed by the acid. The round
point of the probe should be carried as far as where the reflection to
the ball begins, but that part of the conjunctiva which covers it should
be preserved inviolate. The punctum lachrymale, caruncle, and se¬
milunar fold, are also to be avoided ; but the external angle, as well
as every other part, must be carefully rubbed. The effect of the acid
will be observed by the conjunctiva turning white where it has been
touched by it; and, in order to prevent the acid from affecting the
eyeball, a stream of water should now be directed over the eyelid by
an elastic gum syringe. If the acid should not appear to have turned
the conjunctiva sufficiently white, it may be repeated with the same

VOL. XX. - NO. 120. 3 u

510 Analytical Review.

precautions ; and if the patient washes the eye afterwards in cold wa¬
ter, no inconvenience will result, the pain is comparatively trifling, and
very few persons complain of it. The application of the acid should
be repeated every fourth day ; and when applied in the manner di¬
rected, it does not cause a slough, but a general contraction of the part,
which is, however, only perceptible after two or three applications, by
its effects in inverting the lid, which gradually begins to take place.*'

By six or eight applications, the cure will be half accom¬
plished, after which a longer interval may be allowed. Slight
ulceration from the application is not unfavourable to its useful
action. Some gently stimulating ointment is to be applied to
the edges of the eyelid. I’his mode of proceeding is capable
of occasioning inversion, of which Mr. G.has seen an instance.

After the eversion is cured, the disease of the edge of the
eyelid claims a continuance of careful attention.

In the treatment of the second species of the disease, that
arising from acute inflammation of the conjunctiva, as in go¬
norrhoeal or Egyptian ophthalmia, Mr. G. seems to prefer to
an operation the use of sulphuric acid, which ought to be re¬
sorted to every fourth day, aided by the daily application of
sulphate of copper to the granular or fungous conjunctiva.

In the third species, however, which is caused by the con¬
traction of a cicatrix on the healing of a wound in the vicinity
of the eyelid, he employs an operation, of which the princi¬
pal steps are suggested by an operation of Sir W. Adams.

Bordenave recommended the division of the cicatrix, and
the removal of a fold of conjunctiva. Beer is said to have
considered the disease incurable. Professor Dzondi of Halle
divided the attachments of a cicatrix, and kept the wound
open for two months, repeating the operation no less than
three times before a cure was effected, in the instance of Wil¬
liam Konig, a tanner. Mr. G.*s practice is, to make a single
or double incision from a little below the external to the in¬
ternal angle of the eye, follow'ing the curve of the eyelid, and
of the orbit,’* cutting as far -and as deep as may be sufficient
for the removal of the cicatri^x, and all cellular attachments
to the bone. The adhesions are not merely to be divided,
but removed, lest they sk:,ald reunite with greater firmness.
The lid is to be raised, and every thread of cellular membrane
which seems to draw it downwards divided. The cause of its
eversion being in this manner removed, pro tempore^ the next
object to be desired is, a power t)f resistance with which to
oppose the tendency in the future cicatrix to retract the eye¬
lid. Here Mr. G. borrows, from an operation proposed by Sir
W. Adams for the cure of another species of the disease, the
hint of removing a triangular portion of the entire lid, in addi¬
tion to such portions of conjunctiva as may appear to have

Mr. Guthrie on the Operative Surgery of the Eye. 5 1 1

influence in continuing the eversion, and by the removal of
which, and the consequent cicatrization, farther resistance to
the return of the disease is afiorded. The operation for the
third species consists, therefore : —

“ First, in the removal of the adhesions which the cicatrix has form¬
ed to the cheek-bone, with the whole or such part of the cicatrix as
can be with propriety taken away ; secondly, in the cutting out of an
angular portion of the eyelid, near the external canthus ; thirdly, in the
removal of the diseased fold of the conjunctiva (if there be any) by a
horizontal stroke of the scissors, assisted by the forceps ; fourthly, in
the application of two sutures, to bring the divided edges of the, eyelid
together ; one close to the margin of the lid, the other near the point
of the angle below ; these are to be drawn just so tight as to bring the
parts in close apposition, when they are to be cut off close to the knots,
and supported by strips of sticking plaster ; fifthly, in the dressing of
the wound made by the removal of the adhesions to the bottom with
very fine lint, and applying a bandage over the whole.”

The threads are to be removed on the third day, and strips
of plaster, with a compress, used to support the parts. Atten¬
tion must be paid to secure the neat union of the wound.
The wound made by dividing the old cicatrix is to be kept
open by an ointment of equal parts of unguentum lyttas, and
ung. resin, flav. and not allowed to cicatrize until the granula¬
tions are upon a level with the skin. During the progress of
the cure, support to the eyelid is necessary, and must be af¬
forded by strips of plaster.

Two very interesting and successful cases of this operation
are furnished to Mr. G. by Mr. Melin, an Assistant Staff-Sur¬
geon, who seems to have performed the operations at Chatham
in the year 1818. In the first there was no thickening of the
conjunctiva. A portion near the outer angle of the eyelid was
removed, and the divided parts united in three days, the wound
made by the removal of the adhesions to the bone healing in
one month, the cure being then very complete.

In the second, great difficulty was experienced in dividing
the adhesions, which extended within the margin of the orbit,
were very firm, and situated near the lachrymal sac. I'he tri¬
angular portion of the lid w^as taken from near its centre.^’
The operation was performed on the 9th of April, the wound
of the tarsus had united on the 12th, and the cure is said to
have been completed by the lOth of March, by which we pre¬
sume the 10th of May must be meant. The cases are highly
creditable to Mr. Melin,

Eversion of the upper lid is, for obvious reasons, a far more
rare occurrence than of the lower. When it does occur, the
remedial means are, for the^ most part, the same, and the ope-

51£ Analytical Revienf.

ration of Mr. Guthrie for his third species has been found ne-*
cessaryin a case which he relates.

The fourth species of this affection is only to be cured by
the removal of the original disease, of which it is only a
symptom,

Mr. Guthrie is of opinion that cohesion of the edges of the
eyelids does not occur as an effect of disease, but, in every in¬
stance in which it is seen, is congenital ; and that it is never
complete, an opening always existing at the inner canthus,
into which a probe may be introduced. The constant moist¬
ening by secretions, to which they are subject, and their na¬
tural habitual motions, are obstacles to' their agglutination
when excoriated or ulcerated. The eyelids do, however, be¬
come adherent to the eye-ball in consequence of inflamma¬
tion produced by the introduction wdthin the lid of quick¬
lime, and some other substances, which so greatly augment
the sensibility of the eye, that the patient will not move the
lids ; ulceration appears to take place, and portions of the
conjunctiva of the lids and of the ball adhere. The cornea
partakes but little of the adhesive state, and no difficulty is
experienced in separating the partial adhesions of that part
to the lid, whilst it is next to impossible to destroy the union
between the two conjunctival surfaces. On this account- Mr.
G. is of opinion, that the vessels of the lid chiefly supply the
materials of union.

When the adhesions betweeen the conjunctiva palpebrarum
and that part of the same membrane reflected upon the scle¬
rotic coat of the eye, are broad, and continuous from the
point of reflection, it is useless to attempt their destruction,
indeed generally worse than useless. Narrow^ slips of attach¬
ment may be divided near the eye, and then cut away from
the lid, with good prospect of benefit. To prevent adhesion,
the cut surfaces should be" touched with sulphate of copper,
and the eye rolled, and the lid moved frequently for the first
day. Previously to determining upon any operation, it is al¬
ways necessary to consider what is the state of the eye itself,
and to be satisfied of the extent of the adhesions. If requir¬
ed, the operation may be repeated with some farther advan¬
tage.

Wounds of the Eyelids generally require the employment of
one or more stitches, and these will retain the edges in con¬
tact, and prevent the effects of motion better than any knowm
substitute. They should be assisted, however, by plasters,
compress, and bandage. When the division is horizontal,
the eyelid should be supported against the edge of the orbit,
by pressure made w ith a compress and bandage, and even by

Mr. Guthrie on the Operative Surgery of the Eye. 5 IS

ligatures, used as recommended by Mr. Guthrie in his opera¬
tion for inversion.

“ Wounds penetrating the upper eyelids in a horizontal direction
may also injure the eyeball, and if the wound be deep, the eye will in
all probability be lost; but if it be slight, cicatrization will take place,
and a scar only remain, marking the situation of the injury. In such
a case the elevation of the upper lid, necessary to bring the parts in
perfect contact, will effectually prevent the coalition of the wounded
poition of the lid with that of the eyeball; but if the wound should
be in a perpendicular direction, that in the lid will remain opposed
and in contact with the wound in the eyeball; and if passive motion
be not early given to the lid, a union, or symblepharon, might be the
consequence.’^

Incurable amaurosis occasionally comes on during the heal¬
ing of a wound of the forehead, in which the superciliary
nerve has been injured ; and Professor Beer, in recommend¬
ing the complete division of the 'injured nerve, speaks very
positively of the efficacy of such proceeding, when adopted
at a proper period, in preventing this serious mischief. Mr.
Guthrie has seen no successful instance of the employment
of this operation.

On Tumours of the Eyelids. Hordeolum, or stye, is very
well described by our author, and he particular^ notices, that,
when this little tumour suppurates, points, and its little yellow-
pointed head breaks, only (ho, fluid part of its contents escapes,
the swelling not subsiding, because a slough of cellular mem¬
brane remains to be discharged, the disease being of the na¬
ture of furuncuii,” or boils; that there is a subsequent pro¬
cess of softening separation, and removal of the slough, which
may be aided by pressure, and the part slowly heals.’’ He
also states, that the resolution of these tumours is seldom
accomplished, and ought not to be attempted, where the in-
flammator}^ action is acute, for it never succeeds.” Then, as
if to be as inconsistent as possible, not ten lines farther on he
says: The resolution of the more active tumours may be at¬

tempted by iced water, or vinegar and water, constantly ap¬
plied, but which ought to be omitted if the pain be found to
increase, and a small warm poultice substituted.” The ab¬
scess should not be opened, but allowed to discharge itself by
ulceration, and the poultice should be continued until the
slough is discharged, and the hardness of the tumour has sub¬
sided.” This latter direction is quite at variance with good
surgery, and of a piece with the inconsistency just pointed
out.

If the surgeon, we may state, as soon as he perceives that
the little yellow head is formed on the top of the larger tu¬
mour, will pinch up bet\Yeen his left finger and thumb, a por-

514 Analytical Reviezi\

tion of the skin of the eyelid, by which he may pull out the
eyelid to a convenient distance from the eyeball to allow
room, he may then draw the shoulder of a lancet across and
through the tumour ; after which, if it do not at once escape,
either pressure, or a pair of dissecting forceps, will remove
the little slough, and in twenty-four hours, frequently, there
will be scarcely a vestige of the disease, all inconvenience
which it occasioned having ceased from the hour of his using
the lancet. Fomentation, and greasing the edges of the eye¬
lids at night with some mild ointment, will serve to bring the
meibomian glands to their natural state, and to allay any little
irritation of the conjunctiva which may have been excited by
the tumour.

In curing other little tumours which occur on the edges
of the eyelids, between the eyelashes, containing a whitish,
fatty, or chalky matter, which,” Mr. G. says, should be
touched with the point of a lancet, and their contents squeez¬
ed out,” and on all similar occasions, we prefer the use of the
shoulder of the same instrument, used as above described, be¬
cause the point makes a timid patient start before the object
is accomplished; but the side or shoulder has completed the
intention in an instant. These are but trifling occasions for
the exercise of surgical skill; but it is, therefore, doubly dis¬
graceful when they are submitted to us, not to give the patient
all the relief of which they admit, and in the readiest manner.

For the simpler kinds of tumours of the eyelids, when situ¬
ated externally to the orbicularis muscle, an incision across
them through the skin, and squeezing out their contents with
the two thumb nails, is directed ; when within that muscle,
and having no distinctive external characters,” they may
be still removed in the same manner;” but if they adhere to
the tarsal cartilage, the eyelid should be everted, when the pro¬
jection of the tumour will be perceived through it, into which
an incision is to be made, and the contents are to be pressed
out in the same manner. This method of removing tumours
through an opening in the cartilage is never attended with any
inconvenience, and ought always to be adopted when the ap¬
pearance of the inside of the eyelid is changed from its natural
colour to a semitransparent yeliowishness, showing the firm
attachment of the tumour to the cartilage, even if it do not
indicate its partial removal by absorption.”

When fluid contents of a sac have been discharged, the
Surgeon is directed to introduce a probe, and move it about
to excite inflammation ; and to renew’ this proceeding daily
for three or four days, that the sac may be obliterated. If
the tumour be fleshy, it may be raised with a hook,, and cut
off with scissors. In thp case where the contents of the sac

Mr. Guthrie on the Operative Surgery of the Eye. 515

are brain-like, Mr. G. says, that the sac will require scarcely
any subsequent treatment, but it is more necessary in this
than in most descriptions of tumour, to remove the sac, as
the secretion is renewed rapidly. But when Mr. G. talks
of carefully dissecting out the sacs of atheromatous tumours,
he surprises us, as we are persuaded that only in cases where
adhesions have taken place, this can he necessary. In at least
a great proportion of these cases, if the divided edge of the
sac, after the removal of its contents by pressure, be taken
hold of with the dissecting forceps, the whole sac, or its
halves in succession, may be peeled from the surrounding
connections without difficulty. Yet we know, that in par¬
ticular instances, it is necessary to dissect out these sacs,
and Sir A. Cooper mentions an example in which it is so.

‘‘ The swelling of this description (atheromatous) which takes place
at the outer canthus, is the most difficult of these tumours to remove.
It passes within the orbit, and often advances to its periosteum, and
the inner part of the cyst is with great difficulty reached in the opera¬
tion.” — Cooper and Tranters Essay Part II. page 224.

Perhaps we interpret Mr. Guthrie in too general a sense,
when we understand him to direct the dissecting out of these
sacs, as commonly required.

These cases should not be treated by escharotics, for even
if inflammation have attacked a tumour, and produced a par¬
tial discharge of its contents; though in another part caustic
might soon complete the cure, yet in this it is well, unless the
inflammation have already produced a considerable opening,
still to use the knife or lancet to secure a neat cure.

The following is a very good description of the operation for
Pterygium^ including the after treatment:

“ The patient being seated lower than the operator, ought to rest
his head against the breast of an assistant, who elevates the upper eye¬
lid, and fixes the eye with the fore and middle fingers of one hand,
whilst he depresses the lower eyelid with the other. The Surgeon
should then desire the patient to turn the eye outwards, if the ptery¬
gium arise from the inner canthus ; and whilst it is thus on the
stretch, take the opportunity of grasping it between the points of the
forceps, about two lines from the cornea, and then raise it from the
sclerotica, until he has room to pass an iris, or spear-pointed cataract
knife, underneath it, and to the inside of the forceps, when it is to be
cut through from within outwards. The extremity of the pterygium
being still held by the forceps, will allow the operator to cut it off close
to the cornea with the same knife, or by the curved scissors, which will
be more easily effected, and more completely done. If any portion of
the edge of the pterygium should have been left after this operation,
it must be removed by the scissors, or it will keep up for several days
the subsequent suppuration, and the eye should be washed with warm
water until the bleeding ceases, when a corhpress and bandage should

516 • Analytical Review.

be applied, so as to keep the eyelids closed, but not to press on the eye.
The eyelids should be carefully washed clean night aiid morning, or
oftener, if it be found agreeable to do so ; but the eye should be opened
to examine the wound, only so far as will show that the conjunctiva
is not highly inflamed, or that chemosis has not taken place. Qn the
fifth day the eye should be examined, when the divided surface of the
sclerotica will be found covered with a yellow coloured deposit resem¬
bling mucus, whilst the surrounding edge of the conjunctiva is irregu¬
lar, red, and inflamed.’*

This appearance contracts, and a new membrane is formed.
Very little management is required but to remove excrescences,
should they arise.

A section of the work is allotted to the Removal of Rxtra-
neous Substances from the Eyef and Injuries of the Eyeball”
The upper lid should always be everted, as the most sure
means of removing substances lodged beneath it. For this
purpose, the operation of eversion, which, till within these
few years, was rarely, if ever, practised, is now found almost
as useful as for discovering the state of diseased conjunctiva,
for which it seems to have been first proposed. A few older
Surgeons may still not know of the practice, or the most
ready mode of effecting eversion. The Surgeon should draw'
dowm the lid by taking hold of a few of the cilia, and then
place a probe across it, just above the upper edge of the
cartilage, with which instrument he is to make gentle pres¬
sure, whilst by^ his hold upon the cilia he lifts outwards the
lower edge of The eyelid. If the action of the orbicularis
muscle be not strong, the lid becomes readily' everted, and
upon directing the patient to look downwards wdlh his other
eye, the conjunctiva of the upper half of the eye may be per¬
fectly examined, and any foreign substance removed.

In whatever position it is desired to see an injured or dis¬
eased eye, the object will be most easily attained by desiring
the patient to look with his sound eye at some point towards
which you want the pupil of the affected one to be directed.
Fear might deter him from moving the tender eye, if request¬
ed ; but not knowing, or not remembering, that the motion of
the two eyes corresponds, he has no apprehension of incon¬
venience from moving the sound one, and he readily changes
its position at your pleasure, effecting, of course, at the same
instant, the change you desire in the eye under examination.

When foreign substances stick in the cornea, it is necessary
to remove them by the use of a sharp cataract needle,” the
eye being properly steadied by the Surgeon and an assistant.
It is sometimes required literally to dig them out, so tena¬
ciously are they retained in the tough substance of the cor¬
nea. This may be done w ith very little or no ill consequence ;

Mr. Guthrie on the Operatite Surgery of the Eye, 517

ihe worst being a slight opacity, provided it be done be¬
fore inflammation and ulceration have been occasioned.
‘‘ It is a waste of time,’’ says our author, “ to have recourse
to poultices and narcotics, as some foreign authors have re¬
commended,” If an offending body, so large as to be likely
to excite inflammation, be lodged behind tlie cornea, it may
require an incision in the part for its removal, which, under
some circumstances may with great propriety be made, and
will be the means of preventing an inflammation which might
be destructive or highly injurious to the organ.

In all cases of injury to ihe eye or its appendages, inflam¬
mation is the evil to be guarded against. Inflammation of
the eye itself must be treated vigorously and perseveringly,
and that of the neighbouring parts carefully watched whilst
under management, lest the organ become affected. It is im¬
portant to know that inflammation of the iris, arising from ac-;
cidental injury, is as readily influenced by the mercurial treat¬
ment, as when its origin has been of a syphilitic or other con¬
stitutional character. i

An interesting portion of this work treats of Tumours with¬
in the Orbit, and Protrusion of the Eyeball — of the Extirpa^
tion of the Eachrymal Glands — of Alterations of Form in the
anterior part of the Eye — and of Extirpation of the Eyeball it¬
self — followed by the two subjects Cataract and Artificial
Pupil, which we have already noticed as occupying so great
a proportion of the entire publication.

Some parts of the work are creditable to its author for the
ingenuity and originality of his suggestions for improving the
operative Surgery of the eye ; and the whole bespeaks great
industry in tlie pursuit of his inquiries into the opinions and
practices of his predecessors and contemporaries who have
especially directed their attention to this interesting and im¬
portant branch of practice. But the more we see of works
upon this subject, the more do we regret the untimely death
and irreparable loss of our amiable, intelligent, and enterpris¬
ing countryman, Cunningham Saunders. No writer whose
works we have ever perused, has succeeded in imparting to
surgical subjects an interest so vivid, as the accurate me¬
thodical descriptions of Mr. Saunders attach to the few sub¬
jects on which his pen has furnished the observations and
strggestions of his penetrating mind. ; <

In the work before us particularly,, there is a want of that
orderly, methodical, and complete manner of treating any of
the topics which, in lectures, or in an ex professo treatise on
any subject, seems to us more desirable than the heaping to¬
gether of unconnected observations, however material these ob¬
servations may be, towards forming the well-digested production
VOL. XX. — NO. 120. 3 X

olB Foreign Medical Science and Literature,

which we look for from a writer w^ho is also a public teacher.
Lectures are generally a compilation interspersed with origi¬
nal remarks and suggestions, but then the compilation should
at least be neat. The waiter of a treatise, or a lecturer on any
subject, nia}^ and should, as a builder, bring from all parts the
materials most suitable to his purpose ; but these should be
worked into form, and, in the structure which he erects,
should appear only as contributing to the beauty and useful¬
ness of a whole.

It is true Mr. Guthrie has commenced each of his subjects
with an account of the synonyms of the disease in question,
giving their derivation, and has proceeded through a sort of
uniform course in disclosing the particulars of his subject, ex¬
tracting freely from the writings of a great number of authors ;
but the w'hole of his work bears more the character of notes,
original and selected, put together, and ordered to be printed,
than of lectures written for annual delivery, and published af¬
ter the revisals of six successive years. Yet are these lectures
calculated to be very useful in diffusing still more widely than
hitherto has been done, that spreading knowdedge of ocular
surgery which has, of late years, been expanding itself over
the British empire and its dependencies; and however imper¬
fect the manner of the writer, the matter of the book entitles
it to a place on the shelves of every Surgeon.

PART III.

ANALYSIS OF FOREIGN PUBLICATIONS

IN THE DIFFERENT BRANCHES OF MEDICAL AND
SURGICAL SCIENCE AND LITERATURE.

TJeher die Verletzungen des Ruckenmarkes in hinsicht auf i/ir
Lethalit'dts — VerhMtniss. Von Dr. Joh. Ludw. Casper
(aus Rust’s Magazin fltr die gesammte Heilkunde beson-
ders abgedruckt). Berlin, 1823.

On Injuries of the Spinal Marrow with reference to their
relative degrees of Fatality. By Dr. Joh. Ludw. Casper
(reprinted from Rust’s Magazine of Medicine), Berlin,
1823. 12mo. pp. 78.

We have been much gratified by the perusal of this little
work. It is a small 12mo. of 78 pages, reprinted from Rust’s
Magazine, and affords a most excellent and comprehensive
view of the various injuries of the spinal marrow, for the

Dr. Casper on Injuries of the Spinal Marrow, 519

purpose of determining their relative degree of danger. 7diat
this is not a work of supererogation, may be gathered from
the author’s most correct introductory observations. 'I'he
disagreement of authors on any subject may generally be
taken as a presumptive proof that the subject is not fully
understood. If this position be true, what shall we think of
our knowledge of the nature and effects of injuries of the
spinal marrow? Hippocrates regarded wounds of this part
as fatal ; but as early as the period of Galen, a distinction
was made, and the danger was considered to be much dimi¬
nished if the wounds w'ere inflicted in the lower portions of
the cord. Still it was the prevailing opinion that wounds of
the upper portion of the medulla w'ere necessarily fatal:
Man get, Bohn, and Albertis, express this opinion. Woyt
and I’eichmeyer regarded deep wounds in any part as fatal ;
but Boerhaave only considered such as affect the upper
portion as deadly. Heister was the first who considered
injuries of the spinal cord, even very near the head, as not
necessarily fatal ; and 'Haller and Arneman, from experiments
on animals, deduced that such w-ounds were not so abso¬
lutely fatal.” More modern authors have returned to the old
opinion, that the danger is in some ratio as the injury is
inflicted nearer to the head. Ploucquet remarks, ‘‘ Si me¬
dulla spinalis prope cerebrum ubi vertebris colli continetur,
quovis modo laeditur vel premitur, sive per instrumentum
laedens, sive per festucas a vertebris avulsas, sive per cruorem
extravasatum, sive per luxatas vertebras, mors subito et
inevitabiliter sequi solet.” Richter states decidedly, In¬
juries of the spinal marrow, from wounds of the neck, are
fatal:” Metzger, Sikora, Muller, and Bene, are of the «ame
opinion, and VVildberg agrees with them, but thinks that all
injuries of the medulla will prove fatal sooner or later. Henke
agrees with Wildberg. Boyer remarks, that when injuries
do not prove fatal, their consequences often do. Many other
French Surgeons do not regard these injuries as necessarily
fatal. Marc agrees with Metzger. Fodere considers even
wounds in the neck as only generalement mortelles,” and
Ribes considers wounds of the inferior portion as not alwmys
fatal. So much disagreement amongst WTiters fully indicates
the necessity of investigating the subjects, as it is of the
highest importance to know what kind of injuries are really
fatal, and when we may justly entertain hopes that science
and art may rescue the sufferer from danger. To fulfil as
nearly as may be this important object, is the design of the
small treatise now before us; and it is but justice to Dr.
Casper to say, that he has bestowed on it much learning and
talent.

520

Medical and Physical Intelligence,

He di vides his subject into injuries of the spinal, marrow ~
1st, from wounds; 2dly, from compression; 3dly, from con¬
cussion; and discusses each separately, adducing and examining
an amazing mass of opinions and of evidences, in the form of
cases and dissections : and he offers the following table as
the summary result’^ of his labours :

The following injuries of the
spinal marrow are necessarily
fatal : —

a Punctured wounds in the upper
portion.

Contused wounds in ditto.

An entire division of the cord.
Gun-shot wounds passing right
across.

b True luxations of the vertebras
of the neck.

True fractures of vertebrae of
the neck.

Effusions in the spinal canal.

The following injuries of the
spinal marrow are not neces-
sarily fatal : —

a Punctured wounds in the lower
portion.

Contused wounds in ditto.
b True luxation of the vertebrae
of the back or loins.

True fracture of ditto,
c Concussion.

PART IF.

MEDICAL AND PHYSICAL
INTELLIGENCE:

BRITISH AND FOREIGN.

I. Some Account of the Life and Professional Character of the late
Matthew Baillie, M.D. F.R.S. L. Sf E. ^c.

Dr. Baillie was born October 27th, I7dl, at Tholy, near
Hamilton. He was the son of the Rev. James Baillie, D.D. Professor
of Divinity in the University of Glasgow, and of Dorothea, daughter
of Mr. John Hunter, of Kilbride, Lanarkshire, and sister of Dr.
William and Mr. John Hunter. He had an cider brother, who died
very young, and two sisters, who survive him — Mrs, Agnes and
Mrs. Joanna Baillie.

Dr. Baillie entered upon his collegiate education, in the year
1774, at Glasgow, whence he removed, in 1779? by the advice, we
believe, of his uncle. Dr. William Hunter, to Baliol College, Oxford •
in order that he might be enabled, by graduating at an English
University, to enter on the exercise of the medical profession in
London with every adventitious requisite to future eminence. He

Account of the Life of Dr. Baillie. 521

kept the terms required for the degree of Doctor of Medicine at this
College ; but nearly the whole of that period was occupied in prose¬
cuting his medical studies in London. These he commenced in
1780, chiefly under Dr. William Hunter and his brother.

He had the great advantage of residing in the house of Dr.
H unter; and very soon after he entered upon his anatomical studies,
he commenced his assistance to this celebrated Anatomist by making
preparations for his lectures and museum, and, subsequently, by
conducting the dissections of the students, and giving the usual
demonstrations.

How far the assiduity and talents of Dr. Baillie were valued by
his uncle, of whom he was considered as the adopted son, may be
inferred from the tenour of the will left by this eminent man. By it
his museum devolved to Dr. Baillie, for the term of thirty years, under
the direction of trustees, with eight thousand pounds, as a fund for
the support and augmentation of the collection. Dr. Baillie \vas also
left his residuary legatee.

After the death of Dr. William Hunter, which took place the 30th
of March, 1783, Dr. Baillie became his successor in his anatomical
lectures, having for his associate Mr. Cruickshanks, the assistant of
his uncle. His first course of lectures was delivered in the winter
1784-5, and he continued to lecture jointly with this eminent Ana¬
tomist until 1799* During this period he made a collection of
anatomical preparations, which he afterwards presented to the College
of Physicians of London.

In the year 1787 he was elected Physician to St. George’s
Hospital. He became Doctor of Physic in 1789? immediately
afterwards a Fellovv^-of the College of Physicians : he was also elected
a Member of the Royal Society in the same year. He married, in
1791> the eldest daughter of Dr. Denman, whose character as an
Accoucheur was then generally acknowledged and respected. This
connexion proved to him both a source of happiness and of eminence.

In 1795 he published his work on Morbid Anatomy; and the
engravings illustrating it began to appear, in fasciculi, in 1799* He
relinquished his public duties as a lecturer in the same year, owing
chiefly, it was understood, to the association in the lectureship being
unpleasant to him. On the occasion of his taking leave of his pupils^
several eminent individuals were present. The lecture, according to
our information, was not very appropriate; and the concluding
address, which consisted merely of a few plainly expressed sentences,
contained nothing remarkable, excepting a somewhat pettish and
uncalled-for allusion to the real cause of discontinuing his lectures.
But although this address was neither neat nor eloquent, it possessed,
in other respects, a quality more estimable than either the one or the
other — it was honest, and, we believe, conveyed not a sentiment
more than he felt. The esteem in which he was held by his pupils
was honourabl}^ evinced by them on this occasion : they presented
him with a piece of plate, with a Latin inscription, expressive of
their gratitude. In the year 1800 he resigned the office of Physician

522 Medical and Yhymcal Intelligence,

to St. George^s Hospital, and devoted his attention chiefly to the
extension of his practice.

His private practice had become at this time very considerable,
and we believe unusually great for a Physician not yet in his for¬
tieth year. It was not, however, so extensive as to have led to the
resignation of his public duties as an Hospital Physician and Lec¬
turer, if other motives had not co-operated. Dr. Pitcairn having
been obliged, by the state of his health, to leave London in 1798,
Dr. Baillie, the most intimate friend of that Physician, succeeded to
a considerable share of practice amongst the higher classes of society.
To this the powerful influence of his father-in-law. Dr. Denman,
greatly contributed, who at this time enjoyed the most extensive and
most lucrative practice of any Accoucheur in London ; and the intro¬
duction and warm recommendation of such a man as Dr. Denman,
who restricted his practice chiefly to those diseases which come
within the sphere of his department, could not fail of being the most
conducive to the future eminence of a young but rising Physician.

The death of Dr. Warren, to whom Dr. Baillie owed much during
the life of that eminent Physician, was very conducive to the farther
extension of his practice, especially in the higher ranks of society;
and it continued to extend still farther, until 1810, when he was
appointed Physician to the late King.

Dr. Baillie now held the highest rank as a Practitioner ; and we
believe that no one who preceded him, possessing an equally exten¬
sive practice in the circles of fashion, was so frequently consulted by
his professional brethren as he was. In a few years he found it
necessary to restrict his practice chiefly to consultations, in which he
continued to be much engaged until within a few months of his death.

His health had been declining for some time, and W'e believe he
experienced an attack of the epidemic catarrh which was somewhat
prevalent in London during the preceding wdnter. From this he did
not completely recover. His strength gradually sank until his
death, which took place on the 23d of September, 1823, at his
seat, Duntisbourne House, near Cirencester, Gloucestershire, whither
he had retired a few months previously, having nearly completed
the sixty-second year of his age. He left two children — a son
and daughter.

Dr. Baillie made, by the upright discharge of his professional
duties, a large fortune, which, however, might have been much larger,
if he had been desirous of accumulation. His personal effects were
under eighty thousand pounds, exclusive of his estates. He pre¬
sented his museum to the College of Physicians in his life-time, with
a sum of money for the purpose of keeping it in order ; * and he also
bequeathed his medical library to the same learned body.

^ At a meeting of the Royal College of Physicians, on the 30th
September, the following tribute of respect to the memory of the late
Dr. Baillie was ordered to be inserted in the College Annals : —

“ That our posterity may know the extent of its obligations to the

Account of Dr. Baillie’s Pfofesmnal Character, 52S

In the view which we shall attempt to take of the professional
character of Dr. Baillie, it is not our intention to write an eulogy;
that is unnecessary : but briefly to exhibit, as far as we have the means,
a fair estimate of his talents, acquirements, and medical ethics.

During his life-time he was a general object of eulogy, and even of
flattery. Much of this proceeded, we are conscious, from a feeling
of respect for his talents and virtues ; but much also flowed from
interested motives. Much eulogy was publicly bestowed, in hopes
that it might be repaid.^ Dr. Baillie, however, possessed too strict a
principle of honour to repay praise where he did not believe it to be
deserved.

The first point of view, in our opinion, in which a Physician’s
character ought to be viewed, is professional talent; for although
many other points are requisite to secure the confidence of the public
and of the Profession, this one, as on it chiefly depends the safety of
the individuals which come under his care, is of the highest import¬
ance, and all other attainments ought to be rendered subservient to its
advancement. The professional talents of Dr. Baillie were considerable,
but they were limited almost exclusively to one department of medical
science, namely, to pathology — a department which received its most
splendid additions and illustrations from the labours of the Hunters,
who may be considered its fathers in this country. It cannot, there¬
fore, be a matter of surprise that a Physician who, at an early period
of life, was almost exclusively engaged in the investigation of this
branch of medical knowledge, under its chief promoters, and who
lived with, and was adopted by, Dr. William Hunter, should have
his attention chiefly devoted to the study of it.

This too exclusive devotion to one branch of medicine, at the
commencement of his career, injured Dr. Baillie’s practical reputa¬
tion, which entirely rested on his pathological knowledge. This,
however, was considerable even at an early period of his practice ;
but it certainly was not so great as was to be expected from his
uncommon opportunities and advantages. In the exercise of his
profession, especially during the years of his more matured expe¬
rience, his views of the nature of a disease were generally correct,
although seldom intimate, and not always precise; and when it was
expressed, even in doubtful cases, his opinion was given in such a

benefactor whose death we deplore, be it recorded, that Dr. Baillie gave
the whole of his most valuable collection of anatomical preparations to the
College, and six hundred pounds for the preservation of the same : and
this, too (after the example of the illustrious Harvey), in his life-time. His
contemporaries need not an enumeration of his many virtues to account for
their respectful attachment to him whilst he lived, or to justify the pro¬
found grief which they feel at his death. But to the rising generation of
Physicians it may be useful to hold up, for an example, his remarkable
simplicity of heart, his strict and clear integrity, his generosity, and that
religious principle by which his conduct seemed always to be governed, as
well calculated to secure to them the respect and good-will of their col¬
leagues and the Profession at large, and the high estimation and confidence
of the public.’^

* “ Viro laudato laudari.”

524

Medical and Fhydcal Intelligence,

manner as to embrace many of the relations of diseased action, and
thus to avoid every appearance of mistake.

As a Practitioner, he was, in our opinion, timid, and sceptical of
the influence of medicine, in many diseases, to a very blameable
extent. This scepticism was often expressed to young Physicians in
such a manner as was calculated to cool that ardour which is one
of the first sources of professional eminence ; and it evidently pro¬
ceeded from a want of proper knowledge of the operation of medi¬
cines on the animal economy, and from an inability of adapting
them, according to their known operation, to the nature of the
derangement inferred at the time of prescribing them. In the earlier
part of his practice, his prescriptions were often unchemical, and one
ingredient was frequently combined with another possessing opposite
virtues, and calculated to fulfil opposite intentions. As his expe¬
rience, however, advanced, this evil was, in a great measure, avoided ;
but he fell into one but one degree less, namely, into a practice which
was often inefficient from the want of a requisite combination of
active remedies : Nature was too often allowed by him to follow her
own course, when she might have been directed or controlled with
advantage.

For a Physician in his extensive practice, he was remarkable for
forming his judgment of any case before him from his own observa¬
tion exclusively, and for guarding himself against any prepossession
from the opinions suggested by others. When he visited a patient,
he observed him accurately, listened to him attentively, put a few
pointed questions, and formed his judgment from a comprehensive view
of his case. His practice, upon the whole, was seldom the result of
what is commonly called theory : he was chiefly guided by his expe¬
rience; and in his consultations he generally opposed facts to the
theoretical, and even to the rational, inferences of those whom he
met. To this he appeared to be led, in some measure, by the nature
of his abilities. These were not of a kind which were capable of
seizing the nicer distinctions of diseased action, and appreciating its
remoter causes and relations — a faculty indispensably requisite to
profound pathology and to philosophical inquiry. From the want of
this endowment, and from having made the last and most irreme¬
diable changes which the animal textures undergo, his more imme¬
diate study, in preference to the laws and modifications which the
vital operations evince — from having looked more to ultimate effects
than to their causes — he must have been frequently disappointed by
his own pathological and therapeutical speculations, if at any time
he ventured beyond the beaten track of his experience ; and he must
have observed a similar and even greater deficiency amongst many
whom he met. This may have been the cause of the distrust with
which he afterwards viewed every species of medical speculation, and
of the pure empiricism into which he so completely lapsed.

To be led merely by facts in the treatment of diseas^e, or in the
opinions which we form of its nature, is necessary to a certain extent ;
but to be alone guided by reputed facts — for in medicine they are
only reputed — is a dangerous species of mental indolence, most

Account of Dr. Baillie’s Professional Character. 5^5

inimical to the advancement of medical science. Besides, to
appreciate facts in such a manner as to infer the presence of such
strict resemblances only as actually do exist between those facts that
appear similar, and which we wish to treat on similar principles ; and
to seize upon, and to estimate duly, the various points of difference
between those in other respects alike ; require a degree of know¬
ledge of the laws which govern the animal economy, which the
individual unpractised in physiological and pathological speculation
can never acquire ; but which, when acquired, leads, more than any
thing besides, to the due appreciation of the causes and conditions
of disease, and to the adoption of the best indications and means
for their removal. To appreciate facts in medicine, we must have
recourse to the profoundest and fullest exercise of the higher
faculties of our nature — we must reason with precision and depth
respecting them, and with a due reference to the causes in which
they originate, to the various influences by which they are modified
or changed, and to the consequences to which they lead under the
various circumstances of their existence. Without such an exercise
of our reasoning powers, experience is often dangerous — it is only
empiricism, which does not deserve to be dignified by being called
rational.

Dr, Baillie’s conduct to his Professional brethren was open,
manly, and strictly honourable ; he would not injure the reputation
of any one, but would do much to promote the interests of those
whom he considered truly deserving. It was to this liberal and
strictly moral conduct, and to his reputed pathological knowledge,
that he was entirely indebted for the esteem and eminence he ob¬
tained with the members of the Profession. He was punctual to
epgagem^nts and appointments, and in all things he appeared to
observe strictly the great moral precept, to do to others as he would
be done to.

With his patients Dr. Baillie was simple, plain, and gentle. He
acquired their confidence without any apparent endeavour ; and he
adapted the terms and manner of his discourse with them to cir¬
cumstances, managing both so as to leave them calm, encouraged,
and satisfied. He never saw a patient without examining fully
into the nature of his ailments ; and the opinion which he after¬
wards gave to the friends, was explicit, brief, and frank, and
generally well adapted to the circumstances under which he
gave it.

With respect to the rank in which we should estimate the writings
of Dr. Baillie, it may be expected from us to say something. They
added no facts to the branch of science to which they relate. But
no modern production has tended more to diffuse a general knowledge
of pathology amongst the lower ranks of the Profession than his
work on Morbid Anatomy. The chief merit of that production is,
that it contains a digested and clear account of the last changes
produced by disease on the texture of the body ; and although it
is more the result of personal investigation than of medical learn¬
ing, yet it contains nothing more than may be found in the pages

VOL. XX. — NO. 120. 3y

526 Medical and Physical Intelligence.

of Bonnet, Morgagni, and Lieutaud. The’ work would certainJy
have been much improved had he been better acquainted with the
pathological writings which appeared on the Continent about the
middle and end of the eighteenth century and the commencement
of the present. As it is, however, it forms an useful manual ; and
its merits cannot be more favourably mentioned, than by adding,
that it has been translated, with the addition of copious notes
by the translators, into the German, French, and Italian lan¬
guages.'’'

We are not a little surprised, that in the tribute that has been
paid by the College of Physicians to the memory of Dr. Baillie, no
mention is made of his pathological attainments. It is ungracious
to the living, even if our limits could admit, to speculate on the
reason for the want of due respect to the memory of the dead
from those who ought to be the first to pay it with partiality. But
the name of Dr. Baillie, even for professional science, notwith¬
standing the absence of such a tribute from the College annals^,
will appear the greatest that has honoured them for more than half
a century in the class of Fellows.

To sum up — the eminence of Dr. Baillie was the result of the
uncommonly fortunat^„position in which his destiny placed him in
early life. It was, afterwards promoted by his extensive and
powerful connexion — by his extreme prudence and circumspec¬
tion — and by his liberal and honourable conduct towards the
members of the Profession. He was not a man of genius, or
even of great abilities ; but he was a man of sense and of pru¬
dence ; and although he did not actually advance medical science,
he contributed, to disseminate more widely a knowledge of one of
its branches, and to elevate, by his example, the medical cha¬
racter. James Copland.

Jermyn Street, 26,th Nov. 1823.

* The other writings of Dr. Baillie are the following; —

Ib the Philosophical Transactions for the year 1788 and 1789 : 1. “ An
Account of a remarkable Transposition of the Viscera.’’ — 2. An Account
of a particular Change of Structure in the Human Ovarium.”

In the Transactions of a Society- for the Improvement of Medical and
Chirurgical Knowledge : 1. “ On the Want of a Pericardium in the Human
Body.” — 2. “Of Uncommon Appearances of Disease in the Blood Vessels.”

— 3. “ Of a remarkable Deviation from the Natural Structure of the
Urinary Bladder and Organs of Generation of a Male.” — 4. “ Case of
Emphysema not proceeding from local Injury.” — 5. “ An Account of a
Case of Diabetes, with an Examination of the Appearances after Death.”

— 6. “ An Account of a singular Disease in the great Intestines.” — 7. “An
Account of the Case of a Man who had no Evacuation from the Bowels for
nearly Fifteen Weeks before his Death.” — 8. “ On the Embalming of Dead
Bodies.” 9-. “ An Account of several Persons in the same Family being
twice affected with Measles.” — 10. “ Additional Instances of Measles
occurring twice in the same Person.” 1 1. “ Three Cases of Inflammation
of the InnejT Membrane of the Larynx and Trachea, terminating quickly in
Death.”

In tihe MedicalTransactions published by the Royal College of Physicians:

527

Account of the Life of Di\ A, Nicoll.

n*. ^omc Account of the Life and Character of Andrew Nicoll,
M. D. Deputi/ Inspector of Hospitals, Thom sox.

Esq. F. L. S. &c. ike.

Among other losses M'hich the Profession has Jately sustkined,
is that of Dr. Andrew Nicoll, Deputy-Inspector of Hospitals, and
Chief Medical Officer, on the coast of Africa, who died at Acra on
the 27th of April last, on board of his Majesty^s ship Cyrene.

Dr. Nicoll, although not very generally known to the Profession,
yet had honourably distinguished himself abroad in the situations into
which his' destinies had thrown him, in a manner which would have
raised him to a very high rank as a Physician, had he practised at
home. But, independent of mere professional talent, it must ever be
gratifying to the members of the healing art, to rank as one of its body'
an individual who had proved himself a benefactor of the human race,
and worthy of having his name embalmed in the affections of his
country. Me wms an exemplification of the remark, that many indi¬
viduals are sent into our colonies whose activity, enterprise, and ge¬
nius, contribute to bestow invaluable advantages upon thesh isolated
portions of the empire, which are deeply felt by the mother country.
How few, however, of those w’ho have fallen sacrifices to an honourable
sense of duty, have had their merits enrolled in the enviable annals of
futurity ; on the contrary, the great majority have sunk into premature
graves, “ unnoticed and unknown," To prevenf such an act of injus¬
tice in the present instance, is the intention, however feeble the per¬
formance may be, of the following memoir. ‘ ^ ' d '

Dr. Andrew Nicoll W'as the son of Mr. David 'Nicoll, a respectable
farmer in the parish of Seggie, near St. Andrew's, Fifeshire, in Scotland.
He received the rudiments of his education in the parish where he'was
born, and completed his classical studies at the University of Edin¬
burgh, where he entered himself a student of Humanity and of Medicine
in 1 SO7. Having completed his term of study, he graduated in 1810 J
and, almost immediately afterwards, was appointediitssistant-Surgeon
to the SOth regiment, then acting on the Madras establishment, where
he joined it in the followdng year. It was on this stage that Dr.
Nicoll first displayed his professionaf talents. ' He instituted a set of
experiments on tepid, warm, and hot baths, to determine the tempera¬
tures at which baths prove salutary or hurtful, cither to theiicilhhy,
or to those labouring under disease in India ; and, in conducting

1. “The Case of a Boy, seven years of age, who had HydrocephalusMn
whom the Bones of the Skull, once firmly united, were, in the progress of the
Disease, separated to a considerable distance from each other,”- — 2. “ Of
some uncommon Symptoms w hich occurred in a Case, of Hydrocephalus
Interims. ” ^ 3. “ Upon a strong Pulsation of the Aorta in the Epigastric
Region.” — -4. “ Upon a Case of Stricture of the Rectum, produced by a
Spasmodic Contraction of the Internal and External Sphincter of the Anus.*'
— 5. “ Some Observations respecting Green Jaundice.” — 6. “ Some Ob¬
servations on a particular Species of Purging.” — 7. “ Some Observations
upon Paiaph'gia in Adults.”

528

Medical and Physical Intelligence.

them, displayed a turn for experimenting, and an acuteness and accur
racy of observation, of the highest consequence to a medical philo¬
sopher. * His attention was, also, directed to the effects of the climate
of India on the hepatic functions; and, having many opportunities of
ascertaining the inaccuracy of the existing opinions on the nature
and treatment of hepatitis, he threw together his observations on this
disease, and suggested several improvements in the treatment of it, in
an Essay, which he presented to the Medical Board of Madras, in
March 1817, a few months before he left that Presidency on his re¬
turn to Europe. The high opinion which the Board entertained of
this production was evinced by an application which it made to the
author, requesting permission to print it at the expense of the govern¬
ment ; and, also, by a public communication addressed to him on his
leaving India, stating the regret of the members of the Board individu¬
ally and collectively, that one so well calculated to throw light upon
Indian diseases should be withdrawn from the field of inquiry. The
constant attention of Dr. Nicoll to the sufferings of the sick soldier,
led him to suggest many things to promote his comfort ; and, among
others, an excellent, cheap, portable vapour bath, which has been
found of the greatest utility in the treatment of chronic rheumatism ;
a disease under which soldiers suffer severely, particularly those who
have returned home after a long residence in tropical climates.

Soon after his arrival in England, Dr. Nicoll resigned his situation
in the 80th regiment, of which he had continued Assistant-Surgeon
only, although the whole charge of the corps had devolved on him,
owing to the ill health of the Surgeon. In leaving it, he carried with
him the benedictions of the privates, and the regrets and heartfelt
good wishes of his brother officers, to whom his open, affable, obliging,
gentlemanly deportment had greatly endeared him. He continued
for nearly a year officially unemployed after this period, but filling
up his time with acquiring a knowledge of Mineralogy, Botany, and
Natural History, in order to qualify himself for any situation abroad to
which he might fie appointed. His talents and application did not
long remain unobserved by the discriminating eye of Sir James Mac-
gregor, the Director-General of the Army Medical Staff ; who, con¬
ceiving justly that his genius was well adapted to prove useful in
Africa, and believing that he was prepared to combat the unwhole¬
someness of the climate from his previous seven years residence in
India, appointed him, with the rank of Staff-Surgeon, to the situation
of Chief Medical Officer at Sierra Leone; where he arrived in De¬
cember 1818.

The impulse which Dr. Nicoll’s energy, activity, and industry, pro¬
duced in the department over which he now presided in Africa, was
soon conspicuous. The whole was placed under new and more use¬
ful regulations ; the illustration of the effects of the climate on the
constitutions of the troops by morbid dissections, on every opportu¬
nity, was insisted upon; and reports of the appearances observed

1 See Hbpositort, Vol. IX. p. ISO.

529

Account of the Life o/'Dr. A. Nicoli-.

were demanded. The junior* medical officers, also, who had, pre*
viously, merely attended to their duty of visiting and prescribing for
the sick, were roused to direct their minds to obtain an accurate
knowledge of the topography of the places where they were stationed;
to cultivate Mineralogy and Botany; to collect and preserve objects
of Natural History, and to keep regular meteorological tables. The
quarterly reports, which were required from each establishment on the
coast, were embodied by Dr. Nicoli in general half-yearly reports,
which, being sent home, have supplied a mass of information of the
utmost importance to the health of our soldiers and sailors, who
may be destined to serve on a coast so ungenial to the constitution
of Englishmen as that of Africa. How well Dr. Nicoli fulfilled the
expectations formed of him on being appointed to this station, may be
conjectured from the fact, that he was honoured with the rank of De¬
puty-Inspector, a circumstance, when his previous rank is considered,
almost unprecedented in the service. His merits were also made the
subject of eulogy in a Report which was drawn up by Sir George
Ralph Collier in 1820, and laid before the House of Commons.

Before I conclude,’' says Sir George, my observations upon the
improved state of Sierra Leone, it is justice only which disposes me to
notice the indefatigable exertions of the chief of the medical depart¬
ment, Dr. Nicoli. No part of the establishment of this colony reflects
more credit upon the heads of departments, or does more honour to
the mother country, than the liberal manner in which this branch of
public duty is supported in England, and conducted at Sierra Leone.
And it is not merely in his professional duties that Dr. Nicoli shows
his zeal for the public service. His unwearied researches as to the
localities of the country, its capabilities and productions, as well as a
close investigation into the causes of disease, and the best mode of
treatment, make his life a most valuable one ; and his death or
removal would be an irreparable loss to the colony. Talent and
science, industry and application, are in him conspicuously blended.”

With this happy structure of mind and energetic disposition, Dr.
Nicoli could not long remain a passive spectator of the public transac¬
tions connected with the colony of Sierra Leone, nor indifferent to
the progress of civilization in Africa, and the welfare and ameliora¬
tion of the distressed condition of her sable sons. “ Nihil humani a me
alienum puto,” was the ruling principle of his life ; and, having obtain¬
ed a seat in the council of the government of Sierra Leone, he
suggested such measures as have contributed largely towards render¬
ing a station which formerly was not unjustly regarded as a mere place
of banishment, and the certain grave of our countrymen, superior in
many respects to the greater number of our colonies. He demonstrat¬
ed its advantages as a wide field of interesting research in natural his-
tory ; improved by his example the character of its limited society ;
and, by his statistical regulations, rendered the climate more salu¬
brious, at least, under ordinary circumstances, assuredly less fatal to
European life. But his exertions were not confined to Sierra Leone.
He courted the confidence of every stranger w-ho had visited, and of
every native who had come from, the interior of Africa ; and, had he

530

Medical and Physical Intelligence.

lived a few years longer, many of the difficulties which hiavQfC)gp|^fi^i
the efforts of Europeans to penetrate into that niysteriQU;S,;,GjagbtJpy
would have vanished. “ Wherever you turn your eye,” writes,
who was on the spot a witness of the labours of this excellent nian,“4i);
any improvement, to any advancement of civilization at Sierra Leone ;
if you observe a good road, a new bridge, a good essay in the Sierra
Leone Gazette, a correct and full almanack ; if you notice a valuable
collection of specimens of the productions of Africa; — Dr. ISicoll
alome was the projector, the architect, the author, the collector. The
loss of such a man is incalculable, irreparable ! His hospitality, too,
if it impoverished him, threw a lustre upon Sierra Leone, which en¬
livened to many a stranger the monotonous tedium of an African life.
His society was the chief delight of the place ; and it is not to be won¬
dered at that he was sought for by all enlightened visitors. He has
died poor ; but he was a public character, and his private losses aris¬
ing from munificence, if not to be indemnified, ought not to be placed
among his faults.”

The writer of this brief memoir of a friend, whose loss he must ever
deeply deplore, knew Dr. Nicoll before his powers were so fully de¬
veloped by the opportunities of exercising them which his destiny
supplied, and knew well the value of his private character. With
great liveliness of disposition, and a natural talent for satire, his con¬
versation was embellished by wit and pithy remark ; yet he was mild,
amiabk’j and modest, and endowed with all those kindly affections
which attract t)thers to their possessor, cement friendships, and render
them indissoluble. His discrimination of character was {|uick, .his
appreciation of merit in others correct, and his generosity and open¬
ness of heart so conspicuous, that in most instances he had become the
standard of excellence to those around him. He^ was unostentatious
in his habits, simple in his manners, and plain in his attire ; but, as
it may be readily conjectured from vvdiat has been said, his sociable
powers were considerable, and he had acc[uired a profuseness of ex¬
pense in his hospitality which left him the approbation of his conscience
only as the reward of his official labours. A short period before his
death, he made a will, leaving his papers to the writer of Jhmtsketch,
with a request that such of them as me^it publication may be sent
to the press. They have not yet all come tq hand ; but it is to be
hoped that nothing will occur to prevent thai desire from being gra¬
tified.

Dr. Nicoll had suffered from repeated attacks of feVer since his resi¬
dence in Africa ; but his last and fatal iilnCss' was an abscess in the
liver. “ He appeared, it seems, to have been unconscious of his dan¬
ger,” (writes the same gentleman who has already been mentioned as
having witnessed his valuable labours ;) “ and he coniinually talked of
his speedy recovery as soon as he should reach England. His liver,
however, had been long diseased ; but when he left Sierra Leone for
Cape Coast with the Governor, he was well ; yet there was a livid hue
on his cheeks, a restless irritability in his temper, and a gravity on his
face, which indicated that all wars not sound within. He delayed tak¬
ing medicine so soon as he should liave taken it, and he attributed his

Medical and Plijjskal InteUhj^cnce. o3l

complaint to the want of that occupation and active life to which he
was accustomed at Sierra Leone.” The effect which his death pro¬
duced on Sir Charles Maccarth}'’, and those associated with him in
the government of the colony, is thus described. “ The Governor
and suite arrived here (Saint Marys on the Gambia) a few days ago,
in the Cyrene, from Cape Coast, without stopping at Sierra Leone.

A gloom pervaded the whole party whcii it landed in the boats under
discharges of artillery. I anticipated something wrong. There seem¬
ed to be a colc^iindiff’erence in the shaking of hands among old friends ;
and when I had gone through that ceremonial, I thought some one
was wanting, the party was incomplete : but my doubts were at an
end, when VVeatheril, aide-de-camp to Sir Charles, turning to me, said,

‘ We have lost poor Nicoll ! all would have been well if he had been
spared 1’ Sir Charles Maccaithy was deeply affected at his decease,
and the more so as the danger was all along carefully concealed from
him. Sir Charles has lost in Dr. Nicoll his right hand, his adviser,
his confidential friehd, his companion in all his toils and pleasures ;
and life here must appear a blank to him after so great a separation.

Our departed friend kept up his spirits and his sociability even to
the last moment of his life. He fell a sacrifice to his ’sense of duty :
for if, instead of accompanying the Governor to Cape Coast, he had
returned to England from Sierra Leone in November last, his life pro¬
bably would have been spared for many years. So useful was he,
however, to our worthy Governor, that it is not astonishing he should
have persuaded him to remain on the coast; but our friend has just
verified your prophecy, that he would stay until it was too late to re¬
turn.”

To sum up Dr. Nicoll’s character, he was, as a man, simple, ami¬
able, and constituted to adorn society; as a friend, sincere and un¬
changeable ; as a physician, attentive, kind-hearted, acute in his per¬
ception of disease, and ready in devising means to defeat its jnfluence ;
as a man of science, ardent, and possessing a mind of uncommon
grasp; and as a philanthropist, noble-minded and disinterested in the
highest degree. His friends, his country, will ever lament his com¬
pliancy of disposition in sacrificing himself to a feeling of propriety ;
yet it is consolatory to reflect, that the thought that he was in the line
of his duty must have soothed the last moments of a life so devoted to
the service of his country as that of Dr Nicoll.

• “ Dulce et decorum est pro patria mori.” . .

III. Case in which a Tumour was found within the Vena Porta.

By M. Honore.

In our 118th Number, Mr. Ward recorded a case in which a tumour
was found on dissection wdthin the vena porta. A somewhat similar in¬
stance has been detailed in the Academie Poyale de Medecine of Paris, at
their sitting of the 9th of September last, by M. HonorG and the morbid
structure presented to the Academy. This tumour was developed in the
substance of the parietes of this vessel, just before it entered the liver. Its
size was that of a large nut : it projected entirely into the interior of the
vein, and appeared to be developed immediately beneath the internal or
serous tunic of the vessel ; it offered all the characters of the adipose tissue.

532

Medical and Physical Inielligmce^

The individual in whom it was found was affected with icterus and casicer
of the stomach. There was no serous accumulation within the peritoneal
cavity, although the vena porta was almost entirely obstructed by this
tumour.

Pathologists have generally remarked, that adipose tumours have seldom
or ever been found in the cellular texture which unites the different coats of
the vascular parietes, whether arterial or venous. They are very rarely
found in the cellular tissue, uniting the tunics of the digestive canal, and
then only in the sub-mucous texture. A case of this latter description has
been mentioned by M. Andral; (see his account of the pathological
anatomy of the digestive canal in some of our late Numbers;) and the one
now recorded by M. Honore seems to present an analogous character. —
(Archives Gerier. Sept. 1823.^

IV. Case of Softening of the Anterior Part of the Medulla Oblongata
and Spinal Marrow. — By M. Royer-Collard.

M. Royer-Collard, at the August meeting of the Royal Academy of
Medicine of Paris, detailed the particulars of a case in which the anterior
portion of the spinal marrow was exceedingly softened. The subject of the
case had been in a state of mental alienation since 1805. During ten
years this man continued in a state of .stupidity : his taciturnity was re¬
markable. His lower extremities were unsteady. About 1816, the abdo¬
minal members became more and more feeble, and soon were incapable of
executing any kind of motion: they preserved, however, their sensibility
unimpaired. The patient sank, in 1823, into a sort of apoplectic state. —
Dissection : the pia mater of the anterior face of the spinal marrow pre¬
sented a yellowish colour : the corpora olivaria and pyramidalia, as well as
the bundles constituting the anterior part of the spinal chord, were greyish,
and as soft as houillie. The anterior roots of the spinal nerves had also
experienced a similar softening. The posterior portion of the spinal chord,
and the posterior roots of the nerves, were of a healthy appearance. The
thalami optici, and the corpora striata, were also softened, but in a less
degree than the marrow. — (Rev. Med. Sept. 1823.

V. Case of Chronic Hydrocephalus in an Adult Female.

In one of the late Numbers of Hufeland’s Journal, the case of a female,
aged eighteen years, is detailed, who died of hydrocephalus, under which she
had laboured during fifteen years. The dissection of her head presented the
cranium almost completely ossified : it was only slightly transparent in the
situation of the fontanells. The circumference of her head was twenty-six
inches and a half ; the antero-posterior diameter was ten inches and a half ;
the transverse diameter eight and a half; the vertical diameter eight
and three-fourths ; the oblique diameter thirteen inches and three-
fourths ; and the whole length of the body was fifty-four inches and a
half. Between the brain and its meninges, about twenty ounces of a yel¬
lowish fluid were found. The brain itself, in which could no longer be
detected the usual anatomical disposition of parts, and w'hich offered more
the appearance of a kind of pulpy sac than a natural brain, contained about
nine ounces of a similar fluid.

The aqueous accumulation extended also to the spinal column, forming
the complication of hydrocephalus with dropsy of the spine. The verte¬
bral column was inspected, and the spinal chord found only to fill half the
canal; above two ounces of fluid escaped on opening it. Although the
patient had sustained this disease for fifteen years, she enjoyed notwith¬
standing, until the two last months of her life, all her faculties. Her cata¬
menia were always regular, and even abundant.

Medical and Physical Ldelligence. 535

*Vl,Cas^ qf‘ hitiis-S?isception, followed hy the Evacuation, per anumy of about

.»iO inches of Small Jutesiine and a Portion (if Mesentery. By MM.
Bouniol and lliGAL fils.

At a late meeting of the Academie Royale de Medecme, M. Larrey read
a report, in his name, and in that of MM. Roux and Bedard, on a case
under the above title. The individual who was the subject of it had
laboured under violent dyspepsia, after which he was attacked with every
symptom announcing internal strangulation, such as complete suppression
of the alvine evacuations, vomiting of faecal matter, hiccup, and severe pain
of the abdomen, with an elevated tumour, very sensible to the touch, in the
right iliac region. At the end of twelve days, after violent pain in the
bowels, the portion of intestine above mentioned was evacuated per anum.
From this time the patient rapidly improved, a painful sensation in the
right iliac region being the only inconvenience remaining. /Vt the end of
about three months, this individual, after having eaten a large quantity of
cherries, was attacked with symptoms of peritonitis, and died. Permission
could not be obtained to open the body. The preparation sent to tlie
Academie certainly resembled, in every respect, a portion of intestine and
mesentery. M. Larrey supposes, w'hat is indeed the only rational suppo¬
sition, that a portion of intestine, invaginated, strangulated, and struck with
gangrene, had become separated from the living tissues, and had entered
into the great intestine, whence it had been evacuated. By a successliil
effort of nature, both ends of the living intestine, coining in contact, had
reunited. — Revue Mtdicale, AoCit, 1823.

VII. Efficacy of the Chloruret of Lime as a disinfecting Agent.

Messrs, Orfila, Lesueur, Gerdy, and Ilennelle, having been requested by
the Procureur du Roi to examine the body of an individual w'ho was
supposed to have been poisoned, and who had been dead for nearly a
month, found the smell so insupportable, that they were induced to try
the application of the chloruret of lime, as recommended by M. l.abarraque
in the pamphlet to which we had occasion to refer in our last Number. A
solution of this substance was frequently sprinkled over the bodiq and
produced quite a marvellous effect; for scarcely had they made a few
aspersions, when the unpleasant odour was instantly destroyed, and the
operation could be proceeded in with comparative comfort. — Archives
Gtnerales de Medecine, Aofit, 1823.

VIII. Vegetable Milk.

Amongst the many interesting vegetable productions which are met with
in the equinoctial regions, may be reckoned a tree which abundantly affords
a milky juice, similar in its properties to the milk of animals, and is em¬
ployed for the same purposes, as M. de Humboldt witnessed at the farm of
Barbula, where he himself drank of this milky juice. This liquid is derived
from the palo de loche, or de vacca, a tree which grows somewhat abun¬
dantly in ihe mountams above Periquito, situated to the north-east of Mara-
cay, a village to the w^est of Caracas. This milk possesses the same
physical qualities as that of the cow, wdth this only difference, that it i.s a
little viscous : it has the same taste also as cow’s milk. With respect to its
chemical properties, they sensibly differ from those of animal milk, d he
constituent parts of the milk of the Arbre de la Vache are — 1st, wax;
2d, fibrine ; 3d, a little sugar ; 4th, a magnesian salt ; and 5th, water. The
presence, in vegetaVile milk, of a product which is not commonly met with,
except in the secretions of animals, is a surprising fact, wdiich we sliould not
have announced without much circumspection, hud not one of our most
celebrated chemists, M. Vauquelin, already found anmul fibrine in the
milky juice of the carica papaya- — (Gazette de (SftAde, J uillet, 1823. J

VOL. XX. — NO. 120. 3 z

534

Medical and Fhj/skal Intelligence.

IX. On the Exhalation of Carbonic Acid during Kespiration, ,

By Dr. Edwards.

This eiDiDent physiologist has communicated to tlie French Institute the
result of numen^us experiments which he has made respecting the exhalation
of citrbonic acid during expiration. He proves that carbonic acid does not
form instantaneously in the lungs through the action of the respired air, but
that it is secreted from the blood in the respiratory organs. Dr. Edwards
placed some cold-blooded animals in perfectly pure hydrogen. The respira¬
tion was kept up for several hours as in atmospheric air; and he discovered,
after this lapse of lime, the presence of a quantity of carbonic acid, nearly
equal to that which would have been effected in atmospheric air. — Kevue
Xledicale, Aout, 1823.

X. On the Transmission of Contagious Principles from the Lozcer Animals
to the Human Species. By Professor Remer, of Breslau.

One great question in pathology is to ascertain if Hydrophobia and
Vaccinia are the only maladies which may be transmitted from the lower
animals to man ; or if a similar transmission may likewise take place in other
diseases to which ariimals are subject ; and in the latter case, what are
these diseases } In order to solve this question, M. Remer adduces a num¬
ber of facts, which prove, in a very conclusive manner, that certain other
disorders, such as the virulent coryza of horses, the plica of animals
covered with hair, the gangrenous inflammation of the spleen, which occurs
in cows, &c. may, from immediate contact, be transmitted from the animal
to the human species, and there give rise to diseases entirely resembling
those which gave them origin. — Archives Gentr. Sept, 1823.

XI.^ A new Remedp for excessive Salivation.

Dr. Kruger-Haiisen, of Gostrow, has given an account of a man who,
during a state of excessive salivation, attended with haemorrhage from the
gums, had employed the usual astringent gargles without benefit, who after¬
wards covered his tongue and inside of his mouth and fauces with tar, by
means of a brush. He soon afterwards recovered, without any other
remedy. Dr. K. has since employed the same means in several cases, Tvith
the effect of quickly removing this disagreeable consequence of medical
treatment, without any inconvenience resulting from this new method. —
Rev. Med. Juillet, 1823.

XII. Lectures 07i Medical Jurisprudence. By J. Gordon Smith, M.D.

We have been much surprised that, notwithstanding the great attention
that has been devoted to Forensic Medicine by the best writers in our
Profession^ no regular course of lectures has been given on this branch of
medicine for some time. We are happy to find that this desideratum is at
length about to be supplied by Dr. Gordon Smith, to w'hom this department
of medical science is chiefly indebted in this country. This able Physician
intends to commence his course in the first week of January, 1824, and to
continue it till the end of March.

Although the works on medical jurisprudence furnish the student with
much information, yet no one who wishes to obtain a comprehensive know¬
ledge of an important branch of professional practice would rest satisfied
with that alone. The copious and practical details furnished by a full course
of lectures are requisite to the obtaining a satisfactory stock of information
in this, as well as in other departments of medicine. There is no school of
medicine in Europe, except the London schools, where a proper provision is
not made for this study; and we hope the British metropolis will be no
longer an exception.

We are happy to understand that Dr. Smith intends not only to teach by
prbcept, but to exemplify, by experiment and demonstration, the solution of

Monthly Bibliography, Works for Review, S^c. 535

the many important problems which are nsually referred by tribunals and
the administration of a country to medical men. Such modes of instruc¬
tion, we may venture to assert, will put the medical Practitioner at once in
possession of a stock of knowledge equivalent, perhaps even superior, to
experience.

MONTHLY MEDICAL BIBLIOGRAPHY.

BRITISH.

Chemical Recreations : a Series of amusing and instructive
Experiments, which may be performed easily, safely, and at little
expense ; to which are prefixed. First Lines of Chemistry, wherein
the principal Facts of the Science are familiarly explained ; with a
minute Description of a cheap and simple Apparatus; illustrated by
Seventy engraved Figures of the different parts of it. l2mo. Pp. 228.
Glasgow, Edinburgh, and London, 1823.

The title-page of this volume very happily expresses its nature and
objects. It is inscribed to the members of the Mechanics' Institution of
Glasgow^, and, in our judgment, is eminently calculated to fulfil the pur¬
poses for which it has been composed. Simplicity of diction, perspicuity of
arrangement, together with remarkable accuracy and comprehensiveness of
description, form its characteristic traits. It is modest and meritorious :
the early student will peruse it with advantage — the philosopher wdth
approbation.

FOREIGN.

Nouveiles Demonstrations d’Accouchemens ; avec des Planches
en taille-douce, accompagnees d’un texte raisonne propre ^ en
faciliter I’explication. Par J. P. Maygrier, D.M.P. &c. &c.

The three parts of this splendid work which have appeared deserve, in
every respect, the fullest commendation. The plates are on copper, and
are well executed and faithful to nature. The twelve plates contained in
these livraisons furnish views of the pelvis in its healthy and distorted con¬
ditions, and of the anatomy of the external and internal parts concerned in
the generative processes, &c. The work will be peculiarly interesting to
the Accoucheur-Practitioner.,

WORKS RECEIVED FOR REVIEW.

I. Observations illustrative of the History and Treatment of Chronic
Debility ; the prolific Source of Indigestion, Spasmodic Diseases, and
various Nervous Affections. By William Shearman, M. D. Member of the
Royal College of Physicians, London, &c. &c. London, 1824. T. and G.
Underwood.

II. A Statement of the early Symptoms which lead to Water in the
Brain ; with Observations on the necessity of a watchful attention to them,
and on the fatal consequences of their neglect. By G. T. Yeats, M.D.
F.R.S. Fellow of the Royal College of Physicians, London, &c. &c. Second
edition, enlarged. Phillips. 1823.

LITERARY INTELLIGENCE.

Mr. Purseglove, sen. has nearly ready for publication, “ A Guide to
Practical Farriery; containing Hints on the Diseases of Horses and Cattle,
with many valuable and original Recipes, from the Practice of an eminent
Veterinary Surgeon."

THE METEOROLOGICAL JOUHNAL,

Fj^intkef l^th of OCTOBERf to the 9.0th of NOVEMBER, 18*2^3.

By Messrs. HARRIS and Co.

Mathematical Instrument Makers, 50, High Holborn.

•

Moon. 1

Therm.

Barom.

De Luc’s
Hygrom

Winds.

•

9 A.M.

lOP.M.

1 Q A. M.

s’,

•

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j57

! 84

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50 30

! 80

NNE

50 30

7.5

1 75

ENE

NNE

52I29

FNE

NNE

48 29

ENE

45 30

44 30

4530

WSW

46 29

ssw

44 29

WSW

SSW

44i29

NNE

,97

39 28

NNW

34 29

NNW

i43

3330

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45 29

WSW

SSW

51;

44 29'

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f45-29

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49,29

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4030

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39 30

28 30

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30 30

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34 30

35 30

SSW

34 30

SW ■

44 30

isr

40 30

38 30

•

37 30

44 30

E ISW

Atmo. Variation

Clo.

Fair

Fine

Fog.

0"c.

Fine

Rain

Fair

Fine

Fog.

Fine

Rain

Fog.

Rain

Fine

Fog.

A-'

10 P. M.

Fine

^ J

Fog.

Ovc,

Ovc.

Fog.

Clo.

Rain

Fine

Fair j

Rain

Rainj

Sto.

Sto. j

Fine 1

Fine |

Fine

Rain

— 1

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Rain!

Rainj

Clo. 1

cio. !

Fine

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Fog.

—

Fine

Ovc.

Clo.

Fine

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I'og

Mist.

Clo

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Ovc.

Fair

Fog,

Fine

Fog.

The quantity of Rain fallen in tlie month of October was 1 in. 54~100ths.

Notice to Correspondents. — Papers have been received from Dr. Pritchard,
Mr. lliif, Mr. Foshroke, and Mr. Sprague; also from Mr. Law, communicated
by Dr. Birkbeck, and from Dr. Chisholm, Dr. Irvine, and Dr. Bang, through
the hands of Dr. James Johnson.

M.O. must perceive the propriety of placing his name to his Communication.

Pharmacopolist is informed, that w’e have no knowledge w’hen the new
edition of the London Pharmacopoeia will be published.

Oiir Readers will perceive that we have been obliged to print a great part of the present
Number in a smaller type, and to give an additional quarter-sheet, in order to accouimotlate
our esteemed Correspondents.

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

INDEX

THE TWENTIETH VOLUME.

Absorbent System, progress of its

pathology - _ - 23

Acid, nitric, with opium in hec¬
tic fever - - - 175

— the oxalic, researches re¬
specting poisoning by - - 132

Acids, new ones discovered by
MM. Lassaigne and Zeize 131
Acupunctura, Ur. Carter'^s re¬
marks on - - - 455

Acupuncturation in anasarca 313

— successfully employed in

traumatic trismus, by Mr.
Finch - - - 403

Adventitious tissues, on the ra¬
pid developement of - - 254

— cases of - - . 255

Agues treated by frictions with

antimonial ointment - - 86

Alkali, a new vegetable one in
rhubarb - - . - 440

Ammonia, injections of, recom¬
mended in amenorrhcea - 265
Amesbury, Mr. observations on
the nature and treatment of
fractures, by - - - 219

— description of a new appara¬

tus by, for fractures of the
humerus - _ _ 219

Amenorrhcea, case of - - 449

Amaurosis, case of - - 217

Anasarca treated by acupunc¬
turation - - - - 313

Anatomy, General, sketch of
its progress - - - 2

Anatomy, Mr. Lizars* work,
and plates on - - - 442

Andouard, M. on the epidemic
of Barcelona - - - 42

Andral's, M. observations on
the rapid development of ad¬
ventitious tissues - - 254

— cases of - - - - ib.

— experiments with brucine 348
- strychnine - 346

— work on clinical medicine

noticed _ - _ _ 443

VOL. XX. — NO. 120.

Animal bodies, Ur. Ure's re¬
searches respecting - - 125

Aneurism, various operations for 97

— case of axillary successfully
operated on by Mr. Bullen 190

— of the aorta, cases of, by Mr.

Ward - - - 196, 382

Anthelmintics, new ones - 94

Antimonii tartarizat. in the
treatment of agues - - 86

Aorta, cases of aneurism of

196, 382

Apoplexy, its connexion with
diseases of the heart - - 17

Apothecaries, Associated, their
report _ - _ _ 475

Apparatus, Mr. Amesbury’s^ for
fractures of the humerus - 231
Arachnoid, inflammation of,
connected with that of the
mucous surface of the intes¬
tinal canal - - - 3 1

Army medical officers’ fund - 87

Arsenic, on poisoning with the
white oxide of - - - 349

— cases of - - - - ib.

Artery, the subclavian, success¬
fully tied by Mr. Bullen - 190

ADeril, Mr. his operative sur¬
gery reviewed - - -s 77

Baillie, Ur. some account of
his life - - _ _ 520

— of his professional character 523

— ' of his writino;s - - - 525

Barnard, Mr. case of hydroce¬
phalus treated by pressure 314

Bayfield, Mr. on cupping, re¬
viewed - - - - 335

Bayle, Ur. his manual of de¬
scriptive anatomy noticed 265
Bedard, Professor, his opera¬
tion for salivary fistula - 354
Bell, Mr. C. on some of the
functions of the eye - 12

Bennoiston de Chateau-Neuf,

M. on comparative liability
to disease - - - 52

4 A ^

538

INDEX.

Bibliography, Monthly Me¬
dical and Scientific — Bri¬
tish, 87, 178, 265, 442, 535.

— Foreign, 87, 179, 265,

354, 443, 535.

Blackefs, Mr. cases treated by
sulphureous fumigation - 316
Bland, M. case of rupture of
the vena cava by - - 295

Blood, the pathology of its de¬
terminations examined - 321
Boisseau, M. on the pathology
of fever - - - 50

Bonneau and Sulpicy on epi¬
demic fever - - - 43

Books, British and Foreign,
see Beviezvs.

Bories, M. his formulary of
Montpellier _ _ - 355

Botany, sketch of its progress 119
Bouillaud, M. on the oblitera¬
tion of veins - ’ - - 168

Brain, respecting its pathology 14

— Editor’s opinions on a point

of its pathology - - 16

— Mr. Pretty’s case of suppu¬
ration of - - - 204

— softening of M. Rostan’s on,

remewed - - - 337, 429

— the foetal, on the destruction

of - - - - 424

Brayne’s Mr. cases of biliary
calculi - - _ 418

Brera, Professor, his formulae
of, and remarks on, iodine 90
Bronchocele, a case of - - 425

Bronchotomy, performance of 102
Brown, his pathology examined 74
Brucine, the manner of obtain¬
ing it - - - - 347

— -experiments with it in disease 348
Bullen’s, Mr. successful case of
axillary aneurism - - 190

Buren, Mr. Van, his cases of
Caesarean operation - 116

Burrows, Dr. his institution for
the insane . _ - 441

Caesarean operation, successful
cases of - - - 115

Calculi, biliary, cases of - 418

Cancer, on the diseases resem¬
bling, by Mr. Earle - - 420

— Chimney-sweepers, on - 424

Cardia, case of scirrhus of - 210
Carter, Dr. his report of the

medical diseases treated at
the Canterbury Hospital 386, 445

Casper, Dr. on injuries of the
spinal marrow - - 518

Cava, illustrations and re¬
searches on rupture of, by
Dr. Kennedy - - - 269

— cases of, - - - 27 2

Charcoal recommended in ob¬
stinate constipation - - 92

Chemical Recreations, a work
entitled, noticed - - 535

Chemistry, sketch of its pro¬
gress _ - - _ 124

Chz'istison, Dr. on poisoning by
oxalic acid _ _ - 132

Church, Dr. case of rupture of
the uterus from diseased blad¬
der, by - - - - 1 13

Clauhry, M. Gaultier de, on
the pathology of fever - 51

Classification of the textures
and organs of the body - 1

Colchicum, fatal case from its
exhibition - - - 427

Collard, M. Royer, case of
softening of the spinal cord
by - - - 532

— on disease of the spinal mar¬
row - - _ - 173

College of Physicians, its con¬
duct animadverted on - 239
Conception, Fallopian, case of 111
Concretions, pulmonary, on the
nature of - - - 20

Consumption, the tonic treat¬
ment of - - - 64

Contagion, on its transmission
from the lower animals - 534
Copland, Dr. his remarks on the
transmission of a contagious
virus - - - 24

— his pathology of rheumatism 28

— account of the life and cha¬
racter of Dr. Baillie, by - 520

Coster, M. on the therapeutical
effects of iodine - - 438

Coste’s, Dr. cases of perforation
of the stomach - - 212

Craigie, Dr. his views of the
connexion of apoplexy with
cardiac disease - - 17

Cribb’s, Mr. inquiry into the \

procreative powers of twin-
females - - - 213

Cupping, Mr. Bayfield on, re-
mewed - - - 335

— directions how to perform it 336
Daniel's, Dr. recommendation

INDEX.

539

of charcoal in obstinate con¬
stipation - - - - 92

Darrach'Sy Dr. case of puerperal
convulsions cured by the er¬
got of rye - - 153

Decoctions, suggestions respect¬
ing - - - 483

De HaeUf case of rupture of
the vena cava, by - - 293

Delpech, M. on clinical surgery 1 08
Dendy, Mr. case of miliary
fever by - - - - 207

Denton's, Mr. case of haemate-
mosis - . . - 367

Diabetes, Editor's opinions as
to its patliology - - 33

Diarrhoea, chronic, its treatment 6 1

— chronic, treated by ergot of

rye - - - - 151

Diabetes, case of - - - 390

Dictionnaire de M^decine, the
7th voi. noticed - - 179

Digestive canal, on its pathology 33

— organs, treatment of their

diseases . - - 62, 330

Digitalis, on the use of, in pul¬
monary disease - - 457

Diseases resembling cancer, on

the production of - - 420

— treatment of - - - 422

— inflammatory, the treatment

of - - - - 326

— encephalic, respecting - 328

Bloodletting, respecting, in va¬
rious diseases - - - 326

Dommanget, M. on small-pox 52
Dolaus, his case of rupture of
the vena cava - - - 288

Doty, Dr. his cases of success¬
ful Caesarean operation - 116

Doubleday's, Dr. case of rup¬
ture of the vena cava - 296

Dropsy, general, case of, with
the dissection - - - 396

— remarks on - - - 397

— passive, on the pathology

of - - . 168

— - cases illustrating the 169

Dugcs, M. on the pathology of

fever - - - - 51

Dupre, Dr. on endemic fever 43
Earle's, Mr. observations in
surgery noticed - - 178

— remarks in ansv^er to Sir As-

tley Cooper's Reply, &c. - 309

— on local irritation in the pro¬

duction of diseases resem¬
bling cancer _ - - 420

Earle's, Mr. on chimney-sweep¬
ers' cancer - - - 424

Earthquake, shock of, felt at
seal - - - - 175

Editor's opinions as to the pa¬
thology of diabetes - - 33

Edwards, Dr, on the functions
of respiration - - - 10

Emetics recommended in exces¬
sive salivation - - - 174

Empyema, cases of the opera¬
tion in - - - - 103

Encephalic diseases, on their
treatment - - - 328

Encephalitis, chronic, case of 393
Encephalon, on its chronic dis¬
eases - - - - 157

Enteritis, blue urine voided in a
case of - - - - 265

Ergot of Rye, M. Cordier on 86

— in chronic diarrhoea - 151

— in puerperal convulsions 112, 153
Esquirol, M. on hanging - 135
Evidence, medical, the way in

which it ought to be given 247
Extracts, on the preparation of
various - - - - 485

Eye, Mr. C. Bell on some of its
functions - - - 12

— Mr. Guthrie on its opera¬
tive surgery - - - 504

— on the removal of foreign bo¬
dies from the - - 516

Eyelids, on inversion of - 505

— on eversion of - - 508

— on cohesion of - - 512

— wounds of - _ - 512

■ — ^tumours of - - - 513

Fear, the fatal effects of - 352
Femur, on the fracture of the

neck of - - • - 309

Fellows of the College of Phy¬
sicians, on their illiberal po¬
licy - _ . _ 239

Fever, epidemic, causes of 40

— Dr. O' Halloran on - - 40

— M. Audouard on - - 42

— M. Bonneau and Sulpicy

on - - _ 43

— M. Dupri on endemic - 43

— epidemic, writers on its

causes - - - - 45

— writers on its pathology 49

— views of its pathology - 50

— hectic, opium in nitric acid

recommended for - - 175

— miliary, Mr. Dendy's case

of - - - - 207

540

INDEX.

Finch's, Mr. case of trismus
cured by acupuncturation
Fistula into the lungs from the
side of the thorax
— salivary, operation for
FJourens, M. researches by, on
the nervous system
Formulary for the preparation
and exhibition of new reme¬
dies, remewed

Fonblanque, Mr. on medical
jurisprudence, remewed
Fontaneilles, Dr. on the treat¬
ment of glandular diseases -
Fractures, Mr. Amesbury, on

7— of the humerus, a new ap¬
paratus for _ _ -

— of the neck of the femur,
Mr. Earle on

— on local scorbutus in
Fumigation, sulphureous, cases

successfully treated by
Fungus, heematodes of the eye¬
ball, case of - - -

Gaitskell's, Mr. case of lacera¬
tion of the perinasum, bladder,
and rectum - - -

— observations on the use of
the vectis, &c.

Generative organs, facts respect¬
ing - - -

Glandular textures, their pa¬
thology

Gr'deffe, Professor, his case of
ligature of the art. innomi-
nata - _

Gregory, Dr. his elements of
the practice of physic, re¬
viewed - - -

Guthrie, Mr. on the opera¬
tive surgery of the eye, re¬
viewed - - - -

Da den, Mr. T. his translation
of M. Magendie's formulary

— on venous congestion of the

lungs - - - -

Hsematemosis, case of - -

Haemoptysis, case of - -

Halliday, Sir Andrew, case of
melanosis, communicated by

19,

Hanging, on the evidence of
Hernia, umbilical. Dr. Sutton's
singular case of
Heart, on the chronic affections
of the

Heart inflamed after poisoning
by arsenic - - 350

— case of organic disease of 451
Humerus, Mr. Amesbury on

the fractures of - > - 227

Humoral pathology, examina¬
tion of - - - - 68

— how far just - n- - ib.

Hydrargyri oxymuriatis liquor,

a formula for - - - 417

Hydrocephalus, acute, with soft¬
ening of the brain, case of 372

— chronicus, successfully treat¬
ed by pressure - - 314

— chronic, a singular case of,

in an adult - _ - 532

Hydrothorax, cases of - - 399

Inflammation, Editor's opinions
respecting some of its pheno¬
mena - - 22

— M. Payer respecting - 21

Infusions, remarks and sugges¬
tions respecting - - 481

Innominata, ligature of the, by

Dr. Motte - - 97

- — by Gr'deffe - - 98

Insane, account of establish¬
ments for their medical treat¬
ment and care - - 441

Instruments, Mr. Morris's new¬
ly invented - - 318

Intestinal canal, its pathology 35

— treatment of its disorders 62
Intus-susception, a singular

case of - - 533

Iodine, an account of the va¬
rious preparations of - 89

— the action of - - - 92

— recommended in scrofula,

and in tubercular consump¬
tion - - - 428

■ — on the therapeutical effects
of, by M. Coster - - 438

Iron, suggested preparations of 415
Isenflamm, Professor, on the
structure of tendons - - 3

Jacobson, Dr. on the arrange¬
ment of the nervous system
in various animals - - 2

Jaw, the lower, amputation
of - - - 101

JulicA, M. on hydro-cyanate of
iron in urine - - - 264

— his researches on the air of

marshes, noticed - - 354

Jurisprudence, medical lectures
on . _ _ 534

Kennedy, Dr. his illustrations

403

351

354

425

237

■j

219

231

309

352

316

376

379

154

504

425

144

367

454

197

135

358

163

INDEX.

541

and researches respecting
rupture of the vena cava 269
Kennedy' s, Dr. cases of rupture
of the vena cava, by - 300

King, Mr. on the effects of ir¬
ritating substances on the in¬
testines when rubbed on the
spine - - 148

— case of enlarged spleen, with

remarks - _ - 360

Knox, Dr. on the regeneration
of bone - - - - 29

Kunth, Professor, his wmrk on
botany - - - 120

Dallemand, Professor, on the
pathology of the brain - 14

— amputation of the lower jaw

by - - - 101

Lancisi, case of rupture of the
vena cava by - - - 290

Lavagna, Dr, on injections of
the volatile alkali in amenor-
rhoea - - - - 265

Lauren's, M. case of rupture of
the vena cava by - - 276

Lead, on the preparations of 479
Lehidois, M. remarkable case
of fistulous opening by - 351
Legal Medicine, sketch of its
progress - - - 132

Licentiates of the College of
Physicians, on the improper
conduct of many of - 243

Lime, its cloruret as a disin¬
fecting agent - . - 533

Lips, on diseases of - - 421

Liver, cases of rupture of - 149

— case of abscess in, &c. " - 453

Lizars’ Mr. system of anatomi¬
cal plates by - - - 442

Lovadina, Dr. case of rupture
of the vena cava, by - 299

Lunatics, the manner of ascer¬
taining - - - - 251

Lungs, on the structure of - 4

— state of, during respiration 11

— on venous congestion of 144

— case of - - - - 146

Magendie's, M. remarks on the

functions of the spinal mar¬
row - - - - 84

— formulary, by Mr. Haden,

reviewed - - - 425

Mammae, case of scrofula of 448
Marasmus, observations on the
modifications and treatment
of - - - - 137

— cases of - - - 140

Marrow, spinal, case of its de¬
struction - - - 81

— M. Magendie's remarks on 84
Marshes, the air, researches on 354
Materia Medica, sketch of

’its progress - - - 89

— proposed additions to - 409
Maygrier, M. plates illustrat¬
ing midwifery noticed - 535

Mayo, Mr. his physiological
commentaries, noticed - 265
Medical jurisprudence, review
of, Paris and Fonblanque on 237
Medico-chirurgical transactions
reviewed - - - 418

Medulla oblongata, case of soft¬
ening of, &c. - - 532

Melanosis, case of, communi¬
cated by Sir Andrezo Halli-
day _ - - _ 197

— dissection of - - 202

Menorrhagia, case of - - 445

Meteorological Journals

— 88, 180. 268, 356, 444,

356.

Meteorological science, a so¬
ciety for its cultivation - 442
Midwifery, state of its pro¬
gress - “ - - 110

— remarks on its regulation 246

Milk, account of a vegetable 533
Mixtu res, suggestions respect¬
ing - “ . - 487

Morris, Mr. description of new¬
ly invented trephining in¬
struments and saws - - 318

Mott, Dr. ligature of the art.

innominata by - - 97

Ivloxa, its use in India - - 86

Nerves, origin of disease in, the
pathology of, examined - 332

— the ganglial, the difference
of their functions contended

for _ - - _ 333

Nervous system, the researches
of Polando and Flourens on 5

— views of its physiology - 6

— - on the treatment of its dis¬
eases - “ - - 58

Neuralgia faciei, case of - 394
Nicoll, Dr. Andrew, account
of his life and character - 527
Nux vomica, respecting poison¬
ing by - - - - 136

O' Halloran, Dr. on the epide¬
mic of Barcelona - - 40

Oil, its efficacy in poisoning by
potash - - « _ 440

542

INDEX.

Ointments, remarks on - 495

Opium in nitric acid, for hectic
fever _ - . - 175

Orjila, Professor, on poisoning
with the arsenious acid - 349
Palate, congenital division of,
successfully treated - 365

Paralysis, cases of, treated with
strychnine _ _ . 346

— treated with brucine - 348

Paris, Dr. on medical juris¬
prudence, reviewed - - 237

Paris, the marriages, deaths, and

births in, in 1822 - - 353

Pathology, sketch of its pro¬
gress - - - - 14

— Dr. Pring’s views of - 53

— contributions to, by Dr.

Kennedy - - _ 269

— contributions to No. 1 and

2, by Mr. Ward - 307, 382
Penitentiary of Milbank, the
committee of the Commons*
report on - - - 438

Percival, Mr. his veterinary
surgery noticed - - 87

Perinasum, case of laceration of,

&c. - - - - 376

Peritonitis, its treatment dis¬
cussed - - _ - 327

Peru, on the balsam of - 456

Phagedsena, case of sloughing,
by Dr. Sutton - - 305

Pharmacological remarks and
suggestions, by Mr. Sprague

405, 479

Pharmacopoeia, the preparations
of the London, examined 411, 479
Pharmacy, sketch of its pro¬

gress - _ - - 95

Physic, the elements of, by
Gregory, reviewed - - 154

Physician, A, his observations on
the nature and cure of maras¬
mus - - - _ 137

Physicians, College of. Editors'
observations on the policy of
the Fellows of the - - 239

Physician, can he recover his
fees - - _ - 245

Physiology, view of its pro¬
gress - r “ - 5

Pills, suggestions respecting 493

Plants, M. Saussure on the
physiology of - - - 123

Poisoning by potash, the effi¬
cacy of oil in - - - 440

— by lead, cured by sugar 441

Poisons, morbid, respecting 70
Police, medical, respecting 246
Portal, M. on rupture of the
vena cava - - - 297

Poterius, case of rupture of the
vena cava, by - - 289

Powders, suggestions respecting 492
Preparations, additional ones
proposed - _ - 407

Prepuce, on the pathology and
treatment of its diseases 423
Pretty, Mr. his case of suppu¬
ration of the brain - - 204

Pring, Dr. account of his views
in pathology - - - 53

— his general principles of the¬
rapeutics - - - 66

■ — his principles of pathology
and therapeutics reviewed 66, 32 1
Progress op Medical Sci¬
ence, history of - - 1

Pterygium, the operation for 515
Puerarius, his case of rupture
of the vena cava - - 283

Pulmonary disease treated by
digitalis _ - _ , 457

— cases of, illustrative of the

use of digitalis - - 463

Pulse, Dr. Shearman's observa¬
tions on - - - _ 184

Purpura h£emorrhagica, ikfr.
Thompson's case of - - 368

— the state of the blood in - 20

Pyrosis, cases of - - 447

Reisseisen, Dr. on the struc¬
ture of the lungs - - 4

Remedies, the classification of 95
Report, Dr. Carter's, of the
diseases treated at the Can¬
terbury Hospital - 386, 445
Respiration, on the changes
produced by - - - 10

— on the production of car¬
bonic acid in - - 534

Respiratory organs, respecting
their pathology - - 37

— treatment of their diseases 63
Reviews of British Publi¬
cations : — Dr. Pring'se^^
position of the principles of
pathology, and of the treat¬
ment of diseases, 66, 321 —

Mr. Averill's treatise on
operative surgery, 77 — Dr.
Gregory's elements of the
theory and practice of physic,

154 — Dr. Paris and Mr.
Fonblanque on medical ju-

INDEX.

543

risprudence,237 — Mr. Bay-
field on practical cupping,
335 — Medico-chirurgical
transactions, 418 — Mr. Ha-
den’s translation of Magen-
die*s formulary, 425 — Mr.
Guthrie on the operative
surgery of the eye, 504.

Review of ForeignWorks: —
llecherches anatomico-patho-
logiques sur la medecine pra¬
tique. Par C. F. Tacheron,
D. M. &c. — De Toblitera-
tion des veines, et de son
influence sur la formation des
hydropisies partielles, &c.
Par M. Bouillaud, 168 —
Observations surquelques cas
dedeveloppemens rapides des
tissus accidentels. Par M.
Andrul, 254 • — Cases of
scirrhous, encephaloid, and
tuberculous tissues, rapidly
developed in the abdominal
viscera, ib. — Cases of tuber¬
culous disease rapidly deve¬
loped in the lungs, 260 —
M. Rostan on softening of
the brain, 337, 429 — Dr.
Casper on injuries of the
spinal marrow, 518.

Rheumatism, on metastasis of 26

— causes of such metastasis 27

— its pathology - - - 28

— case of - - - 450

— chronic, followed by fatal

epilepsy - - - _ 398

Rhubarb, on a new vegetable
alkali found in - - 440

Richard^ M. his medical bo¬
tany noticed _ _ _ 122

Rolando, Profiessor, his re¬
searches on the nervous sys¬
tem - - 5

RolpFs, Mr. case of softening
of the brain - - - 372

Rogues, M. his phytographie
medicale noticed - - 178

Rostan's, M. work on softening
of the brain reviewed 337, 429
Rullier, M. his case of destruc¬
tion of a part of the spinal
marrow - - 81

Rum, with opium, in large doses
in tetanus - - 106

Rupture of the vena cava, re¬
searches on, by Dr. Kennedy 269

— cases of, by Dr. Kennedy 300

Salivation, excessive, emetics in 174

— a singular remedy for exces¬
sive - - 534

Sauter, Dr. extirpation of the
womb by - - - 105

Sahmann, Profiessor, case of
rupture of the vena cava by 292
Saussure, M. on the physiology
of vegetables - - - 123

Saws,surgical, Mr. iVfomVs im¬
provement in - - 320

Scarlet fever, on its treatment 65
Scorbutus, local, in fractures 352
Scoutetten, M. opinions of, on
the relation of inflammation
of the arachnoid with that of

mucous surfaces - - 31

Shearman, Dr. his observations
on the circulation, and on the
arterial pulse - - 184

Sketch, Historical, of the
Progress OF Medicine, and
of the sciences connected
WITH IT - - 1, 89

Skin, the treatment of its dis¬
eases - - - - 331

Small-pox, M. Dommanget on 52

— hospital, report of - - 176

Snell's, Mr. case of division of

the palate successfully treated 365
Society for the cultivation of
meteorological science - 442
Softening of the brain, its symp-

toms

- 337

— its complication

- 341

— its progress

- 340

— its duration

- 341

— its consequences

- 342

— its nature

- 344

— case of - - -

- 372

— its diagnosis

- 429

— treatment of - -

- 436

— prevention of - -

- ib.

Spasm, doctrine of, examined 73
Spinal marrow, a case of dis¬
ease of - - - - 173

— on the softening of - - 345

— on injuries of - - - 518

Spine, how injuries of, affect the

urinary organs - - - 103'

— of irritating substances on, in

constipation - - - 148’

Spleen, case of disease of, &c. 360

— dissection of - - - 363

Sprague's, Mr. pharmacological

remarks and suggestions 405, 479
Star eke. Dr. his case of rupture
of the vena cava - - 300

544

INDEX,

Stomadij case of scirihus of the
cardia of - - - 910

— cases of ifs perforation - 212

— case of disease of - - 446

Slout’s, Dr. case of chronic

diarrhoea treated by ergot of
rye - - - - 151

Strychnine, M. Andral's expe¬
riments witli _ . _ 346

— cases in which it was em¬
ployed - - - » ib.

St7ychnos pseudo-kina^ its che¬
mical composition - - 353

Sugar, its use in poisoning by
lead - - - - 441

Superfoetation, case of - - 110

Surgery, sketch of its pro¬
gress ~ “ - - 96

— clinical, M. Delpech on 108
Sutton^ Dr. on sloughing pha-

gedesna _ > - _ 305

— singular case of umbilical

hernia, by - _ - 358

Syrups, remarks respecting - 491
Tacheron, M,-his work on pa- .

thology reviewed - - 58, 78

Tendons, on the structure of 3
Tetanus, on the treatment of 69

— traumatic, successful case

of - - „ 106

Textures and organs, arrange¬
ment of - - - - 1

Therapeutics, sketch of its
progress - - - 58

Tkomp sort’s, Mr. case of pur¬
pura hsemorrhagica - - 368

Thomson, Mr. A. T. account of
the life and character of Dr.
Nicoll, by •» - - 527

Thorax, a fistulous opening into 351
Tiedemann, Professor, his ana-
tomie of the brain, noticed 87
Tinctures, suggestions respect¬
ing _ _ „ _ 488

Toe, pointed, M. Delpedis
treatment of - _ - 108

Tongue, on its diseases - 422

Trismus, traumatic, a case of,
cured by acupuncturation 403
Truss, account of an improved
one _ * _ ^ 354

Tumour in the vena porta, cases
of - - - - 307, 531

Tumours of the eyelids, on 513
Turpentine in tetanus - - 59

Tweedale’s, Dr. case of anasar¬
ca treated by acupunctura¬
tion _ - - _ 313

Twins, respecting their procre¬

ative powers - - 213

Vascular system, views respect¬
ing its physiology - - 9

— progress of its pathology 20
Vascular plethora, Dr. Barlow
on - - “ - 22

Vauquelin, M. on the compo¬
sition of the strychnos pseu¬
do-kina _ „ - 353

Vegetable bodies. Dr. Ure’s re¬
searches into - - - 125

Veins, on the obliteration of 168

— cases of - _ - _ 169

Vena cava, researches on the

rupture of, by Dr. Kennedy 269
Vena porta, cases of tumour in,

307, 531

Venous system, its arrange¬
ment in various classes of ani¬
mals - - - 2 '

Veratrine, respecting its opera¬
tion, &c. - - - 427

Viper, treatment of its bite 265
Virus, Dr. Copland’s remarks
on the mode of its transmis¬
sion - - - - 24

Viscera, abdominal, the patho¬
logy of the origin of disease
in, examined _ - _ 329

Ure, Dr. his researches into
the composition of vegetable
and animal bodies - - 125

Urinary organs, respecting their
pathology - - - 38

— how affected by injuries of

the spine - » _ 103

Urine, on the hydro- cyanate of
iron in - - - 264

— of a blue colour voided in

enteritis - _ „ 265

Uterus, rupture of, remarkable
case of - - - 112

Wanshrough, Mr. on digitalis
in pulmonary disease - 457

Ward's, Mr. cases of aneurism
of the aorta - - 196, 382

— case of amaurosis by 217

— case of tumour in the vena

porta „ _ _ 307

Williams, Dr, on the* state of
the lungs in respiration - 11

Wines, remarks on medicated ' 490
Wishart, WIr. his case of fun¬
gus hoematodes - - 99

Witness, medical, the manner
in which he ought to give evi¬
dence - - - - 247

.-S>:

INDEX.

$45

Womb, instance of its extirpa¬

tion

- 105

Works Reviewed, see Books.
Writers on botany who have

Works, monthly catalogue of
those presented for review —
87, 179, 266,443, 535.

lately added to the sci

ence

Wry-neck, treatment of

- 120
- 77

Directions for placing the Plates.

Appearances in Melanosis to be placed opposite page 202.
Plate of Mr. Morris’s Trephining Saws, opposite page Sip.
Plate of Mr. Morris’s Straight Saw, opposite page 320.

Plate of Mr. Snell's Case of Cleft Palate, opposite page 366.

END OF THE TWENTIETH VOLUME.

LONDON ;

PRINTED BY J. MOYES, GREVILLE STREET.

ERRATA IN VCL. XX.

Page 82, line 38, for entirely, read however.

83, line \3,for inflated, read filled.

— line 35, for diflerence, read diffluence.

— line 36, for from the exterior, read at the exterior.

84, line 4i,for reticulations, read filaments.

— line 11 and 4i,_for cerebral, read cervical.

— line 22, for too loose a, read a loose.

— line 4 from the foot, for was without, read was not, without.

85, line 5, for performs, read performed.

— line 28, for incapable of sensibility, read capable of affording sensibility.
150, line 27^ for was, read were.

276, footnote *,for Johanni, read Johannis.

- footnote t, /or Joannis, read Joannes.

£81, footnote J,/br operum, read opera.

282, line 10, /or episthotonal, read opisthotonal.

286, line l6,/or Peterius, read Poterins.

288, line <^, for haemophthysical, read haemoptysical.

292, line 20, for sutrine trunk, read sutrine trade.

295, footnote *,for observations, read aberrations.

297, line 22, for circumstance, read occurrence.

298, line 20,/or contendans, read contondans.

i-f 300, line 9, for mental, read mortal.

306, line 19, /or on hair, read linen.

362, line 3 from the foot,/or is, read was.

399, line 10 from the foot, /or Sup. read Inf.

426, line 6,/or it is, read they are.

433, line 13, for laminating, read lancinating.

480, line 3 from the foot, for found, read formed.

500, line 34, dele universal.

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Full text of "The London medical repository. Volume 20, July - December 1823"

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